Ag Order Sampling and Testing Request

This form should be filled out completely by all customers requesting Agriculture Order sampling:

If you are a Preservation Inc Member and need Agriculture Order sampling, please following the link and contact: https://ccwqp.org/2022-well-sampling/

Contact Information
*First Name:
*Last Name:
*Company Name:
*Best Contact number:
Billing Address:
City:	State:
Zip Code:
*Email Address:
Details of Order
Request date for sampling: (we will call or email to confirm)
*AW#:
*Global ID/AGL Number: Please list all Global IDs and number of wells to be sampled.

Global ID:	# of Irrigation Wells Only	# of Drinking Wells Only	# of Dual Wells

Questions / Comments:
Please enter any additional details or comments below.

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Ag Order Sampling and Testing Request

Contact Information

Details of Order