Lab Certification Application

Instructions:

Submittal:

We prefer that you submit your application electronically as a MS Word document only, andattach it in an email to Jennifer Thoreson at . Please address the subject line with the name of your facility name and Lab Application(For example: St. Peter Lab Application). If you do not have access to email, you may print the completed application and mail it to: Jennifer Thoreson, Minnesota Pollution Control Agency, 520 Lafayette Road North, St. Paul, MN 55155. You may also print your application and fax it to 651-296-8676.

Permittee information

Facility information

Lab information

Authorized representative (current or previous owner)

By typing your name below, you certify the information on this application to be true and correct, to the best of your knowledge, and that you are requesting acceptance to the Minnesota Pollution Control Agency’s Laboratory Registration Program.

Laboratory certification test procedures

(Note: hit tab to move to the next field for automatic calculations to work on Total category number of methods.)

Test category

Analytes in test category

Test method

Number of methods

0. Certification not required

Specific conductance, micromhos/cm at 25°C (Conductivity)

Select test method:EPA 120.11 (Rev. 1982)SM 2510 B-2011ASTM D1125-95(99) (A)AOAC 973.40USGS I-2781-85

If other, specify:

Dissolved oxygen

Select test method:SM 4500-O B-2011SM 4500-O C-2011SM 4500-O D-2011SM 4500-O E-2011SM 4500-O F-2011SM 4500-O G-2011ASTM D888-09 (A)ASTM D888-09 (B)ASTM D888-09 (C)AOAC 973.45BUSGS I-1575-78In-Situ Method 1002-8-2009Hach Method 10360, Rev.1.2, October 2011

If other, specify:

Hydrogen ion (pH)

Select test method:EPA 150.2 (Dec. 1982)SM 4500-H+B-2011ASTM D1293-99 (A or B)AOAC 973.41USGS I-1586-85USGS I-2587-85Technicon 378-75WA Oct 1976

If other, specify:

Hydrogen ion (pH) - Solids

Select test method - Solids:EPA SW-846 9045D

If other, specify:

Total residual chlorine

Select test method:SM 4500-Cl B-2011SM 4500-Cl C-2011SM 4500-Cl D-2011SM 4500-Cl E-2011SM 4500-Cl F-2011SM 4500-Cl G-2011ASTM D1253-08Orion Research Inst Man Electrode Model 97-70.1977

If other, specify:

Temperature

Select test method:SM 2550 B-2010WaterTemperature-InfluentialFactors,USGS,Bk1,ChD1

If other, specify:

Total Category 0 number of methods:

1. Oxygen utilization

Biological oxygen demand (BOD5)

Select test method:SM 5210 B-2011AOAC 973.44American National Standard on Photographic ProcessUSGS I-1578-78In-Situ Method 1003-8-2009Hach Method 10360 Revision 1.2, October 2011

If other, specify:

Carbonaceous biochemical oxygen demand (CBOD5)

Select test method:SM 5210 B-2011In-Situ Method 1004-8-2009Hach Method 10360 Rev. 1.2, October 2011

If other, specify:

Total Category 1 number of methods:

2. Nitrogen

Ammonia (as N)

Select test method:EPA 350.1, Rev. 2.0 (1993)SM 4500-NH3 B-2011SM 4500-NH3 C-2011SM 4500-NH3 D-2011SM 4500-NH3 E-2011SM 4500-NH3 F-2011SM 4500-NH3 G-2011SM 4500-NH3 H-2011ASTM D1426-08 (A)ASTM D1426-08 (B)ASTM D6919-09AOAC 973.49USGS I-3520-85USGS I-4523-85Industrial Method Number 379-75 WE Ammonia

If other, specify:

