Author: Beverly Glass

Demonstration of Capability (DOC), Ammonia NH3

Reference Method (with revision number and effective date)_________________________________________________ SOP number (with revision number and effective date)______________________________________________________

DOC Type: Initial Ongoing

Reason(s) for this DOC:
New Method
Change to Procedure
New Analyte Added to SOP
New Instrument
New Analyst
Annual demonstration (Ongoing)

DOC Data Source:
(What procedure did you use to perform this study?)
Proficiency Testing Study (unknown to lab and analyst) Study ID: ___________
Actual Sample (e.g. effluent; sample with know typical conc. range)
QC Sample (e.g. Lab Control Sample, Lab Fortified Blank, CCV)
Note: the QC may be analyzed concurrently or over a series of days
Monitor Trends (e.g. review of control charts)
Target Analyte(s)___________________________________________________________________________
Matrix____________________________________________________________________________________
Instrument Name (with ID #, Model #, and Serial #)________________________________________________
Prep Technique____________________________________________________________________________
Prep Analyst Name(s) (print)__________________________________________________________________
Reported Units (values must be recorded in same units)____________________________________________
Summary Chart:
(Only applicable to DOCs using “Actual Samples” or “QC Samples” for the data source. For all other DOC data sources, attach a copy of the raw data to this form. Recoveries must meet the criteria in your Quality Manual, as detailed here.)
*Acceptable Recovery: ________% to ________%, Acceptable Standard Deviation or % RSD:_________
Mean__________ %Recovery __________%, Std Deviation of Recovered Values__________, Relative Std Deviation___________%
Analyst Name (print) Analyst Signature Approval Date
Reviewer/Supervisor Name (print) Reviewer/Supervisor Signature Approval Date

Pass
Fail

	Analysis Date	Unique Lab Sample ID	True Value (if known)	Recovered Value	% Recovery	Pass/Fail
1
2
3
4

Created 1/16/2020, BLG
Revised 5/16/24