What does the Water Sample Request Data Form do?

It lets a property owner, tenant, or authorized agent request water sampling and provide applicant, mailing, sample-site, and sample-type details.

What attachment is needed for an ILRP sample request?

The form says to attach the Drinking Water Well Member Information Form for a request under the Irrigated Lands Regulatory Program.

Do I need a notary for the Water Sample Request Data Form?

No. The signer signs and dates the form to authorize property access; it does not state that a notary or notarized attachment is needed.

Merced County, CA · Merced County

No notary required

Water Sample Request Data Form

Property owners, tenants, or authorized agents use this form to request water sampling from Merced County Environmental Health.

At a glance

Issued by: City of Merced County · Merced County, Merced County, California
Notarization: Not required: file this form without a notary.
Official source: countyofmerced.com
Blank form: Download the PDF
Catalogued: Oct 5, 2026
Machine-readable: JSON record · about the forms index

What this form is

This form requests water sampling at a well or another listed location and records applicant, occupant, mailing, and sample-site information. It asks the requester to select the sample type and any rush option, and lists a $64 sampling fee and a $100 ILRP option. For an ILRP request, the form says to attach the Drinking Water Well Member Information Form.

Who needs it

A property owner, tenant, or authorized agent seeking water sampling at a property in Merced County can complete this request.

How to submit it

Submit it to the county department named on the form; check the county website for current contact details.

About notarization

This document is signed and dated without a notary; the signer authorizes property access for inspection and sample collection, with no sworn or notarized attachment stated.

How to submit this form

1
Download the Form
Download the Water Sample Request Data Form.
2
Complete the Request
Enter the applicant and property details, select the sample location and sample type, and sign and date the authorization.
3
Gather Attachments
For an ILRP sample request, attach the Drinking Water Well Member Information Form.
4
Submit to the County
Submit the completed form to the county department named on it; check the county website for current contact details.

Frequently asked questions

What does the Water Sample Request Data Form do?: It lets a property owner, tenant, or authorized agent request water sampling and provide applicant, mailing, sample-site, and sample-type details.
What attachment is needed for an ILRP sample request?: The form says to attach the Drinking Water Well Member Information Form for a request under the Irrigated Lands Regulatory Program.
Do I need a notary for the Water Sample Request Data Form?: No. The signer signs and dates the form to authorize property access; it does not state that a notary or notarized attachment is needed.
How do I submit the Water Sample Request Data Form?: Submit it to the county department named on the form; check the county website for current contact details.

Need something notarized?

This Water Sample Request Data Form doesn’t need a notary, but if you have another Merced County form that does, a commissioned online notary can help.