MURPHY-BROWN LLC WATER QUALITY LABORATORY
“PROGRESS THROUGH KNOWLEDGE” / / WATER SAMPLE SUBMISSION FORM
Before collecting sample, see below
SAMPLING PROCEDURES andSAMPLE REJECTION PARAMETERS
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) / Telephone
580-349-1563 / Email
/ Certifications
EPA ID: OK01026
ODEQ ID: D9938
KDHE ID: E10394
TCEQ ID: T104704496-11-1
Fax
580-349-1567 / Website
Individual or Company name / Contact name / Alternate billing information
Mailing address
Telephone number / Fax number / Check prefer fax
for report and invoice / E-mail address / Check prefer email
for report and invoice / Check prefer regular mail
for report and invoice
Complete separate form for each sample location / Sample identification
Collection by (print name) / Signature / Date / Time
/ PWSID # / Water System Facility ID / Location Code / Chlorine (mg/L, indicate free or total)
Required if regulatory compliance sample
CONTAINER / PRESERVATION
(also see TEMPERATURE receipt conditions) / RECEIPT CONDITIONS AT LABORATORY / SPECIAL NOTE
CODE / TYPE / FILL INSTRUCTIONS / TIME / TEMPERATURE
A120 / Plastic
Wide-mouth
120 mL total volume
Sterile / MUST have liquid volume ≥100 mL bottle mark with some headspace (not liquid full) / NC / No added chemical preservation / 28H / 28 hours / NT / No special temperature conditions / #1 / PWS municipalities and distribution systems MUST provide Chlorine value taken at time of sample collection.
A150 / Plastic
Wide-mouth
150 mL total volume
Sterile / MUST have liquid volume ≥100 and ≤120 mL bottle marks / T / Sodium thiosulfate included in bottle to neutralize chlorine / 4H / 4 hours / 6C / ≤ 6°C / #2 / At receipt, pH MUST be ≤ 2.
P125 / Plastic
Narrow-mouth
125 mL / 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 MUSTbe maintained until sample receipt.
P250 / Plastic
Wide-mouth
250 mL / 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
P250A / Plastic
Wide-mouth
Amber
250 mL / 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.
PL / Plastic
Narrow-mouth
1 L / 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.
H / Glass vial
40 mL / MUST be liquid full. No headspace.
RAD / Plastic
1 gallon jug / Add sample liquid until almost full. NOT completely full.
During sampling, do not rinse out any preservative from the container. / Lab must receive sample before the maximum time shown above. / Avoid direct contact between sample containers and ice to minimize freezing breakage.
EXAMPLE SAMPLE COLLECTION CODE: / P250 / - / S / - / 28D / - / NT / - / #2
CONTAINER TYPE / PRESERVATION / RECEIPT TIME / RECEIPT
TEMPERATURE / SPECIAL
NOTE
SAMPLING PROCEDURES / SAMPLE REJECTION PARAMETERS
- See separate SAMPLING INSTRUCTIONS posted on our website.
- Note these items:
- Container code specific for each analyte or group type.
- Container liquid loading volume.
- Maximum time from sample collection to laboratory receipt.
- Temperature maximum at laboratory receipt.
- Complete Chain-of-Custody below.
- 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.
- Container not of proper type, not properly labeled and/or does not contain proper volume.
- Incorrect or nonexistent preservative, if required.
- For coliform testing, sample contains measureable Chlorine.
- 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
CONTROLLED DOCUMENT WHEN DATA ENTERED / QS.FORM.SAMPLE.GENERAL / Version: / 012 / Issued: / 21 Aug 2012 / Page 1 of 2
Additional notes / MARK REQUESTED
TESTS BELOW
(also indicate preservation or handling if other than code) / RECEIPT CONDITIONS / LIMS Sample #
Receipt Temp / Temp Adj / Actual Temp / pH / Chlorine
TEST / DESCRIPTION / SAMPLE COLLECTION CODE
(see page 1) /
“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
or
A150-T-28H-NT-#1
DRINKING WATER QUALITY / 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
IRRIGATION WATER QUALITY / 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
WATER WELL QUALITY / 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
VOLATILE ORGANIC COMPOUNDS / BTEX – Benzene, Toluene, Ethyl benzene, Xylenes – indication of gasoline contamination / H-V-14D-6C-#3
EPA 524 List – EPA Method 524 volatile compounds / H-V-14D-6C-#3
Regulated VOCs – Volatile organic compounds on EPA regulated contaminants list / H-V-14D-6C-#3
THMs – Trihalomethanes (4) – volatile, organic disinfection by-products / H-V-14D-6C-#3
VOC Scan – General scan of volatile compounds by GCMS / H-V-14D-6C-#3
Selected VOCs / H-V-14D-6C-#3
ALKALINITY / Alkalinity breakdown – Carbonate, Bicarbonate, Hydroxide and Total – to test corrosion potential / P250-NC-48H-10C-#3
Total Alkalinity / P250-NC-48H-10C-#3
ANIONS / Common Anions – Fluoride, Chloride, Bromide, Nitrate-N, Nitrite-N, 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 and HARDNESS / 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 / Residual – For disinfection / P250-NC-4H-10C-#3
Residual and Total – Additional charge beyond residual test / P250-NC-4H-10C-#3
CONDUCTIVITY / Electrical Conductivity – Indication of dissolved solids, corrosion potential / P250-NC-4H-10C-#3
Salinity (Ecw) / P250-NC-4H-10C-#3
LANGELIER SATURATION INDEX / NOTE:Requires water temperature measured at time of collection. / P250-NC-4H-10C-#3
P250-S-28D-NT-#2
METALS / Scan / PL-NC-14D-NT-#5
Mercury / Call lab
Selected Elements / PL-NC-14D-NT-#5
pH / pH – Acid-Base condition, corrosion potential / P250-NC-4H-10C-#3
pHc – Alkalinity, Cations, pH – theoretical pH of irrigation water in contact with lime and soil, acid-base condition / P250-NC-4H-10C-#3
P250-S-28D-NT-#2
RADIOCHEMICAL TESTING / Gross Alpha and Beta, Radium, and Uranium analyzed at subcontracted laboratory / RAD-NC-14D-NT
SODIUM ABSORPTION RATIO / SAR – traditional from Na, Ca, Mg – For evaluating irrigation waters for salting property, 3 calculations available / P250-S-28D-NT-#2
P250-NC-4H-10C-#3
SAR Adj – to include carbonate/bicarbonate contribution / 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
SOLIDS / 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
CONTROLLED DOCUMENT WHEN DATA ENTERED / QS.FORM.SAMPLE.GENERAL / Version: / 012 / Issued: / 21Aug 2012 / Page 2 of 2