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Home My WebLink AboutNCG080896_MONITORING INFO_20190115STORMWATER DIVISION CODING SHEET NCG PERMITS PERMIT NO. /VC& 010�� DOC TYPE ❑HISTORICAL FILE MONITORING REPORTS DOC DATE ❑ D 0 ) q"D i 1 y YYYYMMDD Semi-annual Stormwater Discharge Monitoring _Report for North Carolina Division of Water Quality General Permit No. NCG080000 Date submitted 01/08/19 CERTIFICATE OF COVERAGE NO. NCGO80896 FACILITY NAME Pilot 7983 COUNTY _ Rowan _ PERSON COLLECTING SAMPLES TLH LABORATORY_SGS Lab Cert. # _ _346 Comments on sample collection or analysis: SAMPLE COLLECTION YEAR 2018 SAMPLE PERIOD [] Jan June ® July -Dec or ❑ Monthly, (month) DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA p ❑Zero -flow ❑Water Supply ❑SA T1 �� ❑Other � A1V 16 2419 PLEASE REMEMBER TO SIGN ON THE REVERSE .I CGN-fRA �-� 'J Did this facility perform Vehicle Maintenance Activities using more than 55 gallons Q,uiew,anato�gll per month? _ yes _X_no (if yes, report your analytical results in the table immediately below) Part A: Vehicle Maintenance Areas Monitoring Requirements (If applicable) ❑ No discharge this period' Outfall No. Date Sample Collected, mo/dd/yr 00530 00400 00556 Total Suspended Solids, mg/L pH, Standard units Non -Polar Oil and Grease/TPH EPA Method 1664 (SGT-HEM), mg/L New Motor Oil Usage, Annual average gal/mo Benchmark - 50 or 100 see permit Within 6.0 — 9.0 15 - Part B: Oil/water Separators and Secondary Containmerit Areas at Petroleum Bulk Stations and Terminals (If applicable) Outfall No. Date Sample Collected, mo/dd/yr 00556 00530 00400 Non -Polar Oil and Grease/TPH EPA Method 1664 (SGT-HEM), mg/L Total Suspended Solids, mg/L pH, Standard units Permit Limit - 15 50 or 100 see permit 6.0 — 9.0 001 1Z/11/18 1 <5.0 65.0 6.79 I For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here. SWU-250 last revised April 11, 2013 Page 1 of 2 STORM EVENT CHARACTERISTICS: oate,,_12/11/18 (first event sampled) Total Event Precipitation (inches): _>0.1 Date (list each additional event sampled this reporting period, and rainfall amount) Total Event Precipitation (inches): f Note: Of you report a sample value in excess of the benchmark, you must Implement rer 1, Tier 2, or Tier 3 responses. See General Permit text. FOR PART A AND PART B MONITORING RESULTS: • A BENCHMARK EXCEEDANCE TRIGGERS TIER'1 REQUIREMENTS. SEE PERMIT PART II SECTION B. • - 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART 11 SECTION B. • TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER ATANY ONE QUTFALL? YES ❑ NO 19 1F YES, HAVE YOU CONTACTED THE. DWQ REGIONAL OFFICE? YES ❑ NO ❑ REGIONAL OFFICE CONTACT NAME: Mail an oddinal and one copy of this DMR, including all "No Discharge' reports, within 30 days of receipt of the lob results for at end of monitorina aeriod in the case of `No Discharge" reports) to: Division of Water Quality Attn: DWQ Central Files 1617 Mail Service Center Raleigh, North Carolina 27699-1617 YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED: "I 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. 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 subrnittWfalse information, including the possibility of fines and imprisonment for knowing violations." j"- r 9 (Date) Additional copies of this form may be downloaded at: http://aortal.ncdenr_orglweb/wu/ws/su/npdessw#tab-4 SWU-250 last revised April 11.2013 Pam 2 of 2 ATTACHMENT II Laboratory Certificates of Analysis and Chain -of -Custody Documentation 41 lob w a Dayl The results set florth herein are provided by SGS North America Inc. Technical Report for Pilot Travel Centers LLC ACVAR: #7983, 985 Peeler Road, Salisbury, NC 768490-049 SGS Job Number: JC79685 Sampling Date: 12/11/18 Report to: Apex Companies, LLC 7724 Garland Circle Roanoke, VA 24019 RWagner@apexcos.com ATTN: Robert Wagner Total number of pages in report: 1.4 Test results contained within this data package meet the requirements of the National Environmental Laboratory Accreditation Program and/or state specific certification programs as applicable. e Hardcopy 2.0 Auto►nuted Report B h McGuire General Manager Client Service contact: Tammy McCloskey 732-329-0200 Certifications: NJ(12129), NY(10983), CA, CT, FL, IL, IN, KS, KY, LA, MA. MD, ME, MN, NC, OH VAP (CL0056). AK (UST-103), AZ (AZ0786), PA, RI, SC, TX, UT, VA, WV, DoD ELAP (ANAB L2248) This report shall not be reproduced, except In Its entirety, without the written approval of SGS. Test results relate only to samples analyzed, SGS North America Inc. - 2235 Route 130 - Dayton, NJ 08810 - tel: 732.329.0200 - fax: 732-329-3499 SGS is the sole; uuthority fi r auEhorizing edits or modifications to this document. Please share your ideas about I l—Sr� natrtharized modification of this repnr7 is strictly prohibited. how %vc can serve yu you better at: Kevke,w standard terns at: hltp llw%V`v 1--'l ES.CustornerGare rlsLs.carn 1of14 JC7'966S Sections: Table of Contents Section1: Sample Summary................................................................................................... 3 Section 2: Case Narrative/Conformance Summary.............................................................. 4 Section3: Summary of flits.................................................................................................... 5 Section4: Sample Results........................................................................................................ 6 4.1: JC79685-1: OWS #1........................... ...................................................................... I... 7 Section5: Misc. Forms......................................................... .......................... I........................ 5.1: Chain of Custody........................................................................................................... 8 9 Section 6: General Chemistry - QC Data Summaries.......................................................... 6.1: Method Blank and Spike Results Summary.................................................................. 11. 12 6.2: Duplicate Results Summary .......................................................................................... 13 6.3: Matrix Spike Results Summary..................................................................................... 14 -SGgr. 2 of 14 JC79685 SGS North America Inc. Sample Summary Pilot Travel Centers LLC Job No: JC79685 ACVAR: #7983, 985 Peeler Road, Salisbury, NC • Project No: 768490-049 Sample iCollected Matrix Client Number Date Time By Received Code Type Sample ID JC79685-1 ; 12/11/18 14:OOTLH 12/13/18 AQ Surface Water (OWS_ 1 u c(!� 3 of 14 --�i{�. JC79685 CASE NARRATIVE / CONFORMANCE SUMMARY Client: Pilot Travel Centers LLC Job No JC79685 Site: ACVAR: #7983, 985 Peeler Road, Salisbury, NC Report Date t2/19/2018 1:14:52 P On 12/13/2018, 1 Sample(s), 0 Trip Blank(s) and 0 Field Blank(s) were received at SGS North America Inc. at a maximum corrected temperature of 1.8 C. Samples were intact and chemically preserved, unless noted below. A SGS North America Inc. Job Number of JC79685 was assigned to the project. Laboratory sample ID, client sample ID and dates of sample collection are detailed in the report's Results Summary Section. Specified quality control criteria were achieved for this job except as noted below. For more information, please refer to the analytical results and QC summary pages. Compounds qualified as out of range in the continuing calibration summary report are acceptable as per method requirements when there is a high bias but the sample result is non -detect. General Chemistry By Method EPA 1664A Matrix: AQ Batch ID: GP18047 ■ All samples were prepared within the recommended method