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NC0085359_Response CEI violation_20201020
Strickland, Bev From: Bart Farmer <bart.farmer@unioncountync.gov> Sent: Tuesday, October 20, 2020 12:37 PM To: Scheller, Roberto Subject: [External] FW: September, 2020 COCs Attachments: September 2020.pdf External email. Do not click links or open attachments unless you verify. Send all suspicious email as an attachment to report.spam@nc.gov Roberto, FYI .... We have worked out an arrangement with the lab, where they will be emailing the final COCs monthly. Bart T. Farmer Water Reclamation Facilities Superintendent Union County Public Works 4600 Goldmine Rd Monroe, NC 28112 T 704-296-4227 F 704-289-7395 C 828-260-3583 bart.farmer anunioncountvnc.aov www.unioncountync.gov E-mail correspondence to and from this sender may be subject to the North Carolina Public Records law and may be disclosed to third parties. If you are not the intended recipient of this e-mail, please contact the sender immediately. From: Rusmisell, Cara [mailto:Cara.Rusmisell@ci.charlotte.nc.us] Sent: Tuesday, October 20, 2020 12:27 PM To: Bart Farmer; Jonathan Jordan; Stuart Horton Cc: Cline, Harold; Hutson, Rhonda Subject: September, 2020 COCs WARNING: This email originated outside of our organization. DO NOT CLICK links or attachments unless you recognize the sender and know the content is safe. Good afternoon, all. Please see the attached COCs from September for your records. Thanks so much! 1 Cara Rusmisell / Laboratory Project Manager CHARLOTTE WATER 4222 Westmont Drive / Charlotte, NC 28217 P:704-336-2854 / C:704-622-7280 / charlottewater. E?��N Cp�ry, � ga i F . �?✓ . � yo:�. .:.. ,=Q, �TH CPPO UHAKLU I I h VVA I t:K kNVR(UNfVILN I AL LAkiUKA I UKY 6GKVIUt:6 4222 Westmont Drive, Charlotte, NO 28217 (704) 336 - 2854 or (704) 622 7280 `'JU PAGE' OF NC DENR Certification No.192, NO DHHS Certification No. 37417, US EPA Certification No. 01215 `i Sampled by (Sign Name); CLIENT: SEND REPORT T0; Union County Public Works Jonathan Jordan, Bart Farmer�� FACILITY: Twelve Mile Creels WWTP, NCO085359 8299 Kensington Drive NO 28173 (Pri t Na e) t ADDRESS; 8299 Kensington Drive Waxhaw, NC 28173 Waxhaw, u esr ar7 Iq �- Sample Collection Data Sample Container Preservative Anal ses Requested 0 3 x r o A rn E v o FW— Q 1= M E m b U w o s = LAB USE ONLY SAMPLEID ra T cn a a n N oW LAB SAMPLE ID m c c W W m m cn T c E 2 m ¢ Z O m U) ¢ .c m m E ��; F- m O v ..wJ Z ¢ lit Qom-. 0., rn W W aar m iZ r.2. m m cu c� c O co r4 ruJn °' F- .¢¢� z f•-• J O .� CL CL o. A. m U °� W �'`� O T (n u°fi O O C� In rn Y [.Y z �. 4 U E E E `� o E C z O rn O N m �, ram• W CD =q ?- lu p[n rn Cn ' l� q 1 U U) U m T Z S Z a U m OU ul cn O J ZMai O O 5 U O tr UC12mEFF 1�` 073 *7 � N Q P 1 o X X/! �,� q o UC1MFF p7 � �t1 0} o G 7 v� of o �% � J N 4 P 9 o X X UC12•EFF D7 7 It N Q P 1� X X G � . t �� o�-at-ate 07 � 1 ilt © 0 1 N Q P 1 X �(�6�6 UC121NF 08 . I- !' 0 I o`l of p (� 0 37 t at'�� 0 3 Q� y N Q P 1� X X UC12-tNFi^'� 0 31� oho} ��v -7 oc1� 0 �C3 UC12.1NF 0s31-.0 03 �� / (.�v 3 N TQP 1 L X G X (/ Or1 �0`t'tjO Uri G N UC12•MLSS I� r \ I�� J}'.�� �,1��� ���i..l�I �o (i��`1 l� I�(l-�}.7.p �� r � I N � T I P (1 I N � X Temp of Collection; I INF: � � °C I EFF. j'� � °C Sample Temp at Receiving in Lab; INF: (� °C EFF: °C� ff c O Sam, to Temp of EFF Fecbl Sammle at RecelVing °C in Lab (record only if collected): O Zero Headspace & Teflon septa for VOAs: YES NO Samples in Proper Containers: NO NIA M Chlorinated Samples De -Chlorinated: YES N NIA rV r. Sample Type Codes; Q (Flow) =Automatic Flow Proportioned Sample T (Tlme) =Automatic Time Proportioned Sample H (Hand) Hand Composite Sample G (Grab) = Grab Sample Container Type Codes: A =Amber Glass P =Plastic GL = Clear Glass B = Bag TL = Teflon Lined Cap VOA = 40 ml Glass vial X V Comments: �• G Rel(ngly� ed by (Sig Lure): Received by (Signature), Daige: / Time; R linquid by (Slgna j: — Received by (Signature): Da Time; Rellnquishedby(Slgnature): Receivedby(Signature) Date: Time: by by (Signature); 005; U N O on a) >lum \ o 0 m LOU NVf \ J Y m U CU aJ E �+ OEL UPI > c w v ai Q. E Lu w O Q S U LOU tD Of L 0 3 POPOV r L Q � O O S m •p Li C O N . O u u Q u O m > Y �^ - @ m 2¢ o au) m o w Pool A PC Z CIO, a) L E m❑ d I J �LL T O 6. a a OIPVVVO _ i0. aJ ❑❑ c O � O POP) ❑ 0) Y a anj O to p 6.O Z aJ PC u N L £ 0 U =' Q ❑ > vYOi -O U C O' ❑ v� to Z N u L 7 L L N C F- m L aJ to aJ s_ tU .0 >, Up' V I ❑ 4= N a1 m C to to +% U to y vl Q .. aJ m } v aJ — v Y c ° c aJ ac >- 3 z @ t4 Q. v .O f0 'O ❑ '� Y U 'Vast� O -J C W N M1• N .@ @ v v O '^ .. 0 to L F- Q QJ V mr 'o N E -o z Z -Q U s v c al a1 aJ O to M1, o `' cO 6^ N O .O O. � u ..0 l2 U O O N O E Y W Y ° E ❑ Q U O .O � +L+ m M Q m tu Q. c >. � aJ i v aJ 3+ u -O v E .Q c Y aJ aJ Q 'O to m Y Y a) c v- •y C O O u w Y % i' S v) p O c u = v aJ O L Q V v j c m ++ Y N m N Q .c Q E aJ c t C O L YCL B. ❑ "O w O U 0 E CL d W t c N E C �' v u i•_ O O to i afmalQ * C m z C C aJ + 41 c V I ' N i2 O -p CL i > m 7 Ltf 0) low @ L u m Q o O Q u 0 Y zz a low Q 4 @ > m m y ? -o o x m x oLn O aJ E w c v � ai ar Q m z m to m L v u c C 5> m o o O z ° Q Q T u a Q ` 4 > C 2 C Ca E J c z Z L " @ u aui O cca m h v ° — = to cn az E "" ar OU .� O m C C cPOO "a m — @ 'C o >- m t° '6 > aJ 4.J Cp c O a O O O O O O N U +' v > O '.+-' O Z Z z z z 0 VI M1 t2 +'0. O / O O �Jrmi @ Vast O ++ U 4. 'a to m .c -a 4 Essol El El El C L El El m aJ ° - n E v O Ln a v aJ O m C N E m w p 3 @ 0a) WOMM -p E V N N to to N Z J E ,i O O t�iJ I� O a1 O O to O f? r- Q O >- >- >- >ED - t- 'tn ' bA @ O 'n c� } Y i m LowaJ 'O aJ O. N t on +�+ to a-' c @ cYa .+�-• aci :�.. ,« E m to 3 O cLa C u a aJ o to � o v M1. v ¢ U O' Q) aJ a) U m QJ y aJ a1 (LO N o Q) E m v- Q. C c U E T to 'a p_ bA Co m 'l'' l° v _ to O .+-, Y C° U M1• — v c a Q vl a� o v > O U LL a)aJate u coo E CL m O + n C .c U O a E v Z v_ m S Z u m n U M1• ❑ •'�' aJ N L O .' 4{ = O N N aJ L to +'' O_ O Low Q C N C c Q- 'O aJ a N M1• C C c Q � O aJ 'a .0 4m U of aJ p m O E O E +li O i O. L :+. Z += c. to o v Z Q c E o° v .a 00 E O u aJ C aJ n @ o c i M1. 3 m o r+e Q. v L o+ aJ o v o °� U v C C .a C Y c0 C V u ON O c aci o. @ v m 0 i u -M1p C > aJclass tA CIVO > v 2i Q. OU > x N U '° > c to Q N m U 'm L _O' 'pJ ° •a+ aJ _N a•' _� O x aJ C a) C {� .� Li N a1 f9 metal`A m N m Q O 1- O L 7 L .O s 4- v U p @ n 4 o O O aNJ v aJ o C o. v tv c T C CL m = E = CL m IMI O = aJ •p ORIONa. aJ aJ 'C aJ t v t t1 O� p L V m S O •L)1'~n a O m Ycc a, Y Y lJ 'N n, m > O' ° u �' m to low Q •p °_f— m Y Q G Ql +'c+ O z L Ln macO a O u I Q Q �.% a ivast E c-I N ni C a) u O ..p W J O h z O C .S O 4- 0 Q O u J J O 1� r Z O U Z c co Q O v C .Q H CHARLOTTE WATER - ENVIRONMENTAL LABORATORY SERVICES 4222 Westmont Drive, Charlotte, NC 28217 (704) 336 - 2854 or (704) 622 - 7280 NC DENR Certification No. 192; NC DHHS Certification No. 37417; US EPA Certification No. 01215 CLIENT: Union County Public Works FACILITY: Twelve Mile Creek WWTP, NCO085359 SEND REPORT TO: 8299 Kensington E Drive Waxhaw, NC 28173 Sample Collection Data _ Sample Container 3 m U m a a E E a) SAMPLE ID W o 0 C T co m w w � T E v m a> a a n CO CO Q Q M M N = =O U N U N a a a E E a 'm U z E E E M f0 E m o 0 o O n cn co U) U) U i= U U> U M z UC12-EFF o9 ^0v! 5 f �a91-)1 zo 0'7 SS nq� V 07S N Q P 1 o X UC12-EFF IC12"EFFIF I �� �� D15( o U"hj. jo 07 Q9`�`� ®75 4 N Q P 1 o X o/ c�0 7� o� 0l )D 0755 Ulm ZQ ®� N Q P 1 ,o rr�-�i )o N 09-�z kj �7 �� ��s' / P e kF N Q P 1 N X Q®(J-9� 1® ®� P)" d?�( N Q P 1 N X D4o�, ll 0 �-�N Q P 1 N9 9%mo o o / (� 1oZ �q'��AP ()70 N T P 1 N X UC12,GBT2-TWAS 1_ol�xQ `, ( "/j�ry 3 J J a'"®� �D V r® N H P 1 N X UC12-#3DIG 1`` 1 �'n��0 D�'� N G P 1 X Sample Temp at Collection: INF: i Sample Temp at Receiving in Lab: INF: Sample Temp of EFF Fecal Sample at Receiving in Lab (record only if collected): Zero Headspace &Teflon septa for VOAs: YES in Proper Containers: Samples De -Chlorinated: YES °C EFF: °C W O °C O NO NIA � NO NIA M O NO A z Jonathan Jordan, 8299 Kensington I Waxhaw, NC 281 Preservative x X Sample Tvpe Codes: Q (Flow) =Automatic Flow Proportioned Sample T (Time) = Automatic Time Proportioned Sample H (Hand) = Hand Composite Sample G (Grab) = Grab Sample Container Tvpe Codes: A =Amber Glass P =Plastic GL =Clear Glass B =Bag TL = Teflon Lined Cap VOA = 40 ml Glass vial CHAIN OF CUSTODY RECORD coc#: '� „fir Cn PAGE OF Sampled by (Sign Name): Bart Farmer )rive 73 (P u int �N Ne) lr� j k t:IL / /� l�✓J Anal sesRequested o� x n� v U)_ LAB USE ONLY b U) o LAB SAMPLE ID z N ¢ z '0 O o = CO w M W v J z ¢ Z UJ d �- U W U, W U N w o o ¢J¢ O ~ -1 H O F- J H Z 0 O J m O o cn rn > cn cn U) > o Y z Y o Uj rY Q U Z g a m Z o __ o x I JA 1 x x a D x L X x G x�� ��2JI x x e X X Comments: Relinquished by (Signature): Received by (Signature)r _ Dale: Time: __ , q a.0 /nq-o Relinquished by (Signatur )',' y — " Received y (Signs ure): Date: Time: Relinquished by (Signature): Receive y (Signature): Date: Time: Relinquished by (Signature): Received by (Signature): Date: Time: Form Revision 005; Effective 04/01/2012 � I U N 0 u Q) CJ o - olual M N \ J � u M 41 U = fOia; CL o 'LM > N w VE fl. d' E F w M � ImmumN 0 LOU O J \ Q x U c, Map N a) a O U CL � L 0 3 L OA p U VI O cc O M O a) U G CIOa) U .. 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N 'T �", Q N O vOi v) tWn 1- L ISBN @ L° + 7 m v v" v o v F Q c u 0. 4,J mammal a) E O 'malO Z Z u E v E C a) a) v O O M1• O O L O `1 CL i� U SZ U 0 O C O Y O O O ❑ E N i- U ++ O M L m 0 @ a) T O 3 U v E c o� i= Q v c a) E N a amommeQ c a) o u O E O N L O. ,n @ M O c @ •L MOman '_O O_ E ~' 3 J c 0 o u tea, 3 r ° o o v x° o V) a) }`� x E co U a > c@ 3 v@ tn Q .M Q v ❑ imamc Ln alwalQ46,40, y u (n m L o Ov 'E v" O D ISBNC a@ z a o VI a a. o� L m o4001 •Q •� c N (U a) @ iF C' 0 O Q O 0 a) p ci L +-� U m i -O +�-+ O �' E a) m ++ O N N Q O Z c c c @ vmi @ 7 m •� -!� m N O ai '6 p' p a z O Q Q i u aila U- -d L 4p- •}��+-+ V z z ^@ ♦✓ (�p c c v@ E O u w u 00000, N v O COF— O u m -o a) c -a a) Y L a) m Oc a)+� o (n m °� tea) c o L O .. m l0 O E > 0 v v o O a O o O O .� O Q +—' Z Z Z Z Z O ❑ O O a) +� O� VI u M1• c -o m •a @ a) "•� -a N O ❑c L O O Z Z � in a) kiiiiL a 4° v a) 3 aui L a) Q a) 3 c O a) E N o N z J c o E m L c L 3° o �' E o� 4OMo v c a) m v v `i 'p @ L U) V v N (V Q1 L ' a.., Y m E O• a) -o a) o. 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U o ¢ U > N ¢ y iF .— ('n UHAKLU 1 I L VVA I tK A tNVIKUNNILN I AL LAbUKA I UKY dtKVILtZj 4222 Westmont Drive, Charlotte, NC 28217 (704) 336 - 2854 or (704) 622 - 7280 NC DENR Certification No, 192, NC DHHS Certification No. 37417; US EPA Certification No. 01215 FACILITY: ADDRESS: SAMPLE ID UC12-EFF UC1MFF UC12-EFF Union County Public Works Twelve Mile Cree)C WWTP, NCO085359 8299 Kensington Drive Waxhaw, NC 28173 Sample Collection Data Q N U) Q I c c LU m m a` a (D E E E co jS� /Ir! er1 G%a� c)Fi -60-2C) C.)758 o9 -t)),,> ao SEND REPORT T0; O EQ N 0 a) w W m m cn m T� E tu N U n w U rn U o m 6 U 2)3`7 TN P 1 o X 0 0 69.o3 �o uCj N Q P Z N U�J � Q P 1" �c "7 UC121NF 1W1kt,I,I1 V oa,ao G �.�{ o�o:� a,o.,'I,o Uc12•]NF t+/ u1,w i�� (�r3S8 ac}.o, a� Ci"i7 v -o� �u �rlc1 N 4 P 1 X UC12-INF /fit li/ ori -o'1. oxo aq_n:; 'Iro �i 7 (3W 011 03 /e( N Q P 1 N o0-- Sample Temp at Collection; v Sample Temp at Receiving in Lab; INF:�- °C EFF; °C c Sanip)a Temp of EFF Fecal Sample at Receiving °C O in Lab (record only if collecied): :. O zero Headspace & Teflon septa for VOAe; YES NOch A C Samples in Proper Containers; JE" NO NIA m O Chlorinated Samples De -Chlorinated: YES NOI ( I Jonathan Jordan, Bart Fariner 8299 Kensington Drive x� a� � N V ;n c a� z m O � W m LO ] m ti O ga m X X X 1� f3 00 6 Sampled by (Sign Name): --- PAGE r OF61 (Prins Name) Z-L)l vv�� w aw _ LAB USE ONLY a �, W o LAB SAMPLE ID z � w o --z Z a: {w- �- ' 5 w C� 0Q O ¢ 0 Z Ckb Q 3?5 xl TI�I�'�Ilf' X Sample Type Codes; Commenfs: �. _-�- v , Q (Flow) =Automatic Flow Proportioned Sample �� T (Time) = Automatic Time Proportioned Sample ` H (Hand) = Hand Composite Sample Relinquished by (Signature): Received by (Signature): Date: Time: G(Grab)=Grab Sample �-� � � � ~� o� p — - Relinqulshe by(Signature' Recely )Ignature); Date; Time: r _ Container Type Codes: : A = Amber Glass P = Plastic Relinquished by (Signature); Received by (Signature): Date; Time: GL = Clear Glass B = Bag TL =Teflon Lined Cap Relinquished by (Signature): Received by (Signature); pate: Time: VOA = 40 ml Glass via( Form Revision 005; Effective 04I01/2, On U cu l V L \ 0 LM 0 a-+ "Igold Y m V ++ a1 cs � U c Q-M 0loomp J > W Q. cr Immum W m gogiiiamoo ~ � p w O J Q S U (\ cr +wAl Ln CL QJ V >i L tip 4 B O x v a V V I 0 v u .0c Q N 3 O C C _C L u m o�= Q l p a = z 3 v a +I X ++ ci > ~❑ a) v '6 �- a) u 0 = W a1 i> T k D O v o N O' 0) 0 Q E aa)i O _ m Z ni m Z O. -O O N is 'G N J +�+ N O No '^ O" fl- O� O O v a El N •E z U v L .� = L o N 0O Vl E _ `a— U �+ -O VI v i O +� a4ni vi �i a) v L a) m — 3 v 0 0 Z @ Cow no a @ E '� .Y u U Pool 0 go J C Zu a) �-+ M1• .''1^III cr tin L fa v o Q r+ s Ln C7 cr ++ .c u t Q c Q F to Fv- i a co 0 r,. v a) y u T m E O p ca O o a) E u p a) O (. 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C O O i-i U w O w UHAKLU I l H VVA I L:K m LNVIKUNIVltrN I AL LAbUKA I UKY btKVIUt:6 4222 Westmont Drive, Charlotte, NC 28217 (704) 336 - 2854 or (704) 622.7280 NC DENR Certification No. 192; NC DHHS Certification No. 37417; US EPA Certification No. 01215 Union County Public Works FACILITY; Twelve Mile Ci•eel(WWTP, NCO085359 ADDRESS; 8299 Kensington Drive Waxhaw, NC 28173 Sample Collection Data _ � cv Q f U •U SAMPLE ID E T' a i c c� m S LU LU v • m m m m a) 0) E E a m m E E in W E cn to Cq U) U) q 1 LIC12•EFF L q%U)A l id (95 (J`�ld' ��G i>3��l is// �� A LICIMFF � /v51;�6 4 $�l � o` ltq/z 06�i'� �� q Ai 0g3� UC12•EFF 0`1>vl'�U Uyq I Ul(lt'41A 61 SEND REPORT T0: Jonathan Jordan, Bart Farmer Sample Container o o m [n E m m m E b ♦- N .� N N ro c o U 0. 9 ii N w EO O O D O U Cn U 47 Z N Q °P 1 Q X T N Q P 1 a X Y N Q P 1 CD UC12NINF �'��/chlz , C��1 1 �2%G)%a 0� VV12� v9 N Q P 1 x UC12•lNF cyki>l�V, �� I �tl .d ���% `1/ l ���� N Q P 1 N uc12mMLss Atq vq�c /:?U N T P 1 N x 01 aZI rKI e Temp at Collection; I INF: � � I °C I EFF; C%j � °C Sample Temp at Receiving in Lab; INF: °G EFF; / °C O e Temp of EFF Fecal Sample at Receiving °C rinqLab(ro'coirdoriiy if collected): Zero Head, pace & Teflon septa for VOAw YES NO NIA 0 Samples in Proper Containers; ES NO NIA M O // Chlorinated Samples De•Chiorinate'd'. YES NO 8299 Kensington Drive Waxhaw, NC 28173 X Sample Tvpe Godes; Q (Flow) =Automatic Flow Proportioned Sample T (Time) = Automatic Time Proportioned Sample H (Hand) = Hand Composite Sample G (Grab) = Grab Sample Container Type Codes: A =Amber Glass P =Plastic GL = Clear Glass B = Bag TL = Teflon Lined Cap VOA = 40 ml Glass vial x� R ^ �r N u S" � E z m O � � w LZ Commenfs; ?hk x X x t vw� PAGE % OF / Sampled by (Sign ( rini Name) � .J w w o z s a LAB USE ONLY a o LAB SAMPLE ID `� u� o z? w 0. a W w a c> O C) Q 0 O o23 Q by Form n �3 Yt(I ^ 1\ �3 �I I )ate: l lme; late; Time: u O u s. N cN 0 �n m O O m J Y m U cuU E �c 0 C umi N CdC � Q G W \ (n a0+ 0 w O Q C;z U Cz- v L 0 O O S al .a p U VI o v ca O s u O_ �! CJ C m C L 4a u Owq,O— 0 0_ = Z a) 3 v CLz •o a)c CL O O mOO O N O Q m Z � FOOO Z Q "O O m io v�i ti c L,! 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O O O O O •a-' "O a1 c N O +•' > •ai CL +� O Z Z Z Z Z O @ ❑ E Z Z s V I M1 .F, ❑ O ❑ ❑ ❑v— O .'�� O v m v 0 c C z J c E m a� c L 3 o c �' a p E o E� c a, 0 4 ai c o a�i a"i a�i a�i N v o m 4, m a v .o o. v c co + o > uL� > > ❑❑ > > o L v E c`o -ma = +_ v Ln E E u 6 N v a, u m c — no 0O E 4- Ei V1 o v > u I_! � c a Q � ° a, o L aCL CO a, � v a c E° v U O �° j s- u OF al m v p ,., +, fl 0 ai c c Q vo v a c n. c o .Q W 1,0,00 CIO O o - ma E O *** @ -a v z Q c E a, v 4; u v c m m -o p c r.• 3 m oCL O"o o u c MOO S +' c c c E+ O c Q p a, v n > c a, y E +; a lOOOO *' a`i +' E @ fl m m avi m v, vOi a`, vOi W O > w Q' > u c V N D N m U 'm '- fl. 0 N v o 'O > =' ate+ m _T E m^ u c aJ c +W li a, m o 3 v CL 0 v c° O °' > Low Ow"'Noc oui aci cEo csv Q o 3wo a) u a p° o a`ftOOO, o 0 0 a`, m v o v 5 c cn CL NPORIP hA o_ v^ m S a, a, v E 11111'°' O Q CL m m 0 = E m E uOpopp s c o_ o = 0 E aVIVO n + E c c O O U vi Ln Q p n v+'i a) Q a) ,� OV OPPOWNP O O O a O vA U� Is— U * m Q U N Q a C a) u O LOU J J O 1— Z O U N c .c 0 N t 4- 0 A O U W J J O Z O V Z c O a� c .Q CHARLOTTE WATER • ENVIRONMENTAL LABORATORY SERVICES 4222 Westmont Drive, Charlotte, NC 28217 (704) 336 - 2854 or (704) 622 - 7280 NC DENR Certification No. 192; NC DHHS Certification No. 37417; US EPA Certification No. 01215 CLIENT: Union County Public Works SEND REPORT TO: Jonathan Jordan, FACILITY: Twelve Mile Creek WWTP, NCO085359 8299 Kensington [ ADDRESS: 8299 Kensington Drive Waxhaw, NC 28173 Waxhaw, NC 281 Sample Collection Data Sample Container Preservative d 3 o. E Z o m aai 0 i— N E m a SAMPLE ID C G U T a) m W W U oT ai E m m E E T ~ C m m c E E E N Q m U N Z O O m m m m E in U O m OZ = 2 M = UC12•EFF -�7�� t"/�t/ % `l �s� �q�0� %� 07 y N Q P 1 o X o UC12EFF /`/�`/%�n� 0~ N Q P 1 o X UC12-EFF'q %o '�U�/`� 01�� 05i�4�)D `�7JJ N Q P 1 ,L X UC12INF `)([ O a'J n 114` -a !/ 7 C)N Q P 1 N X UC12INF �� 0OT N Q P 1 N X UC12•INF t�U 0%�� ��i`I�� �0 1 tl .�-�� n N Q P 1 N X UC12•MLSS �l"r�ON0 0� �°� N T P 1 N X Uc12-GBT2•TWAs�Olt (� 0��1� 7�� N H P 1 Lo X (V UC12•#3DIG ` 0)``�(U�5 9 N G P 1 N X Sample Temp at Collection: INF: °C EFF. �i O °C Sample = Au Codes: Q (Flow) =Automatic Flow Proportioned Sample �- ° T (Time) = Automatic Time Proportioned Sample Sample Temp at Receiving in Lab: INF: / °C EFF: �j C 017 H (Hand) = Hand Composite Sample Sample Temp of EFF Fecal Sample at Receiving °C 0 G (Grab) = Grab Sample in Lab (record only if collected): 0 Container Type Codes: Zero Headspace & Teflon septa for VOAs: YES NO ()/A A =Amber Glass P =Plastic Samples in Proper Containers: NO NIA m T L =Clear Glass B =Bag ® TL =Teflon Lined Cap Z VOA = 40 ml Glass vial Chlorinated Samples De•Chlorinated: YES NO (NI CHAIN OF CUSTODY RECORD COC#: � 00y0� PAGE � OF Sampled b (Sig a e): 3arl Farmer 1' )rive 73 Print ame ( ) V 2 Q1w 71h i. F� 1t1 t Anal ses Requested x n A.° N N � w o = wxV LAB USE ONLY U) o Z b o a LL LAB SAMPLE ID U) y Z o = W m J Z Q LLJ d d LU w w O U f- aJa 0 ,~ Q 0 Q Q U J cV m i O 0 O 0 O [n C/) U) O Y Z H r- I- w Q U m Z m cn CO Z Y O O � _ = U O LL x G3G�� X 1' x l/ G X > 3 X X V x �M 6���1 x x 4a 6 x x Comments: �j pea � nkt Relinquished by i Oft r Received by (Signature f` _ _ -- Dale: Time: ., )10 o Relinquished by (Signatur -- Received by ;tore): Date: Time: 9*0 s Relinquished by (Signature): Received by (Signature): Date: Time: Relinquished by (Signature): Received by (Signature): Dale: Time: Form Revision 005; Effective 04/01/2012 � v u •L m N c i v \ O m o +, m,OISES J Y oppowd U m ru V V C Q. OLM W ' CL E W M \ f• � � 0 W O J Q x ui CL � L v 3 L omn o t ) ca rMi o x v ,a g @ wd U VI O v w"O u O_ N U .. C mu .0 N O y _ @ v Q [A� V O aJ m o N CL 'p O O m vi O N ' O o Q❑ a) m Z 11 . a J Z . E -Q m O 0 v v c '0v a`1 ❑❑ O p ❑ �v z N Q 025fi� } O Z ❑ u .� _ N c F— 0) LA� v ❑ T vl 4- a) �` U w m a VI VI i� u Vl Y 'O V) O C Q a' — a' o z a v co 3 u fi� `—' n. E a I �JI v Q U v N N E N °1 m %s °L' `� 07 Q- 0 a) \\ a) U u c C CLCL a� l7 -a 41 E 'o N U Z z ` 4J a u E O a) c N N O 0 n o E C U a a� p_ O N O O OQ CL £ '� N N O N m p O a >, U .Q C C E ++ a) C +, +� aO+ �@+ 6 41 umommom o L O. u Eo L O O p O. "L- +� E � 3 � c a � o � � � OL p .0 rN aEi v xo � cn > O N i x v E = U 47 > c m 3 v i QO n ❑ c Ln p ❑ W.a° moo a w � ►� ; v° E o4. 0 3 H .a. a'i Vi i c0 m L Q 0 a) .� >. U i-+ o i 6 00 N u -O a-+ •Id •%• C Q m Z C C al 1 a�-� a! � VI � v tz O -O CL L > CO 7 @ co v .Q 'v C r4 N co v @ C O 4, o co O so a) p Q �% m i T a Rw O Q m Q a0.+ p a! t~.� @ v m m Q p m z v m V) ro L v c c @ c m Z J .O Q Q >, amommom>?' O" 'O `0 cc � c0 E u cTa '> m U O a cn WIV o m -o c a •t; w m U O O 'i m 'a c c O T m tO v > O al v O c o oL.. 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L ut C c a -O v a t n' E Q @ v O v '> ' 4- u m L o o v o f +� U ai 1 a O ECL CL cn z +- L .0 O O— o o ii s tA C O �'.'� iF 9F 9F m '_O z Q C E p ++ J a1 •� O @ 00 d' n• Q i O (U -0 OV N O w U a +m+ c c +� c E + +� C c c + c p � n. x V. — 0 0 O °C1 Q a v m O v a c co OMUMIN N a1 -O + U ,m m @ O w m O of O a E C N 0 E V1 a m L N d' m i-+ m O_ m '^ EA C N O_ +-� O > X a+ u a) c > N y w N T m V IMMINgtA ` t 3 o u v a, O o> N a� E m c E '6 LL v to Vrml .... = w u 3 U O @ m ++ .o O vmehhe > C L Cr Q >• Q E °� ORWROW 'O +' i C @ m N U �- OOC a) p ,,.., O. v- O O ai E N a o a c �n o o u v _ (n — > o0 _ Q a, � x o, o f °' o a a m m o c E v a C m E E _u c c o. o g L E E x o fl 'O E m E c c o O_ m m +'E o fl ^ E o u �^ a Q v, a� + v O O z apponom L L aVi Q 0 O U vi I— o * Q U r4 c cri CHARLOTTE WATER - ENVIRONMENTAL LABORATORY SERVICES 4222 Westmont Drive, Charlotte, NC 28217 (704) 336 - 2854 or (704) 622 - 7280 NC DENR Certification No. 192; NC DHHS Certification No, 37417; US EPA Certification No. 01215 CLIENT: Union County Public Works SEND REPORT T0: Jonathan Jordan, FACILITY: Twelve Mile Creek WWTP, NCO085359 8299 Kensington ADDRESS: 8299 Kensington Drive Waxhaw, NC 28173 Waxhaw, NC 281 Sample Collection Data Sample Container Preservative 3 E Z o 0 rCS LL } 0 m ® m N SAMPLE ID o U N U, � N m W W 0 0 U a 'c N N m m E E~ m °J 0 N N Q- �- c N G CO Cn d- Q Q a E E 0 `o a m U 0 Z ch O = in u10 in (n fn � 1- U m 0 0 0 O Oz N � U `� yy U j l 1 n J1 cn U m z== z= UC12-EFF a"n"1�/.)l�J! v��-✓��(J��� ���� N Q P 1 o X UC12-EFF �{ (% � �p�]o/�� f� 9 �i(��1� N Q P 1 o X UC12-EFF ` l4` (1 r1� d (�t� l 7l �' 0 l I t�✓�t/ it �j17 N Q P 1 L X UC12-INF �(J 1 � D90 t` El ✓�� nn D0n�j N Q P 1 N X UC12-INF �(� �Ir11) �}�(�ng12r% �n Y� f/ Q i/t� n/ (, N Q P 1 N X UC12 INF firli `J n� `Il it 2o (J ��i qjr1(% II `/ N Q P 1 N X UC12-MLSS n 9l�.� ra �1 l 1 N T P 1 N X UC12-GBT24WAS (� ' l `J 1 (�/ h.� y (✓ '1 N H P 1 N X UC1243DIG G( ►1'yl ? N G P 1 N X Sample Tvpe Codes: Sample Temp at Collection: INF: g °C EFF: °C t Q (Flow) =Automatic Flow Proportioned Sample Sample Temp at Receiving in Lab: INF: C� °C EFF: /� °C T (Time) = Automatic Time Proportioned Sample I U W H (Hand) = Hand Composite Sample Sample Temp of EFF Fecal Sample at Receiving oC G (Grab) = Grab Sample in Lab (record only if collected): ,1 0 Container Type Codes: Zero Headspace &Teflon septa for VOAs: YES NO IA � A = Amber Glass P = Plastic Samples in Proper Containers: YES NO NIA m GL = Clear Glass B = Bag TL = Teflon Lined Cap Z VOA = 40 ml Glass vial Chlorinated Samples De•Chlorinated: YES NO N/A) CHAIN OF CUSTODY RECORD coc#: II" PAGE OF Sampled by n Name Bari FarmerDrive 73 (Print Name)LTAti JJ Anal ses Requested o� x d A d N : w LU o = i LAB USE ONLY i E ' LAB SAMPLE ID z N Q Z O O= U w JO O W m °- U w o U N = N H ¢J¢ Q O Q Z KS Q N <a Ca ` O m O O O O co (n Cn O Y Z Y F-- O H H w O 2' ¢ Q >- J U w z g a U m U W cn z O � = 2 U O w X �j <Z x x X� x X X x . . . X X ; q a �b Comments: Relinqu' d by (Signature): Received by (Signature): Date: Time: C - (i. A0 }LG Form Revision 005; Effective 04/01/2012 f0 c a E c O L C W Ln CL L 0 3 W 0 2 v m VI w ca C QL1 O C O u a) u O a U c m c c > > a ccu O vO - @ v Q N o a L m o 3 v a z 0 4— a C ~ O LU m T d m z LL -o Z CL m O v`° o is C a a 'a > O -O (A O• v at�'i ` V) O o E a - v z a a Q 0 dS } c tEIR O a) Ed ❑�mw > �� u O O=� Nfmom c F= N ` L z ❑ U 0) m VI V) a) E u u s mW N O u ++ Q c N a a C O C v }} a v m} MNM— 3 ®� � Om "a ra ®� 0 0m � ry v a v amy E o N bD O n a m l7 �.. 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O O O O O Low' Z Z Z Z Z O @ O O a L °1 (D O'C Y L VI C M1• a-+ C -p i- a c) a cn @ a +s+ _Q- a5 .'_> -0 CEl O 4- El v--• L o Ln Q ,° a E 3 E Q• � N 3 o o a) E v _ o m c v u z c a E m w 3 m (, a E U N VI V) VI E C N 'n a a v i m E a wo Q. a °c° t', no °� u �f ( j ❑ o T } } °' °1 + a) E c`v v 4.c � ai a I� L�1J c o ❑ aci V) c Q E u a 4- f6 LC U } a) a E C C A � Q. bj sZ o + U _ m VI N M1• V_� a a C a O. a +�+ V (6 a O a Q 1p E p u E a x a V u M1• in ❑ a a v) s= '�' m S O v a Sma a +'' Q L a C y C C a -O O. O M1. c c E o p E a (a O 0 v a � V) a .0 +' aF u m � a O } E +a+ 0 _a ai p a v) Z +- + L Q o O— Q o� ti a a ma OLn @ -O —° v z Q c E o* ' C v W N c �, 3 O m a Oas 3 M1• � Q �) O a -p -a 0 a O a U a) im-( c c E 4. o c c c +� c O M1 = v c o O a Q O a a as O u c > m O a a -O + U o E O b4 cp O (n p a Vf a) a m a L a d' N c N RogowCNPIND j Q 3 Q. 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IzNVIKUNIVII=N I AL LAHUKH I UKY tikKVI 4222 Westmont Drive, Charlotte, NC 28217 (704) 336 - 2854 or (704) 622 - 7280 NC DENR Certification No,192; NC DHHS Certification No, 37417; US EPA Certification No. 01215 CLIENT; FACILITY; SAMPLE ID C12EFF C12-EFF 12-EFF UC12•INF UC12-INF UC12•INF z-r�Lss Union County Public Works Twelve Mile Creels WWTP, N00085359 8299 Kensington Drive Waxhaw, NC 28173 G IJ Q � c m m m cD E E m w C q> w �� 1 q-fw a618' -q,2�io 10551 on Data N � Q i= L1 W a d E E D 7479 06), -70" 0s ja %�-zo2b 04S 5 611 0� 5'( la unto 0$In za�I 0�3� ID n U U N N a E in ru O F I��Za2o b$ l3 lu-wo bg I SEND REPORT TO, Jonathan Jordan, Bart Farmer 8299 Kensington Drive Waxhaw, NC 28173 U C/) CIO cn U) C O O m � T N ro ) c o W C O m 0 0 N Q P 1 o x CD N Q P 1 o X N Q P 1 ,��-ZiTZi7 d$,Z N Q P 1 N X j6-gil6 (�gS��l N Q P 1C:, X ja-P7'4 C9 NITIP111�Ix Preservative Sample Temp of Collection: INF; ¢ (� °C EFF; � � °C Sample Type Codes: U . ( Q (Flaw) =Automatic Floty Proportioned Sample T (Time) = Automatic Time Proportioned Sample Sample Temp at Receiving in Lab; INF: °C EFF; °C C U H (Hand) = Hand Composite Sample Sample Temp of EFF Fecal Sample at Race]vingI °C G (Grab) = Grab Sample A n Lab (record only If collecfeU): Zero Headspace & Teflon septa for VOAs: YES NO lA Container Type Codes: A = Amber Glass P = Plastic Samples in Proper Containers: VE NO NO rn GL = Clear Glass B = Bag TL = Teflon Lined Cap Chlorinated Samples De•Chiorinated: YES NO N/ . r� VOA = 40 ml Glass vial � N 0. ^ w - u ry 'a V ,1 E 2 � O � x x X 910oof�'/(1/ PAGE � of G %� V V ✓ V Sampled y (Sign Name), (Print Name) J ur LT/,A L r W o = s LAB USE ONLY W o LAB SAMPLE ID U) W �O 4 W W 1 U ¢ a oz CD o 0 a G Comments: ` )h(prre� 0 h 0 Ce RelinquIsad by (Signature: Received by (Signature): date,_ Time; Reli quashed by (Signature); Received by (S ghature): Date: Time: Rece ed by (Signature), Date: Time: by Received Form Revision 005; Effective 2 x x X 910oof�'/(1/ PAGE � of G %� V V ✓ V Sampled y (Sign Name), (Print Name) J ur LT/,A L r W o = s LAB USE ONLY W o LAB SAMPLE ID U) W �O 4 W W 1 U ¢ a oz CD o 0 a G Comments: ` )h(prre� 0 h 0 Ce RelinquIsad by (Signature: Received by (Signature): date,_ Time; Reli quashed by (Signature); Received by (S ghature): Date: Time: Rece ed by (Signature), Date: Time: by Received Form Revision 005; Effective 2 W L 0J j L OUA o x v m m (1) ° u vi v c o C)m m ❑. v c C °� 4. m o m o ra v a " '= o aui L z 3 v o o E +I u x v v aj a C U O C W L > T a` O O O O .0 E 4= t ' 'FO CO Z LL Z _ OQ fu C El El C ❑ a LA O cr a) a) } O C E U Z a) N Ou .0 E > O z '� 0-3 v N c+ a) N ~ v o a) w El 4 a o u s — v p � w v m y v a) + o z m ❑ L O. .° m ❑ CL . 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L N u 'a C Y h N S N T m l..) .m 'O 'a) a) a) E Ov X ) v C a) a) E -°o c �. a+ LLM 4' " v m 4' u u " m o i, a o o a) > c 0) p u u Z Q m M o v w N O �.. .O v°- c) v p a 4= 0 E" a) v v ° o = c a o a) u U° a " > W o " m x a) E ai a a m o c E �° E a, �) v c a) c o. o� o E E m S o E a " E C C O O V " Zn Q dO t°'i1 a) Y Q al +L O O Z O O O - O O LL O C ) O ma Vf F- p * u * N m `�" u Q Q u > N v= r4 C U O w J J O h z O a� c 0 s 4— O a O V 0 W J J O Z O u z C m N O U QJ C .Q CHARLOTTE WATER - ENVIRONMENTAL LABORATORY SERVICES 4222 Westmont Drive, Charlotte, NC 28217 (704) 336 - 2854 or (704) 622 - 7280 NC DENR Certification No. 192; NC DHHS Certification No, 37417; US EPA Certification No. 01215 Union County Public Works I I SEND REPORT TO: FACILITY: Twelve Mile Creek WWTP, NCO085359 ADDRESS: 8299 Kensington Drive Waxhaw, NC 28173 SAMPLE IDco N � � <p C G N N N UC12-EFF q-ID• no UC12 EFF-ID-2ot0 ��I� Collection Data m � w. E FIIII -a -a W W a) a) E E N U) Q4eutD Jonathan Jordan, 8299 Kensington Waxhaw, NC 281 Sample Container Preservative 0 z o Nm (n N N U) T N E a E F N c p (n �y Z MO O 2 io t m n o (7 7 N c 0 7;,7 N Q P 1 o X 0Ooal N Q P 1 X UC12-INF �-(6-?.61-e ��j✓�-11-Z4u% C���-j�-lAZb (9 N Q P 1 N X UC12-INF +(ormw cl ow q-�(~vyo i����-II-ZD� S N Q P 1 N X UC12-INF-Ib,VZB VJ�53 grl)2'V ZD Oq �a)�aZ�1,� N Q P 1 N X UC12-MLSS Q 17�Z1J 3 .�(^'1,b7� Q� �} g-�t~®� l� N T P 1 N X uC12wGST2-TWAS �fi/lU o�/ /u ZO !Sl,� `'`% / 20 00/(� N H P 1 N X UC12-#3DIG /4f/� v`� ZU U c�� N G P 1 N X Sample Temp at Collection: INF: °C EFF: 0C Sample Type Codes: Q (Flow) = Automatic Flow Proportioned Sample Sample Temp at Receiving in Lab: INF: (J °C EFF: I 0C T (Time) = Automatic Time Proportioned Sample W H (Hand) = Hand Composite Sample Sample Temp of EFF Fecal Sample at Receiving oC T G (Grab) = Grab Sample in Lab (record only if collected): 00000001 ® ContainerTypeCodes: Zero Headspace & Teflon septa for VOAs: YES NO ON/A A = Amber Glass P = Plastic Samples in Proper Containers: ES NO N/A m GL = Clear Glass B =Bag ® TL =Teflon Lined Cap z VOA = 40 ml Glass vial Chlorinated Samples De -Chlorinated: YES NO r1A) r� COC#: U PAGE l OF Sampled by Sign Name): Bart Farmer ]1 giyeili+�'I-" / n�i T� 73 (Print ame) -F�LA L lA A ! w L L Anal ses Requested x `v d A a .. d N � W _ cC o = _ LAB USE ONLY o F o J E o u) LL LAB SAMPLE ID rn ¢ Q Z S W O M O= W J � Z W t,�- a- W p U W W o CD U J N m` o O u-� O 0 to U U � ¢J Y (D z �, k¢- I— Q I— Q � ¢ U m g m O O v, cn O .� �, Y O W O ¢ >- w z a U m U z O _ = U O U. x {A(��(17`I A X x v G x ldgj 9® X 173 �Z x � x�,�ii �� A X X X X Comments: POP Relinquish (Signature), Received by (Signal r'): Date: Time: . 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O v 0 W J J O H z O U z c O U v C F- CHARLOTTE WATER - ENVIRONMENTAL LABORATORY SERVICES 4222 Westmont Drive, Charlotte, NC 28217 (704) 336 - 2854 or (704) 622 - 7280 NC DENR Certification No. 192; NC DHHS Certification No. 37417; US EPA Certification No. 01215 Union County Public Works FACILITY: Twelve Mile Creek WWTP, NCO085359 8299 Kensington Drive Waxhaw, NC 28173 Sample Collection Data CD SAMPLE ID : $ m w m m °' a a o E CU N A U) U))� l U) n jU ` UC12-EFF ATM q//3la0 UC12-EFF �I t ✓I �� ('i Q ' f ���' UC12-EFF ATA 1 /0 0 1/1 lt� 2 Ff 113/2o G S ( h UC12-INF Alm �3 ,� r04c UC12-INF Inp �Q 3}1 o � �, it�otr UC12-INF A T C V1 `'I13), 0 V ( E U U w U U a Q Q E N co E In o t a 736 1i�1�o p 73 v?3b 4(NIa® 0z37 a7� gl I'I�p 0 r3 c�n37 l� 0 ty%3 SEND REPORT TO: Jonathan Jordan, 8299 Kensington Waxhaw, NC 281 Sample Container Preservative 0 z 3 e, } M � m N U) j U) N N ^ W E 1 W NLi c a 'm U o W �`"� O 2 .c E o n Cn O 1 N Q P 1 o X N Q P 1 CD o X N Q P 1 X LO N Q P 1 N X N Q P 1 N X N Q P 1 N X UC12-MESS � �113,rv✓ . 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O LOU J J O Z O v a) C O a) 4- O O V 0 J J O H Z O U z C A Q 0 U .O C UHAKLU I I L VVAI 1:K - IzNV I KUNIVI LIN I AL LAbUKA I UKY 6tKVlUI=b 4222 Westmont Drive, Charlotte, NO 28217 (704) 336 - 2854 or (704) 622 - 7280 NC DENR Certification No. 192; NC DHHS Certification No, 37417; US EPA Certification No, 01215 CLIENT: Union County Public Works FACILITY: Twelve Mile Creel(WWTP, NCO085359 ADDRESS: 8299 Kensington Drive Waxhaw, NC 28173 Sample Collection Data a) � � b U SAMPLE ID U U m LU j.1] m m E F U a E N L D FL a. L: t� {U rn in in UC12•EFF `ll UC12•EFF�� UC12.EFF ONX q1 /)o ON T/61 SEND REPORT TO. Jonathan Jordan, Bart Farmer 8299 Kensington Drive Waxhaw, NC 28173 Sample Container Preservative . o — a p N N N U T � ar in ICU ~ � n N (/� C N C p � d• a)Q .@ U m w m O x 1= U cn c0 o m d z = O �I 11 CD N Q P 1 a X VI- OSO N Q P 1 o X nR�L N Q P 1� X UC'12.1NF Og N Q P 1 x UC12dNF CC�12 ��� Q v �l #50 N Q P 1 x UC12•MLSS ogo0 15/�t� ��s(0 9 t� 0 N T P 1 N x Sample Temp of Collection: INF: °C Sample Type Codes; EFF. oC Q (Flow) = Automatic Flow Proportioned Sample T (Time) = Automatic Time Proportioned Sample Sample Temp at Receiving in Lab; INF:5 °C EFF: C . � Od H (Hand) =Hand Composite Sample Sample Temp of EFF Fecal Sample at Receiving aC G (Grab) = Grab Sample In Lab (record only if collected): �1 ,Zero Headspace & Teflon septa for V0A6; YES NO O Container Type Codes: A = Amber Glass P = Plastic Samples in Proper Containers; E NO NI m GL =Clear Glass B =Bag TL = Teflon Lined Cap Chlorinated Samples De•Chlorinated: YES NO NI VoA = 40 ml Glass vial by rtelinqu(shed by by X X X x x COC#: PAGE OF Sampled by (Sign Name): (Print Name)��� w w o s s LAB USE ONLY o LAB SAMPLE ID 0 a:W 2 4 Lb � 0. 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O o mo m 7 .0 .c O Q o .0 v- O O O ,C V) U N I- iF U N M w' U 0 Q U to Q 4- iF c-I CHARLOTTE WATER - ENVIRONMENTAL LABORATORY SERVICES 4222 Westmont Drive, Charlotte, NC 28217 (704) 336 - 2854 or (704) 622 - 7280 NC DENR Certification No. 192; NC DHHS Certification No. 37417; US EPA Certification No. 01215 Union County Public Works FACILITY: Twelve Mile Creek WWTP, NCO085359 ADDRESS: 8299 Kensington Drive Waxhaw, NC 28173 SAMPLE ID I �, (6 c a E U) UC12-EFF UC12•EFF UC12-EFF UC12-INF UC12•INF UC12•INF UC12-#3DIG SEND REPORT TO: action Data Sample Container _ 3 E Z p —ate 0 t— a m U) !e U U T � ` W W N <n m N E E CL Q N W W F- iv C N C (/� (n .c N ,c 0 in U) U) CL> (0 U m OZ N Q P 1 o X roq,�/ tq N Q P 1X j/Wzc'c'r IIW Z) ( N Q P 1 ,c o o cSS l��S�Zo is `7j j c�j 7 �Zc i !�v„1 N Q P 1 N X r P,119/ Zd rzh5 clr� Zv '� �i `� ��d �' Cic� a % N Q P 1 N csj�l/2o i S 17�1 `�� 2�7 C'j 'd t� ��k��lv7 3 N T P 1 N X N H P 1 N X CA(3Z N G P 1 N X Sample Temp at Collection: INF: c::t Z Sample Temp at Receiving in Lab: INF: 7 Sample Temp of EFF Fecal Sample at Receiving in Lab (record onlv if collected): Zero Headspace &Teflon septa for VOAs: YES Samples in Proper Containers: Chlorinated Samples De•Chlorinated: YES Jonathan Jordan, 8299 Kensington Waxhaw, NC 281 Preservative X f3 °C EFF: //__ °C Sample Type Codes: w' Q (Flow) =Automatic Flow Proportioned Sample °C EFF: >., 5 °C T (Time) = Automatic Time Proportioned Sample 0o H (Hand) = Hand Composite Sample °C 30O G (Grab) = Grab Sample > O Container Type Codes: NO N X A = Amber Glass P = Plastic NO N/A N GL = Clear Glass B = Bag m TL = Teflon Lined Cap O NO NI z VOA = 40 ml Glass vial CHAIN OF CUSTODY RECORD COC#: 00 �%) ��1 �� (/ PAGE �� 4 OF �%,� Sampled by (Sign Name): Bart Farmer r ' )rive (Print Name) je 73 Analyses Requested o� x n N N lL o = _ LAB USE ONLY o F E 0 n; � LAB SAMPLE ID z Q Z O 0U) w JO m W y J z Q W O=_. d W LLJ U ~, ¢J¢ ZO F- J O Q O O '� m CO m O O J Y O 0 W Cr)Q WU 0 W u> > U)O Z O W = 2 U O X !l� X X / r X X X X X V X X Y G J' LL Comments: r/, Relinquished by (Signature): .- -- - Received by (Sign ure)• ' Dale: Time: Relinquished by (Signature) Received b i"f alure): Da e: Time: 317 Relinquished by (St'dn t re): Received by (Signature): Date: Time: Relinquished by (Signature): Received by (Signature): Date: Time: Form Revision 005; Effective 04/01/2012 u O O •L v � 1 i O 0 O t m V C vU o N > v C w CU a E w E f0 v N m W 0 a c.� m A .a v cu a a O U L O Y f1a O = v 0 VI C o v u m .Q O C O C > a) vOi - m N Q 'N '�' N o N L v v s 0 a = z 3 a, n. o Co C ui v > ❑ a) T a O O U) ai O N O' Q. 0 Q '= v ,�,, O O O 'O J ❑ v O 'D '^ O" o- a) d C u z L) +Ln ..CFID E o v 0 F N ❑ i Y Q > o ❑ ❑ V O 3 NC *' C 0 N v�i v L1 al L T 4 v uO' a) m C VI in cn +� u ti a ..O vi Ou Q. 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O- m m = m u t Q O Q E ,E o. o 'a E @ v� � '� a m > C = v E O n E c c o o v umi Q a v*'i a`) v O O z Q — O O O m 3 c c O Q o .c O O O _ O U N m '�" U Q U � N Q v= r4 O N lD OI Y U v U U _N Q E m U7' O O i-I CJ w O W C v U O L� J O o_ I— Z O U C O 0 :o. 0 c) W J J O Z O U z C m N Q 0 U c .Q N I— UHAKLU I I h VVA ILK - kNVIKUNIVILIN I AL LAbUKA I UKY SkKVIUKb 4222 Westmont Drive, Charlotte, NC 28217 (704) 336 - 2854 or (704) 622 - 7280 NC DENR Certification No, 192, NC DHHS Certification No, 37417; US EPA Certification No. 01215 CLIENT: Union County Public Works SEND REPORT TO: FACILITY: Twelve Mile Creek WWTP, NCO085359 ADDRESS: 8299 Kensington Drive Waxhaw, NC 28173 Sample Collection Data Sample Containt d m Ca t- 6 to SAMPLE ID `° m Q 1= � f✓ U U >, ? °> a m m v o in a) O Z [n � (� L7 q l U rn U m Oz UC12slI;FF s�t.90 �� 7� e `zi 9� 0 Jl��� 7 N Q P 1 o X 0 UC12�EFF �� �r.0�- � G �� �Ft ,I, 7tv Vt 0-0 N Q P 1 � X UC12-EFF km ✓ ci��o-9-o 0 7 r� �°i �I. � u 7 5� � � � % N Q P 1 ,o off ai -ate UCIMNIF 1.1 �0 lI1%3 i`� 0q,at-'1 � 0 ,90 0;� N Q P 1 � X UC12°1NF A M • o.ao �� oy•�i ao cs - t_ a N Q P 1 X UC12swINF V_I o`1-a0•�© �� v 0(-aoO® N R P 1 N UC12•NILSS - o�l ���� l o_ \J� N T P 1 N x t2o�'ri-iwv Aft 09 ao- o tr10 I,olv� �� �Mt\l it - Temp at Collection: I INF: °C I EFF. ,� � °C r oil Sample Temp at Receiving in Lab: WF: no EFF; � °C O Sample Temp of EFF Fecal Sample at Receiving 'C I Lab (record only if collecited): .Zero Headspace & Teflon septa for VOAs: YES NO NI Samples in Proper Containers: YES NO NIA M 0 Chlorinated Samples De -Chlorinated: YES NO ( NIA Jonathan Jordan, Bart Farmer 8299 Kensington Drive Waxhaw, NC 28173 Preservative iAnalyses Requested x Sample Type Codes; Q (Flow) =Automatic Floty Proportioned Sample T (Time) = Automatic Time Proportioned Sample H (Hand) = Hand Composite Sample G (Grab) = Grab Sample Container Type Codes: A = Amber Glass P = Plastic GL = Clear Glass B = Bag TL = Teflon Lined Cap VOA = 40 ml Glass vial U x� a� u N by =y z � O � v am J 0. 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V� .O al0 Wood > c a. 4am 0 0) E v ` c v U a $', = a vO m N U a) o Ea n 4 0 0 0 °�' aci E^ a) 0 a c 0 o _a a, �, c 0 = a) ai ORION? - a a mNodded �o E vOlow offid"WO a= @ E a, °/ u GROWNL L n o +� = o Me 0 CL Or. u m w a) E O n E 0 Luc u, Low a a 1) ..0 O + Q a) +' O O z CL — '-m O 0 [ a (9 O .0 o .c � O NIPPON O •c aC) u * N M !' 0 Q u (n Q 4 r4 c a) V 0 LOU J J O I- Z O U a) C: .O 0 a� 4- 0 o_ O U J J O o: FOR O U z c (6 Q 0 V 'O c .Q CHARLOTTE WATER • ENVIRONMENTAL LABORATORY SERVICES 4222 Westmont Drive, Charlotte, NC 28217 (704) 336 - 2854 or (704) 622 - 7280 NC DENR Certification No. 192; NC DHHS Certification No. 37417; US EPA Certification No. 01215 CLIENT: Union County Public Works SEND REPORT TO: Jonathan Jordan, FACILITY: Twelve Mile Creek WWTP, NCO085359 8299 Kensington [ ADDRESS; 8299 Kensington Drive Waxhaw, NC 28173 Waxhaw, NC 281 Sample Collection Data Sample Container Preservative d 3 N 3 0 y E p Z O N d N 0 t� E lb m SAMPLE ID rj U U o W W e Q E m m T ~ '� a10 f N N N a) Q Q Q Q E E N Q O U N Z O O S m m (4 m L m o 0 o O Z N U U) U) U) (f) U) O 1- U CO U On Z S S Z = UC12•EFF oCt-� o D`t �3 �� D o9 ?3 �0 Ors.SZ� N Q P 1 c X 0 UC12•EFF A1141 �q,� . ��� c 93•cxO U�SJ N Q P 1 o X � n�•a�- � 0�S0 N Q P 1 X UC12•EFF Aui apt ,eioa ea �u .� �: z UC12-INF C`t-2.p,•� e�SS o`1'23�� pgo2 01-�3'a4 ��Q�� N Q P 1 N X UC12•INF V opt ( 55 Oct -3k'3. a`�oz c!I a3-ao o`� N Q P 1 N X UC12•INF c�1.�9.o G$S� �%� N Q P 1 N X UC12-MLSS opt. �a- o 0`�� cfi.�3 t2`IJia 0ct-pa d o�S7 N T P 1 N X UC12•GBT2•TWAS o(A-9•, eP. 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INF: �{ , °C EFF; �I ( °C OW Sample Temp of EFF Fecal Sample at Receiving in Lab (record only if collected): 'C Zero Headspace 8 Teflon septa for VOAs: YES NO NIA C Samples in Proper Containers: YES NO NIA M O Chlorinated Samples De•Chlorinated: YES NO NIA Sample Tvpe Codes: (� (Flow) =Automatic Flow Proportioned Sample T (Time) = Automatic Time Proportioned Sample H (Hand) = Hand Composite Sample G (Grab) = Grab Sample Container Tvpe Codes: A =Amber Glass P =Plastic GL =Clear Glass B =Bag TL = Teflon Lined Cap VOA = 40 ml Glass vial CHAIN OF CUSTODY RECORD COC#: �) �) PAGE U t OF d l Sampled by (Sign Name): 3art Farmer )rive �--- - (Print Name) Lute 73 Analyses Requested o� s 6 w -" w o = z LAB USE ONLY U) ' LAB SAMPLE ID z ��—, 4 z O w O O rn w d U-j�_ Z Z H ° o zUj 0 j v o cn g a4 ¢= 4 o z xs 4 m g m O O O �- Y O w O 4 Z CL U O] U .� Z U = 2 U O LL X 1' X j C� G X X�� i X � 2 X x (�S X X X X v� Comments: C._ _ Relinquished by (Signature): Received by (Sign ure): Date: Time: �0L 5. Rel(nquished by (Signature' 1 _ Received by (i nature): Dale: I Time: Iti �1� Relinquished by (i nature): Receive by (Signature): Date: Time: Relinquished by (Signature): Received by (Signature): Date: Time: Form Revision U05; Effective 04I0112012 CHARLOTTE WATER ENVIRONMENTAL LABORATORY SERVICES 4222 Westmont Drive, Charlotte, NC 28217 (704) 336 - 4335 or (704) 622 - 7280 CLIENT: Union County FACILITY: Twelve Mile Creek WWTP, NCO085359 ADDRESS: 8299 Kensington Drive Waxhaw, NC 28173 SEND REPORT TO: Sample Collection Data Sam le Container _ 3 +�- E Z o 0)} CD 1- m m SAMPLE ID o i o 0 m U O T U) a UJ W a> U) m T a E N N N C C m G (n Q Q a E Q m U N E E E M ° O E G <n in in U) N o m i 0 0 2-WAS ( fl I` I I Q `jI�((I I �) j> I N I G I P I 1 I L( X I 2-GBT2-TWAS � I -� `Id I f J c1 � I N I G P 1 I O &GBT2-FILT I �\ f I I`n I X Sample Temp at Collection: I INF: Sample Temp at Receiving in Lab: (INF: Sample Temp of EFF Fecal Sample at Receiving in Lab (record only if collected): Zero Headspace &.Teflon septa for VOAs: YES Samples in Proper Containers: (YES Chlorinated Samples De -Chlorinated: YES Bart Farmer, Jona 4600 Goldmine Ri Monroe, NC 2811 Nreservative Sample Tvpe Codes: Q (Flow) =Automatic Flow Proportioned Sample T (Time) = Automatic Time Proportioned Sample H (Hand) = Hand Composite Sample G (Grab) = Grab Sample Container Tvpe Codes: A =Amber Glass P =Plastic GL =Clear Glass B =Bag TL = Teflon Lined Cap VOA = 40 ml Glass vial CHAIN OF CUSTODY RECORD COC#: PAGE OF I )1(0 n Sample by (Sign Name): than Jordan, Alex Laytham I. � JV 2 (Print Nam /— Anal ses Requested o x O A U) 111 U)o_ _ _ LAB USE ONLY �p LAB SAMPLE ID A U w U) M vUjz W d UJ O? a Q u-� F- ZO F- O Q Q C9 J N m O o o cn cn U) :EE:Z.t¢ ¢ v S m cn > cn O Y O 2 U Z CL U Z O :�E 2 O ti X � A X Aq ( `17 Comments: l ((C Relin fished by (Si atur� ` Received by (Signature): Date: Time: Relinqui h d by (Signature): m � . 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LNVIKUNIVlLN I AL LAbUKA I Ut'sY St,KVIUt:b 4222 Westmont Drive, Charlotte, NC 28217 (704) 336 - 2854 or (704) 622.7280 NC DENR Certification No, 192; NC DHHS Certification No. 37417; US EPA Certification No. 01215 CLIENT; Union County Public Works FACILITY; Twelve Milo Creek WWTP, NCO085359 ADDRESS; 8299 Kensington Drive Waxhaw, NC 28173 Sample Collection Data a) E Q (✓ SAMPLE ID y Ca D m a) a) 12-EFF 2 yV 0652- i�BYO 1MFIF V/2312u 1 (11-q& oxr) 12•EFF Y/2420 0 PS2 `l2`>la1) o y0 D REPORT T0: Jonathan Jordan, Bart Farmer 8299 Kensington Drive Sample Container � � o o U N U U T CD m m m co m T E E ~ N U) 11J q 1- U to U m N Q P 1 o X 0 r9�241 /,z OX 2(( N Q P 1 CD X 0 `1�Zrl�av O6y ! 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Q• N � �t'A"2-0 p 51 c1 �5 iv U �61% y 4J$4-Lv SEND REPORT T0; Jonathan Jordan, Batt Farmer 8299 Kensington Drive Waxhaw, NC 28173 Sample Container Preservative Analyses Requester 0 3 o m N T � N N N N E c N U o •@ U N LLI o Z m o 0 o O U [n (� m Z N Q P 1 o X 0 N Q P 1 o X N Q P 1 C x llC12.1NF � �f-�4-z� vgvs y z5-w �83y �j��-s•-w Q835 N Q P 1 N x UC12-INF l�Y; �!^y'f_2o 0yoS ?_2.5,.z�> �23N y^z5.w 088 5 N Q P 1 X UC12•INF n ej-2,y_2a dclo5 c 2.,5e,zv 030 ��v D5t35 N Q P 1 x UC12mMLSS �� C1.a."4 041161 `1 2S ' 0 n G �lry _ 1) 085 3 N T P 1 N X UC l 1 GrSfzr rkS j_zy.2v 1,7 1 tl/Ll c1 4 zS z`� a�(o 5 !•/ H (� ( �+� vtr2 1�3D� J �?� `%. 2-5.ZJ c7cl l 3 1v n Sample Temp at Collection: INF; 7d °C EFF; LI L °C Sample Type Codes; Q (Flow) = Automatic Flow Proportioned Sample Sample Temp at Receiving in Lab; INF: °C EFF; �- °C 17 T (Time) = Automatic Time Proportioned Sample - CU H (Hand) =Hand Composite Sample Sample Temp of > FF Fecal Sample at ReceiJing °C G (Grab) = Grab Sample in Lab (recot•d only if collected): zero Headspace & Teflon septa for VOAs: YES NO Container Type Codes: ' A =Amber Glass P = Plastic Samples in Proper Containers; YES / NO NIA m GL Clear Glass B Bag 6 TL = Teflon Lined Cap Chlorinated Samples DekChlorfnat6d; YES NO NIA r� VOA = 40 ml Glass vial X 1� Comments: 1� X x X PAGE OFI Sampled by (Si re):e�/� Name) �eq- k E I ,r% S w LAB USE ONLY W o LAB SAMPLE ID � Q J W O x n x irf� G jGl Rel(nq fished by (Signature): Received b Ignature): D n 2 T m U Relinquishature): Received by (Signature): Date: Time: Reilnquished by (Signature): Received by (Signature): Date: Time: Form Revision 005; Effective y U N O a) L N \ io fV`i•�. � c O J Y m U � U E ++ 1 c Q. 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L) c f0 u U .a >, OffiallitL (6 _N f9 Q aa)) 3 .>3 ')'' 49 c o O O 9 E o(An c WOMEN MOMMOMa)MENEM _o >, C Q- aa)) S a) a) E N p =• a m i0 O = E a) 'a E c cmi •m a o a. o E @ s a` cEa > ;o E y Q- d `^ E O U N rEo v) Q •p +' yt., O O z O Q O MINVIDL O y= U ; .-i N r6 Q U N QLL CHARLOTTE WATER - ENVIRONMENTAL LABORATORY SERVICES 4222 Westmont Drive, Charlotte, NC 28217 (704) 336 - 2854 or (704) 622 - 7280 NC DENR Certification No, 192; NC DHHS Certification No. 37417; US EPA Certification No. 01215 CLIENT: FACILITY: Union County Public Works Twelve Mile Creek WWTP, NCO085359 ADDRESS: 8299 Kensington Drive Waxhaw, NC 28173 Sample Collection Data a) E SAMPLE ID $ _ w w a) a) CO CO Q is a`) a a Q. a n E E f� (z fL'U U UAN UC12-EFF j"1 V�/�� 0`1.0-`7.'J_o Oc, 910 015 � UC12-EFF I�" ► cs7.� 7 av ® ott-1(s �o U / 5J UC12-EFF AM JI Xry o 00 SEND REPORT TO: Jonathan Jordan, 8299 Kensington Waxhaw, NC 281 Sample Container Preservative z o 0 ar N m U U a m m T a E a Q H H m N co C N = =O Cn d. U m Z O S d E L 1- U M U t m z m m O m 0$'Lo 07�� N Q P 1 o X g O�� N Q P 1 o X N Q P 1 L X N X UC12-INF Ai 1 a� Q a`1ra5 3 �. �Ft-J N Q P 1 N X UC12-INF P(r"� t;`i a r a� utt a3ap 4 '� oh a8 �3 N Q P 1 N X UC12-MESS iM (fily t! o.�.FV•fto At8- ( ( N T P 1 N X UC12•GBT2-TWAS I f 71 t . � �/`! �.��.v ( au �<t-ag.� N H P 1 X UC12-#3DIG a,tt-Og.� Q N G P 1 N X (�1 Sample Type Codes: Sample Temp at Collection: INF: I V t °C EFF: t 3 °C Q (Flow) = Automatic Flow Proportioned Sample Sample Temp at Receiving in Lab: INF: ) °C EFF: / / °C � T (Time) = Automatic Time Proportioned Sample W H (Hand) = Hand Composite Sample Sample Temp of EFF Fecal Sample at Receiving °C G (Grab) = Grab Sample in Lab (record only if collected): O Container Type Codes: Zero Headspace &Teflon septa for VOAs: YES NO NI < A = Amber Glass P = Plastic Samples in Proper Containers: Y NO Nl rn GL = Clear Glass B = Bag TL =Teflon Lined Cap VOA = 40 ml Glass vial Chlorinated Samples De Chlorinated: YES NO (N/ E< CHAIN OF CUSTODY RECORD coc#: ao PAGE �JOF Sampled by (Sign Name): Bart Farmer )rive � 73 (Print Name ! � l I Anal ses Re nested t o 1. x `r d A °w •^ m N U � W _ = _ LAB USE ONLY o F o J E � W o u) LAB SAMPLE ID z y Q }} Z O = U) W m O= W w J F z ¢ W d n' O W LL 2' O U o a�a J U rC 1-- q J p Q Q o CD J N m` O 0 !/) U U J F 'Z IQ-. t- F- 2' Q U g m O cn > cn O Y O Z a U Z O � S S U O U x 5 30 X X X 1�G59 14 X X X 04 5 3) 4 X X X X 63" Comments: Relin 6i hed by (Signatur ( Received by (Signal _ Date: Time: Relinqy' ed by( gna%t r - - Received by- ignalure): ' Relinquish d by (Signature): R ceived by (Signature): Date: Time: Relinquished by (Signature): Received by (Signature): Dale: Time: Form Revision 005; Effective 04/01/2012 FWWO w MONO* CL � L a, o oil n . VI a) vO u QO 0. _Ov m > Y °o v ¢ Noma ypvv O am) m x OON Q) 'oZ Q E Q mo o cU > oL O cUa O N O v ° Q Ice4- MOWN O CO Z LL No Z o O c '- ❑ ❑ c a) V N -! ❑ a) -° O 'O a' v L1 V O C 'O E U Z a) a) O ..0 0 U � E N OU o� � =� O❑ > � y� ++ C O 'O ~ Z . U O- v O N c C I— 4) L v�i a1 � 0 N ❑ T Y °' v a) m ac v m wwome_ 3 o a > O CL NoE Y V FROMO a1 J C LJ a)� M1'wo G D i l 41 a lJ v u u NmwNNN n. m CL nLqLU Q� M1• +, > E O o m a a) OU E O = Y O a ` m D @ O y0 T ❑ E a) '� N a) E 3 +J u a) E - c �� v v i= o \O U o E N CL N a) °- m °'o O c = to "O 'a O. Owwo0 J E v c E o c o 0 Y 3 O 0 O w Y v i o cn ° �. O �n o o x v E Q u v@ womme 3@ y Q Q v ❑ c Ln o E mc ❑ E 'o `�' U "O E d W C E C 7 f"' a) M Q >� p E Y N Ou ON _O -O N IMIN m i � Y a) Y ,C a-mome >, oin No L -C t li ..Q ,O a) c Q @ Z fl- c .0 VI v a -° M1i.. C >BONN m O Q .Q C N m a) m i� p w @ p V N O.. o p E a) O r4 Q Y m N >, m N j. O Q Q. in @ v v z v@ m v c c Q c o0 - m E @ v u a) o u a, a) m cn — 'L N c O .—. >. -° > O a) a) p C O d O O O O O 'D N C a-' > '4+ N Q. ,+' O Z Z Z Z Z O N ❑ � E O Z O Z a) Osumm ,C .F., VI U M1 ++ C to Ql m .0 �.' C "o -O ❑ O Y Y ❑ ❑ ❑ ❑v_- C L O El O m •�' o ?� .E v E @ a) v w v N v-El Q) E @ L c t= c @ J a) o NONNI0 "6 E V In N In In V) Z J N Q) a) L4wJ ) Y L "6 (u hA Y O N Q V V❑ c @ommm CL Y a) 0L ^• a) N c Q E E U O' a) — a) a) u @ m O > O a) 41 a) (l0 Ql o E io rL C C U E ,+-' O_ M v' o Y Y E v 6 a) c CL fl c u -n o v ai v 0 u u a) v a) .o m N a) c .c E a U p �° a) Q. V E a) 's= w-NONE m x Q U V1 V M1•Los V ^ i n * 2 o @ w a) N N Y omw — 3 ® v O n c c a a v a s O M1. c c E o E a a) a; o :o v vi > *' w2 u m a, ° aa)) O E ai v Z* m Z o t i o Q c E o t' v E o a) c a) a°u) ,o Q v c t M1• $ m 00 o n; � Q �) YO N _O _O O Q) U +' 4a c E ° G cONN Y V cNOON c Y cONNI ° a C > aci a, 'tw � O4NNO v 4wJmolowl E + m m o_ m e + v m n v v+ poffilkE > v O Q. o v°> N° c N a)OON N w m U 'm 0. a) aXi ° '� momm— u a) E X v a) c m c -^ t, U) v m CL a) �' �,J m aJ v L O �' i c m U U > L +-� m Q .2 a, p v oc m o 4 E a 4 0 o o 0) v ,p o s a = c N n` ° @ V U E m dA Q °) x a 0 ai MOON,M !? Q WOMENm NMONO = E ar a c 'a m E _ c a. '� ° E uINNSm o a o Y a, Y Y o v E n a m ^ Y ° u m m m Q +, o = ° v Y ELE oc oc z° U Q Ov 0 ENRON¢ O cn vi Fs- �° ° * ry ni V V) ri C a) E U O J J O z O u C O a) 4- O Q O U W J J O E--� z O C.J z c m Q O U C .Q t H UHAKLU I I H VVA I HK n lzNVIKUNIVItIV I AL LABUKA I UKY JkKVIVHb 4222 Westmont Drive, Charlotte, NC 28217 (704) 336 - 2854 or (704) 622 � 7280 NC DENR Certification No, 192; NC DHHS Certification No, 37417; US EPA Certification No. 01215 CLIENT: Union County Public Works FACILITY: Twelve Mile Creek WWTP, NCO085359 ADDRESS; 8299 Kensington Drive Waxhaw, NC 28173 Sample Collection Data � Cll Q i— SAMPLE ID LU LU m m N N UC12�EFF /1]r1 UC12-EFF (�/It,-�,. UC12-EFF )-NA Oct SEND REPORT T0; Jonathan Jordan, Bart Farmer 8299 Kensington Drive Waxhaw, NC 28173 Sample Container 3 0 p co N U � p C3 v U U T a) In � a� � m �Q•, a� E c N o co c m c o o a ro O m z E c � a O m O o N Q P 1 CD o x n N Q P 1 o X bn N Q P 1 0 UC12.1NF � 1" r G`i-�`d •�� � �� o`i-�-�-�v �� y 3 opt-a.9 r� �`� �L� N Q P 1 N X UC12°INF o �1' I �}.`�.�.,a� /'�i! oc(-���v O��i•� ..�l �o N Q P 1 � X UC12-INF {' I ,�r ..�c� 7 U c��� P9\9-.x.; �(fit. )�Ct Uc12•MLss Temp of Collection; Sample Temp at Receiving in °C EFF; O Sample Temp of EFF Fecal Sample at Receiving "C in Lab (record only if collecie'd): Zero Headspace & Teflon septa for VOAs: YES NO IA Samples in Proper Containers: S NO NIA rn O Chlorinated Samples De•Chlorinated: YES NO Q/A r 0$51 INITIPI1Iu IX Preservative X Sample Type Codes; q (Flow) =Automatic Flow Proportioned Sample T (Time) = Automatic Time Proportioned Sample H (Hand) = Hand Composite Sample G (Grab) = Grab Sample x r 0. n w u N u- 'a ^� z ro � O w > ro and � J 0. Comments: Container Type Codes: A =Amber Glass P =Plastic Relinquishe y GL = Clear Glass B = Bag TL = Teflon Lined Cap Relinquished by VOA = 40 ml Glass via( X x X X COC : f ;2 PAGE OF Sampled by (Sign Name): l� ri t Namre) W w o z = a LAB USE ONLY Qo o u) o LAB SAMPLE ID J z Q W m 0. (n W O � O z i z 1 x X � V7 Received by (signature): //' Date; Time; C� 9•-.2`A6 l000 Received by ( ignalure)% Date: Time; Received by Form Revision 005; Effective 04(Q112012 � I U O U L cu i L otA `— n \ J.OPINIONG Eggs U C .G\ O U C CL O C c� W � N E cc Fwav W E 'gootog. W O cc Q x U CS' a; a) 3 Y oq O x n 2i C -a lU VI C N L0 o O c'-.) 0_ aci v C (a c c a) o v o Q o n x Z 3 ffi o Y a 3 @> F- a) v v a a C u 0 c ❑ > O O (a O N 0 a Q E w- a) +J m Z '' .a a J z@ O ° o c„ a v v C �- — +' U Z N O >- v @ > 0 > o Foal ❑ aaaa`gc0.) 0 �, i N v E v s ❑ T 4 V I a) u N in N + N +t+ -0 � Q C 68a a" m a ❑ E Y u o�0000% co. -' o e, (�j(y a�i �c M1'gao N m aEi v aui ILL E o 1- m co 4- a) = t_1 Qv a + u t c- wom:Q c F- long o i o ,y aa) n. v +r L m>@ E O o `77�� c—'o E "O z Z i N u E O a) E a) N D v@i M1' D E al O u t a) O a) 0 0Fol D Ou T m O T in E 'al loans 0 M M (CO O_ a) Imam .0 O u c• awoO' O a 'O 0. O E N @ a) E fca M C coo � N E I- E c 4- 0 c o 5 v o o J 3 a, � C o o u v > x v) ° m a) C N x CL v E c N Q U a) j Q .y ❑ avow o ❑ CL O � t' 0 N a1 a) O.. 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CL M E E co N RS cn Un U) Vi Vi o UC12-EFF UC12-EFF UC12-EFF UC12-INF UC12-INF UC12-INF UC12-MLSS UC12•GBT2-TWAS UC12-#3DIG �a ,I/,�� �a; SEND REPORT TO: Jonathan Jordan, 8299 Kensington [ Waxhaw, NC 281 Container Preservative z 3 0 a o a N 4) O W m N U > U) (D U a (D E 6 6 N C C U) _U a> w �`'� O i— U Cn U o m z O S 2 N Q P 1 a X Q P 1 o X N Q P 1� X a�i o •� -qa N Q P 1 N X cF1 •. 3G_v Q ' ' oC "� Jo �i % N Q P 1 N X fi .;�� o°iov t/ ]1 N T P 1 N X N H P 1 N X .Il"..no N G P 1 N X iample Temp at Collection: INF: � � °C EFF: �,�, � °C iample Temp at Receiving in Lab: INF: q 17 C EFF: °C D W iample Temp of EFF Fecal Sample at Receiving O n Lab (record only if collected): °C O :ero Headspace &Teflon septa for VOAs: YES NO IA Samples in Proper Containers: Chlorinated Samples De•Chlorinated: YE NO NIA m O Z YES NO Sample Type Codes: Q (Flow) =Automatic Flow Proportioned Sample T (Time) = Automatic Time Proportioned Sample H (Hand) = Hand Composite Sample G (Grab) = Grab Sample Container Tvoe Codes: A =Amber Glass P =Plastic GL =Clear Glass B =Bag TL = Teflon Lined Cap VOA = 40 ml Glass vial CHAIN OF CUSTODY RECORD USari OF Sampled bWn Farmer)rive73 (Print Name) iAle �f Analyses Requested ol. x CL A w o = _ LAB USE ONLY U) Uj Z ro a o o a� LAB SAMPLE ID ¢ w a °- w w OM QQ m¢ N m O O O J � Y O � w C9 Q W Z J a 01 M-1 U U > co > Z O 2i = S U O LL x %004 X x JZ X % 0% r X /c X % x d x x X X Comments: J ` Ped 911(e)ICe Relinquished by re: Received by (Signature): Dale: Time: i3o /0/0 Relinquished by (Sign ure): Received by0ig tare): Da Relinquished by (Signature): Received by (Signature): Date: tTime: Relinquished by (Signature): Received by (Signature): Date: Form Revision 005; Effective 04/01/2012 � 1 U a) o bell a� N �Jlog O 0 44,10 O ,F, •v J Y m U cu U C EL O ^{1 � U C LOU E Flat Lu "aftwo... w 0 J Q S U G Mae .Q v m Q 0 U vwmj 4,000 FOOO 0 j adMODco _v L O .o H % S . a (; VI O N _� _Q U Uc < > U O 3 L @ vs Z tov a Z'o Q) El O O O N o Q O LL aN-, 4 CL 'O @ m v�i t as m Z IwoN J Z ® v C C Q) a) O a 0 6 Sam,a) O ,� a) 0V) U @ !n Q ❑ V) � �- C ❑ c H L a, ,✓ ❑ ua� a VI µ m C VI VI 4i 0' U vl Y -O vl O Q °' �_ C o W a) W m aa) v Co _ 3 °' o° 7' Q a ( O Y V O eta al J C lJJ a) }�+ M1• v v = 0 a O' Y U ac Q C O- H {v @ E 0 U Z Z a) 'i3 a U Q) E C o) N +' a) OV w "• L ` a' v O O In O '�'' a) a) yaga Yi, O c *' E o o 0 ❑ at a) ,, Uu v Ebeer c°Q. s a) a) F n v a In seat 4- 3 C OU O vOIa) i- S to O O 'n +' U c p L E o U -op E° n w c E c " u FT- Q° O f 3 Q)i a) Y a o o +� ° ° Q a) ~ � Y a) + � �. 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