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INORGANIC / INORGANIC CHEMICAL SAMPLE SUBMISSION REPORT (Fairfield County)

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EPA 5020 (Rev 10/99) Page 1 of 2

INORGANIC CHEMICALINORGANIC CHEMICAL

SAMPLE SUBMISSION REPORT (SSR)SAMPLE SUBMISSION REPORT (SSR)

Division of Drinking and Ground Waters

MAIL COMPLETED REPORT TO: LABORATORY INFORMATION:

Ohio EPA, Division of Drinking and Ground Waters Reporting Lab: ID:

122 South Front Street Analytical Lab: ID:

P.O. Box 1049 Reporting Lab Sample #:

Columbus, Ohio 43216-1049 Sample Received Date: QC Completed Date:

QC Completed by:

PUBLIC WATER SYSTEM INFORMATION:

PWS Name: SAMPLE INFORMATION:

STU Name: Sample Monitoring Point: EP RS Other

PWSID #: STU #: Sample Collection Date: Time:

Address: Sample Purpose: Compliance Resample New Well

Other (explain):

County: Sample Collected by:

Contact Person: Repeat for Sample #:

Contact Phone:

SAMPLE LOCATION DESCRIPTION/LAB REMARKS:

ANALYTICAL INFORMATION:

Preservation Location: Field Laboratory None

Preservation Type:

ASCORBIC ACID HCL NAOH

CLCH2COOH HNO3 NAS

FILTERED ICED NH4CL

H2SO4 NA2O3S2 UNPRESERVED

OTHER (Explain)

ANALYTICAL RESULTS - INORGANIC CHEMICALS:

Parameters Cont. ID Sign Result Unit Analysis Date Method Analyst Number

Aluminum, total 1002

Fg/L

Antimony, total 1074

Fg/L

Arsenic, total 1005

Fg/L

Asbestos, >10um 1094

MF/L

Barium, total 1010

Fg/L

Beryllium, total 1075

Fg/L

Bismuth 1078

Fg/L

Boron, total 1079

Fg/L

Cadmium, total 1015

Fg/L

Calcium, total 1016

mg/L

Chloride, total 1017

mg/L

Chromium, hexavalent 1080

Fg/L

Chromium, total 1020

Fg/L

Cobalt, total 1081

Fg/L

Copper, total 1022

Fg/L

Cyanide, free 1023

Fg/L

Cyanide, total 1024

Fg/L

Fluoride, total 1025

mg/L

Iron, total 1028

Fg/L

Iron, dissolved 1082

Fg/L

Lead, total 1030

Fg/L

Lithium, total 1083

Fg/L

Manganese, total 1032

Fg/L

Magnesium, total 1031

mg/L

INORGANIC CHEMICAL - ContinuedINORGANIC CHEMICAL - Continued

SAMPLE SUBMISSION REPORT (SSR)SAMPLE SUBMISSION REPORT (SSR)

Parameters Cont. ID Sign Result Unit Analysis Date Method Analyst Number

EPA 5020 (Rev 10/99) Page 2 of 2

Mercury, total 1035

Fg/L

Molybdenum, total 1084

Fg/L

Nickel, total 1036

Fg/L

Nitrogen, Ammonia 1003

mg/L

Nitrate 1040

mg/L

Nitrate-Nitrite 1038

mg/L

Nitrite 1041

mg/L

Potassium, total 1042

mg/L

Selenium, total 1045

Fg/L

Silica, dissolved 1049

mg/L

Silver, total 1050

Fg/L

Sodium, total 1052

mg/L

Strontium, total 1051

Fg/L

Sulfate, total 1055

mg/L

Thallium, total 1085

Fg/L

Tin, total 1086

Fg/L

Titanium, total 1087

Fg/L

Vanadium, total 1088

Fg/L

Zinc, total 1095

Fg/L

Acidity, methylorange 1069

mg/L

Acidity, total 1068

mg/L

Alkalinity, phenolphthalein 1931

mg/L

Alkalinity, stability 1067

mg/L

Alkalinity, total 1927

mg/L

Biological Oxygen Demand 1091

mg/L

Chemical Oxygen Demand 1076

mg/L

Color 1905

Pt-CO

Conductivity at 25c 1064

CF-

Dissolved Solids, total 1930

mg/L

Hardness, total 1915

mg/L

MBAS 1089

mg/L

Nitrogen TKN 1037

mg/L

Oil-Grease, total 1090

mg/L

Orthophosphate 1044

mg/L

Phenol 2910

Fg/L

Phosphate, reactive 1073

mg/L

Phosphate, total 1043

mg/L

Phosphorus, soluble 1072

mg/L

Phosphorus, total 1093

mg/L

Residue, settled 1071

mg/L

Residue, total 1070

mg/L

Residue, total filtered 1057

mg/L

Residue, total non-filtered 1061

mg/L

Residue, total volatile 1060

mg/L

Residue, volatile filtered 1058

mg/L

Residue, volatile non-filter 1077

mg/L

Total Oxygen Demand 1092

mg/L

Turbidity 0100

NTU

pH, lab 1925

S.U.

pH, stability 1066

S.U.

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INORGANIC INORGANIC CHEMICAL SAMPLE SUBMISSION REPORT (Fairfield County)

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Completed 15 September 2020

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