St-Donat Pumping 
Station / H2O Technologies
1-888-829-6883

Physico-chemical water analysis form


Complete the form below to get your physico-chemical water analysis. If you have your bacterial analysis certificate and/or your physico-chemical water analysis certificate offered by the Centre de Pompes, use the data from the sample to complete the fields


First name :

 Last name :
Address :

 City :
Postal code :

 Email :
Home phone number :
Ext
Office/other phone number :
Ext


Please only answer questions for which you are certain of your answer
The water flow is clear but stains :   
The water flow has a color :   
The water flow has an odor :   


Please answer the following question on the type of water system installation
Type of installation? :




Piping :





Number of bathrooms :
Number of water rooms :
Any particular plumbing equipment (multi jet shower, etc.) ? :
Number of occupants (an average if needed) :
Do you have a water treatment system? :   
Do you have another water treatment equipment? :
When was the last maintenance done?  :


If you are sending us a water sample, where was it taken?  :

Do you have a bacterial analysis certificate?  :   
Do you have a physico-chemical analysis certificate?  :   
Other information you want us to know :