holding time. ■ All method blanks for this batch meet method specific criteria. ■ Sample(s) JC79685 - I DUP, JC79684-1MS were used as the QC samples for HEM Oil and Grease. ■ Matrix Spike Recovery(s) for HEM Oil and Grease are outside control limits, Spike recovery indicates possible matrix interference. Matrix: AQ Batch ID: GP18048 ■ All samples were prepared within the recommended method holding time. ■ All method blanks for this batch meet method specific criteria. ■ Sample(s) JC79684-1MS, JC79685-IDUP were used as the QC samples for HEM Petroleum Hydrocarbons. ■ RPD(s) for Duplicate for HEM Petroleum Hydrocarbons are outside control limits for sample GPI8046-D1. RPD acceptable due to low duplicate and sample concentrations. General Chemistry By Method SM2540 D-11 Matrix: AQ Batch ID: GN89498 ■ All samples were analyzed within the recommended method holding time. ■ All method blanks for this batch meet method specific criteria. ■ Sample(s) JC79628-2DUP were used as the QC samples for Solids, Total Suspended. General Chemistry By Method SM4500H+ 13-11 Matrix: AQ Batch 10: R175004 ■ The data for SM4500H+ B-11 meets quality control requirements. ■ JC79685-1 for pH: Sample received out of holding time for pH analysis. SGS North America Inc, certifies that data reported for samples received, listed on the associated custody chain or analytical task order, were produced to specifications meeting the Quality System precision, accuracy and completeness objectives except as noted. Estimated non-standard method measurement uncertainty data is available on request, based on quality control bias and implicit for standard methods. Acceptable uncertainty requires tested parameter quality control data to meet method criteria. SGS North America Inc. is not responsible for data quality assumptions if partial reports are used and recommends that this report be used in its entirety, Data release is authorized by SGS North America Inc indicated via signature on the report cover Wednesday, December 19, 2018 Page 1 of 1 -sG$- 4of14 JC78886 Summary of Hits Page 1 of 1 Job Number: JC79685 Account: Pilot Travel Centers LLC Project: ACVAR: #7983, 985 Peeler Road, Salisbury, NC Collected: 12/11/18 Lab Sample 1D Client Sample ID Result/ Analyte Qual RL MDL Units Method JC79685-1 OWS 91 Solids, Total Suspended j 65.0 4.0 mg/l SM2540 D-I I pH 9 .6.78 _ j su SM4500H+ B-11 (a) Sample received out of holding time for pH analysis. _SG 5of1b JG79888 CGS Dayto Sample Results Report of Analysis Section 4 �± 6of14 JC79685 SGS North America Inc. Report of Analysis Client Sample ID: OWS #1 Lab Sample ID: JC79685-1 Date Sampled: 12/11/18 Matrix: AQ - Surface Water Date Received: 12/13/18 Percent Solids: n/a Project: ACVAR: #7983, 985 Peeler Road, Salisbury, NC General Chemistry Analyte Result RL HEM Oil and Grease < 5.0 .. a 5.0 HEM Petroleum Hydrocarbons < 5.0 5.0 Solids, Total Suspended 165.0 4.0 pH a ' 6.78 (a) Sample received out of holding time for pH analysis. RL = Reporting Limit Page 1 of l Units DF Analyzed By Method mg/l 1 12/ 17/ 18 17:00 TM EPA 1664A mg/I 1 12117/ 18 17:15 TM EPA 1664A mg/I 1 12/14/1809:51 RC SM2540D-11 su 1 12/13/18 16:10 sUB SM4500H+ B-11 SGS- 7of14 Jc7"s6 -S —G_ S r, Dayton, NJ fer Misc. Forms Custody Documents and Other Forms Includes the following where applicable: • Chain of Custody Section 5 _SG Sof14 JC79885 CHAIN OF CUSTODY gas nio'm An,.nea ine. - wxm PAGE L OF L I ILL � ■�i■■ii��■■iii■■iiiiiiiiiiiii■■i■■ i ■�r■��i�iiiiiii■■iiiiiiiii�i■ii ■ ■ Fdm:9MOW03c (—h■d v71nif) Zbk �I�:IhYMw.■Q■.cVlNIMYi■!mb•BfKiLfIfWIIIOM1M. JC79685: Chain of Custody Page 1 of 2 —SGS,_. 9of14 JC79985 SGS Sample Receipt Summary Job Number: JC79685 Client: APEX COMPANIES, LLC Date / Time Received: 12l13/2018 9:30:00 AM Delivery Method: Cooler Tamps (Raw Measured) IC: Cooler 1: (2.1); Coolar Tamps (Corrected)'C: Cooler 1: (1.8); Cooler Security Y 1. Custody Seals Present: ® or N ❑ Y_or N_ 3. COC Present: ® ❑ 2. Custody Seals Intact: ® ❑ 4, Smpl Datearrims OK ® ❑ Cooler Temperature 1. Temp criteria achieved: Y W or N ❑) 2. Cooler temp verification: IR Gun 3. Cooler media: Ice (Rag) 4. No. Gaolers: 1 Quality Control Preservation 1. Trip Blank present 1 cooler Y ❑ or N NIA 2 ❑ 2. Trip Blank listed on COG: ❑ ® ❑ 3. Samples preserved property: ja ❑ 4, VOCs headspace free: ❑ El &]i Test Strip Lot #a: pH 1.12: 216017 Comments SM089-03 Rev. Date 12r7117 Ptoject: ACVAR: #7983, 985 PEELER ROAD, SALISBUR Alrblll #'s: S_emnla integrity - Documentation 1, Sample labels present on battles: Y ® or N ❑ 2. Container labeling oamplete: ® ❑ 3. Sample container label I COC agree: ® ❑ Samolelntearity- Condition 1. Sample racvd within HT: Y ® or N ❑ 2. All containers accounted for ® ❑ 3, Condition of sample: Intact Sample Intogribf - Instructions 1. Analysis requested Is dear. Y (� or N NIA ❑ 2. Bottles received for unspecified tests Cl 3. Sufficient volume recvd for analysis: R ❑ 4. Composl8ng instructions dear. ❑ ❑ 5. Filtering Instructions clear: ❑ ❑ pH 12+: 208717 Other: (Specify) JC79685: Chain of Custody Page 2 of 2 (A -SGS- 10 of 14 JC786B3 X I","* A General Chemistry E F QC Data Summaries Includes the following where applicable: • Method Blank and Blank Spike Summaries • Duplicate Summaries • Matrix Spike Summaries Section 6 m —SG�— 11 of 14 JC78686 METHOD BLANK AND SPIKE RESULTS SUMMARY GENERAL CHEMISTRY Login Number: JC79685 Account: PILOTSS - Pilot Travel Centers LLC Project: ACVAR: 07983, 985 Peeler Road, Salisbury, NC MB Spike BSP BSP QC Analyte Batch ID RL Result Units Amount Result %Recov Limits HEM Oil and Grease GP18047/GN89609 5.0 HEM Petroleum Hydrocarbons GP1804SIGN89610 5.0 Solids, Total Suspended GN89498 4.0 Associated Samples: Batch GN89498: JC79685-1 Batch GPIS047: JC79685-1 Batch GP16048: JC79685-1 S'Y Outside of QC limits a 0.0 mg/l 40.05 33.1 i82.6 78-114% 0.0 mg/1 20.01 16.1 180.5 64-132% 10.0 _ mg/1 Page 1 -SG$- 12 of 14 ,rcraeas 1 DUPLICATE RESULTS SUMMARY GENERAL CHEMISTRY Login Number: JC79685 Account: PILOTSS - Pilot Travel Centers LLC Project: ACVAR: 07983, 985 Peeler Road, Salisbury, NC QC Original DUP QC Analyte Batch 1D Sample Units Result Result RPD Limits HEM Oil and Groaae GP18047/GNS9609 JC79685-1 mg/l 0.0 0.0 0.0 _ E 0-18% HEM Petroleum Hydrocarbons GP18048/GNS9610 JC79685-1 mg/l 1.1 0.0 200.0(a) 0-34% solids, Total Suspended GN89496 JC79628-2 mg/1 0.0 0.0 �0.0 0-17% Associated Samples: Batch GN89498: JC79695-1 ^y Batch GPI8047: JC79685-1 Batch JC79685-1 {*} Outsidetside of QC limits • {a} RPD acceptable due to low duplicate and sample concentrations. Page 1 SG$ 13 of 14 JC796815 i MATRIX SPIKE RESULTS SUMMARY GENERAL CHEMISTRY Login Number: JC79685 Account: PILOTSS - Pilot Travel Centers LLC Project: ACVAR: #7983, 985 Peeler Road, Salisbury, NC QC Original Spike M5 QC Analyte Batch ID Sample Units Result Amount Result tRec Limits HEM Oil and Grease GP18047/GN99609 JC79684-1 mg/1 HEM Petroleum Hydrocarbons GP18046/GN89610 JC79684-1 mg/1 Associated Samples: Batch GP18047: JC79685-1 Batch GPI8048: JC79685-1 )") Outside of QC limits (N) Matrix Spike Rec. outside of QC limits (a) Spike recovery indicates possible matrix interference. Page 1 4.5 40.05 33.9 73.4N(a} E 78-114% 0.0 20.01 16.5 02.5 69-132% _SG. 14 of 14 JC78686 July 5, 2018 Division of Water Quality Attention: DWQ Central Files 1617 Mail Service Center Raleigh, North Carolina 27699-1617 RE: Discharge Monitoring Report —January to June 2018 Pilot #7983 985 Peeler Road Salisbury, North Carolina Permit NCG080896 Dear Sir/Madam: Attached is the January - June 2018 Discharge Monitoring Report (DMR) prepared for the above referenced site. The laboratory analytical data for this round of sampling is also attached. If you have any