WS-29842_48944_CA_UST-61_20230405

UST-61 24-Hour Release and UST Leak Reporting Form.
For Releases
in NC
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
suspected release
(DWM USE ONLY)
Incident # ________ Risk (H,I,L,U)_______
Received On ________ Received By ________ Reported by (circle one): Phone, Fax or Report
Region _______
Suspected Contamination? (Y/N) ________
Confirmed GW Contamination? (Y/N) ______
Confirmed Soil Contamination ?(Y/N) ______ Samples Taken?(Y/N) ______
Free Product? (Y/N) _____ If Yes, State Greatest
Thickness ______________
Facility ID Number ______________
Date Leak Discovered ___________
Comm/Non-Commercial? ________ Reg/Non-regulated? _____________
INCIDENT DESCRIPTION
Incident Name:
Address: County:
City/Town: Zip Code: Regional Office (circle one): Asheville, Mooresville, Fayetteville,
Raleigh, Washington, Wilmington, Winston-Salem
Latitude (decimal degrees): Longitude (decimal degrees) : Obtained by:
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) GPS
Topographic map
GIS Address matching
Other
Unknown
Describe location:
HOW RELEASE WAS DISCOVERED (Release Code)
(Check one)
Release Detection Equipment or Methods
During UST Closure/Removal
Property Transfer
Visual/Odor
Water in Tank
Water Supply Well Contamination
Groundwater Contamination
Surface Water Contamination
Other (specify) _______________
SOURCE OF CONTAMINATION
Source of Release
(Check primary source)
Cause of Release
(Check primary cause)
Type of Release
(Check one)
Product Type Released
(Check primary product type released)
Tank
Piping
Dispenser
Submersible Turbine Pump
Delivery Problem
Spill Bucket
Other
Unknown

Definitions presented on reverse
Spill
Overfill
Corrosion
Physical/Mechanical
Damage
Install Problem
Other
Unknown

Definitions presented on reverse
Petroleum
Non-Petroleum
Both

Location
(Check one)

Facility
Residence
Other
Gasoline/ Diesel/
Kerosene
Heating Oil
Other Petroleum
Products
Metals
Other Inorganics
Other Organics
Diesel/Veg. Oil
Blend
Vegetable Oil 100%
E10 – E20
E21 – E84
E85 – E99
Ethanol 100%
E01 – E09
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
Point of Contact Address
City State Zip Code Telephone Number
UST SYSTEM OPERATOR
UST Operator/Company Address
City State Zip Code Telephone Number
LANDOWNER AT LOCATION OF UST INCIDENT
Landowner Address
City State Zip Code Telephone Number
Draw Sketch of Area (showing two major road intersections) or Attach Map
Person Reporting Incident Company Telephone Number
Title Address Date
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

4/5/23, 9:15 AM 5000 Sparrow Ct - Google Maps
https://www.google.com/maps/place/5000+Sparrow+Ct,+Pleasant+Garden,+NC+27313/@35.9818895,-79.7513428,16z/data=!4m6!3m5!1s0x885317eebfc5e821:0x1e9bd30a686f4ae6!8m2!3d35.98257…1/1
Map data ©2023 500 ft
5000 Sparrow Ct

Laboratory's liability in any claim relating to analyses performed shall be limited to, at laboratory's option, repeating the
analysis in question at laboratory's expense, or the refund of the charges paid for performance of said analysis.

4/3/2023
Paragon Environmental Consultants, Inc. Brandon Moore
PO Box 157 Thomasville, NC, 27361
Ref: Analytical Testing
Lab Report Number: 23-082-0032 Client Project Description: Smith Residence
P-2236
Dear Brandon Moore:
Waypoint Analytical, LLC (Charlotte) received sample(s) on 3/23/2023 for the analyses presented in the following report.
The above referenced project has been analyzed per your instructions. The analyses were performed in
accordance with the applicable analytical method.
The analytical data has been validated using standard quality control measures performed as required by the analytical method. Quality Assurance, method validations, instrumentation maintenance and calibration for all
parameters were performed in accordance with guidelines established by the USEPA (including 40 CFR 136 Method Update Rule May 2021) unless otherwise indicated. Certain parameters (chlorine, pH, dissolved oxygen, sulfite...) are required to be analyzed within 15 minutes of
sampling. Usually, but not always, any field parameter analyzed at the laboratory is outside of this holding time. Refer to sample analysis time for confirmation of holding time compliance.
The results are shown on the attached Report of Analysis(s). Results for solid matrices are reported on an as-
received basis unless otherwise indicated. This report shall not be reproduced except in full and relates only to the samples included in this report. Please do not hesitate to contact me or client services if you have any questions or need additional information.
Sincerely,
Angela D Overcash Senior Project Manager
Page 1 of 22
Certification Summary
Laboratory ID: WP CNC: Waypoint Analytical Carolina, Inc. (C), Charlotte, NC
State Program Lab ID Expiration Date
07/31/202337735State ProgramNorth Carolina
12/31/2023402State ProgramNorth Carolina
07/31/202399012State ProgramSouth Carolina
12/31/202299012State ProgramSouth Carolina
Page 1 of 1 00016/23-082-0032
Page 2 of 22
Report Number:
Sample Summary Table
Client Project Description:
23-082-0032
Smith Residence
P-2236
Lab No Client Sample ID Matrix Date Collected Date Received
03/22/2023 10:00Solids 92036 T1-6 03/23/2023 15:10
03/22/2023Solids 92037 NW 03/23/2023 15:10
03/22/2023Solids 92038 EW 03/23/2023 15:10
03/22/2023Solids 92039 SW 03/23/2023 15:10
03/22/2023Solids 92040 WW 03/23/2023 15:10
03/22/2023Solids 92041 PB 03/23/2023 15:10
Page 3 of 22
Summary of Detected Analytes
QualifiersAnalyzedUnitsResult
Report Number:
Client Sample ID
Method Parameters
Lab Sample ID
23-082-0032
Report Limit
Project:Smith Residence
V 92036T1-6
8340 03/30/2023 17:488015C DRO Diesel Range Organics (C10-C28)mg/Kg - dry 577
19.4 03/28/2023 15:31SW-DRYWT Moisture %
V 92037NW
18.5 03/28/2023 15:31SW-DRYWT Moisture %
V 92038EW
24.8 03/29/2023 17:318015C DRO Diesel Range Organics (C10-C28)mg/Kg - dry 6.16
24.5 03/28/2023 15:31SW-DRYWT Moisture %
V 92039SW
28.2 03/28/2023 15:31SW-DRYWT Moisture %
V 92040WW
90.6 03/29/2023 18:138015C DRO Diesel Range Organics (C10-C28)mg/Kg - dry 5.62
17.3 03/28/2023 15:31SW-DRYWT Moisture %
V 92041PB
21.4 03/29/2023 18:358015C DRO Diesel Range Organics (C10-C28)mg/Kg - dry 6.58
29.3 03/28/2023 15:31SW-DRYWT Moisture %
Page 4 of 22

Client: Paragon Environmental Consultants, Inc. CASE NARRATIVE
Project: Smith Residence Lab Report Number: 23-082-0032
Date: 4/3/2023
Total Petroleum Hydrocarbons - Volatile Method 8015C GRO Sample 92037 (NW) Analyte: a,a,a-Trifluorotoluene
QC Batch No: V31169/V31168 Surrogate(s) was flagged for recovery outside QC limits in this project sample. This sample was re-analyzed for
verification, and/or dilution of target analytes. Batch QC samples (method blank and laboratory control samples) all showed surrogates within QC limits.
Sample 92038 (EW)
Analyte: a,a,a-Trifluorotoluene QC Batch No: V31169/V31168
Surrogate(s) exhibited a high bias in this project sample where no target analytes were detected. The high recovery(s) had no impact on the data. Batch QC samples (method blank and laboratory control samples) all
showed surrogates within QC limits.
Sample 92040 (WW) Analyte: a,a,a-Trifluorotoluene
QC Batch No: V31169/V31168 Surrogate(s) exhibited a high bias in this project sample where no target analytes were detected. The high
recovery(s) had no impact on the data. Batch QC samples (method blank and laboratory control samples) all showed surrogates within QC limits.
Page 5 of 22
,
REPORT OF ANALYSISReport Number :
Project
Information :
NC 27361
23-082-0032
01156
Paragon Environmental Consultants, Inc.
PO Box 157
Brandon Moore
Thomasville
P-2236 Received : 03/23/2023
Smith Residence
Report Date : 04/03/2023
Sample ID :
Lab No :
Sampled:T1-6
92036 Matrix:
3/22/2023 10:00
Solids
Test Results Units MDL MQL By Analytical
Method
Date / Time
Analyzed
DF
19.4 %Moisture 1 03/28/23 15:31 SW-DRYWTPEB
Qualifiers/
Definitions
Dilution FactorDFOutside QC Limit*
Method Quantitation LimitMQL
Page 6 of 22
,
REPORT OF ANALYSISReport Number :
Project
Information :
NC 27361
23-082-0032
01156
Paragon Environmental Consultants, Inc.
PO Box 157
Brandon Moore
Thomasville
P-2236 Received : 03/23/2023
Smith Residence
Report Date : 04/03/2023
Sample ID :
Lab No :
Sampled:T1-6
92036 Matrix:
3/22/2023 10:00
Solids
Analytical Method:
Prep Method:
Test Results Units MDL MQL By Analytical
Batch
Date / Time
Analyzed
DF
3546
8015C DRO Prep Batch(es):V31334 03/29/23 10:00
8340 mg/Kg - dry 577 1240Diesel Range Organics (C10-C28)100 03/30/23 17:48 V31436AMP
8015C DROSurrogate: OTP Surrogate 54.1 Limits: 31-123%03/30/23 17:48100 AMP
Qualifiers/
Definitions
Dilution FactorDFOutside QC Limit*
Method Quantitation LimitMQL
Page 7 of 22
,
REPORT OF ANALYSISReport Number :
Project
Information :
NC 27361
23-082-0032
01156
Paragon Environmental Consultants, Inc.
PO Box 157
Brandon Moore
Thomasville
P-2236 Received : 03/23/2023
Smith Residence
Report Date : 04/03/2023
Sample ID :
Lab No :
Sampled:NW
92037 Matrix:
3/22/2023 0:00
Solids
Test Results Units MDL MQL By Analytical
Method
Date / Time
Analyzed
DF
18.5 %Moisture 1 03/28/23 15:31 SW-DRYWTPEB
Qualifiers/
Definitions
Dilution FactorDFOutside QC Limit*
Method Quantitation LimitMQL
Page 8 of 22
,
REPORT OF ANALYSISReport Number :
Project
Information :
NC 27361
23-082-0032
01156
Paragon Environmental Consultants, Inc.
PO Box 157
Brandon Moore
Thomasville
P-2236 Received : 03/23/2023
Smith Residence
Report Date : 04/03/2023
Sample ID :
Lab No :
Sampled:NW
92037 Matrix:
3/22/2023 0:00
Solids
Analytical Method:
Prep Method:
Test Results Units MDL MQL By Analytical
Batch
Date / Time
Analyzed
DF
3546
8015C DRO Prep Batch(es):V31334 03/29/23 10:00
<5.71 mg/Kg - dry 5.71 12.3Diesel Range Organics (C10-C28)1 03/29/23 17:10 V31436AMP
8015C DROSurrogate: OTP Surrogate 56.5 Limits: 31-123%03/29/23 17:101 AMP
Analytical Method:
Prep Method:
Test Results Units MDL MQL By Analytical
Batch
Date / Time
Analyzed
DF
5035 MED
8015C GRO Prep Batch(es):V31168 03/24/23 08:00
<2.54 mg/Kg - dry 2.54 6.13Gasoline Range Organics (C6-C10)50 03/24/23 11:23 V31169TBL
8015C GROSurrogate: a,a,a-Trifluorotoluene 123 Limits: 50-137%03/24/23 11:2350 TBL
Qualifiers/
Definitions
Dilution FactorDFOutside QC Limit*
Method Quantitation LimitMQL
Page 9 of 22
,
REPORT OF ANALYSISReport Number :
Project
Information :
NC 27361
23-082-0032
01156
Paragon Environmental Consultants, Inc.
PO Box 157
Brandon Moore
Thomasville
P-2236 Received : 03/23/2023
Smith Residence
Report Date : 04/03/2023
Sample ID :
Lab No :
Sampled:EW
92038 Matrix:
3/22/2023 0:00
Solids
Test Results Units MDL MQL By Analytical
Method
Date / Time
Analyzed
DF
24.5 %Moisture 1 03/28/23 15:31 SW-DRYWTPEB
Qualifiers/
Definitions
Dilution FactorDFOutside QC Limit*
Method Quantitation LimitMQL
Page 10 of 22
,
REPORT OF ANALYSISReport Number :
Project
Information :
NC 27361
23-082-0032
01156
Paragon Environmental Consultants, Inc.
