NCG030669_2023 DMR_20230615

NCDEQ Division of Energy,Mineral and Land Resources
Stormwater Discharge Monitoring Report (DMR) Form for NCG030000
Metal Fabrication
Click here for instructions
Complete,sign,scan and submit the DMR via the Stormwater NPDES Permit Data Monitoring Report(DMR) Upload form within
30 days of receiving sampling results. Mail the original,signed hard copy of the DMR to the appropriate DEMLR Regional Office.
Certificate of Coverage No. NCGO3 0669 Person Collecting Samples: Robert Hensley
Facility Name: AFS MFG LLC Laboratory Name: Pace Analytical
Facility County: ROWAN Laboratory Cert. No.: DW#37706,WW#12,DW#37712,WW#40,381
Discharge during this period: Yes Ei No (if no,skip to signature and date)
Has your facility implemented mandatory Tier response actions this sample period for any benchmark exceedances?ElYes ErNo
If so,which Tier(l, II, or Ill)?
A copy of this DMR has been uploaded electronically via https://edocs.deq.nc.gov/Forms/SW-DMR 'Yes 0 No
Date Uploaded: Le 51 o
Analytical Monitoring Requirements for Outfalls with Industrial Activities—Benchmarks in(Red)
Parameter Parameter Outfall 18 Outfall 2 Outfall Outfall Outfall
Code
N/A Receiving Stream Class C C
N/A Date Sample Collected MM/DD/YYYY 05/28/2023 05/28/2023
46529 24-Hour Rainfall in inches 1.15" 1.15"
C0530 TSS in mg/L(100 or 50*) <2.5 mg/L <2.5 mg/L
00400 pH in standard units(6.0-9.0 FW, 7.40 7.56
6.8-8.5 SW)
01119 Copper,total recoverable in mg/L <0.0050 mg/L <0.0050 mg/L
(0.010 FW,0.0058 SW)
01051 Lead,total recoverable in mg/L <0.0010 mg/L <0.0010 mg/L
(0.075 FW,0.22 SW)
01094 Zinc,total recoverable in mg/L(0.126 <0.0100 mg/L <0.0100 mg/L
FW,0.095 SW)
00340 Chemical Oxygen Demand(COD)in <25.0 mg/L <25.0 mg/L
mg/L(120)
00552 Non-Polar Oil&Grease in mg/L(15) <4.9 mg/L <4.8 mg/L
*Outfalls to Outstanding Resource Waters(ORW),High Quality Waters(HQW),Trout Waters(Tr)and Primary Nursery Areas(PNA)
have a benchmark TSS limit of 50 mg/L.All other water classifications have a benchmark of 100 mg/L
FW(Freshwater)SW(Saltwater)
Notes(optional):
"I certify by my signature below,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 in ormation,including the possibility of fines and imprisonment for knowing violations."
1 ( [ 5[ 2,,e)z3
igna f Permittee or elegated Authorized Individual Date
KI,6,42 n, . m CY.n �NC)x,A50 rN i i l t�I C vcv1 -1 U 1 - gib - i Z--
Email Address ) Phone Number

(11( Pace Analytical Services,LLC
7 ,PceAnaIyticaI a 9800 Kincey Ave. Suite 100
Huntersviile,NC 28078
www,pacelabs.tom [phone]
June 06, 2023
Robert Hensley
Agility Fuel Systems
1010 Corporate Center Drive
Salisbury, NC 28146
RE: Project: STOMRWATER 2ND QUARTER
Pace Project No.: 92669767
Dear Robert Hensley:
Enclosed are the analytical results for sample(s)received by the laboratory on May 30,2023. The results relate only to the
samples included in this report. Results reported herein conform to the applicable TNI/NELAC 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
•Pace Analytical Services-Peachtree Corners,GA
If you have any questions concerning this report, please feel free to contact me.
Sincerely,
:zeA i-lam---
Tyriek Hooks
[e-mail]
[phone]
Project Manager
Enclosures
cc: Kulema McKoy,Hexagon Agility
AG .
REPORT OF LABORATORY ANALYSIS
r'"' This report shall not be reproduced,except in full,
without the written consent of Pace Analytical Services,LLC. Page 1 of 14

