NCS000295_MONITORING INFO_20191101

4v 0
STORMWATER DIVISION CODING SHEET
NCS PERMITS
PERMIT NO.
/� J L S � L-)
DOC TYPE
❑FINAL PERMIT
[�( MONITORING REPORTS
❑ APPLICATION
❑ COMPLIANCE
❑ OTHER
DOC
;)o I GI I I
DATE
❑
YYYYMMDD

JACKSON PAPER
MANUFACTURING
October 30, 2019
NCDEQ, Division of` Water RCSOLII-Ces, Infonnation Processing Unit
Attu: Central files/e[)MIZ
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
RE-: Discharge Monitoring Report- October 2019 Monthly TiRELFEIt1 ED11 003
NI'DES Permit No. NCS000295
NIP 0 1 2019
Jackson Paper Manufacturing Company
Dcar Division of Water lZesources:
CENTRAL FFLE5
DWR SECTION
Please find enclosed Discharge Monitoring Report for Jackson Paper Mamlfactul•ing Conlpally
NPDE-S Permit No. NCS000295 for the month of October, 2019.
We sampled OLItfill 1 003 and the receiving water directly upstream and downstream Of OL)tfal1 003
for all parameters listed 1n our permit on October16. 2019. Thcre were no benchmark excecdanccs
at Outfall 003.
Per our current "bier "hero response for Outfall 003, we will continue to conduct nlontIlly 111011itoritlg
and reporting for all parameters at Outfall 003. Monthly (analytical and qualitative) monitoring
Wili C011611LIC wltil three consecutive sample results are below the benchmark values. We will also
C011611LIC to ]monitor for all parameters ill the receiving Water dit-Cfitly Upstl—Will and downstream
off the monitoring point in accordance with the "I'ict- Two response.
I certify that based on information and belief forlled from reasonable inquiry, the statements and
information in the document arc true, accurate, and complete.
]'lease contact Kiesha Bridges at [phone] Ext
additional in ormatlon.
Sin � � •cly�_
v
Carr yndtl11
Vice President Operations
Jackson Paper Manufacturing Coinpany
Enclosure: Stormwatcr Discharge Monitoring Rcpert
CC: j?"4C HIC
226 if you have any questions or need any
NORTH CAROLINA'S LARGEST RECYCLED PAPER PROOUC(:R
152 WFSF MAIN STRIETO PO Box 6670 Svl.vA. INIC 28779 TEL [phone] FAX [phone]

Stormwater Discharge Outfall (SDO)
Monitoring Report
Permit Dumber NCS000295
Facilitp Name: Jackson Paper Manufacturing _Companv
Person Collecting Samples: Kiesha Bridges
Certified Laboratory: Pace Analvtical Services. LLC Project # 92449812
Samples Collected During Calendar Year: 2019
(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.)
Countv: Jackson
Phony NO. 828 5 6-5534 xt. 226
4 NATURE OF PER, TTEE OR DESIGNEE)
By this signature. I certify that this report is accurate
and complete to the best of my knowledge.
Oil and Crease
furhidity
'l'SS
pH
COD
Benchmark
Is
50
(6-9)
120
Benchmark
Benchmark
Benchmark
Benchmark
Date
Result
Result
\/A
Result
Result
Result
Outfall
Exceedance
Exceedance
Exceedance
Exceedance
Sampled
m /l.
(YIN)
U
mg/L
1'/N
YIN
mg/L
YIN
10/16/2019
003
N1D
No
33.2
12.8
No
7.8
No
ND
No
8:45am
Creek Pre
10/16/19
N,D
7.3
10.0
6.0
ND
Mill
9:00am
Creek Post
10/16/19
ND
8.4
9.8
6.8
ND
Mill
9:10am
ND: Not detected at or above adjusted reporting limit.
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? _Yes x No
Nleasureable
Storm Event?
Yes
0.06

Storm Event Characteristics:
Date: October 16, 2019
Totahevenhprecipitation (inches):
Duration of storm event: 1 -1.5 hrs
"Time since last rain event: -60 hrs
Drainage
Area
1
II
HI
IV
Area {acres)
Area (sf)
Volume (cf)
1.69
73,616
368
5.43
236,531
1,183
20.45
890,802
4,454
1.77
77,101
386
Jolume (gal)
_ 2,753
. 8;846
33,316
2,884.
Mail Original and one copy to:
Division of Water Quality
Attn: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
"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 fqr )Mgrring violations."
lo4 3(j ( `)L
(Signature of Per r
ittee) (Dat-

(�5a'neAnalytical*
www,peceiabs=m
October 30, 2019
Kiesha Bridges
Jackson Paper Mfg. Co.
152 West Main St.
Sylva, NC 28779
RE: Project: STORMWATER OCTOBER 2019
Pace Project No.: 92449812
Dear Kiesha Bridges:
Pace Analytical Services, LLC
2226 Riverside Dr.
Ashevliie, NC 28804
(828}254-7176
Enclosed are the analytical results for sample(s) received by the laboratory on October 16, 2019.
The results relate only to the samples included in this report. Results reported herein conform to the
most current, applicable TNI/NELAC 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,
Chris Derouen
[e-mail]
[phone]
Project Manager
Enclosures
cc: Keisha Bridges, Jackson Paper Mfg. Co.
pc �0
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, LLC.
Page 1 of 17

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Project: STORMWATER OCTOBER 2019
Pace Project No.: 92449812
Pace Analytical Services, LLC
2225 Riverside ❑r.
Asheville, NC 28804
(828)254-71 M
Charlotte Certification IDs
9800 Kincey Ave. Ste 100, Huntersville, NC 28078
South Carolina Certification #: 99006001
Loulsfana/NELAP Certification # LA170028
FioridalNELAP Certification #: E87627
North Carolina Drinking Water Certification #: 377C6
Kentucky UST Certification M 84
North Carolina Field Services Certification #: 5342
VirginiaNELAP Certification #: 460221
North Carolina Wastewater Certification #: 12
Asheville Certification IDs
2225 Riverside Drive, Asheville, NC 28804
Florida/NELAP Certification #: E87648
Massachusetts Certification #: M-NCO30
North Carolina Drinking Water Certification #: 37712
North Carolina Wastewater Certification #: 40
South Carolina Certification #: 99030001
VirginiaNELAP Certification #: 460222
REPORT OF LABORATORY ANALYSIS
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without the written consent of Pace Analytical Services, LLC, Page 2 of 17

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Pace Analytical Services, LLC
2225 Riverside Dr.
Asheville, NC 28804
[phone]
Project:
Pace Project No.:
STORMWATER OCTOBER 2019
92449812
Analytes
Lab ID
Sample ID
Method
Analysts
Reported
Laboratory
92449812001
OUTFALL#3
EPA1664B
HH
1
PASI-C
EPA 180.1 Rev 2.0 1993
SMK
1
PASI-A
SM 2540D-2011
MJP
1
PASI-A
EPA 9040C
ECH
1
PASI-A
SM 5220D-2011
GC
1
PASI-A
92449812002
CREEK PRE MILL
EPA 1664E
HH
1
PASI-C
EPA 180.1 Rev 2.0 1993
SMK
1
PASI-A
SM 254OD-2011
MJP
1
PASI-A
EPA 9040C
ECH
1
PASI-A
SM 5220D-2011
GC
1
PASI-A
92449812003
CREEK POST MILL
EPA 1664B
HH
1
PASI-C
EPA 180.1 Rev 2.0 1993
SMK
1
PASI-A
SM 2540D-2011
MJP
1
PASI-A
EPA 9040C
ECH
1
PASI-A
SM 522OD-2011
GC
1
PASI-A
REPORT OF LABORATORY ANALYSIS
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aceAnalj4ical o
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ANALYTICAL RESULTS
Pace Analytical Services, LLC
2225 Riverside Dr,
Asheville, NC 28804
[phone]
Project: STORMWATER OCTOBER 2019
Pace Project No.: 92449812
Sample: OUTFALL #3 Lab ID: 92449812001 Collected: 10/16/10 08:45 Received: 10/16/19 11:35 Matrix: Water
Parameters Results Units Report Limit OF Prepared Analyzed CAS No. Qual
1664 SGT-HEM, TPH
Analytical Method: EPA 1664B
Total Petroleum Hydrocarbons
NO mglL 5.0 1
10/29/19 16:44
180.1 Turbidity
Analytical Method: EPA 180A Rev 2.0 1993
Turbidity
33.2 NTU 1.0 1
10/1611915:21
2540D Total Suspended Solids
Analytical Method: SM 254OD-2011
Total Suspended Solids
12.8 mglL 2.5 1
10/19/19 09:47
9040 pH
Analytical Method: EPA 9040C
pH at 25 Degrees C
7.8 Std, Units 0.10 1
1 n/28119 15:33 H3
5220D COD
Analytical Method; SM 5220D-2011 Preparation Method:
SM 5220D-2011
Chemical Oxygen Demand
ND mglL 25.0 1
10123M9 16:22 10/23/1920:34
REPORT OF LABORATORY ANALYSIS
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ANALYTICAL RESULTS
Pace Analytical Services, LLC
2225 Riverside or.
Asheville, NC 26804
[phone]
Project: STORMWATER OCTOBER 2019
Pace Project No.: 92449812
Sample: CREEK PRE MILL Lab ID: 92449812002 Collected: 10/16/19 09:00 Received: 10/16/19 11:35 Matrix: Water
Parameters Results Units Report Limit DF Prepared Analyzed CAS No. Oual
1664 SGT-HEM, TPH
Analytical Method: EPA 1664B
Total Petroleum Hydrocarbons
ND mg1L
5.0 1
10/29/19 16:44
180.1 Turbidity
Analytical Method: EPA 180.1 Rev 2.0
1993
Turbidity
7.3 NTU
1.0 1
10116/1915:21
2540D Total Suspended Solids
Analytical Method: SM 254OD-2011
Total Suspended Solids
10.0 mg/L
2.5 1
10/19119 09:47
9040 pH
Analytical Method: EPA 9040C
pH at 25 Degrees C
6.0 Std. Units
0.10 1
10/28/19 15:50 H3
5220D COD
Analytical Method: SM 5220D-2011
Preparation Method: SM 5220D-2011
Chemical Oxygen Demand
ND mglL
25.0 1
10123/19 16:22 10/23/19 20:34
REPORT OF LABORATORY ANALYSIS
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Date: 10130/2019 08:50 AM without the written consent of Pace Anaiyticai Services, LLC. Page 5 of 17

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ANALYTICAL RESULTS
Pace Analytical Services, LLC
2225 Riverside ❑r.
Asheville, NC 28804
[phone]
Project: STORMWATER OCTOBER 2019
Pace Project No.: 92449812
Sample: CREEK POST MILL Lab ID: 92449812003 Collected: 10116/19 09:10 Received: 10116/19 11:35 Matrix: Water
Parameters Results Units Report Limit DF Prepared Analyzed CAS No. Qual
1664 SGT-HEM, TPH
Analytical Method: EPA 1664B
Total Petroleum Hydrocarbons
ND mg1L 5.0 1
10/29/19 16:45
180.1 Turbidity
Analytical Method: EPA 180.1 Rev 2.0 1993
Turbidity
8.4 NTU 1.0 1
10/16/1915:22
2540D Total Suspended Solids
Analytical Method: SM 2540D-2011
Total Suspended Solids
9.8 mg/L 2,5 1
10/19/10 09:47
9040 pH
Analytical Method: EPA 9040C
pH at 25 Degrees C
6.8 Std. Units 0.10 1
1012C119 16:25 H3
5220D COD
Analytical Method: SM 5220D-2011 Preparation Method:
SM 5220D-2011
Chemical Oxygen Demand
ND mg1L 25.0 1
10/23/19 16:22 10/23/19 20:34
REPORT OF LABORATORY ANALYSIS
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Date: 10/30/2019 08:50 AM without the written consent of Pace Analytical Services, LLC. Page 6 of 17

aceAnalXical.
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QUALITY CONTROL DATA
Project: STOfRMWATER OCTOBER 2019
Pace Project No.: 92449812
QC Batch: 506483 Analysis Method: EPA 1664E
QC Batch Method: EPA 16648 Analysis Description: 1664 SGT-HEM, TPH
Associated Lab Samples: 92449812001, 92449812002, 92449812003
Pace Analytical Services, LLC
2225 Riverside Or,
Asheville, NC 28804
[phone]
METHOD BLANK: 2719999 Matrix: Water
Associated Lab Samples: 92449812001, 92449812002, 92449812003
Blank Reporting
Parameter Units Result Limit Analyzed Qualifiers
Total Petroleurn Hydrocarbons mg1L ND 5.0 10/29/19 16:44
LABORATORY CONTROL SAMPLE: 2720000
Spike LCS LCS % Rec
Parameter Units Conc. Result % Rec Limits Qualifiers
Total Petroleum Hydrocarbons mglL 20 18.5 92 64-132
MATRIX SPIKE SAMPLE: 2720001
92449890001 Spike MS MS % Rec
Parameter Units Result Conc. Result % Rec Limits Qualifiers
Total Petroleum Hydrocarbons mg1L ND 20 15.6 70 64-132
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: 10/3012019 08:50 AM without the written consent of Pace Analytical Services, LLC.
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aceAnalytical
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QUALITY CONTROL DATA
Project: STORMWATER OCTOBER 2019
Pace Project No.: 92449812
QC Batch: 503960 Analysis Method: EPA 180.1 Rev 2.0 1993
QC Balch Method: EPA 180.1 Rev 2.0 1993 Analysis Description: 180.1 Turbidity
Associated Lab Samples: 92449812001, 92449812002, 92449812003
METHOD BLANK: 2708365 Matrix: Water
Associated Lab Samples: 92449812001, 92449812002, 92449812003
Blank Reporting
Parameter Units Result Limit Analyzed Qualifiers
Turbidity NTU ND 1.0 10116I1915:20
Pace Analytical Services, LLC
2.225 Riverside Dr.
Asheville, NC 28804
[phone]
LABORATORY CONTROL SAMPLE:
2708366
Spike LCS LCS
% Rec
Parameter
Units
Conc. Result % Rec
Limits Qualifiers
Turbidity
NTU
10 10.5 105
90-110
SAMPLE DUPLICATE: 270B367
92449812001 Dup
Parameter
Units
Result Result RPD
Qualifiers
Turbidity
NTU
33.2 32.9
1
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
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Date: 10/30/2019 08:50 AM without the written consent of Pace Analytical Services, LLC. Page 8 of 17

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QUALITY CONTROL DATA
Pace Analytical Services, LLC
2225 Riverside Dr.
Asheville, NC 28804
[phone]
Project: STORMWATER OCTOBER 2019
Pace Project No.: 92449812
QC Batch: 504599
Analysis Method:
SM 2540D-2011
QC Batch Method: SM 254OD-2011
Analysis Description:
2540D Total Suspended Solids
Associated Lab Samples: 92449812001, 92449812CO2, 92449812003
METHOD BLANK: 2711845
Matrix: Water
Associated Lab Samples: 92449812001, 92449812002, 92449812003
Blank Reporting
Parameter
Units
Result Limit
Analyzed Qualifiers
Total Suspended Solids
ri
ND
2.5 10/19/19 09:47
LABORATORY CONTROL SAMPLE:
2711846
Spike LCS
LCS % Rec
Parameter
Units
Conc. Result
% Rec Limits Qualifiers
Total Suspended Solids
mglL
250 250
100 90-110
SAMPLE DUPLICATE: 2711871
92450206001 Dup
Parameter
Units
Result Result
RPD Qualifiers
Total Suspended Solids
mg/L
282
244 14 D6
SAMPLE DUPLICATE: 2711872
92449869002 Di
Parameter
Units
Result Result
RPD Qualifiers
Total Suspended Solids
mg/L
161
164 2
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 he reproduced, except in full,
Date: 10/30/2019 08:50 AM without the written consent of Pace Analytical Services, L-C. Page 9 of 17

aceAPalyfrcal.
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QUALITY CONTROL DATA
Project: STORMWATER OCTOBER 2019
Pace Project No.: 92449812
QC Batch: 504653 Analysis Method: EPA 9040C
QC Batch Method: EPA 9040C Analysis Description: 9040 pH
Associated Lab Samples: 92449812003
SAMPLE DUPLICATE: 2711979
92450171003 Dup
Parameter Units Result Result RPD Qualifiers
pH at 25 Degrees C Std. Units 6.9 6.5 7 D6,H3
SAMPLE DUPLICATE: 2711980
Parameter Units
pH at 25 Degrees C Std. Units
92449833003 Dup
Result Result RPD Qualifiers
5.5 5.6 3 DB,H3
Pace Analytical Services, LLC
2225 Riverside Dr.
Asheviiie, NC 28B04
[phone]
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 resutt.
REPORT OF LABORATORY ANALYSIS
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Date: 10/30/2019 08:50 AM without the written consent of Pace Analytical Services, LLC.
Page 10 of 17

(�Iace*ialytical"
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QUALITY CONTROL DATA
Project: STORMWATER OCTOBER 2019
Pace Project No.: 92449812
QC Batch: 506001 Analysis Method: EPA 9040C
QC Batch Method: EPA 90400 Analysis Description: 9040 pH
Associated Lah Samples: 924498'2001, 92449812002
SAMPLE DUPLICATE: 2718169
92449718001 Dup
Parameter Units Result Result RPD Qualifiers
pH at 25 Degrees C Std. Units 6.9 6.7 3 D6,H3
SAMPLE DUPLICATE: 2718170
92450780002 Dup
Parameter Units Result Result RPD Qualifiers
pH at 25 Degrees C Std. Units 5.8 5.3 10 D6,H3
Pace Analytical services, LLC
2225 Riverside Dr.
Asheville, NO 28804
[phone]
Results presented on this page arc 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
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aceAnalytical
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QUALITY CONTROL DATA
Project: STORMWATER OCTOBER 2019
Pace Project No.: 92449812
QC Batch: 505349 Analysis Method: SM 5220D-2011
QC Batch Method: SM 5220D-2011 Analysis Description: 5220D COD
Associated Lab Samples: 92449812001, 92449812002, 92449812003
METHOD BLANK: 2715093 Matrix: Water
Associated Lab Samples: 92449812001, 92449812002, 92449812003
Blank Reporting
Parameter Units Result Limit Analyzed Qualifiers
Chemical Oxygen Demand mg1L ND 25.0 10/23/19 20:30
Pace Analytical Services, LLC
2225 Riverside Dr.
Asheville, NC 28804
[phone]
LABORATORY CONTROL SAMPLE: 2715094
Spike LCS LCS % Rec
Parameter Units Conc. Result % Rec Limits Qualifiers
Chemical Oxygen Demand mg1L 750 751 100 90-110
MATRIX SPIKE & MATRIX SPIKE DUPLICATE: 2715095 2715096
MS MSD
92450104007 Spike Spike MS MSD MS MSD % Rec
Parameter Units Result Conc. Conc. Result Result % Rec % Rec Limits RPD Qual
Chemical Oxygen Demand mg1 349 100 100 452 450 103 101 90-110 1
MATRIX SPIKE & MATRIX SPIKE DUPLICATE: 2715097 2715098
MS MSD
92449730001 Spike Spike MS MSD MS MSD % Rec
Parameter Units Result Conc. Conc. Result Result % Rec % Rec Limits RPD Qual
Chemical Oxygen Demand mg/L 240 100 100 296 298 55 57 90-110 1 M1
Results presented on this page are In the units indicated by the "n nits" column except where an alternate unit Is presented to the right of the result.
REPORT OF LABORATORY ANALYSIS
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Date: 10/30/2019 08:50 AM without the written consent of Pace Analytical Services, LLC,
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QUALIFIERS
Project: STORMWATER OCTOBER 2019
Pace Project No.: 92449812
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.
Pace Analytical Services, LLC
2225 Riverside or.
Asheville, NC 28804
[phone]
PQL - Practical Quantitation Limit.
RL - Reporting Limit - The lowest concentration value that meets project requirements for quantitative data with known precision and
bias for a specific analyte in a specific matrix.
S - Surrogate
1,2-Diphenyihydrazine 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 Acrylonitrile 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
ANALYTE QUALIFIERS
D6 The precision between the sample and sample duplicate exceeded laboratory control limits.
H3 Sample was received or analysis requested beyond the recognized method holding time.
M1 Matrix spike recovery exceeded QC limits. Batch accepted based on laboratory control sample (LCS) recovery.
REPORT OF LABORATORY ANALYSIS
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Date: 10130/2019 08:50 AM without the written consent of Pace Analytical Services, LLC. Page 13 of 17

