APPLICATION FOR WATER TESTING - Maine
ORDER FORM FOR TESTING
PLEASE SEND ME TEST KIT(S) FOR THE FOLLOWING ROUTINE WATER TESTS
[ ] Basic Safety Test $42 [ ] Established Well $127
[ ] New Well $127 [ ] Residential Sales $127
[ ] First Draw Lead $32 [ ] SINGLE METALS $30 EACH*- List below:
[ ] OTHER TEST please specify
TESTS FOR ORGANIC COMPOUND CONTAMINANTS
[ ] REGULATED VOLATILES -EPA524.2 $160
[ ] TOC $45
RADIOLOGICAL TESTS
[ ] RADON WATER $40
[ ] RADON AIR SHORT TERM $40
[ ] GROSS ALPHA $120
Please make check or money order payable to: TREASURER OF STATE.
Send to: HEALTH AND ENVIRONMENTAL TESTING LABORATORY
221 STATE ST., STATION #12, AUGUSTA, ME. 04333.
Do not send cash
For your convenience, payment may be made by VISA OR MASTERCARD.
Visa MC Card Number CVV Code Expiration Date (MMYY)
(( ((((-((((-((((-(((( ((( ((((
Signature of Card Holder_______________________________________ Amount
NAME _______________________________________
STREET_______________________________________ TOWN___________________________________
ZIP TELEPHONE ( ) -
FEE WAIVERS: Free water testing may be available if you meet both (1.) and (2.) below:
1. Food Stamp Eligible (Please provide Food Stamp ID) or demonstrate other proof of financial need or if you have already spent $150.00 on water testing at a state certified lab.
2. There is written professional justification to support the need to test this Private Water Supply.
Examples are: Doctor’s letter, Department of Environmental Protection (DEP) Recommendation, geologist.
*For the Single Metals Test a supplemental $2.00 fee will be included to the total test for the Private Well Safe Drinking Water Fund.
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Metals testing offered:
|Aluminum (Al) |Calcium (Ca) |Magnesium (M) |Selenium (Se) |Vanadium (V) |
|Antimony (Sb) |Chromium (Cr) |Manganese (Mn) |Silicon (Si) |Zinc (Zn) |
|Arsenic (As) |Cobalt (Co) |Mercury (HG) |Silver (Ag) | |
|Barium (Ba) |Copper (Cu) |Molybdenum (Mo) |Sodium (Na) | |
|Beryllium (Be) |Iron (Fe) |Nickel (Ni) |Thallium (Tl) | |
|Cadmium (Cd) |Lead (Pb) |Potassium (K) |Uranium (U) | |
| | | | | |
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