Protecting Public Health and the Environment.


This application is to be used by Public Drinking Water operators or owners to assist in producing laboratory request forms.
This application utilizes data in the State drinking water database to identify samples that are due during the current year.
If you have questions about the data in this application, please contact your regulating agency.
Detailed instructions are available through the instruction button below.



Select Public Water System:   

The date range has been pre-populated with the current year and cannot be modified.
Start Date:  
End Date:


or