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Home My WebLink AboutNCD980602163_19910401_Warren County PCB Landfill_SERB C_Mar 1991 Field Sampling Analyses-OCR. ' .. \ . N, C. Department of Human Resources Division of Health Services SAMPLE ANALYSES REQUEST State Laboratory of Public Health P. 0. Box 28047 306 N. Wilmington Street Raleigh, 27611 Site Number ___ 9_3_-__,.;P_c_._h..;;..() _________ Field Sample Number _ ___:o~o...:;S:;_'-t:...,..J,aa<:,...J7'------------ Name of Site pc B La. I'\ cf/./ ( ( Site Location s· Collected By --=L=w""-'-+-'-,f;,__ ____ ID# o s-c; Type of Sample: Environmental ___ Groundwater ( 1) ___ Surface Water (2) __ Soil (3) _L Ocher ( 4) Concentrate __ Solid (5) ~Liquid (6) __ Sludge (7) __ Ocher (8) INORGANIC CHEMISTRY Extractables Parameter Results mg/ 1 Parameter Results mg/1 __ Arsenic __ Arsenic __ Barium __ Barium __ Cadmium __ Cadmium __ Chromium __ Chloride __ Lead __ Chromium __ Mercury __ Copper __ Selenium __ Fluoride __ Silver __ Iron --__ Lead --__ Manganese --__ Mercury --__ Nitrate --__ Selenium ORGANIC CHEMISTRY Parameter Results mg/ 1 Parameter Results mg/ 1 _P&T:GC/MS _EDB __ Acid:B/N Ext. _0cB's <o .ooot_ _TOX __ Petroleum --__ Endrin --__ Lindane MICROBIOLOGY Total Parameter __ Silver __ Sulfates __ Zinc _Ph __ Conductivity _TDS _TOC -- -- -- -- -- -- Parameter __ Methoxychlor __ Toxaphene -2,4,D __ 2,4,S,TP (silvex) -- RADIOCHEMISTRY Results mg/ 1 Results mg/ 1 Parameter Parameter Results PCi/ 1 --(MF) Coliform Colonies/l00mls __ Gross Alpha __ (MPN) Coliform Colonies/l00mls __ Gross Bera ---- ---- '"' ---;if'.AAd J / -Dare Received 3-2/ q / 6N~ <P_c.'8; :::::::::·" 3 ~ 1p::;::,ve .iA OH S 3191 (Revimi 7 85) .J Cl Solid and Hazardous Waste (Review 7187) pt-/ f / () Z-0 _, Date Reportl"~ L/ / -q / ~s o; ,p Date Analyzed ..:5 -~h-L°M . _ 911-0..-.;0 Lab Number _____ · ______________ _ . , ; N. C. Department of Human Resources Division of Health Services SAMPLE ANALYSES REQUEST State Laboratory of Public Health P. 0 . Box 28047 306 N. Wilmington Smet Raleigh, 27611 Site Number __ 9.L..· _3_-__ ~_l _/3 _________ Field ~ample Number __ ....;;.O_o_~_'-1..;...._.7>___;;_3 ________ _ Name of Site p CB L 0-.,V\Cj ·h' f / Site Location __ • ..;;_s _· R._'-___;_l_~_o_t./_--r-__::.lJ__;q:....cy_·v--"-e-"'vi--'--'C::::..;1-;_;u.o..c•...:..' 'h'-'i'-1- L. f /!., 0 ·? Ci ) 7 Collected By ____ L-\.---'-''----T+-------ID# OS-L Date Collected ----~_-_,:::t_o_-__;,1_!_• ___ Time /,~ ; ~ 'O Type of Sample: Environmental ___ Groundwater ( 1) Concentrate __ Solid (5) __ Surface Water (2) ~ Liquid (6) __ Soil (3) __ Sludge (7) ~ Other (4) __ Other (8) Comments Leo, cha /--e -F /tk1 en/--fro /4-1 Fi'(/.e..,-S 1 s l-e A,,,. 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 _P&T:GC/MS -~B __ Acid:B/N Ext. __ PCB's _TOX __ Petroleum --__ Endrin --__ Lindane MICROBIOLOGY Parameter __ (MF) Coliform Colonies/lO0mls __ (MPN) Coliform Colonies/lO0mls -- -- /I qt/CJ M'f\- Date Received 3 -2/-C( / 6NA Pc.e,!- Date Extractecl 3 -.;!G ·'f I A4,1f'1.) 3 -,;z/4,-CJ/ Ye AA Reported By IJIIS .3191 ( Rcvimi 7 /85) ,. · · 1 Hazardous Waste (Review 7/87) Results mg/ 1 Parameter Results mg/1 __ Methoxychlor ,<o.ooo/ __ T oxaphene _2,4-D __ 2,4,5-TP (silvex) -- RADIOCHEMISTRY Parameter Results PCi/ 1 __ Gross Alpha __ Gross Beta -- -- Date Reported =c=---,------------------t?_C',8.s Date Analyzed ~-,Ztr,-1/-z/P 9 /i ~ 0"-·""1 Lab Number > .. lM A,, Purpose: Enforcement and compliance with the N. C. Solid and Hazardous Waste Management Rules. Preparation A sample analyses request form (OHS 3191) must be completed for each type of evaluation requested ( e.g., inorganic, organic, microbiology, radiochemistry). For sampling conditions which require more than one ( 1) container ( i.e., ground or surface water from landfills) a sample label must be affixed to one of the containers. The collector must then write the site and sample number on the duplicate. Do not submit an analysis request sheet with no parameters indicated. Equivalent measurements: ppm= µg/ml = mg/1 = µg/g = mg/kg ppb = µg/1 = µg/lO00g = µg/kg DEFINITIONS/INSTRUCTIONS Site Number -A twelve-digit site/location identifier, assigned only by the district field representative. Field Sample Number -A six-digit sample identifier which is pre-printed on the sample label. Name of Site -Name of landfill, facility, etc. Site Location -Address, street number, state road, etc. Collected By -Name and ID of sample collector. Date and Time Collected -Self-explanatory. Environmental -A sample of a naturally occurring substance such as groundwater, surface water or soils which may be contaminated. Concentrate -A sample of a waste, including but not limited to, sludges, resins, treatment effluents or drummed wastes. Comments -Lists details regarding sample or sample point, including but limited to, phase separation, and/ or odors. 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 -. . Location of Sampling: Chain of Custodv Record .. Hazardous Waste P.aterials Generator __ Transporter Treatment Facility __ Storage Facility Other: __ Disposal Facility t/Landfill Company's Name Telephone Address (: o l lec co r' s Name _£.;;..-;_" ;...{,,.;;..h...;, ... ( __.L~v1...;.·...;.f...;/,,-,1-I ___ --=----- ; -signatdre :,a t;e Sampled 7 -~.t) -q ~pe of Process Generating Waste ~ield Information ::.c:ld ::-iample ~o. ocs:t/3 ,Y ~ai~ of Possession: signature .·.c: su ~ts reported ~£/?&tL ~ signature Time Sampled_~-------------- -. f/.1dro51 e.o/(lq /u~ / Tech v1 , 'c,'q,-, r , tid e title inc usive da es 3-2/- inclusi ve dates date lnst=uccions: Complete all applicable. information including signatures, and submit ~ith analysis request forms. ..