WQ0020793_Monitoring - 03-2020_20200420 (2)

T):
Tyson
April 3, 2020
DEPARTMENT OF ENVIRONMENT & NATURAL RESOURCES
DIVISION OF WATER QUALITY -INFORMATION PROCESSING UNIT
1617 MAIL SERVICE CENTER,
RALEIGH, NC 27699-1617 Phone: [phone]
Subject: Ground Water Quality Monitoring
Tyson Farms, Inc. Hays Hatchery
Compliance Report — March. 2020
To whom it may concern:
Enclosed is the quarterly Groundwater Compliance report for Hays Hatchery.
Please contact me at 336- 651-2871, should you have any questions.
Sincerely,
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.tysonfoods.com

SUBMIT FORM ON YFI I nw PGPFR rvot v
GROUNDWATER QUALITY MONITORING: vcr^KINrtnr urtrvuzafnl 5N1TAMATURALRESOURCES
DWISMI OF WATER'QUALt1Y4NFORMATiON PROCESSING UNIT
COMPLIANCE REPORT FORM aeliMAIL SERVICE C>`NT,RALEIGH; NC 27699-1617 Phone: (810) 733-Mi
FACILITY INFORMATION PleasePrinfClearlyorType PERMIT Number: W00020793 Expiration Date: 07/31/2026
Facility Name: Tyson Farms, Inc.
Non -Discharge W00020793 UIC
Permit Name (if different): NPDES Other
Facility Address: P.O. Box 936/3649 Airport Road TYPE OF PERMITTED OPERATION BEING MONITORED
NORTH WILKESBORO (street) NC 28659 County Wilkes ❑ Lagoon
(city) ❑Remediation: Infiltration Gallery
(State) (Zip)
❑ 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
WELL ID NUMBER (from Permit): MW - 1 Date sample collected: 3/26/2020
Well Depth: 40 ft. Well Diameter: 2 in.
Depth to Water Level 82546: 25 ft. below measuring point Screened Interval: 23 ft- to 40 ft.
Measuring Point is 2 ft. above land surface Relative M.P. Elevation: 1347.53 ft.
Volume of water pumped/bailed before sampling: 7.33 gallons
Samples for metals were collected unfiltered: ❑ YES ® NO and field acidified: ❑ YES ❑■ NO
FIELD ANALYSES:
H 00400: 5.9
p units Temp. 00010: 15.4 C
Spec. Cond. 0oo94: µMhos
Odor 00085: none
Appearance clear
If WELL
WAS
DRY at
time of
sampling,
check
here:❑
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 (NOZ) as N 00615
mg/L
Pb - Lead o1o51 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 70507
mg/L
Other (Specify Compounds and Concentration Units):
issolved Solids:Total 70300 161
mg/L
Al - Aluminum o11o5
mg/L
pH (Lab) 00403
units
Ba - Barium o1o07
ug/L
TOC 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 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) ■❑ No (0)
pecific 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; NH,as N; Ammonia Nitrogen, Total)
Mn -Manganese o1055
ug/L
TKN as N 00625
mg/L
Ni - Nickel 01067
ug/L
,method #
method #
- -- - - - - - - j %_...... -a- ���N�. ��n unwcru t ULdt vvks: mg/L Ettluent Total VOCs: mg/L VOC Removal%
James S. Brown Complex Environmental Manager '1 / 1.10 Permittee (or Authorized Agent) Name and Title - Please print or type Signatule of Perms ee or A thonzed Agent) (Date)
GW-59 Rev.2/2010

SUBMIT FORM ON YFI I nw PAPFR nMl Y
GROUNDWATER QUALITY MONITORING:
COMPLIANCE REPORT FORM
Facility Name: Tyson Farms, Inc.
Permit Name (if different):
Facility Address: P.O. Box 936/3649 Airport Road
NORTH WILKESBORO (street) NC
(City) (State)
Please Print Clearly or
28659 County Wilkes
act Person: James Brown Telephone#: [phone]
Location/Site Name: Hays Hatchery No. of wells to be sampled: 4
UNIT,...-• --- ---- I
PERMIT Number: W00020793
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
A Other: Evaporation/Infiltration Pond
WELL ID NUMBER (from Permit): MW - 2 Date sample collected: 3/26/2020
Well Depth: 36 ft. Well Diameter: 2 in.
Depth to Water Level 82546: 26 ft. below measuring point Screened Interval: 21 ft. to 36 ft.
Measuring Point is 2 ft. above land surface Relative M.P. Elevation: 1331.83 ft.
Volume of water pumped/bailed before sampling: 4.89 gallons
Samples for metals were collected unfiltered: ❑ YES ® NO and field acidified: ❑ YES N NO
FIELD ANALYSES:
pH 00400: 6.5 units Temp. 000lo: 15.9 °C
Spec. Cond. 00094: µMhos
Odor 000as: none
Appearance clear
If WELL
WAS
DRY at
time of
sampling,check
here:❑
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 (NOZ) as N 00615
mg/L
Pb - Lead olo51 ug/L
Coliform: MF Fecal 31616 <1
/100mL
Nitrate (NO3) as N o0620 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
All - 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 olo34
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 o1o45
ug/L
(Specify test and method #. ATTACH LAB REPORT.)
Sulfate 00945
mg/L
Hg - Mercury 71900
ug/L
Lab Report Attached? ❑ Yes (1) 9 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; N-f3 as N; Annonia Nitrogen, Total)
Mn - Manganese o1o55
ug/L
_..-.,
method #
TKN as N 00625
mg/L
Ni - Nickel 01067
ug/L
method #
vyoIcnra Willy tr,uacn Lao meports/: Inttuent I otal VOGs: mg/L Effluent Total VOCs: mg/L VOC Removal%
James Brown Complex Environmental Manager r
Permittee (or Authorized Agent) Name and Title - Please print or type Signature of Permittee (or Authorized Agent) (Date) `
GW-59 Rev.2/2010

SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING:
COMPLIANCE REPORT FORM
=acility Name: Tyson Farms, Inc.
'ermit Name (if different):
=acility Address: P.O. Box 936/3649 Airport Road
NORTH WILKESBORO (street) NC
(City) (state)
Contact Person: James Brown
Well Location/Site Name: Hays Hatchery
Print Clearly or Type
28659 County Wilkes
(Zip)
Telephone#: [phone]
No. of wells to be sampled: 4
PERMIT Number: W00020793 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:
H 00400: 5.1
p units Temp. 00010: 14.4 C
Spec. Cond. 00094: µMhos
Odor 00085: none
Appearance clear
If WELL
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 01051 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 oo665 0.5
mg/L
(Note: Use MPN method for highly turbid samples)
Orthophosphate 7oso7
mg/L
Other (Specify Compounds and Concentration Units):
issolved Solids:Total 70300 92
mg/L
Al -Aluminum ol1o5
mg/L
pH (Lab) 00403
units
Ba - Barium 01007
ug/L
TOC 00680
mg/L
Ca - Calcium 00916
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 M 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 <0.5
mg/L
Mg - Magnesium 00927
mg/L
method #
(Ammonia Nitrogen; NH3 as N; Anw wnia Nitrogen, Total)
Mn -Manganese oloss
ug/L
TKN as N 00625
mg/L
Ni - Nickel 01067
ug/L
,method #
method #
-- ---------------—,---•••-- -•••� ^•���• �a...�or+v�w/. nu1uCnt tU[al vUUS: mg/L Effluent Total VOCs: - mg/L VOC Removal%a
James Brown
ttee (or Authorized Agent)erm ure o Signature f Pi
Permittee (or Authorized Agent) Name and Title -Please print or type Si(Date)
GW-59 Rev.2/2010

SUBMIT FORM ON YFI I OW PAPER nnu V
GROUNDWATER QUALITY MONITORING:
COMPLIANCE REPORT FORM
Facility Name: Tyson Farms, Inc.
Permit Name (if different):
Facility Address: P.O. Box 936/3649 Airport Road
NORTH WILKESBORO (Street) NC
(cry) (State)
Please Print Clearly or
28659 County Wilkes
act Person: James Brown Telephone#: [phone]
Location/Site Name: Hays Hatchery No. of wells to be sampled: 4
UNIT
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 - 4 Date sample collected: 3/26/2020
Well Depth: 27 ft. Well Diameter: 2 in.
Depth to Water Level 82546: 7.4 ft. below measuring point Screened Interval: 12 ft. to 27 ft.
Measuring Point is 2 ft. above land surface Relative M.P. Elevation: 1299.0 ft.
Volume of water pumped/bailed before sampling: 9.58 gallons
Samples for metals were collected unfiltered: ❑ YES ® NO and field acidified: ❑ YES 0 NO
FIELD ANALYSES:
pH 00400: 5.7 units Temp. oo01o: 12.7 eC
Spec. Cond. 00094: µMhos
Odor 00085: none
Appearance clear
If WELL
WAS
DRY at
time of
check
here:❑
LABORATORY INFORMATION
Date sample analyzed:3/26/20
Laboratory Name: Statesville Analytical
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 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 oil o5
mg/L
pH (Lab) 00403
units
Ba - Barium 01007
ug/L
TOC 00680
mg/L
Ca - Calcium 00916
mg/L
Chloride 00940 18.6
mg/L
Cd - Cadmium 01027
ug/L
Arsenic 01002
ug/L
Chromium: Total olo34
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 <0.5
mg/L
Mg - Magnesium 00927
mg/L
method #
(Ammonia Nitrogen; NH, as N; Ammonia Nitrogen, Total)
Mn -Manganese 01655
ug/L
,method #
TKN as N 00625
mg/L
Ni - Nickel 01067
ug/L
method #
univem iotaiTWLS:_mg/L
I certify that, to the best of my knowledge and belief, the information submitted in this report is true, accurate, and complete, and that the laboratory analytical data was produced using approved methods of analysis by a
DWQ-certified laboratory. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations.
James Brown
Pennittee (or Authorized Agent) Name and Title
GW-59 Rev. 2/2010 - Please print or type of Permittee J �•
•V ..

UW-n9A UUMPLIAINUE REPORT FORM Tyson Farms, Inc. Permit # W00020793
(Submit one each monitoring period with GW-59 forms.)
j
Enter date monitoring results were due. ( ) Will this monitoring report (GW-59 and GW-59A)
YES
(NO!
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
(NO/
identification plate, area overgrown, etc.)? If the answer is ")es", contact the Regional Office for guidance.
4
Are any monitored constituents equal to or above the established standards?
(SIESi
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 constituent(s) 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 4.9mg17
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 for each occurrence (for the last two years).
GW Standards Nitrate 10 GW Standards ammonia 1.5
MW 1 - 07-10-18 11.6 mgA MW-2 3-26-20 4.90 mgA 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
Are the monitoring wells listed in section 5 located at or beyond the review boundary?
YE�
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
ES!
NO
groundwater quality problem?-..
i
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 be
required to determine the impact the waste disposal system is having at the review and coml2lia=
boundaries surrounding this facility Failure to do so may subject the permittee to a Notice of Violation
fines. and/or12enalties.
. c
We
g
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.
I hereby acknowledge that the above information was evaluated and the information submitted in this
report (Compliance Report GW-59A) is true and complete to the best of my knowledge.
"1 C
Signature of Permittee (or Authorized Agent) Date
r_w-cos 11iQnnnz

Worksheet # 4b
Tyson Farms, Inc.
Completed by
Max B ers
Title :
WWT Operator
Date :
7-A r-20
No. of Wells to be Sampled 4
Has Hatchery
Groundwate Water sampling Cato Hays Hatchery Compliance Data
Constituents equal to or above the estahlisherl Ctann�mc
Has
1 per 100ML
500 m /I
250 m /
1.5 m /I
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
1 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
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 1
11
4
1 1
0
5

Analytical Results TAT OSVIL F,
�C ANgALY ICAL
Tyson Foods -Wilkesboro Iw
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
200326-14-01
Ammonia Nitrogen
MW1
Analyzed
Analyst
200326-14-01
Chloride
<0.5
mg/L
SM4500NH3C-201,
03/30/2020
CJE
200326-14-01
Fecal Coliforms
MW1
MW1
10.6
mg/L
SM4500CIC-201,
03/27/2020
MD
200326-14-01
Nitrate
<1
CFU100 ML SM9222D-2006
03/26/2020
WC
200326-14-01
T. Phosphorous
MW1
MW1
7.07
mg/L
SM4500NO3F-2011
03/31/2020
CL
200326-14-01
Total Dissolved
MW1
0.6
mg/L
SM450OPE-2011
03/30/2020
CL
161
mg/LSM
2540 C 18th Edition
03/27/2020
MDSolids
200326-14-02
Ammonia Nitrogen
MW2
4.90
200326-14-02
Chloride
mg/L
SM4500NH3C-2011
03/30/2020
CJE
200326-14-02
Fecal Coliforms
MW2
MW2
20.4
mg/L
SM4500CIC-201,
03/27l2020
MD
200326-14-02
Nitrate
<1
SM9222D-2000 CFU100 ML
03/26/2020
WC
200326-14-02
T. Phosphorous
MW2
MW2
1.19
mg/L
SM4500NO3F-2011
03/31/2020
CL
200326-14-02
Total Dissolved
MW2
0.3
mg/L
SM450OPE-2011
03/30/2020
CL
Solids
69
mg/L
SM 2540 C 18M Edition
03/27/2020
MD
200326-14-03
Ammonia Nitrogen
MW3
<0.5
200326-14-03
Chloride
MW3
mg/L
SM4500NH3C-2011
03/30/2020
CJE
200326-14-03
Fecal Coliforms
MW3
<10
mg/L
SM4500CIC-2011
03/27/2020
MD
200326-14-03
Nitrate
<1
CFU100 ML sMszzzD-zoos
03/26/2020
WC
200326-14-03
T. Phosphorous
MW3
MW3
6
mg/L
SM4500NO3F-2011
03/31/2020
CL
200326-14-03
Total Dissolved
MW3
0.5
mg/L
SM4500PE-2011
03/30/2020
CL
Solids
92
mg/L
SM 2540 C 18th Edition
03/27/2020
MD
200326-14-04
Ammonia Nitrogen
MW4
<0.5
200326-14-04
Chloride
MW4
mg/L
SM4500NH3C-2011
03/30l2020
CJE
200326-14-04
T. Phosphorous
MW4
18.6
mg/L
SM4500CIC-2011
03/27/2020
MD
200326-14-04
Total Dissolved
MW4
0.5
mg/L
SM4500PE-201,
03/30/2020
CL
Solids
170
mg/L
SM 2540 C 18th Edition
03/27/2020 MD
PO Box 228 • Statesville, NC 28687 • 704/872/4697
Page 1 of 5

Sample Number Parameter Sample ID Result
200326-14-04 Fecal Coliforms MW4 <1
200326-14-04 Nitrate MW4 2.83
Respectfully ysubmitted,
rOWwp"'j 'raw,
Dena Myers a
NC Cert #440,
NCDW Cert #37755,
EPA #NC00909
Unit Method Analyzed Analyst
CFU100 MIL SM9222o-2006 03/26/2020 WC
mg/L SM4500NO3F-2011 03/31/2020 CL
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:
,
STAIFSYQLE ANALYTIGU
122 Cam Streit • PO. Bex 228
Staksyipe, NC 28687
[phone]
Address'Ir G I O
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Contact Person
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FAX
Chain Of
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Custody Record
Cusloa»r
Sample tDe
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(Grab 0*)
Dale Sampled
(Grab Only)
Nwrtx
$L rdaa w ww Pa erm requemed for analysis
Lo - f
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r
3 ,
Relinquished by:
Time &'-�)-5- rt ,, pm Date
Sampled by. �Yf
Received by:
/
/
2�m
P ---
Time l t! 2am, m Date ✓ 2
Transported by:
Relinquished by:
Time am, pm Date _/_/_
Holdatg times met:
Received by:
Time am, pm Date _/�_
/
"
Composite SamplIng
#1:
Compliance work
Time begin
am, pm Date _/_/_
Non-compliance work -
Time end
am, pm Date
Composite Sampling
,1129
Lab Comments: Samples Transported On Ice:
Time begin
am, pm Date _J_J
Time end
am, pm Date _!____/
lnitials:
00
00
N
V
Z
N
v
in
00
N
N
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