Tooele Health Department
             
Tooele County Health Department
151 N. Main Street, Suite 140 - Tooele, UT 84074
Phone (435) 277-2440 Fax (435)277-2444
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):

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
Payment Information:
Method of Payment:
 Update Name from Personal/Organizational Information
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Routing Number:
Account Number:
Institution:
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