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OrderID: 022406592 j n4 <br /> ASBESTOS ANALYSIS - Distribution System <br /> Note.All information must be supplied for wmpliance credit. <br /> Water System Number: _ - _-___ County: Orange <br /> Name of Water System: H3yy 86 Property <br /> Sample Type: ❑ Distribution(Compliance) IN Non-compliance <br /> Location Code: ___ Tap Location: Well Head Street Address:Near 1317 NC- 86 City: Hillsborough <br /> Check(4)if sample site is owned or controlled by water system. ❑ <br /> Check(q)if sample site is a daycare or a 1412 school. ❑ Collection Date Collection Time <br /> Facility ID No. (Distribution): D 01 1112012 4 1 2: 4 1, P M <br /> Sample Point: ASB (MMUDW) (SpeciyAMorP4 <br /> David Cave " <br /> Collected By: ,-:_:. W: ,......._,., .w. M .W WWW::- <br /> (Please Print) <br /> Mail Results to(water system representative): <br /> Yadkin Well -David Brown Phone#:{336 ) 374-8736 <br /> 1908 Hamptonville Rd. Fax#: ( __) <br /> Hamptonville,NC 27020 Responsible Person's email: <br /> Laboratory ID#: 3 7 7 6 6 <br /> Required <br /> Contam Method Reporting Analysis Analysis Quantified Allowable <br /> ;Code Contaminant Code Limit Started Ended Detected Results 1,2 Limit <br /> R.R.L. VAc R.R.L) <br /> 1094 ASBESTOS 0.2 MFL [ Z 1 [r b � �b MFL 7 MFL <br /> Notes: ' MFL=Million Fibers per Liter> 10 um. <br /> 2 If result exceeds the allowable limit, the laboratory must report the analytical results to the State within 48 hours <br /> Laboratory Log#:O D q k9 lo59.1`0M J Certified By: <br /> 4-c— <br /> (Pnnt and sign name) <br /> COMMENTS: PACE PROJECT#92765024 <br /> F.CAR-CS-026-rev.00 8/5/2016 NCDEQ <br /> Public Water Supply Section <br /> 2016 <br /> Paae 3 Of 3 <br />