NCD003200383_19930922_Koppers Co. Inc._SERB C_Pre-NPL File 1982 - 1993-OCR

COHF IRMATI OH LI ST
SEP ·22 ' 93 10: zi-<
SEHDER: 9197334811 SUPERFUl,D SECT.
RECEIUER: 913 281 · 5383
F'AGES SEHT:
DURATIOH: 01:0E1
Post-It" brand fax transmittal memo 7671 • of pages ► /
Fax#
• •
State of North Carolina
Department of Environment, Health, and Natural Resources
512 North Salisbury Street • Raleigh, North Carolina 27604
James B. Hunt, Jr., Governor
Mr. Eric Hess
Project Manager
Division of Solid Waste Management
Telephone [phone]
September 22, 1993
PRC Environmental Management, Inc.
650 Minnesota Avenue
Kansas City, KS 66101
Subj: Koppers Chemical Company NPL Site
Morrisville, NC
Dear Mr. Hess:
Jonathan B. Howes, Secreta1y
We have reviewed your faxed response to our comments of 21 September 1993
concerning the test method for dioxin-containing IDW. Although we specified method 8290
for dioxin/dibenzofurans in our comment Jetter, the method you have chosen (1613A) is
specific to water and is essentially the same as 8290. Therefore, we have no objections to
proceeding with your plan.
Please advise this office of the analytical results prior to taking any action with the
IDW. If you need further assistance, please contact Jack Butler or me at [phone].
cc: Jack Butler
i:nJL__
Bruce Nicholson
Chemical Engineer
Superfund Section
P1). Box 27687. Raleigh, North Carolina 27611-7(,87 Telephone [phone] Fax# [phone]!3
An Equal Opportunity Afiirmative .~tion Employt'r
SEP-2J-1993 14:52 . . '
PRC
TO:
Company
FAX No.
FROM:
ADDffiONAT,
COMMENTS
FROM PRC EM! KANSAS CITY TO 191973342,10--716 P.01 •
r:T.o.c~
• PRC ENVIRONMENTAL MANAGEMENT, INC.
650 Minnesota Avenue, 2nd Floor
Kansas City, Kansas 66101
Telephone: 913/'12,1-2277
FAX No.: 913/281-5383
FAX TRANSMITTAL
Date: q }a.i/13
Total Pages: .1.
(Including cover p~ge)
Project Number: (k.Y. '7 -E:J.2£
JS 0-tttc:R
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□ Company Sensitive ~ Urgent
SEP-21-1993 14:52 FROM PRC EM I l<ANSAS C !TY TO 19197334810--716 P.02
A •
September 21, 1993
Mr. Jack Butler
Environmental Engineering Supervisor
CERCLA Special Projects Section
•
North Carolina Department of Environment, Health, and Natural Resources
401 Oberlin Road
Raleigh, NC 2761 11
Dear Mr. Butler:
PRC Environmental Management, Inc.
650 Minnesota Avenue
KanG~G City, KS GG101
913-281-2277
Fax [phone]
PRC
PRC Environmental Management, Inc. (PRC), would like to haYc the treated wastewater, discussed in
your September 21, 1993, letter, analyzed by SW-846 Method 1613A. This method is specific for
the dioxin of concern (2,3, 7 ,8-tetrachlorodibenzo-p-dioxin) and it will meet, or produce analytical
data below, the l x 10-' !'glL level discussed in your September 21, 1993, letter. PRC intends to use
Triangle Labs (801 Capitola Drive, Durham, North Carolina) for the analysis of these samples .
.If you have any questions, please call me or Frank Bryant at [phone].
Sincerely.
L_:_. 14s)
Eric Hess
Project Manager
'State of North C.lino Deportment of Erwironment,
Health and Natural Resources
Division of Solid Waste Management
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
,~iii\
DEHNR
September 21, 1993
Mr. Eric Hess, Project Manager
PRC Environmental Management, Inc.
650 Minnesota Avenue
Kansas City, KS 66101
Subject: Letter from Eric Hess to Jack Butler dated 9/20/93.
Dear Mr. Hess:
The Superfund Section has reviewed the referenced Jetter regarding the proposed
disposal of contaminated water generated from the SITE demonstration project conducted
for the Koppers Company, Inc. Superfund Site, in Morrisville, North Carolina. We concur
with the proposed methodology, with one exception regarding the dioxin analysis to be used. EPA Method #8290 should be used as the analysis method for dioxin. This method has a measurement sensitivity of 1x10-5 ppb which is closest to the NC Groundwater Standards. Any water to be disposed of on site by spray irrigation must be shown to contain dioxins
below this detection limit of lx10·5 ppb.
If you have any questions or would need further information on this, please contact
me at [phone].
Sincerely,
fad~~
Jack Butler, PE
Environmental Engineering Supervisor
Superfund Section
P.O. Box 27687. Raleigh. North Caroline 27611-7687 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ 10% post-consumer paper
• Wt:GtnltU
SEP 21 1993
SUPfRfllNP SECrtON
September 20, 1993
Mr. Jack Butler
Environmental Engineering Supervisor
CERCLA Special Projects Section
•
North Carolina Department of Environment, Health, and Natural Resources
40 I Oberlin Road
Raleigh, NC 27605
Dear Mr. Butler:
PRC Environmental Management, Inc .
650 Minnesota Avenue
Kansas City, KS 66101
913-281 -2277
Fax [phone]
PIIC
During our telephone conversation on September 17, 1993, PRC, representing the U.S.
Environmental Protection Agency, proposed to dispose of approximately 100 55-gallon drums of
contaminated water derived from the Superfund Innovative Technology Evaluation (SITE)
demonstration, conducted at the Beazer East, Inc., site, Morrisville, North Carolina. This SITE
demonstration involved the thermal and catalytic destruction of pentachlorophenol contaminated soil.
The soil used in this demonstration also contained 2,3, 7,8-tetrachlorodibenzo-p-dioxin (dioxin) in the
I 00 µg/kg concentration range.
The water contained in the drums was produced when three inches of rain fell on the containment
pad, and from the decontamination of the containment pad. This water is probably contaminated with
dioxin and pentachlorophenol. Both the dioxin and pentachlorophenol contamination of the water is
primarily caused by contaminated sediments suspended in the water. This hypothesis is based on the
low solubility of the two compounds. PRC estimates that the maximum concentration of dioxin in
water is less than 0.2 µg/L based on the absolute solubility of dioxin in water. It is possible that
pentachlorophenol concentrations are in the 2 to 3 mg/L range due to the higher relative solubility of
pentachlorophenol, and the higher concentrations of pentachlorophenol in the soils.
Based on an evaluation of Resource Conservation and Recovery Act (RCRA) regulations, PRC has
assigned the RCRA hazardous waste codes KOOi and F032 to this waste stream. KOOi was
conservatively assigned because the soil was excavated from the sand filter area of the site; this was
not a wood treatment process area. The RCRA waste code F032 was assigned because the source of
the soil contamination and subsequent water contamination was from wood treating operations.
Hazardous waste codes F027 and F028 (dioxin containing wastes) were not assigned because the
listing required that the waste was derived from discarded, unused formulations of pentachlorophenol.
PRC did not have any indication that unused formulations were disposed of in the sand filter area.
PRC feels that this type of waste release would be restricted to the wood treatment process areas.
PROPOSED ACTION
PRC proposes to treat the contaminated water using an activated carbon filtration system. The system
will consist of the following components:
{j canl•ln• r..:yclod !lt>.r ond I• roqcl•blo
• •
Mr. Jack Butler
September 20, 1993
Page 2
• A 3-micron pre-filter, replaced as its flow is reduced due to sedimentation. These
used filters will be drummed and incinerated off-site.
' • Three carbon filters operated in series. Each filter is contained in a 55-gallon drum,
and contains approximately 165 pounds of activated carbon. Used carbon filters will
be incinerated off-site. This filtration system will be outfitted with secondary
containment as an added precaution to prevent environmental releases· of the untreated
water.
• Containment tanks for effluent. These tanks will store treated water until on-site
analysis determines if pentachlorophenol and dioxin concentrations are ,;;; 1 µg/L.
• Additional activated carbon filters will be on-site, to use if breakthrough occurs in the
first activated carbon filter. ·
PRC will sample the influent and the effluent from the first activated carbon filter, and the final
. effluent from the treatment system, prior to discharge into the holding tank. PRC will use a
laboratory grade gas chromatograph equipped with an electron capture detector. Low detection levels
will be accomplished by sample concentration through the use of a nitrogen evaporation system. PRC
intends to treat the wastewater to the on-site analytical detection limit of 1 µg/L. When the effluent is
verified to meet the 1 µg/L action level then the effluent will be spray. irrigated on the study area.
I have enclosed descriptions of our on-site analytical methods and descriptions of the carbon filtration
units.
If you have any questions, please call me or Frank Bryant at [phone].
Sincerely,
(;_/~s
Eric Hess
Project Manager
EH/ksb
Enclosures
•
August 12, 1993
TO: Patrick Watters
FROM: David Lilley
RE: Comments prepared on the Health and Safety Plan for Koppers
Company, Morrisville, NC
After reviewing the above mentioned document, I offer the
following comments:
1. Page 3: Allowing personnel that have not completed the OSHA
training and medical surveillance requirements as outlined in
29 CFR 1919.120 to enter areas where exposure to hazardous
materials is possible is a direct violation of
29 CFR 1910.120 (e)(l)(i).
2. Page 14: Sodium hydroxide also has a TLV-Ceiling of
2.0 mg/m3 •
3. Page 16: The sentence at the top of the page is worded
incorrectly. It should read: "The allowable particulate
concentration (APC) was calculated for PCP based on the
highest recorded soil concentration of PCP found on site. The
calculated APC was approximately 155 mg/m3 • Since the PEL for
PCP is 0.5 mg/m3 and workers will don respirators at 5 mg/m3 ,
workers will be adequately protected form airborne PCP."
4. Page 18 and 19: The wording used to describe skin protection
for levels C and Bis confusing; lesser protection than what?
5. Page 20: This is the only page where a half-face respirator
is mentioned. Will they be used?
, .
State of North ~lino
Department of~ironment,
Health and Natural Resources
Division of Solid Waste Management
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
_,,JI,~' ~~
crsn: n ;,~~""• 12•
DEHNR
September 27, 1993
Mr. Allen Keith Glover
Deputy Health Director
Wake County Health Department
Post Office Box 14049
Raleigh, NC 27620
RE: Remediation Overview
Koppers Company, Inc.
NCD 003 200 383
Dear Mr. Glover:
David Lilley of the NC Superfund Section left a message on your phone mail today
to notify you that the NC Superfund Section will conduct a preliminary fieldwork remedial
overview of the subject site located in Wake County, NC. The overview will be conducted
on October 12 to 14, 1993 by Randy McElveen of the NC Superfund Section.
You may want to have your representative meet the overview team at the site. If so,
please contact Randy McElveen at [phone] and he will coordinate a meeting. I am
enclosing background data on the site for your information.
P.O. Box 27687. Raleigh, North Carolina 27617-7687 Telephone [phone] FAX [phone] lO
An Equal Opportunity Affirmative Action Employer 50% recycled/ l 0% post-consumer paper
Mr. Glover
9-27-93
Page 2
• •
If the overview indicates the need for future study of the site, we will contact your
office to advise. If you have any questions, please don't hesitate to call David Lilley or me
at [phone].
Enclosures
cc: Dexter Matthews
Doug Holyfield
Debbie Crane
Kim Clarke
David Lilley
File
Sincerely,
cfad~
Jack Butler, PE, Head
Special Projects Branch
NC Superfund Section
• · · Federal
Trip Notification & Authoriz.n
J'repared by: Today's Date: °J -27 -93
~~sc Ulack Ink or Typcwri1cr only-Srnff 10 fill out first 2 blocks only. ,
Site Trip
.,
:', Date of Trip: Qc[D be.-y I 2 ti,,.2'.l< 14-
If trip date changed or cancelled note below:
Trip Date Changed To: _____ Cancelled:
NCD#: 003 z..oa 38'3 SiteNamc: KoPPGRs: eq. Fnc.
City: Mo:Yi,"'.:YJ If e. County: \),/A-K'I;'
· Name of Hotel (Overnight Trip): ________ Hotel Telephone Number: ( ) _ • __ _
Project Team Leader: RQ,\I\.~ Mcf l v:e:e.n
Assistants: t)y-uc..-e.. N;c~olsotj __________________ _
Attach To Notification Form: 1 copy each:
Submit to the
Industrial Hygienist
Preliminary Assessment Form (First page only)
Site Map
PA Transmittal Letter
(Please lisl appropriate County Health Dcpanmcnt conlact person to call to advise of trip)
Environmental Supervisor or Health Director to call: /lJr ke di &fov&"
(Note if Or., M.P., etc.)
Telephone Number: (qf4).26-o. 1-fs?o
Notes: Health Department Official Contacted: /(e :JL G/c-.,er5 o 6Ae. IM,/
Back Up Letter Required: Yes _.:::: No __ 1
Leff a r,){!.5 >C<-;, e ./fr-_ rnr, tlv~rS (1,1<...,.qr,7
Nole: Sil-,'llCd oripnal to Data t-.bnatcr
• ...-51".T[" /s' ....... , ~
h,r, r ~ , ~-i~ ~-j;'~_;; • 11 1v •0 \. Jc!:
~!
State of North Carolina
•
Department of Environment, Health, and Natural Resources
512 North Salisbury Street • Raleigh, North Carolina 27604
James B. Hunt, Jr., Governor Division of Solid Waste Management
[phone]
Mr. Allen Keith Glover
Deputy Health Director
\Yake County Health Department
Post Office Box 14049
Raleigh, NC 27620
RE: Remediation Overview
Koppers Company, Inc.
NCD 003 200 383
Dear Mr. Glover:
August 13, 1993
Jonathan B. Howes, Sec.etary
David Lilley of the NC Superfund Section spoke with you today to notify you that the
NC Superfund Section will conduct a remediation overview of the subject site located in
Wake County, NC. The overview will be conducted over the next few weeks by Patrick
Watters of the NC Superfund Section. ·
You may want to have your representative meet the overview team at the site. If so,
please contact Patrick Watters at [phone] and he will coordinate a meeting. I am
enclosing background data on the site for your information.
P.O. Box 27687, Raleigh, Nonh (::;rolina 27611-7687 Tdephonc 919-733-4984 Fax I! 919-733-0513
An Equal Opporrunity Affi~ativt' Ac.ion Emplo~-r
..
Mr. Glover
8-13-93
Page 2
• •
If the overview indicates the need for future study of the site, we will contact your
office to advise. If you have any questions, please don't hesitate to call David Lilley or me
at [phone].
Enclosures
cc: Dexter Matthews
Doug Holyfield
Debbie Crane
Angie Coppola
David Lilley
Cfile)
Si]:hf/ q
Jack B"n", PE, Heod ;A-
Special Projects Branch
NC Superfund Section
Q,. ~ ,, c.~ •I.-=·
ED---=·
~~l,loLEOE>o .,,,a, osr. '""'·
~87'DC, [m:] PPCV>Ct:J r,., o ~ m«:T/At'£ INC. / .'\·I m(}qRfr 0~ B'r' lNIT S
100
llC<LE O'rrT1
0 )00 200 300
ANY INC. KOPPERS COMPTH CAROLINA
LE NilO~R~:...:::_...:....____ I MORRISVIL , _
FIGURE 1-1
OUT MAP FACILITY l_,A~Y~-:::-::-~~NIC I
-MENT, INC. MANAGE rnc ENVIRONIAENTAL
--MEMORANDUM--
TO:
FROM':
DATE:
RE:
Lee
Rob
Crosby
Gelblum f!);J
April 13, 1992
Koppers/Beazer Site
I understand from Pat that the public meeting last Wednesday
went smoothly. She said that she, you and two others were the only
state personnel there (of whom she was aware), and that the state
officials were not called upon to respond to anything or in any
other way to address the meeting. It is my understanding from the
two of you that an obligatory public information session will be
coming up within the next couple of months, and that I will be
apprised when that is scheduled.
RG/dw
•• ...---;$TAT[,-.
.1>.,,., .. ~·;"'"·• ~ l,:;,r. r , . ~
'" '{;(i'j · ".·"' ~, i5 \i1 Jlr•i ?~'.tu lfip/J}J
'2·~
State of North Carolina
Department of Environment, Health, and Natural Resources
Division of Solid Waste Management
P.O. Box 27687 · Raleigh, North Carolina 27611-7687
James G. Martin, Governor
William W. Cobey, Jr., Secretary
Mr. Bobby Davis
Route 2, Box 119A
Morrisville, NC 27560
Dear Mr. Davis:
9 January 1991
William L. Meyer
Director
On October 4, 1990, a sample was collected from your drinking water well by Mr. Al
Ward, Wake County Health Department and submitted to the State Laboratory of Public Health
for analysis of pentachlorophenol. No pentachlorophenol was detected. The sainple analyses
request sheet is attached for your records. Based on these results, continued normal usage of the
water is reccimmended.
If you have any questions, please feel free to contact me at [phone].
Enclosure
cc: Al Ward
Shannon Craig
Barbara Benoy
Ken Rudo
PD/kc/pat.022
Sincerely,
12M~
Pat DeRosa, Head
CERCLA Branch
Superfund Section
C. Department of H~man ResourcL ..• . .,
,i,ion ofHealch Services · SAMPLE ANALYSES RE~ T
State Laboratory of Public Hea_!th
P.O. Box28047
306 N. \Vi!mington Street
Raleigh, 27611
e Number 9;}/) 01)3:,Z <J03J.3
. . Field Sampfc Number ,/ 2-2d.----.,~---------
1me of Site ~• /J /J (C.f & · J:oc Site L.oca;:ion. Ulcvo i ca-/6-L , I\U
4--,,f ,' " J' ,/) ) I I
Jllected By ,!}J/))a~~_3 £~--Date Collected /i:)-Y-f'. 0 Time _/_/_s:_o_ __
•pe of Sample:
Concentrate Comments
Envir~ental
__ V"_ r. G·ro·undwatet (I)
___ Surface Water (2)
__ Soil (3)
__ Solid (5)
___ Liquid (6)
___ Sludge (7)
___ Other (8)
, 3'6 c11-L3a-6,7,!'-1ltl//2,____ ___ _
__ ·_ Other ( 4)
Extractable6
Parameter Results mg/1
INORGANIC CHEMISTRY
Parameter
__ Arsenic
__ Barium
__ Cadmium
__ . Chloride
Results mg/1
_Arsenic
_Barium
_Cadmium
_·_Chromium
__ Lead
__ Mercury
_·_Selenium
__ Silver
-------· __ Chromium
__ Copper
_P&T:GC/MS
_._ Acid:BiN Ext.
Results mg/1
_TO . ' . ~?t ~ _ ~llt-f//../-. · ·· .
MICROBIOLOGY
__ (MF) Coliform Colonies/!O0mls
, __ (MPN) Coliform Colonies/ !O0mls
· __ Fluoride
__ Iron
__ Lead
__ Manganese·
__ Mercury·
__ Nitrate _
__ Selenium
ORGANIC CHEMISTRY
Parcirne_ter
_EDB
_· _PCB'.s>·
__ Petroleum
__ Endrin
__ -Lindane .
Results rng/1
Paran1.etcr.
· __ Gross Alpha
__ Gross Beta
Total
Parameter
__ Silvet
__ · Sulfates
__ Zinc
_Ph
___ Conductivity
_TDS
_TOC
Parameter
_.:_ Methoxychlor
__ Toxaphene
_. _·2,4-D
__ 2,4,5-TP (silvex)
RADIOCHEMISTRY
Results mg/1
Results 11.1.g/l
Results PCi/1
Date Rccdvcd -'--/ U~-~t/_-_'1~0_._l]~JSl=..c...·._. ---'-~-----Date Reported _______________ _
Date Ex tractcd ~Lccu:::_-_::2.::_..o,3c._~_·L;2C5.o"-'. • .!..:13:::C..::;f)::C,,,,_ "' . .lC='------Dace Anal y,ed --'/'--·-0_-_2__,L/_-_,_9_o_,,,J3=<c'iJJ."'----------
Reported By -~~---------------'-Lab Number 906'774
h\-!.S-3191 (Revised 7/85)
Mid Atlantic Office
Dear Pat:
• KEYSTONE
ENVIRONMENTAL RESOURCES, INC.
P.O. Box 27131, Baltimore, MD 21230
September 7, 1989
RECEIVFD
SUPERFUND BRANCH
Ms. Pat DeRosa
Superfund Branch
Solid Waste Management Section
North Carolina Department of
Human Resources
401 Oberlin Road
Raleigh, NC 27602-2091
On behalf of Ms. Shannon K. Craig, Beazer Materials and Services, Inc., enclosed
please find Revision 2 of the Well Inventory Report for the Morrisville site. Copies
of those pages revised have only been included. Kit Creek Road and Marcom Road
have been added. Also, enclosed is a revised map.
If you require any additional information, please call either Shannon or me (301-547-
7922).
JCM:dac
Enclosures
cc: Ms. Shannon K. Craig
Very truly yours,
John C. Mitsak, P.E.
Senior Project Manager
Ms. Barbara Benoy-EPA Region IV
DCC #12
• •
WELL INVENTORY REPORT
IN THE VICINITY OF
BEAZER MATERIALS & SERVICES, INC.'S
FORMER
MORRISVILLE, NORTH CAROLINA SITE
Prepared for:
BEAZER MATERIALS & SERVICES, INC.
PREVIOUSLY OPERATED PROPERTIES DEPARTMENT
PITTSBURGH, PENNSYLVANIA 15219
Prepared by:
KEYSTONE ENVIRONMENTAL RESOURCES, INC.
3000 TECH CENTER DRIVE
MONROEVILLE, PENNSYVANIA 15146
PROJECT NO. 179255-01
REVISION 2
AUGUST1989
•
SUMMARY
Keystone Environmental Resources, Inc., on behalf of Koppers Co. Inc., at the
request of the Wake County Health Department, conducted a well inventory of
homes and businesses within a one mile radius of Koppers former Morrisville facility,
now known as Unit Structures, Inc. The inventory was conducted through door-to-
door canvasing and personal interviews during September -December, 1988.
The following report provides names, addresses, telephone number of residents and
property owners and provides well information obtained through the interview.
Additionally, locations of each residence/business are located on the attached
drawing, Keystone drawing number B-512474. The report presents information
according to street names.
Approximately 145 residences/businesses are located within one mile of Koppers
former site. Approximately 90 wells are in use. City water is available along Airport
Boulevard and the southern portion of Highway Route 54, although not all
residences/business are connected. At other areas, water is obtained through wells.
At some locations, one well supplies water to more than one residence.
Generally, wells are in the 100-200 ft. range, although a few wells are 300 to 400 ft.
Most wells are constructed with casing set into competent bedrock and an open rock
hole below the casing.
Water quality in the area is universally poor. Many_residents do not use the water for
consumption due to displeasing tastes caused by naturally occurring calcium and
magnesium hardness and rotten-egg smell caused by hydrogen sulfide. Well yields
range from very good (20 gpm) to very poor (2 gpm) which may explain excessive
well depths.
In addition to door-to-door canvasing, the North Carolina Department of Natural
Resources & Community Development, Raleigh Regional office was contacted to
obtain well permitting information for the area which is contained in Appendix A.
DCC#12
• •
CHURCH STREET RESIDENCES AND BUSINESSES
Location
ID No.
N-6
N-5
N-4
N-2
N-7
N-1 & NlA
2M
3M
4M
SM
DCC#12
Resident Name
and Address
Mark & Pam Jones
44 7 Church Street
469-3659
vacant
Richie Pendergraft
450 N. Church
460-9883
Vacant
581 N. Church Street
Ms. Dillie Upchurch
Church Street
467-8246
Wayne Kenned?
580 N. Church tree!
467-9281
Mr. & Mrs. Doug Ray
Route 2 Box 1 ·
467-9544
Wm. Herbert Franks
Route 2 Box 2A
467-8602
Construction Office
Linwood Elmore
Route 2 (Post Office)
469-1062
1
Property
Owner
Same
Mr. Jenkins
Route 2 Box B-4
467-3181
Mr. Jenkins
Route 2 Box B-4
467-3181
Kennedy
(see N-1)
Same
Same
W. Herbert Franks
(see 3M)
Same
W.H. Franks
Same
No. of Wells
on Property
0 -City Water
1 Plus City Water
0 -City Water
0 -supplied by
well at N-1
0 -City Water
2 -Abandoned
1
0 -City Water
0 -City Water
0 -City Water
1
RcYision 2
• •
CHURCH STREET RESIDENCES AND BUSINESSES (Continued)
Location Resident Name Property No. of Wells
ID No. and Address Owner on Property
6M Rickey D. Marshburn Same 0 -supplied by
Route 2 Box 4 15M well
467-1590
SM Doris Mayo Charlie Mayo 0 -water from
Route 2 Box6 well @ Lonely
467-3929 Hearts Club
9M Christine Spivey Same 0 -water from
Route 2 Box 7 well @ Lonely
467-0791 Hearts Club
15M Randy & Robin Marshburn Same 1
Route 2 Box 5
469-1547
16M Mr. D.C. Marshburn Same 0 -water from
Route 2 Box 5 well 15M
467-6575
17M PBS Pipe Service Martha Brandon 0 -no water
Church St. Bunnlevel, NC
469-8428
18M William Harrington Same 1
Route 2 Box 8'
467-8330
19M Queen & Otto Lyons Same 1
Route 2 Box 9
467-9673
13L Linda Hinton Otto Lyons 0 -supplied by
Route 2 Box 9 (sec 19M) well at 19M
467-4336
DCC #12 2 Revision 2
• • DA VIS ROAD RESIDENCES AND BUSINESSES
Location Resident Name Property No. of Wells
ID No. and Address Owner on Property
37M Mr. & Mrs. Terry Allen Bobby Davis 0 -supplied by
Route 2 Box 123 (see 36M) well@ 36M
467-4943
36M Mr. & Mrs. Bobby Davis Same 1
Route 2 Box 119A
467-2836
35M Steve Wintermute Same Contact not
Route 2 Box 119 made
34M Mr. & Mrs. James Peptis Bobby Davis 1
Route 2 Box 121 (see 36M)
481-4780
30M Dora Davis Bobby Davis 1
Rt 2 Box 119 (see 36M)
Contact Bobby Davis -36M
31M No Contact Made
39M/40M David Quate/Quate Welding Same 1 for ail 3
· 41M P.O. Box 131 locations
469-0291
32M Lawrence W. Giles Same 2; one used
P.O. Box 462
481-9590
33M Maxine White L.W. Giles 0 -supplied by well
P.O. Box 462 (see 32M) @32M
No phone
42M. Todd Miller L.W. Giles 0 -supplied by well
Route 2 Box 119 (see 32M) @32M
469-1242
38M Mr./Mrs. Willie Davis Same 1
Route 2 Box 119
467-3132
34M Helen Hovey Bobby Davis 1
P.O. Box 317
460-8774
DCC #12 9 Revision 2
• •
HIGIIWAY ROUTE 54 RESIDENCES AND BUSINESSES (Continued)
Location Resident Name Property No. of Wells
ID No. and Address Owner on Property
lH Paul Wilkins not known 1
Route 2 Box 36
467-1677
lOH Walter C. Greene Same 1
Route 2 Box 35
467-2894
9H Sylvester Currie Same 3
Route 2 Box 34
467-8659
SH Emmitt Holloway Clarence Holland 1
Route 2 Box 33 (see 14!)
467-3517
16H James Harrington William Harrington 1
Route 2 Box 33A (18M)
not known
7H Randy Hester William J. Barbee 1
Route 2 Box 32
No phone
(see OS-9)
6H Mr. & Mrs. Dewey Green Same 0 -supplied by
Route 2 Box 31 well at SH
467-4664
SH James Green/Brisilla Chavas Same 1
Route 2 Box 31
467-9958
OS-11 Mr. & Mrs. Roosevelt Satterwhite Nora Mayo 1
P.O. Box 701
Apex, NC 27502
(see lJ)
460-0462
OS-7 Mr. & Mrs. James Crowe Same 1
Route 2 Box 25
467-8603
DCC#12 13 Revision 2
•
HIGHWAY ROUTE 54 RESIDENCES AND BUSINESSES (Continued)
Location Resident Name Property No. of Wells
ID No. and Address Owner on Property
15K L & D Rental Inc. Same 0
R. James Layne-Manager
P.O. Box 52059
Durham, N.C. 27717
[phone]
383-7241
469-5838
OS-10 The Deli Box Scott Beerman 1
Route 2 Box 24
467-4164
4J Bryant Industrial Bryant J. Marriner 1 -not used
PO Box 1287
Cary, NC27512-1287
467-2492
14K Crowder Construction Co. Same 1
Mr. Don Hancock
Route 2 Box 23
469-5449
OS-6 Wilkerson Construction Co. Same 1
Mr. Joseph Wilkerson
P.O. Box 183
467-1829
OS-4 Mr. & Mrs. Rdy Medlin Charles E. Zimmerli 2 -one
Route 2 Box 124 93 Sunny Reach Dr. abandoned
· 467-8624 West Hartford, CT
06117
16K David Strom Gary Boyette 0 -supplied by
Route 2 Box 126A 469-1720 well@ 18K
460-9234
17K Betty Bennett H.D. Copeland 0 -supplied by
Route 2 Box 127 (see 18K) well @l8K
contact 467-4164
DCC #12 14 Revision 2
• •
MARCOM ROAD RESIDENCES AND BUSINESSES
Location Resident Name Property No. of Wells
ID No. and Address Owner on Property
48H Billy Clarke contact not made
RT 1 Box 267
49H Mr. Buck contact not made
RT 1 Box 266A
50H Billy W. Buchanan Same 1
RT 1 Box 266B
467-0662
51H Rene Adams Same 1
RT 1 Box 266C
467-8828
52H James Watkins contact not made
RT 1 Box 266
53H Stanley Moss contact not made
RT 1 Box 266
54H Bruce Emory Jessie Marcom 0 -water from
RT 1 Box 266 Marcom well (55H)
SSH Jessie William Marcom Same 1
RT 1 Box 266
467-2631
56H David Stegall
RT 1 Box266C
Same 1
469-0396
DCC#12 22 Revision 2
•
KIT CREEK ROAD RESIDENCES AND BUSINESSES
Location
ID No.
35H
36H
37H
38H
39H
40H
DCC#12
Resident Name
and Address
Branch
RT2, Box 79
Jesse Joyner
N.Mayo
RT 2 Box 77
Dunnigan
contact not made
contact not made
RT2Box73
23
Property
Owner
contact not made
contact not made
contact not made
No. of Wells
on Property
contact not made
contact not made
contact not made
Revision 2
•
UNITED STATES ENVIRONMENTAL PROTECTION "AGENCY
4WD-RCRA
CERTIFIED MAIL
RETURN RECEIPT REQUESTED
Ms. Billie Nolan
REGION IV
345 COURTLAND STREET
ATLANTA, GEORGIA 30365
Beazer Materials and Services, Inc.
Law Department
436 Seventh Avenue
Pittsburgh, Pennsylvania 15219
RE: Issuance of EPA Identificat~on Numbers
Dear Ms. Nolan:
;
This is in response to your June 20, 1989, letter to Mr. J.R. Finney which
discussed the acquisition of Koppers Company, Inc., by Beazer Materials and
Services, Inc. (BMS) and the subsequent sale of certain BMS assets to Koppers
Industries, Inc. (KII). The assets sold to KII included facilities regulateC
under the Resource Conservation and Recovery Act (RCRA). Your letter proposed
that at each of these RCRA facilities KII receive new EPA Identification
Numbers. These new numbers would be associated with current and future
operations at the facilities while BMS would retain each facility's current EPA
Identification Number for use during closure and post-closure care.
After review of your proposal, EPA has determined that KII should not receive
new Identification Numbers. This is based on the definition of generation site
a~d hazardous waste management facility found in 40 C.F.R. Part 260.10 and Part
270.2, respect.ivel~·. Specifical~y, EPA has determined that KII is the owner of
each facility and both KII and BMS are the operators of each facility.
Therefore, KII and BMS should submit amended Part A Permit Applications
showing their current status. However, because both KII and BMS are considered
operators, BMS may demonstrate financial responsibility at each facility.
If You, have any questions regarding th.is decision, please contact Jeaneanne
Gettle at [phone].
Sincerely yours,
J1~({~~
cWief, RCRA Branch
Waste Management Division
cc: State Directors
Unite8\tates Department oft.Interior
FISH AND WILDLIFE SERVICE
Raleigh Field Office
Post Office Box 33726
Raleigh, North Carolina 27636-3726
Ms. Lois Walker
t,. C. Division of Heal th Services
Solid Waste Management Section
Superfund Branch
P.o: Box 2091
Raleigh, North Carolina 27602-2091
Dear Ms. Walker:
August 8, 1989
-a D Ill
I apreciate the assistance provided to me by the staff of the Superfund
Branch during my recent file revieh' of Superfw1d Sites. Enclosed 1 for your
f .i les, are cc1pies cf the preliminary natural resource surver!=: th:11-. I' v:?
prepared:
-Jadco-Hughes Site
-Cape Fear Wood Preserving Site
-Eoppcrs Company, Inc., Morrisville Site
-Potter's Septic Tank Service Pits Site
If you have questions regarding these reports, I can be contacted at 919-
856-4520.
Sincerely
!(ate Benkert
Environmental Contaminants Specialist
\
DATE:
REPLY TO
ATTN OF:
SUBJECT:
TO:
~ c..·:,, ) ~~-.:.:.. • -~ 1, -
• UNITED STATES GOVERNMENT
memorandum
July 24, 1989
Field Supervisor, FWS, Fish and Wildlife Enhancement, Raleigh, NC
Preliminary Natural Resource Survey, Koppers Co.,Inc., Morrisville,
Wake County, North Carolina. ER89/337.
Regional Environmenta 1 Officer, Southeast Region, Department of the
Interior, Atlanta, Georgia
In response to Mr. John Farrell's request. of May 4, 1989, the U.S.
Fish and Wildife Service (Service) has conducted a Preliminary Natural
Resource Survey of the Koppers Co., Inc. (Morrisville Plant) Site,
Morrisville, Wake County, North Carolina. The purpose of the survey
is to determine if resources under the trusteeship of the Department
of the Interior are present in the vicinity of the site and, if
present, whether there are documented o.r suspected damages resultant
from the release of hazardous substances at the site. This survey was
coriducted according to procedures outlined in PEP-Environmental
Memorandum No. ER-83-2.
Site Location and History. The site is located approximately 1.25
miles north/northwest of Morrisville, North C2rolina on State Highway
54 (West). It encompasses 52 acres, bounded on three sides by SR
1037, SR 1635 (Koppers Drive), and Southern Railway and Highway 54.
The Koppers Company operated a wood treatment and laminating facility
on the site from 1962 until 1986. A Cellon Treating Process was used
on the wood. This process impregnates the wood with pentachlorophenol
(PCP) with the following cosolvents: butane, isopropyl ether (IPE)
and a glycol-based solvent. Residual PCP salts on the wood were
recovered by steaming. The steam condensate was discharged to two
treatment lagoons and then to the Fire Pond. Detection of PCP in the
lagoon water in 1976, resulted in reclamation by on-site land farming
of the water. The lagoon sludge was spread over the lagoons and
adjacent areas.
On-site soil concentrations of PCP range from <70 ug/kg (detection
limit) to 46,900 ug/kg. Only 2 of 30 samples had PCP concentrations
exc~eding 400 ug/ kg. Ground water concentrations from -wells on or
immediately adjacent to the site ranged from <LOO ug/1 (detection
limit) to 717 ug/1. Both PCP and IPE have been detected in off-site
domestic wells, primarily to the north and northwest of the site.
Sediments collected from the Fire Pond, Medlin Pond (a private pond
off-site) and drainage ditches have PCP concentrations ranging from
<100.0 ug/kg to 892 ug/kg. Surface water samples collected from
Medlin Pond ranged from 0.022 ug/1 to 0. 381 ug/1. The Fire Pond
samples were invalidated d·ue to contamination of the trip blanks.
Congeners of polych1orinated dibenzodioxins 2nd polychlorinated
OPTIONAL FORM NO. 10
{REV. 1-80)
GSA FPMR {'-1 CFR) 101-\ 1.6
!>010-\U
* U.S.GP.0.: 11lBll -20l-7f,0/b0279
•
dibenzofurans (PCDD/PCDF) were detected in Medlin Pond and five of six
domestic wells sampled in 1988. The Fire Pond apparently was not
sampled for PCDD/PCDF.
Fish and/or tadpole kills have occurred in both the Fire Pond and in
Medlin Pond, primarily after heavy rains. Documented die-offs
occurred in 1977 and 1979 in the Fire Pond and in 1971 in Medl.i n Pond.
An investigation of aquatic resources in the ponds was jointly
conducted by the North Carolina Divsion of Environmenta-.1 Management
and the Koppers Company in 1986. Centrachid fish froin both ponds had
detectable concentrations of PCP (65 ug/kg to 220 ug/kg wet weight,
whole body). A macroinvertebrate survey of the Fire Pond documented
the presence of only two pollution tolerant families. Detr.itivores
were absent from the pond macrobenthos community. Anoxic conditions
exist at the pond bottom.
Field Inspection and Natural Resource Survey. An inspection of the
Koppers Company site was conducted on July 19, 1989 by Service
biologist, K.A. Benkert. Level D protection was worn. Site
inspection was limited to th.e site boundaries and immediately adjacent
areas.
The Fire Pond is approximately 3 acres in size, most of which is
bordered with cattails (Typhus sp.) and black willow (Salix
nigra). The pond is contained by a dike along Koppers Drive and
the Southern Railway (Figure 1). The area between the dike and the
railway is densely vegetated with mature loblolly pines, sweetgum,
white ash, red maple, persimmon and various species o.f understory
shrubs. Water was present in shallow ditches between the site
property and the railway. The dike along Koppers Drive is primarily
vegetated with loblolly pines and an herbaceous understory. Numerous
bird species were using these areas including Carolina wrens, mourning
doves, blue jays, cardinals, robins, and bobwhite quail. Other
wildlife or wildlife sign observed on or adjacent to the Koppers
Company prnperty included raccoon, red-winged blackbirds and grackles.
Mourning doves, barn swallows and a box turtle were observed in the
old field successional habitat located north/northwest of the
property.
The Fire Pond serves as a ground water recharge area. Contamination
of Medlin Pond, about 0.5 acre in size and located approximately
1,000 feet south of the Fire Pond, is presumed due to both ground
water infiltration and overland runoff from the Fire Pond. An outlet
culvert from the Fire Pond exists near the southern corner of the pond
( Figure 1). Sediment samples from this culvert had PCP present at a
concentration of 892 ug/kg.
A second source o( overland runoff from the· site to Medlin Pond m,'3)'
exist and requires examin<"3tion during the Remedial Investigation (RI).
The L::rge ungraded wooded area (Figure 1), located in the southwest
corner of the Koppers Property, incJudes a palustrine forested wetland
vegetated with red maple, white a sh, black willow, sweet gum and
loblolly pine. Due to the topography of the property, runoff from the
upland portions is apt to enter this wetland. Flowing water was
present in this wetland during the site inspection. This water exits
the property via a road culvert under Koppers Drive. The flow
continues through a wooded area on the other side of the road.
Al though unable to follow the stream corridor, the topography suggests
that this water may either enter Medlin Pond or downstream.of the pond
outlet (Figure 1). Additional investigation is required to confirm
this overland runoff route.
Trust Resources. Migratory birds, which are trust resources of the
Department, are present on and adjacent to the site. No National
Parks, National Wildlife Refuges or Indian Reservations occur in the
immediate vicinity of the site. No anadromous fish, endangered
species or endangered species critical habitats occur within the
vicinity of or on the subject hazardous waste site. Two endangered
species are present in Wake County, but not on or near the site: ba]d
eagle (Haliaeetus leucocephalus) and red-cockaded woodpecker
(Pic·o·ides borealis). There is one plant species, Michaux'
poison-~umac (Rhus michauxii), proposed for listing as an
endangered species.
Five Wake County species are status review candidates for listing as
endangered species:
Bachman's sparrow (Aimophila aestivalis)
Carolina madtom (Noturus furiosus)
Lewis' heartleaf (Hexastylis lewisii)
Nestronia (Nestronia umbellula)
Carolina trillium (Trillium pusillum v. pusillum)
Status review species a re not now listed or officially propsoed for
listing as Federally endangered or threatened, but they are under
review by the Service. 11 Sta tus review" species are not legally
protected under the Endangered Species Act (Act), and are not subject
to any of its provisions, including Section 7, until they are formally
proposed or listed as threatened or endangered. We are providing this
advance notification as the listing of any of these status review
species during the course of the site remediation, may necessitate an
endangered species survey on the site.
Conclusions. This preliminary assessment of the risk of the Koppers
Co., Inc. site to fish and wildlife resources indicates that
contamination has occurred in the past and 2 high potential for future
contamin2 tion exists. The presence of PCP contamination in the
surf.-ace .wat~r and sediments of both ponds is an ongoing threat to the
fish and wildlife that use. the area. Additionally, the continued
release of PCP and other contaminants v.ia ground water discharge into
•
loc2l s~reams and ponds represents a long-term threat to fish and
wildlife resources. Thus, the Service will not grant a release at
this ti11:.e. We will reconsider this position after we have reviewed
the information generated from the implementation of the following
recommendations.
Recommendations. To insure that public fish and wildlife resources
are addressed during the' remedial investigation and feasibility study,
the Service recommends the following:
1. Conduct surface water and sediment bioassays on both the Fire Pond
and Medlin Pond.
2. The secondary route of overland runoff to and contamination of
Medlin Pond through the ungraded wooded area in the southwest corner
of the Koppers Property should be investigated.
3. Sediment and surface water sampling of the ungraded wooded area,
which includes a palustrine forested wetland, and its downstream flow
corridor on the opposite side of Koppers Road, be conducted during the
RI and analyzed for the identified potential contaminants of concern.
4. Keep the Service informed of the RI/FS process through timely
dissemination of aprropriate reports and data.
-t
o ..
II
PROPERTY
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North Carolina Department of Human Resources
Division of Health Services
P.O. Box 2091 • Raleigh, North Carolina 27602-2091
James G. Martin, Governor
David T. Flaherty, Secretary
Ronald H. Levine, M.D., M.P.H.
Ms. Denise Smith
EPA NC CERCLA Project Officer
EPA Region IV waste Division
345 Courtland street, N.E.
Atlanta, GA 30365
Dear Ms .• Smith:
SUBJECT: ~ite Inspection Report
27 May 1987
Koppers Co,, Inc, NC D003200383
Morrisville, NC
State Health Director
Submitted herewith is the site Inspection Report for the subject
site. Based on our review of the available data, we have concluded the
following.
The Koppers co; Inc. site is located on a 52 acre tract on Highway 54
west, approximately 1 mile northwest of Morrisville, NC. The site was used as
a sawmill until 1959, It was then sold to a company called Unit Structures,
Inc., which produced glue-laminated wood products on site. Koppers Company
purchased the site in 1962 and continued the glue-laminating process. From
1968 to 1975, Koppers used the southeast portion of the site for wood
treatment with pentachlorophenol (PCP). wood treatment was discontinued on
site in 1975, however, laminated wood production continued, The plant was
sold back to unit structures in September 1986. Koppers retained 10 acres of
the original site.
wastewater from the PCP process was discharged to the pond on site
for the first 6 months of operation and then to 2 unlined lagoons on site.
PCP treatment was discontinued in 1975 and Koppers closed the wastewater
lagoons in 1977. Liquid from the lagoons was sprayed over a field on the
northeast corner of the property and the sludge was mixed with soil and spread
over the lagoon area in. the southeast corner. Soil samples collected by
Koppers in 1980, 1981 and 1984 led to the removal of PCP contaminated soil
from the site in 1980 and 1986.
Ms. Denise Smith
27 May 1987
Page 2
To date, PCP contamination has been measured in soil, groundwater,
and pond water and sediment on site. Contaminated soil has been removed from
the old lagoon area. However, post-cleanup sampling in this area indicates
that PCP is still present in the soil. No known remedial action has been
taken regarding contamination in the pond on site or the area in tl1e northeast
corner of the site where wastewater was sprayed.
Groundwater is the primary source of drinking water for 2169
residents within a 3-mile radius of the site. Within this area, all
water-bearing zones are hydrologically connected and function as a singl~
aquifer. Therefore, PCP measured in on-site wells may impact drinking water
wells used by local residents. Trace contaminants have already been detected
in some off-site wells.
Runoff from the northeast corner of the site drains eastward to an
intermittent creek. This creek flows southeast approximately 2.25 miles to
Crabtree creek. Runoff from the southeast corner of the site drains to
Koppers Pond which is used for fire protection. PCP has been detected in
water and sediment from the pond. Intermittent overflow from Koppers Pond
drains south approximately 1,000 ft. to the Medlin Pond. This pond is used
for fishing and irrigation of garden crops.
Based on these findings, it appears that PCP contamination at the
Koppers Co., Inc., site ,may impair groundwater and surface water used by local
residents.
If you have any questions, please contact me at [phone].
PD/tb/0376b
Sincerely,
Pat DeRosa, Waste Management Specialist
CERCLA Unit
solid and Hazardous waste Management Branch
Environmental Health Section
' •'"
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NOTE: ALL LOCATIONS ARE APPROXIHA.TE.
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ENVIRONMENT AL RESOURCES, rue.
\ /
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LOCI/ TIO.IV MAP
fJOMf:STIC WElL SU/:/V€Y
BEAZER MATERIALS G
SERVICES, INC.
FORMER KOPPERS COMPANY
MORRISVILLE SITE
N
0
. .r.T;,;;~n-179225-QJ OATit 09/06/tl!J 11('1, 2 8512474
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rP\.it~~\:t;\ i'-3 --~J ! ,:---"'E \1;·',1J :_1., l.i
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North Carolina Department of Human Resources
Division of Health Services
P.O. Box 2091 • Raleigh, North Carolina 27602-2091
James G. Martin, Governor
Phillip J. Kirk, Jr., Secretary
Ronald H. Levine, M.D., M.P.H.
17 April 1987
Mr. Perry Nelson
NRCD -Division of Environmental Management
Archdale Building -Raleigh, NC
Re: Koppers company, Inc.
NCD003200383
Dear Mr. Nelson:
In response to our agreement to share information on Koppers
Company in Morrisville at the 19 March 1987 meeting, the following
information is enclosed.
State Health Director
1) summary documents including a 3 April 1987 memo from Pat
DeRosa, facility and USGS maps, and laboratory results.
2) 26 January 1987 information package from M. Schlesinger to P.
DeRosa.
3) 5 March 1987 letter from M. Schlesinger to P. DeRosa with
sampling results for off-site wells (sampling dates 9/9/86,
11/6/8 6, 1/14/8 7).
4) 17 December 1986 NC CERCLA trip report and sampling results.
5) 13 November 1984 Koppers Hydrogeologic Investigation.
6) 27 January 1981 EPA Hazardous waste Site Investigation.
Also, a CERCLA Unit report will be finalized by June 1987. We will
also be forwarding a copy of this report to you. If you have any
questions, please call me at 733-2801.
LC/pc
Enclosure
Sincerely,
~by,~~~6
CERCLA Unit Manager
Solid & Hazardous Waste Manage1nent Branch
Environmental Health Section
l)
N. C. Department of Human Resources
Division of Health Services SAMPLE ANALYSES REQUEST
j
State Laboratory of Public Health
P. 0. Box 28047
306 N. Wilmington Street
Raleigh, 27611
Site Number · m umber __,,..,;_;5~f..,__C/,_'l,__ ______ _
Name of Site _L.Lj~'4,!,t:GL_j-42....-1---'!;d::J.JC.....--,-,,,C.~~
Collected By
Type of Sample:
r" C
Environmental Concentrate
L Groundwater (I). __ Solid (5)
__ Surface Water (2) __ Liquid (6)
__ Soil (3) __ Sludge (7)
__ Other (4) __ Other (8) ,.
INORGANIC CHEMISTRY
Extractables
Parameter
__ Arsenic
__ Barium
__ Cadmium
__ Chromium
___ Lead
__ Mercury
__ Selenium
__ Silver
Parameter
LP&T:GC/MS
__ Acid:B/N Ext.
_TOX
Results mg/ 1
Results mg/ 1
£: t. ra12,""'~ L .eWv ,-
MICROBIOLOGY
Parameter
__ (MF) Coliform Colonies/l00mls
__ (MPN) Coliform Colonies/l00mls
--
--
Parameter
__ Arsenic
__ Barium
__ Cadmium
__ Chloride
__ Chromium
__ .Copper
__ Fluoride
__ Iron
__ Lead
__ Manganese
__ Mercury
__ Nitrate.
__ Selenium
Results mg/t'
ORGANIC CHEMISTRY
Parameter Results mg/ 1
_EDB
__ PCB's
__ Petroleum
__ Endrin
· __ Lindane
Parameter
__ Gross Alpha
__ Gross Beta
--
--
. ' .Ne •
Total
Parameter
__ Silver
__ Sulfates
__ Zinc
_Ph
/300
Results mg/1
__ Conductivity
_TDS
_T_o_c ________ ,~
Parameter Results mg/ 1
__ Methoxychlor
__ Toxaphene
-2,4-D
__ 2,4,5-TP (silvex)
--
RADIOCHEMISTRY
Results PCi/ 1
Date Received -~I ~1-~:::"',o"--~S~'i""""tX'-'-'-f~,' ---'--------Date Reported ___ ...,/c___;i__ _ _,f_..,~"-"-r ________ _
Date Extract/~=",---o,c----nc-_ -/fL.--'q_/l-----=-----Date Analyzed ---;7"ff'olr'a~1hGet"7"J---------
Reported By ,f-· ·-+ ~-......c->--.C.A-'-"": ___________ Lab Number __________________ _
~
DHS 3191 (Revised 7/85)
Solid and Hazardous Waste (Review 7 /87)
.t
Purpose: Enforcement and compliance with the N. C. Solid and Haz~rdous Waste Management Rules.
Preparation A sample analyses request form (DHS 3191) must be completed .for each type of evaluation requested ( e.g.,
inorganic, organic1 microbiology, radiochemistry). For sampling conditions which require more than one (1)
container ( i.e., ground or surface water from' landfills) a sample label must be affixed io one of the containers. The
collector must then write the site and sample number .. on the duplicate.
Do not submit an analysis request sheet with no parameters indicated . ..... ·~·-·t·• ......... ,.. ... ,.~'.\It(~,-.-.._ ".,.. \~ J ·.t • ""<.!-I;,._ Equivalent measurements:
,r ~!"7.1')..' ·•..._ ,i .... , \ ppm= µg/ml = mg/I =µgig= mg/kg
'ppb = µg/1 = µg/l000g = µg/kg I \ . .., , ..
\ ' \ \ . .:·~; DEFINITIONS/INSTRUCTIONS
\ .. , Site Number -A.twelve-digit site/location identifier, assigned only by the district field representative. \ ;-,.\ i , ' .•, . . .. ·::.-,i
\.-, : . .field S~n\ple II! i#iher -A six-digit sample identifier which is pre-printed on the sample label.
• , '°i, c· \,I/ ''··N~me of, Sit~. "'Name of landfill, facility, etc .
.... ·•·· __ 1 ........
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, resins, 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: 1. Original to State Laboratory of Public Health
Environmental Sciences Branch
Disposition:
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.
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
CO/JC..
SAMPLE ANALYSES REQUI;:ST
State Laboratory of Public Health
P. 0. Box 28047
306 N. Wilmington Street
Raleigh, 2 7611
Site Number _._9__.J"'-"/)'""-_,,O::..=O:...c3=-=.:l.~0=---=0c..c3-.._F,.__,,3 ___ Field Sample Number _..:3=-?--'--_.C/~JY _______ _
Name of Site .,jG,-y~c,,11',IL<~ll'PL....l.~-;-' .. Cll"",f.J_ ... "'"'•~--lz;Dl,£#'1_,:-C~::~:~~~~-Site J.,oca;ion . //20rr I :ru I '/l5L,
Collected By &± /JL lttl.s4 .3/l Date Collected //-/ 7 -/:Z Time J.;l(!JQ
Type of Sample:
Environmental Concentrate
_L Groundwater ( 1) __ Solid (5)
__ Surface Water (2) __ Liquid (6)
__ Soil (3) __ Sludge (7)
__ Other (4)
Extractable•
__ Other (8)
lNORGAN
Parameter Results mg/ 1 Parameter
__ Arsenic
--Barium
__ Cadmium
__ Chromium
__ Lead
__ Mercury
__ Selenium
__ Silver
__ Arsenic
__ Barium
__ Cadmium
__ Chloride
__ Chromium
__ Copper
__ fluoride
__ Iron
__ Lead
__ Manganese i
__ Mercury
__ Nitrate.
__ Selenium
Results mg/ 1
ORGANIC CHEMISTRY
Parameter Results mg/ 1 Parameter Results mg/ 1
_P&T:GC/MS _EDB
L Acid:B/N Ext. __ PCB'.s
_TOX __ Petroleum
__ Endrin
x._PC:P · __ Lindane
MICROBIOLOGY
FEB 1
Parameter
__ Silver
__ Sulfates
__ Zinc
_Ph
__ Conductivity
_TDS
_TOC
Parameter
__ Methoxychlor
__ Toxaphene
_2,4-0
__ 2,4,5-TP (silvex)
--
RADIOCHEMISTRY
Results mg/ 1
Results mg/ 1
Parameter Parameter Results PCi/ 1
__ (MF) Coliform Colonies/lOOmls __ Gross Alpha
__ (MPN) Coliform Colonies/lOOmls __ Gross Beta
----
----
Reported By
Date Received ~--'\..,_\_-_.,,;;)'-'{)'-----''i\.,_'?_,_..,_af-+'-8'-·--'--------Date Reported-;:-,;-----------------
fCt'1. 1 -~'.' 7 /Cl' ,,!)
Date Extracted --"-"'"'-'/11:'.~il.'-'--------------Date Analyzed ~~~:J.~-/~O_·=Y2~u'"r'...,.,.....,,..-...,.."""'--------. 'l03168
------------------Lab Number __________________ _
DHS 3191 (Revised 7/85)
SoliJ anJ Hazardous Waste (Review 7 /87)
Purpose: Enforcement and compliance with the N. C. Solid and Hazardous Waste Management Rules.
Preparation A sample analyses request form (OHS 3191) must be completed for each type of evaluation requested (e.g.,
inorganic, organic, microbiology, radiochemistry). For sampling conditions which require 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
collector must then write the site and sample number on the duplicate.
/
I
i
Do not submit an analysis request sheet with no parameters indicated.
Equivalent measurements:
pp;,;= µg/ml = mg/1 =µgig= mg/kg
ppb = µgl 1 = µg/ 1 OOOg = µg/kg
DEFINITIONS/INSTRUCTIONS -·• : I : • Site Number;-A twelve-digit site/location identifier, assigned only by the district field representative. {.i . '
~ '.Fiel,l.Samj,le 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, resins, 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: 1. 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 Reco,ds 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 Rt!sourct:s
Division of Health Services SAMPLE ANALYSES REQUEST
State Laboratory of Public Health
P. 0. Box 28047
306 N. Wilmington Street
Site Number
Name of Site
Collected By
Type of Sample:
9,3 /) 003 ZOtJ .3 8 3
Environmental
___L. Groundwater (I)
___ Surface Water (2)
__ Soil (3)
__ Other (4).
Concentrate
__ Solid (5)
__ Liquid (6)
__ Sludge (7)
__ Other (8)
Raleigh, 276 l l
a
INORGANIC CHEMISTRY
Extractables
Parameter
__ Arsenic
__ Barium
__ Cadmium
__ Chromium
___ Lead·
__ Mercury
__ Selenium
__ Silver
Results mg/ 1 Parameter
__ Arsenic
__ Barium
__ Cadmium
__ Chloride
__ Chromium
__ Copper
__ fluoride
__ Iron
__ Lead
__ Manganese
__ Mercury
__ Nitrate.
__ Selenium
Results mg/ 1
__ Conductivity
_TDS
_TOC
ORGANIC CHEMISTRY
Parameter Results mg/ 1
_,L_ P& T:GC/MS
__ Acid:B/N Ext.
_TOX
~ , [D /l-'""/!1/ / e"Hv ,-
MICROBIOLOGY
Parameter
__ (MF) Coliform Colonies/lO0mls
__ (MPN) Coliform Colonies/l0Omls
Pai:ameter
_EDB
__ PCB's
__ Petroleum
__ Endrin
__ Lindane
Dare Received_ --'-I I_-_:;i.__0_-~8_'_7.,,£=/3"----~-------
Date Extracted __________________ _
Reported By
\'JHS 11 q ! { Rt•vised 7185)
S,,li,I ;,ml H:c1r,ious \Va!'tl" (Rc\·it•w 7187)
Results mg/ 1
Parameter
__ Gross Alpha
__ Gross Beta
Parameter Results mg/1
_.• _ Methoxychlor
__ Toxaphene
-2,4-D
__ 2,4,5-TP (silvex}
--
RADIOCHEMISTRY
. Results PCi/ 1
Dare Reported __________________ _
Dare Analyzed ___ __,.7..,0~31-'111-£6'11931-------
Lab Number
:
'
Purpose: Enforcement and compliance with the N. C. Solid and Hazardou~ Waste Management Rules.
Prepara!i9ri\•: 1· :simp}~ analyses request form (OHS 3191) must be completed for each type of ~valuation requested ( e.g.,
,/· .. ~...: . inO}gan~c:;~organic, microbiology, radiochemistry). For sampling condition~ which require more than one ( 1)
/~ • container (i.~:,, ground or surface water from landfills) a sample label must be affixed to one Of the containers. The
I· collector must'then write the site and sample number on the duplicate. ' I
L. D b · 1 1 · h . h . d· d 1 ~:-o not su m1t an ana ys1s requests eet wit no parameters m 1cate .
\\. • ' -' 3.:. :') Equivalent measurements:
'~ ~,, ,. ~ . ..c,1 \~/ 4l J _,1,;, ·-~ \ ··1 .. _ ... , '. ,,,JJ ........ , '-: ;,_... . ., ,-\?;/ '--(:i~~:1, .. · .,,·-1•):-~ .. --
··--..~.~-~-:;:;,-:!-:·:~,.. ·-,.,
"
ppm= µg/ml = mg/1 =µgig= mg/kg
' ppb = µgl 1 = µg/ 1000g = µg/kg
DEFINITIONS/INSTRUCTIONS
Site Number -A rn\lve-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, resins, 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 an'alyzed. 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: 1. Original to State Laboratory of Public Health
Environmental Sciences Branch
P. 0. Box 28047
Raleigh, NC 27611
2. Lab sends copy fo 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 Record.s 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. Departmt!nt 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, 27611
Site Number
N:1me of Site
Collected By
Type of Sample:
Environmental
✓ Groundwater ( 1 )
v,c
ID# 38
Concentrate
__ Solid (5)
__ Surface Water (2) __ Liquid (6)
__ Soil (3) __ Sludge (7)
__ Other (4) __ Other (8)
Extractables
Parameter
__ Arsenic
__ Barium
__ Cadmium
__ Chromium
__ Lead
__ Mercury
__ Selenium
__ Silver
Results mg/ 1 Parameter
__ Arsenic
__ Barium
__ Cadmium
__ Chloride
__ Chromium
__ Copper
__ fluoride
__ Iron
__ Lead
__ Manganese
__ Mercury
__ Nitrate.
__ Selenium
Field Sample Number _.,,s;.3'-"J'"--'lJ=-0=-----------
Site Location /J1Qrr1 ✓VI J/-'?.. I{ c_ ~ ,
Date Collected //-/ "7 -/:Z Time f33Q
Results mg/ 1 Parameter
__ Silver
__ Sulfates
__ Zinc
_Ph
__ Conductivity
_TDS
_TOC
Results mg/ 1
---------
ORGANIC CHEMISTRY ...
Parameter Results mg/ 1,
_P&T:GC/MS
_L Acid:B/N Ext.
_TOX
.:,t.PC..P
MICROBIOLOGY
Parame'ter
__ (MF) Coliform Colonies/lOOmls
__ (MPN) Coliform Colonies/lOOmls
Parameter
_EDB
__ PCB's
__ Petroleum
__ Endrin
__ Lindane
Dare Received ---,-~''--' --~o-~0~·...,a'--·7-'-'o{"-'-', A~--------
ft(J
Date Extracted ~'~2-~-fl"'·~h'.~7~13.,,~cc_ ___________ _
Results mg/ 1
Parameter
__ Gross Alpha
__ Gross Beta
.
Paramet"er· : Results mg/ 1
__ Metho~ychlor ~ £: !, ··1 .. :'.11:'.:
__ Toxaphene
_2,4-D
__ 2,4,5-TP (silvex)
--
RADIOCHEMISTRY
Results PCi/ 1
Date Reported =,,,---------------,-----fC
Date Analyzed ~l.J~-t~.;.-_/f7~~fi,i£!.,,.,.....,....,.-==---------
Reported By -------------------Lab Number
70J l 70
r1HS.1tt)J (R~·viscd 7185)
S.,Ji,I ;u1t\ Ha:;1r,iOl!S \X/astc { Rcvil'w 7 /87)
Purpose:
Preparation
' '
Enforcement and compliance with the N. C. Solid and Ha~rdous Waste Management Rules.
A sample analyses request form (OHS 3191) must be completed for each type of evaluation requested (e.g.,
inorganic, organic, microbiology, radiochemistry). For sampling conditions which require 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
collector must then write the site and sample number on the duplicate. ·
Do not submit an analysis request sheet with no parameters indicated. -------~ ~-,,.. tr~ \J f ~I .... 1'.En-uivalent measurements: _, ·.; --J;:1 '·,
/ ' ' / ppm= µg/ml \ mg/I =µgig= mg/kg
/ ppb = µg/1 =,µg/lOOOg = µg/kg
!, \
: __ ' DEFINITIONS~INSTRUCTIONS , . • .. I
Site Number -A tw~Ite-digit site/location ident_lfi~r, assigned only by the district field representative. \.~ ;' . ... ... .~-,
Field Sample Number\,·A six-digit'sa;.;_ple i\je_n,.tifier which is pre-printed on the sample label. . .... ~, yr
Name of Site -Name of landfill, facility, etc,,
•~-k .. ,.:..~ • , .... ~ 0
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, resins, 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 landfi1l 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 aO.d 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
,'.)·Ir-..::~•·,
:i ..
'
N. C. Department o( Human Resources
Division of Health Services SAMPLE ANALYSES REQUEST
State Laboratory of Public Health
P. 0. Box 2804 7
306 N. Wilmington Street
Raleigh, 27611
Site Number
Nam!.! of Site
Collected By
~f.~'J~l>~~0~0~3_Z~O~O~J~1/~3~---Field Sample Number ---3~J'~O~/ ________ _
__ff() d A.PC£ CA J Z:-0 c Site Location 111,!)ro J(/, lie
/J" ,
.NC •
ra L /)e /4) rA ID# .3 r Date Collected II-17 -<f l Time__,lc....'.Sf~lc....=b_
Type of Sample:
Environmental
_L Groundwater (1)
___ Surface Water (2)
__ Soil (3)
__ Other (4)
Concentrate
__ Solid (5)
__ Liquid (6)
__ Sludge (7)
__ Other (8)
INORGANIC CHEMISTRY
Extractables
Parameter
__ Arsenic
__ Barium
__ ·Cadmium
__ Chromium
__ Lead
__ Mercury
__ Selenium
__ Silver
Results mg/ 1 Parameter
__ Arsenic
__ Barium
__ Cadmium
__ Chloride
__ Chromium
__ Copper
__ Fluoride
__ Iron
__ Lead
__ Manganese
__ Mercury
__ Nitrate.
__ Selenium
Results mg/ 1 Parameter
__ Silver
__ Sulfates
__ Zinc
_Ph
__ Conductivity
_TDS
_Toe
Results mg/ 1
ORGANIC CHEMISTRY
Parameter Results mg/ 1
_,L__ P& T:GC/MS
__ Acid:B/N Ext.
_TOX
L ·1. [D.,2-rtJ/!f/f-e"Hvr
MICROBIOLOGY
Parameter
__ (MF) Coliform Colonies/lO0mls
__ (MPN) Coliform Colonies/l00mls
Parameter
_EDB
__ PCB'.s
__ Petroleum
__ Endrin
__ Lindane
Date Extracted __________________ _
Reported Oy
DHS ]lt)! \Rn1iscd 7/85)
S1,liJ and Ha:ardou~ \Vastc (Revit·w 7/87)
Results mg/ 1
Parameter
__ Gross Alpha
__ Gross Beta
ParametCi Results mg/ 1
_ .• _ Methoxychlor .. . }.;..;: _
__ Toxaphene
_2,4-D
__ 2,4,5-TP (silvex)
--
RADIOCHEMISTRf
Results PCi/ l_
Date Reported __________________ _
Date Analyzed _____ ....,,.....,..,....=--=----------~ ?03171 Lab Number ___________________ _
i
I
Purpose:
Preparation
Enforcement and compliance with the N. C. Solid and HazardoU5: Waste Management Rules.
A sample analyses request form (OHS 3191) must be completed for each type of evaluation requested (e.g.,
inorganic, organic, microbiology, radioch.emistry). For sampling conditions which require 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
collector must then write the site and sample number on the duplicate. ·
Do not submit an analysis request sheet with no parameters indicated.
Equivalent measurements:
ppm= µg/ml = mg/I =µgig= mg/kg
ppb = µg/ I = µg/ IOOOg = µg/kg
DEFINITIONS/INSTRUCTIONS
Site Nunilier -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.
Nam~ 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, resins, 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 desked 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
Disposition:
P. 0. Box 28047
Raleigh, NC 27611
2. Lab sends copy fo Solid and Hazardous Waste Management Branch.
3. Solid and Hazardous Waste Management Branch sends copy to field person.
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 SAMPLE ANALYSES REQUEST
State Laboratory of Public Health
P. 0. Box 2804 7
306 N. Wilmington Street
Raleigh, 276 I I
Site Numbt"r 9.l /j 003.:t 003 .r .3
Name of Site ~Rt·7 Vl<
Collected By ID#
T ypc of Sample:
Environmental ✓ Groundwater (I)
___ Surface Water (2)
__ Soil (3)
__ Other (4)
Concentrate
__ Solid (5)
__ Liquid (6)
__ Sludge (7)
__ Other (8)
31?
Field Sample Number 3go:J-,
Site Loca~ion /J1orr1 Jfl f /I~ ~ , l{C.
Date Collected U-L-;, -1,::.l Time /"l/0
INORGANIC CHEMISTRY
Extractables
Parameter
__ Arsenic
__ Barium
__ Cadmium
__ Chromium
_. Lead
__ Mercury
__ Selenium
__ Silver
Parameter
_P&T:GC/MS
__lL_ Acid:B/N Ext.
__ TOX
-'!t..PC..P
Parameter
Resu Its mg/ I
Results mg/ I
MICROBIOLOGY
__ (MF) Coliform Colonies/lOOmls
__ (MPN) Coliform Colonies/lOOmls
Reported By
DHS .l I tl\ ( Rt·viscJ 7 /S5)
St iii,! am\ Ha:,1rdous \X'astc (Rt:\'it'\<' 7/8/)
Parameter
__ Arsenic
__ Barium
__ Cadmium
__ Chloride
__ Chromium
__ .Copper
__ fluoride
__ lron
__ Lead
__ Manganese
__ Mercury
__ Nitrate.
__ Selenium
Results mg/ I
Total
Parameter
__ Silver
__ Sulfates
__ Zinc
_Ph
__ Conductivity
_TDS
_TOC
Results mg/ 1
ORGANIC CHEMISTRY
Parameter
_£DB
__ PCBls
__ Petroleum
__ Endrin
__ Lindane
Results mg/ 1 Parameter Results mg/ 1
__ Methoxychlor .••: . ..: (\:~.:
__ Toxaphcne
_2,4-D
__ 2,4,5-TP (silvex)
--
RADIOCHEMISTRY
Parameter Results PCi/ 1
__ Gross Alpha
__ Gross Beta
Date Reported~~-----------------
fC,
Date Analyzed 1.J.-J0-!7 86.2, ·
· 703172
Lab Number
Purpose:
Preparation
' .
Enforcement ~nd compliance with the N. C. Solid and Hazardou~ Waste Management Rules.
A sample analyses request form (OHS 3191) must be completed for each type of evaluation requested (e.g.,
inorganic, organic, microbiology, radiochemistry). For sampling conditions which require 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
collector must then write the site and sample number on the duplicate. ·
Do not submit an analysis request sheet with no parameters indicated.
Equivalent measurements:
ppm= µg/ml = mg/1 =µgig= mg/kg
ppb = µg/1 = µg/lOOOg = 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, resins, 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 ~nly 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 Radiocheoii~try -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
Disposition:
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.
This form may be destroyed in accordance with the Environmental Health, Solid and Hazardous Waste Section of
the Record, Di,po,ition Schedule as published by the North Carolina Division of Archives and History.
Additional forms may be ordered from:
,,' ,, ., 'f'.
Solid and Hazardous Waste Management Branch
Division of Health Services
P. 0. Box 2091
Raleigh, NC 27602-2091
,·, .. ~•~·:~it
N. C. Department of Human Resources
[)j\·ision of Health Services SAMPLE ANALYSES REQUEST
State Laboratory of Public Health
P. 0. Box 2804 7
306 N. Wilmington Street
Raleigh, 2761 l
Site Numbc-r ~'i~'t1~./)~0~{)~3~Z~0~0~.3~8'~3~--Field Sample Number _...,,3""--'tr"-'0'-'-3"'---------
Namc of Site -Lk._,_IJl!'c,d~LJ..P..,,c:L.C-':S::'--'C_.A"----,4-"'Z:~..n,_L.JC-----Site Location. /J1(J CO JU I '//12,
/J'f I
.NC •
Collected By ra J /)e I~ r.4 ID# .3 i' Date Collected JI -17 -d' l Time LL/So
Type of Sample:
Environmental
L Groundwater (I)
Concentrate
__ Solid (5)
__ Surface Water (2) __ Uquid (6)
__ Soil (3) __ Sludge (7)
__ ._ Other (4) __ Other (8)
INORGANIC CHEMISTRY
Extractables
Parameter
__ Arsenic
__ Barium
__ Cadmium
__ Chromium
___ Lead
__ Mercury
__ Selenium
__ Silver
Parameter
_LP&T:GC/MS
__ Acid:B/N Ext.
_TOX
Results mg/ 1
Results mg/ 1
!t:__ , rD ,Ori>~ J-e'fw r y--
MICROBIOLOGY
Parameter
__ (MF) Coliform Colonies/lOOmls
__ (MPN) Coliform Colonies/lOOmls
Parameter
__ Arsenic
__ Barium
__ Cadmium
__ Chloride
__ Chromium
__ Copper
__ . Fluoride
__ Iron
__ Lead
__ Manganese
__ Mercury
__ · Nitrate .
__ Selenium
Results mg/1
ORGANIC CHEMISTRY
Parameter
_EDB
__ PCB'.s
__ Petroleum
__ Endrin
__ Lindanc
Results mg/ 1
Parameter
__ Gross Alpha
__ Gross Bera
Total
Parameter
__ Silver
__ Sulfates
__ Zinc
_Ph
__ Conductivity
_TDS
_TOC
Parameter
_.• _ Methoxychlor
__ Toxaphene
-2,4-D
__ 2,4,5-TP (silvex)
--
RADIOCHEMISTRY
Results mg/ 1
--------'
Results mg/ 1
.:.,,
Results PCi/ 1.
Date Received ___ l_l _-~;i._~o~--%_'1~r>S-A~-------Date Reported-----------------
Reported I3y
Date Extracted ___________________ Dare Analyzed ----,...rnr"J-.r-.,...""°----------
't'OJ 173
--------------------Lab Number
r,11s .~IQ\ (Revisi:d 7185)
_.;,1liJ ;in,J lla:ardi)us \Vastl" (Review 7/87)
Purpose:
Preparation
Enforcement and compliance with the N. C. Solid and Hazardou~ Waste Management Rules.
A sample analyses request form {OHS 3191) must be completed for each type of evaluation requested (e.g.,
inorganic, organic, microbiology, radioch.emistry). For sampling conditions which require 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
collector must then write the site and sample number on the duplicate.
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/lOOOg = 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, resins, treatment effluents or drum"mCd.
wastes.
Comn1ents -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. Exttacrables 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
Disposition:
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.
This form may be destroyed in accordance with the Environmental Health, Solid and Hazardous Waste Sectiori of
the Record.s 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
I\. ......
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
Raleigh, 27611
_9L-J.J..__./)_,_0=-=0~3c...:~=-.:0=-=0~3.__,,_F~3....__ Field Sample Number _...3""--"J''-O=-..f.._ _______ _
Site Number
Name of Site ~,_,_"'..,~"'-~,;:-=<c......f._..,6,=,_,_. --Z-n.....,,c _____ Site Location ITJocr I ✓rt I /1-e... I{ c..
Collected By fi;t-'J'J; /2i!) f4:, ID# 3 Jl Date Collected U-I 7 -J: 7 ~ime / 'f S' 0
Type of Sample:
Environmental ✓ Groundwater ( l)
___ Surface Water (2)
__ Soil (3)
__ Other (4)
Concentrate
__ Solid (S)
__ Liquid (6)
__ Sludge (7)
__ Other (8)
INORGANIC CHEMISTRY
Extractables
Parameter
__ Arsenic
__ Barium
__ Cadmium
__ Chromium
_·_·_ lead
__ Mercury
__ Selenium
__ Silver
Parameter
_P&T:GC/MS
_L Acid:B/N Ext.
_TOX
2t._PC...P
Parameter
Results mg/ l
Results mg/I
MICROBIOLOGY
__ (MF) Coliform Colonies/lOOmls
__ (MPN) Coliform Colonies/lO0mls
Parameter
__ Arsenic
__ Barium
__ Cadmium
__ Chloride
__ Chromium
__ Copper
__ Fluoride
__ Iron
__ Lead
__ Manganese
__ Mercury
__ Nitrate.
__ Selenium
Results mg/ l
ORGANIC CHEMISTRY
Parameter
_EOB
__ PCB'.s
__ Petroleum
__ Endrin
· __ Lindane
Results mg/ I
. Parameter
__ Gross Alpha
__ Gross Beta
__ Silver
__ Sulfates
__ Zinc
_Ph
__ Conductivity
_TOS
_TOC
.
Parameter
__ Methoxychlor
__ Toxaphene
_2,4-0
__ 2,4,5-TP (silvex)
--
RADIOCHEMISTRY
::r-
Results mg/ I
Results mg/ I
Results PCi/ I
Date Received -:=~l~/_-~,;J..~0_-~8~'-)~J'\'-6{.),,,_~-------Date Reported ~~-----------------
(!Cf> It~
Date Extracted ~/=,;._-~fl__,-Y~7~6~&c,c___________ Date Analyzed '-"J,J,"---,._,IOcc_·,,_S,._,7 6"'£J"'------'c'7!1lQF\-<;31-'1'-""7~4,'1------
Reported 8y -------------------Lab Number
l)H.S .1 Ii, l ( Rt·vis,'.d 7 IS5 l
Soli,! and Ha:~rdmis \'(1::iHc (Re\·i,c>w i/87)
Purpose:
Preparation
Enforcement and compliance with the N. C. Solid and Hazardou~ Waste Management Rules.
A sample analyses request form (OHS 3191) must be completed for each type of evaluation requested (e.g.,
inorganic, organic, microbiology, radiochemistry). For sampling conditions which require 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
collector must then write the site and sample number on the duplicate. ·
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/lOOOg = µg/kg
DEFINITIONS/INS'fRUCTIONS
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 naturaily occurring substance such as groundwater, surface·water or soils which -·
may be contaminated.
Concentrate -A sample of a waste, including but not limited co, sludges, resins, 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 2761 I
2. Lab sends copy to Solid and Hazardous Waste Management Branch.
Disposition:
3. Solid and Hazardous Waste Management Branch sends copy to field person.
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
', ... ' .....
•, l • t., • t .,.•• ,:;
State Laboratory vi Public Health
N. C. Department of Human Rr:sourci:s
Division of Hc!alth Services SAMPLE ANALYSES REQUEST P. 0. Box 2804 7
306 N. Wilmington Strl!et
Site Number
Raleigh, 27611
Field' Sample Number --~,-1~?,,,__Q~--',5~---------
Collected By
Type of Sample:
Environmental
_L_ Groundwater ( 1)
___ Surface Water (2)
__ Soil (3)
__ Other (4)
Concentrate
__ Solid (5)
__ Liquid (6)
__ Sludge (7)
__ Other (8)
Sire Location . l'/1<Jco '.r v l /( 12 ,1 NC
Dare Collected II -1'7 -,:f l Time
\
JA \_
INORGANIC CHEMISTRY
Extractables
Parameter
__ Arsenic
--. Barium
__ Cadmium
__ Chromium
__ Lead
__ Mercury
__ Selenium
__ Silver
Results mg/ 1 Parameter
__ Arsenic
__ Barium
__ Cadmium
__ Chloride
_·_chromium
__ Copper
__ Fluoride
__ Jron
__ Lead
_·_Manganese
__ Mercury
__ Nitrate.
__ Selenium
Results mg/ 1
Total
Parameter
__ Silver
__ Sulfates
__ Zinc
_Ph
__ Conductivity
_TDS
__ TOC
Remits mg/ 1
ORGANIC CHEMISTRY
Parameter Results mg/ 1
_L_p&T:GC/MS
__ Acid:B/N Ext.
_TOX
.ti , r D /l-rt,/?-1/ L .e..W,,,,, r
MICROBIOLOGY
Parameter
__ (MF) Coliform Colonies/lO0mls
__ (MPN) Coliform Colonies/lO0mls
Parameter
_EDB
__ PCB'.s
__ Petroleum
__ Endrin
__ Lindane
Dare Received ____ I l_-_,;,_._0_-_'3~1-=,,J;~,"-fi.,_ ______ _
Date Extracted __________________ _
Results mg/ 1
Parameter .
__ Gross Alpha
__ Gross Beta
Parameter Results mg/ 1
_.•._ Methoxychlor ,, _.
__ T oxaphene
_2,4-D
__ 2,4,5-TP (silvex)
--
RADIOCHEMISTRY
Results PCi/ 1
Date Reponed __________________ _
Dare Analy:cd ----~77iQt-E-,31-"1r"79ESc-------
Reported By -------------------Lab Number
DHS .ll~)\ (Rt•visl•d 7/85)
S,1\i,I ;ind Ha:tirdous \'Vastc (Re\"icw 7/87)
Purpose:
Preparation
Enforcement and compliance with the N. C. Solid and Hazardous Waste Management Rules.
A sample analyses request form (OHS 3191) must be completed for each type of evaluation requested ( e.g.,
inorganic, organic, microbiology, radiochemistry). For sampling conditions which require more than one (1)
coritainer (i.e., ground or surface water from landfills) a sample label must be affixed to one of the containers. The
collector must then write the site and sample number on the duplicate.
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/lOOOg = µg/kg
DEFINITIONS/INSTRUCTIONS
Site Number -A twelve-digit site/location identifier, assigned only by the disttict field representative.
Field Sample N_umber -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, resins, treatment effluents or drummed
wastes.
Comments -Lists detiils regarding sample or sample point, including but limited to, phase separation, and/ or
odors.
Inorganic Chemistry -Check ( ./ ) the desired parameters to be analyzed. Exttactables 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: 1. 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 accot'dance 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
•:: I ~ l • . \ •.,
.r-:. L, ... ::.
N. C. Department of Human Resources
Division of Health Services
CDl1C--
SAMPLE ANALYSES REQUEST
State Laborarc_,ry of Public Health
P. 0. Box 2804 7
306 N. Wilmington Street
Raleigh, 276 I I
9.;J /) 00 3.:t DO 3 F 3 Field Sample Number ~3~g~o_0~-------Site Number
Name of Site 11-,ft'IJ-S-n<;~,.,;::,;L-J..__,C't,-,._,_,. ,---Z~n-"c,___ ____ Site Loca:ion . /J2ocr, ✓f/, u ~, /I,( c..
?~' ~,,, E!' r,.' 1DM-~~-co11ected Bv ...E...4..--LJ,._ /S,..~,>.q 3/l DateCollected //-/ 7 -J:Z Time /.')"/,f'
Type of Sample:
Environmental
✓ Groundwater (1)
___ Surface Water (2)
__ Soil (3)
__ Other (4)
Concentrate
__ Solid (5)
__ Liquid (6)
__ Sludge (7)
__ Other (8)
INORGANIC CHEMISTRY
Extractables
Parameter
__ Arsenic
__ Barium
__ Cadmium
__ Chromium
__ Lead
__ Mercury
__ Selenium
__ Silver
Parameter
_P&T:GC/MS
.lL.. Acid:B/N Ext.
_TOX
x_PC..P
Parame.ter
Results mg/ I
Results mg/I
MICROBIOLOGY
__ (MF) Coliform Colonies/lOOmls
__ (MPN) Coliform Colonies/lOOmls
Parameter
__ Arsenic
__ Barium
__ Cadmium
__ Chloride
__ Chromium
__ Copper
__ Fluoride
__ Iron
__ Lead
__ Manganese
__ Mercury
__ Nitrate.
__ Selenium
Results mg/ I
ORGANIC CHEMISTRY
Parameter
_EDB
__ PCB'.s
__ Petroleum
__ Endrin
__ Lindane
Results mg/I
Parameter
__ Gross Alpha
__ Gross Beta
__ Silver
__ Sulfates
__ Zinc
_Ph
__ Conductivity
_TDS
_Toe
Paramet'er
__ Methoxychlor
__ T oxaphene
_2,4-D
-
__ 2,4,5-TP (silvex)
--
RADIOCHEMISTRY
Results mg/ I
-------··
Results mg/ I
,., . ; ; ;! /.~ :',: :: :
Results PCi/ I
Date Received --,;c-7'-~I ~/ _-_J.._o_-~'6_7~r,,{=E,~·-------Date Reported -~----------------
Date Extracted -ff_~rJ.~-.,,B~-~%~7~8'-"f)_~·------------Date Analy:ed ff1-ro-k'7 IJ/) 703176
Reported By Lab Number ___________________ _
DHS 3 l •1 l ( Rl·vis,..J 7 /85)
S,,li,l an,l Ha:rirdous \Vastc ( Review 7187)
'
Purpose:
Preparation
Enforcement and compliance with the N. C. Solid and HazardoU5: \Vaste Management Rules.
A sample analyses request form (OHS 3191) must be completed for each type of evaluation requested (e.g.,
inorganic, organic, microbiology, radiochemistry). For sampling conditions which require 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
collector must then write the site and sample number on the duplicate. ·
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/lOOOg = 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, resins, treatment effluents or drummed
wastes.
Comments -Lists details reg2.rding 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 perso·n.
Disposition: This form may be destroyed in accordance with the Environmental Health, Solid a:[ld Hazardous Waste Section of
the Record.s Disposition Scheaule 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 SAMPLE ANALYSES REQUEST
State Laboratory of Public H,:.'.l.\th
P. 0. Bo, 2504,
306 N. Wilmington Street
Raleigh, 2 7611
Site Number 9:l t, 00 3 200 3 8 3 Field Sample Number 3&'.0:l:
Name of Site ,,.v".,,, a.PC£ C!.tJ. ~:, } we
Collected By _ r /1, e t2.rJ cA ID#
Type of Sample:
Environmental
_£ Groundwater (I)
___ Surface Water (2)
__ Soil (3)
__ Other (4)
Concentrate
__ Solid (5)
__ Liquid (6)
__ Sludge (7)
__ Other (8)
.3r
Site Loca~ion 111aco'.r<./ t /le. .NC •
Date Collected 1~13
-., :;-. :l
INORGANIC CHEMISTRY
· Extractables
Parameter
__ Arsenic
__ Barium
__ Cadmium
__ Chromium
__ Lead
__ Mercury
__ Selenium
__ Silver
Results mg/1 Parameter
__ Arsenic
__ Barium
__ Cadmium
__ Chloride
__ Chromium
__ Copper
__ Fluoride
__ Iron
__ Lead
__ Manganese
__ Mercury
__ Nitrate.
__ Selenium
Results mg/ 1
Total
Parameter
__ Silver
__ Sulfates
__ .Zinc
_Ph
_._Conductivity
_TDS
_TOC
Results mg/ I
ORGANIC CHEMISTRY
Parameter Results mg/ 1
_L P&T:GC/MS
__ Acid:B/N Ext.
_TOX
L , rD/2-ro~Je'flvr
MICROBIOLOGY
Parameter
--(MF) Coliform Colonies/lO0mls
__ (MPN) Coliform Colonies/lO0mls
Date Recdved
Parameter
_EDB
__ PCB'.s
_·_ Petroleum
__ Endrin
__ Lindane
Date Extracted-------------------
Reported By
DllS .~191 (Rt·viscd 7/85)
S1,liJ :n1d Ha:adous \Vastl' ( Re\'it'W 7 /87)
Results mg/1
Parameter
__ Gross Alpha
__ Gross Beta
Parameter Results mg/ I
__ Methoxychlor
__ T oxaphene
_2,4-D
__ • 2,4,5-TP {silvex)
--
RADIOCHEMISTRY
Results PCi/ 1
Date Reported __________________ _
Date Anal~·:ed ------....,.....~=-----------",JQJ177
Lab Number
Purpose:
Preparation
Enforcement and compliance with the N. C. Solid and Hazardous Waste Management Rules.
A sample analyses request form (OHS 3191) must be completed for each type of ~valuation requested (e.g.,
inorganic, organic, microbiology, radiochemistry). For sampling conditions which require 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
collector must then write the site and sample number on the duplicate.
Do not submit an analysis request sheet with no parameters indicated.
Equivalent measurements:
ppm= µg/ml = mg/I =µgig= mg/kg
ppb = µg/ I = µg/ ICOOg = 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, sludge5:, resins, 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 Chemistr, -Check ( ✓ ) the desired parameter to be analyzed. If not listed1 enter the name in the space
provided.
Microbiology and Radiochemistry -The Raleigh office should be consulted prior to sampling for either
of these.
Distribution: 1. Original to State Laboratory of Public Health
Disposition:
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.
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 Norrh 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
· • r ·• 1 ., ·• • •
~l ·, _f,, f 1 ·i_; )
N. C. Department of Human Resources
Division of Health Services· SAMPLE ANALYSES REQUEST
State Laboratory 0f Public Health
P. 0. Box 2804 7
306 N. \X-'ilmington Street
Raleigh, 27611
Site Number
Name of Site
Collected By
<JJ /) 003.:t 003 s> .3 FieldSampleNumber _ _._3""'-,:f=-O_cf'=-------
..J(/i L1.o-('/' r <Al-➔ MC Site Loca:ion /17orr, ✓JI I /lfl.. IV c_
A't-'&. R() S4, ID# ~3-=--f~_ Date Collected . #-I 2 -J-: Z ~ime / /a / 3
Type of Sample:
Environmental ✓ Groundwater ( 1)
___ Surface Water (2)
__ Soil (3)
__ Other (4)
Concentrate
__ Solid (5)
__ Liquid (6)
__ Sludge (7)
__ Other (8)
INORGANIC CHEMISTRY
Extractables
Parameter
__ Arsenic
__ Barium
__ Cadmium
__ Chromium
__ Lead
__ Mercury
__ Selel1ium
__ Silver
Parameter
_P&T:GC/MS
-1L.. Acid:B/N Ext.
_TOX
x._P<:!..P
Parameter
Results mg/ l
Results mg/ l
MICROBIOLOGY
__ (MF) Coliform Colonies/lOOmls
__ (MPN) Coliform Colonies/lOOmls
Parameter
__ Arsenic
__ Barium
__ Cadmium
__ Chloride
__ Chromium
__ Copper
__ Fluoride
__ Iron
__ Lead
-.-Manganese
__ Mercury
__ Nitrate.
__ Selenium
Results mg/ l
ORGANIC CHEMISTRY
Parameter
_EDB
_.PCB'.s
__ Petroleum
__ Endrin
__ Lindane
Results mg/ l
Parameter
__ Gross Alpha
__ Gross Beta
Total
Parameter
__ Silver
__ Sulfates
__ Zinc
_Ph
__ Conductivity
_TDS
_TOC
Parameter
__ Methoxychlor
__ T oxaphene
_2,4-D
__ 2,4,5-TP (silvex)
--
RADIOCHEMISTRY
Results mg/ l
Results mg/1
Results PCi/ I
Datt.' Received --'-'-11_-"'o-'-'O'-'-'B"'-')-'-"-'')f'cw.,1_,_, ________ Date Reported -=,,----------------
Date Extracted _P~f1~-8~-_f_7~(3~J9 ____________ Date Anal;-:ed /../f' __ ·/~O_-~kLZ~0~f) _ _,..,'ft-,......~=-------
Rqxxred Oy -------------------Lab Number
. 'i'031?8
DI-IS .1191 (R~·vi~,·d 7/85)
Snlid and Ha:ardnus \Va~tl' {Rc\'il'W 7/87)
I
!
Purpose:
Preparation
Enforcement and compliance with the N. C. Solid and Hazardous Waste Management Rules.
A sample analyses request form (OHS 3191) must be completed .for each type of evaluation requested (e.g.,
inorganic, organic, microbiology, radiochemistry). For sampling conditions which require 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
collector must then write the site and sample number on the duplicate. ·
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/lOOOg = 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 subs~ance such as groundwater, surface water or soils which,-~:,
may be contaminated.
Concentrate -A sample of a waste, including but not limited to, sludges, resins, tr:eatment effluents or drummed: 1
wastes.
Comments -Lists details regarding sample or sample point, including but limited to, phase separation, and/or
~~-.
Inorganic Chemistry -Check ( ✓ ) the desired parameters to be analyzed. Extractsbles 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 He~lth
Environmental Sciences Branch
Disposition:
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.
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
C-Onc.. /IC{
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
Raleigh, 27611
Site Number 9,;J 1) {} D 3 2.. l) 0 .3 P3 Field Sample Number ~-~3=--=J)_tJ.c._....,o/~-------
~:~e:::S~~ 5:fge;gp~ _17;;~~~~=.f~_ o:::e~0~:::; ~o1c;~~i::· /le
Type of Sample:
Environmental Concentrate
_L_ Groundwater (1) __ Solid (5)
__ Surface Water (2) __ Liquid (6)
__ Soil (3) __ Sludge (7)
__ Other (4) . __ Other (8)
INORGANIC CHEMISTRY
Extractables
Parameter
__ Arsenic
__ Barium
__ Cadmium
__ Chromium
__ Lead
__ Mercury
__ Selenium
__ silver
Parameter
LP&T:GC/MS
__ Acid:B/N Ext.
_TOX
Results mg/ 1
Results mg/ 1
-If_ I.f.°{X,j;"'(t e.':t'h e.c.
MICROBIOLOGY
Parameter
__ (MF) Coliform Colonies/lOOmls
__ (MPN) Coliform Colonies/lOOmls
. --
--
Parameter
__ Arsenic
__ Barium
__ Cadmium
__ Chloride
__ Chromium
__ Copper
__ fluoride
__ Jron
__ Lead
__ Manganese
__ Mercury
__ Nitrate.
__ Selenium
Results mg/ 1
ORGANIC CHEMISTRY
Parameter Results mg/ 1
_EDB
__ PCB'.s
__ Petroleum
__ Endrin
· __ Lindane
Parameter
__ Gross Alpha
__ Gross Beta
--
--
Total
__ Silver
__ Sulfates
__ Zinc
_Ph
__ Conductivity
_TDS
_TOC
Parameter
__ Methoxychlor
__ Toxaphene
_2,4-D
__ 2,4,5-TP (silvex)
--
, NC.
Time tJC//7
Results mg/ 1
RADIOCHEMISTRY
Results PCi/ 1
Date Received _ __;/c../_·.c..J....:O:......· 'fi,,_'le......=..'0.J..!...8'-·-~-------Date Reported _________________ _
Date Extracted _________________ Date Analyzed ----~7'TtQ1+.J~1~7.,.....9..--------
Reported By -------------------Lab Number
DHS 3191 (Rt'vised 7/85)
SoliJ ;mJ Hazardous WastC (Review 7 /87)
Purpose:
Preparation
Enforcement and compliance with the N. C. Solid and Hazardous Waste Management Rules.
A sample analyses request form (DHS 3191) must be completed for each type of evaluation requested (e.g.,
inorganic, organic, microbiology, radiochemistry). For sampling conditions which require 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
collector must then write the site and sample number on the duplicate.
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/lO00g = 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, resins, 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
Disposition:
Environmental Sciences Branch
P. 0. Box 28047
Raleigh, NC 2761 I
2. Lab sends copy to Solid and Hazardous Waste Management Branch.
3. Solid and Hazardous Waste Management Branch sends copy to field person.
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 SAMPLE ANALYSES REQUEST
State Laboratory of Public Health
P. 0. Box 28047
,306 N. Wilmington Street
Raleigh, 276\ \
Site Number __,_9,_..d,.___./:,..._,lJ~D'-"3"'-".;1.:..::....::0c...D=..:3=-.8=--..3...e.__ __ Field Sample Number _ _.,,3,,,,,___,£.,__.J'--Q""'-----------
Name of Site -~-4..J~t.l...,j~~!!"-!,CS_L..,;.L--'~"-~d.l.~,-..-&"1'1'...Ls.C. ___ Site Loc3'ion. d2acc,:.S:t11 lie . NC
Collected By /4-MZk.o S t>---1
ID# 3 K Date Collected //-/ £ ._ tf l > Time /J 9/ '1
Type of Sample:
Environniental Concentrate
_L !Jroundwater ( 1 ). __ Solid (5)
__ Surface Water (2) __ Liquid (6)
__ Soil (3)
__ Other (4)
__ Sludge (7)
__ Other (8)
INORGANIC CHEMISTRY
Extractables
Parameter
__ Arsenic
__ Barium
__ Cadmium
__ Chromium
__ Lead
__ Mercury
__ Selenium
__ Silver
Parameter
_P&T:OC/MS ~ Acid:B/N Ext.
_TOX
:it: -Per'
Parameter
Results mg/ 1
Results mg/ 1
MICROBIOLOGY
__ (MF) Coliform Colonies/JO0mls
__ (MPN) Coliform Colonies/JO0mls
--
--
Parameter
__ Arsenic
__ Barium
__ Cadmium
__ Chloride
__ Chromium
__ Copper
__ Fluoride
__ Iron
__ Lead
__ Manganese
__ Mercury
__ Nitrate.
__ Selenium
Results mg/ 1
ORGANIC CHEMISTRY
Parameter Results mg/ 1
_EDB
__ PCB'.s
__ Petroleum
__ Endrin
__ Lindane
.
Parameter
__ Gross Alpha
__ Gross Beta
--
--
Total
Parameter
_·_Silver
__ Sulfates
__ Zinc
_Ph
__ Conductivity
_TDS
_TOC
Parameter
__ Methoxychlor
__ Toxaphene
_2,4-D
__ 2,4,5-TP (si\vex)
--
RADIOCHEMISTRY
Results mg/ 1
Results mg/ 1
Results PCi/ 1
I I .-,;/.O -,;-'7 ,./ID .
Date Received ~,-'-;.-'-'---"U-'--toc.~-'-"O"---'---------Date Reported -==----------------
(&? ft
Reported By
Date Extracted ~/d_·8~-l~7~t3~i!).~------------Date Analyzed ~J~.iJ_-~fO_·~Y~7~8=JfJ~~-----------·
______________ Lab Number ____ ?_0_J_1_8_0 ______ _
OHS 3191 ( R,vised 7/85)
Solid and Hazardous Waste (Review 7 /87)
Purpose:
Preparation
Enforcement and compliance with the N. C. Solid and Hazardous Waste Management Rules.
A sample analyses request form (OHS 3191) must be completed for each type of evaluation requested (e.g.,
inorganic, organic, microbiology, radiochemistry). For sampling conditions which require 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
collector must then write the site and sample number on the duplicate.
Do not submit an analysis request sheet with no parameters indicated.
•. Equivalent measurements:
ppm= µg/ml = mg/I =µgig= mg/kg
ppb = µg/ I = µgl 1000g = 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, resins, 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
Disposition:
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.
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
...
CDnc. MC{
N. C. Dcparttnt!nt of Human Resources
Division of Health Services SAMPLE ANALYSES REQUEST
State Laboratory of Public Health
P. 0. Box 28047
306 N. Wilmington Street
Raleigh, 2761 I
Site Number 9,:J 1) 0 0 3 2-DD .3 f>3 Field Sample Number __ 3~d'~/_/ ________ _
Name of Site ..i{[J#f.r~ ~ C. Site Loca:ion /l)orr,S If,· //c
Collected By ,A:i "/) C..&J:.;;:_ ID# -~3=g,,,_ __ Date Collected / I' -IJ': -l/ ?-
> NC.
Time 015'1
Type of Sample:
Environmental Concentrate
__L__ Groundwater (!) __ Solid (5)
__ Surface Water (2) ___ Liquid (6)
__ Soil (3) __ Sludge (7)
__ Other (4) __ Other (8)
INORGANIC CHEMISTRY
Extractable•
Parameter
__ Arsenic
__ Barium
__ Cadmium
__ Chromium
_.Lead
__ Mercury
__ Selenium
__ Silver
Results mg/ 1 Parameter
__ Arsenic
__ Barium
__ Cadmium
__ Chloride
__ Chromium
__ Copper
__ Fluoride
__ Iron
__ Lead
__ Manganese
__ Mercury
__ Nitrate.
__ Selenium
Results mg/ 1
Total
Parameter
__ Silver
__ Sulfates
__ Zinc
_Ph
__ Conductivity
_TDS
_Toe
Results mg/ 1
ORGANIC CHEMISTRY ..
Parameter Results mg/ 1
LP&T:GC/MS
__ Acid:B/N Ext.
_TOX
_.... Xso,oa,.ayLe.'rl1e.c I ,
MICROBIOLOGY
Parameter
__ (MF) Coliform Colonies/ IOOmls
__ (MPN) Coliform Colonies/lOOmls
Parameter
_EDB
__ PCB'.s
__ Petroleum
__ Endrin
__ Lindane
Date Received -~'~1_-_,;J,.~O~---'o"-'/-'------'---------
Datt' Extracted __________________ _
Reported By
OHS 3\(_)\ (R~·viscd 7185)
Solid and Ha:ardous Waste (Review 7/87)
Results mg/ 1
Parameter
__ Gross Alpha
__ Gross Beta
Parameter Results mg/ 1
__ Methoxychlot
__ Toxaphene
_2,4-D
__ 2,4,5-TP (silvex)
--
RADIOCHEMISTRY
Results PCi/ 1
Date Reported __________________ _
Date Analy:ed __ __,,..,,,>1Q'trJ-tr1Se,-,,ot--------
Lab Number
! i
Purpose:
· Preparation
Enforcement and compliance with the N. C. Solid and Hazardous Waste Management Rules.
A sample analyses request form (DHS 3191) must be completed for each type of evaluation requested (e.g.,
inorganic, organic, microbiology, radiochemistry). For sampling conditions which require 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
collector must then write the site and sample number on the duplicate.
Do not submit an analysis request sheet with no parameters indicated.
Equivalent measurements:
ppm= µg/ml = mg/I =µgig= mg/kg
pp~ =. µg/ 1 = µg/ 1000g = 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.
N~me of Site -Name of landfill, facility, etc.
Site Location -Address, street number, state road, ere.
Collected By -Name and ID of sample collector.
Date and Time Collected -Self-explanatory.
Environmental - A sample of a n~turally 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, resins, treatment effluents or drummed
wastes.
Comments -Lists details regarding sample or sample point, includin·g 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 2761 I
2. Lab sends copy r'o 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
~-. . ,• ,t.··~L:L.·-~ .'· ·1
N. C. Departmt=nt of Human Rt=sourccs
Division of Ht=alth Services SAMPLE ANALYSES REQUEST
State Laboratory of Public Health
P. 0. !lox 2804 7
306 N. Wilmington Street
Site Number
Name of Site
Collected By
Raleigh, 27611
_'/~d~.f,~()~()"-3~.;;>..~D~D~3~=3~3~--Field Sample Number -~3~_J>_/_Z-_______ _
±<wRl'Ss(1/LJ lD-.Z:h3c,~ Site Loca:ion /J?r,cc,:.ru;//e.,
L:i:L£iJ. ~R..(} _ b--7 -'-"""-"'!1__._ __ Date Collected // -/ .f -# 1
Type of Sample:
Environmental Concentrate
~ Groundwater (I) __ Solid (5)
__ Surface Water (2) __ Liquid (6)
__ Soil (3) __ Sludge (7)
__ Other (4) __ Other (8)
INORGANIC CHEMISTRY
Extractable•
Parameter
__ Arsenic
__ Barium
__ Cadmium
__ Chromium
__ Lead
__ Mercury
__ Selenium
__ Silver
Parameter
_P&T:GC/MS
Ji_ Acid:B/N Ext.
_TOX
1 -Per'
Results mg/1
Results mg/ 1
MICROBIOLOGY
Parameter
__ Arsenic
__ Barium
__ Cadmium
__ Chloride
__ Chromium
__ Copper
__ Fluoride
__ Iron
__ Lead
__ Manganese
__ Mercury
__ Nitrate.
__ Selenium
Results mg/ 1
ORGANIC CHEMISTRY
Parameter Results mg/ 1
_EOB
__ PCB's
__ Petroleum
__ Endrin
__ Lindane
Comments
Total
__ Silver
__ Sulfates
__ Zinc
_Ph
__ Conductivity
__ TOS
_Toe
Parameter
__ Methoxychlor
__ T oxaphene
_2,4-0
__ 2,4,5-TP (silvex)
--
RADIOCHEMISTRY
NC.
Time OtJ,£g
Results mg/ 1
Parameter Parameter Results PCi/ 1
__ (MF) Coliform Colonies/lOOmls
__ (MPN) Coliform Colonies/!OOmls
Date Received I I -,:;w -'6 ')
Date Extracted ~,;,-S-Y7 ,e,,9
Rt:ported By
DHS JlQ! (R1 . .'\'iscd 7185)
Solid ;md Ha:ardous \Vastc (Review i/87)
__ Gross Alpha
__ Gross Beta
Date Reported -,,;,.,,,.------------------
Date Analy:ad /ol-/o·.f'7 8~QJ 182
Lab Number
I
's I .
Purpose:
Preparation
Enforcement and compliance with the N. C. Solid and Hazardous Waste Management Rules.
A sample analyses request form (OHS 3 I 91) must be completed for each type of evaluation requested ( e.g.,
inorganic, organic, microbiology, radiochemistry). For sampling conditions which require 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
collector must then write the site and sample number on the duplicate.
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/lOOOg = 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, resins, 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, ente; 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 uboratory of Public Health
Environmental Sciences Branch
P. 0. Box 28047
Raleigh, NC 27611
2. ub 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 Di,po,irion 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
cone. t/L{
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
Raleigh, 2761 I
Site Number 9,,11) () 0 3 2.. 0 D .3 P3
~amcofSite _fro~Rfr~-J Tric
Collected By /4;:t:_fj_~/lt)~ ID# -=3~8~--
T ype of Sample:
Environmental Concentrate
_L__ Groundwater (I) __ Solid (5)
__ Surface Water (2) ___ Liquid (6)
__ Soil (3) __ Sludge (7)
__ Other (4) __ Other (8)
INORGANIC CHEMISTRY
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 _Toe
__ Silver __ Iron --
--__ Lead --
--__ Manganese --
--__ Mercury --
--__ Nitrate --
--__ Selenium --
ORGANIC CHEMISTRY
Parameter Results mg/ 1
LP&T:GC/MS
__ Acid:B/N Ext.
_TOX
A-Xr o,oc/1 "r I e.'rii f.C ... , ,
MICROBIOLOGY
Parameter
__ (MF) Coliform Colonies/lO0mls
__ (MPN) Coliform Colonies/lOOmls
Parameter
_EDB
__ PCB'.s
__ Petroleum
__ Endrin
__ Lindane
Date Extracted __________________ _
Rt.'pnrted By
DH5 )!9! {Revist'J 7/85)
S(lli,l ;ind Haz:udous \Va~tc (Review 7/87)
Results mg/ 1
Parameter
__ Gross Alpha
__ Gross Beta
Parameter Results mg/ 1
__ Methoxychlor
__ Toxaphene
_2,4-D
__ 2,4,5-TP (silvex)
--
RADIOCHEMISTRY
Results PCi/ I
Date Reported __________________ _
Date Analy:ed --------.,..,,TTnorr=.-------7U318J
Lab Number
I
I
Purpose:
Preparation
Enforcement and compliance with the N. C. Solid and Hazardous \Vaste Management Rules.
A sample analyses request form {OHS 3191) must be completed for each type of evaluation requested {e.g.,
inorganic, organic, microbiology, radiochemistry). For sampling conditions which require 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
collector must then' write'the site and sample number on the duplicate. · ·,
Do not·submit an analysis request sheet with no parameters indicated.
Equivalent measurements:
ppm= µg/ml =mg/I= µgig= mg/kg
.. PP.b = µg/1 = µg/lOOOg = 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, resins, treatment effluents or drummed
wastes.
Comments -Lists details regarding sample or sample point, includin·g bllt 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
Disposition:
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.
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 Hurnan Resources
Di\'ision of Health Services SAMPLE ANALYSES REQUEST
State Laboratory oi Public Health
P. 0. Box 2804 7
306 N. Wilmington Strcec
Raleigh. 27611
Site Number
T ypc of Sample:
Environmental Concentrate
~ Groundwater ( 1) __ Solid (SJ
__ Surface Water (2) __ Liquid (6)
__ Soil (3) __ Sludge (7)
__ Other (4) __ Other (8)
INORGANIC CHEMISTRY
Extractable•
Parameter Re•ult• mg/ I
__ Arsenic
__ Barium
__ Cadmium
__ Chromium
___ Lead
__ Mercury
__ Sdenium
__ Silver
--~
--
--
--
--
Parameter Re•ults mg/ I
_P&T:GC/MS
_,./__ Acid:B/N Ext.
_TOX
:,f:: -Pc/3
MICROBIOLOGY
Parameter
__ (MF) Coliform Colonies/lO0mls
__ (MPN) Coliform Colonies/lO0mls
Date Received I /-,,-0-15'/r'/;13
Date Extracted ~r-8-t7 fJi!J
Reported Oy
\"lHS J\Q\ (R~·visl'J 7/85)
:=;, ,I i,l :1 nd Ha:ardmis \Va~tl' ( Review 7 /87)
Total
Parameter Resulto mg/ 1 Parameter Results mg/ I
__ Arsenic __ Silver
__ Barium __ Sulfates
__ Cadmium __ Zinc -·
__ Chloride _Ph
__ Chromium __ Conductivity· 4 •
__ Copper __ TOS
__ Fluoride _TOC
__ Iron --
__ Lead --
__ Manganese --
__ Mercury --
__ Nitrate --
__ Selenium --
ORGANIC CHEMISTRY
Parameter
_EOB
__ PCB's
__ Petroleum
__ Endrin
__ Lindane
Re•ult5 mg/ I
Parameter
__ Gross Alpha
__ Gross Beta
Parameter Results mg/ I
__ Methoxychlor
__ T oxaphene
-2,4-D
__ 2,4,S-TP (sHvex)
--
RADIOCHEMISTRY
Result• PCi/ I
Date Reported ~~-----------------fC
Date Analy:ed ;.;.-/o-J'7 (:!,0 703184
Lab Numt'er
I I
' '
Purpose:
Preparation
Enforcement and compliance with the N. C. Solid and Hazardous Waste Management Rules.
A sample analyses request form (OHS 3191) must be completed for each type of evaluation requested (e.g.,
inorganic, organic, microbiology, radiochemistry). For sampling conditions which require more than one ( 1)
container (i.e., ground ~·r surface water from landfills) a sample label must be affixed to one of the containers. The
collector must then write ,the site and sample number on the duplicate.
Do not submit an analysi~ r1equest sheet with no Parameters indicated.
Equivalent measurements:
ppm= µg/ml = mg/I =µgig= mg/kg
ppb = µg/1 = µg/lO00g = 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 groundw_ater, surface water or soils which.··.
may be contaminated.
Concentrate - A sample of a waste, including but not limited to, sludges, resins, 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 2 7602-2091
·, . .?', • ,. .... , •.
,, i j l.., ; • : '.-1
cone. MC{
N. C. Department of Human Resources
Division of Health Services SAMPLE ANALYSES REQUEST
State Laborarorv of Public Health
P. 0. Box 2804 7
306 N. \Vilmington Street
Type of Sample:
Environmental
_L_ Groundwater (I)
___ Surface Water (2)
__ Soil (3)
__ Other (4)
Concentrate
__ Solid (5)
__ Liquid (6)
__ Sludge (7)
__ Other (8)
INORGANIC CHEMISTRY
Extractables
Parameter
__ Arsenic
__ Barium
__ Cadmium
__ Chromium
__ Lead
__ Mercury
__ Selenium
__ Silver
Parameter
_t,L_ P& T:GC/MS
__ Acid:B/N Ext.
_TOX
Results mg/ 1
Results mg/ 1
_.._ Is:ofY"f'f t e.'tit f.r
MICROBIOLOGY
Parameter
__ (MF) Coliform Colonies/lO0mls
__ (MPN) Coliform Colonies/ IO0mls
Parameter
__ Arsenic
__ Barium
__ Cadmium
__ Chloride
__ Chromium
__ Copper
__ Fluoride
__ Iron
__ Lead
__ Manganese
__ Mercury
__ Nitrate.
__ Selenium
Results mg/ 1
ORGANIC CHEMISTRY
Parameter
_EDB
__ PCB'.s
__ Petroleum
__ Endrin
__ Lindane
Results mg/ 1
'
Parameter
__ Gross Alpha
__ Gross Beta
Total
Parameter
__ Silver
__ Sulfates
__ Zinc
_Ph
__ Conductivity
_TDS
_TOC
Parameter
__ Methoxychlor
__ T oxaphene
_. 2,4-D
__ 2,4,5-TP (silvex)
--
RAO1OCHEMISTR¥
Raleigh, 27611
Results mg/ 1
Results mg/ 1
-·.·, -:·.
Results PCi/ 1
Date Received __ l_l-_;,_o~-8~'/~q-+"-A~----------Date Reported _________________ _
Date Extracted __________________ _
Reporrcd By
Date Analyzed ------=-=-=--::-----------
703185 Lab Number
DJ-IS }1()1 (R~·,·is.:J 7/85)
S,1l iJ ;ind Ha:ar,ious \Vasce (Re,·it•w 7187)
I !
I
Purpose:
Preparation
,
Enforcement and compliance with the N. C. Solid and Hazardous Waste Management Rules.
A sample analyses request form (OHS 3 I 91) must be completed for each type of ~valuation requested ( e.g.,
inorganic, organic, microbiology, radiochemistry). For sampling conditions which require 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
collector must then write the site and sample number on the duplicate.
Do OC!t submit an analysis request sheet with no parameters indicated.
Equivalent measurements:
ppm= µg/ml =mg/I= µgig= mg/kg
ppb = µg/1 = µgllOOOg = 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, faciliry, 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, resins, treatment effluents or drummed
wastes.
Comments -Lists details regarding sample or sample point, includin·g 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
Disposition:
P. 0. Box 28047
Raleigh, NC 27611
2. Lab sends copy r"o Solid and Hazardous Waste Management Branch.
3. Solid and Hazardous Waste Management Branch sends copy to field person.
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. Ocpamnc=nt of Human Rc=sourccs
Division of Health Services SAMPLE ANALYSES REQUEST
State Laboratory oi Public Health
P. 0. Box 2804 7
306 N. Wilmington Street
Raleigh, 276 l l
_9,LJ.<d.___.._J',..,_,,cJ"-'0~3<-~=c.=....D=...;{)c...=.3=...=3_3-,c__ __ Field Sample Number -~L-3~3_/_G:, ______ _
Site Number
Name of Sire -~-R-'-Y,.~{1£.=::..~'--''--'_c;"-:d..__d..L~.,._ .... 7;,d_;,.,_,c,~---Site Location /Jlacc,'.f u; lie .,
Collected By AAZR..LJSD----) ID# 3 8'. Date Collected //-IR -,f 1
Type of Sample:
Environmental
_L Groundwater (1)
___ Surface Water (2)
__ Soil (3)
__ Other (4)
Concentrate
__ Solid (5)
__ Liquid (6)
__ Sludge (7)
__ Other (8)
INORGANIC CHEMISTRY
Extractable•
Parameter
__ Arsenic
__ Barium
__ Cadmium
__ Chromium
___ Lead
__ Mercury
__ Selenium
__ Silver
Parameter
_P&T:GC/MS
...!!L_ Acid:B/N Ext.
_TOX
~ -Per'
Results mg/ 1
Results mg/ 1
MICROBIOLOGY
Parameter
__ Arsenic
__ Barium
__ Cadmium
__ Chloride
_._Chromium
__ Copper
__ Fluoride
__ Iron
__ Lead
__ Manganese
__ Mercury
__ Nitrate.
__ Selenium
Results mg/ 1
ORGANIC CHEMISTRY
Parameter Results mg/ 1
_· _EDB
__ PCB's
__ Petroleum
__ Endrin
__ Lindane
Total
Parameter
__ Silver
__ Sulfates
__ Zinc
_Ph
_._Conductivity
_TDS
_TOC
Parameter
__ Methoxychlor
__ T oxaphene
_2,4-D
--2,4,5-TP (silvex)
--
RADIOCHEMISTRY
NC
Tim•· I I .:;i r
Results mg/ 1
Results mg/ 1
Parameter Parameter Resu Its PCi/ I
__ (MF) Coliform Colonies/l00mls
__ (MPN) Coliform Colonies/lO0mls
Date Received 11-,;;_o-'57 di?,
__ Gross Alpha
__ Gross Beta
Date Reported,..,-, 7,-----------------tc:P -
Date Extracted =;)._' ~-8~•-%7~(3=£) ____________ _ Date Analyzed /.;(-/t.>-S71.3Aj,Q3186
--------------------Lab Number Reported By
!)HS31 1)\ (Rt·viseJ?/85)
S11li,I ;11i.l H:1:ardous W/astc ( Review 7 /87)
I
I I
I
Purpose:
Preparation
. •,
Enforcement and compliance with the N. C. Solid and Hazardous Waste Management Rules.
A sample analyses request form (OHS 3191) must be completed for each type of evaluation requested ( e.g.,
inorganic, organic, microbiology, radiochemistry). For sampling conditions which require 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
collector must then write the site and sample number on the duplicate.
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/lOOOg = 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, faciliry, 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, resins, 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. Exrractables 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 analy:ed. 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: 1. Original t~ State Laboratory of Public Health
Disposition:
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.
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 Qf Health Services
U)nc_. tlL{
SAMPLE ANALYSES REQUEST
State Laboratory of Public Health
P. 0. Box 28047
306 N. Wilmington Street
Raleigh, 2761 l
Site Number 9,,2 )) lJ O 3 2-0 0 .3 P3 Field Sample Number __ ......_c_~.,,'-"p'----'/'--f-...._ ______ _
NamcofSite ~fr~ T,-,c::. SiteLoca:ion /JJorr,'.su,·//c
Collected By ,A±be_/2n:i-;:_ ID# -~3~£'~--Date Collected
1
/I -/ J':-8'7-
., NC.
T ypc of Sample:
Environmental Concentrate
_L_ Groundwater ( 1) __ Solid (5)
__ Surface Water (2) __ Liquid (6)
__ Soil (3) __ Sludge (7)
__ Other (4) __ Other (8)
INORGANIC CHEMISTRY
Extractable•
Parameter
__ Arsenic
__ Barium
__ Cadmium
__ Chromium
__ Lead
__ Mercury
__ Selenium
__ Silver
Parameter
LP&T:GC/MS
__ Acid:B/N Ext.
_TOX
Results mg/1
Results mg/ 1
A. Xs:0 ,,,rll.ayt e.'t'1 t.c '-; '
MICROBIOLOGY
Parameter
__ (MF) Coliform Colonies/lO0mls
__ (MPN) Coliform Colonies/lO0mls
Parameter
__ Arsenic
__ Barium
__ Cadmium
__ Chloride
__ Chromium
__ .Copper
__ fluoride
__ Iron
__ Lead
__ Manganese
-. _Mercury
__ Nitrate _
__ Selenium
Results mg/ 1
ORGANIC CHEMISTRY
Parameter
_EDB
_.PCB'.s
__ Petroleum
__ Endrin
__ Lindane
Results mg/I
Parameter
__ Gross Alpha
__ Gross Beta
Total
__ silver
__ Sulfates
__ Zinc
_Ph
__ Conductivity
_TDS
_TOC
Parameter·
__ Methoxychlot
__ Toxaphene
-2,4-D
__ 2,4,5-TP (silvex)
--
RADIOCHEMISTRY
Time /;;J. ()Q
Results mg/ l
-·:·· ·(,'
Results PCi/ 1 .
Date Reported __________________ _
Date Extracted __________________ _
Reported By Lab Number 703187
DHS 3191 (Rt·visc:d 7/85)
S11li,I ;ind Ha:ar~fous Wastt: { Review 7187)
Purpose:
Preparation
Enforcement and compliance with the N. C. Solid and Hazardou~ Waste Management Rules.
A sample analyses request form (OHS 3191) must be completed for each type of ~valuation requested (e.g.,
inorganic, organic, microbiology, radiochemistry). For sampling conditions which require 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
collector must then write the site and sample number on the duplicate. ·
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/lO00g = 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, resins, 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. O.-Box 2091
Raleigh, NC 27602-2091
N. C. Department of Human Resources
Division of Health Services SAMPLE AN AL YSES REQUEST
State Laboratory of Public Health
P. 0. Box 2804 7
306 N. Wilmington Street
Raleigh, 27 61 l
Name of Site
Collected By
T ypc of Sample:
Environmental
_L Groundwater (I)
___ Surface Water (2)
--Soil (3)
__ Other (4)
Concentrate
__ Solid (5)
__ Liquid (6)
__ Sludge (7)
__ Other (8)
INORGANIC CHEMISTRY
Extractables
Parameter Results mg/ 1
__ Arsenic
__ Barium
__ Cadmium
__ Chromium
___ Lead
__ Mercury
__ Selenium
__ Silver
--
. --
--
--
--
Parameter Results mg/ 1
_P&T:GC/MS ~ Acid:B/N Ext.
_TOX
:,E: -Per'
MICROBIOLOGY
Parameter
__ (MF) Coliform Colonies/l00mls
__ (MPN) Coliform Colonies/lO0mls
Parameter Results mg/ 1
__ Arsenic
__ Barium
__ Cadmium
__ Chloride
__ Chromium
__ Copper
__ fluoride
__ Iron
__ Lead
__ Manganese
__ Mercury
__ Nitrate
__ Selenium
ORGANIC CHEMISTRY .
Parameter
_EOB
__ PCB'.s
__ Petroleum
__ Endrin
__ Lindane
Results mg/ 1
Parameter
__ Gross Alpha
__ Gross Beta
.
Total
Parameter Results mg/1
__ Silver
__ Sulfates
__ Zinc .. .
_Ph
__ Conductivity
_TOS ..
_TOC
--
--
--
--
--
--
Parameter Results mg/ 1
__ Methoxychlor ,, . ··.•
__ T oxaphene
_2,4-0
__ 2,4,5-TP (silvex)
--
RADIOCHEMISTRY
Results PCi/ 1
Date Received I I -;;:(O ·?/) ,3(!3 Date Reported =,,.------------------
Date Extracted ~~~)_-~g_,_S_?~13~t.9-~------------Date Analyzed L,:.:iJ.~-/c,/)c...·.,_'r/.,_,_e,-'-"&"'-------------
Reported By -------------------Lab Number 703188
DHS JI()[ (Revised 7/85)
S,ilid and HarnrJous \Y./ascc (Rcvicv.• 7/8i)
Purpose:
Pre1:1aration
Enforcement and compliance with the N. C. Solid and Hazardous Waste Management Rules.
A sample analyses request form (OHS 3191) must be completed for each type of ~valuation requested ( e.g.,
inorganic, organic, microbiology, radiochemistry). For sampling conditions which require 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
.. ~ollector must then write the site and sample number on the duplicate.
· ':Do ~o~ submit an analysis request sheet with no parameters indicated.
'· Equivalent measurements:
ppm= µg/ml = mg/1 =µgig= mg/kg
ppb = µgl 1 = µg/ 1000g = µglkg
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, resins, tre.itment 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
Disposition:
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.
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
U)n c. If C{
N. C. Department of Human Resources
Division of Health Services SAMPLE ANALYSES REQUEST
State Laboratory of Public Hi.!alth
P. 0. Box 28047
306 N. Wilmington Street
Raleigh, 27611
Site Number 9,:J )) 0 0 3 2.. 0 0 .3 f>3 Field Sample Number -~3~.,,g~/'--9L-----------
NameofSite _Jro~Rer&.) T11c
Collected By /ft±_fJ_~~ ID# -=3~g~--
Site Loca;ion /t)orr,·.s u, · Ile
Date Collected /,-1J--f ?l:
~ NC.
Time /J. 3Q__
Type of Sample:
Environmental
_L_ Groundwater (I)
___ Surface Water (2)
__ Soil (3)
__ Other (4)
Concentrate
__ Solid (5)
__ Liquid (6)
__ Sludge (7)
__ Other (8)
INORGANIC CHEMISTRY
Extractables
Parameter
__ Arsenic
__ Barium
__ Cadmium
__ Chromium
__ Lead
__ Mercury
__ Selenium
__ Silver
Resu Its mg/ l Parameter
__ Arsenic
-----~--· __ Barium
__ Cadmium
__ Chloride
__ Chromium
__ Copper
__ Fluoride
__ Iron
__ Lead
__ Manganese
__ Mercury
__ Nitrate.
__ Selenium
Results mg/ l
ORGANIC CHEMISTRY
Parameter Results mg/ l
JL.P&T:GC/MS
__ Acid:B/N Ext.
_TOX
-4 Zro,oc,""I' e.'rli t.c I v-
MICROBIOLOGY
Parameter
__ (MF) Coliform Colonies/lO0mls
__ (MPN) Coliform Colonies/lOOmls
Parameter
_EDB
__ PCB's
__ Petroleum
__ Endrin
__ Lindane
Results mg/ l
Parameter
__ Gross Alpha
__ Gross Beta
Total
Parameter
__ Silver
__ Sulfates
__ Zinc
_Ph
__ Conductivity
__ TDS
_·_TOC
Parameter
__ Methoxychlor
__ Toxaphene
_z,4-D
__ 2,4,5-TP (silvex)
--
RADIOCHEMISTRY
Results mg/ l
Results mg/ l
Results PCi/ l
Date Received __ \~l_-::,_0_-~'3~7~d=Y'-,~---------Date Reported ________________ _
Dare Exrracred ___________________ Date Analyzed -------'7'7iQW3~11-18.,...9+---------
Reported By --------------------Lab Number
DHS JIQ! (Flt·viscd 7185)
:',u\id ;uni Ha:;m.lous \Vastc (Rc:\'it•w 7/37)
Purpose:
Preparation
Enforcement and compliance with the N. C. Solid and Hazardous Waste Management Rules.
A sample analyses request form (OHS 3191) must be completed.for each type of evaluation requested {e.g.,
inorganic,·organic, microbiology, radiochemistry). For sampling conditions which require 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
collector must then write the site and sample number on the duplicate. ·
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/lO00g = 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.
Envirorimental - 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, resins, treatment effluents or drummed
wastes.
Comments -Lists details regarding sample or sample point, includirig 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 riot 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 RecoTCis 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. O.,Box 2091
Raleigh, NC 27602-2091
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 I
Site Number _J..'t~d~/',~{J~D~3~~~0~0~.3=·=3_3~--Field Sample Number 3 8 Z,,O
Name of Site -~~-°-1?,...,__,_(1£.=.i~c.-,_-_d,._.:a..._d.Lc.__._..,T.,!L_n_._,,c_~--Site Location. /J2acct'Jll/ l/e ~ NC.
Collected By AJ.tiZRLisb---1 ID# 3K Date Collected //-LR -cf l Time/ ;;i 3 0
Type of Sample:
Environmental
~ Groundwater (I)
___ Surface Water (2)
__ Soil (3)
__ Other (4)
Concentrate
__ Solid (5)
__ Liquid (6)
__ Sludge (7)
__ Other (8)
INORGANIC CHEMISTRY
Extractables
Parameter
__ Arsenic
__ Barium
__ Cadmium
__ Chromium
__ Lead
__ Mercury
__ Selenium
__ Silver
Parameter
_P&T:GC/MS
J/_ Acid:B/N Ext.
_TOX
~ -Pc1'
Parameter
Results mg/ I
Results mg/ I
MICROBIOLOGY
__ (MF) Coliform Colonies/lOOmls
__ (MPN) Coliform Colonies/lOOmls
Date Received 11-,;I.O -'3':J ~'3
fef
Date Extracted I ~8-'(7 f2 ,J)
Reported By
1)1-!S .11 11\ (Rt·vis,·J 71$5)
S()lid :m,I H:i:ardnus \X:a~tl' (Re\·iew 7 /87)
Parameter
__ Arsenic
__ Barium
__ Cadmium
__ Chloride
__ Chromium
__ Copper
__ Fluoride
__ Iron
__ Lead
__ Manganese
__ Mercury
__ Nitrate _
__ Selenium
Results mg/ I
Total
Parameter
__ Silver
__ Sulfates
__ Zinc
_Ph
__ Conductivity
_TDS
_TOC
Results mg/ l
ORGANIC CHEMISTRY
Parameter
_EDB
__ PCB's
__ Petroleum
__ Endrin
__ Lindane
Results mg/ I Parameter Results mg/I
__ Methoxychlor
__ Toxaphene
_2,4-D
__ 2,4,5-TP (silvex)
--
RADIOCHEMISTRY
Parameter Results PCi/ I
__ Gross Alpha
__ Gross Beta
Date Reported -o::c,c------------------m
Date Analyzed ;,,i-J0-~78&
Lab Number ' ?OJ,lSQ
Purpose:
Preparation
Enforcement and compliance with the N. C. Solid and Hazardous Waste Management Rules.
A sample analyses request form (OHS 3191) must be completed for each type of evaluation requested (e.g.,
inorganic, organic, microbiology, radiocheil}iscry). For sampling conditions which require 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
collector must then write the site and sample number on the duplicate.
Do not submit an analysis request sheet with no parameters indicated.
Equivalent measurements:
ppm= µg/ml = mg/1 =µgig= mg/kg
ppb = µg/1 = µg/lOOOg = 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 riumber, 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, resins, 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 ( ..I ) 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: 1. Original to State Laboratory of Public Health
Environmental Sciences Branch
Disposition:
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.
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 SAMPLE ANALYSES REQUEST
State Laboratory of Public Health
P. 0. Box 28047
306 N. Wilmingro~treet
Type of Sample:
Environmental
' ,✓-___ , Groundwater (I)
__ Surface Water (2)
__ Soil (3)
_d_ Other (4)
Concentrate
__ Solid (5)
__ Liquid (6)
__ Sludge (7)
__ Other (8)
d,' L,AF-ct.-ler 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
P&T:GC/MS _EDB
__ Acid:B/N Ext. __ PCB'.s
_TOX __ Petroleum
__ Endrin
£ -Ceo L),{)L)'t t e'f/,..v-__ Lindane r-•
MICROBIOLOGY
Parameter Parameter
__ (MF) Coliform Colonies/!00mls __ Gross Alpha
__ (MPN) Coliform Colonies/lO0mls __ Gross Beta
----
----
'll
Total
Parameter Results mg/ 1
__ Silver
__ Sulfates
__ Zinc
_Ph
--Conductivity
_TDS
_TOC
--
--
--
--
--
--
Parameter Results mg/ 1
__ Methoxychlor
__ Toxaphene
-2,4-D
__ 2.4,5-TP (silvex)
--
RADIOCHEMISTRY
Results PCi/ 1
Date Received ___ \.l_--':J..~0_---'S-<--'7~~0-'-'-Pi'-·-~-------Date Reported ------'--------------
Date Extracted ___________________ Date Analyzed ------l"'fflt'cl,.,..-.n=----------17031!-Jl
Reported By Lab Number __________________ _
OHS 3l9l (R1tvised 7185)
SoliJ and Hazardous Waste (Review 7 /87)
• Purpose: Enforcement and compliance with the N. C. Solid and Hazardous Waste Management Rules.
Preparation A sample analyses request form (OHS 3191) must be completed for each type of evaluation requested (e.g.,
.inorganic, organic, microbiology, radiochemistry). For sampling conditions which require more than one (1)
container (i.e., ground or surface water from landfills) a sample label must be affixed to one ofthe containers. The
collector must then write the site and sample number on the duplicate.
Do not submit an analysis request sheet with no parameters indicated.
Equivalent measurements:
ppm= µg/ml = mg/I =µgig= mg/kg
ppb = µgl I = µgl 1000g = 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, resins, 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. Extracrables 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 rhese.
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 SAMPLE ANALYSES,REQUEST
State Laboratory of Public Health
P. 0. Box 28047
306 N. Wilmington Street
Site Number ~-!!-0 3 2-00 .3 <f 3
NameofSite 1: '.:! &. · T/lC
/)' )\ ;
Collected By /71 /: µ e {4!U t>--ID# 3 f'
Type of Sample:
Envi~onmental
_·_·_;Groundwater _(1)
___ Surface Water (2)
__ Soil (3)
_L Other (4)
'0
Concentrate
__ Solid (5)
__ Liquid (6)
___ Sludge (7)
__ Other (8)
Raleigh, 27611
Site L.oca;ion L_ ~l...!<'...LLJ.-'!..!e<..!7""--""'--;,>-!==L-1'#~----
Date Collected -'-''--'-~-'½f!c-----Time-=~---
J,4,,v ,. • ,.,9 1
~-wo.:::/V INORGANIC CHEMISTRY
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 -I __ fluoride _TOC "t,
_··_silver -· __ Jron . --
--__ Lead --
--__ Manganese --
/" __ Mercury ----
--__ Nitrate --
--__ Selenium --
ORGANIC CHEMISTRY
Parameter Results mg/ 1 Parameter Results mg/ 1 Parameter Results mg/ 1
P&T:GC/MS _EDB __ Methoxychlor
2 Acid:B/N Ext. __ PCB's __ Toxaphene
_TOX __ Petroleum _2,4-D
:,t_f:CP
__ Endrin __ 2,4,5-TP (silvex)
__ Lindane --
MICROBIOLOGY RADIOCHEMISTRY
Parameter Parameter Results PCi/ 1
__ (MF) Coliform Colonies/lOOmls __ Gross Alpha
__ (MPN) Coliform Colonies/lOOmls __ Gross Beta
----
----.,.·
Reported By
Date Received ~=-·_I _I ·--'2.=0'----','J"'-'7-'------'--------Date Reported ,.,,,-------------------
ftl!J', .ll. "7 "' ,n J ' 10 "7 L1[)
Date Extracted~"'~-!!-' -~u~IY _____________ Date Analyzed '-'"''-'-'_"'-__ ~o_,_:::::o:'c::'--::::--=--=--,----------
--------------Lab Number ?OJ192
DHS 3191 (Revised 7/85)
Solid and Hazardous Waste (Review 7 /87)
Purpose:
Preparation
Enforcement and compliance with the N. C. Solid and Hazardous Waste Management Rules.
A sample analyses request form (OHS 3191) must be completed .for each type of evaluation requested (e.g.,
inorganic, organic, microbiology, radiochemistry). For sampling conditions which require 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
collector must then write the site and sample number on the duplicate.
Do not submit an analysis request sheet with no parameters indicated.
Equivalent measurements:
ppm= µg/ml = mg/1 =µgig= mg/kg
ppb = µg/ 1 = µg/ 1000g = µg/kg
DEFINITIONS/INSTRUCTIONS I!'
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, resins, 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: 1. Original to State Laboratory of Public Health
Environmental Sciences Branch
Disposition:
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.
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
DIVISION OF HE..:._.I,T:: s::?..vre::s
SOLID AND HAZARDOUS \./AST:: !-'J.J;;.GEY.EJ,;T 3?_,,NG
Chain of Custod,· Reco:cd
Hazardous Waste 112.terials
Generator Transpor:er __ Tre2.toe"n: Faci::..it
__ Storage Facility __ Disposc..l ?acility __ Landfill
-.¼-Other: ~ -d'?ll u;-e.lfk
Company's Name &11r1..cc & 01( U42Z-.,Lr':lephone(W2--) z,2-,'7--u ?-1
Address L/ 3_r (;J;;/ew(C:IL Ate htiJ )J~C, l M /S-1..-/ 1 ";y). J 7 . -Collector's Name >4-ir r frc fl_(~ Tel,ryhone( 911 ) l 1 i -2,E-o I ' signature
Date Sa,npled · JVO() / 7-/9 (Pf: Time S2:n?led /3CfQ-//4/.:3 ' )
Type of Process Generatbg Waste ---------
. Field I:ifo-.:-mation
._,/ ~I c/"
_3 791: 3 79g 3-V_i_
3?o'I / 3f0s 3tf06
Ch~i~ o: Possession:
/
3 rfoo ---·---··
..,,,-. ✓ 3?CJ I 3fQ.,l_ v
c3ftJ f'
1. ,& ·,~L~ aJaJJfllxe:-t#-<_(P 11ILfi:s{~(t/tl:
2. ~u _ ~ . ~J-· dr:t.b :.ic,dvrt,u.,~ 1 t -cJ.o -'6'7 sig?-ature t:it:le inclusive dates
3.
signc.ture tit:le inclusive dates
Res~l:s reported
signz.:ure title C2te
lns::-'Jc-cions: Cm:1plete c.11 2;,plic2.ble inforr:.ctio:. incluCi:-:e:, sign2tures, 2.:-i:C. st.:':nnit. -..;:..th ·2n2lysis request fo:-::::.s.
I
D:::VlSIOl, 0? E.LL.LT,: SERVICES
SO:..:CD Ah'D HJ..ZARDOUS \,/;.STE l:-'J..NAGE!-'.:::NT !lfu'JIG
Receipt fo~ SE.lDoles
Tne samples describeG belo\.'.' \Jere collected in connection "·ith the ad.ministration,
enforcement, and doc~e~tation of the:
( ) North Carolina Hazardous ~aste Management Rules, 10 NCAC lOF
( ) North Carolina Solid ~aste Management Rules, 10 NCAC lOG
() Comprehensive Environmental Response, Compensation and Liability Act (CERC"i..A)
( ) Toxic Substances Control Act (TSCA). 15 U.S.C. §2601,
Section 11.of TSCA, 15 U.S.C. § 2610.
~ ~-, specifically
Inspecto~•s Name
Name of Firm
Finn 0--'!ler, Ope~·a ~or, or Agent
-
SA.¾?LE COLLECTED SAMPLE TYPE
N1.P.-'3ER DATEITIME I WATL-. SOIL J_:1IBER ! I
' ---
I
I I
I
Receipt for the sample(s) described.
above is hereby acknowledged:·
Signature of Inspecto~
'Title
' I
Inspector's Address
Fino Address
Title
DUPLICATE SA.l1PLES SA.¾PLE LOCATION
O?FER.;-::DIACCEPTEDJREJ:ECTEDI ON-SITE I OFF-SITE
I I i
I
I
I
Receipt/rejection of duplicate or split
samples is hereby .cck.nmdedged·:
Title
--·
CO~NTS, ____________________________________________ _
DIVISIOF OF EE.l-.LE SERVIC:::S --SOLID AND c.r.2.JJ-DOUS \,'ASTE !·tLJU-.G~T 3:l'-.JIC:l ·
C:lai~ of Custoci...-Reco:-d
E2z2rdous ~aste Materials
Loc2:icn of Sampling: Generator Transporter __ Treatnient Facili~
__ Storage Facility __ Dispos2l Facility __ Landfill
_k__ other: 1t-c6Cf c&L d-,
Company Is Name~r s:: 11 c.... (£6-'?z, \ Telephone( 02-) 2 2 7 -2b zr
Address z{,3 .< c+-eu-e,c/L /h....e__, > ,,0/ "/IJ bld(9 /..-/'A IS d<o. / 9
Collect.or's Name if!:;.. ,.lJ.L_/t4J,4-.• Teleyhone(9/'t ) 13 3 ✓2 tftJ / ' signature
Date Sampled_·,,__;r;,~~t~t__,_/~f>--+,~/_9~J'__,_7 _____ Tillle Sampled OV 7 -/ 2, 3 0 )
Type of Process Generating Waste ------------------------
. FielC I:Uonnation
Fie.J.6
ChEi~ o: Possession:
_,/
3%'//·
,/
3ft?
,/ e----
38d{) 38'3 t
1. YiJr Ju; /w.✓11; @tUXt Mtat 'f fud--U J± llfltf'_ -(!/$kl 7 signature tl.t.!-e inc.!.usive dates
2. 04< C,. f»~+
signature ' title . inclusive dates
3.
signc.ture title inclusive dates
Res-..::rs reported
signature title date
Inst:-·Jc tions: Complete all Z??licc.ble in£ orr::..s tion inclu6in~ sign2 cur-es, 2nd su·::i~it. t...~::.rh ·.2n2:ysis :-eques: for.:::s.
lJl\' lSlOl, or EEALTE S::3\'ICES
SOLID AND HAZARDOUS \./ASTE YJ.J,AGE:-'.ENT 5lv'.NCE
Receipt fo~ Samoles
Tne samples desc~ibed below ~ere collected in connect.ion ~ith the ad:::inistration,
enforcement, and documentation of the:
( ) North Carolina Hazardous \.iaste Manage□ent Rules, ·10 NCAC lOF
( ) North Carolina Solid Waste Management Rules, 10 NCAC lOG
() Comprehensive Environmental Response, Compensation and Liability Act (CERC".i.A)
() Toxic Substances Control Act (TSCA). 15 U.S.C. §2601, ~~-, specifically
Section ll_of TSCA, 15 U.S.C. !l 2610.
Inspecto~•s Name Inspector's Address
Name of Firm Fi= Address
Title
-
SA.'1PLE COLLECTED' SAMPLE TYPE DUPLICATE SA.l1PLES I SA."fPLE LOCATION
NmIBER DATE TI.HE WATER SOIL OTHER OFFEREDIACCE?TED REJECTED! ON-SITE\ OFF-SITE
·--7-· I
I
I
I
Receipt for the sample(s) described.
above is hereby acknowledged:
Signature of Ins?ector
Ti:le
I
I
I
I
I
I
Recei?t/rejection of duplicate or split
samples is. hereby 2cknmdedged·:
Signa:u::e of Finn er~-ner, Operator, ·or Agent
Tit.le:
CO~'.'fENTS, ___________________________________________ _
SAMPLE II ,L.,UJ/ JL /CfJ
'103/~fl <tJ, o I
.J/10 3/,oZ
3 I 7,;J. tJ. o.S-
317{ <O,O I
.?/7~ <'o,o I
317t <0,0/
? ;Y() -<0,0/
J1fz. ·-{o,o/
31Ji/ <o,o/
?If& <tJ,ol
3/Jf < o. o I
Jtfo -<O,O I
3192 <o.o/
N.C. Division of Health Services
DHS 3068 (6/83 Laboratory)
DEPARTMENT OF HUMAN RESOURCES -DIVISION OF HEALTH SERVICES
LABORATORY SECTION
OCCUPATIONAL HEALTH
G C REPORT SHEET
DATE OF ANALYSIS:
.nn±cL'l'flAAMIY /f .-l.~ ~ ,,,a/' 6
s;.., LJ/ e ;ti-flf/.R::t:P£
7o3/6'l <:..S-
1 o.3/e, 1 0f
70,117 ✓ ,;lO
703/73 13
71) 3/ 7S-<S
113177 <5-
70,179 <!J-
7u 3J/f;J -<5
703/ ,r·i <5"
70J/ 3'.:'I <~
7D3Jfr7 <5"
703/ ?</ <§'
7<J3!9 I <~
. \ .
'
\ J:
CHAIN OF CUSTODY RECORD it ~-"'
PLAR~CODE I PROJECT NAME 5~o£w,; 1I-17-fr'?
, s'i,,
~ Do,-,.esf,c: i;,f p({ NUMBER Ji f ~
SAMPLERS~ ~~~t~ OF ~ ?I ;::
(Signature) CONTAINERS 3 REMARKS OR
I I "',-t-\ ~,()~
I ~ fy (f'; ~Q_
OBSERVATIONS
C G w 8 ~
STA. NO. DATE TIME 0 R E STATION LOCATION Q " A ' P. ' '
We1\ os -I //-17¾1 J(;;i.o X. ;< -Sol-A /11-ecl. \i 11 4 d--d-/J.r-,, I .
\Ji!_: IL oS-7 11-0..\<' /?,eo 't-'/. :r <iflteS Crowe L.j 'd-. ~ rk 4'o 111! , ,.-.Is
i .IP\l oS-'B ll-17-~ /'3:,c; "' ✓ S\..\ \0 1,,, ~on<;f-OrurcL '-( ~ ~ , ,o...,, ore -oreserrreb
f,lell OS-'t IH7-~1 145°0 W i ti :c,-;,. e,,,.<\.ee 4 ~ d-. . \ t i<: ,JN-h HC L,
i,le\1 o<; -I a 1/-17-~ 1'11 S' ~ I( J .1-L lyo115 4 '3--d-L1
~('\\ oC,•/~ t -17,'67 /~;).,; f-'f. --rN. ~\"< ~o'f. L/ ~ d-. Tio ✓ I~ /:4~
r,,r¼t'. n,,, -ore renr¥6
,:a, ' It-. 'so 'I
V
Relin~ed by:~a~ Date Time ~~·'13-~ ~h~z.:~nature) u/7,,1
Date Time Received by: (Signature)
{-17-'i7 ~fl'i? ~ ~/. h ~ ~/7 s-:55 WI' . C · i3Uve&J.-
Rlf!inquished by: (Signature) Date Time I 'Received by: (Signature} Reliquished by: (Signature) Date Time Received by: (Signature)
Reliquished by: (Signature) Date Time Received for Laboratory by: (Signature) Date Time Ice Chest Temp Ice Chest Chain of Custody
OC
*DISTRIBUTION: Original accompanies shipment; Copy to Coordinator Field Files.
# Tag#
PAGE __ OF_
~ i
CHAIN OF CUSTODY RECORD tl:1 ,.
PLA'1?CODE I '"¥0JECT NAME Ii-/ 't-"67 ~ ~ ~I\I 're_ (A\,\\ < _, NUMBER ','--. t ~
SAMPLERS~~· \b\'., , . \1( C., '\/ I ~ OF ,:::
(Signature) ! • --......s... -.._,,. I ~ 1, ./~"Sc :.;:1/s-~-CONTAINERS Ji REMARKS OR
f OBSERVATIONS
C G w 8 i STA. NO. DATE TIME 0 R E STATION LOCATION " A L ' " L
W.:I\ OS-'.:\ t!'{S-c-ll3o "f. k /' 1-(...-l, nc, 4 ~ a /i.) 71. 'lo a,(
li\lQ\\ 05-3 lf-t~--f?, //~:, )< ')( /ii~ s r ... c.l'-&-1:ir t./ ;; cl,. u,c.ls ~·:r:~ -.(
w~1, o~-1../ (-(&,-~ ~ ¥ >< K0v ~Ji,Yl I.{ 'o< I :::i. -" we.~ ~ '
I;. \Q. I\ os-~ lt-1r.-x-Cff5') K K Tr, G.t..((. ~v.k u ·2 d, \s<'\!.. -orese.~vll w ~fl-.
f,Je \\ OS' -1 ... l~ 13 fb -( k Ae1& \':,~"I:::. If ;;2. -a if-lcL
~\\ o~-ts . -Id.,,,_, 'K y: /--~s ~r.,_.. II ~ ~
we1I oS-lt=. i/-rfi'--< /loo )( K llfc.rf-&,.~ L/ ,;2. ~ ~ ,4,,,,,k,
J,~.i:;;., ~cP
, . ..,,...e. "rl' -l\r? ""e. n .2 l
t.,J ~ +\.\. l /f, I Sn,/
.
Relinquished ~ignature) Date Time R;z:_~1sy:::;r/k ~ '!)Jluish'J:Y/lgnature)
11,h..A
Date Time Received by: (Signature)
=L--:: -/,/ '~-I~ I~ '). , .. -':,"7-t:55 ~ C. 'A=,t;io.Y
Relinquished by: (Signature) Date Time Received-by: (Signature) Reliquished by: (Signature) Date Time Received by: (Signature)
Reliquished by: (Signature) Date Time Received for Laboratory by: (Signa;u,e) Date I Time Ice Chest Temp Ice Chest Chain of Custody
OC # Tag#
"DISTRIBUTION: Original accompanies shipment; Copy to Coordinator Field Files. · c.," -\.md·,':S @ ft Sum~\11. ~ £M:. -k~ <l,~ \ij,\~G-r-
~ J,.c i.:::.~{6u-. Q"i:i os-6. PAGE _,f_ OF!__
0..
DIVISION OF HEJ..LTi S:C:RVICES
SOLID Ml) HAZARDOUS WASTE l:-'J..NAGEMEKT ER..;NCB
Chain of Cust:od,· Record
Hazardous Wast:e Materials
Locaticn of Sampling: Generator __ Transporter __ Treatment Facilit;
__ Storage Facility __ Disposal ?acility __ Landfill
-,k_Other: 1Jj -/ill U!:ffk ·
Company· s Name A{ 1-2 ot:1 u:r: 6, U'?( (Km\ Telephone< 0'2--) z, 2,,:7--2.1o T2 rr' µ ~ ~ ~
Address ¥' 3,C Jef/f?/lfi-Ate /?d;IJ ),.;,--4 l /}4-/SL-/~
/) J 7
Collector's Name P7l t= fu ~ Ieleyhone( 9/7 )_2,3 3 -2,J-o 1
' signature
Date Sampled . /Vou I 7: /CJ <r f: Iilne Sampled /...3@ -//4/.:3 ' J
Type of Process Generati:ig Waste ---------
.Field l:iformation
?;;.,.l,' .sA:rcr•le 1;o. _37.J_1: 379g 21:.:J..J... _3 PoQ 3?tJ I 3&':'.Q..l. 3!'D3
3P01 · 3ft)s 3J>06 -~_,rc_z ,3ftJf'
Chain of Possession:
1.
2.
signature
3.
signature title inclusive dates
Res~lts reported
sigri.a:ure title . date
Instructions: Complete all applicable infon;;ation inclucing signatures, and
submit ~~th ·~nalysis request fo:-ns.
DIVISION OF EE.ALIE SERVICES '\.__, ----SO!.ID AND HAZARDOUS WASTE Y.1-.NAGEXENT BRANCH <;, ;'-
Receipt for Samnles
rne samples described belO\: "'ere collected in c·onnection ,,ith the administration, enforcement, and documentation of the:
() North Carolina Hazardous Waste Management Rules, 10 NCAC lOF
() North Carolina Solid Waste Ma..~agement Rules, 10 NCAC lOG
() Comprehensive Enviromnental Response, Compensation and Liability Act (CERC-i..A)
() Toxic Substances.Control Act (TSCA),15 U.S.C. s2601, .!:.!.~·• specifically Section 11.of TSCA, 15 U.S.C. ll 2610.
Inspecto~•s Name Inspector's Address
Name of Firm Fire Address
Title
SAMPLE COLLECTED SAMPLE TYPE DUPLICATE SA.l1PLES SA.'1PLE LOCATION lill!-IBER r--;D;.:;:.;.T;;E;;:!:.;T"'T:;:v.E=-,..+1_-__ '"'_ w:-:_ A.,.,r=r;;"'R:,'.::;s::':o;:;:I=:-L-=_~I ~o"'THE:-:. =-R;:-1.....,o"',"'r:::1:=·R0ED"=.:i=I -=A.;;c;;c~EP"'r=ED=lc':RE.JE:::-~LC';C:::T::;:ED:::::-1jr::o:a:N:=:_::;;s:;I;T;E..,::o::::.FF~-::.:s:::I~T:!.E _____ _ , I ., I
---l--+----4-----,f---t-----,---+----+----t-----1------
F.eceipt for the sample(s) described.
above is here·oy ackno..,ledged: ·
Signature of Inspector
Ti~le
Receipt/rejection of duplicate or split
samples is hereby acknO\dedged:
Sign~tu~e of Finn Crw!ler, Operator, or Agent
Titcle
C0:0!ENTS~----------------------------------------
-----·---·---------· ------·---
DIVISION OF HEJ..l.T:: SE:RVICES
SOLID AND HAZARDOUS !<ASTE HJ..NAGEMENT ERANCR
Chain of_ Cust:och· Re·cord
Eazardous l<ast:e Materials
Location of Sampling: Generat:or __ Transporter __ Trea'tlnent: Facilit:
__ St:orage Facilit:y __ Disposal Facility __ Landfill
..¼,_Ot:her: --4J--cbU c,HLth
Name 4o,ar_r S:: /1 Ji/JC.. (ft:,t,\ Ielephone("/J2.) 2-2 7-2-6 79 Company's
Address._-+-""-'...i__.,,c...._·_.,,--0~C:;;:e,_u-e.,._-,-c/(...., __ A-,,...:....;__--e.,_.:.._,t_>..:..P,,---/·:....:./2:::.'&_!,6::::.:ttl=..;~l------=-~-'M,-_ __,::/__:S"::_d.__:_/-!.'7 __ _ ,,
Collector's Name'.....,.LJ:i:::!::L__,~5=a.L!:.~JL..i ____ Iele_phone( 9/9 ) 73 3 ,2 ,rtJ /
signature·
Date Sa.:npled_~·,r...;r;,L.J.1.-"{f'---.J-/-"J>'--,,,_' /<-L.9_,J':c....-7i....-____ Iime Sampled r?9/ 7 -/ 2-3 C
Type of Process Generating Waste. _______________________ _
.Field Information
:ic.ld Sample No. ,3Jt'.Jf
3'i /ft,
Che.in of Possession:
3!10
38'/'l
3111·
3flf'
3J> /3 Ul<f 3<fl5'
38<1?0 ,3fa, 3r2-2..
1. _ ,Yilc/u;,1ZLJv_11; -@,WI Mym'tft:t~:r± ///4r-(I/Gltt-7
-signature tit.:.e inclusive dates
n{p J; , C, . 'ti /u r{)£),t f-2.
signature
· dn h ::'//(lh/h,/,C{e&JJ--:--cl:-/-=-:o<:::....(J-.....:(5'-1.7 __
title inclusive dates
3.
signature title inclusive dates
Rest:lts reported
signature title date
Instructions: Complete c.ll applicable information inclucing signatures, and
submit "-~ith ·.analysis request forms.
DIVISION or HE.ALIE S:::RVICES
SOLID AND HAZARDOUS WASTE l-',J..NAG:Jfil'lT BRA..'sCE
Receipt for Samples
·The samples described below were collected in c·onnection ;,ith the administration,
enforcement, and documentation of the:
( ) North Carolina Hazardous Waste Management Rules, ·10 NC.AC lOF
() North Carolina Solid Waste Management Rules, 10 NC.AC lOG
() Comprehensive Envirornnental Response, Compensation and Liability Act (CERCLA)
() Toxic Substances Control Act (TSCA). 15 U.S.C. §2601, !:!.~·• specifically
Section 11.of TSCA, 15 U.S.C. e 2610.
Inspecto~•s Name
Name of Firm
Firm Owner, Opi,i·a :er, or Agent
-
SAMPLE · COLLECTED SAMPLE TYPE
NUMBER DATE TTME WATER SOIL OTHER
-·--·~ ;-------
. ,
Receipt for the sample(s) described.
above is hereby acknowledged:
Signature of Inspector
Title
Inspector's Address
Fire Address
Title
DUPLICATE SA.Y.PLES SA.'1PLE LOCATION
OFFEREDIACCEPTED REJECTED oN-srn: I OFF-SITE
..
I
Receipt/rejection of duplicate or split
samples is. hereby ackno1<ledged·:
Signature cf Finn Owner, Operator, or Agent
Title
COJ-NENTS, _________________________________________ _
---------·------·--· ------·---DIVISION OF !iEJ..LTi SERVICES
SOLID AND HAZARDOUS '1-:ASTE !1/-_>iAGEill:KT :SR.'-.NG
Chain of Cus::och· Record
Hazardous 'W2ste Materials
Loca:icn of Sampling: Generator
__ Storage Facility
__ Treatment Facilit:
__ Dispos2l :2cility __ Landfill
z_ 2. ?-2,(:, 7-9
Address S
Collector's Name/iE/2-/~Jt}
/ signature
Tele_?hone(~-~) ________ _
Date Sampled /Vall. I £ 4 19 ? :Z Time Sampled /J9J'i -l:3 &7J --~L.i.,'-1.L-'--'--'.,___7+-''--''-"'-'--------_ ... .,__,_:....L...J....---L-'-u..!..U.-
TY?e of Process Generating 'Waste-'-----------------~-------
. FielC !:iiormation
#,t,T .£::1ay--&, (AL I o-< .t-e.-12 &At R.g_.d (Art 0:-
Fie.le Sample No. 3 x'. 3 S 3 i 3fu
38'{-2= 38:¥-3
3 l? ;,] 3 8 3 &' 3 8 3 't
3 r¥ v 38"¥.r: Bi' y,
~'."'")~;;;~~ @wh{J ":f!Ju ,. I dtt,t:i'f fa
2. L -l/JL/!,U().D.c.-/-o( o..b jp c.£1L<.,C,.{_o..,,,_J / / --,.;)Q-8'7
signature title inclusive dates
. 3.
signature title inclusive dates
Res...:::s reported
signature ti:le d2te
1-:-is ::-uc tions: · Complete all-applicable inf o~a tion inc~ uci ing s ig;1a tures, and
submit ~ith ·2nalysis request forms.
DIVISION OF P.EJ..LTB S::RVICES
SOLID AND E.AZ.A..tUJOUS WASTE Y,.t.NAGE:iENT BRANCH
Receipt for Samoles
The samples described below were collected in c·onnection ,:ith the acbinistration,
enforcement, and documentation of the:
( ) North Carolina Hazardous Waste Management Rules, 10 NCAC lOF
() North Carolina .Solid Waste Management Rules, 10 NCAC lOG
() 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.
Inspector.' s Name Inspector's Address
Name of Firm Firm Address
Title
-
SA."lPLE · COLLECTED SAMPLE TYPE DUPLICATE SA.11PLES SA.'1:PLE LOCATION NUMBER DATE TL'fE WATER SOIL ----
•,
Receipt for the sample(s) described_
above is hereby acknowledged:
Signature of Inspector
Title
OTHER OFFERED ACCEPTED\RE.JECTEDj ON-SITEj OFF-SITE
~
' ' -
I
Receipt/rejection of duplicate or split
samples is hereby acknm..'ledged·:
Sign2.tu:-e of Firm wner, Operator, or Agent
Title
CO~NTS, ______________________________________ _
..
r.
Location of Sampling:
DIVISION OF HEJ..LTi S:'.RVICES
SOLID AND HAZARDOUS \./ASTE ~J-.NAGEK::NT BRANCH
Hazardous \./aste ME.terials
Generator __ Transporter
__ Storage Facility __ Disposal Facility
__ Treannent Facilit:-
__ Landfill .
~Other:_-=-,1,,.,..__-_.,t,"'"""fl,"""""..._.(..,lut<--'.h..='"""0><-----------
Address,_z...,2_..:i._~u~:zl~~:_.,:2.J.'.!Y.:.._t-....L.~dd..U.2-"'L~~:'.....J[L::!..._L.,,,L.,~U.----
Collec tor Is Name A"£/::. / J?a..f b-1' l&J..r,,__
/ ' signature
Tele_phone('--_~) _______ _
Date Sampled · ,k'd I.I 11:, I 9(f 7 ; Time Sampled_./ .... 3=--=:((t)::-=-_-L./...,{,'--4-/_3.1-..
Type of Process Generating \ofaste. ________________________ _
. FielC: !~orniation
Fic.lci S=ple No. ,3tfd3 3 K':J,'f
Che.in o: Possession: . .
3ifJ.S ,3/fa1p 3!?J9'. a f?,jl? a8'~j
av2,.1.. 31?33 alr'3ct
1 · Mt:~,;._.;, t,a.Jifil,,.,.-t-k,; ;/r 7fr lc::.i:d:!:l
2. riPR~ (I_, l&(j~ ~b JJ~rJ
signature title inclusive dates
3.
signature title inclusive dates
Res~lts reported
title · date
Instructions: Complete all applicable infon::ation incluciing signatures, and
submit ~ith ·2nalysis request fo=s.
DIVISION OF P.E.L.LTE S:::RVICES
SOLID AND HAZARDOUS WASTE !-'.1-.NAGEMENT BRANCH
Receipt for Samples
The samples described below were collected in c·onnection ,dth the administration,
enforcement, and documentation of the:
() North Carolina Hazardous Waste Management Rules, 10 NCAC lOF
() North Carolina Solid Waste Management Rules, 10 NCAC lOG
() Comprehensive Environmental Response, Compensation and Liability Act (CERC-.c.A)
() Toxic Substances Control Act (TSCA). 15 U.S.C. §2601, ~~-, specifically
Section 11.of TSCA, 15 U.S.C. § 2610.
Inspector's Name
Name of Firm
Firm 0 .. -ner, Op<e:·a :or, or Agent
-
SA.'1PLE COLLECTED SAMPLE TYPE
NUMBER DATE' TL'1E WATER SOIL OTHER
·-· c--I
.. .
Receipt for the sample(s) described_
above is hereby acknowledged:
Signature of Inspector
Title
Inspector's Address
Fi= Address
Title
DUPLICATE SA..11PLES SAMPLE LOCATION
OFFERED,ACCEPTED,RE.JECTEDj ON-SITE OFF-SITE
--
.
·' ' -
I
Receipt/rejection of duplicate or split
saoples is hereby acknmdedged·:
SignetuYe of Firm Owner, Operator, or Age~t
COM!1ENTS. ___________________________________________ _
RALEIGH, NC 179200-03-COST CODES BEGIN 11-17-87
DOMESTIC WELL SAMPLING !SEE ATTACHED MAP FOR LOCATIONS):
SITE
JOHN MEDLIN
GEORGE HARDING
MRS J ACf< BAl<ER
ROY MEDLIN
TRIANGLE MATERIALS
WILl<ERSON CONTRACTING
JAMES CROWE
SHILOH BAPTIST CHURCH
WILLIAM BARBER
FIELD BLAN!<
TRIP BLANf<
FIELD DUPLICATE 108-21
L.A. LYONS
LOUIS BARBER
WATSON -BURROUGHS
DELI BOX
MACf:: BAl<ER
MS-MSD (TWO SETS I
U\BEL
WELL OS-·1
WELL OS-2
WELL OS-·3
WELL OS-4
WELL OS-5
WELL OS-6
WELL OS-7
WELL OS-8
WELL OS-9
WELL. OS-10
WELL OS-lOA
WELL OS-11
WELL OS-12
WELL OS-13
WELL OS--14
WELL OS-15
WELL OS-16
*SEE BEL.OW
DESCF, I PT I ON
*LABEL.THE MS-MSD SETS WITH THE WELL NUMBER WHERE THE
SAMPLE WAS TAKEN PLUS MS-MSD.
PARAMETERS PER SITE:
pH, COND -FIELD SOZ UNP
ISOF0ROF0YL. ETHEF, - 2 VIALS PER SET SHIP TO HOUSTON
(METHOD 624 SEE ATTACHMENT)
PCF' - 1 AMBER F"ER SET SHIP TD MONROEVILLE
(METHOD 625 SEE ATTACHMENT)
MAKE SURE THE SAMPLES ARE SENT TO THE CORRECT LAB AS NOTED
ABOVE.
* TWO SETS OF ALL OF THE ABOVE BOTTLES WILL BE ON SITE.
-ONE SET OF BOTTLES WILL BE USED BY KEYSTONE AND THE OTHER
WILL BE USED BY NC STATE OFFICIALS TO COLLECT THE SAMPLES.
I
i
:< C l)epartrnent of Human Resources '.,. ' \ t8 Laboratory of Public Health
,,, .. >»on of Health Serv,ces SAMPLE,\rr-1\SES REQUEST_.. I P. 0. Box 28047
Sire Number .fl.,_,{J.. ~Q O 3 ,;1 D~~ i \, \£'Sample Number. ,3~~--···,,~ •-· 706
N. Wi';:l~~~~i;~~elt
Nm,eofSite 2o,;,:«.s fl~ ~ SiteLoca~ion /J}flr,,·r U1/I-('.. J !1((17
<collected By ,HI z':: /)£ /Za ((r--ID# :?rf Date Collected 3 -J Q-f' f: Time q·. 'J-0
Typ~ of Sample:
Environmental Concentrate
~ Groundwater ( 1) __ Solid (5)
____ Surface Water (2) ___ Liquid (6)
___ Soil (3) __ Sludge (7)
__ Other (4) __ Other (8)
lNORGANJC CHEMISTRY
I Extractables :
1 •••
. Parameter Results mg/I
: ____ Arsenic
___ Barium
··--Cadmium
-·--·-Chromium
., ... Lead
____ Mercury
, ____ SeleniL1m
· s·1 I ______ ~ 1 vcr
i----; ,--
·--
--;
: Paraa1eter Results mg/ I
I
1 _____ P& T:GC/MS
I _,L_ Acid~Ext.
:----TOX
; __
1.21"_ r'~P
'
MICROBIOLOGY
Param_eter
I ___ (Mi') Coliforrr, Colonies/ !OOmls
i---(MPN) Coliform Colonies/lOOmls
'
/--
!
Parameter Results mg/ l
__ Arsenic
__ Barium
__ Cadmium
__ Chloride
__ Chromium
__ Copper
__ Fluoride
__ Jron
__ Lead
__ Manganese
__ Mercury
__ Nitrate
__ Selenium
ORGANIC CHEMISTRY
Parameter
_EDB
__ PCB's
__ Petroleum
__ Endrin
__Lindane
Results mg/ I
Parameter
__ Gross Alpha
__ Gross Beta
Total
Parameter Results mg/ I
__ Silver
__ Sulfates
__ Zinc
_Ph
__ Conductivity
__ TDS
__ Toe
--
--
--
--
--
--
Paran1.eter Results mg/ 1
--Methoxychlor
__ Toxaphene
_2,4-D
__ 2,4.S-TP (silvex)
--
RADIOCHEMISTRY
Results PCi/1
.
--------------------~---~-----------------'
Dote Received , J'-d O -8 7 B ,{:1
. &</ft 3--2q.g7 F8,v, J..0
Uctc Extrncted edl' 3-ql-'CZ 8,Q
Re;mrtcci By~ @ /ldif l , .
l)i--1S 3191 (Rt•\'ir.ed 7/Bj)
;;u!i<: :mJ Hi1::irdous W2.He (Review 7/87)
Date Reported 7 {f/~JJ? · 1
Date Analy:.ed f1':!_fJ 3-.2/rg zgj} J. lti1--.2-n A..0
Lab Number ·.-, 700857
i·
#7o t1S s 7;-7o o F 'if.2-
;
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
fil.ii) , . ~.'Gl. Raleigh, 2761 I
Site Number _,_9_,,c:2_~· ,_f>~Q'-.1...Q'--3'='--'cJ-"' ...1D:.L.LO..L..S.~3..L:>?L-=3«._ __ Field Sample Number ;?§·w;:p~ 3S] E
NamcofSite _L:{_Q/J/JfC.S f:.tJ Mc. SiteL.oca.ion il21vo:cu1/I~ /J/(f/
Collected By . .,c:A~-i-~-'~b.,.-?-...,f!LJ.=~C~O::=--ID/I ~,~3.u~"---Date Collected , 3 -a 0-f t: ' ~ Time Cf ·. cfO
Type of Sample:
Environmental
__L_ Groundwater (I)
___ Surface Water (2)
__ Soil (3)
__ Other (4)
Concentrate
__ Solid (5)
__ Liquid (6)
___ Sludge (7)
__ Other (8)
INORGANIC CHEMISTRY
Extractables
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
__L_ P&T:GC/MS _EDB
__ Acid:B/N Ext. __ PCB's
_TOX __ Petroleum
--__ Endrin
...zt:_ .Lr'E __ Lindane
MICROBIOLOGY
Parameter Parameter
__ ( MF) Coliform Colonies/ !O0mls __ Gross Alpha
__ (MPN) Coliform Colonies/ !O0mls __ Gross Beta
----
----
Total
Parameter Results mg/ 1
__ Silver
__ Sulfates
__ Zinc
_Ph
__ Conductivity
_TDS
_Toe
--
--
--
--
--
--
.
Parameter Results mg/ 1
__ Methoxychlor
__ T oxaphene
_2,4-D
__ 2,4,5-TP (silvex)
--
RADIOCHEMISTRY
Results PCi/ 1
Date Received
. -· --:~
-----------'---------Date Reported ------'------'----'--------'----· •:.-...
_,.•'. •.;< • : -.~
Date Extracted ___________________ Date Analyzed ~------------------
Reported By -------------------Lab Number 70085$
OHS 3191 (Revised 7185)
Solid and Hazardous Waste (Review 7 /87)
Purpose:
Preparation
Enforcement and compliance with the N. C. Solid and Hazardous Waste Management Rules.
A sample analyses request form (OHS 3191) must be completed .for each type of evaluation requested (e.g.,
inorganic, organic, microbiology, radiochemistry). For sampling conditions which require 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
collector must then write the site and sample number on the duplicate.
Do not submit an analysis request sheet with no parameters indicated.
Equivalent measurements:
ppm= µg/ml = mg/I =µgig= mg/kg
ppb = µgl I = µgl 1000g = 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, resins, 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
Disposition:
P. 0. Box 28047
Raleigh, NC 2 76 I I
2. Lab sends copy fo Solid and Hazardous Waste Management Branch.
3. Solid and Hazardous Waste Management Branch sends copy to field person.
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
' :~. C. Depar~ment of Human Resources
~'1vi~1on of Health Services SAMPLE ANALYSES REQUEST
State Laborarory of Public HeJJch
P. 0. Box 28047
306 N. Wilminb°COn Stre~t
,-,,..::,l Raleigh, Z 7611
9c2. D Q O 3 d n a 3 g 3 Field Sample Number -------"3"-)"'-) !)_. _,_ ! _______ _
: ; ,, ~,, of Site _/2::'.'-'-':,-"oc.,,:...o-..,,.c.:..t:PLC..:.S=-----'-C~"/1'-'--·-Ta'=-,__,,c.~_____ Site Loc.a:ion 122 l'f fl. c u r /I~ Hz z'.: 1 I\£ /u.Q c (~ ID!! 3' {'. Date Collected , 3 -J a-t l-, ' -~~---
7 ';,e of Sample:
Environmental
~ Groundwater ( 1)
___ Surface Water (2)
__ Soil (3)
__ Other (4)
Concentrate
__ Solid (5)
__ Liquid (6)
__ Sludge (7)
__ Other (8)
INORGANIC CHEMISTRY
Extractables
Parameter
__ Arsenic
____ Barium
. ··-Cadr:iium
_____ Chromium
: ... Lead
.. __ \1ercur\'
__ Selenium
-___ Silva
Results mg/ I Parameter
__ :\r.senic
__ Barium
__ Cadrr:iu:n
__ Chioride
__ Chrc~ium
__ Co;:,F~r
__ ?kcrde
__ !ro:1
Resulrs·mg/1
Total
Parameter
__ Silver
__ Sulfates
__ Zinc
_Ph
, -· · --__ Cond ucti vi ty
-----i-TDS __ TOC:
------________ , __ Le:11'.l
i __ Manganese
__ ~v{ercury
__ Nitrate.
__ Selenium
Paran1eter
:-P& T:GC/MS
: _L_ Acid~Ext.
•_TOX
Results mg/ I
ORGANIC CHEMISTRY
Parameter
_EDB
__ PCB's
__ Petroleum
__ Endrin
__ Lindane
Results mg/ I Parameter
__ Methoxychlor
__ T oxaphene
_2,4-D
__ 2,4,5-TP (silvex)
o_.,__v Time _ _l_.,_~-J __ _
Results mg/ I
Results mg/ I
MICROBIOLOGY RADIOCHEMISTRY
Parafn:eter Parameter Results PCi/ I
:--(MF) Coliform Colonies/l00mls
i--(MPN) Coliform Colonies/I00mls
--Gross Alpha
__ Gross Beta
' ' ---------------------"-----~-------'--:--------
Date Rect::ived ..,.,.-,--,--~.,-~~=.,....=-.,..,-~,-----Date Reporred ________ ··..c"'::.c· .'-'.'-' ~--------. !3/rr A 3-;J. <f-f? Ff>, L/Jr vP .,.,,,._
U:ne Extracted_. __________________ Date Analy:ed ------,------,--------
Rc;:,orted By Lab Number ----~7--'0c,...0,;,._ 85=:.=. '-"'9..__ ___ _
ti:-1S 3191 (Rc.-vi!-ed 7185)
:;.,1:.! :tnJ Ha:ardous \Va~te (Re\'icw 7/87)
/\:. C. Department of Human Resources
Divi~ion of Health Services SAMPLE ANALYSES REQUEST
State Laborator)' of Public Health
P. 0. Box 28047
306 N. Wilmington Street
Raleigh, 27611
Site Number
Name of Site
Collected By
;.. 3 . '7-cc-ru _.,_9-"'c2::,,_.,U""-'Q"""-'-Q-'--'"3"'-'-';J'--L..Ow..C.,_)__.,3""'-'fJ'-'"""---Field Sample Number __ '.'.).,_1_LJ-"--'-----------
l{c, /J Q PCS f;/1 M(: SiteLoca:ion (}71',l'l<rur/l~ ~n ,
,L(I ;t l)-f' M Cc~ ID# ~-·:r,_,g'.,__ __ Date Collected ,-=J -d 0-f +
Type of Sample:
Environmental
_d__ Groundwater ( 1)
___ Surface Water (2)
__ Soil (3)
__ Other (4)
Concentrate
__ Solid (5)
__ Liquid (6)
__ Sludge (7)
__ Other (8)
INORGANIC CHEMISTRY
I Extractable,
I P.1rameter Results mg/1 Parameter Results rng/1
! ___ Arsenic __ Arsenic
; __ Barium __ Barium
·--~-Cadmium __ Cadmium
_____ Chromium __ Chloride
: _ .. L·~aci __ Chromium
' ____ ~dercury __ Copper
; _____ Sden:um __ Fluoride
: --··-s:1ver __ Iron
! __ Lead , __
·---·-__ Manganese
--__ Mercury
--__ Nitrate.
' __ Selenium i---
ORGANIC CHEMISTRY
I Parameter Results mg/1 Parameter Results mg/ 1
I
__:L_p&T:GC/MS _EDB
__ Acid:B/N Ext. __ PCB's
__ TOX __ Petroleum
--__ Endrin
-+-I --""-7p; __ Lindane
' MICROBIOLOGY
Total
Parameter
__ Silver
__ Sulfates
__ Zinc
_Ph
__ Conductivity
_TDS
_TOC
--
--
--
--
--
--
Parameter
__ Methoxychlor
__ T oxaphene
_2,4-D
__ 2,4,5-TP (silvex)
--
RADIOCHEMISTRY
Results mg/ I
Results mg/ I
l P;uameter Parameter Results PCi/ I
1------~------------------1---------------------------l
/ __ (\ff) Coliform Colonies/ tOOmls __ Gross Alpha
1--(\IPN) Coliform Colonies/lOOmls __ Gross Beta
1---[-
Dare Received -----------'---------Date Reported-----------,--,------------1. ,:
DatL· Extracted~------------------Date Analy:ed ----.:;;;=•===-----------700860 Lab Number
DHS 3101 (Rl'vised 7185)
:",u!icl anJ Ha:ardous Waste (Review i /87)
C. Department of Human Resources
;°'1vi~1on of Health Services SAMPLE ANALYSES REQUEST
State Laboratory of Public Health
P. 0. Box 2504 i
306 N. Wilming::on Streer
Raleigh, 2i61 I
3-i~t· Number
··.29_·1 _,,CJ...,cJ.=-..,_/)"'-'Q..._..Q.L.,,,3~,:J"-'-Q..Ll-QL..s-3.,_,,f?'-=3"'---Field Sample Number -~.:>-:-~---'._._-----------
Ko (2/JfCS Q . Jo C. SiteLoca:ioP (2?rr·-c/cu1/l-e.. /?a r '!)£ /utJ r v-ID# __ :r~f'.~--Date Collected 3 -d O -if 1-,
11((!7. /'
7 y;:-e of Sample:
Environmental
.,/ Groundwater ( 1)
Surface Water (2)
Soil (3)
__ Other (4)
Concentrate
__ Solid (5)
__ Liquid (6)
__ Sludge (7)
__ Other (8)
0·1s Time.j.../__:•:..:..._ __
lNORGANIC CHEMlSTRY
Extracta hies
Parameter
. __ Arsenic
___ Barium
____ Cad~ium
____ Chromium
. : ___ Ltad
_____ !-1ercury
·-s~le:tiui-n
. ___ S:i"cr
Parameter
; _ P& T:GC/MS
: _L_ Acid:f.,;tlll.Ext.
•_TOX '
Results mg/ I
Results mg/ I
MICROBIOLOGY
Param_eter
: __ (MF) Coliform Colonies/!00mls
i--(MPN) Coliform Colonies/l00mls
Parameter
__ .--\r.senic
__ Barium
__ Cadr:-:i1..:.:n
__ Chlor:de
_._ Chro:nium
__ Co;,p<r
__ Fluo:-ide
__ lrcn
__ Leaci
__ ~ang:mese
__ :-.1ercury
__ Nitrate
__ Selenium
Results mg/ I
Total
Parameter
__ Silver
__ Sulfates
__ Zinc
_Ph
1
__ Conductivity
_______ i--TDS
__ TOC
Results mg/ I
ORGANIC CHEMISTRY
Parameter
_EDB
__ PCB's
__ Petroleum
__ Endrin
__ Lindane
Results mg/ I
Parameter
__ Gross Alpha
__ Gross Beta
Parameter
__ Methoxychlor
__ T oxaphene
_2,4-D
__ 2,4,5-TP (silvcx}
RADIOCHEMISTRY
Results mg/1
Results PCi/ I
Date Received ....,,----~-~---~---=-----Date Reported ---------,----------. er Irr .:o-d-V -8' 7 r~ L/J ,;,,p . __ _
Dato Extracted · Date Analy:ed -----,,....,..,,====--------
Lab Number ____ ?_0_0_86 __ 1_· _____ _
l)H.S 3101 (Rt""vis.ed 7185)
S,1liJ anJ Ha:ardous Waste ( Re\·iew 7187)
C. Department of Human Resources
D:vi:-:On of Health Services SAMPLE ANALYSES REQUEST
State Laboratory of Public Health
P. 0. Box 2804 7
306 N. Wilmington Street
'1, z::i Raleigh, 27611
........ CJ~o2~D~Q~0~3~s-:J~D~0~3~f~3~--Field Sample Number ___ ::J_-z:-;_J~J~a'~--------
)';ar.fr of Sire ~l'i'-',,./_.Q'+<040=f:,C...;S==...._· ...J.(!__',,,"-'--· .,Ta=-'---'=c.,_· ______ Site Loa:ion /lJ{)rr,;r U t //~
/Ji f 't;; 1u_ if 7 ' 41 (£l ----
Collected By _,_. ""? '7 3 ..., 0 ~ L£Q [(-ID# ~-,~!'.l....~--Date Collected ~ -0: -:
l\'f.'e of Sample:
Environmental·
_:d_ Groundwater ( 1)
___ Surface Water (2)
__ Soil (3)
__ Other (4)
Concentrate
__ Solid (5)
__ Liquid (6)
__ Sludge (7)
__ Other (8)
INORGANIC CHEMISTRY
i--
Extractables !
Parameter Results mg/I Parameter Results mg/ I
___ Arsenic __ Arsenic
_____ Barium __ Barium
____ Cadmium __ Cadmium
___ Chromium __ Chloride
-·-·-.. Le-ad __ Chromium
_____ ~dercury __ Copper
. . C: 1 • ------~~,e-mum __ Fluoride
____ Silver __ Iron
----__ Lead
----__ Manganese
,--__ Mercury
--__ Nitrate
--__ Selenium
I
ORGANIC CHEMISTRY
I Parameter Results mg/ I Parameter Results mg/ 1
!
__ L_ P&T:GC/MS _EDB
__ Acid:B/N Ext. __ PCB:s
_TOX __ Petroleum
--__ Endrin
;r-!--LPE __ Lindane
I
MICROBIOLOGY
Total
Parameter
__ Silver
__ Sulfates
__ Zinc
_Ph
__ Conductivity
_TDS
_TOC
--
--
--
--
----
Parameter
__ Methoxychlor
__ Toxaphene
_2,4-D
__ 2,4,5-TP (silvex)
--
RADIOCHEMISTRY
Time!D '. /'-}
Results mg/ l
Results mg/ 1
Parameter Parameter Results PCi/ 1
···-(MF) Coliform Colonies/l00mls
!--(MPN) Coliform Colonies/lO0mls , __ _
i ,--
'
__ Gross Alpha
__ Gross Beta
D;He: Recdved
,: .. .--.... ~
___________________ Dare Reported ___________________ _
Ue<:e Extracted ___________________ Date Analy:ed -----::-:---=--------------
700862 R.L'ported By --------------------Lab Number
!">H::; 3191 (RcviS(:d 7185)
3>,_1;:J anJ H:cardous Waste (Review 7 /87)
C. Department of Human Resources
t'ivi~1on of Health Services SAMPLE ANALYSES REQUEST
State Laboratory of Public Hca.lrh
P. 0. Box 2804 i
306 N. Wilmington Stree~
Raleigh, 27611
~;,;itt.: Number
3;Cf3 _.£.9...ed.~1...DL..1.oL!olL..,3.d..<d-:t...J:0-1.J....0.L.s.3.L>,Jf?c....,,.3,e_ __ Field Sample Number -=---'-I _________ _
'~:•r.1e of Site ..L((('.~Qc.,.!,.O~o=f'LC..:.S~-1..f!.~//CL-·-U?c!d..1...>.C:.~-----Site Loca:ion (27r,,,,· CU 1/1~ A t:' 1\-f' luQ r ,-ID# __ :1'-'t:.,_ __ Date Collected . 3 -d O -f 1: ) Time-+(~Q_:_!Z)~_ ,~.,ilccted By '
T ,·;:-c of Sample:
Environmental
_L Groundwater ( 1)
___ Surface Water (2)
__ Soil (3)
__ Other (4)
Concentrate
__ Solid (5)
__ Liquid (6)
__ Sludge (7)
__ Other (8)
Commenf' ~ ::f:>ll,\l -
INORGANIC CHE~USTRY
Extractables
Parameter
__ :-\rse:i.ic
.. _Ba:ium
.. __ C:.d::-.ium
_____ Chro:-nium
, ___ \ \ercury
__ 5r..'le:1ium
. ----s::\"(~r
Parameter
. _ P& T:GC/MS
: _L_ Acid~Ext.
,.-TOX
Param_eter
Resuhs mg/I
Results mg/ I
MICROBIOLOGY
: __ (MF) Coliform Colonies/lO0mls
i --(MPN) Coliform Colonies/I00mls
, __
'
Parameter
__ Arse:-ik
__ Barit.:m
__ Cacir..it.:.:-n
__ Chlo,i2e
__ Chromium
__ CoI;;:--er
__ Fluo:-ide
__ Iron
1 . __ -t3C
__ Man~::.nese
__ !v1.er:ury
__ Nitrate _
__ · Seler.ium
Results·mg/1
Total
Parameter
__ . Silver
__ Sulfates
__ Zinc
__ Ph
________ . __ Conduc:i\·ity
_TDS
_TOC
Results mg/ I
ORGANIC CHEMISTRY
Parameter
_EDB
__ PCB's
__ Petroleum
--.Endrin
__ Lindane
Results mg/ 1
Parameter
__ Gross Alpha
--Gross Beta
Parameter
__ Methoxychlor
__ Toxaphene
_2,4-D
Results mg.I 1
__ 2,4,5-TP (silvex) ______ _
RADIOCHEMISTRY
Results PCi/ I
!--------------------------'------,------------------,--
Date Received -------------,,,--------Date Reported __________________ _
· /!:rl /11 31-1 '?] p,e, 1.../J vP
Uatc Extracted_. ___________________ Date Analy:ed ----'-----~----------
Reported By Lab Number ___ 7_(}_0_8_._6_3 ______ _
IH·lS 3191 iRi:vi~ed 7185)
:;o!i-l anJ Ha:ardous Waste (Review 7 /E
· ~~. C. Derartment of Human Resources
i )fvi:,ion of Health Services SAMPLE ANALYSES REQUEST
State Laboratory of Public Health
P. 0. Box 2804 7
306 N. Wilmington Street
Site Number
4-Raleigh, 27611
__,_9-"'cx"'-:7 ...,/)-'--'O""-'-Q'--'=3'--'c:9.,_' -1.D..u...a'--'3..._,:?,,.__,.3="---Field Sample Number -·~~,L..:,..'bt..._ a_11--t+--. ---------
Name of Site Koooecs (!11 Zoe SiteLocationl22cr,,.(U(/I~ 1,U<?
Collected By ,lh t: 1 /)£ 1u.2 r r~ ID/I ~--'-1~t~--Date Collected . 3 -;;i a-f t: ' Time to }tr.)
Type of Sample:
Environmental
~ Groundwater (I)
___ Surface Water (2)
__ Soil (3)
__ Other (4)
Concentrate
__ Solid (5)
__ Liquid (6)
__ Sludge (7)
__ Other (8)
INORGANIC CHEMISTRY
Extractable•
Parameter Results mg/ I
; ___ Arsenic
__ Barium
.. ~Cadmium
·-----Ci1rom.ium
: -·· Ll'ad
. ··--Mercury
; ····---Sd~ni um
\ ------Silver
1---
I 1----
i---' ! -----;
'
i Parameter Results mg/ I I
LP&T:GC/MS
__ Acid:B/N Ext.
__ TOX
·--
?' TPE
MICROBIOLOGY
/ P;irameter
i .-(),IF) Coliform Colonies/lO0mls
I __ edPN) Coliform Co!onies/lO0mls
Parameter Results mg/ I
__ Arsenic
__ Barium
__ Cadmium
-.-Chloride
__ Chromium
__ Copper
__ Fluoride
__ Iron
__ Lead
__ Manganese
__ Mercury
__ Nitrate.
__ Selenium
ORGANIC CHEMISTRY
Parameter
_EDB
__ PCB's
__ Petroleum
__ Endrin
__ Lindane
Results mg/ 1
Parameter
__ Gross Alpha
__ Gross Bera
Total
Parameter Results mg/ I
__ Silver
__ Sulfates
__ Zinc
_Ph
__ Conductivity
_TDS
__ Toe
--
--
--
--
--
--
Parameter Results mg/ I
__ Methoxychlor
__ Toxaphene
_2,4-D
__ 2,4,5-TP (silvex)
--
RADIOCHEMISTRY
Results PCil I
Date Received ___________________ Date Reported ___________________ _
Date Extracted~------------------Date Analy:ed -------..,.===-=---------
Lab Number 700864 Rl'ported By
1)1-1:,; 3JQ\ (Revised 7185)
Soli,l and Ha:ardous \X1astc (Review 7187)
:~. C. Department of Human Resources
':'i\'i~1on of Health Services SAMPLE ANALYSES REQUEST
State Laboratory of Public Health
P. 0. Box 28047
306 N. Wilmington Street
3i~t: Number
Raleigh, 27611
_,_CJ=cQ.~b"'-'-'o'-'o ........ 3~r:9uc...1D...u...a'-'3'-'--"i'--'"'3"----Field Sample Number ---'-~"'--"_,_..,_---=3=S_.9~5"' ____ _
,,,,me of Site _K,'--'--"'Oc.,:.,O:.,./:>..:..,:fLr'...::S"-----'-/?...,'/l'-'--·-M""-.1....:.C:.=------Site Lo=ion (2?(),ri' ( U r/1~
,:oilected By ,H, t= 'b-e /&J [ (r-ID# _-='...,_,-""f __ Date Collected ' ,3 -J 0-f 1: ; l I·. -yD
Time -LJ. -'------
Type of Sample:
Environmental
~ Groundwater (1)
___ Surface Water (2)
__ Soil (3)
__ Other (4)
Concentrate
__ Solid (5)
__ Liquid (6)
__ Sludge (7)
__ Other (8)
lNORGANIC CHEMISTRY
Extractables
Parameter
__ Arsenic
___ Barium
r a · ··--...... ::i .... m1um
·----Chromium
. : ... Lead
_ ··--~1ercury
__ Sdenium
.---s:\vcr
Parameter
:-P& T:GC/MS I _L_ Acid~Ext.
:_TOX
'
Param.eter
Results mg/1
Results mg/ 1
MICROBIOLOGY
: __ (MF) Coliform Colonies/lO0mls
i--(MPN) Coliform Colonies/l00mls
Parameter
__ Arser::c
__ Barium
__ Cadrr:ium
__ Chio,de
__ Ch:-c:-:1ium
__ Co;:,r<,
__ Fh.:o:-:3.e
__ Iro:-i
__ Leaci
__ Mang2nese
__ Mecccry
__ Ni:ra:e.
__ Seler.iurn
Results mg/ 1
Total
Parameter
__ Silver
__ Sulfates
__ Zinc
_Ph
__ Conductidty
-------!--TDS
_TOC
Results mg/ I
ORGANIC CHEMISTRY
Parameter
_EDB
__ PCB's
__ Petro!eum
__ Endrin
__ Lindane
Results mg/ 1
Parameter
__ Gross Alpha
__ Gros·s Beta
Parameter
__ Methoxychlor
__ Toxaphene
_2,4-D
__ 2,4,5-TP (silvcx)
RADIOCHEMISTRY
Results mg/ I
Results PCi/ 1
Date Received Date Reported _________________ _
St/ /rr 3-J</--n N'::, LO vP U:.te Extracted_. __________________ Date Analy:ed ------,,..,.,....,.n-....,=--,------7,()Q86S·
Lab Number ----------~-------Reported By
lHS 310\ (Rc-,..ised 7185)
:iuliJ ;mJ Ha:ardous W;ute (Review 7/87} :r, • ' ... ,.,_ ; ..
:'. C. Department of Human Resources
Di\,'i!.iOn of Health Services SAMPLE ANALYSES REQUEST
State Laboratory of Public Health
P. 0. Box 28047
306 N. Wilmington Street
Raleigh, 2761 I
Sin: Number _..,_9-"62_"'-· ..... D""-'Q"'--'--0'-'=3~.:Ji' .... n...Ll-a'-''-~c-'8',,_,.3~--Field Sample Number _ __.2:...;C.,__9&.-:.J.-C----'--------
Narric of Site ~f\'-,'--,/""Q'-0'-4-0-'-fc.f"C'-"'S"-_/?c..:,,z=~.eU?=L.1.c.:C..e,·e------Site Location /J?fJ, r,; C U 1/! ~ ,4( c?
Collected By ,A t: 'b£ llA c {r---ID# -~3'~rf'.~--Date Collected . 3 -J a-cf l , Time
Type of Sample:
Environmental ·
~ Groundwater ( 1)
___ Surface Water (2)
__ Soil (3)
__ Other (4)
Concentrate
__ Solid (5)
__ Liquid (6)
__ Sludge (7)
__ Other (8)
INORGANIC CHEMISTRY
I Extractables !
Parameter Results mg/ l
I • •
1
___ . Arsenic
__ Barium
------· Cadmium
· ___ Chromium
... _ Lead
, . ____ Me;cury
; ~----·-Selenium
; __ ·_Silver
i --i 1-----I 1---,--I 1----
j
I Parameter Results mg/ I i
I.✓ P&T:GC/MS !--Acid:B/N Ext.
_TOX
--. -+ Lr'E
MICROBIOLOGY
Parameter
__ (MF) Coliform Colonies/l00mls I=--= ( M PN) Coliform Colonies/ l OOmls
i 1-
Parameter Results mg/ 1
__ Arsenic
__ Barium
__ Cadmium
__ Chloriqe
__ Chromium
__ Copper
__ Fluoride
__ Iron
__ Lead
__ Manganese
__ Mercury
__ Nitrate
__ Selenium
ORGANIC CHEMISTRY
Parameter
_EDB
__ PCB's
__ Petroleum
__ Endrin
__ Lindane
Results mg/ l
Parameter
__ Gross Alpha
__ Gross Beta
.
(omments ~ u
Total
Parameter Results mg/ l
__ Silver
__ Sulfates
__ Zinc
_Ph
__ Conducri,·ity
_TDS
_TOC
--
----
----
--
Parameter Results mg/1
__ Methoxychlor
__ T oxaphene
_2,4-D
__ 2,4,5-TP (silvex)
--
RADIOCHEMISTRY
Results PCi/ l
...... ,...,..,;.,..
Date Received
i)a re Extracted
___________________ Date Reported ___________________ _
·, ti
__________________ Date Analy:ed ------,_.====---------
Rq)orred By Lab Number 790866
l'JHS 3191 (Revised 7/85)
S,,l!id and Ha:ardous Waste (Review 7 /87)
::. C. Department of Human Resources
:,i\'is.1on of Health Services SAMPLE ANALYSES REQUEST
State Laboratory of Public Hca.lth
P. 0. Box 2S04 7
306 N. Wilmington Strcer
Raleigh, 2 761 l
-,L.9""cJ."-'-})"'-"Q,;.,,:....;.Qc...,3~c9"-LD.w.O..L..S.3""'-""??-=3"----Field Sample Number ---'-~=-=--,.;:-____::;3_S_9'-'-r ____ _
,;,,r.,e of Site ~/2::'.w,..,,Q-,,t?-4-0c,?':1.C...;.S=!....---'-/?.~//w__ .... Y/<=..,u,,C.~-----Site Loca:ion /221',r,,· CU r/1~ 1 1,/([' :/Jo t: 1 /\-{? @ c r~ ID# -~3'~f'. __ Date Collected 3 -J a -cf l-Time -+'I 1_',~')D'---
:"\·;-·.: of Sample:
Environmental
_:L_ Groundwater ( 1)
---Surface Water (2)
__ Soil (3)
--Other (4)
Concentrate
__ Solid (5)
__ Liquid (6)
__ Sludge (7)
__ Other (8)
INORGANIC CHElsUSTRY
Extracrables
Parameter
__ .-\rsenic
___ Ba:-ium
·---CJ2~ium
-····--Chromium
: .. _ :....e3..;
·--~,fe:-:ury
__ S,c!~::ium
_____ S'.l•.·t:r
Results mg/ 1 Parameter
__ Ar.se!"'lic
__ Barie.~
__ Cacir:-.it.::n
__ Chlo,:~e
__ Chro:-:1iurn
__ Co;;;--e!"
__ ?h.:.o:'.~e
__ Iron
Resulcs·mg/1
______________ , __ Le3...:i
Parameter
_P&T:GC/MS
, __L_ Acid~Ext.
;--TOX
;x_ it'P
Parameter
Results mg/ 1
MICROBIOLOGY
: __ (MF) Coliform Colonies/lO0mls
; --(MPN) Coliform Colonies/l00mls
__ \bn~::rnese
__ ~1crcuf\·
__ Nirra:e.
__ Sele,,iu.n
ORGANIC CHEMISTRY
Parameter
_EDB
__ PCB's
__ Petroleum
--.Endrin
__ Lindane
Results mg/ 1
Parameter
__ Gross Alpha
__ Gross Beta
Total
Parameter
__ Silver
__ Sulfates
__ Zinc
_Ph
I __ Conductivitv ' ' _TDS
_TOC
Parameter
__ Methoxychlor
__ T oxaphene
_2,4-D
__ 2,4,5-TP (silvex)
RADIOCHEMISTRY
Results mg I 1
Results mg/ I
Results PCi/ 1
Date Recdved Date Reported B?~,,-/~ft~3~-~:i~s--s=,7~~t-,3~,-v~1..,~~c~p..--------------------------
Date Extracted Date Analy:ed -----===--,-,,.,...--------
Lab Number ____ 7_(_}0_8_6_7 _____ _
l!HS 3191 (Rc",1i!'i.cd 7185)
3,,,liJ JnJ Ha::.rdous Waste (Review 7/87)
4ct~
; ~. C. Department of Human Resources
[1ivbion of H~alth Services SAMPLE ANALYSES REQUEST
State Laboratory of Public Health
P. 0. Box 28047
306 N. Wilmington Street
Siri: Number
NamL' of Site
Collected By
p Raleigh, 2761 I
_,_9-"'c2."--'b""'-'Q.,__,_,Q._3'""-'-;J.,_' _,_Q-'-'Q'-'-'3.......,fs,,__.,3=---Field Sample Number -=3~;-_r_o ________ _
__c{_Q /J r2 fC .S /I II kl C. Site Loca:io~ /)7 IV C1: C U 1 /I e. J
,Hr f: '/)-€ /Zo Cr~ IOii ~~·:;..,_.g''---Date Collected ,-=f -J O -if'. l
4/(V
Time_\)_._5i_V _
Type of Sample:
Environmental
_;,L_ Groundwater (1)
___ Surface Water (2)
__ Soil (3)
__ Other (4)
Concentrate
__ Solid (5)
__ Liquid (6)
__ Sludge (7)
__ Other (8)
INORGANIC CHEMISTRY
' Extractable, '
Parameter Results mg/ I Parameter Results mg/ I
. _., __ Arsenic __ Arsenic
__ Barium __ Barium
·---~ Cadmium __ Cadmium
·---C!iromium __ Chlo.ice
· .... lead __ Chromium
___ Mercury __ Copper
_____ S!!:t'nium __ Fiuoride
-·----s::vcr __ Iron
·-·-__ Lead
·----__ }v1anga nese
1--__ }.1ercury
--__ Nitrate
--·--__ Selenium
ORGANIC CHEMISTRY
' Parameter Results mg/ I Parameter Results mg/ 1
' i __ LP& T:GC/MS _EDB
__ Acid:B/N Ext. __ PCB's
[-TOX __ Petroleum
__ Endrin
i. ;f-t,P,::: __ Lindane
I
MICROBIOLOGY
P?-rameter Parameter
Total
Parameter Results mg/ 1
__ Silver
__ Sulfates
__ Zinc
_Ph
__ Conducti,•ity
_TDS
_TOC
--
--
--
--
--
--
Parameter Results mg/ 1
__ Methoxychlor
__ T oxaphene
_2,4-D
__ 2,4,5-TP (silvex)
--
RADIOCHEMISTRY
Results PCi/ 1
,------~-------------------+--------------------------!
: __ (\ff) Coliform Colonies/!00mls __ Gross Alpha
i --(~iPN) Coliform Colonies/lO0mls __ Gross &ta
Date Received
Dare Extract~d ~------------------
Reported By
t"JHS 3191 (Rt"vised 7/85)
S,,liJ ;inj Ha:ardous WaHe (Re\'iew 7/87)
Date Reporred ___________________ _
Date Analy:ed ------;:=:=~:-::=:---------
Lab Number 7(}0S6S
: ~. C. Department of Human Resources
;"'ivi!>1on of Health Services
l~~
SAMPLE ANALYSES REQUEST
State Laboratory of Public Health
P. 0. Box 2504 i
306 N. Wilmington S:reet
3i~c Number
Raleigh, 27611
___;lp2. D Q O 3 d D a 3 g 3 Field Sample Number -...S~~:....__;;,_'f-----=:3c;:S:...;9c...9.,___ ___ _
)i:,me of Site ~K.'-'c-"'<2-,,04-0ufCJ.r...;S-----'-l;-'/lu.~•-Mb!...L"=C:.0-_____ Site Loca:ion (27(),r,· Cu r!I~
,f?a 'j-1 ().£ M [ ,~ ID# -S'~·f __ Date Collected 3 -J 0-f r ) Cvilccted By
T r,e of Sample:
Environmental·
~ Groundwater (I)
___ Surface Water (2)
__ Soil (3)
__ Other (4)
Extractables
Concentrate
__ Solid (5)
__ ,Liquid (6)
__ Sludge (7)
__ Other (8)
INORGANIC CHEMISTRY
Parameter Results mg/1 Parameter Results mg/ l
. __ Arsenic
.. -Ba:-ium
____ Cadmium
____ Chromium ·
_. ___ Le-ad
.. __ \1eccury
. __ 51.'."lenium
. ___ Silver
Parameter
; _ P& T:GC/MS
i _L Acid~Ext.
:_TOX
Results mg/1
__ Arsenic
__ Barium
__ Cacirr.il!:-n
__ Chlo,:2e
__ Chro::i.it1m
__ Co;:per
__ Fluor:de
__ Iron
__ Leaci
--. Man~:::nese
--~1erc.:.ry
__ Nirra:e _
__ Seleniur:1
ORGANIC CHEMISTRY
Parameter
_EDB
__ PCB's
__ Petroleum ·
__ Endrin
__ Lindane
Results mg/ 1
Total
Parameter
__ Silver
__ Sulfates
__ Zinc
_Ph
__ Conducti\'ity
_TDS
__ TOC
Parameter
__ Methoxychlor
__ T oxaphene
_2,4-D
__ 2,4,5-TP (silvex)
Time_,(-"-d __ ··,1....;/{)==--
Results mg/ I
Results mg/ 1
MICROBIOLOGY
Param_eter
RADIOCHEMISTRY
:--(MF) Coliforrr. Colonies/ I00mls
i --(MPN) Co!iform Colonies/l00mls
Parameter
__ Gross Alpha
__ Gross Beta
Results PCi/ 1
i ! ---------------------'-----~----_;_ _________ _
Date Received -~---=-~-=~-------Date Reported ---------'-----------grf/A-3 ::J68'7 F6 ~o pf' Dato Extracted .c._ _________________ Date Analy:ed ------,,.· ""'"'. ,.·,_,...;· n-. _______ _ 700869 Lab Number __________________ _ . Reported By
l 1HS 3101 (Rc:-vi~d 7185)
:i, iii,! anJ Ha:ardous Waste ( Review 7 /87)
L\ ~~ l:\ c-~\
N. C. De;iartment of Human Resources
DivhiOn of Health Services SAMPLE ANALYSES REQUEST
State Laboratory of Public Health
P. 0. Box 28047
306 N. Wilmington Street
Raleigh, 27611
Site Number
Narrir: of Site
Collected By
_..,__f..e:cJ.:,....../)'"'->Q""---'-Q'--3"'"'-'-;J"-' ..1.0--"Q'--'-'J...c..:g'"--"'3""---Field Sample Number -~3""'--f>Z.....Cff])'"'·· ......_ _______ _
/<(oooecs Ca 7hc_ SiteLocation l22orc,:cu 1 II~,, 41<?
./J I' I
,L(l ;r t)-£ /urJ cc~ ID# ~-·=rwe'.,_ __ Date Collected 3 -J 0-ft: Time
Type oi Sample:
Environmental ·
_;,L_ Groundwater ( 1)
__ Surface Water (2)
__ Soil (3)
__ Other (4)
Concentrate
__ Solid (5)
__ Liquid (6)
__ Sludge (7)
__ Other (8)
INORGANIC CHEMISTRY
' Extractable, i
' i Parameter Resu It, mg/ I Parameter Results mg/ I
[ ___ :\rsenic __ Arsenic
, __ Darium __ Barium
: ··---Cadmium __ Cadmium
·--Chromium __ Chloride
____ Lead __ Chromium
I ___ :-1ercury __ Copper
i ·-·~-• 5l'lenium __ Fluoride
1--Silver __ Iron
i __ Lead i-__ Manganese 1---
I __ Mercury 1-
' __ Nitrate. 1--
I __ Selenium 1---
' ORGANIC CHEMISTRY
Parameter Re,ults mg/ I Parameter Results mg/ I
v/ P&T:GC/MS _EDB
__ Acid:B/N Ext. __ PCB's
.. _TOX __ Petroleum
--__ Endrin
;;+ LPE __ Lindane
MICROBIOLOGY
Parameter Parameter
__ (\ff) Coliform Colonies/!J0mls __ Gross Alpha
__ (MPN) Coliform Colonies/!O0mls __ Gross Beta
·----
----
j
Total
Parameter Results mg/ I
__ Silver
__ Sulfates
__ Zinc
_Ph
__ Conducti\'ity
_TDS
_TOC
--
--
--
--
--
--
Parameter Results mg/ I
__ Methoxychlor
__ Toxaphene
_2,4-D
--2,4,5-TP (silvex)
--
RADIOCHEMISTRY
Results PCi/ I
Datt: Recd ved -----------'--------Date Reporred ---------,----,--------
Reported By
Dote Extracted ___________________ Date Analy:ed ------:=:--::===::---'--------
-----~-----Lab Number 700870
\")1-!S JJQJ (Rt:"viscd 7/85)
S,_iliJ anJ Ha:ardous \Vaste (Review 7/87) ,..,, .. " . ~ . ""'
.'~. C. Department of Human Resources
L'ivi)1on of Health Services
L\ ff) \ ~~fJlr
State Laboratory of Public He.llth
P. 0. Box 2504 7
306 N. Wilmington Sr:-eet
Raleigh, 276 I l
SAMPLE ANALYSES REQUEST
-..L9-"'d2."'--'-D""---'o.L.L..Ow3..d...Cd>!....L0.LJO....L.<3_,__,,R,______3"'------Field Sample Number l1t:r(prtJ 3 ~ (0 I
Ko oo,:,cs f!11 . LQ C. Site Loca:iol" (}Jr,,,· CU 1/1~ . l)/(i7 ) Hi I" 1 I\£ /u,9 r ,~ ID# :r f'. Date Collected _3 -d O -f + Time
'
7 ,·,., of Sample:
En'\-•ironmental
\ / Groundwater ( 1)
___ Surface Water (2)
__ Soil (3)
__ Other (4)
Concentrate
__ Solid (5)
___ Liquid (6)
__ Sludge (7)
__ Other (8)
INORGANIC CHEMISTRY
Extractables
Parameter
__ Arsenic
·---Barium
·---C:.1Cmium
_____ Chromium
: .... Lea2
____ :. {e:.::ury
--s....i~~ium
. ______ ~:l\.·tr
Results mg/ 1 Parameter
__ Arsenic
__ Barium
__ Cadmic::n
__ Chlo,ide
__ Chromium
__ Copper
__ Fluo:icie
__ Iron
__ LcaC
__ Man~:::.nese
__ Mercury
__ Nitrate.
__ Selenium
Results·mg/1
Total
Parameter
__ Silver
__ Sulfates
__ Zinc
__ Ph
_______ , __ Conductivity
_TDS
__ TOC
Results mg/ 1
ORGANIC CHEMISTRY
Parameter
, _ P& T:GC/MS
, __L_ Acid~Ext.
,_TOX
,-2t_ /f'.P
Param_eter
Results mg/ 1
MICROBIOLOGY
' __ IMF) Coliform Colonies/l00mls
__ (MPN) Co!iform Colonies/lO0mls
Parameter
_EDB
__ PCB's
__ Petroleum
___ Endrin
__ Lindane
Results mg/ 1
Parameter
__ Gross Alpha
--Gross Beta
Parameter
__ Methoxychlor
__ Toxaphene
_2,4-D
__ 2,4,5-TP (silvex)
RADIOCHEMISTRY
Results mg/ I
Results PCi/ 1
Date Recdved =----------~------Date Reported ---------,-· ·c.t;'--' .. ...,.·..,.: _______ _ 6N /fl 3Q'>6'7 F,-.:, I.IP L1> ,..._,. ·:.·
Date Anal;-:ed ------:---:-:,:-----:----------,, "",. _()010.1'"11
Lab Number ------~~--0=-'-==-------
Dote Extracted-'------------------
Reported By
tiHS Jl911Rt"vi_..cd 7185)
::=,.,Jj,J :inJ Ha;.udous Waste (Review 7187)
· r<. C. Department of Human Resources
Di vb.ion of Health Services SAMPLE ANALYSES REQUEST
State Laboratory of Public Health
. P. 0. Box 28047
306 N. Wilmington Street
Raleigh, 27611
5ite Number
Name of Site
Collected By
_,_9-"'o-:::,.'i_./)"'"-'Q"'--'-Q.....,.3<>;).,,_' _.._Q~Q,_;s"'-"-'f,,_,,3""---Field Sample Number _ _.,~3_v;,""'--'Q"'---Z.... ________ _
Ko 0('fC.S (!,,-, M (~ Site Location. /})c,rr,: cu 1/I~ , /1/<:7
/)l'I ,
,L(lt: IJ-f' !wee-ID#~-3'.~•~f'. __ DateCollected ,3 -JO-ft: Time 1a;,4D
Type of Sample:
Environmental
_d_ Groundwater ( 1)
___ Surface Water (2)
__ Soil (3)
__ Other (4)
Concentrate
__ Solid (5)
__ Liquid (6)
__ Sludge (7)
__ Other (8)
INORGANIC CHEMISTRY
Extractable•
Parameter Results mg/1
\ __ Arsenic
: __ Barium
··----Cadmium
1 --·--Chromium
_: __ Lead
, -·---Mercury
; ___ Sd~nium
I S" ! ______ .. ::vcr
--
----
--
---
--!
I Parameter Results mg/ I ,
I_./ P&T:GC/MS 1--Acid:B/N Ext.
1-TOX
1--
I -:;;; .... r-4-TP,E
MICROBIOLOGY
P~rameter
__ (~IF) Coliform Colonies/lO0mls
[--(MPN) Coliform Colonies/ IO0mls
1--1-
Parameter Results mg/ 1
__ Arsenic
__ Barium
__ Cadmium
__ Chloride
__ Chromium
__ Copper
__ Fluoride
__ lron
__ Lead
__ Manganese
__ Mercury
__ Nitrate
__ Selenium
ORGANIC CHEMISTRY
. Parameter
_EDB
__ PCB!s
__ Petroleum
__ Endrin
__ Lindane
Results mg/I
Parameter
__ Gross Alpha
__ Gross Ikea
Comments
lli? 1}L(Yf)'.\ ~n'C' kf .e,_
Total
Parameter Results mg/ I
__ Siiver
__ Sulfates
__ Zinc
_Ph
___ Condueti\'ity
' _TDS
_TOC
--
--
--
--
--
--
Parameter Results mg/ I
__ Methoxychlor
__ T oxaphene
_2,4-D
__ 2,4,5-TP (silvex)
--
RADIOCHEMISTRY
Results PCi/ I
Date Received -----------'--------Date Reported ___________________ _
Dare Extracted~------------------Date Analy:ed -----:::-:----=----,----------
700872.
Reported By --------------------Lab Number
DHS319I (Rcvi!.ed 7185)
Solid anJ Ha:ardous \Vaste (Review 7 /87)
C. Department of Human Resources
r•ivis1on of Health Services SAMPLE ANALYSES REQUEST
State Laboratory of Public Heal ch
P. 0. Box 2S04 i
306 N. Wilmington Street
Raleigh, 2761 i
~i::t." Number 9d. /) Q a 3 d DO 3 g 3 Field Sample Number --⇒~G,..."'-O_'f:~--------
),"r:,e of Sire _K.'--':-,.,Q'-,!-'0'/./'J="LC-=S=-------'-(;~'/lc..c.__z;'='-nL..::.c.=------Site Loca:io,:, 1221',,r,· Cu 1/1~ . ,Hi 5:-'l)-£ 1w c (~ ID# --3'~-f~--Date Collected 3 -d a -f t:
1
Collected By
: ,-;:-e oi Sample:
Environmental
_:L_ Groundwater ( 1)
___ Surface Water (2)
__ Soil (3)
__ Other (4)
Concentrate
__ Solid (5)
__ Liquid (6)
__ Sludge (7)
__ Other (8)
Comments Pl \ _ -I ovvt ':))A \t(J....-
INORGANIC CHEMISTRY
Extraetables
Parameter
__ Arsenic
___ Barium
___ C::idmium
-·--Chromium
: ___ Lead
. _· __ \ ler-:ury
__ Sde:1ium
Results mg/ I Parameter
__ Ar3enic
__ Barium
__ Cadmiu:n
__ Chlo,ide
__ Chromium
__ Co?per
__ Fluord.e
__ lro:1
__ Leaci
__ Manpnese
--~1e:-C'..:ry
__ Nirrate _
__ Selenium
Results mg/ I
Total
Parameter
__ Silver
__ Sulfates
__ Zinc
_Ph
__ Conductivity
_TDS
__ TOC
Results mg/ I
ORGANIC CHEMISTRY
Parameter
'.-P& T:GC/MS
: _L_ Acid:-F,;,:'W..Ext.
;_TOX
:.2t.. ftP
Param.eter
Results mg/ I
MICROBIOLOGY
: __ IMF) Coliform Colonies/ I00mls
; __ (MPN) Coliform Colonies/l00mls
Parameter
_EDB
__ PCB's
__ Perroleum
__ Endrin
__ Lindane
Results mg/ 1
Parameter
__ Gross Alpha
__ Gross Beta
Parameter
__ Mechoxychlor
__ T oxaphene
_2,4-D
--2,4,5-TP (silvex)
RADIOCHEMISTRY
Results mg/ I
Results PCi/ I
Dace Received ---~~-~---=-'--~~..-----Date Reported --------~----------/;IY/1'1 3·cJ S-6? Fis, LO, V p
Datt: Extractt!d _________________ _ Date Analy:ed -----.7~0Ti0,..,..8,,.7.,.a"°" _____ _
___________________ Lab Number --------'-----------
tiHS 3101 (R,:vi~d 7185)
:;Pl1J ;1nJ Ha:ardous Waste (Review 7187)
C. Department of Human Resources
Divi.~:on of Health Sen·iccs SAMPLE ANALYSES REQUEST
State Laboratory of Public Health
P. 0. Box 28047
306 N. Wilmington Street
Site Number
Raleigh, 27611
_,_9_,,cxc,.1 ~D~-0~0.....,,3~,✓~D~a~3~f?~3~--Field Sample Number ~3~-~~o_Lfr-----------
Nar.ie of Sire ~&.'-1c-"Q',,0'4,0L€t:.r<....:,Se_ . ...J(!.c..<.'/1.,___.J;-,"'--''-'c..'=·~-----Site Loca::ion 122 Qr r,; C U I /I<. /I /(il =
,'b f: 1 /)-€ MC r~ ID# ~·~9_g' __ Date Collected 3 -f) ()-ff: J -Tim.a·. OZ') Cc,llected By
Tyr,, of Sample:
Environmental ·
_:oL__ Groundwater ( 1)
___ Surface Water (2)
__ Soil (3)
__ Other (4)
Concentrate
__ Solid (S)
__ Liquid (6)
__ Sludge (7)
__ Other (8)
Comments
Lnu ?hR,~SL
INORGANIC CHEMISTRY
I Extractable• Total ' I
'
' Parameter Results mg/ l Parameter Results mg/ 1 Parameter Results mg/ l
, __ Arsenic __ Arsenic __ Silver
___ Barium __ Barium __ Sulfates
···--Cadmium __ Cadmium __ Zinc
___ Chromium __ Chloride _Ph
_____ L:!ad __ Chromium __ Conductivity
___ Mercury __ Copper _TDS
.. ..:; l . _____ -~.enium __ Fluoride _TOC
, ___ Silver __ Iron --
.--__ Lead --
' __ Manganese
' ------
__ Mercury --1-__ Nitrate --
--__ Selenium --
'
ORGANIC CHEMISTRY
! Parameter Results mg/1
iLP&T:GC/MS
1--Acid:B/N Exr.
!_TOX
I ,---17 TPE 1-
MICROBIOLOGY
Parameter
: __ (~ff) Coliform Col~nies/lOOmls
1 __ (MPN) Coliform Colonies/lOOmls
j' __ _
' I ,--
!
Parameter
_EDB
__ PCB's
__ Petroleum
__ Endrin
__ Lindane
Da::e Received __________________ _
D:ite Extracted __________________ _
Reported By
rn-:s 3\0! (Revised 7185)
5,_ii:J anJ Ha:ardous Waste (Rr.\·iew 7 /87)
Results mg/ 1
Parameter
__ Gross Alpha
__ Gross Beta
Parameter Results mg/ 1
__ Methoxychlor
__ Toxaphene
-2,4-D
__ 2,4,5-TP (silvex)
--
RADIOCHEMISTRY
Re•ults PCi/1
Date Reported---------~-----------
Date Analy:ed --------,....,,....,a,,_,,"""',--------700874 . ' . ' Lab Number
f'0\\
State Laboratory of Public Hc:i)rh .'~. C. Department of Human Resources
~'i,·i51on of Health Services SAMPLE ANALYSES REQUEST P. 0. Box 2804 i
306 N. Wilmin~on Stree~ L Raleigh, 2761 l
9;).. /) 0 0 3 d DO 3 8' 3 Field Sample Number -""'3-"(o'-'c? .... =-Cl'------------3i~L' Number
1,':, ~,e of Site ~/G'-'=--"'Qc,,O!.:.,<O=PLC..::S,e_......1../;..,'/l:.,_~--M<=..L..>C.=-------Site Loca:ion /}?r,,,,· CU 1/1~ · ,Hr t:1 b-R !U!Jcc~ 1011 __ -r~f~--DateCollected 3 -JO-ft: ) c~c,iiected By
: ,·;,-, of Sample:
En ... ironmental
_:L_ Groundwater (l)
___ Surface Water (2)
__ Soil (3)
__ Other (4)
Concentrate
__ Solid (5)
___ Liquid (6)
__ Sludge (7)
___ Other (8)
lNORGANIC CHEMISTRY
Extracta bles
Parameter
._ Arsenic
__ ._Barium
·---Cadr.:ium
-·-··-Chromium
.. __ \ie:-cury
._Sdenium
. ___ S'ivcr
Parameter
:-P& T:GC/MS
: ....L_ Acid:-F,;tl,,I..Ext.
._TOX
.2't.. ftP
Results mg/ I
Results mg/ l
MICROBIOLOGY
Parameter
__ Arse:1ic
__ Barh.:m
__ Cadr:-,ic::n
__ C!olorice
--cr.rc:nium
__ co~r,e:-
--Fluo:-icie
__ Iron
__ LeaC
__ \1:ar:~3.nese
__ Mercory
__ Nitrate
__ Seler.ium
Resu!ts·mg/1
Total
Parameter
__ Silver
__ Sulfates
__ Zinc
_Ph
_______ . __ Conductivity
__ TDS
_TOC
. ORGANIC CHEMISTRY
Parameter
_EOB
__ PCB's
__ Petroleum
__ Endrin
__ Lindane
Results mg/ l Parameter
__ Methoxychlor
__ Toxaphene
_2,4-0
__ 2,4,5-TP (silvcx)
RADIOCHEMISTRY
Results mg/ 1
Results mg/ 1
Param_eter Parameter Results PCi/ l
' __ (MF) Coliform Colonies/lO0mls --Gross Alpha
i --(MPN) Coliform Colonies/ l00mls --Gross Beta
Date Received Date Reported _________________ _
· !P/11 3-.al!>-&7 ~-,·' tct:1 1-b
Date Extracted __________________ Date Analy:ed -----------,-------
Lab Number _____ ,-i..:;..'....:;Oc..;0~8=:....:c't'..,,5,:._ ____ _
tfr{S 3191 (R~vi!-c:d 7185)
:;u!iJ ;rnJ Ha:ardous \Vastc: (Rc:\·ic:w j 37)
L~ ~h \-\Cl
~~-C. Department of Human Resources
Divbion of Health Services SAMPLE ANALYSES REQUEST
State Laboratory of Public Health
P. 0. Box 28047
306 N. Wilmington Street
Raleigh, 27611
Site Number _,_5?-"'::,2"'-'/)'"'--'Q~Q,__.""3'-'-c];;;_' ..,_D..l-'Q'--"-'3"""-'g,,_,_3"'---Field Sample Number -~~~~-· ~l2~'2~--------
Name of Site ~/2~./'"'0:.,,0=0Lfwr'---'=S'---.Jl?._'./1"-'--"z;"'n-'--'c...==·------Site L.oca:iop f22o,,< CU 1/!e. ) (lj(v
Collected By
1 'b 12 ir 7-_,_ -~ ~,,, 3 ° 0 ~ L:f' J') Cc~ ID#-~, n_~--Date Collected -,?' -Time
Type of Sample:
Environmental
....:£ Groundwater ( 1)
___ Surface Water (2)
__ Soil (3)
__ Other (4)
Concentrate
__ Solid (5)
__ Liquid (6)
__ Sludge (7)
__ Other (8)
INORGANIC CHEMISTRY
I Extractables Total i
: Parameter Results mg/ I Parameter Results mg/ l Parameter Results mg/ I
___ Arsenic __ Arsenic __ Silver
__ Barium __ Barium __ Sulfates
_____ Cadmium __ Cadmium __ Zinc
___ Chromium __ Chloride _Ph
__ ~ .. --Ltad __ Chromium __ Conductivity
____ 'rdercury __ Copper _TDS
__ St:!e.nium __ Fluoride _TOC
______ Silver __ Iron --
··--__ Lead --
I __ Manganese I·-----
I __ Mercury ,----
I __ Nitrate. -----
-·-__ Selenium --
I
ORGANIC CHEMISTRY
-I ; Parameter
I
\_LP& T:GC/MS
,
' I
__ Acid:B/N Ext.
_TOX
---;r Ti'°E
P;irameter
Results mg/ I
MICROBIOLOGY
Parameter Results mg/I Parameter Results mg/ I
_EDB __ Methoxychlor
__ PCB's __ T oxaphene
__ Petroleum -2,4-D
__ Endrin __ 2,4,5-TP (silvex)
__ Lindane --
RADIOCHEMISTRY
Parameter Results PCi/1
-----~--------------+----------------------!
) ___ (),IF) Coliform Colonies/lOOmls
· __ (MPN) Coliform Colonies/lOOmls
D::i.te Received
Date Extracted~------------------
Rt:ported By
J')\·lS 3191 (Revised 7/85)
Suli,! am! Ha:ardous Waste (Review i/87)
__ Gross Aipha
__ Gross Beta
Date Reponed ___________________ _
Date Analy:ed -------======---------700876 Lab Number , ·
:;. C, Department of Human Resources
:°"ivi!>ion of Health Services
L~ rr~\ \~o~~ State Laboratory of Public Health
P. 0. Box 2S04 i
306 N. Wilmington Street
Raleigh, 27611
SAMPLE ANALYSES REQUEST
.Sirt: Number CZ..r2 !) on 3~ nn ?-ii 3
~~:1r.1c: of Site l<Q C20.e.r.s
,A } l b:£2. & Tac..
,=c,llected By
:" :;re of Sample:
Environmental
_;L_ Groundwater ( 1)
---Surface Water (2)
__ Soil (3)
__ Other (4)
/urJc,,__ ID#
Concentrate
__ Solid (5)
__ Liquid (6)
__ Sludge (7)
__ Other (8)
Field Sample Number 360j
Site Loca::ion ((}rrr,· cu ell~ (1/{v = ) ' -=; !( Date Collected :3 -,::iO-rf.1-Time j t.)~t;½
INORGANIC CHEMISTRY
Extractabies
Parameter
__ Arsenic
___ Barium
·---Cadmium
___ Chromium
: ___ Lead
_____ \ 1ercury
·-Sdenium
__ Sih·cr
Parameter
: _ P& T:GC/MS
i _L Acid:£,;,:)l...Ext.
._TOX
Param.eter
Results mg/ 1
Results mg/ 1
MICROBIOLOGY
'. __ (MF) Coliform Colonies/ IO0mls
i __ (MPN) Coliform Colonies/ l00mls
Total
Parameter
__ Arsenic
__ Barium
__ Cadmill:n
__ Chloride
__ Chromium
__ Copper
__ Fluoride
__ Iron
__ Lead
__ Manganese
__ Mercury
__ Nitrate.
__ Selenium
Results mg/ 1
ORGANIC CHEMISTRY
Parameter
_EOB
__ PCB's
__ Petroleum
__ Endrin
__ Lindane
Results mg/ 1
Parameter
__ Gross Alpha
__ Gross Beca
Parameter
__ Silver
__ Sulfates
__ Zinc
_Ph
__ Conduc[ivity
_TDS
__ TOC
Parameter
__ Methoxychlor
__ T oxaphene
_2,4-0
__ 2,4,S-TP (silvex)
RADIOCHEMISTRY
Results mg/I
Results mg.I I
Results PCi/1
o_ ate R,e,,;e11·v;_d ~=~=,-=~.,,.,-----------Date Reported ------------------
e9V ,, 3f 3Df81 re 45
Uate Extracted.;_ _________________ Date Anal;-:ed ------~-~-.,,---------
Reported By Lab Number ___ ___,'.7._(,..}""0,:.,,8.L7.,,._.,,.'7 _____ _
llHS 3191 (RC;"vi~ed 7185)
~u!iJ anJ Ha:ardous Waste (Review 7/87)
~<. C. Department of Human Resources
n:vis:Jn of Health Sen·iccs SAMPLE ANALYSES REQUEST
'
Sict: Number
Narr;e of Site
Collected By
State Laboratory of Public Health
P. 0. Box 28047
306 N. Wilmington Street
Raleigh, 27611
_,_9--"c,:."'-')--'/)""--Q"""-'Q.,____.,3""-'-',:)'--'-Q,._,_Q...L..53"'"-"g"--=3""---Field Sample Number _ __.,.c5_h_O.,..., _8 ________ _
f/c O oecs f!c, 1£, C. Site Loca:ior l22or1<c u rile, 111<?
jJ t l l\ n _ r;-7 ; ·\u fLL"
,LCl r {)-f' {(L) Cr~ ID# -~5'~rf'.~--Date Collected 3 -;J 0-cL t Time _,,...,, ..... .-.,.1'/Tj=--
T ;-pe of Sample:
Environmental ·
_L Groundwater ( 1)
___ Surface Water (2)
__ Soil (3)
__ Other (4)
Concentrate
__ Solid (5)
__ Liquid (6)
__ Sludge (7)
__ Other (8)
INORGANIC CHEMISTRY
i Extractables
' ! P.irameter Re,ults mg/ I Parameter Results mg/ I
I
I A . !---. rsemc __ Arsenic
i •
1 -·---Banum __ Barium
i --·--Cadmium __ Cadmium
: ___ Chromium __ Chloride
____ Lead __ Chromium
! ··--Mercury __ Copper
i" c:.' . _____ ~e:enium __ Fluoride
i ___ S:l\'cr __ Iron
I __ Lead .--1---__ Manganese
I __ Mercury 1-__ Nitrate 1--
j---__ Selenium
ORGANIC CHEMISTRY
Parameter Results mg/ I Parameter Results mg/ I
__:L__ P& T:GC/MS _EDB
__ Acid:B/N Ext. __ PCB:s
._TOX __ Petroleum
--__ Endrin
7 rP,E __ Lindane
MICROBIOLOGY
Parameter Parameter
__ (MF) Coliform Colonies/l00mls __ Gross Alpha
__ (MPN) Coliform Colonies/!O0mls __ Gross Beta
-----
----
Total
Parameter Result, mg/ I
__ Silver
__ Sulfates
__ Zinc
_Ph
__ Conductivity
_TDS
_TOC
--
--
--
--
--
--
Parameter Results mg/ I
__ Methoxychlor
__ Toxaphene
_2,4-D
__ 2,4,5-TP (silvex)
--
RADIOCHEMISTRY
Results PCi/ I
Date Received Date Reported ____________________ _
Uate Extracted ___________________ Date Analy:ed -------t-"m,ncr,_,.... _______ _
?00878
Reported By Lab Number
lll-15 3191 (Revised 7/SS)
S,_11:J and Ha:ardous Waste (Review 7/87)
·~ C Dep;rrment of Human Resources
:,i\'i!>ion of Health Services
4 /'i/'i~ \ \ to 4-h__)-
State Laboratory of Public Hea_lth
P, 0, Box 2804 7
306 N. Wilmington Stree:
sAMPLE ANALYSES REQUEST
3itc Number 9c2 D Q O 3 d no 3 8' 3
~,,,r:ie of Site Ko t? o,:;c.s Cc, . M C,
C,,ilccted By ,HJ z'.: 1 /):£ /u:J C <-ID# 3' f
7 ,-;,e of Sample:
Environmental
_:L Groundwater ( 1)
.---Surface Water (2)
__ Soil (3)
__ Other (4)
Concentrate
__ Solid (5)
___ Liquid (6)
__ Sludge (7)
__ Other (8)
Raleigh, 27611
Field Sample Number _:ifkp,==-i'-"·+-/_,_.-3=0'-"D"'--q,__ _______ _
SiteLoca:ion (2711,,,·cuc/l-e.. t,/([i )
Time-1/-"'5'--':_,)'(:_>_ Date Collected 3 -J 0-f l:
INORGANIC CHEMISTRY
Extractables
Parameter
__ :-\rsenic
____ Badum
. ____ ),-1.er..:ury
._ s~!e:-:ium
____ S'.iq::r
Parameter
'_ P& T:GC/MS
'L Acid~Ext,
._TOX
Results mg/ 1
Results mg/ I
.,;, ,,,,, p
: _,,.._ ~l:'-'-1~--'------------
MICROBIOLOGY
Param_eter
: --(MF) Coliform Colonies/ !00mls
i -· -(MPN) Co!iform Colonies/lO0mls
Parameter
__ Arsenic
__ Barium
__ Cadrr-.iu:-n
__ Chlo,icie
__ Chrc:niurn
__ Coprer
__ !='l~o:-:de
__ lro~
__ Lea..-i
__ ~1an;2nese
__ ~v{erc-..;ry
__ Nirra.:e.
__ Selenium
Total ,
Results ·mg.I 1 Parameter
_______ I __ Silver
__ Sulfates
__ Zinc
_Ph
__ Conductivity
__ TDS
__ TOC
Results mg/ I
ORGANIC CHEM!STRY
Parameter
_EDB
__ PCB's
__ Petroleum
__ Endrin
__ Lindane
Results mg/ 1
Parameter
__ Gross Alpha
__ Gross Beta
Parameter
__ Methoxychlor
__ Toxaphene
_2,4-D
Results mg/ I
__ 2,4,5-TP (silvex) ______ _
RADIOCHEMISTRY
Results PCi/ 1
Date Received ,-:,:---,,-,,,,,-~~-=~-,,--------Date Reported ------------'--------. 8N/f\ 3-.::0·!;'1 i:;':fS L[)
Uat< Extracted __________________ Date Anal;-:ed ------➔'"hTl"ll·;_c:_ ,1o··.,'.,·r-------70087!J
Rq,oncd Bv Lab Number --------'---'---------
tfrlS 3191 (Rc-vi'.'ied i/85)
:)uii..! .,nJ Ha:ar..ious WaHe (Re\'iew 7187)
· ~~. C. Department of Human Resources
Divi!.1on of Health Services SAMPLE ANALYSES REQUEST
State Laboratory of Public Health
P. 0. Box 28047
306 N. Wilmington Street
Raleigh, 27611
.Site Number fc:2_ /) QQ 3o1 {)Q 3 g' 3 FieldSampleNumber-~--3,.....,.l'-,I-/ ..... O"-----------
Name of Site ,k'.c...,,_,.,OcµO,.o=e..,_c--'s=-__.(!__'./1"-'--· .. Zo=..'--"C~-----Site Loca:io~ 122 c,r r, :C u r II~ .
f& f: 1 i):£ /lo r 6--ID# __ ·7"-'g'.,__ __ Date Collected ' ,3 -J Q-cf t 1
Collected By
Type of Sample:
Environmental
~ Groundwater (1)
___ Surface Water (2)
__ Soil (3)
__ Other (4)
Concentrate
__ Solid (5)
__ Liquid (6)
__ Sludge (7)
__ Other (8)
INORGANIC CHEMISTRY
I Extractables ' ' ' ' Parameter Results mg/ 1
___ Arsenic
__ Barium
···----Cadmium
____ Chromium
. '·-·-Lead
· _____ Mercury
/ ;_ ___ Sder1ium
I-·-----Silv,~r i , __
I ,----
1-:·--·
1 ___
I :
Parameter Results mg/ 1
/ P&T:GC/MS
__ Acid:B/N Ext.
_TOX
---i·.z:_ TPE
MICROBIOLOGY
I P~rameter 1--(MF) Colifo.rm Colonies/lO0mls
__ (MPN) Coliform Colonies/lOOmls
Parameter Results mg/ 1
__ Arsenic
__ B::i.riurn
__ Cadmium
__ Chloride
__ Chromium
__ Copper
__ Fluoride
__ Iron
__ Lead
__ Manganese
__ Mercury
__ Nitrate.
__Selenium
ORGANIC CHEMISTRY
Parameter
_EDB
__ PCB's
__ Petroleum
__ Endrin
__ Lindane
Results mg/ 1
Parameter
__ Gross Alpha
__ Gross Beta
Time
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
Results PCi/ 1
Date Received ___________________ Dare Reported------;---------,--------
Date Extracted~------------------Date Analy:ed ---------":----..,.._-,-'~------
'
Reported By --------------------Lab Number 7()0880
DHS 3191 (R('viseJ 7185)
Soli,! and Ha:ardous Waste (Review 7187)
.·:.' C. Dep~rtmcnt of Human Resources
~'ivi31on of Health Services
q,f'N-~ ~d8~-
State Laboratory of Public Health
P. 0. Box 2804 7
306 N. Wilmington Street
Raleigh, 27611
sAMPLE ANALYSES REQUEST
Si~r.: Number
~-..':ir7lc: of Sire
Coiiected By
_,_9--"'cY.::,._,;/)""-"o""--'--'o'-'3"""-"c?"--'-D--'-'0-'-'3....,__,,i'-""3"----Field Sample Number _,3-,::· '-1.0'-'--'l_,l'--:.---------
Ko oo,:,cs & . Za c:. SiteLoa:ioI' /J7f'f11'rurl!~
,M z'.:: 1 /)£ @ [ r~ ID# _S'~f __ Date Collected ,3 -.~ 0 -f f-
1
7 ,·;:-e of Sample:
Environmental
'i / Groundwater ( 1)
___ Surface Water (2)
__ Soil (3)
__ Other (4)
Extractables
Concentrate
__ Solid (5)
__ Liquid (6)
__ Sludge (7)
__ Other (8)
INORGANIC CHEMISTRY
Parameter Results mg/ 1 Parameter Results mg/1
. __ Arsenic
___ Barium
.. __ C::id.r.ium
_____ Chromium
. : ___ Leal!
~omments
\ °f<'l (,
Total
Parameter
__ Silver
__ Sulfates
__ Zinc
_Ph
___ ~1e,cury
__ Arsenic
__ Barium
__ CaCr..ie:n
__ Chlvde
__ Chro::iiurn
__ Co;:pec
__ Fluor'.de
__ !ro:o
__ Cond-.1ctivitv I . _______ i--TDS
__ Sde:-iium
. ___ Silver
Parameter
'.-P& T:GC/MS i _L Acid~Ext.
·_TOX
-'.), p ,..LL t:r-
Results mg/ 1
MICROBIOLOGY
l . ___ e::i.:J
__ Mang:rnese
__ Me:-c:..:;y
__ Nitrate.
__ Selenium
ORGANlC CHEMISTRY
Parameter
_EDB
__ PCB's
__ Petroleum
__ Endrin
__ Lindane
Results mg/ 1
__ TOC
Parameter
__ Mechoxychlor
__ Toxaphene
_2,4-D
__ 2,4,5-TP (silvex)
RADIOCHEMISTRY
Results mg/ I
Results mg/ I
Param.eter Parameter Results PCi/ 1
: .-(MF) Coliform Colonies/l00mls
i --(MPN) Coliform Colonies/lO0mls
, __
'
--Gross Alpha
__ Gross Beta
Date Recdved _-,,-=~~-,------'--------Date Reported ---------,----------f.ri/A 3-3b-rl Ff, L-0
· UJtt' Extracted-------------'------
Rerortcd By
Date Analy:ed -------=m=,s'>i,----,,-----'j'()0$S:i
Lab Number ----------,~---------
:i:,s 3191 (Rt"vised 7185)
:=a,i1,! :rnJ Ha:.ar.:!ous Waste {Review 7/87)
~~-C. Department of Human Resources
! 'Jivi~ion of Health Services SAMPLE ANALYSES REQUEST
State Laboratory of Public Health
P. 0. Box 2804 7
306 N. Wilmington Street
Raleigh, 2761 I
Site Number
Nam·e of Sire
Collected By
_,_9--".:x""0_/),_,__.,,.Q'-'Q--'---"3-"-'-',;J"-'-n.LJa-'-'3--'--''2"--"3"""-__ Field Sample Numb« -..,,.3,,..· ~'1,,,__,l____;V ________ _
Ko O oec.s. (1/, . z;-, c.:. Site Loca:ion l22or1< Cu I l!-e.. t,/([l
_/) " I , ; ,<' rat: {).e Mee-= ID# __ ·=r~t'-__ DateCollected .3 -JG-fr Time\1'-e:D
T)'pc of Sample:
Environmental ·
_L Groundwater (I)
___ Surface Water (2)
__ Soil (3)
__ Other (4)
Concentrate
__ Solid (5)
__ Liquid (6)
__ Sludge (7)
__ Other (8)
INORGANIC CHEMISTRY
! Extractables I ' ' Parameter Results mg/ 1
\ ___ Arsenic
, __ Barium
____ Cadmium
· _____ Chromium
.... _ Lead
: ___ Mercury
i ·----·-Sclt'nium
__ ·_Silver
--
. ----
--
---
i--
I Parameter Results mg/ 1
v/ P& T:GC/MS
__ Acid:B/N Ext.
_TQX
---I ;;,;i-.LPE
MICROBIOLOGY
Parameter
! __ (MF) Coliform Colonies/!00mls
I 1--(MPN) Coliform Colonies/lO0mls
1·-
1·-
Date Received
Parameter Results mg/ 1
__ Arsenic
__ Barium
__ Cadmium
__ Chloride
__ Chromium
__ Copper
__ Fluoride
__ Iron
__ Lead
__ Manganese
__ Mercury
__ Nitrate.
__ Selenium
ORGANIC CHEMISTRY
Parameter
_EDB
__ PCB's
__ Petroleum
__ Endrin
__ Lindane
Results mg/ I
Parameter
__ Gross Alpha
__ Gross Beta
Total
Parameter Results mg/ I
__ Silver
__ Sulfates
__ Zinc
_Ph
__ Conductivity
_TDS
_TOC
----
--
--
--
--
Parameter Results mg/ I
__ Methoxychlor
__ Toxaphene
_2,4-D
--2,4,5-TP (silvex)
--
RADIOCHEMISTRY
Results PCi/ 1
Date Reported ----------~---------
Date Extracted ___________________ Date Analy:ed -----=,-----,----------
Lab Number ____ ?_O_/J_88£_~· ·_., _____ _
Rc:ported By
DHS 3191 (R,v;sed 7/85)
S(_i!id anJ Ha:ardous Waste (Review 7 /87)
Location of Sampling:
N. C. DEPARTMENT OF HUMAN RESOURCES
DIVISION OF HEALTH SERVICES
SOLID AND HAZARDOUS WASTE MANAGEMENT BRANCH
Chain of Custodv Record
Hazardous Waste Materials
Generator __ Transporter
__ Storage Facility __ Disposal Facility
_Treatment Facilit;
_Landfill
__LO th er : tfH...; ~ ,Or/ lfa...,Ul l,U--( __l__k
0 U f Co rct,-o-, .. :c-?\.if'<I'l) (\
Company's Name 4-Mer-r {'_lJ. JJJc.· Telephone( L/12,-) 22.?-Z.<a'?0
V ii 5
Address .. __ f/,'-'-';""-'.l'-';Cft...-...s.-S~·-_,_v....,,..,.... _______ .,_;JJ~o:..:r...:.,..:.;~J..;;U..:.l:....1.llc...:e:::....,,,c..:.;V_C. _______ _
Collect~r's Na:e /Jµ tk:cfiA--Tele_phon:( 9'/2 ) 7 3 3-UO /
signature
Date Sampled /l),q,/'!..L 2:-0 I 9R7
? Time Sampled {JJ!) -J 5 S'D
Type of Process Gene~a ting Waste .. _.!.a(/4l:::a::_:Cl::::..:O~d/a::· ..._..t..frc....:...__:::~:::..:..:......;:..:.U;;...,... . ..;fi_~.;;c...J,::...=.:..i ...,fy-1-· ______ _
. Field Information
· Field Sample No. /j6/'] 35'fct: 3,C,f'? ..3C9D .qS---9/ .s[97-, 3I'93
<1(?y · ,3->z.C: s.rfc. =3.0"-'<J--'=r_ .3~9f 31'?1 ,1Gro
fJbDt 3t,o?...-3bCJ3 .3tov 3t,,D.r' 3t.at .:lt:,tJ?-360J'"
Chain of Possession: 3 (, 0 f 2>b/D .3~/ / ,3 l,j 2....
1~1!:Mt== J Wa/4 klfHc/Jf:;f l.
inclusive dates-
2.u,l,db~&~
signature title inclusive dates
3.
signature title inclusive dates
Results reported
signature title date
Instructions: Complete all applicable information including signatures, and
submit .. ith ·.analysis. request forms.
i~ • \,.,. JJL..rJU<...L!'l.t.f',J. U.t t1U!'lAJ\' .K..t.::iUUKL;.t.::i
DIVISION OF HU.LTH SERVICES
SOLID AND HAZARDOUS WASTE MANAGEMENT BRANCH
Receipt for Samples
The samples described below were collec.ted in connection with the administration,
enforcement, and documentation of the:
() North Carolina Hazardous Waste Management Rules, 10 NCAC lOF
( ) North Carolina Solid Waste Management Rules; 10 NCAC lOG
(X) Comprehensive Environmental Response, Compensation and Liability Act (CERCI . .A)
() Toxic Substances Control Act (TSCA). 15 U.S.C. §2601, ~~-• specifically
Section 11.of TSCA, 15 U.S.C. Ii 2610.
Inspector.' s Name
Name of 'Firm
koe,•ers (,,, foe..' . MAR,r,,./ M 5c.lhl?51Nc;e~
Ffu O .. -ner, Opre~·a~or, or Agent
S/.J1PLE COLLECT□ SAMPLE TYPE
lill!13ER DATE TIME WATER SOIL
f:10 ✓ /-/2, 3-~<-.;-~ /'<'~v
I
Receipt for the sample(s) described.
above is hereby acknowledged:
Signature of Inspector
Title
O.:..::ER
I
Inspector's Address
Firm Address'
As.sr. PR001uttr 11 A;NM-Eg l<oepet_r;.
Title -'' Pcevl,ouslv Ot,,:rc::i...tc..J.,.
1f'ro;;,.6k s
DUPLICATE SA..11PLES SA.11PLE LOCATION
OFFERED ACCE?TEDIREJECTEDI ON-SITE OFF-SITE
.. ✓ ✓ ✓
Receipt/rejection of duplicate or split
samples is hereby ackno;,ledged·:
Signature ofFi70-..mer, Operator, or Agent
Title '
COMMENTS _________________________________ _
PURGEASLE COMPOUNDS
COl1POUNO
chlorcxnethane
brarorethane
dichlorodifluorcrnethane
vinvl chloride
ch loroethane
rrethvlene chloride
trichlorofluorcmelhane
ethene. 1. 1-dichloro
ethane 1. 1-<lichloro-
1,2-trans-di ch loroethene
chloroform
ethane 1 2-dichloro-
ethane. l 1. 1-trichloro-
carbontetrachloride
braood ich 1 orcrnethane•
or,.,.,ane. 1.2-<lichloro-
1 3-trans-<lichlo ne
tri chloroethvlene
chlorodibrorrarethane
benzene
ethane. 1.1 2 trichloro-
1 3-cis-<lichlo ne
2-chloroethvl vinvl ether
broroform
SlAlE LAllORAlOOY Of PUBLIC HEAL 111
DIVISION Of HEALTH SERVICES, N.C. DEPARlMENl Of HUMAN HESOUHCES
P.O. BOX 28047 -306 N. ~ILMINGlON, Sl., RALEIGH, N.C. 21611
ORGANIC QjEMICAL ANALYSIS
LAB NO '7 on 9. '-? 700!</nn 7,-,n'?u,;:;;. 70rl'?(o "-
FIELD#
TYPE I I l ( i ) ( I ) ( I I
UNITS ~,n/ko ~nO~ .. n/kn 1·~·•"/kQ l'.,n/1\ua/ko
/0 I• I.A_ .A. ' JI)
;;;l t) ' /iJ
/iJ ,,
:2..,)
<"
/0
,s-
ethane. L 1.2.2-tetrachloro-
ethene. tetrachloro-
toluene
chlorobenzene
ethvlbenzene ' I ,I/ V ; ,/
acetone lo L.A. LA-LA. /Jc.
2-butanone ID
carbondi sulfide ,.-
2-hexanone /I)
4-methvl-2 =ntanone Ji)
stvrene <
vinvl acetate JD
>'•xvlene!\ c+o+r1 I) f"' ,/ w' / /
::Cso.:>ror.>vf e+her Iv I.A..., ,, Q L-'--LA--
'
MDL
• ., I ,I
J -Estunated value. , ~'
K -Actual value is known to be less than value given.
700 'i?I nf, 7005</ex'
( I ) ( I l
/ua/ () .. n/ka "uo7TJ .. n/kn
i ,A G..
/ V
L.L. L,<._
' / ' I
u..... I.,<_.
L -Actual value· is known to be greater than value given.
U -tlaterial was analyzed for but not detected. The nurl>er is the Mini1TUT1 Detection Limit. =,,,.,,l.)L
NA -Not analyzed. ---
l/ -Tentative identification. fl -On NROC List of Priority Pollutants.
N.C. Division of llcaltl1 Services
UIIS 3068-0 (4/86 Laboratory)
PURGEABLE COMPOUNDS
COMPOUND
chlorarethane
braronethane
dichlorodifluoranethane
vinvl chloride
ch loroethane
methvlene chloride
trichlorofluororethane
ethene. l. 1--dichloro
ethane. 1 l-dichlor0-
1,2-lrans-dichloroethene
ch lorofonn
ethane. 1,2-dichloro-
ethane. l. 1. 1-trichloro-
carbontetrachloride
branodichlorarethane
ornnane 1.2-dichlor<>-
1 3-trans-dichlo ne
trichloroethvlene
chlorodibranorrethane
benzene
ethane. 1 1.2-trichlor<>-
1.3-cis-dichlo. ne
2-chloroethvl vinvl ether
brcxnofonn
S l A 1 E li\BOHI\ 1 ORY Of PUBL! C HEALi H
DIVISION Of IIEI\Llll SERVICES, N.C. DEl'ARlMENl Of HUMAN RESOURCES
P.O. BOX 28047 -306 N. WILMINGlON, Sl., RALEIGH, N.C. 27611
ORGANIC 01EMICI\L ANALYSIS
LAS NO 1r1n <:?'7CJ 7 n n c;;; 7 _., 7nn'i?7LL 7 00 <ii 7,/;,
FIELD #
TYPE ( I \ ( I \ ( I l ( J l
UNITS ~/1; .. n/ka r..n/ l) ,on/kn _,-:-;;;-/ l . ""/ka 11JQ/l) ,,a/kQ
u.. U-I ' 1
.c .....
' ,-
' \1
~
h.\
\...ill
•
ethane 1.1 2.2-tetrachlor<>-' I
ethene. tetrachlor0-~ I
toluene '-
chlorobenzene /
ethvlbenzene . / ' ,/
' acetone • 0 I IA--I • I•
2-butanone "' carbondi sulfide
2 hexanone
4-methvl-2-nPntanone
stvrene
vinvl acetate ; ~ ;
• xvlenes (-k-k1) ' / / ,;
Lsc,ovor-,v I ,o.Lh.-r l,<_ / ,ll L,l.. L,,<.-,
' ' '
J -Estimated value.
K -Actual value is known to be less than value given.
'7 () {) 'i/-'7'CJ
( I l
(ijq/ l ),oa/ka
I I ,
'
I
,
, I ,,,
L -Actual value· is known to be greater than value given.
U -Material was analyzed for but not detected. The nurrl>er is the Hininun Detection Limit.
NA -Nol analyzed.
1/ -Tentative identification.
?_/ -On NRDC List of Priority Pollutant_s.
N.C. Division of llcalth Services
DHS 3068-0 (4/86 Laboratory)
'70 O'i?'oO
( I l
,/4,n/ j; .. n/kn
u_
\
I '
./
.J-r a, ,e__
STATE LABOOATORY OF f'UBLIC HEALTH
DIVISION OF HEALTH SERVICES, N.C. DEPARTMENT OF HUMAN RESOUHCES
P.O. BOX 28047 -306 N. 1./ILMINGTON, Sl., RALEIGH, N.C. 27611
ORGANIC CHEMICAL ANALYSIS
PURGEABLE COMPOUNDS LAB NO 7 /) a ????..:J
FIELD#
COMPOUND TYPE ( / ) ( ) ( ) ( )
UNITS ua/ l) ua/kQ ua/1 oon/ka oon/ I oon/ka .. n/ l ua/ka
chloronethane IA-
braranethane
dichlorodifluoranethane
vinvl chloride
ch l oroethane
rrethvlene chloride
trichlorofluoronethane
ethene. 1. 1-dichloro
ethane. 1. 1-dichloro-
1.2 trans-dichloroethene
chloroform
ethane l 2 dichloro-
ethane l. l. 1-trichlora-I
carbontetrachloride ~·
brorodichlororrethane -·
ornnane. 1.2-dichloro-' 1,3-trans-dich lo ne
trichloroethvlene J
chlorodibroronethane '\.'
benzene "'
ethane. 1. 1 2-trichloro-~
1,3-ds-dichlo, ne \~
2-chloroethvl vinvl ether
branofonn '
ethane 1. l .2 2-tetrachloro-\i
ethene tetrach loro-~
toluene ' . chlorobenzene
ethvlbenzene ' ' /_
~
acetone ' I ,
2--butanone
carbondi sulfide
2-hexanone
4-methvl-Z=ntanone
stvrene
vinvl acetate
, xvlenes f +-n+n Jl '/
X:60 O~OM"/ e.+her /.A_...
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 -Katerial was analyzed for but not detected. The nl.lT'ber is the Ninirrun Detection Limit.
NA -Not analyzed.
1/ -Tentative identification. £1 -On NRDC List of Priority Pollutants.
N.C. Division of Health Services
DHS 3068-0 (4/86 Laboratory)
( I ( )
un/ l ,on/kQ un/1 ,on/kQ
DEPAR™ENT OF HUMAN RESOURCES -DIVISION OF HEALTH SERVICES
LABORATORY SECTION
OCCUPATIONAL HEALTH
G C REPORT SHEET
COMPANY: J<~,UJ, / ..J-/1 C-DATE OF ANALYSIS: t./-2-.J> 7 -:::, 1/-7"•-g 7
SAMPLE II AJ,/,,,,.,t ~C.P
'1tltl ;s-7 < O. SOE=,
f .5-9 <0,5,:1-!!:;., .v
9~1 <o. S-CJ
'ii,] -< d. s-o
¥6, s-,i_.
< o. 1-ere::,
967 <o.S-o
fC1 <o.s-o
971 '< 0. ~~i::. I/
~7, <D.j?}
4. I/ i7s-<o. So-
'?77 <o.5o
tl I/
f7f/ <o.~tr
'iff I <o, 5/J~ [/
N.C. Division of Health Services
DHS 3068 (6/83 Laboratory)
V /yt(.,.C e.. Lone er1T1 ",t., f,-"',.., .s :. J; c./J-~ ✓
N. C. DEPARTMENT OF HUMAN RESOURCES
DIVISION OF HE.ALTH SERVICES
SOLID AND HAZARDOUS WASTE MANAGEMENT BRANCH
Chain of Custody Record
Hazardous Waste Materials
Location of Sampling: Generator __ Transporter _Treatment Facilit
__ Storage Facility __ Disposal Facility _Landfill
_LO th er: fy Ji,,U. ,(r, ucL--U! (_,,U-UJk
1:c f Co C\X-r,.-~t 0?.s-4~ f\
Company's Na.me /;~;ft{Jfr s (!o . ..i};~ .· Telephone( i-(1 z._) 22 7 -Z-09O n '
Address f-/,uu ,'.fc/ . /J?o,nJu,//e. ,;VC. ---'-'--'=-','/ -'""--'-_ -,-,, .,..) ---. ---------'--''-"-".::..;_:...:....:.;..:..(....;;;;.~-'-'---------
Collector's Name ./-t!q A<:, /tA-• Tele_phone ( 9'('1 ) ? 3 3 -.Lf'Q I
signature
'
Date Sampled /1),qf'e,L a:0 19,Vl :; ; Time Sampled 9JD ~ / S S'D
Type of Process Gene~ating Waste._-"'c;,.u~0~0::..!d/a.::·s..· -1..i'..:.1_·c: __ J,=..:.rr--,;,.:....::..:./-,{'-'---')i,_::.:a;.;..,;.c:;:_-C=(;...i...,o/r-. ______ _
. Field Information
·Field
Chain
1.
3.
SampleNo./JStf7 35'fcf'. 3U7· 3['9Q 3J9/ .S[:l?--5J9;3
,;(9/f 3.>t,s 31'7t. 3s9'--=J-.s!:9f 3.s<?f ,1Gro
3bDI 3to'2.-3~o3 3te,v 3t'..D.r' 3tcat .:lhD1-36a<J>
of Possession: 3 f, 0 f 36/D .36 // ;J &J 2....
&k, &1/c_;, (A)a,g;_ frlwrd'/4--?-< 7 signature / 1 · /title inclusive dates
~ 3-,,lcJ-f' 7
signature title inclusive dates
signature title inclusive dates
Results reported
signature title date
Instructions: Complete all applicable information including signatures, and
submit ~ith".analysis request ferns.
•
Location of Sampling:
N. C. DEPARTMENT OF HUMAN RESOURCES
DIVISION OF Hf.ALTH SERVICES
SOLID AND liAZAR.DOUS WASTE MANAGEMENT BRANCH
Chain of Custody Record
Hazardous Waste Materials
Generator __ Transporter _Trea'tillent Facilit
__ Storage Facility __ Disposal Facility _Landfill
___L_Other: o?;{-!J",,;tt.. 1(r1 JZl-U! UJ-('_t!_)k
o[, r Cow·o.-,cT /¾,,-4';)(\
Company's Name /(/:l;:7{J(rS {!o. J/Jc.• Telephone( i../12.-) 227-Z.09O ~ '
Address. _ _,_f-.:..../<..::~,U.:..!cf-1--''"''.f~<./!......,,-...,...,.·-------....£/JJ..LJ..-"'O.::..•.:....'.:....iJ::..· ..:.u-'-',/'-"/....::e::....,.,....:.;V_C. _______ _ ~ l .. ) '
Collector's Name. _ ____::h__,ue:.:~=-· _·__,.,./J--c:::::....,a.;.':...lt.aa:A.:....•;__ _____ Teleyhone( 9'1'1 ) ? 3 .3-.2<f0 I
signature -
Date Sampled_."-/t/-'-'-''4.,_"-'f'('-"'."'-A----=-~•'-'-:i::0......:.._-1-t...,_9 .... ,e .... · ... 7 _____ Time Sampled 9JD -J 5 S'D ?
Type of Proces S Gene~a ting Waste_""w-"-'o;...::c;D..,dla:,· ~.:...tr_-_c._cef,;___rr,..;,_ .... ;G-"t'---'fi_a_ . ...;.c_l..._(,_1_0;t+-· -------
. Field Information
Field Sample No. /jStfJ 35'f,f 3fJ'l· 3C9D 3S-f1 .sgi.., .5J93
c:t(CZY 3.>z.s Jfl(., Js?-=r -35"9e 3.s?t .1~LID
3bDI 3/.07....-3bCJ3 .3iDV 3t,o.r 3it!'.J/: ..J001-3bOJ"
Chain
1.
of Possession: 3 t;, 0 f ;3{;/D .9~/ / ,3 l,j 2-.
Wk /&c~ WaXi. ~~ .f:r-7 signature /title inclusive dates
2.vldt,<~A~ ~ 3-,,.za.f' 7
signature title inclusive dates
3.
signature title inclusive dates
Results reported
signature title date
Instructions: Complete all applicable information including signatures, and
submit w-ith-.analysis request forms.
•
~ !:~:::..~=~'fl_ 'f' dr0/J s ,f I~ m,~:Z::.:1,,,
DivisionofHealtbServices !,·: · ·· PLE NALYSES~. RCU P.O.Box28047
, 306 N. Wilmington Street
. . .. . · Raleigh, 27611
Site Nuri';ber ~t.,k.~~.L~~~~\~!Ji~~~~~~--Field Sample Num er -~~--~------------
Name of Site -A~A~~s:;:;~~'.".'.'.:ZL2...s;~-----Site Loca;ion ,A0.1y .s-v; ,llllVY't'nJ//Jr;, /t/ C.
Collected By .S:O..... ID# 3'? Date Collected /o:J-I f -J' 6 Time 71//)
Type of Sample:
Environmental Concentrate Comments
_d_. Groundwater ( 1 ). __ Solid (5) Q 7itaa 11P dJai. aH/f
__ Surface Water (2) __ Liquid (6)
__ Soil (3) __ Sludge (7)
__ Other (4) __ Other (8)
INORGANIC CHEMISTRY
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
: d P& T:GC/MS _EDB __ Methoxychlor
__ Acid:B/N Ext. __ PCB's __ Toxaphene
_TOX __ Petroleum _2,4-D
--__ Endrin __ 2,4,5-TP (silvex)
--L, (/l Lro/1-;..,/,, ':/::ti et:. __ Lindane ---, 1·-
MICROBIOLOGY RADIOCHEMISTRY
Parameter Parameter Results PCi/ 1
__ (MF) Coliform Colonies/lOOmls __ Gross Alpha
__ (MPN) Coliform Colonies/lOOmls __ Gross Beta
----
----
Date Received Id.-I 9 · ~ ID
Reported By
Date Extracted-----------~-------
/~ /.-7 /leq__/'
DHS 3191 (R,v;sed 7/85)
Solid and Hazardous Waste (Review 7 /87)
Date Reported -,,.,---"->!,._/_l~Y,_,/,~'rf_r~-------fr 7
Date Analyzed -~'fJ.=' ~--~;>,~/--~~l>l,.,",~.,..iJ='/l~
3="1}'='~-,
6
______ _
Lab Number ___________________ _
.,#60 3-:?rtf -,{;, o 3 Vo;
Purpo&e:
Preparation
. . . . ' I:,. -·: ..
Enforcement and compliance with the N. C. Solid ~Ha~oS?.,u,'ii~,aste Manag~t Rules. .
~ . -~.1/'lt!Ji.tn. . l A sample analyses request _£on'.' (OHS 3191) must b comli~ted _for·eac.~,1yre1 r;,f eval(iation requested ( e.g.,
inorganic, organic, microbiology, radiochemistry). Fors · --.conditions wliicli reqJire more than one (1)
container (i.e., ground or surface water from landfills) a sample la e ·stJSe affixef to o~e of the containers. The
collector must then write the site and sample number on the duplicate. ~ --.. • ·
Do not submit an analysis request sheet with no parameters indicated.
Equivalent measurements:
ppm= µg/ml = mg/1 =µgig= mg/kg
ppb = µg/ I = µgl I OOOg = 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 .J
may be contaminated.
Concentrate -A sample of a waste, including but not limited to, sludges, resins, 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 Chemi&try -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
Disposition:
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.
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
I
I
-~Af>l&i /,eµ,_r~ (,<)-{'-It-~ dr0;;s o/ /.2/Yl I/Ci!./-10 nt(
N. c:· Department of Human Resources
Division of Health Services SAMPLE ANALYSES REQUEST
State Laboratory of Publlc Health
P. 0. Box 28047
306 N. \Vilmington Street
Raleigh, 27611
Site Number ·_._9.~'.2~...,D~~O~Q"--'-3.,_.,,:2-~fH>~~-•-3~8' .... ·~.3~--Field Sample Number
Name of Site -,,,di.'--"-'c/.fo~'½'-'"'e~c~,..,s:_~C~.n-_,),__I,~n~<-~----Site Loca;ion ,/1«.ll; ss-; ;JJ11/Y'1'01/!Jc;, ill<:..
,?{_, :/: /),e i2t> S<1= ID# 3/? Date Collected /oJ-/ 7 -J' 6 Time (,3 DQ
Collected By
Type of Sample:
Environmental Concentrate Comtnents
_i.L.__ Groundwater ( 1) __ Solid (5) @, James f?,,.o,,,e_ ,oe ee
__ Surface Water (2) ___ Liquid (6)
__ Soil (3) __ Sludge (7)
___ Other (4) __ Other (8)
INORGANIC CHEMISTRY
Excraetables Total
Parameter Result• mg/I Parameter Results mg/ I Parameter Results mg/1
--Arsenic __ Arsenic __ Silver
--Barium __ Barium __ Sulfates
__ Cacimium __ Cadmium __ Zinc
__ Chromium __ Chloride _Ph
__ Lead __ Chromium __ Conductivity -
__ Mercury __ Copper _TDS
_.Selenium __ Fluoride _TOC
___ Silver __ Iron --
--__ Lead --
--__ Manganese --
--__ Mercury --
--__ Nitrate --
--__ Seleniu·m --
•
ORGANIC CHEMISTRY
Parameter Results mg/ 1 Parameter Results mg/ I Parameter Results mg/ 1
.d..P&T:GC/MS _EDB __ Methoxychlor
__ Acid:B/N Ext. __ PCB's __ Toxaphene
_TOX __ Petroleum _2,4-D
__ Endrin __ 2,4,5-TP (silvex) = .LS.tJp:.tiLJ,,,Le':f-6ec. __ Lindane --,, ...
MICROBIOLOGY RADIOCHEMISTRY
Parameter Paran1eter Results PCi/1
__ (MF) Coliform Colonies/lO0mls __ Gross Alpha
__ (MPN) Coliform Colonies/lO0mls __ Gross Beta
----
----
Date Received l d--\ C\-~ lP Date Reported __________________ _
Date Extracted _________________ _
Reported By
Date Analy:ed -----.....-.===='·--------6·'. lJJ97
-------------------Lab Number __________________ _
DH."-J\91 (ReviscJ 7185)
$;11iJ and H:1~ardous \Va!-te (Review 7 /87)
p
;fy-h r"r/f> /&, /d-:U:.r~ (/H,'ft_ ~ cf,-o;; s· uf /.2 /fl. #CL/-Y C 11'-{
r-..·.-c. Depanment of Human Resources State Laboratory of Public Health
Division of Health Servires SAMPLE ANALYSES REQUEST P. 0. Box 28047
Site Number 92 b {)Q 3 2-fHJ 3 8'.3
Name of Site ,Ji,IJPec <; f½) Zn c.._
Collected By ,4; i= /)-e I&) S 6=-ID# 38'
Type of Sample:
Environmental Concentrate
...d._ Groundwater (1) __ Solid (5)
__ Surface Water (2) ___ Liquid (6)
__ Soil (3) __ Sludge (7)
__ Ocher (4) __ Other (8)
306 N. Wilmington Street
Raleigh, 2761 I
Field Sample Number _....,3""'--=5:"--'-/~3c..-_________ _
Site Location ,Ill{ 'Y , 5 st; iJJ()(Y','n/J II <",,t ltl C:
Date Collected /o} -/ 7 -J' 6 Time /, 3 'i<C
Comments
@ /lhl/2 o 01 &z r lie e , v-e Le
INORGANIC CHEMISTRY
Extractables Total
Parameter Results mg/ I Parameter Results mg/ I Parameter Results mg/ I
__ Arsenic __ Arsenic __ Silver
__ Barium __ Barium __ Sulfates
__ Cadmium __ Cadmium __ Zinc
__ Chromium __ Chloride _Ph
___ Lead __ Chromium __ Conductivity
__ Mercury __ Copper _TDS
__ Sdcniutn __ Fluoride _Toe
__ Silver __ Jron --
--__ Lead --
---__ Manganese --
--__ Mercury --
--__ Nitrate --•.
