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NCG140002_MONITORING INFO_20160311
STORMWATER DIVISION CODING SHEET NCG PERMITS PERMIT NO, lv y'[� Del a DOC TYPE ❑ HISTORICAL FILE P/MONITORING REPORTS DOC DATE ❑ YYYYM M DD STORMWATER DISCHARGE OUTFALL (SDO) - Semi -Annual MONITORING FORM `- GENERAL PERMIT NO. NC6140000 CERTIFICATE OF COVERAGE NO. NCG14 11 O FACILITY NAME: PERSON COLLECTING SAMPLES - �.� CERTIFIED LABORATORY? C-1 C.f' Lab # L41 Lab # OPTIONAL INFO: Pa rt A: Stormwater Monitoring Requirements uirements SAMPLE COLLECTION YEAR: 3 D G- - aD l 0 SAMPLING PERIOD: ® July -December ❑ January -June COUNTY �4 t4'> _ PHONE NO. ( RS?4 y c{ _X t 1 ADD TO LISTSERVE? []YES ®NO EMAIL: DISCHARGING TO CLASS: ❑SA ❑HQW ❑PNA ❑Trout [00ther-�.�� a f` OutfallNo �, a{mo/dd/yrOf2.:., ° sup f r ti €�•, T . ,, a a i Z;. NO:I•LOW} r Ay. r 3 r Pwr s.. t ;_ (Standard.-: rDuration �, j lJnIt51` T K9 3 r - T55 r r �u �, si(mltlllte5} !Event E t .Rainfall .-:•� • (Ind ,Monthly ; y r t !: ;Moriitoring?w # of Months rn Tier .,. =}:-t�2 Sampling ...a1.:-;? . fY' c -.. AD ! r- -� a .� �,�v 1t7 K 0� ' if "NO FLOW" or "NO DISCHARGE, Enter "NO FLOW" or "NO DISCHARGE" for each outfall here. Please make sure to mark the sample period above. 2 If a value is in excess of the benchmark, or outside the benchmark range (for pH), you must implement the Tier 1 or Tier 2 responses in the General Permit. Tier 2 Monthly sampling shall be done until 3 consecutive samples are below the benchmark or within the benchmark range. 3 TSS benchmark values are 100 mg/I, except when discharging to ORW, HQW, Trout, and PNA waters where they are 50 mg/I. ° For each sampled measurable storm event the total precipitation must be recorded using data from an on -site rain gauge. CEIVED R 11 Z046 w4L FILES SECTION Permit Date: 7/1/2011-60/30/2015 Last Revised 7/13/11 Page 1 of 2 Part B: Vehicle Maintenance Activitv Monitoring Requirements for facilities using > 55 gal of new motor oil/month - averaged over a calendar year. ss�s��• -W.. `.T`-,ri"- -. 1s, raE: .-,w;blr::r�-.'r"'..-'?-•. C►t:tfa No .,��. a J ,xu ,r .y _h---: s. -a,. ;n ;'= i3 f. zY.' . �_ - Date:Sam le:.. ,.- =3vp�K Collected r ., a: mo/dd/yrfr .i ( a. ..... �s'x',�. -1 .„7 Fc : '-:::s.=_ �s -.: , :ii-rs •`Tt,e a=>-: ;. _.� x'. ,4.-:E _.g,..-r. ..,s ,=i �. nits � ka' 3^ ,:a �,.;b_-� ._ ,r—. fir.' ... ', 3'�E, ^rLst_ a '`1 i':,. - _.?.:- r ...,,, 'fix Ili. w.>.. ��.�". a TPH using.method . , , •.1S64A SGT-HFM a � ,; m" L �:tk ;� a.. `.� �s."z;�- .w,rr :tc.' ...x': s i�'�iySSa. - k:s: 'n t .�sSe: r !'F_' x ..s .z'� „at <.. _ Total SusperidedY•> 1 ..ew w x .Solids , r , :r: dux -_ r m L ? r r '?a�F• ._ ;; us.sx'.: i .Y t; x d.: s t",`•.:•.., :i Njr�_. .. i.?*.-..F'^ .,: , -Event„°TotalNewMofor ;,� Y bra! Durations. ...,sxy' ii v. ' r1 - rr a'u r -�€ i � T- Y.7' 1 "s-.� C .y .�A^Y :.A,�. : �: °' Rainfall -{s .: ra: y,<.n :, •c- , r ,, S q2.'C 4��y •:.4': -?. :.;?v.t ail E �..d'.a,,� _.,�...-��•, ���>�:r Od , . ,Usage q, �, •=ii"?1...,;-.:_, -ts. c e ? `.:.�c::�:�� }; �. r �. z+4 °a . L..», Aln Tier.2� - �;� q',',.:i1 y ev 'Monitoring 13 u4 1•+"'' •. "�;�.�` - s".#. nf:IVlonths- .,rtiri Tier 2x .. ,. r ry x s 3 :tS.:. „ h':^�_-.s.. wT+.a _.; .. r"-,. r"_: ,. ;£.: -: ...i•: .',;=�-e., "' ,. l.� �t ��x# 5 HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES AT ANY ONE OUTFALL (INCLUDING VEHICLE MAINTENANCE)? YES ❑ NO P1 HAVE YOU CONTACTED THE REGION? YES [:]NO REGIONAL OFFICE CONTACT NAME: Mail Original and one coov of this DM (including all "No Flow" & "No Discharge" reportsl within 30 days of receipt of sample (or at end of monitoring period in case of "No FlowD 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 tly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. am aware t t =her are signi cant pe alties for submitting false information, including the possibility of fines and imprisonment for knowing violations." (Sign atu o r` nittee) (Date) Permit Date: 7/1/2011-60/30/2015 Last Revised 7/13/11 Page 2 of 2 NC6jq000a- a0IT Al izA. NCDENR Stormwater Discharge Outfall (SDO) Qualitative Monitoring Report For guidance on filling out this form, please visit:http:l/poEnt.ncdeiir.-Q;-,u,,/webAwq/ws/-aiL/lipde-s..sw#La 4 Permit No.: N/-C/_ Facility Name: County: f A& -I- Inspector: Date of Inspection: Time of Inspection: I—� - Total Event Precipitation (inches): or Certificate of Coverage No.: N/C/C/L/'-1/'0l61Q111 Phone No. Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit? (See information below.) `B- Yes ❑ No Please verify whether Qualitative Monitoring must be performed during a "representative storm event" or "measureable storm event" (requirements vary, depending on the permit). Qualitative monitoring requirements vary. Most permits require qualitative monitoring to be performed during a "representative storm event" or during a "measureable storm event." However, some permits do not have this requirement. Please refer to these definitions, if applicable. A "representative storm event" is a storm event that measures greater than 0.1 inches of rainfall and that is preceded by at least 72 hours (3 days) in which no storm event measuring greater than 0.1 inches has occurred. A single storm event may contain up to 10 consecutive hours of no precipitation. A "measurable storm event" is a storm event that results in an actual discharge from the permitted site outfall. The previous measurable storm event must have been at least 72 hours prior. The 72-hour storm interval does not apply if the permittee is able to document that a shorter interval is representative for local storm events during the sampling period, and the permittee obtains approval from the local DWQ Regional Office. By this signaturwf ce�tify that this report is accurate and complete to the best of my knowledge: (Signature of P-e-rmittee or Designee) Page 1 of 2 5WU-242, Last modified 10/25/2012 *W01G600W3X I 1. Outfall Description: Outfall No. `�S��dl , Structure (pipe, ditch, etc.) _ Receiving Stream: -►"I bsk -� f ' iG-i�12752 Describe the industrial activities t at occur with' the oui L1tfVt-- drainage area: 2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint (light, medium, dark) as descriptors: , !E,Vd b 11 `- 3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil, weak chlorine odor, etc.): 4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is clear and 5 is very cloudy: (P 2 3 4 5 5. Floating Solids: Choose the number which best describes the amount of floating solids in the stormwater discharge, where 1 is no solids and S is the surface covered with floating solids: 0 2 3 4 5 6, Suspended Solids: Choose the number which best describes the amount of suspended solids in the stormwater discharge, where 1 is no solids and 5 is extremely muddy: (11 2 3 4 5 7. Is there any foam in the stormwater discharge? Yes 100 8. Is there an oil sheen in the stormwater discharge? Yes 1 0 9. Is there evidence of erosion or deposition at the outfall? Yes 10. Other Obvious Indicators of Stormwater Pollution: List and describe Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition may be indicative of pollutant exposure. These conditions warrant further investigation. Page 2 of 2 SWU-242, Last modified 10/25/2012 k L acgAnalytical ..pacembxcam November 13, 2015 Mr. Johnny Baines Eastern Environmental Management PO Box 4030 518 S. Pearl Street Rocky Mount, NC 27803 M Paco Analytical Services, Inc. 9800 KinceyAve. Suite 100 Huntersville, NC 28078 (704)875-9092 RE: Project DPD RM arbro Pace Project No.: 92274350 Dear Mr. Baines: Enclosed are the analytical results for sample(s) received by the laboratory on November 03, 2015. 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 anaiyte page for analysis unless otherwise footnoted. If you have any questions concerning this report, please feel free to contact me. Sincerely, r Taylor Ezell taylor.ezell@pacelabs.com Project Manager Enclosures cc: Ms. Cathy Baines, Eastern Environmental Management REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, without the written consent of Pace Analytical Services, Inc.. Page 1 of 12 r" i 1?� aceAr�aly�ical " , ::' w�vw.paeebzbs cam CERTIFICATIONS — -Pace Analytical Services, Inc: ' 9800 KinceyAve:, �Sute 100 Huntersville, NC 28078 — - — -- —-(704)875-9092.,_,..._..._.,.-- Project: DPD RMT-Tarbro Pace Project No.: 92274350 Charlotte Certification IDS 9800 Kincey Ave. Ste .100, Huntersville, NC 28078 Fiorida/NELAP Certification #: E87627 North Carolina Drinking Water Certification #: 37706 Kentucky UST Certification #: 84 North Carolina Field Services Certification #: 5342 West Virginia Certification #: 357 s., _ ,1t f;;,l.,, •,i; North Carolina Wastewater Certification #: 12 VirginiaNELAP Certification #: 460221 - South Carolina Certification #: 99006001,r'r Asheville Certification IDS 2225 Riverside Drive, Asheville, NC 28804 North Carolina Wastewater Certification #: 40 Florida/NELAP Certification #: E87648 South Carolina Certification #: 99030001 " —Massachusetts Certification #;-M-NC030 West -Virginia Certification #: 356 North Carolina Drinking Water Certification #: 37712 VirginiaNELAP Certification #: 460222 REPORT'OF, LA60RATORY ANALYSIS _ This repart shall not N reproduced, except in full ;74;;� without the written consent of Pace'Analytical Service§, J y5 i q' as,> Page 2 of 12 , 1 aceAnalj4 cal :wnnr.A8celaGatom SAMPLE ANALYTE COUNT Project: DPD RMT Tarbro Pace Project No.: 92274360 Pace Analytical Services, Inc. 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 Lab ID Sample ID Method Analysts Analytes Reported - Laboratory 92274350001 SD01 - R EPA 16648 JMS 1 PAST-C S8l25406 SAM 1 PASI-A SM 254&"' MJP 1 PASI-A' 92274350002 SDO1 - T EPA 16648 ` JMS k •, 1 PASI-C SM 2540D SAM 1 PASI-A SM 2540F -. MJP 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 12 E 'ANALYTICALkE§U"L'T"S"_ HA&sville, NC 28076 (704)875-9092 Project: DPD RMT-Tarbro LI Pace Project No.: -,k27.4350 Sariiple; SID01 Labil): 92274350001 Collected: 11102JI5 10:00 :Received: 11103115 09:30 Matrix: Water P �Results... .Report Limit DF_....,_., Prepared Parameters Units Ta tffs4..:" 'Analyzed--- CAS No_;., HEM, OilandGrease Analytical Method: EPA 1664B Oil ariii Grease ND mg/L 5.0 1 11/12/15 07!40 2540D-T6tal Suspended Solids Analytical Method: SM.2540D Total Suspended Solids 28.3 md/U.'14". 3,3 1 11104115 10:20 254OF to61 Seffloible Solids Analytical Method: SM 254OF Total Settleable Solids ND mUUhr 0.10 1 11103115 22:35 IaIRIEP , 0 , R I TOF . LABO " fzAt6ikY,A:R I ALYs is "hl' bereoro'd4e'c'ed�'except in full. Date:1-1/13/2015 12:44 PM the of j P.P66'46aiy peal 5ervices;ilric.. ti Page 4 of 12 aceAnalytical rwww.paceta6a.wm ANALYTICAL RESULTS Project DPD RMT-Tarbro Pace Project No.: 92274350 Pace Analytical Services, Inc. 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 . •(704)875-9092 Sample: SD01 - T Lab ID: 92274350002 Collected: 11/02/15 10:30 Received: 11/03/15 09:30 Matrix: Water Parameters Results Units Report Limit OF Prepared Analyzed. CAS No. Qual HEM, Oil and Grease Analytical Method: EPA 1664B Oil and Grease NO mg/L 5.0 1 11/12/15 07:40 ' 2540D Total Suspended Solids Analytical Method: SM 2540D.• . Total Suspended Solids 157 mglL 25.0 1 11/04/15 10:21 254OF Total Settleable Solids Analytical Method: SM 254OF Total Settleable Solids NO mUUhr 0.10 1 11/03/15 22:35 Date: 11/13/2015 12:44 PM REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, without the written consent of Pace Analytical Services, Inc.. Page 5 of 12 aG` ` F Analytical _i,+:�',�,� st�.www.pacelabsoam ' - -- ... --- --- ------ - --- ----- - - --pace Analytical Services, Enc. '-- — Y 9800 KmlceyAve Sud'ee100 Huntersville, NC 28078 ~ (704)875-9092 QUALITY CONTROL DATA Project: DPD RMT-Tarbro Pace Project No.: 92274350 QC Batch: GCSV123181 Analysis Method: EPA 1664E QC Batch. Method:' EPA 1664E Analysis Description: 1664 HEM, Otl and Grease Associated Lab Samples: `92274350001, 92274350002 METHOD BLANK: i1604434 k �} Matrix: Water Associated Lab Samples: r-92274350001, 92274350002 Blank Reporting Parameter r Units Result Limit .-.--,Analyzed Qualifiers Oil and Grease ._W_ mg/C ND 5:0-11112/15 07:35 LABORATORY CONTROL SAMPLE: 1604435 Spike LCS LCS % Rec Parameter Units Conc. Result % Rec Limits Qualifiers Oil and Grease mg1L 40 33.7 84 78-114 MATRIX SPIKE SAMPLE: 1604436 92275153001 Spike MS MS % Rec Parameter Units Result Conc. Result % Rec Limits Qualifiers Oil and Grease mg1L ND 40 35.0 88 78-114 Results presented on this page ate In the units Indicated by the 'Units' column except where an altemate unit is presented to the right of the result r REPORT'OF LABORA70RY-ANALYSIS This report shall not beNreproduced, excepttlr full, Date: 11/1312015 12:44 PM without the wntten:consent of Pace Analytical lk. Page 6 of 12 acsAnalytical . .. wwir.'pacela6s.com QUALITY CONTROL DATA Pace Analytical Services, Inc. 9800 KinceyAve. Suite 100 V1�1':,Hurttersville,'NC 28078 ;. (704)875-9092 Project DPD RMT-Tarbro Pace Project No.: 92274360 QC Batch: WET141198 Analysis Method:, ; ";:�:, ^5M 25400 QC Batch Method: SM 2540D Analysis Description:.,. ,25400 Total Suspended Solids Associated Lab Samples: 92274350001, 92274350002 METHOD BLANK: '1598226 Matrix: Water .:,,1 `: • Associated Lab Samples: 92274350001, 92274350002 Blank Reporting Parameter Units .., Result, ,. Limit Analyzed,_ Qualifiers .. , Total Suspended Solids 'mg/L ! ND 2.5 11I04I15.10 18 -,.. LABORATORY CONTROL SAMPLE: 1598227 Spike LCS LCS % Rec Parameter Units Conc. .Result % Rec :Limits Qualifiers .:- Total Suspended Solids mg/L 250 -.242 97 90-110 SAMPLE DUPLICATE: 1598228 92274504001 Dup Parameter Units Result Result RPD Qualifiers Total Suspended Solids mg[L 78.0 78.0 0 SAMPLE DUPLICATE: 1598229 92274481001 Dup Parameter Units Result Result RPD Qualifiers Total Suspended Solids mg/L 28.4 7.0 121 D6 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: 11/13/2015 12:44 PM without the written consent of Pace Analyticar Services, Inc.. Page 7 of 12 v aceArralyiical dU A L If"Y"t 6A f 'R 0 L-- DATA wA, -,-,Pace Analytical Servi;cts tFE 6900 Kincby.Ave'i S!Jlte•100 .Project: DPD RMT-Tarbro Pace Project No.: 92274350 . . . .... .... . ....... QC Batch: WET141192 Aj�alysis SM 2540E 4 QC Batch Method: SM254OF ' :' lysis Description' -,�2540`Tb6lSettable W Solids . J.. .,�-.. Ass6ciated Lab Samples: 92274350001,92274350002 METHOD BLANK: 1598139 Matrii:,Wat,ier Associated Lab Samples: 92274350001,92274350002 Reporting' Pa 'meter Units Resulf'"-� Limit A nalMd Qualifiers Total Settleable Solids mIJL/hr NU-- 07.1-61-1/63]15-22.35 SAMPLE DUPLICATE: 1598140 -92274350001 Dup Parameter Units ""Result ',"Result RPD Qualifiers Total Settleable Solids mUUhr ND ND u- -�R&ults$resent(idlc�n this Age a41n the'units i6djcated iiy thi -units- c6l nui except are an 21ternato unit Is presented to e'right of iio result REPORT 0 F) Lr:)AA-0JR-A` T`10RY"A'NA` LY S I S This report ifiiil not be re-p,ro,ducea;i except In full, Es;";Dato: 111,1312015 12:44PM w—rit;ie�-,n,consentof Page 8 of '12 .9 aconalytical w,nrpacefabscnrri QUALIFIERS Project: DPD RMT-Tarbro Pace Project No.: 92274350 DEFINITIONS Pace Analytical Services, Inc. 9800 Kincey Ave. Suite 100 Huntersville, NC 2807a . (704)875-9092 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. PQL - Practical Quantitabon Limit. RL - Reporting Limit. 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 Calcuiable. SG -Silica Gel - Clean -Up U - Indicates the compound was analyzed for, but not detected. Acid preservation may not be appropriate for 2 Chloroethylvinyi ether, Styrene, and Vinyl chloride. 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. ■_I-INIZ7_111101011*: PASI-A Pace Analytical Services - Asheville PASI-C' Pace Analytical Services - Charlotte ANALYTE QUALIFIERS D6 . The relative percent difference (RPD) between the sample and sample duplicate exceeded laboratory control limits. REPORT OF LABORATORY ANALYSIS This report shatl not be reproduced, except in full, Date: 11I1312015 12:44 PM without the written consent or Pace Analytical Services. Inc.. Page 9 of 12 jalyt QUALITY CONTROL ID-iATA 7 CROSS REFERENCE TABLE ------ -Pace -Analytical Services; IhF Y,9800 Kincey AveSvfte 100, Hunt&ville, NC 28078 �4704)137$:9092 Project DPD RMT-Tarbro ,Pace Project No,: .-92274350 iEi -16 Lab ID i Sample 66 Batch Method --dd Batch Analytical Method 'Batch 92274350001 SDOI - R .':EPA 1664B = GCSV/23181 2500 2�435b 2 S bbl"'- T' E0Ai6'64B SV/23181 - -r6 0274350001 SDO1 R SM 25401) W&/41 198 92274350002 '-SE)01 T SM 2540D WET/41198 92274350001 §D01.- R SM 254OF WET141192 SM-254OF - WET141192 kE06kt 604kB6k4tibkY'AhACYtis "7his 600t'i6ll ri6i b6 re`0r0duC43d,`,5;k6pt !�Zll, Date: 1111312015 12:44 PM vAth66 the -"wri:tt'e-'nconsent �8i'Pic'e'Ahilytic'aI Services, Inc.. Page 10 of 12, uccumenc Name: Liu_ l:ul IICI IL MCV IJCu. iJiay iu, &V I'- aceAnalytica!' Sample Condition U on Recei t ` SCUR Page 1 of 2' Document Number: t issuing Ailthority: I~-CHR-CS-003-rev.At , i Pace Huntersville 06ali Office Client: Name. `Page 2 of 2:s for Internal Use Only CFed E❑ UPCommer. ourier,. r :' Custody Seal`on CoolerfBox Present: ❑ ryes Y rta 5eals'iniact:. El:yes ❑, no I PjDuel?ate 4t�;. li Packing Material: ❑ ;Bubble Wra Bubble Bags ❑ None. [],',,Other Thermometer Used: IR 40 Gun. ) Type.of Ice: Wet Blue None ampler on Ice, coollrig process.has begun Temp Correction Factor T1402 No Correction + r -. Carrectt3d Cooler.Temp t' , ' ° •C Biological Tissue is Frozen Yes No 'N! ate and Initials of perso exam'nin ; contents 3 ' Temp shoutd'be above freeiing to 6'GI Comments:' ; Chain of CUS#ody Present:: a :; ❑ es.JQ No :❑NiA Chain.df Custody'Filled Out. "' ' es -b , ,❑ A. 2. s ', i Chain of dustod`y Relinquished: ❑Yes ❑NIA 3. i 1 " i - Sampler. Name &Signature on. COC::i es o ❑NIA 4, J Samples Arfived within Field Timer Yes NQ ❑NIA 5 Short'Hold:Time Analysis (<72hr): Yes ❑f.- ❑NIA, 6 1 , Rush Turn'Around Time Requested: ❑Yes o :❑NIA 7. Sufficient Volume: ❑ en j2No . ❑NIA $; i Coriect Contairers Used: es No ❑Nia r. g, ' - -Pace COntainers Used: 7' . es ' ` No ❑NIA . .. r Containers Intact. Ye' s ❑No ❑NIA 10. _ Filtered,vZ'rme receivBd for.Dissolved'tests . .0Yes No NIn,', 11. Sample Labelsima#ch COC: ls' c es '❑No ON/A.12. ' . -includes date/time/ID/Analysis Matrix: All containers needing preservation nave been checked. . ' Dyes ONO 0N1A 13. Ail containers needing:preservadon are found to'be in OY.,eSs ❑Na ❑NJ'A compliance with EPA:recommandaiion:; - A ,_ excepions: VOA, wfifcrm,1'Oc,1o&G; WI=DRO (water) Samples checked"far deciilo'rination: 13Yes ON. NI ° 14. Headspace in VOA Vials :>Brnm}: ©Yes ❑No hik 5. Trip Blank Present: - ... 'byes []No '61NIA` 16. Trip Blank Custody:Seals Present Oyes ❑No 2eA Pace Trip Blank L'ot,# (if purchased}: Client Notificationf Resolution: Field Data Required? Y 1 N Person Contacted: DatefTime Comments! Resolution: SCURF Review: - - Date: I 1 It � SRF Review: Date: 1 bi 9227435 WO . Note:. Whenever' there is'a ,discrepancy affecting North Carolina compliance samples, a copyof this form will be sent to the North Carollna DEHNR Certification Office.( Le out of hold, incorrect preservative, out of temp, 2274350 . .............. . .. incorrect containers) . .. Page 11 of 12 o CHAIN -OF -CUSTODY ! Analytical Request Document ' PaceAnaly6ca! The Ghaln-0f-Custody is a LEGAL DOCUMENT. All relevant -fields must be completed accurately - ..- p�selaW.cam e. r }� '•fir a' 1 r t � I Section A i - s Sactibn B _ G 5ectlon.G Paga , c _ i[e.��Ruind (."k-� f%o, lnfoat _ lormReuliod a--=- on- :enn: i a # - t %tenon,CL �.I.n ; ComRaM1 .Name: GEfdC.E.:.Y REGULA- T• '- s 70." NPDES r `- GROUND WATER :"(" DRINKING WATER Purchase 3 Order Na ?.. I :... . - -- -:.� ° - •.' - r i UST RCRA r - - k- ". - i F OTHER suG Prged Ph C. �" . i `�VLJ Name Y - �' -, tJ ; i _ [.: 1 f1; / _ L• iJN '' pace plgea �- Manager Site Localloa : a < Re u@afad•DnexDatefT_ AT .'i' Project Number..-•: STATE _ .._9. .-' .• ... _.. i,_ '..'., .. 1 : Regiies d nalys[s ed (YlN) t Fiite r A `i B , Sectlan r s - . i20�llir �tipl l l (a aaikll: MatRDc f cof]E o . COLLECTED Preservatives r Dnnkirq wafer DW 72, :9 c! , z f _ - - Waste water WW , . ATE "'. _ Praduc!- 3 P r'� SoIVS05d. -i i E Fi[E �� - Z4 _. SL'f SAMP_L'E'ID," `,{A•2:b-91,: 1" I A ,: lures 'ARC" Xs to tbs MusT Brz UN1pUE'±' Tissue " TS ': -Q•. O" w ya '.!a- m ; ui 'X' ,i W '. :ice - a - O. -N :QrO 0_ : O O - t E f?1T ssue' vi s27 HI DATE : TIME DATE - TIME, N .:lt Z Z T Z Z Z D ;» :.{ .? ' r ' : - .�I ';'-Pace project Not Lacs I.D.- i- 4 - 1 F r, _ L 1 1 7, ,3 l � 77 �. ^ r rFF4 _; .r"_,� . ..... ... .. .. 1 :ADDtTtONAL COMMENTS-,- �- ., :.RELINQUISHED BYl AFRL1ATION'`:' :':::`DATE .. -'::TIME:" ':: 'CEPTEg BYIAFFILIATIONg '• --`DATE TiME'�SAMPLE CONDiTIONS'f ✓ 1 z r of a r I r F - .. 7 I I E r'. ! ' r '„ `�' •. I - r g SAMPLER NAMEAND.SIGNATU _. .. '.. .. .... .. ... ti PRINT, NameofSAMPLE - '- UJ � C)RIGINAL' '__Iirrod V u �.... ATE S i 4�:! ~ 4 SIGNATURE of SAMPLER• (MMfVplYY 1. t - i i'ce: 4nperebnt NoBy slyl for uds A you era accepting Pace'sET N30 day payment u ms and Na.gn;bY io . d=-gw 0 1.5%par month paJo rath,n 0 tfeyf. F=ALL�Q-020ray.D7,., 5-May-20D7.