WQ0020793_Monitoring - 03-2020_20200409 (2)

April 3, 2020
I
I
DEPARTMENT OF ENVIRONMENT & NATURAL RESOURCES
DIVISION OF WATER QUALITY -INFORMATION PROCESSING UNIT
1617 MAIL SERVICE CENTER,
RALEIGH, NC 27699-1617 Phone: [phone]
0
Subject: Ground Water Quality Monitoring
y
Tyson Farms, Inc. Hays Hatchery
z
a
Compliance Report — March. 2020
nz
O
Z
y
To whom it may concern:
Enclosed is the quarterly Groundwater Compliance report for Hays Hatchery.
el
Please contact me at 336- 651-2871, should you have any questions.
Sincerely,
W
2
0 James Brown
Complex Environmental Manager
Tyson Farms Inc. Fresh Retail Division 704 Factory Wilkesboro, N.C. 28697
336-651-3836 336.838.2171 Fax:[phone] www.hsonfoods.com

6.1977111r AVTi[8LR:14 ]L��J\» t•7�f�1
GROUNDWATER QUALITY MONITORING:
COMPLIANCE REPORT FORMms
;.
FACILITY INFORMATION
Please Print Clearly or Type
PERMIT Number: W00020793 Expiration Date: 07/31/2026
Facility Name: Tyson Farms, Inc.
Non -Discharge WQ0020793 UIC
NPDES Other
Permit Name (if different):
Facility Address: P.O. Box 936/3649 Airport Road
TYPE OF PERMITTED OPERATION BEING MONITORED
NORTH WILKESBORO {'`"t} NC
28659 Coun ty Wilkes
El Lagoon ❑Remediation: Infiltration Gallery
icity) (St<,to)
M11)
❑ Spray Field ❑ Remediation:
Contact Person: James Brown
Telephone#: [phone]
❑ Rotary Distributor ❑ Land Application of Sludge
Well Location/Site Name: Hays Hatchery
No. of wells to be sampled: 4
❑ Water Source Heat Pump ❑■ Other: Evaporation/Infiltration Pond
(from Permit)
SAMPLING INFORMATION
If WELL
WELL ID NUMBER (from Permit): MW - 1
Date sample collected: 3/26/2020
FIELD ANALYSES:
WAS
Well Depth: 40 ft.
Well Diameter: 2 in.
pH 00400: 5.9 units Temp. 000lo; 15.4 °C
DRY at
Depth to Water Level 82546: 25 ft. below measuring point Screened Interval: 23 ft.
to 40
ft. Spec. Cond. 00094: µMhos
time ofsampling,
Measuring Point is 2 ft. above land surface
Relative M.P. Elevation: 1347.53
ft.
Odor 00085: none
check
Volume of water pumped/bailed before sampling:
7.33
gallons
Appearance clear
here:❑
Samples for metals were collected unfiltered: ❑ YES
® NO and field acidified: ❑ YES ® NO
LABORATORY INFORMATION
Date sample analyzed: 3/26/2020
Laboratory Name: Statesville Analyitical
Certification No. 440/3775
PARAMETERS NOTE: Values should reflect
dissolved and colloidal concentrations.
COD 00335
mg/L
Nitrite (NO2) as N 00615
mg/L Pb - Lead 01051 ug/L
Coliform: MF Fecal 31616 <1
/100mL
Nitrate (NO3) as N 00620 7.07
mg/L Zn - Zinc 01092 mg/L
Coliform: MF Total 31504
/100mL
Phosphorus: Total as P 00665 0.6
mg/L
(Note: Use MPN method for highly turbid samples)
Orthophosphate 70607
mg/L Other (Specify Compounds and Concentration Units):
issolved Solids:Tota(70300 161
mg/L
Al - Aluminum 01105
mg/L
pH (Lab) 00403
units
Ba - Barium 01007
ug/L
TOG 00680
mg/L
Ca - Calcium 00916
mg/L
Chloride 00940 10.6
mg/L
Cd - Cadmium 01027
ug/L
Arsenic 01002
ug/L
Chromium: Total 01034
ug/L
Grease and Oils 00552
mg/L
Cu - Copper 01042
mg/L ORGANICS: (by GC, GC/MS, HPLC)
Phenol 32730
ug/L
Fe - Iron 01045
ug/L
(Specify test and method #. ATTACH LAB REPORT.)
Sulfate 00945
mg/L
Hg - Mercury 71900
ug/L
Lab Report Attached? ❑ Yes (1) X No (0)
Specific Conductance 00095
µMhos
K - Potassium 00937
mg/L VOC 78732: method #
Total Ammonia oo6lo <0.5
mg/L
Mg - Magnesium 00927
mg/L method #
(Ammonia Nitrogen; NH, as N; Ammonia Nitrogen, Total)
Mn - Manganese 01055
ug/L
, method #
TKN as N 00625
mg/L
Ni - Nickel 01067
ug/L
method #
For Remediation Systems Only (Attach Lab Reports): Influent Total VOCs
James S. Brown Complex Environmental Manager
Permittee (or Authorized Agent) Name and Title - Please print or type
GW-59 Rev.2/2010
E00] Fill
ind.that the laboratory analytical data
ifity of fines and imprisonment for kn(
�W �
mg/L VOC Removal%
G/.1oa

SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING:
COMPLIANCE REPORT FORM
FACILITY INFORMATION Please
Facility Name: Tyson Farms, Inc.
Permit Name (if different):
Facility Address: P.O. Box 936/3649 Airport Road
NORTH WILKESBORO (sire`''`) INC
(" .0 (Stag:)
28659
or
County Wilkes
tact Person: James Brown Telephone#: [phone]
1 Location/Site Name: Hays Hatchery No. of wells to be sampled: 4
PERMIT Number: WQ0020793 Expiration Date: 07/31/2026
Non -Discharge WQ0020793 UIC
NPDES Other
TYPE OF PERMITTED OPERATION BEING MONITORED
❑ Lagoon ❑ Remediation: Infiltration Gallery
❑ Spray Field ❑ Remediation:
❑ Rotary Distributor ❑ Land Application of Sludge
❑ Water Source Heat Pump 51 Other: Evaporation/Infiltration Pond
SAMPLING INFORMATION
If WELL
WELL ID NUMBER (from Permit): MW - 2
Date sample collected: 3/26/2020
FIELD ANALYSES:
WAS
Well Depth: 36 ft.
Well Diameter: 2 in.
pH 00400: 6-5 units Temp. 000lo: 15.9 °C
DRY at
Depth to Water Level 82546: 26 ft. below measuring point Screened Interval: 21 ft. to
36 ft.
Spec. Cond, 00094:
µMhos
time of
sampling,
Measuring Point is 2 Tft. above land surface
Relative M.P. Elevation: 1331.83 ft.
Odor 00085: none
check
Volume of water pumped/bailed before sampling: 4.89
gallons
Appearance clear
here:❑
Samples for metals were collected unfiltered: ❑ YES
® NO and field acidified: ❑ YES ® NO
LABORATORY INFORMATION
Date sample analyzed: 3/26/2020
Laboratory Name: Statesville Analyitical
Certification No. 440/3776
PARAMETERS NOTE: Values should reflect dissolved and colloidal concentrations.
COD 00335 mg/L
Nitrite (NO2) as N 00615
mg/L
Pb - Lead olo51
ug/L
Coliform: MF Fecal 31616 <1 /100mL
Nitrate (NO3) as N 00620 1.19
mg/L
Zn - Zinc 01092
mg/L
Coliform: MF Total 31504 /100mL
Phosphorus: Total as P oo665 0.3
mg/L
(Note: Use MPN method for highly turbid samples)
Orthophosphate 70507
mg/L
Other (Specify Compounds and Concentration Units):
issolved Solids:Total 703oo 69 mg/L
Al - Aluminum oil o5
mg/L
pH (Lab) 00403 units
Ba - Barium 01007
ug/L
TOC 00680 mg/L
Ca - Calcium 00916
mg/L
Chloride 0094o 20.4 mg/L
Cd - Cadmium 01027
ug/L
Arsenic 01002 ug/L
Chromium: Total 01034
ug/L
Grease and Oils 00552
mg/L
Cu - Copper 01042
mg/L
ORGANICS: (by GC, GC/MS, HPLC)
Phenol 32730
ug/L
Fe - Iron 01045
ug/L
(Specify test and method #. ATTACH LAB REPORT.)
Sulfate 00945
mg/L
Hg - Mercury 71900
ug/L
Lab Report Attached? ❑ Yes (1) © No (0)
Specific Conductance 00095
µMhos
K - Potassium 00937
mg/L
VOC 78732: method #
Total Ammonia 00610 4.90
mg/L
Mg - Magnesium 00927
mg/L
method #
(Ammonia Nitrogen; NH. as N, Ammonia Nitrogen, Total)
Mn -Manganese 01055
ug/L -
.w., ,method #
TKN as N 00625
mg/L
Ni - Nickel 01067
ug/L
method #
For Remediation Systems Only (Attachh-Lab Reports): Influent Total VOCs: mg/L Effluent Total VOCs: mg/L VOC Removal%
James Brown Complex Environmental Manager
Permittee (or Authorized Agent) Name and Title - Please print or type
GW-59 Rev.2/2010
of
r

SUBMIT FORM ON YELLOW PAPER ONLY
IGROUNDWATER QUALITY MONITORING:
COMPLIANCE REPORT FORM
FACILITY INFORMATION Please Print Clearly or Type
Facility Name: Tyson Farms, Inc.
Permit Name (if different):
Facility Address: P.O. Box 936/3649 Airport Road
NORTH WILKESBORO ('f`e`t' NC 28659
County Wilkes
iCii"y) (la(5) (!in)
act Person: James Brown Telephone#: [phone]
Location/Site Name: Hays Hatchery No. of wells to be sampled: 4
PERMIT Number: WQ0020793 Expiration Date: 07/31/2026
Non -Discharge WQ0020793 UIC
NPDES Other
TYPE OF PERMITTED OPERATION BEING MONITORED
❑ Lagoon ❑ Remediation: Infiltration Gallery
❑ Spray Field ❑ Remediation:
❑ Rotary Distributor ❑ Land Application of Sludge
❑ Water Source Heat Pump X Other: Evaporation/infiltration Pond
WELL ID NUMBER (from Permit): MW - 3 Date sample collected: 3/26/2020
Well Depth: 36 ft. Well Diameter: 2 in.
Depth to Water Level 82546: 11.0 ft. below measuring point Screened Interval: 21 ft, to 36 ft.
Measuring Point is 2 ft. above land surface Relative M.P. Elevation: 1326.34 ft. —
Volume of water pumped/bailed before sampling: 12.22 gallons
for metals were collected unfiltered: ❑ YES ® NO and field acidified: El YES ® NO
FIELD ANALYSES:
pH 00400: 5.1 units Temp. 000lo: 14.4 °C
Spec. Cond. 00094: µMhos
Odor 00085: none
Appearance clear
WAS
DRY at
time of
sampling,
check
here:
❑Samples
LABORATORY INFORMATION
Date sample analyzed: 3/26/2020
Laboratory Name: Statesville Analyitical
Certification No. 440/3775
PARAMETERS NOTE: Values should reflect
dissolved and colloidal concentrations.
COD 00335
mg/L
Nitrite (NO2) as N 00615
mg/L
Pb - Lead o1o51 ug/L
Coliform: MF Fecal 31616 <1
/100mL
Nitrate (NO3) as N 00620 6
mg/L
Zn - Zinc 01092 mg/L
Coliform: MF Total 31504
/100mL
Phosphorus: Total as P 00665 0.5
mg/L
(Note; Use MPN method for highly turbid samples)
Orthophosphate 70507
mg/L
Other (Specify Compounds and Concentration Units):
issolved Solids:Total 70300 92
mg/L
AI - Aluminum a11o5
mg/L
pH (Lab) 00403
units
Ba - Barium 01007
ug/L
TOC 00680
mg/L
Ca - Calcium oo916
mg/L
Chloride 00940 <10
mg/L
Cd - Cadmium 01027
ug/L
Arsenic 01002
ug/L
Chromium: Total o1o34
ug/L
Grease and Oils 00552
mg/L
Cu - Copper 01042
mg/L
ORGANICS: (by GC, GC/MS, HPLC)
Phenol 32730
ug/L
Fe - Iron 01045
ug/L
(Specify test and method #. ATTACH LAB REPORT.)
Sulfate 00945
mg/L
Hg - Mercury 71900
ug/L
Lab Report Attached? ❑ Yes (1) X No (0)
Specific Conductance 00095
µMhos
K - Potassium 00937
mg/L
VOC 78732: method #
Total Ammonia 00610 <0.5
mg/L
Mg - Magnesium 00927
mg/L
method #
(Ammonia Nitrogen; NH3asN; Ammonia Nitrogen, Total)
Mn - Manganese o1o55
ug/L
, method #
TKN as N 00625
mg/L
Ni - Nickel 01067
ug/L
method #
Icer�ifythat, to the bestof my knovrlQdge and belief, the information submitted in this report is true, accurate, and complete, and thatthe laboratory analytical data wa;; prgduced'using apprgved'methoda 9f analysis by a
PtNft-certified laboratgry; I am aware that there are significant penalfles for submitting#else infor"merlon, including the possibility'of fines and imprisonment for knowing violations.:
James Brown
Permittee (or Authorized Aqent) Name and Title - Please print or type Signature of Permittee (or Authorized Agent) D.

SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING:
., �4'sr
COMPLIANCE REPORT FORM
FACILITY INFORMATION
Please Print Clearly or Type
PERMIT Number: W00020793 Expiration Date: 07/31/2026
Facility Name: Tyson Farms, Inc.
Non -Discharge WQ0020793 UIC
NPDES Other
Permit Name (if different):
Facility Address: P.O. Box 936/3649 Airport Road
TYPE OF PERMITTED OPERATION BEING MONITORED
NORTH WILKESBORO (4`°Ce1) NC
28659 County Wilkes
❑Lagoon El Remediation: Infiltration Gallery
(eciy) stag)
(Xir)
❑ Spray Field ❑ Remediation:
Contact Person: James Brown
Telephone#: [phone]
❑ Rotary Distributor ❑ Land Application of Sludge
Well Location/Site Name: Hays Hatchery
No. of wells to be sampled: 4
❑ Water Source Heat Pump © Other: Evaporation/Infiltration Pond
(from Permit)
SAMPLING INFORMATION
If WELL
WELL ID NUMBER (from Permit): MW - 4
Date sample collected: 3/26/2020
FIELD ANALYSES:
WAS
Well Depth: 27 ft.
Well Diameter: 2 in.
pH 00400: 5.7 units Temp. 000lo: 12.7 °C
DRY at
Depth to Water Level 82546: 7.4 ft. below measuring point Screened Interval: 12 ft.
to 27
ft. Spec. Cond. 00094: µMhos
time of
sampling,
Measuring Point is 2 ft. above land surface
r
Relative M.P. Elevation: 1299.0
ft.
Odor 00085: none
check
Volume of water pumped/bailed before sampling:
9.58
gallons
Appearance clear
here:Q
Samples for metals were collected unfiltered: ❑ YES
® NO and field acidified: ❑ YES © NO
LABORATORY INFORMATION
Date sample analyzed:3/26/20
Laboratory Name: Statesville Analyitical
Certification No. 440/3775
PARAMETERS NOTE: Values should reflect
dissolved
and colloidal concentrations.
COD 00335
mg/L
Nitrite (NO2) as N 00615
mg/L Pb - Lead o1061 ug/L
Coliform: MF Fecal 31616 <1
/100mL
Nitrate (NO3) as N 00620 2,83
mg/L Zn - Zinc 01092 mg/L
Coliform: MF Total 31504
/100mL
Phosphorus: Total as P 00665 0.5
mg/L
(Note: Use MPN method for highly turbid samples)
Orthophosphate 70507
mg/L Other (Specify Compounds and Concentration Units):
issolved Solids:Total 70300 170
mg/L
Al - Aluminum o11o5
mg/L
PH (Lab) 00403
units
Ba - Barium 01007
ug/L
TOC 00680
mg/L
Ca - Calcium oo916
mg/L
Chloride 00940 18.6
mg/L
Cd - Cadmium 01027
ug/L
Arsenic 01002
ug/L
Chromium: Total 01034
ug/L
Grease and Oils 00552
mg/L
Cu - Copper 01042
mg/L
ORGANICS: (by GC, GC/MS, HPLC)
Phenol 32730
ug/L
Fe - Iron 01045
ug/L
(Specify test and method #. ATTACH LAB REPORT.)
Sulfate 00945
mg/L
Hg - Mercury 71900
ug/L
Lab Report Attached? ❑ Yes (1) A No (0)
Specific Conductance 00095
µMhos
K - Potassium 00937
mg/L
VOC 78732: method #
Total Ammonia 00610 <0.5
mg/L
Mg - Magnesium 00927
mg/L
method #
(Ammonia Nitrogen; NH3 as N; Ammonia Nitrogen, Total)
Mn - Manganese 01055
ug/L
, method #
TKN as N 00625
mg/L
Ni - Nickel 01067
ug/L
method #
For Remediation Systems Only (Attach Lab Reports): Influent Total VOCs: mg/L Effluent Total VOCs: mg/L VOC Removal%
James Brown
Permittee (or Authorized Agent) Name and Title - Please print or type Sigrfatdre of Permittee ( r Au orized Agent) (Orate)
GW-59 Rev.2/2010

1
Enter date monitoring results were due. ( ) Will this monitoring report (GW-59 and GW-59A)
YES
( N
be submitted after the established due date?
2
Was any required information missing on the GW-59 report forms?
YES
NO
IF the answer to question 1 or 2 is "YES", list in the space provided below the well identification number(s) and
explain the problems encountered in obtaining the required information.
3
Are any of the monitor wells in need of repair or maintenance (damaged casing, unlocked or missing cap, missing
YES
N
identification plate, area overgrown, etc.)? If the answer is 'Yes", contact the Regional Ofce Jor guidance.
4
Are any monitored constituents equal to or above the established standards?
ES
NO
if the answer to question 4 is "NO", skip to section 8.
If the answer to question 4 is "YES" list the affected wells individually with constituents) and concentration(s)
exceeding standards in the space provided below
3/26/20 PH 6.5- 8.5 Ammonia 1.5 Nitrate 10
MW-1 PH-5.9
MW- 2 4.9 mgA
MW-3 PH-5.1
MW-4 PH -5.6
5
For the constituents identified in question 4 above, have standards been exceeded previously for the
YES
NO
same constituent(s) in the same well(s) in the last two years?
if the answer to question 5 is "NO'; skip to section 8.
If the answer to question 5 is "YES", list in the space provided below, each well with constituent(s) exceeding
standards, concentration(s) reported, and sample collection date foreach occurrence (for the last two years).
GIN Standards Nitrate 10 GW Standards ammonia 1.5
MW 1 - 07-10-18 11.6 mg/1 MW-2 3-26-20 4.90 mgh MW-2
MW-2 11-7-19 5.04 mgA MW-2
MW-2 07-11-19 4.14mg17 MW-2
MW-2 03-7-19 4.82 mgA MW-2
MW-2 11-19-18 6.16 mgA MW-2
_
6
Are the monitoring wells listed in section 5 located at or beyond the review boundary?
YES
NO
If the answer is "YES", a groundwater quality problem may be occurring. CONTACT THE REGIONAL
OFFICE IMMEDIATELY FOR GUIDANCE. If the answer is "NO", monitoring wells may be improperly
located, contact the Regional Office.
7
Is the permittee implementing previously approved actions required by the Division involving this
E
NO
groundwater quality problem?
If the answer to question 7 is "YES", describe those actions in the space provided below.
if the answer to question 7 is "NO", contact the Regional Office within 90 days: an evaluation may bb
reauired to determine the impact the waste disposal system is having at the review and compliance
boundaries surroundina this faciliW, Failure to do so may subject the nermittee to a Notice of Violation.
fines. and/or penalties. 1
'ice ,. lac;� s '•ct ctV Tot,(l eeu :;��.,t ��w y
A`3 L r
8
The person completing this portion (GW-59A) of the monitoring report should sign below and submit this
form with G W-59 forms for required wells to the address provided at the top of the current G W-59 form.
t fiereby ac ow) iige tha##he atsave mfor Momwas_:eva uated nd a infistmaYion:subtpftt i 'in---
report.(CoriipGartce' ReportGW=5A) isueiciomplte fa the. estmy ktowtedge w
,f
Signature of Permittee (or Aufhorized Agent) Date
(_VU-GQA IIN0nnA

Worksheet # 4b
Tyson Farms, Inc.
