WQ0020793_Monitoring - 11-2020_20201124

Monitoring Report Submittal
............................................................................................................................................
Permit Number #* WQ0020793
Name of Facility:* Hays Hatchery
Month:* November
Report Information
Type *
GW-59
Confirmation Email Address:*
Name of Submitter:*
Signature:
Date of submittal:
Initial Review
Year:* 2020
Upload Document*
Groundwater Monitoring 11- 4.68MB
24-20.pdf
FDF a,ly
Please upload one PDF containing all applicable monitoring reports
(i.e., NDMR, NDAR-1, NDAR-2, NDMLR, GW-59).
[e-mail]
James S. Brown
C' ed L5- Otr~1
Reviewer: Williams, Kendall
11 /24/2020
This will be filled in automatically

Is the project number correct?* WQ0020793
Is the monitoring report t: Yes r No
accepted?*
Regional Office* Winston-Salem
Accepted Date: 11/24/2020

TM
on
November 24, 2020
DEPARTMENT OF ENVIRONMENT & NAT .
DIVISION OF WATER QUALITY-INFORMA IO
1617 MAIL SERVICE CENTER,
RALEIGH, NC 27699-1617 Phone: [phone]
Subject: Ground Water Quality Monitoring
Tyson Farms, Inc. Hays Hatchery
Compliance Report - November. 2
To whom it may concern:
Enclosed is the quarterly Groundwater
Please contact me at 336- 651-3836, should you
RESOURCES
PROCESSING UNIT
report for Hays Hatchery.
any questions.
Sincerely,
James Brown
Complex Environmental Manager
Tyson Farms Inc. Fresh Retail Divisi n '70[j Factory Wilkesboro, N.C, 28697
336-651-3836 336.838.2171 Fax: .[phone] www.tysonfoods.com

SUBMIT FORM ON YELLOW PAPER ONLY
or Type-
=acility Name: Tyson Farms, Inc.
'ermit Name (if different):
=acility Address: P.O. Box 936/3649 Airport Road
NORTH WILKESBORO NC 28659 County Wilkes
act Person: James Brown
Location/Site Name: Hays Hatchery
Telephone#: [phone]
No, of wells to be sampled: 3
PERMIT Number; WQ0020793
Expiration gate: 07/31/2026
Non -Discharge W00020793
11IG
NPI]ES
Other
TYPE OF PERMITTED OPERATION BEING MONITORED
❑ Lagoon
❑ Remediation: Infiltration Gallery
❑ Spray Field
❑ Remediation:
❑ Rotary Distributor
❑ Land Application of Sludge
❑ Water Source Heat Pump
IN Other: Evaporation/Infiltration Pond
WELL ID NUMBER (from Permit): MW - 1 Date sample collected: 11/05/2020
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: 1344.85 ft.
Volume of water pumped/bailed before sampling: 7.33 gallons —
Samples for metals were collected unfiltered: ❑ YES ❑■ NO and field acidified: ❑ YES 0 NO
LABORATORY INFORMATION
Date sample analyzed: 11/05/2020 Laboratory Name: Statesville Analyitical
5ARAMETERS NOTE: Values sill reflect dissolved and colloidal concentrations.
COD 00335
mgiL
Nitrite (11i as N 00615
Conform: MF Fecal 31616 <1
/1 OOmL
Nitrate (11403) as N 00620 6.43
Coliform: MF Total 31504
/1 OOmL
Phosphorus: Total as P o0665 0.1
(Note: Use MPN method for highly turbid samples)
Orthophosphate 7050-1
'issolved Solids:Total 7030o 206
mg/L
Al - Aluminum o11o5
pH (Lab) 00403
units
Ba - Barium 01007
TOC oosso
ri lt.
Ca - Calcium oog16
Chloride 00940 <10
mg/L
Cd - Cadmium 01027
Arsenic 01002
ugiL
Chromium: Total 01034
Grease and Oils 00552rill
Cu - Copper 01042
Phenol 32730
ug/L
Fe _ Iron 01045
Sulfate 00945
mgiL
Hg - Mercury 71900
pecific Conductance o0095
pMhos
K - Potassium 00937
Total Ammonia oo6io <0.5
mg/L
Mg - Magnesium 00927
(Ammonia Nitrogen, NHsas N. Ammonia Nitrogen, Total)
Mn - Manganese o {oss
TICK as N 00625 - - ^�mg/L
Ni - Nickel 01067
For Remediation Systems Only (Attach Lab Reports):
Influent Total VOCs: mg/L
mgiL
mgiL
mg/L
mg/L
mgfL
ugiL
mg/L
ugiL
ugiL
mgiL
ugiL
ugiL
mg/L
mg/L
ug/L
ugiL
FIELD ANALYSES:
pH 00400: 6.2 units
Spec. Cond. 00094:
Odor 00085: none
Appearance
clear
Temp. 000lo: 15.4 °C
Mhos
Certification No. 440/3775
Pb - Lead o1055 ugiL
Zn - Zinc 01092 _m91L _
Other (Specify Compounds and Concentration Units):
ORGANICS: (by GC, GC/MS, HPLC)
(Specify test and method #. ATTACH LAB REPORT.)
Lab Report Attached? ❑ Yes (1) ❑l No (0)
VOC 78732: , method #
Effluent Total VOCs:
method ##
method ##
method #
mg/L VOC Removal%
If WELL
DRY at
time of
sampling,

SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING:
COMPLIANCE REPORT FORM
or Type
Facility Name: Tyson Farms, Inc.
Permit Name (if different):
Facility Address: P.O. Box 936/3649 Airport Road
NORTH WILKESBORO NC 28659 County Wilkes
act Person: James Brown
Location/Site Name: Hays Hatchery
Telephone#: [phone]
No, of wells to be sampled: 3
PERMIT (dumber: WQ0020793
Expiration Date; 07/311202fi
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
❑■ Other: Evaporation/Infiltration Pond
WELL ID NUMBER (from Permit): MW - 2
Date sample collected: 11/05/2020
Well Depth: 36 ft.
Well Diameter: 2 in.
Depth to Water Level 82546: 24 ft. below measuring
_
point Screened Interval:.21 ft.
to 36 ft.
Measuring Point is 2 ft. above land surface
Relative M.P. Elevation: 1329.59
ft.
Volume of water pumped/bailed before sampling:
5.87
gallons
Samples for metals were collected unfiltered: ❑ YES
NO and field acidified: ❑ YES
© NO
LABORATORY INFORMATION
Date sample analyzed; 1105/2020
Laboratory Name: Statesville Analyitical
PARAMETERS NOTE: Values should reflect
dissolved and colloidal concentrations.
COD 00335
mg/L
Nitrite (NO2) as N 00615
mg/L
Coliform: MF Fecal 31616 <1
/100mL
Nitrate (NO.) as N 001520 1.35
m /L
g
Coliform: MF Total 315o4
1100mL
_
Phosphorus; Total as P co665 0A
mg/L
(Nate: Use MPN method for highly turbid samples)
Orthophosphate 70507
m /L
9
)issolved Solids:Total 70300 181
mg/L
Al -Aluminum o11o5�
mg1L
pH (Lab) 00403
units
Ba - Barium 01007— _
_
uglL
TOC oa6E0
mg/L
Ca - Calcium oos16—
mg/L
Chloride 00940 17.9
mglL
Cd -Cadmium olnzl
ug/L
Arsenic 01002
ug/L
Chromium: Total 01034
ug1L
Grease and Oils 00552
mg/L
_
Cu - Copper 01042�
mg/L
Phenol 32730
ug/L
Fe - Iron o1o45
ug/L
Sulfate 00945
mg1L
Hg - Mercury 71900
ug/L
pecific Conductance coo95
pMhos
K - Potassium 00937 - —
mg/L
Total Ammonia oo610 4.14
mg/L
Mg - Magnesium 00927
mg/L
(Ammonia Nitrogen; NH, as N: Ammonia Nitrogen, Tofai)
—-•--••-•••_—
Mn -Manganese 01055 _
ug/L
TKN as N 00625
mg/L
—
Ni - Nickel 01o67
— ug/L
For Remediatio€t Systems Only (Attach Lab Reports):
James Brown Complex Environmental Manager
Permittee (or Authorized Agent) Name and Title - Please print or type
GW-59 Rev, 2/2010
Influent Total VOCs:
FIELD ANALYSES:
pH 00400: 6.3 units
Spec. Cond. 00094:
Odor 000m: none
Appearance clear
Temp. 000lo: 15.6 °C DRY at
mhos time of
Certification No. 440/3775
Pb - Lead o1o51 ug/L
Zn - Zinc 01092 rAg/L
Other (Specify Compounds and Concentration Units)
ORGANICS: (by GC, GC/MS, HPLC)
(Specify test and method #. ATTACH LAB REPORT.)
Lab Report Attached? ❑ Yes (1) © No (0)
VOC 78732: method # -
method #
®_—-- _ method#
method #
mg/L Effluent Total VOCs:
mg/L VOC Removal%
here: ❑

SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING:
sl IV �titl1W�� li
COMPLIANCE REPORT FORM
FACILITY INFORMATION
Please Print Clearly or Type
PERMIT Number: WQ0020793 Expiration Date: 07/31/2026
Facility Name: Tyson Farces, 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 NC
28659 County Wilkes
❑ Lagoon ❑ Remediation: Infiltration Gallery
❑ Spray Field ❑ Remediation:
Contact Person: .lames Brown
Telephone#: [phone]
❑ Rotary Distributor ❑ Land Application of Sludge
Well Location/Site Name: Hays Hatchery
No. of wells to be sampled: 3
❑ Water Source Heat Pump ❑i Other: Evaporation/Infiltration Pond
from Permit
SAMPLING INFORMATION
If WELL
WELL ID NUMBER (from Permit): MW - 3
Date sample collected: 11/0512020
FIELD ANALYSES:
WAS
Well Depth: 36 ft.
Well Diameter: 2 in.
pH 00400: 5.3 units Temp. 000lo: 14.9 °C
DRY at
Depth to Water Level 82546: 9.5 ft. below measuring point Screened Interval 21 ft. to
36
ft. Spec. Coed. 00094: µMhos
time ofsampling,
Measuring Point is 2 ft. above land surface
Relative M.P, Elevation: 1306.40 ft.
Odor 00085: none
check
Volume of water pumped/bailed before sampling:
12.95
gallons
Appearance clear
here: ❑
Samples for metals were collected unfiltered: ❑ YES
❑A NO and field acidified: ❑ YES © NO
LABORATORY INFORMATION
Date sample analyzed: 11/05/2020
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 oo615
mg/L Pb - Lead o1o51 ugfL
Coliform: ME Fecal 316,16 1
11OOmL
Nitrate (NO3) as N omm _6.1_
mg/L Zn-..Zinc 814392-- — mg1L - — -
Coliform: MF Total 31504
1100mL
Phosphorus: Total as P o0665 0.1
mg/L
(Note, Use MPN method for highly turbid samples)
Orthophosphate 70507
mg/L Other (Specify Compounds and Concentration Units):
issolved Solids:Total 7o3oo 63
mg/L
Al - Aluminum o11o5
mg/L
pH (Lab) 00403
units
Ba - Barium 01007
ug/L
TOC 0osso
mg/L
Ca - Calcium 00916
mg/L
Chloride 00940 11
mg/L
Cd - Cadmium 01027
ug/L
Arsenic 01602
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 - Iran 01045
ug/L (Specify test and method #F. 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 01055
ug/L method #
TKN as N 00625
mg/L
Ni - Nickel 01067
ug/L method #
For Remediation Systems Only (Attach Lab Reports): Influent Total VOCs: mg/L Effluent Total VOCs: mg/L VOC Removal%
James Brown
Permittee (or Authorized Agent) Name and Title - Please print or type
t;vv-by
Kev. 212U1 U

SUBMIT FORM ON YELLOW PAPER ONLY
ROUNDWATER QUALITY MONITORING:
OMPLIANCE REPORT FORM
FACILITY INFORMATION riease ennr creany or r ype
Facility Name: Tyson Farms, Inc.
Permit Name (if different):
Facility Address: P.O. Box 936/3649 Airport Road
NORTH WILKESBORO NC 28659 County Wilkes
act Person: James Brown Telephone#: [phone]
LocationlSite Name: Hays Hatchery No. of wells to be sampled: 3
LID NUMBER (from Permit): MW - 4 Date sample collected: 11/06/2020
Depth: 27 ft Well Diameter: 2 in.
i to Water Level 82546: 6 ft. below measuring point Screened Interval: 12 ft.
wring Point is 2 ft. above land surface Relative M.P. Elevation: 1324.13
ne of water pumpedlbaiied before sampling: 10.26 gallons
PERMIT Number: WQ0020793 Expiration Date: 07/31/2026
Non -Discharge W00020793 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 ❑■ Other: Evaporation/Infiltration Pond
to 27 ft
ft
iles for metals were collected unfiltered: ❑ YES ❑■ NO and field acidified: ❑ YES i❑ NO
Date sample analyzed: 11105/2020 Laboratory Name: Statesville Analyitical
PARAMETERS NOTE: Values should reflect dissolved and colloidal concentrations.
COD oo335
mg1L
Nitrite (NO2) as N 00615
mg/L
Coliform: MF Fecal 31616 <1
/100mL
Nitrate (N.%). as N 00620 2.17
mg/L
Coliform: MF Total 31604
/100mL
Phosphorus: Total as P 00665 0.1
mg/L
(Note: Use MPN method for highly turbid samples)
Orthophosphate 70507
mg/L
issolved Solids:Total 70300 106
mglL
AI - Aluminum oil o5
mg/L
pH (Lab) 00403
units
Ba - Barium 0loo7 _
ug/L
TOC 0o68o
mg/L
Ca - Calcium oos16
mg/L
Chloride oo94o 20.4
mg/L
Cd - Cadmium 01027
ug/L
Arsenic 01002
ug1L
Chromium: Total 01034
ug/L
Grease and Oils 00552
mg/L
Cu - Copper 01042
mg/L
Phenol 32730
uglL
Fe - Iron 01045
uglL
Sulfate 00945
mg/L
Hg - Mercury 71900
ug/L
Specific Conductance o0o95
µMhos
K - Potassium 00937
mg1L
Total Ammonia 00610 <0.5
mg/L
Mg - Magnesium 00927
mg/L
(Ammonia Nitrogen. NH,as N. Ammonia Nitrogen, Total)
Mn - Manganese 01055
ug/L
TKN as N 00625
mg/L
Ni - Nickel 01067
ug/L
FIELD ANALYSES:
pH 0040a: 5.7 units
Spec. Cond. 00094:
Odor 0008s: none
Appearance clear
Pb - Lead olo51
Zn - Zinc 01092
If WELL
WAS
Temp. 000lo: 14.6 °C DRY at
µMhos time of
Certification No. 440/3775
ug/L
- mglL
Other (Specify Compounds and Concentration Units):
ORGANICS: (by GC, GC/MS, HPLC)
(Specify test and method #. ATTACH LAB REPORT.)
Lab Report Attached? ❑ Yes (1) © No (0)
VOC 78732: method #
method #
method #
method #
For Remediation Systems Only (Attach Lab Reports): Influent Total VOCs mg/L Effluent Total VOCs: mg/L VOC Removal%
James Brown
Permittee (or Authorized Agent) Name and Title - Please print or type
GW-59 Rev.212010
here: ❑

GW-59A COMPLIANCE REPORT FORM Tyson Farms, Inc. Permit 9- 02 793
(Submit one each nton1loring period with Gl- 59 forrm.)
1
Enter date monitoring results were due. ( ) Will this monitoring report (GW-59 and GW-59A)
YES
O
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
jCNW
identification plate, area overgrown, etc.)? If the answer is "Yes", contact the Regional Dice for guidance.
4
Are any monitored constituents equal to or above the established standards?
YE
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 concentrations)
exceeding standards in the space provided below
11 /05/20 PH 6.5- 8,5 Ammonia 1.5 Nitrate 10
MW-1
MW- 2 4.14 mgA
MW- 3 PH - 5,3
MW-4 PH -5.7
S
For the constituents identified in question 4 above, have standards been exceeded previously for the
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- 07-10-16 11.6 mg/1 MW- 2 11-05-20 4.14 mg/1
MW- 2 7-16-20 4.7 mg7
MW-2 3-26-20 4.90 mgA
MW-2 11-7-19 5.04 mgA
MW-2 07-11-19 4.14 mg1l
6
Are the monitoring wells listed in section 5 located at or beyond the review boundary?
YES
NO
If the answer is "YES", a groundwater quality problem may be occurring. CONTACT THE REGIONAL
OFFICE IMMEDIATELY FOR GUIDANCE. If the answer is "NO", monitoring wells may be improperly
located, contact the Regional Office.
7
Is the permittee implementing previously approved actions required by the Division involving this
—(CESF
NO
groundwater quality problem?
If the answer to question 7 is "YES", describe those actions in the space provided below.
If the answer to question 7 is "NO", contact the RggL=1.Qffice within 90 dayl: an evatuakQij may be
required to determine the impact the WQ2te disposal system is having at the review and compliance
boundaries surrounding this facility- Failure to do so may suW _rQ=t the permime to a Notice of Violation
fines. and/or penalties.
Cor►ap4
g
The person completing this portion (GW-59A) of the monitoring report should sign below and submit this
form with GW-59 forms for required wells to the address provided at the top of the current GW 59 form.
report o liancefteeprtW-5�A) is true ancomplete to the best of rriycnow�edge.
igna e of Ilerm-ftvAe5rAuVtrt1,,t gen Date
GW-59A 12/8/2003

Worksheet # 4b
Tyson Farms, Inc.
Completed by:
Max Byers
Title :
WWT Operator
Date :
24-Nov-20
No. of Wells to be Sampled 4
Has Hatchery
GroundWate Water sampling data Hays Hatchery Compliance Data
Constituents equal to or above the established Stapdards
Has
1 er 100ML
500 m 11
250 m 1
1.5 m 11
10 m 11
NA
6.5-8.5
Date
Wells ID:
Fecal
TDS
Chloride
Total NH3
Nitrate
Phos hours
PH
July-10-2018
MW - 1
<1
208
11.5
<0.5
11.6
<0.1
5.7
MW-2
<1
210
34.6
6.16
2.91
<0.1
6,0
MW - 3
<1
62
11.0
<0.5
4.59
<0.1
5.3
Nov-19-2018
MW - 1
<1
206
<10
<0.5
6.74
0.4
5.9
MW - 2
<1
193
29.2
6.16
1.4
0.9
6.2
MW - 3
<1
67
<10
<0.5
4.93
0.6
4.9
Mar-7-2019
MW - 1
<1
206
<10
<0.5
7.70
0.7
6.0
MW-2
<1
180
24.8
4.82
2.06
0.9
6.2
MW - 3
<1
78
<10
<0.5
7.14
0.7
4.9
July-11-2019
MW - 1
<1
179
<10
<0.5
7.90
0.5
6.0
MW-2
<1
71
<10
4.14
1.72
0.7
6.5
MW - 3
<1
176
19
<0.5
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
6.00
0.5
6.1
MW-4
<1
170
18.6
<0.5
2.83
0.5
5.7
July-16-2020
MW - 1
<1
188
<10
<0.5
6.21
0.2
6.9
MW-2
<1
176
16.2
4.70
1.83
DA
7.1
MW - 3
<1
79
<10
<0.5
5.76
0.5
5.6
MW-4
<1
112
19.6
<0.5
3.78
0.1
6.0
Nov- 5 -2020
MW - 1
<1
206
<10
<0.5
6.43
0.1
6.2
MW-2
<1
181
17.9
4.14
1.35
0.1
6.3
MW-3
<1
63
11.0
<0.5
6.10
0.1
5:3
MW-4
<1
106
20.4
<0.5
2.17
0.1
5.7
Maximum
0
435
43
6
12
2
7
Minimum
<1
53
11
4
1
0
5

Receive Date: 11/05/2020
Reported: 11/24/2020
For, Hays
Comments:
Sample Number
Parameter
Sample ID
Result
Unit
Method
Analyzed
Analyst
201105-20-01
Ammonia Nitrogen
MW1
<0.5
mg/L
sM4500NMC-2011
11/10/2020
CJE
201105-20-01
Chloride
MW1
<10
mg/L
SM4500CIC-2011
11/06/2020
MD
201105-20-01
Fecal Coliforms
MW1
<1
CFU100 ML
SM9222o-2006
11105/2020
MD
201105-20-01
Nitrate
MW1
6A3
mg/L
SM45001403F-2011
11/19/2020
CL
201105-20-01
T. Phosphorous
MW1
0.1
ni
SM45COPE-2011
11/09/2020
MD
201105-20-01
TKN
MW1
1.01
mg/L
SM450%crgB-2011
11/09/2020
CL
201105-20-01
Total Dissolved
M1h/1
206
mg/L
SM 2540 C 1Bth Edition
1110612020
MD
Solids
201105-20-02
Ammonia Nitrogen
MW2
4.14
mg/L
SM4500NH3O211
11110,12020
CJE
201105-20-02
Chloride
MW2
17.9
mg/L
SM4500CIO-2011
11/06/2020
MD
201105-20-02
Fecal Coliforms
MW2
<1
CFJ100 ML
SM92220-2006
11/05/2020
MD
201105-20-02
Nitrate
MW2
1.35
mg/L
SM4500NO3F-2011
11/19/2020
CL
201105-20-02
T. Phosphorous
MW2
0.1
mg/L
SM450OPE-2011
11/09/2020
MD
201105-20-02
TKN
MW2
6.27
mg/L
SM45001N[orgB-2011
11/09/2020
CL
201105-20-02
Total Dissolved
MW2
181
mg/L
SM 2W 01811h Edition
11/06/2020
MD
Solids
201105-20-03
Ammonia Nitrogen
MW3
<0.5
mg/L
SM4500NH3C-2011
11/10/2020
CJE
201105-20-03
Chloride
MW3
11
mg/L
SM45000C-2011
11106/2020
MD
201105-20-03
Fecal Coliforms
MW3
<1
CFIJ100 ML
S11.922213-2006
11/05/2020
MD
201105-20-03
Nitrate
MW3
6.1
mg/L
SM4500NO3=-2011
11/19/2020
CL
201105-20-03
T. Phosphorous
MW3
0.1
mg/L
SM450OPE-2011
11/0912020
MD
201105-20-03
TKN
MW3
0.56
ni
SM4500Norg8-2011
11/09/2020
CL
201105-20-03
Total Dissolved
MW3
63
mg/L
sM 2540 C 18th Edition
11/06/2020
MD
Solids
201105-20-04
T. Phosphorous
MW4
0.1
mg/L
SM450OPE-2011
11/09/2020
MD
P® Box 228 • Statesville, NC 28687 ® 704/872/4697
Page 1 of 6

Sample Number
Parameter
Sample ID
Result
Unit
Method
Analysed
Analyst
201105-20-04
Ammonia nitrogen
MW4
<0.5
mg/L
SM4500NH3C-2011
11/10/2020
CJE
201105-20-04
Chloride
MW4
20.4
mg/L
SM4500CIe20i1
11/06/2020
MD
201105-20-04
Fecal Coli€orris
MW4
<1
CFU100 ML
SIM9222D-2006
11/05/2020
MD
201105-20-04
Nitrate
MW4
2,17
mg/L
SM4500NO3F-2011
11/19/2020
CL
201105-20-04
TKN
MW4
<0.5
mg/L
sW4500Norge-2011
11/09/202.0
CL
201105-20-04
Total Dissolved
MW4
106
mg/L
sIM 2540 C 18th Edition
11/06/2020
Nil?
Solids
201105-20-05
Chloride
Hays Eff
50.2
mg/L
SM4500=-2011
11/06/2020
IVID
201105-20-05
Total Dissolved
Bays Eff
596.5
mg/L
su 2540 C 1SW EdltEon
11/06/2020
MC)
Sofids
Respectfully submitted,
Dena Myers
NC Cert #440,
NCDW Cert #37755,
EPA #NCQ0909
P® Box 228 ® Statesville, NC 28687 e 704/872/4697
Page 2 of 6

Condition of Receipt
Sample Number 201105-20-01 Temp on Arrival: 3.0
Parameter Schedule: Total Dissolved Solids
Received on Ice
Parameter Schedule: Fecal Coliforms
Sodium Thiosulfate Received on Ice
Chemicals in containers, lab
Parameter Schedule: T. Phosphorous
Sulfuric Acid Chemicals in containers, lab
Received on Ice
Parameter Schedule: Ammonia Nitrogen
Sulfuric Acid Received on Ice
Chemicals in containers, lab
Parameter Schedule: TN
Sulfuric Acid Received on Ice
Chemicals in containers, lab
Parameter Schedule: Chloride
Received on Ice
Chemicals in containers, lab
Parameter Schedule: Nitrate
Received on Ice
Chemicals in containers, lab
Sample Number 201105-20-02 Temp on Arrival: 3.0
Parameter Schedule: Total Dissolved Solids
Received on Ice
Parameter Schedule: Fecal Coliforms
Sodium Thiosulfate Received on Ice
Chemicals in containers, lab
Parameter Schedule: TKN
Sulfuric Acid Received on Ice
Chemicals in containers, lab
PO Box 228 ® Statesville, NC 28687 ® 704/872/4697
Page 3 of 6

Parameter Schedule: Ammonia Nitrogen
Sulfuric Acid
Received on Ice
Chemicals in containers, lab
Parameter Schedule: T. Phosphorous
Sulfuric Acid
Received on Ice
Chemicals in containers, lab
Parameter Schedule: Chloride
Received on Ice
Chemicals in containers, lab
Parameter Schedule. Nitrate
Received an Ice
Chemicals in containers, lab
Sample Number 201105-20-03 Temp on Arrival: 3.0
Parameter Schedule: Total Dissolved Solids
Received on Ice
Parameter Schedule: Fecal Coliforms
Sodium Thiosulfate Received on Ice
Chemicals in containers, lab
Parameter Schedule: T. Phosphorous
Sulfuric Acid
Received on Ice
Chemicals in containers, lab
Parameter Schedule: Ammonia Nitrogen
Sulfuric Acid
Received on Ice
Chemicals in containers, lab
Parameter Schedule: TKN
Sulfuric Acid
Received on Ice
Chemicals in containers, lab
Parameter Schedule: Chloride
Received on Ice
Chemicals in containers, lab
Parameter Schedule: Nitrate
Received on Ice
Chemicals in containers, lab
Sample Number 201105-20-04 Temp on Arrival: 3.0
PO Box 228 - Statesville, NC 28687 ® 704/872/4697
Page 4 of 6

Parameter Schedule: Total Dissolved Solids
Received on Ice
Parameter Schedule: Fecal Coliforms
Sodium Thiosulfate Chemicals in containers, lab
Received on Ice
Parameter Schedule: TKN
Sulfuric Acid Received on Ice
Chemicals in containers, lab
Parameter Schedule: Ammonia Nitrogen
Sulfuric Acid Received on Ice
Chemicals in containers, lab
Parameter Schedule: T. Phosphorous
Sulfuric Acid Received on Ice
Chemicals in containers, lab
Parameter Schedule: Chloride
Received on Ice
Chemicals in containers, lab
Parameter Schedule: Nitrate
Received on Ice
Chemicals in containers, lab
Sample Number 201 �05-20-05 Temp on Arrival: 3.13
Parameter Schedule: Total Dissolved Solids
Received on Ice
Parameter Schedule: Chloride
Received on Ice
Chemicals in containers, lab
PO Box 228 � Statesville, NC 28687 4 704/872/4697
Page 5 of 6

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{704) 9724697
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