NCD980602163_19830407_Warren County PCB Landfill_SERB C_Samples and Analysis, April 1983-OCR

---------·--··-----------
1IYl1
DIVISION OF HEALTH SERVICES
STATE LABORATORY OF PUBLIC HEALTH
306 N. Wilmington St.
P.O. Box 28047
Raleigh, N.C. 27611-8047
April 7, 1983
M E M O R A N D U M
TO: Tom Karnoski, Environmental Engineer
Hazardous Waste Branch
FROM:
Division of Health Services
John L. Neal, Supervisor
Occupational Health Laboratory
Laboratory Section
Division of Health Services
Ronald H. Levine, M.D., M.P.H.
ST ATE HEAL TH DIRECTOR
SUBJECT: PCB Landfill Samples #301572, #301573 of March 14, 1983
Results of Laboratory samples #301572 and #301573 were not reported
because laboratory pure water analyzed at the same time contained
detectable levels of PCB, indicating PCB contamination during the
laboratory analysis.
We have corrected the problem, and apologize for any inconvenience.
/sjc
Jomes B. Hunt, Jr/ Sarah T Morrow, M.D , M.P.H STATE OF NORTH CAROLINA DEPARTMENT OF HUMAN RESOURCES GOVERNOR SECRET ARY
North Carolina Department of Human Resources
Division of Health Services
Occupational Health Laboratory
ANALYSIS REPORT
PR 13 .
Company: ___ __.:,.f_(_-_(3 ___ L_,4_rv_'_D_F_:,._I_L_L-. _________________ _
Address: l-v' '+~fZE r/ (' 0. ____ _;__;:_,J_.;.._;_~--------------------------
S er vice Requested: ____ f_C_._8 _______________________ _
Sample Taken On: l/ -/--~ 3 ----------------
Submitted To Laboratory On: ____ </: ..... ·_-_-_6_~_-..;;.J_> __ _
i./ --/_ s· 3 Date of Analysis: ----------------
Analyzed By: ------------------
LABORATORY SAMPLE NUMBER
NUMBER
30 "1 ?7 l/-/-f;J _
/ I J:o& /1,"'1
;J 0"21 ?[j U-/ -S 3 1 I I :3 o
~:--021 0 ~ "!. -~ 1' .. f~,•-r3 I /( :ro
;'1021 ')f) 9--}-n //, 0 •'. . ,, . ' )
CuMMENTS:
OHS Form 1440 (Rev. 2-75)
Occupationa l Health
ltl,-,
~
~n
DESCRIPTION
(LNF)
CtrF)
{_ LtV ,1
( {?/;;p)
Date
REMARKS RESULTS IN
PCB (ppb)
(A12 60)
0. 1
< 0 .1
0.4
0. 1
REPORTED BY: :fl?tk!;U~
Chief, Occup ional Health Lab
STATE LABORATORY OF PUBLIC HEAL TH
DIVISION OF HEALTH SERVICES
N.C. DEPARTMENT OF HUMAN RESOURCES
P.O. BOX 28047 -306 N. WILM INGTON ST., RALEIGH 27611
~
ORGANIC CHEMICAL ANALYSES -PUBLIC WATER SY
Complete All Items Above Heavy Line
(See Instructions on Reverse Side )
Name of
System:
ZIP
County: ------------------------1
··Report To: --=-==--=--~-(,_Ot_h __ A-'--\ --s __ +-_o_V) ___ --l
Address: __ -.5=--_e,_L-L_,,L,AJ=---------------------1
ZIP
Telephone Number: _(~---'-----J=------"2'--'--1 l_.....,.__ __ ------1
Collected By: •---+"""'--'-f _,_v1.!..!.,,"--'!.....!..--=:....:0::....:..l _ti_o_V)_:__ ___ ----1
Date Collected: 4-I -B3 -1f(z) Time:
/0
Location of Sampling Point: ('2CC/-e.nf 6
(Address where sample was collected)
@
PM
Source of Water:
( ) Ground
( ) Surface
Source of Sample:
( ) Distribution Tap
Type of Sample:
( ) Raw
Type of Treatment:
( ) None
( ) Chlorinated
( ) Fluoridated
( ) Filtered
( ) Alum
Type of Sample:
( ) Regular
( ) Check
14 198
Both
Purchased
House Tap
Well Tap
Treated
Lime
Soda Ash
Polyphosphate
Water Softener
Other
Private
Special
Remarks: "' z ~ rn p ,~ ~ co I lected - -
1... 1'rJ.flu-ent -i; 1.e+t)u01+
WATER SYSTEM I.D. NUMBER (COPY FROM MAILING LABEL)
□□-□□-□□□
State Drinking Water Parameters (Required) Optional Parameters (List as needed)
Results Results
(CHLORINATED HYDROCARBONS:) mg/I Endrin 5 T
Lindane mg/I 4
mg/I 3
mg/I 4
(CHLOROPHENOX mg/I 3
mg/I 4
Date Received -f/;.1_)£~3--.___ __ Date Reported __,_'-/_/%-""--'-7.,._~...,.,._J __ Reported B~/\ /?JU~ J 1: // 7 / / ·, /r...._L/)
Date Extracted --+~+/l.....;~'-J~!r..."'--4'>i:C..-----Date Analyzed __,_>J_,_fl_/_2,._-_l-'-~_,_/_tt ..... r"-----Laboratory Number l~
1
T1 .
OHS Form 2886 7/79
Laboratory OWNER
. -, (£.-f-t=I.)
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 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 0-F SAMPLES --------
Regular: A sample(s) submitted to meet the monitoring requirements of the North Carolina Drinking Water Act, GS 130 -
Article 130.
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 Health Services
Occupational Health Laboratory
ANALYSIS REPORT
Company: _ _./;J~o_rf.-=--eV7'---'-_,_(o"'--_ -----'-'-'lo_nd--=-...:..+.'_,· r_J ----------
Address :_....,:Nt;._·.><..C..-', ('-"e:....i.1~rl'--'o"-'f\-)+' _N,__,.__C.-=---------------------
Service Requested: _ ___.p_C..__,;t5=--'-tJ.._·_Y1Cl_~1~~~S=~:;..._r._S_: ___________________ _
Samp 1 e Taken On : ___ J+-+/_'_,_7_,/<--,;;8;;...·,_3 ___ ..) _______ _
Submitted To Laboratory On: __ j'"'--'· l.~8~J ~/;;...8..;;.....;:3;;__ _____ _
t. I
Date of Analysis: -----------------4/11/83
Analyzed By: -------------------s u
"'ABORATORY SAMPLE NUMBER DESCRIPTION
NUMBER
By: F -BO f f oft
By : Sarah Abtc7 Yl
Date Reported: ____ 4_/_1_2_/8_3 __
REMARKS RESULTS IN
nnh I
··~ In . -, ,r-.,,f t ,•', Jnfo 4/7{8 3 •1_:< ' . y-..1{;1 /O :l5 V4-M 0.2
CuMMENTS:
OHS Form 1440 (Rev. 2-75)
Occupational Health
I
STATE LABORATORY OF PUBLIC HEALTH
DIVISION OF HEALTH SERVICES
N.C. DEPARTMENT OF HUMAN RESOURCES
P.O. BOX 28047 -306 N. WILMINGTON ST., RALEIGH 27611
ORGANIC CHEMICAL ANALYSES -PUBLIC WATER SYSTEM
Name of 0 (,1.rvi System: I
Address: /~+ f.__·_:f\ \ r\/0
I
ZIP
County: 1A.-1: { , e. A Lo
Report T:::-: c__,r} ( 61 }7 n ls+nr)
Address:
ZIP
Telephone Number: ( ) -
Collected By:· ~ { (\.?"-;,' ·-, ~J °B0·/ t O V)
Date Collected:· -1-/11/g3 Time: )/
,
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
-~ IZ ~ ( ) Alum
Type of Sample: -/-I,· Ct + ,-r1 t""/J1 f-S..,s.~ew, Location of Sampling Point: ( ) Regular
(Address where sample was collected) I ( ) Check
( ) Both
( ) Purchased
.,
( ) House Tap
( ) Well Tap
( ) Treated
( ) Lime
( ) Soda Ash
( ) Polyphosphate
( ) Water Softener
( ) Other
( ) Private ~=--~-,. ...
( ) Special
Remarks: z ..S u -n-•p le';;> -;1,f i e.\ +. WATER SYSTEM 1.D. NUMBER (COPY FROM MAILING LABEL
□□-□□-□□□
State Drinking Water Parameters (Required) Opfonal Pa,amete~ (Ust as needed) h)
Results Results Pcf3(Ff
(CHLORINATED HYDROCARBONS:) -{) f ) .-1 uf' Endrin mg/I 5 I '·"
Lindane mg/I 4
Methoxvchlor mg/I 3
/ mg/I Err. D. ,q l •· Toxaohene 4
(CH LOROPH ENOXYS:) •·
/' 2,4-D mg/I 3 ,·•· ..
245-TP mg/I 4
/l ' .. . .
ii ;r/ o--< t;· 'J/1 r z R d1· j Ctv, 4-: JU:: .. ~--Date Received ____ J_,__o---" '\_,>---___ Date Reported ______ -__ ,-L-_______ 1-__ l'J_,.,,,. ___ eporte ~~ r I
Date Extracted _ _./J~-+J__./ f< .... ·~/_R_.· _5..___ __ Date Analyzed _ .... /1-_f----+1_'7--+l __ K-. -::>,..'-· ___ Laborat~ry Number ~ · · -.. : /L-~f
Comments:
OHS Form 2886 7/79
Laboratory
I ' I ) f .I ..
SANITARY ENGINEERING
. ,
. ·--"
Mildred A. Kerbaugh
Director
North Carolina Department of
Crime Control .Jlll7#
& Public Safety
512 N Sulisbury Street f-'. 0 Bo>.. '276J37 Huleig/i 27611-7687 [phone]
James B. Hunt, Jr., Governor
Mr. Al Hanke
Environmental Scientist
EPA, Region IV
345 Courtland St., NE
Atlanta, GA 30365
April 15, 1983 Hernan R. Clark, Secretary
Re: Harren County PCB Landfi 11
Water Disposal
Dear Al:
Enclosed are test results of water samples taken from the
upper leachate collection system on April land 5. As indicated
all samples including those before filtration contained less than
l part per billion PCB.
We will continue to take samples and keep you advised of the
results.
WWPjr:jj
Enc.
cc: Joe Lennon
Jim Scarbrough /
0. \~. Strickland
R. E. Helms
~r?i!Pfdt •A .
Will iam W. Phillips~}
Assistant to the Secretary
North Ca rolin a Department of
Crime Control~-
, . . & Public Safety
512 N. Sahsbury Street P 0 . Rox 27687 Raleigh 2761J.768 ! [phone]
James B. Hunt, Jr., Governor
Mr. Al Hanke
Environmental Scientist
EPA, Region IV
345 Cou r tland St., NE
Atlan ta, GA 30365
Apri l 18, 1983
.r
1/ i:S
/Qo
;::i:: APR ~
I l!:'mc1n R Clark, Secretary
Re: Warren County PCB Landfill
Water Di sposal
Dear Al :
Enclosed are test results of water sampl es taken from the
upper leachate collection system on April 7 and 11 . As indicated
all samples including t hose before filtration contained less than
1 part per billion PCB.
We will continue to take samples and keep you advised of the
results. ~z;z , ,/~.
William W. Phi~-/)'
As sistant to the Secretary
l~WPjr:jj
Enc.
cc: Joe Lennon
Jim Scarbrough /
0. W. Strickland v
R. E. Hel ms
Name of
System:
Address:
,. -" : STATE LABORATORY OF PUBLIC HEALTH
DIVISION OF HEALTH SERVICES
N.C. DEPARTMENT OF HUMAN RESOURCES
P.O. BOX 28047 -306 N. WILMINGTON ST., RALEIGH 27611
ORGANIC CHEMICAL ANALYSES -PUBLIC WATER SYSTEM
C
,.,..
Complete All Items Above Heavy Line
(See Instructions on Reverse Side)
Source of Water:
( ) Ground
( ) Surface
Source of Sample:
( ) Distribution Tap
Address: ___________ \ ___________ _, Type of Sample:
( ) Raw
ZIP Type of Treatment:
Telephone Number:-~< ---'------------------1
( ) None
( ) Chlorinated
( ) Fluoridated
( ) Filtered
( ) Alum
Type of Sample:
Location of Sampling Point: ...L."'1·~4-l.JL4.l:;....Ll-l-___.,_"'14>~u......!..4,.~---1 ( ) Regular
(Address where sample was collected) ( ) Check
.,
' _/
h
( Purchased ·
House Tap
Well Tap
Treated
) Lime
)' Soda Ash
) Polyphosphate
) Water Softener
) Other
Private
Special
Remarks: WATER SYSTEM 1.0. NUMBER (COPY FROM MAILING LABEL)
State Drinking Water Parameters (Required)
Results
(CHLORINATED HYDROCARBONS:)
Endrin
Lindane
Methox chlor
(CHLOROPHENOXY :
24-0
245-TP
□□-□□-□□□
Optional Parameters (ListP:::Be{ Al 2 ~
0
)
Re9uits
mg/I 5
mg/I 4
mg/I 3
mg/I 4
mg/I 3
mg/I 4
(/,-l > -8 , ff -f 3 -8 1 ~ LJ i1/J -· t7 Date Received ___________ Date Reported __________ Reported B,~ {\, ~ _
Date Extracted _({-_-_r _3_-_}_> _____ Date Analyzed 'f ~ ( 1---¥ J Laboratory Number ; : . h-f ·,
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 available.
OBTAINING SAMPLE:
· Remove the 'tet10:n lined cap from the 1-gallon bottle.
Run water for tf minutes to assure water is from the distribution system.
Fiii:ise'_!be,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 1?78
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 cMck 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. ·
I
STATE LABORATORY 6F PUBLIC HEAL TH
DIVISION OF HEALTH SERVICES
N.C. DEPARTMENT OF HUMAN RESOURCES
P.O. BOX 28047 -306 N. WILMINGTON ST., RALEIG
ORGANIC CHEMICAL ANALYSES -PUBLIC WATER SY
'' .
" •., J
.v.~')·
Complete All Items Above Heavy Line
(See Instructions on Reverse Side)
. '-(
~ •, 'Name of •Pc e, .L::;tnd
:: System:
ZIP
Report To: --====..i...~~--'---'--....LJ~~..::::....;JC-...-.l--------l •,
ZIP
Telephone Number: _.:....__---=-) __ --''3=-----=z_=-L--L....>o--"'-----1
Collected By: -_.....,·i;""'· =---..t...L.J...-"-=.-'-c-f-----'===--.,D=:::....i._-h..?......::o=--:..t~--=----' -~"""-<I
location of Sampling Pointli--..1......5.=L· f~~LL.J'--~~~,:J..J~---1
Address where sample was a>llected)
Source of Water:
( ) Ground
( ) Surface
Source of Sample:
( ) Distribution Tap
Type of Sample:
( ) Raw
Type of Treatment:
( ) None
.( ) Chlorinated .... . . -) _,. -Flu<3ffi°¾mf· :-----'-
( ) Filtered
( ) Alum'-
Type of Sample:
( ) Regular
( ) Check
PR 28
Both
Purchased
House Tap
Well Tap
Treated
Lime
Soda Ash
(' ' ) • ' Polyphosphate·
( ) Water Softener
( ) Other
Private
Special
"t
llemarks: .Y--1-~ p}e ~_inf £ -e+f. WATER SYSTEM 1.D. NUMBER (COPY FROM MAILING LABEL)
' -
State Drinking Water Parameters (Required)
Results
(CHLORINATED HYDROCARBONS:)
Endrin
Lindane
Methox chlor
mg/I
mg/I
mg/I
□□-□□-□□□
Optional Parameters (List as needed)
Results .✓f}r:,6 { f b
5
4
3
4 . Toxa hene (CHLOROPHENOXY-....... ~~-~---+--------"---+--+-----------+--------,-, -
2,4-D ' \
mg/I
mg/I
245-TP J'
Date Received --~_,_1 ..... /_t;""_/S ____ _
Date Extracted _LJ-,_+/_,_/..,..;_,f.,_,,~S'--3 ___ _
Comments:
OHS Form 2886 7/79
Laboratory
l J
mg/I
Date Reported
Date Analyzed
3
4
'(-:i~f':J
718:1~3
___.___.._ ........ __ Reported •94'. t?, ~
Laborato,v Number;-: '. ~ ~ J , t. · I
OWNER Mildred A. Kerbaugh
Director
.·· ..
