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Home My WebLink AboutNCD980602163_19881206_Warren County PCB Landfill_SERB C_1988 Monthly Inspection and Analyses-OCRNorth 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. State Health Director December 6, 1988 MEMORANDUM TO: Jim Coffey FROM: Mike Babuin t?n;J.!3 RE: PCB Landfill, Warren County The purpose of this memo is to seek guidance, clarification and assistance with regard to the semi-annual sampling requirements of the PCB Landfill. As you may be aware, this project requires monthly inspections (historically performed by M.L. Babuin) and semi-annual sampling. In the past, the Hazardous Waste Permitting Unit has supplied, on an average, four or more individuals to assist in the sampling tasks. When the project was turned-over to this Branch, our two hydrogeological technicians were responsible for sampling duties. Now as you are aware, we have no available team to accomplish the sampling segment of the requirements. In fact, I do not know personally where the surface water sampling stations are located due to the high turnover rate of our hydrogeological personnel. Because ground water monitoring cannot be properly performed by one individual, I am uncertain as how to meet our mandated objectives. I recommend that either you (as unit supervisor) or, perhaps preferably, Gordon as Branch head, communicate with Bill Hamner regarding the possibility of procuring the assistance of Jimmy Carter, Rob McDaniel and Sharon Myers in addition to myself in meeting the required objectives. MLB/mj North Carolina Department of Human Resources Division of Health Services P.O. Box 2091 • Raleigh, North Carolina 27602-2091 I J ames G. Martin, Governor David T. Flaherty, Secretary Ronald H. Levine, M.D., M.P.H. State Health Director MEMORANDUM TO: THROUGH: FROM: October 7, 1988 Edward Garner, Assistant to the Secretary Department of Crime Contr ol and Public Safety Michael L. Babuin, Supervisor ~ Water Resources Protection Unit~ · Solid Waste Management Section Sharon A. Myers, Hydrogeological Technician J.Q,)1!l . Water Resources Protection Unit Solid Waste Management Section Attached is the September, 1988 PCB Landfill Monthly Inspection Report. The metal post that I discussed last month is still out of the ground. The grass within the well fences has not yet been cut. This vegetation must be cut before the late October sampling date. If you have any questions concerning the landfill please contact me at (919) 733-0692. SAM/MLB/mj cc: Mike Babuin PCB LANDFILL MONTHLY REPORT DATE S ep -t 3 0 , ( 9 D ~ ----.i-----7+----------- 1. Entrance Road 2. Monitoring Wells Casings, locks · Fences, gates, locks 3. Landfill fence, gate, locks 4. Air Vent . 5. Landfill Cover 6. 7. Erosion, vegetation Subsidence Leachate Detection System Water in sump Leachate Collection System Access Pipe Pump Piping 8. Treatment Works Influent Piping Sand Filter Carbon Filter Effluent Piping 9. Surface Impoundment Erosion, vegetation 10. Irrigation Syst~ Infl uent Piping Pump Sprinkler Units . NAME._-==5::_;_h_a.._;__ri_c_.;:.V\_A_;___ . ..;._M_._,y~e;.._r_.s __ NO PROBLEM .../ . ...,,,,,.✓• .._.,,-/ ✓ ✓ / ✓-/ POTENTIAL PROBLEM OBSERVATIONS Gra..s5 w,·t t, /"'-+~J/lc.e5 sh.~v--!d be cu. b- :.<PCB LANDFILL MONTHLY REPORT (CONT. DATE NAME ----------------~----------'-------- -:: Pumping Data Pumping -Times Pumping Volume -----,.-----------------:- Irrigatibn Data .::.• .... Irri~ating Times Irrigating Volume 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. September 22, 1988 MEMORANDUM TO: Edward Garner, Assistant to the Secretary Department of Crime Control and Public Safety THROUGH: Michael L. Babuin, Supervisor Water Resources Protection Unit Solid Waste Branch FROM: Solid Waste Management Section Sharon A. Myers, Hydrogeological Technician Water Resources Protection Unit Solid Waste Branch Solid Waste Management Section State Health Director Attached is the August, 1988 PCB Landfill Monthly Inspection Report. One of the metal posts supporting the cable at the entrance has been pushed over. The grass inside the well fences is over six feet tall. This should be cut before the latter part of October because the wells will be sampled then, and tall grass interferes with the sampling. Also, the locks on the landfill gates will be oiled during the next inspection. If you have any questions concerning the landfill please contact me at (919) 733-0692. SAM/MLB/mj cc: Mike Babuin PCB" LANDFILL MONTHLY REPORT DATE A lA91Ast 1. Entrance Road 2. Monitoring Wells Casings, locks 3/ · Fences, gates, locks / 3. Landfill fence, gate, locks 4. Air Vent . 5. Landfill Cover Erosion, vegetation Subsidence 6. Leachate Detection System Water in sump 7. Leachate Collection Access Pipe Pump Piping 8. Treatment Works Influent Piping Sand Filter Carbon Filter Effluent Piping 9. Surface Impoundment System Erosion, vegetation 10. Irrigation Syste~ Influent Piping Pump Sprinkler Units NAME__;;5~h=?\...,_D..;::;..o-=---h~M____._y.,._·-=e_'--r_.::::,s"--_ NO PROBLEM ~ \,.,,,,,..- POTENTIAL PROBLEM OBSERVATIONS O /A.e.. o ! ~£....e. wt e._t_c,) r-osf:_5 Ao ld1 'v\9. u..p l iAe cc...b le... ii.c...s b~ ..... p, u..1/e.. d u.p, C,rt1..~.!> /tA..-s ,·d e. vve_ /J +c.!'l c e sc;'/ I 0~s JA.o.(__ &, e c. V\. PIA. o vv e.. d.. c.,, -r I/ /6c,ks need t o h <.?.. ta.. ¢, fe. d 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. August 15, 1988 MEMORANDUM TO: Edward Garner, Assistant to the Secretary Department of Crime Control and Public Safety THROUGH: Michael L. Babuin, Supervisor Water Resources Protection Unit Solid Waste Branch Solid Waste Management Section State Health Director FROM: Sharon A. Myers, Hydrogeological Technician J,(J. ~1, Water Resources Protection Unit Solid Waste Branch Solid Waste Management Section Attached are the June and July, 1988 PCB Landfill monthly Inspection Reports. There are a couple of potential problems to note. A timber harvester is using the entrance road (he has a key) and is leaving the gate open while loading up his log truck. The truck's commercial license number is North Carolina AK.8497. Also, grass is very high in the small fenced areas surrounding each monitoring well. This grass should be cut each time that grass on and around the landfill is mowed. Lastly, the monitoring well locks were found to be rusted and had to be oiled in order to remain functional. If you have any questions concerning the landfill please contact me at (919) 733-0692. SAM/MLB/mj/25 cc: Mike Babuin ::.-:r·:: t'.:X\\· f YU.l /::.. LI ce""sC -A /(__3 y 1 -; , PCB" LANDFILL MONTHLY REPORT . c O Vlt1 vn.e'(Cl o.../ NC- DATE_J-'-----()...~'~----"2: ___ ~--/-·/_q~_g __ 1. 2. Entrance Road Monitoring Wells Casings, locks · Fences, gates, locks 3. Landfill fence, gate, locks 4. Air Vent . 5. Landfill Cover Erosion, vegetation Subsidence 6. Leachate Detection System Water in sump 7. Leachate Collection Access Pipe Pump Piping 8. Treatment Works Influent Piping Sand Filter Carbon Filter Effluent Piping 9. Surface Impoundment System Erosion, vegetation 10. Irrigation &yst~ Influent Piping Pump Sprinkler Units NAME 5ha..rotA /1i.;evs --....::....-_;__...:...c...-------'-'./f-....;;....__;;:__ __ _ NO PROBLEM V v t...// POTENTIAL PROBLEM v ,.C. OBSER.VA:rIONS . · Lock.. wa...s le.ft Open by . !ct-st V;s ;-1:or /oJJ I .J/1.Cr '-lrl/.cls u..~ hlg J · roo.d. lo<ks ·ho.J.:f o be 0 ; ( e_d /octs ti.o..d +.c be o;/d -...... -·· .. : • N. C. Department of Human Resources Division of Health Services SAMPLE ANALYSES REQUEST State Laboratory of Public Health P. 0. Box 28047 306 N. Wilmington Street Raleigh, 27611 Site Number __ q_3_0_0_·0_0_0......;1_0-,-o---::of-'x__,_,_ ____ Field Sample Number _0........,..O_'--(...J.-"-(p_S;;__;:8:..___--,--.,---__ _ Name of Site pc.. B L 0-. ll\. d f; II Site Location i...,y 0... r:re. h (_ (J. l A.f ion. -IJ L 7 / Collected By Byfd/RoJ:>c,u·hJ17e.r5fD#S""l;..53; 5"'2 Date Collected 7/5 /22 Time /Z,'~tJ f ·i'Y1• Type of Sample: Environmental Concentrate Comments ~ Groundwater (1) __ Solid (5) w'-I ___ Surface Water (2) ___ Liquid (6) __ Soil (3) __ Sludge (7) __ Other (4) __ Other (8) INORGANIC CHEMISTRY Extractables Total Parameter Results mg/ 1 Parameter Results mg/ 1 Parameter Results mg/ 1 __ Arsenic __ Arsenic __ Silver __ Barium __ Barium __ Sulfates __ Cadmium __ Cadmium __ Zinc __ Chromium __ Chloride _Ph __ Lead __ Chromium __ Conductivity __ Mercury __ Copper _ms __ Selenium __ Fluoride _TOC __ Silver __ Iron -- --__ Lead -- --__ Manganese -- --__ Mercury -- --__ Nitrate -- --__ Selenium -- ORGANIC CHEMISTRY Parameter Results mg/ 1 Para~eter Results mg/ 1 Parameter Results mg/ 1 _P&T:GC/MS _EDB __ Methoxychlor __ Acid:B/N Ext. V pcB's <o . oo 07 .J?l!.n-. __ Toxaphene _TOX __ Petroleum _2,4-D --__ Endrin __ 2,4,5-TP (silvex) --__ Lindane -- MICROBIOLOGY RADIOCHEMISTRY Parameter Parameter Results PCi/ 1 __ (MF) Coliform Colonies/l00mls __ (MPN) Coliform Colonies/l00mls -- -- Date Received 1,-(; -f 'i ;Ji. PC8,s -vP Date Exttacterl ?JZ JN Reported By }!J! /4e'~ ( OHS 3191 (Revised 7/85) Solid and Hazardous Waste (Review 7187) __ Gross Alpha __ Gross Beta -- -- Date Reported '2-(Y-U,-- Date Analyzed 1 -'f -~1! J .'.l Lab Number Purpose: Preparation Enforcement and compliance with the N. C. Solid and Hazardous Waste Management Rules. A sample analyses request form (OHS 3191) must be completed for each type of evaluation requested (e.g., inorganic, organic, microbiology, radiochemistry). For sampling conditions which require more than one (1) container (i.e., ground or surface water from landfills) a sample label must be affixed to one of the containers. The collector must then write the site and sample number on the duplicate. Do not submit an analysis request sheet with no parameters indicated. Equivalent measurements: ppm= µg/ml = mg/1 =µgig= mg/kg ppb = µg/1 = µg/lO00g = µg/kg DEFINITIONS/INSTRUcfIONS Site Number -A twelve-digit site/location identifier, assigned only by the district field representative. j Field Sample Number -A six--digit sample identifier which is pre-printed on the sample label. Name of Site -Name of landfill, facility, etc. Site Location -Address, street number, state road, etc. Collected By -Name and ID of sample collector. Date and Time Collected -Self-explanatory. Environmental -A sample of a naturally occurring substance such as groundwater, surface water or soils which may be contaminated. Concentrate -A sample of a waste, including but not limited to, sludges, resins, treatment effluents or drummed wastes. Comments -Lists details regarding sample or sample point, including but limited to, phase separation, and/ or od9rs. · lnorpnic Chemistry -Check ( ✓ ) the desired parameters to be analyzed. Extractables are only performed on a solid or semi-solid. For routine landfill samples, check all parameters in the second and third columns. Organic Chemistry -Check ( ✓ ) the desired parameter to be analyzed. If not listed, enter the name in the space provided. Microbiology and Radiochemistry -The Raleigh office should be consulted prior to sampling for either of these. . Distribution: 1. Original to State Laboratory of Public Health Environmental Sciences Branch _I: P. 0. Box 28047 Raleigh, NC 27611 2. Lab sends copy to Solid and Hazardous Waste Management Branch. 3. Solid and Hazardous Waste Management Branch sends copy to field person. Disposition: This form may be destroyed in accordance with the Environmental Health, Solid and Hazardous Waste Section of the Records Disposition Schedule as published by the North Carolina Division of Archives and History. Additional forms may be ordered from: Solid and Hazardous Waste Management Branch Division of Health Services P. 0 . Box 2091 Raleigh, NC 27602-2091 . . . N. C. Department of Human Resources Dlvialon of Health Services State Laboratory of Public Health SAMPLE ANALYSES REQUEST P. o. Box 28047 306 N. Wilmington Street Raleigh, 27611 Site Number -----=-Cf=3 --""Q_O_O_D_Q_,_/-=O_Q----=Q,-&..X_,__ ____ Field Sample Number ~Q~O_Lf~fo~5=----,-o/----,--::-;----.~- Name of Site __,__p ....;.C~/3._..0,CL-Cl=-h_.d_(,>,_:....i,,'' / ...... I______ Site Location w Ot...V re.. ir--LO, ;1 A.f-Lo h I NC... Collected By .... B.,_,,a"""b....,u ..... , __ '11\.__ _____ ID# 5 > Date Collected 7 /S / g g Time /.'!JO / • ¥1'\ Type of Sample: Environmental ~ Groundwater ( 1) Concentrate __ Solid (5) __ Surface Water (2) __ Liquid (6) __ Soil (3) __ Sludge (7) __ Other (4) __ Other (8) Comments W-2 INORGANIC CHEMISTRY Extractables Parameter Results mg/ 1 __ Arsenic __ Barium __ Cadmium __ Chromium __ Lead __ Mercury __ Selenium __ Silver -- -- -- -- -- Parameter Results mg/ 1 _P&T:GC/MS __ Acid:B/N Ext. _TOX -- -- MICROBIOLOGY Parameter __ (MF) Coliform Colonies/IO0mls __ (MPN) Coliform Colonies/IO0mls -- -- Date Received 7 -(, -J r' 13£.. ~GB!s V P Date Extracted 7 -7-ri' ii£; Reported By OHS 3191 (Revised 7/85) Solid and Hazardous Waste (Review 7 /87) Total Parameter Results mg/ 1 Parameter Results mg/ 1 __ Arsenic __ Silver __ Barium __ Sulfates __ Cadmium __ Zinc __ Chloride _Ph __ Chromium __ Conductivity __ Copper _TDS __ Fluoride _TOC __ Iron -- __ Lead -- __ Manganese -- __ Mercury -- __ Nitrate -- __ Selenium -- ORGANIC CHEMISTRY Parameter EDB --;:;7 PCB's __ Petroleum __ Endrin __ Lindane Results mg/ 1 Parameter Results mg/ 1 __ Methoxychlor <o,o oo/.11J2ol. __ Toxaphene , I _2,4-D __ 2,4,5-TP (silvex) -- RADIOCHEMISTRY Parameter Results PCi/ 1 __ Gross Alpha __ Gross Beta -- -- Date Reported __________________ _ Date Analyzed _7~-~'i_-_r:~r_-v'i---'-'P'----------- 801 l, 3 J Lab Number Purpose: Preparation Enforcement and compliance with the N. C. Solid and Hazardous Waste Management Rules. A sample analyses request form (OHS 3191) must be completed for each type of evaluation requested ( e.g., inorganic, organic, microbiology, radiochemistry). For sampling conditions which require more than one ( 1) container (i.e., ground or surface water from landfills) a sample label must be affixed to one of the containers. The collector must then write the site and sample number on the duplicate. Do not submit an analysis request sheet with no parameters indicated. Equivalent measurements: ppm= µg /ml = mg/1 =µgi g= mg/kg ppb = µg / 1 = µg/ 1000g = µg /kg .) DEFINITIONS/INSTRUCTIONS Site Number -A twelve-digit site/location identifier, assigned only by the district field representative. j Field Sample Number -A six-digit sample identifier which is pre-printed on the sample label. Name of Site -Name of landfill, facility, etc. Site Location -Address, street number, state road, etc. Collected By -Name and ID of sample collector. Date and Time Collected -Self-explanatory. Environmental -A sample of a naturally occurring substance such as groundwater, surface water or soils which may be contaminated. Concentrate -A sample of a waste, including but not limited to, sludges, resins, treatment effluents or drummed wastes. Comments -Lists details regarding sample or sample point, including but limited to, phase separation, and/ or odors. · Inorpnic Chemistry-Check ( ✓) the desired parameters to be analyzed. Extractables are only performed on a solid or semi-solid. For routine landfill samples, check all parameters in the second and third columns. Organic Chemistry -Check ( ✓ ) the desired parameter to be analyzed. If not listed, enter the name in the space provided. Microbiology and Radiochemistry -The Raleigh office should be consulted prior to sampling for either of these. Distribution: 1. Original to State Laboratory of Public Health Environmental Sciences Branch P. 0 . Box 28047 Raleigh, NC 27611 2. Lab sends copy to Solid and Hazardous Waste Management Branch. 3. Solid and Hazardous Waste Management Branch sends copy to field person. Disposition: This form may be destroyed in accordance with the Environmental Health, Solid and Hazardous Waste Section of the Records Disposition Schedule as published by the North Carolina Division of Archives and History. Additional forms may be ordered from: Solid and Hazardous Waste Management Branch Division of Health Services P. 0 . Box 2091 Raleigh, NC 27602-2091 N.' C. Department of Human Resources Division of Health Services SAMPLE ANALYSES REQUEST State Laboratory of Public Health P. 0 . Box 28047 306 N. Wilmington Street Raleigh, 27611 Site Number _1.....;;3~0_0_0_0_0_1--=0_C-=-o ....... x _______ Field Sample Number ~o~o=---c.._[J __ G-=fo--=()'-------,----,,--.---- Name of Site pc 8 La.Md f i' II Site Location ½/°'~ye V\._ C_o , A.ff Ok~ NC Collected By 7 > _g-"-(A.. ...... b'--'IA__,_;_IA--_____ ID# _5_5 ___ Date Collected 7 / :> /8 g Time I ; JO 'f • r1'\ • Type of Sample: Environmental ✓ ___ Groundwater ( 1) Concentrate __ Solid (5) __ Surface Water (2) __ Liquid (6) __ Soil (3) __ Sludge (7) __ Other (4) __ Other (8) Comments W----3 INORGANIC CHEMISTRY Extractables Parameter Results mg/ 1 __ Arsenic __ Barium __ Cadmium __ Chromium __ Lead __ Mercury __ Selenium __ Silver -- -- -- -- -- Parameter Results mg/ 1 _P&T:GC/MS __ Acid:B/N Ext. _TOX -- -- MICROBIOLOGY Parameter __ (MF) Coliform Colonies/l00mls __ (MPN) Coliform Colonies/l00mls -- -- Date Received ✓7-&-· Yi /?£ f'CB's 1/P Date Extracted 7 -Z-Kr ..:,-NJ Pu. Total Parameter Results mg/ 1 Parameter Results mg/1 __ Arsenic __ Silver __ Barium __ Sulfates __ Cadmium __ Zinc __ Chloride _Ph __ Chromium __ Conductivity __ Copper _TDS __ Fluoride _TOC __ Iron --__ Lead -- __ Manganese -- __ Mercury -- __ Nitrate -- __ Selenium -- ORGANIC CHEMISTRY Parameter Results mg/ 1 Parameter Results mg/ 1 _EDB __ Methoxychlor ~CB's <o.OOO/-z>nw. Toxaphene __ Petroleum // _2,4-D __ Endrin __ 2,4,5-TP (silvex) __ Lindane -- RADIOCHEMISTRY Parameter Results PCi/ 1 __ Gross Alpha __ Gross Beta -- -- Date Reported __________________ _ Date Analyzed _7~-~f_-_di~~-J/~p ________ _ Reported By -------------------Lab Number 01(~ .... -8 , to,j-~2 OHS 3191 (Revised 7/85) Solid and Hazardous Waste (Review 7187) Purpose: Preparation • Enforcement and compliance with the N. C. Solid and Hazardous Waste Management Rules. A sample analyses request form (OHS 3191) must be completed for each type of evaluation requested (e.g., inorganic, organic, microbiology, radiochemistry). For sampling conditions which require more than one ( 1) container (i.e., ground or surface water from landfills) a sample label must be affixed to one of the containers. The collector must then write the site and sample number on the duplicate. Do not submit an analysis request sheet with no parameters indicated. Equivalent measurements: ppm= µg/ml = mg/1 =µgi g= mg/kg ppb = µg/1 = µg/lOOOg = µg/kg DEFINITIONS/INSTRUCiJ.ONS Site Number -A twelve-digit site/location identifier, assigned only by the district field representative. Field Sample Number -A six-digit sample identifier which is pre-printed on the sample label. Name of Site -Name of landfill, facility, etc. Site Location -Address, street number, state road, etc. Collected By -Name and ID of sample collector. Date and Time Collected -Self-explanatory. j Environmental -A sample of a naturally occurring substance such as groundwater, surface water or soils which may be contaminated. Concentrate -A sample of a waste, including but not limited to, sludges, resins, treatment effluents or drummed wastes. Comments -Lists details regarding sample or sample point, including but limited to, phase separation, and/ or odors. · Inorganic Chemistry -Check ( ✓ ) the desired parameters to be analyzed. Extractables are only performed on a solid or semi-solid. For routine landfill samples, check all parameters in the second and third columns. Organic Chemistry -Check ( ✓ ) the desired parameter to be analyzed. If not listed, enter the name in the space provided. Microbiology and Radiochemistry -The Raleigh office should be consulted prior to sampling for either of these. Distribution: 1. Original to State Laboratory of Public Health Environmental Sciences Branch P. 0 . Box 28047 Raleigh, NC 27611 2. Lab sends copy to Solid and Hazardous Waste Management Branch. 3. Solid and Hazardous Waste Management Branch sends copy to field person. Disposition: This form may be destroyed in accordance with the Environmental Health, Solid and Hazardous Waste Section of the Records Disposition Schedule as published by the North Carolina Division of Archives and History. Additional forms may be ordered from: Solid and Hazardous Waste Management Branch Division of Health Services P. 0. Box 2091 Raleigh, NC 27602-2091 N'. C. Department of Human Resources Division of Health Services SAMPLE ANALYSES REQUEST State Laboratory of Public Health P. 0 . Box 28047 306 N. Wilmington Street Raleigh, 27611 Site Number _q.:..:::3:c....o=----.::..0-=o-o-'-o-"1_O-,-o;;_o~x'r-------Field Sample Number ----"Q_..O.._L/__,____,.,"t;L. ....... : -..o ........ l __ --:---,.------,---,..-- Name of Site pc_ B Lo... /ll d { ,' IJ Site Location w 0.. f re.. V\.. CO • , A.( to k • NC Collected By ...... -P-=-ax:>--=b_tA~J~"'~----ID# _s-'s-"----Date Collected 7 5 12 8 7 Time 2_ '.I 5 "f>, M I Type of Sample: Environmental ~Groundwater ( 1) Concentrate __ Solid (5) __ Surface Water (2) __ Liquid (6) __ Soil (3) __ Sludge (7) __ Other (4) __ Other (8) Comments INORGANIC CHEMISTRY Extractables Total Parameter Results mg/1 Parameter Results mg/ 1 Parameter Results mg/ l __ Arsenic __ Arsenic __ Silver __ Barium __ Barium __ Sulfates __ Cadmium __ Cadmium __ Zinc __ Chromium __ Chloride _Ph __ Lead __ Chromium __ Conductivity __ Mercury __ Copper _ms __ Selenium __ Fluoride _TOC __ Silver __ Iron -- --__ Lead -- --__ Manganese -- --__ Mercury -- --__ Nitrate -- --__ Selenium -- ORGANIC CHEMISTRY Parameter Results mg/ 1 Parameter Results mg/ 1 Parameter Results mg/1 _P&T:GC/MS _EDB __ Methoxychlor __ Acid:B/N Ext. ./PCB's < O. OOOI.J'l-l'Y\_ __ Toxaphene _TOX __ Petroleum _2,4-D --__ Endrin __ 2,4,5-TP (silvex) --__ Lindane -- MICROBIOLOGY RADIOCHEMISTRY Parameter Parameter Results PCi/ 1 __ (MF) Coliform Colonies/lO0mls __ Gross Alpha __ (MPN) Coliform Colonies/lO0mls __ Gross Beta ---- ---- Date Receivecl r-/-/; · f K' f3;_j) pees 'VP Date Extracted 7 -7-;{ Y'~ Date Reported __________________ _ Date Analyzed _7~-~8'~-~</~Y---='U'--'P._ _______ _ Reported By -------------------Lab Number 0 0'l <.' "). --0 • .. IQ-..,.:_.., DHS 3191 (Revised 7/85) Solid and Hazardous Waste (Review 7 /87) Purpose: Preparation Enforcement and compliance with the N. C. Solid and Hazardous Waste Management Rules. A sample analyses request form (OHS 3191) must be completed for each type of evaluation requested ( e.g., inorganic, organic, microbiology, radiochemistry). For sampling conditions which require more than one ( 1) container (i.e., ground or surface water from landfills) a sample label must be affixed to one of the containers. The collector must then write the site and sample number on the duplicate. Do not submit an analysis request sheet with no parameters indicated. Equivalent measurements: ppm= µg/ml = mg/1 =µgi g= mg/kg ppb = µg/1 = µg/lO00g = µg /kg DEFINITIONS/INSTRUCtJ.ONS Site Number -A twelve-digit site/location identifier, assigned only by the district field representative . . i Field Sample Number -A six-digit sample identifier which is pre-printed on the sample label. Name of Site -Name of landfill, facility, etc. Site Location -Address, street number, state road, etc. Collected By -Name and ID of sample collector. Date and Time Collected -Self-explanatory. Environmental -A sample of a naturally occurring substance such as groundwater, surface water or soils which may be contaminated. Concentrate -A sample of a waste, including but not limited to, sludges, resins, treatment effluents or drummed wastes. Comments -Lists details regarding sample or sample point, including but limited to, phase separation, and/or odors. · Inorpnic Chemistry -Check ( ✓ ) the desired parameters to be analyzed. Extractables are only performed on a solid or semi-solid. For routine landfill samples, check all parameters in the second and third columns. Organic Chemistry -Check ( ✓ ) the desired parameter to be analyzed. If not listed, enter the name in the space provided. Microbiology and Radiochemistry -The Raleigh office should be consulted prior to sampling for either of these. Distribution: 1. Original to State Laboratory of Public Health Environmental Sciences Branch P. 0 . Box 28047 Raleigh, NC 27611 2. Lab sends copy to Solid and Hazardous Waste Management Branch. 3. Solid and Hazardous Waste Management Branch sends copy to field person. Disposition: This form may be destroyed in accordance with the Environmental Health, Solid and Hazardous Waste Section of the Records Disposition Schedule as published by the North Carolina Division of Archives and History. Additional forms may be ordered from: Solid and Hazardous Waste Management Branch Division of Health Services P. 0. Box 2091 Raleigh, NC 27602-2091 ., N'. C, Department of Human Resources Division of Health Services SAMPLE ANALYSES REQUEST State Laboratory of Public Health P. 0 . Box 28047 306 N. Wilmington Street Raleigh, 27611 Site Number _q--=-..3 ....::.0___:0_0_0_0_1-,-o_a'-,o,...,...x'---"--____ Field Sample Number -'O~O_'i_ ....... 6 ...... fa.....:2=-------,,....--r----,--- Name of Sitc --+-~-=c=-:--~<-r--L_aJA_d__._[_;..._I I.....__ _____ Site Location Wo...v-ceh C_o ') J+.fok./ 'NC Collected By By_Y dj_ My e._ Y--S ID# 5 7 / 5 0 Date Collected 7 / 5 / g & Time / .' (JO f ' "h. Type of Sample: Environmental ___ Groundwater ( 1) ~ Surface Water (2) __ Soil (3) __ Other (4) Concentrate __ Solid (5) __ Liquid (6) __ Sludge (7) __ Other (8) Comments gcus INORGANIC CHEMISTRY Extractables Total Parameter Results mg/1 Parameter Results mg/ 1 Parameter Results mg/ 1 __ Arsenic __ Arsenic __ Silver __ Barium __ Barium __ Sulfates __ Cadmium __ Cadmium __ Zinc __ Chromium __ Chloride _Ph __ Lead __ Chromium __ Conductivity __ Mercury __ Copper _ms __ Selenium __ Fluoride _Toe __ Silver __ Iron -- --_Lead -- --__ Manganese -- --__ Mercury -- --__ Nitrate -- --__ Selenium -- ORGANIC CHEMISTRY Parameter Results mg/ 1 Parameter Results mg/ 1 Parameter Results mg/ 1 _P&T:GC/MS _EDB __ Methoxychlor __ Acid:B/N Ext. _,,,,,.-PCB's <0,000/~ __ Toxaphene _TOX __ Petroleum _2,4-D --__ Endrin __ 2,4,5-TP (silvex) --__ Lindane -- MICROBIOLOGY RADIOCHEMISTRY Parameter Parameter Results PCi/ 1 __ (MF) Coliform Colonies/l00mls __ Gross Alpha __ (MPN) Coliform Colonies/lO0mls __ Gross Beta ---- ---- Date Received 1 ft· -,Y ,y1 /?£ pcs=s -VP Date Extracted 7-7-zrY'~ Reported By Date Reported __________________ _ Date Analyzed ~'7~-~'i:_-~'Y,~f'~1/.-,,,P._-=-=-------- 801 ~ ~ .-;. .-·~ \)-,._.;,() -------------------Lab Number OHS 3191 (Revised 7/85) Solid and Hazardous Waste (Review 7 /87) Purpose: Preparation Enforcement and compliance with the N. C. Solid and Hazardous Waste Management Rules. A sample analyses request form (OHS 3191) must be completed for each type of evaluation requested (e.g., inorganic, organic, microbiology, radiochemistry). For sampling conditions which require more than one (1) container (i.e., ground or surface water from landfills) a sample label must be affixed to one of the containers. The collector must then write the site and sample number on the duplicate. Do not submit an analysis request sheet with no parameters indicated. Equivalent measurements: ppm= µg/ml = mg/1 =µgi g= mg/kg ppb = µg/1 = µg/lO00g = µg/kg DEFINITIONS/INSTRUCfIONS Site Number -A twelve-digit site/location identifier, assigned only by the district field representative. i Field Sample Number -A six-digit sample identifier which is pre-printed on the sample label. , Name of Site -Name of landfill, facility, etc. Site Location -Address, street number, state road, etc. Collected By -Name and ID of sample collector. Date and Time Collected -Self-explanatory. Environmental -A sample of a naturally occurring substance such as groundwater, surface water or soils which may be contaminated. Concentrate -A sample of a waste, including but not limited to, sludges, resins, treatment effluents or drummed wastes. Comments -Lists details regarding sample or sample point, including but limited to, phase separation, and/ or odors. · Inorpnic Chemistry -Check ( ✓ ) the desired parameters to be analyzed. Extractables are only performed on a solid or semi-solid. For routine landfill samples, check all parameters in the second and third columns. Organic Chemistry -Check ( ✓ ) the desired parameter to be analyzed. If not listed, enter the name in the space provided. Microbiology and Radiochemistry -The Raleigh office should be consulted prior to sampling for either of these. Distribution: 1. Original to State Laboratory of Public Health Environmental Sciences Branch P. 0. Box 28047 Raleigh, NC 27611 2. Lab sends copy to Solid and Hazardous Waste Management Branch. 3 . Solid and Hazardous Waste Management Branch sends copy to field person. Disposition: This form may be destroyed in accordance with the Environmental Health, Solid and Hazardous Waste Section of the Records Disposition Schedule as published by the North Carolina Division of Archives and History. Additional forms may be ordered from: Solid and Hazardous Waste Management Branch Division of Health Services P. 0. Box 2091 Raleigh, NC 27602-2091 N. C. Department of Human Resources Division of Health Services State Laboratory of Public Health SAMPLE ANALYSES REQUEST P. 0 . Box 28047 306 N. Wilmington Street Raleigh, 27611 Site Number _q-'-3_0_0_0......;::;t)_Q_/ ...... 0~0,_..O'--'?(...,....,._ ____ Field Sample Number _0~O___.fj_.___.,fo"--""'-&_3"-----~~--- Name of Site PC S Lo_ 0d£; II Site Location W °' r ;e V'-Co , , Af te) V1 , NC Collected By 8/ ( <l / M y e Y 5 ID# 571 J0 Date Collected 7 /S-/3 J 7 Time / ; 00 f ~ Type of Sample: Environmental ___ Groundwater ( 1) ___ Surface Water (2) ✓ __ Soil (3) __ Other (4) Concentrate __ Solid (5) __ Liquid (6) __ Sludge (7) __ Other (8) RCL)S Comments INORGANIC CHEMISTRY Extractables Parameter Results mg/ 1 __ Arsenic __ Barium __ Cadmium __ Chromium __ Lead __ Mercury __ Selenium __ Silver -- -- -- -- -- Parameter Results mg/ 1 _P&T:GC/MS __ Acid:B/N Ext. _TOX -- -- MICROBIOLOGY Parameter __ (MF) Coliform Colonies/lO0mls __ (MPN) Coliform Colonies/lOOmls -- -- Date Received 1-Ip · ;) ;J £/) Date Extracted 7w• /o2 -~ i/ P Total Parameter Results mg/ 1 Parameter Results mg/ 1 __ Arsenic __ Silver __ Barium __ Sulfates __ Cadmium __ Zinc __ Chloride _Ph __ Chromium __ Conductivity __ Copper _ms __ Fluoride _Toe __ Iron -- __ Lead -- __ Manganese -- __ Mercury -- __ Nitrate -- __ Selenium -- ORGANIC CHEMISTRY Parameter Results mg/ 1 Parameter Results mg/ 1 _EDB __ Methoxychlor ../PCB's < at l 1'F"'-__ Toxaphene __ Petroleum _2,4-D __ Endrin __ 2,4,5-TP (silvex) __ Lindane -- RADIOCHEMISTRY Parameter Results PCi/ 1 __ Gross Alpha __ Gross Beta -- -- Date Reported _________________ _ Date Analyzed _,7.._-J._.311!C..