Clean Water Team Loan of Equipment - Request and Agreement Form

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Name (First and Last)

Address

Phone number(s)

Email Address

Organization Name and Tax ID Number

Do you have a Quality Assurance Project Plan (QAPP)?

Yes

Yes, but It needs to be updated.

No, and we could use some help with our QAPP.

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Is your data going into the California Environmental Data Exchange Network (CEDEN)?

Yes, by my organization.

Yes, through a partnership.

Not yet, but we are planning to.

No, and my organization could use some help with CEDEN.

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Equipment Request

Please contact the Clean Water Team if you have questions on equipment selection. Most items will also require batteries, calibration solutions, standards, and/or chemical reagents that might not be supplied by the Clean Water Team.

Temperature (T)

Armored bulb thermometer

NIST certified and traceable thermometer

Temperature data logger

Other:

Clear selection

pH strips

Handheld meter

Pen meter

Multi-parameter handheld meter

Other:

Clear selection

Salinity Electrical Conductivity

handheld meter (low range)

Handheld meter (mid range)

Handheld meter (high range)

Multi-parameter handheld meter

Other:

Clear selection

Dissolved Oxygen (D.O.)

Self- filling ampoules test kits (Indigo Carmine Method)

Modified Winkler titration test kits (Iodometric Method)

Handheld meter

D.O. data logger

Other:

Clear selection

Turbidity (Water clarity)

Secchi disk and sounding weight

Turbidity tube

Nephelometer (aka: turbidimeter)

Other:

Clear selection

Water Velocity (Flow)

Flow probe

Price AA current meter

Electromagnetic flow meter

Top-setting rod

Other:

Clear selection

Nutrients

Self-filling ampoule test kit (N)

Self-filling ampoule test kit (PO4)

Other:

Clear selection

Spectrometers/Colorimeters

Spectrometer

Reagents - BDO

Reagents - Nutrients

Reagents - Alkalinity

Other:

Clear selection

Fecal Indicator Bacteria (FIBs)

IDEXX Quanti-Tray sealer

Incubator (freshwaters)

Incubator (marine waters)

UV lamp

Expendables (quanta trays, mixing bottles, anti-foaming agent, pipettes, reagents....)

Other:

Clear selection

Bioassessment (Benthic Macro Invertebrates)

Kick net

500 micron sieve

Compass-inclinometer

Stadia rod

Convex densiometer (17 pint modified)

Dissecting microscope

Other:

Clear selection

Fluorometer

Fluorometer (Detection of Optical Brighteners)

Fluorometer (Chlorophyll a)

Fluorometer (Phycocyanin)

Other:

Clear selection

Lab and Field Supplies

Pipettes

Rinse bottles

Glassware

Other:

Clear selection

LOAN OF EQUIPMENT AGREEMENT:

I will take full responsibility for the care of the equipment loaned to me by The State Water Resources Control Board's Clean Water Team. I have read the Terms and Conditions of Equipment Loan on the bottom of this form. By signing this document, I consent to agree to those terms and conditions. I also waive, release, and discharge the State Water Resources Control Board, its trustees, officers, and employees from any claims, demands, costs, causes of action, or damage as a result of property loss or damage, or personal injuries or death sustained to myself or others from the equipment, tools, calibration standards or reagents loaned and that I and or my organization will assume all liability.

If you agree with the above statement, please enter your Name and todays Date.

TERMS AND CONDITIONS OF EQUIPMENT LOAN

1) It is the Loanee’s responsibility to read and understand all equipment and tool instructions as provided by the manufacture(s). Read, understand, and comply with all Safety Data Sheet (SDS) for all calibration standards, and reagent instructions. Laboratory operations should conform to all local, state, and federal laws.

2) Research laboratories and field work present many hazards that are significantly different from what most participants are exposed to in everyday life. The Loanee will be responsible for all hazard and safety communications to their staff, volunteers, and others as needed.

3) The Loanee acknowledges that the activities those participating in while using the loaned equipment will have certain known and anticipated as well as unknown and unanticipated risks associated with them. The Loanee understands and acknowledges that the risks could cause any of the following: injury, illness, or death to myself and/or others; and/or damage to or destruction of my or another person(s) property.

4) Loanee is responsible for returning the equipment to loaner clean and without damage.

4 a) You are responsible for inspecting all equipment carefully and to bring any missing or damaged equipment to the Clean Water Team’s attention. Make sure any discrepancies are noted on the loan of equipment agreement form. Failure to note any discrepancies may result in a requirement to replace damaged or missing equipment. If needed, please refer to the manufacturer’s manual/instructions on how to properly set-up and use the equipment.

5) Equipment will be returned to loaner within four (4) calendar days after the last day of the period for which the equipment was loaned. Loaner reserves the right to shorten this period if other parties require equipment for outdoor activities within the four-day period. Loanee will be notified in writing of such a change.

6) Loanee agrees to replace any equipment damaged or lost while under loan within fourteen (14) calendar days from the date of the last day of the period for which the equipment was loaned.

7) Loanee agrees that any equipment purchased by loanee to replace equipment that are lost or damaged will be of similar quality and of the same specifications as the lost or damaged equipment.

8) Loanee assumes all financial responsibility for replacing lost or damaged equipment. Loanee will not expect loaner to reimburse loanee for replaced equipment.

Reference to any specific company, products, processes, or services by trade name, trademark, manufacturer, or otherwise, as part of the Clean Water Team’s Loan of Equipment Program, does not constitute or imply its endorsement, recommendation, or favoring by the State of California.

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