NCG060101_DMR_20230331

3/28/23, 10:37 AM Submission Completed
E Q?) NC Department of
Environmental Quality
Received
MAR 31 2023
Winston-Salem
Permit and Facility Information: Regional Office
Please enter the permit number and other details for this upload.
IMPORTANT: Until your storm water permit is registered in the eDMR system, an original signed(not digitally
signed) hardcopy of the DMR must be mailed to the address in your permit, in addition to this electronic upload.
Permit Number* Enter COC or Individual Permit Number(NOT General Permit number with all 0's)
NCG060101
Must begin with NCS or NCG
* This permit should be reporting data through eDMR now instead of uploading
forms here and mailing a paper copy. I understand the permittee should go to
https://deq.nc.gov/sw-edmr and follow instructions to register.
Permits beginning with this prefix should already be registered in the eDMR system and reporting electronically
instead of using this form or mailing a paper copy. Please see the timetable on the Stormwater eDMR website and
follow the Six Step Process for registering in the eDMR system. Permittees who already submitted registration
forms but are still waiting on ownership updates and/or registration confirmation should just indicate this
as the reason below.
Reason for not yet I am a contractor filling in for the EHS director that has been out of work since 2022.
reporting data I am not sure if they have an eDMR login and wanted to assure reporting
through eDMR for compliance. I am checking to see if they have an eDMR login and will submit if so.
this permit:*
Facility Name:* DyStar LP
County:* Rockingham
After uploading here, the original signed hardcopy must be mailed to:
DEQ Winston-Salem Regional Office
Attn: DEMLR Stormwater Program
450 West Hanes Mill Road
Suite 300
Winston-Salem, NC 27105
Further contact details at https://deq.nc.gov/contact/regional-offices/winston-salem
https://edocs.deq.nc.gov/Forms/Form/Submit 1/2

3/28/23, 10:37 AM Submission Completed
Monitoring Period Information:
Multiple DMRs from sampling periods within the same year can be uploaded together, but please upload different
years with a new submittal form.
Monitoring Period What is the YEAR of the sample date(s)?
Year:* 2023
Copies of the lab results and/or qualitative(visual) monitoring should NOT be submitted unless specifically
requested by DEQ staff. Only upload completed and signed DMR forms.
**DMR forms should have original signature (not digital)to comply with requirements in 40 CFR 122.22**
DMR Upload* Click the upload button or drag and drop files here to attach document.
NCG15 Qualitative Monitoring Form 03-10-23 (1).pdf 184.19KB
Pace Analytical Stormwater Results 03-10-23.pdf 424.74KB
Only PDFs are accepted.
Comments:
* By checking the box and signing box below, I certify that:
o I have given true, accurate, and complete information on this form;
o I agree that submission of this Discharge Monitoring Report(DMR) Upload form is a "transaction" subject to Chapter 66,
Article 40 of the NC General Statutes (the "Uniform Electronic Transactions Act");
o I agree to conduct this transaction by electronic means pursuant to Chapter 66,Article 40 of the NC General Statutes
(the "Uniform Electronic Transactions Act");
o I understand that an electronic signature on this upload form has the same legal effect and can be enforced in the same
way as a written signature;AND
o I intend to electronically sign and submit this DMR Upload form.
Full Name:* D. Kevin Dull
Name of person submitting this form
Email Address:* [e-mail]
Phone Number:* 3363148978
Signature:*
* 03/28/2023
https://edocs.deq.nc.gov/Forms/Form/Submit 2/2

NC Department of
Environmental Quality
Received
MAR 31 2023
Environmental
Quality Winston-Salem
Stormwater Discharge Outfall (SDO) Regional Office
Qualitative Monitoring Report
For guidance on filling out this form,please visit https://deo.nc.gov/about/divisions/energy-mineral-land-
resources/energy-mineral-land-permi is/stormwater-permits/npdes-industrial-sw#tab-4
Permit No.: N/C/21/u/6/0/0/0/0 / or Certificate of Coverage No.: N/C/G/0/6/0/1 /0/1 /
Facility Name: DYSTAR LP-REIDSVILLE
County: ROCKINGHAM Phone No. 336-634-3340
Inspector: MARK E.WILEY
Date of Inspection: 03/10/2023
Time of Inspection: 08:50
Total Event Precipitation(inches): 0.1
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 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 DEMLR
Regional Office.
By this signature, I certify that this report is accurate and complete to the best of my knowledge:
(Signature of Permittee or Designee)
1. Outfall Description:
Outfall No. 1 Structure(pipe,ditch,etc.): PIPE OUTFALL LEADING INTO DITCH
Receiving Stream:
TROUBLESOME CREEK
Describe the industrial activities that occur within the outfall drainage area: STORMWATER SHEET FEED
RAIN FROM PARKING LOTS OF PLANT 1 AND PLANT 2
Page 1 of 2
SWU-242,Last modified 07/28/2017

2. Color: Describe the color of the discharge using basic colors(red,brown,blue,etc.)and tint
(light,medium,dark)as descriptors: VERY LIGHT BROWN
3. Odor: Describe any distinct odors that the discharge may have(i.e.,smells strongly of oil, weak
chlorine odor,etc.): VERY FAINT ORGANIC ODOR
4. Clarity: Choose the number which best describes the clarity of the discharge,where 1 is clear
and 5 is very cloudy:
1 2 3 4 5
5. Floating Solids: Choose the number which best describes the amount of floating solids in the
stormwater discharge,where 1 is no solids and 5 is the surface covered with floating solids:
1 2 3 4 5
6. Suspended Solids: Choose the number which best describes the amount of suspended solids in
the stormwater discharge,where 1 is no solids and 5 is extremely muddy:
1 2 3 4 5
7. Is there any foam in the stormwater discharge? 0 Yes 0 No.
8. Is there an oil sheen in the stormwater discharge? °Yes 0 No.
9. Is there evidence of erosion or deposition at the outfall? 0 Yes O No.
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.
Page 2 of 2
SWU-242,Last modified 07/28/2017

Pace Analytical Services,LLC
205 East Meadow Road-Suite A
aceAnalytical Eden,NC 27288
www.pacelabs.com [phone]
March 20, 2023
Charlie Stroman
Dystar
209 Watlington Ind. Drive
Reidsville, NC 27320
RE: Project: SW
Pace Project No.: 92656522
Dear Charlie Stroman:
Enclosed are the analytical results for sample(s)received by the laboratory on March 10,2023. 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-Eden
If you have any questions concerning this report,please feel free to contact me.
Sincerely,
bit .,.,�..2 e'
Ariel S Fitzgerald
[e-mail]
[phone]
Project Manager
Enclosures
cc: Whitney Rogers
Whitney Rogers,Dystar
Charlie Stroman
Mark Wiley,Dystar
ACp
_� - REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced,except in full,
4 without the written consent of Pace Analytical Services,LLC. Page 1 of 14

Pace Analytical Services,LLC
205 East Meadow Road-Suite A
aceAnalytical Eden,NC 27288
www.pacelabs.com [phone]
CERTIFICATIONS
Project: SW
Pace Project No.: 92656522
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 Eden
205 East Meadow Road Suite A,Eden,NC 27288 North Carolina Wastewater Certification#:633
North Carolina Drinking Water Certification#:37738 VirginiaNELAP Certification#:460025
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
e
ace Analytical 205 East Meadow Road-Suite A
Eden,NC 27288
www.pacelabs.com
[phone]
SAMPLE SUMMARY
Project: SW
Pace Project No.: 92656522
Lab ID Sample ID Matrix Date Collected Date Received
92656522001 230310SW-TSS Water 03/10/23 08:50 03/10/23 13:15
92656522002 230310SW-COD Water 03/10/23 08:50 03/10/23 13:15
92656522003 2303105W-OG Water 03/10/23 08:50 03/10/23 13:15
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
e
ace Analytical 205 East Meadow Road-Suite A
Eden,NC 27288
www.pacelabs.com
[phone]
SAMPLE ANALYTE COUNT
Project: SW
Pace Project No.: 92656522
Analytes
Lab ID Sample ID Method Analysts Reported
92656522001 2303105W-TSS SM 2540D-2015 LRB 1
92656522002 230310SW-COD SM 5220D-2011 JP1 1
92656522003 230310SW-OG EPA 1664B REL 1
PASI-A=Pace Analytical Services-Asheville
PASI-C=Pace Analytical Services-Charlotte
PASI-E=Pace Analytical Services-Eden
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced,except in full,
without the written consent of Pace Analytical Services,LLC. Page 4 of 14

Pace Analytical Services,LLC
iz 205 East Meadow Road-Suite A
aceAnalytical Eden,NC 27288
www.pacelabs.com [phone]
ANALYTICAL RESULTS
Project: SW
Pace Project No.: 92656522
Sample: 230310SW-TSS Lab ID: 92656522001 Collected: 03/10/23 08:50 Received: 03/10/23 13:15 Matrix: Water
Parameters Results Units Report Limit DF Prepared Analyzed CAS No. Qual
2540D Total Suspended Solids Analytical Method:SM 2540D-2015
Pace Analytical Services-Eden
Total Suspended Solids 26.1 mg/L 10.9 1 03/15/23 10:04
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced,except in full,
Date:03/20/2023 09:10 AM without the written consent of Pace Analytical Services,LLC. Page 5 of 14

Pace Analytical Services,LLC
g
ace Analytical 205 East Meadow Road-Suite A
Eden,NC 27288
www.pacelabs.com
[phone]
ANALYTICAL RESULTS
Project: SW
Pace Project No.: 92656522
Sample: 230310SW-COD Lab ID: 92656522002 Collected: 03/10/23 08:50 Received: 03/10/23 13:15 Matrix: Water
Parameters Results Units Report Limit DF Prepared Analyzed CAS No. Qual
5220D COD Analytical Method:SM 5220D-2011 Preparation Method:SM 5220D-2011
Pace Analytical Services-Asheville
Chemical Oxygen Demand 87.8 mg/L 25.0 1 03/16/23 01:36 03/16/23 04:58
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced,except in full,
Date:03/20/2023 09:10 AM without the written consent of Pace Analytical Services,LLC. Page 6 of 14

Pace Analytical Services,LLC
ace Analytical u 205 East Meadow Road-Suite A
Eden,NC 27288
www.pacelabs.com
[phone]
ANALYTICAL RESULTS
Project: SW
Pace Project No.: 92656522
Sample: 230310SW-OG Lab ID: 92656522003 Collected: 03/10/23 08:50 Received: 03/10/23 13:15 Matrix: Water
Parameters Results Units Report Limit DF Prepared Analyzed CAS No. Qual
HEM,Oil and Grease Analytical Method:EPA 1664E
Pace Analytical Services-Charlotte
Oil and Grease ND mg/L 4.9 1 03/16/23 03:50
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced,except in full,
Date:03/20/2023 09:10 AM without the written consent of Pace Analytical Services,LLC. Page 7 of 14

Pace Analytical Services,LLC
205 East Meadow Road-Suite A
aceAnalytical Eden,NC 27288
www.pacelabs.com
[phone]
QUALITY CONTROL DATA
Project: SW
Pace Project No.: 92656522
QC Batch: 761023 Analysis Method: SM 2540D-2015
QC Batch Method: SM 2540D-2015 Analysis Description: 2540D Total Suspended Solids
Laboratory: Pace Analytical Services-Eden
Associated Lab Samples: 92656522001
METHOD BLANK: 3953083 Matrix: Water
Associated Lab Samples: 92656522001
Blank Reporting
Parameter Units Result Limit Analyzed Qualifiers
Total Suspended Solids mg/L ND 2.5 03/15/23 10:00
LABORATORY CONTROL SAMPLE: 3953084
Spike LCS LCS %Rec
Parameter Units Conc. Result %Rec Limits Qualifiers
Total Suspended Solids mg/L 250 258 103 90-110
SAMPLE DUPLICATE: 3955182
92656151004 Dup Max
Parameter Units Result Result RPD RPD Qualifiers
Total Suspended Solids mg/L 37.4 33.8 10 25
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:03/20/2023 09:10 AM without the written consent of Pace Analytical Services,LLC. Page 8 of 14

Pace Analytical Services,LLC
205 East Meadow Road-Suite A
aceAnalytical® Eden,NC 27288
www.pacelabs.com [phone]
QUALITY CONTROL DATA
Project: SW
Pace Project No.: 92656522
QC Batch: 761607 Analysis Method: EPA 1664E
QC Batch Method: EPA 1664E Analysis Description: 1664 HEM,Oil and Grease
Laboratory: Pace Analytical Services-Charlotte
Associated Lab Samples: 92656522003
METHOD BLANK: 3955775 Matrix: Water
Associated Lab Samples: 92656522003
Blank Reporting
Parameter Units Result Limit Analyzed Qualifiers
Oil and Grease mg/L ND 5.0 03/16/23 03:50
LABORATORY CONTROL SAMPLE: 3955776
Spike LCS LCS %Rec
Parameter Units Conc. Result %Rec Limits Qualifiers
Oil and Grease mg/L 40 31.2 78 78-114
MATRIX SPIKE SAMPLE: 3955777
92656424002 Spike MS MS %Rec
Parameter Units Result Conc. Result %Rec Limits Qualifiers
Oil and Grease mg/L ND 39 34.0 80 78-114
SAMPLE DUPLICATE: 3955778
92656247002 Dup Max
Parameter Units Result Result RPD RPD Qualifiers
Oil and Grease mg/L ND 1.2J 30
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:03/20/2023 09:10 AM without the written consent of Pace Analytical Services,LLC. Page 9 of 14

Pace Analytical Services,LLC
Q s
�CG /IeA l n�l }I 205 East Meadow Road-Suite A
li y I��/ Eden,NC 27288
www.pacelabs.com
[phone]
QUALITY CONTROL DATA
Project: SW
Pace Project No.: 92656522
QC Batch: 761690 Analysis Method: SM 5220D-2011
QC Batch Method: SM 5220D-2011 Analysis Description: 5220D COD
Laboratory: Pace Analytical Services-Asheville
Associated Lab Samples: 92656522002
METHOD BLANK: 3956207 Matrix: Water
Associated Lab Samples: 92656522002
Blank Reporting
Parameter Units Result Limit Analyzed Qualifiers
Chemical Oxygen Demand mg/L ND 25.0 03/16/23 04:57
LABORATORY CONTROL SAMPLE: 3956208
Spike LCS LCS %Rec
Parameter Units Conc. Result %Rec Limits Qualifiers
Chemical Oxygen Demand mg/L 750 752 100 90-110
MATRIX SPIKE&MATRIX SPIKE DUPLICATE: 3956209 3956210
MS MSD
92656576001 Spike Spike MS MSD MS MSD %Rec Max
Parameter Units Result Conc. Conc. Result Result °A)Rec %Rec Limits RPD RPD Qual
Chemical Oxygen Demand mg/L 71.7 100 100 173 179 101 108 90-110 4 3 R1
MATRIX SPIKE&MATRIX SPIKE DUPLICATE: 3956211 3956212
MS MSD
92656743003 Spike Spike MS MSD MS MSD %Rec Max
Parameter Units Result Conc. Conc. Result Result %Rec %Rec Limits RPD RPD Qual
Chemical Oxygen Demand mg/L 41.9 100 100 154 147 112 105 90-110 5 3 M1,R1
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:03/20/2023 09:10 AM without the written consent of Pace Analytical Services,LLC. Page 10 of 14

Pace Analytical Services,LLC
g 205 East Meadow Road-Suite A
aceAnalytical Eden,NC 27288
www.pacelabs.com
[phone]
QUALIFIERS
Project: SW
Pace Project No.: 92656522
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 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.
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 TNI 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.
R1 RPD value was outside control limits.
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced,except in full,
Date:03/20/2023 09:10 AM without the written consent of Pace Analytical Services,LLC. Page 11 of 14

Pace Analytical Services,LLC
g
aceAnalytical 205 East Meadow Road-Suite A
Eden,NC 27288
www.pacelabs.com
[phone]
QUALITY CONTROL DATA CROSS REFERENCE TABLE
Project: SW
Pace Project No.: 92656522
Analytical
Lab ID Sample ID QC Batch Method QC Batch Analytical Method Batch
92656522001 230310SW-TSS SM 2540D-2015 761023
92656522003 230310SW-OG EPA 1664E 761607
92656522002 230310SW-COD SM 5220D-2011 761690 SM 5220D-2011 761705
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced,except in full,
Date:03/20/2023 09:10 AM without the written consent of Pace Analytical Services,LLC. Page 12 of 14

T.- a g'II• g
b' n O O j
I11I1Tj
O O t/! V1• ` .•
p _
;c < f7. H
I 2 1 §. s
g. ,s
a @ a "
I
♦ `" g < s mya a1 nr,< gdv n Gl G1 G13 yd� B Yls ZW '\ =1 4 .e y N c I i;s 1
;, 1�1d� i '13Y" ill
A �RA �Q im f7
1W' `,12.41"I`t J1•
8 �' ct 9t .. N. C1*( !!!71,1.)`11 i° lgyp= wC . tt44 .afili
,s:a t�1'�tldil
b O. •• O
F rt�
- 11r11IIIIIIIIII
�, H
: a .: ff o c, -' 3 a 3 ~_ _ " F - -/ tI1#
•gyl�Nr� 3' •o "•' ft H a ^I
g , o 'N rj. •T. g. 2 2 ^ N I
1!1_141.1 U'll1 i1`ri 1 o W "' 3 d, �1 z 2 )1�"t si
.l i•�li! tan c n t 7C 'g I"f
..114,1-t f D or
r•ii:litp},51114 `ly,,t,ry,,{t� ,,,1„111�©container Type:PlasticO Glass(G) a
11� t 4f-la�'"4 `lAIi 1 ll {I R' S.,:yj'',,'�(, S1„�,� it j; 1a 7 r 1 iB 113411111
]I r' �j1ll 1 It i ill qF' f I{ 1 �.14 4 � � , }Pe' � `�1 1171 I j'� n.,p�Y
6 h�1F 1 , I., 411 lI •irk I ,i� f,� P, ti ,1_a,+7BItUt7IF`Ia1. l t. la 5' a'i;{ ( V— " + ill i .) �S
1 13i a J1�•Ii l�l Il��lfi 1:14a,ur� si. �I!f :{11f II.JiI.!6i);'f,�aF'",. u ! ,. •it 'C �'���,�tI M � Y ��' �`tt�' i`_, 1}�N{�+I��1I�
.rill:W.21'in
1,r lll A- .tii„■,■, 1� leL �] 3 m n �I I i� ). ' ''^,u©� 83 0 ii li fmf lChemical Oxygen Demand COD � + , , ,r��a' 9� �11 am l 1 _ , t{ {n7
� �1 1�� � t 1 �rt�j�. �r 1�"1�I �� -»:I la911 � J t�"{•'�{I� Gn,'gryl 1 .i n1 GIfi , y.t ,yy:It3 ' � Ilin��'�t �tl�'m , it 1 na �pi�{1 I ll,'tIl I,�411� .tltl, f j t•1 1 I,y7 r rlLt cUl1�F II ,• iCti '�diftriWg .1q � 1',10,1'�` , tY' �5 � IIl1i`�1.I��...4�11fL�I..��fllti�nPdh,��illltil:ill,�������{I�iI)} ..�I�G•,•,`�JI47���� i{'„tlu��(t��IQ�{)d�l�lii��i�1!{IIlII1�1171L�0.1 Elm a 3'� � O p ,1f�h`l{{i"�l`tl�
Ii 1 t 1,ilu I
i, �i.11111 11 uw, It 1' {' T" ^ 1, 11 uii, �•. 1 9' i ie "' b I i 1,
Y:t:, 11tE �? I �r�•�rtFh'�I')�,�aa•i'`ii ll� :�4,1fi l��a , ll� '.1..,. `1 I11{ � >+4` �' q)I k( l tn;. �'`- ��+, � 'I�� h( � ��
�4'' f 11 t ° i iiikio ;!' ,1 c II�i#i fh It t, t11 H � I�r l m IIIi. - il,4' 1 �i1
,1k''1 EI���' '^ ri r i.la,�lh.l�`1'1}.�I!1��+ ,� lllt���l'.NE'c�!Il�141!�r}'�:alltt �!i�'11� f��7����x tl( fh�' �.1� �A ,� d 1 � I,ro � ,. f
I ,la V: i G l ��r! t !I {I hWt !I,. dr"+t,.t. h.,,.#71'i.nti?�tji�a_ ;e n:11;:iM� �''�� 1'
y 4pt _ xnr:rt''ff''1Ir it' cT t�1ti1 -u6 it fli 111I iw I1.1U'i`� Ip1 v itl4' 41'� l"" 'I I ' '''I m1t�1 G�y� I ptr11.Ilk�� 1 7(_h[j �'I1! °jF( y+� r1� �l',��1� I ��� 11 t.9;f�ij1 :�1 '!Ir l �,,�`I' ) 'sij,�rpli i�IIC iu k hq. r { �I10 ell �!1i il i,f l`, {,,1,1isF,1t ,„ 4:41,.tl,,,,,,„..:„..:•ail 1,„,Y11.,k,�,,, .� tt� 1� .„,:,4,111,A::::„ 1c'u,t f 1kwta 11111 i. z
:tut,
1
11111111glillif7 .��1n. f� (i,ii�l i;� �};� o 7 II t j'�.,a1; , i,yfL, I7 IFat•, i9't,1P;f icy irk R 1),II�E•r' tr �{rt,l' ;J�^;n:f. I I! i I 'IZ�' Pr ;o ��
Illiln i,s,lq�,Ita,iv,.d'�it 111° 4. tU' i '¶4Y pl4�o 1 l ,,I re t�l,f e .t 14`y1 i{ , Lf n, (r,. l;{ iruti i' { N`�'� r"
6,5Pt'W iiiip, i, 11;r I' f111 , 1:41i lr:":' . 1. I , I',I ii i i rN IS1f l ,j I t.
1"'1 �� I I I+� ' t9 r ' ' Y � ��tli �Ilne�5.'f����,�dG1,4�I�illl_i�L:u'��UI11lll II��PI���!if�:•"�:7iif�f�lti�� � k`I � i ii� h �'�+S `R ��a N��r..
(i�`1�;u�Ijl ii}l1{l1l'f{1�;f1,iI I�,fp4 tF� ;i1i� `fl lt,,,ll■,,, !^ 1
i�gn, i!4'111��,l1���,r�M },vll T tl l�kl��� ;f�'�ll,'�! �i l II;)'P zk1 1Ipli� �, I(''i� it�!, ".t. .��KK�••,:s r
;1j.1•.4�„ •r:-qr u;n',ii �,': a i nT, p +r
i aili'l+irl>L.11 lli Pith t.lill� rdll l jfitil Ly�1l .1 `1I ,1 ?,1 iil}i [r, '111� I lij,1 '��y Ili h„; 0a}'"f, ` z�jG i4�`,;t li cf:I 1�t i,, V1.
I, 1ti' i } .I Shaj i ' `('3, }'S. 11 lilt''i 'JillIN ,,., 1 �1 1 li f1. t . 'iIS, 1 c„1� ��p,�k,t YI'"' , a r(�
i� i f�yitl�l u�` i � 4!t . .r I t. l attl ,fir' In IN
i'I''`I';( i�I1p '� : . 4i 9.t>�krt.a xffV,• 5i,if Sl.: I :,' �■
n Y f v t I 1, �] �' r r
I<< If>� (� },.i t i` �,I: I Ili I ill l I +tit "G ni y1f;ja, f.Ya+ 'Ir51•W-t' ' l '• I 1. 3 �'� cr) l
1 11•I , a t10 J 11Ik lit- : 1 , ,,i l IL"• }i 1 !.,1,1 :c, , ., ?,, I.,i'
,,iltt.�.1 • J, ,: J ,it 1 !. Ti 1,0:'r' 1. 14,i I l tH [r14,ll,I fI•U;, i,,,.,+ tl„•,. m
11 ,•.. `�i,tll�!y ilr ((���au:l.. I r , � Illli ppl! II I�4� �,t,. �i 1 �'�f I t+ ..��4 Y�l rt t.M.i 1^`q 11' �....5{�.� ! + -+� v a
1<I F. 144,.1•,1}N f p j II �t 11? t ti:ii 1t' 1 i MM,,','t i it.,1 „'LIh' l.,,,,f, " Irk iP• Ear4i 1 1,,;11' :Ili w a
"��!I ti ^' 1 1 ,i ,� a,Yf ?J e•, �I I�j. II; ,' �,i,l'fx r{ lit of ll4'li, 't 11����.1I� + 1 .�1�{�' 11 3 i
1 ��'� ��f�') s r •} - hICn- ,' 6 'tt i j�� 1I... ,i� , 1 {, l
i,•4':r>11, iitti.( ' ' (c L��-I ?
Ili` t. l Ili�1 if 4,1, ,yl t+ i I`siE�I}a1 rlil.,litta Alit 11.{(t{ 1,�t' .. I` "'ir A'
It!- i I Pklj ', �,1 fiiil,g ;. ra I ,nl I ! t7� • 3 • �/I'al•laY rrI-:•1 I , c� I' �'I' „! »•P,I io IIn`: f1h 1I('1�f`.fi latiiI ,t`�:ij1�11+lli nnllti iii 1'1' ,$' ' q ti.hi1,oIf' l�Ii4 ti i(lR!.�t{ rj ',1r1 1,t1- ii'i„ 2 1.1,r 1� 11;;1 (If I�'"'t K i 1'r J f}.1 7 I t'. 11L11;� ipt I .rrr'I N t,h 0,11 l 1, t I ,1, f 1 '1 r 1 , it 1, t, 1
Ti 10 n' S� 1 r1 ,',t , le,1 r Ii ( I] 4, sII I.t 1 i,r a,1 l i Ij �1I!JI ,f' t 11 ' f{ I l .if' ,fr '
( u pp i ,•u J�, aYl' � � T tt��, yI! ',,�� � 4 ! i S Ar�r 1 , l 1. I
II�p c) t8 R, l 1 1_ { a, 1>1 y' I h��i Ob..,t I 1'i'ti} �� 11St I �= 1 �I III i1 &{I�(y}a k I bpi;
;f '�qy '{. k�,F Ii�1 l{ �?'
1 , y 1• 1 t!! ..i 11,1111015 11,1' 1 1'r (ti �jll1,,1f ,�! + 1" lrll. i; 4,`�I'��i1{,'00,191 .1,
If,;'.+ { Ja.•I l�,I I,, gt., Ni l f a,y , , 1,, ; �[+h .. r,h f '1 l tttl .'lit ,
�i• },. 1,,'E�, { a..rr ' f�!�!' a ilk^an �I it I+ • ,t {1r" E• I 4 1
a ,d 11'I '1• 'h j! ' ,,�I , I - � .i' I P �-1 4. til,�'P! ' a1,1" tV �S���z r �
IIill
Ili;
14 � I r , 1 iI 1 11, f1 h + l -,1 I 11;L '1 , Z � � �' � 14,411110tti'^, I ., ,i,. t'. 14u .i�`Iff ' 1 I1f if . 1 �.Lm tl ' II iJ IEY,�y�,L�1i11'1lAti� i, nIll 1U). .'1 1t ? "I 4 ! l'n II I ,, Ili R ,�f "thIffil� _'" ,''LRWI1l l t€1,a ' ,4}Ihi'}
1-,age- of 1•

LK# line:✓tNV+KM.NUN1-0utr4 vu2_iecn spec Sample L:onoreon Upon
Receipt
110 ENecfWe Date:
*Check mark bp half of box if pH and/or dechiorinatlon Project#
is verified and within the acceptance range for WO# : 92656522
preservation samples.
ixcoptiopa Vt1A,califfeni►, Of,Qlland.Greas ORQ/8o Due Date: 03/20/23
e 15(water}DOG tldlg . - PM: ASP
"Bottom half of box Is to list number of bottles CLIENT: 96-Bee me F i
***Check all unpreserved Nitrates for chlorine
1
_ _:JIlIiII
N1 lilillil
I
1 a
tc ''
Eo
vi i F.
IIIMàth1Rii'Niji1ijjjAIij
Ii1116161111N11611.111111111111111111111
IIIIIIIiIIINIIIIII►\
11111441411141R411411
01 ,
fi►■ ►►1 ►1 I11 ■
11111111Slii il ii.il 11111 i
111000 00 III I
•
pH Adjustment Log for Preserved Samples
Sample ID Type of Preservative pH upon receipt Dateprose/ratan adjusted Time pregeenden Amount of P►aservath/a j
adjusted added Loth
I
Note:Whenever there'Is a discrepancy affecting North Carolina compliance samples,a copy of this form will he sent to the North Carolina DEHNR Certification Office(I.e. i
Out of hold,incorrect preservative,out of temp,Incorrect containers)
III
Quattrax Document ID 70677 Pa e 14 of 14
Pace 2 of 2
!!