Form Center

By signing in or creating an account, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.

Water Sample Form - Lead/Copper Testing

Sign in to Save Progress
  2. Water Sample Survey

    The City of Sioux Center recently began receiving high-quality water from the Lewis & Clark Regional Water System. With this new water in our supply, the Iowa DNR is requiring additional testing of City water. One requirement is additional lead and copper testing at homes in the community.

    Your house was selected to be a testing point. Would you be willing to help by taking a couple of samples of your water?

    To help, complete the brief survey below.

  4. 1. Would you be willing to take a couple of water samples?*
  6. 2. Do you have a filter system or a reverse osmosis system in your house?*
  8. 3. Do you have a hard water faucet, like a drinking water faucet? (Example: at your kitchen sink.)*
  14. THANK YOU.

    When we receive your survey, if your house still qualifies as a testing site, City personnel will drop off a bottle for you with directions on how to take the sample. Thank you!

    If you have questions, call Ofelia at the City Office (712) 722-0761. Available in English & Spanish.

    15. Leave This Blank: