WQ0000088_Monitoring - 11-2021_20220204

•
SUBMIT FORM ON YELLOW PAPER ONLY
Mail original 'EPARTMENT OP ENVIRONMENT&NATURAL RESOURCES
GROUNDWATER QUALITY MONITORING: and 1 copy to: •[VISION OF WATER QUALITY-INFORMATION PROCESSING UNIT
COMPLIANCE REPORT FORM 617 MAIL SERVICE CENTER,RALEIGH,NC 27699.1617 Phone:[phone]
FACILITY INFORMATION Please Print Clearly or Type PERMIT Number: Expiration Date: 7-31-2023
Facility Name: Governors Club Non Discharge WQ0000088 UIC
Permit Name(if different): _ NPDES Other
Facility Address: TYPE OF PERMITTED OPERATION BEING MONITORED
Chapel Hill NC County Chatham ❑ Lagoon ❑Remediation: Infiltration Gallery
'' © Spray Field ❑Remediation: 1
Contact Person: Peter Rhodes Telephone#:[phone] ❑ Rotary Distributor ❑Land Application of Sludge
ell Location/Site Name: No.of wells to be sampled: 4 ❑ Water Source Heat Pump ❑Other:
(from Permit)
SAMPLING INFORMATION If WELL
WELL ID NUMBER(from Permit): MW-1A Date sample collected: 11/29/2021 FIELD ANALYSES: WAS
Well Depth: 45.03 ft. Well Diameter: 2 in. pH 7.2 units Temp. 13 °C DRY at
Mhos time of
Depth to Water Level: 21.01 ft. below measuring point Screened Interval: ft. to _ft. Spec.Cond. µ sampling,
Measuring Point is 0 ft.above land surface Relative M.P. Elevation: ft. Odor check
olume of water pumped/bailed before sampling: 2.0 gallons Appearance here:
Samples for metals were c:,.'acted unfiltered: El YES ❑NO a-,!field acidified: ❑YES LI NO
LABORATORY INFORMA i)ly1
Date sample analyzed: 11 _ ;1,:021 I. `oratory Name: Environment 1 Certification No. 10
PARMY TERS NOTE:Valt.•^should reflect dissolved and collc.Jal concentrations.
DD mg/I Nitrite(NO2)as N mg/I Pb-Lead mg/I
' cliiorm: MF Fc-:alb 47/100m1 Nitrate(NO3)as N 0.07 mg/I Zn-Zinc mg/I
.'oliform: MF Total /100m1 Phosphorus:Total as P 0.13 mg/I
(Note: Use MPN method for highly turbid samples) Orthophosphate mg/I Other(Specify Compou.(s„. d Concentration Units):
Dissclved Solids:Total 2000 mg/I Al-Aluminum mg/I Total Suspended 14esititae:7s4 r1tI4-°-
pH(when analyzed) 7.2 units Ba-Barium mg/I
TOC 2.48 mg/I Ca-Calcium mg/I rr'r e'l)
Chloride 883 mg/I Cd-Cadmium mg/I
Arsenic mg/I Chromium:Total mg/I
Grease and Oils mg/I Cu-Copper mg/I ORGANICS:(by GC,GC/MS, HPLC)
Phenol mg/I Fe-Iron mg/I (Specify test and method#.ATTACH LAB REPORT.)
Sulfate mg/I Hg-Mercury mg/I Report Attached? ® Yes(1) ❑ No(0)
Specific Conductance µMhos K-Potassium mg/I VOC , method# a '
Total Ammonia 0.09 mg/I Mg-Magnesium mg/I , method#
(Ammonia Nitrogen,NH,as N,Ammonia Nitrogen,Total) Mn-Manganese mg/I ,method# F ER
TKN as N mg/I Ni-Nickel mg/I , method#
For Remediation Systems Only(Attach Lab Reports): Influent Total VOCs: mg/L Effluent Total VOCs: mg/L VOC Removal%
I certify that,to the best of my knowledge and belief the information submitted in this report is true,accurate,and complete,and that the laboratory analytical data was produced using approved methods of analysis by a
DWQ-certified laboratory. I am aware that there are significant penalties for submittin•fals-, formation,including the possibility of fires and im•risonment for knowing violations.
1
Peter Rhodes-Regional Supervisor i „}` I" l'.1U1)
Permittee(or Authorized Agent)Name and Title-Please print or type Signature of•ermittee(or1Wuthorized Age t) (Date)
GW-59 Rev. 1/2007

r SUBMIT FORM ON YELLOW PAPER ONLY
�— Mail original 'EPARTMENTOF ENVIRONMENT B.NATURALRESOURCES
'l ,^''t.:r;DWATER QUALITY MONITORING: . ISION OF WATER t'UALIT-INFORMATION PROCESSING UNIT,
4�,'..IANCE REPORT FORM and 1 copy to: 617 MAIL SERVICE CENTER,RALEIGH,
CL NC 2769941517 Phone:[phone]
FACILITY INFORMATION Please Print Clearly or Type PERMIT Number: Expiration Date: 7-31-2023
Facility Name: Governors Club Non-Discharge W00000088 UIC
Permit Name(if different): NPDES Other
Facility Address: TYPE OF PERMITTED OPERATION BEING MONITORED
Chapel Hill ,, NC County Chatham ❑ Lagoon ❑Remediation: Infiltration Gallery
fC❑ Spray Field ❑Remediation:
Contact Person: Peter Rhodes Telephone#:[phone] ❑ Rotary Distributor ❑Land Application of Sludge
Well Location/Site Name: No.of wells to be sampled: 4 ❑ Water Source Heat Pump ❑Other:
(from Permit)
$AMPLING INFORMATION If WELL
WELL ID NUMBER(from Permit): MW-3A Date sample collected: 11/29/2021 FIELD ANALYSES: WAS
Well Depth: 44.56 ft. Well Diameter: 2 in. pH 6.5 units Temp. 15 °C DRY at
time of
Depth to Water Level: 25.82 ft. below measuring point Screened Interval: ft. to ft. Spec.Cond. µMhos
sampling,
Measuring Point is 0 ft.above land surface Relative M.P. Elevation: ft. Odor check
Volume of water pumped/bailed before sampling: 2.0 gallons Appearance here:
Samples for metals were collected unfiltered: DYES ❑NO and field acidified: DYES ❑NO
LABORATORY INFORMATION
Date sample analyzed: 11/29/2021 Laboratory Name: Environment 1 Certification No. 10
PARAMETERS NOTE:Values should reflect dissolved and colloidal concentrations.
COD mg/I Nitrite(NO2)as N mg/I Pb-Lead mg/I
Coliform: MF Fecal 1 /100m1 Nitrate(NO3)as N <0.04 mg/I Zn-Zinc mg/I
Coliform: MF Total /100m1 Phosphorus:Total as P 0.47 mg/I
(Note Use MPN method for highly turbid samples) Orthophosphate mg/I Other(Specify Compounds and Concentration Units):
Dissolved Solids:Tota 160 mg/I Al-Aluminum mg/I Total Suspended Residue: 28 mg/I
pH(when analyzed) 6.5 units Ba-Barium mg/I
TOC_ 6.28 mg/I Ca-Calcium mg/I
Chloride! 6 mg/I Cd-Cadmium mg/I
( Arsenic__ _ mg/I Chromium:Total mg/I
Grease and Oils mg/I Cu-Copper mg/I ORGANICS:(by GC,GC/MS, HPLC)
Phenol mg/I Fe-Iron mg/I (Specify test and method#.ATTACH LAB REPORT.)
Sulfate mg/I Hg-Mercury mg/I Report Attached? ® Yes(1) ❑ No(0)
Specific Conductance µMhos K-Potassium mg/I VOC , method#
Total Ammonia 0.30 mg/I Mg-Magnesium mg/I , method#
(Ammonia Nitrogen;NH,as N;Ammonia Nitrogen,Total) , method#
Mn-Manganese mg/I
TKN as N mg/I Ni-Nickel mg/I , method#
For Remediation Systems Only(Attach Lab Reports): Influent Total VOCs: mg/L Effluent Total VOCs: mg/L VOC Removal%
I certify that.to the best of my knowledge and belief,the information submitted in this report is true,accurate,and complete,and that the laboratory analytical data was produced using approved methods of analysis by a
DWQ-certified laboratory. I am aware that there are Si.nificant penalties for submittin.false infgrrnation.includin.the possibility of fines and imprisor.mer.i for knowing violations.
Peter Rhodes-Regional Supervisor 1- f .3( -1 01 -
Permittee(or Authorized Agent)Name and Title-Please print or type Signature ermittee(or •uthorized Agent) (Date)
GW-59 Rev. 1/2007 ///

r
SUBMIT FORM ON YELLOW PAPER ONLY
Mail original DEPARTMENT OF ENVIRONMENT&NATURAL RESOURCES
GROUNDWATER QUALITY MONITORING: and 1 copy to: rIVISION OF WATER QUALITY-INFORMATION PROCESSING UNIT
COMPLIANCE REPORT FORM 617 MAIL SERVICE CENTER,RALEIGH,NC 27699-1617 Phone:[phone]
FACILITY INFORMATION Please Print Clearly or Type PERMIT Number: Expiration Date: 7 31 2023
Facility Name: Governors Club Non-Discharge WQ0000088 UIC
Permit Name(if different): NPDES Other
Facility Address: TYPE OF PERMITTED OPERATION BEING MONITORED
Chapel Hill NC County Chatham ❑ Lagoon ❑Remediation: Infiltration Gallery
❑?c Spray Field ❑Remediation:
Contact Person: Peter Rhodes
Telephone#:[phone]
No.of wells to be sampled: 4 El Rotary Distributor Land Application of Sludge
ell Location/Site Name: El Water Source Heat Pump ❑❑Other:
(from Permit)
SAMPLING INFORMATION If WELL
WELL ID NUMBER(from Permit): MW-7 Date sample collected: 11/29/2021 FIELD ANALYSES: WAS
Well Depth: 30.21 ft. Well Diameter: 2 in. pH 7.0 units Temp. 14 °C DRY at
Depth to Water Level: 23.70 ft.below measuring point Screened Interval: ft. to ft. Spec.Cond. µMhos time of
sampling,
Measuring Point is 0 ft.above land surface Relative M.P. Elevation: ft. Odor check
Volume of water pumped/bailed before sampling: 1.0 gallons Appearance here:
Samples for metals were collected unfiltered: OYES ❑NO and field acidified: ❑YES ❑NO
LABORATORY INFORMATION
Date sample analyzed: 11/29/2021 Laboratory Name: Environment 1 Certification No. 10
PARAMETERS NOTE:Values should reflect dissolved and colloidal concentrations.
COD mg/I Nitrite(NO2)as N mg/I Pb-Lead mg/I
Coliform: MF Fecal <1.0/100m1 Nitrate(NO3)as N 0.35 mg/I Zn-Zinc mg/I
Coliform: MF Total /100m1 Phosphorus:Total as P 1.69 mg/I
(Note Use MPN method for highly turbid samples) Orthophosphate mg/I Other(Specify Compounds and Concentration Units):
Dissolved Solids:Total 780 mg/I Al-Aluminum mg/I Total Suspended Residue: 4.4 mg/I
pH(when analyzed) 7.0 units Ba-Barium mg/I
TOC 4.74 mg/I Ca-Calcium mg/I
Chloride 63 mg/I Cd-Cadmium mg/I
Arsenic mg/I Chromium:Total mg/I
Grease and Oils mg/I Cu-Copper mg/I ORGANICS:(by GC,GC/MS, HPLC)
Phenol mg/I Fe-Iron mg/I (Specify test and method#.ATTACH LAB REPORT.)
Sulfate mg/I Hg-Mercury mg/I Report Attached? ® Yes(1) ❑ No(0)
Specific Conductance µMhos K-Potassium mg/I VOC , method#
Total Ammonia 0.12 mg/I Mg-Magnesium mg/I , method#
(Ammonia Nitrogen,NH3as N,Ammonia Nitrogen,Total) Mn-Manganese mg/I , method#
TKN as N mg/I Ni-Nickel mg/I , method#
,For Remediation Systems Oi,iy(Attach Lab Reports): Influent Total VOCs: mg/L Effluent Total VOCs: mg/L VOC Removal%
I certify that,to the best of my knowledge and belief,the information submitted in this report is true,accurate,and complete,and that the laboratory analytical data was produced using approved methods of analysis by a
DWQ-certified laboratory, I am aware that there are significant penalties for submitting false information.including the possibility of fines and imprisonment for knowing violations.
Peter Rrlodes-Regional Supervisor —//7)/ �>^ -
L, I — L ,1.U1d�
Permittee(or Authorized Agent)Name and Title-Please print or type Signature of P.ermittee(or A horized Agent) (Date)
GW-59 Rev. 1/2007

SUBMIT FORM ON YELLOW PAPER ONLY
Mail original 'EPARTMENTOF ENVIRONMENT&NATURAL RESOURCES
GROUNDWATER QUALITY MONITORING: and 1 copy to: 'IVISIONOF WATER QUALITY-INFORMATION PROCESSING UNIT
COMPLIANCE REPORT FORM 617 MAIL SERVICE CENTER,RALEIGH,NC 27699.1617 Phone:[phone]
FACILITY INFORMATION Please Print Clearly or Type PERMIT Number: Expiration Date: 7-31-2023
Facility Name: Governors Club Non-Discharge WQ0000088 UIC
Permit Name(if different): NPDES Other
Facility Address: TYPE OF PERMITTED OPERATION BEING MONITORED
Chapel Hill NC County Chatham ❑ Lagoon E Remediation: Infiltration Gallery
❑IC Spray Field ❑Remediation:
Contact Person: Peter Rhodes Telephone#:[phone] ❑ Rotary Distributor ❑Land Application of Sludge
Well Location/Site Name: No. of wells to be sampled: 4 ❑ Water Source Heat Pump ❑Other:
(from Permit)
SAMPLING INFORMATION If WAS WELL
WELL ID NUMBER(from Permit): MW-9 Date sample collected: 11/29/2021 FIELD ANALYSES:
Well Depth: 32.09 ft. Well Diameter: 2 in. pH 7.2 units Temp. 15 °C DRY at
Mhos time of
Depth to Water Level: 5.00 ft. below measuring point Screened Interval: ft. to ft. Spec.Cond. µ sampling,
P g.
Measuring Point is 0 ft. above land surface Relative M.P. Elevation: ft. Odor check
Volume of water pumped/bailed before sampling: 4.5 gallons Appearance here:
Samples for metals were r;;lierted unfiltered: EYES ❑NO and field acidified: ❑YES ❑NO
LABORATORY INFORMATION
Date sample analyzed: 11/29/2021 Laboratory Name: Environment 1 Certification No. 10
PARAIar•=TERS NOTE:Values should reflect dissolved and colloidal concentrations.
COD mg/I Nitrite(NO2)as N mg/I Pb-Lead mg/I
C'oliform:MF Fecal <1.0/100m1 Nitrate(NO3)as N <0.04 mg/I Zn-Zinc mg/I
Coliform: MF Total /100m1 Phosphorus:Total as P 0.05 mg/I
(Note Use MPN method for highly turbid samples) Orthophosphate mg/I Other(Specify Compounds and Concentration Units):
Dissolved Solids:Total 710 mg/I Al-Aluminum mg/I Total Suspended Residue: 64 mg/I
pH(when analyzed) 7.2 units Ba-Barium mg/I
TOC 2.01 mg/I Ca-Calcium mg/1
Chloride 225 mg/I Cd-Cadmium mg/I
Arsenic mg/I Chromium:Total mg/I
Grease and Oils mg/I Cu-Copper mg/I ORGANICS:(by GC,GC/MS, HPLC)
Phenol mg/I Fe-Iron mg/I (Specify test and method#.ATTACH LAB REPORT.)
Sulfate mg/I Hg-Mercury mg/I Report Attached? ® Yes(1) ❑ No(0)
Specific Conductance µMhos K-Potassium mg/I VOC , method#
Total Ammonia <0.04 mg/I Mg-Magnesium mg/I , method#
(Ammonia Nitrogen,NH3as N,Ammonia Nitrogen,Total) Mn-Manganese mg/I , method#
TKN as N mg/I Ni-Nickel mg/I , method#
For Remediation Systems Only(Attach Lab Reports): Influent Total VOCs: mg/L Effluent Total VOCs: mg/L VOC Removal%
I certify that to the best of my knowledge and belief,the information submitted in this report is true.accurate,and complete,and that the laboratory analytical data was produced using approved methods of analysis by a
DWQ-certified laboratory. I am aware that there are significant penalties for submitting false information,including the possibility of flies and imprisonment for knowing violations.
Peter Rhodes-Regional Supervisor _ - �0a1
Permittee(or Authorized Agent)Name and Title-Please print or type Signatur- ,' Permittee(oo) uthorized Agent) (Date)
GW-59 Rev. 1/2007

Ilrn(RITPnrMffrPro
•
Drinking Water ID: 37715
Wastewater ID: 10
114 UAKMUNI UHIVE rr UNE (22) iw)-6208
GREENVILLE, N.C. 27858 FAX [phone]
ID#: 296
GOVERNOR' S CLUB (AQUA NC)
MR. R.B. TUPPS
AQUA NORTH CAROLINA DATE COLLECTED: 11/29/21
202 MACKENAN CT. DATE REPORTED : 12/29/21
CARY, NC 27511
REVIEWED BY:
MW-9
MW-lA MW-3A MW-7Analysis Method
PARAMETERS Date Analyst Code
PH (field measurement), Units 7.2 6.5 7.0 7.2 11/29/21 NNK 4500HB-11
Fecal Coliform (MF), /100 Mls MISSING MISSING MISSING MISSING 9222D-06
Total Suspended Residue, mg/I 24 28 4.4 64 11/30/21 DIJ 2540D-15
Ammonia Nitrogen as N, mg/I 0.09 0.30 12/03/21 BMD 350.1 R2-93
Ammonia Nitrogen as N, mg/I 0.12 <0.04 12/08/21 BMD 350.1 R2-93
Nitrate Nitrogen as N, mg/I 0.07 <0.04 0.35 <0.04 12/01/21 ICES 353.2 R2-93
Total Phosphorus as P, mg/I 0.13 0.47 1.69 0.05 12/02/21 BMD 365.4-74
Total Organic Carbon, mg/I 2.48 6.28 4.74 2.01 12/08/21 HMI 5310C-14
Chloride, mg/I 883 6 63 225 12/06/21 DIJ 4500CLB-11
Total Dissolved Residue, mg/I 2000 160 780 710 11/30/21 JMS D5907-13
Temperature, °C 13 15 14 15 11/29/21 NNK 2550B-10
Time 12:14 PM 11:59 AM 01:13 PM 12:49 PM 11/29/21 NNK
Static Water Level, feet 21.01 25.82 23.70 5.00 11/29/21 NNK
Well Depth, feet 45.03 44.56 30.21 32.09 11/29/21 NNK
Water Bailed, Gals. 2. 2.0 1.0 4.5 11/29/21 NNK

ERWIE1IFIEHall
, ,,,,...„ ,, , 4,,,,,,,,,, ,,,,-.,,01,,2.-0,AP,.., ',- ,4-,
Wa#tewater 'Ibc 20
114 OAKMONT DRIVE PHONE [phone]
GREENVILLE, N.C. 27858 FAX [phone]
CLIENT: GOVERNOR'S CLUB (AQUA NC) CLIENT ID: 296
MR. R.B. TUPPS
AQUA NORTH CAROLINA ANALYST: JAP
202 MACKENAN CT. DATE COLLECTED: 11/29/21 Page: 1
CARY, NC 27511 DATE ANALYZED: 12/10/21
� DATE REPORTED: 12/29/21
REVIEWED BY: . 6 y
VOLATILE ORGANICS
STD. METHODS 6200C-11
MW-1A MW-3A MW-7 MW-9
PARAMETERS, ugh!
1. Benzene <0.50 <0.50 <0.50 <0.50
2. Bromobenzene <0.50 <0.50 <0.50 <0.50
3. Bromochloromethane <0.50 <0.50 <0.50 <0.50
4. Bromodichloromethane <0.50 <0.50 <0.50 <0.50
5. Bromoform <0.50 <0.50 <0.50 <0.50
6. Bromomethane <0.50 <0.50 <0.50 <0.50
7. N-Butylbenzene <0.50 <0.50 <0.50 <0.50
8. Sec-Butylbenzene <0.50 <0.50 <0.50 <0.50
9. Tert-Butylbenzene <0.50 <0.50 <0.50 <0.50
10. Carbon Tetrachloride <0.50 <0.50 <0.50 <0.50
11. Chlorobenzene <0.50 <0.50 <0.50 <0.50
12. Chloroethane <0.50 <0.50 <0.50 <0.50
13. Chloroform <0.50 <0.50 <0.50 <0.50
14. Chloromethane <0.50 <0.50 <0.50 <0.50
15. 2-Chlorotoluene <0.50 <0.50 <0.50 <0.50
16. 4-Chlorotoluene <0.50 <0.50 <0.50 <0.50
17. Dibromochloromethane <0.50 <0.50 <0.50 <0.50
18. 1,2-Dibromo-3-Chloropropane <0.50 <0.50 <0.50 <0.50
19. 1,2-Dibromoethane <0.50 <0.50 <0.50 <0.50
20. Dibromomethane <0.50 <0.50 <0.50 <0.50
21. 1,2-Dichlorobenzene <0.50 <0.50 <0.50 <0.50
22. 1,3-Dichlorobenzene <0.50 <0.50 <0.50 <0.50
23. 1,4-Dichlorobenzene <0.50 <0.50 <0.50 <0.50
24. Dichlorodifluoromethane <0.50 <0.50 <0.50 <0.50
25. 1,1-Dichloroethane <0.50 <0.50 <0.50 <0.50
26. 1,2-Dichloroethane <0.50 <0.50 <0.50 <0.50
27. 1,1-Dichloroethene <0.50 <0.50 <0.50 <0.50
28. Cis-1,2-Dichloroethene <0.50 <0.50 <0.50 <0.50
29. trans-1,2-Dichloroethene <0.50 <0.50 <0.50 <0.50
30. 1,2-Dichloropropane <0.50 <0.50 <0.50 <0.50
31. 1,3-Dichloropropane <0.50 <0.50 <0.50 <0.50
32. 2,2-Dichloropropane <0.50 <0.50 <0.50 <0.50
33. 1,1-Dichloropropene <0.50 <0.50 <0.50 <0.50
34. Cis-1,3-Dichloropropene <0.50 <0.50 <0.50 <0.50
35. trans-1,3-Dichloropropene <0.50 <0.50 <0.50 <0.50
36. Ethylbenzene <0.50 <0.50 <0.50 <0.50
37. Hexachlorobutadiene <0.50 <0.50 <0.50 <0.50
38. Isopropylbenzene <0.50 <0.50 <0.50 <0.50
39. 4-Isopropyltoluene <0.50 <0.50 <0.50 <0.50
40. Methylene Chloride <0.50 <0.50 <0.50 <0.50
41. Naphthalene <0.50 <0.50 <0.50 <0.50
42. Propylbenzene <0.50 <0.50 <0.50 <0.50
43. Styrene <0.50 <0.50 <0.50 <0.50
44. 1,1,1,2-Tetrachloroethane <0.50 <0.50 <0.50 <0.50
45. 1,1,2,2-Tetrachloroethane <0.50 <0.50 <0.50 <0.50
46. Tetrachloroethene <0.50 <0.50 <0.50 <0.50
47. Toluene <0.50 <0.50 <0.50 <0.50
48. 1,2,3-Trichlorobenzene <0.50 <0.50 <0.50 <0.50

ERUITC)RENER , _IBUCIT.p©TEN
•
* ° .' 3 <t 1, :' s-, - - '�€
Wastswatsr ID: 10.
114 OAKMONT DRIVE PHONE [phone]
GREENVILLE, N.C. 27858 FAX [phone]
CLIENT: GOVERNOR'S CLUB (AQUA NC) CLIENT ID: 296
MR. R.B. TUPPS
AQUA NORTH CAROLINA ANALYST: JAP
202 MACKENAN CT. DATE COLLECTED: 11/29/21 Page: 2
CARY, NC 27511 DATE ANALYZED: 12/10/21
,\ DATE REPORTED: 12/29/21
REVIEWED BY: �✓ ,��\
VOLATILE ORGANICS
STD. METHODS 6200C-11
MW-1A MW-3A MV6-7 MW-9
PARAMETERS, ug/1
49. 1,2,4-Trichlorobenzene <0.50 <0.50 <0.50 <0.50
50. 1,1,1-Trichloroethane <0.50 <0.50 <0.50 <0.50
51. 1,1,2-Trichloroethane <0.50 <0.50 <0.50 <0.50
52. Trichloroethene <0.50 <0.50 <0.50 <0.50
53. Trichlorofluoromethane <0.50 <0.50 <0.50 <0.50
54. 1,2,3-Trichloropropane <0.50 <0.50 <0.50 <0.50
55. 1,2,4-Trimethylbenzene <0.50 <0.50 <0.50 <0.50
56. 1,3,5-Trimethylbenzene <0.50 <0.50 <0.50 <0.50
57. Vinyl Chloride <0.50 <0.50 <0.50 <0.50
58. Total Xylenes <1.00 <1.00 <1.00 <1.00
59. Methyl Tert Butyl Ether <1.00 <1.00 <1.00 <1.00

r
Environment 1,Inc. CHAIN OF CUSTODY RECORD
P.O. Box 7085, 114 Oakmont Dr. Page_L OI I
Greenville,•IC 27858
environment l inc.com DISINFECTION CHLORINE NEUTRALIZED AT COLLECTION
Phone($252)756-6208•Fax[phone] iii
CHLORINE
CLIENT: 296 Week:48 2 pH CHECK(LAB)
❑ UV L2.
GOVERNOR'S CLUB(AQUA NC) NONE
PPPPPPPPPP GG G GG r CONTAINER TYPE,PIG
MR.R.B.TUPPS
AQUA NORTH CAROLINA CHEMICAL PRESERVATION
202 MACKENAN CT. AGA C A CC A A A EEEEE
CARY NC 27511 m oz A NONE D NAOH
E F- cn
Lis W U Z w t. w
z J �; - �, M B HNO3 E HCL
[phone] 0� J a
o � � � Z c F. 6
lc
c> `= s w V = Z = P. U C-H2SO4 F-ZINC ACETATE/NAOH
COLLECTION J o o. c .a. - b °y�,' G'' A A J U 2, a G NATHIOSULFATE
O 0 O y g E Q C s A 8 ; 8 N N
SAMPLE LOCATION DATE TIME Sco a
ir fa W F Q � F F U F1 F-� fs+ �o �o ,r204 �o cn CI-
1 -
ICLASSIFICATION:
I �
t f2
P
W_1,
1 1•t
5 .- _I. 5
1 I - -
A
WASTEWATER NPDES
W 3A ,
.. S
M
i - -
114W 7
it =
v ❑ DRINKING WATER
1 P
M
PM. igii: =
❑ DWR/GW
❑ SOLID WASTE SECTION
CHAIN OF CUSTODY(SEAL) MAINTAINED
DURING SHIPMENT/DELIVERY
1Y 7 N
SAMPLES COLLECTED BY:
(Please Print) p,/,,'t.ivl 1.1.k el totvl
i, cz dC i. t k.c '-
SAMPLES RECEIVED IN LAB AT Q.(a 'C
RELIN�II HED_BY(SIG,)(SAMPLER) DATE/TIME RECEIVED BY(SIG.) DATE TIME COMMENTS:
iJ-2 ?1 �� !J 1 5tv;>n l'Itg cJ� F�.
/-- I l °� I �) I� L_� /7/4 �. 1Z Mv-IN 1ivlW-1a : .i..,i lts/ ,;:I_ A'v b lov�'•o•'\
RELINQUISHED BY(SIG.) DATE/TIME RECEI Y( .) DATE/TIME !vat. „-A.,i
DATE/TIME DAT IME t Sawl I 'i-0 hL fGi not pied CAR, IV I,.t i t'trOC
RELINQUISHED BY(SIG.) RECEIVED BY(SIG.) P 'uj r!
- I
—H O II/29/Z1
PLEASE READ Instructions for completing this form on the reverse side. Sampler must place a"C"for composite sample or a"G"for N° 392451
FORM#5 Grab sample in the blocks above for each parameter requested.

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.

o
M InI �� (� I��I �I^`'� � I�Ij
ICIF �!�/F0111�i11P7 , -, I!I!+`�7� Frig PFMC(R O_ Drinking Water ID, 37715
Wastewater ID, 10
-11
114 OAKMONT DRIVE PHONE [phone]
GREENVILLE, N.C. 27858 FAX [phone]
ID#: 296
GOVERNOR'S CLUB (AQUA NC)
MR. R.B. TUPPS
AQUA NORTH CAROLINA DATE COLLECTED: 11/30/21
202 MACKENAN CT. DATE REPORTED : 12/02/21
CARY, NC 27511
REVIEWED BY:
MW-1A MW-3A MW-7 MW-9 Analysis Method
PARAMETERS Date Analyst Code
Fecal Coliform (MF), /100 Mls 47 1 <1 <1 11/30/21 BLV 9222D-15

,'Envirohment 1,Inc. CHAIN OF CUSTODY RECORD
P.O.Box 7085, 114 Oakmont Dr. Paige 1 o1, 1
Greenville,NC 27858
environment l inc.com DISINFECTION
CHLORINE NEUTRALIZED AT COLLECTION
Phone[phone]•Fax[phone]
❑ CHLORINE
CLIENT: 296 Week:48 1 (n� nn pH CHECK(LAB)
—F—f"-'—.1 V Zi/�1 L� �at G oy G A J
❑ lJ V T
GOVERNOR'S CLUB(AQUA NC)MR.R.B.TUPPS Ij NONE PPPPPPPPPP GGGGG CONTAINER TYPE,PIG
AQUA NORTH CAROLINA
202 MACKENAN CT. ❑ A GAC ACC A A A EEEEE CHEMICAL PRESERVATION
CARY NC 27511
Zo A-NONE D-NAOH
[phone] w 0 v co q b 1. w
Z w Z oc @ I. ^" N ' ' C B HNO3 E HCL
00 00 z �° i I t a a U cc
_ t- , w z p. U c v a C w a Ca A A A c w C-H2SO4 F-ZINC ACETATE/NAOH
COLLECTION a ww o oR �7 A4 w 0 U ow 6 v o 0 0 0 `N° c
F 0 eL o ;..L., ci 0 's Ca o 0 0 0 G NATHIOSULFATE
SAMPLE LOCATION DATE TIME o o c r' w Z - E■ U F E" w 42 cn Ltc
MW-1A 13 ..... ....... ...... ...... ...... ...... ...... ...... ...... ...... ....... .....: ......
I� !�� a.) Ia;35PM ::.::: :::: : �:::»::>: »»::>:: ;:�:.;:.: ::»:<:> >:::<::::: :>::>::>: ;:.;;:;.: CLASSIFICATION.
MW-3A Ia'sSPM l
1 1 >.... ....... ...... ....... ...... ....... ...... ...... ....... ...... ......
WASTEWATER
TEWATER(
NPDES
)
:::
DRINKING WATER
MW-9
r�
11
IA 5
P
❑ DWR/GW
❑ SOLID WASTE SECTION
CHAIN OF CUSTODY(SEAL) MAINTAINED
DURING SHIPMENT/DELIVERY
C) N
SAMPLES COLLECTED BY:
(Please Print)
I c'a v'i 5 'T,Qer 44
SAMPLES RECEIVED IN LAB AT 3 9 °C
RE WISHED BY(SIG.)(SAMPLER) DATE/TIME RECEIVED BY SIG.) DATE/TIME COMMENTS:
'i/ j 1I 30 13 yiIPM ►�/3% 1.3: li t i c-- LrS ca �•• F- cal�
RELINQUISHED BY(SIG.) ATE/TIME RECE BY(SIG.) DATE/TIME
RELINQUISHED BY(SIG.) DATE/TIME RECEIVED BY(SIG.) DATE/TIME 0/1/ / V .----- 0/ S
1
PLEASE READ Instructions for completing this form on the reverse side. Sampler must place a"C"for composite sample or a"G"for NQ 398684
FORM#5 Grab sample in the blocks above for each parameter requested.

SAMPLING INSTRUCTIONS AND FORM COMPLETION
s.
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.