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Home My WebLink AboutWQ0001077_Monitoring - 07-2022_20220808GW-59A COMPLIANCE REPORT FORM Permit # W, DDOIm (Submit one each monitoring period with GW-59 forms.) 1 Enter date monitoring results were due. 3C I Will this monitoring report (GIN-59 and GW-59A) YES O be submitted after the established due date 2 Was any required information missing on the GW-59 report forms? YES IF the answer to question 1 or 2 is "YES", list in the space provided below the well identification number(s) and explain the problems encountered in obtaining the required information. �; 2 'M) C 3 Are any of the monitor wells in need of repair or maintenance (damaged casing, unlocked or missing cap; -missing YES NO identification plate, area overgrown, etc.)? If the answer is "Yes ", contact the Regional.0 1ce for guidance. 4 Are any monitored constituents equal to or above the established standards? YES O If the answer to question 4 is "NO", skip to section 8. 4d ` o r.. If the answer to question 4 is "YES" list the affected wells individually-wi tii const4t ent(s) and concentration(s) exceeding standards in the space provided below: c�- W r 5 For the constituents identified in question 4 above, have standards' been exceeded previously for the YES NO same constituent(s) in the same well(s) in the last two years? If the answer to question 5 is "NO", skip to section 8. If the answer to question 5 is "YES", list in the space provided below, each well with constituent(s) exceeding standards, concentration(s) reported, and sample collection date for each occurrence (for the last two years). Are the monitoring wells listed in section 5 located at or beyond the review boundary? YES NO If the answer is "YES", a groundwater quality problem may be occurring. CONTACT THE REGIONAL OFFICE IMMEDIATELY FOR GUIDANCE. If the answer is "NO", monitoring wells may be improperly located; contact the Regional Office. 7 Is the permittee implementing previously approved actions required by the Division involving this YES NO groundwater quality problem? If the answer to question 7 is "YES", describe those actions in the space provided below. If the answer to question 7 is "NO", contact the Regional Office within 90 daVs; an evaluation may be required to determine the impact the waste disposal system is having at the review and compliance boundaries surrounding this facility. Failure to do so maV subject the permittee to a Notice of Violation, fines, and/or penalties. 8 The person completing this portion (GW-59A) of the monitoring report should sign below and submit this form with GW-59 forms for required wells to the address provided at the top of the current GW-59 form. I hereby acknowledge that the above information was evaluated and the information submitted in this report (Compliance Report GW-59A) is true and complete to the best of my knowledge. l ti".,`.I'' .70'& Signature of Permittee (ooAuthorized Agent) Date GW-59A 12/8/2003 SUBMIT FORM ON YELLOW PAPER ONLY GROUNDWATER QUALITY MONITORING: • . . • • • DEPARTMENT OF ENVIRONMENTAL QUALITY - DIV. OF WATER RESOURCES INFORMATION PROCESSING UNIT 1617 MAIL SERVICE CENTER, RALEIGH, NC 27699-1617 COMPLIANCE REPORT FORM Phone: 9IM076306 FACILITY INFORMATION Please Print ClearlyorType PERMIT Number: Expiration Date: 6/30/2027 Facility Name: Innospec Performance Chemicals Non -Discharge W00001077 UIC NPDES Other Permit Name (if different): Facility Address: 500 Hinkle Lane TYPE OF PERMITTED OPERATION BEING MONITORED ❑ Lagoon ❑ Remediation: Infiltration Gallery Salsibury, NC 28144 County Rowan (city) X Spray Field ❑ Remediation: Contact Person: Clay White Telephone#: (704) 639-7920 ❑ Rotary Distributor ❑ Land Application of Sludge Well Location/Site Name Long Ferry Road No. of wells to be sampled 3 ❑ Water Source Heat Pump❑ Other: (from Permit) SAMPLING INFORMATION If WELL WELL ID NUMBER (from Permit): MW-6 Date sample collected: 7/12/2022 FIELD ANALYSES: WAS Well Depth: 30 ft. Well Diameter: 2 in. pH 00400 5.68 S units Temp- 00010: 17.2 °C DRY at Depth to Water Level e2546: 19 ft. below measuring point Screened Interval: 30 ft. to 15 ft. Spec. Cond 00094 LtMhos time of Measuring Point is 2 ft. above land surface Relative M.P. Elevation: ft. Odor00085 NIL sampling, Volume of water pumped/bailed before sampling: 6 gallons Appearance Clear checlt-- here: Samples for metals were collected unfiltered: ElYES ❑ NO and field acidified: ❑ YES ❑ NO LABORATORY INFORMATION Date sample analyzed 07/13-29/2022 Laboratory Name: Statesville Analytical Certification No. 440 PARAMETERS NOTE: Values should reflect dissolved and colloidal concentrations. COD 00335 mg/L Nitrite (NO2) as N 00615 mg/L Pb - Lead 01051 ug/L Coliform: MF Fecal 31616 /100ml- Nitrate (NO3) as N 00620 mg/L Zn - Zinc 01092 mg/L Coliform: MF Total 31504 /100mL Phosphorus: Total as P 00665 mg/L (Note. Use MPN method for highly turbid samples) Orthophosphate 70507 mg/L Other (Specify Compounds and Concentration Units): issolved Solids:Total 70300 132 mg/L Al -Aluminum 01105 mg/L MBAS = <0.1 mg/L pH (Lab) 00403 units Ba - Barium 01007 ug/L TOC 00680 <1.0 mg/L Ca - Calcium 00916 mg/L Chloride 00940 mg/L Cd - Cadmium 01027 ug/L Arsenic 01002 ug/L Chromium: Total o1o34 ug/L Grease and Oils 00552 mg/L Cu - Copper 01042 mg/L ORGANICS: (by GC, GC/MS, HPLC) Phenol 32730 ug/L Fe - Iron 01045 ug/L (Specify test and method #. ATTACH LAB REPORT.) Sulfate 00945 mg/L Hg - Mercury 71900 ug/L Lab Report Attached? ❑ Yes (1) [�] No (0) Specific Conductance 00095 103.7 µMhos K - Potassium 00937 mg/L method # Total Ammonia oo610 mg/L Mg - Magnesium 00927 mg/L method # (Ammonia Nitrogen. NH3as N; Ammonia Nitrogen, Total) Mn - Manganese 01055 ug/L , method # TKN as N 00625 mg/L Ni - Nickel 01067 ug/L method # For Remediation Systems Only (Attach Lab Reports): Influent Total VOCs: mg/L Effluent Total VOCs: mg/L VOC Removal% GW-59 Rev. 06-07-2018 SUBMIT FORM ON YELLOW PAPER ONLY GROUNDWATER QUALITY MONITORING: • • • DEPARTMENT OF ENVIRONMENTAL QUALITY - DIV. OF WATER RESOURCES INFORMATION PROCESSING UNIT COMPLIANCE REPORT FORM 1617 MAIL SERVICE CENTER, RALEIGH, NC 27699-1617 Phone: 919107E306 FACILITY INFORMATION Please Print Clearly or Type PERMIT Number: Expiration Date: 6/30/2027 Facility Name: Innospec Performance Chemicals Non -Discharge W00001077 UIC Permit Name (if different): NPDES Other Facility Address: 500 Hinkle Lane TYPE OF PERMITTED OPERATION BEING MONITORED Salsibury, NC 28144 County Rowan ❑ Lagoon ❑ Remediation: Infiltration Gallery (City) (State) (Z,P) X