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Home My WebLink AboutItem No 22 - 20Day Report - Morehead Common Site Area No 4-OCRNCDENR UST Section Mooresville Regional Office 919 North Main Street Mooresville North Carolina 28115 Attention Mr Allen Schiff Dear Mr Schiff 20-DAY REPORT Morehead Common Site Area No 919 West Morehead Street Charlotte North Carolina Incident No Not Yet Assigned ESP Project No E6-UD42.601 On behalf of the property owner and our client Beazer Homes ESP Associates P.A is pleased to provide the attached 20-Day Report for release of petroleum product at the subject site as discovered during mass grading operations of this area Thank you for your attention in this matter If you should have any questions please do not hesitate to contact me at 803 835-0915 Sincerely Christopher J.Ward PG Environmental Services NC License No 1600 P.O Box 7030 Charlotte NC 28241 1800.960.7317 NC 704.583.494 fax 704.S83.4S0 SC 803.802.2440 fax 803.802.2515 Www.espassocjates.com ESP Associates P.A July 18 2007 Reference ESP Associates P.A cc Mr Jade Eastridge 20-Day Report SITE INFORMATION Site Identification Date of Report July 18 2007 Facility ID N/A UST Incident Number Not Yet Assigned Site Name Morehead Common Site Area No Site Street Address 919 West Morehead Street City/County/Zip Code Charlotte Mecklenburg County 28278 Description of Geographical Data Point Approximate center of UST Location Method Mecklenburg County Polaris GIS Map Latitude 35.2277 Longitude -80.8582 Information about Contacts Associated with the Leaking UST System UST Owner Beazer Homes 1300 Blvd Suite Charlotte NC 28203-4265 704370.7200 UST Operator N/A Property Owner Same as above Property Occupant Same as above Consultant/Contractor ESP Associates P.A Chris Ward PG P0 Box 7030 Charlotte NC 28241 803.835.0915 Analytical Laboratory Prism Laboratories Inc P0 Box 240543 Charlotte NC 28224-0403 704.529.6364 NC Certification No 402 Information about Release Date Discovered June 18 2007 Estimated Quantity of Release Unknown Cause of release Unknown Source of Release UST Size and contents of UST system from which release occurred 550-gallon steel diesel UST Certification Chris Ward Professional Geologist for ESP Associates P.A do certif that the information contained in this report is correct and accurate to the best of my knowledge ESP Associates PA is licensed to practice both geology and engineering in North Carolina ESP Associates certification numbers are Geology C-347 Engineering C-0587 20-Day Report ESP Project E6-UD42.601 Morehead Common Site Area No July 18 2007 INTRODUCTION On June 18 2007 ESP responded on behalf of Beazer Homes to an encounter with an underground storage tank UST and impacted soil during mass grading operations at the subject site Upon arriving at the site ESP observed 550-gallon steel apparent diesel UST and soils with petroleum odor located on the south side of West Morehead Street approximately 150 feet west of its intersection with South Clarkson Street on Tax Parcel No 07325210 see Figures and The incident area has been designated as Area No As required following receipt of laboratory results confirming release had occurred ESP emailed notification of the release discovery along with Release and UST Leak Reporting Form to Mr Steve Bograd of the Mooresville Regional Office of NCDENR on June 19 2007 The subject site is located within an urban area of Charlotte which historically included warehouse and retail structures The site is currently mass graded and being developed as mixed-use development see Figures and Based on our review of the Geologic Map of NorthCarolina 1985 the subject site is located within the Charlotte Belt locally comprised of intrusive metamorphosed granitic rocks locally pinkish gray massive to weakly foliated and containing hornblende Soils encountered in this area are the residual product of chemical weathering of rock presently underlying the site Soil weathering is more advanced near the surface grading with depth to less weathered rock and finally bedrock INITIAL ABATEMENT ACTIVITIES On June 19 and 20 2007 ESP documented the excavation of approximately 100 cubic yards of impacted soils from Area No by the sites grading contractor Gelder Thompson of Midland North Carolina The excavation was advanced based on OVA readings and evidence of visible staining The resulting excavation measured approximately 14 ft 28 ft 10 ft deep Neither groundwater bedrock nor free product were encountered within the tank pit 20-Day Report ESP Project E6-UD42 601 Morehead Common Site Area No July 18 2007 The excavated soil was placed on and covered with plastic awaiting subsequent off-site permitted disposal On June 20 2007 ESP collected two composite soil samples for laboratory analysis The soil samples designated 1A and lB were placed in laboratory provided containers labeled and hand delivered on ice to Prism Laboratories for compositing and subsequent analysis The samples were analyzed for TPH-GRO/DRO and BTEX On June 19 2007 confirmatory soil samples were collected at depth of feet BLS from each of the excavations four sides WS-through WS-4 while one sample was collected at depths of 10 feet BLS from the base of the excavation B-i The five soil samples were hand delivered on ice to Prism Laboratories to be analyzed for NCDENR risk-based parameters which include VOCs by EPA Method 8260B SVOCs by EPA Method 8270C VPHIEPH by the Massachusetts Department of Environmental Protection MADEP method and for total lead and chromium by EPA Method 60 lOB Sample locations and excavation dimensions are depicted on Figure Soil Sample Location Map Sampling was performed in general accordance with ESPs SOP see Appendix FUTURE REPORTING An Initial Abatement Action Report is currently being prepared for this release ATTACHMENTS FIGURES WOCTNOQ7 SHEET 77TLE F7GURE \CeSCALENTS2005AERIALPHOTOGRAPH lATE 7/11/07 IRA BYDMH PROJECT MOREHEAD COMMON SITE -1CHECKED CHARLOTTE NORTH CAROLINA LEGEND WEST MOREHEAD STREET WS-4 WS-4 AREA AREA CONF7RMA TORY SOIL SAMPLE LOCA T1ON AREA EXCA VA liON DEPTH OF FEET AREA EXCA VA liON DEPTH OF FEET 20 APPROXIMA7E SCALE IN FEET Iilbu42.6O CALE NTS ATE 5/1/O7 RAVæV 6DMH CHECKED BY ESP Associates PA P.O Bss 7030Ch-IUc 5728241 2475 keoon BIdFoMIIISC29708 704-583-4949 747 903-S022440 so sS--S.espasaocaIes cam ws-1 WS-2 WS-2 WS-3 PROJECT ShEET HILL fiGURE SOIL SAMPLE LOCA liON MAP AREAS AND MOREHEAD COMMON S/iF CHARLOTTE NORTH CAROL/NA SITE PHOTOGRAPHS MOREHEAD COMMON SITE AREA NO 24-HOUR RELEASE AND UST REPORTING FORM Steve On behalf of Beazer Homes am herein providing 24-Hour Notification of the discovery of three orphan USTs on Becizer Homes Morehead Common residential/commercial development currently being graded The Morehead Commons property is located on the south side of West Moreheod Street at its intersection with South Clarkson Street in Charlotte North Carolina On June 18 2007 during grading operations an approximate 550- gallon steel UST was uncovered on Parcel No 07325210 The UST was uncovered and determined to be partially filled with sludge and some fluid with diesel odor this UST is being referred to as AREA An additional approximate 550-gallon likely diesel and an approximate 750-gallon likely gasoline were subsequently encountered side by side approximately 25 feet from the first 550-gallon UST encountered on Parcel No 07325210 these USTs are being referred to as AREA On June 19 2007 AF Environmental and Industrial Services pumped remaining fluid and sludge from the USTs and transported the USTs off-site for permitted disposal The tops of the USTs were buried to depth of approximately feet below original grade and were severely rusted with numerous holes Soils adjacent to and beneath all three USTs exhibited strong petroleum odor and were visibly stained Excavation of soils adjacent to and beneath The three USTs was initiated on June 19 with soils being stockpiled on site on plastic for subsequent off-site disposal Preliminary investigation reveals that Parcel No 07325210 was once occupied by Tonys Auto Body Shop and Shorts Imports The releases are identified on the attached PbF map The Responsible Party for the property is Beazer Homes 1300 South Boulevard Suite Charlotte North Carolina 28203-4265 Mr Jade Eastridge 704.370.7200 UST-61 24Hour Release and UST Leak Reporting Form For Releases This form should be completed and submitted to the UST Sections regional office following Known or suspected release from an underground storage tank UST system This form is required to be submitted within 24 hours of discovery of known or in NC suspected release ________________________________ DWM USE ONLY Suspected Contamination YIN Facility ID Number Incident Risk HILU__Confirmed GW Contamination YIN Date Leak Discovered Received On Received By Confirmed Soil Contamirlation çYIN Comm/Non-Commercial 12M Reported by circle one Phone Fax or Report Free Product YIN 1L If Yes State Greatest Reg/Non-regUlated Region Thickness INCIDENT DESCRIPTION Incident Name i412 4/ Address LAJ County ec-ki Vf City/Town Zip Code nlinsto05e ayetteville Latitude decknal degrees r5 g5 Longitude decimal degrees Obtained by Briefly describe suspected or confirmed release including but not limited to nature of release date of release amount Li GPS of release amount of free product present and recovery efforts initial responses conducted impacts to receptors GiS Address matching Li Unknown-e iP Describe location HOW RELEASE WAS DISCOVERED Check one Li Release Detection Equipment or Methods Li VisuallOdor Li Groundwater Contamination Li During UST Closure/Removal Li Water in Tank LI Surface Water Contamination Li Property Transfer Li Water Supply Well Contamination Other specify o4J SOURCE OF CONTAMINATION Primary Source of Contamination Primary Contaminant Type Location Setting Check one Check one Check one II Gasoline/Diesel/KerOSefle Li Facility Li Residential _i Confirmed UST Release Check one below Li Heating Oil Li Residence Li Industrial Li Dispenser Other Petroleum Products Other JJthan Line Release Metals Rural Tank Release Other lnorganics Spill/Overfill Other Organcs Li Exact Failure Location Unknown or Multiple Failures Ownership Municipal Military Unknown ate Federal County State Operation Type Public Service Agricultural Education/Relig Industrial ommercial Mining UST Form bI 11/05 Page ot2 IMPACT ON DRiNKING WATER SUPPLIES Water Supply Wells Affected Yes No Number of Water Supply Wells Affected Water Supply Wells Contaminated Include Users Names Addresses and Phone Numbers Attach additional sheet if necessary UST SYSTEM OWNER UST Owner/Company$-24 If AddressPointofContactjJtOO //% I__ City State Zip Code Telephone Number ioio/4 /i-37-7z-E UST SYSTEM OPERATOR LANDOWNER AT LOCA11O kJ OF UST INCIDENT UST Operator/Company Landowner Sq-Mc /1-S City State City State Address Zip Code Felepflone Number Address Zip Code Telephone Number Draw Sketch of Area showing two major road intersections or Attach Map A--q-c rI-e7 Person Reporting Incident /qj /nJj Company faP Telephone Numbe5g.O Title 7LJI1 Address j3 Date UST Form 0111/05 Page of PRISM LABORATORY DATA REPORT Case Narrative PRISM LAEORATORIESINC Date 06/29/07 Client Project ID Morehead Commons No.4 Company ESP Associates PA Prism COC Group No G0607588 Contact Chris Ward Collection Dates 06/20/07 Address Box 7030 Lab Submittal Dates 06120/07 Charlotte NC 28241 This data package contains the analytical results for the project identified above and indudes Case Narrative Laboratory Report and Quality Control Data totaling pages chain-of-custody is also attached for the samples submitted to Prism for this project Data qualifiers are flagged individually on each sample key reference for the data qualifiers appears at the end of This case narrative Quality control statements and/or sample specific remarks are included in the sample comments section of the laboratory report for each sample affected Semi Volatile Analysis No Anomalies Reported gTatile Analysis No Anomalies Reported Metals Analysis N/A Wet Lab and Micro Analysj N/A Please call if you have any quesfions relating to this analytical report Date Reviewed by bbi Jones Project Manager Angela ercash Signature Signature Review Date 06/29/07 Approval Date 06/29/07 Data Qualifiers Key Reference Compound also detected in the method blank Result outside of the QC limits DO Compound diluted out Estimated concentration calibration range exceeded The analyte was positively identified but the value is estimated below the reporting limit Estimated concentration with high bias Estimated concentration with low bias matrix effect is present Notes This report should not be reproduced except in its entirety without the writtten consent of Prism Laboratories Inc The results in this report relate only to the samples submitted for analysis 449 Spiingbrook Road P.O Box 240543 chaolle NC 28224-0403 Phone704/529-6364 To Free 6001529-6364 Fax 7041525-0409 Project ID Morehead Commons No Client Sample ID Prism Sample ID Sample Matrix Soil COG Group Time Collected Time Submitted lAI 23 185079 G0607588 06120/07 1000 06/20/07 1635 Percent Solids Determination Percent Solids Diesel Range Orgarrics DRO by GC-FlD Diesel Range Organics DRO Sample Preparation Surrogate Recovery Control Limits Bromofluorobenzene 106 77 128 Dibromolluoromethane 93 67 143 Toluene-d8 93 81 128 400 mg/kg 42 53 8015B 06/27/07 1505 jvogel Q24575 25.18 mL 3545 06/25/07 1515 wconder P18738 Gasoline Range Organics GRO by GC-FID Gasoline Range Organics CR0 BRL mg/kg 1.2 0.076 Surrogate Recovery Control Limits o-Terphenyl 64 49-124 801 SB 06/27/07 643 hwagner 024580 Surrogate Recovery Control Limits aaa-TFT 84 55-129 This report should not be reproduced except in its entirety without the written consent of Prism Laboratories Inc 449 Springbrook Road P.O Box 240543 Charlotte NC 28224-0543 Phone 7041529-5364 Toll Free Number 1-800/529-6364 Fax 7041525-0409 NC Certification No 402 SC Certification No 99012 NC Drinking Water Cart No 37735 run $e AnaIylicl ErMronmeflbJ ...O5 ESP Associates PA Altn Chris Ward Box7030 Charlotte NC 28241 Laboratory Report 06/29/07 .- Parameter Result Units Report MDL Dilution Method Analysis Analyst Batch Limit Factor Daternme ID 83.8 SM2540 06/27/07 1800 Uhao Volatile Organic Compounds by CC/MS Benzerie BRL pg/kg 3.7 0.50 8260B 06/27/07 909 enissell 024552 Ethylbenzene BRL pg/kg 6.2 043 8260B 06/27/07 909 erussell 024552 mp.Xylenes BRL pg/kg 12 0.87 8260B 06/27/07 909 erussell Q24552 o-Xylene BRL pg/kg 6.2 0.37 8260B 06/27/07 909 erusseli Q24552 Toluene BRL pg/kg 6.2 0.42 8260B 06/27/07 909 erussell 024552 Page of4 ESP Associates PA Attn Chris Ward Box 7030 Charlotte NC 28241 Client Sample ID Prism Sample ID COG Group Time Collected Time Submitted 06/29/07 1A123 185079 G0607588 06/20/07 1000 06/20/07 1635 Parameter Result Units Report MDL Dilution Method Analysis Analyst Batch Limit Factor Date/Time ID Sample Comments BRL Below Reporting Limit Estimated value between the Reporting Limit and the MDL The results in this report relate only to the samples submitted for analysis and meet state certification requirements other than IEL4C certification except for those instances indicated in the case narrative and/or test comments All results are reported on dr/-weight basis Angela ft Overcash V.P Laboratory Services This report should not be reproduced except in its entirety without the written consent of Prism Laboratories Inc 449 Springbrook Road P.O Box 240543 Charlotte NC 28224-0543 NC Certification No 402 SC Certification No 99012 NC Drinking Water Cert No 37735 Project ID Morehead Commons No Sample Matrix Soil Laboratory Report Phone 704/529-6364 Toll Free Number 1-800/529-6364 Fax 704/525-0409 Page of ESP Associates PA Attn Chris Ward Box 7030 Charlotte NC 28241 Project ID Morehead Commons No Client Sample ID Prism Sample ID Sample Matrix Soil coc Group Time Collected Time Submitted B-234 185080 G0607588 06/20/07 1015 06/20/07 1635 Percent Solids Determination Percent Solids GasolIne Range Organics GRO by GC.FID Gasoline Range Organics GRO BRL Surrogate Recovery Control Limits aaa-TFT 83 55-129 This report should not be reproduced except In its entirety without the wiitten consent of Prism Laboratories Inc 449 Springbrook Road P.O Box 240543 Charlotte NC 28224-0543 Phone 704/529-6364 Toll Free Number 1-8001529-6364 Fax 7041525-0409 F4I Svie Iytk EMronmnbI Shn NC Certification No 402 SC Certification No 99012 NC Drinking Water Cert No 37735 Laboratory Report 06/29/07 Parameter Result Units Report MDL Dilution Method Analysis Analyst Batch Limit Factor DatelTirne ID 3.6 0.48 6.0 0.42 12 0.84 6.0 0.36 6.0 041 SM2540 06127107 1800 Lthao 826DB 06/27/07 940 erussell 024552 826DB 06127/07 940 erussell 024552 826DB 06/27/07 940 erussefl 024552 826DB 06127/07 940 erussell 024552 826DB 06/27/07 940 erussell Q24552 85.6 Volatile Organic Comeounds byOCIMS Benzene BRL pg/kg Ethylbenzene BRI pg/kg p-Xylenes BRL pg/kg o-Xylene BRL pg/kg Toluene BRL pg/kg Diesel Range Organics DRO by GC-FID Diesel Range Organlcs DRO Sample Preparation 76 mg/kg 8.2 1.0 25.36 Surrogate Recovery Control Limits Bromofluorobenzene 105 77-128 Dibrornofluoromethane 97 67 143 Toluene-d8 96 81 128 8D15B 06/28/07 808 jvogel 024575 mL 3545 06/26/07 1515 wconder P18738 Surrogate Recovery Control Limits o-Terphenyl 99 49-124 mg/kg 1.2 0.074 8015B 06/27/07 615 hwagner 024580 Page of NC Certification No 402 SC Certification No 99012 NC Drinking Water Cert No 37735 Laboratory Report 0612 9/07 ESP Associates PA Attn Chris Ward Box 7030 Charlotte NC 28241 Project ID Morehead Commons No Sample Matrix Soil Client Sample ID Prism Sample ID COC Group Time Collected Time Submitted B-234 185080 G0607588 06/20/07 1015 0620/07 1635 Parameter Result Units Report MDL Dilution Method Analysis Analyst Batch Limit Factor Date/Time ID Sample Comments BRL Below Reporting Limit Estimated valve between the Reporting Limit and the MDL The results in this report relate ony to the samples submitted for analysis and meet state certification requfrements other than NEIJtC certification except for those instances indicated in the case narrative and/or test comments All results are reported on dry-weight basis Angela Overcash V.P Laboratory Services This report should not be reproduced except in its entirety without the written consent of Prism Laboratories Inc 449 Springbrook Road P.O Box 240543 Charlotte NC 28224-0543 PuI S3 AnyJI-EnvlronmnW SoIutons Phone 704/529-6364 Toll Free Number 1-8001529-6364 Fax 704/525-0409 Page of ESP Associates PA Attn Chris Ward Box 7030 Charlotte NC 28241 NC Certification No 402 Sc Certification No 99012 NC Drinking Water Cert No 37735 Project ID Morehead Commons No Level QC Report 6129107 COC Group Number G0607588 Date/Time Submitted 6/20/07 1635 Thisreport should not be reproduced except in its entirety without the written consent of Prism Laboratories Inc 449 Springbrook Road P.O Box 240543 Charlotte NC 28224-0543 Phone 704/529-6364 Toll Free Number 1-800/529-6364 Fax 704/525-0409 S...S1LVfrl-------inds CC/MS method 826DB Method Blank QC Batch Result RL Conot limit Units ID Benzene ND 0.003 0.0015 mg/kg 024552 Ethylbenzene ND 0.005 0.0025 mg/kg Q24552 mp-Xylenes ND 0.01 0.005 mg/kg Q24552 o-Xylene ND 0005 0.0025 mg/kg Q24552 Totuene ND 0.005 0.0025 mg/kg 024552 Laboratory Control Sample Recovezy Rsccvenj 00 Batth Result Spike Amount Units Rag Benzene 0.04358 0.05 mg/kg 87 62-119 024552 Ethylbenzene 0.04417 0.05 mg/kg 88 57-128 024552 mp-Xylenes 0.09048 0.1 mg/kg 90 54-132 024552 o-Xylene 0.04725 0.05 mg/kg 95 57-131 024552 Toluene 0.04544 0.05 mg/kg 91 57-122 024552 Matrix Spike FtsCOVSfY 00 BatchRanges Sample Ift Result Spike Mourt Units ID 185081 Benzene 0.03306 0.05 mg/kg 66 46-1 36 024552 Ethylhenzene 0.02688 0.05 mg/kg 58 51-1 35 024552 mp-Xylenes 0.05588 0.1 mg/kg 5-51-136 024552 o-Xylene 0.02855 0.05 mg/kg 57 49-137 024552 Toluene 0.0296 0.05 mg/kg 59 47-136 024552 Matrix Spike Duplicate Recovery Recovery RPD Ranges RPD 00 Batch Sample lD Result SpikeAmDsnt Units ID 185081 Benzene 0.03495 0.05 mg/kg 70 46-136 -22 024552 Ethytbertzene 0.03244 0.05 mg/kg 65 51-135 12 0-23 Q24552 mp-Xylenes 0.06374 0.1 mg/kg 64 51-1 36 13 -20 024552 o-Xylene 0.03337 0.05 mg/kg 67 49-1 37 16 0-22 024552 Toluene 0.03187 0.05 mg/kg 64 47-136 -22 024552 Page of ESP Associates PA Attn Chris Ward Box 7030 Charlotte NC 28241 NC Cerlificalion No 402 Sc Cefication No 99012 NC Drinking Water Cert No 37735 Project ID Morehead Commons No Level II QC Report 6/29107 COG Group Number G0607588 Dateilme Submitted 6/20/07 1635 RPDRPORange 0-34 024590 This report should not be reproduced except in its entirety without the written consent of Prism Laboratories Inc449SpringbrookRoadP.O Box 240543 Charlotte NC 28224-0543 Phone 704/529-6364 Toll Free Number 1-800152.9-6364 Fax 704/525-0409 Diesel IDRQI by GC-F 80153.sag.lMaluw ...fltfla Method Blank OC Batch Resull RL Confrol Limit Units ID Diesel Range Organics DRO ND 3.5 mg/kg 024575 Laboratory Control Sample Rec Recovery BICh Result Spike Amount Units Diesel Range Organics DRO 490 80 mg/kg 61 55-1 09 024575 Matrix Spike Recovery Recovery CC BatchRanges Sample Reit Spike Amount Units ID 184791 Diesel Range Organics DRO 45.8 80 mg/kg 57 50-117 024575 Matrix Spike luplicate Recov Recovery RPI Ranges RPD Range Sample 1D Result Spike Amount Units ID 184791 Diesel Range Organics DRO 51.9 80 mg/kg 65 50-117 12 0-24 024575 Gasoline Range Or-panics GRO by GC-F1D method 801 SB Method Blank CC Batch Result RI Control Umit Units ID Gasoline Range Organics GRO ND 0.5 mg/kg 024550 Laboratory Control Sample Recoveiy Recovery Ranges QC Batch Result Spike Amount Units Gasoline Range Organics GRO 1.966 mg/kg 98 64-124 024580 Matrix Spike Recovery Recovery Ranges CC Batch Sample Result Spike Amount Unite ID 185077 Gasoline Range Organics GRO 2.016 mg/kg 101 37-126 024580 Matrix Spike Duplicate Recovery QC Baich Sample ro Result Spike Amount ID 185077 Gasoline Range Organics GRO 1.968 -See Case Narrative Units mg/kg 98 Recovery Ranges 37-126 Page of Relinquished By Si9naiure Received By Sinaturo Relinquished By Sign Method ci Shipmenl NOTEAMPLE GoLEI1S SHOULD BETAPED SHU WiTH USTODYSEALS FOR TRANSPoRTATioN TO THE LABORATORY alc1JEs ARE NOT ACCEPTED AND VERIFIED AGAINST OC N11L RECEJVW AT THE LABORATORY Fed Dx UPS ii4ariL-deiivered trism Field Serice Other Date 57/if.it.-- COG Group No rrjpDEs U53 GAOUNDWATER DRINKING WATER SOLID WASTE RCRA CEFICLA LANDFILL OTHER UNC oscJi4ccDSC IJNC USC UNC USC UNC USC ONC USC ONC USC UNC USC ONC OSCo__jD ________________________ nnnrraklIrfl tfliflC flflflto A....t......fSI_._tfl r.%...ni__aL..r..ii.._..4 C.....t.flA 1...i...461.. Ca..........I...A.a..J..a..11....A Lj...d Ii Full Service Artalyticdl Environmental Solutions 449 Springbrooiç Road P.O Box 240543 Charlotte NC 28224-0543Phone104/52.9-6364 Fax 704/52-04 Client Company Name _______________________ Report TolContact.Narne hJ4 4.i-f Reporting Address ______________________________ CHAIN OF CUSTODY RECORD PAGE_LOF_L QUO it TOE SUREP ILLIIS3z Project Name LJ g$41 Short Hold Analysis Yes No liST Project Yes No please ATTACH any project specific reporting QC LEVELI 11111 WI provisions and/or QC Requlp9e1tts Invoice To _AUdui Address Phone ________________Fax Yes No Email Yes NoEmail Address______________________EDD Type .POF_Excel çther Site Location Name irii4 Site Location Physical Address II1 5iL Purchase Order No./Btlling Reference I_ID 21 Requested Due Dale Day 02 Days 03 Days 04 Days tDaye Working Days 06.9 DaYS Standard 10 clays usWork tii3iist Be Samples received afterl50D will be proàessod next business day Turnaround time Is based on business days excluding weekends and holidays SEE REVERSE FOR TERMS CONOR1ONS REGARDING SERVICESRENDERED BY PRISM LABORATORIES INC TO CLIENT TO BE FILLED IN BY CLIENT/SAMPLING PERSONNEL Certification NELAC USACE_FL____NC SC.._OTHER _____N/A _____ WaterChiorinated YES_NO_ Sample toed Upon Collection YES NO CLIENT DATE SAMPLE DESCRIPTION COLLECTED 4-2o/-2 TIME COLLECTED MIUTARY HOURS IIZ /l/ji JZT2_ /a2-c MATRIX SOIL WATER ORSLUDGE SAMPLE CONTAINER PRESERVA- TIVES _____ ANALYSES REQUESTED 4iç REMARKS iL prk-aJ____iL.14L ._---------____ PRISM NO t5 fs5 TYPE SEE BELOW iT4 __ SIZE Samplers Signature Sampled By Print Name Affiliation Upon relinquishing this Ciæof Custody is your authorization for Prism to proceed with the analyses requested above Any changes must be submitted inwriting to the Prism Project Manager There will be charges for any changes after analyses have been inItialized ihd n\R8C8WO oy Date Militasy/Houcs Additional Comments Ii Jl SEEnEVERSE FORTERMSCONDITIONS ORIGINAL