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HomeMy WebLinkAboutNCS000370_2020 DMR_20210118BRIDGESTONE AMERICAS TIRE OPERATIONS, LLC January 7, 2021 Wilson Plant P.O. Box 1139 Wilson, North Carolina 27894-1139 North Carolina DEMLR Raleigh Regional Offices 3800 Barrett Drive Raleigh, North Carolina 27609 Re: Storm water Sampling Year 11, Period 1 Analytical Results Dear Sir or Madam: The BATO-Wilson facility operates under National Pollutant Discharge Elimination System (NPDES) permit number NCS000370. The permit requires semi-annual quantitative sampling of storm water at the facility's two outfalls. The outfalls are named by their geographic locations, South and East. Please find the analytical results and Storm Water Outfail Discharge Monitoring Reports for the Sampling Year 11 Period 1 for the South and East outfalls in the Attachment. The samples were collected on December 20, 2020. The analytical results were received from the laboratory via electronic mail at BATO Wilson on January 6, 2020. As required, the original and one copy are enclosed. If you have any questions concerning this report, please contact Tausha Fanslau at (252) 246-7485. Sincerely, Vergil Norrod Plant Manager BATO — Wilson Plant cc: BATO Wilson Environmental Department p:\My Documents\Water-Stormwater\Files20 il rr 0.5 Co U a U) 3 m a1 co f0 O LL M co ca N M Co m C U Q Q 0 ^ Q) N Q a IL [L m o Q � Q) m w W UO W f� d�a zpA >,UW �zw Ua� a. E U, E T � � Q LO w J J E E T v v J Z Z E E CO (N 00 J J E El ❑ LO N 0 V J z El E mco U r (U 0)co jV o a J J O O E E o � vQiE^+G�� o "a L. CN N Gv�U ET t6 ca_ w O U) � o oz L 0�'+ H W o � O � � zo 0 ox c a o a� y zo w � C y •� H � j C _O R a OO �+••� Ley � L w � A r V E oz h ti N O cF. N O N ti b cl P� 42 i n cq N 0 0 Vs O 9 O �W C ' frto f0 m 1 � tMo C cmm y N H �^qti) CA - r Amy, 0 O O O. A 0fD `� C7CD t�D � a � o � a m � '� •o' 10, fD G N CD in CL `C n c cn C rL ee fb w. co n C. o 1 I CD rt m C fC O m_ fD O tl d 0. � \ f�C �' •Oy � � m m � Qq• A tD � •`'•• . .`1 e� O m S < m C O ua C � O �y O y G z Off. m R m y. O tCA CO CDCb 'F CS CL O lD O m m r? "a v R- ani, O (D (�IacieAnalytical" WWW.Pmlaba.eam January 05, 2021 Allen Henricks Bridgestone Americas RE: Project: Stormwater Sampling Pace Project No.: 92513629 Dear Allen Henricks: Pace Analytical Services, LLC 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 Enclosed are the analytical results for sample(s) received by the laboratory on December 23, 2020. The results relate only to the samples included in this report. Results reported herein conform to the applicable TNIINELAC Standards and the laboratory's Quality Manual, where applicable, unless otherwise noted in the body of the report. The test results provided in this final report were generated by each of the following laboratories within the Pace Network: • Pace Analytical Services -Asheville • Pace Analytical Services - Charlotte If you have any questions concerning this report, please feel free to contact me. Sincerely, VC1l-a Amanda Payne amanda.payne@pacelabs.com (704)875-9092 Project Manager Enclosures cc: Tausha Fanslau, Bridgestone Americas 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 15 aceAnalytical www.pacelabs.com Project: Stormwater Sampling Pace Project No.: 92513629 Pace Analytical Services, LLC 9800 KinceyAve. Suite 100 Huntersville, NC 28078 (704)875-9092 Pace Analytical Services Charlotte 9800 KinceyAve, Ste 100, Huntersville, NC 28078 Louisiana/NELAP Certification # LA170028 North Carolina Drinking Water Certification #: 37706 North Carolina Field Services Certification #: 5342 North Carolina Wastewater Certification #: 12 Pace Analytical Services Asheville 2225 Riverside Drive, Asheville, NC 28804 FloridalNELAP Certification #: E87648 North Carolina Drinking Water Certification #: 37712 CERTIFICATIONS South Carolina Certification #: 99006001 Florida/NELAP Certification #: E87627 Kentucky UST Certification #: 84 Virginia/VELAP Certification #: 460221 North Carolina Wastewater Certification #: 40 South Carolina Certification #: 99030001 Virginia[VELAP 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 15 5ceAna1j&a1 WW.pacelabs.com SAMPLE ANALYTE COUNT Project: Stormwater Sampling Pace Project No.: 92513629 Pace Analytical Services, LLC 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 Lab ID Sample ID Method Analysts Analytes Reported Laboratory 92513629001 South EPA 1664B CJM 1 PASI-C EPA 200.7 Rev 4.4 1994 KQ 1 PASI-A SM 2540D-2011 MJP 1 PASI-A EPA 9040C SMK 1 PASI-A SM 5220D-2011 JP1 1 PASI-A 92513629002 East EPA 1664E CJM 1 PASI-C EPA 200.7 Rev 4.4 1994 KQ 1 PASI-A SM 254OD-2011 MJP 1 PASI-A EPA 9040C SMK 1 PASI-A SM 5220D-2011 J131 1 PASI-A PASI-A = Pace Analytical Services - Asheville PASI-C = Pace Analytical Services - Charlotte 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 15 aceAnalytical www.pacelflaxem ANALYTICAL RESULTS Pace Analytical Services, LLC 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 Project: Stormwater Sampling Pace Project No.: 92513629 Sample: South Lab ID: 92513629001 Collected: 12/20/20 07:55 Received: 12/23/20 10:16 Matrix: Water Parameters Results Units Report Limit DF Prepared Analyzed CAS No. Qua[ 1664 SGT-HEM, TPH Analytical Method: EPA 1664E Pace Analytical Services - Charlotte Total Petroleum Hydrocarbons ND mg1L 5.0 1 12/28/20 11:33 200.7 MET ICP Analytical Method: EPA 200.7 Rev 4.4 1994 Preparation Method: EPA 200.7 Rev 4A 1994 Pace Analytical Services - Asheville zinc 66.3 ug/L 10.0 1 0110512100:54 01/0512112:22 7440-66-6 2540D Total Suspended Solids Analytical Method: SM 2540D-2011 Pace Analytical Services -Asheville Total Suspended Solids 18.6 mg1L 2.7 1 12/24/20 15:07 9040 pH Analytical Method: EPA 9040C Pace Analytical Services -Asheville pH at 25 Degrees C. 6.4 Sid. Units 0.10 1 12/30/20 13:28 H3 5220D COD Analytical Method: SM 5220D-2011 Preparation Method: SM 5220D-2011 Pace Analytical Services -Asheville Chemical Oxygen Demand ND mglL 25.0 1 12/29/20 18:11 12/30/20 05:37 REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, Date: 01/05/2021 02:53 PM without the written consent of Pace Analytical Services, LLC. Page 4 of 15 (�15'neAnalytica( www.pacelabs.eem ANALYTICAL RESULTS Pace Analytical Services, LLC 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 Project: Stormwater Sampling Pace Project No.: 92513629 Sample: East Lab ID: 92513629002 Collected: 12/20/20 08:05 Received: 12/23/20 10:16 Matrix: Water Parameters Results Units Report Limit DF Prepared Analyzed CAS No. Qual 1664 SGT-HEM, TPH Analytical Method: EPA 16648 Pace Analytical Services - Charlotte Total Petroleum Hydrocarbons ND mglL 5.0 1 12/28/20 11:33 200.7 MET ICP Analytical Method: EPA 200.7 Rev 4.4 1994 Preparation Method: EPA 200.7 Rev 4.4 1994 Pace Analytical Services -Asheville Zinc 91.9 ug1L 10.0 1 0110512100:54 01/0512112:26 7440-66-6 2540D Total Suspended Solids Analytical Method: SM 254OD-2011 Pace Analytical Services -Asheville Total Suspended Solids 12.1 mglL 2.5 1 12/24/20 15:07 9040 pH Analytical Method: EPA 9040C Pace Analytical Services -Asheville pH at 25 Degrees C 5.4 Std. Units 0.10 1 12/30/20 13:32 H3 5220D COD Analytical Method: SM 5220D-2011 Preparation Method: SM 5220D-2011 Pace Analytical Services - Asheville Chemical Oxygen Demand 48.5 mglL 25.0 1 12/29/20 18:11 12/30/20 05:38 REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, Date: 01/05/2021 02:53 PM without the written consent of Pace Analytical Services, LLC. Page 5 of 15 laneAnalytical" www.pacelabs.com QUALITY CONTROL DATA Project: Stormwater Sampling Pace Project No.: 92513629 QC Batch: 589533 Analysis Method: EPA 1664B QC Batch Method: EPA 1664B Analysis Description: 1664 SGT HEM, TPH Laboratory: Pace Analytical Services - Charlotte Associated Lab Samples: 92513629001, 92513629002 METHOD BLANK: 3113841 Matrix: VVgter Associated Lab Samples: 92513629001, 92513629002 Blank Reporting Parameter Units Result Limit Analyzed Qualifiers Total Petroleum Hydrocarbons mg1L ND 5.0 12/28/20 11:33 Pace Analytical Services, LLC 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 LABORATORY CONTROL SAMPLE: 3113842 Spike LCS LCS % Rec Parameter Units Conc. Result % Rec Limits Qualifiers Total Petroleum Hydrocarbons mg/L 20 16.3 82 64-132 MATRIX SPIKE SAMPLE: 3113843 92511721003 Spike MS MS % Rec Parameter Units Result Conc. Result % Rec Limits Qualifiers Total Petroleum Hydrocarbons mg/L ND 20 5.0 24 64-132 M1 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: 01/05/2021 02:53 PM without the written consent of Pace Analytical Services, LLC. Page 6 of 15 aceAnalytical www.pacotab3.com Project: Stormwater Sampling Pace Project No.: 92513629 QC Batch: 590579 QC Batch Method: EPA 200.7 Rev 4.4 1994 Associated Lab Samples: 92513629001, 92513629002 METHOD BLANK: 3118106 Associated Lab Samples: 92513629001, 92513629002 Parameter Units Zinc ug1L QUALITY CONTROL DATA Analysis Method: EPA 200.7 Rev 4A 1994 Analysis Description: 200.7 MET Laboratory: Pace Analytical Services -Asheville Matrix: Water Blank Reporting Result Limit Analyzed Qualifiers ND 10.0 01105/2108:51 Pace Analytical Services, LLC 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 LABORATORY CONTROL SAMPLE: 3118107 Spike LCS LCS % Rec Parameter Units Conc. Result % Rec Limits Qualifiers Zinc uglL 500 480 96 85-115 MATRIX SPIKE & MATRIX SPIKE DUPLICATE: 3118108 3118109 MS MSD 92513593001 Spike Spike MS MSD MS MSD % Rec Parameter Units Result Conc. Conc. Result Result % Rec % Rec Limits RPD Qual Zinc uglL 57.5 500 500 562 553 101 99 70-130 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 be reproduced, except in full, Dale: 01/05/2021 02:53 PM without the written consent of Pace Analytical Services, LLG. Page 7 of 15 lacieAnalydcal" W".pacalabsxam Project: Stormwater Sampling Pace Project No.: 92513629 QC Batch: 589415 QC Batch Method: SM 2540D-2011 Associated Lab Samples: 92513629001, 92513629002 MFTHnD BLANK- 3113506 Associated Lab Samples: 92513629001, 92513629002 Parameter Units Total Suspended Solids mg/L LABORATORY CONTROL SAMPLE: 3113507 Parameter Units Total Suspended Solids mg1L Pace Analytical Services, LLC 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 QUALITY CONTROL DATA Analysis Method: SM 2544D-2011 Analysis Description: 2540D Total Suspended Solids Laboratory: Pace Analytical Services -Asheville Matrix: Water Blank Reporting Result Limit Analyzed Qualifiers ND 2.5 12124/2015:06 Spike LCS LCS % Rec Cone. Result % Rec Limits Qualifiers 250 228 91 90-110 SAMPLE DUPLICATE: 3113508 92513700002 Dup Parameter Units Result Result Total Suspended Solids mg1L 225 189 RPD Qualifiers 17 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: 01/05/2021 02:53 PM without the written consent of Pace Analytical Services, LLC. Page 8 of 15 aceAnalytical www.pacelabs.com Project: Stormwater Sampling Pace Project No.: 92513629 QC Batch: 589465 QC Batch Method: EPA 9040C Associated Lab Samples: 92513629001, 92513629002 QUALITY CONTROL DATA Analysis Method: EPA 9040C Analysis Description: 9040 pH Laboratory: Pace Analytical Services -Asheville SAMPLE DUPLICATE: 3113630 92512065001 Dup Parameter Units Result Result RPD Qualifiers pH at 25 Degrees C Std. Units 6.5 6.5 0 H3 Pace Analytical Services, LLC 9800 Kincey Ave. Suite t00 Huntersville, NO 28078 (704)875-9092 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: 01/05/2021 02:53 PM without the written consent of Pace Analytical Services, LLC. Page 9 of 15 lacieAnalXicale www,pocelabs.com Project: Stormwater Sampling Pace Project No.: 92613629 QC Batch: 589801 QC Batch Method: SM 5220D-2011 Associated Lab Samples: 92513629001, 92513629002 METHon RI ANK: 3114779 Associated Lab Samples: 92513629001, 92513629002 Parameter Units Chemical Oxygen Demand mg/L QUALITY CONTROL DATA Analysis Method: SM 5220D-2011 Analysis Description: 5220D COD Laboratory: Pace Analytical Services - Asheville Matrix: Water Blank Reporting Result Limit Analyzed Qualifiers ND 25.0 12/30/20 05:32 Pace Analytical Services, LLC 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 LABORATORY CONTROL SAMPLE: 3114780 Spike LCS LCS % Rec Parameter Units Conc. Result % Rec Limits Qualifiers Chemical Oxygen Demand mg1L 750 762 102 90-110 MATRIX SPIKE & MATRIX SPIKE DUPLICATE: 3114781 3114782 MS MSD 92512387008 Spike Spike MS MSD MS MSD % Rec Parameter Units Result Conc. Conc. Result Result % Rec % Rec Limits RPD Qual Chemical Oxygen Demand mg1L 496 100 100 585 582 89 86 90-110 0 M1 MATRIX SPIKE & MATRIX SPIKE DUPLICATE: 3114783 3114784 MS MSD 92512392001 Spike Spike MS MSD MS MSD % Rec Parameter Units Result Conc, Conc. Result Result % Rec % Rec Limits RPD Qual Chemical Oxygen Demand mg1L 193 100 100 289 298 96 105 90-11 D 3 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: 0110512021 02:53 PM without the written consent of Pace Analytical Services, LLC. Page 10 of 15 aceAnalyfical www.pacclabs.com QUALIFIERS Project: Stormwater Sampling Pace Project No.: 92513629 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 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 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-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. Aseparate vial preserved to a pH of 4-5 is recommended in SW846 Chapter for the analysis ofAcrolein 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. TN - The NELAC Institute. ANALYTE QUALIFIERS H3 Sample was received or analysis requested beyond the recognized method holding time. Mt Matrix spike recovery exceeded QC limits. Batch accepted based on laboratory control sample (LCS) recovery. REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in Full, Date: 01/05/2021 02i53 PM without the written consent of Pace Analytical Services, LLC. Page 11 of 15 leAnalyfical www.pacalabs.com QUALITY CONTROL DATA CROSS REFERENCE TABLE Project: Stormwater Sampling Pace Project No.: 92513629 Lab ID Sample ID QC Batch Method QC Batch 92513629001 South EPA1664B 589533 92513629002 East EPA1664B 589533 92513629001 South EPA 200.7 Rev 4.4 1994 590579 92513629002 East EPA 200.7 Rev 4.4 1994 590579 92513629001 South SM 2540D-2011 589415 92613629002 East SM 2540D-2011 589415 92513629001 South EPA 9040C 589465 92513629002 East EPA 9040C 589465 92513629001 South SM 5220D-2011 589801 92513629002 East SM 5220D-2011 589801 Date: 01/05/2021 02:53 PM REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, without the written consent of Pace Analytical Services, LLC. Pace Analytical Services, LLC 9800 KinceyAve. Suite 100 Huntersville, NC 28078 (704)875-9092 Analytical Analytical Method Batch EPA 200.7 Rev 4.4 1994 590594 EPA 200.7 Rev 4.4 1994 590594 SM 5220D-2011 SM 5220D-2011 589943 589943 Page 12 of 15 CBArel imi" Document Name: Sample Condition Upon Recelpt(SCUR) Document Revised: OCtobEr 28, 2020 Page 1 of z Document No.: F-CAR-CS-033-Rev.07 IssuingAuthority: Pace Carolinas Quality Office Laboratory receiving Samples: Asheville ❑ - Eden❑ Greenwood ❑ Huntersville ❑ Ralelgh§< Mechanicsville❑ Atlanta❑ Kernersville❑ ReceiptSampleCoUpon Client [Name: Project Il: WO# : 92513629 Courier:[]Fed Ifx []UPS USP5 []client 11111111111111111111 ❑ Commercial 4pace ❑other: 92513629 Custody Seal Present? ❑Yes ErNo Seals Intact? []Yes NNo t]ate/1nftlais Person Examining Contents: Z.AWlx-7-3'2,9 Packing Material: ❑Bubble Wrap ❑Bubble Bags RNone ❑ other Biological Tissue Frozen? Thermometer: ❑Yes [f Na ON/A ElIRGun 10: (fp5 S[�Wet ❑Blue []None Type of (ce: Correction Factor: /� Cooter Tamp: Z ' 7 Add/Subtract VC) d 0 Temp should be above freezing to VC ❑Samples out of temp criteria. Samples on Ice, cooling process Cooler Temp Carreeted (°C): 7 has begun USDA Regulated Soil (DEN/A, water sample) Did samples originate In a quarantine zone within the United States: CA, NY, or SC (check maps)? Did samples originate from a foreign source (intematknally, MY.. 11Nn Inrludlrp Hawall and Puprtn Rlroi? l—lYes FINo Comm ents/Olscrepan cy: Chain of Custody Present? Yes EINo ❑N/A 1, Samples Arrived within Hold Time? Yes []Na N/A 2. Short Hold Time Analysis <72 hr.)? Yes allo N/A 3. Rush Turn Around Time Requested? QYas WNO N/A 4. Sufficient Volume? Yes QNo []N/A S. Correct Containers used? -Pace Containers Used? s s t No No ❑N/A ❑N/A 6. Contalners-Intac" Yer— No — _ N/A-- -7... --- -- --- -Dissolved analysis: 5amples Field Filtered? Yes ONO N/A 8, Sample Labels Klatch COC? -includes Date/Time/ip/Analysis Matrix: W ®Yes ❑No ❑N/A 9. Heads ace in VOA Vials >5-6mm)? ElYes []NO M N/A 10. Trip Blank Present? Trip Blank Custody Seals Present? ❑Yes Yes ❑No - ❑No KN/A 11 /A il. COMMENTS/SAMPLE DISCREPANCY ii 1° F l T Field Data Required? []Yes❑Na - : I } Lot ID ofsplit containers: I ! CLIENT NOTIFICATION/RESOLUTION Person contacted: Protect Manager SCURF Review: Project Manager SRF Review: Date/Tlme: Gate: Date: - 1 Page 13 of 15 Document Name: document Revised:October28, 2020 1 2 Anal icaI4 Sample Condltlon Upon Receipt SCUR Pa o 2 of 2 Document No.: issuing Authority: F-CAR-G-033-Rev,07 Pace Carolinas qualfty Office 'Check mark top half of box If pH and/or dechlorination Is verified and within the acceptance range for preservation samples. EKceptlons: VOA, Conform, TOC, oil and Grease, 0110/8015 (Water) DOC, LLHg *"Bottom half of box is to list number of bottles Project WO# : 92513629 PM: RP Due Date: 12/31/20 CLIENT: 92-BFUSA Z Z Z a ;' i1 v V 0 V ^ �+ Z v 2 v V v a \ M i6 4 ^ M N 2 N a �I ` 7 7 a V a 4 4 N m oEo o °.i to P. 0. +n m to in Co 'a E a 0 O S Z v 1lpEr E rylE� co a co co m m m l7 c E Q vCCC C7 A Q y x a EN Q C7 4 Pi a > J n C7 Q Y v m t7 C �v Of nr J E l7 Q a E plE� l7 Q `X x l��l• T E $ [7 o o ¢ n ? z" 0 Q > E I ° $ l9 ] > z 0 > ° cq�� O v, 3 O 7 a qxy 0. �9 ad > u m r� M J E £ V V1 cn z L J EE N ca m l g . UQ• 3 ti �Ll YI E N �n c G E $ c7 1 j I r I Ni N\\ z �I l 3 4 N\A �s N 6 \\�\\N N \J\�\ 8 \N\\N N N\N 9 \NNN \N NN iD NI \N\\� \N\ I I NN 11 i2 N TTI\N\��s pH Adjustment Log for Preserved Samples Sample la Type of preservative pH upon receipt Date preservation adjusted Time preservation adjusted Amount of Preservative added Lot 0 Note. Whenever there is a discrepancy affecting North Carolina compliance samples, a copy of this rerm vAll ee sent to the North Carolina ULHNR Certlticalion OhICG (i.e. Out of hold, Incorrect preservative, out of temp, Incorrect containers, Page 14 of 15 ITEM 4 0 w CA RUN rV r4 MATR&GODE (sievAUdoDdesiolafo ampLETYPE (G-GRAS C-COMP) 1-� P th C2 rl ri N krq U PLETEMPAT COILEOMN 0 OF CONTANER8 Qy Unprawrved H2604 ri HNO3 JHCI R NaOH N&2$203 Methanol Oftr 200.T -Zn X IX x Ix I COD x x IPH th x x -ras I 011 A Greaso 9 OT-HEM FtvtWalChTOdnD(YJN) TETAP In C y .. Rulalvudon 1. (YIN) -Costody Sealed 1.01ir >— N Ll ) Samples Inlacl (YIN) J0 (D 0 L> X 6,6 "n C: 0 M rD 2z 0 c) (D 8 r3 2 CD aam Page 15 of 15