WQ0014785_Monitoring - 03-2020_20200603

FORM: NDAR-1 08-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page of
Permit No.: WQ0014785
Facility Name: Midway Middle School
County: Sampson
Month: March
Year: 2020
Field Name:
1
Field Name:
2
Field Name:
3
Field Name:
4
Did irrigation occur
Area (acres):
0.435
Area (acres):
0.435
Area (acres):
0.435
Area (acres):
0.435
at this facility?
/^.
Cover Crop:
Cover Crop:
Cover Crop:
Cover Crop:
AYES]NO �p 1\/ P
Hourly Rate (in):
0.16
Hourly Rate (in):
0.16
Hourly Rate (in):
0.16
Hourly Rate (in):
0.16
13 202C
Annual Rate (in):
39
Annual Rate (in):
39
Annual Rate (in):
39
Annual Rate (in):
39
Weather
Freeboard
Field Irrigated?
DYES []NO
Field Irrigated?
EYES [:]NO
Field Irrigated?
EYES LINO
Field Irrigated?
EYES LINO
°
°
'e
F
_
a
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a
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= oCL
J
°F
in
ft
ft
gal
min
in
in
gal
min
in
in
gal
min
in
in
gal
min
in
in
1
CL
68
3
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00 1
0
1 0
0.00
0.00
2
C
68
3
1,250
20
0.11
0.11
1,250
20
0.11
0.11
1,250
20
0.11
0.11
1,250
20
0.11
0.11
3
CL
63
3
1,250
20
OA1
0.11
1,250
20
0.11
0.11
1,250
20
0.11
0.11
1,250
20
0.11
0.11
4
CL
59
3
1,250
20
0.11
0.11
1,250
20
0.11
0.11
1,250
20
0.11
0.11
1,250
20
0.11
0.11
5
R
51
3
0
0
1 0.00
0.00
0
1 0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0-00
6
R
62
3
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
7
C
51
3
1,250
20
0.11
0.11
1,250
20
0.11
0.11
1,250
20
0.11
0.11
1,250
1,250
0.11
0.01
8
C
44
3
1,250
20
0.11
0.11
1,250
20
0.11
0.11
1,250
20
0.11
0A1
1,250
1,250
0.11
0.01
9
C
39
3
1,250
20
0.11
0.11
1,250
20
0.11
0.11
1,250
20
0.11
0.11
1,250
1,250
0.11
0.01
10
CL
70
3
1,250
20
0.11
0.11
1,250
20
0.11
0.11
1,250
20
0.11
0.11
1,250
1,250
0.11
0.01
11
C
63
3
1,250
20
1 0.11
0.11
1,250
20
0.11
0.11
1,250
20
0.11
0.11 1
1,250
1,250
0.11
0.01
12
C
78
3
1,250
20
0.11
0.11
1.250
20
0.11
0.11
1,250
20
0.11
0.11
1,250
1,250
0.11
0.01
13
PC
66
3
1,250
20
0.11
0.11
1,250
20
0.11
0.11
1,250
20
0.11
0.11
1,250
1,250
0.11
0.01
14
C
74
3.5
1,250
20
0.11
0.11
1,250
20
0.11
0.11
1,250
20
0.11
0.11
1,250
0.11
0.01
15
CL
49
3.5
1,250
20
0.11
0.11
1,250
20
0.11
0.11
1,250
20
0.11
0.11
1,250
0.11
0.01
16
PC
49
3.5
1,250
20
0.11
0.11
1,250
20
0.11
0.11
1,250
20
0.11
0.11
1,250
M20
0.11
0.01
17
R
50
3.5
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
0
0.00
0.00
18
PC
61
3.5
1,250
20
0.11
0.11
1,250
20
0.11
0.11
1,250
20
0.11
0.11
1,2500.11
OA1
19
C
64
3.5
1,250
20
0.11
0.11
1,250
20
0.11
0.11
1,250
20
0.11
0.11
1,250
20
0.11
0.11
20
C
75
3.5
1,250
20
0.11
0.11
1,250
20
0.11
0.11
1,250
20
0.11
0.11
1,250
20
0.11
0.11
21
PC
72
3.5
1,250
20
0A1
0.11
1,250
20
0.11
0.11
1,250
1 20
0.11
1 0.11
1,250
20
0.11
0.11
221
C
56
3.5
1,250
20
0.11
0.11
1,250
20
0.11
0.11
1,250
20
0.11
0.11
1,250
20
0.11
0.11
23
R
54
3.5
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
24
R
56
3.5
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
25
CL
68
3.5
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
26
CL
66
3.5
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
27
C
75
3.5
0
0
1 0.00
0.00
0
0
0.00
0.00
0
1 0
0.00
1 0.00
0
0
0.00
0.00
28
C
76
3.5
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
29
C
85
3.5
1,250
20
0.11
0.11
1,250
20
0.11
0.11
1,250
20
0.11
0.11
1,250
20
0.11
0.11
30
C
81
4
1,250
20
0.11
0.11
1,250
20
0.11
0.11
1,250
20
0.11
0.11
1.250
20
0.11
0.11
31
C
80
1
4
1
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
Monthly Loading:
25,000
2.12
25,000
2.12
25,000
2.12
25,000
2.12
12 Month Floating Total (in):
8.05
8.05
8.05
8.05

FORM: NDAR-1 08-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page of
Permit No.: WQ0014785
Facility Name: Midway Middle School
County: Sampson
Month: March
Year: 2020
Field Name:
5
Field Name:
6
Field Name:
7
Field Name:
8
Did irrigation occur
Area (acres):
0,435
Area (acres):
0.435
Area (acres):
0.436
Area (acres):
0.435
at this facility?
Cover Crop:Cover
Crop:
P�
Cover Crop:
P�
Cover Crop:
P:
❑YES ❑NO
Hourly Rate (in):
0.16
Hourly Rate (in):
0.16
Hourly Rate (in):
0.16
Hourly Rate (in):
0.16
Annual Rate (in):
39
Annual Rate (in):
39
Annual Rate (in):
39
Annual Rate (in):
39
Weather
Freeboard
Field Irrigated?
EYES [-]NO
Field Irrigated?
EYES ❑NO
Field Irrigated?
EYES ONO
Field Irrigated?
EYES ONO
T
m
0
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X ° °
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°F
in
ft
ft
gal
min
in
in
gal
min
in
in
gal
min
in
in
gal
min
in
in
1
cl
68
4
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
2
C
68
4
1,250
20
0.11
0.11
1,250
20
0.11
0.11
1,250
20
0.11
0.11
1,250
20
0.11
0.11
3
CL
63
4
1,250
20
0.11
0.11
1,250
20
0.11
0.11
1,250
20
0.11
0.11
1,250
20
0.11
0.11
4
CL
59
4
1,250
20
0.11
0.11
1,250
20
0.11
0.11
1,250
20
0.11
0.11
1,250
20
0.11
0.11
5
R
51
4
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
6
R
62
4
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
7
C
51
4
1,250
20
0.11
0.11
1,250
20
0.11
0.11
1,250
20
0.11
0.11
1,250
20
0.11
0.11
8
C
44
4
1,250
20
0.11
0.11
1,250
20
0.11
0.11
1,250
20
0.11
0.11
1,250
20
0.11
0.11
9
C
30
4
1,250
20
0.11
0.11
1,250
20
0.11
0.11
1,250
20
0.11
0.11
1,250
20
0.11
0.11
10
CL
70
4
1,250
20
0.11
0.11
1,250
20
0.11
0.11
1,250
20
0.11
0.11
1,250
20
0.11
0.11
11
C
63
4
1,250
20
0.11
0.11
1,250
20
0.11
0.11
1,250
20
0.11
0.11
1,250
20
0.11
0.11
12
C
78
4
1,250
20
0.11
0.11
1,250
20
0.11
0.11
1,250
20
0.11
0.11
1,250
20
OA1
0.11
13
PC
66
4
1,250
20
0.11
0.11
1,250
20
0.11
0.11
1,250
20
0.11
0.11
1,250
20
0.11
0.11
14
C
74
4
1,250
20
0.11
0.11
1,250
20
0.11
0.11
1,250
20
0.11
0.11
1,250
20
0.11
0.11
15
CL
49
4
1,250
20
0.11
0.11
1,250
20
0.11
1 0.11
1,250
20
0.11
0.11
1,250
20
0.11
0.11
16
PC
49
4
1,250
20
0.11
0.11
1,250
20
0.11
1 0.11
1,250
20
0.11
0.11
1,250
20
0.11
0.11
17
R
50
4
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
18
PC
61
4
1,250
20
0.11
0.11
1,250
20
0.11
0.11
1,250
20
0.11
0.11
1,250
20
0.11
0.11
19
C
64
4
1,250
20
0.11
0.11
1,250
20
0.11
0.11
1,250
20
0.11
0.11
1,250
20
0.11
0.11
20
C
75
4
1,250
20
0.11
0.11
1,250
20
0.11
0.11
1,250
20
0.11
0.11
1,250
20
0.11
0.11
21
PC
72
4
1,250
20
0.11
0.11
1,250
20
0.11
0.11
1,250
20
0.11
0.11
1,250
20
0.11
0.11
22
C
56
4
1,250
20
0.11
0.11
1,250
20
0.11
0.11
1,250
1 20
0.11
0.11
1,250
20
0.11
0.11
23
R
54
4
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
24
R
56
4
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
25
CL
68
4
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
26
CL
66
4
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
27
C
75
4
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0,00
0.00
28
C
76
4
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
29
C
85
4
1,250
20
0.11
0.11
1,250 1
20
0.11
0.11
1,250
20
0.11
0.11
1,250
20
0.11
0.11
30
C
81
4
1,250
20
0.11
0.11
1,250
20
0.11
0.11
1,250
20
0.11
0.11
1,250
20
0.11
0.11
31
c
0
7-1
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
Monthly Loading:
25,000WH05
.12
25,000
2.12
25,000
2.11
252000
2.12
12 Month Floating Total (in):
8.05
8.05
8.05

FORM: NDMLR 08-11 NON -DISCHARGE MASS LOADING REPORT (NDMLR) Page
Permit No.: WQ0014785
Facility Name: Midway Middle School
County: Sampson
Month: March
Year: 2020
Field Name:
1
Field Name:
2
Field Name:
3
Field Name:
4
Field Name:
5
Area (acres):
0.435
Area (acres):
0.435
Area (acres):
0.435
Area (acres):
0.435
Area (acres):
0.435
Cover Crop:
Cover Crop:
Cover Crop:
Cover Crop:
Cover Crop:
Load Type:
PAN
Load Type:
PAN
Load Type:
PAN
Load Type:
PAN
Load Type:
PAN
Field Loaded?
EYES []NO
Field Loaded?
❑� YES ONO
Field Loaded?
EYES ONO
Field Loaded?
EYES ONO
Field Loaded?
EYES ONO
c
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Month
gal
mg/L
Ibs/ac
I Ibs/ac
gal
mg/L
Ibs/ac
Ibs/ac
gal
mg/L
Ibs/ac
Ibs/ac
gal
mg/L
Ibs/ac
Ibs/ac
gal
mg/L
Ibs/ac
Ibs/ac
April
May
June
July
August
September
October
November
December
January
February
March
25,000
9.29
4.5
4.5
25,000
9.29
4.5
4.5
25,000
9.29
4.5
4.5
25,000
9.29
4.5
4.5
25,000
9.29
4.5
4.5
12 Month Floating PAN Load
4.5
4.5
4.5
(Ibs/ac/yr):
Annual PAN Load Limit
11..0
11.00
11.00
11.00
11.00
(Ibs/ac/yr):

FORM: NDMLR 08-11 NON -DISCHARGE MASS LOADING REPORT (NDMLR) Page of
Permit No.: WQ0014785
Facility Name: Midway Middle School
County: Sampson
Month: March
Year: 2020
Field Name:
6
Field Name:
7
Field Name:
8
Field Name:
Field Name:
Area (acres):
0.435
Area (acres):
0.435
Area (acres):
0.435
Area (acres):
Area (acres):
Cover Crop:
Cover Crop:
Cover Crop:
Cover Crop:
Cover Crop:
Load Type:
PAN
Load Type:
PAN
Load Type:
PAN
Load Type:
Load Type:
Field Loaded?
❑✓ YES []NO
Field Loaded?
[DYES ❑NO
Field Loaded?
(]YES ❑NO
Field Loaded?
❑YES ❑NO
Field Loaded?
❑� YES ❑NO
o
Z
a
Z
Z
Z
Z
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Month
gal
mg/L
Ibs/ac
Ibs/ac
gal
mg/L
Ibs/ac
I Ibs/ac
gal
I mg/L
Ibs/ac
Ibs/ac
gal
mg/L
Ibs/ac
Ibs/ac
gal
mg/L
Ibs/ac
Ibs/ac
April
May
June
July
August
September
October
November
December
January
February
March
25,000
9.29
4.5
4.5
25,000
9.29
4.5
4.5
25,000
9.29
4.5
4.5
12 Month Floating PAN Load
4.5
4.5
(Ibs/aclyr):
Annual PAN Load Limit
11
11.00
11.00
(Ibs/ac/yr):

FORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page of
Permit No.: W00014785
Facility Name: Midway Middle School
County: Sampson
Month: March
Year: 2019
PPI: 001
Flow Measuring Point: []Influent❑Effluent [:]No Flow generated
Parameter Monitoring Point: ❑Influent ❑Effluent [:]Groundwater Lowering [-]Surface water
Parameter Code -►
50050
00400
00625
00310
00610
00530
31616
00665
00620
WQ09
00940
00600
70300
is
E
�
O
2
O
3
°
L
N
0
p
mn
O
E
o
E
° _
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U)
ao
E
ti
N
at
y
Y
,U
z
c atE
a °
>.-z Q
L
U
m >
°
zaO
a)d
c -w' o
<no
24-hr
hrs
GPD
su
mg/L
mg/L
mg/L
mg/L
#/100 mL
mg/L
mg/L
mg/L
mg/L
mg/L
mg/L
1
2,514
27
2
2,514
3
2,514
4
2,514
5
2,514
6
2,514
7
2,514
8
2,514
9
2,329
10
2,329
11
2,329
19.3mg/I
17.1 mg/1
49mpn/100
12
2,329
11.8
13
2,329
14
2,329
1
1
1
#VALUE!
15
2,329
16
2,471
7.5
23mg/1
17
2,471
18
2,471
19
2,471
20
2,471
21
2,471
22
2,471
23
300
24
300
25
300
26
300
27
300
28
300
29
300
30
286
0.09
311
286
6.75mg/I
Average:
1,819
27.00
0,00
0.00
0.00
1.00
0.00
0.09
11.80
Daily Maximum:
2,514
7.50
27.00
0.00
0.00
0.00
0.00
0.00
0.09
11.80
Daily Minimum:
286
7.50
27.00
0.00
0.00
0.00
0.00
0.00
0.09
11.80
Sampling Type:
Monthly Limit:
310,000
Daily Limit:
Sample Frequency:

FORM: NDAR-1 08-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1)
Did the application rates exceed the limits in Attachment B of your permit?
Page of
Compliant ❑Non -Compliant
Were adequate measures taken to prevent effluent ponding in or runoff from the sites? ❑� Compliant ❑Non -Compliant
Was a suitable vegetative cover maintained on all sites as specified in your permit? DCompliant []Non -Compliant
Were all setbacks listed in your permit maintained for every application to each permitted site? ❑� Compliant ❑Non -Compliant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit? ❑� Compliant ❑Non -Compliant
If the facility is non -compliant, please explain in the space below the reason(s) the facility was not in compliance. Provide in your explanation the date(s) of the non-compliance and describe the corrective
action(s) taken. Attach additional sheets if necessary.
Operator in Responsible Charge (ORC) Certification11 Permittee Certification I
ORC: Robert Carroll Permittee:
Sampson County School
Certification No.: 26341 Signing Official: Robert Carroll
Grade: s Phone Number: 910/385/6116 Signing Official's Title: ORC
Has the ORC changed since the previous NDAR-1? ❑ves ❑✓ No Phone Number: 910/385/6116 Permit Exp.: 12/31 /21
j 4/20/20 / 4/20/20
Signature Date Signature Date
By this signature, I certify that this report is accurrate and complete to the best of my knowledge. I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance
with a system designed to assure that all qualified personnel properly gathered and evaluated the information submitted. Based on my
inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the
information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant
penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations.
Mail Original and Two Copies to:
Division of Water Quality
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

Environmental Chemists, Inc.
LLenviroch,em 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
5 255-A Wilmington Highway, Jacksonville, NC 28540 • 910.347.5843 Lab/Fax
ANALYTICAL & CONSULTING CHEMISTS [e-mail]
Sampson Co. Schools
Date of Report: Apr 06, 2020
437 Rowan Road
Customer PO #:
Clinton, NC 28328
Customer ID: 19040001
Attention:
Report #: 2020-04387
Project ID: Midway Middle
Lab ID Sample ID:
Collect Date/Time Matrix Sampled by
20-10794 Site: Effluent - Grab
3/16/2020 10:40 AM Water Robert Carroll
Test
Method
Results Date Analyzed
Fecal Coliform
Idexx Colilert-18
49 MPN/100ml
03/16/2020
Residue Suspended (TSS)
SM 2540 D
17.1 mg/L
03/16/2020
Total Phosphorus
SM 4500 P F
6.75 mg/L
03/31/2020
BOD
SM 5210 B
23 mg/L
03/16/2020
Nitrate Nitrogen (Calc)
Nitrite Nitrogen
EPA353.2
0.06mg/L
03/18/2020
Nitrate+Nitrite-Nitrogen
EPA 353.2
0.09 mg/L
03/30/2020
Nitrate Nitrogen
Subtraction Method 0.03 mg/L
04/01/2020
Total Nitrogen (Calc)
Total Nitrogen
Total Nitrogen
11.8 mg/L
04/01/2020
Lab ID Sample ID:
Collect Date/Time Matrix Sampled by
20-10794A Site: Effluent - Grab
3/16/2020 10:40 AM Water Robert Carroll
Test
Method
Results Date Analyzed
Ammonia Nitrogen
SM 4500 NH3 C
19.3 mg/L
04/01/2020
Total Kjeldahl Nitrogen (TKN)
SM 4500 org B
27.6 mg/L
04/01/2020
Comment:
Reviewed by:
Report #:: 2020-04387 Page 1 of 1

E^vironmental Chemist, Inc., Wilmington, VC lab #94
;602 Windmill Way
.vilmington, VC 28405
310.392.0223
Sample Receipt Checklist
Client: SAD nL ,a %SbUo n f 3
Jate: �° 0 3eport Number: (q U Q 1�3
Receipt of sample:
�elivere0
O YES 0 VO V/A JPS O FedEx p Other p
I C3 yES 0 VO 1• Were custody seals present on the cooler?
N/A 2. If custody C temperature upon receipt .-S dY seals were present, were they intact/unbroken?
Haw temperature taken: Corrected temperature upon receipt
able R Gun 10: Thomas S/NN 1925 1657ture Blank
Against Bottles
0 yES O VO R Gun Correction Factor •C: 0.0
3. If temperature of cooler exceeded 6'C, was Project M r,
YES �� NO 4. Were proper Gusto I B /� notified?
YES ;Q VO p dprocedures (relinquished/received) foilo
5. Were sample 1D's listed
on the wed?
ed COC7 YES �� VO 6. 'Nere samples 10's listed on sample containers?
YES O VO 7. Were collection date and time listed on the CDC?
YES 0 VO 8. Were tests to be performed listed on the CC?C?
YES O VO 9. Did samples arrive in proper containers for e
YES l7 VO 10. Did samples arrive in good condition for each est?st?
+ES C3 VO 11. Was adequate sample volume available?'
Sid DES '❑ VO 12. Were samples received within pro
YES C3 VO 13. Were acid preserved samples received a holding aPHtime of <Z� requested tests?
0 YES 0 VO 14. Were cyanide samples received at a pH >127
0 +ES 0 VO 15. Were sulfide samples received at a pH >9?
YES 10 VO 16. Were NH3/TKN/Phenol received at a chlorine residm
0 +ES O VO 17. 'Nual of <0.5ere Sulfide/Cyanide received at a chlorine residual of <0.S m �`? ••
/l
ToC/Volatiles are off checked at time of analysis and recorded on the benchsheet.
" ?acteria samples are checked for Chlorine at time of analysis and recorded on the benchshe et.
Sample Preservation:
,Must be completed for any samolels) incorrectly preserved or with heads----)
Sample(s)
.vere received incorrectly preserved and were adjusted accordingly
by adding (circle one): -I:SO -�
Time of oreservatton: NOS ICI `IaCIH
Noce roc f more than one oreservative is needed, notate ;n comm
fV customer sery ce ;mmealatery for .ncorrectiV preserved samoies. Cbtain a new samoteor
noufv the state 'ab it directed to anatwed by the customer ,vho was not,fled. late and time" entS below
Volatsles Sample(s)
-sere received with neadsoace
COMMENTS:
3C

6602
ndmill Way
min
:. ENVIRONMENTAL CHEMISTS, I N C OFFICE: 9 0-3 2 0223''FAX[phone]
♦ �1
Analytical &Consulting Chemists
NCDENR: DWQ CERTIFICATION # 94 NCDHHS: DLS CERTIFICATION # 37729 [e-mail]
COLLECTION AND CHAIN OF CUSTODY
Client: Sampson County Schools
Project: Midway Middle School/PPI 001 WWTF
REPORT NO: o2Q20 — ULi3d
Address: 437 Rowan Road
CONTACT NAME: Robert Carrol
PO NO:
Clinton, NC 28328
REPORT TO: Robert Carroll
PHONE/FAX: [phone]
copy: R Carroll (rcarroll.blackdo mail.com)
email: 'elmore sampson.k12.nc.us
Sampled By: 'L /Z>2a 0 SAMPLE TYPE: I = Influent, E = Effluent, W = Well, ST = Stream, SO = Soil. SL = Sludae. Other:
Sample Identification
Collection
p,
E r
_2
0 �
a o 2
o
0
v _
C U`
2 `o
o a
"
d
C`
_o rn
L E
"
� W
m
Z
PRESERVATION
ANALYSIS REQUESTED
Date
Time
Temp
w
o
Z
J
=
n
M
=
x
a
Z
o
x
w
o
Effluent
C
P
IOC 9
X
BOD, TSS, NO2
G
G
due March, July, Novem
C
P
X
NH3,NO3, Total P, TKN, N(calc)
G
G
pH(field):
C
P
X
Fecal
G
G
C
P
G
G
C
P
X
TDS,Chloride (November on[ r)
G
G
C
P
G
G
C
P
G
G
Soil Sample (December)
C
P
I
Standard Soil Fertility Analysis
G
G
Transfer
Relinquished By:
Date/Time
Received By:
Date/Time
2.
Temperature when Received: 5 r Accepted:y R f cted: Resample a ested:
Delivered By: 2o-�e�% �` r�... _ Received By: Date:3 Time:
Comments: TURNAROUND: