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WQ0014785_Groundwater Quality Monitoring Compliance report form_20240205
SUBMIT FORM ON YELLOW PAPER ONLY DEPARTMENT OF ENVIRONMENTAL QUALITY-DIV. OF WATER RESOURCES GROUNDWATER QUALITY MONITORING: 3' INFORMATION PROCESSING UNIT COMPLIANCE REPORT FORM E, '1617 MAIL SERVICE CENTER,. RALEIGH, NC 2769971617 FACILITY INFORMATION Please Pnnr Clearly or type PERMIT Number: k/Q00Ij 7WExpiration Date: 10/31/2028 Facility Name: Midway Middle School Non -Discharge UIC NPDES Other Permit Name (if different): Facility Address: 1115 Roberts Grove Road TYPE OF PERMITTED OPERATION BEING MONITORED ❑ Lagoon ❑ Remediation: Infiltration Gallery Dunn (SYeB1j NC 28334 County Sampson (City) (state) (ZIP) E Spray Field ❑Remediation: Contact Person: Robert Carroll Telephone#: 910385-6116 ❑ Rotary Distributor ❑ Land Application of Sludge Well Location/Site Name: Midway Middle No. of wells to be sampled: 2 ❑ Water Source Heat Pump M Other. Surface Drip 'rq SAMPLING INFORMATION If WELL WELL ID NUMBER (from Permit): MW2 Date sample collected: 11/29/2023 FIELD ANALYSES: WAS Well Depth: 25 fL Well Diameter. 2 In. pH 00400: 5.05 units Temp. 000lo: 17.1 eC DRY at Depth to Water level 614 254e: .3 ft. below measuring point Screened Interval: 5 ft. — to 25 ft. Spec. Cond. 00094Mhos : µ time of sampling, Measuring Point is 3 f . above land surface Relative M.P. Elevation: ft. Odor 000as: none check Volume of water pumped/bailed before sampling: 3 gallons Appearance Gear here: El Samples for metals were collected unfiltered: © YES ❑ NO ' and field acidified: EYES ❑ NO LABORATORY INFORMATION Date sample analyzed: 11/29/2023 Laboratory Name: Environmental Chemist Certification No. 23-67290 PARAMETERS NOTE: Values should reflect dissolved and colloidal concentrations. COD 00335 mg/L Nitrite (NO2) as N oasis mg/L Pb - Lead o1a51 uglL Col'Ifonn: MF Fecal 31616 <1 /100mL Nitrate (NO3) as N 00620 0.15 mg/L Zn - Zinc 01092 mg/L Colifonn: MF Total 31so4 /100mL Phosphorus: Total as P ooss5 0.34 mg/L (Note: Use MPN melho4 for NgNy turbid samples) Orthophosphate70607 mg/L Other (Specify Compounds aW Concentration Units): issoived SOIIdS:TOtal 703oo 29 mg/L. Al -Aluminum oltos mg/L` 1p.. OH (Lab) 00403 5.05 units Be - Barium 01007 ug/L _ TOC 00680 1.6 mg/L Ce - Calcium costs mg/L Chloride oo94o <5 mg/L Cd - Cadmium o1o27 uglL � o i Arsenic atoo2 ug/L Chromium: Total o1o34 uglL Grease and Oils aoss2 mg/L Cu - Copper o1o42 mg/L ORGANICS: (by GC, GC/M :: Phenol 32730 ug/L Fe - Iron 01045 uglL (Specify test and method #. ATTACH LAB .) Sulfate 00945 ni Hg - Mercury 71soo uglL Lab Report Attached? ❑ Yes (1) ❑ No (0) Specific Conductance 000as µMhos; K - Potassium oo937.mg/L VOC 7873 , method # Total Ammonia oo6to <2 mg/L Mg - Magnesium 00927 mg/L. , method # �g�yR r (Amnonla Nitrogen: NH3es N; Ammonia Nitrogen, Total) Mn- Manganese otoss ug/L ,method# c 1 TKN N Ni Nickel method # Sf00 Ol~ Wa ROSO as oo625 mg/L - alas? ug/L gf For Remediation Svstems Only (Attach Lab Reoorts): GW-59 Rev. 06-07-2018 Influent Total VOCs: me/L Effluent Total VOCs: mg/L VOC Removal% --- rC00 PU Sampson Co. Schools Date of Report: Dec 13, 2023 437 Rowan Road Customer PO M Clinton, NC 28328 Customer ID: 19040001 Attention: Report M 2023-27747 Project ID: M/Wells - Midway Middle Lab ID Sample ID: Collect Date/Time Matrix Sampled by 23-67291 Site: MW-2 11129/2023 9:15 AM Water Jason Dickinson Test Method Results Date Ammonia Nitrogen EPA 350.1, Rev- 2.0,1993 <0.2mg/L 12/07/2023 Total Dissolved Solids (TDS) SM 2540 c-2015 29 mg/L 11/29/2023 Total Phosphorus SM 4500 P (F-H)-2011 0.34mg/L 12/08/2023 Total Organic Carbon (TOC) SM 5310 B-2014 1.6 mg/L 12/04/2023 Fecal Coliform SM9222D-2015MF <1Coloniesl100mL 11/29/2023 Chloride SW50001E-2011 <5mg/L 12/0112023 1,1,1,2-Tetrachloroethane SW 846 Method 826=50308 <0.50pg/L 12/1/2023 1,1,1-Trichloroethane SW846Method 8260D/50308 <0,50NgIL 12/1/2023 1,1,2,2-Tetrachloroethane SW 846 Method 826OD15030B <0.50pgIL 12/1/2023 1,1,2-Tdchloroethane SW846Method 8260D/$030B <0.50pg/L 12/1/2023 1,1-Dichloroethane SW$46Method 8260D/5030B <0.50pg/L 12/1/2023 1,1-Dichloroethene SW846Method 8260D/5030B <0.50pg/L 12/1/2023 1,1-Dichloropropene SW846Method 8260D/5030B <0.50pg/L 12/1/2023 1,2,3-Trichlorobenzene SW846Method 8260D/5030B <0.50pg/L 12/1/2023 1,2,3-Trichloropropane SW 846 Method 826OD16030B <0.50pg/L 12/1/2023 1,2,4-Trichlorobenzene SW 646 Method 826OD150308 < 0.50 pg/L 12/1/2023 1,2,4-Trimethylbenzene SW 846 Method 826OD15030B <0.50pg/L 12/1/2023 1,2-Dibromo-3-Chloropropane SW 648 Method 826OD15030B <0.50pg/L 12/1/2023 1,2-Dibromoethane SW846Method 8266D/5030B <0.50pg/L 12/1/2023 1,2-Dichlorobenzene SW$46Method 8280D/5030B <0.50pg/L 12/1/2023 1,2-Dichloroethane SW$46Method 82BOD/503DB <0.50pg/L 12/1/2023 1,2-Dichloropropane SW846Method 82600160308 <0.50pg/L 12/1/2023 1,3,5-Trimethylbenzene SW 846 Method 8260016030B <0.50pgIL 12/1/2023 1,3-Dichlorobenzene SW 846 Method 8260DI50308 <0.50pg/L 12/1/2023 1,3-Dichloropropane SW846Method 8260D/50306 <0.50pg/L 12/1/2023 1,4-Dichlorobenzene SW 846 Method MD15030B <0.50pg/L_ 12/1/2023 Report #: 2023.27747 Page 4 of 6 Environmental Chemists, Inc. 0 6602 Windmill Way, Wilmington, NC 28405 0 910.392.0223 Lab - 910.392.4424 Fax x 710 Bowsertown Road, Manteo, NC 27954 - 252.473.5702 Lab/Fax 255-A Wilmington Highway, Jacksonville, NC 28540 c 910.347.5843 Lab/Fax ANALYTICAL & CONSULTING CHEMISTS info;u.environmentalchemists.com Sampson Co. Schools Date of Report: Dec 13, 2023 437 Rowan Road Customer Pt) M Clinton, NC 28328 Customer ID: 19040001 Attention: Report #: 2023-27747 Project ID: MfWells - Midway Middle 2,2-Dichloropropane SW 846 Method8260D/5030B <0,50pg/L 12/1/2023 2-Chlorotoluene SW 846 Method826OD1503013 < 0.50 pg/L 12/1/2023 4-Chlorotoluene SW 846Method 8260D/50308 <0.50pg/L 12/1/2023 Benzene SW$46Method 8260D/5030B <0.50pg/L 12/l/2023 Bromobenzene SIN 846 Method 826OD15030B <0.50pg/L 12/1/2023 Bromochloromethene SW 846 Method82600IM308 <0.50pg/L 12/1/2023 Bromodichloromethane SW 846 Method 826OD150308 <0.50pg/L 12/1/2023 Bromoform SW 846 Method8260015030B <0.50pg/L 12/1/2023 Bromomethane SW 846MeVM82600/503013 <0.50pg/L 12/1/2023 Carbon tetrachloride SW 846 Method 826OD15030B < 0.50 pg/L 12/112023 Chlorobenzene SW 846 Method 826OD15030B < 0.50 pg/L 12/1/2023 Chloroethane SW 846 Method 8260D/5030B < 0.50 pg/L 12/1/2023 Chloroform SW 646 Method 826OD150308 < 0.50 pg/L 12/1/2023 Chloromethane SW 846 Method 8260D/5030B < 0.50 pg/L 12/112023 cis-1.2-Dichloroethene SW 846 Method 826OD150308 < 0.50 pg/L 12/WO23 cis-1,3-Dichloropropene SW 846 Method8260D/5030B <0.50pg/L 12/1/2023 Dibromochloromethane SW 846 Method82600/50308 <0.50pg/L 12/1/2023 Dibromomethane SW 846 Method8260DIS0308 <0.50pg/L 121112023 Dichlorodifluoromethane SW 846 Method 826OD15030B <0.50pg1L 12/1/2023 Ethylbenzene SW 846 MethodSMD16030B <0.50pg/L 12/1/2023 Hexachlorobutadiene SW 846 Method8260DIS0308 <0.50pg/L 12/1/2023 isopropylbenzene SW 846 Method 8280DIS030B < 0.50 pg/L 12/1/2023 M+P Xylene SW 846 Method 8260/5030B < 1.00 pg/L 12/1/2023 Methylene chloride SW 846 Method 828OD160308 < 0.50 pg/L 12/1/2023 Naphthalene SW 846 Method 826OD150308 < 0.50 pg/L 12/1/2023 n-Butylbenzene SW 846 Method8260D/5030B < 0.50 pg/L 12/112023 n-Propylbenzene SW 846 Method MOD15030B < 0.50 pg/L 12/112023 ortho-Xylene SW 846 Method 8260DIS030B < 0.50 pg/L 12/1/2023 p-lsopropyltoluene SW 846 Method 8260D/5030B < 0.50 pg/L 12/l/2023 sec Burylbenzene SW 846 Method6260D/5030B - <0.50pg/L„ 12/1/2023 Report C.: 2023.27747 Page 5 of 6 Sampson Co. Schools Date of Report: Dec 13, 2023 437 Rowan Road Customer PO X: Clinton, NC 28328 Customer ID: 19040001 Attention: Report 0: 2023-27747 Project ID: M/Wells - Midway Middle Styrene SW 846 Method 026OD15030B < 0,50 pg/L 12/1/2023 tert-Butylbenzene SW 846 Method 826OW50308 < 0.50 pg/L 12/112023 Tetrachloroethene SW 646 Method 826OD15030B < 0.50 pg/L 1211/2023 Toluene SW 845 Method 8260D/50308 < 0.50 pg/L 12/112023 Trans-1,2-Dichloroethene SW840Method 8269D/50308 <0.50pg/L 1211/2023 Trans-1,3-dichloropropene SW 846 Method 8280D/5030B < 0.50 pg/L 12JI12023 Trichloroethene SW 846 Method 826OD15030B < 0.50 pg/L 12/l/2023 Trichlorofluoromethane SW 846 Method 82600150309 < 0,50 pg/L 12/1/2023 Vinyl chloride SW 846 Method 826ODMO30B < 0.50 pg/L 121112023 Nitrate Nitrogen (Calc) Nitrite Nitrogen EPA 3532. Rev.2.0.1993 0.03mg/L 11/29/2023 Nitrate+Nitrite-Nitrogen EPA 3532, Rev.2.0,1993 0.18mgIL 11/30/2023 Nitrate Nitrogen Subtractto Method 0.15 mg/L 12/07/2023 Comment: Reviewed by: ¢ UW Report#.: 2023-27747 Page 6 of 6 i m 9 W a N 0 _ 1co 'w a n e 9 .> t 1 0 a% • 3 a o CL a 3 m °8 Bempla Type O Q C 97 O Compoeita or #UG) Grab ® -D o .D Container (P a9 0 cz- o Chlo ne m N ro LAB ID NUMBER X NONE X HCL ma m' X � H2SO4 y m 0 HNOa 17 C NAOH .D.{ X THIO z OTHER z z NO v a a O O = m o n CA)o y Z 3 o m z P1 � N D y m_ m m c t m m 3 - m u` w o.. w U' rn m� J 6 O— Y LU E@ L v C N co H W it o a O .E a o O w o Z O �, Z O o O U N J J O 4] >~ p5S_. O rL � O. �- M ci m m C g❑ 0a a Q U o 1 N o f u =^ �.2 (9:- O U z v v d c U a#### y w J .vc E E J_, a O tl1 K fL J O O O S~} .o L L L w O❑❑❑ N E m @ m vi a E E E E v w Ozw a.s. a y d vR o - q O W o M u E 0 � CEq c >O5: z V co oo c .- .T� _� j LL L V y Q w LL O in a rn a c N m@ 0 0 N d o ti W J N C7 N U F Luci W m$ o `° W S a o v a a @ O N O J rn of� li a O a a N O O y J > o -- a o a ❑ ❑M ❑ ❑ a z -_--r z r: E> E E>> NI „ E E E E E E > E o O Z m M ❑ L U E N O N O M } O C O @ N 'O �@ @ C O > C M M N 6 M M L N E Z W y'� C` M O O r r (0 n V N O r N r N o O m@ C@ > .0 @ @ �o b m n O o m o 0 o m m rn m vi �o (n m U❑ m 'U W w E 120 O O O r O O O O O O O r O O O O T u d c a z>. z z a R E E E E m c v 3O N@ 30@ Urn 3 O O @ E U E I-. O�o dm0 N@@ VO@cl C@mC ZZV U L > m - dE O Q �@y ) m mCU z @ ZZ o Co aQU .U@ N @ U 2 F- co p Y m p Z ... L U U `P t rn Z v Z y ❑ o C L U C R M o V M > E E m h co@ N (n @ J O O J Y o o w N Oi o o rn 'E m rn p� m p� rn g m Orn E r E c E E E E E E z v 0 E o F O Z � U z - °o K N2E O v v E o z m = >O N o U z g w `m 9 d @ E H LL T U Z N N _ n E JF a r v v a Q0 ° z a O rn m n aO z .. o U OE a vQC o o N o Oa 4@ m r v �� m M �i r o o W W �� a �' o f Q n m a E 3 ojr o @ o m m E m a U m o w v v@ e z �O - ° �w ffiW J y a�Z LL N _ _ E° @ Q U O „' N C y V' m E d 0I } C y W LL m N 2 t a C a (n j Z Z v m o O m a E O w o¢ U m c a IY- E E v ._ z t 3 ° m �- n H E E= vi m o E @ Q>, a Z- o, Lu a 7 d J Z. ? J a � o aoi m K m °- aDi o I-o G O .� O U � E � c m m W � a m 2 E m K U O N (7U a a O U� N3 o 2i >° in�oa O O E- U E U O 0 v w m E m 0 c c c M 0 N r m 0 Environmental Chemists, Inc. envirochem 6602 Windmill Way, Wilmington, NC 28405 • 910.392.0223 Lab • 910,392,4424 Fax 710 Bowsertown Road, Manteo, NC 27954 • 252A73.5702 Lab/Fax to 255-A Wilmington Highway, Jacksonville, NC 28540 • 910.347.5843 Lab/Fax ANALYTICAL & CONSULTING CHEMISTS info(renvironmentalchemists.com Sampson Co. Schools Date of Report: Dec 13, 2023 437 Rowan Road Customer PO #: Clinton, NC 28328 CustomerlD: 19040001 Attention: Report #: 2023-27747 Project ID: M/Wells -Midway Middle Lab ID Sample ID: 23-67290 Site: MW-1 Collect DateMme Matrix Sampled by 11/29/2023 9:35 AM Water Jason Dickinson Test Method Results Date Analyzed Ammonia Nitrogen EPA 350.1, Rev, 2.0, 1993 < 0.2 mg/L 12/07/2023 Total Dissolved Solids (TDS) SM 2540 0.2015 65 mg/L 11/29/2023 Total Phosphorus SM 4600 P (F-H1-2011 0.37 mg/L 12/08/2023 Total Organic Carbon (TOG) SM 5310 B-2014 1.0 mg/L 12/04/2023 Fecal Coliform SM 9222 D-2015 MF <1 Colonies/100ml. 11 /29/2023 Chloride SM4500 CI E-2011 7 mg/L 12/01/2023 1.1,1,2•Tetrachloroethane SW 846 Method 82600150308 <0.50ug/L 12/1/2023 1, 1, 1 -Trichloroethane SW 646 Method 8260015030B <0.50ug/L 12/112023 1,1,2,2-Tetrachloroethane SW846Method 82600/50308 <0.60pg/L 12/1/2023 1,1,2-Trichloroethane SW 046 Method $2600150308 <0.50pg/L 12/1/2023 1,1-Dichloroethane SW 846 Method 82600/50306 <0.50pg1L 1211/2023 1,1-Dichlorcethene SW 846 Method 82600150300 <0.50pg/L 12/1/2023 1,1-Dichloropropene SW846Method B260D/5030B <0.50pg/L 12/1/2023 1,2,3-Trichiorobenzene SW 846Method 826oD/50308 < 0.50 pg/L 12/1/2023 1,2,3-Trichioropropane SW846Method 8260D/50306 <0.50pg/L 121l/2023 1,2,4-Trichlorobenzene SW 846Method 8260D/50308 < 0.50 Ug/L 12/l/2023 1,2,4-Trimethylbenzene SW 846Method 8280DIS0308 < 0.50 pg/L 12/112023 1,2-Dibromo-3-Chloropropane SW846Method 8260D/5030B <0.50Ng/L 12/112023 1,2-Dibromoethane SIN 846 Method 8260015030B <0.50ug/L 12/1/2023 1,2-Dichlorobenzene SW 846 Method 826OD16030B <0.50ug/L 12/1/2023 1,2-Dichloroethane SW 846 Method 826OD15030B <0.60pg/L 12/1/2023 1,2-Dichloropropane SW a46 Method 8260DIS030B <0.50pg/L 12/112023 1,3,5-Trimethylbenzene SW 846 Method 8260D/5030B <0.50pg/L 12/1/2023 1,3-Dichlorobenzene SW846 Method 826DD15030B <0.50pg/L 12/1/2023 1,3-Dichloropropane SW846Method B260DIS0308 <0.50pg/L 12/1/2023 1,4-Dichlorobenzene SW 848 Method 8260D15030B < 0.50 Vg/L 121112023 Report C' 2023-27747 Page l of Environmental Chemists, Inc. envirochem 6602 Windmill Way, Wilmington, NC 28405 . 910.392.0223 Lab • 910.392.4424 Fax 710 Bowsertown Road, Mantec, NC 27954 . 252.473.5702 Lab/Fax 255-A Wilmington Highway, Jacksonville, NC 28540 . 910.347.5843 Lab/Fax ANALYTICAL A CONSULTING CHEMISTS info@environmentalchemists.com Sampson Co. Schools Date of Report: Dec 13, 2023 437 Rowan Road Customer PO M Clinton, NC 28328 Customer ID: 19040001 Attention: Report M 2023-27747 Project ID: M/Wells - Midway Middle 2,2-Dichloropropane SW 846 Method8260D/5030B <0.50pg/L 12/1/2023 2-Chlorotoluene SW 846 Method8260D/50308 <0.50Ng/L 12/1/2023 4-Chlorotoluene SW 846 Method6260D/5030B <0.50Ng/L 12/1/2023 Benzene SW 846 Method 8260D/5030B < 0.50 ug/L 12/1/2023 Bromobenzene - SW 846 Method 8200D/S0308 <0.50 pg/L 12/1/2023 Bromochloromethane SW 846 Method 826OD15030B <0.50ug/L 12/1/2023 Bromodichloromethane SW 846 Method8280D/5030B <0.50pg/L 12/1/2023 Bromoform SW 846 Method 826OD150308 < 0.50 Ng/L 12/1/2023 Bromomethane SW 846 Method828OD150308 <0.50Ng/L 12/1/2023 Carbon tetrachloride SW 846 Method 826OD150308 <0.50Ng/L 12/1/2023 Chlorobenzene SW 846 Method 82600150308 < 0.50 Ng/L 12/1/2023 Chloroethane SW 846 Method 826OD15030B < 0.50 Ng/L 12/1/2023 Chloroform SW 846 Method8260015030B <0.50ug/L 12/1/2023 Chloromethane SW 846 Method8260D15030B <0.50pg/L 12/1/2023 CIS-1,2-Dichloroethene SW 846 Method8260D/5030B <0.50pg/L 12/1/2023 CIS-1,3-Dichloropropene SW 846 Method8280D/5030B <0.50pg/L 12/1/2023 Dibromochloromethane SW 846 MethodMOD15030B <0.50ug/L 12/1/2023 Dibromomethane SW 846 Method8260D/5030B <0.50pg/L 12/1/2023 Dichlorodifluoromethane SW 846 Method 826OD15030B <0.50pg/L 12/1/2023 Ethylbenzene SW 846 Method826OD160308 <0,50Ng/L 12/1/2023 Hexachlorobutadiene SW 846 Method8260D/50308 <0.50lig/L 12/1/2023 Isopropylbenzene SW 846 Method 826OD150308 < 0.50 pg/L 12/1/2023 M¢P Xylene SW 846 Method 826OD150308 < 1.00 pg/L 12/1/2023 Methylene chloride SW 846 Method8266D/50308 <0.50pg/L 12/l/2023 Naphthalene SW 846 Method8260DIS0308 <0.50pg/L 12/1/2023 n-Butylbenzene SW 846 Method8260D/50306 < 0.50 pg/L 12/1/2023 n-Propylbenzene SW 846 Method 826OD15030B < 0.50 pg/L 12/112023 ortho-Xylene SW 846 Method 826OD15030B < 0.50 pg/L 12/1/2023 p-Isopropyltoluene SW 846 Method 826OD15030B <0.50ug/L 12/l/2023 SeC Butylbenzene - SW 846 Method 8260D/50308 - < 0.50 ug/L 12/1/2023 Report#: 2023-27747 Page 2 of Environmental Chemists, Inc. 6602 Windmill Way, Wilmington, NC 28405 . 910.392.0223 Lab . 910.392.4424 Fax 710 Bowsertown Road, Manteo, NC 27954 . 252.473.5702 Lab/Fax 255-A Wilmington Highway, Jacksonville, NC 28540 . 910,347.5843 Lab/Fax ANALYTICAL 8 CONSULTING CHEMISTS info(zenvironmentalchemists.com Sampson Co. Schools Date of Report: Dec 13, 2023 437 Rowan Road Customer PO M Clinton, NC 28328 Customer ID: 19040001 Attention: Report #: 2023-27747 Project ID: MM/ells - Midway Middle Styrene SW846Method 8260D/50308 <0.50Ng/L 12/1/2023 tert-Butylbenzene SW846Meurod8280D/503oB <0.50Ug/L 12/1/2023 Tetrachloroethene SW 848 Method 8260D/5D30B < 0.50 pg/L 12/1/2023 Toluene SW 846 Method 826OD150308 < 0.50 Ng/L 12/1/2023 Trans-1,2-Dichloroethene SW846Method 8260D/50308 <0.50Ng/L 12/1/2023 Trans-1,3-dichloropropene SW846Method 8260D/50308 <0.50pg/L 12/1/2023 Trichloroethene SW$46Method 8260D/50308 <0.50pg/L 12/1/2023 Trichlorofluoromethane SW846Method 8260D/5030B <0.50pg/L 12/1/2023 Vinyl chloride SW 846 Method 826OD15030B <0.50pg/L 12/112023 Nitrate Nitrogen (Galt) Nitrite Nitrogen EPA 3532.Rev. 2-0.1993 0.12mg/L 11/29/2023 Nitrate+Nitrite-Nitrogen EPA 3532,Rev. 20,1993 3.33mg/L 11/30/2023 Nitrate Nitrogen SubuactienMetw 3.21 mg/L 12/07/2023 Report #-: 2023-27747 Page 3 of 6 a. N a o 3 m 0 071 w m = m m m ; 0 0 F a TO m m 7 � M a � 9 9 0 o 9 v S � i O � O e = 7 CL a 3 a W � I I Sample Type L------------- 0 p n O n O n O n 0 0 O Composite or G Grab i > ` L7 'O V "O L7 'D ni 'O ' D r Container (P N or G) 1 ry m fl W a' Chlorine 1 $ mglL H � c LAB ID 5 NUMBER o rt X NONE N IT X HCL y 0 :D X xss0< y to HHOO III II A D NAOH •I (n OI X Two i B n OTHER � f m O x Z ? DUT m n w to 0. o O O s O � N O L7 L 0 It ID O Z O (Dm fA —I 4 r (n p Lb II m N m ry m C. n0 N m or — 3 0 m 3 m 0 G mm D N v' m 'S � 3 V � O n E 7 0 z m o 7 N M O O A ma 0 O G IS i i m z Or _ A p RI RI 00 i ° O n a .. ti D S Z 3 Z a 9 A i 0 p�o 9 S ri N 7 A z x y a 0 O N m O {j CO l!J ® 0 Z /A cj/ az a 0 ®mi o c � b N N g b 01 d p s - v1 's'n3 o � 3Nn �m a$ N . Environmental Chemist, Inc., Wilmington, INC Lab #94 6602 Windmill Way Wilmington, NC 28405 910.392.0223 Sample Receipt Checklist /tom Client: =50n • co• Date: I I a a3 Report Number: _ 2023- rx '1 111 Receipt of sample: ECHEM Pickup ❑ Client Delivery UPS ❑ FeclEx ❑ Other ❑ ❑ YES ID NO I ® N/A 11, Were custody seals present on the cooler? ❑ YES 10 NO O N/A 12. If custody seals were present, were they intact/unbroken? Original temperature upon receipt °C Corrected temperature upon receipt °C How temperature taken: ❑ Temperature Blank © Against Bottles IR Gun ID: Thomas Traceable S/N 210886869 IR Gun Correction Factor °C: 0.0 ❑x YES ❑ NO 3. If temperature of cooler exceeded 6°C, was Project Mgr./QA notified? ❑O YES ❑ NO 4. Were proper custody procedures (relinquished/received) followed? ❑O YES ❑ NO 5. Were sample ID's listed on the COC? O YES ❑ NO 6. Were samples ID's listed on sample containers? Ed YES ❑ NO 7. Were collection date and time listed on the COC? 21 YES ❑ NO 8. Were tests to be performed listed on the COV O YES ❑ NO 9. Did samples arrive in proper containers for each test? 9 YES ❑ NO 10. Did samples arrive in good condition for each test? Ox YES ❑ NO 11. Was adequate sample volume available?' d YES ❑ NO 12. Were samples received within proper holding time for requested tests? YES ❑ NO 13. Were acid preserved samples received at a pH of <2? YES ❑ NO 14. Were cyanide samples received at a pH >12? ❑ YES ❑ NO 15. Were sulfide samples received at a pH>9? YES ❑ NO 16. Were NH3/TKN/Phenol received at a chlorine residual of <0.5 m/L? ❑ YES ❑ NO 17. Were Sulfide/Cyanide received at a chlorine residual of <0.5 m/L? ❑ YES ❑ NO 18, Were orthophosphate samples filtered in the field within 15 minutes? * TOC/Volatiles are pH checked at time of analysis and recorded on the benchsheet. *' Bacteria samples are checked for Chlorine at time of analysis and recorded on the benchsheet. sample Preservation: (Must be completed for any sample(s) incorrectly preserved or with ea space Sample(s) were received incorrectly preserved and were adjusted accordingly by adding (circle one): H2SO4 HNO3 HCI NaOH Time of preservation: If more than one preservative is needed, notate in comments below Note: Notify customer service immediately for incorrectly preserved samples. Obtain a new sample or notify the state lab if directed to analyzed by the customer. Who was notified, date and time: Volatiles Sample(s) were received with headmare