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Home My WebLink AboutNCG210097_COMPLETE FILE - HISTORICAL_20181016STORMWATER DIVISION CODING SHEET NCG PERMITS PERMIT NO. /v CCU 41 o0 % DOC TYPE O�-HISTORICALFILE ❑ MONITORING REPORTS DOC DATE 0c?, li J K I D I� YYYYMMDD 1 e ROY COOPER Governor MICHAEL S REGAN Secretary WILLIAM E (TOBY) VINSON, JR Interim Director Mr Rick Waite Oak Valley Hardwoods, Inc 8482 US 221 Marion, NC 28752 Dear Mr Waite NORTH CAROLINA Environmental Quality October 15, 2018 RECEIVED OCT 16 2018 CE1"47RAL FIEFS DWR SEC-rl() Subject NPDES Stormwater Permit NCG210097 Oak Valley Hardwoods, Inc Formerly Oaks Sawmill, LLC Haywood County Division personnel received your request to revise your NPDES Stormwater Permit Certificate of Coverage (COC) to accurately reflect your new company and/or facility name Please find enclosed the revised COC The terms and conditions contained in the General Permit remain unchanged and in full effect This revised COC is issued under the requirements of North Carolina General Statutes 143-215 1 and the Memorandum of Agreement between North Carolina and the U S Environmental Protection Agency If you have any questions of need further information, please contact the Stormwater Program at (919) 707-9220 Sincerely, a� for William E Toby Vinson, Jr, PE, CPESC, CPM Interim Director Division of Energy, Mineral and Land Resources cc Asheville Regional Office Stormwater Program Files DWR Central Files North Carolina Department of Environmental Quality I Division of Energy Mineral and Land Resources 512 North Salisbury Street 11612 Mail Service Center I Raleigh North Carolina 27699 1612 919 707 9200 - STATE OF NORTH CAROLINA DEPARTMENT OF ENVIRONMENTAL QUALITY DIVISION OF ENERGY, MINERAL, AND LAND RESOURCES GENERAL PERMIT NO NCG210000 CERTIFICATE OF COVERAGE No NCG210097 STORMWATER DISCHARGES NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM In compliance with the provision of North Carolina General Statute 143-215 1, other lawful standards and regulations promulgated and adopted by the North Carolina Environmental Management Commission, and the Federal Water Pollution Control Act, as amended, Oak Valley Hardwoods, Inc is hereby authorized to discharge stormwater from a facility located at Jonathan Creek Sawmill 4182 Jonathan Creek Road Waynesville Haywood County to receiving waters designated as Parks Branch, class C waters in the French Broad River Basin, in accordance with the effluent limitations, monitoring requirements, and other conditions set forth in Parts 1, I1, III, and IV of General Permit No NCG210000 as attached This certificate of coverage shall become effective October 15, 2018 This Certificate of Coverage shall remain in effect for the duration of the General Permit Signed this 151h day of October 2018 for William E (Toby) Vinson, J-r, P E, CPM Interim Director, Division of Energy, Mineral and Land Resources By the Authority of the Environmental Management Commission aceAnalXlcal *%wpscda6s cam Pace Analytical Services Inc 2225 Riverside Dr Asheville NC 28804 (828)254 7176 July 27, 2016 Mr Brian Bauer Mountain Environmental 1560 Pisgah Drive Canton, NC 28716 RE Project Oaks 6-05L01-1A Pace Project No 92306067 Dear Mr Bauer Enclosed are the analytical results for sample(s) received by the laboratory on July 21, 2016 The results relate only to the samples included In this report Results reported herein conform to the most current TNI standards and the laboratory's Quality Assurance Manual, where applicable, unless otherwise noted in the body of the report Analyses were performed at the Pace Analytical Services location indicated on the sample analyte page for analysis unless otherwise footnoted If you have any questions concerning this report, please feel free to contact me Sincerely, 64 — �� Lorn Patton lord patton@pacelabs corn Project Manager Enclosures REPORT OF LABORATORY ANALYSIS This report shall not be reproduced except in full without the wntten consent of Pace Analytical Services Inc Page 1 of 16 e aceAnaIXIcal wwwpacelabs com Pace Analytical Services Inc 2225 Riverside Dr Asheville NC 28804 (828)254 7176 Project Oaks 6-05L01 1A Pace Project No 92306067 Asheville Certification IDS 2225 Riverside Drive Asheville NC 28804 F)OrldaiNELAP Certification # E87648 Massachusetts Certification # M-NC030 North Carolina Drinking Water Certification # 37712 CERTIFICATIONS North Carolina Wastewater Certification # 40 South Carolina Certtfication # 99030001 VirginiaNELAP Certification # 460222 REPORT OF LABORATORY ANALYSIS This report shall not be reproduced except In full without the written consent of Pace Analytical Services Inc Page 2 of 16 acmnaiytica! ° wwwpacelabs can Pace Analytical Services Inc 2225 Riverside Dr Asheville NC 28804 (828)254 7176 SAMPLE ANALYTE COUNT Project Pace Project No Oaks 6-05L01-1A 92306067 Analytes Lab ID Sample ID Method Analysts Reported Laboratory 92306067001 S1 SM 2540D WRC 1 PASI-A SM 4500 H+B MLS 1 PASI A SM 5210B CJH1 1 PASI-A SM 5220D WRC 1 PASI A 92306067002 S2 SM 25401) WRC 1 PASI-A SM 4500 H+B MLS 1 PASI A SM 5210B CJH1 1 PASI-A SM 5220D WRC 1 PASI A 92306067003 S3 SM 2540D WRC 1 PASI-A SM 4500 H+B MLS 1 PASI A SM 5210B CJH1 1 PASI A SM 5220D WRC 1 PASI A 92306067004 54 SM 2540D WRC 1 PASI A SM 4500 H+B MLS 1 PASI A SM 5210H CJH1 1 PASI-A SM 5220D WRC 1 PASI A 92306067005 S5 SM 2540D WRC 1 PASI-A SM 4500 H+B MLS 1 PASI A SM 5210B CJH1 1 PASI-A SM 5220D WRC 1 PASI A REPORT OF LABORATORY ANALYSIS This report shall not be reproduced except in full without the written consent of Pace Analytical Services Inc Page 3 of 16 aceAnalytrcal wwwpeolabs com Pace Analytical Services Inc 2225 Riverside Dr Asheville NC 28804 (828)254 7176 ANALYTICAL RESULTS Project Oaks 6 05L01 1A Pace Project No 92306067 Sample S1 Lab ID 92306067001 Collected 07/20/16 13 20 Received 07121116 15 50 Matrix Water Parameters Results Units Report Limit DF Prepared Analyzed CAS No Qual 2540D Total Suspended Solids Analytical Method SM 2540D Total Suspended Solids 8 7 mg1L 2 5 1 07/27/16 12 28 4500H+ pH Electrometric Analytical Method SM 4500-H+8 pH at 25 Degrees C 7 0 Std Units 1 0 1 07/25/16 13 45 H6 5210B BOD 5 day Analytical Method SM 5210B BOD 5 day ND mglL 2 0 1 07/22/16 04 19 07/26/16 22 32 5220D COD Analytical Method SIV 5220D Chemical Oxygen Demand ND mglL 25 0 1 07/27/16 11 00 REPORT OF LABORATORY ANALYSIS This report shall not be reproduced except in full Date 07/27/2016 11 35 PM wthout the written consent of Pace Analytical Services Inc Page 4 of 16 Pace Analytical Services Inc aeeMalytrcal " 2225 Riverside or Asheville NC 28804 wwwpocelabs cam (828)254 7176 ANALYTICAL RESULTS Project Oaks 6 C51-01-1A Pace Project No 92306067 Sample S2 La6 ID 92306067002 Collected 07/20/16 13 10 Received 07/21/16 15 50 Matrix Water Parameters Results Units Report Limit DF Prepared Analyzed CAS No Qual 2540D Total Suspended Solids Analytical Method SM 2540D Total Suspended Solyds 161 mglL 2 5 1 07/27/16 12 28 4500H+ pH Electrometric Analytical Method SM 4500-H+B pH at 25 Degrees C 6 3 Std Units 1 0 1 07/25/16 13 45 H6 5210E BOD 5 day Analytical Method SM 5210B BOD 5 day 144 mglL 2 0 1 07/22/16 04 19 07/26/16 22 32 B2 