STAPLE
HERE
OMB#2080-0021
(Exp. 10/2000)
Pagel of 8
WATER SUPPLY LABORATORY PERFORMANCE EVALUATION STUDY
U.S. ENVIRONMENTAL PROTECTION AGENCY
STUDY NO. WS040
Pre-Printed Label Goes Here
SEND COMPLETED ORIGINAL TO;
Ms Natalie Murff
USEPA, NERL, EERD, NWQAPB
26 West M.L. King Drive, Room 525
Cincinnati, OH 45268
MS MURFF MUST RECEIVE YOUR COMPLETED FORM BY 2/9798 FOR IT TO BE GUARANTEED
OFFICIAL EVALUATION.
RETURN ONLY THIS ORIGINAL FORM TO MS MURFF. DO NOT SEND PHOTO COPIES. HOWEVER,
YOU SHOULD KEEP A PHOTO COPY FOR YOUR OWN RECORDS.
FACSIMILE COPIES OR "SUBSTITUTE" REPORT FORMS WELL NOT BE ACCEPTED.
IT IS YOUR RESPONSD3ILITY TO CONTACT YOUR STATE OR REGIONAL COORDINATOR TO SEE
IF THEY REQUIRE A PHOTO COPY OF YOUR FORM FOR THEBR FILES.
REPORT APPROVED BY:
NAME (Print)
TITLE
TELEPHONE
SIGNATURE
DATE
This report is authorized by law (Public Laws 93-523 and 99-339). Successful annual participation in a water supply study or its equivalent is
mandatory for every analyte or analyte group for which a drinking water laboratory is certified to conduct official analyses.
Paperwork Reduction Act Notice
Public reporting burden for this collection of information is estimated to average 7.87 hours per respondent. The estimate is based on analysis for an average
of thirty-three analytes per respondent. The estimate includes time for reading instructions, preparation of the performance samples, analyses, gathering
and reporting of the information. Send comments regarding the burden estimate or any other, aspect of this collection of information, including suggestions
for reducing this burden, to Director, OPPE Regulatory Information Division, U.S. Environmental Protection Agency (2137), 401 M. Street, SW, Washington,
DC 20460. Include the OMB control number (2080-0021) in any correspondence.
EPA-359 (Cin) Rev. 10-97. Previous editions are obsolete.
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Page 2 of8
CHEMISTRY DATA
."•'•.. Study Number . . ;."' . r .',• • : f; . ;
W j S j 0 | 4 j 0
Analyte Name
'^/••^•"••^EPALab'l.D.
i i ~i
i i
i i
Analyte
Number
i ! !
i i i
Sample #
Results
MC
I! Quantity
• ;•',,. • ' ; -V >":, -/,.. • - >•' .-;: 'A •••' '. ;^ • .;-.' ;.:'-.'. . j: :iv • ! :.." \^\~ ^-i^THACJEMETAi^^ '-K^^V :! ! ^-:^-^k^ ii i ^.; ;.:,';' • • i: ; •: :: ^-.' ••;',<'
Antimony
Arsenic
Barium
Beryllium
Boron
Cadmium
Chromium
Copper
Lead
Manganese
Mercury
Molybdenum
Nickel
Selenium
Thallium
Zinc
1 ! 4 0
0 j 0 1
1 —
0 j 0 2
1 j 4 1
2 j 2 6
1
0 j 0 3
0 j 0 4
1
0 j 9 1
0 j 0 5
2 j 3 6
0 ! 0 6
2 j 3 7
1 j 4 2
0 j 0 7
— i ^ —
1 | 4 3
2 j 3 9
1
1
1
1
2
1
1
1
1
2
1
2
1
1
1
2
•i ••
i
•
i
1
i
>
i
i
1 1 1 1
i
— i — i — i — i —
— i — i —
i
— i — i — i — i —
i
— i — i — i — i —
— i — i —
i
i
i
— — i — i — i — i —
i
— i — i —
i
i
— i — i — i — i —
i
..... ..( — ( — i —
i
— i — i — i — i —
— i — i — i — i —
i
i
— i — i — i — i —
i
i i
i i
!
i
i
^g/L
Mg/L
A "V •" *• * •=• •* -^fj fm ., t i jFfi — r _, rf ^ i f ffif'Z, B. , •*• £.
- •• ^ ,- .- NITRATE & NITRITE & FLUORIDE &ORTHOPHOSPHATE — « ,« '" "r
Nitrate as N
Nitrite as N
Fluoride
Orthophosphate as P
0 j 0 9
0 i 9 2
0 j 1 0
2 j 6 1
1
1
1
1
•
•
•
i i i
i i i i
i 1 1 1
i i
i i
i i i
— i 1 1 1
i i
j
i
mg/L
mg/L
mg/L
mg/L
EPA-359 (Cin) Rev. 10-97. Previous editions are obsolete. (Note: The Data Report Form is continued on the next page.)
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Page 3 of8
CHEMISTRY DATA
'Study Number
W j S | 0 j 4 0
Analyte Name
EFALabLD.
i
Analyte
Number
Alachlor
Aldrin
Atrazine
Total Chlordane
Dieldrin.
Endrin
Heptachlor
Heptachlor Epoxide
Hexachlorobenzene
Hexachlorocyclopentadiene
Lindane
Methoxychlor
Propachlor
Simazine
Toxaphene
Trifluralin
0
2
0
0
2
0
0
'0
1
1
0
0
2
1
0
2
9
5
9
9
5
1
9
9
7
.
1
1
1
5
1
1
4,
i 1 1
i i i
i i i
i i i
Sample #
-
•-
MC
PESTICIDES
3
6
4
7
8
1
5
6
.2
2
2
3
9
3
4.
4
4
1
4
3
1
1
1
1
1
1
1
1
1
4
2
1
Results
s
-
Quantity
"* ""
,
1
- ,
* >• s-
• • .,; . • ,,,;r^> . ^^f^.^^ '^ci&S^^^Vja&AtE^ ? 5%^;'
Aldicarb
Aldicarb Sulfone
Aldicarb Sulfoxide
Carbofuran
Methomyl
Oxamyl (Vydate)
0
0
1
1
2
1
9 !
9
0
o I
4 !
1 i
8
9
0
1
5
4
1
1
1
1
1
1
i,ft,c' -,"'f7f
IS-'K-
<"g/L
A/g/L
yWg/L
Aig/L
Aig/L
Mg/L
Atg/L
Aig/L
A-fg/L
A^g/L
A^g/L
,"g/L
A^g/L
Aig/L
yUg/L
yUg/L
tar^^k
i 1 1 1
i
i
i
i
i
|
Aig/L
Aig/L
A^g/L
yUg/L
A^g/L
W?/L
EPA-359 (Cin) Rev. 10-97. Previous editions are obsolete. (Note: The Data Report Form is continued on the next page.)
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CHEMISTRY DATA
Page 4 of8
• .':;' ;';;'-•;'_ Study Number .'•'•"">••:-'-':
W j S j 0 i 4 | 0
Analyte Name
^ffi&^zbU).
1
1
Analyte
Name
1 1 1
I i i
Sample #
Results
MC
Quantity
^HERBICIDES , ' , ^ J ', " ' I ,• •- ^ V"1
2,4-D
2,4,5-TP (Silvex)
Acifluorfen
Dalapon
Dicamba
Dinoseb
Pentachlorophenol
Picloram
0
0
2
1
2
1
1
1
"•* = 4- l »r * 1 '
1
Benzo (A) Pyrene
1
i " r
Di (2-Ethylhexyl) Adipate
Di (2-Ethylhexyl) Phthalate
1
1
r ~
Diquat
Endothall
Glyphosate
1
1
1
! i
i
6
1
4
1
0
1
T
1
2
-
3
3
"•
3
3
3
J
5
6
2
5
7
6
2
7
1
1
1
1
1
1
1
1
i
i
i
I
j
j
i i i i
i i i i
i i i i
i i i i
i i i i
i i i i
i i i i
1111
i i i i
|
i i i i
i i i i
i i i i
(
i i i
Aig/L
A^g/L
Aig/L
/^g/L
Mg/L
Aig^L
Mg^L
Aig^
„! " PCB'S ^- '„ -{_:!•">„,,_ ~ ^f* '^.N^V'^Y'^C^V**^?^
8
1
Bi i i i II ...
! ! ^g/L
! ! II
— PAH \>: ^ fl $;* ' :'H\^.C"^
2| 1
' i i II /T
t i ! i I VS/L
AUrDPATE & PHTHAXrATE M - ' ^ , 1 1 ' I J^/ J , >44|S%1 ^
4
6
1
1
\
11*1
y"g^
Aig/L
MtSCELlANEOUS SOC^ v , '%,/'" , ^ 'ft^^'f f ^P ^
7
8
9
1
1
1
i
.
i
t I I
I i I
I I I I
Aig/L
A^g/L
Aig/L
-- - , ^VASCTRlHALdMETifVNES ^ ^^SV!'^M?C^;£
Bromodichloromethane
Bromofonn
Chlorodibromomethane
Chloroform
Total Trihalomethanes
0
0
0
0
0
1
1
2
1 .
