Well Water Quality Testing Participation Form
Sign in to Google to save your progress. Learn more
Email *
Name *
Street Address *
City *
State *
Note: We are currently only collecting samples from New Jersey wells (with a focus on North Jersey).
Zip *
Phone Number
Do you have well water? *
How deep is your well? (in feet)
If you're not sure, you can leave this blank.
How confident are you about the depth of your well? *
Do you have a way of collecting well water before treatment with carbon filters, a water softener, or reverse osmosis treatment? *
Water filtered through cellulose or sand filters is acceptable for this study. Water passed through a carbon filter is not acceptable. We will need water collected upstream from (or bypassed by) carbon filters, water softeners, or reverse osmosis treatments.
Would you like to know the results of the water testing? *
Preferred method of contact *
A copy of your responses will be emailed to the address you provided.
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.