PFAS Free Trenton Survey
Please complete this survey by December 1st.  
The Town of Trenton will use a portion of the federal ARPA funds to pay for the cost of PFAS testing for a limited number of residential wells in town. Tests will be provided at no cost to the residents. PFAS Free Trenton is identifying priority residences as there is not enough money to pay for all of the testing that has been requested. Please complete this survey so that your residence may be considered for priority testing.
If you need assistance in completing the survey, please send your telephone number to pfasfreetrenton@gmail.com
Sign in to Google to save your progress. Learn more
Email *
What is your name? *
Best phone number to reach you: *
What is the address of the location where you want the well tested? *
Do you rent or own this location? *
Do you live at this address? *
Has the well been tested for PFAS previously? *
If you answered yes to the previous question, what was the result?
Tell us if the location is *
Do you have a reason to suspect that there may be high levels of PFAS in the well?
Is the residence or business occupied *
Is the well in question *
If you know the depth of the well, please tell us.
You and the town of Trenton will receive the results of any testing paid for by the town.  Do you agree to the town receiving the results? *
The cost of the PFAS tests are typically $250 per residence.  The town is providing the test free to as many residents as there is funding. Would you like to make a donation to support additional work to make Trenton PFAS free?  If you respond with yes or maybe, PFAS Free Trenton will send you information about how to make your donation.
Clear selection
Do you have any other information or thoughts you would like to share with us?
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms