Spreadsheet: 0086aef1-9aee-4917-a5aa-7483c830d658
Sheet: Sheet1

UNDERGROUND STORAGE TANK SECTION | Unnamed: 1 | Unnamed: 2 | Unnamed: 3 | Unnamed: 4 | Unnamed: 5 | Unnamed: 6 | Unnamed: 7 | Unnamed: 8 | Unnamed: 9 | Unnamed: 10 | Unnamed: 11 | Unnamed: 12 | Unnamed: 13 | Unnamed: 14 | Unnamed: 15 | Unnamed: 16 | Unnamed: 17 | Unnamed: 18 | Unnamed: 19 | NORTH CAROLINA | Unnamed: 21 | Unnamed: 22 | Unnamed: 23 | Unnamed: 24
FIELD/LAB FORM |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Dept. of Environment and Natural Resources
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Division of Waste Management - UST Section
COUNTY  : |  |  |  |  |  |  |  |  |  |  |  | SAMPLE PRIORITY
QUAD NO: |  |  |  |  |  |  |  |  |  |  |  | ROUTINE |  |  | EMERGENCY
LATITUDE  : |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Lab Number   :
LONGITUDE: |  |  |  |  |  |  |  |  |  |  |  | CHAIN OF CUSTODY |  |  |  |  |  |  |  |  |  |  |  | Date Received  :
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Time Received  :
REPORT TO   : |  |  | UST - |  |  | Regional Office |  |  |  |  |  | SAMPLE TYPE |  |  |  |  |  |  |  |  |  |  |  | Received By   :
COLLECTOR(S)  : |  |  |  |  |  |  |  |  |  |  |  | Soil
DATE: |  |  |  |  |  |  |  |  |  |  |  | Water |  |  | Location code:
TIME: |  |  |  |  |  |  |  |  |  |  |  | Other |  |  |  |  |  |  |  |  |  |  |  | Released  By  :
PURPOSE (circle): |  |  | Baseline, Complaint, Compliance, LUST, Pesticide Study, Federal Trust, Other: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Date reported :
Field Analysis |  |  |  |  |  |  |  | Owner:
pH | _______ | units | Spec. Cond. at 25ºC   _____________ |  |  | [NAME]/cm2 |  | Location or Site:
Odor ____________ |  |  | Temperature |  | ______________ | ºC |  | Description of sampling point:
Appearance  _____________________ |  |  |  |  |  |  |  | Sampling Method: |  |  |  |  |  |  |  |  |  |  |  | (Pump, bailer, etc.)
Field Analysis by __________________________ |  |  |  |  |  |  |  | Remarks: |  |  |  |  |  |  |  |  |  |  |  | (pumping time, air temp., etc)
LABORATORY ANALYSIS
 | BOD |  |  |  |  |  |  |  | [NAME] |  |  |  |  |  |  | Ag-Silver |  |  |  |  |  |  |  | Organochlorine Pesticides
 | COD High |  |  |  |  |  |  |  | Fluoride |  |  |  |  |  |  | Al-Aluminum |  |  |  |  |  |  |  | Organophosphorus Pesticides
 | COD Low |  |  |  |  |  |  |  | Hardness: total |  |  |  |  |  |  | As-Arsenic |  |  |  |  |  |  |  | [NAME]
 | Coliform: MF Fecal |  |  |  |  |  |  |  | Hardness: (non-carb) |  |  |  |  |  |  | Ba-Barium
 | Coliform: MF Total |  |  |  |  |  |  |  | Phenols |  |  |  |  |  |  | Ca-Calcium |  |  |  |  |  |  |  | Acid Herbicides
 | TOC |  |  |  |  |  |  |  | Specific Conductivity |  |  |  |  |  |  | Cd-Cadium
 | Turbitity |  |  |  |  |  |  |  | Sulfate |  |  |  |  |  |  | Cr-Chromium * |  |  |  |  |  |  |  | Semivolatiles
 | Residue., [NAME] |  |  |  |  |  |  |  | Sulfide |  |  |  |  |  |  | Cu- Copper |  |  |  |  |  |  |  | TPH-Diesel Range
 |  |  |  |  |  |  |  |  | MBAS |  |  |  |  |  |  | Fe- Iron
 | Fixed  510 |  |  |  |  |  |  |  | Oil and [NAME] |  |  |  |  |  |  | Hg- Mercury |  |  |  |  |  |  |  | Volatile Organics (VOA bottle)
 | pH |  |  |  |  |  |  |  | Silica |  |  |  |  |  |  | K-Potassium
 | Alkalinity to pH 4.5 |  |  |  |  |  |  |  | [NAME] |  |  |  |  |  |  | Mg- Magnesium |  |  |  |  |  |  |  | TPH-Gasoline Range
 | Alkalinity to pH 8.3 |  |  |  |  |  |  |  | Formaldehyde |  |  |  |  |  |  | Mn-Manganese |  |  |  |  |  |  |  | TPH-BTEX Gasoline Range
 | Carbonate |  |  |  |  |  |  |  | NH3 as N 610 |  |  |  |  |  |  | Na- Sodium
 | Bicarbonate |  |  |  |  |  |  |  | TKN as N 625 |  |  |  |  |  |  | [NAME]
 | Carbon dioxide |  |  |  |  |  |  |  | NO2 +NO3 as N 630 |  |  |  |  |  |  | Pb-Lead *
 | Chloride |  |  |  |  |  |  |  | P: Total as P |  |  |  |  |  |  | Se-Selenium
 | Chromium: Hex |  |  |  |  |  |  |  | PO4 |  |  |  |  |  |  | Zn_Zinc
 | Color: True 80 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Temperature on arrival (ºC):
 | Cyanide
 | * Metals analyses of groundwater samples (excluding Mercury) require Standard Methods 3030C Preliminary Treatment for Acid Extractable Metals.
COMMENTS :
UST-54 [NAME]. 1/06