Lab Use Only:
North Carolina Division of Water Resources Asheville 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 Other:
Trip Blank
Time Received: Received By:
Delivery Method:
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 Turbidity
mg/L mg/L mg/L mg/L /100ml /100ml /100ml /100ml
Solids Parameters: Residue: Total (Total Solids ) Residue: Volatile/Fixed, Total Residue: Suspended (Suspended Solids ) Residue: Volatile/Fixed, Suspended TDS - Total Dissolved Solids
mg/L mg/L mg/L mg/L mg/L
umhos/cm
NTU Other Parameters: pH
s.u.
LAB COMMENTS : Field Parameters(optional) : Revision: 2/06/2015
Water Temp (oC):
pH (s.u.):
Dissolved Oxygen (ppm):
Conductivity (µmhos/cm):
Salinity (ppt):
State Courier Hand Delivery Other:
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 Other:
Trip Blank
Time Received: Received By:
Delivery Method:
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 Turbidity
mg/L mg/L mg/L mg/L /100ml /100ml /100ml /100ml
Solids Parameters: Residue: Total (Total Solids ) Residue: Volatile/Fixed, Total Residue: Suspended (Suspended Solids ) Residue: Volatile/Fixed, Suspended TDS - Total Dissolved Solids
mg/L mg/L mg/L mg/L mg/L
umhos/cm
NTU Other Parameters: pH
s.u.
LAB COMMENTS : Field Parameters(optional) : Revision: 2/06/2015
Water Temp (oC):
pH (s.u.):
Dissolved Oxygen (ppm):
Conductivity (µmhos/cm):
Salinity (ppt):
State Courier Hand Delivery Other:
