Sample Container Request Form
Please complete this form to request sample containers for
public school
and
child care facilitie
s drinking water lead testing.
Idaho Bureau of Laboratories (IBL) provides sample containers at no cost, with the understanding that the supplies will be used for submitting samples to IBL for testing.
For questions or assistance with this form, contact IBLSUPORD@dhw.idaho.gov or 208-334-0503.
Please complete the following information (required).
Please complete the following information (required).
Contact name:
School/district name:
Ship attention to:
Address:
City:
State:
Zip code:
Email address:
Telephone:
Extension, if applicable:
Please specify the number of 250 ml (8 oz.) chemistry bottles requested for public school drinking water lead testing. Note: You may request 1 bottle per location within each school. Locations may include drinking fountains, food preparation areas, or classroom sinks).
Please specify the number of 250 ml (8 oz.) chemistry bottles requested for public school drinking water lead testing.
Note: You may request 1 bottle per location within each school. Locations may include drinking fountains, food preparation areas, or classroom sinks).
Notes pertinent to your order:
Notes pertinent to your order:
Requested supplies will be sent via:
Requested supplies will be sent via:
Mail
Pick up at IBL
IBL Use Only:
PCA:
14090
Date supplies sent: _____________________
Initials of IBL sender: ___________________
