HomeMy WebLinkAboutWQ0029653_Monitoring - 03-2020_20200424SUBMIT FORM ON YELLOW PAPER ONLY
DEPARTMENT OF ENVIRONMENTAL QUALITY - DIV. OF WATER RESOURCES
GROUNDWATER QUALITY MONITORING:
INFORMA7tONPROCESSMKiUNff
COMPLIANCE REPORT FORM
1617 MAIL SERVICE CENTER, RALEIGH, NC 278"407
FACILITY INFORMATION
Please Print Clearly or Type
PERMIT Number: Expiration Date: 2/29/2020
Facility Name: SCOTCH HALL PRESERVE WWTP
Non -Discharge W00029653 UIC
Permit Name (if different):
NPDES Other
Facility Address: MERRY HILL
TYPE OF PERMITTED OPERATION BEING MONITORED
MERRY HILL NC
27957
County BERTIE
❑ Lagoon ❑ Remediation: Infiltration Gallery
M Spray Field ❑ Remediation:
Contact Person: BRIAN JERNIGAN
Telephone#: 252-325-0771
❑ Rotary Distributor ❑ Land Application of Sludge
Well Location/Site Name:SCOTCH HALL PRESERVE
No. of wells to be sampled: 3
❑ Water Source Heat Pump ❑ Other:
from Permit
SAMPLING INFORMATION
If WELL
WELL ID NUMBER (from Permit): MW1
Date sample collected: 3/20/2020
FIELD ANALYSES:
WAS
Well Depth: 20 ft.
Well Diameter: 2 in.
pH 00400: 5.7 units Temp. 000lo: 15.6 °C
DRY at
Depth to Water Level 82546:5.3 ft. below measuring point Screened Interval: 5 ft.
to 20 ft.
Spec. Cond. 00094: µMhos
time ofsampling,
Measuring Point is 3 ft. above land surface
Relative M.P. Elevation:
ft.
Odor 00085: NONE
check
Volume of water pumped/bailed before sampling:
5.0
gallons
Appearance CLEAR
here:❑
Samples for metals were collected unfiltered: ® YES
❑ NO and field acidified: N YES ❑ NO
LABORATORY INFORMATION
Date sample analyzed:3/2012020
Laboratory Name: ENVIRONMENTAL CHEMISTS INC Certification No. 94
PARAMETERS NOTE: Values should reflect
dissolved
and colloidal concentrations.
COD 00335
mg/L
Nitrite (NO2) as N 00615 <0.02
mg/L
Pb - Lead olo51 ug/L
Coliform: MF Fecal 31616 1
/100mL
Nitrate (NOD as N 00620 4.54
mg/L
Zn - Zinc 01092 mg/L
Coliform: MF Total 31504
/100mL
Phosphorus: Total as P 00665
mg/L
(Note: Use MPN method for highly turbid samples)
Orthophosphate 70507
mg/L
Other (Specify' op K1 ncentration Units):
PP--)
issolved Solids:Total 70300 125
mg/L
Al - Aluminum oil o5
mg/L
,.a
{ _ D
pH (Lab) 00403 5.7
units
Ba - Barium 01007
ug/L
A PP 2 4 0n2„
TOC 00680 1.9
mg/L
Ca - Calcium 00916
mg/L
Chloride oosao 10
mg/L
Cd -Cadmium 01027
g/L
—jN� DWP SECTION
Arsenic 01002
ug/L
Chromium: Total olo34
g/L
OCESSING UNIT
Grease and Oils 00552
mg/L
Cu - Copper 01042
m /
ORGANICS: (by GC, GC/MS, HPLC)
Phenol 32730
ug/L
Fe - Iron olo45
(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 7873 method #
Total Ammonia 00610 <0.2
mg/L
Mg - Magnesium 00927
mg/L
method #
(Ammonia Nitrogen; NH3asN; Ammonia Nitrogen, Total)
Mn - Manganese 01055
ug/L
method #
TKN as N 00625 4.54
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 VOU Kemoval io
GW-59 Rev.06-07-2018
SUBMIT FORM ON YELLOW PAPER ONLY
DEPARTMENT OF ENVIRONMENTAL QUALITY - ENV. OF WATER RESOURCES
GROUNDWATER QUALITY MONITORING:
INFORMATION PROCESSING UNIT ,
COMPLIANCE REPORT FORM
1 117 MAIL SERVICE CENTER, RALEIGH NC 27699-1617
FACILITY INFORMATION
Please Print Clearly orType
PERMIT Number: Expiration Date: 2/29/2020
Facility Name: SCOTCH HALL PRESERVE WWTP
Non -Discharge W00029653 UIC
Permit Name (if different):
NPDES Other
Facility Address: MERRY HILL
TYPE OF PERMITTED OPERATION BEING MONITORED
MERRY HILL NC
27957
County BERTIE
❑ Lagoon ❑Remediation: Infiltration Gallery
IN Spray Field ❑ Remediation:
Contact Person: BRIAN JERNIGAN
Telephone#: 252-325-0771
❑ Rotary Distributor ❑ Land Application of Sludge
Well Location/Site Name:SCOTCH HALL PRESERVE
No. of wells to be sampled: 3
❑ Water Source Heat Pump ❑ Other:
from Permit
SAMPLING INFORMATION
If WELL
WELL ID NUMBER (from Permit): MW2
Date sample collected: 3/20/2020
FIELD ANALYSES:
WAS
Well Depth: 20 ft.
Well Diameter: 2 in.
pH 0o400: 5.8 units Temp. 000lo: 1 6.3 °C
DRY at
Depth to Water Level 82546:11.8 ft. below measuring point Screened Interval: 5 ft. to 20 ft.
Spec. Cond. 00094: µMhos
time ofsampling,
Measuring Point is 3 ft. above land surface
Relative M.P. Elevation: ft.
Odor 00085: NONE
check
Volume of water pumped/bailed before sampling:
4.0
gallons
Appearance MILKY/TAN
here: El
Samples for metals were collected unfiltered: m YES
❑ NO and field acidified: ® YES ❑ NO
LABORATORY INFORMATION
Date sample analyzed:3/20/2020
Laboratory Name: ENVIRONMENTAL CHEMISTS INC Certification No. 94
PARAMETERS NOTE: Values should reflect
dissolved
and colloidal concentrations.
COD 00335
mg/L
Nitrite (NO2) as N 00615 <0.02
mg/L
Pb - Lead 01051 ug/L
Coliform: MF Fecal 31616 <1
/100mL
Nitrate (NO3) as N 00620 0.38
mg/L
Zn - Zinc 01092 mg/L
Coliform: MF Total 31504
/100mL
Phosphorus: Total as P 00665
mg/L
(Note: Use MPN method for highly turbid samples)
Orthophosphate 70507
mg/L
Other (Specify Compounds and Concentration Units):
issolved Solids:Total 70300 91
mg/L
All - Aluminum 01105
mg/L
pH (Lab) 00403 5.8
units
Ba - Barium 01007
ug/L
TOC 00680 1.1
mg/L
Ca - Calcium 00916
mg/L
Chloride 00940 <5
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)
pecific Conductance oo095
µMhos
K - Potassium 00937
mg/L
VOC 7873 method #
Total Ammonia 00610 <0.2
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 0.38
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%
DANIEL SUMEREL, GENERAL MANAGER
Permittee (or Authorized Aqent) Name and Title - Please print or type
GW-59 Rev.06-07-2018
SUBMIT FORM ON YELLOW PAPER ONLY
DEPARTMENT OF ENVIRONMENTAL QUALITY - DIV. OF WATER RESOURCES
GROUNDWATER QUALITY MONITORING:
trIFORMAnoNPRocEsslNUNIT
COMPLIANCE REPORT FORM
1617 MAIL SERVICE CENTER, RALEIGH, NC 27699-1617
FACILITY INFORMATION
Please Print Clearly or Type
PERMIT Number: Expiration Date: 2/29/2020
Facility Name: SCOTCH HALL PRESERVE WWTP
Non -Discharge W00029653 UIC
Permit Name (if different):
NPDES Other
Facility Address: MERRY HILL
TYPE OF PERMITTED OPERATION BEING MONITORED
MERRY HILL NC
27957
County BERTIE
❑ Lagoon ❑ Remediation: Infiltration Gallery
❑■ Spray Field ❑ Remediation:
Contact Person: BRIAN JERNIGAN
Telephone#: 252-325-0771
❑ Rotary Distributor ❑ Land Application of Sludge
Well Location/Site Name:SCOTCH HALL PRESERVE
No. of wells to be sampled: 3
❑ Water Source Heat Pump ❑ Other:
from Permit
SAMPLING INFORMATION
If WELL
WELL ID NUMBER (from Permit): MW3
Date sample collected: 3/20/2020
FIELD ANALYSES:
WAS
Well Depth: 20 ft.
Well Diameter: 2 in.
pH 00400: 6.9 units Temp. 000lo: 17.7 °C
DRY at
Depth to Water Level 82546:15.3 ft. below measuring point Screened Interval: 5 ft.
to 20 ft.
Spec. Cond. 00094: µMhos
time ofsampling,
Measuring Point is 3 ft. above land surface
Relative M.P. Elevation:
ft.
Odor 00085: NONE
check
Volume of water pumped/bailed before sampling:
3.5
gallons
Appearance MILKY/BROWN
here:❑
Samples for metals were collected unfiltered: N YES
❑ NO and field acidified: N YES ❑ NO
LABORATORY INFORMATION
Date sample analyzed:3/20/2020
Laboratory Name: ENVIRONMENTAL CHEMISTS INC Certification No. 94
PARAMETERS NOTE: Values should reflect
dissolved
and colloidal concentrations.
COD 00335
mg/L
Nitrite (NO2) as N 00615 <0.02
mg/L
Pb - Lead olo51 ug/L
Coliform: MF Fecal 31616 <1
/100mL
Nitrate (NO3) as N 00620 0.89
mg/L
Zn - Zinc 01092 mg/L
Coliform: MF Total 31504
/100mL
Phosphorus: Total as P 00665
mg/L
(Note: Use MPN method for highly turbid samples)
Orthophosphate 70507
mg/L
Other (Specify Compounds and Concentration Units):
issolved Solids:Total 703oo 89
mg/L
AI - Aluminum oilo5
mg/L
pH (Lab) 00403 6.9
units
Ba - Barium 01007
ug/L
TOC 00680 0.8
mg/L
Ca - Calcium 00916
mg/L
Chloride oo94o 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 olo45
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 7873 method #
Total Ammonia 00610 <0.2
mg/L
Mg - Magnesium 00927
mg/L
method #
(Ammonia Nitrogen; N113as N; Ammonia Nitrogen, Total)
Mn - Manganese 01055
ug/L
method #
TKN as N 00625 0.89
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%
GW-59 Rev.06-07-2018
Environmental Chemists, Inc.
'SM
ANALYTICAL & CONSULTING CHEMISTS
6602 Windmill Way, Wilmington, NC 28405 • 910.392.0223 Lab • 910.392.4424 Fax
710 Bowsertown Road, Manteo, NC 27954 • 252.473.5702 Lab/Fax
255-A Wilmington Highway, Jacksonville, NC 28540 • 910.347.5843 Lab/Fax
info ,environmentalchetnists.com
Scotch Hall Preserve
Date of Report:
Apr 07, 2020
105 Scotch
Hall Court
Customer PO #:
Merry Hill
NC 27957
Customer ID:
17050011
Attention:
Brian Jernigan
Report #:
2020-04760
Project ID: Monitoring
Wells
Lab ID
Sample ID:
Collect Date/Time Matrix
Sampled by
20-11730
Site: MW-1
3/20/2020 8:37 AM Water
Tom Beasley
Test
Method Results Date Analyzed
Color
Color
Clear
03/20/2020
Depth to water, ft.
Depth to water, Ft.
5.3 feet
03/20/2020
Ammonia Nitrogen
EPA 350.1
< 0.2 mg/L
04/01 /2020
Gallons bailed before sampling
Gallons Bailed before sampling
5.0 gallons
03/20/2020
Odor
Qualitative
None
03/20/2020
Total Dissolved Solids (TDS)
SM 2540 C
125 mg/L
03/20/2020
Temperature
SM 2550 B
15.6 C
03/20/2020
Chloride
SM 4500 Cl E
10 mg/L
03/31 /2020
pH
SM 4500 H B
5.7 units
03/20/2020
Total Organic Carbon (TOC)
SM 5310 B
1.9 mg/L
03/23/2020
Fecal Coliform
SM 9222D MF
1 Colonies/100ml-
03/20/2020
Nitrate Nitrogen (Calc)
Nitrite Nitrogen
EPA 353.2
< 0.02 mg/L
03/21/2020
Nitrate+Nitrite-Nitrogen
EPA 353 2
4.54 mg/L
04/04/2020
Nitrate Nitrogen
Subtraction Method
4.54 mg/L
04/07/2020
Report #: 2020-04760 p,,,e , s Q
renv�irochjem
ANALYTICAL & CONSULTING CHEMISTS
Scotch Hall Preserve
105 Scotch Hall Court
Merry Hill NC
Attention: Brian Jernigan
Lab ID Sample ID:
20-11809 Site: MW-2
Test
Environmental Chemists, Inc.
6602 Windmill Way, Wilmington, NC 28405 ' 910.392.0223 Lab ' 910.392.4424 Fax
710 Bowsertown Road, Manteo, NC 27954 • 252.473.5702 Lab/Fax
255-A Wilmington Highway, Jacksonville, NC 28540 • 910.347.5843 Lab/Fax
info@�).environmentalchemists.com
Date of Report: Apr 07, 2020
Customer PO #:
27957 Customer ID: 17050011
Report #: 2020-04760
Project ID: Monitoring Wells
Color
Depth to water, ft.
Ammonia Nitrogen
Gallons bailed before sampling
Odor
Total Dissolved Solids (TDS)
Temperature
Chloride
pH
Total Organic Carbon (TOC)
Fecal Coliform
Nitrate Nitrogen (Cale)
Nitrite Nitrogen
Nitrate+Nitrite-Nitrogen
Nitrate Nitrogen
Collect Date/Time Matrix
3/20/2020 8:26 AM Water
Method
Color
Depth to Water, Ft.
EPA 350.1
Gallons Bailed before sampling
Qualitative
SM 2540 C
SM 2550 B
SM 4500 Cl E
SM 4500 H B
SM 5310 B
SM 9222D MF
EPA 353.2
EPA 353.2
Subtraction Method
Results
Sampled by
Tom Beasley
Date Analyzed
Milky Tan
03/20/2020
11.8 feet
03/20/2020
< 0.2 mg/L
04/06/2020
4.0 gallons
03/20/2020
None
03/20/2020
91 mg/L
03/23/2020
16.3 C
03/20/2020
< 5 mg/L
03/31/2020
5.8 units
03/20/2020
1.1 mg/L
03/23/2020
<1 Colonies/100ml-
03/20/2020
< 0.02 mg/L
03/21 /2020
0.38 mg/L
04/04/2020
0.38 mg/L
04/07/2020
7
Report #:: 2020-04760
Pnno I nF 1
Environmental Chemists, Inc.
envirochem
ANALYTICAL & CONSULTING CHEMISTS
6602 Windmill Way, Wilmington, NC 28405 ` 910.392.0223 Lab ' 910.392.4424 Fax
710 Bowsertown Road, Manteo, NC 27954 • 252.473.5702 Lab/Fax
255-A Wilmington Highway, Jacksonville, NC 28540 • 910,347.5843 Lab/Fax
infoCa,;environmentalehemists.com
Scotch Hall Preserve
Date of Report:
Apr 07, 2020
105 Scotch
Hall Court
Customer PO #:
Merry Hill
NC 27957
Customer ID:
17050011
Attention:
Brian Jernigan
Report #:
2020-04760
Project ID: Monitoring
Wells
Lab ID
Sample ID:
Collect Date/Time Matrix
Sampled by
20-11810
Site: Mvu-3
3/20/2020 8:12 AM Water
Tom Beasley
Test
Method Results
Date Analyzed
Color
Color
Milky Brown
03/20/2020
Depth to water, ft.
Depth to Water, Ft.
15.3 feet
03/20/2020
Ammonia Nitrogen
EPA 350.1
< 0.2 mg/L
04/06/2020
Gallons bailed before sampling
Gallons Bailed before sampling
3.5 gallons
03/20/2020
Odor
Qualitative
None
03/20/2020
Total Dissolved Solids (TDS)
SM 2540 C
89 mg/L
03/23/2020
Temperature
SM 2550 B
17.7 C
03/20/2020
Chloride
SM 4500 Cl E
6 mg/L
03/31 /2020
pH
SM 4500 H B
6.9 units
03/20/2020
Total Organic Carbon (TOC)
SM 5310 B
0.8 mg/L
03/23/2020
Fecal CQliform
SM 9222D MF
<1 Colonies/100mL
03/20/2020
Nitrate Nitrogen (Ca1c)
Nitrite Nitrogen EPA 353.2 < 0.02 mg/L 03/21 /2020
Nitrate+Nitrite-Nitrogen EPA 353.2 0.89 mg/L 04/04/2020
Nitrate Nitrogen Subtraction Method 0,89 mg/L 04/07/2020
Comment:
Reviewed by:
Report # 2020-04760 P.- 4 �f z
• r
Analytical & Consulting Chemists
ENVIRONMENTAL CHEMISTS, INC
NCDENR: DWO CERTIFICATION # 94 NCDHHS: DLS CERTIFICATION # 37729
mi 1 FCTln?J ANn (_WAIN n1l: CI le-r nV
6602 Windmill Way Wilmington, NC 28405
OFFICE: 910-392-0223 FAX 910-392-4424
into *environmentaichemists.com
Client: Scotch Hall Preserve
PROJECT NAME: Monitoring Wells
REPORT NO: - -7
ADDRESS: 105 Scotch Hall Court
CONTACT NAME: Brian Jernigan
PO NO:
Merry Hill, NC 27957
REPORT TO:
PHONEIFAX:
COPY TO: Rick Harrell rick.harrell@gmail.com
email: bkjshp@gmail.com
Sampled Bv: SAIMPI F TVPF- I - Influnnf G � Ffflnnnf W . We11 CT - Of— On - 0...1 Q1 _ e1aa._..-
Sample Identification
P
Collection
a
!—
CDa
n
40
o
_
C C7
C a£
C J
"
W
m
a
i
PRESERVATION
REQUESTED
Date
Time
Temp
z
$
=
o
a
o
cc
o
MW:
..�
C
P
X
Chloride, NO2, TDS
G
G
Depth to water:
X
NH3,NO3
G
G
Gallons Bailed: C,%
15,
C
P
X
Fecal Coliform
G
G
pH field):
C
P
X
TOC
G
G
color: (,,I r
C
P
G
G
odor: t•1
C
P
3-..�j
G
G
C
P
G
G
C
P
G
G
C
P
G
G
Total of 3 wells (1,2,3) due March, July,
November
Transfer
Relinquished By:
DatetTime
Received By:
Date/Time
1.
to-U
2.
Tgamnnrexfnrn u#hnn
A---- —
Delivered By:
• Comments: _
By:
ile Requested:_
-20 - 2-0
TURNAROUND:
Analytical & Consulting Chemists
ENVIRONMENTAL CHEMISTS, INC
NCDENR: DWO CERTIFICATION # 94 NCDHHS: DLS CERTIFICATION # 37729
nni i 1=1' 7V11il Akin /+u A1w1 nr ^m se%rrw
6602 Windmill Way Wilmington, NC 28406
OFFICE: 910-392-0223 FAX 910-392-4424
lnfo@environmentalchemists.com
Client: Scotch Hall Preserve
PROJECT NAME: Monitoring Wells
REPORT NO: 2.0 — % (y
ADDRESS: 105 Scotch Hail Court
CONTACT NAME: Brian Jernigan
PO NO:
Merry Hill, NC 27957
REPORT TO:
PHONEIFAX:
COPY TO: Rick Harrell rick.harrell@gmaii.com
email: bkjshp@gmail.com
Sampled By:--T'/P� _ 13 CAMDI F TVDF• 1 - inf6.n.,+ C - CKI.-G. \A/ - %At 1
Sample Identification
p
Collection
;�
d
E
y
r
w
a
o
U
5
c a
v"
c-j
r E
"
-
a w
m
J;
z
-----
PRESERVATION
.., --. - ...........,
.. _ .., .. - ........ya, ...ail.
ANALYSIS REQUESTED
Date
Time
Temp
c
z
U
==
g
a
z
=
'-
=
o
MW:
C
P
X
Chloride, NO2, TDS
G
G
i
Depth to water:
C
P
�'
� � 1
X
NH3,NO3
G
G
Gallons Bailed:
j
C
P
X
Fecal Coliform
G
G
H (field):
C
P
X
ITOC
G
G
color: '�"��
C
P
G
G
odor:
C
P
G
G
C
P
G
G
C
P
G
G
C
P
G
G
Total of 3 wells (1,2,3) due March,
July,
November
Transfer
Relin uished By:
Date/Time
Received By:
Datelrime
1.
-3-'Z() w i L'
2.
Ttamnnrn4urn uuhnn >Zse. ;6
A. 9 r
Delivered
• Comments:
esampie mequestea:__ _
By:--� - -jp —Date: 3 - W 26 Time:
TURNAROUND:
Windmill Way
ton,
ENVIRONMENTAL CHEMISTS, INC �� E:910-3 2-0223iFAX9910 2244245
Analytical 8 Consulting Chemists NCDENR: DWO CERTIFICATION # 94 NCDHHS: DLS CERTIFICATION # 37729 info@environmentalchemists.com
COLLECTION AND CHAIN OF CUSTODY
Client: Scotch Hall Preserve
PROJECT NAME: Monitoring Wells
REPORT NO: 2-0 --
ADDRESS: 105 Scotch Hall Court
CONTACT NAME: Brian Jernigan
PO NO:
Merry Hill, NC 27957
REPORT TO:
PHONE/FAX:
COPY TO: Rick Harrell rick.harrell@gmail.com
email: bkjshp@gmail.com
Sampled By: SAMPLE TYPE. I = Influent, E = Effluent, W = Well, ST = Stream, SO = Soil, SL = Sludge, Other:
Sample Identification
Collection
F
a
E
g
� a
o 2
m
cC7
B o
cia
,
c
o �+
v E
9w
m
z
PRESERVATION
ANALYSIS REQUESTED
Date
Time
Temp
z
z
$
£
0
i
0
i
o
w
o
MW:
.2t:
Doi L
C
P
X
Chloride, NO2, TDS
G
G
�i
Depth to water: , •5
C
P
�' �-
! l�l )a
X
NH3,NO3
G
G
Gallons Bailed:F
C
P
X
Fecal Co(iform
G
G
H (field):
C
P
X
TOC
G
G
to
color: �''v
C
P
G
G
odor:
C
P
6C612,
G
G
C
P
G
G
C
P
G
G
C
P
G
G
Total of 3 wells (1,2,3) due March, July, November
Transfer
elinquished By:
Date/Time
Received By:
DatelTime
1 .
2�rLa
2.
Temperature when Received: Z z-
Delivered By: -__
Comments:____._
_Rejected:_ esample Requested:_ _
eceived By: ?!J�—_Date: 3 -Zo -Z L) Time:
_TURNAROUND: