PHQTECTION AGENCY HWl Sompfe-Mcnogement Office REPORT · 2020. 7. 28. · O.f2 0 Kuoo^v2.Q * D il p 3M u F/? 43 UP fioMO U P 3._G) a F_ __-...J-t.O,,^, 41 p Percent Solids (%) %2.3

U.S. E. PHQTECTION AGENCY HWl Sompfe-Mcnogement Office

REPORT

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Oy C^wiw™?pi]foe^:te..n, .jS ^^ TISample Site KfeEme/Code:i© SAMPLE CONCENTRATION

(Check One)Low Concentration

————— Medium Concentration® SAMPLE MATRIX

(Check One)—— - — Water———— Soil/Sediment

: - * '

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.....:S. SLWIROMvE\rrAL PHOTSCTrON AGENCY ' HW! Somoie Monccement OSc Sample Number

e: (Check One)Low ConcentrationMedium Concentration

3) SAMPLE MATRIX(Check One)

Water— SoiVSediment

Ship To:

Attn:TransferShip To:

(e) Shipping Information:Name Of Carrier

Date Shipped:Airbill Number:

Mark Volume LevelOn Sample BottleCheck Analysis required

1 Total

Heed by:

Date Reed: __-' /'/-^d '-

Sample ConditionOn Receipt:

{eg. broken, leakage, chain ot custody, etc)

550^ 01*-OZLABHLECOPV

002009

:CTtON AGENCY KWI Somoie Mcoaaqe*rhen* Office'.

«) a^f&llfr-xL. '>- S^^^/Code:

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@ SAMPLE CONCENTRATION{Check One)

————— Low Concentration- — - ——— Medium Concentration(S) SAMPLE MATRIX

(Check One)——— s— Soil/Sediment

SdJ&tlJMlXS r̂ IP'ejRSIDnilfllT

tPhaa&\ i" ' ' " " -*»*«»* . . . .. . . . . . ..iiil. . . . . . . . . . . .

(e) Shipping Information: *'Name Of Carrier:

j~ f- ""

• - • - :,iti:

- ——— Ground Ai»r

—— ; Scik3s -i(apacify)

MATCHES ORQ^KHC S^MPLS J3O. —— C — -

($\ Mark Volume LevelOn SaniT bottleCheck Aiw-ysis required

. ^T^te2 Metals

(4) Ship To: i .• *"

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©ANALYSIS LAB:If ; • i //;' f-.f-KetfA Ky- /- ('&•< & '-w;, f JeiA^*-

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(eg broken, leakage, chain of custody, etc.)

55QQ- 0(fl-02 .LABFlLEGQPy

002010

US t^a?ONTVIENTALPROtECnONAGENCY HWl'Sam Scrapfe Number

REPORT

LABFEEOOPY

(7) CawfftfesslW? - •-* - f^ Sample Site^air.e/Code:

(?) SaratoiiiraaQ^&e: ^T~Sampling Perso! BBS!:

AL PROTECTION AGENCY HWI Scznpl? ManagejnehtOffice; Sample i&anabea-

SAMPLE CONCENTRATION(Check One)

—— Low Concentration—— Medium ConcentrationSAMPLE MATRIX

(Check One)—— Water—a— Soil/Sediment

Ship To:

Attn:TransferShip To:

'fB&oint i .'.-..Uijlf————————————j. ; n i r fg j .

(B) Shipping Information:Name Of Carrier'

CS) ANALYSIS LAB:IVReed by: .

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i,-"Total Metals


(eg broken, leakage, chain of custody,

LABHUECX^Y

002012

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Medium Concentration(i) SAMPLE MATRIX

fCheck One)———— Water— SeJ — Soil/Sediment

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(J) Shipping Iziionnatioxt:Name Oi Canier:

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©ANALYSIS LAB:Heed by;


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LABHLEOOPY

002013

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TAL PHCTTCTION AGENCY KWJ Sample ManaaesRent Office Sompie Nuraber

t. .-• ..§. i :-""'-'-"-'T5' .If '--SAMPLE CONCENTRATION

(Check One)^ —— Low Concentration

———— Medium Concentration® SAMPLE MATRIX

(Check One)———— Water— XL —— Soil/Sediment

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Mi

(e) Shipping Information:Nense Of Carrier: ;

ANALYSIS LAB:

? ̂ 5"

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(eq. broken, leakage, ch^r < of cuslody, etc ), I

LABHLEOOPY

002014

iii., in-..««Ai. -.j_ '• v. SAMPLE CONCEN1BATION(Check One)

—— Low Concentration—— Medium ConcentrationSAMPLE MATRIX

(Check On«)- Water

tinr.,.,, Soil/Sediment

Ship To:' * ;' "^

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(e) Supping Iniorrnation:Nam« Of C«rri«r : i

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LABmECCS'Y

ANALYSIS LAB:

Sample Conctitien• On Receipt:

(eg broken, leakage, chain oi custody, etc.)

002015

b :,:V -v-HOMMENT,̂ I.. PROTSCTION AGENCY HWI Sample Management Office Scsnpte Number

HUIFFIC REPORTu^.. (Check One}-——— Low Concentration

———— Medium Concentration3) SAMPLE MATRIX

—- Water—- Soil/Sediment

tftnd)

t® Shipping Information:Name Of Carrier:

' I/ /k(a

Ground

Solid* ',f } itU..A!.*'.:« v "• r-••x.l'i

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On Receipt:(r»g broken, kwkage, chain of custody, etc.)

550^-LABFTISCQPY

002017

SAMPLE CQNCE1OTIA(Chock One)

Low ConcentrationMedium Concentration

SAMPLE MATRIX(Check On*)

WaterSoU/Swiun«n« Tran-rfea:

Ship To:

Name Of C^rrw

Out* ShippedAirbill Number

(Eod) . . - ! ? . / 4 Sample CoaiCutooaa

brokwn, leakage, chain erf custody, c«c.)Check Analysis recjuitred

LABHLEOOPy

002018

DOCCMEMTS PCRGE0

CASE

CHEJfTECH JOB tf Gl'

OOCUHENTS SENT TO:

REGION Ofe

TECHLAtf, INC.Atcn: Ketth Wegner12600 West Colfax AvenueSuita C-310takewood, CO 80215

PURGE PERFORMED BY

DATE:

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002020

ENVIRONMENTALOffice of CHAIN OF CUSTODY RECORD . \

SAMPLE ANALYSIS TRACKING CHART

WATER

Z

SOIL,SED TOTAL DATE DATE DATESAMPLES REC'D DUE

VO UP-

DATE INITIALS

SAMPLE EXTRACTED/DIGESTEDPERCENT SOLIDS

TASK I ANALYSISTASK II ANALYSIS:

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K

ADDITIIONAL ANALYSIS ( SAS ) :JOB f: Gl-Csg Gq

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INORGANIC AmUrYSCS DAf A S..Ml; Kfljtft CHEmCH COKSULtiaG GR00F CA

US SAHFig ID. KO. ~Q \ QO

(UFA No.

HO,

tdaaeified and aa i r e dConcentration:Matrix: Water

1 - Aluminum2. Antimony3. Arsenic4. Bariua5* 8*rylllua6. Cadmiua7. Calcium8* Chrood.ua9. Cobalt10. Copper11. Iron12 « teadCyanide

tew // Soil

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550°!- 0(o- 07.-.*-J/-%.i/.W|__ t__r-1|,^;,l,^y ^»'-. I

Lab Manager

002023

Form IU.S. SPA Contract Laboratory ProgramSample Management OfficeF.d, Sax SIS - Alexandria, VA 22313

|EPA Sample No.

•*'•-' ""•'

INORGANIC ANALYSIS DATA SH£&t-ammoi-

LAS SAMPLE £0. MO. QC .XCfOUT SO

elements Identified and MeasuredConcent rat ion : LowMatrix: Water

1 *2.3.4.5.6.7*8.9.10.1 1 .12,

AluminumAatisonyArsenicBariumBerylliumCadmiumCalciumChromiumCobaltCoppe_rIrooLead

1

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703/557-2490 FTS: **537~2490

EFA Sataplc

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ElamenC* tdent lfted and MeasuredConcentration:Matr ix : Water

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13.

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Perceae Solid* (Z)

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Fora IU.$. S?4 Coacr-tct Laboratory ProgramSample Hanageaertt OfficeP.O. Box SIS * Al«xafidi*ia, VA 22313

FTSi 8-557-2490 Date Si£ffOft6AJfIC ANALYSIS SAtA SKIST

US 8-«l« CHEKTECH COHSHLTOG GSffiffi

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Pom IU.S. EPA Contract Laboratory PrograaSampift Management Of fleaP.O. Box 818 - Alexandria, VA 22313703/557-2490 TO* S~557-2490

tHORCAKtC ANALYSIS DATA SHEETLAB 8&t£ CHKOTCH COHSULTIHG CSiQOF g^gg HQB3$f St* j^..- • • -•S'ifltMf S. 784SO* &a.-t>t*i~dS IV* D ff C rtO1V«* HAPUKJ

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El aaiant* Identified and Kaaaurad

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tow »/Soil

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002033

EP» CASE NO:CMfelN OF CUSTOD7: £, -^ a* - *• j**

of Calii

In Reference to Case NO(S)J

Contract laboratory ProgramRecord tog

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ttb_Contact;

_/£> * /XJi i-L. / /W s,

Call Initiated By: ,._mr_j LaboratoryIn reference to data for the following sample number(s)j

MFC fl &*___________

Summary of Questions/Issues Discussed:

No

Summary of Resolution:

Signature

DUtribution: (i) Ub Copy, (2) Region Copy, (3) SMO Copy

002035

O-EIlllECH

INDEX OF DOCUMENTS PURGED

CASE REGION f - SERIALI2EB *

CASE j 55C£|

SEPIALIZED_|

010203

, 04050607080910

ITEM j;_IN_ FILE

Carrier Airbill to Chemtech IInorganics Traffic Reports (yellow) \ \Chain-of-Custody sheets \Sample tags \7.Sample tracking form IInstrument logbook pages or bench sheets (25Inorganic Data Sheets \ \Logbook Page( s ) \Index of Documents \Others - Specify Phcwoe fkeccfui

50V 0(o - 09

002036

barcode: *1002603*barcodetext: 1002603