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Home My WebLink AboutNCG030661_MONITORING INFO_201902261N sp---o STORMWATER DIVISION CODING SHEET NCG PERMITS PERMIT NO. /V C& DOC TYPE 0 HISTORICAL FILE O�MONITORING REPORTS DOC DATE ❑ a VI � YYYYMMDD Stormwater Discharge Monitoring Report for North Carolina Division of Energy, Mineral and Land Resources General Permit No. NCG030000 Date submitted 1/28/2020 CERTIFICATE OF COVERAGE NO. NCG03 0 6 6 1 FACILITY NAME Matlab, Inc. -Plant 16 COUNTY Guilford PERSON COLLECTING SAMPLES Tait Williams LABORATORY Con -lest Lab Cert. # 652 Comments on sample collection or analysis: Part A: Stormwater Benchmarks and Monitoring Results SAMPLE COLLECTION YEAR 2020 SAMPLE PERIOD E) Jan -June ❑ July -Dec or ❑ Monthly' month DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA �� ❑Zero -flow ❑Water Supply ❑SA R� Other DEB 16 �9 PLEASE REMEMBER TO SIGN ON PAGES 2 AND/OR 3 T' GTION ❑ No discharge this period;2 Outfall No. Date Sample Collected' (mo/dd/yr) 24-hour rainfall amount, Inches' Total Suspended Solids pH, Standard units Total Copper Total Lead Total Zinc Non -Polar O&G/Total Total Petroleum Hydrocarbons Toxic Organics5 Benchmarks _ - 100 mg/L or 50 mglO 6.0 — 9.0 0.010 mg/L 0.075 mg/L 0.126 mg/L 15 mg/L 1 mg/L Parameter Code - 46529 C0530 OD400 01119 01051 01094 00552 78141 01 1/14/20 0.51 0 6.1 0.0059 0.000067 0.074 3.8 N/A 1 Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall. Z For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here. 3The total precipitation must be recorded using data from an on -site rain gauge. Unattended sites may be eligible for a waiver of the rain gauge requirement. ° See General Permit, Section B, Table 1 to identify the especially sensitive receiving water classifications where the more protective benchmark applies. 5 Total Toxic Organics sampling is applicable only for those facilities which perform metal finishing operations, manufacture semiconductors, manufacture electronic crystals, or manufacture cathode ray tubes. For purposes of this permit the definition of Total Toxic Organics is that definition contained in the EPA Effluent Guidelines for the facility subject to the requirement to sample (for metal finishing use the definition as found in 40 CFR 433.11; for semiconductor manufacture use the definition as found in 40 CFR 469.12; for electronic crystal manufacture use the definition as found in 40 CFR 469.22; and for cathode ray tube manufacture use the definition found in 40 CFR 469.31). Permit Date: 11/1/2018-05/31/2021 SWU-245, last revised 11/1/2018 Page 1 of 3 Facilities that incorporate a solvent management plan into the Stormwater Pollution Prevention Plan may so certify, and the requirement for TTO monitoring may be waived. The solvent management plan shall include a list of the total toxic organic compounds used and the other elements listed in the General Permit. For those facilities electing to employ the TTO monitoring waiver, the discharger shall sign the following certification statement: "Based upon my inquiry of the person or persons directly responsible for managing compliance with the permit monitoring requirement for total toxic organics (TTO), 1 certify that to the best of my knowledge and belief, no dumping of concentrated toxic organics into the stormwater or areas which are exposed to rainfall or stormwater runoff has occurred since filing the last discharge monitoring report. I further certify that this facility is implementing the all the provisions of the solvent management plan included in the Stormwater Pollution Prevention Plan." Press Brower Name (Print name) VP of Engineering Title t title) 2— Signature Date Note: Results must be reported in numerical format. Do not report Below Detection Limit, BDL, <PQL, Non -detect, ND, or other similar non -numerical format. When results are below the applicable limits, they must be reported in the format, "<XX m L" where XX is the numerical value of the detection limit, reporting limit, etc. in mg/L. Note: if you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier responses. See General Permit text. Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month. ❑ No discharge this period?2 Outfall No. Date Sample Collected' (mo/dd/yr) 24-hour rainfall amount, Inches' New Motor Oil or Hydraulic Oil Usage Non -Polar O&G/ Total Petroleum Hydrocarbons Total Suspended Solids Benchmarks - - - 15 mg/L 100 mg/L or 50 mg/L° Parameter Code . - 45529 N COIL 00552 C0530 Footnotes from Part A also apply to Part B Note: if you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses. See General Permit text. Permit Date: 11/1/2018-05/31/2021 SWU-245, last revised 11/1/2018 Page 2 of 3 FOR PART A AND PART B MONITORING RESULTS: • A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B. • 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART II SECTION B. • TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANYONE OUTFALL? YES ❑ NO Q IF YES, HAVE YOU CONTACTED THE DEMLR REGIONAL OFFICE? YES ❑ NO ❑ REGIONAL OFFICE CONTACT NAME: Mail an original copy of this DMR, including all "No Discharge" reports,. within 30 days of receipt of the lob results for at end of monitoring period in the case of "No Discharge" reports) to: Division of Water Quality Attn: DWQ Central Files 1617 Mail Service Center Raleigh, North Carolina 27699-1617 YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED: "I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations." Signature Permit Date: 11/1/2018-05/31/2021 2 /Y 20 Date SWU-245, last revised 11/1/2019 Page 3 of 3 Stormwater Discharge Monitoring Report for North Carolina Division of Energy, Mineral and Land Resources General Permit No. NCG030000 Date submitted 112812020 CERTIFICATE OF COVERAGE NO. NCG03 0 6 6 1 FACILITY NAME Matlab. Inc. -Plant 16 COUNTY Guilford PERSON COLLECTING SAMPLES Tait Williams LABORATORY Con -test Lab Cert. p 652 Comments on sample collection or analysis: Part A: Stormwater Benchmarks and Monitoring Results SAMPLE COLLECTION YEAR 2020 SAMPLE PERIOD Q Jan -June [] July -Dec or ❑ Monthly' (month) DISCHARGING TO CLASS ❑ORW ❑HQW []Trout ❑PNA ❑Zero -flow ❑Water Supply ❑SA ❑Other PLEASE REMEMBER TO SIGN ON PAGES 2 AND/OR 3 4 ❑ No discharge this period?2 Outfall No. Date Sample Collected' (mo/dd/yr) 24-hour rainfall amount, Inches3 Total Suspended Solids pH, Standard units Total Copper Total Lead Total Zinc Non -Polar COW Total Petroleum Hydrocarbons TotalToxic Organics5 Benchmarks _ - 100 mg/L or 50 mg/O 6.0 — 9.0 0.010 mg/L 0.075 mg/L 0.126 mg/L 15 mg/L 1 mg/L Parameter Code - 46529 C0530 00400 01119 01051 01094 00552 78141 01 1/14/20 0.51 0 6.1 0.0059 0.000067 0.074 3.8 NIA 1 Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall. Z For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here. 'The total precipitation must be recorded using data from an on -site rain gauge. Unattended sites may be eligible for a waiver of the rain gauge requirement. 4 See General Permit, Section B, Table 1 to identify the especially sensitive receiving water classifications where the more protective benchmark applies. 5 Total Toxic Organics sampling is applicable only for those facilities which perform metal finishing operations, manufacture semiconductors, manufacture electronic crystals, or manufacture cathode ray tubes. For purposes of this permit the definition of Total Toxic Organics is that definition contained in the EPA Effluent Guidelines for the facility subject to the requirement to sample (for metal finishing use the definition as found in 40 CFR 433.11; for semiconductor manufacture use the definition as found in 40 CFR 469,12; for electronic crystal manufacture use the definition as found in 40 CFR 469.22; and for cathode ray tube manufacture use the definition found in 40 CFR 469.31). Permit Date: 11/1/2018-05/31/2021 5WU-245, last revised 11/1/2018 Page 1 of 3 Facilities that incorporate a solvent management plan into the Stormwater Pollution Prevention Plan may so certify, and the requirement for TTO monitoring may be waived. The solvent management plan shall include a list of the total toxic organic compounds used and the other elements listed in the General Permit. For those facilities electing to employ the TTO monitoring waiver, the discharger shall sign the following certification statement: "Based upon my inquiry of the person or persons directly responsible for managing compliance with the permit monitoring requirement for total toxic organics (TTO), I certify that to the best of my knowledge and belief, no dumping of concentrated toxic organics into the stormwater or areas which are exposed to rainfall or stormwater runoff has occurred since filing the last discharge monitoring report. I further certify that this facility is implementing the all the provisions of the solvent management plan included in the Stormwater Pollution Prevention Plan." Press Brower Name (Print name) VP of Engineering Title (P i Signature Date Note: Results must be reported in numerical format. Do not report Below Detection Limit, BDL, <PQL, Non -detect, ND, or other similar non -numerical format. When results are below the applicable limits, they must be reported in the format "<XX mg/L", where XX is the numerical value of the detection limit, reporting limit, etc. in mg/L. Note: If you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses. See General Permit text. Part B. Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month. ❑ No discharge this period?2 Outfall No. Date Sample Collected' (mo/dd/yr) 24-hour rainfall. amount, inches; New Motor Oil or Hydraulic Oil Usage Non -Polar O&G/ Total Petroleum Hydrocarbons Total Suspended Solids Benchmarks - - 15 mg/L 100 mg/L or 50 mg/L° Parameter Code - 46529 NCOIL 00552 C0530 Footnotes from Part A also apply to Part B Note: If you report a sample value in excess of the benchmark, you must Implement Tier 1, Tier 2, or Tier 3 responses. See General Permit text. Permit Date: 11/1/2018-05/31/2021 SWU-245, last revised 11/1/2018 Page 2 of 3 FOR PART A AND PART B MONITORING RESULTS: • A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART it SECTION B. • 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART II SECTION B. + TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES ❑ NO 0 IF YES, HAVE YOU CONTACTED THE DEMLR REGIONAL OFFICE? YES ❑ NO ❑ REGIONAL OFFICE CONTACT NAME: Mail an original copy of this DMR, including all "No Discharge" reports, within 30 days of receipt of the lab results for at end of monitoring period in the case of "No Discharge" reports) to: Division of Water Quality Attn: DWQ Central Files 1617 Mail Service Center Raleigh, North Carolina 27699-1617 YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED: "I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations." Signature of Permittee 17 12,U Date Permit Date: 11/1/2018-05/31/2021 SWU-245, last revised 11/1/2018 Page 3 of 3 ton-te-W Table of Contents 39 Spruce Street ' East Longmeadow, MA 01028 ' FAX 4131525-6405 ' TEL. 4131525-2332 January 27, 2020 Paul Spangenberg Mid -Atlantic Associates, Inc. - Raleigh, NC 409 Rogers View Court Raleigh, NC 27610 Project Location: Plant 16 - Greensboro, NC Client Job Number: Project Number: R2943.10 Laboratory Work Order Number: 20A0671 Enclosed are results of analyses for samples received by the laboratory on January 15, 2020. If you have any questions concerning this report, please feel free to contact me. Sincerely, V611 �' r AL9Q Kerry K. McGee Project Manager Page 1 of 14 Table of Contents Table of Contents Sample Summary Case Narrative Sample Results 2OA0671-01 Sample Preparation Information QC Data Metals Analyses (Total) B250219 Conventional Chemistry Parameters by EPA/APHA/SW-846 Methods (Total) B250136 B250158 B250531 Flag/Qualifier Summary Certifications 3 4 5 5 7 S 8 8 9 9 9 9 10 Chain of Custody/Sample Receipt 12 Page 2 of 14 Table of Contents [on!AeW 39 Spruce Street' East Longmeadow, MA 01026 *FAX 413/525-6405 'TEL. 413/525-2332 Mid-AllaNic Associates, Inc. -Raleigh, NC 409 Rogers View Court REPORT DATE: 1/27/2020 Raleigh, NC 27610 PURCHASE; ORDER NUMBER: ATTN: Paul Spangenberg PROJEiC-E' NUMBI?R: R2943.10 ANA INTICAL SUMMARY WORK ORDER NUMBER: 20A0671 The results of analyses performed on the following samples submitted to the CON-TESTAnalytical Laboratory are found in this report. PROjFCT LOCNHON: Plain 16 - Green boro, NC FIELD SAMPLE 4 LAD 117: MATRIX SAMPLE DFSCRIP HON TEST SUB LAB 20A0671-01 Water EPA 1664B SM21-22 2540D SM21-22 4500 li A S W-846 6020B Page 3 of 14 Pcon-LAtEst° FMICAL BORATORY 39 Spruce Street' East Longmeadow, MA 01028 ' FAX 413/525-6405 ' TEL. 413/525-2332 CASE, NARRATIVE SUMMARY All reported results are within defined laboratory quality control objectives unless listed below or otherwise qualified in this report. S\121-22 4500 11 B Qualifications 11-05 Holding time was exceeded. pH analysis should be performed immediately at time of sampling. Nominal 15 minute holding time was exceeded. Analyle & Samples(s) Qualified; pll 20A0671-0111 ] The results of analyses reported only relate to samples submitted to the Can -Test Analytical laboratory for testing. l certify that the analyses listed above, unless specifically listed as subcontracted, if any, were performed under my direction according to the approved methodologies listed in this document, and that based upon my inquiry of those individuals immediately responsible for obtaining the information, the material contained in this report is, to the best of my knowledge and belief; accurate and complete. Lisa A, Worthington Technical Representative Table of Contents Page 4 of 14 Table of Contents i : conTtest° 'J ANALYTICAL LABORATORY _ J 39 Spruce Street *East Longmeadow, MA 0102& 'FAX 4131525-6405 'TEL. 4131525-2332 Project Location: Plant 16 - Greensboro, NC Sample Description: Work Order: 20A0671 Date Received: 1/15/2020 Field Sample #: I Sample ID: 20A0671.01 Stan Datc/Timc: 1/14/2020 8:00:00AM Samnlc Matrix: Water Ston Datc/Time: 1/14/2020 8:02:00AM Metals Analyses (Total) Analvte Results RL DL Units Copper 0,0059 0,0010 0.00087 mg/L [,cad 0.09067 0.00050 0.000085 mg/L Zinc 11.074 0.010 0,0023 mg/l. Dilution rlag/Qual J1ethod 1 SW-846 020B I SW-840 6020B 1 S W-846 6020B Date Daterl'imc Prepared Analyzed Analyst 1/16/20 1/16/2014:02 M311 1116f20 1116/2014:02 MJ11 1/16/20 1/1612014:02 M11i Page 5 of 14 4[11i,conmaestl Table of Contents WIT -I'd ANALYTICAL LABORATORY 39 Spruce Street* East Longmeadow, MA O1028 *FAX 4131525-6405 'TEL. 4131525-2332 Project Location: Plant 16 - Greensboro, NC Sample Description: Rork Ordcr: 20A0671 Dale Received: 111512020 rield Sample #: 1 Samnlc I l): 20A0671-01 Start Datell lme: 111412020 8:00:OOAM Samnlc Matrix: Water Sion Datc/Time: 1/1412020 8:02:OOAM Comentional Chemistr3 Parameters by EPAIAPEIAISW-846 Methods (foal) Anal)te Resalts RI, Di, Units Dilution FlaglQual Method Date Prepared Datel'1'inic Analyzed Aralist pH a@16.6°C 6.1 pH Units I H-05 SM21-2245001115 1/15120 111512020:50 MMH Total Suspended Solids ND 2.0 0.82 mg1l, I SM21-22 2540D Il16/20 L'16120 13:15 L1, Oil & Greaw (I117M) 3.8 3.5 2.5 mg1l. I EPA 166411 I122120 1122l20 13:35 LL 77 Page 6 of 14 Table of Contents 4111tc mmtcst° f ANALYTICAL LABORATORY 39 Spruce Street " East Longmeadow, MA 01028 ' FAX 413/525-6405 ' TEL. 413/525-2332 Sample Extraction Data EPA 1664B Lab Number [Field IDS Balch Initial [mL[ Dale 20A0671-01 [1] 13250531 400 01/22/20 SN121-22 2540D Lab Number [Field ID[ Batch Initial [mL[ pate 20A0671-01 [1] B250158 250 01/1620 SN121-22 4500 13 B Lab Number [Field ]D[ Batch Initial jmL[ Dale 2OA0671-01 [i] B250136 50.0 01/15/20 Prep Method: SR'-846 3005A-SW-846 6020B Lab Number [Field ID[ Batch Initial [m Ll Final [mL[ Dale 20A0671-01 [1] 13250219 50.0 50.0 01/16/20 Page 7 of 14 41.11i'anetcstl -r ANALyncAL LABORATORY 39 Spruce Street' East Longmeadow, MA 01028 ' FAX 4131525-6405 ' TEL. 4131525-2332 QUALITY CONTROL Metals Analyses (Tulnl) - Quality Cnnlrol Table of Contents Reporting Spike Source %RIiC RPD Analytc Result Limit Units Level Result %REC Limits RPD Limil Notes Balch B250219 - S W-846 3005A Blank (B250219-BLKI) Prepared & Analyzed: 01/16/20 Copper 1\1D 0.0010 mg/L Lead I1A0018 0.00050 mg/L Zinc ND 0.010 mgll. LCS (B250219-BS I) Prepared & Analyzed: 0111 6120 Copper 0.984 0.010 mg/L 1.00 98,4 80-120 Lcad 0.470 0.0050 mg/1. 0.500 93.9 80-120 Zinc 0.919 0.10 mg/L 1.00 91.9 80-120 I.CS Dup (62511219-BSDI) Prepared &Analyzed: 0[/16120 Copper 0-979 0.010 mg/L 1.00 97.9 80-120 0.565 20 Lead 0.462 0.0050 mg/L 0.500 92.5 80-120 1.54 20 Zinc 0.919 0.10 mgll. 1.00 91.9 80.120 0.0105 20 Page 8 of 14 Table of Contents 39 Spruce Street ' East Longmeadow, MA 01028 ' FAX 413/525-6405 " TEL. 413/525-2332 QUALITY CO\TRO]. Conventional Chemistry Parametcrs by FIIAIAPIIAISI A46 Methods (Tutal) - Q=tallt,' C.ontril Reporting Spike Source 'ARIiC MID Analyze Result limit Units Level Result %REC Limits RPD Urnit Notes Batch MUM - SM21-22 4500 11 B LCS (B250136-BSI) Prepared & Analyzed: 01/15120 PH Balch B2501S8-S1121-22 25401) 599 PI Units 6.0t) 99.8 90-110 Blank (B250158-BI.K I) Prepared & Analyzed: 01 /16120 Total Suspended Solids LCS (B250158-BS 1) ND 2.5 mg1L Prepared & Analyzed: 01/] 6120 Total Suspended Solids Batch B250531 - EPA 1664E 136 10 mgli. 200 68.0 57.6.1 ]8 Blank (B250531-BLK I) Prepared & Analyzed: 01/22120 Oil & Grease (HEM) Blank (8250531-BLK2) ND 1.4 mg/L Prepared & Analyzed: 01/22120 Oil & Grease (HEM) LCS (B250531-BS 1) ND 56 mglL Prepared & Analyzed: 01/22/20 Oil & Grease (HEM) LCS (B25053 1 -BS2) 1g mg1l, 20.0 91.5 78.114 Prepared & Analyzed: 01/22/20 Oil & Grcasc (I HEM) 710 mg1L 800 88.5 78414 Page 9 of 94 Table of Contents 39 Spruce Street 'East Longmeadow, MA 01028 'FAX 4131525-6405 ' TEL. 4131525-2332 FLAClQUALIFIER SUMMARY * QC result is outside of established limits. 1 Wide recovery limits established for difficult compound. + Wide RPD limits established for difficult compound. k Data exceeded client recommended or regulatory level ND Not Detected RL Reporting Limit is at the level of quantization (LCIQ) DL Detection Limit is the lower limit of detection determined by the MDL study MCI. Maximum Contaminant Level Percent recoveries and relative percent differences (RPDs) arc delcr:nined by the software using values in the calculation which have not been rounded. No results have been blank subtracted unless specified in the case narrative section. H-05 Holding time was exceeded. pH analysis should be performed immediately at time of sampling. Nominal 15 minute holding time was exceeded. ) Detected but below the Reporting Limit (lowest calibration standard): therefore, result is an estimated concentration (CLP ]-Flag). Page 10 of 14 Table of Contents 39 Spruce Street' East Longmeadow, MA 01028' FAX 4131525-6405' TEL. 413/525-2332 CERTIFICATIONS Certified Analyses included in this Report Analvtc Certifications EPA 1664H in Rater Oil & Grease (HEM) Cl',MA,NH,NY,RI,NC,ME,VA S,1121-22 25401) in if tiler Total Suspended Solids CT,MA,NH,NY,RI,NC,ME VA S,W21.22 4500 H Bin Rorer pH C1',MA,R1 SW 846 60208 in Rater Copper Cl',NI I,NY,ME,VA,NC Lead CT,NI I,NY,ME,VA,NC Zinc CT,NH,NY,MF,VA,NC The CON -'PEST Environmental Laboratory operates under the following certifications and accrcditations; Code Description Number Expires AIHA A1HA-LAP, LI.0 - 9SO17025:2017 100033 03/1/2022 MA Massachusetts DEP M-MA100 06/30/2020 CT Connecticut Department of Publile Health PH-0567 09/30/2021 NY Ncw York State Department of Health 10999 NiiLAP 041IY2020 Nli-S New Hampshire Environmental Lab 2516 NELAP 021512020 RI Rhode Island Department of I lealth LA000112 12/3012020 NC North Carolina Div. of Watcr Quality 652 12/31/2020 NJ New Jersey DE I' MA007 NELAP 06/30/2020 Fl. Florida Department of Health ER71027 NELAP 06130Y2020 VT Vermont Department of Hcalth Lead Laboratory 1.1-015036 07/30/2020 ME State of Maine 2011028 06/912021 VA Commonwealth of Virginia 460217 [2/14/2020 NH-P New Hampshire Environmental Lab 2557 NELAP 09l612020 V1, DW Vermunt Department of Hcalth Drinking Watcr VT-255716 06/12/2020 NC-DW North Carolina Department of Health 25703 07/31/2020 PA Commonwealth of Pennsylvania DFP 68.05812 06130f2020 Page 11 of 14 ♦F 1 httw www.cantestlabs.com Doc # 379 Rey 1_03242017 v CQn-`ES`♦i Phone_ 413.525-233 2-()A `• CHAIN OF CUSTODY RECORD (North Carolina) 39 Spruce Street Page of _t_ _1_ East Longmeadow, MA 01028 j� Fax: 413-575-6405 n Email: infoocontestlabs.com 7-Day ❑ 10-Day ❑ 1 21 '1 11 1 11 1 1# of Containers - Mid Atlantic Associates Due Date., H N N N = Preservation Code Address: 409 Rogers Vie+ P G P P P11P S Container Code Phone. (919) 624.0630 1-Day ❑ 3-Day ❑ 2-Da y ❑ 4-Day ❑ e o ANALYSIS REQUESiFD �', a ti ❑si fe[d F [ieri�d >' ::: ❑ °LabtO'F!1[er:- Matiab, Inc. Project Location: Plant 16 - Greensboro, NC w e Project Number; R2943.iO Format- PDF I EXCEL EJ Other. CLP Like Data Pkg Required: LJ Email re: pspanQenherp(O�maaonline.cOm Fax To #: (914) 250.9950 Project Manager: Paul W. Spangenberg ::old Ei[tere� '::= :". '.:" ❑ Iati`taJFilter-=:'_--".:. '. :: Con -Test Quote Name/N Invoice Recipient: pSDangenber online -Corn Sampled B} : Pau( W. Spangenberg 1 1/14/2020 1 1114/2020 t 1IIA/2020 Relinquished by: (signature) /wtir lurdl+.wyo... DatIROMERWORM Received by: (signature} `, Cj' K3 I%t?