--__ Selenium --
•
ORGANIC CHEMISTRY
Paran1eter Results mg/ l Parameter Results mg/ l Parameter Results mg/ 1
: d P& T:GC/MS _EDB __ Merhoxychlor
__ Acid: Il/N Ext. _.PCB's __ Toxaphene
_TOX __ Petroleum _2,4-D
__ Endrin __ 2.4,5-TP (silvex) = ~/.ijl.£'/=&ec. __ Lindane --
MICROBIOLOGY RADIOCHEMISTRY
Parameter Parameter Results PCi/ l
__ (~ff) Coliform Colonies/!O0mls __ Gross Alpha
__ (MPN) Coliform Colonies/l00rnls __ Gross Beta
----
----
Date Recei\"ed Id· \9-'(k ~ Date Reported __________________ _
Dare Extracted __________________ Date Analyzed -------,.....-:~==i-a· ....-------
6 '. 'iJ398
___________________ Lab Number
Reported By
OHS JI Q 1 ( Revis1•d 7185)
.:--:ili,l anJ H:i::i.rdous Wane: ( Review 7187)
/J,v,J--er ve4J (ft{ 'it_ / cf rD(l s of /.2 fYl 1/GJ!../-i/ O ~
N. C: Department of Human Resources State Laboratory of Public Health
Division of Health Services SAMPLE ANALYSES REQUEST P. 0. Box 28047
306 N. Wilmington Street
Raleigh, 276 I I
/? '1 " " ,.; :::, 3,,; / (/
Sire Number ---<L...J•.L.:=.~l2.....,_~l)=Q~3.,_,,,,1,=-"ct:V'--"-'-'-3......,8'__,..::,=---Field Sample Number -...c....-=uc.-__.I. _________ _
Name of Sire ~,J:1>"-'-''-',"'~=4Jker;;.Lc....,,S: _ _,,_C""..n'-'_J,_.;J;,=n"'--'c:::..,.,,.._ _____ Site Location /(1/17' ,5y; ilJ()(Y'1'ou'flc;, /i/ C.
i?:tr/J-e @Sib: ID# 3/? DateCollected /oJ-17 -J't, Time /'-/-'15: Collected By
Type of Sample:
Environmental
~-Groundwater ( l)
Concentrate
__ Solid (5)
Comments
@ 0-e:ocre. ll12cd/a1 ate.I{
___ Surface Water (2) __ Liquid (6)
__ Soil (3) __ Sludge (7)
___ Other (4) __ Other (8)
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
__ }\1ercury __ Copper _TDS
__ Selenium __ fluoride _TOC
__ Silver __ Jron --
--__ Lead --
--__ Manganese --
--__ Mercury --
--__ Nitrate --
--__ Selenium --
•
ORGANIC CHEMISTRY
Parameter Results mg/1 Parameter Results mg/ 1 Parameter 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, r I) frll/'.l,.,I e.':/:IJ ec. __ Lindane --;-,,,-..
MICROBIOLOGY RADIOCHEMISTRY
Parameter Parameter Results PCi/ 1
__ (MF) Coliform Colonies/ I 00mls __ Gross Alpha
__ (MPN) Coliform Colonies/!O0mls __ Gross Beta
----
----
Dare Received I J-1'3-1{,, ~ Date Reported ___________________ _
Date Extracted __________________ Date Analy,ed -----------,,---------
-6'. )3399
Reported By ___________________ Lab Number
DHS JI 41 ( Revised 7185)
SoliJ ::nJ Ha:ardou$ \VaH!' (Rc\"iew 7 /87)
I
I
vf /.J ;n /2"C2/-i O ~
N.-C. Department of Human Resources
Divi!i.ion of Health Services SAMPLE ANALYSES REQUEST
· State Laboratory of Public Health
P. 0. Box 28047
306 N. Wilmington Street
Raleigh, 27611
Site Number 92 b ,QQ 3 J.-It-{) ,3 8'.3
Nnme of Site ,J1,/Jf/f!C 'i: Cn) M C..
Collected By ,,q; /: /J-e /(,t) .S: cb ID# 38'
Type of Sample:
Environmental
L Groundwater (1)
Concentrate
__ Solid (5)
__ Surface Water (2) ___ Liquid (6)
__ Soil (3) __ Sludge (7)
__ Other (4) __ Other (8)
Field Sample Number ________________ _
Site Location ll1.t1y '5 r:; illllCY'r° ah fl cl /i/ C.
Date Collected /oJ-1 7 -J' 6 Time /,S::.JS ...
Comments
(ff) 1 To6a ()'Jedi, 0
0 u&IR
INORGANIC CHEMISTRY
Extractable• Total
Parameter Resu Its mg/ l Parameter Results mg/ l Parameter Results mg/1
__ Arsenic __ Arsenic __ Silver
__ Barium __ Barium __ Sulfates
__ Cadrr.ium __ Cadmium __ Zinc
__ Chromium __ Chloride _Ph
··--Lead __ Chromium __ Conductivity
__ Mercury __ Copper _TDS
__ Se!e-niurn __ fluoride _TOC
__ Silver __ Iron --
--__ Lead --
---__ Mangant:se --
--__ Mercury --
--__ Nitrate --
--__ Selenium --
•
ORGANIC CHEMISTRY
Parameter Results mg/1 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-D
__ Endrin __ 2,4,5-TP (silvex) = L.f.o/DfJ-'f,1£':l:h er:. __ Lindane --
MICROBIOLOGY RADIOCHEMISTRY
Parameter Parameter Results PCi/ l
__ (MF) Coliform Colonies/l00mls __ Gross Alpha
__ (MPN) Coliform Colonies/lO0mls __ Gross Beta
----
----
Date Received µI d-"-'---...Jlc...C\..!.....-..,.R,,=:.....1=e.----'--------Da:e Reponed _________________ _
DatL" Extract~d _________________ _
Reported [ly
Date Analy=ed ------7'r:.:=--=::-------6 '. )3400
___________________ Lab Number
Dl!S 3191 (Rcd~,·d ';/85)
.Snli,l .1nd Hi,:arJou~ \X,.a!>te'(Review 7/87)
Ja/'t)pJe., /r0er~ (ft-{:.;t._ -f cfr0,;:;s of /.2/rl. IIC2-/.i/lJ ~
N. c:·Oepartment of Human Resources
Division of Health Services SAMPLE ANALYSES REQUEST
State Laboratory of Public Health
P. 0. Box Z8047
306 N. Wilmington Street
Site Number
Raleigh, Z76 I I
-L9. .... '.2~D ........ ....,o .... o-<....,3w&=..,l)..{)"--'-''->>..L3-4,8'L..:.3=---Field Sample Number _...,3"'-',r"'--'-/-'&,C..., _· --------
Name of Site ~~~ ...... a-0,,..e"'-r_...,_5"_-_-~/1..,.n""-,,--Z=<n:..L..;C,..,___·_· ----Site Loca:ion l!fd1.1 ,5'( /JJ1vr_/crullc,, /i/ C.
' 'v. I . I ', ,
/?, "/: /)-e @ . 'Ub-ID# . 3/? Date Collected /o.2 -I 7 -J' 6 Time I '7 2.. tl
Collected By
Type of Sample:
Environmental
4.-Groundwater ( 1)
Concentrate
__ Solid (S)
Comments
@) Lo c.u :.S '3a.r6ee. u.JeL/
___ Surface Water (2) ___ Liquid (6)
__ Soil (3) __ Sludge (7)
___ Other (4) __ Other (8)
INORGANIC CHEMlSTRY
Extractable• Total
Parameter Results mg/ I Parameter Results mg/1 Parameter Results mg/ 1
__ Arsenic __ Arsenic __ Silver
__ Barium __ Bariuffi __ Sulfates
__ Cadmium __ Cadmium __ Zinc
__ Chromium __ Chloride _Ph
___ Lead __ Chromium __ Conductivity
__ Mercury __ Copper _TDS
__ Selenium __ Fluoride _TOC
__ Silver __ Jron --
--__ Lead --
--__ Manganese --
--__ Mercury --
--__ Nitrate --
--__ Selenium --
•
ORGANIC CHEMISTRY
Parameter Results mg/ 1 Parameter Re•ult• mg/1 Parameter Results mg/1
I~ 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. C()frriIJ~! "'H,er __ Lindane --,-, r--
MICROBIOLOGY RADIOCHEMISTRY
Parameter Parameter Results PCi/ 1
__ (MF) Coliform Colonies/lO0mls __ Gross Alpha
__ (MPN) Coliform Colonies/IO0mls __ Gross Beta
----
----
Date Received / d /9'-~ t-0 Date Reported _________________ _
Date Extracted __________________ Date Analy,ed --------'-----------
Reported By -------------------Lab Number 603401
DHS 3191 (Revised 7/85)
SoliJ anJ H11,:ardous Waste (Review 7 /87)
N. C. DEPARTMENT OF HUMAN RESOURCES
DIVISION OF HEALTH SERVICES
SOLID AND HAZARDOUS WASTE MANAGEMENT BRANCH
Chain of Custody Record
Hazardous Waste Materials
Location of Sampling: Generator __ Transporter __ Treatment Facility
Storage Facility __ Disposal Facility __ Landfill
v Other: r24ndL tii-CIL. a &c 4--:v:iocc e.a Z,,c_ ~ ~ '-,v J
Company Is Name pa:¥/e, ma tea ,Js Telephone( __ ) _______ _
Address -1/21~1 , ~· m ~Z) l22oco'c,1t//e, . IV~
Collector:s Name. j.i;4•;z;_;;, TelE,phone(~?: J-,3]-:BD/
signature -
Date Sampled . ,(?h> 7,/££ Time Sampled 7/,/ /~ /ll?J
Type of Process Generating·waste _______________________ _
Field Information
Field Sample No. 35 / / 3,517 .3S23
Chain of
1.
Possession:
o n_\ n,1,: _ ~ '-I). ~ w:.....-----
signature inclusive dates
2. /Jr,,))t~
1 'signature
3. l)k1 f? Ju vv(
V signature title inclusive dates
Results reported
signature title date
Instructions: Complete all applicable information including signatures, and
submit. with ·.analysis request. forms.
·,
N. C. DEPARTMENT OF HUMAN RESOURCES
DIVISION OF HEALTH SERVICES
SOLID AND HAZARDOUS WASTE MANAGEMENT BRANCH
Receipt for Samples
The samples described below were collected 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 (CERCI,A)
() Toxic Substances Control Act (TSCA). 15 U.S.C. §2601, ~ ~-• specifically
Section 11.of TSCA, 15 U.S.C. § 2610.
Ins~'s Name ' ' Inspector's Address
' /JJa,o.;t.etl/ e
Firm Owner, 0pe,·a tcr, . or Agent . . ~
Title
-
SAMPLE . COLLECTED SAMPLE TYPE DUPLICATE SAMPLES SAMPLE LOCATION
NUMBER DATE TIME WATER SOIL OTHER OFFERED ACCEPTED REJECTED ON-SITE OFF-SITE
I 12..-17-J //IS' ✓ ✓ ~ ✓ t, .
..
Receipt for the sample(s) described Receipt/rejection of duplicate. or split
ab~A ~c;;:dged: sarlei m;;::edged:
_..
i{~~ector Signature of\A;Firm 0'1ner1 Operator, Vs · T \.
or Agent
.J.,.IA-/4:...::'.. '.L.£,;~~~~~'bhr~=,4.e:.L..VW:=--u.Lr""."""'<-="';,,/,~ . U&«::-:-<>-~, . Title --r ~ Title · ~
COMMENTS, ___________________ ~--------------
N. C. DEPARTMENT OF HUMAN RESOURCES
DIVISION OF HEALTH SERVICES
SOLID AND HAZARDOUS WASTE MANAGEMENT BRANCH
Chain of Custody Record
Hazardous Waste Materials
<Jg~~
~.f?U ~1 Inc..
'9 !) ,b (IQ 3 2,d1J 3 J' 3
Location of Sampling: Generator __ Transporter __ Treatment Facility
__ Storage Facility __ Disposal Facility __ Landfill
Company's Name
....K,_Other: fJo 'u 4.:0, t!j4-,-a /2 driql« ·,,___,,, ,Cil-:&:-: ut-(Lfl T · tJU I
ft@:4? 6m,.u.g. Cf.'-1--:{riR&:£ Telephone(:1. ) _______ _
Address //ry _5 ¥ : t'J'ZtJcaj lld-f
Collector's Name .};5~~
' signature
Date Sampled · /S} -I 7 -cf 6
Type of Process ,Generating· Waste. _______________________ _
Field Information
. ·Field Sample No. 3 5 / 2-
Chain of Possession:
L --LJfldie...!::· =-=· :..=/uv<..:::.::~)l.'------'-za=··· '-=-~//(Ad ?0d-{,tJ/-/d-17~ /2-1~ .,,,(,
signature ~ tit~ inclusive dates
title ' inclusive dates
3.
signature title inclusive dates
Results reported
signature title date
Instructions: Complete all applicable information including signatures, and
submit with·Analysis request forms.
.... .;,-
' .
N. C. DEPARTMENT OF HUMAN RESOURCES
DIVISION OF HEALTH SERVICES
SOLID AND HAZARDOUS WASTE MANAGEMENT BRANCH
Receipt for Samples ...
' The samples described below were collected 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.
Inspector's Name
Name of Firm
V
Firm Owner, _.Op1eratcr, _or Agent
-
SAMPLE · COLLECTED SAMPLE TYPE
NUMBER DATE TIME WATER SOIL
.
Receipt for the sample(s) described
above is hereby acknowledged:
Signature of Inspector
Title
OTHER
Inspector's Address
Firm Address
Title
DUPLICATE SAMPI.1:S SAMPLE LOCATION
OFFERED ACCEPTED REJECTED ON-SITE OFF-SITE
Receipt/rejection of duplicate_ or split
samples is hereby acknowledged:
Signature of Fi= Owner, Operator, or Agent
Title
COMMENTS, ___________________ -,-______________ _
N. C. DEPARTMENT OF HUMAN RESOURCES
DIVISION OF HEALTH SERVICES
SOLID AND HAZARDOUS WASTE MANAGEMENT BRANCH
Chain of Custody Record
Hazardous Waste Materials
Location of Sampling: Generator __ Transporter
Storage Facility Disposal Facility
X Other: M/ dJll ~(,:?dp. civLI
__ Treatment Facility
__ Landfill
. . ?I[} //
Company's Name ,Mar-6e,R, /2e1z'd! a,<.....-(___L. -Telephone( . ) _______ _
Address,_..L.g=...!....1--_cR=-~_L.,.~~~:"--.L.fi-i-~/o~-"-'~~d.:....:ra:...,. . .JJ.1G.!::.m/4e.:::..!:==·...,./.,,_,,41,1-[..._(!. _____ · __
Collector's Name . ;:;_;. /JL~-· Tele_phone( 9/f ) 7-3}--2.{>&? (
Date Sampled
7 signature r
/}_. ~ 17-j>,6 Time Sampled / 1/ __.:.. //YJ
Type of Process Generating ·waste. _______________________ _
Field Information
Field Sample No. 35 I 3 3St9 35,;).5"-
Chain of Possession:
title inclusive dates
signature
3.
1 (/ signature title 'inclusive dates
Results reported
signature title date
Instructions: Complete all applicable information including signatures, and
submit.~ith ·2nalysis request forms.
N. C. DEPARTMENT OF HUMAN RESOURCES
DIVISION OF HEALTH SERVICES
SOLID AND HAZARDOUS WASTE MANAGEMENT BRANCH
Receipt for Samples .
The ·samples described below were collected in connection with the administration,
enforcement, and documentation of the:
( ) North Carolina Hazardous Waste Management Rules, 10 NCAC lOF
() 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,
Section 11,of TSCA, 15 U.S.C. § 2610.
Llo!h~l&Ji A Inspefctor's Name .
/j<JC,b C-f' !ZA.Ad,.e~
et ~-, specifically
Name 'of Firm Firm Address
Firm ·Owner, . Ope,:::a tor,, or Agent Title
.. .
SAMPLE · COLLECTED SAMPLE TYPE DUPLICATE SAMPLES SAMPLE LOCATION
NUMBER DATE TIME WATER SOIL
3 /2-/7-Pi . ,J/Jf)) ✓
Receipt for the sample(s) described
abov~::knowledged: &,/0=--,,_
Sighature of Inspector
OTHER OFFERED ACCEPTED REJECTED ON-SITE OFF-SIJE
✓ '' ✓ v
Receipt/rejection of duplicate_ or split
samples is hereby acknowledged:
7
Owner, Operator, or Agent
a/~ /&46?-:tea «tr/4?<1&?:r/-
Title --"?" . V Title
COMMENTS,-'-,-------------'-------,----------------
_ __j
N. C. DEPARTMENT OF HUMAN RESOURCES
DIVISION OF_REALTH SERVICES
SOLID AND HAZARDOUS WASTE MANAGEMENT ,.BRANCH
Chain of Custody Record
Hazardous Waste Materials
,;vi;_ w-<.,Lg l'!,r✓ 6, 1' C
f:2 /) UD 3 2-r.ro 3J'3
Location of Sampling: Generator __ Transporter __ Treatment Facility
__ Storage Facility __ Disposal Facility __ Landfill
....2(_Other: ~If ,r,ba,;Cj ,O/L...-~_,;-
Company's Name ,(1}r, C'fA<je ,J-.h~;:;;el?phone( )') ___ · ____ _
Address /$ Cl,, tee/-(fl Er ,:)_ (5n v Jc{ 121 o ca c ;// lie
Collector's Name. & Ae,/4o,(// Tele;hone(o//9) t:33--:J/!:O/
7 .signature
Date Sampled-. ' ,&J -~ i 7 -,.j6 !1 L/-S-/JvY} Time Sampled._._~.l<...--..fl.r:....! ,/_;_ ,_ '-->
Type of Process Generating Waste. ______________________ _
. Field Information
Field Sample No• 3 '$Ii: 3 5'J (l 35 J b-. )
Chain of Possession:
l.
sig~ title inclusive dates
2. &/&;?~
' signature -
title inclusive dates
Results reported
signature title-date
Instructions: Complete all applicable information including signatures, and
submit.with ·2nalysis request forms.
N. C. DEPARTMENT OF HUMAN RESOURCES
DIVISION OF HEALTH SERVICES
SOLID AND HAZARDOUS WASTE MANAGEMENT BRANCH
Receipt for Samples
The samples described below were collec.ted in c·onnection ·with the administration,
enforcement, and documentation of the:
() North Carolina Hazardous Waste Management Rules, 10 NCAC lOF
() 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, et~-• specifically
Section 11.of TSCA, 15 U.S.C. § 2610.
&/. !Je EJso-
Inspe'ctoi-s Name
J/occli;JJ Cvucib11 c-e.. ' Firm Address
Firm Owner, 0pe~·atcr,, or Agent Title
-
SAMPLE · COLLECTED SAMPLE TYPE DUPLICATE SAMPLES SAMPLE LOCATION NUMBER DATE TIME WATER SOIL
L,I /,)-/Jtf,. , :J VI:, v
Receipt for the sample(s) described.
above is hereby acknowledged: Bz;&&~-9-._
Signature of Inspector
OTHER
/;J(h Lt /lln~""/Hl,tJ'-~;f✓1:
Ti pfe ~ .
OFFERED ACCEPTED REJECTED ON-SITE OFF-SITE
..
✓ ,.__/ v
Receipt/rejection of duplicate or split
samples is hereby.acknowledged:
Title
COMMENTS, ___________________ -,-______________ _
··•
-----------------------,------,-------,----..
N. C. DEPARTIIENT OF HUMAN RESOURCES
DIVISION OF HEALTH SERVICES
SOLID AND HAZARDOUS WASTE MANAGEMENT BRANCH
Chain of Custody Record
Hazardous Waste Materials
Location of Sampling: Generator __ Transporter __ Treatment Facility
__ Storage Facility __ Disposal Facility __ Landfill
\' Other: ,,,.,,;,,71_ l, <(!.,, .tvQ fJ wu IY'-.tk ,<.o.,,,,.,er:;5 a :VIL . ...,..,_ f' , · tiJ , I V , j:TM o tne A.11) CC'A1a2Pt4-: Telephone( __ ) __ ..:_ ____ _ Company's Name _IYJ.r.
Address._=1.-~c....,.--,1.~~';-L.....,~_,1.'..Ll..!a!..!.....t.....!:.~U!.-=-,...J.~f-.::~=-------------
signature
) ?:3"-J-2.J-01
,-::z·2_0 Date Sampled. __ ...,/c.;,)::.:....-_,_/_7,__--""%--'(,___....:.... _____ T.ime Sampled_..,_~ J __ -,c.;IJ.-L'/7}~:__
Type of Process Generating Waste -----------------------
Field Information
Field Sample No. -?SI~ ,35J.-/ 3'.Sol 7·
Chain of Possession:
l.
2.
I I signature
--L/2....:c--=U.:...' _.:..A__::_;· /4:'--. .::.;t.9✓::.....:....t:1-___ ____,U"'-' 'M lfl-4,,,, fa cfi~c,ct /;y'J,-:
signature I ti tie
title
3.
(v signature title
Results reported
signature title
IJ.-/"7-'¥l
inclusive dates
/:z..-17-cf'6 ,....12-19-r,:,
inclusive dates
inclusive dates
date
Instructions: Complete all applicable information including signatures, and
submit.with'Bnalysis request forms.
N. C. DEPARTMENT OF HUMAN RESOURCES
DIVISION OF HEALTH SERVICES
SOLID AND HAZARDOUS WASTE MANAGEMENT BRANCH
Receipt for Samples ...
The samples described below were collected in connection with the administration,
enforcement, and documentation of the:
() North Carolina Hazardous Waste Management Rules, 10 NCAC lOF
() North Carolina Solid Waste Management Rules, 10 NCAC lOG
() Comprehensive Environmental Response, Compensation and Liability Act (CERC'...A)
() Toxic Substances Control Act (TSCA). 15 U.s.c; §2601,
Section 11.of TSCA, 15 U.S.C. § 2610.
~ ~-; specifically
£r-'1k flq r ~ .
Inspector's Name Inspector's Address
Firm A'ddress
m~ r /lJfl . .A.=---..... ·• -,----'--------:::-,-a------------Firm Owner, .Opie.rater, or Agent Title . . ~
--
SAMPLE · COLLECTED SAMPLE TYPE
NUMBER DATE TIME WATER SOIL
S-· i,,;,2 -1 7-& 3ti_S-✓
Receipt for the sample(s) described
above is hereby acknowledged:
;Cd_r de l<-0, Cf=-
Sig'nature of l'.nspector
OTHER
t/);A M IX--1~c ,'U-tf cfe" r?/@1/(1/-. I V Title .
DUPLICATE SAMPLES SAMPLE LOCATION
OFFERED ACCEPTED REJECTED ON-SITE OFF-SITE
../ ' , / /
Receipt/rejection of duplicate. or split
samples is hereby.acknowledged:
1-<-•yC,6. '111 '-J'J.u..cf (l~
Signature~f Finn Owner, Operator, or Agent
Title
COMMENTS, __________________ ,--____________ _
1
N. C. DEPARTMENT OF HUMAN RESOURCES -.
DIVISION OF HEALTH SERVICES ~ ri;{Z ~
SOLID AND HAZARDOUS WASTE MANAGEMENT,BRANCH '•... . w-er_r ~/ ..za~
Chain of Custody Record '· ~,;L j) {Y..{) 3 ;J_ &-o 3 J'-5'
Hazardous Waste Materials
Location of Sampling: · Generator __ Transporter _Treatment Facility
__ Storage Facility __ Disposal Facility __ Landfill
_ . _ _ ~Other= ,&, ria& <gf-dJZ'g. <fr/ ah 7 1:fulff <1!T'.ll
Company's Name (--&-</1, f Aar/2ee ,·f'Gui::feY&:Telephone( ___ ) _______ _
Address Rt: c2, /12xo>tJ c/le., NC7 ) 7 • ' I
Collector's Name. &L!)eet'4of Tele_phone(9/9) 73;3-2cFtJ;
signature
Date Sampled:.._ __ .£./.,;.el.i:...;.-_,,.../~7:.._-"d'.~6:o..------'T:il!le Sampled / 1: Z(}
Type of Process Generating ·waste. _______________________ _
. Field Information
·Field Sample No. 3,5/0, 3522-,3,5--J,;f
Chain of Possession:
l. ----'M-"'--'"""'. =--J..zie-"""'--...... /t~✓='.>✓-'""'ct:-'----·"'-'14'-=-''r1A;ta Lmt<t!.lle hc;:.c ~ signature ~ ~ Y /~--/?~ I Z--7''?-,JJ>(,
inclusive dates.
2.
signature title 1 inclusive dates
3.
signature title inclusive dates
Results reported
signature date
Instructions: Complete all applicable information including signatures, and
submit.with·analysis request forms.
N. C. DEPARTMENT OF HUMAN RESOURCES
DIVISION OF HEALTH SERVICES
SOLID AND HAZARDOUS WASTE MANAGEMENT BRANCH
Receipt for Samples
The samples described below were collec.ted in c·onnection ·with the administration,
enforcement, and documentation of the:
() North Carolina Hazardous Waste Management Rules, 10 NCAC lOF
() North Carolina Solid Waste Management Rules, 10 NCAC lOG
() Comprehensive Environmental Response, Compensation and Liability Act (CERCLA)
( ) Toxic Substances Control Act (TSCA). 15 U.S.C. §2601, ~~-• specifically
Section 11.of TSCA, 15 U.S.C. !l 2610.
Inspector.' s Name
Name of Firm
Firm _O.;ner, Ope~·atcr,. or Agent
. .
SAMPLE · COLLECTED SAMPLE TYPE
NUMBER DATE TIME WATER SOIL .
Receipt for the sample(s) described.
above is hereby acknowledged:
Signature of Inspector
Title
OTHER
.
Inspector's· Address
Firm Address
Title
DUPLICATE SAMPLES SAMPLE LOCATION
OFFERED ACCEPTED REJECTED ON-SITE OFF-SITE
·•-·
Receipt/rejection of duplicate or split
samples is hereby.acknowledged:
Signature of Finn O,;ner, Operator, or Agent
Title
COMMENTS, ___________________ -,-______________ _
STATE LABORATORY Of PUBLIC HEALTH
DIVISION Of HEALTH SERVICES, N.C. OEPARTl1ENT Of HUIIAH RESOURCES
P.O. BOX 28047 -306 N. WILHINGTON, ST., RALEIGH, N.C. 27611
ORGANIC QjEHICAL NIALYSIS
PURGEABLE COl1POONOS LAB NO /11fJ :3.?{Jf n lnO,;_,,;,y;7 ,/n/13,7.;C/x J, 1)i33C/Ci
FIELD I
CONl'(XJND TYPE /-), l I / l I I ) . I I i
UNITS fua/1 )un/ka r.,n/1/t•n/ka !'unfl)\,n/ka /4.n/i') un/ka
ch lorarethane /0 -t,,;_ -, . ,.,,._
brooanethane /J
dichlorodifluorarethane .2J
vinvl chloride ;ti ;
ch 1 oroethane I iJ
methvlene chloride 7
trichlorofluorarethane ,:2-0
ethene. 1.1-<lichloro 5
ethane. 1. 1-<lichloro-
1.2-trans-<lichloroethene
chlorofonn
ethane 1 2-<lichloro-
ethane. 1 1. 1-trichloro-
carbontetrachloride
brorodi ch 1 orarethane
orooane. 1.2-<lichloro-
1 3-trans-<lichlo .
trichloroethvlene
chlorodibrooanethane
benzene
ethane. 1.1.2-trichloro-,
1 3-cis-<lichlo, ne ' 2-chloroethvl vinvl ether Io
brooofonn ,-
ethane. 1.1.2.2 tetrachloro-I
ethene. tetrachloro-I
toluene I
ch 1 orobenzene I,
ethyl benzene V / I 11/ ,/
acetone /D h IA lA.... Ll_
2-butanone /0 I
carbondisulfide :,
2-hexanone /0
4-n"ethvl-2--0Pntanone /U
stvrene ,,
vinvl acetate I" ,
o-xvlene ~-\!/ / I ' I
/) /) J_,,., •. {.,;,,.,, ,(} "n,"),.-JJ1 .P. +1 r-! r.::J '(+) \ c-_}
I V I
J -Estunated value.
K -Actual value is known to be less than value given.
loll,'3/./.o(l
I-( l
'un/i')un/kn
LA-
,/
1A_
/
A
L -Actual value· is known to be greater than value given.
U -llaterial was analyzed for but not detected. The nunt>er Is the 11ininun Detection Limit.
NA -Not analyzed.
1/ -Tentative identification. fl -On NROC List of Priority Pollutants.
N.C. Division of Health Services
DHS-:3068--0 (4/86 Laboratory)
:1_003 LJ/1 I .·
.J I l
un/J\ ,.afkn -•
I
\
' /
, r:::i;J s/,qf,
Jr era ~ I e-o ~,,-o--e.--d/ c/-H. 11._ --N. C. Department of Human Resources
Division of Health Services
Site Number
Name of Sire
Collected By
Type of Sample:
Environmental
_L_ Groundwater ( 1)
___ Surface Water (2)
__ Soil (3)
__ Other (4)
Concentrate
__ Solid (5)
__ Liquid (6)
__ Sludge (7)
__ Other (8)
Comments
INORGANIC CHEMISTR.Y
Extractables Total
Parameter Results mg/ l Parameter Results mg/ I Parameter Results mg/1
__ Arsenic ../ Arsenic <:...O,°-d _,_L Silver <c.o c:
__ Barium ./ Barium ,I), __ Sulfates
__ Cadmium ~Cadmium < t:,_[,.J, L:'c."?..S-__ Zinc
__ Chromium __ Chloride _Ph
__ Lead ~Chromium < ,?. 1-'">l __ Conductivity
__ Mercury __ Copper _TOS
__ Selenium __ Fluoride _Toe
__ Silver __ Iron --
--.,.L_Lead $ p.c,J --
--__ Manganese --
--_J_ Mercury · -< 0. '(2_(}_()_ ;::t... --
--__ Nitrate . --
--...L. Sele~iu~ ~ tJ /JO,,.---
ORGANIC CHEMISTRY
Parameter Results mg/ l Parameter Results mg/ I Parameter Results mg/ l
_P&T:GC/MS _EOB __ Methoxychlor
__ Acid:B/N Ext. __ PCB's __ T oxaphene
_TOX __ Petroleum 2,4-0
--__ Endrin __ · 2;l,5-TP (silvex)
--__ Lindane --
MICROBIOLOGY RADIOCHEMISTRY
Parameter Parameter ... Results PCi/ l
__ (MF) Coliform Colonies/ IOOmls __ Gross Alpha
__ (MPN) Coliform Colonies/lOOmls __ Gross Beta . ----
----
Date Received /. il /<7? ----------~--------Date Reported __ __, _ _,/'--'-+-l---1---"'/L_, __________ _ l 7
Date Extracted __________________ _ Date Analyzed __________________ _
Reported By Lab Number ---tu+-z:r"' 5""'J""dQ9-f70~Ecc,_,2H24l81t-5---
DHS JI 91 (R~vi!W'd 7185)
Soli,I anJ Huardous Waste (Review 7/87)
• ,. Environmental .
. , ._. .... '. \·" •.. -. ,,, ··_ --· ,:" :-'. . . ~ lli~~water ( 1)
• ;,,:;:._.,,.: · . S~riacc Water (2)
'--_Soil (3). .
--Other (4)
Extractablca
~n~n-~~t~:-~'i-~-~x:~~ _:_? · .
__ Solid (5) ··.·-
--Liquid (6)
__ Sludge (7)
__ Other (8) .,,
INORGANIC CHEMISTRY
Parameter Results mg/1 Parameter Results mg/1
__ . Arsenic ~Arsenic ,<, 12,'?f
--Barium __ Barium o.
_Cadmium ,.,/ Cadmium <: LJ, oos-
__ Chromium __ Chloride
_·_Lc,ad _,LChromium < ~7,ot
__ Mercury -~r
. __ Selenium . __ Fluoride
. -. _silver __ 1roit
.. ..... ~----------. ... ·-·---------d::.Lcad .. <v,o:3 --
Total
Parameter
1-dSilver
__ Sulfates. ,
__ Zinc
_Ph
__ Conductivity
_ms ..
_TOC
'"· .. --.• ------__ Manganese
---4M<rcury .,<,2_ ,QOd.?----
--__ Nitrate. --
~Selenium :::;, ,:2 , DC S .. ·. . .
----
. ORGANIC CHEMISTRY
Parameter Rcaulu mg/1 Parameter Results mg/ 1 Parameter
..
-. P&.T:GC/MS _EDB __ Methoxychlor
_ Acid:B/N Ext. __ PCB~s __ Toxaphene
-TOX __ Petroleum _2,4-D
_---E~l!WfO __ 2,4,5-TP (silvex) --.... --,·•-. ..... --I ,.;·' ~;\
MICROBIOLOGY ""' RADIOCHEMISTRY
~ ..
Results mg/1
<o,o 5
Results mg/1
-. . ..
.• ..
'
•. Parameter ~ · JArtl\ .. Nf;' Z Para~eter Results PCi/1 ..
r-. . _; ·-w s
___ (MF) Coliform Colonies/lOOmls
3, ~ ff Gross Alpha
__ (MPN) Coliform Colonies/ I 0Omls Gross Beta
•fo-.,• ,I'
--,.
--
Date Received ----------'--------Date Reported _ _,_/_·-"'S_-_-...:.•f"'--'7..__--_·· _________ _
Date Extracted _________________ Date Ana!y,cd ---:--:-------------
Lab Number __ 0_25'J9] DEC 22 86
Reported By ------------------
DHS 3191 (R('\;..-J ilSS)
-. .
N. C Department of Human Resources
Division of Health Services SAMPLE ANALYSES REQUEST
State Laboratory of Public Health
.. P.0.Box28047
306 N. Wilmington Street
Ralciw,, 27611
Site Number -J-a9~ ......... D-<--'o.......,o.,._3 ........ 2~-..... D"'--'-()..__3,__~"'-=3"'-_ Field Sample Number --"3'--?-'-'~ ..... f:.,__ ________ .....:_
Collected By
Name of Site ---,.kt+-.4oi...,q~au,.P:,;.r_s;).._.,_L_JJc..t__.....,&..,l'luc,,C.____ Site Location . /It,µ 'f !5 .tf:
.&~ e R>,S ,::,-ID# ·33 Date Collected IJ.. -/ 7-Rfri
m,cojuJ!c N~
Time / 'f'z',:S:
Type of Sample:
Environmental Concentrate Comment&
_L_ Groundwater ( 1 ).
__ Surface Water (2)
__ Soil_ (3)
__ Solid (5)
__ Liquid (6)
__ Sludge (7)
__ Other (8)
&) fucye f{acc0't<-j .-allR
--. Other (4)
INORGANIC CHEMISTRY
Extractables . Total
Parameter Resultamg/1 Parameter Resulta mg/1 Parameter
__ Arsenic -".:7Arsenic ~Q,~ i.-Jsilver
__ Barium __ Barium o. ~,! __ Sulfates
__ Cadmium ./ Cadmium 5·t:,,?C_:..f;-__ Zinc
__ Chromium __ Chloride _Ph
_Lead _,L_ Chromium -< ?7, DI __ Conductivity
__ Mercury __ Copper _TDS
__ Selenium __ Fluoride _TOC
--Silver __ Jron --
--....LL.cad <..· v,<D3 --
--__ Manganese --
--....../.Mercury C,2 ,<JocJ;;:z --
--__ Nitrate --
--_L_ Seleniu;., ""-°' oo .r --
ORGANIC CHEMISTRY
Parameter Results mg/ 1 Parameter Results mg/1 Parameter
_P&T:GC/MS _EDB __ Methoxychlor
__ Acid:B/N Ext. __ PCB's __ Toxaphene
_TQX __ Petroleum _2,4-D
--"udnn'-o __ 2,4,5-TP (silvex) 1+._-..: --J-mdane -... t, --
..
MICROBIOLOGY
.. RADIOCHEMISTRY r . -· ~
Resultamg/1
<..,o.o s
Results mg/ 1
Parameter o .JI-II~ o 1:,0/ z Parameter Results PCi/ 1 :,,
--(MF) Coliform Colonies/lOOmls ,. / j '/--Gross Alpha
--(MPN) Coliform Colonies/lOOmls . ..~ __ Gross Beta
l>ous u.Ai1t.9 --
----
·.· ..
Date Re,eived ----------~-------Date Reported .-1.c_-~S,_-_-__,c.Y_·...,7 ____________ _
Date Extracted _________________ _ Date Analy:ed _________________ _
Lab Number __ ,_,(J.._2~5,_'/'-',._."i,._)JO,..t...,(~2....,Z.._· .::cB,,cb _____ _
OH.5 3 I (l\ ( Rt·Vi!W'.J 7185)
S.oi:.J rnJ H.t:arJou~ WaH<" (Rcvit"W 7:871
N: C. Deparrment of Human Resources
Divbion of Health Services
-
SAMPLE ANALYSES REQUEST
t v ,Q r11v v 3
State Laboratory of Public Health
P. 0. Box 28047
306 N. Wilmington Sneer
Raleigh, 2761 I
Sire Number -·L9,<>:J."-'D_,_Lf).L"'Q"--3"-'2,.__.,QL>-Q_,_._3._$'...._,3=---Field Sample Number --'3"'-'?'--"8'-=3::;_ ________ _
:;:c::ds~,; .~@;g;,S,,~·~C. 38 o:::e:::: 1:itJ;7~fa /JZ<2c(U vJfc N~
Time 13 % '
Type of Sample:
Environmental Comments
_L._ Groundwater (I)
Concentrate
__ Solid (5) <fil@l/4'am Aarle~ a2£LI
__ Surface Water (2) __ Liquid (6)
__ Soil (3) __ Sludge (7)
--. Other (4) __ Other (8)
INORGANIC CHEMISTRY
Extractable• Total
Parameter Results mg/1 Parameter Results mg/ 1 Parameter
__ Ars~nic :J Arsenic <-~.CJ(_ ...J.silver
__ Barium __ Barium o.;;i. __ Sulfates
__ Cadmium ./ Cadmium <_6),BL,5-__ Zinc
__ Chromium __ Chloride _Ph
__ Lead J.LChromium <&,DL __ Conductivity
__ Mercury __ Copper _ms
__ Selenium __ Fluoride _TOC
__ Silver __ Iron --
--... .,.L_Lead. -<.. £',o3 --.
----Manganese --
--_,_,L. Mercury -<' (2_ ,o '2cJ ex. --
--__ Nitrate --
_.L_ Seleniu;,. :5. e>, 00 S ----
ORGANIC CHEMISTRY
Parameter Results mg/ 1 Parameter Results mg/ 1 Parameter
_P&T:GC/MS _EDB __ Methoxychlor
__ Acid:B/N Ext. __ PCB's __ Toxaphene
_TOX __ Petroleum _2,4-D
--__ Endrin __ 2,4,5-TP (silvcx)
---~neo __ --.......__ ----
MICROBIOLOGY I .., 't~ RADIOCHEMISTRY
Results mg/1
<o,o ~
Results mg/1
..
Parameter § I & fl.I () ·~~7
.. .. Parameter .. Results PCil 1
__ (MF) Colifor~ Colonies/JOOmls 0 UJ I~ ..._. v• z ..
.:!!. _ Gross Alpha
__ (MPN) Coliform Colonies/l00mls ., 3/--Gross Beta ~ .. / -~
.. . "'
--"!Do --'\\. 1'/ ----
Date Received __________________ Date Reported __ /_~--=-~=----b_/-'--------------
Datc-Extracted __________________ Dare Analy:ed __________________ _
Reported By Lab Number ---4::::01<"2..;:,§.::,.9::..;-9+1 --HQ'1--1E[;c,;~ ('."72481+-6-----
DH5 J 1 QJ ( Rt",·i~t-J 7185)
~ulid .1n,l H.1:.1rJou~ \Vutt· (Re\'iew 7187)
N. C. D~partmcnt of Human Resources
Dhrision of Health Service&
/1"(..-{ 0 :J
SAMPLE ANALYSES REQUEST
State Laboratory of Public H02lth
-P. 0. Box 2804 7
306 N. Wilmington Street
Raleigh, 2761 I
Site Numbe-r _LJ9n2..,.....J.D..,_·,;;..°rJ.,_,Q=<-...3....._.2""---'D.£..>..cQ..,_._3,_~"'-=3"'-_ Field Sample Numbcr __c3::__·7-----=g,_2..,. _________ _
/JZ, ICN ,1t'llr tJ(! · Nome of Site ..,_·:1:°Al)W.,y~~~:t:.•r;..:\~..1,.\c_JJ'--':!...-~.....,.T:.lD/1,.../lu~C..-· ___
3
__
0
__ Site Location 1-//uy !5 ¥:
Collected By _&.w_e_&'a,Sv--_6 Date Collected Id---/7-/?(,,
Type of Sample:
Comments Environmental
_L_ Groundwater (q
Concentrate
__ Solid (5) @ uzaz e-1 (!,-a uH? t&I R
__ Surface Water (2) __ Liquid (6)
__ Soil (3) __ Sludge (7)
--. Other (4) __ Other (8)
INORGANIC CHEMISTRY
Extractables Total
Parameter Result& mg/1 Parameter Results mg/1 Parameter
../. Arsenic £.O,o{. / __ Arsenic J.L.Silver
__ Barium ./ Barium -o. I __ Sulfates
__ Cadmium ./ Cadmium :::;~~::,D_s-__ Zinc
__ Chromium __ Chloride _Ph
__ Lead ~Chromium < ,P,ol __ Conductivity
__ Mercury __ Copper _TDS
; __ Selenium __ Fluoride _TOC
__ Silver __ Iron --
~Leod · -<~43 -----
--__ Manganese --
--_...,L.Mercury ,< t} ,ooo ;I.,. --
--.. __ Nitrate --_L_ Seleniu;.. <.. ~.()()~ ----
ORGANIC CHEMISTRY
Parameter Reaultsmg/1 Parameter Result& mg/1 Parameter
_P&T:GC/MS _EDB __ Methoxychlor
__ Acid:B/N Ext. __ PCB'.s __ Toxaphene
__ TOX -__ Petroleum . _2,4-D
--~•>l!ftd~ --2,4,5-TP (silvex)
/ ,. __ Lindane · ----
•:•,;;, .. . «' /. -. ¼
Time tS'OO
Results mg/ 1
< o. () _;:;,
Results mg/ I
MICROBIOLI GY ~ RADIOCHEMISTR)' ..
Parameter -JAN u 190/ -· 0 !' Parameter Results PCi/ 1
__ (MF) Coliform Colonies/lOOmls
1
~ ~! --Gross Alpha = (~i~--Coli~orn1_f?/;n'.es/lOO_":ls ...... .,,,o, .. __ Gross Beta ,,,...,.
_w\,.,.. --
----..
• ·t •~-,r.,
Date Received"'_•··-----------'--------Date Reported _ _;_;_· _-_'l.1..-_-_,,?c....·_, ___________ _
Dat< Extracted _________________ _ Date Analy:ed _________________ _
Reported [)y __________________ _ Lob Number __ _,_(,.,_] 2-'.:;,;.... '_.,_1'.,1...7Q61-lQ,;.1E+C .... 2c.,2c..8::116"-----
PHS 11 Q\ ( Revised 7185)
s~,li.l ;inJ H11.:.ardous Wai.tc (Review 7/87}
.. ;
..
\
:
N:·C. Dcpar.:mcnt of Human Resources
Division of Health Services SAMPLE ANALYSES REQUEST
State Laborarory of Public Health
P. 0. Box 28047
306 N. Wilmington Sn-ect
Raleigh, 2761 I
Site Number --L9,.,.q'.l.._.....b--<-·.L.o .... o=....· ... 3:.....2""'~'-'D'""-"0 ........ 3 ........ ~~3~--Field Sample Number _;;;3_7-...L.....:cg_f,'----,---------
Name of Site_: ..,1..«'.<:.i... ,J,0)..,·~0!/-~'-"et!<Cc...)f.__· ,._L..,Ac,·:....·_ ...... T; .. ./1<.J'-"b---,----· Site ~on: ltt.:Uu :S"f: /JJ,1r(Uo,'llc tJe
A@e &-ID# 38 Date Collected' Id--07-, Rfa Collected By
Type of Sample:
Environmental
_L_ Groundwater ( 1)
Concentrate
__ Solid (5)
__ Surface Water (2) . __ Liquid (6)
__ Soil (3) · __ Sludge (7)
--. Other (4) __ Other (8)
{4] Lout's
Comments
8ark, we-£-l
INORGANIC CHEMISTRY
Extractables Total
Parameter Results mg/ l Parameter Results mg/ l Parameter
__ Arsenic JArsenic $ tJ.,.i=J,. ..J..L Silver
__ Barium __ Barium o . ..J __ Sulfates
__ Cadmium ./ Cadmium < ,c. cJOS-__ Zinc
__ Chromium __ Chloride _Ph
_Lead ___,,,,t_chromium < c?,OL __ Conductivity
__ Mercury __ Copper _ms
__ Selenium __ Fluoride _Toe
__ Silver __ Iron .. --
--dt=d <<-Q, 0-;3 --
--__ Manganese --
--~Mercury ~C,OoOix --
__ Nitrate ----
--.....L. Seleniu;,, ,s C2,QDS --
ORGANIC CHEMISTRY
Parameter Results mg/I Parameter Results mg/ l Parameter
_P&T:GC/MS _EDB __ Methoxychlor
__ Acid:B/N Ext. __ PCB's __ Toxaphene
_:__:::.::. TOX __ Petroleum _2,4-D
.,.:t. -~ . __ Endrin .. ... ---·• ":···"·-2·;4,5,TP (silvcx) ~ .--··-·-..... --·-·-'•-
f' ·-__ Linda~~ .. ,: .. ., . ..;
1-/,W,,o-........ --
'
Time
Results mg/ l
<o,o..s
Results mg/ I
MICROBIOLOGY / _ · ·-. ~ RADIOCHEMISTRY
_ f Parameter /~. ~ I. Parameter Results PCi/ I
1-(MF) Coliform Colonies/!OOmls [~ JAN 8 1987 ~ L_ Gross Alpha
; __ (MPN) Coliform Colonies/lO0mls \ if __ Gross Beta
\"',,. 15"
''!~..,. ... ~7 --
"--!!_011.~ ·~•s'Y --
Datt' Rc(t.·i\'cd _________________ _ Date Reported __ J_--_c:5_-_-_;.P--"7'------------
Date Extra<"tt'd _________________ _ bate Analy:cd __________________ _
Lab Number ----.0~2=-,::5J-:;9r..::.i9c,;4--+Q-ll=[~[ 9-'~2Cl..J8:i-l-6 ___ _
DHS JIQ\ !Rt"vi!C.eJ //65)
Suli,I ;111,I H .. :...11,inu<. W:-.~tt' ! Rt'··:(".,.: 7 /87)
N. C. Oepaftment_ofHurnan Resources
Division of Health Services
rii rr@e@n~~~ · !-~ [ / 3 ()~ oratOry of Pubhc Health
SAMPLE ANALYSES REQUEs'I P. o. Box 28047
· ~,.-..:;.;,,.--;,-.::,._-,:.~ ... ;,-i,...,,· ..... i, .... ..,! ~r:.:.. :306-N. Wilmington Street
. . ,., ... -......... ,, .•. ,.. Raleigh, 27611
Site Number .L9_,!L='-_./) __ '-"'0""0<.,.-,3'-2=-.::::&-0-=..=3:;__8-=3=----Field Sample Number _"3~5'"-_/_7-1---------
Name of Site 4,4f¥C-c_f!A_ Inc. Site Loca;ion ,/20.Jj 5tft d"loc//:iutl(<-IV'<?
Collected By 'Aro;/1LJJA ID# ~~3~8'.~-Date Collected /o2 -!"7--R 6 Time /// S-
Type of Sample:
Concentrate Comments En7onmental
..,,_f_ Groundwater (I) __ Solid (5) @ ?r/oarle t27a/:. w--e.lf
__ Surface Water (2) __ Liquid (6)
__ Soil (3) __ Sludge (7)
__ Other (4) __ Other (8)
INORGANIC CHEMISTRY
Extractables
Parameter Results mg/ 1
__ Arsenic
--Barium
__ Cadmium
__ Chromium
__ Lead
__ Mercury
__ Selenium
__ Silver
--
--
--
--
--
Parameter Results mg/ 1
_P&T:GC/MS ✓
£ Acid:B/N Ext. ,/
_TOX
--Pee_ --
MICROBIOLOGY
Parameter
__ (MF) Coliform Colonies/lO0mls
__ (MPN) Coliform Colonies/lO0mls
--
--
Date Received l) -/ 9-S(,, r:£
•/,A.A.
Total "
Parameter Results mg/ 1 Parameter Results mg/ 1
__ Arsenic __ Silver
__ Barium __ Sulfates
__ Cadmium __ Zinc
__ Chloride _Ph
__ Chromium __ Conductivity
__ Copper _TDS
__ Fluoride _TOC
__ Iron --
__ Lead --
__ Mang~nese --
__ Mercury --
__ Nitrate_ --
__ Selenium --
ORGANIC CHEMISTRY
Parameter Results mg/ 1 Parameter Results mg/ 1
_EDB __ Methoxychlor
__ PCB's __ Toxaphene
__ Petroleum _2,4-D
__ Endrin __ 2,4,5-TP (silvex)
· __ Lindane --
RADIOCHEMISTRY
Parameter Results PCi/ 1
__ Gross Alpha
__ Gross Beta
--
--
Date Reported ____ /,\-', /2_;;i_"'-7f'-'/~cP-'-.7 _______ _
Date Extracted ~-:rt, t. 8,
Reported By ~ 6/tc'.~
lv
Date Analyzed ~/~-__,_1_-_,Y'---7--"$~£2:c..·=-c:-::--::-------
61 ~340Z Lab Number __________________ _
DHS 3191 (Revised 7/65)
Solid and Hazardous Waste (Review 7 /87)
Purpose:
Preparation
.,
:iZ-' ._;__ ~ ::/ ·. . ,. •·q,~ .c,. . . ~ .. 1,
'. l . ---····-···· -··
Enforcement and compliance with the N. C. Solid and Hazardous Waste Management Rules.
A sample analyses request form (OHS 3191) must be completed for each type of evaluation requested ( e.g.,
inorganic, organic, microbiology, radiochemistry). For sampling conditions which require 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
cOllector must th~~ write the site and sample number on the duplicate.
Do not submit an analysis request sheet with no parameters indicated.
Equivalent measurements:
ppm= µg/ml = mg/I =µgig= mg/kg
ppb = µgl I = µg/ 1000g = 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, resins, 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
Disposition:
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.
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;'Oepartment of Human Resources
Division of Health Services SAMPLE ANALYSES REQUEST
State Laboratory of Public Health
P. 0. Box 28047
306 N. Wilmington Strttt
· Raleigh, 2761 I
9.!L l::, 00 3 2. ~ 3 g 3 Field Sample Number --·~,J~S:_/...,· "~-------Site Number
Name of Site --,,4'-'-"~'1/¥-/,-C'CL~--'· ~-· ...,.(:A_,,__,. ,--L=n.,__l..,,,c.D#· ~--=-~~-=--=-~---Site Locatiop #q 51(:,. &laca ~ ;ut/(<-N'C'
Collected By ~.f1.tl:£.,tJ. 38'. Dare Collected /o2, -l'r -R 6 Time ;,3 0 (\
Type of Sample:
En7onmental
~ Groundwater (I)
Concentrate .....
__ Solid (5)
___ Surface Water (2) ___ Liquid (6)
__ Soil (3) __ Sludge (7)
__ Other (4) __ Other (8)
Comments
Ceo <JJe. r.ul r2e
INORGANIC CHEMISTRY
Extractables
Parameter Results mg/ 1
__ Arsenic
__ Barium
___ Cadmium
__ Chromium
__ Lead
__ Mercury
__ selenium -
__ Silver
--
--
--
--
--
Parameter Results mg/ 1
_P&T:GC/MS
..,.L.._ Acid:8/N Ext.
_TOX
--Pee._ --
MICROBIOLOGY
Parameter
__ (MF) Coliform Colonies/!O0mls
__ (MPN) Coliform Colonies/ !O0mls
--
--
Date Received \ d · I °i -'(µ; fp ;1.c'I.
Date Extracted /_;--,;LC/-YZ,f:f.·
Total
Parameter Results mg/ 1 Parameter Results mg/1
__ Arsenic __ silver
__ Barium __ Sulfates
__ Cadmium __ Zinc
__ Chloride _Ph
__ Chromium __ Conductivity
__ Copper _TDS
__ Fluoride _TOC
__ Iron --
__ Lead --
__ Manganese --
__ Mercury --
__ Nitrate. --
__ Selenium --
ORGANIC CHEMISTRY
Parameter Results mg/ 1 Parameter Results mg/ 1
_EDB __ Methoxychlor
__ PCB'.s __ Toxaphene
__ Petroleum _2,4-D
__ Endrin __ 2,4,5-TP (silvex)
__ Lindane --
RADIOCHEMISTRY
Parameter Results PCi/ I
__ Gross Alpha
__ Gross Beta
--
--
Date Reported _________________ _
Date Analyzed ~/_-~/~7~~7y,rc7;": . ...,8r:,ri4),.....,r--'-------
Reported ily ___________________ Lab Number ·fi''.i34U3 :i,
OHS 3191 (Revised 7185)
SoliJ and Ha:.irdous Waste (Rt:view 7187)
N.~C. Department of Human Resources
Divbion of Health Sen1ices SAMPLE ANALYSES REQUEST
State Laboratory of Public Health
P. 0. Box 28047
306 N. Wilmington Street
Site Number 9..2.-/) 00 3 2. &-0 3 8 3 Field Sample Number
Raleigh, 27611 3511
Name of Site ,6JJ~rc {:A J rn C. Site LocatiOP ,lll4J 5'/,, t:21Auz:;u1/(-e.. N'C
Collected By ,/1-r-'liJ O /1.,()J,,1 ID# -~3~8'.~-Dace Collected /c2 -I?--f? 6 Time / 3 'IS
Type of Sample:
Enyonmental
....f__ Groundwater ( 1)
Concentrate
__ Solid (5)
Comments
Q)IJJ,l(,am 812rbee ol-fr2e
__ Surface Water (2) ___ Liquid (6)
__ Soil (3) __ Sludge (7)
___ Ocher (4) __ Ocher (8)
INORGANIC CHEMISTRY
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/ I Parameter Results mg/ 1 Parameter Results mg/ 1
_P&T:GC/MS _EDB __ Methoxychlor
->L-Acid:B/N Exe. __ PCB's __ Toxaphene
_TOX __ Petroleum -2,4-D
--Pf~
__ Endrin __ 2,4,5-TP (silvcx)
--__ Lindane --
MICROBIOLOGY RADIOCHEMISTRY
Parameter Parameter Results PCi/ I
__ (MF) Coliform Colonies/!OOmls __ Gross Alpha
__ (MPN) Coliform Colonies/lOOmls __ Gross Beta
----
----
Date Received IJ ~ /9-~ ffi
, A.,9.
Date Excractec:l k;l-..2'1-J/, j[g ·
Dace Reported __________________ _
Reported fly
Date Analyzed _,__/_-_,__7_-~y'-:-· --'7_,8__;,l/.._ _______ _
----------------Lab Number _____ 6_'._·)_J_,,_\_0_4 _____ · , __ _
DHS 31 QI ( Rt•\'i!>t~d 7185)
S1,liJ :ind Ha:ardous \Va~te (Review 7/87)
N. c:· Department of Human Resources
Di,rision of Health Services SAMPLE ANALYSES REQUEST
State Laboratory of Public Health
P. 0. Box 2804 7
. 306 N. Wilmington Street
Raleigh, 2761 I
Site Number 9.2-}) 00 3 2-&-0 3 g 3 Field Sample Number _ _,3::::....::,~c.....::c~-O_· ________ _
NameofSite -1-~~,c;.,3/¥=,::-_,_c_· &~.,-,L=n~· c.=-· ----Sitel-ocatiOP //al' ,'if__ elu>ca~nl!l(<-A/(:'.
Collected By '/4fu;/1N4 · ID# -~3~8'.--Date CoUected
I
Jo2-!?~ £ 6. . Time l'/:'fS.
Type of Sample:
Enyonmental
J..L __ Groundwater ( 1)
___ Surface Water (2)
__ Soil (3)
__ Other (4)
Concentrate
__ Solid (5)
__ Liquid (6)
__ Sludge (7)
__ Other (8)
Comments ..
/larcR,'a7 ,. ,ie I/
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 _ms
__ Selenium __ Fluoride _TOC
__ Silver __ Iron --
--__ Lead --
---__ Manganese --
--__ Mercury --
--__ Nitrate. --
--__ Selenium --
ORGANIC CHEMISTRY
-· · Parameter Results mg/ I Parameter Results mg/1 Parameter Results mg/ 1
_P&T:GC/MS _EDB __ Methoxychlor
_L Acid:B/N Ext. __ PCB's __ Toxaphene
_TOX __ Petroleum _2,4-0
--PCP
__ Endrin __ 2,4,5-TP (silvex)
--__ Lindane --
MICROBIOLOGY RADIOCHEMISTRY
Parameter Parameter Results PCi/ l
__ (MF) Coliform Colonies/l00mls __ Gross Alpha
__ (MPN) Coliform Colonies/lOOmls __ Gross Beta
----
----
Date Received I ;)_ · I S -'.i,la tj/:?
/J..,' .
Date Extracted /,;:>2z-%,?' -fl·~'
Reported By
Date Reported ----------:,-----------
0 A I d /-7 -Y7 8lJJ . ate na yze -'---'---=_ "--i6-,...,1,..3,..,4.,._F,OHS.,_ _____ _
Lab Number ___________________ _
flt-IS 3191 (R,•.'iscd 7165)
Sc.~liJ and Ha:ardous \Vastc (Review 7 /87)
N. C."Oep,atment of Human ResotJrccs
Uivision of H~<>.l:h Sen:iccs SAMPLE ANALYSES REQUEST
State Laboratory of Public Health
P. 0. Box 28047
. 306 N. Wilmington Street
Raleigh, 2761 I
Site Nurnber _,_9_,'!l-=-_..,/)...,___,,O:c,0"--3"---"'2.~0-0C-.-'=:...:3::c...:8=--==3"----Field Sample Number· __ 3...,_5_'2-,,_.cJ.J_· ·_·_· ' ___ ._.:_-_· ·_· ·_. '_· _
Name of Site
Collected By
·~ff; 6) Z:n C. Site Lo~atiop ,&1f sr,. fll40~1Uil("'L ;1,/C
./it;t:;f;-R f/L>-(A · ID# __ __,_3,8',,_,__ Date Collected /,,2, -[7--Jc 6 _Time /S .J.S
Type of Sample:
En7onmental
.J..L___ Groundwater (1)
Concentrate
__ Solid (5)
Comment&
,hbo tll-ed/10 u,ele
___ Susface Water (2) ___ Liquid (6)
__ Soil (3) __ Sludge (7)
__ Other (4) __ Other (8)
INORGANIC CHEMISTRY
Extractable& Total
Parameter Results mg/ 1 Parameter Results mg/1 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
I Pararnf.:ter Results mg/ 1 Parameter Results mg/ 1 Parameter Results mg/ 1
I
__ P& T:GC/MS _EDB __ Methoxychlor
L Acid:B/N Ext. __ PCB's __ T oxaphene
_TOX __ Petroleum _2,4-D
=7?.ep
__ Endrin __ 2,4,5-TP (silvex)
__ Lindane --
MICROBIOLOGY RADIOCHEMISTRY
Parameter Parameter Results PCi/ 1 .
__ (MF) Coliform Colonies/lOOmls __ Gross Alpha
__ (MPN) Coliform Colonies/lOOmls __ Gross Beta
-----
----
Date Reported __________________ _
Date Analyzed _....:/c.--..:..j_· -_Y,r]...,..-,:,6.,..-,'J]).=-· =-:,------'---
t) >34.06 Lab Number _________________ _
DHS3191 fl-lcvised7/35)
Solid ;in,l Ha:ardou~ \'(lam• ( Red~w 7187)
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
9 k o ?<~1-----'
Site Number L-!)_~-o~O~Q~3~2.~&-0"---'~3=c._o~3=c._ ___ Field Sample Number ___ _2...,,__,J:..._ _________ _
Raleigh, 27611
Name of Site ---1-4~-P-'3/¥µ.:t::..:....C.LC _,,6_..&<....,...,...,,L<.LnL,c..=------Site Locatior ,lu4j 5tfi elu>uz ~,-ut!(<-IV<:'.
Collected By '/4fu; flt>-/4 ID# -~3~8'.--Date Collected /,,2 -/ ?--f? 6 Time /7 Z.. 0
Type of Sample:
En7onmental
....f__ Groundwater ( 1)
Concentrate
__ Solid (5)
Comments
<&J Lou.-t'.s 8r1,6ee ,&If
___ Surface Water (2) ___ Liquid (6)
__ Soil (3) __ Sludge (7)
__ Other (4) __ Other (8)
INORGANIC CHEMISTRY
Extractables
Parameter Resu Its mg/ 1
__ Arsenic
--Barium
__ Cadmium
__ Chromium
__ Lead
__ Mercury
__ Selenium
__ Silver
--
--
--
--
--
Parameter Results mg/ 1
_P&T:GC/MS
...i,L_ Acid:B/N Ext.
_TOX
--PCP --
MICROBIOLOGY
Parameter
__ (MF) Coliform Colonies/!OOmls
__ (MPN) Coliform Colonies/JO0mls
--
--
Date Received \;;J-1 °i -'6\o · yf3
-~.A.
Date Extracted /,il-;.29--f'b /;,. ·
Total
Parameter Results mg/1 Parameter Results mg/ 1
__ Arsenic __ Silver
__ Barium __ Sulfates
__ Cadmium __ Zinc
__ Chloride _Ph
__ Chromium __ Conductivity
__ Copper _TDS
__ Fluoride _TOC
__ Iron --
__ Lead --
__ Manganese --
__ Mercury --
__ Nitrate --
__ Selenium --
ORGANIC CHEMISTRY
Parameter Results mg/ I Parameter Results mg/ I
_EDB _· _ Methoxychlor
__ PCB's __ Toxaphene
__ Petroleum _2,4-D
__ Endrin __ 2,4,5-TP (silvex)
__ Lindane --
RADIOCHEMISTRY
Parameter Results PCi/ I
__ Gross Alpha
__ Gross Beta
--
--,
Date Reported __________________ _
Date Analyzed _l_----'-'-,Y_--:-':Y7--t:.6~-'!,...:'1'2',4""'o~·-,,__ ____ _
Rcpo1tcd By ___________________ Lab Number __________________ _
DHS JI OJ ( Rcvi~cd 7185)
SoliJ anJ Ha.:ardous Waste (Review 7187)
STATE LABORATORY Of PUBLIC HEALTH
DIVISION OF HEALTH SERVICES, N.C. DEPARTMENT Of HUMAN RESOURCES
P.O. BOX 28047 -306 N. WILMINGTON, ST., RALEIGH, N.C. 27611
ORGANIC CHEMICAL ANALYSIS
BASE/NEUTRAL AND ACID LAB NO /_t) C,1/n ~ 1.b.3yo =? /.03<10 'I /_03</nc--/-03</nt,
EXTRACT ABLES
COMPOUND
N-nitrosodimethvlamine
bi s(2-ch loroethvl )ether
2-chlor~henol
ohenol
1.3-dichlorobenzene
1.4-dichlorobenzene
1.2-dichlorobenzene
bis(2-<:hloroi llether
hexachloroethane
N-nitroso-di-n lamine
nitrobenzene
i~l'V'>horone
2-nitroohenol
2. 4-dimethvlnheno l
bis(2-<:hloroethoxvlmethane
2 4-d i ch l o=heno l
1.2.4-trichlorobenzene
n•nhthalene
hexachlorobutadiene
4 chloro--m-cresol
hexachlorocvcl~ntadiene
2.4 6 trichloroohenol
2-chloronanhthalene
acenaohthvlene
dimethvl ohthalate
2.6-dinitrotoluene
acenaohthene
2.4-dinitrnnhenol
2 4-dinitrotoluene
4-nitrmhenol
fluorene
4-chloroohenvlohenvlether
diethvl ohthalate
4 6-di ni tro-o-creso l
giohenvlamine
azobenzene
4-br=henvlohenvlether
hexachlorobenzene
n<>ntachlornnhenol
ohenanthrene
anthracene
dibutvl ohthalate
fl uoranthene
6-F t1,1.U><d.. ~ ,6'/a.-,.A..
J -Estimated value.
FIELD# 3S-J 7 3Stfl
TYPE ( I l C / l
UNITS 7.'.::; i) un/kq Cn/Vun/ka
/A u.. u,...
\ I
-<o
10 <o
10
I
.J/
"'D
.I, ,o
I{)
.c:o
10
I
A
J, . , r
K -Actual value ls known to be less than value given.
~,,q 3.s;,o
< I l 1 I l
r.,n/ 1) un/ka uni]) un/kn
t.t.-,.,.....
,V /
L -Actual value is known to be greater than value given .. U -Material was analyzed for but not detected. The nUTber is the Minil!Ull Detection Limit.
NA -Not analyzed.
1/ -Tentative identification.
~I -On NROC List of Priority Pollutants.
,~. C. V-<-v,U-<-on 06 HeaLth SVtv-<-cv.,
VIJS 3068-0 (4/86 La.botta,totty)
-_.....,...;! I
< I l
--~;1>-·•/ka
,
,
/4o3Yo 7
35~.;i.
C / l
un/ l )ua/kQ
I.,(..
I
BASE/NEUTRAL AND ACID
EXTRACTABLES
STATE LABORATORY Of PUBLIC HEALTH
DIVISION OF HEALTH SERVICES, N.C. DEPARTMENT Of HUMAN RESOURCES
P.O. BOX 28047 -306 N. WILMINGTON, ST., RALEIGH, N.C. 27611
ORGANIC OlEMICAL ANALYSIS
LAB NO '~O::, 'i-O.).. {,,c,3<.k, ~ /.o,:::/Yo<f /,,03YDS
FIELD# 3S/7 3SI J1 ::,s-; q ::;"S".;l.D
TYPE ( l l I I l I I l { /l
/.D.3</00
"!S,;l /
{ /l aJl1POUND
UNITS /4n/ 1J uo/ko ,::::-/ i°"L"/kn ··•"/1 \."/ko ,r.,n/ l ~,n/ko Aon/] 'l,n/ka
nvrene 10 LL -µ, , •
benzidine So
butvl benzvl ohthalate Ir,
benz(a)anthracene I
chrvsene J/
3,3-dichlorobenzidine ,c;'O ' ,
bis(2-ethvlhexvllohthalate J O .11 I/JY
di-n-octvl ohthalate JO L,L.-
benzo(blfluoranthene <; t)
benzofklfluoranthene
benzo(alnvrene
i ndeno ( l 2. 3-cdl nurene
dibenzo(a.hlanthracene
benzoln h. il,.,..rvlene ' /
aniline ,::;o
benzoic acid I
benzv l alcohol ,I,
4-chloroaniline ID
dibenzofuran "·
2-rrethvlnaohthalene
2-rrethvlohenol
4-rrethvlohenol " 2-nitroaniline .... 0
3-nitroaniline
4-nitroaniline
2.4.5-trichlONV>henol .I/ / ✓ I, ./
.
ffli>L
8-~-0c.>,(Jt~ ..«j/L
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. The nurl>er is the Mini11>.JT1 Detection Limit.
NA -Not analyzed. 1/ -Tentative identification.
~/ -On NRDC List of Priority Pollutants.
N. C. V-i.v-i..1.,-i.on 06 He.a.Uh Sv,_v-i.cv..
VHS 3068-0 (4/86 Labolta.to~y)
., ~ ..
/
/-n =i<//J7
~S.;1.::L
{ / l
·.,a/ l)un/ko
t,i_
' ,
I
I
I
I
I
I
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
Raleigh, 27611
Site Number _9'-'r2-"'. "'---4/)._,.__.Q.,_O>J...<,3..,_.,;J_~Q~D"--,_3~J?"'--"3=---Field Sample Number -~3---=5~2~3~---------
Name of Site .,_4-'-"-!!·µ4'-f'f)«..£Fµ_.:..,_')_
0
_.__~ ... ·~.,_,,.-,._Z:..,_n~c.-~---Site Location ffe!j 5'f > @oc/'1,/111"//e /Vf!.
Collected By _,_£&._..,,.,.__~i_~b:.=~P __ ,.,IYJ,_=J~-~•4--~--ID# ' 3 g Date Collected · //J -I 7-,!" C. · Time /// ,5·
Type of Sample:
Environmental . Concentrate Comments
~ Groundwater (!). __ Solid (5) ([) lo 'aa7le tllal: tit-f/f
__ Surface Water (2) __ Liquid (6)
__ Soil (3) __ Sludge (7)
__ Other (4) __ Other (8)
INORGANIC CHEMISTRY
Extractables Total
Parameter Results mg/ 1 Parameter Results mg/ 1 Parameter Results mg/ 1
__ Arsenic __ Arsenic __ Silver
__ Barium __ Barium __ Sulfates ,i,'
__ 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/ I Parameter Results mg/ I Parameter Results mg/ I
_P&T:GC/MS _EDB __ Methoxychlor
__ Acid:B/N Ext. __ PCB'.s __ T oxaphene
_TOX __ Petroleum -2,4-D
.PIZ_P ,;--~.2 c.
__ Endrin __ 2,4,5-TP (silvex)
✓ __ Lindane --
-L,. ,,,../,'; /',._ -J'l•.a ,/J , M1CROBIOLOGY RADIOCHEMISTRY
Parameter Parameter Results PCi/ I
__ (MF) Coliform Colonies/lO0mls __ Gross Alpha
__ (MPN) Coliform Colonies/lO0mls __ Gross Beta
----
----
-
Date Recdved ... !~2-~·-t~l\~-~&'t'"~=ft>=-~----------Date Reported _________________ _
/-!.'" -J7 -~.:f!-I I 2 ,, z L? .n
Date Extracted ~-~-~-~~O~~=------------Date Analyzed _,__-_,_~.J,,_-__.{L,.__,c_.,,O=,l,Y""-----------
f ,B.
Reported By ------------------Lab Number 603408
DHS 3191 (Revised 7/85)
Solid and Hazardous Waste (Review 7 /87)
L__
Purpose:
Preparation
Enforcement and compliance with the N. C. Solid and Hazardous Waste Management Rules.
A sample analyses request form (OHS 3191) must be completed for each type of evaluation requested (e.g.,
inorganic, organic, microbiology, radiochemistry). For sampling conditions which require 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
collector must then write the site and sample number on the duplicate.
Do not submit an analysis request sheet with no parameters indicated.
Equivalent measurements:
ppm= µg/ml = mg/I =µgig= mg/kg
ppb = µgl I = µgl 1000g = 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, resins, 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
Disposition:
P. 0. Box 28047
Raleigh, NC 27611
2. Lab sends copy fo Solid and Hazardous Waste Management Branch.
3. Solid and Hazardous Waste Management Branch sends copy to field person.
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 SAMPLE ANALYSES REQUEST
State Laboratory of Public Health
P. 0. Box 2804 7
306 N. Wilmington Street
Raleigh, 27611
Site Number 9cJ.-D OQ ,3 .2 0 Q 3f?3
~:~:c~:ds~: ia:t;~:, w:~ 3 g
Field Sample Number ___ · ~3~5=c1,_· ·_J+·· _________ _
Site Locario~ ffe/y 5.tf > /JZ.aoCt°[IJ//le, Nf,
Date Collected //J -I 7-g l . Time 1,3 DO
Type of Sample:
Environmental . Concentrate Comments
--✓--Groundwater (1) __ Solid (5) (j} ,Hime:? &u/£ tJ.tff(
__ Surface Water (2) __ Liquid (6)
__ Soil (3) __ Sludge (7)
__ Other (4) __ Other (8)
INORGANIC CHEMISTRY
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 _Toe
__ 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 _EDB __ Methoxychlor
__ Acid:B/N Ext. _PCB's __ T oxaphene
_TOX __ Petroleum _· 2,4-D
/-7e."7' ti-~ e c:
__ Endrin __ 2,4,5-TP (silvex)
✓ __ Lindane --
,().i,1/\.A.,./,', , .... __ .......... ~ ,IJ
r MiCROBIOLOGY RADIOCHEMISTRY
Parameter Parameter Results PCi/ 1
__ (MF) Coliform Colonies/lO0mls __ Gross Alpha
__ (MPN) Coliform Colonies/lO0mls __ Gross Beta
----
----V
Reported By
Date Received _11-2..=--_,l'.3__,_-...,'o,p=~fD'="'-___ --'-_______ Date Reported _________________ _
' ·e.D.
Date Extracted ~L_-~/~.2,~~-?~1....,,.il.~-~~~-___________ Date Analy:ed ------::------------
A~ 6
---------------Lab Number -'\J,JQ9
!)HS 3 I 91 ( Revi«d 7185)
SoliJ anJ Ha:.irdous Waste (Re..-iew 7/87)
>t c-f-a~/e:., /f"'f:ftroe-£ c).J-{1/1_ A., 2-/Yi/ tJ :F / f /Yl Jlz. cf0'-1
. '
N,.C. Department of Human Resources
Divbion of Health SerYices SAMPLE ANALYSES REQUEST
State Laboratory of Public Health
P. 0, Box 2804 7
306 N. Wilmington Street
Raleigh, 2761 I
__.9'-'4""'--l:..b,.l-'o~o'--''""3..,2~()...,_,[)~3~f?~3~--Field Sample Number ~3~~-'2-~5~--------
Name of Site !0tP::''~t1; Zn(. ? Q Site Locario!' ;¾oy st, /llco0:rvi"lle /Ve<
Collected By ,Y-ix.;Lf)e KA f 4.. 10# -~~.,,_,_Q...,__ Date Collected · /,Q -I 7-r:f C. Time / 3 'f..:,
Site Number
Type of Sample:
Environmental . Concentrate Comments
~ Groundwater (n __ Solid (5) @ ~ ?(/t1/4'al1:J 8arke. at-et!(
___ Surface Water (2) ___ Liquid (6)
__ Soil (3) __ Sludge (7)
__ Other (4) __ Other (8)
INORGANIC CHEMISTRY
Extractables
Parameter Results mg/1
__ Arsenic
--Barium
__ Cadmium
__ Chromium
__ Lead
__ Mercury
__ Selenium
___ Silver
--
--
--
--
--
Parameter Results mg/ I
_P&T:GC/MS
__ Acid:13/N Ext.
_TOX
✓ 712P t:: ~1ec
A1A/J,.,,,,-I,', I'-........ ..-,.~ A
V MiCROBIOLOGY
Parameter
__ (MF) Coliform Colonies/l00mls
__ (MPN) Coliform Colonies/!O0mls
--
--
Date Received I 2-llli -'ik, f6
'.?, µ
Dute Extracted /-J;;L-ff7 lt.P.' F.B.
Total
Parameter Results mg/ 1 Parameter Results mg/ l
__ Arsenic __ Silver
__ Barium __ Sulfates
__ Cadmium __ Zinc
__ Chloride _Ph
._Chromium __ Conductivity
__ Copper __ TDS
__ Fluoride _Toe
__ Iron --
__ Lead --
__ Manganese --
__ Mercury --
__ Nitrate --
__ Selenium --
ORGANIC CHEMISTRY
Parameter Results mg/1 Parameter Results mg/ 1
_EDB __ Methoxychlor
__ PCB'.s __ T oxaphene
__ Petroleum _2,4-D
__ Endrin __ 2,4,5-TP (silvex)
__ Lindane --
RADIOCHEMISTRY
Parameter Results PCi/ 1
__ Gross Alpha
__ Gross Beta
--
--
Date Reported __________________ _
Dote Analyzed ------t~'4P'7'-+fl---------6 ·3410
Rl'pnrted By ___________________ Lab Number __________________ _
OHS 3 I QI ( Rc:\'iscd 7 /85 l
S\}li,J and Ha~::irdous \'\/astc (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
Raleigh, 2 7 6 I l
Site Number _9,_,;1...s.,::c_,{)t..1-...sO"'--'-Q'--','-'3'-",2""-'-Q.,_· .,_Q<-··_.3..,_,_,f?c..=3.,_ __ Field Sample Number --·~3....._.5'"-"2,"-·-'-(t,'-._· _______ _
Name of Site 4,a~,~~~; W'IDC# . ?O SiteLoca~ion,1/uLy st7. /21.ac,Citt/J//e. NL
Collected By J!&_i_flE lfdl..f.4.. ~ 0-Date Collected · 1/1 -I 7-<f C, : Time / <f ½S
Type of Sample:
Environmental . Concentrate
~ Groundwater (1). __ Solid (5)
Comment,;
@ Geoo/e /!arm 01 (Of/{
___ Surface Water (2) ___ Liquid (6)
__ Soil (3) __ Sludge (7)
__ Other (4) __ Other (8)
INORGANIC CHEMISTRY
Extractables
Parameter Results mg/ 1
--Arsenic
__ Barium
__ Cadmium
__ Chromium
__ Lead
__ Mercury
__ Selenium
__ Silver
--
--
--
--
·--
Parameter Results mg/ 1
_P&T:GC/MS
__ Acid:B/N Ext.
_TOX
✓ 'Pe.7' of-&'ttrn C
,r,i,, -'-'r ,. ---· /}
, MICROBIOLOGY
Parameter
__ (MF) Coliform Colonies/lO0mls
__ (MPN) Coliform Colonies/l00mls
----
Date Received 12.-I 9 -'&-v y.l'=,
I "1 tJ.D. Date Extracted -/;;L-6r: ?. .-a.
Reported By
DHS 3191 (R,vised 7165)
Soli,l and Ha:ardous Waste (Review 7/87)
Total
Parameter Results mg/ 1 Parameter Results mg/ 1
__ Arsenic __ Silver
__ Barium __ Sulfates
__ Cadmium __ Zinc
__ Chloride _Ph
__ Chromium __ Conductivity
__ Copper _TDS
__ Fluoride _TOC
__ Iron --
__ Lead --
__ Manganese --
__ Mercury --
__ Nitrate --
__ Selenium --
ORGANIC CHEMISTRY
Parameter Results mg/1 Parameter Results mg/1
_EDB __ Methoxychlor
__ PCB'.s __ T oxaphene
__ Petroleum _2,4-D
__ Endrin __ 2,4,5-TP (silvex)
__ Lindane --
RADIOCHEMISTRY
Parameter Results PCi/ 1
__ Gross Alpha
__ Gross Beta
--
--
Date Reported __________________ _
Date Analyzed ------,::----,,---c--c----'--'--------
6 '. i 3411 Lab Number __________________ _
;¢ _·cfa"pl&:i /p{:Jero-e-£ ,µ-/YL ~ 2 rn I ":r / f II/ 112-cfOf.f
' ' '
N. C: Department of Human Resources
Divi!,ion of Health Services SAMPLE ANALYSES REQUEST
State Laboratory of Public Health
P, 0. Box 28047
306 N. Wilmington Street
Site Number 9dl-l) OQ 3 .2 0 D 38'3
Name of Site .K_~ 4 OfC 5 {:~ :Z:0 C
Collected By ~ t:be/Q\(A; 10# . ,3 z?
I
Type of Sample:
Environmental . Concentrate
____:,L_ Groundwater ( n __ Solid (5)
___ Surface Water (2) ___ Liquid (6)
__ Soil (3) __ Sludge (7)
__ Other (4) __ Other (8)
Raleigh, 2761 I 3 0'2, 7·. Field Sample Number--''-----"-----------
Site Locarion /luJy 5f, /J1..acCi[cl;"//e /Ve_
Date Collected 1/1 -I 7-g (,, Time /. 5 J ,5"
Comments
rff) ,7:21,~ /JJedl,'o Ul-(/f
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
__ Selenium __ Fluoride _Toe
__ 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 _EDB __ Methoxychlor
__ Acid:B/N Ext. __ PCB's __ T oxaphene
_TOX __ Petroleum _2,4-D
7'<l_p c ~.ec
__ Endrin __ 2,4,5-TP (silvex)
✓ __ Lindane --
,;{)~IJ,._,.-1.',, /' ,,._ -.,., . ;J
' MiCROBIOLOGY RADIOCHEMISTRY
Parameter Parameter Results PCi/ I
__ (MF) Coliform Colonies/lOOmls __ Gross Alpha
__ (MPN) Coliform Colonies/lOOmls __ Gross Beta
----
----
Date Received _1_'2_.-_I_C\_-i.,~~\-13~----------Date Reported ________________ _
Date Extracted ~J_-~/~.,2.;_-~$7~7-~:=ri,P,,;-~-•---------Date Analy:ed ----.,f,fj~)r.~Jti4'rl1f-i2&--------
F; 8, • .. '
Reported By -------------------Lab Number __________________ _
DH~3191 (Revi!ted?/85)
s~)!iJ anJ Ha;:ardous Waste (Re\'iev.: 7187)
_ :t ·JatrJp;e:i /vreJe,u-e-£ iJ_J--(YL A., 2-m/ ti'r Jf/Yl 112-JO'-f
. . . ' .
N~-C. Department of Human Resources
Divi~ion of Hea.lth Services SAMPLE ANALYSES REQUEST
State Laboratory of Public Health
P. 0. Box 28047
306 N. Wilmington Sneer
Site Number
Name of Site
Collected By
Raleigh, 27611
__.9c..,4-=-..-'b_,__,o""-'"'o'-'''-'-3...,:1.~() .... ·'-"0"'-'3~8'c....3~--Field Sample Number --·-3:c...._5,__J,..·'-""g"---------
&_~0 ~= ~; ·ealDC# ?O SiteLocatio~/luly st? /JJ.ac,Ct./11;/le IV~.
t:f5i:Lfle j(,!}J.A... Q. 0-Date Collected . /:J -I 7-rf C. Time / 7 2-(J
Type of Sample:
Environmental
~ Groundwater (I)
. Concentrate
__ Solid (5)
Comments W .l.. t>WS darbee u.>-eif
__ Surface Water (2) ___ Liquid (6)
__ Soil (3) __ Sludge (7)
__ Other (4) __ Other (8)
INORGANIC CHEMISTRY
Extractables
Parameter Results mg/ I
__ Arsenic
--Barium
__ Cadmium
__ Chromium
___ Lead
__ Mercury
__ Selenium
__ Silver
--
--
--
--
--
Parameter Results mg/ I
_P&T:GC/MS
__ Acid:B/N Ext.
_TOX
✓ _297_p ,,_. ~\(!_I"'""
Alhii,v, ,../,',, ,_ -_,., ~ /)
V MiCROBIOLOGY
Parameter
__ (MF) Coliform Colonies/!00mls
__ (MPN) Coliform Colonies/l00mls
--
--
Date Received \2-A-i'l.o ffi
'l3,D,
Date Extracted J -/J._ --5?7 11'.~ F, .
Total
Parameter Results mg/ I Parameter Results mg/ I
__ Arsenic __ Silver
__ Barium __ Su.I fates
__ Cadmium __ Zinc
__ Chloride _Ph
__ Chromium __ Conductivity
__ Copper _TDS
__ Fluoride _Toe
__ Iron --
__ Lead --
__ Manganese --
__ Mercury --
__ Nitrate --
__ Selenium --
ORGANIC CHEMISTRY
· Parameter Results mg/I ParametCr Results mg/1
_EDB __ Methoxychlor
__ PCBls __ Toxaphene
__ Petroleum _2,4-D
__ Endrin __ 2,4,5-TP (silvex)
__ Lindane --
RADIOCHEMISTRY
Parameter Results PCi/ I
__ Gross Alpha
__ Gros:. Beta
--
--
Date Reported __________________ _
Date Analyzed -----..,==·•·r.· .r··...,· .. •---------
Reported lly
6: ·;3413 ___________________ Lab Number __________________ _
DHS 3\Gl (Revised 713;)
S,,lid and Ha:ardous Waste (Re\'ie'.""· 7/87)
..
BASE/NEUTRAL AND ACID
EXTRACTABLES
STATE LABORATORY Of PUBLIC HEALTH
DIVISION OF HEALTH SERVICES. N.C. DEPARTMENT Of HUHAN RESOJRCES
P.O. BOX 28047 -306 N. WILMINGTON, ST., RALEIGH, N.C. 27611
ORGANIC CHEMICAL ANALYSIS
LAS NO -'-o 3<1o .v ' o3WJ'1 .,_,..3y;o /ACJ3Y/I
FIELD# 3'$..23 -=,-5c,?V -=,s-~s-"'\~O( /A
TYPE ( / ) c I l ' I l { / }
/-03Y/°""'
"1-.!,-;;,i 7
( / ) COIIPOJND
UNITS I .. n/1J un/ko ,;,n;jra/ko ,/,.a/ 1) un/ko V.,n/1 J .. n/ko r.,n/ J) un/ka
N-nitrosodirrethvlamine
bis(2-chloroethvllether
2-ch lornnheno 1
phenol
1.3-<lichlorobenzene
1,4-<lichlorobenzene
1.2-<lichlorobenzene
bis(2-chloroi llether
hexachloroethane
N-nitroso-<li-n~rnnuJamine
n i trobenzene
1 cnnhorone
2-nitroohenol
2 4-<lirrethvlohenol
bis(2-chloroethoxu1rrethane
2.4-<lichloroohenol
1,2,4-trichlorobenzene
nanhthalene
hexachlorobutadiene
4-chloro-m-cresol
hexachlorocvclooentadiene
2.4.6-trichlorophenol
2-chloronanhthalene
acenanhthvl ene
dirrethvl ohthalate
2,6-<linitrotoluene
acenanhthene
2 4-<linitr~henol
2.4-<linitrotoluene
4-nitrnnhenol
fluorene
4-chlornnhenvlohenvlether
diethvl Phthalate
4 6-<linitro-o-cresol
diphenvlamine
azobenzene
4-b~henvlohenvlether
hexachlorobenzene , ,
=ntach lor~heno 1 ,L-:i11--_/J,t) .//,t) < /. /) < 1,0
ohenanthrene i·
anthracene
dibutvl Phthalate
fl uoranthene
J -Estimated value. 7) // ,{_ • K -Actual value is known to be less than value given. r'c:/J /i/1,t:? I/ 5 ' 5
L -Actual value is known to be greater than value given. U -Material was analyzed for but not detected. The nurrber is the Mininun Detection Limit.
NA -Not analyzed.
1/ -Tentative identification.
~/ -On NROC List of Priority Pollutants.
N.C. Viv-<..1,ion 06 HeaLth Sv,_vi~v..
VHS 3068-0 (4/86 Labo1LaJ:01Ly)
</,{)
{po. iif JJ
'l,S .;.z y
{ / )
V,-,n/] l,n/ka
<I, ll
N. C: DEPARTMENT··ot HUMAN RESOURCES
DIVISION OF HEALTH SERVICES
SOLID AND-HAZARDOUS WASTE MANAGEMENT BRANCH
Chain of C~~~ody Record· ··
.. :.-
Ha'zar'dous Waste Materials
>"l;'.'."' -. ~
... , .·;,),i','. ~· .. ;•:· ... , -,--. ~
Location of Sampling: Generator __ Transporter _Treatm_ent Facility
Storage Facility · Disposal Facility .. · Landfill :·": < ..
. V Oth~r: c24'nd2 ~vlL.I QI&-£ ~cc fP;_o~Z,c_ ''
Company's Name frr'rf&:jt/e, mateads Telephone(, __ ) ________ .
Addm, 6fw-~· ~~o l?2oea'ut,l#,. IV<"..
Collector:s Nale.;=·~ Tele_phone(~? {_J33-;BD_t
signature -
Date Sampled . ,/7/,/ 7,/,,/'£ Time Sampled.,/,/ /~ /J7>] ·.
Type of Process Generating Waste. _______________________ _
Field Information
Field Sample No. 35 I / 3523
Chain of Possession:
1. r,I~ e~~
signature inclusive dates
2. /2r;J»~ 7 'sigt{ature.
3.
{/ signature title
Results reported
signature title date
Instructions: Complete all applicable information including signatures, and
submit. with ·.analysis request_ forms.
l'l.·_1,;.·D:EPARTMENT 0F:HUMAN RESOURCES DIVISION OF HEALTH SERVICES_,,.-·.
SOLID. AND HAZARDOUS WASTE MANAGEMENT. BRANCH ' •
Receipt for Samples
The samples described below were collected in connection with the
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 (CERCLA).
( ) Toxic Substances Control Act (TSCA). 15 U .S .C. §2601, et ~-, specifically
Sect:ion ll_of TSCA, 15 U.S.C. 11· 2610.
' Inspector's Address
'
~./d:z ~ /JJ1rr1J&lle '7-liz{ Address I ' -
fj_nn Owner, Ope,·a ::or, or Agent Title
-
'}~ii:·.:iiif;.:_;_,
~.r ·~;r-~
.,.tr· ·:;Jr;
-:· ., .. ~ . . '.,.,.,.,
SAM?LE COLLECTED SAMPLE TYPE DUPLICATE SAMPLES SAMPLE LOCATION -
NUMBEP. DATE TIME WATER SOIL
_I 1z-17j . /JJS' . . ✓
I ...
-·
Recdpt for the sample(s) described
above is hereby acknowledged: ....--i '
OTHER
~~:;,1~-_, .,;\ .. //"-:
. .,✓-.-~ ..... ~U1...L_:::::===----· .r.·.~gnature o! lnspector .
-I _, h4
-;-.,.1f1-~d//f.ef~o1aif ,1cle _ . _
OFFERED ACCEPTED REJECTED ON-SITE OFF-SITE
✓ ~
Receipt/rejection of duplicate or
sa~les i's hereQ ackn_owledge_d:
\: ).l ~ .,(,\L.,
/
split
or Agent
COMH'Sl':rs, ______________________ ___, ________________ _
---------------------------'--------------
• ., ~~L.~.,
'..,',:.: .. ~ ~
Tele_phone(f/f ) 23 -~ -2-~0 /
Type of Process Generating Waste·· . ·----------------------------
Field Information .. ·"·-:::---·· .. ~--:-:--: ~":t' ~ .. ·.. . ' ~-.
_ ·Field Sample No. 3 5 / 2-
...:: . ·.,
Chain of Possession:
signature title , inclusive -dates
3 .---___ -_-_--_-_____________ _
signature title inclusive dates
Results reported
signature title date
Instructions: Complete all applicable information including signatures, and
submit_with·~nalysis request forms.
----------.•. •· >-.:·-r\.,~·..t>;_ '"''b"fvisioN· of HEALTH SERVICES ·. · •,:
SOLID _AND ;~ous _WASTE MANAGEMENT :BRANCH i. •·, ·-: ... : · ·.\stt:t< ::s,
Receip_t for Samples_. , ;_;; '.;':·.; · _ ·· · .. ::"':;_;~< •;/~_-·1.".~~_t_·~-( ___ ~.¥.'/'1
__ ·:;.\.j;.L_:;_}_~.l_::
' ....... ,. __ -·~. •¥•--~~ --~----···-.-• ... --,-
The samples described below were collected in c·onnection with the administration~··;'.~,··:•··•'\';,-
euforcement, and documentation of the:· · · ·i::__ , ·,:· ·-.v(:· ··':._:,;j{,~-;.. •s.)~ii
-,, ... , ,· ~-:·. '; .:_:t
:~-~ ;; 1,~.·.-:_.:::.:
( ) North Carolina Hazardous Waste Management Rules, 10 NCAC lOF ..
• ,d_ ~ -~~.'.e:-lt • ·,' • 1-s-" . . • -'• h. . . .'h . . ) No::-th Carolina Solid Waste Management Rules, 10 NCAC lOG '·
( ) Comprehensive Environmental Response, Compensation and Liability Act· (CERCLA) · ·
( ) To4ic Substances· Control Act (TSCA). 15 U.s.c; §2601,
Section 11 of TSCA, 15 U.S.C. § 2610. .!:.E_ ~-, specifically·.
Inspector's Name
Ne.me of Finn
•
::l.r::ri _0-..ner, . Ope1·a ~er,. or Agent
. -
S1--'1PLE · COLLECTED SAMPLE TYPE
NUMRER DATE TIME WATER SOIL .
~
--·-
--
' I .. ,,.,
Rs,ce:i.pt for. the sample(s) described
,,bove is hereby acknowledged:
Si.gn.B.t~re of Inspector
'.Ii tie,
'
OTIU:R
Inspector's Address
Firm Address
Title
DUPLICATE SAMPU:S SAMPLE LOCATION
OFFERED ACCEPTED REJECTED ON-SITE OFF-SITE
Receipt/rejection of duplicate or split
samples is hereby acknowledged:
Signature of Firm 0.'Der, Operator, or Agent
Title
CDI-'J-[,-":'NTS, _______________________ ...,... ___________ -'-'-------
.. . 'I:~ ... r:. >
Date Sampled
Field Information ---·.-•·-·-•-··• .... · ·•·,: .. ~ .-.~.-;"/".J.--;.,:·~-., ,• _________ ___;_ __________________________ .
.,..-... --·-·. ·.-. ' . -..;.-... ·· ... r• r : -----------------------------...;...; ___ .' -, .. ..... ·: . .. . ::
Field Sample No. 35/ 3 · 3S/9 35,2,5-··
. . ... .. , .. ·-:.--.,..,_. ., ...... -~•· ,. . .. -,..,-,~ ..
• J ••. • , .. , .. _: ...... , .... ··."',!'••!. .. . ·-. -~ ........ --·-··· ....... ~,.--... -~·-···-~· .. -.
Chain of Possession:
title
signature
#J.~!f /114/Jvf ;t;;_" ;~~ 1~>~i;~:j~:.:-· ·
t;-1.tle ?: inclusive dates .... ·
.. tJld~,_~._:7 ., . p/,9 jt7 if'-~i.-.: . .::.:..,:• __ _;;;;;.;....:;;.._t--:i-t~l-e ___ _
'inclusive dates
Results reported
signature title date
Instructions: Complete all applicable information including signatures. and
submit .with :.analysis ·request forms.
. .. 1.·,
·····nivis1bN or ·Hmm sritvicEs ·:
SOLID ~ HAZARDOUS WASTE MANAG~T BRANCH,,.
Receipt for Samples ... '. : -~-• .. _.
. ,!..-: .. ::. . . . . . :: :::: ... ~, ,:-; ... ··:·-:.7:-.:.. ...
The samples described below were collected in connection \11th
enforcement, and doctll:lentation of the: · · · ..... " • "·!.::··
. '
( ) North Carolina Hazardous Waste Management Rules, 10 NCAC l0F
•·. ' • " -'t ..
( ) Non:h Carolina Solid Waste Management Rules, l_0 NCAC l0G .
( ·) Comprehensive Environmental Response, Compensation anjd Liability Act (CERCLA) . ·i
() Toxic Substances· Control Act (TSCA).15 U.s.c; §2601, .!:!~·•specifically·
Section 11.of TSCA, 15 U.S.C. 6 2610.
/2 z7lc ,(i)J 4-
Inspe"ctor's Name
bar-hr>.:f, ,C.,t...-td.;i;~
Name 'of Firm
:Cirm Owner, Opet·atcr, or Agent
-
SAMPLE COLLECTED SAMPLE TYPE
NurfllER DATE TLl1E WATER SOIL
3 I?-'/7~ ·JPlh ✓
-
Receipt for the sample(s) described
2bove i_s-·i'l)ereby acknowledged:
~ .~
OTHER
Firm Address
Title
DUPLICATE SAMPLES SAMPLE LOCATION.
OFFERED ACCEPTED REJECTED ON-SITE OFF-SITE
/
✓ .. / ✓
'
'
..
.
Receipt/rejection of duplicate_ or split
samples is hereby acknowledged:
.: ..
--✓-' .e_;.,..-;;/·?)1. ;1~ -
3ig~ature of Inspector
/:,Ju~~-;f)~ · ..
Signature 01/irn Owner, Oper~tor, or Agent
, , /, __ .. ~ ,t,/--12-~ v__ ht,'(.Z..,..,Lt 1~/...dJ'-7-½ec.,. u ~·~ n ---~ ,, Ti t:'..e ,. . Title
C0~1~Ts,·_ -------------------------,,-------------------
' • I
Location of Sampling: Generator _Transporter
_.,. . . .. .. . --~1•+:r r. .,:. , ·
~TreatmeDt' ·F~~ility
_Storage Facility __ Disposal Facility. ~Landfill ·,}° ·
_Lother: s.
Company's
Type of Process Generating Waste. ________________________ _
' . Field Information
----------------------------------------....... -..
Field Sample No. 3 5° / i
Chain of Possession:
l. /2-; ]-,P( ... , ...
sign ure title inclusive dates
2. &J\z12t-~
· ' signature ·
? _, . /JJ~ ~ /Z,i!J2·~
(f/ signature title .inclusive dates ..
Results reported
signature title date
Instructions: Complete all applicable information including signatures, and ..
submit ~ith ·~nalysis request forms.
DIVISION OF HEALTH SERVICES ..
SOLID AND HAZARDOUS WASTE MANAGEMENT :BRANCH
Receipt for Samples
'·-· ·~·= ' -.. ·--~~-..... ~ . The SBlllples described below tJere collec.ted in connection with the administrat:io:;: •. _··;c·,":.'.·::'_ .-". enforcement. 'and documentation of tb1{: _ ... · .t·•: . . ::; . , ;: ~,:; ..
{) North Carolina Hazardous Waste Management Rules, 10 NCAC lOF
() North Carolina Solid Waste Management Rules, 10 NCAC lOG.
() Comprehensive Environmental Response, Compensation a~d Liability Act (CERCLA)
() Toxic Substances Control Act (TSCA). 15
Section 11.of TSCA, 15 U.S.C. ll 2610.
0 /d/· Inspeb:or_sName
Name
Fino. _Owner,. Op ... 1-atcr,, or Agent
SA1'1'LE · COLLECT"'...D SAMPLE TYPE
1'"1.lMBEP. DATE TIME WATER SOIL
~ /.,J-/Jdf ,:J % ✓-
I I
I
I
Receipt for the sample(s) described.
above is hereby acknowledged: _ . ,;;9z he µ~.,,,_
Sis:t-:a-::ure oi Inspector
OTHER
/Lb,, )7 !Jh,~>"/HC-l~;f:r1
Tir.le /
U .S .C. §2601, .!:!_ ~•, specifically · 's ··
Inspector's Address
Firm Address
Title
DUPLICATE SAMPLES SAMPLE LOCATION OFFERED ACCEPTED REJECTED ON-SITE OFF-SITE
✓ J
"
Receipt/rejection of duplicate or split
samples is hereby. acknowledged·:
dlr~ ~.&~L-= . Signa~of Firn &;ifer, Operator, or Agent
Title
C,.}M!-f:':NTS _______________________ .,... ________________ _
Address
Type of Process Generating Waste '-------------------------•
Field Information
___ , . .., ___ .
·;· ~---~· ·. ~ ...
. . .
. Field Sample No. 55'./'5°
•
·-·r: -.-•--!'-----··••'
Chain of Possession:
l. /J_ -1"7-';y(., ..
title inclusive dates .. ,..,
2. /2-~11-i'G ·;.;2,~r-ri::
i.nclu'sive 'dates . ·
Results reported
signature title date
Instructions: Complete all applicable information including signatures, and_
submit.with·£nalysis request forms.
· nivistoN or -HEAi:ra sERvrcEs
SOLID AND HAZARDOUS WASTE MANAGEMENT BRANCH . . ..
. Rece;t for -~ample:~· .. ~ . t~:\\· :·.; · -'-°"· .,.,
. ~· ..:.., -. '· . ,, -~ ;:. ~/.:_:·•,'.·-··, ··~
< :tl~/,._ ~~-~~;
. ,: ii_ ?'\/;:·:~\:\ . ~· ··~--~ ,-,.,. .,.._ ... ~---··~·-~---... ~-. . . ..... . .. '
: ~._.::: -~,--,:~~--:~ Tne samples described below were collected in connection with the administration;'·. er.forcement, and documentation of the:·-· .. ,·,.:·:•., ·· f• ..
() North Carolina Hazardous Waste Management Rules, 10 NCAC lOF
( ) North Carolina Solid Waste Mana_g_ement Rules, 10 NCAC lOG ·:
( ) Comprehensive Envirorllllental Response, Compensation and Liability Act (CERCLA} . ' . I () Toxic Substances Control Act (TSCA).15 U.S.C. §2601, ~ ~-; specifically Section 11.of TSCA, 15 U.S.C. § 2610. ··;
\ ,/' .,,, ~
/'7:.1-· ~4:· /L,{) ft:.-
Inspector's Name
Name of Fir.n
Firm O.,--ner, .Opiera"or, or Agent
SA.¾PLE . COLLECTED SAMPLE TYPE
liuMBER DATE TIME WATER SOIL -1.;;t::-✓ .5 ✓,:2 -11-1' _., .
I
I I
I'.e.ceipt for the sample(s) described
ab~ve is hereby acknowledged:
Q \/ " /· .,..., 7,-/)_.v l(.n. r (-
OTHER
lns'pector' s Address
'.::)c
Firm A'ddress
Title
DUPLICATE SAMPLES SAMPLE LOCATION OFFERED ACCEPTED REJECTED ON-Sin; OFF-SITE
/ " / ✓ .;
Receipt/rejection of duplicate or split
samples is hereby acknowledged·:
f. ~ ,y .c, ~ · l./11 '-J 1-v jl () ,_,:_,
Signature~f Firm Owner, Operator, or Agent
Title
.
C(l~,TS, ________________ -'---------,-------------------
' .
Address Rf: c2. 42aco:rv c/le..., /2((7 ) J . . ) I
--. Collector's Name &r&et4m Tele_phone(<J/9
signature
> 133-2~tJ/ .. ;. ''':; ·-· !
Date Sampled. ___ ,._/..,q.,__-_,,,_/_7+-....._.cf._....";,.------Time Sampled _ _./'--,;1:,__""'h:J"'--"''---'---
Type of Process Generating.Waste. _________________________ _
V
. Field Information
·Field Sample No. :35/0. 3522-,3,5'J8
•' ..
Chain
. ' . ·•·a>•~;---·-···. --........ _ -·------
1. /c:'d~ / z--t~ -J>(,
inclusive dates.
){! k ,r.,/7
V signature
3 •. -------------------signature title inclusive dates
Results reported
signature title date
Instructions: Complete all applicable information including signatures, and
submit with·~nalysis request forms.
.,
DIVISION OF HEALTH SERVICES
SOLID AND HAZARDOUS WASTE MANAGEMENT BRANCH ·. . .
Receipt for Samples
-i~·tt:?;· ·> ~'?f~t:•
,.
':.he .3amples described below were collec.ted in connection ·with the
~-•, ;. • I ·.· -'•¥-~--... .., ... : :f~:~JJ{J;;:-
administration •. :'.i·i .''.<-:_ ,._·. ,"c>;. enforcement, and documentation of the:,: : ' · · . -· . ' ....
. . -~; '~ ·. ~-~:.:~:-{:~: ?.:'i{_-: I
( ) North Carolina Hazardous Waste Management Rules, 10 NCAC lOF
, ·'. ·,,
() North Carolina Solid Waste Management Rules, 10 NCAC lOG
•.. :..~. . .,,._~(:
( ) ' Co.::iprehensive Environmental Response·, Compensation and Liability Act (CERCLA) . j .
Toxic Substances Control Act (TSCA). 15 U .S .C. §2601, ~ ~-, specifically : -.
Section 11 of TSCA, 15 U.S.C. II 2610. · ·
': . ··: . _,
I~specto~1 s Name Inspector's Address
Name. of Firm Firm Address
Title
. --.-·
SA,'i?LE · COLLECF-D SAMPLE TYPE DUPLICATE SA.l{PLES SAMPLE LOCATION l'ilJl'ffit:R DATE TD1E WATER SOIL
.. I
I I
·-··-
-
li.2cP.ip: for the sample(s) described.
.:bc-ve is hereby acknowledged:
,ignat.1ne of lnspector
OTHER OFFERED ACCEPTED REJECTED ON-SITE OFF-SITE -.
.
-
Receipt/rejection of duplicate or split
samples is hereby acknowledged:
Signature of Finn Owner, Operator, or Agent
Tit.le
-
-
N; 'C •. DEPARTMENT OF HUMAN RESOURCES
DIVISION OF HEALTH SERVICES
SOLID AND'RAZARDOUS WASTE MANAGEMENT BRANCH
,-. _._ .
Chain of ·custody Record
· B~ia;dous Waste Materials
Location of Sampling: Generator __ Transporter ' '· -fo~ .. ,-Treatment Facility
Storage Facility Disposal Facility· · · Landfill
v Other: d&ndl ~vlL. 4 tw: ~cc e-0 Mc... 7 ~ ~ .
Company Is Name '7"i--,,j:¥e., ma teo ds Telephone( __ .) _______ _
Address -1/2.1.7, ~-f?rl. ~Z> l22aco Tv/1/-e •. Ne.
Collector: s Name · ii ;J;-;;;..;; Tele_phone (~/ ;[ : J3 J -:J!l(J /
signature -Date Sampled · ,{¥/ 7,/,,££ Time Sampled ,I,/ /~ /J??J.
Type of Process Generating Waste _______________________ _
'
Field Information
Field Sample No. ::3 ],f'/
Chain of Possession:
l.
2.
3.
n, n .
~/tJ.L_..;,.
signature /k.)k~
1 . · 1signature
signature ,__J
Results reported
signature
inclusive dates
title inclusive dates
title date
Instructions: Complete all applicable information including signatures, and
submit.~ith·~nalysis request forms.
N. C. DEPARTMENT OF HUMAN RESOURCES
DIVISION OF HEALTH SERVICES
SOLID AND HAZARDOUS WASTE MANAGEMENT BRANCH
Receipt for Samples
The samples described below were collected in connection with the administration,
enforcement; and documentation of the:
() North Carolina Hazardous Waste Management Rules, 10 NCAC lOF
( ) North Carolina Solid Waste Management Rules, 10 NCAC lOG
() Comprehensive Environmental Response, Compensation and Liability Act (CERCLA)
() Toxic Substances Control Act (TSCA). 15 U.S.C. §2601,·~~-• specifically
Section 11.of TSCA, 15 U.S.C. § 2610.
Ins~ector's Name ' ' Inspector's Address .
,to/Z4Qf 51/ ,/l?ar/"t✓u~e-.· Fi Address' -·
Fi= _o..ner, . Opet·a tor,. or Agent Title
-
SAHPLE I · COLLECTED SA.'IPLE TYPE DUPLICATE SA.'!PLES SA.'!PLE LOCATION NUMBER DATE TIME WATER SOIL OTHER OFFERED ACCEPTED REJECTED ON-SITE OFF-SITE
I '/2.-1775 . /JI~
h ✓ ✓ ~ ~
..
Receipt for the sample(s) described Receipt/rejection of duplicate or split
a.bove is h::eby acknowledged: sa~les i;s h~reb('~ack"._owledged: ,H,;,i~ Lb:://'--__ v-l 2yw,L~ ,L
ji?-.f.gn"ature of'inspector Signature of~nn O<mer, Operator,
/?l{z~cf6-%hr,auif £«< /,.r . ~~ . _llit,~~~-.
Title · ~ . ~ Title · :S
or Agent
COM!-fENTS, _____________________ ---,, _______________ _
N. c; DEPARTMENT OF HUMAN RESOURCES
DIVISION OF HEALTH SERVICES .
SOLID AND HAZARDOUS WASTE MANAGEMENT BRANCH
. ,. ,-%1 ~ ~, ... --"'
JLwf?r:F ~, .iJt.-\<.' Chain of Custody Record · _f,g D./(0_32,({JJ 3 . .f 3.:-:--: ·_ ,,. ,.., ...
Hazardous Waste Materials ·:•/: '''.\ •' ·. ' ' . ' );}: :":(-(: :
, : • : • • -·· ;. ,,,, ~ •• • ·, f
Location of Sampling: Generator __ Transporter
Disposal Facility _Storage Facility
.2(_Other:J7o'v4h lfi/i.
_:__Tr~tmen~ -FaJil~tl
:.__:__ Land£ ill · ·
r cu
Company's Name Mm~ n (} out£-ceud.R r1-U' ~
'
Address 6q 5 ::I: azaca:111,ll-e
Collector's Name ,&~ ~
signature
Date Sampled · /,;}-/ 7 -cfG
a /2 <l'/'/qtt/'"1,<ak uwtR:
Telephone(-jt >--------~ ·
Tele_phone(f/f ) 73 3 -2-d'"a I
Time Sampled __ -'7'; /'--''--::j'-·...,(1/1).....:::;,__ __
Type of Process Generating Waste. ________________________ _
•
Field Information . ; ..
·Field Sample No. 3 l((2-
Chain of Possession:
l.
2.
signatur.e' title inclusive dates
3.
signature title inclusive dates
Results reported
signature title date
Instructions: Complete all applicable information including signatures, and
submit.~ith·2nalysis request forms.
DIViSION OF REALIB SERVICES
SOLID AND HAZARDOUS WASTE MANAGEMENT :BRANCH · .... .-,., ·? .. ::, .. ~--, .. /· ~
' ,·~ :; ·lL... : ~-
Receipt for Samples ... .· ... _·
·-----· ~· . '.the samples described below were collected in connection;with the administration. enforcement, and documentation of the:
( ) No:rth Carolina Hazardous Waste Management Rules, 10 NCAC lOF
( ) Ncrth Carolina Solid Waste Management Rules, 10 NCAC lOG
() Comprehensive Environmental Response, Compensation and_Liability Act (CERCLA).
I ( ' \ J Toxic Substances Control Act (TSCA).15 U.s.c: §2601,·~~-• specifically· Section 11 of TSCA, 15 U.S.C. § 2610.
lnspectcr's Name
IG~e of Finn
V
Fi:r:n _0-~'Iler,. Opi.1·a tcr, . or Agent
------l
SAMPLE I -COLLECTED SAMPLE TYPE
N1J:.SER DATE TIME WATER SOIL
-·-· I
\
1
I
---
__ .,.
I i
Recaipt for the sample(s) described
,,·Dove is hereby acknowledged:
OTHER
Inspector's Address
Firm Address
Title
DUPLICATE SAMPL'.ES SAMPLE LOCATION OFFERED ACCEPTED REJECTED ON-SITE OFF-SITE
. .
.
Receipt/rejection of duplicate or split
samples is hereby acknowledged:
..
0;;:_5na ture of Inspector Signature of Firm Owner, Operator, or Agent
Title
C:Xi~!!-GNTS, _______________________ ..,.. ___________ ;,__ _____ _
.... --------------------'------------
t' ·":'; ,... • ~ -·-.. t.,. '•
Hazardous Waste Materials
Location of Sampling:
Date Sampled
Type of Process Generating Waste. _______________________ _
V
Field Information . :·~
• -~--····· ··•-:· -'•. ,.,,,,, ~ !
·Field Sample No.
,
Chain of Possession:
title inclusive dates .. -: '
2. /d; 7➔ /2,;._/f=J-,-
signature inclusive dates
3.
signature title inclusive. dates
Results reported
signature title date
Instructions: Complete all applicable information including signatures, and
submit vith-.analysis request forms.
DIVISION OF HEALTH SERVICES .·
SOLID AND. HAZARD0US.·WASTE MANAGEMENT BRANCH
• 1', .. ,,., ~ . . " ' . ........ . Receipt for Samples ..... :·. 1, ·: ;... ~. ·. · -.. ~-'._..... . · ... :.~.--.. -:r· .... :·"·{..,:_!·.~
Th~ samples described belo'II were collected in connection 'll'ith
eI'.forcement, and documentation of tb'e·: ·. . :;~.'
() No~th Carolina Hazardous Waste Management Rules, 10 NCAC l0F · ·
() North Carolina Solid Waste Management Rules, 10 NCAC.l0G
( ·) Ccmprehensive Environmental Response, Compensation an·d Liability Act •(CERCLA)
() l'o;;:ic Subst~nces Control Act (TSCA). 15 U.s.c; §2601,
Section 11.of TSCA, 15 U.S.C. § 2610. ~ ~-,,specifically
,/J LZlx IZ4i&: Insp?ctor' s Name
bo--/2.,-,_f, a:..-ud,..e1~;
Jlame 'cf Firm Firm Address
:Fi= ·Owner, 0p1e~·a tor,. or Agent Title
' -
SAM?LE COLLECTED SAMPLE TYPE DUPLICATE SAMPLES SAMPLE LOCATTON H1'1·~E!{ DATE! TL'1E WATER SOIL OTHER OFFERED ACCEPTED REJECTED ON-SITE OFF-SITE -
3 fl /7-J'< · J.Plh ✓
I
'
Receipt for the sample(s) described
a·~•ove :i,s-1'lpreby acknowledged:
-~ ..,A -c-r/ p:.,.-7JJ-t' /2:'.::::---,
/
✓ . ) ✓ V
Receipt/rejection
samples is•hereby
-....
of duplicate or split
acknowledged:
.
..
;~
Signature of Inspector Signature ofi or Agent
Title
COMHEJlTS,_· ______________________ __,,-------------------
' :.;:;-,.· ;,.
Chain of Custody Record
?~.-·t-<'<"', ', ••
Hazardous Waste Materials
Location of Sampling: Generator ·--
_Storage Facility
...l(__Other: :71-,
Company's
Address /-:L
Collector's Name l?d/r l';;e_ /2Q cA
7 5.ignature
Date Sampled /d -I 7 -cf6
_Transporter . -· .. -~Treatment. ·Facilit::)'
__ Disposal Facility ~Landfill· .
s
Tele;hone(i'/9) "733-:JJtD/
.'.'.\" .l./ -:S-. /J vYJ Time Sampled._.,_~_.\J'-----,,r'--1/'--'-'--
Type of Proce~s Generating Waste -------------------------V
.Iield Information
:Field Sample No. 3 '7: f i/-
Chain of Possession:
title inclusive dates
?. •
3.
Results reported
signature title· date
Instructions: Complete all applicable information including signatures, and
submit ~ith·~nalysis request forms.
DIVISION OF HEALTH SERVICES·
SOLID AND HAZARDOUS, WASTE MANAGEMENT BRANCH •
Receipt for Samples .... ,.,j;_,"'
·i·---. " • •·••a• ·' ••: ,...~.~ The sa:nples described below were collec.ted in connection ,with the administration, !:'n:forcemant, and documentation of the:-..: ·: · ·r ·
I ( ) North Carolina Hazardous Waste Management Rules, 10 NCAC l0F
( ) North Carolina Solid Waste Management Rules, 10 NCAC lOG
,,, ·•· -._ ...
() Comprehensive Environmental Response, Compensation and Liability Act (CERC"J..A)
I , .
{ ) Toxic Substances Control Act (TSCA).15 U.S.C. §260i, 'et~-, specifically Section 11 of TSCA, 15 U.S.C. !l 2610.
'
Inspe:ct:o!'. 1 s Name
}) ///, · )kµjL, cXrn k a
Inspector.' s Add-ress
Eir:n ·Owner, Opo::·a ':.er, . or Agent Title
-' -..
SJJ,JPLE COLLECTED SAMPLE TYPE DUPLICATE· SAMPLE.S SAMPLE LOCATION NUY.BEP. DATE THlE WATER SOIL
v-' ✓ . L,I /c)-/Jd,'' :) I .. ".!?I -
' _. ____
'-· .
I
I
:,.eceipt for the sample(s) described.
"bove is hereby acknowledged:
01RER OFFERED ACCEPTED REJECTED ON-SITE OFF-SITE
.. ' L/ v ✓
' '•
'
'
I
.
'
.
' Receipt/rejection of duplicate or split
samples is; hereby acknowledged:
.
'
. ·~---jj ;7,-, < ,l,'f--;?(.:_;/ ~ /C...-r.) __,A__ dlm--,4<-· : c. ,b7~t:Lz= .
Signat<nre of Firn Owfilir, Operator, or Agent
Title
cm!l>IENTS _________________________ -'-_______________ _
I ··•---------'-----------------------'-·
:..' ----------------
N. C. · DEPARTMENT OF HUMAN RESOURCES
DIVISION OF HEALTH SERVICES •
. '.°"ID AND ;:;:• c:~:;"::::" BUNCH fR~D ~;;: ;,; ':
Hazardous Waste Materials __ . , .... . : ... ·: . ' . )· . , .
. : ' . ::: ·. '·'::.~ •.
Location of Sampling: Generator _Transporter _Treatment Facilit)
_Storage Facility __ ._Disposal Facility '__:____:_Landfill •
.)._Other:,;'"'·>·-,, 7; c'i,, eY9 Ci ':-111 I N_./)r K',<;cr_;"'e:: 5 a/.tn.:..
Company's Name /)1 r-.
r dJ .. · ,~ .. :TM O /J1µ _,,/) .111 ,-,.,.,,.,·,ar,,"(.,_ Telephone( ___ ) ________ _
,,
Address if ;l lqt1 Y, 1 </ 1??dr:"'1-/v'1J/t Ji((_ :..,U~ /\ '·/4 . z -,:, b Collector's Namec.__._/-'-?::~l--',1..(_--'-/-'1-t'~_,~1..::;;,f-e..·..::l..-.,-:;;.-::.-_____ Tele_phone('// '7 ) ~ ,:., 2-2. ,j (; /
/
signature
,·:; ·2_0_ Date Sampled'----'/c..;':;;:.)_-_,_/__,_7_-__ -fl;_;C.___--'-_____ Time Sampled_-'-""'-) ___ ,,,_/?_· "-(21~_
Type of Process Generating Waste'--------------------------
Field Information
'Field Sample No. ;31:J')
, .. ,. .·
Chain of Possession:
1.
? 1 1 signature title inclusive dates
2.
·J .
___,_l':__)..:.-·~--.:;;u_;_· .......:/.:....~_;;_-..:../4:....{,:..:J/::.;..,;:.v_• ---·----"'--'{,{J,.,z://Zc:,JJ; cM>ocrl,ri: ·/-z.-17-f6 ,-12-/9-rt,
signature I title inclusive dates ·
3. -pf' u;/. ,J d r
signature) title inclusive dates
Results reported
signature title date
Instructions: Complete all applicable information including signatures, and
submit.Yith-.analysis request forms.
. DIVISION OF HEALTH SERVICES
SOLID AND HAZARDOUS WASTE MANAGEMENT BRANCH . . •-,~--.· . --.·. ',,~ '
Receipt· for Samllles .. . ,_.
... •• ~J.[~ '.A•~' .• • t• ..... --.~!·---··· . . ,.., -~ .. . I·. The :;amples described below were collected in connection ·with enforcement, and documentation of the:·-:•.::: 0 .:--.
the administration~.
() North Carolina Hazardous Waste Ma~agement Rules, 10 NCAC l0F
'·: --; 1, ~ '.
t ) North Carolina Solid Waste Management Rules, 10 NCAC 10G
{ ) Comprehensive Environmental Response, Compensation and Liability Act ·(CERCLA)
() Toxic Substances Control Act (TSCA). 15 U.s.c: §2601, Section 11.of TSCA, 15 U.S.C. § 2610.
/\ /. I .
\.,· _,,,,,,.-) ' ;;-·· ,---I /, •. ___ { /i .-/ .. :J---( / L-f_) / c.-
lnspec tur' s Name.
Name of Firm
!!. ~-; specifically
. ].;·:. ','\:,. ... -..=
' • . .... ,-t.~ :. . . . . . -'· ,--~i-\. ·<<·,
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/'};r ,-/J?~. _),i_=:.-l,_·..,_1..,_;_,_., _____ -'----------:=---=-------------'--------Firu Owner, . 0pe,·a ::.or, or Agent Title
. --
SA..)1:?LE · COLLECTED SA.'1PLE TYPE
NUMBER DATE TL'l1E WATER SOIL
__ .... .( :z· -✓ ._) "~2-11·4 ,,/ ,j . ·-·
-
-
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,
:?.ece:i.ot for the sample(s) described
:c.:,ov,; is ne-reby acknowledged: ....,-,
)(-?5;::'-/)p /{.n rt-'-
S~.g°nati,re of Inspector
OTHER
DUPLICATE SA.'!I'LES SAMPLE LOCATION OFFERED ACCEPTED REJECTED oN-srn: OFF-SITE
/ ' .. / /
Receipt/rejection of duplicate or split
samples is hereby ackno-wledged·:
/). l.., ..... -11, . ,; .. <-•7,,..:.:..lz· /1-1 7'J,LL,: ((<.;v.._,
Signattlre 'of Finn 0-wner, Operator, or Agent
Title
COHt-iENTS, ______________________ -,-__________ ..;,_ ____ --:-
. ) . '
Location of Sampling:
.... •,.
Address Rt: d2 /??()CO :rv ( /I e..., NC' ·--,,.=-'---'-'==--7-----''-,,=...,.'--'---"'---'-'-.t.l....-"'--'---':..;..='-'7, ...... -'-"------------------
Collector' s Name:......_,.:;..h__,_~'£:z..__·,../Jez;...,.-.c./t-"--"✓'-':V><.L!I-.._ ___ Telej>hone(9/9 ) 73 3 -2.f~ I
signature
Date Sampled. ___ .,_/ .... z"----,/,__7+-_.,..cf'.__..~.,__ _____ Time Sampled._.J./-,;z,__..,ZcJ:::...::· __ _
Type of Process Generating.Waste. _________________________ _
y
. Field Information
• ·Field· Sample Nci. <3 ']:J?,
/t:2-/?-" / i.-.f'?-/'(,
inclusive dates.
,. ---· --..
2.
. ·. .. signature J / z_ -/9-&Yi;
title inclusive dates
signature title inclusive dates
Results reported
signature title· date
Instructions: Complete all applicable information including signatures. and
submit.vith·2nalysis request_ forms.
. . ·-·-,· ..
DIVISION OF HEALTH SERVICES
SOLID AND HAZARDOUS WASTE MAN.AGEMENT BRANCH
Receipt for Samples
;,
'f:"" S?.r:ples described below were collec.ted in connection with the administration.· .
e.·.,forc<o'.Iiem:, and documentation of the:
() North Carolina Hazardous Waste Management Rules, 10 NCAC lOF
1. ) North Carclina Solid Waste Management Rules, 10 NCAC lOG
() Conprehensive Environmental Response, Compensation and Liability Act (CER.CLA)
( ) To::ic: s,~bstances Control Act (TSCA).15 U.S.C. §2601, ~ E.!S.·, specifically
Sect"ion 11.of TSCA, 15 U.S.C. ll 2610.
y
-
SAMPLE COLLECTED SAMPLE TYPE
lfG!'f.DER DATE TD-!=: WATER SOIL ·---·--I I
-----
---l I
I I -I
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Eece ipt fer the sample ( s) described_
a,:,;e,ve iG hereby acknoi-.Tledged:
Signature of Inspector
Ti tJ.r;
OTHER
Inspector's· Address
Firm Address
Title
DUPLICATE SAMPLES SAMPLE LOCAnON OFFERED ACCEPTED REJECTED ON-SITI: OFF-SITE
-.
I
Receipt/rejection of duplicate or split
samples is hereby_ acknowledged:
Signature_of Fi= 0-.mer, Operator, or Agent
Title
COht-ffNT5,·_ -----------------------,-,-------------'-------
MEMORANDUM
TO:
FROM:
RE:
•
DIVISION OF ENVIRONMENTAL MANAGEMENT
GROUNDWATER SECTION
March 20, 1987
Lee Crosby
CERCLA Unit, Division of Health Services
Perry Nelson ~
Groundwater Section, Division of Environmental
Management
Groundwater Contamination At Koppers Co., Inc., Wake
County
In reference to the meeting held on March 19, 1987, please
keep me informed of all matters pertaining to the occurrence,
and investigation of groundwater contamination in the vicinity
of Koppers Co., Inc.
Our file to date consists of monitoring well logs for MW-1
through MW-12; boring logs for B-1 through B-15; analytical
results of soil samples RN67-RN96 collected on 9/26/86; and
analytical results of groundwater samples collected during the
period 9/9/86-9/11/86. Please provide us with any additional
information which will enable us to assess the existing and
potential environmental impacts associated with groundwater
contamination at the above referenced facility.
If you should have any questions regarding this request,
please let me know. Thank you for your assistance.
PFN/bjg
cc: Incident Files
North Carolina Department of Human Resources
Division of Health Services
P.O. Box 2091 • Raleigh, North Carolina 27602-2091
James G. Martin, Governor
Phillip J. Kirk, Jr., Secretary
Ronald H. Levine, M.D., M.P.H.
TO:
FROM:
RE:
16 December 1986
Steve Reid, Public Information Officer
Lee Crosby, CERCLA Unit
Solid and HazardousWaste Management Branch
NC CERCLA Site Investigation
Near Koppers Company
Morrisville
State Health Director
The CERCLA Unit will conduct a site investigation near Koppers
Company (NCD003200383) in Morrisville on Wednesday, 17 December 1986. A
preliminary assessment and transmittal letter are attached.
If you need additional information, please contact Pat DeRosa or
me at 7 33-2801.
cc: Doug Holyfield
North Carolina Department of Human Resources
Division of Health Services
P.O. Box 2091 • Raleigh, North Carolina 27602-2091
James G. Martin, Governor
Phillip J. Kirk, Jr., Secretary
Ronald H. Levine, M.D., M.P.H.
16 December 1986
Mr. A. K. Glover
Chief, Environmental Health Section
Wake County Health department
P.O. Box 949
Raleigh, NC 27602
Dear Keith:
Re: Koppers Company
Morrisville
State Health Director
To confirm our telephone conversation, the CERCLA Unit of the
Solid and Hazardous Waste Management Branch will conduct a site investigation
near Koppers Company (NCD003200383) in Morrisville on Wednesday, 17 December
1986. Sampling will be limited at this time to residential drinking water
wells. Copies of the preliminary assessment and transmittal letter have been
enclosed for your information.
If you have any questions or would like to accompany us, please
contact Pat DeRosa or me at 733-2801.
LC/pc
•
Sincerely,
Lee Crosby, Chemist
CERCLA Unit Manager
Solid & Hazardous Waste Management Brauch
Environmental Health Section
D
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&uth C.'. . :a Department of -~1 and Environmental Control .
(Form de•ioned lo, uN on •liH (12-t)rtch) r.,,,..wrrtM)
UNIFORM HAZARDOUS 11 .)Generators u;:, i:, .... ,..., No. Manifest
WASTE M,,:,.NIFEST N .r, n 0, 0, .,_ 2,.0, o, 3,8 i3 1W;b";"R.'~,01
J. Uenerator I Nemu .!Ind Mn1ling AOOress .
Koppers Company, Inc. P.O.Box A
Highway 54 West, Morrisville., NC 27 560
4, Generator's Phone ( 919 I 467 -6151 ,. 1 rans.porter l Company Name 6. us t:t'A ID Number
Dart Trucking 1O,H,D, 0, 0;9 ,8 ,6 ,5, 8, 2,5
I. I ransp,orter 2 Cc:npllny Name 8. US EPA ID Number
I ' ' ' ' ' ' ' ' ' ' ' 9. Deaignetea Facili1.i> Name end Site AOOross 10, US EPA ID Number
GSX Services, Inc.
Route 1, Box 255
Pin"'''""" tsr. ,n,o, 7,0,3,7 ,s· 9 B ,5
'h
Form App(o..,ed 0MB No 20C() 0404 Exp,res 7 Jl 86
2}Page f l Information in the shadea areas -,-1-is not reciuired bv Federal
o la...., but 1., bv State lfflJ .
A.Sune Manifest Document Number
8.::.itate -c;-enen1toi's 1u
C.State TranS()Of'1cr 1 1u
O.Tranaponers -Pnono l.10-:>:):)-'-)b•zl
I E. Sum, TransPort1.ft1 ID Ir Tranaponor10 ~nono
I G.Sune Fec1hty s IQ
H.facilit•ls Phone
[phone] c;_r: ?Ql?S
12.Con1H1ners 13, 14. I. 11. US DOT Descripl!on (Including Prop<Jr Shipping NamtJ, Hazard Class, and ID Numbt1r Tota! Unit
No. T·-e Quentit"' AAA> Watte No.
"·Hazardous Waste -Solid -N.O. S., I K101011 I
ORM-E, NA-9189 0, 0, 1 D1T 4,010,0,1 p I I I I I
b. I I I I I
!
I ' I I I I I I I l I I
C. I I l I I
I I I I ' ' I I I I I I
d. I I I I I
I I I ' I I I I I I j I
~ ~:.;:;;ons 1QI'" 1JitiioADOYO K.H.andlin-g U)OeS i0< Wastes L1stuu J.bove
.a.~-~5_:._~-'3 1 710111 T C, L.J-1 I I I I 1-1 I I I l
b,L.J-1 I I ' \ 1-1 I I I I d. LJ-1 I I I I 1-1 I I I I
1 t>. :special .HendlinQ lns1ruct1ons end Addition~ lnlormetion
Work Order Number -5/Sz& Wear Impervious Gloves and Eye
Truck Number -'fC"S& Protection when handling.
Purchase Order Number -14-6-50248
16. GENERATOR'S CERTl~ICATION: I he,ebv decla~• llul tho con11n11 ol !his con~nment ,,, fuHy 1nd ICCufe\&fy described 1boVll tty p1op,,r Jhippjng ruim,i 1nd 111 clnu,fied, p,a.c~ed. m.or~.o'. 1~
ltbel..;1, end .a,e in all ,~o~cu in p1op.r condition fo, ,,.,....oon by hiQhwMuordinQ 10 1ppl,cab~ in11mt1iori.,I trod na1ioo1I g0vemmon1 re,gulet>Om 1.-.d Suite 1,,...,.
Unlru I am 1 ,mall ouan1,1v g1n1r1tor who has 06"'1 oe,motod by 1tatut11 or •t-Qula!ioo horn 1/a ~~~e 'yWllte minimiu10i> tfln•;~n un~¥
1
Ktion Xl02Cb) ol RCRA, t 1li.o unity 1h11 l have
ii pro,,,ram in p1'!ce w ,.,<Juu 1tle volumfl 1n.d to~ici1y ot wn111 gt1nt11a1fld 10 !h11 d11grllfl I hav11 de\11 ,n&d ,7conomically p;;c1ic.sble ;,n have ,el lfld the mot hod o1 !rNltT\fln1, ,10r1Qf1, o, dl3P01-al
CUff1tntlv ava,lable lO m., ... n,ch min,mlllll the pre .... nt and tuwre !hrea! lo human hen Ith Ind rt.... ti wiro n •
Print&d/Typud Ncme I s;g; ¥Jit1,/-/4 .#0-/v..-, ,f~1"1J~S7 ti Robert A. Fisher
17, Trensport6r 1 Acknow!&dgemenl ol Receipt ol Me1eri.al1 V I Date
PLJ&d/TypOO Ncmo I s;gnorur;.s; ~ J_ . 17 t7 ,;:1, 1:Si 1:t Av..z-~ ~Et.KJ.s
18. Trensporter 2 Ack.nowl&<:S9t1ment or Rocoipt ol Materials I Date
Print&d/Typ-6<1 Namo l Signature Month D•y Year
I I I I I I
19. Diacre~ncy Indication $ptice •· I .~,1-1., .-n, .... ,. , I I I I I I"··
•· I i I i I i 1 .... ,. I i i I ! I '"··· 20. Facility Owner or Op,er■tor: Certification of roceipt of hazardous materials cover&d by this manifest except as noted in Item 19.
;:J,'ed~7~ lsg_ ...._d,,4-'/ /J-.-~-,4"')A_--:-;;,
Monih Day Year
,...-,....,, /) /"? < I?,? 1/,_~&-.. ~-'....,~ '/ /?,./
DIVISION OF HEAL TH SERVICES
P 0. Box 2091
Raleigh, N.C. 27602,2091
January 2, 198 5
Ms. Denise Bland
EPA NC 3012 Project Officer
Air & Hazardous Material Division
345 Courtland St.; NE
Atlanta, Ga. 30365
Dear Ms. Bland:
Ronald H. Levine, M.D., M.P.H.
5Tt-TE HEt-LTH DIRECTOR
Enclosed are P,·eliminary Assessments for the followin-s ERRIS sites 1n
North Carolina:
1. Diamond Shamrock Corporation
Castle Hayne
NC D057454670
2. Dow Chemical Corporation
Charlotte
NC D074518671
3. General Tire & Rubber Company
Charlotte
NC D043679349
4. Kelly-Springfield Tire Company
Fa yet tevi lle
NC D048958615
5. Ko?pers Company, Inc.
Morrisville
NC D003200383
6. Toastmaster, Inc.
Laurinburg
NC D037160439
7. Uniroyal I!!c./Uniroyal C:1emical Di vision
Gastonia
NC D003164464
8. Whittaker Chemical Company
Lenoir
NC 0039058524
Diamond Shamrock Corporation was entered into ERRIS due to a RCRA 3001
notification for storage of spent pickle liquor, lead, and chromium, treatment
Jome~ B Hunt, Jr./ 5oroh T. Morrow MD MD H STATE Of NORTH CAROLINA ____ • ., •• DEPARTMENT Of HUMt,N RESOURCES .•.••.. .' . . ,.
Ms. Denise Bland
January 2, 1985
Page 2
•
of spent ;:,id.le liquor and chromium and disposal of chromium. An on-site
lagoon has received process waste-water and waste-water treatment plant sludge
for some time. A spilla3e of an estimated 1072 tons of chromic acid and
sodium bichromate occurred in 1974. The North Carolina Department of Natural
Resources and Community Development monitors remedial actions to recover this
chromium contamination with approximately 857-tons being recovered through a
series of at least 24 recovery wells. A low priority for site inspection is
recommended in order to evaluate the possibility of contamination in the
lagoon and at the location of the chromic acid/sodium bichromate spill.
Dow Chemical Corporation was entered into ERRIS due to its inclusion
on t!-Je Eckhardt Waste Disposal Site Survey. This site, according to Dow, was
nothing more than a sales facility. No storage or disposal activities ·
occurred at this site. Dow moved fro:n this site on August 3, 1984 to 5727
Westpark Drive in Charlotte. No further action is recommended for this site
based on current information.
General Ti re & Rubber Company was entered into ERR IS due to a RCRA
3001 notification for storage of halogenated solvents,(1-1-1 trichloroethane),
heavy metals (chromium and lead), t:i.iram, toluene, and asbestos. All was
drummed except for chromium and lead which was stored· in waste piles for a
period of time. A low priority for site inspection is recommended in order to
evaluate the presence of contaminants in the drum storage, waste pile, and
evaporation drum areas.
Kelly-Springfield Tire Company was entered into ERRIS due to a RCRA
3001 notification for storage of methylene .chloride, thiram, and
N-ni trosodip;1enylamine. Kelly also informed this office of the transportation
of PCB materials from several transformer cleanups and of the transportation
of 1-1-1 trichloroethane. According to Kelly officials, all spills were of
small quantity and were adequately cleaned up, containerized, and shipped to a
:1azardous waste disposal facility. Several employees, however, have indicated
that either Kelly-Springfield or its industrial maintenance contractor,
D2:ender, have disposed of cleanin, fluids on-site. Due to the relatively
small quantities of known hazardous materials utilized at this site and the
low p_otential for contamination of public water supplies, a low priority for
site inspection is recommended to access the possibility of any on-site
conta.nination.
Koppers Company was entered into ERRIS due to a CERCLA 103 (c)
notification for land treatment of organic wastes (in 1978) and for an on-site
surface imr:,oundment. Wood treatment using pentachlorophenol (PCP) occurred at
this site from 1968 to 1975. Waste materials such as bark, saw dust, and
excess PCP were dumped into pits for disposal. According to an EPA site
investigation report (dated January 27, 1981) waste piles and disposal pits
were still present on-site on September 24, 1980. Ko;:,pers removed
approximately 220 tons of contaminated soil in April, May, and November of
1980, shipping it to SCA. A hydrogeologic investigation by Koppers (11/13/84)
indicated pentachlorophenol contamination in seven on-site wells. Due to the
existence of private groundwater supply wells in the immediate vicinity a
medium priority for site inspection is recommended for this site.
Ms. Denise Bland
January 2, 19S5
Page 3
Toastmaster was entered into ERRIS due to a RCRA 3001 notification for
treatment and storage of chromium and wastewater treatment sludges from
electropl3ting operations. Possible or suspected contaminants are chromium,
hexavalent chromium, cadmium, nickel, cyanide, 1-1-1 trichloroethane, and
trichloroethylene. Areas of most concern are the closed out primary and
secondary lagoons, closed out sand filter bed, and the existing sludge burial
trenches. Monitoring wells at this site show low levels of nickel and cyanide
(0.3 MG/Land 0.08 ~!G./L respectively). A medium priority for site inspection
was assigned to t'.1is site based on the potential problems at this facility and
the existence of private water supply wells in the immediate vicinity. A site
inspection was conducted at this facility December 18, 1984. The site
inspection report will be forwarded to EPA/Region IV upon completion.
Uniroyal Inc./Uniroyal Chemical Division was entered into ERRIS due to
a·RCRA 3001 notification for storage of various hazardous materials in drums
or waste piles. Thiram, maleic hydrazide, and phthalic anhydride were stored
in waste piles. Substances containerized are acetone, chloroform,
formaldehyde, methanol, 1-naphthylamine, toluene diisocynate, xylene,
pyridine, methyl ethyl ketone, and Z-sec-butyl-4,6-dinitrophenol. A low
priority for site inspection has been assigned to this site to access the
likelihood of soil contamination in the drum storage and waste pile areas.
1'/hittaker Chemical Company was entered into ERRIS due to a RCRA 3001
notification for storage of spent non-halogenated solvents, and storage of
sol vent and water cleaning wastes from paint manufacturing. This notification
is a duplication of Reliance Universal of Kentucky (NC D053009510). A lmi
priority for site inspection is recommended for this site to access the
effectiveness of remedial actions at this site.
If you have any questions, please contact me at [phone].
LEB/lw/1706
Enclosures
Sincerely,
,-----__v~---,!_·' ,/(,._,.,--:,--0z__ \_..----, '\ . . . --
Lenox E. Bramble, Environmental Engineer
Solid and Hazardous Waste Management Branch
Environmental Health Section
nit. J •11•-·' ----------1•;...._·, -Ro-nol-d H-. Lev-ine-, M-D,-M.P-.H. -n y . STATE HEALTH DIRECTOR
DIVISION OF HEALTH SERVICES
PO Box 2091
Raleigh, N.C. 27602-2091
December 7, 1984
Koppers Company~ Inc.
Highway NC 54 West
Morrisville, NC 27560
NC 0003200383
I
Wood treatment using pentachlorophenol occurred at this site
1968-197 s; Two lagoons, conuining effluent from this wood treatment, were
''closed'' in 1982, Liquid from these lagoons along with soil surrounding the
lagoons was land applied to a field on Koppers' property. Fertilizer was
added to enhance biodegradation of the pentachlorophenol.
As recently as July 1984; pentachlorophenol contamination has been
documented in wells near the on-site _lake and near the field where land
application of pentachlorophenol occurred. (0.0026 and 0.091 mg/L
resp'=ctively.)
LB/lw/1584A
ST A TE OF NORTH CAROLINA Jame~ B Hunt, Jr/ Sarah T. Morrow, M.D., M.P.H DEPARTMENT OF HUMAN RESOURCES SEC . GOVERt-JOR RET ARY
POTENTIAL HAZARDOUS WASTE SITE I. IDENTIFICATION
&EPA PRELIMINARY ASSESSMENT 0
NCATEl
0D003u200383
PART 1 -SITE INFORMATION AND ASSESSMENT
II. SITE NAME AND LOCATION
01 SITE NAME /L•i;,•I. common. 0,oucrri,1,~• n.,,,• ot ~"•I 02 STREET, ROUTE NO., OR SPECIFIC LOCATION IDENTIFIER
K6nners Co. Inc. Hwy. 54 West
03 CITY
~;TA TE I 05;; ;~~ 106 COUNTY I07COUN ,108 CONG CODE D!ST
Morrisville Wake 92 4
09 COORDINATES LATITUDE LONGITUDE
.35-5D_ 46 ·-I __()1_8__ ..5.Q 2.3 - .
1 0 DIRECTIONS TO SITE /S1anmg 1,om nur•SI publ,c ro•d!
From Morrisville take NC 54 West Approximately 1.7 miles to SR 1635. Koppers site
is on left imnediately after SR 1635.
Ill. RESPONSIBLE PARTIES
01 QWNER1111:no.,nJ 02 STREET /811,,,,u,, me#wtr;, ,es,c,.,,,,,.,1
Koppers Co., Inc. Koppers wilding
03 CITY 04 STATE\ 05 ZIP CODE I 06 TELEPHONE NUMBER
Pittsbury PA 15219 I 412 227-2374
07 OPERATOR (11 •nowr, and r1'/l1>1P/'!I l1om own11r/ 08 STREET /Svs1nus, malllnr;, ,es1<1Pn/1•f/
09 CITY 10 STATE \11 ZIP CODE 112 TELEPHONE NUMBER
I I
13 TYPE OF OWNERSHIP/Ch&c~ on•/
)( A. PRIVATE 0 8. FEDERAL: 0 C.STATE OD.COUNTY □ E. MUNICIPAL
(Ao•11Cyr>ame)
0 F. OTHER: 0 G. UNKNOWN
(Sp•cUy)
1 4 OWNER/OPERA TOR NQTIFICA TlON ON FILE (Cl>•ck e1111>ar atJr,/yJ
0 A. ACRA3001 DATE RECEIVED: , , p('B. UNCONTROLLED WASTE SITE rcERCLA 103 c/ DATE RECEIVED: 6 ,9 ,81 0 C. NONE
-MONTH OAY YEAR MONTH OA'r YEAR
IV. CHARACTERIZATION OF POTENTIAL HAZARD
01 ON SITE INSPECTION BY (Cfleclt all fl>al aotJlyJ
)lives DATE 9 1241 80 )(..A.EPA O B. EPA CONTRACTOR )'{ C.STATE 0 0. OTHER CONTRACTOR
0 NO · MONTH DAY YEAR 0 E. LOCAL HEAL TH OFFICIAL 0 F, OTHER: -~QblJ:R0Q~8A Ii •1!1tE!6j: Haz. Waste Site Invesi:'.1:1'.tion
02 SITE STATUS/Check on•! 03 YEARS OF OPERATION
I XA.ACTIVE 0 B. INACTIVE 0 C. UNKNOWN 1961 ---0 UNKNOWN
-aEGINNING YEAR ENDING YEAR
04 DESCRIPTION OF SUBSTANCES POSSIBLY PRESENT. KNOWN, OR ALLEGED
Waste lll3.terials from Pentachlorophenol (PCP) treatment was land fanned and disposed 0
in on-site pits from 1968 to 1975. A cleanup involving the ranoval of 220 tons of
contaminated soil was conducted in 1980. N.C. Dept. NRCD Jan. 1983 sampling of creek
' ' . ' . ., . . . . . , , --' . -
05 N IL -, vr IVI' ........ , ' ' Surface water contamination, as evidenced by 1983 NRCD sampling requires investigati01
At least three residential v;ells are located near this site. Although sampling of
these wells have not shown any contamination, v;ells have not been sampled since
,-,, lQQ;n A-1..J.:,__.:, __ __,7 ------,71,.... .:.,..... .>..L-__ _: _ _;.,......;t-u ,,,...,-,::, ~,cnocto,-1
V. PRiORITY ASSESSMENT
01 PRIORITY FOR INSPECTION fCl>•clt °"'"· If 11,011 orm•d""" ,s cfl•chd. com.ol•t• Pan 2 War If i,,10,,...rlOfl a11d P•fl 3 D,ucri,oro>i> of Ha,.,i,ou• Co11d!IICH'IS a11d lncia1t11ts/
0 A.HIGH ~B.MEDIUM 0 C.LOW 0 D. NONE /lnspec/1011 tequirM promptly/ (ln1p•cr,on r•quir•d! (ln•P•Cr on //me ••• ,,~t>J• OUI$/ /No funfl.r achon nuded, comp/er~ current d•w,osn1011 lonn/
VL INFORMATION AVAILABLE FROM
01 CONTACT 02 OF /Aaer>qlOti;iar,/zar,on/ 03 TELEPHONE NUMB'.:R
Mike Dvorsky Koppers, Inc; Pittsburgh, Pa 14121 261-1298
04 PERSON RESPONS!BLE FOR ASSESSMENT 05 AGENCY 06 ORGANIZATION 07 TELEPHONE NUMBER 08 DATE
o.w. sttickland NC DHS S&HW M.gt. Br. I 919, 733-2178 11,26,84
MONTI-' DAY YEAll
EPA FORM 2070•12 (7-81)
•
.
POTENTIAL HAZARDOUS WASTE SITE I. IDENTIFICATION
oEPA PRELIMINARY ASSESSMENT ~ct"' l0D0032003ln PART 2-WASTE INFORMATION
11. WASTE STATES, QUANTITIES, AND CHARACTERISTICS
01 PHYSICAL ST ATES /Cll•c• ••rll•t wt>ly/ 02 WASTE QUANTITY AT SITE 03 WASTE CHARACTERISTICS 1cr. .. c11111>11;,opry/
(M~•siHU ot ... ur, QUlrlWU X.e. SOLUBLE 0 L HIGHLY VOLATILE l.J A. SOLID lJ E. SLURRY mus/ t,~ K1<!•11•r1C•r111 ~A. TOXIC
1J B. POWDER. FINES ~.LIQUID TONS .., B. CORROSIVE lJ F. INFECTIOUS LJ.J. EXPLOSIVE
IJ C. SLUDGE ,GAS lJ C. RADIOACTIVE 0 G. FLAMMABLE lJ K. REACTIVE
l.J 0. PERSISTENT )( H. IGNITABLE D L INCOMPATIBLE CUBIC YARDS 0 M. NOT APPLICABLE 1.;o OTHER
rSp6c,tr/ NO.OF DRUMS
Ill. WASTE TYPE
CATEGORY SUBSTANCE NAME 01 GROSS AMOUNT 02 UNIT OF MEASURE OJ COMMENTS
SLU SLUDGE
OLW OILY WASTE
SOL SOLVENTS Unknown
PSD PESTICIDES
DCC OTHER ORGANIC CHEMICALS
IOC INORGANIC CHEMICALS
AC0 ACIDS Unknown
BAS BASES Unknown
MES HEAVY METALS Llnlmown
IV. HAZARDOUS SUBSTANCES (SuAt>t>•""" 10,most ,,eQu•nlly c,redCAS Numberi/ ;,Additional -1.sting at bottan of page
01 CATEGORY 02 SUBSTANCE NAME 03 CAS NUMBER 0.<1 STORAGE/DISPOSAL METHOD : 05 CONCENTRATION . 06 MEASURE OF CONCENTRATION
ACD Pentachlorophenol 87865 IM. SI 6400 UGIKG
SOL Methylene Chloride 75092 l.M, SI 8.5. UG/L
EAS is (2-ethylhexvl) Phtha .ate 117817 IM. SI 31 M:;/KG
MS Di-n-octyl-PDthalate 117840 fr!. SI LS M:;/KG
MS Napthalene 91203 IM. SI <10000 UG/KG
MS Acenaphthvlene 83329 IM. SI < 10000 1)'.;/K(:;
MS Phenanthrene/Anthracene 85018 IM. SI <10000 U:::/KG
MS Fluoranthene 206440 IM, SI <10000 UG/KG
= ryrene lZ,iuuu IM, SI < I 1111\fl UG/KG
ACD 2.4-Dimethvlohenol 105679 · IM. SI "2000 UGIKG
ACD 2,4,6 Trichlorophenol 88002 IN, SI , 2000 tx;/KG
AClJ 1etrachloropheno1 Jo,iuL IM, SI <:2000 UG/KG
MES Arsenic 7440'182 Surface snill~~n l!nkno0-~
MS Diethyl Phthalate 84662 ll-1. SI -
MES Copper 7550508 Surface Spillage Unknown
MES Chraniun 74401f73 Surface Soill~~e Unknown
V. FEEDS TOCKS rse~ Apoend" to, CA.S /1/u,nbersJ
CATEGORY 01 FEEDSTOCK NAME 02 CAS NUMBER CATEGORY 0 1 FEEDSTOCK NAME 02 CAS NUMBER
FDS FDS
FDS FDS
FDS FDS
FOS FDS
VI. SOURCES OF INFORMATION 1c,,~ sp,c,ric ,,,1.,~,,,,,._" g., ,w .. '""'· ump1~ .,,.1,,, •. ,.porn J
1. Letters dated 7-3-80; 7-14-82; 8-9-82; 1-11-83
2. Analyses dated 7-24-80; 1-4-83
3. Site Irwestigation Report dated 1-27-81
4. CERCIA Notification dated 6-9-81
5. EPA Preliminarv data sheet dated 1-25-82
EPAFOAM2070·12 (7-81]
*ACD Hexadecanoic Acid 999 1.1'1, SI 3400 UG/KG
POTENTIAL HAZARDOUS WASTE SITE I. IDENTIFICATION
SEPA PRELIMINARY ASSESSMENT 0'Nc"ID0503200383 PART 3 • DESCRIPTION OF HAZARDOUS CONCIITIONS AND INCIDENTS
11. HAZARDOUS CONDITIONS AND INCIDENTS
0~ A. GROUNDWATER CONTAMINATION 02 0 OBSERVED (DATE: I er. POTENTIAL 0 ALLEGED
03 POPULATION POTENTIALLY AFFECTED: 04 NAAAA TJVE DESCRIPTION
Fran any remaining St ri:face contaminaton left after the 1980 cleanup of pentachlorophenD contamination· or· :fran more recent' suspected CCA spillage fran a holding tank.
1
oi)1s, SURFACE WATER CONTAMINATION 02 0 OBSERVED (DATE: I J;l'.POTENTIAL 0 ALLEGED
03 POPULATION POTENTIALLY AFFECTED: 04 NARRATIVE DESCRIPTION
See "groundwater contamination" above.
Suspected CCA spillage from holding tank was initially identified in the receiving waters of a small creek.
01 [J C. CONTAMINATION OF AIR 02 [) OBSERVED (DATE: I CJ POTENTIAL 0 ALLEGED 03 POPULATION POTENl IALL Y AFFECTED: 04 NARRATIVE DESCRIPTION
Not suspected at this time.
01 0 D, FIRE/EXPLOSIVE CONDITIONS 02 0 OBSERVED (DATE:
03 POPULATION POTENTIALLY AFFECTED: 04 NARRATIVE DESCRIPTION
I ►-(,pOTENTIAL 0 ALLEGED
' .
Not suspected at this time. ··.: ____ .,.
01,Pi(E. DIRECT CONTACT ' . . . 02 0 OBSERVED (DATE: I 0 POTENTIAL 0 ALLEGED 03 POPULATION POTENTIALLY AFFECTED: __ ...... __ , ___ 04 NARRATIVE DESCRIPTION
In areas of prior clean-up @·,d landfarming activities and around the suspected CCA spill and its receiving waters.
..
01)5-4:. CONTAMINATION OF SOIL 02 0 OBSERVEO(DATE: I ~OTENTIAL 0 ALLEGED 03 AREA POTENTIALLY AFFECTED: 04 NARRATIVE DESCRIPTION /-'1Cre>5/
See groundwater contamination above
Inadequate clean-up (1980) is suspected.
Ol¾G. DRINKING WATER CONTAMINATION 02 [J OBSERVED (DATE: I ,).(POTENTIAL D ALLEGED 03 P PULATION POTENTIALLY AFFECTED: 04 NARRATIVE DESCRIPTION
/my suspected groundwater contamination could possibly migrate into the aquifer in .which several private water supply wBlls are located.
0 ~ ?\ H. WORKER EXPOSURE/INJURY 02 0 OBSERVED (DATE: I ~POTENTIAL 0 ALLEGED 03 WORKERS POTENTIALLY AFF~CTED: 04 NARRATIVE DESCRIPTION
In areas suspected·. of contamination.
01 ~. POPULATION EXPOSUAEl!NJURY 02 0 OBSERVED (DATE:
03 POPULATION POTENTIALLY AFFECTED: 04 NARRATIVE DESCRIPTION I ~POTENTIAL 0 ALLEGED
From suspected CCA contamination in the s:nall creek behind the Koppers plant.
EPA FORM 2070-12 (7-81 l
• •
POTENTIAL HAZARDOUS WASTE SITE I. IDENTIFICATION
,S,EPA PRELIMINARY ASSESSMENT 01 STATEl02 SITE NUMBER
T\lr v111-.11•u•-U~.1. PART 3 -DESCRIPTION OF HAZARDOUS CONDITIONS AND INCIDENTS
II. HAZARDOUS CONDITIONS ANO INCIDENTS rco,,,,,,,,.,,i
01 0 J. DAMAGE TO FLORA 02 D OBSERVED (DATE: I D POTENTIAL D ALLEGED
04 NARRATIVE DESCRIPTION
Not suspected at this time.
01 0 K. DAMAGE TO FAUNA 02 0 OBSERVED (DATE: I 0 POTENTIAL 0 ALLEGED
04 NARRATIVE DESCA!PTJON /Jr>clude name/sJ ol $1)ec,~sJ
Not suspected at this time.
01 0 L CONTAMINATION OF FOODCHAtN 02 0 OBSERVED (DATE I D POTENTIAL 0 ALLEGED
04 NARRATIVE DESCRIPTION
Not suspected at this time.
Ol _.lxM. UNSTABLE CONTAINMENT OF WASTES 02 0 OBSERVED (DATE: I 1-·m-H'J I D POTENTIAL fa( ALLEGED
/ Si;:,d1s•runol/1stancJ•nQ hQ11idsl!~a*"''1 d1ums}
03 POPULATION POTENTIALLY AFFECTED 04 NARRATIVE DESCRIPTION
CCA. leaking £ran holding tank.
Al.,,-, -' -~--1-• ~~--=--=-~ .t=_,..,.,,,.. 1 OQn r-1-~..-... .......
~ N. DAMAGE TO OFFSITE PROPERTY
.
~POTENTIAL 02 0 OBSERVED (DATE: I 0 ALLEGED
04 NARRATIVE DESCRIPTION
Through downstream conveyance of spilled CCA. or groundwater migrat~on.
01 0 0. CONTAMINATION OF SEWERS. STORM DRAINS, WWTPs 02 0 OBSERVED (DATE: I 0 POTENTIAL □ ALLEGED
04 NARRATIVE DESCRIPTION
Not suspected at this time.
01 0 P. ILLEGAUUNAUTHOA!ZED DUMPING 02 lJ OBSERVED (DATE I [J POTENTIAL 0 ALLEGED
04 NARRATIVE DESCRIPTION
Not suspected at this time.
05 DESCRIPTION OF ANY OTHER KNOWN, POTENTIAL. OR ALLEGED HAZARDS
None suspected at this time.
Ill. TOT AL POPULATION POTENTIALLY AFFECTED: L)-)U ,estJJI1ai::e,
IV. COMMENTS
Preliminary Assess:nent and Site Inspections originally canpleted 3/80 and 9JSO
respectively and assigned a pending no further action status on the ERRIS list. Thi
site requires additional focus on suspected groundwater contamination and investigat
rr.A rPl ;.:i.t-n~ -:.r,t--iu-i ri CIC A c:.i t"P .; • ~ .; C'
4 1
on of
V. SOURCES OF INFORMATION 1c,ra so11c,1,~ ,e1a,~ncos. a Q. s1a111 mu. s.moi., ,,,,,~.,s. ,ei:,onsJ
See "Part 2 -Waste Information"
Section "VI Sources of Inforr.iation."
EPA FOAM 2070-12{7•81)
: _; -_"
.'I·
-
·~
LEGEND
0 PROPOSED LANDFILLS
0 EXISTING LANDFILLS
6. OPEN DUMPS
WAKE COUN
NORTH CAROLINA
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August 17, 1984
TO: File
FROM: Len Bramble /;P-
SUBJECT: Telephone Conversation with Mark Urbassik of
Koppers Corporation, Pittsburgh, Penn.
On August 16, 1984 I telephoned Mark Urbassik to
introduce myself' and to inquire about Koppers' response
to our request for documentation and historical infor-
mation related to activities at the Morris~ille plant.
Mr. Urbassik informed me that the information was not
compiled yet, and that he hoped we would be receiving it
sometime around the first week of September.
I was also informed that Mr. Urbassik is no longer our
principal contact at Koppers, as he has changed jobs within
the company. Our new contact.is Mike Dvorsky [phone].
Mr. Dvorsky:-is coordinating Koppers response to our data
request.
un•~--~.1~----• (!It,, -Ronald H. Levine, M.D., M.P.H.
STATE HEALTH DIRECTOR
DIVISION OF HEALTH SERVICES
P.O. Box 2091
Raleigh, N.C. 27602-2091
Mr. Thomas Marr
Room 1201
Koppers Building
Koppers Company, Inc.
Pittsburgh, PA 15219
Dear Mr. Marr:
April 13, 1984
As discussed in our phone conversation on April 4,
1984, concerning the clean-up status of the Koppers site
in Morrisville, North Carolina, the Solid and Hazardous
Waste Management Branch is evaluating an inventory of
potential RCRA-hazardous waste/CERCLA-hazardous substance
sites that may pose a significant threat to public health,
welfare, or the environment.
I am requesting any pertinent documentation.you can
provide concerning the status of the Morrisville site.
Waste manifests, soil, surface water, and groundwater
monitoring data that indicate the level of contamination
before and after the site clean-up would be helpful. Also,
a historical summary of the site in terms of waste generation,
waste management practices, known spills, leaks, or other
releases of hazardous substances.or wastes would be extremely
useful. The information will be used in our assessment of the.
site's current status.
If you have any questions, please contact me at 919/733-2178.
Thank you.
JCB: j j
Sincerely,
~~✓
Chris Bird, Environmental Engineer
Solid and Hazardous Waste Management Branch
Environmental Health Section
Jame~ B. Hunt, Jr/ Sarah T. Morrow M.D. MP.H. ~~-· · · STATE OF NORTH CAROLINA DEPARTMENT OF HUMAN RESOURCES ' · ' GOVERNOR SE-CRET ARY
0 e • • 01~!~~:-A-L T..,;H:;;;._S_E-RV-IC_E_S _______ _,_'----R-on-□-ld_H_.
5-;~-~-~n~-~-~-1~-~-
1
~-;--~-R--
P.O. Box 2091
Raleigh, N.C. 27602-2091
Mr. Patrick D. Smith
Koppers Company; Inc.··
P.O. Box A
Morrisville, NC 27560
Dear Mr. Smith:
Date: August 11, 1982
Re: Facility ID No, NCD003200383
Based on infonnation supplied by you we have processed and accepted at the State
level your·request for the facility identified with the above ID number to re-
ceive the indicated change in classification under RCRA:
Add As Delete As
D l3l generator
D .2S1 transporter
D D treater
D D storer .
D □ disposer
D □ small generator
We are advisinr, EPA of the change in your status.. Please notify us if. there is
any further change in y_our o·perations which would -again affect your status,
Your EPA ID NO, is~ is notO being cancelled.
Ol·IS
cc: John Herrmann
EPA Region IV
Emil llreckling
Larry Perry
OHS Form 3048 3/82
Solid & Haz. Waste Mgt.'Brnnch
Cordially,
· (Jf trickland, Head
Solid & Hazardous Waste Management Branch
Environmental Health Section
------------------------------------'----~
•
Dear Mr, Lawson:
Koppers Company, Inc., Forest Products Group
Arc/1itectural Building Products
·p_ 0. Box A. Morrisville, NC 27. Telephone [phone]
Architectural and
Construction Materials
August 9, 1982
Mr, Keith Lawson, Environmental Chemist
Solid & Hazardous Waste Management Branch
Environmental Health Section
P. 0. Box 2091
Raleigh, NC 27602-2091
RE: Application for Change in Classification
Under RCRA
Attached is our Applicati::,n for Change in Classification Under RCRA.
Your immediate attention in processing this application to remove this
plant from your list of hazardous waste facilities will be appreciated.
me
Enclosure
cc: J. E. Heinz
T. A. Marr
l s;n,µJ?H
Patrick D. Smith
Plant Manager
· Department of Human l.ources
Division of Health Services
Solid. & Hazardous Waste Management Branch •
APPLICATION FOR CHANGE IN CLASSIFICATION UNDER
Dnte:
Company Name:
Company Address:
EPA ID No:
Mr. O. W. Strickland, Head
Solid &. Hazardous Waste M:rnagement ·Branch
Division of Health Services
P. 0. Box 2091
Raleigh, N. C. 27602
Dear Mr. Strickland:
Au
Koppers Company, Inc.
P. 0 .. B9.Jl'. A(Hi~hw..a.y6 54 West)
Mornsv1lle, NG £:{:51 0
NCD003200383
Our company requests the following change in its classification under
RCRA (check all that apply):
Add As Delete As
□ IBl generator
□ [x] transporter
□ □ treater
□ □ storer
□ □ disposer
□ □ small generator
Our reason for this request is:
This facility generated hazardous waste during the elimination and
cleanup of former process system, This work has been completed
and our present operation does not generate hazardous waste.
NOTE: Give any pertinent information. This may be a change in your process,
a new calculation of the volume ·of your waste, new analyses of your
.waste, etc. Be specific, Please note thnt this is not a petition
for delisting a listed waste, which requires totally different handling .
. If your request takes you out of the regulated system, but you wish to
retain your EPA ID No., please state why.
NOT APPLICABLE
•
I understand tlwt my company must supply information a.bout any changei,
in its operations which might change its status again on its. own initiative.
I certify that the information supplied is accurate and correct to the
best of my knowledge and helicf. I am authorized to make this request on
hchalf of my company at .the location given .
. Signature: I ,.
· Company Title: Plant M·anager
OHS Form 3047 3/82
Solid & Haz. Waste Mgt. J\ranch
•
Dear Mr. Strickland:
Koppers Company, Inc., Forest Products Group
.Architectural Building Products ·
P. 0. Box A, Morrisville, NC 27. Telephone [phone]
Architectural and
Construction Materials
July 22, 1982
Mr. 0. W. Strickland
Division of Health Services
Soil and Hazardous Waste Management Branch
Environmental Health Section
P. 0. Box 2091
Raleigh, NC 27602
RE: Koppers Company, Inc.
ID #NCD 003200383
In a recent meeting with Mr. Larry Perry of your office, it was agreed
that this facility should not be listed as a generator and/or transporter
as defined by the Resource Conservation and Recovery Act. We would
like to change that classification and have this facility de-listed.
Your cooperation is appreciated.
me
cc: Larry D. Perry
Sincerely,
)!d-//_/1
Patrick D. Smith
Plant Manager
0 @. • H~ l ~:·,·, Jl •.·.·,',-.·.: 1---------~--Ro-no-ld -H.-Le-vin-e,-M-.D.-, M-.P-.H-. -01 y ru.1 STATE HEALTH DIRECTOR
~h~, DIVISION OF HEALTH SERVICES
P.O. Box 2091
Raleigh, N.C. 27602-2091
Mr. Pat Smith
Koppers Company, Inc.
P.O. Box A
Morrisville, NC 27560
Dear Mr. Smith:
July 22, 1982
/l, recent inspection of your plant by Mr. Larry Perry disclosed
that it is not presently a generator of hazardous waste.
If you will please fill out the enclosed form for our records,
we will see to it that this plant is removed from our list of hazard-
ous waste facilities. The form should be returned to me.
KL: l c
Very truly yours, ..
j{r,,1,,ti,. ¼z-ifl--ti-v
Keith Lawson, Environmental Chemist
Solid & Hazardous Waste Management Branch
Environmental Health Section
Smnh T Mmrn,,✓ MD MPH
DIVISION OF HEAL TH SERVICES
P.O. Box 2091
Raleigh, N.C. 27602-2091
MEMORANDUM
TO:
FROM:
SUBJECT:
July 14,
0. W. Strickland, Head
Sol id & Hazardous Waste Management Branch 0
Larry D. Perry, District Representative ~'<J
Solid & Hazardous· Waste Management Branch
Interim Status Inspection -Generator, Transporter
Koppers Company, Inc.
Hwy. 54 West
· Morrisville, N.C.
EPA I.D. #NCD003200383
Contact: Pat Smith, General Manager
On July 9, 1982 an inspection was made on the Koppers facility to determine
compliance with RCRA regualtions. During conferences with the management it
was determined that the facility had originally listed as a RCRA generator due
to misinterpretation of the regulations. The company was once a wood treating
facility and generated large volumes of pentachlorophenol waste. The facility
is now completely out of that business at this site and no hazardous waste is
generated at the Morrisville site. The site should be delisted from RCRA regu-
lations. Mr. Smith will submit a letter to this office to this effect
immediately.
LDP:ns
Jame~ B. Hunt, Jr./ Sarah T. Morrow, M'.D., M P.H. STATE OF NORTH CAROLINA rnum-,no DEPARTMENT OF HUMAN RESOURCES cmc .. o,
• • Date: January 25 1 1982
county:_~W~a~k_e ___________________________ _
Notifier's name and·address:_--'-K~o~p~p~e~r~s_C~o~·~•'--------------
Hwy. 54 West, Morrisville NC 27560
Contact's name: ___ T_h~om_a~s~M~ar~r-~(_41~2.)~2=27_-~2~3~7_4 __ ---,-________ _
Site name and address: __ ~K~o~p~p~e~r~s_,.Co=·~·~I~n~c~.~•-'-'H~w~y~.~5~4~W~e~s~t~,--------
Morrisville NC 27560
Site location: __________________________ _
Type of waste: __ ~P~e~n~ta~c~h~l~o~c~P~P~b~e~n~o~J __________________ _
What process generated the waste? __ ~w~o~o~d_..t~ce~a~twrowe~o~t-________ _
( .· Volume of waste: ___________________________ _
Method of s tor age or dis po s a l : __ _..; mWj.1JpOw!.u!0.1.1d1JJmw.e"-nu.t~,_,_J .o.a uD rl..._t1.Jcue=.,a1.1t.JJmJ.te:JJ□"-t _____ _
Dates of waste activity: __ _.J~9u68"-'-=--J~9~2-5,.__ ______________ _
Site history: Thomas Marr of Koppers Company, Inc., in Morrisville reported
that an unknown volume of pentachlorophenol waste was stored in surface impoundments
and land farmed on the plant site between 1968 and 1975. Pentachlorophenol is
a toxic waste. The Kopp~rs site has·been'evaluated fer its imp,ct on surface
and groundwater. Some contamination of groundwater is evident, but off-site
wells have not been impacted. The site is being cleaned up, and hazardous waste
is being transported to South Carolina for disposal in a hazardous waste landfill.
*The preceding information is based on preliminary data supplied by
the Environmental Protection Agency, and not on detailed site
investigations.
' I 4 i ·-------,.
'.--..,_ ;-,,.
~-------------------"E,.,,'NV I RONIIENTAL ;, .'!_t:CT ru,1 AG,;.E~ .. c~r.,_ __________________ -"
NOTIS DATA MAHAG~~~NT SYSTlK PAGE: 188 •
--N,..,O°'T"'l~Sc-,RccEccP-cU-H""'T--,1""4--------------------~L~l-,S"Tccl71'~G~B~X~f~A~C~l7L7l~T~X-----------------~H~E~P~O~H~T~U~Ac,:T"'Ec':~l.;;0.,;/.;;2~0~/~87l--1
____________________________ __,,R,.,,t:~G~I=O~N-'1--"0~4_.,,S='I~A=T~t:~:_,,_NCo,_ _________________________ ~---•.'
g
10
--,N"O"T"'I"'f"'IccCc-A-T-:l-:Oc-N---:S"'I-'f"E-cN-A7i<-E----------------~N-=o"'r"'I"f"I~E-H-c-N-:A-!S~E----------------,N-=O"'T-=l-=f~I~t:~l<c-,SccTccA-=Tc-U-=s-----------11 '
ID 1\:0 S!Jt:: STHfit . NUTH'It:R :rr~i::~·r (PRES OWN, PAS1' OhN 12
---~~~--~S~I~T"'E-':'C~l~rkY=-----------------;',=u'=r~1"'F'=1"'t:~H_,.C~Ic',r"'x=------S~T~A~'E~t:.,..· --,Zc,Ic,P---~PccR"'E"s'-co'=p~,~-;P""A"'s'=1·,-i'o'=p.c'-.--------
cou ,,1x cCO~TACT HAMt:/'flTLE) TRANSPORTER,
EPA SIT;; ID NO, (CO"TACT PHONE) VOLUNTEER) " -------------------~---=------------------------------~---------------------------------~-~-~-~-------_-____________________________________________________________________________________________________________________________ __,,,.
NCS0000012UO KOPPtHS CO It,lC
HwY S4 liP.ST
M HISV
NCDOOJ209383
RELEASt:S TO TIIE ENVIHUNMENTI
---------------------------
------------
KOPPERS CU
·cNARk, THOMAS, SUPV/ENI t:NGH
(412•227•il74)
UAJES Of WASTE HANDLING! 1968 TO 1975 ------------------
--------------------ft
---------==-,,--~==~-,,.,=~~~~~~-==--=~==~~-=~--,.,..=~=~=~~=~-~~~=--------------J
NOTlf, PusrMARKED DATE1 81/06/09 SIGNATURE PR~SE"T: YES UATE Uf LAST UPDATE! 8~/10/19 i
----------------------------------------------------------~
-----------===-=~=~=~----------~==~~~==------------===~=~=~-------'------8
T1PE Of f'AClLI'!Y TYPES Or' WASTES SOURCES Of •ASTE
------------------------------------------------------------------------------------------.-
COMMENTS
----------------------------~------------------
si;;i,; fILE 1
INCINERATION t,OU ..
• • Date: January 25 1 1982
county: __ W_a_k_e ___________________________ _
Notifier's name and· address: Koppers Co., --~~---~-------------
Hwy. 54 West, Morrisville NC. 27560
Con tact ' s n·ame : __ -'T-'-h..::.o""ma"'s'--'-M""a""r'-r __,("""4..a.l "-2 ._) -=2'-"2-'-7-'-2""3""7-'4 ______ ,,,_ ____ _
:::.
Site name and address : __ ""'K"""o""p""p""er""s:.....aCa.:o""'._..--=-I n""c""'.'"''"'""'H""w.,_y_,_. -'5"-4"--"W""e..::.s..::.t.,_, ______ _
Morrisville NC. 27560
Site location: ___________________________ _
Type of waste: __ ~P~e~n~t~ac=hl~o~r~o~p~h~e~n~o~l __________________ _
What process generated the waste? __ ~w~o~o~d'-"t~c.e~a~tro~e~o~t~---------
Volume of waste: ----------------------------
Ne th od of storage or dis po s a 1 : __ .J.; 111m.,.pou.1wi0wd.urowe:.1□J.Jt~,--1J.aa.uo.ud....1..t 1..C ec..ac..i1.1rowe:.10J.Jt _____ _
Dates of waste activity: __ ~)~9~6~8~--) ... 9~?~5~---------------
S i te history: Thomas Marr of Koppers Company, Inc., in Morrisville reported
that an unknown volume of.pentachlorophenol waste was stored in surface impoundments
and land farmed on the plant site· between 1968 and 1975. Pentachlorophenol is
a toxic waite. ·The Kopp~rs site has ·been evaluated fer its imp~ct on surface
and groundwater. Some contamination of groundwater is evident, but off-site
wells have not been impacted. The site is being cleaned up, and hazardous waste
is being transported to South Carolina for disposal in a hazardous waste landfill.
vCO 003200 '.S'6:?
6ftJ T'RIV fr'[fO(<J ()tv fill
*The preceding information is based on preliminary data supplied by
the Environmental Protection Agency, and not on detailed site
investigations.
DATE:
SUBJECT:
FROM:
TO:
UNI. STATES ENVIRONMENTAL PRO,.TION AGENCY
'JAN 3 0 1?e1
Koppers Co. Inc., Hazardous Waste Site Investigation
Morrisville, NC
Water Surveillance Branch
James Scarbrough, Chief
Residual Management Branch
Attached are six copies of the subject report. During the investigation,
three private wells were sampled. The mailing addresses of the private
well owners are as follows:
Mr. Lewis Baerbee
Rt. 2, Box 106
Morrisville, NC
Mrs. John Medlin
Rt. 1, Box 19
Morrisville, NC
Wilkerson Cmstruc tion Co.
Morrisville, NC
Would you please see that the Water Supply Branch receives these
addresses and the data so that they can notify the well owners.
A copy of the report and sample analyses should be sent to the Koppers
Co., Inc. The compan,: contact and mailing address is:
Mr. Ray Perr, Project Engineer
Koppers Co. Inc., Forest Products Group
Pittsburgh, PA 15219
(] lb (}. :1j,£
Charles A. Till
Attachments
cc: Finger/Adams
Lair/Carter.
Bennett/Carroll
EPA Form 1320-6 (Ru, 3-76)
.... '· '•'" ._, . . ,_.,, ...
• •
Hl,ZARDOUS WASTE SITE INVESTIGATION
KOPPERS CO., INC.
MORRISVILLE, NC
JANUARY 27, 1981
INTRODUCTION
• HAZARDOUS \!ASTE SITE IINESTIGATION
KOPPERS CO. , INC.
MORRISVILLE, NC
JANUARY 27, 1981
The US-EPA, Region IV,. Surveillance and Analysis Division (SAD), at the request
of the·Air and Hazardous ·Materials Division, conducted a hazardous waste site
investigation (HWSI) at the Koppers Co. , Inc. plant in Morrisville, NC on Septemlier
24, 1980. The study was conducted by Hessrs. Rod Davis and Charles Till, US-EPA
SAD personnel with the assistance of .Tom Smith, Ecology and Environment, Inc.
(E&E). Mr. Ray Perr, Koppers Co., Inc. Project Engineer, and l1r. Larry Perry,
representing the North Carolina Department of Natural and Economic Resources, were
present during the investigation.
The Koppers plant in Morrisville, NC produces various types of laminated wood
products. The plant also produced preserved wood products from 1958 to 1975
using a pressure treatment process. Pentachlorophenol (PCP) was the preservative
used in the process. Waste materials such as bark, saw dust and excess PCP were·
dumped into pits for disposal. Koppers no longer treats wood at this plant;
however, waste piles and the disposal pits are still present. In 1978 some of the
waste was'land-farmed on two small areas of Koppers property (see Figure 1 for
locations). Koppers is presently in the process of removing the remaining waste
to acceptable landfills in South Carolina.· Since the waste and disposal pits are
still present, there has been concern that the PCP might be entering the ground
water which supplies private wells in the area. The purpose of this investigation
was to determine if the surface waters and ground water had been contaminated as
a result of runoff and infiltration from the waste area.
Water, sediment, and fish samples were collected and.analyzed for purgeable and
extractable organic compounds. The fish samples were collected for the US-EPA by
the North Carolina Wildlife Resources Cormr,is,;ion. Tt,e fish sample:s were divided
into fish tissue (fillets) and fish liver for analysis. Surface water samples were
collected from the Koppers lake, Medlin pond, and the east ditch runoff under the
railroad tracks. Ground·water samples were collected from three private wells and
three wells on Koppers property;· Sediment samples were collected from the Koppers
lake, Medlin pond, and a ditch draining the land farming area #1. Fish samples
were collected from the Koppers lake and Medlin pond (see Table 1 and Figure 1 for
sampling locations).
SITE LOCATION AND DESCRIPTION
The site is located approximately two miles northwest of Morrisville, HC on Highway
54. The area is being influenced by urban sprawl from Durham to the north and
Raleigh to the east. There are residential areas, light industry and small business
within a one-half-mile radius of the Koppers facility. There is no community water
supply; water comes from :individual wells. Surface drainage appears to be s,,uth to
southeasterly toward Crabtree Creek, which in turn flows into the Neuse River. The
topography of the area is characterized by nearly flat bot·tomlands to gently sloping
uplands. Soils consist of silty s,r.:ds, silty clays, and clayey silts derived from
claystone, siltstone and sandstone. Colors of the soils range from tan-:,r01ms to
tan-reds to purple. Geologically the site is located in the Piedmont pl,,· >:cau of
Horth Carolin,,, with the rock types being classified as Triassic sedimentary rocks ( 1).
• 2
SUHl1ARY
Pentachl_orophenol (PCP) was detected in the sediment sample collected from Koppers
lake at a concentration of 6400 µg/kg. Trace concentrations of nine other organic
compounds were detected in the sediment sample from Koppers lake but were too low
to be quantified. No PCP was detected in the water and fish samples from Koppers
lake. Methylene chloride (8.5 µg/L) was detected in the water sample from the Medlin
pond (PL-002). PCP was detected(< 2000 µg/kg) in the sediment sample from the
Medlin pond, but 'it was too low to be quantified. Three other organic compounds
were detected in the sediment from the Medlin pond, two with concentrations too low
to be quantified .and one with an estimated value of 3400 µg/kg. Bis (2-ethylhexyl)
phthalate was detected in the fish sample from the Medlin pond at a concentration of
31 mg/kg. No PCP was detected in the fish sample from the Medlin pond but it did
contain trace concentrations (< 5 mg/kg) of di-n-octyl-phthalate and an unkno,m
phthalat-=, and so,:ie naturally occurring organic aciils. No PCP or other toxic
organic compounds were detected in the fish sample from Koppers lake, but two
naturally occurring fatty acids were detected. The water sample from (KR-001;)
contained bis (2-ethylhexyl) phthalate at a concentration of 26 µg/L and three
organic compounds with concentrations too low to be quantified. No PCP was
detected in (KR-004). The sediment sample from (KR-003) contained a trace concen-
tration of·(< 800 µg/kg) and eight other organic compounds with concentrations
too low to be quantified. ·
No pentachlorophenol was detected in the water samples from the private wells or
from the wells on Koppers property. A phthalate was detected(< 10 µg/L) in one
of Koppers wells (KW-020) but at a concentration.too low to be quantified. (See
Appendix A). No pesticides that were analyzed for· were detected in any of the
water, sediment or· fish samples.-
RESULTS AND-DISCUSSION
Station locations are indicated on Figure 1 and descriptions of sampling locations
and type of samples are listed in Table 1. Figure 2 gives photographic coverage of
sampling locations and PCP sour~e areas. Tables 2, 3, and 4 give data summaries,
and Appendix A and B contain the analytical data and field data sheets, respectively.
Koppers lake (KL-100) is•approximately three acres in size and located in the
southern portion of the Koppers property immediately downstream from the old waste
disposal pits and land farming area #2 (see Figure 1). The water sample from Koppers
lake did not contain any detectable PCP, but the sediment sample contained 6,400
µg/kg· of PCP. The sediment in the lake consisted of silt, clay and organic matter.
Sorption by organic matter plays a role in the storage and transport of PCP. PCP is
only slightly soluble in water and tends to be absorbed by the sediment (2). Trace
concentrations of nine other organic compounds were detected in the sediment samples
from Koppers lake but were too low to be quantified (see Appendix A). These were
napthalenc (< 10,000 µg/kg), acenaphthylene (<10,000 µg/kg), phenanthrenc/anthracene
(< 10,000 µg/kg), fluoranthene (<10,000 µg/kg), pyrene '(< 10,00D µg/l:g), 2,4-
dimethylphenol (< 2000 µg/kg), 2,4,6-trichlorophenol (< 2000 µg/kg), tetrachlorophenol
(2 isomers) (< 2000 µg/kr,), and hydroxy-methoxy benzaldehyde (< 2000 µg/kg). No PCP
or other toxic organic compounds were detected in the fish samples fro;n Koppers lake.
Two fatty acids wePe detected but were naturally occurring, possibly related to the
natuPal Lots in the fish.
\ • 3
The Medlin pond (PL-002) is located lf00-500 feet do1-1ngradient (south) from the
Koppers lake and receives runoff and drainage from Koppers lake. The J.ledlins had
complained in the past of fish kills which they said were caused by PCP. To avoid
future kills they diverted the drainage from ·Koppers lake around their pond.
However, they have since reestablished the flow back into their pond. The water
sample collected from the Medlin pond (PL-002) did not contain any detectable PCP
or related compounds. Methylene chloride was detected at a concentration of 8.5
µg/L. The sediment sample contained PCP at a trace concentration (< 2000 µg/kg)
that was too low to be quantified. Three other organic compounds, two with trace
concentrations too low to be quantified, namely dimethyloctahydrophenanthrene
. carboxylic acid ( < 2000 µg/kg), hydroxy-methoxy-benzaldehyde ( < 2000 µgfrg),
and hexadecanoic acid (estimated 3400 µg/kg) were detected in the Medlin pond
sediment sample. The fish samples from the Medlin pond did not contain PCP;
.ho;;ever, one of the fatty acids found in the Koppers lake fish sample was also
present in the Medlin pond fish sample. Bis (2-ethylhexyl) phthalate was detected
in the Blue Gill fish tissue (fillets) from the Medlin pond.at a concentration of
31 mg/kg. Bis ( 2-ethylhexyl) phthalate is commonly used as· a plasticizer. · Di-n-
octyl-phthalate and an unknown phthalate were also detected at a trace concentration
(< 5 mg/kg) but too low .to be quantified.
Sample location (KR-003) is located in a drainage ditch on the east side of Koppers
property downgradient from the land farming area #1. Since there was no flow, only
a sediment sample was taken .. Trace concentrations of PCP (< 800 µg/kg) and eight
other organic compou,,ds were detected.but were unquantifiable (see Appendix A).
These compounds are: . acenaphthylele ( < 7000 µg/kg), phenanthrene/anthracene
(< 7000 µg/kg), fluoranthene (< 7000 µg/kg), pyrene (< 7000 µg/kg), 1,2-benzanthracene
(< 7000 µg/kg), indo (l,2,3-cd) pyrene (< 7000 .\Jg/kg), 1,2,5,6-dibenzanthracene
(< 7000 µg/kg) and 1,12-benzoperylene (< 7000 µg/kg).
A water sample from location (KR-004) was collected in a pool of water under the
railroad tracks where. the east drainage ditch drains off Koppers property. The
sample did not contain detectable PCP but ·did contain three organic compounds at
concentrations (< 10 µg/L) too low to be quantified. These were acenaphthene,
fluoranthene and pyrene. Bis (2-ethylhexyl) phthalate was also detected at a
concentration of 26 µg/L. Sampling locations (KR-003) and (Y-.R-004) are located
along the railroad rights of way so creosote from the crossties under the tracks
is a possible . source of some of the compounds detected at these t,m locations.
Three wells on the Koppers property were sampled (KH-010, KW-020, and KW-030). Two
of the wells (KH-010 and KW-020) are used for drinking water (see Table l anr
Figure 1). Diethyl phthalate was detected in (KW-020) at a trace concentration
(< 10 µg/L) which was too low to be quantified. Diethyl pht11alate is commonly ,,1
used as a solvent. None of the samples contained PCP or other organic compounds
.at detectable concentrations.
Three private wells were sampled in close proximity to Koppers property (see Table l
and Figure 1). The Medlin.well is located downgradient and south of Koppers. The
Wilkerson Construction Co. well is located east of Koppers, and the Baerbee well is
located upgradient and northwest of Koppers. No PCP or other organic compounds were
detected in any of the private well water samples.·
• • 4
METHODOLOGY
The water and sediment samples colle~ted during this investigation wer•= grab
samples. The fish samples were collected by a dip net. after "shocking". All
,samples collected by US-EPA SAD c:i:ployees were in accordance with the Water and
Surveillance Branch Standard Operating Procedures and Quality Assurance l·;anual
(WSB~SOPQAl1) (3). All samples were transported to the SAD laboratory in Athens,
Georgia by the investigators while maintaining proper chain-of-custody.
• • References
1-Stuckey, Jasper L. and Conrad, Stephen G., "Explanatory Text for
Geologic Map. of North Carolina", Bulletin _number 71, 1958.
2. Water-Related Environmental Fate of 129 Priority Pollutants,
Vohune II, EPA-440/4-79-0296, 1979.
3. Water Surveillance Branch Standard Ouerating Procedures and Quality
Assurance Manual (Draft), U.S. Environmental Protection Agency,
Region IV, .Surveillance _and Analysis Division, August 29, 1980.
o"' 'I; ,
.. /'
;,½
1
~/.___j/ Bae.rbA
<1;;1 Res1deW
PW-300
/I
figure 1
Map-Sampling LocaA
Koppers Co. Inc. s'lillray
Morrisville, NC
Not to Scale
" ){/
, Koppers Property RR l 7
t (l)
CJ
" "' " +-'
@ KW-020
Main Laminating
Building
Building
Building
Abandoned
PCP Treating '""""U
Main □
Officeu KW-010
I T .L
Q) KW-030 l
□ ti Steel Shop I l
;>>---~,)>---')-J t
... -.!, l
it
~f
KR-003 ·~ ->;,-,----~rt,-: KR-00
1 ' aste piles/ T
1 landi'' T farming, ~I
area 1 ~
#2 I t
© + l
Koppers
3 Acre
Lake
l
I
1
I
i
-------"""-------Paved Road _______ _ ~:--,,w·Too e ,----~
f
t
I
t Mobile Homes
Medlin Residence
~ PL-002
1) = sampling location
I
N
Wilker-
son Con
Co.
PW-200
'>-
u z
<l) ..,
--< .,,
> Cf) ,,-<
" " 0 ::s:
+
Station No.
KL-001
PL-002
KR-003
KR-004
KW-010
KW-020
KH-030
PW-100
PW-200
PW-300
W -Water
•
Table 1
Sampling Locations
Koppers Co. Inc. Study
Morrisville, NC
Sampling Site
Three-acre lake on Koppers Co. Inc.
property
•
One-half-acre pond behind Medlin residence
Runoff from land farming area #1
East ditch runoff under railroad tracks
Well #1 (100 feet deep) Koppers Co., Inc.
main office
Well #2 (110 feet deep) Koppers Co., Inc.
main laminating plant
Well #6 (60 feet deep) Koppers Co., Inc.
east of steel shop
Private well -Medlin well at mobile home
Private well -Wilkerson Construction Co.
Private well -Lewis Baerbee
S -Soil/Sediment
F -Fish
Sample Collected
W,S,F
W,S,F
s
w
H
II
w
w
Organic Compounds
Methylene chloride
Napthalene
Fluoranthene
Pyrene
Bis (2-ethylhexyl) phthalate
Diethyl phthalate
Table 2
Data Summary
Water Samples
Kopper Co. Inc. Study
Morrisville, NC
PL-002
(µg/L)
8.5
KR-004
(µg/L)
T<lO
T<lO
T<lO
26
KW-020
(µg/L)
T<lO
T< -(Trace less than) -the number is the min~mum detection limit.
•
Table 3
Data Summary
Sediment Samples
Koppers Co. Inc. Study
Organic Compounds
Napthalene
Acenaphthylene
Phenanthrene and/or anthracene
Fluoranthene
Pyrene
2,4-dimethylphenol
2,4,6-trichlorophenol
Pentachlorophenol
Tetrachlorophenol (2 isomers)
Dimethyloctahydro;:,henanthrene
carboxylic acid
Hydroxy-methoxy-.benzaldehyde
Hexadecan~ic acid 1J
1,2-benzanthracene and/or chrysene
Indo (1,2,3-cd) pyrene
1,2,5,6-dibenzanthracene
1,12-benzoperylene
Petroleum type product
. KL-001
. ( µg/\g)
T< 10,000
T< 10,000
T< 10,000
T< 10,000
T< 10,000
T< 2,000
T< 2,000
6,400
T< 2,000
T< 2,000
p
•
PL-002
(µg/kg)
T<2,000
T<2,000
T<2,000
3,400J
T< -Trace less than -The number is the minimum detection limit
P -Indicates presence
1/ -Tentative identification
J -Estimated value
KR-003
(µg/kg)
.T<7 ,000
T<7,000
T<7,000
T<7,000
T< 800
T<7,000
T<7,000
T<7,000
T<7,000
p
Organic Compounds
Hexadecanoic Acid "Jc/
•
Bis (2-ethylhexyl) phthlate
Unknown phthalate
Octadecenoic acidy
Di-n-octyl phthalate
J -Estimated value
Table 4
Data Summary
Fish Samples
Koppers Co. Inc. Study
Morrisville, NC
KL-001
(mg/kg)
Fish Fish
fillet liver
6J 360J
160J
1/ -Tentative identification
•
Blue Gill
fillet
200J
31
T< 5
T< 5
PL-002
(m<>/kg)
Blue Gill
liver
290J
T< -Trace less than -The number is the minimum detection limit
Bass Bass
fillet liver
6.7J 2.SJ
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,. , .
. ' • I
_j·
(d)
• Figure 2
Koppers Co. Inc. Study
•
Collecting fish samples in Medlin Pond (l/2-acre.lake).
"
Collecting water and sediment samples . PL-002. in Medlin Pond (1/2-acre ·1ake).
--
~ i ! i I
I_
I
I
I i I i
! !
i I I _,.~
I ;
I
\
• Figure 2 • \ Koppers Co. Inc. Study
/J
(e) Land farming area #2 and waste piles above Koppers 3-acre lake.
(f) Waste piles above Koppers 3-acre lake.
• Figure 2 •
\ Koppers ·Co. Inc. Study
-. :
,.
(g) L. d " ' ~1 an ~ar~ing area N •
(h) East runoff area under railroac tracks. KR-004.
-· ! l I
• :'igure 2 • Koppers Co. Inc. Study
"
(i) Koppers well cast of steel shop.
_(j) KR-003. Ditch where runoff from land farming area #1 and upper
portion of Koppers property come together.
. ,. ..
i
/ Figure 2
I
· 1 · Koppers Co. · Inc i . . .
'. ' i
,'•', •. I
. I
I
Study
(k) Land farming area #2·a d . n waste piles ab K ove oppers 3~acre lake .
l i j
. ·-
-...,_ SITE: NUMBER 2053 PAGE l FOR THIS SITE
KOPPERS COHPANY, INC,
HIGHWAY 54 WEST
tlORRISVILLE,tlC 27560
COHPAf/Y: COMPANY-FACILITY Nl.JMBER 29116
KOPPERS Cot1PM~Y, ItlC.
FOREST PROOUCTS GROUP
RALEIGH PLAI/T
HIGH~AY 54 WEST
HORP.ISVILLE,tlC 27560
COMPOS IT Im~ OF WASTE:
ORGANl
FIRST YEAR USED: 1968
LAST YEAR USEO: 1968
ORGAf/4
ORGAN21
HUf/DREO TONS:
THOUSAHO CUBIC YOS,:
THOUSAt/0 GALLONS:
ORGAN23 ORGAN2f+
LEGrnD: IF LISTED, THEil PRESENT rn WASTED. IF tlOT. LISTED, TP.EN ITEM tlOT PRESENT, HOT KNOh'N IF PRESENT, OR DATA HISSING,
•
•
--. 1··'.' .• :-·
Koppers Company, Inc., Forest Products GH,up
. Pittsburgh, PA 15219, 412-2271
Cf!,~ r_ ·-:::--.r:'."'\_, r·::1 r::-,r-l
· ' \ '• i · ·-·e ,' · •·• ! ·, ' , .... , \1.~1 w u-L.;;:;iw\.;l~
Architectural and
CERTIFIED }IP.IL Construction Materials
Dear Hr. Young:
July 3, 1980
Mr. Joe Young
Environmental Scientist
EPA, Ree;ion 4
345 Courtland Street
Atlanta, GA 30365
RE: Koppers Company, Inc.
Forest Products Group
Raleigh, North Carolina Plant
The Koppers Company, Forest Products Group has reviewed the area
around the old Cellon operation at the Raleigh, North Carolina
plant for pentachlorophenol contamination and has taken action
to clean this area where required. The following has been done
as part of this effort.
1. A physical cleanup of this area was conducted. This
involved removing approximately 220 tons of con-
taminated soil and shipping it to SCA Services, a
secure landfill in South Carolina.
2. Three active wells, an abandoned well and the two .·
surface storm water discharge, leaving the plant,.-_!
were sampled on }lay 6, 1978 and analyzed for ·'
pentachlorophenol at the Koppers Company's,
Monroeville Research Laboratory in MonroevillEi,
Pennsylvania. The results of these tests are as
follows:
Active Wells
Main Office Well itl
Main Laminating Plant Well {,!2
Truck Leasing Building.Hell #3
Inactive Well
East of steel shop
Writer's Direct Dial N_umber. _____ _
Penta ppm
<0.0004
<0.0004.
<0.0004
· 0. 092
• ,. ;
-2-
Surface Storm Water Discharges
East Discharge
Lake Discharge
Penta ppm
0.006
0.0013
The only well that a meaningful amount of pentachlorophenol
was found in was east of the steel shop: This well has
been monitored by Koppers for the past few years and has
shown a significant improvement. The pentachlorophenol
contamination has reduced by a magnitude of 2. As
reference, the Bureau of National Affairs Inc., Environ-
mental Reporter, 2195-2196 reports a.recoITII!lended ambient
water. quality criterion for pentachlorophenol of .140 ppm.
3. Additional testing for pentachlorophenol is currently
being done in the area of the old Cellon operation by
Koppers Company.
4. Mr. Larry Perry of Solid & Hazardous Waste Management
Branch of the State of North Carolina's Environmental
Health Section visited the plant on June 26, 1980. During
this visit he reviewed the site and collected and split
with Koppers four water samples to be tested for penta-
chlorophenol. Koppers plans to work closely with the state
regarding the evaluation of this site.
If you have any questions, please contact me at [phone].
RAP:cg
cc: T. A. Marr .
P. D. Smith
J. E. Heinz
~J~
Raymond A. Perr, P.~
Project Engineer
Environmental Engineering
Forest Products Group
.. ) .HTIAL HAZ:ARDOUS WJ.STE SITE --..) •
SITE IHSPECTIOH REPORT
REGION SITE NUMaER (lob• ... ,,,.,.
•d b7 Hq)
C!:NCRAL IH.STRUCTIOHS: Complete Sections I and m throua;b XV of this Conn as completely as possible. Then u:.ae the inform••
.1.ion on thi• Corm to develop a Tentar:ve Dispoaition (Section II). File this form in ha entirety in the regional Hazar-dous Wute Log
)ue. ·Be sure to include all appropriate Supplemental Reports in the file. Submit a copy of the Conns to: U.S. Environmental Pro-
·tection Agency; Site Tracking System; Hazardous Waste Enforcement Tade. Force (EN·335); 401 M St., SW; Waahlnitton, DC 20460.
A, SITE NAME
/c:or:;~.p.,-.J
C, CITY r r
G. SITE OPERATOR INFORMATION
!, NAJ,,AE
1.1-o p ?E r?.__5 ~------:i. STREET
I. SITE IDEHTIFICATIOH
I U, .;, 1 ·I I:.
,,,....,"'"'"", ,...,, (ti ditlorent tram oper•lor ol •It•)
I. N.lt.ME
---3. CITY
1. SITE DESCRIPTION
i ' ,. I-i:t •~ c/1 i'CL.1· ,..,._ c;; I C //) ,, ,,, ... ,...
J. TYPE OF OWNERSHIP
□ l. FEDERAL 0 2. STATE 0 3. COUNTY 0 4. MUNICIPAL
f-. '-'v.JNTY ,..,....,i::.
r..,.,_;,, /-r· ' ' \
.t. TELEPHONE NUM!IEl'I:
--
2, TEi..EPHONE NUM8EPI
0 !S. PRIVATE
'
-
II. TEHTATIVE DISPOSITION (complete this section last)
A. ESTIMATE DATE OF TENTATIVE
DISPOSITION (:no,, day, & yr.),
;~ . jjl-1· -•-• PREPARER INFORMATION
I. NAME
, ~ (t 1-r---,
8. APPARENT SERIOUSNESS OF PROBLEM
0 1. HIGH ~ 2, MEDIUM
Ill. IHSPECTIOH INFORMATION
A. PRINCIPAL INSPECTOR INFORMATION
1. NAME
_i, IL R E_ tr _j) . _f /: .ru-:;_ Y
3, ORGANIZATION
B, INSPECTION ?ARTIC1PANTS
2. ORC.lt.NlZATlON
C. S!TE REPRE:5!::NTATIVES INTERVIEW!::□ (cor;,or11tt1 otflclt1lt1, workera, tt11Jldent•)
l. NAME 2. TITLE 1!t TELE<>HONE NO.
D ' I le r,-<.) lr'..l,I £-~ .. ;,,_,.,-
~-, I ~.
~ 3. LO'N □ 4. NONE
C
~'! •• -, p,, ...
l o1.TEu::PHoNENo.(';;;• cod& & n~
'7/'7-'.l, '• l, -L/ I[?
3. TELEPHONE NO,
Continued From Front . . ' ID. IHSP ·s10H IHFORMATIOH (conllnu \
o. GENERATOR INFORMATION (•oUTcH of w••I•)
1, NAME 2, TELEPHONE NO. 31, ADDRESS 4. WASTE TYPE GENERATED
Jr,,J,:;~..rr< t'~, ":il9' ·'f/'7-/,;r, I u :;-11 /,,) /'/ . //'(" //·~{. ) , sit, /Jr--,,,, : C. j • , \1' ff(,!f";, ,.IJ, " I ' / I
E. TRANSPORTER/HAULER INFORMATION
1. NAMI!'. 2, TELEPHON!.: NO. 3. ADDRESS -'I.WASTE TYPE TRAN.SPORTED
F. IF WASTE IS PROCESSED ON SITE ANO ALSO SHIPPED TO OTHER SITES, IDENTIFY OFF•SlTE FACILITIES USED FOR DISPOSAL.
1. NAME 2, TELEPHONE NO,' :S. ADDRESS
G. DATE OF INSPECTION H. TIME OF INSPECTtOt ,. ACCESS GAINED BY:(credenllel• mu•t be ehown In all ceaea)
(mo., dey~ & yr,). /j;,:i,:; ! l1:'I ' 0 2. WARRANT ./-· _:.,-,v(, 1. PERMISSION
J. WEA TH ER (de.crib•) ' ,.", ,.,_, . .
f"."-"11,.,_1 . ',·
IV. SAMPLIHG IHFORMATIOH ) A. Mark 'X' for the types of Sll.mples taken and indicate where they have been sent e.g., · regional lab, other EPA lab, contractor,
etc. and estimate when the results will be available.
2, SAMPLE 4. DA TE
1. SAMPLE TYPE TAKEN 3.SAMPLE SENT TO: RES UL TS
'm•rk •x•1 AVAILABLE
•• CROUNOWA TER X Iv,,/, ,) :n . ,J-/p ~-/-;/ <;,. I ( ' ,, ' ., -••v,t';l>f ,. , . ...,
b, ~URFACE W_.,TER x I I /'; /, I I I I/
c. WASTE
d. AIR
e, RUNOFF X / / ' /J I I/
' !.. SPILL /o., I',, -p•/ /~,, /, _, ' J--a , ,"" ,t) -
... ,./.,, ' -' •' .,, " /I ,~ .. , ...
It• ,011-?-]_ -, /f;'() (J •''--J
h. VECETAT10N
I. '?TH F..R (e;,,cT71J
a. FIELD MEASUREMENTS TAKEN (e.Q., _redloect/vlty, oxp/01tlvlry, PH, ntc,).
1.TYPE 2, LOCATION OF MEASUREMENTS J.RESULTS
·-·----·-_______ ,,_
Continued From Pnge 2 • IV. SAMPLING INFORMATION (continued) 'C. PHOTOS I '· PHOTOS 'N CUSTODY OF• 'f. TYPE OF' PHOTOS
Db. AERIAL ' 0-e. GROUND
D. SITE MAPPED?
0 YES. SPECIFY LOCATION OF MAPS:
E. COORDINATES
1. LATITUDE:(def1.·min.-:iec,J I '· C.ONG,TUOE (de,,•min,••oc,)
V. SITE INFORMATION
A. SITE STATUS
0 I. ACTIVE (Those inducirial or ~ 2. INACTIVE (Those 0 3. OTHER(specify):
municipal sites which are beinf1 used· es which no longer receive (Those sites thnt include such incident:J Iika "midnif1ht dumping"
lot wa:Jte treatment, ,;/orat1e, or disposal wastes.). where no re,luler or continuin,: uae of the :site for wa:ste dispo:Ja/
on a con1inuint1 ba:Jis, even If in/re-hes occurred,).
quen//y,)
8. IS GENERATOR ON SITE? .
0 I. NO [SJ 2. YES(speci/y genera/or's Jou,-..diait SIC Code):
c. AREA OF SITE (in ecres) □. ARE THERE BUILDINGS ON THE SITE?
2. -3 □ 1. ND ~ 2. YES(specify):
VI. CHARACTERIZATION OF SITE ACTIVITY
Indicate the major site activity(ies) and details relating to each activity by marking 'X' in the appropriate boxes.
'X X' X' X' -.. TRANSPORTER -B, STORER ~ C, TREATER ); D . DISPOSER
I.RAIL l.PILE 1,F"ILTRAT10N I, LANDF"ILL
,~"t: 2.SH1P 2.SURFACE IMPOUNOMENT 2. INCINERATION X 2. LANDFARM -·~ 3. BARGE 3.0RUMS J. VOLUME REDUCTION J. OPEN DUMP
•• TRUCK 4. TANK, ABOVE GROUND 4. RECYCLING/REC OVERY )( 4.SURFACE IMPOUNDMENT
!i, PIPELINE :;. TANK, BELOW GROUND !i. CHEM.I PHYS./ TREATMENT !i. MIDNIGHT DUMPING
'-a. 0 TH ER (specify): '-e. OTHER(specify): ti. BIOLOGICAL TREATMENT ti.INCINERATION
7.WASTE OIL REPROCESSING 7. UNDERGROUf':10 INJECTION
a.SOLVENT RECOVERY 6. 0 THER(speci/y):
' '-lL OTHER(specifyJ:
i
E, SUPPLEMENTAL REPORTS: !f the site fatls within ony of the categories listed below, Si;pplcmenta! Reports must be completed, Jndicnte
which Supplemen!lll Reports you have filled out and Ott.ached to this for ••
0 1. □ □ □ SURF AC::'. □ I STO:";AC,· 2. INCINERATION 3. LANDFILL 4. IMPOUNDMENT S. DEEP WELL
Q •. CHEM/BIO/ ('.i'.;J 7. LANDFARM □ 8. OPEN DUMP □•· TRANSPORTER □ 10. RECYCLOR/R!::CLAlMER PHYS TREATMENT
VII. WASTE RELATED INFORMATION
A. WASTE TYPE
[Z] 1. LIQUID CZ] 2, SOLID □ 3. SLUDGE □ 4. GAS
8. WASTE CHARACTERISTICS ..
0 I. CORROSIVE □ 2. IGNITABLE □ ,. RADIOACTIVE □ 4. H1GHL Y VOLATILE
~ S. TOXIC □ 6. REACTIVE □ 7. !NERT 0 a. FLAMMABLE
I ~ 9. OTHER(.!!peclfy):
l .,.JtSeT!c~~:~7~~1s~;B evailab! e? Specify items such,.,, r.,r,nife,ts, inventories, etc. he\ow.
lilu I
EPA Form T2070•3 (10-79) PAGE3OF10 ' Conunue On 1-:evers~
--'
Continued From Front ..
·--~LATED IHFORMATIOH (c.,;1ed)
'•
VII. WAST I
2. Estimate the amount (specify unit of measure) of waste by category; mark 'X' to indicate which wastes a,e present.
a. SLUDGE b. OIL c. SOLVENTS d. CHEMICALS t. SOLIDS f. OTHER
AMOUNT AMOUNT AMOUNT AMOUNT AMOUNT AMOUNT
/J,f-,,,,.,,,. .. I UNIT OF MEASURE UNIT OF MEASURE UNIT OF MEASURE UNIT 01'" MEASURE UNIT OF t.4EASURE UNIT OF MEASURE
·x ll)PAINT, l::J OILY . x· x· x· ·x
~ -(1I HALOGENA.TEO ~ (1) ACIDS ,-(1) FLYASH. ._ lll LABORATORY,
PIGMENTS l[lJWASTES SOLVENTS PHARMACEUT.
12) ~~~;~:s LJ2) OTHER(apeclfyJ: l NON•HA.LOGNTD.
\2. SOLVENTS (2l ::~~~~N/ (21 ASBESTOS (2) HOSPITAL
(J) POTW 1--(J) OTHER(specify): l3) CAUSTICS MILLING/MINE
(J) TAILINGS (3) RAOIOACT1VE
\,t) ALUMINUM (,4) PESTICIDES l~I ~NEt:~~~ ::EL T (4)MUNICIPAL SLUOCE
,-!6l OTHER(•p•cllyJ: (:ii DYES/1NKS (~l ~i~~~~:':~~~s _ (:if OTHER(specify):
(6) CYANIDE _ {61 OTHER(specify):
' f'-:.,...i<-' (;...1:.,-rt.,f -_-t .-..u I
X (7) PH ENO LS ,
161 HALOGENS
(9) PC 8
{IOI METALS
(11 l OTHER(specifyJ -
. r O. LIST SUBSTANCES OF GREATEST CONCERN WHICH ARE ON THE SITE (place in descendinB order of haz11rd) -
2. FORM 3. TOXICITY
(mark 'X') (mark 'X')
I.SUBSTANCE ... SO· b. b. C • d. 4.CAS NUMBER 5. AMOUNT 5. Utl!T C, VA ..
C>O LIQ. OOR HIGH MEO. cow NONE
fn,f, 'I/. :-t,; I I;.· I\ ' / X. f-x' . I
VJ□. HAZARD DESCRIPTION
FIELD EVALUATION HAZARD DESCRIPTION: Place an 'X' in the box to indicate that the listed hazard exists. Describe the
hazurd in the space provided.
□ A. H_uMAN HEAL TH HAZARDS
)
'
• f ~ •.
• ~~ontfni.'diJ From ~d:, 4 · . · \ •: .!! , . _ . • , .
-·-· -.... ___,,,,-........ ,Vill~AROtiESC RI PTIOH (C• -··\;;;;;---,------------------;
O e. tic:iN-wORKER INJURY/;_ ~
□ C. WORKER INJURY/EXPOSURE
II] D, CONTAMINATION OF WATER SUPPLY r .
.' I !le,
•,.,,,
''1--------------------------------------------------! ·•i1J E. CONTAMINATION OF FOOD CHAIN
'
.J' ::: u ,·~-,',:.I.;'.'•/~:.
\.•••I• :,_
(yJ F. CONTAt.llNATION OF GROUND WATER ' -
[pJ G. CONTAMINATION OF SURFACE WATER
,) i,.?
I . /,!.-.,. ,,--·(_ 1·
PAGE 5 OF 10
/ o/ F <· u. ,,.c('
i /'-t :· . ,-.
Cor.tinue On Revers::
Contin·Jed From ~ront ---~-.~-n~_.;..•~-·i,.,;,.;,;;_~~-, •' . . .
VIll. H) 10 DESCRIPTION /conHnu•· --..
El H. DAM.A.GE TO FLORA/FAUNA I
;>, '! J -~ .• ' . ' '.
' / ) / ~ Ce..-.... ·' --· ,' ,. ,. ' . .. C, 1 •'f Ct ,'.-· ·' ' -,,
• C " '
J_ /
6 >-' ,JI -r r /" " I
l;2l ,. FISH KILL
C ' I ' ' .J ' ' /
/ ,n_· : //..-Cv (: v-r..\.r :' -,,. ,·•-· ' '· ,-,, r ~t'--
I ;, ~ / •. ' ' ,.. ! ,, ~ -
I ; I ' {) :'.( ' ' t:-:..,c:· ·l/ . // , ' ' ~ : ' /
DJ. CONTAMINATION OF AIR
I
D K. NOTICEABLE ODORS
D L. CONTAMINATION OF SOIL
D M. PROPERTY DAMAGE
)
EPA-Form T2070-3 (10-79) PAGE 6 OF 10 Cor.Unae On Page 7
.. -.. --·---·-·••·.:.. ... J.,·,.:..':.;.;,·; <' .. .. .. ... -~-·----;'\4•~ .. -•. -~----· ....... _~· .. -.. ~.,. ... . .. ' -, .... •,.-
~ Vil!. HAZARD DESCRIPTION (co· d)
□ "· FIRE OR EXPLOSION • •
" ., I '
)
□ O. SPILLS/LEAKING CONTAINERS/RUNOFF/STANDING LIQUID
□ P. SEWER, STORM DRAIN PROBLEMS
!
-~ L] 0, EROSION PROBLEMS
~
[J R. INADEQUATE SECURITY
□ s. INCOMPATIBLE WASTES
:i· j
I
EPA Form T2070-J (10·79) PAGE 7 OF 10
•
VIII. HAZARD DESCRIPTIOr-1 rcontinuedJ .l
□ T. MIONICHT OU~PING
□ U. OTHER (•peclly):
I
..... --
-
-
IX. POPULATION DIRECTLY AFFECTED BY SITE
C. APPROX. NO. OF PEOPLE 0. APPROX. NO. E. DISTANCE
A, LOCATION OF POPULA Tl ON B. APPROX. NO. AFFECTED WITHIN OF BUILDINGS. TO SITE
OF PEOPLE AFFECTED UNIT AREA AFFECTED (s;.iecily units)
l /., .. ,--) 0 1--1 ,. ' ... ~ J
1.IN RESIDENTIAL AREAS .'/ /cl . : ' /; /. ' :.-.~ ,, ,,,, .
2•~NRCI~~~:;;/:~ ARE>.-5 'fu 1 -, I L(O .. ,:
IN PUBLICLY 3 ' TAAVELLED AREAS
• PUBLIC USE AREAS '(parka, 11choo!i,, etc,)
X. WATER AND HYDROLOGICAL DATA
A. DEPTH TO GROUNOWATER(apec//y unit) B. DIRECTION OF FLOW C. GROUNDWATER USE \N VICINITY
1"cll-. :,, .. _.
0. POTENTIAL YIELD OF AQUIFER E. DISTANCE TO DRINKING WATER SUPPLY F. DIRECTION TO ORINK!NG WATER SUPPLY
(:1pecily unir of r:ie11:sure)
G, TYPE OF DRINKING WATER SUPPLY
□ I. NON·COMMUNITY □ 2. COMMU~1TY (1Jp..,cify town): < 1S CONNECTIONS• > 15 CONNECTIONS
I □ 152] !U1 ,
' -. // ,/:., 3. SURF-'CE W-'TER A. WELL (_ (,, I " /\':... ,-)' ,, ~ .. , -' -; :' (.· r.,
EPA Form T207~3 (l 0·79) PAGE 8 OF 10
• Continued From PtJ~e 8
_I X. WATER AHO HYDROLOGICAL DATA (continued)
). LIST ALL DRINKING WATER WELLS WITHIN A 11, MILE RADIUS OF SITE
I. ~ELL 2, DEPTH (11poc/ty unit) ' J.LOCATJON
(proximity to po,pul•llon/bulldln1•)
oP:c, /!) j I l UU•p/.,, .C,. i
,,,;,., ' ✓-' ,
,Pl, ' ., 1 l/ 0 j, ,c .,/(' '-r/; i, ~ , I , ._,, '~-,; I I
I
Ho,,~,~ ....... ;~·u ' ··f I Lv. ' r-
-
I. RECEIVING WATER
1. NAME
-- - -O, SPECIFY USE ANO
\ oo ,. ·••ER•
~ A LAKES/RESERVOIRS
cLAs51FICATION OFREcElV1Nc-;-;_TE'Ri'
D J. STREAMS/RIV ER!!!
XI. SOIL AND VEGITATIOH DATA
..
NON•COM--
MUNITY
(m•r.lt 'X')
y
,,
,,/_
LOCATION' F SITE IS IN:
0 A, 1".NC,,.N FAULT ZONE 0 B, KARST ZONE 0 C. 100 YEAR FLOOD PLAIN □ D, WETLAND
~ E. A REGULATED FLOOOWAY D F. CRITICAL H . .&.SITAT □ G. RECHARGE ZONE OR SOLE SOURCE AQUIFER
XII. TYPE OF GEOLOGICAL MATERIAL OBSERVED
Mark 'X' to indicate the type(s) of geolozical moterial observed and specify where n~cessary, the component p11,_rt9.
'X
-A, (.,VERBURDEN
'X -B. BEDROCK (9pecJfy below)
X'
C, OTHER (•P•c!ly below)
1. SAND
3, GRAVEL
1-------------------"XIIJ=c..· -'S-'0-'-1 Le.PERMEABILITY
DA. UNKNOWN 0 C, HIGH (1000 ro JO cm/u,c,)
, .
COMMUN·
OTV (01•rk 'X')
-
DD. MODERATE (IO to .1 cm/.1ec,)
□ B. VERY HIGH (100,000 to 1000 cm/st-c.)
[Kl E. LOW (.l 10 .00J cm/.1ec.) 0 F. VERY LOW (.001 to .00OOt cm/.1ec,J
G. RECHARGE AREA
□ 1. YES Oz. NO
H. DISCHARGE AREA
□ 1. YES □ 2. NO
I. SLO?E
!. E.5-:'"ll••ATE '1. OF .5LO~E
J. OTHER GEOLOGICAL DAT.ii
) r
EPA Form T2070-3 (1 0-79)
3. COMMENTS;
3. COMMENTS:
2. ~PEC!FY 01RECT!0N OF :5LOPE, CON~ITlON OF :5LOPE. ETC.
PAGE 9 Or 10 Contrnue On Rev!:"r3e
• .,
\ ConUnued From Front
XIV. PERMIT INFORMATION .,
List all upplicable permits held by the site and provide the relsted information.
F. IN COMPLIANCE
O. CA.TE E. EXPIRATION (m•rk 'X')
A. PERMIT TYPE B, ISSUING C, PERMIT ISSUED DATE ,. '. ("•IJ•, RCRA, St•t•,N PDE. S, etc,) A.GENCY NUMBER (mo,,dey,&~,) (mo,,day,&,yr,) J. UN·
YES NO KNOWt. j
. "
' '1!/ A ( .-I
I
XV. PAST REGULATORY OR ENFORCEMENT ACHONS
0 NONE D YES (11ummarli" In th/• epecrt)
!
'
-·
'.
NOTE: Base·d on the information in Sections III through XV, fill out the Tentative Disposition (Section ll) information
on the iirst page of this form.
PAGE 10 OF 10
_.
&EPA l :tNTIAL HAZARDOUS WASTE s ) -• REGION SITE NUMBER (10 be oa-•llln•d by Hq)
IDt:NTIF ATION AND PRELIMINARY ASSESSME 11/ ? --J:."'~ HOTE: Thia form la coaipleted !or each potential hazardous waste site to help set priorities for sitC inspection. The in(ornution aub::iltted on this loffll h baaed on avaUable records and m•Y be updated on subsequent forms &!!. n result of additional inquiries ysd on-"!llte inspections.
I C'!H E;l.\•_ l:-ISTlWCTIOl-15: Coc:o.;,let., Sactiona I a:id TII t!-\?"o•:~', X .:l'J co:-::p'.~:dy a;. possibt<? ~d,1r~ s~c~ton I[ (Pre(i::::inar;· 4"1,3..,i,:1r.n-,.,!). ·Fit" th~:1 fo:i:::::i in L--:.~ Re:rio:i~l Ha::a:-:io•.:~ Was:~ L'):!: Yit!:' and S'.!°:,~.i~ a co;,y i:o: U.S. En·:L·'J:1menta'.. P~:-ecti:l:i .'t.iecy;· Si,-, Tr:i::k!:il 57::1!1:1c,,; H~x:.1rdou:1 'J'a~t~ E:i.lo:ce;-=:e:it Task Fo:-ce (Ei~;.;J.i); 401 M St., :;•,:.;; Washin,tton. DC 2•)460.
I. SITE IDEHTIFICATIOH
A • .SITE•NA""E B. STREET ·(or other ldentiliu) -(o ·--I< c??L°:: i~ -s .L,vG l·l,,v )-4-i..,,) "'. ~.)J
C. CITY o. STATE • l E-ZIP CODE F. COUNTY NAME ~ /)'] ci?...;'.2-.. I~ \.,) J i__.L I -;; NG :l. 7 i-lc C i-u 1-J {.(_ -
G. OWNER/OP.ERATCR (ll kno..-r,)
I. HAM£ 1 •• _T<LEPHONE NU,..BER (SAr.i:) (111,,E.\ t//9-"'t 1,, ·7 -& / 5-I H. TYPE .. OF OWNE:RSHIP '--
D 1. FEDERAL. □2. STATE □3. COUNTY ::::J• MUN!C1PAL -~ PP.JVATE □• UNKNOW .. !
I. SITE OESCRJPTIOH
L) ,\}I(___
J, HOW IOENTIFIEC (l.e,, clt/;;ren'a cornpl•inu, OSHA citation.s, etc,) K. DATE IDENTIFIED
(mo,, day, &. yr,)
I -:=-. 1<'. ,__ ~. ----~----2-..__ c: ·;._,.) .
! L, PRINCIPAL STATE CONTACT •
!· 1, NAME
1 •· TELEPHONE NUM0ER ' )? ' fv"l C y Cc'-'7 ,-3-2-/
}' · II.I PRELIMINARY ASSESSMENT (complete rhis section last)
:_: .PPARE~JT SERIOUSNESS OF PROaLEM
' □1. HIGH □2. MEDIUM □3. LOW ::J• Nm,E ~•,:<Nawn ' j
!
!e. RECOMMENDATION_
0 1. HO ACTION NEEDED (no haztwd) Oz. 1MM::::::rATE SITE INSPECTION NEEDED -•• TE:,,,;--:.1.T·yELY 5CHEOULED FOR: / _"&:.:) 3. SITE INSPECTION tif;:EOED
FOR: b, WILL BE PERFORMED BY: :ii. TENTATIVILL.'1 5CHEOUL.EO
b. WIL.L. DE F>ER..-ORM1£0 flY:
0 4. SITE INSPECTION NEEDED (low priority)
,
C.PREPARERINFORMATION
I. H.I.M~ (} ,i I~ l/fr,_
12, TELEPHONE NUMBER 1 ·· ~~;7;··;7 x:;;·' . I ·:, -½---z. I 7j-
III. Sl";E INFORMATION
A. SITE STATUS
□ 1.iACTiVE (I?lo•e ln:1u•trlal or ~-INACTIVE (Thou Q 3. OTHER (,;:,'!city): :ru.arlclp~t •ltoo ...,h/ch ere beln,2 u•ed t ti 111-'tllch no /on • .,, ,rcr/vr ( osr ,itlll', 1r.a1 include ,uc:h inc:id'!nffl tikc "arld:i/Qht dc.=tpln9" Whf't" lor ..,a,to n-., .. tnt.,nt, •to,z,Jto, o, dl•poaal Prnatt-a.). ·7 no re~ular o: co,-,:inuinsi u:r,. o/ the .sit& for wt1.:rt• dl:spo,a/ ha, oc:c:.:nod,) on o. corit/n--.,Jn.,: b••la, •""" ll "Intro-' quor1tl:,,). •
8. IS GENERATOR ON SITE7 / □1. NO .'] L/-3t [Q-·2. YES (,pi-city arn~:.nor', lnur-di,i! SIC Cod11J): ,:;,;..
-C )E>. OF SJ7E (In ,.c;,u) D. IF APPARENT S~p;QUSNESS OF SITE 15 n1::;H, SPECIFY COORDINATES ,. L.ATITUC£ (d~J.-~/n,-,ec,) I '· LONC.'1 UOS (<<,,-min.-••<•} -
. E. ARE·TH£R..2: EJUILDINGS ON THE SITE? o,.ao 0 2. YES (•p•clf,.):
2070-2 (l<>-79)
--.., '. "' \I • fl " .., ' IV. CHARACTERIZATION OF SITE ACT/V/T\' \ ,_ ., lnt!ica!e the major site acti\·it>·(ies details rela to e;ich acti\·i.ty b,-rnarki.n in th"! ll;:>pro 'le bo,;.es~ \ X' X X x· \ -•• TRA.NSPORTER -8. STORER -C. TREATER -D. DISPOSER ,. AA.IL 1. PILE . '-"°IL TRA.TION ' . LANO FILL I . . . \ ,. 51-!IP ,. SU"-FACE IMPOUN 0'-IEN T 2. INCINEA.-.T 10N ,. LANO,..A.RM r J. e.-.RGE ,_ ORU,.,4' ,. VOLUME A E:)UC TION ,. OPEN OUt.!P -.. ·-TRUC ,<. ·-TANK, A BOVE GROUND .. REC V CLINC/R EC OVER V '· SURFACE l~APOUNOMENT ! 1. P1~'!'°\.l."l :-'. ,. T.HL!-.'..iJ!':L,:;)W G"':O'Jn::, •· c.~•::11.1 :,,..,. "· Tr!!!-~ r•.-~:,,, 1 l-t.-1-:,.~1~~T C:J•,i:>1~,:: LJ•-OT..,.C::t( (:,,p~dl;•J: ,_ OT ►IER (sp.cil>·): f-,. BIOLVG:C.AL Tk5:"-TMC.rll' ,. fNCINE'.RA TION ,. WASTE OIL RE?R0CE~5•NG ,. UNOERCROUNO INJECTION
'. SOLVENT RECOVERY r•-OTHER (sp•cify):
I), OTHER ($pieci{y):
ll~ -
E. SPECIFY OETAll.S OF SITE ACTIVITIES AS NEEDED
V. WASTE RELATED INFORM,HION A. WASTE TYPE
-,· --gr; UNKN.OWN D2, Ll~UID < □3. SOLID 0•-SLUDGE Os-GAS
B. WASTE CH-'\RACTERISTICS .. □ I. .UNKNOWN Oz-CORROSIVE o,. IGNITABLE O• RADIOACTIVE Os HIGHLY VOLATILE ,,.
CS)_i;. TOXIC o, REACTIVE O• INERT 0• FLAMM A BL~
010. 0TH ER (specify):
C. WASTE CATEGORIES
s~ch 51s r.ian!fesis, '•' 1. Are reco:-ds of w11st41, ,i,vull:.ble? Specify items ln\•en!.,)ries, et,:. below. ) ';:i
·'~~ ..
2. Estimate the :a:nount(specify unit of measu:e)of waste by category; mark 'X' to indicate which y;ostl.'s are present.
•• SLUDGE . b. OIL c. SOLVENTS d. CHEMICALS e, SOLIDS I. OTHER AMOUNT AMOUNT AMOUNT AMOUNT AMOUr-. T f
il"'\./ (_
AMOUNT
UNIT OF MEASURE UNIT OF MEASURE UNIT OF MEASURE UNIT OF MEASURE UNIT OF MEASURE UNIT OF MEASURE
. h· 111 PAINT. x· Ill OILY ·x· (II HALOGENATED ·x· 'X ·x·
'.I I ~~:~~1:~~0~, r PIGM!:;NTS ~ WASTES ~ SOLVENTS -(IJA.CIOS -(II FLY ASH -
I l:ZIMETALS -C2l OTHER(specf/yJ: !2) NON•H ALOGNTO (2) PICKLING 421 -"SBESTOS 121H0SPITAL I SLUDGES SOLVENTS LIQUORS
I
I---(J)OTHER(spocifrJ: lllMl!_LING, i 13) POTW (31CAUSTICS MINE TAILINGS t3J RADIOACTIVE !
i t,,t)ALUM!l'.:UM
:.:I ;,;:~:~.V:ASTES
i (41 ~ESTtCtDES l◄),.,.UNICIPAL I SLUOCE
! -151 OTHER(sp,:,c//y):
!:JI OYE5/INKS 15' ~-~i:'~~~~/!~~~s -l:!IOTHER(:.;:,:icllyJ:
ro, OT "'1ER("'Pf>Cify):
(OI C YANIOE -
171 PHENOLS
UIHALOGENS
CO! PCB )
\
llOiME1'A.LS
_ (I l)OT~◄ER(3pc,ci{y)
,-':: PA fonr, T207!J-2 (l 0•79) PAGE20F4
.. -. -~ 2:sr· suBsr ANCES OF CREATE.SI ::6ScERN Wi-llCH MAY BE ON THE SITE (pl•c• in dt1•condint2 order ot h•1t•rcl). ,,
~ ,( .. -!-~~--
, ·.• . ') -
fJ/,""'-o.;_ <~t._
I l Cl t I...· /ti~ --. J .l.C-y~-.f. I t--t. 5e"·=~ l-' ; / I J
"
)'ADDITIONAL COMMENTS OR N,l,.ARATl\'E DESCRIPTION OF SITl.lATION KNO"ri,'i OR r!EPORTEO TO EXIST' AT THE SITE.
VJ. HAZARD DESCRIPTION
e. C, POTEN• O,DATEOF A• TYPE OF HAZARD TIAL ALLEGED INCIDENT E. REMARKS HAZARD INCIDENT (mo.,day,yr,)
{auirk 'X') (auuk 'X')
f• NO HAZARD !::1r~t1: /;_::: ·)l/{11~~ ;·.){,;_fl:~---... ~>t/{, ,, ~·-::):: ·--~i-t.rt1.:::·•. {'f._:r(f/· /~:\":ht,;-. : :.-\r~ . .s:t~ /t:~\{\
z, HUMAN HEALTH
,_ NON•WORKER
INJURY/EXPO.SURE
,i, WORKER INJURY
CONTAMINATION ,. OF WATER SUPPLY
CONTAMINATION
;. OF FOOD CHAIN ..
CONTAMINATION
'OF c;ROUNO WATER
CONi-AMINATION
•• OF SURFACE WATER
.DAMAGE TO
'-r~*•ORAIFA UNA
"' :;,.
O, FISH KILL
,. CONTAMINATION
OF AIR
2. NOTICEABLE ODORS .
. -
3. CONTAMINATION OF SOIL
4. PROPERTY OAMACE
. ,
,. FIRE OR EXPLOSION
1 5PILLS/LEAKINC CONTAINERS/ • RUNOFF/STANDING LIQUIDS
SEWER, STOR!\-1
• ORA.IN PROBLEMS
:. EROSION PROBLEM:!!
,, INA.DE?UA TE SECURITY
INCOMPATIOLE WASTES
• MIONICHT OUMPINC
-\YER (:.;,,:,cify): ..,.
-" .-
\ form T2070·2 (I 0-79) PAGE30F4 Continuo On Rever~e,
C 1· on 1nue dF rom Front ---.... . • ' \ 'ERMIT IHFORMATIOH ' 1 A~ INDICATE ALL APPLICABLE PERMl1 HELO BY THE SITE.
D I. NPO~S PERMIT o, SPCC PLAN D ). STATE PERMIT(•P•cily):
□ 4. AIR PERMITS □ s. LOCAL PERMIT c;::J•· RCRA TRANSPORTER ' 0 7. RCRA STORER □ • RCRA TREATER □• RCRA DISPOSER \
O 10. o--:-r::ci r.~,-.~.:i/:,J: -s. IN co.•,t?:...1 Ml CE:?
0 1. YES □ 2. NO o, UNKNOWN
4. WITH RESPECT TO (1l.9t re~ulation mime & numbi:1):
Vlll. PAST REGULATORY ACTIONS
□ A.NONE □ e. YES.(.7ummarlz• b•tow}
IX. INSPECTION ACTIVITY , ... ast or on-1foin,1'
□ A. NONE □ B. YES (completo ltonu 1,2,3, &. 4 bi:tow)
2 0-'TE OF 3 PERFORMED t. TYPE OF ACTIVITY P,t,ST ACTION BY: 4. DESCRIPTION (mo,, dtty, t. yr,) (EPA/ Stoti:) ..
.. .
'
·"·
X. REMEDIAL ACTIVITY (past or on-Aoin~) ..
□ A.NONE □ B. YES (complete i!em:r 1, '2, 3, &. 4 bC11ow)
2.0ATE OF 3, PERFORMED t, TYPE OF ACTIVITV PAST ACTION BY: 4, DESCRIPTION (mo., day, & yr,). (EPA/State)
.
.
,
NOTE: Based on the information in Sections III through x, fill out. the Preliminary Assessment (Section II)
informatio~ on the first page of this form.
PAGE 4 OF 4
TENTIAL HAZARDOUS WASTE s1·
TENTATIVE DISPOSITION
SITE NUM!.JER
File this forr.i in the rctional Haz;,,rrlous Waste Log File and st;bmil a copy to: U.S. En ... ironmcntal P~oi.ection A~t:ncy; Site Tracking
Sy~tt:m; Jl;,,zardous Waste Enforcement Task Force (EN·J]j); 401 M St., SW; W.is!iinr.ton, DC 20•160.
'•• I. SITE IDENTIFICATION
J A. 5/i E NAME 8. STREET . , G \1 p-,• ,· . s. ( 0-I VI(" ' ll I~ l l-v' I-' 'I s; lf L1.,;
C, CITY J \J lie I o. STATE V I E. ZIP CODE -/17 o ,-r, 5 L,' I /v' C.. J7-;t~ C
II. TENTATIVE DISPOSITION
Indicate the ri::commended action(s) and agencr(ics) th~t should be involved by moHkini: 'X' in the appropriate boxes.
RECOMMENDATION ACTION AGENCY
MARK' X' STATE LOCAL · PRIVATE
A. NO ACTION NEEDED·· NO HAZARD
8, INVESTlGAT.IVE ACTJONIS) NEEDED (II yft.1, completft Section [ll.J
C. REMEDIAL ACTION NEEDED (If ye.s, complete Section IV,)
ENFORCE1.1ENT ACTION NEEDED 1·it ye.s, :ipedfy in P1.1rt E whether the ctt.se will
0, be primi.lrt/y manc11jed by the EPA or the StDto and whnt lype of enforcement oction i:i Dnticipared.).
X x
F. INDICATE THE ESTIMATED DAiE OF FINAL DISPOSITION
j j (mo., dt);'•); tc G. IF A CASE DEVELOPMENT PLAN IS NECESSARY, INDICATE THE
ESTIMATED DATE ON WHICH THE PLAN WILL BE DEVELOPED
(mo,, day,&: yr,),
H. PREPARER INFORMATION
1, NAM ) ./)-(_ y 0"'1,L • '} )
tJ.·1v. Sc,·eh-f,\1
if yf! ;vi/) 1
2. TELEPHONE NUMBER
. Fr<, ,'.? ~-7 -3 o t (,
B. PROPOSED INVESTIGATIVE ACTIVITY (Detailed lnformtHion)
1.METHOD FOR OBTAINING
NEEDED ADDITIONAL INFO.
11, TYPE OF SIT,E 1NSPO::CTION
'"
"'
"'
b. TYPE OF MONlTORINC
"' I-
}
~},TYPE OF SAMPLING
II I
EPA Form T 2070•.I (l 0-79)
2.SCHEDULED
DATE OF
ACTION
(mo,dily, &: yr)
3. TO BE
PERFORMED BY
(£PA, Con-
/t1Jctor, Stille, etc.).
--· --
---
--
----
'· EST0-1ATED
MANHOURS S. REMARKS
-
.
L,-,,~ SITi: INSPECTION REPORT ~ INSTRUCTION
Answer and .Explain (Supplemental Report) as necessary. '? D :.;,,.
I. STATE PERMIT
DYE,· tz;J NO
' 1, AREA,(Dl:n•n•lon• of Site)
I -""?. !.,. l" -{" ....
3, APPLICATION RATE
U,.k
A. IMPROPER DISPOSAL OF UNAUTHORIZED MATERIALS IN LANO FARM
,O YE5 D NO
5. DIVERSION STRUCTURES ARE EFFECTIVELY CONSTRUCTED ANO PROPERLY.MAINTAINED
DYES D NO
6. EVIDENCE OF PONOING OF LIQUID ON SITE
DYES lD NO
7. ODORS (Up•clelfy hydro11en •ulllde) (It YES, Jndlcat .. )
DYES QI NO
'
'
8. GENERAL PHY_SICAL APPEARANCE OF SOIL1(Color, Sand/Silt/Clny Conttml)
l
9, VEGETATION ON LAND FARM
10. pH
J
.
EPA F~m·T2070·JA (10-79)
APPENDIX A
-F(S!I
IH7.\ !U:::10:c-r::c };:!Ei:.:T
EXTRACTABLE o:tc;,:; [C ,',:;AL'iSl s
--246) SAU ::o. BOC
t.L -utJTT-f>?t:E c.nu
of Lake ne.:1r :.our.ci:: ,. STr\TIO~ h'illows adj. to
D..!lt. FI Sf
DAn:/TJ:m 9-23-80 @ 1000 --Compounds on t:RDC Lbt of Priority Conccntr.:i.tion
Pollutants ,,,,. Ike>:
I 7. his ( ch lorometh\'l) ether 'l,!:'.l"'"' KA
61. l{-n it rasoclir.1cthvl.1mine 3i.!..!i2 }:,\
25. 1 2-dichlorohenzene 3!;540 lOU
26. 1, 3-d ichlorober:zi.:nc 3;,570 lOU
27. 1 4-rlichlcrohen7,cne J!i5i5 IOU
18. bis (2-chloroe thy l) cth•.:!r 3>277 · lOL'
12. hex:ichlorocth.'.l.ne. J..',.'..UO lOt:
42. bis(2-chloroisoDLDovl) ether :,'.287 .10t.i
63. N-n it rosed i-n-o roo:t ln:,1i ne _;,_:.!.. 'l? 20~
56. nitrobenzcni! .JU'lL 1ou·
52. ht!:-:.:i. ch loro ti u t :idiene 30393 !OU
8. 1. 2 4-trichlarobenz~ne 3".'.5::.5 lOU
55. n.:tt,hth::il1me ·1! • .'.,.f16 lOU
. 43. bis(2-chloroethoxv) r:1cth,:i.ne 3::282 !OU
51,. i!.":oohorone 3::it. 12.. 20U
53. hcxachlorocvc laDcn tadicne 1: i'JO !OU
20. 2-chloronnPhth.:tlcne ~i.'..385 lOU
77. nccn.J.Dhthvlene '\!.?nl lOV
1. accnaohthcne 3!.209 IOU
71. di~cthvl nhthnlatc 143!,5 lOU
35. 2. l1-dini tro toluene '\!:~l:;,, lOU
36. 2,6-dinitrotolucnc '.{.'.630 '"" · l,0. 4-chloroohenyl ohenvl ctl:cr 1!:Al.S 1o;r
80. f)uorcne '36385 10U
70. dicthvl phth.::il:ite 3:. )lit) 1011
37. 1 22-dinhcnvlhydrnzinc .!J 3.'.350 JOU
62. N-ni t rosadiehenvl3:.iinc.J/ 3!.(;37 IOU
9. hexachlorobcn7.cne 3!.668 lOU
41. ·4-brOmaph{!~W} nhcnvl cth~r 346£.0 lOU
.Bl. nh"n;,,nt.h:c.c...,,..-'..1 3!:465 .
)8. anthr,"lccn~/ 34224 IOU
68. di-n-butvl phthal.Hc 34(,83 lOU
39, fluort?nthene 3/4380 l_OU
64.-pvrcne 34473 lOL!
67. butvl henzvl tihth.'.l.late 34196 IOU
5. -bcnzic!.inc 342l1l ZOU
66. bif:(2-ethylhcx\'l) phthaJntc · 39UY:J 10U
76. chrv::.en~ ':JI · 34324
72. 1. 2-be.nzanthrnccnP. ..,, ).'.;530 IOU
28. 323'-dichlorobenzidinc ]4635 IOU
69. di-n-octvl phthnlatc :;:.Guu IOU
74. 3 11-benzo(luoranth<:!ne _b/ . 1!. ,..,,_
75. 11.12-l,cnzof luoran thcneO/ '.l..'.246 lOU
73. 3. l1-bcnzonvrenc . 3:'+251 100
83. indeno (l 2 J-cd) nvrcuc .. :;.:_r,07 lOU
~ 21516-dibcnzanth r.:iccne 34560 lOU
79. l .12·-lH~n7.oricrv lcne J/1525 lUU
'I.Ii. 2-chloro:ih(:no1 3!1'."l'JU ,. 1J
57. 2-ni t ropheno 1 3:, '."195 /1 I!
6~);\. phcno) (GC/:·:S) ).';.',.-18 4 ll
31,. 2. l,-dime th·t.1 ph':!nol '.',:, t, iO 4ll
31. 2 1, di chloronh;:no 1. 3!1(1():j 4ll
1-.h.:...__l, I,. 6-tric.:h lo :-,mh.::nol 3/;(l:!;) 4G
22. E;1 r.,c.h lo rotr1r~ t:1 cn:~ol J!i!;.)(1 4U
59. 2, 11-rli nit rop!u:•:,o l :V,u'.!1J 32L!
60. /1. 6-d i nit t·o-n-r: rl:r;o 1 ).',(l•,d 40
~,•..:nt,1.d1lo_y_~'.1J)1c:nnl Jl,lllo!J ,. !)
SC. /,-11 i. 1.roni1,:noJ J.','J)i.l S!i
~A -t:ot an;ily;;cd.
J -l·:•:timatc<l v:1lut·.
K -Actu:11 v.iluc ic-known to be lc:5:; th.Jn ,•:1luc f,ivcn.
L -Actu:11 valuC is known to b,~ i:;rcatcr th.in v;1lu~ r,iv..::11.
~ i-l~tcri.il i,.,~; ·an.il):::cd for hut not <l..::tc.ctcd. The nu::-ihcr ir.
_//= Te.nt.iti.ve i<l...:ntific-:ition. 2 . ~/=. ~~~~~~ ~~~;:...:n;:,.::n,.::.
I
PACI: 3
i-:r',\, SAU, r'.G:i, lV
Athi..·ns, C,\ t../30
R:-:c'D. q_?'")-AQ CC:!PL 'n. l j {I-SO
soc 2463
FISH LIVER
-· Co:1cc:1.t ration Conccr:tt:ation
mc/(co mg/kg
:-:A
/\fl
8U
SU
SU
BU
811
8ll
16U
.ou sti-
8U
SU
SU
'"" SU
SU
8ll
8U
SU
BU
SU
6U au
SU sl.J ..
BU
BU
.,;u
SU -..
SU
oU ----sc
oU
16U
OU
SU --.. -. .. ..
_ou
OU
' · .c"··su .. : ·': ..
. . .. .""
SU
SU
·.,, --16U .. -1 (il.j ·-·--16\1
.l(lt;
1 ri U
16ll
16U ---------···---J:201! __
H">li
J6\i
30U
Chr~·~.:nc .,nrJ./or 1,2-ho.?nz:mth:-:i.:
J, f1 -bc:1;;0 f luor :tnthcnc ,:Hld/ or.
ll, 12-licn::.of lu0r .:in th,.::nc.
tht.! }!inbiu:a Uctcction J.itiit.
:_._ ..... ,.:. .. _,
--FI~!\ IJ:\T,\ 1-:r::·c::n1:;c Si{i::ET
EXTiZ.\CT,\1'1.E 07.C:L:tC ,-.:,:,\LYSIS
:.i',\ 5.\:.1. :,.~:;. ;·:
Atho.!ns, C,,\ !./~U
l:.LC'D. 9 25-SQ
" " ----KL-l1Lll Cµper end
ST,\TIO~l of Lake near SOURCE /, \,'_illows. adj. to
delt. FISH FISH LI\'ER
D:\TE./TI~IF. J ::.l-23-80 ~ 1000 =
CO:.IPOmm Concentration Concentr.:i::.ion Concentr.1::.i::in
n~/ke! ".'.':' 'I:':'
he~:.3:_d_~£:.anoic. acid ]c_/ 6J 350J
octadecenoic~acid ]c_/ !OU 160J
.
,
.
---
-. JZ llo other orr,o.nic co;npounds detected with an c~ti::1:itc:d minimum d4tcction li:.:i.t of--· _____ ..:.:,_ ___ --'-------------'---------------'------'120
J -E~timatcd value.
K -Actu.:11 v:1~ue is kno·,.,:1 to he less t·h,:rn v.,111c given.
L. Actual V.'.llcc is known to be r,rc.'.ltcr th.:i.n value given.
-::_,;.f'r:-:
..
<.!•:/kr:: -
:::.,;/~; -
U -i-!.J.tcrial \./,1:; :rnalyzcd for Lut not dctc:ctc.d. The number is the }linii.iula D.::U•ction Li□it.
1/_ Tent;itivc idc:ntHication.
L
-fl,. ux;·,\ 1:£:'(}KTf:;G ~!::~ET
EXTRACTA!lLE O:-',C,\:;1c ;,:: . .\L\'SI~
.P,\GE 6 t.r',\, S,\ll, RC::. r:
Athens, CA 4/StJ
l'ROJ;':CT __ K_o__cp__cp_c_r_s_c_o_._._1_n_c_. ________ ,cm::nsT E. \L Lo);, Jr. R:-:c" n. 9-25-S0co:-!PI. • o. ll-r,-so
--SAD :;o. soc 2466 soc 2,66
PL-002 l'ond be-
SOURCE: & ST,\TIO~ hind H,:dlin
hon:e.
nu:E GILL BLUE GILL LIVER
~:-IE: 9-23-80 @ 1115
=~~ . -Compounds on t,;:RDC List of Priority ·, t.:unccntr.'.lti6n Conc:cntr::ition C,mccntratio:-.
Pollut.:ints _,./k~ 1:-:r./ki't mh/kg
17. hi~.d ch loro~~ th•·l' ether 'If.') .. ., NA .. ~
61. }1-n it ro:c:::1clime thvl::iminc 34442 K\ ,,
25. l 2-dichloro~enzcnc 345.'.0 5U 7{.tt;
26. l. J--dir:hlorobenzcn!? 34570 5U 70U ~i~:. -cl ~ch lorob~•n::cne 34575 5U 70L:"
~(~~-( 2--chloro<.: thvl) ether 34277 5U 70U
12. he:-::1c!l lo:-oc th:inc J4L.CO 5U 70U
~,is ( 2-chloroi~,,p ro1tY: 1) ether J4l87 5U 1ou·
63. :.:-n i. tro~odi-n-nroor l:iminc 1.'..'.-.,-,, . 100 140U
56. nitr"hcn;;cne JdSL 5U IOU
52. he :~ach lo rob u tndicnc )!1193 5U 70U
8. 11 2,4-trich.lorobcnzcne 3!.5JS 5U 70U
55. :rnoh thal cne 3!,.'.46 SU 70ti -43. bis(2 chloroethoxv) mNhanc 3:'.i282 SU 70U
511. isonho!"one 34412.. lUU 140ll
53. hcxaC:hlorocvclo:-cnt.:tdicn:: "l!.1<10 50 70ll
20. 2-chloron.:to!l thal~ne 11,sso: 5U 7Ut_; .
77. i\cen3µhthvlc:ne ~!.',nt, 5U 1ii,;
1. .nccn~ohthC!ne 3!.2()9 5U 70U
71. djmetlwl nhthnlatc '.l!:]45 SU I 7UU
35. 2 11-d initro toluene l.!,1i1=. 5U 70U
35. 1,6-dinitrotolucnc j!.610 5U 7(!'.J
1,0. 4-chlororihcnrl Ehenyl cth<·:.r 1.'.6/,<; 5U 7UU
BO. fluorcne ]t,385 5U 70l!
70. diethvl nhthnl.:it(' 341!,U 51\ 70.U
37. 1. 2-dirihcnvlhv<lr.i ;,_i ne -LI 3:'.350 5U 70U .
62. N-ni t,:-o;,odinhcnyb.r.iinc:J/ 34!+37 5U 70U
9. hexnch loro~cnzcne 3!1688 SU 70U
41. ·4-bro:r:o~nv.l ohcnyl ether 34hl.0 5U 700
81. · -lll1C.IlO,;_thJ"J!J)°7'' 34465 ..
78. antbr.:ice.nei':/ 342211 5U 70U .. -..
68. di-n-butyl nhthalatc 34683 5U 70U
39. fluor:!.nthc-:,e 3-i380 ···SU 700
84. :evr•'n""' 344 73 . 5U 700
67. butvl benzvl rihthal.:1te 342% 50 70U
5 ... be:nzidinc 34241 JOU 140U
66. bis(2-ethv.lhexvl) nhth;:?liltc · .. J~U~IJ 31" . 70U
76. chr,:senc >I · 343:!4 .. '
-
.. · .. .. . . --72. 1.2-benzo.nthrac-ene ~, 34530 ' 511 700 ..
2S. 3,J'~dichlorobenzidinc 34635 SU 70U ..
&9. di-n-octvl nhth;i.lntc · 341>UU . 51'' 7-0l!
74. 3,4 bl:!n7.ofluorantbcne. b/ "!.?-, .. .. '
75. 11 12-henzo (luoran thcncO/ J/12M1 SU 1ot.: .
. -· -73. 3, t,-bcnzonvrcnc )/125] 5U 70U
SJ. indeno (1,2,3-cd) nvrcnc 3:,407 5U 70ti
§.?..=...__!_i 2 1 5 1 G-d ihcn z~mth rncenc 34560 5U 70t: ..
"/9. L 12-henzon<?rvlcnc )!1525 ;u 70U ,
21+. 2-chloro~hcnol 3l+S'J0 !OU ~OU -5'1. 2 nitroohcnol 3:.;,9~. lOU :wu -6~a. nhcnol (CCh!S) 1,',!,(,S JOU 20()
~,t,-dir;:ethvlnhcnol 34'1 l 0 !OU 20t:
31. 7., l,-d ichJ oronhcno l 34(,05 !OU 20U lL ij,· 6-tr.icldornnhcnol Jld,L5 lUli .20l: -
22. E~r.1ch lu rmn!"!t:i cr0.sol 3.'.i.',)1i JOU '.~U~'. ·--· ..
59. 2 /1-d in i_<~~__l_C.::!:' l J!1(>'.!(J oou 1 (,(IL' -----· 6~. Ci-di :1 i_::rc,-0-c:r.:!C>Ol '.\.'.iln•J J!l[! :WU ·--
(,! •• 01.:11 t -~sl~l __ o ~•l1cnol. '.\'.!lltiV IOU 20C -· .. J _____ _
'!A -
J -
K -
t:ot na:ily;,,1;d.
F.:.tir.::ttcd v.,luc.
Ar.:-u.:il v,,lnc. i:• k11ol..'"n to he lc-~s th:w v:1luc r.i.vcn.
L -l1 ... ·1 u,::il value i!. kno.Jn lo h•! 1.:rc-:itcr than v.1111<! r,iv.:n.
~'-Chry~.::1w ,1n1l/"r 1,2-hen::.:in::.h:-.,1
f!./ _ 3,11-h,·n::o(l!.!or:mthcni!" :tnd/o:-
l l, 12-hi~n::ni l11or.1nth.:!nC.
1/,-i-:.itl·ri.11 t✓.:i$ anal):Zt::d for but not dl!tcctc.!. 11li.! nu:::hcr i:; the l·!ini~1um l>i:rcction Licit.
;,-. T('_nc1ti.ve id1.::ntific:ition.
• -and/or azokn:ccne. (ovr::,) ?~-and/or ·i.1i;ihcnyl~1~1in,-::.
-:::~.\. S:\<J, ::c::. l·:
,\rl:.::n:., GA t./SU
ca:·!l'i.'n. 11-6-.S_Q
, .. . ! E''C V ') ' ( ( _.;' '
PL-002 l'ond behinc b SOllRCE ' ST,\TIO:-l He:dlirt Horr.e:.
BLUE GILL BT 1:::-GILL Ll\'F.R
1),\1~!-:/Tl~lt": 9-23-80 Q 1115 I
~
co:-!POUND Concentration Concentr,,tion Concentr.1tion
mg/kt! r,r, /k,. . r:l's.': /k-:::.
unknown-phthalate~ y SK 70U
hcxadccanoic aCid ·y 200J 290J
.
.
.
.
,
-
. .
'
llo other org::i.nic compound~ detected \..'ith an et-:'tir.iatc,1 minimu:il. dJtection lfo1ir. of SU n,;_f'i:..g Bl c·
J -£5timatcd value.
I: Actual v;,l_uc
L -Actual wiluc
V -i'Litct:!.:il w;i~
i:. kno1,,1n
is known
:m.:.lyzcd
to be less than vnluo given.
to be r,rcatcr than v,,luc r,i.ven.
for hut not dctcctccl. The nm::bcr
!/_ Tcnt,1tivc identification.
160 □g/kg -Bl
. GILL l.11
is Lhe :-:ini:;m::i Detection Lh,it.
r4)
FISH
O,\i'A l>E!'O;(."L 1:;G s::c:a
1:::ni:,\CT,\IH.t: o:{C,\~;rc ,·,::,\L"iSIS
.. P,\r.E 7
r..:',\, S,\lJ, t!G:i. :·:
Atb\"LlS, Cr\ :.;5,J
!'R0..!EC7_1:a.µ, . Co., Inc. Cl!E:1!S1' E. 1/. Loy~ ~r. Rr::c • n. --2.::.?. 5-,qor.o:•!i'L' .'J • -11-li-.?:O
~ r i sv q~l=-•~~e.·ce.. ________ _
.. . . -
$,\[l ::o. soc 21,66
PL-002 Pond be-
SOURCE b STATIO~l hind Medlin
hmue.
P.ASS
O.\TE/TI:IS 9-23-80 @ 1115 -~ -
Cornp0l1:uls on 1'RDC List of Pdority Conccntr.:i.tion
Poll ut.:ints -..... ,kP
l 7. his f r:h 1 nrn:r.~thv l) ether .. , •)7-, NA
61. :,;'-nit rosed i1:ic thv l.::i.r.i i r:<! 34442 NA
25. l 2-<lichloro~~11zcnc 34540, 5U
. 26. 113-,tichlorohenz~r:~ 34570 50
27. l 4-c! i ch lorohen~cne 34575 SU
18. his ( 2-chl oroe th\'l) ether 3!.;277 5U
·12. h~x~chlorncth.:in~ J4l100 5U
42. bis ( 2-ch loroi!:oo ror,v 1) ether 30287 !OU
63. N-n it roi;odi-n-n rooyl.;nine: "i!;/1J2 SU
56. ni.tro~cnzcne <H1l1S L SU
52. , hcx.,ch lo rob~ tnd icnt:! 34393 SU s. .1, 2. 4-tiic:hluroLen::en<.? 3455."i so
55. n.,nhth.:ilcn~ 3li44fi 5U
43. bis(2-chloroethoxv) r:-,eth:me 34282 SU
511. isonborone 34412. lOU
· 53. hex.,chloroc,·c lo:,en t.:!.c! icn:! 1!.">no 5U
20. 2-ch 1 oron.:inh th., lcne J!,585 SU
7 7. ncen:inhthv I cne 1,,-.n4 5U
1. :iccnn:>hth.in-!! )4209 SU
71. cli~ethvl nhthnl.;tc 1!1J!,5 50
35. 2.4-dinitrotolucne 1W"i . 'U
36. 2 '6-dinitrotolucnc J4630 SU ,.o .. l-i::h loro~lll~n)'l rihenvl ether .,fif,/1C 5U
80. fh:orcnc ' 34385 • c;. ti
70. dicth\'l nhthnl.ttf' 1!1:\40 SU
37. J '_ 2-di:1hcnv lhvdr;i:dnc LI 34350 SU
62. N.:ni t ro:;od i nhc:ny} ,'.llain<.?J/ 31~437 so
9. hr.-:,:,;ch loro!,cn7,rnc 34688 SU
41. 4-bro:no"'ht•n,·l nhcnyJ cthi:!r JL1640 SU
81. j'l~":J. ... D t}p·c:r '•I 3li465 ..
78. .:Jnthr.:iccne.:'.!/ 3ti n,, ·su
68. di-n-lH1tvl nhth.,l.:irc 34683 SU
39. fluornnthcni:? 34380 SU
64. "\":'t.:ne J441J SU
67. hutvl henzvl nhthalatc 342% SU
5 ... benzidine 34241 lOU
66. his(2-echvlhcxvl) nhthalate · 3;099 SU
76. chrv$cnc .~? · 34J2l+
72. 1, 2-bcn~.,nthr:-rccnc ':JI 34:,:w SU
26. 3-3'-<lichlorobenzidine 34635 .... SU
69. di-n-oct"l 'lhth,1late J~ouu SU
74. 31 t,-bt!n7.ofluor;inthene b/ ' ., ·'? "I/
75. 11 12-bc:nwflu0r:-rnthcnc.GI -;!,2M1 5U
73. 3 1,-bcnzonvr,•nc ' J/1251 ·su
83. indt!no O,2,3-cd) nVr~ne . ' 341,07 SU
~~ 6-d ib~n:-:.,n th r.,cene J/1%0 Sil
79. l-12-bc•n7.oDcr-dcne J/15:!S SU
24. 2-ch 1 nronl1c•nol J!,590 JU
5 7. 2-nitro!'lhcnol J!i595 JU
65,,. nheno] (C.CIIIS) 1.',!,68 JU
J/1. 2 .1,-<l i ,~c thv 1 rhcno l ]!,610 Ill
31. 2. 11-<l i ch loronh.-!nO l 34(105 lU
21. 21416-trichloronhcnol ' 3!,U:!5 JU
22. p., r.,cb lon,:-:.-: ta c:-c~a,l 3M1SC1 lU
59. 2 1,-d ini t ronh~aol :14h?.U 8U
(,O. I,, <,-din 1 t ro-0-c r.::~:ol '.1-'d16J. lU . ]~U\10 _<~11_,::n t.,ch Io r<1plicno l JU
2U
!A -1:ot· ;m;d y:-:c,I.
J -E:;timatcJ v.,l11c.
K -Act~i.,l v.,1.uc l!: known to he lc~s th;-111 v,1l11c tivcn.
L -Aclu.:il valul! i~ kno1-m to b2 brcatcr th:m .v,,lth! r,iv,"'ll.
~,-i-l."1tcri:il v.,s ·:maly7.<:.d for but nut d.:!tecr.;f!d. The nu:-:ihcr is
- -Tcnt~tlvc identification . .,, . .
.. :ind/or :izoh,~n::cnt.:. ~'-= -:in<l/or ~inho•nvl.-,~,in, ....
-· soc 2460
Br\SS ll\'ER
.
Conccntrativn Concc:i.t:r.:itio:"t
t:i~/k~ milk~
M ., ..
JOU I
30ti
I 30V
JOU
JOU
60U
30U
JOE
30[!
30U
JOU
30U
60U
JOU I
JOU
30U
JOU
JOU
JOU
JOU
30U
JOU
JOU
30V I
JOU
JOU
JOU .. .
JOU . .. . ..
JOU
JOU I
JOu r
30U
60U
3UU ..
. . . . . :
' . . 30U .. . . -·· ..
JOU
JOU
' .,···,oil •··. ..
JOU ... ' JOU
JOU
·3or
2U
2U
2U
2U . 2C ... 2.t: .. 2U -lb!.: n
2l;
4C
~1-Chry:;~nr?; nnd/or l ,2-he;1~:inrh:-:1,
fl./_ J,l1-lh•11;:o[luo~-:inlhc1~<.! ::md/o:.
ll, 12-b.:n:of J 1::,r .,u t:h.:ne.
thl! Hinbu:n lh.:tccr.inn Lir~jt.
(OVEi<)
FISII L\\i,\ P.[f'l,C{TI.:;G S!!ELf
EXT['.,.\CL\Hl.E O~GA~/lC .~:,\LYSl~
Ei'.\. S,\.J, :,.,.;:;. 1·.'
Athens, (;,\ 4U,0
n:.uJr.cT: Koprcrs Co., Jue. C!!!:::·!J.ST E. W. Lov, Jr. t~EC'il. 9-25 80
Hordsvi Uc., :-.:c
~-=~-==-~-=-· -· --,c=c=---=-_.~-= --= _...,__,,,...,,=.~~.
$,\ll i,;t). sue 2466 aoc £466 I
PL-002. Pond be-
I hind ~1ecll in ho:ne.
SOURCE • STATION
BASS BASS LIVER
DATE/'rn:r: 9-23-80 @ 1115
Cm!POUND Concentration Concentration Concentr.:itiOn
n1:;Lkt! m-,,.,. . r::.z/'r:..:,,
I !/ 2::sJ ···-..
heY..adecanoic.. acid 6.>J
!
I
I
I ..
'
I
' I
I -
:
:
I ----'
I
, ,.
! -
' .,
:
'
No other orgonic co~pounds detected with an ct;0timatcd minfrum d,!tcction li,oit of JO c,s/k, -t,• 60 q;/i-:.g B.·'
LIi
-J Estim.:ited value.
K Actual v.--il_ue is knm.n to he less th;:in value eivcn.
L Actual value is known to be irc.atcr th,:111 value r,ivcn.
U -Hatcrial was ;1:1;:;.lyzed for. but not dctl'.ct~d. Thc number is the Niriimura D.:·tection Li!Jit.
!/ _ Tcnt.itive identification.
~ SEor:.;r.::r
PATA HEPOKTISG SHEET , i EXTRACTABLE ORGAt',lC A};ALYSIS
?:lOJSC:_·-","o-"a'-,,"-,'-'"-s_Cc..o"-'-. '-' _I~n'-c~. ________ cm::·IIST F.. W. Lov, Jr.
1:-::nri~vill<:' i\C
EPA, SAD, RGX. l'."
Athens, CA 4/50
REC'D. 9-25-BO CO>!PL'D. 11-6-80
R.!::SULTS o:,: DRY t'ET(;!iT R,\SIS .-' -a.-..;.,. ~,\D ::0. soc 2ld19 I
KR-003 Dot.,nstr~.:im
SCt:\CS " STATIC!: from .:ire.:i. dis-
charged & so1m
lui.t.h .. J.'.:rass.
_?,;n::/7!'.·!E Y-ZJ-80 @ 1700 -Compounds on NH.DC List of Priority t:onccntr:.:icioa CO:lC<a!rlCT.ltiun ,.;..:,ncen.tro.cic,:-. Pollut,:mts ug/kr. u~/ke: ue:/k~ 17. his (Ch loro:--e thv 1) ether 34271 NA NA SA 61. !,;-nit rosod i~c thv l;t:rii n,~ J!i .... l " ~· .\ " 25. 1 2-dichloroben?.~ne 3..'+:>J9 7,000U 26. l. 3-<.l i.c!"l lorohcn"?cne 3-1)(.):) 7,000U
27. l.f,-did1lorobcnzcnc J..'+57!.. 7 ,ooou .Ts."""bis (~-c\ilorocthd) ether 34276 7,000U 12. hex.:ich lo roe ::h:mc 34399 7 ,ooou
l.2. his ( 2-ch loroisoo rc,:w 1) l!thcr 3.'..286 7,000U
63. N-ri it rosodi-n-!"lrc~v l,u,inc Jl:43) '4 ooou 56. nitrobcr.zene 3-'..'+S0 7 noou I 52. h!!~:,:ch ln:-obui:ac! ienc 39705 1 noou B. 1 2 4-trichlorobenzene }(,55/i ' "'""' 55. n.:i~hthalcne 3·4445 7 nnnn 4). bis(2-chJor'octhoxv) :::eth,me 3l:23] 7 ooou 54, i!:o"Jho~one 34411 14.000U . 53. hex.:ichlorocvclo:,cnt~dicne 1!11'-lU 7 ooou , 20. 2-chlo:-or.aohthalcnc 1!; ":,H4 7 ooou 77. acen.:i.;'.>l:thvlc:ne " ...... _. ··· 14?n'> ... 7 OOOK 1. acer.,,ohthene -:14, 'lQ 7 noou 71. dimethvl nhthalatc 1[: 144 ' ooou ... 35. 214-dinicrotolu~ne Vi..6, 1, 7 ooou 36. 2. 6-dini tro toluene 34629 7 ooou 1,0. 4-chlororhenvl ohcnvl ~ther 346~4 .7 nr 011 BO. fluorc~,. 3.'[phone]. Ciethvl Phthnlate 311339 7 '" OU 37. 1. 2-d in!":en·; llwc!rnzinc 27 34349 7 ,ooou
62. r:-ni trosociiohenv].:irninc.=_1 3403, 7.0001]
9. hc~:ach lcr('~•::!nzc:ie 39701 7 ,ooou 41. ·4-bro:J2Q-ihen-vl ohenvl ether 34639 7 ooou
~~ Tl ,. >\ .-,-r, '~/ 34fi'64 .. n. anth:-:icen-2.1 34223 7 OOOK· .
68. Ci-n-hu::vl nhthalate 3911:'. 7 .ooou 39. fluorantb.c:-ie .. • .. ' ... . .. .... )!1379" · .. 7 .OOOK 64. n•;r<!.1e-.. ·-·-······-... -. . ._,. . ., 344 72' ··-7 OOOK 67. butvl benzyl ohthalate 34295 7 ooou 5 .. benzidine . 39121 l4_000U 66. bis(2-c.:thvlhe;.:..-J) r,hthal.:ite 39102 7 ooou 76. chr:se·r.e 2_./ 34323 .. . ··-72. .1. 2:-bcnzanthracene JI .... · ..... ---., .. •34529·· · ~-7 .OOOK 28. 3 J' -di chlorobenzidinc 14614 7 ooou 69. di-n-octvl nhthnl.ite '\4599 7 ooou 74, 3. 4-bc::-izofl uor :mtben'!? QI 1t.2·n ' 75. 11 12-henzo fluo::-:inthcneb_/ 1/,24 r, .. ' ooou .. ' •' ., 73. 3 . .'..-:,c.:r,::c;n' rcr.c ., .. ---·-·~t::').'i!\ .. 1·-.. 7 · OQ\JLJ '.,·.•,··-83. i nd~no ,.(l, 2z 3-:cd) .. o•:r£:,r:C ... .. .... ~ 1,/,1,n&... . .. 1 OOOK 82. 1-2~6-dil>en:>:,:mthrnce11e• -.... . 1!,_ \5_~ __ . .. 1 onnK 79. 1r-12-h,:-nzoperylene ..... ..... ---. -· ·-3:,52!!.:..:.: -=._;_l_.000< 24. 2-chloro:ihcnol 311589 . ooou S 7. 2-ni t rric1hc!nOl 3!1S~li souu 65n. o:1•~n"Jl (GC/'.·!S) 31;!,95 suou Jq. L. l-tli:~e: t!iv l n:1c-;101 3!ih09 800U 31. l 4-dichlc,ro~hanol Jl,60!, EIOOU 2 I. 2. ,, • 6-t ric:1 loronbcnol )1,62.!i 800t) -·-· 22. p;i r .1.chloror~c t :-i suou cr<:!!':Ol 3-'i/,55 59. 2 • '•-d i:ii t rcohcno 1 J/di]9 6 ,.ouu "/" 60. /,,(,-di:-iitrn-n-c::-c::ol )!, (lCiO 80DU r--., ~i;_:;~~J;'°Corcoher:!1 t 1'.JDCil · HUllK -~-· ,,-:;!.:.ronhenol -------
J/,6/11) 1 {)0011
.
..--
:,\ -::oc .:1:1:1lyzcd.
J -Estic.:it~d value. Clir:,s".:m<.! :md/or' l.~-Lcn:,:.inth:.:iccn
J,4-b.::n::oflu,)r:1111 hc:11c and/or K -,".ctt:.:il value is kno• .. :n to be le[;~ th.in v.iluc r,ivc.:n.
L -Actu.:il v:iluc is blO\:n to be grc:1tcr t·han v.:ilul.! r,ivl~ll. 1 -!-!..Jtcri.Jl IJ.JS ·an:-ilyzed for but not cktcctcd .. The nurrilic!r
-1
1-Tc:1t:1tivc 1deutification. ? -·~nd/or azobcn~~nc. JI_ nnJ/or diphc11~!a~i~c. ··
~'-t•L--__ L_'.. __ : "
11, 12-hcn::of 1 llO r,u1thc~I.!.
is 1.h..:: Minir..u::i DP-tcction Lii:iiL.
(O\'E:()
•
PROJECT Koin,crs Co., Inc.
l'inrrisvillc ?\C
sr.ur:::::~:T
DATA REPO:tT1 ::G SHEET
EXTR,\CTADI.E ORG,\~;rc A:;,\LYSIS
Cl!E!-II ST E. W. Lo::. Jr.
PACES
EPA, S,'.D, R.C;-;. IV
Athcn:c., CA l;/30
RCC'D. 9-25-80Ccr.iPL'0. ll-6-&J
RESUJ TS 0'1 D:~y 1,'F If.UT B ·\S lS ..
$,\0 :,.;o .. soc 2!,65
PL-00?. rond be-
SOURCE • STATIO~ hind Medlin
ho:ne.
D,\TE/Tim: 9-23-80 @ 1115
Corr:pounds on KR.DC List o( Priority t.:onccntr.1tion
Pollutants u::;/kr,
17. hi~; ( ch loro::ir> thvl) ether 34271 l~A
61. ~-nit n,sadi::ic th\· la:~inc """"l I ...
25. 1. 2-dichlorohen::ene 54539 I 2,0000
26. l, 3.:.dichlnro:>erl::i!ne 45"9 2 ,ooou
27. 1.4-dichlorobcnzcn~ 34574 2,000U
18. his(2-ch1orocchvl) ether 34276 2 ooou
12. hex::ichloroc t!10.nc 34399 2,00UU
42. bis(2-chlorci~o~roovl) ctber 34286 2.0000
63. N-n !. t rosodi-n-pro.1yl.,r.1ine 3li!.31 4.000U
56. nitrobenzene 3<'..!,50 2.000U
52. hc:.:,1.ch lorobut .'.ldienc 39705 2 0000
8. 1 2.4-trichloro~enzcne 3!,554 2,000U
55. naohth.:i.lenc Jl,.4/.S 2. ooou
43. bis(2-chloroethoxv) methi'Lne· 342f;l 2 0000
54. isonhoionc 34"411 4 ooou
53. hexc1.~hlorocvclonentadie11e ~4 )!-.!11 2.000U
20. 2-ch loron.:icih thalene 14534 2 0000
77. ac-en.:1rihthvlene <4?f''> 2 0000
1. . Dcen,?_phthene 1.i_2M 2.000U
71. dirnethvl ohth:tl~::e .,.41!.4 2 0000
35. 2 4-dinitrotolnene <.!;/'.. 1" . ? Q!'","l
36. 2 6-dinitrotoluenc 34629 ? "°""
40. 4-chloronhcnvl r>henvl ether J/;6L4 2 .ooou
80. fluorene 34384 2 0000
70. diethyl ohth.:i.latc 3li339 2.000U
37. 1. 2-diPh!!nvJ h-:drazine ,!:_I 34349 2.000U
62. N-ni t.rosodi11h":::wlar.iincd_/ 34l 36 2 0000
9. hc~:,1ci1 loro!ie:i r.;::-:e 39701 2.000U
.'.il. ·4-bro:;:io~henvl nh£:nvl ether 34639 2 ooou
.fil..:_,~!1..c-.Ililll.t.h.~:1;---. .'..' 34464
78. anthrc1.cen;":?.'~/ 34223 . 2 ooou
68. di-n-\-,utvl nhth.:i.late 39112 2 ooou
39. flu~r.-mthcne 34379 2.000U
84. ovrt-:ne 3!,4 72 2 0000
67. butvl bcnzvl r,hthalatc 30295 2 ooou
5 .. benzi<line 391n 4.000U
66. bis(2:..ethvlhe:,:vl) nhthal:1te 39102' 2 0000
76. chrvsene ~I 3li323
72. 1, 2-benzn.n th racene ·!.I 3£;529 2 0000
28. 3.3'-dichloroben.zidinc "34614 2 0000
69. cli-n-octvl nhthalatc 3!, 599 2.000U
74. 3,4-bcnzofluor,,nthcnc QI 1!,11)
75. 11 1 12-bcnzo fl uvr,,nthcncb/ Jl ?t,., __:__1__._000 U
73. 3111-bcnzonvrcne 1.', '.~50 2 OOOll
83. in<l<.•no (1. ~1 3-cd) pvn~n!'.! V,LQ!_l 2 ()DOU
82. 1121 5. 6-c! ~~1_::ri zan th raccne )4"",5CJ 2 00011 .
79. 1 12-bcnzo1,~~~-:lcne )li)?li 2.000U
24. 2-chloro;,l,-e:101 ).'689 2 ooou
57. 2-ni t ro;ihenol )!,59!. 2 ooou
65a. ol,cnol. (GC/:-iS) 34695 2 OO()U
34. 2-4-<l!E,~;:~;·.-bl:c!nrJl JM,09 1~ooou
31. 2. /1-<l ich l.nro;-,hf!:101 -3!.604 2 000\J
21. 2 1, 6-trichloror>hcnol 346~1, 2 .oouu
22. pnr.'.lclLloromctn. cn•snl Jt.l,SS 2 OUOLI
59. 2 4-dinitro:1hcnol 3tJ,l 9 1(, uoou
60. 4,6-di11itro-o-crcsnl 1/Jib0 2 OOOt:
64. pen tach I oroDh~nn ! 3uo:,1 -· _,..;.;....:...._ ----1... .Q 00 K.
58. 4-n it rorihcnn J j!,(;!1 lj 4 UOOIJ
:A -l\ot .'.lnalyzcd.
J -E!.iti;;,J.':·.'d v~luc.
K -Actual ·:.1luc is k11v·.:n to be lc~s tii.:rn v.,luc ~ill'l~n.
L -Actual v.,luc is k1w1:n tu be grc.'.'ltf!r th;:in \'.:.iluc r,J\'cn.
~( _:-btcri.11 ·.tas an:i.lyzed for but not <lcL~ctcd. The nw:1bl!r is
2(. ::~'.!~~~ i :~ .. }~:~~~.~: ica t ion.
I
I
-~
Conce:itraclon ,.;J:i.ccnccacio:-.
Uf;/k~ uc:/k.:
NA t:A
'" ..
'
-
•. -..
.. .. .. .. __ . ...
' .. . . ' .. ..
...
···-
-
I
I
··--
.
Chrys,m,~ ,1nd/nr J.,2-b .. :n=.'.\nthcac ..
J, !1-bC':1::of l.rn., r.:rnt hcnc nrd/ or
ll, 12-1,~n:rnf luol",,nthcnc:
the Ninir:iurn Dclct:tion Limi.t.
\ I
\
I ·,
•
SClll~lEt:'f
DAT,\ REPORTl::G S!!Ef.T
EXTR,\CT..\BLE OR.G,\~IC A;\/ALYSIS
EPA, ·SAU, P.G:-.. IV
Ath,~ns, GA 4/';!,0
PROJECT Ko1:,er.s Co.
}:orri:-.vi l k
In<'.
NC
CHE..'!lST EI h' I IO\' Tr, REC'D. 9_25-80 co:-rrt 'D. 11-6-S0
R!.:St.:!.TS 0~ URY \~EIGHT l\,\~IS
SAO :,.;u. soc 2465 I
PL-002 Pond
SOURCE • STAT IO:: behind Medlin
home.
DATE/TI~!E 9-23-60 @ 1115
cm!POUXD Conc£:n tr:::i t ion Conct:P.tr.:ition Concentration
ur.fkr-ur:/ke. ur>/k,-,
dime thy lee tahyci rophenan th re ne car boxy lie
acid "'-' •· .• 2QCJOK
hyd rox \'-met hox..,--benzn ld c:1Yd c 1/ zonn ..
hex:idecanoic acid 1/ 3400J
.
.
,
:
No other organic cor.ipounds dctectc<l '-'ith an et,.tim:i.ted minir.ium d..!tcction limit of .• 16 ,000 ug/kg
J -Estimated value.
K Actual value is kno\,m to be less th;in v,3luc given.
L -/\Ci:.u;;i.l value is knu:vn to be greater than value &ivc.u. U -i-L:.itcrial \.'as a:1.ll)'zi.!<l for but not dclcctcd. The number is thl! ·:-Jinfr,t:~ D.::tcction Limit.
!/_ Tentative i<lcntificntion:
•
:>?.OJECT !:c,·iri~r~ Co. Inc.
~brri:.vil le. :,;c
.. -·-Sr\D }:O.
SOURCE b STATIO}l
DATE/Tl}!!::
Compounds on NRDC List of Priority
Pollutants
17. bis { ch loro~~ thd' Prher
61. t,;-nitrosoJiriethvl.:iminc
25. 1-2-dichlorohenzene
26. 1. 3-dichloroben·zcnt.?
27. 1,4-dic.hlorobenzcne
1s. bis (2-ch lore.:! thv 1) e th~~·
12. hcxachloroethane
42. bis(2 ch loroiF.c,oronv l) ether
63." N-nit~osodi-n-nro~vln~inc
SG. nicrobenzcnc
52. hcx.:i.chlorobut.:ldicnc
. 8. 1 2,4-trichlorobenzene
55. naohthalenc
43. bis (2-chlo.:octho:-:v) methane
54. iso1.1!1oro:ie
53. hcxachlorocyclonc:itodienc
20. 2-chloronaohthalcn~
77. ,,cenanhthvl enc
·l. accnoohthc.nc
71. dimethvl "'hthalatc
· 35. 2 14-dinitrotoluenc
36. 2.6:....dinitrotoluenc
'40. 4-:-chloroohcnvl ohcr:y l ether
80. fluorene
70. dit!thvl Ehth.:tl:ttc.
37. l. '..!-dioh•:!nv lhvd r;1zlnc LI
62. N-ni t rosodioh<.?nvla1:iine J/
9. hcx.:?_ch loro!:ienzcne
t,L ·4-bromoph<?nyl Ehcnvl ether
~'lc.n.:1.1--;l,r,:•'1\'i.;
7B. anthraccn~/
68. di-n-butvl ehth.:ilate
39, fluoranthene•
84. evrene-
6). butvl benzvl nhthnlate
5 .. bcnzidine
66. bis(2-cthvlhcxvl) nhthalnte
76. chrvsene ,,
72. l 2-benzanthraccnc ~,
28. 3. )1-dichloroben1.idinc
69. di-n octrI ehtha1.tte
74. 3 4-bcn?.ofluor:mthcnc b/
75. 11 112-bcnzof luor,:rn thcneb/
73. 3. 4-bcn:-.oovrenc
63. in<lcno -r,-2 J-cd) nvrcr:.c
82. l. 2 S. ll-d i benztn\th roc~nc
79. 11 12-benzor•crv I.enc
24. 2-ch loroohc:nol
57. 2-nitronhcnol
65:1. ehcnol (GC/:-:s)
Jt,. 2 4-<l ir.1ethv lni!'.!00 l
JI. 2. t,-d ich 1 oronh12no l
21. 2' ,, 6-tr~ Cblcrophc'.nol
22. par:l.chloro:?:ct;i r:rc~;ol
59. 2, t,-dini tro:ihcnC1 I
60. l. 6-·d in i tro-o-c r,::;n l
64. ,.,c,1 t.,ch lo rn~hcno l
58. l,-nit.roohcnol
• ~r.or:il:::r
D,\TA f,LP0RTl:\G SHEET
EXTR.\CTAllLE ORGANIC A~~Al.YSIS
PACE 2
EPA, SAD, RC~:. IV
Athens, G,\ 4/S0
Cl!EmST E. \.l, Lav Jr. REC'D.--2,:-?.5-8QCO~\Pl.'D. 11-6-80
.. ... ,, "' RJ"SlTLTS 0:-l' DRY \'1~t('1IT I' \S!S -BOC 2<,62
r,L-UUl Upper
end of Lake nc.1r
Willows, adj. to
Dclc.
Y-23-80 @ 1015 ..
Conccntr.::ition Conccncr.::ition ~,mcc.ncracion
ur,/kg ug/kP, u~/ko
34271 NA NA NA
J"l44l N} .,. '" 3453S 10 ooou
J45D~l 10 ooou
}l.5711 1o_ooou
34276 10 ooou
3.'+ 399 10 ooou
34285 10 ooou
344 31 20 ooou
34450 .10.000U
39705 10 QOOU I
Jl1554 10" ooou ,
3441.,5 10 OOOK•
1~:231 10 ooou
J'.~_ll 20 000"
J.'. ·i~q '0 00011 ,
Jt..~84 ,o noon
1-': ,.,,..,1 TO ,.,,..,,.,.,.
-':14·r~ 1n """··
'l.4"' '· 10.000U
3(16 1 1, 10 ooou
. 34629 10 ooou
34644 10 ooou
3.';]84 10 ooou
34339 10 ooou
34 349 10 ooou
34436 10 ooou
39701 10 ooou
34639 JO ouou
34M,4
34223 . l0"000K . ..
~
39112 10 000"
34 379 ~,.., on,..,.,
34472 10 OOOK
3.'.i295 10 000"
39121 20 °00"
30102 10 00011
J/1323 . ·14y,9 '0 60"'·· --. -·-,.
34634 10.000U
<l,599 ,o oonn ' ..
1,,2-;;1 ' ).{i ?!, c;, '0 °""" -· .. --: ··, -·
1!; 2'·0 TQ n(J""
"l1t,nr: ""000 .. -3li 5,;;n 'Q.,J!O.""
39' 5 ?[ 10 ooou
3li5l-;9 2 ooou
31,594 2.000U
)M,95 L..Q.OOU
34(,09 2 OOOK 1•
J!; C,O!i 2 ooou
.1M,L4 2 -~!)OK-, ..
1!1 l, '>'.i 2.000U
34_hl.2_ _j_Q__.__QQO t! --]/1(,(,() 2 .uoou ··--.....
J!!IJ(, l· . (, ,,1.)()
)!, (,!, () I, 0fHIU ... , .. .J.
.
:A -Not .'.lu.:ilyzcd.
J -EscitaJ.t<'.!cl v=-ilmi.
K -Actual v.:iluc i!. known to b<.' lcs:; t.h.'.111 v.::iluc r,ivcu.
Chrysc.1H'.! :11Hi/nr 1,2-bt.m~~.'.l.atbr:ic
J,-'1-bcn::o(lu,1l·.'.l.11tht!1h! and/or
11, 12-hcnzof 1 u,1r:1nthcn.:!.
L -Actu.:il v,,lu<'? is known to bl! gn,,1tcr th::rn v:iluc.-r,iVt.!\l.
~,-i-L"ltcri.:il -..·.:is an.:tl)'7.Cd for but noL clcLcctcd. The nu::1ber
~,-.. Te:ntativc iclcntification. ~/= ~~~~~: ~~~~~~~~~~; __ ~
is the !·linirm:-:i Dl!tcction Limit,
{O\'E'.l)
• •
SEDIHEH
DATA REPORTI::c S!!EET
E..\.TR,\CT,\I\Lt ORGAtac .~;,\L'iSIS
E.PA. SAD, RC:-;. 11•
Athens, GA
PROJECT Kc-ppcrs C.n•~__,1,:n_ec~. ______ CllE:-:IS'f c h' 1.oy. Jr• REC'D. 9-15-80 CO~P L' D • l.L
\\orrl...,\•ill · ~c ·' RY'.SULTS 0~ nr:·:· !,'E!Gii": !:,\SIS -,me 2:,62 I SAU ~O. !:L-UUl Upp•~r
STATlO~
end of Lak~ near
SOURCE & \.Jillovs, adj. to•
Delt.
D,\TE/TI~tE 9-23-30 Q 1015 . -
I
/
Cm!POC~1> Conce.ntrntion Concent-:-ation Concentratio:,
Ul'.'/k!! ug/;..s:: u'!/k,..
tetrachlorophenol .. (2 .. isomers) .. 1/. ·----"-· --· ..... ...... 2000K
hydr .. ncy-rnethoxy--benzaldehyde----1'-... ... 2000K
.
THE CHRmlATOGR..AN l~DICATED THE PRESD:CE
OF 6 ~~IEQI,:EV~l I.YrE PR<;lDUCT.
..
•
.
.
. ----,
No other oq~anic cmnpounds detected wirh an ct/tim3tcd minimum d~tcction J imic of .. 20,00~
• J -Estimated valtte.
K Actual value is known to be less than valur. ~ivcn.·
L -Act.u.'.11 v.:i.lue is known to be grc3tcr tli,111 value r,ivcu.
U -d.1t..:rial vas .'.ln~lyzcd for hut not detected. The nur.1ber is the :-!inir:iuro Dct.ection Li~1ir:..
l/ _ 1'cntative ic!cntHic.:ition~
• • . . .-·. .·· . , -lJA'l'EK
!,l';1,.;n:;1 (:,\ ,jf:,~: i'i~OJ::::cr_~:_,1p;•,:r.s Cn., l_n<_:_. __________ C!IE~JtST E. i,1, Loy, Jr. li.l'.C'J1. 9-:?:,-:-.rJ CC:-'.1'i.'D. ll-·(,-: -----------. 1-&r.l"i::vi 11,•JE ____ _
p ,\,:;:; l!, $~-~:;:=--=-~~-----::._•__c_=.=•=.=...:::--a:'.:..:.....:=-... ----8-0-~----_-,-,,-7) ·------=· --, ·'" -
SOU!i.C[ l. .STi\TIO~
17. l>i::;(:,..l1lor0~:et!1..-l) ctliCr 61. r:-nttr,1sodi:-::-:.-th\'l.1r,1inc
J/1260
Jt1l,:rn
34ITD
31,5(,6
34571
31,17 J
K\{-030 Stc.:d
Shop.
NA ,.,
JOU
lOU
lOU
lOtl
f:A
t;J
Co:\C<'..:tr.1.tio:1
m:/L
Jl1J% lOU
Jf+283 lOU -20U · 3/;4/.8
)!;44 7 .lOU
39702 JOU
31,551 !OU
12. h~x.::ichlorocth.:in-=: ·--1 ·---4 ✓ •• bi~('Z-r.hloroiso,.,ro:lvl) cthP.r
~~~~:~~t~:-~n~i~· ~t~r~o~s~o~d~i~-~"--_"_r_,_•r_,_· 1_._"_m_i_,_"------"-==-i----"';:'r-----\r--,.-------,---------nitrohcnzcnc
52. hcx.:icl1lorobu~adicnc 8. l 2, l1-r. ric.hlorob~c~n~z~c~n~c::-------;;c;--,-';-;"--f----';,;-:,------;---•-------+--------
311696 lOU 05~5~--~"~·n~o~l~•~C~h~,,~l~c~n~e~-----------~=~-,---~'c-"~----t---------l-----/1). bi~ (✓.-chloroethox,:_,)_,~,~c~t~h~o~n~c~. -,---:-"-':'-':';'-ci----,,-;;,::-'------t------------j r _______ _ )!1278 1011 5t,. l.s0·.1horone 1M,or:· 20U
1l1J..SL 1-_:___iou
3t,58J
3/,200 L acC>n~,phthcnc ''ll12fl..L
1.f.0..4.L
3/J, 11
....Jl!..62.6
]/1 (,l;l
BO. fluon~ne 311381
70. diethvl nhthalatc )!1JJ6
311]!16
341133
9. h<":::xilc:hloro~~nv:•:,c 39700
/11. ·t.-tlr~:noel!.cJD,:.} ph~ny.l ether
_8.h_pi,m.--.a.t:lm:1';,;;='7'------------'-=~ 78. anthr,,c:r:ne.:Y
31,636
J/1!161
)!1 220
"]9]]0
311376
3/i!,G9
311 29?.
39_\20
39100 76. chr\'S('llf:! ..!J J/1:1?.0
:A .:. J:-:it ;rn:d y;,.cd.
J OJ)
J_Qll
)(HI
lOU
lUU
lOU
lOU
lUU
JOU
IOU
lOU
JOU
lOU
lOU
lOU
lOU
lOU
IOU
20U
·1ou
.
.I -J•:~.ti1:,.:1tl!<l v:,lu•.!.
K -1-i.u:11 v,1111,:! i:..: knm,•11 lo l;l~ ll!:;c-t:1,an v:iln,: l~{~,c:n.
..
I, -l,ctu:d Y.1.lu(! i~ l:no1Ja to In..! grc-:1t:1:r Lh,111 valul~ t~ivt:n. v,-i,1:~t•.:ri:il_ w.:i:; ·;in.,J.jz.:.=tl for l,ul not ·dcteclL·tl. 'fhl: nu:;i!,,~r j;,
:;,-. _Tc.:ntali.vc itlc.:ntific,11:.lon. 31-. :m<l/or :,zobc•n:~1:nc:
~/-:md/o:-'t!i_p~u:u:1l:,~·:i11,::,. · .,
.
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. . ·-
: .... ··: :·. -~
Ch1·>·~1en~ ,1iid/1•r l, 2-b~•,1:-'.:1:1~::~·.1:
3 ,/1-l,c:1:•.of .l.l:,,, .:,~ t!«•:,,• :111.!/ or
l. l., J. 2-h,:n::o f l.11,H".,n:hcnc.
tin· llinir.nm Ut~U·c:! it111 Lir.d.t:
.,· -1-:,\TER
rROJ:CT l(opp1.:r~: Co., Inc. CIW:,.!l!.>T J-;, \·!. J.oy. Jr.
l ~I~;. i_:,vi l l~{: _________ _
;\:..:i•~·:1.-;, (;;, .,/i . .l
J:.r:c;'D. tJ-2J-?O tc.:-::·!.'ri. 11-C-B
PAGE 15 ---= --::=--=-•-·--,=-==·..::....:c_--=-==----=...--, -------··--=-=---·---=---· ·=·--·----=---.··°' -·--·----,---•-=--· S,\!l :~o. we 2474 I
I'll ·JOO f<1uc..::t be ~--~--J -" sour:.cr. I, ·sTA1'10:l &i<lc of LC\.11.S
Bacrbee rcsidenc
r,,\TC/TJ:0-lf: 9-23-80 @ 1420 ~..--__,.....o=,.,,=-="'~=~=-•~--,-_,,.;,~==-~,..:..,.....~=== ,. -
Cor.i?ound!. on NiWC Li!;t of Priority t:l•acr:;1L rnt lo11 Co11c£:11t rn tio:"i Co:-:cC!:-:.ti;-:!tio:'.. l'olll:t,,nt!. ug/L ug/L ___ , .. :;,:/!.
ct:liCr 311268 --17. hi~ {chlorometl~ l>A r:A t;A 61. ~~-nit rosod ir::~ ~'1rbrni ne Jr.r.:.f8 "' ,;_,.
25. 1. 2-d ichloroben :o:cnc 345]0 !OU
2(,. l. 3-ciichloroben;:cnc 34566 lDU
2). 1.4-d i. ch loro?i~nzc·nc 311571 lOll
lS. bis ( ~-ch lo roe thyl) ether )f,273 lOu I ·12. .. hcx.,chloroc th.inc J/1396 !OU
1,2. bis ( 2-chloroboero~ln~r 3.11283 JOU -,
63. i:-nit rosod i-n-f) roor l .1. nine 311/1'-f. 20U I 56. nit roben.:l•nc 3Yil17 lOU I -52. hcxnch lorc•~utadi enc ]9702 IOU 8. 1. 2, li-trich lorobenzcmc ~\l,SSl lOU I 55. nnphth:i.lcnc 1/16% lOtl I---,, 3. hi.~ ( 2-chlo:-oc thoxy) TI1ethanc 'l;/1/.7fi IOU 54. i~oehoron~ 'l;(l.!!QP, . 20ll T
53. hcxac h loro.:::yc 1 ooc: n t.,di c ne %116.._ -· ,av I
20. ~-chJoronaohthnlcna 311 r:!1il_ \. lOll i-
)7. acen.:1ohthylcne 3Ji2QQ_ ____]_OIi i 1. accnaphthcne 'V?" .. JOU I 71. din\!Lhyl nhtkilatc lOU -.. 3AJAL_ --35 •. 2 l+-clinitrornlucnc ">{i_!i._1, IOU ~2·, (,-<lini trot0luenc 31161.6 IOU
l+O. /,-ch loropl1cnyl nbi'.!nvl ct~1~r .. 3t,6l1l lOU
60. fluorcne 311 )t,1 IOU
i'O. diethyl nhth,1.latc 3~33(!._ lOll -31 ~ l -2_~h':.!~/1 hyd rnzinc 2/ 34V,6 lOU --··• 62. l!-ni trnsnd ir,hc1wL,r:1in,:,3/ 3'1l133 IOU -+--2..:___b.£28.c;hlorobcn ;-:en~ . 39i'O~l JOU
111. ·4-1,ro1i1.92l1cny} phenyl ether 3ldJ)C. IOU
!~J:i..---llillLtl~ 17 Jl1ld)l
•. 31:220 JOU . •.· ·-.. 78. ;:i,nthr:iccut• Y
· 68. di-n butyl ehthal;:i.te 39] 10 IOU
39. fluor:rnthene . 31137,Y ].OU .. ,. 8/1. ~yrcnc 3M169 lOU 67. · butyl hcnzrl ~hth.-.lat,: J(,292 lOU
~-5 .. bcn;:idinc 39\20 20U
66. ld ~: ( 2-c thy) he:xrl) phth.-ilnt£! 'l_9_] 00 'IOU " --
76. chr;sene 57 J/1320 " " .. -. 72. l. 2-bt:nz.:!nthr:iccne )..7 . -J.OU -.. .. ., ' -. ··-JJ.14.6 28. 3 3'-dichloroh.:::m:idinE! · 1illJ. ·1011 " ... . .. ,.
69. di-n-octrl rhthal;1:;,: J/►5% JOU ..
74. 31 1,-benzof luor.,n th(::1~.i b/ 1!,J_J_Q_ .. .. .. " ' 75. 11112-ht.:n:,;ofJ no:-..in tiu:nc-6/ . "l!f!~'l7_ -IOU .:·· • ,-. .. ..
.· ··•. ,,
73. 3 t,-bcnzopvrcne 3!17.!J.1 ·1ou ·-.. .. -&3. inc1£:no (] ,b 3-cd) £)'rc~ne 3M.1..Ql_ ·1ou
~..:..___.!i_Ll1 6-c!ihcnz:in th r.,cene 1/15.5.!i..._ lOU -1..._. 79. I 12-henzor_o:-:r:;tl enc "l!!u.2.L. 10\t
2/i. 2-chJ onp_~:_'.·nol 3!!51:(1 JOU ------57. 2-nitroph_:-_.,ol J!rjJ_L _ _ . rnn. ·-
(1!:i:1. phc:11:.l (G,:/:1S) -)/if,9/, .lOU ! ---· 1!.•.:.._?_, 11-dj mc:thy.11_,hcno l Jt1C,qL 1.0u i
}!..:..._Z_, 11-·cli cl1 loror,hr_on.'.1.l 311(,DJ._ ---10,, -== l=·-----?~, t, 1 (,-tric.hJ c,rr,pli_l2!l01 J!1(i].L_ ---J 011 ----·-•·-•-·-2b____yn r:,chlorn~~ t .!~ t:n'.sOl 3l,jS!J .lOU . -··--·~-.'.>9. 2. 11-d ~ n i tro1~~12'.~ 1· '.i!~~J_(!..... _____ HOU • ·------•-· ·-·· ------···-H.!_._sf,.-::1! i ni 1:ro-u-_c.)~f•:;o 1_ _21, (, ~.~1-10~ ---·-· ····-·· ·-----Q~;:_1~_::·.1.d1 l oroph.::no l ~_')J!;LZ .l<Hl ___ ·-··-·-· ---··--·-... -----·-· J!L 1,-u i .~~1.:_£no l }/16/di /.OU .. --··--· --
;A .: Hot n,1:,lyu~d.
J -E!>tir.:1.ilcd value..
I( -Ac.tlwl v,1lu,:; i:; kno:.rn t.o Le Jr::;~: t·h:in v,1]111: f;iv1:n.
I. -A<;tual vnluC i::; t1101m to h<: r:r1•,1u:r 1.h.-111 v.1lu<~ f~ivc.n.
~/-l·1:tt£:ri~l. v.:i.r. ·an~l~7.cd for. l,ut not ·<lctcclc1\. Th,! nu:::h..:.r
; 1-. ,:cnt:1 t:L -.·,:~ i<lontJ f 1_.c.:. t :Jon.
ii; 1.h.:~ l!ir:i~:11:i Detection Li::1it.
j 1--and/or ~zobcnzi:oc. · ~;. k,-and/or 0<li.rh.:nyl:iai.1h.:.
(O\'E:t) :-. --.-.-:•,:·/.;: :-.-·.
·::•: .•.
hti:~:1::, CA ~/i:
l'P.UJSCT to;'Pl'l'S Co •• Inc. ----~ ___ Cll!~~!I~:T E. \..'. 1.(:Y.~~.:__!c.r:' !J. 9-L~~r G"l'I.' l>.~-~
~"1-.,r._1·i:;dll0, ~:r; ________ _
l',\C::O 1) ·;~-:~o. · · · -8(-1~ 2-'+i2 ----~-------,·--·-------
1--1~-020 /!2 \;<?11.
!:O!.JRC!: [, STATIO~i 1aain ln::iinating
bl<l~. kit faucet.
-----------------11--------+-------l------ll,\TE/Tl~li: 9-23-80 @ 15-'+5 . .
="--'..........,,_~"'--..._-=-=.,._.,...-==.=.•-=-;~=:.c,.•.=---=.-r.,.,.. ~::;.•,.v-------~--·.:.--= c.::.1=.::.=::-·===--""· -~=====-~-~-=-,=-
Cor.tpour.d~ on NROC Li.!it of Priority t:011ccntration Cunct!1:tration Coac(!.:.tr:~tion
l'ollnt.:\llts u~/L u-;:/I. ur,/J.
2h. l J-<iichloroben%cnc J.'.566 lOU -------27. 1-l,-d.ich lorolie;1 zene ~0l,75f7~1-J-~-~l ~O~l/-----+-'---·-------1--------
18. bis ( %-chloroC! thy 1) c the L 3~ 2 i'3 t---~l~U~U~--~-J----------l---------12. hC!x::C:hloroeth.1nc 3!1396 IOU
16,~23~-==~b1~_it,tt<-;~-~;c½hil~otl~:-~o~i~s~·o~·,~t:•o;><~,v1~Illl;_;e:;,~:.;c~r======~3~;t,~8~3=~======tl2.~0(1~1u1=========t==================jt=====~====~= . ,-n1troso 1.-n-riropy .:tr.i1nc 3-1l.2f.
56. 11itrObcnzcnc ~--~3~4~1;~1;~'/-f---~J~O~U'---·--l----------l--------52. hcx,,c:hlorohutu<liene 39102 JOLI
i,\ J!oc .,n:1ly:~c:1l.
J -Esti1:1:1Lt:d v.1luc.
K Actual value i~ knQ\.m to h(~ .l.1!:;s r.h.-1n v:1111,: 1_;ivcn.
I, -Ar:tu.il vnluC i~ 1:nmm to he crc,1t<::: th.111 v.,lt:c t:iv~~n.
C:l1ry:;c:1l'.: .1n;}./~1r 1,2-b~n::.,:,t:;:·
J, 11 -Ji,~a:-.o( h:,1:·.iaL h..:~h"! :m~!/ ~lr
ll, 12-h,:n:-:o [ h:01·:in :.:hen{:.
~/-i-1:-:tcr"j;IJ.. u,1:::: •;:in.'.ll.J;;,,.:.:.l for" l>lit not. cll!lC:C.tl'tl. Tli.i 1a:1:1!,.!r i:::: th<! lli.ni;-:,1r.1 lkt.::cti.c,;1 l.i.:ait.
-1-_ :rcnt;i tivc i1!cnt if i.c:i r:ton. 3/..:. oind/or .n:-<ihcn:.:l!n< (O\'EP.) ·;,-.... -~.,: :,_".":·(~·.,
-; .-:in11/or: d1 rh.::ny1.,r.n nc. ·,.,::: .. ~,:
•
J>r~OJ!•:cr 1-:opl'r-n; Co., lnc.
_MQcrJ..C.:~:J 1,_l~e-~t:~(~: _________ _
sotrncE {, STATI.O~
•
ditch runoff
from under RR
tracks.
-t{ATER
_..§.:_J..z2...l,-trichloroben;,.cnc 3}1551 lOU I
55. n:rnhthalcne '.V1696 lDU ·-,-----~-----li3. bi!:-(2-chlciroetho:<V) 1:ietlianc 34278 1011 .
511~ isciphOrone · 1M,f:r 20U
IOU
70. diethyl nhll1al:ite J/,)36
1X.~_!_1.2-c!ip11c:nylhyclr.:1.zill!: LI 343!1(,
62. ?\-ni.trn~;('ldioh(~11vl:1rnin,·_:y J/1/;J]
JOU
lOLl
lOU
JOU
lOU
lOU
1011
39. fluor.'.l.nth':"ne --·---• 31,376 .. J OK
.. -~ -·• lOK
JOU
20U . ,.,, .. , __ 20--. ..
..
lOU
::\ -1:nt :10:1lyzcd.
J -J:st.i1:iateJ w1lut~.
K -Aclu~l v:1lu~ i~ l:nnwn to l,c ]r::;s t:h;m v:llu,_• 1:i~•t:n.
J, -/,ctu;1l v,1lu(;_ j~ b1m:n to t,c r,n:;1t(\1° th:in v.il.11c gj•h~ll-
~/-.il.:,(cr,j;,1,_ v,,,. ·:i11;1L)·z\:,I for l>ut not ·dclcct.cd . .'flH! nu::1:,...:r
--Jc-------
---·-------
r.b,y:;t•nc :ui1?/0L· l,2-h....::1::.111.:1:r.11
3 .'1-h<!nzofl t:oi-;mt11<.:n.:~ ."\\<d/ ui·
l.J., l 2-l,,.-11::0 f l.uor:111 then..:.
i.:; t.h.~ ?'.t~i::iu:t llc:L.::ction I.i::ii.t.
-l,',\TER 1-.:-:-;:::.-.~~-,.~::.1~ o:~i:;,-,:; ;:..: -·:.\1:1:;~:.;
Cllf.'.-![ST F.. I!. J.ov .Ir.
Atht.:ns,. C,\ '•
Rr:C'J1. 9-25-80 C:C:·!l'/.'[L 11
PAGE 12· ---._ r=-21~ -----==· ·--=-=----· ··--------SAO ~;ll. fi()C Kw-:.0u-1~0~',c1,-,--n----+-----------1------
office well, S";.",\Tim;
faucet in kiccher.
JJ.\TE/TI:-1:-: · 9-23-80 G 1615 ··-----=----a----=-==-=--=--==--=-=•=·-P=-=~--="-~=t=======·-~ ·.--.. ..? •• ~-=-== Co;;i;,o;.111(!~ on 1:RilC List of l'riori,,tY t:o:1ccn.tr..1.tion Conccntr~1ticm (:uncentr.:it: l'ollu.::?nt~
ur,/1. ur,/J. ':!.-1'.J...l_. _ 1~7_. __ h_i~s_(~c~-'~•~l=o~r~o~o~•~t~h~,~·l~)~e=. '='~,-•~'=r ______ · J/1268 NA 61. tl-aitrc1!:0Ji:::-c:th,"bi:lir.c .17iD"H t.•,,
!OU
!OH 27. 1. 4-cl ich lo rob-~n ;.:enc 34 5 7 J. 13. hi~ ( 2-chlorocth•; l) -c--:t-;·1--:,,-.,-. -----';3:-:t,"2:'.7:'.;3--f---_,=,----+---------~-----
. !Ot:
1011
!OU
12. 11~:-:achlo:-oethan..::: 343% 71,"°2-. ---;--b-;-i ,-, (-'2=--.--cch"l,--0-,:r~o ,"· ,-o~,-ro---:,:-v-,-1') -c--:t,~h-:-e r-_ --c-'3,--;4';;2"'8"°3 +------s=---+--------+---··--lOU
20U 56. nitrobcnzcn~ 341,47 ]Ot: 52. l1c:-::.?chlorcibu::.:!clicne 39702 1011
lOU
JOU t,J. bi~(2-chl'oroct!ioxy) 1neth:.i.nc 3t1?..7S lOll
20(;
10!,!
JOU , oi:
JO[j
lUU
IOU
100
100
lOU
IOU
lOU
lOU
·100
!OU
J.OU
100
lOU
·10u .. IOU
ZOU
·1ou --
;,\ -llnt ;1nriJ y;:.cd.
J -Er-.ch1:1lc<l \."alu•.!. I~ -/1ctt!:1l v,1lu~ i:. l:nn:...rn to hr, le:;~ th:111 va111,'. r.iven. I.·· J,ctu,11 v,1l11t~ i:; kno1n1 to In: 1:1-~'.1tc:1· tl1.1n V,'"l)l:1.! 1,;ivc11. U -:-!~tcri:11_ 1.1:1=-: ·.1:1:.i.J)•;.:cd for l,ut not ·1!c·t.cr.ti.:d. 'fli,: nur:1~1~::: J~-Tt:nt:itiv~ ,1.dc.:ntific.-,tloa. 3,-· llnd/nr ;i;:ol,cn,:.,:n~: i. 1-~-;H!/o:-. "di:1hi.:n·tl:1:;,in, ....
------
.. _.
C!ir")·::cnl! :11\tV<,r 1,7.-'.· ·n::,1:,t"t:r J, !1-hc-n::o r lut~ : .. 111 th<!n,~ .,ntl/ o{· 11, 12-b..:n::of h:,1r;intlu:nc.
(0\'F.")
-l.'A TEI: ,-.::_\!.Y:;i:; C,\ PlmJ:~Cl KOi'l)Crs Co.'. Jnc_. _________ Cl!E:-:r~:T E. \..', Loy, _J~.=..__HEt'n. 9-25-R0 co:.it'l.'D. J1-G-,:;~ . -!'k:! ::..r.L~_ti._!_h:.,~•~c~----------
PAGC 9 ·------:=-No..•· -----------==-==·-----· -~~ ....... =---------=·=-~ --=-'-==~-= ~.Au ::n. eoc 2468 I Pi~-2.0U l~dl at
Wilkerson
Contractinr. Co.
SOUitC:.'. {, STATIO~
ll,\Tr:/Tl~!E 9-zJ-80 ~ 1345 =~,_=..,---~~~·===~--~==-••-=ao:===~--~--~·-===
o.c:==.:...--=•=:...-= =====~-C.:o;:ipou:-.dt, on NRDC List of l'riority Conccntratio:i Conccntr.1.tion Concc.:ntratioa l'oll.ut:!nts
U'['./J. ' u~)L ur,/J.
61. fl-nitrc,c-odir.:c'.Lhyl.1.minc
25. 1. 2-d ich lorol,•.:nz:Cnl!
1s. bi~(2-chlorocU1vl) r.tb<!r
52. hc:-:~ch lorobut.1.dicne
8. l,?..l1-tr~c:hlorol,en2c~c
55. r::ipt1tft;,.1l•ne
"f3-_-t;is (2-chloro~ tho:,y) T:'ICtli.:mc
53. hcxc,chlorocycloc'Cntaclicne
LO. 2-chlorc:-i~p!~thalen<::
~<!_cen.1.ph thvlcr.c
1. .-:?ccnanhthcne •·
7J. dimethyl nhthalatc
35. 2,',-dinitrotoluci~c
36. i.6-dinitrotolucnc
80. fluoren'c!
/0. dicthvl Dhth.11.!.tc
3). I, 2-diph,,nyI!•ydrnzinc .,,
311268
Jli!iJO
34o3u
3.'i..'",66
3(1571
3112/3
34396
J/1283
3!:42S
3l.M,7
39702
J/1551
:V16%
31,27r,
1.li!ir,'.>
'.%1~
16~~1
3il!lll
3!12cn~
)l,V,L
3/1/•l 1
"l(,(, ?(.,
31.cit.1
J/1381
3!1 33()
3!1Jl1(,
341,33
. 39700 __
NA !IA tlh ",, '"' ., 1ou
!OU
1ou
lDll
lDU
lOU
zuu·-
JOU
lOlJ
lOtr
JOU
lOU
2011
r-' ,ou
lOU -,011
lOU
IOU
·1011
lDU
lOU
lOU
lOll
lOU
lOU
lOU
J/1636 lOU
62. r:-,.!.~ trci:.orliph~:nv!.;11r.inc,3/
...2.:__.ltq~·:'.';'.hl..9.!:P!,•c'cl:.~n,,,.~•'~"~"~-c---c------'=-"'
!!.!.:-id~:@pl1.::nyJP L~"~"~"~>~• J~c~t~h~.c~'r~---==•~+--~~~----1----------+----------!!.!..:__p_b_r::fu1.1.ltlu:~r-i l . 3l1li 6 l 78. ;:inthr:-!cc:nr.:.:_:/ · J/1220 J.0U 68. <li-n-hutyl phthalnte 39110 lOU 39. (111or.:in then~ J/117~6_1 ___ ~l~[_lU~----+------~~-+---------~PY rcuc _c __ 3,.'c.•4e.6e.9e-t----"1C:0-'U'-·----+-~-,-----,-~-I ________ _ 67 •. hutyl bcnzyLJ~htl!:i.l:i::c 31,292 IOU ~-·· hc:-i:d<lin<:? 391?.0 20Ll 66. hi:::(2-cthylht~?:>·l) phth_:1fatc. 39100 ,_.. __ ·~·1~o~u ____ ,_~·-· ___ ·_·_·_·_·_4_:--______ _ 76. chry~c:li:?. 5/ · · · 311320 · ··· · · .. ... : ;:. .ll..:.____h'.3_:-_El~':2_ t:l1 r.l~ 1!, 5 26 -c-,--,-··~l~O~Ucc-----t-c-c--c~··-,-,-,-·~· ,-,-,-,-+-,,-·-·_,__··_-__ ·_· _ :~: ~i :~=:!~~t~:I~~~~;~~na ~t.-~~i~~~~:----+-~-~.c-cc---c-,-,-c-·~•~•+-,-.' -,--------71,. 3.11-Lr;n;,;,• ,_J.l:oninth.:.:11,~ _f.J__/ ___ · )ill.0_ 15. 11,12-hen·.;o[lue>-:.":-mthf!nt:~ · )!,?/,? lOiJ
·JOU. ,
·1ou
·1ou
JOU
JUL/
1 fl!'.
;,\ -l!ot :tn:1 l y;-.f•d.
J -E:;ti::,;1tt'.<l v,1.l.ur.:.
K -l,ctu:1,l v:1}11,'..! i~: lsnmm to be lc:>5 th:111 v:ilu,-: given. /, Actu,11 v.il::•": i::. b10Hn to he r,rc-:1tc:r Lli:111 v.1.lul~ 1~iv..::n. y1-~L'lrcd::J. 1J;1~ -.,n:;l):zc.J for ln.:t nut ·clct.<:c:l.lid. 'Jh,· nu::1!H'.r ? 1-. _fen t:1 tL '✓.:! idcnt 1 (J_.c:1 t lon. 31-and/or .1zohc.n·:.•:ni.!. · .. ·,-· 1;,-:inl1/or ·rii,pli-::11yl:-::;1in-.!. · .,
.,. .. ... • ··· ...
~!-I Chry!:t•ne .1.11d or 1.:~•-!,c:n:::1nthr.-:.;, f~/-J,'•··hc·n::ufll:or:1ntl1,::1h! :1ml/t1l· ) l,12-be11::ofh:o::-:1nthc.nr:.
i~ t.hc 1-li.ni1:1111:1 Jh.:1.c.:cti.011 Limit.
. •,• ·. \,;.:_:/-.. ~-/~,;;,.-.· ~-_:,:::)~ .,·. .-,.-:.-:·-.-::;· .. '•. '.· .. --~. ,.
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E!',\, :.;,;J, '.·'.G:1. 1·1
Athens, GA .'1/2,0
PROJECT Koppt!rs Co., Inc.
--1.)Q dsvi 11 f! NC:
CHF.'.'-lIST F., H. J.uv. Jr. RT:C'D. 9-25-80 CO~!?l.'D. 11-6-,'-;
---. -•,.· ---2467 -SAO :-:o. ROC
Pw-ou1, h1cll fro;,
SOURCE I, STATiml l':0<llin ~!obilc
home.
DATE/TI:·IE 9c23-80 Q 1315 -··--= ===--~-=,.-~--~..., = -~ Compounds on NRL>C List of Priority Conccntr.:ition
Pollutants c::;/L
17. h i.s { chlocC"r:'tP. th•:J.} r-tliC:r 34263 r:.i\
61. N-n i trosod i;:-,eth·: l :im i. ne :144Js '" 25. l 7.-dichlorolienzene :3t.SJ6 lOU
26. l. 3-dichlot·oben::cne 34566 I.OU
27. l. l1-dich lo ro:len ~cne. 34571 lOU
18. bis(2-chloroethvl) ether 34273 JOU
12. hc:~.:ichloroc th::ine 343% lOU
/12. bis ( 2-chloroiso~ i·onv 1) ether 34233 lOU
63. N-nitrosod i-n-n:-onv l.:i1::ine J!,42S 20U
56. nit rob""en~ene 34447 lOL! 52. hc:-:.i ch lo rohu:: at! i •-~ n e 39702 10\J
6. 1. 2. ,. trich lorobe.-n<.cnc 34551 1(11.J
55. n,,~hth.:i.lcne Jl1696 lOll
43. bis ( 2-chloroe thoxv) Pethaui..: 3L127S ,ou
54. -iso•1~;orOne 14£,..., -20U
53. hex.:iChlorocyclooent.:idien".! 31,* 1 011
20. 2-chloronnnhthnlcnc lOU
77. acen.:iohthylene .3ti\ ] OJ.! 1!, ')
l. accnauhthene 3~~ JOU 71. dimethyl phth?.latc JOU '"l{, )I,]
35. 2 14-dinitrotolucne )L_(ill.._ ]OU
36. 2.6-dinitrotolucne 1!:..6..:1..h JOU
40. -4-chlorophcnyl phenyl ether ~!,::ii,]. .lOU
60. fluorcnc 3!1381 -_ JOU
70. diethyl ~hthalate _}A].?6 lOU
37. 1,2-diph!"!nylhydr:i;:ine 21 :,lf;J!;6 IOU ·-62. 1:-ni trosodiuhenvlaminc37 JY;J3 lOU
9. hc:-,;,,chloro!1cn zcn~ ')9700 JOU ,,1. ·,4-brO:noEhen·rt .:ehenyl ether 34636 JOU
81. nh ~mthI:.cr, ;... 'i 7 . ·:v~~1?l l 78. anthraccn~I JOU ·341.1.0
68. di-n-butvl Ehthalate 39110 lOU
39. fluor.:inthene 34376 I !OU
84. J:!vrcne 3446? I !OU
67. butyl bcnzyl Ehthal.:i.te 3(1292 IOU ----·· 5 ... benzidinc 3~UO ~ov
66. bi.s(2-eth51hexyl) phth.11.1.te 39100· ·1ou ·--·-
76. chrysene 7 · · · 3!,320
72. 2-bcnz.:i.nchr.:i.cene '51 . .. lOU 1 ":1[!_)_2.P_ __.:__ 28. 3.3'-dichlorobenzidinc· J..i6JJ ·10u
69. di-n-octyl phthalatc .. .1!1526 -lUU
74. 31 4-benzofluoranthcne §} J '!..?..J.!L. 75. ll 112-Lenzofluocanthcn~57 · lOU 3!. ?:",., ,
73. 3,li-b~n:wpvrcne 1/,~ .. lOU · -81. :i.nrleno (l 2.J-cd) pv.rcne 'l:/L/1.QJ_ ·10u
82 ~ 5 6-llibenzan th r.:icene 1!\S:;F. ·JOU
79. ]112-bcnzopervlenc. l.:l..'!2.L.; lOU
21,. 2-chloroohcnol J,';~i-'."i(, !Oll
57. 2-nitrophcnol ~!~.:~1__ "!.OU
65:i.. ~hcuol (GC/MS) ,l-~!!211 l~J-~!
Jl,. 2 1,-cl; mt:! thi'.lQhenol l!f(10{1 1nu
l!...:._2., 11-c:! i r:h lorophcnol ~~•JJJJ 19v
21. 2 1, 6-trich.lorophenol 3!i[,'.:ll ·1uu
l~_.: __ p:i r :1 ch lo rome t .i..C a: ~al :iJ:\ .. r!? I 1nu
59. 2 l1-rl ini tro~:-~~11. '.i-~ G 16 I 80i.l
GO. 1, G-dini r. :·o_:~:.£.r:.'.':;ol 1_!.651..__I JUU
(il;. pt:!1rt:1<:.J.!.lr.: ~; ·pb,mo ! :1_'J_:~:sJ 101'
58. 11-n i trnp; ';~:iol :i ·. !',!, 6 2UU ..
iA -Hot :m::ily;:.::d.
J -fa;c.i::1.:itcd value.
K -Actual v.,lu,~ is kno·.10 to be less ti,:•_:, v:1lu,~ ~iv,:11.
I. -Actual v.1luci i5 l:noHn to he. r,rcatt:;:-:.!1:,11 •:,d.t:l~ r.iv.;n.
~/-i-Gtcrial w::i::; ·an.:iljzcd for 1,ut not L'.~•:·•-<.Lt:ii. Tln~ 1:u;:ib,~;:-i:;
;,--~fcnt,,tivc. Jdcnti!~c:ition.
':: .-and/or l"17.nhl'n7P-n.-, ·
Conccntr.:i.tinn Ct:1ncent:::ition
ug/L Uf',/L
?:.I\ NA ..
-
.
. -------·--· ------·--
•. ·-· -..
--
·-·-. -.. -.. -. --.. .. -
....
-· • -·· ... .. .... " .. ..
---
-----·
··--
---------· ·--------
--·-·.
5/ ~/= Ch"ry:a.'nC! .,nJ/ur J.,2-bc.n~.~nthr.,
J,l1-hcn::l>fluor:111Lh.::nc and/or
ll, 12-hcn;:·o [ J.uor .-.n thcnc.
th.::: Mininum Dctcct:ion Limit.
iJ.\·:·.\ ~:::::•Ci\·:·[:.1: :-;?-!;:'.ST
1-::\i."1:,\CTAJ:LE: Oi{G,\:; lC ,;:;ALYS IS
PAGE l. EPA, :~,-..:,, r'.G::. :·.,
Athen~:, C,\ ti/SO
PROJSCT Koppers Co.• Inc. C!iE:-IIST E. W. Loy, Jr. Rf.C'D. 9-25-SCco~li'!.'D. ll-6-SU
~i.:..r.htllu_o1. ________ _
-
SAD ::o. OM 2Mi4
PL-002 Pond be-
SOURCE /, STATION hind Medlin
home.
D,\TE.'71:·IE 9-23-80 Q 1115
Compounds on NROC List o( Priority Concentration
Pollutants ur./L
17. l:d.sfchlorometb·:l' ethCr 34268 NA
61. N-nitrosodi::iethvlnmlne Jl,4:J8 .. ,.
25. 1. 2-dichlorobcn::.cnf: 34531, lOU
26. 1-3-dichloro~enzcne 3t,~,U1 lOU
27, 1 l1-d ich lorobenzcnc 34571 lOU
18. bis ( 2-chlorocth\· l) ether 34273 lOU
12. he-xachloroe th,,ne 311396 lOU
42. bis ( :!-ch loroisonroriv 1) ether Jl,283 lOU
63. ~:-nit rosocl i-n-oronv la:-:i.i:: ~ 34428 20U
56. nitrobcnzcne 3441.7 lOU
52. hc:-.:ac h loro!:> u t nd i er. e 39702 lOU
~ 2 ,L.-trichlorob':!nzene 34551 lOU
55. n.iohth.Jlenc 34696 · lOU
43. bis(4-chlciroethoxv) l:leth,'.\ne ;)4278 lOU
54: isoohorone Jl.l.Q3 20U
53. hexachlorocrcloocntodiene 3:'i "~(, J.OU
20. 2 ·chloron.inhth.::lc11e -~--'is,· lOU
77. accna?hthvlcnc Jli""" IOU
1. accnc1nhthcnc ···--·1ou
71. dimcthvl nhthal:itc '"l.t. "l,, lOU.
35. 2 4-dinitrotolucne )/1'-1, lOU
36. 2,6-dinitrotoluenc "f,t'.. ?t'.. lOU
40. 4-chloronhcnvl nhct:vl ·Cth:!r . 34641 lOU
80: . fluorene 34381 lOU
70. diethyl rhthalate 3!1336 lOU
37. 1 1 2-diehcnylhyd r-.'.I :~ine 2/ 34346 JOU
62. .. ni tro!:odiE:hcnvlctmine Ji 3Mr33 lOU
9. hex:1ch lorohe:n zene . 39700 lOU
41. ·4-b;~monl1en•1l phen·tl ether 34636 lDU
Bl. rb ... n,.~-:t1 ',1 34461
78. lOU anthraccnr,-~1/ · 3!+27.0
68. di-n-butyl. nhth.Jlote 39110 lOU
39. fluoranthcne 311376 lOU
84. E:Yrcne 3!+1,69 IOU
67. butyl benzyl E:hth.'.ll:tte Jl+292 lOU
5 ... bcnzidine 39120 20U
66. bis(2-cthvlhexyl) nbthaJ.1.te 39100 lOU
76. chr'-'sene J/ 34320 -72. 1,2-henzanthrnccne-' )l,J26 lOU •
28. 313 1-dich lorobcnzidine J!16Jl lOU
69. di-n-octvl Ehthalate J!,~96 JOU
74. J. t,-hc:nzofluor,'.\nthenc:>: Vi 'lf,? ~,.
75. ll 112-benzofluo"::".'.1Tlthene61 . 3i2!i.? -JOU
7J. J,4-hcnzoiwrcn"' Jl,?.!.u_ · 1ou
83. incleno (1 2 3-cd) i:ryrcn~ '•!tf&J..._ 1011
82. 11 2, 5, 6-di Len Z,'.\nth C,'.\CC':TI~ vc.,r.r, JOU
79. 1112-hc:nzonerylcnc 1{D2L lOU.
24. 2-chluronhcnol :V,Sl,!6 lOU
57. 2-nit.ro•ihi::nol )!159] lDll
65n. uhcnol (GC/MS) 34(,9!1 lOU
3li. ?. , 4-di r:ic t.hyl phcno 1 J!i(,06 lOU
31. 2, 11-d ic:hJ crop heuo 1. Vd,01. lOU -21. 2. ,. G-t rich} nro11hc:nol Jl,67.1 lOU
2I_._;1.'.lr:1cbloro::ict.'.l crr.::ol J!,/,~)2 1ou
51.J. 7., 4-din i t:roph•~nn l 3.'d~_lG HOll
60. 4. 6-d i.nil"ro-o-c:re:sn 1 3_;:,_G~1_L_ IOU
64. 1•c1!t.'.lc\1lc,ropl1c11nl 31.J{)]~ IOU ·-· ~0:_t,;__r_~_p11e11c1l :Vdild, ZOU
;,\ -1:ot .,nalyzcll.
J -!:'.sti.::iatcd v.nlm:::.
K -Actual v.1.lut! i:. kno:.m to be le:;~ th.,n v.,luc r,iv<Jn.
L -~•stu.'.11 volul! is k~o1J11 to ht~ r.rc.,ter th.:in value r,iven.'
~ -:-btcrinl was ·.-rnalyzcd for l,ut not 11.!tcctc(l. TIH! mmbi.!r i.:::
;~-._Tentative iCcotif~c:itio:1.
j -.'.lt~d/or azobcnzenc. · · _,. _I_ A __ ,, __ ._..,_,. __ •
-= -
--'=-• -Concentration Conccntra~iun
u~/L u~/l.
NA NA ,,.
. .
·. ---
•. .. -..
-----
-· ' ~-. .. . -···-.. . ..
.. -.
.-.-... .. ---:: ' .. . ... ... " --.
-
.. -
-,
--·
...
-.
--
--·· --------..
-----·--·
·---1 ...
Cliry:;e:;v• :1nJ/or 1,2-b~•n;,::-int~r:1,
3, 11-h...::1:·o ( luvr.-1c th~nc: .,nti/ or
ll, 12-h,rn::,1 (luocun th<.'nc.
• llA11:R PAGE l
DATA REPOHTI:-.G Sl!EE.T
tXTP..,\CT,\!JLE Oi(GA:ac A:;ALYSIS
r:r·,\, :~,-..:1, :-:c::. u
Ath~nc.. G,\ Ii/ SO
RF.C' D. 9-25-S0co:-iri. • J). 11-6-S0 PROJECT_~oppcrs Co., Inc. CHE'.HST E. W. Loy, Jr.
Morrisville ~:c
SOURCS & STATION
KL-UOl-upper
end of Lake near
1,'illo,._.s, adj. to
Delt.
----
DATE/Tl~IE 9-23-80 ~ 1015 ""=.;.;;=----=-,...~-==-=--f-======I=-===~=~===~=--===="' Compo~nds on NRDC List of Priority t:oncentro.cion Concentr.:ition Co:i.ccatrncfon
Pollut.1nts ur,/L ll[:/L u'h/L
17. bi~(chlorClrnethvl) ether 34268 NA
61. N-nitro;-OL!ir:it!thvl.:ir.iinc J44:Jl:i
NA t:A .. ,
25. l 2 dichlornben=cne 34)36 •"11
26. l 3-dichlornbenzcne 3!1566 rnn
27. 1.11-dichlorobenzcne 34571 lOU
18. bis(2-chlorocthvl) ether J!.273 lOU
12. hexachloroethane 343% 1011
42. biS.(2-chloroisooro:,vl) ether 3!..283 IOU
63. N-ni.trosor.! i-n-nro::,•.-l.1.ninc 341128 20U
56. nitrobenzE.!nc 3!;447 Iou·
52. hcxnchlorobutndiene 39702 IOU
8, 1, 2. 4-trichlorobenz.:ne 34551 lOU
55. naohthah:m~ 34696 }OU
43. bis(2-chlo:-oetho:<v) mecha:1e -:i;427s lQU
54. isophorone Jld.r)0 20U
53. heXachlorocyclooentadicne 3L1J86 lOU
20. 2 chloron.:i.>hthalenc.· ?.4""1 }OU
77. aceno.nhth\•leni:? .,,_..,, n 10U
1. acen.:iphthene · · 'lt,. ?""" lOU
71. dit!!ethyl ohthalatc 34).Cl IOU
35. 214-dinit~otolucne 34,,1, lOU
36. 2,6-dinitrotoluenc ""!."?r.. JOU
40. 4-chloroohenvl nhenvl -ether"" 3l,6lil lOU
80. fluorene 311381 lOU
70; dfothVl ohthalate 34336 JOU
37. 1 2-diphenvihYdrazinc t.l 343!,6 lOU
62. :-=-nit rosodiphenvlaminc~, -----~3::,l•::,4"3"'3-l--~le,Oc,U'-----+~~------+---------
9. he:<a.chlorobenzenf': 39700 IOU
"1,-'1".-°'.4"'_b-;-6l!!flQhci1v.l nhcnvI ether 34636" IOU
"B,,lc:._-,u~b .. 0 ,.n~aun.t,hw..n.c•n,;,os;· '=\_1 ________ 4 31+1161
78. anthr.icene4/ 3!1220
68. di-n-butvl phthalate 39110
39. fluoranthene .· 3';376
84. ovrcne 36669
67. · butyl ben:wl nhthuiate · 34292
5. ·· be:iZidine 39120
66. bl5(2-cthvlhe;.:yl) ohthalatc 39100
76. chrvsene 5/ 34)20
72. l,2-benzanthr.:
4
o::ie ..,, · "Jf,r.26
28. 3. 3'-dichlor-ob,~nzic:!ine · -:i;t,.6'"
69. di-n-octvl ohtha].1.te "1:!,'-06
lOU
lOU
lOU
lOU
lOU.
20U
.. lOU
·1ou
lOU
7" .. 3 1 f1-benzof111ornntbcne: ci, Jl.?)Q
75. ll.12-benzo:Juor-nnthcnc6/ · "'?!,.? IOU
73. 3 t,-bcn,onvn,nc · ,1,•,01 · · IOU
83. in<.!t'.!no (li1_,3-cd) pyrcne ""!,ln"l .. ·1ou
82. l. 2, 5, 6-dibcnz.inth raceme "! t; c r. ·1011
. -·· .. .. ···.··· ··':
.;7..c9c.:•_c:l~,_,,l;c2~-"b"c=nzo"p"c"r°"y,_l"c"n"'c~-----,-----='!1f1.S2Li----'1'-'0'-'U'-----l---------l-~------21,. 2-chloronhenol ]!;586 lOU
:A -r~oc .,nal.yzed.
J -Escir:iatcd value.
K -Actual valut! i:> known to be lei;s th.,n vnluL' [',iv.-:•n.
L -Actual value is t:no\m to he grc;itcr t.h:rn V.'.llm~ r,iv.::n.
~ -h.:irerial ...,a5 ·analy~t!cl for hut not detected. The nu:nh-.!r ir.
-1
1-Tentative identification. 7 • / 31-and or .azohcnzenc. .-,.
--:>.n<1/r.r ,.1;,.;.,~.,,-1 .. ~,;,,_.
~/-Chr:;seni! :ir.'1/or 1,2-bcnz.:mt!lr.ic
§./ _ 3,11-hcn3o(J,.l:.ir:rnth.::ol.! and/or
11,12-h.:-nz:ofluoranthenc.
the J-lini::n.::,. Dl:tCct.ion Limit..
(OVER)
PROJECT Koppers Co, Inc.
1-:orrisvillc, NC
----SAD t:o.
SOURCE & STATION
~f./TU!E
Comeound . 2/. dichlorodifluoronethane-
methyl s_h loridc_2/
methyl bro:n ld;_,_~_I
vinvl chlo~ i.J,:_• 21
chlo::-oethane2/
methYlene ~hlori<le~/
trichlot:o f luorome thane1.7
lzl-dichlor0~thylen~27
l 1-<lichl o::-oet hane i...7
11 2-trans-dichloroethvlen~/
"thloroforn 21
1.2-dichloroethane.~?
lzlzl-trichloroethane l/
cat:bon tetr2.chloride.I"r
dichlorobro~om?.th~ne..!./
1 z 2-dichloroeroEane.Y. ·
l.3-dichloronro~"lene27
trichloroethvlen,,.2/
benzen~/
chlorodibromo:netlrnne.Y
1.1 ~ 2-t richloroethanelt
\·I.\Tl::i~
OAT.\ 1:r:l'Ll,G ING ~!i:::El"
l'URGL\lJLE O;i..GMI [C A<1ALYSIS
CHE,.'--IIST E. W. Loy, Jr,.
sor ')I,(,(}
BLANK
9-22-SOQ 0815
ug/L
'>[,.l". I!. 0 SU
34418 SU
34413 SU
39175 SU
3t,:n1 SU
J!1423 SU
)4488 SU
j.l._:.iUl SU 3,,,,% SU
C J4)ff6 SU
"I"" SU
l210j SU
"l4'""6 SU
~-~02 SU
32101 SU
)Gj41 SU
34561 SU
39180 SU
31,030 SU
3ti306 SU
31,511 SU
2-chlo-rPt:t"hvl vinvl ether (mixcd,""134S76 SU
bro~ofor:n.?/ 32104 SU
l I l 2 2 ! 2-tl~ ~ rachloroethanc±1 3'i516 . SU
tc t rcchlor-o 6 thv 11..:n~/ 341175 SU
toluene;-=-, 34010 SU
chlorobenzeneL./ 34301 SU
ethylbenzcne.Y · 31,371 SU
acrolein'l:..l 34210 !DOU
ac•-vlonitrilc-1.I 34215 1oou ·
..
-..
-----·~ ------..
J Esti1nated v,,lue.
K Actual v.l.1.ue is,_ knovn to be. less "thnn v:ilue t,iven.
L Actual value is•known to be greti.tC!t" than v;:iluc given.
.
REC'D. 9-25-80
:-:'..-'.\-.i.'.J' :•.,.;:!. -;__·;
AfE::'.~G. G,\
4/80
co:-H'LET'D · 10-21-80
--= -
ijQC 2~QJ HOC 2464
KL7 001 ·r1.-002
Upper End of rand behind Medli
Lake. Home.
9-23-80 @ 1015 9-23-80 e 1115 --· -
ug/L ug/L
<n <n
'" SU
SU SU
SU SU
SU SU
SU 8.5·
SU SU
SU SU
SU .SU
SU SU .. SU SU
SU :,U
:iJ "•:
:",,J c .. .
,u "' SU "' SU c-.
.,u SU su· SU
·SU SU
SU SU
SU SU
.SU .. SLl
SU 5Li
SU St'
SU sU ·---
SU
5iT':" ____
5U SU
1oou 1oou. .
1oou 1000
.
'
. ...
. .
. . . . .. . .
..
·---..
·---. ·-··-.. _, .. ·.
-· ..
··_U Material Yas ·analyzed .fo-r: but not detected. The nu:il!:ter is the Minimum Du.'"·,.ctlon 1.iait.
NA Not analyzed~
:. ·!/ _ ~Tcnf.~tive identification. •'-..
'·'/;/_·On NRDC Li::.t of Pri6rity Pollutants. • ... ::_~)l>ttt/.;:~\~-~f .".•):-{;~·:, ··?:\ ~--\:•:· .:.·~/~.:~~·2·t\.
~~~B~.·~.::\" .. ~.
•. ,. I : . :,·.I .. · '_;._~· .. ,. .·
-:·. _ _.;...;.
./i:)/,)i!f :}\(f; ·•·.·· :·': /i'.:,,.;/~
iiltiJil
PROJECT Koppers Co., Inc.
'.: ., \
0 i: I~ U:\·l·,\ !:i~~•u:ff i),l; SiiC.::::T
l'URC:EAL\LE o:tGANIC.: /\tgLYSIS
Morr bvil~l~c~-"~~C~----
--·--- --
SAD rm. soc "·"'
SOURCE & STATION. P\-1-l00Well
:-ledlin Hone.
DATE/THIE 9-23-80 @ 1315
Compound ug/L
dichlo!'odif luoromethan~/ · '2/,~(,r:, 5U
methyl .chloride}/ 34418 5U
methvl bro:~i<le:.Y 34413 5U
vinyl chlor i.de..Y 39175 5U
chloroeth.:rne21 34311 5U
methvlcn~ chloride71 3!.423 5U
trich lOrofl 1ioroma-th:me .. Y 34!188 5U
1 21-dichlo~o=thylene.f/ 3!1'.>0l SU
1 21-dichloroeth.J.ne.~7 344% 5U
1, 2-tran~-dichloroethyle:ntc"27 ~ 5U
c:hloioforrn 2/ J21Ub 5U
12 2-dichloroethancJ} 14103 5U
1.1.1-trichloroethane 7J ~ti",.." 5U
carbon tetrachloride.9 '") 1 02 5U
dichlorohromometh:inc..Y · 32101 SU
1 2 2-dichloropronnne..=.1. 34'4' SU
1 1 J-d·i chloropro~~cne21 34551 5U
trichloroethvlcneL/ . 39180 5U
henzcne=..1 34030 SU
chlorodibro~om~thane .... ~-' 34306 SU
1.1. 2-tri~hloro.'.!th:!rtc>.=.1 34511 SU
2-chloroethyl vinyl f!thP.r (nixcd)L1 34576 SU
bror:-o fur~] . 32104 . SU
!.,h2 12-tctrn.chlornc th.ine:21 34516 SU
te tr nch lo roe thv ll.;ne3./ 341~75 SU
tolucne:f/ 34010 '"
chlorohenzene..Y · 34301 "'
ethylbc.:nzcr:P~' 34371 ·su
ncrolcln . .=/ 34210 lOOU
acryloni tri.l ~~.!-' 34215 lOOU
.
-
Estimated value.
K. Actual valuf! is knovn to be less "thnn value given .
. L Actual value is":·kno~n to he grc;iter than value r,ivcn.
--= •·•• -----soc 2468 &uc 2470
rw0200 ~ell at KR-004 East ditch
Wilkerson Con-under RR Tracks.
trace· Co.
9-23-80 @ 1345 9-23-80 @ 1715 -'
ug/~ ug/L
511 5U
5U 5U
5U SU
5U ·5U
5U SU .. , 5U
'" 5U
511 5U ... 5U
5U 5U
5U 5U
5U 5U
SU 5U
SU 5U
5U '" SU ~!1 su. "' 5t: "' 5U . "' SU Sil
SU 5U ·-SU )El
SU 5U
SU 5U 5U SU SU 5U ----·
5U SU. ,u 5U 1oou 1ouu
1000 lOUU
-. _,
. . ... . . -
... ..
..
·_U H.:itcrial \.las ·nOalyzcd .for but not detected. The nu;;~cr is the Hinir.mrn r.~t:cction Lir.iit.
_NA _Not _~rialyzed~ ·.:·.· .
,--!/ _ Tcnbitive idcn'tification.
·.]j_ On NRUC List of Priority Pollutants.
---
-<-·..., .. ;-,,,
__ ,.:..:.,:·:,.,_,_~';"O ....... °:-<-•-:-_;...----· ......... ':""'~
iriitii~i
1:,\·r;:;~
nA·,·,\ t:r:L'U:{T [)it.: !.,H!!ET
J'URGEll.llLE Oi{CA~!IC /\N/1.LYSIS.
PP.OJECT Koppers Co., Inc.
-:----Jlornsvn·1c,-r:c CH8-l1ST_E~...ll--1.o,;_.u ___ REC'D. 9-25-80
. -
S!I.U ;:;o. BOC 2471 R(lf" "11,7?
SOURc°E
KW-010 N.'.lin K\/7020 12 \.tell ,. STATION office well main Bldg. Kit
faucet in faucet.
kitchen.•
DATE/TIME -. 9-23-80 @ 1615 9-23-80 @ 1545
Co.:ieound ug/L ug/L
. 2/-dichlorodifluoro~ethane-"·"·" SU su
methvl.chloride~/ 34418 SU sn
rnethvl bromide.£! 34t.1J SU SU
vinyl chlorid~27 39175 SU SU
chloroethane2/ J!1'.Hl SU SU
rnethvlene chloridcZ/ 3!,t,23 SU SU
t rich loro f luo rorne t.h:me1..7 Jl;I,88 SU SU
l! l-dichloroethylend7 )t,501 SU SU
1 1-dichloroethane'L./ j!iw:10 SU SU·
1. 2-t r;ins-d i.ch loroethylene.Y 3;)1;6 SU SU
chlorofocn ~, JS Ub SU SU
1.2-dichloroethane . .:::.' .,_luJ SU SU
1 l 1-trichlOroeth"ane L_I ,4,0< SU SU
carbon tet rac:hlor i<la.=.1 '"0? SU SU
dichlorobro~om2thanelt 32101 SU SU
112-dichlo~oerooane.3.1 '.V1'il1l SU. SU
1. 3-dichlorooroovlene2/ 3!1561 SU SU
trichloroethvlcne~/ 39180 SU SU
bcnzenel1 34030 SU su·
chlor.odib romo:ne th ane!::-7 34306 5U . ·SU·
1.1 ~ 2..:._trich loroc.thanel1 345.ll SU SU
:?.-chloroethvl vinvl ctl1e.r (mixed)~J34576 . 5U SU
bro:.io for~/ 32104 ,u SU
1 11 1 2 t 2-tctrnchlor:oe.thane.l1 34516 Sll SU
tetrachloroeth}'.1 l.;nd1 )!i/1.75 '". c;,
toluene.fl 34010 SU Sil
· chlorobeiizcnc:c.1 34301 SU su
ethylbenzc:-v:·~1 34371 SU ·su
acrolcin..?T 34210 lOOll lOOU
acrylo_nitril~' 31121) 1oou·. JOOU
. .. .
'
...
. . -..
. .
.
.
·J Estimated value..
Y. Actual value is, known to be less 'than value civcn.
L Actual value is kno\lTl to he r.re.:itcr th:m value r,ivr.n.
::/,\-,;.,.,,, i:1;;;_ :..·,
ATHC::i::>, CA
4/80
C0:-1.PJ.ET'D • 10-21-50
-8_0~ 247,
!,,.V-030
Steel Shop.
9-21-80 @ 1500
ug/L
SU
SU
SU
. .)l./
SU
SU
SU
SU -,u
,u
' Sil
sn
"' . SU
SU
SU
SU·
SU
SU
SU
SU
SU
SU
SU
SU
. Sn
'"· SU
lOOL"
lOOU
_U Hatc:rinl was ·analyzed .for but not <lctectcd. The· nlL.iber the Hini.:111m D~tr.:C':t!ion Liait ..
. NA Not ~n.:tlyzcd~ ..
•!/_ Tentative idcntlfication:
· ~/--on lff~UC List of Priority Pollutants.
. . .. ,. . . '·.
,_',);:.:~~<~i~--,/~\-~~\:;·~~..::.. .. ~~-~'.~;-: ~:J:;;_>,;~~-:~:/~:
. . . . ..
-~~--;-~~-~~~:~~ .. /~X~~:~~~~}i~0
. : _. : .. \;i;;,,\i:i,'"1:!z!~';;ft0r,j~
~~~~4fii#~~~~-·
:•/':-~·~\~::{f~~r.~tt\~:t;,'.~{}~:f!/r;_\';;{)i.
, ' · •. :.:.:.:•;::1, ·:·,
~?(?~~:~~~~~~~
. . · .... .-_:,: .:.:::, -~:~'.~_:,, : -~
. . _ _,_
\ : ' ,·:•: ~;
O:\ l'.\ l:i·.1"lJ:{ :." l:,L ;;;i ~-:C.:"l'
l'UltGE.i\gLE on.c,,:ac /1.::ALY'.;IS
,:.,,.
At":~~:><S • G,i.
4/60
l'P..OJ ECT_2_opp~rs Cg. ~I~n~c~•~ ___ CHF.:•IIST_F;_,._}L_L.~_.l~P..CC' ll · 9-22.=.S_D_CO~-!PLE.T' D ~21.=Jill
Morrisville! i;c
~5c,A~D_l~'O"--'--.------------------l_B.Qc_,7j.4~7~4'----------j--------t---------
PiJ-J00
sou::CE & STATIO~ · F.,ucC!t b~sidc
Bacrbee R~sidcnce
9-23-SQ 0=1~4=2~0='"1"===-=-~·==,}a·==-=-~==
Co;,1pound ug/L
dichlorodifluoromethanel/ · ~u."-~ :>U
rn"e"t'-'h=yl'-'_"c"h"1"o°'r"i"d"cc;2c',/;:=.:=='--------c3"':,""4""1"s'-+--~Sc-u=,•-----l~-
-
-
-
-
-
-
-
+
-
-
-
-
-
-
-
-
-
ug/_L ug/L
rnethvl hromid~t 34413 SU
vinvl chlor-idc.£1 39175 )LI
chloroethaneZJ • Jl1311 511
methvlcne cblorl<leZ/ 311423 c;.11
trichlorofluorornet't1~ne.:::.! 34408 SO
1,1-dichlo:i'.'Oethylc~a.Y Jt,SU.l SU
l l-dichloroeth3n~_Z_I 34!,% SU
_L2-dichlornorooane.3.1. "il,'i!1l SU
!,. 3-dichloronroovlene:.U 34561 SU
0t~r~j~c~h~l~o,,__,,r~o~e0t~h~y~l~e~n~e,;;,as":.....----~---3~0>1~8~0:--t---~S~U:--____ --t ____ ~----+---------
bcnzene.£/ '.:l!,030 SU
chlorodibr0mornethane_Y 3!1306 SU
1. J.. 2-trichlaroe::han·0.£1 Jt;Sl l 5U
2-"chloroe.thyl vinyl ether (mixcd)41 Jl,S7G SU
bromr,7e>rmD 3210!+ SU
1,1
2
;,.:':~~--~t~c~t-r~,-,c~l~,1~0-r~o""e~t~h~,~n~=~"r,·,,--~--c374~5~1~67 ---;S~U;--------t-----,------+-'-------~--
tctr~chlo-ro~th)'l1.:ne,:.f ]!11;75 5U
toluend/ 31:010 SU
-------------------t----------i--~--------------
-------------------t--------t--:------------+---~---
---------------------+----------+-------------+-------
--------------------~1--------1-.,..----~-+-------
J E,:;timatc•d value.
K Actu;il va1.uc i~,_known to be less ·t_h:m vnluc t,ivcn.
L Actu:il value i5•knm-1n to be ere;itcr than v.,lue r,iven.
U _Material was ·annly7.c<l .for but not Jetccle<l. '£he nom'...,cr is the. Hini.:iur.i. Datcction l.init.
NA Not ~nalyz.ed. .. .. . .
·!/_:-Ten f3t:f.ve 0idea't:'tf1cnt ion_-.
'l:,/_ 'on NRDC List of Priority Pollot.ants.
•.·.··.•.',:;, .. •.· .. ·_·.·.·.-;_'. ..• --_;_· .. _--?.:,._· . : .. ,:.t .. ."-J· ,·. . . ~: ~-: .~_·.;_•. . /-:;--::_-;._;".<.~_:.:'!. :~;::::.-·~-·,., ·:--·.
_'i..
. . ·,\":, -~·•'·
'
I
I DAL\ e.CP•l sscc·c E?A-.:i.\O-?.C~. l'J
.i l'f:STI : lrES/i'CB' S·. ,\!;Q OTtlt::!t CHLa:n:t\n:o co:·!.POU::os Ath!.!ns, _CA 4/80
I
i'iW..1 E.CT __ K_o.;.p.;.p_e_r_s_c_o_. _,_I,'-.'c_. _____ Cll!:.:.:H~T E. w. Loy, Jr. REC'D. 9-25-80
@ 0800 CITY: Moni:willc
SL\TE: t'forth C:irolin.'.l
S,\D NO.
I
SOURCE & STATION
I
,. cm1P0UND
S9.
90. die:ldrin '?:./ I 39404
91.
soc 2!i63
KL-001 upper
end of lake
near Willows,
Adj. to Ddt.
Cat Fish.
KL-001 u_pper
end of lake
near Willo1.·s,
Adj. to Delt.
Cat Fish Liver
9-23-80@ 1000 9-23-80@ 1000
t:oncentra-
tion mg/kg
0.2U
0.02U
Concentra-
tion ·mg/kg
0.05U
0.031'
chlordane (tech. lilixture &
roetaUolitcs) '?J I 34682 0.2U 0.SU
92.
Concentc.\-
tion
CC:-U'L' D. 11-5-80
Conccntra-
tio:1 mg/k
93.
4 1 4'-DDT (n u'-DDT'17 39302 O.01.U O.lU
4 . 4 ' -on:: (µ , p ' -nnE '~ "-:c':---~3c:9'.c3c:2'-'2'--l----'o'-'.c.'-o'!.!JUc__.1,-_....;;o..:·c;1~u ___ .1,-_.:_ ______ ._ ____ _
4 ,/1' -nrm ( !) • p '-ToS)l:;.., ',---'!3-'-S"'3~1,,2_l-__ o~. o:<,·;,.1.te_.1'_--1---;";.: ··c;l;;Ua,--+--------IL-----94.
95. a-endoJulfan-.:\lohIT/ 34365 o.o~u u.u3U
96. b-endosulfan-Beta 7I 34360 0.0ll1 • U.lU
97. endosulfan sulfate.'!/ 34355 0.0lU U,L.U
98. endrin ~/ I 34'635 0.04U 0.061.i
99. end"tin aldchvde U! 34J70 0.0lU 0.2U
100. ,,_,___,h,:ec,P:,ctachlor f./ ·v·687 O.OlU O.OSU
hcptachlor e2oxide· "/;I· 346S6 0.2U 0.0SU 101.
102.
103.
104.
105.
106.
107.
103.
109.
110.
111.
112.
113.
a-M!C-Alnha / I .:l:JU14 0.0lU 0.05U
· ·b-BHC-Bet;;, '!:_I I 34258 0.0!U 0.05U
y....:U:-!C-(lind.:i.ne)-C:lr.u:ia ?.I 39785 O.OlU O.OSU
A BHC-Delta M J ➔:!b----r 0.0lU 0.05U
l'CB-12112 (Aroclor
i'CC-1254 (Aroclor
PCB-1221 (Aroclor
PCC-1232 (Aroclor
PCB-1248 (Aroclor
PCB-1260 (Aroclor
PCB-1016 (Aroclor
Toxaohcne 2/
'1254)Ll3!.(,90 0.lU lU
·122l)L., <!.6(,t, O.SU O.SU
1232)f./ Jl:.t',67 o.su o.su
121.s)U 34669 o.su o .. su
I2n0)li 3!,670· 0.lU lU
·1016)f/ 3467t, 0.SU 0.5U
I 34691 0.lU lU
Pron.3.clor (Ramrod)! NA NA
Pro~eton I NA NA
2 4-D 1 39734 t-A NA
Silvex 1 NA NA
2'4 5-T , NA NA
01_,2"'9~---'2"--'3"-'7-'-"8'---'T"e-"t"-r"'a';c~h~lo"-'-io""d~i "re"'n"'z"'o"'-~=-1--.--=-::-=-----+---=-=----+-----::-::_ ___ -+--------
. n-dio:..:in fTCDri' 21. 34679 N.-\ NA NA "'A
····· I
. I :
I . -
' :
I
I
I
'
------'----...;------+-------t---~~--+-------1--1------' I ----------'-------+-------!------+-----·----+-----I
I
--------'------'------'-------'------'-----
NA -Not An~lyzed. I
J -Estic.::-tcd v.,luc. .
K -Actual ·valu.::! is knovn to be less thnn vaiuc r,iven.
'L.-·Actual value 'is kno\.m t.o bc·&rcatcr than v."1.luc given:.
U -:-.M.Jtcri.:ll wn~ ..:n;iy:•:'cd for but not: Jc:.ccted. The nur~bcr
·:·!/.:.:fell tat iv~ 'fd~~ti fie~ tion.
2/ _ ·o~ r;i:mc 1.·fi.,t of Prl~rity l'ollut:111t·a.. . I
-----------~
is the }lin1mum D1.:t~ctio~ Li::tiC~ ~ '.
----.
:'.?.\-3,\U-?.(,:,;. 1~1
Attu:ns, G,\ 4/8,J
i'l-1O.JECT Koo;>ers Co .• Inc.
crn·: HorrisvillC
C!!E:-tIST. L t.'. 1.ov Jr. 1:::c·n. 9-25-80 CO'.-!PL'O. 11-5-80
STATE: t-:ortb C<n6lil'3. ====~~;=====,======,======,======,===-= I -
SAU r:o. soc 2-'d.i(,
f'L-002 Pond
behind Medlin
SOURCE E. STATION horr.c.
Bass
DATE/Tl}1E
S°" 2.'.66
r-oo, Pond
ehind Nc.dlin
hone.
Bess liver.
soc 2~§~
pL-002 Pond
behird :Medlin
home.
Blue gill.
pL-002 Pood
behind }:cdlir
home
Blue gill U·.
9-23-80 G 1115 9-23-80 @ 1115 9-23-80 @ 1115 l-23-80 Q 111:
cmlPOUND Conci:ntr.:i.-Ce,ncentr:a-Conccatr.1-C,:-n<:;entra-
tion r.:~.ft:g tion r.ig/kg tion ng/i~& t.ion rr,g/kg
89. al<lrin 2/ 1 34680 0 .03U n "' 0.03t; O.lU
90. dielc!r:in ~/ I 394U11 O.Oll! I"\ , '! O.OlU O.J.U
91. chlordan~ (ccch. _mixture &
6.;?tabolites) U I 34682 0.03U n , " 0.03U O.lU
92.. 4,!,'-DDT (o,n'-DDT).9 39302 O.OlU 0.03U U.OlU 0.03l'"
O.OlU 0.03U O.Oll; 0.0Jl!
0. 01 i.i 0.03U 0.0lU O.OJU
95. a-cndosulfan-Aloha f/ 34365 O.OlU O.lU O.OlU O.lli
96. b-endosulfan-Beta 'l,./ 3!+360 O.OlU 0.03U O.Olt.: 0.03!)
97. endn;:;ulfan sulfate i!,_/ 34355
~9°"3~.--e~.,~,d,'r~:i.·n V 34685 O.Oll: 0.03U O.OlU 0.03U
0.02t: o. 21.! a.on; 0.2ll
99. ern.lrin aldehvde U I J!,370 O.OlU 0.03U O.OlU 0.03U
100. l1eptachlor 2/ I J11t)87 O.OOJU O.OlU 0.003t: O.OlU
101. hcptachlor epoxide I~/· 3tiUS6
102 •. a-BHC-Aloha "L/ I .:.::iu,i+
O.OJU O.lU 0.0JU O. lU
0.0030 O.OlU 0.00JU 0.0JU
103. · ·b-BHC-Bct::: 2/ I Jt1258 0.003U O.OlU 0. 003L: 0. {tJU
104. y.-BHC-(lin<lane)-C:?r.lma 2/ 3978~ 0.003U U.lllU 0.0030 ---o.01u--
10S. t;-BHC-Dc.lta Z.I I j4Ztu
107. l'CC-1254 (Aroclor 125l1)V 1t,690
0.003ll OJl.l,lJ 0.003ti 0.(_llL __
0.21: 0. 21.I 0'2U 0.'i~; __
O.lU 0.3U O.lU 0. :;c:
108. PCB-1221 (Aroclor 1221).f, 1t,r-,r-,:, 0. 2U 0. 2U 0.2U 0.2U
109. PCB-1232 (Arnclor 1232)J/ 346~7 0.2U 0. 2U 0; 2U o.zu
110. PCB-1248 (Aroclor 1248)f.l 34609
111. PCB-1260 (Aroclor 1260):f/ J/+670 ·
0.2U 0.2U 0.2U 0.2U
O.lU . 0.3U o.1U 0.3U
112. PCB 1016 (Ar:oclor 1016)!:, 3!,674 0.2U 0.2U 0.2U 0.21.;
113. Toxo.Dhcne V J4691 O.lU O.JU O.lU U.3LT --!'ro,..•aclor fRamt.od' i NA t--:A t,;,\ NA
Pror::cto:i. NA NA ?~,\ NA
3973!1 NA NA KA NA
Silve:-: NA NA NA NA --2 .4 S T NA NA I\.\ NA
129. 2,3,7,S-Tetrachlororllbe.nzo-
p-dioxin (TCDD) 1:.1. 346 79
-------
NA NA NA ·,;,
------------:-------+------+------+---·-·-----'------
-----------'--------1--------1--------l-------· _ _,_ ____ _
-----------:-------1------~+-------+--------l-----~-
---------~-----+------+------+---·--------1---------------~------!------+------+----·---. _ _,_ ___ _
----~-------,'-------e--------1---------1--------+------
----------------1------l--------'------'-------1 I
1,;A.-~ot An.1lyzcd.
-:1 -E:::.ti□atcd v,1luc.
K -Actual value is kn~\.'n to be. le:.::. than vaiul.! given.
L . .:.·Actunl v.:11ue 'is kncil.lfl to he r,rcar.cr: than v,1luc Given.
U -:-. Material wa~ a"n;iyicd for hut not dctcctl'<l. The nurJbcr
··-!/_: T .... ;..-t:iHv~ ·i,l~~t-ific\tion.
is the }!inir:'luC\ Dt!t.::ction Lir.1it.
\ i
I h'A.TJ::K
DATA REPORTING SHEET
PESTICIDES/PCB' S, AND OTHER CHLORINATED COXPOUNDS
EPA-SAD-RGiL IV 1
Athens, GA 4/80
Marti Sl'11 le
I Inc,
I NC
CHE.~IST_~E~._,,W~._L~o~y~.,.....J~r~---REC'O. 9/25/80
@ 0800
CDHPL' D. 10/30/80
SAD ~O. I ,...,_..,' , . .., __ ..,.,. 3n,...,4;.7 l>l\,...'7 I~<>
I KL-001-Upper PL-002 Pond PW-100, Well PW-200 Well
' End of Lake N1 .behind from Medlin @ Wilkerson
SOURCE & STATION Willows, Adj. Medlin Home Mobile Home Contracting
to Delt Company
I
DATE/Tll1£ I . 9/23/80 @ 101'. 0/23/80@ 1115 9/23/80@ 1315 9/2)/80@ 1345
I Concentra-Concentra-Concentra-Concentra-CO:-IP0UND I tion tion tion tion I ug/L ug/L ug/L ug/L
89. aldrin V i )9)30 0.0JU 0.0'U 0.0JU 0.0JU
90. dieldrin LI I 39380 o.o5u 0.05U ·o.05u o.osu
91. chlordane (tech. mixture &
metabolites) U ! 39350 0.4U n , •• 0.4" n '"
92. 4 4'-DDT 1 "'-DDT '"' 39300 . 0.lU · n •.. O.lU n. 111
93. 414'-DDE ~E2E'-DDE '"' 39320 0.lU n rn 0. lU n "'
94. 4 4'-DDD (n ~'-TDE ,, 39310 O.lU n ,.. 0.lU n rn
95. a-endosulfan-Alnha 117 34361 -;;-;;-;: __
n ""·· o. 0"'" n 0""
96. b-endosulfan-Beta Z/ 34356 n '" n o."' n ,,.
97. 'endosulfan sulfate If/ 343,1 n HT n "' 0. 111 n 1 TT
98. endrin 2/ ' 301.00 n "'
n • •• 0. 1n n rn
99. endrin aldehvde ?7 \ 34366 n ---n "T o .111 · n , ..
100. heotachlor fl I 39410 n no,. n no .. 0.0111 n ,, ..
101. hentachlor enoxide,f/ 39420 n no,. n no,. o.o>u n ""' 102. a-BHC-Alnha f7 I 39337 -nn.. n """· 0.0JU n no.1
103. ·b-BHC-Bets ~I I 39338 n no. n n>n 0.0JU n ,,.
104. ~-BHC-llindane)-Gariuna JI 39340 n nn.• n no,. 0.03U n 01n
105. l!.-BHC Delta ----,1.7 I 34259 -;; no •• n """" 0.03" n no.,
106. PCB-1242 {Aroclor 1242)1./ 39496 n "" n "' 0. JU n ,.
107. PC8-1254 (Aroclor 1254)U 39504 ... ... lU rn
108. PCB-1221 (Aroclor 1221J,1 39488 . n ---n "' 0 • "" n n,.
109. PCB-1232 I Aroclor 12)2)P 39492 n "'I n "T 0. n ,.
110. PCB-1248 (Aroclor 1248)J/ 39500 n "-• n "' · 0. JU n '" 111. PCB-1260 <Aroclor 1260)2/ 39508 ·--"' lU ,,.
112. PCB-1016 (Aroclor 1016fI7 34671 n --n -·· 0 n,. n ""·
113. Toxanhene "l:./ I 39400 . .. ... 111 111
Pronaclor <Ramrod' 1 77729 -·· ... NA ...
Prometon I -;;;-,,-\Y'· --· -,· "A ..
2 4-D ! ... --· ...
Sil vex I ,0750 .. ,. ... "' ...
2 4 5-T I ..,,,..,4n -·· ... N' ..
129. 2 3 7 8-Tetrachlor6dibenzo---------n-dioxin fTCDD) .1:.1 34675 NA NA NA "'
I
' I
I
I
I
I
I
:
' .
' I
I
I
I
. I
I
NA -Not a~alyzed.
J -Estimated value.
' Actual value is kno'Jll to be less than value given. K -
L -u -l/_
Z/_
Actual value is kno~ to be greater than value given.
Material was analyzed for but not Jetected. The number
Tentative identificdtion.
is the Minimum Detection Limit.
On NRDC List of Pricirity Pollutants.
I
•
\
I
.[ -·\ l~A'J'C:H.
, DATA REPORTING SHEET
PESTICIDES/PCB' S, A,.'-l'D OTHER CHLORINATED COMPOUNDS I .
PRO.J ECT_,,_Ko,cpeJpe,ee,r_ssc..sC,co". L' -'Is.cn!Sc~. ____ _;CHEMIST E, W. Loy I Jr. REC' D. 9 / 25 / 80
-~Mu0Lrt~Jusuv~1~1~1~e._.N~•c~I_____ @ 0800
EPA-SAD-RGN. IV
Athens, GA 4/80
COMPL'D, 10/30/80
SAD NO. 80C2470 80C24 71 80C2472 80C2473
2
KR-004 East KW-010 Main
Ditch Runoff Office Well,
fr. under RR Faucet in
KW-Q2 Well, K\,/-030 Steel
Main Laminati1 g Shop
SOURCE & STATION Bldg. Kitchen
Tracks Kitchen Faucet
OATE/TH-1.E , 9/23/80 @ 1715 .9/23/80 @ 1615 9/23/80 @ 1545 9/23/80 @ 1500
89.
90.
91.
92.
93.
94.
95.
96.
97.
98.
99.
100.
101.
102.
103.
104.
105.
106.
107.
108.
109.
110,
111.
112.
129.
coaPOUND
aldrin Z/ 39330
dieldrin !:.I 39380
chlordane (tech. mixture &
metabolites) 'l./ I 39350
Concentra-
tion ug/L
0.03U
o.osu
0.4U
Concentra-
tion ug/L
0.02U
0.06U
o.su
Concentra-
tion ug/L
0.03U
o.osu
0.4U
Concentra-
tion ug/L
0.02U
0.06U
o.su
4.4 1-DDT ("'.n'-DDT).f/ 39300 ·o.lU 0.lU O.lU 0.lU
4 1 4 ' -DOE ( p Ip ' -oo~,.' 2_n'. '---"-39"3""2"0'-+ __ o=. 1.,u'---+--"O"-. "'lU"---+---'o"'"l"U'---+--"o". l""'---4 4'-000 (n n'-TOE)7T 39310 O.lU O.lU O.lU O.lU
a-endosulfan-Aloha M 34361 O. OSU 0. 06U 0. OSU O. 06U
b-endosulfan-Beta 'U 34356 0.10 O.lU O.lU O.lU
endosulfan sulfate f.1 343~1 O.lU O.lU O.lU O.lU
endrin?J I 3a'.loo 0.lU 0.lU 0.lU 0.lU
endrin aldeh\·de ft ! 34366 O.lU O.lU O.lU O.lU
hentachlor 2/ 39410 0.03U 0.02U 0.03U 0.02U
hentachlor enoxide P 39420 0.03U 0.02U 0.03U 0.02U
a-BHC Alnha "!:_I I 39337 0.20 0.02U 0.03U 0.02U
b-8HC-Beta '!) 39338 0. 2U 0. 02U 0,03U O. SU
v-BHC-(lindane)-Gamina f/ 39340 0.2U 0.02U 0.03U 0.02U
ll.-BHC-Delta LI I 34259 0.2U 0.02U 0.03U 0.02U
PCB-1242 (Aroclor 1242)6.t 39496 0.3U 0.4U 0.JU 0.4U
PCB-1254 (Aroclor 1254}f/ 39504 1U 2U lU 2U
PCB-1221 (Aroclor 1221)fi 39488 0.3U 0.4U 0.3U 0.4U
PCB-1232 (Aroclor 1232)f/ 39492 0.3U 0.4U 0.3U 0.4U
PCB-1248 (Aroclor 1248)f/ 39500 0.3U 0,4U 0.3U 0.4U
PCB-1260 (Aroclor 1260):il 39508 1U 2U 1U 2U
PCB 1016 (Aroclor 1016)9 34671 0.1.u 0.4U 0.3U 0.4U
Toxcrnhene 'l,./ 1 30400 lU 2U lU 2U
Prooaclor fRamroifi I 77729 NA NA NA NA
Proceton I •rnou NA NA NA NA
2 4-D I ':107"'n NA NA UA NA
Sil vex I ""760 NA NA NA NA
2 4 ~-T I ~ n ... NA NA NA
2 3 7 8-Tetrachlorodibenzo
n dioxin fTCDD'l .f.l 34675 NA NA NA .,.
NA-Not analyzed
J -Estimated value. I
K -Actual value is known to be less than value given.
L -Actual value is knmm to be greater than value given.
U. -Material was analyzed! for but no~ Jetected •. The number
1/_ Tentative identification.
Z/_ On NRDC List of Priority Pollutants.
I
is the Minimum Detection Limit.
•· ·.-:.. . ~--<·• .... .,
. .. -... ~ .. · ..... ' ~~··=--.,. -~ .:-.·~-~--./ . .:..,,,·,
>,'ATt:K
DATA REPORTI~;G SHEET
PESTICIDES/PCB'S, AND OTHER CHLORINATED COMPOUNDS I ' PRciJECT_.,..!:KeoOo,P:,P_se.,_r_,,s__:,:C,:o:... ,._, ~I°'n°'c~.'-----C,HEMIST E. W. Loy 1 Jr. REC' n9/25/80
@ 0800 ' Morrisville NC
SAD NO. I 80C24 74
PW-300 Fauce
SOURCE & STATION beside
Le...,is
Baerbee
Re~idence
DATE/TU!E ' .
I 9/23/80@ 1420
EPA-SAD-RGN. IV J
Ac.hens, GA 4/80
COMPL'D. 10/30/80
CO:-lPOUND I
Concenc.ra-Concentra-Concentra-Concentra-
tion ug/L tion
89. ald rin 2./ ' 39330 0.03U ' 90. dieldrin "I,./ 39 '"" 0.05U
91. chlordane (tech. mi.xc.ure & 0.4U
metabolites) Z/ , 39350
92. 4 4'-DDT (n.o'-DDT)M 39300 O.lU
93. 4,4'-DDE <e,e'-DDE'2/ 39320 0.lU
94. 4 4'-DDD (n-ri'-TDE)"°V 39310 0.lU
95. a-endosulfan-Alnha £1 34361 0.05U
96. b-endosulfan-Beta fl '4356 0.lU
97. endosulfan sulfate: 'l:./ '4'51 0. lU
98. endrin '[/ -;;;;,no O. lU
99. endrin aldeh,·dc 211 34366 0.lU
100. hentachlor t.J I 39410 0.03U
101. henc.achlor enoxide1---z7 39420 0.03U
102. a-BHC-Aloha ?:_I 39337 0.2U
103. · ·b-BHC-Bet.s. ~/ I 39338 0.2U
104. v-BHC-(lindane)-Gamma t:_J 39340 0.2U
105. 6-BHC-Delta u I 34259 0. 2U
106. PCB-1242 (Aroclor 1242)LI 39496 0.3U
107. PCB-1254 (Aroc.lor 1254)21 39504 lU
108. PCB-1221 (Aroclor 1221@ 39488 0.3U
109. PCB-1232 (Aroclor 1232)f/ 39492 0.3U
110. PCB-1248 (Aroclor 1248),1/ 39500 0. 3U
111. PCB-1260 (Aroc.lor 126Q)LI 39508 lU
112. PCB-1016 (Aroclor 1Ql6}el 34671 0.3U
113. Toxaohene L.J I '>"400 lU
Pronaclor 'Ramrod' 1 77729 NA
Prometon ' QS/, NA
2 4-D I "07"" NA
Silvex I -:t0760 NA
2 4 '-T I 4n NA
129. 2 3.7.8-TetrachlorOdi~enzo---. n-dioxin ITCDD' ~I. 34675 NA
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I
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J -Estimated value.
NA-Not analyzed. I
K -Acc.ual value is known to be less than value given.
L -Actual value is knoJn c.o be greater than value given.
U -Material was analyzJd for but not Jetected. The number
l/_ Tentative identificdtion. · 2/ I ·-On NRDC List of Priority Pollutants.
I
ug/L tion ug/L tion ug/L
----
NA NA ...
is the Minimum-Detection Limit.
I 1 SEDIMENT i ~1:;~-,\. :~t::;':);:'; r:;~; S!i~::·l ~P.\-S:,D-i',C::. L ·,-
PESTICIDES/l'Ct' S, AND OTHER Cl!LORI~lA'fED coa.POUNDS Athens. CA 4/80
Pl~OJECT Koppers CnmoanJ ·1oc Cll..E,.'IIST E. w. Loy, Jr. .REC'D. 9/25/80 CO~.PL'o.10/3.0/80
Morrisville, NG @ 0800 RESULTS ON. DRY WEICHT bASIS I
SAD NO. i
.. r SOURCE & STATION
.. .
' . . ...
:1. . . , ..
DATE/Tl::1.E I
.. CO~tPOUND I
89. aldrir-•. ZI I 39333
90. · dieldrin f./ : 39383
91. chlotdane.(cech. mixture &
metnbolit:es) 1./ I 39351
92. · 4!4'-DDT (eze'-DDT)::1 39301
93. 414'-nnE <2.e'-nnr;1V 39321
94. 4.4'-DDD (o,o'-TDE)~I 39311
95. a-endosulfan-Alpha·f/ 3lf364
96. b-endosulfan-Beta i, 34359
97. endos~lfan sulfate·£/ 34354
98. enC.rin !:.1 ' 3939'
99. emlrin aldehvde 7..7 1 34369
100. heotac.hlor f./ I 39413
101. · hept.:::c.hlor epoxide !:.t · 39423
102. a-BHC-Aloha Z/ 39076
103. · ·b-BHC-Bet<l 2_/ : 34257
104 •. y.-BHC-(lindari.e )-Garrizr.a !:I 39343 ·
105. 6-P.!'1.C-Delta 2.t ' 34262
106. PCD 12l,Z (Aroclor 1242)M 39499
107. PCTI-1254 (·Aroclor 125l1)f/ 39507
J 03. PCB-1221 (Aroclor 1221)0 39!>91
109. PCB-1232 (Aroclor H32)e' 39495
_110. PCB-1248 (Aroclor 121,s),U 39503
111. PCB-1260 (Aroclor 1260)6' 39511
112. PCB-1016 (Aroclor 1016),, 39514
_!13. Toxaohene V · I 3%03
2,4-D 39731
· Silvex I . 39761
2.4.5-T. I 19141
Pronachlor fRamrod'I 66672*
·Prometon ·,. 660 /T;,,
1,2 2,31 71 8-Tetrachlorodib~nzo-
n-dioxin (TCDD) I Z/ 34678
I
I
' . . . ' I
I
. I
I
I
:
I. ,· •. . I
I
' -1 ..
I .
NA.~ Not. analyzed, .
J ·-Estimated value. .
K ~ Actual ·value i~ knowri to he less
• L·:.. 'Actu.Jl value is knm.~ · to be ere.,.
U ·.:. Mat~ri.'11 \.l','1S analyzed for but no d !/: .. : T'C:nt.."'ll"iv.-.. f,lanH,f'-t,.-.t.,-,....,'
80C24'2 °""'4' e
KL-001 Upper PL-Q02 -Pond
End of Lake nr behind
Willows, adj. Medlin
to Delt
•.
9/23iso@ 1015 9/23/80@ 1115
Concentra-Concentra-
tion ug/kg tion ug/kg
l00U 1oou.
40U 6U
70U ,uu
20U 20U .. zuu .. " WU
LUU 20U . , ..
2n". """
20U ·--·
40U 1Qn
20U 20U
lO0U l00U
1oou .. l00U
lO0U lOOU ..
l00U l00U
lO0U l00U
l00U l00U
600U nu0U
l00U l00U
600U 600U
u .600U
ouuu 600U
1oou l00U
600U 600U
l00U l00U
NA NA
NA NA
. NA NA
NA -NA
·. NA NA
--... NA
.
.. ;
th::m value. ei~en.
80C2469
KR-003 downstr
from Area'.
Disced_ and
Sown with
Grass··
9/23/8_0 @ 1700
Concentra-
tion ug/kg
sou
7U
40U
20U
20U
20U
7U
2ou·
20U
7U
20U
sou
u
sou
BOU
BOU
BOU
1.ooou
70U
1,000U·
1 nnn ..
1 "Qnn
7Qn
1 ooou
70U
NA
NA
NA
NA
NA
NA
. .
Concentra-
cion ug/kg
,,.
NA
....
-
·;•:_:·\~\(':_::·
.··i({_:_:.·_ er th;in w1lue given.
.Jc.tcctcd. The nur.1hcr is the Nini::wm Detection Limit.·>'.·.·· : ·> ~· , -.;_ ·.\ .-. ·~·:·
4
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1 ·
I APPENDIX B
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u.s_, E,.-ONMENtAL PROTEcr1c4'AGENCY . I .
SURVEILLANCE :AND ANALYSIS DIVISION
REGION = ATHENS ,GEORGIA "'------------------..l.,--...---------------....:.:.:..:.;.;:.::::.:.:.=~
DI SC HARGER --P-'.J.µJ:LL..::i._.Lc!L...,__-,J~~--_.:_--J
.A DD RESS _ __.l..!..ll,:..r....,.J..Ull.Ll.L....A"'-""-"-------'--'
SAMPLING STATION NO. ki..-06 I ·
SAMPLING LOCATION _Co.c=L...:..1...i.....w...i.....:_:wr.. __ _
SAMPLE
SAMPLER
FLOW
,"' f , .. ._1
I
SAMPLE AND WASTE FLOW INFORMATION
0 MUN. 0 IND. 0 INF. 0 EFF. 0 -'---□---HR. COMP. AT_~MIN. ll<JERVALS O FLOW PRO. □ EPA □ D1scHARGER □ MAN. □ ~uro. □ TYPE ivq-kv d-~e4,111/1';f:. ,:,..).,,.,'-f1'Ll
I
DEPA D DISCHARGER O AVG. D INST.DEST. D EQUIP----------
' COMPUTED FROM ,
I SAMPLE COLLECTION
COMPOSITE GRAfl SAMPLES ,/ I SAMPLE cont'.Lf"""'"
TIME / . lt}I.J /~I., /c"<J.(' ! CYANIDE 2
SEALED BY (5; ... , v~ii, ..J-<.-=-i .... ,1,(;A,(.t.t.4 iJd.-' A
L!. Use Avg. Flow for Composites and Inst. Flow for Grabs I ~ Circle or lnd1cote Anolvsis and F.nter ~h1rnericol Code
SAMPLE CUSTODY '.AND SHIPPING INFORMATION
SAMPLES RELEASED TO (SIG) OR SHIPPED VIA DAT6 TIME NO .. CONT. NO CART. RECEIPT NO.
-/___ -,14,• /-L--::-l,>-7, ;'Jj ,·~-~.f./.1) /)_,.:,.,,,,.-,,,, JJ.:.
7 , / f
' I
' REMARKS AND SKETCHES
11
I ' U.S. E~IRONME\IJTAL PROTECTl1 AGENCY
suWE"JLLAMCE AND tl.NALYSI IVISION
I _R_EG_1_o_N_nz: _______________ .,:.' _ ~ ATHENS ,GEORGI I
• DISCHARGER kc,p-P?:r{, Co, k',\JC---'-1 ---!I SAMPLING STATION No. -I.~ O..Q.1--·-~-
ADDREss M~YYl~I )kl hl-C.., I I SAMPLING LOCATION H'fh (c i/,y·frd
-----.,--.----~---,-------'-----+--k_o -'.I'.\ ?, C\CV-f (,tfce ('(,/ (N:l,1 /_,c,',s;:4,,,rc.<,4-J __ _
CONTACT Pc;, r .St~"tk I et--)\,~'y, f'vo.p..ei1:1 /,,U'.l;t;::v r l --------------' SAMPLE AND 1WASTE FLOW INFORMATION
I
SAMPLE
SAMPLER
FLOW
D MUN. □ IND. □ INF. D EFF. □. ___ O, ___ HR, c9MP. AT_-,-MIN. INT~RVALS D FLOW PR1
0 EPA O DI SCH ARGE k □ MAN. \J AUTO. 0 TYPE _ _,Af±_CK...,___,_C_,,,al-ll4',j,.;" l\:.,..:.f-_.,.C.,edf',~'-"'-S.::,5 ____ · __ _
DEPA D DISCHARGER □ AVG. D INST.DEST. D -----EOUIP----------
COMPUTEO FROM I
S/.H'1PLE COLLECTION -------------.,.... ....... ---....:.' ---,,.,,,..,-_,.....,,.,,.,.,..,,...=-------~.,..,... cm~ POSITE GRAB S.l\MPLES I SAl'\PU': COD,: l3.
TIME /' /OC() I CYANIDE
FLOW ( I L!. I ·UFTAI S
SAMPLE CODE "r,'j.l.,A,c.} I
SAMPLED BY (Sia) ~m· -f!\~ •-----Jf---·---r---,----ll,--..._ ______ _
_ SEALED BY fSinl. '-'" -ov--I
DATE· AND TIIAE 'l·?.J ·'S':...L°(g,·_ ..,_ __ _,_ I PRcSER'IFO ·
Ll Use Avq. Flow for Composites ond Inst. F·lo•;,.. for Grabs Ll c,';,cle or lnd1cote Anolys,s ond E'nter Nur.,,!ricol Code
' SAMPLE CUSTODY AND SHIPPING INFORMATION ' SAMPLES RELEASED TO ( SIC: l OR SHIPPED VIA MTE, TIME NO. CONT. NO CART. RECEIPT NO.
r -?.;; , ..,, /,,::;?., ,,,,..:::::i...., .. .,., .. 1U/A>-~J ...t)_x-00 J /:. ';I /
'
I REMARKS AND.SKETCHES . I
C°'-4U--hJ pe,rs~er ~ N,c, UJ11/cl/,f;.-~,,rfM,1.-,,d-
,
I U.S. E~RONMENTAL PROTECTION AGEl'JCY
SUR-LLANCE ;AND ANALYS1s 9'1s10N
REGION Ill::: I ATHENS ,GEORGIA
s AM Pu NG STAT 10 N No. -'-P-"L-'---,-'-o..,_o'-1-.:..,---c------
s AMP LING LOCATION _,_p"--., "'-'-d=---..,.b"'-'-'h""'""'"'""c-1~.----
,-J • . 'Z 'l sib Med l, ,-} he
CONTACT _____________ _!..I.:...--: LLl::\:tRV ~-j 5'rcl1 WI-" r-
SAMPLE AND WASTE FLOW INFORMATION
i
SAMPLE
SAMPLER
FLOW
0 MUN. 0 IND. 0 INF. 0 EFF. 0 I □---HR.COMP. AT __ MIN. INTERVALS O FLOW PRO.
□ EPA D DISCHARGER D MAN. □IAuTO. D TYPE __________________ _
I 0 EPA O DISCHARGER O AVG-□,INST. 0 EST. 0 -~---EOUIP----------
COMPUTED FROM
I SAMP1LE COLLECTION
FLOW 1 l l!. METALS 3
SAMPLE CODE
. SAMPLED BY (Sia)
SEALED BY ISin\
DATE AND TIME • I PRF.S!::RVFO p
J..!. use Avg. Flow for Composites and Inst. Flow for Grabs L! Circle or Indicate Analysis and EntP,r f'-!wrnericol Code
. . ' SAMPLE CUSTODY1 AND SHIPPING INFORMATION
SAMPLES RELEASED TO ( SI.G..LOR SHIPPED VIA DATE, . T!ME NO. CONT. NO CART. RECEIPT NO.
... ,;_~-/_:.'.:';,: . ./..-:,~.--, ..-;~, //.7 • <"//.2 5 I.VI: ,:?!/(;p .u.
7 /, I
I
I
REMARKS AND SKETCHES
REGION =
U.S. ENVIRONME~TAL PROTECT!~ AGENCY
SU.ILLANCE AND ANALYSI-VISION
l I ATHENS ,GEORGI_A
DISCHARGER P-rivote LAK€ I SAMPLING
ADD RE s s nw:> • J/""o"'b..cr:£,__..,_n,_, LJ...l.c~ ..... I ,.,/ i3.:._ ___ _..,__ __ -I s AM p LING
STATION NO. PL--0 07--
LOCATION Po,-..,J bc-6, VI~
f,f.v (~,,x 11 1}14y.r15\/1II~ /J,c! 600,;_s,.
SAMPLE
SAMPLER
FLOW
SAO NO.
DATE
TIME
SAMPLE AND WASTE FLOW INFORMATION '.
I
D MUN. D INO. D INF. □ EFF. □ I O, ___ HR. COMP. AT __ MIN. INTERVALS □ FLOW ?RO
□ EPA □ DISCHARGER □ MAN. d AUTO. D TYPE------------------
□ EPA O OISCHARGER O AVG. 0 INST. 0 EST. 0 -----EQUIP----------
1 COMPUTED FROM ______ __,1 _______________________ _
' SAii1PLE COLLECTION . '
/ IJJ,r-1 I CYMilDE. 2
FLOW ( ) L!. ~-~"TAI ~ >
. "SAMPLE CODE A~~~c 9
SAMPLED BY (Sis) ff./1.,/\lcin I I A
SEALED BY r Sia l -r E 8
~D~A~T~E~A~N~D:a-!T~IM~E--1------,--,1-----.,.....-.._l. __ ,,_,,.,.....,____,-,----:~--:,---,.-----~f.t~i~cRV~~----..:.
ll U;,e Av9. Flow for Comoosites and Inst. Flow for Grabs _ l.3-Circle er lnd,cnt:? Analysis o'ld En1f'r N1r.: ~~ico! Cod~
SAMPLE CUSTODY! AND SHIPPING INFORMATION
·SAMPLES RELEASED TO (SIG) OR SHIPPED VIA DATE, TIME NO. CONT.
··-L~/_;, '"~_..,-----~ /?, C'"..rl_.l ~-✓ I"/ /!p E)t> J
/ -✓ I-.,
I
I . ..__---.----_n_E..MABK§ AND SKETCHES
li'obde I._........,__
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NO CART. RECEIPT NO.
I U.S. ~IRONME1
1NTAL PROTECT~ AGENCY
suWEILLANCE AND ANALYSl~llVISION
REGION = I
ATHENS ,GEORG ii
SAMPLING
SAMPLE AND ' . WASTE FLOW INFORMATION ' .
SAMPLE
SAMPLER
FLOW
□ MUN. □IND.□ INF.□ EFF. □'I---□---HR. COMP. AT __ MIN. INTERVALS □ FLOW PR! 0 EPA O DISCHARGER O MAN. □ AUTO. 0 TYPE---------------"-~--' 0 EPA O DISCHARGER O AVG. Q INST. 0 EST. 0 -----· EQUIP----------
COMPUTED FROM [.
SAMPLE COLLECTION ' COMPOSITE GRAB SAMPLES SAMPLF C06t 13
~DA::_T!_!E,.._ ____ ~ __ _,l:,---+-'·'I:+/-"-7 •• "-.",'-,/'-'5("',ll"-" .,..' +--'----+-----+----~--r110 cop JOt; TIME /. /7= '.CYf,.NIDE FLOW I l I!. · MFTAI S .
. SAMPLE CODE O""-::,. ,r < •
SAMPLED BY (Sio) . '· '-'1--";,-../ '.
L!. Use Avg. Flow for Composites arid Inst. Flow for Grabs L! Circle. or Indicate Anal ..... sis and EntP.r Nur.ierict'J/ Cod~
SAMPLE CUSTODY[ AND SHIPPING INFORMATION
SAMPLES RELEASED TO (S_lG) OR SHIPPED VIA QATE, TIME NO. CONT,
• .//~.,..,,.,~ •/:j;.. /-:7-/~....-i.-----~ , .,.;,-:>, ,;;:/~ -~/.Ji} /2-f~oo I / / 1/
' I
I.
I REMARKS AND SKETCHES O\.R' (\,, 1
9/;T o { lvc,.y
.:5frC1.'1ec/ f,-r . '1 I._ U, M . ...---~~ Y ~ l,v J 9 <.., 1,~--..c.---
1
NO CART.
0
RECEIPT· NO.
f
J
; :,
U.S. ENVIRONMENTAL PROTECTION AGENCY
Sl&!EILLANtE AND ANALY.DIVISION
REGION IlZ: •· I -ATHENS ,GEOR<
CONTACT ______ ~------;-----r-----------------u __
' SAMPLE ANDI WASTE FLOW INFORMATION
' SAMPLE
SAMPLER
FLOW
0 MUN. 0 IND. 0 _INF. 0 EFF. rp ___ □---HR. COMP. AT __ MIN. INTERVALS O FLOW P 0 EPA O DISCHARGER O MAN.,□ AUTO. 0 TYPE _________________ _ 0 EPA O DISCHARGER O AVG.\□ INST. 0 EST.□-----EOUIP----------
COMPUTED FROM
SAMPLE COLLECTION ' COMPOSITE GR.C.B SAMPLES
DATE / <fi, z t;;r1 Finn rnn TOC TIME / ''/'7/-l CYANIDE FLOW I ) L!.
METAi S
SAMPLE CODE
SAMPLED BY (Sia)
SEALED BY ( Sin 1
DATE AND TIME •i-J, :/,~{) i73, I PRESF,RVEO,,__ __ L!. use Avq. Flow. for Composite~ ond Inst. Flow for Grabs L! Circle or tr.dicat'! Analysis ond Entn Numerical Code SAMPLE CUSTOD~ AND SHIPPING INFORMATION
SAMPLES RELEASED TO (SIG),.D.!l...SHIPPED VIA
~~~ ~'"? / .. a.,v"~ _,,,,,-v--1 F f'"\ _.....,
$ ~ ~ / be s 1.!e
-C,,.--~e. ... J r_
/ ,,.
, DATE, TIME NO. CONT. NO CART.
,r/ ~ S1/.(V /:),<;-'Ct:;> ,...:_.,
/, /
I .
' '
RECEIPT NO.
I .
U.S. EWONMENTAL PROTECTl~AGENCY
suR~ILLAMCE IAND ANALYSIS Wv1s10N
REGION = I ATHENS ,GEORGIA
SAMPLING STATION NO. pvv-/00 'o Is c HAR GER -'--'--"-'-'.!.J._""""C....:....--'-'-'-'""'--'--'-'1.:..:'•\-=-0G..::., ,,_.l,.:..:.J.._1."'"l-,-'-',""<1.'-.1
ADDRESS_.....,..,~~-'--'-'--~~-----~I ------1 SAMPLING LOCATION ----------
SAMPLE AND WASTE FLOW INFORMATION ' .
SAMPLE
SAMPLER
FLOW
0 MUN. 0 IND. 0 INF. 0 EFF. 0 _I __ □--HR. COMP. AT __ MIN. INTERVALS O FLOW PRO.
0 EPA O DISCHARGER O MAN. 0 iAUTO. 0 TYPE_. ________________ _
D EPA D DISCHARGER □ AVG-□ IINST. D EST. □
COMPUTED FROM
EQUIP----------
I SAMPLE COLLECTION ' COMPOSITE GRA9 SAMPLES I s~u: CODt. LJ:c SAO NO. .__::.-"!..!!!.!....><..,"-'-".-'=--+-.. ===,,,,-=-1-=,-~~"""-:.""~'7~·-;:?':;-i. ---"'-'-"-=-,"-'-"~=---,------i, Pt..QFfdAI
D~A!_!T_!:E'------~--_L/,.....-,,----l-_::µ.ti11,;<·3L,1=1~e?d'--J-!--,-------if----,----!-----,--Lllil_ll.....G.QJ_1~T~Q-1 __ ~
TIME / . 1::: /.i" i CYA.NIDE 2
FLow·1 )I.!. ' . IMETAI'' '·
;r:.:·::.'.::,', lil!l----'-~-=--..,,,.&;;·l/ __ 1------1--~--i------1L!:~;;t "" t·
SAMPLE CODE GYt1,);,u,·~ <. ·
SAMPLED BY (Sio) C,,',/!,,/JJ};t,,, .• I
SEALED BY. (Sio) l!,h'-"'<-c.s(.(•-'<,G I.
DATE AND TIME '1-l~-)/t? lq'.lr. I I · PRESf.llVfD
L!. Use Avg. Flo"' for Co:nposites and Inst. Flow for Grabs, L_g_ Circle or tndiccte Analysis ond EntP.r N:Jrncrir.ol Cod~
SAMPLE CUSTODY !AND SHIPPING INFORMATION
SAMPLES RELEASED TO ( SIG l ,QB..._SHIPPED VIA. · D/ITE, TIME NO. CONT. NO .CART.
r-:>.· /,_-~---_;. 11.....-?.,· 01.J.SI."'' /')P'OO ~""'
/✓ / I/
I
I
' REMARKS AND SKETCHES
re ba 1-Pencl 111e-k,.., -7, o <J..-L _ -6q__f11-.,..d k £vc ;,-, f. ~
Crvi~,,-d0f 3.I'{) ~cfo-o ;u,,lc.--, /~ ~luZ::::,· _,4~--4.. ✓ ·
>,·1=(>,&;c/ T//MCJy~ P~rc_ J1tJS'C: -L<1<.{/c/,,,J 'je,_,--f ~.J,_.,y.iJ, Ct.J;//'r.X//
A;; ' /' I · rl C 5c-f"r/y /f/'-f. vJtfr"' we/I)
I ~ -I 40 'deep v.r: l I \
RECEIPT NO. ·
~7,o
</--L
9
A
q
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-
-
I
U.S. E~RONMENTAL PROTECTION AGENCY
suRW\LLANCE AND ANALYSIS.,ISiON
REGION= ATHENS ,GEORGIA
,DISCHARGER f<,,~.~,:,v<. <.O, I SAMPLING ST AT ION NO. -·~K~\,...VO....,.,,,i~0~----
1: SA.MPLING LOCATION /i,,1(11/:) oH\te /,,J(? I/ ADDRESS /\\ovv\~vr'll;, R 1 ·C, , I -t:t I r'J11--r,j .$,, ~,,, f.,-,..,,, k<,«~.-,',,
CONTACT ____________ _cl~-+--1.k~•~'r.~c~t-~,lli._ .. ____________ _
I
I SAMPLE AND WASTE FLOW INFORMATION '.
SAMPLE
SAMPLER
FLOW
D MUN. D IND. D INF. □ EFF, D .!,.I_· --□---HR.COMP. AT ___ MIN, INTERVALS D FLOW PRO.
' 0 EPA O DISCHARGER O MAN. □, AUTO. 0 TYPE __________________ _
□·EPA D DISCHARGER □ AVG-D INST.DEST. D -----EQUIP-----------
COMPUTED FROM 1
' SAMf'rLE COLLECTION
COMPOSITE I GRAB SAMPI.E.S I SAMPLi: COut. ~
SAD NO. ~[JG,,J...'f7,tl I ! RAr,TF(lllll 0
DATE I
TIME I "Ira /r I CYANIDE 2
FLOW ( l l!. I METALS 3
SAMPLE CODE 9
SAMPLED ay· (Sia) A
SEALED BY (Sia) I. B
DATE AND TIME I PREScR\'fD p
L.!. use Avg. Flow for Composites ond Inst. Flow for Grabs L~ Circle or Indicate Analysis and Ent-;r Nurr,ericol Code
' SAMPLE CUSTODY. AND SHIPPING INFORMATION '
SAMPLES RELEASED TO (SIG) OR SHIP.PED VIA DATE, itME NO. CONT. NO CART. RECEIPT NO.
.--:.,_~ -. ,• r-:~-71 ✓-~ < . .:.r-7, ~~l.:,"/'-f /) p,.r~J 3
' ✓ /1 ,
I
I
I REMARKS AND SKETCHES
w c,l /:e y
i U.S. ENVIRON MENTAL PROTECTION AGENCY
SU~ILLANci1 AND AMALYs14v1s10N
REGION TIC ! ATHENS ,GEORGIA
DISCHARGER LewiS b~Y-bie .. , Wei I i
ADDRESS R\---'v l~.11:'. /0<,• ,, r'AOoV~,iii//.p fll, c,, r ,
I
SAMPLING sTAT1ON NO. Pll\!--_3oo
SAMPLING LOCATION '("ctq<v--f /-p,£,j~ AN[(
·coNTACT ___________ . __ ·_~l---l---------------------
1 .
' SAMPLE AND WASTE FLOW INFORMATION ' '
SAMPLE
SAMPLER
FLOW
o MUN. □ IND. □ INF.□ EFF. □ I o ___ HR. coMP. AT __ MIN. INTERVALS o FLow PRo. D EPA D DISCHARGER D MAN. D :AUTO. D TYPE-------------------□ EPA O DISCHARGER O AVG, 0 INST. 0 EST. 0 -· ----EQUIP-----------1 COMPUTED FROM
' SAMP!,-E COLLECTION
COMPOSITE GR,,B SAMPLES S/\MPLJ:. C'OOE. ~ Si?..Ac:O~N!.!0._..'---__ 4 ___ ,---__ +'c:.~,Df--i'i<✓,.;::>.i-,f.,-Sl./-7,n'-•. -----+------,-----t-:';l~O.-"C.,_T~EH..c· '~A"-1 ___ _,,,_o DATE / <Jt2':fl,\r7 BQD COQ TOC I TIME / /•}20 CYANIDE. 2 FLOW { . ) L!. · METAi <; •
:i,AMPLE CODE
SAMPLED BY {Sio) /Utll..j,jtA}t/1 r i
SEALED BY !Siol
. I.ATE ANO TIME PRES!cRVcD L!. use Avg. Flow for Composites and Inst._ Flow for Grabs I_ t.l Circ;e: or Indicate Anol)!'.is and Enter Numerical Cnr1e
SAMPLE CUSTODY AND SHIPPING INFORMATION
SAMPLES RELEASED TO (SIG) OR SHIPPED VIA DATE, TIME
• ~_.,,,,,,,,,--/.;-:,, r_...:... --., : '}..-, ,
/"
Cj'/.:l,!7/,J:f/ ~,1.f."-"UC:,
/ :✓
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' REMARKS AND
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NO. CONT. NO CART.
,?
.
RECEIPT NO.
9
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p
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U.S. E~IRONME~TAL PROTECT!~ AGENCY
SU-ILLANCE AND ANALYSI-VISION ' .
REGION IJZ: I ATHENS ,GEORGIA
DISCHARGER Wi\K'e:,c,r,,.l ~-1~·q,:\w.., f,, ,! SAMPLING STATION NO. P1\J-z.ao
ADDREss_J'.,~:n{;',~5-J,;;:s t.}~1ylSll·1'1/,, /'v',r SAMPLING LOCATION f\r1v(\;h~ k.'?-dl
• _________________ , _ _.l... __ -11...u ~~~-.. .i!--"'-~-3~L~: ,.':Cl!.,CJ:,.~/~;rc...•.!:c.,,,__'.!::::..'.7, <?_'-.!t,!..<~"f!-'"·.el..!. t1f'.1;;<'-:1'" -"--·------~
I
CONTACT--------------,----+-------------------
SAMPLE AND WASTE FLOW INFORMATION
SAMPLE
SAMPLER
FLOW
0 MUN. 0 IND. 0 INF. 0 EFF. □! ___ 0, ___ HR. COMP. AT __ MIN. INTERVALS O FLOW PR<
0 EPA O DISCHARGER O MAN. G AUTO. 0 TYPE-------'------------
' D EPA D DISCHARGER D AVG. [I] INST. D EST. D -----EQUIP----------
COMPUTED FROM. ------'------------------------
SAD NO.
DATE
TIME
FLOW I I I.!.
SAMPLE CODE
SAMPLED BY (Sio)
·, SEALED BY CSinl
DATE ANO TIME
I
SAMPLE COLLECTION
COMPOSITE GRAB SAMPLES
I
I
SAMPLE CODi:. l!t
Ar,r, ron -;nr:
CYANiDE·
I METALS
L!.. Use Avg. Flow for Composites and lnsf. Flow for Grabs
~ PRl:5:;nv;::rJ,__ __ _
~-Ctrcle or lr:d1cote Analvsis ond Ent~r Nur:,~rii:ot Code
SAMPLE CUSTODY AND SHIPPING INFORMATION
'
SAMPLES. RELEASED TO ( SIG.)..O.fl SHIPPED VIA IUATE, TIME NO. "CONT. NO CART.
-::7~ ,I .!.> ~ y ,;;.z..,~~ .. /)-./,, ,,~
4-!"o
App~D'1-, ~ ff~-\--(;.>Q..\ \
Pivviuf. 5 1t¼1 • ·
T/'.)F/1.,.V C:,)~~,)0 ::...~
1/, ✓
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I
REMA~KS AND SKE:CHES / .
2,oi9-:tJ 5· J !vtd,1 fJtJ/:": ,0;tGf1'11
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I
I
RECEIPT 1,0.
•
REGION IJZ::
SAMPLE
SAMPLER
FLOW
U.S. ENVIRONMENTAL PROTECTION AGENCY
SJAVEILLANCE AND ANALY~ DIVISION .,. I .
ATHE.NS ,GEOR,
SAMPLING STATION NO. _ __J:ivo zo SAMP,LING LOCATION ":;tl ,z. {/Jc i { f) ti,1.,.,._:L,,,r,.,.,,,.;1Jaft NJ /x!Jc!; 'l 1 _,-/4,,c,, f, J
' SAMPLE AND \1~ASTE FLOW INFORMATION
I 0 MUN. 0 IND: 0 INF. 0 EFF. 0 1 □---HR. COMP. AT __ Ml N. INTERVALS O FLOW Pl 0 EPA O DISCHARGER O MAN. □\AUTO. 0 TYPE _________________ _ 0 EPA O DISCHARGER O AVG. 0 INST. 0 EST. 0 -----EOUIP----------COMPUTED FROM
' SAMP!,.E COLLECTION
COMPOSITt: l<' D {.., >W / ,, GRAB SAMPLtS SAM PU_ CODE G.
FLOW ( I I!.
Mi:Tt-.' S
SAMPLE CODE CJw-,a,...,c <' 5 I • SAMPLED BY (Sia) /4,,/l..,/'.:>tl,fJ¥. I . SEALED BY ·(Sia) •· -I
,,, L.!_ use AvQ. Flow for Comoosit~s and Inst. Frow for Grob!!> I ~ Circle or lndrcate Analvsis and Enter N::,1rnerir.1.1I Code SAMPLE CUSTODY AND SHIPPING INFORMATION ' SAMPLES RELEASED TO (SIG) OR SHIPPED VIA DAJE . TIME NO. CONT. NO CART. RECEIPT NO. ' r
REMARKS AND
0. -'\ 't'O Y I.::, ,n , h ""r-,,. 5.
SKETCHES
•
I ;
. I
U.S. E~RONMENTAL PROTECTl!iiilii ~GENCY
SU~ILLANCE A~D ANALYSIS.VISION
REGION :nz:: I ATHENS ,GEORGIA
•DISCHARGER ~kOJ.,,.,_, ;",OrlfL'\PJi''S..:::,.. _________ ~~
ADDRESS l\\:Jvfl'5\l(\le. rJ .c_,
SAMPLING
SAMPLING
STATION NO. /<h}-03()
LOCATION :fr b &.,lg sfut shcy
--'--------::--:---"'T7----------'--+---------------------
CONTACT _ _...~~'t'--"s~i~•0~lµ~¼.""'---------'--l--------------~----
I SAMPLE AND WASTE FLO\\I INFORMATION
SAMPLE
SAMPLER
FLOW
D MUN. □ IND. D INF. D EFF. D ---□---HR.COMP. AT __ MIN, INTERVALS D FLOW PRO,
□ EPA D DISCHARGER D MAN. □ AUITO. D TYPE-------------------
□ EPA O DISCHARGER O AVG, 0 IN~T-0 EST. 0 -----EOUIP-----------
COMPUTED FROM
SAMPLE COLLECTION
' COMPOSITE I GRAB SAMPLES SAMPL~ COD>
SAD NO. ~Af"TERIAI
DATE I P.oo rno Tnr
TIME I ' I.F..of'.'J CYAN1uE
FLOW I I L!. . METAL.~
N.P
ORG 1 0 SG. PC:ST I PHENOLS.
'SOLIDS
SAMPLE CODE "-~. ,c · ·I •·
SAMPLED BY (Sia)
DATE AND TIME ·. . 1•X:, ·',(o /6:J.1 PRESEP.111;0
L!. Use Avg. Flow for Composites ond.1nst. Flow for Grabs 1 11 Circle or Indicate Analysis and Enter Numericol CodP.
SAMPLE CUSTODY .11,ND SHIPPING INFORMATION
SAMPLES RELEASED TO (SIG) OR SHIPPED VIA D,ATE,· TIME NO. CONT.
~.aa· L;c £ /~~-~'?""~ ~-:>-,..·,. o .... '.s./e>: Of-0n .:.3
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' REMARKS AND SKETCHES . I,
P~'t ~~i flOIP ~~
Se-e.. \,JOd( flu." 'Mtq' for .S~£j<-ht'..S: -
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NO CART. RECEIPT NO.
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2
' 4
5
6
7
8
9
A
B
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•
STATE LABORATORY OF PUBLIC HEA,
. DIVISION OF, HEALTH SERVICE~•
. N.C. DEPARTMENT OF HUMAN RESOURCES
P.O. BOX 28047-306 N. WILMINGTON ST., RALEIGH 27611 • ' • • I • ·,·: . .. -., ...
ORGANIC CHEMICAL ANALYSES
I
PUBLIC WATER SYSTEM.
Complete All Items Above Heavy Line (See Instructions on Reverse Side)
· ~ ( 4q4) s,;a; -3.30 0.
Namoof ''. ·, · ... I 'Be,.' Fv-c.., Vi vier System: . _,..!lr~l,_:<,~-,L:. ',:.!·A= -.r:::_..:,_ <------------'---.. •, ..
.. -,
Source of Water: , _____ , ___
'-'(".) ,-:-t:;;o·~~d · :· · ::,.,-~ I I Both
I ) Surface . . I I Purchased ' ---~~-----'-..;.._ __ .:_..;:·.:_..:..._ _____ _
Source of Sample: · ...• .• · ·: "( · i Distributi;n Tap · · . '· -.. -:, _.,.
I ) House Tap
· .. , ,c· ,. I I Well Tap
Type of Sample:
'( ) Raw ·· ·· ·,· ( ) '. :Treated · ZIP
•. '' . ,, ; .. -_, : 1·., 'T ~j~ph<>no N~mbe~:.. .. --_-.,_( _._-_· _· ..,_)_~··_-_.:,. .. _·-_·_·· _·-_·-_--...;..·_· -_·· __ -_._! _· -1
Type of Treatment: .. , .. .
· · ( · ) · • None · ·· ' '::· .. .
( ) Chlorinated·
' ... ' ' '
" -· I ) Lime
( I Soda Ash !. r. --,;_ ·'i1.,:,--' --~: Collected By::..· .....!-::..::-..!·:..::.:z.=~!.-.!...!::+~-'-------~~ I ) Fluoridated I ) . Polyphosphate
7 . . . 1AM I ) ·Filtered .... ( ) Water Softene~
TTme: 3; ~ 6 liPM ( ) Alum ( ) Other
. Type of Sample: ... . •:.:, . .. I_-.i .. Regular ( ) Private .·:-:.:ft
.. I -· ) Check ( ) Special.
' WATER SYSTEM I.D. NUMBER (COPY FROM MAILING LABEL! □□-□□~□□□ ,.·::_·
State Drinking Water Parameters (Required).
. ,._, == -i .. i
.. Optional Pare"1a!ers (List a, needed)
-,' -Results
'-..
(CHLORINATED HYDROCARBONS:)
Endrin I.
mg/I s Pc fY 117. 0 7'7 1:i.7(YJ I J I Lindane mg/I 4
I Methoxuchlor rng/1 3
I Toxanhene mg/I
' mg/I
[CHLOROPHENOXYS:l
2,4-D .-
I
mg/I _;2,,4=5=T!,_P ____ j_ ____ _.:._=~...:4.,_ __ E_-----------'--'-------'--~ I . -. :-1 . . . . . ' -r.?J I ,,-. -. ' . r,,, . ; C) . /J . , __ , . 7 -~ :i__ L -_ .. ,.· .,_ , --!J ,;.-c;_ .., -.• ,, o,,te Received ___ ,.___.o;•·=--2.L-_.:._..:...::....._ Date Reported· g -...-(1 ,,-: __ Reported By·.• Z ,c--.-., ·/ 1.L-"_,__
Date Extracted.
1.-~ ,-'/ 7 -_,,.'>,;.../ -f-'D . Date Analyzed I ./-].. Lf -\,,;y Laboratory ~mber ----'---'--:_,"-.:·...:· •:...'! __ _ ./~', .;, ~·. r.J bd j.,).•~;.,..c.. .7 -1 LI_. '41 . Comments: .
'e:;HS Form 2086 7/79
/!1tioratory
l-'11--1,,'-¢" . . ·' 1' . ;-_:" I O -' ~ . . . I
I/
~-ildred A. Kerbaugh
·, ,•·,--· ... . . :--.: :'.• ~ ..
· .. ·.:.:-:_\::.-.. .. .
:.· ';•·· .. ••:.~: .... . .. -·. -·;.. 't,: ·.-~---Y·:.~?·; .·. : INSTRUCTIONS ·_,.
I • • • • . .
Using typewriter or ball point pen; fiH in all requested iriformation'on ,the top po'rtion of_ form front, 'Pleasepiint legibly if typewriter is
not available. · . . . ·. 1. • • • .•. ·, ·.-.. .. . • .•• -... , •. . • . . ... ~ ._-·-::. ......
·OBTAINING SAMPLE:.
C :_:'•.· :: C \ ,. ; •\>l ;•:< .. '·.: .} .;. '. :,. ' ' o
. I
Remove the teflon Hned. cap from the 1-gallon bottle. · :· · -: · · :' : ·. · .· :': 0:-:-: .. · ..
Run ~ater for·s min~1:es t~ assu·r~ ~a~~~ i~ fr~l· the di~~~-~t-.i~~ i~~e~·_: .. ;·7.~-------:· _..:
I ~ ·-~ -;
-· · · · . . ::-1~,-:·,--; ~.:_;, -~;:;..-.::-? . -~, -------· -------~--'--"---·-•'-. --··::l:~:.:hu.':.. '-. ; .•:\ .....
. Rinse the bottle 2 or 3 times and discard the water. . i .
. _ .. .__._ ,.. . :, !':'·.' . ' . ~·. .
:'!:,. : -~ "Afte;J{l)_sL~!i.f!lL!he_b_ottJe.~nrl.ie2i~~cap_;e:,c~iety. : .,.-.:,?.. -. · :;::;: ·--·--------·---,-.
. ··:-. . . . . :· .. f, .. ---·>•-.. ~:: )-:-, .. · . . ' . .. ·.-....... .
Place the bottle and report sheet in· the 'sty'rofoain mailerand ,ape-securely-.-.--~-----:--~----__:: :•_:.,CC':'.
:.:;::: ·:•:::-,::-: . ; . i · .. •.• ·... ,:-.. : ;',:_;;-\/--:;;.;;.; ·. 1-· ·; . .:· ·-~·.·::·< ·. ·.· ',-: .·•
.: .,•,, ·.-· .. ,,,. '' . Mail imm:~~~~l~to the State Laboratory using supplied address.label:. · · · ··· · a:·.· · -,, -~-,.::,,: ,..~,;,;:
. '· I· . :,.;:-.:,:;'!':·~G ~~~_·;..:i·.,::·. . /. . -~-:t ~ •.
... ., ... --b~:-:-.. :..-: ?'". :··\., --'--;,.,:<:f-i . ·-: -~ l ;· ·-··--------'~-·. ·, ~~:--·~\·.)fr~_1·0~-~
. LIMITS OF ALLOWABLE CONCE~~RATIONSFOffb'RtNK;iG~Voi:i.TERA~E i::,~;ED~:~LO~~/:,,.~_;, __ ',~-:-'--
Regular:
·Private:
Specizl:
: --· .• ·•.·.••.:.·,,···.· .. :' •. -· II -~~--=---....;,_--+---_-_-__ ,_. ____ _ --. -~~-·•·/_::.r-/~: ~:-:~r!-;:J:-;t""'.
Lindane
Met)'oxychlor .
Toxaphene .
. , .. ,.'i:EPA, EMSL:·ERC,
0JUL •i"1978.
.· .... · .• -.:.n.-· ...
, -~. EP_A, EMSL,'ERC;JULY 1978
-:·_,_,-,·,·r.c. .: ,·:v. 0.0002
I 0.10
,, .• :·,'·:~:• .. :· ,;:;:,_:,.::,_::i:,-,_ O'i._ .•. · ··o:oos ·-·:· •j:.,·,,, ;,::.,,, ,·;,,,;,::~::,:?\'•:,·;;'."',Ei>A;0E~.1s'L;ERC{' jut'.Y 197'a'
·•.•--; .· .. _.-:·.·-··=<•}-.''.1"• .. ; ......... ·. . . ·:·' .. -:.·._; ..
2,4-D
2,4,5-TP
J 0.10 . "'"'' . . EPA,'.EMl,L,ERC,JULY 1978
.. ___ ·.· --~:.:-------~~:. .. -j . o.01~ /-:'._~~--~----:--!-_~--~?i':~P.(EMst:; ERc;JuLv,191a
-1·-·-·· __ ... _____ __: _______ , __ .. · ... /· ··-·--.. ·:-_·. ,._._--~~-·-..
' ·· .[ .... TYPis ;OF SAMPLES .:.:C-':: ~---· · ... :<..::< :: :··,;~·:: ·
., --------
A' sample(s) submitted to meat' the. monittiring requirements of ·_the North _Carolina' Drinking
0 .Water Act,. GS. 130 :-:-:
Article 130. . ... _ ....... ... · 1 · .· .. ____ · ... . ........ · · _ _' ,.-.,:· ..
. A ::aiT,ple\:,) subm;tt~d. ~:,en o pr1?v;cu5-~~~p!a has :e~ce6J;-~ thG al:owobi?. c~ncantratic;i. ~ The cheick sample should be
taken from the same sample distribution tap as the prCVicius sample.
/ . . · ... · . . . . . . :-.. ·.. ·. •. -:
A sample(s) from a private water supply sub1mitted by a li~ensed physician, ~anitarian o·r other health d~partme-~t represen-
tative. . · . . . .. ...... : ........... I . _: ..... :. .. ...... : ... ·:· ·' -oc,, :,_ ·.: ........ • .. ·,: .. · ... .-·:.:_, · . .: .. : .... · .. : ... :.,; '. •;•; -: .. ·';
A sample(sj submitted by an engin~er .. vorJing with the State or the E.~.A'.·. ·a -sam-~le ~ak~~-b~ th~· ow:ier/op~·ra·~~r o~~a
water system for a new well, a landfill i:eSt we.II sample or other nun-categorized sample. ·· ·----· · · : ·
Name of
System:
A,ddress:
.,
_. ------.. .. -.
, •
' ' ·, . .,.. .. : . ' ..,,. t .
.•. . STATE ~BO~ATORv°OF PUBLIC HEA\oiii
DIVISION OF HEALTH SERVICES.
N.C. OEPARTM
0
ENT OF HUMAN RESOURCES
P.O. BOX 28047 -306 N. WILMINGTON ST., RALEIGH 27611 I·,·,., I· ' ....
ORGANIC CHEMICAL ANALYSES -PUBLIC WATER SYSTEM . I
~-~,,,,.,er< .
·"-/. . : /k. .· ,,.,.,r...., ~
' ZIP
I,.,,~ J. p
Complete All Items Above Heavy Line
(See Instructions on Reverse Side) I . , .. ·. I . . . .
'. ..
::·:,.-:··· : , 'i : . I: . .;, ' . ' __ .,
Source of Water:
I ' : ·, ··):.···Ground' I " ) . Surface·
I ' '
... • .. ' , . .: '"
' ' .. :.1~ ... .. "• .
" ' •, ,;·, .. ,•,:~.' ''('
" ' : ( ''
' . -
I Both
I Purchased -
County: .. .. i'
,Source of Sample: .. ,.' . ··-'. ·:·'::· .: .. ·f; :1:··: ·1 · )' , Distribution Tap ; .. :, • ··s .
J' ~· .~~---fe;~._ · ', . ·.-,· ;). •,
,'' Report To:·
,/ , .,. .
Address:. B,. t,_ · I? ;J., -/<,_; 2,~ -.
'(,',,;;;,/,/ _l/,,, c., · Iv; , f.,. ZIP
" . ' .-.. . •·. ,,
• ... ... -· ..... -.. , .. --·-·-.. -·-···· "" " ( ,) -Telephone Number.
' .0 ·,.. :'--.~ ~ ) 11,,.-r..., . ' Collected By:· I . , ,,
O;teGollected:· ;..:·2?-fo Time: "t;tJa
.
location of Sampling Point: ' '
(Address where sample was collected)
'' l,v • < ' ' /., #-cl. . _.t .. J-er ....,A;,,r-/ ._-t" · .. -·· . Remarks: ... . .' . . . . · " · . _,. /.,J ~/I ·. :· ~-·; ,: ; .. /1 e,.//.'-• /?. .,s. /,.,_, •
' '
State Drinking Water Parameters (Required)
,, :; ·. :~; , ' ',
Results.
(CHLORINATED HYDROCARBONS:)
Endrin
Lindane
'
Methoxvchlor
Toxaphene
[CHLOROPHENOXY:,:1
·, · 24-D
Date Extracted
Comments:
DHS Form 2aas 7/79
Uboratory :t
24,5-TP
.
( ) House Tap I . ,'• ' " . ". " , ' . ., <• J Well Tap '·-.;:_i ·.· ' ---· I
I Type of Sample:
.[ ( I Raw ( I Treated
_Type of Treatment:·, , . .-. : ' ' . ·:·•· .. .. ,• ·1' .. f· I·.:,, None::: .. :·: -J.'· . ' ·.·• :~ ' ., ( \j Lime ' ( ) ,.·, Chlorinated.· .. ··'.". (' ) Soda Ash I
'•
( ) Fluoridated ( I Polyphosphate
( I Filtered · I I Water Softener I~ ( I Alum ' .. ( I Other
· Type of Sample: ... -----
I ( 1. . Regular ( I Private '' '.
I ( I Check ' ( I Special
I ,_ .. WATER SYSTEM I.D. NUMBER (COPY FROM MAILING LABEL) .... "
I □□-□□-□□□ I
I Optional Parameters (List as needed) '.
. '
I Results
I · fr r--: _./ ,' D. h;0/1.-,,n mg/I 5 /
I fl mg/I 4 .
mg/I 3
I
mg/I 4
I
mg/I 3
mg/I 4 ,
.
Mildred A. Kert,,augh
Direcror · ·
' = I
~TATE LABO~. A TORY OF PUBLIC HEA'iiii.. ~-.
.., DIVISION OF HEALTH SERVICES •
· N.C. DEPARTMENT OF HUMAN RESOURCES
P.O. BOX 28047 -306 N. WILMINGTON ST., RALEIGH 27611 .
. ·' .. (., .
ORGANIC CHEMICAL AN~LYSES -P.UBLIC WATER SYSTEM·.
;
,·. I .·t· .,
.•.. i ~~-· ·. ; ·-
Both
Purchased
•:··., ,..,,.,; . ."( . .,, .•.
·:·,:c-~:>(··, ).··
House.Tap
Well Tap
Address: _.c,i1_,,uc.;1:.,i-:.,., .,..: ·_,8::.;/:..:'/7 ,'----·. ~p'-'-'-<''-'' -c......:-L::.I:...:,.? ____ +• --j
fi/,..f-J ,,i~.z'. 1.:,:~/~ . . ZIP !
•' ·---· -..... . .. ··-... . --· ....... ·.-· . .J..,;:!d.~.,:--;· -:, ... •• ::· ... ·.·.-; ,_·.[.·,
Telephone Number: ~-'-( __ _,)'---'----------l'--·--1
C<,ilect~d By: ... f; ,; ·;. r ~--1. r-?. .--; ~ , i .
6rieco!l;,,:ted:· ·;;;/:._) f~ ,f/, • ~ime: i/ :~v iJkJ
•' •'••·
Location of Sampling Point:
[Address where samphtwas collected)
1,:,:·t« ..... ,<., -/. .. 'P 3' ,.
~.~j-~~s: . -· ~ · Y: ~ "''_ _;_ ....
. f~~_-::. .)v. I k,-r-r·!,~ ---'t., C, .-I:-~~ t_~-,..;
State Drinking Water Parameters (Required)
CHLORINATED HYDROCARBONS:)
·--·· Endrin
Lindane
Methoxvchlor
Toxaohena
CHLOROPHENOXY:,:1
2,4-D
::ommP.nts:
)HS Form 2886 ·7179 ·
:?:ion tor:,
2.4.5 TP
Results
I
mg/I
I
mg/I
mg/I
' mg/I
' mg/I
I '
5
4
3
4
3
4
Type of Sample:
( ) Raw ..
· Type of Treatment:·
··(-:·) _:···None · · · ... .. ·-
I ) Chlorinated. ·,.
( I Fluoridated
( I Filtered
( I Alum , .
.,;
• Type of Sample:
( I Regular
( I O.eck •
( I
.. ·•
,!
( I . ( I
( )
, ( I
,-• ( I
( I
t.. I
Treated -:·.
,,,
Lime
Soda Ash
. Polyphosphate
Water Sofn;ner
Other
Private
. ,Special
· WATER SYSTEM 1.0. NUMBER (COPY FROM MAILING LABEL)·
□□-□□-□□□
Optional Parameters (List as needed)
(J(_ p
-
'
,
-
Results
-
-. •-
Mi!dred A. Kerbaush
Director
.; •:_,-.-' i: <' ':,._ /'i,,.,♦ .. ·. ·r· ;-;~·~2;-; ... _;,· ... .,;~,·:-:.:>~:l~.-:-,--i. :·•· ....... ~ .-~ -,:.,..,.',! :;-:: ,..,;_,:
•:-:-,-,, :_:_·_=...'.-=-.:·: ~:~:,•~---_-·::._: :·. · __ '.-_::!;~ ·-.;:! .:_ :;·
: INSTRUCTIONS
. I
Using typewriter or ball point pen; fill in all requested information on the top portion of form front; 'Please print legibly if typewriter is
not ;,vailable. _ , J . _ _ .--.<:-._
. l . . . .• !.: . : .'::;.: •· :: ,: ~ ··.:_;_,_·•.·.·.,--,'::ii.-_·. __ .. ,.·-. . -· '""lt: .::.:;:::-:.:,--: ~:--'-:1 ·
I -Remove the teflon lined cap from the 1-gallon bottle. . · , .. _ _ -._ -. .-.-.•. • -.---. - I · --------------------------:-:_7--· .. --"'.;-:-'-. --'---·.-=-""·--:•
Run water for 5 minutes to assure water is frofn the distribution system. ·---.. ·
OBTAINING SAMPLE: ..
. . -· ·.:.,•. . .. ). ,';: ----__ ._-_·c.··-...::,_:_.-__ "" r~= _Ri'!se tpe bottle 2 or 3 times and~i~~!rdthef ~ter. _ ; ---· / _ -c:•-
...c..:..c._·_·"'· · •. ·-• · After rinsing_fill the bottle_andrepJace_cap securely.· ! .,.,..-5 -_-·->. -.... <'_,_ _ __ . __ ' ,---'--~----:---.-_-:----_-__ .-__..,_--
: cs·;·:
,·_s_::-~.
.... -... I .1 -~ .:_0 · .•• _-
··.·,; ,.,
. . . ':.;.!••···~;:.: :.,.., ,, .. ~.1-_ ... --~ . . ·-. . .
Place the bottle and report sheet in the styrofoiiin mailer-and tape securely.--_ --_.-_--'--:---~----.:;__.:;__.:;__c:..:;:::.,.-.:;__ ·:·;·J~c•:· .. .. •. .) .· ,:-. . :·:;: ··.,,-,<:..':;_-·'.::!-.• •. -~: I. . . '.. '• .. . .· -< .. ·_:·.
Mail immediately to the State __ L_a_b_o_ra_t_o_ry_usi❖g_~uppli,eiaddress lab~I_--_--;--~---,--,---'---,---"-_.-_,.,c.._-'-"---'~--'".'f.::'"'-'.' _
.. ,--: \. . .. .. -:,:½~~:; r;::_·1;~-~'.l"{·T' ..• · ·1 _ _:._;_. _ _;__;_~ • .. ~: .. , ,<_ ~:·_-_·""~-~~:·~: _-___ .:~--~----~.-:~_:~_ ;:::~.~,tr ···•.•.'•;?.·. -. .
. PARAMETERS
l : .. ,s ·--. 1-0 .. ;·.··=::.~···::: -~, ·----.. ··-·
LIMITS OF ALLOWABLE·coNCENTRATIONS-FOR DRINKTN'ifwATER ARE Ds'(Ed'sE[bw:-~ . , .. J. ' ' . . . .
,s~~b:'-:1~0~/_-:i · -·:· .t·:l ·-· ·-. ·----· .. a·~---'----~---~i--.,.··:·.::_~-f~~:_(·.!::?f":s~::-
. ·:.~~:::;b!·:,.~):-i ',•_. -,
t-= ci1..:-ni::. ··;·. -------·-:---'-c-,---_.-___'-:--~;_;___;_;;..,....c..-~ ·:;_.,\~.: ~-~~;:~1::-
--~ ~-___ ,LIMITS fmg/1) .-____ ::::· _,}_-/;, __ ; __ ~~ ~:--:L_M~!!-IO.P_ oi==_AN;L..,;-~i;\~
'.<;·:1:;.:.2 .. ;) :::-;:'
:f:::.;•.~::-•0 . : .cl-' ____ ~:..·.·-:.i:::-~:::~: ---.-·--.::r r-:---·:c~~~:.:; .. _;;-;;-..
" Lindane •· -.-,,.·,y,,•. ·• i_.t-·, 0.004_-(Ls::EPA;'EMSL;_ERC,·J.ULY,1978· -··-····: --··-·-·-·· ··-··-····· --··-···-·-·•--·-!·. . .· ... ' ...... ·.
· 'Endriri, -·-;:::;; '1:~;i:;,: r,_. :,;;-~a·f?::_T:." 0.0002 -:·:: EPA.EMSL,ERC.JULY.-1978
, ·= f~;;~~_:;c~lo~ --~~ ~--~ ·-~]t:-, j 0.10 ' ;, _ EPA, EMSL, ERC, ~u~ ~-1~~8
... :-· .... :: · , ~· '..·-; :-~_:;·_.--·.:-.:s-:~·-· ~~:..."?:c;,~:-. .-::::~>:-~.--=~.::-t:~l"ib:~:.-:-< ... -, . .: ::'._,._;;;.;:.:~_·;·:._:·,:,·_._~..:-:;;:r:"?.7 .. :..~~-·-~-:.~ .• ,~--t::-.-.~.'::::::-:·.· ..... --r,·-•·-•,:--· -~-::~_";•·~ ,, .. ~-.-~::~..;.:. ~---.
To
0
xaph~ne O ,, " _, J: ·•: •. -, ,,::, fo 0.005 -i:c,i,,p·;:~;~P..A.,E.~~~'. ,~_RC;/u,r,y?~78
2,4-D
2.4,5-:--TP
-1-0.10 .,: ;-_
---~-~:::] ~~.01~· c: , _ ·_·_-. < __ -':i;/: EPA;.~h~L;ERC-;JDLY"i978,
EPA, EMSL, ERC. JULY 1978
. ··--·-···-----· l · ... --· _._,_ .. 11
~· __ ·--~·--·-· --'----·--·-..••. ::r:;f _.
I -, •, . . ,. -,-·· TYPES OF SAMPLES,---·.--______ ,, ---__ .:-. ,,_.,., --
'Regular: A ·samp!e{s) submitted to meat
Article 130.
I ' ... • _. ' .. , the :monitoring requirements of the North Carolina· Drinking Water Act, GS·J30.-::
.. Special:
. 1-. :· .. :_·.:._------···-~ -···-----__ .,.... _______ . ('.-~.;:
. I • • •. • . . .. • ·. ·• • .
A sa-;;;pJe:.lJ. j1Jb111ittad w:1en 0 prev;c,us somp}-3 hcis exceed"ed the: at:oyvs:t.i-! concentrdtica_ · The ·check sample shoutd be
taken from the same sample distribution tap as the preV"ious Saniple. · .. · . -· . , • -_ . .-. · . .. .
A sample{s)
tative ...
' . i . . ... _. . ..
from a private water supply submitted by a licensed physician, sanitaria_n or othe~ health department repreSen-
• I • • . . --. . ······ --~.--··-···-·::. ---: .• : ... . , .. i -..... '
A sample(s} submitted by an engineer workin'g with the State or the E.P.A., a sa:nple taken· by the □Viner/operator of a .
water system for a new well, a landfill test well Sample or other non-categorized sample.· ' i .
l
i
..
•·
•' · ..
. . . . . . I ''.:: ·. . . . _··. ~. I . . .
•
STATE LABO~ATORY OF PUBLIC HE.
.. DIVISIOI-/ OF HEALTH SERVICES .
N.C. DEPARTMENT OF HUMAN RESOURCES
. P.O. BOX 28047 -306 N. WILMINGTON ST., RALEIGH 27611 . i ; .: .· : . .
ORGANIC CHEMICAL AN1ALYSES c-PUBLIC WATER SYSTEM· I .
· Complete All Items Above Heavy Line
(See Instructions on Reverse Side)
. I
. -I
'· .....
Source of Water:
· · (' ·. I Ground
( ) Surface-.
.. -. .. . ... ( .. i
..• , .. . (. I
.. ~ . . . --
Both
Purchased
. ,
.... Source_ of Sample: .. , ...
· ( ) Distribution Tap
. ·•-· ~-.-: :-,,,, ..
' ' Report.To: L,,,, .. r ~ 'J fe o-,.C-. . -, ..., __ _
. ' -,.·.-_ . ._ . . .. / . -',,
Add~: R~. fl, f! J,(~ < l? ,-21? ..
. , ' -
)v/',/_.,L //,..,· ··[.;;_, r'Te ZIP
....... _-;; '.", . ,\ -. . ~: . ;• .. '••
······-··---···-------···-Telephone Number:_.,_(---") _____ -_____ __,, __
I
.--~
Collected By:· ~-/ ~ r, -, ). P,; r--....
:. -· ,
I
L~cation of Sampling Point:-~-·.,,.· ··-...,·,,-----------c-1_· --1
(Address where ·sample was collected)
' -· . .S el ;·, .. ;· __ -1 · -~4 ~--/.-ft= J. Remarks: ' ..
:.\c.·· l'iel/;;.: -p~;.) .
I
i
'
I
State Drinking Water Parameters (Required)
. . ,, -,
· Results
.• I .•-.
'
Type of Sample:
( ) Raw
-Type of Treatment:
· ( ·) .: : None·
( I · · Chlorinated
( )
I l
( l
Fluoridated
Filtered
Alum
Type of Sample:
( ) Regular
( I Check
,_::
'••· ...
< I _.,,, ... , (-. I House Tap
Well Tap
--------( I
( )
( )
( )
( I
Treated
Lime
:. ·Soda Ash
Polyphosphate
Water Softener
Other • · •.
( I . .. ~rivate : ( ·1 Special ..
WATER SYSTEM I.D. NUMBER (COPY FROM MAILING LABEL)
□□-□□-□□□
Optional Parameters (List as needed) •
· Results
[CHLORINATED HYDROCARBONS:) CV Y:J •, L1.
· ~Ec.!!.nd~n!!!·"----1----_:_:_:.e;.:.i-"-t~,__,,• L::..L-' ·-----i-..!./l_,,.1/:.:.-•_'7'--'--.· __
I
mg/I 5
' Lindane mg/I 4
Methoxychlor mg/I 3
I
Toxaphene mg/I 4
I :cHLOROPHENOXY:,:J
mgfl 3
' . . ~~~4~-~D=------J-------=-;-rr--·--------i---------
2,4,5-TP mg/I 4 r
.--· .-I
.,,. ,.-
Date Received -~7~-~2~?~---_-=J_V ___ Date Reported 1 . £-). ?f -/,O Reported By9 ~7'.1-"(,,~-"-''-~-_,_1..,_/i...,.~-==-,,:.:._"-"tf!__.c-'--''/-._
Date Extracted _____ · "'..;.'·-· ----,--Date Analyzed -;-I------,-----Laboratory Number __ , _• _ .. _. ·-_· _,.,_· ___ _
Comments:
OHS Form 2886 7/79
li-"'boratory
I
I S!,:lliAR.'/ ti·J:jJ?j~Citl~-lG Mildred A. Ker~ugh
Oirp,r:rnr
., .
. . •> . I •
;1•!: .. -;'.:,,.~:._i_.~ •. :·! .!:~I··-• : .. _,.'£ ·,-;,~ , . .--.:: . I INSTRUCTIONS .
Using typewriter or ball point pen;fill in all requested in for.nation on the top portion 0·1 form front. _l'le~se print legibly if typewriter is not available. I ·
,:~ '
t".-··. ---·---·--
.. -•. ' '. _:_ ~.-..
· Regular:
Check:
· Privote:
' I -~:•,;.:_._ ..... · . ._ .. _ ... _ ... '',";".',;·: ;:,., _~;-~;;:;,·.-,,:,.:.; .. l_'._ . , 1:-t.:.: ·. .> ·: ·,-,,~·:·:-v;::::• ': . ,, ...
OBTAINING SAM~LE: . • ' .. I .
Remove the teflon lined cap from the 1-gall~n bottle. _______________________ _
,.
--;-:',:. -,.·. -~--
LIMITS OF ALLOWABt.E:"tol'itENTRATIONSFOR DRINKiNGWA'rER"Afi1:T1stEo·s·E1ow.--,----_.,--"-.. ·
. PARAMETERS_ -~>
' ', Lin_dane . · · .. ,:
. ···---·----
: I ., ' '.. . . . ).>~_: ,.:' t. ;--,.' : __ ;:y
--,,,:.,:C••c-••'" -,-_-I
i:-:-.:~·:·:~ ~
:,,;_ i_.'..,'
: (_ . __ · ·--~·----_ ... __ ···::. ·.· __ .. · .. i·;·: ~-._•,·,::'.:-.--:~!~ ; .. "';~.~--;>~~:·.-·
.. ---.. -. -.· i_ LIM ITS {mg/I)
• : ., ~ I 'I : 0.004 ---------------
.. -... . -·
--------·-: .:.' :4;:~.:; · ... :/:-·:--\.· . .: ·:.:-r~-'. :---~::
::,, _EPA. EMSL.·ERC;JULY 1978
. :·Ehdrin :-_ · :-:;:~'~).: ;· .<:'-.:.:J·.~ : ,_. EPA, EMSL, ERC, JUL~ ,1~78
·,."; Ef'A,EMSL,ER_C,JULY1978
-,:;;_c;,;.:,;,,;:'l':':~.,~;?~-~~~:;0ifi,~)i},fsi'.:':E~c'._'}LILJ)·~~~
-:: ·· -. EPA. EMSL, ERC, JULY 1978
. . --·-··---·.· .... ··-
........ A sample(s) ·submitted to meet the ·monitoring requir~ments · of the· North Carolina Drinking' Water .Act, GS 130 __ ~ Article 13D . -----.. 1--. .' ·-:"--______ -____ .. ··--··-: ------.--·· <-' ..._
.. A .sample(s} submitted. when a previous sampl~ :iaS exceecl"ed th~ allo~able c~·nce:itration._~The·ch~-~k ;a~pl.e should be taken from the same sample distribution tap aS the previounai"nple. · ·
A·sampte(s) from a private water supply subi"!]itted by a licensed physician, sanitarian or other health department represen• tative. _ _-. _ .. .I-___ ........ -· ___________ .--... ____ ___ , , _, ·., 0 .--· I
A' sample(s) submitted by an engineer working with the State or the E.P,A., a sample taken by the ow~er/operator of a water system for a new well, a landfill test well :;ample or other non-categorized sampfe. --.· · ·····:--. . . I -
. 1 ' . . ·., ..
I
k •
. -STATE LA~ORATORYo"F.PUBUCHE~
. DIVISIO~ OF HEALTH SERVICES
N.C. DEPARTr,iENT OF HUMAN RESOURCES.
P.O. BOX 28047-306 N. WILMINGTON ST., RALEIGH 27611 .,· .
. I
' ORGANIC CHEMICAL ANALYSES -PUBLIC WATER SYSTEM
I . • .. ·. Complete All Items Above Heavy Line
(See lnsthlctions on Reverse Side) I I.
I .. · .. •'' . . . . ·-~->? .~--,;~\-." , . .;. ·:
< . j --:-..... -..
I
. :,,., ... : ·:·)L:: ··. ·-· ·y;:: :·,·, -~:J .:-. .:,.-.-.:.: ::·.: :,.-:_}_:;:•~_:·:.::":
,· ZIP
I .· ·.;_" •.·-> ._ " .. ·._. ,•·,,,, ,.
Cou"ty: ---' . ..,_1.,,Y'--'·,:,=-·.,_;.-.,_, _--c=--·---,-------,-------'---1
ZIP
I.
I
I '. 1 •• •
· source of Water: ·-r -:t·,_. ·Ground·.
• ( :J. · .. Surface
. Source of Sample_:_ .• ·.
· (' ) · ·_-· Distribution Taii'-
Type of Samplo:
. ( ) · Raw ·
._·. Type of Treatment: ...
......... ·::::. ·:-_ •_".:;.:_-:. "f ··1. :
. ·:;"·c:._·_,( .. ) . _-
Both
Purchased
!· :;-··-.-' ..
· (' ) ·House Tap
::i::.,:•-1·• ) Well Tap
·.·.·:. (··).···Treated
. .... -.•..
Lime
( ; . ) .. { :.-:.: ... .:.: .. . . --·(-..
Telephone Number. --'--'--'----'-----'-------'-----I
Coliected By:·-· '-'L,=-~~r-'-,--~r--j)'--·--_f.._,_• r_.'-r.,,_ ~ _______ I_·.--;
···( '. )•··:·None ___ :·.c'.:,:::
( ) Chlorinated
( ) Fluoridated
· ·.' ·: ·l--•-1----.SodaA'sh ·•.·• ·
.. . _.:,_:::,:;:,.r:).-Polyph~;'iitiate
. . ' ;,··A~
b~te <;ollected:· )-c 2 ~ ·-k6 Time: "?,-;, 0 <1 (PM
Location of ;a:p~in~-~~-i~t;_· ---,----------,-II_-;
(Address wh~re· sample was collected) · I
---~· ···· :--f~~it.-~_l>..r .. ~_:~_-._-_ 7~.,... · S_ed, ....... -.: .... -, -~ ...... \ ... y-' Re~arks:· . ' .:. : . .: ,/, 5"' ,..j ,:_, .. : -..,;. . ).« . ..; I.. , , . J_ ' !
Stato Drinking Water Parameters (Required) .
Results ·
I Methoxvchlor mg/l
Toxenhene
CHLOROPHENOXY:,:1
2.4-D
2.4.5-TP
mg/I
5
4
3
4
3
4
. (. ) · Filtered
• ( )
0
Alum
Type of Sample:
. ·( ) Regular
I l · Check
···:·::~r:-, 1: ~:·::water Softener
.. -. ( __ J~ .. c otiier _ .. :::, _·
•• -.. -•. "p"•• --·
WATER SYSTEM l.D.·NUMBER (COPY FROM MAILING LABEL) . . . □□-□□~□□□ .
Optional Parameters (List as needed) . . -·j .
· R_esults
•f(JV· .
.. /J ;_ /lt, ., -
f·· -~ .:.:-.
\ ·, .
r
7 7 ?_fV Date Received ____ -_____ ) __ ,., ___ Date Reported ~ -z_ ~ _;,. \V . Repo~d By a~ //4c.,,.,,e__ . . _· z;, #'"--~!-...,I. . . ~ . . Date Extracted _____ .. _,. ______ Date Analyzed __________ Laboratory Number•_-~_-_·_·-_·_ .• :..._··-----
::om men ts:
)Hs Form 2886 7 /79
_nboratory
i
,,~\
!<~·./
~1_i(~red A. Kerbaugh
. ;_-_ . .-< ~ .. ~--. -·J .. .-.: :_.; ;:;;' ,: .:.:,: ·-;.:.:<·~'.!: . -~·.CJ. ---•
INSTRUCTIONS
r1cennx¥rnr·e·:::cv:,:
. __ ... __ ·--: ·--~ : .... •.·
Using typewriter o; ball point'pen;fill in all requested information on the top portion of form ·tront. Please print legibly if ty~~writer ;, notavailable. · -.. : l -·.,· ._-:· .... :: .... ·. . .. _,:-·, .....
---+:··:,.,,~.-~.!ff.~:-'. --J . .:.. ~:-;':::·_:·,;--;'.)
. ~:.!2 _::·;,,·:~-~ :.:.:: ~··-~-::::;~:-~r.: >2? ·.
OBTAINING SAM~LE: . • • . . I : .
Remove the teflon lined cap from the 1-9allon bottle. ~ . . ·. . . ... .. i . : i--. · ...
,· :•\.~~ :.-::/
:,:.:i:.: ·--------· -·---,·~-'---'-~-·.Run water for 5 ininutes to assure water is from the distribution .S'/stem:
-.·· ' · : · ·· --

-

·

·

·

"'.!'. :-.'-' >·. 1::-'..x.-·.; · .. ~----c.-c-c~--~-'~-_, .
Rinse the bottle 2 or 3 times and discard the water. : ·.. · / :-.: ·: : ... ·-. ·.. . . . . . . .. · .. :i ,·: _.( . _, ··.,,t·:: . . After rinsing fill the bottle and replace cap secuieJy; r:;::.:,::;;--:_--:--··-··-----. . --:,· . . .. . ·.: ... ·. .· ~ . :· .....• i : ' ', \ : ........ '::. : -.. . _.,-Place the bottle and report sheet in 'the styrofoam mailer and-tape securely.-----. ,:u:-. .:~·-· .~ -l . i . -~.~? :--.::,c . .:.:-:::·.:.-.. ~. '·I : ·i . ·. . . .·.
Mail immediately to the State Laboratory us\ng s~ppli_ed address.label'..,._ -'-'-~-·'--''-'---'-.:-c.··_-__ . __:_-"--"-"'' ,-c,o·. --~----.• ----.. . ·-· ---·---~--'---' , • . .. ·. ·= .
_:.\.:i·~~;;,:-,t!'.· ·.-·1
-:::r.~;7•:.;' -. .:.•.
·······----·--..
:~!·.;-•;:? ~-:: ::~\'T. I . ..... . ·-'· :~·-:: ;;_._;:_::-~·.:.-.·· ·. . . . . . . . ,;;;.,'~: ·_. (j: '--. -.--·· . ,.-·-:i':!:r:t,..
... ------: -----·--·--·---. -~.~-----~·--.. -:-.·;-:--~_ . . .... ·--:,!:; ... -· .. · ~:;:~~/:: .. ;;<·_-~ -.~_ >:--·._·. ~~_:.·()?_ •_:\ ~
. LIMITS OF ALLOWABLE CONCENTRATIONS FOR DRINKING WATER ARE LISTED BELO\.V-. · -... -.. ~7 ! . ----I --• --.' -· .f" .
. ·.'
.. ; ...
PARAMETERS ..
. :.·
Lindane
. ."-!
I· • • J . ·-·-····· --::--. . . . ,. . .;-:~·:l.'.'.;,.i!_• .. H'l_~;\,:'.
.I
I
--..::.. ·· -.-~ ... -_-__ ,.__ '.·-./i ·c~;.a!:"·.-.::
·'-.--~:>: :.·· ...
1
ur,i'ii-s_.!i-ngl1i_ METHOD OF ANALYSIS : ···-.-·:-···· . . .. •-;j· • \';i~ . J': ~.004 ... ----·--
.• ··-·--------~~.:: .. ·.: ···---------·---· -····-. ·_ i ·! ' ... , •· -... '. : ..... :-.r• . .-._i .
Regular:
.Check:
Pri'late:
·Endriri -. ·;--~,::~•--_; :·; ·: •.:::_:·:~~; .-·~:.:-.:.•.:_ .. _.
. ·-.----.• j -;_-
,, •'. ' : 0.0002· .
i 0.10
I . . .
EP.A, EMSL, ERC;JUL Y 1978
· ···· ·TYPES OF SAMPLES---,-~
A sample(s) submitted to ·meet· the monitLng
I
requirer::n-ts of the North ·Carolina· Drinkl~g-l,'Jater Act, -GS 1_30,-Article 13D. ····-······· _ _I_ ... :.·-.:. _____ : .. _·_._·_.·.-· .. --•------____ ··.·,.'.,..: •.. ; · · :· I . • . . • . . . . . . . A sample(:.) submitted when c1 prnvioui sarriple .:,ms e~ccecled. thtl' ~llu~'\table q:,nun~ratlon._::_1J1e.:_check somple should bl? taken from the same samp[e distribution tap as the;pre-\tious ·Sample. _ .. ~ .. ·. -

.

. . . · · · . · · .. I • • -• • • • • • •
I • A sample{s) from a private water supp:y submitted by a licensed physician, sanitaria.n or other health department repre5en-tative. . . .. ·. · • ·• . ·.· ·.. . ... :: ...........
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.. : .. '_ .. . .. . . .. : : :·· ·. : • , :c. ·: c .·.: __ --· -~--·:._·---~ ------·--·-·.::-:-:: ;. ·.;
A sample(s} submitted qy an engineer work_ing \~ith the State .of the E.P.A.~\·· sam;le ~ak':?n by the c•,vr1~r/opera.;o; ~fa 1.-Jater system for a new well, a laiidfitl test well sampl~ or other flon-categ_orized sDmpla. -·. -· ·---··· · ·· ·· . . I : . . . . . . . . ! . . .. · : : .. ·.-.
·,.