NCG080164_MONITORING INFO_20200121

i sfl-�)
STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
ljC G
DOC TYPE
❑ HISTORICAL FILE
MONITORING REPORTS
DOC DATE
❑ ���
YYYYMMDD

STORMWATER DISCHARGE OUTFALL (SDO)
ANNUAL SUMMARY DATA MONITORING REPORT (DMR) / SPPP Annual Update DATA REVIEW FORM
Calendar Year 2019
Individual NPDES Permit No.
Certificate of Coverage (COC) No.
or
JAN 21 2020
— — — — — — CENT'
This monitoring report summary of the calendar year should be kept on filel'o'n site witFi the facility SPPP.
" w1V
Facility Name: Guilford Co Scho - Garage
County: Guilford
Phone Number: (336 ) 370-2391
Outfall No. 1
Total no. of SDOs monitored 2
Is this outfall currently in Tier 2 (monitored monthly)?
Was this outfall ever in Tier 2 (monitored monthly) during the past year?
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities?
Yes ❑ No ■❑
Yes ❑ No ®❑
Yes U No
Parameter, (units)
Total
Rainfall,
pH
TPH-1664
Total
Suspended
olids
Solids
Benchmark
N/A
6-9
15 mg/I
100 mg/I
Date Sample
Collected,
mmldd/yy
■-__----_
12/13/19
2.4
7.0
1.1
55
SVVU-Zb4 - ueneric Hnnual uMK
Last revised 61012018
YI

Additional Outfall Attachment
Outfall No. 2
Is this outfall currently in Tier 2 (monitored monthly)? Yes ❑ No ❑
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ❑ No ❑i
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes ❑0 No ❑
Parameter, (units)
Total
Rainfall,
inches
pH
TPH-1664
Total
Suspended
Solids
Benchmark
N/A
6-9
15 mg/I
100 mg/I
Date Sample
Collected,
mm/dd/yy
M'M__---_=
12/13/19
2.4
6.9
<1.4
260
SWU-264 - Generic Annual DMR
Last revised 610V2018

" 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
pos iibility of fines and imprisonment for knowing violations."
Signature 1 �L-- ./
Date /X3—/ iD
For questions, contact your local Regional Office:
DEMLR Regional Office Contact Information:
ASHEVILLE REGIONAL OFFICE
FAVETTEVILLE REGIONAL OFFICE
MOORESVILLE REGIONAL OFFICE
2090 US Highway 70
225 Green Street
610 East Center Avenue/Suite 301
Swannanoa, NC 28778
Systel Building Suite 714
Mooresville, NC 28115
[phone]
Fayetteville, NC 28301-5043
[phone]
[phone]
RAI.EIGH REGIONAL OFFICE
NVASH I NGTONREGIONAL OFFICE
, VILMINGTON REGIONAL OFFICE
3800 Barrett Drive
943 Washington Square Mall
127 Cardinal Drive Extension
Raleigh, NC 27609
Washington, NC 27889
Wilmington, NC 28405-2845
[phone]
[phone]
[phone]
NVINSTON-SALEMREGIONALOFFICE
CENTRAL OFFICE
1617 Mail Service Center
450 Hanes Mill Rd. Suite 300
Winston-Salem. NC 27105
Raleigh, NC 27699-1617
[phone]
[phone]
SWU-264 - Generic Annual DMR
Last revised 6/01/2018

Owhor"n, wal
O1,01j1V
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Fill-guidanceon filling oul Ihi.c fiu•m, please visit https:l/deq.ne.gov/about/divisions/energy-mineral-land-resources/
n fides-stormwater-gps
Pennit No.: N/C/G / 0/8 /o /o /0 /o / or Certificate of Coverage No.: N/C/G/ / / / / / /
FacilityNatne: �7t ��o�G� (�✓niy S( oo15 Bvs "cu'ni-cnc�nc-z Gwkye
r
County: C U r 4 Phone No. i 3 3 69-71 — 99 1 D
Inspector: Colby Pa ne
Date of Inspection: /)/I3// --
Time of Inspection:
"total Event Precipitation (inches):
All permits require qualitative monitoring to be performed during a "measurable storm event."
A "measurable storm event" is a storm event that results in an actual discharge from the permitted site
outfall. The previous measurable storm event must have been at least 72 hours prior. The 72-hour storm
interval does not apply if the pennittee is able to document that a shorter interval is representative for
local storm events during the sampling period, and the pennittee obtains approval from the local DFML.R
Regional Office.
---
By this signature, 1 certify that this report is accurate and complete to the best of my knowledge:
(Signature of Permiftee or
1. Outfall Description: p
Outfall No. SDO - I Structure(pipe. ditch, etc.):
Receiving Stream:
vnnar..L. StreAm i hQ} �S }pwardS Sov+4-) 1 uf6jo CrceJc
Describe the industrial activities that occur within the outfall drainage area:
SChtx,j &),t Ma rnjeno-nsg`
Page I of 2
S W ll-2d2. Last nnnl i twit 06/01 all 18

2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(fight, media n, dark) as descriptors: Li k# grown
3, Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil, weak
chlorine odor. etc.): No odor
4. Clarity: Choose the number which best describes the clarity of the discharge, where I is clear
and 5 is very cloudy:
1 © 3 4 5
5. Floating Solids: Choose the number which best dcscribcs the amount of Iloating solids in the
sturmwater discharge, where I is no solids and 5 is the Surface covered with floating solids:
Q 3 4 5
6. Suspended Solids: Choose the number which best describes the amount of suspended solids in
the stonnwatcr discharge, where f is no solids and 5 is extremely muddy:
0 2 3 4 5
7. Is there any foam in the stonmvater dischargc • Ycs O No.
S. Is there an oil sheen in the stormwatcr discharge'? OYcs O No
yes
9. Is there evidence of erosion or deposition at the oulfall? O Yes 6 No. t b
10. Other Obvious Indicators of Stormwater Pollution:
List and describe
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition may be
indicative of pollutant exposure. These conditions warrant further investigation.
Pugs 2 ol'2
S W U-242, Lust mah lied 064112U IN

Em•imrtmvutol
Quatid
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance onfi/ling out this Jong, please visit hops://deq.nagov/about/divisions/energy-mineral-land-resource /
npdcs-stormwatcr-gps .
Perm itNo.: N/C/6/0/8/0/uIoIo/ or Certificate of Coverage No.: N/C/G/ / / / / / /
Facility Name: GGh/I1 wr"% CuU/ 1Y school S Bu$ µo,�ntenn 0.u- (S j e
(9
County: Uh 14rd Phone No. �3310� eli 1 — .3a 18
Inspector: 61�v Y' t
Date of Inspection: 2 / 3/ 19
Time of Inspection: 9 AM
Total Event precipitation (inches): Q. 1 nC. "S
All permits require qualitative monitoring to be perlormed during it "measurable storm event."
A "measurable storm event" is a storm event that results in an actual discharge from the permitted site
Outfall. The previous measurable storm event must have been at least 72 hours prior. The 72-hour storm
interval does not apply if the permittee is able to document that a shorter interval is representative for
local storm events during the sampling period, and the permittee obtains approval from the local DEMI-R
Regional Office.
133, this signature„[ certify that this report is accurate and complete to the best of my knowledge:
(Signature of PeKpiftce or
I. Outfall Description:
Outfall No. 5A0 —Q Structure (pipe, ditch, etc.): D1 tf
Receiving Stream:
Unname,c StTlpatn ghat flows 8 Sou!-h &410 CreAK
Describe the industrial activities that occur within the outfall drainage area:
�DDI Ri,S AAr.�A it Ao n,I
Page I oft
S W I -2b12. Lost modi fled 06/0112019

2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: the i um brow n
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil, weak
chlorine odor, etc.): N O o do r
4. Clarity: Choose the number which best describes the clarity of the discharge, where I is clear
and 5 is very cloudy:
1 2 Q 4 5
5. Floating Solids: Choose the number which best describes the amount of floating solids in the
stormwatcr discharge, where I is no solids and 5 is the surface covered with floating solids:
© 3 4 5
6. Suspended Solids: Choose the number which best describes the amount of suspended solids in
the stormwatcr discharge, where I is no solids and 5 is extremely muddy:
1 Q 3 4 5
Is there any foam in the storrnwater discharge'? O Yes • No
Is there an oil sheen in the stormwatcr discharge'? oYcs m No
Is there evidence of erosion or deposition at the outfall? (®Ds O No.
Other Obvious Indicators of Stormwater Pollution:
List and describe N
No
yes
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition may he
indicative of pollutant exposure. These conditions warrant further investigation.
Pagc 2 of 2
S W U-242. Lust modified 06,0U2018

Table of Contents
December 19, 2019
Wayne Watterson
S&MF, Inc - Greensboro, NC
8646 West Market St Suite 105
Greensboro. NC 27409
Project Location: Greensboro, NC
Client Job Number:
Project Number: 4358-19-028 Ph.01
Laboratory Work Order Number: 19L0687
Enclosed are results of analyses for samples received by the laboratory on December M, 2019. If you have any questions
concerning this report, please feel free to contact me.
Sincerely,
t&� �' A XPJ
Kerry K. McGee
Project Manager
Page 1 of 14

Table of Contents
Table of Contents
Sample Summary
Hits Only Report
Case Narrative
Sample Results
19L0687-01
19L0687-02
Sample Preparation Information
QC Data
Conventional Chemistry Parameters by EPA/APHA/S W-846 Methods (Total)
B248554
B248574
B248576
Flag/Qualifier Summary
Certifications
Chain of Custody/Sample Receipt
l
3
4
5
6
6
7
8
9
9
9
9
9
10
12
Page 2 of 14

Table of Contents
ANALYTICAL LABORATORY
39 Spruce Street' East Longmeadow, MA 01028' FAX [phone]TEL, 413/525-2332
S&MIi. Inc - Greensboro, NC
8646 West Market St Suite 105 REPORT DATE: 12/19/2019
Greensboro, NC 27409 PURCHASE ORDER NUMBER: 4358-19-029 Ph AI
ATTN: Wayne Watterson
PROJECT NUMBER: 4358-19-028 PLO
ANALYTICAL. SUMMARY
WORK ORDER NUMBER: 19L0687
The results ofanalyses performed on the following samples submitted to the CON -TEST Analytical Laboratory are found in 0ris report.
PROJECT LOCATION: Greensboro, NC
FIELD SAMPLE# LAB ID: MATRIX
SDO-1 191.0687-01 Water
SDO-2 19L0687-02 Water
SAMPLE DESCRIPTION TEST
EPA 16648
SM21-22 2540D
SM21-22 4500 H B
EPA 1664B
SM21-22 2540D
SN121-22 4500 H B
SUB LAB
Page 3 of 14

a
Table of Contents
39 Spruce Street' East Longmeadow, MA 01028 *FAX [phone] * TEL, 413/525-2332
EXECUTIVE SUMMARY
Client ID: SDO-1
lab ID: 19L0687-01
Analyte
Results/Qual
DL
RL
Units
Method
pH
7.0 H-05
p1I Uats
SM21-22 4500 H B
Silica Gel Treated HEM (SGT-HEM)
Ll 1
0,32
1 4
mg/L
EPA 1664B
Total Suspended Solids
55
0,98
2.4
mg/L
SM21-22 2540D
Client ID: SDO-2
Lab ID'. 19L0687-02
Analyte
Results/Qua[
DL
RL
Units
Method
pit
6.9 11-05
pH Units
SM21-22 4500 H B
'Total Suspended Solids
260
26
62
mg/I.
SM21-222540D
Con- rest does not accept liability for the consequences of any actions taken solely on the basis of the information provided in the Executive Summary
section of this report. Users must review this report in its entirety to determine data usability and assessment.
Page 4 of 14

Table of Contents
39 Spruce Street' East Longmeadow, MA 01028' FAX [phone] 'TEL. [phone]
CASE. NARRATIVE. SUMMARY
All reported results are within defined laboratory quality control objectives unless listed below or otherwise qualified in this report.
Sh121-22 4500 11 B
Qmdifieminm:
II-05
Holding time was exceeded. pH analysis should be performed inurediately at time ofsampling. Nominal 15 minute holding time was
exceeded.
Acolyte & Samplea(s) Qualified:
PH
19L0687-0ItSDO-11, 19L0687-02[SDO-21, B248554-DUPI
The results ofanalyses reponed only relate to samples submitted to the Con -Test Analytical Laboratory for testing.
1 certify that the analyses listed above, unless specifically listed as subcontracted, ifany, were perforated under my direction according to the approved methodologies listed
in this document, and that based upon my inquiry ofthose 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
Page 5 of 14

Table of Contents
conAE5t®
ANALYTICAL LABORATORY
39 Spruce Street' East Longmeadow, MA 01028' FAX [phone]' TEL. [phone]
Project Location: Greensboro, NC Sample Description. Work Order: 19L0687
Date Received. 12/16/2019
F-idd Sample 0: SDO-I Sampled: 12/13/2019 09,15
Sensate ID: 191.0687-01
Conventional Chemistry I'urumeten by EPA/AMIA/SW-846 \lethnds (fatal)
Date
Dutdl'inse
Analyta
Results RI,
DL Units Dilution
PIuB/Qual
Method
Prepared
Analyzed
Analyst
PH@33.9°C
7.0
pH Units 1
H-05
SWI-2245W It
12/17/19
12/17/1919:00
KMV
Total Suspended Solids
55 2.4
0.98 mg/L I
S%121-222540D
12/19/19
12/18/1913:25
LL
Silica Gel Treated HEM ISGT-HEM)
1.1 IA
0.32 me/L 1
1
EPA 1664E
12/19/19
12/18/1913.15
LL
Page 6 of 14

Table of Contents
col retest®
ANALYTICAL LABORATORY
39 Spruce Street' East Longmeadow, MA 01028' FAX [phone] - TEL. [phone]
Project lucotlon: Greensboro, NC Sample Descnption: W,1, Ordev 191.0687
Date Received: 12/16/2019
Field Sample N: SDO-2 Sampled: 12/131201909:35
Sample ID: 191,0687-02
Sample Ma0ix. Water
Convenfional Chemistry Parameters by EPA/APILVSW-846 Methods ('Total)
Date
Da10 ime
Analyte
Results RL
DL units Dilutmn Flag/Qmd
Method
Prepared
Anulyaed
Anolys
pH@30, VC
6.9
pH Units I H-05
SM21.2245W 115
12/17/19
12/17/1919. 00
KMV
Total Suspended Solids
260 62
2.6 mg/L I
SM21-222540D
12/18/19
12/18/1913:25
LL
Silica Get Treated HEM(SGT-HEM)
ND IA
0.32 mg/L I
EPA 1664B
12/18/19
12/18/1913: 15
Lt.
Page 7 of 14

Table of Contents
co - testo
ANALYTICAL LABORATORY
39 Spruce Street' East Longmeadow, MA 01028' FAX [phone]TEL. [phone]
Sample Extraction Data
EPA 1664R
Lalr Number lFicld IDl Batch Initial lml'] Dutc
19L0687-01 ISDO-11 B248574 1000 12/18/19
19L0687-02 [SDO-21 B248574 Won 12/18/19
SM21-22 2540D
Lab Nurnbcr IField MI Bawls Initial ImLI Date
191.0697-01 [SDO-11 B248576 210 12/18/19
19L0687-02 [SDO-2] B248576 80.0 12/18/19
SM21-22 4500 11 B
Lob Number Field ID] - Batch Initial lmhl Datc
191,0687-01 [SDO-II B248554 50.0 12/17/19
19L0687-02 [SDO-21 B248554 50.0 12/17/19
Page 8 of 14

Table of Contents
conticsto
ANALYTICAL LABORATORY
39 Spruce Street' East Longmeadow, MA 01028' FAX [phone]' TEL. [phone]
QUA 1,11 V CONTROL
Conventional Chemistry Parameters by EISMAPHA/SN'-146 Methods ('Total)- Qual n Control
Reporting Spike Source %REC RPD
Analyte Result Limit Units Level Result %REC Limits RPD Limit Notes
Batch B248554 - SM21-22 450011 B
Duplicate(6248554-DUPI)
Sourer
191.0687-01
Prepared&Analyzed:
12/17/19
pH
Batch U248574 - EPA 1664B
71
pH Units
70 0.540 5 11-05
Blank (B248574-BLKI)
Prepared & Analyzed:
12/18/19
Silica Go[ Treated HEM (SGT-HEM)
LCS (BD48574-11SI)
ND
1.4 mg/L
Prepared & Analyzed:
12/18/19
Silica Gel Treated HEM (SGT-HEM)
Batch B248576 - SM21-22 2540D
&9
mg/L
10,0
89.0 64-132
Blank (R248576-BLKI)
Prepared & Analyzed:
12/18/19
Total Suspended Solids
LCS (8248576-BSI)
ND
2.5 mg/L
Prepared & Analyzed:
12/I3/19
Total Suspended Solids
182
10 mg/L
200
91 0 57.6-118
Page 9 of 14

