WQ0014785_Monitoring - 03-2022_20220413

FORM: NDAR-1 08-11 NON-DISCHARGE APPLICATION REPORT (NDAR-1) Page of
,
Permit No.: WQ0014785 I Facility Name: Midway Middle School I county: Sampson Month: March Year: 2022
Field Name: 1 Field Name: 2 Field Name: 3 Field Name: 4
Did irrigation occur
Area(acres): 0.435 Area(acres): 0.435 Area(acres): 0.435 Area(acres): 0.435
at this facility?
Cover Crop: ,,,„,." t ri ver Crop: Cover Crop: Cover Crop:
EYES ENO Hourly Rate(in): b' Hourly Rate(in): 0.16 Hourly Rate(in): 0.16 Hourly Rate(in): 0.16
Annual Rate(in): 39 ✓\op 1 '' ArrYritiI1 Rate(in): 39 Annual Rate(in): 39 Annual Rate(in): 39
Weather Freeboard Field Irrigated? EYES NO Fi@ikl Irrigated? EYES ENO Field Irrigated? EYES ENO Field Irrigated? EYES NO
d c _ 1.'- It4i,ril 11.
aa) - m a °' m .0 -a rn E th`o -o cm E C) m -0 'a a> E rn m -o -a rn E rn
>; o f` N Q) N -0 E °' d w T c. 7 i'C E d d r >, c 7 L c E G) N . >, E 7 ` E E N y t; >, c ' ` c
m U ,- R ?U 5 a E m :o E 5 'o 5 a E A •� '5 E '5 v fl E o ,� =o E 5 a = a E '�
o ° a o 2' ai •xo � a) ,� om m 60 xo ,a rn m Rom
.� >,a p a i- 'E 0 0 ,a s 0 a I- O ,e 2 0 o a ~ 'c o ce 2 0 o a i= . 0 o m = J
c F d co co 0 Q _ J 2 J Q = J 2 J Q J J Q _ J 2co J
°F in ft ft gal min in in gal min in in gal min in in gal min in in
1 C 68 7 1,250 20 0.11 0.11 1,250 20 0.11 0.11 1,250 20 0.11 0.11 1,250 20 0.11 0.11
2 C 70 7 1,250 20 0.11 0.11 1,250 20 0.11 0.11 1,250 20 0.11 0.11 1,250 20 0.11 0.11
3 C 74 7 1,250 20 0.11 0.11 1,250 20 0.11 0.11 1,250 20 0.11 0.11 1,250 20 0.11 0.11
4 C 61 7 1,250 20 0.11 0.11 1,250 20 0.11 0.11 1,250 20 0.11 0.11 1,250 20 0.11 0.11
5 C 79 7 1,250 20 0.11 0.11 1,250 20 0.11 0.11 1,250 20 0.11 0.11 1,250 20 0.11 0.11
6 C 78 7 1,250 20 0.11 0.11 1,250 20 0.11 0.11 1,250 20 0.11 0.11 1,250 20 0.11 0.11
7 CL 69 7 1,250 20 0.11 0.11 1,250 20 0.11 0.11 1,250 20 0.11 0.11 1,250 20 0.11 0.11
8 C 60 7 1,250 20 0.11 0.11 1,250 20 0.11 0.11 1,250 20 0.11 0.11 1,250 20 0.11 0.11
9 CL 57 7 1,250 20 0.11 0.11 1,250 20 0.11 0.11 1,250 20 0.11 0.11 1,250 20 0.11 0.11
10 CL 49 7 1,250 20 0.11 0.11 1,250 20 0.11 0.11 1,250 20 0.11 0.11 1,250 20 0.11 0.11
11 CL 46 7.5 1,250 20 0.11 0.11 1,250 20 0.11 0.11 1,250 20 0.11 0.11 1,250 20 0.11 0.11
12 CL 44 7.5 1,250 20 0.11 0.11 1,250 20 0.11 0.11 1,250 20 0.11 0.11 1,250 20 0.11 0.11
13 C 48 7.5 1,250 20 0.11 0.11 1,250 20 0.11 0.11 1,250 20 0.11 0.11 1,250 20 0.11 0.11
14 C 45 7.5 1,250 20 0.11 0.11 1,250 20 0.11 0.11 1,250 20 0.11 0.11 1,250 20 0.11 0.11
15 C 58 7.5 1,250 20 0.11 0.11 1,250 20 0.11 0.11 1,250 20 0.11 0.11 1,250 20 0.11 0.11
16 CL 60 7.5 1,250 20 0.11 0.11 1,250 20 0.11 0.11 1,250 20 0.11 0.11 1,250 20 0.11 0.11
17 CL 59 7.5 1,250 20 0.11 0.11 1,250 20 0.11 0.11 1,250 20 0.11 0.11 1,250 20 0.11 0.11
18 C 74 7.5 1,250 20 0.11 0.11 1,250 20 0.11 0.11 1,250 20 0.11 0.11 1,250 20 0.11 0.11
19 C 75 7.5 1,250 20 0.11 0.11 1,250 20 0.11 0.11 1,250 20 0.11 0.11 1,250 , 20 0.11 0.11
20 C 70 7.5 1,250 20 0.11 0.11 1,250 20 0.11 0.11 1,250 20 0.11 0.11 1,250 20 0.11 0.11
21 C 75 7.5 1,250 20 0.11 0.11 1,250 20 0.11 0.11 1,250 20 0.11 0.11 1,250 20 0.11 0.11
22 C 60 7.5 1,250 20 0.11 0.11 1,250 20 0.11 0.11 1,250 20 0.11 0.11 1,250 20 0.11 0.11
23 C 75 7.5 1,250 20 0.11 0.11 1,250 20 0.11 0.11 1,250 20 0.11 0.11 1,250 20 0.11 0.11
24 CL 60 7.5 1,250 20 0.11 0.11 1,250 20 0.11 0.11 1,250 20 0.11 0.11 1,250 20 0.11 0.11
25 0 0 0.00 0.00 0 0 0.00 0.00 0 0 0.00 0.00 0 0 0.00 0.00
26 0 0 0.00 0.00 0 0 0.00 0.00 0 0 0.00 0.00 0 0 0.00 0.00
27 0 0 0.00 0.00 0 0 0.00 0.00 0 0 0.00 0.00 0 0 0.00 0.00
28 0 V 0 0.00 0.00 0 0 0.00 0.00 0 0 0.00 0.00 0 0 0.00 0.00
29 0 0 0.00 0.00 0 0 0.00 0.00 0 0 0.00 0.00 0 0 0.00 0.00
30 0 0 0.00 0.00 0 0 0.00 0.00 0 0 0.00 0.00 0 0 0.00 0.00
31 0 ` 0 0.00 0.00 0 0 0.00 0.00 0 0 0.00 0.00 0 0 0.00 0.00
Monthly Loading: 30,000 %////� 2.36 %///. /ii,���/���� 2.54 �///��i���� �/ 2.54 �j�/��i���/���� 2.54 4
12 Month Floating Total(in):��������/�/f 8.36 %//i//f/ 8.36 8.36 8.36

FORM: NDAR-1 08-11 NON-DISCHARGE APPLICATION REPORT(NDAR-1) Page of
Permit No.: W00014785 I Facility Name: Midway Middle School I county: Sampson Month: March Year: 2022
Field Name: 5 Field Name: 6 Field Name: 7 Field Name: 8
Did irrigation occur
Area(acres): 0.435 Area(acres): 0.435 Area(acres): 0.436 Area(acres): 0.435
at this facility? Cover Crop: Cover Crop: Cover Crop: Cover Crop:
divES ONO Hourly Rate(in): 0.16 Hourly Rate(in): 0.16 Hourly Rate(in): 0.16 Hourly Rate(in): 0.16
Annual Rate(in): 39 Annual Rate(in): 39 Annual Rate(in): 39 Annual Rate(in): 39
Weather Freeboard Field Irrigated? EYES ENO Field Irrigated? EYES E NO Field Irrigated? EYES ENO Field Irrigated? EYES ONO
m C
-o 0 a) m m m -0 '0 cn E a) a) a '0 Ca E 0) a) a '0 rn E rn a) -0 v m E rn
T 0 E Y D) .fl E a) w y C 3 L C E a) 2 >, C 3 T c E a) d ate.. T C 3 ` C E E . a) 2 T C 3 L C
( L 0 .Q ? (.) = a E as •, n E 3 5 a E m •m =o ,E '3 '5 3 a E m •� i5 E 3 `a 3 o E m •, ii E 3 =5
0 y a 0 0 0- i- ,a) p m X 0 2 C Q I= a) 0 f0 X O )9 0 >_. H .Q1 p 2 x o 2 o a H .°) o g K 0 @
L E N co ,:i pa• > < _ J a J > Q _ J 0 = J > Q J 2 = J > Q _ J 2 = J
0 H d 6 m
°F in ft ft gal min in in gal min in in gal min in in gal min in in
1 C 68 7 1,250 20 0.11 0.11 1,250 20 0.11 0.11 1,250 20 0.11 0.11 1,250 20 0.11 0.11
2 C 70 7 1,250 20 0.11 0.11 1,250 20 0.11 0.11 1,250 20 0.11 0.11 1,250 20 0.11 0.11
3 C 74 7 1,250 20 0.11 0.11 1,250 0 0.11 0.11 1,250 20 0.11 0.11 1,250 20 0.11 0.11
4 C 61 7 1,250 20 0.11 0.11 1,250 0 0.11 0.11 1,250 20 0.11 0.11 1,250 20 0.11 0.11
5 C 79 7 1,250 20 0.11 0.11 1,250 0 0.11 0.11 1,250 20 0.11 0.11 1,250 20 0.11 0.11
6 C 78 7 1,250 20 0.11 0.11 1,250 0 0.11 0.11 1,250 20 0.11 0.11 1,250 20 0.11 0.11
7 CL 69 7 1,250 20 0.11 0.11 1,250 0 0.11 0.11 1,250 20 0.11 0.11 1,250 20 0.11 0.11
8 C 60 7 1,250 20 0.11 0.11 1,250 0 0.11 0.11 1,250 20 0.11 0.11 1,250 20 0.11 0.11
9 CL 57 7 1,250 20 0.11 0.11 1,250 0 0.11 0.11 1,250 20 0.11 0.11 1,250 20 0.11 0.11
10 CL 49 7 1,250 20 0.11 0.11 1,250 0 0.11 0.11 1,250 20 0.11 0.11 1,250 20 0.11 0.11
11 CL 46 7.5 1,250 20 0.11 0.11 1,250 0 0.11 0.11 1,250 20 0.11 0.11 1,250 20 0.11 0.11
12 CL 44 7.5 1,250 20 0.11 0.11 1,250 0 0.11 0.11 1,250 20 0.11 0.11 1,250 20 0.11 0.11
13 C 48 7.5 1,250 20 0.11 0.11 1,250 0 0.11 0.11 1,250 20 0.11 0.11 1,250 20 0.11 0.11
14 C 45 7.5 1,250 20 0.11 0.11 1,250 0 0.11 0.11 1,250 20 0.11 0.11 1,250 20 0.11 0.11
15 C 58 7.5 1,250 20 0.11 0.11 1,250 0 0.11 0.11 1,250 20 0.11 0.11 1,250 20 0.11 0.11
16 CL 60 7.5 1,250 20 0.11 0.11 1,250 0 0.11 0.11 1,250 20 0.11 0.11 1,250 20 0.11 0.11
17 CL 59 7.5 1,250 20 0.11 0.11 1,250 0 0.11 0.11 1,250 20 0.11 0.11 1,250 20 0.11 0.11
18 C 74 7.5 1,250 20 0.11 0.11 1,250 0 0.11 0.11 1,250 20 0.11 0.11 1,250 20 0.11 0.11
19 C 75 7.5 1,250 20 0.11 0.11 1,250 0 0.11 0.11 1,250 20 0.11 0.11 1,250 20 0.11 0.11
20 C 70 7.5 1,250 20 0.11 0.11 1,250 0 0.11 0.11 1,250 20 0.11 0.11 1,250 20 0.11 0.11
21 C 75 7.5 1,250 20 0.11 0.11 1,250 0 _ 0.11 0.11 1,250 20 0.11 0.11 1,250 20 0.11 0.11
22 C 60 7.5 1,250 20 0.11 0.11 1,250 0 0.11 0.11 1,250 20 0.11 0.11 1,250 20 0.11 0.11
23 C 75 7.5 1,250 20 0.11 0.11 1,250 0 0.11 0.11 1,250 20 0.11 0.11 1,250 20 0.11 0.11
24 CL 60 7.5 1,250 20 0.11 0.11 1,250 0 0.11 0.11 1,250 20 0.11 0.11 1,250 20 , 0.11 0.11
25 0 0 0.00 0.00 0 0 0.00 0.00 0 0 0.00 0.00 0 0 0.00 0.00
26 0 0 0.00 0.00 0 0 0.00 0.00 0 0 0.00 0.00 0 0 0.00 0.00
27 0 0 0.00 0.00 0 0 0.00 0.00 0 0 0.00 0.00 0 0 0.00 0.00
28 0 0 0.00 0.00 0 0 0.00 0.00 0 0 0.00 0.00 0 0 0.00 0.00
29 0 0 0.00 0.00 0 0 0.00 0.00 0 0 0.00 0.00 0 0 0.00 0.00
30 0 0 0.00 0.00 0 0 0.00 0.00 0 0 0.00 0.00 0 0 0.00 0.00
31 0 0 0.00 0.00 0 0 0.00 0.00 0 0 0.00 0.00 0 0 0.00 0.00
Monthly Loading: 30,000 %//A 2.54 ...7,���/���� 2.54 j�//������� r� 2.53 % 30,000 � 2.54 AA'
12 Month Floating Total(in):���������/ 8.36 8.36 8.36 � ��,������� 8.36

FORM: NDMLR 08-11 NON-DISCHARGE MASS LOADING REPORT(NDMLR) Page of
Permit No.: W00014785 Facility Name: Midway Middle School County: Sampson Month: March Year: 2022
Field Name: 1 Field Name: 2 Field Name: 3 Field Name: 4 Field Name: 5
Area(acres): 0.435 Area(acres): 0.435 Area(acres): 0.435 Area(acres): 0.435 Area(acres): 0.435
Cover Crop: Cover Crop: Cover Crop: Cover Crop: Cover Crop:
Load Type: PAN Load Type: PAN Load Type: PAN Load Type: PAN Load Type: PAN
Field Loaded? EYES NO Field Loaded? EYES ENO Field Loaded? EYES NO Field Loaded? EYES NO Field Loaded? EYES ENO
m _ C
a a d aai d
z o Z m Z o Z d Z o Z a, Z o Z a) • Z o Z a)
a a « a > •a a a « .2 > •o a a :r a > a c. a :. a > 'o fl. a — a > m
a 2 CL • A a d m Q. :3 M Q d rp a. c9 C. d R °- :. 2 0. a i9 d ...
a, _ a @ o a co o a 03 o a o a m o
Q a) >, co J a W .+ > a1 J a a) ., >, cc J a a) ... >, fa J a d .+ >+ c6 J
CIS m C y p 3 m C L o N M C L O 3 a) cl) C t o 3 a) M C y O 3
E C J E Q £ 1 C J E a E 2 5 v. J E Q g `lc" O J E Q E co u C J E Q
7 j C O 3 a > C O Cl- 3 > C o 0. 3 > O 3 a 3 > C G 3 a
a0 2 > a0 2 > a0 2 > a0 2 >° a0 2
Month gal mg/L lbs/ac lbs/ac gal mg/L lbs/ac lbs/ac gal mg/L lbs/ac lbs/ac gal mg/L lbs/ac lbs/ac gal mg/L lbs/ac lbs/ac
April
May
June
July
August
September
October
November
December
January
February
March 30,000 9.29 5.3 5.3 30,000 9.29 5.3 5.3 30,000 9.29 5.3 5.3 30,000 9.29 5.3 5.3 30,000 9.29 5.3 5.3
12 Month Floating PAN Load 5.3V //// j V##A
(Ibs/ac/yr):
Annual PAN Load Limit(Ibs/ac/yr): 176 17.60 1760 10 17.60

FORM: NDMLR 08-11 NON-DISCHARGE MASS LOADING REPORT(NDMLR) Page of
Permit No.: WQ0014785 Facility Name: Midway Middle School County: Sampson Month: March Year: 2022
Field Name: 6 Field Name: 7 Field Name: 8 Field Name: Field Name:
Area(acres): 0.435 Area(acres): 0.435 Area(acres): 0.435 Area(acres): Area(acres):
Cover Crop: Cover Crop: Cover Crop: Cover Crop: Cover Crop:
Load Type: PAN Load Type: PAN Load Type: PAN Load Type: Load Type:
Field Loaded? EYES NO Field Loaded? DYES NO Field Loaded? EYES NO Field Loaded? EYES ENO Field Loaded? DYES NO
m z c z m z c z m z c z a) c V m C 0
Za aao a > c a as < a) a)ao a > m to a) :° o > a ago o >
o. R a .a w o a °- a -a — o a a a v o a w E —I a a cn E J 'a V
°1 a m >, ct ao _1 a m >, c 'aJ a a) .� >, m � _1 a RSw �, 10 R a >
E CD e c a d o c a a a c c > a c c c>a oc.) a oU c o a s
U a0 0 U 0 0 U> a V E a V E a V 2 > U E c.) E
> > >Month gal mg/L lbs/ac lbs/ac gal mg/L lbs/ac lbs/ac gal mg/L lbs/ac lbs/ac , gal mg/L lbs/ac lbs/ac gal mg/L lbs/ac lbs/ac
April
May
June
July
August
September
October
November
December
i
January
February
March 30,000 9.29 5.3 5.3 30,000 9.29 5.3 5.3 30,000 9.29 5.3 5.3 12 Month Floating PAN Load rf�J r rj
(Ibs/ac/yr): 5.3 5.3 � 5.3 0.0 //, 0.0
Annual PAN Load Limit
(Ibs/ac/yr): 17.6 / 17.60 17.60 i%/III 4

FORM: NDMR 03-12 NON-DISCHARGE MONITORING REPORT(NDMR) Page of
Permit No.: W00014785 Facility Name: Midway Middle School county: Sampson Month: March Year: 2022
PPI: 001 Flow Measuring Point: ❑influent ❑Effluent No flow generated Parameter Monitoring Point: ❑Influent Effluent ❑Groundwater Lowering ❑Surface Water
Parameter Code -* 50050 00400 00625 00310 00610 00530 31616 00665 00620 WQ09 00940 00600 70300
c s N
2 c m E 2 o c m c y
'i N u7 C -o N �, o w i N 'O a) > Vl
£ a; o = m rn p o .'3 c :a 3 ,o '' s ( �o c a) v
>, U F a. Y 0 E i- N V) u !- G Z d j ._ N I- U1 N
O ~ LL O Z Q o 0 < Z o Z b
0 I- a
24-hr hrs GPD su mg/L mg/L mg/L mg/L #/100 mL mg/L mg/L mg/L mg/L mg/L mg/L
1 2,029
2 2,029
3 2,029
4 2,029
5 2,029
6 2,029
7 2,171
8 2,171
9 2,171
10 2,171 8 44 2020
11 2,171 40
12 2,171
13 2,171
14 2,500
15 2,500
16 2,500 6.47
17 2,500
18 2,500
19 2,500
20 2,500
21 1,843 1.04
22 1,843 34 26.9 35.1
23 1,843
24 1,843
25 1,843
26 1,843
27 1,843
28 2,857
29 2,857
30 2,857
31 2857+D12
Average: 2,211 34.00 44.00 26.90 40.00 2,020.00 6.47 1.04 35.10
Daily Maximum: 2,857 8.00 34.00 44.00 26.90 40.00 2,020.00 6.47 1.04 35.10
Daily Minimum: 1,843 8.00 34.00 44.00 26.90 40.00 2,020.00 6.47 1.04 35.10
Sampling Type:
Monthly Limit: 310,000
Daily Limit:
Sample Frequency:

FORM: NDAR-1 08-11 NON-DISCHARGE APPLICATION REPORT (NDAR-1) Page of
R ECompliant ❑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? ECompliant ❑Non-Compliant
Were all setbacks listed in your permit maintained for every application to each permitted site? LiCompliant ENon-Compliant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit? LiCompliant ❑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: Robert Carroll Permittee:
Sampson County School
Certification No.: 26341 Signing Official: Robert Carroll
Grade: S Phone Number: 910-385-6116 Signing Official's Title: ORC
Has the ORC changed since the previous NDAR-1? Eves LiNo Phone Number: 910-385-6116 Permit Exp.: 12/31/21
4/5/22 �� 4/5/22
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 Quality
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

...
Enviro mental Chegriiists,
envirochern 6602 Windmill Way,Wilmingtun,NC 28405 4 910.392.0223 Lab ' 910.39 -I'..d.Fax
710 Bowsertown Road,'Manta),NC 27954 * 252.473.5702 Lab./1•,•,x
9AI
255-A Wilmington Highway,Jacksonville,NC 28541) 6 910347,5843 f -.. : dx
ANALYTICAL&CONSULTING CHEMISTS bed, info a erwironmentalchemists.com
----_=_ .-: -7:- --,----=-- - 777-- _
-= - -
Sampson Co. Schools
Date of Repor(1—Mar 22, 2022Th
437 Rowan Road Customer PO P.
Clinton, NC 28328 Customer ID: 19040001
Attention: Robert Carroll !3eport#: 2022-04452
Project e—alawa y Middle ) ,
01,*64-
Lab ID Sample ID: Collect Date/Time Matrix Sampled by
22-10692 Site: Effluent-Grab 3/10/2022 8:30 AM Water Jason Dickinson
Test Method Results Date Analyzed
Fecal Coliform idexx Coliterti18 2020 MPN/100m1 00110/2022
Residue Suspended (TSS) SM 2540 0-2015 40.0 mg/L 08/11/2022
Total Phosphorus SM 4500 P(F-H)-2011 6.47 mg/L 03,16/2022
BOD sm 5210 B-2016 44 mg/L 02„'' 12022
Nitrate Nitrogen (Cato)
Nitrite Nitrogen EPA 353.2,Rev 2 0,1993 0.05 mq/L 03;1n/2022
Nitrate+Nitrite-Nitrogen EPA 353.2,Rev.2.0,1993 1.09 mg/L 03/14/2022
Nitrate Nitrogen Subtraction Method 1.04 mg/L 0',V2'/2022
Total Nitrogen(Cale)
Total Nitrogen Total Nitrogen 35.1 mg/L 03/22/2022
.„.
Lab ID Sample ID: Collect Date/Time Matrix Sampled by
22-10692A Site: Effluent-Grab 3/10/2022 8:30 AM Water Jason Dickinson
Test Method Results Date . :iyzed
Ammonia Nitrogen SM 4500 NH3 C-2011 26.9 mg/L 0v,2'2022
Total Kjeldahl Nitrogen (TKN) sm 4500 Norg 8-2011 34.0 mg/L 03/22/2022
Comment:
Reviewed by: Ka1:06/ aciatal
•
— — .......
Report# 2022-04452 ri,r

- '
Environmental Chemist, Inc., Wilmington, NC Lab #94
6E. , Hncimili Way
Wiim NC 28405
'392.0223
Sample Receipt Checklist
• f (/' 1 0
022K '
Date:_ . -)11(7_„:\
22
Report Number:_ 2 - L Receipt of sample: E HEM Pickup 0 Client Deliver,/CI YES 0 NO N/A 1. Were custody sea k present on the cooler?
_
0 YES 0 NO N/A 2. If custody seals were present, were they intact/unbroken ,
Original temperature upon receipt I °C Crirrected temperature upon receipt °C
How temperature taken: 0 Temperature Blank Against Bottles
_
IR Gun ID:Thomas Traceable S/N: 210835468 IR 0L.in Correciinn Factor °C: 0.0
0 YES 0 NO 3. If temperature of cooler exceeded 6°C, was Project Mgr./QA notified?—
__________________._______________________________
IMMOEM 0 NO 4. Were proper custody procedures (relinquished/received) followed?
O NO 5. Were sample ID's listed on the COC?
MECUI
MEMA 0 NO 6. Were samples ID's listed on sampi- containers?
LAM0 NO 7. Were collection date and time listeJthe COC?M __________________———. -
0 NO 8. Were tests to be per ntformed listed ohe COC?
_ _____________________.___il 0 NO 9. Did samples arrive in proper containers for each test?
NEW: to 10. Did samples arrive in good COnditio, for each test?
11;i1- tfn IU NO ! -Ii. Was adequate qamole volume avai'-ib!e?'
—
MIMED NO 12. Were samples received within prop(r holding time for requested tests?
—
IMMO 0 NO 13. Were acid preserved sampkis received it a pH of<2? *
0 YES 0 NO 14. Were cyanide samples received at a pH >12?
0 YES 0 NO 15. Were sulfide samples received at a j 9 1 ,>
?
timmik-- o NO 16. Were NH3/TKN/Phenol received at ,- cin1orine residual of<0.5 rn/L? -'
0 YES 0 NO 17. Were Sulfide/Cyanide received at a c'Horine residual of<0.5 rn/L?
0 YES 0 NO 18. Were orthophosphate samples filter, i., H the field within 1.5 minutes?
* ToC/Volatifes are pH checked at time of analysis and recorded cn the be** Bacteria samples are checked for Chlorine at time of analysis and record--i nn the benchsheet,
Sample Preservation: (Must be completed for any sample(s) ins preserved or with headspace)
Sample(s) were received incorrectly c_ne:;eried and were adjusted accorclin ,
by adding (circle one): H2SO4 HNO3 HC1 NaOhi
rime of preservation: If more than one preservatine is r,eeded, notate in comments bele.
—
Note:Notify customer service immediately for incorrectly preserved samplE 3 tl.:,tain -- ,','...-.,7,mole or
notify the state lab if directed to ana'yzed by the customer. ,,iii:c was noifie.... d :e.am: ..
. . ,.
Volatiles Sample(s)
were receives! vlith headspace .
' COMMENI--T-----------.__
•
DOC. QA.002 Rev 1

ENVIRONMENTAL CHEMISTS 6&02 Windmill WayWilmington,NC28405
� � OFFICE: 910-392-0223 FAX [phone]
NCDENR: DWO CERTIFICATION#94 NCDHHS: DLS CERTIFICATION#37729 [e-mail]
Analytical&Consulting Chemists
"' s_r ' C' f " c `7.*''
��i�'it: <. ., .� . ems„
Address: 437 Rowan Road CONTACT NAME: Robert Carrot PO NO:
Clinton, NC 28328 REPORT TO: Robert Carroll PHONE/FAX:
copy: R Carroll ([e-mail]) email: [e-mail]
Sampled By: 3-0%56 et 1)rr fr 45n/7 SAMPLE TYPE: I=Influent,E= Effluent.W_=Well, ST=Stream,SO=Soil, SL=Sludge,Other:
Collection „ �_� —�� PRESERVATION s ___
Q 20 = -� Cw
Sample Identification E l� at E., .s `a o 6 m al w x o w ANALYSIS REQUESTED
Date Time Temp U v " z z x z r
3ro z2 g`3 _ C
Effluent /1/. G ;' =- X BOD TSS, NO2
pH (field): a; . E G G �, '• i X l i l'JF i3, NO3, 3 I-, -1KN, N, ,1,,)
G G e.1 1 1 i i X Fecal
C P Due: Mar, July, Nov
G G
. C P
G G
C P
Effluent G G X TDS, Chloride (November only)
C P
G G
C P
Soil Sample G G X Standard Soil Fertility (December only)
Transfer Relinquished By: Date/Time Received By: Date/Time
1. -1-564 Dta t►t _74 ` 3-I0 2Z (to:.S ►''i
2. ((`
Temperature when Received °C: /1 Accepted: Rejected: Resan Ie Re ested: y�
Delivered By: J.. sow DiOcloscr✓ Received By: �� Date: /[0 o Time:)0, t
Comments: TURNAROUND: