Why Choose Radata ?     State Certified Laboratory     Dependable, High Quality Testing Services     Quick Turn-Around Times     Analysis of Air, Water, Ground Water and Soil What's in your water??? Green, brown or gray stains on fixtures or laundry? White spots on glassware from the dish washer? Fish or rotten egg odors? Radiation, Arsenic, Nitrates or Bacteria (Coliform & E-coli)? Results within one week!   FREE INFO HOTLINE: 800-447-2366 "Private Well Tests" (PWTA)� for real estate sales. ------------------------------------------------------------------------- Evaluate the quality of your drinking water .        Test Your Water Today: This order form is under construction. Please call (800) 447-2366 to schedule your test. SAME DAY SERVICE! * indicates required field CUSTOMER INFORMATION *First Name: *Last Name: *Address : *City: *State: AL AK AR AS AZ CA CO CT DC DE FL FM GA GU HI IA ID IL IN KS KY LA MA MD ME MI MN MO MP MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR PW RI SC SD TN TX UT VA VI VT WA WI WV WY *Zip Code: *Phone(Home/Cell): Phone(Work/Phone): Fax: *Email: LOCATION INFORMATION Check here if location is same as above *Address: *City: *State: NJ *Zip Code: *Municipality: *County: Bergen Essex Hudson Hunterdon Mercer Middlesex Monmouoth Morris Passaic Somerset Sussex Union Warren Block Number: Lot Number: CONTACT INFORMATION Check here if contact name and number is same as customer Contact Name: Contact Phone: Contact Phone: OTHER INFORMATION Estimated Closing Date(if selling): (mm-dd-yyyy) Water Treatment Present: Yes   No   Check what applies to property: New WellSellingRentalCommercialResidential This form is under construction. Please call (800) 447-2366 for immediate service.

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