HomeMy WebLinkAboutWQ0023693_Monitoring - 11-2022_20221222GW-59A COMPLIANCE REPORT FORM Permit # 4)Q0"30;
(Submit one each monitoring period wi w-59 forms.)
I
Enter date monitoring results were due. (/z -1/-.22 ) Will this monitoring report (GW-59 and GW-59A)
YES
NO
be submitted after the established due date?
V
2
Was any required information missing on the GW-59 report forms?
YES
NO -
IF the answer to question 1 or 2 is "YES", list in the space provided below the well identification number(s) and
explain the problems encountered in obtaining the required information.
3
Are any of the monitor wells in need of repair or maintenance (damaged casing, unlocked or missing cap, missing
YES
NO
identification plate, area overgrown, etc.)? If the answer is "Yes ", contact the Regional Office jor guidance.
4
Are any monitored constituents equal to or above the established standards?
YES
N
If the answer to question 4 is "NO", skip to section 8.
If the answer to question 4 is "YES" list the affected wells individually with constituent(s) and concentration(s)
exceeding standards in the space provided below:
5
For the constituents identified in question 4 above, have standards been exceeded previously for the
YES
NO
same constituent(s) in the same well(s) in the last two years?
If the answer to question 5 is "NO", skip to section 8.
If the answer to question 5 is "YES", list in the space provided below, each well with constituent(s) exceeding
standards, concentration(s) reported, and sample collection date for each occurrence (for the last two years).
Are the monitoring wells listed in section 5 located at or beyond the review boundary?
YES
NO
If the answer is "YES", a groundwater quality problem may be occurring. CONTACT THE REGIONAL
OFFICE IMMEDIATELY FOR GUIDANCE. If the answer is "NO", monitoring wells may be improperly
located; contact the Regional Office.
7
Is the permittee implementing previously approved actions required by the Division involving this
YES
NO
groundwater quality problem?
If the answer to question 7 is "YES", describe those actions in the space provided below.
If the answer to question 7 is "NO", contact the Regional Office within 90 days; an evaluation may be
required to determine the impact the�tYaste disposal system is having at the review and compliance
boundaries surrounding this facili . Fattre to do so may subject the permittee to a Notice of Violation
Fines, and/or penalties.
D
rs
g
The person completing this portion (GW-59A) o „ .monitoring report should sign below and submit this
form with G W-59 forms for required wells to the address provided at the top of the current G W-59 form.
I hereby acknowledge that the above information was evaluated and the information submitted in this
report (Compliance Report GW-59A) is true and complete to the best of my knowledge.
—�� (-L/7J /z7
Signature of Permittee (or Aut prized Agent) D to
GW-59A 12/8/2003
SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING:
• .
DEPARTMENT OF ENVIRONMENTAL QUALITY - DIV. OF WATER RESOURCES
INFORMATION PROCESSING UNIT
COMPLIANCE REPORT FORM
1617 MAIL SERVICE CENTER, RALEIGH, NC 27699-1617
FACILITY INFORMATION
Please Print Clearly or Type
PERMIT Number: Expiration Date: 12/31 /2029
Facility Name: West Brunswick WRF
Non -Discharge WQ0023693 UIC
NPDES Other
Permit Name (if different):
Facility Address: 235 Gray Water Road
TYPE OF PERMITTED OPERATION BEING MONITORED
Supply` ` NC
28462 County Brunswick
❑ Lagoon ❑ Remediation: Infiltration Gallery
❑ Spray Field ❑ Remediation:
Contact Person: Matthew Henry
Telephone#: (910)231-8646
❑ Rotary Distributor ❑ Land Application of Sludge
Well Location/Site Name: MW #7
No. of wells to be sampled:
1
❑ Water Source Heat Pump ❑■ Other: Infiltration Basin
from Permit
SAMPLING INFORMATION
If WELL
WELL ID NUMBER (from Permit): MW #7
Date sample collected: 11/21/2022
FIELD ANALYSES:
WAS
Well Depth: 27 ft.
Well Diameter: 2
in.
pH 00400: 4.1 units Temp. 000lo: 20.1 °C
DRY at
Depth to Water Level 82546: 8.2 ft. below measuring point Screened Interval: 27
ft. to
ft. Spec. Cond. 00094: µMhos
time of
sampling,
Measuring Point is 2.8 ft. above land surface
Relative M.P. Elevation:
ft.
Odor 00085: None
check
Volume of water pumped/bailed before sampling:
5
gallons
Appearance Clear
here:
❑
Samples for metals were collected unfiltered: ❑
YES
NNO and field acidified: ❑ YES
® NO
LABORATORY INFORMATION
Date sample analyzed: 11 /21/2022
Laboratory Name: Environmental Chemists Certification No. 94
PARAMETERS NOTE: Values should reflect dissolved and colloidal concentrations.
COD 00335
mg/L
Nitrite (NO2) as N 00615 <0.02
mg/L Pb - Lead 01051 ug/L
Coliform: MF Fecal 31616 <1
/100mL
Nitrate (NO3) as N 00620 0.08
mg/L
Zn - Zinc 01092 mg/L
Coliform: MF Total 31504
/100mL
Phosphorus: Total as P006650.07
mg/L
(Note: Use MPN method for highly turbid samples)
Orthophosphate 70507
mg/L Other (Specify Compounds and Concentration Units):
issolved Solids:Total 70300 140
mg/L
Al - Aluminum ol1o5
mg/L
pH (Lab) 00403
units
Ba - Barium 01007
ug/L
TOC 0068o 2
mg/L
Ca - Calcium 00916
mg/L
Chloride 0094o 46
mg/L
Cd - Cadmium 01027
ug/L
N fy � �n
Arsenic 01002
ug/L
Chromium: Total 01034
ug/L
Grease and Oils 00552
mg/L
Cu - Copper 01042
mg/L ORGANICS: (by GC, GC/MS, HPLC)
Phenol 32730
ug/L
Fe - Iron 01045
ug/L
(Specify test and method #. ATTACH LAB REPORT.)
Sulfate 00945
mg/L
Hg - Mercury 71900
ug/L
Lab Report Attached? X Yes (1) ❑ No (0)
Specific Conductance 00095
µMhos
K - Potassium 00937
mg/L VOC 7873 method #
Total Ammonia 00610 0.4
mg/L
Mg - Magnesium 00927
mg/L method #
(Ammonia Nitrogen; NH3 as N; Ammonia Nitrogen, Total)
Mn - Manganese o1o55
ug/L
, method #
TKN as N 00625
mg/L
Ni - Nickel 01067
ug/L
method #
For Remediation Systems Only (Attach Lab Reports): Influent Total VOCs: mg/L Effluent Total VOCs: mg/L VOC Removal%
Donald Dixon; Deputy Director
Permittee (or Authorized Aqent) Name and Title - Please print or type
GW-59 Rev.06-07-2018
SM
ANALYTICAL 8 CONSULTING CHEMISTS
Brunswick County Public Utilities
Post Office Box 249
Bolivia NC 28422
Attention:
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
info(a,environmentalchemists.com
Revised Report:
Dec 16, 2022
Original Report Date: Dec 12, 2022
Report #:
2022-23246
Customer 1D:
08100011
Project ID:
Clemmons MW
Lab ID Sample ID: Collect Date/Time Matrix Sampled by
22-57184 Site: Well 7 11/21/2022 1:22 PM Water Chris House
Test Method Results Date Analyzed
Color
Color
Clear
11/21/2022
Depth to water, ft.
Depth to Water, Ft
8.2 feet
11/21/2022
Ammonia Nitrogen
EPA 350.1, Rev. 2.0, 1993
0.4 mg/L
12/01/2022
Gallons bailed before sampling
Gallons Bailed before sampling
5.0 gallons
11/21/2022
Odor
Qualitative
None
11/21/2022
Total Dissolved Solids (TDS)
SM 2540 C-2015
140 mg/L
11/22/2022
Temperature
SM 2550 8-2010
20.1 C
11/21/2022
pH
SM 4500 H B-2011
4.1 units
11/21/2022
Total Phosphorus
SM 4500 P (F-H)-2011
0.07 mg/L
12/02/2022
Total Organic Carbon (TOC)
SM 5310 B-2014
2.0 it
11/22/2022
Fecal Coliform
SM 9222 D-2015 MF
<1 Colonies/100ml- 11/21/2022
Chloride
SM4500 Cl E-2011
46 mg/L
11 /23/2022
1, 1, 1,2-Tetrachloroethane
SW 646 Method 8260D/5030B
<0.5 pg/L
11/22/2022
1, 1, 1 -Trichloroethane
SW 846 Method 8260D/5030B
<0.5 pg/L
11/22/2022
1,1,2,2-Tetrachloroethane
SW 846 Method 8260D/5030B
<0.5 pg/L
11/22/2022
1,1,2-Trichloroethane
SW 846 Method 8260D/5030B
<0.5 pg/L
11/22/2022
1, 1 -Dichloroethane
SW 846 Method 826OD/50308
<0.5 pg/L
11/22/2022
1, 1 -Dichloroethene
SW 846 Method 826OD/50308
<0.5 pg/L
11/22/2022
1, 1 -Dichloropropene
SW 846 Method 8260D/5030B
<0.5 pg/L
11/22/2022
1,2,3-Trichlorobenzene
SW 846 Method 8260D/5030B
<0.5 pg/L
11/22/2022
1,2,3-Trichloropropane
SW 846 Method 8260D/5030B
<0.5 pg/L
11/22/2022
1,2,4-Trichlorobenzene
SW 646 Method 82600/50308
<0.5 pg/L
11/22/2022
1,2,4-Trimethylbenzene
SW 846 Method 8260D15030B
<0.5 pg/L
11/22/2022
1,2-Dibromo-3-Chloropropane
SW 646 Method 8260D/5030B
<0.5 pg/L
11/22/2022
1,2-Dibromoethane
SW 846 Method 8260D150308
<0.5 pg/L
11/22/2022
1,2-Dichlorobenzene
SW 846 Method 8260D/5030B
<0.5 pg/L
11/22/2022
Report #: 2022.23246
Page 1 of 3
roww-- -77 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
sM 255-A Wilmington Highway, Jacksonville, NC 28540 • 910.347.5843 Lab/Fax
ANALYTICAL & CONSULTING CHEMISTS infoCaenvironmentalchemists.com
Brunswick County Public Utilities Revised Report: Dec 16, 2022
Post Office Box 249 Original Report Date: Dec 12, 2022
Bolivia NC 28422 Report #: 2022-23246
Attention: Customer ID: 08100011
Project ID: Clemmons MW
1,2-Dichloroethane
SW 846 Method 826OD15030B
<0.5 pg/L
11/22/2022
1,2-Dichloropropane
SW 846 Method 8260D/50308
<0.5 pg/L
11/22/2022
1,3,5-Trim ethyl benzene
SW 846 Method 826OD15030B
<0.5 pg/L
11/22/2022
1,3-Dichlorobenzene
SW 846 Method 8260D/50308
<0.5 pg/L
11/22/2022
1,3-Dichloropropane
SW 846 Method 8260D/50308
<0.5 pg/L
11/22/2022
1,4-Dichlorobenzene
SW 846 Method 8260D150308
<0.5 pg/L
11/22/2022
2,2-Dichloropropane
SW 846 Method 8260D/50308
<0.5 pg/L
11/22/2022
2-Chlorotoluene
SW 846 Method 8260D/5030B
<0.5 pg/L
11/22/2022
4-Chlorotoluene
SW 646 Method 8260D15030B
<0.5 pg/L
11/22/2022
Benzene
SW 846 Method 8260D/5030B
<0.5 pg/L
11/22/2022
Bromobenzene
SW 846 Method 8260D/50308
<0.5 pg/L
11/22/2022
Bromochloromethane
SW 846 Method 8260015030E
<0.5 pg/L
11/22/2022
Bromodichloromethane
SW 846 Method 8260D/50308
<0.5 pg/L
11/22/2022
Bromoform
SW 846 Method 82600/50306
<0.5 pg/L
11/22/2022
Bromomethane
SW 846 Method 8260D/50308
<0.5 pg/L
11/22/2022
Carbon tetrachloride
SW 846 Method 826OD15030B
<0.5 pg/L
11/22/2022
Chlorobenzene
SW 846 Method 8260D/50308
<0.5 pg/L
11/22/2022
Chloroethane
SW 846 Method 8260D/5030B
<0.5 pg/L
11/22/2022
Chloroform
SW 846 Method 8260D/5030B
<0.5 pg/L
11/22/2022
Chloromethane
SW 846 Method 8260D/5030B
<0.5 pg/L
11/22/2022
cis-1,2-Dichloroethene
SW 846 Method 8260D/5030B
<0.5 pg/L
11/22/2022
cis- 1,3-Dichloroprope ne
SW 846 Method 8260D/5030B
<0.5 pg/L
11/22/2022
Dibromochloromethane
SW 846 Method 8260D/5030B
<0.5 pg/L
11/22/2022
Dibromomethane
SW 846 Method 82600/50308
<0.5 pg/L
11/22/2022
Dichlorodifluoromethane
SW 846 Method 8260D150308
<0.5 pg/L
11/22/2022
Ethylbenzene
SW 846 Method 82600/5030B
<0.5 pg/L
11/22/2022
Hexachlorobutadiene
SW 846 Method 8260DY5030B
<0.5 pg/L
11/22/2022
Isopropylbenzene
SW 846 Method 82600/5030B
<0.5 pg/L
11/22/2022
M+P Xylene
SW 846 Method 8260D/5030B
<1.0 pg/L
11/22/2022
Report tt:: 2022-23246 Page 2 of 3
F""07 -0441
Environmental Chemists, Inc.
envirochem 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
sM 255-A Wilmington Highway, Jacksonville, NC 28540 . 910.347.5843 Lab/Fax
ANALYTICAL & CONSULTING CHEMISTS infoiu environmentalchemists.com
Brunswick County Public Utilities
Post Office Box 249
Bolivia NC 28422
Attention:
Revised Report: Dec 16, 2022
Original Report Date: Dec 12, 2022
Report #: 2022-23246
Customer ID: 08100011
Project ID: Clemmons MW
Methylene chloride
SW 846 Method 8260D/50306
<0.5 pg/L
11/22/2022
Naphthalene
SW 846 Method 8260D/5030B
<0.5 pg/L
11/22/2022
n-Butylbenzene
SW 846 Method 8260D/5030B
<0.5 pg/L
11/22/2022
n-Propylbenzene
SW 846 Method 8260D/5030B
<0.5 pg/L
11/22/2022
ortho-Xylene
SW 846 Method 8260D/5030B
<0.5 pg/L
11/22/2022
p-Isopropyltoluene
SW 846 Method 826OD15030B
<0.5 pg/L
11/22/2022
sec-Butylbenzene
SW 846 Method 8260D/5030B
<0.5 pg/L
11/22/2022
Styrene
SW 846 Method 8260015030E
<0.5 pg/L
11/22/2022
tert-Butyl benzene
SW 846 Method 8260D15030B
<0.5 pg/L
11/22/2022
Tetrachloroethene
SW 846 Method 8260D/5030B
<0.5 pg/L
11/22/2022
Toluene
SW 846 Method 8260D/50308
<0.5 dig/L
11/22/2022
Trans-1,2-Dichloroethene
SW 846 Method 8260D/5030B
<0.5 pg/L
11/22/2022
Trans-1,3-dichloropropene
SW 846 Method 8260D/5030B
<0.5 pg/L
11/22/2022
Trichloroethene
SW 846 Method 8260D/50308
<0.5 pg/L
11/22/2022
Trichlorofluoromethane
SW 846 Method 82600/5030B
<0.5 pg/L
11/22/2022
Vinyl chloride
SW 846 Method 8260D/5030B
<0.5 pg/L
11/22/2022
Nitrate Nitrogen (Calc)
Nitrite Nitrogen EPA 353.2, Rev. 2.0, 1993 < 0.02 mg/L 11/22/2022
Nitrate+Nitrite-Nitrogen EPA 353.2, Rev 2.0, 1993 0.08 mg/L 11/28/2022
Nitrate Nitrogen Subtraction Method 0.08 mg/L 12/09/2022
Comment: Amended to correct well idenification number.
Reviewed by: t�-_� I -D-D LLAO-c�l
Report # 2022.23246 Page 3 of 3
Date:
\naI%
Refererct
Caliirati m Time Cal Blffer4 0 s u I Cal Buffer to o s u
Facility Name: f c —
Permit
pH
W SM45i, H-B -2u11
Check Buffer TO s u
10 (o
_o `''
'pH chew buffer
c ,r
must read x ithir. = 0 1 pli units o,r the bu. rr,., s trlc : aiu.,
cuff : Le '_
—
Ricca 41 ! 2869 Een 11 2222
7 su buffer Lot= Ricca 2l lZ:S13 FxZ I? 23
_
— S'•— I:Col1^ctiln
I S n,!cArahsis I Plf Re=al: ►Pn;t-teals.
Tim:• ! s.0 Che talc,
t
Comments
I su buffs t of=. RiCC_a 2I I27i0 Ems. c 23_
► Po,:anal) sic buffer chick is required when performing aaahses at multiple sampling loca:ion, and must be withua n !units \I p;l saloe, ir. pi I uric h e s u i Record all data to the nearest rl of s.0 and report to t-he neares: 0 1 s u
Total Residual Chlorine (TRC)
Kcfarcnx Method. 5\f 4504 CI-G2011 tfach B 16711R. r PI •as c'r 1 I bi
c u c : a•r i.a : ti.e.ned
I)ai!s Check � Post -analysis
T,me check Sam I i Check Sid p a Sample
Stan lard Rcsu:! Standard f Sample Co!!cctior. :\nal%si= 1RC Result
N. l or mg t u„hen only zun� I l.ocaa�n I:gT. or mg 1.
at multiple sites; \natyzed II Time i Time I
to e ca:ue
23 0
Comments ha:_ (,�ualitie-:
1'Ri Dail} Chick Standard true \ atuc µg 1. or mg-1. acceptance range µe 1. or me
C'hc,k standard, mu,t recur er sec tihin :10:u of the check standard's true s alue
RedgeAnnualCalibrationlaal C un e l'enfiation Oetc _ LOT k li)li\X M)JR9 F_ree� Exp. Date: 22`2R 123 IDEAX 220I o To al Es : patr_2^3'2 j
Keaeent Blank Value Mlien applicable Anal%7e and document a reagent blank uhrn standard;. sample dilution: ur PT Sam3plcs a prepared)
Dissolved Oxygen (DO)
Rcf rence Method SM 4500 C) G 2(31 G _ Instrument M. OD
I
C'ahbranon s anab:e • Post-anah sis catrbrauo❑
Ca.ubrl:uor, Meter reading scrification (when nece., I
:e fscata- ---- -- - ! or°;efficij ,:
i-e Barometric I l Corrrarts
TL—.p S3'mity'. aE:r. calibrwior. Th,w,nca! Calcula:e,! !
_C. pressor:
mmila PPE I Value mg 1. l'a!ue mg', I
Use this row "hen performing a s erification instead or
--- calibration
Sanpk 1-ova tar.
Sample Collection.
Time
Sample Anahsis
Time
NO--, aj
mt , CoatmenLs D:!ta Qui::iers
. ....... ivLdc:ors. tee miter must ne recalibra:ed at each sit: befog era:: ir5 0.' a p a5:•1^11:5I5 calibration : :i,a:ion mos: be earfrrr rd Tc • is r. ea _ :' _i _..
the 5:7_27: 1n { =
,r o r i as:: , a
tirre anais r•: ± np,
: td b: :rrded n
.� a r :_ ! t� _ ...:asur: i ur : .d•,
Temperature
Re even:e Me i:aj, SM 2;5
9-' l instr :rt i7
Sarnp - •Sample
T•:-rr .-.car;
- .. c.t cxwn
Co: e,:Cur Analysts
'C^'-_„L
Time
D::1 C1u2::.`.:r•
r7ime
:s .•^.eacurz�l ::=:ate, 3- 'n th�% ird or or ._ or:'•• :tee a:^ l: + a , IN ;e -_'eZ' x ` a 7e. :•e•• 1: Tel: ,..... ,r
Field Personnel Note:
Environmental Chemist, Inc., Wilmington, NC Lab #94 6602 Windmill Way
Wilmington, NC 28405
910.392.0223
Sample Receipt Checklist
Client:V4YlSt,��t ��p �� Dater Z� a Report Number: _ 2022- o�,��0
Receipt of sample: ECHFrA' Picl up Client Delivery ❑ 11P5 ❑ F: dFr F1 "' her ❑
❑ YES ❑ NO Q6 N/h 1. Were custody seals present on the cooler.
❑ YES ❑ NO N/A 2. If custody seals were present, were they intact/unbroken?
Original temperature upon receipt °C Corrected temperature upon receipt__ °C
How temperature taken: ❑ Temperature Blank W Against Bottles
IR Gun ID: Thomas Traceable S/N 192511657 IR Giin rnrrarrinn I=mrtnr °r• n n
IR
YES
❑
NO
3.
If temperature of cooler exceeded 6°C, was Project Mgr./QA notified?
YES
❑
NO
4.
Were proper custody procedures (relinquished/received) followed?
®
YES
❑
NO
5.
Were sample ID's listed on the COC?
YES
❑
NO
6.
Were samples ID's listed on sample containers?
YES
❑
NO
7.
Were collection date and time listed on the COC?
IN
YES
❑
NO
8.
Were tests to be performed listed on the COC?
C>�
YES
❑
NO
9.
Did samples arrive in proper containers for each test?
LpJ
YES
❑
NO
10.
Did samples arrive in good condition for each test?
®
C9
YES
YES
❑
10
NO
NO
11.
12.
Was adequate_ sample volume available?'
V.'ere samples received within proper holding time for requested tests?
YES
El
NO
13.
Were acid preserved samples received at a pH of <2?
❑
YES
I ❑
NO
14.
Were cyanide samples received at a pH >12?
❑
YES
ID
NO
15.
� Vere sulfide samples received at a pH >9?
YES
0
NO
16.
Were NH3/FKN/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/Volatiies are pH checked at tune 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): H,S0 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 samp;e or
notify the state tab if directed to analyzed by the customer. who was notified, date and time:
Volatiles Sample(s) were received with headspace
COMMENTS:
DOC. QA.002 Rev 1
ENVIRONMENTAL CHEMISTS, INC 6602 Windmill Way Wilmington, NC 28405
Analytical &Consulting Chemists NCDENR: DWQ CERTERICATION # 94 NCDHHS: DLS CERTIFICATION # 37729 OFFICE: 910-392-0223 FAX 910-392-4424
C0I 1 Fr_TIr)M AMn r-WAIAI nP r`I ICTnnv
CLIENT: BCPU
PROJECT NAME: Clemmons MW
REPORT NO:
ADDRESS:
CONTACT NAME:
PO NO:
REPORT TO:
PHONE/FAX:
COPY TO:
E-MAIL:
Sampled Bv: l / t, k V V v O t__1 SAMPI F TYPF• 1 = Inflnanf F = Ffflunnf w v Well CT - Ct........ en - of _
Sample Identification
Collection
F
E `o
O
`o
° a
0 o
u E
mccZ
g z
PRESERVATION
ANALYSIS REQUESTED
Date
Time
Temp
O
Z
=
o
o
z
=o
a
z
o
=
~
w
x
o
MW #I:
L
`
X
Chloride, TDS, NO2
G
G
Depth:
C
P
�
X
NO3, NH3, TP
G
G
�^
Gallons Bailed - J
C
P
X
TOC
G
G
Field pH
C
P
X
Fecal Coliform
G
G
Color
C
P
G
G
T
Odor � U _J
C
P
/VOC (November)
G
G
f
I
i
Due March, July, and November
Transfer
Relinquished By:
Date/Time
Received By:
Date/Time
1.
2.
I emperature wnen Kecelvea -c: - Acceptea: Rejected: Resample Requested:
Delivered By: Received By: _Czl Date: T1/ 7_ 1 72 Time: