B08_Appendix_E_ASR.pdf
PDF 248 KB Posted
- Attached to
- RADCHEM TESTING
- Solicitation number
- 140G0225R0019
About this file
The document is a U.S. Geological Survey (USGS) Analytical Services Request (ASR) form, revision 3.0 from October 2023, designed for a general chemistry contract with a to-be-determined (TBD) contractor. The form is a comprehensive template for submitting sample analysis requests, featuring sections for sample identification, site/project information, and analytical work requests. It includes fields for laboratory tracking, station details, project contacts, sample conditions, and a chain of custody record. The form is specifically structured to capture critical information for scientific sample analysis, with designated areas for Contract Item Numbers (CINs), sample types, and preservation methods. Key sections require details such as station ID, begin/end dates, medium codes, and space for specifying analytical methods, specific analytes, and special instructions for metals and anion analyses.
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Other files
| File | Type | Posted |
|---|---|---|
| Sol_140G0225R0019_Amd_0001.pdf | ||
| Sol_140G0225R0019.pdf | ||
| B08_Appendix_A_Pricing_Schedule.xlsx | XLSX spreadsheet | |
| B08_Appendix_C_Daily_Sample_Receipt_-_Example.xlsx | XLSX spreadsheet | |
| B08_Appendix_D_Methods_with_Reporting_Requirements.xlsx | XLSX spreadsheet | |
| B08_Appendix_B_EDD_File_Example.xlsx | XLSX spreadsheet |
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Text version
Page ___ of ___
USGS General Chemistry Contract ASR, Rev 3.0, October 2023
U.S. GEOLOGICAL SURVEY – ANALYTICAL SERVICES REQUEST (ASR)
For USGS Contract with TBD
SAMPLE IDENTIFICATION
CONTRACT LAB USE ONLY SUB-CONTRACT LAB USE ONLY
W
LABORATORY ID User Code Project Account (Check if Late sample ☐) LABORATORY ID
2 0 STATION ID* Begin Date (YYYYMMDD)* Begin Time* Medium code* Sample Type
2 0 USGS Project Contact Name End Date (YYYYMMDD) End Time USGS Project Contact Email
SITE / SAMPLE / PROJECT INFORMATION (Optional)
NO RUSH Allowed State County Geologic
Unit Code Analysis
Status Analysis
Source Hydrologic
Condition Hydrologic
Event
Note: State, County, and Geologic Unit Code data will not be entered in by Contract Laboratory
Contact Name Contact Email Contract Lab Project Name USGS Project Name
Station Name or Field ID:
Sample conditions or hazards:
ANALYTICAL WORK REQUESTS: SCHEDULES AND CONTRACT ITEM NUMBERS (CINs) Note: Contract Item Numbers (CINs) are used as Lab Codes for this specific ASR.
Containers/Preservatives
CIN
Filtered
(F) or
Unfiltered (U)
Remarks: list analytical method no., specific analytes for metals and anion analyses, special instructions, and other comments
U np re s.
H 2S
O
H N
O
H C l
N aO
Zn Ac
N aO
CHAIN OF CUSTODY RECORD
ASR: Relinquished by: Date: Time:
ASR: Received by: Date: Time:
SAMPLE IDENTIFICATION
| For USGS Contract with TBD: |
| CONTRACT LAB USE ONLY: |
| User Code: |
| SUBCONTRACT LAB USE ONLY: |
| Project Account Check if Late sample: |
| undefined: Off |
| 2 0: |
| 2 0_2: |
| Contact Name: |
| fill_59: |
| Station Name or Field IDRow1: |
| Sample conditions or hazardsRow1: |
| Remarks list analytical method no specific analytes for metals: |
| ContainersPreservativesRemarks list analytical method no specific analytes for metals and anion analyses special instructions and other comments: |
| ContainersPreservativesRemarks list analytical method no specific analytes for metals and anion analyses special instructions and other comments_2: |
| CINRow1: |
| Filtered F or Unfiltered URow1: |
| Remarks list analytical method no specific analytes for metals and anion analyses special instructions and other commentsRow1: |
| HCl: |
| NaOH: |
| CINRow2: |
| Filtered F or Unfiltered URow2: |
| Remarks list analytical method no specific analytes for metals and anion analyses special instructions and other commentsRow2: |
| ZnAc: |
| NaOH_2: |
| undefined_2: |
| undefined_3: |
| CINRow3: |
| Filtered F or Unfiltered URow3: |
| Remarks list analytical method no specific analytes for metals and anion analyses special instructions and other commentsRow3: |
| undefined_4: |
| undefined_5: |
| CINRow4: |
| Filtered F or Unfiltered URow4: |
| Remarks list analytical method no specific analytes for metals and anion analyses special instructions and other commentsRow4: |
| undefined_6: |
| ContainersPreservativesRow5: |
| CINRow5: |
| Filtered F or Unfiltered URow5: |
| Remarks list analytical method no specific analytes for metals and anion analyses special instructions and other commentsRow5: |
| undefined_7: |
| ContainersPreservativesRow6: |
| CINRow6: |
| Filtered F or Unfiltered URow6: |
| Remarks list analytical method no specific analytes for metals and anion analyses special instructions and other commentsRow6: |
| undefined_8: |
| ContainersPreservativesRow7: |
| CINRow7: |
| Filtered F or Unfiltered URow7: |
| Remarks list analytical method no specific analytes for metals and anion analyses special instructions and other commentsRow7: |
| undefined_9: |
| ContainersPreservativesRow8: |
| CINRow8: |
| Filtered F or Unfiltered URow8: |
| Remarks list analytical method no specific analytes for metals and anion analyses special instructions and other commentsRow8: |
| undefined_10: |
| ContainersPreservativesRow9: |
| CINRow9: |
| Filtered F or Unfiltered URow9: |
| Remarks list analytical method no specific analytes for metals and anion analyses special instructions and other commentsRow9: |
| undefined_11: |
| ContainersPreservativesRow10: |
| ASR Relinquished by: |
| Date: |
| Time: |
| ASR Received by: |
| Date_2: |
| Time_2: |
| Row1: |
| Row2: |
| Row3: |
| Row4: |
| Row5: |
| Row6: |
| Row7: |
| Row8: |
| Row9: |
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