/ Lab Registration Form
Environmental Data Quality Unit
NPDES Permit Program
Doc Type: Permitting Registration Form

MPCA use only

Permit Number
Date Received
(MM/DD/YYYY)

Instructions: The Minnesota Pollution Control Agency (MPCA) registration program applies to all Minnesota Municipal, Government or Industrial laboratories that perform analyses for National Pollutant Discharge Elimination System (NPDES) for permit compliance or water quality work.

Complete the form by typing or printing in black ink. Attach additional sheets as necessary. For more information, please contact Lab Registration Staff:

Sandy McDonald 651-757-2560 or Matt Lindon 651-757-2530

or e-mail:

Applications that are submitted without an authorized signaturewill be returned. Please make a copy for your records.

Send the completed form to:

Attn: Sandy McDonald

Minnesota Pollution Control Agency

520 Lafayette Road North

St. Paul, MN 55155-4194

Permittee Information

Permittee name: / Permit number: / MN
Mailing address:
City: / State: / Zip:
Telephone: / Fax: / E-mail:
Authorized agent: / Title:

Facility Information

Facility name:
Street address:
City/Township: / State: / Zip:
County:

Lab Contact Information

Contact name:
Mailing address:
City: / State: / Zip:
Telephone: / Fax: / E-mail:

Signature

By signing this registration form you are requesting acceptance to the MPCA’s laboratory registration program for 2013.

Printed name: / Title:
Current or previous owner
Authorized signature: / Date:

Analysis Registration Requests

Facility name:

For Inorganic Chemistry, Metals, and Microbiology, enter the method for which you are requesting registration next to the analyte.

For Semi-volatiles, Volatiles and PCB/Pesticides, check the method box if you are requesting registration.

For Biosolids, please write in the parameters and methods for which you are requesting registration.

Inorganic Chemistry

Analyte / Method
Acidity as CaCO3
Alkalinity as CaCo3
Ammonia as N
Biochemical oxygen demand (BOD)
Bromide
Carbonaceous BOD, CBOD
Chemical oxygen demand
Chloride
Chromium VI
Color
Cyanide – Available
Kjeldahl nitrogen – total, as N
Nitrate as N
Nitrate-nitrite as N
Nitrite as N
Oil and grease
Orthophosphate as P
Residue – filterable (TDS)
Residue – nonfilterable (TSS)
Residue – settleable
Residue – total
Residue – volatile
Sulfate
Sulfide
Total Cyanide
Total hardness as CaCO3
Total Organic Carbon
Total Phenolics
Total Phosphorus
Turbidity

Metals

Analyte / Method
Aluminum
Antimony
Arsenic
Barium
Beryllium
Boron
Cadmium
Calcium
Chromium VI
Cobalt
Copper
Iron
Lead
Magnesium
Manganese
Mercury
Molybdenum
Nickel
Potassium
Selenium
Silver
Sodium
Thallium
Tin
Total chromium
Total hardness as CaCO3
Vanadium
Zinc

Microbiology

Analyte / Method
Escherichia coli
Fecal coliforms
Fecal coliforms with chlorine present

Semi-Volatile Organic Compounds

Analyte / Method
Method 625

Volatile Organic Compounds

Analyte / Method
Method 624

PCB/Pesticides

Analyte / Method
Method 608

Biosolids

Analyte / Method

651-282-5332 or 800-657-3864•Available in alternative formats

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