Attachment_2_-_ASR_Example.doc

Attachment 2

U.S. GEOLOGICAL SURVEY – NATIONAL WATER QUALITY LABORATORY

ANALYTICAL SERVICES REQUEST

THIS SECTION MANDATORY FOR SAMPLE LOGIN

NWIS RECORD NUMBER

LAB USE ONLY

FORMTEXT

FORMTEXT

SAMPLE TRACKING ID

User Code

Project Account

NWQL LABORATORY ID

STATION ID

Begin Date (YYYYMMDD)

Begin Time

Medium Code

Sample Type

District Contact Phone Number

End Date (YYYYMMDD)

End Time

District Contact Email

SITE / SAMPLE / SPECIAL PROJECT INFORMATION (Optional)

Sample Set

State

County

Geologic

Unit Code

Analysis

Status*

Analysis Source*

Hydrologic Condition*

Hydrologic Event*

Chain of Custody

NWQL Proposal Number

NWQL Contact Name

NWQL Contact Email

Program/Project

ANALYTICAL WORK REQUESTS: SCHEDULES AND LAB CODES (CIRCLE A=add D=delete)

SHIPPING INFORMATION (Please fill in number of containers sent)

TPCN

UAS

WCA

FIELD VALUES

Lab/P Code

Lab/P Code

Lab/P Code

21/00095

51/00400

2/39086

Specific Conductance uS/cm @ 25 deg C pH Standard Units

Alkalinity – IT mg/L as CaCO3

Field Comments:

*MANDATORY FOR NWIS

Form 9-3094

(August 2000)

PLEASE USE BLACK INK ONLY

INSTRUCTIONS FOR COMPLETING ANALYTICAL SERVICES REQUEST FORM

SAMPLE IDENTIFICATION (Mandatory)

NWIS Record No.

Record number of sample assigned by NWIS database (District)

User Code

Enter District user code (indicates which office sample data are to be directed)

Project Acct

Enter 9 character account number

NWQL Laboratory ID

Leave blank (for Laboratory use only)

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)

Sample Type

Enter sample type code (see attached table)

District Contact Phone Number Enter complete phone number for District 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 sample collection ended

End Time

Enter 4 digit military time sample collection ended

District Contact Email

Enter complete email address for District contact for sample questions or problems SITE / SAMPLE / SPECIAL PROJECT INFORMATION (Optional)

State

Enter 2 digit FIPS code for State in which station is located

County

Enter 3 digit FIPS code for county in which station is located

Geologic Unit Code

Enter geologic unit code for ground-water sample (multiple aquifer identification) *Analysis Status

Enter analysis status code (see attached table) *Analysis Source

Enter analysis source code (see attached table) *Hydrologic Condition

Enter hydrologic condition code (see attached table) *Hydrologic Event

Enter hydrologic event code (see attached table)

Chain of Custody

Enter Y if sample is chain of custody

Sample Set

Enter identifier for sample set, and place on all bottles and associated log form, for example: "A", "BB" (max. 2)

NWQL Proposal Number Denotes non-routine or custom work assigned by NWQL in negotiated proposal

NWQL Contact Name

Enter name of NWQL person to be contacted when sample arrives at Lab

NWQL Contact Email

Enter email of NWQL person to be contacted when sample arrives at Lab

Program/Project

For example: NAWQA, NASQAN, NPDES, DW - if applicable

Station Name

Enter local station name

Field ID

Enter identification assigned by District

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

Hazard

Describe any known hazard associated with sample (chemical, biological, radiological, etc.)

ANALYTICAL WORK REQUESTS: 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 15.

SHIPPING INFORMATION (Please fill in number of sample types sent)

NWQL Login Comments

NWQL login personnel comments.

Collected by:

Enter name of individual that collected/shipped samples

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 sc, pH, alk, if needed, enter P code, value, remark for other field values

Field Comments

For field use only. Will not be used by NWQL.

*Mandatory for storage in NWIS