\\-,·. . / INSTRUCTIONS
Using tvr>e.lN,_r-iter'O.!,.blfll 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. ·
• ..... • I ,,
I STATE LABORATORY OF PUBLIC HEAL TH
DIVISION OF HEALTH SERVICES
' N.C. DEPARTMENT OF HUMAN RESOURCES
P.O. BOX 28047 -306N. WILMINGTON ST., RALEIGH 27611
ORGANIC CHEMICAL ANALYSES -PUBLIC WATER SYST
Complete All Items Above Heavy Line
(See Instructions on Reverse Side)
Name of
~ystem: fcB [l-ltvDJ-Jl( l/crl'JT /7£,vl Wo,z1cS
Address: ___ w_~A~J11_1f_l:...~: N_~C_o_, ______ _
ZIP
County: -------------------~
Report To:··_.,._-~l~o~--lr_~Kt_A_!f__'_f\}_O_~_J:::._/ _____ __,
Address: ___________________ ___,
ZIP
Telephone Number: _(-'---_----'-) _____ -_______ ---i
Collected By: . __ E_._~is_o_L_,_O_IV _______ ~..-=-::..-1
'-I I 1q,/ F:::]. r,·me.· lo.· JO ~PM Date Collected:·_---------.......:....:-=-==-'--------~
Location of Sampling Point: _____________ __,
(Address where sample was collected)
Source of Water:
( ) Ground
( ) Surface
Source of Sample:
( ) Distribution Tap
Type of Sample:
( ) Raw
Type of Treatment:
( ) None
( ) Chlorinated
( ) Fluoridated
( ) Filtered
( ) Alum
Type of Sample:
( ) Regular
( ) Check
( ) Both
( ) Purchased
( ) House Tap
( ) Well Tap
( ) Treated
( ) Lime
( ) Soda Ash
( ) Polyphosphate
( ) Water Softener
( ) Other
( ) Private
( ) Special
-z. SAr1PCf5
Remarks: WATER SYSTEM 1.0. NUMBER (COPY FROM MAILING LABEL)
State Drinking Water Parameters (Required)
Results
(CHLORINATED HYDROCARBONS:)
Endrin
Lindane
Methoxvchlor
Toxaohene
(CHLOROPHENOXY::;:J
2,4-D
2 4 5-TP
"''
mg/I
mg/I
mg/I
mg/I
mg/I
mg/I
□□-□□-□□□
Optional Parameters (List as needed) )
Results ?c (3 ( p tb
5 rl/lt·
4
3
4 J;J!?· LO, I
3
4
Date Received _Jf,___7.,...l~_f.._j_}<-+-"'~..__3 ___ Date Reported Reported ~~!:t5of__.__C?,_, ~-----
Date Extracted _JJ-1 ..... J _J.j)~/-/_t_~3~--Date Analyzed __ y~J-),~D'-1/ ..... Q,___ ____ Laboratot= '" i " ~r I . _..,._ "1 ? . Comments: · -.L . ·§~
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 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 8'1owable 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 hulth 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 Health Services
Occupational Health Laboratory
ANALYSIS REPORT
Company : __ _Jjj:JL==:.hb:a?__.:t-oJv1~::._:C-:::::' ~£[.;c~1
/_.:.1 ______________ ~~~--
Address: (}J;.H~ + o \/\ , NC. __ ___,_...._ __ --'-----'---'--+-1 ------------------------
Service Requested: _ ___;_R_t-_r--~')~··_(~M-~~c~~-l½-+--'=~~1_S _____________________ _
Samp 1 e Taken On : __ 1.....-..... /_i_o ..... /_8_~_ ..... (_J_?--__ '3ct. __ ;\'l-l _r;_( ~_">_) __ By: r-. B u! fo v1 -------------
Submitted To Laboratory On: ___ f._,._/_2_1 ..... /_8_-:S _____ _ By : __ s,:;;;.-_~_·ra_\ 1_. _l\_\ s_-l_~_<-'::l_V) __ _
Date of Analysis: JJ../ ,)..,i.J 83 ------~'t'"'"/· ...;;;.;....,"""-,j..1-"'""'"'-------Date Reported: _______ _
Anal yzed By: _________ 11...,·,· .... , ._., -I:........, _.7-..... ,--\...;;;li.U1~..;::\..,, ___ _
.,ABORATORY SAMPLE NUMBER DESCRIPTION REMARKS
NUMBER
RESULT 1 IN
DO -,_
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CuMMENTS :
OHS Form 14 40 (Rev . 2-75)
Occupa tiona l Health
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North Carolina Department of Human Resources
Address: \W O"\{e.,,l\t O\r'\ l
Division of Health Services
Occupational Health Laboratory
ANALYSIS REPORT
Service Requested: ___ ~_C_6---"-..._~o.,_'Y\_O.---'-\~~f,"'--(·_s _· ___________________ _
)
Samp 1 e Taken On: __ 4~----'-/ 0...:,.._-_'6--'2:,:;;;;,_---1.L"-Z~_So_·_._0_' ,.__y _l-e_· '-~--·""", _
Submitted To Laboratory On: t/zr /Bs ----+-. ___ ....._ ______ _
Date of Ana 1 ysi s =-------'++-7,_/ ___ )..._.2_/ .... 8 __ 3 _______ _
Ana 1 yzed By: ________ 't-1~---«~•'f__,_. /J-"'-"h""L ;:;:;;&!\.-::..,,,..___ __ _
LABORATORY SAMPLE NUMBER
NUMBER
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, ,t ..-~ ...... ,'ll ·')
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CLlMMENTS:
OHS Form 1440 (Rev. 2-75)
Occupational Health
DESCRIPTION
'1 l 1 {/I ( {) "' t II Arn
c.f\/tt-e.,iTT ) I A r-1
By: fv()e~-+ l~o /+o V1
By: ~{cJ/A Alston
Date Reported:
REMARKS RESUt ';;t./N
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