MO-9473_40915_G_C_20190430_Heating Oil Tank Risk Email Inquiry

Beverly, Trudy
From: Patrick Kelly <[e-mail]>
Sent: Tuesday, April 30, 2019 11:36 AM
To: Beverly, Trudy
Cc: Greg Icenhour
Subject: [External] 7609 Linda Lake Drive - Heating Oil UST removal
Attachments: 7609 Linda Lake Dr.pdf, 2019-04-18 UST-61 Form-7609 Linda Lake.pdf
• xternal email. Do not click links or open attachments unless you verify. Send all suspicious email as an
[e-mail]
Ms. Beverly,
I understand that you are working from home today. I am assisting a client with a residential non-commercial
non -regulated heating oil tank issue at a property located at 7609 Linda Lake Drive in Charlotte, Mecklenburg
County, NC. A release was documented during a property transaction from a soil sample collected adjacent to
the UST and a UST-61 form was submitted to your office on April 18, 2019. 1 have attached the UST-61 for your
reference.
My client is planning to remove the UST and properly dispose of the tank. They are a non-profit entity, and as
part of my proposal I am trying to determine what Initial Abatement Actions will be required by the NCDEQ so I
can accurately provide a cost for services. The subject property and surrounding properties are used as
residential properties. According to the Mecklenburg County Well information system (see attached GIS Map),
there are no known wells within 1,500 feet of the site, however there are several surface water bodies located
inside 1,500 feet, the closest of which is approximately 250 feet from the tank. Assuming there are no other
circumstances that would require additional work (tank in water, free product, ect) would this site be
considered a "high risk" site with initial abatement required by the NCDEQ? Or is this site considered to be low
risk, and no abatement will be required (I.e. — Closed with a deed restriction)?
If you would like to discuss this site in greater detail, I can be reached at the office at 980-585-1271 or by cell
phone at 704-560-0645.
Sincerely,
MidAtlantic
t.i 4E.9 E
Patrick R. Kelly, P.G.
Project Geologist
MID -ATLANTIC ASSOCIATES, INC.
1125 E. Morehead Street, Suite 104, Charlotte, NC 28204
980-585-1271 Office
704-560-0645 Mobile
www.MAAONLINE.com I Outstanding Service Since 1993

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UST-61
24-Hour Release and UST Leak Reporting Form.
For Releases This form should be completed and submitted to the UST Section's regional office following a known or suspected release from
an underground storage tank (UST) system. This form is required to be submitted within 24 hours of discovery of a known or
in NC suspected release
(DWM USE ONLY)
Suspected Contamination? (Y/N) Yes
Facility ID Number
Incident # Risk (H,I,L,U)
Confirmed GW Contamination? (Y/N) NO
Date Leak Discovered March 29, 2019
Received On Received By
Confirmed Soil Contamination ?(Y/N) Yes
Comm/Non-Commercial? NON
Reported by (circle one): Phone, Fax or Report
Samples Taken?(Y/N) Yes - Lab Data Attached
Reg/Non-regulated? NON
Region
Free Product? (Y/N) If Yes, State Greatest
Thickness
INCIDENT DESCRIPTION
Incident Name: 7609 Linda Lake Drive
Address: 7609 Linda Lake Drive
County: Mecklenburg
City/Town: Charlotte
Zip Code: 28215
Regional Office (circle one): Asheville Mooresville, ayetteviIle,
Raleigh, Washington, Wilmington, Wins on- a em
Latitude (decimal degrees): 35.245964 Longitude (decimal degrees) : 80.733156
Obtained by:
❑GPS
Briefly describe suspected or confirmed release: (including but not limited to: nature of release, date of release, amount
of release, amount of free product present and recovery efforts, initial responses conducted, impacts to receptors)
❑Topographic map
❑GIS Address matching
®Other Google Earth
❑unknown
Describe location:
One soil sample collected on March 29, 2019 as part of real estate due diligence
indicated TPH GRO concentrations of 45.2 mg/kg and DRO concentrations of
3,770 mg/kg. UST system was not in use at the time of discovery. No known sensitive
receptors are believed to be impacted. UST remains in place.
Single-family residential
neighborhood.
HOW RELEASE WAS DISCOVERED (Release code)
(Check one)
❑Release Detection Equipment or Methods ❑Visual/Odor ❑Groundwater Contamination
❑During UST Closure/Removal ❑Water in Tank ❑Surface Water Contamination
x]Property Transfer ❑Water Supply Well Contamination ❑Other (specify)
SOURCE OF CONTAMINATION
Source of Release Cause of Release Type of Release Product Type Released
(Check primary source) (Check primary cause) (Check one) (Check primary product type released)
❑X Tank ❑ Spill X❑ Petroleum ❑ Gasoline/ Diesel/ ❑ Diesel/Veg. Oil
❑ Piping ❑ Overfill ❑ Non -Petroleum Kerosene Blend
❑X ❑
❑ Dispenser ❑X Corrosion (Suspected) ❑Both Heating Oil Vegetable Oil 100%
❑ Other Petroleum ❑ E10 - E20
❑ Submersible Turbine Pump ❑Physical/Mechanical
Location Products
❑ (Check one) Metals Delivery Problem Damage ❑ E21 - E84
❑
❑ Install Problem ❑ E85 - E99
❑ Spill Bucket ❑ Other Inorganics
❑ Other [-]Facility ❑Ethanol 100%
❑ Other ❑ Other Organics
❑ Unknown ❑X Residence ❑ E01 - E09
❑ Unknown
❑Other
Definitions presented on reverse
Definitions presented on reverse
Ownership
1. Municipal 2. Military 3. Unknown 4. Private 5. Federal 6. County 7. State
Operation Type
1. Public Service 2. Agricultural 3. Residential 4. Education/Relig. 5. Industrial 6. Commercial 7. Mining
UST Form 61 (02/19) Page 1 of 2

IMPACT ON DRINKING WATER SUPPLIES
Water Supply Wells Affected? 1. Yes
2. No 3. Unknown
Number of Water Supply Wells Affected
Water Supply Wells Contaminated: (Include Users Names, Addresses and Phone Numbers. Attach additional sheet if necessary)
1.
2.
3.
UST SYSTEM OWNER
UST Owner/Company Unknown
Point of Contact
Address
City
State
Zip Code
Telephone Number
UST SYSTEM OPERATOR
UST Operator/Company
Address
Unknown
City
State
Zip Code
Telephone Number
LANDOWNER AT LOCATION OF UST INCIDENT
Landowner
Lifespan Inc.
Address
1511 Shopton Road, Suite A
City Charlotte
State NC
Zip Code 28217
Telephone Number
[phone]
Draw Sketch of Area (showing two major road intersections) or Attach Map
Map Attached
_77Person Reporting Incident Greg D. Icenhour
Company Mid -Atlantic Associates, Inc.
Telephone Number [phone]
Title Principal Geologist
Address 1125 E. Morehead Street, Ste. 104, Charlotte, NC 28204
Date April 18, 2019
UST Form 61 (02/19)
Page 2 of 2
Definitions of Sources
Tank: means the tank that stores the product and is part of the underground storage tank system
Piping: means the piping and connectors running from the tank or submersible turbine pump to the dispenser or other end -use equipment (Vent, vapor recovery, or fill
lines are excluded.)
Dispenser: includes the dispenser and the equipment used to connect the dispenser to the piping (e.g., a release from a suction pump or from components located above
the shear valve)
Submersible Turbine Pump (STP) Area includes the submersible turbine pump head (typically located in the tank sump), the line leak detector, and the piping that
connects the submersible turbine pump to the tank
Delivery Problem: identifies releases that occurred during product delivery to the tank. (Typical causes associated with this source are spills and overfills.)
Other: serves as the option to use when the release source is known but does not fit into one of the preceding categories (e.g., for releases from vent lines, vapor
recovery lines, and fill lines)
Unknown: identifies releases for which the source has not been determined
Definitions of Causes
Spill: use this cause when a spill occurs (e.g., when the delivery hose is disconnected from the tank fill pipe or when the nozzle is removed from the dispenser)
Overfill: use when an overfill occurs (e.g., overfills may occur from the fill pipe at the tank or when the nozzle fails to shut off at the dispenser)
Physical or Mechanical Damage: use for all types of physical or mechanical damage, except corrosion (e.g., puncture of tank or piping, loose fittings, broken
components, and components that have changed dimension)
Corrosion: use when a metal tank, piping, or other component has a release due to corrosion (e.g., for steel, corrosion takes the form of rust)
Installation Problem: use when the problem is determined to have occurred specifically because the UST system was not installed properly
Other: use this option when the cause is known but does not fit into one of the preceding categories (e.g., putting regulated substances into monitoring wells)
Unknown: use when the cause has not been determined

LO 0\so VP
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7609 Linda Lake Drive
0 40
ds
� J
Date Printed: 4/18/2019 9:04:38 AM
0 0.005)'01 0.02 Miles E
This map or report is prepared for the inventory of real property within Mecklenburg County and is compiled from recorded deeds, plats, tax maps, surveys, planimetric maps, and other public records and data.
Users of this map or report are hereby notified that the aforementioned public primary information sources should be consulted for verification. Mecklenburg County and its mapping contractors assume no legal
responsibility for the information contained herein.

aceAnalytical
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Pace Analytical Services, LLC
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
April 05, 2019
Lee Shank
Carolina Environmental Respons
5648 Daphne Drive
Charlotte, NC 28269
RE: Project: 7609 Linda Lake Dr
Pace Project No.: 92423343
Dear Lee Shank:
Enclosed are the analytical results for sample(s) received by the laboratory on March 29, 2019. The
results relate only to the samples included in this report. Results reported herein conform to the most
current, applicable TNI/NELAC standards and the laboratory's Quality Assurance Manual, where
applicable, unless otherwise noted in the body of the report.
If you have any questions concerning this report, please feel free to contact me.
Sincerely,
f&ro- l
Amanda Payne
[e-mail]
[phone]
Project Manager
Enclosures
cc: Steve Hamilton, Carolina Environmental Response Team
Cassandra Kisiah, Carolina Environmental Response
Team
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, LLC.
Page 1 of 14

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Project: 7609 Linda Lake Dr
Pace Project No.: 92423343
Charlotte Certification IDs
Pace Analytical Services, LLC
9800 KinceyAve. Suite 100
Huntersville, NC 28078
[phone]
9800 Kincey Ave. Ste 100, Huntersville, NC 28078
Louisiana/NELAP Certification # LA170028
North Carolina Drinking Water Certification #: 37706
North Carolina Field Services Certification #: 5342
North Carolina Wastewater Certification #: 12
CERTIFICATIONS
South Carolina Certification #: 99006001
Florida/NELAP Certification #: E87627
Kentucky UST Certification #: 84
Virginia/VELAP Certification #: 460221
REPORT OF LABORATORY ANALYSIS
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SAMPLE ANALYTE COUNT
Pace Analytical Services, LLC
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
Project:
Pace Project No.:
7609 Linda Lake Dr
92423343
Analytes
Lab ID
Sample ID
Method
Analysts
Reported
Laboratory
92423343001
Tank #1
EPA 8015C Modified
BAJ
2
PASI-C
EPA 8015C Modified
LMB
2
PASI-C
ASTM D2974-87
KDF
1
PASI-C
REPORT OF LABORATORY ANALYSIS
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Project: 7609 Linda Lake Dr
Pace Project No.: 92423343
Lab Sample ID
Method
92423343001
EPA 8015C Modified
EPA 8015C Modified
ASTM D2974-87
SUMMARY OF DETECTION
Client Sample ID
Parameters
Tank #1
Diesel Range Organics(C10-C28)
Gas Range Organics (C6-C10)
Percent Moisture
Result
Units
3770
mg/kg
45.2
mg/kg
24.8
%
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, LLC.
Pace Analytical Services, LLC
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
Report Limit
Analyzed
66.3
04/04/1915:42
7.1
03/31 /19 19:06
0.10
03/29/1916:22
Qualifiers
Page 4 of 14

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PROJECT NARRATIVE
Project: 7609 Linda Lake Dr
Pace Project No.: 92423343
Method: EPA 8015C Modified
Description: 8015 GCS THC-Diesel
Client: Carolina Environmental Response Team
Date: April 05, 2019
Pace Analytical Services, LLC
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
General Information:
1 sample was analyzed for EPA 8015C Modified. All samples were received in acceptable condition with any exceptions noted below or
on the chain -of custody and/or the sample condition upon receipt form (SCUR) attached at the end of this report.
Hold Time:
The samples were analyzed within the method required hold times with any exceptions noted below.
Sample Preparation:
The samples were prepared in accordance with EPA 3546 with any exceptions noted below.
Initial Calibrations (including MS Tune as applicable):
All criteria were within method requirements with any exceptions noted below.
Continuing Calibration:
All criteria were within method requirements with any exceptions noted below.
Surrogates:
All surrogates were within QC limits with any exceptions noted below.
QC Batch: 466960
S4: Surrogate recovery not evaluated against control limits due to sample dilution.
• Tank #1 (Lab ID: 92423343001)
• n-Pentacosane (S)
Method Blank:
All analytes were below the report limit in the method blank, where applicable, with any exceptions noted below.
Laboratory Control Spike:
All laboratory control spike compounds were within QC limits with any exceptions noted below.
Matrix Spikes:
All percent recoveries and relative percent differences (RPDs) were within acceptance criteria with any exceptions noted below.
Duplicate Sample:
All duplicate sample results were within method acceptance criteria with any exceptions noted below.
Additional Comments:
REPORT OF LABORATORY ANALYSIS
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PROJECT NARRATIVE
Project: 7609 Linda Lake Dr
Pace Project No.: 92423343
Method: EPA 8015C Modified
Description: Gasoline Range Organics
Client: Carolina Environmental Response Team
Date: April 05, 2019
Pace Analytical Services, LLC
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
General Information:
1 sample was analyzed for EPA 8015C Modified. All samples were received in acceptable condition with any exceptions noted below or
on the chain -of custody and/or the sample condition upon receipt form (SCUR) attached at the end of this report.
Hold Time:
The samples were analyzed within the method required hold times with any exceptions noted below.
Sample Preparation:
The samples were prepared in accordance with EPA 5030B with any exceptions noted below.
Initial Calibrations (including MS Tune as applicable):
All criteria were within method requirements with any exceptions noted below.
Continuing Calibration:
All criteria were within method requirements with any exceptions noted below.
Surrogates:
All surrogates were within QC limits with any exceptions noted below.
QC Batch: 466516
S5: Surrogate recovery outside control limits due to matrix interferences (not confirmed by re -analysis).
• Tank #1 (Lab ID: 92423343001)
• 4-Bromofluorobenzene (S)
Method Blank:
All analytes were below the report limit in the method blank, where applicable, with any exceptions noted below.
Laboratory Control Spike:
All laboratory control spike compounds were within QC limits with any exceptions noted below.
Matrix Spikes:
All percent recoveries and relative percent differences (RPDs) were within acceptance criteria with any exceptions noted below.
Duplicate Sample:
All duplicate sample results were within method acceptance criteria with any exceptions noted below.
Additional Comments:
This data package has been reviewed for quality and completeness and is approved for release.
REPORT OF LABORATORY ANALYSIS
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ANALYTICAL RESULTS
Pace Analytical Services, LLC
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
Project: 7609 Linda Lake Dr
Pace Project No.: 92423343
Sample: Tank #1
Lab ID: 92423343001 Collected: 03/29/19 13:10 Received: 03/29/19 14:05 Matrix: Solid
Results reported on a "dry weight" basis and are adjusted for percent moisture, sample size and any dilutions.
Parameters
Results Units Report Limit DF Prepared Analyzed CAS No. Qual
8015 GCS THC-Diesel
Analytical Method: EPA 8015C Modified Preparation Method: EPA 3546
Diesel Range Organics(C10-C28)
3770 mg/kg 66.3 10 04/03/19 15:53 04/04/19 15:42
Surrogates
n-Pentacosane (S)
0 % 33-129 10 04/03/19 15:53 04/04/19 15:42 629-99-2 S4
Gasoline Range Organics
Analytical Method: EPA 8015C Modified Preparation Method: EPA 5030B
Gas Range Organics (C6-C10)
45.2 mg/kg 7.1 1 03/31/19 14:46 03/31/19 19:06
Surrogates
4-Bromofluorobenzene (S)
161 % 63-130 1 03/31/19 14:46 03/31/19 19:06 460-00-4 S5
Percent Moisture
Analytical Method: ASTM D2974-87
Percent Moisture
24.8 % 0.10 1 03/29/19 16:22
REPORT OF LABORATORY ANALYSIS
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Date: 04/05/2019 12:46 PM without the written consent of Pace Analytical Services, LLC. Page 7 of 14

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QUALITY CONTROL DATA
Pace Analytical Services, LLC
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
Project: 7609 Linda Lake Dr
Pace Project No.: 92423343
QC Batch: 466516
Analysis Method: EPA 8015C Modified
QC Batch Method: EPA 5030E
Analysis Description: Gasoline
Range Organics
Associated Lab Samples: 92423343001
METHOD BLANK: 2535606
Matrix: Solid
Associated Lab Samples: 92423343001
Blank Reporting
Parameter
Units
Result Limit
Analyzed Qualifiers
Gas Range Organics (C6-C10)
mg/kg
ND 6.0
03/31/19 13:20
4-Bromofluorobenzene (S)
%
93 63-130
03/31/19 13:20
LABORATORY CONTROL SAMPLE: 2535607
Spike LCS
LCS % Rec
Parameter
Units
Conc. Result
% Rec Limits Qualifiers
Gas Range Organics (C6-C10)
mg/kg
50.4 51.6
102 70-130
4-Bromofluorobenzene (S)
%
117 63-130
MATRIX SPIKE SAMPLE: 2535609
92423362004 Spike
MS MS
% Rec
Parameter
Units
Result Conc.
Result % Rec
Limits Qualifiers
Gas Range Organics (C6-C10)
mg/kg
ND 58.9
73.0 114
40-155
4-Bromofluorobenzene (S)
%
123
63-130
SAMPLE DUPLICATE: 2535608
92423362001 Dup
Parameter
Units
Result Result
RPD Qualifiers
Gas Range Organics (C6-C10)
mg/kg
10.9 13.8
24
4-Bromofluorobenzene (S)
%
110 129
16
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
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Date: 04/05/2019 12:46 PM without the written consent of Pace Analytical Services, LLC. Page 8 of 14

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QUALITY CONTROL DATA
Project: 7609 Linda Lake Dr
Pace Project No.: 92423343
QC Batch: 466960 Analysis Method: EPA 8015C Modified
QC Batch Method: EPA 3546 Analysis Description: 8015 Solid GCSV
Associated Lab Samples: 92423343001
METHOD BLANK: 2537732 Matrix: Solid
Associated Lab Samples: 92423343001
Blank Reporting
Parameter Units Result Limit Analyzed
Diesel Range Organics(C10-C28) mg/kg ND 5.0 04/03/19 12:50
n-Pentacosane(S) % 74 33-129 04/03/1912:50
LABORATORY CONTROL SAMPLE:
2537733
Parameter
Units
Diesel Range Organics(C10-C28)
mg/kg
n-Pentacosane(S)
%
MATRIX SPIKE SAMPLE:
2537734
Parameter
Units
Diesel Range Organics(C10-C28)
mg/kg
n-Pentacosane(S)
%
SAMPLE DUPLICATE: 2537735
Parameter
Diesel Range Organics(C10-C28)
n-Pentacosane(S)
Pace Analytical Services, LLC
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
Qualifiers
Spike LCS LCS % Rec
Conc. Result % Rec Limits Qualifiers
67.1 61.8 92 43-130
79 33-129
92423331003 Spike MS
Result Conc. Result
ND 98.6 88.8
92423331004 Dup
Units Result Result
mg/kg ND ND
% 67 66
MS % Rec
% Rec Limits Qualifiers
90 10-130
80 33-129
RPD Qualifiers
N
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
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QUALITY CONTROL DATA
Project: 7609 Linda Lake Dr
Pace Project No.: 92423343
QC Batch: 466378 Analysis Method: ASTM D2974-87
QC Batch Method: ASTM D2974-87 Analysis Description: Dry Weight/Percent Moisture
Associated Lab Samples: 92423343001
SAMPLE DUPLICATE: 2535004
92423163001 Dup
Parameter Units Result Result RPD Qualifiers
Percent Moisture % 11.9 14.0 16
SAMPLE DUPLICATE: 2535005
92423197001 Dup
Parameter Units Result Result RPD Qualifiers
Percent Moisture % 81.1 82.8 2
Pace Analytical Services, LLC
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
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
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QUALIFIERS
Project: 7609 Linda Lake Dr
Pace Project No.: 92423343
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.
Pace Analytical Services, LLC
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
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.
Pace Analytical is TNI accredited. Contact your Pace PM for the current list of accredited analytes.
TNI -The NELAC Institute.
LABORATORIES
PASI-C Pace Analytical Services - Charlotte
ANALYTE QUALIFIERS
S4 Surrogate recovery not evaluated against control limits due to sample dilution.
S5 Surrogate recovery outside control limits due to matrix interferences (not confirmed by re -analysis).
REPORT OF LABORATORY ANALYSIS
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QUALITY CONTROL DATA CROSS REFERENCE TABLE
Pace Analytical Services, LLC
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
Project:
Pace Project No.:
7609 Linda Lake Dr
92423343
Analytical
Lab ID
Sample ID
QC Batch Method
QC Batch Analytical Method
Batch
92423343001
Tank #1
EPA 3546
466960 EPA 8015C Modified
467087
92423343001
Tank #1
EPA 5030B
466516 EPA 8015C Modified
466519
92423343001
Tank #1
ASTM D2974-87
466378
REPORT OF LABORATORY ANALYSIS
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Date: 04/05/2019 12:46 PM without the written consent of Pace Analytical Services, LLC. Page 12 of 14

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Page 13 of 1

Document Name:
Sample Condition Upon Recei
Document No.:
F-CAR-05-033-Rev.06
Document Revised: February 7, 2018
Page 1 of 2
Issuing Authority:
Pace Carolinas Quality Office
*Check mark top half of box if pH and/or dechlorination is
verified and within the acceptance range for preservation
samples.
Exceptions: VOA, Coliform,TOC, Oil and Grease, DRO/8015 (water) DOC, LLHg
**Bottom half of box is to list number of bottle
Project # rWo# ; g2423343
PM: AP Due Date: 04/05/19
CLIENT: 92—CERT
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pH Adjustment Log for Preserved Samples
Sample ID
Type of Preservative
pH upon receipt
Date preservation adjusted
Time preservation
adjusted
Amount of Preservative
added
tot k
Note: Whenever there is a discrepancy affecting North Carolina compliance samples, a copy of this form will be sent to the North Carolina DEHNR Certiftcation Office [I,e.
Out of hold, incorrect preservative, out of temp, incorrect containers.
Page 14 of 14

4/30/2019 Well Information System 4.0
Well Information System 4.0 Mecklen' r-"..r.
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d.
600ft
1,486,791.917 550,503.761 Feet
https://edmsmapserver.mecklenburgcountync.gov/wis4/index.htmI
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