DERR-2024-012894

Cost Code: .1§_1_ METHOD BTEX Lab lt 9312705
Send Report To:
BIG 'O' TIRE B-11
D.E.R .R.I PATRI CK SHEEHAN
1950 W NORTH TEMPLE
Utah Division of Laboratory Services
46 North Medical Drive
Salt Lake City, UT 84113
SALT LAKE CITY, UT 84116
Date/Time Collected: 93/12/11 Sample Matrix: _W~a~t~e~r _______ _
Collected By: PATRICK SHEEHAN Sampling Site:
Description of Sampling Point: =B=I~G'--'~O~'---=T~I~R=E,c___,B~-~l=l==-------------------
Analyst:
Amt. Purged:
Analysis Certified By:
Date Received: 93/12/13 Date Analyzed:
(MDL based on 5ml purge vol.) Dilution:
Compound MDL/Results
Benzene 0.5
Toluene 0.5
Ethylbenzene 0.5
Xylenes 0.5
U-Analyzed for but not detected.
J-An estimated value or a value
less than the detection limit
but greater than zero.
B-Found in the blank.
ug/1
u
6.9
1
7.1
Date: ~a..nl\, l°t'l4
/
Cost Code: 2§1__
Send Report To:
BIG 'O' TIRE B-11
D.E.R.R./PATRICK SHEEHAN
1950 W NORTH TEMPLE
SALT LAKE CITY, UT 84116
METHOD TPH Lab # 9312705
Total Petroleum Hydrocarbon
Utah Division of Laboratory Services
46 North Medical Drive
Salt Lake City, UT 84113
Date/Time Collected: 93/12/11 Sample Matrix: ~W=a=t=e=r _______ _
Collected By: PATRICK SHEEHAN Sampling Site:
Description of Srunpling Point: =B~I~G,_'~O,.__'_T=I~R=E----=B~-~1~1=--------------------+--
Analyst: ____ iQ__ .-c---------Date-Received:-93/12/13 _____ Date-Analyzed:--,~-ri-1 ----
--------------------========-=========-==-=-==================================== ========
Compound MDL/Results mg/1
TPH 0 .3 0.6
U-Analyzed for but not detected.
Analysis Certified By: 66 Date:
Cost Code: .1g1_ METHOD BTEX Lab # 9312704
Send Report To:
BIG 'O' TIRE B5
D.E.R.R./PATRICK SHEEHAN
1950 W NORTH TEMPLE
Utah Division of Laboratory Services
46 North Medical Drive
Salt Lake City, UT 84113
SALT LAKE CITY, UT 84116
Date/Time Collected: 93/12/11 Sample Matrix: ~W~a~t~e~r _______ _
Collected By: PATRICK SHEEHAN Sampling Site:
Description of Sampling Point: =B=I~G_'~O_'-=T=I=R=E'-______,B~5'--------------------
Analyst: ::5·. 5:J.k)-\::\:.t)
Amt. Purged: \~ u.hi >
Analysis Certified By:
Date Received: 93/12/13 Date Analyzed:
(MDL based on 5ml purge vol.) Dilution:
Compound MDL/Results
Benzene JSO
Toluene ~50
Ethylbenzene .Q.50
Xylenes J-.50
U-Analyzed for but not detected.
J-An estimated value or a value
less than the detection limit
but greater than zero.
B-Found in the blank .
ug/1
480
2400
610
4100
Date:
Cost Code: l.§l_
Send Report To:
BIG 'O' TIRE B5
D.E.R.R./PATRICK SHEEHAN
1950 W NORTH TEMPLE
SALT LAKE CITY, UT 84116
METHOD TPH Lab It 9312704
Total Petrolewn Hydrocarbon
Utah Division of Laboratory Services
46 North Medical Drive
Salt Lake City, UT 84113
Date/Time Collected: 93/12/11 Sample Matrix: ~W~a~t~e~r'---------
Collected By: PATRICK SHEEHAN Sampling Site:
Description of Sampling Point: ~B~I~G'--'~O~'____,T~I~R~E"------'B~5"'--------------------,,--
=::~;:~;== R:L ==========;:~:=;:::~~:~;=;;;~;;~;=====;:~:==::~;::~;==73= ,f-= q======
Compound MDL/Results mg/1
TPH 0.3 23
U-Analyzed for but not detected.
I<. L
Analysis Certified By: 6G Date: J)-ec,. '2-1-1 I q '=f.3
Cost Code: .1§l__ METHOD BTEX Lab It 9312702
Send Report To:
BIG 'O' TIRE B5@9.5'
D.E.R.R./PATRICK SHEEHAN
1950 W NORTH TEMPLE
Utah Division of Laboratory Services
46 North Medical Drive
Salt Lake City, UT 84113
SALT LAKE CITY, UT 84116
Date/Time Collected: 93/12/12
Collected By: PATRICK SHEEHAN
Description of Sampling Point:
Sample Matrix: =S~o=i=l,__ _______ _
Sampling Site:
BIG 'O' TIRE B5@9.5'
Analyst: Date Received: 93/12/13 Date Analyzed:
Amt. Purged: L\---1.1.l. Dilution:
-----------------------------------------------------------==========----------==========
Analysis Certified By:
Compound MDL/Results::m,g/~
Benzene
Toluene
Ethylbenzene
Xylenes
6.2
6.2
6.2
.6. 2
U-Analyzed for but not detected.
J-An estimated value or a value
less than the detection limit
but greater than zero.
B-Found in the blank.
11
100
24
180
Date: ~Q...b iii I 9 9 4
Cost Code: l.§1_
Send Report To:
BIG 'O' TIRE B5@9.5'
D.E.R.R./PATRICK SHEEHAN
1950 W NORTH TEMPLE
SALT LAKE CITY, UT 84116
METHOD TPH Lab # 9312702
Total Petrolewn Hydrocarbon
Utah Division of Laboratory Services
46 North Medical Drive
Salt Lake City, UT 84113
Date/Time Collected: 93/12/12 / Sample Matrix: ~S=o=i=l _______ _
Collected By: PATRICK SHEEHAN yr-Sampling Site:
Description of Sampling Point: =B=I~G_' o~• _T~I=R=E~· -~8~5~@~9~·~5_' _______________ _
Analyst;====R==i:-=========Date=Received:=93/12/13=====Date=Analyzed:=== /~7,==1,3==
===================·========================================================= '==t;:======
Analysis Certified By:
Compound MDL/Results mg/i<a--
TPH 386
U-Analyzed for but not detected.
.5c.,
(<. L
Date: J)ec.. 22, / 9 '13
UTAH DEPARTMENT OF
ENVIRONMENTAL QUALITY
DEC 2 8 1993
DIV. OF ENVIRONMENTAL
RESPONSE AND REMEDIATI ON
Cost Code: l.Q.L METHOD BTEX Lab i 9312703
Send Report To:
BIG 'O' TIRE 811@ 9'
D.E.R.R./PATRICK SHEEHAN
1950 W NORTH TEMPLE
Utah Division of Laboratory Services
46 North Medical Drive
Salt Lake City, UT 84113
SALT LAKE CITY, UT 84116
Date/Time Collected: 93/12/12 Sample Matrix: =S~o=i=l _______ _
Collected By: PATRICK SHEEHAN Sampling Site:
Description of Sampling Point: =B~I=G'-•~o~•---=T~I~R=E=--------=B=l=l~@,.__9=-----'-----------------
Analyst:
Amt. Purged:
" .-
\CX) •• ,u,L
Analysis Certified By:
Date Received: 93/12/13 Date Analyzed:
Dilution:
Compound MDL/Results mgL~
Benzene
Toluene
Ethylbenzene
Xylenes
o.~5
o .0~5
0 .0~5
O .0~5
U-Analyzed for but not detected.
J-An estimated value or a value
less than the detection limit
but greater than zero.
B-Found in the blank.
u
u
u
u
Date:
Cost Code: .l§.1..__
Send Report To:
BIG 'O' TIRE B11@ 9'
D.E.R.R./PATRICK SHEEHAN
1950 W NORTH TEMPLE
SALT LAKE CITY, UT 84116
METHOD TPH Lab # 9312703
Total Petrolewn Hydrocarbon
Utah Division of Laboratory Services
46 North Medical Drive
Salt Lake City, UT 84113
Date/Time Collected: 93/12/12 Sample Matrix: =S~o=i=l~--------
Collected By: PATRICK SHEEHAN Sampling Site:
Description of Sampling Point: =B=I~G_'~O~'---=T~I~R=E=----=B=l=l~@,.__9=-'-----------------,-
~=:!~:~::::::€:=~=:::::::::~:~::::~:~::=::~!:!!:!!:::::~:~::~:=~~==~:::::~:-%~1=~2:
Compound MDL/Results mglk;(
TPH u
U-Analyzed for but not detected.
R. L
'
Analysis Certified By: Date:
BTEX ANALYSIS
( SOIL)
Send Report To: jPLKASE PRINT)
Name or Agency: --"'/I_E=---....,__l!...:....;_f<_,__ ____________ _ LAB NO. _______ _
Address /'{so i,v, "-'~r+I... r<-M/(.:: l City,State,Zip:_~5~l~lT,,~v.~·~C: ___________ _
Phone Number: s'U,'-4 {OD
STATE OF UTAH DEPT.OF HEALTH
DIVISION OF LABORATORY SERVICES
46 North MEDCIAL DRIVE
Salt Lake City,Ut. 84113
[phone]
COST CODE: _____ _
Account I ______ _
Field t t) e 7q I
DATE COLLECTED pfr/23 Time Collected(24hr.Clock) ____ _
Col lee ted By: fit±,~ 1'--C r L c__-. I, e-c-1 Sampling site: __ B.:.::..:.:'1~0:..___;_r_;_,_;_/_<-_______ _
========-=====================================================-=----=---=----------------
Analyst: Date Rec'd _____ _ Date Analyzed: ____ _
Arnt.Purged. _____ (MDL based on 5ml purge vol.) Dilution: ______ _
==================================-=============================---------=---------------
Compound
Benzene
J.!.91~
POL/RESULTS
4.0U
6.0U Toluene
Ethylbenzene
Xylenes
11. U
7.ou
U -Analyzed for but not detected.
J -An estimated value for a compound
at a value less than the PQL, but
greater than zero.
B -Found in the blank.
-----------------------------------------------------=-----------------------------------
Analysis Certified By: ______________ _ Date: __________ _
LAB USE ONLY: l-2-3-4-5-6-7-8-9-10-ll-12-13-14-15-16-17-18-19-20-21-22-23-24-25-26-27
28-29-30-31-32-33-34-35-36-37-38-39-40-41-42-43-44-45-46-47-48-49-50-51-52~53-54-55-56
57-58-59-60-61-62-63-64-65-66-67-68-69-70-71-72-73-74-75-76-77-78-79-80-81-82-83-84-85
86-87-88-89-90-91-92-93-94-95-96-97-98-99-100
BO'ITLES RE<1]IRED: (2) 40ml GLASS VIALS
LID MUST BE LINED WITH TEFLON
IF YOU WANT TPH(TOTAL PETROLEUM HYDROCARBONS)
YOU WILL NEED 1 MORE VIAL. SAME AS ABOVE.
CHAIN .OF CUSTODY
BTEX ANALYSIS
(SOIL)
Send Report To: (PLEASE PRINT)
Name or l\gency :~/J_E~/!_.J!. ____________ _ LAB NO. _______ _
Address /<l~o w, 1v_~.,..,e&
I City,State,Zip:~~~i~c'f-u_r~· ___________ _
Phone Number: r:n. -'-{ I 6 °
STATE OF UTAH DEPT.OF HEALTH
DIVISION OF LABORATORY SERVICES
46 North MEDCIAL DRIVE
Salt Lake City,Ut. 84113
[phone]
COST CODE: _____ _
Account I ______ _
Field I /!;// e_ 1 J DATE COLLECTED /cJ-/4/4,; Time Collected(24hr.Clock) ____ _
Collected By: /l,:;--!--v-1 c.-k. S/1, e...~ &---J Sampling Site: _..::,g,::...:'-+1-=()_17__,_1-=-/'<----,------
===========================================================================--------------
Analyst: _______________ Date Rec'd _____ _ Date Analyzed: ____ _
Amt.Purged (MDL based on 5ml purge vol.) Dilution: ______ _
================================================================================------===
Compound
Benzene
Toluene
Ethylbenzene
Xylenes
yg/L
POL/RESULTS
4.0U
6,0U
11. U
7.ou
U -Analyzed for but not detected.
J -An estimated value for a compound
at a value less than the PQL, but
greater than zero.
B -Found in the blank.
----------------==-----------------------------=-===============================---------
Analysis Certified By: _____________ _ Date: __________ _
LAB USE ONLY: l-2-3-4-5-6-7-8-9-10-ll-12-13-14 -15-16-17-18-19-20-21-22-23-24-25-26-27
28-29-30-31-32-33-34-35-36-37-38-39-40-41-42-43-44-45-46-47-48-49-50-51-52~53-54-55-56
57-58-59-60-61-62-63-64-65-66-67-68-69-70-71-72-73-74-75-76-77-78-79-80-81-82-83-84-85
86-87-88-89-90-91-92-93-94-95-96-97-98-99-100
BOTTLES REQUIRED: (2) 40ml GLASS VIALS
LID MUST BE LINED WITH TEFLON
IF YOU WANT TPH(TOTAL PETROLEUM HYDROCARBONS)
YOU WILL NEED 1 MORE VIAL . SAME AS ABOVE.
',,,..c.--· .--., ••
BTEX ANALYSIS
·(WATER)
Send Report To: (PLEASE PRINT)
Name or Agency: _,_/Ji_,,'€"--'f-c...:-"-1._::,__ __ -..,-_______ _
Address /1~0 1,......, Al .. 1~.-1/.e
City,State,Zip: "SU:,, ur' </.1/t((,,,
Phone Number: S-3(, -lf(oo
~91(112704
LAB NO. _______ _
STATE OF UTAH DEPT.OF HEALTH
DIVISION OF LABORATORY SERVICES
46 North MEDCIAL DRIVE
Salt Lake City,Ut. 84113
[phone]
COST CODE: ____ _
Account# ______ _
Field i Ii<~ DATE COLLECTED J 1/il/43 Time Collected ( 24hr. Clock) ,,,
Collected By: @+nd J/, .. c."-f.>fd Sampling Site: /,j O T(re . /. J....f,~&.._ /) 1
SAMPLE USED FOR: DRINKING: __ ENVIRONMENTAL:)(" OTHER: _________ _
==============-====--------------------------------------------------------------.-------
Analyst: Date Rec'd _____ _ Date Analyzed: ____ _
Amt.Purged ______ (MDL based on 5ml purge vol.) Dilution: _______ _
===~=========================================-------===----------------------------------
Compound
Benzene
Tolu~ne
Ethylbenzene
Xylenes
----=====· ===-=========================================---=-==---------------------------
BOTTLES REQUIRED
TWO 40ml glass septum vials.
IF YOU ALSO WANT TPH(total petroleum hydrocarbons) YOU WILL NEED AT LEAST ONE EXTRA
VIAL, ALSO WRITE TPH ON THE LINE BESIDE OTHER
-----------------------------------------------------------------------------------------
TOTAL COST: $75.00
--------------------------------===--------==--------==--------==---------------======---
INSTRUCTIOOS FOR COLLECTIOO OF SAMPLES
l.When sampling from a water tap open the tap and allow the system to flush until water
temperature has stabilized. (usually 10 minutes)
2.fill vials, being careful not to wash out the preservative or aerate the sample.
no air bubbles should pass through the sample as the bottle is filled, or be trapped
Jn the sample when the vial is sealed. fill to the very top of the vial
3.The pH of the sample must be adjusted to a pH of <2 by carefully adding two drops of
6n HCl acid from the vial, provided with your sampling kit. Highly buffered
water may require more acid. sample received with a pH )2 will be discarded
4.following the addition of the acid the vial must be sealed with the teflon face down
shaken vigorously for 1 minute, and store at 4°C until received by the LAB
"DO NOT USE DRY ICE" when shipping. •
5.Sample must be delivered to the lab as soon as possible. all sampling should be
scheduled with the lab prior to collection. FILL OUT ENTIRE FORM
BTEX ANALYSIS
(WATER)
Send Report To: )PLE.ASEf"R_J;NT) L / /(r_
Name or Agency: ~ ,LI i 7 /Z-n0Y0, ,-+r~,2~ £e::-
Address /0;....:::,')? k,/, /141 ,-p ~le
City,State,Zip~ ;!!=1, ;;!;:1= fj/=uQ ,'JO 6:'(I/~
Phone Nwnber: ..,5: -/
LAB NO. _______ _
STATE OF UTAH DEPT.OF HEALTH
DIVISION OF LABORATORY SERVICES
46 North MEDCIAL DRIVE
Salt Lake City,Ut. 84113
[phone]
COST CODE: ____ _
Account i ______ _
Field i .,8 ~/( ·
Collected By: &.i-:
DATE COLLECTED /_2_/J//tjTime Collect?;,d(24hr.Clock) ______ _
.;5,t:f e ~A-., Sampling Site : Jl>:J§ tJ2 7) IX:'.:....
SAMPLE USED FOR: DRINKING: __ _ ENVIRONMENTAL:L OTHER: _________ _
===-===============-------------------------------------------==============-------------
.Analyst: Date Rec'd, _____ _ Date Analyzed: ____ _
Amt.Purged _____ (MDL based on 5ml purge vol.) Dilution: _______ _
==============--=-==-------============================----------------------------------
Compound
Benzene
Toluene
Ethylbenzene
Xylenes
OTHER : µ fl-/ l ../-J. ,:yk_.).) .JL • -------=-· ========================----------====--=====----------------------------------
BOTILES REQUIRED
TWO 40ml glass septwn vials.
IF YOU ALSO WANT TPH(total petrolewn hydrocarbons) YOU WILL NEED AT LEAST ONE EXTRA
VIAL, ALSO WRITE TPH ON THE LINE BESIDE OTHER
-----------------------------------------------------------------------------------------
TOTAL COST: $75.00
-======--====-======-------------------------==========-======-======--------------------
INSTRUCTIOOS FOR COLLECTIOO OF SAMPLES
l.When sampling from a water tap open the tap and allow the system to flush until water
temperature has stabilized. (usually 10 minutes)
2.Fill vials, being careful not to wash out the preservative or aerate the sample.
no air bubbles should pass through the sample as the bottle is filled, or be trapped
"in the sample when the vial is sealed. fill to the very top of the vial
3~The pH of the sample must be adjusted to a pH of <2 by carefully adding two drops of
6n HCl acid from the vial, provided with your sampling kit. Highly buffered
water may require more acid. sample received with a pH >2 will be discarded
4.Following the addition of the acid the vial must be sealed with the teflon face down
shaken vigorously for 1 minute, and store at 4°C until received by the LAB
"DO NOT USE DRY ICE" when shipping.
5.Sample must be delivered to the lab as soon as possible. all sampling should be
scheduled with the lab prior to collection. FILL OUT ENTIRE FORM
~ .. ~-··---~-~
.CHAIN OF CUSTODY
LM.:..--...: . ....._. ___ ,_ •. ~,--·---->-.. _____ -·-
Send Report To:1PLEASE PRINT)
BTEX ANALYSIS
(SOIL) L.i i 2 7 0 2
Name or Agency:_/1.c_E~/!._R..~------------LAB NO. _______ _
Address /'{s-o w, ''-hr+/... r<...,M//..:!
I City,State,Zip:_~s='='T·'i~v.~-~r: ___________ _
Phone Nwnber: S'U,·-4 for,
STATE OF UTAH DEPT.OF HEALTH
DIVISION OF LABORATORY SERVICES
46 North MEDCIAL DRIVE
Salt Lake City,Ut. 84113
[phone]
COST CODE: ____ _
Account f ______ _
Field t ,!) e ~s-1
DATE COLLECTED /;;-fr/23 Time Collected(24hr.Clock) ____ _
Collected By: ~r,c..,c_ 1Lc......._he-r,1 Sampling Site:_-'B='Jf---'-o_-_l'--1'--1'_<-_______ _
=========================================================================================
Analyst: ________________ Date Rec'd. ______ Date Analyzed: ____ _
Amt.Purged (MDL based on 5ml purge vol.) Dilution: ______ _
Compound
Benzene
Toluene
Ethylbenzene
Xylenes
yg/~
POL/RESULTS
4.0U
6.0U
11. U
7.ou
U -Analyzed for but not detected.
J -An estimated value for a compound
at a value less than the PQL, but
greater than zero.
B -Found in the blank.
====================================================================================-=-=-
Analysis Certified By: ______________ _ Date: __________ _
LAB USE ONLY: 1-2-3-4-5-6-7-8-9-10-ll-12-13-14-15-16-17-18-19-20-21-22-23-24-25-26-27
28-29-30-31-32-33-34-35-36-37-38-39-40-41-42-43-44-45-46-47-48-49-50-51-52~53-54-55-56
57-58-59-60-61-62-63-64-65-66-67-68·69-70-71-72-73-74-75-76-77-78-79-80-81-82-83-84-85
86-87-88-89-90-91-92-93-94-95-96-97-98-99-100
BC11TLES RE~IRED: (2) 40ml GLASS VIALS
LID MUST BE LINED WITH TEFLON
IF YOU WA.NT TPH(TOTAL PETROLEUM HYDROCARBONS)
YOU WILL NEED 1 MORE VIAL. SAME AS ABOVE.
--··-·· ... ·····---~--·-
BTEX ANALYSIS
(SOIL)
\ Send Report To: (PLEASE PBIRT)
Name or Agency :__,_/J_~_R~-"'""'/. ___________ _
i: f' ; ·; 'i:· u ; 7-7 0 3
LAB NO. _______ _
Address lt::/~tJ w, AJrt.,.,,l'if
City,State,Zip:_~~-~-c~u_r~· __ ' _________ _
Phone Nwnber: [:J, -Lr ( i, t)
STATE OF UTAH DEPT.OF HEALTH
DIVISION OF LABORATORY SERVICES
46 North MEDCIAL DRIVE
Salt Lake City,Ut. 84113
[phone]
COST CODE: ____ _
Account t ______ _
Field I /3/ / e_ 1 1
DATE COLLECTED /.}-fefa,; Time Collected( 24hr. Clock) ____ _
Collected By: /Jn--f,,.1c.-k -S/1.e..%&-,J Sampling Site:_~LJ.:::!~::i-1~0""-..:..r;.L./!..../l<--=--------
==============================================================================-----------
Analyst: Date Rec'd _____ _ Date Analyzed: ____ _
Amt.Purged _____ (MDL based on 5ml purge vol.) Dilution: ______ _
=============================================================================------====-=
Compound
Benzene
Toluene
yg/L
POL/RESULTS
4.0U
6.0U
Ethylbenzene
Xylenes
11. U
7.ou
U -Analyzed for but not detected.
J -An estimated value for a compound
at a value less than the POL, but
greater than zero.
B -Found in the blank.
=============================================================================------======
Analysis Certified By: _____________ _ Date: __________ _
LAB USE ONLY: l-2-3-4-5-6-7-8-9-10-ll-12-13-14-15-16-17-18-19-20-21-22-23-24-25-26-27
28-29-30-31-32-33-34-35-36-37-38-39-40-41-42-43-44-45-46-47-48-49-50-51-52~53-54-55-56
57-58-59-60-61-62-63-64-65-66-67-68-69-70-71-72-73-74-75-76-77-78-79-80-81-82-83-84-85
86-87-88-89-90-91-92-93-94-95-96-97-98-99-100
BO'l'TLES REQUIRED: (2) 40ml GLASS VIALS
LID MUST BE LINED WITH TEFLON
IF YOU WANT TPH(TOTAL PETROLEUM HYDROCARBONS)
YOU WILL NEED 1 MORE VIAL. SAME AS ABOVE.
tHA1t[cicUS100Y
~-.....--·
BTEX ANALYSIS
·(WATER)
Send Report To : (PLEASE PRINT)
Name or Agency: _.,_/Z....,,r"-'f-t..:_='--,"'-------------
Address h~o 1,...., AJ . J<...,,../1<
C.ity,State,Zip: -SLc., urr 11/tffo
Phone Number: S-3L -
1
<./(1JD
LAB NO. _______ _
STATE OF UTAH DEPT.OF HEALTH
DIVISION OF LABORATORY SERVICES
46 North MEDCIAL DRIVE
Salt Lake City,Ut. 84113
[phone]
COST CODE: ____ _
Account i ______ _
Field I /JS~ DATE COLLECTED J,/u/23 Time Collected(24hr.Clock) -r.,
Collected By: {:_14-+r,d '51--e.y,eJ Sampling Site: /,1 0 7L,,-e, £. J...ft~&._ ?I 1
SAMPLE USED FOR: DRINKING: __ ENVIRONMENTAL:)(" OTHER: _________ _
=================================------------------------------------------------.-------
Analyst: Date Rec'd _____ _ Date Analyzed: ____ _
Amt.Purged ______ (MDL based on 5ml purge vol.) Dilution: _______ _
======================================================-----==-=--------------------------
Compound
Benzene
Toluene
Ethylbenzene
Xylenes
=========· =================================================================--========----
BOTILES REQUIRED
TWO 40ml glass septum vials.
IF YOU ALSO WANT TPH(total petroleum hydrocarbons) YOU WILL NEED AT LEAST ONE EXTRA
VIAL, ALSO WRITE TPH ON THE LINE BESIDE OTHER
TOTAL COST: $75.00
-----------------------------------------------------------------------------------------
INSTRUCTIOOS FOR COLLECTIOO OF SAMPLES
I.When sampling from a water tap open the tap and allow the system to flush until water
temperature has stabilized. (usually 10 minutes)
2.Fill vials, being careful not to wash out the preservative or aerate the sample.
no air bubbles should pass through the sample as the bottle is filled, or be trapped
in the sample when the vial is sealed. fill to the very top of the vial
3 '.'The pH of the sample must be adjusted to a pH of < 2 by carefully adding two drops of
6n HCl ac i d from the vial, provided with your sampling kit . Highly buffered
water may requi r e more acid. sample r e c eived with a pH >2 will be discarded
4.Following the addition of the acid the vial must be sealed with the teflon face down
shaken vigorously for l minute, and store at 4°C until received by the LAB
"DO NOT USE DRY ICE" when shipping . ✓-
5. Sample must be delivered to the lab as soon as possible . all sampling should be
scheduled with the lab prior to collection. FILL OUT ENTIRE FORM
BTEX ANALYSIS
(WATER)
Send Report To: ~PLEASE,rR_JNT) ,(}
Name o r Agency: /.J ,V, a L/f?-;-11/;Y"&, ,-.rJ✓ fL'2~ ~-
Address /0,_::,")2 hL. M, ,--1-1, ~le
C.i:ty,State,Zip~ ~]-~f: ~ fj"';f?f°D f5:'(//~
Phone Number: ..,5:, _ ~-L._
LAB NO. _______ _
STATE OF UTAH DEPT.OF HEALTH
DIVISION OF LABORATORY SERVICES
46 North MEDCIAL DRIVE
Salt Lake City,Ut. 84113
[phone] .
COST CODE: ____ _
Account i ______ _
Field i A-If ·
Collected By: RJ--DATE COLLECTED /.2-//1(2_3Time Collect_;d(24hr.Clock) ____ _
..,Sq'ee---4'£&, Sampling Site: Jb:.}j tf2 n·l"C.:__
SAMPLE USED FOR: DRINKING: __ _ • ENVIRONMENTAL:L OTHER: _________ _
--==-===-=-----------------------------------------------------------------------~-------
Analyst: Date Rec'd _____ _ Date Analyzed: ____ _
Amt.Purged, _____ (MDL based on 5ml purge vol.) Dilution: _______ _
===========================================================================--------------
Compound
Benzene
Toluene
Etbylbenzene
Xylenes
OTHER: µ A-/ /_,../-J. 14'/.L.JJ ..JL • =========· ============================================---==------------------------------
BOTTLES REQUIRED
TWO 40ml glass septum vials.
IF YOU ALSO WANT TPH(total petroleum hydrocarbons) YOU WILL NEED AT LEAST ONE EXTRA
VIAL, ALSO WRITE TPH ON THE LINE BESIDE OTHER
TOTAL COST: $75.00
====================================================================================---==
INSTRUCTIOOS FOR COLLECTIOO OF SAMPLES
1.When sampling from a water tap open the tap and allow the system to flush until water
temperature has stabilized. (usually 10 minutes)
2.Fill vials, being careful not to wash out the preservative or aerate the sample.
no air bubbles should pass through the sample as the bottle is filled, or be trapped
in the sample when the vial is sealed. fill to the very top of the vial
3 ·~ The pH of the sample must be adjusted to a pH of <2 by carefully adding two drops of
6n HCl acid from the vial, provided with your sampling kit. Highly buffered
water may require more acid . sample r ec eived with a pH >2 will be disca r ded
4.Following the addition of the acid the vial must be sealed with the teflon face down
shaken vigorously for 1 minute, and store at 4°C until received by the LAB
"DO NOT USE DRY ICE" when shipping. -
5 .Sample must be delivered to the lab as soon as possible. all sampling should be
scheduled with the lab prior to collection. FILL OUT ENTIRE FORM
I h 11 ',j I •·.,I I" ,, llt ,,· •I '\• II,, ,I
~/'JI (hl :or~ ink uni)')
proj # 'flP proj name t,,, () -r, r' ~
,~,~.L I
samplen 5/ ... J. ,t--1\J
bureau/company /)If: M, / Lt./. 5{
address /'1~" t-J , Alor+1... ~,..Ji, phone S-3l-'II~ 'l> ,
cty/st/zip -s'L-~ ur-. <l'l//l.
10, D T Type Station Location
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CHAIN OF CUSTODY RECORD
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53
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State or Utah
Department 9( Health ~l ;k Division o( l.aboratory Services
)<_ ~ 44 Medical Drive
~ ~ Salt l..akc Ci1y, Utah 84113-1105
~ "t:
~
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~ -~ ~ T/\G t t NUMBERS 5 ..c
c5
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ll----+--+--+----+------------11 --t---lc---t---t--t--t---t--1--.__+--+----¼-·t---f--+--f-•1t-----+--+------■
-----•----------f--------------•------•
---•·--------+--,t--+--+--<t-f---f---+-t---t---+-
Rel. fly (signa1t11c) 0 Rd . lly (signn1ttrc) Rd . fly (si:inalurc) 0
T T T
Rec . lly (sii:naiurc) D Rcr. lly (sig11a1111c) D Rec . Dy (•if.nature) I) Spill Samples (signature): I) -
T T T T
llclinquishc!l h y (s if_nalurcl
Cost Code: l.§1__ METHOD BTEX Lab lt 9312702
Send Report To:
BIG 'O' TIRE B5@9.5'
D.E.R.R./PATRICK SHEEHAN
1950 W NORTH TEMPLE
Utah Division of Laboratory Services
46 North Medical Drive
Salt Lake City, UT 84113
SALT LAKE CITY, UT 84116
Date/Time Collected: 93/12/12 Sample Matrix: =S=o=i=l _______ _
Collected By: PATRICK SHEEHAN Sampling Site:
Description of Sampling Point: =B=I=G_'=O_'-=T=I=R=E--=B=5~@=9~·=5_' _______________ _
Analyst: K-fu\afu
Amt. Purged: l\.--t-,.,l,
Analysis Certified By:
Date Received: 93/12/13 Date Analyzed:
Dilution:
Compound MDL/Results :m.g/ ~
Benzene
Toluene
Ethylbenzene
Xylenes
6.2
6.2
6.2
.6. 2
U-Analyzed for but not detected.
J-An estimated value or a value
less than the detection limit
but greater than zero.
B-Found in the blank.
11
100
24
180
Date: ~C!-b 1..l119CJ4
Cost Code: 1§.L METHOD BTEX Lab fl: 9312703
Send Report To:
BIG 'O' TIRE 811@ 9'
D.E.R.R./PATRICK SHEEHAN
1950 W NORTH TEMPLE
Utah Division of Laboratory Services
46 North Medical Drive
Salt Lake City, UT 84113
SALT LAKE CITY, UT 84116
Date/Time Collected: 93/12/12 Sample Matrix: =S~o=i=l _______ _
Collected By: PATRICK SHEEHAN Sampling Site:
Description of Sampling Point: ~B~I~G'-'~O~'-=T~I~R=E=----=B~l~l~@._9=---'-----------------
===============================================================-=------------------------
Analyst: Date Received: 93/12/13 Date Analyzed:
Amt. Purged: Dilution:
===========================================================------------------------------
" ,:
Analysis Certified By:
Compound MDL/Results mg/~
Benzene
Toluene
Ethylbenzene
Xylenes
o.~5
o .0~5
0 .0~5
o .0~5
U-Analyzed for but not detected.
J-An estimated value or a value
less than the detection limit
but greater than zero.
B-Found in the blank.
u
u
u
u
Date:
Cost Code: l.§2__ METHOD BTEX Lab i 9312704
Send Report To:
BIG 'O' TIRE B5
D.E.R.R./PATRICK SHEEHAN
1950 W NORTH TEMPLE
Utah Division of Laboratory Services
46 North Medical Drive
Salt Lake City, UT 84113
SALT LAKE CITY, UT 84116
Date/Time Collected: 93/12/11 Sample Matrix: ~W~a~t~e~r _______ _
Collected By: PATRICK SHEEHAN Sampling Site:
Description of Sampling Point: =B~I~G_'~O~'~T=I=R=E=--~B=5=---------------------
Analyst: --<. ':n\c::y\u::i
Amt. Purged: \Qi uh, >
Analysis Certified By:
Date Received: 93/12/13 Date Analyzed:
(MDL based on 5ml purge vol.) Dilution:
Compound MDL/Results
Benzene cl.SO
Toluene d.50
Ethylbenzene .Q.50
Xylenes J-,50
U-Analyzed for but not detected.
J-An estimated value or a value
less than the detection limit
but greater than zero.
B-Found in the blank.
ug/1
480
2400
610
4100
Date:
Cost Code: 367 METHOD BTEX Lab t 9312705
Send Report To:
BIG 'O' TIRE B-1 1
D.E.R.R./PATRICK SHEEHAN
1950 W NORTH TEMPLE
Utah Division of Laboratory Services
46 North Medical Drive
Salt Lake City, UT 84113
SALT LAKE CITY, UT 84116
Date/Time Collected: 93/12/11
Collected By: PATRICK SHEEHAN
Description of Sampling Point:
Sample Matrix: _W~a~t~e~r ________ _
Analyst:
Amt. Purged: 5mL
Analysis Certified By:
Sampling Site:
BIG 'O' TIRE B-11
Date Received: 93/12/13 Date Analyzed:
(MDL based on 5ml purge vol.) Dilution:
Compound MDL/Results
Benzene 0.5
Toluene 0.5
Ethylbenzene 0.5
Xylenes 0.5
U-Analyzed for but not detected.
J-An estimated value or a value
less than the detection limit
but greater than zero.
B-Found in the blank.
ug/1
u
6.9
1
7.1
Date:
I I X\
Send Report To: 1PLEA.SE PRINT)
BTEX ANALYSIS
(SOIL) :2 702
N rune or Agency: ___../1'-E"" . ...!.f?..::..-.. '-!<__,__ __________ _ LAB NO. _______ _
Address /'{so W, JJ~r+I.. T<..--rt1./{~~
I City,State,Zip:_~S~l~l~.,;~V.~-~r: ___________ _
Phone Number: s'U,•-4 {OD
STATE OF UTAH DEPT.OF HEALTH
DIVISION OF LABORATORY SERVICES
46 North MEDCIAL DRIVE
Salt Lake City,Ut. 84113
[phone]
COST CODE: _____ _
Account I ______ _
Field t If-:) e ~s-1
DATE COLLECTED ;,/:,/23-Time Collected(24hr.Clock) ____ _
Co 11 ec ted By: /31:.±_r n. c 1 L c....~ h e-r,I Sampling Site : __ B.='j:J-=()'--,-.-.;._l.;_1 '--1'_<-_______ _
==-=======---=================================================-=-------------------------
Analyst: Date Rec'd _____ _ Date Analyzed: ____ _
Amt.Purged _____ (MDL based on 5ml purge vol.) Dilution: ______ _
-======================-==========---===================-=-=-=---------------------==-===
Compound
Benzene
Toluene
Ethylbenzene
Xylenes
_ug/L
POL/RESULTS
4.0U
6.0U
11. U
7.0U
U -Analyzed for but not detected.
J -An estimated value for a compound
at a value less than the PQL, but
greater than zero.
B -Found in the blank.
==-=-=------------------------------------==---=================-==========-=========----
Analysis Certified By: ______________ _ Date: __________ _
LAB USE ONLY: l-2-3-4-5-6-7-8-9-10-ll-12-13-14-15-16-17-18-19-20-21-22-23-24-25-26-27
28-29-30-31-32-33-34-35-36-37-38-39-40-41-42-43-44-45-46-47-48-49-50-51-52~53-54-55-56
57-58-59-60-61-62-63-64-65-66-67-68-69-70-71-72-73-74-75-76-77-78-79-80-81-82-83-84-85
86-87-88-89-90-91-92-93-94-95-96-97-98-99-100
BOTTLES REQUIRED: (2) 40ml GLASS VIALS
LID MUST BE LINED WITH TEFLON
IF YOU WA.NT TPH(TOTAL PETROLEUM HYDROCARBONS)
YOU WILL NEED 1 MORE VIAL. SAME AS ABOVE.
CHAIN OF CUSTODY
BTEX ANALYSIS
(SOIL)
Send Report To: (PLEASE PRINT)
Name or Agency :__:./J"---c.:...:/!=/.....:.._ ___________ _
,-.1 •-; n 3
,; f ' 'i ', i ; (_ I V
LAB NO. _______ _
Address /<:'/1{'"tJ N, J..,(;,e_.,.,,l'(-f'
I City,State,Zip:-=-~~·~~c~u-'-'--r ___________ _
Phone Number: fjl. -'-{/(JtJ
STATE OF UTAH DEPT.OF HEALTH
DIVISION OF LABORATORY SERVICES
46 North MEDCIAL DRIVE
Salt Lake City,Ut. 84113
[phone]
COST CODE: ____ _
Account t ______ _
Field I II>!/ e_ 1 1
DATE COLLECTED /t1-faJ/2,; Time Collected( 24hr. Clock) ____ _
Co 11 ec ted By: /JR-+ irt <--k.. S/,. e__..j, &---J Sampling Site : _..:::.8.:..c"+1-'C,,,___77-'-'; /I<'------,------
========--========================================================-======----------------
Analyst: Date Rec'd. _____ _ Date Analyzed: ____ _
Amt.Purged _____ (MDL based on 5ml purge vol.) Dilution: ______ _
====-==-==================================================================---------------
Compound
Benzene
Toluene
Ethylbenzene
Xylenes
yg/L
POL/RESULTS
4.0U
6.0U
11. U
7.ou
/I-L70 TPlf
U -Analyzed for but not detected.
J -An estimated value for a compound
at a value less than the PQL, but
greater than zero.
B -Found in the blank.
------------=----=----==---=-=--==-------=============================================---
Analysis Certified By: _____________ _ Date: __________ _
LAB USE ONLY: 1-2-3-4-5-6-7-8-9-10-11-12-13-14-15-16-17-18-19-20-21-22-23-24-25-26-27
28-29-30-31-32-33-34-35-36-37-38-39-40-41-42-43-44-45-46-47-48-49-50-51-52~53-54-55-56
57-58-59-60-61-62-63-64-65-66-67-68-69-70-71-72-73-74-75-76-77-78-79-80-81-82-83-84-85
86-87-88-89-90-91-92-93-94-95-96-97-98-99-100
Bal'TLES REQUIRED: (2) 40ml GLASS VIALS
LID MUST BE LINED WITH TEFLON
IF YOU WANT TPH(TOTAL PETROLEUM HYDROCARBONS)
YOU WILL NEED 1 MORE VIAL. SAME AS ABOVE.
BTEX ANALYSIS
·(WATER)
Send Report To: (PLEASE PRINT)
Name or Agency: _;:./Jic...s[«-f_L.:_::.cj__~------------
Addres s /ct~o i---, A/. ,~.,.,.,I<
City,State,Zip: -SU.., UTr f.1/tftz
Phone Number: S-3(, -
1
lljao
LAB NO. _______ _
STATE OF UTAH DEPT.OF HEALTH
DIVISION OF LABORATORY SERVICES
46 North MEDCIAL DRIVE
Salt Lake City,Ut. 84113
[phone]
COST CODE: ____ _
Account i ______ _
Field t Ii<."_ DATE COLLECTED / ,/u/23 Time Collected( 24hr. Clock) _ "
Collected By: Ll'l-+r,d. :f J..c."-:f.l'f-d Sampling Site: /,j O T;:re , /. J..f,-e&, t11
SAMPLE USED FOR: DRINKING: __ ENVIRONMENTAL:.>(' OTHER: _________ _
=========================--------------------------------------------------------.-------
Analyst: Date Rec'd _____ _ Date Analyzed: _____ _
lunt.Purged ______ (MDL based on 5ml purge vol.) Dilution: _______ _
==============================================-----==-==---------------------------------
Compound
Benzene
Tolu~ne
Ethylbenzene
Xylenes
====-====· ========================================================---------------------==
BOTILES REQUIRED
TWO 40ml glass septum vials.
IF YOU ALSO WANT TPH(total petroleum hydrocarbons) YOU WILL NEED AT LEAST ONE EXTRA
VIAL, ALSO WRITE TPH ON THE LINE BESIDE OTHER
TOTAL COST: $75.00
----------=====-=-=======----============================================================
INSTRUCTIONS FOR COLLECTION OF SAMPLES
l.When sampling from a water tap open the tap and allow the system to flush until water
temperature has stabilized. (usually 10 minutes)
2.Fill vials, being careful not to wash out the preservative or aerate the sample.
no air bubbles should pass through the sample as the bottle is filled, or be trapped
;in the sample when the vial is sealed. fill to the very top of the vial
3.The pH of the sample must be adjusted to a pH of <2 by carefully adding two drops of
6n HCl acid from the vial, provided with your sampling kit. Highly buffered
water may require more acid. sample received with a pH >2 will be discarded
4.Following the addition of the acid the vial must be sealed with the teflon face down
shaken vigorously for l minute, and store at 4°C until received by the LAB
'"DO NOT USE DRY ICE" when shipping.
5.Sample must be delivered to the lab as soon as possible. all sampling should be
scheduled with the lab prior to collection. FILL OUT ENTIRE FORM
•~-BTEX ANALYSIS
(WATER)
Send Report To: ~PLEASE,f'Ig?IT) 1 / /}
Name or Agency : LJ r ii c7C ffe.--11 Vi 'rc.l , rr sd?1/ ft r2~ £<z-
Address /0,..:::,J2 lei/,, /1.4> ,~-n. ~le
City,State,Zip: ~]-~f: ~ 8 ,;9(/,£;> 6:'(//~
Phone Nwnber: ..,5: __ _.:::_/ _
LAB NO. _______ _
STATE OF UTAH DEPT.OF HEALTH
DIVISION OF LABORATORY SERVICES
46 North MEDCIAL DRIVE
Salt Lake City,Ut. 84113
[phone]
COST CODE: ____ _
Account t_· ______ _
Field i J3-/( ·
Collected By: 8£
DATE COLLECTED /.2_//!/1-3Time Collect)?d(24hr.Clock) ______ _
.S,{e~~, Sampling Site: ~ tf? 7) ~
SAMPLE USED FOR: DRINKING: __ _ • ENVIRONMENTAL:.,x__ OTHER: __________ _
================================--=---------==-----------------------------------.-------
Analyst: Date Rec'd. _____ _ Date Analyzed: _____ _
Amt.Purged. ______ (MDL based on 5ml purge vol.} Dilution: _______ _
=============================================================----------------------------
Compound
Benzene
Toluene
Ethylbenzene
Xylenes
----====-==----==========-------------------==-------===---------------------------------
BOTTLES REQUIRED
TWO 40ml glass septwn vials.
IF YOU ALSO WANT TPH(total petrolewn hydrocarbons) YOU WILL NEED AT LEAST ONE EXTRA
VIAL, ALSO WRITE TPH ON THE LINE BESIDE OTHER
TOTAL COST: $75.00
-------------==-----------------------------=-=========================================--
INSTRUCTIONS FOR COLLECTIOO OF SAMPLES
1.When sampling from a water tap open the tap and allow the system to flush until water
temperature bas stabilized. (usually 10 minutes}
2.Fill vials, being careful not to wash out the preservative or aerate the sample.
no air bubbles should pass through the sample as the bottle is filled, or be trapped
in the sample when the vial is sealed. fill to the very top of the vial
3:The pH of the sample must be adjusted to a pH of <2 by carefully adding two drops of
6n HCl acid from the vial, provided with your sampling kit. Highly buffered
water may require more acid. sample received with a pH >2 will be discarded
4.Following the addition of the acid the vial must be sealed with the teflon face down
shaken vigorously for 1 minute, and store at 4°C until received by the LAB
"DO NOT USE DRY ICE" when shipping.
5.Sample must be delivered to the lab as soon as possible. all sampling should be
scheduled with the lab prior to collection. FILL OUT ENTIRE FORM