WS-4653_15063_F_SLINV_20230207_Invoice TA02

PLEASE NOTE
NEW REMITTANCE INFORMATION
Please Remit Payment to:
ATC Group Services, LLC Depository
Atlas Technical
P.O. Box 735811
Dallas, TX 75373-5811
Overnight or Special Delivery: JPMorgan Chase (TX1-0029)- Lockbox Processing, Attn: ATC Group Services, LLC Depository - Lockbox 735811, 14800
Frye Road, 2nd Floor, Ft Worth, TX 76155
Credit Card or Wire Transfer Payments, Please Contact Accounts Receivable at 337-234-8777
INVOICE

Invoice # :
Invoice Date :
Invoice Group :
Project Name :
Project :

For Professional Services Rendered through: 2/7/2023
Project Name : Williams Grocery - TA-02
Contract #N122019A
Williams Grocery TA-02
2425 US Highway 21
Hamptonville, NC 27020

Task Description Units ** Type of Unit Max Rate Costs
99.200 Administrative TA/Invoice Prep 1 TA/Invoice $350.00 $350.00
99.500 Safety Briefing 1 Activity $150.00 $150.00
4.031 Cost for Sampling Well 5 Well $110.00 $550.00
4.041 Cost for Sampling Supply Well 3 Well $75.00 $225.00
4.090 #272 Standard Methods 6200B (Including MTBE,
IPE, & EDB*) 10 sample $66.00 $660.00
4.090 #280 EPA 504.1 EDB 3 sample $45.00 $135.00
4.090 #810 Water Levels and pH, Field Measurements 2 sample $11.00 $22.00
6.091 Monitoring Rpt. 1 report $1,125.00 $1,125.00
12.050 Consultant Mobilization 1 Mobe $250.00 $250.00
12.055 Temporary Impact Increase 1 Mobe $50.00 $50.00
Total $3,517.00
0.00 Less Previous Billings
3,517.00 Fee Earned To Date
Total Project Fee Authorized 3,517.00
100.00 Percent Complete as of: 2/7/2023
Current Billing Amount 3,517.00
Amount Due this Invoice 3,517.00
______________________________________________________
Thrash, Ashleigh Marie
Billing Summary
0.00
3,517.00
3,517.00
3,517.00
Contract Balance
Contract Amount
Paid To Date
Billed To Date
Fee Earned To Date
Total This Invoice
Previously Billed 0.00
0.00
3,517.00
Raleigh NC 27699-1646
1646 Mail Service Center
Division of Waste Management
Attention: Scott Ryals, Trust Fund Project Manager
NCDEQ-State Lead
02/07/2023
**
Williams Grocery - TA-02
SLC1506302
2482277
Incident Name: Williams Grocery SLT PM: Scott Ryals
Incident No.: 15063 ATC PM: Al Quarles
Address: 2425 U.S. Highway 21 ATC Phone #: [phone]
City: Hamptonville ATC Project No.: SLC1506302
ZipCode: 27020 SLTA Submitted: 10/19/22
County: Yadkin Due Date: 12/23/22
Regional Office: Winston-Salem TA #: 02 Revised
Description Units **Type of Unit Max Rate Costs
State-Lead Program Administrative Tasks 1
99.200 Administrative TA/Invoice Prep 1 TA/Invoice $350.00 350.00$
99.500 Safety Briefing 1 Activity $150.00 150.00$
SAMPLING & ANALYTICAL COSTS 1
4.031 Cost for Sampling Well 5 Well $110.00 550.00$
4.041 Cost for Sampling Supply Well 3 Well $75.00 225.00$
Analytical 1
Hydrocarbon Sampling (water)1
4.090 #272 Standard Methods 6200B (Including MTBE,
IPE, & EDB*)10 sample $66.00 660.00$
4.090 #280 EPA 504.1 EDB 3 sample $45.00 135.00$
4.090 #810 Water Levels and pH, Field Measurements 2 sample $11.00 22.00$
REPORTS 1
6.091 Monitoring Rpt.1 report $1,125.00 1,125.00$
TRAVEL TIME & LODGING 1
12.050 Consultant Mobilization 1 Mobe $250.00 250.00$
12.055 Temporary Impact Increase 1 Mobe $50.00 50.00$
34 Total 3,517.00$
NCDEQ STATE-LEAD PROGRAM
SLTA/PATA Backup
Scope of Work: Sample six monitoring/remediation wells (MW-1, MW-2, MW-3, MW-5, RW-1, and AS-1), measure depth to water in three
monitoring wells (MW-4, MW-6, and MW-12), and sample five water supply wells within 500 feet (WSW-1, 2, 3, 5, and 6). All samples and
one field blank and one trip blank will be analyzed using SM 6200B, and the WSW samples will also be analyzed using EPA Method 504.1
for EDB. Results of the sampling event will be compiled and submitted in a Monitoring Report.
Services Completed: Sample five monitoring/remediation wells (MW-1, 2, 3, 5 and AS-1) and 3 water supply wells (WSW-1, 2, and 5)
during October 27-28, 2022. Analysis by SM 6200B including one field blank and one trip blank, and EPA 504.1 for the three water supply
well samples. Measured water levels in two monitoring wells not sampled (MW-4 and MW-12). Monitoring Report.
Task
ATC Contract Number : N122019A
Page 1 of 1
Site Name City / County /Yadkin Incident #15063
STF PM UST#WS-4563
Invoice Number / Date /STF Alt PM
Contractor / PM /
Telephone / Fax #/Task Authorization Number:02 ChangeOrd:
Project Mgr Email
Proposal# / Due Date /
Contract Number Site Risk / Rank / Abatement:RRA Date:
With Invoice: [ ] All Contractor invoices attached?[ ] Proof of payment attached directly to the front of each invoice?
w Important: The date of reimbursement is dependent on the Trust Fund balance. There may be a delay in the reimbursement of claims for work under this ePATA.
Task #Lab /
SubCode
STF PM Task ApprovalProposed
Rate/Price
(Contractor)STF PM Price ApporvalProposed Task
Subtotal
(Contractor)
Preapproved
Subtotal
(STF PM)
99.200 1 /TA/Invoice y $350.00 y $350.00 $350.00
99.500 1 /Activity y $150.00 y $150.00 $150.00
4.031 6 /Well y $110.00 y $660.00 $660.00
4.041 5 /Well y $75.00 y $375.00 $375.00
4.090 #272 13 /sample y $66.00 y $858.00 $858.00
4.090 #280 5 /sample y $45.00 y $225.00 $225.00
4.090 #810 3 /sample y $11.00 y $33.00 $33.00
6.091 1 /report y $1,125.00 y $1,125.00 $1,125.00
12.050 1 /Mobe y $250.00 y $250.00 $250.00
12.055 1 /Mobe y $50.00 y $50.00 $50.00
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
Requested Preapproved Approved
TOTALs:$4,076.00 $4,076.00 $0.00
STF PM Signature: Date:
Contractor Signature:Date:
STF 2020-2023 Contract ePATA 4/4/2022 for use with State-Lead Incidents ONLY.
Proposed
Units / Type
(Contractor)
Herb Berger
SLC1506302 12/23/2022
704-529-3272
Invoiced Amount
(Contractor)
FINAL REIMBURSEMENT
[e-mail]
ATC
(Must Complete with Claim Submittal)(See 2020 RRD abd Task Scopes of Work)
704-529-3200
(Reserved for STF Project Manager)
PREAPPROVAL / TASK AUTHORIZATION
Scope of Work:Sample six monitoring/remediation wells (MW-1,MW-2,MW-3,MW-5,RW-1,and AS-1),measure depth to water in three monitoring wells (MW-4,MW-6,and MW-12),and
sample five water supply wells within 500 feet (WSW-1,2,3,5,and 6).All samples and one field blank and one trip blank will be analyzed using SM 6200B,and the WSW samples will also be
analyzed using EPA Method 504.1 for EDB. Results of the sampling event will be compiled and submitted in a Monitoring Report.
Services Completed:Sample five monitoring/remediation wells (MW-1,2,3,5 and AS-1)and 3 water supply wells (WSW-1,2,and 5)during October 27-28,2022.Analysis by SM 6200B
including one field blank and one trip blank,and EPA 504.1 for the three water supply well samples.Measured water levels in two monitoring wells not sampled (MW-4 and MW-12).Monitoring
Report.
Al Quarles
N122019A
2020-2023 STF ePATA w/ T&M Codes
HamptonvilleWilliams Grocery
Invoiced
$350.00
$150.00
$550.00
$225.00
$660.00
$135.00
$22.00
$1,125.00
$250.00
$50.00
$3,517.00
10/20/2022
10/20/2022
ELECTRONIC PREAPPROVAL TASK AUTHORIZATION FORM
Dept of Environmental Quality -Division of Waste Management
ELECTRONIC PREAPPROVAL TASK AUTHORIZATION FORM
Dept of Environmental Quality -Division of Waste Management
2482277 2/7/2023
PLEASE REFERENCE THE INVOICE NUMBER ON ALL REMITTANCE ADVICE.
AN EQUAL OPPORTUNITY EMPLOYER
Page 1 of 1
Please complete and return copy of invoice with your payment.
INVOICE TOTAL $315.00
Amount Paid:
Check No:
Invoice No:2292368436
$
Customer No:92-616873
**1.5% MONTHLY FINANCE CHARGE ASSESSED AFTER 30 DAYS OR TERMS OF CONTRACT.
A 2.5% CREDIT CARD SURCHAGE OF $7.88 MAY BE ADDED TO ANY CREDIT CARD PAYMENT. DEBIT
AND ACH/E-CHECKS INCUR NO ADDITIONAL FEES.
Sold To:
Accounts Payable
ATC Group Services
7606 Whitehall Exec Ctr Dr
Charlotte, NC 28273
Please Remit To:
Pace Analytical Services, LLC
P.O. Box 684056
Chicago, IL 60695-4056
Invoice Number:
Date:
Client Number/Client ID Purchase Order No Pace Project Mgr Terms**Page
Client Project:
Pace Project No:
Comments:
Report Sent To:
11/07/2022
1
Suite 800
[phone] x420
WILLIAMS GROCERY STATE LEAD Client Name:ATC Group Services, LLC - Charlotte
Sample Received:
92-616873 / 92-ATC Taylor M Cannon
2292368436
10/28/2022
Al Quarles, ATC Group Services LLC
LIMS OBJECT ID: 92368436
INV
92633606
Total Amount Due:$315.00
Net 30 Days
Quantity
ANALYTICAL CHARGES
Unit Description Method Matrix Price Total
Ea $315.00$45.006200B MSV SM 6200B Water7
Analytical Subtotal $315.00
Total Invoice Amount $315.00Total Number of Charges7
If paying by credit card, a 2.5% surcharge of $7.88 will be assessed, PAY $322.88
Samples Received for analysis:
Lab ID Client Sample ID Received
92633606001 MW1 10/28/2022
92633606002 MW2 10/28/2022
92633606003 MW3 10/28/2022
92633606004 MW5 10/28/2022
92633606005 AS1 10/28/2022
92633606006 FIELD BLANK 10/28/2022
92633606007 TRIP BLANK 10/28/2022
If you have any questions, please contact Taylor M Cannon at Pace.
Phone: [phone] Email: [e-mail]
Pace Analytical Services, LLC
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
Phone: [phone]
INVOICE
Pace Analytical Services, LLC 41-1821617
Pace Analytical National 62-0814289Pace Analytical Gulf Coast 45-4027089
PLEASE REFERENCE THE INVOICE NUMBER ON ALL REMITTANCE ADVICE.
AN EQUAL OPPORTUNITY EMPLOYER
Page 1 of 1
Please complete and return copy of invoice with your payment.
INVOICE TOTAL $207.00
Amount Paid:
Check No:
Invoice No:2292368435
$
Customer No:92-616873
**1.5% MONTHLY FINANCE CHARGE ASSESSED AFTER 30 DAYS OR TERMS OF CONTRACT.
A 2.5% CREDIT CARD SURCHAGE OF $5.18 MAY BE ADDED TO ANY CREDIT CARD PAYMENT. DEBIT
AND ACH/E-CHECKS INCUR NO ADDITIONAL FEES.
Sold To:
Accounts Payable
ATC Group Services
7606 Whitehall Exec Ctr Dr
Charlotte, NC 28273
Please Remit To:
Pace Analytical Services, LLC
P.O. Box 684056
Chicago, IL 60695-4056
Invoice Number:
Date:
Client Number/Client ID Purchase Order No Pace Project Mgr Terms**Page
Client Project:
Pace Project No:
Comments:
Report Sent To:
11/07/2022
1
Suite 800
[phone] x420
WILLIAMS GROCERY STATE LEAD Client Name:ATC Group Services, LLC - Charlotte
Sample Received:
92-616873 / 92-ATC Taylor M Cannon
2292368435
10/28/2022
Al Quarles, ATC Group Services LLC
LIMS OBJECT ID: 92368435
INV
92633609
Total Amount Due:$207.00
Net 30 Days
Quantity
ANALYTICAL CHARGES
Unit Description Method Matrix Price Total
Ea $72.00$24.00504 GCS EDB DBCP EPA 504.1 Water3
Ea $135.00$45.006200B MSV SM 6200B Water3
Analytical Subtotal $207.00
Total Invoice Amount $207.00Total Number of Charges6
If paying by credit card, a 2.5% surcharge of $5.18 will be assessed, PAY $212.18
Samples Received for analysis:
Lab ID Client Sample ID Received
92633609001 WSW-1 10/28/2022
92633609002 WSW-2 10/28/2022
92633609003 WSW-5 10/28/2022
If you have any questions, please contact Taylor M Cannon at Pace.
Phone: [phone] Email: [e-mail]
Pace Analytical Services, LLC
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
Phone: [phone]
INVOICE
Pace Analytical Services, LLC 41-1821617
Pace Analytical National 62-0814289Pace Analytical Gulf Coast 45-4027089