PO Box 157
Brandon Moore
Thomasville
P-2236 Received : 03/23/2023
Smith Residence
Report Date : 04/03/2023
Sample ID :
Lab No :
Sampled:EW
92038 Matrix:
3/22/2023 0:00
Solids
Analytical Method:
Prep Method:
Test Results Units MDL MQL By Analytical
Batch
Date / Time
Analyzed
DF
3546
8015C DRO Prep Batch(es):V31334 03/29/23 10:00
24.8 mg/Kg - dry 6.16 13.2Diesel Range Organics (C10-C28)1 03/29/23 17:31 V31436AMP
8015C DROSurrogate: OTP Surrogate 58.9 Limits: 31-123%03/29/23 17:311 AMP
Analytical Method:
Prep Method:
Test Results Units MDL MQL By Analytical
Batch
Date / Time
Analyzed
DF
5035 MED
8015C GRO Prep Batch(es):V31168 03/24/23 08:00
<2.74 mg/Kg - dry 2.74 6.62Gasoline Range Organics (C6-C10)50 03/24/23 11:52 V31169TBL
8015C GROSurrogate: a,a,a-Trifluorotoluene 149 *Limits: 50-137%03/24/23 11:5250 TBL
Qualifiers/
Definitions
Dilution FactorDFOutside QC Limit*
Method Quantitation LimitMQL
Page 11 of 22
,
REPORT OF ANALYSISReport Number :
Project
Information :
NC 27361
23-082-0032
01156
Paragon Environmental Consultants, Inc.
PO Box 157
Brandon Moore
Thomasville
P-2236 Received : 03/23/2023
Smith Residence
Report Date : 04/03/2023
Sample ID :
Lab No :
Sampled:SW
92039 Matrix:
3/22/2023 0:00
Solids
Test Results Units MDL MQL By Analytical
Method
Date / Time
Analyzed
DF
28.2 %Moisture 1 03/28/23 15:31 SW-DRYWTPEB
Qualifiers/
Definitions
Dilution FactorDFOutside QC Limit*
Method Quantitation LimitMQL
Page 12 of 22
,
REPORT OF ANALYSISReport Number :
Project
Information :
NC 27361
23-082-0032
01156
Paragon Environmental Consultants, Inc.
PO Box 157
Brandon Moore
Thomasville
P-2236 Received : 03/23/2023
Smith Residence
Report Date : 04/03/2023
Sample ID :
Lab No :
Sampled:SW
92039 Matrix:
3/22/2023 0:00
Solids
Analytical Method:
Prep Method:
Test Results Units MDL MQL By Analytical
Batch
Date / Time
Analyzed
DF
3546
8015C DRO Prep Batch(es):V31334 03/29/23 10:00
<6.48 mg/Kg - dry 6.48 13.9Diesel Range Organics (C10-C28)1 03/29/23 17:52 V31436AMP
8015C DROSurrogate: OTP Surrogate 55.7 Limits: 31-123%03/29/23 17:521 AMP
Analytical Method:
Prep Method:
Test Results Units MDL MQL By Analytical
Batch
Date / Time
Analyzed
DF
5035 MED
8015C GRO Prep Batch(es):V31168 03/24/23 08:00
<2.88 mg/Kg - dry 2.88 6.96Gasoline Range Organics (C6-C10)50 03/24/23 12:22 V31169TBL
8015C GROSurrogate: a,a,a-Trifluorotoluene 128 Limits: 50-137%03/24/23 12:2250 TBL
Qualifiers/
Definitions
Dilution FactorDFOutside QC Limit*
Method Quantitation LimitMQL
Page 13 of 22
,
REPORT OF ANALYSISReport Number :
Project
Information :
NC 27361
23-082-0032
01156
Paragon Environmental Consultants, Inc.
PO Box 157
Brandon Moore
Thomasville
P-2236 Received : 03/23/2023
Smith Residence
Report Date : 04/03/2023
Sample ID :
Lab No :
Sampled:WW
92040 Matrix:
3/22/2023 0:00
Solids
Test Results Units MDL MQL By Analytical
Method
Date / Time
Analyzed
DF
17.3 %Moisture 1 03/28/23 15:31 SW-DRYWTPEB
Qualifiers/
Definitions
Dilution FactorDFOutside QC Limit*
Method Quantitation LimitMQL
Page 14 of 22
,
REPORT OF ANALYSISReport Number :
Project
Information :
NC 27361
23-082-0032
01156
Paragon Environmental Consultants, Inc.
PO Box 157
Brandon Moore
Thomasville
P-2236 Received : 03/23/2023
Smith Residence
Report Date : 04/03/2023
Sample ID :
Lab No :
Sampled:WW
92040 Matrix:
3/22/2023 0:00
Solids
Analytical Method:
Prep Method:
Test Results Units MDL MQL By Analytical
Batch
Date / Time
Analyzed
DF
3546
8015C DRO Prep Batch(es):V31334 03/29/23 10:00
90.6 mg/Kg - dry 5.62 12.1Diesel Range Organics (C10-C28)1 03/29/23 18:13 V31436AMP
8015C DROSurrogate: OTP Surrogate 55.1 Limits: 31-123%03/29/23 18:131 AMP
Analytical Method:
Prep Method:
Test Results Units MDL MQL By Analytical
Batch
Date / Time
Analyzed
DF
5035 MED
8015C GRO Prep Batch(es):V31168 03/24/23 08:00
<2.50 mg/Kg - dry 2.50 6.05Gasoline Range Organics (C6-C10)50 03/24/23 12:51 V31169TBL
8015C GROSurrogate: a,a,a-Trifluorotoluene 146 *Limits: 50-137%03/24/23 12:5150 TBL
Qualifiers/
Definitions
Dilution FactorDFOutside QC Limit*
Method Quantitation LimitMQL
Page 15 of 22
,
REPORT OF ANALYSISReport Number :
Project
Information :
NC 27361
23-082-0032
01156
Paragon Environmental Consultants, Inc.
PO Box 157
Brandon Moore
Thomasville
P-2236 Received : 03/23/2023
Smith Residence
Report Date : 04/03/2023
Sample ID :
Lab No :
Sampled:PB
92041 Matrix:
3/22/2023 0:00
Solids
Test Results Units MDL MQL By Analytical
Method
Date / Time
Analyzed
DF
29.3 %Moisture 1 03/28/23 15:31 SW-DRYWTPEB
Qualifiers/
Definitions
Dilution FactorDFOutside QC Limit*
Method Quantitation LimitMQL
Page 16 of 22
,
REPORT OF ANALYSISReport Number :
Project
Information :
NC 27361
23-082-0032
01156
Paragon Environmental Consultants, Inc.
PO Box 157
Brandon Moore
Thomasville
P-2236 Received : 03/23/2023
Smith Residence
Report Date : 04/03/2023
Sample ID :
Lab No :
Sampled:PB
92041 Matrix:
3/22/2023 0:00
Solids
Analytical Method:
Prep Method:
Test Results Units MDL MQL By Analytical
Batch
Date / Time
Analyzed
DF
3546
8015C DRO Prep Batch(es):V31334 03/29/23 10:00
21.4 mg/Kg - dry 6.58 14.1Diesel Range Organics (C10-C28)1 03/29/23 18:35 V31436AMP
8015C DROSurrogate: OTP Surrogate 50.5 Limits: 31-123%03/29/23 18:351 AMP
Analytical Method:
Prep Method:
Test Results Units MDL MQL By Analytical
Batch
Date / Time
Analyzed
DF
5035 MED
8015C GRO Prep Batch(es):V31168 03/24/23 08:00
<2.93 mg/Kg - dry 2.93 7.07Gasoline Range Organics (C6-C10)50 03/24/23 13:19 V31169TBL
8015C GROSurrogate: a,a,a-Trifluorotoluene 125 Limits: 50-137%03/24/23 13:1950 TBL
Qualifiers/
Definitions
Dilution FactorDFOutside QC Limit*
Method Quantitation LimitMQL
Page 17 of 22
Quality Control Data
23-082-0032Report No:
Project Description:
Client ID:Paragon Environmental Consultants, Inc.
Smith Residence
QC Prep Batch Method:
Total Petroleum Hydrocarbons - Extractable
8015C DRO
V31436QC Analytical Batch(es):
Analysis Method:
Analysis Description:
3546
QC Prep:V31334
Associated Lab Samples: 92036, 92037, 92038, 92039, 92040, 92041
LRB-V31334 Matrix: SOLLab Reagent Blank
Parameter
AnalyzedMQLMDLBlank
ResultUnits
%
Recovery
% Rec
Limits
03/29/23 14:4210.04.65<4.65mg/KgDiesel Range Organics (C10-C28)
03/29/23 14:42OTP Surrogate (S)50.9 31-123
LCS-V31334 LCSD-V31334Laboratory Control Sample & LCSD
LCSD
ResultParameter Max
RPD
LCSD
% Rec
LCS
%Rec
LCS
Result
Spike
Conc.Units
% Rec
Limits RPD
60.8 91.189.659.866.7mg/KgDiesel Range Organics (C10-C28)46-126 1.6 20
58.360.1OTP Surrogate (S)31-123
Page 1 of 3Date:04/03/2023 04:25 PM
Page 18 of 22
Quality Control Data
23-082-0032Report No:
Project Description:
Client ID:Paragon Environmental Consultants, Inc.
