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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
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