2
9
8
o
7
1
1
1
1
1
1
4
I
I i
i
! \
VSfL .
Aig/L
Atg/L
^
fj.g/L
EPA-359 (Cin) Rev. 10-97. Previous editions are obsolete. (Note: The Data Report I^orm is continued on the next page.)
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CHEMISTRY DATA
Page 5 of8
Study Number
W | S | 0 j 4 | 0
Analyte Name
EPALabLD.
r
1
i i : i i
i : : : ;
Analyte
Number
Sample #
1
Results
MC
Quantity
AS REGULATED VOC's
- ••' f * ,_.-.
Benzene
Carbon Tetrachloride
Chlorobenzene
1 ,2-Dibromo-3-Chloropropane
(DBCP) By Method 504
1 ,2-Dichlorobenzene
1 ,4-Dichlorobenzene
1 ,2-Dichloroethane
1 , 1-Dichloroethylene
Cis- 1 ,2-Dichloroethylene
Trans- 1 ,2-Dichloroethylene
Dichloromethane
1 ,2-Dichloropropane
Ethylbenzene
Ethylene Dibromide (EDB)
By Method 504
Styrene
Tetrachloroethylene
Toluene
1,1,1 -Trichloroethane
1 , 1 ,2-Trichloroethane
Trichloroethylene
1 ,2,4-Trichlorobenzene
Vinyl Chloride
Total Xylenes
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
3
3
4
4
5
4
3
3
4
4
5
4
4
4
5
4
4
3
6
3
7
3
9 i
9
7
9
'5
4
I
5
4
3
2
h
4
8
6
3
0
7
6
1
8
6
2
0 .
1
1
1
3
1
1
1
1
1
1
1
1
1
3
1
1
1
1
1
1
1
1
1
i
i
i
i
j
i
i
i
i
j
j
i
i
i
j
i
i
i
i
i
i
i
i
i
Aig/L
Aig/L
Aig/L
A£g/L
Aig/L
Aig/L
Aig/L
Aig/L
Aig/L
Aig/L
Aig/L
Mg/L
Aig/L
Aig/L
•
Aig/L
Aig/L
A^g/L
Aig/L •
Aig/L
Aig/L
Aig/L
Aig/L
EPA-359 (Cin) Rev. 10-97. Previous editions are obsolete. (Note: The Data Report Form is continued on the next page.)
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Page 6 of 8
CHEMISTRY DATA
• v. .:'.. ..; ! '; ' •.;.:'' Study:Number
W \ S
0 ; 4 ; 0
Analyte Name
EFALabLD.
i i ""i
i i
i
Analyte
Number
i • "—i i
! ! i
Sample #
, Results ,
MC 1
Quantity
' ;l :.-':• V. •':-"• :.:>•. '-'• : "•-.• -. .-;:*:. -iK ' ^ : ••:••: V :-"%• :^St|N^OtjiMEiX V^^ £>>.;•• ;-•,{:•= ,"4/:; ' :• • •;:.,;;• v'-lC ?.'*• -^
Bromobenzene
Bromochloromethane
Bromodichloromethane
Bromoform
Bromomethane
n-Butylbenzene
Sec-Butylbenzene
Tert-Butylbenzene
Chlorodibromomethane
Chloroethane
Chloroform
Chloromethane
2-Chlorotoluene
4-Chlorotoluene
Dibromomethane
1 ,3-Dichlorobenzene
Dichlorodifluoromethane
1 , 1 -Dichloroethane
1 ,3-Dichloropropane
2,2-Dichloropropane
1 , 1 -Dichloropropene
Cis- 1 ,3-Dichloropropene
Trans- 1 ,3 -Dichloropropene
Fluorotrichloromethane
Hexachlprobutadiene
Isopropylbenzene
0
0
1
0
0
0
0
0
1
0
1
0
0
0
0
0
0
0
0
0
0
1
1
0
0
~0~
6
8
0
6
6
7
8
8
0
7
1
6
7
7
5
6
8
5
5
6
5
5
5
8
8
7
9
8
2
9
9
6
5
9
0
0
8
1
2
7
6
8
6
9
0
8
2
3
7
1
i
8 4
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
,,.,..
