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2. Thank you for your interest in the Village's water sample collection process.  This is a simple procedure of filling sample bottles that the Village's Public Works Department will deliver and collect at no cost.  Your participation will provide you with complimentary test results.  

   When you click submit, this form with your information will be sent to the Public Works Utilities Division.  We will contact you with more information and a schedule if you wish to participate.   

   If you have further questions, please call 847-362-3434 to speak with Public Works staff. 

4. Name*
5. Address*
7. Phone Number*
8. Email

   Please include if you would like to receive your test results via email.

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10. 1. Receive an email copy of this form.
11. Email address

    This field is not part of the form submission.

12. Submit

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