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WQ0014785_Monitoring - 07-2024_20240806
Monitoring Report Submittal ................................................... Permit Number#* WQ0014785 Name of Facility:* Month: * July Midway Middle School Report Information Type * NDMR, NDAR-1, NDAR-2, NDMLR Year:* 2024 Upload Document* D00080624-08062024095313.pdf PDF Only 1.1MB Please upload one PDF containing all applicable monitoring reports (i.e., NDMR, NDAR-1, NDAR-2, NDMLR, GW-59). Confirmation Email Address: * jelmore@sampson.k12.nc.us Name of Submitter: * Robert Carroll Signature: 1?0-1)eyfclgwo// Date of submittal: Initial Review Reviewer: Wanda.Gerald 8/6/2024 This will be filled in automatically Is the project number correct?* WQ0014785 Is the monitoring report accepted?* Yes No Regional Office* Fayetteville Reviewer: _anonymous Review Date: 8/8/2024 FORM: NDAR-1 08-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page of Permit No.: W00014785 Facility Name: Midway Middle School Field Name: { _ Field Name: 2 Did irrigation occur Area (acres) D 435 - Area (acres): 0.435 at this facility? _ .Cover_Crop.. _ Cover Crop: ❑vEs 2N0 Hourly Rafe (m) 0 16 _ Hourly Rate (in): 0.16 Annual Rate (m) 39 - Annual Rate (in): 39 Weather Weather Freeboard Fieldirrgate�?, YES;!,. ❑NO ". Field Irrigated? ❑YEs ONO a 3 _ y y m ,� a o : 8 of as v a E G S l: 'G'; C/ 7 -¢ rG J j V OF in ft it gal _ <min -: m - m ,_=' gal min in in o a 0.00 0.00 z0.00 ;; 0 0 0.00 0.00 3 0 ;' 0 ' 0 00 a YF00 ' 0 0 0.00 0.00 4 0 ° : 0 0.00, , 0:00 "-- 0 0 0.00 0.00 $ _o 0 0.00 0 00 . , 0 0 0.00 0.00 6 0 0 - 0 00 , , 0 00 , r_=: 0 0 0.00 0.00 :o o - _oao. aoo --_ 0 0 0.00 0.00 s o o a:oo . ,` now __ 0 0 0.00 0.00 9 0 0 o 00 - 000 _ 0 0 0.00 0.00 10 U 0 -' 0 00 0;00 -• 0 0 0.0o O.aO 11 %0 0 0 0 0 0.00 0.00 12 ` 0 a QO - 0 00. -` o o 0.00 0.00 1300 = a.oa-_: 0 0 0.00 0.00 14 no .� P 0 00 ;?_- 0 0 0.00 0.00 15 0 ` o =aoo 0 0 0.00 0.00 16 0 0 0.00 0.00 17 fl 0, . ':_ O a0 '_. 0 00 0 0 0.00 0.00 18 0 >= 0 - 0 00 = 0.00 ' 0 0 0.00 0.00 19 0 0 0 00 - 0 00;' ; 0 0 0,00 0.00 20 0 a - 0 00 0 00 - = 0 0 0.00 0.00 21 0 0 0.00 0.00 22 a -�! a 00 .,,; 0 aa- j a 0 0.00 0:00 23 0 0 0.00,;_ 0.00., . 0 0 0.00 0.00 24 0 0 = 0 00 ;., 0 0.00 0.00 25 0 0 _ . 0 00' - 0 00 0 0 0.00 0.00 25 0 -0 ' 0 00, .- 0.00 ___. 0 0 0.00 0.00 27 0 o.oa-_ 0 0 0.00 0.00 28 -0 = 0 _ 0 00 _ ozop `; 0 0 0.00 0.00 29 0 0 000 - 0 00_ = 0 0 0.00 0.00 30 0 0 aoo 0 0.00 0.00 31 r .'0 - 0 `000':- 000 'ill 0 1 0 0.00 0.00 Monthly Loading 0 - 0 00 ME= 0 0.00 12 Month Floating Total (in): -_51.9___- 5.19 County: Sampson Month: July Year: 2024 ;Field.Name = 3 Field Name: 4 Area (acres) 0.435 Area (acres): 0.435 Cover Crop _ Cover Crop: Hourly Rate (in) O.i6= Hourly Rate (in): 0,16 Annual Rate"(in) = 39 `' Annual Rate (in): 39 Fieltl Irrigated? ❑-YES ONo` Field Irrigated? DYES [aNO _ tea= - T p co= �_�. ., E N -c oa >a C7 �'� i=•°7 0 E c Ewa xOa In - In .'; gal min in in _ooa __=o 00 =- 0 0 0.00 0.00 o. o 0 oa, o:oo .. 0 0 0.00 0.00 0 0 0.00 0.00 0 0. 0.00. 0 0 0.00 0.00 00 o0 0 0 0.00 0.00 0 fl_ :-000 _-a 000,0 0 0.00 0.00 0 . -o.o0 -o 08 0 0 0.00 0.00 0 00 0 0 0.00 0.00 o =- _ ;a 000 ,.: o.o0 0 0 0.00 0.00 0 0 0,00 -0 0a . 0 0 0.00 0.00 0 -- 0, 0 00 a QO 0 0 0.00 0.00 0 0 0.00 0.00 '0 4 00 o ou _ 0 0 0.00 a.00 00 _- o 0.00 0.00 0 o a.00 0.00 0 1 0 0.00 0.00 00 0 00 ' 0 1 0 0.00 0.00 00 0 00 0 1 0 0.00 0.00 00 0 0 0.00 0.00 0_ 0 0 0.00 0.00 o as 0 0 0.00 0.00 0 00 °- 0 0 0.00 0.00 T 0 a 00 l0 00 0 a 0.00 0.00 0.: 40 U00. OOOF; 0 0 0.00 0.00 0 Oq _ 0 0 0.00 0.00 "=000. =; 0 a 0.00 0.00 0 =` 0 °"0100 - 0.00 = 0 0 0.00 0.00 -0 00, 0 0 0.00 0.00 MET =o 0 oa o 00 0 a 0,00 0.00 0 U,00 :#Ri;F1 0 a 0.00 0.a0 0 0.00 5 19 _VZONIA 5.19 FORM: NDAR-1 08-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page of Did the application rates exceed the limits in Attachment B of your permit? 11Compliant ❑Non -Compliant Were adequate measures taken to prevent effluent ponding in or runoff from the sites? OCompliant El 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? RCompliant ❑Non -Compliant Were all freeboards maintained in accordance with the specified freeboard heights in your permit? 21Compliant ❑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 SCHOOLS Certification No.: 26341 signing official: Robert Carroll Grade: SI Phone Number: 910-385-6116 Signing Official's Title: ORC Has the ORC changed since the previous NDAR-1? ❑Yes nNo Phone Number: 910-385-6116 Permit Exp.: 10/31/28 f/ 8/6/24 8/6/24 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 FORM: NDAR-1 08-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page of Permit No.: W00014785 Facility Name: 0 Field Name Field Name: 6 Did irrigation occur =_ Area (acres) 0 435 Area (acres): 0.435 at this facility? Cover -Crop. _ Cover Crop: ❑YES orvo Hourly Rate (tn) = 016 = Hourly Rate (in): 0.16 Annual Rate (tn) 39 Annual Rate (in): 39 Weather Freeboard Field Irrigated? :'DYES a qN0 Field Irrigated? ❑YES QNO m c . - CL ~ LA 04 OF in ft ItM'o -min - m __ In '`" gal min in in 1 _ O 00 0 0 0.00 0.00 20.00W0 0 0.00 0.00 3 0 0 DO __ 0 00 0 0 0.00 0.00 4` 0 0 00 0 00 - 0 0 0.00 0,00 5 0 0 -0 00 ; waoc 0 0 0.00 0,00 6 0 � 0 0:00., = 0 00 -_ 0 0 0.00 0.00 7 9 =0 0OD 000 _ 0 0 0.00 0.00 s 0 , o , . :• aoo 0 00 ' 0 0 0.00 0.00 9 0 D _o oa> , 0.00"? 0 0 0.00 0.00 10 D o %%0.0Gn, 0 0 0.00 0.00 11 =0 0 -0 00 f 0 00 0 0 0.00 0.00 12 0 0 0 00 ... ODD ': 0 0 0.00 0.00 13 - ` 0`DO F'a o 0 0.00 0.00 14 =o 0 o ao . - o 00 _= o o a.00 0.00 15 0 0 0.00 0.00 16 0 = a 0 00 _' _ 0 qD -' 0 0 0.00 0.00 17 -o A o ao >;_ 0 00 0 0 0.00 0.00 18 0 0 = D oo :." _ __>_ 0 00 _ ;_ o 0 0.00 0.00 19 '0 ` 0 -- GAO = o DO '_ ;' 0 0 0.00 0.00 za 0 0 0.00 0.00 21 0 0 a.00 o.00 22 0 0 0.0 '- 0 00_� 0 0 0.00 0.00 23 0 0 -= a 00 0 00 "__1 0 1 0 0.00 0.00 24 =-0„ 0 0 00 0 Q0:_ 0 0 0.00 0.00 25 l) y 0 _ 0 00 '`:_ 0 0 0.00 0.00 26 0 0 0.00 0.00 27 0.0 0 00 _t_ 0 0 0.00 0.00 28 =0 - 0 0,001, .' 0 00 s-;K 0 0 0.00 0.00 29 0 0 0.00 0.00 30 i -0..,00;,', 0 0 0.00 0.00 31 `0 0 A 00 0 Q0''_ 0 0 0.00 0.00 Monthly Loading p -_DOD 0 0.00 12 Month Floating Total (in): 5 19 - 5.19 County: Sampson I Month: July Year: 2024 Field Name: 8 Area (acres): 0.435 Cover Crop: Hourly Rate (in): 0.16 Annual Rate (in): 39 Field Irrigated? DYES 13NO ' Q E ~ c _j 14 0 CD E M = J gal min in in 0 0 0.00 0,00 0 0 0.00 0.00 0 0 0.00 0.00 0 0 0.00 0.00 0 0 0.00 0.00 0 0 0.00 0.00 0 0 0.00 0.00 0 0 0.00 0.00 0 0 0.00 0.00 0 0 0.00 0.00 0 0 0.00 0.00 0 0 0.00 0.00 0 0 0.00 0.00 0 0 0.00 0.00 0 0 0.00 0.00 0 0 0.00 0.00 0 0 0.00 0.00 0 0 0.00 0.00 0 0 0.00 0.00 0 0 0.00 0.00 0 0 0.00 0.00 0 0 0.00 0.00 0 0 0.00 0,00 0 0 0.00 0.00 0 0 0.00 0.00 0 0 0.00 0.00 0 0 0.00 0.00 0 0 0.00 0.00 0 0 0,00 0.00 0 0 0.00 0.00 0 0 0,00 0.00 6 mm 0.00 5.19 FORM: NDAR-1 08-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page of Did the application rates exceed the limits in Attachment B of your permit? OCompliant 11Non-Compliant Were adequate measures taken to prevent effluent ponding in or runoff from the sites? 9Compliant ❑Non Compliant Was a suitable vegetative cover maintained on all sites as specified in your permit? 2Compliant DNon-Compliant Were all setbacks listed in your permit maintained for every application to each permitted site? OCompliant ❑Non -Compliant Were all freeboards maintained in accordance with the specified freeboard heights in your permit? 2Compliant ❑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 SCHOOLS Certification No.: 26341 Signing Official: Robert Carroll Grade: S1 Phone Number: 910-385-6116 Signing Official's Title: ORC Has the ORC changed since the previous NDAR-1? El Yus o No Phone Number: 910-385-6116 Permit Exp.: 10/31 /28 8/6/24 8/6/24 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. t 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 FORM: NDMLR 08-11 NON -DISCHARGE MASS LOADING REPORT (NDMLR) Page of Permit No.: WQ0014785 Facility Name: Midway Middle School County: Sampson Month: July Year: 2024 Field Name: 1 Fleltl Name _ 2 - - Field Name: 3 = FJeld Name = 4 _ - Field Name: 5 Area (acres): 0.435 Area (acres) 0 435 . Area (acres): 0.435 Area (acres): 0.435 Cover Crop: Icover Crop - Cover Crop: <,oVer Crop = Cover Crop: Load Type: PAN Load Type =PAN - Load Type: PAN = rload Type :PAN = Load Type: PAN Field Loaded? DYES 21No N0 ,- Field Loaded? ❑YES El NO FIe1d Loaded? ❑YES, oNo. ;. Field Loaded? El YES 0 NO a z z m z z o41 z ZE n ° Q az a a>o `,'�o ao co a NC •• azE f0 Qa> !=0 O O A_a E d Jzam id J E E e• E E >o c ; > °? EE Month gal mglL Ibslac lbslaC „gal mglL_ Ibslac ;Itis/ac`- ga! mg1L Ibslac Ibslac = gal '- mglL , Ibslac !bslec gal mglL Ibslac Ibslac August September = - October November December January =_ February = - March - April May - - June July 0 0 0.0 0.0 .0'; 0= , 09 0 0 0 0.0 0.0 O,::aa, 0_- O.O , „ OQ> >- 0 0 0.0 0.0 12 Month Floating PAN Load 0.0 = - 00 0.0 0 0 0.0 (Ibslaclyr): Annual PAN Load Limit 11 11 00 ` 11.00 11 00 ' 11.00 (lbslaclyr): FORM: NDMLR 08-11 NON -DISCHARGE MASS LOADING REPORT (NDMLR) Page of Did the mass loading rates exceed the limits in Attachment B of your permit? 2Compliant LlNon-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 actions) taken. Attach additional sheets if necessary. Operator in Responsible Charge (ORC) Certification ORC: Robert Carroll Certification Number: 26341 Grade: SI Phone Number: 910-385-6116 Has the ORC changed since the previous NDMLR? El Yes ❑ No Signature By this signature, I certify that this report is accurrate and complete to the best of my knowledge. Permittee Certification Permili SAMPSON COUNTY SCHOOLS Signing Official: Robert Carroll Signing Official's Title: ORC Phone No.: 910-385-6116 Permit Exp.: 10/31/28 8I6/24 / / 8/6/24 Date Signature Date 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 an 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 Inforrnation Processing Unit 1617 Mail Service Center Raleigh, North Carolina 27699-1617 FORM: NDMLR 08-11 NON -DISCHARGE MASS LOADING REPORT (NDMLR) Page of Permit No.: W00014785 Facility Name: Midway Middle School County: Sampson Month: July Year: 2024 Field Name: 6 -Field Name - 7 - Field Name: 8 FieldNtame = = Field Name: Area (acres): 0.435 Area (acres) Area (acres): 0.435 = 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? ❑Yes allo Field 60aded? ❑YES ❑No, - Field Loaded? UYes El NO Fl ld Loaded? ❑YES ❑nto Field Loaded? ❑YES allo zaLc aa' za z z az oo da > ° n - > Lcaa ryF � cN o`y J p 6 C J t J EO r c YJ 3 EE rC+ a? o J> E c e 3 o o Month gal mglt Ibslac Ibslac gal;:, _rttgiL,,.lbslac Jbslac= gal mglL Ibslac Ibslac _ gal- ,rtiglL Ibslac 'Itislac` gal mg1L Ibslac Ibslac August = _ - September _ - October November n66 A- -'a December January _ February March . April May = June - July 0 0 0.0 0.0 }0 '- - 00` Raml 0 0 0.0 0.0 12 Month Floating PAN Load 0.0 0 0 0.0 0 I) 0.0 (Ibslaclyr): Annual PAN Load Limitrd 11 - 11300y 11.00 Y (lbslaclyr): FORM: NDMLR 08-11 NON -DISCHARGE MASS LOADING REPORT (NDMLR) Page of Did the mass loading rates exceed the limits in Attachment B of your permit? RCompliant ❑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 SCHOOLS Certification Number: 26341 Signing Official: Robert Carroll Grade: SI Phone Number: 910-385-6116 Signing Official's Title: ORC Has the ORC changed since the previous NDMLR? El Yes o No Phone No.: 910-385-6116 Permit Exp.: 10/31/28 8/6/24 44 8/6124 Signature Date Signature Date By this signature, 1 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 FORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page of Permit No.: WQ0014785 Facility Name: MidwayMiddle School County:• • 1 - .�- a� a �a�aa ea. as � aa. a �� a aa.. ei. a •�• ai•o ia.�� o as INN ®-- Average. _ 126_. ''; 6d 8d_; `; 0.00 47.90. ' 22.90 "1 00 22.20 Daily Maximum: ' `_ 371 , 1; 6.71 6..Q 80:' 0.00 47 X = 22.90 ffiA.00, , 22.20 Daily Minimum " = '14 ..' 6.71 tiU. 80;, 0.00 47 9_D - 22.90 -0 fl0, ,'' 22.20 004 - , _ BO $0+ Sampling Type: Monthly Limit 310 Daily Limit Sample Frequency FORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page of Sampling Person(s) Certified Laboratories Name: Name: Name: Name: Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? 121Compliant El 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 Schools 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 NDMR? LJ Yes G_l No Phone Number: 910-385-6116 Permit Expiration: 10/31/2028 Iz- 8/6/2024 / 8 16/2024 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 r"07— Environmental Chemists, Inc. envirochem 6602 Windmill Way, Wilmington, NC 2M • 910,392.0223 Lab • 910.392.4424 Fax ® 710 Bowsertown Road, Manteo, NC 27954 " 252.473.5702 Lab/Fax 255-A Wilmington Highway, Jackaonville, NC 28540 ' 910.347.5843 Lab/Fax ANALYTICAL a CQNSLUING CHEMISTS info@environmentalchemismcom Sampson Co. Schools Date of Report: Jul 12, 2024 437 Rowan Road Customer PO #: Clinton, NC 28328 Customer ID: 19040001 Attention: Report #: 2024-14908 Project ID: Midway Middle PPI001 Lab ID Sample ID: Collect Datemme Matrix Sampled by 24-36592 Site: Effluent - Grab 7/1/2024 9:30 AM Water Robert Carroll Test Method Results Date Analyzed Ammonia Nitrogen EPA350.1, Rev. 2.0,1993 47.9 mg/L 07/03/2024 Fecal Coliform Idea« colIN"t-16 1340 MPN/100mi 07/01/2024 Residue Suspended (TSS) SM 2640 D-2015 22.9 mg/L 07/02/2024 Total Phosphorus SM 4500 P (P.14).2011 20.2 mg/L 07/10/2024 BOD SM 5210 6.2016 8 mg/L 07/01/2024 Nitrate Nitrogen (Calc) Nitrite Nitrogen EPA 353.2, Rev. 2-0,1993 < 0.02 mg/L 07/01/2024 Nitrate+Nitrite-Nitrogen EPA 363.2, Rev, 2,0,1993 0.04 mg/L 07/02/2024 Nitrate Nitrogen SuWaction Method 0,04 mg/L 07/02/2024 Total Nitrogen (Cale) Total Kjeldahl Nitrogen (TKN) EPA 351.2, Rev. 2.0,1993 60.8 mg/L 07/10/2024 Total Nitrogen Total Nitrogen 60.8 mglL 07/10/2024 Comment 16 ., . n _— A 1% 1 Reviewed by: Report V 2024.14908 Page 1 of 1 Environmental Chemist, Inc., Wilmington, NC Lab #94 6602 Windmill Way Wilmington, NC 28465 910.392.0223 Sample Recelpt Checklist Client r �Ul V t �� ► •.[ f \Rkle Date: ReportNumber: _ 2024 Receipt.ofsempit: ECHEM Pickup Client Delivery O UPSE3 FeclEx ❑ other ❑ YES 113 NO J 0 N/A I. Were custody seals present :on the cooler? ©. YES 10 NO ® N/A 11, if custody seals were present, were they Intact/unbroken? Original temperature upon receipt 'C Corrected temperature upon receipt "C How temperature taken: ❑ Temperature Blank 0 Against Bottles IR Gun ID: Thomas Traceable S/N 210886869. lR Gun Correction Factor "C: 0.0 19 YES ❑ NO 3. If temperature of cooler exceeded 60C, was Project Mgr./QA notified? © YES ❑ NO 4.. Were proper custody procedures (relinquished/received) followed? © YES 0 NO S. Were sample 1D's listed on the COC? W YES ❑ NO 6. Were samples ID's listed on sample containers? Im YES ©. NO 7. Were collection date and time listed on the COC? . go YES ❑ NO 8. Were tests to be performed listed on the COC? ®: YES. ❑ NO' 9. Did samples arrive in proper containers for each test? 91 YES © NO 10. Oid samples arrive in good condition for each test? YES ❑ NO 11. Was adequate sample volume available?' © 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 1.14. Were cyanide samples received at a pH >12? YES ❑ NO is, Were sulfide samples received at pH >9? YES © NO 16. Were NH3/TKN/Phenol receivedat a chloride residual of <Q.S m/L? ** YES ❑ NO 17. Were Sulfide/Cyanide received ata. chlorine residual of <O.S m/L? 13 YES 1.CI - NO 18. Were orthophosphate samples filtered in the field within 1S 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 headspace) 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 wlth headspace • Analytical & Consulting Chemists ENVIRONMENTAL CHEMISTS, INC NCDENR: DWO CERTIFICATION # 94 NCDHHS: DLS CERTIFICATION # 37729 COLLECTION AND CHAIN OF CUSTODY 6602 Windmill Way Wilmington, NC 28405 OFFICE: 910-392-0223 FAX 9ID-392-4424 info denvironmentalchemists.com Client: Sampson County Schools Project: Midway Middle School/PPI 001 W1MTF REPORT NO: Address: 437 Rowan Road CONTACT NAME: Robert Carrot PO NO: Clinton, NC 28328 REPORT TO: RobertCarroll PHONE/FAX: co : R Carroll rearroll.blackd mail.com email: (more*sam son.kl2.nc.us Sampled Or SAMPLE TYPE: I = Influent, E = Effluent, W = Well, ST = Stream, SO = Soil, SL = Sludge, Other. Sample Identification Collection S a v o _ " W m zz PRESERVATION ANALYSIS REQUESTED Date Time TampV $ _ o ' o `z o r Effluent - - L sv � 7 % P� J X BOD, TSS, NO2 G G H field : tV" X NH3, NO3, Total P, TKN, N calc G G C P I X lFecal G G C P Due: Mar, July, Nov G G C P G G Effluent G P X TDS, Chloride November onl G G G P G G Solt Sample C P X I Standard Soil Fertility (December only) G G Transfer Relinquished By. DateMm/e( Received B : t]atdiime 2. Temperature when Received Delivered BY: Resample Requested: It► gj.p!g66kjpaff m1.wo-l' i a21>fTit'