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| 1. |
General Information - Please make sure you accurately type in your street address so you can receive your sample collection materials in the mail.
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| 2. |
Did you receive an invitation letter from the New Jersey Department of Health? Only homes who received an invitation letter are eligible.
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| 3. |
Enter your registration code included in your the invitation letter:
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| 4. |
Do you have a private well? This free testing opportunity is for homes on private well water only. If you receive a water bill, that means you have a water provider and you're not on private well water. You can find lead in drinking water results from your water provider at NJDEP Drinking Water Watch: https://www9.state.nj.us/DEP_WaterWatch_public/
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| 5. |
By entering your name below, you are confirming that the information you have provided is accurate.
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| 6. |
What year was your home built?
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| 7. |
Have you tested your water for lead before?
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| 8. |
Did your water test detect lead in your water?
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| 9. |
Do you have any concerns about lead in your drinking water?
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| 10. |
Are you aware of any materials that contain lead in your well (e.g., well pump) or household plumbing (e.g., lead service line, lead pipes or solder)?
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| 11. |
Which of the following items contain lead (or you suspect may contain lead)?
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| 12. |
Which of the following describes the water you drink at home most often?
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| 13. |
Do you use any of these water filters or water treatment systems in your home? Check all that apply.
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Please correct the errors before moving forward.
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