Water Pollution (WP) Series Organic Data Return Form
Please fill in your information below:
Name: asi Client Code:
Company: US EPA ID #:
Address: DMRQA Permittee #:
City: State: Zip: Phone #:
email: Fax #:
Study #: asi Order #:
Now please fill in the </>, Reporting Value and Method Description for each parameter that you wish to report on. All values reported should be in the units provided in the units column.
Please enter the Pesticides I sample lot number to the right
asi Lot #:
Pesticides I
EPA Analyte #
</>
Reporting Value
Units
Method Description
Aldrin
0047
ug/L
alpha-BHC
0079
ug/L
beta-BHC
0080
ug/L
delta-BHC
0081
ug/L
gamma-BHC [Lindane]
0082
ug/L
4,4'-DDD
0049
ug/L
4,4'-DDE
0050
ug/L
4,4'-DDT
0051
ug/L
Dieldrin
0048
ug/L
Endosulfan I
0083
ug/L
Endosulfan II
0084
ug/L
Endosulfan sulfate
0085
ug/L
Endrin
0086
ug/L
Endrin aldehyde
0087
ug/L
Heptachlor
0052
ug/L
Heptachlor epoxide (beta)
0078
ug/L
Methoxychlor
0234
ug/L
Please enter the Pesticides II sample lot number to the right
asi Lot #:
Pesticides II
EPA Analyte #
</>
Reporting Value
Units
Method Description
Chlordane (total)
0053
ug/L
Please enter the Pesticides III sample lot number to the right
asi Lot #:
Pesticides III
EPA Analyte #
</>
Reporting Value
Units
Method Description
Toxaphene
0241
ug/L
Please enter the PCB's in water sample lot number to the right
asi Lot #:
PCB's in water
EPA Analyte #
</>
Reporting Value
Units
Method Description
Aroclor 1016
0040
ug/L
Aroclor 1221
0041
ug/L
Aroclor 1232
0042
ug/L
Aroclor 1242
0040
ug/L
Aroclor 1248
0044
ug/L
Aroclor 1254
0045
ug/L
Aroclor 1260
0046
ug/L
Please enter the PCB's in oil sample lot number to the right
asi Lot #:
PCB's in oil
EPA Analyte #
</>
Reporting Value
Units
Method Description
Aroclor 1016
0099
mg/Kg
Aroclor 1242
0099
mg/Kg
Aroclor 1254
0100
mg/Kg
Aroclor 1260
0101
mg/Kg
Please enter the Herbicides sample lot number to the right
asi Lot #:
Herbicides
EPA Analyte #
</>
Reporting Value
Units
Method Description
2,4-D
0257
ug/L
Dicamba
0258
ug/L
2,4,5-T
0140
ug/L
2,4,5-TP [Silvex]
0259
ug/L
Please enter the Volatiles sample lot number to the right
asi Lot #:
Volatiles
EPA Analyte #
</>
Reporting Value
Units
Method Description
Benzene
0065
ug/L
Bromodichloromethane
0060
ug/L
Bromoform
0062
ug/L
Bromomethane
0243
ug/L
Carbon tetrachloride
0058
ug/L
Chlorobenzene
0064
ug/L
Chloroethane
0244
ug/L
Chloroform
0055
ug/L
Chloromethane
0245
ug/L
Dibromochloromethane
0061
ug/L
1,2-Dichlorobenzene
0094
ug/L
1,3-Dichlorobenzene
0096
ug/L
1,4-Dichlorobenzene
0095
ug/L
1,2-Dichloroethane
0054
ug/L
1,1-Dichloroethene
0246
ug/L
trans-1,2-Dichloroethene
0247
ug/L
1,2-Dichloropropane
0248
ug/L
trans-1,3-Dichloropropene
0249
ug/L
Ethylbenzene
0066
ug/L
Methylene chloride
0063
ug/L
1,1,2,2-Tetrachloroethane
00250
ug/L
Tetrachloroethene
0059
ug/L
Toluene
0067
ug/L
1,1,1-Trichloroethane
0056
ug/L
1,1,2-Trichloroethane
0251
ug/L
Trichloroethene
0057
ug/L
Trichlorofluoromethane
0252
ug/L
Vinyl chloride
0253
ug/L
Xylenes, total
0242
ug/L
Please enter the Semivolatiles sample lot number to the right
asi Lot #:
Semivolatiles (BNA's)
EPA Analyte #
</>
Reporting Value
Units
Method Description
Acenaphthene
0189
ug/L
Acenaphthylene
0190
ug/L
Anthracene
0192
ug/L
Benzidine
0176
ug/L
Benzo(a)anthrecene
0177
ug/L
Benzo butyl phthalate
0254
ug/L
Benzo(b)fluoranthene
0178
ug/L
Benzo(k)fluoranthene
0179
ug/L
Benzo(g,h,i)perylene
0180
ug/L
Benzo(a)pyrene
0255
ug/L
4-Bromophenyl-phenylether
0198
ug/L
bis(2-Chloroethoxy)methane
0195
ug/L
bis(2-Chloroethyl)ether
0196
ug/L
bis(2-Chloroisopropyl)ether
0197
ug/L
bis(2-ethylhexyl)phthalate
0256
ug/L
4-Chloro-3-methylphenol
0161
ug/L
2-Chlorophenol
0162
ug/L
4-Chlorophenyl-phenylether
0204
ug/L
2-Chloronaphthalene
0203
ug/L
Chrysene
0181
ug/L
Dibenzo(a,h)anthracene
0182
ug/L
3,3'-Dichlorobenzidine
0185
ug/L
2,4-Dichlorophenol
0163
ug/L
Diethyl phthalate
0208
ug/L
2,4-Dimethylphenol
0165
ug/L
Dimethyl phthalate
0209
ug/L
Di-n-butylphthalate
0205
ug/L
2,4-Dinitrophenol
0167
ug/L
2,4-Dinitrotoluene
0186
ug/L
2,6-Dinitrotoluene
0210
ug/L
Di-n-octylphthalate
0211
ug/L
Fluoranthene
0212
ug/L
Fluorene
0213
ug/L
Hexachlorobenzene
0214
ug/L
Hexachlorobutadiene
0215
ug/L
Hexachlorocyclopentadiene
0216
ug/L
Hexachloroethane
0217
ug/L
Indeno(1,2,3-cd)pyrene
0218
ug/L
Isophorone
0219
ug/L
2-Methyl-4,6-Dinitrophenol
0168
ug/L
Naphthylene
0222
ug/L
Nitrobenzene
0226
ug/L
2-Nitrophenol
0171
ug/L
4-Nitrophenol
0173
ug/L
N-Nitrosodimethylamine
0227
ug/L
N-Nitroso-di-n-propylamine
0230
ug/L
N-Nitrosodiphenylamine
0229
ug/L
Pentachlorophenol
0158
ug/L
Phenanthrene
0231
ug/L
Phenol
0174
ug/L
Pyrene
0187
ug/L
1,2,4-Trichlorobenzene
0092
ug/L
2,4,5-Trichlorophenol
0175
ug/L
2,4,6-Trichlorophenol
0159
ug/L
Additional comments: