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WP0040802
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4200/4300 - Liquid Waste/Water Well Permits
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WP0040802
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Last modified
7/6/2021 3:04:24 PM
Creation date
6/25/2020 10:19:29 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
WP0040802
PE
4370
STREET_NUMBER
28728
Direction
E
STREET_NAME
LONE TREE
STREET_TYPE
RD
City
OAKDALE
Zip
95361-
APN
22912025
ENTERED_DATE
5/11/2020 12:00:00 AM
SITE_LOCATION
28728 E LONE TREE RD
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
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EHD - Public
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Types of <br />Samples <br />LIQUIDS <br />Types of <br />Preservatives <br />KEEP ALL SAMPLES COOL <br />BLUE HCI pH 5 or NH4 Cl <br />(DW) Drinking Water YELLOW H2SO4 pH 5 2 <br />(GW) Ground Water RED HNO3 pH 2 <br />(MW) Monitoring Well BLACK Monochloroacetic Buffer <br />(SW) Surface Water GREEN NaOH pH ?. 12 or <br />(TB) Travel Blank NaOH + Zinc Acetate <br />(WW) Waste Water BLACK Na2S203 <br />(AgW) Ag Water WHITE Other <br />SOLIDS Types of <br />(Oil) Oil Containers (S) Soil <br />(Sid) Solid <br />(Sig) Sludge (at) Amber Glass TFE-Cap <br />(av) Amber Glass VOA TFE-Cap <br />(b) Brass Tube <br />TISSUE (9) Glass Jar <br />(LF) Leaf Tissue (gt) Glass TFE-Cap <br />(Pet) Petiole Tissue (m) Metal Tube <br />(Prd) Produce (o) Other <br />Plastic (Tsu) Tissue ()) <br />(s) Bag <br />(v) Glass VOA TFE-Cap <br />BACTI Conversions (Sys) System <br />(Src) Source 8oz. = half pint = 1 cup (W) Waste 16oz. = <br />32oz. = <br />pint = 2 cups <br />quart = 4 cups <br />1L = 1000m1 = 1 quart OTHER <br />(AF) Air Filter <br />(0th) Other <br />(Swp) Swipe <br />CONTAINER - PRESERVATIVE: <br />The type of container(s) to be used is listed with the Test <br />Description on the Chain of Custody. <br />Eg. Oil & Grease, EPA 624 <br />cont. 32oz.(p)-H2SO4 & 40m1(av)--HCI <br />The number of containers to fill is specified by a number(s) in <br />the sample Location /Description-- Test Description Intersection. <br />Eg. 1 1,2 1 <br />This example is read as ONE (1) container of size 32oz. <br />made of Plastic (p); preserved with H2SO4 plus TWO (2) containers <br />of size 40m1 type amber glass VOA (av) preserved with HC1. <br />COLOR CODING OF PRESERVATIVE LABELS: <br />All Containers which contain a preservative are marked <br />with a Color printed Label. The color scheme conforms to industry <br />standards, where applicable, and is provided as a quick reference <br />for locating the correct container. The appropriate colors for the <br />different preservatives can be found to the left under TYPE OF <br />PRESERVATIVES. <br />REQUESTED INFORMATION: <br />The person responsible for sampling must fill out the <br />Section pertaining to the sampler. For each sampling event, the date <br />and time of the sampling must be recorded in the space provided. <br />If the sample is a liquid, the potability of the sample should be <br />indicated if the water is for human consumption. If there are any <br />additions or changes to the test descriptions indicated, please <br />make the appropriate modifications on this form. The sampler must <br />SIGN and DATE the Chain of Custody prior to the samples being <br />relinquished to the transporter. The FIELD copy should be retained <br />by a responsible party at the sampling site. The remaining Chain of <br />Custody must be returned to FGL with the samples.
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