ill. , dep rtment of design and construction - new york€¦ · 10.nature of business: {describe...

Ill. , Dep�rtment ofDesign and Construction

Kevin F. Donnelly, P.E. Deputy Commissioner Program Management

March 27, 2017

Mr. Stephen Watts

Dr. Feniosky Pena-Mora Commissioner

Mark A. Canu Associate Commissioner Safety and Site Support

Deputy Regional Permit Administrator New York State Department of Environmental Conservation 47-40 21st Street, 2nd FloorLong Island City, New York, 11101-5407

Jean M. Jean-Louis LEED AP BD+C, ENV SP, CIAOM Assistant Commissioner Safety and Site Support

Re: Application for Jurisdictional Determination to Discharge into Existing Storm Sewers on Collier Avenue and Beach 27th Street Con�truction of Storm Sewers, Sanitary Sewers and Water Mains in New Haven Avenue, etc., Rockaway, Queens, New York 11691 NYCDDC Project ID: SEQ200524 Notice of Determination of SPDES Jurisdiction DEC application ID 2-6308-00999

Dear Mr. Watts:

Applemon Corporation has been contracted by CAC Industries, Inc., the project contractor, for designing a dewatering system and obtaining necessary permits to facilitate the construction of the above project.

In response to your determination of jurisdiction, we are requesting an individual State Pollutant Discharge Elimination System (SPDES) permit to temporarily discharge up to 3.22 MOD (2,240 gpm) of groundwater to existing storm sewer on Collier Avenue and Beach 2 7t1t Street during Construction of Storm Sewers, Sanitary Sewers and Water Mains in New Haven Avenue, etc., in Rockaway, Queens. The said sewer discharges to Norton Basin through existing NYCDEP MS4 Outfall ROC-651. Based on the groundwater analytical results, cis-1,2-dichloroethylene, and trichloroethylene at a concentration of 29 ug/L and 33 ug/L, respectively, were detected in one of the groundwater samples collected from a monitoring well at the site. Since chemical or activated carbon treatment of the large dewatering flow is not practical, and may not be necessary, the discharge will be remediated using a settling tank. Effluent will be regularly sampled for any evidence of contamination. If Exceedances are detected in the discharge, groundwater will be locally treated using proper treatment methods. Header pipes will convey groundwater from individual wells to the settling tank. Up to seven (7) pumps discharging at 320 gpm each will be used at one time for a period of maximum two years to facilitate this operation.

Herein, we are submitting three copies of the followings: 1) Complete SPDES Industrial Application Form NY-2C2) Complete Discharge Monitoring Report (DMR) Signature Authorization Form3) Dewatering Plan showing the location of the project on the street right-of-way, groundwater

discharge system, outfall location for discharge into receiving storm sewer, locations of thedewatering wells, and groundwater monitoring wells.

4) Laboratory Analytical Report and Field Measurement Report of the samples collected frommonitoring wells within the project site.

30-30 Thomson Avenue, Long Island City, NY 11101 718-391-3134 nyc.gov/ddc twitter.com/@nycddc

Department of Design and Construction

As always, the City of New York appreciates the continued cooperation of the NYSDEC in facilitating important infrastructure projects through your applicable permit programs. Please do not hesitate to contact me at (718)391-3134 if you have any questions, or Cavy Chu at (718)391-1005.

Jean M. Jean-Louis, LEED AP BD+C, ENV SP, CIAQM Assistant Commissioner

Cc: E. Macfarlane, M. Canu, D. Granger, P. Larkin, G. Williams, C. Chu

Cc: Fuad Adib, P.E., PhD (Applemon Corp.)

•

30-30 Thomson Avenue, Long Island City, NY 11101 718-391-3134 nyc.gov/ddc twitter.com/@nycddc

Form NY-2C (11/01) - Section I Forms

State Pollutant Discharge Elimination System (SPDES) INDUSTRIAL APPLICATION FORM NY-2C

For New Permits and Permit Modifications to Discharge Industrial Wastewater and Storm Water Section I - Pennlttee and Facility lnfonnatlon

Please type or print the requested information. 1. Current Pennlt Information (leave blank if for new discharge)I SPDES Number:

I DEC Number:

2. Permit Action Requested: (Check applicable box) [TI A NEW proposed discharge CJ An EBPS INFORMATION REQUEST response CJ A RENEWAL of an

Page 1

i==i A MODIFICATION of the existing permit r=] An EXISTING discharge currently without permit exiSllng SPDES permit

Does this request include an increase in the quantity of water discharged from your faclllty to the waters of the State?

[=:J YES - Describe the increase:

� NO - Go to Item 3. below.

3. Pennittee Name and AddressName New York City Department of Design and Construction j

Attention Jean Jean-Louis

Street Address 30-30 Thomson Avenue

City or Village Long Island City I State NY

I ZIP Code 11101

4. Facility Name, Address and LocationName Construction of Stonn Sewers, Sanitary Sewers and Water Mains in New Haven Avenue, etc.

Street Address Collier Ave, Beach 22nd & 25th Streets, Deerfield Rd P.O. Box

City or Village Rockaway

Town Rockaway

Telephone I FAX

Tax Mao Info /New York City, Nassau Countv and Su.ffolk Counlv onlv) Section

I Block

5. Facility Contact PersonName Donna J. Cettina

Straet Address CAC Industries Inc. 54-08 Vernon Blvd

-

City or Village Long Island City

Telephone (347) 619-5866 I FAX

6. Discharge Monitoring Report (DMR) Malling AddressMailing Name CAC Industries Inc.

Street Address 54-08 Vernon Blvd

City or Village Long Island City

Telephone (347) 619-5866 I FAX

Name and Title of person responsible for signing DMRs Donna J. Cettina, Sr Project Manager

stateNY

ZIP Code 11691

County

Subblock

Queens

NYTM -

E 605051 I NYTM

-N

4494886

J

Lot

Title Sr Project Manager

State NY

E-Mail or Internet

State NY

E-Mail or Internet

P.O. Box

ZIP Code 11101

[email protected]

P.O. Box

ZIP Code 11101

[email protected]

Signature

JJ�_ q__ �; I{,�/ I I (

Form NY-2C·(11/01) - Section I Forms

INDUSTRIAL APPLICATION FORM NY-2C Section I - Pennittee and Facility Information

Facility Name: Construction of Storm Sewers, Sanitary Sewers and Water Mains in New Haven Avenue, etc.

SPDES Number:

7. Summarize the outfalls present at the facility:Outfall Number Recelvlna Water Tvoe of discharoe

001 Norton Basin MS4 Outfall ROC-651 Groundwater - construction dewatering



8. Map of Faclllty and Discharge Locations:

Pege2

Provide a detailed map showing the location of the facility, all buildings or structures present, wastewater discharge systems, outfall locations into

receiving waters, nearby surface water bodies, water supply wells, and groundwater monitoring wells, and attach it to this application. Also submit

proof, either by indication on the map or other documentation, that a right of way for the discharges exists from the facility property to a public right of

way.

9. Water Flow Dia ram:

t N

POD (Point of Discharge)= Outfall

For:m NY-2C, (11/01) - Section I Fonns INDUSTRIAL APPLICATION FORM NY-2C

Section I - Permittee and Facility Information

Facility Name: Construction of Storm Sewers, Sanitary Sewersand Water Mains in New Haven Avenue etc.

SPDES Number:

10. Nature of business: {Describe the activities at the facility end the date{s) that operatlon(s) et the facility commenced)

Temporary dewatering to be conducted during excavation for Construction of Storm Sewers, SanitarySewers and Water Mains in New Haven Avenue, etc.scheduled to start in March 2017.

11. List the 4-diglt SIC codes which describe your facility in order of priority:Priority 1 Description: Priority 3 Description: 1 I 1 I 9 I 4 Excavation Work I I I

Priority2 Description: Priority 4 Description: 1 I 61 2 I 3 Water and sewer work I I I

12. Is your facility a primary Industry as listed In Table 1 of the Instructions?

C=:J YES -Complete the following table.

[J[J NO - Go to Item 13. below.

Industrial Category 40CFR Industrial Category 40CFR

Page3

Part Subpart Pert Subpart

13. Does this facility manufacture, handle, or discharge recombinant-DNA, pathogens, or other potentially Infectiousor dangerous organisms?

C=:J YES - Attach a detailed explanation to this application.

C=:J NO - Go to Item 14 below.

14. Is storm runoff or leachate from a material storage area discharged by your facility?

C=:J YES -Complete the following table, end show the location of the stockpile(s) and discharge point(s) on the diagram in Item 9.

[XJ NO - Go to Item 15 on the following page.

Size of area Type(s) of materiel stored Quantity of materiel stored Runoff control devices

F(?rrn NY-2� (11101) - Section I Fonns

INDUSTRIAL APPLICATION FORM NY-2C Section I - Pennittee and Facility lnfonnatlon

Facility Name: Construction of Storm Sewers, Sanitary Sewersand Water Mains in New Haven Avenue, etc.

SPDES Number:

15. FaciU[

Owr

ership: (Place an •x• in the appropriate box) Corporate Sole Proprietorship D Partnership D Municipal� StateO Federal D

Are any of the discharges applied for in this application on Indian lends? YesD No[KJ

16. List infonnation on any other environmental permits for this facility:Issuing Agency PennltType Pennit Number Penni! Status

Active Aoolied for

NYSDEC LI Well 2-6308-00999/0002 X

NYCDEP Discharge

17. Laboratory Certification:

OtherL

Inactive

Were any of the analyses reported in Section Ill of this application performed by a contract laboratory or a consulting firm?

[KJ YES - Complete the following table.

D NO· Go to Item 18 below.

Name of laboratory or consulting finn Address Telephone Pollutants analyzed (area code and number)

Applemon Corporation New City, NY (845) 634-0858 NYSDEC-Region 2 List for dewatering projects

18. CertificationI certify under penalty of law that this document and sf/ attachments were prepared under my direction or supervision in accordance with s 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 respansible forgathering the information, the information submitted is, to the best of my knowledge and belief, trus, accurate,

and complete. I am aware that there are significant pens/ties for submitting false information, including the passibility of fine and imprisonment for knowing

violations.

Name and official title (type or print) Jean M. Jean-Louis, Assistant Commissioner

Signature Telephone number

(718) 391-3134

Date signed

FAX number

Form NY-�C (11/01) - Section I Forms

INDUSTRIAL APPLICATION FORM NY-2C Section I - Permittee and Facility Information

Facility Name: Construction of Stonn Sewers, Sanitary .Sewers and Water Mains in New Haven Avenue, etc.

19. Industrial Chemical Survey (ICS)

SPDES Number:

Page 5

Complete all Information for those substances your facility has used, produced, stored, distributed, or otherwise disposed of in the past five (5) years at or above

the threshold values listed In the Instructions. Include substances manufactured at your facility, as well as any substances that you have reason to know or

believe present in materials used or manufactured at your facility. Do not Include chemicals used only in analytical laboratory work, or small quantities of routine

household clean Ing chemicals. Enter the name and CAS number for each of the chemicals listed In Tables 6-10 of the instructions, and the table number which

lists the chemical. You may use ranges (e.g. 10-100 lbs., 100-1000 lbs., 1000-10000 lbs., etc.) to describe the quantities used on an annual basis as well as

for the amount presently on hand. For those chemicals listed in Tables 6, 7, or 8 which are Indicated as being potentially present In the discharge from one

or more outfalls et the facility, indicate which outfalls may be affected In the appropriate column below, and Include sampling results in Section Ill of this

application for each of the potentially affected outfalls. Make additional copies of this sheet if necessary.

Average Amount Units Purpose of Use Present In

Name of Substance Table CASNumber Annual NowOn (gallons, Kaea codes In Table 2 o1 Discharge?

Usage Hand Iba, etc) Instructions) (Outfall(s)?)

None

This completes Section I of the SPDES Industrial Application Form NY-2C. Section II, which requires specific Information for each of the outfalls at your faclllty, and Section Ill, which requires sampllng Information for each of

the outfalls at your faclllty, must also be completed and submitted with this appllcatlon.

F�rm NY-2<? (12/98)- Section II Forms


Page 1

For New Permits and Permit Modifications to Discharge Industrial Wastewater and Storm Water Section II - Outfall Information

Please type or print the requested information. Facility Name: Construction of Storm Sewers, Sanitary Sewers SPDES Number:

and Water Mains in New Haven Avenue, etc.

1. Outfall Number and LocationOutfall No.:

001

Latitude Longitude 40 ° 35 55 II -73 O 45

I Receiving Water I32 11 Norton Basin Through MS4 Outfall ROC-651

2. Type of Discharge and Discharge Rate (List all Information applicable to this outfall)

Units

Other

Units

Other Volume/Flow MGD GPM (specify) Volume/Flow MGD GPM (specify)

a. Process Wastewater f. Noncontact Cooling Water

b. Process Wastewater g. Remediation System Discharge

c. Process Wastewater h. Boller Blowdown

d. Process Wastewater i. Storm Water

e. Contact Cooling Water J. Sanitary Wastewater

k. Other discharge (specify): Construction Excavation Dewaterlng 2,240 X

I. Other discharge (specify):

3. List process Information for the Process Wastewater streams Identified In 2.a-d above:a. Name of the process contributing to the discharge N/A Process SIC code:

I I I Describe the contributing process Category Quantity per day Units of measure

Subcategory

b. Name of the process contributing to the discharge Process SIC code:


Subcategory

c. Name of the process contributing to the discharge Process SIC code:

I I Describe the contributing process Category Quantity per day Units of measure

Subcategory

d. Name of the process contributing to the discharge Process SIC code:


Subcategory

4. Expected or Proposed Discharge Flow Rates for this outfall:a. Total Annual Discharge b. Daily Minimum Flow c. Dally Average Flow d. Daily Maximum Flow e. Maximum Design flow rate

1175 MG 3.22 MGD 3.22 MGD 3.22 MGD 4.0 MGD

Fqrm NY-2� (12/98)- Section II Forms

INDUSTRIAL APPLICATION FORM NY-2C Section II - Outfall Information

I Facility Name: Construction of Storm Sewers, Sanitary Sewers and Water Mains in New Haven Avenue, etc.

5. Is this a seasonal discharge?� YES - Complete the following table.

[TI NO - Go to Item 6 below.

Discharge frequency Operations contributing flow (list) Batches Duration Flow rate per day

6. Water Supply Source (indicate all that apply)

per year per batch LTA Dally Max

Outfall No.: 001

SPDES Number:

Flow Total volume per Units

discharge

Name or owner of water supply source Volume or flow rate Units (check one)

Municipal Supply MGD

Private Surface Water Source MGD

Private Supply Well MGD

Other (specify) Groundwater 3.22 XMGD

7. Outfall configuration: (Surface water discharges only)

A. Where is the discharge point located with respect to the receiving water?

In the streambank: [KJ Discharge to MS4 outfall through a storm sewer

In the stream: D Within a lake or ponded water: D

GPD

GPD

GPD

GPD

Page2

Duration (Days)

GPM

GPM

GPM

GPM

Within an estuary: D Attach Supplement C, MIXING ZONE REQUIREMENTS FOR DISCHARGES TO ESTUARIES.

Discharge Is equipped with diffuser: D Attach description, Including configuration and plan drawing of diffuser, If used.

B. If located in a stream, approximately what percentage of stream width from shore Is the discharge point located?

10%0 25%0 50%0 other:�------�

C. If located In a stream, describe the stream geometry in the general vicinity of the discharge point, under low flow conditions:Stream width Stream depth

Feet

Stream velocity Are the results of a mixing/diffusion study attached? DYES

Feet FeeUSec ONO

INDUSTRIAL APPLICATION FORM NY-2C

F�rm NY-2� (12/98)- Section II Forms

Section II - Outfall Information

I Facility Name: Construction of Storm Sewers, Sanitary Sewers


8. Thermal Discharge Criteria

Outfall No.: 001

SPDES Number:

Page 3

Is your facility one of the applicable types of facilities listed in the instructions, and does the temperature of this discharge exceed the receiving water temperature by greater than three (3) degrees Fahrenheit?

CJ YES • Complete the following table.

CT] NO - Go to Item 9. below.

j=:J 1nfonnatlon on the Intake and discharge configuration of this outfall Is attached.

Dischar1 e Temoerature, deg. F Duration of Dates of maximum Average Maximum maximum discharge discharge Maximum Discharge configuration (e.g. subsurface, surface,

change in change In temperature temperature flow rate effluent diffuser, diffusion well, etc.) temperature temperature Maximum hours per days per

(delta T) (delta T) temperature day year From To MGD

9. Are any water treament chemlcals or additives that are used by your faclllty subsequently discharged throughthis outfall?

C=:J YES • Complete the following table and complete pages 1 of 3 and 2 of 3 of Form WTCFX for each water treatment chemical listed.

� NO - Go to Item 10. below.

Manufacturer WTC trade name Manufacturer WTC trade name

10. Has any blologlcal test for acute or chronic toxicity been performed on this outfall or on the receivingwater in relation to this outfall in the past three (3) years?

[=:J YES • Complete the following table.

[TI NO ·Go to Item 11. on the following page.

Water tested Purpose of test Type of test Chronic Subject species Testinc date(s) Submitted? or Acute? Start Finish (Date)

Fo(TTl NY-2G (12/98)- Section II Forms




Page4

Outfall No.: 001

SPDES Number:

11. Is the discharge from this outfall treated to remove process wastes, water treatment additives, or other pollutants?[TI YES - Complete the following table. Treatment codes are llsted in Table 4.

[==:J NO - Go to Item 12 below.

Treatment Design Flow Rate Treatment process Code(s) Treatment used for the removal of: (Include units)

1-USedimentation Suspended Solids 3.22 MGD

12. Does this facility have either a compliance agreement with a regulating agency, or have planned changes inri duilon, which will materlally alter the quantity and/or quallty of the discharge from this outfall?

YES • Complete the folloWlng table.

[==:J NO - Go to Section Ill on the following page.

Description of project Subject to Condition or Agreement In Change due to Completion Date(s) existing pennit or consent order? (List) production increase? Required Projected

Construction of Storm Sewers, Sanitary SPDES Permit None 2018

sewers ana vvater Mains m for MS4 Outfall ROC-651 New Haven Avenue etc.

on Norton Basin

This completes Section II of the SPDES Industrial Application Form NY-2C. Section I, which requires general Information regarding your faclllty, and Section Ill, which requires sampllng Information for each of the outfalls at

your facility, must also be completed and submitted with this application.

Form NY-2C (12198)- Section Ill Forms

1. Sampling lnfonnation - Conventional Parameters

INDUSTRIAL APPLICATION FORM NY-2C Section Ill - Sampling Information

ewers etc.

SPDESNo.:

Page 1

Outfall No.: 001

Provide the analytical results of at least one analysis for every pollutant in this table. If this outfall is subject to a waiver as listed in Table 5 of the instructions for one or more of the parameters listed ... -- . . - - -·--- -· . ···- ·- --· ·---·· -· - ____ ,. __ ·-· -·-- .. ·-- -· ----···

PLEASE PRINT O R TYPE IN THE UNSHADED AREAS ONLY. You mav rP.nnrt some or all of this information on �=rm� sheets tusina the same format\ instead of comoletina this """e. Effluent data U nits Intake data (optional)

Pollutant a. Maximum daly value b. Mexhnum 30 day value C. I.Dng term IMll'8g8 d. Number of a. Concentration b.Mess a. Long IBnn ewn,ge value 1. Concanlratian 2.Mas9 1. Concentration 2.Mess 1. Concenlratlon 2.Mass

analyses a. Biochemical Oxygen Demand,

5day(BO D) b. Chemical Oxygen Demand

(CO D) c. Total Suspended Sofids

32.4 (TSS) d. Total Dissolved Solids

(TDS) e. on & Grease

<0.541

f. Chlorine, Total Residual (TRC)

g. Total Organic Nitrogen (TON)

h. Ammonia (as N)

i. Flow Value 3.22

VMJ& Value

j. Temperature, winter Value Value Value

k. Temperawre, summer Value Value Value 55.4

I.pH Minimum Max1mum Minimum MaximUm 7.2

2. Sampling lnfonnation - Priority Pollutants, Toxic Pollutants, and Hazardous Substancesa. Primary lndustr1es: I. Does the discharge from this outfall contain process wastewater? CJ Yes - Go to Item II. below.

[TI No - Go to Item b. below.

1.Ccncanlrallon

mg/L

mg/L

MGD Value

0 Value F

OF Value

Mi\imum

II. Indicate which GCIMS fractions have been tested for: Volatiles: [==:J Acid: � Base/Neutral: [==:J Pesticide: c=I

b. All applicants: I. Do you know or have reason to beReve that any of the pollutants Osted in Tables 6, 7, or 8 of the lnstroctions are l)lllSOOt in the -discharge from this outfall?

CJ Yes - Concentration and mass data attached. IT] No - Go to Item II. below.

II. Do you kna.v or have reason to believe that any of the pollutants listed In Table 9 § Yes - Source or reason for presence In discharge attached or Teble 10 of the lnstructlons, or any other toxic, harmful, or Injurious chemical Yes _ Quantitative or qualltative data attached substances not llsted in Tables 6-10, are present in the discharge from this outfaR?

X No

2.Mass

I Maxftnum

b. Number of analy,les

Fann NY-2C (12/98)- Section Ill Forms

Facility Name:


SPDESNo.:

3. Projected Effluent Quality - Priority Pollutants, Toxic Pollutants, and Hazardous Substances

Page2

Outfall No.: 001

Provide analytical results of at least one analysis for each pollutant that you know or have reason to believe is present in this discharge, as well as for any GCIMS fractions and metals required to be sampled from Section Ill R>rms, Item 2.a on the preceding page.

Ust the name and CAS number for each pollutant that you know or have reason to believe is present in the discharge from this outfall. For each pollutant fisted from Tables 6, 7, Page 1

of or 8, provide the results of at least one analysis for that pollutant, and determine lhe mass discharge based on the flow rate reported in Item 1.1. For each pollutant listed from Table 1 9, or any other toxic pollutant not listed in Tables 6-10, you must provide concentration and mass data. (if available) and/or an explanation for their presence in the discharge. Make as manv cooies of this table as necessary for each outfall

Pollutant and CAS Number Effluent data Units Intake data (optional) Berlllll8d

a. Mmcimum clally wlua b. Maximum� day value (If c. Lang lann 1M118Q9 va!ua � d. Numbe< cf· a. Cancer>- b. Mass a. Long term awrage wlUe d. Number of present, no sampling

Sll8ilab/e} t1118fabl9 J analyMa !ration analyaes results (1)Cona,n. (2) Mass (1)ConceD- (2)Mass (1)Concan- (2)Mass (1)Co� (2)Mass avalable

ln!lion - tration trallon

Arsenic 0.007 mg/L

CAS Number. 7440-38-2 .

Chromium 7440-47-3 0.010 mg/L

CASNumber.

Copper 0.005 mg/L

CASNumber: 7440-50-8

Nickel 0.008

CAS Number. 7440-02-0 mg/L

Lead <0.003 mg/L

CASNumber. 7439-92-1

Zinc 0.0308 mg/L


CAS Number.

CAS Number:

CASNumber.

CASNumber.

CASNumber.

CAS Number:

CAS Number.

Form NY-2C (12/98) - Section Ill Forms

Facility Name:


SPDESNo.:

4. Existing Effluent Quality - Priority Pollutants, Toxic Pollutants, and Hazardous Substances

Page3

Outfall No.: 001

Provide analytical results for the last three (3) years for each pollutant that you know or have reason to believe present in this discharge from this outfall, as well as for any GC/MS fractions and metals required -- - . - - ·----- - - . --- -·- . ·--·

Make as many copies of this table as Parameter name: Parameter name: Parameter name: Parameter name: Pararoomr name: Parameter name: Parameter name:

necessary for each outfall. You can cis-rist the results from 24 sampHng dates 1,2-dichloroethylene Trichloroethylene on each copy of this page.

Page 1 Of 1 CAS Number: CAS Number: CASNumber: CASNumber: CAS Number: CASNumber: CAS Number:

1�59-2 79-01-6

Flow rate Concentration Concentration Concentration , Concentration Concentration Concentration Concentration Date Units: Units: ug/L Units: ug/L Units: Units: Units: Units: Units:

5/3/2016 MW-1 29 33

'

F_orm NY-2,C (12/98)- Section II Forms State Pollutant Discharge Elimination System (SPDES)


Page 1




1. Outfall Number and Location Outfall No.:

002

Latitude 40 0 35

Longitude 54" -73 ° 45 I

Receiving Waler

I 37" Norton Basin Through MS4 Outfall ROC-651

2. Type of Discharge and Discharge Rate (List all information applicable to this outfall) Units Units

Other Other Volume/Flow MGD GPM (specify) Volume/Flow MGD GPM (specify)



c. Process Wastewater h. Boiler Slowdown

d. Process Wastewater i. Storm Water

e. Contact Cooling Water j. Sanitary Wastewater

k. Other discharge (specify): Construction Excavation Dewatering 2,240 X


3. List process Information for the Process Wastewater streams Identified In 2.a-d above:a. Name of the process contributing to the discharge N/A

Process SIC code: I I

Describe the contributing process Category Quantity per day Units of measure

Subcategory

b. Name of the process contributing to the discharge Process SIC code: I I


Subcategory

c. Name of the process contributing to the discharge Process SIC code: I I


Subcategory

d. Name of the process contributing to the discharge Process SIC code: I I I


Subcategory

4. Expected or Proposed Discharge Flow Rates for this outfall:a. Total Annual Discharge b. Dally Minimum Flow c. Daily Average Flow d. Daily Maximum Flow e. Maximum Design flow rate

1175 MG 3.22 MGD 3.22 MGD 3.22 MGD 4.0 MGD

Form NY-2C (12/98)- Section II Forms


j Facility Name: Construction of Storm Sewers, Sanitary Sewers

. and Water Mains in New Haven Avenue, etc.

5. Is this a seasonal discharge?[::=J YES - Complete the following table.


Operations contributing flow (11st)

6. Water Supply Source (Indicate all that apply)

Discharge frequency Batches Duration per year per batch

Flow rate per day LTA Daily Max

Outfall No.: 002

SPDES Number:


discharge








In the streambank: [ZJ Discharge to MS4 outfall through a storm sewer


GPO

GPO

GPO

GPD

Page2

Duration (Days)

GPM

GPM

GPM

GPM


Discharge Is equipped with diffuser: D Attach description, including configuration and plan drawing of diffuser, if used.

B. If located in a stream, approximately what percentage of stream width from shore is the discharge point located?10%0 25%0 50%0 Other:�-------�

C. If located In a stream, describe the stream geometry in the general vicinity of the discharge point, under low flow conditions:Stream width Stream depth

Feet

Stream velocity Are the results of a mixing/diffusion study attached? D YES

Feet Feet/Sec DNo


Fc;>rm NY-2C (12/98) - Section II Forms





Page 3

Outfall No.: 002

SPDES Number:

Is your facility one of the applicable types of facilities listed in the Instructions, and does the temperature of this discharge exceed the receiving watertemperature by greater than three (3) degrees Fahrenheit?

CJ YES • Complete the following table.

[ZJ NO - Go to Item 9. below.

[=:::J lnfonnatlon on the Intake and discharge configuration of this outfall ls attached.

Discherne Temperature, dea. F Duration of Dates of maximum Average Maximum maximum discharge discharge Maximum Discharge configuration (e.g. subsurface, surface, change in change in temperature temperature flow rate effluent diffuser, diffusion well, etc.)

temperature temperature Maximum hours per days per (delta T) (delta T) temperature day year From To MGD

9. Are any water treament chemicals or additives that are used by your faclllty subsequently discharged throughthis outfall?

[=:=} YES - Complete the following table and complete pages 1 of 3 and 2 of 3 of Form WTCFX for each water treatment chemical listed.

� NO- Go to Item 10. below.


10. Has any blologlcal test for acute or chronic toxicity been performed on this outfall or on the receivingwater in relation to this outfall in the past three (3) years?

[=:=} YES • Complete the following table.

� NO - Go to Item 11. on the followlng page.

Water tested Purpose of test Type of test Chronic Subject species Testinc date(s) Submitted? or Acute? Start Finish (Date)

F!)nn NY-?.C (12/98)- Section II Forms


I Facility Name: Construction of Storm Sewers, Sahitary Sewers


Page4

Outfall No.: 002

SPDES Number:

11. ls the discharge from this outfall treated to remove process wastes, water treatment additives, or other pollutants?IT] YES - Complete the following table. Treatment codes are listed In Table 4.

c:J NO- Go to Item 12 below.

Treatment Design Flow Rate Treatment process Code(s) Treatment used for the removal of: (Include units)


12. Does this facility have either a compliance agreement with a regulating agency, or have planned changes In�ctlon, which will materially alter the quantity and/or quality of the discharge from this ou�II?L..15_J YES - Complete the following table.

[==i NO - Go to Section Ill on the following page.

Description of project Subject to Condition or Agreement in Change due to Completion Date(s) existing permit or consent order? (List) production increase? Required Projected


!Sewers and water Mains in for MS4 Outfall ROC-651New Haven Avenue etc

on Norton Basin

This completes Section II of the SPDES Industrial Application Form NY-2C. Section I, which requires general Information regarding your facility, and Section Ill, which requires sampling Information for each of the outfalls at


Fonn NY-2C (12/98)- Section Ill Fonns

Facility Name:

1. Sampling Information -Conventional Parameters


Section Ill - Sampling Information

SPDESNo.: Outfall No.:

Page1

002

Provide the analytical results of at least one analysis for every pollutant in this table. If this outfall is subject to a waiver as listed in Table 5 of the instructions for one or more of the parameters listed

Pl.EASE PRINT OR TYPE IN THE UNSHADEn'AREAS�ONLY. Y��-�v ;.;�;i"some � all of this information on separate sheets 1usino the same format\ Instead of comoletina this ru1ne. Effluent data Units Intake data (optional)

Pollutant a. Mmnum daly value b. Maximum 30 day value C. Long term a-. d. Number of 8. ConcenlraUon b.Mass 8. Long '9nn IMl&gB value 1. Concemelian 2.Mass 1. Ccn:entr1dlon 2.Mau 1. Concanlr8tlon 2.Mass

. analyses

a. Biochemical Oxygen Demand,5 day(BOD)

b. Chemical Oxygen Demand(COD)

C. Total Suspended Solids 32.4 (TSS)

d. Total Dissolved SoUds (TDS)

e.. Oil & Grease <0.541

f. Chlorine, Total Residual{TRC)

g. Tola! Olganlc Nitrogen (TON)

h. Ammonia (as N)

i.Aow Value Value Value

3.22

j. Temperature, winter Value Value Veiue

k. Temperature, summer Value Value Value

55.4

I.pH Minimum Maximum Minimum Maxfmum 7.2

2. Sampling Information - Priority Pollutants, Toxic Pollutants, and Hazardous Substancesa. Primary Industries: I. Does the discharge from this outfall contain process wastewater? [:=:J Yes - Go to Item II. below.

IT] No- Go to Item b. below.

1. Concenlration

mg/L

mg/L

MGD Value

0 V9iue F

OF Value

Minimum

IL Indicate which GCIMS fractions have been tested for: Volatiles: CJ Acid: CJ Base/Neutral: CJ Pesticide: [==:J

b. All appllc:ants: I. Do you know or have reason to belfeve1hat any of the pollutants rlStedin Tables 6, 7, or 8 of the instructlons are present in the discharge from this outfall?

� Vas - Concentration and mass data attached. [TI No - Go to Item II. below.

11. Do you know or have reason to beneve that any of the pollumrts listed In Table 9 § Yes - Source or reason for presence in discharge attached or Table 10 of the lnstrucllons, or any other toJdc, harmful. or Injurious chemical Yes _ Quantitative or qualllatlve data attached substances not Dsted in Tables 6-10, are present In !he discharge from this outfall?

X No

2. Mass

Maximum

b. Number ofana1yaes

Form NY-2C (12198)- Section Ill Forms

Facility Name:


SPDESNo.:

3. Projected Effluent Quality - Priority Pollutants, Toxic Pollutan1s, and Hazardous Substances

[ Outfall No.: 002

Page2

Provide analytical results of at least one analysis for each pollutant that you know or have reason to believe is present in this discharge, as well as for any GC/MS fractions and metals required to be sampled from Section Ill Forms, Item 2.a on the preceding page.

List the name and CAS number f'Or each pollutant that you knCJIN or have reason to believe is present in the discharge from this outfall. For each pollutant llsted from Tables 6, 7, Page 1 of 1or 8, provide the results of at least one analysis for that pollutant, and determine the mass discharge based on the flow rate reported in Item 1.i. For each pollutant listed from Table 9, or any other toxic pollutant not listed in Tables 6-10, you must provide concentration and mass data (if available) and/or an explanation for their presence in the discharge. Make as many copies of this table as n , • for each outfall.

Pollutant and CAS Number Effluent data Units Intake data (optional) llef""'80

a. Maximum clai1y va\ua b. Mlixlmum 30 day wlue (' c. Long term 8"8lage value (if d.Numberof a. C0noer>- b.Ma,ss a Long term awrage vakJa d. Number of present, no

S1181fel)/&J awhblel analyses tratfon analyses results (1)Concer>- (2)Mass (1)Concen- (2)Mass (1 )Cancer>- (2)Mass (1)Concen- (2)Mass avaffable

1nltion !ration !ration lnltion

Arsenic 0.007 mg/L CASNumber. 7440-38-2

Chromium 7440-47-3 0.010 mg/L

CASNumber.

Copper 0.005 mg/L

CASNumber. 7440-50-8 Nickel 0.008

CASNumber. 7440-02-0 mg/L Lead <0.003 mg/L

CASNumber. 7439-92-1 Zinc 0.0308 mg/L

CAS Number. 7440-66-6

CAS Number.

CAS Number:

CAS Number:

CASNumber:

CAS Number:

CAS Number:

CAS Number:

Fonn NY-2C (12/98) - Section Ill Fonns

Facility Name:


SPDESNo.:

4. . Existing Effluent Quality - Priority Pollutants, Toxic Pollutants, and Hazardous Substances

[ OutfaH No.: 002

Page3

Provide analytical results for the last three (3) years for each pollutant that you know or have reason to believe present in this discharge from this outfall, as well as for any GC/MS fractions and metals required- - -- --- -- --- . -----· -� ... - ·-· --- ---···-·""'-·

Make as many copies af this table as Parameter name: Pan,meter name: necessary for each outfall. You can list the results from 24 sampling dates 1,2-dichloroethylenE Trichloroethylene on each copy of this page.

Page 1 Of 1 CAS Number: CAS Number:

156-59-2 79-01-6

Flow rate Concentration Concentration Date Units: Units: ug/L Units: ug/L

5/3/2016 MW-1 29 33

Pan,meter name: Pan,meter name: Parameter name: Pan,meter name: Pammetername:

CASNumber: CASNumber: CASNumber: CASNumber: CAS Number:

Concentration Concentration Concentration Concentration Concentration

Units: Units: Units: Units: Units:

Form NY-2� (12/98)- Section II Forms


Page 1




1. Outfall Number and LocationOutfall No.:

003

Latitude 40 ° 35

Longitude 51 " -73 ° 45

l Receiving Water I 38" Norton Basin Through MS4 Outfall ROC-651

2. Type of Discharge and Discharge Rate (List all information applicable to this outfall)

Units

Other

Units

Other Volume/Flow MGD GPM (specify) Volume/Flow MGD GPM (specify)



c. Process Wastewater h. Boiler Blowdown

d. Process Wastewater I. Storm Water

e. Contact Cooling Water j, Sanitary Wastewater

k. Other discharge (specify): Construction Excavation Dewatering 2,240 X


3. List process information for the Process Wastewater streams identified In 2.a-d above:a. Name of the process contributing to the discharge N/A Process SIC code:


Subcategory

b. Name of the process contributing to the discharge Process SIC code:


Subcategory

c. Name of the process contl'ibuling to the discharge Process SIC code:


Subcategory

d. Name of the process contributing to the discharge Process SIC code:


Subcategory

4. Expected or Proposed Discharge Flow Rates for this outfall:a. Total Annual Discharge b. Daily Minimum Flow c. Daily Average Flow d. Daily Maximum Flow e. Maximum Design flow rate

1175 MG 3.22 MGD 3.22 MGD 3.22 MGD 4.0 MGD

Fonn NY-2<;: (12/98)- Section II Forms


Outfall No.: 003

I Facility Name: Construction of Storm Sewers, Sanitary Sewers and Water Mains in New Haven Avenue, etc.

5. Is this a seasonal discharge?� YES - Complete the following table.


Discharge frequency Operations contributing flow (list) Batches Duration Flow rate per day

6. Water Supply Source (Indicate all that apply)

per year per batch LTA Daily Max

SPDES Number:


discharge








In the streambank: [RJ Discharge to MS4 outfall through a storm sewer


GPD

GPD

GPD

GPO

Page2

Duration (Days)

GPM

GPM

GPM

GPM


Discharge Is equipped with diffuser: D Attach description, including configuration and plan drawing of diffuser, If used.

B. If located In a stream, approximately what percentage of stream width from shore is the discharge point located?

10%0 25%0 50%0 Other:�-------�

C. If located in a stream, describe the stream geometry in the general vicinity of the discharge point, under low flow conditions:

Stream width Stream depth

Feet

Stream velocity Are the results of a mixing/diffusion study attached? D YES

Feet Feet/Sec ONO


Fqrm NY-2C (12/98)- Section II Forms





Page 3

Outfall No.: 003

SPDES Number:

Is your facility one of the applicable types of facilities listed in the instructions, and does the temperature of this discharge exceed the receiving watertemperature by greater than three (3) degrees Fahrenheit?

[:=J YES • Complete the following table.

[][J NO - Go to Item 9. below.

CJ lnfonnatlon on the Intake and discharge configuration of this outfall Is attached.

Discher e Temperature, deg. F Duration of Dates of maximum Average Maximum maximum discharge discharge Maximum Discharge configuration (e.g. subsurface, surface, change in change in temperature temperature flow rate effluent diffuser, diffusion well, etc.)

temperature temperature Maximum hours per days per (delta T) (delta T) temperature day year From To MGD

9. Are any water treament chemicals or additives that are used by your faclllty subsequently discharged throughthis outfall?

CJ YES - Complete the following table and complete pages 1 of 3 and 2 of 3 of Form WTCFX for each water treatment chemical listed.

[KJ NO - Go to Item 10. below.


10. Has any biological test for acute or chronic toxicity been performed on this outfall or on the receivingwater in relation to this outfall in the past three (3) years?

� YES - Complete the following table.

[:KJ NO - Go to Item 11. on the following page.

Water tested Purpose of test Type of test Chronic Subject species Testino date(sl Submitted? or Acute? Start Finish (Date)

Form NY-2q (12/98)- Section II Forms


I Facmty Name: Construction of Storm Sewers, Sanitary Sewers


Page4

Outfall No.: 003

SPDES Number:

11. ls the discharge from this outfall treated to remove process wastes, water treatment additives, or other pollutants?� YES - Complete the following table. Treatment oodes are listed in Table 4.

j==1 NO. Go to Item 12 below.

Treatment Design Flow Rate Treatment process Code(s) Treatment used for the removal of: (include units)


12. Does this facility have either a compliance agreement with a regulating agency, or have planned changes in�ction, which wlll materially alter the quantity and/or quallty of the discharge from this outfall?� YES • Complete the following table.

� NO - Go to Section Ill on the following page.

Description of project Subject to Condition or Agreement in Change due to Completion Date(s) existing permit or oonsent order? (List) production increase? Required Projected


::;ewers ana water Mams in for MS4 Outfall ROC-651 New Haven Avenue. etc

on Norton Basin

This completes Section II of the SPDES Industrial Application Form NY-2C. Section I, which requires general Information regarding your faclllty, and Section Ill, which requires sampling Information for each of the outfalls at



1. Sampling Information - Conventional Parameters


Section Ill - Sampling Information

SPDES No.:

Page 1

Outfall No.: 003

Provide the analytical results of at least one analysis for every pollutant in this table. If this outfall is subject to a waiver as listed in Table 5 of the instructions for one or more of the parameters listed,_ ..... , ... --··-- ......... -·-·-· ... �, .... 1,, ...... _,_ ••• .. _.., _,._ ,,_LO_n ·-· -··- .. , .... _ -· --- ..

PLEASE PRINT OR TYPE IN THE UNSHADED AREAS ONLY. You mav reoort some or all of this Information on seoarate sheets (usinq tha same format) instead of comoletino this ruane.Effluent data Units Intake da!a (optional)

Pollutant a Maxmum daiy""1ue b. Maximum 30 day value C. Long 1111m average d. Nurmerof a. Concanlndlon b. Mass ' a. Long tenn average value

1. Ccncenlnltion 2. Mass 1. Concentration 2.Mass 1. Concentration 2. Mass analysas

a. Biochemical Oxygen Demand,5 day (BOD)

b. Chemical Oxygen Demand(COD)

c. Total Suspended Solids 32.4 (TSS}

d. Total Dissolved Solids (TDS)

e. Oil & Grease<0.541

f. Chlorine, TotalResidual(TRC)

g. Total Organic Nitrogen(TON)

h. Ammonia (as N)

i. Flow Value Value Value 3.22

j. Temperature, winter Value Value Value

k. Temperature, summer Value Value Value 55.4

I.pH Minimum Mn!mum Minimum Maximum

7.2

2. Sampling Information - Priority Pollutants, Toxic Pollutants, and Hazardous Substancesa. Primary lnduslrles: I. Does the discharge from this outfall contain process wastewater? � Yes - Go to Item II. below.

IT] No - Go to Item b. below.

1. Concenlration

mg/L

mg/L

MGD Value

0 Value F

OF Value

�lmum

II. Indicate which GC/MS fractions have been tested for: Volatiles: CJ Acid: CJ Base/Neutral: CJ Pesticide: CJ

b. All appllcants: I. Do you know or have reason to believe that any of the pollutants listed in Tables 6, 7, or 8 of the Instructions are present in the discha!ge from this outfall?

C:=J Yes - Concentration and mass data attached.

[KJ No - Go to Item II. below.

IL Do you know or have reason to believe that any of the pollutants listed in Table 9 § Yes - Source or reason for presence in discharge attached or Table 10 of the Instructions, or any other toxic, harmful, or Injurious chemical y _ Q ntitative lltative data attached substances not listed in Tables 6-10, are present in the discharge from this outfall? es ua or qua

X No

2. Mass

I�

b. Number of analysao


Facility Name:


SPDESNo.:

3. Projected Effluent Quality - Priority Pollutants, Toxic Pollutants, and Hazardous Substances

Page2

Outfall No.: 003

Provide analytical results of at least one analysis for each pollutant that you know or have reason to believe is present in this discharge, as well as for any GC/MS fractions and metals required to be sampled from Section Ill Fonns, Item 2.a on the preceding page.

List the name and CAS number for each pollutant that you know or have reason to believe is present in the discharge from this outfall. For each pollutant listed from Tables 6, 7, Page 1 of 1 or 8, provide the results of at least one analysis for that pollutant, and detennine the mass discharge based on the flow rate reported in Item 1.i. For each pollutant listed from Table 9, or any other toxic poUutant not listed in Tables 6-10, you must provide concentration and mass data (if available) and/or an explanation for their presence in the discharge. Make as many copies of this table as necessary for each outfall.

Pollutant and CAS Number Effluent data Units Intake data (optional) Believed

a. Maximum clailyvalua b. Mmnwn 30 day""""' (N- c. Long 1111m 1M1111g& val"" fl' d.Numberol a. COncan- b. Mass a Long term !Mirage vabl d. Number al present, no

IIV8i/eble) 11vtiiabk1) analyses lralion analyses sampr,ng

1'89Ulls (1)Concen- (2)Mass (1)COncan- (2)Mass {1)Concen- (2)Mass (1)Concen- (2)Mass available - lralion tration tration

CAS Number: mg/L

Chromium 7440-47-3 0.010 mg/L

CASNumber:

Copper 0.005 mg/L CAS Number: 7440-50-8

Nickel 0.008

CAS Number: 7440-02-0 mg/L

Lead <0.003

CAS Number: 7439-92-1 mg/L

Zinc 0.0308 mg/L


CAS Number:

CASNumber:

CAS Number:

CAS Number:

CAS Number:

CAS Number:

CAS Number:

Form NY-2C (12/98) - Section Ill Forms

Facility Name: Construction o·

and Water Mai


SPDESNo.:

4. Existing Effluent Quality - Priority Pollutants, Toxic Pollutants, and Hazardous Substances

Page3

Outfall No.: 003

Provide analytical results for the last three (3) years for each pollutant that you know or have reason to believe present in this discharge from this outfall, as well as for any GC/MS fractions and metals required

"""' .., .... -.,q,, ... , ......... ·''""''' _...., ................. _,, ...... , ......... -............ .......... -·· ........... ,.,.. ..

Make as many copies of this table as Para-name: Parameter name: Paranaername: Parameter name: Parameter name: Parameter name: Para-name:

necessary for each outfall. You can Tetrachloroethylen e list the results from 24 sampling dates

on each copy of this page.

Page 1 Of 1 CAS Number: CAS Number: CASNumber. CASNumber. CAS Number: CASNumber. CAS N..nber.

127-18-4

Flow rate Concentration Concentration Concentration Concentration Concentration Concentration Concentration Date Units: Units: ug/L Units: Units: Units: Units: Units: Units:

5/3/2016 MW-2 4.7

Discharge Monitoring Report (DMR) Signature Authorization Form

Pennittee Name New York City Department of Design and Construction SPDES NO. ------------

Facility Name Construction of Storm Sewers, Sanitary Sewers Date ______________ _ and Water Mains in New Haven Avenue, etc.

Name of person described in paragraph (1), (2) or (3): Title: Jean M. Jean-Louis Assistant Commissioner

Date: o?J/2.:J/t 7

THE PERMITTEE MUST NOTIFY THE DEPARTMENT OF ANY CHANGE IN THIS INFORMATION DURING THE LIFE OF THE PERMIT

Name and/or Title of person responsible for signing and submitting DMR's: Donna J. Cettina, Sr Project Manager

Mailing Name: CAC Industries Inc.

Mailing Address: 54-08 Vernon Blvd

Name and/or Title of person responsible for signing and submitting DMR's:

Mailing Name: Mailing Address:





Return To: SPDES Compliance Information Section Bureau of Water Compliance Programs

Phone: ( 347) 619-5866

City: Long Island City

Phone: ( )

City:

Phone: ( )

City:

Phone: ( )

City:

New York State Department of Environmental Conservation 625 Broadway Albany, NY 12233-3506

A-15

I State:

NY I ZipCode:

11101

I State: I Zip Code:

I State:

I ZipCode:

I State: I ZipCode:

PR_O_JECT SUMMARY

Project Name & No.

Scope of Work

Construction of Storm Sewers, Sanitny Sewers and Water Mains in New Haven Avenne, etc. , Qneens, New York 11691 (NYCDDC Project ID: SEQ200524)

Header pipes will convey groundwater from individual wells to the settling tank. The discharge from the tank will enter the existing storm sewers by way of a temporary connection. The dewatering pumps, header pipe and settling tank will be relocated with

Notes

CALCUUI.TIONS FOR P001 & POD2 MAXIMUM FLOVV RATI: INSIDE THE EXISTING 6' -i"X4'-6" STORM SEWER Slope:

-S-; '0.0013

Area of Sev...r in fl2: A =rrHW A= 22.96 Hfdrau!ic Radius in feet = Area of pipe/Perimeter Mamin_g's coeffieient n (NYCDEP approwd \Glue is 0,013)_

FlowVelflcily in II/sec: V = {(1.486)•(Hr):n.(S),,.}/n Flow Volume in cts: Q = A·v

Flow Volume in gpm: Q ri cts• 448.8

Flow Ralia in �

CALC\ILATIONS FOR f>Q_D3

Hr= n=

V=

01nc1s =

a .. ....,=

Flow Ratio=

1.33 0.013

4.98

114.43 61,368 4.4%

"MAXIMUM FLOW RATI: INSIDE THE EXISTlNG 10'-6".JW'-6' STORM SEWER Slope:

-S-;- '0.0013

l\r<>..a of Se'M!r in ft2: A =n:HW A= 37.09 Hydraulic Radius in feet = Area of pipe/Perimeter Maming's coefficient n (NYCDEP approYed val.le is 0.013)

Flow Velocity in II/sec: V = {(1.486)'(Hr),,,.(S}"'}ln FlowVol.Jme in cfs: Q = A·v

Flow Vol.Jme in gpm: Q in cts· 448.8

Flcv,,Ratio in

FLOW RATI: IN TEMPORARY12" DISCHARGE PIPE Slope

Area of pipe in 112: A= 3.1416'r2 H;>a-auic Radius in feet= Area of pipe/Perimeter= r/2 Manning's.coefficient n (NYCDEP approwd vaue is 0.013)

FlowVelocily in fl/sec: V = {(1.486)"(Hr).,,.(S)"'}ln RowVoune in cfs: Q = A'V

Flew Voune in gpm: Q in cts• 448.8

Flew Ratio in

Hr= n= V= 01nc1a =

01ngpm=

Flow Ratio=

S= A=

Hr= n= V=

0sid's =

1.58 0.013

5.58 206.97

92,888 2.4%

'0.10 0.79

0.25 0.013

14.34

11.26 5,054

44,3"/,

Flow from individual wells will be discharged to a settling tank before conveyance to the point of discharge

DEWATERING PLAN

FOR NEW HA VEN A VENUE, ETC. PROJECT, QUEENS

December 7, 2016 Fuad F. Adib, P.E.

C.A.C. Industries, Inc.54-08 Vernon BlvdLong Island City, NY 11101

PE License No. 078921 Applemon Corporation 151 S. Mountain Road New City, NY 10956 Tel (845) 634-0858

This plan 1s prepared based on lhe infonnation provided by other3 and reasonable engineering assumptions. The reeonuncndations c:rcpressed in this plan .vc nol an opinion concerning the complkmce of any past or present o\\ner or operator of the sile wilh any federal. state or locaJ law or regulation No �ty or guaJ"3ntec. v.-tielher express or implied, 1s roode with respect to 1he data reported or conclusions expressed in lhis plan. The project construction manager :rid thereabouts the project o,mer hereby agree to indenmify and to Sa\'e harmless Appleman Corporation end hs prof�ionals from and against any and all claims. suits, actions. proceedings, and losses that may arise after the d:ite of this agreement from the construction, maintenance, oper3tion. or use of any equipment (direct or indirect) for the purpose of dewatering ill tlus location In addition it is noted th:i.t Appleman is held h:mnless due lo any h.irmful side effects of lowering lhe Willer table such as but not limited to impact of drawdown on the perimeter of the site, salt waler intrusion, movement of contaminated groundlll.lter. back flow due to surcharge of outlet sewer and effect on any wed3nds. Monitoring procedures for securing adjacent structures against any impaclS dming dewalering such as settlement and fomwion of cracks should be adopted.

December 7, 2016

Mr. Stephen Watts Deputy Regional Permit Administrator New York State Department of Environmental Conservation 4 7-40 21st Street, 2nd Floor Long Island City, New York, 11101

Re: Groundwater pH Measurement Construction of Storm Sewers, Sanitary Sewers and Water Mains in New Haven Avenue, etc. Queens, New York 11691 NYCDDC Project ID: SEQ200524

Dear Mr. Watts:

pH of groundwater was measured at the above location on May 3, 2016 according to the followings:

pH of groundwater at the time of sampling was 7. 8 and 7 .2 for MW-1 and MW-2, respectively.

Please do not hesitate to contact me if you have any questions.

Sincerely,

Fuad F. Adib, Ph.D., P.E. Project Engineer

Applemon Corporation 151 S. Mountain Rd., New City, NY 10956 Phone: (845) 634-0858 Fax: (845) 634-7398 Visit us at: www.applemon.com

CT Cert. No. PH-0723

120 RESEARCH DRIVE

Technical Report

prepared for:

Applemon Corporation 151 S. Mountain Road

New City NY, 10956

Attention: Fuad Adib

Report Date: 05/11/2016

Client Project ID: New Haven Ave Queens

York Project (SDG) No.: 16E0100

New Jersey Ce,t. No. CT-005 New York Cert No. 10854

STRATFORD, CT 06615 (203) 325-1371

PA Cert. No. 68-04440

FAX (203) 357-0166

Page 1 of 14

Purpose and Results

Report Date: 05/11/2016

Client Project ID: New Haven Ave Queens

York Project (SDG) No.: 16E0100

Applemon Corporation

151 S. Mountain Road

New City NY, 10956

Attention: Fuad Adib

This report contains the analytical data for the sample(s) identified on the attached chain-of-custody received in our laboratory

on May 04, 2016 and listed below. The project was identified as your project: New Haven Ave Queens.

The analyses were conducted utilizing appropriate EPA, Standard Methods, and ASTM methods as detailed in the data

summary tables.

All samples were received in proper condition meeting the customary acceptance requirements for environmental samples

except those indicated under the Notes section of this report.

All analyses met the method and laboratory standard operating procedure requirements except as indicated by any data flags,

the meaning of which are explained in the attachment to this report, and case narrative if applicable.

The results of the analyses, which are all reported on dry weight basis (soils) unless otherwise noted, are detailed in the

following pages.

Please contact Client Services at 203.325.1371 with any questions regarding this report.

York Sample ID

16E0100-0l

16E0100-02

Cli.enf Sample 1D

MW-I

MW-2

General. Notes for York Project (SDG) No.: 16E0100

Matrix

Water

Water

Date Collected

05/03/2016

05/03/2016

Date Received

05/04/2016

05/04/2016

1. The RLs and MDLs (Reporting Limit and Method Detection Limit respectively) reported are adjusted for any dilution necessary due to

the levels of target and/or non-target analytes and matrix interference. The RL(REPORTING LIMIT} is based upon the lowest

standard utilized for the calibration where applicable.

2. Samples are retained for a period of thirty days after submittal ofreport, unless other arrangements are made.

3. York's liability for the above data is limited to the dollar value paid to York for the referenced project.

4. This report shall not be reproduced without the written approval ofYorkAnalytical Laboratories, Inc.

5. All samples were received in proper condition for analysis with proper documentation, unless otherwise noted.

6. All analyses conducted met method or Laboratory SOP requirements. See the Qualifiers and/or Narrative sections for further information.

7. It is noted that no analyses reported herein were subcontracted to another laboratory, unless noted in the report.

8. This report reflects results that relate only to the samples submitted on the attached chain-of-custody form(s) received by York.

Approved By:

Benjamin Gulizia

Laboratory Director

Date: 05/11/2016

II

Page 2 of 14

Clien! Sam11le ID: MW-I

York Project (SDG) No.

16E0I00

Volatile Ori:nnics, 601/602/MTHE Li.st

Semple Prepared by Method: EPA 5030B

CASNo. Parameler

71-55-6 I, I, 1-Trichloroethane

79-34-5 I, 1,2,2-Tetrachloroethane

79-00-5 I, 1,2-Trichloroethane

75-34-3 I, 1-Dichloroethane

75-35-4 I, 1-Dichloroethylene

95-50-1 1,2-Dichlorobenzene

107-06-2 1,2-Dichloroethane

78-87-5 1,2-Dichloropropane


I 06-46-7 1,4-Dichlorobenzene

110-75-8 2-Chloroethylvinyl ether

71-43-2 Benzene

75-27-4 Bromodichloromethane

75-25-2 Bromofotm

74-83-9 Brom om ethane

56-23-5 Carbon tetrachloride

108-90-7 Chlorobenzene

75-00-3 Chloroethane

67-66-3 Chlorofonn

74-87-3 Chloromethane

156-59-2 tis-1,2-Dichloroetbylene

120 RESEARCH DRIVE

Sample Information

Clienl Pro1ect ID

New Haven Ave Queens

Result Flag Units

ND ug/L

ND ug/L

ND ug/L

ND ug/L

ND ug/L

ND ug/L

ND ug/L

ND ug/L

ND ug/L

ND ug/L

ND VOA-R ug/L

EAC

ND ug/L

ND ug/L

ND ug/L

ND ug/L

ND ug/L

ND ug/L

ND ug/L

ND usn.

ND ug/L

29 ug/L

J.,oi:-in Notes:

�porttd to

LOD/MDL LOQ

1 2 5.0

1 2 5.0

1.2 5.0

1.2 5.0

1.6 5.0

1.2 5.0

1.2 5.0

1.5 5.0

I.I 5.0

1.2 5.0

2.1 20

1.3 5.0

1.2 5.0

1.3 5.0

4.2 5.0

1.4 5.0

1.2 5.0

].3 5.0

1.1 5.0

0.96 5.0

0.89 5.0

Matrix

Water

York Samnle.ID:

Collection Datcfl'jme

May 3, 2016 5:00 pm

16E0IO0-0l

Date Received

05/04/2016

Satn(!le Notes:

Dateffime Dateffime Dilution Reference Method Prepared Analyzed Analyst

EPA624 05/06/2016 08:42 05/06/2016 13:53 ss

Certifications: CTDOH,NELAC-NY 10854,NJDEP,PADEP

E PA624 05/06/2016 08:42 05/06/2016 13:53 ss

Certifications: CTDOH,NELAC-NYI0854,NJDEP,PADEP

EPA624 05/06/2016 08:42 05/06/2016 13:53 ss

Certifications: CTDOH,NELAC-NYI0854,NIDEP,PADEP

EPA624 05/06/2016 08:42 05/06/2016 13:53 ss

Certifications CTDOH,NELAC-NY l 0854,NIDEP.PADEP

EPA624 05/06/2016 08:42 05/06/2016 13:53 ss Certifications: CTDOH,NELAC-NY 10854,NIDEP,PADEP

EPA624 05/06/2016 08:42 05/06/2016 13:53 ss

Certifications: CTDOH,NELAC•NYl0854,NJDEP,PAOEP

EPA624 05/06/2016 08:42 05/06/2016 13:53 ss

Certifications: CTDOH,NELAC-NYI0854,NJDEP.PADEP

EPA624 05/06/2016 08:42 05/06/2016 JJ:53 ss

Certifications: CTDOH.NELAC-NYl0854,NJDEP.PADEP

EPA 624 0l/06/2(116 (18:42 05/()6/2016 l3:l3 ss

Certifications: CTDOH,NELAC•NY I 0854,NJDEP,PADEP

EPA624 05/06/2016 08:42 05/06/2016 13:53 ss

Certificatio11s: CTDOH.NELAC·NY I 0854,NJDEP,PADEP

EPA 624 05/06/1016 08:42 05/06/2016 13:53 ss

Certifications: NELAC-NYI0854,NIDEP,PADEP

EPA624 05/06/2016 08:42 05/06/2016 13:53 ss


EPA 624 05/06/20 I 6 08:42 05/06/2016 13:53 ss

Certifications: CTDOH,NELAC·NY I 0854 ,NJDEP, PADEP

EPA 624 05/06/2016 08:42 05/06/2016 13:53 ss

Certifications: CTDOH,NELAC-NY I 0854,NJDEP,PADEP

EPA624 05/06/2016 08:42 05/06/2016 13:53 ss Certifications: CTDOH,NELAC-NY 10854,NlDEP,PADEP

EPA 624 05/06/2016 08:42 05/06/2016 13:53 ss Ccrtificalions; CTDOH.NELAC-NY I 0854,NlDEP,PADEP

EPA 624 05/06/2016 08:42 05/06/2016 13:5) ss


EPA 624 05/06/2016 08:42 05/06/2016 13:ll ss

Certifications: CTDOH,NELAC-NY l 0854,NlDEP,PADEP

EPA624 05/06/2016 08:42 05/06/2016 13:5) ss

Certifications; CTDOH,NELAC-NYI0854,NlDEP,PADEP

EPA 624 05/06/2016 08:42 05/06/2016 13:5) ss


EPA624 05/06/2016 08:42 05/06/2016 13:53 ss

Certifications: CTDOH,NELAC-NY10854,NJDEP

STRATFORD, CT 06615 (203) 325-1371 FAX (203) 357-01 GS

I Page 3 of 14

Client omplt ID: MW-1

York Project (SDG) No.

16E0I00

Volatile Organics, 601/602/MTRE LL�•·

Sample Prepared by Method: EPA 5030B

CASNo. Parameter

10061-01-5 cis-1,3-Dichloropropylene

124-48-1 Dibrornochloromethane

75-71-8 Dich\orodifluoromethane

100-41-4 Ethyl Benzene

1634-04-4 Methyl tert-butyl ether (MTBE)

75-09-2 Methylene chlmide

95-47-6 o-Xylene

179601-23-I p- & m- Xylenes

127-18-4 Tetrachloroethyle,,e

108-88-3 Toluene

156-60-5 trans-1,2-Dichloroethylene

10061-02-6 trans-1,3-Dichloropropylene

79-01-6 Tricbloroethylene

75-69-4 T1 ichlornfluoromethane

75-01-4 Vinyl Chlodde

1330-20-7 Xylenes, Total

Surrogate Recoveries

I 7060-07-0 Surrogate: 1,2-Dich/oroethane-d.J

2037-26-5 Sur/'Ogate: Toluene-d8

460-00-4 Surroga/e: p-Bromoj/11oroheuze11e

Melols, Prlol'ily Pollutant in Wnslcwaler

Sample PrepB1ed by Method: EPA 200 7

CASNo. Parameter

7440-36-0 Antimony

120 RESEARCH DRIVE

Sample Information

Clien\ Project LP


Result Flag Units

ND ug/L

ND ug/L

ND ug/L

J.4 ug/L

1.5 ug/L

ND ug/L

ND ug/L

ND ug/L

ND ug/L

1.3 ug/L

ND ug/L

ND ug/L

33 ug/L

ND ug/L

ND ug/L

ND ug/L

Log-in Noles:

Reported to LOD/MDL LOQ

1.2 5.0

l.l 5,0

3.3 5.0

l.2 5,0

0.53 S.0

2,l 10

I.) s.o

2.3 10

3.3 5,0

0,81 so

3,5 S.O

1.3 S.0

1.2 5.0

1.4 5,0

l.3 5.0

3.4 IS

Matrix

Water

York Sample TD:

Collection !Jatt•/Timc

May 3, 2016 5:00 pm

16E0100-01

Date Received

05/04/2016

Sample Noles:


EPA624 0S/0612016 08:42 0S/06/2016 13:53 ss


EPA624 05/06/2016 08:42 0S/0612016 13:53 ss

Certifications: CTDOH,NELAC•NYI0854,NJDEP,PADEP

EPA624 05/06/2016 08:42 05/06/2016 13:53 ss

Ct:rtifications: NELAC-NYI0854.NJDEP

EPA624 0S/0612016 08:42 05/06/2016 13:53 ss

Certifications: CTDOH,NELAC,NYI0854,NJDEP,PADEP

EPA624 05/06/2016 08:42 0S/0612016 13:53 ss


EPA624 05/06/2016 08:42 05/06/2016 13:53 ss


EPA624 05/06/2016 08:42 05/06/2016 13:53 ss

Certifications: CTDOH,NELAC-NY I 0854,NJDEP

EPA624 05/06/2016 08:42 05/06/2016 13:53 ss

Ccrtific.itions: CTDOH,NELAC•NY 10854,NJDEP

EPA624 05/06/2016 08:42 05/06/2016 13:53 ss

Ctrtificalions: CTDOH,NELAC•NY I 0854 ,NJDEP,PADEP

EPA 624 05/06/2016 08:42 05/06/2016 13:53 ss

Certifu::ations CTDOH,NELAC-NYI0854,NJDEP,PADEP

EPA624 05/06/2016 08:42 05/06/2016 13:53 ss

Certifications: CTDOH,NELAC•NY 10854,NJDEP,PADEP

EPA624 0S/06/2016 08:42 05/06/2016 13:53 ss

Cer1ifit.ltions: CTDOH,NELAC-NY I 0854,NJDEP,PADEP

EPA624 05/06/2016 08:42 05/06/2016 13:53 ss

Certifications: CTDOH,NELAC-NY 10854.NJDEP,PADEP

EPA624 0S/06/2016 08:42 05/06/2016 13:53 ss

Certifications: CTDOH,NELAC-NY I 0854,NJDEP,PADEP

EPA624 0S/0612016 08:42 05106/2016 13:53 ss


EPA624 05/06/2016 08:42 0S/0612016 13:53 ss

Certifications: CTDOH,NELAC-NYI0854,NJDEP

Result Acceptance Range

105 %

9/J,0%

JOI%

Result Flag Units

ND mg/I..

STRATFORD, CT 06615

65-135

86-118

8/-JJ.I

Log-in N(lfe.�:

R.t!portcd 10 LOD/MDL LOQ Dilution

0.003 0 006

Sample Note

Reference Method Dateffime

Prepared Date/Time

Analyzed

0S/0S/2016 10:19 05/05/2016 18:47

Analyst

KV EPA 200 7 Certifications; CTDOH,NELAC-NYI0854,NJDEP,PADEP

(203) 325-1371 FAX (203) 35.,7-.. 0.,JG .. a ..... ____ _ I Page 4 of 14

lie111 Snmple U); MW-1

York Project {SPG\ No.

16E0I00

Melals, Prio.-itl'. Pollul'anl in Waslcw:tte.r

Semple Prepared by Method: EPA 200.7

CASNo. Parameter

7440-38-2 Arsenic

7440-41-7 Betyllium

7440-43-9 Cadmium

7440-47-3 Chromium

7440-50-8 Copper

7439-92-1 Lead

7440-02-0 Nickel

7782-49-2 Selenium

7440-22-4 Silver

7440-28-0 Thallium

7440-66-6 Zinc

Mercu1)'. b� EPA 245.J

Semple Prepared by Method: EPA 245, I Mercury

CASNo. Parameter

7439-97-6 Mercury

Toh1t SeWe11ble Solids (low-level}

Sample Prepared by Method: Analysis Preperation

CASNo. Parameter

To1al Settleable Solids

Tof11l Sus12cnded Solids (EPA}

Sample Prepared by Method:% Solids Prep

CASNo. Parameter

• Total Suspended Solids

120 RESEARCH DRIVE

Sample Information

Client Project ID


Result Flag Units

0.007 mg/L

ND mg/L

ND mg/L

0.015 mg/L

0.006 mg/I..

ND mg/L

0.008 mg/L

ND mg/l..

ND mg/L

ND mg/L

0.021 mg/L

Result Flag Units

ND mg/L

Result Flag Unils

ND mL/L

Result Flag Units

3.40 mg/L

Log-in Noles:

Reponed to LOD/MDL LOQ

0.003 0.004

0,001 0 001

0,003 0 003

0,001 0.006

0,001 0 003

0 .001 0.003

0,001 0 006

0 004 0 Oil

0,001 0 006

0,002 0,006

0.003 0,011

,Loi:;-in .Notes:

Rtpo11c:d 10

LOD/MDL LOQ

0.00009500 0 000200•

Log-In Notes:

Rcportcd1o LODIMDL LOQ

0.100 0 100

Log-in Notes:

LODIMDL Reponcd to

LOQ

2 00 2 00

York Sompfo ID: 16E0100-01

Matrix

Water

Collection Dateffime

May 3, 2016 5:00 pm

Date Rece-ivcd

05/04/2016

Sample Nplc�:

Date/Time Date/Time Dilution Rderence Method Prepared Analyzed Analyst

EPA200,7 05/05/2016 10:19 05105/2016 18:47 KV

Ci;:nifications: CTDOH,NELAC-NYI0854,NJDEP,PADEP

EPA200 7 05/05/2016 10:19 05/05/2016 18:47 KV

Certifications· cmoH,NELAC-NYl0854,NJDEP,PADEP

EPA200 7 05/05/201610:19 0S/05/2016 18:47 KV

Certifications· cmoH,NELAC-NY I 08S4,NJ DEP,PADEP

EPA200.7 05/05/201610:19 0S/0512016 18:47 KV

Certifications, CIDOH,NELAC-NY I 0854,NIDEP,PADEP

EPA200.7 05/05/201610:19 0510S12016 18:47 KV


EPA200,7 05/05/2016 I 0: 19 05/0S/2016 18:47 KV

Certifications: CTDOH.NELAC-NY I 0854 ,NIDEP,PADEP

EPA200.7 05/05/2016 10:19 05/05/2016 18:47 KV


EPA 200 7 05/05/2016 I0:19 05105/2016 18:47 KV

Ce1tifications: CTDOH,NELAC-NY 10854,NJDEP,PADEP

EPA200 7 05/0512016 IU: 19 0l/0512016 18:47 KV

Certificalions: cmoH ,NELAC-NY 10854,NJDEP,PADEP

EPA200,7 05/05/201610:19 05/0S/2016 18:47 KV

Certifications: CTDOH,NELAC-NYI0854,NJDEP.PADEP

EPA200 7 05/05/2016 10:19 0l/05/2016 18:47 KV

Certifications: cmoH.NELAC-NY 108S4.NIDEP,PADEP

S111nl!le Notes:

Date/Time Date/Tim, Dilution Reference Method Prepared Analyzed Analyst

EPA24l.l 05/04/2016 21:30 05/0412016 21:30 AA

Certifications: CTDOH,NELAC-NY 10854,NIDEP.PADEP

Saml!le Notes:

Date/Time Date/Time Dilution Reference Method Prepared Analyzed Analyst

SM 2540F 05/04/2016 23:56 05105/2016 01:03 AA Certifications: NELAC-NY I 0854,NIDEP,PADEP

Sa.mule Notes:

Date/Time Date/Time Dilution Reference Method Prepared Analyzed Analyst

EPA 160.2 05/05/2016 16:20 05/06/2016 00:52 AA Certificotions:

STRATFORD, CT 06615 (203) 325-1371 FAX(203)357.,.

-_,0

,_J§

.i8 .... ____ _

! Page 5 of 14

.lie11t Sample .ID; MW-I

York Prnjeot {SDG\ No.

J6E0I00

Nitrate+ Nih"ite a. itrogcn

Sample Prepared by Method: Method Specific

CASNo. Parameter

Nitrate+ Nitrite Calculated Analytc

itrahi + Nil'l·itt Nitrogen as N

San1ple Prepared by Method: EPA 300

CAS No. Parameter

14797-55-8 Nitrate as N

14797-65-0 Nitrite as N

Oil & Grease

Sample Prepared by Method: Analysis Preparation

CASNo. Parameter

OILGREASE Oil & Grease

Client S11mplt JD: MW-2

York Project fSDG} No.

16E0100

Volalilc Om:rnie. 1 60'1/602/MT.BE Lis!


CASNo. Parameter

71-55-6 1,1, I-Trichloroethane

79-34-5 I, 1,2,2-Tetrachloroethane

79-00-5 I, 1.2-Trichloroethane

75-34-3 l, 1-Dichloroethane

75-35-4 1,1-Dichloroethylene

95-50-1 1,2-Dichlo, a benzene

120 RESEARCH DRIVE

Sample Information

lient Project ID


Result Flag Units

5.20 mg/L

Result Flag Units

5.20 mg/L

ND n,g/L

Result Flag Units

ND mg/L

16EOIOO-Ol

Matrix

Water

York 11111ple .ID;

ol lcction Date/Time

May 3, 2016 5:00 pm

Date Received

05/04/2016

Log-in Notes:

Reported to

LOD/MDL LOQ

0 0210 0 JOO

Log-in Note,:

Repo1tcd to LOD/MDL LOQ

0 _0120 0,0500

0 00900 0 0500

Log-in Notes:

Report�d 10

Dilution

Dilulion

LOD/MDL LOQ Dilution

0 541 0 541

Snmplt Notes:

Reference Method

Nitrite Nitrate Caci Certifications:

Sample Notes:

Reference Method

Date/Time Prepared

05/04/20!6 18:20

Date/Time Prepared

EPA 300,0 05/(>l/2016 18:20

Date/Time Analyzed

05/04/2016 18:20

Date/Time Analyzed

05/04/2016 18:20 Ccrtificatiot1s: NELAC-NY I 0854, CIDOH,NJDEP,PADEP

EPA 300 o 05/04/2016 18:20 05/04/2016 18:20 Certifications: NELAC-NY I 0854, CIDOH,NJDEP,PADEP

'ample Notes:

Reference Method Dat<ffime

Prepared Date/Time

Analyzed

05/09/2016 16: 16 05/10/2016 00:47 EPA 1664A Certifications: NELAC-NYJ0854, CTDOH,NJDEP,PADEP

Analyst

AD

Analyst

AD

AD

Analyst

AA

Sample Information

Client Project ID New Haven Ave Queens

Result Flag Units

ND ug/L

ND ug/L

ND ug/L

ND ug/L

ND ug/L

ND ug/L

STRATFORD, CT 06615

Log-hi Notes:

Reported 10 LOD/MDL LOQ

I 2 5,0

1.2 5.0

1,2 5,0

1.2 l.0

L6 5.0

1.2 5,0

Matrix

Water

York SompJe JD:

Co!legt1011 Dute/rime

May 3, 2016 5:00 pm

16E0I00-02

Date Received

05/04/2016

Sample Notes:

Dilution Refereuce Method Date/Time

Prepared Date/Time

Analyzed

EPA624 Ccrtificalions:

EPA624 Certificario11s:

EPA624 Certifications:


EPA 624 Cc1tific11tions:


05/06/2016 08:42 05/06nOJ6 14: 19 CIDOH,NELAC-NY 10854,NJDEP,PADEP

0l/06/201608:42 05/06/2016 14:19 CIDOH,NELAC-NY 10854,N)DEP.PADEP

05/06/2016 08:42 05/06/2016 14:19 CIDOH NELAC-NY 10854,NJDEP.PADEP

05/06/2016 08:42 05/06/201614:19 CIDOH,NELAC-NY !0854 ,NJOEP,PADEP

05/06/201608:42 05/06/2016 14:19 CTDOH,NELAC-NY 10854,NJDEP.PADEP

0l/06/2016 08:42 05/06/2016 14:19 CTOOH,NELAC-NYl0854,NJDEP,PADEP

Analyst

ss

ss

ss

ss

ss

ss

(203) 325-1371 FAX (203) 35 .• 7.,-o_,_ss .... _____ _ I Page 6 of 14

Clie.nt Sample .rD: MW-2

York Project (SDGl Nn.

16E0I00

Volatile Organics, 60J/602/MTBE List


CASNo. Parameter

107-06-2 1,2-Dichloroethane

78-87-5 1,2-Dichloropropane


I 06-46-7 1,4-Dichlorobenzene

110-75-8 2-Chloroethylvinyl ether

71-43-2 Benzene

75-27-4 Bromodichloromethane

75-25-2 Bromofo1m

74-8]-9 Bromomethane

56-23-5 Carbon tetrachlo1ide

l08-90-7 Chlorobenzene

75-00-3 Chloroethane

67-66-3 Chlorofo•m

74-87-3 Chloromethane

I 56-59-2 cis-1,2-Dichloroethylene

10061-01-5 cis-1,3-Dichloropropylene

124-48-1 Dibromochloromethane

75-71-8 Dichlorodifluorornethane

100-41-4 Ethyl Benzene

1634-04-4 Methyl tert-butyl ether (MTBE)

75-09-2 Methylene chloride

95-47-6 o-Xylenc

120 RESEARCH DRIVE

Sample Information

Client Project lD


Result

ND

ND

ND

ND

ND

ND

ND

ND

ND

ND

ND

ND

ND

ND

ND

ND

ND

ND

ND

ND

ND

ND

Flag Units

ug/L

ug/L

ug/L

ug/L

VOA·R ug/L

EAC

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

.Log-iJ1 Notes:

Rcpor1ed to

LOD/MDL LOQ

l.2 5.0

1.5 5.0

l.l 5.0

1.2 5.0

2.1 20

1.3 5.0

l.2 5.0

1.3 5.0

4.2 5.0

l.4 5.0

1.2 5.0

1.3 5.0

I.I 5.0

0.96 5.0

0.89 5.0

l.2 5.0

I.I 5.0

l.3 5.0

l.2 5.0

0.53 5.0

2.1 10

I.I 5.0

Matrix

Water

York ample. m:

Collection Date/Time

May3,2016 5:00pm

16E0100-02

Dale Received

05/04/2016

Sample Notes:

Dilution Refer<ne< Mtlhod Date/Time

Prepared Date/Time

Analyzed

EPA624

Certifications:

EPA624

Certifications:

EPA624

Certifications:

EPA624

Certifications:

EPA624

Certifications:

EPA 624

Certifications:

EPA624

Certifications:

EPA624

Certifications:

EPA624

Certifications:

EPA624

Certifications:

EPA 624

Ct:rtificalions;

EPA624

Certifications:

EPA624

Ccrtifica1io11s

EPA624

Ct:rtificalions:

EPA624

Certifications:

EPA624

Certifica1ions·

EPA 624

CcrtificMions:

EPA624

Certifications:

EPA624

Certifications:

EPA624

Certifications:

EPA 624

Ccrtificatio11s:

EPA624

Certifications:

0510612016 08:42 05/0612016 14:19

CTDOH,NELAC-NYI0854,NJDEP,PADEP

05/06/2016 08:42 05/06/2016 14:19

CTDOH,NELAC-NY 10854,NJDEP,PADEP

05/06/2016 08:42 05/06/2016 14:19

CTDOH,NELAC-NYI0854.NJDEP,PADEP

05/06/2016 (18:42 05/06/2016 14: 19

CTDOH,NELAC-NYI0854.NJDEP,PADEP

05/06/2016 08:42 05/06/2016 14: 19

NELAC-NY I 0854.NJDEP,PADEP

05/06/2016 08:42 05/0612016 14:19

CTDOH,NELAC-NY I 0854 ,NJDEP,PADEP

05/06/2016 OR:42 05/06/2016 14: 19


05/06/2016 08:42 05/0612016 14:19


05/06/2016 08:42 05106/201614:19

CTDOH,NELAC-NYI0854,NJDEP.PADEP

05/06/2016 08:42 05/0612016 14:19


05/06/2016 08:42 05/06/2016 14:19

CTDOH,NELAC·NY I 0854 ,NJDEP,PADEP

05106/2016 08:42 05/06/2016 14:19

CTDOH,NELAC-NY I 0854,NJDEP,PA DEP

05/06/2016 08:42 05/06/2016 14:19

CTDOH,NELAC-NY10854,NJDEP,PADEP

05/0612016 08:42 05/061201614:19


05/0612016 08:42 05/06/2016 14:19

CTDOH,NELAC-NYI0854,NJDEP

05106/2016 08:42 05/06/2016 14:19

CTDOH,NELAC-NY 10854,NJDEP,PADEP

05/06/2016 08:42 05/06/201614:19


05/06/2016 08:42 05/06/2016 14:19

NELAC-NYI0854.NJDEP

05/06/2016 08:42 05/06/2016 14:19


05/06/2016 08:42 05/06/2016 14:19

CTDOH,NELAC-NYI0854,NJDEP.PADEP

05/06/2016 08:42 05/06/2016 14:19


05/06/2016 08:42 05/06/2016 14:19

CTDOH,NELAC-NYI08l4,NlDEP

Analyst

ss

ss

ss

ss

ss

ss

ss

ss

ss

ss

ss

ss

ss

ss

ss

ss

ss

ss

ss

ss

ss

ss

STRATFORD, CT 06615 (203) 325-1371 FAX(203)35r7-.o,.1s_e ______ _ ! Page 7 of 14

Cliinl Sample JD: MW-2

York Project (SDG) No,

16E0I00

olaHlc Organics, 601/602/MTBE ist


CAS No. Parameter

179601-23-1 p- & m- Xylenes

127-18-4

108-88-3

I 56-60-5

10061-02-6

79-01-6

75-69-4

75-01-4

1330-20-7

17060-07-0

2037-26-5

460-00-4

Tetrachloroethylene

Toluene

trans-1,2-Dichloroethy lene

n ans-1,3-Dichloropropylene

Trichloroethylene

Trichlorofluoromethane

Vinyl Chloride

Xylenes, Total

Surrogate Rrcoveries

Surroga/e: J,2-Dtchloroe/hane-d4

Surroga/e: Toluene-d8

Surrogalr.:: p-Bromofluorohcnzene

Metals, Priorit)'. Pollutant in Wastewac·er

Sample Prepared by Method: EPA 200 7

CASNo. Parameter

7440-36-0 Antimony

7440-38-2 Arsenic

7440-41-7 Be1yllium

7440-43-9 Cadmium

7440-47-3 Chromium

7440-50-8 Copper

7439-92-1 Lead

7440-02-0 Nickel

120 RESEARCH DRIVE

,. A .,-

-:r� V

YORK

Sample Information

Client prqjecl ID


Log-in Notes:

Reported 10

Result Flag Units LOD/MDL LOQ

ND ug/L 2.3 10

4.7 ug/L 3.3 5.0

ND ug/L 0.81 5.0

ND ug/L 3.5 5.0

ND ug/L 1.3 5.0

ND ug/L 1.2 5.0

ND ug/L 1.4 5.0

ND ug/L 1.3 5.0

ND ug/L 3.4 15

Result Acceptance Range

/05 % 65-135

97.l % 86-Jl8

104 % 81-11./

Log-in Notes:

Reported 10

Yol'k Ample ID: 16E0100-02

� Collection Dmc/:rimg

May 3, 2016 5:00 pm

Dnle Recc1vcd

05/04/2016 Water

Sample Notes:


EPA624 0l/06/2016 08:42 05/06/2016 14:19 ss

Certifications: CTDOH,NELAC-NY t 0854,NJDEP

EPA624 05/06/2016 08:42 05/06/2016 14:19 ss

Certifications: CTDOH,NELA C-NY I 0854 ,NJDEP,PADEP

EPA 624 05/06/2016 08:42 05/06/2016 14:19 ss


EPA624 05/06/2016 08:42 05/06/2016 14:19 ss

C�rtifications: CTDOH,NELAC-NY I 0854,NJDEP, PADEP

EPA 624 0l/06/2016 08:42 0l/06/2016 14: 19 ss

Certificacions: CTDOH,NELAC-NY 10854,NJDEP,PADEP

EPA624 05/06/2016 08:42 05/06/2016 !4:l9 ss

Certifications CIDOH,NELAC•NY 10854,NJDEP,PADEP

EPA624 05/06/2016 08:42 05/06/2016 14:19 ss

Certificalions: CTDOH,NELAC-NY I 0854,NIDEP,PADEP

EPA 624 05/06/2016 118:42 05/06/2016 14:!9 ss

C�rtificalions: CIDOH,NELAC-NY I 0854,NJDEP,PADEP

EPA 624 05/06/2016 08:42 05/06/2016 14:19 ss

Ccrtificatio11s: CIDOH,NELAC-NYI0854,NIDEP

Snmple Notes:

Result Flag Units LOD/MDL LOQ Dilution Reference Method Dateffime

Prepared Dateffime

Analyzed Analyst

ND mg/L

ND mg/L

ND mg/L

ND mg/L

0.010 mg/L

0.005 mg/L

ND mg/L

0.018 mg/L

,,

STRATFORD, CT 06615

0 003

0 003

0,001

0 003

0.001

0 001

0 001

0 001

0 006

0 004

0 001

0.003

0,006

0 003

0 003

0 006

EPA200 7

Certifications:

EPA 200.7

Certifications:

EPA200 7

Certifications:

EPA 200.7

Certifications:

EPA 200,7 Certifications:

EPA 200,7 Certifications:

EPA 200.7

c�r1ifications:

EPA 200 7 c�rtifications:

(203) 325-1371

05/05/2016 10:19 05/05/2016 18:53 KV

CTDOH,NELAC•NY I 0854,NJDEP,PADEP

05/05/2016 10:19 05/05/2016 18:53 KV

CTDOH,NELAC-NY I 0854,NJDEP,PADEP

05/05/2016 10:19 05/05/2016 18:53 KV

CTDOH,NELAC-NY I 0854,NJDEP,PADEP

05/05/2016 !0:19 05/05/2016 18:53 KV

CfDOH,NELAC-NY I 0854,NJDEP,PADEP

05/05/2016 I0:19 05/05/2016 18:53 KV CTDOH,NELAC-NYI0854,NJDEP,PADEP

05/05/2016 10:19 05/05/2016 18:53 KV CTDOH,NELAC•NY 10854,NJDEP,PADEP

05/05/2016 10:19 05/05/2016 18:53 KV

CTDOH,NELAC-NY I 0854 ,NIDEP,PADEP

05/05/2016 10:19 05/05/2016 18:53 KV CIDOH,NELAC-NYI0854,NlDEP,PADEP

FAX(203)35,.7-.,.0 .. 16�6-------. I Page 8 of 14

Clicul Sample ID: MW-2

York Project CSPGl No. 16E0J00

MctalB1 Priority Pollutant in Wa lewater

Sample Prepared by Method: EPA 200. 7

CAS No. Parameter

7782-49-2 Seleniwn

7440-22-4 Silver

7440-28-0 Thallium

7440-66-6 Zinc

Mercury by EPA 245.1

Sample Prepared by Method: EPA 245 I Mercury

CASNo. Parameter

7439-97-6 Mercury

1'otal Scttleable Solids (low-level}

Sample Prepa1ed by Method: Analysis Preparation

CASNo. Parameter

Tolal Settleable Solids

Total Sus11cndcd Solids (.EI'A}

Sample Prepared by Method: % Solids Prep

CASNo. Parameter

• Total Suspended Solids

Nitrate+ 'ilrile as Nitrogen

Sample Prepared by Method: Method Specific

CASNo. Parameter

Nitrate+ Nitrite Calculated Analyte

Nitrate+ Nitrite Nilrogen a

Sample P1epa,ed by Method: EPA 300

CASNo. Parameter

14797-55-8 Nitrate as N

120 RESEARCH DRIVE

Sample Information

licnt Project 10New Haven Ave Queens

Result Flag Units

ND mg/L

ND mg/L

0.012 mg/L

0.023 mg/L

Result Flag Units

ND mg/L

Result Flag Units

ND mL/L

Result Flag Units

32.4 m�/L

Result Flag Units

ND mg/L

Result Flag Units

ND mg/L

STRATFORD. CT 06615

Ynrk Sllmplc Jn: 16E0100-02

Matrix

Water

Collection Dateffime

May 3, 2016 5:00 pm

Date Received

05/04/2016

Log-in Notes:


0 004 0.011

0.001 0 006

0 002 0 006

0 003 0 011

Log-in Note

Reported to

LOD/MDL LOQ

0 .00009500 0.000200·

Loi:;-in Notes:


0 100 0 100

Log-in No1cfi:

Rtportt:d to LODIMDL LOQ

4 00 4,00

Log-in Noles:

Ri.:portt:d to

Dilution

Dilution

Dilution

Dilution


0 0210 0 100

Log-in Notes:

Reported to LOD/MDL LOQ Dilution

0 0120 0.0500

Sample Notes:

Date/Time Date/Time Reference Method Prepared Analyzed

EPA200.7 Ol/Ol/2016 10:19 05/0l/2016 18:l3

Certificalions· CTDOH,NELAC-NYI0854,NJDEP,PADEP

EPA200 7 05/0512016 JO: 19 Ol/05/2016 18:53

Certifications: CTDOH,NELAC-NYJ0854,NJDEP,PADEP

EPA200.7 05/05/2016 10:19 05/05/2016 18:53 Certifications: CTDOH,NELAC-NY 10854,NJDEP,PADEP

EPA200.7 05105/2016 I 0: 19 05/05/2016 18:53 Certificatious: CTDOH,NELAC-NY I 0854.NJDEP,PADEP

Saniplc Noles:

Reference Method

EPA245.1

Date/Time Prepared

05/04/2016 21:30

Date/Time Analyzed

Ol/0412016 21 :30

Certifications: CTDOH,NELAC-NY 10854 ,NJDEP,PADEP

Samnle Notes:

Date/Time Reference Method Prepared

SM 2540F 05/04/2016 23:56

Certifications: NELAC-NY 10854,NJDEP,PADEP

§amnlc Noles:

Rererence Method

EPA 160.2 Certifications:

Samnlc Notes:

Reference Method

Date/Time Prepared

05/05/2016 16:20

Date/Time Prepared

Date/Time Analyzed

05/05/2016 01:03

Date/Time Analyzed

05106/20 I 6 00: 52

Date/Time Analyzed

Ni1rite Nitrate Caci Certifications:

05/04/2016 18:38 Ol/0412016 18:38

Samnlc Notes:

Reference Method Date/Time

Prepared Date/Time

Analyzed

05/04/2016 18:38 Ol/041201618:38 EPA300.0 Certifications: NELAC-NY 10854,CTDOH,NIDEP,PADEP

Analyst

KV

KV

KV

KV

Analyst

AA

Analyst

AA

Analyst

AA

Analyst

AD

Analyst

AD

(203) 325-1371 FAX (203) 357.,-_.o..,1s .. a _____ _ I Page 9 of 14

Client Sam pl� ID: MW-2

York Pro1cci (SDG) No_

16EOIOO

Nitrate + Nitrite itrogcn as N

Sample Prepared by Method: EPA 300

CASNo. Parameter

14797-65-0 Nitrite as N

Oil & Grease

Sample Prepared by Method: Analysis Preparation

CASNo.

OILGREASE Oil & Grease

Parameter

120 RESEARCH DRIVE

Sample Information

Clien1 Project ID


Result Flag Units

ND mg/L

Result Flag Units

ND mg/L

STRATFORD, CT 06615

16E0100-02

Matrix

Water

Vork Sample ID:

ollcc1ion Date/rime

May 3, 2016 5:00 pm

Date Received

05/04/2016

Log-in Notes:

Reported to


0 00900 0 _0500

Log-in oles:

Reported lo


0 526 0.526

Snmpk Notes:

Date/Time Reference Method

Dateffime Prepared Analyzed Analyst

EPA 300 O OS/04/2016 18:38 05/04/2016 18:38

Certifications: NELAC-NYI0854,CIDOH,NJDEP,PADEP

S11mpk Notei,:

Dateffime

AD

Reference Method Date/Time

Prepared Analyzed Analyst

EPA 1664A 05/09/2016 16: 16 05/10/2016 00:47

Certifications: NELAC-NY10854,CIDOH,NJDEP,PADEP

AA

(203) 325-1371 FAX(203)357,.·..,01..;;B .. G _____ .,. I Page 10 of 14

Lab ID

l6E0I00-0l

l6E0I00-02

120 RESEARCH DRIVE

,, A _,.

=Q,,,-,tf, V �

YG!t)RJfi( ,111&1.1'1'1.:&L�..&�•-''t'VUtal•<"

Volatile Analysis Sample Containers

Client Sample ID

MW-I

MW-2

STRATFORD, CT 06615

Volatile Sample Container

40ml Clear Vial (pre-pres.) HCI; Cool to 4° C

40ml Clear Vial (pre-pres.) HCI; Cool to 4° C

(203) 325-1371 FAX (203) 36.,7-..,o,..,s_e _____ __ I Page 11 of 14

.... I, ./

�Q V

YORK

Notes and Definitions

VOA-REAC2-chloroethylvinyl ether readily breaks down

under acidic conditions. Samples that are acid preserved, including standards will exhibit breakdown. The data user should take note.

M-ACCB Ana\yte in CCB. Run is bracketed by acceptable CCBs.

J Detected below the Reporting Limit but greater than or equal to the Method Detection Limit (MDL/LOD) or in the case of a TIC, the

result is an estimated concentration.

Analyte is not certified or the state of the samples origination does not offer certification for the Analyte

ND NOT DETECTED - the analyte is not detected at the Reported to level (LOQ/RL or LOD/MDL)

RL REPORTING LIMIT - the minimum repottable value based upon the lowest point in the analyte calib1ation cwve.

LOQ LIMIT OF QUANTITATION - the minimum concentration of a target analyte that can be repo1ted within a specified degree of confidence. This is the lowest point in an analyte calibration curve that has been subjected to all steps of the processing/analysis and verified to meet defined criteria. This is

based upon NELAC 2009 Standards and applies to all analyses,

LOO LIMIT OF DETECTION - a ve1ified estimate of the minimum concenh·ation of a substance in a given matrix that an analytical process can reliably

detect. This is based upon NELAC 2009 Standa, ds and applies to all analyses conducted under the auspices of EPA SW-846.

MDL METHOD DETECTION LIMIT - a statistically derived estimate of the minimum amount ofa substance an analytical system can reliably detect with a 99% confidence that the concentration of the substance is greater than zero. This is based upon 40 CFR Part 136 Appendix B and applies only to EPA

600 and 200 series methods_

Reported to This indicates that the data for a particular analysis is reported to either the LOD/MDL, or the LOQ/RL_ In cases where the "Reported to" is located above the LOD/MDL, any value between this and the LOQ represents an estimated value which is "J" flagged accordingly. This applies to volatile and

semi-volatile target compow1ds only.

NR Nol reported

RPD Relative Percent Difference

Wet The data has been 1epo1ted on an as-received (wet weight) basis

Low Bias Low Bias flag indicates that the recovery of the flagged analyte is below the laboratory or rei,'lllatory lower control limit. The data user should take note

that this analyte may be biased low but should evaluate multiple lines of evidence including the LCS and site-specific MS/MSD data to draw bias

conclusions. In cases where no site-specific MS/MSD was requested, only the LCS data can be used to evaluate such bias.

High Bias High Bias flag indicates dial the recovery of the flagged analyte is above the laboratory or regulatory upper control limit. The data user should take

note that this analyte may be biased high but should evaluate multiple lines of evidence including the LCS and site-specific MS/MSD data to draw bias

conclusions. In cases where no site-specific MSiMSD was requested, only the LCS data can be used to evaluate such bias.

Non-Dir. Non-dir. flag (Non-Directional Bias) indicates that the Relative Percent Difference (RPD) (a measw-e of precision) among the MS and MSD data is

outside the laboratory or regulato1y control limit. This alerts the data user where the MS and MSD are from site-specific samples that the RPD is high

due to either non-homogeneous dishibution of target analyte between the MS/MSD or indicates poor reproducibility for other reasons

If EPA SW-846 method 8270 is included herein it is noted that the target compound N-nitrosodiphcnylamine (NDPA) decomposes in the gas chromatographic inlet

and cannot be separated from diphenylamine (DPA). These results could actually represent 100% DPA, 100% NDPA or some combination of the two.

For this reason, York rep011s the combined result for n-nitrosodiphenylamine and diphenylamine for either of these compounds as a combined concentration as

Diphenylamine.

If Total PCBs are detected and the target aroclors reported are "Not detected", the Total PCB value is reported due to the presence of either or both Aroclors 1262 and

1268 which are non-target aroclors for some regulato1y lists.

2-chloroethylvinyl ether readily breaks down under acidic conditions Samples that are acid preserved, including standards will exhibit breakdown. The data user should take note,

Certification for pH is no longer offered by NYDOH ELAP.

Semi-Volatile and Volatile analyses are reported down to the LOO/MDL, with values between the LOD/MDL and the LOQ being "J" flagged as estimated results.

For analyses by EPA SW-846-8270D, the Limit ofQuantitation (LOQ) reported for benzidine is based upon the lowest standard used for calibration and is not a

ve1ified LOQ due to this compow,d's pl'opensity for oxidative losses dwing exu·action/concenbation procedures and non-reproducible chromatographic perfomiance.

120 RESEARCH DRIVE STRATFORD, CT 06615 (203) 325-1371 FAX(203)35.,.7-,..o.1a_a _______ __ I Page 12 of 14

120 RESEARCH DRIVE STRATFORD, CT 06615 (203) 325-1371 FAX (203) 3Sj_-0166 I Page 13 of 14 ---------

YORI:: ANALYTICAL l.ABDRATDRIE9

1 20 RESEARCH DR,

STRATFORD, CT 06615

(203) 325·1371

Field Chain-of-Custody Record NOTE: York's Std. Terms & Conditions are listed on the back side of this document. Page---l- of _J_

YorkProjectNo./4:> E. 0 J DO FAX 1203) 357·01 66 This document serves as your written authorization to York to proceed with the analyses requested and your signalllre binds you to York's Std. Terms & Condlfions. YOUR Information company: A:f P lc.nto"'-' Addt=: (. OV\> {V" q,1] lM..,,

eJrooflfo. h/c\..J �i--bCon!act Pcison:

Report To: Invoice To: YOUR Project ID

Ccmpany: 5 � Company: .5 4'M.(_ /ti {W fhwevi., AvttAddmss: ______ Address:______ \.).(Ui..S f-,--;�-==-----l

Purchase Order No. l'honeNo. ----------I Phone No. ________ _ -

Tum-Around Time Report Type RUSH- Same Day O Summary Report ___ _RUSH-NenDay O Summaryw/QA5umma,y __CTRCP Package ___ _ RUSH-Two Day D CTRCP DQNDUE Pkg __RUSH-Three Day D NY ASP A Package ___ _RUSH- Four Day D NY ASP B Pacbge ----Altrlllian: S � Attention: Sz:n11..(. l---------r----J-::-:---:---::::=--=-:=-�:::::::;-1NIDEPRed. Deliv. ___ _ · ElectronicDqtaDefiverablesfEDDJ E-Mail Address: E--MllilAddress: E-Mail Arum:ss: . s. le Excell'riiilCliiulj, ailil ugiblj. All Informliiwn must l,i ctii,qjfiii. 8260ful1Vo1a:� ��:s 8082PCB 8 TPHGRO Nri'oECEQuIS ___ _ ·Samples will NOT l,e logged in fl1lil tl,e turn-around ti1lte 624 s1� spec.. TPRDRo EQuIS (std) ___ _ · • • • . · STARS list Nassan Co. CT EIPH TAL Md.Of lgni11lbifily EZ-EDD (EQuIS) ___ _ clock will not begm until ""J' questions 1,y York tire resolvetl. BTEX SufJblkCo. cidsOnly CTRCP NY310-13 FullTCLP FlmhFm NJDEPSRPHazSiteEDD ,

�-"F-/2AL Samples Collected/Authorized By (Signature) f¼A,J_ M lL Name {printed)

Matrix Codes MTBE Kdones \l,,Blist TPB 1664 FullA;w-lX SieYcAml. GIS/KEY(std) ___ �--S - soil 'ICLlist � TAGMlist AirT014A � H� Other --------:----Olhcr-specify(oil,em.) TAGM!ist TCLPlist ota.l AirT015 l'a!L� rox YorkRegalatoryComparison WW - wastewater CTRCP!ist 524.2 TCLPPest Dissolved AirSTARS �� BTU1b. Exoo Spnadshee.t GW - groundwater Arom. only 502.2 EPlist TCLPHerb S!'U'irlUP AirVPH Pa\� Atj,ru,Tn,c. emp.n1olhof�R<,...�-('°"p1.,..--:lill=inc-c�--D_\V- � �ater Halog.only NIDEP list pp. IX Chlonbrne � AitTICs N\'CIE'S<= roe

I Ak-A- am1nentair App.IX list CI.PBNA 60l!Pcst LISTaac.v Meib:mo �.,, � rur-SV • sm1 Vl!pOT Rm1,:i list illllllli........,.:A.GM_ . _ Siooi__ Sample Identification Datemme Sampled I Sample Matrix Choose Analyses Needed from the Menu Above and Enter Below Ccmiaine, MW-\ 713.!Ulfo

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.. reservation-- 4-C_L_ }'rozen __ BO-,,L- 11Je01J __ I Q,eck thoseA 11<:mle 7.nAc Ascorbic Add Otbec Special

Fu« el M; L Instructions Field Filtered 0 Samples Relinquished By Lab to Filter D Samples Relinquished By �/lj_fwl� Datemme

Datemme �·("t..,-1

� By t /'/rem

.re_ , s- ¥ 1, -- I..!> I ::,Rea!ivadnLAB Date/Time

Temperature on Receipt

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