Name First Required Last Required Phone Required Email Required Testing Location Address (if known) Testing Location Latitude Required Testing Location Longitude Required Sampled Water Type Required - Select -SurfaceWell What was the surface water type? What was the surface water type? - Select -StreamRiverPondLakeOther… Enter other… If known, what was the estimated well depth in feet? Sampling Date Required Sampling Date: Date Required Sampling Date: Time Required Nitrite Reading Required - Select -0 mg/L0.15 mg/L0.3 mg/L1 mg/L1.5 mg/L3 mg/L (Closest to your hand on the test strip with two color pads). Nitrate Reading Required - Select -0 mg/L1 mg/L2 mg/L5 mg/L10 mg/L20 mg/L50 mg/L Phosphate Reading Required - Select -0 mg/L5 mg/L15 mg/L30 mg/L50 mg/L (Test strip with a single color-pad). Additional comments or observations Leave this field blank