J_NWQL_ASR_Form_0006.pdf

Form 9-3094

(November 2017)

ANALYTICAL SERVICES REQUEST

U.S. GEOLOGICAL SURVEY – NATIONAL WATER QUALITY LABORATORY

LAB USE ONLY LAB USE ONLY

C A 4 G C 2 2 Z G 1 3 U 4 N G S 0 0

SAMPLE ID NUMBER User Code Project Account NWQL LABORATORY ID

U S G S 2 0 2 1 0 0 W G

Source Agency Code Station ID Begin Date (YYYYMMDD) Begin Time Medium

Code

WSC Contact (email) WSC Contact (phone) End Date (if req’d) End Time (if req’d) Sample Type

SITE / SAMPLE / SPECIAL PROJECT INFORMATION (optional)

Check boxes as appropriate X Chain of

Custody Hazard* USDA Soil Lab Spike

(add LC4000) Lab

Filter

*Hazard Details: Sample collected from well in or near oil and gas field.

State CA County Hydr. Event X Hydr. Cond. X

CL21008 COGG-GW

NWQL Proposal Number Proposal Contact Email ID Proposal Contact Phone # Program/Project

Station Name:

Comments to NWQL:

Drops of HCl:_____

SCHEDULES AND LAB CODES (SCHED = Schedule; LC = Lab Code; A = add or D = delete)

SCHED 1: 2020 SCHED 2: 1948 SCHED 3: 2755 SCHED 4: SCHED 5: SCHED 6:

LC:

2114 (ADD) LC: A D LC: A D LC: A D LC: A D

LC: A D LC: A D LC: A D LC: A D LC: A D

SHIPPING INFORMATION (Number of containers sent)

ALF 1 FA GCC POCIS-SPMD SUSO UAS

BGC FAM 3 GCV RA TBI WCA

CC FAR HFL RAM TBY

CHL FCA HUN RAR TOC

CU 1 FCC MBAS RCB TPCN

CUR FCCVT OXW 1 RU

DIC 1 FU PEST SAS RUR Time: :

DOC FUS PHARM SUR RURCV Time: :

NWQL Login Comments (Lab only):

Collected by Email: Phone: Ship Date:

FIELD VALUES

Lab/P Code Value Remark Lab/P Code Value Remark Lab/P Code Value Remark

21/00095 51/00400 2/39086

Specific Conductance uS/cm @ 25 deg C pH Standard Units Alkalinity – IT mg/L as

CaCO3

NWIS RECORD NUMBER