Kalamazoo County, MI · Kalamazoo County
Surface Water Sampling Request Form
Kalamazoo County residents and other applicants use this form to request surface water sampling and provide sample collection and results-delivery information.
At a glance
- Issued by
- City of Kalamazoo County · Kalamazoo County, Kalamazoo County, Michigan
- Notarization
- Not required: file this form without a notary.
- Official source
- kalcounty.gov
- Blank form
- Download the PDF
- Catalogued
- Machine-readable
- JSON record · about the forms index
What this form is
Use this form to request sampling of a bathing beach or other surface water, such as a stream or creek. It asks for the sample collection address, water body name, contact details, where to send results, requested samples, and payment information. The form lists sample analysis and collection fees and asks the applicant to sign and date it.
Who needs it
Anyone requesting bathing beach or other surface water sampling from the Kalamazoo County Health & Community Services Department can complete this form.
How to submit it
Return the form with payment by mail to Environmental Health at 311 East Alcott Street, Kalamazoo, MI 49001, or email it to [email protected]. Credit card payment requires mailing the Credit Card Authorization Form.
About notarization
This document is signed without a notary; it has an applicant signature and date line, and it does not describe a notarized or sworn attachment.
How to submit this form
- 1
Download the Form
Download the Surface Water Sampling Request Form.
- 2
Complete the Request
Select bathing beach or other surface water and fill in the collection, contact, results-delivery, and sample information.
- 3
Prepare Payment
Calculate the sample and collection costs shown on the form and include payment. For credit card payment, mail the Credit Card Authorization Form.
- 4
Submit to Environmental Health
Return the form with payment by mail to the listed Environmental Health address or email it to [email protected].
Frequently asked questions
- Do I need a notary for the Surface Water Sampling Request Form?
- No. The form has an applicant signature and date line but no notary block. The document does not describe a notarized or sworn attachment.
- How do I submit the Surface Water Sampling Request Form?
- Return the form with payment by mail to Environmental Health at 311 East Alcott Street, Kalamazoo, MI 49001, or email it to [email protected]. Credit card payment requires mailing the authorization form.
- What water can I request sampling for?
- The form lets you select bathing beach or other surface water, with streams and creeks given as examples.
- What information does the form ask for?
- It asks for the sample collection address, parcel or tax ID, water body name, owner and contact information, results recipient details, requested samples, and payment information.