questions, please feel free to contact me at (540) 563-4920. Sincerely, Robert S. Wagner Program Manager Attachments cc: Melody Mayville, Pilot Flying J Apex Companies, LLC - 7724 Garland Circle • Roanoke, VA 24019 T 540.563.4920 • F 540.563.4921 • apexcos.com ATTACHMENT I Discharge Monitoring Report January - June 2018 6 Semi-annual Stormwater Discharge Monitorinz Report for North Carolina Division of Water Quality General Permit No. NCG080000 Date submitted 7/5/18 CERTIFICATE OF COVERAGE NO. NCG080896 FACILITY NAME Pilot 7983 COUNTY Rowan PERSON COLLECTING SAMPLES RSW LABORATORY_SGS Lab Cert. # _346 Comments on sample collection or analysis: SAMPLE COLLECTION YEAR 2018 SAMPLE PERIOD ® Jan -June ❑ July -Dec or ❑ Monthly' _ (month) DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA ❑Zero -flow ❑Water Supply [—]SA ❑Other PLEASE REMEMBER TO SIGN ON THE REVERSE --> Did this facility perform Vehicle Maintenance Activities using more than SS gallons of new motor oil per month?_ yes _no (if yes, report your analytical results in the table immediately below) Part A: Vehicle Maintenance Areas Monitoring Requirements (If applicable) ❑ No discharge this period' Outfall No ' Date.. Sample Collected, mo dd ,.<" / j, 00530 s > 00400.:.. �� 06556 ; Total Suspended So dsr m �Ls...:: ,t ._ g/ pH, ., Sta_n( _jpni w: Non -Polar Oil and Grease/TP tp >. `" MAhod<lfi644(SGT HEM], mgJl New''Mator Oil�Usage, , Mntia1 a�+erage gal/mom, Benchmark, . :. _-.,_,�, � s_ 4� 5'0� 100'see errrit „fit. riirthin6b9 015 a Part B: Oil/water Separators and Secondary Containment Areas at Petroleum Bulk Stations and Terminals (If applicable) Outfa[I _ No 9 Date] `SampleCnllected;� mo" dd/yr _ . <' = 4056 e r n s530; - ,, Non Palar Od and=Grease/TPNwEPAMethad �Y «� 1664 (SGT„HEM], mg/L� Total 5uspendedSohds, r pH,, Standar`d.u�niis -PermitiVmit` • - . , F .... , �. I5 �. 'S0 or>lDO.seetpermit ' 001 6/22/18 8.8 66.7 7.46 I For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here. SWU-250 last revised April 11, 2013 Page 1 of 2 STORM EVENT CHARACTERISTICS: Date _6/22/18 (first event sampled) Total Event Precipitation (inches): _>0.1 Date (list each additional event sampled this reporting period, and rainfall amount) Total Event Precipitation (inches): Note: if you report a sample valve in excess of the benchmark,, you most implement Tier I,. Tier 2, or. Tier responses. See General Permit text. FOR PART A AND PART B MONITORING RESULTS: • A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART 115ECTION B. • 2 EXCEEDANCES IN A ROW FOR THE,SAME PARAMETER AT THE SAME OURE TFALL TRIGGER TIER 2 QUIREMEi ITS. SEE PERMIT PART 11 SECTION a. • TIER 3: HAS YOUR FACILITY HAD -4OR MORE: BENCHMARK EXCEEDENCES FOR -THE SAME-PARAMETER-AT:ANY ONE OUTFALL? YES 0 NO IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE:? YES ❑ NO ❑ REGIONAL OFFICE CONTACT NAME: " ys end of monitoring Reriod in Mail an original and one copy of this L?MR, rneleidina off No Discharue reports 'within 3D da of receipt of the tab results for at , thecase o "No Discharge" reports) to. Division of Water Quality Attn: DWQCentral Files 1617 Mail Service Center Raleigh, North Carolina 27699-1617 YOU MUST SIGN .THIS C1EFMFICATI0N*6R Aky mFoirtmATION REPORTED.. "I certify, under penalty of law; that this docurnent and all attachi•nents were prepare&u.nder my direct on,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 informationsubmitted is, to the best of:my.knowledge:and,belief, true, accurate, and complete. l am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations." (Signature of (Date) Additional copies of this form may be downloaded at: htt: onal.ncdennor web/wcl/ws/sulnpdessw#jtab=4 SWU-250 last revised April 1.1, 2011 Page 2 of 2 Laboratory Certificates of Analysis and Chain -of -Custody Documentation Pe SSA The results set forth herein are provided by SGS North America Inc. Technical Report for Pilot Travel Centers LLC ACVAR: #7983, 985 Peeler Road, Salisbury, NC SGS Job Number: JC68739 Sampling Date: 06/22/18 Report to: Apex Companies, LLC 7724 Garland Circle Roanoke, VA 24019 RWagner@apexcos.com ATTN: Robert Wagner Total number of pages in report: 1.4 e-Hardcopy 2. 0 Automated Report Test results contained within this data package meet the requirements Nancy Cole of the National Environmental Laboratory Accreditation Program Laboratory Director and/or state specific certification programs as applicable. Client Service contact: Tammy McCloskey 732-329-0200 Certifications: NJ(12129), NY(10983), CA, CT, FL, IL, IN, KS, KY, LA, MA, MD, ME, MN, NC, OH VAP (CL0056), AK (UST-103), AZ (AZ0786), PA, RI, SC, TX, UT, VA, WV, DoD ELAP (ANAB L2248) This report shall not be reproduced, except In its entirety, without the written approval of SGS. Test results relate only to samples analyzed. SGS North America Inc. - 2235 Route 130 • Dayton, NJ 08810 • tel: 732-329-0200 • fax: 732-329.3499 SGS is tite sole authority IM authorizing edits or Inodificmions to this document. (lease share your ideas about I,4molhorized rnodiliealrnn [rl'this report is strictly prohibited. how we can serve you better at: Review standard terms at: http:6%wiv.sgs.cA)nJcn/term, and -conditions ICI iS.US.CustomerC:arc rr'Ssgs.com 1 of 14 JC68739 Sections: Table of Contents Section1: Sample Summary................................................................................................... 3 Section2: Case Narrative/Conformance Summary.............................................................. 4 Section3: Summary of flits.................................................................................................... 5 Section4: Sample Results........................................................................................................ 6 4.1: JC68739-1. OWS.......................................................................................................... 7 Section4: Misc. Forms............................................................................................................ 8 S.l : Chain of Custody........................................................................................................... 9 Section 6: General Chemistry - QC Data Summaries.......................................................... 6.1: Method Blank and Spike Results Summary.................................................................. 11 12 6.2: Duplicate Results Summary.......................................................................................... 13 6.3: Matrix Spike Results Summary ..................................................................................... 14 i 2of1b JC68739 SOS North America Inc, Sample Summary Pilot Travel Centers LLC Job No: JC68739 ACVAR: #7983, 985 Peeler Road, Salisbury, NC Sample Collx_ted _ Matrix Client Number Date Time By + Received Code Type Sample ID iJC68739-1 _ ' 06/22/18 13:15 HC 06/26/ 18 AQ Water rr 3of14 �.i JC6B779 CASE NARRATIVE 1 CONFORMANCE SUMMARY Client: Pilot Travel Centers LLC Jots No JC68739 Site: ACVAR: g7983, 985 Peeler Road, Salisbury, NC Report Date 6/29/2018 9:01:IS AM On 06/26/2018, 1 Sample(s), 0 Trip Blank(s) and 0 Field Blank(s) were received at SGS North America Inc, at a maximum corrected temperature of3.6 C. Samples were intact and chemically preserved, unless noted below. A SGS North America Inc. Job Number of JC68739 was assigned to the project. Laboratory sample 1D, client sample ID and dates of sample collection are detailed in the report's Results Summary Section. Specified quality control criteria were achieved for this job except as noted below. For more information, please refer to the analytical results and QC summary pages. Compounds qualified as out of range in the continuing calibration summary report are acceptable as per method requirements when there is a high bias but the sample result is non -detect. General Chemistry By Method EPA 1664A Matrix: AQ Batch ID: GP14112 ■ All samples were prepared within the recommended method holding time. ■ All method blanks for this batch meet method specific criteria. ■ Sample(s) JC68733-1MS, JC68739-IDUP were used as the QC samples for HEM Oil and Grease. ■ RPD(s) for Duplicate for HEM Oil and Grease are outside control limits for sample GP14112-13I . High RPD due to possible nonhomogeniety between sample bottles, E Matrix: AQ Batch ID: GP14121 ■ All samples were prepared within the recommended method holding time. ■ All method blanks for this batch meet method specific criteria. ■ Sample(s) JC68733-1 MS, JC68739-1 PUP were used as the QC samples for HEM Petroleum Hydrocarbons. ■ RPD(s) for Duplicate for HEM Petroleum Hydrocarbons are outside control limits for sample GP14121-DI. High RPD due to possible nonhomogeniety between sample bottles. General Chemistry By Method SM2540 D-11 Matrix: AQ Batch ID: GN82021 ■ All samples were analyzed within the recommended method holding time. ■ All method blanks for this batch meet method specific criteria. ■ Sample(s) JC68703-2DUP were used as the QC samples for Solids, Total Suspended. General Chemistry By Method SM4500H+ B-11 Matrix: AQ Batch ID: R170848 ■ The data for SM4500H+ B-1 I meets quality control requirements. ■ JC68739-1 for pl l: Sample received out of holding time for pH analysis. SGS North America Inc. certifies that data reported for samples received, listed on the associated custody chain or analytical task order, were produced to specifications meeting the Quality System precision, accuracy and completeness objectives except as noted. Estimated non-standard method measurement uncertainty data is available on request, based on quality control bias and implicit for standard methods. Acceptable uncertainty requires tested parameter quality control data to meet method criteria. SGS North America Inc. is not responsible for data quality assumptions if partial reports are used and recommends that this report be used in its entirety. Data release is authorized by SGS North America Inc indicated via signature on the report cover Friday, June 29, 2018 Page 1 of 1 ee[� 4 of 14 JC68739 Summary of Hits Page l of 1 Job Number: JC68739 Account: Pilot Travel Centers LLC Project: ACVAR: #7983, 985 Peeler Road, Salisbury, NC Collected: 06/22/ 18 Lab Sample ID Client Sample ID Result/ Analyte Qua] RL MDL Units Method JC68739-1 OWS HEM Oil and Grease 8.8 { 5.0 mg/l EPA 1664A HEM Petroleum Hydrocarbons I8.5 5.0 mg/l EPA 1664A Solids, Total Suspended 66.7 4.0 i-5.88 mg/l SM2540 D-1 I pH a _ su SM4500H+ 13-11 (a) Sample received out of holding time for pH analysis. n S _SG$- oi14 JC66739 SGS� Dayton, Sample Results Report of Analysis Section 4 _S.G�r. 6 of 14 JC68739 SGS North America Inc. Report of Analysis Client Sample ID: OWS Lab Sample ID: JC68739-1 Date Sampled: 06/22/18 Matrix: AQ - Water Date Received: 06/26/ 18 Percent Solids: n/a Project: ACVAR:.#7983, 985 Peeler Road, Salisbury, NC General Chemistry Analyte Result RL HEM Oil and Grease 8.8 5.0 8.5 HEM Petroleum Hydrocarbons 5.0 Solids, Total Suspended 166.7 i 4.0 pH ° 5.88 (a) Sample received out of holding time for pH analysis. RL = Reporting Limit Page 1 of 1 Units DF Analyzed By Method mg/I 1 06/28/18 16:00 TM EPA 1664A mg/I 1 06/28/18 17:00 TM EPA 1664A mg/I 1 06/27/18 10:55 RC SM2540 D-11 Sul 1 06/26/18 15:15 sua SM4500H+ s-11 r%r%$ 7of14 JC88739 _S-G Dayton, Misc. Forms Custody Documents and Other Forms Includes the following where applicable: • Chain of Custody Section 5 8of14 �V� JC68739 01%6 LJ CHAIN OF OD Day- r. i• r`}}- �A� Y f i'1 "":�'.. ��... � 1 . Yl.r`'I..Y 7 X-.- �M b:�..i�', .�i ' p'C 7+ 4sih�.,,� Y -,F' 7F 1'iin: Fi ti..�a. ..ivz 1. �.f'. rL�.• „� 3..r, .1+4:: +■L:J'l ..1 r.:� `..i. 1. I�:�.♦I �y u♦ '� �� I 'ti i� '.i �:._'.ILl�:.L:1 is pr i r ��■�e��0000aoo■ ■ �■r+r.L'�� R&EMIMIILSMFAII■■■i�■■■■MfANN■■■■■■011111111 _ il"'a �iSF3u�1dP+�'1,F. r.P.'.u}:�'"L.:."t.:sF.'vP' IfIL.A'.: �,•4'r.w'."'e'_Ii C'..�I.irt'd; ��".7 � 1111 A F"lMM"lCA" DW Ylarre JC68739: Chain of Custody Page 1 of 2 CiF 9 _SG$- oF94 JC88739 SGS Sample Receipt Summary Job Number: JC68739 Client: APEX COMPANIES, LLC Project: ACVAR: #7983, 985 PEELER ROAD, SALISBl1R Data I Time Received: 6126I2018 9:20:00 AM Delivery Method: Alrbill Wa: Cooler Temps (Raw Measured) 'C: Cooler 1: (3.6); Cooler Temps (Corrected) 'C: Cooler 1: (3.6); Cooler Security Y or 1. Custody Seals Presenl: ® N Y or N ❑ 3. COC Present: W ❑ Sample Integriiy. Documentation 1. Sample labels present on bottles: Y ® or N ❑ 2. Custody Seals Intact: ® ❑ 4. Smpi Dataw7ime OK 66 ❑ Container leveling complete: 92 El2. Coaler, Temperature Y or N 3, Sample contalner label ! COC agree: ® ❑ 1. Temp criteria achieved: ® ❑ Sample Integrity . Condltlon Y or N 2. Cooler temp verification: IR Gun Semple recvd within HT; El1. 3. Cooler media: Ice (Bag) 2. Ali containers accounted for. ® ❑ 4. No. Coolers: auall Preservallon 1 N NIA 3, Condition of sample: Intact rUflJrol X 1. Trip Blank present I cooler. ❑ or ❑ 1. Analysis requested Is dear. Y ® or N jylA ❑ 2. Trip Blank listed on COC: ❑ ® ❑ 2. Battles received for unspecified tests ❑ 3. Samples preserved property: ® ❑ 3. SuMclent volume recvd for analysis: �ji ❑ 4. VOCs headepace free: ❑ ❑ ® 4, Composlting Instructions Gear. ❑ ❑ W 5. Filtering Instructions clear: ❑ Cl Test Strip Laths: pH 1-12: 216017 pH 12+: 208717 Other: (Specify) Rev. Rate 1XV17 JC68739: Chain of Custody Page 2 of 2 10 of 14 —au JC68739 f General Chemistry QC Data Summaries Includes the following where applicable: • Method Blank and Blank Spike Summaries • Duplicate Summaries • Matrix Spike Summaries Section 6 n _SG 71 of tb JC63139 METHOD BLANK AND SPIKE RESULTS SUMMARY GENERAL CHEMISTRY Login Number: JC68739 Account: PILOTSS - Pilot Travel Centers LLC Project: ACVAR: #1983, 985 Peeler Road, Salisbury, NO M3 Spike BSP BSP QC Analyte Batch ID RL Result Units Amount Result tRecov Limits HEM Oil and Greasy GP14ll2/GN82117 5,C HEM Petroleum Hydrocarbons GP14121/GN62119 5.0 Solids, Total Suspended GN82021 4.0 Associated Samples: Batch GN82021: 7C68739-1 Batch GP14112: JC68739-1 Batch GP14121: 7C68739-1 (*) Outside of QC limits 0.0 mg/l 40.3 32.1 79.7 78-114% 0.0 mg/1 20,13 14.6 72.5 64-132% 0.0 mg/l Page 1 �� 12 of 14 JC68739 DUPLICATE R£SULT5 SUMMARY GENERAL CHEMISTRY Login Number: JC68739 Account: PILOTSS - Pilot Travel Centers LLC Project; ACVAR; #7903, 905 Peeler Road, Salisbury, NC QC Original DUP QC Analyte Batch ID Sample Units Result Result RPD Limits HEM Oil and Grease GP14112/GN82117 JC69739-1 mg/l HEM Petroleum Hydrocarbons GP14121/GN82119 JC68739-1 mg/l Solids, Total Suspended GNS2021 JC68703-2 mg/l Associated Samples: Batch GN92021: JC68739-1 Batch GP14112: JC68739-1 Batch GP14121: JC68739-1 (*) Outside of QC limits (a) High RPD due to possible nonhomogeniety between sample bottles. Page 1 8.0 15.3 53.9•(a) 0-18% 6.5 14.0 48.91(a) 0-34% 0.57 U 0.0 OOTM,, 0-17% -SG$- 13 of 14 JC68739 MATRIX SPIKE RESULTS SUMMARY GENERAL CH&MISTRY Login Number: JC68739 Account: PILOTSS - Pilot Travel Centers LLC Project: ACVAR: $7983, 985 Peeler Road, Salisbury, NC QC original Spike MS QC Analyte Batch ID Sample Units Result Amount Result %Rec Limits HEM Oil and Grease GP14112/GN82117 JC68733-1 mg/l 0.0 40.3 34.5 '-85.6 18-1141 HEM Petroleum Hydrocarbons GP14121/GN82119 JC68733-1 mg/l 0.0 20.13 15.6 77.5 64-132% Associated Samples: Batch GP14112: JC68739-1 Batch GP14121: JC68739-1 W (*) outside of QC limits (N) Matrix Spike Rec. outside of QC limits r Page 1 SCE14 of 14 JC68739