/zb JS Datemrn❑ Reitnqulshed by: (signature) Datellflmll Received by: (signature) Da + n'107 woAshed by: (signature) Dat Project Entity ❑ DatelTitr❑ ❑ tD N ived by: Isignature) O_ A &OD MA 8:01 AM 8:02 AM GWPC MSCC Government Federal } t. d� T�l�'�irlDed�u _ Fr WEN Swa'G141RrdYleell K 0 L X X ;'°�11M/e°Drltlkitlj(WeEsi•'.,",; x 0 L X J S.aSerlY SG� Sli dge ? ' . , % 0 L x K K '.SOL Selld;':f_t,.'.'::` .' O e Odor 066nie ' - ��? Pres`ervati6ri'Cedes:' ..: V'iIced:::_=>:::,- . �- - :M'i Metiiariol ..: N itilc Acid .: .S'�'Sutftldc Acid 5oi€itieilEisiitfate •'. X'r'5odifiiil.Hydrtxide- .: %ThfossU Cate:"' Please use the fallowing codes to indicate possible sample concentration within the Cont Code column above: H - High: M - Medium: L - Low; C • Clean; U - Unknown nfainer Codes: - ='.`.A■;Amber Glass :.v':ViOI';::=r".;- :5 5t117Ar18 Cailfster -' T i Tedtai ..0�.. - a Ini. Program Information DSCA ❑ UST/Trust Fund SWS Landfill ❑ REC State Lead F] lHSB Orphaned Landfill Other. Other PCB (MLY W CrMunici ❑ li Municipality ❑ Chromatogram ❑ Soxhlet tD ❑ Ekownfield ❑ AIHA-LAP,LLC ❑ Nan Soxhlet 0 ❑ School O tD N 1/15/2020 Track your package or shipment with FedEx Tracking Table of Contents 41135978466At Delivered Wednesday 1 /15/2020 at 9.43 am DELIVERED Signed for by: RPETRAMS GET STATUS UPDATES OBTAIN PROOF OF DELIVERY Shipment Facts TRACKING NUMBER SERVICE WEIGHT 411359784662 FedEx Priority Overnight 5 Ibs / 2.27 kgs DIMENSIONS DELIVERED TO TOTAL SHIPMENT WEIGHT 1 Sx11 x17 in Shipping/Receiving 5 lbs / 2.27 kgs PACKAGING SPECIAL HANDLING SECTION STANDARD TRANSIT Your Packaging Deliver Weekday, Additional Handling 0 Surcharge 1 /15/2020 by 10:30 am SHIP DATE ACTUAL DELIVERY 0 t.Ned 1 / 15/2020 9:43 am Tue 1/11/2020 * r Travel History Local Scan Time u Wednesday,1/15/2020 9:43 t+m Delivered 7:59 am WINDSOR LCCKS, CT On FedEx vehicle io; delrVery 7:49 am WINDSOR LOCKS, CT At focal FedEx facility 6:41 am EAST GRANBY, CT At destintition sort facility 3:36 am MEMPHIS, TN Departed FedEx location Tuesday,111412020 1 A. Gn.,,,, Ur KIbI-0C TIJ A,;,,.A e4 rear„ r.....C— https:llwww.fadox.r-omlappstfedextrack?trknbr411359784662&trkqual=2458863000-411359784662-FX&locale=en_US&cntry_codecus Page 13 of 14 Table of Contents I Have Not Confirmed Sample Container Numbers With Lab Staff Before Relinquishing Over Samples ANAiLYZ'1CAL LABCyRATORY ................. ... -... ............ ............................................................ Login Sample Receipt Checklist - (Rejection Criteria Listing - Using Acceptance Policy) Any False Statement will be brought to the attention of the Client - State True or False 1 fl Client / _., ....._._., Received By J4 Date I I V 20 Time 3 How were the samples In Cooler -T- No Cooler On Ice f No Ice received? Direct from Sampling Ambient Melted Ice Were samples within By Gun # Z Actual Temp - S• Temperature? 2-6°C By Blank # Actual Temp - Was Custody Seal Intact? V- 4 _ Were Samples Tampered with? . Was COC Relinquished ? T Does Chain Agree With Samples? Are there brokenlleaking/loose caps on any samples? _ F Is COC in ink/ Legible? z Were samples received within holding time? -j- Did COC include all Client~ AnalysisSampler Name fi pertinent Information? Project ID's Collection Dates/Times�_ Are Sample labels filled out and legible? Are there Lab to Filters? F Who was noted? Are there Rushes? F Who was notified? Are there Short Holds?� Who was notified? Is there enough Volume? Is there Headspace where applicable? �— MSIMSD? F Proper Media/Containers Used? ?- Is splitting samples required? Were trip blanks received? f On COC? F Do all samples have the proper pH? Acid Base