Ammonia – Solids

Select test method - Solids:EPA 350.1, Rev. 2.0 (1993)SM 4500-NH3 B-2011SM 4500-NH3 C-2011SM 4500-NH3 D-2011SM 4500-NH3 E-2011SM 4500-NH3 F-2011SM 4500-NH3 G-2011SM 4500-NH3 H-2011ASTM D1426-08 (A)ASTM D1426-08 (B)ASTM D6919-09AOAC 973.49USGS I-3520-85USGS I-4523-85Industrial Method Number 379-75 WE Ammonia

If other, specify:

Kjeldahl Nitrogen-Total, (as N)

Select test method:EPA 350.1 Rev. 2.0 1993EPA 351.1 (Rev. 1978)EPA 351.2 Rev. 2.0 1993Hach 10242SM 4500-NH3 C-2011SM 4500-NH3 E-2011SM 4500-NH3 D-2011SM 4500-NH3 F-2011SM 4500-NH3 G-2011SM 4500-NH3 H-2011SM 4500-Norg D-2011ASTM D1426-08 (A)ASTM D1426-08 (B)ASTM D3590-02(06) (B)AOAC 973.48USGS I-4551-78USGS I-4515-91NCASI TNTP W10900

If other, specify:

Kjeldahl Nitrogen-Total, (as N) - Solids

Select test method - Solids:EPA 350.1 Rev. 2.0 1993EPA 351.1 (Rev. 1978)EPA 351.2 Rev. 2.0 1993Hach 10242SM 4500-NH3 C-2011SM 4500-NH3 E-2011SM 4500-NH3 D-2011SM 4500-NH3 F-2011SM 4500-NH3 G-2011SM 4500-NH3 H-2011SM 4500-Norg D-2011ASTM D1426-08 (A)ASTM D1426-08 (B)ASTM D3590-02(06) (B)AOAC 973.48USGS I-4551-78USGS I-4515-91NCASI TNTP W10900

If other, specify:

Nitrate (as N)

Select test method:AOAC 973.5AOAC 993.30ASTM D4327-03ASTM D6508-00(05)Calculated: Nitrate-nitrite N minus Nitrite N EPA 300.0, Rev 2.1 (1993)EPA 300.1-1, Rev 1.0 (1997)EPA 352.1 (Issued 1971)EPA 419DHach 10206SM 4110 B-2011SM 4110 C-2011SM 4140 B-2011SM 4500-NO3 D-2011Waters Corp D6508, Rev. 2 Dec2000Technicon Auto Analyzer II 379-75 WE 2-19-76American National Standard on Photographic ProcessEasy (1-Reagent) Nitrate Method Rev. 11-12-11

If other, specify:

Nitrate - Solids

Select test method - Solids:EPA SW-846 9056AEPA SW-846 9210A

If other, specify:

Nitrate-nitrite (as N)

Select test method:EPA 353.2, Rev. 2.0 (1993)EPA 300.0, Rev. 2.1 (1993)EPA 300.1-1, Rev. 1.0 (1997)SM 4500-NO3 E-2011SM 4500-NO3 F-2011SM 4500-NO3 H-2011SM 4110 B-2011SM 4110 C-2011SM 4140 B-2011Hach 10206ASTM D3867-04 (B)ASTM D3867-04 (A)ASTM D4327-03ASTM D6508-00(05)USGS I-2545-90Easy (1-Reagent) Nitrate Method Rev. 11-12-11AOAC 993.3Waters Corp Method D6508, Rev. 2. Dec2000

If other, specify:

Nitrite (as N)

Select test method:EPA 353.2, Rev. 2.0 (1993)EPA 300.0, Rev. 2.1 (1993)EPA 300.1-1, Rev. 1.0 (1997)SM 4500-NO2 B-2011SM 4500-NO3 F-2011SM 4500-NO3 E-2011SM 4110 B-2011SM 4110 C-2011SM 4140 B-2011ASTM D3867-04 (A)ASTM D3867-04 (B)ASTM D4327-03ASTM D6508-00(05)Hach Company Method 8507 1979USGS I-4540-85USGS I-4545-85Easy (1-Reagent) Nitrate Method, Rev. 11-12-11Waters Corp Method D6508, Rev. 2 12-2000AOAC 993.3

If other, specify:

Total Category 2 number of methods:

(Note: hit tab to move to the next field for automatic calculations to work on Total category number of methods.)

Test category

Analytes in test category

Test method

Number of methods

3. Phosphorous

Total phosphorous

Select test method:EPA 365.1 Rev. 2.0 (1993)EPA 365.3 (Issued 1978)EPA 365.4 (Issued 1974)EPA 200.7, Rev. 4.4 (1994)SM 4500-P E-2011SM 4500-P F-2011SM 4500-P G-2011SM 4500-P H-2011SM 3120 B-2011ASTM D515-88 (A)ASTM D515-88 (B)AOAC 973.55AOAC 973.56USGS I-4600-85USGS I-4471-97USGS I-4610-91ThermoJarrell Ash Corp Method AES0029 1986 Rev1991NCASI TNTP W10900

If other, specify:

Total phosphorous - Solids

Select test method - Solids:EPA 365.1 Rev. 2.0 (1993)EPA 365.3 (Issued 1978)EPA 365.4 (Issued 1974)EPA 200.7, Rev. 4.4 (1994)SM 4500-P E-2011SM 4500-P F-2011SM 4500-P G-2011SM 4500-P H-2011SM 3120 B-2011ASTM D515-88 (A)ASTM D515-88 (B)AOAC 973.55AOAC 973.56USGS I-4600-85USGS I-4471-97USGS I-4610-91ThermoJarrell Ash Corp Method AES0029 1986 Rev1991NCASI TNTP W10900

If other, specify:

Orthophosphate as P

Select test method:EPA 365.1, Rev. 2.0 (1993)EPA 365.3 (Issued 1978)EPA 300.0, Rev. 2.1 (1993)EPA 300.1-1, Rev. 1.0 (1997)SM 4500-P E-2011SM 4500-P F-2011SM 4500-P G-2011SM 4110 B-2011SM 4110 C-2011SM 4140 B-2011ASTM D515-88(A)ASTM D4327-03ASTM D6508-00(05)AOAC 973.55AOAC 973.56AOAC 993.30USGS I-4601-85Waters Corp. D6508, Rev. 2.54 Dec2000

If other, specify:

Total Category 3 number of methods:

4. Physical

Residue-Total (total solids)

Select test method:SM 2540 B-2011USGS I-3750-85

If other, specify:

Residue-filterable (total dissolved solids)

Select test method:SM 2540 C-2011ASTM D5907-03USGS I-1750-85

If other, specify:

Residue-Volatile (volatile solids)

Select test method:EPA 160.4 (Issued 1971)SM 2540-E-2011USGS I-3753-85

If other, specify:

Residue-non-filterable (total suspended solids)

Select test method:SM 2540 D-2011ASTM D5907-03USGS I-3765-85

If other, specify:

Oil and grease

Select test method:EPA 1664 Rev. AEPA 1664 Rev. BSM 5520 B-2011SM 5520 F-2011

If other, specify:

Turbidity

Select test method:EPA 180.1, Rev. 2.0 (1993)SM 2130 B-2011ASTM D1889-00USGS I-3860-85Mitchell Method M5331 Rev. 1.0, 7-31-2008Mitchell Method M5271 Rev. 1.0, 7-31-2008Orion Method AQ4500 Rev. 5, 3-12-09

If other, specify:

Total, Fixed and Volatile solids in Solid and Semisolid samples

Select test method:SM 2540 G-2011

If other, specify:

Total Category 4 number of methods:

5. General I

Acidity, as CaCO3

Select test method:SM 2310 B-2011ASTM D1067-06USGS I-1020-85

If other, specify:

Alkalinity, as CaCO3

Select test method:EPA 310.2 (Rev. 1974)SM 2320 B-2011ASTM D1067-06AOAC 973.43USGS I-1030-85USGS I-2030-85

If other, specify:

Color

Select test method:SM 2120 B-2011NCASI Technical Bulletin 253, 12-1971USGS I-1250-85

If other, specify:

Hardness-total, as CaCO3

Select test method:EPA 130.1 (Issued 1971)SM 2340 B-2011SM 2340 C-2011ASTM D1126-02(07)AOAC 973.52BUSGS I-1338-85

If other, specify:

Silica-dissolved

Select test method:EPA 200.5, Rev 4.2 (2003)EPA 200.7, Rev 4.4 (1994)EPA 200.8, Rev 5.4 (1994)SM 4500-SiO2 C-2011SM 4500-SiO2 E-2011SM 4500-SiO2 F-2011SM 3120 B-2011SM 3125 B-2011ASTM D859-05ASTM D5673-05USGS I-1700-85USGS I-2700-85USGS I-4471-97AOAC 993.14

If other, specify:

Sulfite (as SO3)

Select test method:4500-SO3 2-B-2011

If other, specify:

Surfactants

Select test method:SM 5540 C-2011ASTM D2330-02

If other, specify:

Total Category 5 number of methods:

(Note: hit tab to move to the next field for automatic calculations to work on Total category number of methods.)

Test category

Analytes in test category

Test method

Number of methods

6. General II

Chemical oxygen demand

Select test method:EPA 410.3 (Rev. 1978)EPA 410.4 Rev. 2.0 (1993)SM 5220 B-2011SM 5220 C-2011SM 5220 D-2011Hach Company Method 8000 Hach Hdbk of Water AnalysASTM D1252-06 (A)ASTM D1252-06 (B)AOAC 973.46USGS I-3560-85USGS I-3561-85American National Standard on Photographic ProcessOIC Chemical Oxygen Demand Method.1978.Oceanograph

If other, specify:

Total phenolic compounds

Select test method:EPA 420.1 (Rev. 1978)EPA 420.4, Rev. 1.0 (1993)SM 5530 D-2010ASTM D1783-01 (A or B)

If other, specify:

Cyanide-total

Select test method:EPA 335.4, Rev. 1.0 (1993)SM 4500-CN D-2011SM 4500-CN E-2011SM 4500-CN F-2011ASTM D2036-09(A)ASTM D7284-08Lachat Instruments, QuikChem Method 10-204-00-1-XAmerican National Standard on Photograph ProcessUSGS I-3300-85USGS I-4302-85

If other, specify:

Cyanide-available

Select test method:SM 4500-CN G-2011ASTM D2036-09(B)ASTM D6888-09OIA-1677-09

If other, specify:

Sulfide

Select test method:SM 4500-S2 B-2011SM 4500-S2 C-2011SM 4500-S2 D-2011SM 4500-S2 F-2011SM 4500-S2 G-2011ASTM D4658-08USGS I-3840-85

If other, specify:

Sulfate

Select test method:EPA 375.2, Rev 2.0 (1993)EPA 300.0, Rev 2.1 (1993)EPA 300.1-1, Rev 1.0 (1997)SM4500-SO4 2-C-2011SM4500-SO4 2-D-2011SM4500-SO4 2-E-2011SM4500-SO4 2-F-2011SM4500-SO4 2-G-2011SM 4110 B-2011SM 4110 C-2011SM 4140 B-2011ASTM D516-07ASTM D4327-03ASTM D6508-00(05AOAC 925.54.3AOAC 993.303USGS I-4020-05Waters Corp Method D6508, Rev. 2.54 12-2000

If other, specify:

Chloride

Select test method:EPA 300.0, Rev 2.1 (1993)EPA 300.1-1, Rev 1.0 (1997)SM 4500-Cl-B-2011SM 4500-Cl-C-2011SM 4500-Cl-D-2011SM 4500-Cl-E-2011SM 4110 B-2011SM 4110 C-2011SM 4140 B-2011ASTM D512-04 (A)ASTM D512-04 (B)ASTM D512-04 (C)ASTM D4327-03ASTM D65-08-00(05)USGS I-1183-85USGS I-1184-85USGS I-1187-85USGS I-2187-85USGS I-2057-90AOAC 993.30AOAC 973.51Waters D6508, Rev. 2 12-2000

If other, specify:

Total Category 6 number of methods:

7. General III

Total organic carbon

Select test method:SM 5310 B-2011SM 5310 C-2011ASTM D7573-09ASTM D4839-03AOAC 973.47USGS, Book 5, Ch. A3, 1972 Rev. 1987, p. 14

If other, specify:

Total Category 7 number of methods:

8. Metals

AluminumAntimonyArsenicBariumBerylliumBoronCadmiumCalciumTotal ChromiumCobaltCopperIronLeadMagnesiumManganese,MolybdenumNickelPotassiumSeleniumSilverSodiumStrontiumThalliumTinVanadiumZinc

Select test method:EPA 200.5, Rev. 4.2 (2003)EPA 200.7, Rev. 4.4 (1994)EPA 200.8, Rev. 5.4 (1994)EPA 200.9, Rev. 2.2 (1994)SM 3111 B-2011SM 3111 D-2011SM 3111 E-2011SM 3113 B-2010SM 3120 B-2011SM 3125 B-2011ASTM D5673-05ASTM D4190-08USGS I-3051-85USGS I-4471-97AOAC 993.14Thermo Jarrell Ash Corp Method AES0029

If other, specify:

–Metals - Solids

AluminumAntimony ArsenicBariumBerylliumBoronCadmium Calcium Total ChromiumCobaltCopperIronLeadMagnesiumManganese,MolybdenumNickelPotassiumSeleniumSilverSodiumStrontiumThalliumTinVanadiumZinc

Select test method - Solids:EPA SW-846 6010DEPA SW-846 6020BEPA SW-846 7000BEPA SW-846 7010

If other, specify:

Hexavalent chromium

Select test method:EPA 218.6, Rev. 3.3 (1994)SM 3111 C-2011SM 3500-Cr B-2011SM 3500-Cr C-2011

If other, specify:

Mercury

Select test method:EPA 245.1, Rev. 3.0 (1994)EPA 245.2 (Issued 1974)EPA 245.7 Rev. 2.0 (2005)EPA 1631ESM 3112 B-2011ASTM D3223-02(07)AOAC 977.22USGS I-3462-85USGS I-4464-01

If other, specify:

Mercury - Solids

Select test method - Solids:EPA SW-846 7471B

If other, specify:

Total Category 8 number of methods:

(Note: hit tab to move to the next field for automatic calculations to work on Total category number of methods.)

Test category

Analytes in test category

Test method

Number of methods

9. Microbiology

E.coli, number per 100 mL

Select test method:SM 9223 B-2004SM 9223 B (Colilert)-2004SM 9223 B (Colilert-18)-2004SM 9221 B.1-2006SM 9221 F-2006

If other, specify:

Coliform (fecal) number per 100 mL or number per gram dry weight

Select test method:Colilert-18EPA/600/8-78/017 P.132 1978EPA/600/8-78/017 P.124 1978SM 9221 C E-2006SM 9222 D-2006USGS B-0050-85

If other, specify:

Coliform (fecal) number per 100 mL or number per gram dry weight - Solids

Select test method - Solids:EPA/600/8-78/017 P.124 1978EPA/600/8-78/017 P.132 1978EPA 1680EPA 1681SM 9221C E-2006SM 9222 D-2006

If other, specify:

Coliform (total), number per 100 mL

Select test method:EPA/600/8-78/017 p.108 1978EPA/600/8-78/017 p.111 1978EPA/600/8-78/017 p.114 1978SM 9221 B-2006SM 9222 B-2006USGS B-0025-85 1989

If other, specify:

Total Category 9 number of methods:

10. Organics; Purgeable by Gas Chromatography or Gas Chromatography/ Mass Spectrometry

Volatile organic compounds

Select test method:EPA 624.1EPA 1624B

If other, specify:

