*Fields marked by an asterisk are required
Address to be sampled:
Public Water Supply ID No.
or NJPDES Permit No.
Which of our services do you desire?
Private Well Testing
Solid Hazardous Waste
Desired turnaround time:
Sample will be :
Taken by Agra (required for PWTA)
Taken by me and delivered in person to Agra
Taken by me and sent by courier service to Agra
Desired report format(s):
NJDEP Drinking Water Forms
NJDEP NJPDES Forms
Report delivery method:
Do you want us to notify you if a NJDEP standard is exceeded?
Are you interested in periodic scheduled service?
Would online data review
capability interest you?
What lab are you currently using?
Which of these items are important to you when choosing a testing lab?
(Check all that apply)
Quality of service
Precision and accuracy
How did you find out about Agra Environmental & Laboratory Services?
On the Internet
Article in a publication
From a colleague
In an advertisement
Any other notes, questions, or comments?