New Customer Environmental Enrollment Form

Enrollment Information

Enrollment Information

This request is for enrollment year: *

Identification Information

Identification Information

WSLH PT ID (7 Digits)

Current/previous account ID (if known)

WI DNR ID#

Wisconsin Department of Natural Resources

WI DATCP ID#

Wisconsin Department of Agriculture, Trade and Consumer Protection

Contact Information of person completing this form

Contact Information of person completing this form

Facility Name *

Contact Name *

Phone *

Example: 123-456-7890

Email *

Type Of Testing Site For This Order

Type Of Testing Site For This Order

Select Type

Indicate "Other" type of testing here

Shipping Information

Shipping Information

Facility Name *

Contact Name *

Address

Apt, suite, etc.

Country

City

State

Zip code

Phone *

Example: 123-456-7890

Fax

Email *

Billing Information

Billing Information

Check here if same as shipping information

Facility name

Contact name

Address

Apt, suite, etc.

Country

City

State

Zip code

Phone

Example: 123-456-7890

Fax

Send Reports To:

Send Reports To:

Check here if same as shipping information.

Facility Name

Contact Name

Address

Apt, suite, etc.

Country

City

State

Zip code

Phone

Example: 123-456-7890

Fax

Order Form: Potable Water

Order Form: Potable Water

Certification Samples

Quality Control Standards

SDWA Cyanide - Cert

Item#:PT08160 - Price: $48.00

(Total Cyanide)

SDWA Cyanide - QC

Item#:PT08370 - Price: $144.00

(Total Cyanide)

SDWA Metals - Cert

Item#: PT08170 - Price: $66.00

(Antimony; Arsenic; Barium; Beryllium; Cadmium; Chromium; Copper; Lead; Mercury; Nickel; Selenium; Sodium; Thallium)

SDWA Metals - QC

Item#: PT08380 - Price: $198.00

(Antimony; Arsenic; Barium; Beryllium; Cadmium; Chromium; Copper; Lead; Mercury; Nickel; Selenium; Sodium; Thallium)

SDWA Minerals - Cert

Item#: PT08180 - Price: $46.00

(Nitrate as N; Nitrate + Nitrate as N; Fluoride; Sulfate)

SDWA Minerals - QC

Item#: PT08390 - Price: $138.00

(Nitrate as N; Nitrate + Nitrate as N; Fluoride; Sulfate)

SDWA Nitrate - Cert

Item#: PT08190 - Price: $44.00

(Nitrate as N)

SDWA Nitrate - QC

Item#: PT08400 - Price: $132.00

(Nitrate as N)

Order Form: Non-Potable Water

Order Form: Non-Potable Water

Certification Samples

Quality Control Standards

BOD/CBOD/COD - Cert

Item#: PT08000 - Price: $50.00

(Biological Oxygen Demand; CBOD; Chemical Oxygen Demand)

BOD/CBOD/COD - QC

Item#: PT08200 - Price: $150.00

(Biological Oxygen Demand; CBOD; Chemical Oxygen Demand)

Chlorine - Cert

Item#: PT08010 - Price: $47.00

(Total residual chlorine)

Chlorine - QC

Item#: PT08210 - Price: $141.00

(Total residual chlorine)

Cyanide - Cert

Item#: PT08020 - Price: $48.00

(Total Cyanide)

Cyanide - QC

Item#: PT08220 - Price: $144.00

(Total Cyanide)

Hardness - Cert

Item#: PT08030 - Price: $44.00

(Hardness [EDTA])

Hardness - QC

Item#: PT08240 - Price: $132.00

(Hardness [EDTA])

Metals A - Cert

Item#: PT08040 - Price: $66.00

(Aluminum; Barium; Cadmium; Calcium; Chromium; Cobalt; Copper; Hardness; Iron; Lead; Magnesium; Manganese; Nickel; Potassium; Silver; Sodium; Zinc)

Metals A - QC

Item#: PT08250 - Price: $198.00

(Aluminum; Barium; Cadmium; Calcium; Chromium; Cobalt; Copper; Hardness; Iron; Lead; Magnesium; Manganese; Nickel; Potassium; Silver; Sodium; Zinc)

Metals B - Cert

Item#: PT08050 - Price: $60.00

(Arsenic; Mercury; Selenium)

Metals B - QC

Item#: PT08260 - Price: $180.00

(Arsenic; Mercury; Selenium)

Metals C - Cert

Item#: PT08060 - Price: $60.00

(Antimony; Beryllium; Molybdenum; Strontium; Thallium; Vanadium)

Metals C-QC

Item#: PT08270 - Price: $180.00

(Antimony; Beryllium; Molybdenum; Strontium; Thallium; Vanadium)

Metals D - Cert

Item#: PT08070 - Price: $66.00

(Bismuth; Lithium; Silicon; Titanium)

Metals D - QC

Item#: PT08280 - Price: $198.00

(Bismuth; Lithium; Silicon; Titanium)

Metals E - Cert

Item#: PT08080 - Price: $61.00

(Boron; Tin)

Metals E - QC

Item#: PT08290 - Price: $183.00

(Boron; Tin)

Minerals - Cert

Item#: PT08090 - Price: $50.00

(Alkalinity CaCO3; Chloride; Conductivity; Fluoride; Sulfate)

Minerals - QC

Item#: PT08300 - Price: $150.00

(Alkalinity CaCO3; Chloride; Conductivity; Fluoride; Sulfate)

Nitrite - Cert

Item#: PT08100 - Price: $44.00

(Nitrite as N)

Nitrite - QC

Item#: PT08310 - Price: $132.00

(Nitrite as N)

Nutrients A - Cert

Item#: PT08110 - Price: $50.00

(Ammonia as N; Nitrate as N; Nitrate + Nitrite as N; ortho‐Phosphate as P)

Nutrients A - QC

Item#: PT08320 - Price: $150.00

(Ammonia as N; Nitrate as N; Nitrate + Nitrite as N; ortho‐Phosphate as P)

Nutrients B - Cert

Item#: PT08120 - Price: $44.00

(Total Kjeldahl nitrogen [TKN]; Total phosphorus)

Nutrients B - QC

Item#: PT08330 - Price: $132.00

(Total Kjeldahl nitrogen [TKN]; Total phosphorus)

Oil and Grease - Cert

Item#: PT08130 - Price: $63.00

(HEM)

Oil and Grease - QC

Item#: PT08340 - Price: $198.00

(HEM)

pH - Cert

Item#: PT08140 - Price: $42.00

(pH)

pH - QC

Item#: PT08350 - Price: $126.00

(pH)

Solids -Cert

Item#: PT08150 - Price: $53.00

Total Dissolved Solids [TDS]; Total Suspended Solids)

Solids - QC

Item#: PT08360 - Price: $159.00

Total Dissolved Solids [TDS]; Total Suspended Solids)

Order Form: Water Microbiology

Order Form: Water Microbiology

Water Microbiology – Certification

Item#: PT08460 - Price: $296.00

Water Microbiology – Quality Assurance (Two events: March and October)

Item#: PT08420 - Price: $156.00

Water Microbiology – Quality Assurance (One event: March)

Item#: PT08430 - Price: $78.00

Water Microbiology – Quality Assurance (One event: October)

Item#: PT08440 - Price: $78.00

Other Environmental Samples

Other Environmental Samples

Survey Validated Samples and Rapid Response PT

Customers wanting to order Survey Validated Samples or Rapid Response PT please provide order information from WSLH PT coordinator in the field below.

Order Total

Order Total

Order Total

Add price of all checked items

Payment Information

Payment Information

Purchase Order (PO#) - optional

VISA/MC: If you wish to pay by credit card, please wait for your invoice for instructions.

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Contact WSLH Proficiency Testing | (800) 462-5261 | ptservice@slh.wisc.edu |