WQ0004910_Monitoring - 02-2021_20210311 (2)

FORM: NDAR-1 05-16 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page ( of 1�4
Permit No.: W00004910
Facility Name: Town of Woodland WWTF
County: Northampton
Month: February
Year: 2021
Did irrigation occur
Field Name:
1
Field Name:
2
Field Name:
4
Field Name:
4
this facility?
Area (acres):
5.3
Area (acres):
5.3
Area (acres):
5.3
Area (acres):
5.3
at
�l1
Cover Crop:Fescue
Cover Crop:
p:
Fescue
Cover Crop:
p:
Fescue
Cover Crop:
p:
Fescue
0 YES��N-� NO
Hourly Rate (in):
0.33
Hourly Rate (in):
0.33
Hourly Rate (in):
0.33
Hourly Rate (in):
0.33
Annual Rate (in):
52
Annual Rate (in):
52
Annual Rate (in):
52
Annual Rate (in):
52
Weather
Freeboard
Field Irrigated?
❑ YES ❑ NO
Field Irrigated?
❑ YES ❑ NO
Field Irrigated?
❑ YES ❑ NO
Field Irrigated?
E YES ❑ No
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°F
I in
ft
ft
gal
min
in
in
gal
min
in
I in
gal
I min
in
I in
gal
min
in
in
1
CL
33
1 0
2
47,500
40
0.33
0.33
47,500
40
0.33
0.33
47,500
40
0.33
0.33
47,500
40
0.33
0.33
2
CL
37
2
2
3
C
44
0
2
47,900
40
0.33
0.33
47,900
40
0.33
0.33
47,900
40
0.33
0.33
47,900
40
0.33
0.33
4
C
40
0
2
47,000
40
0.33
0.33
47,000
40
0.33
0.33
47,000
40
0.33
0.33
47,000
40
0.33
0.33
5
R
44
0.2
2.25
47,300
40
0.33
0.33
47,300
40
0.33
0.33
47,300
40
0.33
0.33
47,300
40
0.33
0.33
6
C
35
0.25
2
47,100
40
0.33
0.33
47,100
40
0.33
1 0.33
47,100
1 40
0.33
1 0.33
47,100
40
0.33
0.33
7
R
41
0-6
2
8
C
36
1 0.25
2
47,000
40
0.33
0,33
47,000
40
0.33
0.33
47,000
40
0.33
0.33
47,000
40
0.33
1 0.33
9
CL
42
0
2.25
16,000
40
0.11
0.11
16,000
40
0.11
0.11
16,000
40
0.11
0.11
16,000
40
0.11
0.11
10
C
44
0
2.5
15,700
40
0,11
1 0.11
15,700
40
0.11
0.11
15,700
40
0A1
0.11
15,700
1 40
0.11
0.11
11
CL
49
0
2.5
16,100
40
0.11
0.11
16,100
40
0,11
0.11
16,100
40
0.11
0.11
16,100
40
0.11
0.11
12
R
39
1
2.5
13
R
37
0.35
2.5
17,900
40
0.12
0.12
17,900
40
0.12
0.12
17,900
40
0.12
0.12
17,900
40
0.12
0.12
14
CL
35
1 0.5
2.25
15
CL
37
0.75
2.25
16
CL
59
0.75
2
17
C
34
0.1
2
18,100
40
0.13
0.13
18,100
40
0.13
0 13
18,100
40
0.13
0.13
18,100
40
0.13
0.13
18
CL
33
1
2
19
R
33
1.25
2.25
20
CL
32 1
0.25
2.25
18,700
40
0.13
0.13
18,700
40
0.13
0.13
18,700
40
0.13
OA3
18,700
40
0.13
0.13
21
C
26
0
2.25
47,500
40
0.33
0.33
47,500
40
0.33
0.33
47,500
40
0.33
0.33 1
47,500
40
0.33
0.33
221
CL
40
0
2
36,200
40
0.25
1 0.25
36,200
40
0.25
0.25
36,200
40
0.25
0.25
36,200
40
0.25
0.25
23
C
50
0.5
2
47,100
40
0.33
0.33
47,100
40
0.33
0.33
47,100
40
0.33
0.33
47,100
40
0.33
0.33
24
C
47
0
2.25
46,700
40
0.32
0.32
46,700
40
0.32
0.32
46,700
40
0,32
0.32
46,700
40
0.32
0.32
25
C
55
0
2.25
47,100
40
0.33
0.33
47,100
40
0.33
0.33
47,100
40
0.33
0.33
47,100
40
0.33
0.33
26
CL
46 1
0
2.25
48,200
40
0.33
0.33
48,200
40
0.33
0.33
48,200
40
0.33
0.33
48,200
40
0.33
0.33
27
CL
52
1
2.25
45,300 1
40
0.31
0.31
45,300
40
0.31
0.31
45,300
40
0.31
0.31 1
45,300 1
40
0.31
0.31
281
CL
59
0
2.25
47,100 1
40
0.33
0.33
47,100
40
0.33
0.33
47,100
40
0.33
0.33
47,100
40
0.33
0.33
30
L3129
Monthly Loading:
751,500
5.22
751,500
5.22
751,500
5.22
751,500
5.22
12 Month Floating Total (in):
20.12
19.86
20.43
19.64

FORM: NDAR-1 05-16 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page -`L of
Permit No.: WQ0004910
Facility Name: Town of Woodland WWTF
County: Northampton
Month: February
Year: 2021
Did irrigation occur
Field Name:
5
Field Name:
6
Field Name:
7
Field Name:
8
this facility?
Area (acres):
5.3
Area (acres):
5.3
Area (acres):
5.3
Area (acres):
5.3
at
Cover Crop:Fescue
Cover Crop:
P:
Fescue
Cover Crop:
p:
Fescue
Cover Crop:
p:
Fescue
[] YES ❑ NO
Hourly Rate (in):
0.33
Hourly Rate (in):
0.33
Hourly Rate (in):
0.33
Hourly Rate (in):
0.33
Annual Rate (in):
52
Annual Rate (in):
52
Annual Rate (in):
52
Annual Rate (in):
52
Weather
Freeboard
Field Irrigated?
❑ YES ❑ NO
Field Irrigated?
0 YES ❑ NO
Field Irrigated?
❑ YES ❑ NO
Field Irrigated?
R] YES ❑ NO
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I in
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min
in
in
gal
min
in
in
gal
min
in
in
gal
min
in
I in
1
CL
33
1 0
2
47,500
40
0.33
0.33
47,500
40
0.33
0.33
47,500
40
0.33
0.33
47,500
40
0.33
0.33
2
CL
37
2
2
3
C
44
0
2
47,900
40
0.33
0.33
47,900
40
033
0.33
47,900
40
0.33
0.33
47,900
40
0.33
0.33
4
C
40
0
2
47,000
40
0.33
0.33
47,000
40
0.33
0.33
47,000
40
0.33
0.33
47,000
40
0.33
0.33
5
R
44
0.2
2.25
47,300
40
0,33
0.33
47,300
40
0.33
0.33
47,300
40
0.33
0.33 1
47,300
40
0.33
0.33
6
C
35
0.25
2
47,100
40
0.33
0.33
47,100
40
0.33
0.33
47,100
40
0.33
0.33
47,100
40
0.33
0.33
7
R
41
0.6
2
8
C
36
0.25
2
47,000
40
0.33
0.33
47,000
40
0.33
0.33
47,000
40
0.33
0.33
47,000
40
0.33
0.33
9
CL
42
0
2.25
16,000
40
0A 1
0.11
16,000
40
0.11
0.11
16,000
40
0.11
0.11
16,000
40
0.11
0.11
10
C
44
0
2.5
15,700
40
0.11
0.11
15,700
40
0.11
0.11
15,700
40
0.11
0.11
15,700
40
0.11
0.11
11
CL
49
0
2.5
16,100
40
OA1
0.11
16,100
40
0.11
0.11
16,100
40
0.11
0.11 1
16,100
40
0.11
0.11
12
R
39
1 1
2.5
13
R
37
0.35
2.5
17,900
40
0.12
0.12
17,900
40
0.12
0.12
17,900
40
0.12
OA2
17,900
40
0.12
0.12
141
CL
35
0.5
2.25
15
CL
37
0.75
2.25
16
CL
59
0.75
2
17
C
34
0.1
2
18,100
40
0.13
0.13
18,100
40
0 13
0.13
18,100
40
0.13
0.13
18,100
40
0.13
0.13
18
CL
33
1
2
19
R
33
1.25
2.25
201
CL
32
0.25
2.25
18,700
40
0.13
0.13
18,700
40
0.13
0.13
18,700
40
0.13
0.13
18,700
40
0.13
0.13
21
C
26
0
2.25 1
47,500
40
0.33
0.33
47,500
40
0.33
0.33
47,500
40
0.33
0.33
47,500
40
0.33
0.33
22
CL
40
0
2
36,200
40
0.25
0.25
36,200
40
0.25
0.25
36,200 1
40
0.25
0.25
36,200
40
0.25
0.25
23
C
50
0.5
2
1
47,100
40
0.33
0.33
47,100
40
0.33
0.33
47,100
40
0.33
0.33
47,100
40
0.33
0.33
24
C
47
0
2.25
46,700
40
0.32
0.32
46,700
1 40
0.32
0.32
46,700
40
0.32
0.32
46,700
40
0.32
0.32
25
C
55
0
2.25
47,100
40
0.33
0.33
47,100
40
0.33
0.33
47,100
40
0.33
0.33
47,100
40
0.33
0.33
261
CL
46 1
0
2.25
48,200
40
0.33
0.33
48,200
40
0.33
0.33
48,200
40
0.33 1
0.33
48,200
40
0.33
0.33
27
CL
52
1
2.25
45,300
40
0.31
0.31
45,300
40
0.31
0.31
45,300
40
0.31
0.31
45,300
40
0.31
0.31
28
CL
59
0
2.25
47,100
40
0.33
0.33
47,100
40
0.33
033
47,100
40
0.33
0.33
47,100
40
0.33
0.33
29
30
31
Monthly Loading:
751,500
5.22
4=
V
751.500
5.22
751,500
5.22
751,500
5.22
12 Month Floating Total (in):
19.49
19.32pre
20.05
20.09

FORM: NDAR-1 05-16 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page .3 of
Permit No.: .
Facility Name: Town of Woodland WWTF
County: Northampton
Month: February
Year: 2021
Did irrigation occur
Field Nme:
Field Name:
this facility?
Area (acres):
5.3
Area (acres):
503
Area (acres):
Area (acres):
at
Cover Crop:Fescue
Cover Crop:
p:
Fescue
Cover Crop:
p:
Cover Crop:
p:
0 YES ❑ No
Hourly Rate (in):
0.33
Hourly Rate (in):
0.33
Hourly Rate (in):
Hourly Rate (in):
5
Annual Rate (in):
52
Annual Rate (in):
52
Annual Rate (in):
Annual Rate (in):
Weather
Freeboard
Field Irrigated?
YES ❑ No
Field Irrigated?
YES ❑ No
Field Irrigated?
❑ YES ❑ No
Field Irrigated?
❑ YES ❑ No
❑
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in
ft
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gal
min
in
in
gal
min
in
in
gal
min
in
in
gal
min
in
in
1
CL
33
0
2
47,500
40
0.33
0.33
47,500
40
0.33
0.33
2
CL
37
2
2
3
C
44
0
2
47,900
40
0.33
0.33
47,900
40
0.33
0.33
4
C
40
0
2
47,000
40
0.33
0.33
47,000
40
0.33
0.33
5
R
44
0.2
2.25
47,300
40
0.33
0.33
47,300
40
0.33
0.33
6
C
35
0.25
2
47,100
40
0.33
0.33
47,100
40
0.33
0.33
7
R
41
0.6
2
8
C
36
0.25
2
47,000
40
0.33
0.33
47,000
40
0.33
0.33
9
CL
42
0
2.25
16,000
40
0.11
0.11
16,000
40
0.11
0.11
10
C
44
0
2.5
15,700
40
0.11
0.11
15,700
40
0.11
0.11
11
CL
49
0
2.5
16,100
40
0.11
0,11
16,100
40
0.11
0.11
12
R
39
1
2.5
13
R
37
0.35
2.5
17,900
40
0.12
0.12
17,900
40
0.12
0.12
14
CL
35
1 0.5
2.25
15
CL
37
1 0.75
2.25
16
CL
59
0.75
2
17
C
34
0.1
2
18,100 1
40
0.13
0.13
18,100
40
0.13 1
0.13
181
CL
33
1
2
191
R
33
1.25
2.25
201
CL
32
0.25
2.25
18,700
40
0.13
0.13
18,700 1
40
0.13
0.13
21
C
26
0
2.25
47,500
40
0.33
0.33
47,500 1
40
0.33
0.33
22
CL
40
0
2
36,200
40
0.25
0.25
36,200
40
0.25
0.25
23
C
50
0.5
2
47,100
40
0.33
0.33
47,100
40
0.33
0.33
24
C
47
0
2.25
46,700 1
40
0.32
0.32
46,700
40
0.32
0.32
25
C
55
0
2.25
47,100
40
0.33
0.33
47,100
40
0.33
0.33
261
CL
46
0
Z25
48,200
40
0.33
0.33
48,200
40
0.33
0.33
27
CL
52
1
2.25
45,300
40
0.31
0.31
45,300
40
0.31
0.31
28
CL
59
0
2.25
47,100
40
0,33 1
0.33
47,100
40
0.33
0.33
29
30
31
Monthly Loading:
751,500
5.22
751,500
=
t25
jj
0
0.00
0
0.00
12 Month Floating Total (in):
21.10

FORM: NDAR-1 05-16 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page Ll of
Did the application rates exceed the limits in Attachment B of your permit?
l Compliant ❑ Non -Compliant
Were adequate measures taken to prevent effluent ponding in or runoff from the sites? ❑� Compliant ❑ Non -Compliant
Was a suitable vegetative cover maintained on all sites as specified in your permit? ❑✓ Compliant ❑ Non -Compliant
Were all setbacks listed in your permit maintained for every application to each permitted site? ✓❑ Compliant ❑ Non -Compliant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit? El Compliant ❑ Non -Compliant
If the facility is non -compliant, please explain in the space below the reason(s) the facility was not in compliance. Provide in your explanation the date(s) of the non-compliance and describe the corrective
action(s) taken. Attach additional sheets if necessary.
Operator in Responsible Charge (ORC) Certification
Permittee Certification
ORC: Raymond S. Eaton Permittee:
Town of Woodland
Certification No.: 1003144 Signing Official: Raymond S. Eaton
Grade: 1 Phone Number: 252-209-1759 Signing Official's Title: Public Works Director/ ORC
Has the ORC changed since the previous NDAR-1? ❑ yes El No Phone Number: 252-209-1759 Permit Exp.: Sept. 30, 2021
r
3/8/21
Signature Date
By this signature, I certify that this report is accurrate and complete to the best of my knowledge.
3/8/21
Signature Date
I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance
with a system designed to assure that all qualified personnel properly gathered and evaluated the information submitted. Based on my
inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the
information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant
penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations.
Mail Original and Two Copies to:
Division of Water Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

FORM: NDMR 05-16
NON -DISCHARGE MONITORING REPORT (NDMR)
Page j of 2-.-
Permit No.: W00004910
Facility Name: Town of Woodland WWTF
County: Northampton
Month: February 7Year:
2021
PPI: 001
Flow Measuring Point: ❑ Influent ❑ Effluent ❑ No flow generated
Parameter Monitoring Point: ❑ Influent 0 Effluent ❑ Groundwater Lowering [J Surface Water
Parameter Code - P.
50050
00310
00940
50060
31616
00610
00625
00620
00600
00400
00665
70300
00530
O
@
U
O
c
p
E°
F y
O
3
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m
v
r
H N O
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to
24-hr
hrs
GPD
mg/L
mg/L
mg/L
#/100 mL
mg/L
mg1L
mg/L
mg/L
su
mg/L
mg/L
mg/L
1
07:57
0.5
216,050
0.06
7.91
2
09:30
0.5
149,910
N/A
N/A
3
11:30
0.5
112,920
0.07
7.85
4
10:27
0.5
98,940
0.06
7.85
5
08:43
0.5
185,460
0.05
7.86
6
08:39
0.5
229,460
0.07
7.89
7
0849
0.5
287,550
N/A
N/A
8
08:33
0.5
161,390
0.05
7.8
9
08:19
0.5
171,040
0.05
7.75
10
08:17
0.5
91,060
0.06
7.8
11
09:51
0.5
257,330
26
489
0.07
18
2.96
10.12
0.68
10.89
7.75
1.46
810
54
12
10:00
0.5
321,940
N/A
N/A
13
09:00
0.5
1 383,410
0.06
7.89
14
08:15
0.5
1 368,370
N/A
N/A
15
09:06
0.5
311,410
N/A
N/A
16
09:40
0.5
214,200
N/A
N/A
17
09:11
0.5
163,090
0.07
7.8
18
09:47
0.5
380,610
N/A
N/A
19
08:12
0.5
316,450
N/A
N/A
201
0817 1
0.5
167,690
0.05
7.9
21
08:13
0.5
127,000
0.03
709
22
09:03
0.5
237,340
0.05
8
23
09:40
0.5
174,460
0.04
8
24
09:05
0.5
132,770
0.06
8
25
08:30
1
120,060
0.07
7.91
261
09:05
0.5
234,220
0.06
7.9
27
09:00
0.5
251,870
0.03
7.9
28
08:15
0.5
130,850
0.03
7.85
29
30
31
Average:
214,173
26.00
489.00
0.04
18.00
2.96
10.12
0.34
10.89
1.46
810.00
54.00
Daily Maximum:
383,410
26.00
489.00
0.07
18.00
2.96
10.12
0.68
10.89
709.00
1.46
810.00
54.00
Daily Minimum:
91,060
26.00
489.00
0.03
18.00
2.96
10.12
0.68
10.89
7.75
1.46
810.00
54.00
Sampling Type:
Recorder
Grab
Grab
Grab
Grab
Grab
Grab
Grab
Grab
Grab
Grab
Grab
Grab
Monthly Limit:
185,000
Daily Limit:
Sample Frequency:
Continuous
Monthly
3 X Year
Per Event
Monthly
Monthly
Monthly
Monthly
Monthly
Per Event
Monthly
3 X Year
Monthly

FORM: NDMR 05-16 NON -DISCHARGE MONITORING REPORT (NDMR) Page .=� of
Sampling Person(s) Certified Laboratories
Name: Raymond S. Eaton Name: Environment 1 Inc.
Name: Name:
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? El Compliant ❑ Non -Compliant
If the facility is non -compliant, please explain in the space below the reason(s) the facility was not in compliance. Provide in your explanation the date(s) of the non-compliance and describe the corrective
action(s) taken. Attach additional sheets if necessary.
Operator in Responsible Charge (ORC) Certification
Permittee Certification
ORC: Raymond S. Eaton
Permittee: Town of Woodland
Certification No.: 1000927/ 1003978
Signing Official: Raymond S. Eaton
Grade: 1- Phone Number: 252-209-1759
Signing Official's Title: Public Works Director/ ORC
Has the ORC changed since the previous NDMR? ❑ yes El No
Phone Number: 252-209-1759 Permit Expiration: Sept. 30, 2021
3/8/2021
A 3/8/2021
Signature Date
Signature Date
By this signature, I certify that this report is accurrate and complete to the best of my knowledge.
I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in
accordance with a system designed to assure that all qualified personnel properly gathered and evaluated the information
submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for
gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am
aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for
knowing violations.
Mail Original and Two Copies to:
Division of Water Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

13
. E[0WuT@fl g1W Flo hmpumUd
114 OAKMONT DRIVE
GREENVILLE, N.C. 27858
TOWN OF WOODLAND
P.O. BOX 297
WOODLAND ,NC 27897
Well #9
Analysis
Method
PARAMETERS
Date
Analyst
Code
Fecal Coliform (MF), /100 Mls
<1
02/11/21
JMS
9222D-06
Ammonia Nitrogen as N, mg/l
<0.04
02/12/21
KES
350.1 R2-93
Nitrate Nitrogen as N, mg/l
0.16
02/11/21
DTL
353.2 112-93
Total Phosphorus as P, mg/l
0.06
03/02/21
DTL
365.4-74
Total Organic Carbon, mg/1
< 1.00
02/18/21
KDS
531OC-11
Chloride, mg/l
427
02/15/21
KDS
4500CLB-11
Total Dissolved Residue, mg/l
780
02/16/21
KDS
D5907-13
ANWAM
PHONE [phone]
FAX [phone]
ID#: 254
DATE COLLECTED: 02/11/21
DATE REPORTED : 03/03/21
REVIEWED BY: 'Zd�

SMA� min(W % hgoo mnmn, %A
114 OAKMONT DRIVE
GREENVILLE, N.C. 27858
ID#: 254
Drinking Water ID: 37715
Wastewater ID: 10
vvc [phone]
FAX [phone]
TOWN OF WOODLAND
P.O. BOX 297
WOODLAND ,NC 27897 DATE COLLECTED: 02/11/21
DATE REPORTED : 03/03/21
REVIEWED BY:
Effluent
Well #1
Well #3
'"'ell #6
Well #8
Analysis
Method
PARAMETERS
Date
Analyst
Code
BOD, mg/l
26
02/11/21
KDS
521OB-11
Fecal Coliform (MF), /100 Mls
18
< 1
< 1
< 1
< 1
02/11/21
JMS
9222D-06
Total Suspended Residue, mg/l
54
02/12/21
BLV
2540D-11
Ammonia Nitrogen as N, mg/l
2.96
< 0.04
< 0.04
< 0.04
< 0.04
02/12/21
KES
350.1 112-93
Total Kjeldahl Nitrogen as N,mg/l
10.12
02/16/21
KES
351.2 R2-93
Nitrate+Nitrite as N, mg/l (calc)
0.77
353.2 R2-93
Nitrate Nitrogen as N, mg/l
0.68
0.10
0.06
0.13
<0.04
02/11/21
DTL
353.2 112-93
Nitrite Nitrogen as N, mg/l
0.09
02/11/21
TLH
353.2 R2-93
Total Phosphorus as P, mg/l
1.46
02/16/21
TLH
365.4-74
Total Phosphorus as P, mg/l
< 0.04
< 0.04
0.07
<0.04
03/02/21
DTL
365.4-74
Total Organic Carbon, mg/l
< 1.00
< 1.00
< 1.00
< 1.00
02/18/21
KDS
531OC-11
Chloride, mg/l
489
28
38
70
14
02/15/21
KDS
4500CLB-11
Total Dissolved Residue, mg/l
810
77
97
170
110
02/16/21
KDS
D5907-13
Total Nitrogen, mg/l (calc)
10.89

'Environment 1, Inc. CHA17 OF CUSTODY RECORD
P.O. Box 7085, 114 Oakmont Dr. Page 1 of 1
(lrapn,,dla Nf 77R5R
environment I inc.com
DISINFECTION
CHLORINE NEUTRALIZED AT COLLECTION
Phone [phone] •Fax [phone]
CHLORINE
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pH CHECK (LAB)
254 Week:ll
CLIENT:
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CONTAINER TYPE,P/G
'OWN OF WOODLAND
,.O. BOX 297
❑NONE
A
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A
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A
CHEMICAL PRESERVATION
VOODLAND NC 27897
❑
A - NONE D - NAOH
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DATE
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CLASSIFICATION:
X WASTEWATER (NPDES)
❑ DRINKING WATER
Well #1
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CHAIN OF CUSTODY (SEAL) MAINTAINED
DURING SHIPMENT/DELIVERY
JY N
SAMPLES COLLECTED BY:
(Please Print)
'7
1�� i-� 6z
SAMPLES RECEIVED IN LAB AT • ( °C
RELINIDUISHEVY (SIG. MP )
DATFITIME
RECEIVED BY (SIG.)
DATFITIME
COMMENTS:
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i1%•Z1 I it 2
RELINQUISHED BY (SIG.)
DATE/TIME
RECEIVED BY (SIG.)
DATErnME
RELINQUISHED BY (SIG.)
DATE/11ME
RECEIVED BY (SIG.)
DATE/TIME
PLEASE READ Instructions for completing this form on the reverse side. Sampler must place a "C"for composite sample or a "G"for
FORM #5 Grab sample in the blocks above for each parameter requested. N n 387037

SAMPLING INSTRUCTIONS AND FORM COMPLETION
FAILURE TO PROPERLY CHILL, CHEMICALLY PRESERVE, COLLECT IN PROPER BOTTLE
TYPES, MEET REQUIRED HOLDING TIMES, NEUTRALIZE CHLORINE IN CHLORINE
SENSITIVE SAMPLES, AND SEAL COOLERS WITH TAPE WILL RESULT IN SAMPLES BEING
REJECTED BY THIS LABORATORY AS PER NORTH CAROLINA REGULATORY CODE.
1) Samples not falling within the required guidelines will need to be re -collected. The client will be contacted and informed of any deviation
and asked to collect another set of samples. The client may request the laboratory to proceed with the analyses of the current samples. Any
samples analyzed outside of the required guidelines will be "qualified" This means that a note will be included on the sample result and
"Chain of Custody" specifying the deviation. The laboratory is also required to send a letter to the State noting the deviations.
2) Sample Temperature. Samples for compliance monitoring must be chilled with wet ice to a temperature of 6C or less. Freezing is not
permitted. Samples delivered to the lab shortly after collection may not have had enough time to be chilled below 6C. In this case the
temperature at time of collection must be noted in the space provided. The samples will meet the requirements of the regulation if there is
a temperature drop from the time of collection until received in the lab. Regardless, all samples should be packed in wet ice using as much
ice as will fit in the cooler.
3) Sample Chemical Preservation. Many samples require a chemical preservation such as Sulfuric Acid or Sodium Hydroxide. The
laboratory will either provide the preservative in the sample bottle, or in the case of 40 ml. Volatiles Vials, provide a bottle of Acid with
detailed instructions on how to collect the sample. Never rinse sample bottles before collecting samples. Any residue or liquid in the
bottle is required for proper chemical preservation. Unless specific instructions are provided for a test or bottle (example: cyanide or
volatile organics), fill sample bottles to the bottom of the bottle threads. This will leave a small air space for shaking the sample to mix with
any preservative and again prior to analysis. The lab must verify proper chemical preservation upon arrival in the lab and will note this
information in the spaces provided on the front of this form.
4) Chlorine Neutralization. Some samples require that any Total Chlorine Residual be removed at the time of collection. The lab will
provide the proper neutralizing agent in the sample bottle when technically possible. There are some samples (Total Kjeldahl Nitrogen
and Ammonia Nitrogen) where this is not possible due to interferences between the required chemical preservation (Acid) and the
dechlorinating agent. Therefore, these samples must be de -chlorinated at the time of collection before being placed in our sample bottles.
Sodium Thiosulfate is the chemical of choice to neutralize chlorine. It must be added to your sample and then the sample checked for
Total Chlorine before the sample is poured in our bottle. Facilities using chlorine for disinfection should have a means of measuring Total
Chlorine. Non -chlorinated sample sources will not need to be checked. The person neutralizing the chlorine must put his initials in the
"Chlorine Neutralized at Collection" row on the front of this form above the proper parameter. Samples such as Coliforms (which have
Thiosulfate in the bottles shipped from the lab) will be checked for proper neutralization upon arrival in the lab. It is also required that
you note the "Total Chlorine at Collection" on the front of this form for any sample locations applicable. This value would be before any
neutralization is performed.
5) A "C" for Composite Sample or a "G" for Grab Sample should be placed in the box for all requested parameters. Grab temperatures as
well as Composite start dates and times can be recorded in the "comments" section.
6) Other information required to be completed by the client are:
Collection Date and Collection Time for each sample location Temperature at Time of Collection
Printed name of person or persons collecting samples Signature, Date, and Time samples are relinquished
Other added sample locations and analyses required Type Of Disinfection
Deletion on the form for any samples which are not needed (example: dry upstream location)
Any other information felt to be pertinent should be included in the "Comments" section
CONSIDERATIONS:
Coliform and Enterococci samples have a holding time of 6 hours from time of collection to time of analysis. Therefore, samples should be
collected as late in the day as possible to allow enough time for transportation, checking in at the lab and analysis.
BOD, Nitrate, Ortho Phosphorus, Settleable Matter, Turbidity, Color, and MBAS samples have a 48 hour holding time. The lab reserves the
right to establish required sample collection and delivery dates in order to meet the required holding times.
CAUTION
Sample bottles may contain acids or other corrosive and potentially harmful chemicals. Laboratories are required to add these chemicals
for certain analyses in order to comply with EPA preservation requirements. Use extreme care when opening and handling the shipping
container and bottles. If any chemical should get into your eyes, on your skin or on your clothes, flush liberally with water and seek
medical attention. Material Safety Data Sheets (MSDS) are available upon request which specify proper handling and personal protection.