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HomeMy WebLinkAboutWS-6603_19720_CA_MRP_20160504Groundwater Monitoring Report S&ME Project No. 4305-15-198A TF-19720 Former Purgasons Grocery, Graham, Alamance County, North Carolina May 4, 2016 i TABLE OF CONTENTS 1. FEDERAL/STATE-LEAD MONITORING REPORT ......................................... 1 2. EXECUTIVE SUMMARY ....................................................................................... 2 3. SCOPE OF SERVICES ............................................................................................ 3 3.1 Contract Information ........................................................................................... 3 3.2 Approved Scope of Services ............................................................................... 3 4. SITE HISTORY AND CHARACTERIZATION ................................................... 3 4.1 UST Owner and Operator Information ............................................................... 3 4.2 UST Information ................................................................................................. 3 4.3 Description of the UST Release .......................................................................... 3 5. CURRENT SITE ASSESSMENT INFORMATION ............................................. 4 5.1 Current Liquid Levels ......................................................................................... 4 5.2 Groundwater Monitoring Event .......................................................................... 4 5.3 Summary of Groundwater Analytical Results .................................................... 4 5.4 Evaluation of Groundwater Information ............................................................. 4 5.4.1 Current Extent and Severity of Contamination ..................................... 4 5.4.2 Cleanup Levels Achieved ...................................................................... 5 6. CONCLUSIONS AND RECOMMENDATIONS .................................................. 5 FIGURES 1 Vicinity Map 2 Site Map 3 Groundwater Contour Map 4 Groundwater Constituent Map TABLES 1 UST Owner/Operator Information 2 UST Information 3 Groundwater Elevation Data 4 Summary of Groundwater Analytical Results APPENDICES I Photographic Log II Well Sampling Forms and Field Notes III Laboratory Analytical Report and Chain-of-Custody Record Groundwater Monitoring Report S&ME Project No. 4305-15-198A TF-19720 Former Purgasons Grocery, Graham, Alamance County, North Carolina May 4, 2016 2 2. EXECUTIVE SUMMARY On March 1, 2016, S&ME collected groundwater samples from five groundwater monitor wells (MW-1 through MW-5) at the Purgason’s Grocery site in Graham, Alamance County, North Carolina. The laboratory analytical results indicated that no targeted contaminant constituents were detected in concentrations exceeding their respective North Carolina 15A NCAC 2L Standards (2L Standards). One constituent (Methyl tert-butyl ether) was detected above its laboratory detection limits, but below the 2L Standard. The concentration is shown below: Contaminant 2L Standard (µg/L) Concentration (µg/L) Well ID Date Methyl tert-butyl ether 20 11.0 MW-4 3/1/2016  S&ME did not measure free product in the monitor wells sampled (MW-1 through MW- 5). Based upon the historical reports provided to S&ME, free product has not been reported in any of the monitor wells during previous groundwater sampling events.  Concentrations of methyl tert-butyl ether were below the 2L Standard in monitor well MW-4 during the March 1, 2016 sampling event (11 µg/L), but was higher than the October 14, 2015 sampling event (8.9 µg/L).  A receptor survey update and site reconnaissance were conducted on October 14, 2015. The following sensitive receptors were noted within 1,000 feet of the site: Distance from source (ft) Municipal Water Available Active Drinking Water Well Inactive Drinking Water Well Irrigation Well Surface Water Body 0 – 500 No Four: (WSW-3, WSW-4, WSW-5, WSW-6) Unknown Unknown Three Ponds: (P-1, P-2, P-3) 500 – 1000 No 12: (WSW-1, WSW-2, WSW-7, WSW-8, WSW- 10 through WSW-16) Unknown Unknown None  Based on S&ME’s receptor survey conducted on October 14, 2015, 17 potable water supply wells were identified within 1,000 feet of the site. Four of these wells are located within 500 feet of the site. Municipal water is not available to the site and or properties within 1,000 feet of the site.  S&ME recommends abandoning the groundwater monitoring wells and site closure. Groundwater Monitoring Report S&ME Project No. 4305-15-198A TF-19720 Former Purgasons Grocery, Graham, Alamance County, North Carolina May 4, 2016 3 3. SCOPE OF SERVICES 3.1 Contract Information The scope of services for this report was performed in general accordance with S&ME’s proposal number 43-1500851-A dated February 29, 2016. The scope of services was authorized by the North Carolina Department of Environmental Quality (NCDEQ’s) Task Authorization TA#02, dated February 29, 2016, and within contract number N14005i. 3.2 Approved Scope of Services S&ME’s approved Scope of Services for this Task Authorization included:  Collecting groundwater samples from five monitor wells (MW-1 through MW-5);  Preparing and submitting this report. These services were completed as proposed. 4. SITE HISTORY AND CHARACTERIZATION The former Purgason’s Grocery site is located at 4956 NC Highway 54 in Graham, Alamance County, North Carolina. According to the June 2000 Preliminary Assessment Report prepared by Geophex, Ltd. (Geophex), the site formerly operated as a grocery with retail petroleum sales. The on-site structure is currently being utilized as a machine shop. A vicinity map is provided as Figure 1, and a site map is provided as Figure 2. Photographs of the site taken during the monitoring event are included in Appendix I. 4.1 UST Owner and Operator Information According to the Soil and Groundwater Assessment Report prepared by Pyramid Environmental & Engineering, P.C. (Pyramid) on January 25, 2010, an inspection was performed by NCDENR in 1993, and the UST system was determined to be out of compliance. The Geophex report indicates that a notice of intent to close the USTs was filed in April 1998; however, the owner/operator of the USTs, Janice Purgason, indicated that she lacked the funds to properly abandon the tanks. The owner/operator information is provided in Table 1. 4.2 UST Information According to the NCDEQ Registered Underground Storage Tank (RUST) database, four USTs were installed at the site on September 25, 1992; two 8,000-gallon gasoline, one 2,000-gallon diesel, and one 500-gallon kerosene. According to the UST Closure Report prepared by Geophex and dated June 2000, the USTs were closed by removal on March 24 and 25, 2000. Information about the USTs is provided in Table 2. The locations of the former USTs are shown in Figure 2. 4.3 Description of the UST Release According to the UST Closure Report prepared by Geophex in June 2000, the four USTs were closed by removal by Geophex on March 24 and 25, 2000. Soils removed during the UST closure were placed back in the excavation following the removal of the USTs. The laboratory Groundwater Monitoring Report S&ME Project No. 4305-15-198A TF-19720 Former Purgasons Grocery, Graham, Alamance County, North Carolina May 4, 2016 4 analytical results of post excavation soil samples collected indicated that targeted constituents were reported at concentrations above their respective maximum soil contaminant concentrations (MSCCs) in soil samples collected from the diesel and kerosene tank pits. 5. CURRENT SITE ASSESSMENT INFORMATION 5.1 Current Liquid Levels On March 1, 2016, S&ME personnel measured depth to groundwater in the monitor well network. Depth to groundwater was measured using an electronic water level indicator, which emits an audible tone when in contact with water. The depth to groundwater measurements and the top-of-casing elevations were used to calculate groundwater elevations. Based upon the groundwater elevations, groundwater flows to the west and southwest. Groundwater elevations are recorded in Table 3, and a groundwater contour map is presented as Figure 3. 5.2 Groundwater Monitoring Event On March 1, 2016, after collecting depth to groundwater measurements, S&ME personnel purged and sampled monitor wells MW-1 through MW-5 using new, disposable polyethylene bailers. Each well was purged a minimum of three well casing volumes, and the field parameters temperature, pH, and conductivity were recorded for each casing volume. Copies of the well sampling forms are provided in Appendix II. Groundwater samples were placed in laboratory- supplied containers, placed in a cooler on ice, and shipped under standard chain-of-custody procedure to Con-Test Analytical Laboratory (ConTest) of East Longmeadow, Massachusetts, a North Carolina certified laboratory. The samples were analyzed for VOCs by EPA Method 6200B. 5.3 Summary of Groundwater Analytical Results The laboratory analytical results of the groundwater samples collected from monitor wells MW-1 through MW-5 indicated that methyl tert-butyl ether was detected in concentration exceeding the laboratory reporting limit, but below the 2L Standard in the sample collected from monitor well MW-4. No other targeted contaminant constituents were detected in the other groundwater samples collected from the other groundwater monitor wells. A summary of the groundwater analytical results are presented in Table 4, and shown in Figure 4. A copy of the laboratory analytical report and chain of custody record is provided in Appendix III. 5.4 Evaluation of Groundwater Information 5.4.1 Current Extent and Severity of Contamination One monitor well (MW-4) has reported a concentration of methyl-tert butyl ether exceeding the laboratory detection limit, but below the 2L Standard. Historically, concentrations of methyl tert-butyl ether have steadily decreased since the over-excavation of approximately 387.7 tons of contaminated soils and the introduction of PermeOx Plus® in 2011 in the area adjacent to MW-4. None of the other on-site monitor wells have been impacted with targeted contaminant constituents in concentrations exceeding the 2L Standards. There have been no detections of targeted contaminant constituents in monitor wells MW-1 through MW-3 since January 2013 Groundwater Monitoring Report S&ME Project No. 4305-15-198A TF-19720 Former Purgasons Grocery, Graham, Alamance County, North Carolina May 4, 2016 5 (lead in monitor wells MW-2 and MW-4). There have been no detections of VOCs in these wells since prior to 2011. There have been no detections of targeted contaminant constituents in MW-5 since January 2013, when lead, sec-butylbenzene, and diethylphthalate were detected. In 2011, approximately 390 tons of petroleum contaminated soils were excavated from the area around monitor well MW-4. The laboratory analytical results of post-excavation soil samples indicated that concentrations of VOCs were below their respective maximum soil contaminant concentrations (MSCCs). Additional soil excavation was not possible in one direction due to specific site constraints. Concentrations of targeted contaminant constituents were above their respective MSCCs in the soil samples collected from this sidewall. 5.4.2 Cleanup Levels Achieved  Soil (soil-to-groundwater maximum soil contaminant concentrations) Yes  Groundwater (2L standard concentrations) Yes 6. CONCLUSIONS AND RECOMMENDATIONS Based on the current and historical assessment information for the site, the following conclusions are presented: 1. The UST Incident meets the following conditions for a Low classification: a. There are 17 water supply wells within 1,000 feet of the source area. Four of these wells are located within 500 feet of the source area. Historical laboratory analytical data for samples collected from some of these water supply wells indicate that there were no detections of targeted contaminant constituents. b. Municipal water service is not available to the site and properties within 1,000 feet of the site. c. Contaminant levels in the groundwater are below the 2L Standards. Based on the above, S&ME recommends abandoning the on-site groundwater monitor wells and site closure. TABLES UST Information Owner/ Operator Dates of Operation 8,000-Gallon Gasoline 1972 - March 2000 8,000- Gallon Gasoline 1972 - March 2000 2,000-Gallon Diesel 1972 - March 2000 500-Gallon Kerosene 1972 - March 2000 Notes: S&ME Project No. 4305-15-198A Janice Purgason Owner/operator information obtained from Underground Storage Tank Closure Report , prepared by Geophex, Ltd. and dated June 2000. TABLE 1 UST Owner/Operator Information Former Purgasons Grocery 4956 NC Highway 54 Graham, Alamance County, North Carolina NCDEQ Incident No. 19720 UST ID Number Contents Capacity (gallons) Tank Dimensions Date Installed Date Closed Release from System 1 Diesel 2,000 5.5' x 12'1972 March 2000 Yes 2 Kerosene 500 4' x 6'1972 March 2000 Yes 3 Gasoline 8,000 8' x 21'1972 March 2000 Yes 4 Gasoline 8,000 8' x 21'1972 March 2000 Yes Notes: UST information obtained from Underground Storage Tank Closure Report , prepared by Geophex, Ltd. and dated June 2000. S&ME Project No. 4305-15-198A TABLE 2 UST Information Former Purgasons Grocery 4956 NC Highway 54 Graham, Alamance County, North Carolina NCDEQ Incident No. 19720 Well ID Date Installed Top of Casing Elevation (ft. rel.) Total Well Depth (ft. TOC) Casing Depth (ft. BTOC) Screened Interval (ft. BTOC) Date Measured Depth to Groundwater (ft. BTOC) Groundwater Elevation (ft. rel.) 1/24/2013 8.61 91.39 1/8/2014 6.22 93.78 10/14/2015 9.85 90.15 3/1/2016 5.18 94.82 1/24/2013 7.90 90.26 1/8/2014 5.86 92.30 10/14/2015 8.50 89.66 3/1/2016 5.13 93.03 1/24/2013 6.31 89.44 1/8/2014 5.20 90.55 10/14/2015 7.17 88.58 3/1/2016 4.70 91.05 1/24/2013 7.30 90.04 1/8/2014 5.89 91.45 10/14/2015 8.07 89.27 3/1/2016 5.26 92.08 1/24/2013 7.07 91.72 1/8/2014 5.18 93.61 10/14/2015 7.61 91.18 3/1/2016 4.40 94.39 Notes: 1. Top of casing elevations obtained from UST Closure Report prepared by Geophex, Ltd., dated June 2000. 2. Depth to water measurments prior to 2014 were obtained fromActive Remediation Monitoring Report prepared by Progress Environmental, dated February 8, 2013. 3. fT-BTOC: feet below top of casing 4. ft. rel.: feet relative 5. --: information not available -- MW-4 7/8/2011 97.34 32.41 0.0 - 13.0 18.00 ---- MW-5 7/8/2011 98.79 20.00 -- 13.0 - 32.41 MW-3 5/11/2000 95.75 37.40 0.0 - 17.0 17.0 - 37.4 MW-2 5/11/2000 98.16 S&ME Project No. 4305-15-198A MW-1 5/11/2000 100.00 40.00 0.0 - 20.0 20.0 - 40.0 NCDEQ Incident No. 19720 TABLE 3 Monitor Well Construction and Depth to Water Measurements Former Purgason's Grocery 4956 Highway 54 Graham, Alamance County, North Carolina Lead by 3030C Extraction Constituent of Concern Date Collected 7/26/2011 ND ND ND ND ND ND ND ND 6/1/2012 ND ND ND ND ND ND 1.1J ND 1/24/2013 ND ND ND ND ND ND ND ND 1/8/2014 ND ND ND ND ND ND ND ND 10/14/2015 ND ND ND ND ND NR NR NR 3/1/2016 ND ND ND ND ND NR NR NR 7/26/2011 ND ND ND ND ND ND ND ND 6/1/202 ND ND ND ND ND ND ND ND 1/24/2013 ND ND ND ND ND ND ND 13.4 1/8/2014 ND ND ND ND ND ND ND ND 10/14/2015 ND ND ND ND ND NR NR NR 3/1/2016 ND ND ND ND ND NR NR NR 7/26/2011 ND ND ND ND ND ND ND ND 6/1/2012 ND ND ND ND ND ND ND ND 1/24/2013 ND ND ND ND ND ND ND ND 1/8/2014 ND ND ND ND ND ND ND ND 10/14/2015 ND ND ND ND ND NR NR NR 3/1/2016 ND ND ND ND ND NR NR NR 7/26/2011 24.4 118 2,270 ND ND ND ND ND 6/1/2012 1.6 20.2 272 ND ND ND ND ND 1/24/2013 ND 9.5 153 ND ND ND ND 5.1 1/8/2014 ND 2.8 52.9 ND ND NR NR NR 10/14/2015 ND 0.3 8.9 ND ND NR NR NR 3/1/2016 ND ND 11 ND ND NR NR NR 7/26/2011 ND ND 1.1 2.6 0.62 ND ND ND 6/1/2012 ND ND ND ND 0.95 ND ND ND 1/24/2013 ND ND ND ND 0.29J 1.0J ND 5.2 1/8/2014 ND ND ND ND ND ND ND ND 10/14/2015 ND ND ND ND ND NR NR NR 3/1/2016 ND ND ND ND ND NR NR NR 0.4 70 20 6 70 NE 3 15 400 70,000 20,000 6,000 8,500 NE 170 15,000 Notes: 1. Groundwater data prior to 6/11/2014 is from the Terraquest Groundwater Monitoring Report,dated February 7, 2012. 2. Analytes that are not shown were not detected. 3. Concentrations are reported in micrograms per liter (µg/L). 4. 2L Standard: North Carolina Groundwater Quality Standards: 15A NCAC 2L.0202 5. VOCs: Volatile Organic Compounds. 6. Concentrations exceeding the 2L Standards are shown in Shaded and BOLD fields. 7. Concentrations exceeding the laboratory's reporting limits are shown in BOLD fields. 8. NR: Analysis for sample not requested. 9. NE: Regulatory standard has not been established for the listed constituent.diethylphthalatebis(2-ethylhexyl)phthalateMW-3 MW-1 MW-2 naphthalenesec-butylbenzeneTABLE 4 Summary of Groundwater Analytical Results Former Purgason's Grocery 4956 Highway 54 Graham, Alamance County, North Carolina 2L Standards Gross Contamination Levels leadNCDEQ Incident No. 19720 S&ME Project No. 4305-15-198A MW-5 MW-4 Analytical Method methyl-tertbutyletherWell ID 1,2-dichlorethanedi-isopropyletherVolatile Organic Compounds (VOCs) by EPA Method 6200B (µg/L) Polyaromatic Hydrocarbons (PAHs) by EPA Method 625 (µg/L) FIGURES DATE: DRAWN BY: 3201 SPRING FOREST RD, RALEIGH, NC 27616 NC ENGINEER LICENSE #F-0176 SCALE: PROJECT NO: FIGURE NO. WWW.SMEINC.COM VICINITY MAP 4956 HWY 54 GRAHAM, NORTH CAROLINA 1" = 2,000' BTR APRIL 2016 4305-15-198A 1 A-5900 FORMER PURGASON'S GROCERY TF-19720 2000 4000 (IN FEET)GRAPHIC SCALE 0 (IN FEET)GRAPHIC SCALE Q:\PROJECTS\2015\4305-15-198A\CAD\A5900.dwg, FIG1, 4/25/2016 11:19:33 AM, 1:1 DATE: DRAWN BY: 3201 SPRING FOREST RD, RALEIGH, NC 27616 NC ENGINEER LICENSE #F-0176 SCALE: PROJECT NO: FIGURE NO. WWW.SMEINC.COM SITE MAP 4956 HWY 54 GRAHAM, NORTH CAROLINA 1" = 40' BTR APRIL 2016 4305-15-198A 2 A-5901 FORMER PURGASON'S GROCERY TF-19720 40 80 (IN FEET)GRAPHIC SCALE 0 (IN FEET)GRAPHIC SCALE Q:\PROJECTS\2015\4305-15-198A\CAD\A5901.dwg, FIG2, 4/25/2016 11:17:03 AM, 1:1 DATE: DRAWN BY: 3201 SPRING FOREST RD, RALEIGH, NC 27616 NC ENGINEER LICENSE #F-0176 SCALE: PROJECT NO: FIGURE NO. WWW.SMEINC.COM WATER SUPPLY WELL LOCATION MAP 4956 HWY 54 GRAHAM, NORTH CAROLINA 1" = 400' BTR APRIL 2016 4305-15-198A 3 A-5902 FORMER PURGASON'S GROCERY TF-19720 400 800 (IN FEET)GRAPHIC SCALE 0 (IN FEET)GRAPHIC SCALE Q:\PROJECTS\2015\4305-15-198A\CAD\A5902.dwg, FIG3, 4/25/2016 11:16:43 AM, 1:1 DATE: DRAWN BY: 3201 SPRING FOREST RD, RALEIGH, NC 27616 NC ENGINEER LICENSE #F-0176 SCALE: PROJECT NO: FIGURE NO. WWW.SMEINC.COM GROUNDWATER CONTOUR MAP 4956 HWY 54 GRAHAM, NORTH CAROLINA 1" = 40' BTR APRIL 2016 4305-15-198A 4 A-5903 FORMER PURGASON'S GROCERY TF-19720 40 80 (IN FEET)GRAPHIC SCALE 0 (IN FEET)GRAPHIC SCALE Q:\PROJECTS\2015\4305-15-198A\CAD\A5903.dwg, FIG4, 4/25/2016 11:16:27 AM, 1:1 DATE: DRAWN BY: 3201 SPRING FOREST RD, RALEIGH, NC 27616 NC ENGINEER LICENSE #F-0176 SCALE: PROJECT NO: FIGURE NO. WWW.SMEINC.COM GROUNDWATER CONSTITUENT MAP 4956 HWY 54 GRAHAM, NORTH CAROLINA 1" = 40' BTR APRIL 2016 4305-15-198A 5 A-5904 FORMER PURGASON'S GROCERY TF-19720 40 80 (IN FEET)GRAPHIC SCALE 0 (IN FEET)GRAPHIC SCALE Q:\PROJECTS\2015\4305-15-198A\CAD\A5904.dwg, FIG5, 4/25/2016 11:15:24 AM, 1:1 APPENDICES APPENDIX I Photographic Log Former Purgason’s Grocery 4956 Highway 54, Graham, North Carolina S&ME Project No. 4305-15-198A Taken by: Bob Bryant Date Taken: 3/1/2016 1 1 View of former Purgason’s Grocery Site 2 View of monitor well MW-1 (view is to the northeast). 3 View of monitor well MW-3 (view is to the east). 4 View of monitor well MW-4 (view is to the north). MW-1 MW-3 MW-4 APPENDIX II Well Sampling Forms and Field Notes APPENDIX III Laboratory Analytical Report and Chain of Custody Form Page 1 of 27 Table of Contents Table of Contents Sample Summary 3 Hits Only Report 4 Case Narrative 6 Sample Results 7 16C0090-01 7 16C0090-02 9 16C0090-03 11 16C0090-04 13 16C0090-05 15 Sample Preparation Information 17 QC Data 18 Volatile Organic Compounds by GC/MS 18 B143860 18 Flag/Qualifier Summary 22 Certifications 23 Chain of Custody/Sample Receipt 25 Page 2 of 27 Table of Contents Page 3 of 27 Table of Contents Page 4 of 27 