PLEASE USE BLACK INK ONLY

INSTRUCTIONS FOR COMPLETING ANALYTICAL SERVICES REQUEST FORM

SAMPLE IDENTIFICATION (Mandatory)

NWIS Record No. - Record number of sample assigned by NWIS database (District)

User Code - Enter District user code (indicates which office sample data are to be directed)

Project Acct - Enter 9 digit account number

NWQL Laboratory ID - Leave blank (for Laboratory use only)

Station ID - Enter downstream order number, 15 digit latitude, longitude and sequence number or unique sample identifier

Begin Date (YYYYMMDD) - Enter 4 digit number for year, 2 digit number for month, 2 digit number for day sample collection started

Begin Time - Enter 4 digit military time sample collection started

Medium Code - Enter sample medium code (see attached table)

Sample Type - Enter sample type code (see attached table)

District Contact Phone Number - Enter complete phone number for District contact for sample questions or problems

End Date (YYYYMMDD) - Enter 4 digit number for year, 2 digit number for month, 2 digit number for day sample collection ended

End Time - Enter 4 digit military time sample collection ended

District Contact Email - Enter complete email address for District contact for sample questions or problems

SITE / SAMPLE / SPECIAL PROJECT INFORMATION (Optional)

State - Enter 2 digit FIPS code for State in which station is located

County - Enter 3 digit FIPS code for county in which station is located

Geologic Unit Code - Enter geologic unit code for ground-water sample (multiple aquifer identification)

*Analysis Status - Enter analysis status code (see attached table)

*Analysis Source - Enter analysis source code (see attached table)

*Hydrologic Condition - Enter hydrologic condition code (see attached table)

*Hydrologic Event - Enter hydrologic event code (see attached table)

Chain of Custody - Enter Y if sample is chain of custody

Sample Set - Enter identifier for sample set, and place on all bottles and associated log form, for example: "A", "BB" (max. 2)

NWQL Proposal Number - - Denotes non-routine or custom work assigned by NWQL in negotiated proposal

NWQL Contact Name - Enter name of NWQL person to be contacted when sample arrives at Lab

NWQL Contact Email - Enter email of NWQL person to be contacted when sample arrives at Lab

Program/Project - For example: NAWQA, NASQAN, NPDES, DW - if applicable

Station Name - Enter local station name

Field ID - Enter identification assigned by District

Comments to NWQL - Enter information about sample that NWQL should be aware of (high concentration, etc.)

Note: Samples collected for analysis by Geologic Division MUST have the latitude/longitude provided for login

Hazard - Describe any known hazard associated with sample (chemical, biological, radiological, etc.)

ANALYTICAL WORK REQUESTS: SCHEDULES AND LAB CODES

Schedule - Enter schedule number(s) for the desired analyses.

Lab Code - Enter lab code for analyses to be added or deleted. Circle "A" for addition or "D" for deletion. Maximum 15.

SHIPPING INFORMATION (Please fill in number of sample types sent)

NWQL Login Comments - NWQL login personnel comments.

Collected by: - Enter name of individual that collected/shipped samples

Phone No. - Enter phone number of individual that collected/shipped samples

Date Shipped - Enter date samples packed/shipped to NWQL.

FIELD VALUES

Lab/P Code/Value/Remark - Enter values and remarks for sc, pH, alk, if needed, enter P code, value, remark for other field values

Field Comments - For field use only. Will not be used by NWQL.

*Mandatory for storage in NWIS