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Run: Wastewater Discharge Sampling Log

Log wastewater discharge sampling events, chain of custody, and lab results in one place for NPDES review. Use it to document what was sampled, how it was ha...

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Sampling Event Details

Sampling Date (required)

Date the sample was collected.

Sampling Time (required)

Time the sample was collected.

Facility Name (required)

Name of the facility associated with the discharge point.

NPDES Permit Number (required)

Permit identifier associated with this discharge location.

Discharge Outfall / Sampling Point (required)

Identifier for the outfall or sampling location.

Sampling Event Type (required)

Select the reason for the sampling event.

Sample Collection Details

Sample Type (required)

Select the sample collection method.

Collection Method (required)

Method used to collect the sample.

Number of Sample Containers (required)

Total number of containers collected for this event.

Preservation Method (required)

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 (required)

Select all parameters included in this sampling event.

Parameter Notes

Add any permit-specific notes, method references, or parameter exceptions.

Holding Time Verified (required)

Confirm that sample handling and transport met applicable holding-time requirements.

Yes No N/A

Custody Seals Intact on Transfer

Check if custody seals were used and remained intact during transfer.

Yes No N/A

Chain of Custody

Sample Collector Name (required)

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 (required)

Name or organization receiving custody of the sample.

Custody Transfer Date and Time (required)

Date and time when custody was transferred.

Transport Method (required)

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 (required)

Name of the laboratory that performed the analysis.

Laboratory Sample ID (required)

Unique identifier assigned by the laboratory.

Sample Received Date

Date the laboratory received the sample.

Results Summary (required)

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 (required)

Confirm that the laboratory report or certificate of analysis is attached.

Yes No N/A

Compliance Review and Follow-Up

Permit Exceedance Observed? (required)

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.

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