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Test – Gravity and Infusion with Captcha




Contact Information
First Name *
Last Name
Email *
Water Source
Well Water Flow Rate
Red / Orange Stains
Yes
No
Brown stains
Yes
No
Black stains
Blue stains
Yes
No
White spots / scale
Yes
No
Sediment
Yes
No
Color
Yes
No
Sulfur odor in cold well water
Yes
No
Sulfur odor in hot water only
Yes
No
Water has other odors
Yes
No
Corrosion
Yes
No
Hardness mg/L or PPM
Hardness Grains/Gallon
Iron
Manganese
Nitrate
Tannin
Coliform Bacteria Present
Yes No
Fecal Coliform Bacteria Present
Yes No
Hydrogen Sulfide
=Iron
Yes
No
=Manganese
Yes
No
=Nitrate
Yes
No
Bacteria
Yes
No
Chemical or Heavy Metals
Yes
No
Salts
Yes
No
Total Dissolved Solids
pH
Number of Bathrooms
Background Info
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  • Clean Water Systems & Stores, Inc., Water Treatment Equipment,Service & Supplies, Santa Cruz, CA
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