8.d)2) Results of Monitoring Well Sampling and Other Activities for Anderson-Erickson 201 Wastewater Treatment System Meeting Date: 4/17/2012
Agenda Item: � � � � ��
City Council Agenda Report
City of Scandia
14727 209�' St. North
Scandia, MN 55073 (651) 433-2274
Action Requested: Receive results of monitoring well sampling and other activities
relating to the Anderson-Erickson portion of the 201 Wastewater
Treatment System.
Deadline/Timeline: The Council authorized various repairs, testing and monitoring of the
system at its March 20 meeting.
Background: • One of the items authorized at the March 20 meeting was the
collection and analysis of samples from groundwater monitoring
wells around the drainfield. A report describing the results of the
testing is attached. Based on the sampling results, it appears that
the system has impacted groundwater quality. The engineers are
recommending that the wells be re-sampled to see if the results are
repeatable.
• This report is being shared with the Washington County
Department of Health and Environment,the permitting authority
and operator of the sysetm. More information on the potential
impacts of the test results and recommendations for action should
be available for discussion at the Council's May 8, 2012 work
session.
Recommendation: The Council should receive the report. Staff and consultants will be
available to answer questions about the progress made on other work
on the Anderson-Erickson system (including repairs and sump-pump
inspections) at the April 17 meeting.
Attachments/ • Memo from Clint Jordahl, Stantec, dated April 12, 2012
Materials provided:
Contact(s): Ryan Goodman, PE (651) 967-4616
Prepared by: Anne Hurlburt, Administrator
(Anderson Erickson report)
Page 1 of 1
04/13/12
Memo
��� To: Ryan Goodman From: Clint Jordahl
Stantec, St. Paul MN Stantec, St. Cloud, MN
File: 193802153 Date: April 12, 2012
Reference: Anderson/Erickson Wastewater System— City of Scandia
Ryan,
Attached you will find the analytical results for the samples collected from the four deep
groundwater monitoring wells surrounding the Anderson/Erickson drainfield. The wells
were samples on March 22, 2012 using the dedicated balder pumps installed in the
1980s when the system was new. Samples collected from the wells were analyzed for
Chlorides, nitrite plus nitrate (NOz + NO3), Total Kjeldahl Nitrogen (TKN), and ammonia
nitrogen. These four parameters are typical of those required for groundwater
monitoring systems at drainfields operated under permits issued by the State of
Minnesota.
Chloride is a general water quality parameter and its presence can be used track
impacts to shallow aquifers from wastewater systems. Chloride concentrations ranged
from 7.7 mg/L in Well C to 493 mg/L in Well B. There is no enforceable drinking water
limit for Chloride, but there is a secondary limit (aesthetic limit)of 250 mg/L. This
secondary limit for Chloride was exceeded in three of the four wells sampled.
The three nitrogen species (TKN, ammonia and NO2 + NO3) are collectively of concem
in drinking water due to their ability to be metabolized into nitrite, and nitrite's potential
to negatively impact the health of infants. The Minnesota Department of Health has
established a Health Risk Limit (HRL)of 10 mg/L for nitrate as nitrogen in drinking
water. The Environmental Protection Agency (EPA) has established a Maximum
Concentration Limit (MCL)of 1 mg/L nitrite as nitrogen in public water supplies.
Neither TKN nor ammonia was present in any of the water samples tested; however,
NOZ + NO3 was present in concentrations ranging from 1.4 mg/L in monitoring Well C to
19.6 mg/L in Well B. The nitrogen concentration was in excess of the HRL in three of
four wells sampled.
The water table beneath the site is about 50 feet below the surface or roughly the
elevation of Big Marine Lake. Because the water level in two of the wells was below the
top of the pumps, accurate groundwater elevations could not be measured. Therefore,
the direction of groundwater flow could not be determined based on direct
measurement during the March 2012 sampling event. Nevertheless, MPCA
One Team.lnfinite Solutions.
jc c:\users\cjordahl\documents\bonestoo�2011Gscandia\well sampling memo.docx
Starttec
April 11,2012
Ryan Goodman
Page 2 of 2
Reference: AndersonlErickson System
correspondence from the early 1990s suggests that the groundwater flow direction
beneath the site is northwesterly.
Based on the sampling results, it appears that the system has impacted groundwater
quality. Well C, which is located in a presumptively upgradient position with respect to
the drainfield is likely to best represent the quality of the groundwater flowing to the site.
Both the Chloride and nitrogen concentrations in the water sample collected from this
well were fairly low. In contrast, Chloride and nitrogen concentrations in each of the
other wells were much higher. Wells A and B are located so close the actual drainfield
area that they appear to be impacted by wastewater trickling through the soil and
diffusing at the water table. According to MPCA correspondence, Well D is not located
directly downgradient of the system, but "is probably located just far enough within the
plume edge to be useful as an indicator of downgradient water quality".
At this point I would recommend that the wells be resampled to see if the results are
repeatable. I might suggest waiting until after the heavy use period surrounding the 4tn
of July to sample the wells. It may also be interesting to install a truly downgradient well
at the drainfield property boundary to determine if groundwater impacted above drinking
water standards is traveling off site.
If the condition persists, it may be necessary to alter the configuration and/or use of the
drainfield system to address the high nitrogen concentrations in the groundwater.
Sincerely,
Stantec Consulting Services
Clinton . Jord I, PG
Senior G i
clint.jordahl@stantec.com
Attachment: Laboratory Analytical Report
� Pace Analyticai Services,Ine.
aceAnalytical 1700 Elm Street-Suite 200
www.paoeJebs.com
Minneapolis,MN 55414
� (612)607-1700
April 05, 2012
Mr. Clint Jordahl
Stantec
3717 23rd St. S.
Saint Cloud, MN 56301
RE: Project: 193802153 ANDERSON/ERICKSON DR
Pace Project No.: 10186674
Dear Mr. Jordahl:
Enclosed are the analytical results for sample(s) received by the laboratory on March 23, 2012. The
results relate only to the samples included in this report. Results reported herein conform to the
most current TNI 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,
i%�i���,�-
Mariah Peronto
mariah.peronto@pacelabs.com
Project Manager
Enclosures
�A � REPORT OF LABORATORY ANALYSIS Page 1 of 12
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CERTIFICATIONS
Project: 193802153 ANDERSON/ERICKSON DR
Pace Project No.: 10186674
Minnesota Cert�cation IDs
1700 Elm Street SE Suite 200,Minneapolis,MN 55414 Mississippi Certification#:Pace
A2LA Certification#:2926.01 Montana Certification#:MT CERT0092
Alaska Certification#:UST-078 Nevada Certification#:MN 00064
Alaska Certification#MN00064 Nebraska Certification#:Pace
Arizona Certification#:AZ-0014 New Jersey Certification#:MN-002
Arkansas Certification#:88-0680 New Mexico Certification#:Pace
California Certification#:01155CA New York Certification#: 11647
EPA Region 8 Certification#:Pace North Carolina Certification#:530
Florida/NELAP Certification#:E87605 North Dakota Certification#:R-036
Georgia Certification#:959 North Dakota Certification#:R-036A
Idaho Certification#:MN00064 Ohio VAP Certification#:CL101
Illinois Certification#:200011 Oklahoma Certification#:D9921
lowa Certification#:368 Oklahoma Certification#:9507
Kansas Certification#:E-10167 Oregon Certification#:MN200001
Louisiana Certification#:03086 Pennsylvania Certification#:68-00563
Louisiana Certification#:LA080009 Puerto Rico Certification
Maine Certification#:2007029 Tennessee Certification#:02818
Maryland Certification#:322 Texas Certification#:T104704192
Michigan DEQ Certification#:9909 Washington Certification#:C754
Minnesota Certification#:027-053-137 Wisconsin Certification#:999407970
Green Bay CeRification IDs
1241 Bellevue Street,Green Bay,WI 54302 New York Certification#: 11888
Florida/NELAP Certification#:E87948 North Carolina Certification#:503
Illinois Certification#:200050 North Dakota Certification#:R-150
Kentucky Certification#:82 South Carolina Certification#:83006001
Louisiana Certification#:04168 US Dept of Agriculture#:S-76505
Minnesota Certification#:055-999-334 Wisconsin Certification#:405132750
REPORT OF LABORATORY ANALYSIS Page 2 of 12
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SAMPLE SUMMARY
Project: 193802153 ANDERSON/ERICKSON DR
Pace Project No.: 10186674
Lab ID Sample ID Matrix Date Collected Date Received
10186674001 WELL A DEEP Water 03/22/12 14:15 03/23/12 16:15
10186674002 WELL B DEEP Water 03/22/12 13:05 03/23/12 16:15
10186674003 WELL C DEEP Water 03/22/12 15:15 03/23/12 16:15
10186674004 WELL D DEEP Water 03/22/12 16:35 03/23/12 16:15
REPORT OF LABORATORY ANALYSIS Page 3 of 12
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SAMPLE ANALYTE COUNT
Project: 193802153 ANDERSON/ERICKSON DR
Pace Project No.: 10186674
Analytes
Lab ID Sample ID Method Analysts Reported Laboratory
10186674001 WELL A DEEP EPA 350.1 MWD 1 PASI-M
EPA 3512 DAW 1 PASI-G
SM 4500-NO3 H MWD 1 PASI-M
SM 4500-CI E KEO 1 PASI-M
10186674002 WELL B DEEP EPA 350.1 MWD 1 PASI-M
EPA 351.2 DAW 1 PASI-G
SM 4500-NO3 H MWD 1 PASI-M
SM 4500-CI E KEO 1 PASI-M
10186674003 WELL C DEEP EPA 350.1 MWD 1 PASI-M
EPA 351.2 DAW 1 PASI-G
SM 4500-NO3 H MWD 1 PASI-M
SM 4500-CI E KEO 1 PASI-M
10186674004 WELL D DEEP EPA 350.1 MWD 1 PASI-M
EPA 351.2 DAW 1 PASI-G
SM 4500-NO3 H MWD 1 PASI-M
SM 4500-CI E KEO 1 PASf-M
REPORT OF LABORATORY ANALYSIS Page 4 of 12
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ANALYTICAL RESULTS
Project: 193802153 ANDERSON/ERICKSON DR
Pace Project No.: 10186674
Sample: WELL A DEEP Lab ID: 10186674001 Collected: 03l22/12 14:15 Received: 03/23/12 16:15 Matrix: Water
Parameters Results Units Report Limit DF Prepared Analyzed CAS No. Qual
350.1 Ammonia Analytical Method:EPA 350.1
Nitrogen,Ammonia ND mg/L 0.040 1 04/03/12 11:34 7664-41-7
351.2 ToWI Kjeldahl Nitrogen Analytical Method:EPA 351.2
Nitrogen,Kjeldahl,Total ND mg/L 1.0 1 04/04/12 09:15 04/04/12 13:17 7727-37-9
SM4500NO3-H,NO2+NO3 pres. Analytical Method:SM 4500-NO3 H
Nitrogen,NO2 plus NO3 16.2 mg/L 1.0 10 03/27/12 15:50
SM4500CI-E Chloride Analytical Method:SM 4500-CI E
Chioride 377 mg/L 20.0 10 03/29/12 11:02 16887-00-6
Sample: WELL B DEEP Lab ID: 10186674002 Collected: 03/22/12 13:05 Received: 03/23/12 16:15 Matrix: Water
Parameters Results Units Report Limit DF Prepared Analyzed CAS No. Qual
350.1 Ammonia Analytical Method:EPA 350.1
Nitrogen,Ammonia ND mg/L 0.040 1 04/03/12 1135 7664-41-7
351.2 Total Kjeldahl Nitrogen Analytical Method:EPA 351.2
Nitrogen,Kjeldahl,Total ND mg/L 1.0 1 04/04/12 09:15 04/04/12 13:18 7727-37-9
SM4500NO3-H,NO2+NO3 pres. Analytical Method:SM 4500-NO3 H
Nitrogen,NO2 plus NO3 19.6 mg/L 1.0 10 03/27/12 15:58
SM4500CI-E Chloride Analytical Method:SM 4500-CI E
Chloride 493 mg/L 20.0 10 03/29/12 10:53 16887-00-6
Sample: WELL C DEEP Lab ID: 10186674003 Collected: 03/22/12 15:15 Received: 03/23/12 16:15 Matrix: Water
Parameters Results Units Report Limit DF Prepared Analyzed CAS No. Qual
350.1 Ammonia Analytical Method:EPA 350.1
Nitrogen,Ammonia ND mg/L 0.040 1 04/03/12 11:36 7664-41-7
351.2 Total Kjeldahl Nitrogen Analytical Method:EPA 351.2
Nitrogen,Kjeldahl,Total ND mg/L 1.0 1 04/04/12 09:15 04/04/12 13:19 7727-37-9
SM4500NO3-H,NO2+NO3 pres. Analytical Method:SM 4500-NO3 H
Nitrogen,NO2 plus NO3 1.4 mg/L 1.0 10 03/27/12 15:59
SM4500CI-E Chloride Analytical Method:SM 4500-CI E
Chloride 7.7 mg/L 2.0 1 03/29/12 10:16 16887-00-6
Date:04/05/2012 04:55 PA4 REPORT OF LABORATORY ANALYSIS Page 5 of 12
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(612)607-1700
ANALYTICAL RESULTS
Project: 193802153 ANDERSON/ERICKSON DR
Pace Project No.: 10186674
Sample: WELL D DEEP Lab ID: 10186674004 Collected: 03/22/12 16:35 Received: 03/23/12 16:15 Matrix: Water
Parameters Results Units Report Limit DF Prepared Analyzed CAS No. Qual
350.1 Ammonia Analytical Method:EPA 350.1
Nitrogen,Ammonia ND mg/L 0.040 1 04/03/12 11:37 7664-41-7 M1
351.2 Total Kjeldahl Nitrogen Analytical Method:EPA 351.2
Nitrogen,Kjeldahl,Total ND mg/L 1.0 1 04/04/12 09:15 04/04/12 13:21 7727-37-9
SM4500NO3-H,NO2+NO3 pres. Analytical Method:SM 4500-NO3 H
Nitrogen,NO2 plus NO3 12.9 mg/L 1.0 10 03/27/12 16:03
SM4500CI-E Chloride Analytical Method:SM 4500.CI E
Chloride 415 mg/L 20.0 10 03/29/12 10:53 16887-00-6
Date:04/05/2012 04:55 PM REPORT OF LABORATORY ANALYSIS Page 6 of 12
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�s�z>so�-��oo
QUALITY CONTROL DATA
Project: 193802153 ANDERSON/ERICKSON DR
Pace Project No.: 10186674
QC Batch: WETA/11947 Analysis Method: EPA350.1
QC Batch Method: EPA 350.1 Analysis Description: 350.1 Ammonia
Associated Lab Samples: 10186674001,10186674002, 1 01 866 74 00 3, 10186674004
METHOD BLANK: 1165712 Matrix: Water
Associated Lab Samples: 10186674001,10186674002,10186674003, 10186674004
Blank Reporting
Parameter Units Result Limit Analyzed Qualifiers
Nitrogen,Ammonia mg/L ND 0.040 04/03/12 11:23
LABORATORY CONTROL SAMPLE: 1165713
Spike LCS LCS %Rec
Parameter Units Conc. Result %Rec Limits Qualifiers
Nitrogen,Ammonia mg/L 1 1.1 108 90-110
MATRIX SPIKE 8 MATRIX SPIKE DUPLICATE: 1165714 1165715
MS MSD
10187261001 Spike Spike MS MSD MS MSD %Rec Max
Parameter Units Result Conc. Conc. Result Result %Rec %Rec Limits RPD RPD Qual
Nitrogen,Ammonia mg/L 0.52 1 1 1.7 1.6 115 113 90-110 2 20 M1
MATRIX SPIKE 8�MATRIX SPIKE DUPLICATE: 1165716 1165717
MS MSD
10186674004 Spike Spike MS MSD MS MSD %Rec Max
Parameter Units Result Conc. Conc. Result Result %Rec %Rec Limits RPD RPD Qual
Nitrogen,Ammonia mg/l ND 1 1 1.1 1.1 113 110 90-110 2 20 M1
Date:04/05/2012 04:55 PM REPORT OF LABORATORY ANALYSIS Page 7 of 12
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aceAnalyticai� 1700 Elm Street-Suite 200
N,N,N,�S� Minneapolis,MN 55414
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QUALITY CONTROL DATA
Project: 193802153 ANDERSON/ERICKSON DR
Pace Project No.: 10186674
QC Batch: WETA/11843 Analysis Method: EPA 351.2
QC Batch Method: EPA 351.2 Analysis Description: 351.2 TKN
Associated Lab Samples: 10186674001,10186674002,10186674003, 10186674004
METHOD BLANK: 586523 Matrix: Water
Associated Lab Samples: 10186674001, 10186674002,10186674003, 10186674004
Blank Reporting
Parameter Units Result Limit Analyzed Qualifiers
Nitrogen,Kjeldahl,Total mg/L ND 1.0 04/04/12 13:11
LABORATORY CONTROL SAMPLE: 586524
Spike LCS LCS %Rec
Parameter Units Conc. Result %Rec Limits Qualifiers
Nitrogen,Kjeldahl,Total mg/L 5 5.1 102 90-110
MATRIX SPIKE&MATRIX SPIKE DUPLICATE: 586525 586526
MS MSD
10186449001 Spike Spike MS MSD MS MSD %Rec Max
Parameter Units Result Conc. Conc. Result Result %Rec %Rec Limits RPD RPD Qual
Nitrogen,Kjeldahl,Total mg/L 1.9 5 5 7.1 6.9 105 101 90.110 3 20
MATRIX SPIKE 8 MATRIX SPIKE DUPLICATE: 586527 586528
MS MSD
4058016001 Spike Spike MS MSD MS MSD °/a Rec Max
Parameter Units Result Conc. Conc. Result Result %Rec %Rec Limits RPD RPD Qual
Nitrogen,Kjeldahl,Total mg/L <0.35 5 5 5.8 5.7 112 110 90-110 2 20 MO
Date:04/05/2012 04:55 PM REPORT OF LABORATORY ANALYSIS Page 8 of 12
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QUALITY CONTROL DATA
Project: 193802153 ANDERSON/ERICKSON DR
Pace Project No.: 10186674
QC Batch: WETA/11922 Analysis Method: SM 4500-NO3 H
QC Batch Method: SM 4500-NO3 H Analysis Description: SM4500NO3-H,NO2+NO3 pres.
Associated Lab Samples: 10186674001,10186674002, 10186674003, 10186674004
METHOD BLANK: 1161991 Matrix: Water
Associated Lab Samples: 10186674001,10186674002, 10186674003, 10186674004
Blank Reporting
Parameter Units Result Limit Analyzed Qualifiers
Nitrogen,NO2 plus NO3 mg/L ND 0.20 03/27/12 11:08
LABORATORY CONTROL SAMPLE: 1161992
Spike LCS LCS %Rec
Parameter Units Conc. Result %Rec Limits Qualifiers
Nitrogen,NO2 plus NO3 mg/L 2.5 2.4 97 90-110
MATRIX SPIKE&MATRIX SPIKE DUPLICATE: 1161993 1161994
MS MSD
10186543012 Spike Spike MS MSD MS MSD °/,Rec Max
Parameter Units Result Conc. Conc. Result Result %Rec %Rec Limits RPD RPD Qual
Nitrogen,NO2 plus NO3 mg/L ND 2.5 2.5 2.5 2.5 98 97 80-120 1 30
MATRIX SPIKE&MATRIX SPIKE DUPLICATE: 1161995 1161996
MS MSD
10186674001 Spike Spike MS MSD MS MSD %Rec Max
Parameter Units Result Conc. Conc. Result Result %Rec %Rec Limits RPD RPD Qual
Nitrogen,NO2 plus NO3 mg/L 16.2 12.5 12.5 30.9 30.2 118 112 80-120 3 30
Date:04/05/2012 04:55 PM REPORT OF LABORATORY ANALYSIS Page 9 of 12
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QUALITY CONTROL DATA
Project: 193802153 ANDERSON/ERICKSON DR
Pace Project No.: 10186674
QC Batch: WETA/11935 Analysis Method: SM 4500-CI E
QC Batch Method: SM 4500-CI E Analysis Description: SM4500CI-E Chloride
Associated Lab Samples: 10186674001,10186674002,10186674003, 10186674004
METHOD BLANK: 1163726 Matrix: Water
Associated Lab Samples: 10186674001, 10186674002,10186674003, 10186674004
Blank Reporting
Parameter Units Result Limit Analyzed Qualifiers
Chloride mg/L ND 2.0 03/29/1210:16
LABORATORY CONTROL SAMPLE: 1163727
Spike LCS LCS %Rec
Parameter Units Conc. Result %Rec Limits Qualifiers
Chloride mg/L 30 31.7 106 90-110
MATRIX SPIKE 8 MATRIX SPIKE DUPLICATE: 1163728 1163729
MS MSD
10186943001 Spike Spike MS MSD MS MSD °/a Rec Max
Parameter Units Result Conc. Conc. Result Resutt %Rec %Rec Limits RPD RPD Qual
Chloride mg/L 122 30 30 149 151 91 99 80-120 1 30
MATRIX SPIKE&MATRIX SPIKE DUPLICATE: 1163730 1163731
MS MSD
10186964005 Spike Spike MS MSD MS MSD %Rec Max
Parameter Units Result Conc. Conc. Result Result %Rec %Rec Limits RPD RPD Qual
Chloride mg/L 61.4 30 30 87.1 86.9 86 85 80-120 .3 30
Date:04/05/2012 04:55 PM REPORT OF LABORATORY ANALYSIS Page 10 of 12
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QUALIFIERS
Project: 193802153 ANDERSON/ERICKSON DR
Pace Project No.: 10186674
DEFINITIONS
DF-Dilution Factor,if reported,represents the factor applied to the reported data due to changes in sample preparation,dilution of
the sample aliquot,or moisture content.
ND-Not Detected at or above adjusted reporting limit.
J-Estimated concentration above the adjusted method detection limit and below the adjusted reporting limit.
MDL-Adjusted Method Detection Limit.
S-Surrogate
1,2-Diphenylhydrazine(8270 listed analyte)decomposes to Azobenzene.
Consistent with EPA guidelines,unrounded data are displayed and have been used to caiculate%recovery and RPD values.
LCS(D)-Laboratory Control Sample(Dup�icate)
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.
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
PASI-G Pace Analytical Services-Green Bay
PASI-M Pace Analytical Services-Minneapolis
ANALYTE QUALIFIERS
MO Matrix spike recovery and/or matrix spike duplicate recovery was outside laboratory control limits.
M1 Matrix spike recovery exceeded QC limits. Batch accepted based on laboratory control sample(LCS)recovery.
Date:04/05/2012 04:55 PM REPORT OF LABORATORY ANALYSIS Page 11 of 12
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QUALITY CONTROL DATA CROSS REFERENCE TABLE
Project: 193802153 ANDERSON/ERICKSON DR
Pace Project No.: 10186674
Analytical
Lab ID Sample ID QC Batch Method QC Batch Analytical Method Batch
10186674001 WELL A DEEP EPA 350.1 WETA/11947
10186674002 WELL B DEEP EPA 350.1 WETA/11947
10186674003 WELL C DEEP EPA 350.1 WETA/11947
10186674004 WELL D DEEP EPA 350.1 WETA/11947
10186674001 WELL A DEEP EPA 351.2 WETA/11843 EPA 351.2 WETA/11848
10186674002 WELL B DEEP EPA 351.2 WETA/11843 EPA 351.2 WETA/11848
10186674003 WELL C DEEP EPA 351.2 WETA/11843 EPA 351.2 WETA/11848
10186674004 WELL D DEEP EPA 351.2 WETA/11843 EPA 351.2 WETA/11848
10186674007 WELL A DEEP SM 4500-NO3 H WETA/11922
10186674002 WELL B DEEP SM 4500-NO3 H WETA/11922
10186674003 WELL C DEEP SM 4500-NO3 H WETA/11922
10186674004 WELL D DEEP SM 4500.NO3 H WETA/11922
10186674001 WELL A DEEP SM 4500-CI E WETA/11935
10186674002 WELL B DEEP SM 4500-CI E WETA/11935
10186674003 WELL C DEEP SM 4500-CI E WETA/11935
10186674004 WELL D DEEP SM 4500-CI E WETA/11935
Date:04/05/2012 04:55 PM REPORT OF LABORATORY ANALYSIS Page 12 of 12
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� 13 of 14
Document Name: Revised Date: 15Feb2012
� _� CEA1t8/yt1C�lrt Sam le Condition U n Recei t Form. Pa e 1 of 1
� Document Number: Iss�ing Authority:
F-MN-L-213-rev.02 Pace Minnesota Quality Office
• , a
.
Client Name: �'��-�-e-�'�s�--�+�.�,� Project# b l ���D(���
Courier: ❑ Fed Ex❑ UPS� USPS❑ Client❑ Commeraat ❑ Pace a0ther
Tracking#;
Custody Seal on CooleNBox Presene: ❑ yes � no Seals intact: ❑yes � no
Packing Materiat: ❑Bubble Wrap ❑ Bubble Bags �None ❑ Other Temp Blank:Yes �_ No
Thermometer Used 03a4 2 or 60512447 Type of ice:�� Blue None ❑ Samptes on ioe;cooNn rooess has begun
Cooler Temperature � ' � BiotoBical Tissue is Frozen: Yes No p8���^�-��exa ng
contones:'� 3 ��S
Temp shoWd be above ireezing to 6'C Comments: �
Chain of Custod Present: Yes �No Own �,
Chain of Custod Filted Out: ve$ Owo Drua 2,
Chain of Custod Reifn uished: res �n►o Own 3.
Sam er Name&Si nature on COC: es ONo ❑nun 4.
Sam les Arrived within Hold T(me: Yes ❑n�o pruq 5.
Short Hold Time Anal sis <72hr: �res No Owp g,
Rush Turn Around Time Re uested: Ovea Mo OnuA 7.
Sufficient Volume: v� ONo Ciwn g.
Correct Containers Used: �ves ONo Onuq g.
-Pace Containers Used: res DNo Own
Containers Intact: res Orro Own 10.
Fltered volume received for Dissoived tests Ores ONo N/A 11,
Sample Labeis match COC: res �rvo Own �Z,
_..—�ludes dateQim�e/IQlAnal.sis. ..Matcix:---... . .._._._ �_.. _.. . .
–AII-conteiners-needin�acid/tTa�se-prSs�ti�i-IS�v�been —-
Checked. Noncompiiance are noted in 13. Yes ❑No OhVA 13. � HNO3 H� � O NaOH O HG G �
AN contafners needing preservation are found to be in � Samp# �
compliance wilh EPA recommendation. (HNO3,�yes Q� ON�A ��2 ���- ���'�' � �
H2SO4.HCL<2;NaOH>12) �y+GL�� �� ��� �,. ���.,`��,y- �
OYes f�r,b �nillaf when -� Lot#of added ��
Exceptions:VOA,Cotilortn,TOC,Oil and Greeae,WI•DRO(water) COmpleted p►eSeN8tiV8
Heads ace in VOA Vials >6mm: Ores Orro wa �q.
Trip Blank Pr�esent: Oves Owo �nun 15,
/
Trip Blank Custody Seals Presen! Uves �No �MrA
Pace Trip Blank Lot# if urchased :
Client Notitication/Resolution: Field Data Requ�red? Y / N
Person Contacted: Date/T'ime:
Comments/Resotution:
�,� ,�
Projec4lWanager Review: �f,,�' r•'' � 'T-
_ �:,�ll.••:•i�i7'�`%'�i_�',Y:9ir��v°-.._ Date: 'Ii' '.C.ifj'%�v
- L._
Note: Whenever there is a discrepancy affecting North Carotina compliance samples,a copy of this form will be sent to the North Carolina DEHNR Certificalion
Office(i.e out of hold,incorrect preservatNe,out o(temp,incorrect containers)
10186674 14 of 14