New Jersey DAYCARE RADON Inspection Order Form ARCH INSPECTIONSNEW JERSEY DAYCARE RADON INSPECTIONORDER FORM Contact InformationName:* First Last Company NameEmail* Best Phone Number to contact you*May we send text messages to this number? Yes No Preferred Contact Method: Call Text Email Facility InformationFacility Name*Inspection Property Address:* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Type of Facility: Day Care Center Home-based daycare Preschool Public School Is this a licensed day care/ child care facility?* Yes No In process / applying for license Not sure Is the Inspection Property Address the same as your Billing Address?* YES NO Current Billing Address:* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Inspection Related QuestionsReason for Radon Measurement* Licensing / compliance Parent / staff concern Property Lease Property Purchase Renewal When was the facility last tested for radon?*Within the last year1–3 years ago3–5 years agoMore than 5 years agoNot sureNever testedApproximate Building Square Footage*Number of Ground-Level Rooms / Classrooms:Does the daycare occupy the ground floor, basement, or crawlspace level?*Ground floor onlyBasement levelAbove crawlspaceMultiple levelsNot sureHow soon do you need testing?*As soon as possibleWithin 1 weekWithin 2–4 weeksBefore license renewalJust gathering pricingUpload Prior Radon Report, if Available.Accepted file types: pdf, jpg, png, Max. file size: 25 MB. Anything else we should know?Preferred Inspection Date:* Preferred Inspection Time:* Morning Afternoon Evening Preferred SECOND Inspection Date:* Preferred SECOND Inspection Time:* Morning Afternoon Evening FOR SCHEDULING PURPOSES ONLY Provide onsite property contact’s information (if other than previously listed)Onsite property contact's full name. First Last Onsite property contact's email address Onsite property contact's phone number.Is this inspection related to any current or future legal claims (eg. lawsuits, insurance claims, etc.)?* YES NO Consent* I understand that submitting this form does not schedule testing automatically. Arch Inspections will review the information provided and contact me with pricing, availability, and next steps.