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QUALITY CONTROL DATA CROSS REFERENCE TABLE
Pace Analytical Services, LLC
2225 Riverside Dr.
Asheville, NC 28604
[phone]
Project:
Pace Project No.:
STORMWATER OCTOBER 2019
92449812
Analytical
Lab ID
Sample ID
QC Batch Method
QC Batch
Analytical Method
Batch
92449812001
OUTFALL #3
EPA 1664B
506483
92449812002
CREEK PRE MILL
EPA 1664E
506483
92449812003
CREEK POST MILL
EPA 1664E
506493
92449812001
OUTFALL 43
EPA 180.1 Rev 2.0 1993
503960
92449812002
CREEK PRE MILL
EPA 180.1 Rev 2.0 1993
503960
92449812003
CREEK POST MILL
EPA 180.1 Rev 2.0 1993
503960
92449812001
OUTFALL #3
SM 2540D-2011
504599
92449812002
CREEK PRE MILL
SM 254OD-2011
504599
92449812003
CREEK POST MILL
SM 254OD-2011
504599
92449812001
OUTFALL #3
EPA 9040C
506001
92449812002
CREEK PRE MILL
EPA 9040C
506001
92449812003
CREEK POST MILL
EPA 9040C
504653
92449812001
OUTFALL #3
SM 5220D-2011
505349
SM 5220D-2011
505410
92449812002
CREEK PRE MILL
SM 5220D-2011
505349
SM 5220D-2011
505410
92449812003
CREEK POST MILL
SM 5220D-2011
505349
SM 5220D-2011
505410
Date: 10/30/2019 08:50 AM
REPORT OF LABORATORY ANALYSIS
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without the written consent of Pace Analytical Services, LLC.
Page 14 of 17

Document Name:
Document Revised: February 7, 2018
r �C2An8IytlC�1
Sample Condition Upon Receipt(SCUR)
Page 1 of 2
DocumentNo.:
Issuing Authority:
F-CAR-CS-033-Rev.06
Pace Carolinas quality Office
Laboratory receiving samples:
Asheville, Eden❑ Greenwood ❑ Huntersville❑ Raleigh[] Mechanicsville❑
Client Name:
WV# : 92449812
n Projec
t,otCcr 021 n) C0
t 4f:
Courier: []Fed Ex ❑UPS ❑LISPS
,Erclient
❑ Cam mercial ❑Pace ❑Other:
92449812
Custody Seal Present? []Yes o Seals intact? ❑Yes ZNo
J
Date/Initials Person Examining Contents:
ioi6lr
Packing Material: []Bubble Wrap ❑Bubble Bags one ❑ Other
Biological Tissue Frozen?
////
Thermometer;
�IR Gun 10: 43Tt! 1 Type of Ice: ) et ❑Blue
Oyes ❑No Env/A
❑!lone
Cooler Temp ('C): r% O Correction Factor: Add/Subtract ('C) 12,0
0
Temp should be above freezing to VC
Cooler Temp Corrected ('C):
[]Samples out of temp criteria. Samples on ice, cooling process
has begun
��
USDA Regulated Soil N/A, water sample)
J�-'
Did samples originate in a quarantine zone within the United States; CA, NY, or SC (check maps)?
Dld samples originate from a foreign source (internationally,
Dyes nNo
Incicdine Hawaii and PuertoRicol? ❑Yes ❑No
Comments/Discrepancy:
Chain of Custody present?
Yes
❑No
©N/A
1.
Samples Arrived within Hold Tme?
Yes
❑No
EINJA
2.
Short Hold Time Analysis (<72 hr.)?
es
[]NO
NIA
3.
Rush Turn Around Time Requested? []Yes
No
NJA
4.
Sufficient Volume?
es
No
❑N/A
5.
Correct Containers Used?
-Pace Containers Used?
Yes
Yes
[]No
[]No
❑N/A
❑N/A
6.
Containers Intact?
Yes
❑No
❑N/A
7.
Dissolved analysis: Samples Field Filtered? []Yes
E5No
[]N/A
S.
Sample Labels Match COC? Toes
-Includes Date/Time/ID/Analysis Matrix: ft/
[]NO
❑NIA
9.
Headspace in VOA Vials (>5-6mm)? Dyes
otio
N/A
10.
Trip Blank Present? ❑Yes
Trfp Blank Custody Seals Present? Yes
[:]No
No
NIA
N/A
11.
COMMENTS/SAMPLE DISCREPANCY
Lot ID of split containers:
CLIENT NOTIFICATION/RESOLUTION
Person contacted:
Project Manager SCURF Review:
Project Manager SRF Review:
Date/Time:
Date:
Date:
Field Data Required? []Yes
Page 15 of 17

/�
Document Name:
Document Revised: February 7, 2018
J /C8/�f1a1`�►1Cc�1
Sample Condition Upon Recelpt(SCUR)
Page 1 of 2
Document No.:
Issuing Authority:
�� �
F-CAR-CS-033-Rev.Ob
Pace Carolinas Quality Office
*Check mark top half of box if pH and/or dechlorination is
verified and within the acceptance range for preservation
samples.
Exceptions: VOA, Coliform, TOC, Oil and Grease, DRO/8015 (water) DOC, LLHg
**Bottom half of box is to list number of bottle
Project# WO# : 92449812
PM: C01 Due Date: 10/30/19
CLIENT: 93-Jackson P
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pH Adjustment Log for Preserved Samples
Sample ID
Type of Preservative
pH upon receipt
Date preservation adjusted
Time preservatlon
adjusted
Amount of Preservative
added
Lot ft
Note: Whenever there is a discrepancy affecting North Carolina compliance samples, a copy of this form will to sent to the North Carolina DEHNR Certification Office [i.e.
Out of hold, Incorrect preservative, out of temp, incorrect containers.
Page 16 of 17

J PaceAnalytical'
CHAIN -OF -CUSTODY I Analytical Request Document r
The Chain -of -Custody is a LEGAL DOCUMENT. All relevant fields must be completed accurately.
l r
r .paeelatra.eem
Page: of Cq
Section A Section S Section C
Required Client Information: Required Project Information: imroice Information:
Campan RCpOrl To: ' Attention: 13 514 9 3
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Adtl Copy
Company Name:
REGULATORY AGENCY
SL 11l-Ci �tG . � �'�
Address'
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r UST r- RCRA i OTHER
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