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HomeMy WebLinkAboutNCG120080_DMR_20200113 DocuSign Envelope ID:CC36D715-97AE-46F7-A980-BE5CC14E8FA1 SMITH GARDNER ADDRESS TEL WEB 14 N.Boylan Avenue,Raleigh NC 27603 919.828.0577 wwwsmithgardnerinc.com ENGINEERS February 21, 2020 NCDEQ Division of Water Quality Attention: DWQ Central Files 1617 Mail Service Center Raleigh, NC 27699-1617 RECr RE: January 2020 Discharge Monitoring Report MAR 0 3 Lu�1l South Wake MSW Landfill Certificate of Coverage#NCG120080 ,6,NTRAL FILES ES General Permit#NCG120000 Dear Sir/Madam: On behalf of South Wake MSW Landfill (SWLF), Smith Gardner, Inc. (S+G) is pleased to submit this discharge monitoring report. The facility is currently permitted discharge stormwater related to landfilling activities under Certificate of Coverage NCG120080, General Permit NCG120000. Currently, the facility is required to monitor discharge at the following Stormwater Discharge Outfall (SDO) locations: 1) SDO-1 2) SDO-4 3) SDO-6 Semiannual sampling was completed at SDO-6. The site was in Tier 2 status at SDO-1 (fecal coliform). SDO-1 and SDO-6 exceeded the benchmark threshold for fecal coliform. SDO-6 also exceeded the benchmark threshold for chemical oxygen demand (COD). SDO-1 is now in Tier 3 status as the January 2020 event was the fourth time it exceeded the fecal coliform benchmark threshold. As a response to the Tier 3 trigger, S+G met with Thad Valentine (NC DENR) on February 6, 2020 at SWLF to identify potential sources of fecal coliform at SDO-1.As a result of the visit, the site is making grading adjustments to alleviate direct runoff from this area as well as making maintenance repairs to the forebay and the riser and barrel structure at Basin 1 to improve water quality. S+G will continue to monitor SDO-1 at Tier 3 status and semiannual sampling will continue at SDO-4 and SDO-6. For this submittal, we are providing you with two (2) copies of the DMR. If you have any questions, or require further information, please contact us at (919) 828-0577 or by e-mail. DocuSign Envelope ID:CC36D715-97AE-46F7-A980-BE5CC14E8FA1 February 20 Discharge Monitoring Report South Wake MSW Landfill February 21, 2020 Page 2 of 2 Sincerely, SMITH GARDNER,INC. „--DocuSigned by:LDocuSigned by: th44u Staati Q. S►I& "-3369FBA008BB445... FT9917,EE9. Stacey A. Smith, P.E. Staff Engineer, ext. 170 Senior Engineer, ext. 127 jesselasmithgardnerinc.com staceyfdsmithgardnerinc.com Attachment CC: Troy Mitchell, GFL Environmental File H:\Projects\South Wake\NPDES ISWAKE 15-1)\2020\1-January\SW_Jan2020_NPDES report.docx DocuSign Envelope ID:CC36D715-97AE-46F7-A980-BE5CC14E8FA1 Semi-annual Stormwater Discharge Monitoring Report for North Carolina Division of Energy, Mineral and Land Resources General Permit No. NCG120000 Date submitted February 21. 2020 CERTIFICATE OF COVERAGE NO. NCG12 0 0 8 0 SAMPLE COLLECTION YEAR 2020 FACILITY NAME South Wake MSW Landfill SAMPLE PERIOD 1•f Jan-June I I July-Dec COUNTY Wake or 10 Monthly'. January (month) PERSON COLLECTING SAMPLES Jesse Li (Smith Gardner, Inc) DISCHARGING TO CLASS ORW f HQW I 'Trout I PNA LABORATORY Pace Analytical Lab Cert. It 37738 I 1Zero-flow Water Supply SA Comments on sample collection or analysis: •Other C PLEASE REMEMBER TO SIGN ON THE REVERSE --) :-aFCEIVED Part A: Stormwater Benchmarks and Monitoring Results MAR 0 3 2020 No discharge this period' Date Sample 24-hour rainfall Chemical OxyghefN I I 5L FILES Total Suspended Outfall No. Collected' amount, Demand )WR SECifKoliform Solids pH, (mo/dd/yr) Inches mg/L Colonies per 100 mL mg/L Standard Units Benchmarks - - 120 1000 100 or 504 6.0-9.0 Parameter Code - 46529 00340 31616 C0530 00400 SDO-1 1/13/20 0.36 73.6 6000 12.0 7.5 SDO-6 1/13/20 0.36 204 6000 61.9 7.6 1 Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall. 2 For sampling periods with no discharge at any single outfall,you must still submit this discharge monitoring report with a checkmark here. 'The total precipitation must be recorded using data from an on-site rain gauge. Unattended sites may be eligible for a waiver of the rain gauge requirement. ' See General Permit text,Table 1, identifying the especially sensitive receiving water classifications where the more protective benchmark applies. Note: Results must be reported in numerical format. For example,do not report Below Detection Limit, BDL, <PQL, Non-detect, ND, or other similar non- numerical format. When results are below the applicable limits, they must be reported in the format, "<XX mg/L", where XX is the numerical value of the detection limit, reporting limit, etc. in mg/L. Conversely, where fecal coliform results exceed the dilution upper limit, report the result as ">XX". Note: If you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses. See General Permit text. Permit Date: 11/1/2018-5/31/2021 SWU-248, last revised 11/1/2018 Page 1 of 2 DocuSign Envelope ID:CC36D715-97AE-46F7-A980-BE5CC14E8FA1 Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging> 55 gal of new oil per month. No discharge this period2 Outfall No. Date Sample Collected' 24-hour rainfall amount, Non-Polar Oil&Grease Total Suspended Solids, New Motor or Hydraulic Oil Usage, (mo/dd/yr) Inches3 mg/L mg/L gal/mon Benchmarks - - 15 100 or 504 — Parameter Code - 46529 00552 C0530 NCOIL Footnotes from Part A also apply to this Part B Note: If you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses. See General Permit text. FOR PART A AND PART B MONITORING RESULTS: • A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B. • 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART II SECTION B. • TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES 10 NO❑ IF YES,HAVE YOU CONTACTED THE DEMLR REGIONAL OFFICE? YES El NO❑ REGIONAL OFFICE CONTACT NAME: Thad Valentine Mail an original copy of this DMR, including all"No Discharge"reports, within 30 days of receipt of the lab results(or at end of monitoring period in the case of"No Discharge"reports)to: Division of Water Quality Attn:DWQ Central Files 1617 Mail Service Center Raleigh, North Carolina 27699-1617 YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED: "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 qualified personnel properly gather and evaluate 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." DocuSigned1b-y:: ''I' L1'oi (t&1-d.UJL 2/21/2020 09C00EE9C799400. Signature of Permittee Date Permit Date: 11/1/2018-5/31/2021 SWU-248, last revised 11/1/2018 Page 2 of 2 DocuSi n Envelope ID:CC36D715-97AE-46F7-A980-BE5CC14E8FA1 Pace Analytical Services,LLC e 9800 Kincey Ave. Suite 100 aceAnalytical Huntersville,NC 28078 www•pacMsb•coe (704)875-9092 January 22, 2020 Jesse Li Smith Gardner, Inc. 14 N. Boylan Ave Raleigh, NC 27603 RE: Project: Swake-19-1 Pace Project No.: 92460438 Dear Jesse Li: Enclosed are the analytical results for sample(s) received by the laboratory on January 13, 2020. The results relate only to the samples included in this report. Results reported herein conform to the most current, applicable TNI/NELAC standards and the laboratory's Quality Assurance Manual, where applicable, unless otherwise noted in the body of the report. If you have any questions concerning this report, please feel free to contact me. Sincerely, ( , 131C.,`.�--1) Matthew Brainard matthew.brainard@pacelabs.com (704)875-9092 Project Manager Enclosures e . ,,,-. 2 tia REPORT OF LABORATORY ANALYSIS /,, This report shall not be reproduced,except in full, ( without the written consent of Pace Analytical Services,LLC. Page 1 of 12 /1 DocuSi n Envelope ID:CC36D715-97AE-46F7-A980-BE5CC14E8FA1 Pace Analytical Services,LLC ® 9800 Kincey Ave. Suite 100 _ 13aceAnalytical Huntersville,NC 28078 www.pacNsbs.com (704)875-9092 CERTIFICATIONS Project: Swake-19-1 Pace Project No.: 92460438 Pace Analytical Services Raleigh 6701 Conference Drive,Raleigh,NC 27607 North Carolina Bioassay Certification#: 16 North Carolina Wastewater Certification#:67 North Carolina Drinking Water Certification#:37731 Pace Analytical Services Asheville 2225 Riverside Drive,Asheville,NC 28804 North Carolina Wastewater Certification#:40 Florida/NELAP Certification#:E87648 South Carolina Certification#:99030001 Massachusetts Certification#:M-NC030 VirginiaNELAP Certification#:460222 North Carolina Drinking Water Certification#:37712 Pace Analytical Services Eden 205 East Meadow Road Suite A,Eden,NC 27288 North Carolina Wastewater Certification#:633 North Carolina Drinking Water Certification#:37738 VirginiaNELAP Certification#:460025 REPORT OF LABORATORY ANALYSIS This report shall not be reproduced,except in full, without the written consent of Pace Analytical Services,LLC. Page 2 of 12 .00911 DocuSi n Envelope ID:CC36D715-97AE-46F7-A980-BE5CC14E8FA1 Pace Analytical Services,LLC aceAnalytical 9800 Kincey Ave. Suite 100 Huntersville,NC 28078 www.pacelabs.com (704)875-9092 SAMPLE ANALYTE COUNT Project: Swake-19-1 Pace Project No.: 92460438 Analytes Lab ID Sample ID Method Analysts Reported Laboratory 92460438001 SDO-001 SM 25400-2011 AMI 1 PASI-E SM 9222D-2006 WT 1 PASI-R SM 5220D-2011 JP1 1 PASI-A 92460438002 SDO-006 SM 25400-2011 AMI 1 PASI-E SM 9222D-2006 WT 1 PASI-R SM 5220D-2011 JP1 1 PASI-A REPORT OF LABORATORY ANALYSIS This report shall not be reproduced,except in full, without the written consent of Pace Analytical Services,LLC. Page 3 of 12 DocuSi n Envelope ID:CC36D715-97AE-46F7-A980-BE5CC14E8FA1 Pace Analytical Services,LLC aceAnalytical 9800 Kincey Ave. Suite 100 Huntersville,NC 28078 www.pacelabs.com (704)875-9092 ANALYTICAL RESULTS Project: Swake-19-1 Pace Project No.: 92460438 Sample: SDO-001 Lab ID: 92460438001 Collected: 01/13/20 11:17 Received: 01/13/20 13:31 Matrix: Water Parameters Results Units Report Limit DF Prepared Analyzed CAS No. Qual 2540D Total Suspended Solids Analytical Method:SM 2540D-2011 Total Suspended Solids 12.0 mg/L 3.1 1 01/16/20 11:19 MBIO 9222D Fecal Coliform RAL Analytical Method:SM 9222D-2006 Preparation Method:SM 9222D-2006 Fecal Coliforms 6000 CFU/100 mL 1.0 1 01/13/20 15:02 01/14/20 14:44 u2 5220D COD Analytical Method:SM 5220D-2011 Preparation Method:SM 5220D-2011 Chemical Oxygen Demand 73.6 mg/L 25.0 1 01/16/20 21:38 01/17/20 05:54 REPORT OF LABORATORY ANALYSIS This report shall not be reproduced,except in full, Date:01/22/2020 08:53 AM without the written consent of Pace Analytical Services,LLC. Page 4 of 12 DocuSi n Envelope ID:CC36D715-97AE-46F7-A980-BE5CC14E8FA1 Pace Analytical Services,LLC yceAnalytical 5 9800 Kincey Ave. Suite 100 Huntersville,NC 28078 www.pacelabs.com (704)875-9092 ANALYTICAL RESULTS Project: Swake-19-1 Pace Project No.: 92460438 Sample: SDO-006 Lab ID: 92460438002 Collected: 01/13/20 11:40 Received: 01/13/20 13:31 Matrix: Water Parameters Results Units Report Limit DF Prepared Analyzed CAS No. Qual 2540D Total Suspended Solids Analytical Method:SM 2540D-2011 Total Suspended Solids 61.9 mg/L 6.7 1 01/16/20 11:19 MBIO 9222D Fecal Coliform RAL Analytical Method:SM 9222D-2006 Preparation Method:SM 9222D-2006 Fecal Coliforms 6000 CFU/100 mL 1.0 1 01/13/20 15:02 01/14/20 14:44 u2 5220D COD Analytical Method:SM 5220D-2011 Preparation Method:SM 5220D-2011 Chemical Oxygen Demand 204 mg/L 25.0 1 01/16/20 21:38 01/17/20 05:54 REPORT OF LABORATORY ANALYSIS This report shall not be reproduced,except in full. Date:01/22/2020 08:53 AM without the written consent of Pace Analytical Services,LLC. Page 5 of 12 DocuSi(9n Envelope ID:CC36D715-97AE-46F7-A980-BE5CC14E8FA1 Pace Analytical Services,LLC aceAI Ia yticaI� 9800 Kincey Ave Suite 100 Huntersville,NC 28078 www.pacelabs.com (704)875-9092 QUALITY CONTROL DATA Project: Swake-19-1 Pace Project No.: 92460438 QC Batch: 519522 Analysis Method: SM 2540D-2011 QC Batch Method: SM 2540D-2011 Analysis Description: 2540D Total Suspended Solids Associated Lab Samples: 92460438001,92460438002 METHOD BLANK: 2780369 Matrix: Water Associated Lab Samples: 92460438001,92460438002 Blank Reporting Parameter Units Result Limit Analyzed Qualifiers Total Suspended Solids mg/L ND 2.5 01/16/20 11:26 LABORATORY CONTROL SAMPLE: 2780370 Spike LCS LCS %Rec Parameter Units Conc. Result %Rec Limits Qualifiers Total Suspended Solids mg/L 250 256 102 90-110 SAMPLE DUPLICATE: 2780371 92460646001 Dup Parameter Units Result Result RPD Qualifiers Total Suspended Solids mg/L 103 128 22 SAMPLE DUPLICATE: 2780372 92460647002 Dup Parameter Units Result Result RPD Qualifiers Total Suspended Solids mg/L 776 813 5 • Results presented on this page are in the units indicated by the"Units"column except where an alternate unit is presented to the right of the result. REPORT OF LABORATORY ANALYSIS This report shall not be reproduced,except in full, Date:01/22/2020 08:53 AM without the written consent of Pace Analytical Services,LLC. Page 6 of 12 /1 DocuSi n Envelope ID:CC36D715-97AE-46F7-A980-BE5CC14E8FA1 Pace Analytical Services,LLC ceAnalytical 9800 KineyAve. Suite 100 Huntersville,NC 28078 wwrr.pecPah.caa (704)875-9092 QUALITY CONTROL DATA Project: Swake-19-1 Pace Project No.: 92460438 QC Batch: 519433 Analysis Method: SM 9222D-2006 QC Batch Method: SM 9222D-2006 Analysis Description: 9222D Fecal Coliform(MF)-RAL Associated Lab Samples: 92460438001,92460438002 METHOD BLANK: 2779897 Matrix: Water Associated Lab Samples: 92460438001,92460438002 Blank Reporting Parameter Units Result Limit Analyzed Qualifiers Fecal Coliforms CFU/100 mL ND 1.0 01/14/20 14:44 SAMPLE DUPLICATE: 2779898 92460438001 Dup Parameter Units Result Result RPD Qualifiers Fecal Coliforms CFU/100 mL 6000 6000 0 u2 Results presented on this page are in the units indicated by the"Units"column except where an alternate unit is presented to the right of the result. REPORT OF LABORATORY ANALYSIS This report shall not be reproduced,except in full, Date:01/22/2020 08:53 AM without the written consent of Pace Analytical Services,LLC. Page 7 of 12 .00111 DocuSi n Envelope ID:CC36D715-97AE-46F7-A980-BE5CC14E8FA1 Pace Analytical Services,LLC aceAnalytical 9800KineyAve. Suite 100 Huntersville,NC 28078 www.pacelabs.com (704)875-9092 QUALITY CONTROL DATA Project: Swake-19-1 Pace Project No.: 92460438 QC Batch: 519818 Analysis Method: SM 5220D-2011 QC Batch Method: SM 5220D-2011 Analysis Description: 5220D COD Associated Lab Samples: 92460438001,92460438002 METHOD BLANK: 2781989 Matrix: Water Associated Lab Samples: 92460438001,92460438002 Blank Reporting Parameter Units Result Limit Analyzed Qualifiers Chemical Oxygen Demand mg/L ND 25.0 01/17/20 05:42 LABORATORY CONTROL SAMPLE: 2781990 Spike LCS LCS %Rec Parameter Units Conc. Result %Rec Limits Qualifiers Chemical Oxygen Demand mg/L 750 755 101 90-110 MATRIX SPIKE&MATRIX SPIKE DUPLICATE: 2781991 2781992 MS MSD 2627510001 Spike Spike MS MSD MS MSD %Rec Parameter Units Result Conc. Conc. Result Result %Rec %Rec Limits RPD Qual Chemical Oxygen Demand mg/L 1420 100 100 1510 1530 91 114 90-110 2 M1 MATRIX SPIKE&MATRIX SPIKE DUPLICATE: 2781993 2781994 MS MSD 2627495002 Spike Spike MS MSD MS MSD %Rec Parameter Units Result Conc. Conc. Result Result %Rec %Rec Limits RPD Qual Chemical Oxygen Demand mg/L 19900 100 100 19700 19300 -229 -572 90-110 2 M1 Results presented on this page are in the units indicated by the"Units"column except where an alternate unit is presented to the right of the result. REPORT OF LABORATORY ANALYSIS This report shall not be reproduced,except in full, Date:01/22/2020 08:53 AM without the written consent of Pace Analytical Services,LLC. Page 8 of 12 DocuSi n Envelope ID:CC36D715-97AE-46F7-A980-BE5CC14E8FA1 Pace Analytical Services,LLC _ PCceAnalytical 9800 Kincey Ave. Suite Huntersville,NC 2807878 www.pacNsbs.cas (704)875-9092 QUALIFIERS Project: Swake-19-1 Pace Project No.: 92460438 DEFINITIONS DF-Dilution Factor,if reported,represents the factor applied to the reported data due to dilution of the sample aliquot. ND-Not Detected at or above adjusted reporting limit. TNTC-Too Numerous To Count J-Estimated concentration above the adjusted method detection limit and below the adjusted reporting limit. MDL-Adjusted Method Detection Limit. PQL-Practical Quantitation Limit. RL-Reporting Limit-The lowest concentration value that meets project requirements for quantitative data with known precision and bias for a specific analyte in a specific matrix. S-Surrogate 1,2-Diphenylhydrazine decomposes to and cannot be separated from Azobenzene using Method 8270.The result for each analyte is a combined concentration. Consistent with EPA guidelines,unrounded data are displayed and have been used to calculate%recovery and RPD values. LCS(D)-Laboratory Control Sample(Duplicate) MS(D)-Matrix Spike(Duplicate) DUP-Sample Duplicate RPD-Relative Percent Difference NC-Not Calculable. SG-Silica Gel-Clean-Up U-Indicates the compound was analyzed for,but not detected. Acid preservation may not be appropriate for 2 Chloroethylvinyl ether. A separate vial preserved to a pH of 4-5 is recommended in SW846 Chapter 4 for the analysis of Acrolein and Acrylonitrile by EPA Method 8260. N-Nitrosodiphenylamine decomposes and cannot be separated from Diphenylamine using Method 8270. The result reported for each analyte is a combined concentration. Pace Analytical is TNI accredited.Contact your Pace PM for the current list of accredited analytes. TNI-The NELAC Institute. LABORATORIES PAST-A Pace Analytical Services-Asheville PAST-E Pace Analytical Services-Eden PAST-R Pace Analytical Services-Raleigh ANALYTE QUALIFIERS M1 Matrix spike recovery exceeded QC limits. Batch accepted based on laboratory control sample(LCS)recovery. u2 Colonies are too numerous to count. Actual result may be greater than reported. REPORT OF LABORATORY ANALYSIS This report shall not be reproduced,except in full, Date:01/22/2020 08:53 AM without the written consent of Pace Analytical Services,LLC. Page 9 of 12 DocuSi n Envelope ID:CC36D715-97AE-46F7-A980-BE5CC14E8FA1 Pace Analytical Services,LLC ID ace Analytical 9800 KineyAve Suite 100 Huntersville,NC 28078 www.pacelabs.com (704)875-9092 QUALITY CONTROL DATA CROSS REFERENCE TABLE Project: Swake-19-1 Pace Project No.: 92460438 Analytical Lab ID Sample ID QC Batch Method QC Batch Analytical Method Batch 92460438001 SDO-001 SM 25400-2011 519522 92460438002 SDO-006 SM 25400-2011 519522 92460438001 SDO-001 SM 92220-2006 519433 SM 9222D-2006 519435 92460438002 SDO-006 SM 92220-2006 519433 SM 9222D-2006 519435 92460438001 SDO-001 SM 52200-2011 519818 SM 5220D-2011 519884 92460438002 SDO-006 SM 52200-2011 519818 SM 5220D-2011 519884 REPORT OF LABORATORY ANALYSIS This report shall not be reproduced,except in full, Date:01/22/2020 08:53 AM without the written consent of Pace Analytical Services,LLC. Page 10 of 12 Y_....../1 CHAIN-OF-CUSTODY Analytical Request Document LAB USE ONI WO# 92460438 NUr O �ceAnalytical' I!'II 11111liIIIIIIIIIIII Chain-of-Custody is a LEGAL DOCUMENT-Complete all relevent fields co Company: Billing Information: 92460438 m 55 Int 61cu d ,c_ N Address: 1yN >7` 1� e- Container Preservative Type"` I I - -1, 1 1 . 1 L I g Lab Project Manager: Report To: t s Email To: ••? se vat Ve Types:(1) { } { ! y (4) y I-} 5— Q-sse eJ_j m i �(',� s—t nC�eel 'nitric acid, 2 sulfuric acid, 3 hydrochloric acid, sodium hydroxide, S zinc acetate, J (6)methanol,(7)sodium bisutlate,(S)sodium thiosulfate,(9)hexane,(A)ascorbic acid,(B)ammonium sulfate, Copy To: Site Collection Info/Address: (C)ammonium hydroxide,(D)TSP,(U)Unpreserved,(0)Other w O)— Analyses Lab Profile/Line: p Customer Project Name/Number: State County/City: Time Zone Collected. Lab Sample Receipt Checklist: S LSlA�/E -I(1---1 NC / viGLkQ_ [ )PT[ ]MT( ]CT [ ET u Custody Sealsnatures PresePresentn tl Intact YY NNA to Phone:Cos 3 _3g53105 Site/Facility ID#: Compliance Monitoring? eoay Sig NA y Email: 7 s0I)(� kAia6 (Y'Yes [ ]No Collector.signature Present (�N NA m Collected ByFes- ' sorties:Intact Q!N NA m T (print): Purchase Order#: OW PWS ID#: Correct Bottles 6i N NA m 'JeSl L__s Quote#: OW Location Code: Q sufficient Volume ®N NA Samples Received on Ice Qj.N NA Collected B signature): Turnaround Date Required: Immediately Packed on Ice: voA treads e�JpJ paceACceptoble Y N S'rU-��dL�� (�es ( JNo USDA Regglated ile Y N co F/ Samples in"Hb g.?ime ®N NA M Sample Disposal: Rush: leld Filtered(if applicable): Residual.Chlorine. Present Y N l0 n ispose as appropriate I I Return I I Same Day [ ]Next Day ( )Yes o 4 C1 Strips: t J Archive: j ]2 Day [ ]3 Day [ 14 Day [ )5 Day �' a Sample pa A gp 0 N NA [ ] Analysis: 1� '` A Hold: (txpediteChargesApply} {t pH Strips: J m 'S Sulfide Present Y N tQ OD "Matrix Codes(Insert in Matrix box below):Drinking Water(DW),Ground Water(GW),Wastewater(WW), Lead Acetate Strips: y Product(P),Soil/Solid(SL),Oil(OL),Wipe(WP),Air(AR),Tissue(TS),Bioassay(B),Vapor(V),Other(OT) -" - LAB USE ONLY: Comp/ Collected(or Res #of Lab sample # / Comments Customer Sample.ID Matrix' Grab Com Composite End posite Start) CI Ctns Date Time Date Time i SDO-oo k v✓ CI 1-t3 11 1- 3 )o ?o - 5 Do -op(' t47/ "lzk i-'3 i1;1t0 v4., V y Customer • t Remarks/Speciale Conditions/Possible Hazards: Type of Ice Used: C - Blue Dry None SHORT HOLDS PRESENT(<72 hours): ON N/A Lab Sample Temperature Info: l'J C t -5 't Packing Material Used: - Lab Tracking#: [` 2 4 2 4 2 2 Temp Blank Received: Y N NA SrJo � 1 O 7 Therm ID#: Q troo S Cooler 1'Temp Upon Receipt:S I oC 5Oo ''O & . , r„ Samples received via: Cooler 1 Therm Corr.Factor: O oC c7 Yj Radchem sample{s)screened(<500 cpm): Y N NA 'FEDEX UPS li Courier Pace Courier Cooler 1 Corrected Temp: 5-1 oC Relinquished by/Compan :(Signature) Date/Time: Received b /Compa :(Signature) Date/Time: MTJL LAB USE ONLY Comments: ( 1, fable#: L5 1'1� 13.3 7./4 1_13"20 l 3.3i Table : t elinquished by/Company:(Signature) Date/Time: ceived by/Company:(Signature) Date/Time: Template: Trip Blank Received: Y N NA u LD ° HCL McOH TSP Other Prelo1(in: -Relinquished by/Company(Signature) Date/Time: Received by/Company:(Signature) Date/Time: PM. 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