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HomeMy WebLinkAboutNCD980602163_19901114_Warren County PCB Landfill_SERB C_Field Sample Anlysis, Mar - Oct 1990-OCRN. C. Department of Human Reaourcea OMalon of Health Servlcea SAMPLE ANALYSES REQUEST State Laboratory of Public Health P. 0. Box 28047 306 N. Wilmin"con Scrccc Rale111h, 27611 Site Number Yi -. Field Sample Number -eo~ .... 'f:...;iw..J,'a"-12-=---------- Name of Site f. C. B, l ANO ft LL-Site Location 4 ,/{d2 f' 4,r70N Collected By J...tq"F 71JJZP,t1~~ 5 ID/I ~ Date Collected -~./i ... '2~--'.2=5'_,_]_9;;_,jo_, __ Time _Q ___ : ___ 3....,-> ____ _ Type of Sample: · -r- Env~nmental -f,L__ Groundwater ( 1) ___ Surface Water (2) __ Soil (3) Concentr.ate __ Solid (5) __ Liquid (6) __ Slud"c ( 7) __ Other (8) M c.,., :JJ. I __ Other (4) Extractable• Parameter __ Arsenic __ Darium __ Cadmium __ Chromium __ Lead __ Mercury __ Selenium __ Silver Parameter __ P&. T:GC/MS __ Acid:B/N Exe. _TOX ---- Parameter Re,ulu mail 1 Rc,ulta mK/ 1 MICROBIOLOGY __ ( MF) Coliform Colonie,;/ lOOmls --CMPN) Coliform Colonies/lOOmls INORGANIC CHEMISTRY Parameter __ Arsenic __ Darium __ Cadmium __ Chloride __ Chromium __ Copper __ fluoriJe __ lron __ Lead __ Manganese __ Mercury __ Nitrate __ Selenium Re11ult11 mg/ 1 ORGANIC CHEMISTRY Parameter ~B D's __ Petroleum __ Endrin __ Lindane Re11uh.11 mK/1 <o,.ooo[ Parameter __ Gross Alpha __ Gross Beta Comment• Total __ Silver __ Sulfates __ Zinc __ Ph __ Conductivity _TDS _Toe Parameter __ Metho!_Cychlor __ Toxaphene _2,4.0 __ 2,4,S•TP (silvcx) -- RADIOCHEMISTRY Dare Reported //-/ f -9 J' Date Analyzed )0-30 -to YP Reliultli mi:/ I Lab Number _____ ...;;S..,·_Q __ .. ~.;;.;'...;Q;:;..;.;~=-!>8=-------- Y/ I I .. N. C. Department o( Human Rcaourcca Dlv!.lon o( Health Service. SAMPLE ANALYSES REQUEST State: Laboratory o( Public Hc:.&lch P. 0. Box 28047 306 N. WilminKton Sm:c:c Ralc:illh, 27611 Site Number t5 -, Field Sample Number _ __,fJQ-. .... lj:.,._.e,...._.f,_3...._ ______ _ Name of Site /?. C, B, L A,yt) fr LL---Site Location -ft ,/'fJ tf' ,d,E7QN Collected By J...l4TF)/fnP#~~5 ID/I~ Date Collected -,"-'/~i..:;---..:..2::;.;;~;:;__']~9111:.D __ Time l:2..·<-17 Type of Sample: · ~ Envir~mental _JL_ Groundwater (1) ___ Surface Water (2) __ Soil (3) __ Other (4) Concentr.,&te __ Solid (5) __ Liquid (6) __ Sludiic (7) __ Other (8) INORGANIC CHEMISTRY Extractable, Paramecer Rc1ulu m.i/ 1 __ Arsenic __ Barium __ Cadmium __ Chromium __ Lead __ Mercury __ Selenium __ Silver ---------- Parameter Re1ulta mail 1 _P&T:GC/MS __ Acid:B/N Ext. _TOX ---- MICROBIOLOGY Parameter __ (MF) Coliform Colonies/ lOOmls __ (MPN) Coliform Colonies/lOOmls Parameter Re11ulc11 mg/ 1 __ Arsenic __ Barium __ Cadmium __ Chloride __ Chromium __ Copper __ Fluoride __ Iron __ Lead __ Manganese __ Mercury __ Nitrate __ Selenium ORGANIC CHEMISTRY Parameter ~ll ll's __ Petroleum __ Endrin __ Lindane Rc11ulc. mg/1 -c.::-ol oooL Parameter __ Gross Alpha __ Gross Ikea . Comment• Total Parameter Re11ulc11 mg/1 __ Silver __ Sulfates __ Zinc __ Ph __ Conductivity _TDS _TOC ------------ Parameter Reliultli mi:/ 1 __ Metho?CYchlor __ Toxaphene _2,4.0 --2,4,S•TP (silvcx) -- RADIOCHEMISTRY Re11ultli PCi/ 1 Date Received /O-¢ fe -'Z O j/p Date Reported ________________ _ Date Extracted /0-90-'f tJ--v&,t,!lJ Date Analyzed _,,/,~(J~-3""-IIO,:..,_-...c;9c..:i0,:;._1/PL£,. _______ _ o o r~o .... >9 Reported By ------------------Lab Number _____ ,_-_.,_,-..,_,, __ i<._, _________ _ f111 S JJC)J (Rtviw:<17185) f' I : I ' N. C. Department of Human Rcaourcca DM1lon o( Heahh Servlcca SAMPLE ANALYSES REQUEST State Laboratory of Public Hc;alth P. 0 . Box 28047 306 N. Wilmin11ton Street Ralci!lh, 27611 Slte Number y@ -, Field Sample Number --"'0_0-..'f:_,S__,'6"-+f--------- Namc of Site /?. C. B, L A,yt) Fr l. '-Site Location .J$ /t,f,) ( 4,E70N Collected By '-~TF 1;/~ft1! I'll~~ :i ID/I 05£Lp~ Date Collected /Cl-.1 ~ J 9Q Time /,;/: 'I /J Type of Sample: · ~ Environmental __ ifl_ Groundwater (1) ___ Surface Water (2) __ Soil (3) __ Other (4) Concentr.ate __ Solid (5) __ Liquid (6) __ Sludge (7) __ Other (8) Comment• kt w tt3 INORGANIC CHEMISTRY Extractable1 Parameter Rc1ulu mii/ 1 __ Arsenic __ Barium __ Cadmium __ Chromium __ Lead __ Mercury __ Selenium __ Silver ---------- Parameter Re1ulta mii/ 1 _P&T:GC/MS __ Acid:B/N Ext. -TOX ---- MICROBIOLOGY Parameter __ (MF) Coliform Colonies/lOOmls __ (MPN) Coliform Colonies/lOOmls Date Received Jt:)-~t:.,-f O 1/P Date Extracted /O-:J Q-9o:u2} NiJJ Reported By f'\IISJl<>I (Rrvi~,17/8'i) f• I: f ·, ,r l ,,,. 1¥1 .• -, 'l,.ui .. ,.,.,/f,t?) Tot.al Pllrameter Re,iult11 mg/1 Parameter Re1ult11 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 ~D B's __ Petroleum __ Endrin __ Lindane Rc11uhM m.:/ 1 <o .,ooot,_ Parameter __ Gross Alpha __ Gross Ikea Par.ameter Rc11,ulti; mi:/ I --Methoicvchlor __ Toxaphene -2,4-D --2,4,5-TP (silvex) -- RADIOCHEMISTRY Re1ult• PCi/ I Date Reported _________________ _ Date Analyzed _/2c...;'0:::;,__-.,.3~'0--..... ~~'0---&U~'P~-------- ,,..,.nr""110, "::10 Lab Number ':;:h . .t t O Q.:, I N. C. Department of Human Rcaourca . Dlvlalon of Health Servlcea SAMPLE ANALYSES REQUEST State: Laboratory of Public Hc:alch P. 0. Box 28047 306 N. Wilminiicon Street Ralc:iKh, 27611 Site Number Yi -, Field Sample Number _,_$ .... D_~-~-Q_S _______ _ Name of Site /?. C, B, L A!':1) Ff L L-Site Location 4 /'fJ tf J 4E7QN CollectedBy J..«TF/liJ'Z/'#~~5 IDII05Y,/4•z._ OateCollected ,/()--.15' 9D Time Type of Sample: / Environmental _L_' Groundwater ( 1) __ Surface Water (2) __ Soil (3) __ Other (4) Concentr.ate __ Solid (5) __ Liquid (6) __ Sludge (7) __ Other (8) INORGANIC CHEMISTRY Extractable• Parameter Reaulu m1i/ l Parameter Re8ult11 mg/ l __ Arsenic __ Arsenic __ Barium __ Barium __ Cadmium __ Cadmium __ Chromium __ Chloride __ Lead __ Chromium __ Mercury __ Copper __ Selenium __ fluoride __ Silver __ Iron --__ Lead --__ Manganese --__ Mercury --__ Nitrate --__ Selenium ORGANIC CHEMISTRY Parameter Re,ulu m1i/l Parameter Re8ult11 m1i:/ l _P&T:GC/MS ~B __ Acid:B/N Ext. B's <:o,ooo/ _TQX __ Petroleum --__ Endrin --__ Lindane MICROBIOLOGY Parameter Parameter __ (MF) Coliform Colonies/lOOmls __ Gross Alpha __ (MPN) Coliform Colonies/lOOmls __ Gross Beta -------- Comment• Total Parameter Result8 mg/ 1 __ Silver __ Sulfates __ Zinc _Ph __ Conductivity _TDS _TOC -------- ---- Parameter Results mi:/ l __ Methol'Ychlor __ Toxaphene _2,4-D __ 2,4,5-TP (silvcx) -- RADIOCHEMISTRY Re8ult8 PCi/ 1 Date Received / tJ-PS. fJ -9 0 --VP Date Extracted /0-,,.-jO-90 l13 NW Date Reported------------------ Date Analyzed __ /i_0-___,-,3_0_-__._f __ c,_-n&....:..P _______ _ Reported By ------------------Lab Number 9!J7'0:11 OHS 3191 (Rrvi~d 7185) f• I: I '1 -, .. ,, ... 110 , •. , 'l,.."j~"·.,/R'7' 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 (l) 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 11ite 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/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. Comment, -Lists details regarding sample or sample point, including but limited to, phase separation, and/or odc;,rs. · lnorpnic Chemistry -Check ( ✓ ) the desired parameters to be analyzed. Extractablcs are only performed on a solid or semi-solid. For routine landfill samples, check all parameters in the second and third columns. Orianic Chemistry -Check ( ✓ ) the desired parameter to be analyzed. If not listed, enter the name in the space provided. Microbiology and Radiochemi11try -The Raleigh office should be consulted prior to sampling for either of these. Di11tribution: 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. Dispo11ition: This form may be destroyed in accordance with the Environmental Health, Solid and Hazardous Waste Section of the Records Di5p0Jition 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 t,;I, C. Department o( Human Rcaourcu . Olvlalon of Health Scrvlcca SAMPLE ANALYSES REQUEST State Laboratory of Public Hc,.lch P. 0 . Box 2804 7 306 N. WilminKton Screet RalciKh, 27611 Slee Number qg -, Field Sample Number __ So ____ 'f+-4,8 .... '6.-:+'7,.__ ______ _ Name of Site P, (. B, L A,yt) FILL-Site Location 4 /'f2 ( tfr70N Collected By J..u.TF)/frz/7#~~5 ID#~ Date Collcctcd __,.~b .... %2 ..... -__ J=5°_J ___ 9__,D,.__ __ Time ---"-2;,,...·_·o __ c'--·) __ Type of Sample: · ~ Environmental _ _y,oundwater (1) _L_ Surface Water (2) __ Soil (3) __ Other (4) Concentr,ue __ Solid (5) __ Liquid (6) __ Slud1te (7) ___ Other (8) Comment• INORGANIC CHEMISTRY Extractable• Parameter Rc1ult1 m.i/ 1 __ Arsenic __ Barium __ Cadmium __ Chromium __ Lead __ Mercury __ Selenium __ Silver ---------- Parameter Re1ult1 m.i/ 1 _P&T:GC/MS __ Acid:B/N Exe. _TOX ---- MICROBIOLOGY Parameter __ ( MF) Coliform Colonies/ 1 OOmls __ (MPN) Coliform Colonics/lOOmls Date Received /t)-·d& -CjtJ y'P Date Extracted I ()-3o :9a :l'2; NW Total Parameter Re11ult11 mi/I Parameter Re1ult11 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 ~B PCB's __ Petroleum __ Enclrin __ Lindane Re11ult11 m.:/ 1 -<0 1.0~0 L Parameter __ Gross Alpha __ Gross Beta Parameter Rei;ultli ma:/ I --Mechoicychlor __ Toxaphene -2,4-D --2,4,5-TP (silvcx) -- RADIOCHEMISTRY Re11ult11 PCi/ 1 Date Reported _________________ _ Date Analyzed /tJ--?0-90-VP 9 ~1'7'032 Reported By ------------------Lab Number _____ ..,._~~;;....;.;."----------- N. C. Department of Human Rcaourccs . Dlvialon of Health Service. SAMPLE ANALYSES REQUEST State Laboratory of Public Hnlth P. 0. Box 28047 306 N. Wilmin"con Scrccc Ralci"h, 27611 Site Number YY -' Field Sample Number .....1e-0~¥ .... £"'-lllf>i:..7_,_ _______ _ Name of Site P, C. B, L A!YJ) ff LI-Site Location .Jt ,/'(!) '/ 4,r70N Collected By J..«TF)/t,zr'#~~5 lDII 1$9,/4•2--Date Collected ____,~b1o.::%'_--...:..J::;.;5';;,__cj--=-9&() __ Time ____..f_: __ r;> .... ---__ Type of Sample: · / Environmental ___ Groundwater ( 1) ~urfacc Water (2) __ Soil (3) __ Other (4) Concentr.ate __ Solid (5) __ Liquid (6) __ Sludiie (7) __ Other (8) Re. l>S INORGANIC CHEMISTRY Extractable, Parameter Rc1ulu mw:/ 1 __ Arsenic __ Barium __ Cadmium __ Chromium __ Lead __ Mercury __ Selenium __ Silver --------- Parameter Reaulta mw:/ l _P&T:GC/MS __ Acid:8/N Ext. _TOX ---- MICROBIOLOGY Parameter __ (MF) Coliform Colonies/ lOOmls __ (MPN) Coliform Colonies/lOOmls Parameter Re1ult1 mg/1 __ Arsenic __ Barium __ Cadmium __ Chloride __ Chromium __ Copper __ fluoride __ lron __ Lead __ Manganese __ Mercury __ Nitrate __ Selenium ORGANIC CHEMISTRY Parameter ~B PCB's __ Petroleum __ Endrin __ Lindane Rc1ult1 m"/ l '<:Oe.ooo/ Parameter __ Gross Alpha __ Gro:.s Beta Comment, Total Parameter Rc1ult1 mg/ 1 __ Silver __ Sulfates __ Zinc _Ph __ Conductivity _TDS _Toe ------------ Parameter Rc1ult• mi:/ I --Methoicychlor __ Toxaphene _2,4-D __ 2,4,5-TP (silvex) -- RADIOCHEMISTRY Date Received .... J __ O ____ ----':;i ____ l,_-_9-o---'n> ......... ______ _ Date Reported _________________ _ Date Extracted .... l....__tJ-._-,3 ____ Q:9_ ........ o----i1~'LP~./ .... M .... 'W==------Date Analyzed /0 -30-90yP Reported By -----------------Lab Number _____ ..;;9;;..0 __ ~--·l!'"'S_,_0_:_J_J _______ _ n11s JI <>I (llrvi1.e,l 7/ll'i) f• I ; I 't -ir t ,.,, l't/f •. , fJ,,.,-i,-u• .,/P.1) I N. C. DcparJmcnt o( Human Rcaourcca . Dlvlllon of Health Scrvlcca SAMPLE ANALYSES REQUEST State Laboratory of Public Hnlth P. 0. Box 28047 306 N. WilminKton Scrc:cc Ralci1th, 27611 Site Number y,i -, Field Sample Number _....11,{)-0_'f~B~~~s=-------- Name of Site /?, C, B, l ANO FILL-Sitc Location 4 ,/'() tf 4,f70N CoUected By J..uTFr/U.ahl,t;~ 5 ID• ,/4,~2-Date Collected /t)-.15" ,] 9 D . Time__.f_. __ '-k_ ___ ) __ Type of Sample: · Environmental Concentr.ate __ Groundwater (1) __ Solid (5) ,/surface Water (2) __ Liquid (6) uTY.S __ Soil ( 3) __ Sludiic ( 7) __ Other (4) __ Other (8) INORGANIC CHEMISTRY Extract.able• Parameter Rc1ult1 mK/ 1 __ Arsenic __ Barium __ Cadmium __ Chromium __ Lead __ Mercury __ Selenium __ Silver ---------- Parameter Rc•ulta mK/ l _P&T:GC/MS __ Acid:B/N Exe. _TQX ---- MICROBIOLOGY Parameter __ (MF) Coliform Colonies/lOOmls __ (MPN) Coliform Colonies/lOOmls Pilrameter Re11ult1i mK/ 1 __ Arsenic __ Barium __ Cadmium __ Chloride __ Chromium __ Copper __ fluoride __ Iron __ Lead __ Manganese __ Mercury __ Nitrate __ Selenium ORGANIC CHEMISTRY Parilmcter ~8 B's __ Petroleum __ Endrin __ Lindane Rc11ult11 m.:/ I <01,000{_ Parameter __ Gross Alpha __ Gross Ikea Comment• Total Parameter Re1iult11 mg/ l __ Silver __ Sulfates __ Zinc __ Ph __ Conductivity _TDS _TOC ------------ Parameter Rc,;ultli mg/ 1 __ Mechoicvchlor __ Toxaplu:nc _2,4-D --2,4,5-TP (silvcx) -- RADIOCHEMISTRY Rc11ult11 PCi/ 1 Date Received ~/.__.,tJ_-..... a ........ 6~--i _,O:;.._,Jli""-''P ________ Date Reported---------------- Reported By Date Extracted .... l,.;;;()_-.... ~=~--2...,Q-:V: ....... 7;-r, .... M~-------Dace Analyzed ..... 1 ..... o_-_..3"'-£,.,/--"'-9-=o:;.......1/P~-------- 9 070:.J .ti Lab Number _________ ,, _________ _ ntlS JI<>! (Rtvi~tl 7/RS) ,. I: I I I N. C. Dcpar.rmcnr of Human Rcaource1 . Dlvlalon of Hcahh Servlcca SAMPLE ANALYSES REQUEST State Laboratory of Public Helllch P. 0. Box 28047 306 N. Wilmin1tcon Serret Ralei11h, 27611 Site Number Yi -, Field Sample Number _...,Q"n""""'f......,B.....,.£,......,.9 _______ _ Name of Site £ C, B, L A,y1? fr L '-Site Location 4 /t,(') tf tf.E70N Collected Dy J..tq·F 7Lrtz f,',11~~ $ 1011 ~ Date Collected -~o ... i2:;....-_J=-5'_J __ 9_D ___ Time _/_._. ·35_--__ Typco(Sample: · ~ Environmental Concentr~te __ Groundwater (1) __ Solid (5) / Surface Water (2) __ Liquid (6) __ Soil ( 3) --Sluditc ( 7) __ Other (4) __ Other (8) INORGANIC CHEMISTRY Extractable, Pilrameter Rt.-.ulu mKI 1 __ Arsenic __ Barium __ Cadmium __ Chromium __ Lead __ Mercury __ Selenium __ Silver ---------- Parameter Re1ult1 mK/ 1 _P&T:GC/MS __ Acid:B/N Exe. _TOX ---- MICROBIOLOGY Parameter __ (MF) Coliform Colonies/lOOmls __ (MPN) Coliform Colonies/lOOmls P.&rameter Re11ult11 mic/ 1 __ Arsenic __ Barium __ Cadmium __ Chloride __ Chromium __ Copper __ fluoride __ Iron _Lead __ Manganese __ Mercury __ Nitrate __ Selenium ORGANIC CHEMISTRY Parameter zgn PCU's __ Petroleum __ Enclrin __ Linclane Re11ulr,i mK/ 1 <"i OOOf. Parameter __ Gross Alpha __ Gross Ikea Comment, Total P.&rameter Re11uh11 mg/ 1 __ Silver __ Sulfates __ Zinc __ Ph __ Conductivity _TDS _TOC ------------ Parameter Rctiulti; mi:/ I __ Metho~ychlor __ Toxaphene _2,4,D --2,4,5,TP (silvcx) -- RADIOCHEMISTRY Re1ult1i PCi/ 1 Dace Received __._f_..() __ -....,o{........,,f, __ -...... ~--rJ_· Y...z.· __.P ______ _ Date Reported------------------ Dace Extracted ... J .... tJ.........,-,3...._0 ___ ~.......,.cJ~~......_.,..A....,~------- Reported By ------------------Lab Number Date Analyzc:J -'-/_0_-:3~/_-..:;9,_'0....,....10~P ________ _ 9 oi--.0 ~11 S J ,'. ~..J .:, n11s JJQI (lttvi.cd 7/B'i) I I N. C. Depa~rmenr o( Human Reaourca . Dlvlalon of Health Servlcea SAMPLE ANALYSES REQUEST Srarc Laboratory o( Public Hcalch P. 0. Box 28047 306 N. Wilminiccon Scree, Ralciiih, 27611 Slte Number Yi - . Field Sample Number _.;.t)c:,..=...~'t:_._8,,,_1..._.o:...... _______ _ Name of Site P, C. B, LANO fr l. L-Site Location 4 ,/'() '/ 4,E70N Collected By J..1<7! 1;//.f'TZl?lil'i_~ 5 ID# ~ Date Collected -,~b .... z?'---.1 ___ 5"_J __ 9_.()_,__ Time d -· c.) / Type of Sample: · Environmental Concentr.ite Comment• Groundwater ( 1) Solid (5) Rel.LS Surface Water (2) Liquid (6) r/ Soil (3) SEf>lll'JI..K Sludicc (7) Other (4) Other (8) INORGANIC CHEMISTRY Extractable, Parameter Rt.-.ulu m1it/ 1 __ Arsenic , __ Barium __ Cadmium __ Chromium __ Lead __ Mercury __ Selenium __ Silver ---------- Parameter Reaulu m1it/ 1 _ P&. T:GC/MS __ Acid:B/N Exe. _TOX ---- MICROBIOLOGY Parameter __ (MF) Coliform Colonieti/ lOOmls __ ( M PN) Coliform Colonies/ 1 OOmls Date Received /0 -,2.6-90::1/P Dace Extracted / / - / -C/C) :YP Total Parameter Re11ulu mg/1 Parameter Re11ult11 mg/ 1 __ Arsenic __ Silver __ Barium __ Sulfates __ Cadmium __ Zinc __ Chloride __ Ph __ Chromium __ Conductivity __ Copper _TDS __ fluoride _Toe __ [ron --__ Lead --__ Manganese --__ Mercury --__ Nicrace --__ Selenium -- ORGANIC CHEMISTRY Par;amcter zga PCD's __ Petroleum __ Endrin __ Lindane Re11ulu mg/ 1 <O,LO ~ Parameter __ Gross Alpha __ Gross Bera Parameter Rei.ultli mi:/ I __ MechoHchlor __ Toxaphene _2,4-D __ 2,4,5-TP (silvcx) -- RADIOCHEMISTRY Re11ulti; PCi/ 1 Date Reported _________________ _ Date Analyzed ....,/."-1'/;....-..::;-;l...;_-...,,Z~~~:1/P~-,---------907036 Reported By ------------------Lab Number _________________ _ N. C. Dcpar.tmcnt of Human Rc:aourccs . Dlvlalon of Health Scrvlcca SAMPLE ANALYSES REQUEST State Laboratory of Public Healch P. 0. Box 2804 7 306 N. Wilmin"con Smee Ralei"h, 2761 l Site Number Yi - . Field Sample Number _e--....a.o_Lf: ........ ~ .... :l ........ l ________ _ Name of Site f. C, B, L A~ FILL-Site Location .J$ /'fJ t/ 4.E?ON Collected By l..t<TFY//ff!l!ll,f~ 5 ID# ~ Date Collected __ _..b ... ~::...--';J=S'_J_9:..1D~--Time __ /_, •_r, __ 5 __ Type of Sample: · Environmental Concentr.ate Co~ment1 Groundwater ( 1) Solid (5) It C. b.S Surface Water (2) Liquid (6) V Soil (3) .SE(/11'/fttf( SludKe (7) __ Other (4) Other (8) INORGANIC CHEMISTRY Extractable• Parameter Rl.-.ulu mKI 1 __ Arsenic __ Darium __ Cadmium __ Chromium __ Lead __ Mercury __ Selenium __ Silver ---------- Parameter Reaulta mK/ 1 _ P&. T:GC/MS __ Acid:B/N Ext. _TOX ---- MICROBIOLOGY Para merer __ (MF) Coliform Colonia;/lOOmls __ (MPN) Coliform Colonic:s/lOOmls Date Received /0 -'20 -90:,/P Date Extracted //-/-'/() 1/P Total Parameter Re11ulu mK/ 1 Parameter Re11ult11 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 ~8 B's __ Petroleum __ Endrin __ Lindanc: Re11ulc. m~/1 Parameter Rci;ultli mg/ I __ Methoi_c:ychlor <CtL~+Jl,lLn , __ Toxaphene r-_2,4-D __ 2,4,5-TP (silvcx) -- RADIOCHEMISTRY Parameter __ Gross Alpha __ Gross Bc:ca Rc11ulti; PCi/ 1 Date Reported _________________ _ Date Analyzed ....,/.'--,,j'/_~_-_,2_-_.9i;..:ic;;~]Qc..,;'P~-------- 9Q7 Q:J ~/ Reported By ------------------Lab Number _________________ _ n11s JI QJ (Rrvii.c,I 1 IB'i) ,. I : I I N. C. Ocpar.tmcnt o( Human Rcaourcca . Dlvlalon of Health Scrvlcca SAMPLE ANALYSES REQUEST State Laboratory of Public He.&lch P. 0. Box 28047 306 N. Wilminl(ton Sm:cc Ralei1th, 27611 Slte Number Y</ -, Field Sample Number -...::◊~P-4.:....::£>_lf._2=-===--------- Name of Site /?. C, B, L A,yt) ff LL-Site Location _..JJ""'.R.µ.,_,,_,/i.z~w.f2-,.(_-.-...i14,r.u-c~7l?~N.;...._ ____ _ Collected By l..'4TF 7/trzP#7:~ 5 lDII ~ Date Collected __,,~A"'"Z>~---..1=5'_2---:9:..iD~--Time _,,f-l-/.'_'-f __ O~_ Type of Sample: · ~ Environmental ___ Groundwater ( 1) ___ Surface Water (2) _JL:'_ Soil (3)~~11'il'Nr __ Other (4) Concentr•te __ Solid (5) __ Liquid (6) __ Slud1'c (7) ___ Other (8) INORGANIC CHEMISTRY Extractable• Parameter Rc1ult1 mi/ 1 Parameter Re11ultli mic/ 1 __ Arsenic __ Arsenic __ Barium __ Barium __ Cadmium __ Cadmium __ Chromium __ Chloride __ Lead __ Chromium __ Mercury __ Copper __ Selenium __ fluoride __ Silver __ lron -__ Lead --__ Manganese --__ Mercury --__ Nitrate --__ Selenium ORGANIC CHEMISTRY Parameter Re1ult1 mi/ 1 Parameter Re11ultli mKl l _P&T:GC/MS Comment• Total Parameter __ Silver __ Sulfates __ Zinc __ Ph __ Conductivity _TOS _TOC ------------ Parameter ~B __ Mcthol(Vchlor __ Acid:B/N Ext. ll's <IJtlO~ __ Toxaphcnc _TOX , __ Petroleum _2,4-0 --__ Endrin --2,4,5-TP (silvcx) --__ Lindane -- MICROBIOLOGY RADIOCHEMISTRY Re1uh11 mg/ 1 Rctiulti; mi:/ l Parameter Parameter Re11ultli PCi/ 1 __ (MF) Coliform Colonieti/lOOmls __ (MPN) Coliform Colonie6/100mls __ Gross Alpha __ Gross Beta Date Received _.,/;L...:()----1111:"tfl:i,.,µ,-._-_9~0"-1/PL-.I _________ Date Reported ________________ _ /1/, ~/ -Ci /'f~p /'/ .,, ~•.I""\~ Date Extracted -._., ______ _.;.,..;:V:;.....X-"--'--'----------Date Analyzed ..L...'---..:;...;....;:.,-,+,(./,n:o,,.+!f-n:~---------~ 9 ··;,~8 Reported By ------------------Lab Number _________________ _ [)JIS JJQI (Rrvit.c=d 7/ll'i) ,· I: f ., .,., f ,.,,, I'll/, •.• 'l ,.,,f~0 ,-,IA1l N. C. Oeparrmenr of Human Reaourcea Divlllon or'Heahh Servlcea SAMPLE ANALYSES REQUEST State Laboratory of Public Health P. O. Box 2804 7 306 N. Wilminiicon Screer Ralc11ih, 27611 Site Number Y~ -· Field Sample Number _..i,,[)"-C=-"""4-~.-:;...Q.....,3"'---------- Name of Site f. C, B, l A,yt) fr L l-Site Location 4 /t,tJ ( 4E7QN Collected By J...u7F 7Lorzm~~ 5 ID# ~ Date Collected /ti-.1 S: :J 9D Time_,/_·-'?_.,;£ __ Typeo(Sample: · ~ Environmental __ Groundwater ( 1) ___ Surface Water (2) _..,.t/-. Soil ( 3) j ~ ,,,,_.,,.--- --Other (4) Concentr.&te __ Solid (5) __ Liquid (6) __ Sluditc ( 7} __ Other (8) Comment• lATDS INORGANIC CHEMISTRY Extractablea Parameter Rc1ulu mai/1 __ Arsenic __ Barium __ Cadmium __ Chromium __ Lead __ Mercury __ Selenium __ Silver --------- Parameter Reaulu mail 1 _P&T:GC/MS __ Acid:B/N Ext. _TOX ---- MICROBIOLOGY Parameter __ (MF) Coliform Colonieti/lOOmls --(MPN) Coliform Colonies/lOOmls Total Parameter Re1ult1 mg/ 1 Parameter Re1ult1 mg/ I __ Arsenic __ Silver __ Barium __ Sulfates __ Cadmium __ Zinc __ Chloride __ Ph __ Chromium __ Conductivity __ Copper _TDS __ fluoride _TOC __ Iron --__ Lead --__ Manganese --__ Mercury --__ Nitrate --__ Selenium -- ORGANIC CHEMISTRY Parameter Rc11ullll mKI I Parameter Re1ulb m.:/ 1 ~8 --Methoicychlor PCll's <OiZO~ __ Toxaphenc r-__ Petroleum __ Endrin __ Lindane Parameter __ Gross Alpha __ Gro:.s Beta _2,4.0 __ 2,4,5•TP (silvcx) -- RADIOCHEMISTRY Re1ult1 PCi/ 1 Date Received _J __ CJ_-_~-~--....... ~_l?__.J/).,..'P ________ Date Reported _______________ _ Reported By Date Extracted __ / __ /_-__ /_-.... z'-· .:;.tJ_J/..a,r.....Pi... ________ Date Analyzed -#,L~'L--..... ,;t.=----~9~0~11P~--------- ,n. A•~ 0 r~ fll ::,tJ a c.)~1 Lab Number _________________ _ !1115 JJQI (Rrvi~d 7/RS) •··L I -,.,,.1 ,,,.,'tl/, •. , 'l~"i .. u,-,IR'7) N . C. Dcpai:_rmcnt o( Human Reaourcea . Dlvlalon of Health Scrvlc~ SAMPLE ANALYSES REQUEST Stare Laboratory of Public Healch P. 0. Box 28047 306 N. Wilminiicon Scrcct Ralei11h, 27611 Site Number Yi -, Field Sample Number __ t'.1;...D.;;..'_.l/j.....:.;;8 ....:~-c ,1-y _______ _ Name of Site e C. B, L ANO E, l. L-Site Location .rt .1,f,) tf l 4.E7QN Collected By J..L4TF:J/5(ZPH~~5 ID/I {)S"!/_Lp~ Date Collected /()--.25", 9D Time Type of Sample: · ~ Environmental Comment• __ Groundwater ( 1) ___ Surface Water (2) __ Soil (3) __ Solid (5) V Liquid (6) __ Sludiie (7) __ Other (8) frv c/. £j ~,-v-r __ Other (4) Extractable, Parameter Rc•ulu mail 1 __ Arsenic __ Barium __ Cadmium __ Chromium __ Lead __ Mercury __ Selenium __ Silver --------- Parameter Reaulu mail 1 _P&T:GC/MS __ Acid:8/N Ext. _TOX ---- MICROBIOLOGY Parameter __ (MF) Coliform Coloniei;/lOOmls __ (MPN) Coliform Colonies/lOOmls INORGANIC CHEMISTRY Parameter Reaulu mg/I __ Arsenic __ Barium __ Cadmium __ Chloride __ Chromium __ Copper __ fluoride __ Iron __ Lead __ Manganese __ Mercury __ Nitrate __ Selenium ORGANIC CHEMISTRY Par;;ameter ~8 PCll's __ Petroleum __ Endrin __ Lindane Rc1ult:11 mg/ 1 <o,ooo/ Parameter __ Gross Alpha __ Gross Beta Total Parameter Re1ult1 mg/ 1 __ Silver __ Sulfates __ Zinc _Ph __ Conductivity _TDS _TOC ------------ Parameter Re1ult1i mi:/ I __ Metho~ychlor __ Toxaphene _2,4.0 --2,4,5•TP (silvcx) -- RADIOCHEMISTRY Reault• PCi/ 1 Date Received /O -e:l ~-ro-1/P Date Reported ---------------- Date Extracted I0-30-:90 :P.AA Date Analyzed -L__,o..__--=3~/'-'.--~9'..;o;;._11.L...P _______ _ Reported By _______ -"-'--::, ___________ Lab Number _____ 9_0_1;-_;_0_~_· ~_Q ________ _ f)J IS JI<> I ( Rrvi1oeJ 7185) f· I : t ' N. C. Dcpartn\cnt of Human RcaourcC6 . Dlvlalon of Health Scrvlcca SAMPLE ANALYSES REQUEST State Laboratory of Public Health P. 0. Box 28047 306 N. WilminKton Screec Raleigh, 27611 Site Number _ .. fr-_______________ Field Sample Number --'~"""-=O.'-"£;.....,."ff: .... _?. .... ~..__ _______ _ Name of Site e, I{.. LA,vL>fe~ Site Location ..f£ /~t>; dfflAJ Collected By __________ ID# _____ Date Collected j;. 2.S-~ * Time ,J./_£ Type of Sample: Environmental ___ Groundwater ( 1) __ Surface Water (2) __ Soil (3) __ Other (4) Concentr.ate __ Solid (5) ~Liquid (6) __ Sludge (7) __ Other (8) Co~menta fffLIA. ENT-L(A~ INORGANIC CHEMISTRY Extractable• Parameter Re11ulu mail 1 __ Arsenic __ Barium __ Cadmium __ Chromium __ Lead __ Mercury __ Selenium __ silver ---------- Parameter Reaulta mii/1 _P&T:GC/MS __ Acid:B/N Ext. _TOX ---- MICROBIOLOGY Parameter __ (MF) Coliform Colonies/lOOmls __ (MPN) Coliform Colonies/lOOmls ---- DateReceived JO -o?fo -70::Jk Date Extracted Jo -... :ra -ro:V,e, M Total Parameter Re8ulu mg/I Parameter Re8ult8 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 Re8ult8 m.:/ l Parameter Relliultt; ma:/ I ~B __ Methot<Ychlor PCB's <o,oooL __ Toxaphene __ Petroleum _2,4-D __ Endrin --2,4,5-TP (silvcx) __ Lindane -- RADIOCHEMISTRY Parameter Re8ultlli PCi/ I __ Gross Alpha __ Gross Beta -- -- Date Reported _________________ _ Date Analyzed _~_'0_-..... 3=-a../_-... ?.--a.o_yP __________ _ Reported By ~0-7-0~1. ------------------Lab Number --------·-" __ .. _: ________ _ nHS 3191 (RrviM:d 7185) •:. ,Ii.I q.,.,,l,111< w (l,·•· 1 ll rvirw 7 /fl7) .,, Purpoee: 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 (l) 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 11ite 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/lOOOg = µg/kg DEFINITIONS/INSTRUcnONS 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. Extractablcs are only performed on a solid or semi-solid. For routine landfill samples, check all parameters in the second and third columns. Orianlc Chemi11try -Check ( ./ ) the desired parameter to be analyzed. If not listed, enter the name in the space provided. Microbiology and Radiochemi11try -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. Dispo9ition: This form may be destroyed in accordance with the Environmental Health, Solid and Hazardous Waste Section of the Record.s Di1p0Jition 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 Chain of Cu 5todv Record Hazardous ~aste P.aterials ... ,._ ~ocation of Sampling: Generator __ Transporter _Treatment Facility __ Storage Facility __ Disposal Facility ~andfill Other: :ompany Is Name _e_c ___ e_. _ _.\~A=N__,D--...E~' L_L-____ _ Telephone .l---'-------------- \ddress :ollector's Name .~\A.J]:'( /.51rzfME'6 l-sig~ure Telephone <1tt> 73:J-o,9L :,at;e Sampled _ ..... I.__O_-... ~......,;i5'i:;..._ __ -__ i=o ____ _ Time Sampled __________ ..,.... ___ _ . ~pe of Process Generating Waste "ield Information .:..::ld Sample ~o. ~toil 1ge,3 4&8t ~B iS-lf98' l/8~7 ~B~· Lf899 4-8'/o 'l:~9/ ·yBPz '/893 L/89// £¥?9 ~ai~ of Possession: )l>P@'-EtJt. "&-tcJ<. 1il::C0'-/o -2s--2,-z-o t it le inclusive dates signature title inclusive dates signature title inclusive dates csu~cs reported -~~~ title date · nst:uctions: Complete all applicable. information including signatures, and submit ~ith analysis request forms. ' 'I . , . ' , I {i I .,· .. . 7~e sa~?les described below ~ere collected .in connection vith the administration,. c~forcer:ient, and documcncaciOn of the: ~ ' ( ) Nor:h Carolina Hazardous Waste Hanagcment Rules, 10 NCAC !OF · ( ) ~orth Carolina Solid Waste Management Rules, 10 NCAC lOG . . ( ) Com?rehensive Environmental Response, Compensati~n and Liability Act (C~RCLA) ( ) Toxic Substances Cont.rol Act (TSCA) 15 U.S.C. S2601, !:.!:. seq., ·.specifically Section 11 of TSC/\, 15 U.S.C. s2610. Inspector's Name Inspector's Address !fame of Firm Firm Address ·:=m Owner, Operator, or Agent Title .. .:•:?::.~ COLLECTED SAMPLE TYPE DUPLICATE s:-..!-:?L::s SAMPLE . •:-:3ER DAT£ TIME. WATER ·SOIL OTHER OFFER£D IACC£?T~O ! Rr:'.JECTED ON-SIT£ I . - . - . LOG.TIO~ OF:-S17E Rec_eipt for the· sarnple(s). descri1>ed c:DO\le is hereby acknowledged: Receipt/rejection of -duplicate o~ split samples is hereby acknowledged: ... S~gnature of Inspector Signature of Fir~ o~ner, Operator, or Agent Ticle Title Co..-..1lents: ------------------------------- N. C. Department of Human Rcaourcca D!vi1ion of Health Servicca SAMPLE ANALYSES REQUEST State Laboratory of Public Healt~ P. 0 . Box 2804i 306 N. Wilmington Street Ralei"h, 27611 Site Number ___ ;...f_3_·-___________ Field Sample Number __ O_O_!tf.........,~1-0~Z-;......_ ________ _ Name of Site f C, ].. LAND fJ l L Site Location Ae:orJ/L,ft/i[lSN CD. Collected Dy c;.,ea Y S.ra,PJ{E.N5 ID# O' L. Date Collected 'l-» fv Time II,' 3 z_ Type of Sample: Environmental __ Groundwater ( 1) __ Surface Water (2) __ Soil (3) __ Other (4) Coneentrate" __ Solid (5) 6iquid (6) __ Sludge (7) __ Other (8) INORGANIC CHEMISTRY Extractables Total Parameter Re11ulu mii/1 Parameter Resulu mg/1 Parameter Re1ult11 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 Resulu mg/1 Parameter Results mg/ 1 Parameter Results mg/ 1 _P&T:GC/MS z;:os __ Methoxychlor __ Acid:B/N Ext. PCB's 0!0()~-__ Toxaphene _TOX __ Petroleum _2,4,D --__ Endrin __ 2,4,5,TP (silvex) --__ Lindane -- MICROBIOLOGY RADIOCHEMISTRY Parameter Parameter Results PCi/ l --(MF) Coliform Coloni~/lOOmls __ Gross Alpha --(MPN) Coliform Colonies/lOOmls __ Gross Bera -------- Date Received CJ -2. ? ~ CJ O t9£). Date Extcacte~~ 'l"Jf,.Vf , Reported By m ' M~- 011Sll91(Re,i0, 0 = ft '10(,,6 7 _ s .. I,,! .,id l il :rdous \I . IC (Rrview 7/87) / Date Reported I (} -'l -'10 pea ✓ Date Analyzed 10-~-9'crVP Lab Number ____ 9_066 __ 7__::::1:.....· ______ _ I I N. C. Department of Human Rcaourcca " Dlvlalon of Health Servlcca SAMPLE ANALYSES REQUEST State Laboratory of Public Health P. 0. Box 28047 306 N. Wilmington Street RaleiKh, 2761 l Site Number __ ..;..C/....;J_-_· ___________ Fidd Sample Numbe, C,O ..'f'i {) 3 Name of Site f C, 'B, LAN'DfJl L Site Location Ac'IJ'"' /41(9:#{Uly co. Collected Dy (,.gA y S.'[]i-PJIE.NS ID# a, z_ Date Collected f-~ fu Time / 2 ,' 2? Type of Sample: Environmental __ Groundwater ( 1) __ Surface Water (2) __ Soil (3) __ Other (4) Concentrate- --Solid (5) ~iquid (6) __ Sludge (7) __ Other (8) INORGANIC CHEMISTRY Extractable• Total Parameter Re1ulu ms/I Parameter Re1ulu 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 Re1ult1 mail 1 Parameter Re1ult1 mii/ 1 Parameter _P&T:GC/MS z!DB __ Methoxychlor __ Acid:B/N Ext. CB's <.n .. dQ'1 I nr. .. _ Toxaphene ,, _TOX __ Petroleum _2,4,D --__ Endrin --2,4,5,TP (silvcx) --__ Lindane -- MICROBIOLOGY RADIOCHEMISTRY Results mg/ 1 Results mg/ 1 Parameter Parameter Results PCi/ 1 __ (MF) Coliform Coloni~/lOOmls __ Gross Alpha __ (MPN) Coliform Colonies/lOOmls __ Gross Beta -------- Date Received. ;i -.2 Y -lf_Q____JJ iJ Date Reported Date Extract~,b -S-9~,J Date Analyzed f]g!' ?-9crt/P 906672 Reported By ------------------Lab Number _________________ _ OHS H91 (Rcviu<l 7/li'i) Soll.I a11d Haiardou.s \\',••tC (Review 7/87) • Cha in of Custod\' Record Hazardous ~aste P.aterials ,cation of Sampling: Generator __ Transporter /rrea tment Faci 1 i ty ,mpany's Name 1dress __ Storage Facility Other: ,lleccor's Name~ ~ ~ -signa~ __ Disposal Fae il i ty /Land fi 11 Telephone Telephone (t./Jg) ?33-061'L at;:.e Sampled 9-2?-·fo Time Sampled ___________ __,,_ ___ _ ::pe of Process Generating Waste · BC. (t LM'i) ff u ...... ___.i...:...;;::;;.;._,Jo,g___,;;:.;..,i;_;;,..w_.L.-L.,;~------------- ield Information fiffLl.4. EdT:. ::.c::ld Sample ~o. ~a~~ of Possession: I u)~J¼o½d signature signature J/'Qle; fft!!L:DHMlc title title title title inclusive dates inclusive dates inclusive dates date ,sc:uctions: Complete all applicable information including signatures, and submit ~ith analysis request forms. ) . ' 'I I · 1 . ' i'i '1 . :.,e sar.i?les described belo1.1 were collected :in connection \Jith [he administration,( c~forcer.ient, and documentation of the: ( ) Nor:h Carolina Hazardous Waste Management Rules, 10 NCAC !OF · ( ) ~arch Carolina Solid Waste Management Rules, 10 NCAC lOG . . ( ) Corn?rehensive Environmental Response, Compensati?n and Liability Act (CERCLA) ( ) Toxic Substances Cont.rol Act (TSCA) 15 U.S.C. s2601, !:.E_ ~-, ·specifically Section 11 of TSCA:, 15 U.S.C. s2610. Inspector's Name Inspector's Address !fame of Firm Firm Address ·:=m 01.1ner, Operator, or Agent Title .:•'.?2.:S COLLECTED SAMPLE TYPE DUPLICATE s;.2-:?L::s SAMPLE . •~-:3::R DATE TIME . HATER ·SOIL OTHER OFFEREDIACC£PT~o ! Rr::JECTED ON-SIT£ ' i I ; I I . . ' . . • LOG.TIO!\ Of:-SI::: ?-ee;eipt for the· samp le(s). descri~ed above is hereby acknowledged: Receipt/rejection of ,duplicate or split samples is hereby acknowledged: .... S~gnacure of Inspector Signature of Fir~ o~ner, Operator, or Agent Title Coi:'..-nen c. s: ------------------------------- N. C. Department of Human Resources Division of Health Services Site Number Name of Site Collected By Type of Sample: Environmental Concentrate Comments State Laboratory of Public Health P. 0 . Box 2804 7 306 N. Wilmington Street Raleigh, 27611 __ Groundwater (1) __ Solid (5) :r ~ F L l.t £ II.ff: (s111.11b re IL TE,C, ) __ Surface Water (2) ~Liquid (6) __ Soil (3) ~ Other (4) __ Sludge (7) __ Other (8) INORGANIC CHEMISTRY Extractables Parameter Results ma/ 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 mi/ 1 _P&T:GC/MS ~B __ Acid:B/N Ext. PCB's <a,.n~at. _TQX __ Petroleum --__ Endrin --__ Lindane MICROBIOLOGY Parameter Parameter __ (MF) Coliform Coloni~/lOOmls __ Gross Alpha __ (MPN) Coliform Colonies/lOOmls __ Gross Beta -------- Total Parameter Results mg/ 1 __ Silver __ Sulfates __ Zinc _Ph __ Conductivity _ms _Toe -- ---- -- -- -- Parameter Results mg/ 1 __ Methoxychlor __ Toxaphene -2,4-0 __ 2,4,5-TP (silvex) -- RADIOCHEMISTRY Results PCi/ 1 Date Received ft-ti< ?-9 cJ J1? Date Reported __ __,9'---..;;;;6_-:/<---=0=------------ Date Extracted 'i'--,,<.9 -9d1/IJAA Date Analyzed ___..i': ...... -.r.6~9::--?i_,,o~-v;~p _______ _ Reported By ~ 6r N.d Lab Number ----=~=--l_0_6_?-_J_8_1. _______ _ DHS3191 (Revised~ #tJ & '3 $--J .-<?0 6J 8-c 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 ==i mg/1 = µg/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 ~~ ' 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 ordeted from: Solid and Hazardous Waste Management Branch Division of Health Services P. 0. Box 2091 Raleigh, NC 27602-2091 N. C. Department of Human Reaourcea Division of Health Services SAMPLE ANALYSES REQUEST State Laboratory of Public Health P. 0. Box 28047 306 N. Wilmington Street Raleigh, 27611 Site Number Name of Site Collected By Type of Sample: Environmental Concentrate __ Groundwater (1) __ Solid (5) __ Surface Water (2) V Liquid (6) __ Soil (3) __ Sludge (7) ~ Other (4) __ Other (8) INORGANIC CHEMISTRY Extractable, Parameter Reaulta m1r/ l Parameter Result, 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 Reau I ta mg/ 1 Parameter Reaults mii/1 _P&T:GC/MS ~B __ Acid:B/N Ext. PCB's < o, o oo l _TOX __ Petroleum --__ Endrin --__ Lindane MICROBIOLOGY Parameter Parameter __ (MF) Coliform ColoniC$/100mls __ Gross Alpha __ (MPN) Coliform Colonies/lOOmls __ Gross Beta ---- ---- PM ' / 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 Date Received -~---t,,ef__,.9_--~ ....... ~---\I_P._ _________ Date Reported ________________ _ Date Extracted _.Y ___ -,,2~9_--9 .... tJ ........ AA __ ../'T""1/P ......... _______ Date Analyzed ___.Y:.IL--<-2-9'---..... 9 ..... o=-16...L.<'P _______ _ ~0608~ Lab Number ____ -______________ _ Reported By DI-IS 3191 (Ri:viseJ 7 /85) r , I; t . .. •rL ~.,,. '"'' .,,. ,...., .,:,. .• , "'7 "C'l"'7) N. C. Dc;artmcnt of Human Rcaourcca Divlaion of Health Scrvlcc11 SAMPLE ANALYSES REQUEST State Laboratory of Public Health P. 0 . Box 28047 306 N. Wilmington Street Raleigh, 27611 Site Number Name of Site Collected By q3 O{)Ot)Q I eoo t Fi~l(i Sainpi~! N~~b~l-. ..,---'e>"'-o=---lf: ..... ~ .... ~.a..if.___ _____ _ /.C. j:,._ l:!M?£!'-~':•:=tlo~t,,fllf£3 ~'j ~,V.C. G-Mf: SJ:,bf;frV.5 lDII Oi>Z-· Date:.Collected~·,; F 2-8 ':!._{) Time /0,.S-l> I Type of Sample: Environmental __ Groundwater ( 1) __ Surface Water (2) __ Soil (3) ~ Other ( 4) Concentrate __ Solid (5) ~Liquid (6) __ Sludge (7) __ Other (8) / . ,.i '-. /,. Comment• fo@Jzj:.? /4-cw INORGANIC CHEMISTRY Extractable• Parameter Re1ult1 ml(/ 1 __ Arsenic __ Barium __ Cadmium __ Chromium __ Lead __ Mercury __ Selenium __ Silver ------ ---- Parameter Re1ult1 m1r/ l _P&T:GC/MS __ Acid:B/N Ext. _TOX ---- MICROBIOLOGY Parameter __ (MF) Coliform Coloni~/lOOmls __ (MPN) Coliform Colonies/lOOmls ---- Date Received 5?'-~ q _,CJ O]/P Date Extracted <T-' :z.1-r~ M Reported By OHS 3191 (Revised 7185) Solid 1111J Huurdous Waare (Review 7187) Total Parameter Resulta mg/ 1 Parameter Re1ult1 mg/ 1 __ Arsenic __ Silver __ Barium __ Sulfates __ Cadmium __ Zinc __ Chloride _Ph __ Chromium __ Conductivity __ Copper _ms __ Fluoride _TOC __ Iron -- _Lead -- __ Manganese -- --Mercury --__ Nitrate --__ Selenium -- ORGANIC CHEMISTRY Parameter Re1ult11 mg/ l Parameter Resultli mg/ 1 ~B __ Methoxychlor PCB's <:Oi oool __ Toxaphene __ Petroleum _2,4-D __ Endrin --2,4,5-TP (silvcx) __ Lindane -- RADIOCHEMISTRY Parameter Re1ult11 PCi/ 1 --Gross Alpha __ Gross Beca ---- Date Reported _________________ _ Date Analyzed 8-3 0 -901/P Chain of Cu s todv Record .. Hazardous ~aste Materials ,, \ I ,-, / Location of Sampling: Generator __ Storage Facility Other: Company's Name f C B. Address J ~ollector Is Name G-/2,4 t aTlfH/13/lJ..S . -signature c: ~--t l 1~:::_, J l } __ Transporter ,,Treatment --r- Disposa 1 Fa·c._i 1 i ty ~ ~andfi 11 --·----...... --"' -- Telephone Telephone (t1t1 ) 733--o6 9L - Facility :,a t;e Sampled __ ___.$...._-_.;;;..2.-'8'"""·----Z'-L>;;;;_.. ______ _ Time Sampled......;.-'-----------,,------ ::pe of Process Generating Waste · f,c. {), I-4NJ h L--____ ___,.;; ___ ....;........;....=-.:....;...-------------------- ~ield Information ::.c:lci Sample ~o. ~ai~ of Possession: 71i e"H/v/C,,-4,V fg-;2,E -3D -fQ · inclusive dates signature title inclusive dates signature title inclusive dates title date lnst=uctions : Complete all applicable. information including signatures, and submit ~ith analysis request forms. I Rec e i p t f o r Sam pl es . ,~e sa~ples described below were collected .in connection with the administration,. c~force~enc, and documentation of the: l ) North Carolina Hazardous Waste Management Rules, 10 NCAC !OF ( ) ~orth Carolina Solid Waste Management Rules, 10 NCAC lOG . . ( ) Comprehensive Environmental Response, Compensati?n and Liability Ace (CERCLA) () Toxic Substances Control Act (TSCA) 15 U.S.C. s2601, ~ seq., ·specifically Section 11 of TSCA:, 15 U.S.C. s2610. Inspector's Name Inspector's Address !~ame of Firm Firm Address -:~m Owner, Operator, or Agent Title ·.•:,:· r-.. .:. ... --COLLECTED SAMPLE TYPE DUPLICATE S;...!-:?L::S SAMPLE •~<3:::R DATE TIME . WATER ·SOIL OTHER OFFEREDIACCE?T::O ! R:::JECTED ON-SITE i I I . Loc.;..rro!\ OF:-sr:-::: Rec_eipt for the· sample(s). descri~ed above is hereby acknowledged: Receipt/rejection of -duplicate O?=" split samples is hereby acknowledged: ... Signature of Inspector Signature of Fir~ o~ner, Operator, or Agent Title Title Co.::.-nents: ----------------------------------- .. N. C. G•epartment·of Human Resources Divisic:,n of Health Services ~ '.( .. ·:.·,: .. , , ·, , '· State Laboratory of Public Health Sf~PLE ANALYS,ES REQUEST P. 0 . Box 28047 -306 N. Wilmington Street Site Number _ __;1_3_-________ r __ · __ tI_:t_:,_: _';_'.,_::_, _,s;;~ld L ple Numbe, _ ___;:o_c_,...z.r/-=.cf._3:.;_,_~ _______ R_a_le-ig_h_, 2_1_6_1_1 Name of Site --'p'--._C_,-<...;;f3:;:;;._. _L=-q....,_n_,__d_;;t...;_· ..... >.t ...... _____ ,,,,lte Location wg v-ren Cou vcfyj ;9.ff.,,,, ,, Al C. Collected By __ L_tA._f-'-:8;.:.......------m~'-......, ~--~! /./ Date Collected .5" -~ -'7 () . Time ~ : S 0 Type of Sample: Environmental ✓ Groundwater ( 1) Concentrate __ Solid (5) __ Surface Water (2) __ Liquid (6) __ Soil (3) __ Sludge (7) __ Other (4) __ Other (8) LeG\.ch,q-fe 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 Comments Iv,£/ue11-I Total Parameter __ Silver __ Sulfates __ Zinc _Ph __ Conductivity _TDS _TOC -- -- -- -- -- -- Parameter -~B __ Methoxychlor __ Acid:B/N Ext. __ PCB's ~/1 ooo/nnYi ,.. Toxaphene _TOX __ Petroleum 77 _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/l0Omls __ Gross Alpha __ (MPN) Coliform Colonies/lOOmls __ Gross Beta ---- ---- Date Received 5 /9/90 'il' "1 Date Repmted 5'-~ 3 ~! Date Extta:~~Ol · Dare Analy,~-/'Jt-21 Reported By _ /Ztd.--, Lab Number 9 052~0 Dl-1:S3191(Revised~ ~ /:F{lt)L=-.-, 57) -005""~~ / Solid and Hazardous Waste (Review 7187) · :;_.) 0( / ' J 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 = 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. 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 Sciem:es: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. De}:)artment'of Human Resources Division of Health Services SAMPLE ANALYSES REQUEST State Laboratory of Public Health P. 0 . Box 28047 306 N. Wilmington Street Site Number 93- Name of Site PC.B. LctV\d~· t I Raleigh, 27611 Field Sample Number _.,,._O ____ o__._ff--"-'___:2)=·-;;_6 _________ _ Collected By Lq+fy ID# 057 Site Location ()} 0.. r-re "' {1 <-< ~ j Af-fo "'f fl C- -~-Date Collected .5;-~ -9 O Time 3 · o 0 Type of Sample: ~ental Concentrate oundwater ( 1) __ Solid (5) ___ Surface Water (2) __ Liquid (6) __ Soil (3) __ Sludge (7) __ Other (4) __ Other (8) 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/l0Omls __ (MPN) Coliform Colonies/lOOmls -- -- Reported By OHS 3191 (Revised 7185) 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 ~ 's __ Petroleum __ Endrin __ Lindane Results mg/ 1 Parameter Results mg/ 1 __ Methoxychlor ~o. a 116 I ::Il/1i!'I. ""'---Toxaphene ,, _2,4-D __ 2,4,5-TP (silvex) -- RADIOCHEMISTRY Parameter Results PCi/ 1 __ Gross Alpha __ Gross Beta -- -- Date Reporte~-r------------------ Date Analyzed :!!-L-s"-90 -,/P Lab Number ______ __._.9 .....,0'"'--C::.._.,2..,..__._5"""1 _____ _ , 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. 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 ,J\J<..J ..l..l..l .{"\..J ~U 11 ... L....f'\...J.\.UVU.J Y'i r\.J .L L l--.1,n.v:...... •• _,, L ..ur,./'\l'V l l Cha in of Custodv Record ' . Hazardous Waste Materials Location of Sampling: Company's Nam e Address Sollector's Name :,at;:.e Sampled Generator __ Storage Facility Other: ~pe of Process Generating Waste •0 ield Information :.2:d Sample :-.2 ~;\ of Possession: ~natt#h ~ ;£L y!:7/ VI.. (, signature signature .. i:: SU:. tS signature Transporter Treatment Facility __ Disposal Facility VLandfill Telephone Telephone _._('fl __ r ___ 9 ..... )_7_3_3_-_0_~_9 __ ..z_a...-=------ Time Sampled __________ ...,.... ____ _ llvd o/!l{o!!y-1:sf ·/ tle in CJJ.;ltl , t! 1/ -t-, l:. I Lo); ,_,L J_, title J i dates title inclusive dates ::itle date inst~uctions: Complete a ll applicable information including signatures, and submit ~ith analysis request forms. Receipt f or S2~plcs ,. . ,~e sa~ples described below were collected in connection ~i th t he ad mini s tration,., c~f orce~ent, and documentation of th e : l ) Nor~h Carolina Hazardous Waste Management Rules , 10 NCAC !Of ( ) North Carolina Solid Waste Management Rul e s, 10 NCAC lOG ( ) Comprehensive Environmental Response, Compensati?n and Liability Act (C~RCLA) ( ) Toxic Substances Control Act (TSCA) 15 U.S.C. S2601, ~ ~-, ·spe~ifically Section 11 of TSCA, 15 U.S.C. s2610. Inspector's Name Inspector's Address :~ame of Firm Firm Address ·:rm Ow~er, Operator, or Agent Title . ' ·.•:,:·i:-COLLECTED SAflPLE TYPE DUPLICATE S!-..!-:?L:::S SAHPLE LOG.TIO~ .. .;. ... -- '\•"::.r.:, ··--·" DATE TIME WATER ·SOIL ·- I i i ' Re~eipt for the sarnple(s) described above is hereby acknowledged: S:gna~ure of Inspector Title Co~nents : OTHER OFFEREDIACCE?T:::D ! R::JECTED ON-SITE OF:-SI~E I I I - Receipt/reject i on of duplicate or split s amples is here by acknowledged: Signa ture of fir~ o~ner, Op e r a tor, or Agent Ti tl e ... ,,.~•~ :,~i·;.~~.:--:;•:,:· .. < \\) 'td . ._JI/ (;_:_•~ / '•.,-' i...:,t,,.-:,'. / --~) ~/-..·. N ,, C. Depa'ctment of Human Resources Division of Health Services I -'2---\ SAMPLE ANAL YSR" Rij~yp1s,r . 1 ~\ -1 -~ ,J ,,1(,:. ' State Laboratory of Public Health P. 0. Box 28047 306 N. Wilmington Street Raleigh, 27611 \ . .... ... .;~..} I \ , ___ 9_3 __ · -----------Field SamN.e Number ----"O'--o~--'--'-~---------Site Number Name of Site f C. ~ L/},.,;j) ff LL Site Locat '61.l,i._..La~~~:£'..---1~eti.~~;J::_ _____ _ Collected By ,(u rz:t;lsnfMcJ.:5 ID# t?;/0~ Z Date Collected -~~--~~~{!: Type of Sample: Environmental ___ Groundwater ( 1) Concentrate __ Solid (5) __ Surface Water (2) __ Liquid (6) __ Soil (3) __ Sludge (7) ___!:::::_ Other ( 4) __ Other ( 8) Comments /,,f,CZc /H(F _ J //)/:tu ,F/l/~ INORGANIC CHEMISTRY Extractable, 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 _P&T:GC/MS zPDB __ Acid:B/N Ext. CB's _TOX __ Petroleum --__ Endrin --__ Lindane MICROBIOLOGY Parameter __ (MF) Coliform ColoniC$/100mls __ (MPN) Coliform Colonies/lOOmls ---- Date Received S-£1-'tot1¼) ~C--'8~ Date Exrr~,,a ~,r;;; Reported By 1-J/ d DHS 3191 (Revised /85) -LL a O 5;:< I 't - Solid and Hazardous Waste (Review 7187) er-/ Results mg/ 1 Parameter Results mg/ 1 __ Methoxychlor <(), oool 'DJJrY\. Toxaphene , , _2,4-D __ 2,4,5-TP (silvex) -- RADIOCHEMISTRY Parameter Results PCi/ 1 __ Gross Alpha __ Gross Beta ---- Date Reported --:c-::~--'f'--_3= . ...a./_-_p;__,:~'--------- l'Cl!Js Date Analyzed S-9 -t!jCJ 1/P 90.5219 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 = µg/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 he 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 ~n. , I 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. Di1poeition: 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 ordeted 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 ,J -Field Sample Number --""o_o__,:l/___,_7 ...... Z_;;:.Z_' =--------- Name of Site l!c ll J.4/l/Q ~/LL.. Site Location &~ c6'2 ' //#ZJA./ Collected By Lt, 771/fa ~;£-ID• cz~Z Date Collected = :;< ) 4t ',i0/2~o Time 3' .:, S Type of Sample: Environmental Comments __ Groundwater ( 1) Concentrate __ Solid (5) Ent/ £/1/' T -/Ir fe ,vJ> __ Surface Water (2) __ Liquid (6) __ Soil (3) __ Sludge (7) _iL_ Other (4) __ Other (8) INORGANIC CHEMISTRY Extractables Total Parameter Reaults 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 m.:/ l Parameter Results mg/1 _ P&. T:GC/MS --=7!DB __ Methoxychlor __ Acid:B/N Ext. __ PCB's <O, tJ00/1)/U!\ k __ Toxaphene _TOX __ Petroleum II _2,4,D --__ Endrin __ 2,4,5,TP (silvex) --__ Lindane -- MICROBIOLOGY RADIOCHEMISTRY Parameter Parameter Results PCi/ 1 __ (MF) Coliform Coloni~/lOOmls __ Gross Alpha __ (MPN) Coliform Colonies/lOOmls __ Gross Beta -------- Date Received !) _, 'f-CZ{) IU{J Date Reported ...-7"""':::-r----------------~C(fr P~~ Date Extracted 5-f--9'01'E,MW Date Analyzed S-"9-101/P 9 0 5 2 2 0 Reported By ------------------Lab Number _________________ _ n11s J 191 (Revised 7 /85 ! .I Haza rrl , w~ · ·, :,. , 7187) . ' Purpose: Enforcement and compliance with the N. C. Solid and Hazardous Waste Management Rules. Preparation 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 = µg/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 odc;,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 ordeted 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 ---''-------------...------Field Sample Number ---""U_L..;;..()_$-:"---'. 7__.Z'--.c..3_· ________ _ ? /) ) Name of Site J.:>' L ,e,: 1 G · · I/ Site Location )4. r e ,1 tl:Ju. '"I A Collected By ,~H,A,e 11S ID# os-~~;:?.DateCollected _:? 70 Time 2: /_<; Type of Sample: l:"/c-17/ov~ Environmental Concentrate ___ Groundwater ( 1) __ Solid (5) __ Surface Water (2) __ Liquid (6) __ Soil (3) ___iL Sludge (7) __ Other (4) __ Other (8) 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. --.0CB's <0,[0 f2P-nL __ 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 __ 5_· -_'-/-'-·---~:....'();___;_;11(A}'---=--· _______ _ Date Extracted _/Jc_p_,,_s_-~:i.._lf_.____.-~--=o~ll.........,,4._ ____ _ Date Reported ,;;;:--=-"""7""----------------Pc.JfJ s- Date Analyzed 5-3/-90 vP Reported By 905221 -------------------Lab Number __________________ _ OHS 3191 (Revised 7/85) Solid and Hazardous Waste (Review 7187) Chain of Custodv Record .. Hazardous ~aste Materials Location of Sampling: Generator __ Transporter Tre~tment Facility Company's Name Address :,at;e Sampled __ Storage Facility Other: __ Disposa 1 Fae i 1 i ty _K::'.~i and fill Telephone Telephone (7/'.{) 73 ~ -0 G ;?,;z Time Sampled_~-------._,_ ___ _ ::pe of Process Generating Waste . -:r;x ,,-c. ic)a..sl-t? Lo. V\.cl./J 1/ ___ ......., _____ ....._ _______ _..;. _____________ _ ~ield Information :.e'.:.d Sample ~o. CC'·1/-77( ~=~~ of Possession: ·/ t{i/cle J inclus'ive 1dates inclusive dates .".csu~ ts · reported ~4~1£ tit le date lnst~uccions: Complete all applicable. information including signatures, and submit ~ith analysis request forms. .. . ' '! t Receipt for Samples . ,~e san?les described below were collected .in connection with the administration,. c~forcenent, and documentation of the: ( ) Nor~h Carolina Hazardous Waste Management Rules, 10 NCAC !Of ( ) ~orth Carolina Solid Waste Management Rules, 10 NCAC lOG ( ) Comprehensive Environmental Response, Compensati?n and Liability Act (C~RCLA) ( ) Toxic Substances Control Act (TSCA) 15 U.S.C. S2601, ~~-,·specifically Section 11 of TSCA:, 15 U.S.C. ~2610. Inspector's Name Inspector's Address !\ame of Firm Firm Address ·i=m Owner, Operator, or Agent Title ·.•:,,· . .. .;. --COLLECTED SAf1PLE TYPE DUPLICATE s;.2-:?L::s SAMPLE . ·:.:3::R DATE TIME . HATER ·SOIL OTHER OFFEREDIACCE?T::D ! R:::JECTED ON-SITE i I 1. I . LQC,;..TIO!\ or:-sr:-:: Re~eipt for the· sample(s)_descri~ed above is hereby acknowledged: Receipt/rejection of -duplicate or split samples is he reby acknowledged: S£gnature of Inspector Signature of fir~ Owner, Operator, or Agent Ti tle Title Co..:.1'lents: ----------------------------------- N. C. Department of Human Resources Division of Health Services SOLID WASTE BRANCH 401 OBERLIN RO,l\D SAMPLE ANALYSES REQUEST State Lab 'ratory of Public Health - P. 0 . Box 28047 06 N. Wilmington Street Raleigh, 27611 Site Number _ ___.C/...;;~;...__-____________ Field Sample Number __ ...... 1/___z8;..::/_2-__________ _ Name of Site fj~ . L~nd_~ I/ Site Location Wa,re.n,, au,, tr; A/lion/ N, c. CollectedBy '-'-17sk;h01.s IDIIIJS'J/ol,::z_ DateCollected Apn·I /91 l'tt/o Time 9!,Jo I 7 t Type of Sample: Environmental _L.. Groundwater ( 1) Concentrate __ Solid (5) __ Surface Water (2) __ Liquid (6) __ Soil (3) __ Sludge (7) __ Other (4) __ Other (8) INORGANIC CHEMISTRY Extractable8 Parameter Results mg/ 1 Parameter Re8ulu 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/ l Parameter Results mg/ l Comment8 Total Parameter __ Silver __ Sulfates __ Zinc _Ph __ Conductivity _TDS _TOC -- -- -- -- -- -- Parameter _P&T:GC/MS "v{DB __ Methoxychlor __ Acid:B/N Ext. __ PCB's <a, onn7-nn ... __ Toxaphene _TOX __ Petroleum J 7 _2,4-D --__ Endrin __ 2,4,5-TP (silvex) --__ Lindane -- MICROBIOLOGY RADIOCHEMISTRY Re8ult1 mg/ 1 Results mg/1 Parameter Parameter Results PCi/ l __ (MF) Coliform Colonies/l00mls __ Gross Alpha --(MPN) Coliform Colonies/lO0mls __ Gross Beta -------- Date Received t./--:20-9 0 77/J r: Date Reported .=,.,,---·.-S:,._-_-¥-..!._--,Lf--'-O'-".,...,...-,,..------ 'P.()_E ~ ---~ -pc.-,,,~ ~ G;d.,,Jm3 Date Extracted l./::~~4 -9D~r1/2~f-;t _ ·· -·D ate Analyzed Lf-~'f-9o ~5043 ~t)~t) Reported By ;;,(.--;. <-K v(_....--Lab Number _________________ _ ~t:IS_31~1JRevised7/8~ tF<?O 5'7:J(f-3 --c; 0 ~u S-6 -. . 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 Field Sample Number _ ..... OO~'t+...r..fiu.l...,3..-L----------- Name of Site --.J---=C-Oo"-__,_.;....::..-=--..:.=...;,..;1/-c....· ,_I._________ Site Location w a.m,11.,, a c.c..., :! j Al¼n/ /'I. c. ___ {)_,_:Z._ Date Collected Apr// /9/ /'t't/0 Time 9:go Ali? Collected By Type of Sample: Envir?mental _1l_ Groundwater ( 1) Concentrate __ Solid (5) __ Surface Water (2) __ Liquid (6) __ Soil (3) __ Sludge (7) __ Other (4) __ Other (8) Comments /JIJ W-2, 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 <o.oool~ __ 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 lf-JO-C/0 7U.AJ-~s Date Extracted 4 -24:--C/oVP Date Reported .--:::-.:;;-::,----------:,r,.-,,...,,..,,-,-------6' ~-S 0,('f/U 3 Date Analyzed 4 -ol_'-/-90 1/P ,y :;J 4 oM Reported By --------------Lab Number -------=9=---==-0-=5=:..:Q=----=4=----4~----- 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) c;ontainer (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/l000g = 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. 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 C/ ,3 -Field Sample Number __ __,s.½~'&::..:~..,..¥ _________ _ Name of Site a~ . Lcv,d_~ I I Site Location w~mn.-t:J«.-.. !l j Al¼nl ~/. c. CollectedBy ~ /sk;;b01..s ID#t)Se,/o1,2 Date Collected A-pr,·/ /9. ;9qo Time Cj.'/() r r 1 , Type of Sample: Envi1nmental -.lL-Groundwater ( 1) Concentrate __ Solid (5) __ Surface Water (2) __ Liquid (6) __ Soil (3) __ Sludge (7) __ Other (4) __ Other (8) Comments Mu# :> 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 Re1ults mg/ 1 Parameter _P&T:GC/MS ---v!DB __ Acid:B/N Ext. __ PCB's _TQX __ Petroleum --__ Endrin --__ Lindane MICROBIOLOGY Parameter __ (MF) Coliform Colonies/lOOmls __ (MPN) Coliform Colonies/lOOmls ---- Date Received ",1--;}.()-CjO 7U..l.T "'P9-K3.s- Date Extracted 4: -6'-/: -90 :::VP Results mg/ 1 Parameter Results mg/1 __ Methoxychlor <: o. noo /"ffn,... _ Toxaphene I' _2,4,D __ 2,4,5,TP (silvex) -- RADIOCHEMISTRY Parameter Results PCi/ 1 __ Gross Alpha __ Gross Beta -- -- Date Reported=-,,;-;,----------------- Date AnalyzeW~¥::901/P Reported By --------------Lab Number ____ 9_0_,_5_0_4___..:.;;5~------ DHS 3191 (RcviRd 7/85) C' -11 _J --1 •' _I . '• 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/..;;~--------------Field Sample Number ----'-¥'._..B_l..,;;;;'5'----------- Name of Site B.~ , L~nd_li-I/ Site Location Wamn,, au., tr j Al¼nl N, c. Collected By Ltt~sk;;h;;,.s ID#l)St:J/pt,:z_ Date Collected A-pn·I 19, /9't/O Time 'l: Z..o T l t Type of Sample: Environmental L Groundwater ( 1) Concentrate __ Solid (5) __ Surface Water (2) __ Liquid (6) __ Soil (3) __ Sludge (7) __ Other (4) __ Other (8) Comments INORGANIC CHEMISTRY Extractable& 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 ---v{DB __ Methoxychlor __ Acid:B/N Ext. __ PCB's < Q,l'JQ.O/ff'Y'-, __ 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 L../--;;J.O-C/ 0 7l.,I.J.r -Pi.k5s Date Extracted 4:-;l 4--9 b·1/P Date Reported ..-.....-:r----------------ptJSt Date Analyzed !L -~'f-901/P Reported By ---------------Lab Number _____ ___,.;,9;....0_5_0_4_6 _____ _ OHS 3191 (Revised 7185) r"' 1• I I ., 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/...;;;~--------------Field Sample Number-. _____ 0 .... ~'""""~"""---------- Name of Site B.~ . LA,,,d_~ II Site Location tv'amn,, alA.f,\ 2'; Al¼n/ ,N • c. Collected By E,.~sk;b;,.s ID#l)SeJ/t;,2 Date Collected Apn·/ /9. /'l't/0 Time II-l.5 I I ~ I 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 Extractablea 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 ~DB __ Acid:B/N Ext. __ PCB's _TOX __ Petroleum --__ Endrin --__ Lindane MICROBIOLOGY Parameter __ (MF) Coliform Colonies/lOOmls __ (MPN) Coliform Colonies/lOOmls ---- Date Received 4-;J.1)-q O --n,w-/?C.IJA .. Date Extracted , -;? <../ -CJ() :/P {'i W Results mg/ 1 Parameter Results mg/ 1 __ Methoxychlor < o . 000/--rna.,. Toxaphene ' , _2,4-D --2,4,5-TP (silvex) -- RADIOCHEMISTRY Parameter Results PCi/ 1 __ Gross Alpha __ Gross Beta -- -- Date Reported~...,,.---------------- Date Analyzed'!lt.'l-90Y'f' .., Reported By ----------------Lab Number ______ 9_0_5_0_4_7 _____ _ OHS 3191 (Revised 7185) ------·------ N. C. Department of Human Resources State Laboratory of Public Health Diviaion of Health Services SAMPLE ANALYSES REQUEST P. o. Box 28047 306 N. Wilmington Street Raleigh, 27611 Site Number CJ .3 -Field Sample Number ___ ',L..:......::.~..s.1/--,,...7 ________ _ Name of Site 8.~ . La."'d_~ I I Site Location Warre.& a~ 1' j di¼..>'!~ N, C. Collected By Ztt~sk;;hett.s ID#l)St:J/()/,2 Date Collected A-pn·I 19, l'{t/0 Ti~j ; 6J> I I I J Type of Sample: Environmental __ Groundwater ( 1) Concentrate __ Solid (5) _K_ Surface Water (2) __ Liquid (6) __ Soil (3) __ Sludge (7) __ Other (4) __ Other (8) Comments /?.C .D.S . 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 ~DB __ Acid:B/N Ext. __ PCB's _TOX __ Petroleum --__ Endrin --__ Lindane MICROBIOLOGY Parameter __ (MF) Coliform Colonies/lOOmls __ (MPN) Coliform Colonies/lOOmls ---- Dote Received 4-::W-90 ~ Date Extractf'cict3q _ e:l. lf -CJ O ::tl,e, fv1 Results mg/ 1 Parameter Results mg/ 1 __ Methoxychlor <n.onolDDm __ Toxaphene 77 _2,4-D __ 2,4,S-TP (silvex) -- RADIOCHEMISTRY Parameter Results PCi/ 1 __ Gross Alpha __ Gross Beta -- -- Date Reported """'"2'1i"'.,----------------- Date Analyzed p~4'-9011'AB 90SUZ. Reported By ------------------Lab Number _________________ _ OHS 3191 (Revised 7/85) -•-. . -··· 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/....;;~=----------------Field Sample Number _-J.,.f ..;:;B,-=-1/. .... 'Jc,__ _________ _ Name of Site a~ ( Lctl'\d__.(;, I/ Collected By J;.~sk;;het,.s ID#f)S"~/pr,:z. r I Type of Sample: Site Location Wa.m& au,, 1' j Al¼m/ N, c. Date Collected lt:jPn·I /91 l'{t/0 Time /O J 2..-G,, Environmental Comments __ Groundwater ( 1) L Surface Water (2) __ Soil (3) Concentrate __ Solid (5) __ Liquid (6) __ Sludge (7) __ Other (8) U .T Y S: __ Other (4) 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 --v{DB __ Methoxychlor __ Acid:B/N Ext. __ PCB's < /J , Ot:J0/:111m1 __ Toxaphene _TOX __ Petroleum I I _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 t..J-;l.O-qQ -rwr Date Extracte~c.6q-cZ l/ -90·1/g, A1 r,J Reported By _________________ _ Date Reported..c-r___,,__ ______________ _ Date Analyzef ~ii-'/01/P Lab Number ____ S_{_J_5_0_4_9 ______ _ ----·--------- 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/_~----,----------- 'l-819 Field Sample Number _ ____.7'-4..::;.8_2_2:..__ __________ _ Name of Site lJ.~ , Lt:tl'li_4 // Collected By l,.~.Sk;/,,o,.s ID#bS'I ftJ/,2 I I Site Location Wamn.-au., ;r j Al¼n; N, C. Date Collected A:pn· / I 9 1 /9 't/0 Time /c>: Z.6 Type of Sample: Environmental Concentrate __ Groundwater (1) __ Solid (5) / --1..L Surface Water (2) __ Liquid (6) __ Soil (3) __ Other (4) __ Sludge (7) __ Other (8) Comments INORGANIC CHEMISTRY Extractables Total Parameter Results mg/ l Parameter Results mg/ l Parameter Re8ults 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 _P&T:GC/MS 7PDB __ Acid:B/N Ext. __ PCB's _TOX __ Petroleum --__ Endrin --__ Lindane MICROBIOLOGY Parameter __ (MF) Coliform Colonies/lOOmls __ (MPN) Coliform Colonies/lOOmls ---- Dote Received ~-~ = Date Extracter'Wf:_ o< ~ ii= Reported By I?HS 3191 (Revised 7185) Results mg/ l Parameter Results mg/ 1 __ Methoxychlor </J, 0 0 0 /-Df)w. i.., __ Toxaphene ---,---, _2,4-D --2,4,S-TP (silvex) -- RADIOCHEMISTRY Parameter Results PCi/ l __ Gross Alpha __ Gross Beta -- -- Date Reported ,-::-:-::-:------------------ Date Analyzef Cff ~,7_ S-901/P Q 905lfu Lab Number __________________ _ .,. N. C. Department of Human Resources Dlvlalon of Health Services SAMPLE ANALYSES REQUEST State Laboratory of Public Health P. 0. Box 28047 306 N. Wilmington Street Raleigh, 27611 __ '/ ..... ~-----,----------Field Sample Number __ _.V__._7-9_1.7,.._ ________ _ Name of Site a~ , Lcv,d_4 !L Site Location Wamne i:Zu"' _! j Al¼n/ N, C. Site Number CollectedBy &. /Skp!,et,.s ID#bS-9/ot,2 DateCollected Apr/I /91 /'('t/O Time 11-'.Jo 7 I t 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 Extra.ctablea 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 ---v;oB __ Acid:B/N Ext. __ PCB's _TOX __ Petroleum --__ Endrin --__ Lindane MICROBIOLOGY Parameter __ (MF) Coliform Colonies/lOOmls __ (MPN) Coliform Colonies/lOOmls ---- Date Received J-/--,J.O-qo ~ Date Extractef cge:...3 0 -'IO 16 Results mg/ 1 Parameter Results mg/ 1 __ Methoxychlor ~OJ /0 H~rn .. Toxaphene I I _2,4-D __ 2,4,5-TP (silvex) -- RADIOCHEMISTRY Parameter Results PCi/ 1 __ Gross Alpha __ Gross Beta -- -- Date Reported _-=--:-----------------Pc.BS Date Analyzed 5 -1-9.t:J 1/p . Reported By 91JSIT55" ------------------Lab Number _________________ _ OHS 3191 (Revised 7185) Solid and Huardoua 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 _ _..:,.'/...;;~--------------Field Sample Number --------'~~~-z.._,7._I ________ _ Name of Site {j~ I Lct.l'\d_//-! I Site Location Wa.mn,, au,,. 2' j Af!lon~ N, c. Site Number CollcctedBy &,. /Sk~ho,.s ID#IJSt:J/41,2 DateCollected Apn·/ 191 /'/'t/0 Time 7'.'>D r l t Type of Sample: Environmental __ Groundwater ( 1) __ Surface Water (2) / Soil (3) __ Other (4) Concentrate __ Solid (5) __ Liquid (6) __ Sludge (7) __ Other (8) RcDs 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 ---v;DB __ Methoxychlor __ Acid:B/N Ext. __ PCB's <o , I l'l DDM Toxaphene _TQX __ Petroleum I , _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' L/--2()-90 ---rl,lJ,.F: pCb Date Extracted 'I -30 -Cf O 1/P Date Reported :7""----------,=---=-------·pc.JfJs t4t!J/1\5' Date Analyzed 5'-/-;~;,:: .5:-2--lt()l3/) Reported By ----~-------------Lab Number _________________ _ ~~-s. 3l~~!Rev~d 7/85) 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,_~_-____________ Field Sample Number --'-µ:....!7--1....~-1=,~;;....._ _________ _ Name of Site r..~ , La..~d_./;-f I Site Location Wary~n, au,, :t j Al¼nl /'I. C. Collected By LWff'fj .skf b.,, .S ID# t>S-1µ~ ;2. Date Collected lt;m· / I 9 1 /'?110 Tim• At·· 2.¢ Type of Sample: Environmental __ Groundwater ( 1) __ Surface Water (2) -----tL_, Soil ( 3) __ Other (4) Extractablea Concentrate __ Solid (5) __ Liquid (6) __ Sludge (7) __ Other (8) (~ r I u ,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 Comments Total Parameter __ Silver __ Sulfates __ Zinc _Ph __ Conductivity _ms _TOC -- -- -- -- -- -- Parameter 7-oB __ Methoxychlor __ Acid:B/N Ext. __ PCB's <,., , IO ..,,,,.,,.,,.. __ Toxaphene _TOX __ Petroleum I I _2,4~0 --__ Endrin --2,4,S~TP (silvex) --__ Lindane -- MICROBIOLOGY RADIOCHEMISTRY Results mg/ 1 Results mg/I Parameter Parameter Results PCi/ 1 __ (MF) Coliform Colonies/ lO0mls __ Gross Alpha --(MPN) Coliform Colonies/ 1 OOmls __ Gross Beta -------- Date Received l-/-;:){)--90 77..W- Date Extract:i~ 3 0 -9 /J 1/P Reported By Date Reported.......:-=--.----------------- Date Analyzedp~}-90:::t/P --------------Lab Number 9 0S05"lf- DHS 3191 (Revised 7/85) ..... .. . . ·-. 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,_~;___-____________ Field Sample Number __ __,_f:,_,9._....;2;::;..._2..=---------- Name of Site E...C§. I L&:4.1'\i.G I I Site Location Wam,n,, al,f.., 1' j A£/onl N, c. Collected By zw11y7.skf'h"1 .s ID# os-'9f t. 2 o ... Collected trn· I 19 I /'l'l O Time /0 ll.:r Type of Sample: Environmental Comment8 __ Groundwater ( 1) __ Surface Water (2) _..L. Soil (3) Concentrate __ Solid (5) __ Liquid (6) __ Sludge (7) __ Other (8) UL D 5 __ Other (4) INORGANIC CHEMISTRY Extractable8 Total Parameter Results mg/ 1 Parameter Re8ult8 mg/1 Parameter Re8ult8 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 Results mg/ l Parameter Results mg/ l _P&T:GC/MS ~DB __ Methoxychlor __ Acid:B/N Ext. __ PCB's <o! /.O .pp.M., __ Toxaphene _TOX __ Petroleum ,- _2,4-D --__ Endrin __ 2,4,5-TP (silvex) --__ Lindane -- MICROBIOLOGY RADIOCHEMISTRY Parameter Parameter Re8ults PCi/ l __ (MF) Coliform Colonies/lOOmls __ Gross Alpha __ (MPN) Coliform Colonies/lOOmls __ Gross Beta -------- Date Received L/ -;)..1)-qo 71MJ: peia~ DateExtracted 1/-30 -901/P Date Reported =--=-cr----------,-~~------p~} <.i}C,,//H5 Date Analyzed S-/-901/P 5---.2~/J~i) Reported By _________________ _ Lab Number ____ 9_0_S_0_5_3 _______ _ OHS 3191 (Revised 7185) (""_I, I 1 '1 1' I N. C. Department of Human Resources Diviaion of Health Services SAMPLE ANALYSES REQUEST State Laboratory of Public Health P. 0 . Box 28047 306 N. Wilmington Street Raleigh, 27611 Site Number ---"C/-~---------------Field Sample Number __ .._~.J,'E~ZO-=----------- Name of Site B.~ . L~~d_/;-I I Site Location w a.mn,, au., 2' j Al¼n/ ~-C. CollectedBy ~~sk;t,e,,.s ID#bSt:J/t;r,2 DateCollected Apn·I 19, 19'10 Time /IJ~$;) / I t Type of Sample: Environmental __ Groundwater ( 1) __ Surface Water (2) _L_ 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 v-;DB __ Methoxychlor __ Acid:B/N Ext. __ PCB's < ~-I n ,.....,...,""' __ Toxaphene _TOX __ Petroleum l I _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 Receive~ :; t./--;).{)-qo -n,v._;- Date Extracted cz; _ 3 0 -tj'(J 1f1) Date Reporte'i~..,...-;=r:r _______________ _ Date Analyze~ J--9(21/P Reported By ---------------Lab Number ____ 9_0_-5_0_6 __ 1 _______ _ DHS 3191 (Revised 7185) -.Ii __ .J ------·-'--•~ tn ---1-.. .., / -,, N. C. Department of Human Resources Dlvialon of Health Services --·. ---------------------- SAMPLE ANALYSES REQUEST State Laboratory of Public Health P. 0. Box 28047 306 N. Wilmington Street Raleigh, 27611 Site Number _--.:...9,~~--------------Field Sample Number -----.f..._.1__._i .... ~c.--------- Name of Site e...~ I L~"'d_~ I I Site Location w~m& au.,. !l j Af!/on,. N, C. Collected By ZWMY/ skf b. OJ .s ID# os-•1)'t>, Z Date Collected 8f>o· I I 9,. /'{90 Tim• /CH .sS Type of Sample: Environmental __ Groundwater ( 1) ----;;;:7 Surface Water (2) _V __ Soil (3) __ Other (4) Concentrate __ Solid (5) __ Liquid (6) __ Sludge (7) __ Other (8) J.5//Crt&-a Ct/24e co l}L Comments (c>LL-€ C 7lt:J'1J INORGANIC CHEMISTRY Extractable, 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 _P&T:GC/MS ~DB __ Acid:B/N Ext. __ PCB's _TOX __ Petroleum --__ Endrin --__ Lindane MICROBIOLOGY Parameter __ (MF) Coliform Colonies/lOOmls __ (MPN) Coliform Colonies/lOOmls ---- Date Received Lf-;;J.D-90 7UJ .. r Prf-~ Date Extracted ~.3 0-90 :tP Reported By _________________ _ Results mg/ 1 Parameter Results mg/1 __ Methoxychlor <O,lO~ __ Toxaphene _2,4,D __ 2,4,5,TP (silvex) -- RADIOCHEMISTRY Parameter Results PCi/ 1 __ Gross Alpha __ Gross Beta -- -- Date Reporte~ci....-::-=-r----------------- Date Analyze:~}/-901/P_ 9USU-5~ Lab Number --------·---------- Chain of Custodv Record Hazardous Waste P.cterials Location of Sampling: Generator Transporter Treatment Facility __ Storage Facility Other: __ Disposal facility l,//'Candfill Company's Name Telephone Address ~ o l lec tor's Name ___ ff>0_ ..... /6,..,,6 ..... ~-· -=L_u_--+-1 ...... F .... '---_'-'+-/...:.·----Telephone ~<~11~y_._) __ ?_S_3_-_C_?_b_9_z_.;;;,.... ___ _ :,a~e Sampled / / !gnature o/'d o L!i.D . I ~pe of Process Generating Waste -~ield Information :. c:::. d Sample ~0-t/Yl2 {/p/3 . ftl'7 yg;;.o I :-.2 ::.:1. of Possession: signature Time Sampled_--'---------""T------- f'c' 6 </£1/ c/86-f/S'l,6 t./81 7 19/8 I t//?2 _/ p;&zz Y79p L/71 7 t'7J8 title title inclusive dates title inclusive dates title date lnsc=uctions: Complete all applicable information including signatures, and submit ~ith analysis request forms. Receipt for S3m o les 7~e sa~?les described below were collected in connection ~ith the a dminist ration,. c~fo~ce~ent , and documentation of the: l North Carolina Hazardous Waste Ma nagement Rules , 10 NCAC !O F ( ) North Carolina Solid Waste Hanagern~nt Rules, 10 NCAC lOG ( ) Comprehensive Environmental Response, Comp ensation and Liability Act (CERCLA) ( ) Toxic Substances Control Act (TSCA) 15 U.S.C. S2601, !:....!:_~-,·spec ifically Section 11 of TSCA, 15 U.S.C. s2610. Inspector's Name Inspector's Address '.~a me of Firm Fi rm Address -~rm Owner, Operator, or Agent Title -_,::,,·c-.. ~. _...., COLLECTED SAHPLE TYPE DUPLICATE S:'-~-:?L"::S SAl-1PLE ·>:3:::R DATE TIME WATER ·s011 OTHER OFFERED IACCEPT::D ! R:::JECTED ON-SITE : I I I i I ; I I - I : - ! I LOG.TIO~ Of:-SI~E - --- ReC:eip t for the sample(s)_ described above is hereby acknowledged: S:gnature of Inspector Title Co.:::nents: Receipt/rejection of duplicate or split samp les is hereby ackno~ledged: Signature of fir~ o~ner, Operator, or Agent Title ---------------------------------------- ... s%± >' Sv ~;r {v,1J N. C. Department of Human Resources Division of Health Services SAMPLE ANALYSES REQUEST Collected By l(, CI:;--5 ~ /1 , , f\ Type of Sample: Environmental ___ Groundwater (1) ___ Surface Water (2) __ Soil (3)- --Other (4) ID# c7nce trate s ~ C 1'0 ~ ~-S6lid (5) __ Liquid (6) __ Sludge (7) __ Other (8) I £ ; c ,_. + , I {-f he 7 P / ,'-q t2 Ui 5t2 m;/e__ ) Q ? -I-, o r, a J t1 -z...,e fo r --J h e__ o J /2 e rs 1 INORGANIC CHEMISTRY Extractables Parameter Results mg/ 1 __ Arsenic __ Barium __ Cadmium __ Chromium __ Lead __ Mercury __ Selenium __ Silver -- -- ' ---· ........ -- -- Parameter Results mg/ 1 ~T:GC/MS 1d:B/N Ext. LTOX . J ( J,.,_ / n r o b,f--Z.c, c. u c,· L r /\/o r obcr1 7AJt .. H1 0rr~,L c1c;<A ,,/ .., vc, ~ ·1, r--,7'. I C1n1 · o ~),r:_,-ccrv,f)(>vn,/< \,J 1-, IC" TV\, 9 h T < 1--,.. , ,1 u o i h, Ar ;. J, ru ,MICROBIOLOGY ·~ I . -; ~·t ' er I '7 _:, J __ ':, Parameter __ (MF) Coliform Colonies/lO0rnls __ (MPN) Coliform Colonies/lO0mls APR l 9 1990 Reported By OHS 319! (Revised 7/ ) Snlid 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 ~B __ PCB's __ Petroleum __ Endrin __ Lindane Results mg/1 <01. LO :PPM_ r Parameter __ Gross Alpha __ Gross Beta Parameter Results mg/I __ Methoxychlor __ T oxaphene _2,4-D __ 2,4,5-TP (silvex) -- RADIOCHEMISTRY Results PCi/ 1 s.s: p>.t N. C. Department of Human Reso urces Division of Health Services <5 u ;,o-P r SAMPLE ANALYSES REQUEST State Laboratory of Public Heald P. 0. Box 2804. 306 N. Wilmington Sere( Site Number Name of Site Collected By Raleigh, 2761' _.,_/1-'-V.-"'G"'--'-Q_,____r.:;;_, &"-. v_,'l_~_-·_·,D-";=l,~/i~(_,., _?_> __ Field Sample Number _/_di_· _·6_~_("_5~-------- 17 ·" ,,') i .. ! ,,/'•. ' / ,1. -0 / ' r '--· r ) '-· c., ,\ 1 Site locarion ; ,,.,.., · .5 ,-; :-' ) ,, i Type of Sample: Environmental ___ Groundwater ( 1) ✓ Surface Water (2) __ Soil (3)- --Other (4) Extractables ID# __ !...J~1 ~/ __ Date Collected . =-/ j ) f? ) Cj (; I I I Co~c __ Solid (5) __ Liquid (6) __ Sludge (7) __ Other (8) A-S-i Comments l et;, .. ,;~, _(_ (- ) Q f-+ I G/ i1 {,I J 1./ -z_,e INORGANIC CHEMISTRY Total Parameter Results mg/1 Parameter Results mg/1 Parameter __ Arsenic __ Arsenic __ Silver __ Barium __ Barium __ Sulfates __ Cadmium __ Cadmium __ Zinc __ Chromium __ Chloride _Ph 1---Lead __ Chromium __ Conductivity __ Copper _TDS 1 __ Mercury ' __ Selenium __ Fluoride -------__ TOC __ Silver __ Iron -- --__ Lead -- --__ Manganese -- --· -__ Mercury --·-· ·- --__ Nitrate -- --__ Selenium -- ORGANIC CHEMISTRY Parameter Results mg/1 Parameter Results mg/1 Parameter ~T:GC/MS ~B __ Mechoxychl or Acid:B/N Exe. __ PCB's <Ot.10:pp.~ __ Toxaphene TOX . . __ Petroleum _2,4-D , ,7 ( J"> i o r u b, r L-O , c_ ,, • , J __ Endrin __ 2,4,5-TP (silvex) .LL_ ( I" Io r o o t n Z-0 ,,_,Ji" ; ,,, l ct l, · , ;\ __ Lindane -- ,/ CA.~,,~~t··rc/?f;l e ,.--(~ L,;1''1.'~·:1.J/\,; < RADIOCHEMISTRY Results mg/1 ---- Results mg/ 1 Parameter Results P C i/1 __ (MF) Coliform Colonies/lO0 mls __ (MPN) Coliform Colonies/lO0mls APR 1 9 1990 8 n Date Received -=c,=--,--------N _________ _ 1'¢6;- Datc Extracted f./.-2_3··1/{}j(P 4--.lS-'lO AA Re ported By OHS 319 I ( Revised 7185) __ Gross Al pha __ Gross Be ta Dace Reported A PG!3 "s f3 µ Date Analyzed l/-2,3-10--VP 5-J-1ot,f) on-:-:-01 fJ ~j • •. J , . .}) .....-.. Lab Number () J fl) 71 N. C. Department of Human Resources Division of Health Services ..., --= r S uf-Pr SAMPLE ANALYSES REQUEST State Laboratory of Public Heald P. 0. Box 2804- 306 N. Wilmington Scree Raleigh, 2761 _:_:/i,,c_/c_-' ':....c()c....c__,-;:;_, K=-· C'-)-~_~o_,=:1=----.cli=0_, ---__ -; __ Field Sample Number __ l _"o_-c_, _(c_f ______ _ Site Number Name of Site ( C , ~-'--· '. :, ,, ,,) I', . l J ID# .1_, i I DaStieteCLoolcleac.ttieodn ::./~,.,.,-_,J· ,)So,,:; :..),/ ;,a~1 c(: .... ,l Y1/:, r r ,, ,·: 1 n r.< ) ri Jc '· ' Time AM Collected By //, ( ):/ :: }. /-, f\ --..; _ o _ t__ ' "'-'---'--'-"-'---'-"--'---'----'--'--'--------~~--I ' I Type of Sample: 8-b ----. j Environmental ___ Groundwater ( 1) ___ Surface Water (2) __ Soil (3)_ __ Other (4) Concentrate ( I c.rc,:i-> -J ~ (5 ) __ Liquid (6) __ Sludge (7) __ Ocher (8) Comments I ( ..... , , I \ ,.-_, ;' :1/ ) Q { f , Cf /\ o J l/ '2---e fo r ; n ,-. (. -i) J I j , 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 ~T:GC/MS vfr?B __ Methoxychlor Acid:B/N Ext. __ PCB'.s < o. Io p;l./l\.J __ T oxaphene ,/ ~~~i orobf'lc-,c.o ,,·J __ Petroleum _2,4-D __ Endrin __ 2,4,5-TP (silvex) ,/ ( l\ Jo r o C 11 2-0· .... J./'J rr,1, c Ci t ,· r/~ __ Lindane ----'1 ~ c, "·1 , Fr,, I . ', , (1 n Li C· ! t. c ,.-C<;rv,1'<'c't11f < -, ·v.-· T· 1~ I"'\ TV\,' LJ /' ..- < f-/ . ,:-, !, () ; ,_:_;,/, j, /< I a¥ICROBJQLOGY RADIOCHEMISTRY Results mg/1 Results mg/ 1 J ! , ·--t I \ LI / I.../ _) / -~ Parameter · Parameter Results PCi/ 1 __ (MF) Coliform Colonies /l00mls __ (MPN) Coliform Colonies/l0Omls APR 1 9 1990 B ,(\ Date Received ~~~------=~J.Y'----------- Da re ExcractedPff..J..3-90::V? B/JIA Reporced By OHS 3 I 9 I ( Revised 7185) t"" .\: l •-J u ___ p,.:_,.,.. \YI-,.,..,.. f'Q,...,j,,.u, 7 /P,7) __ Gross Alpha __ Gross Beta Date Reported ...--,.--=-,--------~~--------1' Cl3 s 13 /J A Date Analyzed Lj-:23-90-1/P S-J-qt !3£). Lab Number S_j ►" -p I N. C. Department of Human Resources Division c f Health Services S u,o--Pr I SAMPLE ANALYSES REQUEST State Laboratory of Public Hcalt P. 0 . Box 2804 306 N. Wilmingwn Stm Raleigh, 2 761 --'--'A'--1~-=G~O,____c;;-'CI ~-0-~ __ ,-._o-'-':l=--~lt~~,_~'_-=-: __ Field Sample Number __ \_~_-_C=J-0,-..'--]....,____ ______ _ Site Number Name of Site /7/.:-_/. ).!"''1 ) ! ~----{ ' 1....__, <. ..... i Y\ r·~ . : , Collected By //..,,r/;,-_<, J;/r ,-r\ Type of Sample: Site Locarion ::/,,,.., oS <°' i.' /) ,: I 0/ LJ;· oJc, ID# -~'~--Date Collected T 1 ) 0 / /(, 5-S -.j En vi ronmen tal Concentrate Comments ___ Groundwater ( 1) . -/Surface Water (2) _V_ S 'oil (3)_ __ Other (4) __ Solid (5) __ Liquid (6) __ Sludge (7) ___ Other (8) ,, l C .J":. -, ;; _,, .L ,c fh1';'P 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 __ Conductivit y __ Mercury __ Copper _TDS __ Selenium , __ Fluoride --------__ TOC __ Silver __ Iron -- --__ Lead -- --__ Manganese -- --· -__ Mercury --.... --__ Nitrate -- --__ Seleniu m -- ORGANIC CHEMISTRY Parameter Results mg/ 1 Parameter Results rng/1 Parameter =z!T:GC/MS ~B __ Methoxychlo r Acid:B/N Ext. __ PCB's -< O, / 0 /!Pl'\._, __ T oxaphene _TOX , __ Petroleum _2,4-D L C .['\ i o r c L ~ "2.c , c. u , , J __ Endrin __ 2,4,5-TP (silvex) L ./ /\ ) O r o C -: n 7-o :..,,/ -{c, r r,1 , l c, , , . ;\ __ Lindane \ --'r ..... .:..: "l c FY, · 1 ,/ C~n u c, li c ,--c:c.:-vi f>,,.,.",./, , .;_ ·vv h • C "· ""_ I ':j I\ : ;.. -,· ,,. () , "· A ,J, (\ 1 }1ICROBIOLOGY RADIOCHEMISTRY ' I' '-·l \ LI ,' -... _) / __ ., Time C ') . ··/,·· ·, __ /L /J:.( c·. Results mg/ 1 Results rng/1 Parameter ' Parameter Results PCi/1 __ (MF) Coliform Colonies/lO0 ml s --(MPN) Coliform Colonies/ lO0mls APR 1 9 1990 Bf) Date Receiveri Date Extracre n_]-.LJ(};)p_~~~-~/lJ~fl=/A~~Lf_-,).~,S_-~7--'-D~lf~tl,___ Reported By OHS 3191 (R~vised 7/85) C' · I: l --J U __ .., p.J ...,. , .. \YI.., .. .,,. IR,,..,;,.,., 7 /P,7) __ Gross Alpha __ Gross Beta Date Repo rted ..,.....,,---------~-------1C6 S 6NA Date Analyzed L/-;23-C/Oyp -f-/-C)tJ 8lJ Q A l""-(\,C ~y t.,J· .;.._J, ... ) t, ---~·"'-Lab Number - . ' N. C. Department of Human Resources Division of Health Services ::, .::: . ;z;;r f Sut,0-Pr SAMPLE ANALYSES REQUEST State Laboratory of Public Hcalt P. 0. Box 2804 306 N . Wilmington Scm / Raleigh, 2761 --'-/1"-V~G=--->O..L-.._0_-'1~~-0_:e6 __ .-._o~:1~_!0~---· 0_-> __ Field Sample Number -·~1 _a __ 0_·.1_({,_c_. _f ________ _ Site Number C' ,· .,, I I ('' I / I ' I ~ \ \ / . ::~:ec;e~S~: -!./--',~--, 1-... -'-·/f_;._;=-·-~-~=1c....,-~:-~-'-j\'--'r_·._'. _;·_·~! ~-1-D_# ____ -_-0_)=1=1-1_-_-_-_-_-D~::'~~~:::; ~) /;;) ~:: /1/. ";;:,~':, f ~ Type of Sample: ~ _ b .-/ Environmental Concentrate , Comments ___ Groundwater ( 1) ___ Surface Water (2) __ Soil (3)- --Other (4) v-~!s) __ Liquid ( 6) __ Sludge (7) __ Other (8) ~ ,) ' '-'/ I I·'(" ,·.> .. [ . t (::, (/ · <; '..,· (.. , (, _ , , . i , .~ I C 7) e rs ' I I ~ · n c J ,-c r,{ i e cJ . INORGANIC CHEMISTRY Extractables Parameter Results mg/ 1 ___ Arsenic __ Barium __ Cadmium I~---Chrnm;um ____ Lead __ Mercury __ Sdenium . ____ Silver -- -- ---~.,. -- -- Parameter Results mg/ 1 ~T:GC/MS Acid:B/N Ext. _TOX . . L ( -+· ! n r u L, ,1 '7..e , c q c ,· J L ( I\ lo r O 0'.'f1 'Z-Ot_,,/+0 rr,1 1 l C( t ,· J ' ,,-(.//~ ~,' 'c/7(; ('. ,.-CC ~1(.l<' c' n,/ < ., ~ ' -l-·,.~· h ,_" f', C1h , -,. ,-, __,, , ; r: ; "J 11r· ,./,"' 1 }1ICROBIOLOGY J t_.l \. t..l I '·i ...:i ,' _::, Parame-ter 1 __ (MF) Coliform Colonies/l00mls __ (MPN) Coliform Colonies/lO0mls Date Received Dare Exrrac tJ1fJ,3-9QVP APR 1 9 1900 {30 Reported By DHS 3 I 9 I ( R~vised 7/85) ,..., I· I ·-J IJ-. .., • ..J_ •. ,. ,v,..,._ .. ,. /0-.,,;,..,,, 7 /Q.7) Total Parameter Results mg/ 1 Parameter Results mg/1 __ Arsenic __ Silver __ Barium __ Sulfates __ Cadmium __ Zinc __ Chloride _Ph __ Chromium __ Co::1duc:ivi ty __ Copper __ TDS __ Fluoride --------__ TOC __ Iron -- __ Lead -- __ Manganese -- __ Mercury -- __ Nitrate -- __ Selenium -- ORGANIC CHEMISTRY Parameter ~B __ PCB's __ Petroleum __ Endrin __ Lindane lf-2-5-90 itl/l Results mg/1 Parameter Results mg/I __ Methox'.1chlor < o l Lo -P/2--y)I\_, __ Toxap!:ene I-_2,4-D __ 2,4,5-TP (silvex) -- RADIOCHE\.iISTR Y Parameter Results PCi/ 1 __ Gross Alpha __ Gross Beta Date Reported ---='7'"'"--------~-------?c.(3, J £3 ,v )f Date Analyzed '/ -2,3-90,YP 5-(-9rJ/31!) Lab Number N. C. Department of Human Resources Division of Health Services -~;;;,.;,, ,5 \_) fl) ._p · (' SAMPLE ANALYSES REQUEST Seate Laboratory of Public Hcal1 P. 0 . Box 280~ 306 N. Wilmington Sere Site Number Raleigh, 276' _..L/1-"--v_,,'C=.:,.....!0:....1.-__ °i--=· 'K:....::1::--1=-----~-'1_l--"7;=l---.::.h=0'-' _?_> __ Field Sample Number __ )_~_-......:C=1----=b=----_.!.9 ______ _ Name of Site ---''.:....(J____::c .:....· ,..._/~:)_(:.=~"--.:..'.(~:.:..'....!..I.,_\~· ,::.:_J_.1,1_~_-..Ll---'--1 --------Site loca,ion ::./ ,"(',.. S c; ,.· _J), ,_: / , I j o ) C h/c, r r " r1 l r: t"'l '/. ) ' . . Collected By /, {, i' la..:> /2 /1 ; f\ Type of Sample: Environmental ___ Groundwater ( 1) -----:-7 Surface Water (2) _V_ Soil (3)- 0ther ( 4) !._;/ ID# _ ______:,~•--C --5- Concentrate __ Solid (5) __ Liquid (6) __ Sludge (7) ___ Other (8) Date Collected '---1 ) i;5 I f(; I I I Comments ,, l \1·· ;::_ , . · , .. ' , , ·' Time \-3 Pm I / INORGANIC CHEMISTRY Extractables Total Parameter Results mg/ 1 Parameter Results mg/1 Paran1eter 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 ~T:GC/MS ~B __ Methoxychlor \ Acid:B/N Ext. __ PCB's < o. Ld-PJ2r"-__ Toxaphene _TOX . . __ Petroleum ,- _2,4-D L ( .J'\ in f'O hc.-,~-z.c-1 c_ G. c,·J __ Endrin __ 2,4,5-TP (silvex) / ( /\iurob,·,1Z.Ot,J{Jrr,1 ,L c1t ;,;\ __ Lindane ----<1..,. c1 .,. -, , F/. · / ' /' (,{ ;, l; 0 I), c v Cc.mf!-:,,:11 .. /, ' . - ··. ,. r-~~"'--,·t" /1,,..,.,.~; ~~'.-J~~-"cl,-'t"-',.,'-,-1 :.,.,fl+;/..:.,•'M..c., .':~I,,__~7T-~-rc.,.._?.,..,, ~-:-I-:_?-,.,-\~_o_G_Y _________ -,-----....,..-----R_A_D_I_O_C_H_E_M_I_S_T_R_Y_:__ ______ _ Parameter · Parameter Results PCi/ 1 __ (MF) Coliform Colonies/lOOmls __ (MPN) Coliform C olonies/lOOmls Dace Received APR 1 g J990 /3/) 1"-1c.8~ Dace Extracted q-:B-C/01/p &/.4 4-2_r£-lj0 J,4 Reported By OHS 31 9 1 (Revised 7185) __ Gross Alpha __ Gross Beta Date Reported p""i?;B,.....,,......:'J--,--------,-67TJN-,,-' lf.,....------ Oate Analyzed l/-~-t:JOVp S-f -CJa6i) %7;2 ¾' N. C. Oeparcment of Human Resources Division of Health Services S v i,0 -P r /..) ,1 J SAMPLE ANALYSES REQUEST State Laboratory of Public Hcalt P. 0 . Box 2804 306 N. Wilmington Stm Site Number Name of Site Raleigh, 2 761 _.,___,/1/'--'='G~D'--_'1_.::;~'-'C_, -~--~-O=J=------..li=L'---: -~-: __ Field Sample Number -+-1 -'~-'-'---'(-'-)_7.:____cc::;_l _______ _ ,0 ,r__ ,.,·,, .( <.-.' '1\. ,.j f"_, ' / ,J . I I r ) ' / . ' _, --' Site Loca;ion :-:....,-·~,""-'--''~.' --'.'-.:;"'-.• _,_(-'; 'c..,-' f-! /Jc.:_1_,c.~· -'-1--''v'-.r',c.r'-'r-',-''-' ...:..Y''-· .:_f ;_n'._!.r'l.!_ __ _ Collected By i/r, r i.,-. <, /1 /1 , f\ ID# --0'--'-~- 6 -_o')' Collected · 1)) fr' j 9_C Time /-3 f t0 Type o( Sample: Environmental ___ Groundwater ( 1) ___ Surface Water (2) __ Soil (3)- --Other (4) Concen~~a~e1 S <;- \o,/ ~-(5) __ Liquid (6) __ Sludge (7) __ Other (8) !_i c .. ~ C- . ,f' I } (' , -~ I Q 1-r , o ,. o , u -z...,e. ro r ·-/ h e.. o j} e rs 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 -,.B& T:GC/MS ...\L Acid:B/N Ext. Results mg/1 __ (MF) Coliform Colonies/lO0mls --(MPN) Coliform C olonies/lOOmls Parameter _f.DB -~-P Pr'CB' s __ Petroleum __ Endrin __ Lindane . APR 1 9 Date Re ceived Date ExtracrTa~-901/P 1990 ~LJ .AA Reported By DHS 3191 (Revised 7185) Results mg/1 Parameter Results mg/1 __ Methoxychlor <n, /Onn,,...__ ___ Toxaphene _____ '' ____ 2,4-D __ 2,4,5-TP (silvex) RADIOCHEMISTRY Parameter Results PCi/1 __ Gross Alpha __ Gross Beta Lab Number .:::,:3 arc f ; N.· C. Department of Human Resources Division of Health Services ,5 u 1,o-r r SAMPLE ANALYSES REQUEST Site Number Environmental ___ Groundwater ( 1) ~ Surface Water (2) __ Soil (3)- --Other (4) Concentrate __ Solid (5) __ Liquid (6) __ Sludge (7) __ Ocher (8) I ! I ; . u ) p · .. Comments I' i' ,,-.--·~. I \. / \ :"° / ; ; ,;' h/c, r _r f' ,: i (! r) Time ____ _ I' ' / 1-c r I-}, e_ o J/2 e rs 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 __ Chromiu m __ Chloride _Ph ___ Le ad __ Chromium __ Conductivity __ Mercury __ Copper _TDS __ Selenium __ Fluoride -------__ TOC __ Silver __ Iron -- --__ Lead -- ---__ Manganese -- ---__ Mercury --··-··- --__ Nitrate -- --__ Selenium -- ORGANIC CHEMISTRY Parameter Results mg/ 1 ~T:GC/MS 1d:B/N Ext. ~ TOX, . j L ( ../'.\ I n r :....' ,½;.• I' -z.c ,-c_ o ( ,· c L ( /\ / C· r o 0,' n Zo • .. ){.: rr,;, c ct ( ,· r A ,/ c.;1,~~;~';/?I), CV c~.~l'<'c'n,/ < __ (MF) Coliform Colonies/lO0mls __ (MPN) Coliform Colonies/l00mls Parameter ~B _PCB's __ Petroleum __ Endrin __ Lindane Dace Received APR 1 g 1900 .jJ/) • D ate Excraccm3-90-VP /);}A l/-2S-ro 11A Reported By DHS 3191 (Revised 7185) Results mg/1 -<(lLLO~, Parameter __ Gross Alpha __ Gross Beta Parameter Results mg/ 1 __ Methoxychlor __ Toxaphene _2,4-D __ 2,4,5-TP (silvex) -- RADIOCHEMISTRY Results PCi/ 1 Date Reporte~ Date Analyzed ik#-901/P ~1~1o8A9 Qn1"·"-0•~ £._• Lab Number '-"" ·_Ji •'D ~==-2Jc:' F f) J N. C. Department of Human Resources Division of Health Services ,5 U /J) -f f' f-v 11 SAMPLE ANALYSES REQUEST State Laboratory of Public Heal, P. 0. Box 280~ 306 N . Wilmington Sere Site Number Name of Site Raleigh, 2761 -? " _.,_/1.::....V....:sG""-'D--'--"-1....::.?5'c_o __ ~_·_..,_o--<.;=l~li-={-·, _'_> __ Field Sample Number -~-'~°'-· _0=\-7-'----_c_>-_____ _ /' r .. ~ .' .. , . / ,t"' , / ) S. L . c.._/ <; ,··.·, ,,,• .. i _.l. . .. i' )'1 ~, r ·r ,-"" ./·· r: ~ ; '--· ' , . '·\ r\ 1 ,. 1 , , tte oca.tton -:--'-"~~-----"-,--"-7'---'~--'-v.:c.:.,_· _,___'-'--· ...1..!...!.-'-'---'--'-'''....:..._ • __ _ :;;. ,.}, . j / .• Collected By f.. :11 i t ;-':> /\1: f\ ID# __ ZJ-'-, __.._/_' __ Date Collected =/ / ) '1S / 9 (; T ype of Sample: Enviro nmental Concentrate ___ Groundwater ( l) __ Solid (5) __ Surface Water (2) ___ Liquid (6) _L_ ~)_5ec/i'mbt+ Sludge (7) __ Other ( 4) Other (8) ,, ii (.i (. I '. I ; . )1 ,-) . i.J ). p /'. . Comments ,, I / INORGANIC CHEMISTRY Extractables Total Parameter Results mg/I 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/I Parameter Results mg/ I Parameter ~T:GC/MS ~B __ Methoxychlor d:B/N Ext. _PCWs 0 I :;J...7 -J: __ T oxaphene ppr,\_ TOX __ Petroleum _2,4-D Z ,-J" in ro 1~•'1!-Z.c ; c. 1; r,-J __ Endrin __ 2,4,5-TP (silvex) L r /\ lo ro b,:n zovN~ rr,1, L C( c,· J __ Lindane :k('#/;1.,bO -Pe.A) -- ,/ c?,:: ,"'-.,_~ r-/(;l C. ,r C ~ ~'l/)(! '~' n,./ ( . ' ' ' RADIOCHEMISTRY Results mg/I Results mg/I Param.eter Results PCi/ 1 __ (MF) Coliform Colonies/lO0mls __ (MPN) Coliform Colonies/lO0mls Date Receive~ APR 1 9 1900 Dare Extracted 'e/f!':J.3~()yp ;Si). 611/fl 4, 2 5, 9 o AA Reported By OHS 319 I ( Revised 7/85) •-'•' I • Y I \Vt •-· rn .. / /Q'7\ __ Gross Alpha __ Gross Beta N. C. Department of Human Resources Division of Health Servic es s-s: r;:-;.;i' ,5 \.) 1J>-P (' SAMPLE ANALYSES REQUEST State Laboratory of Public Hcalc P. 0. Box 2804 306 N. Wilmington Stm Site Number -:;;z Raleigh, 2761 /U'C, Q Cj'2(0 .:e&O)__ /{, ~> Field Sample Number ___ · ·_._0 __ 7_J ________ _ Name of Site ---'/_f'_'--..::.···._.'-',·'=-'___:_!_=,-' ___ '1'---'--',,._,_1...:._j;..._._f'_,_· ,__1 __,_I _________ Site Location </,-r .· ·s ,:, •-' /), ('. f h/:', r ,·" r, i (! r) ID# __ l.J_,,_' .,_/ __ Date Colle~ced . Y '-}-:--. ~}"---?f=-_ _;:_}r9--"(_C.....)'----...:....::.....'-"-....!.._:_T:.:_i....!_m.!_e..:.....J..:.3.!...!...../l_J_Y)_ ; /' l ; I , Collected By //,_-., I' 1:-' ,.::, /1/1 . r\ Type of Sample: -f, I I 5l\ M, pl(, 3 Environmental ___ Groundwater ( 1) ___ Surface Water (2) __ Soil (3)- _J.i_ Oth-eT (4) e,k(,.[L6Qi Concentrate Solid (5) Liquid (6) Sludge (7) Other (8) Comments ( / "> I I ·~ / \ i ; i I ;i' ) Q ( +-, o n tJ J t1 2.--,e fo r ! h e__ o ! /2 e r .. s ' I I ,· lJ /") ' ( () j f J · , c:. e 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 ~ T: GC/MS Acid:B/N Ext. L ~0i~i o t'U ,l /'"7 .. c, C Ci cJ L ( /, /Cr O iJ: f1 Z.0 1,,,/{ur,1 ," l o. t,· <A 1"'/ 'r v« ,·,, Fy I C-{1,,_, o.'i.1:,--ccM G.:>c•11 . ./, ..... ',- . / .' . L·t ~ LI / '-/ _) / _"';, Parameter · __ (MF) Coliform Colonies/lO0mls __ (MPN) Coliform Colonies/lO0mls Parameter ~B _\ __ PCB's __ Petroleum __ Endrin __ Lindane Dare Received ___ A_P_R_l _9_1990 _ _,t3.c...._:IJ-~pe_e--· ~ .. 1--• ____ _ Date Ex trac red _t,'-'-<d ...... llJ~_,__4-=-2c..,.,Sc_-_,_q.>£o_LJ.A.L..LJ ........ _4:._-_,~.....,0::.._-CJ-'--=-0-'-✓--'-P __ J Reported By OHS 3191 (Revised 7185) Results mg/I < {_, Qp_prvu Parameter __ Gross Alpha __ Gross Beta Parameter Results mg/ 1 __ Methoxychlor __ Toxaphene _2,4-D __ 2.4,5-TP (silvex) -- RADIOCHEMISTRY Results PCi/1 Date Reported -==-:a-:::--r---------=----------JXM:3 8/VI+ Date Analyzed , Lf-3tJ-qcr/P .£-.2-9cJ8iY Lab Number Criain of Cus::oci.._-Record B2z2rcious ~2ste H.ateri2.ls Loc2.::icJ o: S2.IDpling: Generator Transporter Tre2~~~t Facil: __ Storage Facility Other: Disposal ?2cility (;?C2ndf:Ul ---------------------------f 1 ~ . t ·c o:rrp in:· , s N 2.m e. __ _L____::C::::_!....,f):'..._:_C____!;'.6.~;Ll.'1-_.!,Jd__1L_l,___L/-1-_--------,---I el e? none t. ___ ) ______ -_· :;:_· -- A.d cir es s I V (,1 f f '). !\ { r~ --------1~~_:_.L.:.;~.:.,._~~---,-------------------------- C o l le Ct or I s N ame_....:::C==:::....:..t!.CJ.f-".~J\.~/~LlLJµ.!.L·-=-'t-=-1 ~ _1-7-U_, 1 {,:c..:0u...::::_.:C"""'-d.J..::,.Vi'-.!..L='-'·---T ele~'Jho::ie (;__ __ ) _______ _ . rignature Date s 2...'.::P_ 1 ed _____ u...../...._.l_J.)_<t:._;.,-9_(_) ___ .: _··_· ____ Ti.me s c..mpl ed 1 111 3 · ') _ J_ _ 10 I} -~ ;,20trl} 1 TY?e o: ?recess Generating ~aste __ ~f~c-·~G~~:::_~0Ll---'-;_s~p:..__::o:.......,,..J'-J.q-\--( _____________ _ V -Field Sc·cllple Ne. /d-0 (c i.,/ ./;J [:{;,~:J fd Cbb /d,U{c/ id 60~ \ d--01 I· \,:) c 7 J.__ ·1 ~l 73 Co air: c: Pas session: . signature 1•/ · ;r/-'"'/ / ':f --/ 1/t) ibclusive · d2.tes 2. sign2.ture title inclusive dates 3. sign2.ture i"IJ.clusive dates 02.:: e lns:::-uctio.-is: Complete all 2.pplica·ole iilfcrc::2.tio .. inclucin6 sign2tures, 2~d submit \ .. :ith ·..2.n2.lysis reaues:: fo~s. BASE/NEUTRAL AND ACID EXTRACT ABLES COMPOOND N-nitrosodimethylamine bis (2-ch l oroethvl) ether 2-chloroohenol phenol 1 3-d i ch 1 orobenzene l 4-dichlorobenzene 1 2-dichlorobenzene bis (2-chloroi ~. v,..ry l)ether hexachloroethane - N-nitroso-di-n-oroovlamine nitrobenzene i soohorone 2-ni troohenol 2 4-dimethvlohenol bis(2-chloroethoxv)methane 2 4-d i ch 1 orooheno l 1,2 4-trichlorobenzene naohthalene hexachlorobutadiene 4-chloro-m-cresol hexachlorocvclooentadiene 2,4 6-trichloroohenol 2-chloronaphthalene acenaohthvlene dimethyl phthalate 2 6-dinitrotoluene acenaohthene 2 4-dinitroohenol 2 4-dinitrotoluene 4-n i trooheno 1 fl uorene 4-chlorophenylphenvlether diethvl ohthalate 4 6-dinitro-o-cresol diohenvlamine azobenzene 4-brarophenylphenylether hexachlorobenzene pentachloro0henol phenanthrene anthracene dibutvl ohthalate fluoranthene J -Estimated value . STATE LABORATORY OF PUBLIC HEALTH DIVISION OF HEALTH SERVICES, N.C. DEPARTMENT OF HUMAN RESOURCES P.O. BOX 28047 -306 N. WILMINGTON, ST., RALEIGH, N.C. 27611. ORGANIC OlEHICAL ANALYSIS LAB NO f/OSoo9 CJos-01 o <?os-01 I q~So/,;i., FIELD# 1..:i.o&l/ 1..:iio&S l-<.o~~ I.;;, Ob 7 TYPE (S) ( ..3 ) (.5") ( ~) UNITS ~(\JQ/kq' il!2:t (i".iQ/kQ J ~\JQ/ka' ~ \J Q / k q' Jo/~3o II I/ t,/ . /,( ,.r S0/ihSO 10/3.:?o SO/;t.t;o /0/.330 I -J,, so/J~.c;o I ~ /{J/.330 I o/.$.'3/J solltcS"O 111/_:;~o , \ I' \/ ,1; \V \/ K -Actual value is known to be less than value given . L -Actual value is known to be greater than value given. '90501 =? l~D~:? (S) ~Q/kq I-' \/ U -l'laterial was analyzed for but not detected. The nurber NA -Not analyzed . is the Hinirrun Detection Limit. rn'J)L .... -- 1/ -Tentative identification. ~/ -On NRDC List of Priority Pollutants. N. C. D-<.v-<.J.i-<.on 06 He.a.U.h SVtv-<.c.u VHS 3068 -0 (4/86 LaboJtMo~y) - CD ( ) \JQ/1 \JQ/kq STATE LABORATORY OF PUBLIC HEAL TH DIVISION OF HEALTH SERVICES, N.C. DEPARTMENT OF HUMAN RESCXJRCES P.O. BOX 28047 -306 N. WILMINGTON, ST., RALEIGH, N.C. 27611 ORGANIC 01EMICAL ANALYSIS BASE/NEUTRAL ANO AC 1D LAB NO C?o5ooq 905010 9oso11 9o.Sol~ EXTRACT ABLES FIELD# I.J.o&l/ / :)Q~J / .:?l'>fo fLJ /.:),()/07 CXlMPOOND TYPE CS> (3) C 5) (3) UNITS mii=i('µ q/k q um'-1 (uq/kq, ~(uq/kq ~1Cuo/kq' pyrene /0/3~1) IA LL. IA I,(__ benzidine 5"0/1160 butvl ben zvl phthalate J0/.330 benz(a)anthracene ' chrysene J, 3 3--di ch l orobenz i dine so//650 bis(2~thvlhexyl)phthalate 10/330 di-n-octyl ohthalate /0/.1~0 benzo(b)fluoranthene so/1150 benzo(k)fluoranthene benzo(a)ovrene indeno( 1 2 3--cd)pyrene dibenzo(a h)anthracene benzo(q h i)perylene ,:,, \/ \v \V "v aniline so/1,1,,,;o I.A-IA-/;{ l,{__, benzoic acid benzyl alcohol 4--ch l oroan i 1 i ne ~ '_/ dibenzofuran /()/3~0 2--methyl M!>htha l ene 2--methyl phenol J 4--methylpheool ,J., 2-nitroaniline S"o/;~~o 3-nitroani 1 ine 4-nitroaniline 2 4 5-trichloroohenol 'IJ.1 \I \v \/ ,1 n,1)1- J -Est in.at~ value. H2.0/ Sol'- K -Actual value is kl')C)\,,/n to be less than value given. L -Actll<ll value is kl')C)\,,/n to be greater than value given. U -~terial was analyzed for but not detected. The nUTt>er 1s the Minirrun Detection Limit. NA -Not analyzed. 1/ -Tentative identification. ~/ -On NRDC List of Priority Pollutants . ,V.C. D-<.v,t,6-<.Cm oS HeaUh SVtv-<.c.e/2 VHS 3068 -0 (4/86 Labolta):o~y ) 9oSoJ~? l~o0R (-5) ( ) ~lcuq/kq" uo/1 µq/kq u__ \V U- ,I STATE LABORATORY OF PUBLIC HEALTH DIVISION OF HEALTH SERVICES, N.C. DEPARTMENT OF HUMAN RESOURCES P.O. BOX 28047 ---306 N. WIU1INGTON, ST., RALEIGH, N.C . 27611. ORGANIC CHEMICAL ANALYSIS BASE/NEUTRAL ANO ACID LAB NO EXTRACT ABLES FIELD# COMPaJN0 TYPE UNITS N---nitrosodirrethvlamine /ri/ :?3o bis (2---<:h 1 oroethyl) ether 2---chloroohenol ohenol 1.3-dichlorobenzene 1.4-dichlorobenzene 1,2-dichlorobenzene bis(2---chloroisooropyl)ether hexachloroethane - N---nitroso---di-n---oroovlamine nitrobenzene isoohorone 2---ni trooheno l 2 4-dirrethylphenol bis(2---chloroethoxv)rrethane 2 4-dichloroohenol l 2.4---trichlorobenzene nanhthalene hexachlorobutadiene 4---chloro--m---cresol hexachlorocyclooentadiene 2 4 6---trichloroohenol 2---chloronaohthalene acenaphthylene dirrethyl phthalate 2,6-dinitrotoluene acenanhthene '" 2 4-dinitroohenol so//~so 2 4-dinitrotoluene I0/330 4---ni trophenol 'S'O/;~-~O fl uorene /0/~30 4---chloroohenvlohenylether I diethyl ohthalate -l, 4,6-dinitro---o---cresol So/Jf,,C::O di phenyl amine I azobenzene ~ 4---braroohenylphenylether I tJ/..330 hexachlorob€nzene /t?/33D oentachloroohenol so/Jto5"o ohenanthrene Jt1/_:J~O anthracene dibutyl ohthalate fl uoranthene '4,. J ---Estimated value. rn'"DL fl-z..O/SO/l- qo5ol '-I 90.:-J 0/S /<?{00'1 Jo?070 ( 3) ( ~) ~q/kq' ~0' q I k q) IA I.)_ \V \/ K ---Actual value is known to be less than value given. L ---Actual value is known to be greater than value given . C/oSO/t:, /-?07 / ( "1) _m?y'.J q/k q) IA \v 9 (). "JD I 7 /...<.07cJ. l.3) ~tµq/kq) 11 \V 9 n .c; !)/ 15 /~D7~ ( 'I) ~ (µq/kq--... LL / ,/ U ---~4terial was analyzed for but not detected. The nurber NA ---Not analyzed. is the Hinirrun Detection Limit. m])L ---1/ ---Tentative identification. ~/ ---On NROC List of Priority Pollutants . ,\J .C. Vi v..uion 06 He.a.l:th SVtvic.e.1.> VHS 3068 ---0 (4 /86 Lab oJta.to~y ) - 0 ( ) '.JQ/1 ug/kq STATE LABORATORY OF PUBLIC HEAL TH DIVISION Of HEALTH SERVICES, N.C. DEPARTMENT Of HUMAN RESOUfiCES P.O. BOX 28047 -306 N. WILMINGTON, ST ., RALEIGH, N.C . 27611 ORGANIC 01EMICAL ANALYSIS BASE/NEUTRAL AND ACID LAB NO 9o5/JJt./-90.-"i'OI) 9'0SO!fc Y~ ,017 EXTRACT ABLES FIELD# jd(()/, q /.,;;o71J /-7.07/ /o<D7c:l mMPOUND TYPE (3) (.::J) ( ..3) (-3) UNITS ~(uQ/kQ l~(µq/kq ~f'G':o/kq ~Q/kq) pyrene /0/.3.=?n fl -/.A__. IA--l{__ benz idine s-o/1hS0 butyl benzyl phthal ate J0/.330 benz (a)anthracene I chrvsene J, 3 3--<lichlorobenzidine '1h50 SOI bis(2-ethvlhexyl)phthalate 10/330 di-n--octvl ohthalate IO/.s~o ben zo (b) fl uoran thene so/11-50 benzo(k)fluoranthene benzo(a)pyrene i ndeno ( 1 2 3-<:d) pyrene dibenzo(a h)anthracene benzo(q h i )oervlene \/ \/ ,/ \V \/ aniline .S'CJ/Jh."'O IA..-IA-l,,L_ !A.- benzoic acid benzvl alcohol 4-chloroani 1 ine "-~ dibenzofuran /0 /..z-10 2-{Tiethyl naphtha ler.e I 2--methylpheool 4--methvloheool ...i✓ 2-n i troan i 1 i r,e S"o/;laSo 3-ni troani 1 ine I 4-nitroaniline 2 4 5-trichlorooheool ""' \/ \/ 1/ \V mn1... J -Estimated value . Hz.OI $()Ii.- to be less than value given . K -Actual value is known L -Act U<l l value is known U -Katerial was analyzed NA -Not ana lyzed . to be greater than value given . for but not detected. The nurber is the Minirrun Detection Limit . 1/ -Ten tative identificat ion. ~I -On NROC List of Pr iority Pollutants. N.C. D-<.v.u-<.011 06 He.a...U.h SVtv-<.c.V-> VHS 30 68 -0 (4/86 Labott.a):o~y) 9/J'\o/ R /-207...3 ( '/) ( ) ~l(uq/ko uq/1 uq/kq u.. \V u._ \/ f11::Z)t ... - ,. 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-O{)OOOO .-.-Z0:,0 Field Sample Number ----''----'--'--..L...J.----------~--- Name of Site ]?E"~/IJ(.5 IZ?fcPRIS Site Location""--"=::__:=-..;....:....:::...:....i;_,._~::.=.=,:.:..:..£:~:......;.~::i...~- Collected By GR// P l? Sff~S:-ID# OG ;;:z__ Date Collected__;;:"/-<....:::..,'---'-'-=-----+--Time 3:w , Type of Sample: MAR 2 9 1990 Environmental Concentrate Comments /oroundwater (1) __ Solid (5) __ Surface Water (2) __ Liquid (6) __ Soil (3) __ Sludge (7) •. : .• ·-.~ .. ,,.1 e-.. '.: / ... S ; ;: :; : j __ Other (4) __ Other (8) l ~ • ,. MAR 2 8 1990 (~:) INORGANIC CHEMISTRY Extractables ,tn1.7 ~,i•,c,, .... i_ , ..... o1:al1,c, ,tJ ~ ~V-'~-1 r. ("·('r1~' · • I\/ L vr , , ~H.i 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 ~B __ Methoxychlor __ Acid:B/N Ext. PCB's <a. o oo l.pp.11 ~ Toxaphene _TOX __ Petroleum _2,4-D --__ Endrin __ 2,4,5-TP (silvex) --__ Lindane -- MICROBIOLOGY RADIOCHEMISTRY Parameter Parameter Results PCi/ 1 __ (MF) Coliform Colonies/lO0mls __ (MPN) Coliform Colonies/lOOmls __ Gross Alpha __ Gross Beta ......,...,.,2-....L:!.....:....-L~---1,t(.,.j....~...:::::::::=:::::::'.... ____ Date Reporte'}'c::t(s 3 -c). 7 -tf? (2 --'-'i!:~~..:...__L._=-.._.JL.J~.:!...1£!11.---,....-------Date Analyzed 3-,;<,;z 401/P Reported By Lab Number 9 ·~d701 OHS 3191 (Revised 7 S) Solid and Hazardous Waste (Review 7187) .j;t 9 CJ 1/ 7 CJ / Chain of Custodv Record Hazardous Waste P.aterials Location of Sampling: Generator Company's Name Address Collector's Name __ Storage Facility Lother: __ Tr ans p Orte r ~!,,.1li'\r•',~:n:;sT~'f·.~~-E~~r,·f:oT!ac i 1 it y __ Disposa 1 Fae i 1 i ty· __ Land f i 11 Telephone Telephone {'r/7 ) 733 -CJb f 2- -s~natur :.a t;e Samp 1 ed ______ c:;::......._~.,,.//'""-1/-' t~"-+-6__._o/-'0 _________ _ / Time Sampled ·3/uD /:N: ::pe of Process Generating Waste · t? C,. /! //-1-rv p p t:..c_ ___ ,,.._ ____________ _,_ ___________________ _ •7 ield Information 7 l?c .6 c1:·4c-f2&?-(_. ·· .:.::::.cl Sample ~o. CJC>~Zff ~ai~ of Possession: " title . signature ~ title inclusive dates signature title inclusive dates signature title date lnst=uctions: Complete all applicable information including signatures, and submit ~ith analysis request forms. I . I I Receipt for Samples ,~e sanples described below were collected .in connection uith the administration,. ~~forcenent, and documentation of the : ( ) North Carolina Hazardous Waste Management Rules, 10 NCAC !OF ( ) ~orth Carolina Solid Waste Management Rules, 10 NCAC lOG ( ) Com?rehensive Environmental Response, Compensati?n and Liability Act (C~RCLA) ( ) Toxic Substances Control Act (TSCA) 15 U.S.C. S2601, ~~-,·specifically Section 11 of TSCA:, 15 U.S.C. s2610. Inspector's Name Inspector's Address !~ame of Firm Firm Address -:~m Owner, Operator, or Agent Title ·.•::,:·r-.. ;. --COLLECTED SAf1PLE TYPE DUPLICATE Sr..!-:?L:::S SAMPLE ·:-:3::R DATJ:" TIME . HATER ·SOIL OTHER OFFEREDIACCEPT:::D ! R'::JECTED ON-SITE i I I - LOC-.TIO~ OF:-SI:E Re~eipt for th~· sample(s)_descri~ed above is hereby acknowledged: Receipt/rejection of -duplicate or split samples is hereby acknowledged: .... S:gnature of Inspector Signature of Fir~ o~ner, Operator, or Agent Title Tit le Co.::."Tlent s: ---------------------------------------- ...