U.S. GEOLOGICAL SURVEY -- NATIONAL WATER QUALITY LABORATORY

ANALYTICAL SERVICES REQUEST

# THIS SECTION MANDATORY FOR SAMPLE LOGIN

  ---------------- -- -- ------- -- -- -- -- -- --------- -- -- -- -- -- -- -- -- -- -- -----------------
  NWIS RECORD                                                                           LAB USE ONLY
  NUMBER                                                                                

                                                                                        

  SAMPLE TRACKING        User                   Project                                 NWQL LABORATORY
  ID                     Code                   Account                                 ID
  ---------------- -- -- ------- -- -- -- -- -- --------- -- -- -- -- -- -- -- -- -- -- -----------------

  ------------ --- --- --- --- --- --- --- --- --- --- --- --- --- --- -- ------------ ------------ ------- --- --- --- --- --- --- -- -- ------ ------- --- --- --- -- -- ------------ -------- -- -------- -------
                                                                                       **2**        **0**                                                                                                      

  STATION ID                                                              Begin Date                                                             Begin                                  Medium      Sample   
                                                                          (YYYYMMDD)                                                             Time                                   Code        Type     

                                                                                                                                                                                                             

                                                                                                                                                                                                             

  **District                                                                           End Date                                           End                              **District                        
  Contact                                                                              (YYYYMMDD)                                         Time                             Contact                           
  Phone                                                                                                                                                                    Email**                           
  Number**                                                                                                                                                                                                   
  ------------ --- --- --- --- --- --- --- --- --- --- --- --- --- --- -- ------------ ------------ ------- --- --- --- --- --- --- -- -- ------ ------- --- --- --- -- -- ------------ -------- -- -------- -------

**SITE / SAMPLE / SPECIAL PROJECT INFORMATION** (Optional)

<table style="width:100%;">
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</colgroup>
<tbody>
<tr class="odd">
<td>  </td>
<td></td>
<td>   </td>
<td></td>
<td>     </td>
<td></td>
<td> </td>
<td></td>
<td> </td>
<td></td>
<td> </td>
<td></td>
<td> </td>
<td></td>
<td> </td>
<td></td>
<td>Sample Set</td>
</tr>
<tr class="even">
<td>State</td>
<td></td>
<td>County</td>
<td></td>
<td><p>Geologic</p>
<p>Unit Code</p></td>
<td></td>
<td><p>Analysis</p>
<p>Status*</p></td>
<td></td>
<td>Analysis Source*</td>
<td></td>
<td>Hydrologic Condition*</td>
<td></td>
<td>Hydrologic Event*</td>
<td></td>
<td>Chain of Custody</td>
<td></td>
<td> </td>
</tr>
</tbody>
</table>

  ---------------- -- ---------------- -- ---------------- -- -----------------
                                                                   

  NWQL Proposal       NWQL Contact        NWQL Contact        Program/Project
  Number              Name                Email               
  ---------------- -- ---------------- -- ---------------- -- -----------------

  ------------- ----------- ----------- ----------- ------------------------------ ------- -------------------
  **Station                 **     **                                              Field   **     **
  Name:**                                                                          ID:     

  **Comments to                         **     **                                          
  NWQL:**                                                                                  

                **     **                                                                  

  **Hazard                                          **     **                              
  (please                                                                                  
  explain):**                                                                              
  ------------- ----------- ----------- ----------- ------------------------------ ------- -------------------

**ANALYTICAL WORK REQUESTS: SCHEDULES AND LAB CODES** (CIRCLE A=add
D=delete)

  ------- ------ -- ------- ------ -- ------- ------ -- ------- ------ -- ------- ------ -- ------- ------
  SCHED             SCHED             SCHED             SCHED             SCHED             SCHED       
  1:                2:                3:                4:                5:                6:      

  ------- ------ -- ------- ------ -- ------- ------ -- ------- ------ -- ------- ------ -- ------- ------

  ------- ------ --- --- ------- ------ --- --- ------- ------ --- --- ------- ------ --- --- ------- ------ --- ---
  Lab            A   D   Lab            A   D   Lab            A   D   Lab            A   D   Lab            A   D
  Code:                  Code:                  Code:                  Code:                  Code:              

  Lab            A   D   Lab            A   D   Lab            A   D   Lab            A   D   Lab            A   D
  Code:                  Code:                  Code:                  Code:                  Code:              

  Lab            A   D   Lab            A   D   Lab            A   D   Lab            A   D   Lab            A   D
  Code:                  Code:                  Code:                  Code:                  Code:              
  ------- ------ --- --- ------- ------ --- --- ------- ------ --- --- ------- ------ --- --- ------- ------ --- ---

**SHIPPING INFORMATION** (Please fill in number of containers sent)

  ---- ----- ---- ----- ---- ----- ---- ----- ---- ----- ---- ------ ---- ----- ---- ------- ---- ------ ---- -- -------
       ALF        COD        FA         FCN        IQE        IRM         RA         RU           SUR            TPCN

       BGC        CRB        FAM        FU         IQL        MBAS        RAM        RUR          SUSO           UAS

       C18        CU         FAR        FUS        IQM        OAG         RAR        RURCT        TBI            WCA

       CC         CUR        FCA        GCC        IRE        PHE         RCB        RURCV        TBY                 

       CHL        DOC        FCC        GCV        IRL        PIC         RCN        RUS          TOC                 
  ---- ----- ---- ----- ---- ----- ---- ----- ---- ----- ---- ------ ---- ----- ---- ------- ---- ------ ---- -- -------

  ----------- ------- ------------ ------- ------------------ ---------- ----------
  NWQL Login                                                             
  Comments:                                                              

                                                                         

  Collected                        Phone                      Date            
  by:                              No.                        Shipped:   
  ----------- ------- ------------ ------- ------------------ ---------- ----------

**FIELD VALUES**

  ------------- -------- -- -- ----------- ------- ------------ ----- -- -- ---------- ---- -------- -- -- ----------- ------- ------------ ----- -- -- ------------ ---- -------- -- -- ----------- ------------
  **Lab/P                      **Value**           **Remark**               **Lab/P                        **Value**           **Remark**               **Lab/P                          **Value**   **Remark**
  Code**                                                                    Code**                                                                      Code**                                       

  21/00095                                                                  51/00400                                                                    2/39086                                        

  Specific                                                                  pH                                                                          Alkalinity                                   
  Conductance                                                               Standard                                                                    -- IT mg/L                                   
  uS/cm @ 25                                                                Units                                                                       as CaCO3                                     
  deg C                                                                                                                                                                                              

                                                                                                                                                                                                     

                /                                                                           /                                                                             /                            

                                                                                                                                                                                                     
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  ------------- ------------------------------------------------------------
  **Field       
  Comments:**   

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\*MANDATORY FOR NWIS Form 9-3094

(August 2000)