Master Water
Master Water
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Sample Test Form
  PLEASE NOTE:  We do not test for Bacteria
Purity a question? Contact your local Health Dept.
 
WATER SAMPLING PROCEDURE:
  1. COMPLETELY fill out form. Water will not be analyzed without Distributor's Name.
  2. Let UNFILTERED water run from cold water faucet 2-3 minutes. Fill bottle.
  3. If troubleshooting existing equipment, take a treated sample from kitchen faucet and a raw water sample before equipment.  List Model #                    .
224 Shoemaker Road, Pottstown, PA 19464
PLAINLY PRINT INFO BELOW: PHONE GENERAL INFORMATION:
Owner:                                                                                     No. of persons in family
Dealer:                                                                                     No. of bathrooms
Distributor:                                                    Branch:
                      		           No. of whirlpools
REMARKS: WATER SUPPLY:
        City           Water Pressure
        Pipe Dia
        Well                   PSI Settings
Well Pump Capacity            gal per min.
ON SITE RESULTS, IF ANY: Run boiler drain on well tank piping for
10 min. Time the fill rate of a 5 gal. bucket.
CO2                    Hardness                    Iron                 
pH                    Sulphur                               Submersible Pump
           Jet Pump
When drawn, water is:
         clear
         colored
         sediment
Does air spurt from faucet?
HOT            COLD          		Notable Stains:
         orange/brown
         blue/green
         black
         yellow
 Taste/Odor:
         rotten egg
     hot         cold       
         chlorine
         musty/earthy
         other                                 
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