This site requires Javascript be enabled.
To continue, please enable Javascript by following instructions specific to the browser you are using.
Tooele County Health Department
151 N. Main Street, Suite 140 - Tooele, UT 84074
Phone (435) 277-2440 Fax (435)277-2444
www.tooelehealth.org
eh@tooelehealth.org
Application For Meth Testing
Please put N/A for any fields that are not applicable
Inspection requested by:
Name
Address
Telephone Number
Email Address
Association to property:
Rush Sample results (2 day):
If you have additional documents to send, please email them to eh@tooelehealth.org.
Property to be tested:
Address
Owner
Owner's Phone Number
Owner's Address
Standard Sampling
First Test:
$150.00
Select:
Item Subtotal:
$0.00
Each Additional Test:
$50.00
Quantity:
Item Subtotal:
$0.00
Rush Sampling
Rush Sampling Test:
$185.00
Select:
Item Subtotal:
$0.00
Additional Rush Sampling Tests:
$85.00
Quantity:
Item Subtotal:
$0.00
Total:
$0.00
Applicant's E-Signature
Date
'Please Select Method of Payment to Continue'
Payment Information:
Method of Payment:
Credit/Debit Card
eCheck
Update Name from Above
Name on Account:
Routing Number:
Account Number:
Institution:
Name on Card:
Account Number:
Expiration Date:
Billing Street Address:
Billing ZIP/Postal Code:
Change Payment Method
Submitting ...
Cancel
SIP
© 2023
CORE Business Technologies
DBA Secure Instant Payments. All rights reserved.
~
Our Solutions
~
Privacy Policy
~
Contact Us
~
SIP Version 3.30.16805; (API: 2.22)
