NCD980602163_19891025_Warren County PCB Landfill_SERB C_Field Sample Analyses-OCR

N'. C. D.::partment 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_0_0_/_o_o_o_-J-X-=--Field Sample Number __ 0_D___.,l/;__:1_8_"-------
Name of Site _._8_t:'=--,.:/3~__,Le:=.,_4.:;....'1.:;....J_:_~::....:....<-/_/_____ Site Location lt}q rre ~ Co j..cJ/¼,.. ', N. C.
Collected By Bohby L&-\f-hj ID# _____;;O::c.....=S:;._z_9_ Date Collected Clef. ~ /fl{_<j Time ,2..'!,f?
Type of Sample:
Envi~mental
__ V_ ( Groundwater ( 1)
Concentrate
__ Solid (5)
f
· __ Surface Water (2) __ ._Liquid (6)
__ Soil (3) __ Sludge (7)
__ Other (4) __ 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 yPDB
__ Acid:B/N Ext. PCB's <o.ooo/
_TOX __ Petroleum
--__ Endrin
--__ Lindane
MICROBIOLOGY
Comments
Total
Parameter Results mg/ 1
__ Silver
__ Sulfates
__ Zinc
_Ph
__ Conductivity
_TDS
_Toe
--
----
--
--
--
Parameter Results mg/1
__ Methoxychlor
__ Toxaphene
_2,4-D
__ 2,4,5-TP (silvex)
--
RADIOCHEMISTRY
Parameter Parameter Results PCi/ 1
__ (MF) Coliform Colonies/l00mls __ Gross Alpha
__ (MPN) Coliform Colonies/lO0mls __ Gross Beta
----
----
Date Received _O_C_T-'2=--><Q__._198...,.9~/j...c.=/1:...__ __ ...::0;..::C...:..T_2...1..61-....1:100Q~-Date Reported -L.l..,.O"'---_:c;.3_;/'---'=-5:.......L.j __________ _
Date E~tracted~~-;+----'~=-;l,-..L7_::: ...... ~-..L-~-L'P.--H"~------Date Analyzed ...,,.J...,.0.,__-_..,,3c....1tJ'---...,,.f9'--L---'yp~--------~ 0 0 ~1 1 1 Reported By /J\i. Lab Number c..h .. · •• ~ .J...,
DHSJ191 (Revis 7185) ~a// 3/7 3 0() 3/ 1 (L Solid and Huardous Waste (Review 7187) n-I l/ -7 t?'-r
N. 8. D~partment 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/.:....:~=-0---=-0_0=----=0=---=0:..,_;__/_0_0_0_--Lx--=--Field Sample Number __ 0_0_'/_7_3_~--------
Name of Site _,_8_t:'-=--,,:....;/3=---,z.L::...;.::Qc......:'1:...=J:....:.f,,_,,'-'--/-'-----Site Location /))a. rre,,.., Co. · A_./-h,11, . r1. c.
Collected By Bohby L "'f °'o/ ID# --.:0::::....-=Sc........L.9_ Date Collected (7 CT. ~ S" / /iin: ~ ""= '/ o
Type of Sample:
Environmental
~roundwater ( 1)
Concentrate
__ Solid (5)
___ Surface Water (2) ___ Liquid (6)
__ Soil (3) __ Sludge (7)
__ Other (4) __ Other (8)
INORGANIC CHEMISTRY
Extractable&
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 <O,QOO L
_TOX __ Petroleum
--__ Endrin
--__ Lindane
MICROBIOLOGY
Parameter Parameter
__ (MF) Coliform Colonies/I00mls __ Gross Alpha
__ (MPN) Coliform Colonies/l00mls __ Gross Beta
----
----
Comments
Total
Parameter Results mg/ 1
__ Silver
__ Sulfates
__ Zinc
_Ph
__ Conductivity
_TDS
_TOC
--
--
--
--
--
--
Parameter Results mg/ 1
__ Methoxychlor
__ Toxaphene
_2,4-D
__ 2,4,S-TP (silvex)
--
RADIOCHEMISTRY
Results PCi/ 1
Date Received __ O_C_T_2_6_939....:....:.~8<>..<.<µ'-'-----------Date Reported __________________ _
Date Extracted ~/_o_--.;1.._7&....-..... &.,_.,.9_1~t,A...P_,..),_.A"'-'-'-'A"-------Date Analyzed ...... /2c.....:'IJ:::___-.... 3=~e::.._..111189!:...a-..... :lh>~,....--::---=-------903114 Reported By Lab Number
OHS 3191 (Revised 7185)
Solid and Hazardous Waste (Review 7 /87)
N. €. 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_o_o..:..._:o::.......;./_o_o_o_--L,X--=--Field Sample Number ___ o_o___,:,<./,_?_3_.'/:'----------
Name of Site ec 13 L4,,J/!,// Site Location Wa.rren Co. , A/¼,.,_ . ,,y.C.
Collected By _B_o_h_ky_,___L-----'"'-'-f-bj...__ __ ID# ---'O=--=SC-L--9_ Date Collected CJ cf. ~S" / 9Kin:: '2 .' 3 O
Type of Sample:
Envir~ental
_.L Groundwater ( 1)
Concentrate
__ Solid (5)
__ Surface Water (2) __ Liquid (6)
__ Soil (3) __ Sludge (7)
__ Other (4) __ Other (8)
Comments
M w-3
INORGANIC CHEMISTRY
Extractable&
Parameter Results mg/ l
__ Arsenic
__ Barium
__ Cadmium
__ Chromium
__ Lead
__ Mercury
__ Selenium
__ Silver
--
--
--
--
--
Parameter Results mg/ l
_P&T:GC/MS
__ Acid:B/N Ext.
_TOX
--
--
MICROBIOLOGY
Parameter
__ (MF) Coliform Colonies/l00mls
__ (MPN) Coliform Colonies/lO0mls
--
--
Date Receive~C OCT 2 6 1989 t3,&.
Date Extracted 2o -p].,, 7 -g 9 --Vf; M
Reported By
OHS 3191 (Rc:vised 7185)
Solid and HazardoU& Waste (Review 7 /87)
Total
Parameter Results mg/1 Parameter Results mg/ l
__ Arsenic __ Silver
__ Barium __ Sulfates
__ Cadmium __ Zinc
__ Chloride _Ph
__ Chromium __ Conductivity
__ Copper _TDS
__ fluoride _Toe
__ Iron --
__ Lead --
__ Manganese --
__ Mercury --
__ Nitrate --
__ Selenium --
ORGANIC CHEMISTRY
Parameter Results mg/ l Parameter Results mg/ 1
yPDB __ Methoxychlor
PCB's <o.oooL __ 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 --=-/0=--_.-.3-...:GJ::;___-_.nA.;l~-t/P.,_.4'~he::IC-"ll'--------!m3.J..1~ Lab Number __________________ _
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_o_o_o_o_o_/_o_o_o _ __._X--"--_ Field Sample Number ___ 0_0__,_4_'7"-i_S" ______ _
Name of Site ec 13 Lo.,,J.f.·/1 Site Location /).)grren Co. · .cl./f.e11. • N'.C.
Collected By _B_o_;;b;;_b_y ___ L-"--'-"'-'-f-hj~-ID#----'O~S'-9.,,___ Date Collected Clef. ;J.S ;98:9-nme ;-2 :;to
Type of Sample:
Enviro~ntal
~ Groundwater ( 1)
Concentrate
__ Solid (5)
__ Surface Water (2) __ Liquid (6)
__ Soil (3) __ Sludge (7)
__ Other (4) __ 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 =:az;DB __ Acid:B/N Ext. PCB's -<o.ooo/
_TOX __ Petroleum
--__ Endrin
--__ Lindane
MICROBIOLOGY
Parameter Parameter
__ (MF) Coliform Colonies/l00mls __ Gross Alpha
__ (MPN) Coliform Colonies/l00mls __ 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
Date Received ___ 0_C_T~2~6~ ... 198 ... 9,._..A--'-'--& ________ Date Reported _________________ _
Date Extracted -'-(J~--~-·~7_-~Y~· __._9_-V~e..,,., ...... A ..... A--'-------Date Analyzed ~'~o_-~3_0--=--.,,,,..?....,.,~~:0'-="-"-P ______ _
903116 Lab Number Reported By
DHS 3191 (Revised 7/85)
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 oflandfill, 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.
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
}';/. C. Depa;tment 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 CJ 3 0000 0 / D O O )( Field Sample Number _ _..t)'-O----'-<f--'1_9..,_0;:..__ ______ _
Name of Site __.8.._~~13 __ Lc.=,_Q'--'1_cl-'-'A'-'-'--J_/_____ Site Location /,)}g rre "2.. Co. · t!J/toH. . t-1. c.
Collected By Bohky L"'f°o/ ID# __;O:c.....=S'---<--9_ Date Collected Clef :; !: J/i9Time '/!DO
Type of Sample:
Environmental
_ _yroundwater ( 1)
__ V_ s S•urface Water (2)
__ Soil (3)
__ Other (4)
Concentrate
__ Solid (5)
__ Liquid (6)
__ Sludge (7)
__ Other (8)
Comments
1<: d,..f a "'d (r-e-c, k -Yf5fr eo. ""
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 7PDB __ Methoxychlor
__ Acid:B/N Ext. CB's -<£J ,oo"L __ 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
----
----
Date Received ___ OC_T_2_6_tQ8_9_,,3c:a::.:....;!}-______ _ Date Reported __________________ _
Date Extracted .... 1 ..... 4....__----_7_7_-'?:;::;..-...:..o/_· v~r:~''-J-A...,.A..._:_ _____ _
Reported By
Date Analyzed __:./....::0;__,.. ...3.=..;GJ:::...._-~ff....:::.._-_--j/p~-------
Lab Number ______ ?_,,_Q_._3_1_._?_~_1.::.._ ______ _
OHS 3191 (Revised 7185)
Solid and Hazardous Waste (Review 7187)
N. C. Depa;tment 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=--O_O_o_o.;:___:o::;__;_/_o_o_o_--L.X-=---Field Sample Number __ o_o_4-_?'-i_7..___ _______ _
NameofSite ec 13 L,:v,J.f.!,// Site Location /)}grr-en Co. · A../!./-,,,,._ . r/.C.
Collected By _B_o_h-"--b_,_y_L---'---'"-L.f-bj--4---ID# __;:O::....::Sc.....J_9_ Date Collected tJ cf. ~ ~ ; 9'8'9Tune 3: O 5"
Type of Sample:
Environmental
_ yroundwater ( 1)
~ Surface Water (2)
__ Soil (3)
__ Ocher (4)
Concentrate
__ Solid (5)
__ Liquid (6)
__ Sludge (7)
__ Other (8)
Comments
g,-e,t, la. n.J c,e e.t. -[::>o tJJ..,.S1veA. fa'\
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 7PDB __ Methoxychlor
__ Acid:B/N Ext. PCB's ~O .Ot:JOL __ 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 ___ O_Cl_-_2_6_939_-=~"-t(9-'-. _____ _ Date Reported __________________ _
Date Extracted _l(J_-_ol--_?--'--F'._, -"-9_VL......:...P ...... .._.A-'-'--'A'----------.7" Date Analyzed --1-../=t)_-...._.,3-L.E:(J'----Y91L...L_l4.$..-Lrp _______ _
Reported By Lab Number ____ ?=-:._,;....;0;;:_;.:3 ::..:l=·=-=1=--;::8~--------
OHS 3191 (Revised 7185)
Solid and Haiardous Waste (Review 7187)
l.11ci1Lion of Sampling:
N. C. DEPARTMENT or HUMAN RESOURCES
DIVISI'ON OF HEALTH SERVICES
SOLID AND HAZARDOUS WASTE MANAGEMENT BRANCH
Chain of Cu stody Record
Hazardous Wa ste Materials
Generator __ TransporLL·r Trc:1Lrnl'nl F.1(·ilil
__ Storage Facility
Other:
__ Dis posa l Fac ility __l('t:rndfill
--------------------------
{'timpil ny 's Name :e.__C __ g ____ L_"-~"'-J~~-•_\_I ______ Telepho11 l! ( ___ ) _______ _
/\ddress __ l)J°'-f"r~'-" C.o\A."'-!y
Col I (>Ctor 's Name ~ob~ ~"'-+(t
sign~
IJ;ttl' Samplt!d Oc.7: ~~ 1 l'i8C/ , Time Sc1111p L L·d
Type of Process Generating Waste />CB. '-4.r\.J.{],•f/ ----<--------=-----------------
1-'idd Information
FiL•lu Sample No. oot/-7tZ-oo 'l-783 l>o'/78'1-()O'/-JSS-____
()t>t/7'/0 (Jocf7~7 oo'l-7'fff oot.flK'i
Ch;d n lJf Possession:
J.
Jll_~w-1 &mvJ-
signacure title inclusive c.lntl'S
signature title inclus ive dates
lksu I ts n•ported
signc1ture title d;iL o
l11str11clions: Complete all applicable information including s i g n:Hurcs, and
s ubmit with an.1lysis request forms .
N. C. Department of Human Resources
Division of Health Services SAMPLE ANALYSES REQUEST
State Laboratory of Public Healt
P. 0 . tlox 2804
306 N. Wilmin.;ton Stm
Site Number _C/.:._:3_:___o_o_o_o___:o_/_O_O_O_~XL-..:._ Fidd Sample Number
Name of Site _f__C /3 L Q., J /!, // Site Location _/Jj_a, r~ h Co· • A/h,..., . #. C •
Raleigh, 2761
Collected By --=B=--ob=-h==-1-·1---=L~ll\f..,_.-bj~-ID# OS 9 Date Collected Clef-. .-:?S" If~ Time~~: </o
Type of Sample:
Environmental
~round water ( 1)
Concentrate
__ Solid (5)
___ Surfact: Water (2) ___ Liquid (6)
__ Soil (3) __ Sludge (7)
__ Other (4) __ Ocher (8)
Comment8
INORGANIC CHEMISTRY
Extractable8 Total
Parameter Resultli mg/1 Parameter Rc1mlt11 mg/ 1 Parameter Reliulu mg/1
__ Arst:nic __ Arsenic __ Silver
__ Barium __ Barium __ Sulfates
__ Cadmium __ Cadmium __ Zinc
__ Chromium __ Chloride _Ph
__ Lead __ Chromium __ Conductivity
__ Mercury __ Copper _TDS
__ Sdenium __ Fluoride _TOC
__ Silver __ lron --
--__ Lead --
--__ Manganese --
--__ Mt:rcury --
--__ Nitrate --
--__ Selenium --
ORGANIC CHEMISTRY
Parameter Results mg/ 1 Parameter
_P&T:GC/MS ?PDB __ Acid:B/N Ext. PCB's
_TOX __ Petroleum
--__ Endrin
--__ Lindane
MICROBIOLOGY
Parameter
__ (MF) Coliform Colonies/lO0mls
__ (MPN) Coliform Colonies/lOOmls
--
--
Date Received __ 0_CT_2_6_tl89_..;;_;~f3_,_,J)'--· ______ _
Date Extracted _./'-O;;:;.._---';)._::;.., ..;,.7..1..--.,...0:r-.91---"UuP:__· ......,t::.A:i..A::...i_ ___ _ ,.,)
Reported By
DHS .ll91 (Rc:vised 7185)
Solid and HazurdoUII WHte (Review 7187)
Rei;ulcs mg/ I Parameter Rei;ulci; mg/ 1
"'0 ,Q tJ OL
__ Mt:thoxychlor
__ Toxaphenc
_2,4-D
--2,4,5-TP (silv.:x)
--
RADIOCHEMISTRY
Paramt::ter Rcmltli PCi/ 1
__ Gross Alpha
__ Gross Ikea
--
--
Date Reported __________________ _
Date Analyzed ~f.~0_-_."3.=-='LJ-___.gc/~_:J/P,z..-:...---------c, (>, .... , -~ -~ --~ -,,. ···' ·~-' -1 .......... "~ Lab Number
N. C. Department of Human Resources
Divi6ion of Health Services SAMPLE ANALYSES REQUEST
State: Laboratory of Public Heah
P. 0 . Box 2804
306 N. Wilmington Scm
RaleiKh, 2761
Site Number _C/.:._:3=-0___:,0_o_o..;___:o::.......;/_o_o_o_--LX~-Fidd Sample Number --~o_o_t/....:......:,?_S__,_Lf ______ _
Name of Site _._[1_~~/3~_.,.,L~Q,.;....."l,;_J-=-.f,~,'-'·/_/_____ Site Location _/,l) 4 r~ h Co· j A.£hn. 1 M-C ·
Collected By Bobh'/ L "'f-bj ID# 0 S 9 Dace Collected tJ cf-. ~ 5:" / 9_R!l Time e< : 3 °
Type of Sample:
Envir~ental
~ Groundwater ( 1)
Concentrate
__ Solid (5)
___ Surface Water (2) ___ Liquid (6)
__ Soil (3) __ Sludge (7)
__ Ocher (4) __ Ocher (8)
Comments
INORGANIC CHEMISTRY
Extractable&
Parameter Re&ults mg/ 1
__ Arsenic
__ Barium
__ Cadmium
__ Chromium
__ Lead
__ Mercury
__ Selenium
__ Silver
--
--
--
--
--
Parameter Re11ult11 mg/ 1
_P&T:GC/MS
__ Acid:B/N Exe.
_TOX
--
--
MICROBIOLOGY
Parameter
__ (MF) Coliform Colonies/lO0mls
--( M PN) Coliform Colonies/ 1 00mls
--
--
Dace Receive~c OCT 2 6 1989 M
Dace Extracted 1a -pl., 7-f?J -Vt; AA
Reported By
DHS .ll91 (R.:viscd 7/85)
Solid und HuurdoUli Wu~te (Review 7 /87)
Tocal
Parameter Re11ultt1 mg/ 1 Parameter Rei;ults 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 Rei;ulci; mg/ 1 Parameter Rei;ult!i mg/I
7PDB __ Mechoxychlor
CB's <o.oooL __ T oxaphene
__ Petroleum _2,4-D
__ Endrin __ 2,4,5-TP (silvex)
__ Lindane --
RADIOCHEMISTRY
Parameter Rei;ultti PCi/ I
__ Gross Alpha
__ Gross Beca
--
--
Dace Reported __________________ _
Dace Analyzed /,0 -.3 a -al.'-;t{f;, ..
~ J -. . -~ JL -•-.....,
Lab Number ___________________ _
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
Raleigh, 27611
Site Number C/ 3 0000 0 / 0 00 X Field Sample Number ___ 0_0_4.,_'7--'--~-,; ______ _
Name of Site --'8'--~~13 __ L"-"-Q'-11_J.,_~'--''-'-· /_I_____ Site Location /.).)4 rre h Co. . Alf.on. . ,,y'. C.
Bobby L~+-bj ID#-=-O--=S'-J9'--Date Collected Clef. ;J..5 /98'9 Time ;? ;;t() Collected By
Type of Sample:
Concentrate Comments
__ Solid (5) /JI/ w---t
__ Surface Water (2) __ Liquid (6)
__ Soil (3) __ Sludge (7)
__ Other (4) __ Other (8)
INORGANIC CHEMISTRY
Extractables Total
Parameter Results mg/ 1 Parameter Re,mltti mg/ 1 Parameter Resulcs 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 Re!iults mg/ 1 Parameter Results mg/1
_P&T:GC/MS ~DB __ Methoxychlor
__ Acid:B/N Ext. PCB's ....:::::.0,000/!._ __ T oxaphene
_TOX __ Petroleum _2,4-D
--__ Endrin __ 2,4,5-TP (silvex)
--__ Lindane --
MICROBIOLOGY RADIOCHEMISTRY
Parameter · Parameter Rernltti PCi/ 1
__ (MF) Coliform Colonies/l00mls __ Gross Alpha
__ (MPN) Coliform Colonies/lO0mls __ Gross Beta
----
----
Date Received __ O_C_T--'=2'-'fl..___.198........,_g ..... 61..,L:.::.&:;__ ______ _ Date Reported __________________ _
Date Extracted _.J....,{1""----'--:J..--'-7_-_,?,e__,:9---=i/'--'p'-->..>.,_, J}t:....1-LA-=--------Date Analyzed ~/_0_-~· 3~1J--=-~;?-="7~j/ji.. ......... P ______ _
0 :f'; ') ~ -~ :'.· ._;; ·.), .• ... b .JL ..,_ l!..) Reported By -------------------Lab Number
DIIS 3191 (R~visccd 7/85)
Solid and Hazardous Waste (Review 7187)
N. C. Department of Human Resources
Division of Hi:alth Services SAMPLE ANALYSES REQUEST
Staci: Laboratory of Public Heal1
P. 0 . Box 180~
306 N. Wilmin~on Seri:
Rlllt:i"h, 2761
Site Number --'q'-:3_0_0_0_0_0_/_o __ o_o _ __.__X-'--_ Fidd Sample Number _...,.b'-O----'l/_1.L....-.<CJ__;;_o _______ _
Name of Site __.8._t:'::::;__.,.:c/3__;:._____.L:::;;;:__..Q:......11.:_..J..:....;.f,"-','-'--/_/_____ Site Location /.JJ4 r~ t1.. Co• • A/!h,11, . MC•
Collected By Bohky Lfl\f-fy-ID# OS 9 Date Collected CJ cf 2 $""" ~98'9 Time 'l!vo
Type of Sample:
Environmental
_ yroundwater ( 1)
__ V_ S S•urface Water (2)
__ Soil (3)
__ Other (4)
Concentrate
__ Solid (5)
__ Liquid (6)
__ Sludge (7)
__ Other (8)
Comments
{<,'ch( all\d Cr:e~k -lff51YelJl."'1
INORGANIC CHEMISTRY
Extractables Total
Parameter Result11 mg/ 1 Parameter Rc1mlt11 mg/ I Parameter Re11ults mg/ 1
__ Arsi:nic __ Arsi:nic __ Silvi:r
__ Barium __ Barium __ Sulfates
__ Cadmium __ Cadmium __ Zinc
__ Chromium __ Chloride _Ph
__ Lead __ Chromium __ Conductivity
__ Mercury __ Coppi:r _TDS
__ Sdi:nium __ Fluoride _Toe
__ Silver __ Iron --
--__ Lead --
--__ Manganese -~
--__ Mercury --
--__ Nitrate --
--__ Selenium --
ORGANIC CHEMISTRY
Parameter Result11 mg/ 1 Parameter Results mg/ 1 Parameter Rei;ults mg/1
_P&T:GC/MS ~DB __ Methoxychlor
__ Acid:B/N Ext. PCB's </J ,.POOL __ Toxaphi:ne
_TOX __ Petroleum _2,4-D
--__ Endrin --2,4,5-TP (silvi:x)
--__ Lindane --
MICROBIOLOGY RADIOCHEMISTRY
Parameter Parameter Re11ulti; PCi/ 1
__ (MF) Coliform Colonies/lOOmls __ Gross Alpha
--(MPN) Coliform Colonies/lOOmls __ Gross lkra
--------
Date Received ___ O_C_T_2_B __ 1Q8_g-J.:./-"3;J-'---1 ________ Dare Reported __________________ _
Date Extracted --/ r2~-..;..;L_-_7 _--=?,.....:c";e-. -"V-'p'--~Au_J_,_\ _____ _ J
Reported By
OHS 3191 (Rcvi,;.,d 7185)
SoliJ and Huordoua WHtc (Review 7187)
Date Analyzed _/_0_·....::=·3""-·-....:::~--_,?9e<...-:.._· _-Vj)~--------
0 ."·~ 3,-i: ,_..,,.,,
Lab N umber .. , ·· · .. Jl .. ~,...L
N. C. Dcparcment of Human Resources
Division of Hcalth Serviccs SAMPLE ANALYSES REQUEST
Sea cc Laboratory of Public Heall
P. 0. Box 280'1
306 N. Wilmin1:con Scrc,
Ralcigh, 2761
Site Number -'C/.~:3==---0___:0___:0_0-=--0=--,:_/_0_0_0.::___1,_X~-Fidd Sample Number __ o_o_4-_1.:_f_7_,__ _______ _
N,m, of Sit, E_C /3 b 4 .. J/'.· / I Sit< Location /))4 rr< t1 Co 0 a.f!h ... ' ':f C.
Collected By __;__;:::Bc_o-=b==-b'--1+---'L~"_,_f-bj--#-'7---ID# _0_5_9~-Dace:: Collected tJ cf. ). ~ / i__E!i Time 3 · £
Type of Sample:
Environmental
_ yroundwater ( 1)
~ Surface Water (2)
__ Soil (3)
__ Ocher (4)
Concentrate
__ Solid (5)
__ Liquid (6)
__ Sludge (7)
__ Ocher (8)
Comments g,·c~ fo.J Cv--eet. -Pol,J~~1vea/V\
INORGANIC CHEMISTRY
Extractables Total
Parameter Reliultli mg/ 1 Paramt:ter Rci;ult11 mg/I Paran1ctcr Rci.ult11 mg/ 1
__ Arsenic __ Arsenic __ Silver
__ Barium __ Barium __ Sulfates
__ Cadmium __ Cadmium __ Zinc
__ Chromium __ Chloride _Ph
__ Lead __ Chromium __ Conductivity
__ Mercury __ Copper _TDS
__ Selenium __ Fluoride _TOC
__ Silver __ lron --
--__ Lead --
--__ Manganese ----__ Mercury --
--__ Nitrate --
-·-__ Selenium --
ORGANIC CHEMISTRY
Parameter Resultli mg/1 Parameter Rcliults mg/ 1 Parameter Rei;ulu mg/1
_P&T:GC/MS 7roB __ Mcthoxychlor
__ Acid:B/N Exe. CB's -<:o,ocoL __ Toxaphcne
_TOX __ Petroleum _2,4-D
--__ Endrin --2,4,5-TP (silvcx)
--__ Lindane --
MICROBIOLOGY RADIOCHEMISTRY
Parameter Parameter Rci.ultli PCi/ I
--(MF) Coliform Colonies/lO0mls __ Gross Alpha
--(MPN) Coliform Colonies/ lO0mls __ Gross Bcca
--------
Date Received ___ O_CT_· -2-6 _9J_9~n..::.:ieJ:::....C ______ Dace Reported ______________ _
Date Excracred __._I .... 0:.......:-<>;;;..1
.....:· 7_-~F;_, 7L--Vc.-LP-,J,...,Ai:.l..!..A.!._ ______ Date Analyzed -'-/-=CJ"---'-:~3~(}'--_...,_Y'c....9<-~4-L~---------
Reported By 0 fl: _'l ,..~ -~ ~'.-}
Lab Number ------=--·c...· _. ·'-· _}..::J::..:;·~-··:::.-.::..'-7~---------
DHS 3191 (Revised 7/RS)
Solid and Haiardoua W118te (Review 7 IR?)
State Laboratory of Public Healt N. C. Department of Human Resources
Division of Heulth Services SAMPLE ANALYSES REQUEST P. 0 . Box 2804
306 N. Wilmington Sm1
Raleigh, 2761
Site Number C/300000 / 0 00 X Field Sample Number --=0_0_4'_7,-...;g..,_8=---------
Name of Site _._A_t:'=--,.:....:/3=--,.c:L=---=Qc.....:'1:__:.J"-'.f,=--=,:-L-/_/_____ Site Location /))4 r~ h Co· • A/!fo,,._ • MC•
Bobhy L~f-fy-ID#-=O:::.....cS=-.L.9_ Date Collected t.Jcf :;i,~ /9f9 Time £: 3.o Collected By
Type of Sample:
Environmental
-~round water ( 1)
_lL.., Surface Water (2)
__ Soil (3)
__ Other (4)
Concentrate
__ Solid (5)
__ Liquid (6)
__ Sludge (7)
__ Ocher (8)
Comments
C.c.e ~ -{¥-jv~&t M
' INORGANIC CHEMISTRY
Extractables Total
Parameter Results mg/ 1 Parameter Reliultli mg/ 1 Parameter Rcliultli mg/ 1
__ Arsenic __ Arsenic __ Silver
__ Barium __ Barium __ Sulfates
__ Cadmium __ Cadmium __ Zinc
__ Chromium __ Chloride __ Ph
__ Lead __ Chromium __ Conductivity
__ Mercury __ Coppt:r _TDS
__ Selenium __ fluoride _TOC
__ Silver __ Iron --
--__ Lead --
--__ Manganese --
--__ Mercury --
--__ Nitrate --
--__ Selenium --
ORGANIC CHEMISTRY
Parameter Resultli mg/ I Parameter
_P&T:GC/MS =z1;01J
__ Acid:B/N Ext. CB's
_TOX __ Petroleum
--__ Endrin
--__ Lindane
MICROBIOLOGY
Parameter
--(MF) Coliform Colonies/lO0mls
--( MPN) Coliform Colonies/ lO0mls
----
Dace Received OCT 2 6 1989 IJ;S).
Date Extracted / {)-;L.7--:_~/11J's IJ A
Reported By
DHS 3191 (Ro:vis.-d 7185)
SoliJ anJ HazurdoWI Wustc: (Review 7 IR7)
Rt:liultli mg/ 1 Parameter Reliulti; mg/ 1
__ Methoxychlor
<=o, aooL __ Toxapht:ne
_2,4-D
__ 2,4,5-TP (silvex)
--
RADIOCHEMISTRY
Parameter Reliulcs PCi/ 1
__ Gross Alpha
__ Gross Bera
--
--
Date Reported _________________ _
Dace Analyzed //) -,.. ? 0 -(?I -V-P
O H ':~...., -~ o Lab Number ------=-~-=--'....:.'·-' ·-=--· . ...,.:;.......,. .. _,.2~ .. ________ _
N. C. Department of Human Resources
Division of Health Services SAMPLE ANALYSES REQUEST
State Laboratory of Public Heall
P. 0. Box 280'1
306 N. Wilmini:ton Sere,
Rali:igh, 2761
Site Number ---'CJ.'-~-0_0_0_0_0_/_0--c-0_0 ___ x...c.-.._ Field Sample Number __ .,,,_l)_O_L/----'-7--=8'--]£.--_____ _
Name of Site _L-8_..:=:c-..:-/3::;__-;-LL~4'-,,'-J-'-.f,=-''-'-/_I_____ Si« Lomion Wa. r("!.,, Co 0 cJ/!h,.,_ , IY, C.
Collected By Bohky L 11\f~ ID# --'O=-=S'--'-9_ Dace Collected tJ cf-. ~ > / '/...K_:l Time 1; 2 ~
Type of Sample:
Environmental
_ _,,9roundwater ( 1)
-L Surface Water (2)
__ Soil (3)
__ Other (4)
Concentrate
__ Solid (5)
__ Liquid (6)
__ Sludge (7)
__ Ocher (8)
Commentll
(:("al. pow..,:;+retvV\.
INORGANIC CHEMISTRY
Extractables Total
Parameter Results mg/ l Parameter Rei;ults mg/ l Parameter Re,;ults mg/ l
__ 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/ l Parameter Re,;ult,; mg/ I Parameter Rei;ult,; mg/ l
_P&T:GC/MS yPDB __ Mechoxychlor
__ Acid:B/N Exe. PCB's -<o. oooL __ T oxaphene
_TOX __ Petroleum -2,4-D
--__ Endrin __ 2,4.S-TP (silvex)
--__ Lindane --
MICROBIOLOGY RADIOCHEMISTRY
Parameter Parameter Result11 PCi/ l
--(MF) Coliform Colonies/l00mls __ Gross Alpha
__ (MPN) Coliform Colonies/lO0mls __ Gross Bera
--------
OCT 2 6 1989 3!·1 Date Received --------.o.~..=:..:.._ _______ _ Date Reported __________________ _
Date Extracted _}~,-~_----"17'_-, __ 7_f ............. 1-'J/"'-'-P+, .,_,A-=-,A ______ _ J Date Analyzed __,_/_;0:.;::__-_,,,__,7''-'--0.::__-_,5...!_,_.''/"-.,...-7(;.Jf.J.P ________ _
Reported By
0 ,q ') 4 ,-. ni Lab Number _______ ... _,_·._ .. _• -_>..L_-:·::_·;,~iiJ :__ _______ _
OHS ]191 (Rcvisc,d 7/85)
Solid and Haz11rdoU11 W11oCc: (Review 7187)
I
N. C. Dc:parcmc:nt of Human Resources
Division of Health Services SAMPLE ANALYSES REQUEST
State: Laboratory of Public Heali
P. 0. Box 2801
306 N. Wilmin1,'ton Sere:,
Raleigh, 2761
Site Number
Name of Site
Collected By
C/300000 / 0 00 X Field Sample Number __ D_O lf_,__7.t......::.fe....::c{, _____ _ ec 13 L Q ~ J .f,. I I Site Location lt}4 rre h Co. . A./fr,H. . t-1. C.
Bohky L"'+-h/-IDll _.ccO_S=-----9-Date Collc:ctt:d Clef-. .;ts 198:9 Time l; .'ot>
Type of Sample:
Environmental
___ Groundwater (1)
___ Surface: Water (2)
~oil (3)
__ Other (4)
Concentrate
__ Solid (5)
__ Liquid (6)
__ Sludge (7)
__ Other (8)
Comments
If'.· eb 1~J ev-('.'_:e l · &,?~ f<A-\
INORGANIC CHEMISTRY
Extractables Total
Parameter Results mg/ l Parameter Rc:11ultt1 mg/ I Parameter Result11 mg/ I
__ Arsenic __ Arsenic __ Silvc:r
__ Barium __ Barium __ Sulfates
__ Cadmium __ Cadmium __ Zinc
__ Chromium __ Chloride _Ph
__ Lead __ Chromium __ Conductivity
__ Mercury __ Copper _TDS
__ Sdc:nium __ Fluoride _TOC
__ Silver __ Iron --
--__ Lead --
--__ Manganese --
--__ Mercury --
--__ Nitrate --
--__ Selenium --
ORGANIC CHEMISTRY
Parameter Results mg/ l Parameter Re11ult11 mg/ l Parameter Results mg/ l
_P&T:GC/MS 7PDB __ Mcthoxychlor
__ Acid:8/N Ext. CB's --::-0 i LO .pD.✓11\.. __ Toxaphc:ne
_TOX __ Petroleum
}
_2,4-D
--__ Endrin --2,4,5-TP (silvex)
--__ Lindane --
MICROBIOLOGY RADIOCHEMISTRY
Parameter Parameter lle1iult11 PCi/ 1
__ (MF) Coliform Colonies/lO0mls __ Gross Alpha
__ (MPN) Coliform Colonies/lO0mls __ Gross Bera
----
----
Dace Received OCT 2 8 'QRQ ol-Q_ Date Reported __________________ _
Date Extracted / U ·· .2.,/./ -ff 131) Dace: Analyzed JO-3tJ -j'9 7/P
Reported By Lab Number
DHS 3191 (R~vi~d 7185)
Solid and Hazurdoua W11~t,: (Review 7187)
I
N. C. Department of Human Resources
Division of Health Services SAMPLE ANALYSES REQUEST
State Laboratory of Public Heall
P. 0 . Box 2804
306 N. Wilmini,:ton Strc,
Ralci~h, 2761
Site Number ---'C/.~:3=-O--=-0_0=---:0~0;__;_/_0_0_0,;__---1.X--=--Field Sample Number __ _,.Q_o_4-_1_q......:./ ______ _
Name of Site _L,_8__:::::;c?-,-:--/3;:;.._-,...c;L=.......:tt;....,'l;_d-'-'~a._;l:....,&· /_I_____ Site Location Lua r~ n Co. i A/1-r,.., ~ t-1. c.
Bobh~ ID# 0S9 DateCollected Clef: .J..~ /'J_R!ZTime 3,'o£" Collected By
Type of Sample:
Environmental
___ Groundwater ( 1)
v!surface Water (2)
Soil (3)
__ Other (4)
Concentrate
__ Solid (5)
__ Liquid (6)
__ Sludge (7)
__ Other (8)
Comments
R:e,h(cv1d Cre.d<-~w"' s-\-ye.a.,v,
INORGANIC CHEMISTRY
Extractables
Parameter Results mg/ l
__ 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/ 1 OOmls
----
Date Received OCT 2 6 1989 ,$/)
Date Extracted /0 -·,2 & -,f ~ 1$1.D
Reported By
OHS 3191 (Rcvist"d 7185)
Solid and Haiardou• WHtc (Review 7187)
Total
Paramt:ter Re1mlti; mg/1 Parameter Rei;ults mg/ 1
__ Arsenic __ Silver
__ Barium __ Sulfates
__ Cadmium __ Zinc
__ Chloride _Ph
__ Chromium __ Conductivity
__ Copper _TDS
__ Fluoride _Toe
__ Iron --__ Lead --
__ Manganese --__ Mercury --
__ Nitrate --
__ Selenium --
ORGANIC CHEMISTRY
Parameter Resulci; mg/ 1 Parameter Results mg/ l
yPDB __ Methoxychlor
CB's -< at La Pf-cl. __ Toxaphenc
__ Petroleum -2,4-D
__ Endrin --2,4,5-TP (silvex)
__ Lindane --
RADIOCHEMISTRY
Parameter Rei;ulci; PCi/ l
__ Gross Alpha
__ Gross Beta
--
--
Date Reported _________________ _
Date Analyzed / U -3 O-?9 1/t?
oq,,4 •>0 Lab Number _____ .... _,_._· _· _.l _.A_ •. _,_u.:::....,~--------
I
N. C. Department of Human Resources
-Division of Health Services SAMPLE ANALYSES REQUEST
State Laboratory of Public Heah
P. 0. Box 2804
306 N. Wilmington Sm:,
Raleigh, 2761
Site Number __,C/.'-:3,::._O_0_0_0_0..::.-/'---0_0_0_--'-x--'--_ Field Sample Number _ _,.(J"-0!<--'f:.........L.7_.q,_~-'---------
Name of Site _,_/4_c'=--,=--.:/3=--eLL=-.c..::ct'---',,=-=J:....:.f,,...,,~-/-/_____ Si« Lomion /,Lia, rCT_ h _Co! clf!h,.._ , _I½ C •
Collected By Bohby L "'f-bj--ID# _O~S'---L.-9_ Date Collected tJ cf-. 2$' / tE.2 Time .5 ' 3.<>
Type of Sample:
Environmental
___ Groundwater ( 1)
_ ~rface Water (2) __ v_ S C:Aoil ( 3)
__ Other (4)
Concentrate
__ Solid (5)
__ Liquid (6)
__ Sludge (7)
__ Other (8)
Comment11
~ ( ~ {'._ k:,. -u r.s+r ~ IV\
INORGANIC CHEMISTRY
Extractable& Total
Parameter Re11ult11 mg/1 Parameter Re11ulc11 mg/ l Parameter Rei;ults mg/ l
__ Arsenic __ Arsenic __ Silvc:r
__ 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 Rei;ulti; mg/ 1 Parameter Results mg/ 1
_ P&. T:GC/MS 7PDB __ Mcthoxychlor
__ Acid:B/N Ext. CB's -=::r1 . In n o /V\ __ T oxaphc:ne
_TOX __ Petroleum ---, ,
_2,4-0
--__ Endrin __ 2,4,5-TP (silvcx)
--__ Lindane --
MICROBIOLOGY RADIOCHEMISTRY
Parameter Parameter Reliultli PCi/ 1
--(MF) Coliform Colonies/lO0mls __ Gross Alpha
__ (MPN) Coliform Colonies/l00mls __ Gross Ikea
--------
Date Received ___ o_c_r_2_6_1989__.:,__.M~:..c:· ______ _ Date Reported __________________ _
Date Extracted /0 · 2~ -)?J 6JY1 Date Analyzed /{} -3 O-Z--CJ-,Vp
Reported By Lab Number
OHS 3191 (Revised 7185)
Solid ,md Harnrdol.li WH1e (Review 7187)
N. C. Department of Human Resources
Division of Health Services SAMPLE ANALYSES REQUEST
Scace Laboratory of Public Healc
P. 0. Box 2804
306 N. Wilmin~con Scree
Rald~h, 2761
Site Number ~C/.,_:.3=----O_0_o_o_o..::;__/_o_o_o_--L-X-::..-_ Fidd Sample Number _ _.D.c....~_c./-_7_~-=3 _______ _
Name of Site ec 13 LQ.,,J-f,/1 Site Location Wa.r~n Co. i A-1611-, r/.C.
Bobh'/ L~+-bj ID#-=-0-=5~9'---Date Collected _C'.--=--c-f.~-~~-=~'---~/9.R:1 Time 3: 25' Collected By
Type of Sample:
Environmental Comments
___ Groundwater ( 1)
_ yrface Water (2)
-.lL'soil (3)
Concentrate
__ Solid (5) C "<. <:, k:, ---Po~ sh~"'-IV\
__ Other (4)
__ Liquid (6)
__ Sludge (7) .Q,,((1.1\1\ S<J; (':\t,V\t S'"'-7(-c..,
__ Other (8)
INORGANIC CHEMISTRY
Extractables Total
Parameter Results mg/ 1 Parameter Rci;ulti; 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 Result11 mg/ 1 Parameter Resultli mg/ 1 Parameter
_P&T:GC/MS yPDB __ Methoxychlor
__ Acid:B/N Ext. PCli's -<::a~ LO 12 Ot'VI. '-Toxaphene
_TOX __ Petroleum 7 1 _2,4-D
--__ Endrin __ 2,4,5-TP (silvex)
--__ Lindane --
MICROBIOLOGY RADIOCHEMISTRY
Rcliulti; mg/ 1
Results mg/1
Parameter Parameter Rernlti; PCi/ I
__ (MF) Coliform Colonies/lO0mls
--(MPN) Coliform Colonies/l00mls
----
Date Received __ O_C_T_2_6_~---=-(2""' _ _..,~:;.._-------
Date Extracted / O -,2jp -)19 ,lq &
Reported By
OHS Jl9l (Revised 7185)
Solid und Hauirdoua WHtc (Review 7187)
__ Gross Alpha
__ Gross Beta
--
--
Date Reported __________________ _
Dace Analyzed J0-30-?'91/P
Lab Number
N. C. Deparcment of Human Resources
Division of Health Services SAMPLE ANALYSES REQUEST
State Laboratory of Public Health
P. 0 . Box 28047
306 N. Wilmington Screec
Raleigh, 27611
Site Number ---'CJ.'-:3_0_0_0_0_0_/_o_o_o _ __..X--=--Field Sample Number ---=o~o_'+~7~8&=---------
Name of Site __,8.__t:'=-.:/3~--::-1L=-Q=-"'.;-J..:....;A::.....:..L· /_/_____ Site Location /pg r(!! h Co• ' A.//-,,,,,._ . #. C •
Collected By Bohky Lfl\f-hj ID# __;0=-=5~9-Date Collected Clef. .:i,> tiiin::f: 3.o
Type of Sample:
Environmental
-~round water ( 1)
_JL__ Surface Water (2)
__ Soil (3)
__ Other (4)
Concentrate
__ Solid (5)
__ Liquid (6)
__ Sludge (7)
__ Other (8)
INORGANIC CHEMISTRY
Extractable&
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 7PDB __ Acid:B/N Ext. PCB's <=o{. t:JooL
_TOX __ Petroleum
--__ Endrin
--__ Lindane
MICROBIOLOGY
Total
Parameter Results mg/ 1
__ Silver
__ Sulfates
__ Zinc
_Ph
__ Conductivity
_TDS
_Toe
--
------
--
--
Parameter Results mg/ 1
__ Methoxychlor
__ Toxaphene
_2,4-D
__ 2,4,5-TP (silvex)
--
RADIOCHEMISTRY
Parameter Parameter Results PCi/1
__ (MF) Coliform Colonies/lO0mls __ Gross Alpha
__ (MPN) Coliform Colonies/l00mls __ Gross Beta
--------
Date Received ____ O_C_T_2_6 __ Q39_--"'tJ""'~=--------Date Reported _________________ _
Date Extracted _l_o~-;L ___ 7__.~ ......... ~-~ .................. , ..... A_,__,_A,__ ______ Date Analyzed 10 -30 -8'f:1(p
Reported By Lab Number 90-3119
OHS 3191 (Revised 7185)
Solid and Hazardous Waste (Review 7187)
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/.'--~-o_o_o_o_o;__/_o_o_o _ __._X_;:..__ Field Sample Number -----'~..__o_lf_7:....;l=:....j--i---------
Name of Site ec 13 L 4,, J .f,. // Site Location Lua rre n Co. . .cJ.../-1,,H.. . MC.
Collected By -=B=-o----'b=::....:_h_,.y_L=--="'-'-f-fr-_,_~_ ID#----'0==-=5:.....L...9_ Date Collected tJcf. ~> /fg~ 3; 2,5'
Type of Sample:
Environmental
_ _,.9 roundwater ( 1)
~ Surface Water (2)
__ Soil (3)
__ Other (4)
Concentrate
__ Solid (5)
__ Liquid (6)
__ Sludge (7)
__ Other (8)
Comments
C.:(·u l 'Pee,..,.., ~-J.rUJV\.
INORGANIC CHEMISTRY
Extractables Total
Parameter Results mg/ l Parameter Results mg/ l 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/ l Parameter Results mg/ l Parameter Results mg/ l
_P&T:GC/MS yPDB __ Methoxychlor
__ Acid:B/N Ext. PCB's <0, 0OC'l. __ Toxaphene
_TOX __ Petroleum -2,4-D
--__ Endrin __ 2,4.S-TP (silvex)
--__ Lindane --
MICROBIOLOGY RADIOCHEMISTRY
Parameter Parameter Results PCi/ l
__ (MF) Coliform Colonies/lO0mls __ Gross Alpha
__ (MPN) Coliform Colonies/lOOmls __ Gross Beta
----
----
OCT 2 6 1989 ~n
Date Received --------""~=---------Date Reported __________________ _
Date Extracted ....,..._.J , .... 1_--_.~'-/;..:..7_~ .......... ...:.i...'1-'-VL....:...7;-+, ..._A....,,,A _______ Date Analyzed -.<..1....:·o:::...._-.a3.........:;o _-,w%9c....'L· _X.x....LP _______ _
LbN b S031 ?,·0 a um er ...., ~ Reported By
OHS 3191 (Revised 7185)
Solid and Hazardous Waste (Review 7187)
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/300000 IO 00 )( Field Sample Number __ o_o...,Ltf_7L..,;K=---''---------
Name of Site ____.8L.-..;~=---,:/3-=---,-,L=-=-Q=---'1.:....:J:=.....,A~· L...;..I_____ Site Location /µg rre n Co. · A_./,h,H.. . u. c.
Collected By Bohby L"'f-h/ ID# _____,O=-=S~9-Date Collected Clef. ~~ tiiin:: i; .'ot>
Type of Sample:
Environmental
___ Groundwater ( 1)
___ Surface Water (2)
--6oil (3)
__ Other (4)
Concentrate
__ Solid (5)
__ Liquid (6)
__ Sludge (7)
__ Other (8)
Comments
If,· eh /g,.,.J ~e-c k. -Up~-.~
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 <0,. LO ;p,am. __ Toxaphene
_TQX __ 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 OCT 2 8 1'-'BQ 8fJ Date Reported __________________ _
Date Extracted /() ··Zb-S'f 13£) Date Analyzed JO-3tJ -3'91/P
Reported By Q.0?.111-"1 Lab Number ______ ... .:.."-~--,_ • ...,,_.A._ ..... _, _______ _
OHS 3191 (Revised 7185)
Solid and Hazardous Waste (Review 7187)
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_0~0=----=0;__;__/_0_0_0_-..Lx__:_._ Field Sample Number __ _.0'-0"--4-_1_q-'-'-/ ______ _
Name of Site ec 13 L Q.,, J/!,· / I Site Location /).)a rre n Co. · A_./1,,'1, . .Al. c.
Collected By --'B_o_h=c.....;_l,-1-1-L....;;;...._;"'_,_f-bj--4-'11---ID# -----'O"--=S'--9.,,__ Date Collected CJ cf. ~£ / iiiTime 3: 0 5"'
Type of Sample:
Environmental
___ Groundwater ( 1)
-,Jurface Water (2)
~ Soil (3)
__ Other (4)
Concentrate
__ Solid (5)
__ Liquid (6)
__ Sludge (7)
__ Other (8)
Comments
R:ci-l(ari d Cre.e-\<-D,w~ sh~..vi
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/I
_P&T:GC/MS =z;DB __ Methoxychlor
__ Acid:B/N Ext. PCB's ~ n , I 11 rmw1. __ Toxaphene
_TOX __ Petroleum T 7 _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 OCT 2 6 S89 R,/J-Date Reported __________________ _
Date Extracted /0 ··,).,bJ-%~ ;81.D Date Analyzed _,...::o:;__,:,-do£.....:O::....-----=.f9__.__v'P..L...,1 _______ _
Reported By -----------------Lab Number _____ ~_:._O_,J_1_2_2.;__ _______ _
DHS 3191 (Revised 7/85)
Solid and Hazardous Waste (Review 7 /87)
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~O_0_0_0__::;0--'-l_o-,,..o_o_--Lx-=--Field Sample Number _.....,0._0=--'-1-_7_.__._q_~ _______ _
:Name of Site ____.8L--t:'=---=-'S...:::;___.,.,L=-4=--,,.:....:J::....;A:......:...L· /_/_____ Site Location /).}g rre n Co. , .c:J.../1,,H. . MC.
Collected By Bohky L &\f~ ID# --'0=-=5~9-Date Collected tJ cf. 2$ J iii-r:: 3 ~ 3<>
Type of Sample:
Environmental
~ Groundwater ( 1)
_ _,,§µrface Water (2) __ v_ S C:r.oil ( 3)
__ Other (4)
Concentrate
__ Solid (5)
__ Liquid (6)
__ Sludge (7)
__ Other (8)
Comments
(: f ~ <. ~ -l,J'(?S11' u.. IV\
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 7PDB __ Methoxychlor
__ Acid:B/N Ext. PCB's <",,.., • I n ,, ,., JI/\ Toxaphene
_TOX __ Petroleum I t _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
--------
Date Received OCT 2 6 1989 M Date Reported __________________ _
Date Extracted / 0 · .2.h -!l-9 6'.IJ Date Analyzed Jo -3 o-8"o/--VP
Reported By QQ'>"' '>3 LbN b -·~i ~ -------------------a um er __________________ _
DHS 3191 (Revised 7185)
Solid and Hazardous Waste (Review 7187)
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_0_0_/_0_0_0_---'x_;:__ Field Sample Number _ __.,f)'-c,_c./-_1_1.::..3 _______ _
Name of Site ec 13 L Q.,, J /!,·/I Site Location /))a. rre,,, Co. · A..tfo... . u. c.
Collected By Bohky L"'f"o/ ID#---'O=-=S::........L...9_ Date Collected tJcr. ~~ iiiir:: 3: 2-,S::
Type of Sample:
Environmental Concentrate
__ Solid (5)
__ Liquid (6)
Comments
cl("(.(, t ..-j)c,<AOV\S1:!~ "-N\ ___ Groundwater ( 1)
_ _Jµrface Water (2)
---!L' Soil (3)
__ Other (4)
__ Sludge (7) >M~ $<.J; f'\C,,V\:\:: .S~f-<:,,
__ 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 Parameter
_P&T:GC/MS yPDB __ Acid:B/N Ext. PCB's
_TOX __ Petroleum
--__ Endrin
--__ Lindane
MICROBIOLOGY
Parameter
__ (MF) Coliform Colonies/l00mls
__ (MPN) Coliform Colonies/l00mls
--
--
Date Received __ O_C_T_2_6 __ ~___,_..,.6,&=--------
Date Extracted / 0 ·-..2.d:, -ff 9 /1 &
Reported By
OHS 3191 (Revised 7185)
Solid and Hazardous Waste (Review 7187)
Results mg/ 1 Parameter Results mg/ 1
__ Methoxychlor
<"" I/J -nni'VI .___ Toxaphene I I _2,4-D
__ 2,4,5-TP (silvex)
--
RADIOCHEMISTRY
Parameter Results PCi/ 1
__ Gross Alpha
__ Gross Beta
--
--
Date Reported __________________ _
Date Analyzed -L.L~O--_.,Pr-:J .... ~o~-JK"Z~:......._,.::V'---L.P _______ _
Lab Number S03124
l.o('.tl it>n o f Sampling:
N. C. DEPARTMENT OF HUMAN RESOURCES
DIVISION OF HEALTH SERVICES
SOLID AND HAZARDOUS WASTE MANAGEMENT BRANCH
Ch ain of Custody Record
Hazardous Wa ste Materia l s
Ge ne rator __ Transpor LL'r Tr('almt•nl J,';1cility
__ Stora ge Facility
Othe r:
__ Disposa l Facility V La ndfill
Cnmp;rny Is Name pc g L"-V'\d~' I Telephone ( ) --1-------'----""-'----'--'------------------
Address W°'rr~"' C.o\A.V\.:\.y
Co ll ect or's Name ~ob~ ~".\-Cu
sign~
1);1 l l' Sampled O C. T• ;;)..S' 1 f '18 't , Time Sample d _________ _
Type of Process Gen era ting Wa ste f'C 8 '-4,""J.{!,•f / ---~-----=----------------
fi e ld Info rma tion
ula-/er JI. ,..p le s
Fi e ld Sample No . oo<l7tZ-oo c/-783 Do'l7l'f IJ0'/-78.r ----
Dt>Y-7'1 o (Jt>c./-1i7 oo'l-7~1 oo'Plr'j
Ch ;il n uf Po s s ession:
,. ~ !i!/:;p ~ ~-1~lfu:L2 i'!
{j)~J-J d}.vfJtuJ'-~£ 16 ·-2&-t9
signatur e title i nclusi ve da t es
signature title inclus ive da t es
Rl'SU I t s rti ported
s i gn,lture t itle d:i t c
Instruc tions : Compl e t e all applicable informa tion including s i gna tures , a nd
s ubmit with analysis request forms.
N. C. DEPARTMENT OF HUMAN RESOURCES
DIVISION OF HEALTH SERVICES
SOLID AND HAZARDOUS WASTE MANAGEMENT BRANCH
Receipt for Samples
The-1;,111,ples described below were collected in connection with the administration,
cnforc1:•ment, and documentation of the:
( ) North Carolina Ha zardous Waste Management Rules, 10 NCAC ]OF
(.,(°'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. §2601, et~-• specifically
Section 11 of TSCA, 15 U.S.C. § 2610.
~nspector's Name
Name of Firm
Firm Owner, Operator, or Agent
--·--
(' ,) i\M l'L E COLLECTED SAMPLE TYPE
N UMBl-:P. DATE TIME WATER SOIL
--------1---
--
..
.
l{(•cl'ipl for the sample(s) described
:1liov e is hereby acknowledged:
Signature of Inspector
COMMENTS
OTHER
Inspector's Address
Firm Address
Title
I DUPLICATE SAMPLES SAMPLE LOCATION
OFFERED ACCEPTED REJECTED ON-SITE OFF-SITE
Receipt/rejection of duplicate or split
samples is hereby acknowledged:
Signature of Firm Owner, Operator, or Agent
Title
----·--··---------------------------------------------
1.,w.il ion of Sampling:
N. C. DEPARTMENT OF HUMAN RESOURCES
DIVISION OF HEALTH SERVICES
SOLID AND HAZARDOUS WASTE MANAGEMENT BRANCH
Chain of Custody Record
Hazardous Waste Materials
Generator
__ Storage Facility
Other:
__ TransporLl'r
__ Disposal Facility
Tr(':ltmenl (.';1(· il ily
~ndfill
-------------------------
Cllrnp,111y 's Name _ __,pc~--'B_· __ l_a~ .. "'\_J_ff~l_f _______ Telephone ( ___ ) _______ _
Add ress __ ___,wa.-~.....a.-(i_f_e_a,,....a......_a,_~l,.----"'-tr_.,.---------------------
Name ~o""r . Lwf~ Collector's
signatu~
Telephone ( 1tf ) 7~3-~ 9 2...
1);1 t l' Sampled ._O,...__;c::::..:;;...f_. __ ~~s_,_. --=-l -"9-~__._9 ____ Time Sampled _______ _
Type of Process Generating Waste Pc B L4"✓..f;-/I ----------~~-------------
field Information
Field Sample No.OO'flt(, (J0'/-7/1 oo'l-7f2.. 1/0'17'/$
Ch;ii n of Possession:
I.
---'--~-. ~~--'---ilsi -apr-e --~t "{iJ..
__&!_~---~ /4 ~✓
signature title inclusive cfates
signature title inclusive dates
Rl'sulls r('ported
sig1rnture title date
lnstr11cLions: Complete all applicable information including signatures, and
submit with analysis request forms.
N. C. DEPARTMENT OF HUMAN RESOURCES
DIVISION OF HEALTH SERVICES
SOLID AND HAZARDOUS WASTE MANAGEMENT BRANCH
Receipt for Samples
The• i;,111,p I es described below were collected in connection with the ;:i.dminist rntinn,
cnforcl'ment, ,1nd documentation of the:
( ) North Carolina Hazardous Waste Management Rules, 10 NCAC lOF
( ) North CaroUn.1 Solid Waste' Management Rules, 10 NCAC lOG
( Comprehensive Environmental Response, Compensation and Liability Act (CERCLA)
( ) Toxic Substances Control Act (TSCA) 15 U.S.C. §2601, ~ ~-, specifically
Section 11 of TSCA, 15 U.S.C. § 2610.
Inspector's N.1me
N.ime of Firm
Firm Owner, Operator, or Agent
------,.
,) AMPLL COLLECTED SAMPLE TYPE
N UMBER DATE TIME WATER SOIL
---------
----
•·
---
•..
-
Rf'c(:ipt for thP sample(s) de_scribed
:i!HJVL' is hereby acknowledged:
Signnture of Inspector
Tit I(•
COMMENTS
OTHER
Inspector's Address
Firm Address
Title
I DUPLICATE SAMPLES SAMPLE LOCATION
OFFERED ACCEPTED REJECTED ON-SITE OFF-SITE
-
Receipt/rejection of duplicate or split
samples is he reby acknowledged:
Signature of Firm Owner, Operator, or Agent
Title
------··---------------------------------------------
:;.,11<1 ,\ llaz;1rdo11s \.la ste
Statt: Laboratory of Public Heal. N. C. D.::partment of Human Resourc1:s
Division of Hc:o.lth Servicc:s SAMPLE AN AL YSES REQUEST P. 0 . Box 280'1
306 N. Wilmin~ton Sm:,
R11leigh, 2761
Site Number C/300000 / 0 00 )( Field Sample Number __ O_D___._l/;_1_8_~ ______ _
Name of Site _,_8_r:.=-,.c-.:/3=--____cL=-::4c.....:l'l:..__;_J:.....:.f,:.....:,~· /_I_____ Site Location Wa r~ h Co. i Alb11-i cl. C. Bobh~ ID#~O_S~9-Datc:Collected tlcf-. ;;.t' /9.R.2T1me ;i.:£17 Collected By
Type: of Sample::
Env7'mental
_L Groundwater ( 1)
Concentrate
__ Solid (5)
Commenti;
I · __ Surface Water (2) __ . _ Liquid (6)
__ Soil (3) __ Sludge: (7)
__ Other (4) __ Ocher (8)
INORGANIC CHEMISTRY
Extractable11 Total
Parameter Re11ult11 mg/ 1 Parameter Rei;ulc11 mg/ l Parameter Rei;ultll mg/ 1
__ Arsenic __ Arsenic __ Silver __ Barium __ Barium __ Sulfa tes __ Cadmium __ Cadmium __ Zinc __ Chromium __ Chloride _Ph __ Lead __ Chromium __ Conductivity __ Mc:rcury __ Copper _TDS __ Selt:nium __ Fluoride _TOC __ Silver __ Iron ----__ Lead ----__ Manganese ----__ Mercury ----__ Nitrate ----__ Selenium --
ORGANIC CHEMISTRY
Parameter Rellults mg/ 1 Parameter
_P&T:GC/MS ?PDB __ Acid:B/N Ext. CB's
_TOX __ Petroleum
--__ Endrin
--__ Lindane
MICROBIOLOGY
Parameter
__ (MF) Coliform Colonies/lO0mls
__ (MPN) Coliform Colonies/lO0mls
--
--
'
hte Received _o..;;..c·_r -=2::....:.G_...]98,u.9~/2~B:__ __ _:U:..:::C..!..T-.fL2..L6L..J:~AAl--
>ate farracce~ 7;1!-yp L-
eported By 11/, ~
iS 119l(R.,i,~/~: fff(} 31? 0 liJ anJ Harnrdou,; Wa~te (Rcvi~w 7 I R7) ...:> -
Rci;ulti; mg/ 1 Parameter Rei;uh1, mg/1
__ Mcthoxychlor -<o .ooo/ __ T oxaphcne
_2,4-D
--2,4,5-TP (silwx)
--
RADIOCHEMISTRY
Paramdcr Resulci; PCi/ 1
__ Gross Al pha
__ Gross Beta
--
--
Date Reported --L..1 .... 0"----'-'3-'-1 _·----'S~r-------------
Date Analyzc:d -L~0~-~3~~0_---'i(~f___.:1/P'---'---------
() / !. ,-~ •• , -4 ,,, ; Lab Number .._,·,.'·-~.i: ...... )