WI0700308_Sample collection forms_20210914

North Carolina Division of Water Resources
LaboratoryWater Sciences Section Water Sample Collection & Submittal Form � d1
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Visit ID:
(optional)
Tag��r
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Lab Use
Laboratory
Sample Number:
Only:
ti,,., n ---� r
Location Description: I
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Location Code:
11 ��E �‘
Date Received:
M/D/Y
/ /
County:
r
L CkF\ Lrl C /.
Collector:
C.—/.
_ 1 l-T
N
Priority:
Ambient
Routine
COC
Emergency
OA
Water
----
Matrix:
Surface
Ground
Waste
Blank
Solution
Foam
Location
River Stream
/
Estuary
Stormwater
Monitoring Well
Effluent
Field Blank
E
Other: l CE
Type:
Lake
Canal '(24
Influent
Filter Blank
Blank
Water Supply
,y�
yrl 1
Time Received:
hr format)
•
•
DWR Region:
(based on county)
2 /�j
�r�' \ �,/p
DWR Office:
(or agency name)
l ) (,
L;� �` v
K.
ZCompliance
_
Received By:
River Basin:
L
(1 �i e
C'
uate
(m/d/y):
fhPnlrr/ ,rdl
�y ,
/. /„y
I
/ /
—
'--i
—
^Trip
Delivery Method:
State Courier
Notes:
Time (24 hr):
(begin/end)
[ •
•
r
Hand Delivered
Other:
Sampling
Method:
Grab
Other:
Chlorinated
Filtered Dissolved analysis; Enter ^D!G" in
in Field check -boxes for parameters
Sample i Secchi (
Nj �.t 1� 1 ` gin file:
Depth: N. r Depth: r �t
Temperature on
Arrival ('C):
•
Composit.
De -chlorinated in Field
Lab Comments:
`/
Lot #s / i' / t 7� r
Collector i f'I + i. { C 1 ti ( 6 c ` NK Gr,.,,i c� e `7 (} G 61 l U[` Li ��l { i `� E
Comments: ll
Field Parameters (optional) :
Preservative : Y
Water Temp ( C):
pH (s.u.):
tom,.`
C. --)
Dissolved Oxygen
(µPm):
`
Conductivity 1
GISMOS/CT):i
Salinity
(ppt):
Microbiology Parameters:
Preservative
Wet Chemistry Parameters:
Preservative
Metals Parameters:
Preservative
Metals Parameters Con't:
Preservative
Alkalinity, as CaCO3, to pH 4.5/8.3
A
Bromide
A
>
Aluminum (AI)
E
Thallium (TO
E
BOD: Biochemical Oxygen Demand, 5-day
A
Chloride
A
Antimony (Sb)
E
Tin (Srt
E
cBOD: Carbonaceous BOO, 5-day
A
Fluoride
A
)(Arsenic
(As)
E
Titanium (Ti)
E
iof
Coliform: Fecal MF
B - C
Sulfate
A
Barium (Ba)
E
Vanadium IV)
E
Coliform: Total MF
B - C
Chlorophyll a
A
Beryllium (Be)
E
Zinc (2n)
E
Specific Conductance, at 25 °C
A
Color: ADMI
A
Cadmium (Cd)
E
Mercury 1631, low-level
I
TOC - Total Organic Carbon
A - G
Color: Platinum Cobalt
A
!\♦
Calcium (Ca)
E
Boron (B)
E
'turbidity
A
COD: Chemical Oxygen Demand
A- D
`
Chromium (Cr), Total
E
Hardness, Total as CaCO3 - by titration
E
Other Parameters:
Cyanide, Total
A - H - P
>
Cobalt (Co)
E
Organics Parameters:
pH
Y
Hexavalent Chromium (Cr6+)
A - I
Copper (Cu)
E
Acid Herbicides
A - C
MBAS (surfactants)
A
/ `
Iron (Fe}
E
Organochlorine Pesticides
A - C
Nutrients Parameters:
Oil and Grease, HEM, Total Recoverable
A - D
X
Lead (Pb)
E
Organonitrogen Pesticides
A - C
Ammonia as N (NH3-N)
A - C - D
Phenols, Total Recoverable
A- D - M
Lithium (Li)
E
Organophosphorus Pesticides
A -C
y,
x
C
Nitrate -Nitrite as N (NO3+NO2-N)
A - D
Residue: Total (Total Solids)
A
X
Magnesium (Mg)
E
PCBs (polychlorinated biphenyls)
A - C
Total Kjeldahl Nitrogen as N (TKN)
A- D
Residue: Volatile/Fixed, Total
A
Manganese (Mn)
E
Semi -Volatile Organics (BNAs)
A -C
Total Phosphorus as P (TP)
A- D
Residue: Settleable
A
Mercury (Hg)
E
TPH Diesel Range
A- C
Nitrite as N (NO2-N)
A
Residue: Suspended (Suspended Solids)
A
Molybdenum (Mo)
E
Volatile Organics (VOA)
A - C - F - L
Nitrate as N (NO3-N calculated)
Residue: Volatile/Fixed, Suspended
A
)Nickel
(Ni)
E
1,4-Dioxane
C - L
Orthophosphate as P (PO4)
A - Z
)x`
TD5 - Total Dissolved Solids
A
)Potassium
(K)
E
TPH Gasoline Range
A - C - F - L
Cyanotoxins:
f
Silica
A
Selenium (Se)
E
Perfluorinated Compounds (PFAS)
A - T
Microcystin
A
Sulfide
A -1
Silver (Ag)
E
Biological:
Tannin & Lignin
Sodium (Na)
E
Phytoplankton / Algae
A - R
Strontium (Sr)
E
Preservative Legend (circle above as needed): (A) cool 56°C, (B) cool <10°C, (C) 0.008% Na2S20s [when chlorine is present(,(D) HZSO4 to pH <2, (E HNO3 to pH <2, (F) HCI to pH <2, (G) H3PO4 to pH <2, (H) 6N Na0H to pH >10<11, (I) (NH4)zSO4 pH=93-9.7, (1) zinc acetate
& NaOH to pH to >9, (K) pH 6-9 ascorbic acid [when chlorine is present],(L) leave no headspace, (M) ferrous ammonium sulfate (when chlorine is present],(P) ascorbic acid (when chlorine is present],(R) Lugols, {T) Trizma ]when chlorine is present], (Y) analyzed within
15 minutes of sample collection, (2) filtered in field within 15 minutes using 0.45um pore size

North Carolina Division of Water Resources
Laboratory (Water Sciences Section] Water Sample Collection & Submittal Form
fu it
Visit 1O:
(optional)
Tag
ID L �
•
y i
Lab Use
Sample Number:
Only:
Y
Location Description:
�`1
C)1 0 7 0 _7, 0
!!!
Location Code:
•Laboratory
J !
- cm --
\
Date
Date Received:
M/D/Y
Time Received:
(24 hr format)
/ /
•
•
County:
K r\` U e 4
Collector:(
isl i �-
•---
Priority:
•
Ambient
Routine
Compliance
COC
Emergency
RA
Water
----
Matrix:
Surface
Ground
Blank
Foam
-
Location
River/Stream
Estuary
Monitoring Well
Effluent
Field Blank
(g (� Other: 111(C (
Type:
Lake
Canal
Influent
Filter
Trip
Water
`
Blank
Blank
Supply
G -
DWR Region:
(based on county}
p`,� 7
C11 1 1 Z� v
DWR Office:
(or agency name)
/r 7 ��
l�'L-,i �` `�
r—
E"�'•
���
I�[
YReceived
By:
River Basin:
%
G I c ` ` i I_'.:
L �l
care
(+n/d/yj:
Jbeainlendl
1 /
/ 2 %/ ,2 i/
/ /
—Waste
—Stormwater
—Solution
Delivery Method:
State Courier
Notes:
Time(24hr):
(begin/end)
--
) �/
,-
Hand Delivered
Other:
Sampling
Method:
07,Grab
Other:
Chlorinated
Filtered Dissolved analysis: Enter "DIS" in
in Field check-beees for parameters
Sample ii ,� Secchi /i / ,C/�
Depth: III Cut Depth: j r ` ogin file.
Temperature on
Arrival ('C):
•
composit:
De -chlorinated in Field
Lab Comments:
.
Lot Collector �.) (7 L �•k. ' �I . 4 (l t (,_ 1' 6 `- i l'. {' :) ( C., C
f j : ' • l`
Cokledoc5 C-(...
Comments: l
tional
Field Parameters (optional): 1
(
Preservative : Y
Water Temp (°C):
pH (s.u.):
/ r.'.
e
Dissolved Oxygen
(ppm):
Conductivity 1
(µmhos/cm): '
-
Salinity
(ppt):
Mit obiology Parameters:
Preservative
Wet Chemistry Parameters:
Preservative
Metals Parameters:
Preservative
Metals Parameters Con't:
Preservative
Alkalinity, as CaCO3, to pH 4.5/8.3
A
Bromide
A
Aluminum (Al
E
Thallium (TO
E
BOD: Biochemical Oxygen Demand, 5-day
A
x
/ `
Chloride
A
Antimony(Sb)
E
Tin (Se)
E
cBOD: Carbonaceous BOD, 5-day
A
Fluoride
A
/
1XL
i >Barium
Arsenic (As)
E
Titanium (Ti)
E
-y
Coliform: Fecal MF
B- C
Sulfate
A
(Ba)
E
Vanadium (V)
E
Coliform: Total MF
B -C
Chlorophyll a
A
Beryllium (Be)
E
X.
Zinc (Zn)
E
Specific Conductance, at 25°C
A
Color: ADMI
A
Cadmium (Cd)
E
Mercury1631, low-level
I
TOC - Total Organic Carbon
A - G
Color: Platinum Cobalt
A
Calcium (Ca)
E
Boron (B)
E
Turbidity
A
COD: Chemical Oxygen Demand
A - D
Chromium (Cr), Total
E
Hardness, Total as CaCO3- by titration
E
Other Parameters:
Cyanide, Total
A - H - P
Cobalt (Co)
E
Organics Parameters:
pH
Y
Hexavalent Chromium )Cr6+)
A - l
x.
Copper (Cu)
E
Acid Herbicides
A - C
MBAS (surfactants)
A
Iron (Fe)
E
Organochlorine Pesticides
A - C
Nutrients Parameters:
Oil and Grease, HEM, Total Recoverable
A- D
Y.,
Lead (Pb)
E
Organonitrogen Pesticides
A - C
Ammonia as N (NH3-N)
A -C - D
Phenols, Total Recoverable
A- D - M
Lithium (Li)
E
Organophosphorus Pesticides
A- C
x
Nitrate -Nitrite as N (NO3+NO2-N)
A - 0
Residue: Total (Total Solids)
A
X.
rX.
Magnesium (Mg)
E
PCBs (polychlorinated biphenyls)
A - C
Total Kieldahl Nitrogen as N (TKN)
A - D
Residue: Volatile/Fixed, Total
A
Manganese (Mn)
E
Semi -Volatile Organics (BNAs)
A - C
Total Phosphorus as P (TP)
A - D
Residue: Settleable
A
Mercury (Hg)
E
TPH Diesel Range
A - C
X
Nitrite as N (NO2-N)
A
Residue: Suspended (suspended Solids)
A
Molybdenum (Mo)
E
Volatile Organics (VOA)
A - C - F - L
Nitrate as N (NO3-N calculated)
Residue: Volatile/Fixed, Suspended
A
Nickel (Ni)
E
1,4-Dioxane
C - L
Orthophosphate as P (PO4)
A - Z
`
X
JJJ
��'TDS -Total Dissolved Solids
A
Y...,
Potassium (K)
E
TPH Gasoline Range
A - C - F - L
Cyanotoxins:
Silica
A
Selenium (Se)
€
Perfluorinated Compounds (PEAS(
A - T
Microcystin
A
Sulfide
A -1
Silver (Ag)
E
Biological:
Tannin & Lignin
Sodium (Na)
E
Phytoplankton / Algae
A - R
Strontium (Sr)
E
Preservative Legend (circle above as needed): [A) cool 56"C, (B) cool <10°C, (C) 0.008% Na2SZ03 when chlorine is present ,(D) H5S0a to pH <2, (E HNO3 to pH <2, (F) HCI to pH <2, (G) H3PO4 to pH <2, (H) 6N NaOH to pH >10<11, (I). (NH4),SO4 pH=93-9.7, (J) zinc acetate
& NaOH to pH to >9, (K) pH 6-9 ascorbic acid [when chlorine is present], L) leave no headspace, (M) ferrous ammonium sulfate (when chlorine is present),(P) ascorbic acid [when chlorine is present],(R) Lugols, (T) Trizma (when chlorine is present(, (Y) analyzed within
15 minutes of sample collection, (Z) filtered in field within 15 minutes using 0.45um pore size