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HomeMy WebLinkAboutWQ0020793_Monitoring - 03-2021_20210329Monitoring Report Submittal ............................................................................................................................................ Permit Number #* WQ0020793 Name of Facility:* Month:* March Report Information Type * GW-59 Tyson Farms,lnc Hays Hatchery Confirmation Email Address:* Name of Submitter:* Signature: Date of submittal: Initial Review Year:* 2021 Upload Document* Mar 2021.pdf 2.15MB FDF only Please upload one PDF containing all applicable monitoring reports (i.e., NDMR, NDAR-t, NDAR-2, NDMLR, GW-59). james.s. brown@tyson. con James Brown Reviewer: Williams, Kendall 3/27/2021 This will be filled in &Aormticaly Is the project number correct? * WQ0020793 Is the monitoring report r Yes r No accepted?* Regional Office * Winston-Salem Accepted Date: 3/29/2021 March 27, 2021 DEPARTMENT OF ENVIRONMENT & NATURAL RESOURCES DIVISION OF WATER QUALITY -INFORMATION PROCESSING UNIT 1617 MAIL SERVICE CENTER, RALEIGH, NC 27699-1617 Phone: (919) 733-3221 Subject: Ground Water Quality Monitoring Tyson Farms, Inc. Hays Hatchery Compliance Report - March 2021 To whom it may concern: Enclosed is the quarterly Groundwater Compliance report for Hays Hatchery. Please contact me at 336- 651-3836, should you have any questions. Sincerely, James Brown Complex Environmental Manager Tyson Farms Inc. Fresh Retail Division 704 Factory Wilkesboro, N.C. 28697 336-651-3836 336.838.2171 Fax:38.651.386'7 laww.tysonfoods.com Gam'-59A COMPLIANCE REPORT FORM Tyson Farms, Inc. Permit #_WQ0020793 (Submit one each monitoring period with G)- 59 forms.) 1 Enter date monitoring results were due. ( ) Will this monitoring report (GW-59 and GW-59A) YES be submitted after the established due date? 2 Was any required information missing on the GW-59 report forms? YES N 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 identification plate, area overgrown, etc.)? f the answer is "Yes ", contact the Regional Office for guidance. 4 Are any monitored constituents equal to or above the established standards? Q9 NO If the answer to question 4 is "NO", skip to section 8. If the answer to question 4 is "YES" list the affected wells individually with constituent(s) and concentration(s) exceeding standards in the space provided below 03/04/21 PH 6.5- 8.5 Ammonia 1.5 Nitrate 10 MW-1 MW- 2 4.82 mg/I MW- 3 PH - 5.0 MW-4 PH -5.3 5 For the constituents identified in question 4 above, have standards been exceeded previously for the Y 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). GIN Standards Nitrate 10 GWStandards ammonia 1.5 MW-2 03-04-21 4.82 mg/1 MW- 2 11-05-20 4.14 mg/1 MW- 2 7-16-20 4.7 mgA MW-2 3-26-20 4.90 mgA MW-2 11-7-19 5.04 mgA MW-2 07-11-19 4.14 my? 8 Are the monitoring wells listed in section 5 located at or beyond the review boundary? O 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 groundwater quality problem? j�r1c�,�; }��.;�;( 4V{w�`c :w� d gkc-arc�s ��• NO If the answer to question 7 is "YES", describe those actions in the space provided below. If the answer to question 7 is "NO",==fU.eegional,Office.W,ii2.2Q-dMLM,evaluation mav,&g LegUjLed to -de rmiag thg.l1I1Q=the.w-i ste.d1jP4.WLsyltem.iLbgY.[=gLtu=kimaad.comr)l&= L2guada#i2e.B.�CLt2ittlig1Q�.�L4�i Qf.Y1Q1�tiQQ. f agg, 3Qi)&Lpenalties. 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. I hereby acknowledge that the above information was evaluated and the information submitted in this report pliance Repo GW-59A) is true and complete to the best of my knowledge. 3-0� �^ d Si?8ture ot Ferminee for Authorize Agent) Date GW-59A 12/8/2003 Worksheet # 4b Tyson Farms, Inc. Com leted by James Brown Title : WWT Operator Date : 27-Mar-21 No. of Wells to be Sampled 4 Has Hatchery GroundWate Water sampling data Hays Hatchery Compliance Data Constituents equal to or above the established Standards Ha s 1per 100ML 500 m /I 250 m / 1.5 m /I 10 m /I NA 6.5-8.5 Date Wells ID: Fecal TDS Chloride Total NH3 Nitrate Phos hours PH 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 1 6.21 0.2 6.9 MW-2 <1 1 176 16.2 4.70 1.83 0.1 7.1 MW-3 <1 79 <10 <0.5 5.76 0.5 5.6 MW-4 I <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 1 17.9 4.14 1.35 0.1 6.3 MW-3 <1 63 11.0 [ <0.5 6.10 1 0.1 5.3 MW-4 <1 106 20.4 <0.5 2.17 0.1 5.7 Mar-04-2021 1 MW- 1 <1 212 <10 <0.5 7.05 <0.1 6.3 MW-2 <1 187 1 14.5 4.82 2.00 <0.1 6.4 MW-3 <1 69 <10 <0.5 6.19 <0.1 <0.1 5.0 MW-4 <1 118 1 19.6 <0.5 6.71 5.3 Maximum 0 435 43 6 12 2 7 1 Minimum i <1 53 11 4 1 0 5 SUBMIT FORM ON YELLOW PAPER ONLY • . DEPARTMENT OF ENVIRONMENT & NATURAL RESOURCES GROUNDWATER QUALITY MONITORING: DIVISION OF WATER QUALITY -INFORMATION PROCESSING UNIT 11617 COMPLIANCE REPORT FORM • • MAIL SERVICE CENTER, RALEIGH, NC 27699-1617 Phone: (919) 733-3221 FACILITY INFORMATION Please Print Clearly or Type PERMIT Number: WQ0020793 Expiration Date: 07/31/2026 Facility Name: Tyson Farms, Inc. Non -Discharge WQ0020793 UIC Permit Name (if different): NPDES Other Facility Address: P-0. Box 936/3649 Airport Road TYPE OF PERMITTED OPERATION BEING MONITORED NORTH WILKESBORO NC Contact Person. James Brown Well Location/Site Name: Hays Hatchery 28659 County Wilkes Telephone#: (336)651-3836 No. of wells to be sampled: 3 (Trom-Rr rrit) ❑ Lagoon ❑ Remediation: Infiltration Gallery ❑ Spray Field ❑ Remediation: ❑ Rotary Distributor ❑ Land Application of Sludge ❑ Water Source Heat Pump ❑■ Other: Evaporation/Infiltration Pond SAMPLING INFORMATION If WELL WELL ID NUMBER (from Permit): M W -1 Date sample collected: 03/04/2021 FIELD ANALYSES: WAS Well Depth: 40 ft. Well Diameter: 2 in. pH 00400 6.3 units Temp. 000lo: 14.5 or DRY at Depth to Water Level 82546: 24 ft. below measuring point Screened Interval: 23 ft. - to 40 ft. Spec. Cond. 00094: µMhos time ofsampling, Measuring Point is 2 ft. above land surface Relative M.P. Elevation: 1344.85 ft. Odor 00085. none check Volume of water pumped/bailed before sampling: 7-82 gallons Appearance cle ar here: ❑ Samples for metals were collected unfiltered: ❑ YES ❑■ NO and field acidified: ❑ YES ■❑ NO LABORATORY INFORMATION Date sample analyzed: 03/04/2021 Laboratory Name: S tat; si ile Analyiti ca I Certification No. 440/3775 PARAMETERS NOTE: Values should reflect dissolved and colloidal concentrations. COD 00335 mg/L Nitrite (NO2) as N 00615 mg/L Pb - Lead 01051 ug/L Coliform: MF Fecal 31616 <1 /100mL Nitrate (NO3) as N 00620 7.05 mg/L Zn - Zinc 01092 mg/L Coliform: MF Total 31504 /100mL Phosphorus. Total as P 00665 <0.1 mg/L (Note, Use MPN method for highly turbid samples) Orthophosphate 70507 mg/L Other (Specify Compounds and Concentration Units): lissolved Solids:Total 703oo 212 mg/L Al -Aluminum 01105 _ mg/L pH (Lab) 00403 units Ba - Barium 01007 ug/L TOC 00680 mg/L Ca - Calcium 00916 mg/L Chloride 00940 <10 mg/L Cd - Cadmium 01027 ug/L Arsenic 01002 ug/L Chromium: Total 01034 ug/L Grease and Oils 00552 mg/L Cu - Copper 01042 mg/L ORGANICS: (by GC, GC/MS, HPLC) Phenol 32730 ug/L Fe - Iron 01045 ug/L (Specify test and method #. ATTACH LAB REPORT.) Sulfate 00945 mg/L Hg - Mercury 71900 ug/L Lab Report Attached? ❑ Yes (1) ❑■ No (0) Specific Conductance 00095 µMhos K - Potassium 00937 mg/L VOC 78732: method # Total Ammonia o0610 <0.5 mg/L Mg - Magnesium 00927 mg/L method # (Ammonia Nitrogen, NH3 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 S. Brown Complex Environmental Manager Permittee (or Authorized Agent) Name and Title - Please print or type (or �py� % (Date) GW-59 Rev 2/2010 SUBMIT FORM ON YELLOW PAPER ONLY DEPARTMENT OF ENVIRONMENT&NATURAL RESOURCES GROUNDWATER QUALITY MONITORING: ffili, DIVISION OF WATER QUALITY -INFORMATION PROCESSING UNIT COMPLIANCE REPORT FORM 1617 MAIL SERVICE CENTER, RALEIGH, NC 27699.1617 Phone: (919) 733.3221 FACILITY INFORMATION Please Print Clearly or Type PERMIT Number: WQ0020793 Expiration Date: 07/31/2026 Facility Name: Tyson Farms, Inc. Non -Discharge W00020793 UIC Permit Name (if different): NPDES Other Facility Address: P.O. Box 936/3649 Airport Road TYPE OF PERMITTED OPERATION BEING MONITORED NORTH WILKESBORO (Sfi"M) NC 28659 County Wilkes El Lagoon El Remediation: Infiltration Gallery ❑ Spray Field ❑ Remediation: Contact Person: James Brown Telephone#: (336)651-3836 ❑ Rotary Distributor ❑ Land Application of Sludge Well Location/Site Name: Hays Hatchery No. of wells to be sampled: 3 ❑ Water Source Heat Pump ❑■ Other: Evaporation/Infiltration Pond from Pe rrt SAMPLING INFORMATION If WELL WELL ID NUMBER (from Permit): MW - 2 Date sample collected: 03/04/2021 FIELD ANALYSES: WAS Well Depth: 36 ft. p Well Diameter: 2 in. pH ooaoo: 6.4 units Temp. 00010. 1a,6 °C DRY at Depth to Water Level 82546: 22 ft. below measuring point Screened Interval: 21 ft. to 36 ft. Spec. Cond. 00094: µMhos time of sampling, Measuring Point is 2 ft. above land surface Relative M.P. Elevation: 1329.59 ft. Odor 00085: none check Volume of water pumped/bailed before sampling: 6.85 gallons Appearance clear here:❑ Samples for metals were collected unfiltered: ❑ YES ❑■ NO and field acidified: ❑ YES ❑■ NO LABORATORY INFORMATION Date sample analyzed: 03/04/2021 Laboratory Name: Statesville Analyitical Certification No. 440/3775 PARAMETERS NOTE: Values should reflect dissolved and colloidal concentrations. COD 00335 mg/L Nitrite (NO2) as N 00615 mg/L Pb - Lead 01051 ug/L Coliform: MF Fecal 31616 <1 /100mL Nitrate (NO3) as N 00620 2 mg/L Zn -Zinc 01092 mg/L Coliform: MF Total 31504 /100mL Phosphorus: Total as P 00665 <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 70300 187 mg/L Al -Aluminum 01105 mg/L pH (Lab) 00403 units Ba - Barium 01007 ug/L TOC 00680 mg/L Ca - Calcium 00916 mg/L Chloride 00940 14.5 mg/L Cd - Cadmium 01027 ug/L Arsenic 01002 ug/L Chromium: Total 01034 ug/L Grease and Oils 00552 mg/L Cu - Copper 01042 mg/L ORGANICS: (by GC, GC/MS, HPLC) Phenol 32730 ug/L Fe - Iron 01045 ug/L (Specify test and method #. ATTACH LAB REPORT.) Sulfate 00945 mg/L Hg - Mercury 71900 ug/L Lab Report Attached? ❑ Yes (1) ❑■ No (0) Specific Conductance 00095 µMhos K - Potassium 00937 mg/L VOC 78732: method # Total Ammonia 00610 4.82 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 Complex Environmental Manager Permittee (or Authorized Agent) Name and Title - Please print or GW-59 Rev.212010 3" 7_ JULfMI 1 t-UKM UN YLLLUVV PAPLK UNLY • . DEPARTMENT OF ENVIRONMENT & NATURAL RESOURCES GROUNDWATER QUALITY MONITORING: DIVISION OF WATER QUALITY -INFORMATION PROCESSING UNIT COMPLIANCE REPORT FORM 1617 MAIL SERVICE CENTER, RALEIGH, NC 27699.1617 Phone: (919) 733-3221 FACILITY INFORMATION Please Print Clearly or Type PERMIT Number: WQ0020793 Expiration Date: 07/31/2026 Facility Name: Tyson Farms, Inc. Non -Discharge W00020793 UIC Permit Name (if different): NPDES Other Facility Address: P.O. Box 936/3649 Airport Road TYPE OF PERMITTED OPERATION BEING MONITORED NORTH WILKESBORO `"`' NC 28659 County Wilkes ❑Lagoon ❑Remediation: Infiltration Gallery (Ufy' (�"'"�' "'P' ❑ Spray Field ❑ Remediation: (Contact Person: James Brown Telephone#: (336)651-3836 ❑ Rotary Distributor ❑ Land Application of Sludge 1^Well Location/Site Name: Hays Hatchery No. of wells to be sampled: 3 ❑ Water Source Heat Pump 0 Other: Evaporation/Infiltration Pond SAMPLING INFORMATION If WELL WELL ID NUMBER (from Permit): MW - 3 Date sample collected: 03/04/2021 FIELD ANALYSES: WAS Well Depth: 36 ft. Well Diameter: 2 in. pH 00400: 5.0 units Temp. 000lo: 14.3 °C DRY at Depth to Water Level 82546: 14 ft. below measuring point Screened Interval: 21 ft. to 36 ft. Spec. Cond. 00094: µMhos time of sampling, 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: 10.75 gallons Appearance clear here: ❑ Samples for metals were collected unfiltered: ❑ YES 9NO and field acidified: ❑ YES NO Date sample analyzed: 03/04/2021 Laboratory Name: Statesville Analyitical PARAMETERS NOTE: Values should reflect dissolved and colloidal concentrations. COD 00335 mg/L Nitrite (NO2) as N 00615 Coliform: MF Fecal 31616 <1 /100mL Nitrate (NO3) as N 00620 6.19 Coliform: MF Total 31504_ /100mL Phosphorus: Total as P 00665 <0.1 (Note Use MPN method for highly turbid samples) Orthophosphate 70507 issolved Solids:Total 703oo 69 mg/L Al -Aluminum ol1o5 pH (Lab) 00403 units Ba - Barium 01007_ TOC 00680 mg/L Ca - Calcium 00916 Chloride 00940 <10 mg/L Cd - Cadmium 01027 Arsenic 01002 ug/L Chromium: Total 01034 Grease and Oils 00552 mg/L Cu - Copper 01042 Phenol 32730 ug/L Fe - Iron 01045 Sulfate 00945 mg/L Hg - Mercury 71900 ;pecific Conductance 00095 µMhos K - Potassium 00937 Total Ammonia 00610 <0.5 mg/L Mg - Magnesium 00927 (Ammonia Nitrogen. NH. as N. Ammonia Nitrogen, Total) Mn - Manganese 01055 TKN as N 00625 mg/L Ni - Nickel 01067 mg/L mg/L mg/L mg/L mg/L ug/L mg/L ug/L ug/L mg/L ug/L ug/L mg/L mg/L ug/L ug/L Pb - Lead 01051 Zn -Zinc 01092 Certification No. 440/3775 ug/L mg/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 # 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.2/2010 SUBMIT FORM ON YELLOW PAPER ONLY (GROUNDWATER QUALITY MONITORING: COMPLIANCE REPORT FORM FACILITY INFORMATION Please Print CleaAyorType Facility Name: Tyson Farms, Inc. Permit Name (if different): Facility Address: P.O. Box 936/3649 Airport Road NORTH WILKESBORO ''`"''t' NC 28659 County Wilkes (Contact Person: James Brown Well Location/Site Name: Hays Hatchery Telephone#: (336)651-3836 No. of wells to be sampled: 3 DEPARTMENTOF ENVIRONMENT& NATURAL RESOURCES DIVISION OF WATER QUALITY -INFORMATION PROCESSING UNIT 1617 MAIL SERVICE CENTER, RALEIGH, NC 27699-1617 Phone: (919) 733-3221 PERMIT Number: WQ0020793 Expiration Date: 07/31/2026 ' Non -Discharge WQ0020793 UIC NPDES Other TYPE OF PERMITTED OPERATION BEING MONITORED ❑ Lagoon ❑ Remediation: Infiltration Gallery ❑ Spray Field ❑ Remediation: ❑ Rotary Distributor ❑ Land Application of Sludge ❑ Water Source Heat Pump ❑■ Other: Evaporation/Infiltration Pond SAMPLING INFORMATION If WELL WELL ID NUMBER (from Permit): MW - 4 Date sample collected: 03/04/2021 FIELD ANALYSES: WAS Well Depth: 27 ft. Well Diameter: 2 in. pH 00400: 5.3 units Temp. 000lo: 14.2 °C DRY at Depth to Water Level 82546: 6 ft. below measuring point Screened Interval: 12 ft. to 27 ft. Spec. Cond. 00094: µMhos time of sampling, Measuring Point is 2 ft. above land surface Relative M.P. Elevation: 1324.13 ft. Odor 00085: none check Volume of water pumped/bailed before sampling: 10.26 gallons Appearance L-ar here:❑ Samples for metals were collected unfiltered: ❑ YES ❑■ NO and field acidified: ❑ YES ■❑ NO LABORATORY INFORMATION Date sample analyzed: 03/04/2021 Laboratory Name: t$ t# sille Analyitical Certification No. 440/3775 PARAMETERS NOTE: Values should reflect dissolved and colloidal concentration s. COD 00335_ mg/L Nitrite (NO2) as N 00615 mg/L Pb - Lead 01051 ug/L Coliform: MF Fecal 31616 <1 /100mL Nitrate (NO3) as N 00620 6,71 mg/L Zn - Zinc 01092 mg/L Coliform: MF Total 31504 /100mL Phosphorus: Total as P 00665 < 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 70300 118 mg/L Al -Aluminum oil o5_ mg/L pH (Lab) 00403 units Ba - Barium 01007____ ug/L TOC 00680 mg/L Ca - Calcium 00916 _ mg/L Chloride 00940 19.6 mg/L Cd - Cadmium 01027 ug/L Arsenic 01002 ug/L Chromium: Total 01034 ug/L Grease and Oils 00552 mg/L Cu - Copper 01042 mg/L ORGANICS: (by GC, GC/MS, HPLC) Phenol 32730 ug/L Fe - Iron 01045 ug/L (Specify test and method #. ATTACH LAB REPORT.) Sulfate 00945 mg/L Hg - Mercury 71900 ug/L Lab Report Attached? ❑ Yes (1) ❑■ No (0) Specific Conductance 00095 µMhos K - Potassium 00937_ mg/L VOC 78732: method # Total Ammonia 00610 <0.5 mg/L Mg - Magnesium 00927 mg/L method # (Ammonia Nitrogen, NH3 as N: Ammonia Nitrogen, Total) Mn - Manganese olo55 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% r-errnmee tar mutnarizea mgeny rvame ano i ❑ie - "ease print or type GW-59 Rev.2/2010 Analytical Results Tyson Foods -Wilkesboro 704 Factory Street Wilkesboro, NC 28697 Receive Date: 03/04/2021 Reported: 03/23/2021 For: Hays MW Comments: �V ' Sample Number Parameter Sample ID Result Unit Method Analyzed Analyst 210304-25-01 Ammonia Nitrogen MW1 <0.5 ni SM4500NH3C-2011 03/09/2021 MD 210304-25-01 Chloride MW1 <10 mg/L SM4500CIC-2011 03/05/2021 MD 210304-25-01 Fecal Coliforms MW1 <1 CFU100 ML SM9222D-2006 03/04/2021 WC 210304-25-01 Nitrate MW1 7.05 mg/L SM4500NO3F-2011 03/16/2021 CL 210304-25-01 T. Phosphorous MW1 <0.1 mg/L SM4500PE-2011 03/19/2021 CL 210304-25-01 Total Dissolved MW 1 212 mg/L SM 2540 C 18th Edition 03/05/2021 MD Solids 210304-25-02 Ammonia Nitrogen MW2 4.82 mg/L SM4500NH3C-2011 03/09/2021 MD 210304-25-02 Chloride MW2 14.5 mg/L SM4500CIC-2011 03/05/2021 MD 210304-25-02 Fecal Coliforms MW2 <1 CFU100 ML SM9222D-2006 03/04/2021 WC 210304-25-02 Nitrate MW2 2 mg/L SM4500NO3F-2011 03/16/2021 CL 210304-25-02 T. Phosphorous MW2 <0.1 mg/L SM4500PE-2011 03/19/2021 CL 210304-25-02 Total Dissolved MW2 187 mg/L SM 2540 C 18th Edition 03/05/2021 MD Solids 210304-25-03 Ammonia Nitrogen MW3 <0.5 mg/L SM4500NH3C-2011 03/09/2021 MD 210304-25-03 Chloride MW3 <10 mg/L SM4500CIC-2011 03/05/2021 MD 210304-25-03 Fecal Coliforms MW3 <1 CFU100 ML SM9222D-2006 03/04/2021 WC 210304-25-03 Nitrate MW3 6.19 mg/L SM4500NO3F-2011 03/16/2021 CL 210304-25-03 T. Phosphorous MW3 <0.1 mg/L SM4500PE-2011 03/19/2021 CL 210304-25-03 Total Dissolved MW3 69 mg/L SM 2540 C 18th Edition 03/05/2021 MD Solids 210304-25-04 Chloride MW4 19.6 mg/L SM4500CIC-2011 03/05/2021 MD 210304-25-04 Fecal Coliforms MW4 <1 CFU100 ML SM9222D-2006 03/04/2021 WC 210304-25-04 Nitrate MW4 6.71 mg/L SM4500NO3F-2011 03/16/2021 CL 210304-25-04 Total Dissolved MW4 118 mg/L SM 2540 C 181h Edition 03/05/2021 MD Solids PO Box 228 • Statesville, NC 28687 • 704/872/4697 Page 1 of 6 Sample Number Parameter Sample ID Result Unit Method Analyzed Analyst Page 2 of 6 Condition of Receipt Total Dissolved Solids Fecal Coliforms Nitrate Ammonia Nitrogen T. Phosphorous Chloride Total Dissolved Solids Fecal Coliforms T. Phosphorous Ammonia Nitrogen Page 3 of 6 Nitrate Chloride Total Dissolved Solids Fecal Coliforms Nitrate Ammonia Nitrogen T. Phosphorous Chloride Total Dissolved Solids Fecal Coliforms T. Phosphorous Ammonia Nitrogen Nitrate Chloride Page 5 of 6 Client: T _ Address: A) LeGsbos , r4 (-. 111c4 `t Contact Person: _ Phone 11 FAXtI PO 11 Requisitioned by: Cuslornen -- — ,5amplc IONI(irah Lnh•Iq R I'm SgngAMI <)nIV) Llito Sampled Inrnb r)rity) u Mlatmc } to tr -4b A. _ �-ul_ j l Lk — - Relinquished by:�—� Received by: l �---- -- -- T Relinquished by: ..... ...... —� r Received by:`_�.. ComtTosite SmApling Wt: J Time begin am. pm Date ! 1_ Time end_—.__— am, pm Date / 1 CQmtlnQitP Samntin tit; — Time begin am, pm Date 1 1 Time end am, pm Date 1 1 1 22 (.1Irl strccl • C) Ihr. ''-2X 1,101c,, illc. fvl 1.86%7 1 JIFI 11�.�.-�Ifr')7 Chain of Custudy Record I':rranneci� wy—tol lin wmlysil> ;1a�i<., .�`L•.}TLt3GT�'M�^tuS.(� 745� �.r�] k1.l,cdt� . h 1tl..:.►. -t tc. -Q 1� J�.1 tt a Time /ZC— am,aM Date 31 7 !-Z_/ Sampled b Time /Lt'' am, VW Date_ir'?�._/O / Transported by: Time,Tz_i amon Date / ._/2 — — Holding times met: I 2 Time it L; am, Date Compliance work: Non-compliance work: Lab Comments, Samples Transporled On Ice. Initials. /17 n rn N O Wcfl O C • lb �o 00 N U z ai N IU 16 00 N N x cc 0 IZ