Water Purity Form

Location Name: ___________________________________________


Location Description: ___________________________________________


Address: ___________________________________________


City: ______________________________________________


State: ______________________________________________


Zipcode: ______________________________________________




Device Reading: ______________________________________________


Taste: ______________________________________________


Danger Level (circle one)


0 - Perfectly Healthy

1 -

2 -

3 - Average

4 -

5 -

6 -

7 - Can Kill