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Home My WebLink AboutNCD980602163_19830401_Warren County PCB Landfill_SERB C_Analysis Reports, 1983-OCRNorth Carolina Department of Human Resources Division of Health Services Occupational Health Laboratory ANALYSIS REPORT -~ vc;s !ia,, ·i APR 5 19 ~ '-'Asre Company:_P_c_B __ L_C1._r-_&-.J _i(_( -------------- Address: ------------------------------------- Service Requested:_f_C_B ____________________________ _ Samp 1 e Taken On: ___ J_,. _-_~_O_-_~_.J _________ _ By: ------------- d 7-'2!-?3 Submitte To Laboratory On: ___ ...:i __ ✓ _______ _ By: GQl,( R re K ------------- Date of Analysis: ___ __;I{-_-__._(_·_-_¥_> _______ _ Date Reported: __ i./.;___-_l_-_f_J_ Analyzed By: __________________ _ ~ABORATORY SAMPLE NUMBER DESCRIPTION REMARKS NUMBER RESULTS~IN 1)0 ' ~.., cit ''),·,'] d ··t:. .. , _.'.• ;_ ,,, / I , Oo AM ~-,, u ~l-)i.''.\,l ·' <~· · __ ( ·. {I, oo A M - CuMMENTS: OHS Form 1440 (Rev. 2-75) Occupationa l Hea lth ( f-\ \2 {11 CJ \ '-J -k ,. () I L -, ci i,.. t++ L..Or i CJ() North Carolina Department of Human Resources Division of Health Services Occupational Health Laboratory ANALYSIS REPORT ~)( ~,;.. . ; \\ Company: \ \..---,, '•4, 1 i ------------------------------------ Address: K. e_.f)L~'1 1 ' \ ·, ..... "t Service Requested:_·;~•··~\..-=---=----------------------------- Samp 1 e Taken On: __ '<._.·.._) _,_2-_4 ___ ... _8=· _3_· ______ _ Date of Analysis: 5-11-Y "J ____ a-,_ ___ ;__ _________ _ Date Reported: __ lf-_-_f_-_f _3 __ Analyzed By: ------------------- .,ABORATORY SAMPLE NUMBER DESCRIPTION REMARKS NUMBER RESULTS BN 00 A .. (. ... ~,(\ . '~ <1:;;t.> 1,_, . -1 ~fl ,:> .t', •.• .. ""Llt I 1..) . ~ q'~/?? .4' "· • --:{f\ ~ 10i20 t:.: u~ CuMMENTS: OHS Form 1440 (Rev. 2-75) Occupational Health I A fl(oO J -/ .c.· C, I I C L(J , / 0 REPORTED BY: ~ p 1'l_,2~ Chief, Occupa ~Health Lab 4 North Carolina Department of Human Resources Division of Health Services Occupational Health Laboratory ~ ANALYSIS REPORT ~ 5 1983 ~ .... Company: ~-' (~ I') 'i ' Service Requested: \-:\ { --""------------------------------- Sample Taken On: ------------------By: ___________ _ Submitted To Laboratory On: .:?;-':.-\0 "4-;,,<'.0,,.,, ::' ---~'""--'--· ·---~--------By :_b~r>--=•t,__.b _____ _ Date of Analysis: ------------------Date Reported: __ 'f_-_l_-_~_J __ Analyzed By: -------------------- ,..ABORATORY SAMPLE NUMBER DESCRIPTION REMARKS RESULT t IN NUMBER PP · ,, ~-) ,-1 n ",; r3 -,,,,,\ .... H ', ()O lt'\r-/ lJ,,, 1/J -~-·J_: ~ \.. ,:~:, ,.iq::~ E,C £ 1 i .,, •· } ~ I· • •-I .., -~. ' ·~ CuMMENTS: OHS Form 1440 (Rev. 2-75) Occupationa l Health l\','-l ~ ( ;i-l~G ) / <.. C, I 0 L. C, JO North Carolina Department of Human Resourc Division of Health Services '. -t, Occupational Health Laboratory ·,;1 ~' . cc R 5 190-) : ANALYSIS REPORT Company: ___ P_c_;.8,=--__._~_a_vt_c:L---'-+-'--;_,_/ '-------------------- Address: (Doste..Yl Co Service Requested: ___ :P_,___c. __ ~=-__;().;..;.vt~a_;\_41-s=-15"""'-------------------- Sample Taken On: __ 3;;;..,../ _z..:;;.3_i:_~ _3_/_z_<f-'-_ --+(_3 __ 5_~_p_k __ ..s ___ ) Submitted To Laboratory On: __ 3_,.}_2_& ________ _ Date of Analysis: ____ __.~-~.,_/z_--..... 0 .. /_f_✓_j--______ _ Analyzed By: ------------------ ~ABORATORY SAMPLE NUMBER DESCRIPTION NUMBER By= ~f-"-v--'l\_-e-"--5_+_&,_\'--+_o_>'\ __ _ By :-=.=n~-=ra.;.;:_;_h.:..__;_A_l=s..~+_0_n..--__ Date Reported: __ _,_t/-+~z-~r-li"""'t _;J-__ REMARKS RESUtJb IN I IH)t,; C \ . ) 'LJ r r~,'-.1:5 3-23 -83 •) . '1' ~,,-·1(' 3 -z 3 -83 rr:..._j : : : :_,:~-,_) "'' ? 3-24--g3 ~:J .-f p,r,,/ CuMMENTS: OHS Form 1440 (Rev. 2-75) Occupational Health Tv1f . JI A i'-r_ cff. /I: 50 Ati E-+f. /1~30 /.\,...., I., .) J, .3 V9 {)./{)7 ~~ a, Joo REPORTED BY: ~ '4;_ I\..Qc:v Chief, Occupa -onal Health Lab / / North Caro l ina Depar t men t of Human Resources Division of Hea lth Services Occupat i onal Hea l th Laboratory ANALYSIS REPORT Company: ___ ---'f'----"CC...ls ____ c ....;f/;._N.a..,.0.a;...J-:;_-_,,_t _________________ _ Address : ___ ..;.Jl4 ..... J ..... Ac..:.lt:=/e=:.../.""-',v"--__ G~v ____________________ _ Service Requested: f C {3 Sample Taken On :_~~~::J~/~7~-;_-ct,:_?~::~~~~~~~~~~~~~~~~~--B-y_: __ /6_t_:-,-,1-1--L-&_w_,-(O_'\,I __ _ Submi tted To Laboratory On: _____ ~ __ I .... ? ......... !-~ .... ~--------By: la"'Z K'6reNDJJC/ Date of Anal ysis: -----------------3/8/83 Ana lyzed By: -------------------S .U. Green ..,ABORATORY SAMPLE NUMBER DESCRIPTION NUMBER IA 0 -J_ ,~_;{4 f~A-Cl-/4,~ ,n . i ;'·1 l'J ')s ( 1:._fiJr '/.1.A-r~ c...:. • A. .. a,"'·• --·-.... ...: 2. J "t/'.,?6 7/r f'4i 17£rvT f-:.f-fLl.JWT CuMMENTS: OHS For m 1440 (Rev . 2-75) Occupational Health Date Reported:_3_/_8_/_8_3 ___ _ REMARKS RESULT S IN ppb (A12bU ) 0.42 0.44 0 .24 North Carolina Department of Human Resources Division of Health Services Occupational Health Laboratory ANALYSIS REPORT Company: ___ -.!-f_;:C::::..::.[?'--_--=l~fl..::.;N~O~J-...;,-,_;_l....:;.C. _________________ _ Address: ___ ..:.,v(l,,L/.Z..e.4,.;e=:,:lc:;.,,..f...,;./\/_.._ _ __.,G...:v;._ ____________________ _ Service Requested =----.--7"-fi---=C;....:...___ _______________________ .. ~- Sample Taken On: ___ 3_._7..:....:....;:~::..:? __ __, _______ _ Date of Analys 1 s: __ .......,3_/8_/_8_3 ___________ _ Analyzed By: ------------------S.U. Green .. ABORATORY SAMPLE NUMBER DESCRIPTION . NUMBER IA 3 .J1J.34 ff-A-( 114 r-~ I i1 3 j j_435 {1:.~r t.J.A-i~ 2.. 3 J_t.1.16 it? p,q.; 17~,vj t-/:hl.JE.JJi CuMMENTS: OHS Form 1440 (Rev. 2-75) By: _---=-!<r...._F_._r ...... r...._fl __ L=-&"-=w""-,....,{Q""-,y.....__ __ By: la/'1 KAteNOJJC/ Date Reported:_3_/_8_/_83 ___ _ REMARKS RESULTS IN ---ppb \Al~bUJ 0.42 0.44 0.24 REPORTED BY~-1":;;-;I{! ./C.e<,c_Z_ Chief, Occupltional Heal th Lab ' .; ---· -~ . J STATE LABORATORY OF PUBLIC HEAL TH DIVISION OF HEAL TH SERVICES N.C. DEPARTMENT OF HUMAN RESOURCES P.O. BOX 28047 -306 N. WILMINGTON ST., RALEIGH 27611 Complete· All Items Above Heavy Line (See I nst'ructions on Reverse Side) N ame o ,iJ. 'lf System: f f Address: lJ..?atre,n Co Source of Water: ( ) Ground ZIP ( ) Surface County: Source of Sample: ~ v\ 1~+011t ( ) Distribution Tap Report To: -~-rah Address: Type of Sample: ( ) Raw ZIP Type of Treatment: ( ) ( ) None Telephone Number: -( ) · Chlorinated /;:ft1..e.st-Bot~ ltJt:D"( op . .IC ( ) Fluoridated Collected By:· ( ) Filtered Date Collected:·.~ -z l -B 3 10µ0~30 &, ( ) Alum Time: PM Location of Sampling Point: 1'Ym t~ e..wt $--i '5ti2,yV\ Type of Sample: ( ) Regular (Address where sample was collected) 1' ( ) Check ( ) Both ( ) Purchased ( ) House Tap ( ) Well Tap ( ) Treated ' ( ) Lime ( ) Soda Ash ( ) Polyphosphate ( ) Water Softener ( ) Other ( ) Private ( ) Special Remarks: .St:itl'>-'\)Ol,~ 1vtf. J e:~ .. WATER SYSTEM 1.D. NUMBER (COPY FROM MAILING LABEL) 2 t □□-□□-□□□ State Drinking Water Parameters {Required) Optional Parameters (List as needed) ~ Results. Results (CHLORINATED HYDROCARBONS:) mg/I Endrin 5 Iff. (A 1260)PCB 2.471 nnh .. lindane mg/I 4 Eff. · PCB 0. 184 DDb Methoxvchlor mg/I 3 Toxaohene mg/I 4 (CHLOROPHENOXY~:) mg/I 2,4-D 3 2 4,5-TP mg/I 4 - Date Received __ ... 3 .... { ..... 2 ... 3 ..... I_R ... 3 ______ Date Reported ___ 3~Lc...c2 .... 5....,lc...8.,_3...__ ___ Reported~ Q ~ '- -') ·,..., tCY'l 1 t·' (1 Date Extracted _ __..3""'/.,,,2 ..... 4.._/=8-.3 ______ Date Analyzed --~3~L~2~4-L~8~3~---Laboratory Number t J • ... _: .· , • ...-. l-i-r1 Comments: OHS Form 2886 7/79 Laboratory FILE "' . ·.? m J ·--<3}:r'~ r-./ .R..-n-, Mildred A. Kerbaugh Director Name of System: STATE LABORATORY OF PUBLIC HEAL TH DIVISION OF HEAL TH SERVICES N.C. DEPARTMENT OF HUMAN RESOURCES P.O. BOX 28047 -306 N. WILMINGTON ST., RALEIGH 27611 ORGANIC CHEMICAL ANALYSES ZIP Complete All Items Above Heavy Line (See Instructions on Reverse Side) Source of Water: ) Ground ) Surface Source of Sample: ( ) Distribu'tion Tap Address: ----------------------1 Type of Sample: ( ) Raw ZIP Type of Treatment: Telephone Number: --'-----=-)--------------i ( ) None ( ) Chlorinated Collected By:· ,-;;, est-Boltov\ ~,--r _ ( ) Fluoridated ( ) Filtered PM ( ) Alum Type of Sample: ( ) Regular ( ) Check Both Purchased House Tap Well Tap Treated Lime Soda Ash Polyphosphate Water Softener Other Private Special Remarks: 2 s~W\~~ fV\.f-fr e.t+ .. WATER SYSTEM I.D. NUMBER (COPY FROM MAILING LABEL) State Drinking Water Parameters (Required) (CHLORINATED HYDROCARBONS:) Endrin Lindane Methox chlor (CHLOROPHENOXY : 2,4-D 245-TP Results ¥-mg/I 5 mg/I 4 mg/I 3 mg/I 4 mg/I 3 mp/I 4 □□-□□-□□□ Optional Parameters (List as needed) Results Date Received __ 3.u.1 .... 2_3,./.._A.._.3.__ _____ Date Reported ___ J,.l-62...;5¥-l...,8...,J ____ Reported<jkl6. W ~ ' __ __.3L../,.__2::L4'-'/8...,3..,__ ___ Laboratory Number G ,"! .e---J_ jµ+I Date Extracted __ 3_1_24~/8_3 ______ Date Analyzed Comments: OHS Form 2886 7/79 Laboratory OWNER <'' ~ .,,-.. ., ~ ~ ffi c.__. • -:--n-, Mildred A. Kerbaugh Director INSTRUCTIONS Using typ_ewriter o r ball point pen, fill in all requested information on the top portion of form front. Please print legibly if typewriter is not available.:._:: · · -~- OBTAINING SAMPLE: Remove the teflon lined cap from the 1-gallon bottle. Run water for 5 minutes to assure water is from the distribution system. Rinse the bottle 2 or 3 times and discard the water. After rinsing fill the bottle and replace cap securely. Place the bottle and report sheet in the styrofoam mailer and tape securely. Mail immediately to the State Laboratory using supplied address label. LIMITS OF ALLOWABLE CONCENTRATIONS FOR DRINKING WATER ARE LISTED BELOW. PARAMETERS LIMITS (mg/I) METHOD OF ANALYSIS Lindane 0.004 EPA, EMSL, ERC, JULY 1978 Endrin 0.0002 EPA, EMSL, ERC, JULY 1978 Methoxychlor 0.10 EPA, EMSL, ERC, JULY 1978 Toxaphene 0.005 EPA, EMSL, ERC, JULY 1978 2,4-D 0.10 EPA, EMSL, ERC, JULY 1978 2,4,5-TP 0.010 EPA, EMSL, ERC, JULY 1978 TYPES OF SAMPLES -------- Regular: A sample(s) submitted to meet the monitoring requirements of the North Carolina Drinking Water Act, GS 130 - Article 13D. Check: 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. 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) submitted 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. .. STATE LABORATORY OF PUBLIC HEAL TH DIVISION OF HEAL TH SERVICES N.C. DEPARTMENT OF HUMAN RESOURCES P.O. BOX 28047-306 N. WILMINGTON ST., RALEIGH 27611 ORGANIC CHEMICAL ANALYSES - Name of System· Address: County: Report To: Address: U) a v r e4-1. Co ~v,:;.h ~ l<..to11t Telephone Number: ( ) ZIP ZIP - Complete All Items Above Heavy Line (See Instructions on Reverse Side) Source of Water: ( ) Ground ( ) Surface Source of Sample: ( ) Distribution Tap Type of Sample: ( ) Raw Type of Treatment: ( ) None ( ) Chlorinated _/;'fv\_E'St \3o ltu;,\ kv-,,q:).E ( ) Fluoridated Collected By:· ( ) Filtered Date Collected:· ~ -2 i -8 .3 ;oj1u.30 {.AM ( ) Alum Time: PM tl'Pu tiM e/Vt S -.{Sfczw\ Type of Sample: Location of Sampling Point: ( ) Regular (Address where sample was collected) ~ ( ) Check I ( ) Both ( ) Purchased ( ) House Tap ( ) Well Tap ( ) Treated ( ) Lime ( ) Soda Ash ( ) Polyphosphate ( ) Water Softener ( ) Other ( ) Private ( ) Special Remarks: 5 c.. W\ ,d <-.'?:> {V\f ,; ~++, WATER SYSTEM 1.D. NUMBER (COPY FROM MAILING LABEL) 2 ' □□-□□-□□□ State Drinking Water Parameters (Required) Optional Parameters (List as needed) ,_~ / [.//, Results Results (CHLORINATED HYDROCARBONS:) mg/I Iff. (A 1260)PCB 2.471 DDb Endrin 5 Lindane mg/I 4 Eff. PCB 0.184 nob Methoxvchlor mg/I 3 Toxaohene mg/I 4 (CH LOROPHENOXYS: J mg/I 2,4-D 3 245-TP mg/I 4 Date Received _ __,,3=/-=2=3=/-=8""3.__ _____ Date Reported ___ 3~/_2_5_/=8_3 ____ Reported~ t/,) -1£.~~ Date Extracted __ 3""'/_2_4'"""/_8...,c3 ______ Date Analyzed ---=3-'-/=2-'-4/=-8=3=-----Laboratory Number t ,,. .--1 -JtJ+, Comments: OHS Form 2886 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 legibly if typewriter is not available. OBTAINING SAMPLE : Remove the teflon lined cap from the 1-gallon bottle. Run water for 5 minutes to assure water is from the distribution system. Rinse the bottle 2 or 3 times and discard the water. After rinsing fill the bottle and replace cap securely. Place the bottle and report sheet in the styrofoam mailer and tape securely. Mail immediately to the State Laboratory using supplied address label. LIMITS OF ALLOWABLE CONCENTRATIONS FOR DRINKING WATER ARE LISTED BELOW. PARAMETERS LIM ITS (mg/I) METHOD OF ANALYSIS Lindane 0.004 EPA, EMSL, ERC, JULY 1978 Endrin 0.0002 EPA, EMSL, ERC, JULY 1978 Methoxychlor 0.10 EPA, EMSL, ERC,JULY 1978 Toxaphene 0.005 EPA, EMSL, ERC, JULY 1978 2,4-D 0.10 EPA, EMSL, ERC, JULY 1978 2,4,5-TP 0.010 EPA, EMSL, ERC, JULY 1978 TYPES 0-F SAMPLES -------- Regular: A sampfe(s) submitted to meet the monitoring requirements of the North Carolina Drinking Water Act, GS 130 - Article 13D. Check: A sample(s) submitted when a previous sample has exceeded the allowabte concentration. The check sample should be taken from 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) submitted 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. .. .,,... -· _________ .. ,.-_....,r ruoLIC HEAL TH ·--OIvIsION OF HEALTH SERVICES N .C. DEPARTMENT OF HUMAN RESOURCES P.O. BOX 28047 -306 N. WILMINGTON ST .• RALEIGH 27611 Name of {)G]; lartd+t I I System: Address: Wa..fleVl Cc ZIP County: 1l) Report To: -5aJtt.h /Hs+-ov1 Address: ZIP Telephone Number: ( ) - Collected By:· F=-~t-8oL-b-, Complete All Items Above Heavy Line (See Instructions on Reverse Side) Source of Water: ( ) Ground ( ) Surface Source of Sample: ( ) Distribution Tap Type of Sample: ( ) Raw Type of Treatment: ( ) None ( ) Chlorinated ( ) Fluoridated ( ) Filtered ~ 5 -'2-1--B 3 . 10:3,oj,, ( ) Alum Date Collected:· T,me: ~+m~-t-.6t.f Stewt Type of Sample: Location of Sampling Point: ( ) Regular (Address where sample was collected) -(. ) Check ( ) Both ( ) Purchased ( ) House Tap ( ) Well Tap { ) Treated ( ) Lime ( ) Soda Ash ( ) _ Polyphosphate ( ) Water Softener ( ) Other ( ) Private ( ) Special Remarks: z .sD.mfl~s-i1,f ~ e.ft,, WATER SYSTEM 1.D. NUMBER (COPY FROM MAILING LABEL □□-□□-□□□ State Drinking Water Parameters (Required) Optional Parameters (List as needed) Results Results (CHLORINATED HYDROCARBONS:) mg/I Inf. ( A 1200 ) PCB 1. 408 oob Endrin 5 Lindane mg/I 4 Eff. PCB 0.294 ppb Methoxvchlor mg/I 3 Toxaohene mg/I 4 (CHLOROPHENOXY:S:) mg/I 24-D 3 2,4 5-TP mg/I 4 Date Received ___ ._3_1_2_3_1_8_3 _____ Date Reported ___ 3_/_2_5_/_8....,3~---Report(J/4 kl M~ 3/24/83 · 3/24/83 F . ~ -...,.. Q-'1 3 Date Extracted ___________ Date Analyzed __________ Laboratory Number !-,.1 · -~ t , , , · IN Comments: OHS Form 2886 7/79 Laboratory flLE Mildred A. Kerbaugh Director Name of System: Address: County: Report To: Address: STATE LABORATORY OF PUBLIC HEAL TH DIVISION OF HEAL TH SERVICES N.C. DEPARTMENT OF HUMAN RESOURCES P.O. BOX. 28047 -306 N. WILMINGTON ST., RALEIGH 27611 ORGANIC CHEMICAL ANALYSES - -Pa landh II Wa..r✓e V\ Co ZIP ·ffb -5a.1tth A\stot\ ft•' ZIP Complete All Items Above Heavy Line (See Instructions on Reverse Side) Source of Water: ( ) Ground ( ) Surface Source of Sample: ( ) Distribution Tap Type of Sample: ( ) Raw Type of Treatment: ( ) None ( ) Telephone Number: -( ) Chlorinated ,=rn.e?t Sol tov1 ( ) Fluoridated Collected By:· ( ) Filtered ~ -'J_2....-a~ . /0!3o/tt ~ ( ) Alum Date Collected:· Time: +rea.+vtt~t '-Y~tewt Type of Sample: Location of Sampling Point: ( ) Regular (Address where sample was collected) ., ( ) Check ( ) Both ( ) Purchased ( ) House Tap ( ) Well Tap ( ) Treated ( ) Lime ( ) Soda Ash ( ) Polyphosphate ( ) Water Softener ( ) Other ( ) Private ( ) Special Remarks: 2-S,::;d•?1 ;,l.e s -II\ { ' .~ff, WATER SYSTEM 1.D. NUMBER (COPY FROM MAILING LABEL) ~ □□-□□-□□□ State Drinking Water Parameters (Required) . . Optional Parameters (List as needed) Results Results (CHLORINATED HYDROCARBONS:) mg/I Inf. (A1280 )PCB . 1 .408 oob Endrin 5 Lindane mg/I 4 Eff. PCB 0 .294 oob Methoxvchlor mg/I 3 Toxaohene mg/I 4 (CHLOROPHENOXYS:) mg/I 2,4-D 3 2 4 5-TP mg/I 4 Date Received ____ 3_/_2_3/_8_3 _____ Date Reported __ ...;3=/'-'2,..5 .... /'"""8""'3c.--___ Repo~ ,{.J ~~ __ ~ . r Date Extracted ___ 3_/_2_4_/_8_3 _____ Date Analyzed ___ 3_/_2_4_/_8_3 ____ Laboratory Number _;; 1 Nii Comments: OHS Form 2886 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 availc1_ble. · OBTAINING SAMPLE: Remove the teflon lined cap from the 1-gallon bottle. Run water for 5 minutes to assure water is from the distribution system. Rinse the bottle 2 or 3 times and discard the water. After rinsing fill the bottle and replace cap securely. Place the bottle and report sheet in the styrofoam mailer and tape securely. Mail immediately to the State Laboratory using supplied address label. LIMITS OF ALLOWABLE CONCENTRATIONS FOR DRINKING WATER ARE LISTED BELOW. PARAMETERS LIMITS (mg/I) METHOD OF ANALYSIS Lindane 0.004 EPA, EMSL, ERC,JULY 1978 Endrin 0.0002 EPA, EMSL, ERC, JULY 1978 Methoxychlor 0.10 EPA, EMSL, ERC,JULY 1978 Toxaphene 0.005 EPA, EMSL, ERC, JULY 1978 2,4-D 0.10 EPA, EMSL, ERC, JULY 1978 2,4,5-TP 0.010 EPA, EMSL, ERC, JULY 1978 TYPES OF SAMPLES -------- Regular: A sample(s) submitted to meet the monitoring requirements of the North Carolina Drinking Water Act, GS 130 - Article 13D. Check: 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. 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) submitted 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. .... .... STATE LABORATORY OF PUBLIC HEAL TH DIVISION OF HEAL TH SERVICES N.C. DEPARTMENT OF HUMAN RESOURCES P.O. BOX 28047-306 N. WILMINGTON ST., RALEIGH 27611 ORGANIC CHEMICAL ANALYSES --~' Name of -Pc..£. l{hl,J ,.\-; I I System: Address: /_,0Q { /(:_ V\ Co ZIP County: ,•· Report To: ._::; l{ICl h A\st o"'\ Address: ,- ZIP Telephone Number: ( ) - Collected By: · ffl"I e<;;>t 8ol+o1 Complete All Items Above Heavy Line (See Instructions on Reverse Side) Source of Water: ( ) Ground ( ) Surface Source of Sample: ( ) Distribution Tap Type of Sample: ( ) Raw Type of Treatment: ( ) None ( ) Chlorinated ( ) Fluoridated ( ) Filtered _-:2, -1--1--f]3 . /0 !3°/,1 C'AM ( ) Alum Date Collected: Time: PM f rea.fY11~ t ~'-f ~Jewt Type of Sample: Location of Sampling Point: ( ) Regular (Address where sample was collected) ·-( ) Check ( ( ( ( ( ( ( ( ( ( ( ( ) Both ) Purchased ) House Tap ) Well Tap ) Treated ) Lime ) Soda Ash ) Polyphosphate ) Water Softener ) Other ) Private ) Special Remarks: Sa rn y>f e S-If\ { I -~rr , WATER SYSTEM I.D. NUMBER (COPY FROM MAILING LABEL) 2 ~. □□-□□-□□□ State Drinking Water Parameters (Required) Optional Parameters (List as needed) Results Results (CH LOR I NA TED HYDROCARBONS:) mg/I Inf. (A 1260 )PCB 1.408 nob Endrin 5 Lindane mg/I 4 Eff. PCB 0 .294 oob Methoxvchlor mg/I 3 Toxaohene mg/I 4 (CHLOROPHENOXYS:I mg/I 2,4-D 3 2 4.5-TP mg/I 4 Date Received ___ 3_/_2_3_/_8_3 _____ Date Reported ___ 3""'/_2 .... 5"""/_8 __ 3 ______ Repo~ k /(£,,_~ ., '"> . Date Extracted ___ 3_1_2_4_/_S_3 _____ Date Analyzed ___ 3_/_2_4_/_8_3 ____ Laboratory Number _;; 1 N-F, Comments: DHS Form 2886 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 legibly if typewriter is not available. OBTAINING SAMPLE: Remove the teflon lined cap from the 1-gallon bottle. Run water for 5 minutes to assure water is from the distribution system. Rinse the bottle 2 or 3 times and discard the water. After rinsing fill the bottle and replace cap securely. Place the bottle and report sheet in the styrofoam mailer and tape securely. Mail immediately to the State Laboratory using supplied address label. LIMITS OF ALLOWABLE CONCENTRATIONS FOR DRINKING WATER ARE LISTED BELOW. ------------ PARAMETERS LIM ITS (mg/I) METHOD OF ANALYSIS Lindane 0 .004 EPA, EMSL, ERC, JULY 1978 Endrin 0.0002 EPA, EMSL, ERC,JULY 1978 Methoxychlor 0 .10 EPA, EMSL, ERC, JULY 1978 Toxaphene 0.005 EPA, EMSL, ERC, JULY 1978 2.4-D 0.10 EPA, EMSL, ERC,JULY 1978 2,4,5-TP 0.010 EPA, EMSL, ERC,JULY 1978 TYPES OF SAMPLES -------- Regular: A sample(s) submitted to meet the monitoring requirements of the North Carolina Drinking Water Act, GS 130 - Article 13D. Check: 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. 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) submitted 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. North Carolina Department of Human Resources Division of Healtn Services Occupational Health Laboratory ANALYSIS REPORT Company: ___ _..;P-=cc....:g__,_-_~Lfl~rv~D..L..~ ....... l..;;....lL __________________ _ Address : _____ ¼(_L..A.,,_.£~((..,.,.['-l\l-'--__ _,(;_o'---____ ~-------------- Service Requested: ___ ~f_C.,--""(s"--------------------------- Samp le Taken On : __ 3_· .... l~'~f-~~3 ___ J-/_t~i~~~t-f ______ _ Submitted To Laboratory On~_--a.(S~(~I_Y~A~~=] _______ _ Date of Analysis: .~ / i§'"/ f J-------...,......-'"'-r--"-------------- Analyzed By: -------------------5..lL. ... ABORATORY SAMPLE NUMBER DESCRIPTION NUMBER 3 ..J1 S~2 ~-·,_; 1,/ I /lvilowr-:1!t'-f(t'/. J By: £, &ol./OAJ By: / or-r kA,e,1v1JSt::/ Date Reported: 'J /J,tj rf+ REMARKS RESULTS (<ll~:.,,,,--... /l{_-/J4. '?-14'A ;J , IN -:i /4,/r:;. 3 ..,··;, ·-1 C:->-'1") z f t:-t-lfJ F,A) T CD1.1MY-_~~ ~J_/'_dl,,..-:,-0 :J _,1 ,1\J CuMMENTS: DHS Form 1440 (Rev. 2-75) Occupational Health u ,,. ~ North Carolina Department of Human Resources Division of Health Services Occupational Health Laboratory ANALYSIS REPORT Company: _______ P_c_,2> __ t_0_::_1 l_c_l -~--, '..;,_/_;_l_-_w_o_r_r i'.'_·,_11_(_(_) _. ------------- Address: ----------------------------------- Service Requested: ___ P_(_~_B ___________________________ _ Sample Taken On: _,; /J" /8 :3 f 2,//Lf / '(-_; '?:, j Submitted To Laboratory On: 3 )17 Is -~ 7 Dat e of Analysis: 3?!-1~/Y,} Analyzed By: ------------------- ~ABORATORY SAMPLE NUMBER DESCRIPTION NUMBER By: E 2,o i ~ v Y\ By: ~ {c,L 1--I }~ I ~ t O V\ Date Reported: ,/Jf/.rl-: 7 J REMARKS RESU~JZ IN IL 'I-!/_}.(, C } ✓ ~~ 3 -1 b .. &3 111+. ID JiNl L / .. l' ·. '·! s: r:;.3 _ _..,_ ~ .... , .,__, 5 -I 4 -rJ 3 E t=r., I I A/Y\ L. /, () ~1 ·? l' t:-j f" .. '-·:i, .. ,_ .• -3 ·-/6 .. 83> . P--rr_ 10 : 2v i'\ IYl -<.. /. 0 CuMMENTS: OHS Form 1440 (Rev . 2-75) Occupational Health North Carolina Department of Hunan Resources Division of Bealth Services Occupational Health Laboratory -ANALYSIS REPORT ~=-· --~ .. . . -._ ._ --~ . ···--. .. . ·-. -----.--~. .. . . Company: _____ __:P,._c_o_n __ La_,_t_cl_-f-'~'-·1_,_·~-· w_·_o_{_re_· ·_~1_C_o_. ______ ·•-::_., __ ··_~ ___ _ Address: ---------------------------------------- Service Requested: ___ P_c_B....::.._~--------------~--------·_··_···_· _____ _ Sample Taken On: 3 /J b /8 :3 · ,/ · 3/14 / ~ ~ •· By: ·E. f1o(+~ Y\·.:: '.;. ----''----J.,'---":;__'-------'---''--''----- Su bmi t ted To Laborat~ry On:··,:: '~·3/,7 )§~ ·By:~f?t}/1 ~-1·~~6 h ~ • Date of ~n~lysis: ___ ,_<~j...,,;;)i..;..¼,..<..1_,=1'-"·:·1.~··z-"· .. :r.:....,:3--::z.' ·_._ .. _ 7 _··:·_'·::,_·:._.· ___ ·:•_., -._·,_,; . Date' Re~rted::~: ·.·:~;ftkb .:· ,. Analyzed ~;: . ' ~. U... /.::: .. }~~~!•).~-~:·:: :,<,>f~-'> ;),:~·.: ,.< T :•,:' . ;~<_: __ ;_~,}.;;~.;;?X&~~--:.·: · :-: -./.:: ·_; -----.-.-.,-----------:_:-_;.-~:~---::·_-·_:-.. ,--.. -.. ~_-;-_-i ___ :_::-::~-:~:-.~l-\ ... ·•. ?ik')i,ti~14;1±t~{\$:t};\i~f~i,} '"'ABORATORY NUMBER ·· · ·· ., . ..:• :-- CuMMENTS: SAMPLE NUMBER · 5-/4 ~ g3 3-/6~83 DHS Form 1440 (Rev. 2-75) Occupational Health DESCRIPTION ll Af/\ 10:20 AIY1 R_~SU~pl, IN .. / L 'fl J;l.6 o ) L/.0 L /, 0 -·~1.0 .,, NORTH CAROLI NA DEPARTMENT OF HUMAN RESOURCES INTER OFFICE MEMORANDUM DATE 3-8-8~ To Tom l<a r vt o :::,k.; > i3,· I I , vt ~'f e-r Cotl1 por..vt cl.. ~vt< p le. I 1) /2 "o pc 13 / ~ I z. ~ o Pc '3 ( b I a ~ l b are. i nfluen.t 2 ,· 5 e f+/ ~ ert -t DHR Fom 2 (8/75) a.rn oc . .o\ t J ::::!.7 / .R (pp b) 0.4 0.1