Completed by:
Max Byers
Title :
WWT Operator
Date :
7-A r-20
No. of Wells to be Sampled 4
Has Hatchery
GroundWate Water sampling data Hays Hatchery Compliance Data
Constituents edual to or above the established Standards
Has
1 per 100ML
500 m /I
250 m /
1.5 m /I
10 m /I
NA
6.5-8.5
Date
Wells ID:
Fecal
TDS
Chloride
Total NH3
Nitrate
Phos hours
PH
Mar-8-2018
MW - 1
<1
331
10.6
<0.5
8.00
1.3
6.4
MW-2
<1
213
37.5
6.27
4
0.9
6.0
MW-3
<1
53
<10
<0.5
5
1.8
5.5
July-10-2018
MW - 1
<1
208
11.5
<0.5
11.6
<0.1
5.7
MW-2
<1
210
34.6
6.16
2.91
<0.1
6.0
MW-3
<1
62
11.0
<0.5
4.59
<0.1
5.3
Nov-19-2018
MW - 1
<1
206
<10
<0.5
6.74
0.4
5.9
MW-2
<1
193
29.2
6.16
1.4
0.9
6.2
MW-3
<1
67
<10
<0.5
4.93
0.6
4.9
Mar-7-2019
MW - 1
<1
206
<10
<0.5
7.70
0.7
6.0
MW-2
<1
180
24.8
4.82
2.06
0.9
6.2
MW-3
<1
78
<10
<0.5
7.14
0.7
4.9
July-11-2019
MW - 1
<1
179
<10
<0.5
7.90
0.5
6.0
MW-2
<1
71
<10
4.14
1.72
0.7
6.5
MW-3
<1
176
19
<0.5
1 5.70
0.9
5.4
Nov-7-2019
MW - 1
<1
178
<10
<0.5
4.30
<0.1
6.2
MW-2
<1
182
<10
5.04
0.68
<0.1
6.4
MW-3
<1
73
<10
<0.5
4.14
<0.1
5.0
Mar-26-2020
MW - 1
<1
161
10.6
<0.5
7.07
0.6
5.9
MW-2
<1
69
20.4
4.90
1.19
0.3
6.5
MW-3
<1
92
<10
<0.5
1 6.00
0.5
6.1
MW-4
<1
170
18.6
<0.5
2.83
0.5
5.7
Maximum
0
435
43
6
12
7
7
Minimum
<1
53
11
4
1
0
5

Analytical Results
Tyson Foods -Wilkesboro
704 Factory Street
Wilkesboro, NC 28697
Receive Date: 03/26/2020
Reported: 04/02/2020
For: Hays Hatchery
Comments:
Sample Number Parameter Sample ID Result
Unit Method Analyzed Analyst
200326-14-01
Ammonia Nitrogen
MW1
<0.5
mg/L
SM4500NH3C-2011
03/30/2020
CJE
200326-14-01
Chloride
MW1
10.6
mg/L
SM4500CIC-2011
03/27/2020
MD
200326-14-01
Fecal Coliforms
MW1
<1
CFU100 ML
SM9222D-2006
03/26/2020
WC
200326-14-01
Nitrate
MW1
7.07
mg/L
SM4500NO3F-2011
03/31/2020
CL
200326-14-01
T. Phosphorous
MW1
0.6
mg/L
SM450OPE-2011
03/30/2020
CL
200326-14-01
Total Dissolved
MW1
161
mg/L
SM 2540 C 18th Edition
03/27/2020
MD
Solids
200326-14-02
Ammonia Nitrogen
MW2
4.90
mg/L
SM4500NH3C-2011
03/30/2020
CJE
200326-14-02
Chloride
MW2
20.4
mg/L
SM4500ac-2011
03/27/2020
MD
200326-14-02
Fecal Coliforms
MW2
<1
CFU100 ML
SM9222D-2006
03/26/2020
WC
200326-14-02
Nitrate
MW2
1.19
mg/L
SM4500NO3F-2011
03/31/2020
CL
200326-14-02
T. Phosphorous
MW2
0.3
mg/L
SM450OPE-2011
03/30/2020
CL
200326-14-02
Total Dissolved
MW2
69
mg/L
SM 2540 C 18th Edition
03/27/2020
MD
Solids
200326-14-03
Ammonia Nitrogen
MW3
<0.5
mg/L
SM4500NH3C-2011
03/30/2020
CJE
200326-14-03
Chloride
MW3
<10
mg/L
SM45000IC-2011
03/27/2020
MD
200326-14-03
Fecal Coliforms
MW3
<1
CFU100 ML
SM9222D-2006
03/26/2020
WC
200326-14-03
Nitrate
MW3
6
mg/L
SM4500NO3F-2011
03/31/2020
CL
200326-14-03
T. Phosphorous
MW3
0.5
mg/L
SM450OPE-2011
03/30/2020
CL
200326-14-03
Total Dissolved
MW3
92
mg/L
SM 2540C 18th Edition
03/27/2020
MD
Solids
200326-14-04
Ammonia Nitrogen
MW4
<0.5
mg/L
SM4500NFIX-2011
03/30/2020
CJE
200326-14-04
Chloride
MW4
18.6
mg/L
SM4500CIC-2011
03/27/2020
MD
200326-14-04
T. Phosphorous
MW4
0.5
mg/L
SM450OPE-2011
03/30/2020
CL
200326-14-04
Total Dissolved
MW4
170
mg/L
SM 2640 C 18th Edition
03/27/2020
MD
Solids
PO Box 228 • Statesville, NC 28687 • 704/872/4697
Page 1 of 5

Sample Number
Parameter
Sample ID
Result
Unit Method
Analyzed
Analyst
200326-14-04
Fecal Coliforms
MW4
<1
CFU100 ML sM9222o-2006
03/26/2020
WC
200326-14-04
Nitrate
MW4
2.83
mg/L SM4500NO3F-2011
03/31/2020
CL
Respectfully submitted,
hQv,wouO""4t
Dena Myers
NC Cert #440,
NCDW Cert #37755,
EPA #NC00909
PO Box 228 • Statesville, NC 28687 • 704/872/4697
Page 2 of 5

Condition of Receipt
Sample Number 200326-14-01 Temp on Arrival: 3.2
Parameter Schedule: Total Dissolved Solids
Received on Ice
Parameter Schedule: Fecal Coliforms
Sodium Thiosulfate Received on Ice
Parameter Schedule:
Sulfuric Acid Received on Ice
Parameter Schedule: Ammonia Nitrogen
Sulfuric Acid Received on Ice
Parameter Schedule: T. Phosphorous
Sulfuric Acid Received on Ice
Parameter Schedule: Chloride
Received on Ice
Sample Number 200326-14-02 Temp on Arrival: 3.2
Parameter Schedule: Total Dissolved Solids
Received on Ice
Parameter Schedule: Fecal Coliforms
Sodium Thiosulfate Received on Ice
Parameter Schedule: T. Phosphorous
Sulfuric Acid Received on Ice
Parameter Schedule: Ammonia Nitrogen
Sulfuric Acid Received on Ice
Parameter Schedule:
Sulfuric Acid Received on Ice
Parameter Schedule: Chloride
Received on Ice
Sample Number 200326-14-03 Temp on Arrival: 3.2
PO Box 228 • Statesville, NC 28687 • 704/872/4697
Page 3 of 5

Parameter Schedule: Total Dissolved Solids
Received on Ice
Parameter Schedule: Fecal Coliforms
Sodium Thiosulfate Received on Ice
Parameter Schedule:
Sulfuric Acid Received on Ice
Parameter Schedule: Ammonia Nitrogen
Sulfuric Acid Received on Ice
Parameter Schedule: T. Phosphorous
Sulfuric Acid Received on Ice
Parameter Schedule: Chloride
Received on Ice
Sample Number 200326-14-04 Temp on Arrival: 3.2
Parameter Schedule: Total Dissolved Solids
Received on Ice
Parameter Schedule: Fecal Coliforms
Sodium Thiosulfate Received on Ice
Parameter Schedule: T. Phosphorous
Sulfuric Acid Received on Ice
Parameter Schedule: Ammonia Nitrogen
Sulfuric Acid Received on Ice
Parameter Schedule:
Sulfuric Acid Received on Ice
Parameter Schedule: Chloride
Received on Ice
PO Box 228 • Statesville, NC 28687 • 704/872/4697
Page 4 of 5

Client:
STA'R+SYII.LB ANAT.YTICAI.
122 Court Saeet • P.O. Box 228
Statesville, NC 28687
Address:
`#�
(704) 872-W
Contact Person:zr,X.
✓
_ , /
W
F
J
FAX
CWn of
Cwtody Rmord
PO # Mquis oned by: Time Dale}
Cugttarnar
Sample IDY
tebip Y
Time Sampled
(Grab On)
Date Sam
Grab 0 )
6*
Ma"a
w
ww
Parmnerets regwimd for.Wy.1
�
f♦
�, tf
r f fr
qn
t
!�
it rr �t 4!
t �{
t
Relinquished by:
Received by:
Relinquished by:
Received by:
Composite Sam li g #1:
Time begin am, pm Data _J_j_._
Time end am, pm Date ��/ _
Composite Sampling #2:
Time begin am, pm Date.._J—J_
Time end- . am, pm Date ^J__J_
Time !+ !�-� C)f' pm Date c Sampled by: 71kZale—
Time l j 2 am, pm Dated Transported by:—�
Time am, pm Date _J__J Holding times met:
Time am, pm Date ��_ Compliance work:
Non-compliance work:
Lab Comments: Samples Transported On Ice:
Initials:
rn
�LO
N O
r- LO
00
O a
r"
r\
00
00
N
U
Z
N
N
r0
N
00
rV
N
X
O
m
O
a

=>
Lr)
t.0
Certified Mail Fee
®—r....� m
m
$
r-9
17-9
Extra Services & Fees (check box, add tee as appropriate)
a
[I Return Receipt (hardcopy) S
�- Q
Q
ElReturn Receip[ (electronic} $
O
%I
[j certified Mail Restricted Delivery $
0
C:3
]Adult Signature Required $
Adult Signature Restricted Delivery $
ED
1-3
Postage
S
C3
-91
Total Postage and Fees
5
rrrrrrrrr�rr r-R
r-q
'_.! k!i Q'� W4.A'-r �ate`1_:iy pCtS
tti
C`
_ -
$jr et a,D�Apt. No„ or Pt3 fox No
1��' L Q.l. �ri�14"CC�-t f
--�-------'--'-------"-'---'--------------------------
S�ate,`27P+4�
■ Complete items 1, 2, and 3.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
1 t' I M.Q.,1..
r I K i, qtAc� - I ca i,7
A. Signature
X
B. Received by (Printed Name)
Postmark
Here
•^!�_-VA f%r 4�
----------------
❑ Agent
❑ Addressee
C. Date of Delivery
D. Is delivery address different from item 1? ❑ Yes
If YES, enter delivery address below: ❑ No
3. Service Type
❑ Priority Mail Express®
El Adult Signature
❑ Registered Mail —
kl Ill!
El Ac�tlt Signature Restricted Delivery
❑Registered Mail Restricted
■■ ■■ 1{
ertified Mail@
Dery
Receipt for
9590 9402 5030 9063 4464 22
Certified Mail Restricted Delivery
eturn
2. Article Number (transfer from service lehel)
0 Collect on Delivery
10 Collect on Delivery Restricted Delivery
Merchandise
0 Signature ConfirmationTM
0 Signature Confirmation
Mail
7019 0140 0001 1357 4775 Mail Restricted Delivery
Restricted Delivery
I tuverz�000)
PS Form 3811, July 2015 PSN 7530-02-000-9053
Domestic Return Receipt