NCG080064_DMR_20191014

ir\I(.6-ov°(alf
FecEx ® o C-c 16 2019 ,M
Ground
CENT Vane
FEDEX EXPRESS
October 14, 2019
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, NC 27699-1617
919.707.9129
Re: FedEx Ground Package System, Inc.
6660 CXS Way
Charlotte, NC 28214
Permit No: NCG080000
To Whom It May Concern:
Please find enclosed the 2nd Semi-annual stormwater DMR for the above referenced
property.
If you have any questions or concerns, please contact me.
Sincerely,
Natalie 0 ns
Senior Environmental Compliance Specialist
FedEx Ground
Enclosures

7606 Whitehall Executive Center Drive, Suite 800
111,„itTc Charlotte, North Carolina 28273
Telephone [phone]
Fax [phone]
ENVIRONMENTAL • GEOTECHNICAL www.atcgroupservices.com
BUILDING SCIENCES • MATERIALS TESTING
October 3, 2019
Natalie Owens
FedEx Ground Environmental Services
1000 FedEx Drive
Moon Township, PA 15108
Subject: Stormwater Discharge Monitoring Report
FedEx Ground East-CHAR 282
6660 CSX Way
Charlotte, North Carolina 28214
ATC Project No.: 199FED1902
Dear Ms. Owens:
ATC was contracted to perform a semi-annual stormwater monitoring event for the FedEx Ground East facility
(CHAR 282)at 6660 CSX Way in Charlotte, North Carolina. The stormwater sampling event included the collection
of a stormwater sample and outfall observations for qualitative parameters during a measurable storm event. The
monitoring was conducted in general conformance with the requirements of the State of North Carolina
Department of Environmental Quality (NCDEQ), National Pollutant Discharge Elimination System (NPDES),
General Permit NCG080000,which is effective from November 1, 2018 to May 31, 2021.
On September 13, 2019, a stormwater sample was collected at the designated discharge point, Outfall #1 (OF-1),
which includes an oil/water separator discharge (stormceptor), based on a storm event that meets the
requirements for monitoring. Figure 1 is provided depicting the stormwater sampling location. The collected
sample was submitted to North Carolina-accredited Pace Analytical Lab, Inc. in Charlotte, North Carolina, for
analysis of total suspended solids (TSS) by EPA Method SM2540D-11 and Non-Polar Oil and Grease(O&G)/Total
Petroleum Hydrocarbons by EPA Method 1664A(SGT-HEM). A total rainfall amount reading was collected from a
nearby gauging location. Results of visual observations, qualitative parameters, and the total rainfall readings are
provided in the attached Stormwater Discharge Outfall (SDO) Qualitative Monitoring Report and SDO Monitoring
Report.
Based on the specified monitoring parameters, as outlined in Part II, Section C of the NPDES for North Carolina
General Permit NCG080000, the laboratory results of the O&G of <4.8 mg/L (milligrams/liter) did not exceed the
discharge benchmark of 15 mg/L. The laboratory results of the TSS of 35.2 mg/L did not exceed the discharge
benchmark of 100 mg/L. Field testing of pH indicated a level of 6.92, which is within the range of the discharge
benchmark values.
Please note that the SDO Monitoring Report requires certification by signature of permittee (FedEx employee)
before submittal of the entire report to the address on page one of the SDO Monitoring Report. Please sign on
Page 2 of 2 of the SWU-250 SDO form and then send to the DWQ. Please provide a copy of the signed SDO
Monitoring Report to ATC. If you have any questions, please contact us at 704-529-3200.
Sincerely,
•
iav
Diana Lanier Elliot J. Nightingale, P.G.
Project Manager Senior Consultant
ATC ATC
Email: diana.lanier(a atcos.com Email: elliot.nightingale(o)atcgs.com
Attachments:
Figure 1
SDO Monitoring Report

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7606 Whitehall Executive Center STORMWATER SAMPLE LOCATION MAP
ATC Drive, Suite 800
Charlotte, North Carolina 28273 FedEx Ground East(CHAR 282)
ENVIRONMENTAL'GEBTECHNICAL [phone] 6600 CSX Way
BUILDING SCIENCES•MATERIALS TESTING
Charlotte, Mecklenburg County, North Carolina
28214
Scale:As Shown PROJECT No. : 199FED1902

