NCS000235_DMR_20220223

NC Department of
Environmental Quality
rt d
STORMWATER DISCHARGE OUTFALL(SDO) FEB , 3 � �
MONITORING REPORT
Winstonr Clem
Permit Number NCS: 000235 SAMPLES COLLECTED DURING CALENDAR YEAR: 2022.
(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.)
FACILITY NAME: Southern Resin,Inc. COUNTY : Davidson
PERSON COLLECTING SAMPLE(S)_Brandon Conrad PHONE NO.[phone]
CERTIFIED LABORATORY(S)_Pace Analytical Lab#_704-977-0981_
CERTIFIED LABORATORY _Analytical Environmental Services_Lab#_800-972-4889_
SIGNATURE OF PERMITTEE OR DESIGNEE
REQUIRED ON PAGE 2.
Part A: Specific Monitoring Requirements
Outfall Date 50050
No. Sample Total Total Formaldehyde COD NH3-N NO2+NO3 TKN Zinc pH
Collected Flow(if app.) Rainfall
mo/dd/yr MG inches Mg/I Mg/I Mg/I Mg/I Mg/1 Mg/I Std
units
Bench Mark .49 120 7.2 .68 20 .126 6-9
SW01 02/03/2022 1.4 BRL 53.1 .53 .86 2.0 ND 7.3
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month?_yes _ X no
(if yes,complete Part B)
Part B: Vehicle Maintenance Activity Monitoring Requirements
Outfall Date 50050 00556 00530 00400
No. Sample Total Flow Total Oil&Grease Non-polar Total pH New Motor
Collected (if applicable) Rainfall (if appl.) O&G/TPH Suspended Oil Usage
(Method 1664 Solids
SGT-HEM),if
appl.
mo/dd/yr MG inches mg/I mg/1 unit gal/mo
Form SWU-247,lase revised 2/2/2012
Page 1 of 2

STORM EVENT CHARACTERISTICS: Mail Original copy to:
Land Quality Section,Winston-Salem Regional Office
Date_02-03-2022 Division of Energy,Mineral and Land Resources
Total Event Precipitation(inches): 1.4 North Carolina Department of Environmental Quality
Event Duration (hours): (only if applicable—see permit.) 450 West Hanes Mill Road, Suite 300
Winston-Salem,NC 27105-7407
(if more than one storm event was sampled)
Date
Total Event Precipitation (inches):
Event Duration (hours): _(only if applicable—see permit.)
"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 impriso ent for knowing violations."
,444 Z Zz
//7
ure of Perm /
(Si ) (Date)
Form SWU-247,Iasi revised 2/2/2012
Page 2 of 2

Pace Analytical Services,LLC
m
1377 South Park Drive
aceAnalytical
Kemersville.NC 27284
w pacilabs.con
[phone]
Page 1 of 1
Laboratory Report
Brandon Conrad Report Date: 02/17/2022
Southern Resin Date Received: 02/03/2022
3440 Denton Road
Thomasville, NC 27360
Project: Southern Resin SW
Pace Project No.:92586077
Sample: SW01 Outfall Lab ID: 92586077001 Collected: 02/03/22 11:45 Matrix: Water
Method Parameters Results Units Report Limit Analyzed Qualifiers
EPA 350.1 Rev 2.0 1993 Nitrogen,Ammonia 0.53 mg/L 0.10 02/07/22 13:04
SM 4500-H+B-2011 pH at 25 Degrees C 7.3 Std.Units 0.10 02/04/22 15:05 H3
EPA 200.7 Zinc ND ug/L 20.0 02/08/22 18:32
TKN+NO3+NO2 Total Nitrogen 2.9 mg/L 0.52 02/17/22 13:45
Calculation
EPA 351.2 Rev 2.0 1993 Nitrogen,Kjeldahl,Total 2.0 mg/L 0.50 02/13/22 11:34
EPA 353.2 Rev 2.0 1993 Nitrogen,NO2 plus NO3 0.86 mg/L 0.040 02/15/22 09:37
SM 5220D-2011 Chemical Oxygen Demand 53.1 mg/L 25.0 02/16/22 05:30
ANALYTE QUALIFIERS
H3 Sample was reecceiiveedd'or analysis requested beyond the recognized method holding time.
Reviewed by: ,
Stephanie Knott
704-977-0981
[e-mail]
Pace Analytical Services Asheville
2225 Riverside Drive,Asheville,NC 28804 South Carolina Laboratory ID:99030
Florida/NELAP Certification#:E87648 South Carolina Certification#:99030001
North Carolina Drinking Water Certification#:37712 VirginiaNELAP Certification#:460222
North Carolina Wastewater Certification#:40
Pace Analytical Services Eden
205 East Meadow Road Suite A,Eden,NC 27288 North Carolina Wastewater Certification#:633
North Carolina Drinking Water Certification#:37738 VirginiaNELAP Certification#:460025
Pace Analytical Services Peachtree Corners
110 Technology Pkwy,Peachtree Corners,GA 30092 North Carolina Certification#:381
Florida DOH Certification#:E87315 South Carolina Certification#:98011001
Georgia DW Inorganics Certification#:812
Page 1 of 11

i CHAIN-OF-CUSTODY Analytical Request Document LAB USE ONLY-Affix Workordei WO# ; 92586077
Pace Analytical
V
Ci+a moFCustody is a LEGAL DOCUMENT-Complete all relevent fields 1111111IIiIIDII III
Company: Billing Information:
1.
`jam... ti.e..
k ALL SHADED
Ad s Ype s: Container Preservative T 9zg86077
. 4 t Dc.‘l,::.-1 R.d• r ilk Z7?il.''Q 11 I l I l I ---r---- -.._
Report To: px.r, Email TO: ••Preservative Types.(1)nitric arid,(2)sulfuric acid,131 hydrochloric acid,(4)sodium hydroxide,l',I nnc aret.ite,
/r `'imCla:1 CUs1{t..Ci (6)methanol,(7)sodium bisulfate,(B)sodium thiosullate,(9)hexane,(A)ascorbic acid,(B)ammonium sulfate.
Copy To: Site Collection Info/Address: IC)ammonium hydroxide,(D)TSP,(U)Unprescrved,(0)Other
ies`e_ Analyses lab Profile/Line-
Customer Project Name/Number: State: County/City: Time Zone Collected: Lab Sample Receipt Checklist:
/ I 1PT1 (MT( JCT I lET S
Phone: Site/Facility ID d Compliance Monitoring? ? Custody Seals Present/intact u p
/1 D .Y� Custody Signatures Present ' r NA
Email: (ant- Id� j i. [ I Yes ( )No t� Collector Signature Present R NA
1. •+Cntxh fl/y�rt•(Ovr .4 Bottles Intact n NA
Collected By(print)' Purchase Order tl: DW PW5 ID t Correct Bottles rt NA
(�i,-�hc01,1 �e.tr�(/ Quote Si: OW Location Code: 1 �1 Sufficient Volume H NA
Coll d Hy + n ure)' Turnaround Date Required: Immediately Packed on Ice: .. ti samples Received on ice H t�1�s
VOA - Headspace Acceptable Y N }b��
[ )Yes I I No `y �' j USDA Regulated Soils N Ci++
-F 'S 1 Samples in Holding Time N Nfq
Sample Disposal: Rush: Field Filtered(if applicable): 7 Residual Chlorine Present Y ri ql(
l I Dispose as appropriate I I Return I I Same Day I I Next DayYes (No -S 'r
I J ( -C Cl Strips: —_
1 I Archive I )2 Day [ 13 Day 114 Day I 15 Day ' Sample pN Acceptable Y N�A
I I Hold:_ __ Ihipedite Charges APPly) Analysis: __ _ _ e.-d -- 1, pH Strips:
Sulfide Present Y VA'Matrix Codes(Insert in Matrix box below):Drinking Water(DW),Ground Water(GW),Wastewater(WWI, S. --fi 1�1 [ 4. t= Lead Acetate Strips:
Product(P),Soil/Solid(SL),Oil(OL),Wipe(WP),Air(AR),Tissue(TS),Bioassay(B),Vapor(V),Other(OT) -1 r- LAB USE ONLY:
Camp/ Collected(or Res II of Lab Sample N / Comments:
NJ
Customer Sample ID Matrix' Grab Composite Start) Composite End CI Ctns
Date Time Date Time
Z) I I- l l zi' iC) z/3 ir;us- v`
� L , ✓ .---
Customer Remarks/Special Conditions/Possible Hazards: Type of Ice Used: Blue Dry None SFIORT HOl DS PRESENT(<72 hour 9 N N/A lab Sample Temperature Info:
Packing Material Used: lab Tracking ItTemp Blank R ceived N NA
260 02 Therm loll: Ic/ -1
Cooler]Temp Upon Receipt:• ' roC
Samples received via: Cooler I Therm Corr.Factor:"
Radchem sample(s)screened(<SOD cpm). Y N NA FEDEX UPS lien Courier Pace Courier Cooler 1 Corrected Temp: S 1<1__oC
Relinquished by moan i�rtature) Date/Time:// Re ived by/C y'(Si nature) Da /Time: (� (� MTlL LAB USE ONLY Comments:
C �t 'r� 2il % 2 I /��)Ji,[/�/� IJ,SO Table it
Re unshed by/Company:(Signature) Date/Time: e[ely omp: ( ,matt Da e/ me:
m Template Trip Blank Received Y N NA
IV HCL McOH TSP Other
p Prelogm:
Relrr�uished by/Company:(Signature) Date/Time: Received by/Company:(Signature) Date/Time: PM
Non Conformancel5l: Page: _
PB: YES / NO of:

Document Name: 1 Document Issued:November 15,2021 '
fBottle Identification Form(BIF) Page 1 of 1
/• aceAnalytieal. Document No.: I Issuing Authority:
F-CAR-CS-043-Rev.01 Pace Carolinas Quality Office •
"Check mark top half of box if pH and/or dechlorination is Project# 5'��ne � `/�
verified and within the acceptance range for preservation V� V
samples.
Exceptions:VGA,Coliform,TOC,Oil and Grease,DRO/8015(water)DOC,LLHg
**Bottom half of box is to list number of bottles
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c = " N Z v j _ ry 2 < ry a O4 > 0. F. z O o c
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pH Adjustment Log for Preserved Samples
Sample ID Type of Preservative pH upon receipt 1 Date preservation adjusted Time preservation Amount of Preservative Lot p
Iadjusted added
I
Note: Whenever there is a discrepancy affecting North Carolina compliance samples,a copy of this form will be sent to the North Carolina DEHNR Certification Office(i.e,
Out of hold,incorrect preservative,out of temp,incorrect containers.
Page 3 of 11

ANALYTICAL ENVIRONMENTAL SERVICES, INC.
p.., a
AES
February 15,2022
Stephanie Knott
Pace Analytical
1377 South Park Dr
Kemsville NC 27284
RE: 92586077
Dear Stephanie Knott: Order No: 2202763
Analytical Environmental Services,Inc. received 1 samples on 2/7/2022 8:40:00 AM
for the analyses presented in following report.
"No problems were encountered during the analyses except as noted in the Case Narrative or by qualifiers in
the report or QC Summary.Additionally,all results for the associated Quality Control samples were within
EPA and/or AES established limits.
AES's accreditations are as follows:
-NELAP/State of Florida Laboratory ID E87582 for analysis of Non-Potable Water,Solid&Chemical
Materials,Air&Emissions Volatile Organics,and Drinking Water Microbiology&Metals,effective
07/01/21-06/30/22.
State of Georgia,Department of Natural Resources ID#800 for analysis of Drinking Water Metals,effective
through 06/30/22 and Total Coliforms/E.coli,effective 04/20/20-04/24/23.
-All-IA-LAP, LLC Laboratory ID: 100671 for Industrial Hygiene samples(Metals and PCM Asbestos),
Environmental Lead(Paint,Soil,Dust Wipes,Air),and Environmental Microbiology(Fungal)Direct
Examination,effective until 11/01/23.
These results relate only to the items tested as received. This report may only be reproduced in full.
If you have any questions regarding these test results,please feel free to call.
Sincerely,
lQ/ M CzYnit etti
Paris Masoudi
Project Manager
;11;:0 I)rivc • Atlanta,Gv.,r.ia 30340 • Tvl: 770.457.81 77 • Fax: [phone] • Toll Free:800.972.4889
www.aettaliania.com
Page 4 of 11
Page 1 of 8

Chain of Custody
PASI Charlotte Laboratory 'aceAnalytical
I11IfI1 IIIIII[IIIIIN II IIIIIIIIIIIIIII www.pecelet».cam
Workorder: 92586077 Workorder Name: Southern Resin SW Results Requested By: 2/17/2022 .2,ZO276S
Raped/invoice To l.SubcontractTo
—Requeated.Analyale
Stephanie Knott
Pace Analytical Kemersville AES P.O. SJK020322
1377 South Park Drive 3080 Presidential Dr.
Kemersville,NC 27284 Atlanta,GA 30340
Phone [phone]
Email:[e-mail]
State of Sample Origin: NC Preserved Containers €
0
U.
Collect GW
Item Sample ID DatelTime Lab ID Matrix 1 LAB USE ONLY
1 SW01Outfall 2/3/2022 11:45 92586077001 Water 2 X _ -
2 . .
3 — -
4 .
5
Comments
Transfers 7_Td By Koi2
q D i!Time{ Received B Datefrime
2 4
3 1
Cooler Temperature on Receipt °C I Custody Seal Y or N I Received on Ice Y or N Samples Intact Y or N
4
I
Thursday,February 03,2022 3:57:25 PM FMT-ALL-C-002rev.00 24March2009 Page 1 of 1
Page 5 of 11
Page 2 of 8

Analytical Environmental Services,Inc Date: 15-Feb-22
Client: Pace Analytical
Project: 92586077 Case Narrative
Lab ID: 2202763
Sample Receiving Nonconformance:
Samples for Workorder 2202762 were received outside EPA/Method specified holding time of 3 days for method SW8315A.
The laboratory proceeded with analysis per Stephanie Knott via email 2/8/2022 4:05pm.
Formaldehyde by SW8315A:
Since North Carolina does not offer certification for Formaldehyde by SW8315A,per regulation,the laboratory is required to
report the results as uncertified.The results for Formaldehyde by SW8315A are therefore reported as uncertified.
Page 6 of 11
Page 3 of 8

Analytical Environmental Services,Inc Date: 15-Feb-22
Client: Pace Analytical Client Sample ID: SW01 OUTFALL
Project Name: 92586077 Collection Date: 2/3/2022 11:45:00 AM
Lab ID: 2202763-001 Matrix: Aqueous
Reporting Dilution
Analyses Result Qual Units BatchlD Date Analyzed Analyst
Limit Factor
Formaldehyde by SW8315A
Formaldehyde BRL 50 H ugn- 330425 1 02/09/2022 10:41 DS
Qualifiers: • Value exceeds maximum contaminant level E Estimated(value above quandtation range)
BRL Below reporting limit S Spike Recovery outside limits due to matrix
II Holding times for preparation or analysis exceeded Nate See case narrative
N Analyse not NELAC certified F Analyzed in the lab which is a deviation front the method
B Analyse detected in the associated method blank < Less than Result value
> Greater than Result value I Estimated value detected below Reporting Limit Page 7 of 11
Page 4 of 8

Clear Save as
114. 'ANALYTICAL
ENVIRONMENTAL
AES SERVICES,INC. SAMPLE/COOLER RECEIPT CHECKLIST
1. Client Name: PACE ANALYTICAL AES Work Order Number: 2202763
2. Carrier: FedEx ❑i UPS❑ USPS❑ Client❑ Courier❑ Othei
Yes No N/A Details Comments
3. Shipping container/cooler received in good condition? • damaged 0 leaking ❑ other❑
4. Custody seals present on shipping container? •
5. Custody seals intact on shipping container? •
6. Temperature blanks present? • O
7 Cooler temperature(s)within limits of 0-6°C?(See item 13 and 14 for • O O Cooling initiated for recently collected samples/ice
temperature recordings.] present❑
8. Chain of Custody(COC)present? 0 •
9. Chain of Custody signed,dated,and timed when relinquished and received? 0 •
10. Sampler name and/or signature on COC? ` 0
11. Were all samples received within holding time? • 0
12. TAT marked on the COC? 0 • If no TAT indicated,proceeded with standard TAT per Terms&Conditions. ❑
13. Cooler 1 Temperature 3.4 °C Cooler 2 Temperature °C Cooler 3 Temperature °C Cooler 4 Temperature °C
14. Cooler 5 Temperature °C Cooler 6 Temperature °C Cooler 7 Temperature °C Cooler 8 Temperature °C
15. Comments:
I certify that I have completed sections 1-15(dated initials). CW 2/7/22
Yes No N/A Details Comments
16. Were sample containers intact upon receipt? •
17. Custody seals present on sample containers? •
18. Custody seals intact on sample containers? • -
19. Do sample container labels match the COC? 0 ® O incomplete info ❑ illegible El
no label ❑ other ❑
20. Are analyses requested indicated on the COC? Q 0 0
21. Were all of the samples listed on the COC received? $ O samples received but not listed on COC ❑
samples listed on COC not received ❑
22. Was the sample collection date/time noted? 0
23. Did we receive sufficient sample volume for indicated analyses? 0
24. Were samples received in appropriate containers? 0
25. Were VOA samples received without headspace(<1/4"bubble)? ` •
26. Were trip blanks submitted? • listed on COC ❑ not listed on COC ❑
27. Comments:
This section only applies to samples where pH can be I certify that I have completed sections 16-27(dated initials). CW 2/7/22
checked at Sample Receipt. Yes No N/A Details Comments
28. Have containers needing chemical preservation been checked?* 0
29. Containers meet preservation guidelines? § § ..
0
V. Was pH adjusted at Sample Receipt? 0
co
m 'Note:Certain analyses require chemical preservation but must be checked in the laboratory and not upon Sample Receipt such as Coliforms.VOCs and Oil&GreasefTPH.
co
CW 2 7
S.:„. This also excludes metals by EPA 200.7.200.8 and 245.1 which will be verified between 16 and 24 hours after preservation. I certify that I have completed sections 28-30(dated initials). / /22
Checklist 7.9.20 Rev 3 Locked
Page 5 of 8

Analytical Environmental Services, Inc Date: 15-Feb-22
Client: Pace Analytical
Project Name: 92586077 Dates Report
Lab Order: 2202763
Lab Sample ID Client Sample ID Collection Date Matrix Test Name TCLP Date Prep Date Analysis Date
2202763-001A SW01 OUTFALL 2/3/2022 11:45:00AM Aqueous Formaldehyde by SW8315A 2/8/2022 1:54:10 PM 02/09/2022
Page 9 of 11
Page 6 of 8

Analytical Environmental Services,Inc Date: I5-Feb-22
Client: Pace Analytical ANALYTICAL QC SUMMARY REPORT
Project Name: 92586077
Workorder: 2202763
BatchlD: 330425
Sample ID: MB-330425 Client ID: Units: ug/L Prep Date: 02/08/2022 Run No: 477386
SampleType: MBLK TestCode: Formaldehyde by SW8315A Batch1D: 330425 Analysis Date: 02/09/2022 Seq No: 11024574
Analyte Result RPT Limit SPK value SPK Ref Val %REC Low Limit High Limit RPD Ref Val %RPD RPD Limit Qual
Formaldehyde BRL 50
Sample ID: LCS-330425 Client ID: Units: ug/L Prep Date: 02/08/2022 Run No: 477386
SampleType: LCS 'I'cstCode: Formaldehyde by SW8315A BatchiD: 330425 Analysis Date: 02/09/2022 Scq No: 11024575
Analyte Result RPT Limit SPK value SPK Ref Val %REC Low Limit High Limit RPD Ref Val %RPD RPD Limit Qual
Formaldehyde 905.0 50 1000 90.5 70 130
Sample ID: 2202907-001AMS Client ID: Units: ug/L Prep Date: 02/08/2022 Run No: 477386
SampleType: MS TcstCodc: Formaldehyde by SW8315A BatchlD: 330425 Analysis Date: 02/09/2022 Seq No: 11024577
Analytc Result RPT Limit SPK value SPK Ref Val %REC Low Limit I ligh Limit RPD Ref Val %RPD RPD Limit Qual
Formaldehyde 5642 250 5000 734.0 98.2 49.4 135
Sample ID: 2202907-001AMSD Client ID: Units: ug/L Prep Date: 02/08/2022 Run No: 477386
SampleType: MSD TcstCodc: Formaldehyde by SW8315A BatchID: 330425 Analysis Date: 02/09/2022 Seq No: 11024578
Analytc Result RPT Limit SPK value SI'K Ref Val %REC Low Limit High limit RI'D Ref Val %RPD RPD Limit Qual
Formaldehyde 5022 250 5000 734.0 85.8 49.4 135 5642 11.6 26.4
Qualifiers: > Greater titan Result value < less than Result value B Analyte detected in the associated method blank
BRi. Below reporting limit E Estimated(value above quantization range) 11 Holding times for preparation or analysis exceeded
1 Estimated value detected below Reporting Limit N Analyse not NELAC certified R RFD outside limits due to matrix
Rpt Lim Reporting Limit S Spike Recovery outside limits due to matrix Page 10 of 11
Page 7 of 8