Residents and Nonprofit Organizations

 
Please correct the field(s) marked in red below:

1
Contact Name
 *
Contact Name
2
Mailing Address
3

Water Sample Address/Test Location

NOTE: Use only if the water sample location is different than your mailing address.

4
Phone Number
 *
5
Email Address
 *
6
Preferred Language
Preferred Language
7
Type of Pipe in Home/Building
 *
8

Faucets/Sinks and Drinking Fountains You Want to Test 

NOTE: The Hillsboro Water Department recommends testing faucets and drinking fountains used the most for drinking and cooking (not bathrooms, showers, hose bibs, etc.).

 *
Faucets/Sinks and Drinking Fountains You Want to Test NOTE: The Hillsboro Water Department recommends testing faucets and drinking fountains used the most for drinking and cooking (not bathrooms, showers, hose bibs, etc.).
9

Approximate Year House/Building was Constructed

 *
10
How did you hear about this free testing program?
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