Qualitycheck Proficiency Testing Schemes Independent external evaluation of the analytical competence of testing laboratories. Application Form

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1 Qualitycheck Proficiency Testing Schemes Independent external evaluation of the analytical competence of testing laboratories Customize your participation, and only pay for what you need! The laboratory may choose: the measurands to be evaluated; the matrix of interest; the period in which to participate. Instruction for the compilation 1 - Please complete the relevant pages, including General Information, selecting (please tick ) for each matrix the measurands and the period in which you want to participate. 2 - Send by (sales@qualitychecksrl.com) or by FAX ( ), the compiled. 3 - In three days, you will receive our Quote with the price of participation, including the transportation cost. Phone: Fax: Website: sales@qualitychecksrl.com

2 Distribution Schedule Proficiency Testing Schemes Qualitycheck 2019 Qualitcyheck Proficiency Testing Schemes January February March April May June July August September October November December Microbiological and Chemical parameters Feb May 2019 Sep Microbiological parameters: Drinking water Physical-Chemical parameters: Natural waters and wastewater Metals March 2019 October 2019 Natural waters and wastewater Contaminated soil and sewage sludge Leaching test according to standard EN Organic Compounds April 2019 Nov Pesticides: Natural waters Polycyclic Aromatic Hydrocarbons (PAHs): Natural waters Volatile Organic Compounds (VOC): Natural waters Hydrocarbon Oil Index according to standard ISO : Natural waters Registration deadline Proficiency testing scheme Registration deadline Despatch samples Reporting deadline Final Report Registration deadline Despatch samples Reporting deadline Final Report February /01/ /02/ /03/ /03/2019 March /02/ /02/ /03/ /04/2019 May /05/ /05/ /06/ /07/2019 October /09/ /10/ /10/ /11/2019 September /09/ /09/ /10/ /11/2019 April /03/ /03/ /04/ /04/2019 November /10/ /10/ /11/ /12/2019 Phone: Fax: Website: (Mod. PG05-1, rev4 del 30/10/2018)

3 Qualitycheck Proficiency Testing Schemes Independent external evaluation of the analytical competence of testing laboratories General information Contact Name (first name and last name): Name of Organization: Address for shipment of the proficiency testing items Street Address: Postal Code: City/ Province/Country: Phone / Fax: PRIVACY In accordance with and in compliance with the General Data Protection Regulation (EU) 2016/679 ("GDPR") we authorize the use of personal data for any purpose related to this service. DATE: SIGNATURE: Phone: Fax: Website: sales@qualitychecksrl.com

4 MICROBIOLOGICAL PARAMETERS IN DRINKING WATER February /feb 18/mar required (please tick ) May /may September /jul 23/sep 04/nov Total aerobic count at 22 C Total aerobic count at 37 C Enumeration of Coliform Bacteria Enumeration of Enterococci Enumeration of Escherichia coli Enumeration of Pseudomonas aeruginosa Enumeration of Clostridium perfringens Enumeration of Staphylococcus aureus Enumeration of Legionella pneumophila Enumeration of Legionella spp New 2019! Read more - Note: Measurement methods for the determination of the Colony Forming Units (CFU/volume). New 2019!: New measurand available in 2019.

5 PHYSICAL-CHEMICAL PARAMETERS IN NATURAL WATERS February /feb 18/mar required (please tick ) May /may 01/jul September /sep 04/nov Alkalinity Ammonia Calcium Chloride Conductivity (20 oc) Dry residue at 180 oc Fluoride Magnesium Nitrate Nitrite Permanganate Index ph (20 oc) Phosphate Potassium Sodium Sulphate Turbidity Total Hardness Total Organic Carbon (TOC) Read more -

6 PHYSICAL-CHEMICAL PARAMETERS IN WASTEWATER February /feb 18/mar required (please tick ) May /may 01/jul September /sep 04/nov Ammonia Nitrogen BOD5 Chloride COD Conductivity (20 oc) Fluoride Nitrate Nitrogen Nitrite Nitrogen oc) Sulphate Total Kjeldahl Nitrogen Total Nitrogen (*) Total Organic Carbon (TOC) Total Phosphorus Total Dissolved Solids Total Solids Total Suspended Solids ph (20 Read more - *: Determination of the Total Nitrogen (organic and inorganic). Reference methods: ISO , UNI EN or equivalent methods.

7 METALS IN NATURAL WATERS required (please tick ) March /feb 08/apr October /oct 18/nov Aluminum (Al) Antimony (Sb) Arsenic (As) Barium (Ba) Beryllium (Be) Boron (B) Cadmium (Cd) Chromium (Cr) Cobalt (Co) Copper (Cu) Iron (Fe) Manganese (Mn) Mercury (Hg) Molybdenum (Mo) Nickel (Ni) Lead (Pb) Selenium (Se) Silver (Ag) Thallium (Tl) Tin (Sn) Vanadium (V) Zinc (Zn) Read more -

8 METALS IN WASTEWATER required (please tick ) March /feb 08/apr October /oct 18/nov Aluminum (Al) Antimony (Sb) Arsenic (As) Barium (Ba) Beryllium (Be) Boron (B) Cadmium (Cd) Chromium (Cr) Chromium VI (Cr VI) Cobalt (Co) Copper (Cu) Iron (Fe) Manganese (Mn) Mercury (Hg) Molybdenum (Mo) Nickel (Ni) Lead (Pb) Selenium (Se) Silver (Ag) Tin (Sn) Vanadium (V) Zinc (Zn) Read more -

9 METALS IN CONTAMINATED SOILS required (please tick ) March 2019 Antimony (Sb) 25/feb October /apr 07/oct 18/nov Arsenic (As) Beryllium (Be) Cadmium (Cd) Chromium (Cr) Cobalt (Co) Copper (Cu) Iron (Fe) Lead (Pb) Manganese (Mn) Mercury (Hg) Molybdenum (Mo) Nickel (Ni) Selenium (Se) Thallium (Tl) Tin (Sn) Vanadium (V) Zinc (Zn) Read more -

10 METALS IN SEWAGE SLUDGE required (please tick ) March /feb October /apr 07/oct 18/nov Aluminum (Al) Arsenic (As) Cadmium (Cd) Chromium (Cr) Cobalt (Co) Copper (Cu) Iron (Fe) Lead (Pb) Manganese (Mn) Mercury (Hg) Molybdenum (Mo) Nickel (Ni) Selenium (Se) Vanadium (V) Zinc (Zn) Read more -

11 LEACHING TEST ACCORDING TO STANDARD EN (WASTES) required (please tick ) March /feb October /apr 07/oct 18/nov Antimony (Sb) Arsenic (As) Barium (Ba) Cadmium (Cd) Chromium (Cr) Copper (Cu) Lead (Pb) Mercury (Hg) Molybdenum (Mo) Nickel (Ni) Selenium (Se) Zinc (Zn) Chloride oc) Dissolved Organic Carbon (DOC) Dry mass at 105 C Nitrate (as NO3) oc) Sulfate Total dissolved solids (TDS) Conductivity (20 ph (25 New 2019! New 2019! Read more - New 2019!: New measurand available in 2019.

12 HYDROCARBON OIL INDEX ACCORDING ISO (NATURAL WATERS) required (please tick ) April /mar Hydrocarbon Oil Index November /apr 21/oct 02/dec Read more -

13 PESTICIDES IN NATURAL WATERS required (please tick ) April /mar 29/apr November /oct 02/dec Organochlorine Pesticides Alachlor, Aldrin, alpha-endosulfan, beta-endosulfan, Endosulfan (alpha+beta) New 2019!, Chlordane (cis+trans), 2,4'-DDE, 4,4'-DDE, 2,4'-DDD, 4,4'-DDD, 2,4'-DDT, 4,4'-DDT, Total DDT* New 2019!, Dieldrin, Endrin, Heptachlor, Heptachlor epoxide New 2019! Hexachlorobenzene (HCB), Pentachlorobenzene, Trifluralin Triazines Atrazine, Atrazine-desethyl, Prometryn, Propazine, Simazine, Terbuthylazine, Terbuthylazine- desethyl, Terbutryn Organophosphorus Pesticides Azinphos-ethyl, Azinphos-methyl, Chlorfenvinphos, Chlorpyrifos (ethyl), Dichlorvos, Fenitrothion, Parathion-ethyl, Parathion-methyl Read more - *: DDT total comprises the sum of the isomers 4,4'-DDT (CAS number: ), 2,4'-DDT (CAS number: ); 4,4'-DDE (CAS number: ); and 4,4'-DDD (CAS number: ). New 2019!: New measurand available in 2019.

14 POLYCYCLIC AROMATIC HYDROCARBONS (PAHS) IN NATURAL WATERS required (please tick ) April /mar November /apr 21/oct 02/dec Acenaphthene Acenaphthylene Anthracene Benzo[a]anthracene Benzo[a]pyrene Benzo[b]fluoranthene Benzo[k]fluoranthene Benzo[g,h,i]perylene Chrysene Dibenzo[a,h]anthracene Fluoranthene Fluorene Indeno[1,2,3-cd]pyrene Naphthalene Phenanthrene Perylene Pyrene Read more -

15 VOLATILE ORGANIC COMPOUNDS (VOCS) IN NATURAL WATERS required (please tick ) April /mar November /apr 21/oct 02/dec AROMATIC SOLVENTS Benzene Ethylbenzene Styrene Toluene o-xylene Xylene (m+p)* Xylene (o+m+p)** Bromodichlorometano Bromoform Chloroform Dibromochloromethane Total Trihalomethane (THMs)*** 1,2-Dichloroethane Hexachlorobutadiene Tetrachlorethylene Tetrachloromethane Trichloroethylene New 2019! HALOGENATED SOLVENTS New 2019! New 2019! New 2019! Read more - *: Xylene (m+p) - Sum of m-xylene (CAS number: ) and p-xylene (CAS number: ). **: Xylene (o+m+p) - Sum of o-xylene (CAS number: ), m-xylene (CAS number: ) and p-xylene (CAS number: ). ***: Total Trihalomethane - Sum of Chloroform (CAS number: ), Bromoform (CAS number: ), Dibromochloromethane (CAS number: ) and Bromodichloromethane (CAS number: ). New 2019!: New measurand available in 2019.