NCD003200383_19890424_Koppers Co. Inc._SERB SAP QAPP_Private Well Sampling - February 1989-OCR

N. C. Department of Human Resources
Division of Health Services
Ju p
SAMPLE ANALYSES REQUEST
State Laboratory of Public Health
P. 0. Box 28047
306 N. Wilmington Street
Site Number
Raleigh, 2761 I
---<~c..-;,,;:1_,_,_,,b~o,...,o.c,='3'-"'-1,.,"=-LJ(D)CJ.L=3_,_,,,J'c..3..,_ __ Field Sample Number _ _,!/4~',:J-~J~r'-.---------
Name of Sire ./2:i. (1/2,n,f ,-;.f f'.:a_ Lb L Site Location oJ1)cc1; itrj/,u_,
-:r,;; 7 I Al(
Collected By /(EiC ;{;~ flt: he/?<,1/t+ID# ,3 s> Dare Collected & Ii ,Lee; ./ I
Time _____ _
Type of Sample:
Environmental
___L_ Groundwater (I)
___ Surface Water (2)
__ Soil (3)
__ Other (4)
Extractables
Concentrate Comments
__ Solid (5)
__ Liquid (6)
__ Sludge (7)
__ Other (8)
·zr 1~ i3Jaak.-REC!E~\JED
<:IIPJ:RFIIND BRANCH
INORGANIC CHEMISTRY
Total ·;,
Parameter Results mg/ 1 Parameter Results mg/ 1 Parameter Results mg/ 1
__ Arsenic __ Arsenic __ silver
__ Barium __ Barium " __ Sulfates
__ Cadmium __ Cadmium __ Zinc
__ Chromium __ Chloride _Ph
__ Lead __ Chromium __ Conductivity
__ Mercury __ Copper _TDS
__ Selenium __ Fluoride _TOC
__ Silver __ Iron --
--__ Lead --
--__ Manganese --
--__ Mercury --
--__ Nitrate --
--__ Selenium --
ORGANIC CHEMISTRY
Parameter Results mg/ 1 Parameter Results mg/ 1 Parameter Results mg/ I
LP&T:GC/MS _EDB __ Methoxychlor
__ Acid:B/N Ext. __ PCB's __ T oxaphene
_TOX __ Petroleum _2,4-D
--__ Endrin __ 2,4,5,TP (silvex)
~ I.PE OQ~ Sf£ ATT6CtiEu f.H :EI(S)Lindane --
MICROBIOLOGY RADIOCHEMISTRY
Parameter Parameter Results PCi/ I j
__ (MF) Coliform Colonies/lOOmls __ Gross Alpha ,/
__ (MPN) Coliform Colonies/lOOmls __ Gross Beta
----
----
Date Received d-I .S--8' 7 Q 1.._Q Date Reported ___ ~_-_,,,2_(,/_-tf"---'f'----------
i'r /&ct "'1 J
Date Extracte~ Date Analyzed,.il11/i95:r/l1V1 ·, d-0,, I -?9-ndJ ·-
,0 _ f c#+ll-6,PIJ · ' 90niQR
Reported By ~~()6-[&rtoA/ Lab Number _______ -___________ _
1-IMIT 7-/<f-lr7
DHS319l(Revlsed7/65) dc;/},f3ac_ 0,1 A
Sol1J anJ Ha1ardous Waste (Review ?/87) "/J / (.,/ll-/ 0 / U {/ ~ 7
•
• J.C. Department of Human Resources
)ivision of Health Services SAMPLE ANALYSES REQUEST
State Laboratory of Public Health
P. 0. Box 28047
306 N. Wilmington Street
Raleigh, 27611
)ice Number
\Jame of Site
:ollected By
r ypc o( Sample:
Environmental
___lL.. Groundwater (1)
___ Surface Water (2)
__ Soil (3)
__ Other (4)
Concentrate
__ Solid (5)
__ Liquid (6)
___ Sludge (7)
___ Other (8)
Field Sample Number ___ · ,,,_~ ____ . ..Q-"-'cf>"'---'~-"f'--_· _________ _
Sire Loca,ion /221',crr; [(d/Cy
I j
Date Collected & /;.,/R'f ./ I
Ll/C
Time _____ _
Comments
· 1c'r? :.3/oqk
INORGANIC CHEMISTRY
SUP£RFUND BRANCH
Extractables Total
Parameter Results mg/ 1 Parameter Results mg/ l Parameter Results mg/ l
__ Arsenic __ Arsenic __ Silver
__ Barium __ Barium __ Sulfates
__ Cadmium __ Cadmium __ Zinc
__ Chromium __ Chloride __ Ph
__ Lead __ Chromium __ Conductivity
__ Mercury __ Copper _TDS
__ Selenium __ fluoride _Toe
__ Silver __ Iron --
--__ Lead --
--__ Manganese --
--__ Mercury --
--__ Nitrate --
--__ Selenium --
ORGANIC CHEMISTRY
Parameter Results· Parameter Results mg/ l Parameter Results mg/ l
_P&T:GC/MS _EDB __ Merhoxychlor
~ Acid:B/N Exe. __ PCB's __ Toxaphene
__ TOX __ Petroleum _2,4-D
.:;t__ Pe.Pun_~
__ Endrin __ 2,4,5-TP (silvex)
LO,W l~L'-__ Lindane --
MICROBIOLOGY RADIOCHEMISTRY
Parameter Parameter Re.suits PCi/ l
__ (MF) Coliform Colonies/lOOmls __ Gross Alpha
__ (MPN) Coliform Colonies/lOOmls __ Gross Beta
----__ , --.
Dare Received c:J -IS--fi' '1 fJ J'...9 Date Reported-----~--------------
Dare Extracted ~_c__,f'·:t=l=:i.=~~fa'-Jc,'-';J'---"-3""~-'-'/f;'.;,_,__-"/w=-----Date Analyzed --'3"-/~1 ~I ~'-!,,....,"+~3h~if9'='-!D'-==--------
Reported By
9(}0 ~:, Q 9
____________________ Lab Number ---------------"--------
DHS 3191 (Revised 7185)
Solid and Haz:i.rdous Waste (Review 7 /87)
' I
C. DepartmCnt of Human Resources
vision of Health Services
• SAMPLE ANALYSES REQUEST
State Laboratory of Public Health
P. 0. Box 28047
306 N. Wilmington Street
Raleigh, 27611
te Number -~,LCJ_,,___"'b"--"o"-'a'-"<-3LO';L.,.._,r..1.DJ.lL..e3.,---"'.J''--'•-=s'----Field Sample Number --~~_._d..,,_-"f'--'2~--------
ame of Sire /(°J'11:: I e,'( (1/) , ,.Ii, L Site L.ocaiion ,/21tccr; [N/,l{_,7 /\((
ollected By YU zGc Md }) e 72tY11-10# 3 ~ Date Collected ,jJ /1 s-1 ,e q
I
./ I f-Time Ma<
ype of Sample:
Environmental
_..\L.. Groundwater ( 1 ).
___ Surface Water (2)
__ Soil (3)
__ Other (4)
Concentrate
__ Solid (SJ
__ Liquid (6)
__ Sludge (7)
__ Other (8)
INORGANIC CHEMISTRY
Extractable•
Parameter Results mg/ 1 Parameter Results mg/1
__ Arsenic __ Arsenic
__ Barium __ Barium
__ Cadmium __ Cadmium
__ Chromium __ Chloride
__ Lead __ Chromium
__ Mercury __ Copper
__ Selenium __ Fluoride
__ Silver __ Iron
--__ Lead
--__ Manganese
--__ Mercury
--__ Nitrate
--__ Selenium
ORGANIC CHEMISTRY
Parameter Results mg/ 1 Parameter Results mg/1
LP&T:GC/MS _EDB
__ Acid:B/N Ext. __ PCB's
_TOX __ Petroleum
__ Endrin
i 1 rr ri/111, SEE ATTl\Ct:IEI:! SH Il(S)Lindane.
J
MICROBIOLOGY
Parameter Parameter
__ (MF) Coliform Colonies/lOOmls __ Gross Alpha
__ (MPN) Coliform Colonies/!OOmls __ Gross Beta
----
----
Comments
1·1-1 ·i 1, ·ogg vi..~ (.l .t (..,
SUPERFUND BRANCH
Total
Parameter Results mg/ 1
__ Silver
__ Sulfates
__ Zinc
_Ph
__ Conductivity
_TDS
_TOC
--
----
--
----
Parameter Results mg/1
__ Merhoxychlor
__ T oxaphene
_2,4,D
__ 2,4,5-TP (silvex)
--
RADIOCHEMISTRY
R~sults PCi/ 1
Dare Received ....c..d~----'~s-_--'f~7-~l3~10=Q.c_.c. _______ Dare Reported-----~------------
~ol'.. . prj&c-/r.Ao
Date Extracted __________________ Date Analyzed ~t1/6 'iijf]'! ol.-2,IJ-,?9 zu,,-
Reported By _________________ Lab Number 90()/)(\0
OHS 3191 {Revised 7/85)
Solid and Hazardous Waste {Review 7/87)
• N. C. Department of Human Resources
Division of Health Services SAMPLE ANALYSES REQUEST
State Laboratory of Public Health
P. 0. Box 28047
306 N. Wilmington Street
Site Number
Raleigh, 2 7611
a )',(/•) oa
_7'-"'-'d,'~=/J~{}~C)~,5'--'d---=~{~W~.B~J'~3~---Field Sample Number --~z.__.__o<~/~--------
Namc of Site IIO-(v13 ,(,":.< ~ • L/l L Site )_,oca_rion 1/21()cr1; rv-c/,y_,,1
Collected 13y ,f'E/c zfi~ ML: DeRtYLrlD# ,3 2 Date Collected ol /; .,/ ,£7' I I
,I\[(
Time &3.<
Type of Sample:
Environmental Concentrate Comments
_£ Groundwater (1) ___ Solid (5) IJ (-0-'J :3 /I) e lvt n ·2~3 (,LI ff!j
___ Surface Water (2) ___ Liquid (6)
__ Soil (3) __ Sludge (7)
__ Other (4) __ Other (8)
INORGANIC CHEMISTRY SUPER FUND RRANrl-1
Extractables Total
Parameter Results mg/ 1 Parameter Results mg/1 Parameter Results mg/ 1
__ · Arsenic __ Arsenic __ Silver
__ Barium __ Barium __ Sulfates
__ Cadmium __ Cadmium __ Zinc
__ Chromium __ Chloride _Ph
__ Lead __ Chromium __ Conductivity
__ Mercury __ Copper _TDS
__ Selenium __ Fluoride _TOC
__ Silver __ Iron --
--__ Lead --
--__ Manganese --
--__ Mercury --
--__ Nitrate --
--__ Selenium --
ORGANIC CHEMISTRY
P3.rameter Results mg/ 1 Parameter Results mg/ 1 Parameter Results mg/I
_P&T:GC/MS _EDB __ Methoxychlor
_..L Acid:B/N Ext. __ PCB"s __ Toxaphene
_TOX __ Petroleum _2,4-D
__ Endrin __ 2,4.5-TP (silvex)
± r11 f-' ,,., I, . -l..O.o:?ftff /I-__ Lindane --
~ I . I i.
MICROBIOLOGY RADIOCHEMISTRY
.
Parameter Parameter Results PCi/1
__ (MF) Coliform Colonies/l00mls __ Gross Alpha
__ (MPN) Coliform Colonies/l00mls __ Gross Beta
----
' --
Date Reported-----~---,-~---=-----
Date Analyzed _f c_f--''.?'-'!.L.,\LJJ8:9'-.L--'-'l---'--3....!.jq~l 8'1::_:_....._!f._:W ___ _
Reported By Lab Number -----'-~"'-,-_._0_(_l'-'u=-('-'\-'1'---------
OHS 3191 (Rcvis,d 7/65)
Solid and Hazardous Waste (Review 7/87)
JP
C. Department of Human Resources
vision of Health Services • SAMPLE ANALYSES REQUEST
State Laboratory of Public Health
P. 0. Box 28047
306 N. Wilmington Street
Raleigh, 27611
__,Z-o<--:L"'-"=b'---"'o-'-a"'-"3""-;L=_,_(tp.w.,c,3-,· _,,J'c_..3~--Field Sample Number _ __,_Y:--'o:J=---..:...9_,_/ _______ _
te Number
amcofSitc /(O-o,n,u:.r Cd L/J L SiteLoca_tion /22{1cr1;[N/6,
-y-,;; I I
ollected By j(tjc ifi~ ftLt: he/?/)ffeIDN ,3 J? Dace Collected dJ /1-,/£'7 I I
/\IC
Time Of,tj
;pc of Sample:
Environmental Concentrate Comn1ents
__L Groundwater (1) __ Solid (5)
__ Surface Water (2) __ Liquid (6)
__ Soil (3) __ Sludge (7) REGEiVIED
__ Other (4) ___ Other (8)
INORGANIC CHEMISTRY SUPER FUND RRIINrl-1
Extractable6 Total
Parameter Results mg/ 1 Parameter Results mg/ 1 Parameter Results mg/ 1
__ Arsenic __ Arsenic __ Silver
__ Barium __ Barium __ Sulfates
__ Cadmium __ Cadmium __ Zinc
__ Chromium __ Chloride _Ph
__ Lead __ Chromium __ Conductivity
__ Mercury __ Copper _TDS
__ Selenium __ Fluoride _TOC
__ Silver __ Iron --
--__ Lead --
--__ Manganese --
--__ Mercury --
--__ Nitrate --
--__ Selenium --
ORGANIC CHEMISTRY
Parameter Results mg/ 1 Parameter Results mg/ 1 Parameter Results mg/I
-1..P&T:GC/MS __ EDB __ Mechoxychlor
__ Acid:B/N Ext. __ PCB's __ T oxaphene
_TOX __ Petroleum _2,4-D
__ Endrin __ 2,4,5-TP (silvex)
L If£ tTo-!!J .SEE AU~CtlEO SH£ @_Lindane --
MICROBIOLOGY RADIOCHEMISTRY
Parameter Parameter Results PCi/ 1
__ (MF) Coliform Colonies/lOOmls
__ (MPN) Coliform Colonies/lOOmls
__ Gross Alpha
__ Gross Beta
Date Received __ d?_-~/_J-~~~f_· _9_JJ~J!J~. _______ Date Reported .
~oe-I I . · pr/6(.;;,,,1,::i
Date Extracted Date Analyzed Jja, S 11 /2 .z-20-f<t 7u,,-
Reported By __________________ Lab Number 90 · £.~ n2
OHS 3191 (Rcvis,d 7/85)
Solid and Hazardous Waste (Review 7/87)
?it. ~ •. f'e-d' ~ cru /N.'9
J. C. Deparrrrn:nt of Human Resources
)ivision of Health Services SAMPLE ANALYSES REQUEST
State Laboratory of Public Health
P. 0. Box 2804 7
306 N. Wilmington Street
Raldgh, 27611
__.,c?,'-'~_,,,' ~/)~O~C2~.2=cb-~C~tD~3~J'~3~--Field Sample Number __ ij-L.J..;J.oc._,.9_,'J-~--------iicc Number
-Jamc of Site /2i. 0--tm j ,-:, L &_ ' Lil L Site J.,oca;ion /22{)cr ,; rH-il-<.1
~ I j
:ollected By ,£££ i£.~ ML/: })pft2fltID# c3 2 Dace Collected & /1-,/£'7
Ill(
Ti me tf/'v._ (,,.-,-
r ype of Sample:
Environmental
___£ Groundwater ( 1)
___ Surface Water (2)
__ Soil (3)
__ Ocher (4)
Concentrate
__ Solid (5)
___ liquid (6)
__ Sludge (7)
__ Other (8)
./ I ,
Con1n1cnts
iff -R.ooctJ fk.Slfc
\RIECIE~VIEl!J
INORGANIC CHEMISTRY ~llDt'OrllMn 00••1nu -.... , -....... .... IHHI-I
Extractables Total
Parameter Results mg/ l Parameter Results mg/ l Parameter Results mg/ l
__ Arsenic __ Arsenic __ Silver
__ Barium __ Barium __ Sulfates
__ Cadmium __ Cadmium __ Zinc
__ Chromium __ Chloride _Ph
__ Lead __ Chromium __ Conductivity
__ Mercury __ Copper _TOS
__ Selenium __ Fluoride _TOC
__ Silver __ Iron --
--__ Lead --
--__ Manganese --
--__ Mercury --
--__ Nitrate. --
--__ Selenium --
ORGANIC CHEMISTRY
Parameter Results mg/ l Parameter Results mg/ l Parameter Results mg/ l
_P&T:GC/MS .-EDB __ Methoxychlor
~ Acid:B/N Exe. __ PCB's __ T oxaphene
_TOX __ Petroleum _2,4-0
__ Endrin __ 2,4,5-TP (silvex)
.:'lJ_ P(!.P •-Al,, 1..75.o;;.i'f t ~ __ Lindane --
. '-I
MICROBIOLOGY RADIOCHEMISTRY
.
Parameter Parameter Results PCi/ l
__ (MF) Coliform Colonies/lOOmls __ Gross Alpha
__ (MPN) Coliform Colonies/lOOmls __ Gross Beta
----
----
Date Reported --,,~--~--------------
Dace Analyzed _fi_tP_ . ...,_3 .... /1~/~~'Y-:?~~ f~q~/g~'j _____ _
Reported By Lab Number 9f)fl60:-J
OHS 3191 (Revi><d 7185)
Solid and Hazardous Waste (Review 7/87)
N. C. Department of Human Resources
Division of Health Services • SAMPLE ANALYSES REQUEST
State Laboratory of Public He~lth
P. 0. Box 28047
306 N. Wilmington Street
--'-~---":L""'' "-'b""'-o"'--'-"o~,'ic..:1=.=-.LL<W~~~"--'J'"'----3'-----Field Sample Number ffe:: ¼-9 Z3
NamcofSirc kQ.-oa,1,-;,< & . UJ L Sire)._ocaiion /22e,cr1:rH/,lc, Site Number
.,.,_,..,. ,, IJ
Collected By ,KM 7Jc flt: uelZ&AlD# c3:? Dare Collected & /1,,Lf7
Type of Sample:
Environmental
__JL_ Groundwater ( 1)
___ Surface Water (2)
__ Soil (3)
__ Other (4)
Concentrate
__ Solid (SJ
__ Liquid (6)
__ Sludge (7)
__ Other (8)
l I
Comments
i)eikr!:J m-/_rf 4':-c{
Raleigh, 27611
Ill(
Time,/(),5]1
"'•1r.rl"II,-., •• , ... -....... .. INORGANIC CHEMISTRY
Extractables Total vv, L.I\I U11U DllttlH,11
Parameter Results mg/ l Pararhetcr Results mg/ l Parameter Results mg/1
__ Arsenic __ Arsenic __ Silver
__ Barium __ Barium __ Sulfates
__ Cadmium __ Cadmium __ Zinc
__ Chromium __ Chloride _Ph
__ Lead __ Chromium __ Conductivity
__ Mercury __ Coppe, _TDS
__ Selenium __ Fluoride _TOC
__ Silver __ Iron --
--__ Lead --
--__ Manganese --
--__ Mercury --
--__ Nitrate --
--__ Selenium --
ORGANIC CHEMISTRY
Paraffieter Results mg/ l Parameter Results mg/ 1 Parameter Results mg/ l
4P&T:GC/MS _EDB __ Methoxychlor
__ Acid:B/N Ext. __ PCB's __ Toxaphene
_TOX __ Petroleum _2,4-D
Endrin __ 2.4.5-TP (silvex)
2LU°f ·~ SEE ATTACHED SH "ET(S\.indane --
MICROBIOLOGY RADIOCHEMISTRY
Parameter Parameter Results PCi/ l
--(MF) Coliform Colonies/!O0mls __ Gross Alpha
__ (MPN) Coliform Colonies/lO0mls __ Gross Beta
----
----
d ..,. I -~--o CJ &5).__ -----~,5----~--------Date Reported-----~--,,--,-,-,----------~ !7T"l&</M?
Date Extracted ------------------Date Analyzed ".,P:f-17+/.,,.s1=1-'-",,-P_11.,__,£~:,2,uV<..-.. f~9-'---'?(,ur='-------
Date Received
'
Reported By ____________________ Lab Number
OHS 3191 (RcviS<d 7/85)
Soli~ and Hazardous Waste (Review 7 /87)
I
C. Ocpanment of Human Resources
vision of H~alth Services • SAMPLE ANALYSES REQUEST
State Laboratory of Public Health
P. 0. Box 28047
306 N. Wilmington Street
Raleigh, 2761 I
__,Z'....C"l""-"b"'--"o'-'a-'-• ...,3''-<J._,,=.1..Cill'-'-'-'~""~'--".J''--'3-'----Field Sample Number --~Y'.~· /)~'J_y~·-------
tc Number
amc of Site ~. 4-&n.J,7, L f°-0_ . Lb L Site J...ocarion oJ{'ccr; [!rl/.(u
,.__,......In J . J
ollectcd By ,J:'E/c Ji, HU IJfbAID# ,3 J? Date Collected & /;.,/cf<f
llfC
ypc of Sample:
Environmental
_£. Grou~dwater (1)
__ Surface Water (2)
__ Soil (3)
__ Other (4)
Concentrate
__ Solid (5)
__ Liquid (6)
__ Sludge (7)
__ Other (8)
I I I
Time /Q 5]')
Com.men ts
r().f -r.J'l A-e!H0fj lrut!...ad(
RtCt~VED
\\ '.1
INORGANIC CHEMISTRY Sl!Prnrnrun DDAM""
Extractable, Total
..........
Parameter Results mg/ l Parameter Results mg/ l Parameter Results mg/ l
__ Arsenic __ Arsenic __ Silver
__ Barium __ Barium __ Sulfates
__ Cadmium __ Cadmium __ Zinc
__ Chromium __ Chloride _Ph
__ Lead __ Chromium __ Conductivity
__ Mercury __ Copper _TDS
__ Selenium __ Fluoride _TOC
__ Silver __ Iron --
--__ Lead --
--__ Manganese --
--__ Mercury --
--__ Nitrate --
--__ Selenium --
ORGANIC CHEMISTRY
Parameter Results mg/1 Parameter Results mg/ l Parameter Results mg/ l
_P&T:GC/MS .-EDB __ Methoxychlor
L Acid:B/N Exe. __ PCB's __ Toxaphene
_TOX __ Petroleum _2,4-D
__ Endrin __ 2,4,5-TP (silvex)
± f[l__f' (¥11.:!J L0,0~ 7Uj tL __ Lindane --
MICROBIOLOGY RADIOCHEMISTRY
Parameter Parameter Results PCi/ 1
__ (MF) Coliform Colonies/ IOOmls --Gross Alpha
__ (MPN) Coliform Colonies/lOOmls __ Gross Beta
----
----
Date Received ~-./ S--Jl "J J3 t!}_
Rei;! . I I 6)
Date Extracted j/-;i. /<,?9 Cf 3 IO 'is9 9
Date Reported ~=---~------------
Date Analyzed _r_rP__,,3}~!,/,...,p;..,_q_V-~:?,"-'/'-'-''t 2<..J.'-'/gq'-'--'-i...:;.cJ..:._ ___ _
Reported By __________________ Lab Number _____ ?_,'i_O_._L_o_0-'"5"----------
, DHS 3191 (ReviS<d 7/85)
1 Solid and Hazardous Waste (Review 7/87)
N. C. Department of Human Resources
bi vision of Health Services SAMPLE ANALYSES REQUEST
State Laboratory of Public Health
P. 0. Box 28047
306 N. Wilmington Street
~ Raleigh, 2 7611
~~'--0':2-'-"bcc.__..oo~o~.'3u:cb:=-.~<tnLJ.~8-· '-",J~3""'------Field Sample Number ___ ,'f.!._;J,_·:.._.f_.s_· ______ _ Site Number
Name of Site _;½'-_'-"4--0417'-"l-'~/..,G~S:::'--'-(O,,-./lL~--M-· -'--'L=----Site J.,oca,ion /J2,Qcr f; [N//,<,, -T,;; I J
Collected By /(E,/c tnc /tJ: heR<YltlD# ,3 fl Date Collected & /1.,/R'j'.
T1·pe of Sample:
Environmental
__1L_ Groundwater (I)
___ Surface Water (2)
__ Soil (3)
Concentrate
./ I
Comments
()[-3 mac /4, da kec
/2[(
Time~,~l~.l'-LL~I __
__ Other (4)
__ Solid (5)
__ liquid (6)
__ Sludge (7)
__ Other (8) I! 1: . ,I 1 'OQO
.•.J\.,,_ ....
INORGANIC CHEMISTRY ~IIPrDi:nr,m "DAl\l/'IJ -...........
Extractables Total
Parameter Results mg/ 1 Parameter Results mg/ 1 Parameter Results mg/ 1
__ Arsenic __ Arsenic __ Silver
__ Barium __ Barium __ Sulfates
__ Cadmium __ Cadmium __ Zinc
__ Chromium __ Chloride _Ph
__ Lead __ Chromium __ Conductivity
__ Mercury __ Copper _TDS
__ Selenium __ Fluoride _TOC
__ Silver __ Iron --
__ Lead ----
--__ Manganese --
--__ Mercury --
__ Nitrate ----__ Selenium ----
ORGANIC CHEMISTRY
Parameter Results mg/ 1 Parameter Results mg/ 1 Parameter Results mg/ 1
_,L_ P& T:GC/MS _EDB __ Methoxychlor
__ Acid:B/N Ext. __ PCB'.s __ Toxaphene
_TOX __ Petroleum _2,4-D
Endrin __ 2,4,5-TP (silvex) --
.:1t... r_e1> ~-SEE ATTA(;HEQ SHI ET(S\ Lindane --
MICROBIOLOGY RADIOCHEMISTRY
Parameter Parameter Results PCi/1
__ (MF) Coliform Colonies/!OOmls __ Gross Alpha
__ (MPN) Coliform Colonies/lOOmls __ Gross Beta
--------
Date Received _,d"'----· .,_l.,.0_'---_--'y'--·_9_:__t3.c...._l)___;_:c_· -------Date Reported -----~--,-~=-------
Date Extracted __________________ Date AnalyzeJ0(_ajr1/ ~qij-/J"'M. ~-!/ifi{.,.,_,..,-
. 9'1fl!.J or Lab Number · · · ._) Reported By
DHS3l91 (Revised 7/85)
SoliJ and Hazardous Waste (Review 7/87)
N. C. Department of Huni.an Resources
'bi vision of Health Services SAMPLE ANALYSES REQUEST
State Laboratory of Public He3.lth
P. 0. Box 28047
306 N. Wilmington Street
Site Number
Raleigh, 2761 I
_.,_9,_..,d-,~})~IJ~Q=,'3<-<cb.=-~CD2~3~J'~3~--Field Sample Number __ _,{/;c...d'--'-'-f-'10~·------
Namc of Site kP-::oa, Ir..< 01 , Uz L Site )...oca;ion /22{;cct; [1(1'/,6..,,
-=--r-"'t,.., )J
Collected By ,rf&e ifc ML: hel?m,110# ,3:? Date Collected d) /1,:,/,e7 :; I Time ~/'--'-1-,,/c,7,_1 __
Type of Sample:
Environmental Concentrate Comments
_L Groundwater ( 1) __ Solid (5) 12-S-3 OJiuJ,,c 2-ia k-e r
__ Surface Water (2) ___ Liquid (6)
__ Soil (3) __ Sludge (7)
__ Other (4) _· __ Other (8)
INORGANIC CHEMISTRY SUP £RFUND BRANr.H
Extractables Total
Parameter Results mg/ 1 Paramete~ Results mg/ 1 Parameter Results mg/ 1
__ .Arsenic __ Arsenic __ Silver
__ Barium __ Barium __ Sulfates
__ Cadmium __ Cadmium __ Zinc
__ Chromium __ Chloride _Ph
__ Lead __ Chromium __ Conductivity
__ Mercury __ Copper _TDS
__ Selenium __ Fluoride _TOC
__ Silver __ Iron --
--__ Lead --
--__ Manganese --
--__ Mercury --
--__ Nitrate --
--__ Selenium --
ORGANIC CHEMISTRY
Parameter Results mg/ 1 Parameter Results mg/ 1 Parameter Results mg/ 1
_P&T:GC/MS _EOB __ Methoxychlor
..,L_ Acid:B/N Ext. __ PCB's __ Toxaphene
_TOX __ Petroleum _2,4-0
--__ Endrin __ 2,4,5-TP (silvex)
~ P(I f-' mi , . L0.0:J ,., IL __ Lindane --
-\ , v•
MICROBIOLOGY . RADIOCHEMISTRY
Parameter Parameter Re~ults PCi/ 1
__ (MF) Coliform Colonies/lOOmls __ Gross Alpha
__ (MPN) Coliform Colonies/lOOmls __ Gross Beta
----.
----
Date Received ;; -Is--J' '7 t3 ..&
Date Extracte/c\l '3/a /'ifi 'i-3lco /fR ~~ Date Reported--~--~------------
fCJ> 3b/'is9 "r-3/13/g=j f'uJ
Date Analyzed ---------~--------
Reported By __________________ Lab .Number
OHS 3191 (Revised 7/85)
SoliJ :and Hatardous Waste (Review 7 /87)
4DIVISION OF HEALTi SERVICES
SOL IDWJ) EJ..2ARDOU S \lASTE !-'J-.NAGEY.D; •• ,.!.NCE
C"nain of Custoch· Re·c:ord
E2z2rdous ~asc.e Materials RECEIVED
Loc:a~ic~ of Sampling: Gener2-:or __ Transporte~
( /,H, j_f a /7?+,'11(; (. ;'---"'c
l/ :J
Co:i;pany's Name ·~,S
Address ,m 0,,--Q (IM-i/ (/_ :;, /lLG
Collector• s Name)(£ A ;I;.--a.,,f/)..1 ~4
signature
Telephone( __ _.) _______ _
Date S2.!!!pled _ _____,r,}_.·'-------'/C.:'.::i=---___,,f.__'7'--_________ Time S=pled 6?,:f'3s -II 11
Type o: Process Generati2g ilaste ------------------------
. FielC. I:::i..fonnation
·:Fie.le Sample No.
Cn~in c: Possession:
1.
signature I
2. Y2rk@r+
• signature
3.
sig:1at.ure 7
~es~:~s reported
sig:-.a:cure
J9J'.'l
Y,Qf£ . '
&Ju~r.( l?/wz«d---
title
t.itle
inclusive dates
/£230
oJ-1.r-f'9
inclusive dates
inclusive dates
date
Ins:::-uctions: Coplplete c..11 2pplic2ble info~ation incluCir.~ signatures, 2nd
· submit ,cith ·.analysis request forms.
• $!All: LABORATORY OF PUBLIC HEAi
DIV!SlON OF HEALTH SERVICES, N.C. DEPARTMENT Of HUMAN RESOURCES
PO BOX 28047 306 N WILMINGTON ST RAIElGH NC 27611 -. .
Date of Analysis ;/;7 Is 9 ORGANIC CHEMICAL AtlALYS!S
--Lab No. l/ [)_I) . .,, 'i 'x' I,{ I} I! J/J /J n
PURGENJLE COMPOUNDS Field# ,
-MDL
Tvne ( I ) ( I ) -CQ11eQi.1Nll 11,,.; t ,-/ .,.,/1\ .,,., /l,,. A«i"I) ,,,../Vn -'. n(}J, r,: ···•di fluun.,·,.··,• L, -~,C. -~.LL --
. :~I•. .. '·· .. ::,·hdne -I_Y_L_·_
✓Vi nv1 en lcr i ,:i(' -
Bran::methane
Chloroethane
Trlchlorofluoranethane
✓1 1 Di ch loroethvlene
Methylene Chloride
tert-Butvl Methvl Ether
_ (Transl l 2-Dich loroethvl ene
I snnrrinvl ether -· l 1-Dichloroethane
2.2 Oichlornnrooane
(Ci s l l 2-Dichloroethvlene -
Chloroform
(BCH) Brarochloro-rethane
✓1 1.1-Trichloroethane
1. 1 Dichloroor(Y)ene
✓carbon Tetrachloride
✓Benzene
✓1 2-0ichloroethane
{Tri ch loroethvlene
-112-0ichloroQropane
Br01cdi ell l oron?thane -.. Pi br~thane
Toluene .
1 1 2-lrichloroethane -Tetrachloroethene -__ l, 3-Di ch loc22ro2ane
Oibrmochloro-rethane I
l 2-0ibraroethane (EDB) . , i -1-Chlorohexane ' I ,'/ ' I
--
-·
-
CCA'N:NTS:
J -Estimated value.
K -Actual value ls known to be less than value given.
L -Actual value is known to be greater than value given.
U -Material was analyzed for but not detected.
NA -Not analyzed.
1/ -Tentative identification.
MDL -Minimum Detection Limit for water (EPA Method 502.2), µg/1.
✓ -Re9ulated voe T -Tr1halo-rethane
N.C. Division of Health Services
OHS 3068--0 (4/88 Laboratory)
L\_
I
·+ fa.;:_<!..
l,\.
..J..rn" e.,.
;
'
I I
Y/)1)4,, 1 , " ,, ,!, 'ft II J LI--'{)/_
I I ) ( I l (/ l
/ ,,a!V ""'"" ,<.,;n ).,n/vn /4,,.., ,i) . ,.,/1,,n
U--. I ,< ···-
IU II.. -. n;; I UJ!;;n 11 . """' 71ml 'Ui.:=11=:'
,, .. ; 111; .,\
~JI., '-(.j. ~ t-.,vv
-··---····----uuri::1 rum; DRl\l,t,1 1
' I ' I
PURGEABLE COl1POUNDS
o==,.,n
Chlorobenzene
Ethvlbenzene
1.1 1.2-Tetrachloroethane -n-Xvlene
m-Xvlene
o-Xvlene
Stvrene
• STATE LABORATORY Of PUBLIC HEAL.
DIVISION Of HEALTH SERVICES, N.C. DEPARTMENT Of HUMAN RESOURCES
P.O. BOX 28047 -306 N. WILMINGTON Sl, RALEIGH, N.C. 27611
ORGANIC CHEMICAL ANALYSIS
Lab No. '-/{)I) -i, <j ~, 'IIJ,,, 4,11 n ~jl/1.t.p/Jl'J
MDL Field#
Type ( l l (1 l ( I )
lloit< /t,n/1) un/Vn ,,<.;,11 l,n/On /,;all '\.~/On
l " ,., I, ~ j -· Ii ,,
r I, '
;
==· In It" I
'f/l /l ,d,n,J.. Cl/!" ,1,11 /_ •
l I l I I )
/.fn/ 1 ).,n/On (,CnJj ~n/Cn -" '
-~· -~ .. . ~---~
-..::.. n=rr 1 ftlZ'!:'""'1.
1!1"' ~ IU 11"' D 9
Braooform ll I :-1, l! '1~!!:1~l
!St'V'lNVlvlbenzene
1 1.2.2-Tetrachloroethane
Brarobenzene
n-Prnnvlbenzene -l 2,3-Trichloronronane ' ; -2-Chlorotoluene ! i
1 3 5-Trimethvlbenzene I I ' -4-Chlorotoluene i
_ nertl Butvl Benzene I !
Pentachloroethane i !
1,2,4-Trimeth~lbenzene : j
(Sec) Butvl Benzene I i
_D· IsfV1rfVlvltoluene i I
1.3-Dichlorobenzene ' ! '
✓1.4-Dichloroben,ene i '
n-Butvlbenzene ' '
1. 2-Di ch lorobenzene :
_(Bis) 2 Chloroisoornovl Ether ! :
1.2 Dlbraoo-3 ChloNV'\rfY"lane i -1 2 4-Trichlorobenzene : :
Hexachlorobutadiene ; '
Naohthalene
_.1.,2 3-Trichlorobenzene V V . I
-
J -Estimated value.
K -Actual value is known to be less than value given.
L -Actual value is known to be greater than value given.
U -Material was analyzed for but not detected.
NA,-Not analyzed.
1/ -Tentative identification.
MDL -Minimum Detection Limit for water (EPA Method 502.2), µg/1.
✓ -Re9ulated VOC
T -Tr1halcmethane
N.C. Division of Health Services
OHS 3068--0 (4188 Laboratory)
CllD!:I tllMn lDAll/1 I --· -. -··-""llflll-I
I
'
-!,/ I I \
Ji )5 -c._ lt_
~ v~..,C
7J-Jl0'::27Q
• •
• • State Laboratory of Public Health
N. C. Department of Human Resources
Division of Health Services SAMPLE ANALYSES REQUEST P. 0. Box 28047
306 N. Wilmington Street
Site Number
Raleigh, 27611
___,~_,,:)__=-=/)'-"-0_,_0""3"-',.L=_._(1})'-"'-'3""'-=J'~.3.,_ __ Field Sample Number _ _,.¢~· ·'.:)=~rf~Tc.....-______ _
~:~e:::s~~ ,izr& g;~1~ ~ S' D~::e~:~:::; ';/):CJ;~NL-¼,
Type of Sample:
Environmental Comments
_L Groundwater (I)
___ Surface Water (2)
__ Soil (3)
Concentrate
__ Solid (5)
__ Liquid (6)
_· _ Sludge (7)
__ Other (8)
·y;./,o Bia.a/.<.,,
__ Other (4)
INORGANIC CHEMISTRY SUPERFUND fllllil\lf:H
Extractables Total
Parameter Results mg/ 1 Parameter Results mg/ 1 Parameter
__ · Arsenic __ Arsenic __ silver
__ Barium __ Barium __ Sulfates
__ Cadmium __ Cadmium __ Zinc
__ Chromium __ Chloride _Ph
__ Lead __ Chromium __ Conductivity
__ Mercury __ Copper _TDS
__ Selenium __ fluoride _TOC
__ Silver __ Iron --
--__ Lead --
--__ Manganese --
--__ Mercury --
--__ Nitrate --
--__ Selenium --
ORGANIC CHEMISTRY
P:lrameter Results mg/ 1 Parameter Results mg/ 1 Parameter
LP&T:GC/MS _EDB __ Methoxychlor
__ Acid:B/N Ext. __ PCB'.s __ Toxaphene
_TOX __ Petroleum _2,4-D
--__ Endrin --2,4,5-TP (silvex)
#-IPE 0~ Sf.£ AlTACl:lED RH Er(S)Lindane --
MICROBIOLOGY RADIOCHEMISTRY
/\/(
Time _____ _
Results mg/ 1
Results mg/ 1
Parameter Parauneter Results PCi/ 1
__ (MF) Coliform Colonies/lO0mls __ Gross Alpha
__ (MPN) Coliform Colonies/lO0mls __ Gross Beta
----
----
Date Received ,il-1 g--f 1 /3 JI-Date Reported ___ <,t"-_-_,.,2_~V_-.f-'-f'---~~~------
I (',/&Gt p,j ~ .
