Water Quality Assessment
Please provide information so that we may evaluate the quality of the water in your home.
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Email *
How many people live in the home? *
Have you noticed any COLOR in the water? *
Please explain any colors in the water:
Have you notice any particular SMELL in the water? *
Please explain any smells in the water:
Have you notice any particular TASTE in the water? *
Please explain any strange taste in the water:
About how much do you spend on drinking water in a week:
Does anyone living in the home have any of these medical issues? *
Required
From 1 to 5 How do you rate your tap water? *
Horrible
Excellent
TDS Reading
Do you cook with the tap water? *
Name *
Phone number *
Adress *
Date available for testing:
MM
/
DD
/
YYYY
Time available for testing:
Time
:
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