RESPONSE TO NOV-2025-MV-0050 AND NOV-2025-MV-0051

109 N Main Street Town of Rich Square Phone: [phone]
P.O Box 336 Fax: [phone]
Rich Square, NC 27869 Website: richsquarenc.org
August 1, 2025
Mr. Michael Hall, Regional Supervisor
Water Quality Regional Operations Section
Raleigh Regional Office
Division of Water Resources, NCDEQ
3800 Barrett Drive
Raleigh, NC 27609
Subject: NOV 2025-MV-0050
NOV-2025-MV-0051
Permit No: NCO025437
Town of Rich Square WWTP
Dear Mr. Hall:
AUG I I Z025
As per attached with this letter a copy of the Notice of Violation & Intent to Access Civil Penalty
the Town is being violated for not monitoring the parameters on Nitrogen, Total - Concentration
(C0600), and Phosphorus, Total (as P) Concentration (C0665) for the months of December 2024
and March 2025. Also included with this letter are the Waypoint sampling reports of analysis for
the months of December 2024 and March 2025 for your records. I have contacted and spoken to
Waypoint Analytical in reference to this matter so hopefully they will do a better job in the future
with providing the correct sampling packages depending on the month and type of samples
required to be pulled monthly versus quarterly by permit requirements. The Town would like to
ask for an amendment in these matters.
Thank you kindly for your assistance in verifying that this process had not been completed.
Sincerely,
/efflre'y/L g, ORC
Town of Rich Square
�
V
Victoria Newcombe, Mayor
Town of Rich Square

Docusign Envelope ID: C5098610-1250-4214891E-DB7CC782885A
JOSH STEIN
G-ent,
D. REID WILSON
V1."m,
RICHARD E- ROGERS. JR.
Anuv
3
NORTH CAROUNA
Environmental Quality
Certified Mail # 9589 0710 5270 1260 2148 76
Return 'Receipt Requested
July 21, 2025
Victoria Newcombe, Mayor
Town of Rich Square
PO Box 336
Rich Square, NC 27869
SUBJECT: NOTICE OF VIOLATION & INTENT TO ASSESS CIVIL PENALTY
Tracking Number: NOV-2025-MV-0050
Permit No. NCO025437
Rich Square WWTP
Northampton County
Dear Mayor Newcombe:
AU,g d m -
C0C.5
A review of the March 2025 Discharge Monitoring Report (DMR) for the subject facility revealed the violation(s)
indicated below:
�uiZli r • I OR
Sample
Location Parameter
Monitoring
Date Frequency Type of Violation
001 Effluent Nitrogen, Total - Concentration 3/31/2025 Quarterly Frequency Violation
(C0600)
001 Effluent Phosphorus, Total (as P) - 3/31/2025 Quarterly Frequency Violation
Concentration (C0665)
A Notice of Violation/Intent to Issue Civil Penalty is being issued for the noted violation of North Carolina General
Statute (G.S.) 143-215.1 and the facility's NPDES WW Permit. Pursuant to G.S. 143-215.6A, a civil penalty of
not more than twenty-five thousand dollars ($25,000.00) may be assessed against any person who violates or
fails to act in accordance with the terms, conditions, or requirements of any permit issued pursuant to G.S.
143-215.1.
Remedial actions should have already been taken to correct this problem and prevent further occurrences in the
future. Please respond in writing within ten (10) business days after receipt of this Notice, stating whether the
violation(s) has been corrected, or if it is of an ongoing nature. If the violation(s) has been resolved, your
response should include a description of the actions that were taken to address the violation(s) and to prevent
their reoccurrence.
w� �I�Crv.�Mrynm�n.Clmsmn.m.�IQ.y.ItMnwdNyn Ynnne.
