PFAS sampling request form for public water systems
To apply for PFAS sampling or re-sampling, please complete this form. This form is for public water systems only, and intended for small-scale sampling projects. If you have a larger-scale sampling project, please complete the Request for Application (RFA). Once you complete this form, someone from the department will review your submission and contact you. Due to the large amount of requests received the department will not be contacting new requests for several months. The completion of this form does not guarantee sampling. Each submission will be reviewed with the prioritization method outlined in the Request for Application. For more information, please visit our website or contact us at cdphe_wqcd_pfas_grant@state.co.us. Thank you for your interest!
Email *
Name (i.e., Public Water System) *
Public Water System Identification # (CO0XXXXXX)
Did you participate in the 2020 PFAS Sampling effort?
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Please check all that apply for sampling
How many entry points do you have? *
Contact person for PFAS sampling *
Email of contact person *
Phone number of contact person *
Do you have the ability and experience to take your own PFAS samples? *
Shipping address to receive sampling kits (street, city, state, zip code) *
A copy of your responses will be emailed to .
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