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2. The Yakima Health District is providing free under-the-sink water filters for East Selah households with PFAS levels above the EPA's Maximum Contaminant Levels (MCLs) in their well water.
   
   Please complete this form to see if you are eligible. If you qualify, YHD staff will contact you with next steps.
   
   If you need help completing the questions, please call 509-249-6555.
   
   
   

4. 
6. Name
8. Phone number
10. Property address (Include street address, city, and Zip code)
12. Do you use an individual or shared well?
    -- Select One --Individual wellShared wellNot sure
14. Have you ever had your water tested for PFAS?
    -- Select One --YesNoNot sure
16. If you've had your water tested, who did the testing?
    -- Select One --Yakima Training CenterYakima Health DistrictMyselfNot sure
18. Have you received a whole house treatment system (also called a POET system) from the Army?
    -- Select One --Yes, it has been installedNo, but I'm currently waiting for oneNo, I have not been offered oneNot sure
20. Please upload a picture or copy of your test results if available
Leave This Blank:


22. 1. Receive an email copy of this form.
23. Email address

    This field is not part of the form submission.

24. Submit

* indicates a required field