DHEC Form 2802 "Application for Environmental Laboratory Certification" - South Carolina

What Is DHEC Form 2802?

This is a legal form that was released by the South Carolina Department of Health and Environmental Control - a government authority operating within South Carolina. Check the official instructions before completing and submitting the form.

Form Details:

  • Released on April 1, 2020;
  • The latest edition provided by the South Carolina Department of Health and Environmental Control;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of DHEC Form 2802 by clicking the link below or browse more documents and templates provided by the South Carolina Department of Health and Environmental Control.

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Download DHEC Form 2802 "Application for Environmental Laboratory Certification" - South Carolina

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Application for Environmental Laboratory Certification
Office of Environmental Laboratory Certification
Personal information provided in this document is subject to public scrutiny or release.
COMPLETE AND SUBMIT ONLY THE APPLICABLE PAGES FOR CERTIFICATION
A. Purpose of Application: Check one and complete the information.
Initial Certification (New Lab)
EPA Lab Code ___ ___ ___ ___ ___ ___ ___
Additional Parameter Certification
Assigned S.C. Laboratory I.D. # ___ ___ ___ ___ ___
PT Recertification (Due to PT Failure)
Certificate # (Ex: 001, 002, etc.) ___ ___ ___
Recertification of Entire Lab (Lab Previously Certified) – – Old SC Laboratory I.D. # ___ ___ ___ ___ ___
Change in Certifying Authority
B. Type of Laboratory
Commercial
Federal
Industrial
Mobile
Municipal
State
C. Laboratory Name:
D. Legal Company Name: Name as registered with the South Carolina Secretary of State’s Office.
E. Laboratory’s Federal Employee Tax ID Number (FEIN): ___ ___ -- ___ ___ ___ ___ ___ ___ ___
Is the FEIN assigned to the Company listed in D.?________ If not, list Parent Company in F. below.
F. Parent Company Name: If different from legal company name above, enter the name of the parent company that owns
the laboratory.
G. Laboratory Mailing Address:
(P.O. Box or Number and Street)
(City)
(State)
(Zip Code)
H. Laboratory Business (Physical) Address:
(Number and Street)
(City)
(State)
(Zip Code)
(County Code)
I. Laboratory Telephone Number:
Laboratory FAX Number:
DHEC 2802 (04/2020)
Page 1 of 36
Application for Environmental Laboratory Certification
Office of Environmental Laboratory Certification
Personal information provided in this document is subject to public scrutiny or release.
COMPLETE AND SUBMIT ONLY THE APPLICABLE PAGES FOR CERTIFICATION
A. Purpose of Application: Check one and complete the information.
Initial Certification (New Lab)
EPA Lab Code ___ ___ ___ ___ ___ ___ ___
Additional Parameter Certification
Assigned S.C. Laboratory I.D. # ___ ___ ___ ___ ___
PT Recertification (Due to PT Failure)
Certificate # (Ex: 001, 002, etc.) ___ ___ ___
Recertification of Entire Lab (Lab Previously Certified) – – Old SC Laboratory I.D. # ___ ___ ___ ___ ___
Change in Certifying Authority
B. Type of Laboratory
Commercial
Federal
Industrial
Mobile
Municipal
State
C. Laboratory Name:
D. Legal Company Name: Name as registered with the South Carolina Secretary of State’s Office.
E. Laboratory’s Federal Employee Tax ID Number (FEIN): ___ ___ -- ___ ___ ___ ___ ___ ___ ___
Is the FEIN assigned to the Company listed in D.?________ If not, list Parent Company in F. below.
F. Parent Company Name: If different from legal company name above, enter the name of the parent company that owns
the laboratory.
G. Laboratory Mailing Address:
(P.O. Box or Number and Street)
(City)
(State)
(Zip Code)
H. Laboratory Business (Physical) Address:
(Number and Street)
(City)
(State)
(Zip Code)
(County Code)
I. Laboratory Telephone Number:
Laboratory FAX Number:
DHEC 2802 (04/2020)
Page 1 of 36
J. Laboratory Billing Address (for Certification Fees):
(Billing Name)
(P.O. Box or Number and Street)
(City)
(State)
(Zip Code)
K. Laboratory E-mail Address:
L. Parent Company Business (Physical) Address:
(Number and Street)
(City)
(State)
(Zip Code)
M. Parent Company Telephone Number:
N. Out-of-State Laboratories Only: Only one State Certifying Authority can be designated for each program below and the
State Certifying Authority must have performed an on-site laboratory evaluation.
Safe Drinking Water Act:
Name of State Certifying Authority:________________________________________ Expiration Date: ___________
Clean Water Act:
Name of State Certifying Authority:________________________________________ Expiration Date: ___________
Solid and Hazardous Waste:
Name of State Certifying Authority:________________________________________ Expiration Date: ___________
O. Laboratory Director: (Primary Contact) - Designate the person responsible for the laboratory operations.
Attach a resume´ and/or qualifications. A laboratory director designation letter must accompany the
application if not already on file.
Name and Title
Telephone Number & Ext
Mobile Number
E-Mail Address:
Education:
Name of Institution: _____________________________________________________________________________
Degree: _____________________________________ Major Field: ______________________________________
Certificates or Registrations Held: _____________________________________________________________________
Issuing Agency: __________________________________________________ Date of Issue:_________________
Experience (related to laboratory analysis):______________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
DHEC 2802 (04/2020)
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P. Quality Assurance Officer or General Certification Contact Person for Laboratory:
Name and Title
Telephone Number & Ext
Mobile Number
E-Mail Address:
Q. Laboratory Personnel: List all personnel involved in the laboratory operations. Please make copies of this form for
additional personnel. Resumes may be attached.
Name: ____________________________________ Position Held:__________________________________________
Education and Experience: __________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
License or Registration:_____________________________________________________________________________
Primary Responsibilities in the Laboratory:______________________________________________________________
________________________________________________________________________________________________
Name: ____________________________________ Position Held:__________________________________________
Education and Experience: __________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
License or Registration:_____________________________________________________________________________
Primary Responsibilities in the Laboratory:______________________________________________________________
________________________________________________________________________________________________
Name: ____________________________________ Position Held:__________________________________________
Education and Experience: __________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
License or Registration:_____________________________________________________________________________
Primary Responsibilities in the Laboratory:______________________________________________________________
________________________________________________________________________________________________
Name: ____________________________________ Position Held:__________________________________________
Education and Experience: __________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
License or Registration:_____________________________________________________________________________
Primary Responsibilities in the Laboratory:______________________________________________________________
________________________________________________________________________________________________
DHEC 2802 (04/2020)
Page 3 of 36
R. Safe Drinking Water Act Methodology:
Disinfection By-Products: Circle only the EPA-approved methodology that the laboratory is seeking certification to
Perform. Out-of-state laboratories: The State Certifying Authority’s certificate must reflect the appropriate certification for
each parameter and method circled.
1
Parameter
Methodology
EPA
Standard Methods
Other
Bromate
300.1 (1987)
302 (2009)
45
317.0
(2001)
45
326.0
(2002)
45,46
321.8
(1987)
557 (2009)
Bromide
300.0 (1993)
300.1 (1987)
11
Chlorite (Monthly/Daily)
300.0 (1993)
300.1 (1997)
317.0 (2001)
326.0 (2002)
11
327.0 (2005)
SM 4500-CIO
E-2011
2
49
UV
415.3 (2009)
SM 5910 B-2011
254
Inorganic-Demand: Circle only the EPA-approved methodology that the laboratory is seeking certification to perform.
Out-of-state laboratories: The State Certifying Authority’s certificate must reflect the appropriate certification for each
parameter and method circled.
1
Parameter
Methodology
EPA
Standard Methods
Other
Total Organic Carbon/ Dissolved
SM 5310 B-2011
47,48
Organic Carbon (TOC/DOC)
415.3 (2009)
SM 5310 C-2011
SM 5310 D-2011
Inorganic Mineral: Circle only the EPA-approved methodology that the laboratory is seeking certification to perform.
Out-of-state laboratories: The State Certifying Authority’s certificate must reflect the appropriate certification for each
parameter and method circled.
Parameter
Methodology
1
EPA
Standard Methods
Other
Alkalinity
SM 2320 B-2011
Calcium-Hardness
SM 3500-Ca B-2011
Chloride
300.0 (1993)
SM 4110 B-2011
300.1 (1997)
-
SM 4500-CI
B-2011
SM 4500-CI
-
D-2011
Fluoride
300.0 (1993)
SM 4110 B-2011
300.1 (1997)
-
SM 4500-F
B,D-2011
SM 4500-F
-
C-2011
-
SM 4500-F
E-2011
Hydrogen-Ion Concentration (pH)
150.1 (1983)
SM 4500 H
+
B-2011
150.2 (1983)
Specific Conductance
SM 2510 B-2011
Sulfate
300.0 (1993)
SM 4110 B-2011
300.1 (1997)
2-
375.2 (1993)
SM 4500-SO
C-2011
4
SM 4500-SO
2-
D-2011
4
2-
SM 4500-SO
E-2011
4
SM 4500-SO
2-
F-2011
4
DHEC 2802 (04/2020)
Page 4 of 36
R. Safe Drinking Water Act Methodology:
Inorganic-Miscellaneous: Circle only the EPA-approved methodology that the laboratory is seeking certification to
perform. Out-of-state laboratories: The State Certifying Authority’s certificate must reflect the appropriate certification for
each parameter and method circled.
1
Parameter
Methodology
EPA
Standard Methods
Other
Asbestos
100.1 (1983)
100.2 (1994)
Chlorine Dioxide
327.0 (2003)
8
SM 4500-CIO
C-2011
2
SM 4500-CIO
E-2011
2
Color - Visual
SM 2120 B-2011
9
- Spectrophotometric (Plat. Cobalt)
NCASI-71.01-TB803 (2000)
31
-
Cyanide,Total (Screening)
335.4 (1993)
SM 4500-CN
C-2011
10-204-00-1-X (Rev. 2.1, 2000)
32
(Manual Distillation Required)
OIA-1677
-
335.4 (1993)
SM 4500-CN
E-2011
SM 4500-CN
-
F-2011
-
31
SM 4500-CN
G-2011
Odor
SM 2150 B-2011
Ozone
SM 4500-O
B-2011
3
Residual Chlorine
SM 4500-CI D-2011
SM 4500-CI E-2011
SM 4500-CI F-2011
SM 4500-CI G-2011
Surfactants (MBAS)
SM 5540 C-2011
Temperature
SM 2550 B-2010
Turbidity – 90° Nephelometry (Tungsten Lamp)
180.1 (1993)
SM 2130 B-2011
Turbidity – 90° Nephelometry (LED)
Orion AQ 4500 (Rev. 1.0, 2009)
Turbidity – 360° Nephelometry (Laser)
Hach 10258 (Rev. 1.0, 2016)
Inorganic – Nutrient: Circle only the EPA-approved methodology that the laboratory is seeking certification to perform.
Out-of-state laboratories: The State Certifying Authority’s certificate must reflect the appropriate certification for each
parameter and method circled.
1
Parameter
Methodology
EPA
Standard Methods
Other
Nitrate-Nitrogen
300.0 (1993)
SM 4110 B-2011
300.1 (1997)
-
353.2 (1993)
SM 4500-NO
F-2011
3
-
SM 4500-NO
E-2011
3
-
SM 4500-NO
D-2011
3
Nitrate-Nitrite (NO
+ NO
)
300.0 (1993)
SM 4110 B-2011
3
2
300.1 (1997)
-
353.2 (1993)
SM 4500-NO
F-2011
3
-
SM 4500-NO
E-2011
3
Nitrite-Nitrogen
300.0 (1993)
SM 4110 B-2011
300.1 (1997)
-
353.2 (1993)
SM 4500-NO
F-2011
3
-
SM 4500-NO
E-2011
3
-
SM 4500-NO
B-2011
2
Orthophosphate
300.0 (1993)
SM 4110 B-2011
300.1 (1997)
365.1 (1993)
SM 4500-P F-2011
SM 4500-P E-2011
Phosphorus
300.0 (1993)
SM 4110 B-2011
365.1 (1993)
SM 4500-P F-2011
365.2 (1971)
365.3 (1978)
SM 4500-P E-2011
DHEC 2802 (04/2020)
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