Smith Residence
QC Prep Batch Method:
Total Petroleum Hydrocarbons - Volatile
8015C GRO
V31169QC Analytical Batch(es):
Analysis Method:
Analysis Description:
5035 MED
QC Prep:V31168
Associated Lab Samples: 92037, 92038, 92039, 92040, 92041
LRB-V31168 Matrix: SOLLab Reagent Blank
Parameter
AnalyzedMQLMDLBlank
ResultUnits
%
Recovery
% Rec
Limits
03/24/23 10:545.002.07<2.07mg/KgGasoline Range Organics (C6-C10)
03/24/23 10:54a,a,a-Trifluorotoluene (S)99.4 50-137
LCS-V31168Laboratory Control Sample
Parameter
LCS %RecLCS
Result
Spike
Conc.Units
% Rec
Limits
10954.550.0mg/KgGasoline Range Organics (C6-C10)41-138
115a,a,a-Trifluorotoluene (S)50-137
V 92037-MS-V31168 V 92037-MSD-V31168Matrix Spike & Matrix Spike Duplicate
MS Result
Parameter
Max
RPD
MS
%Rec
MSD
Result
MSD
Spike
Conc.
MS Spike
Conc.ResultUnits
%Rec
Limits
MSD
%Rec RPD
65.2 13059.750.050.0<2.07mg/KgGasoline Range Organics (C6-C10)119 41-138 8.8 34
157*a,a,a-Trifluorotoluene (S)138*50-137
Page 2 of 3* QC Fail Date:04/03/2023 04:25 PM
Page 19 of 22
Quality Control Data
23-082-0032Report No:
Project Description:
Client ID:Paragon Environmental Consultants, Inc.
Smith Residence
Dry Weight Determination
SW-DRYWT
V31307QC Analytical Batch:
Analysis Method:
Analysis Description:
V 91868-DUPDuplicate
Max RPD
Parameter
AnalyzedRPDDUP
Result
Result
Units
20.0 03/28/23 15:311.314.514.7%Moisture
V 92036-DUPDuplicate
Max RPD
Parameter
AnalyzedRPDDUP
Result
Result
Units
20.0 03/28/23 15:314.718.519.4%Moisture
Page 3 of 3Date:04/03/2023 04:25 PM
Page 20 of 22
Fed Ex
UPS
US Postal
Client
Lab
Courier
Other :
Shipment Receipt Form
Customer Number:
Customer Name:
Report Number:23-082-0032
Paragon Environmental Consultants, Inc.
01156
Shipping Method
Shipping container/cooler uncompromised?
Thermometer ID:IRT15 3.3C
Chain of Custody (COC) present?Yes No
Yes No Not Present
Yes No Not Present
Yes No
COC agrees with sample label(s)? Yes No
COC properly completed
Samples in proper containers?
Sample containers intact?
Sufficient sample volume for indicated test(s)?
All samples received within holding time?
Cooler temperature in compliance?
Yes No
Yes No
Yes No
Yes No
Yes No
Yes NoCooler/Samples arrived at the laboratory on ice.
Samples were considered acceptable as cooling
process had begun.
Yes No
Yes No N/A
Yes No N/A
Yes No N/ASoil VOA method 5035 – compliance criteria met
Water - Sample containers properly preserved
Water - VOA vials free of headspace Yes No N/A
Trip Blanks received with VOAs
Low concentration EnCore samplers (48 hr)
High concentration pre-weighed (methanol -14 d) Low conc pre-weighed vials (Sod Bis -14 d)ü
High concentration container (48 hr)
Custody seals intact on shipping container/cooler?
Custody seals intact on sample bottles?
Number of coolers/boxes received
Yes No
1
Signature:Angelo Norvell Date & Time:03/23/2023 19:09:16
Special precautions or instructions included?
Comments:
Page 21 of 22
Page 22 of 22