Spray Field ❑ Remediation: Contact Person: Clay White Telephone#: (704) 639-7920 ❑ Rotary Distributor ❑ Land Application of Sludge Well Location/Site Name: Long Ferry Road No. of wells to be sampled: 3 ❑ Water Source Heat Pump ❑ Other: (from Permit) INFORMATIONSAMPLING If WELL WELL ID NUMBER (from Permit): MW-7 Date sample collected: 7/12/2022 FIELD ANALYSES: WAS Well Depth: 38 ft. Well Diameter: 2 in. pH 00400: 6.01 units Temp. 00010: 17.4 °C DRY at Depth to Water Level 82546: 29 ft. below measuring point Screened Interval: 38 ft. to 18 ft. Spec. Cond. 00094: µMhos time of Measuring Point is 2 ft. above land surface Relative M.P. Elevation: ft. Odor 00085. NIL sampling, Volume of water pumped/bailed before sampling: 5 gallons Appearance Ligth Brown check her Samples for metals were collected unfiltered: ❑ YES ❑ NO and field acidified: ❑ YES ❑ NO LABORATORY INFORMATION Date sample analyzed: 07/13-29/2022 Laboratory Name: Statesville Analytical Certification No. 440 PARAMETERS NOTE: Values should reflect dissolved and colloidal concentrations. COD 00335 mg/L Nitrite (NO2) as N oo615 mg/L Pb - Lead o1o51 ug/L Coliform: MF Fecal 31616 /100mL Nitrate (NO3) as N 00620 mg/L Zn - Zinc 01092 mg/L Coliform: MF Total 31504 /100mL Phosphorus: Total as P 00665 mg/L (Note: Use MPN method for highly turbid samples) Orthophosphate 70507 mg/L Other (Specify Compounds and Concentration Units): issolved Solids:Total 70300 38 mg/L Al -Aluminum o11D5 mg/L MBAS = <0.1 mg/L pH (Lab) 00403 units Ba - Barium 01007 ug/L TOC oo68o <1.0 mg/L Ca - Calcium o0916 mg/L Chloride oos4o mg/L Cd - Cadmium 01027 ug/L Arsenic 01002 ug/L Chromium: Total o1o34 ug/L Grease and Oils 00552 mg/L Cu - Copper 01042 mg/L ORGANICS: (by GC, GC/MS, HPLC) Phenol 32730 ug/L Fe - Iron D1o45 ug/L (Specify test and method #. ATTACH LAB REPORT.) Sulfate 00945 mg/L Hg - Mercury 71900 ug/L Lab Report Attached? ❑ Yes (1) ❑X No Specific Conductance Dom 21.3 µMhos K - Potassium 00937 mg/L method # Total Ammonia o0610 mg/L Mg - Magnesium 00927 mg/L method # (Ammonia Nitrogen; NH3 as N; Ammonia Nitrogen, Total) Mn - Manganese 01055 ug/L , method # TKN as N 00625 mg/L Ni - Nickel 01067 ug/L method # For Remediation Systems Only (Attach Lab Reports): Influent Total VOCs: mg/L Effluent Total VOCs: mg/L VOC Removal% Allen Robey, SHE Director, NA Permittee (or Authorized Agent) Name and Title - Please print or type GW-59 Rev. 06-07-2018 SUBMIT FORM ON YELLOW PAPER ONLY GROUNDWATER QUALITY MONITORING: • . . . • • DEPARTMENT OF ENVIRONMENTAL DUALITY - DIV. OF WATER RESOURCES INFORMATION PROCESSING UNIT COMPLIANCE REPORT FORM 1617 MAIL SERVICE CENTER, RALEIGH, NC 27699-1617 Phone: 919-807-6306 FACILITY INFORMATION Please Print Clearly or Type PERMIT Number: Expiration Date 6/30/2027 Facility Name. Innospec Performance Chemicals Non -Discharge W00001077 UIC Permit Name (if different): NPDES Other Facility Address: 500 Hinkle Lane TYPE OF PERMITTED OPERATION BEING MONITORED Salsibury, NC 28144 County Rowan ❑ Lagoon ❑ Remediation: Infiltration Gallery (cty) (state) (Zip) X Spray Field ❑ Remediation: Contact Person: Clay White Telephone#: (704) 639-7920 ❑ Rotary Distributor ❑ Land Application of Sludge Well Location/Site Name: Long Ferry Road No. of wells to be sampled: 3 ❑ Water Source Heat Pump ❑ Other: (from Permit) SAMPLINGI If WELL WELL ID NUMBER (from Permit): MW-8 Date sample collected: 7/12/2022 FIELD ANALYSES: WAS Well Depth: 40 ft. Well Diameter: 2 in. pH oo400: 6.32 units Temp. 00010: 16.0 °C DRY at Depth to Water Level 82546: 19 ft. below measuring point Screened Interval: 40 ft. to 20 ft. Spec. Cond. 00094: µMhos time of Measuring Point is 3 ft. above land surface Relative M.P. Elevation: ft. Odor OOG85: NIL sampling, Volume of water pumped/bailed before sampling: 10.5 gallons Appearance Light Brown check hers❑ Samples for metals were collected unfiltered: ❑ YES ❑ NO and field acidified: ❑ YES ❑ NO LABORATORY INFORMATION Date sample analyzed: 07/13-29/2022 Laboratory Name: Statesville Analytical Certification No. 440 PARAMETERS NOTE: Values should reflect dissolved and colloidal concentrations. COD 00335 mg/L Nitrite (NO2) as N oos15 mg/L Pb - Lead o1o51 ug/L Coliform: MF Fecal 31616 /100mL Nitrate (NO3) as N oo62o mg/L Zn - Zinc 01092 mg/L Coliform: MF Total 31504 /100mL Phosphorus: Total as P 00665 mg/L (Note. Use MPN method for highly turbid samples) Orthophosphate 70507 mg/L Other (Specify Compounds and Concentration Units): issolved Solids:Total 70300 30.5 mg/L Al - Aluminum 01105 mg/L MBAS = <0.1 mg/L pH (Lab) 00403 units Ba - Barium 01007 ug/L TOC oo68o <1.0 mg/L Ca - Calcium 00916 mg/L Chloride Dow mg/L Cd - Cadmium 01027 ug/L Arsenic 01002 ug/L Chromium: Total olo34 ug/L Grease and Oils 00552 mg/L Cu - Copper 01042 mg/L ORGANICS: (by GC, GC/MS, HPLC) Phenol 32730 ug/L Fe - Iron 01045 ug/L (Specify test and method #. ATTACH LAB REPORT.) Sulfate oo945 mg/L Hg - Mercury 71900 ug/L Lab Report Attached? ❑ Yes (1) N No (0) Specific Conductance 00095 35.5 µMhos K - Potassium 00937 mg/L method # Total Ammonia oo6lo mg/L Mg - Magnesium 00927 mg/L method # (Ammonia Nitrogen; NH3asN; Ammonia Nitrogen, Total) Mn - Manganese o1o55 ug/L , method # TKN as N 00625 mg/L Ni - Nickel 01067 ug/L method # For Remediation Systems Only (Attach Lab Reports): Influent Total VOCs: mg/L Effluent Total VOCs: mg/L VOC Removal% I certify that. to the best of my knowledge and belief, the information submitted in this report is true, accurateand complete. and that the laboratory analytical data was produced using approved methods of analysis by a DWR-certified laboratory. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violationsAllen Robey, SHE Director, NA ?A— j • GW-59 Rev. 06-07-2018 Analytical Results Innospec Performance Chemicals US Company 500 Hinkle Lane Salisbury, NC 28144 Receive Date: 07/13/2022 Reported: 08/03/2022 For: Monitoring Wells Comments: STATESVILLE ANALYTICAL Sample Number Parameter Sample ID Result Unit Method Analyzed Analyst 220713-17-01 Conductivity MW6 103.7 umhos/cm SM251OB-2011 07/15/2022 CE 220713-17-01 MBAS MW6 <0.1 mg/L SM554OC-2011 07/13/2022 MD 220713-17-01 TOC MW6 <1.0 mg/L SM5310B 07/29/2022 MT 220713-17-01 Total Dissolved MW6 132 mg/L SM 2540C 181h Edition 07/15/2022 MD Solids 220713-17-02 Conductivity MW7 21.3 umhos/cm SM25108-2011 07/15/2022 CE 220713-17-02 MBAS MW7 <0.1 mg/L SM554OC-2011 07/13/2022 MD 220713-17-02 TOC MW7 <1.0 mg/L SM5310B 07/29/2022 MT 220713-17-02 Total Dissolved MW7 38 mg/L SM 2540 C 18th Edition 07/15/2022 MD Solids 220713-17-03 Conductivity MW8 35.5 umhos/cm SM251OB-2011 07/15/2022 CE 220713-17-03 MBAS MW8 <0.1 mg/L SM554OC-2011 07/13/2022 MD 220713-17-03 TOC MW8 <1.0 mg/L SM5310B 07/29/2022 MT 220713-17-03 Total Dissolved MW8 30.5 mg/L SM 2540 C 18th Edition 07/15/2022 MD Solids Respectfully submitted, Melissa Myers NC Cert #440, NCDW Cert #37755, EPA #NC00909 PO Box 228 • Statesville, NC 28687 • 704/872/4697 Page 1 of 6 Condition of Receipt Sample Number 220713-17-01 Temp on Arrival: 5.0 Parameter Schedule: Total Dissolved Solids Received on Ice Parameter Schedule: Conductivity Received on Ice Parameter Schedule: MBAS Received on Ice pH on Arrival: <2 Parameter Schedule: Phosphoric Acid Received on Ice Chemicals in containers, lab Sample Number 220713-17-02 Temp on Arrival: 5.0 Parameter Schedule: Total Dissolved Solids Received on Ice Parameter Schedule: Conductivity Received on Ice Parameter Schedule: MBAS Received on Ice pH on Arrival: <2 Parameter Schedule: Phosphoric Acid Received on Ice Chemicals in containers, lab Sample Number 220713-17-03 Temp on Arrival: 5.0 Parameter Schedule: Total Dissolved Solids Received on Ice Parameter Schedule: Conductivity Received on Ice Parameter Schedule: MBAS Received on Ice PO Box 228 • Statesville, NC 28687 • 704/872/4697 Page 2 of 6 pH on Arrival: <2 Parameter Schedule: Phosphoric Acid Received on Ice Chemicals in containers, lab PO Box 228 • Statesville, NC 28687 • 704/872/4697 Page 3 of 6 Client: G \Jp— !�. RTAT��>Ilt r F ,1� . N0ALt I (CAL 122 Court Str dr • P.O. Nmc 228 Address Q� u �� _ Statesvillc, NC 28687 1704) 97 Chain o Custody Record Contact Person: t Phone # FAX# A PO # Requisitioned by Ale lame — Date) Customer Sample ID# Lab -ID M Time Sampled (Grab Only) Date Sampled (Grab Only) Matrix sue. w ww P,vumcrcn rcyueatal ( nnulysi. 13 -7-0 : ' -711 ►Z T-05 rt 06 (orib . 2 1 Z-1Z2 ✓ ✓ hoc 1 11 q u, 6 - 156) 7 Z 2ozZ ✓ kl(- TD5 . A Relinquished by:/1 Time /D �00a , pm Date -T /33 l Sampled byC-,-]6i— Reseiued-by: ITmey \0jt 6am)pm Date // Trans rted Ge7- Relinquished by: Time pm Date f7/ob _3l)- Holding times met: Received by: Time am, pm Date 7/3/ LI4 / Compliance work: Composite Sampling #1: Time begin am, pm Date / /_ Non-compliance work: Time end am, pm Date _/ /_ Lab Comments: Samples Transported On Ice; Composite Sampling #2: Time begin am, pm Date _/—j_ Time end am, pm Date _/_/� IrritFals: r` 00 tD 00 N U z ai N 41 00 N N X O Co Meritech, Inc. Environmental Laboratory Laboratory Certification No.165 Contact: C. Little Report Date: 8/2/2022 Client: Statesville Analytical 122 Court St Project: Innospec MW f Statesville, NC 28677 Date Sample Rcvd: 7/15/2022 Meritech Work Order # 071522105 Sample: 220713-17-01 Grab 7/12/2022 Parameter Results Analysis Date ReportingLimit Method TOC 4.0 mg/L 7/29/2022 1.0 mg/L SM 5310C Meritech Work Order # 071522106 Sample: 220713-17-02 Grab 7/12/2022 Parameter RUWU Analysts Date Reporting Limit good TOC <1.0 mg/L 7/29/2022 1.0 mg/L SM S310C Meritech Work Order # 071522107 Sample: 220713-17-03 Grab 7/12/2022 Parameter 1110111111 Analysis Date Rp.RQrtllng Limit Method TOC <1.0 mg/L 7/29/2022 1.0 mg/L SM S310C I hereby certify that I have reviewed and approve these data Laboratory Representative 642 Tamco Road, Reidsville, North Carolina 27320 tel.(336)342-4748 fax.(336)342-1522 PO Box 228 • Statesville, NC 28687 • 704/872/4697 Page 5 of 6 Chain of Custody Record (COC) NPDES#: MERITECH, INC. Client: Phone: Address: Fax: ENVIRONMENTAL LABORATORIES Email: 44, 642 Tamco Rd. Phone: 336-342-4748 Pro)ec Reidsville NC 27320 Fax: 336-342-1522 p O #; tv Email: info@meritechlabs.com www.meritechlabs.com Attention: T A'oundr..e' *RUSH woaA needs poor approval, How would you like your report sent? Cirde all that apply: Email(p(eferred), Fax, Mail Std 0 ) t 5 t�ty,1 2 4 4s ii., Sample Location and/or ID # 2 n -ip 1 Sampling Dates & Times Person TaMng Sampie (s�gn/Pnnc): Lab use Only Start End Grab' G Cont t Test(s) Required �W U On /reNo Yes Cl OK? Date Time Date 1 2 Time 09 11 t�t -102 LOOS G 6 W Temperature Upon Receipt • 1 Method Of "' Ikchlorination <0.5 m of Ammonia, Cyanide, Phenol and TKN samples must be done in the field prior to enervation. • •' Comments: Shipment: Compositor p UPS Jug If Fed Ex Are su is for re la ses? Yes No u Repor es Its L j mgJkg E I ug/L [� c: J ' rt .�me: I Hand Delivery rtei n e I by r _ Time: j Other b by, Date: Time: li by: Date Time: Re�!red by 1` 1 1 Date: Time: t It r- rn v \ N O 00 N � m o a 00 N N x 0 m O Wft Analytical Results STATESVILLE ANALYTICAL Innospec Performance Chemicals US Company 500 Hinkle Lane Salisbury, NC 28144 Receive Date: Reported: For: Comments: Sample Number 07/13/2022 08/03/2022 Monitoring Wells Parameter Sample ID Result Unit Method Analyzed Analyst 220713-17-01 Conductivity MW6 103.7 umhos/cm SM251OB-2011 07/15/2022 CE 220713-17-01 MBAS MW6 <0.1 mg/L SM554OC-2011 07/13/2022 MD 220713-17-01 TOC MW6 <1.0 mg/L SM5310B 07/29/2022 MT 220713-17-01 Total Dissolved MW6 132 mg/L SM 2540 C 18th Edition 07/15/2022 MD Solids 220713-17-02 Conductivity MW7 21.3 umhos/cm SM251OB-2011 07/15/2022 CE 220713-17-02 MBAS MW7 <0.1 mg/L SM554OC-2011 07/13/2022 MD 220713-17-02 TOC MW7 <1.0 mg/L SM5310B 07/29/2022 MT 220713-17-02 Total Dissolved MW7 38 mg/L SM 2540 C 18th Edition 07/15/2022 MD Solids 220713-17-03 Conductivity MW8 35.5 umhos/cm SM25108-2011 07/15/2022 CE 220713-17-03 MBAS MW8 <0.1 mg/L SM554OC-2011 07/13/2022 MD 220713-17-03 TOC MW8 <1.0 mg/L SM5310B 07/29/2022 MT 220713-17-03 Total Dissolved MW8 30.5 mg/L SM 2540 C 18th Edition 07/15/2022 MD Solids Respectfully submitted, Melissa Myers NC Cert #440, NCDW Cert #37755, EPA #NC00909 PO Box 228 • Statesville, NC 28687 • 704/872/4697 Page 1 of 6 Condition of Receipt Sample Number 220713-17-01 Temp on Arrival: 5.0 Parameter Schedule: Total Dissolved Solids Received on Ice Parameter Schedule: Conductivity Received on Ice Parameter Schedule: MBAS Received on Ice pH on Arrival: <2 Parameter Schedule: Phosphoric Acid Received on Ice Chemicals in containers, lab Sample Number 220713-17-02 Temp on Arrival: 5.0 Parameter Schedule: Total Dissolved Solids Received on Ice Parameter Schedule: Conductivity Received on Ice Parameter Schedule: MBAS Received on Ice pH on Arrival: <2 Parameter Schedule: Phosphoric Acid Received on Ice Chemicals in containers, lab Sample Number 220713-17-03 Temp on Arrival: 5.0 Parameter Schedule: Total Dissolved Solids Received on Ice Parameter Schedule: Conductivity Received on Ice Parameter Schedule: MBAS Received on Ice PO Box 228 • Statesville, NC 28687 • 704/872/4697 Page 2 of 6 pH on Arrival: <2 Parameter Schedule: Phosphoric Acid Received on Ice Chemicals in containers, lab PO Box 228 • Statesville, NC 28687 • 704/872/4697 Page 3 of 6 Client: t� crnr��uit.l.� A , A14Aif I (SAL 122 Court Sln-et • P.O. Hnz 228 Statesvillc, NC 28687 (7041 RT2-4697 Chain of Custody Record Address: Qo in f _ u A/C V 1 Contact Person: A ` I Phone # FAX# t PO # Requisitioned by. e l Time Date) Customer Sample lDM Lab-{D R Time Sampled (Grab Only) [Yale Sampled (Grab Only) sx nus Matrix w I wv rarumcrcrx rcyuc�te.l lx onnlysu i -0s AABAS LOA . 1 03.- 1-7 U; 05 ZZ ✓ ✓ �oc 1 D 41 q Relinquished by:/' Receive�by: Relinquished by: Received by: Composite Sampling #1: Time begin am, pm Date // Time end am, pm Date / / Com�site Sampling Time begin am, pm Date Time end am, pm Date /_/__ — Time �j9 D0 a , pm Date I/3j§4 Sampled by ITrne ' ��pm Date // Transported �7 Po by: Time ( ., pm Date / /_3/ Holding times met: - Time IA am, pm Date l! 3/ / Compliance work: Non-compliance work: Lab Comments: Samples Transported On Ice: Initials: r- tr N00 O 0 \ Ot n a n DD lD 00 N U Z ai H N 00 N N X O co a Meritech, Inc. Environmental Laboratory Laboratory Certiflcation No.165 s Contact: C. Little Report Date: 8/2/2022 Client; Statesville Analytical 122 Court St Project: Innospec MW s Statesville, NC 28677 Date Sample Rcvd: 7/15/2022 Meritech Work Order # 071522105 Sample: 220713-17-01 Grab 7/12/2022 Parameter Resins Analysis Date Reporting Limit Method TOC <1.0 mg/L 7/29/2022 1.0 mg/L SM 5310C Meritech Work Order # 071522106 Sample: 220713-17-02 Grab 7/12/2022 Parameter Results Analysis Date Reporting Limit Ml dw TOC <1.0 mg/L 7/29/2022 1.0 mg/L SM S310C Meritech Work Order # 071522107 Sample: 220713-17-03 Grab 7/12/2022 Parameter Hasults Ana1y s Date Rep rting Limit McdLed TOC 4.0 mg/L 7/29/2022 1.0 mg/L SM 5310C I hereby certify that I have reviewed and approve these data , �c 1Y)CA cot-) Laboratory Representative 642 Tamco Road, Reidsville, North Carolina 27320 tel.(336)342-4748 tax.(336)342-iS22 PO Box 228 • Statesville, NC 28687 • 704/872/4697 Page 5 of 6 Chain of Custody Record (COC) _ , / NPDESN: MERITECH, INC. Client: �{— Phone: Address: Fax: ENVIRONMENTAL LABORATORIES Email: 642 Tamco Rd. Phone: 336-342-4748 Proje-M-rl Reidsville NC 27320 Fax: 336-342-1522 fY�c- P.C)X-g K G rz 'Email: info@meritechlabs.com www.meritechlabs.com _ _.-- Attention: Tu Around Time• J. 'RH work needs prior approval, How would you like your report sent? 0 1, pp y: (prelerrcd) , Fax Mail Circle allthata I Email J:S�idu'dD)��„ Sample Location and/or ID # 2 20-1 l3— Il -10 I Sampling Dates &Times Person Taking Sample(Sign/Print): Lab Use Only Start End Comp? Grab? G " Cont. Test(s) Required GW c� On onlce? / No pH OK? Cl OK? Date Time Date -1I 2 Time oa ! -7 t1--62 LOOS- G C W c Temperature Upon Receipt - Method of ITechlonnation <O.5 m of Ammonia, Cyanide, Phenol and TKN samples must be done in the field prior to preservation. '•• ; Shipment: Comments: Compositor fl Jug q Are su t for re tat ses? Yes No LI Repor eS Its � ; / m l _I mgAg I I ug/L U Reiingr' edb,i ! _D Time: j' q �jirrte:au f id b D t ^�dA�me: ..�Aeceivedby. Dale: Time: �( UP5 -� Fed Ex I j Hand Delivery i-j Other linquish d hy: IF Date- Timc: Req?ived by l.ab: Date: Time: 00 N N x 0 m O