Lr/�-�C��//f� Y.isf�M.youlg4e Laa4rri�6nr LYp1.W�I.f�idutie0o
IMa.Ty

Docusign Envelope ID: CF07587D-6E22-4FBB-8926-33CC8ECA9B6A
Vic►
JOSH STEINCcnernor
```
D. REID WILSON'�
RICHARD E. ROGERS. JR. NORTH CAROLINA
Environmental Quality
Certified Mail # 9589 0710 52701260 2148 83
Return Receipt Requested
July 21, 2025
Victoria Newcombe, Mayor
Town of Rich Square
PO Box 336
Rich Square, NC 27869
SUBJECT: NOTICE OF VIOLATION & INTENT TO ASSESS CIVIL PENALTY
Tracking Number: NOV-2025-MV-0051
Permit No. NCO025437
Rich Square WWTP
Northampton County
Dear Mayor Newcombe:
A review of the December 2024 Discharge Monitoring Report (DMR) for the subject facility revealed the
violation(s) indicated below:
Monitoring Violation(s):
Sample
Location Parameter
Monitoring
Date Frequency Type of Violation
001 Effluent Nitrogen, Total - Concentration 12/31/2024 Quarterly Frequency Violation
(C0600)
A Notice of Violation/Intent to Issue Civil Penalty is being issued for the noted violation of North Carolina General
Statute (G.S.) 143-215.1 and the facility's NPDES WW Permit. Pursuant to G.S. 143-215.6A, a civil penalty of
not more than twenty-five thousand dollars ($25,000.00) may be assessed against any person who violates or
fails to act in accordance with the terms, conditions, or requirements of any permit issued pursuant to G.S.
143-215.1.
Remedial actions should have already been taken to correct this problem and prevent further occurrences in the
future. Please respond in writing within ten (10) business days after receipt of this Notice, stating whether the
violation(s) has been corrected, or if it is of an ongoing nature. If the violation(s) has been resolved, your
response should include a description of the actions that were taken to address the violation(s) and to prevent
their reoccurrence.
^ , ..... �_ � ��� North Carolina DepartateM of Ern~rotnnefttal Quality I Division of Water Rc satrcees
Raleigh Regional Office 1 3800 Barrett Drive I Raleigh. North Ufalina 27609
o.�.� /' 0 90.7%4200

•
• 114 Oakmont Drive, Greenville, NC 27858
Waypoint Main 252.756.6208 ° Fax [phone]
ANALYTICAL www.waypo � lntanai cal.com
00197
Town of Rich Square
Jeff Long Project 197 - Rich Square WW
PO Box 336 Information
Rich Square, NC 27869
Report Date: 03/24/2025
Report Number: 25-077-0607
REPORT OFANAL Y57S
Received: 03/18/2025
Lab No : 75952
Matrix: Aqueous
Sample ID: Influent
Sampled: 3/18/202511:35
Test
Results
Units
MOL
DF Date / Time By Analytical
Analyzed Method
Biochemical Oxygen Demand (5-day)
22
mg/L
22
1 03/19/25 09:32 ANSI 5210E-2016
Total Suspended Solids
22.7
mg/L
6.2
1 03/19/25 09:00 BLV 254OD-2020
Lab No : 75953
Matrix: Aqueous
Sample ID: Effluent
Sampled: 3/18/202511:00
Test
Results
Units
MOL
DF Date /Time By Analytical
Analyzed Method
Ammonia Nitrogen
.W.49
m9/L
0.10
5 03/24/25 11:25 MSK 350.1
Biochemical Oxygen Demand (5-day)
f20
mg/L
8.0
1 03/19/25 09:32 ANSI 5210E-2016
Fecal Coliform
.,.4 '
cfu/100mL
1
1 03/18/25 15:40 BLV 9222D-2015
Total Suspended Solids
21.5
mg/L
6.2
1 03/19/25 09:00 BLV 254OD-2020
Qualifiers/ DF Dilution Factor
Definitions MQL Method Quantitation Limit
L Limit Exceeded
Page 2 of 4

0 o 114 Oakmont Drive, Greenville, NC 27858
Waypoint. Main 252.756.6208 ° Fax [phone]
ANALYTICAL w w.waypcintanalytical.com
00197
Town of Rich Square
Jeff Long Project 197 - Rich Square W W
PO Box 336 Information
Rich Square , NC 27869
Report Number: 25-070-0602
REPORT OFANAL YSIS
Report Date : 03/23/2025
Received : 03/11/2025
Lab No : 74955
Matrix: Aqueous
Sample ID: Influent
Sampled: 3/11/202511:20
Test
Results
Units
MOL
DF Date/Time By Analytical
Analyzed Method
Biochemical Oxygen Demand (5-day)
94
mg/L
40
1 03/11/25 10:48 ANSI 52108-2016
Total Suspended Solids
61.5
mg/L
12.5
1 03/12/25 09:00 AAM 254OD-2020
Lab No : 74956
Matra: Aqueous
Sample ID : Effluent
Sampled: 3/11/2025 10:45
Test
Results
Units
MQL
DF Date / Time By Analytical
Analyzed Method
Nitrate (NO3-N)
/632
mg/L
0.10
1 03/11/25 15:38 EPA-353.2
Ammonia Nitrogen
'1'i99
mg/L
0.10
5 03/19/25 09:15 HMM 350.1
Biochemical Oxygen Demand (5-day)
-a1
mg/L
20
1 03/11/25 15:20 ANSS 521OB-2016
Fecal Coliform
.i<1
cfu/100ml.
1
1 03/11/25 15:04 BLV 9222D-2015
Chloride
/16.0
mg/L
1.00
1 03/13/25 08:00 AAM 4500CIB-2021
Nitrate+Nitrite-N
O�39
mg/L
0.10
5 03/1212510:39 MSK 353.2
Total Dissolved Solids
1D
mg/L
12
1 03/12/25 09:00 BLV 254OC-2020
Total Suspended Solids
.k2;6
mg/L
3.1
1 03/12/25 09:00 AAM 254OD-2020
Qualifiers/ DF Dilution Factor
Definitions MQL Method Quantitation Limit
L Limit Exceeded
Page 2 of 4

Waypoint
ANALYTICAL
2/13/2025
Town of Rich Square
Jeff Long
PO Box 336
Rich Square, NC, 27869
Ref: Analytical Testing
Lab Report Number: 25-035-0901
Client Project Description: 197 - Rich Square WW
114 Oakmont Drive, Greenville, NC 27858
Main 252.756.6208 0 Fax [phone]
www.waypointanalytical.com
Dear Jeff Long:
Waypoint Analytical Carolina (Greenville) received sample(s) on 2l4/2025 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,
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 Cert# 37715
NC DEQ W W Cert# 10
NC DEQ W W Satellite Cert# 610

•
114 Oakmont Drive, Greenville, NC 27858
Waypoint.0
Main 252.756.6208
° Fax [phone]
www.waypointanalytical.com
ANALYTICAL
00197
Town of Rich Square
Jeff Long
Project
197 -
Rich Square W W
PO Box 336
Information :
. w b L�LJ
Rich Square , NC 27869
Report Date : 02/13/2025
Report Number : 25-035-0901
REPORT OFANAL YSIS
Received : 02/04/2025
Lab No : 98863
Matrix: Aqueous
Sample ID : Influent
Sampled: 2/4/2025 10:55
Test
Results
Units
MOL
DF Date/Time By Analytical
Analyzed Method
Biochemical Oxygen Demand (5-day)
59
nag/L
20
1 02/04/25 11:20 ANSI 5210E-2016
Total Suspended Solids
25.0
mg/L
8.3
1 02/05/25 08:50 BNC 254OD-2020
Lab No : 98864
Matrix: Aqueous
Sample ID : Effluent
Sampled: 2/4/202511:17
Test
Results
Units
MOL
DF Date / Time By Analytical
Analyzed Method
Ammonia Nitrogen
12.14
mg/L
0.10
5 02/05/25 13:25 HMM 350.1
Biochemical Oxygen Demand (5-day)
21
mg/L
8.0
1 02/04/25 15:06 ANSI 5210E-2016
Fecal Colifonn
<1
cfu/100ml-
1
1 02/04/25 14:32 AAM 922213-2015
Total Suspended Solids
10.0
mg/L
2.5
1 02/05/25 08:50 BNC 254OD-2020
Qualifiers/ OF Dilution Factor L Limit Exceeded
Definitions MQL Method Quantitation Limit

Waypoint.
ANALYTICAL
114 Oakmont Drive, Greenville, NC 27858
Main 252.756.6208 0 Fax [phone]
www.waypolntanalytical.com
Shipment Receipt Form
Customer Number: 00197
Customer Name: Town of Rich Square
Report Number: 25-035.0901
Shipping Method
0 Fed Ex (> US Postal • Lab
0 UPS _ Client Courier
Other
Thermometer ID:
11.8c Oakton
Shipping container/cooler uncompromised?
• Yes
iJ No
Number of coolers/boxes received
F 1
Custody seals intact on shipping container/cooler?
0 Yes
0 No
Not Present
Custody seals intact on sample bottles?
0 Yes
U No
CO) Not Present
Chain of Custody (COC) present?
n Yes
C, No
COC agrees with sample label(s)?
• Yes
0 No
COC properly completed
0 Yes
(J 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?
U Yes
0 No
Cooler temperature in compliance?
0 Yes
c -) 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 N/A
Water - VOA vials free of headspace
Yes
G No
* N/A
Trip Blanks received with VOAs
Yes
C) No
G N/A
Soil VOA method 5035 — compliance criteria met
Yes
No
(6) N/A
High concentration container (48 hr) 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: F
Yes
No
Signature: asey Gurganus Date & Time: 2/04/2025 14:08:01

Waypoittt© CHAIN OF CUSTODY RECORD
Waypoint Analytical - Greenville Page 1 of
Greenville. NC 27858
DISINFECTION
CHLORINE CHECK (LAB)
www. WaypoiiiiAiialytical.com
Phone [phone](��• Nix (252)17�,ee063
❑ CHLORINE
<0.5 mg/L-Yes Mar No(N)
CLIENT-
UV
pH CHECK (S.U.) (LAB)
I
CONTAINERTYPE,P/G
TOWN OF RICH SQUARE
ATTN: JEFF LONG
NONE
P.O. BOX 336
RICH SQUARE NC 27869
Ll4
1
4
CHEMICALPRESERVATION
A -NONE D-NAOH
Z o
[phone]
E F
z
y
uw
u+
iz B•HNO, E-HCL
O
o f
ui
¢
W
z
a
o�
C-H,SO, F-ZINCACETATE/NAOH
COLLECTION
¢
� a
d G-NATHIOSULFATE
a
SAMPLE LOCATION
DATE
TIME
Influent
.
2
l�
CLASSIFICATION:
Ll WASTEWATER(NPDES)
Effluent
-2 7
// 7
4
�.'CI:
<
/
❑ DRINKINGWATER
DWR/GW
SOLID WASTE SECTION
CHAIN OF CUSTODY (SEAL) MAINTAINED
DURING YHIPMENT/DELIVERY
II�II�I�IUIIIIIII�NIIIUIIIIIIIIIIWIII�IIWIIIIIi� 00197 sl
Tovm of Rich SaUale is o7-_0
SAMPLES COLLECTED BY:
197 - Rich Suuare W W
(Please Print)
SAMPLES RECEIVE IN LAB AT I L—. <C
R
ISHEDBY(SIG.)(SAMPLER)
DAATTFITIME
RECEIVED BY (SIG.)
DATE/fIM1E
COMMENTS: l(
SAMPLES RECEIVED ON ICE: fES - NO
f� 4g0�
') it': Ili 1"(11I
`
FIEUIbUIS41ED BY (SIG.)
DATERME
RECE Y (SIG.)
DATERME
REUNCUISHEDBY(SIG.)
DATE/TIME
RECEIVED BY (SIG.)
DATERME
PLEASE READ Instructions for completing this form on the reverse side. Sampler must place a "C" for composite sample or a "G" for
FORM as Grab sample in the blocks above for each parameter requested.

Waypoln't.
ANALYT]CAL
00197
Town of Rich Square
114 Oakmont Drive, Greenville,. -NC 27858
Main 252.756.6208 0 Fax [phone],
w.ww.waypointonelyt[cal.com
Jeff Long Project 197 - Rich Square WW
PO Box 336 Information
Rich Square , NC 27869
Report Date: 12/31/2024
Report Number: 24-352-0609
REPORTOFANALYSIS
Received : 12/17/2024
Lab No : 93174
Matrix: Aqueous
Sample ID : Influent
Sampled: 12/17/202410:50
Test
Results Units MOL
DF Date / Time By Analytical
Analyzed Method
Biochemical Oxygen Demand (5-day)
/87 mg/L 40
1 12/18/2410:14 IMMS 521OB-2016
Total Suspended Solids
Af,4 mg/L 9.6
1 12/18/24 09:00 AAM 254OD-2020
Lab No : 93175
Matrix: Aqueous
Sample ID : Effluent
Sampled: 12/17/202411:11
Test
Results
Units
MOL
DF Date / Time By
Analytical
Analyzed
Method
Ammonia Nitrogen
10.15
mg/L
0.08
4 12/30/24 10:29 HMM
350.1
Biochemical Oxygen Demand (5-day)
-*'10
mg/L
8.0
1 12/18/2410:14 IMMS
521OB-2016
Fecal Coliform
! <1
cfu/100mL
1
1 12/17/2415:20 BNC
9222D-2015
Total Suspended Solids
/19.0
mg/L
5.0
1 12/18/24 09:00 AAM
254OD-2020
Qualifiers/ DF Dilution Factor L Limit Exceeded
Definitions MQL Method Quantltation Limit
Page 2 of 4

a
•
Waypoint
ANALYTICAL
00197
Town of Rich Square
114 Oakmont Drive, Greenville, NC 27858
Main 252.756.6208 0 Fax [phone]
www.waypointenalytical.com
Jeff Long Project 197 - Rich Square WW
PO Box 336 Information
Rich Square , NC 27869
Report Date : 12/20/2024
Report Number: 24-338-0510
REPORTOFANALYSIS
Received : 12/03/2024
Lab No : 90788
Matrix: Aqueous
Sample ID: Influent
Sampled: 12/3/202410:55
Test
Results
Units
MQL
DF Date / Time By Analytical
Analyzed Method
Biochemical Oxygen Demand (5-day)
/120
mg/L
40
1 12/03/24 09:14 IMMS 5210E-2016
Total Suspended Solids
/ 6.6
mg/L
16.6
1 12/04/24 09:00 AAM 254OD-2020
Lab No : 90789
Matrix: Aqueous
Sample ID: Effluent
Sampled: 12/3/202411:25
Test
Results
Units
MQL
DF Date / Time By Analytical
Analyzed Method
Ammonia Nitrogen
/0.09
mg/L
0.02
1 12/16/24 11:25 MTK 350.1
Biochemical Oxygen Demand (5-day)
*4.8
mg/L
2.0
1 12/03/24 09:14 3MMS 5210E-2016
Fecal Coliform
1
cfi/100mL
1
1 12/03/2414:48 BNC 9222D-2015
Total Suspended Solids
/f7.5
mg/L
5.4
1 12/04/24 09:00 AAM 254OD-2020
Qualifiers/ DF Dilution Facbor L Limit Exceeded
Definitions MQL Method Quantitation Limit
Page 3 of 5

WaY oint
ANALYTICAL
11 /12/2024
Town of Rich Square
Jeff Long
PO Box 336
Rich Square, NC, 27869
114 Oakmont Drive, Greenville, NC 27858
Main 252.756.6I08 0 Fax [phone]
www.waVpointanalytical.com
Ref: Analytical Testing
Lab Report Number: 24-310-0908
Client Project Description: 197 - Rich Square WW (2xMonthly)
Dear Jeff Long:
Waypoint Analytical Carolina (Greenville) received sample(s) on 11/5/2024 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 0V %
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 Cert# 37715
NC DEQ W W Cert# 30
NC DEQ W W Satellite Cert# 610

• 114 Oakmont Drive, Greenville, NC 27858
Waypoi nt . Main 252.756.62080 Fax [phone]
ANALYTICAL www.waypointanalytical.com
00197
Town of Rich Square
Jeff Long Project 197 - Rich Square W W (2xMonthly)
PO Box 336 Information
Rich Square , NC 27869
Report Date : 11/12/2024
Report Number : 24-310-0908 REPORT OF ANALYSIS Received : 11/05/2024
Lab No : 86757
Matrix: Aqueous
Sample ID : Influent
Sampled:
11/5/202410:50
Test
Results
Units
MOL
OF Date/Time
By Analytical
Analyzed
Method
Biochemical Oxygen Demand (5-day)
110
mg/L
40
1 11/05/24 09:26
BNC 5210B-2016
Total Suspended Solids
81.0
mg/L
25.0
1 11/06/24 08:44
HMV 2540D-2020
Lab No : 86758
Matrix:
Aqueous
Sample ID : Effluent
Sampled:
11/5/2024 11:30
Test
Results
Units
MOL
DF Date / Time
By Analytical
Analyzed
Method
Ammonia Nitrogen
0.05
mg/L
0.02
1 11/11/24 13:29
KID 350.1
Biochemical Oxygen Demand (5-day)
it
mg/L
8.0
1 11/05/24 09:26
BNC 5210E-2016
Fecal Coliform
<1
cfu/100ml-
1
1 11/05/24 14:52
HMV 9222D-2015
Nitrate+Nitrite-N
3.49
mg/L
0.10
5 11/06/2413:43
MSK 353.2
Total Suspended Solids
37.3
mg/L
16.6
1 11/06/24 08:44
HMV 2540D-2020
Total Kjeldahl Nitrogen
5.35
mg/L
0.20
1 11/08/24 11:19
KID EPA-351.2
Phosphorus
1.39
mg/L
0.02
1 11/08/24 11:19
KID 365.4
Qualifiers/ DF Dilution Factor L Limit Exceeded
Definitions MQL Method Quantitation Limit

0
Waypoint.
ANALYTICAL
114 Oakmont Drive, Greenville, NC 27858
Main 252.756.6208 0 Fax [phone]
www.waypointana lytiral.com
Shipment Receipt Form
Customer Number: 00197
Customer Name: Town of Rich Square
Report Number: 24-310-0908
Shipping Method
Fed Ex US Postal 4 Lab
;`) UPS Client _ Courier
Other
Thermometer ID:
IlFluke 1.6C
Shipping container/cooler uncompromised?
0- Yes
�,) No
Number of coolers/boxes received
E 1
Custody seals intact on shipping container/cooler?
Yes
! No
0 Not Present
Custody seals intact on sample bottles?
Yes
No
0 Not Present
Chain of Custody (COC) present?
•Yes
^; No
COC agrees with sample label(s)?
• Yes
- ) No
COC properly completed
• Yes
No
Samples in proper containers?
• Yes
(j No
Sample containers intact?
• Yes
(J No
Sufficient sample volume for indicated test(s)?
• Yes
C) No
All samples received within holding time?
• Yes
O No
Cooler temperature in compliance?
• Yes
0 No
C) Not Present
Cooler/Samples arrived at the laboratory on ice.
Samples were considered acceptable as cooling
process had begun.
• Yes
No
Water - Sample containers properly preserved
• Yes
O No
^ % N/A
Water - VOA vials free of headspace
Yes
C) No
L) N/A
Trip Blanks received with VOAs
Yes
L No
N/A
Soil VOA method 5035 — compliance criteria met
Yes
—, No
0 N/A
High concentration container (48 hr) 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?
Yes
(1� No
Comments:
Signature: Hanna McCormick Date & Time: 1 /1 05/2024 15:01_40

Waypointw CHAIN OF CUSTODY RECORD
Waypoint Analytical - Greenville Page of!
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Grccnville. NC 27858
DISINFECTION
CHLORINE CHECK (LAB)
www.WaypoinlAnalyticai.LO1n
<os mg/L - Yes (vl or No IM
Phone [phone] • Fax [phone]
CHLORINE
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pH CHECK (S.U.) (LAB)
CLIENT: 197 Week: 51
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11
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CONTAINERTYPE,P/G
TOWN OF RICH SQUARE
ATTN: JEFF LONG
❑NONE
P.O. BOX 336
RICH SQUARE NC 27869
❑
A
C
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CHEMICALPRESEFNAMON
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[phone]
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C- H1SOr F -ZINC ACETATE/NAOH
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COLLECTION
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G- NATHIOSULFATE
a
SAMPLE LOCATION
DATE
TIME
Influent
/ 5'zir
OSO
2
CLASSIFICATION:
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DRIN19NG WATER
Lj SOLID WASTE SECTION
+DWMW
CHAIN OF CUSTODY (SEAL) MAINTAINED
DURING SHIPMENT/DELIVERY
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(Please
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6-
197 - Rich SaWuale W (2dNonlhty)
SAMPLES RE EIVED IN LAB AT
'C
BY (SIG.) (SAMPLER)
DATE/nME
R C IVED BY (SIG.)
DATETIME
COMMENTS:
SAMPLES RECEIVED ON ICE: ES NO
VRSHED
1
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EL BY (SIG.)
DATEN.M7E
RECEIVEDBY(SIG.)
ATE/rIMEKWb,
REUNO ISHED BY(SIG.)
DATEMME
RECEIVED BY (SIG.)
DATEITIME
PLEASE READ Instructions for completing this form on the reverse side. Sampler must place a "C" for composite sample or a "G" for
FORM 05 Grab sample in the blocks above for each parameter requested.