Lead Sample Kit Form

Please note that submission of this form is not a request for sample pick-up

Prior to collecting your samples, please fully review the specific sampling instructions for your sample kit. Sampling instructions may also be included in your sample kit.

To process your lead samples, this form must be filled out accurately. Ideally, fill out this form at the time you are collecting your samples to ensure the information is as accurate as possible. Submission of a lead sample kit is required for Halifax Water to initiate testing of your samples. Without the submission of a Lead Sample Kit Collection Information form your lead samples will be held for analysis until a completed form is submitted.

Direct any questions regarding your sampling instructions or this form to lead@halifaxwater.ca along with the:

  • Address
  • Participation ID
  • and Event ID included in the sample kit you received.
     

Required fields are marked with an asterisk (*)

Service Address Where Sample Was Taken

Sample Collection Information

Which sample kit are you using?
Faucet Location for Samples 1 through 4
Was Sample 5 collected from the same faucet as samples 1 through 4?
Faucet Location for Sample 5
Faucet Location for Sample 1
Was the Flush Sample collected from the same faucet as samples 1 through 4
Was the Flush Sample collected from the same faucet as sample 1
Faucet Location for Flush Sample

Reporting Preferences

* Turnaround time for receiving results is approximately 21 to 28 business days.

Please note: Any test results exceeding the maximum allowable concentration for lead in drinking water as per Health Canada’s Guidelines for Canadian Drinking Water Quality will be reported via a phone call as well as the selected reporting method.

 

Select preferred method for receiving test results

Mailing Address

Additional Information

To accurately interpret your test results, please provide the following information:

Select your building type:
Approximately how many units occupy your building:

Submission Information

In order for your application to be reviewed, all information must be filled out correctly. 

Please note that submission of this form is not a request for sample pick-up.

Samples can be picked up Tuesday through Thursday. Contact lead@halifaxwater.ca or 902-292-2437 before 10:00 AM to arrange sample pick-up.

Samples are not temperature sensitive and remain viable in both cold and hot temperatures.

Acknowledgement

I acknowledge that by submitting this form I hereby confirm that I have read the sampling instructions and collected the water samples in accordance; and I understand that my sample results may be used for research and/or regulatory reporting purposes, but my personal information, including address, will be kept confidential.

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