Lab Use Only:
North Carolina Division of Water Resources Central Laboratory (Water Sciences Section)
Water Sample Collection & Submittal Form
Location Description:
Visit ID: (optional)
Lab Use Only:
Tag ID
Laboratory Sample Number:
Location Code:
Date Received:
County:
Collector:
DWR Region:
DWR Office:
(based on county)
(or agency name)
River Basin:
Time:
Chlorinated
Sampling Method:
De-chlorinated in Field Dissolved analysis: Enter "DIS" in check-boxes for parameters
Water Matrix: Surface
Lake Canal
Compliance
Ground
Monitoring Well
Water Supply
COC
Waste
Effluent
Influent
Routine
Grab
Composite
Other:
Sample Depth:
Location Type: River/Stream Estuary Stormwater
Ambient
Date:
Notes:
Filtered in Field
Priority:
Emergency
Blank
QA
Solution
Field Blank Filter Blank
Trip Blank
Other:
Time Received: Received By:
Delivery Method:
State Courier Hand Delivery Other:
Temperature ( °C) on Arrival :
Collector's Comments: Microbiology Parameters: Acidity, as CaCO3, to pH 4.5/8.3 Alkalinity, as CaCO3, to pH 4.5/8.3 BOD: Biochemical Oxygen Demand, 5-day cBOD: Carbonaceous BOD, 5-day Coliform: Fecal MF Coliform: Total MF Coliform: Tube Fecal Coliform: Tube Total Specific Conductance, at 25 oC TOC - Total Organic Carbon Turbidity Wet Chemistry Parameters: Bromide Chloride Fluoride Sulfate Chlorophyll a Color: ADMI Color: Platinum Cobalt COD: Chemical Oxygen Demand Cyanide, Total Formaldehyde Hexavalent Chromium (Cr6+)
mg/L mg/L mg/L mg/L /100ml /100ml /100ml /100ml umhos/cm
mg/L NTU
mg/L mg/L mg/L mg/L µg/L c.u. c.u. mg/L mg/L mg/L mg/L
MBAS (surfactants) Oil and Grease, HEM, Total Recoverable Phenols, Total Recoverable Residue: Total (Total Solids ) Residue: Volatile/Fixed, Total Residue: Suspended (Suspended Solids ) Residue: Volatile/Fixed, Suspended TDS - Total Dissolved Solids Silica Sulfide Tannin & Lignin Other Parameters: pH Hardness, Total as CaCO3 - by titration
Nutrients Parameters: Ammonia as N (NH3-N) Nitrate-Nitrite as N (NO3+NO2-N) Total Kjeldahl Nitrogen as N (TKN) Total Phosphorus as P (TP) Nitrite as N (NO2-N) Nitrate as N (NO3-N calculated) Orthophosphate as P (PO4)
mg/L mg/L µg/L mg/L mg/L mg/L mg/L mg/L mg/L mg/L mg/L
s.u. mg/L
mg/L mg/L mg/L mg/L mg/L mg/L mg/L
Metals Parameters: Aluminum (Al) Antimony (Sb) Arsenic (As) Barium (Ba) Beryllium (Be) Cadmium (Cd) Calcium (Ca) Chromium (Cr), Total Cobalt (Co) Copper (Cu) Iron (Fe) Lead (Pb) Lithium (Li) Magnesium (Mg) Manganese (Mn) Mercury (Hg) Molybdenum (Mo) Nickel (Ni) Potassium (K) Selenium (Se) Silver (Ag) Sodium (Na) Strontium (Sr) Thallium (Tl)
µg/L µg/L µg/L µg/L µg/L µg/L mg/L µg/L µg/L µg/L µg/L µg/L µg/L mg/L µg/L µg/L µg/L µg/L mg/L µg/L µg/L mg/L µg/L µg/L
Tin (Sn) Titanium (Ti) Vanadium (V) Zinc (Zn)
µg/L µg/L µg/L µg/L
Boron (B), Total Mercury 1631, low-level
µg/L ng/L
Organics Parameters: Acid Herbicides Organochlorine Pesticides Organonitrogen Pesticides Organophosphorus Pesticides PCBs (polychlorinated biphenyls) Semi-Volatile Organics (BNAs) TPH Diesel Range Volatile Organics (VOA) TPH Gasoline Range Biological: Phytoplankton / Algae
LAB COMMENTS : Field Parameters(optional) : Revision: 2/06/2015
Water Temp (oC):
pH (s.u.):
Dissolved Oxygen (ppm):
Conductivity (µmhos/cm):
Salinity (ppt):
Water Sample Collection & Submittal Form
Location Description:
Visit ID: (optional)
Lab Use Only:
Tag ID
Laboratory Sample Number:
Location Code:
Date Received:
County:
Collector:
DWR Region:
DWR Office:
(based on county)
(or agency name)
River Basin:
Time:
Chlorinated
Sampling Method:
De-chlorinated in Field Dissolved analysis: Enter "DIS" in check-boxes for parameters
Water Matrix: Surface
Lake Canal
Compliance
Ground
Monitoring Well
Water Supply
COC
Waste
Effluent
Influent
Routine
Grab
Composite
Other:
Sample Depth:
Location Type: River/Stream Estuary Stormwater
Ambient
Date:
Notes:
Filtered in Field
Priority:
Emergency
Blank
QA
Solution
Field Blank Filter Blank
Trip Blank
Other:
Time Received: Received By:
Delivery Method:
State Courier Hand Delivery Other:
Temperature ( °C) on Arrival :
Collector's Comments: Microbiology Parameters: Acidity, as CaCO3, to pH 4.5/8.3 Alkalinity, as CaCO3, to pH 4.5/8.3 BOD: Biochemical Oxygen Demand, 5-day cBOD: Carbonaceous BOD, 5-day Coliform: Fecal MF Coliform: Total MF Coliform: Tube Fecal Coliform: Tube Total Specific Conductance, at 25 oC TOC - Total Organic Carbon Turbidity Wet Chemistry Parameters: Bromide Chloride Fluoride Sulfate Chlorophyll a Color: ADMI Color: Platinum Cobalt COD: Chemical Oxygen Demand Cyanide, Total Formaldehyde Hexavalent Chromium (Cr6+)
mg/L mg/L mg/L mg/L /100ml /100ml /100ml /100ml umhos/cm
mg/L NTU
mg/L mg/L mg/L mg/L µg/L c.u. c.u. mg/L mg/L mg/L mg/L
MBAS (surfactants) Oil and Grease, HEM, Total Recoverable Phenols, Total Recoverable Residue: Total (Total Solids ) Residue: Volatile/Fixed, Total Residue: Suspended (Suspended Solids ) Residue: Volatile/Fixed, Suspended TDS - Total Dissolved Solids Silica Sulfide Tannin & Lignin Other Parameters: pH Hardness, Total as CaCO3 - by titration
Nutrients Parameters: Ammonia as N (NH3-N) Nitrate-Nitrite as N (NO3+NO2-N) Total Kjeldahl Nitrogen as N (TKN) Total Phosphorus as P (TP) Nitrite as N (NO2-N) Nitrate as N (NO3-N calculated) Orthophosphate as P (PO4)
mg/L mg/L µg/L mg/L mg/L mg/L mg/L mg/L mg/L mg/L mg/L
s.u. mg/L
mg/L mg/L mg/L mg/L mg/L mg/L mg/L
Metals Parameters: Aluminum (Al) Antimony (Sb) Arsenic (As) Barium (Ba) Beryllium (Be) Cadmium (Cd) Calcium (Ca) Chromium (Cr), Total Cobalt (Co) Copper (Cu) Iron (Fe) Lead (Pb) Lithium (Li) Magnesium (Mg) Manganese (Mn) Mercury (Hg) Molybdenum (Mo) Nickel (Ni) Potassium (K) Selenium (Se) Silver (Ag) Sodium (Na) Strontium (Sr) Thallium (Tl)
µg/L µg/L µg/L µg/L µg/L µg/L mg/L µg/L µg/L µg/L µg/L µg/L µg/L mg/L µg/L µg/L µg/L µg/L mg/L µg/L µg/L mg/L µg/L µg/L
Tin (Sn) Titanium (Ti) Vanadium (V) Zinc (Zn)
µg/L µg/L µg/L µg/L
Boron (B), Total Mercury 1631, low-level
µg/L ng/L
Organics Parameters: Acid Herbicides Organochlorine Pesticides Organonitrogen Pesticides Organophosphorus Pesticides PCBs (polychlorinated biphenyls) Semi-Volatile Organics (BNAs) TPH Diesel Range Volatile Organics (VOA) TPH Gasoline Range Biological: Phytoplankton / Algae
LAB COMMENTS : Field Parameters(optional) : Revision: 2/06/2015
Water Temp (oC):
pH (s.u.):
Dissolved Oxygen (ppm):
Conductivity (µmhos/cm):
Salinity (ppt):
