NCS000235_DMR_20220119 (2)

N C Depai tment of
Environmental Quality
STORM WATER DISCHARGE OUTFALL(SDO) Received
MONITORING REPORT
JAN 1 9 2G22
Permit Number NCS: 000235 SAMPLES COLLECTED DURING CALENDAR YE r ,
(This monitoring report shall be received by the Divisi no lat �L n 30 days from
the date the facility receives the sampling results from�h S�ttS ..je
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/I Mg/1 Std
units
Bench Mark .49 120 7.2 .68 20 .126 6-9
SW01 12/13/2021 0.5 .06 49.9 2.0 BRL 2.0 BRL 7.6
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/I unit gal/mo
Form SWU-247,last revised 2/2/2012
Page 1 of 2

STORM EVENT CHARACTERISTICS: Mail Original copy to:
Land Quality Section, Winston-Salem Regional Office
Date 12-13-2021 Division of Energy, Mineral and Land Resources
Total Event Precipitation (inches): 0_5 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.)
"1 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. Rased 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 fi• 4 nd imprisonment for knowing violations."
1/i7/ZZ
( ature of Permittee) (Date)
Form S W U-247,Iasi revised 2/2/2012
Page 2 of 2

Pace Analytical Services,LLC
n 1377 South Park Drive
aceAnalytical Kemersville,NC 27284
www.pacelebs.com [phone]
Page 1 of 1
Laboratory Report
Brandon Conrad Report Date: 01/04/2022
Southern Resin Date Received: 12/13/2021
3440 Denton Road
Thomasville, NC 27360
Project: Southern Resin SW01
Pace Project No.:92577449
Sample: SW01 Outfall Lab ID: 92577449001 Collected: 12/13/21 10:30 Matrix: Water
Method Parameters Results Units Report Limit Analyzed Qualifiers
EPA 350.1 Rev 2.0 1993 Nitrogen,Ammonia ND mg/L 0.10 12/23/21 22:20
SM 4500-H+B-2011 pH at 25 Degrees C 7.6 Std.Units 0.10 12/15/21 14:58 H3
EPA 200.7 Rev 4.4 1994 Zinc ND ug/L 10.0 01/04/22 12:56 BC
TKN+NO3+NO2 Total Nitrogen 2.0 mg/L 0.52 01/03/22 16:13
Calculation
EPA 351.2 Rev 2.0 1993 Nitrogen,Kjeldahl,Total 2.0 mg/L 0.50 12/31/21 04:40 M1
EPA 353.2 Rev 2.0 1993 Nitrogen,NO2 plus NO3 ND mg/L 0.040 12/22/21 11:35
SM 5220D-2011 Chemical Oxygen Demand 49.9 mg/L 25.0 12/22/21 06:07
ANALYTE QUALIFIERS
BC The same analyte was detected in an associated blank at a concentration above 1/2 the reporting limit but below the
laboratory reporting limit.
H3 Sample was received or analysis requested beyond the recognized method holding time.
M1 Matrix spike recoveryexceeded QC limits. Batch accepted based on laboratory control sample(LCS)recovery.
Reviewed by: CDC teem" e..'
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
Page 1 of 10

,1,,,�,r„,, CHAIN-OF-CUSTODY/Analytical Request lac:, WO# : 9257.
nqr rwr'��rrae/ The Chain-of-Custody is a LEGAL DOCUMENT All relevant fields must V 44 9
Submitting a sample via this chain of custody constitutes acknowledgment end acceptance of the Pace Terms and Conditions found al hltps:/Cnfo pacr.:-
Section A Section 0 Section C 1111
III I I III
li
I I I III
Required Client Information: Required Project Information: Invoice Information:
Company Southern Resin Report To: Brandon Corr ad Attention: -----
Address 3440 Denton Road CopyTo, - ----- - - --- 9Zg77449
Company Name:
Thomasville.NC 27360 Address
Email conradQ±soutlorrreamcom 0—Purchase Order --- - - rcogwurur y J.,,,•._,
Peso Quote:
Phone_ NONE --_ IFax Pra ec Warne Slomnvaler Kit --- Pace Prci Stephanie eci Manager. knoll -- State/Location
Requested Due Dale. -- �pacelabs.cam, —
Prgect N. Paw Profile*. 14225 - --
NC
.-.. Requested Analysts Filtered(YIN)
F
s a 2
ugmns «ce : V _ COLLECTED z Preservatives
Wee WT S V
Wash-1.Why WW Y g W
ivoauo P Q 0 Yg Z
SAMPLE ID Sg°` ° SI g 3 START LND
One Character per box. Wipe WP W U1 a y W m 8 . o
(A-Z,0.8/.•) Pr Sli g 2 a ra -. fi z -io r
Sample Ids must be unique
Other L °F x W w rzo 0M o i. L O R
H ~ d a. U rn O O _ Q € Z r- o
_. _ _ _ tO DATE TIME DATE TIME a « = Y S I z z m b eo• .O F N
aAf izlt3 i ..- tz is o,p .r .. --
3
10
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ADDITIONAL COMMENTS-• REUNOUISHED BY/AFFILIATION DATE TIME ACCEPTED SY - IATION DATE TIME , SAMPLE CONDITIONS
T
- - - :,.(1 1r, CO 1 t-2-If3_- ir03 ' !1(c 5 Ii:33
-D SAMPLER NAME AND SIGNATURE —"
N c
co PRINT Name of SAMPLER: o
InN
p SIGNATURE of SAMPLER: j\ DATE Signed: 7 I z o g z E g%

• Ol bo e6ed Document Name: Document Revised:Navem.ber 15,2C21
Sample Condition Upon Receipt(SCUR) Raze 2 of 2
_/ ace Analytical Document No.: Issuing Authority:
F-CAR-CS-033-Rev.OS I Deco Carolinas Quality O'flc
*Check mark top half of box if pH and/or dechlorination is Project„
verified and within the acceptance range for preservation l
samples. ,
Exceptions:VOA,Cclifarm,IOC,Oil and Grease,DR0/3015(water)COC,.LH;
**Bottom half of box is to list number of bottles ()A ��1 n
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pH Adjustment Log for Preserved Samples
I
Sample ID Type of Preservative pH upon receipt Date preservation adjusted Time preservation Amount of Preservative Lot ft
adjusted added
Note: Whenever there is a discrepancy affecting North Carolina compliance samples,a copy of this form will be sent to the North Carolina DEHfIR Certification office(i.e.
Out of hold,incorrect preservative,out of ternp,incorrect containers.
i

:;, `:. ANALYTICAL ENVIRONMENTAL SERVICES, INC.
PM;
AES
December 22,2021
Stephanie Knott
Pace Analytical
1377 South Park Dr
Kemsville NC 27284
RE: 92577449
Dear Stephanie Knott: Order No: 2112H 11
Analytical Environmental Services,Inc.received 1 samples on 12/14/2021 10:09:00 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.
-AIHA-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,
Pcvz- 110,002, ott,
Paris Masoudi
Project Manager
3080 Pre,:nlential Drive • Atlanta,Georgia 30340 • Tel:[phone] - Fax: [phone] • Toll Free:800.972.4889
ww7v.aeaatlanta.enm
Page 4 of 10
Page 1 of 7

Chain of Custody -- __ — //2N%/
PASI Charlotte Laboratory aceAnalytical
IIIII IIIII I III I II IIIII IIIII IIIII III I IIIIIIII www.pacelabs.com
Workorder: 92577449 Workorder Name: Southern Resin SW01 Results Requested By: 12/28/2021
Roport/Invoice To J Subcontract To Requested Analysis
• Stephanie Knott
Pace Analytical Kerersville ABS Atlanta P.O. SJK121321
1377 South Park Drive
Kemersville,NC 27284 3080 Presidential Dr.
Phone [phone] Atlanta,GA 30340
Email:stephanie.knott@pacelabs corn p
E
State of Sample Origin: NC Preserved Containers €
0
y LL
L
Collect F.
Item Sample ID Datelllmo Lab ID Matrix g LAB USE ONLY
1 Swot Outfall 12/13/2021 10:30 92577449001 Water 3 X
2
3
4
_ .
5
�n Comments
Transfers 'ei ed By {Date/Time { y j, eceived By Date/Time
1 — /,U (,7QQX , I,-`,7)/e I/ 1` (. ) ii
2 c -. /2'l'/•2) Zo7
3
Cooler Temperature on Receipt °C I Custody Seal Y or N I Received on Ice Y or N I Samples Intact Y or N
Monday,December 13,2021 2:03:36 PM FMT-ALL-C-002rev.00 24March2009 Page 1 of 1
Page 5 of 10
Page 2 of 7

Analytical Environmental Services,Inc Date: 22-Dec-21
Client: Pace Analytical Client Sample ID: SW01 OUTFALL
Project Name: 92577449 Collection Date: 12/13/2021 10:30:00 AM
Lab ID: 2112H11-001 Matrix: Aqueous
Reporting Dilution
Analyses Result Qual Units BatchID Date Analyzed Analyst
Limit Factor
Formaldehyde by SW8315A
Formaldehyde 59 50 ug/L 327305 1 12/15/2021 17:46 DS
Qualifiers: • Value exceeds maximum contaminant level E Estimated(value above quantitation range)
BRL Below reporting limit S Spike Recovery outside limits due to matrix
H Holding times for preparation or analysis exceeded Narr See case narrative
N Analyte not NELAC certified F Analyzed in the lab which is a deviation front the method
B Analyte detected in the associated method blank < Less than Result value
> Greater than Result value J Estimated value detected below Reporting Limit Page 6 of 10
Page 3 of 7

Clear Save as
,.• ALLYTICAi.
•
-"" I L'NVIRONME.NTAL
AES SERVICES,INC. SAMPLE/COOLER RECEIPT CHECKLIST
1. Client Name: PACE ANALYTICAL AES Work Order Number: 2112H11
2. Carrier: FedEx ❑° UPS❑ USPS❑ Client[1] Courier[ l Othei
Yes No N/A Details Comments
3. Shipping container/cooler received in good condition? i� damaged ❑ leaking ❑ other❑
4. Custody seals present on shipping container?
5. Custody seals intact on shipping container? ,• •
6. Temperature blanks present? lip o
Cooler temperature(s)within limits of 0-6°C?[See item 13 and 14(or 0 0 1 ® Cooling initiated for recently collected samples/ice
7.
temperature recordings.] present❑
8. Chain of Custody(COC)present? 0i` ill
9.Chain of Custody signed,dated,and timed when relinquished and received? 0 . .
10. Sampler name and/or signature on COC? • 'o
11. Were all samples received within holding time? 10 I. fp
12. TAT marked on the COC? (.7:). i* i. If no TAT indicated,proceeded with standard TAT per Terms&Conditions. LI
13. Cooler 1 Temperature 1.8 °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 12/14/21
Yes No N/A Details Comments
16. Were sample containers intact upon receipt? g
17. Custody seals present on sample containers? §
18. Custody seals intact on sample containers? §
®° ® 0 incomplete info [ 1 illegible Ft
19. Do sample container labels match the COC7 no label ❑ other [_
20. Are analyses requested indicated on the COC? 0 0 0
21. Were all of the samples listed on the COC received? 0 0 0 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? (
24. Were samples received in appropriate containers? to
25. Were VOA samples received without headspace(<1/4"bubble)? 11111 i
m
26. Were trip blanks submitted? {. listed on COC ❑ not listed on COC ❑
27. Comments:
I certify that I have completed sections 16-27(dated initials). CW 12/14/21
This section only applies to samples where pH can be
checked at Sample Receipt. Yes No N/A Details Comments
28. Have containers needing chemical preservation been checked?'
29. Containers meet preservation guidelines? § § ig
33/. Was pH adjusted at Sample Receipt? 0
co
'Note:Certain analyses require chemical preservation but must be checked in the laboratory and not upon Sample Receipt such as Colitorms,VOCs and Oil&GreaselTPH.
o I certify that I have completed sections 28-30(dated initials). CW 12/14/21
This also excludes metals by EPA 200.7,200.8 and 245.1 which will be verified between 16 and 24 hours after preservation.
0
Checklist 7.9.20 Rev 3 Locked
Page 4 of 7

Analytical Environmental Services, Inc Date: 22-Dec-21
Client: Pace Analytical
Project Name: 92577449
Lab Order: 2112H11 Dates Report
Lab Sample ID Client Sample ID Collection Date Matrix Test Name TCLP Date Prep Date Analysis Date
2112H11-001A SW01 OUTFALL 12/13/2021 10:30:00AM Aqueous Formaldehyde by SW8315A 12/14/2021 2:13:55 PM 12/15/2021
Page 8 of 10
Page 5 of 7

Analytical Environmental Services,Inc
Date: 22-Dec-21
Client: Pace Analytical ANALYTICAL QC SUMMARY REPORT
Project Name: 92577449
Workorder: 2112H11 BatchlD• 327305
Sample ID: MB-327305 Client ID: Units: ug/L Prep Date: 12/14/2021 Run No: 472789
SampleType: MBLK TestCode: Formaldehyde by SW8315A BatchiD: 327305 Analysis Date: 12/15/2021 Seq No: 10890788
Analyte Result RPT Limit SPK value SPK Ref Val %REC Low Limit High Limit RPD Ref Val %RPD RPD Limit Qual
Fonnaldehyde BRL 50
Sample ID: LCS-327305 Client 1D: Units: ug/1. Prep Date: 12/14/2021 Run No: 472789
SampleType: LCS TestCode: Formaldehyde by SW8315A BatchiD: 327305 Analysis Date: 12/15/2021 Seq No: 10890789
Analyte Result RPT Limit SPK value SPK Ref Val %REC Low Limit High Limit RPD Ref Val %RPD RPD Limit Qual
Formaldehyde 882.4 50 1000 88.2 70 130
Sample ID: 2112H26-001AMS Client ID: Units: ug/L Prep Date: 12/14/2021 Run No: 472789
SampleType: MS TestCode: Formaldehyde by SW8315A Batch1D: 327305 Analysis Date: 12/15/2021 Seq No: 10890792
Analyte Result RPT Limit SPK value SPK Ref Val %REC I.ow Limit High Limit RPD Ref Val %RPD RPD Limit Qual
Formaldehyde 5960 250 5000 936.4 100 49.4 135
Sample ID: 2112H26-001AMSD Client ID: Units: ug/L Prep Date: 12/14/2021 Run No: 472789
SampleType: MSD TestCode: Formaldehyde by SW8315A 13atchlD: 327305 Analysis Date: 12/15/2021 Seq No: 10890794
Analyte Result RPT Limit Sl'K value SI'K Ref Val %REC Low Limit High Limit RPD Ref Val %RPD RPD Limit Qual
Formaldehyde 6085 250 5000 936.4 I03 49.4 135 5960 2.07 26.4
Qualifiers: > Greater than Result value < Less than Result value 13 Analyze detected in the associated method blank
RRL Below reposing limit E Estimated(value above quantization range) 11 Holding times fur preparation or analysis exceeded
1 Estimated value detected below Reporting Limit N Analyze not N1iLAC certified R RPD outside limits due to matrix
Rpt Lim Reporting Limit S Spike Recovery outside limits due to matrix Page 9 of 10
Page 6 of 7