WQ0029653_Monitoring - 03-2021_20210428

- SUBMIT FORM ON YELLOW PAPER ONLY
Mail original DEPARTMENT OF ENVIRONMENTAL
PROCESSING UNITTOF WATER RESOURCES
GROUNDWATER QUALITY MONITORING: INFORMATION
COMPLIANCE REPORT FORM and 1 copy to:
1617 MAIL SERVICE CENTER,RALEIGH,NC 27699-1617
FACILITY INFORMATION Please Print Clearly or Type PERMIT Number: Expiration Date: 2/28/2026
Facility Name: SCOTCH HALL PRESERVE WWTP Non-Discharge WQ0029653 UIC
Permit Name(if different): NPDES Other
Facility Address: MERRY HILL TYPE OF PERMITTED OPERATION BEING MONITORED
MERRY HILL NC 27957 County BERTIE ❑ Lagoon ❑ Remediation: Infiltration Gallery
® Spray Field ❑ Remediation:
Contact Person: BRIAN JERNIGAN Telephone#:[phone] ❑ Rotary Distributor ❑ Land Application of Sludge
Well Location/Site Name:SCOTCH HALL PRESERVE No.of wells to be sampled: 3 ❑ Water Source Heat Pump ❑Other:
(from Permit)
SAMPLING INFORMATION If WELL
WELL ID NUMBER(from Permit): MW1 Date sample collected: 3/11/2021 FIELD ANALYSES: WAS
Well Depth: 20 ft. Well Diameter:2 in. pH 00400:5.29 units Temp.cool 0: 121 °C DRY at
Depth to Water Level 82546:4.7 ft. below measuring point Screened Interval: 5 ft. to 20 ft. Spec. Cond.00094: µMhos time of
sampling,
Measuring Point is 3 ft.above land surface Relative M.P. Elevation: ft. Odor 00085: NONE check
Volume of water pumped/bailed before sampling: 3.0 gallons Appearance CLEAR here:❑
Samples for metals were collected unfiltered: ®YES ❑ NO and field acidified: I YES ❑NO
LABORATORY INFORMATION
Date sample analyzed: 3/((/�0ai. Laboratory Name: ENVIRONMENTAL CHEMISTS INC Certification No.94
PARAMETERS NOTE:Values should reflect dissolved and colloidal concentrations.
COD 00335 mg/L Nitrite(NO2)as N 00615<0.02 mg/L Pb-Lead 01051 ug/L
Coliform: MF Fecal 31616<1 /100mL Nitrate(NO3)as N 00620 2.40 mg/L Zn-Zinc 01092 mg/L
Coliform: MF Total 31504 /100mL Phosphorus:Total as P 00665.34 mg/L
(Note: Use MPN method for highly turbid samples) Orthophosphate 70507 mg/L Other(Specify Compounds and ° ntr�tion Units):
Dissolved Solids:Total 70300 84 mg/L Al-Aluminum 01105 mg/L �¢
pH (Lab)00403 5.29 units Ba-Barium 01007 ug/L 4PR L/
TOC o0eao 2.2 mg/L Ca-Calcium 00916 mg/L 2 8 7021
Chloride 00940 8 mg/L Cd-Cadmium o1027 ug/L II tF DI�R SECT101V
Arsenic 01002 ug/L Chromium:Total 01034 ug/L L' ylATI�NPR�CcrSr�
Grease and Oils 00552 mg/L Cu-Copper 01042 11 1'h mg/L ORGANICS: (by GC, GC/MS, HPLC) uN(
Phenol 32730 ug/L Fe-Iron 01045 ,, ug/L (Specify test and method#.ATTACH LAB REPORT.)
Sulfate 00945 mg/L Hg-Mercury 71900 9/ .'(j ug/L Lab Report Attached? El Yes(1) CI No(0)
Specific Conductance 00095 µMhos K-Potassium 00937 L�Jz irng/L VOC 7873 , method#
Total Ammonia o0610<0.2 mg/L Mg-Magnesium 00927 mg/L , method#
(Ammonia Nitrogen;NH3as N;Ammonia Nitrogen,Total) Mn-Manganese o1055 ug/L , method#
TKN as N 00625 2.40 mg/L Ni-Nickel 01067 uglL , method#
For Remediation Systems Only(Attach Lab Reports): Influent Total VOCs: mg/L Effluent Total VOCs: mg/L VOC Removal%
I certify that.to the best of my knowledge and belief the information submitted in this report is true,accurate,and complete.and that the laboratory analytical data was produced using approved methods of analysis by a
DiNR-certified laboratory. I am aware th,,l thane are significant penalties for submitting false information,including the possibility of fines and imprisonment for knowing violations.
DANIEL SUMEREL, GENERAL MANAGER / S 1 6' /J 't1 - 3-Q (
Permittee(or Authorized Agent)Name and Title-Please print or type Signature Octo Permittee(or Authorized Agent) (Date)
GW-59 Rev.06-07-2018

. • SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING: Mail original DEPARTMENT OFINFORMATIONTPR CESSING UNITOF WATER RESOURCES
OMPLIANCE REPORT FORM and 1 copy to: 1617 MAIL SERVICE CENTER,RALEIGH,NC 27699-1617
f
AGILITY INFORMATION Please Print Clearly or Type PERMIT Number:
Non-Discharge WQ0029653 Expiration Date: 2/28/2026
acuity Name: SCOTCH HALL PRESERVE WWTPUIC
-ermit Name(if different): NPDES Other
Facility Address: MERRY HILL TYPE OF PERMITTED OPERATION BEING MONITORED
ERRY HILL NC 27957 County BERTIE ❑ Lagoon ❑ Remediation: Infiltration Gallery
NI Spray Field ❑ Remediation:
ontact Person: BRIAN JERNIGAN Telephone#: [phone] ❑ Rotary Distributor 0 Land Application of Sludge
ell Location/Site Name:SCOTCH HALL PRESERVE No.of wells to be sampled: 3 0 Water Source Heat Pump 0 Other:
(from Permit)
SAMPLING INFORMATION If WELL
WELL ID NUMBER(from Permit): MW2 Date sample collected: 3/11/2021 FIELD ANALYSES: WAS
Well Depth: 20 ft. Well Diameter:2 in. pH 00400:5.20 units Temp.00010: 14.3 °C DRY at
Depth to Water Level 82546:11.2 ft. below measuring point Screened Interval: 5 ft. to 20 ft. Spec. Cond.00094: µMhos time of
sampling,
Measuring Point is 3 ft.above land surface Relative M.P. Elevation: ft. Odor 00085: NONE check
Volume of water pumped/bailed before sampling: 3.5 gallons Appearance TAN here:❑
Samples for metals were collected unfiltered: ®YES 0 NO and field acidified: ®YES ❑NO
LABORATORY INFORMATION
Date sample analyzed: 3/it/goal Laboratory Name: ENVIRONMENTAL CHEMISTS INC Certification No. 94
PARAMETERS NOTE:Values should reflect dissolved and colloidal concentrations.
COD 00335 mg/L Nitrite(NO2)as N 00615<0.02 mg/L Pb-Lead o1051 ug/L
Coliform: MF Fecal 31616<1 /100mL Nitrate(NO3)as N 00620 0.05 mg/L Zn-Zinc 01092 mg/L
Coliform: MF Total 31504 /100mL Phosphorus: Total as P 00665 0.19 mg/L
(Note: Use MPN method for highly turbid samples) Orthophosphate 70507 mg/L Other(Specify Compounds and Concentration Units):
P issolved Solids:Total 70300 51 mg/L Al-Aluminum 01105 mg/L
pH (Lab)00403 5.20 units Ba-Barium 01007 ug/L
TOC 00680 1.2 mg/L Ca-Calcium 00916 mg/L
Chloride 00940<5 mg/L Cd-Cadmium 01027 ug/L
Arsenic o1002 ug/L Chromium:Total 01034 ug/L
Grease and Oils 00552 mg/L Cu-Copper 01042 mg/L ORGANICS: (by GC, GC/MS, HPLC)
Phenol 32730 ug/L Fe-Iron 01045 ug/L (Specify test and method#.ATTACH LAB REPORT.)
Sulfate 00945 mg/L Hg-Mercury 71900 ug/L Lab Report Attached? 0 Yes(1) ❑ No(0)
specific Conductance 00095 µMhos K-Potassium 00937 mg/L VOC 7873 , method#
Total Ammonia 00610<0.2 mg/L Mg-Magnesium 00927 mg/L , method#
(Ammonia Nitrogen;NH3as N;Ammonia Nitrogen,Total) Mn-Manganese 01055 ug/L , method#
TKN as N 00625 0.05 mg/L Ni-Nickel 01067 ug/L , method#
For Remediation Systems Only(Attach Lab Reports): Influent Total VOCs: mg/L Effluent Total VOCs: mg/L VOC Removal%
:I certify that,to the best of my knowledge and belief.the information submitted in this report is true,accurate,and complete and that the laboratory analytical data was produr:r 0 , r;; wed mrrthods of analysis by a
:DWR-ceihfied laboratory. I am aware that there are significant penalties for submitting false information.including the possibility of fines and imprisonment for knowing violations.
.DANIEL SUMEREL, GENERAL MANAGER r
1 -a3-a
Permittee(or Authorized Agent)Name and Title-Please print or type Sipnatu =of ermittee(or Authorize (Date)
GW-59 Rev.06-07-2018

i
SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING: Mail original DEPARTMENT OFINFORMATIONTPR CESSINGU ITAL QUALITY-Div.OF WATER RESOURCES
COMPLIANCE REPORT FORM and 1 Copy to: 1617 MAIL SERVICE CENTER,RALEIGH,NC 27699-1617
FACILITY INFORMATION Please Print Clearly or Type PERMIT Number: Expiration Date: 2/28/2026
Facility Name: SCOTCH HALL PRESERVE WWTP Non-Discharge WQ0029653 UIC
Permit Name(if different): NPDES Other
Facility Address: MERRY HILL TYPE OF PERMITTED OPERATION BEING MONITORED
MERRY HILL NC 27957 County BERTIE ❑ Lagoon ❑ Remediation: Infiltration Gallery
® Spray Field ❑ Remediation:
Contact Person: BRIAN JERNIGAN Telephone#: [phone] ❑ Rotary Distributor ❑ Land Application of Sludge
Well Location/Site Name:SCOTCH HALL PRESERVE No.of wells to be sampled: 3 ❑ Water Source Heat Pump ❑ Other:
(from Permit)
SAMPLING INFORMATION If WELL
WELL ID NUMBER(from Permit): MW3 Date sample collected: 3/11/2021 FIELD ANALYSES: WAS
Well Depth: 20 ft. Well Diameter: 2 in. pH 00400:6.08 units Temp.00010: 17.9 °C DRY at
Mhos time of
Depth to Water Level 82546:14.3 ft, below measuring point Screened Interval: 5 ft. to 20 ft. Spec.Cond.00094: µ sampling,
Measuring Point is 3 ft.above land surface Relative M.P. Elevation: ft. Odor 00085: NONE check
Volume of water pumped/bailed before sampling: 2.5 gallons Appearance RUST/BROWN here:❑
Samples for metals were collected unfiltered: EYES ❑ NO and field acidified: I YES ❑NO
LABORATORY INFORMATION
Date sample analyzed:3/11/2021 Laboratory Name: ENVIRONMENTAL CHEMISTS INC Certification No. 94
PARAMETERS NOTE:Values should reflect dissolved and colloidal concentrations.
COD 00335 mg/L Nitrite(NO2)as N 00615<0.02 mg/L Pb-Lead 01051 ug/L
Coliform: MF Fecal 31616<1 /100mL Nitrate(NO3)as N 00620 0.82 mg/L Zn-Zinc 01092 mg/L
Coliform: MF Total 31504 /100mL Phosphorus: Total as P 00665 1.01 mg/L
(Note: Use MPN method for highly turbid samples) Orthophosphate 70507 mg/L Other(Specify Compounds and Concentration Units):
Dissolved Solids:Total 70300 85 mg/L Al-Aluminum 01105 mg/L
pH (Lab)00403 6.08 units Ba-Barium 01007 ug/L
TOC 00680 0.9 mg/L Ca-Calcium 00916 mg/L
Chloride 00940 25 mg/L Cd-Cadmium 01027 ug/L
Arsenic 01002 ug/L Chromium:Total 01034 ug/L
Grease and Oils 00552 mg/L Cu-Copper 01042 mg/L ORGANICS: (by GC, GC/MS, HPLC)
Phenol 32730 ug/L Fe-Iron 01045 ug/L (Specify test and method#.ATTACH LAB REPORT.)
Sulfate 00945 mg/L Hg-Mercury 71900 ug/L Lab Report Attached? ❑ Yes(1) ❑ No(0)
Specific Conductance 00095 µMhos K-Potassium 00937 mg/L VOC 7873 , method#
Total Ammonia 00610<0.2 mg/L Mg-Magnesium 00927 mg/L , method# _
(Ammonia Nitrogen;NH3 as N;Ammonia Nitrogen,Total) Mn-Manganese 01055 ug/L , method#
TKN as N 00625 0.82 mg/L Ni-Nickel 01067 ug/L , method#
For Remediation Systems Only(Attach Lab Reports): Influent Total VOCs: mg/L Effluent Total VOCs: mg/L VOC Removal%
I certify that,to the hest of my knowledge and belief.e. I in this report is true,accurate.and complete,and that the laboratory analytical data was produr ad using approved methods of analysis by a
MR-certified laboratory. I am aware that there arc siyndn till;n nails s for submitting false information,including the possibility of fines and imprisonment for knowing violations.
DANIEL SUMEREL, GENERAL MANAGER �' i L('A.3—r ,i
Permittee(or Authorized Agent)Name and Title-Please print or type Sign a of'ermittee(or Atithoriz nt) (Date)
GW-59 Rev.06-07-2018

Environmental Chemists, Inc.
envirochem 6602 Windmill Way,Wilmington,NC 28405 • 910.392.0223 Lab • 910.392.4424 Fax
710 Bowsertown Road,Manteo,NC 27954 • 252.473.5702 Lab/Fax
255-A Wilmington Highway,Jacksonville,NC 28540 • 910.347.5843 Lab/Fax
ANALYTICAL&CONSULTING CHEMISTS [e-mail]
Scotch Hall Preserve Date of Report: Mar 26, 2021
105 Scotch Hall Court Customer PO#:
Merry Hill NC 27957 Customer ID: 17050011
Attention: Brian Jernigan Report#: 2021-04149
Project ID: Monitoring Wells
Lab ID Sample ID: Collect Date/Time Matrix Sampled by
21-10193 Site: MW-1 3/11/2021 9:38 AM Water Tom Beasley
Test Method Results Date Analyzed
Color Color Clear 03/11/2021
Depth to water, ft. Depth to Water,Ft. 4.7 feet 03/11/2021
Ammonia Nitrogen EPA 350.1 < 0.2 mg/L 03/17/2021
Gallons bailed before sampling Gallons Bailed before sampling 3.0 gallons 03/11/2021
Odor Qualitative None 03/11/2021
Total Dissolved Solids (TDS) SM 2540 C 84 mg/L 03/12/2021
Temperature SM 2550 B 12.7 C 03/11/2021
Chloride SM 4500 CI E 8 mg/L 03/15/2021
pH SM 4500 H B 5.29 units 03/11/2021
Total Phosphorus SM 4500 P F 0.34 mg/L 03/24/2021
Total Organic Carbon (TOC) SM 5310 B 2.2 mg/L 03/16/2021
Fecal Coliform SM 9222D MF <1 Colonies/100mL 03/11/2021
Nitrate Nitrogen (Calc)
Nitrite Nitrogen EPA 353.2 < 0.02 mg/L 03/11/2021
Nitrate+Nitrite-Nitrogen EPA 353.2 2.40 mg/L 03/17/2021
Nitrate Nitrogen Subtraction Method 2.40 mg/L 03/25/2021
Report# 2021-04149 0 ,

enviroche><a ENVIRONMENTAL CHEMISTS, I N C Of E:910i 392-0223iIFAX 91on,NC
0 392-44245
Analytical&Consulting Chemists NCDENR:DWQ CERTIFICATION#94 NCDHHS:DLS CERTIFICATION#37729 [e-mail]
COLLECTION AND CHAIN OF CUSTODY
Client: Scotch Hall Preserve PROJECT NAME: Monitoring Wells REPORT NO: 2,/ --, el/4/ C;
ADDRESS: 105 Scotch Hall Court CONTACT NAME: Brian Jernigan PO NO:
Merry Hill, NC 27957 REPORT TO: PHONE/FAX:
COPY TO: Rick Harrell [e-mail] email: [e-mail]
�'"�
Sampled By: / SAMPLE TYPE: I=Influent, E=Effluent,W=Well,ST=Stream,SO=Soil,SL=Sludge,Other:
Collection 2 m _ , PRESERVATION
Sample Identification E o `: c m
A ►- E S V. c ' g 2 z ' o o w ANALYSIS REQUESTED
Date Time Temp y z' z° _ _ _ $ o
1-11-2-/ inss c P
MW: 1
G G 10 19J' X Chloride, NO2, TDS
f •-I C P
Depth to water: `I Z' I G G L X NH3,NO3, TP
C p
Gallons Bailed: 3, 0 G G X Fecal Coliform
C
pH (field): 5 ,2Q
f GC P GP X TOC
Color: C.(c-Ar- G G
C P
Odor: N 0 3--f-Z) 0?3 L, G G
C P
G G
C P
G G
C P
G G
Total of 3 wells(1,2,3)due March,July, November
Transfer Relinquished By: Date/Time Received By: Date/Time
1.
2.
Temperature when Received°C: 4" Accepted: Z/ Rejected: Resample Requested:
Delivered By: Received By: Date: 3//- Z/ Time:
Comments:
TURNAROUND:

Environmental Chemists, Inc.
envirochem 6602 Windmill Way,Wilmington,NC 28405 • 910.392.0223 Lab • 910.392.4424 Fax
710 Bowsertown Road,Manteo,NC 27954 • 252.473.5702 Lab/Fax
sM 255-A Wilmington Highway,Jacksonville,NC 28540 • 910.347.5843 Lab/Fax
ANALYTICAL&CONSULTING CHEMISTS info'u environmentalchemists.com
Scotch Hall Preserve Date of Report: Mar 26, 2021
105 Scotch Hall Court Customer PO #:
Merry Hill NC 27957 Customer ID: 17050011
Attention: Brian Jernigan Report#: 2021-04149
Project ID: Monitoring Wells
Lab ID Sample ID: Collect Date/Time Matrix Sampled by
21-10194 Site: MW-2 3/11/2021 9:28 AM Water Tom Beasley
Test Method Results Date Analyzed
Color Color Tan 03/11/2021
Depth to water, ft. Depth to Water,Ft 11.2 feet 03/11/2021
Ammonia Nitrogen EPA 350.1 < 0.2 mg/L 03/17/2021
Gallons bailed before sampling Gallons Bailed before sampling 3.5 gallons 03/11/2021
Odor Qualitative None 03/11/2021
Total Dissolved Solids (TDS) SM 2540 C 51 mg/L 03/12/2021
Temperature SM 2550 B 14.3 C 03/11/2021
Chloride SM 4500 CIE < 5 mg/L 03/15/2021
pH SM 4500 H B 5.20 units 03/11/2021
Total Phosphorus SM 4500 P F 0.19 mg/L 03/24/2021
Total Organic Carbon (TOC) SM 5310 B 1.2 mg/L 03/16/2021
Fecal Coliform SM 9222D MF <1 Colonies/100mL 03/11/2021
Nitrate Nitrogen (Calc)
Nitrite Nitrogen EPA 353.2 < 0.02 mg/L 03/11/2021
Nitrate+Nitrite-Nitrogen EPA 353.2 0.05 mg/L 03/16/2021
Nitrate Nitrogen Subtraction Method 0.05 mg/L 03/25/2021
Report#. 2021-04149 ___

•
enviroche > ENVIRONMENTAL CHEMISTS, I N C 660
f SCE:91 U 392-0223i1FAX [phone]
m
Analytical&Consulting Chemists NCDENR: DWQ CERTIFICATION#94 NCDHHS: DLS CERTIFICATION#37729 [e-mail]
COLLECTION AND CHAIN OF CUSTODY _
Client: Scotch Hall Preserve PROJECT NAME: Monitoring Wells REPORT NO: Z I — y/Y,'
ADDRESS: 105 Scotch Hall Court CONTACT NAME: Brian Jernigan PO NO:
Merry Hill, NC 27957 REPORT TO: PHONE/FAX:
r
I. COPY TO: Rick Harrell [e-mail] email: [e-mail]
Sampled By: ,
SAMPLE TYPE: I=Influent, E=Effluent,W=Well, ST=Stream,SO=Soil, SL=Sludge,Other:
Collection
PRESERVATION
fii
Sample Identification E 1 i; 0 i. o = ° m
F- E c� c - -°� E a i o p 0 w ANALYSIS REQUESTED
Date Time Temp N v v a v -' z i = _ = z o
2_ 3-«-zl 01'Z9 C P
MW: l G G 10174 X Chloride, NO2, TDS
C P 44
Depth to water: 1( Z I L . 3 G G �. ,6- X NH3,NO3, TP
C P
Gallons Bailed: 3, G G X Fecal Coliform
1 C P
pH (field): 5 •2. G G
X TOC
C P
Color: "(WO G G
C P
Odor: IJ 0 3- rnc,�I1-2.j V / 9 G G
C P
G G
C P
G G
C P r
G G
Total of 3 wells (1,2,3)due March,July, November
Transfer Relin uished B
_ Y• Date/Time Received By: Date/Time
1. 3-If-ZI
2.
Temperature when Received °C: Ti ,4 Accepted: /- Rejected: Resample Requested:
Delivered By: L _ Received By:
Date: Time:
Comments: TURNAROUND:

•
Environmental Chemists, Inc.
envirochem 6602 Windmill Way,Wilmington,NC 28405 • 910.392.0223 Lab • 910.392.4424 Fax
710 Bowsertown Road,Manteo,NC 27954 • 252.473.5702 Lab/Fax
sM 255-A Wilmington Highway,Jacksonville,NC 28540 • 910.347.5843 Lab/Fax
ANALYTICAL&CONSULTING CHEMISTS [e-mail]
Scotch Hall Preserve Date of Report: Mar 26, 2021
105 Scotch Hall Court Customer PO#:
Merry Hill NC 27957 Customer ID: 17050011
Attention: Brian Jernigan Report#: 2021-04149
Project ID: Monitoring Wells
Lab ID Sample ID: Collect Date/Time Matrix Sampled by
21-10195 Site: MW-3 3/11/2021 9:16 AM Water Tom Beasley
Test Method Results Date Analyzed
Color Color Rust/Brown 03/11/2021
Depth to water, ft. Depth to Water,Ft. 14.3 feet 03/11/2021
Ammonia Nitrogen EPA 350.1 < 0.2 mg/L 03/17/2021
Gallons bailed before sampling Gallons Bailed before sampling 2.5 gallons 03/11/2021
Odor Qualitative None 03/11/2021
Total Dissolved Solids(TDS) SM 2540 C 85 mg/L 03/12/2021
Temperature SM 2550 B 17.9C 03/11/2021
Chloride SM 4500 CI E 25 mg/L 03/15/2021
pH SM 4500 H B 6.08 units 03/11/2021
Total Phosphorus SM 4500 P F 1.01 mg/L 03/24/2021
Total Organic Carbon (TOC) SM 5310 B 0.9 mg/L 03/17/2021
Fecal Coliform SM 9222D MF <1 Colonies/100mL 03/11/2021
Nitrate Nitrogen (Calc)
Nitrite Nitrogen EPA 353.2 < 0.02 mg/L 03/11/2021
Nitrate+Nitrite-Nitrogen EPA 353.2 0.82 mg/L 03/16/2021
Nitrate Nitrogen Subtraction Method 0.82 mg/L 03/25/2021
Comment:
Reviewed by: kt,'7.,tT, /
Report#:: 2021-04149 pap 1"r 1

envirochem* ENVIRONMENTAL CHEMISTS INC 6602 Windmill Way Wilmington,NC 28405
7 OFFICE:910-392-0223 FAX [phone]
Analytical&Consulting Chemists NCDENR: DWQ CERTIFICATION#94 NCDHHS: DLS CERTIFICATION#37729 [e-mail]
COLLECTION AND CHAIN OF CUSTODY f C/
Client: Scotch Hall Preserve PROJECT NAME: Monitoring Wells REPORT NO: Z 'l - `7 / 7 Y
ADDRESS: 105 Scotch Hall Court CONTACT NAME: Brian Jernigan PO NO:
Merry Hill, NC 27957 REPORT TO: PHONE/FAX:
COPY TO: Rick Harrell [e-mail] email: [e-mail]
Sampled By: ts,..,, 3 SAMPLE TYPE: I =Influent, E=Effluent,W=Well,ST=Stream,SO=Soil,SL=Sludge,Other:
Collection
y o W PRESERVATION
Sample Identification E ; i; m
m �- E c� c ° t E m 1 - v `o p oz o w ANALYSIS REQUESTED
Date Time Temp `" u u Q. o g Z ° I _ _ `_ = 0
�j 3-11-2.l 05i ( C P
MW: . G G /0I 97 X Chloride, NO2, TDS
J' I' ` C P <.Z.
Depth to water: `j `t G G 4: .7 X NH3,NO3, TP
q C P
Gallons Bailed: 2, 7 ) G G X Fecal Coliform
r Q� C P
pH (field): �Q G G
X TOC
C P
Color: RVqt 3 w N G G
C P
Odor: N 0 3-11-2( 091 1 G G
C P
G G
C P
G G
C P
G G
Total of 3 wells(1,2,3) due March,July, November
Transfer Relinquis d By: Date/Time Received
�/ -- By: Date/Time
1. 3-II-2I
2.
Temperature when Received °C: ,•k-( Acce ted: ti Rejected: Resas le equested:
Delivered By: Received By: 7 _ Date. 11 Time:
,Comments: TURNAROUND:U AROUND: