WATER SAMPLE ANALYSIS REQUEST
Water Sample Analysis Request
Water Sample Analysis Request
Client Information
Client Registration
Are you a Registered Client?
-- No / Select Registered Name --
ABC Takeaways
ABC Water
Fresh Water
George Forman
MY COMPANY
PCCS
PIL DM (PTY) LTD
Water World
Full Name
Telephone
E-mail
Discovery Source
-- Select --
Facebook
Google
Gumtree
Other
Radio
Other Source
Sample Details & Logistics
Sample Name / Site Reference
Sample Address / GPS Location
How should the sample be collected?
Sampling (H2O Guru Call Out)
Couriers (Client to send sample via Courier)
Testing Type
-- Select Testing Type --
Bottled Water
Chemical + Microbiological Testing
Chemical Testing
Irrigation Water
Microbiological Testing
Other Specialized Testing
Physical Testing
Radiological Testing
Waste/Effluent Water
Testing Sub-Type
-- Select Sub-Type --
Collection Address
City / Town *
Postal Code *
Package Size
-- Select Package Size --
ScaleStop Box
Water Sample Source
Borehole
Municipal
River
Spring
Dam
Rain
Filtered
Purpose
Drinking
Household
Industrial
Irrigation
Bottling Plant
Food Preparation
Special Requirements
Active Chlorine?
Newsletter?
Submit Analysis Request
