English Español English Morrow-Umatilla Counties Well Sampling Form If you own a well in Morrow or Umatilla County and would like to have your water sampled, we invite you to complete this form to express your interest. Your participation will help us ensure safe and clean drinking water in the community. Question Title * 1. Please provide your name. Question Title * 2. Email Address Question Title * 3. Phone Question Title * 4. Home address Question Title * 5. Do you live in Morrow or Umatilla County? Yes No Not Sure Question Title * 6. Does your residence rely on a well for drinking water? Yes No Not Sure Question Title * 7. Have you experienced any of these issues or problems with your well? Low summer capacity Cloudy water Taste and odor issues Tests show contamination Mechanical problems No issues or problems Other (please specify) Question Title * 8. Would you like to schedule a FREE water quality test for your well? (Must be within the project area) Yes No Not now - maybe later Question Title * 9. If Yes, what's the best day/time to schedule a well test? Question Title * 10. Would you be interested in receiving information, or a link to learn more about maintaining and protecting your well? Yes No The well test results will be sent to you at the above address or email, and also to the Oregon Health Authority. Your included well results will not be shared. Done