Welcome to our Bottle Request form customized for VT Drinking Water System Operators.


This request form is laid out in the same format as your permit.

Please note the Multiple Options under IOC kits. This is attributed to the many different ways the Water Supply Division has grouped the IOC Testing Requirements for different Water Systems. Also, if you do not require all 10 Metals plus Fluoride typically requested under the IOCs, please indicate in the “Special Request” section of this form.

If you would like to check your current permit follow the link:Vermont Drinking Water Monitoring Schedules

Select the Public Community Water Systems or Non-Transient Non-Community Systems depending on your system type.

If there is a discrepancy between the monitoring letter you received from WSD and the web version, contact the Water Supply Division to confirm the correct testing requirements.

Name:
WSID #:
Company or Organization:
Phone #:
Email:
UPS Mailing Address:
Date to be Delivered/Picked up:
Shipping Method:
Water at Sample Point:
Sample Kits Number of Kits Needed
Coliform - Bacteria:
Coliform
Lead and Copper:
Pb/Cu
Disinfection By-Products:
Organic - DBP
Chemical Monitoring:
Ammonia
Chloride
Cyanide
Fe, Mn only
Gross Alpha
IOC w/F
IOC w/F,CN
IOC w/F,Fe,Mn
IOC w/F,Fe,Mn,CN
Nitrate
Radium 226/228
SOC
TOC
Uranium
VOC
Special Request: