Sheet 1: Data Form

	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	

		


		


		


		


		


		


		


		


		


		


		


		
Land Application Values
		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		

 
		
		


		


		


		
Type Data:
		


		


		
 
		


		


		


		


		
D-3734
		


		


		


		


		


		


		


		


	
	

		


		


		


		


		
Facility Name:
		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		
Application/Field:
		


		


		


		


		


		


		


		
6/9/2017
		


		


		


		


		


		


		


		


	
	

		


		


		


		
Results in Milligrams per Kilogram
		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		
Application 1
		
Application 2
		
Application 3
		
Application 4
		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		
Sample 1
		
Sample 2
		
Sample 3
		
Sample 1
		
Sample 2
		
Sample 3
		
Sample 1
		
Sample 2
		
Sample 3
		
Sample 1
		
Sample 2
		
Sample 3
		


		


		


		


		


		


		


		


	
	

		
Facility Sample ID #
		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		
Laboratory Sample ID #
		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		
Laboratory Name
		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		
SC Laboratory Certification #
		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		
Laboratory Receipt Information (Chain of Custody Must be Attached)
		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		
Location of Solid Waste Application (I.e. Field 1, 2, etc.)
		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		
Other
		


		


		


		


		


		


		
 
		


		


		
 
		


		


		
 
		


		


		
 
		


		


		


		

 
		
		
	

		
Other
		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		
	

		
Inorganic Chemicals
		


		


		


		


		


		


		
 Note: The number 1 is meant as a cell filler below. Enter your applicable values in these cells.
		


		
	

		
Analytical Parameter
		
Digestion Method
		
Analytical Method
		
Reporting Limit (mg/l)
		
Cumulative Avg. Constituent Load lb/acre
		
Action
		
Max. Life-Time Load (lb/ac)
		
Enter Application Rate
lb/acre
 ===>
 Application 1
		
6000
		
Enter Application Rate
lb/acre
 ===>
 Application 2
		
3000
		
Enter Application Rate
lb/acre
 ===>
 Application 3
		
5000
		
Enter Application Rate
lb/acre
 ===>
 Application 4
		
0
		


		
	

		
Arsenic
		
SW3015
		
SW6010B
		
0.010
		
0.0140
		
NO
		
37
		
1
		
1
		
1
		
1
		
1
		
1
		
1
		
1
		
1
		
1
		
1
		
1
		


		
	

		
Cadmium
		
SW3015
		
SW6010B
		


		
0.0140
		
NO
		
35
		
1
		
1
		
1
		
1
		
1
		
1
		
1
		
1
		
1
		
1
		
1
		
1
		


		
	

		
Lead
		
SW3015
		
SW6010B
		
0.0002
		
0.0140
		
NO
		
274
		
1
		
1
		
1
		
1
		
1
		
1
		
1
		
1
		
1
		
1
		
1
		
1
		


		
	

		
Mercury
		
 SW7471A
		
SW7471A
		


		
0.0140
		
NO
		
15
		
1
		
1
		
1
		
1
		
1
		
1
		
1
		
1
		
1
		
1
		
1
		
1
		


		
	

		
Selenium
		
SW3015
		
SW6010B
		


		
0.0140
		
NO
		
91
		
1
		
1
		
1
		
1
		
1
		
1
		
1
		
1
		
1
		
1
		
1
		
1
		


		
	

		
Copper
		
SW3015
		
SW6010B
		


		
0.0140
		
NO
		
1370
		
1
		
1
		
1
		
1
		
1
		
1
		
1
		
1
		
1
		
1
		
1
		
1
		


		
	

		
Nickel
		
SW3015
		
SW6010B
		


		
0.0140
		
NO
		
383
		
1
		
1
		
1
		
1
		
1
		
1
		
1
		
1
		
1
		
1
		
1
		
1
		


		
	

		
Zinc
		
SW3015
		
SW6010B
		


		
0.0140
		
NO
		
2550
		
1
		
1
		
1
		
1
		
1
		
1
		
1
		
1
		
1
		
1
		
1
		
1
		


		
	

		
Tot. Alkalinity
		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		
	

		
Keldj-Nitrogen
		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		
	

		
NO3 Nitrogen
		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		
	

		
NH3 Nitrogen
		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		
	

		
Parameters - Analyzed by Agricultural Laboratory
		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		
	

		
Conductivity
		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		
	

		
PAN
		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		
	

		
Soil-Lime Req
		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		
	

		
Boron
		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		
Sodium
		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		
Sulfate
		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		
Quality Assurance (for above samples) 
		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		
Digestion Batch # 
		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		
Digestion Blank
		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		
Laboratory Control Sample
		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		
Matrix Spike (MS)
		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		
Matrix Spike Duplicate (MSD)
		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		
Unspiked Duplicate (If Used)
		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		
Analysis Batch Number 
		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		
LCS Recovery
		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		
MS & MSD Recovery
		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		
 
		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		
DHEC-3734 (07/2017)