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HomeMy WebLinkAboutMO-4641_15664_CA_CLO_19920205_Report of Underground Storage Tank ClosureLAW ENVIRONMENTAL, INC. 4333 WILMONT ROAD • SUITE 300 CHARLOTTE, NORTH CAROLINA 28208 TO: A't44 Ca,,ol/nh Div%f/�r o� �y�irrh�� N, pa"" 1fe L/�Oo rcld� NG � I DATE a� JOB NO. PROJE N s 4r_ Q� � r- i �/1-k O4C6c ATTENTION: J /C� ^ e�t RE: vd�l ,A/ � tnu&t o yo!ly��� -art-, c✓%u2 Y�.150U7-CV5 AND p EE �9 ldl 3 LETTER OF TRANSMITTAL Of MAUGIMEI1T GENTLEMEN: WE ARE SENDING YOU Attached ❑ Under separate cover via the following items: ❑ Shop drawings ❑ Prints ❑ Plans ❑ Samples ❑ Specifications J Copy of letter ❑ Change order ❑ Go�a�vy IF ENCLOSURES ARE NOT AS NOTED, KINDLY NOTIFY US AT ONCE. COPIES DATE NO. DESCRIPTION Lm6o,�Nf ✓Lett*/`/ 3 THESE ARE TRANSMITTED as checked below: COPY TO ❑ For approval 13"For your use C�1As requested ❑ For review and comment ❑ FOR BIDS ❑ Approved as submitted ❑ Approved as noted ❑ Returned for corrections ❑ Resubmit copies for approval ❑ Submit copies for distribution ❑ Return corrected prints 19 ❑ PRINTS RETURNED AFTER LOAN TO US A/&1 . � a-e- 7�c 1 Xis eel /�Oo ffc-,5 44�- 41wl. Signed: WHITE - ORIGINAL CANARY - FILE COPY N.C> DEPT, OIP t'NVIR.ONIP.9Ph1'i, ' '"4 &NA'T`URAL P1',3,i';;_. First Colony Corporation P.O. Box 31876 Charlotte, North Carolina 28231 Attention: Mr. Hayden McMahon FEES'' � q February 51992 DAWJ rP M'�Li'� i' tit',: LAW ENGINEERING Subject: Report of Underground Storage Tank Closure Coltsgate Road Site Charlotte, North Carolina Law Job No. 229-07757-02 A MEMBER OF LAW COMPANIES GROUP As authorized by our Work Authorization Sheets dated January 10, 1992 and January 20, 1992, Law Engineering has monitored the tank closure operations at the site. In addition, we installed a temporary observation well (TW-1) and sampled the ground water for laboratory analysis. Project Information Two 550-gallon home heating oil underground storage tanks (USTs) were noted during the site walkover performed by our Mr. David Jerose as part of a Preliminary Environmental Site Assessment (Law Job No. 229-07757-01) at the Coltsgate Road Site in Charlotte, North Carolina. Due to expected construction activities at the site, the USTs were scheduled for removal. Law Engineering was requested to observe and document the tank excavation activities and collect soil samples for laboratory analysis. The above project information was based on a telephone conversation between our Mr. David Jerose and Mr. Hayden McMahon of First Colony Corporation on January 8, 1992 and the Report of Preliminary Environmental Site Assessment performed by Law Engineering. Tank Closure Activities 2 5`v Two -550-gallon USTs were excavated and removed from the site by Curbmaster Inc. on January 10, 1992. The excavated tanks were pitted and contained several holes. The soils in the excavations appeared discolored and a strong fuel oil odor was noted. Based on our observations, soil samples (Block-! and Block-2) were collected at 13 feet at the base of the excavations. As authorized, Law Engineering also contacted the North Carolina Division of Environmental Management (DEM) to notify them of a potential release. Apparent petroleum contaminated soils (approximately 65 cubic yards) were stockpiled on plastic sheeting at the site. Analytical results of the soil samples from the base of the excavations indicated �tha_total petroleum hydrocarbons (semi -vol ati1es) were present in sample Block- 7 at 18 parts per million (ppm). No petroleum hydrocarbons were noted in sample Block-2 above the detection limit of 10 ppm. Based on the results from Block-1, additional excavation activities were performed on January 15, 1992. A soil sample (Block- /V�� y , 1A) was obtained at the base of the excavation at 17 feet. The analytical results indicated that no petroleum hydrocarbons were present above the detection P.O. BOX 11297 CHARLOTTE, NC 28220 4333 WILMONT ROAD, SUITE 100 CHARLOTTE, NC 28217 704-357-8600 FACSIMILE 704-357-8639 First Colony Corporation Law Job No. 229-07757-02 February 5, 1992 limit; however, water was noted seeping into the excavation at 14 feet and an oily sheen was observed. Law also obtained a composite soil sample from the stockpile. The results of the stockpile sample indicated total petroleum hydrocarbons (semi-volatiles) at 2400 ppm. Ground -Water Sampling and Analysis Based on the site observations, Law installed a temporary observation well (TW-1) on January 21, 1992 downgradient from the tank excavation (Figure 1) to determine if petroleum contaminants were present on the ground water. The results of the polynuclear aromatic hydrocarbons (EPA Method 610) analysis indicated that naphthalene was present at 86 parts per billion (ppb), 2- Methylnaphthalene at 89 ppb and 1-Methylnaphthalene at 55 ppb. The laboratory results of the water sample and soils samples are attached. Chain of custody procedures were maintained. Comments and Recommendations At this time, no standards have been set for the detected petroleum constituents by the DEM; thus, the constituents detected above the practical quantitation limit (PQL) in well TW-1 are considered ground -water contamination by the DEM. Typically, the DEM would require a ground -water contamination assessment to determine the extent of contamination; however, since the levels are relatively low and the source (UST and contaminated soils) has been removed, it may be prudent to request the DEM if periodic monitoring of the groundwater would be appropriate for this site. Closing Law Engineering appreciates the opportunity to offer our professional environmental services on this project. Mr. Corbitt will be contacting you in a few days to answer any questions concerning this report. Sincerely, LAW ENGINEERING Christopher L. Corbitt, P.G. Senior Geologist Robert E. Smith, Jr., P.E. Chief Engineer FIGURE LAW ENGINEERING REF.: CITY OF CHARLOTTE, TOPOGRAPHIC MAP, SHEET No. 127, DATED 1980 3 CENTER E30 970 EXPLANATION x 1 x 69P.7 APPROX. SITE BOUNDARY SOUTH PARK MALL 696. 6971 /c x FT-1 FORMER UNDERGROUND STORAGE TANK LOCATION TW-1 TEMPORARY MONITORING WELL 6974 s/A LOCATION PARKING' AREA 69Z 680-2. x P/A -,P�RKING' It /I J %REA Leo P/A \4- 5. 702.4 V 2 x Sri 6 Tw-T 701.2 x BLOCK I 660 Al 680 70,?2 0 P/A 0 200 400 x 707.8 70 APPROX.SCALE, FT P/A 708. LAW ENGINEERING x 8 V CHARLOTTE, NORTH CAROLINA c pli. x x 08.8 TEMPORARY WELL LOCATION COLTSGATIE ROAD 709.7 70 x 1/0 f k, 772CHARLOTTE. NORTH CAROLINA , x P/A 692.5 b 71J. 5 ,695.6 -07757-02 FIGURE JOB NO. 229 7 1 APPENDIX LAW ENGINEERING LAW ENVIRONMENTAL, INC. NATIONAL LABORATORIES DIVISION 300 CHASTAIN CENTER BLVD. SUITE 315 KENNESAW, GEORGIA 30144 404-426-4309 FAX 426-0243 January 14, 1992 Law Engineering, Inc. 4333 Wilmont Road, Ste. 100 Charlottte, NC 28217 Attention: Dave Jerose LE Job Number: 2290775702 Subject: Chemical Analysis of Samples Received on 01/11/92. Dear Mr. Jerose: Law Environmental National Laboratories has completed its analysis of your samples and reports the results on the following pages. These results relate only to the contents of the samples as submitted. This report shall not be reproduced except in full without the approval of Law Environmental National Laboratories. If there are any questions, please do not hesitate to contact us. Sincerely, LAW ENVIRONMENTAL NATL LABS Linda Harris Hydrocarbon Laboratory Supervisor Attachment: Data Report Invoice LAW ENVIRONMENTAL NATIONAL LABORATORIES TEST DATA REPORT Date 01/15/92 Page 1 --- Project Information --- Lab Number : 62-3643-01 Project No. : 2290775702 Cust. No. : Project Name : COLTSGATE ROAD Manager: DAVID JEROSE Station ID : BLOCK 1 @ 13.0' Matrix : SO Type : GRAB Collector : CNN --- Sample Information --- Sampled Date/Time : 01/10/92 14:30 Received Date/Time : 01/11/92 15:00 Received From/By : GP/ST Chain of Custody : 4111 Number of Containers : 1 Remarks : *THE CHROMATOGRAM RESEMBLES THAT OF DIESEL WITH HEAVIER CONSTITUENTS. --- Test Data --- Parameter .............................. Method.... Units PQL....... Results... Test Date Ana] -- SAMPLE PREPARATION RESULTS -- EXT/TPH SEMI-VOLATILE/SO/SON SF 3550 NA 01/13/92 JMK MOISTURE (Oven Dried @ 105 C) EPA 160.3M wt % 1 26 01/14/92 JMK --- SERIES 17000 TPH-SEMI-VOLATILE EPA SFB mg/kg 10 18* 01/14/92 RO Signed LAW ENVIRONMENTAL NATIONAL LABORATORIES TEST DATA REPORT Date 01/15/92 Page 1 --- Project Information --- Lab Number : 62-3643-02 Project No. : 2290775702 Cust. No. Project Name : COLTSGATE ROAD Manager: DAVID JEROSE --- Sample Information --- Station ID : BLOCK 2 @ 13.0' Sampled Date/Time 01/10/92 15:00 Matrix : SO Received Date/Time 01/11/92 15:00 Type : GRAB Received From/By GP/ST Collector : CNN Chain of Custody 4111 Number of Containers 1 Remarks : --- Test Data --- Parameter .............................. Method.... Units PQL....... Results... Test Date Ana -- SAMPLE PREPARATION RESULTS -- EXT/TPH SEMI-VOLATILE/SO/SON SF 3550 NA 01/13/92 JMK MOISTURE (Oven Dried @ 105 C) EPA 160.3M wt % 1 15 01/14/92 JMK --- SERIES 17000 TPH-SEMI-VOLATILE EPA SFB mg/kg 10 ND 01/14/92 RO \ Signed r'� 41 LLL �� ME v d J J m o m D m m X C U i O z m O Z � O � r :0 Z m p z a O c� < n Cn D m r m Cl) m D (n C) m D O z 0{ Cl) (� D o� { r ,m � _ D z m m p z {o r 03 D mo ml o r-0cmim c p r D O m m K m p O :u Z_ r m I O Z m � � r Z r cnG. O:� m N O m n m Z p z 0 Cn a: O c D :0 -0G Z m D z m m D�ozoco c m O O m c cn O m D D D z �j Cp m O D U) m m _ z O (A I Cn I m m N! O U m zi mil% D I GRAB c z! Vmi• O m COMP. C m - V ^ m pI N) V c rr T g (I m m Z 6 O� cn M D z 70 mI i Z ,V i mi I Z T D r Y TOTAL NO. OF o z v CONTAINERS (mn D z po c�� T9j2F9 Z O c co z o/CL !C �9 TEA N m ti, F ?G � D �, K m i m m O o /y Sip �spJ D T p D p n 9� m 7 I A 20 m A� 0 x /7 i�boy°% l A� 9CP�O�B 0�6/C (T l9- n .r 10 z o D > J J > D m V ;� i J z r � /✓ D o r 2 D Z O c q v m O v SHIPPER INSPECTION FORM JOB NUMBER:, 2 1 y 0 7 7 s— 7 v z l/ JOB NAME: _ C v L r s c- 4 1-. 1�0 .4 n ARE CUSTODY SEALS PRESENT? V N ARE CUSTODY SEALS INTACT? 0 N N/A INSPECTED BY: ,r /j� DATE: LAW ENVIRONMENTAL, INC. NATIONAL LABORATORIES DIVISION 300 CHASTAIN CENTER BLVD. SUITE 315 KENNESAW, GEORGIA 30144 404-426-4309 FAX 426-0243 January 20, 1992 Law Engineering, Inc. 4333 Wilmont Road, Ste. 100 Charlottte, NC 28217 Attention: David Jerose LE Job Number: 229-0775702.2 Subject: Chemical Analysis of Samples Received on 01/16/92. Dear Mr. Jerose: Law Environmental National Laboratories has completed its analysis of your samples and reports the results on the following pages. These results relate only to the contents of the samples as submitted. This report shall not be reproduced except in full without the approval of Law Environmental National Laboratories. If there are any questions, please do not hesitate to contact us. Sincerely, LAW ENVIRONMENTAL NATL LABS Linda Harris Hydrocarbon Laboratory Supervisor Attachment: Data Report Invoice LAW ENVIRONMENTAL NATIONAL LABORATORIES TEST DATA REPORT Date 01/20/92 Page 1 --- Project Information --- Lab Number : 62-3667-01 Project No. : 229-0775702.2 Cust. No. Project Name : COLTSGATE RD. Manager: DAVID JEROSE --- Sample Information --- Station ID : BLOCK 1-A @ 17.0' Sampled Date/Time : 01/15/92 13:1! Matrix : SO Received Date/Time : 01/16/92 15:5! Type : GRAB Received From/By : CNN/SN Collector : CNN Chain of Custody : 4512 Number of Containers : 1 Remarks : --- Test Data --- Parameter .............................. Method.... Units PQL....... Results... Test Date Any -- SAMPLE PREPARATION RESULTS -- EXT/TPH SEMI-VOLATILE/SO/SON SF 3550 NA 01/17/92 KH MOISTURE (Oven Dried @ 105 C) EPA 160.3M wt % 1 21 01/20/92 JM1 --- SERIES 17000 TPH-SEMI-VOLATILE EPA SFB mg/kg 10 ND 01/20/92 RO Signed U ZIP I m 0 m n D4 m � C N � 0 m O Z � O D r 73 Z m_ U' D < z 0O co:* li, O > I m m tm D m n O m m r > r z G � ("; D O� rn M m = z K m m o z W � jor 03 D O -4 D O 0 < m r OC)m m c O m O o z m0 O z m � � r Z r G) O m m O n m zcn=oz0 Oc: N m -0c m D z m m D n o z mmOG)� c D O m D m D Z:�cnmG) m D cn _ � cn ^ i v �1� /m /,/ 0 Z —cnci lco I GRAB D ml �} 3 Z m III m COMP. ( Ci� _ pan Z - V r c CA) IO ml� 1U'� 0 0 CDm 7 CD c m `. �T( � v j ; W f7 o m m m (n D A �)7 m 0 m_ m o O Z m m ) Oo < j n j! m d >o C , m �I vI I O 3 TOTAL NO. OF o m u CONTAINERS D z �o 00 cmn Z -� -K z m m m & IC �F9 m �nl ��� (n z > m m 1 O m o /ti SOS S�J �/ T 0 D to _ 9 (7 r mcn c A! �° j` �tiso/ r y m o r 0 a� I y qso J 0�6� f cq c; x2O� a P� �! p y �•A`�1�y� jl /Al r' ` � w 0 r z > z ' I D o� i b m 3 1 r m Z V oD m D co Q SAMPLE RECEIPT AND NON-CONFORMANCE FORM LENL#:� 7 �`` ��� /�� DATE: 1 -16 \ -.4i PROJECT NAME: CG IAA C ie,Y� PROJECT #: :�211 (-)1-7 % Z t A: PRELIMINARY EXAMINATION: Date shipment was opened: 1. Did shipment come with a shipping air bill? N NA 2. If YES document carrier and air bill # ' C� (% `� Y N -- 3. Were custody seals present? I Y / �N __- 4. Were custody seals intact? ( Y ) N NA 5. Were custody papers filled out properly? N _ 6. Did you sign custody papers? (Q1 N _ 7. Are sampling time(s) present? N --- S. Are sampling date(s) present? py, N - 9. Type of packing and ice used, A-n o"� _ �j(` z `(' e, Y N - B: LOGIN -IN PHASE Date samples were logged -in: q 1. Did all bottles arrive intact? N _ 2. Did all bottle labels agree with custody papers? N _ 3. Were proper containers used for requested test? N _ 4. Were correct preservatives added for requested test? Y 1 N - S. Was sufficient sample received for requested test? N 6. Were air bubbles present in VOA samples? Y N COMMENTS: �" ��7 _L � oJi-) C: CORRECTIVE ACTION: 1. Client notified verbally Date: Time: 2. Samples processed as received: ( Y l N COMMENTS: IN TIALS \ DATE SAMPLE CONTROL COORDINATOR ��� I I ID `q 2_ SAMPLE CONTROL SUPERVISOR l-1 �-•�i2 QC COORDINATOR LAB MANAGER LAW ENVIRONMENTAL, INC. NATIONAL LABORATORIES DIVISION 300 CHASTAIN CENTER BLVD. SUITE 315 KENNESAW, GEORGIA 30144 404-426-4309 FAX 426-0243 January 23, 1992 Law Engineering, Inc. 4333 Wilmont Road, Ste. 100 Charlottte, NC 28217 Attention: David Jerose LE Job Number: 2290775702.3 Subject: Chemical Analysis of Samples Received on 01/17/92. Dear Mr. Jerose: Law Environmental National Laboratories has completed its analysis of your samples and reports the results on the following pages. These results relate only to the contents of the samples as submitted. This report shall not be reproduced except in full without the approval of Law Environmental National Laboratories. If there are any questions, please do not hesitate to contact us. Sincerely, MONMENTAL NATL LABS , Linda Harris Hydrocarbon Laboratory Supervisor Attachment: Data Report Invoice 0 LAW ENVIRONMENTAL NATIONAL LABORATORIES TEST DATA REPORT Date 01/28/92 Page 1 --- Project Information --- Lab Number : 62-3675-01 Project No. : 2290775702.3 Cust. No. Project Name : COLTSGATE ROAD Manager: DAVE JEROSE --- Sample Information --- Station ID : STOCKPILE COMPOSITE Matrix : SO Type : COMP Collector : CNN Sampled Date/Time : 01/15/92 16:OC Received Date/Time : 01/17/92 13:40 Received From/By : CNN/AP Chain of Custody : 4514 Number of Containers : 1 Remarks : *THE CHROMATOGRAM RESEMBLES THAT OF DIESEL. --- Test Data --- Parameter .............................. Method.... Units PQL....... Results... Test Date Ana -- SAMPLE PREPARATION RESULTS -- EXT/TPH SEMI-VOLATILE/SO/SON SF 3550 NA 01/22/92 JMK MOISTURE (Oven Dried @ 105 C) EPA 160.3M wt % 1 22 01/24/92 JMK --- SERIES 17000 TPH-SEMI-VOLATILE EPA SFB mg/kg 10 2400* 01/27/92 RO Signed V 4 J .m v m D m C � C u O Z JJ z z' m z m z r- 0O K m m m m D 0 O m D oz 0 o> v �m -< D � Z m m a m O W D x 0 O m r-OCCim 0 r D O m m 0 m 0 O Z_ r m0 o z m i m r Z cn og� m rr- N O n m Z Cn 20 Z 0 0CD7J_0c Z cn inO> 0 Z CZ m 0 D ohm*(8 D m D m 7Do Z �3 Cn M G7 D U) _ 0 z' j m m � m C r- (u0 m = m /�� I Z ' / < r�DIV - D S D GRAB ai V _ , . ; ml 3 m III L1 COMP. m n D j C �/ p z p 1 TI j U o o .� m z m / D V .� 0 I ( o M o mo o j m a D W m m � O j (6 D m m o (� O S� W i m W Q i Q E) z, i ° I J l m! ! ml � 42m N Z TOTAL N0. OF o d CONTAINERS m n z Qo °2 �jC Tqi� !G, Oq Tyo Z � C) C zz m m 6o qy� yCi F '! G c �� (m m m � o � m o /ti Spy soy m ( o m n AT m A(j� �F9 CJ n I D i �f C m , ,�A�q�PfPco�6i I ( i c c �o?A( xy0%Ito` m m DSO %L/� O n < 7j10 7y� n o z' / c�J a000 I m % r ti �' V W D m m r m C " O G Z O n U) O v m O v SAMPLE RECEIPT AND NON-CONFORMANCE FORM LENL#:_DATE: 1 PROJECTNAME: `CI+Sc1,A4-C Pcl • PROJECT#: ZZ"I_G_� `� _� CZ . 3 A: PRELIMINARY EXAMINATION: Date shipment was opened: 1 -2- 1. Did shipment come with a shipping air bill? O N NA 2. If YES document carrier and air bill # f3j,. 6 8 0 0 5 4 5 8 3 Y N -- 3. Were custody seals present? ✓ YD� N -- 4. Were custody seals intact? CYJ N NA 5. Were custody papers filled out properly? N — 6. Did you sign custody papers? 9 N — 7. Are sampling time(s) present? N — S. Are sampling date(s) present? N — 9. Type of packing and ice used.PjL4?0,i' �l y roilyVyl 1,gc.r ut♦,; bLLue Y N — B: LOGIN -IN PHASE Date samples were logged -in: 1. Did all bottles arrive intact? Y N 2. Did all bottle labels agree with custody papers? N — 3. Were proper containers used for requested test? 1� N — 4. Were correct preservatives added for requested test? (� N — S. Was sufficient sample received for requested test? N — 6. Were air bubbles present in VOA samples? Y N �A COMMENTS: :ry) v Pre Vl c l In C: CORRECTIVE ACTION: 1. Client notified verbally Date: Time: 2. Samples processed as received: Y N COMMENTS: INITIALS DATE SAMPLE CONTROL COORDINATOR SAMPLE CONTROL SUPERVISOR QC COORDINATOR LAB MANAGER LAW ENVIRONMENTAL, INC. 112 TOWNPARK DRIVE KENNESAW, GEORGIA 30144-5599 404-421-3400 January 28, 1992 Law Engineering,Inc LakePoint Office Park 4333 Wilmont Road, Suite 100 Charlotte, NC 28217 Attention: David Jerose Subject: Chemical analysis of samples received on 01/22/92. Dear Mr. Jerose: Law Environmental National Laboratories has completed its analysis of your samples and reports the results on the following pages. These results relate only to the contents of the samples as submitted. This report shall not be reproduced except in full without the approval of Law Environmental National Laboratories. If there are any questions, please do not hesitate to contact us. Sincerely, LAW ENVIRONMENTAL NATL S i Clifford H. McBride QC Coordinator Attachment: Data Report Invoice LAW ENVIRONMENTAL NATIONAL LABORATORIES TEST DATA REPORT Date 01/28/92 Page 1 --- Project Information --- Lab Number : 92-1837-01 Project No. : 2290775702 T3 Cust. No. Project Name : COLTSGATE ROAD Manager: DAVID JEROSE --- Sample Information --- Station ID : TW 1 Sampled Date/Time : 01/21/92 12:55 Matrix : W Received Date/Time : 01/22/92 12:00 Type : GRAB Received From/By : SE/EES Collector : CVN Chain of Custody : 7248 Number of Containers : 2 Remarks : --- Test Data --- Parameter .............................. Method.... Units PQL....... Results... Test Date Anal -- ORGANIC PREP RESULTS -- Ext/PAH/W --- SERIES 57000 Naphthalene 2-Methylnaphthalene 1-Methylnaphthalene Acenaphthylene Acenaphthene Fluorene Phenanthrene Anthracene Fluoranthene Pyrene Benzo(a)anthracene Chrysene Benzo(b)fluoranthene Benzo(k)fluoranthene Benzo(a)pyrene Indeno(1,2,3)pyrene Dibenzo(a,h)anthracene Benzo(g,h,i)perylene 3510/610 N/A O1/22/92 TGU EPA 610 ug/1 10 86 01/23/92 DJ EPA 610 ug/1 10 89 01/23/92 DJ EPA 610 ug/1 10 55 01/23/92 DJ EPA 610 ug/1 10 ND O1/23/92 DJ EPA 610 ug/1 10 ND O1/23/92 DJ EPA 610 ug/1 10 ND O1/23/92 DJ EPA 610 ug/1 10 ND O1/23/92 DJ EPA 610 ug/1 10 ND O1/23/92 DJ EPA 610 ug/1 10 ND O1/23/92 DJ EPA 610 ug/1 10 ND O1/23/92 DJ EPA 610 ug/1 10 ND O1/23/92 DJ EPA 610 ug/1 10 ND O1/23/92 DJ EPA 610 ug/l 10 ND O1/23/92 DJ EPA 610 ug/1 10 ND O1/23/92 DJ EPA 610 ug/1 10 ND O1/23/92 DJ EPA 610 ug/1 10 ND O1/23/92 DJ EPA 610 ug/1 10 ND O1/23/92 DJ EPA 610 ug/1 10 ND O1/23/92 DJ Signed 4��'�I / SAMPLE RECEIPT AND NON-CONFORMANCE FORM LENL#: / Z—/O3/ —61 �L DATE: &ZZ/Z2 PROJECT NAME: _ D/ S V� / e I1 �. PROJECT il: Zv 7Q ��5 / &) L A: PRELIMINARY EXAMINATION: Date shipment was opened: ,�z —,7 Z9z 1. Did shipment come with a shipping air bill? (Y—) N NA N. If YES document carrier and air bill x A f3 75684 5390 Y N 3. Were custody seals present? 4. Were custody seals intact? N NA S. Were custody papers filled out properly? (Y l N --- 6. Did you sign custody papers? (�Y*1) N --- 7. Are sampling time(s) present? { Y) N --- 8. Are sampling date(s) present? Y N --- 9. Type of packing and ice used. Y N B: LOGIN -IN PHASE Date samples were logged -in: 1. Did all bottles arrive intact? ( Y / N --- 2. Did all bottle labels agree with custody papers? (Y I N --- 3. Were proper containers used for requested test? (Y / N --- 4. Were correct preservatives added for requested test? (Y / N --- 5. Was sufficient sample received for requested test? (Y) N --- 6. Were air bubbles present in VOA samples? Y N NA COMMENTS: /V i C e --so b I C: CORRECTIVE ACTION: 1. Client notified verbally Date: Time: 2. Samples processed as received: f Y / N COMMENTS: INITIALS DATE SAMPLE CONTROL COORDINATOR SAMPLE CONTROL SUPERVISOR L7 Z_ QC COORDINATOR LAB MANAGER SHIPPER INSPECTION FORM JOB NAME: Co HS � JOB NUMBER: Z2 ( 0775 70 z ARE CUSTODY SEALS PRESENT? OY N ARE CUSTODY SEALS INTACT?0 N N/A INSPECTED BY: � _e DATE: Z L /2,---- r sl r of n J_ W � U m < r W O f- WLLI W i 2 T- z U — m w m Z O Z CO ?mo a ¢ 0 OLL z a Z 0 M w oN a�>Q W=Q � � 00 zQcCo D zz�<"' W o CD z a I J w Z J i I i o N m in r�6 %bJ w 0. /9Jo /deb y� osbx i y �y • cr °sue �d /e y/fin • iI w � 4 s _ _ Z m ; 80,/ w mr 0 I J10 !yam 6 w v ¢ u r i S83NId1N00 J0 'ON lViOi / N �S W z O 0 CL a Z 0 (a 0 2 U w m o � a r W J i w w cn ^ I a d m o W 3Z) E- S dW00 � a w a n U w F- o/ ava� z m w ' 'o �CL O 2 J 7 Z a m/ w Q a cn z3: LLI W U Q U) Z cWQwcn =Q�QZ) ��U)30 C7LU 0w=) N Y m ¢ O LLjQLL DaaCa�0 Uz02cnz W U J r J w Q � O O O 2 -j }Zotn wmcoCw7 Q J 0 W U O ::! m m m U) 00 d o< V� 'm O J om z 0 w w g z i a_ a n _~ 6 (n w LU m I� a a <° n }o Z J 2} d OU U. , QW r N a W o� r } m O o J Z } H Qcr J } J o.Y Z 0 0 `1 Fr z O n. z O F- N m `.e m Q L