Wastewater Discharge Sampling Log

A structured form for documenting wastewater discharge sampling activities for NPDES compliance, including sample details, parameters, chain of custody, and laboratory analysis results.

Sampling Event Details

• Sampling Date
  Date the sample was collected.
• Sampling Time
  Time the sample was collected.
• Facility Name
  Name of the facility associated with the discharge point.
• NPDES Permit Number
  Permit identifier associated with this discharge location.
• Discharge Outfall / Sampling Point
  Identifier for the outfall or sampling location.
• Sampling Event Type
  Select the reason for the sampling event.

Sample Collection Details

• Sample Type
  Select the sample collection method.
• Collection Method
  Method used to collect the sample.
• Number of Sample Containers
  Total number of containers collected for this event.
• Preservation Method
  Select all preservation methods applied to the sample.
• Field Temperature (°C)
  Measured sample temperature at collection, if applicable.
• Sample Condition / Observations
  Note any visible issues, odors, color, turbidity, or unusual field conditions.

Parameters and Holding Requirements

• Parameters Monitored
  Select all parameters included in this sampling event.
• Parameter Notes
  Add any permit-specific notes, method references, or parameter exceptions.
• Holding Time Verified
  Confirm that sample handling and transport met applicable holding-time requirements.
• Custody Seals Intact on Transfer
  Check if custody seals were used and remained intact during transfer.

Chain of Custody

• Sample Collector Name
  Name of the person who collected the sample. Avoid collecting unnecessary PII.
• Collector Title / Role
  Job title or role of the sample collector.
• Custody Transferred To
  Name or organization receiving custody of the sample.
• Custody Transfer Date and Time
  Date and time when custody was transferred.
• Transport Method
  Method used to transport the sample to the laboratory.
• Chain-of-Custody Notes
  Document any custody exceptions, delays, temperature excursions, or seal issues.

Laboratory Analysis Results

• Laboratory Name
  Name of the laboratory that performed the analysis.
• Laboratory Sample ID
  Unique identifier assigned by the laboratory.
• Sample Received Date
  Date the laboratory received the sample.
• Results Summary
  Summarize analytical results, including units, qualifiers, and any exceedances.
• QA/QC Notes
  Include method deviations, blanks, duplicates, qualifiers, or other quality notes.
• Laboratory Report Attached
  Confirm that the laboratory report or certificate of analysis is attached.

Compliance Review and Follow-Up

• Permit Exceedance Observed?
  Indicate whether any result exceeded permit limits.
• Exceedance Parameters
  Select the parameters that exceeded permit limits.
• Corrective Action / Follow-Up
  Describe notifications, investigations, resampling, or corrective actions taken.
• Reviewer Name
  Name of the person reviewing the sampling record for completeness.