AppendixE_Analytical_Services_Request_Form.docx

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RADIO CHEMISTRY ANALYSIS SERVICES
Solicitation number
140G0223Q0138
Issued by

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This analytical services request form is used by the U.S. Geological Survey National Water Quality Laboratory to request radio chemistry analysis services. It requires key sample identification information such as a unique sample ID number, user code, project account number, source agency code, station ID, and date and time parameters. The form also requires information on sample type, any hazards, as well as state, county, hydrologic event details. It specifies schedules and lab codes for desired analyses to be added or deleted. Shipping details such as number of sample containers by type must be provided. Field values for specific conductance, pH, alkalinity may also be included.

The related federal contract opportunity is a solicitation from the Department of the Interior US Geological Survey Office of Acquisitions and Grants to provide radio chemistry analysis services. The solicitation number is 140G0223Q0138 and seeks these analytical services but no further details are provided on the requirements, response date, or other contractual terms.

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ANALYTICAL SERVICES REQUEST

U.S. GEOLOGICAL SURVEY – NATIONAL WATER QUALITY LABORATORY For RADCHEM Please read carefully and fill out accurately – Changes require a copy of the updated ASR (cross out the incorrect entry, write the correct information, initial & date, DO NOT write over the mistake) write on the upper left corner “Revised ASR and your complete name” then send a copy of the corrected ASR immediately to colabhelp@usgs.gov and nwql_billing_team@usgs.gov – additional handling charges may apply.

The projects are established for approved CINs or m-codes and p-codes for the matrix of desired sample, if a new analyte/matrix is requested, STOP – make sure you obtain project clearance by the CoLabs Coordinator before submitting samples. No Rush TAT available

LAB USE ONLY

LAB USE ONLY

SAMPLE ID NUMBER

User Code

Project Account

NWQL LABORATORY ID

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

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

SITE / SAMPLE / SPECIAL PROJECT INFORMATION (optional)Late Billing Samples Y/N:_________
Check boxes as appropriate

Chain of Custody

Hazard*

USDA Soil

Lab Spike

Lab Filter

Sample Set

*Hazard Details:

State

County

Hydr. Event

Hydr. Cond.

NWQL Proposal Number

Proposal Contact Email ID

Proposal Contact Phone #

Program/Project

CoLabs Contacts:

Station Name:

_Wes Abdulameer or Dawn Hemmerly at CoLabHelp@USGS.gov

Comments to NWQL:

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

SCHED 1:

SCHED 2:

SCHED 3:

SCHED 4:

SCHED 5:

SCHED 6:

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
LC:
A
D

SHIPPING INFORMATION (Number of containers sent)

ALF

FA

GCC

POCIS-SPMD

SUSO

UAS

BGC

FAM

GCV

RA

TBI

WCA

CC

FAR

HFL

RAM

TBY

CHL

FCA

HUN

RAR

TOC

CU

FCC

MBAS

RCB

TPCN

CUR

FCCVT

OXW

RU

DIC

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

101/00419

103/29813

102/29802

ANC, unfiltered, incr

ANC, unfiltered, Gran

Alkalinity filtered, Gran

NWIS RECORD NUMBER

Form 9-3094
(February 2023)

PLEASE USE BLACK INK ONLY

INSTRUCTIONS FOR COMPLETING ANALYTICAL SERVICES REQUEST FORM

SAMPLE IDENTIFICATION (Mandatory)

Sample ID Number-Unique number assigned by the laboratory
User Code-Enter numeric user code (indicates where sample data are to be received) available at https://qwdx.cr.usgs.gov/
Project Acct-Enter 15 character account number for Billing. Note: NWIS-QWDATA “Project” field holds 9 characters
NWQL Laboratory ID-Leave blank (for Laboratory use only)
Source Agency Code-Enter Agency Code for the site owner if not USGS
Station ID-Enter downstream order number, 15 digit latitude, longitude and sequence number or unique sample identifier
Begin Date (YYYYMMDD)-Enter 4 digit number for year, 2 digit number for month, 2 digit number for day sample collection started
Begin Time-Enter 4 digit military time sample collection started
Medium Code-Enter sample medium code (see attached table)
WSC Contact (email)-Enter email ID of Water Science Center contact for sample questions or problems
WSC Contact (phone)-Enter complete phone number for Water Science Center Contact for sample questions or problems
End Date (YYYYMMDD)-Enter 4 digit number for year, 2 digit number for month, 2 digit number for day composite sample collection ended
End Time-Enter 4 digit military time composite sample collection ended
Sample Type-Enter sample type code (see attached table)

SITE / SAMPLE / SPECIAL PROJECT INFORMATION (Optional)

Chain of Custody-Check box if sample is chain of custody
Hazard-Check box if sample is considered hazardous – Please include details in “Hazard Details” section
USDA Soil-Check box if sample is considered a USDA certified soil
Lab Spike-Check box if sample should be spiked at the NWQL. IDENTIFY CLEARLY WHICH BOTTLE SHOULD BE SPIKED.
Lab Filter-Check box if sample should be filtered at the NWQL. IDENTIFY CLEARLY WHICH BOTTLE SHOULD BE FILTERED.
Hazard Details-Describe any known hazard associated with sample (chemical, biological, radiological, etc.)
State-Enter 2 digit FIPS code or postal abbreviation for State in which station is located
County-Enter 3 digit FIPS code for county in which station is located
Hydrologic Event-Enter hydrologic event code (see attached table)
Hydrologic Condition-Enter hydrologic condition code (see attached table)
NWQL Proposal Number-Denotes non-routine or custom work assigned by NWQL in negotiated proposal and provided to WSC personnel
Proposal Contact Email ID-Enter name of NWQL person to be contacted for questions about the proposal
Proposal Contact Phone-Enter phone number of NWQL person to be contacted for questions about the proposal
Program/Project-Program or Project Code - if applicable
Station Name-Enter local station name
Comments to NWQL-Enter information about sample that NWQL should be aware of (high concentration, etc.)

Note: Samples collected for analysis by Geologic Division MUST have the latitude/longitude provided for login

SCHEDULES AND LAB CODES
Schedule-Enter schedule number(s) for the desired analyses
Lab Code-Enter lab code for analyses to be added or deleted. Circle "A" for addition or “D” for deletion. Maximum 10.

SHIPPING INFORMATION (Please fill in number of containers sent for each bottle type)

NWQL Login Comments-NWQL login personnel comments
Collected by Email ID:-Enter email ID of individual that collected/shipped samples
Collected by Phone No.-Enter phone number of individual that collected/shipped samples
Date Shipped-Enter date samples packed/shipped to NWQL

FIELD VALUES

Lab/P Code/Value/Remark-Enter values and remarks for specific conductance, pH, or alkalinity
NWIS Record No.-Record number of sample assigned by NWIS database (Science Center)

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