This application is designed for use by laboratories seeking accreditation for samples analyzed for compliance with a National Pollution Discharge Elimination System (NPDES) permit issued under Minnesota Statutes, section 115.03, subdivision 5. Minnesota Statutes 144.98, subd. 8 and 9 allow exemption from compliance with parts of the national standards for accreditation for laboratories meeting certain requirements.
To obtain this exemption and receive accreditation under this second tier, laboratories must
follow the application process outlined in this document. All steps must be completed for the
application to be approved.
Grey‐boxed areas throughout the application are for MN‐ELAP use only!
THE
APPLICATION
PROCESS
Step 1: Read all instructions carefully before completing the application. Applications must be typewritten. Step 2: Fill in all required information on the application form provided. Attach the required documentation as specified on the application form. Step 3: Complete Section 4 and 5 by selecting the field of testing for the laboratory is seeking to be accredited. The laboratory may apply to be accredited for any routine analytical test and the necessary preparation procedure or comparison procedure. Please contact MN‐ELAP prior to requesting method variance, preparation technique variance, or Minnesota Rule variance requests. Please review all information entered into Scope of Accreditation. No changes will be accepted without written notification from the laboratory (Minnesota Rules 4740.2050, subpart 15). Step 4: Attach evaluated proficiency testing results for each requested field of testing. MN‐ELAP does not allow revised proficiency testing reports. The proficiency testing frequency must meet the requirements outlined in Minn. Statutes 144.98, Subd. 9.
Appendix A
Tier 2 Application
A
Step 5: Review the terms and conditions of the application materials as written in Section 11 and sign the affidavit. The application will not be considered a valid application unless the application is signed with a notary witness. Step 6: Application fees will be calculated based on the number and types of preparation techniques and fields of testing requested. MN‐ELAP will generate and send an invoice to the primary contact upon receipt of the completed application. Fees will be assessed according to Minn. Statutes 144.98. Step 7: Please review the completed application for errors and omissions. Please use the application instructions steps to assess completeness. Step 8: Print all the application materials and supporting documents to be assembled in the application packet. Please do not staple, tape, three‐hole punch or otherwise bind the documents. Please place supplemental materials in the following order behind the main application form (Appendix A): additional personnel, directions or maps to the laboratory (if applicable), additional requested fields of testing (if applicable) laboratory quality manual standard operating procedures for each requested field of testing graded proficiency test results for each requested filed of testing (please include all acceptable and not acceptable reports , if applicable) Step 9: Send the completed application and supporting documentation to the Minnesota Department of Health’s Environmental Laboratory Accreditation Program. The remittance types and address information is located in Section 9.
SECTION
1:
LABORATORY
IDENTIFICATION
Please complete this section with care. The information contained within this section will be used for communication with the laboratory and will be used to generate the Scope of Accreditation. Attach additional sheets if necessary. Laboratory Information Laboratory Name (legal): USEPA Laboratory ID: Laboratory Description/Type: Web Address:
State Lab ID: Issue Date: Expiration Date: Certificate Number: Physical Location of the Facility
Primary Contact Person: Email:
Street Address:
City: State: Postal Code: County:
Phone Number: Fax Number:
Mailing Address
Street Address:
City: Postal Code: County:
Billing Address
Street Address:
City: Postal Code: County:
Hours of Operation Directions to the Laboratory
SECTION
2:
IDENTIFICATION
OF
LABORATORY
PERSONNEL
The following information regarding personnel is required per Minnesota Statutes 144.98. Please see the qualifications for laboratory personnel Chapter 3 of the Quality Systems for
Wastewater Analysis. Attach additional sheets, if necessary.
Area of Responsibility Name Title Email Address
Laboratory Owner Managing Agent Lab Manager/Director Operator of Responsible Charge (Minn. Statutes 115.73) Quality Manager (however titled) Primary Contact
S
ECTION
3:
DOCUMENTATION
REQUIRED
The following documents must be attached to the application and must be available for inspection at the time of the onsite assessment. The laboratory must have a copy of the most recent revision of Standard Methods for the Examination of Water and Wastewater approved for use as stated in part 136 of Title 40 of the Code of Federal Regulations. The Standard
Methods for the Examination of Water and Wastewater is prepared and published jointly by the American Public Health Association, the American Water Works Association, and the Water Environment Federation. The associations are represented by a Joint Editorial Board
administered by the Standard Methods consensus organization (http://www.standardmethods.org/).
Section 1020A of the Standard Methods for the Examination of Water and Wastewater and Minnesota Rules 4740.2085 list the required documents for a laboratory quality system. For additional information and manual content, please see Chapters 2 and 3 of this guide. Please indicate below the required documents attached to your laboratory’s application. laboratory quality manual (including signatures and quality policy statement) organizational structure/organizational chart(s) job descriptions and staff responsibilities list of tests performed by the laboratory inventory of equipment and instrumentation used within the laboratory standard operating procedure for each requested analytical method graded proficiency test report for each requested field of testing
Policies and procedures relating to all practices used for the analysis of environmental
sampling, testing and assessment, including:
analyst training and performance requirements procedures for sample handling and receiving sample control and documentation/chain of custody reference measurement standards and measurement traceability generation, approval, and control of policies and procedures
Policies and procedures, continued:
procurement of supplies and reference material procedure for subcontractor’s services (if applicable) internal quality control activities calibration and verification and maintenance of instrumentation/equipment data verification practices (QA samples, proficiency test schedule, and etc) feedback, complaints, and corrective action mechanism exception reporting data reductions, validation and reporting Performance assessments and reviews method detection limit and data precision and accuracy records archiving management reviews
S
ECTION
4:
S
ELECT
M
ETHOD
PREPARATIONS
(
IF APPLICABLE)
Please select all preparation techniques, preparation comparison studies, and preparation technique variances used by the laboratory.
Inorganic
Inorganic Chemistry ‐ Digestion, autoclave
Inorganic Chemistry ‐ Digestion, hotplate or HotBlock
Inorganic Chemistry ‐ Distillation, macro
Inorganic Chemistry ‐ Distillation, micro
Inorganic Chemistry ‐ Distillation, MIDI
Inorganic Chemistry – Distillation, comparison study
Inorganic Chemistry ‐ Extraction, separatory funnel liquid‐liquid (LLE)
Inorganic Chemistry ‐ Extraction, solid phase (SPE)
Others
(please
specify):
Comparison
Studies
(please
specify):
Variances
(please
specify):
S
ECTION
5:
R
EQUESTED
S
COPE
OF
A
CCREDITATION
Please select all Clean Water Program fields of testing for which the laboratory seeks initial or renewal accreditation. Please
complete this section with care. The information selected will be used to generate the Scope and Certificate of Accreditation. If
necessary use an additional application template to request needed fields of testing, and please attach parameter and method lists
from the facility’s NPDES permit or contract requiring the analysis.
Shaded areas are designated for MN‐ELAP use only.
Clean
Water
Program
Non
Potable
Water
Category:
Microbiology
Applied Prep Re q uir ed
Parameter Method Technology PT Provider Name
PT Study ID (Feb‐March) Other PT Studies (Minn. Statutes 144.98, subd. 9) Appr oved
Coliform, fecal in presence
of chlorine, number per 100
mL 9221 C E‐ 1999 MPN, 5 tube, 3 dilution
Coliform, fecal in presence
of chlorine, number per 100
mL 9221 C E‐ 1999 MPN, 5 tube, 3 dilution
Clean
Water
Program
Non
Potable
Water
Category:
Microbiology
Applied Prep Re q uir ed
Parameter Method Technology PT Provider Name
PT Study ID (Feb‐March) Other PT Studies (Minn. Statutes 144.98, subd. 9) Appr oved
Coliform, fecal in presence
of chlorine, number per 100
9222 D‐
1997
MF, single step
Coliform, total number per
100 mL
9221 B‐2006 MPN, 5 tube, 3
dilution
Coliform, total number per
100 mL 9222 B‐1997 MF, single step or two step
Coliform, total in presence
of chlorine, number per 100
mL 9221 B‐1999 MPN, 5 tube, 3 dilution
Coliform, total in presence
of chlorine, number per 100
mL 9222 (B +B.5c)‐1997 MF with enrichment
E. coli, number per 100mL 9223 B‐1997 MPN multiple
tube/multiple
well
Clean
Water
Program
Non
Potable
Water
Category:
Inorganic
Chemistry
Applied Prep Requir ed
Parameter Method Technology PT Provider Name
PT Study ID (Feb‐March) Other PT Studies (Minn. Statutes 144.98, subd. 9) Appr oved X Ammonia (as N), mg/L 4500‐NH3 B‐1997 Manual distillation or gas diffusion (pH >11) X Ammonia (as N), mg/L 4500 NH3 C‐ 1997 Titration X Ammonia (as N), mg/L 4500 NH3 D‐1997 or E‐ 1997 Electrode
X Ammonia (as N), mg/L 4500 E‐1997 Electrode
X Ammonia (as N), mg/L 4500 NH3
G‐1997
Automated phenate,
Clean
Water
Program
Non
Potable
Water
Category:
Inorganic
Chemistry
Applied Prep Requir ed
Parameter Method Technology PT Provider Name
PT Study ID (Feb‐March) Other PT Studies (Minn. Statutes 144.98, subd. 9) Appr oved
Biological oxygen demand
(BOD5), mg/L 5210 B‐2001 (including Hach 10360 LDO) Dissolved Oxygen Depletion Carbonaceous biochemical
oxygen demand (CBOD5),
mg/L 5210 B‐2001 (including Hach 10360 LDO) Dissolved Oxygen Depletion w/ inhibitor
X Chemical oxygen demand
(COD), mg/L
5220 C‐1997 Titrimetric
X Chemical oxygen demand
(COD), mg/L 5220 D‐ 1997 Spectrophotometric, manual or automatic
Chlorine‐Total residual, mg/L 4500–Cl D–
2000
Amperometric direct
Clean
Water
Program
Non
Potable
Water
Category:
Inorganic
Chemistry
Applied Prep Requir ed
Parameter Method Technology PT Provider Name
PT Study ID (Feb‐March) Other PT Studies (Minn. Statutes 144.98, subd. 9) Appr oved
Chlorine‐Total residual, mg/L
(low level) 4500–Cl E– 2000 Amperometric direct .
Chlorine‐Total residual, mg/L 4500–Cl B–
2000
Iodometric direct
Chlorine‐Total residual, mg/L 4500–Cl C–
2000
Back titration ether
end–point
Chlorine‐Total residual, mg/L 4500–Cl F–
2000
DPD–FAS
Chlorine‐Total residual, mg/L 4500–Cl G–
2000. Spectrophotometric, DPD Chromium VI dissolved, mg/L 3111 C– 1999 AA chelation‐ extraction
Clean
Water
Program
Non
Potable
Water
Category:
Inorganic
Chemistry
Applied Prep Requir ed
Parameter Method Technology PT Provider Name
PT Study ID (Feb‐March) Other PT Studies (Minn. Statutes 144.98, subd. 9) Appr oved Chromium VI dissolved, mg/L 3500–Cr C– 2001 Ion Chromatography Chromium VI dissolved, mg/L 3500–Cr B– 2001 Colorimetric (Diphenyl‐ carbazide). Hydrogen ion (pH), pH units 4500–H+‐ 2000 Electrometric measurement X Kjeldahl Nitrogen —Total, (as N), mg/L 4500–Norg B–1997 or C–1997 and 4500–NH3 B–1997 Manual digestion 20 and distillation or gas diffusion
Clean
Water
Program
Non
Potable
Water
Category:
Inorganic
Chemistry
Applied Prep Requir ed
Parameter Method Technology PT Provider Name
PT Study ID (Feb‐March) Other PT Studies (Minn. Statutes 144.98, subd. 9) Appr oved X Kjeldahl Nitrogen —Total, (as N), mg/L 4500–NH3 C–1997 Titration X Kjeldahl Nitrogen —Total, (as N), mg/L 4500–NH3 D–1997 Electrode X Kjeldahl Nitrogen —Total, (as N), mg/L 4500 E– 1997 Electrode X
Oil and grease—
Total recoverable, mg/L 5520 B– 2001 Hexane extractable material (HEM): n‐ Hexane extraction and gravimetry Orthophosphate (as P), mg/L. 4500–P F– 1999 Automated
Clean
Water
Program
Non
Potable
Water
Category:
Inorganic
Chemistry
Applied Prep Requir ed
Parameter Method Technology PT Provider Name
PT Study ID (Feb‐March) Other PT Studies (Minn. Statutes 144.98, subd. 9) Appr oved Orthophosphate (as P), mg/L 4500–P E– 1999 Manual single reagent Orthophosphate (as P), mg/L 4110 B– 2000 Ion Chromatography Oxygen, dissolved, mg/L 4500–O F– 2001 Winkler (Azide modification) Oxygen, dissolved, mg/L 4500–O G– 2001 Electrode X Phosphorus—Total, mg/L 4500‐P E (including Hach 8190) Manual
Clean
Water
Program
Non
Potable
Water
Category:
Inorganic
Chemistry
Applied Prep Requir ed
Parameter Method Technology PT Provider Name
PT Study ID (Feb‐March) Other PT Studies (Minn. Statutes 144.98, subd. 9) Appr oved Residue—Total, mg/L 19972540 B– Gravimetric,105° 103– Residue—filterable, mg/L 19972540 C– Gravimetric, 180° Residue—non‐filterable (TSS), mg/L 2540 D– 1997 Gravimetric, 103– 105 °C post washing of residue
Residue—settleable, mg/L 25401997 F– Volumetric,cone), or gravimetric (Imhoff
Sulfide (as S), mg/L 4500–S 2–F– 2000 Titrimetric (iodine) Sulfide (as S), mg/L 4500–S 2–D– 2000 Colorimetric (methylene blue) Sulfide (as S), mg/L 4500–S 2–G– 2000 Ion Selective Electrode
EXAMPLE
Please use the format below to request additional parameters and methods. The analytes and methods must be approved for use in part 136 of
Title 40 of the Code of Federal Regulations as required by the facility’s NPDES permit.
Clean
Water
Program
Non
Potable
Water
Category:
Other
Applied Prep Requir ed
Parameter Method Technology PT Provider Name
PT Study ID (Feb‐March) Other PT Studies (Minn. Statutes 144.98, subd. 9) Appr oved
S
ECTION
6:
P
REFERRED
M
ONTH
FOR
O
NSITE
A
SSESSMENT
Please select below the preferred month (or months) for a scheduled onsite assessment of the
laboratory. MNELAP will consider a laboratory’s request when scheduling the onsite assessment but
cannot guarantee availability of staff during the preferred months. March July April August May September June October
S
ECTION
7:
P
ROFICIENCY
T
ESTING
S
TUDIES
For each proficiency testing study identified in Section 5, please attach the proficiency testing study vendor‐evaluated results with this application packet. Please attach all evaluated results (acceptable and not acceptable). MNELAP maintains a list of approved proficiency test providers on the program’s webpage: http://www.health.state.mn.us/divs/phl/accreditation/ptproviders.html The studies must be conducted at the times and frequency described in Minn. Statutes 144.98, Subd. 9. Laboratories must analyze a PT study in February or March of each year. If the laboratory receives acceptable results on the initial attempt, no additional studies are required. If the laboratory fails the initial study, the laboratory must obtain a remedial PT study within 15 days of the notice of the failed PT result and must participate in a follow‐up study selected from available studies scheduled during July or August of the same year.
S
ECTION
8:
T
ERMS
AND
C
ONDITIONS
OF
THE
A
PPLICATION
Please review the terms and condition of accreditation and provide authorized signature.
Affidavit:
State of _________________________________County of______________________________
I hereby certify that I have read Minnesota Statutes 144.98 and Minnesota Rules, Chapter 4740 for
accreditation procedures for Environmental Testing Laboratories and I am authorized thereunder to
make an application for Certification by the Minnesota Department of Health (MDH). I further certify
that all environmental testing information required for compliance will be provided and that I will allow
representatives of the commissioner to perform on‐site inspections of the laboratory pursuant to the
rules to assure compliance with accreditation standards.
I understand and acknowledge that my laboratory is required to be continually in compliance with Minn.
Statutes 144.98, and with the provisions in Minnesota Rules, Chapter 4740, regarding the certification
requirements for environmental laboratories. I understand that the laboratory is subject to the
enforcement and penalty provisions of the State of Minnesota.
I certify that I have not submitted information through this application that is classified as "trade secret"
or "not public" under the Minnesota Data Practices Act. I understand that accreditation program
information is public unless designated by me as meeting conditions for trade secret classification.
I certify that I am the designated representative of the applicant/owner and that there are no
misrepresentations in my submitted information and any related documentation required for
compliance with accreditation requirements.
Application Terms and Conditions
Laboratory Name (legal): USEPA Laboratory ID: Signatures Authorized Lab Representative (print): Signature Title: Date (mm/dd/yyyy): Signature of Notary Public and Seal Stamp
S
ECTION
9:
R
EVIEW
AND
S
UBMIT
THE
C
OMPLETED
A
PPLICATION
Please review the completed application and use the application instruction steps to assess completeness. Please remit application and documents to the Minnesota Department of Health Laboratory Accreditation Program. Send completed applications by U.S. mail to: Minnesota Department of Health Environmental Laboratory Accreditation Program (ELAP) PO Box 64899 St. Paul, MN 55164‐0899 If using a commercial delivery service or couriers please use the following address: Minnesota Department of Health Environmental Laboratory Accreditation Program (ELAP) 601 Robert Street North St. Paul, MN 55155‐2531 If you need further assistance in completing your application, please contact MNELAP at: Telephone: 651‐201‐5200 Email: health.mnelap@state.mn.us Website: http://www.health.state.mn.us/accreditation
MN‐ELAP USE ONLY
Laboratory Number: Application Type (circle one):
Initial Renewal Add Analyte
Deposit Number: Date (mm/dd/yyyy):