DSHW-2012-003636 - 0901a068802e0420

Launch Systems Group
P.O. Box 707
Brigham City, UT 84302 Division of
Solid and HazardousWaste
www.atk.com JUN 1 3 2012
12 June 2012
8200-FY13-011
Scott T Anderson
Executive Secretary,
c/o UDEQ Division of Solid and Hazardous Waste
PO Box 144880
SALT LAKE CITY UT 84114-4880
Subject: ATK Launch Systems Promontory Facility, Well Completion Report for Well P-10;
EPA ID #UTD009081357
Re: March 13, 2012 Letter from Division of Solid and Hazardous Waste, Approving the P-10
Installation Plan
Dear Mr. Anderson
On March 13, 2012, your office sent a letter approving the monitoring well installation plan for well
P-10. This well has been installed, please find the P-10 Well Completion Report included with this
letter.
If you have questions regarding this report, please contact Paul Hancock at [phone].
I certify under penalty of law that this document and all attachments were prepared under my direction or
supervision in accordance with a system designed to assure that qualified personnel properly gather and
evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or
those persons directly responsible for gathering the information, the information submitted is, to the best of
my knowledge and belief, true, accurate, and complete. 1 am aware that there are significant penalties for
submitting false information, including the possibility of fine and imprisonment for knowing violations.
Sincerely,
Robert Ingersoll, Director
ATK Environmental Services
GROUNDWATER MONITORING
WELL P-10 COMPLETION REPORT
ATK Launch Systems
Promontory Facility
Promontory, Utah
May 2012
EarthFax Earth Fax Engineering, Inc.
Engineers / Scientists
www.earthfax.com
ATK Launch Systems Inc
Promontory Facility
Monitoring Well P-10 Report
April 2012
TABLE OF CONTENTS
SECTION PAGE
CHAPTER 1 - INTRODUCTION 3
1.1 PURPOSE : 3
1.2 SCOPE 3
CHAPTER 2 - WELL CONSTRUCTION AND DATA COLLECTION 4
2.1 WELL LOCATION 4
2.2 WELL CONSTRUCTION 4
2.3 HYDROGEOLOGIC DATA COLLECTION 4
CHAPTER 3 - RESULTS OF WELL INSTALLATION AND TESTING 5
3.1 WELL COMPLETION 5
3.1.1 P-10 Well Completion 5
3.2 GEOLOGY '. 5
3.3 WELL DEVELOPMENT 6
3.4 ANALYTICAL RESULTS 6
LIST OF FIGURES
FIGURE 1 SITE LOCATION MAP
FIGURE 2 MONITORING WELL LOCATIONS AND NEW WELL P-10
LIST OF APPENDICES
APPENDIX A DRILLERS DAILY LOGS
APPENDIX B GEOLOGIC LOG AND AS-BUILT COMPLETION DIAGRAM
APPENDIX C GROUNDWATER ANALYTICAL RESULTS
ii
ATK Launch Systems Inc
Promontory Facility
Monitoring Well P-10 Report
May 2012
MONITORINGWELL P-10
INSTALLATION REPORT
ATK LAUNCH SYSTEMS
CHAPTER 1 - INTRODUCTION
1.1 PURPOSE
ATK Launch Systems drilled and completed a groundwater monitor well north west of
Well P-6 and building M-585 in Box Elder County, Utah (Figure 1). The primary objective of the
monitoring well installation was to provide a third point to assess the potentiometric surface and
subsequent flow direction downgradient of M-585 and any impact to the environment from past
disposal practices. ATK Launch systems has previously drilled and constructed monitoring wells
P-2, P-6, and P-7 west of the building. Constituents that have been detected near the new well
are, organic solvents (chloroform, TCE, TCA, DCE), and more recently, perchlorate.
1.2 SCOPE
This report has been prepared to present data obtained during the installation of
monitoring well P-10. It is intended to serve as a stand-alone document; however, the reader is
referred to the Groundwater Flow and Contaminant Transport Model Report for the ATK
Promontory Facility (EarthFax Engineering, Inc., January 2008) for general background
information regarding (1) descriptions of facilities at the Promontory Facility, (2) regional
geologic and groundwater conditions, (3) local geology and groundwater hydrology, and (4) the
local groundwater quality at the site.
This document is divided into four chapters, including this introduction. The methods
used to install and to test the monitoring well can be found in Chapter 2. Results are found in
Chapter 3, and Chapter 4 contains a list of references cited in this report.
3
ATK Launch Systems Inc
Promontory Facility
Monitoring Well P-10 Report
May 2012
CHAPTER 2 - WELL CONSTRUCTION AND DATA COLLECTION
2.1 WELL LOCATION
The location of monitoring well P-10 is shown on Figure 2. The locations of adjacent
site monitoring wells are also shown on Figure 2.
2.2 WELL CONSTRUCTION
Well drilling and completion tasks were performed by Mike Zimmerman Well Service of
Magna, Utah. All rig operators were licensed by the Utah Division of Water Rights to drill water
wells in the State of Utah. Well drilling, completion, and associated activities were supervised
by EarthF.ax Engineering, Inc. of Midvale, Utah. All activities at the site were conducted in
compliance with ATK health and safety requirements. Also, guidelines contained in a health
and safety plan (developed for earlier drilling phases at ATK and updated for this site) were
used to monitor the work area around the well during construction.
Monitoring well P-10 was installed by cable tool drilling methods. Appendix A contains
copies of the driller's daily work logs.
2.3 HYDROGEOLOGIC DATA COLLECTION
During drilling operations, composite cuttings samples were collected at approximate 5-
foot intervals and as major lithologic changes occurred. Typical information logged from the
cuttings was grain size, mineralogy, saturation, source material, color, etc. Appendix B
contains a geologic log of sediments penetrated in P-10 in addition to an as-built well
construction diagram.
A groundwater grab sample was collected for analysis following installation and
development of the monitoring well. This sample was collected by ATK personnel from the well
and analyzed at the ATK Environmental Laboratory for perchlorate and VOC's.
4
ATK Launch Systems Inc
Promontory Facility
Monitoring Well P-10 Report
May 2012
CHAPTER 3 - RESULTS OF WELL INSTALLATION AND TESTING
3.1 WELL COMPLETION
Monitoring well P-10 was drilled to a depth of 105 feet. An 6-inch diameter borehole was
drilled using cable tool drilling techniques from the surface to a depth of 105 feet where water
was detected during drilling in tight sandy/silty clay.
3.1.1 P-10 Well Completion
The well consists of nominal 2-inch diameter schedule 40 PVC from the surface to a
depth of 85 feet, below which the well is constructed of 20 feet of factory slotted 0.010 slot, 2-
inch diameter PVC screen to a depth of 105 feet. A gravel-pack consisting of 20-40 mesh silica
sand was placed around and to a depth of 6 feet above the screen, and 1 foot of 70-mesh silica
sand was placed immediately above the 20-40 mesh gravel pack and allowed to settle
overnight.
The annulus above the gravel-pack was sealed with pure gold bentonite grout from 79 to
5 feet below ground surface. The remainder of annulus was filled with bentonite chips to within 2
feet of the surface. The surface to 2 feet below surface was filled with cement and covered with
an above ground protective casing with locking cap and cement pad.
3.2 GEOLOGY
The lithology at P-10 consists primarily of Quaternary erosional sediments. The
materials encountered fluctuated between clay, silt, sand, and gravel. The well was screened
across an interval comprised of sandy clay and silty clay. Water was encountered in the well
near 90 feet below ground surface, which roughly corresponded with the saturated interval at
nearby wells P-6 and P-7.
5
ATK Launch Systems Inc
Promontory Facility
Monitoring Well P-10 Report
May 2012
3.3 WELL DEVELOPMENT
Following completion of P-10, the well was developed by bailing water from the well into
a barrel at the well head. During this development process, the well was drawn down to near
100 feet below ground surface. Approximately 5 days later, ATK attempted to continue
development by pumping the well but were unable to due to a limited amount of water in the
well. Only 0.5 ft of water was measured in the bottom of the well. This may be due to a very tight
formation and water does not recharge quickly or because the well was completed in a perched
aquifer, the producing zone may be limited and by developing, we depleted the water in this
portion ofthe aquifer.
3.4 ANALYTICAL RESULTS
Although sufficient water was not available to continue development of the well, a grab
sample was collected using a disposable bailer. This sample was submitted to the ATK
laboratory at Building M53 for analysis of VOCs and perchlorate. No perchlorate was found in
the sample. VOC constituents acetone, benzene, chloroform, toluene, xylene, DCE and TCE
were found in the water. Benzene, toluene, xylene and acetone were most likely a result of
possible contaminants coming from the drill rig and/or the cable on the drill rig. These
constituents are not at concentrations that are cause for concern. Constituents DCE and TCE
are found in the groundwater at other wells downgradient of building M585 at concentrations
much higher than those found at P-10. Results of the groundwater samples can be found in
Appendix C
6
ATK Launch Systems Inc
Promontory Facility
Monitoring Well P-10 Report
May 2012
CHAPTER 4 - REFERENCES
EarthFax Engineering Inc. 2008. Groundwater Flow and Contaminant Transport Model Report
for the ATK Promontory Facility. Submitted by ATK to the Utah Division of Solid and
Hazardous Waste. Salt Lake City, Utah.
7
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ATK Launch Systems Inc Monitoring Well P-10 Report
Promontory Facility May 2012
APPENDIX A
DRILLERS DAILY LOGS
WELL DRILLER'S REPORT
State of Utah
Division of Water Rights
For additional space, use "Additional Well Data Form" and attach
Owner
Non-Production Well: 1213001M00
Note any changes
ATK LAUNCH SYSTEMS
KRIS BLAUER
PO BOX 707 M/S 301
BRIGHAM CITY, UT 84302-0707
WIN: 4 35679
Contact Person/Engineer:
N 2021 E 2360 from the SW corner of section 04, Township UN, Range 5W, SL B&M
Location Description: (address, proximity to buildings, landmarks, ground elevation,local well #)
Drillers Activity Start Date:
Check all that apply: [x]New QRcpair ODeepen Dcican DReplace fjpublic Nature of Use:.
If a replacement well, provide location of new well. feet north/south and . feei cast/west of the existing well.
DEPTH (feet)
FROM TO
J2_ its
BOREHOLE
DIAMETER (in) DRILLING METHOD DRILLING FLUID
DEPTH (feet)
FROM TO
DESCRIPTION AND REMARKS
(e g , relative %, grain size, sorting, angularity, bedding,
grain composition density, plasticity, shape, cementation,
consistancy, water bearing, odor, fracturing, minerology,
texture.degree of weathering, hardness, water quality, etc.)
iSL 2d. *7fcHA
2b S3v
3a
^ ncCfclvfcu 4£ ta
in 2W HAR1 ? 20^ J/J 97 vVATEH HIGH! S
Date^-lX— ^OlS- Water Level ff?iS
Method of Water Level Measurement fr '
Point to Which Water Level Measurement was Referenced
Height of Water Level reference point above ground surface.
_feet Flowing7 OYes []&No
If Flowing, Capped Pressure
Cz> (P Elevation
PSI
@P> feet Temperature_ .degrees DC QF
Well Log
Construction Information
DEPTH (feet) CASING DEPTH (feet) <ErSCREEN • PERFORATIONS • OPEN BOTTOM
FROM TO
CASING TYPE
AND
MATDtlALfGRADE
WALL
THICK fm)
NOMINAL
DIAM.
(Ul) FROM TO
SCREEN SLOT SEE
OR PERF SEE (ta)
SCRfcfcN DIAM
OR PERF LENGTH
(Ul)
SCREEN TYPE OR NUMBER PERF (per.Dund/uitMvjl)
<6$ MP ~2_" oto
Well Head Configuration
Casing Joint Tvpe: "f^sT**-^ u^cvA-S.£ Perforator!
Was a Surface Seal Installed? J^Ycs • No
Was a temporary surface casing used?
Depth of^ Surface^ ^e^_
es DNo Ifycs.deptn of casing ^.C?
Perforator Used._
feet_
Access Port Provided'' J3tYes ONo
Dnve Shoe' • YesiSwo
Surface Seal Matenal Placement Method: OK^Cj <^uhj cf J^P&£J d4 Qe^-Wj Lyfc^ f UMJ
_ feet diameter _ . inches
DEPTH (feet) SURFACE SEAL / INTERVAL SEAL / FILTER PACK / PACKER INFORMATION
FROM TO
SEAL MATERIAL, FILTER PACK
and PACKER TYPE and DESCRIPTION
Quantity of Matenal Used
(if applicable)
GROUT DENSITY
(lbsVgal., # bag mix, galJsack etc.)
/O- 2o S. ^ Ceo
"7U
3/1
Well Development and Well Yield Test Information
DATE METHOD YIELD
Units
Check One
GPM CFS
DRAWDOWh
(ft)
TIME
PUMPED
(hn & min)
Pump (Permanent)
Pump Description:_ Horsepower:, Pump Intake Depth:_ .feet
Approximate Maximum Pumping Rate:_ Well Disinfected upon Completion? DYes DNo
Comments Description of constmction activity, addidonal matenals used, problems encountered, extraordinary
Circumstances, abandonment procedures Use additional well data form for more space
2V£
.11 HUMMED
Well Driller Statement This well was drilled and constructed under my supervision, according to applicable rules and regulations,g ^ j A I'* t=
and this rcport is complete and correct to the best of my knowledge and belief. — — " ' S
Name ZIMMERMAN, MIKE WELL SERVICE
fj y (Pravn.hmnrCMpantlaa Mtf »rT]rp«>
Signature.
License No._ 527
Date_
(l-ja-.d Will Dri*'r)
ATK Launch Systems Inc Monitoring Well P-10 Report
Promontory Facility May 2012
APPENDIX B
GEOLOGIC LOG AND AS-BUILT COMPLETION DIAGRAM
EarthFax
Monitoring Well P-10
ATK Launch Systems
Promontory Facility
Promontory, Utah
Project UC1023
Date Started
Date Completed
Hole Diameter
Drilling Method
Sampling Method
March 5, 2012
March 27, 2012
6 3/8"
Cable Tool
Grab
Drilling Contractor
Logged By
Northing
Easting
Mike Zimmerman Well
KHB
N 504474.04
E 1747904.77
Depth
in
Feet
10-.
20-- 4518
30-
40-
50-
60-
70-
90-
Surf.
Elev.
4538.4'
4538
4528
4508
4498
4488
4478
- 4468
80-- 4458
4448
100--4438
110-
DESCRIPTION
Well:
Elev
P-10
: 4540.32' amsl
6" Steel
Well Construction
Information
SILTY CLAY. Moist. Tight. Approx 5%
Gravel, 25% Silt, 70% Clay. 2.5 Y 6/2 at
the surface to 10YR5/4 Light Yellowish
Brown at depth.
SANDY CLAY. Approximately 5% Gravel,
10% Silt, 25% Sand, 60% Clay. Gravel
comprised of sandstone and limestone
fragments. 10 YR 5/4.
fine to medium grained, SANDY GRAVEL.
With Minor Clay. Gravel is comprised of
limestone, dolomite. 10 YR 5/4. Light
Yellowish Brown.
SILTY SAND, with minor gravel. 10 YR 5/4
Light Yellowish Brown.
CLAYEY SILT. Low plasticity. Firm. No
HCL reaction. Yellowish Brown.
SILTY SAND AND GRAVEL. Gravel
comprised of limestone and some
quartzite. 10 YR 5/4.
SANDY CLAY. Sand is very fine grained.
Minor amount of silt. 10 YR 4/1 Yellow
Brown.
SILTY CLAY. With minor Gravel. Clay is
sticky. Firm. Gravel up to 1/4" comprises
less than 5% of sample. 10 YR 4/1.
f
-3/8" Bentonite
Chips
-2" SCH 40
PVC
20-40 Mesh
Silica Sand
0.01 Slot
SCH 40
PVC
Screen
PVC End
Cap
ATK Launch Systems Inc Monitoring Well P-10 Report
Promontory Facility May 2012
APPENDIX C
GROUNDWATER ANALYTICAL RESULT
988P LS333 GW
CERTIFICATE OF ANALYSIS
Listing of Sample Information and Testing Requested
Tuesday, May 01, 2012
TESTED FOR: ATK: DLV
Environmental Monitoring
Thiokol Corp, UT 84322
ANALYZED BY: ATK Launch Systems
Analytical Chemistry Laboratory
P.O. Box 707, M/S 245
Brigham City, UT 84302-0707
435-863-3732
435-863-8080
Contact Name: Paul Hancock
Project-
Sample Delivery Group:
Ground Water Testing - DLV
1203031
Page 1 of 5
Pnnted 05/01/12 15 32
Sample Delivery Group: 1203031
Sample No. Client No.
Test Requested Sample Description
Received Collect Date/Time
Matrix
1203031-01 P-10 03/27/12 3/27/2012 12 30 00
EPA 314 0
SW-846, 8260B (Water)
Perchlorate - lon Chromatography
Volatile Organic Analysis
Water
Water
Certified By:
W. Scott Fraser, Quality Assurance Officer
05/01/2012
Date
This certifies that the following data meets the requirements of the National Environmental Laboratory Accreditation
Program (NELAP) unless otherwise annotated
Page 2 of 5
Pnnted 05/01/12 15 32
Listing of Results by Sample
Sample Delivery Group: 1203031
Client Sample ID: P-10
Sample Description: ATK-DLV - P-10 Well
Laboratory Sample ID: 1203031-01
Date Sampled: 03/27/12 12 30
CAS Number Test Parameter Result Units MDL
Diluti
EQL Fac]
Test Method: EPA 314.0 Perchlorate - lon Chromatography
or Analyst Test Date
014797-73-0 PERCHLORATE ug/L
| Test Method: SW-846, S260B (Water) Volatile Organic Analysis
JMM 04/05/12
67-64-1 ACETONE
71-43-2 BENZENE
74- 97-5 BROMOCHLOROMETHANE
75- 27-4 BROMODICHLOROMETHANE
108-86-1 BROMOBENZENE
75-25-2 BROMOFORM
74- 83-9 BROMOMETHANE
78-93-3 2-BUTANONE
104-51-8 N-BUTYLBENZENE
135-98-8 SEC-BUTYLBENZENE
98-06-6 TERT-BUTYLBENZENE
75- 15-0 CARBON DISULFIDE
56-23-5 CARBON TETRACHLORIDE
108-90-7 CHLOROBENZENE
75-00-3 CHLOROETHANE
110-75-8 2-CHLOROETHYL VINYL ETHER
67-66-3 CHLOROFORM
74-87-3 CHLOROMETHANE
95- 49-8 2-CHLOROTOLUENE
106-43-4 4-CHLOROTOLUENE
124-48-1 DIBROMOCHLOROMETHANE
96- 12-8 1.2-DIBROMO-3-CHLOROPROPANE
74- 95-3 DIBROMOMETHANE
106-93-4 1,2-DIBROMOETHANE
95-50-1 1,2-DICHLOROBENZENE
541-73-1 1,3-DICHLOROBENZENE
106- 46-7 1,4-DICHLOROBENZENE
75- 71-8 DICHLORODIFLUOROMETHANE
75-34-3 1,1-DICHLOROETHANE
107- 06-2 1,2-DICHLOROETHANE
75-35-4 1,1-DICHLOROETHENE
156-59-4 CIS-1,2-DICHLOROETHENE
156-60-5 TRANS-1,2-DICHLOROETHENE
78-87-5 1,2-DICHLOROPROPANE
142-28-9 1,3-DICHLOROPROPANE
563-58-6 1,1-DICHLOROPROPENE
10061-01-5 CIS-1,3-DICHLOROPROPENE
10061-02-6 TRANS-1,3-DICHLOROPROPENE
590- 20-7 2,2-DICHLOROPROPANE
100-41-4 ETHYLBENZENE
591- 78-6 2-HEXANONE
87-68-3 HEXACHLOROBUTADIENE
98- 82-8 ISOPROPYLBENZENE
99- 87-6 4-ISOPROPYLTOLUENE
73 1
56 J
U
U
U
U
34 J
13 1
U
U
U
U
U
U
U
U
55J
38 J
U
U
U
U
U
U
U
U
U
U
U
U
68 J
u
u
u
u
u
u
u
u
u
u
u
u
u
ug/L
ug/L
ug/L
ug/L
ug/L
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ug/L
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ug/L
ug/L
ug/L
ug/L
ug/L
ug/L
ug/L
ug/L
ug/L
ug/L
ug/L
ug/L
ug/L
5
02
03
02
04
04
06
1 1
03
04
04
0 1
0 3
02
04
1 7
0 3
08
02
0 2
02
04
0 3
02
59
56
59
07
0 5
0 3
02
02
03
02
02
02
04
04
0 9
02
07
09
06
02
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
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10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
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PCI
PCI
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PCI
PCI
PCI
PCI
PCI
PCI
PCI
PCI
PCI
PCI
PCI
PCI
PCI
PCI
PCI
PCI
PCI
PCI
PCI
PCI
PCI
PCI
PCI
PCI
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PCI
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Listing of Results by Sample
Sample Delivery Group: 1203031
Client Sample ID: P-10
Sample Description: ATK-DLV - P-10 Well
Laboratory Sample ID: 1203031-01
Date Sampled: 03/27/12 12 30
CAS Number
I Test Method:
Test Parameter Result Units MDL
Dilution
EQL Factor Analyst Test Date
SW-846, 8260B (Water) Volatile Organic Analysis
75-09-2 METHYLENE CHLORIDE
108-10-1 4-METHYL-2-PENTANONE
91-20-3 NAPHTHALENE
103-65-1 N-PROPYLBENZENE
100-42-5 STYRENE
630-20-6 1,1,1,2-TETRACHLOROETHANE
79-34-5 1,1,2,2-TETRACHLOROETHANE
127-18-4 TETRACHLOROETHENE
108-88-3 TOLUENE
87-61-6 1,2,3-TRICHLOROBENZENE
120-82-1 1,2,4-TRICHLOROBENZENE
71-55-6 1,1,1-TRICHLOROETHANE
79-00-5 1,1,2-TRICHLOROETHANE
79-01-6 TRICHLOROETHENE
75-69-4 TRICHLOROFLUOROMETHANE
96-18-4 1,2,3-TRICHLOROPROPANE
95-63-6 1,2,4-TRIMETHYLBENZENE
108-67-8 1,3,5-TRIMETHYLBENZENE
108-05-4 VINYL ACETATE
75-01-4 VINYL CHLORIDE
1330-20-7 m,p-XYLENE
95^17-6 O-XYLENE
460-00-4 BROMOFLUOROBENZENE
1868-53-7 DIBROMOFLUOROMETHANE
17060-07-0 1.2-DICHLOROETHANE-D4
2037-26-5 TOLUENE-D8
U
U
U
U
U
U
U
U
57 J
U
U
U
U
95 J
U
U
U
U
U
U
11 7
U
100
100
106
94 8
ug/L
ug/L
ug/L
ug/L
ug/L
ug/L
ug/L
ug/L
ug/L
ug/L
ug/L
ug/L
ug/L
ug/L
ug/L
ug/L
ug/L
ug/L
ug/L
ug/L
ug/L
ug/L
%
%
%
%
08
05
4
05
0 3
0 3
09
04
05
02
44
02
03
07
03
03
02
0 3
20
03
06
03
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
50
10
10
10
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Data Reporting Qualifiers
U Indicates that the analyte concentration is less than the MDL.
B This flag is used when an analyte is found in the blank as well as the sample.
Indicates an extimated value. This flag is used either when estimating a concentration
for tentatively identified compounds or when the data indicated the presence of a
compound that meets the identification criteria but the result is less than the
EQL (e.g. 3 J with an EQL of 10).
MDL Method Detection Limit. The minimum concentration of a substance that can be
confidently measured and reported The laboratory has demonstrated that the
MDL can be achieved in a laboratory reagent blank, but does not guarantee it
can be achieved in all sample
matrices.
EQL Estimated Quantitation Limit The EQL generally is 5 to 10 times the MDL. For
many analytes the EQL is selected as the value of the lowest standard in the
calibration curve.
Dilution Dilution Factor The prepared sample was diluted by this factor because the
Factor sample was too concentrated or due to other interferences in the sample
matrix.
Any dilution factor causes a corresponding increase in the MDL and EQL.
Page 5 of 5
Pnnted 05/01/12 15 32
ATK Space Systems Group
Environmental Laboratory
Client Name
Sample Receipt Checklist
Carrier
SDG No
Carrier Number
Hand delivered, no cooler \yftand delivered, sample(s) taken out at receiving counter
Date 3/27 j 12,
initials •/JSP
Cooler Information:
Cooler Number/ID.
Condition of Shipping Container
Cooler Sealed (taped)
Custody Seals Present
Coolant tyyiiygD
State of Coolant iQllffiigt^
Thermometer ID "
Packing Description
:Good
,Yes
jYes
i Intact
;lce
Frozen
. Fair ^rNot Applicable
/fto vftfpt Applicable
ANOI Applicable
jDamaged (explain).
INo
11Broken
•iBIuelce 'iNone
11 Partially Frozen
Seal Number .
aher
'1 Melted
Reading \0 °C CF • Corrected Temp 10 °C Temp Blank Included :]Yes
Notes
t/fes Chain-Of-Custody Information.
COC Present v- i OOAf
COC Numberts), t> I Ozft'i
COC signed (relinquished and received) trfes
COC or LWI agrees wtth sample labels' Pfes
DNo
UNO
LINO
Other.
UNot Applicable
D Not Applicable
Sample Information: .
Sample, included In cooler: jf^fj] _ j jQ^^ *
Custody Seals Present
Sample containers intact
Samples in proper containers
Sufficient sample volume
All samples received In hold time
DYes
;jlntact
fes
^Yes
ydYes
Water - VOAIs have zero headspace
'tJPre-preserved with HCI
Notes
Other
•Broken Seal Number(s) _
•No Notes.
•No
• No
•No
•No
•Pre-preserved with Na2S20i
•Not Applicable
•Non-Preserved.
HCL =
Water - pH acceptable upon receipt nYes ^Adjusted (see comments below) yioi Applicable
HNOs = H,SO, = NaOH = ZnAC /NaOH =
Water - pH adjusted (mfg & Lot No)
HNOj H,S04 NaOH ZnAC
NajSOjOj Other
Notes
HCI
SOP-102 Form A
ENVIRONMENTAL LAB WORK REQUEST
1203031
TO ATK LAUNCH SYSTEMS INC. ENVIRONMENTAL LABORATORY LWR No. E13347
Login No.
WOM' EXTENSION
2430
COST CENTER-
8200
WORK ORDER DATE *
988P/LS333^37/5://Z~
ORGANIZATION
ENVIRONMENTAL SERVICES
MAIL STOP REPORT RESULTS TO
301 BLAIR PALMER
SAMPLE INFORMATION
SAMPLE DATE TYPE LOCATION TIME TEST REMARKS
X V-/0
u T-/Q
CHAIN OF CUSTODY
RELINQUISHED BY DATE TIME RECEIVED BY DATE TIME
27/S//Z.
FOR LABORATORY USE ONLY
DATE COMPLETED DATE REPORTED SIGNATURE