Kalamazoo County, MI · Kalamazoo County
Water Sampling Request Form
Kalamazoo County residents and property contacts use this form to request water sampling and select requested tests for a well system.
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 water sampling for a well system serving a home, multifamily dwelling, business, or other listed property type. It collects the sampling address, parcel information, contact details, requested tests, payment total, and applicant signature. The form lists sample and shipping charges and includes a credit card payment request form for applicants paying by card.
Who needs it
Property owners or their contacts who want water samples collected and analyzed by the county or the listed EGLE lab need this form.
How to submit it
Return the completed form with payment to Kalamazoo County Health & Community Services Department, Environmental Health, 311 East Alcott Street, Kalamazoo, MI 49001, or email it to [email protected]. Credit card authorization forms must be submitted by mail only.
About notarization
This form is signed and dated without a notary; the applicant and cardholder sign their respective sections, with no notarized or sworn attachment identified.
How to submit this form
- 1
Download the Form
Download the Water Sampling Request Form and its included credit card payment request, if paying by card.
- 2
Complete the Request
Fill in the system and property details, contact information, requested samples, fee total, and applicant signature and date.
- 3
Gather Payment
Include payment. For credit card payment, complete and sign the authorization form; it must be submitted by mail.
- 4
Submit to Environmental Health
Mail the form and payment to the Environmental Health address shown, or email it to [email protected].
Frequently asked questions
- Do I need a notary for the Water Sampling Request Form?
- No. Sign and date the applicant section; if paying by credit card, the cardholder also signs and dates the authorization form. Neither section requires a notary.
- How do I submit the Water Sampling Request Form?
- Return the completed form with payment to Environmental Health at 311 East Alcott Street, Kalamazoo, MI 49001, or email it to [email protected]. Credit card authorization must be mailed.
- What information does the Water Sampling Request Form ask for?
- It asks about the well system and sampling address, parcel details, contact information, requested samples, payment, and the applicant’s signature and date.
- Can I pay by credit card?
- Yes. Complete and sign the Credit Card Payment Request included with the form and submit it by mail to Kalamazoo County Environmental Health.