Submit a Lab Sample

Now Offering Free Return Shipping!

After you’ve filled out your Lab Analysis Form, call us at 888.757.9577 when your test kit is ready to schedule your package pickup.

Lab Analysis Form

The lab form below is required in order for our lab to process your lab sample.

Contact Information

Plant Information

Sample Information

Contact Information

Company/Municipality Name*

Plant Name*

State*

Collection Date*

Primary Contact*

Phone Number*

Email*

Does your organization operate multiple facilities?*
NoYes

If so, what is the name and location of the facility the sample is from?

Plant Information

Plant Type*

Other

Daily Flow Rate*

BOD (mg/L) Influent

Ammonia (mg/L) Influent

Effluent TSS (mg/L)

BOD (mg/L) Effluent

Ammonia (mg/L) Effluent

Primary Issues Experienced*

Other Concerns*

Are you currently adding any Aquafix products? If so, at what amounts?

Sample Information

Important Note: Each submission can only accommodate up to 3 sample bottles. Please complete this form again for each additional set of 3 bottles that you are sending. To ensure accurate and timely results, please fill out the form to the best of your ability.

Bottle 1

Sample Name*

Sample Type*

Sample Location*

Temperature °F/°C

Average Dissolved Oxygen (mg/L)

Average MLSS* (mg/L)

30 Minute Settling (% 1000 ml)

Bottle 2

Sample Name*

Sample Type*

Sample Location*

Temperature °F/°C

Average Dissolved Oxygen (mg/L)

Average MLSS* (mg/L)

30 Minute Settling (% 1000 ml)

Bottle 3

Sample Name

Sample Type

Sample Location

Temperature °F/°C

Average Dissolved Oxygen (mg/L)

Average MLSS (mg/L)

30 Minute Settling (% 1000 ml)

Additional Information

Upload Files

(e.g. pictures of foaming, plant schematics, 30 minute settling test pictures, etc.)

Upload photo

Please leave this field empty.

Instructions to Obtain and Submit a Sample

1. Freeze included ice pack immediately after receiving kit.

2. Properly label each sample bottle and fill out corresponding online paperwork

3. Fill sample bottles 1/2 full.

a. Unless requested, do not send duplicates of the same sample.

b. am samples should be in separate bottles. Only include a foam sample if foaming is your main concern.

4. Seal sample bottles in Ziplock bag provided. Place samples in original box with frozen ice pack.

5. Attach included shipping label over the original label and tape the box closed.

6. Call us at 888-757-9577 to schedule your free pick up.

a. Call prior to 9 am CST to arrange same day pickup Monday – Wednesday

b. To preserve the quality of the sample, please do not send samples later than Wednesday.

NOTE: The $400 fee includes two samples and return shipping. Additional sample bottle are billed at $100 each.

Shipping Address: 505 S Rosa Road Room 240 Madison, WI 53719

Now Offering Free Return Shipping!

Lab Analysis Form

Contact Information

Plant Information

Sample Information

Important Note: Each submission can only accommodate up to 3 sample bottles. Please complete this form again for each additional set of 3 bottles that you are sending. To ensure accurate and timely results, please fill out the form to the best of your ability.

Bottle 1

Bottle 2

Bottle 3

Additional Information

Upload Files

Instructions to Obtain and Submit a Sample

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