Table of Contents
con- esto
ANALYTICAL LABORATORY
39 Spruce Street' East Longmeadow, MA 01028' FAX [phone]' TEL. [phone]
FLAG/QUAI.IFIER SUMMARY
• QC result is outside ofestablished limits.
} Wide recovery limits established for difficult compound.
j Wide RPD limits established for difficult compound.
N Data exceeded client recommended or regulatory level
Percent rccmeries mid relative percent differences (RPDs) are determined by the software using values in the
calculation which have not been rounded.
No results he%c been blank subtracted unless specified in the case narrative section.
II-05 Holding time was exceeded, pH analysis should be performed immediately at time ofsampling. Nominal 15
minute holding time was exceeded.
J Detected but below the Reporting Limit (lowest calibration standard), therefore, result is as "mooted
concentration (CLP J-Flag).
Page 10 of 14

Table of Contents
Con-Acsto
ANALYTICAL LABORATORY
39 Spruce Street' East Longmeadow, MA 01028' FAX [phone]' TEL. [phone]
CERTIFICATIONS
Certified Analyses included in this Report
Anodyne Certifications
5'A721-22 2540D in Winer
Total Suspended Solids C'f,MA,NH,NY.RI,NC,M2,VA
S1721-22 4500It 8 in NLter
pH CT,MA,RI
The CON. TEST Enviorrmreatal Laboratory operates under the following certifications and accreditations:
Code Description Number
Expires
AIIIA
AIIIA-LAP, LLC- ISO 17025:2017
100033
03/1/2022
MA
Massachusetts DEP
hI-MAI00
06/30/2020
CT
Connecticut Deparvnent of Publilc Health
PH-0567
09/30/2021
NY
New York State Department of Health
10899 NELAP
04/1/2020
NII-S
New Hampshire Environmental Lab
2516 NELAP
02/52020
RI
Rhode Island Department of Health
LAO00112
12/30/2019
NC
North Carolina Div. of Water Quality
652
12/31/2020
NJ
New Jersey DEP
MA007 NELAP
06/30/2020
FL
Florida Department of Health
E871027 NELAP
06/30/2020
VT
Vermont Department of Health Lead Laboratory
LL015036
07/30/2020
ME
State of Moire
20H028
06/92021
VA
Commonwealth of Virginia
460217
12/142020
NII-P
New Hampshire Environmental Lab
2557 NELAP
09/62020
V'6DW
Vermont Department of Healdr Drinking Water
VT-255716
06/122020
NC-DW
North Carol inn Department of Health
25703
07/312020
PA
Commonwealth of Pennsylvania DEP
68-05812
06/30/2020
Page 11 of 14

`iLL ' n(C /
h>J�.; i www.cuntestlaDs.com
Doc
A 379
Rev 1 03242017
fl WIN pr CLISFDDY P.V:ORD
Isar
39 Spruce Street
s v�r
Phone: [phone]
lNoiih
olio.:)
Page of
Fax: [phone]
ffilpmummmm '
East Longmeadow, MA 01028
Email: info®contestlabs.com
7-Day ❑ 10-Day
i.
❑
a
Aof Containers
• ••. ,a.,,.
'
Address: j�(yN (p �sj. /LlJ.v fCQ�f S'f - St4-• IOS
S�.oro
Due Date:
'•• '„v'_
.5
Pe
z Preservation Code
'Container Code
Phone: (33 (v �8 - 7 1 $O
/l/
1-Day ❑ 3-Day
❑
ANALYSIS
REQUESTED
2-Day ❑ 4-Day
❑
❑ I:Field Filtered "'• -;I
Project Location: CyYtn,j Se/b
/t/G
"•: : r= ';
Vi
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❑Lab to Filter
Project Number: (/3 S�? -
- Oa 8
1
Format: PDF ❑ EXCEL
❑
-
9
-
Project Manager: n
o
Other.
- r
Con -Test Quote Name/Number.
CLP Like Data Pkg Required:
Field Filtered i
Invoice Recipient.
Email To
❑ ;Lab to Filter
Sampled By U.r
Fax To A
' ':•
..
'1�
IB>O -a--
/1
Pa 13 '1
/�1
M6
V...
/\
�A1
_'.....
u W = uroune water :.
WW =Waste Water
"
"� —
a 3 H
o93s
X
�t7
1/l
AW AiDrinkingWa[er
-
-
S =Soil
SL
= Sludge
SOL = Solid
_
0 = Other (please'
define)
s
L Prese"ation Cod6is
I = Iced
H = HCL
_
-
M = Methanol
N = Nitric Acid -.
S = Sulfuric Acid i
-
B = Sodium Bisulfate
X = Sodium Hydroxide
-
T = Sodium
_
s:
i mosulfate
O = Other (please"
Please use the following codes to indicate possible sample concentration
define)
within the Conc Code column above:
H - High; M - Medium; L - Low; C - Clean; U - Unknown
3 Container Codes:..-
A
Ind by: (signs ) ,
/!
Date/Time: `z �/
- x r :
1
Pr am Information
- Amber Glass
G = Glass
❑ 2L
'p
?
.0/
/'�-(b'
OSCA ❑ UST/Trost Fund
P=Plastic :
ST = Steele "
ems, i Lure)
Date/Time: /Z. !J
❑ GWPC
SWS Landfill ❑ REC
_�
7I
1 ! !
r -
IHSB Orphaned Landfill
State Lead
V = Vial
.S = Summa Canister
-T = Tedlar Bag -
SWSI
by: (si tore}.
Da a/Time: !/� y
IHSB
❑ MSCC
J
Other:
O = Other (please'..:-:...':'.
by: nature)
Date/Time:
define)
'2 i"L 1L "
t. '. .� Q
- F.BAebanil':pj,HA
awMIt'.. A4ci•§di[ed,
led by: (signature
Date/Time:
Project Entity
Other
PCB ONLY m
❑ Government ❑ Municipality
❑ Federal Brownfield
❑
❑ Chromatogram
❑ AlHA-LAP, LLC
❑ Sozhlet
n
❑ Non Soxhlet O
by: (signature)
Dete/Time:
❑ City ❑ School
(D
N

Table of Contents
WE-
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Table of Contents
I Have Not Confirmed Sample Container
Numbers With Lab Staff Before Relinquishing .y
Over Samples 40
ANALYTICAL LABORATORY
D6c#271 :Rev 5 2017
Login Sample Receipt Checklist - (Rejection Criteria Listing - Using Acceptance Policy) Any False
�$Tatement will be brought to the attention of the Client - State True or False
Client ll /u W
How were the samples
received?
Were samples within
Temperature? 2-6°C
Date
In Cooler —r No Cooler
Direct from Sampling
By Gun # ;
By Blank #
Time
On Ice _T No Ice
Ambient Melted Ice
Actual Temp - 2
Actual Temp -
Was Custody Seal Intact? jJfi Were Samples Tampered with? NA
Was COC Relinquished ? -T Does Chain Agree With Samples? 7
Are there broken/leaking/loose caps on any samples?
Is COC in ink/ Legible? r Were samples received within holding time? -r
Did COC include all Client -T Analysis -T Sampler Name T
pertinent Information? Project T ID's —F Collectionbales/Times 7
Are Sample labels filled out and legible?
T
Are there Lab to Filters?
-F
Are there Rushes?
-F
Are there Short Holds?
Is there enough Volume?
Is there Headspace where applicable?
Proper Media/Containers Used?
Were trip blanks received?
Do all samples have the proper pH?
Who was notified?
Who was notified?
Who was notified?
MS/MSD?�
Is splitting samples required? {
On COC? -F
Acid Base
Viais. -
#
Containers;,
'#MERNSINAMMOAR
Un -
1 Liter Amb.
e -�55 Lr}
1 Liter Plastic
16 oz Amb.
HCL-
500 mL Amb.
500 mL Plastic
8oz Amb/Clear
Meoh-
250 mL Amb.
250 mL Plastic
4oz Amb/Clear
Bisulfate-
Flashpoint
Col./Bacteria
2oz Amb/Clear
DI-
Other Glass
Other Plastic
Encore
Thiosulfate-
SOC Kit
Plastic Bag
Frozen:
Sulfuric----•-
-•- ---• --
-Perchlorate -.
Ziplock
ME,
Nuts" ' , , #
Contal"rW,
Un -
1 Liter Amb.
1 Liter Plastic
16 oz Amb.
HCL-
500 mL Amb.
500 mL Plastic
8oz Amb/Clear
Meoh-
250 mL Amb.
250 mL Plastic
4oz Amb/Clear
Bisulfate-
Col./Bacteria
Flashpoint
2oz Amb/Clear
DI-
Other Plastic
Other Glass
Encore
Thiosulfate-
SOC Kit
Plastic Bag
Frozen:
Sulfuric-
I Perchlorate
Ziplock
Comments: