Schedule A Bacteria Test


We will try to get your test scheduled as close to if not on preferred p/u date. You will be contacted within 24 hours to confirm scheduling. Results will not be released until full payment is received.

There must be power to the house & we must have access to the well in order for us to collect a sample.

Agent:

Well Owner:
Property Address:
Agency Name:
Agent Name:
Phone #:
Fax #:
Preferred pickup date:
Party responsible for payment:
Preferred payment arrangement:	Drop off check Check on-site Mailed check Credit card by phone
Mail Results or Pickup:	Mail Pickup
Mailing Address:
Is there power? Access to the well? Locked gates? Dogs or animals? Comments / Special Instructions

21220 Highway 36    Covington, LA 70433    Phone: 985-892-8329    Fax: 985-892-9128