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HomeMy WebLinkAboutWQ0005910_Monitoring - 07-2024_20240827 (3)Monitoring Report Submittal ................................................... Permit Number#* WQ0005910 Name of Facility:* Avoca LLC Month: * July Report Information Type * NDMR, NDAR-1, NDAR-2, NDMLR Confirmation Email Address: * Name of Submitter: * Signature: Date of submittal: Initial Review Year:* 2024 Upload Document* Avoca LLC July 2024 NDAR & NDMR.pdf 1.79MB PDF Only Please upload one PDF containing all applicable monitoring reports (i.e., NDMR, NDAR-1, NDAR-2, NDMLR, GW-59). brian.conner@ashland.com Brian M. Conner Reviewer: Wanda.Gerald 8/27/2024 This will be filled in automatically Is the project number correct?* WQ0005910 Is the monitoring report accepted?* Yes No Regional Office* Washington Reviewer: _anonymous Review Date: 8/28/2024 FORM NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page k of 2. Permit No.: WQ0005910 Facility Name, Avoca - Merry Hill WWTP County Serbe Month: July Year: 2024 PPI 001-7 Flow Measuring Point- ❑ Influent 2 Effluent ❑ No Flow generated Parameter Monitoring Point: ❑ Influent CO Effluent ❑ Groundwater Lowering ❑ Surface water Parameter Code ol 50050 00310 00916 00940 00927 00610 1 00625 00620 00600 00400 00665 00931 00929 70300 00536 F 0d LL o ? m C ao F Yz z z CL o o aa M to o 2: ;o y- u, v7 �5p 0 in 24-hr hrs GPD mg/L mg/L mg/L mg/L mg1L mg/L mg1L mg/L su mg/L Ratio mgJL mg1L mg/L 1 0800 8 31,082 625 2 0730 8 42,973 637 3 0745 8 27,032 643 4 0745 4 23,820 697 5 0745 8 22,145 667 6 07 15 2 1 17,816 7 07 00 2 25,540 8 0730 8 30,010 687 9 0715 8 26,004 6.35 101 07 30 8 29,382 644 111 0730 8 27,252 622 12 0745 8 21,948 665 13 0815 2 11,374 14 0715 2 4,695 15 0745 8 5,083 662 16 0745 8 11,784 668 171 0700 8 5,749 674 18 0700 8 43,228 671 19 0800 8 2,447 691 20 0800 2 17,943 21 0620 2 28,397 22 0745 8 16,198 656 23 0815 8 19,951 759 241 0745 8 23,540 77 25 0745 8 19,831 766 26 0800 8 12,906 701 27 07 40 2 15,990 28 0715 2 14,317 29 0745 8 12,191 1 1 688 301 0730 10 8,819 4500 5,65 115 193 <0 02 11.87 <0 02 11.9 669 2.98 0 638 218 1700 230 311 0915 10 8,338 679 Average: 19,606 4,50000 5.65 115 00 1 93 000 11.87 000 11.90 298 064 21800 1,70000 23000 Daily Maximum: 43,228 4,50000 565 115 00 1.93 002 1187 002 11.90 #REFl 2.98 064 21800 1,70000 23000 Daily Minimum: 2,447 1 4,500 00 5.65 11500 1.93 002 11.87 002 11.90 #REFl 298 1 064 218,00 1,700 00 230.00 Sampling Type: Recorder Grab Grab Grab Grab Grab Grab Grab Grab Grab Grab Calculated Grab Grab Grab Monthly Avg. Limit: 50,000 Daily Limit - Sample Frequency: Continuous Monthly 3 X Year 3 X Year 3 X Year Monthly Monthly Monthly Monthly 5 X Week Monthly 3 X Year 3 X Year 3 X Year Monthly FORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page 2 of 2- Sampling Person(s) Certified Laboratories Name: Brian Conner Name: Waypoint Analytical Name: Name: Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? El compliant ❑ Nan -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-ccmpliance and describe the corrective action(s) taKen. Attacn aaattlonal sneeis It Operator in Responsible Charge (ORC) Certification Permittee Certification ORC: Briars M. Conner Permittee: Avoca, LLC Certification No.: 993283 Signing Official: Sam Tynch Grade: WW2 Phone Number: 252-482-2133 Signing Officials Title: Plant Manager Has the ORC changed since the previous NDMR? ❑ Yes p No Phone Number: 252-482-2133 Permit Expiration: 10/31 /2024 6 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 ingwiry 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 Resources Information Processing Unit 1617 Mail Service Center Raleigh, forth Carolina 27699-1617 FORM NEAR-1 05-16 NON -DISCHARGE APPLICATION REPORT (NDARTfl page 1 of ll000 Av._ - Merry Hill WWTPAnnual Did irrigation occur 2 YES El NO Bermuda Grass Bermuda Grass Hourly Rate (in)- Hourly Rate (in). Rate (in): �� // ■/ Field Irrigated? � � r Monthly Loading, VOMM. I W�ZIMMMOMIW/' FORM NDAR-1 05-16 NOWDISCHARGE APPLICATION REPORT (NQAR-1) Page 2- of Permit No WQ000591 0 Facility Name, Avoca - Merry Hill VVVVTP Month: July i • irrigation occurArea at this facility?■� p YES NO Cacresy ., ..Cover C... .. Annual Rate (in):, Annual Rate (in) Annual Rate (in-Y logo ® ��M MM ... %!/!!/®%!////%,.0%/!!/// %///,ON/.I //// %/f///0" �'%///f/ N 011 FORM: NDAR-1 05-16 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page --ZL cf I Did the application rates exceed the limits in Attachment B of your permit? Were adequate measures taken to prevent effluent ponding in or runoff from the sites? Was a suitable vegetative cover maintained on all sites as specified in your permit? Were all setbacks listed in your permit maintained for every application to each permitted site? Were all freeboards maintained in accordance with the specified freeboard heights in your permit? ❑� Compliant ❑ Non -Compliant 0 Compliant ❑ Non -Compliant ❑� Compliant ❑ Non -Compliant 21 Compliant ❑ Non -Compliant 0 Compliant ❑ Non -Compliant If the facifty 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-compfance and describe the corrective action(s) taken. Attach additional sheets if necessary. Operator in Responsible Charge (ORC) Certification Permittee Certification ORC: Brian M. Conner Permittee: Avoca, LLC Certification No.: 991857, 993283 Signing Official: Sam Tynch Grade: SI 1 WW2 Phone Number: 252-482-2133 Signing Official's Title: Plant Manager Has the ORC changed since the previous NDAR-1? ❑ Yes p No Phone Number: 252-482-2133 Permit Exp.: 10/31/24 v - 6 Signature Date Sic}sature 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 property 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 infermatior, 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 fees and imprlsonmem for knowing violatons. Mail Original and Two Copies to: Division of Water Resources Information Processing Unit 1617 Mail Service Center Raleigh, North Carolina 27699-1617 WayPAoint NALYTICAL 8/19/2024 Avoca, LLC Brian Conner P.O. Box 129 Merry Hill, NC, 27957 Ref: Analytical Testing Lab Report Number: 24-213-0603 Client Project Description: 132 - AVOCA, LLC Effluent & Wells 114 Oakmont Drive, Greenville, NC 27858 Main 252.756.6208 ° Fax 252.756.0633 www.waypointanalytical.com Dear Brian Conner: Waypoint Analytical Carolina (Greenville) received sample(s) on 7/31/2024 for the analyses presented in the following report. The above referenced project has been analyzed per your instructions. The analyses were performed in accordance with the applicable analytical method, Where the laboratory was not responsible for the sampling stage (refer to the chain of custody) results apply to the sample as received. The analytical data has been validated using standard quality control measures performed as required by the analytical method. Quality Assurance, method validations, instrumentation maintenance and calibration for all parameters (NELAP and non-NELAP) were performed in accordance with guidelines established by the USEPA (including 40 CFR 136 Method Update Rule May 2021). Certain parameters (chlorine, pH, dissolved oxygen, sulfite...) are required to be analyzed within 15 minutes of sampling. Usually, but not always, any field parameter analyzed at the laboratory is outside of this holding time. Refer to sample analysis time for confirmation of holding time compliance. The results are shown on the attached Report of Analysis(s). Results for solid matrices are reported on an as - received basis unless otherwise indicated. This report shall not be reproduced except in full and relates only to the samples included in this report. Please do not hesitate to contact me or client services if you have any questions or need additional information. Sincerely, �9 � V� Ron Boquist General Manager Laboratory's liability in any claim relating to analyses performed shall be limited to, at laboratory's option, repeating the analysis in question at laboratory's expense, or the refund of the charges paid for performance of said analysis. NC DHHS DW Cert44 37715 NC DEQ WW Cert# 10 NC DEQ W W Satellite Cert4t 610 Page 1 of 8 (2) 114 Oakmont Drive, Greenville, NC 27858 Waypoint, Main 252.756.6208 ° Fax 252.756.0633 ANALYTICAL www.waypointanalyrical.com Sample Summary Table Report Number: 24-213-0603 Client project Description: 132 - AVOCA, LLC Effluent & Wells Lab No Client Sample ID Matrix Date Collected Date Received Method Lab ID 72686 Effluent Aqueous 07/30/2024 14:00 07/31/2024 72686 Effluent Aqueous 07/30/2024 14:00 07/31/2024 300.0 WP CNC 72687 Well#5 Aqueous 07/30/2024 14:35 07/31/2024 72687 Well #5 Aqueous 07/30/2024 14:35 07/31/2024 300.0 WP CNC 72688 Well #7 Aqueous 07/30/2024 15A5 07/31/2024 72688 Well #7 Aqueous 07/30/2024 15:45 07/31/2024 300.0 WP CNC 72689 Well #8 Aqueous 07/30/2024 15:15 07/31/2024 72689 Well #8 Aqueous 07/30/2024 15:15 07/31/2024 300.0 WP CNC 72690 Well #9 Aqueous 07/30/2024 14:55 07/31/2024 72690 Well #9 Aqueous 07/30/2024 14:55 07/31/2024 300.0 WP CNC 72691 Well #10 Aqueous 07/30/2024 15:30 07/31/2024 72691 Well #10 Aqueous 07/30/2024 15:30 07/31/2024 300.0 WP CNC 72692 Well #11 Aqueous 07/30/2024 14:20 07/31/2024 72692 Well #11 Aqueous 07/30/2024 14:20 07/31/2024 300.0 WP CNC WP CNC - Charlotte, NC: Waypoint Analytical - Charlotte, Charlotte, NC Page 2 of e 0 0 Oakmont Drive, Greenville, NC 27858 Waypoint. 114 Maid 252.756,62081 Fax 252.756.0633 ANALYTICAL www.waypointanalytical.com 08604 Avoca, LLC Brian Conner Project 132 - AVOCA, LLC P.O. Box 129 Information : Effluent & Wells Merry Hill , NC 27957 Report Number : 24-213-0603 REPORT OF ANALYSIS Report Date : 08/19/2024 Received : 07/31/2024 Lab No : 72686 Sample ID : Effluent Matrix; Aqueous Sampled: 7/30/2024 14:00 Test ReSURS Units MQL DF Date / Time By Analytical Analyzed Method Nitrite (NO2-N) 0.02 mg/L 0.02 1 07/31/24 16:18 K)D 353.2 Nitrate (NO3-N) <0.020 mg/L 0.020 1 07/31/24 16:18 3RF EPA-3S12 Ammonia Nitrogen <0.02 mg/L 0.02 1 08/06/24 16:29 HMM 350.1 Biochemical Oxygen Demand (5-day) 4500 mg/L 2000 1 07/31/24 09:18 AAM 5210E-2016 Bromide 74.8 rng/L 0.500 5 08/11/24 15:36 NDL 300.0 Chloride 115 mg/L 5.00 1 08/09/24 09:30 BNC 4500-CI-B Nitrate+Nitrite-N 0.03 mg/L 0.02 1 08/01/2412:07 353.2 Total Dissolved Solids 1700 mg/L 50 1 08/06/24 10:38 HMV 254OC-2015 Total Suspended Solids 230 mg/L 62.5 1 08/01/24 10:00 BLV 254OD-2015 Total Kjeldahl Nitrogen 11.87 mg/L 2.00 10 08/08/24 15:46 HMM EPA-351.2 Total Nitrogen 11.9 mg/L 0,020 1 08/01/24 12:07 CALCULATION Phosphorus 2.98 mg/L 0.02 1 08/08/2414:19 HMM 365.4 Calcium 5.65 mg/L 0.500 1 08/05/2417:48 MTM EPA-200.7 Magnesium 1.93 mg/L 0.500 1 08/05/2417:48 MTM EPA-200.7 Sodium 218 mg/L 2.50 1 08/OS/2417:48 MTM EPA-200.7 Sodium Absorption Ratio 0.638 Ratio 0.100 1 08/05/24 17:48 CALCULATION Qualifiers/ DF Dilution Factor Definitions MQL Method Quantitation Limit L Limit Exceeded Page 3 of 8 Waypointo ANALYTICAL 08604 Avoca, LLC 114 Oakmont Drive, Greenville, NC 27858 Main 252.756,6208 ° Fax 252.756.0633 www.waypointatialytical.com Brian Conner Project 132 - AVOCA, LLC P.O. Box 129 Information : Effluent & Wells Merry Hill , NC 27957 Report Date ; 08/19/2024 Report Number : 24-213-0603 REPORT OF ANAL MSIS Received : 07/31/2024 Lab No : 72687 Matrix: Aqueous Sample ID : Well #5 Sampled: 7/30/2024 14:35 Test Results Units MQL DF Date / Time By Analytical Analyzed Method Nitrate (NO3-N) 0,030 mg/L 0.020 1 07/31/24 16:26 7RF EPA-353.2 Ammonia Nitrogen 0,06 mg/L 0.02 1 08/06/24 16:06 HMM 350.1 Bromide 10.9 mg/L 0.100 1 08/14/2413:57 NDL 300.0 Chloride 32.0 mg/L 2.00 1 08/09/24 09:30 BNC 4500-CI-B Total Dissolved Solids 550 mg/L 25 1 08/06/24 10:38 HMV 254OC-2015 Phosphorus <0.02 mg/L 0.02 1 08/08/2414:21 HMM 365.4 TOC 2.31 mg/L 1.00 1 08/12/2412:22 BLV 531OC-2014 Calcium 32.1 mg/L 0.500 1 08/05/2417:52 MTM EPA-200.7 lab No : 72688 Matrix: Aqueous Sample ID : Well #7 Sampled: 7/30/2024 15:45 Test Results Units MQL DF Dale / Time By Analytical Analyzed Method Nitrate (NO3-N) 0.760 mg/L 0.Og0 1 07/31/24 16:25 3RF EPA-353.2 Ammonia Nitrogen <0.02 mg/L 0.02 1 08/06/24 13:57 HMM 350.1 Bromide 8.27 mg/L 0.100 1 08/14/2414:09 NDL 300.0 Chloride 23.0 mg/L 2.00 1 08/09/24 09:30 BNC 4500-CI-B Total Dissolved Solids 180 mg/L 13 1 08/06/24 10:38 HMV 254OC-2015 Phosphorus <0.02 mg/L 0.02 1 08/08/2410:53 HMM 365.4 TOC 2.73 mg1L 1.00 1 08/12/2412:22 BLV 531OC-2014 Calcium 10.6 m9/L 0.500 1 08/05/2417:57 MTM EPA-200.7 Qualifiers/ DF Dilution Factor L Limit Exceeded Definitions MQL Method Quantitation Limit Page 4 of 8 Waypointo ANALYTICAL 08604 Avoca, LLC 114 Oakmont Drive, Greenville, NC 27858 Main 252.756.62081 Fax 252,756.0633 www.waypointanalytical.com Brian Conner Project 132 - AVOCA, LLC Ro. Box 129 Information : Effluent & Wells Merry Hill , NC 27957 Report Date : 08/19/2024 Report Number : 24-213-0603 REPORT OFANAL YSIS Received : 07/31/2024 Lab No : 72689 Matrix: Aqueous Sample ID : Well #8 Sampled: 7/30/2024 15:15 Test Results Units MCIL DF Date/Time By Analytical Analyzed Method Nitrate (NO3-N) 0.110 rng/L 0.040 1 07/31/24 16:23 3RF EPA-353.2 Ammonia Nitrogen 2.46 mg/L 0.02 1 08/06/24 13:59 HMM 350.1 Bromide 5.82 mg/L 0.100 1 08/14/2414:22 NDL 300.0 Chloride 12.5 mg/L 1.00 1 08/09/24 09:30 BNC 4500-CI-B Total Dissolved Solids 570 mg/L 25 1 08/06/24 10:38 HMV 2540C-2015 Phosphorus 6.06 mg/L 0.02 1 08/08/2410:55 HMM 365.4 TOC 1.40 mg/L 1.00 1 0811212112:22 BLV 531OC-2014 Calcium 9,32 mg/L 0.500 1 OB/05/2418:01 MTM EPA-200.7 Lab No: 72690 Matrix: Aqueous Sample ID : Well #9 Sampled: 7/30/2024 14:55 Test Results Units MOL DF Date 1 Time By Analytical Analyzed Method Nitrate (NO3-N) 3.07 mg1L 0.080 1 07/31/24 16:22 7RF EPA-353.2 Ammonia Nitrogen <0,02 mg/L 0.02 1 08/06/24 13:03 HMM 3SO.1 Bromide <0.100 mg/L 0.100 1 08/14/2414.34 NDL 300.0 Chloride 27.5 mg1L 1.00 1 08/09/24 09:30 BNC 4500-Cl-B Total Dissolved Solids 270 mg/L 25 1 08/06/24 10:38 HMV 2540C-2015 Phosphorus <0.02 mg/L 0.02 1 08/08/24 14:16 HMM 365.4 TOC <1.00 m9/L 1.00 1 08/12/2412:22 BLV 531OC-2014 Calcium 46.6 mg/L 0.500 1 08/05/2418:05 MTM EPA-200.7 Qualifiers/ DF Dilution Factor L Limit Exceeded Definitions MQL Method Quantitation Limit Page 5 of 8 0 • 114 Oakmont Drive, Greenville, INC 27858 Waypoint.Main 252.756.6208 ° Fax 252.756.0633 ANALYTICAL www.waypointanalytical.com 08604 Avoca, LLC Brian Conner Project 132 - AVOCA, LLC P.O. Box 129 Information : Effluent & Wells Merry Hill , NC 27957 Report Date ; 08/19/2024 Report Number : 24-213-0603 REPOR T OFANAL YSIS Received : 07/31/2024 Lab No: 72691 Matrix: Aqueous Sample ID : Well #10 Sampled: 7/30/2024 15:30 Test Results Units MQL DF Date / Time By Analytical Analyzed Method Nitrate (NO3-N) 9.31 mg/L 0.400 1 07/31/24 16:20 JRF EPA-353.2 Ammonia Nitrogen <0.02 mg/L 0.02 1 08/06/24 16:21 HMM 350.1 Bromide <0.100 mg/L 0.100 1 08/14/24 14:46 NDL 300.0 Chloride 71.0 mg/L 1.00 1 08/09/24 09:30 BNC 4500-CI-B Total Dissolved Solids 380 mg/L 25 1 08/06/24 10:38 HMV 254OC-2015 Phosphorus 0.05 mg/L 0.02 1 08/08/2414:37 HMM 365.4 TOC 1.26 mg/L 1.00 1 08/12/2412:22 BLV 5310G2014 Calcium 26.6 mg/L 0.500 1 08/05/2418:09 MTM EPA-200.7 Lab No: 72692 Matrix: Aqueous Sample ID: Well #11 Sampled: 7/30/2024 14:20 Test Results Units MQL DF Date 1 Time By Analytical Analyzed Method Nitrate (NO3-N) 0.080 mg/L 0.040 1 07/31/24 16:14 JRF EPA-353.2 Ammonia Nitrogen 7.81 mg/L 0.02 1 08/06/24 16:27 HMM 350.1 Bromide 9.66 mg/L 0.100 1 08/1412414:59 NDL 300.0 Chloride 27.0 mg/L 2.00 1 08/09/24 09:30 BNC 45MCI-B Total Dissolved Solids 1100 mg/L 25 1 08/06/24 10:38 HMV 2540C-2015 Phosphorus 0.54 mg/L 0.02 1 08/08/24 14:44 HMM 365.4 TOC 9.57 mg/L 1.00 1 08/12/2412:22 BLV 531OC-2014 Calcum 27.0 mg/L 0.500 1 08/05/2418:13 MTM EPA-200.7 Qualifiers/ DF Dilution Factor L Limit Exceeded Definitions MQL Method Quantitation Limit Page 6 of 8 (2) Waypoint ANALYTICAL 114 Oakmont Drive, Greenville, NC 27858 Main 252.756.6208 ° Fax 252.756.0633 www.waypointanalytical.com Shipment Receipt Form Customer Number: 08604 Customer Name: Avoca, LLC Report Number: 24-213-0603 Shipping Method 0 Fed Ex 0 US Postal # Lab 0 UPS 0 Client 0 Courier Other: Thermometer ID: 11.5c oakton Shipping container/cooler uncompromised? Yes 0 No Number of coolers/boxes received �1 Custody seals intact on shipping container/cooler? 0 Yes 0 No 0 Not Present Custody seals intact on sample bottles? 0 Yes 0 No Not Present Chain of Custody (COC) present? 0 Yes 0 No COC agrees with sample label(s)? Yes 0 No COC properly completed Yes 0 No Samples in proper containers? Yes 0 No Sample containers intact? Yes 0 No Sufficient sample volume for indicated test(s)? Yes 0 No All samples received within holding time? Yes 0 No Cooler temperature in compliance? Yes 0 No 0 Not Present Cooler/Samples arrived at the laboratory on ice. Samples were considered acceptable as cooling process had begun. Yes 0 No Water - Sample containers properly preserved Yes 0 No 0 NIA Water - VOA vials free of headspace 0 Yes 0 No # NIA Trip Blanks received with VOAs 0 Yes 0 No NIA Soil VOA method 5035 — compliance criteria met 0 Yes 0 No NIA High concentration container (48 hr) F Low concentration EnCore samplers (48 hr) High concentration pre -weighed (methanol -14 d) [_ Low conc pre -weighed vials (Sod Bis -14 d) Special precautions or instructions included? Comments: 0 Yes 0 No Signature: I inter Foreman Date & Time: ,07/31/2024 1216:20 Page 7 of 8 Waylaoint o Wavnoint Analvtical - Greenrille CHAf*T rx TQ-rnnv RFCY?RD Pai!e 1 pI [ I .tk% mont 13r y � II � 111 gl5ltil»1?CTION CHLORINE CHECK (LAB) Grcen� sllc. �iC'_785R e n [ � 08504 I�I 11� f �) fll 1 I� 1 f11 u1 w%%w WaypointAnAytcc.sl.com Phone (2521 756-62€ 8 • faY (252 t 756-063 3 ❑ CHLORINE: p7 3 � p6q' Avoca LLC = - 132 -AVCCA LLC 1, 33 3 s ^ tp 5 mg L -Yes YJ or No {NI pH CHECK (S U) (LAB) CLIENT- 132 Week. 33 ❑ UV COMAINERTYPE, PIG AVOCA, LLC (WASTEWATER) P MR. SRIAN CONNER ❑ NONEI P.O. SOX 129 MERRY HILL NC 27957 ❑A. A G C C A CHEMICAL PRESERVATION A - NONE D - NAOH (252) 452-2133 LLr z� z w B HNO, E I ICL EZ Ui ,� zCC ca4 C - H.SO, F -ZINC ACETATE/NAOH COLLECTION ¢ o o w 25 r- t7t -1 Uj ¢ G - NA THIOSULFATE SAMPLE LOCATION DATE I TIME Effluent `1 3a d�k i�{p0 Yl S ,•.. V CtASS4EICATiOiV ❑ WASTEWATER(NPDES) Wc1I 74 7 + well _ d,-1 ��,— 1I s 7 ❑ DR€NKiNG WATER ell N7 , -30 , 7 ` DWR/GW ❑ SOLID WASTE SECTION %Nel[ 118 -1-30.4ti Isis DUO 7 1�cll #9 -1 3n apt y�{5s,� 41'cII #110 7 CHAINDURING CUSTOIDY V1 cif f�1 i 7 rrMENT/DELIVERYL)MANTINED N SAMPLES COLLECTED BY (Please Pnnt) SAMPLES RECEIVED IN LABAT-1 -�� •C RELINQUISHED BY (SIG) (SAMPLER) DATEMME —�— DATEICIME COMMENTS � SAMPLES RECEIVED ON ICE- YE//S - NO -c7 ���5 7CMEIVED, �[�i ��r RE NO Ed (SIC 1 DATEMME R C 6ED BY (SIG 1 DATFj nME RELINQUISHED BY (SIG) DATEMME RECEIVED BY (SIG) DATEMME PLEASE READ Instructions for complettng this form on the reverse stde. Sampler must place a "C" for composite sample or a "T for Joann �� Grab sample m the blocks above for each parameter requested Page 8 of 8