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NCG140448_MONITORING INFO_20190318
STORMWATER DIVISION CODING SHEET NCG PERMITS PERMIT NO. ------------- DOC TYPE ❑HISTORICAL FILE 91 MONITORING REPORTS DOC DATE YYYYMMDD PROCESS WASTEWATER —Discharge Monitoring Report GENERAL PERMIT No. NCG140000 CERTIFICATE OF COVERAGE No. NCG140448 FACILITY NAME: _MacLeod Construction, Inc. — North Pointe Plant SAMPLE COLLECTOR: AUl CERTIFIED LABORATORY: -4C U Lab # rL•ab,#,-% r— I N i C .. %_0 L_ I V 1_U LIMIT VIOLATIONS? YES ❑ NO [D- MAR 18 2019 Part A: Wastewater MonitorineReauirements r`.11=NTRA1 FILES SAMPLE COLLECTION YEAR: 'W19 SAMPLE PERIOD: ❑July -December anuary-June SAMPLE FREQUENCY: Quarterly 2' Semi-annually ❑ COUNTY: Mecklenburg PHONE NO.: 704-483-3580 ADD TO LISTSERVE? ❑YES ❑NO EMAIL: DISCHARGING TO CLASS: []SA ❑HQW ❑PNA []Trout ®Other C OPTIONAL INFO: Outfall No.. Date Sample . 1 Collected - [mm/dd/yr} M Type of Wastewater (VE; RM, MD)' IR'SECTIU� i.:,. pH (standard) ; Total Suspended • solids (mg/0 Settleable Salida (mL/L) , (Not. Applicable for Macleod) ... Non=Polar Oil &Grease - usingmethod . s 1664SGT-HEM . = Discharge Duration- (minutes).. Total Flow (gallons/day)' (Not hot Applicable for t . MacLeod) :. .-• 1 01• IZ�l9 Co r f wastewaters stems have not dischar ed in this quarter— report "No Flow" or "No Discharge" here. Please make sure to mark the sam le uarter above. 11 Y g P p q z Report the abbreviation for the type of Authorized Wastewater Discharges here: Vehicle and Equipment Cleaning (VE), Raw Material Stockpiles (RM), Mixing Drum Cleanout (MD). Report more than one type if the waste -stream is commingled. Permit Date: 8/1/2017-06/30/2022 Last Revised 08/09/17 Page 1 of 2 'If an effluent limit is exceeded twice in a row, the permittee is required to institute monthly monitoring for that parameter for six months, unless DEMLR RO staff notifies you to continue monitoring. ° pH limits are 6-9 S.U. for wastewater discharges to freshwaters, and 6.8-8.5 S.U. for discharges to saltwaters. 5 TSS limits are 20 mg/L for wastewater discharges to HQW waters, .10 mg/L for Trout and PNA waters, and 30 mg/L for all other water classifications. 6 Process wastewater discharges shall only be monitored for TPH when commingled with stormwater discharges from VMA areas. TPH does not have a limit for wastewater, but instead is subject to benchmarks and provisions of Part IV, Section A, including the Tiered Response Action. ' Flow rate can be measured continuously or calculated. Flow limits for wastewater discharges to HQW waters shall be set to 50% of the Summer 7Q10 Flow as per 15A NCAC 02B .0224. Permittees who discharge wastewater to HQW waters shall obtain a Summer 7Q10 flow and report this information to DEMLR, if the permittee cannot obtain a Summer 7Q10 flow for the receiving waters at the discharge location, the permittee shall notify DEMLR, and the DEMLR Regional Office may require an annual flow report on a case -by -case basis. MAIL ORIGINAL AND ONE COPY OF THIS ANNUAL SUMMARY -(INCLUDING ALL "NO FLOW", "NO DISCHARGE") WITHIN 30 DAYS OF RECEIPT OF SAMPLE (OR AT END OF MONITORING PERIOD IN CASE OF "NO FLOW") TO: Division of Water Resources - Attn: DWR Central Files 1617 Mail Service Center Raleigh, North Carolina 27699-1617 (919) 807-6379 YOU MUST SIGN THIS CERTIFIG4TION 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 directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations." (Signature of Permittee) Permit Date: 8/1/2017-06/30/2022 0/,� (Date) Last Revised 08/09/17 Page 2 of 2 aceAnalytical wwwpacelabs torn February 25, 2019 Mr. Michael Houser MacLeod Construction PO Box 320 4304 N. Pointe Ind Charlotte Denver, NC 28037 RE: Project: 02/12/2019 Pace Project No.: 92417490 Pace Analytical Services, LLC 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 Dear Mr. Houser: Enclosed are the analytical results for sample(s) received by the laboratory on February 12, 2019. The results relate only to the samples included in this report. Results reported herein conform to the most current, applicable TNIINELAC 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, wa' " • �Ll-QXLI Angela Baioni angela.baioni@pacelabs.com (704)875-9092 Project Manager Enclosures PC�EO 2 TNI 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 12 aceAnalytical. www.pacelabx mm Project: 02/12/2019 Pace Project No.: 92417490 Charlotte Certification IDs 9800 Kincey Ave. Ste 100, Huntersville, NC 28078 Louisiana/NEL.AP Certification # LA170028 North Carolina Drinking Water Certification #: 37706 North Carolina Field Services Certification #: 5342 North Carolina Wastewater Certification #: 12 Asheville Certification IDs 2225 Riverside Drive, Asheville, NC 28804 Florida/NELAP Certification #: E87648 Massachusetts Certification #: M-NCO30 North Carolina Drinking Water Certification #. 37712 CERTIFICATIONS South Carolina Certification #: 99006001 Florida/NELAP Certification #: E87627 r Kentucky UST Certification #: 84 VrginiaNELAP Certification #: 460221 North Carolina Wastewater Certification #: 40 South Carolina Certification #: 99030001 Urginia/VELAP Certification #: 460222 REPORT OF LABORATORY ANALYSIS Pace Analytical Services, LLC 9800 Kincey Ave. Suite100 Huntersville, NC 28078 (704)875-9092 This report shall not be reproduced, except in full, without the written consent of Pace Analytical Services, LLC, Page 2 of 12 aceAnalytical wwwpacelabs.com SAMPLE ANALYTE COUNT Project: 02112/2019 Pace Project No.: 92417490 Pace Analytical Services, LLC 9800 Kincey Ave, Suite 100 Huntersville, NC 28078 C704y875-9092 Analytes Lab ID Sample ID Method Analysts Reported Laboratory 92417490001 DP-1 EPA 16643 JMS 1 PASI-C SM 254OD-2011 CRV 1 PASI-A SM 254OF-2011 CEH 1 PASI-A REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, without the written consent of Pace Analytical Services, LLC. Page 3 of 12 Pace Analytical Services, LLC aceAnalyircal 980Q Kincey Ave. 28 7 Huntersville, NC 28D78 wwwpacelabs.com (704)875-9092 ANALYTICAL RESULTS Project: 02/12/2019 Pace Project No.: 92417490 Sample: DP-1 Parameters Lab ID: 92417490001 Collected: 02/12/19 15:09 Results Units Report Limit DF Received: 02/12/19 15:35 Matrix: Water Prepared Analyzed CAS No. Qual Field Data Analytical Method: Collected By JA 1 02/12/19 03:11 pH 6.80 Std. Units 0.10 1 02/12/19 03:11 Temperature 11.1 deg C 0.50 1 02/12/19 03:11 HEM, Oil and Grease Analytical Method: EPA 16643 Oil and Grease ND mg/L 4.8 1 02/25/19 07:02 2540D Total Suspended Solids Analytical Method: SM 25400-2011 Total Suspended Solids ND mg1L 2.5 1 02/14119 13:50 2540E Total Settleable Solids Analytical Method: SM 2540E-2011 Total Settleable Solids ND mL/Llhr 0,10 1 02/13/19 03:00 REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, Date: 02/25/2019 04A5 PM without the written consent of Pace Analytical Services, LLC. Page 4 of 12 aceAnalytical wwwpacefaba.com QUALITY CONTROL DATA Project: 02112/2019 Pace Project No.: 92417490 QC Batch: 459887 Analysis Method: EPA 1664B QC Batch Method: EPA 1664B Analysis Description: 1664 HEM, Oil and Grease Associated Lab Samples. 92417490001 METHOD BLANK: 2505906 Associated Lab Samples: 92417490001 Parameter Units Oil and Grease mg1L Matrix: 4lthater Blank Reporting Result Limit Analyzed Qualifiers NO 4.8 02/25/19 06:47 Pace Analytical Services, LLC 9800 Kinsey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 LABORATORY CONTROL SAMPLE: 2505907 Spike LCS LCS % Rec Parameter Units Conc. Result % Rec Limits Qualifiers Oil and Grease mg1L 38.5 38.8 101 78-114 MATRIX SPIKE SAMPLE: 2505908 92417400008 Spike MS MS % Rec Parameter Units Result Conc. Result % Rec Limits Qualifiers Oil and Grease mg/L NO 38.5 37.9 87 78-114 Results presented on this page are In the units inditated by the "Units" column except where an alternate unit Is presented to the right of the result. r REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, Date: 02/25/2019 04:45 PM without the written consent of Pace Analytical Services, LLC, Page 5 of 12 aceAnalytical wwwpacerabscom Pace Analytical Services, LLC 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 QUALITY CONTROL DATA Project: 02/1212019 Pace Project No.: 92417490 QC Batch: 458192 Analysis Method: SM 254OD-2011 QC Balch Method: SM 254OD-2011 Analysis Description: 2540D Total Suspended Solids Associated Lab Samples: 92417490001 METHOD BLANK: 2498171 Associated Lab Samples: 92417490001 Parameter Units Total Suspended Solids mg/L LABORATORY CONTROL SAMPLE: 2498172 Parameter Units Total Suspended Solids mg/L SAMPLE DUPLICATE: 2498173 Parameter Units Total Suspended Solids mg/L SAMPLE DUPLICATE: 2498174 Parameter Total Suspended Solids Matrix: Water Blank Reporting Result Limit Analyzed Qualifiers ND 2.5 02/14/1913:41 Spike LCS LCS % Rec Conc. Result % Rec Limits Qualifiers 251 240 96 90-110 92417550001 Dup Result Result RPD Qualifiers <5.0 ND 92417382002 Dup Units Result Result mg1L ND ND RPD Qualifiers 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: 02/25/2019 04:45 PM without the written consent of Pace Analytical Services, LLC. Page 6 of 12 aceAnalytical www.pacelaftoom Project: 02/12/2019 Pace Project No.: 92417490 QC Batch: 457784 QC Batch Method: SM 2540E-2011 Associated Lab Samples'. 92417490001 METHOD BLANK: 2496535 Associated Lab Samples: 92417490001 Parameter Total Settleable Solids QUALITY CONTROL DATA Analysis Method: SM 254OF-2011 Analysis Description: 254OF Total Settable Solids Matrix: Water Blank Reporting Units Result Limit Analyzed Qualifiers mL1Llhr ND 0.10 02/13/19 03:00 SAMPLE DUPLICATE: 2496536 92417492001 Dup Parameter Units Result Result Total Settleable Solids mL1L1hr ND ND RPD Qualifiers Pace Analytical Services, LLC 9800 Kinsey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 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: 02/25/2019 04:45 PM without the written consent of Pace Ana#ytical Services, LLC. Page 7 of 12 �;acmnalyfical" www pacelabs.carn QUALIFIERS Project: 02/12/2019 Pace Project No.: 92417490 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 28076 (704)875-9092 POL - 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 SVVB46 Chapter for the analysis of Acrolein and Acrylonitrile by EPA Method 8260. N-Nitrosodiphenylamine decomposes and cannot be separated from Diphenyiamine 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-A Pace Analytical Services -Asheville PASI-C Pace Analytical Services - Charlotte REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, Date: 02/25/2019 04:45 PM without the written consent or Pace Analytical Services, LLC. Page 8 of 12 1�;a'neAnalyfical 1 wwwpecelahscrm I QUALITY CONTROL DATA CROSS REFERENCE TABLE Project: 02/ 1212019 Pace Project No.: 92417490 Lab ID Sample ID QC Batch Method 92417490001" DP-1 92417490001 DP-1 EPA1664B 92417490001 DP-1 SM 254OD-2011 92417490001 DP-1 SM 254OF-2011 Date: 02/25/2019 04A5 PM Pace Analyticat Services, LLC 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 QC Batch Analytical Method 459887 458192 457784 REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, without the written consent of Pace Analytical Services, LLC. Analytical Batch Page 9 of 12 Document Name: Document Revised: February 7, 2018 CBAlk?II}�fCc?I Sample Condition Upon Rece1 t(SCUR) Page 1 of 2 Document No,: Issuing Authority: F-CAR-CS-033-Rev.06 Pace Carolinas Quality Office Laboratory receiving samples: Asheville ❑ Eden[] Greenwood ❑ HuntersvilleL3� Raleigh❑ Mechanicsville[] Client hfame: �111V :9243.7490 Project #; ff �L Qrt�LAt Un Courier: Fed Ex []UPS ❑USPS Client���� El Commercial ❑Pace 00ther: 114171111 Custbd Sea! Present?? []Yes L y ❑Yes (110 Sealslntact. �) pate/Initials Person Examining Contents: Packing Material: QBubble Wrap Ibble Bags --_❑None—❑ _Other_.__ _ Bielogical Tis rozen? Thermom .,( Myes ❑Na JI /A PC'): un ID: 42TO48 Typeofice: CCC�et ❑slue CoolerTem� I �Correction Factor: Add/Subtract ('C)0J.0 Cooler Temp Corrected ('C), 4_I USDA Regulated So!! N/A, water sample) Did sample, €J ate in a.qu rantine zone within the'United States: CA, NY, at SC (check maps)? []Yes a ❑Plane Temp should be above freezing to 6'C ❑Samples out of temp criteria. Samples on Ice, cooling process has begun Did sarnp€as originate (rdm a foreign source {irate tlanaliy, Inducting Hawall and Puerto Rico)? ❑Yes Comments/D€screpan : Chain of Custody Present? es ❑No ❑NIA 1, Samples Arrived within Hold Time? Yes ONO ❑NIA 2. Short Hold time Analysis e72 hr.)? Yes o ❑NIA 3. Rush Turn Around Time Requested? []Yes No ❑P7/A 4. Sufficient volume? tiles No ❑N/A S. Correct Containers Used? -Pace Containers Used? tjYes C�es ❑No ON. ❑N/A ❑NIA 6. . Containers Intact? es []No El N/A 7. Dissolved analysis: Samples Field Filtered? Oyes EINO SrSNIA 8. Sample labels Match COC? -Includes Date/Time/IC/Analysis Matrix: Agyes ONO ❑NIA 9. Headspace In VOA Vials (>5-6mm)? clyes ❑Plo NIA lo. Trip Blank Present? Trip Blank Custody Seals Present? ❑Yes Yes ❑No []NO A IA 11. COMMENTS/SAMPLE DISCREPANCY Field Data Required? ❑Yes ❑No Lot ID of split containers: _ _- CUENT NOTIFICATION/RESOLUTION Person contacted: Date/Time: �� , r Project Manager SCURF Review: �} � �] Project Manager 5RF Review: 1TM Date: �`��j€ 3"i-_ Date: C d�-(q Page 10 of 12 _ Document Name: Sample Condition Upon Receipt(SCUR) Document Revised: February 7; 2018 Page 1 of 2 Document No.: F•CAR-CS-033-RevA6 Issuing Authority: _ Pace Carollnas 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, Caliform, TOC, Oil and Grease, DRO/8015 (water) DOC, LLHg **Bottom half of box is to list number of bottle Project III W0 :924i-7490 PM: AMB Due Date: 02/26/19 CLIENT: 92-MACLEOD iz > i -a--0 ¢ v as a v v n a V v y a =— ?- - v a m v ] Ra " ni 2> « aO o5 7ar = c v�� oaN va n77 7c A u ro NY " � m m d E v E o = a 2 a d `m w` n E c m , .0 -0 a E J N > Q O O O . N v J E E E u E E E J E Q `m v J c `w E m E E E ? r .g J E E J c E J E J E yOy77 O L N O N Ln r } 3 _ _ H N O N g C7 a a Y u-, Ni O N 11Ln tV Ln N N C N rn M rl N v m o � m d aa. aa' a a 2 d a A. 3 t7 0 f7 to to 0 40 e�7 t7 l�7 o 0 � > d 0. m a > a m m m m m m m W a a a a a a a > > a 1 I N\ 1 2 \N ' 3 \NN\d I \\\I 6 \ 1 \NN\ I N 1 \\N\ I INN 8 9 10 1 A\ \J I 11 12 pH Adjustment Log for Preserved Samples Sample 10 Type of Preservative pH upon receipt Date preservation adjusted rime preservation adjusted Amount of Preservative added lot 4 Note: Whenever tMre is a discrepancy affecting North Cara Gna compliance samples, a copy of this fam Wig to sent to the North Carolina uCHi1H t.ertincauon truce ti.e. Out of hold, incorrect preservative, out of temp, Incorrect containers. Page 11 of 12 i .•PaceAnalytical" CHAIN -OF -CUSTODY ! Analytical Request Document The Chain-of•Custotly is a LEGAL DOCUMENT. All relovant fields must be completed accurately. nS Page: of Q. Suction A Section 13 Section C 2268735 Required Client Infofntolion: Requied Project Information: Invoice Information: A1lention: .G Report To: ! Addy 3,2 Copy To: Cartp+tn Naglah i ���,. REGULATORY AGENCY )ut �l C F I A s - � , r- PDES r GROUND WATER €- DRINKING WATER r UST r RCRA r OTHER Emil oPurchase Order No.: P ace Ouo lc d I RMtrttr ; P,gonp. Fax: Propd Name: pace PrDloct Site Location JGi, — S Sr'J ' I M,n:x>nr: STATE: Requested Due DatetrAT: ProjCU NumI bar: Pam PrDfle N: Requested Analysis Filterod (YIN) Section D Matrix Codes — _ R�gw-d Ch-1 Innemt:eu+n MA1RiX l COiIE q a COLLECTED Preservatives i Drinking 4vnler DW }Jt O Water WT Writ(, WalAr WW l7 COMPOSnE coupo4rrF [wfk:rrnu S ri Z PrWuct P SotY5olid SL 'r MAW 1 SAMPLE ID °wipe WP `—' a m IA•2. 0.9 1: f Air AR 0 w $ i F jL' �] o Sample IDs MUST BE UNIQUE Tissue TS -O n- w H a ay 01 0 U a Other OT 'x w IL w a O w y �' O = t- � a a O a y 0 _ V Oto a`y Q r re DATE TIME DATE TIME n T r S Z Z z O y — Pace Project No./ Lab I.D. 2 I 3 4 5 t; I 7 8 II E 9 10 11 12 ! ADDITIONAL COMMENTS RELINQUISHED BY! AFFILIATION DATE TIME ACCEPTED BY t AFFILIATION DATE TIME SAMPLE CONDITIONS 1'h 6. S' SY, �I.; `�-Y ° r; ls'; Z iz 1`r 1� `E 3 i SAMPLER NAME AND SIGNATURE PRINT Name of SAMPLER:4 I;�;- a > n a Z m ? ' E u$ w U 2 N ar SIGNATURE of SAMPLE DATE 5fgned _ f l I IMMfDDrYY]; rn -err ,nn to Lile dtaroos of t.5x rwr mat anv nua�s for nnid rotten nn �.. F-ALL•C-010-rev.00. 04Nov2017 'knponnnt MAu By sgnnll [Ins frxnt you ara arcapinq Paws NET 30 kV Payrr>, N IL-, aril ANNUAL SUMMARY DISCHARGE MONITORING REPORT (DMR) — STORMWATER k SUBMIT TO CENTRAL OFFICE* General Permit No. NCG140000 RECEIVEf) Calendar Year , 01P .. 0 ,)n,u jAN 1 a LU Report ALL STORMWATER monitoring data on this form (include "No Flow"/"No Discharg0" and, Ben hark Exceedances) from the previous calendar year to the DEQ by MARCH 1 of eb `.h �7t-V- i'1&.1 Certificate of Coverage No. NCG140448 Facility Name: MacLeod Construction, Inc. — North Pointe Business Park Concrete Batch Plant County: Mecklenburg Phone Number: 704-483-3580 Total no. of SDOs monitored _ J Certified Laboratory PAr,6' AAVALyT _CAL Lab # dj2 A)7-FR S V,[1 t C Lab # Stormwater Discharge Outfall (SDO) No. D_ _ P1 VMA Outfall? Yes ❑ No -- co m dzmm I Is this outfall current) Tier 2 for an y ' in y parameter? Yes ❑ No [� wAs7&-w,#rM Was this outfall ever in Tier 2 during the past year? Yes ❑ No If this outfall was in Tier 2 last year, was monthly monitoring discontinued? Yes, enough consecutive samples below benchmarks to decrease frequency ❑ Yes, received approval from DEMLR to reduce monitoring frequency Other h Outfall No. �P 1 _ Total Rainfall, inches Total Suspended TSS , Solids ( ) m II pH, SU Non -polar O&G (EPA Method 1664 SGT-HEM , ( )) mgll (VMA) ffopplicanle New Motor Oil Usage (gallmo.) rrenpficenfe Stormwater Benchmarks fndfcate NO PLOW !t applicable cirri nchmark !1 o 6'a-�'0 C 1 `� >55 gallmo. average requires T55 and Non-polar080 monitoring Date Sample Collected, molddlyr 03 o I 7 z . L i6 1013 728 o /e Z. 00 12,13 ? B E Permit Date 81112017 — 6/3012022 Last Revisers 8-22-2015 Certificate of Coverage No. NCG140448 C` CERTIFICATION "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 directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations." [Required by 40 CFR §122.22) Signaturerr-' Date / Mail Annual Summary Stormwater DMR to the NCDEQ Central Office: Note the address is correct — Central Files is housed in DWR (not DEMLR) N.C. Department of Environmental Quality (DEQ) Division of Water Resources Attn: DWR Central Files 1617 Mail Service Center Raleigh, NC 27699-1617 Central Files Telephone (919) 807-6300 Questions? Contact DEMLR Stormwater Permitting Staff in the Central Office at: (919) 707-9220 Permit Date 811/2017 -- 6/30/2022 Last Revised 8-22-2015 s Ia• y 4 PROCESS WASTEWATER —Discharge Monitoring:Report D ` GENERAL PERMIT No. NCG140000 JAN I g 2- - CERTIFICATE OF COVERAGE NO. NCG140448 lFACILITY NAME: MacLeod Construction, Inc. — North Pointe Plant SAMPLE COLLECTOR: _ ) C4�0 67L gy Y SCY2 CERTIFIED LABORATORY- EaCE: L,46-L V Ti7& l,ab # Lab # LIMIT VIOLATIONS? YES ❑ NO E P CENTRAL FJLE , O�nrq rr.� SAMPLE COLLECTION YEAR: q1Or4 SAMPLE PERIOD:. (Duty -December anuary-June SAMPLE FREQUENCY: Quarterly 1 Semi-annually ❑ COUNTY: Mecklenburg PHONE NO.: 704-483-3580 ADD TO LISTSERVE? 1 fY S i W W DISCHARGING TO CLASS: [:)SA ❑HQW OPTIONAL INFO: Other C 1 If wastewater systems have not discharged in this quarter —report "No Flow" or "No Discharge" here. Please make sure to mark the sample quarter above. 2 Report the abbreviation for the type of Authorized Wastewater Discharges here: Vehicle and Equipment Cleaning (VE), Raw Material Stockpiles (RM), Mbdng Drum Cleanout (MD). Report more than one type if the waste -stream is commingled. Permit Date: 8/1/2017-06/30/2022 Last Revised 08/09/17 `/ Pagef 2 7 4/ �-'Z— 31f an effluent limit is exceeded twice in a row, the permittee is required to institute monthly monitoring for that parameter for six months, unless DEMLR RO staff notifies you to continue monitoring. "pH limits are 6-9 S.U. for wastewater discharges to freshwaters, and 6.8-8.5 S.U. for discharges to saltwaters. s TSS limits are 20 mg/L for wastewater discharges to HQW waters, 10 mg/L for Trout and PNA waters, and 30 mg/L for all other water classifications. s Process wastewater discharges shall only be monitored for TPH when commingled with stormwater discharges from VMA areas. TPH does not have a limit for wastewater, but instead is subject to benchmarks and provisions of Part IV, Section A, including the Tiered Response Action. Flow rate can be measured continuously or calculated. Flow limits for wastewater discharges to HQW waters shall be set to 50% of the Summer 7Q10 Flow as per iSA NCAC 02B .0224. Permittees who discharge wastewater to HQW waters shall obtain a Summer 7Q10 flow and report this information to DEMLR. If the permittee cannot _ obtain a Summer 7Q10 flow for the receiving waters at the discharge location, the permittee shall notify DEMLR, and the DEMLR Regional Office may require an annual flow report on a case -by -case basis. MAIL ORIGINAL AND ONE COPY OF THIS ANNUAL SUMMARY (INCLUDING ALL, "NO FLOW", "NO DISCHARGE") WITHIN 30 DAYS OF RECEIPT OF SAMPLE (OR AT END OF MONITORING PERIOD IN CASE OF "NO FLOW") TO: Division of Water Resources Attn: DWR Central Files 1617 Mail Service Center Raleigh, North Carolina 27699-1617 (919) 807-6379 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 assurethat qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person ar persons who manage the system, or those persons directly responsible for gathering the information, the Information submitted is, to the best of my knowledge and belief, true, accurate, and complete. i am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing vlolatians," of Permittee) Ap (Date' Permit Date: 8/1/2017-06/30/2022 Last Revised 08/09/17 Page 2 of 2 Analytical www.pace)abs.com March 14, 2018 Mr. Michael Houser MacLeod Construction PO Box 320 4304 N. Pointe Ind Charlotte Denver, NC 28037 RE: Project: DP-1 Pace Project No.: 92375263 Pace Analytical Services, LLC 9800 Kincey Ave. suite 100 Huntersville, NC 28078 (704)B75-9092 Dear Mr. Houser: Enclosed are the analytical results for sample(s) received by the laboratory on March 01, 2018. The results relate only to the samples included in this report. Results reported herein conform to the most current; applicable TNIINELAC 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, .Q.a, �m , LPL AN, Angela Baioni angela.baioni@pacelabs.com (704)875-9092 Project Manager Enclosures 1 pQ. ptCRfO REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, without the written consent of Pace Analytical Services, LLC. Pane 1 of 13 C Analytical WW..Pacelabs.cwn SAMPLE ANALYTE COUNT Project: OP-1 Pace Project No.: 92375263 Pace Analytical Services, LLC' 9800 K'incey Ave, Suite 100 Huntersvil{e, NC 20078 (704)875-9092 Analytts Lab ID Sample ID Method Analysts Reported Laboratory 92375263001 DP-1 EPA 1664B JMS i PASI-C SM 2540D NAL 1 PASI-A SM 254OF MVC 1 PASI-A EPA 9040 ECH 1 PASI-A REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, without the written consent of Pace Analytical Services, LLC. D- 0 -4 " aceAnalj&al ttww.pacela6s.com Project: DPA Pace Project No.: 92375263 QC Batch: 401685 QC Batch Method: EPA 1664E Associated Lab Samples: 92375263001 METHOD BLANK: 2228025 Associated Lab Samples: 92375263001 Parameter Units Oil and Grease mglL LABORATORY CONTROL SAMPLE: 2228026 Parameter Units Oil and Grease mg1L MATRIX SPIKE SAMPLE: 2228027 Parameter Units Oil and Grease mglL Pace Analytical Services, LLC` 9800 Kincey Ave, Suite 100 Huntersville, NC 28078 (704)875-9092 QUALITY CONTROL DATA Analysis Method: EPA 1664E Analysis Description: 1664 HEM, Oil and Grease Matrix: Water Blank Reporting Result Limit Analyzed Qualifiers ND 5.0 03/13/18 04:33 Spike LCS LCS % Rec Cone. Result % Rec limits Qualifiers 40 37.0 92 78-114 92375210001 Spike MS MS % Rec Result Cone. Result % Rec Limits, Qualifiers ND 40 39.6 97 78-114 Results presented an this page are In the units Indicated by the "Units" column except where an alternate unit Is presented to the right of the result C� REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, Date: 03/14/2018 06:01 AM without the written consent of Pace Analytical Services, LLC. aceAnalXical www.pecelabs.com C Project: DP-1 Pace Project No.: 92375263 QC Batch: 400371 QC Batch Method: SM 254OF Associates! Lab Samples: 92375263001 QUALITY CONTROL DATA Analysis Method: SM 254OF Analysis Description: 254OF Total Settable Solids METHOD BLANK: 2220418 Matrix: Water Associated Lab Samples: 92375263001 Blank Reporting , Parameter Units Result Limit Analyzed Qualifiers Total Settleable Solids mLJUhr ND 0.10 03/02/18 03:30 Pace Analyttcat Services, LLC . 9800 Kincey Ave. Suite 100 Huntersville, NC 2B078 (704)075-9092 Results presented an this page are In tha units Indicated by the "units" column except wham en alternate unit Is presented to the right of the result. REPORT OF LABORATORY ANALYSIS This report shag not be reproduced, except in full, Date: 031114/2018 06:01 AM without the written consent of Pace Analytical Services. LLC. Pace Analytical Services, LLC m 9800 Kincey Ave. Suite 100 aceAnapicar Huntersville, NC 28078 www.pacalahs.cmm (704)875-9092 C QUALIFIERS Project: DP-1 Pace Project No.: 92375263 DEFINITIONS C 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. PQL - Practical Quantitation Limit. RL - Reporting Limit. S - Surrogate 1,2-Diphenythydrazine 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 6270. 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-A Pace Analytical Services -Asheville PAST-C Pace Analytical Services - Charlotte ANALYTE QUALIFIERS D6 The precision between the sample and sample duplicate exceeded laboratory control limits. H6 Analysis initiated outside of the 15 minute EPA required holding time. REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, Date: 03114/2018 06:01 AM without the written consent of Pace Analytical Services. LLC. c Document Name: Document Revised: February7, 2018 _ aceAnapcal' Sample Condition Upon Recel t(SCUR) Page 1 of 2 Document No.: issuing Authority: F•CAR•CS•033•Rev,06 Pace Carolinas Quality Office Laboratory receiving samples: Asheville ❑ Eden❑ Greenwood ❑ Fiuntersv(Ile e] Raleigh[:] Mechanicsville❑ Client Name: alp# 923152f 3 Protect 1i: Courler; Fed Ex ❑UPS DUSPS ❑Client I � � II [� �1� ❑ Commercial [--]Pare ' ❑Qther• { Iiii III iiiillllllll 111 iii Custody Seal Present? Dyes ❑�✓ Sealslntact? ❑Yes O'No 92375263 _ � r pate/Initlah Person Examining ContentsRs .31 �' � Packing Material: ❑Bubble Wrap [36bble Bags ❑None ❑ Other Biological Tissue Frozen? Thermometer: ❑Yes (:]No❑] /A ❑IR Gun ID: 92TO36 Typa of Ice: Owet ❑Blue []None Cooler Temp ('C}: C.�) . Correction Factor: Add/Subtract ('C) +O. i Temp should be above freezing to 6'C [Dater Temp Corrected VC)-, Temp out of temp criterla. Samples on ice, cooling process has begun USDA Regulated Soli. (Q N/A, water sample) Did s�+a�m7ples orlgii to In •a quararitine zone within the United States: CA, NY, or SC (check maps)? Did samples originate from a foreign source (internationally, I rYes R+fNo Includlna Nawall and Puerto Alcot? nYes 1'INo comments/Discrepancy: Chain of Custody Present? rice ONO N/A 1. Samples Arrived within Hold Time? Yes Na N A 2. Short Hold Time Anal els e72 hr.)? es No N A I Rush Turn Around Time Requested? Uves 40' CINIA 4. Sufficient volume? t s Na N A S. Correct Containers Used? -Pace Containers used? EIVes EBYrFi ONO ONO [-']N/A N A - 5. Containers Intact? es QNO N/A 7. Dissolved analysis: Samples Field Filtered? ❑Yes (]No N/A 8. Sample labels Match COC? •IncludesDate/Tlme ID/Anal Is �Matrlx: Elves CrNo ©N/A 9, Heads ace In VOA Vials >S•Gmm)? Yes Na H/A 10, Trip Blank Present? Trip,Blank CustodSeals Present? ❑Yes Yes 2tYo OND N/A KJA 11, COMMENTS/SAMPLE DISCREPANCY Lot ID ofsiontcontainers: CLIENT NOTIFICATION/RESOLUTION _ �T Person contacted: CProject Manager SCURF Revlt:wi Project Manager SRF Review- Date/Time. 1� i Field Data Required? []Yes [—]No Date: Date: Panty 11 nr 1 z v PaceAnapicaf wxw.pacelalrs.cam Section A Required Cient lnfomtalion; CHAIN -OF -CUSTODY / Analytical Request Document The Chairs-af-Custody is a LEGAL DOCUBENT_ All relevant fields must be completed aceuratelY. Section 3 Section C Required Pn4eci Informalion: Invoice lnformalion: Page_ of --- t7 Co. Report To- Altcntgn: .— c Cog�To: Com nv 7-C' —rf� REGULATORY AGENCY V ~J NPDES GROUND WATER i DF2SNKIfJG 'WATER UST RCRA OTHER . Email T : Purchase ' rii i e '/ -!l Order No.: i' �e ftderc te: P�:Le: fy�t i� 4tJ'I-�� ` Y � Fay- y Projetl Jar-�L' �� VM: P''u '-'d ♦rI.Y1.lQCf. Site Location STATE: Roquested Due Date/TAT: Prpied Number: Pscc Proftle p: Requested Analysis Filtered (YIN) Section D Matrix Codes — 2 z" �' 0.oq�ifotl Gl.:rx lnromt�:Klrt 1.1ATRTX r coo COLLECTS❑ 1'feSt'fV;a1fVBS } Drinking water DW Water 1NT z o - ,� r y WasteWater ww 4 GpBOStT£ fX)rtPO51 w '.y> Z SOlVSoW SL SAMPLE ID OR OL m t. ��, U fn } V� (A-7- 0-91:) Air AR ,� Cl u, Sample ID!; MUST BE UNIQUE Tissue TS o a ti z a w U Ocher OT V ti m p ZE 0: ~ 4 0-LL 2 iJ 11 O III O O C S ✓1 ~ x L DATE TIME DATE TIME _ = z z i O .Qi a Pace Praject NDJ Lab I-D. 2 3 4 5 5 7 S 9 i0 11 ' iz ADDITIONAL COMMENTS RELI'AFFILIATION DATE TIME ACCEPTED BY I AFFILIATION DATE TIME SAMPLE CONDITION$ SAMPLER NAME AND SIGNATURE c `ta y, o c u Z a+ > PRINT Name of SAMPLE.� /A /y� m u o as } DATE Slgnod SIGNATURE of SAMPLER: ] {Mf+1lDDlYYj: t/.� G' f IG i_, i � r r E - 1 . •r rrmr•ny :.rn Q du form lvrr:xe: ;exrztsnp P.prs ld=T 30 d:ry paymce n uxms and agrr M to trte rhiWs of 1.V4 rwr moon IrT}^"-�ov�s r �a tIld wi:rnn 30 days. ` r F-ALL-Q-020rev.07. 1 -007 ceAnalyfical r www.patelabs.com Section A Required Client Information: �..:-s...It, i , ,-.iiaiytiLaii r%ugUCJL 1JVl:U111C11L The Chain-of-Custodyis a LEGAL DOCUMENT. All relevant fields must be completed accurately. Section B Section C Required Project Information: Invoice Information: Pago; of Cow r , h / l rn t �. I %�l f !�' Report To: Attention: 9 A Copy To: Company Name: G[) Y"AGENCY" _RE• r Address: `. �f NPDES I� GROUNDWATER r DRINKING WATER _ /1 ? f Ci/ ; ?7 !J r7 7)!� I,r._yr 3JC. ..f. G -? r UST I— OTHER RCRA r EffrA a: Purchase Order No.: Paco cgrole " Relerence: Name: Pace Project SIte.LocatiOnd '�T,--MMane rPhoyne6�:Project r STATE:, �p Due Daterl-AT: Project Number. Pace Profile k: _ Reques_ fed Analysis Fait#eredi(YLjM, Section D Matrix Codas J Requiredaienttntormation MATRut f CODE COLLECTED Preservatives r„ • Drinking Water DW '^ cl It zD _ Water WT WasteProduWater WW m scoutosRE cErracPtia w , tt Z Solysond SL SAMPLE ID Oil OL o : ' i } CD Wipe WP fA-Z. 6-9 I.-) Air AR w to Z o . Sample IDs MUST BE UNIQUE T"rssuo TS O a - m aye Other OT U �= LU Z O Z a) O ^p u5 " - -� dd J a orn > OIL 2 t9; -- 7 'o Ju ~ DATE TIME GATE TIME 0 # � = Z 2 U = m Z z m O ..► j� fY Pace Project No./ Lab 1.1 a'51 r. �8d 1.t �12 .. - �'Y�AOxOo;OA�LC.QMEI'!TS �R.EnQ.s ISHEtaD'Bc.. � tyr+— TE SAMPLE CONDITIONS . �* r.i• ��-a -Fnu+..mr CE AM • 'SAMPLER NAMErAND SIGNATURE c m •4d' PRINT Name of SAMPLER:r ., e>•� �- a • u c) T EE SIGNATURE of SAMPLER: 1 / %+ DATE Signed fMMfDDIM, G'.: 'lmponant I�signing this, form yap, are accep&:g Paoe's NET 30 day payment terms and agreeing to late charges of 1.5% per manlh Fw eiVices rwi pall within 30 days. F-ALL-0-020rav C7 `N+ dnu-911n7 �PaceAna1ytica1 * ' www.pacelahs.com Section A Required Client Information: %—r7Hntl-yr-%rUi )u I I ruIC1IyLI%,,c11 r'%CyuwL vv.......�... The Chain -of -Custody is a LEGAL DOCUMENT. Alt relevant fields must he completed accurately. Section B Section C Required Protect information: Muni— Infnrmatinn: Page: of Co a Report To: Attention: 1 J 1 7L�Jj 77 �.J A Copy To: Company Name: REGULATORY AGENCY ? t , % Alr17 U2 d ess: 1-7 r NPDES r GROUNDWATER r DRINKING WATER e44-7 v �C r UST r RCRA r OTHER E Purchase Order NO.: ce ote ..� .. /. Reference: Phone: Faz: - Project Name: Pace Project Site Location - i/fJ_(JI Manager STATE: Requested Due DaterrA : T Project Number: Pace Profile 9: Requested Analysis Filtered (YIN) Section D Matrix Codes -- — y Z Required Client Information MATRIX r CODE s o COLLECTED Preservatives 5- el - Drinking Water DW 8 v a Water T W ' waste WW � COMPOSITE COMPOSITE: 0 U -! ProducWaier m m START EMDIGRA13 J Z Soil/Solid SL p �► Si4MPL E ID Oil c� h a wipe (A-Z, 0-91 ; ) Air AR p � a w Z H o Sample IDS MUST BE UNIQUE Tissue TS 0 w EL w I- a m m U Other Of X w w O O ?+ v a a V m O z V L M r r F a a u- O Q`�z ° CU 0 ¢ r CU — co DATE TIME DATE TIME rn x r r x r Z Z O D_ Pace Project Nod Lab 1.0 03 03 2 3 4 5 6 7 6 9 10 11 12 - ADDITIONAL COMMENTS RELINQUISHED BY I AFFILIATION DATE TIME ACCEPTED BY I AFFILIATION DATE TIME SAMPLE CONDITIONS SAMPLER NAME AND SIGNATURE o 9 v — $ PRINT Name of SAMPLER: ? C v } DATE Signed _ SIGNATURE of SAMPLER: �% F v `L, O T E Y m . �� .✓� ;y 't (MMIDDNY): % t rn -Importantly signing this form you are accepting Pace's NET 30 day payment terms and agreeing to late charges of 1.5% per month for t fices not 4id mthin 30 days. y I F-ALL-0-020rev.07..dy-2007 PROCESS WASTEWATER —Discharge Monitorin Re ort g g p GENERAL PERMIT NO. NCG140000 JAN 18 2019 CERTIFICATE OF COVERAGE No. NCG140448 FACILITY NAME: MacLeod Construction, Inc. — North Pointe Plant SAMPLE COLLECTOR: M l C(� E- _ 4Q(Z s&--YZ CERTIFIED LABORATORY: CE A Y 1 C/} 4_ Lab # — — Lab # LIMIT VIOLATIONS? YES ❑ NO Part A: Wastewater Monitorine Reouirements CENT;YkL FILES �t,tifR cECT10'`� SAMPLE COLLECTION YEAR: SAMPLE PERIOD: ❑July -December anuary-June SAMPLE FREQUENCY: Quarterly Sem)-annually ❑ COUNTY: Mecklenburg PHONE NO.: 704-483-3580 ADD TO LISTSERVE? []YES []NO EMAIL: DISCHARGING TO CLASS: ❑SA ❑HQW ❑PNA []Trout ®Other C OPTIONAL INFO: Outfall No. - Date Sample. -Collected' (mm/dd/yr) Type of Wastewater (VE RM MD)2 pH (standard) . Total Suspended- Solids (mg/L) Settleable s Non.�Polar Solid Oil & Grease ". (ML/L) : using method :;'(blot 1664 SGT-HEW Applicable for (mg/1) MacLeod) -. Discharge Duration; (minutes) Tatal Ffow (gallons/day) (Not Applicable for. Kacleod) =.53' (1S)6 - ! Q� eo r %J 6 Q f t d have systems rr i 1 1 e y e h e o discharged in this quarter— o report N Flow' or Na Drscharge here. Please make sure toa m rk the sample quarter above. 2 Report the abbreviation for the type of Authorized Wastewater Discharges here: Vehicle and Equipment Cleaning (VE), Raw Material Stockpiles (RM), Mixing Drum Cleanout (MD). Report more than one type if the waste -stream is commingled. Permit Date:8/1/2017-06/30/2022 Last Revised 09/09/17 Page 1 of 2 If an effluent limit is exceeded twice in a raw, the permittee is required to institute monthly monitoring for that parameter for six months, unless DEMLR RO staff notifies you to continue monitoring. 4 pH limits are 6-9 S.U. for wastewater discharges to freshwaters, and 6.8-8.5 S.U. for discharges to saltwaters. _ s TSS limits are 20 mg/L for wastewater discharges to HQW waters, 10 mg/L for Trout and PNA waters, and 30 mg/L for all other water classifications. s Process wastewater discharges shall only be monitored for TPH when commingled with stormwater discharges from VMA areas. TPH does not have a limit for wastewater, but instead is subject to benchmarks and provisions of Part IV, Section A, including the Tiered Response Action. Flow rate can be measured continuously or calculated. Flow limits for wastewater discharges to HQW waters shall be set to 50% of the Summer 7Q10 Flow as per 15A NCAC 02B .0224. Permit -tees who discharge wastewater to HQW waters shall obtain a Summer 7Q10 flow and report this information to DEMLR. If the permittee cannot obtain a Summer 7Q10 flow for the receiving waters at the discharge location, the permittee shall notify DEMLR, and the DEMLR Regional Office may require an annual flow report on a case -by -case basis. MAIL ORIGINAL AND ONE COPY OF THIS ANNUAL SUMMARY (INCLUDING ALL "NO FLOW", "NO DISCHARGE") WITHIN 30 DAYS OF RECEIPT OF SAMPLE (OR AT END OF MONITORING PERIOD IN OF "NO FLOW") TO: Division of Water Resources — Attn: DWR Central Files 1617 Mail Service Center Raleigh, North Carolina 27699-1617 (919)807-6379 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 directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations." l (Signature of Permittee) (Da e) Permit Date: 8/1/2017-06/30/2022 Last Revised 08/09/17 Page 2 of 2 C Pacp Analytical Services, LLC 9800 KinceyAve. Suite 100 aceAnalytical Y _ Huntersville, NC 28078 www.paCofatS,C= O yC (70A)875�9097. r ! June 11, 2018 Mr. Michael Houser MacLeod Construction PO Box 320 . 4304 N. Pointe Ind Charlotte Denver, NC 28037 RE: Project: DP-1 Pace Project No.: 92386334 Dear Mr. Houser: Enclosed are the analytical results for sample(s) received by the laboratory on May 29, 2018, The results relate only to the samples included in this report. Results reported herein conform to the most current, applicable TNIINELAC 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, Sarah Graham for Angela Baioni angela.baioni@pacelabs.com (704)875-9092 Project Manager ErIC eMlres REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, without the written consent of Pace Analytical Services. LLC. Page 1 n3 13 C c aceAnalytical � - www.pacalaGs.com I Project.: DP-1 Pace Project No,: 92380334 Charlotte Certification IDs 9800 Kincey Ave. Ste 100, NLill tersville, NC 28078 LouisianalNELAP Certification # LA170028 North Carolina Drinking Water Certification #: 37706 North Carolina Field Services Certification #: 5342 North Carolina Wastewater Certification #: 12 Asheville Certification IDs 2225 Riverside Drive, Asheville, NC 28804 FloridalNELAP Certification #: E87648 Massachusetts Certification #. M-NC030 North Carolina Drinking Water Certification #: 37712 CERTIFICATIONS South Carolina Certification #: 90000001 FloridalNELAP Certification #. E87627 Kentur•.ky UST Certification #: 84 VirginiaNELAP Certification #; 460221 North Carolina Wastewater Certification #: 40 South Carolina Certification #: 09030001 VirginiaNELAP Cerfifcation #: 460222 Pace Analytical Services, LLC tMO Kierey Avo. Siitn Ioo Nuntersville, NO 2807a (704)875-9002 REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, without the written consent of Pace Analytical Services, LLC. Page 2 of t3 C C' aceAnalytical wempacafabs.c6m SAMPLE ANALYTE COUNT Project: DP-1 Pace Project No.: 023813334 Pace Analytical Services, LLC 0000 Kinr_ey Ave. Suite 100 Huntersville. NC 28078 (704)875-90s2 Analytes Lab ID Sample ID Method Analysts Reported Laboratory 92386334001 DP-1 EPA 1664B JMS 1 PAS!-C SM 254UD MDW 1 PASI-A SM 2540F MDW I PASI-A EPA 9040 RLO 1 PASI-A REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, without the written consent of Pace Analytical Services, LLC. Page 3 bt 13 �.l aceAnalyilcal " wwwPocelaLs, cram ANALYTICAL RESULTS Project: DP-1 Pace Project No.: 02386334 PTce Analytical Services, LLC 9600 Kinney Avr,. Suite 100 hluntersville, NC 28078 (704)875-9097- Sample: DP-1 Lab ID: 92386334001 Collertod: 05/29/W 09:00 Racolvod: 05120114i 09: 0 Matrix: W ller I Parameters Results Units Report Limit OF Prepared Analyzed CAS No. ) Oiml HEM, Oil and Grease Analytical Method: EPA 1664E Oil and Grease NO mg/L 5.0 1 06/11/18 04:17 2540D Total Susponded Solids Analytical Method: SM 2540D Total Suspended Solids 10.3 mg/L 3.5 1 06104/18 10:40 254OF Total Sottloablo Solids Analytical Method; SM 254OF Total Settleable Solids NO mL1Llhr 0.10 1 05/30/18 18:15 9040 pH Analytical Method: EPA9040 PH 7.8 Std. Units 0.10 1 05/29/18 22:57 HG Date: 061/1/2018 03:34 PM REPORT OF LABORATORY ANALYSIS This report shail not be reproduced, except in full, without the written consent of Pace Anaiytical Services, LLC. Page 4 of 13 aceAnalytical � � W11M1YpdLe1di15.COrn 1 r 1 Project: DP-1 Pace Project No.: 92386334 OC Batch: 414f52 OC Batch Method: EPA 1664E Associated Lab Samples: 92386334001 METHOD BLhAW 2200538 Associated Lab Samples: 92386334001 Parameter Oil and Grease QUALITY CONTROL DATA Analysis Method: EPA 1664B Analysis Description: 1G04 HEM, Oil and Grease Matrix: Water Blank Reporting Units Result Limit Analyzed Oualifiers mglL ND 5.0 0(3111118 04;17 Pare Am ilyllcal Services, UG 9600 Kincey Ave. Spite 100 Huntersville. NC 280715 (704)875-00:}2 LABORATORY CONTROL SAMPLE R LCSD: 2299539 2299540 Spike LCS LCSD LCS LCSD °/, Rec Max Parameter Wits Conc. Result Result % Rec % Ror, Limits RPD RPD OuaYifiefs Oil and Grease nig/L 38.5 37.9 37.7 98 98 78-114 0 30 Rr.sults presented en this, pa0o are In the units indicated by the "Units" column except wlsere nn altomate unit is presented to the right of the re —it. REPORT OF LABORATORY ANALYSIS This report shatl not be reproduced, except'u) full, Date: 061111201 B 03 34 PM without the written consent of Face Analytical Services, I -LC. Page 5 of 13 Pace Analytical Services, LLC • /+aet f �+ °q /j /'711a1ocal D800 KincdyAve. Suite IOr) Huntersvihe, NC 28078 www,pocolabs.com r (704)875-9092 QUALITY CONTROL DATA Project: DP-1 Pace Project No.: 92386334 OG Balch: 413661 Analysis Method'. SM 2540D OC Batch Method: SM 2540D Analysis Description: 254013 Total Suspended Solids Associated Lab Samples; 92386334001 METHOD BLANK: 229301B Matrix: Water Assoriaied Lab Samples: 92386334001 Blank [Reporting Parameter Units Result Limil Analyzed Qualifiers Total Suspended Solids mg1L ND 2.5 06/04/18 16:36 LABORATORY CONTROL SAMPLE: 2293919 Spike LCS LCS % Rec Parameter units Colic. Result `y. Rec Limits Qualifiers Total Suspended Solids mc11L 250 246 98 90-110 SAMPLE DUPLICATE: 2293920 92386252001 Dup Parameter Units Result Result RPD Qualifiers 1 16tal Suspended Soligs mg/L NO 9.G SAMPLE gUPL)CATE: 2293921 92386670002 Dup Parameter Units Result Result RPD Qualifiers Total Suspended Solids rnglL 38.0 43.5 13 DG Refiulte presented on this page are to the urlits indicated by the "Units" column except where an alternate unit is presented to the right (it the result. REPORT OF LABORATORY ANALYSIS This report shnll not be reproduced, except in full, Date: 06111/2018 03:34 PM without the written consent of Pace Analytical Services, LLC. Page 6 of 13 aceAnalytical wmv pacefabs.com i 1 Project: DP-1 Pace Project No.: 92386334 QC Batch: 413026 CSC Balch Method: SM 254OF Associated Lab Samples: 92386334001 METHOD BLANK: 2290891 Associated Lab Samples: 92386334001 Parameter Units Total Settleable Solicls nil-1Lfhr QUALITY CONTROL DATA Analysis Method: SM 2ri40F Analysis Duscription: 2540F Total Settable Solids Matrix: Water Blank Reporting Result LiaA Analyzed Qualifiers ND 0,10 0513011 B 18:15 Paco Analytical Services, LLC JBOf7Kin reyAve. Soito Inn I Ionter5ville, NC 78078 (7o4)876-0aa2 IiCSut1A pmsnn[nd An this pa{7r. am fn the uHlts indirnlyd Iry Iha "IJn#1a" coh�mn nxrept whrrn an ultrmnke unit Fx proacntnd to thn rirplH of ih� rceult. REPORT OF LABORATORY ANALYSIS This report shall not be reprodored, except in fufi, j ate: 06/11/2018 03:34 PM without the written consent of Pace Analytical Services. LLC. Page 7 of 13 aceAnalytical ' www.pncelabs.ccm r QUALITY CONTROL DATA Pace Analytical services, LLG 9800 i(inrey Avn, ;uitc; IOD Huritersville, NC 28078 (704)875-9092 Project: DP-1 Pace Project No,: 9238133334 OC Batch: 412818 Analysis Melhod: CPA 0040 OC batch Method; EPA 9040 Analysis Description: 9040 pl-I Assorinlerl Lab Samples: 92386334001 SAMPLE DUPLICATE: 2289848 92386304001 Dtlp Parstrneter Units Result ResUll RPD Cliialitiers PH std. Units 6.3 6.3 0 H6 1 Results prosentnd on this pane are in the units indlrated by the "ilnitn" column axvepr whoa nn nitrrnniv unit in prngnnted to thn rirrld or trm rn9n11. REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, Dale: OG/ 1112018 03:34 PM without the written consent of Pace Analytical Services, LLC. Page 8, of 13 Pace Analytical Services, LLC aceAnalytical 9800 KinceyAve, Suite 100 liuntersville, NC 28078 wwWpacelabs,com (704Jt375-QO ]'l.. 1 QUALIFIERS Project: DP-1 Pace Project No.: 92386334 DEFINITIONS DF - Dilution Factor, if reported, represents the factor applied to the reporlad data due 10 dilution of tho sample aliquot. ND - Not Detected at or above adjusted reporting limit. TNTC - TOO Numerous "% Count ,I - Estimated concentration above the adjusted method detection limit and below the adjusted reporting limit. MDL- Adjusted Method Defection Limit. POL _ I cortical Quantitation Unlit, RL - Reporting Limit. S - Surrogate 1,2-Dipheny1hydrazine decomposes to and cannot be separated from Azabenzene using Method 8270. The result for each anaiyte 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 Chloraethylvinyl ether. A separate vial preserved to a pH of 4-5 is recommended in SW846 Chapter 4 for the analysis ofAcrolein and Acrylonitrile by EPA Method 8260. N-Nitrosodiphenylarnine decomposes and cannot be separated from Diphenylamine using Method 8270. The result reported for each analyte is a comhined concentration. Pace Analytical is TNI accredited. Contact your Pace PM for the current list of accredited analytes, TNI -The Nl;-:LAC Institute. LABORATORIES PASI•A Pare Analytical Services -Asheville PAS!-C Pace Analytical Services - Charlotte ANALYTE QUALIFIERS DG The precision between the sample and sample duplicate exceedod laboratory control limils, H6 Analysis initiated outside of the 15 rnintlte EPA required holding time. REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, 'Date: 0611112018 03:34 PM without the written consent Of Pace Analytical Services, U.C. Page 0 of 1 J ace Analytical www.paCelabS CWft QUALITY CONTROL DATA CROSS REFERENCE TABLE Project: DP-1 Pace Project No,: 923865334 Pace Analytical Servicor, LLC 9800 Kinney Ave, Suite 100 Plantersville, NC 28079 (704)f37. •c1092 Analytical Lab i❑ Sample Ili QC Batch Method QC Batch Analytical Mothod Batch 92386334001 DP-1 ODA 1664B 414652 92386334001 DP-1 SM 25400 413661 92386334001 DP-1 SM 254OF 413020 92386334001 DP-1 EPA 9040 412818 Date: 06111/2018 03:34 PM REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, without the written consent of Pace Analytical Services, LLC. Page 10 of 13 C� C 1 Document Name: Document Revised: February 7, 2018 Sample Condition U on Recet t SCUR Page I of 2 Analytical" Document No.: Issuing Authority: F-CAR-CS•033•Rev.06 Pace Carolinas Quality Office Laboratory receiving samples: Asheville ❑ Eden[] Greenwood ❑ Huntersville D �J Raleigh[] Mechanicsville❑ Clfen ame: wo 38633 ' IT' t #: Courier: ti❑Fed Ex � []UPS ❑U5P5 ,.-• Client ❑Commercial ❑Pace ❑Other; 92386334 IICCCIIIl1111 �ll Custody Seal Present? Dyes ❑No Seats intact? (Dyes Q. l)alolInitials Pcrsan EaarnlnlnQ Contents; Packing Material: ❑Bubble wrap ❑Bubble Bags E]None ❑ Other Biological Tissue Frozen? Thermometer" ❑Yes ❑No ON/A plR Gun ro: 9.2Td4O Type of Icc'. ❑wet ❑slue ❑None Cooler Temp ('C): / (.: , I Correction Factor: Add/Subtract ('Ci +0"4 f- Temp should be above freezing to VC Cooler Temp Corrected ('CJ: } i • 0Samples out of temp criteria. Samples on Ice, coating Process r hasbegun USDA Regulated 5011.(❑ N/A, water samglel Did samples originate in a quarantine Zone within the United States: CA, NY, or SC (check maps)? Did samples originate from a foreigns}"rce (Intern�lonally, i`-IYes nNrs inrl,idina Nawali and Pur �nrtn Rleni? r IYP% r- Nn Comments/Dlsere parlcY: Chain of Custody Present? QYi' Qr10 NIA 1. Samples Arrived within Hold Time? Yes ❑No N/A 2. Short Hold Time Analysis (02 he.)? Yes .' No N/A 3, Rush Turn, Around Time Requested? E2Yej ON -a— N/A 4. Sufficient volume? -ties ONO N/A S. Correct Containers Used? -Pace Containers Used? -©Yes Yes [:]No MNo ❑NIA ❑N/A 6. Containers Intact? w rs QN0 Q N/A 7. Dissolved analysis: Samples Field Filtered? aVes ❑No -[DNf 8, Sample Labels Match COC? -Includes Date ime/EO/Anal sis Matrix: -[3Yc ❑No ❑N/A 9.�I\5 4 r Headspace In VOA Vlats (55-6mm)? ❑Yes QNo l N/A 10, Trip Blank Present? Trip Blank Custody Seals Present? ❑Yes OYes ONO No �QN/A— [IN/A CD MENT515AMPLE DISCREPANCY FlOd Data Required? []Yes []NO Lot lD of split containers: CLIENT NOTLFICATION/RESOLUTION Person Contaaed: Date/Time; Prolect Manager SCURF Review: C 1 Date: Project Manager 5RF Review: _ �r�'', Date: 4 I^: Page 1 I of 13 Cl Document Name: Document Rcvlscd: February 7, 2018 c7GCMr9y1cal ^ sample Condition Upon Recel t SCURi Page 1 of 2 Document No.: issuing Authority: F•CAR-CS-033-Rev.06 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. Exceptlans: VOA, Conform, TOC, Oil and Grease, DRO/8015 (water) DOC, LLHg `*Bottom half of box is to list number of bottle Projectd :W0#'*-92386334: 06/12/18 CLIENT: 92-IIPICLEOD e ? Z C 2 2 a m e ^ A n a m a 2. v rJ w a z a i n �+ C� ^, 0 `dam' = 4 A m n a n T .n Q `. ?fi . 0 �V i ? n th j iel ry ri d$i Z C Z w z y G c m K 9 .p •� .V '.'�. _ rJ w `w aE E I E S a Z Q 7 2 +r jr _ _ • ` A E •a c L E E E E .E E E E 8 m m E w E r� E E E E 3 ,9 E E E E ,^ � L 17 N 3 Ng N o q o o a ', qE a ka 17 a m a ry a .� a a z rn a N a n U v LL V N U w L7 M Jr t7 t7 M t7 Ch env t7 01 - Ch `� a " l7 in a ~ ry a •. i'` a 4 m a l7tj U 7 wt m ra m m a, m 3 a a 4� a a a > > > v vt 1 1 2 3 4 S 6 7 8 9 I0 \ \\ 11 12 pH Adjustment Log for Preserved Samples Sample 10 Type of Preservative pH upon receipt pate preservation adjusted Time preservation adjusted Amount of Preservative added lot d Note: Wr=Cver Inere I5 a Wscrepancy artecttng Nortn Wrarina Comp;Idnce samplts, a Copy or tors form wB oe sent to the Mrtn t.arouna UUMM 6e RIJIUVOn kj-Le %I.e. Out of hold, Incorrect preservative, out of IMP, Intarrect containers. Page 12 of 13 or CHAIN -OF -CUSTODY 1 Analytical Request Document The Cheinbt-Custody is a LEGAL DOCUMIENT. All relevant fields must be comple.ed accuralety. PaceAnalXical' rwv_aa[claez_ [enr 1 Page: o! Section A Section 3 Section C _ Required Ciient Inlurma:ion: Required Prok�ct Inlonr *5on: Invoice Iniorrma:lon: Reno t To: Alle-4ion: Rr Copy To� Comp�?ny Na. e: REGULATORY AGENCY t to NPDES F GROUND WATER OR INKING WATER - -- -- UST i RC RA OIFicR Email 7e: Purenzs+: Order Np.: Pace Lhxi:c r�}' 4.v� ``+=%Y• is {r�.'..�i'✓ . !�,'i^- ric}rer:c: �n; - Vt Fi ( ti f Prole F1T ne: Pr Prolat MAn Site Location STATE: Requested Due Data:TAT: Project nvm = p— �-.fh c: Requested Analysis Filtered Section D lratri- Codes j(Y!N} Requ'ued Ci: nl I�'la--ncn l:,cr-„Ir, r rnn-r_ _- COLLECTED Preservwivas I Drinklgg YaLr DW U Z t. V.Wer VVT Waste 141aler L1 VV Z rOt;POs:TE coup) -SITE v • PrpduCl P 5'A?* EI:G+GRl.B L) � co .} �_ SAMPLE 1D Oil IA•Z.0-3/:3 A}r AR o LJ _ F s Samafe 0s MUST BE UNIOUE T-rss-ae TS O � -= G +- o -N Omer CT X Q 2 c r� � � a Q ti a� Q p p L t C •+ 1� � N O 2 ~ N DATE TIf.7E v^kTE TIMEN � x i Z Z 2 O y' � Pace Project No.! Lab I.D. r 7!y 2 3 5 5 T 8 9 12 ADDITIONAL LOMt.:ENT$ RELINQUISHED 6YlAFFILIATION DATE T1ME l�� 6Y LfA�'1pJ/N1 ¢7AT��!E,tJi` f T{11r`.7+E SAMPLE CONDITIONS j(f�A`C�fCEPTEp (/)AFFfr �lr •r / `/r`t•� (/, �4 ``r' I/��GZ�L�/� Il j •i I. Ir .I 1 f /�7J� 1 ! �A l 'IC L•'r'\� �1 SAMPLER NAME AND SIGNATURE n > > c U z PRINT Name of SAhiPLER:mly `� '•�- r V n / SIGNATURE DATE Signed J' ls�fla�c! �:!' {SIM1DDIl'YF: -�.1 %•y .,• r :a hrxun:rn r!.�:•. 9; s�:i»�xl :t.s t:+n:: r v: n. _.�.wi.rmn P,r�k NE t �o rL q I'.,I rr ni tmrsrs yin". a,-rrrcmp to i":r cl.e:rn n! +_57:: r �:sr:r.�n !�r �r+..lrn ntc� tin; read m0sin 9;I d3ys. .� F•fILL•f]-aZOrev 07. 1 Sj�,.'007 V �aceAnaIXical' J` rww.pacela6s.tam CHAIN-OF-CUS, )Y t€ Analytical Request Document The Chain -of -Custody is a LEGA DOCUMENT. All relevant fields must be completed accurately. Section A Section B Section C Page: of 4equired Client Information: Required Project Information: Invoice Information: o Report To: Attention: tJ jj a O6 2 2 4d re n �U� ►�� Copy To: r Co p n Name: , E U10 a/O^gr—77?.�'� !3� REGULATORY AGENCY P'U" l Y 3�p D `/�—X �� 'f,}� 'SCTi r NPDES r GRQUND WATER (- DRiNKING WATER r UST r RCRA r OTHER Purchase pfdor No.: Pace Ouaatte r n Reference Ap opg,J/�' yy�d F'ryu I II�3'3 �TC� Project Name: r' : Site Location CD`7 �1 / + ManagerPace - 'T STATi=: - tequesled Due DaterTAT: Project Number: Pace Profile a: ;~ Requested Analysis Filtered (YIN) Section D Matrix Codes- RequlredCliantlnrormation MATRIX r CODr= s COLLECTED Preservatives 3- ' Drinking Water DW g Q. z - Water, WT Waste Water WW "' U COMPOSITE COA1Po5i7E O t� +' Product P a m" START ENDlGRA6 W V Z Soivsolid SL y SAMPLE ID a.i,• OL H �; 0 .. L W,pe' WP (A-Z. 0-9 I: Y iA r i' Aft w a a w z m t" c O Sample IDS MUST BE UNLQUE , �!!!_ Tissue TS p a_ LIJN at U .Other OT U x I- z J o J L) y m a� V O z 2 Oro N cc T A w a a O U m ID L Q m ~ DATE TIME DATE TIME u) a Z = S z z 2Q y Pace Project No./ Lab I.D. 2 3 4 5 6 � r 7 1 B - 9 10 11 ! 12 9€t f ADDITIONAL COMMENTS - -_ RELINQUISHEDBYlAFFILIATION DATE . . TIME k ACCEPTED BYI Fy Ar N ATE TIME SAMPLE CONDITIONS I Z r ,, v I r; f •1 pIi f! SAMPLER NAME AND SIGNATURE U o 0 9 — } v } PRINT Name of SAMPLER:mJ 6-Z NQ,Kcoo v a l SIGNATURE of SAMPLER DATE Signal // �y (J 7r/ , m ~ as = O m E yr (MWDDNY): PkeAnalXical" w .pacelabs.com CHAIN -OF -CUSTODY 1 Analytical Request Document The Chain -of -Custody is a LEGAL DOCUMENT. All reSevant Iieids must be completed accurately. O Page: of Q Section A Section B Section C Required Client Inlonnation: Required Project Inrormalion: Invoice Information: Co o Report To', AR0780n: e j `tj f b Ad ' J 96 Copy To: Comp ny Na a: C t l REGULATORY AGENCY f a dr�f��J -• �L/� NPDES GROUND WATER .7 DRINKING WATER C L•�Purchae �� �(` UST RCRA OTHER�� Email To, Order No.: Px 0". y f ? ,ry--I IRVfemncn: Narne: P-L P`�°ct Site Location S*ATE: Roquostod Due DatarTAT: P"ect NumbLT: Pacer Profia k: Requested Analysis Filtered (YIN) Section D Mama Codes Z Ragairod Gnnt UATRIK r CODE 3 a COLLECTED Preservatives > Drinking Water DW U Waior WT Waste Water 4WV COMPOSITE ouposITE p ` Product P 'n E NaCan w Z SoiVsoed SL SAMPLE ID °wmo $ La " o A r WOt-P Y ¢ a (A-Z.0-91:) Air AR w O ! 4 Z ~ $ample IOs MUST BE UNIQUE Tissue TS p a Q U 4t N C U Other OT U l!: z Z a a U N`a p am c Q ��•. t DATE TIME DATE TIME a = S S z z � O .,o it w Pace Project No./ Lab I.D. 1 �� ) 2 3 4 5 6 7 8 9 10 11 if 12 f ADDITIONAL COMMENTS RELINQUISHED BY l,AFFILJATION DATE TIME / ACCEPTED BY I F 11t ATE TIME CONDITIONS f ISA jMPLE `f �1 SAMPLER NAME AND SIGNATURE f 0{r71!V: a Z q o PRINT Name of SAMPLER: ' r C U n n SIGNATURE of SAMPLE //� ,,/� � DATE Signed v�,14 /LiLYff' , f��roD+rn: � L 4n. Wrnr NWO- u•rs Iran you:�:rrnd;tn] P—ris NET 30 LT..- Pnym:+M tenor snd agreona ro Wo rJetgres A 1.5;L per nlorLl:i fir .v,v invoiu:s n-.d .11- 3D love ! F-ALL-0-020rev.07, zS-- 1.007 ` ')• V PROCESS WASTEWATER -Discharge Monitoring MeI vr��IVEb � �} 00 GENERAL PERMIT No. NCG140044 JAN 18 2019 --- -1-- SAMPLECOLLEMON �Dmjjj `S` CTlQ;�J CERTIFICATE OF COVERAGE NO. NCG1�S — FAC ITY NAME: MacLeod Construction, Inc. — North Pointe Plant SAMPLE PERIOD: Duly -Dec mtr er nuary-June SAMPLE COLLlcGT01�: r r=� �= ^!ti C. sf� �r''�` _ SAMPLE FREQUENCY: Quarterly{ Semi-awwa W El CERTIFIED LABORATORY- Lab 9 COUNTY: Mecklenburg Lab # PHONE NO.: 704-483-3580 ADD TO USTSERVE? YES ONO EMAIL LIMIT "OLATIONS? YES l'<O 1] DIS+CFIARGING TO cL6m: [}SA Qi-IQW []PNA E]Trout 20ther C OPTIONAL INFO: a if wastewater systems have not discharged in this quarter— report "No Flow' or `No Discharges here. Please make sure to mark the sample quarter above. 2 Report the abbreviation for the type of Authorized Wastewater Disd-arges here: Vehicle and Equipment Cleaning (VE), Raw Material Stockpiles (RM), Mixing Drum Geanottt (MD). Report more than one type if the waste -stream is commingled. Permit Date: 811/2017-06130/2022 Last Revised OS109J17 Page 1 of 2 a 11�1_ ' if an effluent limit is exceeded twice in a row, the permittee is required to institute monthly monitoring for that parameter for six months, unless DEMLR RO staff notifies you to continue monitoring. 4 pH limits are 6-9 S.U. for wastewater discharges to freshwaters, and 6.8-8.5 S.U. for discharges to saltwaters. 5 TSS limits are 20 mg/L for wastewater discharges to HQW waters, 10 mg/L for Trout and PNA waters, and 30 mg/L for all other water classifications. s Process wastewater discharges shall only be monitored for TPH when commingled.with stormwater discharges from VMA areas..TPH_does not have a limit for wastewater, ---- -._.:but Instead -is subject to benchmarks and provisions -of Part Ill, Secfion-A; Including ttie 3 iered Response Action. Flow rate can be measured continuously or calculated. Flow limits for wastewater discharges to HQW waters shall be set to 50% of the Summer 7Q10 Flow as per 15A NCAC 02B .0224. Permittees who discharge wastewater to HQW waters shall obtain a Summer 7Q10 flow and report this information to DEMLR. If the permittee cannot obtain a Summer 7Q10 flow for the receiving waters at the discharge location, the permittee shall notify DEMLR, and the DEMLR Regional Office may require an annual flow report on a case -by -case basis. MAIL ORIGINAL AND ONE COPY OF THIS ANNUAL SUMMARY (INCLUDING ALL "NO FLOW", "NO DISCHARGE") WITHIN 30 DAYS OF RECEIPT OF SAMPLE (OR AT END OF MONITORING PERIOD IN CASE OF "NO FLOWS TO: Division of Water Resources Attn: DWR Central Files 1617 Mail Service Center Raleigh, North Carolina 27699-1617 (919)807-6379 YOU MUST_SIGN THIS CI RTIFIG4TION 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 directly responsible for gathering the information, the information submitted is, to the Kest of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations." (Signature of Permittee) (Date) Permit Date: 8/1/2017-06/30/2022 Last Revised 08/09117 Page 2 of 2 11�;ZeAnalyficalo + wwr�:pecelabs.cpm k August 16, 2018 Mr. Michael Houser MacLeod Construction PO Box 320 4304 N. Pointe Ind Charlotte Denver, NC 28037 RE: Project: DP-1 - Plant Pace Project No.: 92394171 Pate Analytical Services, LLC 9600 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 t Dear Mr. Houser: Enclosed are the analytical results for sample(s) received by the laboratory on August 02, 2018, Tne results relate only to the samples included in this report. Results reported herein conform to the most current, applicable TNIINELAC 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, Angela Baioni angela.baioni@pacelabs.com (704)875-9092 Project Manager Enclosures 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 12 aceAnalytical Viompacefabs.cnm i Pace Analytical Services, LLC 9800 Kincey Ave. Sutte 100 Huirrtersville, NC 28078 (704)875-9092 CERTIFICATIONS Project: DP-1 - Plant Pace Project No.: 92394171 Charlotte Certification IDs 9800 ttinceyAve. Ste 100, Huntersville, NC 28078 South Carolina Certification #: 99006001 LouisianaINEI-AP Certification # LA170028 Florida/NELAP Certification #: E87627 North Carolina Drinking Water Certification #: 37706 Kentucky UST Certification #: 84 North Carolina Field Services Certiflcation #, 5342 Virginia[VELAP Certification #; 460221 North Carolina Wastewater Certification #: 12 Asheville Certification IDs 2225 Riverside Drive, Asheville, NC 28804 North Carolina Wastewater Certification #: 40 FloridalNELAP Certification #; E87648 South Carolina Certification #: 90030001 Massachusetts Certification #: M-NCO30 VirgiriiaNELAP Certification #: 460222 North Carolina Drinking Water Certification # 37712 y 1 REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, without the written consent of Pace Analytical Services, LAC. Page 2 of 12 _ laceAnalytical"' WM..Aacelabs.am f Project: DIP-1 - Plant Pace Project No.: 92394171 Lab ID Sample ID 92394171001 DP1 SAMPLE ANALYTE COUNT Method EPA 1884E SM 254OD-2011 SM 2540E-2011 EPA 9040C REPORT OF LABORATORY ANALYSIS This report shall not be reproduced. except in full, without the written consent of Pace Analytical Services, LLC. Pace Analy 9800 K Hi An Analysts Rai JMS CEH CEH RLO Services, LLC Ave. Suite too vide, NC 28078 (704)875-9092 1, Laboratory 1 PASI-C 1 PASI-A 1 PASI-A 1 PASI-A n Page' of 12 I 17;a'ceAnalytical' WW..Pacelabs.cm 1 ANALYTICAL RESULTS Project: DP-1 - Plant Pace Project No.: 92394171 Pace Analytical Servicos, LLC 9800 K;ncey Ave. Suite 100 Hontersville, NC 28078 (704)875-9092 Sample: DP1 Lab ID: 92394171001 Collected: 08/02/18 06:50 Received: 08/02/18 08:57 Matrix: Water Parameters Results Units Report Limit DF Prepared Analyzed CAS No. Qual HEM, Oil and Grease Analytical Method: EPA 1664B Oil and Grease ND mg1L 4.8 1 08116118 03:49 2540D Total Suspended Solids Analytical Method: SM 254OD-2011 Total Suspended Solids 32.0 snglL 4.3 1 08/03/18 22:58 254OF Total Settleable Solids Analytical Method: SM 254OF-2011 Total Settleable Solids ND mL1Uhr 0.10 1 08J02/18 23:20 9040 pH Analytical Method: EPA 9040C pH at 25 Degrees C 8.5 Std. Units 0.10 1 08/10/18 22:27 H6 Dates 08/16/2018 12:43 PM REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, without the written consent of Pace Analytical Services, LLC. Page 4 of 12 aceAna1j4ica1' wwtvprtce�abs.crom Project: DP-1 - Plant Pace Project No.: 92394171 QC Batch: 425254 QC Batch Method: EPA 16648 Associated Lab Samples: 92394171001 METHOD BLANK: 2351578 Associated Lab Samples: 92394171001 Parameter Units Oil and Grease mg1L LABORATORY CONTROL SAMPLE: 2351579 Parameter Units Oil and Grease mglL MATRIX SPIKE SAMPLE: 2351580 Parameter Units Oil and Grease mg1L C Pace Analytical Services, LLC 9800 K ncey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 QUALITY CONTROL DATA Analysis Method: EPA 16648 Analysis Description: 1664 HEM, Oil and Grease Matrix: Water Blank Reporting Result Limit Analyzed Qualifiers ND G 4.8 � 08/16/18 03:47 Spike LCS LCS % Rec Conc. Result % Rec Limits Qualifiers 38.5 36.5 95 78-114 92394679008 Spike MS MS % Rec Result Conc, Result % Rec Limits Qualifiers ND 40 39.2 95 78-114 Results presented an this page are in the unite Indicated by the "Units- column except where an alternate unit Is presented to the rrght of the result. REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in Full, Dale: 08/16/2018 12:43 PM without the written consent of Pace Analytical Services, LLC Page 5 or 12 IceAnaiXiol' www.patalabs.com QUALITY CONTROL DATA Paco Analytical Sorricos, LLC 9800 K'mcey Ave. Suite 100 Hurltersville, NC 28078 (704)875.9092 Project: DP-1 - Plant Pace Project No.: 92394171 QC Batch: 423077 Analysis Method: SM 254OD-2011 QC Batch Method: SM 254OD-2011 Analysis Description: 2540D Total Suspended Solids Associated Lab Samples: 92394171001 METHOD BLANK: 2341177 Matrix: Water Associated Lab Samples: 92394171001 Blank Reporting Parameter Units Result Limit Analyzed Qualifiers Total Suspended Solids mg/L ND 2.5 08f03118 22:53 LABORATORY CONTROL SAMPLE: 2341178 Spike LCS LCS % Rec Parameter Units Conc. Result a/n Rec Limits Qualifiers Total Suspended Solids mg/L 250 252 101 90-110 SAMPLE DUPLICATE: 2341179 _ w 92394167002 Dup Parameter Units Result Result RPO Qualifiers C Total Suspended Solids mg/L 177 175 2 SAMPLE DUPLICATE: 2341180 92394138001 Dup Parameter Units Result Result RPD Qualifiers Total Suspended Solids mg/L 10.8 15.6 36 06 Rasulta presented on this page are In the units tntlFcated by the "Units" column except where an alternate unit Is presented to the right of the result. I� REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, Date: 08/16/2018 12A3 PM without the written consent of Pare Analytical Services, LLC, Page 6 of 12 aceAnalXical"' WWW.p43Cel8bS.COM �I Project: DP-1 - Plant Pace Project No.: 92394171 QC Batch: 422811 QC Batch Method: SM 254OF-2011 Associated Lab Samples: 92394171001 METHOD BLANK: 2339885 Associated Lab Samples: 92394171001 Parameter Units Total Settleable Solids ml-Vhr SAMPLE DUPLICATE: 2339886 Parameter Units Total Settleable Solids mL/L1hr Pace AnaJ tical Services, LLC 9E300 Kinsey Ave. Suite 100 HuntersviHe, NC 28078 (704)875-9092 .l QUALITY CONTROL DATA I :I i Analysis Method: SM 2540E-2011 Analysis Description: 254OF Total Settable Solids it Matrix: Water Blank Reporting Result Limit Analyzed Qualifiers ND 0.10 08/02118 23:20 92394171001 Dup Result Result RPD Qualifiers NO ND Results prasenfed on this papu are in the units Indlcatort by the "Units" colunvi 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' 0811612018 12:43 PM without the written consent of Pare Analytical Services, LLC, Page 7 of 17 C Analytical wmv.Pacela6s.com QUALITY CONTROL DATA i Pace Analytical Services, LLC 000 Kincey Ave. Suite 100 Hontersville, NC 28078 I {704)875-9092 Project: I)P-1 - Plant Pace Project No.: 92394171 QC Batch: 424234 Analysis Method: EPA 9040C i QC Batch Method: EPA 9040C Analysis Description: 9040 pH Associated Lab Samples: 92394171001 SAMPLE DUPLICATE: 2346699 Parameter Units pH at 25 Degrees C Std, Units SAMPLE DUPLICATE: 2346700 Parameter Units pH at 25 Degrees C Std. Units C 92394219001 Dup Result Result RPD Qualifiers 6.9 6.9 1 H6 92394239001 Dup Result Result RPD Qualifiers 7.2 7,2 0 H6 Rnsldts presontod on this pogo are in the units Indicsted by the "Units" column except whore an altanlate unit is preeented to tha right of the reaUlt. C REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, Date: 08M612018 12:43 Ph1 without the written consent of Pace Analytical Services, LLC. Page 8 of 12 Pace Analytical Services, LLC 9800KinceyAve. Suite f00 aceAnalXical Huntersville, NC 28078 www.pacaiabs.com i (704)875-9092 QUALIFIERS Project: DP-1 -Plant Pace Project No.: 92394171 DEFINITIONS DF - Dilution Factor, if reported, represents the factor applied to the reported data due to dilution of the sample aliquot. NO - 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. 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-Diphenythydrazine decomposes to and cannot be separated from Azobenzene using Method 6270, 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. SC - Silica Gel - Clean -Up n U - Indicates the compound was analyzed for. but not detected. C Acid preservation may not be appropriate for 2 Chloroethyivinyl 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-Nitrosodiphenyiamine decomposes and cannot be separated from Diphenylamine using Method 8270. The result reported for I� 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-A Pace Analytical Services -Asheville PASI-C Pace Analytical Services - Charlotte ANALYTE QUALIFIERS D6 The precision between the sample and sample duplicate exceeded laboratory control limits. H6 Analysis initiated outside of the 15 minute EPA required holding time. C' I REPORT OF LABORATORY ANALYSIS This report shall not be reproduced. except in full, Date: 08/16/2018 12:43 PM without the written consent of Pace Analytical Services, LLC. I Page 9 of 12 aceAnalytical www.pacwabs,mm QUALITY CONTROL DATA CROSS REFERENCE TABLE Project: DP-1 - Plant Pace Project No,: 92394171 Lab ID Sample ID QC Batch Method QC Batch 92394171001 DPI EPA1664B 425254 92394171001 DPI SM 2540D-2011 423077 92394171001 DP1 SM 2540E-2011 422811 92394171001 DPI EPA 9040C 424234 n C" REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, Date: 08/1612018 12:43 PM without the written consent of Pace Analytical Services, LLC. Pace An 9800 Analytical Method Services, LLC Ave. Suite 100 ville, NC 28078 t7041t375.9082 Analytical Batch Page 10 of 12 C C Document Name: Document Revised: February 7, 2018 = Sample Condition Upon ReCel t SCUR Page 1 of 2 Document No.: issuing Authority: aceAnalytrcar F-CAR-CS-033-Rev.06 Pace Carolinas Quality Office Laboratory receiving samples: Asheville ❑ Eden[] Greenwood ❑ Huntersville Client Name: Project �: Corti` Courier: ❑Fed Ex ❑UPS+ ❑USPS lablent ❑ Commercial ❑Pace ❑ether Custody Seal Present? Des ONO Seals Intact? Dyes ON Raleigh❑ Mechattlssville❑ f WO#:9239417i Ill 92394171 DalellnitialsPerson Examining Contents: Packing Material: ❑Bubble Wrap [Bubble Bags []None ❑ Other Biological Tissue Frozen? Thermomete . rrrr..--,,,,,,ffffrr ❑yes ❑Na �N/A LiRGun loc 92TO44 Type of Ica: I�Iwet ❑Blue ❑None Cooler Temp ('C): Correction Factor. Add/Subtract ('t) +0.4 t' Temp should be above freezing to VC Cooler Temp Corrected ('C): �.} - ❑Sa mplos out of temp Criteria. Samples on Ice, co i ling process has Begun USDA Regulated Soll (V N/A, water sample) i Did samples on 'mate In a quarantine Lone within the United States: CA, NY, or SC tcheck mapsl7 Did samples originate from a foreign source (Internationally, ❑Yes &0 Including Hawaii and Puerto Rico)? Dyes (2KJo f Cam mentstolscrepancy: Chain of Custody Present? ONo N/A I� 1. I Samples Arrived within Hold Time? 14ves Yes ❑No N A 2, Short Hold Time Analysis <72 hr.)? ptyes 0No N/A 3. i Rush Turn Around Time Rei quested? QYrs No N/A 4. Sufficient Volume? VYes No QNJA S. Correct Containers Used? -Pace Containers Used? Yes 2fyes []No No (]N/A ❑NIA 6, Containers Intact? Edits QNo QNJA 7. Olssolved analysis: Samples Field Filtered? Yes ONO [%tJ a. Sample Labels Match CDC? -includes Date/Time/ID/Analysis Matrix: oyes ` w ❑No ❑NJA 9. I I I Headspace In VOA Vials (>5.6mm)? []Yes QNo JfNIA I 10, i Trip Blank Present? Trip Blank Custody Seats Present? ❑yes Yee []NO QNo N/A N/A 11. I i r l COMMENTS/SAMPLE DISCREPANCY Field Data Required? Dyes ❑No i I Lot ID of Split containers: I CLIENT NOTIFICATION/RESOLUTION i I I ii Person Contacted: Date/Time: Project Manager SCURF Review: _.� Project Manager SRF RevVew: Date: i I I Pacle 11 of 12 r CHAIN -OF -CUSTODY ! Analytical Request Document N PaeeAnalyticai The Chain -of -Custody is a LEGAL DOCUt.,FNT. Ail relevant rields mLsi be completed accurately. s .pacela6s.com "- (17 Pager oe 0) Section A Section a Section C Required Client Informaton. Required Project Information- invoice Information: _ Anention—_ Repor Te, t L' %Ivor (_ ii7 fr lt' _ Ao��s Copy To: m ny Name: E . T o' r ,y41,�`' •� •� - iL'rar Purchase Order No.: /7 . ] I Pace ❑nma Rater �nco: S�� Project Nam - Q ! Pa a Requested Due DaterrAT;Mamper Project Njnt : Pace PnXal a= Section D Matrix Codes = Requiredcaum MATRIX ; CME a COLLECTED Preservatives r Drinking Water DW Oz 1513ter Waste Waver WT WW 8 " U G.7»IPOSrrE CpltEpsfTE V �� uc= P - Q STn rr ENevf.RAR SodlSaCd SL c O O N SAMPLE ID 01 L - i; 0 W H (A-Z. 0-9 V) Air AR Y c Z F Sample IDS MUST BE UNIQUE Tissue TS O Other OT U X u7 Z U Z y O = a At g a J a y 0 ~ 2 y DATE TIME DATE TIME O Y 1 2 A 10 1 1 ��7_ /.;ul2 F%z/rY &-rV r: REGULATORY AGENCY NPDES 7 GROUNDWATER _ DRINKING WATER UST RCRA OTHER Site Lopation STATE: Requested Analysis Filtered (YIN) Z } g 2_Z9 t I 73 tr Pace Project No.! Lab I-D. ADDITIONAL COMMENTS RELINQU SHED BY! AFFILIATION DATE TIME ACCEPTED BY I AFFILIATION DATE I TIME SAMPLE CONDITIONS r r r 4 SAMPLER NAME AND SIGNATURE PRINT Name of SAMPLER: 1 r �- J DATE Sig ' SIGNATURE of SAMPLAed ER1 !% r+ei, 8y s.rn r' rues fnm, you" :rttyiinG ?:,a'. Ir'ET 30 a;ey ry tare rh -gcs o1 1,51,: x a y inraiecs na P wliiir '_!} days. {! p Q 'o z c U Z �_ � y � F-ALL-O-020;vv.07. 1 `5-Ma�y-2007 �w r l Pace Analytical' www.pacalabs. com Section A Reaulred Client Information: ►.nru>!�-vr-4VJ I �T ! Analyucat Kequest Document The Chain -of -Custody is a LEGAL OCUMENT. All relevant fields must be completed accurately. Section 8 Section C Reouired Proiect Information: Invoice information'. {Page: of i Report To <<r !Attention: 4 U Ou � Copy To: i REGULATQRYGENCY ,,? r NPDES .r GROUNDWATER r DRINKING WATER i� UST r RCRA j` OTHER /If Ts��'/ C�pUc;r7C - (iJrFt Purchase Order No.: � � e l_ 1'r-C i Pace uote Q Rare l Pha of C. �'�- Fax. r• y '�OY-1/v"x Project Name.PaceProleC (� 19 Ma,ae� 1Ya Etyaf s�xur f,site l acatfon '7 ` f la?7 - Project Number. Pace Profile #: Requested Due DateIFAT: {�L r"'�`si + STAsir t Requasled Aniii;7 S�Fjlle�edi(,Yll!};� 'y gr ,SSection D Matrix Codes Requirl C4ient Infoirnabon MATRIX / CODE COLLECTED - Presarvafives-ill Ems'EMN ` —MIAMEN, Ddnking Water DW-' ti RR coi n Z O �! 1 Water WT Waste Water WW a V m COMPOSITE START. CDMPOSn"E Ek0iGw1B r J -• Product P Soil/Sclid SL SAMPLE ID- OL i ej �► ape a {A-Z, 0-9 ! ,-) Air AR Sample IDs MUST BE UNIQUE Tissue TS E3 O w a a Lu z - Q F' t"- N L Other OT U rr F H Z N p N # J Lu N n Z I N r_ r 3 3 w !X a ¢ Q o CL °z°c;°ro ~ rn DATE- TIME DATE 41, z z 2 O :. of Pace Project NoJ Lab I.D. /TIME J f2 ' a3 t A 4 >5 gS _8 i9 .' 0 t1 tz < •' .".�'ADDITIONALxCOMMENTSr �( '- REL NNQUISH 5`BY I AFFILfATIOIY DATE TIM - ACC CE BYI.�RF.F Tt� N-, D '1'E�i � ME SAMPLE CONDETiONS ..f.�-'rctu:¢^tmx(+..+o�'. •r.:ocarxa•+.rnn:sc�.v:vf:_ ` his tis �.' AE 'y lr iSAMPL'ER',NAM£'ANDSIGNATURE i�ST7tli:!�.Cu'YC�4L".`1M=d�.�^i�.��: i1u -t ~ s „/SSA` �iptgf� WWSC c `m i�.�i... ! k} 1. PRINT Name of SAMPLER: i1 7 l4 f'i."�� �. fi' r � f, r i �� r o- m in zi m • ' m 0 rt U � >` E SIGNATURE of SAMPLER; �� �� ! I` DATE Signed j E i r .t 1 !' (MMIDDNY): 'Importanl;.,y signing this farm you are accepting Pace's NET 30 day payment terms and agreeing to late charges of 1.5% per month For ali,_c6ices not paid within 30 days- F-ALL-Q-020rev.07- 15-MA ->nn7 b" �t PROCESS AASTCWATCR —Discharge Monitoring Report. � GENERAL PERMT NO. NCGI40000 CERTIFICATE OF COVERAGE NO. NCG140448 FACILITY NAME: MacLeod Construction Inc. — North Pointe Plant SAMPLE COU ECI OW CERTIFIED LABORATORY: Lab # Lab LIMIT VIOLATIONS? YF_S91r0E3 Part 14:1fifastewaW Monitorine Requirements SAMPLE COLLECfI7,7L;;r 20f5SAMPLE PERIOD: ber anuary-June SAMPLE FREQUENCY: Quarter � i-ammolly ❑ COUNTY- Meddenburg PHONE NO.: 704-493-3580 ADD TO LISTSERVP ]YES ❑NO EMAIL DISCHARGING TO CLASS: D A ❑HQw ❑PNA ElTcatrt Other C OPTIONAL INFO: IN �~ �n{�� •a �*L s i1 �r t 1 If wastewater systems have not discharged in this quarter — report `No Floe' or "No Discharge" here. Please make sure to mark the sample quarter above. Z Report the abbreviation for the type of Authorized Wastewater Discharges here: Vehicle and Equipment Cleaning (VE), Raw Material Stockpiles (RM), Mixing Drum Cleanout (MID). Report more than one type if the waste -stream is commingled. Permit Date: 81112017-00012022 [ast Revised WJ09%17 Page 1 of 2 PROCESS WASTEWATER —Discharge Monitoring Report. GENERAL PERMIT NO. NCG140000 CERTIFICATE OF COVERAGE NO. NCG140448 FACILITY NAME: MacLeod Construction, Inc. — North Pointe Plant SAMPLE COLLECTOR: M[ C "fZZ j4pVSM� _ CERTIFIED LABORATORY:MC.F AlAtVTi C4L Lab # Lab # LIMIT VIOLATIONS? YES ❑ NO F_ Part A: Wastewater Monitoring Requirements RECEi1iED 4/7V JAN 18 2019 CENTRAL FILES null - J SECTION, SAMPLE COLLECTION YEAR: 2018 SAMPLE PERIOD: auly-December []January -June SAMPLE FREQUENCY: Quarterly [' Semi-annually ❑ COUNTY: Mecklenburg PHONE NO.: 704-483-3580 ADD TO LISTSERVE? ❑YES ❑NO EMAIL: DISCHARGING TO CLASS: ❑SA ❑HQW ❑PNA ❑Trout ®Other C OPTIONAL INFO: Settleable Non=Polar Total Flow Date Sample Type of Wastewater pH Total Suspended Solids (mL/L) Oil & Grease Discharge (gallons/day)' Outfall No. - Collected' (VE; RM, MD) (standard) Solids .' (Not usingme�hod Duration; (Not (mm /dd /yr) (mg/L) 1964SGT-HEMe (minutes). Applicable for. Applicable for (mg/T) MacLeod) MacLeod) ZL QG If wastewater systems have not discharged in this quarter— report "No Flow" or "No Discharge" here. Please make sure to mark the sample quarter above. z Report the abbreviation for the type of Authorized Wastewater Discharges here: Vehicle and Equipment Cleaning (VE), Raw Material Stockpiles (RM), Mixing Drum Cleanout (MD). Report more than one type if the waste -stream is commingled. Permit Date: 8/1/2017-06/30/2022 Last Revised 08/09/17 Page 1 of 2 _ A, 3if an effluent limit is exceeded twice in a row, the permittee is required to institute monthly monitoring for that parameter for six months, unless DEMLR RO staff notifies you to continue monitoring. 4 pH limits are 6-9 S.U. for wastewater discharges to freshwaters, and 6.8-8.5 S.U. for discharges to saltwaters. 5 TSS limits are 20 mg/L for wastewater discharges to HQW waters, 10 mg/L for Trout and PNA waters, and 30 mg/L for all other water classifications. 6 Process wastewater discharges shall only be monitored for TPH when commingled with stormwater discharges from VMA areas. TPH does not have a limit -for wastewater, but instead is subject to benchmarks and provisions of Par# 1V, Section A, including the Tiered Response Action. Flow rate can be measured continuously or calculated. Flow limits for wastewater discharges to HQW waters shall be set to•50% of the Summer 7Q10 Flow as per 15A NCAC 02B .0224. Permittees who discharge wastewater to HQW waters shall obtain a Summer 7Q10 flow and report this information to DEMLR. if the permittee cannot obtain a Summer 7Q10 flow for the receiving waters at the discharge location, the permittee shall notify DEMLR, and the DEMLR Regional Office may require an annual flow report on a case -by -case basis. MAIL ORIGINAL AND ONE COPY OF THIS ANNUAL SUMMARY (INCLUDING ALL "NO FLOW". "NO DISCHARGE") WITHIN 30 DAYS OF RECEIPT OF SAMPLE (OR AT END OF MONITORING PERIOD IN CASE OF "NO FLOW") TO: Division of Water Resources (1 Attn: DWR Central Files 1617 Mail Service Center Raleigh, North Carolina 27699-1617 (919) 807-6379 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 directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing (Signature of Permit Date: 8/1/2017-06/30/2022 (Date) Last Revised 08/09/17 Page 2 of 2 C aceAnalytical9 MAYN,pBCelatISCOT November 09, 2018 Mr. Michael Houser MacLeod Construction PO Box 320 4304 N. Pointe Ind Charlotte Denver, NC 28037 RE: Project: DP-1 Pace Project No.: 92405064 Pace Analytical Services, LLC 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 " 3 Dear Mr. Houser: Enclosed are the analytical results for sample(s) received by the laboratory on October 26, 2018. The results relate only to the samples included in this report. Results reported herein conform to the most current, applicable TNIINELAC 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, Sarah Graham for Angela Baioni angela.baioni@pacelabs.com (704)875-9092 Project Manager Enclosures REPORT OF LABORATORY ANALYSIS This report shalt not be reproduced, except in full, without the written consent of Pace Analytical Services, LLC. to17b11b Page 1 of 11 C aceAnalytical www.pacelabs.mi Project: DP-1 Pace Project No.: 92405064 Charlotte Certification IDs 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 Asheville Certification IDs 2225 Riverside Drive, Asheville, NC 28804 FloridalNELAP Certification #: E87648 Massachusetts Certification #: M-NCO30 North Carolina Drinking Water Certification #: 37712 CERTIFICATIONS South Carolina Certification #: 99006001 FloridalNELAP Certification #: E87627 Kentucky UST Certification #: 84 VirginiaNELAP Certification #: 460221 North Carolina Wastewater Certification #. 40 South Carolina Certification #: 99030001 VirginiaNELAP Certification #: 460222 Pace Analytical Services, LLC 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704 )875-9092 REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, without the written consent of Pace Analytical Services, LLC. Page 2 of 11 C aceAnalytical' www.pacerabs.= SAMPLE ANALYTE COUNT Project: DP-1 Pace Project No.: 92405064 Pace Analytical Services, LLC 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 Analytes Lab ID Sample ID Method Analysts Reported Laboratory 92405064001 DP-1 EPA 1664E JMS 1 PASI-C SM 254OD-2011 CRV 1 PASI-A REPORT OF LABORATORY ANALYSIS This report shad not be reproduced, except in full, without the written consent of Pace Analytical Services, LLC. Page 3 of 11 L Pace Analytical Services, LLC e 9800 Kincey Ave. Suite 400 aceAnalytical Huntersville, NC 28078 www.pacelabscom (704)e75-9092 ANALYTICAL RESULTS Project: DP-1 Pace Project No.: 92405064 Sample: DP-1 Parameters Lab ID: 92406064001 Collected: 10/2511B 15:50 Results Units Report Limit DF Received: 10126/18 16:20 Matrix: Water Prepared Analyzed CAS No. Qual Field Data Analytical Method: Collected By J. Qualtierl 1 10/30/18 08:16 Collected Date 10/26/18 1 10/30118 08:16 Collected Time 16:20 1 10/30118 08:16 pH 8.7 Sid. Units 0.10 1 10/30/18 08:16 Temperature 10.8 deg C 0.50 1 10/30/18 08:16 Hl=-M, oil and Grease Analytical Method: EPA 1664E Oil and Grease ND mglL 4.8 1 11/09/18 04:55 2540D Total Suspended Solids Analytical Method: SM 25400-2011 Total Suspended Solids 12.3 mglL 2.6 1 10/30/18 20:18 REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, Date: 11 /09/2018 05700 PM without the written consent of Pace Analytical Services, LLC. Page 4 of 11 aceAnalytical www,pacefabs.com QUALITY CONTROL DATA Project: DP-1 Pace Project No.: 92405064 OC Batch: 441311 Analysis Method: EPA 1664B QC Batch Method: EPA 1664B Analysis Description: 1664 HEM, Oil and Grease Associated Lab Samples: 92405064001 METHOD BLANK: 2423457 Associated Lab Samples: 92405064001 Parameter Units Oil and Grease mg/1- LABORATORY CONTROL SAMPLE: 2423458 Parameter Units Oil and Grease mg1L Pace Analytical Services, LLC 9800 Kincey Ave, Suite 100 Huntersville, NC 28078 (704)875.9092 Matrix: Water Blank Reporting Result Limit Analyzed Qualifiers ND 4.8 11/09/18 04:49 Spike LCS LCS % Rec Conc. Result % Rec Limits Qualifiers 38.5 36.5 95 78-114 MATRIX SPIKE SAMPLE: 2423459 92404990003 Spike MS MS % Rec Parameter Units Result Conc. Result % Rec Limits Qualifiers Oil and Grease mg1L 15.4 40 51.5 90 78-114 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: 11/09/2018 05:00 PM without the written consent of Pace Analytical services, LLC. Page 5 of i 1 aceAnalyiical www.pacdabs.com Project: DP-1 Pace Project No.: 92405064 QC Batch: 439304 QC Batch Method: SM 254OD-2011 Associated Lab Samples: 92405064001 METHOD BLANK: 2414421 Associated Lab Samples: 92405064001 Parameter Units Total Suspended Solids mg1L LABORATORY CONTROL SAMPLE: 2414422 Parameter Units Total Suspended Solids mg/L SAMPLE DUPLICATE: 2414423 Parameter Units Total Suspended Solids mg/L SAMPLE DUPLICATE: 2414424 Parameter Total Suspended Solids Pace Analytical Services, LLC 9800KinceyAve, Suite 100 Huntersville, NC 28078 (704)875-9092 QUALITY CONTROL DATA Analysis Method: SM 254OD-2011 Analysis Description: 2540D Total Suspended Solids Matrix: Water Blank Reporting Result Limit Analyzed Qualifiers ND � 2.5 10130118 20:15 Spike LCS LCS % Rec Cone. Result % Rec Limits Qualifiers 250 246 98 90-110 92405026002 Dup Result Result RPD Qualifiers 34.5 36.2 5 92405069004 Dup Units Result Result mg/L ND 7.3 RPD Qualifiers 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: 11/09/2018 05:00 PM without the written consent of Pace Analytical Services, LLC. Page 6 of 1 i Pace Analytical Services, LLC 9800 Kircey Ave. ace Analytical � Huntersville, NC128078 we^xpacefabxcam (704)875-9092 C QUALIFIERS Project: DP-1 Pace Project No.: 92405064 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. 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 resuit 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 C 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 AcrylonitMe 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 PAST -A Pace Analytical Services -Asheville PASI-C Pace Analytical Services - Charlotte REPORT OF LABORATORY ANALYSIS This report shalt not be reproduced, except in full, Date: 11/09/2018 05:00 PM without the whiten consent of Pace Analytical Services, LLC. Page 7 of 11 c C aceAnapical wwwpacelahs.cow QUALITY CONTROL DATA CROSS REFERENCE TABLE Project: DP-1 Pace Project No.: 92405064 Lab ID Sample ID QC Batch Method 92405064001 DP-1 92405064001 DP-1 EPA1664B 92405064001 DP-1 SIN 254OD-2011 Pace Analytical Services, LLC 980C Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 QC Batch Analytical Method 441311 439304 Analytical Batch Date: 11I0912018 05:00 PM REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, without the written consent of Pace Analytical Services, LLC. Page 8 of 11 C Document Name: Document Revised: February 7, 2018 58CeAndlx1Ca?rl Sample Condition Upon Recei t(SCUR) Page 1 of 2 Document No.: Issu"rng Authority: I F-CAR-CS-033-Rev.66 Pace Carolinas Quality Office Laboratory receiving samples: Asheville ❑ Eden[—] Greenwood ❑ Huntersvllle[J Raleigh❑ Mechanicsville[] Client Name; OEM=M Project Courier: ❑Fed Ex ❑UPS ❑LISPS `i❑Client ❑ Commercial ❑Pace ❑Other: �f Custody Seal Present? ❑Yes ,❑No Seals Intact? ❑Yes ONo Packing Material: ❑Bubble Wrap ]Bubble Bags ❑None ❑ Other Thermometer. 92T 45 Type of ice: Owet ❑Blue ❑IR Gun ID'. Cooler Temp {'C): r ( Correction Factor: Add/Subtract ('C) Cooler Temp Corrected I'Cj: USDA Regulated Sall (❑ N/A, water sample) Did samples originate in a quarantine zone within the United States: CA, NY, or SC (check maps)? Flyer nNn WO# : 924050fi4 1111 H III 11111-11111111 92405064 Date/Initials Person Examining Contents Biological Tissue Frozen? ❑None Dyes ❑No .[]hf/A Temp should be above freezing to WC ❑Samples out of temp crheria. Samples on Ice, cooling process hasbegun Drd samples originate from a foreign source lintemationally, ;.AAW Hawaii and Punrin Rire17 F IYPs RNa Comments/Discrepancy; Chain of Custody Present? No N/A 1. -Samples Arrived within Hold Time? (]Yes ❑Na (]N/A 2. Short Hold Time Analysts 102 hr.)? Yes D NO 0141A 3. Rush Turn Around Time Requested? Yes No []N/A 4. Sufficient Volume? . Yj�' NO ❑N/A S. Correct Containers Used? -Pace Containers Used? QYes Yes ❑NO [I NO ❑NIA ❑N/A 6. ContalrlerS IntaCt? es DNO []N/A 7. Dissolved analysis; Samples Field Filtered? []Yes QNo I]N/A B. Sample Labels Match COC? -includes Date/Time/10/Anal sis _ Matrix: (Ares L^J 4 ❑NO ❑N/A 9. Headspace in VOA Vials (>5-6mm)? ❑Yes ❑No . NIA 1Q. Trip Blank Present? Trip Blank Custody Seals Present? QYes []Yes ❑No NA QN/A EfNJA 11. COMMENTS/SAMPLE DISCREPANCY Field Data Required? ❑Yes ❑NO uj6ts G 01f161n _ C1 41 k I i�'le f i1'n (:ui 1 f tAct!f : t21 Z @ I Gl_ 1 r Lot ID of split containers: CLIENT NOTIFICATION/RESOLUTION Person contacted: Date/Time: Project Manager SCURF Review: _ i:1V Date', ^2—4 Project Manager SRF Review: W Date: f�tU Page 9 of 11 PaceAnalytical " x"e"t.oxeelahs tom CHAIN -OF -CUSTODY / Analytical Request Document The Chain -of -Custody is a LEGAL, DOCUMENT, All relevant fields must be completed accurately. Section A Section B Section C Page: of Required Client Information: Required Prafeet Information; Invoice Information: Coma Report To: Attention; n 2 l 29 3 6 L Ad d Copy To; C p n Na i Z?t/C REGULATORY AGENCY Ad rAss' �-3Z-ZL4t; j f NPDES r GROUNDWATER f DRINKING WATER F— UST f RCRA OTHER [mai o• e fit' Purchase Order No.: Pace Ouoto t)Ii `Zi Ra[aonwa P r�-, PmjOC1 Name: Pace Proluct Site Location Yoq STA 7'E: Requested Clue Dato/TAT: Protect N>rrnher. Paw Profile d: Requested Analysis Filtered (YIN) Soction D Matrix Codes 2 �— RoqulredClieN Infmn'xion MAT{tll(r CODE o - ti COLLECTED Proservatives Dnnking Water DW " U Z 0 WT Waste Wraod-i Water WW $ n M f0 COUPOSITE COMPOSITE w z = START F.NVCRAp SoipS Iid SL w 0 p y SAMPLE ID Chi °L = Wipe JA•Z. 0-91: i Air AR AR q ¢ o. Z k-• Sample IDs MUST BE UNIQUE Tissue TS O U a x Other OT +— Z O o N X ly W LL w SZ O O C a j ~ 2 In I DATE TIME DATE TIME V) a fO S r= ra z TV z i Q y Pace Project NoJ Lab I.D. 2 3 a 5 B 7 8 9 TO 11 12 A"nDRIONAL COMMENTS RELINQUISCHED BY I AFPILI 7fON DATE TIM►Ej ACCEPTED BY I AFFILIATION DATTE�l SAMPLEnCONDITIONS y -' U • T • V, L ri :�IBW �O C.ir' � G.1 .Z1� GES" DTIIMMEE%� 1.(r LL.J f�• "I r U Ill 1 SAMPLER NAME AND SIGNATURE U o " z OF,IGINAL — S PRINT Name of SAMPLER: ,� `'—) f 'Q �z > > .2 m ~ir `—' U �+ N E ur I` DATE Signed J SIGNATURE of SAMPLER- ' f% iJ 'e ` ` (MWDDIYY): L 'lnywd:ml NOW BY sgnnq 11+5 lam you am mceplM Pacdw NET 30 day paymoel terms and ;"Treeing to tale ctw9m of 1.5 : per nlonil= 6r any in�oices mI p&dm1hin an day,. F-ALL-0-020rev,07, 15-May-2007 ii 0 O m 3 m O a n n m c n s 6 n = Rn Q C IA O y� A 9ry r! N n � 3 o C R Q n � a ID fµD m 3 b 4 n CL w Nf u 3 fD N p 3 c a �c n � a „ n 0 R .- Itemb ZZZZZZZZZ,-ZZZ BP4U-125 mL Plastic Unpreserved (NIA) (CI-) BP31.1-250 mL Plastic Unpreserved (N/A) BP2U-500 ml Plastic Unpreserved (N/A) BP1U-1 liter Plastic Unpreserved (NJA) BP4S-125 mL Plastic H2SO4 (pH < 2) (Cl.) BP3N-250 mL plastic HUO3 (pH c 2) BP4Z-125 mL Plastic ZN Acetate & NaOH (>9) zzzBP4C-125 mL Plastic NaOH (pH > 12) (CI-) WGFU-Wide-mouthed Glass )at Unpreserved AG1U-1 liter Amber Unpreserved (N/A) (CI-) r AG1H-1 liter Amber MCI (pH < 2) AGSU-250 ml. Amber Unpreserved (N/A) (CI-) AG15-1 liter Amber H2504 (pH c 2) AG3S-250 mL Amber H2SO4 (pH a 2) AG3A(DG3AJ-250 mL Amber NH4CI (N/A)(CI-) DG9HAO mt VOA MCI (N/A) VG9T-40 ml. VOA Na2SZ03 (N/A) VG9U40 mL VOA Unp (NIA) DG911-40 mL VOA H3PO4 (N/A) VOAK (6 vials per kit)-5035 kit (N/A) V/GK 13 vials per kit}-VPH/Gas kit (N/A) SPST-125 mL Sterile Plastic (N/A— lab) SPZT-250 mL Sterile Plastic (N/A —lab) nl BP3A-250 mL Plastic (NH2)2504 (9.3-9.7) AGGU-100 mL Amber Unpreserved vlats (N/A) VSGU-20 mL 56millation vials (NIA) 0G9U-40 mL Amber Unpreserved vials {NJA) 3L IN I C� CHAIN-OF-CUS�DY 1 Analytical Request Document --� ,vP ceAnal1 /`{ical • The Chain -of -Custody is a LEL.— DOCUMENT. All relevant fields must be completed accurately. www.oatelaha.cam � - :tion A Section B Section C Page: of lulred Client Information: Required Project Information: invoice information: npa y:_� Report To: Attenlipn; ' 2 2 2 9 3 6 7 2229367 n O Copy To: C n IV ( REGUL.ATORYAGENPCY "t—lyz 9BD-� YC Ad eJs' � � 37 jq- r NPDES r, GROUND WATER DRINKING WATER r UST r RCRA r OTHER ai D: 0 Purchase Order ND.: Pace Quote OtlS�� /1G. UM Reference: Project Name: Pace Project Site Location _ Ce Manager. x:'STAiE. luested Due Data/TAT: Project Number: Pace Profile a: Requested Analysis Filtered (YIN) Section D Matrix Codes z Y Required Client Information MATRIX ! CODE e m COLLECTED Preservatives Drinking Water DW o O z Water WT ' WaSle Water WW . o U al COMPOSITE COMPOSITE w _ Product P R < START END/GRAB Z SoigSolid SL 0 J p to y } SAMPLE ID Wpe OIL CSU Ir `) wP (A-Z, D-9! r) Air AR p w F- rL Ltl Z YI Sample IDs MUST BE UNIQUE Tissue TS O a 2 H Other OT X w Om o .T a o- m a O cl O T b L iv. C v o N N T = 2 L y' DATE TIME DATE TIME :m 7 Z Z 2 O , IY Pace Project No./ Lab I.D. r i✓ .t, 1 'D 1 1r ADDITIONAL COMMENTS REU QUIS`HED BY t AFFILI TION DATE TIME ACCEPTED BY ! AFFILIATION DATE TIME SAMPLE CONDITIONS' — �•� a D,'�°G �� �° Lc 16, zP 12 lc,-26q f 6; 6 B V SAMPLER NAME AND SIGNATURE o m z T PRINT Name of SAMPLER: .ten �+� (7 S olz— r a a LUG z Zi z E ~ e 5 0} Q} !� DATE Signed SIGNATURE of SAMPLE '��, - u (MMfDOfYY):'v/!<a PROCESS WASTEWATER —Discharge Monitoring Report. GENERAL PERMIT NO. NCG140000 CERTIFICATE OF COVERAGE NO. NCG140448 FACILITY NAME: MacLeod Construction Inc. — North Pointe Plant SAMPLE COLLECTOR: _[Y►j[AA t &U�, CERTIFIED LABORATORY:Ak.F AAALVn C.4C Lab # Lab # LIMIT VIOLATIONS? YES ❑ NO E_ Part A: Wastewater Monitoring Requirements DEC 0 6 2oig CENT FILES DWG{ SECTION SAMPLE COLLECTION YEAR: 2018 SAMPLE PERIOD: �uly-December []January -June SAMPLE FREQUENCY: Quarterly Fe ' Semi-annually ❑ COUNTY: Mecklenburg PHONE NO.: 704-483-3580 ADD TO LISTSERVE? ❑YES ❑NO EMAIL: DISCHARGING TO CLASS: ❑SA ❑HQW ❑PNA ❑Trout ®Other C OPTIONAL INFO: Outfall No.. Date Sample , : Collected1 dd r (mm / /y) Type of Wastewater [VE; RM, MD} Z pH (standard) Total Suspended Solids (mg/L} Settleable Solids' [mL/L) :." (Not. :Applicable for ..MacLeod} Hon -Polar ' Oil & Grease.. using method, 16645GT--HEM6. (mgJC} Discharge Duration (minutes). Total Flow (gallons/day)' (Not Applicable for, Y MacLeod) . a 2 B CoM i Goo 12.2 } QG fi 1 If wastewater systems have not discharged in this quarter — report "No Flow" or "No Discharge" here. Please make sure to mark the sample quarter above. 2 Report the abbreviation for the type of Authorized Wastewater Discharges here: Vehicle and Equipment Cleaning (VE), Raw Material Stockpiles (RM), Mixing Drum Cleanout (MD). Report more than one type if the waste -stream is commingled. Permit Date: 8/1/2017-06/30/2022 Last Revised 08/09/17 Page 1 of 2 0-- 'if an effluent limit is exceeded twice in a row, the permittee is required to institute monthly monitoring for that parameter for six months, unless DEMLR RO staff notifies you to continue monitoring. pH limits are 6-9 S.U. for wastewater discharges to freshwaters, and 6.8-8.5 S.U. fordischarges to saltwaters. 5 TSS limits are 20 mg/L for wastewater discharges to HQW waters, 10 mg/L for Trout and PNA waters, and 30 mg/L for all other water classifications. 6 Process wastewater discharges shall only be monitored for TPH when commingled with stormwater discharges from VMA areas. TPH does not have a limit -for wastewater, but instead is subject to benchmarks�and provisions of Part IV, Section A, including the Tiered Response Action. 7 Flow rate can be measured continuously or calculated. Flow limits for wastewater discharges to HQW waters shall be set to-50% of the Summer 7Q10 Flow as per 1SA NCAC 02B .0224. Permittees who discharge wastewater to HQW waters shall obtain a Summer 7Q10 flow and report this information to DEMLR. If the permittee cannot obtain a Summer 7Q10 flow for the receiving waters at the discharge location, the permittee shall notify DEMLR, and the DEMLR Regional Office may require an annual flow report on a case -by -case basis. MAIL ORIGINAL AND ONE COPY OF THIS ANNUAL SUMMARY (INCLUDING ALL "NO FLOW", "NO DISCHARGE") WITHIN 30 DAYS OF RECEIPT OF SAMPLE.(OR AT END OF MONITORING PERIOD IN CASE OF "NO FLOW_") TO: Division of Water Resources rr Attn: DWR Central Files 1617 Mail Service Center Raleigh, North Carolina 27699-1617 (919) 807-6379 YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED: "1 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 directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violatio " (Signature of Per i ee) (bate) Permit Date: 8/1/2017-06/30/2022 Last Revised 08/09/17 Page 2 of 2 Document Name: Document Revised: February 7, 2018 Sample Condltlon Upon Recel t(SCUR) Page 1 of 2 Document No.: issuing Authority: aceAnalpicai' F•CAR•C5-033•Rev.06 Pace Carolinas Qualiy Office 'Check mark top half of box if pH and/or dechlorination Is Project # verified and within the acceptance range for preservation samples. Exceptions: VOA, Coliform, TOC, Oil and Grease, DR0/8015 (water) DOC, LLHg "'Bottom half of box is to list number of bottle W0#:92405064 FM: AMB Due Date: 11/09/18 CLIENT: 92-MACLEOD E 2 a meti c u ... a E .r 7 v m 2 ti { u a E ry a in m z U C u _ a E LIP 7 ry m ¢ -Zr Z G :? .- 7 .� iA K n N N a -E1 ^� v Q. N q Z u N n J E N 2 m m x m N Y a u�� N N v m s U ri C3 u a E n V c m 10 w E a u Z Z a 7 a E m •.• Q ~ 2 s E m .r N 2 w ¢ E 1/a� N m �7 a ,y = _ `a E `a - t7 a V a b 4 Ean7 � N,JJ� w1 L7 ¢ U 2 Z E E r� C _ ^ a 2 z > E G a=+ o ry N z p 1. tri l9 > Z C > E O a u > 4 a M z > E O m 64 o t O O Y a n i m W V a a m E N I'n s a A u E r` r a W,I -� n 6 S u N E Ln N ¢ r� a m 2 b C Y a E J E S M a = C = c N E p N c7 Z ro Y a E a E in +a a 1 N NNN 1. KN- 2 NN 3 4 S 6 \N 7 -\\NN \\1 8 10 N .\\N -1 11 \�\i I 12 \:�S\N N\ pH Adjustment Log for Preserved Samples Sample 10 Type of Preservative pH upon receipt Date preservation adjusted Time prestrvatlon adjusted Amount of Preservative added Lot N Note: Whenever thereis a discrepancy affecting North Carolina comp}lance samples, a copy of this form will be tent to the North Carolina DEHNR Certification office (i.e. Out of hold, incorrect preservative, out of temp, incorrect containers. Page 10of11 CHAIN-OFXUF'DY I Analytical Request Document PaceAnalytical • The Chain -of -Custody is a LEUIL DOCUMENT. All relevant fields must be completed accurately. na�alahs ection A Section B Section C Page: of equlred Client information: Required Project Information: Invoice Information: mpa y: Report To: Attention: 2229367 - CV: to 664 b Copy To: C n N- . `/ /C REGULATORYAGENCy 504 YC C 7 YC / Ad ess: � - w �137 F NPDES F. GROUNDWATER r DRINKING WATER r UST r RCRA [` OTHER mat o: Purchase Order No.: Pace Quote CiliSQi nG. UM Mac— Reference: F x: Name: Pace Project •Site Location _Project � Manager: 'STATE: equested Due DatelrAT: Project Number: Pace Profile tt: Requested Analysis Filtered (YIN) Section D Matrix Codes z �— Required Client lnfonnaUon MATRIX f CODE , COLLECTED Preservatives ' Drinking Water DW 8 Water WT - Waste Water WW o inv COMPOSITE STET COMPOSITE ENO GRAB 2 Z Product P J - SoillSolid SL p } SAMPLE ID WipeWP vof A (A-2, 0-9 J :) Air AR w w a Z H o Sample IDs MUST BE UNIQUE Tissue TS O a F Z ,� {Lj Other OT X w w o �7 k R h IL O ?. 0 0 C - DATE TEME DATE TIME 2 # cry x aC x z z �_ O . y }— W Pace Project No./ Lao I.D. •.T i I 1. i r I I D 2 ' • ADDITIONAL COMMENTS OUI9)1ED BY./ AFFILIATION DATE TIME ACCEPTED BY I AFFILIATION) DATE _ TIME SAMPLE CONDITIONS' � �7 /RELI / 7 � 6, CJ t .. SAMPLER NAME AND SIGNATURE U o m C G } 2 G 9 g o U z_ O c z �, • PRINT Name of SAMPLER:AJC 4AS �� l�z F 4 U N 6 E E; SIGNATURof SAMPLE ��%, �/ DATE Signed v [�ix IQ _ 4�TLlli' (MMIDDfYYJ: N PROCESS WASTEWATER —Discharge Monitoring Report GENERAL PERMIT No. NCG140000 CERTIFICATE OF COVERAGE NO. NCG140448 SAMPLE COLLECTION YEAR: 1 a( 2 FACILITY NAME: MacLeod Construction, Inc. -- North Pointe Plant SAMPLE PERIOD: ❑July -December anuary-June SAMPLE COLLECTOR: I SAMPLE FREQUENCY: Quarterly V Semi-annually ❑ CERTIFIED LABORATORY: AWM&WCAL Lab # _ COUNTY: Mecklenburg Lab# � `L.�ICCHONE•NO::704-483-3580 ADD TO LISTSERVE? ❑YES ❑NO EMAIL: LIMIT VIOLATIONS? YES ❑ NO �J JU N WlSCHARGING TO CLASS: ❑SA ❑HQW ❑PNA ❑Trout ®Other C CEN I-IRAOPITIONAL INFO: Part A: Wastewater Monitoring Requirements r,tiA/.Q car r,nn� Outfall No. Date Sample , Collected' dd (mm / /yr) Type of Wastewater (VE, RM, MD)z pH (standard) Total Suspended Solids (mg/L) Settleable Non -Polar solids Oil & Grease (mL/L) using method (Not 16b4 SGT-HEM6 Applicable for (mg/L) MacLeod) Discharge Duration. (minutes) Total Flow (gallons/day)l (Not Applicable far MacLeod) _♦ - 6-93,4 303s i 60 Jr f wastewater systems have not dischareed in this auarter— renart "No Flnw" nr "No Dischar¢p" hprp. Please make surf to mark the samnlp nuartpr shove. Z Report the abbreviation for the type of Authorized Wastewater Discharges here: Vehicle and Equipment Cleaning (VE), Raw Material Stockpiles (RM), Mixing Drum Cleanout (MD). Report more than one type if the waste -stream is commingled. Permit Date: 8/1/2017-06/30/2022 Last Revised 08/09/17 Page 1 of 2 " !%j f �• ti!!J F i 3 if an effluent limit is exceeded twice in a row, the permittee is required to institute monthly monitoring for that parameter for six months, unless DEMLR RO staff notifies you to continue monitoring. 4 pH limits are 6-9 S.U. for wastewater discharges to freshwaters, and 6.8-8.5 S.U. for discharges to saltwaters. 5 TSS limits are 20 mg/L for wastewater discharges to HQW waters, 10 mg/L for Trout and PNA waters, and 30 mg/L for all other water classifications. 6 Process wastewater discharges shall only be monitored for TPH when commingled with stormwater discharges from VMA areas. TPH does not have a limit for wastewater, but instead is subject to benchmarks and provisions of Part IV, Section A, including the Tiered Response Action. I Flow rate can be measured continuously or calculated. Flow limits for wastewater discharges to HQW waters shall be set to 50% of the Summer 7Q10 Flow as per 15A NCAC 02B .0224. Permittees who discharge wastewater to HQW waters shall obtain a Summer 7Q10 flow and report this information to DEMLR. If the permittee cannot obtain a Summer 7Q10 flow for the receiving waters at the discharge location, the permittee shall notify DEMLR, and the DEMLR Regional Office may require an annual flow report on a case -by -case basis. _MAIL ORIGINAL AND ONE COPY OF THIS ANNUAL SUMMARY (INCLUDING ALL "NO FLOW", "NO DISCHARGE-) WITHIN 34 DAYS OF RECEIPT OF SAMPLE (OR AT END OF MONITORING PERIOD IN CASE OF "NO FLOW") TO: Division of Water Resources Attn: DWR Central Files 1617 Mail Service Center Raleigh; North Carolina 27699-1617 (919) 8b7-6379 YOU MUST SIGN THIS CERTIFIG4TION 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 directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing Violations." (Signature of Permittee) f Permit Date:8/1/2017-06/30/2022 (Date) Last Revised 08/09/17 Page 2 of 2 aceAnalytical wtinepdtelabxcam June 11, 2018 Mr. Michael Houser MacLeod Construction PO Box 320 . 4304 N. Pointe Ind Charlotte Denver, NC 28037 RE: Project: DP-1 Pace Project No.: 92386334 Pace Analytical Services, LLC 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 Dear Mr. Houser: Enclosed are the analytical results for sample(s) received by the laboratory on May 29, 2018. 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, Sarah Graham for Angela Baioni angela.baioni@pacelabs.com (704)875-9092 Project Manager Enclosures A, pl�`LICI'J! \mod REPORT OF LABORATORY ANALYSIS [VI This report shall not be reproduced, except in fO. QRA1O0- without the written consent of Pace Analytical Services, LLC. Page 1 of 13 Pace Analytical Services, LLC 100 aceAnalytical s 6/ 9800 KinteyAve. C 2 078 �-- Hunter5ville, NC 28078 Wompacefabaoom (704)875-9092 November 09, 2018 Mr. Michael Houser MacLeod Construction �b PO Box 320 4304 N. Pointe Ind Charlotte Denver, NC 28037 RE: Project: DP-1 Pace Project No.: 92405064 Dear Mr. Houser: Enclosed are the analytical results for sample(s) received by the laboratory on October 26, 2018. The results relate only to the samples included in this report. Results reported herein conform to the most current, applicable TNIINELAC 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, Sarah Graham for Angela Baioni angela.baioni@pacelabs.com (704)875-9092 Project Manager Enclosures 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 11 C c aceAnalytical www.pacelabs.=n Project: DP-1 Pace Project No.: 92405064 Charlotte Certification IDs 9800 Kincey Ave. Ste 100, Huntersvilte, NC 28078 Louisiana/NELAP Certification # LA170028 North Carolina Drinking Water Certification #: 37706 North Carolina Field Services Certification #: 5342 North Carolina Wastewater Certification #: 12 Asheville Certification lDs 2225 Riverside Drive, Asheville, NC 28804 Florida/NELAP Certification #; E87648 Massachusetts Certification #: M-NC030 North Carolina Drinking Water Certification #: 37712 CERTIFICATIONS South Carolina Certification #: 99006001 Florida/NELAP Certification #: E87627 Kentucky UST Certification #: 84 VirginiaNELAP Certification #: 460221 North Carolina Wastewater Certification #: 40 South Carolina Certification #; 99030001 VirginiaNELAP Certification #: 460222 Pace Analytical Services, LLC 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, without the written consent of Pace Analytical Services, LLC. Page 2 of 11 C ace Analytical wwwpa"Iabtmn SAMPLE ANALYTE COUNT Project: DP-1 Pace Project No.: 92405064 Pace Analytical Services, LLC 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 Analytes Lab ID Sample ID Method Analysts Reported Laboratory 92405064001 DPA EPA 1664E JMS 1 PASI-C SM 2540D-2011 CRV 1 PASI-A REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, without the written consent of Pace Analytical Services, LLC. Page 3 of 11 7 Pace Analytical Services, LLC m 9800 Kincey Ave. Suite 100 aceAnalytical Huntersville, NC 28073 www.pacelabs.com (704)875-9092 ANALYTICAL RESULTS Project: DP-1 Pace Project No.: 92405064 Sample: DP-1 Lab ID: 92405064001 Collected: 10/26/18 15:59 Received: 10126118 16:20 Matrix: Water Parameters Results Units Report Limit D]= Prepared Analyzed CAS No. Qua] Field Data Analytical Method Collected By J. Qualtleri 1 10/30/18 08:16 Collected Date 10126118 1 10/30/18 08:16 Collected Time 16:20 1 10/30/18 08:16 pH 8.7 Std. Units 0,10 . 1 10/30/18 08:16 Temperature 10.8 deg C 0.50 1 10/30/18 08:16 HEM, Oil and Grease Analytical Method: EPA 1664B Oil and Grease ND mg1L 4.8 1 11/09/18 04:55 26400 Total Suspended Solids Analytical Method: SM 254OD-2011 Total Suspended Solids 12.3 mg1L 2.6 1 10/30/18 20:18 REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, Date: 11/09/2018 05:00 PM without the written consent of Pace Analytical Services, LLC. Page 4 of 11 aceAnalytical www.pace)abs.com QUALITY CONTROL DATA Project: DP-1 Pace Project No.: 92405064 Pace Analytical Services, LLC 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 QC Batch: 441311 Analysis Method: EPA 1664B QC Batch Method: EPA 1664E Analysis Description: 1664 HEM, Oil and Grease Associated Lab Samples: 92405064001 METHOD BLANK: 2423457 Matrix: Water T Associated Lab Samples: 92405064001 Blank Reporting Parameter Units Result Limit if �:1 Analyzed Qualifiers Oil and Grease mg/L NO 4.8 11/09/18 04:49 LABORATORY CONTROL SAMPLE: 2423458 Spike LCS LCS % Rec Parameter Units Conc. Result % Rec Limits Qualifiers Oil and Grease mg/L 38.5 36.5 95 78-114 MATRIX SPIKE SAMPLE: 2423459 92404990003 Spike MS MS % Rec Parameter Units Result Conc. Result % Rec Limits Qualifiers Oil and Grease mg1L 15.4 40 51.5 90 78-114 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: 11/09/2018 05:00 PM without the written consent of Pace Analytical Services, LLC. Page 5 of 11 aceAnalytical www.pacelabicom C Project: DP-1 Pace Project No.: 92405064 QC Batch: 439304 OC Batch Method: SM 254OD-2011 Associated Lab Samples: 92405064001 METHOD BLANK: 2414421 Associated Lab Samples: 92405064001 Parameter Units Total Suspended Solids mg/L LABORATORY CONTROL SAMPLE: 2414422 Parameter Units Total Suspended Solids mg/L SAMPLE DUPLICATE: 2414423 Parameter Units Total Suspended Solids mg1L SAMPLE DUPLICATE: 2414424 Parameter Units Total Suspended Solids mg1L QUALITY CONTROL DATA Analysis Method: SM 254OD-2011 Analysis Description: 2540D Total Suspended Solids Matrix: Water Blank Reporting Result Limit Analyzed Qualifiers ND -2.5 1013011820:15 Spike Conc. 250 92405026002 Result 34.5 Pace Analytical Services, LLC 9800 Kincey Ave, Suite 100 Huntersville, NC 28078 (704)875-9092 LCS LCS % Rec Result % Rec. Limits Qualifiers 246 98 90-110 Dup Result 36.2 92405069004 pup Result Result ND 7.3 RPD Qualifiers 5 RPD Qualifiers 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 /09/2018 05:00 PM without the written consent of Pace Analytical Services, LLC. Page 6 of 11 aceAnalyfical www.pacelabs.com QUALIFIERS Project: DP-1 Pace Project No.: 92405064 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 huntersvi le, NC 28078 (704)875-9092 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-Diphenythydrazine 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 C U - Indicates the compound was analyzed for, but not detected. Acid preservation may not be appropriate for 2 Chloroethylvinyt 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-A Pace Analytical Services -Asheville PASI-C Pace Analytical Services - Charlotte REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, Date: 11/09/2018 05:00 PM without the written con seat of Pace Analytical Services, LLC. Page 7 of 11 C ace Analytical www.pacefabs.cam QUALITY CONTROL DATA CROSS REFERENCE TABLE Pace Analytical Services, LLC 9800 Kincey Ave. Su to 100 Huntersville, NC 28078 (704)B75-9092 Project: DP-1 Pace Project No.: 92405064 Analytical Lab lD Sample ID QC Batch Method QC Batch Analytical Method Batch 92405064001 DP-1 92405064001 DP-1 EPA 1664E 441311 92405064001 DP-1 SM 254OD-2011 439304 REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, Date: 11/09/2018 05:00 PM without the written consent of Pace Analytical Services, LLC. Page 8 of 11 C C c Document Name: Document Revised: February 7,1018 e aceAnalytica! SampleCondltlon Upon Rece! t(SCUR) Page 1 of 2 Document No.: Issuing Authority: l F-CAR-CS-033-Rev.06 Pace Carolinas Quality Office Laboratory receiving samples: Asheville ❑ Eden[ —]Greenwood ❑ Huntersville 0 Raleigh❑ Mechanicsville[]Client Narne: WO# : 924®5064 Project g:. Courier: ❑Fed Ex CUPS ❑LISPS -❑Client ❑ Commercial ❑Pace []Other: 92405064 Custody Seal Present? ❑Yes ,❑No Seals Intact? []Yes [36'o Packing Material: ❑Bubble Wrap[], 9ubble Bags ❑None ❑ Other Thermometer: 92,I 45 Type of Ice: Owet []Blue❑IR Gun 1D: Cooler Temp ('Cj: r I / <Correction Factor: Add/Subtract ['Cj Cooler Temp Corrected USDA Regulated Sall (0/A, water sample) Did samples originate in a quarantine zone within the United States: CA, NY, or SC (check maps)? Ayes r No Rate/Initlats Person Examining Contents/ Biological Tissue Frozen? ❑None ❑Yes []No ,QNIJA Temp should be above freezing to 6'C ❑Samples out of temp criteria. Samples on ice, cooling process has begun Did samples originate from a foreign source linternatlonally, ..�L�dlno Hamaii and N.Orm RI-17 myoc f—INn Comments/Discre ancy: Chain of Custody Present? ElYes QNo N/A 1. Sam Les Arrived within Hold Time? Dyes [IN. ❑N/A 2. Short Hold Time Anai sis R72 hr.)? yes Q No []NIA 3. Rush Turn Around Time Requested? []Yes l No ❑NIA 4. Sufficient Volume? .Yews QNo ❑N/A S. Correct Containers Used? -Pace Containers Used? 3 es Qy6s ❑No 11 No ❑N/A ❑N/A 6. Cant alners Intact? o es Na N/A ?. Dissolved analysis: Samples Field Filtered? Des Eho E1QA 8, Sample Labels Match COC? -Includes Date/Time/ID/Analysis . Matrix: QVes 4 ❑No ❑N/A 9. Headspace in VOA Vials (>S-6mm)? ❑Yes []No i O NIA 10. Trip Blank Present? Trip Blank Custody Seals Present? (]Yes Dyes ❑No CIN. ON/A / N/A 11. COMMENTS/SAMPLE DISCRJfEPANCY Field Data Required? ❑yes []No GQ e#-Lisn 1 �n e _J0'J'J 1: � 1 �zt t .vi Q �s _ l t�l Z vi @ i tic� Lot ID of split Containers: CLIENT NOTIFICATfON/RESOLUTION Person contacted: Oate/Time: Project Manager SCURF Review: pJ� Date; f r� —1 Project Manager SRF Review: I vVVt� Date: to 1705 Page 9 of 11 � n � FaceAnalyiical " wwu.dacelahs.com CHAIN -OF -CUSTODY / Analytical Request Document The Chain-cf-Custody is a LEGAL DOCUMENT. Ali relevant fields must be completed accurately. Section A Section 8 Section C Page: of EL RequiredClient Information: Required Project Information Invoice Information: ' Reparl To: Attention:2229367 1�01,n ae s. n Copy Ta: C p n N d �C REGULATORY AGENCY Ad -AC NPDES GROUND WATER r DRINKING WATER .- i- UST f RCRA OTHER _ [rnai o' Purchase Order No.: Paco Ouoiu Refaeuw: Project Name: Pace Project Site Location STATE: Ruquesled Duo DalofTAT: Prolact Number: Pea: Prw&a 9: Requested Analysis Filtered (YIN) Section D Mairix Codes c — z ]- RequiradCliunl lnlern'dion MATRns.r CODF R COLLECTED Preservatives 3 Drinking Water OW U O Water wT Waste ater YUW V an E COMPOSITE w ProduG SLOTART rNnAGi Ao Soil/Solid SL = '� L) Ir -� V SAMPLE ID oil 0L t m Wipe WP w 4 z N (A-Z, 0-91;) Air AR b a a Q ~ �� Sample IDs MUST BE UNIQUE Tissue TS zi ul a rrt U v " "' "•' Other QT X w J Lu J o U O N C In m :3a ,v_ w N Z Z y f ca DATE TIME DATE TIME 2= 2 O r Pace Project NoJ Lab I.D. 2 3 4 5 6 7 8 9 10 11 12 ADDITIONAL COMMENTS RELINGUIZNED BY I AFFIU TION DATE TIME ACCEPTED BY I AFFILIATION DATE TIME SAMPLE CONDITIONS SAMPLER NAME AND SIGNATURE c - ORfG UAL G _ -a s PRINT Name of SAMPLER: ,� f •' ;l/L -a > i N V ? U Z_ E m u v SIGNATURE of SAMPLER• f DATE Signed / •T �� V GCi 1,�% a E IMARlDDfYYI: C rn i IPOM I Note: By snnng this lam yqu aru aece.p1ffV Pace a NET 3a day payrnr• t tarns and: yaeffV to Lilo ehxgm of 1.5% yar nion611dr any inmeice nal IlV wnhin M days. F-ALL-0-020fev.07, 15-May-2007 aceAnalj cal www.pacelabs.can Project: DP-1 Pace Project No.: 92386334 Pace Analytical Services, LLC 9800 Kincey Ave, Suite 100 Huntersville, NC 28078 (704)875-9092 Charlotte Certification IDs 9800 Kincey Ave. Ste 100. Huntersville, NC 28078 Louisiana)N ELAP Certification # LA170028 North Carolina Drinking Water Certification #: 37706 North Carolina Field Services Certification #: 5342 North Carolina Wastewater Certification #: 12 Asheville Certification iDs 2225 Riverside Drive, Asheville, NC 28804 Florida/NELAP Certification #; E87648 Massachusetts Certification #: M-NC030 North Carolina Drinking Water Certification #: 37712 CERTIFICATIONS South Carolina Certification #: 99006001 Flofida/NELAP Certification #: E87627 Kentucky UST Certification #: 84 VirginiaNELAP Certification #: 460221 North Carolina Wastewater Certification #; 40 South Carolina Certification #: 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, LLC. Page 2 of 13 aceAnalytical www.pacelabs.com SAMPLE ANALYTE COUNT Pace Analytical Services, LLC 9800 Kincey Ave. Suite 100 Huntersvllte, NC 28078 (704)B75-9092 Project: DP-1 Pace Project No,: 92386334 Analytes Lab ID Sample ID Method Analysts Reported Laboratory 92386334001 DP-1 EPA 1664E JMS 1 PASI-C SM 2540D MDW 1 PASI-A SM 254OF MDW 1 PASI•A EPA 9040 RLO 1 PASI-A REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, without the written consent of Pace Analytical Services, LLC. Page 3 of 13 aceAnalytical. www.Pacellbs.= ANALYTICAL RESULTS Project: DP-1 Pace Project No.: 92386334 Pace Analytical Services, LLC 9800 Kincey Ave. Suite 100 Huntersville. NC 28078 (704)875-9092 Sample: DP-1 Lab ID: 92306334001 Collected: 05/29/18 09:00 Received: 05/29/18 09:50 Matrix: Water Parameters Results Units Report Limit DF Prepared Analyzed CAS No. Qual HEM, Oil and Grease Analytical Method: EPA 166413 Oil and Grease ND mg/L 5.0 1 06/11/18 04:17 2540D Total Suspended Solids Analytical Method: SM 2540D Total Suspended Solids 10.3 mg1L 3.5 1 06/04/18 16:40 254OF Total Settleable Solids Analytical Method: SM 2540F Total Settleable Solids NO mL/Uhr 0.10 1 05/30/18 18:15 9040 pH Analytical Method: EPA 9040 pH 7.8 Sid. Units 0.10 1 05129118 22:57 H6 Date: 06/11/2018 03:34 PM REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, without the wntten consent of Pace Analytical Services, LLC, Page 4 of 13 aceAnalytical www.pacelabs.00m QUALITY CONTROL DATA Project: DP-1 Pace Project No.: 92385334 QC Batch: 414652 Analysis Method: EPA 16646 QC Batch Method: EPA 1664B Analysis Description: 1664 HEM, Oil and Grease Associated Lab Samples: 92386334001 METHOD BLANK: 2299538 Associated Lab Samples: 92386334001 Parameter Units Oil and Grease mg/L Matrix: Water Blank Reporting Result Limit Analyzed Qualifiers ND 5.0 06/11/18 04:17 Pace Analytical Services, LLC 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9G92 LABORATORY CONTROL SAMPLE & LCSD: 2299539 2299540 Spike LCS LCSD LCS LCSD % Rec Max Parameter Units Conc. Result Result % Rec % Rec Limits RPD RPD Qualifiers Oil and Grease mg/L 38.5 37.8 37.7 98 96 78-114 0 30 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 futl, Date: 06/11/2018 03:34 PM without the written consent of Pace Analytical Services, LLC. Page 5 of 13 aceAnalytical www.pacefobs.00m QUALITY CONTROL DATA Project: DP-1 Pace Project No.: 92386334 QC Batch: 413661 Analysis Method: SM. 2540D QC Batch Method: SM 2540D Analysis Description: 2540D Total Suspended Solids Associated Lab Samples. 92386334001 METHOD BLANK: 2293918 Matrix: Water Associated Lab Samples: 92386334001 Blank Reporting Parameter Units Result Limit Analyzed Qualifiers Total Suspended Solids mg/L ND 2.5 06/04/18 16:36 LABORATORY CONTROL SAMPLE: 2293919 Parameter Units Total Suspended Solids mg/L SAMPLE DUPLICATE: 2293920 Parameter Units Total Suspended Solids mg1L SAMPLE DUPLICATE: 2293921 Parameter Total Suspended Solids Pace Analytical Services, LLC 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 Spike LCS LCS % Rec Cone. Result % Rec Limits Qualifiers 250 246 98 90-110 92386252001 Dup Result Result RPD Qualifiers ND 9.6 92386670002 Dup Units Result Result mg/L 38.0 43.5 RPD Qualifiers 13 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: 06/11/2018 03:34 PM without the written consent of Pace Analytical Services, LLC. Page 6 of 13 aceAnalytical www.pxelabs.com QUALITY CONTROL DATA Project: DP-1 Pace Project No.: 92386334 QC Batch: 413026 Analysis Method: SM 254OF QC Batch Method: SM 254OF Analysis Description: 2540F Total Settable Solids Associated Lab Samples: 92386334001 METHOD BLANK: 2290891 Associated Lab Samples: 92386334001 Parameter Units Total Settleable Solids mUL1hr Matrix: Water Blank Reporting Result Limit Analyzed Qualifiers ND 0.10 05130118 18:15 Pace Analytical Services, LLC 9B00 Kincey Ave, Suite 400 Huntersvilie. NC 28078 (704)875-9092 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: 06/11I201 B 03:34 PM without the written consent of Pace Analytical Services, LLC. Page 7 of 13 acmnalytrcal www,pacalabs.cwn QUALITY CONTROL DATA Project: DP-1 Pace Project No.: 92386334 QC Balch: 412818 Analysis Method: EPA 9040 OC Balch Method: EPA 9040 Analysis Description: 9040 pH Associated Lab Samples: 92386334001 SAMPLE DUPLICATE: 2289848 92386304001 Dup Parameter Units Result Result RPD Qualifiers pH Std. Units 6.3 6.3 0 H6 Pace Analytical Services, LLC 9800 Kincey Ave, Suite 100 Huntersville, NC 28078 (704)875-9092 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: 06/11/2018 03:34 PM without the written consent of Pace Analytical Services, LLC. Page 8 of 13 aoAnalytical www.paWabs.com QUALIFIERS Project: DP-1 Pace Project No.: 92386334 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. MOIL -Adjusted Method Detection Limit. POL - Practical Quantitation Limit. RL - Reporting Limit. Pace Analytical Services, LLC 9800 Kincey Ave. Suite 100 HuntersvIle, NC 2807E (704)875-9092 S - Surrogate 1,2-Diphenylhyd(azine 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 Chloroethyl vinyl 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-A Pace Analytical Services - Asheville PASI-C Pace Analytical Services - Charlotte ANALYTE QUALIFIERS D6 The precision between the sample and sample duplicate exceeded laboratory control limits. H6 Analysis initiated outside of the 15 minute EPA required holding time. REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, Date: 06/11 /201 El 03:34 PM without the written consent of Pace Analytical Services, LLC. Page 9 of 13 ace Analytical wwwpaeWaba.=n QUALITY CONTROL DATA CROSS REFERENCE TABLE Project: DP-1 Pace Project No.: 92386334 Pace Analytical Services, LLC 9800 Kincey Ave. Suite 100 Nuntersviile, NC 28078 (704)675-9092 Lab ID Sample ID QC Batch Method QC Batch Analytical Method 92386334001 DP-1 EPA 1664B 414652 92386334001 DP-1 SM 2540D 413661 92386334001 DPA SM 254OF 413026 92386334001 DP-1 EPA 9040 412818 Date: 06/11/2018 03:34 PM REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, without the written consent of Pace Analytical Services, LLC, Analytical Batch Page 10 of 13 Document Name: Document Revised: February 7, 2018 a aceMalytrcal Sample Condition Upon Recelpt(SCURI Page 1 of 2 Document No.: Issuing Authority: F-CAR-CS-033•Rev.06 Pace Carolinas Quality Office Laboratory receiving samples: Asheville ❑ Eden❑ Greenwood ❑ Huntersville-{]"'! Raleigh[] Mechanicsville[] Client ame: I WO.�@ ./_238.6334 �� P roe ti: .. Courier❑Fed Ex CUPS ❑LISPS Clcommercial❑Pace ❑Other: 82386334 1���11 GGG Custody Seal Present? []Yes .[]No Seals Intact? ❑Yes _QNo ' J Dalellnitialspersan Examinrny Contents: C Parking Material: ❑Bubble Wrap ❑Bubble Bags ]None ❑ Other Biological Tissue Frozen? Thermometer []Yes [:]No ❑NIA ©1AGun ID: 92rTfl4� Type of Ice: []Name ❑slue Nave Cooler Temp ('C): / C: , 1 Correction Factor: Add/Subtract ('C) *0,4 `/ Temp should be above freezing to VC Cooler Temp Corrected ('C): *' " 5 —nples out of temp criteria. Samples on Ice, cooling process has begun USDA Regulated Soil,([] N/A, water sample) Did samples originate is a quarantine tone within the United States: CA, NY, or SC (check maps)? Did samples originate from a foreign source (Internationally, mvpV 171No Ineludin¢ Hawail and Puerto Rlrnl711Yes F'l n / Comments/Discrepancy: Chain of Custody Present? es rro N/A 1. Samples Arrived within Hold Time? Yes ❑Na NIA 2. Short hold Time Analysis 102 hr.)? Elves Q a N/A 3, Rush Turn Around Time Requested? Yes No N/A 4. Sufficient Volume? 18r., QNO ❑N/A S. Correct Containers Used? -Pace Containers Used? f J'Y-es j]Yes []No EINO ❑NIA []N/A 6. Containers Intact? ~ Vs QN0 N/A 7. Dissolved analysis: Samples Field Filtered] Oves QNo •ElIPr 8. Sample t.abels Match COO -Includes Date/Time/ID/Analysis Matrix: A e-s ❑No ❑NIA 9. r w Headspace in VOA Vials (�-5.6mm)? ❑Yes QNo N/A 10: Trip Blank Present? Trip Blank Custody Seals Present? ❑Yes Dyes [3No Duo '�]N/A' N/A 11. LE DISCREPANCY !' Lot ID of s lit containers: CLIENT NOTIFICATSONIRESOLUTION Field Date Required? ❑Yes ONO Person contacted: Date/Time: �, i Project Manager SCURF Review: _ (_ Date: Project Manager SRF Review:_ _ Date: Page 11 of 13 Document Name: Document Revised: February 7, 2018 aceAnaYicaf Sample Condition Upon Recel t SCUR) Pat 1 of 2 Document No.: Issuing Authority: f-CAR-CS-033-Rev.06 Pace Carolinas Quality Office "Check marlc top half of box if pH and/or dechlorination Is Project a verified and within the acceptance range for preservation samples. Exceptions: VOA, Collform, TOC, oil and Grease, ORO/8015 {water) DOC, UHS "Bottom half of box Is to list number of bottle l---- - -_ - ---- — - - - -- . _ .. g3.00:33' PM: AM- Due Date:,�66/12/18 CLIENT: 92-M'ACLEOD' t4 t u z 2 Z i z z a u o Ci i z A CD a+ v v o2f •• n 7 v y �`+ v y - i a ? a 4 u n ro .=a. = Z , v zi a z _ Y - G 2 Z i ry Al `° $ 3 E' O n m Q O A a a [ 949 O a A ¢ rn a n Z '� M b _ n i i o c 5 7 c S i x i.r m 7 z 2 N a y _ a u ro nb a t03N aE v E z dOO z Q T C da c a E . s�d } n au sy J J ¢EE ry CD N .Er� E ry E N E W m u E = of r i E E o E E O i g E E N E q tn{: g o o ern n .6i N r=n a " ., ..� ._.� nOi `h N r¢.t q j a �i a Y .NN. 0 N a m m Cis a CC) CIDm m m Q d d Q d d > > C ? a vt a h do d ,\\Nl\ o - 1 \N\J I L 1, 1 N\ 2 3 \1 I \\N\. 4 5 6 7 9 10 lk 12 -\FN 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 d Note: Whenever there is a discrepancy affecting North Carolina compliance samples, a Copy of this form will be sent to the North Carelina OEHNR Certification Office (i.e. Out of hold, incorrect preservative, out of temp, Incorrect containers. Page 12 of 13 1/iPa eAna1ytcal° CHAIN-OF-CUS )Y 1 Analytical Request Document The Chain -of -Custody is a LEL,. -_ DOCUMENT. All relevant fields must be completed accurately. Section Section B Section C Page: of Required Client Informaton: Required Project Information: - Invoice Information: Co n : Report To: Attention: 2240761 Ad res . ao Copy To: f. Comp n N�m L / JJ REGULATORY AGENCY J� ��7 /�/ �'�eSi C A��Ss�,y� �Q�Dkw4lL-'7[4c �i r NPDES r GROUNDWATER 'r DRINKING WATER r UST r RCRA r OTHER Finail O: J Pumhase (PA&V Order No.: PNace 4ulot�et / /1/1 /] /1� _ Reference: 3�.� Project P e: yF q �-s�e) (1iTp Name: a Pace f roject Site Location - • +a r ' 16 , / 7 Manager. Requested Due Date] TAT: Project Number: V ' Pace ProfileTE: r hy,l� Requested Analysis Filtered (YIN) Section D Matrix Codes x a z Required Client Information MATRIX r CODE COLLECTED Preservatives 3- Dunking Walar DW w O Ur Water, ' WT Waste Water ww rI.- m t COMPOSITE COMPOSITE ENnlGR4q O U e Pfoducl P m ¢ START J V Z t S&Vsolid SL p to } SAMPLE ID `� cmi e OL 11W pe WP i U � w y - �t (A-Z, 0-9 f,-) i (A r, AR wp w ¢ a z F rd `o Sample IDS MUST BE UNIClUfi Tissue TS O a LU H Z m -uT • #Other OT X ~ � O m O c N • m g a a LL v CILO O O Q N ~ N DATE TIME DATE TIME fD • 'ItZ) = x = Z Z O Pace Project No./ Lab I.D. p r 9;� r 2. 3 4 5 6 l t• r pp 9 - 10 11 � 12 l Jr ADDITIONAL COMMENTS RELINQUISHED BY AFFILIATION GATE TIME / I ACCEPTED 8Y ! AFF1 vVON DATE I TIME v SAMPLE CONDITIONS r f I Of •L,�l' � � . - r1 ri J r 1 SAMPLER NAME AND SIGNATURE U o d u/ Jam) ��/� PRINT Name of SAMPLER: 1 S./'K'r F'L v Z 00 z } 5 " z } E m n ' 74 DATE Signed SIGNATURE of SAMPLE f d �ILyI/9 ~ S m — v m E {MM/DDlYl'): 'Important Note: By sgning [his form you are awaping Pace's NET 30 day payment terms and agr00ing to late charges of 1.5 k per month rar any invoices 6 paid within 30 days. > >. F-ALL-O-020rev.07, 15-May-2007 Instructions for completing Chain of Custody (COC) 1. Section. A and B: Complete all Client information. at top of sheet: company name, address, phone:, far; contact (the: person to contact if there: are questions, and who will receive the final report.), e-mail address (if available); PO#; Project Name and/or Project Number as you would like to see it appear on the report. 2. Section C: Invoice Information: Billing information is included in this section. This information should include the name and address of the: person, receiving the invoice. 3. Quote Reference should be completed ifa-quotation was provided by Pace Analytical. The Project Manager, and Profile No. will be completed by Pace Anal�lical Services. 4. Site Location: A separate COC must be: filled out for each day of sample collection. Record the two letter postal code; for the US state in which the samples were collected. 5. Regulatory -A List the program that is guiding the work to ensure proper regulations are followed. 6. Section D: Complete a Sample Description in the "SAMPLE ID' section as you would like it to appear on the laboratory report. The: following information should also be included: the sample matrix, sample type (G (grab) or C {composite). When collecting a composite, the start time and end time should be documented in the respcctive boxes. The collection time for a grab (G) sample should be entered in the bones marked 'Composite End/Grab'), Sample temp at collection (if required by state), the total number of containers. and preservative used. 7. Mark if the sample was. filtered in the field by marking Y or N in 'Filtered' row by the Analysis requested. w 8. Requested Analysis: List the required analysis and methods on the lines provided and place a check in the column for the: samples requiring the analysis. Additional comments should be referenced in the bottom left hand corner or include attachments for extended lists of parameters. 9. The sampler should print their name: in the.space provided and sign their name followed by the date of the swripling event at the bottom of tht: COC in the: spaces designat-ed for `SAMPLER NAME, AND SIGNATIJRI '. 10. When relinquishing custody of the; samples to a representative of the; laboratory or other organization, indicate the Item Numbers of those samples being transferrcd;•sign relinquished by, date and time:, and include vour affiliation.. *Important Note: Standard Turnaround Time is 2 Weeks/10 business days. Results will be delivered by end of business on the date due unless other arrangements . have been wade with your project manager. Special Project Requirements such as Low Level Detection Limits or level of QC reported must be included on the chain of custody in the Additional Comments section. c Q c� PROCESS WASTEWATER —Discharge Monitoring Report GENEW PERMIT NO. NCG140000 MAR 2 2 2018 CERTIFICATE OF COVERAGE No. NCG140448 CS: N 1 +` AL F IL ,,SAMPLE COLLECTION YEAR: U/e FACILITY NAME: MacLeod Construction Inc. — North Point PI.antT(Cl1? SAMPLE PERIOD: []July -December anuary-June SAMPLE COLLECTOR: G _LHQII569 SAMPLE FREQUENCY: Quarterly R/ Semi-annually ❑ CERTIFIED LABORATORY: Lab # COUNTY: Mecklenburg Lab # PHONE NO.: 704-483-3580 ADD TO LISTSERVE? DYES-ONO—EMAI LIMIT VIOLATIONS? YES []NO DISCHARGING TO CLASS: ❑SA ❑HQW ❑RNA ❑Trout ®Other C OPTIONAL INFO: Part A: Wastewater Monitoring Requirements Outfall No. Date Sample., Collected dd (mm / /yr) Type of Wastewater (VE, RM, MD)z pH (standard) Total Suspended Solids .(mg/L) 5ettle'able (mL/L} (Nof Applicable for MacLeod} NPola Oil & Grease : using method 15645GT-HE1M5 rng/0' Discharge Duration (minutes) T66ow : (gallons/day)T (Not Applicable for. MacLeod} _ 6 93.4 3035. 03/01 r 6 .� f wastewater systems have not dischamed in this quarter— renort "No Flaw" or "No Discharge" here. Please make sure to mark the sample nuarter above. 2 Report the abbreviation for the type of Authorized Wastewater Discharges here: Vehicle and Equipment Cleaning (VE), Raw Material Stockpiles (RM), Mixing Drum Cleanout (MD). Report more than one type if the waste -stream is commingled. Permit Date: 8/1/2017-06/30/2022 Last Revised 08/09/17 Page 1 of 2 Iif an effluent limit is exceeded twice in a row, the permittee is required to institute monthly monitoring for that parameter for six months, unless DEMLR RO staff notifies you to continue monitoring. ° pH limits are 6-9 S.U. for wastewater discharges to freshwaters, and 6.8-8.5 S.U. for discharges to saftwaters. s TSS limits are 20 mg/L for wastewater discharges to HQW waters, 10 mg/L for Trout and PNA waters, and 30 mg/L for all other water classifications. c Process wastewater discharges shall only be monitored for TPH when commingled with stormwater discharges from VMA areas. TPH does not have a limit for wastewater, but instead is subject to benchmarks and provisions of Part IV, Section A, including the Tiered Response Action. 'Flow rate can be measured continuously or calculated. Flow limits for wastewater discharges to HQW waters shall be set to 50% of the Summer 7Q10 Flow as per 15A NCAC 02B .0224. Permittees who discharge wastewater to HQW waters shall obtain a Summer 7Q10 flow and report this information to DEMLR. If the permittee cannot obtain a Summer 7Q10 flow for the receiving waters at the discharge location, the permittee shall notify DEMLR, and the DEMLR Regional Office may require an annual flow report on a case -by -case basis. MAIL ORIGINAL AND ONE COPY OF THIS ANNUAL SUMMARY (INCLUDING ALL "NO FLOW", "NO _DISCHARGE_") WITHIN 30 DAYS OF RECEIPT OF SAMPLE OR AT END OF MONITORING PERIOD_ IN CASE OF "NO FLOW") TO: ^ Division of Water Resources Attn: DWR Central Files 1617 Mail Service Center Raleigh, North Carolina 27699-1617 (919) 807-6379 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 directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing Permittee) Date:8/1/2017-06/30/2022 -V 6 A9 (Dat Last Revised 08/09/17 Page 2 of 2 aceAnalytical www.pacWabs.cam March 14, 2018 Mr. Michael Houser MacLeod Construction PO Box 320 4304 N. Pointe Ind Charlotte Denver, NC 28037 RE: Project: DP-1 Pace Project No.: 92375263 Dear Mr. Houser: Pace Anatytical Services, LLC 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 Enclosed are the analytical results for sample(s) received by the laboratory on March 01, 2018. The results relate only to the samples included in this report. Results reported herein conform to the most current, applicable TNIINELAC 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, 01*0 , ql , Angela Baioni angela.baioni@pacelabs.com (704)875-9092 Project Manager Enclosures Ncc - W 6; N� 9B�Aj0�� 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 13 lacmnalytkal* www.pwalabs'= Project: DP-1 Pace Project No.: 92375263 Charlotte Certification IDs 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 Asheville CertiFlcation Ids 2225 Riverside Drive, Asheville, NC 28804 Florida/NELAP Certification #: E87648 Massachusetts Certification #: M-NC030 North Carolina Drinking Water Certification #: 37712 CERTIFICATIONS South Carolina Certification #: 99006001 FtoridalNELAP Certification #: E87627 Kentucky UST Certification #: 84 VirginiaNELAP Certification #: 460221 North Carolina Wastewater Certification #: 40 South Carolina Certification #: 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, LLC. Pace Analytical Services, LLC 9800 Kincey Ave. Suite 1 QO Huntersville, NC 28078 (704)875-9092 Page 2 of 13 ace Analytical wwia.pacelabs.cam SAMPLE ANALYTE COUNT Project: DP-1 Pace Project No.: 92375263 Pace Analytical Services, LLG 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)B75-9092 Lab ID Sample ID Method Analysts Analytes Reported Laboratory 92375263001 DP-1 EPA 1664B JMS 1 PASI-C SM 2540D NAL 1 PASI-A SM 2540F WC 1 PASI-A EPA 9040 ECH 1 PASI-A REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, without the written consent of Pace Analytical Services, LLC. Page 3 of 13 aoAnalytical mvwcpacefabs.= ANALYTICAL RESULTS Pate Analytical Services, LLC 9800 Kincey Ave, Suite 1 Q0 Huntersville, NC 28070 (704)875-9092 Project: DP-1 Pace Project No.: 92375263 Sample: DP-1 Lab ID: 92375263001 Collected: 03/01/18 07:20 Received: 03/01/18 12:00 Matrix: Water Parameters Results Units Report Limit DF Prepared Analyzed CAS No. Qual HEM, Oil and Grease Analytical Method: EPA 1664E Oil and Grease ND mglL 5.0 1 03/13/18 04:39 2540D Total Suspended Solids Analytical Method: SM 2540D Total Suspended Solids 12.2 mglL 6.2 1 03/06/18 17:15 • �!'�540F Total Settleable Solids Analytical Method: SM 254OF ( Total Settleable Solids ND mL Uhr 0.10 1 03/02/18 03:30 9040 pH Analytical Method: EPA9040 pH 6.6 Std. Units 0.10 1 03/05/18 12:10 H6 Date: 03/14/2018 06:01 AM REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, without the written consent of Pace Analytical Services, LLC. Page 4 of 13 acimnalyfrcal www,Mcolaba.cam QUALITY CONTROL DATA Project: OP-1 Pace Project No.: 92375263 QC Batch: 401685 Analysis Method: EPA 1664E QC Batch Method: EPA 1664B Analysis Description: 1664 HEM, Oil and Grease Associated Lab Samples:' 92375263001 METHOD BLANK: 2228025 Associated Lab Samples: 92375263001 Parameter Units Oil and Grease mglL Matrix: water Blank Reporting Result Limit Analyzed Qualifiers ND 5.0 03/13/18 04:33 Pace Analytical Services, LLC 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 LABORATORY CONTROL SAMPLE: 2228026 Spike LCS LCS % Rec Parameter Units Conc. Result % Rec Limits Qualifiers Oil and Grease mg1L 40 37.0 92 78-114 MATRIX SPIKE SAMPLE: 2228027 92375210001 Spike MS MS % Rec Parameter Units Result Conc. Result % Rec Limits, Qualifiers Oil and Grease mglL ND 40 39.6 97 78-114 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: 03/14/2018 06:01 AM without the written consent of Pace Analytical Services, LLC. Page 5 of 13 aceAnalytfical. wmrpacMabs.=" QUALITY CONTROL DATA Project: DP-1 Pace Project No.: 92376263 QC Batch: 400776 Analysis Method: SM 2540D QC Batch Method: SM 25400 Analysis Description: 2540D Total Suspended Solids Associated Lab Samples: 92375263001 METHOD BLANK; 2222445 Associated Lab Samples: 92375263001 Parameter Units Total Suspended Solids mg1L LABORATORY CONTROL SAMPLE: 2222446 Parameter Units Total Suspended Solids mg1L Pace Analytical Seivices, LLC 9800 Kincey Ave. Suite 1Qo Huntersville, NC 26078 (704)875-9092 Matrix: Water Blank Reporting Result Limit Analyzed Qualifiers ND 2.5 03/06/18 17:13 Spike LCS LCS % Rec Conc. Result % Rec Limits Qualifiers 250 232 93 90-110 SAMPLE DUPLICATE: 2222447 92375189001 Dup Parameter Units Result Result Total Suspended Solids mg1L 10.2 9.8 SAMPLE DUPLICATE: 2222448 92375310002 Dup Parameter Units Result Result Total Suspended Solids mg1L 24,3 28.3 RPD Qualifiers 5 RPD Qualifiers 15 D6 Results presented on this page are In the units Indicated by the "Units" column except where an attemate unit Is presented to the right of the result. REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, Date: 03/1412018 06:01 AM without the written consent of Pace Analytical Services, LLC, Page 6 of 13 aceAnalX cal www.pacalabs.com QUALITY CONTROL DATA Project: DP-1 Pace Project No.: 92375263 QC Batch: 400371 Analysis Method: SM 254OF QC Batch Method: SM 254OF Analysis Description: 254OF Total Settable Solids Associated Lab Samples: 92375263001 METHOD BLANK: 2220418 Associated Lab Samples: 92375263001 Parameter Units Total Settleable Solids mUUhr Matrix: Water Blank Reporting Result Limit Analyzed Qualifiers NO 0.10 03/02/18 03:30 Pace Analytical Services, LLC 9800 KinceyAve. Suite 100 Huniersviile, NC 28078 (704)875-9092 Results presented on this page are in the units indicated by the "Units" column except where an adernate unit is presented to the right of the result. REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, Date: 03/14/2018 06:01 AM without the written consent of Pace Analytical Services, LLC. Page 7 of 13 (�Iacmnalyfical" WM..pacelabs.wm QUALITY CONTROL DATA Project: DP-1 Pace Project No.: 92375263 QC Batch: 400615 Analysis Method: EPA 9040 QC Batch Method; EPA9040 Analysis Description: 9040 pH Associated Lab Samples: 92375263001 SAMPLE DUPLICATE; 2221726 Parameter pH 92375263001 Dup Units Result Result RPD Qualifiers Std. Units 6.6 6.6 0 H6 Pace Analytical Saivices, LLC 9800 Kincey Ave. Suite 190 Huntersvitle, NC 28078 (704)875-9092 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: 03/1412018 06:01 AM without the written consent of Pace Analytical Services, LLC. Page 8 of 13 aceAnalytical www.pacelabs.c= QUALIFIERS Project: DPA Pace Project No.: 92375263 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. PQL - Practical Quantitation Limit. RL - Reporting Limit. Pace Analytical Services, LLC 9800 Kincey Ave. Suite 100 Huntersvilte, NC 28078 (704)875-9092 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. Aseparate vial preserved to a pH of 4-5 is recommended in SW846 Chapter 4 for the analysis ofAcrolein 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. TN - The NELAC Institute. LABORATORIES PASI-A Pace Analytical Services - Asheville PASI-C Pace Analytical Services - Charlotte ANALYTE QUALIFIERS D6 The precision between the sample and sample duplicate exceeded laboratory control limits. H6 Analysis initiated outside of the 15 minute EPA required holding time. REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, Date: 03/14/2018 06:01 AM without the written consent of Pace Analytical Services, LLC. Page 9 of 13 acMnalytical wwwpacelabs.c m QUALITY CONTROL DATA CROSS REFERENCE TABLE Project: DP-1 Pace Project No.: 92375263 Pace Analytical Servlcen, LLC 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 Lab ID Sample ID QC Batch Method QC Batch Analytical Method 92375263001 DP-1 EPA 1664E 401685 92375263001 DP-1 SM 2540D 400776 92375263001 DP-1 SM 254OF 400371 92375263001 DP-1 EPA 9040 400615 Date: 03/14/2018 06:01 AM REPORT OF LABORATORY ANALYSIS This report shall not he reproduced, except in full, without the written consent of Pace Analytical Services, LLC. Analytical Batch Page 10 of 13 Document Name: Document Revised: February 7, 2018 aceAnd! lCd�� Sample Condition Upon Recel t 5CUR) Page 1 of 2 Document No.: Issuing Authority: F•CAR•CS•033•Rev,06 Pace Carolinas Quality Office Laboratory receiving samples: Asheville ❑ Eden[] Greenwood ❑ Huntersville� Ralelgh❑ Mechanicsville[] [llentName: Project q: WO# : 92375263 / Courier: Fed Ex ❑UPS LIUSPS ❑Commercial [-]Pace "❑Qther: 92375263 III I Custody Seal Present? Oyes NSeal$ Intact? ❑Yes No �2 �' 1' Dale/Initials Person Examining Contents: (J Packing Material: []Bubble Wrap Q16ble Bags []None ❑ Other Thermometer: ❑IR Gun ID: 92TO36 Type of Ice: © ❑slue Cooler Temp ('C): Correction Factor: Add/Subtract ('C) +0,1 Cooler Tamp Corrected ('C): USDA Regulated Soil (El"N/A, water sample) Did samples orlilinate in 'a guararitine zone within the United States: CA, NY, or SC (check maps)? IriYesI A o Biological Tissue Frozen? ❑Yes ❑No ❑ly/A [—]None Temp should be above freezing to 6'C ❑Samples out of temp criteria, Samples on ice, cooling process has begun Old samples originate from a foreign source (intern tlonatly, indudlne Hawaii and Puerto Riro17 I—IYes Rua Comments 0lscre ant : Chain of Custody Present? es No N/A 1. Samples Arrived within Hold Time? Yes No N A 2. Short Hold Time Analysis c72 hr.)? es 0 No NIA 3. Rush Turn Around Time Requested? Yes o N/A 4. Sufficient Volume? es No N A S. Correct Containers Used? -Pace Containers Used? ffyes Of& No QN0 [-]N/A CINIA 6. Containers Intact? Qfes No N/A 7. Dissolved analysis: Samples Field Filtered? ❑Yes QHva N/A 8, Sample Labels Match COL? rfAJ -includes Date/Time7lc/Anal Is Matrix: ©Yes ` No ON/A �1/'� ✓ " 9. ` (,•b{ (,ill 4� C� G{ � G• cSG�I'l'�1 �6 1'k pl'c' `�? (rli{' Vfo — U (. ul c rt Heads ace in VOA Vials >5.6mm)? QYeS ONO 0NIA 10. 1710 V 16 Trip Blank Present? Trip Blank Custody Seals Present? (]yes 0yq B NO N/A IIA t`'s f/ a. - f !/"t.. CDMMENtS/SAMPLE DISCREPANCY Lot ID of split containers: CLIENT NOTIFICATION/RESOLUTION Person contacted: Date/Time: Field Data Required? ❑Yes []No } 1 Project Manager SCURF Review: (t _ _ Date: 1— I Project Manager SRF Review: bate: f Nil Page 11 of 13 Document Name: Document Revised: February 7, 2018 aceAnaViCal d Sample Condltlon U on Recelgt(SCUR) Page ] of 2 Document No.: Issuing Authority: F-CAR-CS-033•Rev.06 Pace Carolinas Quality Office `Check mark top half of box if pH and/or dechiorination Is Project # verified and within the acceptance range for preservation samples. Exceptlons: VDA, Coliform, TOC, Olt and Grease, DRO/8015 (water) DOC, LLHg "Bottom half of box Is to list number of bottle WO#:92375263 PM: AMB Due Date: 03/15/18 CLIENT: 92-MACLEOD a �i 2 7 ,3 M �-+ > A m us yLy� JI 7 B o N > d ra m y� Yl 7 o Y�1 > d m �uS L ] u a ° ri > s m v S qyG �,7/rnlll N cE7 N 4 rtl v = v 0 = of N 2 m ca M w Z : E N IJ m ^+ n = v _ VET ^ U m c 'g 7E il°J LL z LI C ... n N V G L Y d .. M z yV V C g pEn7pE� N M = Y 9 O N = E ai ri vv Vf = EN nj 'Atp=�i x S 4 7� O 2 Z E R TOTVV v1 z E q n 7 >Q y E ui = Q E Y (Oy, Q Z, rn O A is tY� QQ4 2 7 3 .�.r x m ',V_i '.4 y E .Ni pr t4 d n� E N r V1 V1 ! Cll m 6M 2 yoE� N m N n JEE SE ^ Q ~ C O e E N La c arL QE Y 1 N r r 3 4 5 6 7 B 4 10 11 -- 12 pH Adjustment Log for Preserved Samples Sample 10 Type of Preservative pH upon receipt Date preservation adjusted Time preservation adjusted Amount of Preservative added Lot # Note: Whenever there is a discrepancy affecting North Carolina compliance samples, a copy of this form will be Sent to the North Carolina DEHNR Certification Office (i.e. Out of hold, incorrect preservative, out of temp, Incorrect containers. Page 12 of 13 ov CHAIN -OF -CUSTODY 1 Analytical Request Document - a �� The Chain-ofis a LEGAL DOCUMENT. All relevant fields must be completed accurately. o PaceAnalytrcal' V Section A Section 3 Section C Page: of CL 2192 597 Requifed Cbeni Information: Required Project Information: Invoice Information: t Report To: Attention: Arucba�_ ��.�yy V•�! aC r N rc - Copy To: Com an �` REGULATORY AGENCY ,� [/ �J NPDES r GROUND WATER DRINKING WATER j- UST RGRA r OTHER Emad T Purchase �1 Order No,: P.1— Ohtu �_,f, Relerunee: {�'�/�• �_ - Pro'ect f N.mme: P.—PmjeG Site Location .DJateITAT: lsmyer: STATE: Requested Due Project Nlnit]er: Pxc Prddu a. Requested Analysis Filtered (YIN} Section D Matrix Codes — z RvpuLvdclio. k i--gym n rx r CME o a COLLECTED Preservatives Y Drinking Water oW L) zz � rz Water WT Waste Water WIN P[tx—t P ii - L) COLO"S1TF �t+tint COMPOSITE rnwcmtnu w STl Y � iusdtid SAMPLE ID CX WEpe WP c� �► v C n r n Air AIR p tv a Z F- l Sample IDS MUST BE UNIQUE Tissue TS O Oieer 07 X 1 U n O T n7 a ILL E'O' n xO O a m c a h t- z En DATE TIME DATE TIME w Z) _ _ = z z 2 O fY Pace Project Nod Lab I.D. 7 7, Z�� U 1 2 3 4 5 fi 7 8 s 1D 1t 12 ADDITIONAL COMMENTS RELINQUISHED BY I AFFILIATION DATE TIME ACCEPTED BY 1 AFFILIATION DATE TIME SAMPLE CONDITIONS ORIGINAL SAMPLER NAME AND SIGNATURE U o .-. m mx z > y e K e } �/ ,�,/� PRINT Name of SAMPLER Rf'i-U s E� o m !� SIGNATURE of SAMPLER: J 7 OATS Slgnad iMMlbblYYj: GJ G LaF f .tom Yoic By sign" tnis loan you x auo % ng Py 's tXT 30 day peymmaa kr n aw rKFmvv to btc cAargct of 1.5% Per month Ir •eiml not �x WOW 30 days. ` I F-ALL-"20rev.07• t • -2007 rt ANNUAL SUMMARY DISCHARGE MONITORING REPORT (DMR) — STORMWATER SUBMIT TO CENTRAL OFFICE-Frj irI=II/Cr-t General Permit No. NCG140000 JAN 10 2018 Calendar Year / 7 Uiv�, ";CTION i+vFORMATIC}' PPnrr:c wq- I , *Report ALL STORMWATER monitoring data on this form (include "No Flow"I"No Discharge" and Benchmark Exceedances) from the previous calendar year to the DEQ by MARCH 9 of each year. Certificate of Coverage No. NCG140448 Facility Name: MacLeod Construction Inc. - North Pointe Business Park Concrete Hatch Plant County: Mecklenburg Phone Number: 704-483-3580 Total no. of SDOs monitored Certified Laboratory _�� �t Vn64L _ _ Lab # IMIJ EWLV 74z _n1C- Lab # Stormwater Discharge Outfall (SDO) No. j)PL! VMA Outfall? Yes ❑ No ❑-C:nrnAbIFO STD - t vdAs-f�- Is this outfall currently in Tier 2 for any parameter? Yes ❑ No [2g WF}1mwiz Was this outfall ever in Tier 2 during the past year? Yes ❑ No If this outfall was in Tier 2 last year, was monthly monitoring discontinued? Yes, enough consecutive samples below benchmarks to decrease frequency ❑ Yes, received approval from DlMLR to reduce monitoring frequency ❑. Other ❑ Outfall No, Total Rainfall, inches Total Suspended Solids TSS , ( ) m 11 pH, SU Non -polar O&G (EPA Method 1664 SGT-HEM , ( )� mgll (VMA) ff applicable New Motor Oil Usage (gallmo.) Nappfkablo Stormwater Benchmarks Indicate NO FLOW f appllcablo clrc nchmadc � & n 6•Q-a.0 .� � >56 gaumo. averago requires TSS and Non -polar OSG monitoring Date Sample Collected, molddlyr - 10 1Z fr /.S- - $, 2- AJ4 J� F Permit Date 8/112017 - 6/30/2022 Last Revised 8-22-2015 Certificate of Coverage No. NCG140448 ` Additional Outfall Attachment (make copies as needed for additional outfalls) �'Stormwater Discharge Outfall (SDO) No. VMA Outfall? Yes ❑ No ❑ Is this outfall currently in Tier 2 for any parameter? Yes ❑ No ❑ Was this outfall ever in Tier 2 during the past year? Yes ❑ No ❑ If this outfall was in Tier 2 last year, was monthly monitoring discontinued? Yes, enough consecutive samples below benchmarks to decrease frequency ❑ Yes, received approval from DEMLR to reduce monitoring frequency ❑ Other _ ❑ I Outfall No. Total Rainfall, inches Total Suspended Solids , ( } mg/1 pH, SU Non -polar O&G (EPA Method 1664TSS (SGT-HEM)} , mgll (VMA) Ifappllcabfe New Motor Oil Usage (gallmo.) Ifappllcablo Stormwater Benchmarks Indicate NO FLOW if applicable circ nchmark n �'� 0 rt 6.0-9.0 15 n55 gallmo. average requiroa TSS and Non -polar O&Gmonitoring Date Sample Collected, molddl r ; E. Permit Date 8/1/2017 — 6/30/2022 Last Revised 8-22-2015 Certificate of Coverage No. NCG140448 ` Additional Outfall Attachment (make copies as needed for additional outfalls) 5tormwater Discharge Outfall (SDO) No. VMA Outfall? Yes ❑ No ❑ Is this outfall currently in Tier 2 for any parameter? Yes ❑ No ❑ Was this outfall ever in Tier 2 during the past year? Yes ❑ No ❑ If this outfall was in Tier 2 last year, was monthly monitoring discontinued? Yes, enough consecutive samples below benchmarks to decrease frequency ❑ Yes, received approval from DEMLR to reduce monitoring frequency ❑ Other ❑ Outfall No. Total Rainfall, inches Total Suspended Solids (TSS), m 11 p SU Non -polar O&G (EPA Method 1664 (SGT-HEM)), mgll (VMA) New Motor Oil Usage (gallmo.) Stormwater Benchmarks lndlcato NO FLOW if applicable CtrC nchmark ,f 00 n 1 V 6.0 9.0 1 gallmo. average requires TSS and Non -polar O&G monitoring Date Sample Collected, moldd! r Permit Date 8/1/2017 — 6/30/2022 Last Revised 6-22-2015 x Certificate of Coverage No. NCG140448 CERTIFICATION "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 directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations." [Required by 40 CFR §122.22] Signature Date 0 1 J-006 Mail Annual Summary Stormwater DMR to the NCDEQ Central Office: Note the address is correct — Central Files is housed in DWR (not DEMLR) N.C. Department of Environmental Quality (DEQ) Division of Water Resources Attn: DWR Central Files f�-1617 Mail Service Center Raleigh, NC 27699-1617 Central Files Telephone (919) 807-6300 Questions? Contact DEMLR Stormwater Permitting Staff in the Central Office at: (919) 707-9220 Permit Date 8/1/2017 — 6/30/2022 Last Revised 8-22-2015 PROCESS WASTEWATER —Discharge Monitoring Report GENERAL PERMIT No. NCG140000 CERTIFICATE OF COVERAGE NO. NCG140448 FACILITY NAME: MacLeod Construction Inc. — North Pointe Plant SAMPLE COLLECTOR: /A 11 iJ4 -z YJOZtC(Orz CERTIFIED LABORATORY: &CEAcil&V77CAl Lab# 0 Lab # LIMIT VIOLATIONS? YES []NO 0 Part A: Wastewater Monitorine Requirements SAMPLE COLLECTION YEAR: ,ZD 7 JAN 10 2018 SAMPLE PERIOD: Eouly-December ❑January -June SAMPLE FREQUENCY: Quarterly EJ Semi-annually ❑ DVVr SECTION COUNTY: Mecklenburg l�FoRk%TlOt4PROCESSINGUN11 PHONE NO.: 704-483-3580 ADD TO LISTSERVE? ❑YES_❑NO—EMAIL: DISCHARGING TO CLASS: ❑SA ❑HQW ❑PNA ❑Trout ®Other C OPTIONAL INFO: Outfall No. Date Sample . Collected' (mm/dd/yr) Type of Wastewater (VE RM MD)z pH (standard) Total Suspended Solids (mg/L) Settleable Solids (mL/L) (Not applicable for MacLeod) Non=Polar'_, Oil & Grease using method 1664 SGT-HEN16 (mg/L) - Discharge Duration (minutes) TntalFlow" (gallons/day)' (Not Applicable for MacLeod) n 7 62 - c�ev M ;' A)c r f w stewa s sr a din u — " ' I a ter y ems h ve not discharge this q arter report No Flow' or No Discharge here. Please make sure to mark the sample quarter above. a Report the abbreviation for the type of Authorized Wastewater Discharges here: Vehicle and Equipment Cleaning (VE), Raw Material Stockpiles (RM), Mixing Drum Cleanout (MD). Report more than one type if the waste -stream is commingled. Permit Date.8/1/2017-06/30/2022 Last Revised 08/09/17 Page 1 of 2 t 3If an effluent limit is exceeded twice in a row, the permittee is required to institute monthly monitoring for that parameter for six months, unless DEMLR RO staff notifies you to continue monitoring. 4 pH limits are 6-9 S.U. for wastewater discharges to freshwaters, and 6.8-8.5 S.U. for discharges to saltwaters. , 5 T5S limits are 20 mg/L for wastewater discharges to HQW waters, 10 mg/L for Trout and PNA waters, and 30 mg/L for all other water classifications. 6 Process wastewater discharges shall only be monitored for TPH when commingled with stormwater discharges from VMA areas. TPH does not have a limit for wastewater, but instead is subject to benchmarks and provisions of Part IV, Section A, including the Tiered Response Action. Flow rate can be measured continuously or calculated. Flow limits for wastewater discharges to HQW waters shall be set to 50% of the Summer 7Q10 Flow as per 15A NCAC 02B .0224. Permittees who discharge wastewater to HQW waters shall obtain a Summer 7Q10 flow and report this information to DEMLR. If the permittee cannot obtain a Summer 7Q10 flow for the receiving waters at the discharge location, the permittee shall notify DEMLR, and the DEMLR Regional Office may require an annual flow report on a case -by -case basis. MAIL ORIGINAL AND ONE COPY OF THIS ANNUAL SUMMARY (INCLUDING ALL "NO FLOW. "NO DISCHARGE") WITHIN 30 DAYS OF RECEIPT OF SAMPLE (OR AT END OF MONITORING PERIOD IN CASE OF "NO FLOW") TO: Division of Water Resources T Attn: DWR Central Files 1617 Mail Service Center Raleigh, North Carolina 27699-1617 (919) 807-6379 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 directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations." pot) C- (Signaturd(if Permittee) Permit Date:B/1/2017-06/30/2022 �� o (Date) Last Revised 08/09/17 Page 2 of 2 STORMWATER DISCHARGE OUTFALL (SDO) - Semi -Annual MONITORING FORM GENERAL PERMIT NO. NCG140000 CERTIFICATE OF COVERAGE NO. NCG140448 FACILITY NAME: MacLeod Construction North Pointe Batch Plant PERSON COLLECTING SAMPLES _ IC.1jL-L Pof4.SL--2 CERTIFIED LABORATORY Lab # Lab # OPTIONAL INFO: Part A: Stormwater Monitoring Requirements SAMPLE COLLECTION YEAR: ZQ Z _ SAMPLING PERIOD: [j?'luly-December ❑ January -June COUNTY — PHONE NO. (� alai --5i" 6 ADD TO LISTSERVE? ❑YES ❑NO EMAIL: DISCHARGING TO CLASS: ❑SA ❑HQW ❑PNA ❑Trout ❑Other Outfall No. i Date Sample Collected (mo/dd/yr OR - NO FLOW)1 pH (Standard Units) TSS (mg/L) Event Duration (minutes) Total Rainfall' (in) In Ter 2 Monthly Monitoring? (y/n) # of Months in Tier 2 Sampline _ 1001.3- v2.�. ij — sz v ' 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. a 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. a TSS benchmark values are 100 mg/I, except when discharging to ORW, HQW, Trout, and PNA waters where they are 50 mg/l. `For each sampled measurable storm event the total precipitation must be recorded using data from an on -site rain gauge. ` Permit Date: 7/1/2011-60/30/2015 Last Revised 7/13/11 Page 1 of 2 Part B: Vehicle Maintenance Activity Monitoring Requirements for facilities using > 55 gal of new motor oil/month — averaged over a calendar year. • Outfall No. Date Sample Collected (mo/dd/yrjl pH (Standard Units) TPH using.method 1664A 5CrT NEM, . (mg/L) Total Suspended . Solids; (mg/L) Event Duration (minutes) Tota! L , RaErifall4 (in} 1�iew Motor OBI ` Usage (gal/month) Lti, ' �� =Monthly Monitoring? {Y/n) ' # of Months - in Tier 2 t� t 5amp1[ngZ 6-91 152 1002s HAS YOUR FACILITY HAD 4OR MORE BENCHMARK EXCEEDENCES ATANY ONE OUTFALL (INCLUDING VEHICLE MAINTENANCE)? YES []NON HAVE YOU CONTACTED THE REGION? YES NO REGIONAL OFFICE CONTACT NAME: Mail Original and one coon of this DMR (including all "No Flow" & "No Discharee" reports) within 30 days of receipt of sample (or at end of monitoring Deriod in case of "No Flow") 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: 1 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 directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for su mitting false information, including the possibility of fines and imprisonment for knowing violations." (i nature of Permitteej (Date) Permit Date: 7/1/2011-60/30/2015 Last Revised 7/13/11 Page 2 of 2 n a 0 acoAnalytical www.Pacele6s.eom October 26, 2017 Mr. Michael Houser MacLeod Construction PO Box 320 Denver, NC 28037 RE: Project: Northpointe Plant Pace Project No.: 92360250 Pace Analytical Services, LLC 9800 Kincey Ave, Suite 100 Huntersville, NC 26078 l' (704)875-9092 Dear Mr. Houser: Enclosed are the analytical results for sample(s) received by the laboratory on October 24, 2017. 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, Wit Q(n Angela Baioni angela.baioni@pacelabs,com (704)875-9092 Project Manager Enclosures pCCRFO0 REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, without the written consent of Pace Analytical Services, LLC. Page f of 12 m a '.: aceArralXical xnrwpacalebsaanr Project: Northpointe Plant Pace Project No.: 92360250 1 Asheville Certification lDs 2225 Riverside Drive, Asheville, NC 28804 FloridalNELAP Certification #: E87648 Massachusetts Certification M M-NC030 North Carolina Drinking Water Certification #: 37712 CERTIFICATIONS North Carolina Wastewater Certification M 40 South Carolina Certification #: 99030001 Virginia/VELAP Certification #: 460222 REPORT OF LABORATORY ANALYSIS Pace Analytical Services, LLC 9800 Kincey Ave, Suite 100 Huntersville, NC 28078 (704)875-9092 This report shall not be reproduced, except in full, without the written consent of Pace Analytical Services, LLC. Page 2 of 12 aceAnalyiical www.pacelebs.com SAMPLE ANALYTE COUNT Pace Analytical Services, LLC 9800 Kincey Ave, Suite 100 Huntersville, NC 28078 (704)875-9092 Projecl: Northpointe Plant Pace Project No.'. 92360250 Analytes Lab iD Sample ID Method Analysts Reported Laboratory 92360250001 DP-1 SM 25400 SM 254OF EPA 9040 f 1 REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, without the written consent of Pace Analytical Services, LLC. MVC 1 PASI-A NAL 1 PAS I -A KMM 1 PASI•A Page 3 of 12 Pace Analytical Services, LLC 9000 KinceyAve, Suite 100 aCeAnalytical Huntersville, NC 28078 _P00eta6s[0m (704)075-9092 ANALYTICAL RESULTS Project: Northpointe Plant Pace Project No.: 92360250 Sample: ❑P-1 Lab ID: 92360250001 Collected: 10124/17 06:32 Received: 10/24/17 10:03 Matrix: Water Parameters Results Units Report Limit OF Prepared Analyzed CAS No. Qua) 2540D Total Suspended Solids Analytical Method: SM 2540D Total Suspended Solids 15.5 mglL 5.3 1 10125/17 20:37 2540F Total Settleable Solids Analytical Method: SM 2540F Total Settleable Solids NO mlJlJhr 0.21 1 101241l7 2130 1g 9040 pH Analytical Method: EPA 9040 PH \,__1 8.2 Std, Units 0.10 1 10/24/17 21:49 H6 iI REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, { Date: 10/26/2017 04:58 PM without the written consent of Pace Analytical Services, LLC. Page 4 of 12 0 aceAnaVical wmvpacabbs.com Project: Northpointe Plant Pace Project No.: 92360250 QC Batch: 383996 QC Batch Method: SM 2540D Associated Lab Samples: 92360250001 METHOD BLANK: 2128309 Associated Lab Samples: 92360250001 Parameter Units Total Suspended Solids mg/L LABORATORY CONTROL SAMPLE: 2128310 Parameter Units Total Suspended Solids mg/L SAMPLE DUPLICATE: 2128311 Parameter Units Total Suspended Solids mg/L SAMPLE DUPLICATE: 2128312 Parameter Units Total Suspended Solids mg/L QUALITY CONTROL DATA Analysis Method: SM 2540D Analysis Description: 2540D Total Suspended Solids Matrix: Water Bldnk Reporting Result Limit Analyzed Qualifiers ND _-..... _- 2.5 u ~10/25/17 20:31 — Spike LCS Conc. Result 250 240 92360395002 Dup Result Result Pace Analytical Services, LLC 9800 Kincey Ave, Suite 100 Huntersville, NC 28078 (704)875-9092 LCS % Rec % Rec Limits Qualifiers 96 90-110 RPD Qualifiers 92360491005 Dup Result Result RPD Qualifiers NO NO Results presented on this page are In the units Indicated by the "Units" column except Where an sitarnala unit Is preaerded to the riphl of the result. REPORT OF LABORATORY ANALYSIS This report shali not be reproduced, except in full. ' Dote: 10/26/2017 04:58 PM without the written consent of Pace Analytical Services, LLC, Page 5 of 12 aceAnalyificalD annr pacwabs.com QUALITY CONTROL.DATA Project: Northpointe Plant Pace Project No.: 92360250 QC Batch; 383804 Analysis Method: SM 254OF QC Batch Method: SM 254OF Analysis Description: 2540F Total Settable Solids Associated Lab Samples: 92360250001 METHOD BLANK: 2127223 Matrix: Water Associated Lab Samples: 92360260001 Blank Reporting Parameter Units Result Limit Analyzed Qualifiers Total Settleable Solids mL/L1hr NO 0.10 10/24/17 23:30 Pace Analytical Services, LLC 9800 Kincey Ave. Suite 100 Huntemville, NC 28078 (704)875-9092 Results presented on this page are In the units Indicated by the "Units' column except where an alfamafe unit is nraeenfed l0 (he right of the rseidt. REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, Date: 10/26/2017 04:58 PM without the written consent of Pace Analytical Services, LLC. Page 6 of 12 xAnalXical www.pacalribs.Corp QUALITY CONTROL DATA Project'. Northpointe Plant Pace Project No.: 92360250 QC Batch: 383802 Analysis Method: EPA 9040 QC Batch Method: EPA 9040 Analysis Description: 9040 pH Associated Lab Samples: 92360250001 SAMPLE DUPLICATE: 2127218 92360250001 Dup Parameter Units Result Result RPD Qualifiers pH Std. Units 8.2 8-3 1 H6 Pace Analytical Services, LLC 9800 Klncey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 Results presented on this page are In the units Indlcated by the "Units" column except where an alternate unit is prasented to the right or the result. REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, Dale: 10/26/2017 04:58 PM without the written consent of Pace Analytical Services, LLC. Page 7of12 �i e acMnaly icaf QUALIFIERS Froject: Northpointe Plant Pace Project No.: 92360250 DEFINITIONS Pace Analytical Services, LLC 9800KInceyAve , Suite 100 Huntersville, NC 28078 (704)875-8092 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. PQL - Practical Quantitation 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 Cafculable. 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 ofAcrolein and Acrylonilrile by EPA Method 8260. N-Nitrosodiphenylamine decomposes and cannot be separated from Diphenylaroine 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-A Pace Analytical Services -Asheville A&ALYTE QUALIFIERS 10 Sample relieved was less than 1000mL . H6 Analysis initiated outside of the 15 minute EPA required holding time. REPORT OF LABORATORY ANALYSIS Date: 10/26/2017 04:58 PM This report shall not be reproduced, except in full, without the written consent of Paoo Analytical Services, LLC. Page 8 of 12 Pace Analytical Services, LLC aceMalytieal 9800 Kincey Ave, Suite 100 Huntersville, NC 28078 www.pwae obs.com (704 )875-9092 QUALITY CONTROL DATA CROSS REFERENCE TABLE Froject: Northpointe Plant Face Project No.: 92360250 Analytical Lab ID Sample ID QC Batch Method QC Batch - Analytical Method Batch 92360250001 DP-1 SM 2540D 383996 92360250001 DP-1 SM 254OF 383804 92360250001 DP-1 EPA 9040 383802 REPORT OF LABORATORY' ANALYSIS This report shall not be reproduced, except in full. •► - 091e 1012612017 04:58 PM without the written consent of Pace Analytical Services. LLC. Page 9 o1 12 :Document6: .N�.nfi. Sam to Condition UpdwilecelpijkAj A* s Page I ofl� Document No.; F=CARICS-033-116V,04!:Pace Issuing Authority: Qualit Ofke, rrp ps Labbraf&Ay�oteMng-s-- ' I-"' a, ifieville,E], Eden[J Greenwood H . un'tewsvibe AalieighM M'echan1tsv'i11e[:] b,ibnt Name; ]INEZ=. Koject'#- n F6d ,Ex QUIPS OUSPS." IePient E190hriierdal .00ace (,]Other:- 'Custody Seal Present? 0yes [J�";Seals Inlaet? "Elves. 044/iniflils Person Examining Cohjentj:j 0a'ckfng,MateriaA'- E]quibbie' Wrap Qaiiti6ie'aagi;� :2-Nbrte '0. Other. Biblo'gleal TWui.Fr'6xen? Thiermometer: tlejud' Owe' Nd _]N/K 7 TV Ice; Correction Factor. :Cooler Temp Corrected -Terrtia.ihould beAoVi-fredzlhg,t6'6T' a M phs out of temp criterla.'Sa rn ples'o Oce, cooling process ;has beguh. USDA Regulated Sol Did,sampf'es,oLri�SVinatj!i�a.qua�aniini2:zonewithintheOrtitedStat�s:CAiNV,orSC'(ch&k:maps)?- Old 4mpl6sodfrom ginaiefroa preignsourceynyternat, I Yes _Wgo—, r�cliidingk6i41 and Puerto H IC015 Ove " s 'Chain.of 6st'ady P . resent?. Lei UNo tj?JjA Sarn pies Arrived , withiwlpfoltf 7iM0' 5 brio bN/A Short Hbld Ti rile -Arialysh (<72 hT.17- 7 Yes. o (:,N%A K us ii Turn Araund Time Re ties t ed QN/A '4� sufficknOblume? NaEI rect Containers: Used? -Pace Containers Used? [3N6 ON/A G.r •�riljssar"Jved . anal slI S' Sa milles Fie ld Filtered? — nre No []NIA Sample.Labals March CO.C17; Yes ONO [3N/A. 9. HeadSpace in'V6AVials j>5-6rnrr!?; r-jYd nNo 'ItKm [Dips. .2hfo [7)N/A Seals Pr6j4hr? Elie,, —[]NO CLIENf.tgCTIFICATtC)N/:RkSPLUTJON field data, RequIred? []Yet ONO 16 . Person Contacted-, Dafemme:� Coiriry7eqi/5ampl6 Dikrepar0t' 0,\, A) LOZ ID Of Split Cant;lners; . Project Manager. SCURF Review: Date,:;, vfy Nbw:`Wliih��&,thiri7li 6 dlsa�oancVaff&tl�fl Nd�th Cir'060 compliance sample's will be sent to the North carolloa ONN11 Cei11flcatJqrt�0ffl'ce,(l.'i: 06t of Kold, p ry riig ailve; but oftemp, ihcorr ct cont.i.iners) Page 10 of 12 r-) F-CAR-1 Check rnak to 163f k1fpw6nol" 'bo ordeOldrIn'atibn is verffied:and within -the acceptance ,.range for preserviition samples, ! ":Bott&n:halfof b'6g:is'.t'o'list"'nu'mber"6f.'b6ttlii. Name: � '06cument on R6 - cei((SCUR)_ �Piojocvfti d; August 4,.2017 2 of I_ uthc)titw, I ity Of V 3: < A dit V. .8 CZ ZI: CL Z: 10 LA :0 U E c;: z; CL CA61 M :A. E rE z CL E EI E -1 E 'Ev E E It. 2 JO E kn or 1� ;Q yy va J; V z M 7 & CL 06 LO to L'i Q 331 C) a. & as In 0 \N� N\J\ 8. ONAdjuttmentLqgfor-PreserVedSamples. '18MI310 10"" i 'Type of PreservaUve PH upon ieWipt' - Dole PM%efVJttOnodjtmited - TlnieOfMrvaticn_ adjusted; Amo6ntofPrelervative; added Lot it Page 11 of 12 CHAIN -,,OF -CUSTODY I Analy#rcal Redoes ©vcuitien# Y - " Titer Chakil of odj +5 a LEGAL DOCt3�1EF1T Ap rel vast fields must be completed as ErrateEy: o - F t&Ahj jea!`" _ = N Section'A Secwi h:B Sectian:C " tl :Rcgi.�rcd crew iniamatio.: _.. R©qufred Pro�ectlrs:os4s�ian. inv"nix irEfarmaliuri_ _ Atterisca __ . .. 2 9: 5 RePortTa .t.%� LL15 [ .1 i3.4 Copy To; N- ..- ,,__.. ._.. t .1 RE GULATORYAGENCY �Vt�L.hi fS u.� Add riifs- a-�C- �NPDES' r -GROUNDWATER,: j-_.DRINKFNGwATER Ards -. dctNo-• - P2!wGuote IFST j F2CrZA' — C)THER: 5 1` :2. C C : C L "\ t i. Fteramnce; A . .. Site Locatitsn Re4nestad t3uo DaEe/TAT: Project Num¢ot•. � - _ face PraWak --- � - -- - •.-: "STATE: - ':' .. -` - .� ,Re4E.eested"Anaiy595,Filtered Scctio6 D' iY ztr x Cotles, RbcvlicdCSietn-tct�l� ti - M� IS clQE T. g - s "=: �� COLLECTED: Preservatives' � z � Diinkiiruraj Water OW a` i7 Vbste-rj lnlaste �Yater 4ySn1; p m cp cmiaosiie i w 4` i cieaascrt UtDOPA SA M -LE 11 o;E _... r ae V ¢ z (A-Z::0.91,, 1� Air, - AR AR -Ev a ; Sam* ID. MiST8EUMQL'E Tissue: -. TS O' U. z OT O. - f9e N *� •iE ttl �.. 4 r' a, c O - to . - w DATE T[ME .C+ckTE: 'TTN.E �_ �+ 7 Z 2 Z 2 O.y. - Pace.Piojcu ect-Pa Lab i.D. .k 3` .... - - T _ 9 : to - - -_ ADUt170NRt;GOAfMENTSt--- - ,- iRELIHQ[l1SHED6YtAFfiLWFION - DATE.-T1ME ACCEPTEDSYlAFFILWTiON �-'DATE; TIME' �-� SA[+1PLEG6NDRlQNS ., /11, Q31 08 ILL ORIGINAL SAESPLEfi NA9AE AAtt3 SIGHATUitE(t 3 '..... + .. , PRINT NamcofSANFPLER.rf' ' : �' ',~- - o. _ o er �'. .m.Z, • --- S1GNAiUREo15AMPL ._ S _ MtdlDDlYYj: ,_. • ' Nose: EY sRltir'� slzy rxjrE you OMaastilYrp Pacu4 t+ET 30 tlar pssyrrreAl icrrns and egeci� =a taro Bkxga� of t 5(n ter matt! f +a!ks . t.'� vknirihk 3ftdn"- -... ... P; ALL-Q-ii20r+'v.Ul:. ' 2007, - - E ;. Analytical www.putalabs.cam Section A Required Client information: CHAIN-OF-CUS-1 1DY I Analytical Request Document The Chain -of -Custody is a LEGAL DOCUMENT. All relevant fields must be completed accurately. Section B Section C Required Project Information: Invoice Information: Page, of Company- - �nrrrn�� Report To: Attention: l �s 1 }4 4 ti.! 8J tititiJJJ A'djldess: - - - Copy To: Company Name: REGUIJIORYAGEIV_CY:��r -t -�z•�,; r __ _ zn- }} F } [ _ Ti L.�A i # 1f,- ♦: 1 C. .C� t .� -7 Address: "" "' "'" 7 ! i - j NPDES r GROUND WATER r DRINKING WATER r UST j— RCRA f 7 OTHER Emaif To. Purchase rYl Ihs s,tiF -•'G' , f ri •.{ r ! Order No.: rvT f 11 11' 2'4 Pace ouote Reference: Phone: , " - f, - "Fax: Project Name: ' - Pace Project Manages '"��=f sue' $,sw.catlon-/f'iA_, TATE: f Lnra .s 4L 'r- }Requested v, M Due Date1TAT: Project Number. - ' Pace Pmfde #: y" Zf equested'Analjr is;Flltet•eot(Y!N)"- A In Section D Matrix Codes m Required Client information M r f 9 o COLLECTED Preservatives Drinking Water DW Water T W Waste Water WW m I v m coMPaslTe coMPCSITE z0 L) I U Product P a > 9 START END0CRAe LJ Z SONSord SL SAMPLE ID Oil c� 1 o W L } Wipe 1°P ' (A-Z, G-91,-) Air AR p m a a a Z t� Sample IDs MUST 8E UNIOUE Tissue TS O Other OT X w J OU a� 2 ( c [!J ¢ Q (5Q o Q 0 Cn L L C 2.J1 �` ~ DATE TIME DATE TIME W D X i z z z 2 O ' Pace Project No./ Lab I.D. z. �• , 3 4 5 6 _ T C 8 R? 10 11 `ADDITIONALCOMMENTS;��[r.. x-�RE:LIN4UISREDSY1'A FILIATION' DATES TIME awn, E,/ DATEyr T[ME. SAMPLE CONDITIONS =t'�r t4X.S1ariLS [s S�a; `".. j Y:ae^`two- d'hr - ^aF33t -ACCEPTEUBYIAFFILfATION s,=r % ,t-.[qyc �lf! z 111 -1 /1`.' tit !/, V I ,-SAMPLER NAME'AND SiGNATURE'C° v rS-Ewa«s.[u:;r,-=ar�- ��. .- & ULID m y .a 1. — O'7 t z PRINT Name of SAMPLER. 1 -'-' DATE Signed SIGNATURE of SAMPLER: �'� {MMroofYY): j f= f � f r rn 'Important Note: By signing this form you are accepting Pace's NET 30 day payment terms and agreeing to late charges of 1.5% per McAti for any invoices not paid wfthin 30 days. - F_G I I _r s-non...., n7 I c STORMWATER DISCHARGE OUTFALL (SDO) - Semi -Annual MONITORING FORM GENERAL PERMIT NO. NCG140000 CERTIFICATE OF COVERAGE NO. NCG140448 FACILITY NAME: MacLeod Construction North Pointe Batch Plant PERSON COLLECTING SAMPLES M L-40LS'o_ CERTIFIED LABORATORY_84CJ� yrCAL Lab # G1�17 i�l7Cz�l, r c �}G Lab # OPTIONAL INFO: ^ Part A: Stormwater Monitoring Requirements SAMPLE COLLECTION YEAR: 2", 7 SAMPLING PERIOD: [p July -December ❑ January -June COUNTY PHONE NO. (r 2.'v) OC9 •- 'S_':'1 ADD TOLISTSERVE?❑YES ZINO EMAIL: phoucco 0—m<-CIPeclN,Garr DISCHARGING TO CLASS: []SA ❑HC;W ❑PNA ❑Trout ❑Other Outfall No. Date Sample Collected (mo/dd/yr OR NO FLOW)l pH (standard Units) TSS (mg/L) Event Duration (minutes) Total 4 Rainfall (in) In Tier 2 Monthly Monitoring? (y/n) . # of Months in Tier 2 Sampling' 6-9Z 1ooz,s - - - - �Lt f 7 8, C ENTRAL FILE i I WR btu I lul, ' 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. = 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/l, 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. Permit Date: 7/1/2011-60/30/2015 Last Revised 7/13/11 Page 1 of 2 Part B: Vehicle Maintenance Activity Monitoring Requirements for facilities using > 55 gal of new motor oil/month — averaged over a calendar year. Outfall No. Date Sample Collected (mo/dd/yr)l pH (Standard Units) TPH using method 1664A SGT-HEM (mg/L) Total Suspended Solids (mg/L) Event Duration (minutes) Total Rainfall' (in) New Motor Oil Usage (gal/month) In Tier 2. Monthly Monitoring? (y/n) # of Months in Tier 2 ' Sampling' 6-9' 152 1002" /1lb ✓"-Cc- Ac HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES AT ANY ONE OUTFALL (INCLUDING VEHICLE MAINTENANCE)? YES ❑ NO HAVE YOU CONTACTED THE REGION? YES ❑ NO ❑ REGIONAL OFFICE CONTACT NAME: Mail Original and one coon of this DMR f includina all "No Flow" & "No Discharge" reports) within 30 days of receipt of sample (or at end of monitoring period in case of "No Flow") to: Division of Water QualityT 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 directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations." re of Permittee) Permit Date: 7/1/2011-60/30/2015 0 IG-P�/�_ (Date) Last Revised 7/13/11 Page 2 of 2 // aceAnalytrcal l wwwPa , cefsbs,em Pace Analytical Services, LLC 9800 Kincey Ave. Suite 100 Huntersvi{ie, NC 2.8078 (704)875-9CG92 N October 26, 2017 Mr. Michael Houser MacLeod Construction PO Box 320 Denver, NC 28037 RE: Project: Northpointe Plant Pace Project No.: 92360250 Dear Mr. Houser: Enclosed are the analytical results for sample(s) received by the laboratory on October 24, 2017. 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, Angela Baioni angela.baioni@pacelabs.com (704)875-9092 Project Manager Enclosures REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, witnvut the written consent of Pace Analytical Services. LLC, Page 1 of 12 aceAnalytical IwwwparWabs.com Project: Northpointe Plant Pace Project No.: 92360250 Asheville Certification 10s 2225 Riverside Drive, Asheville, NC 28804 FloridalNELAP Certification #: E87648 Massachusetts Certification #: M-NCO30 North Carolina Drinking Water Certiffcation #: 37712 CERTIFICATIONS North Carolina Wastewater Certification #: 40 South Carolina Certification #: 99030001 Virginia/VELAP Certification #: 460222 REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, without the written consent of Pace Analyhcat Services. LLC. Pace Anatyticot Services, LLC 9800 Kincey Ave. Suite 100 I-luntersville, NC 28078 (7041875-9092 Page 2 of 12 Pace Analytical Services, LLC aeeArralytrcal 9800 Kincey Ave. Suite 100 _.,,. Huntersville, NC 28078 www.pwwebs.corn (704)875-9092 ANALYTICAL RESULTS Project: Northpointe Plant Pace Project No.: 92360250 Sample: DP-1 Lab ID: 92360250001 Collected; 10124/17 06:32 Received; 10/24/17 10:03 Matrix: Water Parameters Results Units Report Limit DF Prepared Analyzed. CAS No. Qual 2540D Total Suspended Solids Analytical Method: SM 2540D Total Suspended Solids 15.5 mglL 5.3 1 10/25/17 20:37 254OF Total Settleable Solids Analytical Method: SM 2540F Total Settleable Solids ND mLlL1hr 0.21 1 10/24/17 23:30 1g 9040 pH Analytical Method: EPA9040 pH i 8.2 Sid. Units 0,10 1 10/24/17 21:49 H6 REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full. Date: 10/2612017 04'.58 PM without she written consent of Pace Analytical Services, LLC. Page 4 of 12 aceAnal fcal 1 www.pacatabs.rbm Pace Analytical Services, LLC 9800 Kincey Ave. Suite 100 Hunteisviife, NC 28078 (704)875-4032 QUALITY CONTROL DATA Project: Northpointe Plant Pace Project No.: 92360250 QC Balch: 383996 Analysis Method: SM 2540D QC Batch Method: SM 2540D Analysis Description: 2540D Total Suspended Solids Associated Lab Samples: 92360250001 METHOD BLANK: 2128309 Matrix: Neater Associated Lab Samples: 92360250001 Blank Reporting Parameter Units Result Limit Analyzed Qualifiers Total Suspended Solids rig/L ND 2.5 10/25/17 20:31 LABORATORY CONTROL SAMPLE: 2128340 Parameter Units Total Suspended Solids mglL SAMPLE DUPLICATE: 2128311 Parameter Tota! Suspended Solids SAMPLE DUPLICATE: 2128312 Parameter Total Suspended Solids Spike LCS LCS % Rec Conc. Result % Rec Limits Qualifiers 250 240 96 90-110 92360395002 Dup Units Result Result RPD Qualifiers ..... ........ ........_.._..............._............_.,..,..__._,..,..,.._........._...._._.__._...__.,.__. _------__.__ mglL 34:8 35.6 2 92360491005 Dup Units Result Result RPD Qualifiers mg1L ND ND Results presented on this page are in the units Indicated by the "Units" column except where an altemate unit is presented to the right of the result. REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, Date: 10/26/2017 04:58 PM without tha written consent of Pace Analytical Services, LLC. Page 5 of 12 /%Analyfical" i www.pw&abs.com QUALITY CONTROL DATA Project: Northpointe Plant Pace Project No.: 92360250 QC Batch: 383804 Analysis Method: SM 254OF QC Batch Method: SM 254OF Analysis Description: 254OF Total Settable Solids Associated Lab Samples: 92360250001 METHOD BLANK: 2127223 Matrix: Water Associated Lab Samples: 92360250001 Blank Reporting Parameter Units Result Limit Analyzed Qualifiers Total Settleable Solids InULhr ND 0.10 10/24/17 23:30 Pace Analytical Services, LLC 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 {704)975-9092 Results presented on this page are in the unite indicated by the "Unite" column except where an alternate unit is presented to the right of the result. REPORT OF LABORATORY ANALYSIS This report shall not be re;aoduced, except in full, Date: 10/2612017 04:58 PM widiout the written consent of Pace Analytical Seniices, LLC. Page 6 of 12 aceAnalytical w6w.pacelabs.cam r QUALITY CONTROL DATA Project: Northpointe Plant Pace Project No.: 92360250 QC Batch: 383802 Analysis Method: EPA 9040 QC Batch Method: EPA 9040 Analysis Description: 9040 pH Associated Lab Samples: 92360250001 SAMPLE DUPLICATE: 2127218 92360250001 Dup Parameter Units Result Result RPD Qualifiers pH Sid. Units 8.2 8.3 1 H6 Pace Analytical Services, LLC 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 Results presented on this page are in the units Indlcated by the " Unila' column except where an alternate unit is presented to the right of the result. REPORT OF LABORATORY ANALYSIS This report shall not he reproduced, except in full, Date: 1012612017 04'.58 PM without the written consent of Pace Analytical Services, LLC. Page 7 of 12 aceAnalytical w»wpacefatxt.crom r QUALIFIERS Project: Northpointe Plant. Pace Project No.; 92360250 DEFINITIONS Pace Analytical Services, LLG 9800 Kincey Ave Suite 100 Huntersville, NC 28079 (704)875-9092 OF - 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. POL - Practical Quantitation Limit. RL - Reporting Limit. S - Surrogate 1,2-Dipheny1hydrazine decomposes 10 and cannot be separated from Azobenzene using Method 8270. The result for each analyze 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 Chloroethylvinyi ether. A separate vial preserved to a pF1 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 tot - 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-A Pace Analytical Services -Asheville ANALYTE QUALIFIERS 19 Sample recieved was less than 1000mL H6 Analysis initiated outside of the 15 minute EPA required holding time. REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full. Date'. 10f261'2017 04:58 PM without the written consent of Pace Analytical Services. €.LC. Page 8 of 12 aceAnalytical � www.pacefabs.tarn i QUALITY CONTROL DATA CROSS REFERENCE TABLE . Project: Norlhpointe Plant Pace Project No.: 92360250 Pace Analytical Services, LLC 9800 Kincey Ave, Suite 100 Huntersville. NC 28078 (704)875.9092 Lab lD Sample ID QC Batch Method QC Batch Analytical Method 92360250001 DP-1 SM 2540D 383996 92360250001 DP-1 $M 254OF 383804 92360250001 DP-1 EPA 9040 383802 Date'. 10126I2017 04:58 PM REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, without the written consent of Pace Analytical Services, LLC. Analytical Batch Page 9 of 12 Document Name: Document Revised: August 4, 2017 21c6malytjor Sample Condition Upon Recei t(SCUR) Page 1 of 2 C3atument Na.: I Issuing Authority: i F-CAR-CS•031-Rev.04 Pace Qualit Offite Laboratory receiving samples: Asheville ❑ EdenLJ Greenwood Huntersville -' Raleigh❑ Mechanicsville[] OWN ClientName: Project It; Courier: []Fed'Ex ❑LIPS ❑USPS C€€ent ❑ Commercial ❑Pace ❑Mher Custody 5eaiPresent? ❑Yes ❑ klr_ Seals intact? Packing Material: Thermometer: ❑ OR Gun ID Correction Factor; ❑Bubble Wrap ❑Bubble Bags ❑Yes �Is�-"'"� Norte ❑ Other WO# 236025 92360250 4�.�!'] S rt Date/Initlais Person Fxamfning Contenirlo— �, 4 _QWet []Blue ❑,)None fff Type III Ice: Cooler Temp Corrected ('C): , USIA Regulated Soil �a NIA, water sample) Did samples origin at in a quarantine tone within the United States: CA, NY, or SC (check maps)? ❑Yes ifs Biological Tissue Frozen? ❑Yes�o ❑N/A Temp should be above freezing to 6'C []Samples out Of temp criteria. Samples on ice, cooling process has begun Did samples originate from a foreign source (internatigDally, including Hawaii and Puerto Rico)? []Yes J jJ Comments/Discre ancy: Chain of Custody Present? es NO Q N/A 1, Samples Arrivod within Hold Tirne7 s Na N/A 2. Short Hold Time Anal sis (<72 hr. ? ❑Yes o ❑NIA 3. Rush Turn Around Time Requested? Yes o ONJA 4. Sufficient Volume? es , ❑Tao ONJA S. Correct Containers Used? -Pace Containers Used? S es ❑Na ❑NIA N A 6. ContainerstntaCt? No N/A 7. Dissolved analysis: Samples field Htefed? ye No NIA B. Sample Labels Match CDC? -Includes Date/Time/ID/Anal s€s Matrix: Efye, ❑Na ❑N/A 9. Heads ace in VOA Vials (>5-6mm)? Yes No /A 10. Trip Blank Present? Trip Blank Custody Seals Present? ❑Yes Dyes o FING ❑N/A ON / 11. CLIENT NOTIFICATtON/RESOLUTION _) I field Date Required? (,,,jYeS . ❑Np Person Contacted; AW)") iI �,( Date/Time: Comments/Sample Discrepancy:: 0 R1t!CSaw�� �ik:. Lot 10 of split Containers: Project Manager SCURF Review: �) Date: \'4— lI Project Manager SRF Review: C� Date: Note: Whenever there =s a discrepancy affecting North Carolina compl€ante samples, a coP1of This form will be sent to the North Carolina DEHNR Certificaggo I.Offtee (Le, put of hold, incorrect preservative, out of temp, ineorrgciContalners)'_ _ 1;.i1.1,..�. lvz. �(l ki ; f tit .5 � G�. V1``iG �;� ��� -t7c�} �' r._l . page,] 0 of '12 b v `a 0 v n m n s 3 a a m N � 3 A ro o 0 � m a 0 m � a A fD C 'a(CL cagy n R a � 7 H A tS 3 A � to n' R C 0 e n �I a O ttcrnts BP4U-125 mL Plastic Unpresetved (NIA) (Cl-) SM-250 mL Plastic Unpreserved (N/A) BP2U-500 mL Plastic Unpreserved (N/A) SP2U-1 liter Plastic Unpreserved (M/A) BP45-125 mL Plastic H2SO4 (pH < 2) {CI-) SP3N-250 mL plastic HNM (pH c 2) a BP4Z-12S mt Plastic 2N Acetate & NaOH (>9) z z 8P44C-125 mL Plastic NaOH JPH a 12) (U-) WGFCI-Wide-mouthed Glass jar Unpreserved AG1U-1 liter Amber Unpreserved JN/A) (0-) AG1l+1 liter Amber HCI (pH < 2) AG3U-250 mt Amber Unpreserved {NJA) (Ct-) AGES-3 liter Amber 1,12504 (pH < 2) ZZ AG35-250 mL.Amber H2504 (pH < 2) AG3A(OG3A)-250 mt. Amber NH4C1 (N/A)(C!-) I UG9H-40 mt VOA HC1 (N/A) VGST-a0 mL VOA Na25203 (N/A) I V69U-40 ant VOA Unp (N/A) UG9P-40 mt VOA 113PO4 (N/A) VOAK (6 vials per kit)-5035 kit {N/A) V/GK 13 vials per kit)-VPH/Gas kit (N/A) SPST-37S mL-5teriie Ptastic (N/A --lab) SPZT•250 mt 5terlle Plastic (N/A —lab) ozz z z MA-75p ml Plastic {NH2)25t7A (93-9.7) - Cubrtainer VSGU-20 mt Scintillation vials (N/A) GN ■ 'p n t fr {� M !1 Ti' 3 °: CL y 3 3 yr CL er o 3 Cr a �' x O n1 Cr 0 ` n x w n ^' CD -w 3 M � � w Cr ro tDCal Cr CL a y � Q t7 rb ram* fl S vas � O Su nI 0 0 v F'accAnafytical ww.osccists:.tam CHAIN -OF -CUSTODY 1 Analytical Request Document The Chnin•ol-Comedy is a LEGAL DOCUMENT. All relevant ilelds muss be completed accurately. o m Page: of CU Section A Section B Section C Required Client hilunnuticm: Required Project tntorma6aw invoice Information: R@pOrt TO: Atl@n1iCn; f, r%� .y�s Yet 1S v L1 l 35 L S SC?Ki Cow ° REGULATORY AGENCY AdIn. e - !1 �"}� 4 .•.� C- � !J NPDES GROUNDWATER _ CIRINKING WATER r- UST RCRA - OTHER E PnrGras der No.' Pa¢ thwur P Fax- Pr 1 nm Pan: Piujct.a Site Location STATE: Regwcst-d Dare DatorrAT- Project Numtor: P.- t''°N° a; Requested An*SiS Filtered (YIN) Section D Matrix Codes y x Required Cr✓n^t irlp:m. an rMATQix,9CN1F - a COLLECTED Preservatives 3� Drinking Waler OW Y U \4ral.:r YJT WasteN'aler W", _ cotes-s,'!nt catrvo_nts _ PIr1.]Vel Sd1+56ld S_ s l9 ST/.FiT F:tiyf:R�E1 ' �► _ 3 A Z V SAMPLE I❑ ape LVIP U LU i,a-7.t1Dl.-} Air AR w 4 ¢ d ,-ample IDs MUSTUNIQUE Tissue TS O m tlI _BE Other CT U w 1- z O a c 1 - 3 a a k �'OO LLI — DATE rlh+E L'AYE TIME ax r x z z z 2 D .,a Of PaceProjectNOJ Lab I.D. J 2 3 4 J 6 7 8 9 S0 11 12 ' AtHNT1ONAL COMMENTS RELINQUISHED BY f AFFIUATTON 'DATE TIME ACCEPTED BY I AFFILIATION DATE TIME SAMPLE CONDITIONS SAMPLER NAME AND SIGNATURE - a a > } PRINT Namo of SAMPLER: C w y SIGNATURE of SAMPL ; L i .� ' ligned - 7 I O Z [MwDD/YY) i { 'fmpr 'v s.trsr+q riav ldm a.i;s mo a..caotn9 P.w:l NET 30 tlay p;ryment lard+:. ;arN agrv#ww kale cf—gui ol 1.i n our W er pact - tar+:ln r>:". ' F-ALL-0-020rev.07, 1