TEST REQUEST
Well identity / location / known concern:
Local authority consulted / recommendation date:
Laboratory / requested analytes and methods:
Raw, treated or named tap question:
Collection instructions and conditions:
SAMPLE AND RESULT
Sample ID / point / collection and receipt dates:
Treatment present / recent work or flood/change:
Result, unit, reporting limit and flags for each analyte:
Comparison standard and interpretation source:
FOLLOW-UP
Untested questions / local response / planned retest: