Name Required 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 - Surface Well What was the surface water type? What was the surface water type? - Select - Stream River Pond Lake Other… Enter other… If known, what was the estimated well depth in feet? Sampling Date Required Nitrite Reading Required - Select - 0 mg/L 0.15 mg/L 0.3 mg/L 1 mg/L 1.5 mg/L 3 mg/L (Closest to your hand on the test strip with two color pads). Nitrate Reading Required - Select - 0 mg/L 1 mg/L 2 mg/L 5 mg/L 10 mg/L 20 mg/L 50 mg/L Phosphate Reading Required - Select - 0 mg/L 5 mg/L 15 mg/L 30 mg/L 50 mg/L (Test strip with a single color-pad). Additional comments or observations Leave this field blank