HomeMy WebLinkAboutMO-88110_88110_CA_WSW_20181116_October 2018 Water Well Sampling Results - DuffeyJACOBS
November 16, 2018
Delivery via FedEx
Stephen and Teresa Duffey
11092 Poplar Tent Road
Huntersville, NC 28078
Subject: October 2018 Water Well Sampling Results
Poplar Tent Road Site, Concord, North Carolina
NCDEQ Groundwater Incident No. 88110
Dear Mr. and Mrs. Duffey,
14120 Ballantyne Corporate Place, Suite 200
Charlotte, North Carolina 28277
United States
T +1.704.544.4040
F +1.704.544.4041
www.jacobs.com
As you are aware, CH2M HILL North Carolina, Inc. (CH2M, now part of Jacobs Engineering Group Inc.),
working on behalf of Plantation Pipe Line Company (Plantation), has been monitoring groundwater in the
area of your property as part of a Corrective Action Plan (CAP) required by the North Carolina
Department of Environmental Quality (NCDEQ) in response to a turbine fuel release that occurred in April
1976. As part of this monitoring, samples were collected in October 2018 from the water supply well
located on your property. For the purposes of our monitoring activities, we have designated this well as
WSW-13.
The samples were analyzed by SGS Accutest Laboratories of Scott, Louisiana and TestAmerica of
Nashville, Tennessee for benzene, toluene, ethylbenzene, xylenes (BTEX), and naphthalene using
Environmental Protection Agency (EPA) Method 8260B. The BTEX and naphthalene compounds are
found in petroleum products and serve as an indicator of petroleum contamination in the environment.
The following is a summary of the October 2018 analytical results:
The samples collected on October 17, 2018, from well WSW-13, did not contain detectable
concentrations of BTEX or naphthalene.
Copies of the validated laboratory analytical reports are attached for your review (Attachment A). When
reviewing the attached laboratory reports, please refer to the results associated with Sample ID WSW-13.
If you have any questions or wish to discuss any matter involving these results or Plantation's monitoring
in the area, please do not hesitate to contact Mr. Jerry Aycock with Plantation at 770.751.4165.
Stephen and Teresa Duffey
November 16, 2018
Page 2 of 3
Sincerely,
Mike Skeean, P.E.
Project Manager
N.C. Professional Engineer
License No. 030914
JACO BS
Copies to: Jerry Aycock, Plantation (via email)
Trudy Beverly, North Carolina Department of Environmental Quality (via email)
William F. Pilkington, D.P.A, Cabarrus County Health Director/Cabarrus Health Alliance (via
email)
David Troutman, R.S., Environmental Health/Cabarrus Health Alliance (via email)
File —Jacobs
Attachment:
Attachment A — Laboratory Analytical Report
Attachment A
Laboratory Analytical Report
October 17, 2018
(Sample ID WSW-13)
JACOBS
Memorandum
14120 Ballantyne Corporate Place, Suite 200
Charlotte, North Carolina 28277
United States
T +1.704.544.4040
F +1.704.544.4041
www.iacobs.com
Subject
Data Validation Summary — Plantation Pipe Line Poplar Tent Road Site
Project Name
Plantation Pipe Line Poplar Tent Road Site
Attention
Kelly Ramsey/CLT, Jacobs
Mike Skeean/CLT, Jacobs
From
Juan Acaron/GNV, Jacobs
Date
November 2, 2018
Copies to
Tiffany Davis/GNV, Jacobs
1. Introduction
The purpose of this memorandum is to present the results of the data validation process for the water
supply well samples collected at the Plantation Pipe Line Company (PPL) Poplar Tent Road. The
samples were collected in October 2018.
Samples were submitted to SGS North America Inc. in Scott, Louisiana and Test America Laboratories in
Nashville, Tennessee for the following analyses:
• SW8260B Volatile Organic Compounds (VOCs)
These data were validated for compliance with the analytical method requirements. This process included
a review of these data to assess the accuracy, precision, and completeness based upon procedures
described in guidance documents such as the Environmental Protection Agency (EPA) National
Functional Guidelines for Organic Data Review (EPA 2017). The Quality assurance/quality control
(QA/QC) summary forms and data reports were reviewed and the resulting findings are documented
within each subsection that follows.
During the data validation, if QA/QC parameters were not within the acceptance limits, associated sample
results were appended with a primary qualifying flag that indicated a possible anomaly with these data.
The qualifying flags originated during the data review and validation processes. This qualification also
included the use of secondary sub -qualifier flags. The secondary qualifiers provide the reasoning behind
the assignment of a qualifier to these data. The definitions of the primary qualifiers are presented below.
2. Validation Flag Definitions
The following primary qualifiers were used to qualify the data:
[_]: Detected. The analyte was analyzed for and detected at the concentration shown.
[J]: Estimated. The analyte was present but the reported value may not be accurate or precise.
[U]: Undetected. The analyte was analyzed for but not detected above the method detection limit.
[UJ]: Detection limit estimated. The analyte was analyzed for but qualified as not detected; the
detection limit is estimated.
[R]: Rejected. The data are not useable.
[X]: Excluded. Data were not used due to another value being more appropriate.
JACOBS. Data Validation Summary — Plantation Pipe Line Poplar Tent Road Site
3. Organic Parameters
3.1 Quality Control Review
The following list represents the QA/QC measures that were reviewed during the data quality evaluation
procedure for organic data:
• Holding Times — The holding times are evaluated to verify that samples were extracted and
analyzed within holding times.
• Blank samples — Method blank and trip blank samples were provided for this project. Blank samples
enable the reviewer to determine if an analyte may be attributed to sampling or laboratory
procedures, rather than environmental contamination from site activities.
• Surrogate Recoveries — Surrogate Compounds are added to each sample and the recoveries are
used to monitor lab performance and possible matrix interference.
• Lab Control Sample (LCS) — These samples are a "controlled matrix", laboratory reagent water, in
which target compounds have been added prior to extraction/analysis. The recoveries serve as a
monitor of the overall performance of each step during the analysis, including sample preparation.
• Matrix Spike/Matrix Spike Duplicate (MS/MSD) Samples — Spike recovery is used to evaluate
potential matrix interferences, as well as accuracy. Precision information is also determined by
calculating the reproducibility between the recoveries of each spiked parameter.
• Field Duplicate Samples — These samples are collected to determine precision between a native
and its duplicate. This information can only be determined when target compounds are detected.
4. Volatile Organic Compound Analyses
The QA/QC parameters for VOC analyses by SW-846 8260B for all samples were within acceptable
control limits with the exceptions listed below. A brief overview of the data evaluation follows:
4.1 Holding Time
All holding time requirements were met.
4.2 Field Duplicates
Duplicate field samples were collected and submitted to the laboratory for analysis. There are two
conditions under which the native and field duplicate are deemed outside acceptance criteria. For
condition one, if a result for the native and field duplicate are less than five times the reporting limit, the
two results must be within one times the reporting limit to meet acceptance criteria. In condition two, if the
result is greater than five times the reporting limit, the two results must agree to within 20 percent relative
percent difference to meet acceptance criteria. No field duplicates were included in this data set.
4.3 Recoveries - Surrogate, MS/MSD and LCS/LCSD
Surrogates, MS/MSD, and LCS/LCSD recoveries all met acceptance criteria.
4.4 Analytical Blanks
No target analytes were detected in the blanks.
5. PARCC
Precision is defined as the agreement between duplicate results, and was estimated by comparing
duplicate MS recoveries, and field duplicate sample results. The precision between the duplicate MS
recoveries were within acceptable criteria indicating that the sample matrix did not interfere with the
overall analytical process.
Accuracy is a measure of the agreement between an experimental determination and the true value of
the parameter. In the case of VOC analysis, each of the samples were spiked with a surrogate compound
Data Validation Summary - Plantation Pipe Line Poplar Tent Road Site JACOBS
with a known concentration before preparation. The surrogate and MS/MSD data provides a measure of
the matrix effects as they may affect accuracy and precision of the analytical method. The LCS results
demonstrate accuracy of the method. Spike recoveries were within the method acceptance limits,
showing no evidence of matrix interferences that affect the usability of the data.
Representativeness criteria are a qualitative measure of the degree to which sample data accurately
and precisely represent a characteristic environmental condition. Representativeness is a subjective
parameter and is used to evaluate the efficacy of the sampling plan design. Representativeness was
demonstrated by providing full descriptions in the project scoping documents of the sampling techniques
and the rationale used for selecting sampling locations.
Completeness is defined as the percentage of measurements that are judged to be valid compared to
the total number of measurements made. There were no data rejected and or seen as not usable due to
quality control or sampling issues.
Comparability is another qualitative measure designed to express the confidence with which one data
set may be compared to another. Factors that affect comparability are sample collection and handling
techniques, sample matrix type, and analytical method. Comparability is limited by the other PARCC
parameters because data sets can be compared with confidence only when precision and accuracy are
known. Data from this investigation are comparable with other previous data collected at the site due to
the laboratories use of EPA or appropriate methods to analyze the samples and supported by the results
of the laboratory's analytical reports.
6. Conclusion
A review of the analytical data submitted regarding the investigation of PPL Poplar Tent Road sampling
event in October 2018 by Jacobs has been completed. The validation demonstrated that the analytical
systems were in control and all data results can be used in the decision -making process.
ffm
Scott, LA
The results set forth herein are provided by SGS North America Inc. a-Hl ydcopy 2. 0
Automated Report
Technical Report for
Kinder Morgan
CHMHNCC: PPL/Poplar Tent Road (Water Wells), Concord, NC
699855.PT.EM
SGS Job Number: LA48883
Sampling Date: 10/ 17/ 18
Report to:
Jacobs CH2M
14120 Ballantyne Corporate Place
Charlotte, NC 28277
mike. skeean@jacobs. com; kelly.ramsey@ch2m.com
ATTN: Mike Skeean
Total number of pages in report: 15
Ac Fp
Ar .
Test results contained within this data package meet the requirements Ron Benj a illl n
of the National Environmental Laboratory Accreditation Program Lab Director
and/or state specific certification programs as applicable.
Client Service contact: Ralph Frye 337-237-4775
Certifications: LDEQ(2048), LDHH(LA150012), AR(14-045-04), AZ(AZ0805), FL(E87657), IL(200082), KY(#31),
NC(487), SC(73004001), NJ(LA007), TX(T104704186-15-7), WW(257)
This report shall not be reproduced, except in its entirety, without the written approval of SGS.
Test results relate only to samples analyzed.
SGS North America Inc. • 500 Ambassador Caffery • Scott, LA 70583 • tel: 337-237-4775
SGS is the sole authority for authorizing edits or modifications to this document. Please share your ideas about
Unauthorized modification of this report is strictly prohibited. how we can serve you better at:
Review standard terms at: http://www.sgs.com/en/terms-and-conditions EHS.US.CustomerCare@sgs.com
1 of 15
LA48883
Sections:
Table of Contents
-1-
Section1: Sample Summary...................................................................................................
3
Section2: Summary of Hits....................................................................................................
4
Section3: Sample Results........................................................................................................
5
3.1: LA48883-1: WSW-13...................................................................................................
6
3.2: LA48883-2: TRIP BLANK..........................................................................................
7
Section4: Misc. Forms............................................................................................................
8
4.1: Chain of Custody...........................................................................................................
9
Section 5: MS Volatiles - QC Data Summaries.....................................................................
1
5.1: Method Blank Summary................................................................................................
13
5.2: Blank Spike/Blank Spike Duplicate Summary..............................................................
14
5.3: Matrix Spike/Matrix Spike Duplicate Summary...........................................................
15
W,
SGS North America Inc.
Sample Summary
Kinder Morgan
Job No: LA48883
CHMHNCC: PPL/Poplar Tent Road (Water Wells), Concord, NC
Project No: 699855.PT.EM
Sample Collected Matrix Client
Number Date Time By Received Code Type Sample ID
LA48883-1 10/17/18 09:15 JH/NU10/18/18 AQ Ground Water WSW-13
LA48883-1D 10/17/18 09:15 JH/NU10/18/18 AQ Water Dup/MSD WSW-13
LA48883-IS 10/17/18 09:15 JH/NU10/18/18 AQ Water Matrix Spike WSW-13
LA48883-2 10/17/18 00:00 JH/NU 10/ 18/ 18 AQ Trip Blank Water TRIP BLANK
6 3of15
LA48883
Summary of Hits Page 1 of 1
Job Number: LA48883
Account: Kinder Morgan
Project: CHMHNCC: PPL/Poplar Tent Road (Water Wells), Concord, NC
Collected: 10/ 17/ 18
Lab Sample ID Client Sample ID Result/
Analyte Qual RL MDL Units Method
LA48883-1 WSW-13
No hits reported in this sample.
LA48883-2 TRIP BLANK
No hits reported in this sample.
6 4of15
LA48883
i
SGS
Scott, LA
Section 3
Sample Results
Report of Analysis
6 5of15
LA48883
SGS North America Inc.
Report of Analysis
Client Sample ID: WSW-13
Lab Sample ID: LA48883-1 Date Sampled: 10/17/18
Matrix: AQ - Ground Water Date Received: 10/ 18/ 18
Method: SW846 8260B Percent Solids: n/a
Project: CHMHNCC: PPL/Poplar Tent Road (Water Wells), Concord, NC
Page 1 of 1 j
File ID DF Analyzed By Prep Date Prep Batch Analytical Batch
Run #1 2X0055845.D 1 10/19/18 15:54 AR n/a n/a V2X1264
Run #2
Purge Volume
Run # 1 5.0 ml
Run #2
Purgeable Aromatics, Naphthalene
CAS No.
Compound
Result
RL
Units Q
71-43-2
Benzene
ND
1.0
ug/l
108-88-3
Toluene
ND
1.0
ug/1
100-41-4
Ethylbenzene
ND
1.0
ug/l
1330-20-7
Xylene (total)
ND
2.0
ug/1
91-20-3
Naphthalene
ND
5.0
ug/l
CAS No.
Surrogate Recoveries
Run# 1
Run# 2
Limits
17060-07-0
1,2-Dichloroethane-D4
93%
84-124%
2037-26-5
Toluene-D8
100%
83-115%
460-00-4
4-Bromofluorobenzene
96%
89-111%
ND = Not detected
RL = Reporting Limit
E = Indicates value exceeds calibration range
J = Indicates an estimated value
B = Indicates analyte found in associated method blank
N = Indicates presumptive evidence of a compound
6 6of15
LA48883
SGS North America Inc.
Report of Analysis
Client Sample ID: TRIP BLANK
Lab Sample ID: LA48883-2 Date Sampled: 10/17/18
Matrix: AQ - Trip Blank Water Date Received: 10/ 18/ 18
Method: SW846 8260B Percent Solids: n/a
Project: CHMHNCC: PPL/Poplar Tent Road (Water Wells), Concord, NC
Page 1 of 1 N
File ID DF Analyzed By Prep Date Prep Batch Analytical Batch
Run #1 2X0055843.D 1 10/19/18 15:27 AR n/a n/a V2X1264
Run #2
Purge Volume
Run # 1 5.0 ml
Run #2
Purgeable Aromatics, Naphthalene
CAS No.
Compound
Result
RL
Units Q
71-43-2
Benzene
ND
1.0
ug/l
108-88-3
Toluene
ND
1.0
ug/1
100-41-4
Ethylbenzene
ND
1.0
ug/l
1330-20-7
Xylene (total)
ND
2.0
ug/1
91-20-3
Naphthalene
ND
5.0
ug/l
CAS No.
Surrogate Recoveries
Run# 1
Run# 2
Limits
17060-07-0
1,2-Dichloroethane-D4
92%
84-124%
2037-26-5
Toluene-138
100%
83-115%
460-00-4
4-Bromofluorobenzene
95%
89-111%
ND = Not detected
RL = Reporting Limit
E = Indicates value exceeds calibration range
J = Indicates an estimated value
B = Indicates analyte found in associated method blank
N = Indicates presumptive evidence of a compound
6 7of15
LA48883
ffm
Scott, LA
Misc. Forms
Custody Documents and Other Forms
Includes the following where applicable:
• Chain of Custody
1
Section 4
6 8of15
LA48883
PAGE ' OF I
M-.11mil.,
CHAIN OF CUSTODY
SGS North America tric. -Scott
500 Ambassador Caffeny P.irk—y, Scott, LA 70583
TEL 337.237.4775 FAX: 337.237.7838
�i.sgs-corniahsusa
F�I—x Tv,—,4
eom0--Vg
aotiodd..
as—
Jji q,4;
MIRE=�11�� rim" 1�",
Matrix Codes
.20,411WOMA
.N—
Pneect N—
25
DW - Making Wait
W W- W- e
SW - Sjr1ace Water
so -sal
SED-S-off—t
SU0- S1 W9.&,rl)4q
' - other UwkJ
MR - AJ,
SOL - Other Sotd
AT -wipe
FS - F.W Blank
ES -Equipment Blank
Re - Rinse Blank
TB -Trip Blank
StrW, Aodr—
14110 Bt;kitax-�,, COT, )ISSO
1"at%ZIp IU,
4c w
Gjvcbr1,Xl, Ptp, b
� $Wt."l. 6Z
"—,C-tad. =-maB
(A'M
Proi¢ca street Address�,,t ��
6Rc1Sr,5-?—,. Fm icoo wok4wam
'��3- 3 1 q5
C11.11'.1chassords,# 1w
4-YyAwA�C, A- '3&)Ir,
a
t4AT 0
Field 10 1 Point of Colic ;`lion
W`ko kee an
—'s"
wte
rme
sama¢d aya.
LAB USE ONLY
VIVI S 13/m S 14 5 F)
i6il-177 il
/I
I
VILM-V"
liz�
13
V
I
I I
I I
V
P!
77'7-4
T --nl e, Eh,sma— 14,-�
Data
Dell
el
We 1
7�7777
—777777,
�
-
10 a-!.., Day. Approved a, (aGa IM: I-.:
r 1 , Bus Hess Days Ru
17 3 S..inaa. Day. RUSH
Days RUSHV•J
1 : Day EMERGENCY
1 as:
E] other
Emergency &Rush TIA date available via, blink, Approval needed for RUSHIE—gency TAT
-W (Level's) TRRP
(L.--1 2) mzcAP
FULLTI (L.Y.13-4) Q state F.—
R-DT1 JL-13-S' EDD F—
Comatemial"C" Other
C,,—ci,c-A" = Rez-ftt)My,
Commercial 'B'= Results - OC Surn—Y
Note: Sample inventory is verified upon receipt in the Laboratory
•
r
-0-4
Custody mustber-d-ocu,mented
N,by
balm each time samples change possession, including courier delivery.
Mgp
a iaVs
I All
d ,
E�
- 1I
.." I
Li;
140)
-
T.K,eenn, —11N.; -.-d By:3
14 j4
5
5 0
EH5A-QAC-0026-00-F0RN,1-Sjlt - s,.M.- .-
LA48883: Chain of Custody
Page 1 of 3
W,
9 of 15
LA48883
E:1
. . ....... . -------------- - - . ....
. .... . . 7,�,, 7
FecEx.
.... ......
Express ,.,',,G,8106 9617 5440
02 0 0
4 Express Package Service
Saufs
Ph—
.,d!lxnlsrss 0,., ,,1,
❑ 11 d 1, Ir
G-My
gE,""
0
E 1,d1,111.y
,rseooe.•meaaw .ea
Add,.., e
Fed &vd.,d 0mht
Fedix Express Saver -
L:1
CiLy State zip
Packaging
2 Your Internal Billing Reference
Fed& Emd,p,' NdEPk' R
E] FedEx W
a. Tub.
3 To
Recipients SAMPLE RECEIVING
6 Special Handling and DeliverVSignafte Options m
6
Name Phone
13.1119
(337) 237-4775
C..P.,sy
EJ
SGS NORTH AMERICA INC -SCOTT ..,,H.wXt.kdy
Address
dMes-spoft?
BtV
Yes
Hold day Li No Li m,=,� El DrUl ueurs __s
0 ECargoAnaftOrOy
7 Payment Binw,
cit, Ste, ZIP El
Seller
Ll iwftLr E] Recipisot 0- Third Party E] CmdkCard E) cawmeek
T'"s 7T.-
Lwua,mw��,,,am..�.rra.x,a.ommrr.s..mcwaam O�T
8106 9617 8440
........................ . ......... .. .. ... .... ... .......... ........... ... .. ....... .... ......
LA48883: Chain of Custody
Page 2 of 3
d%6 10 of 15
LA48883
SGS Sample Receipt Summary
Job Number: LA48883 Client: JACOBS
Date / Time Received: 10/18/2018 8:45:00 AM Delivery Method:
Cooler Temps (Initial/Adjusted): #1:0.3/1.3):
Cooler Security Y or N
Y or N
1. Custody Seals Present: W
❑ 3. COC Present:
❑d ❑
2. Custody Seals Intact: ❑d
❑ 4. Smpl
Dates/Time OK
W ❑
Cooler Temperature
Y or N
1. Temp criteria achieved:
❑// ❑
2. Thermometer ID:
DV441;
3. Cooler media:
Ice (direct contact)
4. No. Coolers:
1
Quality Control Preservation
Y or N
N/A
1. Trip Blank present / cooler:
❑d ❑
❑
2. Trip Blank listed on CDC:
❑d ❑
❑
3. Samples preserved properly:
❑� ❑
4. VOCs headspace free:
k ❑
❑
FedEx
Project: POPLAR TENT ROAD SITE
Airbill #'s: 8106 9617 8440
Sample Intearity - Documentation
Y
or N
1. Sample labels present on bottles:
❑�
❑
2. Container labeling complete:
❑�
❑
3. Sample container label / CDC agree:
❑�
❑
Sample Integrity - Condition
Y
or N
1. Sample recvd within HT:
❑O
❑
2. All containers accounted for:
❑
3. Condition of sample:
Intact
Sample Integrity - Instructions
Y
or N N/A
1. Analysis requested is clear:
❑d
❑
2. Bottles received for unspecified tests
❑
❑d
3. Sufficient volume recvd for analysis:
❑,i
❑
4. Compositing instructions clear:
❑
❑ W
5. Filtering instructions clear:
❑
❑ ❑d
LA48883: Chain of Custody
Page 3 of 3
A
0
W,
11 of 15
LA48883
ffm
Scott, LA
MS Volatiles
QC Data Summaries
Includes the following where applicable:
• Method Blank Summaries
• Blank Spike Summaries
• Matrix Spike and Duplicate Summaries
i
no
Section 5
6 12 of 15
LA48883
Method Blank Summary Page 1 of 1
Job Number: LA48883
Account: KINDERGA Kinder Morgan
Project: CHMHNCC: PPL/Poplar Tent Road (Water Wells), Concord, NC
Sample
File ID
DF
Analyzed
By
Prep Date
Prep Batch
Analytical Batch
V2X1264-MB2
2X0055825.D
1
10/19/18
AR
n/a
n/a
V2X1264
The QC reported here applies to the following samples:
LA48883-1, LA48883-2
CAS No.
Compound
Result
RL Units Q
71-43-2
Benzene
ND
1.0 ug/l
100-41-4
Ethylbenzene
ND
1.0 ug/l
91-20-3
Naphthalene
ND
5.0 ug/l
108-88-3
Toluene
ND
1.0 ug/l
1330-20-7
Xylene (total)
ND
2.0 ug/l
CAS No.
Surrogate Recoveries
Limits
17060-07-0
1,2-Dichloroethane-D4
93%
84-124%
2037-26-5
Toluene-D8
99%
83-115%
460-00-4
4-Bromofluorobenzene
94%
89-111%
Method: SW846 8260B
� 13 of 15
LA48883
Blank Spike/Blank Spike Duplicate Summary Page 1 of 1
Job Number: LA48883
Account: KINDERGA Kinder Morgan
Project: CHMHNCC: PPL/Poplar Tent Road (Water Wells), Concord, NC
Sample
File ID
DF
Analyzed
By
Prep Date
Prep Batch
Analytical Batch
V2X1264-BS1
2X0055819.D
1
10/19/18
AR
n/a
n/a
V2X1264
V2X1264-BSD1
2X0055821.D
1
10/19/18
AR
n/a
n/a
V2X1264
The QC reported here applies to the following samples: Method: SW846 8260B
LA48883-1, LA48883-2
Spike
BSP
BSP
BSD
BSD
Limits
CAS No.
Compound
ug/1
ug/l
%
ug/1
%
RPD
Rec/RPD
71-43-2
Benzene
20
20.7
104
19.3
97
7
82-119/30
100-41-4
Ethylbenzene
20
19.3
97
18.6
93
4
84-117/30
91-20-3
Naphthalene
20
18.8
94
17.3
87
8
74-136/30
108-88-3
Toluene
20
21.6
108
20.6
103
5
80-121/30
1330-20-7
Xylene (total)
60
59.8
100
57.6
96
4
81-122/30
CAS No.
Surrogate Recoveries
BSP
BSD
Limits
17060-07-0
1,2-Dichloroethane-D4
94%
96%
84-124%
2037-26-5
Toluene-D8
100%
102%
83-115%
460-00-4
4-Bromofluorobenzene
95%
97%
89-111%
* = Outside of Control Limits.
6 14 of 15
LA48883
Matrix Spike/Matrix Spike Duplicate Summary Page 1 of 1
Job Number: LA48883
Account: KINDERGA Kinder Morgan
Project: CHMHNCC: PPL/Poplar Tent Road (Water Wells), Concord, NC
Sample
File ID
DF
Analyzed
By
Prep Date
Prep Batch
Analytical Batch
LA48883-1MS
2X0055847.D
2
10/19/18
AR
n/a
n/a
V2X1264
LA48883-1MSD
2X0055849.D
2
10/19/18
AR
n/a
n/a
V2X1264
LA48883-1
2X0055845.D
1
10/19/18
AR
n/a
n/a
V2X1264
The QC reported here applies to the following samples: Method: SW846 8260B
LA48883-1, LA48883-2
LA48883-1
Spike
MS
MS
Spike
MSD
MSD
Limits
CAS No.
Compound
ug/l Q
ug/l
ug/l
%
ug/l
ug/l
%
RPD
Rec/RPD
71-43-2
Benzene
ND
40
41.0
103
40
40.8
102
0
31-161/15
100-41-4
Ethylbenzene
ND
40
39.7
99
40
38.3
96
4
47-146/30
91-20-3
Naphthalene
ND
40
34.9
87
40
35.8
90
3
34-169/42
108-88-3
Toluene
ND
40
43.3
108
40
42.2
106
3
36-155/17
1330-20-7
Xylene (total)
ND
120
121
101
120
118
98
3
41-154/29
CAS No.
Surrogate Recoveries
MS
MSD
LA48883-1
Limits
17060-07-0
1,2-Dichloroethane-D4
94%
94%
93%
84-124%
2037-26-5
Toluene-D8
99%
101%
100%
83-115%
460-00-4
4-Bromofluorobenzene
96%
94%
96%
89-111%
* = Outside of Control Limits.
6 15 of 15
LA48883
TestAmerica °
THE LEADER IN ENVIRONMENTAL TESTING
ANALYTICAL REPORT
TestAmerica Laboratories, Inc.
TestAmerica Nashville
2960 Foster Creighton Drive
Nashville, TN 37204
Tel: (615)726-0177
TestAmerica Job ID: 490-161516-1
Client Project/Site: Kinder Morgan - Plantation Pipe Line
Foi
CH2M Hill, Inc.
14120 Ballantyne Corporate Place
Suite 200
Charlotte, North Carolina 28277
Attn: Kelly Ramsey
am-aC-OYI 6k2&(r
Authorized for release by:
1012412018 4:19:33 PM
Carol Webb, Project Manager II
(850)471-6250
carol.webb@testamericainc.com
The test results in this report meet all 2003 NELAC and 2009 TNI requirements for accredited
parameters, exceptions are noted in this report. This report may not be reproduced except in full,
and with written approval from the laboratory. For questions please contact the Project Manager
at the e-mail address or telephone number listed on this page.
This report has been electronically signed and authorized by the signatory. Electronic signature is
intended to be the legally binding equivalent of a traditionally handwritten signature.
Results relate only to the items tested and the sample(s) as received by the laboratory.
Client: CH2M Hill, Inc.
Project/Site: Kinder Morgan - Plantation Pipe Line
Table of Contents
TestAmerica Job ID: 490-161516-1
CoverPage ..............................................
1
Table of Contents .........................................
2
Sample Summary .........................................
3
Case Narrative ...........................................
4
Definitions...............................................
5
Client Sample Results ......................................
6
QC Sample Results ........................................
8
QC Association ...........................................
10
Chronicle................................................
11
Method Summary .........................................
12
Certification Summary ......................................
13
Chain of Custody ..........................................
14
TestAmerica Nashville
Page 2 of 15 10/24/2018
Sample Summary
Client: CH2M Hill, Inc. TestAmerica Job ID: 490-161516-1
Project/Site: Kinder Morgan - Plantation Pipe Line
Lab Sample ID Client Sample ID Matrix Collected Received
490-161516-1 WSW-13 Water 10/17/18 09:15 10/18/18 10:00
490-161516-2 Trip Blank Water 10/17/18 01:01 10/18/18 10:00
TestAmerica Nashville
Page 3 of 15 10/24/2018
Case Narrative
Client: CH2M Hill, Inc.
Project/Site: Kinder Morgan - Plantation Pipe Line
Job ID: 490-161516-1
Laboratory: TestAmerica Nashville
Narrative
TestAmerica Job ID: 490-161516-1
0
Job Narrative
490-161516-1
Comments
No additional comments
Receipt
The samples were received on 10/18/2018 10:00 AM; the samples arrived in good condition, properly preserved and, where required, on
ice. The temperature of the cooler at receipt was 5.31 C.
GC/MS VOA
Method 8260B: The method blank for analytical batch 490-551272 contained Naphthalene above the method detection limit. This target
analyte concentration was less than half the reporting limit (1/2RL); therefore, re -extraction and re -analysis of samples was not performed.
No additional analytical or quality issues were noted, other than those described above or in the Definitions/Glossary page.
VOA Prep
No analytical or quality issues were noted, other than those described in the Definitions/Glossary page.
TestAmerica Nashville
Page 4 of 15 10/24/2018
Definitions/Glossary
Client: CH2M Hill, Inc.
Project/Site: Kinder Morgan - Plantation Pipe Line
Glossary
Abbreviation
a
% R
CFL
CNF
DER
Dil Fac
DL
DL, RA, RE, IN
DLC
EDL
LOD
LOQ
MDA
MDC
MDL
ML
NC
ND
PQL
QC
RER
RL
RPD
TEF
TEQ
TestAmerica Job ID: 490-161516-1
These commonly used abbreviations may or may not be present in this report.
Listed under the "D" column to designate that the result is reported on a dry weight basis
Percent Recovery
Contains Free Liquid
Contains No Free Liquid
Duplicate Error Ratio (normalized absolute difference)
Dilution Factor
Detection Limit (DoD/DOE)
Indicates a Dilution, Re -analysis, Re -extraction, or additional Initial metals/anion analysis of the sample
Decision Level Concentration (Radiochemistry)
Estimated Detection Limit (Dioxin)
Limit of Detection (DoD/DOE)
Limit of Quantitation (DoD/DOE)
Minimum Detectable Activity (Radiochemistry)
Minimum Detectable Concentration (Radiochemistry)
Method Detection Limit
Minimum Level (Dioxin)
Not Calculated
Not Detected at the reporting limit (or MDL or EDL if shown)
Practical Quantitation Limit
Quality Control
Relative Error Ratio (Radiochemistry)
Reporting Limit or Requested Limit (Radiochemistry)
Relative Percent Difference, a measure of the relative difference between two points
Toxicity Equivalent Factor (Dioxin)
Toxicity Equivalent Quotient (Dioxin)
TestAmerica Nashville
Page 5 of 15 10/24/2018
Client Sample Results
Client: CH2M Hill, Inc.
Project/Site: Kinder Morgan - Plantation Pipe Line
F
TestAmerica Job ID: 490-161516-1
Client Sample ID: WSW-13 Lab Sample ID: 490-161516-1
Date Collected: 10/17/18 09:15 Matrix: Water
Date Received: 10/18/18 10:00
Method: 8260B - Volatile Organic Compounds (GC/MS)
Analyte Result Qualifier
RL
Benzene <1.0
1.0
Ethylbenzene <1.0
1.0
Naphthalene <5.0
5.0
Toluene <1.0
1.0
Xylenes, Total <3.0
3.0
Surrogate %Recovery Qualifier Limits
1,2-Dichloroethane-d4 (Surr) 98 70- 130
4-Bromofluorobenzene (Surr) 104 70 - 130
Dibromofluoromethane (Surr) 94 70 - 130
Toluene-d8 (Surr) 98 70 - 130
MDL Unit
D Prepared Analyzed
Dil Fac
ug/L
10/19/18 02:03
1
ug/L
10/19/18 02:03
1
ug/L
10/19/18 02:03
1
ug/L
10/19/18 02:03
1
ug/L
10/19/18 02:03
1
Prepared Analyzed
Dil Fac
10119118 02:03
1
10119118 02:03
1
10119118 02:03
1
10119118 02:03
1
TestAmerica Nashville
Page 6 of 15 10/24/2018
Client Sample Results
Client: CH2M Hill, Inc.
Project/Site: Kinder Morgan - Plantation Pipe Line
F
TestAmerica Job ID: 490-161516-1
Client Sample ID: Trip Blank Lab Sample ID: 490-161516-2
Date Collected: 10/17/18 01:01 Matrix: Water
Date Received: 10/18/18 10:00
Method: 8260B - Volatile Organic Compounds (GC/MS)
Analyte Result Qualifier
RL
Benzene <1.0
1.0
Ethylbenzene <1.0
1.0
Naphthalene <5.0
5.0
Toluene <1.0
1.0
Xylenes, Total <3.0
3.0
Surrogate %Recovery Qualifier Limits
1,2-Dichloroethane-d4 (Surr) 97 70- 130
4-Bromofluorobenzene (Surr) 103 70 - 130
Dibromofluoromethane (Surr) 94 70 - 130
Toluene-d8 (Surr) 98 70 - 130
MDL Unit
D Prepared Analyzed
Dil Fac
ug/L
10/19/18 01:36
1
ug/L
10/19/18 01:36
1
ug/L
10/19/18 01:36
1
ug/L
10/19/18 01:36
1
ug/L
10/19/18 01:36
1
Prepared Analyzed
Dil Fac
10119118 01:36
1
10119118 01:36
1
10119118 01:36
1
10119118 01:36
1
TestAmerica Nashville
Page 7 of 15 10/24/2018
QC Sample Results
Client: CH2M Hill, Inc. TestAmerica Job ID: 490-161516-1
Project/Site: Kinder Morgan - Plantation Pipe Line
Method: 8260B - Volatile Organic Compounds (GC/MS)
Lab Sample ID: MB 490-551144/7
Client Sample
ID: Method Blank
Matrix: Water
Prep Type: Total/NA
Analysis Batch: 551144
MB MB
Analyte Result Qualifier
RL
MDL Unit
D Prepared
Analyzed Dil Fac
Benzene <1.0
1.0
ug/L
10/19/18 00:44 1
Ethylbenzene <1.0
1.0
ug/L
10/19/18 00:44 1
Naphthalene <5.0
5.0
ug/L
10/19/18 00:44 1
Toluene <1.0
1.0
ug/L
10/19/18 00:44 1
Xylenes, Total <3.0
3.0
ug/L
10/19/18 00:44 1
MB MB
Surrogate %Recovery Qualifier
Limits
Prepared
Analyzed Dil Fac
1,2-Dichloroethane-d4 (Surr) 97
70- 130
10119118 00:44 1
4-Bromofluorobenzene (Surr) 106
70 - 130
10119118 00:44 1
Dibromofluoromethane (Surr) 93
70 - 130
10119118 00:44 1
Toluene-d8 (Surr) 97
70 - 130
10119118 00:44 1
Lab Sample ID: LCS 490-551144/3
Client
Sample ID:
Lab Control Sample
Matrix: Water
Prep Type: Total/NA
Analysis Batch: 551144
Spike
LCS
LCS
%Rec.
Analyte
Added
Result
Qualifier
Unit
D %Rec
Limits
Benzene
50.0
44.5
ug/L
89
70-130
Ethylbenzene
50.0
44.3
ug/L
89
70 -130
Naphthalene
50.0
46.7
ug/L
93
54 -150
Toluene
50.0
43.5
ug/L
87
70 -130
Xylenes, Total
150
132
ug/L
88
70 -132
LCS LCS
Surrogate %Recovery Qualifier
Limits
1,2-Dichloroethane-d4 (Surr) 90
70- 130
4-Bromofluorobenzene (Surr) 109
70 - 130
Dibromofluoromethane (Surr) 89
70 - 130
Toluene-d8 (Surr) 96
70 - 130
Lab Sample ID: LCSD 490-551144/4
Client Sample ID: Lab Control Sample Dup
Matrix: Water
Prep Type: Total/NA
Analysis Batch: 551144
Spike
LCSD
LCSD
%Rec. RPD
Analyte
Added
Result
Qualifier
Unit
D %Rec
Limits RPD Limit
Benzene
50.0
44.1
ug/L
88
70-130 1 12
Ethylbenzene
50.0
44.7
ug/L
89
70 -130 1 12
Naphthalene
50.0
45.8
ug/L
92
54 -150 2 15
Toluene
50.0
44.5
ug/L
89
70 -130 2 13
Xylenes, Total
150
135
ug/L
90
70 -132 2 11
LCSD LCSD
Surrogate %Recovery Qualifier
Limits
1,2-Dichloroethane-d4 (Surr) 90
70- 130
4-Bromofluorobenzene (Surr) 108
70 - 130
Dibromofluoromethane (Surr) 91
70 - 130
Toluene-d8 (Surr) 97
70 - 130
TestAmerica Nashville
Page 8 of 15 10/24/2018
QC Sample Results
Client: CH2M Hill, Inc. TestAmerica Job ID: 490-161516-1
Project/Site: Kinder Morgan - Plantation Pipe Line
Method: 8260B - Volatile Organic Compounds (GC/MS) (Continued)
Lab Sample ID: 490-161516-1 MS
Client
Sample ID: WSW-13
Matrix: Water
Prep Type: Total/NA
Analysis Batch: 551144
Sample Sample
Spike
MS MS
%Rec.
Analyte Result Qualifier
Added
Result Qualifier
Unit
D %Rec
Limits
Benzene <1.0
50.0
44.7
ug/L
89
55-147
Ethylbenzene <1.0
50.0
46.0
ug/L
92
65 -139
Naphthalene <5.0
50.0
44.8
ug/L
90
32 -150
Toluene <1.0
50.0
45.6
ug/L
91
64 -136
Xylenes, Total <3.0
150
137
ug/L
91
69 -132
MS MS
Surrogate
%Recovery Qualifier
Limits
1,2-Dichloroethane-d4 (Surr)
90
70- 130
4-Bromofluorobenzene (Surr)
104
70 - 130
Dibromofluoromethane (Surr)
91
70 - 130
Toluene-d8 (Surr)
97
70 - 130
Lab Sample ID: 490-161516-1
MSD
Client
Sample
ID: WSW-13
Matrix: Water
Prep Type: Total/NA
Analysis Batch: 551144
Sample Sample
Spike
MSD MSD
%Rec.
RPD
Analyte
Result Qualifier
Added
Result Qualifier
Unit
D %Rec
Limits
RPD Limit
Benzene
<1.0
50.0
44.3
ug/L
89
55-147
1 22
Ethylbenzene
<1.0
50.0
45.1
ug/L
90
65 -139
2 18
Naphthalene
<5.0
50.0
47.6
ug/L
95
32 -150
6 40
Toluene
<1.0
50.0
45.2
ug/L
90
64 -136
1 18
Xylenes, Total
<3.0
150
134
ug/L
89
69 -132
2 17
MSD MSD
Surrogate
%Recovery Qualifier
Limits
1,2-Dichloroethane-d4 (Surr)
89
70- 130
4-Bromofluorobenzene (Surr)
107
70 - 130
Dibromofluoromethane (Surr)
89
70 - 130
Toluene-d8 (Surr)
98
70 - 130
TestAmerica Nashville
Page 9 of 15 10/24/2018
QC Association Summary
Client: CH2M Hill, Inc.
Project/Site: Kinder Morgan - Plantation Pipe Line
GC/MS VOA
Analysis Batch: 551144
Lab Sample ID
490-161516-1
490-161516-2
MB 490-551144/7
LCS 490-551144/3
LCSD 490-551144/4
490-161516-1 MS
490-161516-1 MSD
TestAmerica Job ID: 490-161516-1
Client Sample ID
Prep Type
Matrix
Method
WSW-13
Total/NA
Water
8260B
Trip Blank
Total/NA
Water
8260B
Method Blank
Total/NA
Water
8260B
Lab Control Sample
Total/NA
Water
8260B
Lab Control Sample Dup
Total/NA
Water
8260B
WSW-13
Total/NA
Water
8260B
WSW-13
Total/NA
Water
8260B
Prep Batch
0
TestAmerica Nashville
Page 10 of 15 10/24/2018
Lab Chronicle
Client: CH2M Hill, Inc.
Project/Site: Kinder Morgan - Plantation Pipe Line
Client Sample ID: WSW-13
Date Collected: 10/17/18 09:15
Date Received: 10/18/1810:00
F
TestAmerica Job ID: 490-161516-1
Lab Sample ID: 490-161516-1
Matrix: Water
Batch
Batch
Dil
Initial
Final
Batch
Prepared
Prep Type
Type
Method
Run Factor
Amount
Amount
Number
or Analyzed Analyst Lab
Total/NA
Analvsis
8260B
1
10 mL
10 mL
551144
10/19/18 02:03 RP TAL NSH
Client Sample ID: Trip Blank Lab Sample ID: 490-161516-2
Date Collected: 10/17/18 01:01 Matrix: Water
Date Received: 10/18/18 10:00
Batch Batch Dil Initial Final Batch Prepared
Prep Type Type Method Run Factor Amount Amount Number or Analyzed Analyst Lab
Total/NA Analysis 8260B 1 10 mL 10 mL 551144 10/19/18 01:36 RP TAL NSH
Laboratory References:
TAL NSH = TestAmerica Nashville, 2960 Foster Creighton Drive, Nashville, TN 37204, TEL (615)726-0177
L
Page 11 of 15
TestAmerica Nashville
10/24/2018
Method Summary
Client: CH2M Hill, Inc.
Project/Site: Kinder Morgan - Plantation Pipe Line
TestAmerica Job ID: 490-161516-1
Method Method Description Protocol Laboratory
8260B Volatile Organic Compounds (GC/MS) SW846 TAL NSH
5030B Purge and Trap SW846 TAL NSH
Protocol References: L
SW846 ='Test Methods For Evaluating Solid Waste, Physical/Chemical Methods", Third Edition, November 1986 And Its Updates.
Laboratory References:
TAL NSH = TestAmerica Nashville, 2960 Foster Creighton Drive, Nashville, TN 37204, TEL (615)726-0177
TestAmerica Nashville
Page 12 of 15 10/24/2018
Accreditation/Certification Summary
Client: CH2M Hill, Inc.
TestAmerica Job ID: 490-161516-1
Project/Site: Kinder Morgan - Plantation Pipe Line
Laboratory: TestAmerica Nashville
All accreditations/certifications held by this laboratory are listed. Not all accreditations/certifications are applicable to this report.
Authority Program
EPA Region
Identification Number
Expiration Date
A2LA ISO/IEC 17025
0453.07
12-31-19
Alaska (UST) State Program
10
UST-087
06-30-19
Arizona State Program
9
AZ0473
05-05-19
Arkansas DEQ State Program
6
88-0737
04-25-19
California State Program
9
2938
10-31-18
Connecticut State Program
1
PH-0220
12-31-19
Florida NELAP
4
E87358
06-30-19
Georgia State Program
4
NA: NELAP & A2LA
12-31-19
Illinois NELAP
5
200010
12-09-18
Iowa State Program
7
131
04-01-20
Kansas NELAP
7
E-10229
10-31-18
Kentucky (UST) State Program
4
19
06-30-19
Kentucky (WW) State Program
4
90038
12-31-18
Louisiana NELAP
6
30613
06-30-19
Maine State Program
1
TN00032
11-03-19 m
Maryland State Program
3
316
03-31-19
Massachusetts State Program
1
M-TN032
06-30-19
Minnesota NELAP
5
047-999-345
12-31-18
Mississippi State Program
4
N/A
06-30-19
Montana (UST) State Program
8
NA
02-24-20
Nevada State Program
9
TN00032
07-31-19
New Hampshire NELAP
1
2963
10-09-18'
New Jersey NELAP
2
TN965
06-30-19
New York NELAP
2
11342
03-31-19
North Carolina (WW/SW) State Program
4
387
12-31-18
North Dakota State Program
8
R-146
06-30-19
Ohio VAP State Program
5
CL0033
07-06-19
Oklahoma State Program
6
9412
08-31-19
Oregon NELAP
10
TN200001
04-26-19
Pennsylvania NELAP
3
68-00585
07-31-19
Rhode Island State Program
1
LAO00268
12-30-18
South Carolina State Program
4
84009 (001)
02-28-19
Tennessee State Program
4
2008
02-23-20
Texas NELAP
6
T104704077
08-31-19
USDA Federal
P330-13-00306
12-01-19
Utah NELAP
8
TN00032
07-31-19
Virginia NELAP
3
460152
06-14-19
Washington State Program
10
C789
07-19-19
West Virginia DEP State Program
3
219
02-28-19
Wisconsin State Program
5
998020430
08-31-19
Wyoming (UST) A2LA
8
453.07
12-31-19
Laboratory: TestAmerica Pensacola
The accreditations/certifications listed below are applicable to this report.
Authority Program
EPA Region
Identification Number
Expiration Date
North Carolina (WW/SW) State Program
4
314
12-31-18
" Accreditation/Certification renewal pending - accreditation/certification considered valid.
TestAmerica Nashville
Page 13 of 15 10/24/2018
Test erica
THE LEADER IN ENVIRONMENTAL TESTING
Nashville, TN
COOLER RECEIPT FORM
111111111111111111111111111
490-161516 Chain of Custody --
Cooler Received/Opened On 10/18/2018 (a)-1000
Time Samples Removed From Cooler ;? , / 6 Time Samples Placed In Storag(2 Hour Window)
1. Tracking # O6 ? (last 4 digits, FedEx) Courier: FedEx
IR Gun ID 17610176 pH Strip Lotr Chlorine Strip Lot
2. Temperature of rep. sample or temp blank when opened:_ 2 Degrees Celsius
3. If Item #2 temperature is 0°C or less, was the representative sample or temp blank frozen?
4. Were custody seals on outside of cooler? // I
If yes, how many and where: l C d d�)� � � ` I aG
5. Were the seals intact, signed, and dated correctly?
6. Were custody papers inside cooler? )
certify that I opened the cooler and answered questions 1-6 (intial)
7. Were custody seals on containers: YES 49� and Intact
iG- )
YES NO..9
f�SE ... NO ... NA
O... NO ... NA
Y_E'�... NO ... NA
YES ... NO„:NIR
Were these signed and dated correctly? YES ... NO.&&
8. Packing mat'I used? , ubble p Plastic bag Peanuts Vermiculite Foam Insert Paper Other None
9. Cooling process: �+ / Ice -pack Ice (direct contact) Dry ice Other None
10. Did all containers arrive in good condition (unbroken)?
11. Were all container labels complete (#, date, signed, pres., etc)?
12. Did all container labels and tags agree with custody papers?
13a. Were VOA vials received?
b. Was there any observable headspace present in any VOA vial?
0 4""11 Larger than this.
14. Was there a Trip Blank in this cooler? J91.NO... NA
�tE ... NO ... NA
... NO ... NA
CyF.S... NO ... NA
�..NO... NA
YES..O..NA
If multiple coolers, sequence #.
15a. On pres'd bottles, did pH test strips suggest preservation reached the corre"H level? YES...NO.SA'
b. Did the bottle labels indicate that the correct preservatives were used 45tS... NO...NA
16. Was residual chlorine present? YES ... NO ...
t%
I certify that I checked for chlorine and pH as per SOP and answered questions 15-16 (intial)
17. Were custody papers properly filled out (ink, signed, etc)? E .NO ... NA
18. Did you sign the custody papers in the appropriate place? Y S... NO ... NA
19. Were correct containers used for the analysis requested? �... NO ... NA
20. Was sufficient amount of sample sent in each container? 6Y 21..NO... NA
certify that I entered this proiect into LIMS and answered questions 17-20 (intial)
certifv that I attached a label with the unique LIMS number to each container (intial) tx
21. Were there Non -Conformance issues at login? YES.&G Was a NCM generated? YES ... ...#
BIS = Broken in shipment
Cooler Receipt Fonn.doc
LF-I
End of Form
Revised 8/23/17
Page 14 of 15 10/24/2018
N
1
N
N
CD
TestAwi ca Savamah
5102 LaRoche Avenue
Savannah, 64 31404
Phone: 912.354.7859 Fax:
Chain of Custody Record
Regulatory Program: ❑ DW ❑ NPDES ❑ RCRA ❑ Other:
2330912 TestAmerica
A... MUD
- THE LEADER IN ENVIRONMENTAL TESTING
TestAmerica Laboratories, Inc.
TAL-8210(0713)
Client Contact
Project Manager: JU i Q 6 _IZ(,UA
Site Contact: V_Z
Date: J ) '
COC No:
Company Name: J A E3 S
Tel/Fax:
Lab Contact:
Carrier:
4 of COCs
Address: j 4j,2.0 .Wj
ZVO Analysis Turnaround Time
Z
;
E
ut
4
,-,
^
Z
}
U)
rn
a
°
't
d
I
Sampler: �Lt
City/State/Zip: a - �'',
❑ CALENDAR DAYS ❑ WORKING DAYS
For Lab Use Only:
Walk-in Client:
Lab Sampling:
Phone: =`i — 22 S
TAT if different from Below
❑ 2 weeks
❑ 1 week
❑ 2 days
❑ 1 day
Fax:
Project Name: 0y lev 'j,L2,} 0�ej
Site: K-M I M71.,
Job / SDG No.:
P O# gS „y FM
Sample Identification
Sample
Date
Sample
Time
Sample
Type
(C=Comp,
G=Grab)
Matrix
#of
Cont.
Sample Specific Notes:
W -, 13
4-,17�
Do, 15-
-3
y
K).W-I3-M
6
60.
3
y
LOG: 490
W12
161516
:����� �
�
,A:.,�
u��
\,
A\At�..A�,
Possible Hazard Identification:
Are any samples from a listed EPA Hazardous Waste? Please List any EPA Waste Codes for the sample in the
Comments Section if the lab is to dispose of the sample.
Sample Disposal (A fee may be assessed if samples are retained longer than 1 month)
❑ Return to Client ❑ Disposal by Lab ❑ Arch ive for Months
❑ Non -Hazard ❑ Flammable ❑ Skin Irritant ❑ Poison B ❑ Unknown
Special Instructions/QC Requirements & Comments:
`� .,� f f.� �, � � : �-� � � k-� • ��- � P� � fit. C�d�s � G� C�l.�.�` �:c'� I t ` ���v � ° �-�'►r
Cbstody Seals Intact: ✓ Yes ❑ No
Custody Seal No.: Cooler Temp. (C): bs'd: Corr'd: Therm ID No.:
ReI q
she1d1 by: � �
l 1 t
Company:
k-o
Date/Tiime:
I( Hi g 0
Received by:
Company:
Date/Time:
Relinq ished by:
Company.
Date/Time:
Received by:
Company:
Date/Time:
Relinquished by:
Company:
Date/Time:
Received in L rato by:
Company:
Date/Time: