Use this form to request bottles for Daycare Lead Testing.
Please Fill Out Information Below...
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Next »
Do you have a kitchen sink that needs to be tested?
How many kitchen sinks?
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Do you have a refrigerator that dispenses drinking water?
How many refrigerators?
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Do you have an icemaker?
How many icemakers?
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Do you have a bathroom sink that needs to be tested?
How many bathroom sinks?
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Are there any additional handwashing sinks or water fountains that needs to be tested?
How many?
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
How would you like to receive the bottles?
Next »
« Back
Submit
Please Sign Below
Sorry, your browser is not supported.
Done
Clear