Pace Analytical Services,LLC
e, 9800 KinceyAve. Suite i00
aceAnalytieal Huntersville.NC 28078
www.pacelabs.cora [phone]
CERTIFICATIONS
Project: STOMRWATER 2ND QUARTER
Pace Project No.: 92669767
Pace Analytical Services Charlotte
South Carolina Laboratory ID:99006 South Carolina Certification#:99006001
9800 Kincey Ave.Ste 100,Huntersville,NC 28078 South Carolina Drinking Water Cert.#:99006003
North Carolina Drinking Water Certification#:37706 Florida/NELAP Certification#:E87627
North Carolina Field Services Certification#:5342 Kentucky UST Certification#:84
North Carolina Wastewater Certification#:12 Louisiana DoH Drinking Water#:LA029
South Carolina Laboratory ID:99006 VirginiaNELAP Certification#:460221
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 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 Virginia Certification#:460204
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 14

Pace Analytical Services,LLC
aceAnalyticai 9800l<inceyAve. Suite 100
Huntersville,NC 28078
www.pacelebs.com [phone]
SAMPLE ANALYTE COUNT
Project: STOMRWATER 2ND QUARTER
Pace Project No.: 92669767
Analytes
Lab ID Sample ID Method Analysts Reported Laboratory
92669767001 OUTFALL 1B GRAB EPA 1664E REL 1 PASI-C
EPA 200.8 CW1 3 PASI-GA
SM 2540D-2015 RVS 1 PASI-A
SM 5220D-2011 JP1 1 PASI-A
92669767002 OUTFALL 2 GRAB EPA 16648 REL 1 PASI-C
EPA 200.8 CW1 3 PASI-GA
SM 2540D-2015 RVS 1 PASI-A
SM 5220D-2011 JP1 1 PASI-A
PASI-A=Pace Analytical Services-Asheville
PASI-C=Pace Analytical Services-Charlotte
PASI-GA=Pace Analytical Services-Peachtree Corners,GA
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 14

Pace Analytical Services,LLC
o 9800 Kincey Ave. Suite100
aceAnalytical Huntersvilte,NC 28978
www.pacalabs,com [phone]
ANALYTICAL RESULTS
Project: STOMRWATER 2ND QUARTER
Pace Project No.: 92669767
Sample: OUTFALL 1B GRAB Lab ID: 92669767001 Collected: 05/28/23 10:00 Received: 05/30/23 13:56 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 mg/L 4.9 1 05/31/23 16:25
200.8 ATL ICPMS,NC Analytical Method:EPA 200.8 Preparation Method:EPA 200.8
Pace Analytical Services-Peachtree Corners,GA
Copper ND ug/L 5.0 1 06/01/23 11:01 06/01/23 16:42 7440-50-8
Lead ND ug/L 1.0 1 06/01/23 11:01 06/01/23 16:42 7439-92-1
Zinc ND ug/L 10.0 1 06/01/23 11:01 06/01/23 16:42 7440-66-6
2540D Total Suspended Solids Analytical Method:SM 2540D-2015
Pace Analytical Services-Asheville
Total Suspended Solids ND mg/L 2.5 1 05/31/23 17:34
5220D COD Analytical Method:SM 5220D-2011 Preparation Method:SM 5220D-2011
Pace Analytical Services-Asheville
Chemical Oxygen Demand ND mg/L 25.0 1 05/31/23 01:54 05/31/23 05:56
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced,except In full,
Date:06/06/2023 05:49 PM without the written consent of Pace Analytical Services,LLC. Page 4 of 14

Pace Analytical Services,LLC
aceAnalytical® 9800 Kincey Ave. Suite 100
Huntersville.NC 28078
t www.pacelabs,com [phone]
ANALYTICAL RESULTS
Project: STOMRWATER 2ND QUARTER
Pace Project No.: 92669767
Sample: OUTFALL 2 GRAB Lab ID: 92669767002 Collected: 05/28/23 11:00 Received: 05/30/23 13:56 Matrix: Water
Parameters Results Units Report Limit DF Prepared Analyzed CAS No. Qual
1664 SGT-HEM,TPH Analytical Method:EPA 1664B
Pace Analytical Services-Charlotte
Total Petroleum Hydrocarbons ND mg/L 4.8 1 05/31/23 16:25
200.8 ATL ICPMS,NC Analytical Method:EPA 200.8 Preparation Method:EPA 200.8
Pace Analytical Services-Peachtree Corners,GA
Copper ND ug/L 5.0 1 06/01/23 11:01 06/01/23 16:45 7440-50-8
Lead ND ug/L 1.0 1 06/01/23 11:01 06/01/2316:45 7439-92-1
Zinc ND ug/L 10.0 1 06/01/23 11:01 06/01/23 16:45 7440-66-6
2540D Total Suspended Solids Analytical Method:SM 2540D-2015
Pace Analytical Services-Asheville
Total Suspended Solids ND mg/L 2.5 1 05/31/23 17:34
5220D COD Analytical Method:SM 5220D-2011 Preparation Method:SM 5220D-2011
Pace Analytical Services-Asheville
Chemical Oxygen Demand ND mg/L 25.0 1 05/31/23 01:54 05/31/23 05:56
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced,except in full,
Date:06/06/2023 05:49 PM without the written consent of Pace Analytical Services,LLC. Page 5 of 14

Pace Analytical Services,LLC
® 9800 KinceyAve. Suite 100
ace Analytical Huntersviile,NC 28078
www.pacelabs.cam [phone]
QUALITY CONTROL DATA
Project: STOMRWATER 2ND QUARTER
Pace Project No.: 92669767
QC Batch: 777769 Analysis Method: EPA 1664E
QC Batch Method: EPA 16648 Analysis Description: 1664 SGT-HEM,TPH
Laboratory: Pace Analytical Services-Charlotte
Associated Lab Samples: 92669767001,92669767002
METHOD BLANK: 4034869 Matrix: Water
Associated Lab Samples: 92669767001,92669767002
Blank Reporting
Parameter Units Result Limit Analyzed Qualifiers
Total Petroleum Hydrocarbons mg/L ND 5.0 05/31/23 16:25
LABORATORY CONTROL SAMPLE: 4034870
Spike LCS LCS %Rec
Parameter Units Conc. Result %Rec Limits Qualifiers
Total Petroleum Hydrocarbons mglL 20 15.9 80 64-132
MATRIX SPIKE SAMPLE: 4034871
35802284002 Spike MS MS %Rec
Parameter Units Result Conc. Result %Rec Limits Qualifiers
Total Petroleum Hydrocarbons mg/L 4.8U 20 17.1 79 64-132
SAMPLE DUPLICATE: 4034872
92669523002 Dup
Parameter Units Result Result RPD Qualifiers
Total Petroleum Hydrocarbons mg/L ND ND
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:06/06/2023 05:49 PM without the written consent of Pace Analytical Services,LLC. Page 6 of 14

Pace Analytical Services,LLC
tf ace Analytical 9800 Kincey Ave. Suite 100
Huntersvllle,NC 28978
www.pacelaba,com [phone]
QUALITY CONTROL DATA
Project: STOMRWATER 2ND QUARTER
Pace Project No.: 92669767
QC Batch: 778004 Analysis Method: EPA 200.8
QC Batch Method: EPA 200.8 Analysis Description: 200.8 ATL
Laboratory: Pace Analytical Services-Peachtree Corners,GA
Associated Lab Samples: 92669767001,92669767002
METHOD BLANK: 4035803 Matrix: Water
Associated Lab Samples: 92669767001,92669767002
Blank Reporting
Parameter Units Result Limit Analyzed Qualifiers
Copper ug1L ND 5.0 06/01/23 16:16
Lead uglL ND 1.0 06/01/2316:16
Zinc ug/L ND 10.0 06/01/23 16:16
LABORATORY CONTROL SAMPLE: 4035804
Spike LCS LCS %Rec
Parameter Units Conc. Result %Rec Limits Qualifiers
Copper ug/L 100 105 105 85-115
Lead ug/L 100 103 103 85-115
Zinc uglL 100 104 104 85-115
MATRIX SPIKE&MATRIX SPIKE DUPLICATE: 4035805 4035806
MS MSD
92668647001 Spike Spike MS MSD MS MSD %Rec
Parameter Units Result Conc. Conc. Result Result %Rec %Rec Limits RPD Qual
Copper ug/L ND 100 100 103 102 101 100 70-130 1
Lead ug/L ND 100 100 98.9 99.4 99 99 70-130 0
Zinc ug/L 16.1 100 100 118 115 102 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 rtght of the result.
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced,except In full,
Date:06/06/2023 05:49 PM without the written consent of Pace Analytical Services,LLC. Page 7 of 14

Pace Analytical Services,LLC
x 9800 Kincey Ave. Suite 100
aceAnalytical Huntersville.NC 28078
www,pacetabs,com [phone]
QUALITY CONTROL DATA
Project: STOMRWATER 2ND QUARTER
Pace Project No.: 92669767
QC Batch: 777821 Analysis Method: SM 2540D-2015
QC Batch Method: SM 2540D-2015 Analysis Description: 2540D Total Suspended Solids
Laboratory: Pace Analytical Services-Asheville
Associated Lab Samples: 92669767001,92669767002
METHOD BLANK: 4035217 Matrix: Water
Associated Lab Samples: 92669767001,92669767002
Blank Reporting
Parameter Units Result Limit Analyzed Qualifiers
Total Suspended Solids mg/L ND 2.5 05/31/23 17:33
LABORATORY CONTROL SAMPLE: 4035218
Spike LCS LCS %Rec
Parameter Units Conc. Result %Rec Limits Qualifiers
Total Suspended Solids mg/L 250 250 100 90-110
SAMPLE DUPLICATE: 4035375
92669794001 Dup
Parameter Units Result Result RPD Qualifiers
Total Suspended Solids mg/L 190 206 8
SAMPLE DUPLICATE: 4035376
92669915001 Dup
Parameter Units Result Result RPD Qualifiers
Total Suspended Solids mg/L 27.0 34.0 23
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:06/06/2023 05:49 PM without the written consent of Pace Analytical Services,LLC. Page 8 of 14

Pace Analytical Services,LLC
e 9800 Kincey Ave. Suite 100
ace Analytical Huntersvllle,NC 28078
www,pacelabt.com [phone]
QUALITY CONTROL DATA
Project: STOMRWATER 2ND QUARTER
Pace Project No.: 92669767
QC Batch: 777623 Analysis Method: SM 5220D-2011
QC Batch Method: SM 5220D-2011 Analysis Description: 5220D COD
Laboratory: Pace Analytical Services-Asheville
Associated Lab Samples: 92669767001,92669767002
METHOD BLANK: 4034067 Matrix: Water
Associated Lab Samples: 92669767001,92669767002
Blank Reporting
Parameter Units Result Limit Analyzed Qualifiers
Chemical Oxygen Demand mglL ND 25.0 05/31/23 05:41
LABORATORY CONTROL SAMPLE: 4034068
Spike . LCS LCS %Rec
Parameter Units Conc. Result %Rec Limits Qualifiers
Chemical Oxygen Demand mg/L 750 805 107 90-110
MATRIX SPIKE&MATRIX SPIKE DUPLICATE: 4034069 4034070
MS MSD
92669253004 Spike Spike MS MSD MS MSD %Rec
Parameter Units Result Conc. Conc. Result Result %Rec %Rec Limits RPD Qual
Chemical Oxygen Demand mg/L ND 100 100 135 137 122 124 90-110 2 M1
MATRIX SPIKE&MATRIX SPIKE DUPLICATE: 4034071 4034072
MS MSD
92669015001 Spike Spike MS MSD MS MSD To Rec
Parameter Units Result Conc. Conc. Result Result %Rec %Rec Limits RPD Qual
Chemical Oxygen Demand mg/L ND 100 100 132 132 108 108 90-110 0
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:06/06/2023 05:49 PM without the written consent of Pace Analytical Services,LLC. Page 9 of 14

Pace Analytical Services,LLC
® 9800 Kinsey Ave. Suite 100
aceAnalytical Huntersvllle,NC 28078
www,pacolabs.com [phone]
QUALIFIERS
Project: STOMRWATER 2ND QUARTER
Pace Project No.: 92669767
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.
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.
A separate vial preserved to a pH of 4-5 is recommended in SW846 Chapter 4 for the analysis of Acrolein and Acrylonilrile 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.
Reported results are not rounded until the final step prior to reporting.Therefore,calculated parameters that are typically reported as
"Total"may vary slightly from the sum of the reported component parameters.
Pace Analytical is TNl accredited.Contact your Pace PM for the current list of accredited analytes.
TNI-The NELAC Institute.
ANALYTE QUALIFIERS
M1 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:06/06/2023 05:49 PM without the written consent of Pace Analytical Services,LLC. Page 10 of 14

Pace Analytical Services,LLC
ace Analytical a 9800 KinceyAve, Suite 100
Huntersville,NC 28078
www,pacelabs.sem [phone]
QUALITY CONTROL DATA CROSS REFERENCE TABLE
Project: STOMRWATER 2ND QUARTER
Pace Project No.: 92669767
Analytical
Lab ID Sample ID QC Batch Method QC Batch Analytical Method Batch
92669767001 OUTFALL 1 B GRAB EPA 1664B 777769
92669767002 OUTFALL 2 GRAB EPA 1664B 777769
92669767001 OUTFALL 1B GRAB EPA200.8 778004 EPA200.8 778117
92669767002 OUTFALL 2 GRAB EPA 200.8 778004 EPA 200.8 778117
92669767001 OUTFALL 1B GRAB SM 2540D-2015 777821
92669767002 OUTFALL 2 GRAB SM 2540D-2015 777821
92669767001 OUTFALL 1 B GRAB SM 5220D-2011 777623 SM 5220D-2011 777639
92669767002 OUTFALL 2 GRAB SM 5220D-2011 777623 SM 5220D-2011 777639
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced,except in full,
Date:06/06/2023 05:49 PM without the written consent of Pace Analytical Services,LLC, Page 11 of 14

DC#_Title: ENV-FRM-HUN1.0083 v02_Sample Condition Upon Receipt
/ ace
Effective Date: 11/14/2022
Laboratory receiving samples:
Asheville ❑ Eden❑ Greenwood ❑ Huntersville ® Raleigh Mechanicsville❑ Atlanta❑ Kernersvillen
Sample Condition '' Client Name: W0## / 92669767
Upon Receipt ,,ff _ I Project#:
Courier: ❑Fed Ex ❑UPS ❑USPS ❑Client 1111111,I II I�II II
El Commercial ©Pe ❑Other: 111 111
92669767
Custody Seal Present? Oyes ❑No Seals Intact? Oyes ElNo
Date/Initials Person Examining Contents: 5 ��
Packing Material: ❑Bubble Wrap ©l3uhble Bags alone ❑ Other Biological Tissue Frozen?
Thermometer:
Oyes ❑No ❑r(A
IR Gun ID: ,70 Type of ice: ❑We[ ❑Blue ['None
Lt Li Correction Factor: P�
Cooler Temp: Add/Subtract(°C) t-1 Temp should be above freezing to 6°C
❑Samples out of temp criteria.Samples on ice,cooling process
Cooler Temp Corrected("C has begun
USDA Regulated Soil( N/A,water sample)
Did samples originate in a quarantine zone within the United States:CA,NY,or SC Dld samples originate from a foreign source(internationally,
(check maps)?Dies ONo including Hawaii and Puerto Rico)?Dies ONo
Comments/Discrepancy:
Chain of Custody Present? , Yes ONo ON/A 1.
• Samples Arrived within Hold Time? © eir ON EN/A 2.
Short Hold Time Analysis(e72 hr.)? ❑Yes No ON/A 3.
Rush Turn Around Time Requested? OYes a No ON/A h.
Sufficient Volume? )JY ONo ❑N/A S.
Correct Containers Used? ( Yes ONo ON/A 6.
-Pace Containers Used? ❑Yes' ONo ON/A
Containers Intact? [ZIYes ONo ON/A.,, 7.
Dissolved analysis:Samples Field Filtered? ❑Yes ❑No UN/A S.
Sample Labels Match COC? ONo ON/A 9.
u `
-Includes Date/Time/ID/Analysis Matrix: -
Headspace in VOA Vials(>5.6mm)? ❑Yes f]Na ON/A 10.
Trip Blank Present? O Yes ❑Na ON/A 11.
Trip Blank Custody Seals Present? Yes ONo ON/A
COMMENTS/SAMPLE DISCREPANCY Field Data Required? ❑Yes ❑Na
Lot ID of split containers:
CLIENT NOTIFICATION/RESOLUTION
Person contacted: Date/Time:
Project Manager SCURF Review: Date:
Project Manager SRF Review: Date:
Page 12 of 14
Qualtrax ID:69614 Page 1 of 2

DC#_Title: ENV-FRM-HUNI-0083 v02_Sample Condition Upon Receipt
7-Pace
i Ski t'flI : it
Effective Date: 11/14/2022
* p 92669767
Check mark top half of box if pH and/or dechlorination is verified and project#
within the acceptance range for preservation samples. PM. TNi Due Date' '06/f)6/23
Exceptions:VOA,Coliform,TOC,Oil and Grease,DR0/8015(water)DOC,LLHg CLIENT: 92—Ag i L i#.Y F
**Bottom half of box is to list number of bottles
***Check all unpreserved Nitrates for chlorine
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pH Adjustment Log for Preserved Samples
Sample ID Type of Preservative pH upon receipt Date preservation adjusted Time preservation Amount of Preservative Lot II
adjusted added
Note: Whenever there is a discrepancy affecting North Carolina compliance samples,a copy of this form will he sent to the North Carolina DENR Certification Office(i.e,
Out of hold,Incorrect preservative,out of temp,incorrect containers,
Page 13 of 14
Qualtrax ID:69614 Page 2 of 2

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Page 14 of 14