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Home My WebLink AboutNCG100124_MONITORING INFO_20180201STORMWATER DIVISION CODING SHEET NCG PERMITS PERMIT NO. IV C� b c) DOC TYPE ❑HISTORICAL FILE C�,MONITORING REPORTS . DOC DATE ❑ ows o a o l YYYYMMDD MW Atlantic Engineering & Environmental Solutions January 9, 2018 Mr. Tom Jackson Jackson Auto Salvage 7120 Poole Road Raleigh, North Carolina 27610 Subject: STORMWATER SAMPLING RESULTS JACKSON'S AUTO SALVAGE, INC. 7120 POOLE ROAD RALEIGH, WAKE COUNTY, NORTH CAROLINA PERMIT NCG100124 MID -ATLANTIC JOB NO. 000R1996.01 Dear Mr. Jackson: 409 Rogers View Court Raleigh. NC 27610 office 919.250.991 B facsimile 919.250.9950 MAAONLINE.COM R E'lVED FEe 01 2018 CENTRAL FILES CN,/P SECTION Attached please find three copies of the Stormwater Discharge Monitoring Report (DMR) for the above -referenced site. Please follow the instructions below to complete this sampling event: 1. Sign and date each DMR on page 2; 2. Forward the first two copies of the report along with the attached cover letter to the Division of Water Quality (mailing address is on the first page of the DMR); and 3. Insert the third copy (labeled "FILE") into Appendix C of your Stormwater Pollution Prevention Plan. As always, if you have any questions or need additional information, please contact me at 919-250-9918. Sincerely, MID -ATLANTIC ASSOCIATES, INC. ?, ��Q!ts7e___r0 Ron Davis Stormwater Services Attachments: Cover Letters Stormwater Discharge Monitoring Reports Laboratory Analytical Reports EXPERIENCED CUSTOMER FOCUSED INNOVATIVE 409 Rogers View Court GAid Atlantic ffic 919.2, NC Z9976 10 office office 919.250.4919 Engineering & Environmental Solutions facsimile 919.250,9950 MAAONLINE.COM January 9, 2018 NCDEQIDWR Attention: Central Files 1617 Mail Service Center Raleigh, North Carolina 27699-1617 O g � Subject: STORMWATER SAMPLING RESULTS JACKSON'S AUTO SALVAGE, INC. 7120 POOLE ROAD RALEIGH, WAKE COUNTY, NORTH CAROLINA PERMIT NCGlOO124 MID -ATLANTIC JOB NO. 00OR1996.01 To Whom It May Concern: • Attached please find the Stormwater Discharge Monitoring Report (DMR) and analytical report for the sampling conducted at the above -referenced site. A stormwater sample was collected from Outfall 001 on December 20, 2017 and analyzed for total suspended solids (TSS), total recoverable lead, oil and grease and ethylene glycol. As indicated on the attached DMR, all parameters were reported below or within their respective benchmark values. If you have any questions or need additional information, please contact me at 919-250-9918 is Sincerely, MID -ATLANTIC ASSOCIATES, INC. Ron Davis Stormwater Services Attachments: Stormwater Discharge Monitoring Report Laboratory Analytical Report EXPERIENCED CUSTOMER FOCUSED INNOVATIVE STORMWATER DISCHARGE OUTFALL (SDO) MONITORING REPORT CERTIFICATE OF COVERAGE NO. NCGIO0124 FACILITY NAME Jackson Auto Salvage, Inc., Raleigh, NC PERSON COLLECTING SAMPLE(S) Sandra Miller CERTIFIED LABORATORY(S) Pace Anal ical Lab # 12 Lab # Part A: Stormwater Benchmarks and Monitoring Results SAMPLES COLLECTED DURING CALENDAR YEAR: 2017 (This monitoring report shall be received by the Division no later than 30 days from the date the facility receives the sampling results from the laboratory.) COUNTY Wake PHONE NO. 919) 266-2704 PLEASE REMEMBER TO SIGN ON THE REVERSE 4 For sampling periods with no discharge, you must submit this discharge monitoring farm noting "No Flow" or "No Discharge" within 30 days of the end of that period to comply with permit reporting requirements. Outfall No. Date Sample Collected, mo/dd/year Total Rainfall, inches 00530 - - - - 77023 01051 .78141 Total Suspended Solids (TSS), mg/L Non -polar O&G/TPH (Method 1664 SGT-HEM), mg/L Ethylene Glycol, mg/L Lead, Total Recoverable, mg/L Total Toxic Organics3, mg/L Benchmark - - 100/502 15 8,000 (Tiers 2 and 3) 0.03 1.0 Outfall001 12/20/17 0.42 33.6 <5.0 <10.0 0.0141 NA Note: If you report a sampled value in excess of the benchmark value, or outside the benchmark range for pH, you must implement Tier 1 or Tier 2 responses in the General Permit. ILSee If pH values outside this range are recorded in sampled stormwater discharges, but ambient precipitation pH levels are lower, then the lower threshold of this benchmark range is the pH of the precipitation (within instrument accuracy) instead of 6 S.U. Readings from an on -site or local rain gauge (or local precipitation data) must be documented to demonstrate background concentrations were below the benchmark pH range of 6-9. 2See General Permit text to identify whether the more protective benchmark applies for especially sensitive receiving waters. 0 0 Farm SWU-251, last revised®25, a12012 of 2 ' ® STORMWATER DIAGE OUTFALL (SDO) 0 - MONITORING REPORT 3For purposes of this permit the definition of Total Toxic Organics is that list as stated in Appendix D, Table II of Chapter 40 Code of Federal Regulations (CFR) Part 122. Facilities that incorporate a solvent management plan into the Stormwater Pollution Prevention Plan may request that DWQ waive monitoring of total toxic organics. 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 allowed such a waiver, the discharger shall sign the following certification statement: Solvent Management Plan 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 fast discharge monitoring report. I further certify that this facility is implementing all the provisions of the solvent management plan included in the Stormwater Pollution Prevention Plan." Name (Print name) Title (Print title) Signature Mail Original and one copy to: Division of Water Quality Attn: Central Files 1617 Mail Service Center Raleigh, North Carolina 27699-1617 Date "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 6111-ermittee or Designee) (D te) Form SWU-251, last revised October 25, 2o12 Page 2 of 2 aceAnalytical� www.pacelabsmn Pace Analytical Services, LLC 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 January 05, 2018 Chuck Hoffman Mid -Atlantic Associates, Inc 409 Rogers View Court Raleigh, NC 27610 RE: Project: Jackson's Auto Salvage Pace Project No.: 92367941 Dear Chuck Hoffman: Enclosed are the analytical results for sample(s) received by the laboratory on December 21, 2017. The results relate only to the samples included in this report. Results reported herein conform to the most current, applicable TNIINELAC standards and the laboratory's Quality Assurance Manual, where applicable, unless otherwise noted in the body of the report. If you have any questions concerning this report, please feel free to contact me. Sincerely, Nicole Gasiorowski nicole.gasiorowski@pacelabs.com (704)875-9092 Project Manager Enclosures cc: Ron Davis, Mid Atlantic Associatees. Inc. pCG{F�' REPORT OF LABORATORY ANALYSIS D] • 0 This report shall not he reproduced, except in full, without the written consent of Pace Analytical Services, LLC. Page 1 of 13 aceAnalytical o www.pBcolabs.com Pace Analytical Services, LLC 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 0 Project: Jackson's Auto Salvage Pace Project No.: 92367941 Indiana Certification IDs 7726 Moller Road, Indianapolis, IN 46268 Illinois Certification #: 003971 Indiana Certification M C-49-06 KansaslNELAP Certification #:E-10177 Kentucky UST Certification #: 80226 Kentucky WW Certification #:98019 Charlotte Certification IDs 9800 Kincey Ave. Ste 100, Huntersville, NC 28078 LouisianalNELAP Certification # LA170028 North Carolina Drinking Water Certification #: 37706 North Carolina Field Services Certification #: 5342 North Carolina Wastewater Certification #: 12 Asheville Certification IDs 2225 Riverside Drive, Asheville, NC 28804 Florida/NELAP Certification #: E87648 Massachusetts Certification #: M-NC030 North Carolina Drinking Water Certification #: 37712 • CERTIFICATIONS Ohio VAP Certification #: CL-0065 Oklahoma Certification M 2017-124 Texas Certification #: T104704355-17-11 West Virginia Certification #: 330 Wisconsin Certification #: 999788130 USDA Soil Permit #: P330-16-00257 South Carolina Certification M 99006001 Florida/NELAP Certification M E87627 Kentucky UST Certification M 84 VrginiaNELAP Certification #: 460221 North Carolina Wastewater Certification #: 40 South Carolina Certification #: 99030001 VrginiaNELAP Certification #: 460222 REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, without the written consent of Pace Analytical Services, LLC. Page 2 of 13 aceAnalytrcal www.pacelabs.com Pace Analytical Services, LLC 9800 Kincey Ave. Suite 100 Hunters5ille, NC 28078 (704)875-9092 SAMPLE ANALYTE COUNT 0 Project: Jackson's Auto Salvage Pace Project No.: 92367941 Analytes Lab ID Sample ID Method Analysts Reported Laboratory 92367941001 Outfall No. 1 EPA 1664B JIVIS 1 PASI-C EPA 8015 Alcohol -Glycol RID 1 PASI-I EPA 6010 SER 1 PASI-A SM 2540D NAL 1 PASI-A • REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, without the written consent of Pace Analytical Services, LLC. Page 3 of 13 aceAnalytical www.paceiabs.com Pace Analytical Services, LLC 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 s Project: Jackson's Auto Salvage Pace Project No.: 92367941 ANALYTICAL RESULTS Sample: Outfall No. 1 Parameters Lab ID: 92367941001 Collected: 12/20/17 15:35 Received: 12/21/17 09:20 Matrix: Water Results Units Report Limit DF Prepared Analyzed CAS No. Qual 1664 SGT-HEM, TPH Analytical Method: EPA 1664B Total Petroleum Hydrocarbons ND mg/L 5.0 1 01/05/18 04:45 8015M Glycols in water Analytical Method: EPA 8015 Alcohol -Glycol Ethylene glycol ND mg/L 5.0 1 12/26/17 11:37 107-21-1 6010 MET ICP Analytical Method: EPA 6010 Preparation Method: EPA 3010A Lead 14.1 uglL 5.0 1 01/02/18 15:35 01/04/18 00:39 7439-92-1 2540D Total Suspended Solids Analytical Method: SM 2540D Total Suspended Solids 33.6 mg/L 5.0 1 12/27/17 03:27 0 • REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, Date: 01/05/2018 01:02 PM without the written consent of Pace Analytical Services, LLC. Page 4 of 13 aceAnalytical www.pacelabs,com Pace Analytical Services, LLC 9800 Kincey Ave. Suite 100 Huntersdille, NC 28078 (704)875-9092 QUALITY CONTROL DATA Project: Jackson's Auto Salvage Pace Project No.: 92367941 QC Batch: 393325 Analysis Method: EPA 1664B QC Batch Method: EPA 1664E Analysis Description: 1664 SGT-HEM, TPH Associated Lab Samples: 92367941001 METHOD BLANK: 2180920 Associated Lab Samples: 92367941001 Parameter Units Total Petroleum Hydrocarbons mg/L Matrix: Water Blank Reporting Result Limit Analyzed Qualifiers ND 5.0 01/05/18 04:32 C LABORATORY CONTROL SAMPLE & LCSD: 2180921 2180922 Spike LCS LCSD LCS LCSD % Rec Max Parameter Units Conc. Result Result % Rec % Rec Limits RPD RPD Qualifiers Total Petroleum Hydrocarbons mg/L 20 19.8 19.6 99 98 64-132 1 30 Results presented on this page are in the units indicated by the "Units" column except where an alternate unit is presented to the right of the result. REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, Date: 01/05/2018 01:02 PM without the written consent of Pace Analytical Services, LLC. 0 Page 5 of 13 JaceAnalytical"' www.p&cetabs.corn Pace Analytical Services, LLC 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 0 Project: Jackson's Auto Salvage Pace Project No.: 92367941 QC Batch: 421779 QC Batch Method: EPA 8015 Alcohol -Glycol Associated Lab Samples: 92367941001 METHOD BLANK: 1945165 Associated Lab Samples: 92367941001 Parameter Units Ethylene glycol mglL LABORATORY CONTROL SAMPLE: 1945166 Parameter Units Ethylene glycol mg/L • QUALITY CONTROL DATA Analysis Method: EPA 8015 Alcohol -Glycol Analysis Description: EPA 8015 Modified Matrix: Water Blank Reporting Result Limit Analyzed Qualifiers ND 5.0 12/2611710:02 Spike LCS Conc. Result 25 30.3 LCS % Rec % Rec Limits Qualifiers 121 41-162 Results presented on this page are in the units indicated by the "Units" column except where an alternate unit Is presented to the right of the result. REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, Date: 01 /05/2018 01:02 PM without the written consent of Pace Analytical Services, LLC. Page 6 of 13 aceAnalytical www.pacafab3.COM Pace Analytical Services, LLC 9800 Kincey Ave. Suite 160 HuntersJille, NC 28078 (704)875-9092 Project: Jackson's Auto Salvage Pace Project No.: 92367941 QC Batch: 392621 QC Batch Method: EPA 3010A Associated Lab Samples: 92367941001 METHOD BLANK: 2177679 Associated Lab Samples: 92367941001 Parameter Units Lead ug/L LABORATORY CONTROL SAMPLE: 2177680 Parameter Units Lead ug/L QUALITY CONTROL DATA Analysis Method: EPA 6010 Analysis Description: 6010 MET Matrix: Water Blank Reporting Result Limit Analyzed Qualifiers ND 5.0 01/03/18 23:30 Spike LCS LCS % Rec Conc. Result % Rec Limits Qualifiers 500 459 92 80-120 MATRIX SPIKE & MATRIX SPIKE DUPLICATE: 2177681 2177682 MS MSD 92367744001 Spike Spike MS MSD MS MSD % Rec Parameter Units Result Conc. Conc. Result Result % Rec % Rec Limits RPD Qual Lead uglL ND 500 500 466 473 93 95 75-125 2 a Results presented on this page are In the units indicated by the "Units" column except where an alternate unit Is presented to the right of the result, is REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, Date: 01/05/2018 01:02 PM without the written consent of Pace Analytical Services, LLC. Page 7 of 13 aceAnalytical www.pacefelmcom 0 Project: Jackson's Auto Salvage Pace Project No.: 92367941 QC Batch: 392409 QC Batch Method: SM 2540D Associated Lab Samples: 92367941001 METHOD BLANK: 2176808 Associated Lab Samples: 92367941001 Parameter Units Total Suspended Solids mg/L LARORATORY CONTROL SAMPLE? 2176809 Parameter Units Total Suspended Solids mg/L Pace Analytical Services, LLC 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 QUALITY CONTROL DATA Analysis Method: SM 2540D Analysis Description: 2540D Total Suspended Solids Matrix: Water Blank Reporting Result Limit Analyzed Qualifiers ND 2.5 12/27/17 03:19 Spike LCS LCS % Rec Conc. Result % Rec Limits Qualifiers 250 252 101 90-110 SAMPLE DUPLICATE: 2176810 92367589003 Dup Parameter Units Result Result RPD Qualifiers Suspended Solids mg/L 280 324 15 D6 SAMPLE DUPLICATE: 2176811 92367923002 Dup Parameter Units Result Result RPD Qualifiers Total Suspended Solids mg/L 555 575 4 ® Results presented on this page are in the units indicated by the "Units" column except where an alternate unit is presented to the right of the result. REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, Date: 01/05/2018 01:02 PM without the written consent of Pace Analytical Services, LLC, Page 8 of 13 aceAnalytical w w.pecelebs.com Pace Analytical Services, LLC 9800 Kincey Ave. Suite 160 Huntersville,'NC 28078 (704)875-9092 QUALIFIERS Project: Jackson's Auto Salvage Pace Project No.: 92367941 DEFINITIONS DF - Dilution Factor, if reported, represents the factor applied to the reported data due to dilution of the sample aliquot. ND - Not Detected at or above adjusted reporting limit. TNTC - Too Numerous To Count J - Estimated concentration above the adjusted method detection limit and below the adjusted reporting limit. MDL-Adjusted Method Detection Limit. PQL - Practical Quantitation Limit. RL - Reporting Limit. S - Surrogate 1,2-Diphenylhydrazine decomposes to and cannot be separated from Azobenzene using Method 8270, The result for each analyte is a combined concentration. 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. SG - Silica Gel - Clean -Up U - Indicates the compound was analyzed for, but not detected. Acid preservation may not be appropriate for 2 Chloroethylvinyl ether. A separate vial preserved to a pH of 4-5 is recommended in SW846 Chapter 4 for the analysis of Acrolein and Acrylonilrile by EPA Method 8260, 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 TNI accredited. Contact your Pace PM for the current list of accredited analytes. TNI - The NELAC Institute. LABORATORIES PASI-A Pace Analytical Services -Asheville PASI-C Pace Analytical Services - Charlotte PASI-I Pace Analytical Services - Indianapolis ANALYTE QUALIFIERS D6 The precision between the sample and sample duplicate exceeded laboratory control limits. REPORT OF LABORATORY ANALYSIS J u • LI I This report shall not be reproduced, except in full, Date: 01/05/2018 01:02 PM without the written consent of Pace Analytical Services, LLC. Page 9 of 13 Pace Analytical Services, LLC • accAnalytrcal 9800 KinceyAve. Suite 100 kuntersville, NC 28078 wmvpacefubs•com (704)875-9092 ® QUALITY CONTROL DATA CROSS REFERENCE TABLE Project: Jackson's Auto Salvage Pace Project No.: 92367941 Analytical Lab ID Sample ID QC Batch Method QC Batch Analytical Method Batch 92367941001 Outfall No. 1 EPA 1664B 393325 92367941001 Outfall No. 1 EPA 8015 Alcohol -Glycol 421779 92367941001 Outfall No. 1 EPA 3010A 392621 EPA 6010 392714 92367941001 Outfall No. 1 SM 2540D 392409 • REPORT OF LABORATORY ANALYSIS This fepon shall not be reproduced, except in full, Date: 01/0512018 01:02 PM without the written consent of Pace Analytical Services, LLC. Page 10 of 13 Document Name: Document Revised: July 25, 2017 aceAnalXiol - Sample Condition Upon RecelptiSCURj Page 1 of 2 Document No.: Issuing Authority: F-CAR-CS-033-Rev.03 Pace Quality Office ----Laboratory-receiving.sampies : — --•--- -_� _� —� — ®— Asheville ❑ Eden[] Greenwood ❑ Huntersvilie ❑ Raleigh Mechanicsville[:] v Client NameU 1� W®# : 92367941 ' ;I A a'�1�,� `� '� Project #: Courier:Commercial �E]FedPaEx ❑UPS Client 0r00ther. 92367941 I !!!! ■■■ Custody Seal Present? ❑Yes o Seals Intact? „0Yes io /L�� Date/initials Person Examining Contenrt�2L Packing Material: Bubble Wrap ubbl8 a Bags None Other Biological Tissue Froze ---- Thermometer: P ❑ g ❑❑ B Thermometer: � 7 wet ❑81ue ❑None ❑Yes ❑No ❑ IR Gun ID: �gLr Type of ice: / ^CotrectlonYactor:___Cooler Temp. Corrected j'C): r Temp should .be above. freezing to 6'C -- i ❑Samples out of temp criteria. Samples on ice, cooling process �Sulfn,t�� ..• has begun USDA Regulated Soil •N/A, watersample) Did samples origin tern a quarantine zone within the United States: CA, NY, or SC (check maps)? Did samples originate from a foreign source (interna ' y, ❑Yes DA including Hawaii and Puerto Rico)? ❑Yes No -Y Comments/Discrepancy: Chain of Custody Present? YesjQN6 ❑N/A I. Samples Arrived within Hold Time? es []No N/A 2. Short Hold Time Analysis <72 hr.)? [--]Yes o A 3. Rush Turn Around Time Requested? Elyes o N/A 4. Sufficient Volume? Y No N/A 5. Correct Containers Used? -Pace Containers Used? yes ❑No ❑N/A No ❑N/A 6. Containers Intact? es [:]No [3N/A 7: Dissolved analysis: Samples Field Filtered? QYes j]No NIA a. Sample Labels Match COC? r -Includes Date/Time/ID/Anal is Matrix: i es []No ❑N/A 9. Headspace in VOA Vials I>5-6mm)? ❑Yes No /A 10. Trip Blank Present? Trip Blank Custody Seals Present? []Yes ❑Yes [:]No ❑No " N/A NIA 11. CLIENT NOTIFICATION/RESOLUTION Person Contacted: Comments/Sample Discrepancy: Project Manager SCURF Review: Field Data Required? LJYe5 L_jNo Date/rime: Date: mmg 1 _ 6, Project Manager SRF Review: AV M7 Date: Note: Whenever there is a discrepancy affecting North Carolina compliance samples, a copy of this form will be seni to the North Carolina DEHNR Certification office (i.e. Out of hold, Incorrect preservative, out of temp, Incorrect containers) Page 11 of 13 0 ,a 3 v m a s 0 c n 0 �n w v m A s � ID 3 m rF �'- a tlq a n .n to M H Q C N Iv 5 M th b 3 0 91 O d n � 6 A C w m 0 a hemp 1! ZZZZZZZZIZ Izz, r �L Plastic Unpreserved (N/A) (CJ-) —SP411.11-125 SP3U-250 r4l. Plastic Unpreserved (N/A) MU-500 mL Plastic Unpreserved (N/A) $P1U-1 liter, Plastic Unpreserved (N/A) BP4S-125 m! Plastic H2SO4 (pH c 2) (CI-) $PM-250 rr+L plastic HNO3 (pH < 2) BPR-250 mL Plastic ZN Acetate & NaOH (>9) BP3C-250 m,L Plastic NaOH (pH > 12) (CJ-) WGFU-Wid i-mouthed Glass jar Unpreserved I AG111.1-1 liter Amber Unpreserved (N/A) (Cl-) ZZZZZZVAZZZ AG1H-1 liter Amber HCI (pH < 2) G3U-250 mL Amber Unpreserved (N/A) (Cl-) I AG1S-1 Iiter,Amber H2504 (pH < 2) AG3S-250 mlLAmber H2504 (pH <2) 1 AG3A(0G3A)-250 mL Amber NH4CI (N/A)(CJ-) I DG91,11-40 mL VOA HCI (N/A) VG9T-40 mf i�VOA NaZS203 (N/A) V VG9U-40 m l VOA Unp (N/A) UGSP-40 mL' VOA H3PO4 (N/A) VOAK (6 vials per kit)-5035 kit (N/A) V/GK (3 vials per kit)-VPH/Gas kit (N/A) I SPST-125 mL Sterile Plastic (N/A -Jab) I SPZT-250 mI L Sterile Plastic (N/A - lab) MA-250 mL Plastic (NH2)2$04 (93-9.71 Cubitainer VSGU-20mLI5cintHlationvials (N/A) GN tD t3 CD A CHAIN-OF-CUY 1 Analytical Request Document • aeeAnieal , The Chain -of -Custody is a LE OCUMENT. All relevant fields must be completed accurately. t � arI Section SA Section B Section C Page: f of Required Client Iniorrrtatian: Required Project Information- Invoice Information:J - =dmaany: Mid -Atlantic Associates, Inc. Report To, Chuck Hoffman (choffman@maaonline.com) Attention: Chuck Hoffman 4ddross: 409 Rogers View Court COPY TO: Ron Davis (rdaviS@maaanline.com Company Name: Mid -Atlantic Associates, inc. REGULATORY AGENCY Raleigh, NC 27610 Andress: 409 Rogers View Court, Raleigh, NC IF NPOES f- GROUNDWATER I- DRINKING WATER r-- UST I" RCRA 17- OTHER Email To: choffman@maaonline.com Puf=Se Order No.: R1996.01 Pace Qual. -- Reference: mane: 919-250-9918 Fax: 919-250-9950 Project Name: Jackson's Auto Salvage Nicole Gasiorowski Site Location Ma9aP'a°n STATE: NC Requested Due DaterTAT: Standard Protect Ntdhber: R1996.01 c pmfue a: -- Requested Analysis Filtered (YIN) Seddon O Valid Matrix Codes a I I Raqulmd client Informaion MATRIx CODE - .2 COLLECTED Preservatives 'y N Y N Y ORIWUNG WATER OW 2 WATER W7 WASTE WATER WW PROOUCT P 0 v [.1 m CO M-OS1TE START COWOSITE ENOr.RAB J SO ccv 04 OL SAMPLE ID WWE WP 9 O to en CO `D d7 O U G1 AIR AR {A-Z. 0-9 1.-) OTHER Of 0 to S a w d) -0 O }" Q1 O Sample IDs MUST BE UNIQUE TISSUE TS O UQ 0, w a yy11 �N a~c ` 2ac7e EL LL zC m0 rn DATE TIME o a � = x M A 2 O IX P Lab I.D. Pace Project o�./ 1 Outfall No. 1 wr G I5 5s 7 4 1 2 x x x x Cp 2 3 4 5 6 7 8 9 10 11 12 J ADDITIONAL COMMENTS RELINQUISHED BY BY I AFFILIATION DATE TIME ACCEPTED BY I AFFILIATION DATE TIME SAMPLE CONOITIONS /it�sai.74�L i.u-T.'�-' fi�l ` it- b-o 4 Le - SAMPLER NAME AND SIGNATURE;Ilia ►� K^'L'� �� `�" ;� o a > > v m r PRINT Name of SAMPLER: SC�•1 �� . C ` I✓i z d m O SIGNATURE of SAMPLER. ff DATE Slgnod ; ,.Z — Z `1 •- l i ' ZLL is {MMIDDlYY : 'Important Note: By sgninq this form yew are wcepthV Pace's NET 30 day Payment tarns and agreemp to We charges of 1.5% per month for any Mv&Od 5 rot paid wdhW 30 days. F-ALL-0-020fev.08, 12-00-2007