TWISS ANALYTICAL LABORATORIES, INC
DRINKING WATER SAMPLE INFORMATION (WSI) FOR
ASBESTOS ANALYSIS
EPA 100.0 or 100.2
See Sampling Instructions on back of this page
1. System ID No:
2. System Name:
3. Group (Circle one)
A
5. Date Sampled:
4. Sample Location:
B
Private
6. DOH Source No:
S92
7. Sampled By:
Accredited Lab Sample No.
Date Received:
__ ___ ___ - ___ ___ ___ ___ ___
Date Analyzed:
8. Phone #:
Twiss Lab No.
Date Reported:
11. Sample Composition:
9. County: (circle one) Kitsap  Clallam 10. Sample Purpose:
Routine
Compliance
Single Source
King  Jefferson  Mason  Thurston
Confirmation
Blended
Pierce
Island 
Grays Harbor
Investigative
Composite
Other:
Other
Distribution
13. Send Report To: (Print Name, Address, Zip Code)
14. Phone No.:
12. Sample Type:
Treated
Untreated
(Raw)
Unknown
15. Fax No.:
16. Email:
17. Special Instructions or Comments:
DOH#
Analyte
0115
Asbestos
Results
Units
SRL
Trigger
MCL
MFL
0.2
---
7
MCL
exceeded?
Method /
Analyst Initials
Notes:
SRL (State Reporting Level): The minimum reporting level established by the Washington State Department of
Health (DOH).
Trigger Level: DOH drinking water response level. Systems with compounds detected at concentrations in excess
of this level may be required to take additional samples or monitor more frequently.
MCL (Maximum Contaminant Level): If the contaminant amount exceeds the MCL, please contact your regional
DOH office to determine follow-up actions.
ND (Not Detected): In the results column, indicates that this compound was analyzed for and not detected at a level
greater than or equal to the SRL.
<0.00X: The compound was not detected in the sample at or above the concentration indicated (usually the lab
method reporting limit).
---: No trigger value exists.
Sample Relinquished
By:
Date /Time:
Condition on Receipt:
Sample Received
By:
Date /Time:
Temperature On Receipt:
26276 Twelve Trees Lane, Suite C
D:\106737257.doc
Poulsbo, WA 98370
www.Twisslabs.com
Revised 031213
Tel (360) 779-5141
Fax (360) 779-5150
TWISS ANALYTICAL LABORATORIES, INC
Sampling Instructions for
Drinking Water Asbestos
To help us serve you better, the following guidelines should be followed before sending water samples to
our laboratory.


If you are testing to comply with State and Federal regulations for Public Water Systems, then
you must complete the attached Asbestos Test Panel form. The results of the test will he reported
to the State and Regional offices of the Department of Health.
If you are testing for your own information or concern, you only need to fill out your name,
address, phone number and purpose on the Asbestos Test Panel form. The results will be reported
only to you.
Introduction
You have received a sampling kit from Twiss Analytical which contains a l liter polyethylene container,
specific instructions dealing with issues of sampling for drinking waters suspected of containing asbestos,
and an Asbestos Test Panel form to fill out before sample delivery to the laboratory. The sample must be
returned to Twiss Analytical on Monday, Tuesday or Wednesday the same day as sampling,
before 2 PM or an additional processing charge will be assessed. (See Transportation of Samples)
Types of Samples
Water samples should be collected from the distribution system or, if required by the Health Dept, from
the source. If there is a potential for hazardous chemicals, radiological or biological agents in the
sample, you must warn us by indicating the suspected potential in the ‘Comments’ section at the bottom
of the form or by letter which accompanies the samples. In general, if it is a public drinking water, you do
not have to make any comments.
Collection of Samples

Allow the water to flow through the system until the temperature of the sampling water stabilizes.

Fill the container only to the 800 ml line on the bottle to leave enough airspace for agitation at
the laboratory during preparation. Cap the bottle.

Write the analysis requested, location, date and time of collection and sampler on the bottle label.
Use indelible ink. Place the bottle in a baggie with ice or in a cooler.
Transportation of Samples
Immediately deliver the sample(s) to Twiss Analytical with one Asbestos Test Panel form per
sample.
Samples must arrive at the laboratory on a Monday, Tuesday or Wednesday on the same day
as collection, by 2 PM so that they can be processed by the contract laboratory in Seattle within
the 48 hour holding time.
Samples arriving past the 2 PM time or on a Thursday or Friday will be prepared using UV/ozone to
destroy organics and will incur an additional charge. If you do not want to pay the additional fee, the
sample must be retaken.
26276 Twelve Trees Lane, Suite C
D:\106737257.doc
Poulsbo, WA 98370
www.Twisslabs.com
Revised 031213
Tel (360) 779-5141
Fax (360) 779-5150