Total Category 10 number of methods:

11. Organics; Semivolatile by Gas Chromatography/Mass Spectrometry

Phenolic Compounds (acid-extractables) and base/neutral extractable compounds (excluding pesticides)

Select test method:EPA 625.11625B

If other, specify:

Total Category 11 number of methods:

12. Organics; Organochlorine Compounds

Polychlorinated biphenyls

Select test method:EPA 608.3

If other, specify:

Polychlorinated biphenyls - solids

Select test method solids:EPA SW-846 8082A

If other, specify:

Organochlorine pesticides

Select test method:EPA 608.3

If other, specify:

Total Category 12 number of methods:

(Need to manually add from categories above)Total number of methods:

Additional permit required testing(To add a new row, place cursor in last row of last column and hit tab)

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Laboratory

Accrediting body

Parameter

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Fee calculator

(Note: hit tab to move to the next field for automatic calculations to work on Total fee due.)

Application instructions

To complete your laboratory certification application, start by opening a copy of the application. We strongly suggest that you save a copy of the application to the computer before completing it, and save changes frequently while you are working. Be sure to save the document in a place where you will be able to find it later.

Certification year

Enter the certification year that is being applied for.(For example: The labs applying in November 2015 for the 2016 certification year would indicate 2016 in the field.)

Authorized representative section

The form must be signed by your authorized representative. This is the person at your facility responsible for submitting Discharge Monitoring Report data.

Laboratory certification test procedures section

If your method is not listed on the form, please be sure that your method is compliant with U.S. Environmental Protection Agency 40 CFR 136.3 and/or 503.8 lists of approved test procedures. If you have approval for a method not listed, please specify this in the “Other” field.

If you are uncertain of the year of approval for the method you are using from Standard Methods, please refer to the Introduction page of the method in Standard Methods to find the year of approval by the Standard Methods Committee.

New test methods can also be added to your certification at any point in the certification cycle.

Additional permit required testing section

Please fill in the name(s) of any laboratories used by your facility for compliance testing.This might include priority pollutants, biosolids, and acute toxicity. It may also include individual testing for ammonia or total phosphorus if not performed by your laboratory.

If you use multiple laboratories, fill in the requested information for the one used most often, and only list the names for labs that that are used occasionally.

Fee calculator section

If your laboratory has never had Minnesota Pollution Control Agency (MPCA) certification, or if MPCA certification has lapsed, select “initial” for the application type.

To complete the “Test category” section, refer to the Laboratory Certification Test Procedures section of the form. Select the box that corresponds to each test category for which your lab does testing. There is only one fee for each test category, regardless of the number of test procedures that are performed.

The form will calculate your estimated total amount due. No fee is due at this time. Invoices will be sent out in the early part of the next certification year.

Supporting documentation

If you are renewing your certification, and have revisions to your QAM or SOPs, please attach them to your application. Please also attach performance testresults if you have not already submitted them.

If you are applying for initial certification or certification for new test methods, please submit the following for each method:

• Standard operating procedure for the method
• Quality assurance manual
• Method detection limit study, if applicable
• Initial demonstration of capability, if applicable
• Passing results from a blind performance test

Submitting your application

After completing the application, save the completed form to your computer.

We prefer that you submit your application electronically as a MS Word document only (Save your file named: application year followed with lab name Lab Application. Example: 2017 St. Peter Lab Renewal Application.doc or docx) by attachment in an email to Jennifer Thoreson . Please address the subject line with the name of your facility name and Lab Application. For example: 2017 St. Peter Lab Application. If you do not have access to email, you may print the completed application and mail it to: Jennifer Thoreson, Minnesota Pollution Control Agency, 520 Lafayette Road North, St. Paul, MN 55155. You may also print your application and fax it to 651-296-8676.

Renewal applications (including forms and Quality Assurance/Quality Control documents) are due by November 30.

Initial applications may be submitted at any time.

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