HomeMy WebLinkAbout970008_Laboratory Results_20171207AC45679
North Carolina Division of Water Resources Water Sciences Section Laboratory Results
Loc. Descr.:
County:
Region:
River Basin
Emergency
COC Yes/No
ABOVE CULVERT
WILKES
Collector:
R CHANDLER
VisitlD
WSRO
Report To
WSRO
Location ID:
WSRO NLC
YADKIN
Collect Date:
12/06/2017
Priority
COC
Collect Time:
17_65
Sample Matrix:
SURFACEWATER
YES
Sample Depth
Loc. Type:
River/Stream
Final Report
Sample ID:
AC45679
PO Number #
Date Received:
12107/2017
Time Received:
08_30
Labworks LoginlD
MSWIFT
Delivery Method
NC Courier
Final Report Date:
12120117
Report Print Date:
12/20/2017
If this report is labeled preliminary report, the results have not been validated. Do not use for Regulatory purposes.
Result/
Method
Analysis
CAS # Analyte Name
P L
Qualifier
Units
Reference
Date
Validated by
LAB
Sample temperature at receipt by lab
2.2
°C
1217/17
PGAUTHIER
MIC
BOD, 5-Day in liquid
2.0
2.0 U
mg/L
SM 5210 B-2001
1217117
ESTAFFORDI
C011form, MF Fecal in liquid
1
2200 B401
CFU/100ml
SM 9222 D-1997
12/7/17
ESTAFFORDI
Turbidity
1.0
5.8
NTU
SM 2130 B-2001
12/7/17
ESTAFFORDI
NUT
NH3 as N in liquid
0.02
0.06
mg/L as N
EPA 350.1 REV 2
12/12/17
CGREEN
NO2+NO3 as N in liquid
0.02
1.1
mg/L as N
EPA 353.2 REV 2
12/12/17
CGREEN
Phosphorus —total as P in liquid
0.02
0.09
mg/L as P
EPA 365.1 REV 2
12/15/17
CGREEN
Total Kjeldahl N as N in liquid
0.2
0.35
mg/L as N
EPA 351.2 REV 2
12/13/17
CGREEN
WSS Chemistry Laboratory>> 1623 Mail Service Center, Raleigh, NC 27699-1623 (919) 7334908
"Not Detected" or "U" does not indicate the sample is analyte free but that the analyte is not detected at or above the PQL.
Page 1 of 1
AC45680
North Carolina Division of Water Resources Water Sciences Section Laboratory Results
Loc. Descr.:
County:
Region:
River Basin
Emergency
COC Yes/No
AT CULVERT
WILKES
Collector:
R CHANDLER
VisitlD
WSRO
Report To
WSRO
Location ID:
WSRO NLC
YADKIN
Collect Date:
12/06/2017
Priority
CDC
Collect Time:
16_65
Sample Matra:
SURFACEWATER
YES
Sample Depth
Loc. Type:
River/Stream
Sample ID:
AC45680
PO Number #
Date Received:
12/07/2017
Time Received:
08_30
Labworks LoginlD
MSWIFT
Delivery Method
NC Courier
Final Report Date:
12/20/17
Report Print Date:
12/20/2017
Final Retort
If this report is labeled preliminary report, the results have not
been validated.
Do not use for Regulatory purposes.
Result/
Method
Analysis
CAS # Analyte Name
PSG _L
Qualifier
Units
Reference
Date
Validated by
LAB
Sample temperature at receipt by lab
2.2
T
12/7/17
PGAUTHIER
MIC
BOD, 5-Day in liquid
2.0
4.3
mg/L
SM 5210 B-2001
1217/17
ESTAFFORDI
Coliform, MF Fecal in liquid
1
8600 B401
CFU/100ml
SM 9222 D-1997
1217/17
ESTAFFORDI
Turbidity
1.0
13
NTU
SM 2130 B-2001
1217117
ESTAFFORD1
NUT
NH3 as N in liquid
0.02
0.13
mg/L as N
EPA 350.1 REV 2
12/12/17
CGREEN
NO2+NO3 as N in liquid
0.02
3.3
mg/L as N
EPA 353.2 REV 2
12/12/17
CGREEN
Phosphorus total as P in liquid
0.02
0.16
mg/L as P
EPA 365.1 REV 2
12/13/17
CGREEN
Total Kjeldahl N as N in liquid
0.2
0.86
mg/L as N
EPA 351.2 REV 2
12/13/17
CGREEN
WSS Chemistry Laboratory>> 1623 Mail Service Center, Raleigh, NC 27699-1623 (919) 733-3908
"Not Detected" or "U" does not indicate the sample is analyte free but that the analyte is not detected at or above the POL.
Page 1 of 1
AC45681
North Carolina Division of Water Resources- Water Sciences Section Laboratory Results
Loc. Descr.:
County:
Region:
River Basin
Emergency
CDC Yes/No
BELOW CULVERT
WILKES
Collector:
R CHANDLER
VisitlD
WSRO
Report To
WSRO
Location ID:
WSRO NLC .
YADKIN
Collect Date:
12/0612017
Priority
CDC
Collect Time:
17_76
Sample Matrix:
SURFACEWATER
YES
Sample Depth
Loc. Type:
River/Stream
Sample ID:
AC45681
PO Number#
Date Received:
12107/2017
Time Received:
08_30
Labworks LoginlD
MSWIFT
Delivery Method
NC Courier
Final Report Date:
12/20/17
Report Print Date:
12/2012017
rinai KeporL
If this report is labeled preliminary report, the results have not
been validated.
Do not use for Regulatory purposes. -
ResulU
Method
Analysis
Units
CAS # Analyte Name
P L
Qualifier
Reference
Date
Validated by
LAB
Sample temperature at receipt by lab
2.2
°C
12f7/17
PGAUTHIER
MIC
BOD, 5-Day in liquid
2.0
8.2
mg/L
SM 5210 B-2001
12/7/17
ESTAFFORDI
Collform, MF Fecal in liquid
1
40000 01
CFU/100mi
SM 9222 D-1997
1217/17
ESTAFFORDI
Turbidity
1.0
16
NTU
SM 2130 B-2001
12/7/17
ESTAFFORDI
NUT
NH3 as N in liquid
0.02
0.28
mg/L as N
EPA 350.1 REV 2
12/12/17 CGREEN
NO2+NO3 as N in liquid
0.02
3.6
mg/L as N
EPA 353.2 REV 2
12/12/17 CGREEN
Phosphorus total as P in liquid
0.02
0.43
mg/L as P
EPA 365.1 REV 2
12/15/17 CGREEN
Total Kjeldahl N as N In liquid
0.2
1.4
mg/L as N
EPA 351.2 REV 2
12/13/17 CGREEN
WSS Chemistry laboratory» 1623 Mail Service Center, Raleigh, NC 27699-1623 (919) 7333908
"Not Detected" or "U" does not indicate the sample is analyte free but that the analyte is not detected at or above the PQL.
Page 1 of 1
North Carolina Division of Water Resources
Central Laboratory (Water Sciences Section) Water Sample Collection &Submittal Form
d ,
Eb 'e
River/Stream ❑lake
❑Estuary ❑Canal
❑Stormwater
❑Monitoring Well ❑Water Supply
❑Effluent ❑Influent
[:]Field Blank
❑Trip Blank
❑Filter Blank
❑Other:
Q� V
W Vv S
❑Ambient
❑Routine
❑Compliance
ktoc
❑ Emergency
❑
r�
Surface
❑Ground
❑ Waste
❑Blank
El Solution
State Courier
p If ❑Hand Delivery
❑Other:
-` �
V-� U
Notes:
a
❑ Chlorinated ❑De -chlorinated in Field
Grab Composite
❑ Other:
❑ Filtered in Field Dissolved analysis: Enter "DIS"
in check -boxes for parameters
S J � OqC .Q�
Co .. a ����`r(1G„\
Acidity, as CaCC3, to pH 4.5/8.3 mg/L
MBAS (surfactants) mg/LFArsenic(As)
r'drli fe,;,i
(AI) pg/L
Tin (Sn) µg/L
Oil and Grease, HEM, Total Recoverable mg/Lm
Titanium (Ti) µg/L
Alkalinity, as CaCO3, to pH 4.5/8.3 mg/L
Phenols, Total Recoverable pg/L
(Sb) µg/L
Vanadium (V) µg/L
BOD: Biochemical Oxygen Demand, 5-day mg/L
Residue: Total (Total Solids) mg/L
pg/L
Zinc (Zn) µg/L
cBOD: Carbonaceous BOD, 5-day mg/L
Residue: Volatile/Fixed, Total mg/La)
pg/L
oliform: Fecal MF /100ml
Residue: Suspended (Suspended Solids) mg/L
(Be) pg/L
Boron (B), Total µg/L
Coliform: Total MF /100mi
Residue: Volatile/Fixed, Suspended mg/L
Cadmium (Cd) pg/L
Mercury 1631, low-level ng/L
Coliform: Tube Fecal /100ml
TDS - Total Dissolved Solids mg/L
Calcium (Ca) mg/L
Coliform: Tube Total /100ml
Silica mg/L
Chromium (Cr), Total pg/L-
Specific Conductance, at 25 °C umhos/cm
Sulfide mg/L
Cobalt (Co) pg/L
Acid Herbicides
TOC - Total Organic Carbon mg/L
Tannin & Lignin mg/L
Copper (Cu) pg/L
Organochlorine Pesticides
Turbidity NTU
Iron (Fe) pg/L
Organonitrogen Pesticides
. ;
pH - S.U.
Lead (Pb) pg/L
Organophosphorus Pesticides
. e ; °
Bromide mg/L
Lithium (Li) pg/L
PCBs (polychlorinated biphenyls)
Hardness, Total as CaCO3 - by titration mg/L
Magnesium (Mg) mg/L
Chloride mg/L
Manganese (Mn) pg/L
Semi -Volatile Organics (BNAs)
Fluoride mg/L
Mercury (Hg) pg/L
TPH Diesel Range
Sulfate mg/L
N"t;t4 „",
Molybdenum (Mo) pg/L
Chlorophyll a pg/L
Ammonia as N (NH3-N) mg/L
Nickel (Ni) pg/L
Volatile Organics (VOA)
Color: ADM] C.U.
><
Nitrate -Nitrite as N (NO3+NC2-N) mg/L
Potassium (K) mg/L
Color: Platinum Cobalt C.U.
x
Total Kjeldahl Nitrogen as N (TKN) mg/L
Selenium (Se) pg/L
TPH Gasoline Range
COD: Chemical Oxygen Demand mg/L
Total Phosphorus as P (TP) mg/L
Silver (Ag) Ng/L
Cyanide, Total mg/L
Nitrite as N (NO2-N) mg/L
Sodium (Na) mg/L
(1.
Formaldehyde mg/L
Nitrate as N (NO3-N calculated) mg/L
Strontium (Sr) Ng/L
Phytoplankton /Algae
Hexavalent Chromium (Cr6+) mg/L
Orthophosphate as P (PO4) mg/L
Thallium (TI) Ng/L
LAB COMMENTS:
yIF�ylry
North Carolina Division of Water Resources
Central Laboratory (Water Sciences Section) Water Sample Collection &Submittal Form
A,4- � U I
❑Ambient
❑ Routine
❑Compliance
COC
❑Emergency
❑qA
[
r`,- 7�1 Surface
t"
❑Ground
❑ Waste
❑Blank
❑ Solution
River/Stream
[:]Estuary[:]canal
❑Stormwater
❑Monitoring Well
❑Effluent
❑Field Blank
❑Filter Blank
❑Other:
❑Lake
❑Water Supply
❑Influent
❑Trip Blank
` Is 2���
/A
-
L
State Courier
❑Hand Delivery
❑Other:
Notes:
❑ Chlorinated [lDe-chlorinated in Field
Grab Licomposite
❑ Other:
❑ Filtered in Field Dissolved analysis: Enter"DIS"
in check -boxes for parameters
V Y t n
O ,jc.
a r .
MBAS (surfactants)
Acidity, as CaCO3, to pH 4.5/8.3
mg/L
Oil and Grease, HEM, Total Recoverable
mg/L
Aluminum (Al)
µg/L
Titanium (Ti)
µg/L
Alkalinity, as CaCO3, to pH 4.5/8:3
mg/L
Phenols, Total Recoverable
µg/L
Antimony (Sb)
µg/L
Vanadium (V)
µg/L
BOD: Biochemical Oxygen Demand, 5-day
mg/L
Residue: Total (Total Solids)
mg/L
Arsenic (As)
µg/L
Zinc (Zn)
µg/L
cBOD: Carbonaceous BOD, 5-day
mg/L
Residue: Volatile/Fixed, Total
mg/L
Barium (Ba)
µg/L
Coliform: Fecal MF
/100ml
Residue: Suspended (Suspended Solids)
mg/L
Beryllium (Be)
µg/L
Boron (B), Total
µg/L
Coliform: Total MF
/100ml
Residue: Volatile/Fixed, Suspended
mg/L
Cadmium (Cd)
µg/L
Mercury 1631, low-level
ng/L
Coliform: Tube Fecal
/100ml
TDS - Total Dissolved Solids
mg/L
Calcium (Ca)
mg/L
Coliform: Tube Total
/loom[
Silica
mg/L
Chromium (Cr), Total
µg/L
i
Specific Conductance, at 25 °C
umhos/cm
Sulfide
mg/L
Cobalt (Co)
µg/L
Acid Herbicides
TOC - Total Organic Carbon
mg/L
Tannin & Lignin
mg/L
Copper (Cu)
µg/L
Organochlorine Pesticides
Turbidity
NTU
Iron (Fe)
µg/L
Organonitrogen Pesticides
Lead (Pb)
pg/L
Organ ophosphorus Pesticides
pH
S.U.
Lithium (Li)
µg/L
PCBs (polychlorinated biphenyls)
Bromide
mg/L
Hardness, Total as CaCO3 - by titration
mg/L
Magnesium (Mg)
mg/L
Chloride
mg/L
Manganese (Mn)
Ng/L
Semi -Volatile Organics (BNAs)
Fluoride
mg/L
Mercury (Hg)
µg/L
TPH Diesel Range
Sulfate
mg/L
SIR
Molybdenum (Mo)
Ng/L
Chlorophyll a
µg/L
Ammonia as N (NH3-N)
mg/L
Nickel (Ni)
pg/L
Volatile Organics (VOA)
Color: ADMI
C.U.
Nitrate -Nitrite as N (NO3+NO2-N)
mg/L
Potassium (K)
mg/L
Color: Platinum Cobalt
C.U.
><
Total Kjeldahl Nitrogen as N (TKN)
mg/L
Selenium (Se)
pg/L
TPH Gasoline Range
COD: Chemical Oxygen Demand
mg/L
Total Phosphorus as P (TP)
mg/L
Silver (Ag)
pg/L
Cyanide, Total
mg/L
Nitrite as N (NO2-N)
mg/L
Sodium (Na)
mg/L
Formaldehyde
mg/L
Nitrate as N (NO3-N calculated)
mg/L
Strontium (Sr)
µg/L
Phytoplankton / Algae
Hexavalent Chromium (Cr6+)
mg/L
Orthophosphate as P (PO4)
mg/L
Thallium,(TI)
Ng/L
LAB COMMENTS :
T).b
�_�4S
,o S-,
��s.a-
,,
North Carolina Division of Water Resources 11-31
Central Laboratory (Water Sciences section) Water Sample Collection &Submittal Form
4.� of e
C,h , d 1
❑Ambient
❑Routine
❑Comfiance
p
N EOC
❑Emergency
❑�
Surface
Ground
❑ Waste
❑ Blank
❑Solution
FVwej>-
EstuaStream ❑L
❑ ry ❑ anal
❑Stormwater
El Well ❑Water Supply
❑EfFluent ❑Influent
❑Field Blank
❑Trip Blank
❑Filter Blank
❑Other:
C� o�v
�� .. �v `
5
D t��
O
State Courier
❑Hand Delivery
❑Other:
Notes:
❑ Chlorinated ❑De-chlorinated in Field
Pq Grab Composite
❑ Other:
t i
❑ Filtered in Field Dissolved analysis: Enter "DIS"
in check -boxes for parameters
r (' QJ
�(
(surfactants)
Acidity, as CaCO3, to pH 4.5/83 mg/L
Oil and Grease, HEM, Total Recoverable mg/L
Aluminum (Al) Ng/L
Titanium (Ti) µg/L
Alkalinity, as CaCO3, to pH 4.5/8.3 mg/L
Phenols, Total Recoverable Ng/L
Antimony (Sb) Ng/L
Vanadium (V) µg/L
XI
BOD: Biochemical Oxygen Demand, 5-day mg/L
Residue: Total (Total Solids) mg/L
Arsenic (As) pg/L
Zinc (Zn) Ng/L
cBOD: Carbonaceous BOD, 5-day mg/L
Residue: Volatile/Fixed, Total mg/L
Barium (Ba) pg/L
Coliform: Fecal MF /loomi
Residue: Suspended (Suspended Solids) mg/L
Beryllium (Be) pg/L
Boron (B), Total µg/L
Coliform: Total MF /loom[
Residue: Volatile/Fixed, Suspended mg/L
Cadmium (Cd) Ng/L
Mercury 1631, low-level ng/L
Coliform: Tube Fecal /loom[
TDS - Total Dissolved Solids mg/L
Calcium (Ca) mg/L
Coliform: Tube Total /100m1
Silica mg/L
Chromium (Cr), Total pg/L
_
Specific Conductance, at 25 °C umhos/cm
Sulfide mg/L
Cobalt (Co) pg/L
Acid Herbicides
TOC - Total Organic Carbon mg/L
Tannin & Lignin mg/L
Copper (Cu) Ng/L
Organochlorine Pesticides
Turbidity NTU
Iron (Fe) Ng/L
Organonitrogen Pesticides
Lead (Pb) Ng L
Organophosphorus Pesticides
ra.
pH S.U.
Lithium (Li) Ng/L
PCBs (polychlorinated biphenyls)
Bromide mg/L
Hardness, Total as CaCO3 - by titration mg/L
Magnesium (Mg) mg/L
Chloride mg/L
Manganese (Mn) Ng/L
Semi -Volatile Organics (BNAs)
Fluoride mg/L
Mercury (Hg) pg/L
TPH Diesel Range
Sulfate mg/L
Molybdenum (Mo) jig
Chlorophyll a pg/L
Ammonia as N (NH3-N) mg/L
Nickel (Ni) pg/L
Volatile Organics (VOA)
Color: ADMI C.U.
Nitrate -Nitrite as N (NO3+NO2-N) mg/L
Potassium (K) mg/L
Color: Platinum Cobalt C.U.
Total K)eldahl Nitrogen as N (TKN) mg/L
Selenium (Se) pg/L
TPH Gasoline Range
COD: Chemical Oxygen Demand mg/L
Total Phosphorus as P (TP) mg/L
Silver (Ag) Ng/L
Cyanide, Total mg/L
Nitrite as N (NO2-N) mg/L
Sodium (Na) mg/L
t
Formaldehyde mg/L
Nitrate as N (NO3-N calculated) mg/L
Strontium (Sr) pg/L
Phytoplankton / Algae
Hexavalent Chromium (Cr6+) mg/L
Orthophosphate as P (PO4) mg/L
Thallium (TI) Ng/L
COMMENTS:LAB
_"��+,[.�`. 'v`""","�; .�., pf }�, .::{ ,.: r� t, y , i o. p�'.,`. i� �. "*:.; s,;, t { � 7;^.' . a"p �t4� s r :�' :'. 1,.'^ ;^' :v1 : �j�P"?"
�5-+�i' 3?� ..�.., :j�.," t� ,��yry�' [["�'� 7.0 .Tk9a. 1','.fd'i "f. ®'41'LA. N'S'4 1 , Y] r ..;'�h� ,�µ' `SEC a'le ,'^"Gf...
.i...n........ ... ..... 1.,. ....�.., '.... <. .,... � mYe�..iso®H...ce�nw .. ....�.,..�v: _.:�.r�a. -9 rt s .,�'..4 ._ �,,���.�u. _..� .,.�. . r, �C„ u.<_��t,�.e-e�u
Chain of Custody (COC) Record - Water Samples Page I of
North Carolina Division of Water Resources - Water Sciences Section Chemistry Laboratories
Revised: 4/12/2016
Water Quality Monitoring Field Meter Calibration Sheet
Collector(s):
Studv:
wn.rnng wwawn. � �.
Meter Modek
Meter / Sonde Serial No: \ "Vs 1:16a.f., ILN Clb� N
Dam
Time
initials
yy/mm/dd
24hr hh:mm
Pre -Sampling -Calibration
Post -Sampling Check
,-
12--
MISCeIIaneOUS(Does not apply to YSI or Accumet Meters)
Level M
Stirrer Working?
Pre -Sampling Calibration
E2ttery
Y / N
Post Sampling Check. , .
Y / N
naksery Kanges = burveyor: imemai - i.z - i.sv, tnkemai - ii- mv; tkuanca: q.0 - w.ov
Dissolved Oxygen (mg/1)
Barometer Calibration (mmHg)
•YSI Pro Plus Meters Only
Initial
Calibrated
Reading
Value
Initial %
Barometric
D.O. Table
initial Meter
Calibrated Meter
Calibrated %
Temp. °C
Saturation
Pressure
Altitude (ft.)
Value
Reading (m
(mg/1)
Reading (mg/1)
Saturation
(mmHg)
Pre -Sampling Calibration
Post=Sampling Check
i yak>5ta 0 Withint0.5 Y
Specific Conductance (µS/cm at 25°C) Loiota
DryAirX' conductivityStandard3 Calibration Check\
am (0) Value:,..-- S%A value:
Initial Meter . 61ibrated4 Initial Meter Calibrateda Initial Meter.
Reading Meter Reading , Reading Meter Reading. Reading
Pre-Samolina Calibration
r o - n
Within t 2? With N10%?
Wt ±10%? Y Y
NOTES: Quanta reads in m5/cm; move deMal 3 places to the rightfor 0/cm. a
'Dry Air CALIBRATIONS are conducted for 4aand N155 Hydrolabs Only.
213ry Air CHECKS (confirmation of zero in dry air) are conducted for YSI 85, YSI 6920, YSI Pro Pius &'Quanta meters. SAL
3Conductivity standards are used to CHECK the YSI 85 meter and to CALIBRATE all Hydroiab. meters and the YSI 6920 &
YSI Pro Plus
4D6es not apply -to Dry Air CHECKS or Conductivity Standard CHECKS (leave blank).
H (SU) Lot #• C Lot #.
Buffer#1 Buffer.#2' Confirmation .
7.0 0.0 Buffer
BufferTemp: Buffer Tempi_ SlopeEfBciencys 7.0
Initial Meter Calibrated Meter Initial Meter Calibrated Meter Meter Reading
Reading Reading Reading Reading
WIN smw [#k' ■li1i1-01®tIvA1k7 ��� WAR
Post -Sampling Check
-Samp:11ngChe,
�t►!•,i i�Vlh� Sul mom i ''dliiu�h�l�+1�. u���lIi1119V1I�uhaui [tQl6i�l '{t iuli�tih
W-12e STATE OF NORTH CAROLINA Total Miles
Plate # IPA-2495 DEPARTMENT OF ADMINISTRATION Rate Per Mile $0.39
Vehicle # 1261392 MOTOR FLEET TRAVEL LOG Mileage Chare
Vehicle Model Pathfinder Minimum Amount
Next Oil Change Due For Permanently Assigned Vehicles Total Amount
Agency
Division/Section
Company
Fund RCC
Prog
Dept/ Off. No.
DELI
DWR-Water Quality Regional Operations
1602
1690 6901
4300
Individual Responsible for Vehicle
Approval of Agency Head or Supervisor
Vehicle No. For Month of
Sherri Knight
261392 11 Dec'L Iftki e r
TRIP DATES
OFFICIAL TRAVEL
Pur ose of Trl ""
Division
Center
Print Name Above line
Pre -Trip
Inspection
Complete
Fuel Type —
Fuel Qty
(gallons)
MILEAGE
Leave
Return
From
To
Div Code if
di8erent
Sign our name"
Out
In
Mlles
3
W6
'
V uc�i'V
V �1 I �� •
r C-c C,
J
j)j�l�zs
} p jOWN
��
Vv � l� t`
�(Lii (5
('�
i c1
Gh�
�
Y\C)CA&
w ,14G
�-
�_
ca—1
��Igmc�
7
Ib q5���
��t3
� U�
t�
,1
C urib
e"t- '�4
0"I
U
ale
l
No. of Trips
No. of TripI Days
1
No. of Local Trips
Odometer Readings:
, egmning of
Month
j
n o
Month:
I �O
' By signing out a vehicle, the user:
1. Shall ensure that your HR Office has on file a current, valid, appropriate NCOL, and
2. Attests the above license does not have in excess of 5 points for moving violation in last 3 yrs or drug/alcohol conviction in last 5 yrs.
Failure to provide the above information may result in disciplinary action up to and Including dismissal.
Non- CDL Pre -trip Inspection Checklist
Safety, / Emergency Equipment available Brakes — good pedal pressure
-lom operational Tires — inflated and with adequate tread
rail Lights operational Head Lights — High and Low Beam operational
rum Signals operational Emergency Flashers operational Parking lights operational
3rake lights operational Windshield Wipers operational and washer fluid in reservoir
Vo visible fluid leak Mirrors — adjusted properly
DENR 0052
" Purpose of Trip: C - Complaint
E - Enforcement/Legal
F- Field trips
I - Inspection/Site Visits
M - MeetinglTraining
P - Permitting
S - Sampling
T - Technical
O - Other (Please specify in box)
Fuel Types: B5 - BloDlesel, 5"/
B20 - BloDiesel, 20%
D —Diesel, regular
E10 - Ethanol, 10%
E85 - Ethanol, 85°/
G87 - Gasoline, unleaded
G89 -Gasoline, unleaded
G93 - Gasoline, unleaded
O - Other (Please specify In box)
rev. 12-28-09