Equipment Request Form

To receive additional non-consumable supplies, due to breakage, loss, or expansion of a monitoring program, the required criteria must be met. These items may include a transparency tube, aquatic thermometer, aquatic kick net, dip net, and E. coli testing materials (IF you have been through a special E. coli training workshop).

All supply requests will be handled under the sole discretion of Riverwatch staff and may be contingent upon availability of requested materials. The Hoosier Riverwatch program may discontinue this policy at any point in time, especially due to financial constraints.

Questions marked with a * are required.

*1.	Name:

*2.	Organization:

*3.	Vol. ID#

*4.	Site Number(s):

Shipping Address:

*5.	Street Address:

*6.	City:

*7.	State:

*8.	ZIP Code:

Supplies Requested: Enter the Quantities Needed

9.	CHEMets® Phosphate Refills (30 max)

10.	CHEMets® Phos. Color Comparator (Range 0-1)

11.	CHEMets® Phos. Color Comparator (Range 1-10)

12.	CHEMets® Phos. Activator Solution (1 max)

13.	CHEMets® Dissolved Oxygen Refills (30 max)

14.	CHEMets® DO Color Comparator (1 max)

15.	WaterWorks® Nitrite-N/Nitrate-N test strips (50 max)

16.	WaterWorks® pH test strips (50 max)

17.	Coliscan EasyGel® Media Bottles, pipettes, petri dishes - available only to Special Topic workshop participants (10 max)

18.	Other