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Payment is required. If payment is not received within 5 business days, this application will be held in pending and discarded after 30 days.
Please select which type of sample(s) you are requesting.
Water samples may be requested by the owner or tenant of the property. The well head and sampling spigots should be exposed and made accessible. Please do not chlorinate the well before sampling unless instructed to do so otherwise.
By typing in my name, I authorize the Orange County Health Department to enter the property and to perform the service requested.
This field is not part of the form submission.
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