Table of Contents Page 5 of 27 Table of Contents Page 6 of 27 Table of Contents Page 7 of 27 Table of Contents Page 8 of 27 Table of Contents Page 9 of 27 Table of Contents Page 10 of 27 Table of Contents Page 11 of 27 Table of Contents Page 12 of 27 Table of Contents Page 13 of 27 Table of Contents Page 14 of 27 Table of Contents Page 15 of 27 Table of Contents Page 16 of 27 Table of Contents Page 17 of 27 Table of Contents Page 18 of 27 Table of Contents Page 19 of 27 Table of Contents Page 20 of 27 Table of Contents Page 21 of 27 Table of Contents Page 22 of 27 Table of Contents Page 23 of 27 Table of Contents Page 24 of 27 Table of Contents Page 25 of 27 Table of Contents xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx Page 1 of 2 CLIENT NAME:RECEIVED BY:DATE: 1) Was the chain(s) of custody relinquished and signed?Yes X No 2) Does the chain agree with the samples?Yes X No If not, explain: 3) Are all the samples in good condition?Yes X No If not, explain: 4) How were the samples received: On Ice X Direct from Sampling Ambient In Cooler(s)X Were the samples received in Temperature Compliance of (2-6°C)?Yes X No N/A Temperature °C by Temp blank Temperature °C by Temp gun 3 5) Are there Dissolved samples for the lab to filter?Yes No X Who was notified _____________Date ____________Time ___________ 6) Are there any RUSH or SHORT HOLDING TIME samples?Yes No X Who was notified _____________Date ____________Time ___________ Permission to subcontract samples? Yes No 7) Location where samples are stored:(Walk-in clients only) if not already approved Client Signature: _______________________ 8) Do all samples have the proper Acid pH: Yes No N/A X 9) Do all samples have the proper Base pH: Yes No N/A X 10) Was the PC notified of any discrepancies with the CoC vs the samples: Yes N/A X 40 mL vials:# HCl 15 # Methanol Time and Date Frozen: # Bisulfate # DI Water # Thiosulfate UnpreservedRev. 4 August 2013 Doc# 277 Encore Other Dissolved Oxygen bottle Other glass jar Colisure / bacteria bottle Flashpoint bottle 40 mL Vial - type listed below 15 Perchlorate Kit 250 mL plastic SOC Kit 500 mL Plastic Plastic Bag / Ziploc 1 Liter Plastic 2 oz amber/clear jar 250 mL Amber (8oz amber)4 oz amber/clear jar 500 mL Amber 8 oz amber/clear jar 1 Liter Amber 16 oz amber 3/2/2016 No COC Incl. Containers received at Con-Test # of containers # of containers 39 Spruce St. East Longmeadow, MA. 01028 P: 413-525-2332 F: 413-525-6405 www.contestlabs.com Sample Receipt Checklist S&ME RLF Page 26 of 27 Table of Contents Page 2 of 2 Login Sample Receipt Checklist (Rejection Criteria Listing - Using Sample Acceptance Policy) Any False statement will be brought to the attention of Client Question Answer (True/False)Comment T/F/NA 1) The cooler's custody seal, if present, is intact. 3) Samples were received on ice. 4) Cooler Temperature is acceptable. 5) Cooler Temperature is recorded. 6) COC is filled out in ink and legible. 7) COC is filled out with all pertinent information. 8) Field Sampler's name present on COC. 10) Samples are received within Holding Time. 11) Sample containers have legible labels. 12) Containers are not broken or leaking. 13) Air Cassettes are not broken/open. 14) Sample collection date/times are provided. 15) Appropriate sample containers are used. 16) Proper collection media used. 17) No headspace sample bottles are completely filled. 19) Trip blanks provided if applicable. 21) Samples do not require splitting or compositing. Doc #277 Rev. 4 August 2013 Log-In Technician Initials: RLF T 18) There is sufficient volume for all requsted analyses, including any requested MS/MSDs. N/A T T Date/Time: 3/2/16 10:23 T 20) VOA sample vials do not have head space or bubble is <6mm (1/4") in diameter. T Who notified of False statements? Date/Time: T T N/A T T T 9) There are no discrepancies between the sample IDs on the container and the COC. T T T T T T T T T 2) The cooler or samples do not appear to have been compromised or tampered with. Page 27 of 27 Table of Contents