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