5220D COD Analytical Method SM 5220D Chemical Oxygen Demand 111 mglL 25 0 1 07/27/16 11 00 REPORT OF LABORATORY ANALYSIS This report shall not be reproduced except in full Date 07/27/2016 11 35 PM without the written consent of Pace Analytical Sennces Inc Page 5 of 16 acemalXtcal wwwpacelabs com Pace Analytical Services Inc 2225 Riverside Dr Asheville NC 28804 (828)254 7176 ANALYTICAL RESULTS Project Oaks 6-051-01 1 A Pace Protect No 92306067 Sample S3 Lab ID 92306067003 Collected 07/20/16 14 00 Received 07/21 /16 15 50 Matrix Water Parameters Results Units Report Limit DE Prepared Analyzed CAS No Qual 2540D Total Suspended Solids Analytical Method SM 2540D Total Suspended Solids 109 mg/L 29 1 07/27/16 12 29 4500H+ pH Electrometnc Analytical Method SM 4500-H+B pH at 25 Degrees C 70 Std Units 10 1 07/25/16 13 45 H6 5210E BOD 5 day Analytical Method SM 5210B BOD 5 day ND mg/L 20 1 07/22/16 04 19 07/26/16 22 32 5220D GOD Analytical Method SM 5220D Chemical Oxygen Demand ND mg/L 250 1 07/27/16 11 00 Date 07/27/2016 11 35 PM REPORT OF LABORATORY ANALYSIS This report shall not be reproduced except in full wthout the written consent of Pace Analytical Services Inc Page 6 of 16 Pace Analytical Services Inc �CaltceAnalyticp! 2225 Riverside Dr Asheville NC 28804 wwwpacelabs cam {828)254 7176 ANALYTICAL RESULTS Prcject Oaks 6-051-01 1 A Pace Project No 92306067 Sample S4 Lab I❑ 92306067004 Collected 07/20/16 14 15 Received 07/21/16 15 50 Matrix Water Parameters Resu€ts Units Report Limit DF Prepared Analyzed CAS No Qua[ 2540D Total Suspended Solids Analytical Method SM 2540D Total Suspended Solids 29 0 mg/L 2 5 1 01/27/16 12 29 4500H+ pH, Electrometric Analytical Method SM 4500 H+B pH at 25 Degrees C 6 6 Std Units 1 0 1 07/25/16 13 45 H6 5210B BOD 5 day Analytical Method SM 52108 BCD 5 day 3 9 mg/L 2 0 1 07/22/16 04 19 07/26/16 22 32 5220D COD Analytical Method SM 5220D Chemical Oxygen Demand ND mg1L 250 1 07/27/16 11 00 REPORT OF LABORATORY ANALYSIS This report shall not be reproduced except in full Date 07/27/2016 11 35 PM wthcut the wntten consent of Pace Analytical Services Inc Page 7 of 16 0 aceAnaljftal wwwpacelabs cam Pace Analytical Services Inc 2225 Riverside Or Asheville NC 28804 (828)254 7176 ANALYTICAL RESULTS Project Oaks 6 051-01 1 A Pace Project No 92306067 Sample S5 Lab ID 92306067005 Collected 07/20/16 15 00 Received 07121116 15 50 Matrix Water Parameters Results Units Report Limit DF Prepared Analyzed CAS No Qual 2540D Total Suspended Solids Analytical Method SM 2540D Total Suspended Solids 106 mgfL 2 8 1 07/27/16 12 29 4500H+ pH Electrometric Analytical Method SM 4500 H+B pH at 25 Degrees C 7 2 Std Units 1 0 1 07/25/16 13 45 H6 521 OB BOD 5 day Analytical Method SM 5210B BOD 5 day ND mg/L 2 0 1 07/22/16 04 19 07126/16 22 32 5220D COD Analytical Method SM 5220D Chemical Oxygen Demand ND mglL 25 0 1 07/27/16 11 00 Date 07/27/2016 11 35 PM REPORT OF LABORATORY ANALYSIS This report shall not be reproduced except in full without the wntten consent of Pace Analytical Services Inc Page 8 of 16 aceAnaljftal wwwpacelabs com Pace Analytical Services Inc 2225 Riverside Dr Asheville NC 28804 (828)254 7176 QUALITY CONTROL DATA Project Oaks 6 051-01 1A Pace Project No 92306067 QC Batch 322743 Analysis Method SM 2540D QC Batch Method SM 254DD Analysis Description 2540D Total Suspended Solids Associated Lab Samples 92306067001 92306067002 92306067003 92306067004 92306067005 METHOD BLANK 1788064 Matrix Water Associated Lab Samples 92306067001 92306067002 92306067003 92306067004 92306067005 Blank Reporting Parameter Units Result Limit Analyzed Qualifiers Total Suspended Solids mg1L ND 2 5 07/27/16 12 25 LABORATORY CONTROL SAMPLE 1788065 Parameter Units Total Suspended Solids mg/L SAMPLE DUPLICATE 1788066 Parameter Units Total Suspended Solids mg/L SAMPLE DUPLICATE 1788067 Parameter Total Suspended Solids Units mgIL Spike LCS Conc Result 250 248 92305939002 Dup Result Result 1340 1170 92306092001 Dup Result Result 86 92 LCS % Rec % Rec Limits Qualifiers 99 90-110 RPD Qualifiers 14 D6 RPD Qualifiers 7 ❑6 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 07/27/2016 11 35 PM without the written consent of Pace Analyticai Services Inc Page 9 of 16 aceAnalytical wwwpaceiabs.com Pace Analytical Services Inc 2225 Riverside Dr Ashevilie NC 28804 (828)254 7176 QUALITY CONTROL DATA Project Oaks 6 051-01-1A Pace Project No 92306067 QC Batch 322431 Analysis Method SM 4500-H+B QC Batch Method SM 4500-H+B Analysis Description 45001-1+8 pH Associated Lab Samples 92306067001 92306067002 92306067003 92306067004 92306067005 SAMPLE DUPLICATE 1786614 92304560001 Dup Parameter Units Result Result RPD Qualifiers pH at 25 Degrees C Std Units 7 5 75 1 H6 SAMPLE DUPLICATE 1786615 92306C20005 Dup Parameter Units Result Result RPD Qualifiers pH at 25 Degrees C Std Units 62 63 1 H6 Results presented on this page are in the units indicated by the Units column except where an alternate unit is presented to the nght of the result REPORT OF LABORATORY ANALYSIS This report shall not be reproduced except in full Date 07/27/2016 11 35 PM without the written consent of Pace Analytical Seances Inc Page 10 of 16 aceAnalytical wwwpacelabs cam Pace Analyticaf Services Inc 2225 Riverside Dr Asheville NC 28804 (826)254 7176 QUALITY CONTROL DATA Project Oaks 6 051-01 1A Pace Project No 92306067 QC Batch 322132 Analysis Method SM 5210B QC Batch Method SM 5210B Analysis Description 521OB SOD 5 day Associated Lab Samples 92306067001 92306067002 92306067003 92306067004 92306067005 METHOD BLANK 1785342 Matnx Water Associated Lab Samples 92306067001. 92306067002 92306067003 92306067004 92306067005 Blank Reporting Parameter Units Result Limit Analyzed BOD 5 day mg/L ND 2 0 07/26/16 22 32 LABORATORY CONTROL. SAMPLE 1785343 Spike LCS Parameter Units Conc Result BOD 5 day mg/L 198 189 SAMPLE DUPLICATE 1785344 92306092001 Dup Parameter Units Result Result BOD 5 day mg/L 429 489 Qualifiers LCS % Rec % Rec. Limits Qualifiers 95 846 1154 PPE) Qualifiers 13 06 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 07/27/2016 11 35 PM without the written consent of Pace Analytical Services Inc Page 11 of 16 aceAnaljdical wwwpacefabs com Pace Analytical Services Inc 2225 Riverside Dr Asheville NC 28804 (82B)254 7176 QUALITY CONTROL DATA Project Oaks 6 05L01 1A Pace Project No 92306067 QC Batch 322464 Analysis Method SM 5220D QC Batch Method SM 5220D Analysis Description 5220D COD Associated Lab Samples 92306067001 92306067002 92306067003 92306067004 92306067005 METHOD BLANK 1786770 Matrix Water Associated Lab Samples 92306067001 92306067002 92306067003 92306067004 92306067005 Blank Reporting Parameter Units Result Limit Analyzed Chemical Oxygen Demand mg1L ND 25 0 07/27/16 11 00 Qualifiers LABORATORY CONTROL SAMPLE 1786771 Spike LCS LCS % Rec Parameter Units Conic Result % Rec Limits Qualifiers Chemical Oxygen Demand mg1L 750 778 104 90-110 MATRIX SPIKE & MATRIX SPIKE DUPLICATE 1786772 1786773 MS MSD 92305350001 Spike Spike MS MSD MS MSD % Rec Parameter Units Result Conc Conc Result Result % Rec % Rec Limits RPD Qua[ Chemical Oxygen Demand mg/L 10800 750 750 11800 11800 131 131 90-110 0 M6 MATRIX SPIKE & MATRIX SPIKE DUPLICATE 1786774 1786775 MS MSD 92305188001 Spike Spike MS MSD MS MSD % Rec Parameter Units Result Conc Conc Result Result % Rec % Rec Limits RPD Qual Chemical Oxygen Demand mg& 7490 750 750 8880 8880 185 185 90 110 0 M6 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 07/27/2016 11 35 PM without the written consent of Pace Analytical Services Inc Page 12 of 16 aceAnalytrcal wwwpaL6abs.com Pace Analytical Services Inc 2225 Riverside Dr Asheville NC 28804 (828)254 7176 QUALIFIERS Project Oaks 6-05L01-tA Pace Project No 92306067 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 J Estimated concentration above the adjusted method detection limit and below the adjusted reporting limit MDL -Adjusted Method Detection Limit POL Practical Quantitation Limit RL - Reporting Limit S - Surrogate 1 2-Diphenyihydrazine 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 Styrene and Vinyl chlonde A separate vial preserved to a pH of 4-5 is recommended in SW846 Chapter 4 for the analysis of Acrolein and Acrylonitnle 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 Analyticaf is TNI accredited Contact your Pace PM for the current list of accredited analytes TNI The NELAC Institute LABORATORIES PASI A Pace Analytical Services Asheville ANALYTE QUALIFIERS B2 Oxygen usage is less than 2 0 for all dilutions set The reported value is an estimated less than value and is calculated for the dilution using the most amount of sample D6 The precision between the sample and sample duplicate exceeded laborafcry control limits H6 Analysis initiated outside of the 15 minute EPA required holding time M6 Matrix spike and Matrix spike duplicate recovery not evaluated against control limits due to sample dilution REPORT OF LABORATORY ANALYSIS This report shall not be reproduced except in full Date 07/27/2016 11 35 PM without the written consent of Pace Analytical Services Inc Page 13 of 16 aceAnalytical wwwpacelabs cam Pace Analytical Services Inc 2225 Riverside Dr Asheville NC 28804 (828)254 7176 QUALITY CONTROL DATA CROSS REFERENCE TABLE Project Pace Project No Oaks 6 051-01 1A 92306067 Analytical Lab ID Sample ID QC Batch Method QC Batch Analytical Method Batch 92306067001 S1 SM 2540D 322743 92306067002 S2 SM 2540D 322743 92306067003 S3 SM 2540D 322743 92306067004 S4 SM 2540D 322743 92306067005 S5 SM 2540D 322743 92306067001 S1 SM 4500-1-1+13 322431 92306067002 S2 SM 4500 H+8 322431 92306067003 S3 SM 4500-H+B 322431 92306067004 S4 SM 4500-H+B 322431 92306067005 S5 SM 4500 H+B 322431 92306067001 S1 SM 5210B 322132 SM 5210B 322152 92306067002 S2 SM 52108 322132 SM 5210B 322152 92306067003 S3 SM 5210B 322132 SM 5210B 322152 92306067004 S4 SM 5210B 322132 SM 5210B 322152 92306067005 S5 SM 5210B 322132 SM 52109 322152 92306067001 S1 SM 5220D 322464 92306067002 S2 SM 5220D 322464 92306067003 S3 SM 5220❑ 322464 92306067004 S4 SM 5220D 322464 92306067005 S5 SM 5220D 322464 Date 07/27/2016 11 35 PM REPORT OF LABORATORY ANALYSIS This report shall not be reproduced except in full vnthout the written consent of Pace Analytical Services Inc Page 14 of 16 117palceAnalyhcal Condition Document No F ASV CS 003 Rev 20 Page 1 of 2 Issuing Authority Pace Asheville Quality Office Simple Condition 11pon Client Name Receipt MPr -lect # �� Courier ❑Fed Ex clbps ❑U5P5 ivotent ❑ Commercial ❑Pace ❑Other WQ# : 9230606�-_,, nniry I23l06057llllnlllllll Custody Seal Present? ❑Yes No Seals Intact? []Yes ❑No Date/initials Person Examining ContentPo- TZ PFun Material ❑Bubble Wrap ❑Bubble Bags one ❑other Tmeter #S SN 15527198 Type of I e Wet ❑Blue ❑None ❑Samples on ice cooling process has be un Correction Factor 0 