----'<-L,__.,'3:"----"1)'--'p.._ _______ _ Reported By 801 t-~tj ' -y -------------------Lab Number ,:., -' OHS 3191 (Revised 7/85) Solid and Hazardous Waste (Review 7 /87) Purpose: Preparation Enforcement and compliance with the N. C. Solid and Hazardous Waste Management Rules. A sample analyses request form (DHS 3191) must be completed for each type of evaluation requested ( e.g., inorganic, organic, microbiology, radiochemistry). For sampling conditions which require more than one ( 1) container (i.e., ground or surface water from landfills) a sample label must be affixed to one of the containers. The collector must then write the site and sample number on the duplicate. Do not submit an analysis request sheet with no parameters indicated. Equivalent measurements: ppm= µg/ml = mg/1 =µgi g= mg/kg ppb = µg/1 = µg/lO00g = µg/kg DEFINITIONS/INSTRUCTIONS Site Number -A twelve-digit site/location identifier, assigned only by the district field representative. Field Sample Number -A six-digit sample identifier which is pre-printed on the sample label. Name of Site -Name of landfill, facility, etc. Site Location -Address, street number, state road, etc. Collected By -Name and ID of sample collector. Date and Time Collected -Self-explanatory. Environmental-A sample of a naturally occurring substance such as groundwater, surface water or soils which may be contaminated. Concentrate -A sample of a waste, including but not limited to, sludges, resins, treatment effluents or drummed wastes. Comments -Lists details regarding sample or sample point, including but limited to, phase separation, and/ or od<;>rs. · Inorpnic Chemistry -Check ( ✓ ) the desired parameters to be analyzed. Extractables are only performed on a solid or semi-solid. For routine landfill samples, check all parameters in the second and third columns. Organic Chemistry -Check ( ✓ ) the desired parameter to be analyzed. If not listed, enter the name in the space provided. Microbiology and Radiochemistry -The Raleigh office should be consulted prior to sampling for either of these. Distribution: 1. Original to State Laboratory of Public Health Environmental Sciences Branch • I P. 0. Box 2804 7 Raleigh, NC 27611 2. Lab sends copy to Solid and Hazardous Waste Management Branch. 3. Solid and Hazardous Waste Management Branch sends copy to field person. Disposition: This form may be destroyed in accordance with the Environmental Health, Solid and Hazardous Waste Section of the Records Disposition Schedule as published by the North Carolina Division of Archives and History. Additional forms may be ordered from: Solid and Hazardous Waste Management Branch Division of Health Services P. 0. Box 2091 Raleigh, NC 27602-2091 N.' C. Department of Human Resources Division of Health Services SAMPLE ANALYSES REQUEST State Laboratory of Public Health P. 0 . Box 2804 7 306 N. Wilmington Street . Raleigh, 27611 Site Number -----'1-=-3 ......... ~..c....o_o~_C)_/_()-,-0.,......CJ...,..t....-----Field Sample Number _..,O~Q__.</ ....... fa~C~~ 4~----,----~ NameofSite PCB Lo.vtJ{,'ff SiteLocation V\/0-.yie.0-Co./A{{o')N L Collected By B1rd IM ;e. (S ID# 51; s-r.o Date Collected 7 IS-/88 Time /; '-1 5=/ I vn Type of Sample: Environmental ___ Groundwater ( 1) ✓ ___ Surface Water (2) __ Soil (3) __ Other (4) Concentrate __ Solid (5) __ Liquid ( 6) __ Sludge (7) __ Other (8) Comments INORGANIC CHEMISTRY Extractables Total Parameter Results mg/ 1 Parameter Results mg/ 1 Parameter Results mg/ 1 __ Arsenic __ Arsenic __ Silver __ Barium __ Barium __ Sulfates __ Cadmium __ Cadmium __ Zinc __ Chromium __ Chloride _Ph __ Lead __ Chromium __ Conductivity __ Mercury __ Copper _ms __ Selenium __ Fluoride _TOC __ Silver __ Iron -- --__ Lead -- --__ Manganese -- --__ Mercury -- --__ Nitrate -- --__ Selenium -- ORGANIC CHEMISTRY Parameter Results mg/ 1 Parameter Results mg/ 1 Parameter Results mg/ 1 _P&T:GC/MS _EDB __ Methoxychlor __ Acid:B/N Ext. /PCB's <O,ooo~ __ Toxaphene _TOX __ Petroleum _2,4-D --__ Endrin __ 2,4,5-TP (silvex) --__ Lindane -- MICROBIOLOGY RADIOCHEMISTRY Parameter Parameter Results PCi/ 1 __ (MF) Coliform Colonies/lOOmls __ Gross Alpha __ (MPN) Coliform Colonies/lOOmls __ Gross Beta ---- ---- , . ' J. ·• I Q Date Received 7 {_, d O I... pea} i7P Date Extracted '/ -7-· 7Y ~ Reported By Date Reported __________________ _ Date Analyzed _ _,_7_-..... Y..__----'F'Y~"'t--F-1/~..:.,P..,,........,..,,.,...._ _______ _ ~1 ~3 :3 Lab Number DHS 3191 (Revised 7/85) Solid and Haza rdous Waste (Review 7 /87) Purpose: Preparation Enforcement and compliance with the N. C. Solid and Hazardous Waste Management Rules. A sample analyses request form (OHS 3191) must be completed for each type of evaluation requested (e.g., inorganic, organic, microbiology, radiochemistry). For sampling conditions which require more than one ( 1) container (i.e., ground or surface water from landfills) a sample label must be affixed to one of the containers. The collector must then write the site and sample number on the duplicate. Do not submit an analysis request sheet with no parameters indicated. Equivalent measurements: ppm= µg/ml = mg/1 =µgi g= mg/kg ppb = µg/1 = µg/lO00g = µg/kg DEFINITIONS/INSTRUctJ.ONS Site Number -A twelve-digit site/location identifier, assigned only by the district field representative. j Field Sample Number -A six-digit sample identifier which is pre-printed on the sample label. · Name of Site -Name of landfill, facility, etc. Site Location -Address, street number, state road, etc. Collected By -Name and ID of sample collector. Date and Time Collected -Self-explanatory. Environmental -A sample of a naturally occurring substance such as groundwater, surface water or soils which may be contaminated. Concentrate -A sample of a waste, including but not limited to, sludges, resins, treatment effluents or drummed wastes. Comments -Lists details regarding sample or sample point, including but limited to, phase separation, and/or od9rs. · Inorpnic Chemistry -Check ( ✓ ) the desired parameters to be analyzed. Extractables are only performed on a solid or semi-solid. For routine landfill samples, check all parameters in the second and third columns. Organic Chemistry -Check ( ✓ ) the desired parameter to be analyzed. If not listed, enter the name in the space provided. Microbiology and Radiochemistry -The Raleigh office should be consulted prior to sampling for either of these. Distribution: 1. Original to State Laboratory of Public Health Environmental Sciences Branch P. 0 . Box 28047 Raleigh, NC 27611 2. Lab sends copy to Solid and Hazardous Waste Management Branch. 3. Solid and Hazardous Waste Management Branch sends copy to field person. Disposition: This form may be destroyed in accordance with the Environmental Health, Solid and Hazardous Waste Section of the Records Disposition Schedule as published by the North Carolina Division of Archives and History. Additional forms may be ordered from: Solid and Hazardous Waste Management Branch Division of Health Services P. 0. Box 2091 Raleigh, NC 27602-2091 N. C. Department of Human Resources Division of Health Services SAMPLE ANALYSES REQUEST State Laboratory of Public Health P. 0. Box 28047 306 N. Wilmington Street Raleigh, 27611 Site Number ----!'f-=3_0.;._O_{)_0_()~/ C)_{)..;...0.,_X,__ ____ Field Sample Number Od L((o 0 :> Name of Site __._p....:c_=....l3_..,...L_a.._M_J___,_+___,1' ... /.._J _____ Site Location Wo..r-,eJ;"---Co '/A{f;oVL1 AJ C Collected By _/3-v_✓i_d'--"/ _____ t.....;1_v_e..---"~-S_· -ID# 5 "Z, s~ Date Collected 7 / ~ /3 3 Time I : L/ 5 ,1>' ~' / I Type of Sample: Environmental ___ Groundwater ( 1) ___ Surface Water (2) ~ Soil (3) __ Other (4) Concentrate __ Solid (5) __ Liquid (6) __ Sludge (7) __ Other (8) INORGANIC CHEMISTRY Extractables Parameter Results mg/ 1 Parameter Results mg/1 __ Arsenic __ Arsenic __ Barium __ Barium __ Cadmium __ Cadmium __ Chromium __ Chloride __ Lead __ Chromium __ Mercury __ Copper __ Selenium __ Fluoride __ Silver __ Iron --__ Lead --__ Manganese --__ Mercury --__ Nitrate --__ Selenium ORGANIC CHEMISTRY Parameter Results mg/ 1 Parameter Results mg/ 1 _P&T:GC/MS EDB __ Acid:B/N Ext. ~PCB's < o , I -:pp.w.. _TOX __ Petroleum --__ Endrin --__ Lindane MICROBIOLOGY Parameter Parameter __ (MF) Coliform Colonies/lO0mls __ Gross Alpha __ (MPN) Coliform Colonies/lO0mls __ Gross Beta ---- ---- Comments Total Parameter Results mg/ 1 __ Silver __ Sulfates __ Zinc _Ph __ Conductivity _ms _TOC -- -- -- -- -- -- Parameter Results mg/ 1 __ Methoxychlor __ Toxaphene _2,4,D __ 2,4,5,TP (silvex) -- RADIOCHEMISTRY Results PCi/ 1 rJ. f.r-).· { ;J;J.. Date Received _l ____ cJ ______________ Date Reported __________________ _ Date Extracted ?-/ ,2-g'V 1/P Reported By Date Analyzed _7.L..--..a.../..,.3'--~~p,-,.,.,.,~,.""7f....-; ..... ;J,...._,3=-_______ _ -------------------Lab Number OHS 3191 (Revised 7185) Solid and Hazardous Waste (Review 7 /87) Purpose: Enforcement and compliance with the N. C. Solid and Hazardous Waste Management Rules. Preparation A sample analyses request form (OHS 3191) must be completed for each type of evaluation requested (e.g., inorganic, organic, microbiology, radiochemistry). For sampling conditions which require more than one (1) container (i.e., ground or surface water from landfills) a sample label must be affixed to one of the containers. The collector must then write the site and sample number on the duplicate. Do not submit an analysis request sheet with no parameters indicated. Equivalent measurements: ppm= µg /ml = mg/1 = µg/g = mg/kg ppb = µg/1 = µg/lO00g = µg/kg DEFINITIONS/INSTRUCTIONS Site Number -A twelve-digit site/location identifier, assigned only by the district field representative. Field Sample Number -A six-digit sample identifier which is pre-printed on the sample label. Name of Site -Name of landfill, facility, etc. Site Location -Address, street number, state road, etc. Collected By -Name and ID of sample collector. Date and Time Collected -Self-explanatory. Environmental -A sample of a naturally occurring substance such as groundwater, surface water or soils which may be contaminated. Concentrate -A sample of a waste, including but not limited to, sludges, resins, treatment effluents or drummed wastes. Comments -Lists details regarding sample or sample point, including but limited to, phase separation, and/ or ~~-' Inorpnic Chemistry -Check ( ✓ ) the desired parameters to be analyzed. Extractables are only performed on a solid or semi-solid. For routine landfill samples, check all parameters in the second and third columns. Organic Chemistry -Check ( ✓ ) the desired parameter to be analyzed. If not listed, enter the name in the space provided. Microbiology and Radiochemistry -The Raleigh office should be consulted prior to sampling for either of these. Distribution: 1. Original to State Laboratory of Public Health Environmental Sciences Branch P. 0. Box 28047 Raleigh, NC 27611 2. Lab sends copy to Solid and Hazardous Waste Management Branch. 3. Solid and Hazardous Waste Management Branch sends copy to field person. Disposition: This form may be destroyed in accordance with the Environmental Health, Solid and Hazardous Waste Section of the Records Disposition Schedule as published by the North Carolina Division of Archives and History. Additional forms may be ordered from: Solid and Hazardous Waste Management Branch Division of Health Services P. 0. Box 2091 Raleigh, NC 27602-2091 . N. C. Department of Human Resources Division of Health Services SAMPLE ANALYSES REQUEST State Laboratory of Public Health P. 0. Box 28047 306 N. Wilmington Street Raleigh, 27611 Site Number __ C/_3_0_0_()_0_6___...:./_;0;._0_0 ..... ~_,,_ ______ Field Sample Number _0........,()_,__l.f_.__· ro=· .... G ........ 0 ... o.__ ___ ~---- Name of Site P L B l 0, V\c/ ( ;( ( Site Location W c,._y·y-e K (_ 0 , , ,4f to lll, N (_ . 7 , CollectedBy By<d/My ef5 ID# sz.st;;, DateCollected 7 /~ /33 Time /: 5-0 f 1 VVl:· Type of Sample: Environmental ___ Groundwater ( 1) v ___ Surface Water (2) __ Soil (3) __ Other (4) Concentrate __ Solid (5) __ Liquid (6) __ Sludge (7) __ Other (8) UTbS Comments INORGANIC CHEMISTRY Extractables Total Parameter Results mg/ 1 Parameter Results mg/ 1 Parameter Results mg/ 1 __ Arsenic __ Arsenic __ Silver __ Barium __ Barium __ Sulfates __ Cadmium __ Cadmium __ Zinc __ Chromium __ Chloride _Ph __ Lead __ Chromium __ Conductivity __ Mercury __ Copper _ms __ Selenium __ Fluoride _TOC __ Silver __ Iron -- --__ Lead -- --__ Manganese --- --__ Mercury -- --__ Nitrate -- --__ Selenium -- ORGANIC CHEMISTRY Parameter Results mg/ 1 Parameter Results mg/ 1 Parameter Results mg/1 _P&T:GC/MS EDB __ Methoxychlor __ Acid:B/N Ext. ✓ PCB's <CJ,ooo~ __ Toxaphene ---,---, _TOX __ Petroleum _2,4-D --__ Endrin __ 2,4,5-TP (silvex) --__ Lindane -- MICROBIOLOGY RADIOCHEMISTRY Parameter Parameter Results PCi/ 1 __ (MF) Coliform Colonies/l00mls __ Gross Alpha __ (MPN) Coliform Colonies/lOOmls __ Gross Beta ---- ---- 1/ {; (1 )I '. 1 Date Received · · " ;, :)A' -Peas VP Date Extracted 2-7-7'g1 Pw JM Reported By Date Reported _________________ _ Date Analyzed 7--g:-1/?'-,Jp Lab Number 801{:it~.q DHS 3191 (Revised 7185) Solid and Hazardous Waste (Review 7 /87) Purpose: Enforcement and compliance with the N. C. Solid and Hazardous Waste Management Rules. Preparation A sample analyses request form (OHS 3191) must be completed for each type of evaluation requested ( e.g., inorganic, organic, microbiology, radiochemistry). For sampling conditions which require more than one ( 1) container (i.e., ground or surface water from landfills) a sample label must be affixed to one of the containers. The collector must then write the site and sample number on the duplicate. Do not submit an analysis request sheet with no parameters indicated. Equivalent measurements: ppm= µg/ml = mg/1 =µgi g= mg/kg ppb = µg/1 = µg/lO00g = µg/kg DEFINITIONS/INSTRUCTIONS Site Number -A twelve-digit site/location identifier, assigned only by the district field representative. Field Sample Number -A six-digit sample identifier which is pre-printed on the sample label. Name of Site -Name of landfill, facility, etc. Site Location -Address, street number, state road, etc. Collected By -Name and ID of sample collector. Date and Time Collected -Self-explanatory. Environmental -A sample of a naturally occurring substance such as groundwater, surface water or soils which may be contaminated. Concentrate -A sample of a waste, including but not limited to, sludges, resins, treatment effluents or drummed wastes. Comments -Lists details regarding sample or sample point, including but limited to, phase separation, and/ or ~~ ' lnorpnic Chemistry -Check ( ✓ ) the desired parameters to be analyzed. Extractables are only performed on a solid or semi-solid. For routine landfill samples, check all parameters in the second and third columns. Organic Chemistry -Check ( ✓ ) the desired parameter to be analyzed. If not listed, enter the name in the space provided. Microbiology and Radiochemistry -The Raleigh office should be consulted prior to sampling for either of these. Distribution: 1. Original to State Laboratory of Public Health Environmental Sciences Branch P. 0 . Box 28047 Raleigh, NC 27611 2. Lab sends copy to Solid and Hazardous Waste Management Branch. 3. Solid and Hazardous Waste Management Branch sends copy to field person. Disposition: This form may be destroyed in accordance with the Environmental Health, Solid and Hazardous Waste Section of the Records Disposition Schedule as published by the North Carolina Division of Archives and History. Additional forms may be ordered from: Solid and Hazardous Waste Management Branch Division of Health Services P. 0 . Box 2091 Raleigh, NC 27602-2091 N. C. Department of Human Resources Division of Health Services SAMPLE ANALYSES REQUEST State Laboratory of Public Health P. 0. Box 28047 306 N. Wilmington Street Raleigh, 27611 Site Number __ 1_3_0_0_00_0_/""T'"o___,o,-o ...... x..,...._----Field Sample Number --=O_,.Q<-</ ............. l,..,_n_.7_..;G=------=..----- Name of Site ..... P-..a:Ca_.B--...... L-....a.=V\---=d .... { .......... ; ..... [______ Site Location __.\N...,.__,0-.~(_,_Y_,e"'--'-v,-=--_;;C_. o_, ,,~A-L...l..f t=tJ::..:..vt __ .,_, -1-'!J"---""C.:::__ Collected By Bf -rd / Mye.,(5 ID# 57) 5(o Date Collected 7 /5 188 Time I ', so ,P, J.-\.-,.., Type of Sample: Environmental ___ Groundwater ( 1) ___ Surface Water (2) ~ Soil (3) __ Other (4) Concentrate __ Solid (5) __ Liquid (6) __ Sludge (7) __ Other (8) UTD2 INORGANIC CHEMISTRY Extractables Parameter Results mg/ 1 Parameter Results mg/ 1 __ Arsenic __ Arsenic __ Barium __ Barium __ Cadmium __ Cadmium __ Chromium __ Chloride __ Lead __ Chromium __ Mercury __ Copper __ Selenium __ Fluoride __ Silver __ Iron --__ Lead --__ Manganese --__ Mercury --__ Nitrate --__ Selenium ORGANIC CHEMISTRY Parameter Results mg/ 1 Parameter Results mg/ 1 _P&T:GC/MS ~DB __ Acid:B/N Ext. _· _PCB's <n,l ppm _TOX __ Petroleum --__ Endrin --__ Lindane MICROBIOLOGY Parameter Parameter __ (MF) Coliform Colonies/lO0mls __ Gross Alpha __ (MPN) Coliform Colonies/lO0mls __ Gross Beta ---- ---- Comments Total Parameter Results mg/ 1 __ Silver __ Sulfates __ Zinc _Ph __ Conductivity _ms _Toe -- -- -- -- -- -- Parameter Results mg/ 1 __ Methoxychlor __ Toxaphene _2,4-D __ 2,4,5-TP (silvex) -- RADIOCHEMISTRY Results PCi/ 1 'l-11 -~-S 1J£ Date Received _________________ _ Date Reported __________________ _ Date Extracted _J ........... -/.'"""'.2-'---..... ~ ...... 7'_-J._..1_,_'P ________ _ DateAnalyzed 7-/3-$~1/P Reported By 801')~ ,1;-; -------------------Lab Number ________ ·"-~_....,...:;;__ ________ _ DHS 3191 (Revised 7185) Solid and Hazardous Waste (Review 7 /87) Purpose: Enforcement and compliance with the N. C. Solid and Hazardous Waste Management Rules. Preparation A sample analyses request form (OHS 3191) must be completed for each type of evaluation requested (e.g., inorganic, organic, microbiology, radiochemistry). For sampling conditions which require more than one (1) container (i.e., ground or surface water from landfills) a sample label must be affixed to one of the containers. The collector must then write the site and sample number on the duplicate. Do not submit an analysis request sheet with no parameters indicated. Equivalent measurements: ppm= µg/ml = mg/1 =µgi g= mg/kg ppb = µg/1 = µg/lO00g = µg/kg DEFINITIONS/INSTRUCTIONS Site Number -A twelve-digit site/location identifier, assigned only by the district field representative. Field Sample Number -A six-digit sample identifier which is pre-printed on the sample label. Name of Site -Name of landfill, facility, etc. Site Location -Address, street number, state road, etc. Collected By -Name and ID of sample collector. Date and Time Collected -Self-explanatory. Environmental -A sample of a naturally occurring substance such as groundwater, surface water or soils which may be contaminated. Concentrate -A sample of a waste, including but not limited to, sludges, resins, treatment effluents or drummed wastes. Comments -Lists details regarding sample or sample point, including but limited to, phase separation, and/ or od9rs. · lnorpnic Chemistry -Check ( ✓ ) the desired parameters to be analyzed. Extractables are only performed on a solid or semi-solid. For routine landfill samples, check all parameters in the second and third columns. Organic Chemistry-Check ( ✓ ) the desired parameter to be analyzed. If not listed, enter the name in the space provided. Microbiology and Radiochemistry -The Raleigh office should be consulted prior to sampling for either of these. Distribution: 1. Original to State Laboratory of Public Health Environmental Sciences Branch P. 0 . Box 28047 Raleigh, NC 27611 2. Lab sends copy to Solid and Hazardous Waste Management Branch. 3. Solid and Hazardous Waste Management Branch sends copy to field person. Disposition: This form may be destroyed in accordance with the Environmental Health, Solid and Hazardous Waste Section of the Records Disposition Schedule as published by the North Carolina Division of Archives and History. Additional forms may be ordered from: Solid and Hazardous Waste Management Branch Division of Health Services P. 0 . Box 2091 Raleigh, NC 27602-2091 , N. C. Department of Human Resources Division of Health Services SAMPLE ANALYSES REQUEST State Laboratory of Public Health P. 0 . Box 28047 306 N. Wilmington Street Raleigh, 27611 Site Number _Cf'--3_0_0_0_0_0_/ ()~Q,,;._.,;,;;.O ...... X..,._,__ ____ Field Sample Number ____,.Q,c..;O:=c-t/J-....=~'-7------'-7 ___ ,.,...........,,----_.--.- Name of Site PC B l °'-IA J ( ;-j l Site Location V\/ RY re iA CO 1 , A { fo I/\ , N {_ Collected By "fiy-r d /M j e_·( 5 ID# 57,, 5~ Date Collected 7 / 5" / 25, P, T~e Z 1 , 30 f' l.N\..., Type of Sample: Environmental ___ Groundwater ( 1) v ___ Surface Water (2) __ Soil (3) __ Other (4) Extractables Concentrate __ Solid (5) __ Liquid ( 6) __ Sludge (7) __ Other (8) 12 c. bs INORGANIC CHEMISTRY Parameter Results mg/ 1 Parameter Results mg/ 1 __ Arsenic __ Arsenic __ Barium __ Barium __ Cadmium __ Cadmium __ Chromium __ Chloride __ Lead __ Chromium __ Mercury __ Copper __ Selenium __ Fluoride __ Silver __ Iron --__ Lead --__ Manganese --__ Mercury --__ Nitrate --__ Selenium ORGANIC CHEMISTRY Parameter Results mg/ 1 Parameter Results mg/ 1 _P&T:GC/MS _EDB Comments Total Parameter __ Silver __ Sulfates __ Zinc _Ph __ Conductivity _ms _Toe -- -- -- -- -- -- Parameter __ Methoxychlor __ Acid:B/N Ext. ...,-PCB's <oi 0001.ffi~ __ Toxaphene _TOX __ Petroleum _2,4-D --__ Endrin __ 2,4,5-TP (silvex) --__ Lindane -- MICROBIOLOGY RADIOCHEMISTRY Results mg/1 Results mg/ 1 Parameter Parameter Results PCi/ 1 __ (MF) Coliform Colonies/l00mls __ Gross Alpha __ (MPN) Coliform Colonies/lOOmls __ Gross Beta ---- ---- Reported By Date Received :J: (c -f J 1.-JL~-Date Reported ~-----y:;-'P~---------------------------- Date Extracted 7-7-ll~ Date Analyzed _7.L.--....:'f=----:.'ff-=?~1/1!:....!....P ________ _ T 801 L" ;~ •:-> Lab Number ________ •t_.»•'-.::_·,_"" ________ _ OHS 3191 (Revised 7185) Solid and Hazardous Waste (Review 7 /87) ... Purpose: Enforcement and compliance with the N. C. Solid and Hazardous Waste Management Rules. Preparation A sample analyses request form (OHS 3191) must be completed for each type of evaluation requested (e.g., inorganic, organic, microbiology, radiochemistry). For sampling conditions which require more than one (1) container {i.e., ground or surface water from landfills) a sample label must be affixed to one of the containers. The collector must then write the site and sample number on the duplicate. Do not submit an analysis request sheet with no parameters indicated. Equivalent measurements: ppm= µg/ml = mg/1 =µgi g= mg/kg ppb = µg/1 = µg/lO00g = µg/kg DEFINITIONS/INSTRUCTIONS Site Number -A twelve-digit site/location identifier, assigned only by the district field representative. Field Sample Number -A six-digit sample identifier which is pre-printed on the sample label. Name of Site -Name of landfill, facility, etc. Site Location -Address, street number, state road, etc. Collected By -Name and ID of sample collector. Date and Time Collected -Self-explanatory. Environmental-A sample of a naturally occurring substance such as groundwater, surface water or soils which may be contaminated. Concentrate -A sample of a waste, including but not limited to, sludges, resins, treatment effluents or drummed wastes. Comments -Lists details regarding sample or sample point, including but limited to, phase separation, and/ or ~~ . Inorpnic Chemistry -Check ( ✓ ) the desired parameters to be analyzed. Extractables are only performed on a solid or semi-solid. For routine landfill samples, check all parameters in the second and third columns. Organic Chemistry -Check ( ✓ ) the desired parameter to be analyzed. If not listed, enter the name in the space provided. Microbiology and Radiochemistry -The Raleigh office should be consulted prior to sampling for either of these. Distribution: 1. Original to State Laboratory of Public Health Environmental Sciences Branch P. 0 . Box 28047 Raleigh, NC 27611 2. Lab sends copy to Solid and Hazardous Waste Management Branch. 3. Solid and Hazardous Waste Management Branch sends copy to field person. Disposition: This form may be destroyed in accordance with the Environmental Health, Solid and Hazardous Waste Section of the Records Disposition Schedule as published by the North Carolina Division of Archives and History. Additional forms may be ordered from: Solid and Hazardous Waste Management Branch Division of Health Services P. 0 . Box 2091 Raleigh, NC 27602-2091 N. C. Department of Human Resources Division of Health Services SAMPLE ANALYSES REQUEST State Laboratory of Public Health P. 0 . Box 28047 306 N. Wilmington Street Raleigh, 27611 Site Number _q-'--"'-3_0_0_0_0_0---'-1,-o_o_o_x _________ Field Sample Number ~0=<-0=--Y.L..G"""-'7'---',_,,_8 ___ ~--- Name of Site Pc_ B Lo...0d i i I I Site Location_~V\/~cxc,_;V-!......J_Y...:::e~~_.,.__....::L=--0 _:....,.µIAt~t~O="'--J-.1 NL..Jl......=c Collected By By ( d IM ye ( s ID# s-~ 5 C:, Date Collected 7 / s-/3 8 ~me 2 1 1 3 0 pi pl,\ , Type of Sample: Environmental ___ Groundwater ( 1) ___ Surface Water (2) V Soil (3) __ Other (4) Concentrate __ Solid (5) __ Liquid (6) __ Sludge (7) __ Other (8) Comments INORGANIC CHEMISTRY Extractables Total Parameter Results mg/ 1 Parameter Results mg/ 1 Parameter Results mg/ 1 __ Arsenic __ Arsenic __ Silver __ Barium __ Barium __ Sulfates __ Cadmium __ Cadmium __ Zinc __ Chromium __ Chloride _Ph __ Lead __ Chromium __ Conductivity __ Mercury __ Copper _ms __ Selenium __ Fluoride _TOC __ Silver __ Iron -- --__ Lead -- --__ Manganese -- --__ Mercury -- --__ Nitrate -- --__ Selenium --- ORGANIC CHEMISTRY Parameter Results mg/ 1 Parameter Results mg/ 1 Parameter Results mg/ 1 _P&T:GC/MS EDB __ Methoxychlor __ Acid:B/N Ext. --::;7 PCB's <o. l pp m.. __ Toxaphene _TOX __ Petroleum _2,4-D --__ Endrin __ 2,4,5-TP (silvex) --__ Lindane -- MICROBIOLOGY RADIOCHEMISTRY Parameter Parameter Results PCi/ 1 __ (MF) Coliform Colonies/lO0mls __ Gross Alpha __ (MPN) Coliform Colonies/lO0mls __ Gross Beta ---- ---- 1-J_ -J. · .I ,<Ji Date Received __ if ___ u _____________ _ Date Reported __________________ _ Date Extracted -'7'--"-/_R;_-=f[-=--__.7/'--7>.,__ _________ _ Date Analyzed _,7'-----'/...,,,3~-..._?i_...'%'--1/__,,__,_p ________ _ Reported By -----------------Lab Number ----'8=-=0=--1=' "-'b'-"''--'(IW\ • .._.·'-lL----------- DHS3191 (Revised 7/85) Solid and Hazardous Waste (Review 7 /87) .. Purpose: Enforcement and compliance with the N. C. Solid and Hazardous Waste Management Rules. Preparation A sample analyses request form (OHS 3191) must be completed for each type of evaluation requested (e.g., inorganic, organic, microbiology, radiochemistry). For sampling conditions which require more than one (1) container (i.e., ground or surface water from landfills) a sample label must be affixed to one of the containers. The collector must then write the site and sample number on the duplicate. Do not submit an analysis request sheet with no parameters indicated. Equivalent measurements: ppm= µg/ml = mg/1 =µgi g= mg/kg ppb = µg/1 = µg/lO00g = µg /kg DEFINITIONS/INSTRUCTIONS Site Number -A twelve-digit site/location identifier, assigned only by the district field representative. Field Sample Number -A six-digit sample identifier which is pre-printed on the sample label. Name of Site -Name of landfill, facility, etc. Site Location -Address, street number, state road, etc. Collected By -Name and ID of sample collector. Date and Time Collected -Self-explanatory. Environmental-A sample of a naturally occurring substance such as groundwater, surface water or soils which may be contaminated. Concentrate -A sample of a waste, including but not limited to, sludges, resins, treatment effluents or drummed wastes. Comments -Lists details regarding sample or sample point, including but limited to, phase separation, and/ or ~~-' ! Inorpnic Chemistry-Check ( ✓) the desired parameters to be analyzed. Extractables are only performed on a solid or semi-solid. For routine landfill samples, check all parameters in the second and third columns. Organic Chemistry-Check ( ✓ ) the-desired parameter to be analyzed. If not listed, enter the name in the space provided. Microbiology and Radiochemistry -The Raleigh office should be consulted prior to sampling for either of these. Distribution: 1. Original to State Laboratory of Public Health Environmental Sciences Branch P. 0. Box 28047 Raleigh, NC 27611 2. Lab sends copy to Solid and Hazardous Waste Management Branch. 3. Solid and Hazardous Waste Management Branch sends copy to field person. Disposition: This form may be destroyed in accordance with the Environmental Health, Solid and Hazardous Waste Section of the Records Disposition Schedule as published by the North Carolina Division of Archives and History. Additional forms may be ordered from: Solid and Hazardous Waste Management Branch Division of Health Services P. 0. Box 2091 Raleigh, NC 27602-2091 .:,uL1.u i,.J~U t1AL.AK1JUU0 WA::iTt M...~l·U,G t:MENT BRANCH Chain of Cu s tody Record Hazardous Waste Materials 1.ocation of SaTilpling: Ge nerator __ Transporter Treatment Facility __ Storage Facility __ Disposal facility ✓ Landfill Other: Company's Name PCB Telephone~--'-------------- .~ddress C A -d, ,4~01-'t, 7 .) Co}'¥cto~_''ss Jlt ~ ;;i ~ ~ -signature :,ate Sampled ~,&fl-a-: 7/5/J;J Telephone ..i.{_..L.) __ ·....;.7 ...c::3....;3;;;.._-_~...=0::..9!..:2-=.. __ _ Time Sampled _.;:../.;;;;.2_....;.:..::;3;...0..;.._ __ ___,~--- ~pe of Process Generating Waste · ---------------------------- ' f el d Information ·:.2;.d Sample ~o-ao t/{o58 OOt/rol2 ~e:<l of Possession: signature signature --~s u~ts r eported signature 6ol/G 59 80l/fo(p0 DO</(ol,/ 004 fti(r; Z 001/~ ~ 3 00 L/G (p C 00 t./ l 7~ O(Y-! fa 7 7 O O Y<a 72 title inclusive dates title . inclusive dates title date i~st~uc cions: Complete all applicable information including signatures, and submit ~ith analysis r equest forms. .'.:lULJ.U ·AhU t1A L..AKUUU::, 1-i AYlt. .M.ANAGt:Mt:NT b KANCH Rec eipt f o r Sa mpl e s Tne s amp les d e scribed below were collected in connection with the administration,. e~Eo rc ernent, and documentation of the: ( North Carolina Hazardous Waste Manageme nt Rules, 10 NCAC lOF ( North Carolina Solid Waste Management Rules, 10 NCAC lOG ( ) Comprehensive Environmental Response, Compensation and Liability Act (CERCLA) ( ) Toxic Substances Control Act ( TSCA) 15 U .S .C. S 2601, et ~. , ·spec if ica lly Section 11 of TSCA, 15 U.S.C. 52610. Inspector's Name Inspector's Address :~ame of Firm Firm Address -:~m Owner, Operator, or Agent Title ·.--;:,,·r- · •• .;.a, --COLLECTED SAMPLE TYPE DUPLICATE SA!·,PLES SAMPLE ·-__ •:-:SER DATE TIME WATER SOIL OTHER OFFEREDIACCEPTED ! REJECTED ON-SITE I l - LOCl-.TION OF:-SI':'E Receipt for the sample(s)_described above is hereby acknowledged: Receipt/rejection of duplicate or split samples is hereby acknowledged: ~ignature of Inspector Signature of firm Owner, Operator, or Agent T i t l e Title Co:-:,:ne nts : ---------------------------------------------- PCB LANDFILL MONTHLY REPORT DATE Ju vte_ 1. Entrance Road 2. Monitoring Wells Casings, locks · Fences, gates, locks 3. Landfill fence, gate, locks 4. Air Vent . 5. Landfill Cover Erosion, vegetation Subsidence 6. Leachate Detection System Water in sump 7. Leachate Collection System Access Pipe Pump Piping 8 •. Treatment Works Influent Piping Sand Filter Carbon Filter Effluent Piping 9. Surface .Impoundment Erosion, vegetation 10. Irrigation sxst~ Influent Piping Pump Sprinkler Units NAME 5h_0,_rv vi__ Myers __ ___;;;; _______ -t,'-___;~--- NO PROBLEM ✓ ./ POTENTIAL PROBLEM / OBSERVATIONS L6 :)_'J',11\.J f-ru... c.J _s C{ re. us,ny e01;rqvtce @o..d 1 ro...55 5/1..0 IA.. IJ l_c cu±_ ;'vi,si'd e tM:-1 1 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. State Health Director MEMORANDUM TO: THROUGH FROM: May 31, 1988 Edward Garner, Assistant to the Secretary Department of Crime Control and Public Safety Michael L._Babuin, Hy~rogeo~ogist,,0,w-- Water Quality Protection Unit vj/YL Solid Waste Branch Solid Waste Management Section Sharon A. Myers, Hydrogeological Technician~.Q .·7/1._ _ Water Resources Protection Unit Solid Waste Branch Solid Waste Management Section Attached is the May 1988, PCB Landfill Monthly Inspection Report. It is imperative that the grass be mowed before the June 14, 1988 sampling date. Grass at the landfill is easily chest high, and will greatly hamper sampling. The iandfill and monitoring wells are in good condition, with the exception of the tall grass, and there are no problems to report. There are four locations along the entrance road where someone has apparently poured used oil onto the ground, killing small patches of vegetation. If there are any questions concerning the landfill please contact at (919) 733-0692. SAM/MLB/mj cc: Mike Babuin PCB LANDFILL MONTHLY REPORT DATE Max Z7, /c;gs ---'---'----(.1"------'~7~~~.i.....;:;___ ___ _ NAME __ .S_h_a_;_r_o_l/L_/v1-+-,Yi_e.-_r 5 __ _ 1. 2. 3. 4. . 5. 6. 7. 8 • · .. 9. 10. Entrance Road Monitoring Wells Casings, locks · Fences, gates, locks Landfill fence, gate, locks Air Vent Landfill Cover Erosion, vegetation Subsidence Leachate Detection System Water in sump Leachate Collection System Access Pipe Pump Piping . Treatment Works Influent Piping Sand Filter Carbon Filter Effluent Piping Surface Impoundment Erosion, vegetation Irrigation Syst~ Influent Piping Pump Sprinkler Units NO POTENTIAL PROBLEM PROBLEM OBSERVATIONS S'o"1-te.o«e 1Mt1 beeV\... d.,'s~0;,i"'7 o-f a.~ yo, :I/ ~ 1At,sf,<;;U,tc_e. a. / o'; f:t.ie e..d9e3 o+ t./4e · e_lA t rtf 1/1..C(:_ '("O a.._J :,' PCB LANDFILL MONTHLY REPORT (CONT. DATE NAME ---------------------------'-------,.-- -: Pumoing Data Pumping -Times Pumping Volume ---------------------,-- Irrigatibn Data IrriSating Times Irrigating Volume 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. MEMORANDUM TO: THROUGH: FROM:' May 9, 1988 Edward Garner, Assistant to the Secretary Department of Crime Control and Public safety Michael L. Babuin, Supervisor Water Quality Protection Unit Solid Waste Branch Solid Waste Management Section Sharon A. Myers, Hydrogeological Technician Water Quality Protection Unit Solid Waste Branch Solid Waste Management Section State Health Director Attached is the April 1988 PCB Monthly Inspection Report. There does not seem to be any evidence of vehicles entering the landfill area, but there is evidence of entry by horses along the main road. The landfill and wells are in good condition, and there are no problems to report. The grass will need to be mowed before the May visit and throughout the remainder of the growing season. If you have any questions concerning the landfill please contact me at (919) 733-0692). SAM/mj PCB LANDFILL MONTHLY REPORT 1. Entrance Road 2. Monitoring Wells Casings, locks · Fences, gates, locks 3. Landfill fence, gate, locks 4. Air Vent . 5. Landfill Cover 6. Erosion, vegetation Subsidence Leachate Detection System Water in sump 7. Leachate Collection System Access Pipe Pump Piping 8. Treatment Works Influent Piping Sand Filter Carbon Filter Effluent Piping 9. Surface Impoundment Erosion, vegetation 10. Irrigation Syste~ Influent Piping Pump Sprinkler Units NAME 50-r1 rD £A_ Mye r.s NO POTENTIAL PROBLEM PROBLEM ~ ✓ / ,/ / . . ./ OBSERVATIONS Cv i'd. e V\C e. o..f hors eel. CA.. ( o (AJ eHtr°' ~ < e roo... ,· PCB LANDFILL MONTHLY REPORT (CONT. DATE _______________ NAME _________ ---=-------- -:: Pumping Data Pumping -Times Pumping Volume-------'---'-------------,- Irrigation Data Irritating Times Irrigating Volume 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. April 13, 1988 State Health Director MEMORANDUM ,t TO: Edward Garner, Assistant to the Secretary Department of Crime Control and Public Safety THROUGH: Michael L. Babuin, Supervisor Solid Waste Hydrogeological Assessment Unit Solid Waste Branch Solid Waste Management Section FROM: Sharon A. Myers, Hydrogeological Technician Solid Waste Hydrogeological Assessment Unit Solid Waste Branch Solid Waste Management Section Attached are the January, February, and March, 1988 PCB Landfill Monthly reports. The landfill seems to be in good shape with all locks in working order and well-trimmed grass. Also enclosed is a copy of the February, 1988 biannual sampling results. All samples were analyzed at the State Environmental Health Lab, and all test results fell beneath the prescribed upper limits. If you have questions concerning the landfill please contact me at (919) 733-0692. SAM/mj/8272p5 !:::.:::.•: r.·.·.·.-.·.·.·. L '.:\\; PCB LANDFILL MONTHLY REPORT DATE ____ ✓ __ i_/_2_o/~/_J_6 ______ _ 1. Entrance Road 2. Monitoring Wells Casings, locks · Fences, gates, locks 3. Landfill fence, gate, locks 4. Air Vent . 5. Landfill Cover Erosion, vegetation Subsidence 6. Leachate Detection System Water in sump 7. Leachate Collection System Access Pipe Pump Piping 8. Treatment Works Influent Piping Sand Filter Carbon Filter ;: Effluent Piping 9. Surface Impoundment 10. Erosion~ vegetation Irrigation Syst~ Influent Piping Pump Sprinkler Units NAME_5__,__.,/2...=.9' ....... r:_o--'--½_.___M__...,...v_:e ...... r-=-s __ 7 NO PROBLEM 1,,/ . . POTENTIAL PROBLEM OBSERVATIONS -------,,,,,..-~--------· ............................. :..;:: .,.. ..... ·----•-,·., . . ··• --. ·-. N. C. Department of Human Resources Division of Health Services SAMPLE ANALYSES REQUEST State Laboratory of Public Health P. 0 . Box 28047 306 N. Wilmington Street Raleigh, 27611 Site Number '\3 QQC>(:)0 \ 0 06 )<. · Name of Site ?C$ ~~h.,\ \ Collected By ~'i cc).. l 'v-> ,LL Type of Sample: Environmental ~round water ( 1) Concentrate __ Solid (5) __ Surface Water (2) __ Liquid (6) __ Soil (3) __ Sludge (7) __ Other (4) __ Other (8) Field Sample Number -~':!1-5"_7_1 ___________ _ Site Location _,_f\f ........ h_~--------------- Date Collected _d_· &--_-_~_·i _____ _,_ · Tf"me'--·.J .:"DO Comments •• • ....• J INORGANIC CHEMISTRY Extractables Total Parameter Results mg/ 1 Parameter Results mg/ 1 Parameter Results mg/ 1 __ Arsenic __ Arsenic __ Silver __ Barium __ Barium __ Sulfates __ Cadmium __ Cadmium __ Zinc __ Chromium __ Chloride _Ph __ Lead __ Chromium __ Conductivity __ Mercury __ Copper _TDS __ Selenium __ Fluoride _Toe __ Silver __ Iron -- --__ Lead --\ --__ Manganese -- --__ Mercury -- --__ Nitrate -- --__ Selenium -- ORGANIC CHEMISTRY Parameter Results mg/ 1 Parameter Results mg/ 1 Parameter Results mg/ 1 ~P&T:GC/MS _EDB __ Methoxychlor __ Acid:B/N Ext. -0cB's <.,,., t'Jt?~I -nn .... __ Toxaphene _TOX __ Petroleum ,, _2,4-D --__ Endrin __ 2,4,5-TP (silvex) --__ Lindane -- MICROBIOLOGY RADIOCHEMISTRY Parameter Parameter Results PCi/ 1 __ (MF) Coliform Colonies/lO0mls __ Gross Alpha __ (MPN) Coliform Colonies/lO0mls __ Gross Beta ---- ---- Date Received ,,;,2 -J -7f'F 1/ P. Date Reported -~d: .... · ---Jo/~ ..... &>'---__,_£:.L......flY---_______ _ Date Extracted ~ J)m ;W; ~ 'iAf " Reported By ~ ,/-? /(...R'c~ DHS 3191 (Revised {!85) Date Analyzed ;1.,-/ /-3'a'1Jp 800325 Lab Number Solid and Hazardous Waste (Review 7187) Purpose: Enforcement and compliance with the N. C. Solid and Hazardous Waste Management Rules. Preparation A sample analyses request form (OHS 3191) must be completed for each type of evaluation requested (e.g., inorganic, organic, microbiology, radiochemistry). For sampling conditions which require more than one (1) container (i.e., ground or surface water from landfills) a sample label must be affixed to one of the containers. The collector must then write the site and sample number on the duplicate. Do not submit an analysis request sheet with no parameters indicated. Equivalent measurements: ppm= µg/ml = mg/1 =µgi g= mg/kg ppb = µg/1 = µg/lO00g = µg/kg DEFINITIONS/INSTRUCTIONS Site Number -A twelve-digit site/location identifier, assigned only by the district field representative. Field Sample Number -A six-digit sample identifier which is pre-printed on the sample label. Name of Site -Name of landfill, facility, etc. Site Location -Address, street number, state road, etc. Collected By -Name and ID of sample collector. Date and Time Collected -Self-explanatory. Environmental -A sample of a naturally occurring substance such as groundwater, surface water or soils which may be contaminated. Concentrate -A sample of a waste, including but not limited to, sludges, resins, treatment effluents or drummed wastes. Comments -Lists details regarding sample or sample point, including but limited to, phase separation, and/ or ~~-' Inorpnic Chemistry -Check ( ✓ ) the desired parameters to be analyzed. Extractables are only performed on a solid or semi-solid. For routine landfill samples, check all parameters in the second and third columns. Organic Chemistry -Check ( ✓ ) the desired parameter to be analyzed. If not listed, enter the name in the space provided. Microbiology and Radiochemistry -The Raleigh office should be consulted prior to sampling for either of these. Distribution: 1. Original to State Laboratory of Public Health Environmental S,cil,!nces Branch P. 0 . Box 2804 7 Raleigh, NC 27611 2. Lab sends copy to Solid and Hazardous Waste Management Branch. 3. Solid and Hazardous Waste Management Branch sends copy to field person. Disposition: This form may be destroyed in accordance with the Environmental Health, Solid and Hazardous Waste Section of the Records Disposition Schedule as published by the North Carolina Division of Archives and History. Additional forms may be ordered from: Solid and Hazardous Waste Management Branch Division of Health Services P. 0 . Box 2091 Raleigh, NC 27602-2091 • .. N. C. Department of Human Resources Division of Health Services SAMPLE ANALYSES REQUEST State Laboratory of Public Health P. 0. Box 28047 306 N. Wilmington Street Raleigh, 27611 Site Number _ __,q _5--=0.__()"--o_· _O_O_\_O_CO __ X _______ Field Sample Number _t.t~i;-l_"J. ___________ _ Name of Site _ _._t'...;::C ... f?,_..,\__q.=h-=~--~-'-\ ... \~---------Site Location ➔f'--~ _____ ......., ______________ _ Collected By _ \s_'f-f-'r._c:....,\-+t\ ..... c:>~\ \....l..."--=----ID# ,S-b, S7 Type of Sample: Environmental _xGroundwater ( 1) Concentrate __ Solid (5) __ Surface Water (2) __ Liquid (6) __ Soil (3) __ Sludge (7) __ Other (4) __ Other (8) · Date Collected ...,9"'---'-d"----'' <>"""~~--~-----i_.,· ___ \. _ ... _· ~l1tfut ·_..l""'):;._O __ _ INORGANIC CHEMISTRY Extractables Total Parameter Results mg/ 1 Parameter Results mg/ 1 Parameter Results mg/1 __ Arsenic __ Arsenic __ Silver __ Barium __ Barium __ Sulfates __ Cadmium __ Cadmium __ Zinc __ Chromium __ Chloride _Ph __ Lead __ Chromium __ Conductivity __ Mercury __ Copper _ms __ Selenium __ Fluoride _TOC __ Silver __ Iron -- --__ Lead -- --__ Manganese -- --__ Mercury -- --__ Nitrate -- --__ Selenium -- ORGANIC CHEMISTRY Parameter Results mg/ 1 Parameter Results mg/ 1 Parameter Results mg/ 1 _P&T:GC/MS JZ!DB __ Methoxychlor __ Acid:B/N Ext. PCB's ~,, naa /710.. __ Toxaphene , , ., _TOX __ Petroleum _2,4-D --__ Endrin __ 2,4,5-TP (silvex) --__ Lindane -- MICROBIOLOGY RADIOCHEMISTRY Parameter Parameter Results PCi/ 1 __ (MF) Coliform Colonies/lO0mls __ Gross Alpha __ (MPN) Coliform Colonies/lOOmls __ Gross Beta ---- ---- Date Received ;:i.. -3-"if? t/, P. Date Reported __________________ _ Date Extracted 2-// -gg om} 1/pl f. W Reported By Date Analyzed ,,,:Z -/ /-i';? 1/P 0,_.· 003:~6 -------------------Lab Number C.7 OHS 3191 (Revised 7185) Solid and Hazardous Waste (Review 7187) Purpose: Enforcement and compliance with the N. C. Solid and Hazardous Waste Management Rules. Preparation A sample analyses request form (OHS 3191) must be completed for each type of evaluation requested (e.g., inorganic, organic, microbiology, radiochemistry). For sampling conditions which require more than one ( 1) container ( i.e., ground or surface water from landfills) a sample label must be affixed to one of the containers. The collector must then write the site and sample number on the duplicate. Do not submit an analysis request sheet with no parameters indicated. Equivalent measurements: ppm= µg/ml = mg/1 =µgi g= mg/kg ppb = µg/1 = µg/lO00g = µg/kg DEFINITIONS/INSTRUCTIONS Site Number -A twelve-digit site/location identifier, assigned only by the district field representative. Field Sample Number -A six-digit sample identifier which is pre-printed on the sample label. Name of Site -Name of landfill, facility, etc. Site Location -Address, street number, state road, etc. Collected By -Name and ID of sample collector. Date and Time Collected -Self-explanatory. Environmental -A sample of a naturally occurring substance such as groundwater, surface water or soils which may be contaminated. Concentrate -A sample of a waste, including but not limited to, sludges, resins, treatment effluents or drummed wastes. Comments -Lists details regarding sample or sample point, including but limited to, phase separation, and/ or ~~-' Inorpnic Chemistry -Check ( ✓ ) the desired parameters to be analyzed. Extractables are only performed on a solid or semi-solid. For routine landfill samples, check all parameters in the second and third columns. Organic Chemistry -Check ( ✓ ) the desired parameter to be analyzed. If not listed, enter the name in the space provided. Microbiology and Radiochemistry -The Raleigh office should be consulted prior to sampling for either of these. Distribution: 1. Original to State Laboratory of Public Health Environmental Sciences Br1tnch P. 0. Box 2804 7 Raleigh, NC 27611 2. Lab sends copy to Solid and Hazardous Waste Management Branch. 3. Solid and Hazardous Waste Management Branch sends copy to field person. Disposition: This form may be destroyed in accordance with the Environmental Health, Solid and Hazardous Waste Section of the Records Disposition Schedule as published by the North Carolina Division of Archives and History. Additional forms may be ordered from: Solid and Hazardous Waste Management Branch Division of Health Services P. 0 . Box 2091 Raleigh, NC 27602-2091 N. C. Department of Human Resources Division of Health Services SAMPLE ANALYSES REQUEST State Laboratory of Public Health P. 0. Box 28047 306 N. Wilmington Street Raleigh, 27611 Site Number C\3 c.)OOOC\ OOOX Field Sample Number __ L\_~_,_3 __________ _ Name of Site ~C.. ~ Lo.~,\\ Site Location A FTP r::: Collected By '\S'I ta , \r' \U... Type of Sample: Date Collected __,d""--v~d_' 3;;;...g _____ • Time c9-'DO Environmental ~ Groundwater ( 1) Concentrate __ Solid (5) __ ·_Surface Water (2) __ Liquid (6) __ Soil (3) __ Sludge (7) __ Other (4) __ Other (8) Comments INORGANIC CHEMISTRY Extractables Total Parameter Results mg/ 1 Parameter Results mg/ 1 Parameter __ Arsenic __ Arsenic __ Silver __ Barium __ Barium __ Sulfates __ Cadmium __ Cadmium __ Zinc __ Chromium __ Chloride _Ph __ Lead __ Chromium __ Conductivity __ Mercury __ Copper _TDS __ Selenium __ Fluoride _TOC __ Silver __ Iron -- --_Lead -- --__ Manganese -- --__ Mercury -- --__ Nitrate -- --__ Selenium -- ORGANIC CHEMISTRY Parameter Results mg/ 1 Parameter Results mg/ 1 Parameter _P&T:GC/MS ~DB __ Methoxychlor __ Acid:B/N Ext. CB's < /'J, ,,,,,,..,,,,,., I~~ Toxaphene _TOX __ Petroleum T/ _2,4-D --__ Endrin __ 2,4,5-TP (silvex) --__ Lindane -- MICROBIOLOGY RADIOCHEMISTRY Results mg/ 1 Results mg/ 1 Parameter Parameter Results PCi/ 1 __ (MF) Coliform Colonies/l00mls __ Gross Alpha __ (MPN) Coliform Colonies/lOOmls __ Gross Beta ---- ---- Date Received d--3 -'g3"7/. P. Date Reported ________________ _ Date Extracted -2::.I I-BBD m, 1/f) p l.f.,/ Date Analyzed ::z-1 /-l%11P Reported By _________________ Lab Number 800~2/t DHS 3191 (Revised 7/85) Solid and Hazardous Waste (Review 7 /87) Purpose: Enforcement and compliance with the N. C. Solid and Hazardous Waste Management Rules. Preparation A sample analyses request form (OHS 3191) must be completed for each type of evaluation requested (e.g., inorganic, organic, microbiology, radiochemistry). For sampling conditions which require more than one (1) container (i.e., ground or surface water from landfills) a sample label must be affixed to one of the containers. The collector must then write the site and sample number on the duplicate. Do not submit an analysis request sheet with no parameters indicated. Equivalent measurements: ppm= µg/ml = mg/1 =µgi g= mg/kg ppb = µg/1 = µg/lOOOg = µg/kg DEFINITIONS/INSTRUCTIONS Site Number -A twelve-digit site/location identifier, assigned only by the district field representative. Field Sample Number -A six-digit sample identifier which is pre-printed on the sample label. Name of Site -Name of landfill, facility, etc. Site Location -Address, street number, state road, etc. Collected By -Name and ID of sample collector. Date and Time Collected -Self-explanatory. Environmental-A sample of a naturally occurring substance such as groundwater, surface water or soils which may be contaminated. Concentrate -A sample of a waste, including but not limited to, sludges, resins, treatment effluents or drummed wastes. Comments -Lists details regarding sample or sample point, including but limited to, phase separation, and/ or ~~-' Inorpnic Chemistry -Check ( ✓ ) the desired parameters to be analyzed. Extractables are only performed on a solid or semi-solid. For routine landfill samples, check all parameters in the second and third columns. Organic Chemistry -Check ( ✓ ) the desired parameter to be analyzed. If not listed, enter the name in the space provided. Microbiology and Radiochemistry -The Raleigh office should be consulted prior to sampling for either of these. Distribution: 1. Original to State Laboratory of Public Health Environmental Sciences Branch P. 0 . Box 28047 Raleigh, NC 27611 2. Lab sends copy to Solid and Hazardous Waste Management Branch. 3. Solid and Hazardous Waste Management Branch sends copy to field person. Disposition: This form may be destroyed in accordance with the Environmental Health, Solid and Hazardous Waste Section of the Records Disposition Schedule as published by the North Carolina Division of Archives and History. Additional forms may be ordered from: Solid and Hazardous Waste Management Branch Division of Health Services P. 0 . Box 2091 Raleigh, NC 27602-2091 N. C. Department of Human Resources Division of Health Services SAMPLE ANALYSES REQUEST State Laboratory of Public Health P. 0 . Box 28047 306 N. Wilmington Street Raleigh, 27611 Site Number _C\_S_D __ o_t>_◊_, _O_\_D_b_D_'f.. _______ Field Sample Number _4.._S .... l_j,.___ __________ _ Name of Site _..,_p_c,g-=-_~;;..._~--'"--'-" \ _________ _ Site Location __ __,_t\..,.s=~~='C:::-...._'--__________ _ Collected By __,X$ .... i>(...,.r._c\_.......1 .... \=,,, .... \ \j_ _____ ID# S'(.;S: 7 Type of Sample: Environmental ___ Voroundwater ( 1) Concentrate __ Solid (5) __ Surface Water (2) __ Liquid (6) __ Soil (3) __ Sludge (7) __ Other (4) __ Other (8) Date Collected _d_" a_~f>_8 ____ ~ Time ;;: 3o Comments INORGANIC CHEMISTRY Extractables Total Parameter Results mg/ 1 Parameter Results mg/ 1 Parameter Results mg/ 1 __ Arsenic __ Arsenic __ Silver __ Barium __ Barium __ Sulfates __ Cadmium __ Cadmium __ Zinc __ Chromium __ Chloride _Ph __ Lead __ Chromium __ Conductivity __ Mercury __ Copper _ms __ Selenium1 __ Fluoride _TOC __ Silver __ Iron -- --__ Lead -- --__ Manganese -- --__ Mercury -- --__ Nitrate -- --__ Selenium -- ORGANIC CHEMISTRY Parameter Results mg/ 1 Parameter Results mg/ 1 Parameter Results mg/ 1 _P&T:GC/MS ~B __ Methoxychlor __ Acid:B/N Ext. PCB's <n. nnn/ ,...,.,,. Toxaphene ,, ~- _TOX __ Petroleum _2,4-D --__ Endrin __ 2,4,5-TP (silvex) --__ Lindane -- MICROBIOLOGY RADIOCHEMISTRY Parameter Parameter Results PCi/ 1 __ (MF) Coliform Colonies/lO0mls __ Gross Alpha __ (MPN) Coliform Colonies/lOOmls __ Gross Beta ---- ---- Date Received __;;;__-_.3--=----=~'--=-'Z-"V.'-"-' P..___.. _________ Date Reported ________________ _ Date Extracted 1..-11 -88 rm t 1/P, Pl ,t,J Date Analyzed -~_-.....,/l'--__ ff"-"'-_--V.&-L7> ________ _ Reported By Lab Number ___ 8_0_0_3_· _2_8_· ________ _ DHS 3191 (Revised 7/85) Solid and Hazardous Waste (Review 7 /87) Purpose: Enforcement and compliance with the N. C. Solid and Hazardous Waste Management Rules. Preparation A sample analyses request form (OHS 3191) must be completed for each type of evaluation requested (e.g., inorganic, organic, microbiology, radiochemistry). For sampling conditions which require more than one ( 1) container (i.e., ground or surface water from landfills) a sample label must be affixed to one of the containers. The collector must then write the site and sample number on the duplicate. Do not submit an analysis request sheet with no parameters indicated. Equivalent measurements: ppm= µg/ml = mg/1 = µg/g = mg/kg ppb = µg/1 = µg/lO00g = µg/kg DEFINITIONS/INSTRUCTIONS Site Number -A twelve-digit site/location identifier, assigned only by the district field representative. Field Sample Number -A six-digit sample identifier which is pre-printed on the sample label. Name of Site -Name of landfill, facility, etc. Site Location -Address, street number, state road, etc. Collected By -Name and ID of sample collector. Date and Time Collected -Self-explanatory. Environmental -A sample of a naturally occurring substance such as groundwater, surface water or soils which may be contaminated. Concentrate -A sample of a waste, including but not limited to, sludges, resins, treatment effluents or drummed wastes. Comments -Lists details regarding sample or sample point, including but limited to, phase separation, and/ or od<;>rs. Inorpnic Chemistry -Check ( ✓ ) the desired parameters to be analyzed. Extractables are only performed on a solid or semi-solid. For routine landfill samples, check all parameters in the second and third columns. Organic Chemistry -Check ( ✓ ) the desired parameter to be analyzed. If not listed, enter the name in the space provided. Microbiology and Radiochemistry -The Raleigh office should be consulted prior to sampling for either of these. Distribution: 1. Original to State Laboratory of Public Health Environmental Sciences Branch P. 0. Box 28047 Raleigh, NC 27611 2. Lab sends copy to Solid and Hazardous Waste Management Branch. 3. Solid and Hazardous Waste Management Branch sends copy to field person. Disposition: This form may be destroyed in accordance with the Environmental Health, Solid and Hazardous Waste Section of the Records Disposition Schedule as published by the North Carolina Division of Archives and History. Additional forms may be ordered from: Solid and Hazardous Waste Management Branch Division of Health Services P. 0. Box 2091 Raleigh, NC 27602-2091 N. C. Department of Human Resources Division of Health Services SAMPLE ANALYSES REQUEST State Laboratory of Public Health P. 0 . Box 28047 306 N. Wilmington Street Raleigh, 27611 Site Number ?\3 00000 \ ooo;,< Name of Site \?e,_8, L<Ar--¥, \ \ Collected By ~I s;:A 1 \c --.LL ID# ~ b 157 Type of Sample: Environmental ___ Groundwater ( 1) 4surface Water (2) __ Soil (3) __ Other (4) Concentrate __ Solid (5) __ Liquid ( 6) __ Sludge (7) __ Other (8) u.:;15 Field Sample Number _ _J_._--'--------------- Site Location ,f\ Z-°"tDY::::::, Date Collected .... 2..._·_a_,_8_3 _____ , Titit; ~• C>O Comments ·\"":r . . • ...... >,, INORGANIC CHEMISTRY Extractables Total Parameter Results mg/ 1 Parameter Results mg/ 1 Parameter Results mg/1 __ Arsenic __ Arsenic __ Silver __ Barium __ Barium __ Sulfates __ Cadmium __ Cadmium __ Zinc __ Chromium __ Chloride _Ph __ Lead __ Chromium __ Conductivity __ Mercury __ Copper _TDS __ Selenium __ Fluoride _TOC __ Silver __ Iron -- --__ Lead -- --__ Manganese -- --__ Mercury -- --__ Nitrate -- --__ Selenium -- ORGANIC CHEMISTRY Parameter Results mg/1 Parameter Results mg/ 1 Parameter Results mg/ 1 _P&T:GC/MS _EDB __ Methoxychlor __ Acid:B/N Ext. __Lc-pcB•s -<o 1.rJt'Jt2.LffW', __ Toxaphene _TOX __ Petroleum _2,4-D --__ Endrin __ 2,4,5-TP (silvex) --__ Lindane -- MICROBIOLOGY RADIOCHEMISTRY Parameter Parameter Results PCi/1 __ (MF) Coliform Colonies/l00mls __ Gross Alpha __ (MPN) Coliform Colonies/lOOmls __ Gross Beta ---- ---- Date Received _ _.,;2'"""'...__--=3::;___-...,.;?'--'?'~j/sc....:.,..,,,P~--------Date Reported _________________ _ 2.-11-88 om , 1/._._,P.t,.....,._:P...:.=LJ __ Reported By Date Analyzed _;2._-_/_',,2._-_r/'~~J/~P~--------- ~:)00329 -------------------Lab Number _____ a _____________ _ Date Extracted OHS 3191 (Revised 7/85) Solid and Hazardous Waste (Review 7 /87) Purpose: Enforcement and compliance with the N. C. Solid and Hazardous Waste Management Rules. Preparation A sample analyses request form (OHS 3191) must be completed for each type of evaluation requested (e.g., inorganic, organic, microbiology, radiochemistry). For sampling conditions which require more than one ( 1) container ( i.e., ground or surface water from landfills) a sample label must be affixed to one of the containers. The collector must then write the site and sample number on the duplicate. Do not submit an analysis request sheet with no parameters indicated. Equivalent measurements: ppm= µg/ml = mg/1 = µg/g = mg/kg ppb = µg/1 = µg/lO00g = µg/kg DEFINITIONS/INSTRUCTIONS Site Number -A twelve-digit site/location identifier, assigned only by the district field representative. Field Sample Number -A six-digit sample identifier which is pre-printed on the sample label. Name of Site -Name of landfill, facility, etc. Site Location -Address, street number, state road, etc. Collected By -Name and ID of sample collector. Date and Time Collected -Self-explanatory. Environmental -A sample of a naturally occurring substance such as groundwater, surface water or soils which may be contaminated. Concentrate -A sample of a waste, including but not limited to, sludges, resins, treatment effluents or drummed wastes. Comments -Lists details regarding sample or sample point, including but limited to, phase separation, and/ or odors. · l Inorpnic Chemistry -Check ( ✓ ) the desired parameters to be analyzed. Extractables are only performed on a solid or semi-solid. For routine landfill samples, check all parameters in the second and third columns. Organic Chemistry -Check ( ✓ ) the desired parameter to be analyzed. If not listed, enter the name in the space provided. Microbiology and Radiochemistry -The Raleigh office should be consulted prior to sampling for either of these. Distribution: 1. Original to State Laboratory of Public Health Environmental Sciences Branch P. 0 . Box 28047 Raleigh, NC 27611 2. Lab sends copy to Solid and Hazardous Waste Management Branch. 3. Solid and Hazardous Waste Management Branch sends copy to field person. Disposition: This form may be destroyed in accordance with the Environmental Health, Solid and Hazardous Waste Section of the Records Disposition Schedule as published by the North Carolina Division of Archives and History. Additional forms may be ordered from: Solid and Hazardous Waste Management Branch Division of Health Services P. 0 . Box 2091 Raleigh, NC 27602-2091 N. C. Department of Human Resources Division of Health Services SAMPLE ANALYSES REQUEST State Laboratory of Public Health P. 0. Box 28047 306 N. Wilmington Street Raleigh, 27611 Site Number ~ C>bOOO \oocx Name of Site 'yc.,B, L~.--.r..W'-\ \ Collected By ~r&. 1y\.'-\, ID# Sl, S7 Type of Sample: Environmental ___ Groundwater ( 1) ~Surface Water (2) __ Soil (3) __ Other (4) Concentrate __ Solid (5) __ Liquid (6) __ Sludge (7) __ Other (8) Field Sample Number _Lj_,· ..... 5_7_0;:;...._ __________ _ Site Location Af'to'r-- Date Collected ....;d;;;.._~_;J._-_P:15 _______ -Ti e-3 '. 1 D . ·-:·:.,.!· .~\,-... ---- Comments s-\~-S.o-~~ I •/ \;:.'-"-.:.,)~ . ~ INORGANIC CHEMISTRY Extractables Total Parameter Results mg/ 1 Parameter Results mg/ 1 Parameter Results mg/ 1 __ Arsenic __ Arsenic __ Silver __ Barium __ Barium __ Sulfates __ Cadmium __ Cadmium __ Zinc __ Chromium __ Chloride _Ph __ Lead __ Chromium __ Conductivity __ Mercury __ Copper _TDS __ Selenium __ Fluoride _TOC __ Silver __ Iron -- --__ Lead -- --__ Manganese -- --__ Mercury -- --__ Nitrate -- --__ Selenium -- ORGANIC CHEMISTRY Parameter Results mg/ 1 Parameter Results mg/ 1 Parameter Results mg/ 1 _P&T:GC/MS _EDB __ Methoxychlor __ Acid:B/N Ext. --JLl'CB's < n, nool.1212h ,-, __ Toxaphene _TOX __ Petroleum _2,4-D --__ Endrin __ 2,4,5-TP (silvex) --__ Lindane -- MICROBIOLOGY RADIOCHEMISTRY Parameter Parameter Results PCi/ 1 __ (MF) Coliform Colonies/lO0mls __ Gross Alpha __ (MPN) Coliform Colonies/lOOmls __ Gross Beta ---- ---- Date Received d -3 -:-IT'" '16 .f'. Date Reported __________________ _ Date Extracted ~-P.L.__,W=:c..-;;._.12__,_M_._.-::J...,,J..~,_R...,.'--------Date Analyzed ;l.-/S--Y'if1[P Reported By --------------Lab Number ___ 8 __ 0_0_3_3_0 _______ _ OHS 3191 (Revised 7/85) Solid and Hazardous Waste (Review 7 /87) Purpose: Enforcement and compliance with the N. C. Solid and Hazardous Waste Management Rules. Preparation A sample analyses request form (OHS 3191) must be completed for each type of evaluation requested (e.g., inorganic, organic, microbiology, radiochemistry). For sampling conditions which require more than one ( 1) container ( i.e., ground or surface water from landfills) a sample label must be affixed to one of the containers. The collector must then write the site and sample number on the duplicate. Do not submit an analysis request sheet with no parameters indicated. Equivalent measurements: ppm= µg/ml = mg/1 =µgi g= mg/kg ppb = µg/1 = µg/lO00g = µg/kg DEFINITIONS/INSTRUCTIONS Site Number -A twelve-digit site/location identifier, assigned only by the district field representative. Field Sample Number -A six-digit sample identifier which is pre-printed on the sample label. Name of Site -Name of landfill, facility, etc. Site Location -Address, street number, state road, etc. Collected By -Name and ID of sample collector. Date and Time Collected -Self-explanatory. Environmental -A sample of a naturally occurring substance such as groundwater, surface water or soils which may be contaminated. Concentrate -A sample of a waste, including but not limited to, sludges, resins, treatment effluents or drummed wastes. Comments -Lists details regarding sample or sample point, including but limited to, phase separation, and/ or od<;>rs. · Inorpnic Chemistry -Check ( ✓ ) the desired parameters to be analyzed. Extractables are only performed on a solid or semi-solid. For routine landfill samples, check all parameters in the second and third columns. Organic Chemistry -Check ( ✓ ) the desired parameter to be analyzed. If not listed, enter the name in the space provided. Microbiology and Radiochemistry -The Raleigh office should be consulted prior to sampling for either of these. Distribution: 1. Original to State Laboratory of Public Health Environmental Sciences Branch P. 0. Box 28047 Raleigh, NC 27611 2. Lab sends copy to Solid and Hazardous Waste Management Branch. 3. Solid and Hazardous Waste Management Branch sends copy to field person. Disposition: This form may be destroyed in accordance with the Environmental Health, Solid and Hazardous Waste Section of the Records Disposition Schedule as published by the North Carolina Division of Archives and History. Additional forms may be ordered from: Solid and Hazardous Waste Management Branch Division of Health Services P. 0. Box 2091 Raleigh, NC 27602-2091 N. C. Department of Human Resources Division of Health Services SAMPLE ANALYSES REQUEST State Laboratory of Public Health P. 0 . Box 28047 306 N. Wilmington Street Raleigh, 27611 Site Number _q ___ ~ ____ O_D~C?~6~0=-+l,_O_D_O_X _______ Field Sample Number __ y~t;l_]~---------- Name of Site _f'_c""'· R .... ~Lo..=--r-c__..~ .......... \ .... \....,\.__________ Site Location t,-.f·tr?'v--..... Collected By _\?;=ri~r&:_;;.:...._,'\,-..>;:__'-_U.. _____ ID#c;-b1$7 Date Collected _d_-_d_'_?:i_8 ______ Time '3,'Dt) Type of Sample: Environmental ___ Groundwater ( 1) ___ Surface Water (2) __ Vsoil (3) __ Other (4) Concentrate __ Solid (5) __ Liquid (6) __ Sludge (7) __ Other (8) Comments Sec-,hrw2..~ sc:.r¾L INORGANIC CHEMISTRY Extractables Total Parameter Results mg/ 1 Parameter Results mg/ 1 Parameter Results mg/ 1 __ Arsenic __ Arsenic __ Silver __ Barium __ Barium __ Sulfates __ Cadmium __ Cadmium __ Zinc __ Chromium __ Chloride _Ph __ Lead __ Chromium __ Conductivity __ Mercury __ Copper _ms __ Selenium __ Fluoride _TOC __ Silver __ Iron -- --__ Lead -- --__ Manganese -- --__ Mercury -- --__ Nitrate -- --__ Selenium -- ORGANIC CHEMISTRY Parameter Results mg/ 1 Parameter Results mg/ 1 Parameter Results mg/ 1 _P&T:GC/MS ~DB __ Methoxychlor __ Acid:B/N Ext. __ PCB's ~tJ,.lpP-m __ Toxaphene _TOX __ Petroleum -,-_2,4-D --__ Endrin __ 2,4,5-TP (silvex) --__ Lindane -- MICROBIOLOGY RADIOCHEMISTRY Parameter Parameter Results PCi/ 1 __ (MF) Coliform Colonies/lO0mls __ Gross Alpha __ (MPN) Coliform Colonies/lO0mls __ Gross Beta ---- ---- Date Received 2 -J-3'3'1,(. />. Date Reported __________________ _ Date Extractec. ----------•··•r-a~. 2 -iO £6 l>db\. Reported By Date Analyzed _:Z.~-~L~l.;~-~l',_'ff"_1..,..r/~P ________ _ 800331 -------------------Lab Number OHS 3191 (Revised 7185) Solid and Hazardous Waste (Review 7187) Purpose: Enforcement and compliance with the N. C. Solid and Hazardous Waste Management Rules. Preparation A sample analyses request form (OHS 3191) must be completed for each type of evaluation requested (e.g., inorganic, organic, microbiology, radiochemistry). For sampling conditions which require more than one (1) container ( i.e., ground or surface water from landfills) a sample label must be affixed to one of the containers. The collector must then write the site and sample number on the duplicate. Do not submit an analysis request sheet with no parameters indicated. Equivalent measurements: ppm= µg/ml = mg/1 =µgi g= mg/kg ppb = µg/1 = µg/lO00g = µg/kg DEFINITIONS/INSTRUCTIONS Site Number -A twelve,digit site/location identifier, assigned only by the district field representative. Field Sample Number -A six,digit sample identifier which is pre,printed on the sample label. Name of Site -Name of landfill, facility, etc. Site Location -Address, street number, state road, etc. Collected By -Name and ID of sample collector. Date and Time Collected -Self,explanatory. Environmental-A sample of a naturally occurring substance such as groundwater, surface water or soils which may be contaminated. Concentrate -A sample of a waste, including but not limited to, sludges, resins, treatment effluents or drummed wastes. Comments -Lists details regarding sample or sample point, including but limited to, phase separation, and/ or od9rs. Inorpnic Chemistry-Check ( ✓ ) the desired parameters to be analyzed. Extractables are only performed on a solid or semi,solid. For routine landfill samples, check all parameters in the second and third columns. Organic Chemistry -Check ( ✓ ) the desired parameter to be analyzed. If not listed, enter the name in the space provided. Microbiology and Radiochemistry -The Raleigh office should be consulted prior to sampling for either of these. Distribution: 1. Original to State Laboratory of Public Health Environmental Sciences Branch P. 0 . Box 28047 Raleigh, NC 27611 2. Lab sends copy to Solid and Hazardous Waste Management Branch. 3. Solid and Hazardous Waste Management Branch sends copy to field person. Disposition: This form may be destroyed in accordance with the Environmental Health, Solid and Hazardous Waste Section of the Recards Disposition Schedule as published by the North Carolina Division of Archives and History. Additional forms may be ordered from: Solid and Hazardous Waste Management Branch Division of Health Services P. 0 . Box 2091 Raleigh, NC 27602,2091 N. C. Department of Human Resources Division of Health Services SAMPLE ANALYSES REQUEST State Laboratory of Public Health P. 0 . Box 28047 306 N. Wilmington Street Raleigh, 27611 Site Number __ q.,_"7:>=6¢=.:0=:;6=.::0;.;_i._\ __,,Db=..:;..0..:..:"f(. ________ Field Sample Number __ i-1-S7 __ "5 ___________ _ Name of Site Pc£ l,...o,....c~,\\ Site Location Af+-1>'==- Collected By \3,y,c\ \ \,..,,1....\... ID# 5CS::2 Date Collected ___;;;;Jc...-.';?.;c.....,""'~"-'~.__ _____ ..,.,,Y'-.,\fffrrfg _~_:_~_O __ _ Type of Sample: Environmental ___ Groundwater ( 1) ___ Surface Water (2) ~ Soil (3) __ Other (4) Concentrate __ Solid (5) __ Liquid (6) __ Sludge (7) __ Other (8) J, •. Comments ,---·--- SQ_ch~ ""c..~si. INORGANIC CHEMISTRY E:xtractables Total Parameter Results mg/ 1 Parameter Results mg/ 1 Parameter Results mg/ 1 __ Arsenic __ Arsenic __ Silver __ Barium __ Barium __ Sulfates __ Cadmium __ Cadmium __ Zinc __ Chromium __ Chloride _Ph __ Lead __ Chromium __ Conductivity __ Mercury __ Copper _TDS __ Selenium __ Fluoride _Toe __ Silver __ Iron -- --__ Lead -- --__ Manganese -- --__ Mercury -- --__ Nitrate -- --__ Selenium -- ORGANIC CHEMISTRY Parameter Results mg/ 1 Parameter Results mg/ 1 Parameter Results mg/ 1 _P&T:GC/MS ~DB __ Methoxychlor __ Acid:B/N Ext. PCB's <ntl ppm., __ Toxaphene _TOX __ Petroleum _2,4-D --__ Endrin __ 2,4,5-TP (silvex) --__ Lindane -- MICROBIOLOGY RADIOCHEMISTRY Parameter Parameter Results PCi/ 1 __ (MF) Coliform Colonies/lO0mls __ Gross Alpha __ (MPN) Coliform Colonies/lOOmls __ Gross Beta ---- ---- Date Received ___,r2, ____ --J.._....,_-_.1[.._.?.._ZL--, -'--P,-=-'--------Date Reported __________________ _ Date Extracted __ 2_-~i o_-_,·SB~"-->i!WY\_--'-'r--------0'-· Reported By Date Analyzed -';l.=-=-_-..:...:1 ;i_::::...:::..._,-gy,c._w__]/JL...!...P ________ _ 80033·2 -------------------Lab Number DHS 3191 (Revised 7/85) Solid and Hazardous Waste (Review 7 /87) \' Purpose: Enforcement and compliance with the N. C. Solid and Hazardous Waste Management Rules. Preparation A sample analyses request form (OHS 3191) must be completed for each type of evaluation requested (e.g., inorganic, organic, microbiology, radiochemistry). For sampling conditions which require more than one ( 1) container (i.e., ground or surface water from landfills) a sample label must be affixed to one of the containers. The collector must then write the site and sample number on the duplicate. Do not submit an analysis request sheet with no parameters indicated. Equivalent measurements: ppm= µg/ml = mg/1 =µgi g= mg/kg ppb = µg/1 = µg/lO00g = µg/kg DEFINITIONS/INSTRUCTIONS Site Number -A twelve-digit site/location identifier, assigned only by the district field representative. Field Sample Number -A six-digit sample identifier which is pre-printed on the sample label. Name of Site -Name of landfill, facility, etc. Site Location -Address, street number, state road, etc. Collected By -Name and ID of sample collector. Date and Time Collected -Self-explanatory. Environmental-A sample of a naturally occurring substance such as groundwater, surface water or soils which may be contaminated. Concentrate -A sample of a waste, including but not limited to, sludges, resins, treatment effluents or drummed wastes. Comments -Lists details regarding sample or sample point, including but limited to, phase separation, and/ or od9rs. Inorpnic Chemistry -Check ( ✓ ) the desired parameters to be analyzed. Extractables are only performed on a solid or semi-solid. For routine landfill samples, check all parameters in the second and third columns. Organic Chemistry -Check ( ✓ ) the desired parameter to be analyzed. If not listed, enter the name in the space provided. Microbiology and Radiochemistry -The Raleigh office should be consulted prior to sampling for either of these. Distribution: 1. Original to State Laboratory of Public Health Environmental Sciences Branch P. 0 . Box 28047 Raleigh, NC 27611 2. Lab sends copy to Solid and Hazardous Waste Management Branch. 3. Solid and Hazardous Waste Management Branch sends copy to field person. Disposition: This form may be destroyed in accordance with the Environmental Health, Solid and Hazardous Waste Section of the Records Disposition Schedule as published by the North Carolina Division of Archives and History. Additional forms may be ordered from: Solid and Hazardous Waste Management Branch Division of Health Services P. 0. Box 2091 Raleigh, NC 27602-2091 N. C. Department of Human Resources Division of Health Services SAMPLE ANALYSES REQUEST State Laboratory of Public Health P. 0 . Box 28047 306 N. Wilmington Street If Raleigh, 27611 q~oooool 157a Site Number __ .........,~""---------G_O_o __ ~------Field Sample Number--~~-----/ __________ _ Name of Site __._p.....;c::;;....;.:a~"----'-b-r=-_-__________ Site Location ___ Cl ___ t_+_o_n. __ l __ \/ __ ('"""---------- Collected By -'-6--i~.-•_c _ _l -+----/)j~_·! _I I ___ ID# S (o S-l Date Collected ~ / ~ / x' g" Type of Sample: Environmental ___ Groundwater ( 1) _:/__ Surface Water (2) __ Soil (3) __ Other (4) E:xtractables Concentrate __ Solid (5) __ Liquid ( 6) __ Sludge (7) __ Other (8) IL T1)S INORGANIC CHEMISTRY Parameter Results mg/ 1 Parameter Results mg/ 1 __ Arsenic __ Arsenic __ Barium __ Barium __ Cadmium __ Cadmium __ Chromium __ Chloride __ Lead __ Chromium __ Mercury __ Copper __ Selenium __ Fluoride __ Silver __ Iron --__ Lead --__ Manganese --__ Mercury --__ Nitrate --__ Selenium ORGANIC CHEMISTRY Parameter Results mg/1 Parameter Results mg/ 1 _P&T:GC/MS EDB Comments Total Parameter __ Silver __ Sulfates __ Zinc _Ph __ Conductivity _TDS _TOC -- -- -- -- -- -- Parameter __ Methoxychlor __ Acid:B/N Ext. / PCB's <n,.l)Ol'J/1'J)),, __ Toxaphene _TOX __ Petroleum I I _2,4,D --__ Endrin __ 2,4,5,TP (silvex) --__ Lindane -- MICROBIOLOGY RADIOCHEMISTRY Time J .' i O Results mg/ 1 Results mg/ 1 Parameter Parameter Results PCi/ 1 __ (MF) Coliform Colonies/l00mls __ Gross Alpha __ (MPN) Coliform Colonies/lO0mls __ Gross Beta ---- ---- Date Received e? -3-8'}? 7/ f>. Date Reported _________________ _ Date Extracted ~l;-ff' Pv~J'-7-;J:D~M~;)+=L~'B _______ Date Analyzed ....:,;;l;c..__/;__S:_-_.n,:;_:;__JP~'---------- 800333 Reported By Lab Number DHS 3191 (Revised 7/85) Solid and Hazardous Waste (Review 7 /87) Purpose: Enforcement and compliance with the N. C. Solid and Hazardous Waste Management Rules. Preparation A sample analyses request form (OHS 3191) must be completed for each type of evaluation requested (e.g., inorganic, organic, microbiology, radiochemistry). For sampling conditions which require more than one ( 1) container (i.e., ground or surface water from landfills) a sample label must be affixed to one of the containers. The collector must then write the site and sample number on the duplicate. Do not submit an analysis request sheet with no parameters indicated. Equivalent measurements: ppm= µg/ml = mg/1 =µgi g= mg/kg ppb = µg/1 =_µg/lO00g = µg/kg DEFINITIONS/INSTRUCTIONS Site Number -A twelve-digit site/location identifier, assigned only by the district field representative. Field Sample Number -A six-digit sample identifier which is pre-printed on the sample label. Name of Site -Name of landfill, facility, etc. Site Location -Address, street number, state road, etc. Collected By -Name and ID of sample collector. Date and Time Collected -Self-explanatory. Environmental-A sample of a naturally occurring substance such as groundwater, surface water or soils which may be contaminated. Concentrate -A sample of a waste, including but not limited to, sludges, resins, treatment effluents or drummed wastes. Comments -Lists details regarding sample or sample point, including but limited to, phase separation, and/ or odors. · lnorpnic Chemistry -Check ( ✓ ) the desired parameters to be analyzed. Extractables are only performed on a solid or semi-solid. For routine landfill samples, check all parameters in the second and third columns. Organic Chemistry -Check ( ✓ ) the desired parameter to be analyzed. If not listed, enter the name in the space provided. Microbiology and Radiochemistry -The Raleigh office should be consulted prior to sampling for either of these. Distribution: 1. Original to State Laboratory of Public Health Environmental Sciences Branch P. 0 . Box 28047 Raleigh, NC 27611 2. Lab sends copy to Solid and Hazardous Waste Management Branch. 3. Solid and Hazardous Waste Management Branch sends copy to field person. Disposition: This form may be destroyed in accordance with the Environmental Health, Solid and Hazardous Waste Section of the Records Disposition Schedule as published by the North Carolina Division of Archives and History. Additional forms may be ordered from: Solid and Hazardous Waste Management Branch Division of Health Services P. 0 . Box 2091 Raleigh, NC 27602-2091 N. C. Department of Human Resources Division of Health Services SAMPLE ANALYSES REQUEST State Laboratory of Public Health P. 0. Box 28047 306 N. Wilmington Street Raleigh, 27611 q30°0 001 ooox L/-s Bo Site Number -=--------------------Field Sample Number ---~~~----------- Name of Site ___,p_c __ ..... 6.___L_F_----------Site Location __ H_+_-_+_o_//\~--------- Collected By 8 I j r cf 1 (,A ) 1 I/ Type of Sample: ID# 50 5 7 Environmental ___ Groundwater ( 1) L Surface Water (2) __ Soil (3) __ Other (4) Concentrate __ Solid (5) __ Liquid (6) __ Sludge (7) __ Other (8) Date Collected d / rl / /3G ; Comments . ·~ 'i(,~~ -. '--\., i INORGANIC CHEMISTRY E:xtractables Parameter Results mg/ 1 __ Arsenic __ Barium __ Cadmium __ Chromium __ Lead __ Mercury __ Selenium __ Silver -- -- -- -- -- Parameter Results mg/ 1 _P&T:GC/MS __ Acid:B/N Ext. _TOX -- -- MICROBIOLOGY Parameter __ (MF) Coliform Colonies/lO0mls __ (MPN) Coliform Colonies/lO0mls -- -- Date Received ,;2-,?[-;?;Tt/, J>. Date Extracted .1::/2:ff 'PW;12M_;LJ3 Total Parameter Results mg/ 1 Parameter Results mg/ 1 __ Arsenic __ Silver __ Barium __ Sulfates __ Cadmium __ Zinc __ Chloride _Ph __ Chromium __ Conductivity __ Copper _TDS __ Fluoride _TOC __ Iron --__ Lead -- __ Manganese -- __ Mercury -- __ Nitrate -- __ Selenium -- ORGANIC CHEMISTRY Parameter Results mg/ 1 Parameter Results mg/ 1 ±_EDB __ Methoxychlor PCB's <n.ooo/1:Vr>'I __ Toxaphene __ Petroleum , I _2,4~0 __ Endrin __ 2,4,S~TP (silvex) __ Lindane -- RADIOCHEMISTRY Parameter Results PCi/ 1 __ Gross Alpha __ Gross Beta -- -- Date Reported __________________ _ Date Analyzed _.:z_-_~_J_S-_-_<ff_,/ __ P _________ _ Reported By ______________ Lab Number 80033:.l OHS 3191 (Revised 7/85) Solid and Hazardous Waste (Review 7 /87) Purpose: Enforcement and compliance with the N. C. Solid and Hazardous Waste Management Rules. Preparation A sample analyses request form (OHS 3191) must be completed for each type of evaluation requested (e.g., inorganic, organic, microbiology, radiochemistry). For sampling conditions which require more than one (1) container (i.e., ground or surface water from landfills) a sample label must be affixed to one of the containers. The collector must then write the site and sample number on the duplicate. Do not submit an analysis request sheet with no parameters indicated. Equivalent measurements: ppm= µ.g/ml = mg/1 =µ.gi g= mg/kg ppb = µ.g/1 = µ.g/lO00g = µ.g /kg DEFINITIONS/INSTRUCTIONS Site Number -A twelve-digit site/location identifier, assigned only by the district field representative. Field Sample Number -A six-digit sample identifier which is pre-printed on the sample label. Name of Site -Name of landfill, facility, etc. Site Location -Address, street number, state road, etc. Collected By -Name and ID of sample collector. Date and Time Collected -Self -explanatory. Environmental-A sample of a naturally occurring substance such as groundwater, surface water or soils which may be contaminated. Concentrate -A sample of a waste, including but not limited to, sludges, resins, treatment effluents or drummed wastes. Comments -Lists details regarding sample or sample point, including but limited to, phase separation, and/ or od9rs. · Inorpnic Chemistry-Check ( ✓ ) the desired parameters to be analyzed. Extractables are only performed on a solid or semi-solid. For routine landfill samples, check all parameters in the second and third columns. Organic Chemistry -Check ( ✓ ) the desired parameter to be analyzed. If not listed, enter the name in the space provided. Microbiology and Radiochemistry -The Raleigh office should be consulted prior to sampling for either of these. Distribution: 1. Original to State Laboratory of Public Health Environmental Sciences Branch P. 0 . Box 28047 Raleigh, NC 27611 2. Lab sends copy to Solid and Hazardous Waste Management Branch. 3. Solid and Hazardous Waste Management Branch sends copy to field person. Disposition: This form may be destroyed in accordance with the Environmental Health, Solid and Hazardous Waste Section of the Records Disposition Schedule as published by the North Carolina Division of Archives and History. Additional forms may be ordered from: Solid and Hazardous Waste Management Branch Division of Health Services P. 0 . Box 2091 Raleigh, NC 27602-2091 N. C. Department of Human Resources Division of Health Services SAMPLE ANALYSES REQUEST State Laboratory of Public Health P. 0. Box 28047 306 N. Wilmington Street Raleigh, 27611 Site Number __ 9.;....._3_u_· _0_O_O_C_/_O_, _O_· _c_X ____ Field Sample Number _ _,4..,...., _5_3_/ ________ _ Name of Site PC 6 LF Site Location Q + f u Y'-- Collected By ~W'---'--_i _/ _I )_13_._._.~~+--r ..;...e._l _ ID# 6 <o ) ~; 7 Date Collected a I -::1, / t' ~ Type of Sample: Environmental ___ Groundwater ( 1) ___ Surface Water (2) __:!___ Soil (3) __ Other (4) Concentrate __ Solid (5) __ Liquid ( 6) __ Sludge (7) __ Other (8) INORGANIC CHEMISTRY Extractables Parameter Results mg/ 1 Parameter Results mg/ 1 __ Arsenic __ Arsenic __ Barium __ Barium __ Cadmium __ Cadmium __ Chromium __ Chloride __ Lead __ Chromium __ Mercury __ Copper __ Selenium __ fluoride __ Silver __ Iron --__ Lead --__ Manganese --__ Mercury --__ Nitrate --__ Selenium ORGANIC CHEMISTRY Parameter Results mg/ 1 Parameter Results mg/ 1 _P&T:GC/MS EDB __ Acid:B/N Ext. / PCB's <a, L .p;irtt _TOX __ Petroleum --__ Endrin --__ Lindane MICROBIOLOGY Total Parameter __ Silver __ Sulfates __ Zinc _Ph __ Conductivity _TDS _TOC -- -- -- -- -- -- Parameter __ Methoxychlor __ Toxaphene _2,4-D __ 2,4,5-TP (silvex) -- RADIOCHEMISTRY Results mg/ 1 Results mg/ 1 Parameter Parameter Results PCi/ 1 __ (MF) Coliform Colonies/lO0mls __ Gross Alpha __ (MPN) Coliform Colonies/l00mls __ Gross Beta ---- ---- ,,,2 -3 -gg-v, P. Date Received ~---~-<--..M-"--_......,___._ _ __._ __________ Date Reported _________________ _ Date Extracted _~2_-~3...._ .. -'8."'"R._......,_µ)Af~___._ _______ Date Analyzed ,:;.-/;l-lf'8"1/P Reported By ________ LJ ___________ Lab Number 800335 DHS 3191 (Revised 7185) Solid and Hazardous Waste (Review 7 /87) Purpose: Enforcement and compliance with the N. C. Solid and Hazardous Waste Management Rules. Preparation A sample analyses request form (OHS 3191) must be completed for each type of evaluation requested (e.g., inorganic, organic, microbiology, radiochemistry). For sampling conditions which require more than one ( 1) container (i.e., ground or surface water from landfills) a sample label must be affixed to one of the containers. The collector must then write the site and sample number on the duplicate. Do not submit an analysis request sheet with no parameters indicated. Equivalent measurements: ppm= µg/ml = mg/1 =µgi g= mg/kg ppb = µg/1 = µg/lOOOg = µg/kg DEFINITIONS/INSTRUCTIONS Site Number -A twelve-digit site/location identifier, assigned only by the district field representative. Field Sample Number -A six-digit sample identifier which is pre-printed on the sample label. Name of Site -Name of landfill, facility, etc. Site Location -Address, street number, state road, etc. Collected By -Name and ID of sample collector. Date and Time Collected -Self-explanatory. Environmental -A sample of a naturally occurring substance such as groundwater, surface water or soils which may be contaminated. Concentrate -A sample of a waste, including but not limited to, sludges, resins, treatment effluents or drummed wastes. Comments -Lists details regarding sample or sample point, including but limited to, phase separation, and/ or ~~-' Inorpnic Chemistry-Check ( ✓ ) the desired parameters to be analyzed. Extractables are only performed on a solid or semi-solid. For routine landfill samples, check all parameters in the second and third columns. Organic Chemistry -Check ( ✓ ) the desired parameter to be analyzed. If not listed, enter the name in the space provided. Microbiology and Radiochemistry -The Raleigh office should be consulted prior to sampling for either of these. Distribution: 1. Original to State Laboratory of Public Health Environmental Sciences Branch P. 0. Box 2804 7 Raleigh, NC 27611 2. Lab sends copy to Solid and Hazardous Waste Management Branch. 3. Solid and Hazardous Waste Management Branch sends copy to field person. Disposition: This form may be destroyed in accordance with the Environmental Health, Solid and Hazardous Waste Section of the Records Disposition Schedule as published by the North Carolina Division of Archives and History. Additional forms may be ordered from: Solid and Hazardous Waste Management Branch Division of Health Services P. 0. Box 2091 Raleigh, NC 27602-2091 State Laboratory of Public Health N. C. Department of Human Resources Division of Health Services SAMPLE ANALYSES REQUEST P. 0. Box 28047 306 N. Wilmington Street Site Number q 3 0 OO <JO ( Name of Site ___.y_c_-1_~_"'--L~r-________ _ o oc X Raleigh, 27611 Field Sample Number _4_.__S_S_d-___________ _ Site Location ----'"U\'-'--t-'---f_G---'-V\ ___________ _ Collected By \A,) .1 l / 1 gy ;--cl ID# 50 :;7 Date Collected __ d .::.....J.-/ _cl ____ / ...;::.K_?" __ _ Type of Sample: Environmental ___ Groundwater ( 1) ___ Surface Water (2) L Soil (3) Concentrate __ Solid (5) __ Liquid ( 6) __ Sludge (7) __ Other (8) U I US -Comments Se c{ I Vr1 f Vt t __ Other (4) INORGANIC CHEMISTRY Extractables Total Parameter Results mg/ 1 Parameter Results mg/1 Parameter __ Arsenic __ Arsenic __ Silver __ Barium __ Barium __ Sulfates __ Cadmium __ Cadmium __ Zinc __ Chromium __ Chloride _Ph __ Lead __ Chromium __ Conductivity __ Mercury __ Copper _TDS __ Selenium __ Fluoride _TOC __ Silver __ Iron -- --__ Lead -- --__ Manganese -- --__ Mercury -- --__ Nitrate -- --__ Selenium -- ORGANIC CHEMISTRY Parameter Results mg/ 1 Parameter Results mg/ 1 Parameter _P&T:GC/MS EDB __ Methoxychlor __ Acid:B/N Ext. XPCB's <oiLPP11 __ Toxaphene _TOX __ Petroleum _2,4-D --__ Endrin __ 2,4,5-TP (silvex) --__ Lindane -- MICROBIOLOGY RADIOCHEMISTRY :/ ' 3 /'~ I Time ___,;-..:;=----\...._)=-- Results mg/ 1 Results mg/ 1 Parameter Parameter Results PCi/ 1 __ (MF) Coliform Colonies/lO0mls __ Gross Alpha __ (MPN) Coliform Colonies/lOOmls __ Gross Beta ---- ---- Date Received _,;2. __ -_.5"""~------'~::;,__"j''--__.-t(;:....;_, . .L.E-L----------Date Reported _________________ _ Date Extracted -"""f;=di .... ~_._-__,.a5..,_,e.,_.,,mf11=,,q,L-,14,\-------Date Analyzed __,;2_'-=--_._/.=:..~=-....:"::;,..,..:;~1/P~--------- Reported By LJ7 Lab Number __ 8_0_0_3_j_~_(._' __________ _ DHS3191 (Revised 7/85) Solid and Hazardous Waste (Review 7 /87) Purpose: Preparation Enforcement and compliance with the N. C. Solid and Hazardous Waste Management Rules. A sample analyses request form (OHS 3191) must be completed for each type of evaluation requested (e.g., inorganic, organic, microbiology, radiochemistry). For sampling conditions which require more than one ( 1) container ( i.e., ground or surface water from landfills) a sample label must be affixed to one of the containers. The collector must then write the site and sample number on the duplicate. Do not submit an analysis request sheet with no parameters indicated. Equivalent measurements: ppm= µg/ml = mg/1 =µgi g= mg/kg ppb = µg/1 = µg/lOOOg = µg/kg DEFINITIONS/INSTRUCTIONS Site Number -A twelve-digit site/location identifier, assigned only by the district field representative. Field Sample Number -A six-digit sample identifier which is pre-printed on the sample label. Name of Site -Name of landfill, facility, etc. Site Location -Address, street number, state road, etc. Collected By -Name and ID of sample collector. Date and Time Collected -Self-explanatory. Environmental -A sample of a naturally occurring substance such as groundwater, surface water or soils which may be contaminated. Concentrate -A sample of a waste, including but not limited to, sludges, resins, treatment effluents or drummed wastes. Comments -Lists details regarding sample or sample point, including but limited to, phase separation, and/ or od<;>rs. ' Inorpnic Chemistry-Check ( ✓ ) the desired parameters to be analyzed. Extractables are only performed on a solid or semi-solid. For routine landfill samples, check all parameters in the second and third columns. Organic Chemistry -Check ( ✓ ) the desired parameter to be analyzed. If not listed, enter the name in the space provided. Microbiology and Radiochemistry -The Raleigh office should be consulted prior to sampling for either of these. Distribution: 1. Original to State Laboratory of Public Health Environmental Sciences Branch P. 0. Box 2804 7 Raleigh, NC 27611 2. Lab sends copy to Solid and Hazardous Waste Management Branch. 3. Solid and Hazardous Waste Management Branch sends copy to field person. Disposition: This form may be destroyed in accordance with the Environmental Health, Solid and Hazardous Waste Section of the Records Disposition Schedule as published by the North Carolina Division of Archives and History. Additional forms may be ordered from: Solid and Hazardous Waste Management Branch Division of Health Services P. 0 . Box 2091 Raleigh, NC 27602-2091 )_o cation of Sampling: .:,v1-,1.u ruw n.'I.L.AKUUU~ WA::;Tt; M...\NAG!::.:MEt,T B?J,N CH Chain of Custody Record Hazardous Waste Materials Generator __ Storage Facility Other: __ Transporter __ Disposal Fa cility Company's Name ~K_;;..B;.__\__o.;_~_~_~_,_\\ _________ _ Telephone _;ddress ~ ' Tr;:,Jiai:,rne h't .:facility y(\:~~d f i 11 Sollector's Name ne ~{____,i}.;....7.;....)_~_,_J _l7_2 ____ _ -signature :::,at:e Sampled _9_-_&_' __ 3._3 ______________ _ Time Sampled_/._ ..... · 0.......,0 ____________ _ ~pe of Process Generating Waste '~eld Information t lc:'1 / · :,2:;.d Sample No. 7 ;:) I of Possession: ~ l-, »/{dA,da.._~~ooloycR signa_ture 1 ( • · title signature signature title ~suits reported signature title inclusive/dates inclusive dates inclusive dates date lnst~uctions: Complete all applicable information including signatures, and submit with analysis request forms. .::iV L l.U ·./-\!HJ ttAL..A.KUUU ~ WAYft, MANAG t:Mt:NT ~K.ANCH Re c e ipt fo r Samp l es The s amples de scribed b e low were collected in connection with the admini s tration,. e nforce me nt, a nd docume nta tion of the: ( ) North Carolina Hazardous Waste Management Rules, 10 NCAC l OF ( ) North Carolina Solid Waste Management Rules, 10 NCAC lOG ( ) Comprehensive Environmental Response, Compensati_on and Liability Act (CERCLA) ( ) Toxic Substances Control Act (TSCA) 15 U.S.C. 52601, et~-, ':specifically Section 11 of TSCA, 15 U.S.C. 52610. Inspector's Name Inspector's Address !fame of Firm Firm Address -irm Ownei, Operator, or Agent Title ·- ... ._,-:,,-. ··--~~ _..., COLLECTED SAMPLE TYPE DUPLICATE SA!-~PLES SAMPLE .. ·:-;3ER DATE TIME WATER SOIL OTHER OFFERED !ACCEPTED ! REJECTED ON-SITE I ! - \ LOC;..TIO!\ Of:-sr:·:: Re~eipt for the sample(s) described above is hereby acknowledged: Receipt/rejection of duplicate or split samples is hereby acknowledged: ~ignature of Inspector Signature of Firm o~ner, Operator, or Agent Title T i tle Comme nt s : Lo cation of Sampling: ;:,v L.1.u ru'w t1ALAKuuu:, wA~Tr. M?.r-,;G::.:~u n BRAN CH Chain of Custodv Reco ~d Hazardous Waste Materials Generator __ Storage facility Other: __ Tran s porter Dis pos al facility Company's Name fcB Low-'(l).~\ \ \ Telephone __ T,r'ea i:me~c--,.fac i 1 i ty ·/·L'~ndfill Address \\~\:a~ ~'-- Colleccor' s Name ~ [,._,J__/ Q _)_J2a_ &Lone ( l ::rn -). \l'o -signature J !)at~ Sampled ~-"d -'8''8 Time Sampled_-'-/'-,_O~O;...._ ____ ~---- Ty?e of Process Generating Waste f{eld Information f'itld Sample No. (hei~ of Possession: signa_ture signature signature Re.su ~ ts r e ported signature -:;)·;J ·◊-7 /2-'3 -o7 inclusiledates ~~71 · title inclusive dates title inclusive dates title date i nst~uc tions : Complete all applicable information including s i gnatures, and submit with ana lysis request forms. ;)ULl.U ·ANU t1AL.Al<.UUU':) \.,'A':) ~t. Kt\.NAGt:Mt:NT bKANCH Receipt for Sam~les The samples desc ribe d b e low were collected in connection with the admini s tration ,. enforcement, a nd documentation of the: ( North Carolina Hazardous Waste Management Rules, 10 NCAC lOF ( ) North Carolina Solid Waste Management Rules, 10 NCAC lOG ( ) Comprehensive Environmental Response, Compensation and Liability Act (CERCLA) ( ) Toxic Substances Control Act (TSCA) 15 U .S .C. S2601, et ~., 'specifically Section 11 of TSCA, 15 U.S.C. 52610. Inspector's Name Inspector's Address !fame of Firm Firm Address :irrn Owner, Operator, or Agent Title 5AMPLE COLLECTED SAMPLE TYPE DUPLICATE SA!·1PLES SAMPLE flat-1"' ~p . . -=-... , DATE TIME WATER SOIL OTHER OFFEREDIACCEPTED ! REJECTED ON-SITE I ! - ,. . . ' ' Loc.;..rro~ .OF:-SI':E ---- ReC:eipt for the sample(s)_described a bove is hereby acknowledged: Receipt/rejection of duplicate or split samples is hereby acknowledged: Signature of Inspector Signature of Firm Owner, Operator, or Agent Title Title Comme nt s: PCB' LANDFILL MONTHLY REPORT DATE 2 /2/8 2 ---=----------------------- 1. Entrance Road 2. Monitoring Wells Casings, locks · Fences, gates, locks 3. Landfill fence, gate, locks 4. Air Vent . 5. Landfill Cover Erosion, vegetation Subsidence 6. Leachate Detection System 7. 8. Water in sump Leachate Collection Access Pipe Pump Piping Treatment Works Influent Piping Sand Filter Carbon Filter Effluent Piping 9. Surf ace Impound.men t System Erosion, vegetation 10. Irrigation Syst~ Influent Piping Pump Sprinkler Units NAME NO PROBLEM ✓ ./ / / / ✓ ... / POTENTIAL PROBLEM Bvrd l OBSERVATIONS GROUND WATER MONITORING WELL DOCUMENTATION SHEET Date: .2-7t_ -·8'6 Site Name: ~C.J?, lc,.,,..__~f,\\ Site Desc.: ____________ District: ________ _ Permit #:~S ()<-?_DC)?_\_ ClXJX County:__,.,J'..,,__,,.vo.""'c_r.;;;11..,.;..°I"'------(munic.-i-nd-us../.sani .-demo) Site Address:__________ Site Contact: _________ _ Abbreviations: PVC= Polyvinylchloride; GS= Galvanized Steel; S = Steel; SS = Stainless Steel Type of Size of Depth from Top of Stickup Well Casing Casing Outer Casing Feet of Height Comments # inner inner outer to Bottom to Water Standing inner outer outer Water I pvl--"(\eJ .) L}'✓ 6-/ t-f b.S 4(.r1> s.o ? ' ·, ~1 -. 6 // ~o,i )5'.0 c "6 ' -::> . ---i ,., ' 'lh b , / ½3 )d -l ~0.1 ; ' i -\ .,. ;/ ~I /1 .7 :71.1 ·-., ., 6 1 . ~ .. ' ;:-::·(t:: k.'.'.ii i PCB LANDFILL MONTHLY REPORT DATE _ __,_/.,__/-'-'--/5__._/_g~8 ____ _ 1. 2. 3. 4. . 5. 6. 7. 8 • 9. 10. Entrance Road Monitoring Wells Casings, locks -Fences, gates, locks Landfill fence, gate, locks Air Vent Landfill Cover Erosion, vegetation Subsidence Leachate Detection System Water in sump Leachate Collection System Access Pipe Pump Piping . Treatment Works Influent Piping Sand Filter Carbon Filter Effluent Piping Surface Impoundment Erosion, vegetation Irrigation Syst~ Influent Piping Pump Sprinkler Units NO POTENTIAL PROBLEM PROBLEM OBSERVATIONS . . ./ / . ./