NCD980840409_19830502_Charles Macon Lagoon & Drum_FRBCERCLA C_Pre-NPL file (1983)-OCR

NCD991289521
ENVIRO·CHEM WASTE MANAGEMENT SERVICES
P.O. Box 10784
Raleigh, North Carolina 27605
[phone]
May 2, 1983
Mr. Glenn Dunn
N.C. Division of Health Services
Solid and Hazardous Waste Branch
P.O. Box 2091
Raleigh, N.C. 27602
Dear Glenn,
Our most current drum count at the Macon Farm numbers about
275 drums. This is the number we feel are hazardous. The remaining
drums are oil and grease type wastes. The hazardous waste is a mixed
assortment of the catagories from our initial analysis and do not
appear to be predominated by any one catagory. We are compositing
these waste to develop a batch profile for disposal. This batch
method appears to be the best approach to complete this project.
All of the drums may not be full, so the highest total volume we
can expect is about 12,000 gallons. Provided we can bulk these wastes.
to SCA Services in South Carolina, we anticipate the cost to be about
$ 13,500. \ve will know whether we can proceed with this approach in
about two weeks. If this is practicable, we should be able to finish
this phase in five weeks inclusive of the two week period previously
mentioned.
After reading Dr. Rubins report on land application of the waste
water from the lagoons, we calculated that it would cost about $5,500.00
and ten full working days to complete. This would also be subject to
the availability of Mr. Billy Thompson and his vacutanker. This phase
would bring us up to the point of liming the empty lagoons and filling
with the residue from General Tire and such other backfill as might
be required. If the weather is conducive to~ procedures ,as 'describ~d
by Dr. Rubin, I would estimate that the last two phases could be
completed in not more than four weeks.
I hope this letter answers the questions you have, but if I 1nay
be of further service, please do not hesitate to call.
Very truly yours,
q2£J-e--
r;
North Carolina Department of Human Resources
Division of Health Services
P.O. Box 2091 • Raleigh, North Carolina 27602-2091
James G. Martin, Governor
David T. Flaherty, Secretary
Ronald H. Levine, M.D., M.P.H.
Ms. Denise Smith
EPA NC CERCLA Project Officer
EPA Region IV waste Division
345 Courtland Street, N.E.
Atlanta, GA 30365
Dear Ms. Smith:
7 December 1987
SUBJECT: Preliminary Assessment Report
Dockery Property NCO 980 840 342
Cordova, NC 28330
State Health Director
Please find enclosed the Preliminary Assessment Report for the
subject site. The priority for inspection is based on a review of the
available data and on conversations with state and EPA investigators who are
familiar with the site.
The Dockery Property is part of the Macon Site, 1 mile south of
Cordova, NCO 980 840 409. It was cleaned-up in 1983 and 1984 by US EPA as
part of the clean-up of the Macon site. This site should be included with the
Macon site and should be considered a duplication. No further action is
necessary.
If you have any questions, please call me at [phone].
GN/gn/0400b/71
Sincerely,
<f:o::: N~~/~eologist
CERCLA Unit
Solid and Hazardous waste Management Branch
Environmental Health section
• •
Date: 7 December 1987
To: File
From: Grover Nicholson 9--t_j;J.j_
Re: Dockery Property
NCD 980 840 342
Today I spoke with Terry Dover about this site. He explained that
Dockery Property is part of the Charlie Macon Site, NCD 980 840 409, and was
cleaned -up along with the Macon site. He suggested that I call Diane Hazaga
of US EPA, who was the On-Site-Coordinator for the Charlie Macon Site. I
called Hazaga and she confirmed Dover's information. She added that the
clean-up consisted of pumping the liquid out of the one lagoon on-site and
solidifying the remaining sludge. Both liquid and sludge were removed from
the site. There was no post-removal sampling done but visual examination
indicated that all wastes were removed from the lagoon. Some drums containing
solvents and other contaminants were also removed from the site.
GN/gn/0400b/70
)
-
North Carolina Department of Human Resources
Division of Health Services
P.O. Box 2091 • Raleigh, North Carolina 27602-2091
James G. Martin, Governor
David T. Flaherty, Secretary
Ronald H. Levine, M.D., M.P.H.
TO: Lee Crosby
CERCLA Unit Supervisor
FROM: Cheryl A. McMorris tM-A..
Chemist, CERCLA Unit
RE: Charlie ~~con Site
NCD980840409
State Health Director
23 November 1987
I have completed a file search on the above referenced site, using
files located in the Department of Human Resurces, Division of Health
Services, Solid and Hazardous Waste Management Branch. I did not find any
information in the files pertaining to Anderson Oil Company. I also spoke
with Mr. Terry Dover, Eastern Area Supervisor, Solid and Hazardous Waste
Management Branch concerning the relationship, if any, between Anderson Oil
Company and the Charlie Macon site. Mr •. Dover, who has been directly involved
with the Charlie Macon site since discovery, was not familiar with Anderson
Oil Company.
CM/ds/0526b-6
cc: Chris Provost
I
I
-· · .. • B E S K I N D A N D R U D O L F , P. A.
LAW OFFICES
104 EAST MAIN STREET
DURHAM, NOR TH CAROUNA 27701
November 2, 1986
HEIDI G. CHAPMAN
Mr. William L. Meyer
Solid and Hazardous Waste Management,
Division
306 N. Wilmington Street
Raleigh, NC 27609
Dear Mr. Meyer:
Re: Macon/Dockery Site
I am writing to informally request copies of any and all
documents relating to the Macon/Dockery site near Rockingham,
North Carolina, including but not limited to the documents
contained in the two files labeled respectively, CERCLA
file-Macon site and Dover file-Macon site, and a larger file
labeled Macon. The term "documents" is defined in the attached
rider.
We represent Clark Equipment Company, one of the
defendants in an EPA Superfund case in federal court involving
the Macon/Dockery site. I understand that a co-defendant, C&M
Oil Distributors, Inc., requested similar information from you in
August 1986 and paid the copying costs. We likewise are willing
to pay any copying costs.
If possible,
requested documents
Wednesday, November
your assistance.
I I
we would like to obtain the copies of
1
the
within the next week .. Please contact me by
' 5th to discuss this further. Thank you for
Sincere.ly,
~·)1.~
Heidi G. Chapman I·
ll .... :t. @ trL. ~ q-t>· fnAA>½,b: '11/r,IW\ ~~ ~ di> ~ ~ ,t7,2/fJ<. !
cc: Michael McCluggage I
Carol Shiller
,.
RIDER
"Document" means the original ( unless otherwise specified,,
and copies when originals are not available) of each and every
instrument, writing or thing used or useful for the purpose, or
having the effect of conveying, retaining or transmitting
information, thought or expression by means of mechanical (i.e.,
handwriting, typing, xerography and all other similar means_)_,_
electronic, photographic, and all other means. The term
"document" as used herein includes, but is not limited to, each,
every and all items of correspondence, memoranda (including
internal memoranda), minutes, agreements, contracts, leases,
accounts, ledgers, journals, calendars, diaries, microfilms,
paper, recordings, photographic, computer printouts, worksheets,
financial statements, interview statements, reports, manuals,
study papers, analyses, charts, graphs, surveys, orders,
directives, bulletins, announcements, advertising material,
publications, trancripts, telegrams, cablegrams, applications,
schedules, lists, forms, notes, agenda, plans, proposals, drafts,
projections, speeches, tabulations, maps, drawings, booklets,
articles, indices, and all other kinds of writings, whatever
kinds, whether formal or informal, final or draft, wherever
located, which are within the Government's actual or constructive
possession, custody, care or control. Each and every
nonidentical copy of a document as defined above ( whether
different from the original because of any other stampings, notes
or other marks made upon such copy or otherwise) is itself a
separate document as used herein.
James G. Martin, Governor
Phillip J. Kirk, Jr., Secretary
24 October 1986
TO: Bill Meyer, Head
Solid and Hazardous Waste Management Branch
FROM: Lee Crosby, CERCLA Unit ~
Solid and Hazardous Waste Management Branch
RE: National Priority List Update
November 1986
Ronald H. Levine, M.D., M.P.H.
State Health Director
According to EPA ten (10) additional sites in Region IV will be.added to the National Priority List in November 1986. The sites are located in Georgia, Tennessee, South Carolina, and North Carolina. The specific sites with the final HRS scores are listed below:
LC/tb/0184b
Aberdeen Pesticide Sites·
Aberdeen, Moore County
NC D981030679
NC D980843403
NC D980843346
NC D980844468
Carolina Transformer·
Fayetteville, Cumberland County
NC D003188844
Charles Macon Drum Storage
Cordova, Richmond County
NC D980840409
NC D980840342
52.7
33.76
47 .10 ·
--~ /. ,,._ SlATl: _,
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••
North Carolina Department of Human Resources
Division of Health Services
P.O. Box 2091 • Raleigh, North Carolina 27602-2091
James G. Martin, Governor
Phillip J. Kirk, Jr., Secretary
Mr. Douglas S. Brossman
Nile, Barton & Wilmer
Attorneys at Law
P.O. Box 589
Annapolis, Maryland 21404
Ronald H. Levine, M.D., M.P.H.
September 5, 1986 State Health Director
RE: C & M Oil Distributors, Inc./Charles A Macon Site, Rockingham, North
Carolina
Dear Mr. Brossman:
We are in receipt of your letter of August 28; 2986, and check for
$200.00. In ·response, I am enclosing herewith the requested duplicate file.
I trust this will satisfy your requirements. If you have need of further
assistance, please advise.
CHH:job
Enclosure
Doc. No. 5320A
Sincerely,
4ief0~~
Assistant Branch Head for Administration
Solid & Hazardous Waste Management Branch
NILES, BARTON & WILMER
ATTORNEYS AT LAW
BALTIMORE, MARYLAND . " '
August 27,
No.G 56562
1986
N11.ES BARTON & ? dlflll1 ofll"i n· r11 c• ,..m,, ·"°"' , .. ]';•:" -WILMER.--,!!! ... ~m,1 r,nuP .. '··' L,J 1:,11,~ '_r,n,,P , .• , ... , 2 0 0 • 0 0 PAY--------~=-'-__________________ DOLLARS $, _ __:e=.=='----
TO
"'' omH
Of
r . North Carolina Division.
Health Services •· . i
7
I i;;~osr,sr,211•
0
1:os20001,1,31: OS3rnB'17b 211•
~~E!il•-ii:\if;l.•-Ill£e<,t!lle•D1U•-E!il•~•m~m•_.:uI>:J:<~:i.•DiO:<~:.i.•rn~•m•-••31i:J:•.i:.;:a.•£i
--Ni~s, BARTON & ... :
WILMtW• ·
(PRINCIPAL OF'F"ICE)
1:129 N. f-10WARD SH~EET
BALTIMOAE. "1D 21201
301-C!,:J0-3240
Mr. William Meyer
ATTORNEYS AT LAW
93 MAIN STREET -P. 0. BOX 589
ANNAPOLIS, MARYLAND 21404
301-268-3090
FRO!-f BALTD-IORE 269·1610
FRO!-!: WASHISOT0:,.1 261·1138
August 28, 1986
Head, Solid and Hazardous Waste
Management Branch
State of North Carolina
P.O. Box 2091
Raleigh, NC 27602
,cue H STREET, N. w.
WASHINGTON. 0. C. 20000
202-731-oe.12
Re: C & M Oil Distributors, Inc./Charles A. Macon
Site, Rockingham, North Carolina
Dear Mr. Meyer:
Pursuant to a telephone conversation with Terry Dover, and
a letter of May 9, 1986, to Lester O. Brown, please find
enclosed a check in the amount of $200. 00 for copies of the
documents concerning C & M Oil Distributors, Inc., and the
Charles A. Macon Site in Rockingham, North Carolina.
Your prompt attention to this matter is greatly appreci-
ated. If you have any questions, please feel free to contact me
at this office.
Very truly yours,
DSB/cje
Enclosure
•• .,& STA7t Q, ...,o,... .. .,,,~ 'f,lrJ: ':).~~ s l-. -~ ~'{rj-rJIJJJ
~
• •
North Carolina Department of Human Resources
Division of Health Services
P.O. Box 2091 • Raleigh, North Carolina 27602-2091
James G. Martin, Governor
Phillip J. Kirk, Jr., Secretary
Mr. Lester 0 .. Brown
Niles, Barton & Wilmer
Attorneys At Law
P.O. Box 589
Annapolis, Maryland 21404
Dear Mr. Brown:
May 9, 1986
Ronald H. Levine, M.D., M.P.H.
State Health Director
. 919/733-3446
Reference our phone conversation of May 7, 1986 concerning your request
pursuant to the Freedom of Information Act, for public records concerning
C & M Oil Distribution, Inc., and the Charles A. Macon site. As stated to
you, the files are quite lengthy and it will be most difficult for our office
to respond to your request in a timely fashion.
We have calculated that there will be in excess of 500 pages to be copied
and this will consume at least· two days work time for a secretary. Our cost
calculation totals at least $200.00.
We strongly suggest that you or your client visit our office. Our files
are totally available to you for your examination. We are sure that there
are parts of the file which will be of no value to you; however, you should
make that determination •
. Please inform us of your decision. If you still desire us to furnish the
complete file to you, provide a check payable to the Division of Health Services
in the amount of $200.00. We will bill you for any additional charges if our
estimate is not accurate. Expect a minimum three weeks time frame for the
wor-k to be completed.
If you have any questions, feel free to contact me at [phone].
TFD:nlp
~rely, .
r!!::Z.~'2c:::stern Area Supervisor
Solid & Hazardous Waste Management Branch
Environmental Health Section
•• ••
NILES, BARTON & WILMER,
ATTORNEYS AT LAW
93 MAIN STREET -P. 0. BOX 589
ANNAPOLIS, MARYLAND 21404
(PRINCIPAL OF'FICE)
929 N. HOWARD STREET
BALTIMORE, MD 21201
FROM BALTIMORE 269-1610
CERTIFIED MAIL
RETURN RECEIPT REQUESTED
Mr. William Meyer
301-268-3090
April 22, 1986
Head, Solid and Hazardous Waste
Management Branch
State of North Carolina
Post Office Box 2091
Raleigh, NC 27602
_,.,.,.·.,.
Re: C & M Oil Distributors, Inc./Charles A. Macon
Site, Rockingham, North Carolina
Dear Mr. Meyer:
Pursuant to the Freedom of Information Act I am hereby
requesting on behalf of C & M Oil Distributors, Inc., that all
existing public records in your agency's possession concerning
C & M Oil Distributors, Inc., and the Charles A. Macon site in
Rockingham, North Carolina be copied and transmitted to this
office forthwith.
,-r'" ....... ~--·
It is anticipated that records exist in your office and
possibly in the files of Terry Dover of your office. Once those
records are located, please contact me. Of course, we agree to
reimburse your agency for its reasonable costs related to
retrieval and copying the requested documents. Your prompt
attention to this matter will be appreciated.
Thank you for your cooperation.
LOB/mra
cc: Elza Mitchum
C •
POST OFFICE BOX 551 • BATON ROUGE, LOUISIANA 70821-0551
CH,',RU:S GOLDBERG
:, noru,EY
Mr. Rubin T. Bussey, Jr.
Assistant Regional ·counsel
Hazardous Waste Law Branch
U.S: EPA, Region IV
345 Courtland Street, N.E.
Atlanta, GA 30365
Dear Mr. Bussey:
•
March 26, 1986
Macon/Dockery Site SR-1103
Cordova, North Carolina
Please refer to my letter of February 27, 1986 regarding the above-referenced
site. In that letter I informed you that Exxon would make a renewed search of
its files under the names listed in your letter of February 24, 1986. That
search has revealed no references to the new names supplied.
In view of the above, Exxon continues to believe that it should not be con-
sidered a potentially responsible party at this site.
Very truly yours,
CG:mg
;, OIVISION OF E,qQN CORPORA TIO/I
\
I
I ,
North Carolina Department of Human Resources
Division of Health Services
P.O. Box 2091 • Raleigh, North Carolina 27602-2091
James G. Martin, Governor
Phillip J. Kirk, Jr., Secretary
Ronald H. Levine, M.D., M.P.H.
March 18, 1985
Ms. Denise Bland
NC 3012 Project Officer
Air and Hazardous Material Division
345 Courtland Street, N.E.
Atlanta, GA 30365
Re: Preliminary Assessments Transmittal Letter
Dear Ms. Bland:
State Health Director ·
919/ 733-3446
Enclosed please find the Preliminary Assessments completed for the
following ERRIS sites in North Carolina which are based on our review of
available data. ·
Macon Site,
1 mile South of
Cordova, NC
Macon Machine Co.
Rockingham, NC
Allied Corp.
Moncure, NC
NC D980840409
NC D980600472
NC 0053488409
· The Macon Site, 1 Mile South of Cordova (N:: D980840409) notified under
RCRA for storage of slop oil solids (from petroleum refining industry),
organic liquids, acids, sodium hydroxide, etc. , in 8 unlined lagoons used for
surface impoundment, and 2,173 drums. The site was one of the most
contaminated in North Carolina, and was given a high priority site inspection
. to determine response by EPA. EPA is currently actively involved in cleanup
·of the site, installing groundwater monitoring wells, and working closely with
NC Solid and Hazardous Waste Management Branch. No Further Action for a site,
inspection is recamnended because of current action taken by the EPA. "-
The Macon Machine Company (NC D980600472) is a duplication of Macon
Site, 1 Mile South of Cordova (NC D980840409), but was given a different
name. All facts concerning contamination and cleanup at Macon Site, 1 Mile
South of Cordova pertain equally to this site. Macon Machine Company (NC
D980600472) may be r;leleted from the ERRIS list.
· An Equal Opportunity/ Affirmative Action Employer
Page 2
Ms. Denise Bland
March 15, 1985
• I
The Allied Corporation (N: 0053488409) notified under RCR~ for storage
and treatment of various industrial ·chemicals and solvents, from 1970-1975.
Treatment consisted of open-pit evaporation. This site is a RCRA permitted
facility (Part B). A Medium Priority for site inspection is recO!Illllended to
determine any groundwater or other possible contamination not specifically
covered during the Part B permitting process.
On 14 March 1985, the Department of Human Resources Acting Assistant
Branch Head of Solid and Hazardous Waste Management, Jerry Rhodes, and 3012
Personnel reviewed each of the subject sites along with Natural Resources and
C.omnunity Development Department personnel from Water and Air Quality and
Groundwater Sections. Each of the subject site recommendations was approved
by the committee.
If you have any questions, please contact me.
UJL/lw/2226A
Enclosures
~ c9. er;
Lawrence O 'Neal Lenz
Waste Management Specialist
Solid and Hazardous Waste Management Branch
Environmental Health Services
POTENTIAL HAZARDOUS WASTE SITE I. IDENTIFICATION oEPA PRELIMINARY ASSESSMENT 01 STATEI02 SITE NUMBER
PART 1 • SITE INFORMATION AND ASSESSMENT NC I D980840409
II. SITE NAME AND LOCATION
01 SITE NAME (L11g1I, common. or dt1$Criprlve neme or site) 02 STREET, ROUTE NO., OR SPECIFIC LOCATION IDENTIFIER Macon Site
Milp c~n<-h nf Cordova Old Cheraw Rd. (Rt. l, Box 288)
03 CITY 04 STATE I 05 _ZIP ~ODE 106 COUNTY 107COUNTTB CONG
:ordova NC 28330 Richmond 7 7o□E s°IST
09 COORDINATES LATITUDE LONGITUDE
1.4~ _53' 45'.' I 79° 50' 2s 11
1 0 DIRECTIONS TO SITE 1s ra.1,ng ,,om nu,e$t pub#c road/
Located approximately 1 mile south of Cordova at the above address
.
Ill. RESPONSIBLE PARTIES
01 OWNEA/!llrnownJ 02 STREET {Bu$Jtius, mal/inu. re,ld11ntlal/
Charles Macon (deceased) Rt. 1, Box 288
03 CITY 04 ST A TE I 05 ZIP CO0E 06 TELEPHONE NUMBER
I Rockingham NC 28379 I I ---
07 OPERA TOR (II ~nown and dl/19,unf Imm owner) 08 STREET (Busineu, maWm;,,. ruldem,al)
09 CITY 10 STATE I" ZIP CODE 12 TELEPHONE NUMBER I I I
13 TYPE OF OWNEASHIP1Cr,11ck on11)
ij A. PRIVATE 0 8. FEDERAL:
{A9.,ncy n.:rme) 0 C.STATE DD.COUNTY 0 E. MUNICIPAL
0 F. OTHER: 0 G. UNKNOWN /SpBc,ly /
14 OWNER/OPERATOR NOTIFICATION ON FILE 1Check~1l1h,1/ar,p!y)
lXA. RCRA 3001 DATE RECEIVED: Z / 9 l 8] 0 B. UNCONTROLLEDWASTESITErc£RCu. 10JcJ DATE RECEIVED· , , 0 C. NONE MONTH DAY YEAR MONTH DAY YEAR
IV. CHARACTERIZATION OF POTENTIAL HAZARD
0 1 ON SITE INSPECTION BY (Chee• all /hat apply/
)CXYES DATE l / ] ]l 8~ 0 A. EPA 0 B. EPA CONTRACTOR Xl(C.STATE 0 D. OTHER CONTRACTOR
0 NO MONTH DAY YEAR □ E. LOCAL HEAL TH OFFICIAL IJ F. OTHER:
/Sp.,c1/~/
CONTRACTOR NAME($):
02 SITE STATUS (Chee• one) 03 YEARS OF OPERATION
0 A. ACTIVE 11 8. INACTIVE 0 C. UNKNOWN 1971 -? I 1981 0 UNKNOWN BEGINNING YEAR ENDING YEAR
04 DESCRIPTION OF SUBSTANCES POSSIBLY PRESENT, KNOWN, OR ALLEGED C • Macon intormed or ~resence or JS.uq~ (slop oil solids from petroleum refining industry). Also, misc. organic liquids, acids, slop oil solids,. sodium hydroxide, etc., were identified in samples taken on site.
NCYI'E: OCRA ID# FOR THIS SITE IS NCD980558811
05 DESCRIPTION OF POTENTIAL HAZARD TO ENVIRONMENT ANO/OR POPULATION 8 unlined lagoons, 2,073 drums, potential
groundwater contamination. At present, EPA is actively involved in cleanup and is
working closely with NC Solid & Haz. Waste Mgmt. Branch. EPA is presently installing
gw monitoring wells. Groundwater & surface water runoff toward waste.
v. PRIORITY ASSESSMENT ( see study plan for Charles Macon site, NUS Corp. lL/ lL/1l4J
0 1 PRIORITY FOR INSPECTION fChec• Me. If high 01 medium Is checked, ci,mp/818 P•t! 'l. Wul• /nto,m•llon ~nd Pa,t 3 O.sc,~//oll ol H.,a,doU$ Cond~JQl1$ tnd lnclden/fJ
0 A. HIGH 0 8. MEDIUM DC. LOW IX D. NONE fln$pect,on ,equited ptomplly) (lnspltc/ron requirMJ fln,pecr on rim,. sva,lable basis) /NO lut1t,., 8Cl!on nHd6d, compflfl• CUfl"nt d/SJ)oslrion to,m)
VI. INFORMATION AVAILABLE FROM
01 CONTACT 02 OF {Apency10,psni1alion) 03 TELEPHONE NUMBER Solid & Terry Dover N.C. Dept. of Human REsources/Maz. Wast, 19191 733 \gmt. 217R 04 PERSON RESPONSIBLE FOR ASSESSMENT 05 AGENCY 06 ORGANIZATION 07 TELEPHONE NUMBER 08 DATE Lawrence o. Lenz/L. Crosby NCDHR Solid & Haz. 3 7 I 85 19191 733 I T.7,--,c-t-n 2178 MONTH DAY YEAR
EPA FORM 7 . ' 7. 20 o 2 ( 61 J
• •
POTENTIAL HAZARDOUS WASTE SITE I. IDENTIFICATION
oEPA PRELIMINARY ASSESSMENT 01 STATE 102 SITE NUMBER
PART 2-WASTE INFORMATION
II. WASTE ST ATES, QUANTITIES, ANO CHARACTERISTICS
01 PHYSICAL ST ATES ,c11,ck ;o//11!8I apply) 02 WASTE QUANTITY AT SITE 03 WASTE CHARACTERISTICS 1c1t~c1< ,1, 111~1 anoly/
(Measu1u nl ..-as/t quan/11,es LJ I.HIGHLY VOLATILE
L1 A. SOLID lJ E. SLURRY mus/ (HI •n!Jei,ence~r! tJ A. TOXIC IJ E. SOLUBLE
I] B. POWDER. FINES [j F.LIOUID TONS lJ B. CORROSIVE LJ F. INFECTIOUS 0 J. EXPLOSIVE
UC. SLUDGE i.l G GAS [) C. RADIOACTIVE (J G FLAMMABLE lJ K. REACTIVE
CUBIC YAHDS \} 0. PERSISTENT LI H. IGN!TABLE l] L. INCOMPATIBLE
::J M. NOT APPLICABLE
: ; D. OTHER
/Spoc1ly/ NO.OF DRUMS
Ill. WASTE TYPE
CATEGORY SUBST ANGE NAME 01 GROSS AMOUNT 02 UNIT OF MEASURE 03 COMMENTS
SLU SLUDGE
OLW OILY WASTE
SOL SOLVENTS
PSO PESTICIDES
DCC OTHER ORGANIC CHEMICALS
ICC INORGANIC CHEMICALS
ACO ACIDS
BAS BASES
MES HEAVY METALS
IV, HAZARDOUS SUBSTANCES /Sea App<JMI> lormo.,l lroQuenlly c,1ed CAS Numbers!
01 CATEGORY 02 SUBSTANCE NAME 03 CAS NUMBER 04 STORAGE/DISPOSAL METHOD 05 CONCENTRATION 06 MEASURE OF
CONCENTRATION
V, FEEDSTOCK$ /Sea Apriendi, lot CAS Numbers!
CATEGORY 01 FEEDSTOCK NAME 02 CAS NUMBER CATEGORY 01 FEEDSTOCK NAME 02 CAS NUMBER
FOS FDS
FDS FOS
FDS FDS
FOS FDS
VI. SOURCES OF INFORMATION ,c,,upec,t/ctefe,ences, e "" s/ele /~es. umple an~l~s,,. reports /
EPAFORM2070 12 (7•81)
Duplicate of~--I
Delete from US
. te-1 Mile South of Cordov • 10840409
POTENTIAL HAZARDOUS WASTE SITE I. IDENTIFICATION
oEPA PRELIMINARY ASSESSMENT 01 STATE}02 ~-71'! "'' "'"cq
PART 1 -SITE INFORMATION AND ASSESSMENT NC , D980.60H472
IL SITE NAME ANO LOCATION
01 SITE NAME /Le11,1, common, or de~~np1i.,,. mime ol s1/eJ 02 STREET. ROUTE NO., OR SPECIFIC LOCATION IDENTIFIER
L M.alo!m· Machine Co. Old Cheraw Rd. (Rt. 1, Box 288)
03 CITY 04 STATE 05 ZIP CODE 106 COUNTY T'C0UN706 CONG : Rockingham NC 28379 Richmond f'IDE s°'ST
09 COORDINATES LATITUDE LONGITUDE
31, 0 ..53.' ~.5.. " I 29 ° ..5 Q'_ ..2 5.'.'
10 DIRECTIONS TO SITE (Slart,na lr()mnBatesl pub/le ,oad/
Located approximate 1 mile south of Cordova at the above address.
Ill. RESPONSIBLE PARTIES
01 OWNER /llknownJ -02 STREET fBvslnus, mall1t1p, 16sld1tntialJ
Charles Macon (deceased) Rt. 1. Box 288
OJ CITY 04STATE IQS ZIP CODE I 06 TELEPHONE NUMBER
I I I Rockingham NC 28379
07 OPERA TOR (II known and O.rf•t•nt from owner) 08 STREET (Bus/n.,n, melllog. ruldent,a!/
09 CITY lO_STATE 11 ZIP CODE I'' TELEPHONE NUMBER
I I
13 TYPE OF QWNERSHIP/Cr.•c• oneJ
f"XA. PRIVATE 0 B. FEDERAL:
(A(lencynam1t} 0 C.STATE OD.COUNTY 0 E. MUNICIPAL
0 F. OTHER: 0 G. UNKNOWN /Sp•c1fy J .
1 4 OWNER/OPERATOR NOTIFICATION ON FILE (Check ~1, tflm a1Jply/
Xl A. RCAA 3001 DATE RECEIVED, _J_~3.L DB. UNCONTROLLED WASTE SITE rcERCLA 103 c! DATE RECEIVED· , ' 0 C. NONE MONTH AV YEAR MONTH DAY YEAR
IV, CHARACTERIZATION OF POTENTIAL HAZARD
01 ON SITE INSPECTION BY fChecli a# that appJy)
Jli YES DATE 1 111 1 84 0 A. EPA 0 8. EPA CONTRACTOR ~ C.STATE 0 D. OTHER CONTRACTOR
0 NO MONTH DAY YEAR 0 E. LOCAL HEAL TH OFFICIAL 0 F. OTHER:
/Specify)
CONTRACTOR NAME($):
02 SITE STATUS {Cflttck on1t/ 03 YEARS OF OPERATION
0 A. ACTIVE IJtB. INACTIVE DC. UNKNOWN 1971 -? I 1981 0 UNKNOWN
BEGINNING YEAR ENDING YEAR
04 DESCRIPTION OF SUBSTANCES POSSIBLY PRESENT, KNOWN, OR ALLEGED
Duplicate of Macon 'Site 1:Miie South of Cordova (NC D980840409) .,,
05 DESCRIPTION OF POTENTIAL HAZARD TO ENVIRONMENT ANOIOA POPULATION
V. PRIORITY ASSESSMENT
0 I PRIORITY FOR INSPECTION /Ch•ck 1>,,,,. lth,gh ormedlu1111s checked, compl1tle P•n 2 Wur, /nlorm,rlon ilnd Pe,r 3 Descrlpr/cm ol H1tludous Cond1110ns •nd /nc101tn/s!
0 A. HtGH □ B. MEDIUM 0 C. LOW O{ D. NONE (lnsp1tclion reQuilfd promptly) /lnspect,on requited/ (lnspecl on 11n,e ava,iabl1t ba$rs} (No funl1&r acl!on nuded. complete curr1Jn( dispos//ion form}
VI. INFORMATION AVAILABLE FROM
01 CONTACT 02 OF (Apency10rr;1tniurion!
R /Solid & Haz. 03 TELEPHONE NUMBER
Terry Dover N.C. Dept, of Human es. Mgmt. 1919 1 733-2178 Waste 04 PERSON RESPONSIBLE FOR ASSESSMENT 05 AGENCY D6 ORGANIZATION S~l id I 07 TELEPHONE NUMBER 08 DATE
Lawrence o. Lenz/L. Crosby NC DHR & Haz, Was e 1 I 7185 Management 19191 733-2178 MONfH DAY YEAR
EPA FORM 2070-12 !7-81)
• •
POTENTIAL HAZARDOUS WASTE SITE I. IDENTIFICATION
&EPA PRELIMINARY ASSESSMENT 01 STATEI02S1TENUMBER
PART 2 • WASTE INFORMATION
II. WASTE ST ATES, QUANTITIES, AND CHARACTERISTICS
01 PHYSICAL STATES /C/1<,c••"r~a1applyJ 02 WASTE QUANTITY AT SlTE 03 WASTE CHARACTERISTICS fCh.,clr aNrrra1 d;,ply!
(M<MS<m,s ol ,US/8 QUBrrti/,es lJ !. HIGHLY VOLATILE
(J A, SOLID lJ E. SLURRY m,is1 06 ,rr<1ep6r><terr1/ iJ A. TOXIC IJ E. SOLUBLE
lJ 6. CORROSIVE l] F. INFECTIOUS lJ J. E°xPLOS!VE
U B. POWDER. FINES lJ F. LIQUID TONS I] C. RADIOACTIVE [J G FLAMMABLE l] K. REACTIVE
[J C. SLUDGE i.J G.GAS l 'J D. PERSISTENT LI H. IGNITABLE tJ l.. lNCOMPATIBLE
CUBIC YARDS L.: . .' M. NOT APPLICABLE
1J D. OTHER
f5p~c,ty/ NO.OF DRUMS
Ill. WASTE TYPE
CATEGORY SUBSTANCE NAME 0 1 GROSS AMOUNT 02 UNIT OF MEASURE 03 COMMENTS
Sl.U SLUDGE
OLW OILY WASTE
SOL SOLVENTS
PSD PESTICIDES
occ OTHER ORGAN!C CHEMICALS
IOC INORGANIC CHEMICALS
ACD ACIDS
BAS BASES
MES HEAVY METALS
IV. HAZARDOUS SUBSTANCES {$9e Apµ.,r,do, lormosl lrequanrly c,1ed CA$ Numbers)
01 CATEGORY 02 SUBSTANCE NAME 03 GAS NUMBER 04 STORAGEIOISPOSAL METHOD 05 CONCENTRATION 06 MEASURE OF CONCENTRATION
.
V. FEEDSTOCK$ (See Apµendo, /01 CAS Numb<'1S)
CATEGORY 01 FEEDSTOCK NAME 02 GAS NUMBER CATEGORY 01 FEEDSTOCK NAME 02 CAS NUMBER
FDS .. FDS
FDS FDS
FDS FDS
FDS FDS
VI. SOURCES OF INFORMATION 1c,ie sp1U:.//c references, e.g., s/Blf /Nu. ump/e 1n1!,s,s, ,.po,rs /
EPAFORM2070·12 (7•81)
-· ..
. ' (.--:;_-;;-~
' 7--~~ -,-
Z66 .-. . ·
"09
50'
-NAMEPLATE 8c MFG. INC.
PHONE [phone] TELEX 572-406
P. 0. BOX 312
MONROE, NORTH CAROLINA 28110
January 13, 1984
NC Solid & Hazardous Waste Mgt Branch PO Box 2091
Raleigh NC 27602
ATTENTION: Mr. Terry Dover
Gentlemen:
This letter is to confirm our conversation of yesterday at the Charlie Macon site. I have enclosed a copy of the analysis of our waste.
As you will notice, there are three {3) samples listed. The watse you have which is thick will probably be a combination of samples #1 and #2. We used to combine the two streams. The clear waste will probably be the #3 sample.
Our process is that of applying coatings of vinyl, polyester, enamels and acrylics to metal surfaces. These of course have their own respective thinner. We also apply inks which are of a UV light curable type. These also have their own thinner. Leftover coatings and inks are then put into drums for incineration by Stablex SC.
If I can be of any further help, please contact me.
Regards,
ACME NAMEPLATE & MFG INC t,!,7
Manager Quality Assurance
JL/bcw
a
A.
'
B.
C.
G.
!-J.
' ' ..
:--omn l. ;1rnunu uerar1rn~·111 l'I neann arw 1:11\ u,1nmcma1 Lomro1 $nlid :md Haiardou~ \\';1,tc ~lanagcment Di\i<ion
~60J Bull Street. Coh1mbia. SC: :Q~OI
Phone: tROJ) 75B-56~i
Name I.I). Cude --------
ii l
·-·-
Gcn.J)i1tor C.Hli N/IMf:PIA!F j,/__lO 00,1 r,_po
(2) Tran~roner No. I
HAZARDOUS WASTE MANIFEST
,\ddrc~( -------·--------------
A:'".; i),~. /1!..,', . .:'·:1...l.: ---.tv'C ). ~'//(.,' ---.
.\1anilt'\I Df?Cunirn: ·,-...t1!t1Ml·r
i~ ~ 19 2 7 2
l'ht,nc Number U:tlt' "ihippcd
!:lll"<L coUC' & numt"eo nr :\\'".:l'j'le(l ---···-·--· ----·-·-··-----------·--Jy I ___ 1~·.L 7o'-l·;J.{] Sil:/ I
·.,·Jr ,n,.r:h ,:,. -------------
ff L,};_·A _11i11 __ ,·.(· ,;,o~ _rj_J_ __ _/ .. __ j__ / 2..._ 501fl_i,:!=X 5 ( __ s f-v__Q_ 'l!L'-l_'!.:Z_3 , J . _;)l{ -,· St c' HJf "'"'l''' ''" --------------. ----------Tran~porter No. 2 ___ / --------I ·----· -•ur 111<•nll'I "" --···--·----(]) TSDF
,-{::: /,;.' ~"!-' \· y J I _j_l 2-snw,1.cx ~-C: S-C/) 01{1/'1_1/~3"-3 3 ,.,.. . -//,// ,· ;;l/ -c,1c {"/, } -(~--·-------·--· -----' ')'-' _) •rar ri11•n1!1 ,,. -··---
I 1 t Generator Item Coim1 l~t DOT Proper Shirring !J) Total 141 Wci,11ht I.') Wrt\lC Co<le (fiJ TSDF Item Chee!,. (7) Ouamicy
Name/Ha1.ar<l Clnt<; ()uanticy lpountl,J t-y Wei.du
Number Cont.1iner Tyr,e DOT Identification ,'1urnher Numher Con1~in~r r~•re !_pounchl -··•-·· ... ----· --➔--•·-·-----"----·
' t..:, )Sn; ;:'UJ1-J,•i,ff>'t.1.. L, 'i I
21( (-, -·' ' '/. N:,;, :;. jPt..1:,.,,,..,, .. 1,;,.,;· LI ( I /loo J,d. C/{;C}o;;,:. j)OO/ --' , "jl/1 a:•✓ II JtJ!J!l..5. ··--➔---·-·--------·-~
-----··-···---------·------·--·---· ----·--·-------· ·-··----•--·· -·--· ------.. ··------,
--··---------·-----------·-. -------·--··------· --·· ·-.... ·--------· --... -----· ·----·--·-·--··--·•·· -· ·······-·· .... -----------------·-------·-----------·
Emergen~·y Respon\e Information: I l. Srci.:ia! Han<llin:,i: ln.,1rucliP11t: E. t·o111rnent~: 1)/( "1. ~• I 1~'C/.lf~-·,. ·.:.J) ;-=;· .. In event at an emrizency, phlme the Generat0r ,n: ,/
L7c· ii L,.:.l'.1_· (UL __ ;}.·c '-.,.:/.:-. ·: 1/C ,',✓ ,':;_Jl..dth:,',\, .', (\ : 'i·i'.:..' In event of u ~pill in Soulh Carolina,
call the Di:partmenl at (ROJJ 7~R-553\ l1 ,> "'. ,,. 1-I.
Thi~ i~ 10 cenify !hat the nbovc-named material~ arl' prnrcrly da~~ificJ. dc\i.:rihcd, rack a.red. marled an<l l.ibclcJ, and are in rroper condili("ln for tran\pon.1ti0n a.:cnrd1n!{ rr:, all applicablr rei,i:ulatmm or 1hr: U.S.
OT. U.S .• L": the_.r,.'·PSC and the S.C. DHEC.
~/•( L er..~{ .1__.:. c..1vc-1,1,-t.:::.:?Z _ijL Jt/L ___________ ' . '""-_,~ ...-c..-. -----~-------s,;i, .. 111~ / .-..Jm~ Jr,d 1,11c I l ,:~
'I hercbi:/cnify that I am'an autllorl1eU reprc\cnrn1i~·e 11f the tran~rnner ,inU 1ha1 the wattf'1,) .ind qua111ity de,.:ribcd 1n 1hi; ,\la11Jfc,1 have hecn :ici.:er1ed hy U\ l'or ultima1c delivery 10 the TSDF identified abo\'!?
/ d ., ..
Tramporter No. i. ·:-/-.L.1L,l,,·-/• _'.:.)mo_:;;. x c; 11~r}r: I ···; ., . -_j -I 2. -· S;.f __________ / 'l.\ .:.+, _,._ ;J_....t.._.!:-_:~
rn•tu C ' "imc !/olf
Tramporter No, 2: ·--------·--·--------•------·-----',i~nawre -..~me 1~-
I hereby certify that I am an authorized represcn1ntive nf the TSDF idcmified nho\'e and that 1he wu~ret,1 nnd qunnfity in 1hi\ ,\lanifeq have been acr:ep1ed hy me fnr treatment, ,1orai,i:e. and/or d1,p1".::il. .
.'i,rn.iurc IJ.•·r
DHEC 1988 il/801 /mtructions for completing thi, Form on rever\c ~idc.
•
N. C. DEPARTMENT OF· HUMAN RESOURCES
DIVISION OF HEALTH ScRVlCES
STATE LABORATORY OF PUBLIC HEALTH
P. 0. BOX 28047 -306 N. Wilmington St.; Raleigh 27611
Site Number 77 tJOOOC, /i,oo}(, Field Sample Number ()Do 411? Lab ID 11 ___ _
Name of "Site" /2111:t.o" Site Location ~,(./,,.,,., .,..t-_L_
(A~<-_,i/,4,-~-I,_?' //'1,,,1,,._ ,,t-1-.)
Collected by: /2. fr.A, ( ,:p.) ID II t, ', I Date Callee led /._-//-& It Time /I) .'f0/>.J-...
Type of Sample: Environmental
Ground
Surface
Soil
Other
Comments:
f.3,qs c.-·
Extractables
Parameter Results
Concentrate
Solid
-vf:iquid
_ Sludge
Other
INORGANIC CHEMISTRY
Total
Parameter Results
..2::' Arsenic. ~ Arsenic /A;'\/
~Barium ~Barium t=,· \ x·cadmium xcadmium ~Q, Of;,_-
~Chr-omium ___!::"'Chr:omium o. l
X Lead ,...!:Lead (2, ' ~Mer:cur:y ~Mercur:y <o.o o ' ~Selenium v Selenium < a. w. c..l:(S il ve r ✓silver Q. l;J
1---
I--
~ -
'-, -.__ -
I--
Date Received ·------Date Reported 9 «> ~ Q l(
Par:ameter Results
Chlor:ide -_ Conductivity
_ Copper:
nuodde -Ir:on -_ Manganese
Nitrate
a/pH L.;2.,0
Sulfates -TDS -
Zinc r v 9/;#JA fi ;,, ::2: l':J.o•t
-
-
Reported by ____________ ~ Lab Number _____________ _
DRS 3191
Solid and Hazardous Waste
~ .. •
N. C. DEPARTMENT OF HUMAN RESOURCES
DIVISION OF HEALTH StRVlCES
STATE LABORATORY OF PUBLIC HEALTH
P. O. BOX 28047 -306 N. Wilmington St., Raleigh 276il
<!.sr
Site NumbeC' 77 t;Jt'OOO /tltHJX Field Sample NumbeC" (Joo '{/.r Lab ID 11 ___ _
Name of "Site" f)'JAC-/21", Site Location. 6,f.J,,v,,. .A,-_L_
( /J,:..m r. /4,;.,,c ;ell>'le I l?1,n1.1H._,,d--L. )
Callee ted by: /2. QA:y (zp.} ID II CJ f Date Collected /-lcS-4 Time /A.')t>/f}r--.
Type of Sample: Environmental
Ground
Surface
Soil
Concentrate
Solid
_ Liquid
_t.--Sludge
Other OlheC'
Comments:
r"' /JI 6 "1 -f »~ .. --J
INORGANIC CHEMISTRY·
Extract ables Total
Parameter Results PaC"ameteC" Results
YArsenic ~C'senic a. a~ ~Barium _vllaC'ium CJ.. 2
_!:cadmium VCadmium <o.ar
~ChC'omium vchromium l, i,c;-
~Vl..ead -✓Lead ~D ~Mercury -✓MercuC"y <:. Q;i
....=-'Selenium ✓selenium < /J., QQi._
~ilVeC' ✓silveC" (a.as-
~--
1---
~ -
1-------
Date Received _____ _ Date Reported Cf & >tC 'SC/
PaC'ameter Results
Chloride -_ Conductivity
_ CoppeC'
Fluoride -IC'on -_ Manganese
Ni tC"ate
VpH L/. ;}_
Sulfates -TDS -Zinc .
V ~ B,.i .. +-Zl8. • F.
-
-
Date Analyzed. _____ _
RepoC'ted by ____________ _ 26465 clAN?O 84 Lab NumbeC' _____________ _
DHS 3191
Solid and Hazardous Waste
. . .. '
N. ~-DEPARTMENT OF· HUMAN RESOURCES
DIVISION OF HEALTH S~RVlCES
STATE LA11ORATORY OF PUBLIC HEALTH
P. 0. BOX 28047 -306 N. Wilmington St.; Raleigh 27611
Site Number 77 ()o,:,oo /(!bOX ID 11
Name of "Site"
-----
Collected by: f. 611y V:D) ID 11---'0'-"9'---_ Date Collected /-J/-';l( Time lo: 30h.-,.._
Type of Sample: Environmental
Ground
Surface
Soil
Other
Comments:
fed D~u-.$
Concentrate
Solid
_ Liquid
~Sludge
Other
INORGANIC CHEMISTRY·
Extract ables Total
Parameter Results Parameter Results ✓ Arsenic VArsenic I\. ( -. vBarium LB a ri um I() -v Cadmium-...!::::"Cadrni um s-. s
._!:Chromium ..!:::: Chromium ¾ ~ Lead .!:'.' Lead
~ Mercury _l::'Hercury
,_.!:: Selenium ....!'.:'Selenium
.._!::' Silver ....!:'.' silver
-------------
Date Received ______ Date Reported 7 M>cliiY
Lab Number
Parameter Results
Chloride -
-Conductivity
_ Copper
Fluoride -Iron -_ Manganese
Nitrate -....!:::'"'PH
Sulfates -TDS -
~nc = 1M.ib fMif-I.()_ 8 ,, !=,
-
-
Date Analy~ed..,.,.,..,,..,,..----2b4b6 ,!~N'.:'O 84 Reported by _____________ _ ---------------
DRS 3191
Solid and Hazardous Waste
N. C. DEPARTMENT OF HUMAN RESOURCES
DIVISION OF HEALTH StRVlCES
STATE LABORATORY OF PUBLIC HEALTH·
P. 0. BOX 28047 -306 N. Wilmington St.; Raleigh
Site Number 77 0/H!JOO /ODO J<. Field Sample Number
Collected by: /l.. r;,,,, Cr./). ) ID 11_-"t)C...9<----Date Collected /-II-?'{ Time /~.'3'0,,9.,-...;. I
Type of Sample: Environmental
Ground
Surface
Soil
Other
Comments: •·1>"'f
R~J .D1-u-~
Extractables
Parameter Results
.,__ Arsenic -
1--Bat'" i urn -Cadmium---Chromium --Lead --
Concentrate
Solid
_ Liquid
~ludge
Other
INORGANIC CHEMISTRY
Total
Parameter Results
Arsenic
Bar-ium
Cadmium
Chromium
Lead
_ Mercury _ Mercury
_ Selenium -Selenium
_ Silver -Silver
-, -----
--
--
-· -
Repot"ted by
DHS 3191
Solid and Hazardous Waste
Parameter Results
Chloride -_ Conductivity
_ Copper
Fluoride -Iron -_ li·anganese
Nitrate --pH
Sulfates -TDS -Zinc -
7~ ~. j{ IMS<~ v~ .
•
• f:}.-.;t ......
'
•• J .. '., ' •.~ ORGANIC CliEMlSTRY ·--·------·i··· ·-·---------Parameter Results Endrin · · •
Lindane• •
Methoxy.chlor
Toxaphene
2,4-D
2, 4, 5-·TP (Si 1 vex)
PCB's
Petroleum
roe
TOX
-----------------------------------·-------------·----Date Received __ ~--Date Reported _________ Reported by ______ _
Date Extracted _________ Date Analyzed_
Parameter
(MF) Coliform Colonies/lOOmls
(MPN) Coliform Colonies/lOOmls
MICROBIOLOGY
Date Received ------Date Analyzed ______ _
Reported by ____________ _ Lab Number
RADIOCHEMISTRY
Lab Number
Date Reported _____ _
Parameter Results Parameter Results
-Gross Alpha -Gross Beta· --
>-,.... -I'--~· ..
. . ' ' • >--. .-· ~.~' \--~) '\J • ! • ,._.. ~ >-. -
Date Received _____ _ Date .Analyzed _____ _ Date Reported _____ _
Reported· by _____________ _ Lab Number ______________ _
• •
N. C. DEPARTMENT OF HUMAN RESOURCES
DIVISION OF HEALTH SERVlCES
STATE LABORATORY OF PUBLIC HEALTH
P. o. aox·2s047 -306 N. Wilmington St., Raleigh 27611
Site Number 77 O()DOD /fJDfJ J< Field Sample Number CJDO 4/S-Lab ID 11 ----
Name a f "Site" _,fJJ=.=-A:.:C..=i>.=-.,,.;,· _· ______ Si le Loe at ion ____________ _
Callee ted by: R, 6:& I
ID li _ __,0"'-'9 __
Type of s·ample: Environmental
Ground
Surface
Soil
Other
Comments:
J;, /1111 .. f-. j)~,,,-J
Extrectables
Parameter Results
_ Arsenic -
i.-Barium -Cadrni um---Chromium --_ Lead -
Concentrate
Sol id
_ Liquid
~Sludge
Other
INORGANIC CHEMISTRY·
Total
Parameter Results
Arsenic
Bari um
Cadmium
Chromium
Lead
~ Her-cur-y _ Mercury
_ Selenium -Selenium
-Silver -Silver -------
f---
----
Date Received_.!/J.'l.J-~t._-Date Reported /-3/-,?,;fC
Parameter Results
Chloride -_ Conductivity
_ Copper
Fluoride -Iron -_ }(anganese
Nitrate -
-pH
Sulfates -TDS -Zinc -
JL dcJMs!~ 'ti-~ ,
Reported by~~~~~-..!.,A.£.~~~:::====-
Date Analyzed J/ .2.¼ ,I~</
:1-:. ·,( '390 -I •• ,-,-::/ Lab Number _____________ _
DRS 3191
Solid and Hazardous Waste
•
ORGANIC CHEHISTRY .. __ Parameter ____________ Results _________ Parameter ___________ Results_ Endrin
Lindane
Hethoxychlor
Toxaphene
2,4-D
2,4,5-TP(Silvex)
PCB's
Petroleum
TOC
TOX
Date Rece i ved-777<j / ~Y._ Dat~;ported_=-----=--R~pci~t~d-by ________ ·---·-----r J
Date Extracted _________ Date Analyzed ___________ Lab Number
,__
Par-ameter
fHF) Coliform Colonies/lOOmls
(HPN) Coliform Colonies/lOOmls
HICROBIOLOGY
~ -----------------------------------------------
,__ ----------------------
Results
-----------------------------------------
Date Received ------Date Analyzed ____ _ Da t,e Reporte_d ·
Reported by _____________ _ Lab Number
RADIOCHEHISTRY
Par-ameter-Results Parameter Results
~ Gross Alpha -t--Gross Beta--• --.f_' ,t,:~ \1 _, ; t -r" \\1, \ )·"" \t -" ~ • J -. -.;,
Date Received ------Date Analyzed ______ _ Date Reported _____ _
Reported by ____________ _ Lab Number ---------------
• •
N. C. DEPARTMENT OF· HUMAN RESOURCES
DIVISION OF HEALTH SERVlCES
STATE LABORATORY OF PUBLIC HEALTH
P. 0. BOX 28047 -306 N. Wilmington St., Raleigh 27611
Site Number 7")00000 /400)(_ Field Sample Number /JOD i/l'( Lab ID 11 ___ _
Name of "Site" -LttJ.~'-'Ac.:U=-·"....:·_. ______ Site Location (1,e J,.u'4 /2L
Collected by:/(. C.11,__ (rD)
I
ID 11_....;(y;_, -''t __ Date Collected
Type of ·sample: Environmental
Ground
Concentrate
Sol id
VLiquid
Sludge
Other
· ~/27/?'f Ti me /f ~ i>P /J -·
..;--c&c',,, a..-L..t~/
Surface
Soil
Other
·7?4 /1)/?8
Comments:
8il-s c...
INORGANIC CHEMISTRY
Extractables Total
Parameter Results Parameter Results Parameter Results
_ Ac-senic -Arsenic -Chloride -Barium -Barium -Conductivity
-Cadmium -Cadmium -Copper -Chromium -Chromium -Fluoi:-ide
.__ Lead -Lead -Iron
1---Her-cury -Hei:-cury -Manganese
~ Selenium -Selenium -Nitrate
.__ Silver -Silver--pH
Sulfates . ----TDS ---Zinc ---
--~ -ea ?~~; --Jl :&1 ~ . \ ,d;t:i;,,, .,l,_,/_ -. , /_1 -· -.
Date Received
Reported by
1,119,t'ff ~Date Repoi:-ted. -3 -? Date Analyzed v,·v1'o" <,I {1t)CiJl,(j) , I ~ Lab Number-______________ _
DRS 3191
Solid and Hazardous Waste
•
ORGANIC CiiEHJSTRY ___________ -·-·-·-----·•--··· ··-____ Parameter ____________ Results ________ Parameter_. __________ Results ·····-·--End r in
Lindane
Hethoxychlor
Toxaphene
2,4-D
2 , 4 , 5-T P ( S i 1 vex )
PCB's
Petroleum
TOC
TOX
Date Received_, ___ _ Date Reported ________ Reported by ______ _
Date Extracted __________ Date Analyzed ______ _ Lab Number
MICROBIOLOGY
Parameter
(MF) Coliform Colonies/lOOmls
(MPN) Coliform Colonies/lOOmls
Results ----1
----'----=I
Date Received ------Date Analyzed ______ _ Date Reported _____ _
Reported by ____________ _ Lab Number
RADIOCHEMISTRY
Parameter Results Parameter Results Gross -Alpha -Gross -Beta• -
--,,.;, ·Tl \J -......... . \ -.. ' ... ..,_· "?: J\!\~ \""' '\_1 •. ~-.J ~~ -
Date Received _____ _ Date Analyzed _____ _ Date Reported _____ _
Reported by ____________ _ Lab Number --'--------------
I
100.0
I RIC
RIC
01/23/84 14:22:00 SAMPLE, -RANGE: G l,1831
~ ~ j
.\I .,
~
ct
~
~ 'l;
<i;. ..,
' ~ ~
}
"" ~ ,/ " -cc " 0 • .::i' 0 0' ' .!!
-' .<: 429 ~' ..... "'..:: C + ~l-"5
' 295
DATA: 0400398 #870 CALI: FC43J23 #3
LABEL: N 0, 4.0 QUAH: A (), 1.0 BASE: U 20, 3 557
' -0
C
r
' '-' i ) ' •
l
<;:, ~ ,_
~ i: 1 " cJ
i \l C: • ... • f ' "' ~ ~ "'' "'l.
$: _,,"'-. ~ ' Cl { > ... \--' <:::) ') i ' "' "' " .,.
<., ,,---I 622 --897
1200 13')5
500 1000 12:55 25,50
I TO 1831
32768
1493 1638
1500 SCAtl 38,45 TIME
I
100.0
I RIC
108
RIC
01/24/84 11:22:00 SAMPLE: -
r""\
DATA: 400399 #1 CALI: FC43JAN17 13 RANGE: G 1,1439 LA8E'f N 0, 4. 0 i 564
QUAN: A 0, I.fl BASE: U 20, 3
230
200 5'10
~
' "" ~
q: ,(,
';, ' -< ;.
z .,_
434
371
400
10:20
J <;::, >-~
~ '-' s
1:
"'
""' " "' " "Q
' 'i,
628
600 15:38 800
20:40 1000
25:50
SCANS
1200
-31:00
1 TO 1439
2692
1400 SCAN
36: 10 TIME
I
100.0
I RIC
50
RIC
01/24/84 13!02:00 SAMPLE: -
RAHGE! G 1. 1500 LABEL: H 0, 4.0
162
200
5: 10
291
j
f
0
" <I .s
1:
~
436
400
10,20
~
~ <U
-"
s-
'! ....
0
C a...
r I .,.
• ' sw
566
€00
15:'.30
DATA: 400400 #1 CALI: FC43JAH17 #3
QUA'l A r 31
0, 1. 0 BASE: U 20, 3
,. --~ ~5
~
1
:!
.""\ <J\
~"'\
~
-:[
<.J
782 j
800
20,40
1027
1000
25:50
1105
SCANS I TO 1500
1400
%:10
547
SCAN
TIN£
/
N. C. DEPARTMENT OF HUMAN RESOURCES
DIVISION OF HEALTH S~RVlCES
STATE LABORATORY OF PUBLIC HEALTH P. 0. BOX 28047 -306 N. Wilmington St.; Raleigh 27611
Site Number 7 Z OrJOt'O /00 0 X Field Sample Number QL10 YO,Z Lab ID ·11 ____ _
Name of "Site" /'[}Ac 01'\ Site Location all C/2e,e-9.,., />J. CN J,.,,., --+-~~~~~-----I
Collected by:£ &l'h, (,.p) ID II ()9 I --~--Date Collected /;,-;19-i,3 Time ;;; 30 /ti--.
Type of Sample: Environmental
Ground
Surface
Soil
Other
Comments:
Fly flsl-.
Extractables
Parameter Results
Concentrate
__1/solid
_ Liquid
_ Sludge
Other
INORGANIC CHEMISTRY
Total
Parameter Results
...
..!:(Arsenic <a. so ~Arsenic ±tt VBarium '<'. O• f vBarium -k Cadmium ~Q.oS' ..J:'."Cadmi urn ~ Chromium (o.o("' .....!:"Chromium q_ ':(_
~Lead f fl. I _J,(Lead '.;l ~ ~Mercury ~.;'J. VMercury Co. I V Selenium <o, so~ Vseleniurn !J.~ -
Vsilver ...le silver ~Q,Q('° -------------
···-·· ·-· ..... -.. _ .. .... _, .. -..... -, .....
Parameter Results
_Chloride . "' ·'• •· .. -Conductivity' :·:,· .• ..
_ Copper
Fluoride -Iron -_ Manganese
Nitrate -..J:c:'1'iH ~ 8. Sulfates -TDS .. -Zinc .. -
•'-' ' ---
Reported by ____________ _ Lab Number ___________ -'----'-
OHS 3191
Solid and Hazardous Waste
•
N. C. DEPARTMENT OF· HUMAN RESOURCES
DIVISION OF HEALTH SERVICES
STATE LABORATORY OF PUBLIC HEALTH
P. 0. BOX 28047· -. 306 N. ,Wilmington St.; Raleigh 27611
Site Number 7700/Jt'O /t:><JO )s Field Sample Number 000 4/0 Lab ID 11
Name of "Site" Site Location {)/,/ OAe,,e,,, • ._.pJ t'1uc/4ur1
7
Collectedby:/?,/2,-i,, Ro) ID/I 09 l Date Callee ted /~/.:Zif'i':3Time //.' tJt!"1-
Type of Sample: Environmental
Ground
Surface
Soil
Other
Comments: W.rH / e_ (),' / ; I'\
Extractables
Parameter
Arsenic
Barium
Cadmium•
Chromium
Lead
Results
Concentrate
Sol id
_f:'.'.1,i q u i d
..ti,Sludge
Other
INORGANIC CHEMISTRY
Total
Parameter
Arsenic
Barium
Cadmium
Chromium
Lead
Results
i~v~•~-_, __ _
_ci#ict-
OHS 3191
Solid and Hazardous Waste
Parameter
Chloride
Conductivity
Copper
Fluoride
Iron ~i»wses.
· Sulfates
TDS
Zinc
Results
·~~~~
... ., .. -~~.,. •
Parameter---~---·-------R___gsults
Endrin
Lindane
•
_? <!_v~o;uf-e_
Methoxychlor
Toxaphenc
X 1/-v/?-,. v: I/) ,,;r ..,,_
v,, · 1-l;d~t> t..~irbn,
2,4-D '
2,4,5-·TP(Silvex)
PCB's
Pelcoleum
TOC
TOX
Date Received Date Reported ___________ Reported by ______ ~
Date Extracted Date Analyzed _________ . __ Lab Number
f--
Parameter
(HF) Coliform Colonies/lOOmls
(MPN) Coliform Colonies/lOOmls
MICROBIOLOGY
f-------------------------
----------------------
----------------------
Results·
---------------------------------------
Date Received ------Date Analyzed ____ _
Reported by ______________ Lab Number
Pat'ameter-
Gross Alpha
Gross Beta
Results
Date Received _____ _ Date Analyzed _____ _
Date Reported
Date Reported
Reported by _____________ _ Lab Number _________ _
-sc_,-ft,/r/\ r -c~15 I CL.p ma C!,,7// 01 le
11 o (Y--(,c..e__ ~ J2o,tifnL1A
~( ~ '-'G<k r 0~
·51-~ u)~ 1'/48 ,
l~ · I :5ov-lh f-o /2.i~~ .
0 e,,'-+ ,t/ <JO ..s/raL0 lcf-. o,,___, I -5~~
·. -=~ ~---:-::~-'~.t-7(
:11~~;-_;:~~~~
. . •
N. C. DEPARTMENT OF HUMAN RESOURCES
DIVISION OF HEALTH SERVlCES
STATE LABORATORY OF PUBLIC HEALTH
P. 0. BOX 28047 -306 N. Wilmington St.; Raleigh 27611
Site Number ))-'CJa;wl.,oo-)(
Name of "Site" t2Jtico,, ~;/c_
Field Sample Number l/07 Lab ID 11 ____ _
Site Location {)JJ C/2t:R'91-vl!/, f1d,,,,/t I
6 o,--<-)
Callee ted by: P,, /,,w) &i ID 11_~0'--1-7--Date Callee ted/.2-6-6'3 Time/-<; IS Ph--.
Type of Sample: Environmental
Comments:
.J/GrOund
Surface
Soil
Other
Extractables
Parameter Results -Arsenic
Barium -Cadmium -~ Ch~omium --Lead
Mercury = Selenium
Silver -
--
--,-
-
-
-
--
-
-
-
-
-
-
-
---
-
-
--1,{
-
Concentrate
Sol id
Liquid
Sludge
Other
INORGANIC CHEMISTRY
Total
Parameter Results
Arsenic
Barium
Cadmium
Chromium
Lead
Mercury
Selenium
Silver
Tl[L-LS' elt!J H
Parameter Results
Chloride -
-Conductivity
-Copper
Fluoride -Iron -
-Manganese
Nitrate -
-pH
Sulfates -TDS -Zinc -Bie,,,u/J k. V -V H.r
H,idroc.11.rk11f. #, , .., -,
Date Received 1.J-7-~.:, Date Reported /J,.-/~--83. Date Analyzed f!J-11.:.;5,-f,f<
(, 0 ~ /1.£-~ab Number_~3~:~)7~1=d~f~; ____ ,_ Reported by
I, r DHS 3191
Solid and Hazardous Waste
ORGANIC Cll_!l_ltl STRY _________________ . _____________ _
---~ ___ Parameter-··----·-----___ Results
Endrin
Lindane
Hethoxychlor
Toxaphene
2,4-D
2,4,5-TP(Silvex)
PCB's
Petroleum
vfoc
TOX
Results -··--···--
Date Received __ _ Date Reported ___________ Reported by ______ _
Date Extracted _____________ _ Date Analyzed
MICROBIOLOGY
Parameter
(HF) Coliform Colonies/lOOmls
(HPN) Coliform Colonies/lOOmls
Date Received _____ _ Date Analyzed_. _____ _
Reported by _____________ _ Lab Number
RADIOCHEHISTRY
Lab Number
Results
Date Reported ______ _
Par'ameter Results Parameter Results
-Gross Alpha -_ Gross Beta -
---,\ ---
Date Received _____ _ Date Analyzed _____ _ Date Reported ------
Reported by ____________ _ Lab Number
" .
•
N. C. DEPARTMENT OF· HUMAN RESOURCES
DIVISION OF HEALTH SERVlCES
STATE LABORATORY OF PUBLIC HEALTH
P.O. BOX ?804:r:;_°:iO6,N.:Wilmington St., Raleigh
Field Sample Number l/t; I Lab ID 11 Site Number 77-011060 /HO /C
Name of ·•site" Pl11eo,i s;;.s.
(De..,,~ 76,-f&•n ..,,_LI)
Site Location (U,/ CJi•u,..., R/ C..,,/4,.,;9
Collected by: !l:cl,~~J f,."'J ID 11 _ _,,Q_,9 ___ Date Collected, /.2~,-,JTime lj:c6,q,....
Type of Sample: Environmental
_0round
_·· Surface,
Soil
Other
Concentrate
Sol id
_ Liquid
_ Sludge
Other
Comments: ,,.,_,:I-,? ffeU t,./..ffiv,..; ~/,
·INORGANIC CHEMISTRY
Extract ables Total
Parameter Results Parameter Results Parameter Results
Arsenic Arsenic Chloride ---
-Barium -Barium _ Conductivity
-Cadmium -Cadmi urn _ Copper
_ Chromium -Chromium -Fluoride
Lead Lead Iron ---,__ Mercury _ Mercury _. Manganese
_ Selenium -Selenium -Nitrate
1-Silver -Silver . -pH
Sulfates ~---
I---TDS
--Zinc I-()~ < I pp...., v
I-✓ 7 ff'11
-
t+S ~ • TOC v' ---1,1.i,, ✓ H,,,dvvc a"'rn> ----
' Ctvlf'U... "· v. '')
-· Date Received 1.l-7-f-3 Date Reported 12-1s--.?3 Date Analyzed 1)./1-, S-/ J'l
(,r),? 3'.)7100 , , e~ Lab Number Reported by
II
DHS 3191 V
Solid and Hazardous Waste
•
~ ..:_ __ ·-· .. --------------· ... -----------ORGANIC CH§__H_-LSTRY _______________________________ _ . Parameter , . r -

.

Endrin ..r
Lindan~_'/
Hethoxychlor
Toxaphene
2,4-D
2,4,5-TP(Silvex)
PCB' S, :·
Petroleum
VToc
_ Results __ Resu l_ts_
. '
,.
, __ T~O~X"------------------'---------------------
Date Extracted ______________ Date Analyzed_ Lab Number
MICROBIOLOGY
Parameter
(Hf) Coliform Colonies/lOOmls
(HPN) Coliform Colonies/lOOmls
_____ Re_s_·u_1_t_s ______ -=1
Date Received ------Date Analyzed -----Date Reported _____ _
Reported by _____________ _ Lab Number
RADIOCHEMISTRY
Parameter Results Parameter Results
~ Gross Alpha -r---Gross Beta -
~ -
f--; -•'
f---
Date Received _____ _ Date Analyzed _____ _ Date Reported
Reported by _____________ _ Lab Number
I . •
N. C. DEPARTMENT OF HUMAN RESOURCES
DIVISION OF HEALTH SERVlCES
STATE LABORATORY OF PUBLIC HEALTH
P. 0. BOX 28047 -306 N, Wilmington St., Raleigh 27611
Site Number '27-(')QoQo/Ooo ·-A. Field Sample Number I/tit:, Lab ID 11 -----
Name of "Si le" IJ7nc_,,,,, ::J,-/.,
{Bm;C e.. Uou?,£)
Site Location O/j (VI,&-/!) 1 GRJov,,._ I
Collected by: /?,,h,qPJ.0""; ID 11_--'C,~r~--Date Collected /.)--t,-b'3 Time /.2.'00/il-.
Type of Sample: Environmental
Comments:
_veround
Surface
Soil
Other
Extract ables
Parameter Results
~ Arsenic
t--Bari um
Cadmium -Chromium -Lead --_ Mercury
Selenium -Silver -
---
-
-
-
--
Date
Reported by
OHS 3191
----
-
-
-
-
--
-
-V -
-
Solid and Hazardous Waste
Concentrate
Solid
__ Liquid
Sludge
Other
INORGANIC CHEMISTRY
Total
Pai:-ameter Results
Arsenic
Barium
Cadmium
Chromium
Lead
Hercui:-y
Selenium
Silver
Tlll. s-
Parameter-Results
Chlot"ide -
-Conductivity
-Copper
Fluoride -Iron -
-Manganese
Nitrate -
-pH
Sulfates -TDS -Zinc -v Rie .. •b · · ~ ..., :S .. , --ft;.dni ~ vbul'l5 /-.f. () · · K
•
ORGANIC CHEMISTRY ____________________________ ,, ___ _ ___ ---~c:_am1£ter _______________ Re~ul ts
Endrin
Lindane
Methoxychlor
Toxaphene
2,4-D
2,4,5--TP(Silvex)
PCB's
Petroleum
l/TOC
TOX
____ Results_
Date Received ________ _ Date Reported __________ Reported by ______ _
Date Extracted,, ____________ Date Analyzed ____________ Lab Number ________________ _
Par-ameter
(MF) Coliform Colonies/lOOmls
(HPN) Coliform Coloriies/lOOmls
MICROBIOLOGY
Date Received ------Date Analyzed ____ _
Reported by _____________ _ Lab Number
RADIOCHEMISTRY .
Results
Date Reported _____ _
Par-ameter-Results Parameter Results
-Gross Alpha -Gross Beta --
f--------
Date Received _____ _ Date Analyzed ______ _ Date Reported
Reported by _____________ _ Lab Number _____________ _
' I
' . .. •
N. C. DEPARTMENT OF HUMAN RESOURCES
DIVISION OF HEALTH SERVlCES
STATE LABORATORY OF PUBLIC HEALTH
P. 0. BOX 28047 -306 N. Wilmington St.; Raleigh 27611
site Number 27-@rn 1000 -/\ Field Sample Number L/ 0 '6 Lab ID 11 -----
Name of "Site" ~/JJ,~~'ll~L=O~n~:>.~t~1~· -'---Site Location Oil C!tetr1,,.,..?~. c;!'){.,lc)v/4
)
7
Collected by: ,1.,'}vl,,q,,,.Jfu;, ID 11_~6,,__,'7 ___ Date Collected L.z-£-,f3 Time /'tJo/lj--.
Type of Sample:
Comments:
Envj,conmental
_.1/Ground
Surface
Soil
Other
Extractables
Parameter Results
_ Arsenic -Bari um --Cadmium --Chromium --Lead --_ Mercur-y -_ Selenium -_ Silver -
---------V --
--
DRS 3191
Solid and Hazardous Waste
Concentrate
Sol id
Liquid
Sludge
Other
INORGANIC CHEMISTRY
Total
Parameter Results
Arsenic
Barium
Cadmium
Chromium
Lead
Mercury
Selenium
Silver
TlJC. 4,~
Parameter Results
Chloride . -
-Conductivity
-Copper
l'luoride -Iron -
-Manganese
Nitrate --pH
Sulfates -TDS -Zinc -
-I<'.'. /Jlte010/J < l A1!!:> v H;:S' -6'4V11c..,i.vb. .. ~ ✓ -
•
ORGANIC CHEM! STRY ____ ·-··-·-·----... __ .. _______ ···--
_____ .Paramet_er _________________ Results
Endrin ,.,,....
Lindane ,.,... --';'7-'-j==~,.-,,-5-
Methoxychlor
Toxaphene ~ --~w...==1P=..>..~----------
2, 4-D
2,4,5--TP(Silvex)
PCB's
Petroleum
V'roc
TOX
----------·-----------------------------------·-·-·-----·--·· ·--··---· Date Received ___ _ Date Reported ___________ Reported by ______ _
Date ~:xtracted Date Analyzed_ Lab Number
MICROBIOLOGY
Parameter Results 1-----~====~--------------------~===~-----------(HF) Coliform Colonies/lOOmls
t---(HPN) Coliform Colonies/lOOmls
t---------------------------
t--------------------------
t--------------------------
>-----------------------------------------
Date Received ------Date Analyzed ____ _ Date Reported ______ _
Reported by _____________ _ Lab Number
RADIOCHEMISTRY
Parameter Results ., Parameter Results
Gross Alpha --_ Gross Beta -
----'' -
--
Date Received _____ _ Date An.alyzed _____ _ Date.Reported. _____ _
Reported by _____________ _ Lab Number ________________ _
. ,
. .
• • •
N. C. DEPARTMENT OF HUMAN RESOURCES
DIVISION OF HEALTH S~RVlCES
STATE LABORATORY OF PUBLIC HEALTH
P. 0. BOX 2804i -306 N. Wilmington St.; Raleigh 27611
Si le Number-"7]-boooo /000 -X
Name of "Site" /JJ8co,. ;r·i'c
Field Sample Number-'-/OS Lab ID 11
Site Location 6//. Cliu?n..,,/JJ . (!t,,,,/,,.,,... 7
llssce,, ) r ,
Callee ted by: fit /219, / 6"'7 ID 11_....,()"-o/+---Date Callee ted IJ-6-0 Time //'l./5'
Type of Sample:
Comments:
Envir-onmental
_t..---c:r'~ u n d
Sur-face
Soil
Other-
Extr-actables
Par-ameter-Results
~ Arsenic -Barium ~ -Cadmium --
f--Ch r-om i um -Lead --
Concentr-ate
Solid
Liquid
Sludge
Other-
INORGANIC CHEMISTRY
Total
Par-ameter-Results
Arsenic
Barium
Cadmium
Chr-omium
Lead
,__ Mer-cury _ Mer-cur-y
_ Selenium -Selenium
_ Silver--Silver-
---
--
--
--V n,c.. ~s-PI"' --t ---
Date Received__,=__,,_--"'--'--Date Repor-ted /,t:-IS-~f3
Par-ameter-Results
Chlor-ide -
-Conductivity
-Copper-
Fluor-Ide -Ir-on -_ Manganese
Ni tr-ate -
-pH
Sulfates -TDS -Zinc -
....!:::: /Jhel'fOII ~
V Hs -
V Jfv4_i,--,u,r-J,,.J )✓, D.
Date Analyzed J.. 1.:.1rr i.
Repor-ted by I' eat? Lab Number-__ 3=' ...o,J~1~l ..... C...e»c=,4.._ ____ _
DHS 3191
Solid and Hazardous Waste
CSf
•
ORGANIC CHEM_ISTRY __________________________________ _ ___ Parameter ____________ Results Parameter __ Results_
Endrin Y fbetmb" Lindane
Methoxychlor y ijJ;JRO;&W
V _,qd .S_ fl< L. Toxaphene
2,4-D
2,4,5-TP(Silvex)
PCB' s _
Pelroleum
I/foe
· TOX ~----------------------.J. ______________________ _
Date Received __ _ Date Reporled ___________ Reported by~--------
· Date Extracted ______________ _ Date Analyzed ______ _ Lab Number
MICROBIOLOGY
Parameter
(HF) Coliform Colonies/lOOmls
(HPN) Coliform Colonies/lOOmls
Results =====i -===,
Date Received _____ _ Date Analyzed _____ _ Date Reported
Reported by _____________ _ Lab Number
RADIOCHEMISTRY
Parameter Results ParameteL Results
f-Gross Alpha -r--Gross Beta ' ---
-., -
--
Date Received ------Date Analyzed ______ _ Date Reported _____ _
Reported by __ ,_· __________ _ Lab Number ..
• •
I • •
N. C. DEPARTMENT OF HUMAN RESOURCES
DIVISION Or HEALTH SERVlCES
STATE LABORATORY OF PUBLIC HEALTH
. P. O. BOX 28047 '0 '306 N-. Wilmington St., Raleigh 27611
Site Number 7 7 -eoooo loOQ -X rield Sample Number 1./.o<t-Lab ID 11
Name of "Si le" 07&:-on ,<u· /e Site Location O/) C/,e;u1,v ,el 0.edovs
{/'~" h,, n C-ttdne & )
cs(
ID 11_-"C)'-'--Cf __ Collected by: fie /,,:111J, be(
Type of Sample: Environmental
...!::'Ground
Date Collected /).-j,-f:3 Time //.'30f}./ll.
Comments:
Surface
Soil
Other
Extract ables
Parameter Results
r-Arsenic
Bari um -Cadmium -_ Chr-omium
Lead -_ Mer-cury
-Selen\um
_ Silver .
--
-
-
-
-
--
--
-
--
-
-
-
-
-
--V -
-
Concentrate
Solid
Liquid
Sludge
Other
INORGANIC CHEMISTRY
Total
Parameter Results
Arsenic
Barium
Cadmium
Chromium
Lead
Mercury
Selenium
Silver
{QC. ¥P!!'.l
Parameter Results
Chloride -
-Conductivity
-Copper
rluoride -·Iron -_ Manganese
Nitrate -
-pH
Sulfates -TDS -Zinc -Pnei,,,/J -~ -
V ;-IS -
...t:. lly_dn:1tA.,,, ""'J -
Date Received 4-7-f:, Date Reported J!l-IJ-~J''3 Date Analyzed;;). 1..:.1,r-3
Reported b_y e ~Lab Number _ __::3:::...::,0:....,7'-'1,..,..()j.J:Ul'------
DRS 3191
Solid and Hazardous Waste
•
ORGAN IC _ CIIEHI STRY _____________________ . ____________ ··-
_____ Parameter-·----·-------Results
F:ndrin
Parameter Results
Lindane
Hethoxychlor ~ f!!rf;~r -
Toxaphenc
2,4-D
2,4,S--TP(Silvex)
. PCB' s.
Petroleum
v-TOC
TOX
Date Received Date Reported ____________ Reported by _______ _
Date ~:xtracted ___________ _ Date Analyzed _______ _ Lab Number
HICROBIOLOGY
Parameter Results t-----~~===----,-------------------~===~-------·-----
(HF) Coliform Colonies/lOOmls
(HPN) Coliform Colonies/lOOmls
-------------------------
---------------------------------------------------------------------------------------------------------------------------------
Date Received ------Date Analyzed _____ _ Date Reported ______ _
Reported by _____________ _ Lab Number
RADIOCHEHISTRY
Parameter Results Parameter-Results
-Gt'OSS Alpha -Gross Beta ----
~ -
~ -
Date Received _____ _ Date Analyzed ______ _ Date Reported _____ _
'' Reported by _____________ _ Lab Number
• C
. ' -•
N. C. DEPARTMENT OF HUMAN RESOURCES
DIVISION OF HEALTH SERVlCiS
STATE LABORATORY OF PUBLIC HEALTH
P. 0. BOX 28047. -306 N. Wilmington St.; Raleigh 27611
Site Number 77-boqoo loco ·-X
Name of "Site" J'!Jac.o,." S,'fc
( Thaer , • ,, 1'hi, we )
Field Sample Number~ Lab ID H
Site Location 6/J(!/,,,(lf!,vf>J Gr,/c,,.,d I
Collect_ed by: Rich6~J 611y ID 11_~6~"+-f---Date Callee ted /1-t -'?3 Time Jl' IS'/?~.
Type of Sample:
Comments:
Environmental
_l(Ground
Surface
Soil
Other
Extract ables
Parameter Results
_ Arsenic -_ Bar-ium -Cadmium --Chromium --Lead --_ Mercury -Selenium --Silver -----
-------V --
---
DHS 3191
Solid and Hazardous Waste
Concentrate
Sol id
Liquid
Sludge
Other
INORGANIC CHEMISTRY
Total
Parameter Results
Arsenic
Barium
Cadmium
Chromium
Lead
Mercury
Selenium
Silver
~c, j~
-
-
-
-
-
-
-
-
-
-
---
V
V
Parameter Results
Chloride
Conductivity
Copper
Fluoride
Iro'n
Manganese
Nitrate
pH
Sulfates
TDS
Zinc
p;,e,,,,.,/:r ~
1-15. Syd.,_. U<V'[,rltf /", ~
l.:s(
.,
_______ Paramet_er ______________ Results Parameter
v-Pl,~ ,10/,: Endrin
Lindane
Methoxychlor
Toxaphenc
2,4-D
2,4,5-TP(Silvex)
PCB's
Petroleum
VTOC
TOX
Date Received ---
~ fi,~5·;;:/::.·
Date Reported ___________ Reported by
Results
--------
Date Extracted _____________ Date Analyzed ___________ Lab Number _________________ _
Parameter
(MF) Coliform Colonies/lOOmls
(MPN) Coliform Colonies/lOOmls
MICROBIOLOGY
Date Received _____ _ Date Analyzed ____ _
Reported by _____________ _ Lab Number
RADIOCHEMISTRY
Results
Date Reported ______ _
Par-ameter-Results Par-ameter Results
Gross Alpha --Gross Beta ----
--
--
Date Recei·,ved _____ _ Date Analyzed _____ _ Date Reported _____ _
Repor,ted by ---------------Lab Number _______________ _
' '
, • •
N. C. DEPARTMENT OF HUMAN RESOURCES
DIVISION OF HEALTH SE_RV lCES
STATE LABORATORY OF PUBLIC HEALTH
P. 0. BOX ?80~7 ~ 306 N. Wilmington St .• Raleigh 27611
Site Number "77-ooooo iooo-X.. Field Sample Number_____9-iJ;;,___ Lab ID 11 -----
Name of "Site" __,/}z'-'--'-'11-'-l."'Q""Y\'-'--~S,_,1_,_·f_,,.___ ___ Site Location 0/j CheRA'-<' fl Gx,dow
Collected by: R,Jii1ey b-o/ ID II 64 Date Collected /42-b--~ Time //:lo /Ii--.. I
Type of Sample: Environmental
Ground
Surface
Soil
Other
Comments:
Extract ables
Parameter -Arsenic
Barium -Cadmium
_ Chromium
Lead
_ Mercury
Selenium -_ Silver
--
Results
------------
------------------------
Concentrate
Solid
Liquid
Sludge
Other
INORGANIC CHEMISTRY
Total
Parameter
Arsenic
Barium
Cadmium
Chromium
Lead
Mercury
Selenium
Silver
Results
V' /CJC-
Date Received ,;i. -2-S-.J Date Reported
Parameter
Chloride
Conductivity
_ Copper
Fluoride
Iron
_ Manganese
Nitrate
-pH
Sulfates
TDS
Results
Date Analyzed/.,)._//);.;~· IJ:J
I
Reported by....c,{"---4~t}=_L..'.:,f.:!.'...!.~:..._.:..:._ __ _ Lab Number_~: ... l~f~l?.,___.1.._.(.,.J...,1..__ _____ _
Ii
DRS 3191 V
Solid and Hazardous Waste
•
ORGANIC _CHEMISTRY
_____ Parameter ______ -----·--Results Parameter ______ . ___ Results_.
Endrin
Lindane
Methoxychlor
Toxaphenc
2,4-D
2,4,5--TP(Silvex)
PCB' s .
Petroleum
VTOC
·TOX
r P/2eoals ~ ljJ,/J;;::f11 5
Date Received ___ _ Date Reported ___________ Reported by ______ _
Date Extracted _______________ _ Date Analyzed ____________ Lab Number
MICROBIOLOGY
Parameter Results f-----f--~===~------------------~==~C---------(MF) Coliform Colonies/lOOmls
(MPN) Coliform Colonies/lOOmls
Date Received ------Date Analyzed _____ _ Date Reported
Reported by _____________ _ Lab Number
RADIOCHEMISTRY
Parameter Results Parameter Results
1--Gross Alpha -
f--Gr-oss Beta -
f---
f---
f---
Date Received ------Date Analyzed _____ _ Date Reported
Reported by _____________ _ Lab Number __________ _
V''i 'I
'• ,·•~ (..c,---<--· .orth Carolina Department of-:1
t,,I .e.. ~ Division of Health Services
Occupational Health Laboratory
tf /l-2 ,A.Ii!. C>u<4 S .,,; 1/.s Tic
~~ALYSIS REPORT
Resources
/v'/IM E c,F '5 I rr:: .
Company: ______ "1 __ 11<_oN--_C_o_«_IU_;__1'_,_'(~'.'-"S_,c_',;,..,oE_;_N;,._O...:.W1_;,_;l,::_'.l.::;c-',;.f?.!.:---'7--'-7----'o;;__o.::;a_o_c,=' D=--O_o-"'x--___ _ '
Address: _____ __:tl:....::.t .=D_..:C:...✓<_E_.::f?:...A.:...:...v:__..:.R.::..:::l>-+--'c::..::.o.:.:1!..:0...:d_:V_:_.,.:...._ _____________ _
Service Requested: _____ T?J_C.;::,__ ________________________ _
Sample Taken On: _____ ,2-----'~:._-_f>-.::3:._ ___ _._,_,..:.·.'--'v'-o.:..:.:«_-_;;__
Submitted To Laboratory On: ___ ,_~_-_7_-_f~J:._ ____ _
Date of Analysis: ________________ _
Analyzed By: ___________________ _
~ABORATORY
NUMBER
SAMPLE NUMBER
'83 I/ (/2..
23L22 DEC 7 83 lf o"'
CuMMENTS:
OHS Form 1440 (Rev. 2-75)
Occupational Health
DESCRIPTION
Wei/
,,
Wet/
lf.5 fe v..., 'I
, '
By:
By:
Date
IZ ' C /...a.., .,( 6-11-:j
r:e~v-y Dover
Reported:
REMARKS
()JI#
307100
30)1cJ:t
RESULTS IN
~-· roe, ·1 I
REPORTED BY: --,-------,-----Chief, Occupational Health Lab
a
N. C. DEPARTMENT OF HUMAN RESOURCES
DIVISION OF HEALTH SERVICES
STATE LABORATORY OF PUBLIC HEALTH P. 0. BOX 28047 -306 N. Wilmington St., Raleigh 27611
Sile Number JJ-()OO<!>O/t!OCJJ> · X Field Sample Numbcr-----2'.".O_/ __ Lab ID ti _______ _
Name of "Site''
Date Collected l)·C· .f3 Time_f/~
Type of Sample: Environmental Concentrate
Solid
_LLiquid
Sludge
Other
Comments:
/Ground
Surface
Soi 1
Other
Extractables
Par-arneter Results
f--Arsenic
Bari um -Cadmium -
>--Chromium
Lead --
f---Mer-cury
>--Selenium
Silver >--
1--
>--
~
>--
-
-·-
INORGANIC CHEMISTRY
Total
Parameter Results
Ar-senic -....t:'."B a ri um < o. I
J(Cadmi um ✓-., c:; #-e:JO .§''
_i Ch ram i um ---< ,:"-()J
_VLead ,.. , > L -~3
-MercuC'y
Selenium -Silver -x -;z.;,., 0 ,0?:,
-
-
-
-
-
Date Received Date Reported -------
Parameter Results
VChloride J
i/Conductivity "1-8 ".,,/,,.
-Copper
Fluoride -
Iron -
-Manganese
Nitrate
__l,('pH <e. "' Sulfates -TDS -
z'inc -
-
--
Date Analyzed ______ _
Reported by _____________ _ Lab Numbe r ____ 2_:J_0_' 6_(_.J _0...cf::..:C'--'8'--8"'-J"--_
OHS 3191
Solid and Hazardous Waste
C5( • •
N. C. DEPARTMENT OF HUMAN RESOURCES
DIVISION OF HEALTH SERVICES
STATE LABORATORY OF PUBLIC HEALTH
(;, OEC 15
•
P. 0. BOX 28047 ·· 306 N. Wilmington St., Raleigh 27611
Si le Number 77-tJOIDD /100 ~ )I, Field Sample Number 1/12. Lab ID II
Name of "Site" hz,,ccn .f",'f <.
Collected by: f;c.hA.eJ t-lh, I ID 11 _-"--()_'J,__ __ Date Collected /l-,-'J3Time_li_:...LQJ}r-,
Type of Sample:
Comments:
Envir-onmental
XGr-ound
Sur-face
Soil
Other-
Concentr-ate
Solid
Liquid
Sludge
Other
INORGANIC CHEHISTRY
E,tr-actables Total
Pat"ameter Results Par-ameter Results
1---Arsenic Arsenic
f-Bar-iwn ~ Bar-ium <o, I
-Cadmium ___t'Cadmium -<(_,l-QO$'
_ Chromium _k Chr-omium ~ .-,o. a,
~/J-o.:3 --Lead V Lead
_ Mer-cury -Hercuc-y
Selenium Selenium --_ Silver -Silver
✓ 2.i-"l... () '112'> -· -
~ -
f--
f----i-·--
Par-ameter Results
v'Chloride L/
y'Conductivity ('i_t,b1.-' -Copper
Fluoride -Iron --Manganese
Ni tr-ate -...':::: pH t,-. 2
Sulfates -TDS -Zinc -
-
-
-
Date Received ______ Date Repor-ted / -// 2-/,r'.JDate Analyzed ) -------
Repoc-ted by ____________ _
OHS 3191
Solid and Hazardous Waste
• •
N. C. DEPARTMENT OF HUMAN RESOURCES
DIVISION Of HEALTH SERVICES
STATE LABORATORY OF PUBLIC HEALTH P. O. BOX 28047 -306 N. Wilmington Sl., Raleigh 27611
site Number 2.2:;ooocio /c,IJO ·-X field Sample Number_!ivL_ Lab ID 11_
Name of "Site" /JJ&co{) .5;·/c
(rAc~,ese,,. ta,.,/,,,,)
Si le Loe at ion 6/J C!/u-«dev RJ. . C,,r<,/='"~"'~-
Collected by: /!:,./4,,,,J br7 ID II 69 Date Collected /)-{,-SJ Time--11.:..Js.ll,..._
Type of Sample:
Comments:
Environmental
VGrnund
Surface
Soil
Other
Concentrate
Solid
Liquid
Sludge
Other
INORGANIC CHEMISTRY
Extractables Total
Parameter Results Parameter Results Par-ameter Results _ Arsenic -Arsenic __::::-'i::; h 1 o ri d e s-_ Barium _VBarium Ci, I _1::::--tonducti vi ty Cf) ... ,, bk Cadmium t--cadmium :< .,,,-Copper -c."'J, ;.:, .,,,.) -Vchromium -Chromium /. ,-), cJ/ Fluoride -Lead _t--1.ead ,, ·. o.'} Iron --'-C -f--Her-cury -Mercury -Manganese -Selenium -Selenium Nitrate -Silver -Silver ~H (-.),
..L ::Z, re (.)' -6 (~) Sulfates f---
f--TDS -Zinc ---
f------
1-·· --i
Date Received ______ _ Date Reported_~(~?~,/~/~Z~,~/-j_0_.}_ Date Analyzed ______ _
Reported by ____________ _ Lab Number 23Qb~-OE[ 3 /3] ----------------
',
-------------------------------------------~-
DHS 3191
Solid and Hazardous Waste
.,
• •
N. C. DEPARTMENT OF HUMAN RESOURCES
DIVISION Of l!EALTH SERVICES
STATE LABORATORY OF PUBLIC HEALTH
P. 0. BOX 28047 -306 N. Wilmington St., Raleigh 2761
Si le Number 77-0c,>oo /i>c•o ·-,,\ field Sample Number Vo y Lab ID 11
Name of "Site" n?At..on s;·/c
_(J<;Jlh1'1"1 0AR Jncfl, )
Sile Location CJ/j CAee-,~PJ C:,,&<J,,,v,4-,
ID 11_~0~1--Collected by: /!,'< l,,,aJ 6-""f
Type of Sample: Environmental
~round
Date Collected /.2-/4-§'3 Time_j.J_."Jo/1.,.___.
Comments:
Surface
Soil
Other
Extractables
Parameter Results
1--Arsenic
f--Barium
Cadmium -
>--Chromium
Lead --
>--Het"cury
>--Selenium
>--Silver
--
>--
-
-
-
1-··
i
Concentrate
Solid
Liquid
Sludge
Other
INORGANIC CHEMISTRY
Total
Parameter Results
Arsenic -~Barium -<c,, I
k Cadmium ·<tJ-oO~
,__,,... Cht'omi um < £-.o/
VLead -,;.d>. o3
-Mercury
Selenium -Silver -
..L 2; d C--n,c//
-
-
--
-
Parameter Results
vchloride .)
VConduc ti vi ty "' Ad !'tt h.:. -~· (1 ,-' -Copper
fluoride -Iron -
-Manganese
Nitrate -__!::-pH (,. ~
Sulfates -TDS -Zinc -
--
-
Date Received _______ Date Reported I'! /!J./! < Date Analyzed _____ _ I "7
Reported by ____________ _
OHS 3191
Solid and Hazardous Waste
• •
N. C. DEPARTMENT OF HUMAN RESOURCES
DIVISION Of HEALTH SERVICES
STATE LABORATORY OF PUBLIC HEALTH
P. 0. BOX 28047 -306 N. Wilmington St., Raleigh
Si le Number :2:J_::::C(:X)() o /Qo o ·-c\;
Name of "Sile" lh,1cr,c1 s,lc,
Field Sample Number~--Lab ID ll ____ _
_[_7 o~--ti,,ee1)
Callee ted by: /!,r.h,1fl.J 6,.,,
I ID 11 /)'( Dale Collected /.J-/.-fi3 Time /{'IS
Type of Sample: Environmental
_V"'Ground
Comments:
Surface
Soil
Other
Extractables
Para.meter-Results
Arsenic --
Concentrate
Solid
Liquid
Sludge
Other
INORGANIC CHEMISTRY
Total
Parameter Results
Arsenic
Parameter Results
1./Chloride ~
CST'
_ Barium ~arium <c•, I Vconductivity C/ 1_,. i.;,b,-, -Cadmium __!:" C adm i um < <''·· oo~--Copper
-Chromium V Chromium -<_ ,:) .. ,o/ -Fluoride
--Lead 1./ Lead < ,,:-;,,c:.3 -Iron _ Mercury -Mercury -Manganese _ Selenium -Selenium -Nitrate Silver -Silver ___icj,H lo. '1 -
i..-·z.:,,L-L;o ,o.)-Sulfates ----TDS ---
Zinc ---------:-· --
Date Received _______ Date Reported 2 l "d _:• Date Analyzed -------
Reported by _____________ _
DHS 3191
Sol.id and Hazardous Waste
-•
EC 15 N. C. DEPARTMENT OF HUMAN RESOURCES
DIVISION OF HEALTH SERVICES
STATE LABORATORY OF PUBLIC HEALTH
P. 0. BOX 28047 -306 N. Wilminglon Sl., Raleigh 276
Site Number _2_?-wQOO/dC'l' -,X Field Sample Numbcr_Jj.Q:.2_ Lab ID 11
Name of "Site" J1Js,on 5//c
_{maum dom(.)
Sile Location o/J C/iu(lw i?) Cd,ia1 I
ID 11 __ 0""-/.'f __ Collected by: /,),,.IJ&KJ ~
Type of Sample: Environmental
L--{;"found
Date Callee ted /)--l--€) Time_j_~/'I>--.
Comments:
Surface
Soil
Other
Extractables
Parameter Results
......... Arsenic
L_ Barium
Cadmium -
L-Chromium
Lead -·
L._ Mercury
'--Selenium
1-. Silver
~-
'--
~
'--
-
1-··
Concentrate
Solid
Liquid
Sludge
Other
INORGANIC CHEMISTRY
Total
Parameter Results
Arsenic -_!:..-Bari um <. o. I
~Cadmium :<c, oo'.•
V"°Chromium -<. ;:-:. fl. I v'L e ad -<" ·, 03 c
-Mercury
Selenium -Silver -
.1:..::.. /: .,, ( -(! '·/ (!
-
-
-
-
-
Pa["ameter Results
_L--Chloride /
_I/Conductivity ~ i./._,!.&. !:~~;,.(
-Copper
Fluoride -Iron --Manganese
Nitrate -_/_/"J)H (.,, 7
Sulfates -TDS -Zinc -
-
-
-
Date Received _____ _ Date Reported i 2;/!,;i':,Date Analyzed ______ _
Reported by ____________ _ Lab Numbe r _ _,_)-'-:J~fl~f..,.,~6~U .... f-~C-U.R ....,d'-'}'-----
DHS 3191
Solid and Hazardous W11stc
•
N. C. DEPARTMENT OF HUMAN RESOURCES
DIVISION OF HEALTH SERVICES
STATE LABORATORY OF PUBLIC HEALTH
P. 0. BOX 280~7 -306 N. llilmington St., Raleigh
Site Number ~ O(JOOQ/0/Jo ·-c, Field Sample Number__2.OL_ Lab ID II
Name of "Si le" /J2aco1'"' s~·/e Site Location__Q'.'.'.J C/,e,e,9':1-/.'J Llllcblur~ I . (_B"'FL-r""":"°'e~"-=' ""'(..~1,.....,),_ ___ _
Collected by: R,·{.,/2,,~d /J-,;, l ID II __ C~; c+·--Date Collected /)-(,-fd Time~,P..)~.
Type of Sample: Environmental
~Ground
Concentrate
Solid
Liquid
Sludge
Other
Comments:
Surface
Soil
Other
Extractables
Parameter Results
Arsenic ,._
I-Barium
Cadmium -,._ Chromium
Lead --_ Hercur-y
~ Selenium
,._ Silver
---
--
-
:-·-
INORGANIC CHEMISTRY
Total
Parameter Results
Arsenic -_vaarium <c>.· I
£,.,.....Cad.mi um < C, 0'05'°
_::--Chromium -<,c:. O·I
....!:'"'Lead L.' ,: 0.03·
-Mercury
Selenium -Silver -
;...-"7 I) ( • () ,uh
-
-
-
-
-
Parameter Results
_::Chloride '-!
__!::Conductivity '::Fl.. , <; ' ' "" ' Copper ' -Fluoride -Iron -
-Manganese
Nitrate -_!::"pH c-o
Sulfates -TDS -Zinc --
-
-
Date Received -------Date Reported f· Date Analyzed ______ _
Reported by _____________ _ ')'• fl, I (~ :'[( 8 • J Lab Number 1 .• ·) r-,_, '.J U
DHS 3191
Solid and Hazardous Waste
•
N. C. DEPARTMENT OF HUMAN RESOURCES
DIVISION Of HEALTH SERVICES
STATE LABORATORY OF PUBLIC HEALTH
P. 0. BOX 28047 -306 N. Wilmington St., Raleigh 27611
Site Number )7-/1:?(XJC>/oou* field Sample Number 911"6 Lab ID II
EC 15
tM C ·j Name of "Site" UfAlt)n ._;, · c_ Site Location C)jj C)£fll~ J'J . ., Q,.,,/4,idL.._
Collected by: /?; / I,,,,, j Cr//--.,
I
ID II 6~ -=--.~---Date Collected/.)-,(,-&\ Time / .·oopJ-...
Type of Sample: Environmental
_1,,-G r o u n d
Concentrate
Solid
Liquid
Sludge
Other
Comments:
Surface
Soil
Other
Extractables
Parameter-Results
Arsenic -~ Barium
Cadmium -Chromium -Lead ·--Mercury
-Selenium -Silver -
------
1-··
i
INORGANIC CHEMISTRY
Total
Parameter Results
Arsenic -~Bar-ium <c.-1
XCadmium ---<...., 6), o,:JS-
V Ch ram i "um .,,:,_ ,:-: . -o I
~Lead :::;: ,.-.<J;,
-Mercury
Selenium -Silver -,_, -7 , " ( (),I(
-
-
-
-
-
Parameter Results
v-chloride ~ ·' 1.---'conductivity ,_ ( ' h, // +"'k
-Copper
Fluoride -Iron -
-Manganese
Nitrate
'-"flH (., . 9
Sulfates -TDS -Zinc -
-
-
-
Date Received _______ Date Reported I ··; ~ ' , 1 d ..... 1 ,.,,, ;(1 Date Ana yze ______ _ I ,
Reported by _____________ _ 2·,n17 ~. Lab N umber ____ ~~· ·~J<J=t~• ,_,..:.,..lt=t.6--.-3+fdr]-t--
DHS 3191
Solid and Hazardous Waste
<,
f
I,. 't •• ••• •• Bllo 1111----------'_,_..,._Ro-na-ld_H_. L-ev-ine-, M-.D-.,-M-.P.H-.--n T I STATE HEALTH DIRECTOR
DIVISION OF HEALTH SERVICES
P.O. Box 2091
Raleigh, N.C. 27602-2091
Mr. John Penn
General Tire and Rubber Co.
1 General Street
Akron, Ohio 44329
Dear Mr. Penn:
March 1, 1984
Representatives of the North Carolina Solid and Hazardous
Waste Management Branch have inspected the Macon Farms
hazardous waste site and determined that all of the General
Tire Rubber Company drums containing rubber waste have been
properly removed from the site. According to hazardous
waste manifests provided to this Branch by Triangle Resource
Industries, the waste has been delivered to the SCA disposal
site in Pinewood, South Carolina.
Thank you very.much for your cooperation in this matter.
Sincerely,
· 7/!( , 1 /1 ,/ './ ,, i I I>/ l /.,G. / .s~,L..C.':/
W. Strickland, Head
Solid & Hazardous Waste Management Branch
Environmental Health Section
GD:ns
cc: Terry Dover
Jome~ B. Hunt, Jr./ Sorah T. Morrow, M.0., M.P.H
~TATF OF NORTH CAROLINA · __ ·--··--DEPARTMENT OF HUMAN RESOURCES «ron,oy
• ••• •• Ille 111.,...· ---------=---=-Ro-na-ld_H_. Le-vi-ne-, M-.D-., M-P-.H-. -n y STATE HEALTH DIRECTOR
DIVISION OF HEALTH SERVICES
·P.O. Box 2091
Raleigh, N.C. 27602-2091
MEMORANDUM
TO: Glenn Dunn
FROM: Terry Dover W.
February 27, 1984
SUBJECT: General Tire Waste at Macon Site
On Monday, February 6, 1984, Mr. Richard Gay made an inspection of the
Macon site and determined that all of the General Tire and Rubber Company
waste had been properly removed by Triangle Resource Industries. All
waste material was delivered to the SCA disposal sit~ i~ Pinewood;
South Carolina.
TD: le
STA TE OF NORTH CAROLINA
James B. Hunt, Jr/ · . . · . · ·Sarah .T. Mo·rrow M.D MPH, ·. ... . DEPARTMENT OF HUMAN RESOURCES · · . ' . '· ·. ·. . ·
GOVERNOR · . ·sEC~ETARY' . ·. _ _ .
m•1...,,-1• m. :22-::--..u•
Watlington Industrial Road • P.O. Box210 • Reidsville, NC27320 • 919/342-6106 • 800/334-5953
Glenn Dunn
N. C. Division Solid and Hazardous Waste
P. 0. Box 2091
Raleigh, NC 27602
Dear Hr. Dunn;
February 14, 1984
Enclosed are the invoice and South Carolina manifest for the General Tire
Waste that was removed, transported and disposed of from Macon Farms Hazardous
Waste Site at Cordova, NC.
I spoke with Terry Dover today (2/14/84) about billing, and he instructed me
to send all correspondence to you for processing.
If you have any questions· concerning this action, please let me know._
Terry W. Waddell
Project Manager
ERT Projects Group
TW/lm
cc:. Terry Dover NCDSHW V
Richard Gay NCDSHW (Fayetteville)
Enclosure
(
... ,• ..
I
C·ATE:
)UBJECT·
F' ROM:
UNITED s,41ts ENVIRONMENTAL PROTECTI.GENCY
Immediate Removal at Ch.~rles Macon Site, Cordova, NC.
Diane Hazag(,\ · ~
EPA Region ;~tlanta
TO: Terry Dover
NC Div. of Health Services
The Charles Macon Site in Cordova, NC. was once a oil reclamation
business which handled paint and solvent wastes and waste acid
and bases. The 16 acre facility in Richmond County ceased opera-
tion in October of 1981 after Charles Macon's d~ath. A ~ite survey
conducted by the NC Solid and Hazardous Waste Branch revealed that
the Macon Site was an illegal hazardous waste storage facility.
It involved eleven (11) surface impoundments containing contaminated
waste oil and sludge and 2,173 55-gallon drums con~aining various
chemical wast€:s.
Ten of the surface impoundments were unlined; none of which met
the 40 CFR -112.7 SPCC regulations. As a result the lagoons were
overflowing ·their berms and spilling oil to the surrounding environ-
ment. Analysis of the oil/sludge within the lagoons revealed levels
of lead, chromium and barium above E.P. toxicity limits thus classify
them as hazardous wastes. The 55-gallon drums contained waste
solvents such as -methanol, toluene, vinyl thinners, epoxy, enamels
and lacquers. Other drum wast~s included ethyl acetate, acetone,
caustic soda, methylene chloride, and sodiui~ hydroxide.
In November of 1332 D0nald Dawkins executor of the Charles Macon
Site contracted Environ-Chem Waste Manage~ent Services to proceed
with cleanup actions to comply with a court order initiated by
NC Solid and Hazardous Waste Division. Fifty thousand dollars
obtained from the now dissolved business was used to install two
ground watermonitoring wells down gradient from the lagoon area
and field screen label, sample and remove drums. When funds were
expended 1,695 55-gallon drums and the 11 surface impoundments
remained on·site. Analysis of ground water in the lagoon area
revea~ed elevated levels of heavy metals which corresponded with
the heavy metals found above E.P. toxicity limits in the lagoons.
When no other funds were available to complete the cleanup the
NC Department of Human Resources requested EPA's assistance to
finish stabilizing the site.
EPA Form 1320·6 (Ro-3-76)
.. -• -2-The remo11al acti·-1itiP.s co;:r;11ctC:ri i),; 0.e<1i0;1 I''/ E?.1\ •.,:ere n'?c~ss?.rJ r'.·,:~ t:J the irninent threat JOS~·'i t,,1 the re.11r1inina •.•.'2.Stes on the en·1ironri~nt. r:nrl public health. If the cleanuo ·,,as not co,,1pleted the follo·.-,inr, hanrds •,ioulrl remain: 1) Within a 100 yard r·adius of the fr.cil ity, there are ~1 ho.7'1':S all beino supplied \·1ith ·,,ater frocn shallo·.-1 ,iells. E1e·1ated le•1els of heavy ,.ietals rletected on site inciiccteri ~he ootent_i'.:11 for around •,iater contamination 0f the surroudinq potable ·,1eils. 2) The laaoons beinq unlinerl and 011erflo1.•1ina futher intensified the potential for qr·ound ·,-,ater contaminct ion. 3) d) Cont 2.minat ion of the shal lo,i aquifers •.,as also threatened b•1 the de~erioration and vandalism.of drums on the ordoerty. □ue io,the hazardous, volatile and fla:nmable nature of their contents, no other act ion but removal could re'lerse the threct they oos-ed. The Macon property ,,,as ,,iithin the drainaoe be.sin of the 0ee nee Ri·1er 11:hich is a high r':crectio-nal use r111er. Concerns ,,1er1? exoresserl relatina to the oossibie miaration of contaminants the impact they may oose on the river. Several actions ·,1ere taken to stabilize the site and remove c.n•1 hazarrls which existed. 'liith resoect to the surface impoudments the follO'dino actions v✓ere taken: 1) Lagoons ,iere de,iatered. Water oumoed from the laQoons ,ias lan~ applied in accordance 'dith the procedures outlined b•1 the iiC Divis ion of Health Ser•1ices and the office of Environment Manaqement. 2) Oil ,ihich could be reused ·,1as pu01perl and transported to an oil reclaiming facility. 3) Remaininq oil and hydrocarbon sludges •.vithin the laqoons ·,,ere solidified, removed and disposed. 4) Lagoons were then backfillerl, grad':d and seeded. The remaininq 55-gal lon drums, 1-gal lon antifreeze containers and calcium hydride flare charges •.ve,·e handled in the follo,1ino ,~anner:
. .
DRU:•1S:
•
-3-
Of the 1,0 21 'iS-qallon drums l,'11'i ·,1ere solidified on site; ?.02 •,iere
removed in rol loff hoxes for solidification/disposal at SCA-Pine•11oorl.
The V2 emoty rlru01s •,1hich contained residual solids and liquids v1ere
crushed and sent to SCP.-Pine·..,ood. Ninety one of the emoty drucns were
bouoht by Cardinal Steel and Drucn Co. for reconrlitioninq. The
recnaining 902 ernoty drums were taken by Rockinqham Scrao Metal and
I ran Cocnp any.
ANTI-FREEZE:
The 3,0IJ() 1-qallon containers of a methanol hased antifreeze were
transferre,j into 55-gallon druc;s and solidified on site.
FL~.qE CHARGES:
The ?.<l6 calc i usi hydride fl are charqes
Ordin.ance Disoosal of the U.S. Army.
were removed by the Explosive •
The fnl lo•.'lino i.s a ~reakdo·.-in of activities and nonies soent for
solidification, removal and disoosal of contasiinants on site.
DISPnSAL OF SOLIDIFIED WASTES:
142 Truckloads of solinified oil/slurloe
Totals:
6 Trucklocds of solidified rlru'11 '"astes-(202 Drums)
14~. 1rnckloads .Jld.6~'J ions ,~::Jii,YJ .. IJi
SOLIDIFYING MATERIALS UTILIZED:
Totals:
/lhsorbant -32 Truckloads
Kiln nust -17 Truckloads
Tus/Kll -t,q !ruck loans
483.98 Tons
3Sfi. 29 Tons
8ai).!7 ions
$14,519.40
SlO,fiRS. ?n
~2s, 1.t1iZ:Ti1
311(K) WASTE OIL DISPOSAL/REMOVAL:
Totals:
21i,011n Gallons of ',;aste oil transported for recvclino
111,onn Gallons of waste oil disposed of at SCA
WASTE WATER LANn APPL!CATin~:
4fi7,7nn G2llnns nf lan00n •.-:2trr lcnrl fr.rn~d
CALCIIF·l ~YQRIDE FLP.RE REi·iO'/il.L:.
2llF C2lciu."'1 h?rlrirlr f1,3re ch2r-n~s ':!er·~ rerno•,1~(1 hv
the f:xplos i,1p Ordinance Oisposal of th~ U.S. P.r:nv
. . . ---t1 -REMOVAL/DISPOSAL OF l,~95 DRUMS 3 -Acid drums ~ere overnacked for disoosal at SCA-Pinewood. 30 -Fiber drums in building •3 viere solidified in laqoon 'i2. 91 -Emoty drur11s ·,1ere taken for recnndit ionina hy ThP Cardinal Steel A.nd Druri Co. 16n -~ruri containinq solirl ·,1;,stes ·,1pre disoose'1 of at Sca-Pine•,iood ·1ia roll-off boxes. 13.'1 -Crushed "'<llotv dru:,,s •t1ere disooserl at SCA-Pine•,1ood. • 1,227 -:moty drums ·,,ere re,noved by Rockinaha"l Scrap Het;il and Iron Co. l,tn3 -nrur11s containina paint •..:astAs, orocr1ic solvents, bcses, oils and assorted chemicol '.'last es ,,,ere so·l idified 1n laaoons El anrl =?. for disoosal c,t SCA-Pine·,mod. 508 -Drums were remJved from site by the identified a<onPrators: The Acme i·!ame Platina, Inc.: The Crovm Cork . . and Seal Co., Inc. and ThP General Tire Co. Laqoon =10 recieved the followina waste arior to the installation of a polyethylene cover and a 3' clay cao. 1) 'i Loads of solidified sludqe from laaoon #7. 2) 2 Lo ads of b o i l er fly ash. 1) 43 crushed e:noty drums ,1nd cont c'.'linaterl soil from dru"l staqino area. This laqoon already containerj an estimated 940 tons of a creosote baseri sluriae orior to recievinq the arlditinnal ,,,aste. nue, to the lack of funds the decision "as -narle hy the nsc to ter,iporarily contain the ,,,aste in laqoon =10 until the remedial ohase of the :.1acon Site can he initiateri. The Cro•,m CorK ;,nd Seal Inc. anrl t~e f;ener,,1 Tire Co. •,:ere id0ntifierl as rienerators. They !1a(1 contr,3cteri TrirrnalF? ~esource IndustriP.s to re:n0·/e a.nrl dispose t:1':ir respect i11e ',·:astes. This ·,:ns to be :ioni:: t;nrjer ~he suoP.rvis ion of the north Cnrol ina Sol id anri H.uadous ':!aste 8n~c'1; fol lo·.·:ina EPA's departure. The follo•,1ina rioc•.r:i0nt,1tion (loo notes): federal, stcte 0.nrl industrial mernorcnria and contractor cost reoorts (for,n 1nrin-ss) account for the activities v:hich took olnce at the Charles 1·1acon Site in Corrlova)!.C. from ll/21/83 to 1/17/Ra.
• •••• ·' Ille 111.:=-=------------'----~-na-ld...:;.:-. L-e-vin_e_, M-.D-.,-M-.P-.H-. --n T STATEHEALTHDIRECTOR
~~~ DIVISION OF HEAL TH SERVICES
P.O. Box 2091
Raleigh, N.C. 27602-2091 January 10, 1985
MEMORANDUM
TO: William L. Meyer, Head
FROM:
Solid and Hazardous Waste Management Branch
Margaret J. Woodco ·.A,)
Assistant Directo~anagement Services
SUBJECT: Request for Payment to Triangle Resource Industries
for Services at Macon Site
JAN 11198
I have reviewed your memorandum of January 7, 1985, to Johnny Poplin in which
you requested reimbursement of $3,000 to Triangle Resource Industries for
services rendered in conjunction with General Tire and Rubber Company waste
at the Macon Site. The request has been forwarded to the Budget Office for
payment.
The cleanup services obviously were conducted prior to the time you became
Head of the Solid and Hazardous Waste Management Branch; however, it concerns
me greatly that these cleanup services were negotiated and carried out in the
absence of a contract. Possibly you are unaware of the Division policy which
requires written contractual arrangements for the expenditure of all state or
Federal funds for services. A copy of the Division's directive governing
contracts is attached for your information and use.
Should you have any questions about the material in the Directive or about
the need for contracts, please contact John Perkinson, Office of Administrative
Procedures, or Doris Strickland, Office of Contracts Administration.
MJW/JLP/bmm
STATE OF NORTH CAROLINA-James G. Martin, Governor/ DEPARTMENT OF HUMAN RESOURCES-Phillip J. Kirk, Jr., Secretary
An Equal Opportunity I Affirmative Action Employer
. ]Q\[ ("'--\
1l't'i 1·~L Ronald H. Levine, M.D., M.P.H.
STATE HEALTH DIRECTOR
DIVISION OF HEAL TH SERVICES/!) lE.
P.O. Box 2091 ,ffi
Raleigh, N.C. 27602-2091 January 10, 1985
,av1ROIIMttilAL h~•n Stt.110N
MEMORANDUM
TO:
FROM:
SUBJECT:
Johnny Poplin \
Budget Officer r\}J
Margaret J. Woodcoclp\ ~
Assistant Director
for Management Services
Request for Reimbursement for
Services at Macon Site
I have reviewed the circumstances outlined in the attached memo :Erom
William Meyer relative to reimbursement of Triangle Resource Ind,istries
for services rendered at the Macon Site.
It is apparent, even in the absence of a written agreement, that a Division
employee arranged for the services and made a committment on behalf of the
Division for reimbursement for services rendered.
Please prepare payment to T.R.I. as soon as possible.
MJW:JLP:kp
cc: v<fim Stamey ~r11ey er
STATE OF NORTH CAROLINA-James G. Martin, Governor/ DEPARTMENT OF HUMAN RESOURCES-Phillip J. Kirk, Jr., Secretary ~
An Equal Opportunity I Affirmative Action Employer ~
••• • · Bile 111----------Ro-n□-ld -H. -Lev-ine-, M-.D-., M-.P-.H.-n v m STATE HEALTH DIRECTOR
DIVISION OF HEAL TH SERVICES
·P.O. Box 2091
Raleigh, N.C. 27602-2091
January 7, 1985
MEMORANDUM:
TO:
THRU:
FROM:
Johnny Poplin, Budget Officer
Margaret Woodcock, Assistant Director for Management Services
William L. Meyer, Head tz.&-111
Solid & Hazardous Waste Management Branch
SUBJECT: General Tire & Rubber Company Waste at Macon Site
Richmond County
In late 1982 General Tire and Rubber Company was contacted by Glenn Dunn,
Solid & Hazardous Waste Branch Attorney, and Terry Dover, Eastern Area Super-
visor, and informed of the presence of 476 drums of their waste on the Macon
site. The waste was nonhazardous and they had paid a broker to properly dispose
of their waste. The waste, in fact, was sent to the Macon property, which was
not permitted to receive it-
The State. could not legally hold General Tire responsible. General Tire
voluntarily agreed to provide $8,0QQ_QQ to dispose of the waste on-site. This
money was forwarded to Glenn Dunn by check payable to N. C. Division of Health
Services and acknowledged in the release document dated April 12, 1983, signed
by 0. W. Strickland.
In June of 1983 we were informed by U. S. Environmental Protection Agency
that a cleanup would be initiated by them using superfund monies on the Macon
site. The formal cleanup did not begin until November, 1983. Triangle Resource
Industries was the cleanup contractor hired by the Environmental Protection Agency.
Glenn Dunn and Terry Dover felt that on-site disposal of the General Tire
waste was now not· appropriate in that E.P.A. intended to remove all hazardous
waste from the site. T.R.I. was asked by us (ve~bally) to work up a new cost
estimate to remove the 476 drums fo~ disposal at the S.C.A. hazardous waste
· landfill in Pinewood, South Carolina. James V. Noles, Site Manager for T.R.I.,
presented a cost estimate of $17,200.00 to Terry Dover for removal of all General
Tire waste. The State only had $8,000.00 that had been previously contributed by
General Tire.
Glenn Dunn contacted General Tire once again and asked them to contribute
the balance between the $8,000.00 the Division held and the $17,200.00 price T.R.I.
had proposed. General Tire agreed and negotiated directly with T.R.I. for the
balance of payment and removal of the waste. Glenn Dunn and Terry Dove verbally
authorized T.R.I. to proceed and they completed the work in February, 1984. No
James G. Martin;,-,.,..,..,.,..,T,, .. ~,.,.,...._,.J,,,., ..... ,nr:r-,-..,,nrr:::cphillip J. Kirk, Jr.
• -2-
formal contract was signed .between the Division and T .R. I.
You are requested to proceed with payment of the $8,000.00 as quickly
as possible.
WLM: sms
cc: Mr. Terry Dover .,,,.,...-
NORTH LAKE SQUARE OFFICE PARK
1 726 MONTREAL CIRCLE
SUITE20
TUCKER, GEORGIA 30084
(.<:104) 938-771 0
Terry Dover
DEC 2719
Division of Health Services
Solid and Hazardous Waste Management
P.O. Box 2091
Raleigh, North Carolina 27602
Mr. Dover;
December 20, 1984
Enclosed you will find a copy of the Charles Macon Site investigation
study plan as requested.
(:)A Halliburton Company
Nov. 18, 1983
WE~,~ -AC:1<, BRYANT! !
I'M IN, A
UP ON AF
• •
LL NOT SEE YOU. TO CATCH YOU
FRIDAY, I SPOKE lvITH GORDON KENNA OF THE EPA, ABOUT· THE IMMEDIATE CLEAN-UP
GETTING READY TO GET STARTED IN RICHMOND COUNTY. SPECIFICALLY_ THE CHARLES MACON SITE
AND THE DOCKERY PROPERTY WHICH ivOW-DECEASED MR. MACON ALSO USED. THE SITES ARE
IN CORDOVA, NC, AND THE ESTATE OF 1-!R. MACON IS BEING HK!ilElllKlll HANDLED BY DON DAWKINS
OF ROCKINGHAM. FRED STROUD, THE OSC FROM KK EPA, IS MEETING TODAY ( MONDAY, 11/21)
WITH THE CONTRACTOR AND N@KE RICHARD GAY WILL PROBABLY BE THERE AS WELL. THE
CONTRACT IS EXPECTED TO BE SIGNED ON TEUSDAY, WITH K WORK TO BEGIN ON MONDAY 11/28.
KENNA IS PLANNING TO VISIT THE SITE THE WEEK OF THE 28TH, AND HAS SUGGESTED THAT
I MIGHT WANT TO MEET HIM DOWN THERE TO LOOK l!. OVER THE AREA AND LEARN MORE ABOUT
IT IN CASE OF MEDIA QUESTIONS. I WOULD EXE LIKE TO GO IF YOU THINK IT IS NECESSARY.
THE WASTE ON THE SITE CONSISTS OF APPROXIMATELY 926 DRUMS, MOST CONTAINING RK!il PAINT,
WASTE, OIL, AND OIL SLUGDE. THERE ARE ALSO 13 PITS WITH ABOUT ONE HEKR HALF MILLION
GALLONS OF WATER AND OIL MIXED. THERE IS CURRENTLY NO COST ESTIMATE FOR THE CLEAN-UP,
EXPECTED TO TAKE ABOUT THREE WEEKS. KENNA IS ALSO PLANNING A NEWS RELEASE FOR THE
WEEK OF THE 28TH, AND IS TRYING TO WORK UP SOME TYPE OF PUBLIC PARTICIPATION/EDUCATION
PLAN FOR THE CLEAN-UP. IF YOU WOULD LIKE TO CALL HIM FOR MORE INFO, HIS NUMBER
IS 404-881-3004. ~-,=-----------------NEXT:
(
DR. LEVINE KNlll GREG SMITH, BILL NKR MEYER, BILL STRICKLAND, AND OTHERS MET FRIDAY
AFTERNOON TO ·DISCUSS THE INFAMOUS HIUSINGH/HATLEY REPORT AND WHAT ACTION IF ANY SHOULD
BE TAKEN AS FAR AS AN OFFICIALS RESPONSE TO ITS CONCLUSIONS AND STATEMENTS. THE
CONSENSUS WAS FOR LEVINE TO WRITE A LETTER, REPLYING TO A LETTER TO STRICKLAND FROM
WATER RESOURCES AND RESEARCH INSTITUTE, INVITING STRICK TO REPLY TO THE REPORT IN
' THE 1/RRI NEWSLETTER. THE LETTER WILL QUESTION SPECIFIC STATEMENTS AND CONCLUSIONS
IN THE REPORT, WHILE NOT CRITICIZING WRRI FOR FUNDING THE PROJECT. R)':CORDS WILL
' ALSO BE CHECKED TO SEE IF THE RK@ REPORT FITS INTO THE ORIGINAL PROJECT PROPOSAL,
WHICH SMITH SAYS ALSO CARRIED THE NAME OF AL TURNER FROM UNC. A DRAFT OF THE
LETTER WILL BE Rl~--fll:JROFF FOR COMMENT BEFORE GOING OUT. ·, TH 'EGI
I ~EETING
··-r ASKED
YOUR TURN.
S 0
L f-_ __/
0e/\~
Ronald H. Levine, M.D., M.P.H.
DIVISION OF HEALTH SERVICES
P.O. Box 2091
Raleigh, N.C. 27602-2091
Mr. Keith Eidson
· South Teck Corporatior.,
1201 Berry Hill Road
Charlotte,. N. C. 28208
Dear Mr. Eidson:
STATE HEAliH DIRECTOR
October 7, 1983
This office has no objection to your company recovering waste oil and
utilizing on-site equipment at the Macon site in Cordova, N. C., for the
recovery, with the following conditions:
1. Permission is granted from the Macon Estate.
2. After existing oil is removed, stop operations until after EPA
clean-up is completed. No new waste oil can be brought on site
until after this time.
3. All recovered .oil must be manifested to its final destination
(records furnished to this office).
4. Clean air permit must be obtained prior to start-up of on-site
recovery boiler. (Contact Ken Smack, Division of Environmental
Management, Fayetteville, N. C.)
Mr. Richard Gay, Waste Management Specialist in our Fayetteville office,
will be closely monitoring your efforts. Please notify him at 486-1191 when
you expect to begin operations.
TFD:ct
cc: Glenn Dur~n
Ken Smack
Donald Dawkins
Sincerely,
~r~
Terry F. Dover, Eastern Area Supervisor
Solid & Hazardous Waste Management Branch
Environmental Health Section
Jome!. B. Hunt, Jr/ Soroh T Morrow, M.D., M,P.H.
STAT: Of NORH, CAROLINA GOVERNOR DEPARlMENT OF HUM4N RESOURCES . SECRElAOY
.l~l. l1·· --. .....,,M..._· -----~'--one-Id H-. L-evi-ne,-M.D-., M-.P-.H. -:1 T STATE HEALTH DIRECTOR
DIVISION OF HEALTH SERVICES
P.O. Box 2091
Raleigh, N.C. 27602-2091
Theodore E. Ravas, Jr., Esquire
Assistant Counsel
The General Tire & Rubber Company
One General Street
Akron, Ohio 44329
Dear Mr. Ravas:
September 19, 1983
I am writing to inform you of the status of clean-up of
the Macon site in Richmond County, N.C. The clean-up is
progressing steadily but rather slowly. We decided to remove
hazardous waste from the site before removing the General
Tire waste with the money contributed. Funds available for
removing hazardous waste are now almost depleted and a considerable
amount of hazardous waste still remains on the site. We are now
asking EPA to use Superfund money to finish removing the h·azardous
waste. While awaiting their response we are still holding up on
removing the General Tire waste because, if EPA becomes involved,
they will have to approve the method of disposition.
The $8,000.00 that General Tire contributed for clean-up of its
waste at the site is being held in a fund ·designated for that
purpose. I will inform you of further developments that may be of
interest to you.
Yours truly,
Glenn Dunn, Attorney
Solid & Hazardous Waste Management Branch
_Environmental Health Section
GD:ns
\ _______ _
Jomes B. Hunt, Jr/ Soroh T. Morrow, M.D., M.P.H. '.'TA TE Of NORTH CAROLINA DEPARTMENT OF HUMAN RESOURCES GOVERNOR SECRET ARY
DIVISION OF HEAL TH SERVICES
P.O. Box 2091
Raleigh, N.C. 27602-2091
Ronald H. Levine, M.D., M.P.H.
STATE HEALTH DIRECTOR
August 30, 1983
Donald Dawkins, Attorney
212-14 East Franklin Street
Rockingham, NC 28379
Dear Don:
I have received from you the accounting for Macon Machine
Company ;,ind for the Charles Macon Estate. -The latter was
unsigned and, in order to assure its official nature, I would
like to have it signed by either you or Mrs. Dawkins.
I understand from discussions with you that Dorothy Macon has
no significant income or assets other than the real property
subject to the injunction. I feel it necessary to ask for
some written confirmation, and therefore request that you
send me copies of her income tax return and property receipts
for 1981 and 1982. '
At this point it appears that the best hope for completing
the site clean-up is through use of EPA "Superfund" money, and
EPA will eventually need the information that I am requesting.
I hope that EPA representatives will be able to make a decision
on clean-up in the near future and I will inform you of any
developments.
If you have ·problems with providing the information I have
requested, please let me know. I would like the information
as soon as possible.
Very truly yours,
Glenn Dunn, Attorney
Solid & Hazardous Waste Management Branch
Environmental Health Section
GD:ns
Jomes B. Hunt, Jr./ Sarah T. Morrow MD. MPH STATE OF NORTH CAROLINA --··-·· ·~· DEPARTMENT OF HUMAN RESOURCES . ' . . . ..
• • • .-• ~leNo .
81-SP-267
l
STATE OF NORTH CAROLINA Film No.
(I ., ·-1' ·-' ... • • •1 • '1' __ _jj-,J.../ • • l_ -I Richmond In the General Court of Justice County Fl') · I 1~ ., ·11 :1 _ Super'1or Court Divis'ion .,Jl!J /'. Jl} r..9 "' ::i O Before the Clerk
In the Matter of the Estate of: ··•. ·-
I
//:imc
ACCOUNT Clli\RLES ALBERT MACON
D Annual iu Final 5J Di~CDilSP,d D t.1inor D Incompetent D Trus1 GS 2BA-21-1; 21-2; 21-3
I, the undersigned representative, being first duly sworn, say that the following is a complete and accurate account of my receipts, disbursements and other transactions as representative of this estate.
/,c:co11nlir1g P(!riod From Extending ro October 21, 1981 i\ugus t 16, 1983
Personal Property Shown on Inventory or Balance on Hand as Shown on Last Account ► $ None Plus Total Receipts as Shown on Reverse + $ 4 ]Jl_,J. ·--
TOTAL ASSETS ► $ 4,332.1
Less Total Disbursements as Shown on Reverse -$ 4. 332 .1
Balance at End of Accounting Period After All Disbursements ► $ None
Balance Held or Invested as Follows
$
$
$
$
TOTAL ► $ None
Balance Distributed as Follows
TOTAL ► $ None
SWORN AND SUBSCRIBED TO BEFORE ME
Da:c -·
. ' , 'i ,. ,, ' /'-,) .j/ ;'3 I ' , \ Y1 Ii \ '} ' '!; ._, ~ -, , '. -'--'!'( .. ~ '• !, 7 /l,t,( ·, ll. 1 , .. . ..
~•lrJn;iturt) . ,0 v'j , , Xaministratr:Lx J ' ,· ( ~--.,, . . I ; ; -,.•-,:'r~-·t ,:\-~-· . -------·--·--D Dup1!1/' CSC □ Ass1st;int CSC D Clerk of Superior Goud
The above account has been audited by me and the vouchers or verified proof submitted in support were
I I i
uxamined. The account is hereby approved.
Date
Si nature g
0 Assistant CSC l AOC-E-5tJ6
I !le\'. 11/81 Original-File Copy-f'.iduciary Copy-Revenue
0 Clerk ot Superior Court
0
0
0
Medical Faculty Practice Plan
Durham County General Hospital
Watson-King Funeral Home ($2,282.92 & $1,000.00)
Sandhill Radiology Association
Richmond Memorial Park
Pinehurst Surgical Clinic
Dr. Stanley Vetter
-N. C. Memorial Hospital
Richmond Medical Center
(Use Additional Sflcets If Necessary)
TOTAL
6.80
204.00
3 , 282 . 9_2 __ _
15.00
525.00 ·---
68.00
7.58
116. 80
106.00
4,332.10 $
-•RB.;Ji••---tt·
DIVISION OF HEAL TH SERVICES
P 0. Box 2091
Raleigh, N.C. 27602-2091
Mr. Jan Rogers
July 14, 1983
Environmental Protection Agency, Region IV
345 Courtland St.
Atlanta, GA 30365
Dear Mr. Rogers:
Ronold H. Levine, M.D., M P.H.
STATE HEALTH DIRECTOR
Please find enclosed copies of the site investigation data, waste
analyses, and other technical data related to the Charles Macon hazardous
waste.
I have quite a bit of information concerning generators and other
potentially liable parties, but am not enclosing it at this time .. I would
suggest that we get together and discuss the matter of the existing lawsuit
and related matters before I transmit information concerning such matters.
GD:ct
Enclosures
Yours truly,
Glenn Dunn, Attorney
Solid & Hazardous Waste Management Branch
Environmental Health Section
STATE OF NORTH CAROLINA ' DEPARTMENT OF HUMAN RESOURCES . " w, . ' ... Jome~ B. Hunt Jr/ Sarah T Mo o MD MPH
. G9VERNOR . SKR~T ARY
. •.
·• N.c:·oEPARTMENT OF HUM~._RESOURCES.
-~ P.O. BOX 28047-306_ N. WILMIN?TO~J., RALEI_GH 27611 · R~'~
. l! . . • ..... • • • • !7d ~ ~ ~ . •, . ., , ,
INORGANIC ,CHEMICAL ANAL YSE,S -PUBi..lC WATERS ~~
' } : 1 : . ·. . ;ii / .,
' Q .... ' Complete All Items Above Heavy Line c::. :Q0 ~
(S~e fnstructions oii Reverse Sid.e) i:l',i "YJ ~
·: ·'. '?J' ~ "t MANf>.G\:.~'<:
,
_l·
T fS .. ··--' I .. r;. w\ · Y~.e o ystem: Name of Mo..cC'(\ ' . ~ ' ' • System: . .. . ( ) Community · ' . 'l/' ·,,i-" ( ) '-.Non_-Community-
Address: Source of Water: •
ZiP, ' . '-,( ). Ground ( ) . Both,
' ( ) . Surface ( ) Purchased
County: K;c~~J ' . f · · ~ource of Sam.pie: .. -i ( ) Dist?ibution i:ap ( ) House Tap
Report To: I "'--v-Y '\ U=•-< . ... I ( . )· Well Tap
•. J ~
Address: S~\. ~ t ~"',. . I, \2~Aii ' Type of Sample:
. ' ·, j ) •.".Raw .. . ( ) Treated
I ..
ZI~ . Type of T.reatmerit:
( I ) .-.--~__......,,. -"' ( ) None ( ) Lime
Telephon~ Number: -' -. --( .) Chlorinated ( ) Soda Ash.
T '2:--'<' , " ~ ; c\ \ e ( ) Fluoridated · ( ) Po!ypnosphate
Collected By: . .. .. ... ( ) Filtered ·( ) Water Softener J .. ' -· ,,2A1111' ..
l.\-03' ( ) Alum ( ) Other
Date Collected: -\] . Tim~·: \C\'.S() PM
' ,.
. -1·.:.. \(:_.,lj
""':',_,,_ Type of Sample:
Location of Sampling Point:• z_· ,.__......._
( ) ·Regular ( ) Private
(Address where sample was collected) ,. ( ) Check ( ) Special
" ... ·.·
Remarl(s: + t'.::~"' .. , ' WATER SYSTEM I.D. NUMBER (CO_PY FROM MAILING LABEL) . ,~. ··' □□.:.□□-□□□· ~ ..
Stlte Drinking Water Parameters (Required)· r . Optional Parameters (List as needed)
., .. · ReSults : Results .. .. -• . . ,, ~ ,,
Arsenic <o,of mg/I 2 ( I , .... , _\ r ~ ,_:+., I
Barium t:I. I mg/I 2 ~,\, J "'."<i .
' Cadmium < ,tl, CJ <:>.> .mg/I 3 -.
Chromium 1 L..~-c,/ mg/I 2 <2...u-.r"\,'"\Q..--.r. L. -&.~'C-
Fluoride ( <n,10. •mg/I 2 'T1v' I .. ,.
Lead , ' ...::,.,P. o,3 mg/I. 2 <,,., .j_ . .; , :._~ ........ ,,, /J I
Mercury /IUJL FFICJc-,,,J $;4'1/Lt:' mg/I ·4 -z_ : "'1-" .. /Jf!) ,0 '1' . ff
Nitrate (as N) J,,s,., ,,.. .{,,: I ,;:",. ;-SJ,,-,,,., ~ mg/I-2 IT)<. V /. /\
Selenium <'O' IJT> ~ mg/I 3 -~-
Silver < ~;VJ mg/I 2
pH r,.,. -ll. units 1 ••: .
Iron . 19,/J~· mg/I 2 ' ... '• .
Manganese o,;;,,..;z_ mg/I 2 s_ -11_ -J'--3 Date Received ____________ Date Reported -~---'-~-----Reported By ___________ _
09608. APR ZS 83 '\ j
,Pate Analyzed ________ ......:,._ __ Laboratory Number:------.,,--------------,,------'-
OHS.Form 2887 7/79
Laboratory ·
OWNER Mildred A. Kerbaugh
Director
'
INSTRUCTIONS .,. ... ~-:-~ -:--
Using typewriJet.-of..6all _p6int pen, fill in all requested inf9rmation o_n the top portion of form front. Please print l':?gibly if typewriter is not
available. /f°:/-·· · ':., ~, r'--· ~-\ -
Before ta~in~ 1:he sampl~ .. te~1i\,e1 the tWo "freeze ·packs" from the styrofoam.r11ailer,and·place in a freezer-overnight. (SAMPLES NOT
'PRESER~~ BY_ ICl;NG DURlfllfJ5HIPMENTWILl NOT BE TESTED.)
SAIV!Pli:E COLLECTION: ~J ". . . . _
1) RefnOve')he two 1-quar,q)lastic c6ntainers and inflate by mouth, if uninflated. ..
2) Let thli\,[a'tw,(to.♦Pe sii'if;Pt'ed) run for 5 ITlinutes to assure that the water is from the distribution system.
3) Riiise eacfi·piastic .. COnta'iner two or three times, and discard the water. ·
4) After rinsing, ffil~ch container to ·within approximateiY. One inch of top of the sampling container. Then cap the container securely:,
Check samples (see Types of Samples below), samples'-from non~community systems, and special samples-may contain only one 1-quart
sampling container, rather than two. · 1 • •
SAMPLE SHIPMENT: ,
1) After collection of the sample(s), replace the two froze·n "freeze packs" in the styrofoam mailer.
2)-Next, .place the two 1-quart samples into the:mailer and cap. ' ,
3) After capping the styrofoam mailer, place the report from (UNFOLDED) _on top, then seal the cardbo_ard box.
State Laboratory using the supplied label.: The sender is required to .Pav ship~i~_g_ c9sts_.. _ . ~-
Mail immediately to the
... -..
The· analysis takestseveral days for completion, and the report will be mailed back as soon as possible. Please do not call the laboratory-•
to request "early" results, unless absolutely necessary: --· · · · ·--, · ' · · · · · ·
Parameters
•\
Arsenic-.
Bari Um · ;:-• · tadiuni -
-~; Ctiromill.m
Fluoride' 1
LIMITS OF ALLOWABLE CONCENTRATIONS FOR DRINKING WATER ARETISTED BELOW: ·
Limits (mg/I),.
0.05 • i, ••
1.0 ; o.ofo· ~
0.05 , •. · '
1.4-2.4 . "
Methods (EPA~600/4-=-79-020) -
...• AA, furnace technique, pp. 206.2-1 ~.206.2-2 • ·
AA, direct aspiration, pp. 208.1-1 -208. f-2
(Temperature Dependerit)·
Lead
AA, furnace technique, pp. 213.2-1 -·213.2-2
·i, AA, furnace tecfiniq.ue,·pp. 210.2:f.:. 210:2-2·
Ion Selective Electrode, pp. 340.2-1 -340.2-3 _ • ·1 l l -:. . ' ,
Mercur-.;1
Nitrate.(~, N),
.Selenium_ .. __ _
1 Silvei-·• · ·, · · · ·
Iron
· Manganese '
; pH . ,-
0.05
0.002
10.0
0.01 .
~-.0.05'. ~ -• '
-· •. 03 ·
:i . -0:05
nofles~ than 6:!? units
AA, furnace technique, pp. 239.2-1 -239.2-2 •
.".Manual Cold Vapor,technique;.pp. 245:1-1 °'245.1'.6.
Colorimetric, Brucine, pp. 352,-1-1'-352.1-3.
AA; furnace technique, pp. 270.2-1 -270.2-3
AA. direct aspiration, pp. 272:1-1 -272.1-2
AA, direct aspiration, pp. 236: 1-1 -236.1-2
AA, direct aspiration, pp. 243,1-1 243.1-2
pj-i Electrometric, PP: 150.1-1•,-, 150.1-3 ·.,
If sample concentrations are greater than the allowable concentrations, a check sample(s) will be required. . ' .. • ,, . . . . ,. ,.
:'. /D'..lli OF SAMPLES . ' ..
Regular: --·, ' ., ~ ...
A sample(s)• submitted to. meet
. Article 130 .• _ ..
the -monitoring requirements ot' the North Carolina-Drinking -Water Act,-GS 130:_.
1) ' ' . -· •
Check:
Private:
Special:
\ ... -· •• T" r ·,_ . ·-. . -.: . • •
A samP.le(s) submitted when a previous sample has ~xceeded the allowable ~concentration.· :rhe check sample should be
taken frofn, t~~ sam·e sample distriDutiOi, tap" as the previOus scimple. __
• ... ... , --,. . • • --• t -r-
• ' • • • ... • • •• 4 •
A sample(s) .from a private water supply submitted by a licensed physiciaa .. sanitarian-or-6ther health department represen-
tativ_e. J' • · _,. -l.-.:. ..,•·: ---;.. _t
.,
A scimPIE!(s) subrTlittE!d by an erigineef w-orking with the.State.or the E.P.A., ~ salllple taken by the.owner/operator of a
Water sy·stem for a"nel/l(well, a laridfill tes·t well sample Or other_ non-cate"gorized ·sa·inple. i ·•n . ~ . ·-. '. ~ .
r 7
1 .• -·
..
• STATE LABORAT6RY OF PUBLIC HE-
DIVISIONOF HEALTH SERVICES
-~ .... 1,,,,... ..
. ........ .N_.C."DEPARTMENl; OF HUMAN RESOURCES
•·· P.OiBOX~28047 .:::·305 N: WiLMINGTON ST., RALEIGH(27611
.......
· ·r: -1..•",.:~. ,. 1 · -· ·
e· ·.'\
INORGANIC CHEMICAL.ANALYSES -PUBLIC WATERSYST ' 1 \ -~ !
Compl.~te Alf.Items· Above Heavy Line ( ":·
'-(See ~~?u~,ns on Rever_se Side) ,. }
~-Type of System· • f,
. i
... /
Name of M~,c~ fl-+~ ' .
System·:·· J . ( I Co~ITlunitY "·
./ -. I ~ •-Y.Nofi~onimunity _ ... _____
Address: /· ' ~ " Source of Water: < ·.
_,,/_ Gr";;'Und " •,
..-!!!l • I ,.J -·" I . I Both ZIP I I Surface I· I Purchased R·;;:_,~~j ,. l _,.
County: Source of Sample:•\. \ ,,,: . .
Te..-v-(:v. -\)(iv-Q.,,(" ' I I • Distribution Tap· ( I ,House·Tap
I ' :: Well Tap Report To: ........ -I ' . I I
. ' ,,
Sc\,cl ~) ,\..\0-2 . i /.._)a.-:t' ' Type of Sample:\
,,
Address: ' ' l ,/ . I I Raw :, I I Tre"ated .
. , . ZIP . ·'.. .. ' ;r .. ,., ' Type of Treatment. .. ! ' .. \ ( ) Non~ I ) Lime . -.
( I -Telephone Number: , ( ) Chlorinated I ) Soda Ash
-'.I -~-12 ,,\-\ <!. ' ( I Fluoridated I ) Polyphosphate
Collected By: .
( ) Filtered I .. . ) Water Softener
L\ -11-P,3 I I . L"--0 ~) ( I Alum ( I Other
Date Collected: Time: -~ Type of Sample:
Location of Sampli~g Point:-~ -~--•r'l ':l t;-y-'.,_ ~ (,\.\°' •· ( ) Regular I ) Priv.ate
(Address wn·ere sample was collected) , 1 · · ( ) Check ( ) Special .. . . .... .. .,'.,, WATER SYSTEM I.D. NUMBER (COPY FROM MAILING LABEL) Remarks:, -t-~f\ , ' .. DD-:-DD-□□□ .. '· .. .
S:tate Drinking Water Parameters (Required) Optional Parameters (List as needed)
' ..
Results Results
/ --, ~ d
Arsenic <.(0;1 O~Y I mg/I 2 ~-L' . ...:-LJ Q ~ --
Barium -< /] I mg/I ? r
Cadmium < ,o, c,c::JJ mg/I 3 ·(1 .n r'l\"\.; r . £ tt?.or-
Chromium <.O-al mg/I 2 .I' h' I\,,, .. .l ·, ..:u -
Fluoride ~, //) mg/I 2 -s ~) ,l .
. .__ .,/.J ..: '... .::::,-.-<\./'J, ,t/,
Lead <.!?-.,,3 mg/I 2 ,,.,,,.-_ ,,, . JI
Mercury /,u.7,,;~!CiC/E,u .S ,Q,t//,rm,IA 4 '. -.. . ,,. -:::1..~~·
Nitrate (as N) /,u,, l',r,,, ,_;--· _{.,,,,_,,.mg/I 2 7 ', "' n.,.~
Selenium <r::...c}, ()'i)' mg/I _3· --.. -Silver ' 1./;cl!, ')19/1 2 .
pH '/,/ ,/units 1
Iron .. <; 0, {/ J _,, mg/I 2 '
Manganese . <"11.0-::>· mg/I 2
s~11-J1..3
Date Received ____________ Date Reported ---------~-·Reported By----------'---
096:JJ APRZB 83 \ Date Analyzed ____________ Laboratory Number-------,------------------~-
OHS Form 2887 7/79
Laboratory
OWNER· Mildred A. Kerbaugh
Director
.
'
'
·--~---, -..
. --,_;,'-~·' · ,.:,.. INSTRUCTIONS
-~ Usi~g'~;~~writer or ba;;, ~\t pen, fill in all reque.sted in;ormati~n on:the ~op p~rtion of f~rm front. Please print legibly if typewriter is not ava'labl • · ;\ / · · -· · · 'a· e. , , , -:\\ .
''.i ~·.... CS?
B_eto'r.e ;takirig• the sample/r~move the two "freeze packs" from the styrof9am_ mailer. anq place in a freezer overnight. (SAMPLES NOT.
PRESE.RVED BY ICING;DlJR ING SHIPMENT WILL NOT BE TESTED.)
\ .. ,"?,\, ,.
SAMPLE,COLLECTION: • I • • 1) Remove·the'two 1-quart plastic containers and inflate by mouth, if uninflated. ,
2) Let the water (to be sampled) run for 5 minutes to assure that the water is. from_ the distribution system.
3) Rinse each plastic container two or three times, and discard the water.
4) After rinsing, fill each container to with.in approximately one inch of top 9f the sarhpling container. Then cap the container securely. -·, ·
Check samples (see Types of Samples below)·, samples· from non-comrou·nity systems, and_ special samples i:nay contafn_only one 1-quart.
sampling container, rathe'r than tWO: , ·
SAMPLE SHIPMENT:
1) After:collection of the sample(s), replace the two frozen "freeze packs" in the styrofoam mailer.
2) Next, place the two 1-quart samples into the mai_ler and cap. · -. . • •· '
3f After capping the styrofoam mailer, place the report from (UNFOLDED) on top, then seal the cardboard box. Mail immediately to the
State Laboratory using the supplied label.• The sender is required to pay _s~ip~i~g cos_ts.
The analysiS takes.several days for completion, and the report will be mailed back as soon as possible.! Please do not call the labora~ory
to request •~early" results, unless absolutely.necessary. · ·· --·· · -· -· · -· · · · · ·
Parameters
Arsenic
Barium
· ', Cad-ibm
·· Chromium
Fluoride
" .. , . ·' ·1
LIMITS OF ALLOWABLE.CONCENTRATIONS FOR DRINKING WATER-ARE LISTED BELOW:-· ··
Limits (mg/I)
0.09.,
1.0 ·'
0.010
0.05
1.4-2.4
Methods (EPA-600/4-79-020) · -
...
(:remperature Dependent)·
Lead 0.05
AA,Jurnace technique, pp. 206.2·.1 -206.2-2
AA, direct aspiration, pp. 208.1· 1 -208.1-2
AA, furnace technique, pp. 213.2-1 -213.2·2
AA, furnace technique, pp. 218.2.r-218.2:2-
lon Selective Electrode, pp. 340.2· 1 -340.2-3 ...
AA, furnace technique, pp. 239.2· 1 -239.2-2
Manual Cold Vapor technique,.pp. 245 .. 1-1 -,,245.,1,6
Colorimetric, Brucine, pp. 352, 1·11-352.1-3.
Mercury
Nitrate.(as N)
0.002
10.0 r
seienium
SilVer
Iron
Manganese·
pH
0.!).1 0.05: ,,..: IJ
•0 0.3 ,
0.05 t,
riot less t~ah '6.5\mits
..... ,;
AA, furnace technique, pp. 270.2-1 -270.2·3
AA. direct aspiration, pp. 272.1•1 -272.1-2
AA, direct aspiration, pp. 236. 1·1 -236.1·2
AA, direct aspiration. pp. 243.1-1 -243.1·2
pH Electrometric, pp. 150.1·1 -150.1·3
If sample concentrations are greater than the allowable concentrations, a check sample(s) will be required. \' .' ~
·.,.""' 1 • • ·.'"\.r
:..
: ·r-; ~--
TYPE·s OF SAMPLES-· ' ' .
Regular: A sample(s) submitt~d to .meet the. monitoring requirements of: the North Carolina Drinking Wate.r Act, GS .130. :_-. ~-' ·
~rtic1~_13D. • · ·, , 1· 1 i
A sample(s) 1subnlitte"d when a previous sample haS exceeded the,:alloWable concentr8tiori.
taken tro'ni th'e same sample distribution tap as the prevlOus sample. · · " . . ..
The check sample should be •
'
.. ,
,.
Private:. A sample(si from a private wate; supply su·bmitted by a.l~~ensed dh-ysici~'n. S'a.~ita~_;a~·~r other h~~lth departmen~ r~p;ese·ii-· ~· -~
tatlve:.. .;. · 1 '~ , _':, -~ • · ·
Special: A sirilple(s) submitted by an engineer woFking with the state or the' e:P:A.;.a ~a~ple ·taken by the OWner/operatOF 6-f a
water system for a new well, ·a landfill tesfwell sample or other, non-catego"iized ·samPle.-,.i--' ·-• -~· --::~/
. ' • STAT~ L;~ORATO~Y OF PU~LIC HE •
D.IVISION OF HEALTH SERVICES'
N.C. DEPARTMENT OF HUMAN RESOURCES
P.O. BOX 28047-306 N. WILMINGTON ST .. RALEIGH 27611'
INORGANIC CHEMICAL ANALYSES -PUBLIC WATER SYSTE
\
\ I
Name,of · Mo...car---. '. .. r System: •
l
Address: ' i . . p_; ~-J",_ ~.1 ..
C<:>unty:
ReportTo: -,-ex-,,-,.,. ::D--···'
Address: <$"\ :·1 l 1-\ ,,.z.
''
Telephone Number: (:' ) .• 1'
..
ZIP
.
-
Complete All Items Above Heavy Line
(See lhstructions on Reverse Side) .. ,, ~ ' .
Type of System: . ./'r\ wl . ( ). Community . I ) Non-CC?mmunity
Source of Water: . ' . '. ( I Ground
( I -Surface
·Source of-Sample:
I I Distribution Tap
, ' .vS;,.,...,~ -Type of Sample:
' ( . -.. I Raw
ZIP Type of T~eatmerit·" .. .
( I .None -. ' : I·· I ·chlorinated
' I ). -Fluoridated
' 'I( .5 l9
fr'. ~$TE tll~
., .
'
( I Both
( I Purchased
' ( I House-Tap
I I Well Tap ..
/ ( I Treated
''
( I Lime .
( I Soda Ash
I ) Polyp~osphate T·\)o,,.\\~· Col_lected By: . ( ) · Filtered • I ) Water Softener
' ~ I I Alum ( ) Other '-( -1.'l-83 • ·t '\1' 'o-i'\-p Date Collected: Time:
. L,(,e.,\_\' ' I • Type of Sample:
Location of SampJing Point: ( ) . Regular . ( ) Private
(Address where s~mple was collected) . .. ( ) Check I ) Special -·J ,··
Re_marks: E·rl\ . WATER SYSTEM I.D. NUMBER (COPY FROM MAILING LABEL)
-\--,, □□-□□~□□□ .. . ' • ' '. '·. ..
State Drinking Water Parameters (.Required) ·-Optional Parameters (List as needed)
,· 1'· . , . •.•I:: •• .. .
ResUlts ~ ..... ReSUlts
Arsenic <0-01 . mg/I 2 f"~,\ .•• ~. ~-" lf ,:;;, ,l,( •• L . ~
Barium /./, / mg/I ?
~"
l t'-
Cadmium .L ,fl, <3as-mg/I 3 I .
· Chromium . . . -,,:, O. DI mg/I 2 ~ -.O\'-" .. -C /j, t) ~
Fluoride < 0, 10 mg/I 2 ""'':s' 1-ll
Lead -< ,!}, t!?3 mg/I '2 Sue\ LI ,.. ~ ·-
Mercury' . o.oao Ci( mg/I· 4 .. , (J ,, ... -ic-" /I
Nitrate (as NI /, Ob mg/I· 2 ? ~.'\-.c. ' (!JI, I .. 7
Selenium <o,oor mg/I 3 ... l
Silver ,!"/1 A, mg/I 2
pH r,,., • I units 1
Iron /J. '7.(/ mg/I 2 . ;
Mangarlese ' C>,76,' · mg/I 2
~'To c. A.""'-".ly,,_e.._v-d.J~'-i ,S...,t,.,i..j,do ,'o o. o ,lo. {'-, ... >,t..,/y,,{
Date Received ____________ Date Reported _s--1(-~ _3,, ', Reported By ___________ _
07296 _/.iPRzs· 83 Date Analyzed ___________ Laboratory Number _________________________ _
OHS Form 2887 7/79
Laboratory
OWNER Mildred A. Kerbaugh
Director
• • · INSTRUCTIONS -
Using typewriter or ball point pen, fill i~ all requested infor.mation on the_ top po~tion of form _ _front. Please print legibly if typewriter is not
available. · .,
Before taking the sample; remove the two "freeze packs" from the stYrofoam mailer and place in. a freezer. overnight. (SAMPLES NOT
PRESERVED BY ICING:DURING SHIPMENT WILL NOT BE TESTED.) . .
·:SAMPLE COLLECTION: .: · ... -• . 1 ,11.). Remove the Jwo 1-quart plastic containers and inflate by mouth, if llnirifl'cited. .
2) Let the water (to bE! sampled) run for 5 minutes to assure that the water is from the distribution systeni.
3) Rinse each plastic cOntainer two or three times, and discard the water.
4) JXtfe1\rinsing:·m'feach container to within apprOXimately'one inch of top of the sampling container. Then cap the container securely.
Chirck SamP1es· (see Types of Samples below)·, samples from non-co·r:nm!Jnity system_s, and special samples may contain only on,e 1-quart
sampling container, rather than two.
SAMPLE SHIPMENT: , --· -"•.
1) After collection of the sample(s), replace the twO frozen "freeze packs" in the styrofoa(!I mailer.
2)'lf':Jext, place 1he two 1-_quart samples into the mailer and cap. . - . ~ ~ · . •
·,f , I 1
-3) After capping the stytofoam mailer, place the report from (UNFOLDED) on top, then seal the-cardboard box.
State Laboratory using the supplied label.. "(he sender is required.to pay shi~pirlg ~?sts. ·
Mail imffiediately to the
The analysis takes several days for completion, and the report w)II be mailed back as soon as possible. Please do not call the la_boratory .
. . to request "early" results, unless.absolutely:necessary. • · • · ~-·· · -· · ·
.•)![1:-< t. ' ' -
LIMITS OF ALLOWABLE.CONCENTRATIONS FOR DRINKING-WATER ARE LISTED BELOW: -·
Parameters Limits (mg/I)_.,:_.,.,, Methods (EPA'-600/4-79-020) ---
', . r
Arsenic
~~ri.U_m:.
Cadium
0.05
1.0. . , 0.010 I ,; •·i
[_ AA. furnace.technique. pp._206.2-.1 -_206.2-2 ,, '
AA, direct aspiration, pp. 208.1-1 ~ 208.1-2
·f1.~, · ChromiUm
Fluorid8 ,
• (Temperature Dependent) 4
Lead
0.05 C• •
1.4-2.4
AA. furnace technique, pp. 213.2-1 -213.2-2
AA, furnace technique, pp. 218.2-1 -·210:2:2 -·
,. Ion Selective Elec~rnde, pp. 340.2-1 ;:--310,2-3
·--- -·-. ,1__ --···
AA, furnace technique, pp. 239.2-1 -239.2-2
.Manual Cold Vapor technique, pp. 24_5,U -,245.1-6,. Mercury,
Nitrate (as N)
_$eleni~tn
0.05
0.002
10.0
0.01 Colorimetric, Brucine, pp. 352,-1-,11-:•352. 1:·~11'· <-' .• • . •1 •. :-
.. , Silver · • 1··. ,.: . ..t~ · 0.05• • /::.:· '. AA, furnace technique, pp. 270.2-1 -270.2-3 ·
AA. direct aspiration, pp. 272.1-1 -272.1-2
Iron ,
Manganese
pH I • a
--• ·0.3 •
, 0.05' •
AA. direct aspiration, pp. 236. 1,1 -236.1-2
AA, direct aspiration. pp. 243.1-1 243.1-2
Regular:
Private:
special:
_ _ .. : t. ·:--~ not less iha~·6.5 9nits p_H ~lectrometric,_ pp. 150, 1-1. -·150.1-3
. , . .. . ,·
If sample concentrations are greater than the allowable cOncentrations, a check sample(s) will be required. . . . . "'•-.
.. ,.~.
-7 TYPES OF SAMPLES ·
\ . ' .
A: sample(s)
/\rticle '13[).
su'bmitted to meet the monitoring. requirements of: ~the N,orth · Carolina Drin~ing Water Act, GS 13ci _:_~·
: '' ..
< A s~mPle(s) sUbniitte·d when a previous Sample has exCeeded the ·allowable concentration. Ihe check Sample should be-•
· taken from the sari"le sample distribution tap as the ffrevious Sample·. ~ · --· -, . ~-. \
•• ... • f) ···-'•. ' A sampl~(s) _from a private water supply. submitted. by a licensed J)hysicia_n, sanitarian or other health department rep_resen-
ta~ive. · · ·· · · ·
A S'ainJ)le(s)' submitted .by an engine.er workiriQ with the State' 6r the E.P.~., a sample .t.a"ken by the owner/0perat0r of 'a
water system for a ne~_well, a·Jandfill test well sample·or o~h~r non-categorized sa~rTlple. · -· · ·:.~~-,
.-
. ' , < ' -"'7 ;
-STATE LABORATORY OF ~~B~IC HE-
. DIViSION OF HEAL TH SERVICES. .,
\ . .. ' _;,, .• •.•·" N.C. DEPARTMENT OF HUMAN RESOURCES
/•••• . P.O. BOX 28047 -306 N. WILMINGTON ST., RALEIGH
••
27611
. . INORGANIC CHEMICAL ANALYSES -PUBLIC WATER SYS
Complet~'AII Items.Above Heavy Line '
\ (See Instructions on Reverse Side)
\
Name of J\c.(C..o,, ' , (1-1CJ') J " System: ,. \ ( ~) 'Community
"' ( )· ~Non-Community • ·. '-.-
TytSystem·
'-' -Address: Source Of Water: • . ' -~ ( GrOund
. ,
I ) ( , ) Both.
' _,.ZIP . 'i .. ' ( ) Surfac;e~:::_ --) Pur.chased ~-(
,..,.• -f-,,.h(\-...0,d --~ Source of Sample:~ County:
' -~ ( ) Distribuiioh• ,ap _. ( ) House Tap Go.,,. --( ) Well Tap Report To: u \~ Type of Sample: Address: . , ' . ( ) Raw ( ) Treated '-'•~ .... ' ' ~ ZIP' ·-\ s Type of Treatment: ·-( '-.) ( ) . Lime ( I --, -None -.
Telephone Number: ( ) Chlorinated ( ) Soda Ash.
T. ·o E' c-t\ c... ( ) Fluoridated ( ) Polyphosphate
Collected By: ( ) Filtered ( ) Water Softener ,,.
<'~
, . \-2·1~':fJ3 2 :30 ( ) Alum -( ) Other ' Date Collected: Time: / ·"""'· ...
Location of Sampling Point:· · : ·'-LG~\\ 2.-... Type of Sample:
( ) Regular ( ) Private .
(Address where samPle was colle~ted)'· ( ) Check ( ) Special .,,.;.'
t~ .
RE!rii'arkS_:~ .; . ·:,. WATER SYSTEM 1.D'.\NUMBER (COPY FROM MAILING LABEL) + :i::::Pfl--.. ~-□□-□□-□□□ • I "" -
State Drinking Water Parameters (Required) Optional Parameters (!-J.~t.as needed)
Results Results
Arsenic <._0.0/ mg/I 2 ( I ,,&'C\ d .. 1A( +-i \~·\..._,\ '· _.{ "· s ~ .. , .. ~La,ic~ .,
Barium < 0, I mg/I 2 C--i,l&<', L-) (,,.,
Cadmium L t!),ooS ~mg/I 3~
.
Chromium ,< O, a I ~ · mg/I 2 C'_.uni':>'L, {j ~ 2.,-5-
Fluoride "-. .._ u If) I v·· mg/I 2 Tb:S' ·, ,· -"'I .-,j -··.
Lead ~-.0.J mg/I 2 SD -\ . ..-.·-0·'--· , 4/ .,
Mercury o.oa·os mg/I 4 z~r~'"~c. <n,o...-
Nitrate (as N) ·<. ,:.,, 0.5 mg/I 2 i.:,o c. <~
Selenium <0.0.11.s mg/I 3
Silver .. ..... o,o~ mg/I 2
pH ,..>.,/ units 1
Iron I LJ O //,,:, mg/I 2
Manganese \ ~.v~ mg/I 2 , .
f_.EB O 1 19.011_ ,;)_,/I _.WC,/)
. Date Received --..;------Wtl=----Date R_eported ----~,,fr'fd'-'/--<~+~e_J=='--Reported By ___________ _
\ \ ·, Ill 03658
Date Ana_ly,_ed ___________ Laboratory Number------'----------------------
OHS Form 2887 7/79
Laboratory
OWNER Mildred A. Kerbaugh
Director
r
i INSTRUCTIONS : .;:, ~ .... ,
Using tyPewriter or ball point Pen, fill in all requested information on the top portion of form front.· Please print legibly if typewriter is not • -,. ~· ~, I availab_le. f . ..:2i. '-~· t~ ::. : .
¥ . 1
Before \;king the sample,·,(~rpove the two "freeze packs" from the Styrofoam mailer•and place in a freezer overnight. (SAMPLES NOT
PRESERVED .BY ICIN(i DU,R ING SHIPMENT WILL NOT BE TESTED.)
,; _·· ' .. · ~: ... :.. ::_ .. -·
SAMPLE "CDl:~ECTION:
1) Remove the two 1-quart plastic containers and inflate by mouth, if unirlflated.
2) Let the water (to be sampled) run for 5 'minutes to assure that the water is from the distribution system.
3) Rinse each plastic container two or three times, and discard the water.
4) After rinsing, fill each container to within apf)roxi_mately one inch of top of the sampling container. Then cap the container securely.
Check samples (see Types of Samples below), samples from non-community systems, and special samples may contain only one 1-quart
sampling container, rather than two.
SAMPLE SHIPMENT: ◄ '.t
1) After collection of the sample(s), replace the two frozeh "freeze packs" in the styrofoam mailer.
2) Next, .place the two 1-quart samples into' the mailer and cap.
31 After-capping the styrofoam mailer, place the report from (UNFOLDED) on top, then seal the cardboard box.
State Laboratory using the supplied l~bel. •The sender is required to pay shipping costs.
Mail immediately to the
The analysis takes several days for completion, and the report will be mailed back as soon as possible. Please do not call the laboratory
to request "early" results, unless absolutely necessary. · · · ·
LIMITS OF ALLOWABLE CONCENTRATIONS FOR DRINKING WATER ARE LISTED BELOW:
Parameters
Arsenic
Bariuin •
''Cadiuni
·• Chromium
Fluoride
(Temperature Dependent)
Lead
Mercury
Nitrate (as NI
Se!e'rliUm ·
SilVer '
Iron , , ·1
Manganese '
.PH
Limits (mg/I)
0.05
1.0
0.010
0.05
1.4-2.4
0.05
0.002
10.0
0.01
0:05
0.3' 7.
Q.05
not less thari-6.5 ·units
-l
Methods (EPA-600/4-79-020)
AA, furnace technique, pp. 206.2-1 -206.2-2
AA, direct aspiration, pp. 208.1-1 -208.1-2
AA, furnace technique, pp. 213.2-1 -213.2-2
AA, furnace technique, pp. 218.2-1 -218.2-2
Ion Selective Electrode, pp. 340.2-1 -340.2-3 ·,
AA, furnace technique, pp. 239.2-1 -239.2-2
Manual Cold Vapor technique, pp. 245.1-1 •-·245 .. 1-6
Colorimetric, Brucine, pp. 352, 1-1 -352.1-3
AA, furnace technique, pp. 270.2-1 -270.2-3
AA. direct aspiration; pp. 272.1-1 -272.1-2
AA, direct aspiration, pp. 236. 1-1 -236.1-2
AA, direct aspiration. pp. 243.1-1 -243.1-2
pH Electrom_etric, pp. 15_0.1-1 .-150.1-3
If sampJe coricentrations are greater than the allowable concentrations, a check ~ample(s) will be required.
· TYPES OF SAMPLES ----
Regular: A __ sample(s)' submitted .to .meet the monitoring requirements of the North. Carolina Drinking Water Act, GS 130 -·
,·Article 13D. \ . ' ·
-A~ sainPle(s) submitted when a previOus sample has ·exceeded the allowable concentration. The check sample should be
taken fr~~~_,!he-~·ame sample distributiOn tap as the previous· sample. -
Private: A sample(s) from a private .water supply submitted by a licenied Physician, sanitarian or.other health-department represen·· ·
tative. · ,: · · '
Special: A salllple(sf submitted by an engineer working With the State or the E.P.A.~ ... a Sample taken bY the oWrler/operator of a
water system for a neW Well, a landfill test well sample or other,non;categorize~ saffiple. ·
\
'
. '
;
.I
• l . • ... : 1
••~T~TE LABORATOR~ OF PUB~IC HE-.
,.. ·DIV.ISION.OF HEALTH SERViCES
N.C. DEPARTM.EiiJT'OF HUMAN RESOURCES .
P.O. BO,128047: 1tN; WILMINGTON ST . .'R~LE;\~~~27611 . I , ·,.·.,._, ""7"--• .. ,
INORGANIC CHEMlCAL:"ANAL YSES -PUBLIC WATER.SYSTE ~iCElVfo ':~
1 ' ·-.' .. \ ' -~ / -t, Coniplete·/1,11 Items Above Heayy Line, · .. V{j . (See Instructions on Reverse Side) · .. ""' i J -..
_s,, FEB 15 1983 i . .. ."'----' .. ' ' '· -" ·. Ul ~-·-; E. I ,. " \ /L~~af'\
. ··:✓:•e:.µ,l;) Type_o_fS~e ';' ~ '~ j Name of ~~ . ~',; Systeln: ( ) '. Community a' 11-As,i ~~~ t -·· -( ) Non-Community •
Address: Source of Watkri .
I-' -·~ ( ) Ground ( ) Both ZIP (. ) Surface ( ) Purchased R. c.1 I\,, . d. . "s -.. County: I V\ I .o-'(\ . _ . Source of Sample: ,.,I
Gc, .. <q (2:>~'o\J' ( I Distribution· Tap ( ) House Tap
Report To: ( ) Well Tap u -----:-
Address: Type of Sample: -( )' Raw ( ) Treated
ZIP Type of Treatment:· -( ) None ( ) Lime , ..
Telephone Number: I ) -( I , ChlOrinated . ( ) Soda Ash -. ·uec\~\e. ( ) Fluoridated ( ) Polyphosphate
Collected By: ..-.],
( ) Filtered ( ) Water Softener
/-27--83 3 :co ~: ( ) Alum ( I Other
Date Collected: Time:
we\ I I Type of Sample:
Location of Sampling Point: I I Regular I I Private
(Address where san:,ple was collected) I I Check I I Special
' t:. p /.\_ WATER SYSTEM 1.D. NUMBER (COPY FROM MAILING LABEL) Reniarks: -i--□□-□□-□□□
State Drinking Water Paramet"ers (Required) Optional Parameters (List as needed)
ResUlts Results
Arsenic .._o,o I · mg/I 2 c..'..c-<-;::\.t..\L +, \) I '\-c-'-I ,_ ::, .. •• I. A (
Barium o. I mg/I 2 C h\c,~ ,<I"-, ;;.,;;_ .
Cadmium -< cJ, o,o.!i" mg/I 3
.,
-
Chromium "",&• Of mg/I 2 ( I c;v') l'J.S:.,C-.,-;:_ CJ rcJ~-
Fluoride -v, /0 mg/I 2· ,-L)":> 50><
Lead <._&.OJ mg/I 2 SD~ ~/
Mercury ..._ 0, OOv ::z__mg/1 4 :z._ 1Y'\.< < o, o,
Nitrate (as NI O,u~ mg/I 2 &-TO<...-.. //4,<../
Selenium <O.o0...5 mg/I 3
.
Silver -c:;; 0,0:5, mg/I 2 -
pH f,..,, I units 1
Iron /J, XI mg/I 2
Manganese /~,,.,,.'° mg/I 2
·fEB O 1 \9~ ;J_ J;,/JJ?_J Date Received ___________ Date Reported -----+{,-'-'-Tf'+----··_ Reported By __________ _ I • ' -~au~~ ._. Date Analyzed -----------~aooratory Number _______________________ _ ,,,.,·
OHS Form 2887 7/79
Laboratory
OWNER Mildred A. Kerbaugh Director
• INSTRUCTIONS
Using typewriter or ball point pen, fill in all requested information on the top portion of form-front. Please print legibly if typewriter is not
available.
Before taking.,'-the:.SarTlple~ .re_move the two "freeze packs" from the styrofoam mailer ai:id pl.ace in a freezer overnight. (SAMPLES NOT
PRESERVED·BY ICING DURING SHIPMENT WILL NOT BE TESTED.)
SAM.PLE COLLECTION:\
1) Remove the.two 1-quart·plastic containers and inffate by mouth, ifuninflated.
2) frer the wate"r (to be samPied) run for 5 minutes to assure that the water is from the distribution system.
3) R.iT'lse each plcistic contairier two or three tim'es, and discard the water.
4) Aftef~r,lnsing, fill ea~~~C?rltainer to within approximately one inch of top of the sampling c0ntainer. Then cap the container securely.
Checl<~amples (seet:f_ypes of Samples below), samples from non-community systems, and Special samples may contain only one 1-quart ~ ·••I;,,· :,v':,.::.t~.,,;---samplmg,c;2.,i:,_t_!1!1er,.-rather than two. ,
SAMPLE SHIPMENT:
1) After collection of the sample(s), replace the two frozen "freeze Packs" in the styrofoam mailer.
2) Next, place the two 1-quart samples into the mailer and cap .
. 3) After capping the styrofoam mailer. place the report from (UNFOLDED) on top, then seal the cardboard box. Mail immediately to the
State Laboratory using the supplied label. The sender is required:to pay shipping costs.
The analysis takes several days for completion, and the report will be mailed back as soon as possible. Please do not call the laboratory
to request "early" results, unless absolutely necessary. · · · --
Parameters
Arsenic
Bari uni
Ciidium
Chromium
Fluoride
LIMITS OF ALLOWABLE CONCENTRATIONS FOR DRINKING WATER ARE LISTED BELOW:
Limits (mg/I)
,0.05
1.0
0.010
0.05
1.4-2.4
Methods (EPA-600/4-79-020)
AA, furnace technique, pp. 206.2-1 -206.2-2
AA, direct aspiration, pp. 208.1-1 -208.1-2
AA, furnace technique. pp. 213.2-1 -213.2-2
AA, furnace technique. pp. 218.2-1 -218.2-2
Ion Selective Electrode, pp. 340.2-1 -340.2-3 · (Temperature Dependent)
Lead
Mercury
Nitrate (as N)
Seleniulll
0.05
0.002
10.0
0.01
0.05
0.3
0.05
AA, furnace technique, pp. 239.2-1 -239.2-2
Manual Cold Vapor technique, pp. 245.1:1 ;-,•245.1-6
Colorimetric, Brucine, pp. 3_52,-1-,1_ -352.1:3
Silver
Iron
Manganese
pH not less ~han ·6:5· uni~s
AA. furnace technique, pp. 270.2-1 -270.2-3
AA. direct aspiration, pp. 272.1-1 -272.1-2
AA, direct aspiration, pp. 236. 1-1 -236.1-2
AA, direct aspiration, pp. 243.1-1 -243.1-2
pH Electrometric, pp. 150.1-1_:.__ 150.1-3.
''
If sample concentrations are greater than the allowable concentrations, a check sample(s) will be required.
___ TYPES OF SAMPLES
_ Regular: A sample(s) submitted. to meet the monitoring requirements of the North CaroJirla Drinking Water Act, GS 130 --
Art'icle 13D. ·. · ·
. Check: :._A sample(s) submitted when a previous sample has exceeded the· allowable concentration. The check sample should be
· taken fr~nl the' same sample distribution tap as the previous sample. . .
Private:_ A sample(s) from a private water supply submitted bY a licensed physician:sanitarian or other· health department represen-
tative.
' Special: A sample(s) subrriitted by an engineer working with the State or the· E.P.A.,\a _sampleJaken by the owner/OperaiOr of a
water system for a new Well, a landfill test well sample or other. non-categorized· sample. · '
' . . ·'' .-
. '
'.
-·STATE LABO.RATORY OF PUBLIC H~-
DIVISION OF HEALTH SERVICES
'N.C, DEPARTMENT OF HUMAN RESOURCES
P.O. BOX 28047 -306 N. WILMINGTON ST.,.RALEIGH 27611
,,
INORGANIC CHEMICAL ANALYSES ,--PUB.UC WATER SYSTEM
Name of M ('loC1•,.;.. System:
Address:
zw
County:
t:<.:,..I,, ___ )/
·•
rio..r.v_ m \1\I
Report To:. -,
Address:
ZIP
Telephone Number:: ( I .,..
Collected By: i ..
Date C_ollected: Time:
Location of Sampling Point: I
(Address where sample was collected).
-~-
Complete All Items Above;Heavy Line·
(See lhstructions on Reverse ~ide)
. Type of System·:
' 1Jn~...:) ( . ) .Community
I ) • Non-Community
' Source of Water:
( I Grou11d •
. ( . ): . Sl.lrface
Source of Sample:
I I Distribution Tap ..
;
Type of Sample:
( ) .. Raw
Type of Treatment:
( I . None ,·. ( I Chlorinated
( ) · Fluoridated
( I · Filtered .
AM ( I Alum PM
Type of Sample:
( I Regular .. I I Check
., . . . ( I Both
( I Purchased
( I House Tap
( I Well Tap
,·
' ( I Treated
. ( . I Lime
I ) Soda Ash
I I Polyphosphate
I I . Water Softener
( I Other
( I Private
I I Special
1,<,.A f,,._ ,· ... /.Air)O "": WATER SYSTEM 1.0. NUMBER (COPY FROM MAILING LABEL) Remarks: Q \~~.\ ---~-~ .
'":::.C □□-□□-□□□ -
Staie Drinking ~ater Parameters (Required)~ Optional Parameters (List as needed) ' ..
. ·Ae'slllts • • « . . .. ResultS .
Arsenic mg/I 2
Barium mg/I 2 C..t..i•\;)."--'v ""'-0, O_.c,
Cadmium ✓ ~ O,oo.5"" mg/I 3 ,-, 1 • .c.. ' ....... ~ D.q_s-
ChromiLim ./ "'-<?,of mg/I 2 1cc /~O:r
Fluoride mg/I 2 . '. ..
Lead ✓ O~ .?Cl mg/I 2
Mercury mg/I 4 ., , .
Nitrate las NI mg/I 2 ;; . .
' Selenium . mg/I 3 ,
Silver mg/I 2 .. ,. . -
pH 7 , '/. units 1
Iron ·-mg/I 2 ,_ .
Manganese mg/I 2 .
JAN ·11: 1911:r_. · 1,,l1hJ / J'_J Date. Received-------=-='--'-. Date Reported ____ · _._'/ _ __,_1/' _____ Reported By------------'----
:.,•·~ ..,2153
Date Analyzed ____ _;_ _______ LabO~ratory Number---------"'-------------'----'--
-OHS Form 2887 7/79
Laboratory
SANITARY ENGINEERING Mildred A. Kerbaugh.
Director
INSTRUCTI_ONS /
Using typewriter.or ball point Pen, fill in all requested information on the top portion of form front. Please Print I
·available:
Before taking the sample,. reiiiove the-tWo ".freeze packs" from .the styi-ofoam,.._mailer ar,d place in a tree~.er ov
PRESERVED BY ICING DURING SHIPMENT WILL NOT BE TESTED.) .
SAMPLE COLLECTION: . . , ,
1) Remove the two 1-quart plastic-c6r;itain~rs and irlfiate by rTlouth, _if uriinflated. .
2) Let the water (to be sampled) run for 5 minutes to-assure that the water is from the distribution system.
.... ~--·-•
. HJN
if t&writef' i 0 -~,
Lu ~ > . ,miht. (S LES N . ·
1.) ' .
\J'I
3) Rinse each plastic container two or three times,_ and discard the water. .
4) After rinsing, fill each.container to within apPi-Oximately One inch of top of the sampling container. Then cap the container;sett..ii-ely .. t
Check samples (see Types of Sample$ below),'Samples' from non-community syste·ms, and special samples may_contain ... ohly one 1-quart
sampling container, rather than two: · ·.· ·· , t.. "
SAMPLE SHIPMENT: • c .
1) After c611ection of the sample(s). replace the two frozen "freeze packs" in the styrofoam mailer.
2) Next, Rlace the two 1-quart samples into th_e_ mailer and cap.
3) After capping the styrofoam mailer, place the-report from (UNFOLDED) on top, then seal the cardboard box. Mail immedia,tely to the
State-Laboratory using t.he supplied label .. The sender is re(1uired to pay shipping cost~. _ _ 1,.: :· ,,~'i ~ ,.: , \ .
.'. '. ~--,-'" )! • • . , •
· The analysis takes several days for completion, and the report wili° _be mailed bac~ as soon as po_ssibJ~LP~_~se do,n.ot cat)·\:he laboratpfY;
to request !'early" results, ,unless absolutely-necessary. -:. i
.:.J· LIMITS OF ALLOWABLE,CONCENTRATIONS"FOR DRINKING WATER ARE L:ISTED BELOW:-
Parameters
·--:,n _1
1ArsenLc
Barium
·tadium_'
ChroniiUm
Fluorid8 J
-(Temperature 0ependent)·
Lead
Limits (mg/I) : ... · ·
0.Q5.,, . ,
1 o .
0:010· '· ,: ·'
0.05 t. :.i.i'
1.4-2.4~---'
0.05 '-" ·
Methods (EPA-600/4,.., 79-020)
• AA, furnace technique, pp .. 206.2-1 -.206.2-2
AA, direct aspiration, pp. 208.1-1 -208.1-2 .
AA, furnace technique, pp. 213.2-1 -213.2-2
AA, furnace iechnique, pp. 218.2-1 -·218.2-2
Ion Selective Elec;rode, pp. 340.2-1 -340.2-3
AA, furnace technique, pp. 239.2-1 -239.2-2
- • , . .!
Mercury
Nitrate, (as NI
0.002 . 10.0 Manual Cold Vapor tech'nique, pp. 245.1-1 °-245:-1'6 .•.
__ se1en-iulll _ ..
·• Silver :f, ... , ~ '. }-... ·
0.01
Colorimetric, Brucine, pp. 352, 1-1.-352.1-3 ·. ,,, : .. · ·
AA, furnace technique, pp. 2W.2-1,~.27_DJ13
0.05, AA. direct aspiration, pp, 272.1-1 -272'.1-2 Iron • · . 1 · 0.3 AA, direct aspiration, pp: 236. 1-1 -236.1-2 Marlganese, 0.05 AA, direct aspiration, pp. 243.1-1 243.1-2 pH
Regular:.
not less· than ·5 __ ~ ufli~s pH Electro_me_tric, pp. 150, 1·1 -_ 150.1-3 ..
If sample concentrations are greater than the allowable concentrations, a check sample(s) wil_l_be required. . ., . . -·
TYPES OF SAMPLES
' r
A sample(s) Wbmitted to meet the-monitoring requirements of the North-Carolina
Article 130.
Drinking Water Act, GS 130. ~-· ,.
l
A sample{s) submitte·d When" a PT~ious samPie has exceeded the allowable -cOncentralion. _[h_e_ check S_af!:'ple sh-C?uld b~
taken from the s8me sample-distribution tap as the previOuS sample. ·
-. •-• -.
· ··Private: -· ---A.sample (s)· from·.a· private· water-stipp1y-,Ubrriitted•.-oy-a1ic·e·n-sea·ph'ysiCiaii, sanitiiriaiiOr ·othifheilth department-represefl-
tative. . _
' Special: A sample(s) submitted by an engineer -working with the State or the E.P.A .. a sam~e taken1bY the owne;/operator of a
Water-system for a neVv; well; a landfill test well sample Or other non-c3tegorii:ed ·sample. · ·
,, j
::-,.
"
• S~ATE ~ABORATO:Y OF PUBLIC ~E-, '
DIVISION OF HEALTH SERVICES
N.C. DEPARTMENT OF HUMAN RESOJJRCES .
P.O. BOX 28047-306 N. WILMINGTON ST., RALEIGH 27611 . ~ ~ . . . . . l
•." I INORGANIC CHEMICAL ANALYSES -PUBLIC WATER SYSTEM ·. . . . . a . .
Name of
System··
Address:
County: . ~{ ;. ch r11. ~,,, ,.1 ..
Report To; f;r,.,--~• fs.afh.
. () -
Address: .
'
Telephone Number:. ( )
,'
Collected By: -
Date Collected: .
Location of Sanipling ~oint: •
--,
. -
-
Time:
3
(Address where sample was collected) · ,
·~
ZIP
"
ZIP.
Complete All Items Above Heavy Line.
(See lhstruction~ on Rever~e Side) ~~
Type oi Syste'!': _
( Community
( ) Non-Community
Source of Water:
( ) • Ground ( ). Both .. -,'
Purchased· ( ) Surface. ( ) .-
.. Source of Sarnp)e:
( ) Distribution Tap ( ) House Tap
.. , •,
" ( ) Well Tap·
Type of Sample:
( ) Raw ' ( ) Treated
Type·ot Treatment:
( ) None ( ) Lime
( ) Chlorinated ( ) Soda Ash
( ) Fluoridated ( ) Polyphosphate .. ( ) • Filtered ( ) Water Softener AM
PM ( ) Alum ( ) Other
' Type of Sample:
( ) Regular ( ) Private
( ) Ch.eek ( ) Special
.;· _ . ·. t,A;l41~., _ ;~ A~.,~"'"
·Remarks: •i \ · ' ---· .. ·•·--WATER SYSTEM I.D. NUMBER (COPY FROM MAILING LABEL)
$..C<-~·-·-~,.__, □□-□□-□□□ -,, '· .. -.
State Drinking Water Parameters (Required) -Optional Parameters (List as ne_e.ded) ..
Resul~s .. . -Re;·ults .,
Arsenic mg/I 2 C.,. ·{). ·\ }..._..,; --., V • o~
Barium mg/I 2 ·-" V•/D .:_,,_.:..
Cadmium .,....... L 17, oo,5' . mg/I 3 ~\T~.c.. I-</.a
Ctir'omium ✓ L tJ. ,r,/ mg/I 2 .
Fluoride .. mg/I 2 . a'
.. Lead ,/ tl·07 . -mg/I 2
Mercury ' -mg/I 4 ,· ·:
Nitrate (as N) mg/I 2 . -,
Selenium mg/I. 3 ,, .
Silver --mg/I 2 ..
pH ....,,.~. units 1
Iron "
, mg/I 2 '
Manganese -· mg/I '2 .. ._,. ...
~:11 inS:3 ·' 1/ ,IJ0 ~
Date Received ____________ Dati, Reported ____ I,_,,,_/ •-~..,,_~r-' ____ Reported By ___________ _
.; .J ;c_i,a)j_
Date Analyzed ____________ Lab_orato_ry. Number.---------------------~--.,..,.-..... ~~-.
OHS Form 2887 7/79
Laboratory
SANITARY ENGINEERING Mildred A. Kerbaugh
Director
INSTRUCTIONS
Using typewriter or ball point pen, fill in all requested information on the•top portion of form front .. Please print leg·
available.
Befofe taking the sample; remove the tWo "freeze packs" from .the Stytofoam.~mailer and place in· a freezer ave
PRESERVED BY ICING DURING SHIPMENT WILL NOT BE TESTED.)
SAMPLE COLLECTION: ..
1) Remove the two 1-quart plastic c6ntainers and inflate by mouth, if uninflated.
2) Let the water (to be sampled) run for 5 ffiinutes to assure that the water is from the distribution system.
3) Rinse each plastic container two or three times, arid.~iscard the water. .., _ ...
4) After rinsing, fill each container to within approximately one inch of top of the sampling container. Then cap the cctrltain_e~ securelY: · ,_
Check samples (see Types of Samples below); samples-from non-community systenis, and special samples rriay~ccin1:Birl (jnly one ·1-quare
sampling·container, rather than tWo. · '
SAMPLE SHIPMENT:
1) After collection of the sample(s), replace the two trOzen "freeze packs" in the.styrofoani mailer.
2) Next, place the two 1-quart samples into.the mailer and cap.
3) After capping the styrofoam mailer, place the report from (UNFOLOED) on top, then seal the cardboard box. Mail, immedjately to the
State Laboratory using the supplied label. .-The sender is-re-quired-~o pay shipping costs. .J::,:\'l :-:.~ :~~.:._. ,(°'"";_ . ~ ....... ~
I •.
,. C: ' The analysis takes several days for completion, and the report will be mailed back as soon as possible. r~P1ease dQ, n·ot Call the laboratory.
-to request "early" results; unless absolutely necessary. · · -'. · · ·· -..... · · --.-\ --· · · ' . .
LIMITS OF ALLOWABLE CONCENTRATIONS.FOR DRINKING"WATER ARE t:.ISTED BELOW:
Parameters , Limits (mg/I) ,. I ----MethociS'(EPA~600/4-'-79-020)--
Arsenic • .. -'· ~=~\t% ·: 0.05,-
1.Q,
0.010
0.05
1.4-2.4
AA,.furnace technique, pp. 206.2-1 -206.2-2 · ,.,. s > :, ! :
AA, direct aspiration, pp. 208.1-1 -208.1-2
Chromium
Fluoride·
AA, furnace technique, pp. 213.2-1 -213.2-2 ,,;
AA, furnace technique: pp~218.2-l-218.2-2
-{Temperature Dependent)
Lead
Ion Selective Electrode, pp. 340.2-1 -340.2-3
.-,.. J i" ! . J --~ ••
0.05 AA, furnace technique, p·p. 239.2-1 -239.2-2
Mercury
Nitrate (as NI
Selenium __
· Silve·r • : .-.<\~
0.002 !•; ,' '
10.0
0.01_
0.05:·, •···-' · ,,;-,-1_
0.3' ,_. I
.Manual Cold Vapor technique, pp. 245,1°1 ..,--245.1,6 ,, ,;._ , ..
Colorimetric, Brucine, pp. 352,1-1 ~-352.1'3 ·; ,, , ·'•'
AA, furnace technique,pp.,270.2-l • ..'., 270.2-3--!
Iron -•
Manganes; t
A~,.direct aspiration, pp. 272.1-1 -272.1-2
AA, direct aspiration; pp. 236. 1-1 -236.1-2
. H -l'-p _·. ~ ..
r , 0.05. · i,
· nofl~ss-ih8n•-6.5 u_nits
AA, di;ect aspiration, pp. 243.1-1 243.1-2
pH .Electrometric,. pp. _150. 1-1 :f-150.1-3
-Regular:
. Check:
If sample co_ncentrations are gre_ater than th·e allowable concentrations,, a check ~a,:nple(s) wiil• be required.
TYPES OF SAMPLES
· A. sample(s) submitted to meet the-monitoring-requirerpents' of :the North Carolina •Drin~ing Water Act, •GS 1301 -
Article 13D ..
r•. ·,
A sample(s) · submitted when a preVious ,ample ha! ·exc8edCd the allOwable conC8ntr8tion.
-taken frOrii the same sample disfri6ution tap as the previous sampl.e. : -The check •~pie _sho:uld be_
·-·
. .
· ... Prlva'te: ....... A ~s·amp1e·(s) from·a privit,nNateYSUpp1y·stibl'Tiihe'd"tiy"allc'~hsii~·ph'ys!Ci8n·; sanitariaii~or Othir"~ilth department represen-· ,.
. . -. tative. . _ ... . .. . _ . . . _ · _: --•; .. • _ _ : . _ _ · _ __ · ·
. ' Special:. A. sample(sf submitted by ari engineer working with .the State -o, the E.P.A., a sample taken by th; owne;/operator of ;;
water system 'for ·a new well, a landfill test well sample or ott'\er; non-categorized sample. ---·
.• ·--. • ... L -~----••
..
, . . '
. )
... _ -:. r·::.., ... : ' .· ,, '.-~-·-~ --~ •' . . . . .. ~
• ;TATE .LAB~RATORY ~F PUB~IC. HE-
.,.. DIVISION_ Of. HEJ:-LTH SERVICES
N.C. D~PARTMENT OF HUM~N RESOURCES
P.O. BOX28047 -306 N. WILMINGTON ST., RALEI_GH 27611
•,,:.s
. -~ ' . ·::~ . INORGANIC CHEMICAL ANALYSES -PUBLIC WATER SYSTEM
. '
Complete All Items Above Heavy Line
(See lnstructio~s on Reverse S_id~) ·
Name of-··'· /l/1 ·
System: ' . I ''I :ti-<!. "''Y'l,
Typ~ of Systerr/
( ) Community
I ) Non-Community
J:\dd~ess: -----------------.• ----_--, Source of Water:
( I Ground· _____________ ZIP ___ __c_-;
( I Surface .. ,
Source of Sample:
I\_ I · .-, Distri~u-tion Tap·
AdiJress: --~----~----~-----~-~---; i.' ·, !f ,ti
' ·'• -------------'-ZIP-'--~----1 \\\\;ci'·
Telephone Number: _(_. ___ ) ____ .. _· --~~·~• -~-~·-------<
• .., < ,. ~
. 'Type of Sample:
I I . Raw··
Type of TreatiTient:-
I ) None . Chlorinated. '. ·I I
-', Collected By:---•-·~.-----·•-·----,-------'<
I I Fluoridated .. ( I · Filtered· AM ..
.... )
'
I )
I I
( 1\
(·•_.)
( I
'
( I
( )
( I
' ( I
' -
Both
Purchased
House Tap
Well Tap
Treated·
...... ~· -' Lime .. ,-: _,.. -
Soda Ash
._ Polyphosphate
Water Softe·ner
( I Alum PM ( I Other
Date Collected: --~------Tiffie: ----------<----------------~--------
' Type of Sample: •,
; I I Regular Location of Sampling Poin-t: .,_ ---'-· ~(\;=••_· _/._..,,:3"'-'-:·-_,_, -~"---I ( · I Private
-. I I Check (AddresS where sample was collected}. ' ( I Special ,' . . .. t,.v/11-fe,<,, • , ".'. -. ' i
Remarks:
. . • l
.. -~.C\., • \.: .. (. \ l \\ .. , :1?•" .• -
State Drinkir)g Water Par·ametersJRequired)
:1· . ~
.. ·-''
· mg/I
mg/_l
WATER SYSTEM 1.D. NUMBER (COPY FROM MAILING LABEL),
□□~.□□-□□□,:· '
Optional Parameters (List as'need~d) . . I ' .. ... '!. ResultS
2
2
Cadmium ,..,./ .L' t?, o=.t:"" "!• 1c, C · //,0 L .·
..'-f-"+----'-'---·c.· ::...· -'---"-'"~-f--'--'-------'-· -----,!
.mg/I' 3·
mg/I . 2
mg/I 2 -'.
mg/I 2 . . I
Mercury · , mg/I 4
Nitrate (as N) · • · '· ,. : \ --~--'---'------+---------~-!-,--"+-----'--------->--'----------'---\ mg/I 2 .
Selenium _ , ,, . ' . mg/I 3 '· .-
Silver f mg/I 2
Units 1
Iron u -.1-, . , mg/I 2 .
Manganese mg/I 2
' f ~/f?:~ :_:. ~~p~rted By _________ _ Date. Received __ -_.J_._A_N~_.--'1_f-'.,!c'j"'Q.,,,93=-: __ Date Reported
_ _..--I., iC,,.L ':£: .._ . . I
. Date Analyzed -~f ____ ~ _____ La'bora~ory f'Jumber ___ -_'l'J_._. __ ··_· ._ .. __________________ _
-"
· OHS Farm 2887 7/79
Laboratory
.".' SANITARY ENGINEERING Mildred A. Kerbaugh
Director
:; !
INSTRUCTIONS
c'l
ibly i'~\,pewriter a .t
UJ r~
. ~
Using typewriter or·ball point pen, fill in all requested information oil the top portion.of,.form front.
available. · · -· -Please prin
>. J Before taking the sample, rem·ove ·the -two "freeze Packs". from the" stYr9foam. ·mane·r and-plac~,in a freeze_r:o ~ight. ( PL 1
PFJESERVED BY _IC_IN_G DURING SHIPMENT_W_IL_L_NO_T BE TESTED.) 0-.,><? _ . , .
' . SAMPLE COLLECTION: , · . , _.,.
1) Remove the two 1-quart plastic containers and inflate by mouth, if uniiiflclted. ·
2) Let the water (to be sampled) run for 5 minutes to assure that the water iS from the distribution system.
3) Rinse each plastic container two or three times, and discard the water. . · ~
4) After rinsing, fill each container to within-aPpr0ximately One inch of top of the sampling container. Then cap the co,i:,tain'~r securely. ·,
Check samples (see· Types of Samples below), samples from non-communiJy sysJems, al)d special Sc!rriples _may,CQ_ritaih 9'hly one .1-quart_
sampling container, rather than two. :. , .
SAMPLE SHIPMENT:
1) After;collection of the sample(s),. replace-the two frozen "free'ze packs" in the styrofoam mailer.
2) Next, place the two 1-quart samples into the mailer and cap. •
3) Aiter capping the styrofoam mailer, place the report from (UNFOLDED) on top, then seal the cardboard box. M~,I ,mm~diately to the
State Laboratory using the supplied label. T_he,serider is required1..to pay s~ipping cos_ts .. _ _ {_ (. ,-!_: . r :_-1 .",..'L .-,
... ! . .•' .-"-'. \ I I t.~· ....
The anal'ysis takes:·several days for completion, and the report will be mailed back as soon as possibl~.~ iPl~ase dq,nqt c·a~IAhe·l_abora.tory;
to request ;,early".results, unless absolutely iiecessary. . ... -. ---.. . --. --''
LIMITS OF ALLOWABui'~ON°CENTRATIONS FOR DRINKING WATER ARE LISTED BELOW:
Parameters
· Arsenic;:
Bariurfr.
·•·'1-cad·iul"l1' •
Chromium
Fluoride
-· (Temperature Dependent)
Lead
Mercu_ry;
Nitrate. (as N) • se1enh)m \
Limits (mg/I).
0,0!\ , , . 1 1.0
0.010'
0.05
1.4-2.4 '
0.05
0.002 · I
10.0
I
· Methods (EPA7600/4-79-020)
_AA, furnace technique, pp. 206.2-.1 .-c 206.2-2 • ·' '•.
AA, direct aspiration, pp, 208.1-1 -208.1-2
AA, furnace technique, pp, 213.2-1 -213.2-2
::~·'AA, furnace tecnnique, pp..218.2·1 ·-218.2-.2
,•.·-;-, Ion Selective Electrode, pp, 340.2-1--340.2-3 . .,, '. i .
AA, furnace technique, pp, 239.2-1 -239.2-2
Manual.Co18:V.~por technique, pp, 245,hl ;' 245.1°6, .•,.
, Colorimetric, Brucine, pp. 35~, 1-1 -_35~.1-3. .,111 '· •
l_~:": ·:-silvet': ·, ,, ._.,.. . 0.01 ..
·, ,., 0.05. ,!·•
. 0.3 I ·••
0:05
AA, furnace.technique, pp. 270.2, h";-270,,2-3
AA. direct aspiration; pp.•272.1-1 -272. 1'.2
Iron •: ...
Manganese· AA, direct aspiration, pp. 236. 1-1 -236.1-2 \
pH_ -.
_Regular:
Special'
not less th~n 6.5 un_its
AA, direct aspiration, pp. 243.1-1 243.1-2 '·,,,
'· .,. pH Electrometric, pp, 150.1-1-150.1-3 ... ,
• -• -· •• • + ,. •
If sample concentrations are greater than.the allowable concentrations, a check sample(s) will.be required. . .· , . . ·•''·
,.
TYPES OF SAMRLES ----. . ... ~.
A sample(s) .submitted to meet the monitoring require~ents ol the. North Carolina Drinking Wat.er Act, GS 130 -!':.: ;"..•
.• ~r~ticl!! 13p. · ··1 ....
A sample(S) submitted ·wheil a previous sample·· has exc'eeded the alloWable concentration." the ctieC:k Saniple sh0uld be
taken from the same s6mple distribution tap as·the previous sitmple . .,,. · · ,,. .
·-_:. ··-. -. :·,· _.,. --. ~t-. . .. , •
A sump~e(S,·•from a.Pf_ivate·water suppry s"ubmitted by a lic;n~ed Physician, sanitarian or othei-health'.Qepi-rtrT'lentrep·resert:1~ ',.~,i.._ tative. · ....... ~-
A firiiple(s) submitted bv ·an -engineer ·working with the S~ate"-or the E.P.A., a s·a~J)le -~-akerl ·by tn~ ownei-/oJ)er3tcir of a·
~ater system·tor a ne~ well, a• landfill .test well sample or o}~-~~ n~11-categorized samPle. , · · · -_-_· _·: · ,,_. ·: -:..i, _ ..
1
--~-:~ ~-?{~·· ; ·';. ~: :;r / ,,~
' I
r
N.C. DEPARTMENT OF't-iuMAN RESOURCES
P.O. BOX 2804?-306 N. WILMINGTON ST., RALEI_GH 27611
. .
INORGANIC CHEMICAL ANALYSES -PUBLIC WATER SYSTE
Name of
System: 0-L l.-"")...
-
Address:
ZIP
County: o ; , La-., J ·
Report To: Gc:.._,r""' 11.,c.~ \,
()
Address:
ZIP
Telephone Number: ( , ) -
Collected By:
Date Collected:. Time: ·~
Location of Sampling Point: . q
(Address where sample was collected)
Complete All Items Above Heavy Line
(See lhstructions on Reverse Side)
Type of System:
( ) C ommunity
' I ) Non-Community
Source of Water:
.. I I Ground
( ) Surface
Source of S~mple:
( I o·istribution Tap
' ,
' 1 Type of Sample:
(. I Ra'w
Type of Treatment:
( ) None / ( ) Chlorinated I ( I Fluoridated
( ) Filtered AM
PM ( ) Alum I,
----.._
' Type of Sample:
-;
" ( ) Regular ...
~ ( I Check
re,-
\
~519
I ) Both
( I ·· Purchased
'i
( ) House Tap
( ) . Well Tap
( ) Treated
( ) Lime
( I Soda Ash
( ) Polyphosphate
( ) Water Softener
( ) Other
I ) Private
( ) Special
Rerriarks: l-o.. \ CJ""'
,: "~-WATER SYSTEM 1.0. NUMBER (COPY FROM MAILING LABEL)
·-,:,...c...._ ,.t;.r .. -~~-□.□-□□-□□□
State Drinking Water Parameters (Required) ·-t, Optional Paramete;; (List as needed)
Results Results ·'
Arsenic -mg/I 2 . ( .U"I)\~<'" "'-v,0~
Barium mg/I 2 7 ~~·c,__ u • .3.:2..
Cadmium ✓ <D,0~ mg/I 3 """Tur / .,;,< / r:7
Chromium ,/ cJ. Of mg/I 2 , \
Fluoride ·• ~-mg/I 2 -' \ -.
Lead ,/ ~ cl, (':l~ mg/I 2 ~ \
Mercury mg/I 4 '
Nitrate (as NI mg/I• 2 ,'
· Selenium mg/I 3 '
Silver . . mg/I 2
pH -=>, t, units 1
Iron mg/I 2 .,._ ; ...... , ..
Manganese mg/I 2
JAN 11 1983. 1,1/~ ft .3
Date Received ----------~~□a'te Reported ---~,,__.,1/'.°c......._· --'--Reported By ___________ _
' -"· "" ~:149 Date Analyzed ___________ Laboratory Number-----,-"'~--------------------
l
OHS Form 2887 7/79
Laboratory
OWNER Mildred A. Kerbaugh
Director
..-::-7:i ·.
/ 1,.\·, • · · -,~ • INSTRUCTIONS
Llsit~·•ttypewriter or bcil.l ~oint pen, fill in all req~ested info'r~ation on the top portion of form front. Please print legibly if typewriter is not ava'Hable. · :_. ', r. ·_.,, ""' . .. . .. ;.. \ b ,_ ... ;•, .:. ':J,.! •::,: --
Befcff~ taking the "Sahiple';Jemove the two "freeze packs" from the styrofoam mailer·and place in a freezer overnight. (SAMPLES NOT
PRESERVED BY ICING"DUR ING SHIPMENT WILL NOT BE TESTED.) '{·~-, -. :::-~:~~. -----
S,lliMRLE,COLl'.ECTION:
1) Reinbve&tfie·-t\1\/o 1-quart plastic c6ntainers and inflate by mouth, if uninflated.
2) Let the water (to be sampled) run for 5 ffiinutes to assure that the water is from the distribution system.
3) Rinse each plastic container two or three times, and discard the water.
4) After rinsing, fill each container to within approXimately one inch of top of the sampling container. Then cap the container securely.
Check samples (see Types of Samples below), samples from non-community systems, and special samples may contain only one 1-quart
sampling container, rather than two.
SAMPLE SHIPMENT:
1) After collection of the sample(s), replace the two frozen "freeze packs" in the styrofoam mailer.
2) Next, place the two 1-quart samples into the mailer and cap.
-3) After capping the styrofoam mailer, place the report from (UNFOLDED) on top, then seal the cardboard box. Mail immediately to the
State Laboratory using the supplied label. The sender is required to pay shippi_!lg costs.
The analysis takes several days for completion, and the report will be mailed back as soon as pos~ible. Please do not call the laboratory
to request "early" results,· unless absolutely necessary.
LIMITS OF ALLOWABLE CONCENTRATIONS FOR DRINKING WATER ARE LISTED BELOW:
Parameters
Ar~enic
Barium
Cadium
Chromii.Jm
Fluoride
·(Temperature Dependent)
Lead
Mercury
Nitrate (as NI -
Selenium
Silver 1
Iron·
Manganese
pH
Limits (mg/I)
0.05.
1.0
0.010
0.05
1.4•2.4
0.05
0.002
10.0
0.01
0.05
0.3
0.05
nofless tha[l·6.5 units
Methods (EPA-600/4-79~020)
AA, furnace technique, pp. 206.2-'1 -206.2·2
AA, direct aspiration, pp. 208.1·1 -208.1-2
AA, furnace technique, pp. 213.2-1 -213.2-2
AA, furnace technique, pp. 218.2-1 -218.2-2
Ion Selective Electrode, pp. 340.2-1 -340.2-3
AA, furnace technique, pp, 239.2-1 -239.2-2
Manual Cold Vapor technique, pp. 245. 1-1 -· 245.1-6
Colorimetric, Brucine, pp. 352,1-1 -352.1·3
AA, furnace technique, pp. 270.2-1 -270.2-3
AA. direct aspiration, pp. 272.1-1 -272.1-2
AA, direct aspiration, pp. 236. 1-1 -236.1-2
AA, direct aspiration, pp. 243. 1-1 243.1-2
pH Electrometric; pp._ 150. 1-1. -150.1-3
If sample concentrations are greater than the allowable concentrations, a check sample(s) Will: be required .
. .
I.
t TYPES OF SAMPLES
Regular: A .sample(s) submitted to meet the monitoring requirements of the Nortt1 Carolina Drinking Water Act, GS 130 -
Article 13D. .\
Check: A Sample(s) submitted when a previous sample has exceeded the allowable concentration. The check s~mple ... should be
taken from the same sample distribution ·tap as the prt!vious sarTiple.
Private: A sample(s) from a private water supply submitted by a licensed p.hysician, sanitarian or other.health department represen-
t~tive. . • ._..
"-· ' -.-Special: A sample(s) subnihted by an· 'engineer workirlg w(th the State or the E:P.A., a sample taken by the owner/operate~ ~f a
water system for a ·neW well, ii' landfill" test well sample or other non-categ0rized sample. · 4
'
.. ' ' ., ••: \ ',
• t)A;E LAB~R;T;R·Y OF PUBLIC H.);i-
DIVISION OF HEAL TH SERVICES
N.C. D~PARTMENT OF HUMAN REsquRCES
P.O.BO~2804~-~06N.WILMINGTON.S:r .. ,R,LEIGH 27611 ·.
INORGANIC CHEMICAL ANALYSES -PUBL1,C WATER SYST
. it
Complete All Items Ab.ave Heavy Lin\
(See Instructions on Reverse Side)· l
.}
Name of s t ys em:
Address:
County: (,Z ; e,l,.,,,_a.,, <L
{_~ t:°..-rh (1o.~'0 Report To:
0
Address:
Telephone Number: ( )
Collected By:
Date Collected:
Location of Sampling Point:
(Address where sample was collected)
Remarks: $.Q.JL \.,.e \ -..:,_,
._,,..
ZIP
,•
ZIP
-
Time:
3
-.......,~
State Drinking Water Parameters (Required)
· Results
' Arsenic mg/I
Barium mg/I
Cadmium v 'AO,o= mg/I
Chromium ✓ .L. tl, 0/ mg/I
Fluoride mg/I
.. Lead ✓ ()'. o,, mg/I
Mercury mg/I
Nitrate (as N) mg/I
Selenium mg/I
Silver -mg/I
pH J,~ units
Iron mg/I
Manganese . mg/I
Date Received, ____________ Date Reported
-
AM
PM
2
2
3
2
2
2
4
2
3
2
1
2
2
t r
Type of System: .-
Community
I ) Non-Community
Source of Water:
( l.,~· Ground I ) Both
I ) Surface I ) ,Purchased
Source of Sample:
I ) Distribution Tap I ) House Tap
I ) Well Tap
Type of Sample:
I ' ) Raw I ) Treated
Type of Treatment:
I ) None I ) Lime
I ) Chlorinated I ) Soda Ash
I ) Fluoridated I ) Polyphosphate
I ) Filtered I ) Water SOttener
I ) Alum I ) Other
Type of Sample:
I ) Regular. I ) Private
I ) Ch.eek I ) Special
WATER SYSTEM I.D. NUMBER (COPY FROM MAILING LABEL)
□□-□□-□□□
Optional Parameters (List as needed)
Results · ·
( .J.:r/l,,() ,.__,,. .......... V• V~
-z..~·-c... U•/LJ
\ {'-L / '(/, F§
' '
\
/ I ~/J'_j .Reported By _________ _ . ~iai. . "fl .,# Date Analyzed __ _:_ ________ Laboratory Number _________________________ _
OHS Form 2887 7/79
Laboratory
OWNER Mildred A. Kerbaugh
Director
/, c ,: . INSTRUCTIONS
/'
1 Usin_Q;typewriter or ball p~int pen, fill in all requested information on the top portion of form front. Please print legibly if typewriter is not
avail8ble. ..-.,; ' f; _; ,. ,;1 .-. •, I
Bef(?fe. lak .. i~g ihe sample, remove the two "freeze packs" from the styrofoam mailer and place in a freezer overnight. (SAMPLES NOT
PRESEf)VED BY ICING DURING SHIPMENT WILL NOT BE TESTED.) . ,.,.,.:~. ---. ·•,-,,.~
SAMP.LE COLL'ECTION:
1) Remove~tlie'':two 1-quart plastic c6ntainers and inflate by mouth, if uninflated.
2) Let the water (to be sampled) run for 5 ffiinutes to assure that the water is from the distribution system.
3) Rinse each plastic container two or three times, and discard the water.
4) After rinsing, fill each container to within approximately one inch of top of the sampling container. Then cap the container securely.
Check samples (see Types of Samples below), samples from non-community systems, and special samples may contain only one 1-quart·
sampling container, rather than two.
SAMPLE SHIPMENT:
1) After collection of the sample(s), replace the two frozen "freeze packs" in the styrofoam mailer.
2) Next, place the two 1-quart samples into the mailer and cap.
31 After capping the styrofoam mailer, place the report from (UNFOLDED) on top, then seal the cardboard box. Mail immediately to the
State Laboratory using the supplied.label. The sender is required to pay shipping costs.
, ,'
The analysis takes several days for completion, and the report will be mailed back as soon as possible. Plea'se do not call the laboratory
to request "early" results, unless absolutely necessary. -·
LIMITS OF ALLOWABLE CONCENTRATIONS FOR DRINKING WATER ARE LISTED BELOW:
Parameters
Arsenic.
Bariur:n
Cadium
Chromium
Fluoride
• (Temperature Dependent)
Lead
Mercury
Nitrate (as N),
Selenium
Silver·
Iron
Manganese pH ,
Limits (mg/I)
0.05
1.0
0,010
0.05 '
1.4-2.4
0.05
0.002
10.0
0,01
0.05
0.3
0.05
f!Ot less than 6.5 units
Methods (EPA-600/4-·79-020)
AA, furnace technique, pp. 206.2-1 -206.2-2
AA, direct aspiration, pp. 208.1-1 -208, 1-2
AA, furnace technique, pp. 213.2-1 -213.2-2
AA, furnace technique, pp. 218.2-1 -218.2-2
Ion Selective Electrode, pp. 340.2° 1 -340.2-3
AA, furnace technique, pp. 239.2-1 -239:2-2
Manual Cold Vapor technique, pp. 245.1-1 -245.1-6
Colorimetric,.Brucine, pp. 352;1-1 -352. 1-3
AA, furnace technique, pp, 270.2-1 -270.2-3
AA direct aspiration, pp, 272.1-1 -272.1-2
AA, direct aspiration, pp. 236. 1-1 -236.1-2
AA, direct aspiration, pp. 243.1-1 -243, 1-2
pH Electrometric, pp, 150,1-1 -150.1-3
If sample concentrations are greater than the allowable concentrations, a check sample(s) Will be re9ulred.
TYPES OF SAMPLES
Regular: A sample(s) submitted to meet the monitoring requireriients of the North Carolina DrinRing Water Act, GS 130·--i
Article 13D.
Check-: "A sample(s) submitted when a previous sample has exceeded the allowable concentration: J"he cheCk sample should be
taken from the same sample distribution tap as !he previous sample. · · ·
Private: ' A ~ample(s) from a private water supply submitted by a-licensed physician, sanitarian or other1health department represen-
tative. · o:--.-:--· • -
C ( .. , --' Speci31: A sample(s) sUbmitted by an engineer working with the State or the E.P.A., a sample.taken,.by the o~ner/operator of a
-water system for" a new well, a landfill teSt well sample or other non-categorized-sample . . .. -,
',
• I.ATE LABORATORY OF PUBLIC HE·H·
. DIVISION OF HEALTH SERVICES
N.C. DEPARTMENT OF HUMAN RESOURCES
P.O. BOX 28047 -306 N. WILMINGTON ST.>,RALEIGH 27611 · i
~
INORGANIC CHEMICAL ANALYSES,-'-PUBLIC WATER SYST:
Name of s ystem:
Address:
Coun"ty: R.: ,_ \-. ""'-.,.__J
Ge__,, . .._ 6..\) •. Report To: (_)
Address:
.
Telephone Number: ( )
I
Collected By: ' , ..
I
Date Collected:
Location of Sampling Point:
"(A~dress where sample was collected)
I ZIP -
'
ZIP
-
I
I
Time:
I ' '
I
I'" ·, •
Complete All Items Abov~Heavy Line
(See lhstructions on Reverse Side)
l i .
Type of System:
1-<W ( ; ) Community
I ) Non-Community
Source of Water:
( I Ground
( ) Surface
Source of Sample:
I I Distribution Tap
'·
Type of Sample:
(. I Raw .
Type of Treatment'
. ( I None
I I Chlorinated
I I Fluoridated
I I Filtered AM I I Alum PM
Type of Sample:
I· I Regular
( ) Check ..
( I Both ; . ( I Purchased :
,
I I House Tap
I I Well Tap
I I Treated
I I Lime
I ) Soda Ash
( I Polyphosphate
( I Water Softener
I I Other
I ) Private
.1 I Special
Remarks:
S,(~ l:i.s,.\~ WATER SYSTEM I.D. NUMBER (COPY FROM MAILING LABEL)
□□~□□-□□□
State,Drinking Water Parameters (Required)' Optional Parameters (List as needed)
-
Results _., Res·ults ...
Arsenic mg/I 2 .... ~-. -
Barium I mg/I " C..~o,~ ---0, 0...)
Cadmium ✓ L 0,D0.5 mg/I 3 z;......_.,_ U•C/J
Chromium ./ -<;.. o. o/ mg/I 2 11:)c:.. /~/1.r
Fluoride mg/I 2 t·
Lead ✓ C?, ~ '1 mg/I 2 ' Mercury mg/I • .,
Nitrate (as N) mg/I 2 ;, " Selenium mg/I 3 ·., , .... ... ~
Silver , mg/I 2 ,·
pH -, 7 , '/. units 1
.
Iron ' mg/I 2·
Manganese mg/I 2 :
~N H i-f"'19"'... ,J-u l,J-3 Date Received ------'-'-.!2J"""!?l!;'"---Date Repo'rted ___ _;.n,_'/ __ ,_1/_ ' ____ · Reported By ___________ _
, . \ "!,,' ..,2153
Date Analyzed -----~------Laboratory Number _________ ...;,q;::.··----------'-------
OHS Form 2887 7/79
Laboratory
OWNER Mildred A. Kerbaugh
Director
-----. /"".--• -~-.... •• INSTRUCTIONS
Using t.vPe~i~~r ~~ b
1ii'1 P.Oint pen, fill in all requested information on the top portion of form front. available: -·~ .... Please print legibly if typewriter is not
I ., , .-•"
Beto.re ;takir,g t_he_ SBfflP,le, remove the two "freeze packs" from the styrofoam
PRESERVED BY'•ICING Dl,IRING SHIPMENT WILL NOT BE TESTED.I
mailer and place in a freezer overnight. (SAMPLES NOT
\ ~.. .· .... ~,,
SAMPLE COLLECTION:
1) RE!inOve the two ·1'-Qu'art plastic c6ntainers and inflate by mouth, if uninflated.
2) Let"'thJ'i--Vatir,(iO,be sampled) run for 5 'minutes to assure that the water is from the distribution system.
3) Rinse e~tiPlaStic container two or three times, and discard the water.
4) After rinsing, fill each container to within approximately one inch of top of the sampling container. Then cap the container securely.
Check samPles (see Types of Samples below), Samples from non-community systems, and special.samples may contain only one 1-quart
sampling container, rather than two.
SAMPLE SHIPMENT:
1) After collection of the sample(s), replace the two frozen "freeze packs" in the styrofoam mailer.
2) Next, place the two 1~quart samples into the mailer and cap.
3) After capping the styrofoam mailer, place the report from (UNFOLDED) on top, then seal the cardboard box. Mail immediately to the
State Laboratory using the supplied label. The sender is required to pay shipping costs.
The analysis takes.several days·for completion, and the report will be mailed back as soon as possible. Please do n9t call the laboratory
to request "early" results, unless absolutely necessary. · '
LIMITS OF ALLOWABLE CONCENTRATIONS FOR DRINKING WATER ARE LISTED BELOW:
Parameters
A:-senic
Bariui-n
· Cadium
Chromium
Fluoride'
(Temperature Dependent)
Lead
Mercury
Nitrate (as N)
Selenium.
Silver . ·
Iron
Manganese '
pH
Limits (mg/I)
0.05
1.0
0.010·
0.05
1.4-2.4
0.05
0.002
10.0
0.01
.0.05
0.3
0.05
not less than 6.q units
M~thods (EPA-600/4-79-020)
.AA, .furnace technique, pp. 206.2· 1 -206.2-2
AA, direct aspiration, pp. 208.1-1 -208.1·2
AA, furnace technique, pp. 213.2-1 -213.2-2
AA, furnace technique, pp. 218.2-1 -218.2-2
Ion Selective Electrode, pp. 340.2-1 -340.2-3
AA; furnace technique, pp. 239.2-1 -239.2-2
Manual Cold Vapor technique, pp. 245.1-1 °-245:1-6. ·•
Colorimetric, Brucine, pp. 352, 1-1'-352.1-3
AA, furnace technique, pp. 270.2-1 -270.2-3
AA: direct aspiration, pp. 272.1-1 -272.1-2
AA, direct aspiration, pp. 236. H -236.1-2
AA. direct aspiration. pp. 24:i.1-1 243.1-2
pH Electrometric, pp. 150.1-1-: 1!:;0.1-3
If sample concentrations are greater than the allowable concentrations, a check sample(s) will be required.
Regular:
Check:
Special:
TYPES OF SAMPLES
. '
A sample(SrSubmitted to meet the monitoring requirements· of the' North Carolina Drinking Water Act; GS 130 -
Article13D.
A sample(s) submitted when a previous sample has exceeded the allowable concentration. The check sam_p_le s~ould b~
taken from the same s~mple distribution tap as the previous saTTlple.
A sample(s) from a private water supply submitted by a licensed physician, sanitarian or other health department represen-
tativ.e. · , •. \.' ·-;~-
A sample(s) sUbmittetj by an engineer· working with the State or the E·.P.A., a sample taken-' by the owner/operator of a
water system for a·new well, a landfill test well sample or other non-categorized sample. ·
·.,
.,
•• ATE LABORATORY OF PUBLIC HE ••
' . \
' •, DIYISION OF HEALTH SERVICES
N.C. DEPARTMENT OF HUMAN RESOURCES
P.O.1 BOX 28047 -306 N. WILMINGTON ST., RALEI_GH-27611
INORGANIC CHEMICAL ANALYSES -PUBLIC WATER $YST
Name of
System·
Address:
County: ) ' \ ~ .-K, L.• ,, ... ,v\...._ L,),,_
~c,..,v ... 1?, '<. (:, \J Report To:.
()_
Address:
..
Telephorie Nury,ber: ( I
Collected By:
Date Collected:
Location of Sampling Point:
(Address where sample was collected)
I
-
Time:
, Ei
ZIP
ZIP
Complete All Items Above Heavy Line
(See lhstructions on Reverse Side)
Type of System:
) Community
I ) Non-Community
Source of Water:
I ) · Ground ' I ) Surface
Sour.ce of Sample:
I ) Distribution Tap
' Type of Sample:
( ) Raw
Ty·pe of Treatment:
( ) N_one
( ) Chlorinated
I ) Fluoridated
I ) Filtered AM I ) Alum PM
13 Type of Sample:
I ) Regular
( ) Check
·.-
' ~.
N 25 1983 fa . t
-
I ) Both
I ) Purchased
.( \
) \ House Tap
I ) Well Tap
( ) Treated
( ) Lime
( ) Soda Ash
I ) Polyphosphate
I ) Water Softener
I· ) Other
I I Private
I I Special
Remarks: \_,_, \ """ .. WATER SYSTEM I.D. NUMBER (COPY FROM MAILING LABEL)
~Q □□-□□-□□□
.
State Drinkjng Water Parameters (Required) Optional Parameters (List as needed)
\ -.. '· . Results Results
h ·•• ' ArsE!riiC~.t:t mg/I 2 (' ,o--1) (l..,x C/• TL-
Barium mg/I 2 -z_, ...... ~ /, '-1' '7
Cadmium ✓ .( V• 00$. mg/I 3 77::, (_ /tH. 6,
Chromium ./ G/,/',1--mg/I 2
Fluoride mg/I 2 i
Lead ,./' . n, /{_ mg/I 2 !
·Mercury mg/I 4
Nitrate (as·N) mg/I 2
Selenium ~-mg/I 3
Silver , -/ mg/I 2
pH "r',T units 1
Iron -. mg/I 2 •,• -
Manganese mg/I 2 -
Date Received ____________ Date Reported l/~/(3, -Reported By _________ _
-\., iiG .A. 5.:11.._ )
· Date Analyzed ____________ Laboratory Number ____ r!J_. _·_• _-_· _· _________________ _
OHS Form 2887 7/79
Laboratory
OWNER Mildred A. Kerbaugh
Director
•• INSTRUCTIONS
Using typewriter or ball point pen, fill in all requested information on the top portion of form front. Please print legibly if typewriter is not
available. _ ~ .· _ ,.~,. ~\ .... -:~:--..... ~-
Before takin·g the sample, remove the two "freeze packs" from the styrofoam mailer and place i_n a freezer overnight. (SAMPLES-NOT
PRES~'R_VED BY ICING DU°FJING SHIPMENT WILL NOT BE TESTED.)
I.: ---... ~. ·1 -----
:SAMPLE COLLECTION:
1) ;Renio\ie·the two 1-quart plastic containers and inflate by mouth, if uninflated.
2) Let.the water (to be sin1Pled) run for 5 minutes to assure that the water is from the distribution system.
3) R-iii'se each plastic coritainer two or three times, and discard the water.
4) Atl:etr'i_nsing, fill e•ilCh ,.container to within approximately one inch of top of the sampling container. Then cap the container securely.
Chec·k:...salTlpJ~S ~(See .. Types of Samples below), samples from non-community systems, and special samples may contain only one 1-quart
sanipling container, rather than two. !
SAMPLE SHIPMENT:
1) After collection of the sample(s), replace the two frozen "freeze packs" in the styrofoam mailer.
2) Next, place the two 1-quart samples into the mailer and cap.
3) After capping the Styrofoam mailer, place the report from (UNFOLDED) on top, then seal the cardboard box. Mail immediately to the
State Laboratory using the supplied label. .The sender is required to pay shipping costs.
The analysis takes several days for completion, and the report will be mailed back as soon as possible. Please do not call the laboratory
to request "early" results, unless absolutely necessary:
LIMITS OF ALLOWABLE CONCENTRATIONS FOR DRINKING WATER ARE LISTED BELOW:
Parameters
Arsenic
Barium~
Cadiuhi
Chromium
Fluoride
(Temperature Dependent)
Lead
Mercury
Nitrate (as N)
Sele_nium
.,Silver_
Iron
Manganese
pH
Limits (mg/I)
0.05
1.0
0.010
0.05
1.4-2.4
0.05
0.002
10.0
0.01
0.05
0.3.
0.05
not les_s than 6.5 units
Methods (EPA-600/4-79-020)
AA, furnace technique, pp. 206.2-1 -206.2-2
AA, direct aspiration, pp. 208.1-1 -208.1-2
AA, furnace technique, pp. 213.2-1 -213.2-2
AA, furnace technique, pp. 218.2-1 -218.2-2
Ion Selective Electrode, pp. 340.2-1 -340.2-3
AA, furnace technique, pp. 239.2-1 -239.2-2
Manual Cold Vapor technique, pp. 245. 1;1 --245.1-6
Colorimetric, Brucine, pp. 352, 1-1·-352.1-3·
AA, furnace technique, pp. 270.2-1 -270.2-3
AA. direct aspiration, pp. 272.1-1 -272.1-2
AA, direct aspiration, pp. 236. 1-1 -236.1-2
AA, direct aspiration, pp. 243.1-1 243.1-2
pH Electrometric, pp. 150.1-1 -150.1-3
If sample concentrations are greater than the allowable concentrations, a check sampl~(s) will be required.
TYPES O~ SAMPLES
Regular: A sample($) submitted_ to meet the monitoring requirements of the North ... Car0lina Drinking Water Act, GS 130' -
Article 13D.
Private:
Special'
A sample(s) submitted when a previous s·alTiple has exceeded the allowable co~centration. The check sample should be
taken from the same sample distribution tap as the· previous samplt?.
A sample(s) from a private water supply submitted by a licensed physician, sanitarian or other health department represell-·
ta!ive. ·
' ·-' ' \ \-
A sample(s) submitted by an engineer working with the St"ate or the E.P.A., a sa·m·ple taken by the owner/operator of a
water system for a new well, a landfill test well sample or oih_er non-categorized Sample.· ·
.,"',
,-· STATE LABORATORY-~F ~UBLIC·~-I'
DIVISION OF HEAL TH SERVICES
N.C. DEPARTMENT OF HUMAN·RESOURCES
· P.O. BOX 28047-306 N. WIL.MINGTON ST., RALEIGH 27611
INORGANIC CHEMICAL ANAL:YSES -PUBLIC WATER SYSTEM
Complete All Items Above Heavy Line
(See lhstructio~s on Reverse Side)
Name of /\A;_ CO"',
System: _-LI..:.!. Vl===''cL'---'-------''---~--'---
Type of System:
( ) Community
I ) Non-Community
Address: ----------------------1 Source of Water:
I I Ground ZIP ______ _, ( .'···) Surface·
0 .. ,· ,-1-,-o"' 11. County: _.Q,.L!.d~UJ£.!'~· ,(J.:.::::_ ________ ---''-------l ,.Source of Sample:
I I Distribution Tap
'·
I I Both
( ) Purchased
I I House Tap·
( . I Well Tap ' Report To: _Jr--.._...,,!_!a<!..!_r.),J.._ ,,___!f.2..=a~h!!:,h'..,_' -·-----'-----l
I~ -------------------~-
'Address: ----~-----------------1 Type of Sample:
I •)'.' Raw
.
I I Treated
-----------~ ZIP-------l Type of Treatment: .
Telephone Number: --'("'-~..:.) __ ~ __ -________ _, Lime I I None ( I
( ) Chlorinated , I. )
" Collected By: -------~----..:.·..:.·------'-----l
( ) FluoridaJed ,· " ' . '
( )
Filtered
S'?da Ash
Polyphosphate
Water Softener·
AM Other
Oate Collected: _________ Time: ______ __:.P,.::M"-l------~----~--~------~----
( I ( . )
( I Alum ' ( I ' .
Location of.Sampling· Point: ~· ~~-~ ··~ ~~2· '...''_-1.q __ _,,.:_· __ ·_· __ _J
Type of Sample:
( . I Regular Private
Specia_l (Address where sample was collected) ·
W"' 'I,,_ ; ... ~""'d"~-
"·R.emarks: , · \ , \ __ .. , ., · ·,• ·
~-'-.. ~ .~.... 'l.;.~· ...... 1·...._.i.
1 State·Dfinking.Water Parameters (Required) ,,...... . . ' ,. •,
Arsenic
Barium
Results
.
Cadmium / ~ 0 • v c::C'"·
· Chrorrliµni· ✓ 6. DJ
Fluoride_..\.
,1"• lead / • ✓ -< ?J, 0~
. MerclJry "
Nitrate (as N)
Selenium '
Silvei'. '
pH '-.">, /1
Iron "-, ,, < .
Manganese '",
( )· Check
.WATER SYSTEM I.D. NUMBER (COPY FROM MAILING LABEL)
~---,□□-□□-□□□
, Optional ParameterS (List as needed)
,' Results
mg/I 2 < O,O<.
mg/I 2 0, 3.1..
mg/I 3
mg/I 2 . ,
mg/I 2 \
mg/I 2
mg/I 4
mg/I· 2
mg/I 3
mg/I 2
units 1
·mg/I 2
mg/I 2 ,,
.._,,UHt~!l::,H 1111 lU~.~ -
Date Receiv~d ____________ Date Reported ____ (,.,_1/_~~0,__f_.J ___ Reported By--'-----------·-_·
' .. ' :., -~::149
Da'tfAnalyzed ____________ Laboratory Number---'----"'""--------------------
OHS Form 2887 7/79
Laboratory
SANITARY ENGINEERING Mildred A. Kerbaugh
Director
INSTRUCTIOf'!S•
Using typewriter or ball point pen, fill in ·all· r~quested .information on the top portion of form front, Please print legibly if typewriter is not
available. · ./ r::-1:1@,s jY,.
Before taking the sample, remove the two "freeze packs" from the styiofoam mailer and place in. a freezer overni t. · (S!lf LES ~,1\.,
PRESERVED BY ICING DURING SHIPMENT WILL NOT BE TESTED.) '.:-\
~ ~»I SAMPLE COLLECTION: 0,S
1) Remove the two 1•quart plastic·c6ntainers and in.flate by mbuth, if uni°nfla·ted. ~ j
2) Let the water (to. be sampled) run for 5 'minutes to assure that the water is from the distribution system. "5 c,,(c ..
3) Rinse each plastic container two or three times, and discard the Water. N0"/;/
4) After rinsing, fill each container to within approximately'one inch of top of the sampling container. Then cap the co iner sectfteV.
Check samples (see Types of Samples'below), Samples from non-commuriity systems, and special samples mai/cdrifa:irl bn -qua~t
sampling container, rather than two.
SAMPLE SHIPMENT:
1) After collection of the sample(s), replace the two frozen "freeze Packs" in the styrofoam mailer.
2) Next, place the two 1-quart samples into the mailer and cap.
31 After capping the styrofoam mailer,-place the report from (UNFOLDED) on top, then seal the cardboard box. Mail immediately to the
State Laboratory using-the ·supplied label.· T:he sender is required ~o ~ay sh.ipping cosJs. -~'·.• ~•~ ;"'t 1__.· •• , : •. ~ _ " -"
: T
1
h~ .an~lysis takes, several days f~~ compl~~;~~~ ~nd the report will be mailed back as soon as poss~ie: ,;1\ase d0.'ridfci311 the laboratory,
to request "early" results, unless absolutely necessary. -· · -•-- -· · · -· ·
LIMITS OF ALLOWABLE CONCEN'fRATIONS FOR DRINKING WATER ARE L:ISTED BELOW:
Parameters Limits (mg/I)
l' J
Arsenic·~
·sariulTI •
cadiurri
chromium
FluoriOe .
·(Temperature Dependent) - -
Lead
Mercury.
Nitrate (as NI.
. Selenium ·
,·_;, SilVer:_·, ."
Iron .-
Mang8nese ·
. J --· ' -
0.05 1.6 __
. 0.010 .·
0.05
1.4-2.4
0.05
0.002
10.0
0.0.1.
0.05
0.3 :· · · , ,
0.05
'•
..
,,pH .... :... -----. -~ not less Jhan q.5 units
Methods (EPA 600/4 79 020) · -
• AA, furnace technique,.pp. 206.2-1' -206.2-2
AA, direct aspiration, pp; 208.1-1 -208.1-2
AA, furnace technique, pp. 213.2-1 -213.2-2
AA; furnace technique, pp. 218.2-1 -218.2-2'
Ion Selective Electrode, pp. 340.2-1 -340.2-3
AA, furnace technique, pp. 239.2-1 -239.2-2
,.
... Manual Cold Vapor technique, pp. 245. H --245.1,6'..· •
Colorimetric, Brucine, pp. 352, 1-1 ~ 352.1-3
AA, furnace technique,. pp.,210:2.1 ~·2?0.2-3
AA. direct aspiration, pp. 272.1-1 -272.1-2
AA, direct aspiration, pp. 236. 1-1 -236.1-2
· AA, direct aspiration, pp. 243.1-1 243.1-2
pH Electrometric, pp.0150.1-1 -150.1-3 ,,, .·
If sampl~ concentrations are g~eater than the allowable concentrations, a check sarryple(s) will be requif'ed.
,£ r ; --
l -TYPES OF SAMPLES
. Regular: A-snmple(sl-wbmitted to meet the monitoring .. requirements of the -North Carolina
Article 130. ' .,
-I
Drinking I Water Act, GS 130 -~
' . . . Che.ck:· --A satTlple(Sf-sUbmitte·d Whef'l a Pf6Vious sampfe hilS exceeded· the,allOwabte conceritratioll. iThe check sample should be• -:·-~.
taken frOITI the same·fample distribution ·tap as the preVious, sample.·: •1. · ·· · · , _.: .,.,_. . , .. . • . . .. . . . . .·---• 1 . .. .
·. «:P.tfvate: --~A-sample(s). from·a private"wiifersupplyiubriiitted'oy'alice·n·,,;~phyilcian, sanitiirian-0r:Ottiei;Fieilth departmont represe'n·:~
---tative. _ . . 1 •,-
·specill: -A saniple(s) SUbmitted by an engineer Work-i"ng with the State or,ttie E.P.A., a sampte tak8n4 by-the oWner/operator of a
water system for a·ne-w w'ell, a lan·dfill tl?st well saiTiple or other non-cite:goriied·sampte. _ _ ---J~ .'
·" ,_·;~~-
.• 1'
.•. STATE L~BORATO~:~ ~F· PUBLIC HE-.
DIVISION OF HEAL TH SERVICES
'' ... ·,
N.C. DEPARTMENT OF HUMAN RESOURCES
. P.O. BOX 28047 -306 N . .WI LMINGTOl'J.ST .. RALEIGH 27611
Name of . Mr.~~---System:
.
Address:
(2,, • .1L ·ri .
County: 'r'C . • ~ .r" t:2., a 1Wh Report To: Tl
Address:
Telephone Number: ( )
Collected By: '
.
Date Collected: .
Loca·tion of Sampling Point:
(Address where sample was collected) ,;,,,..-1,~ ,_
Remarks: S..c....l. ,.l· ~·
" . l
'
Complete All Items Above Heavy Line
(See. lhstructio_ns on Reverse Side)
Type of Syste,;,·' ·...-i ::·o _,r
'. ( ) , ~Community ~--,,,,..
(· ) Non-Community
Source of Water: ,· . ( ), . : Ground ( ) Both ZIP ( )· . SurfaCe ( ) Purchased
'
' Sour~e of San:,ple: ' :
( ) Distribution Tap ( I House Tap
' ' ( I Well Tap
Type of Sample:
' ( I Raw . ( I Treated
· ZIP Type of Trea~me'n'i: ' . .
( I None ( I Lime. -. ( I Chlorinated ( I Soda Ash
, ( I Fluoridated ( I Polyphosphate
( I Filtered .. ( } Water Softener AM ( . I Alum ( I Other T.irhe: PM
Type of Sample: 2,. ( I Regular ( I Private
( I Check ( I Special. L:'J··~ WATER SYSTEM·I.D. NUMBER (COPY FROM MAILING LABEL) -·, □□-□□:_□□□ ' .-, . ., .. . ' . .. '.
State Drinking Water Parameters (Required) Optiona1·Parameters ((ist as neede.d)
"'· Results .; ..
'Res~lis ,
Arsenic mg/I 2
Barium mg/I ' . <'. c),C).~ 2 \..._1: (,!.,(;\_ 1... <
Cadmium ....... L ?"· 0~ ·.mg/I 3 ., ,1 i\ .D,n,; .!.... ',-,,:
Chromium ✓ <~, ol mg/I 2 ·-;--o < .. ~ C:
Fluoride mg/I 2 '
-
Lead •/ -<. J).03 mg/I 2
Mercury .. mg/I 4 . . -
Nitrate (as NI mg/I: 2
Selenium mg/I ·3 .
Silver ✓ mg/I 2
pH ~-'J units 1 '
Iron mg/I 2 1 ' Manganese ' ' -mg/I 2 ' ., ! .
,JAN 1 t 1886 141 l?f;:J Date Recei\ied _____ ·_· '----· _·_,.•_·_Date Reported ____ .,__~/_-•~:.._,_ ____ Reported .By ___________ _ I. . .... -..,21->2
Date Analyzed ------~-----Laboratory Number ________ ._.,.;:· __________ ~-------
OHS Form 2887 7/79
Laboratory
SANITARY ENGINEERING Mildred A. Kerbaugh
Director
, ................ ,.. .. .
!"IS LJ,/,~ ., , .
. _ .. , 'i; , . · . ' ·1NSTRUCTIONS
. ,
# ·, ~ •• '. • ' • • , • •
i;·_;_;;..;· -,.i:,: oint pen, fill in all requested inf_orrpation on the top portion of form fro,:i.t. Please print legibly if typewriter is not
ave· the two ,"freeze p~_cks" from the styroJoam m·ailer and place in a·freezer overnight. !SAMPLES NOT
-'-'---l-lN..:G SHIPMENTW_IL_L_NO_T BE TESTED.)
! . ' ·•r, :~ ..
' . ' . • ~ • ), ·: :· J t j
1 lastic containers and inflate by mouth, ifuninflated:
2 led) run for 5 minutes to assure that the water is from the distrib.ution system.
3 er two or three times, and discard the water. .
. 4 ritainer to within app""rOxim'ately One tnch of top of the sampling container. Then cap the contaj"'!~r~securely.,. · ~-..,,-rs; pe_slof Samples below); samples from non-community systems, and spe.cial samples may cOntaili!ohl'{ One 1-quart
sampling container, rather than two. : 7 • n•,' ·
SAMPLE SHIPMENT: , _ .
1) After collection of the sample(s), replace the-two frozen "freeze packs" in the styrofoam inailer.
., -
2).Next, place the two 1-quart samples into the,mailer and cap. ·: -·
3).Afte·r.capping the styrofoam-mailer,.place the report from (UNf,OLDED! on top, then' seal the cardboard,-_box. Mail.im~~diately fo the
S_tate Laborator~ using the supplied label. .:The sender..is.reQuire_d to pay sh!pping ~?sts. 4-::~!',. ;• :}! t•l. .
' ' • I • . . "
The analysis takes1 several days. f~r completion, ~nd th.e report ~ill_ be rTlailed ~ac~ as soon -~s possibl~~~P.lea~;\~o. nO~ ~all•,!he 1aborat~ry
to request '.'early" results, unless absolutely necessary.
• I, Ji(. ·J:..r•,·:
LIMITS OF ALLOWABLE CONCENTRl,\TIONS FOR DRINKING WATER ARE LISTED BELOW:·
Parame'ters
-.
Arse'nic,...
·sariUnl:
CadiuITl·
ChromiJm
Fluoride I
!Temperature Dependent)
Lead
Mercury.
Nitrate las N).
SelefliUrp
Silver .... , . ~ ,..
Iron 1
Manganese' pH. _.,
-•.
f'
Limits lmg/1). , ..
0.05
1.0
0.010 c .. ·
0.05 '.
1.4-2.4 ..
0.05 j .,-..... ,
0.002 ....
10.0
0.01
.•• 0:05
0.3,
0:05 .
n()(l~~s thari 6.5 units•
I -Methods IEPA-600/4 79 020)-'
. _A.;,_furnace technique;pp. 206.2-1-, 206.2,2
AA, direct aspiration, pp. 208.1-1 -208.1-2
AA, furnace technique, pp .. 213.2-1 -213.2-2
• · 'AA, 'furnace technique;-pp: 218:2:1 -218'.2-2 · . ' , Ion Selective Electrode, pp. 340.2-1 -340.2-3
. ·--' .. '~ .. , ~ --. -. -
AA, furnace technique,.pp. 239.2-1 -239.2-2
Manual Cold Vapor.te"chnique, pp. 245.-1-1 --245J'6.
Colorimetric, Brucine, pp. 352, 1-1 -,-352.1-3 • ·
AA, furnace techniqu~ •. PP-2]0,2-1 -_-27,90 ~-3
AA. direct aspiration, pp. 272.1-1 -272.1-2
AA. direct aspiration, pp. 236. 1-1 -236.1-2
AA, direct aspiration. pp. 243.1-1 -243.1-2
-pHEl_e~rometric, .. ~P-)20:J-1. -15_q, 1-} ·• ·
If sample·concentrations are greater than the allowable concentrations, a check sample(s) will be reQuired. dr . .
' '.J
TYPES OF SAMPLES
•
'"
Regular:
·---~
the .. monitoring. requirem~nts· Of the North Carolina Drinking Water Act, GS -130 ·-:-·
·' 1
' '
A sa~ple(s') submitted to meet
Article 13D. .~-"'II , i
Check: A sample(s) subrriitted when ·a previous sample h-as e·xceeded ;~e allowable concentration. ·~he check sa'mple should be
taken from the same sample distribution tap ·as the pr"eviouS sample. ; ·• · · .. -, • · · --. ~
· ·Prtvate:·-A sample(S, :from a p(ivate Water s·Uppty s"ubmitted bY a lii:ensed physician, sanitarian or othef health <1eP4rtl'Tli,rlfrip'rei~fl:-~ :.~.---
tative. ' · ··
Special: A sa·mj:)le(s) Subniitteg by an engineer· Working with_ the State or the E.P.A., a sa~ple ·takeri:·by the oWner/operator-of a
w~ter sys_tem for a· ne~ well, a landfill test Well sarrlple Or othe~ non,-~ate~orized sample. . ·· -· ~·.. ·:.~. . . . . .. -.. . ~ . . -... ---. . . .
'
·, ..:•:.
,.,_,
; N.C. DEPARTMENT OF HUMAN RESOURCES
P.O. BOX 28047 -306 N. WILMINGTON ST., RALEIGH· 27611 . . . ~
Name of M /1 r.;..n ..
System: '
-~· .
Address:
ZIP
County: g i E-h ,,,,..011&
Rabb Report To:. G-aru .
I,\
Address: ,
ZIP .. ·-.
Telephone Number: ( ) ' -. .
-.. .. ' Collected By: ... ---
Tillle: • Date Collected:
(j;. : ttE,. Location of Sampling Point: · . 1,: 1 .
(Address where sample w3s collected)
Remarks: ~-"-..(; . \ ~c:1 c-,,_, ,
-. .) -.
State Drinking Water Parameters (Required)
k,,,A ft,-,_ ; ._ -~··-,, ti'
ReSults r .
; ,;
Arsenic \, .,
BariUi-n
Cadmium· ✓ ,#,de:>.::;::
Chromium ,/ " -<:. b', o/.,
Fluoride
Lead .,,-<6'.c,_j'
Mercury t ~•·S. :·, .. .
Nitrate (as N)
Selenium
Silver
pH /4,, I
Iron .,, : " ,• ..
Manganese '~ ~ ..• , -
,.
,,
-/
.
' AM
PM
.mg/I 2
mg/I 2
-mg/I' 3
. mg/I .. 2
mg/I 2
mg/I 2
··•:mg/I 4
mg/I 2
mg/I 3 . mg/I 2
units 1
·mg/I 2
mg/I, 2
, .
Type of System· -·( ) Community i
( ,.. · Non-Community
Source¥C?lWater:
( I Ground
( I Surface
Source of Sample:
( I Distribution Tap
Type of Sample:
: ( ) · .. 'Raw
Type of Treatmerit:
( )' None
( I Chlorinated ·
( ) Fluoridated
( ) Filtered
( ) Alum
Type of Sample:
( ) Regular
( ) Check
' . . ·• ' ....... . , .. . ......... _;·~·
., •.. ,•
( :)
·( )
( )
. ( ) .
( )
'
( )
( I
( )
( I
( )
,.
( I
( )
. Both.
Purchased
House Tap
Well Tap
Treated
Lime
Soda Ash
Polyphosphate
Water Softener
Other
Private ,
-~pe~ial' ..
WATER SYSTEM 1.D. NUMBER (COPY FROM MAILING LABEL)
□De-DD-□□□
. Optional Parameters (List as needed)
. '
., Results
(_~P"'f1.., t;L(..-t ·· .-:::...OrQO
' 0.//-.:::..-,.,,.._(.
· t0 (_ < r,;:-I
,. . .
, "
.. ,
·-..
"
. --' ,~ '
Date Received -~--J_A_N_-..;:1~f~·-_fu9u8..,J,__Date Reported ____ (,,./~ /,~-,_~~-~----Reported By _________ ,,......_·"-_'..;:, __ ·--, .,. ('' Date. Analyzed ___________ Laboratory Number _______ ,,.'fl ______________ -"---"--
"--~
OHS Form 2887 7/79
Laboratory
SANITARY ENGINEERING Mildred A. Kerbaugh
Director
, INSTRUCTIONS
' • I
n, fill in all r~quested information on the top portion of f9rm front .. Please print legibly if typewriter is not
mailer arfd P,lac~ in a free_zer overnight. (SAMPLES NOT
•.... . ' • • ,;,,-· 1' .. . . . : ; ,, -\ • ·' SAMPLE COLLECTION: . , . ., . • , . ,,.,
1) Remove the 'two 1-quai-t-"plastic containers and inflate by niOuth, if uninflated.
2) Let the water (to be~am·pled) run for 5 minutes to assure that the water is from the distribution system.
3) Rinse each plastic cbntainer two or three ti_mes, and discard the water. ·
4) Afte_r rinsing,,,filhirncti container to within approXimately One inch of top.of the sampling con_tainer. ,:hen cap the container securely .. •
Check samples· (see Types of Samples below), samples from non-community systems,.ar]d-special J_amp_l~s 1)'1ay~:c6ritaJr1 orl)'y one 1:quart
sampling container, rather than two. ·
SAMPLE SHIPMENT:
1) After collection of the sample(s), replace the.two frozen "freeze packs" in ~he styrofoam mailer.
2) Next, place the two 1-quart samples into the mailer ar'ld cap. ·' ·~
· 3) After .capping the styrofoam mailer, place the report from (UNFOLDED) on top, then seal the cardboa(d box,
State Laboratory using the supplied label. The s~nder is required'.t~ P!IY 'shipping ;osts. :;:"\ .~ .. :r Mail immediately to the . ·-. , r ..
The an~lysis takes, several days for ~om~let;~~:•;nd th~ re~ort Will be mailed back as soon as possibleJ._P.1.ea;; do.not!cai.1 ·the laboratory
. _ to request "eafly" results, unless absolutely necessary. · ~. ' ·· •--• ·· · · · ·-"" .. , · \ · .... · · ··· ~
~:.-"f-. > (:\ • I ._,
:,:. .
Parameters
' Ars~,:ijc _.
BariUm
··cadilJm
Chromium
Fluoride !
LIMITS OF ALLOWABLE CONCENTRATIONS,FOR·DRINKING WATER-ARE LISTED BELOW:
Limits (mg/I)
0,05. •',
1,0
· 0.010 c
0.05
1.4-2.4
('
Method;' (EPA-600/4-79-020) · -
. AA, furnace.tecnriique, 'pp,,206.2, 1. -206.2-2 ·,
AA, direct aspiration, pp, 208. 1-1 -208.1-2
AA, furnace technique, pp, 213.2-1 -213,2·2
-AA;fumace technique, pp: 218:2-1 -218,2-2 -·.
(Temperature Dependent)
Lead 0,05
0.002
10,0
9,01
',0,05',;
Ion Selective Electrode, pp, 340.2-1 -340.2-3
' '
AA, furnace technique, pp. 239.2-1 -239.2-2 Mercury, 1 N itratejas N)
__ Sele~iuf!l.
-·., · Silver
Iron
Manganes~ ·
pH .. -
1-' •
0,3 · 7
" 6.05 .
·:;. not less than 6.5 units
. Manual Cold,\/.apor,technique, pp. 245,1-1 -,-;145.,1°6
. Colorimetric, Brucine, pp, 352, 1-1 .,.,352, 1-3 ,
AA, furnace technique, pp, 270.2-1 -270,2-3
AA. direct aspiration, pp. 272. 1-1 -272, 1-2
AA, direct aspiration, pp, 236. 1-1 -236,1-2
AA, direct aspiration, pp, 243, 1-1 ·-243.1-2
.f?.H ElectrnmetriC,;PP,, 150.1_-1, --15.,0, 1,3
. . . -·<.,.<::........ ~-~ ... ~~; ...... If sample concentrations are greater than the allowable concentrations, a check sample(s) will•be required. ; . . ' -...
TYPES OF SAMPLES ·
'I
•''
: • 1
. : . , ..
Regular: A sample(s) submitted to meet. the mo~itoring .requirerhenis'. cit the Nortti Carolina
• ,!!.rti~le 13D, · '· Drinking Water Act, GS 130' -· ·
\
"A sample(s) stibmitt8d when a~ previous· sample has exceeded· the.rallowable concentrati0n.
· taken from the,same s·ample distribution tap as the pre·vious ~ample.-·
' I -• ---• . ifhe check sample should be , ._; #,o. ._ -'
.... i,
. ( . -
~A sample(s1 .from-a p·rhlate~water sUJ)ply si.ibmitted bY a licensed'physician-, sanitarian or-othef.he·a1th08pirtinltriffej)f'esef1:1·~ .,. • .;.
tative. . _ . . • .• _ , · . · ' · · _ · . .. -.-J _ _ _ _ __
1
--:-i~
Special: • ; , .' • • \ . I ' ' •
A sample(s)'-submitted by an engineer working with the State or the E.P.A., a Sa"mp1e takf!n""bV the oWller/oPerator of a ,) •
·water·system for.a ne~ well, a landfill t~st Well sample·or other norl;categorized·sample. -. ~ ·· · · -·.~ .. _"; ...
-.,. -4
t . • .. •.
..... ·---·--.
• -C ~l
• STATE LABOR~TORY OF PUBLIC HE-
DIVISION OF HEAL TH SERVICES
N.C. DEPARTMENT OF HUMAN RESOURCES
P.O. BOX 28047 -306 N. WILMINGTON ST., RALEIGH 27611 , .
INORGANIC CHEMICAL ANALYSES -PUBLIC WATER SYST
Complete All Items Above Heavy Line
(See Instructions on Reverse Side)
Name of AA.
System: -'"-'-C...~'--'-"""------------------,
Type of System:
( ) Community
( ) Non-Community
Address: -----------------~----1 Source of Water:
( ) Ground ______________ ZIP ______ _,
( ) Surface
C \2-:cL-s\. ounty: -------~--------------< Source of Sample:
G c.__,... " D c,_\,,YJ ( • ) Distribution Tap
Both I
, Purchased)
\
House Tap
Well Tap
'
Report To:.--=...,_ ,_-,,.,-...:0=-'--------------1 u ---------------------~
Address: ----------------------< Type of Sample:
· ( ) Raw ( ) Treated
------------ZIP-------! Type of Treatment:
Telephone Number: _( ___ ) _____ -________ -! ( ) None
( ) -Chlorinated
( ) Lime
( ) Soda Ash
( ) Fluoridated. ( ) Polyphosphate
Collected By: --------------------l Water Softener ( ) Filtered
AM ( ) Alum
Date,Coii°ected: _________ Time: -------'-P'-'M'-1------------------
( )
( ) Other
::; · :;,!t;;::~lt<'.. ~-... ·
t:OcatiOn O(Sampling Point: • .,. ''fo/✓-1,'"<""·' ~ _(Address _where sample was coll_ected)
2--
Remarks: ·
State Drinking Water Parameters (Required)
AesultS
Arsenic
Barium
Cadmium
Chromium
Fluoride
Lead
Mercury
Nitrate (as N)
Selenium
Silver
pH
Iron
Manganese
mg/I
mg/I
·mg/I
mg/I
mg/I
mg/I
mg/I
mg/I
mg/I
mg/I
units
mg/I
mg/I
Type of Sample:
( ) Regular ( ) Private
( ) Check ( ) Special
WATER SYSTEM 1.D. NUMBER (COPY FROM MAILING LABEL)
□□-□□-□□□
Optional Parameters {List as needed)
Results
2
2
3 o,os-
2 ,oc ,c s
2
2
4
2
3
2
1
2
2
~:-· . ·-. ~J11 1983 . / / / 0 J::..J Date Received ____________ Date Reported----~!./.+/ __ •cJL+-----Reported By ___________ _ I ...... ., v21a2
Date Analyzed ____________ · Laboratory Number--------"'------------------
OHS Form 2887 7/79
Laboratory
OWNER
__ ,
Mildred A. Kerbaugh
Director
• INSTRUCTIONS
Using typewriter or ball point pen, fill in all requested information on the top portion of form front: Please print legibly if typewriter is not
available. '
Before taking· the 'sa·ITlple, ... remove the two "freeze packs" from the Styrofoam mailer and place in a freezer overnight. (SAMPLES NOT
PRESERVED BY ICING.bLJ.FllNG. SHIPMENT WILL NOT BE TESTED.)
SAMP~E COLLECTIO~·;,"\ .
1) Remove the two 1 ;quart plastic containers and inflate by mouth, if uninflated.
2) Let ~the·'Waier· (tb o·e1Samp1_ed) run for 5 minutes to assure that the water is from the distribution system.
3) Ri~Se'each plastic contai'nii two or three times, and discard the water.
4) Aftetrlnsing, fill each-co"ri"iainer to within approXimately one inch of top of the sampling container. Then cap the container securely.
Ched~ .S8inples _(see~f.\f}p~s of Samples below), samples from non•community systems·, and special samples may contain only one 1-quart
samplinQ'cO'°Rt~\[l~~ .• raiher than two. . ·
SAMPLE SHIPMENT:
1) After collection of the sample(s), replace the two frozen "freeze packs" in the styrofoam mailer.
2) Next, place the two 1-quart samples into the maiJer and cap. .
3) Afte·r capping the Styrofoam mailer, place the report from (UNFOLDED) on top, then seal the cardboard box. Mail immediately to the
State Laboratory using the supplied label. The sender is required to pay shipping C:_OSts.
The analysis takes several days for completion, and the report w_ill be mailed back as soon as possible. P~ea~e_ do not call the laboratory
.to request "early" results, unless absolutely necessary. · · ·
LIMITS OF ALLOWABLE CONCENTRATIONS FOR DRINKING WATER ARE LISTED BELOW:
Parameters
Arsenic
·BariurTI
Cadiu'rn
Chromit.im
Fluoride
(Temperature Dependent)
Lead
Mercury
Nitrate (as N)
Selenium
, Silver
Iron
Manganese ·
pH
Limits (mg/I)
0.05
1.0
0.010
0.05
1.4-2.4
0.05
0.002
10.0
0.01
0.05 0.3 ._
0.05
not less than 6:S units
Methods (EPA-600/4-79-020)
AA, furnace technique, pp. 206.2-1 -206.2-2
AA, direct aspiration, pp. 208. 1-1 -208.1-2
AA, furnace technique, pp. 213.2-1 -213.2-2
·AA, furnace technique, pp. 218.2-1.:. 218.2-2
Ion Selective Electrode, pp. 340.2-1 -340.2-3
AA, furnace technique, pp. 239.2-1 -239.2-2
Manual Cold Vapor.technique, pp. 245.1-1 -, 245.1-6
Colorimetric, Brucine, pp. 352, 1-1 -352.1-3
AA, furnace technique, pp. 270.2-1 -270.2-3
AA. direct aspiration, pp. 272. 1-1 -272.1-2
AA, direct aspiration, pp. 236. 1-1 -236.1-2
AA, direct aspiration, pp. 243.1-1 -243.1-2
pH Electrometric, pp. 150.1-1 -150.1-3
If sample concentrations are greater than the allowable concentrations, a check sample(s) will be required. ' . ' . ' '
Regular:
Private:
Special:
· TYPES O_F SAMPLES
A sample ... {~) submitted to meet the monitoring requirerr1fnts of the North' C~rolilla Drinking Water Act, GS 130 -
Article 13D.
A Sample(s) submitted when a previous sample has exceeded the allowable conce"ntration. The check sample should be
taken from the same sample distribution ·tap as the previous ~ample ..
A sample(s) from a private water supply submitted by a lic~~ed physician, sanitarian or other health department represen-.·
tative_.. _ .
\ ~;:
A s"ample(s) submitted by an en'gineer· working with the Sta~e or the E.P.A., a sa,;,ple ta'ken by the owner/operator o(a
water system for a new well, a landfill"test well sample or other non-categorized sam·pte:
, .
i...
• I
• •: "-' ., • ,-:.;, "\ ,,. {·, •: l
'
.: STATE LABORATOFlY OF P~BLIC HE.
DIVISION OF HiiALTH SERVICES
.N.C. DEPARTM_ENT OF HUMAN RESOURCES ... -,
P.O. BOX 28047-306 N. WILMINGTON ST .• RALEI_GH 27611 !
INORGANIC CHEMICAL ANALYSES -PUBLIC WATER SYSTEM -· .. S)OBYe. .t,j'" Complete All Items Above Heavy Line ---(See Instructions on Reverse Side) ...
··• & ' 'ti 1~ r~ ~
Type of System: 191983 ia Name of ~0-.'-
i:e JAN ...
( . I Community ';,: ilt System: G"-... ~ ··•~-.. ( . ,,. Non-Community , . .§IJ
Address: Source··of Water: ~WAs1E~~~
( I Ground I I Both ZIP ( I Surface ( ) Purchased ~-.~
('.2__ I ,.J~D"\, cl CoUnty: Source of Sample:
' ( I Distribution Tap ( ) House Tap G o.,., .. ,6 c.\\ Report To: ( ) Well Tap
(\ •
Address: Type of Sample:
( ) Raw ( ) Treated
\
ZIP Type of Treatment: ..
I ( ) None ( I Lime
Telephone Number: ( -( ) Chlorinated· ( ) Soda Ash
( I Fluoridated ( ) Polyphosphate. Collected By: ( ) Filtered ( ) Water Softener AM ( ) Alum ( ) Other
Date Collected: Time: PM
(.,, Type of Sample:
Location of Sampling Point: ( ) Regular ( ) Private
(Address where sample w3S collected). ( ) Check ( ) Special
Remarks: . \;,.(I~ WATER SYSTEM 1.D. NUMBER (COPY FROM MAILING LABEL)
::ut.Q □□-□□-□□□
State Drinking Water Parameters (Required) Optional Parameters (List as needed)
~ Results ~\ . Results
Arsenic ~ mg/I 2 (',~ . ..,.. ,<o ,...oo
Barium mg/I 2 -z._;'""(. \J =·/&
Cadmium ✓--<.. p,dd:>~ mg/I 3 \Uc_ --<,.__ I
Chromium v ..c ,.._,_ ol mg/I 2
Fluoride mg/I 2
Lead v -<..d?.c:;J mg/I 2
Mercury mg/I 4
Nitrate (as N) mg/I 2
Selenium mg/I 3
Silver mg/I 2 .. , . .. ,,_....._.._..~,-.
pH /,.,' '/ units 1 -
Iron '. mg/I . 2
Mannanese mg/I. 2
, :,I_ANc11 l~Gii /l'vl£3
Date Received ____________ Date Reported---~,/_,_ /4~'-,'----. __ Reported By ___________ _
.., ~.2ia0
Date Analyzed ___________ Laboratory Number ______ __;<>;::.· __________________ _
OHS Form 2887 7/79
Laboratory
C
OWNER Mildred A. Kerbaugh
Director
INSTRUCTIONS
Using typewriter or ball point pen, fill in all requested information on the top portion of.form front. Please print legibly if typewriter is not
available. ·
Before taking the sample, remove the two "freeze _packs" from the st','rofoam mailer and place in a tre·ezer overnight. (SAMPLES NOT
PRESERVED BY ICING DURING SHIPMENT WILL NOT BE TESTED.)
SAMPLE COLLECTION:.
1) Remove the two 1-quart Plastic containers and inflate by mouth, 'it uriiriflated.
2) Let.the water (to be sampled) run for 5 minutes to assure that the water is from the distribution system.
3) Rinse each plastic container two or three times, and discard the water.
4) After, rinsing, fill each,container to within approximately one inch of top of the sampling container. Then cap the container securely.
Check'Samples (see Types of Samples below), samples fr()ri, non-community systems, and specia_l samples may contain only one 1-quart
sampliriQ ~~ntainer, rather tlian two.
• . •I;.
SAMPLE SHIPMENT:
1) After collectiorl·of the sample(s), replace the two frozen "freeze packs" in the styrofoam mailer.
2) Next, place the two 1-quart samples into the mailer and cap.
· 3) After capping the styrofoam mailer, place the report from (UNFOLDED) on top, then seal the cardboard box. Mail immediately to the
State Laboratory u.sing the supplied label. The sender is required to pay shipping cost~.
The analysis takes several days for completion, and the report will be mailed back as soon as possible. Ple~se do not call the laboratory,
to request "early" results, unless absolutely necessary. · · ·
LIMITS OF ALLOWABLE CONCENTRATIONS FOR DRINKING WATER ARE LISTED BELOW:
Parameters
Arsenic
Barium
Cadium
Chromium
Fluoride
(Temperature Dependent)
Lead
Mercury
Nitrate (as N)
Self!rliUm
,., Silver
Iron
Manganese
pH
Limits (mg/I)
0.05.
1.0 .
0.010
0.05
1.4-2.4
0.05
0.002
10.0
0.01
0.05
0.3
0.05
'·
not les~ thar:i· 6.5 units
Methods (EPA '600/4 79 020)
AA, furnace technique, pp. 206.2-.1 -206.2-2
AA, direct aspiration, pp. 208.1-1 -208.1-2
AA, furnace technique, pp. 213.2-1 -213.2-2
AA, furnace technique, pp. 218.2-1 -218.2-2
Ion Selective Electrode, pp. 340.2-1 -340.2-3
AA, furnace technique, pp. 239.2-1 -239.2-2
Manual Cold Vapor technique, pp. 245.1-1 --,245.1-6
Colorimetric, Brucine, pp. 352,1-1 -352.1-3
AA, furnace technique, pp. 270.2-1 -270.2-3
AA. direct aspiration, pp. 272.1-1 -272.1-2
AA, direct aspiration, pp. 236. 1-1 -236.1-2
AA, direct aspiration, pp. 243.1-1 243.1-2
pH Electrometric, pp. 150.1-1 -150.1-3
If sample concentrations are greater than the allowable concentrations, a check sampl_e,(s) will be required.
TYPES OF SAMPLES
,. .
Regular: A sample(s) submitted to meet the monitoring requirements of the North' Carolina· Drinking Water Act, GS -130 -
Article 13D.
Private:
·Special:
A sample(s) submitted when a previous sample has exceeded thE! allowable Concentration. The check sample should be_
taken from the same sample distribution tap as the previous sample.
I •• •
A sample(s) from a private water supply submitted by a licensed physician, sanitarian or other.health department represen-
tative. · ' -' :-.,
A sample(s) sllbmitted py an engineer working with the State or the E.P.A., a 'sample taken. by the owner/opefato-r of a
water system'for a new well, ·a landfill test·well sample or other non-categorized sample.
•
'\ .. /. ~·
-a' .•
·<~TATE LABORATO;Y OF PUBLIC HE.
\ DIVISIO,N OF HEAL TH SERVICES
·N.C .. DEPARTMENT OF HUMAN RESOURCES
P.O. BOX-2B047 -306 N. WiLMINGTON ST., RALEIGH 27_611
INORGANIC CHEMICAL ANALYSES -PUBLIC WATER SY
Name of s ystem:,
Address:
.,
, .... -··
.
County: µ__ ; <-L L ,,,._ i
Ci C'-.A'-\ ~ cJ,\,,. Report To: a
Address:
Telephone Number: ( I
Collected By:
Date Collected:
Location 'of Sampling Point:
(Address where sample was collected)
ZIP
ZIP
-
Time:,
-~ 8,
Complete All Items Above Heavy Line
(See Instructions on Reve_rse Side)
Type of System:
• ( ) Community
( ) Non-Community
' Source of Water:
( ) Ground -· ( ) . -Surta:Ce
Source of Sample:
( ) Distribution Tap
Type of Sample:
( ) Raw
Type of Treatmf!nti
( ) None
·-. ( . ) Chlorinated
( ) Fluoridated
( ) Filtered AM . ( ) Alum PM
' Type of Sample: ...
( ) Regular
( ) Check
: ....
...._ ·-
JAN 19
WASTE \Ii
( ) , Both
( ) Purchased
( i House Tap
( ) Well Tap
( ) Treated
( ) Lime
( ) Soda Ash
( ) Polyphosphate
( ) Water Softener
( ) Other
( ) Private'
( ) Special
Remarks: h.. \ '"'-' WATER SYSTEM LD. NUMBER (COPY FROM MAILING LABEL)
$.J,,-0 □□-□□-□□□
State Drinking Water Parameters (Required) Optional Parameters (List as needed)
..
A esults ,,,·. Results
•'·
Arsenic mg/I 7' "½;) (L:,,,. ..,: -LC) /Jo 2
Barium mg/I 2 "-; ~\\. \le._ // O,oQ
Cadmium ,/ L'.6/. oe:i~ mg/I 3 -.--u <... /,f ~-? -'i
Chromium .,,,.. LO,ol mg/I /J .
' 2
Fluoride -mg/I 2 ./
Lead ' /. --;;;; d?, d?. mg/I 2
Mercury \. mg/I 4
Nitrate (as N) ' ,._ mg/I 2
Selenium mg/I. 3
Silver ' mg/I 2
pH -z; ',.:. units 1
Iron .. mg/I 2
Manganese \ -mg/I 2
.t.•_A .-.'''". rr11 ·, 1983 / /J ,ff O :, Date Received ___ _::,,:rt=n'-"' . .,_,_'--'=c::..-Date Reported -------'+l-/.+f-',7'+-'.r:..:: • .J:._ ___ Reported By ___________ _
Date Analyzed~~-~~----'--~-Laboratory Number -----=-~~•~·~-";c;=·:.:1.=· ;;.:4=8"------------~---
}
OHS Form 2887 7/79
Laboratory
OWNER Mildred A. Kerbaugh
Director
• INSTRUCTIONS
Using typewriter or ball point pen, fill in all requested information-on the top portion of tafm front. Please print legibly if typewriter is not .
available. '
Before taking d·i'e silmple, remove the twO "freeze packs" from the' styrofoam mailer and place in a freezer overnight. (SAMPLES NOT
PRESERVED BY ICING DURING SHIPMENT WILL NOT BE TESTED.)
....
SAMPLE COLLECTION:
1) Remove the two 1-quart plilstic containers and inflate by mouth, if uninflated.
2) Let _the water (to be sample"d) run for 5 minutes to assure that the water is from the distribution system.
3) Rinsee"ach plastic container.two or three times, and.discard the water.
4) After riilsing, fill each~cbnt'ainer to within approximately one inch of top of the sampling container. Then cap the container securely.
Check Saf'n·Q1es:(s_e·ef;rypeS of Samples below),-samples frorrr non-community systems, and special samples may contain only one 1-tjuart
sampling coi:iritainer; rather than two. .
SAMPLE SHIPMENT:
1) After collection of the sample(s). replace the two frozen "freeze packs" in the styrofoam mailer.
2) Next, place the two 1-quart samples into the mailer and cap.
3) After capping the styrofoam mailer, place the report from (UNFOLDED) on top, then seal the cardboard box. Mail immediately to the
State Laboratory using the supplied label. The sender is required to pay shipping costs.
The analysis takes several days for completion, and the report will be mailed back as soon as possible. Please do not call the laboratory
to request "early" results, unless absolutely necessary. ·
LIMITS OF ALLOWABLE CONCENTRATIONS FOR DRINKING WATER ARE LISTED BELOW:
Parameters
Arsenic
Barium
Cadium
Chromium
Fluoridf
(Temperature Dependent)
Lead
Mercury·
Nitrate (as N)
Selenium
Silver:.
Iron
Manganese
pH
Limits (mg/I)
0.05
1.0
0.010
0.05
1.4-2.4
0.05
0.002
10.0
0.01
0.05
0.3
0.05
nof 1ess than ·5_5 units
Methods (EPA 600/4 79 020)
AA, furnace technique, pp. 206.2-1 -206.2-2
AA, di reel aspiration, pp. 20B. 1-1 -208.1-2 ·
AA, furnace technique, pp. 213.2-1 -213.2-2
AA, furnace technique, pp: 218.2-1 -218.2-2
Ion Selective Electrode, pp. 340.2-1 -340.2-3
AA, furnace technique, pp. 239.2-1 -239.2-2
Manual Cold Vapor technique, pp. 245.1-1 --245.1-6 .
Colorimetric, Brucine, pp. 352, 1-1 -352.1-3
AA, furnace technique, pp. 270.2-1 -270.2-3
AA. direct aspiration, pp. 272.1-1 -272.1-2
AA, direct aspiration, pp. 236. 1-1 -236.1-2
AA, direct aspiration, pp. 243.1-1 243.i-2
pH Electrometric, pp. 150. 1-1 __ -150. 1-3
If sample concentrations are greater than the allowable concentrations, a check sample(s) will_be required.
TYPES OF SAMPLES
Regular: A sample(s) • submitted to meet the monitoring requirements of the North' Carolin'•-Drin~ing Water Act, GS-130' -
Article 13D.
Private:
Special:
A sample(s) SUbmitted when a ·prfvious sample has exceided 1he ~llowable concent.ra;ion. Jhe check sample should be.
taken from the·same sample distribution tap as the previous sam·p1e .. ~ · · · -
A sample(s) from a private water supply. submitted. by a licenSed physician, sanitarian or other health department repres!!n-
tative.
• -~~•I~
A sampJe(s) ·submitted by an eiigineei working with the Sta~e or the E.P.A., a sample taken by the ow-ner/opera~tor of a
water system for a new well, a landfill test well sample or·other;non-Categorized sample.
l ·• "I
I \ ' i' ·,' \.
-STATE LABOR~TORY OF P~BLIC H.
DIVISION OF HEALTH SERVICES
N.C. DEPARTMENT OF HUMAN RESOURCES
P.O. BOX 2B047 -306 N. WILMINGTON ST'., RALEIGH 27611 : ·v . .
INORGANIC CH~M~CAL AN~L YSES -PUBLIC WATER svsi~CEIVeo ~
Complete All Items Above Heavy Line 1'f!! ~
if (See lhstructions on Reverse Side) f<::i §
f ,~ JAN 191983 .... . ~ ~ i-:! -~-
Name of Type of System: '11 /\/\ °''-L-h ( ) · Community <9d'c, . ~-System: ( ), ' Non-Community ;i-WAS'll: \t>~~
Address: Source of Water: ,
( ) Ground ( ) Both
ZIP ( ) Surface ( ) Purchased
County: \~ ; c_ \, v1,,_'c.,-..,. ¢\ Source. of Sample: '
('.:, o,..,,r " b,J:,~ ( ) Distribution Tap ( ) House Tap
Report To: ( ) ,Well Tap
' a Type of Sample: .'
Address: ( ) Raw ( ) Treated
.f
ZIP Type of Treatme·nt: ·
( ) ( ) None ( ) Lime
Telephone Number: -( ) Chlorinated ( ) Soda Ash·
( ) Fluoridated ( ) Polyphosphate
Collected By: ( ) Filtered ( ) Water Softener AM ( ) Alum ( ) Other
Date Collected: Time: PM
Type of Sample: '
Locationrof Sampling Point: A /2 ( ) Regular ( ) Private
(Address where sample was collected) ( ) Check ( ) Special
Remarks: b_Q \~ WATER SYSTEM 1.0. NUMBER (COPY FROM MAILING LABEL)
-:S.= ' □□~□□-□□[:] ..
State Drinking Water ParametersJRequired) OPtional Parameters (List a~ needed) ..
¥~,,. ,...,.
""',i~ ·~"'' .
· >Results ..•. Results ,· .,
Arsenic .. mg/I 2 \ ' ' ,..., '"' ,. ,-/ ./ o,OS-
Barium mg/I 2 2-,~L _., .,,.., . ~ ~ , .
Cadmium .,.... -< ,:9, 0 c:,::;-mg/I 3 --i--i::.c... /£,. -:1
Chromium v -"', •(!? .·01 mg/I 2
Fluoride mg/I 2
Lead / "'\t?.oJ mg/I 2
Mercury mg/I 4
Nitrate (as N) mg/I 2
Selenium mg/I 3 '. Silver mg/I 2 ' pH v• I units 1
Iron mg/I 2
Manganese mg/I 2
JAN :11 1983 / l;z ,f..3 Date Received ____________ Date Reported ___ .,./_~ !.·_,~t,------Reported By---------'------~ . ' "':1,
.,_,,._,..t..'::aO .Date Analyzed ___________ Laboratory Number---------''-'--------------------
OHS Form 2887 7/79
Laboratory
OWNER Mildred A. Kerbaugh Director
• INSTRUCTIONS
Using typewriter or ball point pen, fill in all requested information on the top portion of form front. Please print legibly if typewriter is not
available.
Before taking the sample, remove the two "freeze packs" from the styrofoam mailer and place in a frefzer overnight. (SAMPLES NOT
PRESERVED BY ICING DURING SHIPMENT WILL NOT BE TESTED.)
SAMPLE COLLECTION:
1) Remove the two 1-quart plastic c6ntainers and inflate by mouth, if uninflated.
2) Let the wate·r (to be sampled) run for 5 'minutes to assure that the water is from the distribution. system.
3) Rinse each plastic container two or three times, and discard the water.
4) After·rinsing, fill each container to within approximately one inch of top of the sampling container. Then cap the container securely ..
Check s.imples _(see Types of Samples below), samples from non-community systems, and special samples may contain only one 1-quart
sampling container, rather than two.
SAMPLE SHIPMENT:
1) After collection of the sample(s), replace the two frozen "freeze p8cks" in the styrofoam mailer.
2) Next, place the two 1-quart samples into the mailer and cap.
31 After capping the styrofoam mailer, place the report from (UNFOLDED) on top, then seal the cardboard box. Mail immediately to the
State Laborato_ry using the supplied l?bel. The sender is required to pay shipping costs.
The analysis takes several days for completion, and the report will be mailed back as soon as possible. _Please d9 not cal_l the laboratory
to request "early" results, unless absolutely necessary.
LIMITS OF ALLOWABLE CONCENTRATIONS FOR DRINKING WATER ARE LISTED BELOW:.
Parameters
Arsenic
Barium
Cadium
Chromium
Fluoride
(Temperature Dependent)
lead
Mercury
Nitrate (as NI
Selenium
Silver
Iron
Manganese
pH
Limits (mg/I)
0.05
1.0
0.010
0.05
1.4-2.4
0.05
0.002
10.0
0.01
0.05
0.3
, 0.05
riot less th_an-6~5 units
Methods (EPA~600/4-79-020)
AA, furnace technique, pp. 206.2-1 -206.2-2
AA, direct aspiration, pp. 208.1-1 -20B.1-2
AA, furnace technique, pp. 213.2-1 -213.2-2
AA, furnace technique, pp. 218.2-1 -218.2-2
Ion Selective Electro9e, pp, 340.2-1 -340.2-3
AA, furnace technique,.pp. 239.2-1 -239.2-2
Manual Cold Vapor technique, pp, 245.1-1 --245.1-6
Colorimetric, Brucine, pp. 352, 1· 1.-352.1-3 .,
AA, furnace technique, pp. 270.2-1 -270.2-3
AA. direct aspiration, pp, 272.1-1 -272.1-2
AA, direct aspiration, pp. 236. 1-1 -236.1-2
AA, direct aspiration. pp. 243.1-1 243.1-2
_pH Electrometric, pp. 150.1-1 ~ 150.1-3
If sample concentrations are greater than the allowable concentrations, a check sample(s) will be required.
Regular:
. Check:
TYPES OF SAMPLES
A sample(s) submitted to meet the monitoring requirements. of the North 1
• caiolina · Drinking Water Act, GS 130 :._'' ·
Article 13D.
A samPle(s) submitted when a previous sample has -exceeded the allowable concentration. Th~e check sample should be 1
taken from the same sample distribUtion tap as the previous sample. , 1
,.
Private: A sample(s) from a private -water supply submitte~ by a lic;nsed-Physician, sanitarian or othe/ ~ealth department represe~·-·· ~ ·
tative. . ' Sp~cia1: A sample(s)--submitted by an.engineer working with the-State Or the E.P.A., a sample taken· by th~ owner/op~rator of a .... •
water system for a new well, a landfill test well sample or other non-categorized s·ample. ·
1· -.
• ST~TE LABO~A~ORY OF PUBLIC HE. s
. DIVISION OF HEAL TH SERVICES !'':
,
N.C. DEPARTMENT OF HUMAN RESOURCES/
P.O. BOX 28047 -306 N. Y._'IILMINGTON ST:, RALEIGfj 27611
• : . 1'1iCeTVe-0
INORGANIC CHEMICAL ANALYSES -PUBLIC WATER SYST M ,t• I,-...,,• . !i$
Name of
System: '
Address:
ZIP
County: ~ i' c \, i\,C-:~\
Gcvr~. 1S,\.b \, Report To: ()
Address:
.
ZIP -
Telephone Number: ( ) --
Collected By: .
Date Collected: Time:
Location of Sampling Point: ' I I
(Address where sample was collected) ' I
Complete All Items Above Heavy Line ,,,. 19 198
(See Instructions on Reverse Side) ',~ JAN . ii!/
Type of System:
Community
( ) Non-Community
Source of Water:
( ) Ground
( ) Surface
Source of Sample:
; I ) Distribution Tap
. .. Type of Sample:
I ) Raw
Type of Treatment:
I ) , I None
I 'i Chlorinated
-I ) Fluoridated
I ) Filtered ..
AM I ) Alum PM
Type of Sample:
I ) Regular
; ( ) Check
~ -~ ~"°' ~ ;s-WASTI: ~'I-~ ,_ ~
( ) Both
( ) Purchased
I ) House Tap
I ) Well Tap
I ) Treated
( ) Lime
I ) Soda Ash
I ) Polyphosphate
I ) Water Softener
I ) Other
I ) Private
I ) Special
• C
Remarks: k\~ WATER SYSTEM LD. NUMBER (COPY FROM MAILING LABEL)
$JZ,e.. □□-□□-□□□ I .. v .. ~ j ,• -..
State Drinking.Water Parameters (Required) ,;,}/ Optional Parameters (List as needed)
I \ii ;i,.i
Results ll) l~ .. ,, _,, Results
Arsenic mg/I· 2 L=<JA<i ~ .-::::: /} ,o,-
Barium mg/I ~ z,~"'-/ _J, ' ~
Cadmium _/ ,<:;. £}, c) o.::-mg/I 3 I D<-~ :.L .
Chromium ✓ ,.t: . .1.9. c.3i i mg/I 2 -
Fluoride ' mg/I 2
Lead ✓ ~ZJ. D.3 ' mg,(L~ '.2
Mercury :ri:ig/1 4' :
Nitrate (as N) .m§I!" "'2 ' .
Selenium mg/I'-3 ·: .w --.
Silver , ' ·-mg/I '2 ' l
pH ,; ---:75. ? units 1 , ;
. Iron / . mg/I 2
Manganese . -~ . mg/I 2 J
•
\l'M.t't . l lj l!Jll\1, .
· Date Received -----------~Date Reported ____ .J(/JC.L_J/,,L-:f:_'J __ :__ Reported By ________ •--~--·_-_____ _
"1
_,;c:;1~·,
Date Analyzed----------~-Laboratory Number _________________________ _
OHS Form 2887 7/79
Laboratory
OWNER Mildred A. Kerbaugh
Director
• INSTRUCTIONS
Using typewriter or ball point pen, fill in all requested information on the top portion of form front: Please print legibly if typewriter is not
available. ·
Before taking the sample, remove the two "freeze packs" from the styrofoam mailer and place .in a free.zer overnight. (SAMPLES NOT
PRESERVED BY ICING DURING SHIPMENT WILL NOT BE TESTED.)
SAMPLE COLLECTION:
1) Remove the two 1-quart·plastic containers and inflate by mouth, if uninflated.
2) Let the water (to be sampled) run for 5 minutes to assure that the water is from the distribution system.
3) Rinse each plastic container two or three times, and discard the water.
4) Aftef rinsing; fill eaC:h container to within approximately one inch of top of the sampling container. Then cap the container securely ..
Check saTTiples (see Types of Samples below), samples from non-community systems,.and special samples may contain only one 1-quart
sampling container, rather than two:
SAMPLE SHIPMENT:
1) After collection of the sample(s), replace the two frozen "freeze packs" in the styrofoam mailer.
2) Next, place the two 1-quart samples into the mailer and cap.
3) After capping the Styrofoam mailer, place the report from (UNFOLDED) on top, then seal the cardboard box. Mail immediately to the
State Laboratory using the supplied label.-The sender is required to pay shipping costs.
The analysis takes several days for completion, and the report will be mailed back as soon as possible. Pl~ase do not.call the laboratory
to request "early" results, unless absolutely necessary.
LIMITS OF ALLOWABLE CONCENTRATIONS FOR DRINKING WATER ARE LISTED BELOW:
Parameters
Arsenic
Barium
Cadium
·Chroinium
Fluoride
(Temperature Dependent)
Lead
Mercury
Nitrate (as NI
Selenium
Silver
Iron ·
Manganese
pH
Limits (mg/I)
0.05
1.0
0.010
0.05
1.4-2.4
0.05
0.002
10.0
. 0.01.
0.05
0.3 ·
0.05
not less than 6.5 unit$
Methods (EPA-600/4-79-020)
AA, furnace technique, pp. 206.2-1 -206.2-2
AA, direct aspiration, pp. 208.1-1 -208.1-2
AA, furnace technique, pp. 213.2-1 -213.2-2
AA, furnace technique, pp. 218.2-1 -218.2-2
Ion Selective Electrode, pp. 340.2-1 -340.2-3
AA, furnace technique, pp. 239.2-1 -239.2-2
Manual Cold Vapor technique, pp. 245.1-1 -245.1-6
Colorimetric, Brucine, pp. 352, 1-1 -352.1-3
AA, furnace technique, pp. 270.2-1 -270.2-3
AA. direct aspiration, pp. 272.1-1 -272.1-2
AA, direct aspiration, pp. 236. 1-1 -236.1-2
AA, direct aspiration, pp. 243.1-1 243. 1-2
pH Electrometric, pp. 150.1-1 -150.1-3
If sample concentrations are greater than the allowable concentrations, a check sample(s) will be required.
Regular:
Private:
Special:
TYPES OF SAMPLES
A sample(s) submitted to meet the monitoring r~quirements o·f the North Carolina· Drinking Water Act, GS 130 -
Article 130. · '
A sample(s) Submitted when a previous sample has exceeded the allowable concentration. The check sample shoLild be
taken from the same sample distribution tap as the previous sample .
•
A sample(s) from a private water supply submitted by a liCensed physician, sanitarian or other health department represen-
tative. · ·
\.; .. (.:.,
A sample(s) submitted by an engineer working with the State or the E.P.A., a sa~ple taken by the owner/operator of a
water system for a new well, a landfill test well sample or other non~categorized sample.
'', '.
\
-
'
. ! • . . • .>r \-· •• P. ~I::-.,~ r • -.~ .. -r :~:-~;'--;-:> .
ST~TE t:AB'ORATORY OF PUBLIC HE ,? ·. . ..,.-:, '\
DIVISION OF HEALTH SERVICES if -. ·: :\ •.
N.C. DEPARTMENT OF HUMAN RESOURCES 'f '•:~ ·. ·"~: .. \
....J P.O. BOX 28047 -306 N.,WI LMINGTON ST., RALEIGH 27611 r· /' ;j ... " .\-t
INORGANIC C~EMICAL ANALYSES.-:-PUBLIC WATER svs\iii.ti;: -~ ··:. ·:;'.:::· J~Y . ,~~iJ· . ,·
,. ~---"'' Complete All Items Above Heavy Line•
(See l~structions on Reverse Side)
Type of System:
ystem: -• .
.( ) Non-Community ·,
( ) Coni,;;unity
Address: Source of Water: .
( ) Ground -· ( ) Both ZIP . ( ) ·. Surta~c·e ( ) · Purchased·
ti..; ch,.,, I)..," ..
County: Source· of Sample:
Report To: Ga Y''. gA\W,, ( ) Distribution Tap ( ) House Tap . ( ). .Well Tap . . I'\ .
Address: . . Type of Sample:
. ' ' ( .. ) R.iw· ( ) Treated
. ZIP Type Of Treatinerit: ·
,, .. ( I ( )' None ( ) Lime
Telephone f'.:)umber: -. ( ) Chlorinated ( ) Soda Ash ·
. ( ) , . Fluoridated ( ) Polyphosphate : Collected By: • ( ) Filtered ( ) Water Softener AM ( ) Alum ( ) Other Date Collected: Time: PM
. ;/~ s . Type of Sample: •·
Location of Sami:,ling Poiflt: .. ( ) Regular ( .) Private
(Address where sample waS collected) ( ) Check : ( ) Speci_al "' . . . ..
WATER SYSTEM I.D. NUMBER (COPY FROM MAILING LABEL) ·,
Remarks: .. \ :
;:S...~..V L!..::_,-'\.., . □□~□□~□□□·· . . ..
State Drinking Water Parameters (Required) Optional Parameters (List as nee'ded) , . · . ll'v,,,,.f1-,._ · ;,.,,_, .,c.c1'o~ .,,.,,. ✓-
'Resu.ltS ✓/ · Results ,,.//
Arsenic mg/I 2 · C..l'-..:· 1)1:.c~ //' ./ C}.rl,S"
Barium ' mg/I 2 ·:, ~ \......\. // O,o 9
Cadmium ✓ -<. ,-!/. OeJ~ mg/I. 3 ' --;---,_: / // ... ,,, "1 <...
Chromium .,/, .• ,.{ O,o/ . mg/I 2 /I . ' Fluoride mg/I 2 ,/,/. -, .
Lead I/·' , . _,.., cP.C< mg/I .2 ._/' . -
Mercury ' ' .. · -mg/I 4 .-::; .. :.---·· .. . -. . , ,.
Nitrate (as N) mg/I 2 ' .. ' .. .. .
Selenium , mg/I 3 ' . ' :1 .-
Silver· . 'mg/I 2 ; ' pH /.,, ' I,, units 1 I
Iron • c,• ·-. ' mg/I ,2 .. ...
Manganese ·-:.1 '. .. mg/I 2 ,. ·,, .. _,
~AN ~tt 1983 · ·/
Date Received ,.-,::.,---.-----------Date Reported ___ __:/-/./1-/.'J.'-'~:P'.P.'-='.3::.__· __ Reported By ___________ _
. Date Anal~z';: ______ ~--~-..:··Laboraiory Nu':!'ber -----.,,•.,.• -~· •:.:·jc;,::=.:.::l.=4=8:::. ______________ _
OHS Form 2887 7/79
Laboratory
SANITARY ENGINEERING Mildred A. Kerbaugh
Director
INSTRUCTIONS·
Using
avail ab
n, fill in all r~ques,t~d information on the ~op portion of form front:· Please print legibly if typewriter is not
Before ave the two "freeze packs" fror,j the' s;yrofoam mailer and place in a fr~ezer overnight. (SAMPLES NOT·
.:.:R:..:R.::.E::::SE::.:.:.::..::.;: ~....;...-,i'.,...-'--'--R_l__cN...::G SH I PM ENT _W_I L_L _N O_T BE TESTED.)
.,
SAMPLE COLLECTION:··· .•
1) Remove the two 1-quart plastic containers and inflate by moutti, if uninflated.
2) Let the water (to be sampled) run for 5 minutes to assure that the water is from the distribution system.
3) Rinse each plastic container two or three times, and discard the water.
4) After rinsing, fill each container to within apf)roximately one inch of top of the sampling container. Then cap the,co,r,tajher securely.
Check samples (see Types of Samples below):s"an:iples from non-~omm~n_ity systems, an_d special samples may'-c"'cntciiri ohly one 1-quart
sampling container, rather than twO.
SAMPLE SHIPMENT: · ': ·.
1) After collection of the sample(s), replace the two frozen "freeze packs" in the styrofoam mailer.
2) f'Jext, place the two 1-quart samples into the·,mailer and cap.· ! ..
3).After capping the Styrofoam mailer, place the.report from (UNFOLDED) on top, then seal the cardboard box. Mai[im!llecjiately to the
State Laboratory using the supplied label. The sender is required:to pay shipping costs. ...k,. 11~;:-.-.;. _ 1 ... -·,,, .•
• . • . •· -* -• . •..
The a_n-~lysis takes sever.al days for compl;'.t;on, and the re~ort will be. mailed back as soon as possible:-!'~l.~.as~:do riot~call~the laboratory
to request "early" results, unless absolutely nece~sary. ... .. : -·--· ---· ··
~~-. ~ . .
LIMITS OF ALLOWABLE CONCENTRATIONS FOR DRINKING·WATER ARE LISTED BELOW:
Parameters
Arsenic
Barium
Cadium'
Chromilim
Fluoride .
(Temperature Dependent) -
Lead
Mercury ..
Nitrate (as N):.
Seleniu·m
~-.:snyer'.:
Iron
Manganese,
pH
Limits (mg/I), , _, .
0.05, , ,
1.0
0.010
0.05
1.4-2.4
0.05
0.002
Hl,0
!).01
0,05·_.: ·
0.3, · · •
0.05
· not leJS than 6.5Imi!S
Methods (EPA-600/4~79-020)
AA, f.urnace tech·nique, pp. 206.2-1 ;-206.2-2
AA, direct aspiration, pp. 208.1-1 -208.1-2
AA;furnace technique, pp. 213.2-1 -213.2-2
· AA, furnace.technique, pp: 218.2-r.:. 218.2-2
Ion Selective Electrode, pp. 340.2-1 -340.2-3
•I•
AA, furnace technique, pp. ·239.2· 1 -239.2-2
Manual Cold'Vapor technique, pp. 245.1,1 ~ 245,1-6,
Colorimetric, Brucine, pp. 352, 1-1 -352.1,3 ·.,
AA, furnace technique, pp. 270.2-1 -270.2-3
AA. direct aspiration, pp. 272.1-1 -272.1-2
AA, direct aspiration, pp. 236. 1-1 -236.1-2
AA, direct aspiration·, pp. 243.1-1 -243.1-2
pH Electrometric, pp._ 1~0.1-1 -.150.1:3
' -"'"'"· ,~~.:i\--.: ..... ,
If sample concentrations are greater than the allowable concentrations, a check sample(s) will be required. ' . . :•., ,
l TYPES OF SAMPLES ........ ,,. . .
Regular: A sample(sL submitteO to me{!t the monitoring.require~ents.1 rif the North-:.Carolina Or.inking Water Act,-GS 130'·..'.,;.·_·_:1
Article 130. . ..$.. .j ' · ' I·:'!·~,
P·.
A Sainple(sr submi~ted When a preViOus Saniple · has exceeded· the:allOwable ~oncentratiori. The check Sample· should_ be.
taken from the sa~~~s~ple distributiofrtap as the-previous salllpi~~--· · .. •·· -,. } .
i .
A sampJe(s1 from a private· water s'upply si.Jbmitted by" a licensed p·hysician, sanitarian or-other he81th·ciep8rtlTIOiif iejj'resefi:.•:h ·-·~-
tative. ' · · · c,
;. '
·special':' A ·sample(S)' submiftecf by an engineer wOrking With the State or the E.P.A:, a sample taken by the oWrier/o?eiator·o(a
water system for a new well, a landfill test well sample or Othe~ rioil~catiJgoriZe'd samJ)le. ..., '. · .. ----·. ~-: -
. ' . :. ..... --·-· .. ·
.i
tS(i ~i• ;;;,,t
, ·" ..
.
' 'I'
~ ~ • I "\ ~
STA~E LABORAT6RY OF PUBLIC. Ha f . ·.
DIVISION OF HEALTH SERVICES
0
N.C. DEPARTMENT OF HUMAN RESOURCES·,
'P.O.'BOX 2804~ -306 N. WILM_INGTON ST., RALEIGH 27611
INORGANIC CHEMICAL ANALYSES
'. '.
,Complete All Items Above Heavy Line
{See lhstructions1on Reverse Side)
Type of System:·.
( ) Community
( ). Non-Community
Address: ---------------~~-----, Source of Water:
( ) Ground
ZIP·---~---1 ( )·: Surface
County:
Report To: · ~A.f"• 1
r\
Sou_rce of Sam.Pie:
( ) Distribution Tap
. Type of Sample:
-
(
(
(
) (
J
,-;:~ .. /'
. ' .. . -'· l ·•,> . .--·
I Both'c•.·
I · Purchased . . • "·•
'
f:t: (~ ..
) House Tap
I Weil Tap
' ;
•J. .. Address: --------------_-,,_--------+ '. , ( )' Raw -( ) :Tre~ate·ct ~ ;..,,;r _t-•· • ' ..
Type Of--Tr'eatmE!rit:
·.-;:--: .. ,;., ---
Telephone Number: _(_. __ )_~-~-----------;
( I None.
( ) • Chlorinated
( ) Lime .. ,
.) . ) Soda ·Ash •.
( • ) · Fluoridated
Collected By: _____ -____ ~_-__ ._· --''--------t ( ) Filtered
. AM ( I Alum
Date Collected: _________ Ti.~e': _______ P_M_. ____________ ·_·-~--~--------
( . ) Polyphosphate
( ) Water S6ftener ·
( ) Other
-.
,fl. /2. Locati_on of Sampling Point: -'--'"--~l"'---'-----'--==--------i
(Address where sample~ was collected)
1,,c..'J6, ft A / ....
Type of Sample:
_(_ ) Regular
( ) Check
I
'( ) Private··:1> ' ( I. Special ·,
Remarks: WATERSYSTEM 1.D. NUMBER (COP)'.;FROM MAILING LABEL)'
OO-c00-□□12J · ·
State Drinking Water Parameters (Required) Optional Parameters (List as needed)
. -~"" ... .
' ' . ' .
Arsenic mg/I 2 ./ o,OS
Barium mg/I 2
Cadmium mg/I 3 /.?,. "7
Chromium mg/I 2 V
.
Fluoride mg/I 2
Lead mg/I 2
Mercury ' '. . •. mg/I 4
Nitrate (as N) mg/I 2 -·Selenium_ mg/I 3
Silver mg/I 2
pH &• I units 1
Iron· . mg/I 2 i,•,
··Manganese . ' .. mg/I· ·2
_ Date Received __ b_· _'_11
_1_1_9_!i_•~ ____ Date Reported ___ J-F-/__,/~-..,&'-'. -~f:,./',_:S'_. __ ·_Reported By __________ _
I .' ; -,
~llil.JL':alQ .Date Analyzed ____________ Lab'oratory, Number _______ ·~"-------------------
OHS Form 2887 7/79
Laboratory
SANITARY ENGINEERING Mildred A. Kerbaugh
Director
. •
Usi
;z:· . 7
r,! > ~,-. ·· INSTRl:JCTIOf-!:i '•
':: i
-avail
Ty~t&\r.-.ball, poin
ble-. .·.···
Pf.ii, fill in all requested infor~atiqn on the top portion of ,form front. Please print legibly if typewriter is not
mailer and place in a freezer. overnight. (SAMPLES NOT
SAMPLE COLLECTION:
1) Remove the two 1-quart plastic cOntainers and i~flate'"'bv mouth, if unintlated.
2) Let the water (to· be· sampled) run for 5 ITlinutes to assure that the water is from the distribution systeni ..
3) Rinse each plastic container two or three times, and discard the water. · ·
4) After rinsing, fill each container to within ap.J)ro.Ximately'One inch of top of the sampling container. Then cap the container securel.v.· '
Check samples (see Types of Samples below), samples from non-community systems, and special samples m·aY~Cont'airi'"Only one 1-quart
sampling container, rather than two. · · •' '
SAMPLE SHIPMENT:
1) After. collection of the sample(s), replace the two frozen "freeze packs" in the styrofoam mailer.
2) Next; place the twp 1-quart samples into the mailer and cap. ' .
3) After capping the styrofoam mailer, place the report from (UNFOLD.EDI on top, then seal the cardboard box. Mail immediately to the
State La_~,oratory using the supplied label. .The•sender is required to pay sh~pping costs. . ·:~ ~·· ~~ ,·, t'.1.. .. ') , ~~• ·\•,
. . ,r--. -r : r
The analysis takes several days for completion, and the rePort.Will be mailed back as soon as pos·sible. Please do nOt'.(:811 ttie la~oratory
•••to-request "early"-results,-unless absolutely necessary. .::. -. · -..... · ·· .,. · · -· \ •· -
Parameters
Arsenic
'saiiUm
·· · ·, c·adiuITl ·
Chromium
Fluoride
LIMITS OF ALLOWABLE CONCENTRATIONS FOR DRINKING WATER ARE LISTEO BELOW:
Limits (mg/II,.
0.05
1.0 ·.
0.010
·0.05 -.
1.4-2.4
Meth~ds (EPA-'600/4-79-020)· ·
. .
l '·'
--(Temperature Dependent)·
Lead 0.05
0.002
10.0
.AA,'furnace.technique, pp .. 206.2-1 -206.2-2 ··
AA, direct aspiration, pp. 208.1-1 -.208.1-2
AA, furnace technique, pp. 213.2-1 -213.2-2
AA,-furnace technique, pp. 218.2-1 -218.2-2-.
Ion Selective Electrode, pp. 340.2-1 -340.2-3 • • __ ·1;r:, _ •• ,... . __
AA, furnace technique, pp. 239:2-1 -239.2-2
_Manu·al.Cold Vapor. technique,. pp. 245,1-1 -.245: 1-6. ~.,
Colorimetric, Brucine, pp. 35~. 1-.1 -,352.1-3 · , ·_.," . ,
AA, furnace technique,-pp. 270.2-1 ~ ·270,2-3
Mercury 1
Nitrate (as NI
Seleniur:n : __
Silver. : ''.•·
Iron ·-..
Manganese·
pH. c• .. •
. ~, .(. _.
_ 0.0.1 _
.. 0:05< .
-, : · 0.3
0.05
.• " AA. direct aspiration: pp. 272.1-1 -272.1-2
AA, direct aspiration, pp. 236. 1-1 -236.1-2
AA, direct aspiration, pp. 243.1-1 -243.1-2
pH E_lectrometric; PP.· ! 50_. 1-1 -150. 1-3
f .-, ~I • ..
If sample concentrations are greater than the allowilble concentrations, a check sample(s) wiii be required . . , . ' ' . "
Regular: -A sample(s)
. ~rticle 13D.
,
•• , '!
1 TYPES OF SAMRLES
submit;e~ -to~ meet the -monitoring requ1rements \,t"the North..: Carolina Drinking Water-Act, GS 130 -
! ' • ' • ·,
. A ·salTlple(sr Submitted When a Pf6Viol.Js ,ample has exceeded the allowable Concentration.
taken from tne same sample diStribution tap -as 'the preVioUs. saffipte. , !he check !ample should be
. . . . . . -. -. . -~ ·'Private: -·-:A -s:ar'tlple(s) ·trom:a .prlvite-wata~rrupp1y:,uornitted· ~"a·1rce·r1secrph~ .. s:1Ci81'1, sanit8iiarl-Or Oth"iir"fieilth dapartment-raprese~:_•i . ----t_ati~e. i · • .--·,
"'; . r ~-. ·. .... .·
' . --.. -~ --. -·--} . ' . -; . . . Seefial:-A sample(s) submitted by an engineer working with the State or. the E.P.A., a sample taken by the owner/operator of a , ,J,
water system for'a-rieW well,-a landfill test well SBrri'plit or-Othetnon-cat"egcirized Sample.' . -• . .. . -
J ,_ • .•, ~ .t • . ' ' ..
. 1 '
''J. . . . -
r
--...
,· •;!~-.... , '··. / •·,;[ ... ~
:.1. 1
-~--STATE LABORATO~; OF PUB~IC HE·~/
DIVISION OF,HEAL TH.SERVICES • •
N.C. DEPARTMENT OF HUMAN RESOURCES ·
P_O_ BOX 28047 -306 N. WILMINGTON ST .. RALEIGH/21611·-• . . J
INORS,ANIC CHEMICAL ANALYSES -PUBLIC WATER SYSTEM
Complete All Items Above Heavy Line
(See lhstructions on Reverse Side) . . {".
Name of AA ·.
System: -, /'I Ot.C01r-1
Type of System·
" ( ) Community
( ) Non·Community
Address: ----------------------1 Source of Water:
_______ . _______ . ziP ______ --1
'
( ) Ground
.( ) Surface
f"'l' ,' r,1 -, -<"'A ;;,iii,
County: _ __.!-"i_.--'--'"':rl'-'_,_,. ,., .... "LJ.""'"~----'-------~--1
~,bh -· Report To:
Source Of Sample:
( ) Distribution Tap_
Address: ' .
Type ofSample:
: ( ) Raw ·-. ---~---,-c--· zip ______ _, , Type of Treatmei:it:
Telephone Number: ( I
,
( ,) None
(""') Chlorinated
( ) Fluorida~ed.
Collected By:
' Date Collected:
( ) Filtered ..
( ) Alum AM
" _________ Time: -------'--P~M--!
. Type of Sample:
( I · Regular
( ) Check
-~ l I Location of Sarripling Point: ~-"-----'---£_,/!'.'--'---',--'-~--,----(
(Address where sample was collected)
,
.
'
..
.
( ) . Both
( ) Purchased
( ) House Tap
( . ) Well Tap -
'.
( ) Treated
( ) .Ume
( ) Soda Ash
( )' Polyphosphate
( I Water Softener
( ) Other
( ) Private
( ) Special
"
Remarks:
1;,-14·r~-'-: . .-c.~,,-·
~-C.. (_ \:.J.,. \ i:-.,,.:.\ .
WATER ?YSTEM 1.D. NUMBER (COPY FROM MAILING LABEL)
Stat~ Drinking Water Parameters (Required)
I'
Res·ults
Arsenic
Barium
Cadmium ,/
Chiomium 1. .. ,/ L &., 0/
Fluoride
lead ✓
Mercury '
Nitrate (as N)
Seleniu111~ .
Silver
pH
Iron ' ..
Manganese i
□□~□□-□□□ ~-•--·-
Optional Parameters (List as needed) -, "· -".f,
>/ ... ReSults •. ' mg,1 2
mg/I 2
-mg/I 3
n:ig/1 2
mg/I 2
mg!sk' 2 ,-,,.mg/I 4 I
mg/1_ 2
mg/I :3 '•
mg/I 2.
units 1
mg/I· 2 /_
mg/I 2
:!IMI 111. 1983., ;/1 H,f ..3 _ Date Received __________ ,_._Date Reported ----+tL~_Vf':.,_ ____ Rf!porled By __________ --. __ ~_-_• ~ -~;.;;:i.~·, .
"I Date Analyzed ____________ Labora.tory Number·_-------------------------"=
OHS Form 2887 7/79
Laboratory
SANITARY ENGINEERING Mildre□ A. Kerbaugh
Director
~ ,-. Ci, •S ·,1d', •
~-~~ .' . ? , :-~) . , INSTRUC,TIONS _
Using type riterS88u,Ji} loii'{f"p1,~• n, ·f II ,n all requested information on_the top portion of form front. Please print legibly if typewriter is not
available. ~ ,,,,,-. ·
o the two "freeze packs" from the styrofoam mailer• and place in a freezer overnight. (SAMPLES NOT =...;;==---=G SHIPMENT_W_IL_L_NO_T BE TESTED.) ' . SAMPLE.COLLECTION: . . . . , .
1) Remove th1ttwo 1-quart plastic containers and infla'te by\nouth, if uri(nflated.
2) Let the water (to be sampled) run for 5 minutes to assure that the water is from the distribution system.
3) Rinse each plastic container two or three times, and discard-the water .
. 4) After rinsing, fill each container to within af'.iProximately one inch Of top of the sampling container. Then cap the 99n1_ainer secur~ly. .
Check samples (see Types of Samples below); samples from non-_£.ommunLty systems, and special s_amples ma•{Contain orl1Y one 1-quart
sampling container, rather thari two. · · ·
SAMPLE SHIPMENT:
1) After.collection of the sample(s), replace the two frozen "freeze packs" in the styrofoam mailer.
2) .Next, place the two 1-quart samples into the mai_ler and cap.
3).After capping the styrofoam mailer, place the report from-(UNFOLDED) on top, then seal the cardboard bcix, Mail i,:nmediately to the
State Laboratory using the supplied label.-,. The s_ender is required to pay shipping costs.·~ k'-, .. , ~••.-"« 1-,~f~i ~ > i · , ---~. . -· -'... . -' ...
i • • • , , • . • • I .;__, ,
· The analysis takes· several days for completion, and the repo"rt will be ·mailed back as soon as pbss~bl~r.':P.lease do not}:§11 the laboratory
to reques~ "ea~ly"··results', unless.absolutely necessary. -· ·-· --........ ·-, --· · · -· '· '
LIMITS OF ALLOWABLE c·oiZic~NTRATIONS FOR DRINKING.WATER ARE LISTED'BELOW: ·
Parameters
Arsenic
Barium'
-~-1 Cadil.l'm ·
; Chroniium . \
Fluoride" t
· -• -(Temperature Dependent)•
Lead
Limits (mg/I) ,w.
~:gs ...
0.010·
. 0.05 ·. •: 1
1.4-2.4
,.
-Methods' (EPA-600/4-79-020). ·
AA, furnace.technique, PP,.206.2-1 c-.206.2-2 -.
AA, direct aspiration, pp. 208.1-1 -208, 1-2·
AA, furnace technique, pp. 213,2-1 -213,2-2
AA, furnace technique, jjp_ 218:2-1 -·218,2-2
Ion Selective Electrode, pp, 340,2-1 -340.2-3
Mercury
Nit rate (as NI , ·•'• . Seler-iu'm __
0,05
0.002
10.0
0,01
.0:05
0.3
0.05
''
AA, furnace technique, pp, 239.2-1 -239.2-2
.. __ Manual Cold V-aPor. technique,.pp. 245.,1-1 -245.;1:6 •; ,,fl, .• ~n_,
Colorimetric, Brucine, pp, 352;1-1 -352.1-3,
l'. Silver. . ,·:•.
Iron
Manganese
pH - - -'
·• r, ' .. '
: ~-.. noness than ·6:5 units
AA, furnace technique, pp; 270.2-1 ~ 270.2-3
AA. direct aspiration, pp, 272.1-1 -272, 1-2
AA, direct aspiration, pp. 236. 1-1 -236.1-2
AA, direct aspiration, pp. 243.1-1 -243, 1-2
pH Electrometric,.pp. 150.1-_1 -150,1-3
If sample concentrations are greater than the allowable concentrations, a check sample(s) will be required.
• II • .
_Regular: . A sample(s) submitted
• ~iticle 130, ·
. TYPES OF SAMPLES
to meet the monitorinQ. requirem·ents. Of the North Carolina· Drinking Water Act, GS-130"'....'..
A siiniPle(S) submitted when a previous sanif)le has exce'ected the allowable: COncentration. The check sample should be
taken from· the same·sample distribution tap as the previous sample.
f • . •
,, .... ,
. _· . . . . -. ~ .-. . --. . -: ' _j. . -Pm ate:~--. A sample(rl ·from a_priv'ate· wat"r s·uppty Submitted 'by.a licensed j)hysician,.sanitariari or other health.'departinerit .. rePresen;~•-.. ~-
•.! •
tative. 1 :~ .. • ' • \· ... __
Special: -A sainple(s) submitted by an engineer working with the State or the E.P.A., a sample taken by the ·owner/operatoi of a ;
water system·tor a neW well, a landfill test well sample or Other iion-categorizei:l'sample .
. ''
-orth Carolina Department of -n
Division of Health Services
Occupational Health Laboratory
A..'lALYSIS REPORT
Resources
Company: _ _.· rY/__,_,__!..!.1!/'.?"'0:.:.10-=---==-'£."",S'-+.~6..=+-'---o--------------------
Address: _____ _,{!_,IJ"'r',....,d,ci::-,L.Jr/w,&:..._~c.:::::.....c(?_=-------------------------
Service Requested: __ -:P~c-.~B.L.-,--~lfc.L...,~s'---------------------------1
Samp 1 e Taken On: __JQ_·_,,d?cc.,...l_-...,8'-----2... __________ _
Submitted To Laboratory On: // ~ /!i' -t' 2-
Analyzed By:_~N~e~a~l_....,. ________________ _
,.AllORATORY SAMPLE NUHBE~
NUMBER
;'.,.q0l>O ... ,t,C, .:!t
.
CLlMMENTS:
DI-IS Form 1440 (Rev. 2-7S)
Occupational Health
DESCRIPTION
'
'
-
By: __ -"-/--'-. .......:...D_o_v'_e..L.,---=e,____----
By: f[,q fr . /,y45._.:...f L--=------
Date Reported: / /-2-(?-Jj L---
REMARKS RESULTS
No PCB indicated bl GC/MS
analysis, sample cc ntains
high molecular wei1 ht hydro-
carbons,
1N
--
-
STATE.LABORATORY OF PUBLIC HEAT.Tl!
• DIVISION OF HEALTH SERVIfiA
... C. DEPARTMENT OF HUMntJ RESO-S
P. 0. BOX 28047 -306 N. WILMINGTON ST. , RAI.EIGH 27611
CHEMICAL ANALYSES -SOLID AND HAZARDOUS WASTE
Source: /1/, ',4(.,d ~ J '4 '<. R k emar.s:
Address: r.,,,, Ir , .... A--.t.. •
Zip
County: R,· ,_ 4 ,.._,,,.. J l'.b .. --nvt-«-Report To: 1 ~,,_,
l,ddress: RA-/., ,.fl. .,l,,d,•L "-
u
Zip
Telephone Number: ( ) 7~~-.::2.l7f'
Collected By: /:-D"vt-<..
AM
Date Collected: //)-2. /-'i, <.. Time ').'of) .fM)
Location or Sarnf.ling Point: )..,4,,.. _ ....... ·~
Lo~<t'-f''f'" ) a
{ Extractable Metals Results Results expressed in ~ unless otherwise
( ) Total Metals Total Extract: indicated. Total Extractab 1 E ,
Arsenic Zinc -
Barium (_/ <.S-Ianitabi l itv
Cadmium / ~ / 0 ,.j~ Corrosivity
Chlo;:ide . Rear.ti vitv
Chromium /0 Spec. Conductivity
Color Ln1or1nated Hydrocarbons -Copper "n~~in
V Flammability(~.P.) /'I'/" r-Lindane
Fluoride Methoxvchlor
Iron Toxaphene
T '"'ad I ., / t? 2.4-D
M!:llnoanese 2,4,5-TP
Mercury ~ n /J:J /' Al('(JC,) C -----< ,?.
Nitrate Vy I.._
v oH ,/ I, ,_/;LI 5.1 .. ,,../, ..
Selenium I
Silver ...;:: ....... /
Date Received 29------'0~c.-wte-... o<-=.?,.>,,,~-Date Reported /B Nov <;)~ Reported By _____ _
Laboratory Nur:iber 07431. -------------------
.orth Carolina Department of -n
Division of Health Services
Occupational Health Laboratory
Resources
'
ANALYSIS REPORT
Address: C,:,,,,.. do· .,._ -----~~~~~~~-------------------------
Sample Taken On: ------------------
Submitted To Laboratory On: t:/p.....>-J.r-.>-
' I
Date of Analysis: /2-,;2 fF: '6 ,?--,
Analyzed By: ~ N c b/.;;_,
.ABORATORY SI\MPLE NUMBER
NUMBER
c 0 237 .. ' .,.· A" /\' -
):) "8 D , ?;) fa, "' -
CuMMENTS:
OHS Form 1440 (Rev. 2-75)
Occupational Health
7
,P'
I
d~,.J"'.._,..
..E,-_ t,,
V
DESCRIPTION
_y,· .. .,,· ct
/
' '
By: -------------
By: _/. (/C. {, e .Jc.-..:, ---,V'~~-----------
Date Reported: 6 ,,;; ! 'Kµ
REMARKS RESULTS IN
'
DEPARTMENT OF HUMAN RESOURCES -DIVISION OF HEALTH SERVICES
LABORATORY SECTION
OCCUPATIONAL HEALTH
G C REPORT SHEET
COMPANY: r:D~CI/J:\-l'.\'k~ ~-DATE OF ANALYSIS: b -,;> s -g .1, I 6 -;2 8 -g ,;i..,
I
SAMPLE II m~J<.
:<.:?31 -I-
:.J,J :? 'ii +
DHS Form 2123 11-74
Laboratory
,'P?18 f
-I-
-r
TOTAL MILLIGRAMS
'ii, ) t,l..a,,_L ,'77 -Y'-'IL ~¥,.
+ I 0
+ -,-
f-!YD ND ,
-..
• •
------:r:·=-=-=------'.=,=,,. ,C=".=l=--.-,--0=.2::_o::~2=,.::-:i.:_=-=-=-=-=--:.=-=s-o=-=I-L=--=T:::E::S::T;;:,R=,E=-P:::;=-R=-,T====:-=-=-=--=-=-=-----:-:-=---=---=---=-=--=--M-~:= '--.. ---REP(..-,. ~ AGRONOMIC DIVISION. N.C. OE?ARTMENT OF AGRICULTURE
Ji •• BLUE RIOGE ROAD CENTER. RAL!::IGH, :'-J.C.
' I I •· I
i I
i .i
i
?HON.=., \919) JJJ-2655 COPIES SENT JO:
02/07/'33 X COUNTY C:XiENSION Ci-!AIRMAN
TO: CA'ri'K1NS, TCNALO
?o ecx 75£:i
ROCKINGHA~ NC
FARM LOCA.TlQN ( COUNTY f: P!Cr.~ON[
-· FIELD INFOR:.1ATION ..
~-... 1 rne,,oom~ I APl'\.lf;J LIME I ~E~r.l.o.s-:-c110~ ' ~ .. I .. , I WN
-~0-. . . _-. cc= /'2 1:4~-I -1 :·I'" 1-•,o, I ,,o
--1 MIN ·
SUGGESTED TREATMENT FOR FIRST CAO? [OR YEAR1••
PEACH M I 0 !
• FIELD 1NFORl\.1AT!ON
$.\"•LE IPREV1CU3 C<\OP so
--2
Cl>OP ro SE ;:mo .....
FES/OG/T_lf. :-1
.
SUGGESTED TREATMENT FOR FIRST CROP (OR YEAR]••
Ll>,lf ·• . ,,,,,. ,,o .. '" ..
0.61 llC0-200 0 07(}-090 0 0
FIELD INFORMATION ..
I .O.Pf'll(O UMC
0
,.
0
-"~ · 1 ~-
· 3· .. 2 50
.. I "' NOH
. 17
I
' 1··1"' NOTS
· --·o 12
..
TEST RESULTS~
SUGGESTED TREATM!::NT FOR SECOND CROP (OR Y!::AR)• • ..
TEST RESULTS•
1, (10S+ll084)' ·. '' I '" I .. , t -~ I , .. , ,! , ~. 1· . "
30 146.9 113.s 166+ I oa4 I 047
SUGGESTED TREAT,\1:CNT FOR SECOND CRGP (OR YEA.RI••
TEST RESULTS·
"
'" 1 · '
L 2, l 7, -S
u, .. on
SUGGESTED TREATMENT FOR FIRST CROP (OR YE;!.R)"• SUG(;ESTEO TR:CAT,\lENT FOR SECOND CROP !OR Y!:AR)•• •
"I
I
,.
I
SAl,VL( j'"'VIOIJSCAO~ NO• • 1 •-
•• .
~ ~ . . . .
·· SUGGESTED TREATMENT i'OR FIRST CROP (OR YEAR)••
CIIOP TO SE CIIOWtJ .
i .... ,. . ; .,' .. :;'
-SUGGESTED TREATMENT FOR FIRST CROP !OR Y!:ARJ••
CIIOP TO 8E QIIOWN I
Ll .. f -P20~
I
. (20 .. ,. I ,. ..
..
• TEST RESULTS {N.C. tests ..,;u not cor.'lpare dir~tly to numbea obtained by otht1r m~hod~.I .
So!I O:u: MIN• Minual ss-, • eau 5a~snnlc;r., "', of CEC 1J1t-"' • r,.•._nnium. ~ of CEC
M-0 • Mir@,al-Or.,•~ic Ac• .l.dd;IY. mOQ/!O,J ~..,.,, Mn•l •Mang.one,~!"<!"•
0RG • Qrg.,,ric PH• 1-1,d,o,~n.;.;,., Ac,,vi11 Zn•I • Zfr,c lnde•
HM-"r, • l-lum;.; Mactl'<'. Pc,c~~, b> ,G!. 1'.1 • P1'o..,hor.,, Ind•~ Cu-I -Co;;p., Ind••
wr1 ~ w,;9h1 l>@r Vol"m"· 1,fcm'
CEC -C..,lon E.<c..,, Cap .me<l/100 cm'
,(_I• Pou:sNm IM~,
C.,."!. • C~!ci<."'. ~ ol CEC
5.( • Sulf1t• ;y\!•Jr 1ndu
SS-1 ~ S01uot9 S...lt lMu
• .. m
I
,.OTE
No.N • Nltr3~ /'l, mg/<lrn'
Nf'.,'I • .i.n,moni .. rn .'I, m1{c:,n'
/'la• S<>di ... m. m..or:oo c,,.,•
CROP TO SE GROW..,
"
CROP TO SE GROW"
LIME
.-.
TEST RESUl TS• -. ,
•.
SUGGESTED TAEol.t..!ENT FOR SECOND CROP {OR YEAR)••
SUGGESTED TREATM!:NT FOR SECOND CROP !OR YEAR)••
..TREATMENT, lbYa un!as.s spe-cifit1d
L1Mi';: T • «:,n,/3, M • lt>s.fli)OO <q. h,
~ • Ni:rogon. M • lbo./1000 ,o. h_
P,0, • Phc..,na,o, M • lb./10CO SQ. ft.
1(,0 • Pota•h. M • 11::t.11000 SQ. !t.
'.'ej • !Aaq,,,,,b,,,
Cu• COPP~•
READ SUPPLEMENTAL MATERIAL AND BACK OF REPORT FOR FURTHER DETAIL
...
Zn• Zi~c
8 • aor.::n
I ...
Mn• Ma"9,1>1•.-
•• •• North Carolina Department of Natural
DIVISION OF
ENVIRONMENTAL
MANAGEMENT
Resources &Community Development Robert F. Helms
Director·
James B. Hunt, Jr .. Governor Joseph W. Grimsley, Secretary Telephone [phone]
Mr. Donald M. Dawkins, Receiver
Macon Machine Company, Inc.
Pittman, Pittman and Dawkins, P.A.
P. 0. Box 758
Rockingham, North Carolina 28379
July 6, 1983
SUBJECT: Permit No. 9235
Macon Machine Company, Inc.
Cordova Facilities -
UL~!
Waste Oil/Water Land Application
Disposal Facilities
Richmond County
Dear Mr. Dawkins:
In accordance with your application received March 18, 1983, we are
forwarding herewith PermiLNo. 9235, dated July 6, 1983, to Macon Machine
Company, Inc. for the construction and operation of the subject non-discharge
type wastewater land application disposal facilities.
This permit shall be effective from the date of issuance until July 31,
1985, and shall be subject to the conditions and limitations as specified
therein for the one time disposal of approximately 500,000 gallons of
wastewater.
If any parts, requirements, or limitations contained in this permit are
unacceptable to you, you have the right to an adjudicatory hearing before a
hearing officer upon written demand to the Director within thirty (30) days
following receipt of this permit, identifying the specific issues to be
contended. Unless such demand is made, this permit shall be final and binding.
One (1) set of approved plans and specifications is being forwarded to
you. If you have any questions or need additional information concerning
this matter, please contact Mr. H. Dale Crisp, telephone No. 919/733-5083,
ext. 108.
cc: Richmond County Healt~partment
Mr. 0. W. Strickland/-·
Mr. Forrest R. Westall
Fayetteville Regional Supervisor
Fayetteville Regional Manager
Sincerely yours,
Original Signed By
W. LEE FLEMING, JR., for
Robert· F. Helms
POLLUTION PREVENTION PAYS
P. 0. Box 27687 Raleigh, N. C. 27611-7687 I
•• ,(~'.;.'~'.'.'" ~
I\ .\' :::,_°'1 i; -t:t ,, \~ North Carolina Deportment of Natural
Resources &Community Development
DIVISION OF
ENVIRONMENTAL
MANAGEMENT
,.Jl'l . ~
Robert F. HellllS
Director
James 8. Hunt, Jr., Governor Joseph W. Grimsley, Secretary Telupllonc 919 733•7015
'
Mr. Donald M. Dawkins, Receiver
Macon Machine Company, .Inc.
Pittman, Pittman and Dawkins, P.A.
P. 0. Box 758
Rockiri'gham, North Carolina 28379
July 6, 1983
SUBJECT: Permit No. 9235
Dear Mr. Dawkins:
Macon Machine Company, Inc.
Cordova Facilities
Waste Oil/Water Land Application
Disposal Facilities
Richmond County
In accordance with your application received March 18, 1983, we are
forwarding herewith PermiL,No. 9235, dated July 6, 1983, to Macon Machine
Company, Inc. for the construction and operation of the subject non-discharge
type wastewater land application disposal facilities.
This permit shall be effective from the date of issuance until July 31,
1985, and shall be subject to the conditions and limitations as specified
therein for the one time disposal of approximately 500,000 gallons of
was tewa te r.
If any parts, requirements, or limitations contained in this permit are
unacceptable to you, you have the right to an adjudicatory hearing before a
hearing officer upon written demand to the Director within thirty (30) days
following receipt of this permit, identifying the specific issues to be
contended. Unless such demand is made, this permit shall be final and binding.
One (1) set of approved plans and specifications is being forwarded to
you. If you have any questions or need additional information concerning
this matter, please contact Mr. H. Dale Crisp, telephone No. 919/733-5083,
ext. 108.
Sincerely yours,
(,.J. }f_ ~ j 1 Robert F. Helms( J
cc: Richmond County Health Department
Mr. O. W. Strickland
Mr. Forrest R. Westall
Fayetteville Regional Supervisor
Fayetteville Regional Manager
POLLUTION PREVENTION PAYS
P. 0. Box 276B7 Raleigh, N. C. 27611-7687
An Equal Opportunity Affirmative Action Employer
.·
•• ••
NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF NATURAL RESOURCES AND COMMUNITY DEVELOPMENT
RALEIGH
PERMIT
· For the Discharge of Sewage, Industrial Wastes, or Other Wastes
In accordance with the provisions of Article 21 of Chapter 143, General
Sta tut es of North Carolina as amended, and other applicable Laws, Rules, and
Regulations
PERMISSION IS HEREBY GRANTED TO
Macon Machine Company, Inc.
Richmond County
FOR THE
construction and operation of a non-discharge type wastewater land application
disposal facility consisting of approximately two (2) acres of irrigation
area owned by Macon Machine Company, Inc. for the one-time disposal of
approximately 500,000 gallons of wastewater by tanker truck from the Cotnpany' s
existing oil/water storage lagoons with no discharge of wastewater· to the
surface waters of the State,
pursuant to the application received March 9, 1983, and in conformity with
the project plans, specifications, and other supporting data, subsequently
filed and approved by the Department of Natural Resources and Community
Development and considered a part of this Permit.
This Permit shall be effective from the date of issuance until rescinded
and shall be subject to the following specified conditions and limitations:
1. This permit shall become voidable unless the facilities are
constructed in accordance with the approved plans, specifications
and other supporting data.
2. This permit is effective only with respect to the nature and
volume of wastes described in the application and other
supporting data.
3. The facilities shall be properly maintained and operated at all times.
4. This permit is not transferable.
•• Permit No. 9235
Page Two
5. This permit shall become voidable in the event of failure of the
soil to adequately absorb the wastes, and may be rescinded unless the
facilities.are maintained and operated in a manner which will protect
the assigned water quality standards of the surface waters, and prevent
any contamination of the ground waters which will render them unsatis-
factory for normal use.
6. In event the facilities fail. to perform satisfactorily including the
creation of nuisance conditions, the Permittee shall take such immediate
corrective action as may be required by this Division.
7. The Permittee shall employ a certified wastewater treatment plant.
operator in responsible charge of the wastewater treatment facilities.
Such operator must hold a certificate of the grade at least equivalent
to the classification assigned to the wastewater treatment facilities
by the Certification Commission.
8. The maximum application rate shall not exceed one (1) acre-inch per
week (27,150 gal/Ac/wk).
9. The site shall be adequately limed to a soil pH of 6.5 prior to any
was.tewater application.
lO. This permit shall be issued for this one-time application of approximately
500,000 gallons of wastewater.
11. The application site shall be adequately flagged prior to disposal to
identify the wetted area.
12. No other type of wastewater, sludge or waste oil, or waste material is
to be applied to and disposed of at this site other than that indicated in
this permit application package.
13. A minimum buffer zone of at least 30 feet shall be maintained between
the perimeter of the application area and any property lines.
14. The wastewater application site shall not accumulate heavy metals in
excess of the following limits:
Pb 450.0 lb/Ac
Zn 225.0 "
Cu 112 .5 "
Ni 45.0 "
Cd 4.5 "
Cr 1,. 5 "
15.. Irrigation shall not be performed during inclement weather or when the
ground is in a condition that will cause runoff.
. Pe~mit No. 9235
Page Three ••
16. Any monitoring deemed necessary by the Division of Environmental Management
to insure surface and ground water protection will be established and
an acceptable sampling reporting schedule shall be followed.
17. A suitable year round vegetative cover shall be maintained.
18. No root or leaf crops for_public consumption shall be raised on these
sites.
19. · The issuance of this permit shall not relieve Macon Machine Company,
Inc. of the responsibility for damages to surface or ground waters resulting
from the operation of this facility.
20. The facilities shall be e·ffectively maintained and operated as a non-
discharge system to prevent the discharge of any wastewater into the
surface waters of the State.
21. · In any future transfer of this land, a notice shall be given to the new
owner that gives full details as to the materials applied or incorporated
at this site.
22. No wastewater shall be applied within 100 feet of any water course or
potable water supply well.
Permit issued this the 6th day of July, 1983.
NORTH CAROLINA ENVIRONMENTAL -MANAGEMENT COMMISSION
/ F. Helms, irector 4 Division of Envi onmental Management
By Authority-of the Environmental Management Commission
Permit No. 9235
••
Nonli~Carolina·Dcpartrncnl of Natural Hesourccs and Community Development
Environmental i\!unagcment Cornrnls,-;ion
NON-D!SCIIAHGE PEHil-1 T APPLICATION•
DEM USE ONLY
Permit.Number: ,,
' ~ '·:.:.: '
'
County_;
• iu ;1r:cordancP. with N.C. General Statutes Chapter 143, Article 21 _.:::...:==..::..:...::.:.::..:.:.:..:..:::...:=::.::.:..==::....::::=.:::...:..:.:.:..:.:.:..:.=..::..:...-------'-----+----------Appl!c?nt (nom,: of board, individual, or other,s): -··
' "
/"' I q C,<JY-. /VI a ._ I, , ;, .__ l'. o >'h or, " ,, -ln C I
Application O.itc:
/\.1J /I ,· r/ ... /./ I (i ,-:: ., ' ·' '', ,I
I
FOil, 'I I
/
81.._N owi)jsclrnrge Treatmcn t/Disposn l F ac i Ii l ics -
0 Prt!ti-carn1ent Facilities
Brief Project Description:
f /. __ ,_ (/,~ /71.J 1,v(
' I
Scw:r Collection System {private) □ □ !•:xkHd Sewer and Sewer Systems (puUlicl. ·---····
·I .. (,q-~(:.-, j / -, __ _
NATURE OF --□ \VAST8\VATl,n,
~
Sewage . . ... ,.
SI uJ~;j[utius;ri;i l
Other Waste
Waste
., ..
From (sewers, pretreatment facilitie~, !reotmenl plonts):
l-,~ '-Wu ti, 0: I
)\/\..-<.1..,_j)
/
Serving (city, institution, industry):
ft,_,·, :I.! jJ J /) '
f Tri butory
f
To (name of water course):
1V I J-1
, ..
Nome and Complete Address cif Engineering Firm: •.:.t " I Iv/ fl ~ . / ·-/, ;;
Treotm,:nt Works Capacity lo Serve (nomci of pro(ect): /) rv--vr r 'Far (no, yrs,} Average Doily Gallons Sewage or Waste flow:
/1-/,.,...,,~/vloc./.,~e C.-o .]''1',.c.. IVq-/._ ()i/ !iecr,/'-ii): D1-,c. l,n:c. 1 ..i,t. ,e,, l'!:/lc,,.-/.,J· i,!,.,n.,--f"·
Affect Overall Reduclion in Poll6tion (not applicable for sewer proiec'ts): / I fh1,1./,; ,i-l't"tJi..
IL O. ll. (5-Jay 2d' C) fl I 11 %
Tuxic l\!aterials (specify% ench1}odd Rages il(neede~)
;V /II ( 5,.., 1?~--1. ;'/'')/1//:,,;X;:'.)• )
' ' Suspended Solids
TOTAL SOLIDS
,·~ :>.:,:.--. • ; .••.•• :-·· ••• ,y •
{ )b.<~:\·,\} .... :.:.:'.::::'• ::(::::-:):;:;:;:.::,~
Coliform !3at.:tcria % TOTAL TOXIC MATEHIALS
Pumping
% Slution
%
Treatment
Pinnt
Other (specify)
% $
j i ,/ ,l / )'·t
Estimated Completion Date:
% ·r I / · (1 ·" ., u ,., . t'I 1:i __ _,
t\pplica1\l· nssurcs that proposed works wi'll be constructed,· superViscd, oPCratCd and ~aintuined in aceor<lancc.: with api(i'.ov,ed p!aus and
~;pcci fic.:1Jtio11s or approved chaiiges thereto.
Print Nome:
Do ~\ /A/,J 1'1 , D <A.;'-'J J.. , i-. 1
s/(f~~--~.Q~J )}'\, /J.,vJk.:_
INST RUCTIONS:
1. Fill.in ALL spaces, If not applicable, enter N/A,
2. Secure appropriate signature (mayor/city manager for municipality; chairman for sanitary district baord; owner/praper official of carp.:natian;
or legally con~!ituted baard or commission in chorge of proposed works), A letter o°f outhorizotion is requi"red from proper official if
design engineer or other agent signs application, ··
3. Submit to N.C. Department of Natural Resources and Community Development, Environmental Mon~·gemenl, Raleigh, NC, the,
original and first copy of application, 2 sets of finalized plans, specifications ond other supporting dato as required by.C?mmissian Rules,
NOTE: Application reviews ore scheduled on receipt of COMPLETE information. Generally, 30 cioys ore required for pollutia,:.,.,botemcnt projects; 90 doys for athcr projects · ; , '. ,.
FOR ASSISTANCE, coll 1ho Stoto Offic, [phone] o, tho opp,opdoto liold offico li,t,d b,;'l?(."•ff',",tl"<"'-:,,'o)~·"':,>: ·
',hheville [phone] *Mooresville [phone] *Washi.nglon (919) ~l l:J ~'V'flf -Solem [phone] . ' , : If \.1::>m!J \!/rj1,l;W'II\-" ·
159 Waodfin Street 919 North Main Street 1502 North Mark " eet \~ J/, las Creek Parkway Ex!ension
Asheville, NC 28801 Mooresville, N': 28115 Wosh1ngton, NC 9 . V. r i-Solem, NC 27106
°Foyerteville [phone]
Suite 714 Wachovia Building
Foyeltevillo, NC 28301
*Raleigh [phone]
80:,c 27687
Raleigh, NC 27611
: '-'" l /l 198
3wilmlngton [phone] · . w.ATER· QUAL/...ll-25. Wdgh,ssill, A,ono, . • J film1ngton, NC 28403
OPERATIONS· BRAN~I-I
••
NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF NATURAL RESOURCES AND COMMUNITY DEVELOPMENT
RALEIGH
PERMIT ------
For the Discharge of Sewage, Industrial Wastes, or Other Wastes
In accordance with the provisions of Article 21 of Chapter 143, General
Statutes of North Carolina as amended, and other applicable Laws, Rules, and
Regulations
PERMISSION IS HEREBY GRANTED TO
Macon Machine Company, Inc.
Richmonc\ County
FOR THE
construction and operation of a non-discharge type wastewater land application
disposal facility consisting of approximately two (2) acres of irrigation
area owned by Macon Machine Company, Inc. for the one-time disposal of
approximately 500,000 gallons of wastewater by tanker truck from the Company's
existing oil/water storage lagoons with no discharge of wastewater to the
surface waters of the State,
pursuant to the application received March 9, 1983, and in conformity with
the project plans, specifications, and other supporting data, subsequently
filed and approved by the Department of Natural Resources and Community
Development and considered a part of this Permit.
This Permit shall be effective from the date of issuance until rescinded
and shall be subject to the following specified conditions and limitations:
1. This permit shall become voidable unless the facilities are
constructed in accordance with the approved plans, specifications
and, other supporting data.
2. This permit is effective only with respect to the nature and
volume of wastes described in the application and other
supporting data.
3. The facilities shall be properly maintained and operated at all times.
4. This permit is not transferable.
Permit No. 9235
Page Two
5. This permit shall become voidable in the event of failure of the
soil to adequately absorb the wastes, and may be rescinded unless the
facilities are maintained and operated in a manner which will protect
the assigned water quality standards of the surface waters, and prevent
any contamination of the ground waters which will render them unsatis-
factory for normal use.
6. In event the facilities fail to perform satisfactorily including the
creation of nuisance conditions, the Permittee shall take such immediate
corrective action as may be required·by this Division.
7. The Permittee shall employ a certified wastewater treatment plant
operator in responsible charge of the wastewater treatment facilities.
Such operator must hold a certificate of the grade at least equivalent
to the classification assigned to the wastewater treatment facilities
by the Certification Commission.
8. The maximum application rate shall not exceed one (1) acre-inch per
week (27,150 gal/Ac/wk).
9. The site shall be adequately limed to a soil pH of 6.5 prior to any
wastewater application.
· 10. This permit shall be issued for this one-time application of approximately
500,000 gallons of wastewater.
11. The application site shall be adequately flagged prior to disposal to
identify the wetted area.
12. No other type of wastewater, sludge or waste oil, or waste material is
to be applied to and disposed of at this site other than that indicated in
this permit application package.
13. A minimum buffer zone of at least 30 feet shall be maintained between
the perimeter of the application area and any property lines.
14. The wastewater_ application site shall not accumulate heavy metals in
excess of the following limits:
Pb 450.0 lb/Ac
Zn 225.0 "
Cu 112 .5 "
Ni 45.0 "
Cd 4.5 "
Cr 4.5 "
15. Irrigation shall not be performed during inclement weather or when the
ground is in a condition that will cause runoff.
Permit No. 9235
Page Three
16. Any monitoring deemed necessary by the Division of Environmental Management
to insure surface and ground water protection will be established and
an acceptable sampling reporting schedule shall be followed.
17. A suitable year round vegetative cover shall be maintained.
18. No root or leaf crops for public consumption shall be raised on these
sites.
19. The issuance of this permit shall not relieve Macon Machine Company,
Inc. of the responsibility for damages to surface or ground waters resulting
from the operation of this facility.
20. The facilities shall be effectively maintained and operated as a non-
discharge system to prevent the discharge of any wastewater into the
surface waters of the State.
21.· In any future transfer of this land, a notice shall be given to the new
owner that gives full details as to the materials applied or incorporated
at this site.
22. No wastewater shall be applied within 100 feet of any water course or
potable water supply well.
Permit issued this the 6th day of July, 1983.
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
Original Signed By
W. LEE FLEMING, JR., for
Robert F. Helms, Director
Division of Environmental Management
By Authority of the Environmental Management Commission
Permit No. 9235
NCD991289521 • -
ENVIRO-CHEM WASTE MANAGEMENT SERVICES
P.O. Box 10784
Raleigh, North Carolina 27605
[phone]
March 10, 1983
Mr. O. W. Strickland
N.C. Division of Health Services
Soild and Hazardous Waste Division
P.O. Box 2091
Raleigh, N.C. 27602
Dear Mr. Strickland,
In November of 1982 Mr. Donald Dawkins, acting for the estate
of Mr. Charles Macon instructed Enviro-Chem to proceed with remedial
services to comply with a recent court order initiated by your office
to require clean up of the Macon Machine Co. site. To comply with
the intent of that order, Enviro-Chem established and initiated the
following plan.
1) Field screen all drumed waste
2) Assign an affix field identification numbers
3) Prepare composite samples from drumed waste of
similar nature
4) Analyze the composite samples in the laboratory
for compliance with hazardous waste regulations
5) Locate and install two ground water monitoring
wells down gradient from the lagoon area
6) Sample and analyze water samples from these wells
in accordance with instructions from the state
geologist in the Solid and Hazardous Waste Branch
office
7) Take soil boring samples for contamination assays
After approval of this proposed plan by Mr. Donald Dawkins and
the North Carolina Division of Health Services, Enviro-Chem proceeded
with and completed the aforementioned plan. The data collected from
this service plan is attached and is self explanatory.
To further stabilizecand improve the site, Mr. Dawkins
instructed Enviro-Chem to begin removal of waste from the site.
Three main areas were identified for immediate action and were
addressed in order of apparent hazard. Each.area contained several
hundred drums of as sorted materials .. It was. apparent•.: that many of
the drums were carelessly unloaded and were in very poor condution.
Enviro-Chem technicians began by moving drums to a more i.
accessable position and segregating them as to there generic chemistry
and proposed method of disposal. Pumper tankers were then brought
in and the waste removed for disposal.
Macon Machine Co. Report
page 2 •
The two types of waste we encountered in the largest quantities were aqueous waste and solvent waste. The analysis of thes materials are attached. The disposal site selected was Caldwell Systems and Mitchell Systems. It was ascertained before shipping that these waste were compatible with the incineration capabilities of thes two sites.
Our prposed procedure for the remainder of the drummed waste is to ship burnable waste to Caldwell and Mitchell Systems and to ship the acid, basic, and solid materials to SCA Services landfill in Pinewood, S.C. We will continue in this manner until financial resources are no longer available. Itemized invoices and work reports are currently being tendered to Mr. Dawkins in order that he may be up to date on job phase completion and cost accounting-for this project.
With respect to the surface impoundments, Enviro-Chem would like to propose the following plan.
1) Oil and hydrocarbon sludges will be removed and disposed of according to the hazard classification
2) Water from the lagoons will be removed and land applied in accordance with recently completed
studies by the NorthCarolina Division of Health Services and the Office of Environmental Management 3) After being emptied, the lagoons will be heavily limed, back filled, and seeded.
Our firm has investigated the availability of equipment which can carry out this plan.-We have found that because of the topography and location of the surface impoundments, there is limited availibility of the equipment and services to support this effort. However, we have located an individual,Mr. Billy Thompson of Roctingham, who is willing to entertain the use of his liquid manure spreader for the execution of this phase. Additionally, Mr. Thompson's farm is adjacent to t,he Macon Machine Co. site. We have not worked out the particulars of this arrangement, but we feel optomistic that an agreement can be reached which will allow us to proceed as soon as is practical.
It is already obvious that the availabiltiy of funds to close this site is far exceeded by the requirements to do so. We have given Mr. Dawkins all of our resources to recycle, reclaim, or otherwise dispose of waste from the site in the most timely, cost efficiently, and legaly correct manner possible. It is our opinion that to close this facility in such :.manner which would eliminate the liklihood of personal or environmental liability, a sum in the neighborhood of$ 50,000.00 would have to made available. This would, of course, in addition to the funds already on hand.
I hope that this report will satisfy its intended purpose. If there is any additional information which you~ require,· pl~ase do not hesitate to call.
JPD:em
71 t~~~' /~~~~-
Jerry P. Deakle
GRA-GER ,!;o~A~Q.QRIES
ANALYTICAL AND CONSULTING CHEMISTS
709 West Johnson Street • Raleigh, North Carolina 27603
ANALYTICAL LABORATORY
En\'ironmcnl Analysis
Construrtion Materials
!dentifieation of Unknowns
Agriculture
[phone]
February 17, 1983
83-6091
Fuels
T(•xtiles
Chl·mi(';1ls
llawrdous \\';1sll'
Envi ro-Chem ,Jaste Management Services
Post Office Box 10784
Raleigh, North Carolina 27605
Attn: Jerry Deakle
Subject: Analyses of Samples Received 1/27/83
Sam~le Identification:
1. Well 1, Macon Farm
2. Well 2, Macon Farm
RESULTS
1
Total Organic Carbon, mg/1 15.7
Conductance, µmhos 31. 0
Lead, as Pb, mg/1 2.0
Chromium, as Cr, mg/1 0.53
~1t~
Laboratory
WRC/ab
Customer #44500
2
24.1
420
1.1
1. 93
CONSULTATION
:\kwllurgirnl Srrrin•s
Pollution Abatt'ml'nl
Pron.•~s Dt'\'l'lopml'nl
Quality Control
:\le1hnds DP\'t'lopnwnt
Special ITI\'l'Stig:1tion
R.CH:\
GRA.GER I~OR~A~ORt1JfORIES
ANALYTICAL AND CONSULTING CHEMISTS
709 West Johnson Street • Raleigh, North Carolina 27603
ANALYTICAL LABORATORY [phone]
Enrironmcnt Analysis
Construrtion '.'11aterials
lden:ifkation of l'.nknowns
Agrirulture
February 25, 1983
82-5515
fuels
Te:-.tiles
Ciwmical,;
H,iz:mlous \\':isle
Envi ro-Chem v!aste Management Services
Post Office Box 10784
Raleigh, North Carolina 27605
Attn: Jerry Deakle
Subject: Analyses of Samples Received 2/21/83
Sample Identification:
1. Haste Solvents Composite
2. Waste Oil Composite
RESULTS
1
Trichloroethylene, wt% 1. 53
1, 1, I-Trichloroethane, wt% 2. 96
Other Organics identified were: Methyl Isobutyl Ketone, p-Xylene,
m-Xylene, a-Xylene, and Toluene.
HPB/ab
Customer#44500
-\0--0oA ,G,,t{~
vi. Paul Brafford
Laboratory Supervisor
CONSULTATIO:-..-
l'lletallurgir;il SNric·l'5
Pollution ,-\ll:iternent
Pron•s~ Dt'l"L'itipmem
Qu:ditr Control
~ll·th11rls Dt•\'Plopnwnt
Spl'l'i:11 Imestiga:ion
2
<0.2
<0.2
HCR.-\
A lUt.1,!lYllAllU'I ,N., __ TI()N
EPA ID NO. NAME
GENERATOR
TR'WSPORTER 1
TRANSPORTER 2
TSDF*
,L.:. ~--~;
J ,;_. • ..;~r,;,;
NCT
380010330
B v/ASTE INFORMATIOO
: •. _,. ·-.. !
MITCHELL SYSTEMS
ADDRESS ITELEPHONE
Altapass Road
Spruce Pine, N.C. 28777 704-728-5931
CONTAINERS($) TOTAL EPA WASTE DISCnEPANCY DOT DESCRI,~!IO~,/CLASS/ID NO. WEIGHT ,__NO_._,,_T_Y_P_E_-+------~---~-------+-~OV=AN=T~I.T,~Y l----+>Cc,O,.,D,,E,.__,_N,,U"M:,;B,,Ea.eR'-1-~I.,r~ff'-'O"'R-"M"A:,_T'--'I'-'ON=----J -_, _____ _
·J~··?J::i \
: '·i :'.-~) .. y;:;
_.• I ' -.
C EMERGENCY NT.MBER<:i NATIONAL RESPONSE CENTER: 1-800-424-8802
' . . .•. i, .. --;~. ,.':) .... ,.
GENERATOR: ( i,• ::-,·-. ,.
704
)DISPOSER:( 728-5931 ). N. C.,HIGHWAY PATROL
-( 919) 733-3861
D SPECIAL 1-WIDLING/EXCEPHON REPORT/DISCREPANCY REPORT (NO.
'(
.:,_: ~ ·~-. ~-t -· ~ !.
(IF t4EEDEO, USE .A.DOITlcr-lAL SHEETS.)
E CEIUIFICATICNS
THIS IS TO CERTIFY THAT THE ABOVE-NAMED MATERIALS ARE PROPERLY CLASSIFIED, DESCRIBED, PACK-
AGED, MARKED AND LABELED, AND ARE IN PROPER CONDITION FOR TRANSPORTATION ACCORDING TO THE
APPLICABLE REGULATIONS OF THE DEPARTMENT OF TRANSPORTATION AND THE UNITED STATES ENVIRON-
MENTAL PROTECTION AGENCY. --.
.... \ ! \ :.·~, ..... )t·•·:·, -:·; ;-.
··~ ,ir,LJTHOO.izs:-r: RFPREsENTATIVE OF GFNERATOR
THIS IS TO CERTIFY ACCEPTANCE OF THE HAZAROOUS WASTE .SHIPMENT DESCRIBED ABOVE.
,:·1 ; ~ .... •.,'TR~~ TER,\E·p~~SE~-T ~ ~·I Ve 'S SIONA TURE
i t
-'1.JTt<>AIZEO REPRESENTATIVE OF TR.All/SPORTER 2 I TRANSPORTER REPRESENTATIVE'S SIGNAruRE
THIS IS TO CERTIFY ACCEPTANCE OF THE HAZARCX>US WASTE SHIPMENT DESCRIBED ABOVE FOR
(SJ TREATMENT □ STORAGE OR n DISPOSAL
•TSDF -TREATWENT STORAGE OR DISPOSAL FACILIT'I'
OHS FORM 2080 ( 10/80)
SOLID f'-ND HAZAAt.0.JS W~TE
(IUSTRVCTICNS ON BACK SHEET)
\.., ... / , !/ ' ~..,,.•-;. ' •:i-,, ,• I -,..,.....;-;, ·-r--V rn ... :-:.·;,· ,ri.·~" _.,,.,, _ _,; · TSOF REPRESENTATIVE'S SIGNATURE
FOA AOOITIONAi.. INFORMATIOO:
CONTACT MANIFEST SYSTEM
SOLID & HAZ.Aq[X)OS WASTE MANAGEMENT BR~
N. C. DEPARTMENT OF HUMAN RESOt.RCES
P. 0. BOX 2091, RALEIGi, NC 27&02
( QH~l 733-2H8
DATE
'
• NOOTH [AqQLINA HAZJlRDOUS WA-~IFEST
A llJt.N11r ilAflU'< • '·-'.'TION
EPA 10 NO. NAME ADDRESS ELEPHONE
NCO
fnc-1.. ,:c,.,/1) o ,-t.,;-., .;,
:;, L'i ci, I!..~ H~( I GENERATOR :tJ.:,~ (>_ .( ,{ Ct!J I I l' . 1~ ,. .,,._}t.' ~(Ii .-1 .~ .. I~ /(c,/1 ,., ..0. ' A!CD 91 I Cv·/ «k.L-A.>j ~.--6 t'i/) 7 <;if ""-~"" :? I TRANSPORTER 1 ,"..·x:,r-t..;:·_:;: .::, .. t:!J>atk-t'. -r,:0.ri.k,'·;r,, 1-t:.~i,'J)...,• Aff r -! TRANSPORTER 2
NCT Altapass Road
TSDF* 380010330 MITCHELL SYSTEMS Spruce Pine, N.C. 28777 704-728-5931
B \.)AST£ I NFORMA TICt-1
CONTAINERS(S) TOTAL WEIGHT EPA WASTE DISC11EPANCY
NO. TYPE DOT DESCRIPTION/CLASS/ID NO. /"\ ... I Q!,.!ANTITY CODE NUMBER INFORMATION
/1,,,.,f) ,' C . .:,fh.\,, ... '.i-\'.:\;i-? L1'-'-~d "·0.5. A ~' i-'-"-' f 1 J-,-1 f" .. ~:,Uuif [)co_5
q 6 c,j Joi i. 50'-1joL( Co '""w.,_s(. 1-:. ~"{_ '-'-~ "--0 .5 -/' '--. / 'T "--< il '1'.\ v'.f-l:l. '1 o ~p,,__; e;,,) ·h, ..
1-u).,, !I,,,,
,',w.-t,,J
!
C EMERGENCY Nl.MBF"R "1 NATIONAL RESPONSE CENTER: 1-800-424-8802
GENERA TOR: ( /JOt\cZ _f )DISPOSER: (
704
728-5931 ) N. C. HIGHWAY PATROL
( 919) 733-3861
D SPECIAL HANDLING/EXCEPTION REPORT/DISCREPANCY REPORT (NO. )
+-! "--\k.,_ ~-ve... t 0 ~ o c..e,~J. ~.i.:, Ced\ iS;'.'l. 0 ,' to -dt-e.. "'\. 6.1'f)1&7-f tS 5.5
(IF NEEDED, USE A.001TI(;'t,jAL SHEETS.)
i
E CE!TTIFICATICNS
THIS IS TO CERTIFY THAT THE ABOVE-NAMED MATERIALS ARE PROPERLY CLASSIFIED, DESCRIBED, PACK-
AGED, MARKED AND LABELED, AND ARE IN PROPER CONDITION FOR TRANSPORTATION ACCORDING TO THE
APPLICABLE REGULATIONS OF THE DEPARTMENT OF TRANSPORTATION AN~ UNITED STATES ENVIRON-
MENTAL PROTECTION AGENCY. ,....--.., ""-....
J~.r.,___.\ y ~~a.(Cl-e Y· ' :,) -trd.f_,r_ ~/f.~(¥5 k.JTMnn ZJ:r·,· RE~ESENTATIVE OF GEl'-JERATOO GE ER~~ NTAT1 , ,,-, ,r,,oc'--
THIS IS TO CERTIFY ACCEPTANCE OF THE HAZAROOUS I WAS)'E ~HfPMENT DES~~IBED.ABOVE.
GAt~ ,-S:JH\~tfrs ~I /; ,, 0 Lo:iJ ~ 'vv...-:'VL--··
~1 IZED R•PR:t;E TATIVI= OF TRANc,IY\DT~R 1 :jTR~)'{R\i;f;('ESENTATlVE '5 SIGNATURE O•T
AUlt-ORIZEO REPRESENTATIVE OF TRANSPORTER 2 I
THIS IS TO CERTIFY ACCEPTANCE OF THE HAZARDOUS .WASTE
0 TREATMENT O STORAGE OR n DISPOSAL
~THOfHZEO REPRESENTATIVE OF TSOF
•TSDF -TREATM.ENT, STORAGE, OR DISPOSAL FACILITY
OHS FORM 2080 (10/60)
SOL) 0 ANO HAZ ARCOJS WAS TE
(INSTRUCTICNS ON BACK SHEET)
J I
TRANSPORTER REPRESENTATIVE'S SIGNAruRE
SHIPMENT DESCRIBED ABOVE FOR
.
TSOF REPRESENTATIVE'S SIGNATURE
FOR ADDITIONAL lNFORMATICf\l:
CONTACT MANIFEST SYSTEM
SOLID & HAZ .. CfOO.JS '11'.4.STE MANAGEMENT BRANCH
N. C. DEPARTMENT OF HUMA.N RE~CES
P, 0, BOX 2001, RALEIQ-1, NC 27602
( 01'11 733-2178
DATE
llA TE
(
• NCR-rn (MOLINA HAzAqoous WA-11.~IFEST
A wu;unCATlU'< lNru=TION
EPA ID NO, N/~ME ADDRESS TELEPHONE '
NCO 0 L--i ci, ,t_:U,..j i~~(
GENERATOR 1!?,C,_.;' .{~ II rn,,, , .. />to_.r,;,-.. •. lb. -, I/ , . _/' t.fc,Ab ,I;; • 'h,,.,,J ~ '1'\
,\!CD
c. ~,.,.,.v_ < l .. iu_,_j,. >-,.., .•
S11 c~i'!«kiu..,j ~r-~vi/) 7 S'-f ~-~-:::::? TRANSPORTER 1 .. ,,:,r..,r..&,·< h, t_ i.:.r1.•?'1 ( A I .r. . ...,
TRANSPORTER 2
NCT Altapass Road
TSDF* 380010330 MITCHELL SYSTEMS Spruce Pine, N.C. 28777 704-728-5931
B •/ASTE INFORMATIO'.,
CONTAINERS ( S) TOTAL WEIGHT EPA WASTE DISCf1EPANCY
NO. TYPE OOT DESCRI~ION/CLASS/ID NO. INFORMATION ' ' Q\.!ANT I ll. CODE NUMBER
r'(.)ppro/-~'""-\o..,_5~\,\1?. L:.r,u.~<l .... 0.5. A f,..'.tu f 3$'ft61t Dc.a-5
q o oD jd Co ,-,...ULLs(. 1-:.~"{.'-'-KX ..__o. S -I{ so'-'g"..C /" .__ /
't<U.ll ~f\.J ~o\\-o;. j_
LJ.,, Sd'\
1'-114-ta.')(.) ,' "'-'--i' ,,J
!
c EMERGENCY Nl.MBERsl NATIONAL RESPONSE CENTER: 1-800-424-8802
704
GENERATOR: ( t-.\o.-u2 _.f ) DISPOSER: ( 728-5931 ) N. c. HIGHWAY PATROL
( 919) 733-3861
D SPECIAL HANDLING/EXCEPTION REPORT/DISrnEPANCY REPORT (NO. )
•. lk \:.k "-"'." e.-\:' 0 i;:: o CG-~c1 -e..< ,le 1 Cct..l \ &;-"-t)j'\o -(.k,e_~ 6_1'{) 1.B 7 -/ B 5..5 r
(IF NEEDED, USE AOOITION~L SHEETS.)
E CERTIFICATICNS
THIS IS TO CERTIFY THAT THE ABOVE-NMIED MATERIALS ARE PROPERLY CLASSIFIED, DESCRIBED, PACK-
AGED, MARKED AND LABELED, AND ARE IN PROPER CONDITION FOR TRANSPORTATION ACCORDING TD THE
APPLICABLE REGULATIONS OF THE DEPARTMENT OF TRANSPORTATION AN~ UNITED STATES ENVIRON-
MENTAL PROTECTION AGENCY, .,,....--., <:....... .
Je-v-"'-,) J) ~-e~(ll<e I ~L 2>c ), .. /j-!:--_ :i/ ~.~/!15 '--,. '
.&l.JTHOR zi:"f',' REPRESENTATIVE OF GENERA.TOO GI: R'i'TOR RE~ ~NTA.T 5 0
THIS IS TO CERTIFY ACCEPTANCE OF THE HAZAROOUS WASl'E H1PMENT DES~~IBED ABOVE.
GA ~g._1:i. :S:.rpa~f s "" 1zr::n-R P TATIVF OF TRAN .......... ~r----1 i "~ .\:;~v VL-· TR..&NS 1~R ~ESENTATive ·s s1CiNArURE :} .!..1/;:
-'UTK>RIZEO REPRESENTATrve OF TRANSPORTER 2 I
THIS IS TO CERTIFY ACCEPTANCE OF THE HAZAROOUS
0 TREATMENT O STORAGE OR n OISPOSAL
. ,lLJTHORIZED REPRESENTATIVE OF TSOF
-R • NT STORAG TSDF T E T\.IE • EI QA DISPOSAL FACILllY
OHS FORM 2QBO {10/80)
SOLID ANO HAZARCOJS WASTE
(INSTRUCTICNS ON BACK SHEET)
WASTE
I '
TRANSPORTER REPRESENTATIVE'S SIGNAruAE
SHIPMENT DESCRIBED ABOVE FOR
TSOF REPRESENTATIVE'S S10\IATURE
FOR ADDITIONAL lNFORt,u,Ticr-.i:
CONTACT MANIFEST SYSTEM
SOLID & HAZ.6q[)QOS WASTE MANAGEMENT SR-'NCH
N. C. DEPARTMENT OF HU~AN RE~CES
P, 0, BOX 20'-1, RALElCrt, NC 27602
( QHI) 733-2H8
OATE
!
'
DATE
(
• NCRTH CAROLINA Hf-\ZA~DOUS WA-~IFEST
A llJt.l,iU lCAflLN I"'"' • TION 1 I
EPA ID NO, NM-.lE ADDRESS !TELEPHONE I
/\!CO 0 L-t Cl, 1!._\"o-..) I~~( I
GENERATOR 't?D . .;' ;;i:i,; II I Mu ,.c:,. J?i o d ... :-.. .:, Q, l(CJA ,~ I /7 ~··-I,'~,.., ll.(," ,,;,,, . f i
AtC,D
C,f:o:I< ,; 1.,t...,iM>-1,-•
'cl// CV (! .,_J::._~ j i.:>r-6,,.r) ? <;'-{ .:c ~-,:_ ;z
i
TRANSPORTER 1 (-/,,r.,(:,:,;,.·.;; -f,. ,_c.,,,,,.· ,./j
-'
TRANSPORTER 2
NCT Altapass Road
TSDF* 380010330 MITCHELL SYSTEMS Spruce Pine, N.C. 28777 704-728-5931 I
' B WASTE INFORMATia-l 7
CONTAINERS(S) OOT DESCRI~~:re~/CLASS/ID TOTAL EPA WASTE DIScnEPANCY
NO. TYPE NO. WEIGHT Q!,,!AUTITY CODE NUMBER INFORMATION
/ Cc, i'h. \:,..._-.; {; \,, \~ L i ..._\ct "'· o_ .5. ()ppro{-A f?-"-' f 3f ,,[£61i Dc:>0,.5
q 6 vD :f I Co,·-U«.s(. l-:, t "{_ U...l,c\ I'.. O • 5 . . (' /'' '--::L -./ 'f<u.~
I.{ ~oc.-g,J.-. ~Fk <:">*o ..
0,-:Jd,\
'I,.\ 14-ta.'12' ~•=-t-,J
i
C EMERGENCY N\.MBF"R sJ NATIONAL RESPONSE CENTER: 1-800-424-8802
GENERATOR:( None .:IC: )DISPOSER: (
704
728-5931 ) N. C. HIGHWAY PATROL
( 919) 733-3861
I
D SPECIAL HANDLING/EXCEPTION REPORT/DISCREPANCY REPORT (NO. ) !
f-l "-O i;:: c, =~J. ~le, <:"'-l I &;; . ~ tk 6._1,'f)1&7-/8 5,< ~k"-"'-ve... \' '\ \) i' ( 0 --e. •t\. I
'
'
(IF NEEDED, USE A.DDITl(:f',jAL SHEETS.)
'
E CERTIFICATICNS
THIS IS TO CERTIFY THAT THE ABOVE-NAMED MATERIALS ARE PROPERLY CLASSIFIED, DESCRIBED, PACK-
AGED, MAAKED AND LABELED, AND ARE IN PROPER CONDITION FOR TRANSPORTATION ACCORDING TO THE
APPLICABLE REGULATIONS OF THE DEPARTMENT OF TRANSPORTATION AN~ UNITED STATES ENVIRON-
MENTAL PROTECTION AGENCY. .,...-., s-....... .
J.e..r-"'-_\ 'y 0)-e~(<:l-e 1 :L D, )s-~~ '----., . Jl/ :1.3/J'5
~.iTHOR zr:::r·.' RFPRESENTAT!V► OF GE""'RATOO GE RfTOR REF'~ 15.NTAT n'T
THIS IS TO CERTIFY ACCEPTANCE OF THE HAZAROOUS WAS1'E H!l'MENT DES(11IBED.ABOVE.
GAe.~ .S:r ... ~~ts .. ,-,. IZ"" R PA ,c:-i::I TATIVF OF TRAN,.. ....... ,..T .. ,.. 1 ~ "~ ,\:/t._.,./h---TR"'-"lS 1"J-t"R ESENTATIVE '$ SIGNATURE ';}Lzi/s: Al,
AUTI-ORIZEO REPRESENTATIVE. OF TRANSPORTER 2 I
THIS IS TO CERTIFY ACCEPTANCE OF THE HAZARDOUS
D TREATMENT □ STORAGE OR n DISPOSAL
AL.Jll-tORIZEO REPRESENTATIVE OF TSDF
•TSOF -TREATMENT STORAGE I OA DISPOSAL FACILITY
OHS FORM 2080 (10/BO)
SOLID ANO HAZAACOJS WASTE
( INSTRUCTIONS ON BA.CK SHEET)
WASTE
I
TRANSPORTER REPRESENTATIVE '5 SlGNAfURE
SHIPMENT DESCRIBED ABOVE FOR
TSOF REPRESENTATIVE'S SIGNATURE
FOR ADDITIONAL. lNFORMATIClt',I: ·
CONTACT MANIFEST SYSTEM
SOLID & HAl-"qro.,s WASTE MANAGEMENT BR-'NCH
N. C. DEPARTMENT OF HUMA.hl RESOLACES
P, 0. SOX 2091, RALEIGt, NC 27002
( 010) 733-2178
DATE
0,. TE
GRA.GER l~OR~A~OR-ORIES
ANALYTICAL AND CONSULTING CHEMISTS
709 West Johnson Street • Raleigh, North Carolina 27603
ANALYTICAL LABORATORY [phone] CONSULTATION
En\·ironml'nt . .i..nalysis
Cnn~trurtic,n ;ll:11e,ial1-
Jrkntifinti(in of l"r,kno·,rns
,\ ~1-iri1 It u rt'
December 30, 1982
82-5637
;lll'i<tllurgic·al Sl'r\'kt'.'•
Pollu1ion .-\halt'llll'nt
Pro<·1.•.-;...-Dl'l'l'lnpml'111
Qu;,lit~· Control
;\ll'lhod...-Dt·rt•lopmenl
Speei:1! !nl"C'!-ti,:::11ion
PL'.'tir·idt•.'
ful'I;
Tt'.\lilrs Enviro-Chem Waste Management Services
Post Office Box 10784 AMENDED COPY
(1-5-83)
(3-11-83)
Raleigh, North Carolina 27605
Attention: Mr. Jerry Deakle
Subject: Analyses of Samples Received 11/24/82, 12/6/82
Sample Identification:
Incineration Profile
1. Solvents
2. via s te Dils
3. Oxidizing Oils
Incineration Profile
Lead, total as Pb, µg/g
Sulfur, total as S, µg/g
Beryllium, total as Be, µg/g
Mercury, total as Hg, µg/g
Arsenic, total as As,
Cadmium, total as Cd,
Chromium, total as Cr,
Halogens, as Cl, µg/g
pH
Ash, wt%
BTU/lb
Specific Gravity
Flash Point, (CC), °F
JDT:ca
Customer #44500
µg/g
µg/g
µg/g
Landfi 11 Profile
1. Al ka l i ne 5. Acid 1
2. Aqueous 6. Acid 2
3. Paint 7. Tar
4. Solids 8. Pesticides
RESULTS
1
<2.4
0.0003
<0.12
0.20
0.13
0.17
0.96
73,990
3.8
0.01
15,389
0.941
<60
2
<4.8
0.0002
0.82
<0,05
0.24
0.33
46.8
14,350
7 .1
3.26
16,226
0.979
60-140
3 -
0.6
0.0002
0.11
<O, 20
<0.20
0.11
1. 4
1,386
6.3
0.07
15,424
0.962
>140
~-~/ ~~ c. c_ ____ _
mes D. Thacker
Techical Director
HCfl:\
Enviro-Chem Waste Management Services
GLI #82-5637
December 30, 1982
Page 2
Landfill Profile
Physical State
Viscosity -70°F
l ering(l)
cific Gravity at 70°F
pended Solids, by vol.
Suspended Solids, by wt.
Dissolved Solids, by wt.
Thousands of BTUs/lb
Flash pt. (cc) °F
Toxicity
Affinity for Water(2)
Organically bound Sulfur, wt%
Organically bound Chlorine, wt%
lanically bound Nitrogen, wt%
Volatile Solids, wt%
Moisture, wt%
Cyanides, total as CN, µg/g
Pesticides
Total Organic Carbon, µg/g
Arsenic, total as As, 119/g
-Leod, total r1s Pb, 119/g
Copper, total as Cu, µg/g
1
Liquid
Medi um
BL
1.088
5-20%
5-20%
<l
>140
Unknown
H
<0.1
<0.0001
0. 360
13.8
90.89
82.84
21. 82
*
53,000
<O. 20
<2.5
1. 2
2
Liquid
Medium
ML
1.028
5-20%
5-20%
<l
>140
Unkn01·m
H
<0.1
<0.0002
0.244
6.1
97.48
88.07
1. 27
*
62,900
0.06
2.5
2.5
RESULTS
(con't)
3
Liquid
Medium
BL
1.030
5-20%
5-20%
12-16
60-140
Unknown
H
<0.1
<0.0003
0.598
96. 92
77 .80
3.85
*
238,000
0.5
57.8
2.3
4
Solid
High
None
>20%
>20%
<l
>140
Unknown
L
<0.1
0.077
0.120
51. 33
29.58
2.17
*
62,500
5.6
165
241
5
Liquid
Medi um
BL
1.476
5-20%
5-20%
<l
>140
Medium
H
<0.1
<0.0001
0.175
<l
89.98
33.50
*
*
546
0.09
21. 9
4.1
6
Liquid
Medium
None
1.042
<5%
<5%
<l
>140
Medium
H
<0.1
<0.0001
0.0093
<l
99.29
99.02
*
*
149,000
<0.20
<2. 5
4.3
7
Solid
High
None
N/A
>20%
>20%
<l
60-140
Unknown
L
<0.1
0.748**
0.463
97 .18
13.60
*
*
***
42.9
283
4.6
8
Liquid
Medium
None
0.820
<5%
<5%
9-12
>140
Unkno~m
H
<0.1
0.0043
0.794
8.1
98.57
99. 71
*
*
***
<0.20
<2.5
<0.50
Enviro-Chem Wnste Management Services
GLI #82-5637
December 30, 1982
Page 3
Landfill Profile
1
Titanium, total as Ti, µg/g <9.9
Barium, total as Ba, µg/g 2.5 lenium, total as Se, µg/g <0.10
c, total as Zn, µg/g 2. I)
Cadmium, total as Cd, µg/g <0.12
Silver, total as Hg, µg/g <0.02
Nickel, total as Ni, µg/g <0.99
Chromium, total as +3 Cr , µg/g 1. 7
Iron, total as Fe, µg/g 46
Antimony, total as Sb, µg/g <5.0
Manganese, total as Mn, µg/g 1. 5
Cobalt, total as Co, µg/g 2.0
Chromium, total +6 as Cr , µg/g <0.1
I BL -13ilayered
ML -Multi layered
( 2) H -Hydrophilic
L -Lypophilic
*Not Detected
• **Method of Method by Schoniger
***Sample not ammenable to test
2
<10.0
82.8
<0.10
9.9
<O. 13
0. 50
1.0
220
57
7.5
5.0
<1. 3
<0.8
RESULTS
(can't)
3 4 5 6 7 8 --
<10.1 <20.7 9.7 12.6 36.1 10.0
10.0 72.4 2.4 7.5 10. 3 2.5
<0.10 <0.10 <0.10 <0.10 <0.10 <0.10
3.3 510 2.2 2.6 2,898 1.1
0. 68 49.1 0.88 3.3 1.1 0.13
<0.25 0.52 <0.24 0.25 0.52 0.25
1.8 17 540 1.0 6.7 1.0
8.6 540 <0.7 1.8 <1. 6 0.75
220 12,000 260 160 190 2.5
<5.0 16 7.3 <5.0 <10 <5.0
3.5 19 10,000 0.8 8.3 0. 25
<1. 3 45 20 2.8 2.6 1. 3
<1.0 3.8 0.43 0.47 <1.0 <0.10
9
AQUEOUS
~ H20 H2O
Sam~l e # Oxidizer Reducer 1scibilitv Reacti vit.)'
A2C Neutral +
Al2 Neutral +
Al3 Neutral +
Bl Neutral +
D5 Neutral +
SOLVENTS
H2O H2O
Sam~le # Rt! Oxidizer Reducer Mi sci bil it.)' Reactivity
D-3 Neutral
C-9 Neutral
B-8 Neutral
C-2 Neutral
C-6 Acidic +
Cl Acidic
B-6 Acidic +
D-6 Acidic -
2AG Acidic
PAINTS
H2O H2O
Sam~l e # Rt! Oxidizer Reducer Miscibil it.)' Reactivit.)'
A2B Neutral Suspendable
A2Cl Neutral Suspendable
SOLIDS
H2O H2O
Sample # Rt! Oxidizer Reducer Miscibil it.)' Reactivity
B-7 Neutral +
B-2 Neutral +
A2D Neutral +
B-14 Neutral
A2Sl Neutral
C-11 Neutral +
B-12 Neutral
A2S Neutral
A2F Neutral +
*Sample C-6 reclassified as an Acid.
• OILS • HzO H20
Sam~l e # _p_fi_ Oxidizer Reducer Miscibilit.)'. Reactivit.)'.
B-9 lieutra l
C-0 Neutral
I D-1 Neutral
C-10 Neutral Slight
C-3 Neutral
D-2 Alkaline +
A-1 Neutral
C-12 Neutral Strong +
D-7 Neutral
B-10 Neutral
D-4 Neutral
A-1-A Neutral Slight
B-0 Neutral 50/50
C-5 Neutral
ACIDS
H2D H20
Sample ~ _p_fi_ Oxidizer Reducer Miscibilitv React iv it.)'. "
B3 Acidic +
C13 Acidic +
C4 Acidic + + +
BASES
H2D H20
Sam~l e # _p_fi_ Oxidizer Reducer Mi sci bi lit.)'. Reactivit.)'.
A2E Alkaline +
B-5 Alkaline +
C-8 Al ka l i ne +
D-11 Al ka l i ne +
C-7 Alkaline +
• COMPOSITE FORMAT • Oils, Redox Neutral, pH Neutral
Al co D4
BO C3 D7
B9 C5 1+3
B1O Dl 1+3
Oils, Oxidizing, pH Neutral
AlA
Cl.O
Cl2
Acids, Composite #1
C-4
Cl3
F8
A4
Acids, Composite #2
B3
F2
H-14
C6
Solvents
H-4 B8
H-6 C-2
2AC C-9
B6 D-3
D-6
Al ka l i ne
F-4 H-4 C-7
F-6 H-8 C-8
H-11 B-5 D-2
H-12 B-11 42E
Paint
A2b
Cl
• COMPOSITE FORMAT
(continued) • Aqueous
A-1-2 0-5 H-9
A-1-3 F-5 H-7
A-2-6 E-6
B-1 F-16
Solids
A20 H5 B14 H5
A2Sl B7 A2F
B2 F3 H15
B12 H13 Cll
i ;
,,. •• ~ ~ North Carolina Department of Natural r Resources &Community Development
James B. Hunt, Jr., Governor · Joseph W. Grimsley, Secretary
Mr. Donald M. Dawkins
Pittman, Pittman and Dawkins, P.A.
P, 0, Box 758
Rockingham, North Carolina 28379
DIVISION OF ENVIRONMENTAL MANAGEMENT
PROJECT: March 29, 1983
}!aeon Machine Company, Inc,
Cordova Facilities
·:··Dear Mr. Dawkins:
Waste Oil/water Land Application
Disposal -Richmond County . ,,
We acknowledge receipt of the following documents:
. ' ·,:}
:.,_· __ _,X"---____ p,ermit application -APN -'0"'0"'2,,_0,,_6,,_6,,__ __ _
__ __;Ma=rc..=cc.ch_9=-----' 19 83
_______ _;engineering plans
_______ _;specifications
__ _,X"---_:==--_;other Order aonointin~ receiver and soils renort
Your project has been assigned to Mr. H. Dale Cr1.sn for a detailed
engineering review. All project documents will be reviewed with respect to the
proposed wastewater tacilities. This review will not commit this Division to
approving any expansion of these treatment facilities or increase of flowrate in
the future.
Prior to the issuance of the permit, you will be advised of the recommendations
and comments of this Division. You will also be informed of any matter which needs
to be resolved.
Our reviews are scheduled based on receipt date of complete informations. The
items checked below are needed before your project can be reviewed.
________ permit application (copies enclosed)
________ engineering plans (signed and sealed by N.C.P.E.)
_______ _;specifications (signed and sealed by N.C.P.E.)
__ _,X"---·----'other additional information detailed on attachment
The above checked information is needed by May 2~, 1983 If not received,
your application package will be returned as incomplete. Please be aware that the
Division's Fayetteville Regional Office must provide RECOMMENDATIONS from
the Regional Supervisor or a Procedure Four Evaluation for this project, prior to final
action by the Division.
If you have any questions, please call the review engineer at this telephone number
919/733-7120.
cc: Mr, O. W, Strickland
Mr. Dennis Ramsey
HDC/mcb
SincertJly ,~7
l?'x,,/, , . , :~=-~ ft e:
'H. Dale Crisp, J1'/E., Supervis <lo 1 State Engineering Revie_w Group .,,,
Permits and Engineering Unit
P_ 0. Box 27687 HolP.igh. N.C.27611•7687
An Equal Opportunity At'firmative Action Employer
•• ••
RUFUS L. EDMISTEN
ATTORNEY GENERAL
MEMORANDUM
TO:
FROM:
SUBJECT:
~hrle of ~ortiy @11roliu11
,![lcpurhnrnl nf 3Juolirr
Glenn Dunn
Attorney
Robert R.
Assistant
P. 0. BOX 629
RALEIGH
27602-0629
February 22, 1983
Reilly1{Z
Attorney General
The General Tire & Rubber Company Release
I agree that the language "approximately five hundred
(500) drums of waste oil" should be substituted for
the word "waste" on line 8 of the first paragraph.
I trust that it has been established that (i) $8,000
is sufficient to dispose of the waste and (ii) there
has been no soil or groundwater contamination from
the drums.
RRR:flf
DIVISION OF HEAL TH SERVICES
P.O. Box 2091
Raleigh, N.C. 27602-2091
MEMORANDUM
TO:
FROM:
SUBJECT:
February 18, 1983
Glenn Dunn, Attorney
Solid & Hazardous Waste Management Branch
Environmental Health Section
Terry F. Dover, Eastern Area Supervisor
Solid & Hazardous Waste Management Branch
Environmental Health Section
Status of Macon Site
Ronald H. Levine, M.D., M.P.H.
STATE HEALTH DIRECTOR
In my opinion the Macon Estate site has met the intent of the order given by
Superior Court Ju_dge Mo_rgan on November 8, 1982. The site has been secured
by fenci_ng, gates, and signs. A plan has been submitted describi_ng disposal
or· recovery options. This information was submitted to our office on January 5,
1983. Additionally, two monitori_ng wells have been installed to determine
groundwater quality. Results from these wells should be available within
the next week or ten days.
The estate's contractor, Envirochem, is in the process of developing a final
closeout plan which will address all aspects of closure and a timetable for
same.
TFD:ct
ST A TE OF NORTH CAROLINA James B. Hunt, Jr/ Sarah T. Morrow, M.D., M.P H DEPARTMENT OF HUMAN RESOURCES GOVERNOR SECRET ARY
•• THE GENERAL TIRE & RUBBER COMPANY
ONE GENERAL STREET AKRON OHIO 44329
February 14, 1983
Glenn Dunn, Esquire
Solid & Hazardous Waste Management Branch
Environmental Health Section
Division of Health Services
P.O. Box 2091
Raleigh, N.C. 27602-2091
Re: Disposal of General Tire Waste
Dear Mr. Dunn:
Pursuant to our discussion on Friday, I am enclosing proposed
Release language to resolve your request to General Tire for
cleanup costs relating to its non-hazardous waste located on
the Macon Estate in Richmond County.
Please let me know your reaction to this proposal. My
telephone number is: [phone]. ·
TER:vm
Enclosure
;;;:✓• /Ls I,
Theodore E. Ravas, fr.
Assistant Counsel
\
' ' '• ' ..
. j:1 ·•· _,:_.~~--;-.~'.'fl)..))
~La•-~{?~ t. ....,.....,,,,.,~· ___ ., .. Scho
/Yf 0..C tn-J
arolina State University =::::::=-
ulture and Life ScieT1ces
Extension Biological & Agricultural Engineering
North Carolina State University
P.O. box 5906
Raleigh, North Carolina 27650
r.car Sir or Madam:
' . .···. . . . '
The No.rth Carolina Agricu.ltura1 Extension Service is Sending yo~ ~ateria1 y~U
req'Jested or material we think might be Of interest ~o you, .We sincerely hope
you will find it .helpful.
Sincereli, · · · · ··;"·
a . £ -~~
Extension Specialist
Biological.an~ Agricultural Enginc~ring
Cvr,11rratiur E:rtrnsioii Work in Agricultu" and Home Econamics A&Tand N.C. State UnWersities, 100 Co,mtie~·and U. S, Department of Agriculture
\
S11'£ INVESTIGATlCJi< .. .• i~fcD JO
. . 1,:-.; -, ' '. .. Richmond
Introduction
Macon Estate
County, North
1ss3 ''c.V
Carolina tNV. /,11A:'.1AGLVtENT
FA Ym EV!LLE REG. OFFICE
The est.::.tc of Mr. Charles Macon has inherited a waste disposal
site on· which nine pits have been const~ucted for.purposes of·
disy-.o:;al of various wastes. These pitS contain a·large volume_of
water which,_ if ~isposed of on the site, will reduce the volume of
\·:a3te. for ultimate disposal appreciably. The purpose of this report
is to address t·he · capability of the site for assimilating the hydraulic
an~ the heavy metal load present. iri 'this volume of water.
Tooograo~y ·
The topography on the proposed receiver site is gently sloPing
to the southwest. The maximum slope on the property appears to be
le$s than 5 perl Jnt.
Soil Investigation
The soil on'the receiver site h~s been mapped by the Uni~ea·
;;tates Department of Ag_riculture, Soil Conservation Service. The
predominant·soil'series encountered on the site is O~angeburg loamy
sand. A tXpica~_description of the Orangebur9 sand is:
A .P 0-7"
7-12"
12-54"
·aark gray biown· loamy sand; weak,
fine granuiar struc_ture; very fr.iable;
many medium and fine roots.
strong brown sandy loam; weak, fine
subangular blockeY structur~; very
friable, ma~y.fine roots.
· y~llow red sandy clay loam; moderate
medium subangular blockey ·structure;
friable; many fine rootsi patchy clay
films on ped faces.
boring terminated.
' \
-2-
The soil aMo be well suited as a recei ..... for the
wastewater contained in the pits. ·Soil tests have been taken and
sent to the North Carolina De"par~nt of r'.griculture, Agrcnor.-:y
,Divi~i~n, for analysis. The critical factors in the soil tests
are the pH and the cation exchange capacity. The most restrictive
case which could.exist is a cation exchange capacity (CEC) ·1ess
than 5. For purposes •'of the calclllat;.ions which follow, this
most restrictive condition is assumed. Prior to the application of
any waste material to _1::-he land, the soil pH Should be increased to
6.2 to 6.5. This can be accomplished by the addition of lime to the
-soil~
Nutrients
The plant nutrients of major concern in a land treatment facility
are nitrocjen and phosphor~s. Data was not provided on the ni troge_n
·or phosphorus concentration in these pits. The nutrient value of
this w0astewa ter is_ assumed to be at or near O a"nd ·should not be a·
factor in the disposal of this wastewater on land.
Heavy Metal Loadings
Analysis of the wastewater· from the nine· _lagoons was provided.
The table below listS·th~ volume and the heavy metal load in each
of the nine lagoons. A total of each constituent is then presented
at the bott~;n· of the table. The ma:x'imum cu.mlllative metal loads on
sandy soils (those considered most restrictive from the ~EC standpoint)
are given in the table below. Based on this table, "the copper load
appears to control the size of the land area "required. The .008 of
an acre are readily available on the site investigated, and metals
should prove,, to .. be .. no. problem in the operation of this land disposal
site.
\
-3-
~ .. The hydrologic budget •for a land treatment Site is best determined
for any site by developing a water balance. In the process of land
applicatio~, all wastewater applied to the ·soil surface must move into
t!'lc soil profile. Once .the water has moved into the profile, the waler
move~. ·through the piofile by a variety of physical processes including
evapotianspiration, deep dra_inage, and lateral flow. The slow rate
syStems are deSigned as nondischargin'g systems so there can be no run-
off of wastewater which has been applied to the site. Unfortunately
it is imp9ssible to account for all ·water entering the site as percolate
or evapotran·spirate, a'na a runoff factor ml.1st be proyided for rainfall.
A 10 percent factor i"s allowed for rainfall runoff. This is very
conservative and does not affect the overall hydraulic balance appreciably.
Th .... hydraulic budget f~7 this site indicates that. the monthly dr·1inage
on the Orangeburg soil is 7. 53 .inches. The total amount of wastewater
·that can be irrigated onto the site aimually is 55. 2 inches.
:.-::iplication Method
The primary _objective of land applicittion is to ·alleviate or
eliminate~ surface· discharge of pOllutants. This is accomplished by
eliminating the direct discharge-of .treated wastewater into receiver
streams. The method of a·pplying wastewater to the land is important
in achieving this _goal. ·-~-ither sprinkler lrrigation or ·application
of the liquid from a tanker·truck would be suitable. The application
rate should be limited to slightly over 1 inch·of W?ter per week per
acre of land. A single pump truck with a 250Q gallon tank capacity
· would be able to i;nake 10 "passes" over each acre of land on the
irrigation site per week.
I ,
\
-
Bcsic Assumptions:
Na~e
Richmond
Count~
(1) Soil Series: Orangeburg Sandy Loam (2-6% Slope)
( 2) Average Depth nA" Horizon 7"
(3) Hater Lost to 1/3 Amount 23.3% ·
(4) Water Loss From ''A'' Horizon -1.631 inch/cycl~
(5) Hydraulic Cycle Time
Monthly Drainage
(1) 1.631
(a)· Irrigation Time-
(b) Drainage Time.
(c) Reae=ation Time-
(d) Total Hydraulic
Cycle
in./cycle X 30 days/mo
6.5 days/cycle
. 5 Cays
3.0 days 3. 0. da:,.•s
6.5 days
7. 53"
MO E.T. Draina9:e Total_l Runoff · Total2 Rainfall Irriqation
J .93 7.53 8.46 .54 9. 0 5.40 3.60
F 1. 40 .7.53 8.93 .60 9.53 5.79 3.74
i•l 2.17 7. 53 9. 70 · .61 10.31 6. 06. 4.25
A. 3.30 7.53 10. 8:i .53 11. 36 ·S.30 6.06
M 4.34 7.53 11.87 .51 12.38 5.12 7;25
J 4. 80•. 7.53 12.33 .89 13.22 .. e .. sg 4.33
J 4. 65 7.53 12.18 • 9.2 13.10 9.21 · 3.89
A 4.03 7.53 11. 56 .69 12.25 6.86 5.39
s 3.30 7.53 10; 83, .81 11. 64 8.08 3.56
0 1. 86 7.53 9.39 .62 10.01 6.17 3.84
ll 1.20 7.53 8.7] . 4 9 .9. 22 4.92 4. 30
D . 62 7. 53 . 8.15 .35 a.so 3.52 4.98
75.31 55 o 2 II
(worst in
20) ·
LAND AREA REQUIRED:
STORAGE REQUIRED
·----·----·----
Tota:
Star. St.or
i,/A N/A
0 • SOIL & MATERIAL ENGINEERS INC. ENGINEERING-TESTING-INSPECTION
3109 Spring Forest Road, Box 58069, Raleigh, NC 27658-8069, Phone [phone]
February 3, 1983
Enviro-Chem Waste Management Services
Post Office Box 10734
Raleigh, North Carolina 27605
A.ttention: Mr. Jerry Deakle, President
Reference: Groundwater Monitoring Wells
Gentlemen:
Macon Farm
Cordova, North Carolina
S&ME Job No. 051-83-008-A
Soil and Material Engineers, Inc. has completed the installation of
two groundwater monitoring wells at the Macon Farm located off SR 1103 in
Richmond County. Attached are copies of the test boring records, well
records, a location diagram, and a typical well schematic. Copies of the test
boring logs and well records are attached. Copies have also been supplied to
the t-lorth Carolina Department of Natural Resources and Community
Development.
It has been a pleasure working with you on this project. Please
contact us if you have any questions or if we can be of further service.
EFP/bsp
Attachment(s}
Sincerely,
SOIL & MATERIAL E/~INEERS,
-=----C~ 'l~J/
Ernest F. Parker, J~ .• P.E.
RALEIGH, GREENSBORO. ASHEVILLE, WILMINGTON, FAYETTEVILLE. CHARLOTTE, NC
SPARTANBURG, COLUMBIA, CHARLESTON, MYRTLE BE~.CH. SC
INC.
ATLANTA, ALBANY, GA-TRI-CITIES, KNOXVILLE. TN-MONTGOMERY, AL-CINClr<NATI. OH-ORLANDO, FL
PROJECT
M
C ...... .....
"" Vl
Macon Fann Monitoring
Wells
DUNCAN•l'AR,..E:LL, INC., RALll!:IGH 111111
• •
LOCATION DIAGRAM
D
□
SOIL SMATERIAL ENGINEERS,INC
RALEIGH, NORTH CAROLINA
v1-2
Lagoon
Laqoon
SCALE: Not to Scale
JOB NO: 051-83-008-A
FIG. NO: 1
.-:-·_. -----.----_-~-. --.....'Ill-• i
Steel Locking Cao ----e,,~
4" Steel Casing
...
. . Neat Cement Grout-.----l,,..H. . .
2" !Jia. Sch. 40 PVC Pipe--+---..
Washed Coarse Sand (ASTM C-33) --•f21i;i
2" Sch. 40 Well Screen
8"
.:-F . 1:::-r--.--i+------
. . . . . .. .
. ... . . . . . . . . . . . . . . . . . . . .
3-c
Varies (20'+)
2'
2'
20'
PROJECT
Macon Farm
Richmond County, NC
SOIL 8 MATERIAL ENGINEERS,INC
RALEIGH, NORTH CAROLINA
SCALE: NTS
JOB NO: 051-83-008~A
FIG. NO: 2
DUNCA.N,,-,UU•t:LL, INC., ll"Ll:IQH 1181
DEPTH
i Ff . DESCRIPU
0.0
Brm·m Fine to Medi um Silty SANO
5.0
Red to Orange Sliqhtly Clayey Fine to
Medium Sandy SILT
20.0
Brm,n Clayey Fine to Medium Sandy SILT
30.0
Orange to Brown Fine to Medium Sandy
Silty CLAY
36.0
Brown Fine to Medium Sandy Silty CLAY
40.0
BORING AND SAMPLING MEETS ASTM D-15B6
CORE DRILLING MEETS ASTM 0-2113
·-
PENETRATION IS THE NUMBER OF BLOWS OF 140 LB. HAMMER
FALLING 30 IN. REQUIRED TO DRIVE 1.4 IN. 1.0. SAMPLER I FT.
.UNDISTURBED SAMPLE
Jsq 0/o ROCK CORE RECOVERY
◄ LOSS OF DRILLING WATER
-=-WATER TABLE-24HR.
--=--WATER TABLE-IHR.
ELEV.
0
®P.TRATI0N-BL0WS PER FT.
10 20 30 40 60 80 100
TEST BORING RECORD
BORING NO. _W_-~1 __
DATE DRILLED 1-12-83
JOB NO. 83-008
SOIL 8i MATERIAL ENGINEERS, INC.
DEPTH ·FT .. . . . .
40.0
DESCRIP-
See Previous Paqe for Oescription
53.0 1---------..... ------1
Boring Terminated at 53.n'
Note: Field Classification, Bag
samples collected from auger
cuttings remain at site.
Note: ~loni taring \\'ell Instal lee!
in Borehole, See Attached Sheet.
BORING ANO SAMPLING MEETS ASTM 0-1586
CORE DRILLING MEETS ASTM 0-2113
PEN~TRATION IS THE NUMBER OF BLOWS OF 140 LB. HAMMER
FALLING 30 IN. REQUIRED TO DRIVE 1.4 IN. 1.0. SAMPLER I FT.
.UNDISTURBED SAMPLE -=-WATER TABLE-24HR. J5i 0/o ROCK CORE RECOVERY --=--WATER TABLE-I HR.
.. LOSS OF DRILLING WATER
ELEV. ©PillfiliiTRATION-BLOWS PER FT.
0 P 20 30 40 60 80 100
.\-,, n :_ . ~
• 0 Hr.
TEST BORING RECORD
BORING NO. _W_-""'1 __
DATE DRILLED 1-12-83
JOB NO. 83-nns
SOIL a MATERIAL ENGINEERS, INC.
WELL RECORD
NORT~OLINA DEPART.'~.on OF IJATURAL RESOURC-ES r COM~UNTTY DEVELOP"",ENT
.,ISION OF EtlVI~OW'ENTAL ~M~AGEMENT, WATE~ SECTION
P.O. BOX 27687 RALEIGH, N.C. 7611
COt0P.ACTOR8Oi 1 &· \fateri al Engrc?.EG. ·No. .110 WELL C0NSTRUCT:o:, PE?~~IT ~o.
1. WELL LOCATION: (Show sketch of the location below)
Nearest Town' Cordova' North Carolina County' Richmond
WELL 1•;-1
_ _,;SR;u..~l"'lbl,!,L ___________ ~ ________ Quadrangle r:o. --"Rcc""-~kiala,0 n,.g""-'h"am'-"--------
( Roaci ,Community or Subdivision and Lot No.)
Contracted
2. By: Envtr~Em Waste ~!anagement Serv. DRILLI:,;G LOG
J. ADDREss, P.O. Box 10784, Rale.igb, NC 27605
4. TOPOGRAPHY: draw,valley~lo??}hilltop,flat(circle one)
s. usE DF WELL, GWR Monitoring DATE, 1/13/83
6. DOES !HIS ~ELL REPLACE AN EXISTING WELL?_-~N~Q.,_ __ _
DEPTH
FRO~TO FOR!-~TIO!~ DESCaIPT!0N
See Attached Test Boring Records
1. TOTAL DEPTH,· 53 Ft. RIG TYPE oR METHOD,Hollow Stem'--'A-"u'°g"'e=r _________________ _
8. FORMATION SAMPLES COLLECTED: YE~N0 _____ _
9. CASING: Depth Inside Wall thick. type
Dia. or weight/ft.
From_O_to 33 ft. 211 .. Sch. 4Q PVC
10. GROUT: Depth Material Method
From~to~ft N. Cement _Pum_._P ____ _
..n_ __illL_ Bentonite ~f..,.e""l_.l.,_e'-"t,.s'-----
11. SCREEN: Depth Dia. Type & Opening
From~to 53 ft 2" PVC-0. 010"
If additional space is neeoeo, use oacx a£ zo~~
LOCATION Si<.ETCH
(Show distance to numbered roads, or other map reference ~oints)
See Attached Sketch
1~. GRAVEL: Depth Size Material
Frcm~to~ft Sand ASTM C-33
13. WATER ZONES (depth) , __ 4"-"3'---"5"3"--'Ft'-"-'-'------
14. STATIC WATER LEVEL: 43 ft.b l ···top of casing --e ow
Casing is2'+ ft. above land surface ELEV:-==-
15, YIELD{gpm): NI A METHOD OF TESTING: ___ _
NIA 16. PUMPING WATER LEVEL: ______ ~ft,
after ____ hours at. ______ gpr:i.
17. CHLORINATION: Type _____ ~Arnount. ____ _
18. WATER QUALITY: NQt Tested ~rE:MPERATURE (oF) __ _
19. PER'1ANENT PUMP: Date Installed. ____ N_/_A ___ _
Type. ______ Capacity _____ (gpm) HP __ _
Make. __________ Intake Depth.'-----
Airline Depth __ Y_e_s __
20. HAS THE OWNER BEEN PRO'f~D A COPY OF THIS RECORD AND INFOR.'1E0 OF THE DEPARTMENTS REQUIREMENTS ASD
RECOMMENDATIONS?
21. REM.AR.KS-:----:--:---:----:---:-:---------:-:-----.,-----,------.,-----------I do hereby certify that this well was constructed in accordance with N.C. Well Construction
Regulations and Standards and that thi~ w 11 record is true and exact •
.7.,/3 83
SIG<i1\TliRJ.: OF OR OF AGENT
Form GW-1 Revised 11/3/77 Submit original to Groundwater Section and copy to well o,.:ner.
DEPTH . DESCRIPTIO-
FT.· '
l. 0
7.5
8.0
10.0
15.0
22.5
25.0
40. 0
Brown ~o Red Slightly Clayey Silty
Fine to Medium SAND
., '
Brov1n to Red Silty Clayey Fine to
Medium SAND
Red Slightly Clayey Fine to Medium
Sandy SILT
Red Clayey Fine to 11ediur.i Sandy SILT
Red to Brown Slightly Clayey Fine to
Medium Sandy SILT
Brown_ Silty Fjne to Medi um Sandy CLAY
BORING ANO SAMPLING MEETS ASTM 0-1586
CORE DRILLING MEETS ASTM 0-2113
PENETRATION IS THE NUMBER OF BLOWS OF 140 LB. HAMMER
FALLING 30 IN. REQUIRED TO DRIVE 1.4 IN. 1.0. SAMPLER I FT.
-UNDISTURBED SAMPLE -::-WATER TABLE-24HR.
j59% ROCK CORE RECOVERY -~--WATER TABLE-I HR.
◄ LOSS OF DRILLING WATER
ELEV. (3PEN~ATION-BLOWS PER FT.
o 10 'Po 30 40 60 so 100
TEST BORING RECORD
BORING NO. __,W;_-.,:.2 __
DATE DRILLED 1-11-83
JOB NO. 83-008
SOIL a MATERIAL ENGINEERS, INC.
DEPTH;
FT,
40.0
DESCRIPTIO-
See Previous Page for Descriotion
48.0 -
Boring Terminated at 48.D'
NOTE: Field Classification, Bag Samoles
Collected From Auger Cuttings Remain
at Site
NOTE: Monitoring Well Installed in
Borehole, See Attached Sheet
'
* Brown.Silty Fine to Medium SAND
BORING AND SAMPLING MEETS ASTM D-1586
CORE DRILLING MEETS ASTM D-2113
PENETRATION IS THE NUMBER OF BLOWS OF 140 LB. HAMMER
FALLING 30 IN. REQUIRED TO DRIVE 1.4 IN. I.D. SAMPLER I FT.
.UNDISTURBED SAMPLE
j!9% ROCK CORE RECOVERY
◄ LOSS OF DRILLING WATER
-=-WATER TABLE-24HR.
-~-WATER TABLE-I HR.
ELEV. G)PEN,WTION-BLOWS PER FT.
0 IO 30 40 60 80 100
--40' ,]
• 0 \lr.
..
'
TEST BORING RECORD
BORING NO. ....;.:.H_,-2'-_
DATE DRILLED l-ll-S3
JOB NO. 83-008
SOIL& MATERIAL ENGINEERS, INC.
WELL RECORD
NORT.a\,ROLINA DEPART"IENT OF tJATURAL RESOURCE-COMMUNITY D=VELOPMENT
~ISION OF ENVIROtW,ENTAL MANAGEMENT, ~WATER SECTION
P.O. BOX 27687 RALEIGH, N.C. 27611
DRILL1~;G co!:-rRACTOR &:,; J ~· \fa teri a J En ~G. }:o. 41? KELL CONSTRt.:CT!ON PER"1IT ~:o.
1. WELL LOCATiml: (Show sketch of the location below)
Nearest To ..... n: Cordova, North Carolina
WELL W-2
County : __ _.R.,__1-1-· Cc.bJOOl.1..1.J...... _________ _
-=---c--=---..,...SS"'R-"-1==1,'0',a3'-,--,-____ -,-~-cc--c------Quadrang 1 e No. _Ru,.OCs...rk.,i.in.,_ge.hl.!S!am!.!.!... ______ _
(Road,Community or Subdivision and Lot No.)
2 _ ~~tracted Enviro--Chan Waste ~!anaganent Serv. DRILLING LOG
J. ADDREss, P.O. &lx 10784, Raleigh, NC 27605
4. TOPOGRAPHY: dra ..... ,valley,slope,hilltop,flat(circle one)
5. usE OF WELL, GWR Monitoring DATE, 1/11/83
6. DOES THIS ~ELL REPLACE AN EXISTING WELL?--1>1.J ____ _
DEPTH FR0-:.1--TO FOR.'-~TION DESCRIPTION
See Attached Test &iring Records
1. TOTAL DEPTH,· 48 ft.RIG TYPE OR METHOD, Hollow Stem An· er -=~----------------
8. FORMATION SAMPLES COLLECTED: YELll_ NO
9. CASING: Depth Inside Wall thick. type
Dia. or weight/ft.
Fro~_Q_to....28._ft 211 Sch, 1.0 PYC
10. GROUT: Depth Material Method
From _Q_ to__g§_ ft N. Cement ~Pum~~P~-----
26....._ ...21_ Eentonite --"P~e~J~J~e~t~s,_ ___ _ It aac1t1onal space 1s neeaea, use back of term 11. SCREEN: Depth Dia. Type & Opening
PVC 0.010" LOCATION' SKETCH Fro~to~ft 2"
(Show distance to nucl>ered roads, or other map reference uoints)
l?, GRAVEL: Depth Size Material
From..21....to~ft Sand ASTM C-33
13. WATER ZONES(depth) , __ 4_0_-_4_8_Ft __ , _____ _
14. STATIC WATER LEVEL:..1Q_ ft.belo~top of casing
Casing is~ft. above land surface ELEV:..:.:.._
15. YIELD (gpm) :_N,/.lL__METHOD OF TESTING:
16. PUMPING WATER LEVEL: NIA ft.
after hours at gpn..
17. CHLORINATION: Type !'!L!). Amount
1a. WATER ouALITY: Not TestedTEMPERATURE<0rJ __ _
19. PERMANENT PUMP: Date Installed._~Nu{~A~------
Type, ______ Capacity _____ (gpm) HP __ _
Make, __________ Intake Dept.h0 ____ _
Airline Depth, _____ _
See Attached Sketch
20. HAS THE OWNER BEE~ PROV!DED A COPY OF THIS RECORD AND INFOR."1.ED OF THE DEPARTMENTS REQUIREMENTS AND
RECOMMENDATIONS?
21. RDI.AF..i<S -------,-:---------,--,----,--------------I do hereby certify that this well was constructed in accordance with N,C. Well Construction
Regula~ions and Standards and that this well ecord is true and exact.
,,_ :;, 2-/3 '83
SIGNATUR.1:: OF CONTRACTOR OF AGENT D, ~
Form GW-1 Revised 11/3/77 Submit original to Groundwater Section and copy to well owner.
0 G • • R, e J, ..,,_o ;1. j
Ronald H. Levine, M.D., M P.H 1n6+8-11 .------4 1---':....__.,;;;,,_-=---
DIVISION OF HEALTH SERVICES
P.O. Box 2091
Raleigh, N.C. 27602-2091
Mr_ F. G, Troppe, Manager
Environmental Control & Energy
Tire Division
General Tire and Rubber Company
Akron, Ohio 44329
Dear Mr. Troppe:
STATE HEALTH DIRECTOR
January 17, 1983
The State of North Carolina is involved with remedial action on
property owned by the Macon Estate, located near Cordova in Richmond
County_ The site had been utilized by Mr. Charlie Macon, deceased, for
a host of illegal storage and disposal activities of hazardous and non-
hazardous waste without a permit.
Site surveys have revealed that there are thirteen surface impoundments
on site_ Additionally, approximately 3,000 55_-gallon drums were found.
Waste types found include oils, solvents, paint residues, and, of course,
the non-hazardous waste from your plant in Charlotte.
To date, the Macon Estate through its attorney, Mr. Donald Dawkins,
has been able to auction personal property and has accumulated $42,000
which can be utilized toward site cleanup. These monies are not adequate
for total site cleanup and must be spent in a degree of hazard priority.
Therefore, we are asking General Tire and Rubber Company to contribute
funds which would allow the estate to properly dis_pose of the approximately
500 drums of the waste from your company.
The following is offered for your consideration. The disposal will
take place on site as per your November 9, 1982, letter to this office,
alternative 3., b. The operation will be supervised by this branch and
will be in accordance with the N. C. Solid Waste Man_agement Rules. A quote
of $15 .96 per drum has been received by the site contractor worki_ng for the
estate (Enviro-Chern Waste Management Services, Raleigh, N. C.). We feel
that this f_igure is reasonable and are willing to acknowledge that the
contribution which you make would not constitute an admission of liability
on your part.
Please consider this request as we know of your concern for the proper
disposal of your waste and your wishes to be a good corporate citizen in
our state.
GD:ct
cc: J. C. Sadler/
Terry Dover✓
Richard Gay
Donald Dawkins
Sincerely,
Glenn Dunn, Attorney
Solid & Hazardous Waste Management Branch
Environmental Health Section
ST ATE OF NORTH CAROLINA Jomes B Hunt, Jr/ Sarah T. Morrow M.0. MPH DEPARTMENT OF HUMAN RESOURCES ' ' . GOVERt-JOP SECRET Al<'!
nt? Houi,e I Apt. I Furni.shed
Hent v.er Month s mW 1£ Ta~ Lister: Map Lot .... :
!
I \
\
\
~l;i®M?f..1w&MPiMV4g1e1 11
·' ' :2/::,07 ~ 00
[,OFoJTHY MACON
RT. l 1 BOX.
ROCl<INGHAM,
(_ ·0-10
P., 2, 09:;:
LOT:3/ACRE:3=
DWELLINO
39.70
RICHMOND COUNTY
BLANK Foa:.c REAL AND PERSONAL i'HOP~:i;·I'y
W ASOFJANUARYl ·
All values shown on this form represent 100% of true value.
TOWNSHIP • :· .. .. YEAR 19 __ +:cc:
OCCUPATION OH BUSINESS ... -
E~IPLOY EH --'-P._"":,,"'c-,"·;:-cc·_,_, ______________ _
1. STOCK, FIXTURES. AND EQUIPMENT
Inventory will be listed as of last fiscal year end
Value of merchamlise in stock Jan. I S
Value of equipment _________ _
Value of furniture and fixtures Jan. I
Value machinery rH?l ·affi.xe<l to realty
s
$
s
Total of item No. 1 _____________ $ ___ _
2. MATERIALS IN PROCESS OF MANUFACTURE
Value articles on hand Jan. ~----$
Value articles in process Jan. I ___ _ s
Value raw material on hand Jan. l ___ S
Total of Item 2 \ $ __ _
3. PERSONAL PROPERTY
Livestock _____________ _
Tractors
Oth(!r Farm Equip.
Other
Rent or Hom1ehold ,'(( l\lohilc Home.!> ___ _
s
s
s
s
s
Less $300 exemption on rent or homsehold S
Total of Item 3
4. MOTOH VEHICLE1 ~r-.-• !J _., ,.. . :1 i.J..~ ,., q
Auto: ~•y,.,,,,, I Type·• ' 19 ....1....+c-S
Auto: ____ Type __ 19 $
Tn,ck: ___ Type __ 19 S
Truck: Type ___ 19 s
l\lohile Homes Type s
Boats & Motors s
Boat Trailers s
Airplanes s
l\.lotor Cyclf!s $
Other s
/1'7,-3
Total Vehicles_______________ S G/ t/0
TOTAL VALUE OF PERSONAL PROPERTY __ ·_s J 7;93 I
TOTAL VALUE OF REAL PROl'ERTY ____ ,S $'-3.'7oo
GRAND TOTAL ALL PHOPERTY _____ ,S t,,I, 7"13
PROPERTY TAX. RELIEF FOR ELDERI.Y ANH PJ-:RMA,"it:.-..TLY, ·
OISAHI.ED PERSONS: " • 'hl~ . ;.· ·_.'}:,,.-.> ,',·.--~-,,.. .,.,~ ,_ t.'';;
Per-ion~ ~ho l'1"Ct'ived lhe e,clu:iion in 1982 11re nol n-1p1i~d lo ~e-upply ··
in 198.1 or :iuh,iequenl yt•nri unle,i,1 they ch~ngt: lhl'ir pt'rrrnrnt'nl re .. M,inct'.
They are required to notify the Tax Supervi,.or if' lh,:y b..:co111c indigihle . "(":
for the, e;cclm,ion .' .becau!ie their dhipo.,11ble income e;cc_.\! the !lalutory ·
lintlL Di~ahled person!! •nllll'II 11l!o noti£y the Tu;c Supervi11ur H !heir.
dh11bility improves lo thf': poinl thal they can no longt'r qualify. If a
penon receiving the e.,clm1io11 die,, the pe!"l'on r~pon,ible for li1'11ing
the pl'Operty mu!!l ndvh,e the Tnx Supervi.imr.
Atnsey A. Boyd, Ta;c Snpcrvi~or "· P.O. Ro:,c; 1644, Rockinghnm, N.C. 28:179
Tel~phone: m-5041
·. ·(.• ,;.~ : ~i
Untlt!r pr-n•hil:"'I preAcrit...d by law, I ho,reby ,.f(irm lhMI lu 1hr. 1,.,.1 or my knowl..,li,io, 1111,I
~11,.f thl• li•tin!f, in<"lmling any ac('on1p11nying •tat .. nwnt•, in~enlori,'"• •ch,.,fuJ,.., 1111,I olh<'r
inrorm•tiun, i11 ln>e ...,J c-ompl .. 1 ... t If 1hi~ aHirm11lion i~ •itl;n,od hy an inclhidual 01h .. r thnn thr,
La"p•yr.r, hr affirm• 1h111 h .. ;,. familiar wilh lho, .,,,,.nt an,1 true ~-.,lne of 1111 th,:, ''"'Jl"Y"r•,
propo,rty ~uhjo,cl 10 ta,alion in thif l'Onnty and th11t 1hi" afrirmalion i11 1,.,,.,,1 nn nll inform,.tion ofwhichh.-h■.•aYknnwl:,4:' .... 1t . \ '-vl,a · . ) ~ ·. ~·~ .. ~_
SignaluN' . Ii )\ / I •i -/ I ,r M-U -.,,.~~·2• ____ _
L1111 TaJ..,r
. ', . ., ' !' . .. .. .·· .· , ' G R A iif G E R l!;Ol~IA~ 0 R9f O R I E S
ANALYTICAL LABOHATURY
En1·i•n11menl Analysis.
Con.~lnwtion Materials
!drnti£ic.ition of Unknowns
Agriculture
ANALYTICAL AND CONSULTING CHEMISTS
709 West .Johnson Street • Raleigh. North Carolina 27603
[phone]
December 30, 1982
82-5637
CONSULTATION
illetallurgie.'.ll Scr\'il'l'S
Pollution Ab,1\enwnl
Prnt'eSS [le\'\'lopml'l11
Qualit~· Control
illelbods De\'elopnwnt
Special !nn'stigalion Textiles
ChPrnieals
Hazardous Wastt'
Enviro-Chem Waste Management Services
Post Office Box 10784
Raleigh, North Carolina 27605
AMENDED COPY
{1-5-83) HCH,\
Attenti o·n: Mr. Jerry Dea kl e
Subject: Analyses of Samples Received 11/24/82, 12/6/82
Sample Identification:
Incineration Profile
1. Solvents•
2. Waste Oils
3. Oxidizing Oils
Incineration Profile
Lead, total a~ Pb, µg/g
Sulfur, total as S, µg/g
Beryllium, total as Be, µg/g
Mercury, total as Hg, µg/g
Arsenic,.total as As, µg/g
Cadmium, total as Cd, µg/g
Chromium, total as Cr; µg/g
Halogens, as Cl, µg/g
pH
Ash, wt%
BTU/lb
Specific Gravity
Flash Point, (CC), °F
JDT:ca
Customer #44500
Landfill Profile
1. Alkaline 5.
2. Aqueous 6.
3. Paint 7.
4. Solids 8.
RESULTS
1 2
<2.4 <4.8
0.0003 0.0002
<0.12 0.82
0.20 <0.05
0.13 0.24
0.17 0.33
0.96 46.8
73,990 14,350
3.8 7.1
0.01 3.26
15,389 16,226
0.941 0.979
· -~ <140
~~1 ~
mes.~-Thacker
Techical Director
Acid 1
Acid 2
Tar
Pesticides
3.
0.6
0.0002
0.11
<0.20
<0.20
0.11
1.4
1,386
6.3
0.07
15,424
0. 962
>140
Enviro-Chem Waste Management Services
GLI #82-5637
December 30, 1982
Page 3 .
Landfi 11 Profile
1
Titanium, total as Ti, µg/g <9.9
Barium, total as Ba, µg/g
Selenium, total as Se, µg/g 9:, total as Zn, µg/g
Cadmium, total as Cd, µg/g
Silver, total as Hg, µg/g
Nickel, total as Ni, µg/g
+3 Chromium, total as Cr , µg/g
Iron, total as Fe, µg/ g
Antimony, total as Sb, µg/g
2.5
<0.10
2.4
<0.12
<0.02
<0.99
1. 7
46
<5.0
Manganese, total as Mn, µg/g 1.5
Cobalt, total as Co, µg/g 2.0.
+6 Chromium, total -as Cr , µg/g <0.1
( 2)
-Bilayered
ML Multilayered
H -Hydrophilic
L -Lypophil i c
*Not Detected
**Method of Method by Schoniger
-***Sample not ammenable to test
2
<10.0
82.8
<0.10
9.9
<0.13
0.50
1.0
220.
57
7.5
5.0
<1.3
<0.8
RESULTS
(can't)
3 4
<10.1 <20.7
10.0 72. 4
<0.10 <0.10
3. 3. 510
0.68 49.1
<0.25 0.52
1.8 17
8.6 540
220. 12,000
<5.0 16
3.5 19
<1.3 45
<1.0 3.8
5 6
9.7 12.6
2.4 7.5
<0.10 <0.10
2.2 . 2. 6
0.88 3.3
<0.24 0.25
540 1.0
<0.7 1.8
260 160
7.3 <5.0
10,000 0.8
20 2.8
0.43 0.47
7
36.1
10.3
<0.10
2,898
1.1
0.52
6.7
<1.6
190
<10
8.3
2.6
<1.0
8
10.0
2.5
<0.10
1.1
0.13
0.25
1.0
0.75
2.5
<5.0
0.25
1.3
<0.10
' ' ,·
i ' I
I i i
i
r
Enviro-Chem Waste Management Services
GLI #82-5637
December 30, 1982
Page 2
Landfi 11 Profile
Physical State
Viscosity -70°F
'· ;erin/1l
411:cific Gravity at.70°F
Suspended Solids, by vol.
Suspended Solids, by wt.
Dissolved Solids, by wt.
Thousands of BTUs/lb
Flash pt. (cc) °F
Toxicity.·
Affinity for Water(2)
Organically bound Sulfur, wt%
Organically bound Chlorine, wt%
'anically bound Nitrogen, wt%
Volatile Solids, wt%
Moisture, wt%
Cyanides,.total as CN, µg/g
Pesticides
Total Organic Carbon, µg/g
Arsenic, total as As, µg/g
... Lead, total as Pb, µg/g
·.copper, total as Cu, µg/g
1
Liquid
Medium
BL
1.088
5-20%
5-20%
<l
>140
Unknown
H
<0.1
<0.0001
0.360
13.8.
90.89
82.84
21.82
*
53,000
<0.20
<2.5
1.2
2
Liquid
Medium
ML
1.028
5-20%
5-20%
<l
>140
Unknown
H
<0.1
<0.0002
0.244
6.1
97.48
88.07
1.27
*
62,900
0.06
2.5
2.5
RESULTS
. (con' t)
3
Liquid
Medium
BL
1.030
5-20%
5-20%
12-16
60-140
Unknown
H
<0:1
<0.0003
0.598
96. 92
77 .80
3.85
*
238,000
0.5
57.8
2.3
4
Solid
High
None
N/A
>20%
>20%
<l
>140
Unknown
L
<0.1
0.077
0.120
51. 33
29.58
2.17
*
62,500
5.6
165
241
5
Liquid
Medium
BL
1.476
5-20%
5-20%
<l
>140
. Medium
H
<0.1
<0.0001
0 .175
<l
89.98
33.50
*
*
546
0.09
21. 9
4.1
6
Liquid
Medium
None
1.042
<5%
<5%
<l
>140
Medium
H
<0.1
<0.0001
0.0093
<l
99.29
99.02
*
*
149,000
<0.20
<2.5
4.3
7
Solid
High
None
N/A
>20%
>20%
<l
60-140
·unknown
. L
<0.1
0.748**
0.463
97 .18 .
13.60
*
*.
***
42 .. 9
283
4.6
8 i
Liquid . I
Medium
None
0.820
<5%
<5%
9-12
>140
Unknown
H
<0.1
0.0043
0.794
8.1
98.57
99. 71
. '
*
*
***
<0.20
<2.5
<0.50
~ '~ :.;t ~ :-.. OILS ·' • .HO '' H20 2
Samele # .Pl! Oxidizer Reducer Miscibilitv Reactivit,)'
B-9 Neutral
C-0 · Neut ra 1
D-1 Neutra 1
C-10 Neutral Slight
C-3 Neutral
D-2 Alkaline +
A-1 Neutral
C-12 Neutral Strong +
D-7 Neutral
B-10 Neutra 1
D-4 Neutral -
A-1-A Neutra 1 Slight
B-0 Neutral 50/50 . I;
C-5 Neutral -
ACIDS
H20 H20
Samele # .Pl! Oxidizer Reducer Miscibility Reactivity
B3 Acidic +
C13 Acidic +
C4 Acidic + + +
BASES
H20 H20
Samele # .Pl! Oxidizer Reducer Miscibility Reactivity
A2E Alkaline +
B-5 Alkaline +
C-8 Alkaline +
D-11 Alkaline +
C-7 Alkaline +
• AQUEOUS .H 20 H20
Samele # Eli Oxidizer Reducer Mi scibil it,)' Reactivit,)'
A2C Neutral +
Al2 Neutral +
Al3 Neutral +
Bl Neutral +
05 Neutral -+
SOLVENTS
H20 H20
Sami;>le !! .P.ti Oxidizer Reducer Misci~-il itv Re2ctivitv
0-3 Neutral
C-9 Neutral
B-8. Neutral
C-2 Neutral
C-6 Acidic +
Cl Acidic
B-6 Acidic +.
0-6 Acidic
2AG Acidic
PAINTS
H20 H20
Sami;>le # Eli Oxidizer Reducer Miscibil it,)' Reacti vi t,)'
A2B Neutral Suspendable
A2Cl Neutral Suspendable
SOLi OS
H20 H20
Samele # Eli Oxidizer Reducer Miscibil it,)' Reactivit,)'
B-7 · Neutral +
B-2 Neutral +
A2D Neutral +
B-14 Neutral
A2Sl . Neutral
C-11 Neutral +
B-12 Neutral
A2S Neutral
A2F Neutral +
*Sample C-6 reclassified as an Acid.
• COMPOSITE FORMAT •
Oils, Redox Neutral, pH Neutral
Al co D4
BO C3 07
B9 C5 1+3
B10 01 1+3
Oils, Oxidizing, pH Neutral
AlA
ClO
Cl2
Acids, Composite #1
C-4
Cl3
F8
A4
Acids, Composite #2
B3
F2
H-14
C6
Solvents
H-4 B8
H-6 C-2
2AC C-9
B6 0-3 0-6 .
Alkaline
F-4 H-4 C-7
F-6 H-8 C-8
H-11 B-5 0-2
H-12 B-11 42E
Paint
A2b
Cl
. I
. .
• ~. -• ··~· ◄-•·-•• -··-·-··. . .
' " • COMPOSITE FORMAT. ''·· (continued) ·
Aqueous
A-1-2 · D-5 . H-9
A-1-3 F-5 H-7
A-2-6 E-6
8-1 F-16
Solids
A2D H5 814 HS
A2Sl 87 A2F
82 F3 H15
812 H13 Cll
. '