WI0700087_GW Sample Collection & Submittal Form_20220112

North Carolina Division of Water Resources
Laboratory (Water Sciences Section) Water Sample Collection &
Submittal Form
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V
Visit 1P:
(optional)
S
Tag r'
ID 4r"), _� fr�. ��
Olj 1.
Lab
Laboratory
Sample Number:
Use Only:
Location Description:
;� • � � 7 C 0 /�� 3 7
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Location Code:
f ( (
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l
Date Received:
M/D/Y
/ /
County:
( A r, j
Collector:
[ ^
If_J
i___
(,Compliance
' V
Priority:
Ambient
Routine
COC
Emergency
QA
�` Secchi
iv (�
F Depth:
Water
Matrix:
Surface
Ground
Blank
Solution
Foam
NIA ogin
f t
Location Type:
River/Stream
Estuary
Stormwater
Monitoring Weil
Effluent
Field Blank
Other: [ ()
Lake
Canal
Influent
Filter Blank
Trip Blank
Water Sup
ii....1m IA
ly
Time Received:
(24hrformat)
•
DWR Region:
Based on count)
( y
f( ;'.) 1I1�
L... i`\ I'�V
DWRo�ce:
(or agency
j
`
i
!� ��
j�
l `Waste
—f.
Received By:
River Basin:
-' j � ! 1 L. \
_ VA o c U 1
Uare
jm/d/0:
Ogg' /end)
I
f / / R .—),
` e
1
! \/ A- /
—
—
—
^
Delivery Method:
Temperature on
Arriva!(°C):
State Courier
Notes:
Time (24hr):
(begin/end)
f
6 • )-5
�'tj,
i v [ f 1 .
file:
—
Hand Delivered
A -
Other:
.
Sampling
Method:
Grab
Other:
Chlorinated
Filtered Disc
in Field check
bred analysis: Enter" ols" in
-boxes forparamerers
Sample
Depth:
Composite
De -chlorinated in Field
Lab Comments:
Lot #sf j jj/ (E. L, jjr}
Collector !) t,W` L t C� L '4 L �_ L 1 t2. 0\:v�
Comments:
4�
-) 9 r () 1 f�� �.)C Li Li\ 6 &In
Field Parameters (optional) :
Preservatve : Y
1
Water Temp (C):
pH (s.u.):
-
7
�.
Dissolved Oxygen j
(ppm):
Conductivity
(µmhos/cm):
1Salinity
{PIA):
Mic
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 (TI)
E
80D: Biochemical Oxygen Demand, 5-day
A
Chloride
A
Antimony (Sb)
E
Tin (Sn)
E
cBOD: Carbonaceous BOD, 5-day
A
Fluoride
A
/
�x
Arsenic (As)
E
Titanium (Ti)
E
x
Coliform: Fecal MF
8 - C
Sulfate
A
Barium (Ba)
E
Vanadium (V)
E
Conform: Total MF
8 - C
Chlorophyll a
A
Beryllium (Be)
E
//Zinc
(Zn)
E
Specific Conductance, at 25°C
A
Color: ADMI
A
Cadmium (Cd)
E
�Mercury1631, low-level
1
TOC - Total Organic Carbon
A - G
Color: Platinum Cobalt
A
Calcium (Ca)
E
Boron (B)
E
Turbidity
A
COD: Chemical Oxygen
Demand
A - D
``
x
i�
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
7r`
�Copper
!•
(Cu)
E
Acid Herbicides
A - C
MBAS (surfactants
A
.:
Iron (Fe)
£
Organochlorine Pesticides
A - C
Nut ients 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
>/
j�
Nitrate -Nitrite as N (NO3+NO2-N)
A- D
Residue: Total (Tote/Solids)
A
x
Magnesium (Mg)
E
PCBs (polychlorinated bsphenyls)
A - C
Total Kjeldahl Nitrogen as N (TKN)
A - D
Residue: Volatile/Fed,
Total
A
.I\
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: 5uspende1:1
{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
TDS - Total Dissoly
d Solids
A
`
X
JJJ '_Selenium
Potassium (K)
E
TPH Gasoline Range
A - C - F - L
Cyanotoxins:
Silica
A
(Se)
E
Perfluorinated Compounds (PEAS)
A - T
Microcystin
A
Sulfide
A -1
Silver (Ag)
E
Biological:
Tannin & Lignin
Sodium [NO
E
Phytoplankton / Algae
A - R
Strontium (5r)
E
Preservative Legend (circle above as needed}: (A) cool 56 C, (B) cool a10 C, {C) u.D08% Nags Li [�ruhen chlorine Is present

North Carolina Division of Water Resources
Laboratory (Water sciences Section} Water Sample Collection &
ubmittal Form
(;,
G i 5 -
/
e - (`
Visit JD:
(optional[
_
Tag '
!b �'
�t 4
E , t 1
Lab
Laboratory
Sample Number:
Use Only:
r,
Location Description: ! ✓' L.. L;. J `3 '
4 ' (
Location Code:
t
E )± C.--)e
Date Received:
M/D/Y
Time Received:
(24hrformat)
/ /
i.
•
'"' "`
County:; kp- ,�
i \ l
yOWROffice:
Collector:
..) C
(
•--
Priority:
•
Ambient
Routine
Compliance
COC
Emergency
OA
Water
---
Matrix:
-
Surface
Ground
Waste
Blank
Solution
Foam
-
Location
,---
River/Stream
Estuary
Stormwater
Monitoring Well
Field Blank I
Other: G C (MA
Type:
Lake
Canal
Influent
Filter Blank
Blank
Water S}tpply
l irk.
DWR Region:
(based en county)
;� `, } l-
L.'•.,J �%
S
(or agency name)
1
��
..17 � �
(' 1 �~�
�
Received By:
ii i
River Basin: `. I, 0 (.9 A L;\
ware
(m/d/y):
Ihvai_entif
j ^rye
I / / f / -,Y
l
Al (ir-
r It /
`
—
Delivery Method:
State Courier
Notes:
Time (24 ter):
(begin/end)
,, F
0 1
: (
j`�[ fyyy
l ` ! `'
—Effluent
—Trip
Hand Delivered
E-1
Other:
s�mQa„qFiltered
Method:
Grab
Other:
Chlorinatedo
OissI
�
in Field ctleck-boxes
Ivedanalysis: Enter
parameters
I
Sample ` Secchi i1'
1 Y j t `} ogin file:
Depth: Depth: U
Temperature on
Arrival (•C):
•
composite
De -chlorinated in Field
Lab Comments:
Lot#s/ ,r .... �,t1 i) I t (: (t t C� E �-L [....L.[}L1:\ Lid
Collector i
Comments:
((} lJ A4 L �( L� y ( .
f
Field Parameters (optional):
Preservative : Y
Water Temp (°C):
pH (s.u.);
j/,
`� '
Dissolved Oxygen
(ppm):
Conductivity
(µmhos/cm):
1 Salinity
! (ppt):
Mic 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
X\
Aluminum (Al)
E
Thallium (TI)
E
DOD: Biochemical Oxygen Demand, 5-day
A
>C
`
Chloride
A
Antimony (Sb)
E
Tin (Sn)
E
cBOD: Carbonaceous SOD, 5-day
A
Fluoride
A
'x
Arsenic (As)
E
Titanium (Ti)
E
.
Coliform: Fecal MF
B -C
Sulfate
A
Barium (Ba)
E
Vanadium (V)
E
;�
Coliform: Total MF
B - C
Chlorophyll a
A
Beryllium (Be)
E
Zinc (Zn)
E
Specific Conductance, at 25°C
A
Color: ADM!
A
Cadmium (Cd)
E
Mercury 1631, low-level
1
TOC - Total Organic Carbon
A - G
Color: Platinum Colsalt
A
x
Calcium (Ca)
E
Boron (B)
E 1
Turbidity
A
COD: Chemical Oxygen
Demand
A - D
x
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 Chrom
um (Cr6+)
A - I
X
Capper (Cu)
E
Acid Herbicides
A - C
MBAS (surfactants
A
Iron (Fe)
E
Organochlorine Pesticides
A - C
Nut ients Parameters:
Oil and Grease, HEM,
Total Recoverable
A - D
Lead (Pb)
E
Organonitragen Pesticides
A - C
Ammonia as N (NH3-N)
A - C - D
Phenols, Totah Recoverable
A - D - M
Lithium (Li)
E
Organophosphorus Pesticides
A - C
1,
r\
Nitrate -Nitrite as N (NO3+NO2-N)
A - D
Residue: Total (TotlofSolids)
A
5(
.,
Magnesium (Mg)
E
PCBs (polychlorinated biphenyls)
A - C
Total Kjeldahl Nitrogen as N {TKN)
A - D
Residue: Volatile/F#xed,
Total
A
K
Manganese (Mn)
E
Semi -Volatile Organics (BNAs)
A - C
Total Phosphorus as P (TP)
A - 0
Residue: Settleablq
A
Mercury (Hg)
E
TPH Diesel Range
A - C
X\
Nitrite as N (NO2-N)
A
Residue: Suspendcd
(Suspended Solids)
A
Molybdenum (Mo)
E
Volatile Organics (VOA)
A - C - F - L
Nitrate as N (NO3-N calculated)
Residue: Volatile/Rxed,
Suspended
A
X...NNickel
(Ni)
E
1,4-Dioxane
C- L
Orthophosphate as P (PO4)
A - 7
e r
%
` `Silica
TDS -Total Dissolved
Solids
A
Potassium (K)
E
TPH Gasoline Range
A - C - F - L
Cyanotoxins:
A
Selenium (Se)
E
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 (ctrde above as neededj: (A) cool 56"C, (B] cool <1o'C, (C] 0.008% Na25202.
& N OH to pH to >9, (K). pH 6-9 ascorbic acid [when chlorine is present), L) leave no headspace, (IVE) ferrous ammonium sulfate [when chlorine is present),(P) ascorbic acid (when chlorine is present],(R) Lugols, (T) Triune [when chlorine is present], (Y) analyzed within
15 minutes of sample collection,(Z) filtered in field within 15 minutes using 0.45um pore size
when chlorine is present], (D H2 4 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) (NH,)2504 pH=9.3-9.7, (1) zinc acetate