0'CeJA' I'rTemp Corrected ( C) Biological Tissue Frozen? ❑Yes [-]No L.". _ Temp should be above fro 6 C USDA Regulated Soil (ter sample) Did samples originate in quarantine zone within the United States CA NY or SC (check maps)? Did samples originate from a foreign source (internatio Ily ❑Yes ❑No raduding Hawan and Puerto Rico)? ❑Yes ❑ 7' Comments/Discrepancy Chain of Custody Present? a ❑No ❑N/A 1 Samples Arrived within Hold Time? es [!]No ❑N/A 2 Short Hold Time Analysis 5<72 hr )? es ❑No ❑N/A 3 Rush Turn Around Time Requested? ❑Yes o ❑N/A 4 Sufficient Volume? 9<s ❑No ❑N/A S Correct Containers Used? �ty❑No [:]No❑N/A 6 Pace Containers Used? ❑N/A Containers Intact? Zlyes ❑No ❑N 7 Samples Field Filtered? ❑Ye ❑No N/A 8 Note if sediment is visible in the dissolved container Sample Labels Match COC? es ❑No ❑N/A 9 includes Date/Time/ID/Analysis Matrix All containers needing acid/base preservation have been 10 Hr:a]pikz checked? es ❑No El NIA All containers needing preservation are found to be in Ha OH r compliance with EPA recommendation? 112so4PH z (HNOs, H2SO4, HCIc2, NaOH >9 Sulfide NaOH>12 Cyanide) es ❑No ❑N/ Exceptions VOA, Coliform TOC Oil and Grease rr.oiiaii 1z DRO/8015 (water) DOC,LLHg ❑Y ❑Na N/A Ha0H1Zn0AcpWt Samples checked for dechlormation? Yes ❑No ❑N/ 11 Headspace in VOA Vials (>5 6mm)? ❑Yes ❑No N/ 12 Trip Blank Present? ❑Yes ❑No 13 Trip Blank Custody Seals Present? ❑Yes ❑No Z/A Pace Trip Blank Lot # (if purchased) CLIENT NOT] FICATION/RESO LUTI ON Person Contacted Corn ments/Sampie Discrepancy Date/Time Field Data Required? Dyes ❑No Project Manager SCURF Review A, Date ZLIz 1 Project Manager SRF Review Date 2( / Note Whenever there is a discrepancy affecting North Carolina compliance samples a copy of this form will be sent to the N rth Car6lina DEHNR Certification Office (i e Out of hold incorrect preservative out of temp incorrect containers! Page 15 of 16 � PaceAnalyt�cal" CHAIN -OF -CUSTODY 1 Analytical Request Document The Chain of Custody is a LEGAL DOCUMENT All relevant fields must be completed accurately Section A Section S Section C Page of un Required Client Waffnalion Required Pro;ect €nformallon Invoice Information Com any Report To Allenlion 20 5905 26� Address Copy To Company Name REGULATORY AGENCY } Address r NPDES T- GROUND WATER F DRINKING WATER j UST r RCRA bI- OTHER EmaJ To }� Purchase Order No /� ao 0 cuoie Lf ..-. V ronm Phone Fax Prefect Name O ` Paco Prnl°cl !7 9 4 `� Maniger r� Site Location STATE 4 r �'-" Requested Duo DatafTAT Project Number v PicoPrafraN Requested Analysis Filtered (Y/N) Section D Matrix Codes c x RequrradCl,ant lntom,ahon MATRIX r CODE, -" COLLECTED Preservatives } Drinking Water DW O o Water WT Waste Water WW v m COMPOSITE COMPOSITE U _ Product P Q S7ART CNtlICRA6 J SaillSoltd SL Y� p SAMPLE ID ail OL " C3 C Wipe WP (A Z 0 91 j Air AR Lu `- w 4 a Ul z 47 H o` Sample IDs MUST BE UNIQUE Tissue TS Ci U a � w H v a, Z U Other OT z OOV Q p N # a a a U v 0 n S N M rC y rL 73 a to Q x O c 11 V h ~ w DATE TIME o�rE TIME N 3 = x z z 2- O .a.' Pace Protect No 1 Lab I D 1 w7- 7-7. 13 2 S a7 1trr G 7-to ?,§p a q 6 7-Zd " 4 6 -�: Yi O fi 7 8 9 10 11 +1 121 1 1 ADDITIONAL COMMENTS RELIN f AFF[L1A DATE TIME ACCEPTED BY I AFFILIATION DATE TIME SAMPLE CONDITIONS SAMPLER NAME AND SIGNATURE ©RIGIN,8L PRINT Name of SAMPLER > > N a } m } SIGNATURE of SA1Mf EA DATE Signed `] � i 4 E 12 ca - U y a� (MMIDDNY) / rE Imporl7ni Note By signing this loran you ore ,cv�phnq Paces NET 30 day piyniLm ierms Ind ngfCeb,g to Idn- chlnigs 4f 1 5 V per monih for any Invoico5 not paid within 3n days F ALL Q 020rev 07 15 May 2007