Form 050-42 "Oil Spill Chain of Custody" - Washington

What Is Form 050-42?

This is a legal form that was released by the Washington State Department of Ecology - a government authority operating within Washington. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on May 1, 2016;
  • The latest edition provided by the Washington State Department of Ecology;
  • 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 Form 050-42 by clicking the link below or browse more documents and templates provided by the Washington State Department of Ecology.

ADVERTISEMENT
ADVERTISEMENT

Download Form 050-42 "Oil Spill Chain of Custody" - Washington

591 times
Rate (4.8 / 5) 29 votes
Oil Spill
Project Name:
Page____ of ____
Chain-of-Custody Form
SIC: __ __ __ __ __
Program:
Send Results to:
Mail Stop:
Date results needed by:_______________
Sampling Information
Analyses Requested
Other Analyses (write in)
Time
Date
Lab Sample
(Military)
Year:
Field Station Identification
Number
0000-
(maximum of 12 characters)
2400
(assigned by the
laboratory)
Mo
Da
Hr
Mn
Custody Record
Project Officer:
Phone Number:
Relinquished By:
Received By:
Yr
Mo
Da
Hr
Mn
Seal I.D.
Condition
Cell Number:
Samplers:
Recorder:
Date Recorded:
Comments:
Temperature of Cooler at Lab:
ECY 050-42 (REV. 05/2016)
Oil Spill
Project Name:
Page____ of ____
Chain-of-Custody Form
SIC: __ __ __ __ __
Program:
Send Results to:
Mail Stop:
Date results needed by:_______________
Sampling Information
Analyses Requested
Other Analyses (write in)
Time
Date
Lab Sample
(Military)
Year:
Field Station Identification
Number
0000-
(maximum of 12 characters)
2400
(assigned by the
laboratory)
Mo
Da
Hr
Mn
Custody Record
Project Officer:
Phone Number:
Relinquished By:
Received By:
Yr
Mo
Da
Hr
Mn
Seal I.D.
Condition
Cell Number:
Samplers:
Recorder:
Date Recorded:
Comments:
Temperature of Cooler at Lab:
ECY 050-42 (REV. 05/2016)
Matrix Codes
Source Codes
Source Codes
(cont.)
(cont.)
Code Description
Code Description
Code Description
10
Water
10
Water (General)
70
Tissue (General)
40
Soil/Sediment
12
Ambient Stream/River
71
Fish Tissue
70
Tissue
13
Lake/Reservoir
72
Shellfish Tissue
80
Oil/Solvent
14
Estuary/Ocean
73
Bird Tissue
90
Waste
17
Surface Runoff/Pond
74
Mammal Tissue
00
Other
18
Irrigation Canal/Return
75
Macroinvertebrate
40
Sediment (General)
76
Algae
Source Codes
42
Bottom Sediment or Deposit
78
Plant/Vegetation
Code Description
44
Sludge (General)
80
Oil/Solvent (General)
00
Unspecified Source
45
Sludge (Waste/Pond)
81
Oil (Transformer/Capacitor)
01
Unknown Liquid Media
46
Sludge (Drum/Tank)
82
Oil/Solvent (Drum/Tank)
(Drum/Tank)
48
Soil (General)
83
Oil/Solvent (Spill Area)
02
Unknown Liquid Media
49
Soil (Spill/Contaminated Area)
84
Oil/Solvent (Waste/Pond)
(Spill Area)
Analyses Requested Guidelines
360-871-8800
(Questions about an analysis? Contact the laboratory at
.)
HCID
– Hydrocarbon Identification, a qualitative analysis used to identify the type of oil in a sample and to match samples to a
source. Cannot be used to quantify the concentration of hydrocarbons in the sample (concentrated or floating oil cannot be
quantified). Collect one-liter for sheens (head-space is okay) or use a Teflon sheen net, 40 mL vial for concentrated oil, and
8 oz. for oil in soil or sediment. Identify which samples should be compared for a match on the “Comments” line. If the oil is
known or suspected to be vegetable based, enter this information on the “Comments” line. Bio-Markers – A second analysis
that can be used to confirm a match. The lab will contact the project officer to authorize this analysis if bio-markers are present
in the sample and the analysis is necessary to confirm a match. A separate sample is not necessary for this analysis.
NWTPH-Dx
– Total Petroleum Hydrocarbons-Diesel Extended Range, for quantitation of all petroleum products except
gasoline range hydrocarbons (kerosene, diesel, lube oils, hydraulic oil, IFO, HFO, crude oil, etc.). For dissolved oil in water, or
oil adsorbed to soil or sediment (concentrated or floating oil cannot be quantified). Collect one-liter for water (fill at least
to bottle shoulder), and 8 oz. for soil or sediment (fill to ¾ full). 7-day holding time for water and 14 days for soil or sediment.
NWTPH-Gx
– Total Petroleum Hydrocarbons-Gasoline Range Hydrocarbons, for quantitation of gasoline range hydrocarbons
(volatiles; including mineral spirits, naphtha, etc.). For dissolved oil in water, or oil adsorbed to soil or sediment. Collect three
40 mL VOA vials (with septum caps) for water (no head-space (no bubbles), 7-day holding time or 14 days if preserved with
1:1 acid); and three airtight capsules (Encore or equivalent), plus one 4 oz. jar (with septum cap, no head space) for soil or
sediment (48-hour holding time, call laboratory to coordinate).
For samples that may contain a mixture of gasoline and other petroleum products, collect samples for both analyses
(NWTPH-Dx and NWTPH-Gx).
BTEX
– Benzene, Toluene, Ethylbenzene, and Xylene, for quantitation of these four components of gasoline, which are highly
soluble in water and cause most of the acute toxicity. Separate samples are not necessary, simultaneous BTEX analyses can be
performed using the samples for NWTPH-Gx. For separate samples, use the same collection guidance as provided above for
NWTPH-Gx.
VOA
– Volatile Organics Analysis, for low-level quantitation of an extensive list of volatile compounds, including BTEX.
Used in special circumstances when unusual volatile compounds (solvents, etc.) are expected. Use the same collection guidance
as provided above for NWTPH-Gx.
PAHs-NOAA List
– Polynuclear Aromatic Hydrocarbons, a low-level analysis for an extended list of hydrocarbons that
include petroleum based compounds, are generally more persistent, and are thought to cause chronic toxicity. Primarily used for
NRDA. Collect one-liter for water, and 8 oz. for soil or sediment. 7-day holding time for water and 14 days for soil or
sediment. Consult lab regarding tissue samples.
Recommended Field Station Identification (Sample Number) format
– Use the first letter of the first two words in the
incident name; for vessels use “V” and the first letter of the vessel name; add “S” for sediment, “W” for water, “O” for
concentrated oil, “SO” for source oil, or “T” for tissue; the date (MMDDYY); and a number if multiple samples of the same type
are collected at the same station on the same date. Example: For the first water sample collected for the Bob’s Trucking Spill on
July 5, 2016, the Field Station Identification would be BTW0705161. If a second water sample is collected, it would be
BTW0705162.
Page of 2