Date Extracte~ · Date Analy.:ed'',1/17 i~flJVI) ,il-.01-T'.'1::nJJ ,-
R d -,0,; .?-ff L bN b 9-t.0398
cporte By . ~~~ a um er ___________________ _
DHS3191 (Rm:: --rt::Q 3ac 0
SolidandHazardousWaste(Review7/87) /f/(}~ 76-7'()(} ~.:7
• •
Purpose: Enforcement and compliance with the N. C. Solid and Ha,;,rdous Waste Management Rules.
Preparation A sample analyses request form (OHS 3191) must be co,.;pleted for each type of evaluation requested (e.g.,
inorganic, organic, microbiology, radiochemistry). For sampling Conditions Which req\Jire more than one (1)
container (i.e., ground or surface water from landfills) a sample label must be affixed to one of the containers. The
~olle~t:Or must ·then writ:e·rne··site and sample number on the dui,licate. · ·
Do not submit an analysis request sheet with no parameters indicated.
·Equivalent measurements:
ppm= µg/ml = mg/I =µgig= mg/kg
ppb = µg/1 = µg/l000g = µg/kg
DEFINITIONS/INSTRUCTIONS
Site Number -A twelve-digit site/location identifier, assigned only by the district field representative.
Field Sample Number -A six-digit sample identifier which is pre-printed on the sample label.
Name of Site -Name of landfill, facility, etc.
Site Location -Address, street number, state road, etc.
Collected By -Name and ID of sample collector.
Date and Time Collected -Self-explanatory.
Environmental - A sample of a naturally occurring substance such as groundwater, surface water or soils which
may be contaminated. _.
Concentrate -A sample of a waste, including but not limited to, sludges, re.Sins, treatment effluents or drummed
wastes.
Comments -Lists details regarding sample or sample point, including but limited to, phase separation, and/or
odors. )
Inorganic Chemistry -Check ( ./ ) the desired parameters to be analyzed. Extractables are only performed on a
solid or semi-solid. For routine landfill samples, check all parameters in the second and third columns.
Organic Chemistry -Check ( ./ ) the desired parameter to be analyzed. If not listed, enter the name in the space
provided.
Microbiology and Radiochemistry -The Raleigh office should be consulted prior to sampling for either
of these.
Distribution: I. Original to State Laboratory of Public Health
Environmental Sciences Branch
P. 0. Box 28047
Raleigh, NC 27611
2. Lab sends copy to Solid and Hazardous Waste Management Branch.
3. Solid and Hazardous Waste Management Branch sends copy to field person.
Disposition: This form may be destroyed in accordance with the Environmental Health, Solid and Hazardous Waste Section of
the Records Disposition Schedule as published by the North Carolina Division of Archives and History.
Additional forms may be ordered from:
Solid and Hazardous Waste Management Branch
Division of Health Services
P. 0. Box 2091
Raleigh, NC 27602-2091
N. C. Department of Human Resources
Division of Health Services • • State Laboratory of Public Health
SAMPLE ANALYSES REQUEST P. 0. Box 28047
306 N. Wilmington Street
Site Number
Raleigh, 27611
_-.;.Z..cl-,._' ,...,b"'--'o"--'o ... ,..,_1ac2-...=<J...(ufV.,_.3.,__· ,,,.J'~3,___ __ Field Sample Number --+,½ ..... ~,L-"'i:f".~· ...,;/'--' _-------
Name of Site ~-(1/vn,lr..S &_ .. L)JL SiteLoc:arion 020cc1:rHL,lv
-:rT;:. 7 J
Collected By ,kt£ ldc 13..t: De&M10# ,-3 s> Date Collected & /;.,/,er
Type of Sample:
Environmental
____i,L__ Groundwater ( 1)
___ Surface Water (2)
__ Soil (3)
__ Other (4)
Concentrate
__ Solid (5)
__ Liquid (6)
__ Sludge (7)
__ Other (8)
. I I
Comments
Ye~ Blaak.
INORGANIC CHEMISTRY
Extractables Total
Parameter Results mg/1 Parameter _. Results mg/ 1 Parameter
__ Arsenic __ Arsenic __ silver
--Barium __ Barium __ Sulfates
__ Cadmium __ Cadmium __ . Zinc
_._Chromium __ Chloride _Ph
__ Lead __ Chromium ___ Conductivity
__ Mercury __ .Copper _TDS
__ Selenium __ Fluoride _TQC
__ Silver __ Iron .
., " . -.. --
--__ Lead --
--__ Manganese --
--__ Mercury --
--__ Nitrate, --
--__ Selenium --
ORGANIC CHEMISTRY -
P3rameter Results mg/1 Parameter Result, mg/ 1 Parameter
.
_P&T:GC/MS __ EDB __ Methoxychlor
_,.,/_ Acid:B/N Ext. __ PCB'.s __ Toxaphene .
__ TOX __ Petroleum _2,4CD
p(J,t) m5 __ Endrin _. _ z,4,5,TP (silvex)
)t_ J.6.oo I · __ 'Lindane ·
MICROBIOLOGY RADIOCHEMISTRY
/\[( -Time _____ _
Results mg/ 1
Results mg/ 1
Parame·tei-. .·.,·.· : Paramteter J•. ·: 1;• R~sults PCi/ 1
--(MF) Coliform Colonies/lOOmls --Gross Aipha
__ (MPN) Coliform Colonies/lOOmls __ 'Gross Beta
-----
----
c7-t s--K 9 13& Date Received =.=-'-~~~-~~~'--=--------Date Reported -----~--------------
Date Extracte/_c"~-2-=l:i~j',,~fa~c,~.'i-'~3Q......,__,,/fl't~li=O~---Date Analyzed --=3'-"-/<.;,1~lfl~c_--,"l~3cl--fl-'d-/!9"-'--B:,)==-------
vfJO ~(q9
Reported By ____________________ Lab Number
OHS 3191 (Rev;~d 7185)
Solid and Hazardous Waste (Review 7 /87) ·
N. C. Department of Human Resources
'bi vision of Health Services SAMPLE ANALYSES REQUEST
State Laboratory of Public He.alth
P. 0. Box 28047
306 N. Wilmington Street
Raleigh, 27611
-../-~.O:L'-'-""bc_,e_o {)""""'-'-3=;L.=<..Ll(DJ_..,_.,..3'-"'J''-"'.3.,_ __ Field Sample Number __ · _,_'/,:,_,,Q.__f~'9------
Site Number
Name of Site _,./2:'.tCL..0-n,,-,,,0<:µ,+J-,-'<..w(;..,___s:_.Le..a./lut.....,.., ~~M.,.<..LC..:=._ ____ Site Loca_fion /22C,r:r1: [H-0¼
Jlr, I I
Collected By RU zGcf?dbe'/24'1/,"/-ID# 3!? DateCollected &/;..,/,ec;:
~ ./ I ,.
Type of Sample:
Environmental
___iL_ Groundwater ( 1)
___ Surface Water (2)
__ Soil (3)
__ Other (4)
Comments Concentrate
__ Solid (5)
__ Liquid (6)
__ Sludge (7)
__ Other (8)
6}_ f-d 3 //Je/;M O 2344J_ .
INORGANIC CHEMISTRY
MA'{ u l-J 1989
11fC
Time 0£3"(
Extractables Total SUPERFUND BRANCH .
Parameter Results mg/ 1 Parameter Resul1:s mg/ 1 Parameter Results mg/1
__ · Arsenic __ Arsenic __ Silver
__ Barium __ Barium __ Sulfates
__ Cadmium __ Cadmium . __ . Zinc
_·_Chromium __ Chloride _Ph
__ Lead __ Chromium -.-_-Con_ductivity
__ Mercury __ Copper . _TDS
__ Selenium __ Fluoride _TOC
__ Silver __ Iron .. :. •. --
--__ Lead --
--__ Manganese --
--__ Mercury --
--__ Nitrate --
--__ Selenium --
ORGANIC CHEMISTRY ·
P.irameter Results mg/ 1 Parameter Results mg/ 1 Parametei-Results mg/1
LP&T:GC/MS _EDB __ Methoxychlor
__ Acid:B/N Ext. __ PCB's __ Toxaphene
_TOX __ Petroleum _2,4-D
__ Endrin __ 2,4,5-TP (silvex)
i rPF ,..,./,. SEE ATTACl::IED SH :EI(S)Undane ·
'J'
--
MICROBIOLOGY RADIOCHEMISTRY
, ... :•· Results PCi/ 1
,-... Parame-~er: . ,_ :Parameter ' ._ .. . .
.
__ (MF) Coliform Colonies/lOOmls __ Gross Alpha
__ (MPN) Coliform Colonies/JOOmls __ 'Gross Beta
·----.. ·'
----
_;?_-_. _I.J_-_~_f_'j~~/3"-'~=· --'------Date Reported----~~~~-------
~oe.-I prj&:./Mo
.Date Extracted ___________________ Date Analyzed £ji'.l S'li):f?,1 r7--iYJ-f?9?W,..
9 D0 1' oo
.Reported By Lab Number ; ·±-.
Date ReccivCd
' 'bHs 3191 (Revised 7/85)
Solid and Hai:ardous Waste (Review 7/87)
' .
.
Seate Laboratory of Public Health
N. C. Department of Human Resources
bi vision of Health Services SAMPLE ANALYSES REQUEST P. 0. Box 2804 7
306 N. Wilmington Street
Site Number
Raleigh, 27611
--J.Z.c2-,_,_,,b"'---"o:..i..<2c...Zi"-':L=<u..D2.,,.3;,.;· cs.!c...3_,___ __ Field Sample Number --~y._;;_· _,,1_0_· _____ _
/\[( Name of Site M_ 4-fvnj ,--:.[' f?o_ . Lb C.. Site Location /l2{',crr: [H/,lu
~ .; )
Collected By ,££/c. !Ge fat: l>e"/?Y;i.m# 3:? Date Collected &ll1s/,e1 . Time 0£.5.S:
Type of Sample:
Environmental Concentrate Comments
_\L'.'._ Groundwater (1) ___ Solid (5) fJ (-t0.3 melut'n flCYS
__ Surface Water (2) __ Liquid (6)
__ Soil (3) _·_ Sludge (7)
__ Other (4) __ Other (8)
INORGANIC CHEMISTRY SIJPERF"UND BRANCH
Extractables Total
Parameter Results mg/1 Parameter Results mg/1 Parameter Results mg/ 1
.
__ · Arsenic __ Arsenic __ Silver
__ Barium __ Barium __ Sulfates
__ Cadmium __ Cadmium __ Zinc ·•·· ..
_·_Chromium __ Chloride _Ph·
__ Lead _·_Chromium -. _ Con_ductivity
__ Mercury __ Copper _TDS
__ Selenium __ Fluoride _Toe
__ Silver __ Iron --
--__ Lead --
--__ Manganese --
--__ Mercury --
--__ Nitrate --
--__ Selenium --
ORGANIC CHEMISTRY
Parameter Results mg/ 1 Parameter
_P&T:GC/MS __ EDB
-1/--Acid: BIN Ext. __ PCB's
_TOX __ Petroleum
-__ Endrin
• ..:it-r,, r' ,,,,, /, <.O.UV I .. _. _'Lindane ·
~ I .
MICROBIOLOGY
P3rametet'. .. . ,,,
·w., . ;
__ (MF) Coliform Colonies/ IO0mls
__ (MPN) Coliform Colonies/l00mls
--
--
Date Received ,i?-c/)-'t9 /3/)_ ·
Date ExtractefclJ,;1(is-ls<1 'I 3/8"18"1 ~W
" .. ..
R_esults mg/ 1 Parameter Results mg/1
__ Methoxychlot .. __ Toxaphene .
_2,4-D
__ -2,4,5-TP (silvex)
--
RADIOCHEMISTRY
Param,~ter ' .. J' ·' .. , R~sults PCi/.1
_· _· Gross -~iph·a ..
__ Gross Beta
--.
--
Date Reported -----~------------
Date Analyzedf _c_f~'2c,,l.wd~x:'--'9'--"l---'--_3_,.fl-'-•-'--'l89c..c...._,.fi_W ___ _
Reported By ----------------Lab Number ----=9,.. . .fl'-'"'-'()-'-=u-'-'.0'--'.-'1~-------
'
bHS 3191 (Revised 7 /85.)
SoliJ and Hazardous Waste (Review 7 /87)
JP
N. C. Department of Human Resources
bi vision of Health Services SAMPLE ANALYSES REQUEST
State Laboratory of Public Health
P.O. Box 28047
306 N. Wilmington Street
Raleigh, 2761 I
Site Number -~4:>:2'-'--'b""-""IJ-'-o,.__5'-'-0:J.,..'='--(l..!1])_.,,_,,3~J'c...3_,__ ___ Field Sample Number -~y;~· ~r-2~9_/_ ________ _
Name of Sire kt:1:tkn,1r:,,'. f?r, , Lb L Site Location /J21)cc1: [(C('./,l<.,
~ I )
Collected By ,Kl/c. z6c Met: be "l«mm# (3 2 Date Collected &/1 >/ ,e 7
Type of Sample:
Environmental Concentrate
---1L.. Groundwater ( 1 ). ___ Solid (5)
__ Surface Water (2) ___ Liquid (6)
__ Soil (3)
__ Other (4)
_·_ Sludge (7)
__ Other (8)
Comments
9 fl -P..aJ)tJ -/k rkc:
INORGANIC CHEMISTRY
Ill(
Time Of/j
Extractables Total SUPERFllND BRAN1.>n
Parameter Results mg/ I Parameter Results mg/ 1 Parameter Results mg/ I
__ Arsenic __ Arsenic __ silver
__ Barium __ Barium __ Sulfates
__ Cadmium __ Cadmium __ . Zinc
__ Chromium __ Chloride _Ph
__ Lead __ Chromium __ Conductivity
__ Mercury __ Copper _TDS
__ Selenium __ Fluoride _TOC
__ Silver
.. , .. ..
__ Iron ·. ' --
--__ Lead --
--__ Manganese --
--__ Mercury --
. __ Nitrate. ----
--__ Selenium --
ORGANIC CHEMISTRY
Parameter Results mg/ 1 Parameter Results mg/ I Parametei-Results mg/1
_LP& T:GC/MS -. _EDB __ Methoxychlor
__ Acid:B/N Ext. __ PCB'.s __ Toxaphene
_TOX __ Petroleum _2,4-D
__ Endrin __ 2,4,5-TP (silvex)
L-1..ff ~. SEE AUACl:!ED fil::lE 1(§)_ Li ndane · --
MICROBIOLOGY RADIOCHEMISTRY
. Para"me.tei-1
.. Parameiter •, Re.suits PCi/1
·' -
__ (MF) Coliform Colonies/lOOmls _·_· _ Gross iipha
__ (MPN) Coliform Colonies/lOOmls __ Gross Eeta
----
----
Date Received __ o?~-~L~S-:~· ---"'-$7_'1;__'3=...:J!}.=:.· ______ Date Reported. ___ · ____________ _
,roe. I / PT/6cf;,,/6
Dare Extracted __________________ Date Analyzed ~17 31, ~ .z-:m-?9 1:1-W:
Reported By __________________ Lab Number 9D ~L1H2
OHS 3191 (Revised 7/85)
Solid and Hazardous Waste (Review 7/87)
)17 a/4.,,_.f'e-47 ~ J-u·//vl'.
N. C. Department of Human Resources State Laboratory of Public Health
P. 0. Box 28047
306 N. Wilmington Street
Raleigh, 27611
bi vision of Health Services SAMPLE ANALYSES REQUEST
Site Number 9J.., b oo,=JJ_,. cro3J' 3
Name of Site /13/Y::,1,-:,S: f?o_ 1i, L
Collected By ,KU lie ltt.L be ~ID# ,3 2
Type of Sample:
Environmental Concentrate
_£ Groundwater (1). ___ Solid (5)
__ Surface Water (2) ___ Uquid (6)
__ Soil (3) _·_ Sludge (7)
__ Other (4) __ Other (8)
Field Sample Number ___ 4,/;=L',;J"'-<fc.,i#--"'"----------
Site Locafion 020.r:c 1: [H/,U I I
Date Collected & /;.., / £ q ./ I f-
Al(
Time tf/j'/r
Comments
lil: -?001:J f)esfer
INORGANIC CHEMISTRY. · SUPERFUND BRANCH
Extractable, Total
Parameter Results mg/ 1 Parameter Results mg/ 1 Parameter Results mg/ 1
__ · Arsenic __ Arsenic __ Silver
.
__ Barium __ Barium __ Sulfates
__ Cadmium __ Cadmium __ . Zinc ..
_·_Chromium __ Chloride _Ph·
__ Lead __ Chromium -.-Conductivity
__ Mercury __ Copper _TOS
__ Selenium __ Fluoride _TOC
__ Silver __ Iron --
--__ Lead --
--__ Manganese --
--__ Mercury --
--__ Nitrate. --
--__ Selenium --
ORGANIC CHEMISTRY
Piirameter Results mg/1 Parameter Results mg/ 1 Parametei-Results mg/ 1
_P&T:GC/MS .-EDB __ Methoxychlor
~ Acid:B/N Ext. __ PCB's __ Toxaphene
_TOX __ Petroleum _2.4,0
~(:!fl-P~
__ Endrin __ 2,4,5,TP (silvex)
J..75,CDI . , __ Lindane· --
MICROBIOLOGY RADIOCHEMISTRY
.. Parame.ter ' ,. ~ Parar~u:ter · -·. · R~sults PCi/.1
r,·, .. .,,
. . . ' .. •,·
__ (MF) Coliform Colonies/lO0mls __ Gross Alpha
__ (MPN) Coliform Colonies/lO0mls __ 'Gross Beta
-----
----
Date Received d ""/ ,')-f Cf iJ .i:Q,
Date Extracte/Cfl;;i./7-3/519 ()j. 3/g-/gq fW
Date Reported --,.---~------------
Date Analyzed _~_rP_..,_,a lw.., ....,./~_,__..;_.___.3<.L/q_,_,/-=-g_,._c; ____ _
Reported By ----------------Lab Number ----'=9'--. n"',_,0=..L...o~''-'O"-'-':l'------'-----
DHS 3191 (Revised 7/85)
S~liJ and Hazardous Waste (Review 7 /87,)
JP
N. C. Department of H~man Resources
Division of Health Services SAMPLE ANALYSES REQUEST
State Laboratory of Public Health
P. 0. Box 2804 7
306 N. Wilmington Street
Raleigh, 27611
__,_~...._;L,,_' ~/)=-0~<?-3'-"J__.=-~(TU~B~J'~J~--Field Sample Number ~ ';z'.':,2 !.3
Name of Site kP--&n-< r:.S::: &1 . ...IJi L Site J.,oca;ion /J2C,r:rt; [tc(J.,U,,
--::r-,;; I J
Collected By ,RE£ iGc flt: l>ehA-ID# 3 f? Date Collected &//15-/ ,e7
Site Number Al(
Time /0,5]) ,
Type of Sample:
Environmental Concentrate Comments
___IL__ Groundwater (1) ___ Solid (5)
__ Surface Water (2) ___ Liquid (6)
__ Soil (3) _·_ Sludge (7)
__ Other ( 4) __ Other (8)
INORGANIC CHEMISTRY SUPERFUND BRANCH
Extractables ' Total
Parameter Results mg/ 1 Parameter Results mg/ 1 Parameter Results mg/ 1
__ · Arsenic __ Arsenic __ Silver
__ Barium __ Barium __ Sulfates
__ Cadmium __ Cadmium __ . Zinc
_._Chromium __ Chloride _·_Ph
__ Lead . __ Chromium -.. _ Conductivity
__ Mercury __ Copper _TDS
__ Selenium __ Fluoride _TOC . '
__ Silver __ Iron ---
--__ Lead --
--__ Manganese --
--__ Mercury --
__ Nitrate
.
----
--__ Selenium _,_
ORGANIC CHEMISTRY .·
Pilrameter Results mg/ 1 Parameter Results mg/ 1 Parametel' Results mg/ 1
_,,L_ P&T:GC/MS __ EDB __ Methoxychlor
.
__ Acid:B/N Ext. __ PCB's __ Toxaphene .
_TOX __ Petroleum _2,4-D
Endrin __ 2,4,5-TP (silvex)
1-.1P£ ~-
SEE ATTACHED SH ET(5¾ .indane · --
MICROBIOLOGY RADIOCHEMISTRY
.. ' .. , Re.suits PCi/ 1
,· ·r .. . Parameter~ 'r..
Parameter· .,
__ (MF) Coliform Colonies/l00mls __ Gross /\lpha
__ (MPN) Coliform Colonies/lO0mls __ Gross Beta
----.
----
Date Received _d<~--· _l_~---~~?~'1~_&9-__ .c· _______ Date Reported-----~-::-:-,,-,-,,.,.---------
~ I pr/6<:f,wj
Date Extracted -----------------~ Date Analyzed "~R:ft-l~1t-, s~-~~-tl-.P_'1'\~ ... £L.,2=0~-~fi'_9~'tl,µr=~------
Reported By
DHS 3191 (Revised 7/85)
SoliJ and Hazardous Waste (Review 7 /87)
• N. C. Department of Hum.an Resources
bi vision of Health Services .SAMPLE ANALYSES REQUEST
State Laboratory of Public Health
P. 0. Box 28047
306 N. Wilmington Street
Raleigh, 2761 I
Site Number f;2.}) 0()3:J.... tWBJ' 3
Name of Site /(3/113:JC.S f"o_ • Lb C..
Collected By ;f& me ltr:1: be &wm# ,3 2
Type of Sample:
Environmental
__IL_ Groundwater ( 1)
___ Surface Water (2)
__ Soil (3)
__ Other (4)
Concentrate
__ Solid (5)
__ Liquid (6)
_· _ Sludge (7)
__ Other (8)
Field Sample Number --~$/~,')~'J_y',,_ ________ _
Site Loca;ion /22t,ccc; [(C(/.lu
Date Col.!ected I & /;., / ,e ,., . ,
. I I I.
/\((
Time ,I a 572
Comments
6if-o29 :Rewr/j' ,t/2.l&&rf _
INORGANIC CHEMISTRY . " ~..,.·-···-·· .......... , ........
Extractable• Total
Parameter Results mg/ 1 Parameter Results mg/ 1 Parameter Results mg/ 1
__ Arsenic __ Arsenic __ Silver
__ Barium __ Barium __ Sulfates
__ Cadmium __ Cadmium __ -Zinc .... ~
_. _ Chromium __ Chloride _Ph
__ Lead __ Chromium __ Conductivity
__ Mercury __ Copper _TDS
__ se1en:ium __ Fluoride _TOC
__ Silver _· _Iron --
--__ Lead --
. __ Manganese ----
--__ Mercury --
. __ Nitrate ----
--__ Selenium --
ORGANIC CHEMISTRY
P3.rameter Results mg/ 1 Parameter Results mg/ 1 Parameter Results mg/ 1
_P&T:GC/MS _EDB __ Methoxychlor
.L_ Acid:B/N Ext. __ PCB:s .. __ T oxaphene .
_TOX __ Petroleum -2,4-D
__ Endrin __ 2,4,5-TP (silvex)
.±.. 111.f' en& <!. 0,00 I ' __ Lindane --
MICROBIOLOGY RADIOCHEMISTRY
Parameter -Param1:?ter .· .. Results PCi/ 1 . .
. ..
__ (MF) Coliform Colonies/lO0mls __ Gross Alpha
__ (MPN) Coliform Colonies/lO0mls __ Gross Beta
----
----
Date Recci ved o/ -:/ ,)-JI '7 J3 &_
Date Extractelc_fj 3/J./'{9 Cf 3/t0/'69 OW
Date Reported -n:=---~-----:-----------
Date Analyzed _11i_rP_2=h.,..lm~~V-~:!>~/~(J'-'/gq~~/._W ____ _
Reported By Lab Number 900405
OHS 3191 (Revised 7/85)
Solid and Hazardous Waste {Review 7 /87)
• N. C. Department of H~rrian Resources
bi vision of Health Services SAMPLE ANALYSES REQUEST
State Laboratory of Public Health
P. 0. Box 2804 7
306 N. Wilmington Street
,;--Raleigh, 27611
----.'~C.....,,:l.~b"-'o~o~,-=1c..c;l.=-_...lf0~3,.,_· ~J'~3 ___ Field Sample Number ___ /-j~,;l,_f_._s_· ______ _
Site Number
Nam<! of Site ktl-tkn -{ cs: &_ . 1), L Site )._o,:a;ion 020cc 1: ucc/.,lu
7Tn 7 I
Collected By £££ ?Ge ltd: l>el2tYA-ID# ,3 !? Date Collected ol l1s-l ,e;z:
Type of Sample:
Environmental
_L Groundwater (1)
___ Surface Water (2)
__ Soil (3)
__ Other (4)
Concentrate
__ Solid (5)
__ Liquid ( 6)
_· _ Sludge (7)
__ Other (8)
./ I
f)(-3
Comments
macl.i , Ba kec
Time _,,,..l+/...,lc..l,____
INORGANIC CHEMISTRY -~ ~ .. '""'.
Extractables Total "'"""' ...,,., v11i., ..,l\r\UVII
Parameter Results mg/ 1 Parameter Resul:ts mg/ 1 Parameter Results mg/ 1
__ · Arsenic __ Arsenic __ Silver .
__ Barium __ Barium __ Sulfates
__ Cadmium __ Cadmium __ .Zinc· .. ..
_._Chromium __ Chloride _Ph
__ Lead __ Chromium -.-Conductivity
__ Mercury __ .Copper _TOS
__ Selenium __ Fluoride _TOC
__ Silver _· _Iron .. . " --
--__ Lead --
--__ Manganese --
--__ Mercury --
--__ Nitrate --
--__ Selenium --
ORGANIC CHEMISTRY ·
Parameter Results mg/ 1 Parameter Results mg/ 1 Parameter · Results mg/ 1
__L P&T:GC/MS _EOB __ Methoxychlor
__ Acid:B/N Ext. __ PCB's __ Toxaphene
_TOX __ Petroleum _2,4-0
--__ Endrin __ 2,4.S-TP (silvex)
::J!_ If.~~-SEE ATTACl:!ED SI:!• 'Tl<:\ Li ndane
MICROBIOLOGY RADIOCHEMISTRY
P.irame.teE .. . ' ... ·Parameter . R.;sults PCi/ 1
,·.1 , .. / .. .. -•·· ,; .. -. ··J,c ..
. . . . '
__ (MF) Coliform Colonies/ IOOmls __ Gross Alpha
__ (MPN) Coliform Colonies/lOOmls __ .Gross Beta ·"
----" " -L
----
Date Rect:iv"ed
Reported By
bHs 3191 (Revised 7/85)
Solid and Hazardous Waste (Review 718?) ·
N. C. Department of Human Resources
'Division of Health Services • SAMPLE ANALYSES REQUEST
State Laboratory of Public Health
P. 0. Box 2804 7
306 N. Wilmington Street
Raleigh, 2761 l
Site Number -+-~4"'1..""-=b-'o"-"o ..... ';J"-C4,.;=,,...J.(_,_,rv,.,.3"'-'J'~3-__ Field Samp:le Number --0.<---<-4-d_,._l_,,_6~· -----
Name of Site /(3/iv:/t;S: l'.?o. ML SiteLo.ca;ion 1IJ2{',cr1;[(C(/.U,.,1
Collected By /(tic. 76c &1: De°f2()fffID# ,3 2 Date Collected &//;.,/,er Time_,l~•Lf~l~lc.__ , I
Type of Sample:
Environmental Concentrate Comments
_L Groundwater (1) __ Solid (5) IJS-3 liJacl<-lbkfr
__ Surface Water (2) ___ Liquid (6)
__ Soil (3) __ Sludge (7)
__ Other (4) __ Other (8)
INORGANIC CHEMISTRY
Extractable, Total ->UrtliWfVD BRANCH
Parameter Results mg/I Parameter Resullts mg/ 1 Parameter Results mg/1
__ · Arsenic __ Arsenic __ Silver
__ Barium __ Barium __ Sulfates
__ Cadmium · __ Cadmium __ . Zinc· ·---·
_·_Chromium __ Chloride _Ph·
__ Lead __ Chromium -. _ Conductivity
__ Mercury __ Copper _TDS
__ Selenium __ Fluoride _TOC
__ Silver .. ~ Iron •. . .. .. --
--__ Lead --
--__ Manganese --
--__ Mercury --
--__ Nitrate_ --
--__ Selenium --
ORGANIC CHEMISTRY.
P3rameter Results mg/1 Parameter Results mg/I Parametei-Results mg/ 1
_P&T:GC/MS __ EDB __ Methoxychlor
_L_ Acid:B/N Ext. __ PCB's __ Toxaphene
_TOX __ Petroleum _2,4-D
--__ Endrin __ 2,4,5-TP (silvex)
_;ii.. ~r•,., rrnJ " LO.DOI.. _,_'Lindane
J
--
MICROBIOLOGY RADIOCHEMISTRY
.. P.irameter;
,. . .. c•• ·-., Pararneter;, Results PCi/1. ' : •.
,• :,·,t I. ' .. '.
__ (MF) Coliform Colonies/ IOOmls __ Gros,; Aipi{a·
__ (MPN) Coliform Colonies/lOOmls __ Gros,; Beta '.
----.. .• ' .,
----
Dare Received ;/-/ S"-fl 'J 6 D:
· Date Extracte/c",1 ~ IS'i 'l-2>lco liR ~~ Date Reported ~=...---~---~~-------
Date Analyzed _f_C._f..,..c3_/:).c...c/B9'--'----¥--'~/_I 3-'-j_g=f---'-f'<_tJ __ _
Reported By Lab Number ---'9=-'-:J"-'0~6\,_,0"--7..e........ ___ _:.__ ___ _
. DHS3191 (Rev;,ed?/85)
, SoliJ and Hazardous Waste (Review 7 /87.)
•
DIVISION OF HE.ALTS SE.RV~c_.
SO AND RA.2.A.RDOUS wASTE !-'JJ\AG~
Cnain of CustodY Record
Hazardous waste Materials REC/EH/ED
Loca:icn of S2!llpling: Gene rat.or Transporte~Af U !:J 19~Treat:tnent Facilit
__ Storage Facility ___ Disposal~l:i{r;:;,i:&J8~"•.1!!!.!.!_Landf ill . iv .. ~'-'"
-IL_Other: ~-~ . CttL!.J h~,6:j<
C0.tpany's N2!lle. ~cs: c:0. kc. Telephone( __ ~) ________ _
Address ,m QrC} ,'/IM L( (!, ;, .11LG
Collector's N2!lle,f'EA ;Ii;-~ '/2a1;4..
signature .
Tele_?hone('------') f 3 3 -a J> 0 I
Date Sa,npled. _ __,d).,,·:._---<.l..::S:::_-__,._R-L-/ _________ T.ime S2m?led._..&::e,!c?c..1.,,_· _.<:--=:.._./.~'/'....L./-1.I:___
Type of Process Generating waste ------------------------
. Fielci Information
·:Fie.le Sample No. ca fr K:Jrf,f ' ,
,@fY .KJfC
Chain o: Possession:
1.
signature I
2. Y2c:lx4w-A= ' signature
3.
sig7lature 7
~es~:ts reported
sig:-,a ture
_'.6}fJ
title
ti:.le
inclusive dates
/,R:30
6)-/.S--!'9
inclusive dates
inclusive dates
date
lns::--uctions: Complete all applicable info~ation incluGir.f signatures, and
submit ,:ith·.analysis request forms.
SOLID
DIVISION OF
~ous
Receipt for
EEJ..LTE S:::RVICES
WASTE P..?.NAGE:lENT
S21DPles
The samples descr:.bed below were collec.ted in connection with the administration,
enforcement, and documentation of the:
() North Carolina Hazardous Waste Management Rules, 10 NCAC l0F
() North Carolina Solid Waste Management Rules, 10 NCAC l0G
.( ) Comprehensive Environmental _Response, Compensation and Liability Act (CERC-i..A)
() Toxic Substances Control Act (TSCA). 15 U.S.C. §2601, ~~-• specifically
Section 11.of TSCA, 15 U.S.C. § 2610.
Inspecto~•s Name
Name of Firm
V
Firm Ow-ner, 0p<e~·a :er, or Agent
-
S . .A.MPLE C0LLECED SA."1PLE TYPE
!,'UMBER DATE TI..?-E WATER SOIL
I
Receipt for the s=ple(s) described.
above is hereby acknowledged:
Signature of Inspector
Title
OTHER
Inspector's Address
Fire Address
Title
DUPLICATE SA."1PLES SA..'1PLE LOCATION
0FFEREDIACCEPTED REJECTED! ON-SITE OFF-SITE
..
I
I
I
I
I
Receipt/rejection of duplicate or split
samples is hereby acknmdedged·:
Signctu~e of Firm 0-..mer, Ope~ator, o~ Agen
Title
C0J-!!-!ENTS, ____________________________________ _
• STATE LABORATORY OF PUBLIC HEI
DIVISION Of HEALTH SERVICES, N.C. DEPARTMENT OF HUMAN RESOURCES P.O. BOX 28047 -306 N. WILMINGTON ST, RALEIGH,
ORGANIC CHEMICAL PNALYSIS
Lab No. <.J /fr. -,xa <1
PURGEABLE COMPOUNDS MDL Field#
T= { )
------····--·;1-!.i..-/ .. ,, . --"·-
Dichlorodifluoranethane I -·' -
Chloranethane ,,
{Vinvl Chloride
Broom,ethane
Chloroethane
Trichlorofluoranethane
✓l 1-Dichloroethvlene
Hethvlene Chloride
tert-Butvl Hethvl Ether
ITransll 2-Dichloroethvlene
I•=r="l ether
l 1-Dichloroethane
2-2-Dichlor=ronane
_ICisl l 2-Dichloroethvlene
Chlorofonn
IBCMl Branochloranethane
✓1 1 1-Trichloroethane
1. 1-Dichloronr=ene
✓Carbon Tetrachloride
✓Benzene
✓1 2-Dichloroethane
✓Trichloroethvlene
1 2-Dichloronronane
Branodichloranethane
Dibroom,ethane
Toluene
1 1 2-Trichloroethane
Tetrachloroethene
1 3 Dichloronronane -Dibranochloranethane
1 2-Dibranoethane CEOBl ,
1-Chlorohexane ' ,l/ 7
J -Estimated value.
K -Actual value is known to be less than value given. L -Actual value is known to be greater than value given.
U -Material was analyzed for but not detected.
NA -Not analyzed.
1/ -Tentative identification.
-YlnliJt, 11 n ,
{ . )
.--=-, -"·-
I
4-f~<L
lJ-.
..Lr··~
'
MDL -Minimum Detection Limit for water (EPA Method 502.2), µg/1.
✓ -Re9ulated voe T -Tr1halanethane
N.C. Division of Health Services
DIIS 3068--0 (4/88 Laboratory)
N.C. 27611
1/11189 Date of Analysis
I I
C//)n ,J,,," C/n,id,~ ,/. C/1175 #,/Jr-
I ) ) (/ )
✓---11l ___ ,1._ /C,,, ___ ,1._ /4,,.rv .,n/l,,n , '' ,
..
•-.. .. ... . -
1wr,;-, 'lt" 'l'I RF=o~ ·-""lb, 11/eN IJ
ti;,,.,, __
"""' ._Hf :nw1 rtla~,,.,. ..... , ,
' I ' I
• STATE LABORATORY OF PUlll.lC H~
DIVISION OF HEALTH SERVICES, N.C. DEP,\RTHENT OF HUMAN RESOURCES P.O. BOX 28047 -306 N. WILHINGTON ST, RALEIGH, N.C. 2/611
ORGANIC CHEMICAL AIIALYSIS
Lab No.
Field#
'-//J/1 '1/1?[
PURGEABLE COMPOUNDS
I I I
Chlorobenzene
Ethvlbenzene
l l 1 2-Tetrachloroethane
m-Xvlene
o Xvlene
Braooform
Is-r--··lbenzene
l 1 2 2-Tetrach loroethane
Branobenzene
n-P---· · 1 benzene
__ 1 2 3-Trichlor-ronane
2-Chlorotol uene
_ 1. 3. 5-Trimethvlbenzene
4-Chlorotoluene
.'Tertl Butvl Benzene
Pentachloroethane
1,2,4-Trimethylbenzene
/Seel Butvl Benzene
_n-Is--r--··ltoluene
1 3-Dichlorobenzene
✓1 4-Dichloroben,ene
n-Butvlbenzene
1 2-Dichlorobenzene
/Bisi 2 Chlorois--r-"l Ether
l 2 Dibrano-3 Chlo~r=ane
_l 2 4-Trichlorobenzene
Hexachlorobutadiene
Nanhthalene
_ 1 2 3-Trichlorobenzene
J -Estimated value.
I J r ,,
' , I
K -Actual value is known to be less than value given.
L -Actual value is known to be greater than value given. U -Material was analyzed for but not detected.
NA -Not analyzed.
1/ -Tentative identification.
'
HDL -Minimum Detection Limit for water (EPA Method 502.2), µg/1.
✓ -Re9ulated voe T -Tr1halanethane
N.C. Division of Health Services
OHS 3068--0 (4/88 Laboratory)
" I
/
( ' )
,
f
I
I I ) Ii )
. I '
V.
•
DIVISION OF H.EALTt s:::RVIC..illiii.
SO .?J•m HAZ.ARDOUS WASTE HJ.J,AGEJ-9 ER..!.NCR
Chain of Custod,· R,,cord
I
B2z2rdous 'l-12ste Materi2ls
Loca~ic~ of Sampling: Gener2~or __ Transporte:.-__ Treatment Facili1
__ St:orage Facility __ · _Disposal ?acility __ Landfill
. ~Dt:her: OM_-A{;[, {AH-6,.f h~,05
Coo,pany's N'."'"e . ~S: & . .kc. Telephone( __ ~) ________ _
Address m Or<) ,'LMLI e llLC...
Collector·• s Name )(EA _/4'.,.-:;~ i2<vt4:
. . signature
Date S=pled._.-d2.:·'--__,_/...::S,:..._-_,._R_,_1 _________ Ti.me Szmpled &:1'3:C-// /I
Type o: Process Generating W2ste -------------------------
. Field I::ifonnation
".Fitlci Sample No.
Chain c: Possession:
1.
sign2ture I
2. Y2c:lx/4J01=
' signature
3.
signc..t.ure 7
~es~::s reported
ti7.le
inclusive dates
/,R3<J cJ}-/.s-19
inclusive dates
inclusive dat:es
d2te
lns::-uctions: Complete 2..11 2pplicable infornation incluciir.g signc.t.ures, and
submit \,."ith ·.anc.lysis request £oms.