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37 BELLEVIEW AVENUE - 2007 TITLE 5 REPORT Five Centennial Drive 1 - Peabody,MA 01960-7985 tel:978-532-1900 fax:978-977-0100 www.westonandsampson.com wasto t Aquapoint Blue Heron Pond,LLC WSS Job # C205250 September 16, 2007 Ms. Ellen Kelleher RECEIVE Blue st 37 Bellevie SEP 19 2007 Salem, MA 01970 CH Y of SAL.CIvi BOARD OF HEALTH RE: Blue Heron Pond, LLC Monthly Inspection Report August 2007 Dear Ms. Kelleher: Enclosed please find the August 2007 Bioclere Field Report, DEP Approved Inspection Form and laboratory analysis report for your system. Mr. James Vurgaropulos of Weston & Sampson Services performed the monthly inspection on August 13, 2007. Weston and Sampson Services would like to note the following: • The facility appears to be operating efficiently. If you have any questions or concerns regarding this report, or your wastewater treatment system, please feel free to contact me at(978) 532-1900, ext 2202. Regards, WEST N & SAMPSON SERVICES Amy Planz Compliance Coordinator cc: MA DEP —Title V Program, Boston Salem Board of Health Ms. Linda Garnett—Aquapoint File Massachusetts HQ) Massachusetts Connecticut Rhode Island New Hampshire Maine Vermont New York Frye Centennial Drive 100 Foxbomugh BNd. 273 Dividend Road 4778 Toque Avenue 195 Hanover Street PO Box tag 38 North Man Street 301 Manchester Road Peabody,MA 01960-79135 Suite 250 Rocky Hill,CT 06067 Coventry,R102815 Suite 28 York,ME 03909 Second Floor Suite 201A Foxbomugh,MA 02035 PortsmouHl,NH 03801 Waterbury,Vr 05676 Poughkeepsie,NY 12603 225 New Boston Street Wobum,MA 01801 When its essential...its Weston&sampson® 1+11ESTON & SAMPSON SERVICES FIVE CENTENNIAL DRIVE PEABODY, MA 01960 TEL. 978 532-1900 / FAX. 978 977-0100 BIOCLERE FIELD REPORT Date: 8/13/2007 Installation: Tested: Client: Blue Heron Pond LLC Service: Commissioned: Address: Lancaster,MA Other: Scheduled Maint:.X Inspector: Jim Vurgaropulos Bioclere Model Number(s) 1) Odor around site? No, Source of odor? Check all that apply: Mild: Strong: Mustv: Septic: Bioclere Permit Type: 2) Take influent/effluent samples: (pH,BOD,TSS,NH4,NO2,NO3,TKN, other) January, April, July, October Influent Sample Location: Effluent Sample Location: Visual observation of Influent: (color, turbidity, smell,etc.) Visual observation of Effluent: (color, turbidity, smell,etc.) 3) Scum/sludge measurem ents:(inches) Scum Sludge Does Tank(s) Require Pumping? a Grease Trap N/A No b) Primary Tank #1(recycle tank) 0 in 8 in No c) Primary Tank#2 N/A No d) Bioclere Units: #1 trace No #2 0 No No No e) Effluent Tank No f) Other No Zabel filter checked and cleaned (if applicable) Tank Location(s): Effluent tank: 8 x 16 ft RECEIVLro" iSEP 1 g 2001 CITY OF SALEM BOARD OF HEALTH UNIT 1 UNIT 2 4 SIOCLERE VENTS a Is air passing through the vent? Yes Yes If in doubt put a small plastic bag around vent and allow to fill b)Is the fan operating and in good condition? Yes Yes 5 GENERAL a)Any external damage to the unit(s)?If yes,then provide details on back No No b)Are cover,fan box and control panel secure) locked? Yes Yes c)Any filter flies in the unit? No No Location of flies: d)Locks/Latches/Handles, OK? Yes Yes e)Lid Gasket,OK? Yes Yes f)Does the fan box contain standing water? No No If yes,then remove water and clean drain holes if necessary. 6 BIOMASS CHARACTERIZATION a)Color of biomass? re /brown red/brown 1)white 2)white/ re 3) re 4) re /brown 5)brown 6)red/brown 7)black 8)other b)Thickness of biomass 6-12 inches below media surface medium/light light 1)light 2)medium 3)heavy 7 NOZZLE SPRAY PATTERN a)Does spray cover the entire surface area of media? Yes Yes If not then clean each nozzle with a bottle brush Does the spray now cover the entire surface area? Y / N Y / N If not then: 1)remove nozzles and clean 2 manually engage both dosing pumps for 2 minutes 3)replace nozzles Does the spray now cover the entire surface area? Y / N Y / N If not then consult AQUAPOINT 8)PUMPS AND CONTROL PANEL a)Record dosing and recycle pump timer settings from control panel Dosing um 1 and 2: 10 min on/2 min off 10 min on/2 min off Recycle pump: 2 min on/1 hrs off 6 min on/1 hrs off In Bioclere control panel set dosing and recycle timers to a test cycle: a Measure amperage of dosing um 1: 5.0 ams 5.0 amps b Measure amperage of dosing um 2: 5.0 amps 4.9 amps c)Measure amperage of recycle pump: 8.7 ams 8.4 amps Are the dosing pumps alternating? Yes Yes Are the timers operating properly? Yes Yes Visually inspect relays for wear and record problems below. `Ifs are components are needed contact Agualpoint If an ammeter is not available,set the timers to a test cycle as above and physically at the Bioclere,check the pumps operation as follows: Dosing pumps: check that um (s)are operating, alternatin and the pump 1:OK? No pump 1:OK? Yes designated rest cycle is occurring. pump 2:OK? Yes pump 2:OK? Yes Recycle um (s):check that um (s)are operating and the designated rest cycle is occurring. OK? Yes OK? Yes 'If pumps or control components are not operating ro erl record below and consult AWT Environmental, Inc. RESET TIMERS TO ABOVE SETTINGS: Note any changes here: min on/ min off i min on/ min off 'Do not change timers without consulting Aquapoint min on/ hrs off 15 min on/1/2hrs off 9) PLUMBING a) Are the unions in the Biocleres leaking? No If yes then tighten with pipe wrench 10) EFFLUENT PUMPS(if used) 1 2 Amperes 0.69 0.56 8/13/2007 Run time 18.27 17.91 7/30/2007 Run time 17.6 17.25 Difference 0.67 0.66 11) FINAL CHECK: All Units Unit1 Unit2 a) Main power"on" Yes Yes b) Pumps set to Normal Yes Yes c) Alarm toggle "on" Yes Yes d) All panels/covers/boxes locked Yes Yes e) Record water meter reading 456 g d 80 gals/in or 4,800 gals/hr REPORT SUMMARY: Flow based on effluent pump run times (6,000 ph) Pre EQ station #1: Pump#1 hrs: 187.9 Pump#2 hrs: 200.7 timer settings: 3 min on / 1-1/2 hrs off 0 activations amps: 5.2 amps: 5.3 Pre EQ station #2: Pump#1 hrs: 35.5 Pump#2 hrs: 34.7 hrs timer settings: 3 min on / 3 hrs off 0 activations amps: 5.7 amps: 5.5 Field Tests: 8/13: Effl: pH=7.20, NH3=0.8, NO3=16.0 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Title 5 DEP Approved Inspection and O&M Form for Title 5 I/A Treatment and Disposal Systems A. Installation Important: Blue Heron Pond, LLC Kurt Plante When filling out Owner forms on the computer, use Blue Heron Pond Road only the tab key Facility Street Address to move your Lancaster cursor-do not use the return City Zip key. Mailing address of owner, if different: Street Address/PO Box: MA City State Zip (978) 422 - 5001 ext. Telephone Number B. Authorized Service Provider Weston & Sampson O&M Firm 5 Centennial Drive Street Address Peabody MA 01960 City State Zip ( ) ext. Telephone Number James Vurgaropulos 8970 Certified Operator Name Certification Number C. Facility/System Information Aquapoint Bioclere (2) 24/30 DEP ID Manufacturer ID Model Number November 2006 25 January 2006 Installation Date Start of Operation Approval Type: ❑ General ® Provisional ❑ Piloting ❑ Remedial Seasonal Residence—used less than 6 mo./year: ❑ Yes ® No D. Operating Information 8/13/07 7/20, 7/30/07 Inspection Dale Previous Inspection Date 8 in Sludge Depth(to be checked yearly) Pumping Recommended ❑ Yes ® No l5aiom.doc•rev. 11-07-05 Page 1 of 3 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Title 5 DEP Approved Inspection and O&M Form for Title 5 I/A _Treatment and Disposal Systems E. Field Testing Field Inspection: Color: ❑ gray ❑ brown ® clear ❑ turbid ❑ Other(specify): Odor: ❑ musty ® earthy ❑ moldy ❑ offensive ❑ turbid Effluent Solids: ❑ no ❑ some pH 8.04 SU DO mg/L Turbidity NTU 6 to 9 2 or greater 40 or less Should a Remedial or General Use system fail the Field Testing, effluent samples shall be collected per Standard Methods and analyzed for BOD and TSS. F. Sampling Information Samples Taken: ❑ Influent ❑ Effluent Commercial systems or systems with a design Flow of 2000 gpd and greater, and General Use nitrogen reducing systems: 456 gpd Parameters sampled: ❑ pH ❑ BOD ❑ CBOD ❑ TSS ❑ TN ❑ Other (list below) Other 1 Other 2 Other 3 G. Inspection and Maintenance Description of any maintenance performed since previous inspection & during this inspection: Notes and Comments: Extra visits are not necessary this month. Monthly samples. Samples: January, April, July, October t5aiom.doc•rev. 11-07-05 Page 2 of 3 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Title 5 DEP Approved Inspection and O&M Form for Title 5 I/A Treatment and Disposal Systems H. Certification I certify: I have inspected the sewage treatment and disposal system at the address above, have conducted the required Field Testing and/or sample collection in accordance with Standard Methods, have completed this report and the attached technology operation and maintenance checklist, and the information reported is true, accurate, and complete as of the time of the inspection. I am a Mass husetts certifie, d gperator in accord th 257 CMR 2.00.00. 8/13/07 Oper or Signature ° Date System owner must submit this report, technology O&M checklist, and any required sampling results to the local board of health and DEP as follows for each inspection performed: Remedial Use— by January 31"of each year for the previous calendar year Piloting Use -within 45 days of inspection date Provisional Use—by March 31`h of each year for the previous 12 months General Use—by September 301h of each year for the previous 12 months Send to: Department of Environmental Protection Attention: Title 5 Program One Winter Street, 8t Floor Boston, MA 02108 t5aiom.doc•rev. 11-07-05 Page 3 of 3 Five Centennial Drive Peabody,MA 01960-7985 tel:978-532-1900 fax:978-977-0100 www.westonandsampson.com RECEIVED esto p soy® MAR 102008 Aquapoint CITY OF SALEM BOARD OF HEALTHBlue Heron Pond, LLC WSS Job # C205250 March 4, 2008 / Ms. Ellen Kelleher Blue Heron Realty Trust 37 Belleview Ave Salem, MA 01970 RE: Blue Heron Pond, LLC Monthly Inspection Report January 2008 Dear Ms. Kelleher: Enclosed please find the January 2008 Bioclere Field Report and DEP Approved Inspection Form and laboratory analysis report for your system. Mr. James Vurgaropulos of Weston & Sampson Services performed the monthly inspection on January 15, 2008. Weston and Sampson Services would like to note the following: • Effluent BOD, TSS and Total Nitrogen, collected on January 15, 2008, were in compliance with MassDEP's Modified Provisional Use Approval, revised on November 6, 2006. If you have any questions or concerns regarding this report, or your wastewater treatment system, please feel free to contact me at (978) 532-1900, ext 2202. Regards, WESTK & SAMPSON SERVICES Amy Plant Compliance Coordinator cc: MA DEP—Title V Program, Boston Salem Board of Health Ms. Linda Garnett—Aquapoint File Massachusetts(He) Massachusetts Connecticut Rhode Island New Hampshire Maine Vermont New York Frye Centennial Drive 100 Foxborough Blvd. 273 DMdend Road 477B Togue Avenue 195 Hanover Street PO Box 189 38 North Main Street 301 Manchester Road Peabody,MA 01960-7985 Sufte 250 Rocky Hill,CT 06057 Coventry,RI 02816 Sufte 28 York,ME 03909 Second Floor Suite 201A Foxborough,MA 02035 Portsmouth,NH 03801 Waterbury,Vr 05676 Poughkeepsie,NY 12603 225 New Roston Street Woburn,MA 01801 When its essential...its Weston&SampSon.a WESTON & SAMPSON SERVICES FIVE CENTENNIAL DRIVE PEABODY, MA 01960 TEL. 978 532-1900 / FAX. 978 977-0100 BIOCLERE FIELD REPORT Date. 1/15/2008 Installation: Tested: Client: Blue Heron Pond LLC Service: Commissioned: Address: Lancaster,MA Other: Scheduled Maint:.X Inspector: Jim Vurgaropulos Bioclere Model Number(s) jBioclere Permit Type: 1) Odor around site? No, Source of odor? Mild: Med: Strong: Check all that apply: Musty: Septic: 2) Take influent/effluent samples: (pH,BOD,TSS,NH4,NO2,NO3,TKN, other) January, April, July, October Influent Sample Location: Effluent Sample Location: Visual observation of Influent: (color, turbidity, smell,etc.) Visual observation of Effluent: (color, turbidity, smell,etc.) 3) Scum/sludge measurements:(inches) Scum Sludge Does Tank(s) Require Pumping? a) Grease Trap N/A No b) Primary Tank#1(recycle tank) 0 in 6 in No c) Primary Tank#2 N/A No d) Bioclere Units: #1 trace No #2 0 No e) Effluent Tank 8x16 No 0 Other No g) Zabel filter checked and cleaned (if applicable) 4) BIOCLERE VENTS UNIT 1 UNIT 2 a) Is air passing through the vent? Yes Yes If in doubt put a small plastic bag around vent and allow to fill b) Is the fan operating and in good condition? Yes Yes 5) GENERAL a) Any external damage to the unit(s)? If yes, then provide details on back No No b) Are cover, fan box and control panel securely locked? Yes Yes c) Any filter flies in the unit? No No Location of flies: d) Locks / Latches / Handles, OK? Yes Yes e) Lid Gasket, OK? Yes Yes f) Does the fan box contain standing water? No No If yes, then remove water and clean drain holes if necessary. 6) BIOMASS CHARACTERIZATION a) Color of biomass? grey/brown red/brown 1)white 2)white/grey 3)grey 4)grey/brown 5)brown 6)red/brown 7)black 8)other b) Thickness of biomass 6 - 12 inches below media surface medium/light light 1) Tight 2) medium 3) heavy 7) NOZZLE SPRAY PATTERN a) Does spray cover the entire surface area of media? Yes Yes If not then clean each nozzle with a bottle brush Does the spray now cover the entire surface area? If not then: Y I N Y / N 1) remove nozzles and clean 2) manually engage both dosing pumps for 2 minutes 3)replace nozzles Does the spray now cover the entire surface area? Y / N Y / N 8) PUMPS AND CONTROL PANEL a) Record dosing and recycle pump timer settings from control panel Dosing pump 1 and 2: 10 min on/2 min off 10 min on/2 min off Recycle pump. 2 min on/1 hrs off 5 min on/1/2 hrs off In Bioclere control panel set dosing and recycle timers to a test cycle: a) Measure amperage of dosing pump 1: 5.1 ams 5.4 amps b) Measure amperage of dosing pump 2: 5.7 ams 5.0 amps c) Measure amperage of recycle pump: 9.5 ams 8.8 amps Are the dosing pumps alternating? Yes Yes Are the timers operating properly? Yes Yes Visually inspect relays for wear and record problems below. If an ammeter is not available,set the timers to a test cycle as above and physically at the Bioclere, check the pumps operation as follows: Dosing pumps. check that pump(s)are operating,alternatin and the Pum 1:OK? No pump 1: OK? Yes designated rest cycle is occurring pump 2:OK? Yes pump 2: OK? Yes Recycle pump(s):check that pump(s)are operating and the designated rest cycle is occurring. OK? Yes OK? Yes RESET TIMERS TO ABOVE SETTINGS: Note an than es here: min on/ min off min on/ min off `Do not change timers without consulting A ua oint min on/ hrs off 2 min on/1/2 hrs off 9) PLUMBING a)Are the unions in the Biocleres leaking? No If yes then tighten with pipe wrench 10) Pre EQ station#1: Pump#1 hrs: 235.9 Pump#2 hrs:265.6 timer settings: 3 min on]1-1/2 hrs off 8 mid level activation(s) amps. 5.1 amps: 5.1 change to:4 min on/3 hrs off 11) Pre EQ station#2: Pump#1 hrs:49.3 Pump#2 his 48.0 hrs timer settings: 3 min on/3 hrs off 0 activations amps: 5.5 amps:5.4 12) EFFLUENT PUMPS(if used) 1 2 Amperes 0.69 0.56 1/15/2008 Run time 26.17 25.69 12/13/2007 Run time 24.38 23.93 Difference 0.79 1.76 13) FINAL CHECK: All Units Unitl Unit2 a) Main power"on" Yes Yes b) Pumps set to Normal Yes Yes c)Alarm toggle"on" Yes Yes d)All anels/covers/boxes locked Yes Yes e) Record water meter reading 946 gpd 80 galstin or 4,800 gaill /hr(based on effluent pumps) REPORT SUMMARY: Field Tests: 1/15 Effluent: pH=7.10/6.5`C, NH3=0.8, NO3=17.5, infl pH=7.27/5.4'C Quarterly Samples Add 30 Ibs of sodium acetate to pre eg#2. Ll Massachusetts Department of Environmental Protection Bureau of Resource Protection Title 5 DEP Approved Inspection and O&M Form for Title 5 I/A -- - -- Treatment and Disposal Systems A. Installation Important: Blue Heron Pond, LLC Kurt Plante When filling out Owner forms on the - computer, use Blue Heron Pond Road only the tab key Facility Street Address to move your Lancaster cursor-do not City Zip use the return key. Mailing address of owner, if different: Street Address/PO Box. MA aru" City State Zip (978) 422_5001 ext. Telephone Number B. Authorized Service Provider Weston_& Sampson_—_ O&M Firm 5 Centennial Drive Street Address Peabody _ _ MA 01960 City State Zip ext. Telephone Number James Vurgaropulos —_ __— _ 89_70 Certified Operator Name Certification Number C. Facility/System information Aquapoint Bioclere (2) 24/30 DEP ID Manufacturer ID Model Number November 2006 25 January 2006 Installation Date Start of Operation Approval Type: ❑ General ® Provisional ❑ Piloting ❑ Remedial Seasonal Residence— used less than 6 mo./year: ❑ Yes ® No D. Operating Information 1/15/08_ 12/13/2007 Inspection Dale Previous Inspection Date 6 in Pumping Recommended ❑ Yes ❑ No Sludge Depth(to be checked yearly) l5aiom.doc• rev. 11-07-05 Page 1 of 3 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Title 5 DEP Approved Inspection and O&M Form for Title 5 I/A -- -- Treatment and Disposal Systems E. Field Testing Field Inspection: Color: ❑ gray ❑ brown ® clear ❑ turbid ❑ Other (specify): Odor: ❑ musty ® earthy ❑ moldy ❑ offensive ❑ turbid Effluent Solids: ❑ no ❑ some pH 7.04 t0 e SU DO or gree n V_ Turbidity q0 or es NTU Should a Remedial or General Use system fail the Field Testing, effluent samples shall be collected per Standard Methods and analyzed for BOD and TSS. F. Sampling Information Samples Taken: ® Influent M Effluent Commercial systems or systems with a design flow of 2000 gpd and greater, and General Use nitrogen reducing systems: 391 gpd Parameters sampled: ❑ pH ❑ BOD ❑ CBOD ❑ TSS ❑ TN ❑ Other (list below) Other 1 Other 2 Other 3 G. Inspection and Maintenance Description of any maintenance performed since previous inspection & during this inspection: 30 lbs sodium acetate added to the recycle tank to briny nitrate-N into compliance. Notes and Comments: Samples: January, April, July, October However additional sampling in between the quarterly requirement is being done sometimes to tyand-achieve consistant compliance t5aiom.doc• rev. 11-07-05 Page 2 of 3 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Title 5 DEP Approved Inspection and O&M Form for Title 5 I/A - Treatment and Disposal Systems H. Certification I certify: I have inspected the sewage treatment and disposal system at the address above, have conducted the required Field Testing and/or sample collection in accordance with Standard Methods, have completed this report and the attached technology operation and maintenance checklist, and the information reported is true, accurate, and complete as of the time of the inspection. I am a Massachusetts certified operator in accordance with 257 CMR 2.00. — -- --------- ----- — --------- -----------...-------- Operator si ture Date System owner must submit this report, technology O&M checklist, and any required sampling results to the local board of health and DEP as follows for each inspection performed: Remedial Use— by January 31" of each year for the previous calendar year Piloting Use -within 45 days of inspection date Provisional Use—by March 31t" of each year for the previous 12 months General Use — by September 30" of each year for the previous 12 months Send to: Department of Environmental Protection Attention: Title 5 Program One Winter Street, 6t Floor Boston, MA 02108 t5aiom.doc• rev. 11-07-05 Page 3 of 3 1 R.I. ANALYTICAL Specialists in Environmental Services Page t of 2 CERTIFICATE OF ANALYSIS WSS Inc.dba Weston & Sampson Date Received: 1/16/08 Attn: Mr. Wallace Bruce Date Reported: 1/23/08 Five Centennial Drive P.O.#: Peabody, MA 01960-7985 Work Order#: 0801-00910 DESCRIPTION: BLUE HERON POND Subject sample(s) has/have been analyzed by our Warwick, R.I. laboratory with the attached results. Reference: All parameters were analyzed by U.S. EPA approved methodologies. The specific methodologies are listed in the methods column of the Certificate Of Analysis. Data qualifiers (if present) are explained in full at the end of a given sample's analytical results. Certification #: RI-033, MA-RI015, CT-PH-0508, ME-RI015 NH-253700 A &B,USDA S-41844 If you have any questions regarding this work, or if we maybe of further assistance, please contact our customer service department. Approved by: Data Reporting enc: Chain of Custody 41 Illinois Avenue,Warwick,RI 02888 , 131 Coolidge Street,Suite 105,Hudson,MA 01749 Phone:401.737.8500 Fax 401.738.1970 Phone:978.568.0041 Fax: 978.568.0078 Page 2 of 2 R.I. Analytical Laboratories,Inc. CERTIFICATE OF ANALYSIS J � WSS Inc.dba Weston& Sampson Date Received: 1/16/08 Approved by: L Work Order k 0801-00910 IDUata Reporting Satnplc# 001 SAMPLE DESCRIPTION: INFL SAMPLE,TYPE: COMPOSITE SAMPLE DATE/TIME: 1/15/2008 SAMPLE DET. DATE PARAMETER RESULTS LIMIT UNITS METHOD ANALYZED ANALYST 130135 100 30 mg/1 SM 5210B 1/17/08 CCP I'mal Suspended Solids 45 2.0 mg/l EPA 160.2 121/08 MI. Nitrite(as N) <0.01 0.01 mg/l EPA 300.0 1/17/08 LA N itmte(as N) <0.01 0.01 mg/1 EPA 300.0 1/17/08 LA Alkalinity(as CaCO3) 250 1.0 mg/1 SM 23208 1/17/08 CAA Ammunia(as N) 24 0.10 mg/I SM 45MNH3 C 1122/08 KA TKN(as N) 36 0.50 mall EPA 351.3 1/21/08 KA Sample# 002 SAM PLEDESCRIPTION: EFFL SAMPLETYPE: COMPOSITE SAMPLE DATE/TIME: 1/15/2008 SAMPLE DET. DATE. PARAMETER RESULTS LIMIT UNITS METHOD ANALYZED ANALYST BOD5 <3.0 3.0 mg/l SM 52108 1/17/08 CCP Total Suspended Solids 3.0 2.0 mg/1 EPA 1602 1121/08 ML Nitrite(as N) <0.01 0.01 mg/1 EPA 300.0 1/17/08 LA Nitrate(as N) 17 0.01 mg/l EPA 300.0 1/17/08 LA Alkalinity(as CaCO3) 86 1.0 mg/1 SM 2320B 1/17/08 CAA Ammonia(as N) 0.43 0.10 mg/I SM 4500-NI13 C 1/21/08 EC I'KN(as N) 2.0 0.50 mg/l EPA 351.3 1/21108 KA CHAIN OF CUSTODY RECORD R.I. Analytical Laboratories, Inc. 41 Illinois Avenue 131 Coolidge St,Bldg. 2 g, g Warwick, RI 02888 Hudson, MA 01749 ul o Tel: 800-937-2580 Tel: 888-228-3334 a ro v Fax: 401-738-1970 Fax: 978-568-0078 v z � Date Time v Collected a C Iles ColleField Sample Identification C71 a E "�I � L b K G C S lien[Information Project Information Company Name: Yjj(J 4`l O Project Name: nz'aE'711�reolo) ti Address: P.O.Number. Project Number: City/State/Zip: ReportTo: Phone: Fax: Telephone: Fax: Sampled by: p Contact Person: Quote No: tmail add=: Relinquished By Pate ime I Rec ived By Date Time Turfi-Arroupti Time J '3 Norma EMAILReport 04 4 -UM q ( 6 O / 5 Busines days.Poublcsmche . 6�6 (business days) Project Comments - Lab Use Only Circle if applicable: GW-1, GW-2, GW-3, S-1, S-2, S-3 MCP Data Enhancement QC Package? Yes No Semple Pick Up Only RIAL sampled;attach field hours o Shipped on ice L Wor order No: ICV 1'J J Container TvDes: P=Poly,G=Glass,AG=Amber Glass,V=Vial,St=Sterile Preservation Codes: NP=None,N=HNOs, H=HCI,S=H2M,SH=NaOH,SB=NaHSO.,M=MeOH,T=Na2S2C Z=Zn0Ac, 1=Ice Matrix Codes:GW=Groundwater,SW=Surface Water,WW=Wastewater,DW=Drinking Water,S=Soil,S1=Sludge,A=Air,B=Bulk1solid,0= Page of