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Sample Bottle Order Form
South Dakota Public Health Laboratory
(testing public water supplies)

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 also provided. Questions can be directed to the Lab's mailroom at 605-773-3368.

Shipping Information

Name:
Title:
Water System:
Street Address:
Mailing Address:
City:
State:
Zip Code:
Work Phone Number:
FAX number:
EPA ID Number:
E-mail address:

Quantity of samples bottles requester

Bacteria - unchlorinated
Bacteria - chlorinated
Nitrate:
Lead/Copper
Other (specify test type)
Other (specify test type