l i
l 1
i i
I i
1 1
1 1
l 1
i 1
i 1
i 1
l 1
I 1
l i
i 1
1 1
i 1
1 1
i 1
i
^g/L
Aig/L
/zg/L
Aig/L
Atg/L
Vg/L
Vg/L
Mg/L
yUg/L
jUg/L
HgfL
Vg/L
f^g/L
VgfL
VgfL
VgfL
yUg/L
yUg/L
/wg/L
f^g/L
Mg/L
A*g/L
Hg/L
/"g/L
VgfL
yUg/L
EPA-359 (Cin) Rev. 10-97. Previous editions are obsolete. (Note: The Data Report Form is continued on the next page.)
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Page 7 of8
CHEMISTRY
. . Study Number
W | S | 0 j 4 j 0
Analyte Name
EPA Lab LD.
! i
Analyte
Number
i i i
i i i
i i i
Sample #
Results
HMC
Quantity
•"'••.-:i,.. ':,-.': ';•> ;/.'• '-.'...- . :.;;:./ ,':;.';\7'^.:'.: ;AS UNREGULATED VOJC's . . - _ ^ .. \.
4-Isopropyltoluene
n-Propylbenzene
1,1,1 ,2-Tetrachloroethane
1 , 1 ,2,2-Tetrachloroethane
1 ,2,3-Trichlorobenzene
1 ,2,4-Trimethylbenzene
1 ,2,3-Trichloropropane
1,3,5-Trimethylbenzene
0
0
0
0
0
0
0
0
8 3
7 8
16 3
! 6 5
1 1
7 5
6 4
8 2
2
2
2
2
2
2
2
2
'
1
£ ORGANIC DISINFECTION BY-IJRODUCTST "* *„ <, / r
Bromochloroacetic Acid
Chloral Hydrate
Dibromoacetic Acid
Dichloroacetic Acid
Monobromoacetic Acid
Monochloroacetic Acid
Trichloroacetic Acid
2
1
1
1
i
1
1
1
5 0
6 5
5 7
5 8
6 0
6 1
6 2
1
2
1
1
1
1
1
i 1
A^g/L
Mg/L
yUg/L
Mg/L
;"g/L
/"g/L
Aig/L
yUg/L
- 'V* '
1
i
i
-INORGANIC DISINFECTION BY-PRODUCTS
Bromate
Bromide
Chlorate
Chlorite
1
2
1
1
9 3
6 0
9 4
9 5
2
2
1
1
i 1
1
1
1
yUg/L
Aig/L
yUg/L
yUg/L
yUg/L
/-ig/L
/Ug/L
- '° ', » * *
1 1
i"g/L
yUg/L
yUg/L
fig/I-
EPA-359 (Cin) Rev. 10-97. Previous editions are obsolete. (Note: The Data Report,Form is continued on the next page.)
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CHEMISTRY DATA
Page 8 of 8
Study Number
W | S ] 0 | 4 ! 0
Analyte Name
EPA Lab I.D.
!
Analyte
Number
: ; i
Sample #
Results
MC
Quantity
MISCELLANEOUS
Residual Free Chlorine
Turbidity
Low-Level Turbidity
(by bench-top, portable, or
IR instrument)
Low-Level Turbidity
(by on-line instrument)
Total Filterable Residue (at 180° C)
Calcium Hardness
(as Calcium Carbonate)
pH
Alkalinity (as Calcium Carbonate)
Sodium
Sulfate
TOC
Total Cyanide
Dioxin
Asbestos
0
0
2
2
o
0
0
0
0
.
2
1
2
2
'2
2
~
6
<
2
3
4
5
2 |4
2 J5
2 6
2
7
2|9
4 |5
6 ' 3
U 1 J
4
5
5
6
2
3
1
1
2
3
2
1
1
1
1
1
1
1
1
1
1
i
1
i
i>
i;
i
i
i;
•
i
|:
i
{
i
i
i
!
i i
! !
!
!
j
i
!
i
i
i
i
!
!
i
i i i
i
i
i
]
i
i
i
i
i
i
'
!
i —
i —
!
1
!
—
mg/L
NTU
NTU
NTU
mg/L
mg/L
Units
mg/L
mg/L
mg/L
mg/L
mg/L
Pg/L
MFL
EPA-359 (Cin) Rev. 10-97 Previous editions are obsolete.
•&U.S. GOVERNMENT PRINTING OFFICE: 1997 -«5IM»7
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