OKLAHOMA PANHANDLE STATE UNIVERSITY WATER SAMPLE SUBMISSION FORM MURPHY-BROWN LLC WATER QUALITY LABORATORY Before collecting sample, see below SAMPLING PROCEDURES and SAMPLE REJECTION PARAMETERS “PROGRESS THROUGH KNOWLEDGE” Shipping address Water Quality Laboratory Oklahoma Panhandle State U. Science and Agriculture Building – Room 108 417 W. Sewell St. Goodwell, OK 73939 Mailing address Water Quality Laboratory Oklahoma Panhandle State U. P.O. Box 430 Goodwell, OK 73939 Location OPSU campus Science and Agriculture Building – Room 108 (see map and directions at website) Individual or Company name Telephone 580-349-1563 Email waterlab@opsu.edu Fax 580-349-1567 Website www.waterlab.opsu.edu Certifications EPA ID: OK01026 ODEQ ID: D9938 KDHE ID: E10394 TCEQ ID: T104704496-11-1 Contact name Alternate billing information E-mail address Check prefer email Check prefer regular mail for report and invoice for report and invoice Mailing address Telephone number Fax number Check prefer fax for report and invoice Sample identification Complete separate form for each sample location Collection by (print name) Signature PWSID # Date / Time Water System Facility ID Location Code Chlorine (mg/L, indicate free or total) Required if regulatory compliance sample CONTAINER CODE A120 A150 P125 P250 P250A PL H RAD TYPE Plastic Wide-mouth 120 mL total volume Sterile Plastic Wide-mouth 150 mL total volume Sterile Plastic Narrow-mouth 125 mL Plastic Wide-mouth 250 mL Plastic Wide-mouth Amber 250 mL Plastic Narrow-mouth 1L Glass vial 40 mL Plastic 1 gallon jug FILL INSTRUCTIONS MUST have liquid volume ≥100 mL bottle mark with some headspace (not liquid full) PRESERVATION (also see TEMPERATURE receipt conditions) NC No added chemical preservation RECEIPT CONDITIONS AT LABORATORY 28H TIME 28 hours NT SPECIAL NOTE PWS municipalities and distribution systems MUST provide Chlorine value taken at time of sample collection. T Sodium thiosulfate included in bottle to neutralize chlorine 4H 4 hours 6C ≤ 6°C #2 At receipt, pH MUST be ≤ 2. Add sample liquid until almost full. NOT completely full. S Sulfuric acid included in sample bottle 14H 14 hours 10C ≤ 10°C #3 Solid ice MUST be maintained until sample receipt. Add sample liquid until almost full. NOT completely full. N Nitric acid included in sample bottle 48H 48 hours #4 See special Lead and Copper sampling instructions Add sample liquid until almost full. NOT completely full. V Ascorbic acid included in vial. Hydrochloric acid added after collection. 14D 14 days #5 For filterable metals, contact lab prior to collection. Add sample liquid until almost full. NOT completely full. E Ethylenediamine added after collection 28D 28 days #6 Systems using chlorine dioxide treatment must sparge prior to preservation. MUST be liquid full. No headspace. Add sample liquid until almost full. NOT completely full. EXAMPLE SAMPLE COLLECTION CODE: P250 CONTAINER TYPE - S PRESERVATION - 28D RECEIPT TIME - Lab must receive sample before the maximum time shown above. NT RECEIPT TEMPERATURE SAMPLING PROCEDURES • #1 MUST have liquid volume ≥100 and ≤120 mL bottle marks During sampling, do not rinse out any preservative from the container. • • TEMPERATURE No special temperature conditions See separate SAMPLING INSTRUCTIONS posted on our website. Note these items: o Container code specific for each analyte or group type. o Container liquid loading volume. o Maximum time from sample collection to laboratory receipt. o Temperature maximum at laboratory receipt. Complete Chain-of-Custody below. - Avoid direct contact between sample containers and ice to minimize freezing breakage. #2 SPECIAL NOTE SAMPLE REJECTION PARAMETERS Samples are rejected at the laboratory for ANY of the following reasons. 1. Incomplete documentation on the following: lack of collection date and time; sample name, type, and location; sampler’s signature; and if applicable, public water system identification (PWSID) and Chlorine residual before collection. 2. Container not of proper type, not properly labeled and/or does not contain proper volume. 3. Incorrect or nonexistent preservative, if required. 4. For coliform testing, sample contains measureable Chlorine. 5. Sample is beyond time limit or out of temperature range when received at the laboratory. Relinquished by / Date / Time Comments Delivery Method Relinquished by / Date / Time Comments Delivery Method Laboratory received by / Date / Time Comments Chain-of-Custody CONTROLLED DOCUMENT WHEN DATA ENTERED QS.FORM.SAMPLE.DETAILED Version: 013 Issued: 1-Nov-2012 Page 1 of 2 MARK REQUESTED TESTS BELOW “Bac-T” Presence/Absence of Total Coliforms and E. coli For NELAC-compliant samples: • Chlorine valve at time of collection must be provided, otherwise additional charge • Container and volume must meet requirements, otherwise additional charge A120-T-28H-NT-#1 or A150-T-28H-NT-#1 pH, Conductivity, Alkalinity (total), Anions, Cations and Hardness, Metals (iron, manganese), TDS, LSI – for general drinking water evaluation. P250-NC-4H-10C-#3 P250-S-28D-NT-#2 PL-NC-14D-NT-#5 pH, pHC, Conductivity, Salinity, Alkalinity (breakdown), Anions, Cations and Hardness, Boron, SAR, TDS – for evaluating water for irrigation suitability P250-NC-4H-10C-#3 P250-S-28D-NT-#2 pH, Conductivity, Turbidity, Alkalinity (total), Anions (nitrate, nitrite, chloride, fluoride, sulfate), Hardness (total), Metals (sodium, iron, manganese, antimony, arsenic, barium, beryllium, cadmium, copper, chromium, mercury, lead, nickel, selenium, thallium, zinc), TDS, VOC (524 list), Radiological group P250-NC-48H-10C-#3 P250-S-28D-NT-#2 H-V-14D-6C-#3 PL-NC-14D-NT-#5 BTEX – Benzene, Toluene, Ethyl benzene, Xylenes – indication of gasoline contamination H-V-14D-6C-#3 DRINKING WATER QUALITY IRRIGATION WATER QUALITY WATER WELL QUALITY VOLATILE ORGANIC COMPOUNDS ALKALINITY ANIONS CATIONS and HARDNESS EPA 524 List – EPA Method 524 volatile compounds Regulated VOCs – Volatile organic compounds on EPA regulated contaminants list H-V-14D-6C-#3 H-V-14D-6C-#3 VOC Scan – General scan of volatile compounds by GCMS H-V-14D-6C-#3 Selected VOCs Alkalinity breakdown – Carbonate, Bicarbonate, Hydroxide and Total – H-V-14D-6C-#3 Total Alkalinity Common Anions – Fluoride, Chloride, Bromide, Nitrate-N, Nitrite-N, LIMS Sample # H-V-14D-6C-#3 THMs – Trihalomethanes (4) – volatile, organic disinfection by-products to test corrosion potential Chlorine DESCRIPTION pH TEST Actual Temp SAMPLE COLLECTION CODE (see page 1) RECEIPT CONDITIONS Temp Adj (also indicate preservation or handling if other than code) Receipt Temp Additional notes P250-NC-48H-10C-#3 P250-NC-48H-10C-#3 Sulfate, ortho-Phosphate-P – for general drinking water evaluation. If individual anions are critical, see other tests below. P250-NC-48H-10C-#3 Nitrate and Nitrite P250-NC-48H-10C-#3 Selected Call lab Cations – Lithium, Sodium, Potassium, Magnesium, Calcium – for general drinking water evaluation P250-S-28D-NT-#2 Hardness – magnesium hardness, calcium hardness, total hardness P250-S-28D-NT-#2 Cations and Hardness P250-S-28D-NT-#2 Ammonia (as ammonium) P250-S-28D-NT-#2 Selected P250-S-28D-NT-#2 CHLORINE CONDUCTIVITY LANGELIER SATURATION INDEX METALS Residual – For disinfection P250-NC-4H-10C-#3 Residual and Total – Additional charge beyond residual test Electrical Conductivity – Indication of dissolved solids, corrosion P250-NC-4H-10C-#3 potential P250-NC-4H-10C-#3 Salinity (Ecw) P250-NC-4H-10C-#3 NOTE: Requires water temperature measured at time of collection. P250-NC-4H-10C-#3 P250-S-28D-NT-#2 Scan PL-NC-14D-NT-#5 Mercury Call lab Selected Elements PL-NC-14D-NT-#5 pH pH – Acid-Base condition, corrosion potential pHc – Alkalinity, Cations, pH – theoretical pH of irrigation water in contact with lime and soil, acid-base condition RADIOCHEMICAL TESTING Gross Alpha and Beta, Radium, and Uranium analyzed at subcontracted laboratory SAR – traditional from Na, Ca, Mg – For evaluating irrigation waters for salting SODIUM ABSORPTION RATIO SOLIDS property, 3 calculations available P250-NC-4H-10C-#3 P250-NC-4H-10C-#3 P250-S-28D-NT-#2 RAD-NC-14D-NT P250-S-28D-NT-#2 P250-NC-4H-10C-#3 SAR Adj Rna – to include bicarbonate/calcium contribution P250-S-28D-NT-#2 P250-NC-4H-10C-#3 P250-S-28D-NT-#2 P250-NC-4H-10C-#3 Total Dissolved Solids (TDS) – measured gravimetrically P250-NC-48H-10C-#3 Total Dissolved Solids (TDS) – estimated from conductivity P250-NC-48H-10C-#3 Turbidity P250-NC-48H-10C-#3 SAR Adj – to include carbonate/bicarbonate contribution CONTROLLED DOCUMENT WHEN DATA ENTERED QS.FORM.SAMPLE.DETAILED Version: 013 Issued: 1-Nov-2012 Page 2 of 2