NCG140014_MONITORING INFO_20101117

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO. c, I L4coly
DOC TYPE El HISTORICAL FILE
3/,MONITORING REPORTS
DOC DATE I 0 QLlfi )
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Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance opt filling out this form, please visit: httn://h2o.enr.state.nc.us/su/Forms Documents.httn#miscforms
Permit No:: NICI—/ I_l�l_I 1_I or Certificate qf Coverage No.: N/C/G/ I_ /—/—/ /_I
Facility Name:*�� nI 2�1� rPa�
County: j7xy,010'l _ Phone No. _ ?3-c"• 2-oy 035//
Inspector:
Date of Inspection: 14 2 se1C2
Time of Inspection: o oZ-2
Total Event Precipitation (inches): to
Was this a Representative Storm Event? (See information below) �O Yes ❑ No
Please check Your permit to verify if Qualirative Nlonitorittg tnrest be performed daring a representative
stonn event (requirements vary).
A "Representative Storm Event" is a storm event that measures greater than 0. t inches of rainfall and that .
is preceded by at least 72 hours (3 ays) in which no storm event measuring greater than 0.1 inches has
occurred. A singlerm event ryfay contain up to 10 consecutive hours of no precipitation.
By this signgGre, I cfiftify/thi#yYis report is accurate and complete to the best of my knowledge:
(Signature of Permittee or Designee)
1. Outfall Description:
Outfall No. _/ Structure (pipe, ditch, etc.)
Receiving Stream:
Describe the industrial activities that occur within the outfall drainage area:
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors:
3, Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil, weak
chlorine odor, etc.): -VoN — - -- _- .
Page 1 of 2
SWU-242-1 12608

4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is clear
and 5 is very cloudy:
6 2 3 4 5
5. Floating Solids: Choose the number which best describes the amount of floating solids in the
stormwater discharge, where 1 is no solids and 5 is the surface covered with floating solids:
/1 J 2 3 4 5
6. Suspended Solids: Choose the number which best describes the amount of suspended solids in
the stormwater discharge, where l is no solids and 5 is extremely muddy:
I 2 3 4 5
7.' Is there any foam in the stormwater discharge? Yes to
S. Is there an oil sheen in the stormwater discharge? Yes
9: Is there evidence of erosion or deposition at the outfall? Yes
10. Other Obvious Indicators of Stormwater Pollution:
List and describe
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition may be
indicative of pollutant exposure. These conditions warrant further investigation.
Page 2 of 2
Swv-242-1 12608

1 ,
aceAnalytical
wx'w<'.pacelabs.com
November 29, 2010
Mr. Derek Secrist
Foltz Concrete Pipe Company
11875 North NC Highway 150
Winston Salem, NC 27127
RE: Project: Stormwater 11/17
Pace Project No.- 9282375
Pace Analytical Services, Inc.
2225 Riverside Dr.
Asheville, NC 28804
[phone]
Pace Analytical Services, Inc.
9800 KinceyAve. Suite 100
Huntersviile, NC 28078
[phone]
Dear Mr. Secrist:
Enclosed are the analytical results for sample(s) received by the laboratory on November 17, 2010.
The results relate only to the samples included in this report. Results reported herein conform to the
most current NELAC standards, where applicable, unless otherwise narrated in the body of the
report.
Analyses were performed at the Pace Analytical Services location indicated on the sample analyte
page for analysis unless otherwise footnoted.
If you have any questions concerning this report, please feel free to contact me.
Sincerely,
qtn M t�)alz�
Erin Waters
erin.waters@pacelabs. corn
Project Manager
Enclosures
cc: Ms. Ouida Campbell, Foltz Concrete Pipe Company
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, Inc..
%i lehni=
Pagel of 7

Pace Analytical Services, Inc- Pace Analytical Services, Inc.
�aceAnalyfical" 2225 Riverside Dr. 9800 Kincey Ave. Suite 100
wwwparelabs.com Asheville, NC 28804 Huntersville, NC 28078
(828)254 -7 i 76 (704 )875-9092
Project: Stormwater 11117
Pace Project No.: 9282375
Asheville Certification IDs
2225 Riverside Dr., Asheville, NC 28804
Connecticut Certification #: PH-0106
Florida/NELAP Certification #: E87648
Massachusetts Certification #: M-NCO30
New Jersey Certification #: NC011
North Carolina Bioassay Certification #: 9
North Carolina Drinking Water Certification #: 37712
CERTIFICATIONS
North Carolina Wastewater Certification #: 40
Pennsylvania Certification #: 66-03578
South Carolina Bioassay Certification #: 99030002
South Carolina Certification #: 99030001
Virginia Certification #: 00072
West Virginia Certification #: 356
REPORT OF LABORATORY ANALYSIS
This repart shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, Inc..
n6hC
Page 2 of 7

�aceAnalytical
' wwwpacelabs.com
Project: Stormwater 11117
Pace Project No,: 9282375
Pace Analytical Services, Inc.
2225 Riverslde Dr.
Asheville, NC 28804
[phone]
SAMPLE ANALYTE COUNT
Lab ID Sample ID Method
9282375001 Stormwater SM 2540D
EPA 9040
REPORT OF LA B 0 RATO RY ANA LYS IS
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, Inc..
nelac:=
Analysts
MLM
MLM
Pace Analytical Services, Inc.
9800 KinceyAve. Suite 100
Nuntersville, NC 28078
[phone]
Analytes
Reported Laboratory
1 PASI-A
1 PASI-A
Page 3 of 7

�eAnalytical
wwwpacelabs-cam
Project: Stormwater 11117
Pace Project No.: 9282375
Pace Analytical Services, Inc-
2225 Riverside Dr.
Asheville, NC 28804
[phone]
ANALYTICAL RESULTS
Pace Analytical Services, Inc.
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
Sample: Stormwater Lab ID: 9282375001 Collected: 11117/10 08:00 Received: 11/17/10 16:25 Matrix: Water
Parameters Results Units Report Limit DF Prepared Analyzed CAS No. Qual
25400 Total Suspended Solids Analytical Method: SM 2540D
Total Suspended Solids 20.7 mg/L 4.2 1 11/23/10 18:36
9040 pH Analytical Method: EPA 9040
pH 6.3 Std. Units 0.10 1 11/19/10 16:48 H6
Date: 11/29/2010 10:32 AM REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, Inc..
heh&
Page 4of7

® Pace Analytical Services, Inc. Pace Analytical Services, Inc.
aceAnalytieal 2225 Riverside Dr. 9800 Kincey Ave. Suite 100
wwwpacelabs-com Asheville, NC 28604 Huntersville, NC 28078
[phone] [phone]
QUALITY CONTROL DATA
Project: Stormwater 11117
Pace Project No.: 9282375
QC Batch: WET/14560 Analysis Method: SM 2540D
QC Batch Method: SM 2540D Analysis Description: 2540D Total Suspended Solids
Associated Lab Samples: 9282375001
METHOD BLANK: 532724
Associated Lab Samples: 9282375001
Parameter
Units
Total Suspended Solids
mg1L
LABORATORY CONTROL SAMPLE:
532725
Parameter
Units
Total Suspended Solids
mg/L
SAMPLE DUPLICATE: 532726
Parameter •
Units
Total Suspended Solids
mg/L
Date: 11/29/2010 10:32 AM
Matrix: Water
Blank Reporting
Result Limit Analyzed Qualifiers
ND 2.5 11/2311018:32
Spike t_CS LCS % Rec
Conc. Result % Rec Limits Qualifiers
250 270 108 80-120
9292305001 Dup
Result Result
285 225
RPD Qualifiers
24 D6
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, Inc..
n
he�ac,
Page 5 of 7

aceAnalytical
mwcpaaelabs.eom
Project: Stormwater 11/17
Pace Project No.: 9282375
QC Batch: WET114531
QC Batch Method: EPA 9D40
Associated Lab Samples: 9282375001
SAMPLE DUPLICATE: 530939
Parameter Units
Std. Units
V
Date: 11 /29/2010 10:32 AM
Pace Analytical Services, Inc.
2225 Riverside Dr.
Asheville, NG 28804
[phone]
QUALITY CONTROL DATA
Analysis Method: EPA 9040
Analysis Description: 9040 pH
9282151001 Dup
Result Result RPD
6.6 6.6
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, Inc..
�cnelae",
Qualifiers
0 H6
Pace Analytical Services, Inc.
9800 Kincey Ave. Suite 100
Huntersville, NC 28076
[phone]
Page 6 of 7

�eAnalyfical"
wwwpacelabsxom
Pace Analytical Services, Inc.
2225 Riverside Dr.
Asheville. NC 28804
[phone]
Pace Analytical Services, Inc.
9800 Kincey Ave. Suite 10o
Huntersville, NC 2BC78
(704) B7 5-9092
QUALIFIERS
Project: Stormwater 11117
Pace Project No.: 9282375
DEFINITIONS
DF - Dilution Factor, if reported, represents the factor applied to the reported data due to changes in sample preparation, dilution of
the sample aliquot, or moisture content.
ND - Not Detected at or above adjusted reporting limit.
J - Estimated concentration above the adjusted method detection limit and below the adjusted reporting limit.
MDL-AdjustedMethod Detection Limit.
S - Surrogate
1,2-Diphenylhydrazine (8270 listed analyte) decomposes toAzobenzene.
Consistent with EPA guidelines, unrounded data are displayed and have been used to calculate % recovery and RPD values.
LCS(D) - Laboratory Control Sample (Duplicate)
MS(D) - Matrix Spike (Duplicate)
DUP - Sample Duplicate
RPD - Relative Percent Difference
NC - Not Calculable.
U - Indicates the compound was analyzed for, but not detected.
N-Nitrosodiphenylamine decomposes and cannot be separated from Diphenylamine using Method 8270. The result reported for
each analyte is a combined concentration.
Pace Analytical is NELAP accredited. Contact your Pace PM for the current list of accredited analytes.
LABORATORIES
PASI-A Pace Analytical Services -Asheville
ANALYTE QUALIFIERS
De The relative percent difference (RPD) between the sample and sample duplicate exceeded laboratory control.iimits.
HIS Analysis initiated more than 15 minutes after sample collection.
Date: 11/29/2010 10:32 AM REPORT OF LABORATORY ANALYSIS Page 7 of 7
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, Inc..

7aceAnalyfical'
CHAIN -OF -CUSTODY 1 Analyticai Request Document
Tho Chain -of -Custody is a LEGAL DOCUMENT. All relevant fields must be Completed accurately.
Page: of
3oction A Section 0 Section C.
tequired Client Information: Required Project Information: Invoice Information:
:ompany: Repori'Io Attonlio
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Project Name:
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Manager:
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taquested Due Date/TAT:
Project Number.
Pace Profile #:
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Requested
Analysis
Filtered
(YIN)
Section D Matrix Codes
X'
Required Client lnfonnatlon MATRIX 1 CODE
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COLLECTED
PreSetvahves
Drinking Water OW
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Waste Waler WW
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PaceArJalyical Client Name: VQ\�,) Project # �2�s 23�
ere Received: 2 Huntersvilie ❑ Asheville ❑ Eden
Trier: ❑ Fed Ex ❑ UPS ❑ USPS ❑ Client ❑ Commercial ' Pace Other Optional
;tody Seat on CoolerlBox Present: El�
Yes "o Seals intact: ❑ yes ❑ no P!Ql Dtie date
PF6i.°.Name: ::.
king Material: ❑ Bubble Wrap ❑Bubble Bags one ❑Other
rmometer Used: IR Gun : T809 Type of Ice: b Blue None ❑ sa es on ice, cooling process has begun
,o Correction Factor: Add / Subtract 0 C
rested Cooler Temp,:C
p should be above freezing to 6'C
Biological Tissue is Frozen: Yes No
Comments:
Hate and Ini als of erso� v7g
contents:
in of Custody Present:
—,E Yes
ONo
❑NIA
1
in of Custody Filled Out:
Yes
ONo
❑NIA
2,
in of Custody Relinquished:
- Yes
ONo
❑NIA
3.
Ipler Name & Signature on COC:
Yes
❑No
©NIA
4.
Iples Arrived within Hold Time:
Eryes
ONo
CNIA
5.
rt Hold Time Analysis (<72hr):
❑Yes
C?<o ' ❑N/A
6.
h Turn Around Time Requested:
Dyes
Df<
❑NIA
7.
dent Volume:
es
❑Nc
❑NIA
8,
ect Containers Used:
7)ace Containers Used:
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ONO
ONO
❑NIA
ON/A'
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tainers intact:
es
ONO
❑NIA
Jo -
red volume received for Dissolved tests
OYes
❑No
eTNIA
11.
ple Labels match COC:
ncludes date/time/ID/Analysis Matrix:
❑Yes
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❑NIA
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ntainers needing preservation have been checked.
)ntainers needing preservation are found to be in
diance with EPA recommendation.
Lions: VOA, coliform, TOC, O&G, WI-I]RO (water)
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es ❑No
❑Yes ONO
❑NIA
❑N1A
13.
Initial when completed
pies checked for dechlorination:
❑Yes
ONO
In
14.
lspace in VOA Vials ( >6mm):
❑Yes
©No
A
15.
Blank Present:
Blank Custody Seals Present
Trip Blank Lot # (if purchased):
❑Yes
DYes
ONo
ONo
CJW<
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16.
it Notification) Resolution: Field Data Required? Y / N
Person Contacted: DatelTime:
mmentsl Resolution:
JRF Review:1 ]Date: l�+ I 1�0 I SRF Revi
Whenever there is a discrepancy affecting North Carolina compliance samples, a c
ication Off ice ( i.e out of hofd, incorrect preservative, out of temp, incorrect container
r � Date: 1 J(
form wilt be sent to the North Carolina DEHNR
F-CHR-CS-003-rev.01

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