Page 1 of 2
SO C
Reset Form
SYNTHETIC ORGANIC COMPOUNDS (SOC's) IN DRINKING WATER
State Form 53287 (6-07)
Indiana Department of Environmental Management (IDEM) Office of Water Quality - Drinking Water Branch - Compliance Section
INSTRUCTIONS: Please submit completed forms to: IDEM OWQ Drinking Water, Mail Code 66-34, 100 N Senate Ave, Indianapolis, IN 46204-2251
Lab Received: For Laboratory Use Only =>
(Write dates as MM/DD/YY)
QA Review Date:
Report Date:
Lab Report Number:
.
.
.
.
.
.
PWSID:
System Name:
I N
Main Lab Certification: Main/Contracted Laboratory Name:
Testing Lab ID:
Lab Contact Person: Contact Phone No:
C .
Comp ID#
Sample ID: POE: SamplingSite/Location:
-
-
Collection Date (MM/DD/YY):
.
Compound Name
Alachlor (Lasso) Atrazine Benzo(a)pyrene Carbofuran Chlordane (alpha & gamma) 2,4-D Dalapon DBCP Dinoseb 2,3,7,8-TCDD (Dioxin) Diquat Di(2-ethylexyl)adipate Di(2-ethylexyl)phthalate Endothall Endrin Ethylene Dibromide (EDB) Glyphosate (Round-up) Heptachlor Heptachlor Epoxide Hexachlorobenzene Hexachlorocyclopentadiene
Analysis Date (MM.DD.YY)
Approved Method **
Result (ug/L)
Unit ug/L ug/L ug/L ug/L ug/L ug/L ug/L ug/L ug/L
Detection BDL Level
MCL (ug/L)
2051 2050 2306 2046 2959 2105 2031 2931 2041 2063 2032 2035 2039 2033 2005 2946 2034 2065 2067 2274 2042
. . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . .
2. 3. 0.2 40. 2. 70. 200. 0.2 7. 0.0 3 20. 400. 6. 100. 0.2 0.0 5 700. 0.4 0.2 1. 50.
pg/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
PWSID:
Page 2 of 2
I N
Collection Date (MM/DD/YY):
.
Comp ID#
.
Compound Name
Regulated SOCs (Continued)
Analysis Date (MM.DD.YY) Approved Method ** Result (ug/L) Unit ug/L ug/L ug/L ug/L ug/L ug/L ug/L ug/L ug/L Detection BDL Level MCL (ug/L)
2010 2015 2036 2326 2040 2383 2037
Lindane Methoxychlor Oxamyl (Vydate) Pentachlorophenol Picloram (Tordon) PCBs Simazine
2 1 1 0 2,4,5-TP (Silvex) 2 0 2 0 Toxaphene 2047 2044 2043 2356 2076 2021 2440 2070 2066 2022 2045 2595 2077
Aldicarb Aldicarb Sulfone Aldicarb Sulfoxide Aldrin Butachlor Carbaryl Dicamba Dieldrin 3-Hydroxcarbofuran Methomyl Metolachlor Metribuzin Propachlor
. . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . .
Yes Yes Yes
. . . . . . . . . . . . . . . . . . . . . .
No No No
. . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . .
0 .2 40. 200
. 1. 500. 0 .5 4. 50. 3.
(No MCL) (No MCL) (No MCL) (No MCL) (No MCL) (No MCL) (No MCL) (No MCL) (No MCL) (No MCL) (No MCL) (No MCL) (No MCL)
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
Unregulated SOCs
Other Information:
Does the system chlorinate its water? Was the sample dechlorinated at the lab? Was this information sent to IDEM by the lab?
Preservative Used: Iced Na2S2O3 HCl H2SO4 Other:
Important Notes:
- if a constituent was below detection limits (i.e., not detected), select "BDL" and enter the method detection level (example: 0.5 ug/L) in the column provided. - Please make every possible effort to print clearly and inside the lines; - Return completed form to: Indiana Department of Environental Management Drinking Water Branch - Compliance Section 100 N Shadeland Avenue Indianapolis, IN 46204-2251
I hereby certify that all the information submitted herein is true and accurate to the best of my knowledge. Completed By: Date: Reviewed by: