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Sample Bottle Order Form
South Dakota Public Health Laboratory
(testing private wells)

To request sample bottles for testing of water supplies, please complete and submit the following form, indicating the quantity of bottles needed for each test specified. Bottles include complete instructions for collecting and submitting water samples for testing. Fee information for the various tests is included. Questions can be directed to the Lab's mailroom at 605-773-3368. Sample bottles and instructions are also available from County Extension offices.

Shipping Information

Name:
Street Address:
Mailing Address:
City:
State:
Zip Code:
Phone Number:
E-mail address:

Quantity of samples bottles requester

Bacteria/Nitrate
Lead
New Well
Other (specify test type)