Environmental
Quality
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance on filling out this form,please visit https://deq.nc.gov/about/divisions/energv-mineral-Iand-
resources/energy-mineral-land-permits/stormwater-permits/npdes-industrial-sw##tab-4
Permit No.: N/C/ 8 / 0 / 0 / 0 / 0 / 0 or Certificate of Coverage No.: N/C/G/0/8/ 0 / 0 /0 / 0
Facility Name: FedEx Ground East(CHAR 282)
County: Mecklenburg Phone No. 704-399-9646
Inspector: Diana Lanier with ATC Group Services LLC(For stormwater discharge sampling onlyl
Date of Inspection: _9-13-2019
Time of Inspection: _15:45
Total Event Precipitation(inches):_0.04
All permits require qualitative monitoring to be performed during a"measurable storm event."
A"measurable storm event"is a storm event that results in an actual discharge from the permitted site
outfall. The previous measurable storm event must have been at least 72 hours prior. The 72-hour storm
' interval does not apply if the permittee is able to document that a shorter interval is representative for
local storm events during the sampling period,and the permittee obtains approval from the local DEMLR
Regional Office.
By this signature,I certify that this report is accurate and complete to the best of my knowledge:
•
4Lw.. `•-• with ATC Group Services LLC for FedEx Ground
(Signature of Permittee or Designee)
1. Outfall Description:
Outfall No. 1 Structure(pipe,ditch,etc.): Two pipes(Approx.72"and 54"dia.)drain to
same stream
Receiving Stream: Intermittent tributary of Paw Creek
Describe the industrial activities that occur within the outfall drainage area: No industrial activities
are performed at the outfall area.A stormwater retention pond is located adjacent to the
north of Outfall No. 1. The FedEx facility is located further north.
Page 1 of 2
SWU-242,Last modified 07/28/2017

2. Color: Describe the color of the discharge using basic colors(red,brown,blue,etc.) and tint
(light,medium,dark)as descriptors: Light brown
3. Odor: Describe any distinct odors that the discharge may have(i.e.,smells strongly of oil,weak
chlorine odor,etc.): None
4. Clarity: Choose the number which best describes the clarity of the discharge,where 1 is clear
and 5 is very cloudy:
1 2 3 4 5
5. Floating Solids: Choose the number which best describes the amount of floating solids in the
stormwater discharge,where 1 is no solids and 5 is the surface covered with floating solids:
1 2 3 4 5
6. Suspended Solids: Choose the number which best describes the amount of suspended solids in
the stormwater discharge,where 1 is no solids and 5 is extremely muddy:
1 2 3 4 5
7. Is there any foam in the stormwater discharge? Q Yes 1 No
8. Is there an oil sheen in the stormwater discharge? Yes 0 No
9. Is there evidence of erosion or deposition at the outfall? 0 Yes 0 No.
10. Other Obvious Indicators of Stormwater Pollution:
List and describe
Heavy with leaves,no noticeable sheen
A retention pond for a newly constructed parking lot also drains to the same discharge location of
Outfall#1 that was dry at the time of sampling.
Note: Low clarity,high solids,and/or the presence of foam,oil sheen,or erosion/deposition may be
indicative of pollutant exposure. These conditions warrant further investigation.
Page 2 of 2
SWU-242,Last modified 07/28/2017

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Energy, Mineral and Land Resources General Permit No. NCG080000
Date submitted October 3, 2019
CERTIFICATE OF COVERAGE NO. NCGO8 0 0 0 0 SAMPLE COLLECTION YEAR 2019
FACILITY NAME FedEx Ground (CHAR 282) SAMPLE PERIOD Jan-June X July-Dec
COUNTY Mecklenburg or ( 1 Monthly' (month)
PERSON COLLECTING SAMPLES Diana Lanier with ATC DISCHARGING TO CLASS ❑ORW ❑HQW —Trout ❑PNA
LABORATORY Pace Analytical Lab Lab Cert.# 12 Zero-flow IWater Supply ❑SA
Comments on sample collection or analysis: [Other
PLEASE REMEMBER TO SIGN ON THE REVERSE -
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new oil per month?n yes X no (if yes, complete Part A)
Part A:Vehicle& Equipment Maintenance Areas Monitoring Requirements(If applicable) No discharge this period2
Date Sample Collected' 24-hour rainfall amount, Non-Polar Oil&Grease Total Suspended Solids, New Motor or Hydraulic Oil Usage,
Outfall No. (mo/dd/yr) Inches; mg/L mg/L gal/mon
Benchmarks - - 15 100 or 504 -
Parameter Code - 46529 00552 C0530 NCOIL
Monthly sampling(instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
2 For sampling periods with no discharge at any single outfall,you must still submit this discharge monitoring report with a checkmark here.
'The total precipitation must be recorded using data from an on-site rain gauge. Unattended sites may be eligible for a waiver of the rain gauge requirement.
See General Permit text,Table 1, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Note: Results must be reported in numerical format. For example,do not report Below Detection Limit, BDL, <PQL, Non-detect, ND, or other similar non-
numerical format. When results are below the applicable limits, they must be reported in the format, "<XX mg/L",where XX is the numerical value of the
detection limit, reporting limit, etc. in mg/L. Conversely,where fecal coliform results exceed the dilution upper limit, report the result as ">XX".
Permit Date: 11/1/2018-5/31/2021 SWU-248, last revised 11/1/2018
Page 1 of 2

Part B: Oil/water Separators and Secondary Containment Areas at Petroleum Bulk Stations and Terminals(If applicable) ❑ No discharge this period2
Outfall Date Sample 24-hour rainfall Sample Collected' Total Suspended pH, Non-Polar Oil&
No. Collected' amount, mo/dd/yr Solids, Standard units Grease,
(mo/dd/yr) Inches' mg/L mg/L
Permit Limit - - - 100 or 504 6.0—9.0 15
Parameter Code - 46529 - C0530 00400 00552
Outfall No. 1 9-13-2019 0.04 9-13-2019 35.2 6.92 <4.8
Footnotes from Part A also apply to this Part B
Note: If you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses. See General Permit text.
FOR PART A AND PART B MONITORING RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES ❑ NO❑
IF YES,HAVE YOU CONTACTED THE DEMLR REGIONAL OFFICE? YES ❑NO❑
REGIONAL OFFICE CONTACT NAME:
Mail an original copy of this DMR, including all"No Discharge"reports, within 30 days of receipt of the lab results(or at end dof±nonitoring period in the
case of"No Discharge"reports)to:
Division of Water Quality
Attn:DWQ Central Files
1617 Mail Service Center
Raleigh,North Carolina 27699-1617
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED:
"I certify,under penalty of law,that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to
assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system,or
those persons 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."
O
Signature of i Dat
Permit Date:11/1/2018-5/31/2021 SWU-248,last revised 11/1/2018
Page 2 of 2

Pace Analytical Services,LLC
® 9800 Kincey Ave. Suite 100
aceAnalytical Huntersville,NC 28078
www.pecefaba.com [phone]
September 20, 2019
Ms. Diana Lanier
ATC Group Services LLC
7606 Whitehall Executive Cente
Suite 800
Charlotte, NC 28273
RE: Project: FEDEX GROUND
Pace Project No.: 92445570
Dear Ms. Lanier:
Enclosed are the analytical results for sample(s) received by the laboratory on September 13, 2019.
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, `-"-----Q
Taylor Ezell
[e-mail]
[phone]
Project Manager
Enclosures
cc. Elliot Nightingale,ATC Associates
/' " .014.
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

Pace Analytical Services,LLC
to 9800 Kincey Ave. Suite 178
aceAnalytical
Huntersville,NC 28078
wwwPecelabs.com [phone]
CERTIFICATIONS
Project: FEDEX GROUND
Pace Project No.: 92445570
Charlotte Certification IDs
9800 Kincey Ave.Ste 100,Huntersville,NC 28078 South Carolina Certification#:99006001
Louisiana/NELAP Certification#LA170028 Florida/NELAP Certification#:E87627
North Carolina Drinking Water Certification#:37706 Kentucky UST Certification#:84
North Carolina Field Services Certification#:5342 Virginia/VELAP Certification#:460221
North Carolina Wastewater Certification#: 12
Asheville Certification IDs
2225 Riverside Drive,Asheville,NC 28804 North Carolina Wastewater Certification#:40
Florida/NELAP Certification#:E87648 South Carolina Certification#:99030001
Massachusetts Certification#:M-NC030 Virginia/VELAP Certification#:460222
North Carolina Drinking Water Certification#:37712
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

Pace Analytical Services,LLC
aceAnalytical 0 9800 Kincey Ave. Suite 100
/'. Huntersville,NC 28078
078
www.pacelabs.com [phone]
SAMPLE ANALYTE COUNT
Project: FEDEX GROUND
Pace Project No.: 92445570
Analytes
Lab ID Sample ID Method Analysts Reported Laboratory
92445570001 OUTFALL#1 EPA 1664E AAC1 1 PASI-C
SM 2540D-2011 NAL 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

Pace Analytical Services,LLC
is9800 Kincey Ave. Suite 100
/11?eAnalytical Huntersville,NC 28078
wwwpecefebs.com [phone]
i
ANALYTICAL RESULTS
Project: FEDEX GROUND
Pace Project No.: 92445570
Sample: OUTFALL#1 Lab ID: 92445570001 Collected: 09/13/19 15:45 Received: 09/13/19 16:44 Matrix: Water
Parameters Results Units Report Limit DF Prepared Analyzed CAS No. Qual
1664 SGT-HEM,TPH Analytical Method:EPA 1664E
Total Petroleum Hydrocarbons ND mg/L 4.8 1 09/20/19 06:31
2540D Total Suspended Solids Analytical Method:SM 2540D-2011
Total Suspended Solids 35.2 mg/L 4.6 1 09/19/19 11:22
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced,except in full,
Date:09/20/2019 06:14 PM without the written consent of Pace Analytical Services,LLC. Page 4 of 11

Pace Analytical Services,LLC
/11/ aceAnalytical 9800 Kincey Ave. Suite 100
Huntersville,NC 28078
wwwpacefabs.com [phone]
QUALITY CONTROL DATA
Project: FEDEX GROUND
Pace Project No.: 92445570
QC Batch: 498910 Analysis Method: EPA 1664B
QC Batch Method: EPA 1664B Analysis Description: 1664 SGT-HEM,TPH
Associated Lab Samples: 92445570001
METHOD BLANK: 2685357 Matrix: Water
Associated Lab Samples: 92445570001
Blank Reporting
Parameter Units Result Limit Analyzed Qualifiers
Total Petroleum Hydrocarbons mg/L ND 4.8 09/20/19 06:24
LABORATORY CONTROL SAMPLE: 2685358
Spike LCS LCS %Rec
Parameter Units Conc. Result %Rec Limits Qualifiers
Total Petroleum Hydrocarbons mg/L 19.2 19.4 101 64-132
MATRIX SPIKE SAMPLE: 2685359
35497603001 Spike MS MS %Rec
Parameter Units Result Conc. Result %Rec Limits Qualifiers
Total Petroleum Hydrocarbons mg/L 5.0U 19.6 21.8 107 64-132
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:09/20/2019 06:14 PM without the written consent of Pace Analytical Services,LLC. Page 5 of 11

/11/ Pace Analytical Services,LLC
® 9800 Kincey Ave. Suite 100
aceAnalytical Huntersville,NC 28078
wwwpacelabs.com [phone]
i
QUALITY CONTROL DATA
Project: FEDEX GROUND
Pace Project No.: 92445570
QC Batch: 498705 Analysis Method: SM 2540D-2011
QC Batch Method: SM 2540D-2011 Analysis Description: 2540D Total Suspended Solids
Associated Lab Samples: 92445570001
METHOD BLANK: 2684413 Matrix: Water
Associated Lab Samples: 92445570001
Blank Reporting
Parameter Units Result Limit Analyzed Qualifiers
Total Suspended Solids mg/L ND 2.5 09/19/19 11:13
LABORATORY CONTROL SAMPLE: 2684414
Spike LCS LCS %Rec
Parameter Units Conc. Result %Rec Limits Qualifiers
Total Suspended Solids mg/L 251 256 102 90-110
SAMPLE DUPLICATE: 2684415
92445552005 Dup
Parameter Units Result Result RPD Qualifiers
Total Suspended Solids mg/L 5800 4900 17 D6
SAMPLE DUPLICATE: 2684604
92445552007 Dup
Parameter Units Result Result RPD Qualifiers
Total Suspended Solids mg/L 3100 3900 23 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:09/20/2019 06:14 PM without the written consent of Pace Analytical Services,LLC. Page 6 of 11

Pace Analytical Services,LLC
tical 9800 Kincey Ave. Suite 100
aceAnaly
Huntersville,NC 28078
ww'wPacelabs.c°m [phone]
QUALIFIERS
Project: FEDEX GROUND
Pace Project No.: 92445570
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 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 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.
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced,except in full,
Date:09/20/2019 06:14 PM without the written consent of Pace Analytical Services,LLC. Page 7 of 11

Pace Analytical Services,LLC
9800 Kincey Ave. Suite 100
aceAnalytical Huntersville,NC 28078
w Awpacelebs.com [phone]
QUALITY CONTROL DATA CROSS REFERENCE TABLE
Project: FEDEX GROUND
Pace Project No.: 92445570
Analytical
Lab ID Sample ID QC Batch Method QC Batch Analytical Method Batch
92445570001 OUTFALL#1 EPA 1664E 498910
92445570001 OUTFALL#1 SM 2540D-2011 498705
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced,except in full,
Date:09/20/2019 06:14 PM without the written consent of Pace Analytical Services,LLC. Page 8 of 11

Document Name: Document Revised:February 7,2018
Sample Condition Upon Recelpt(SCUR) Page 1 of 2
aceAnalytical Document No.: Issuing Authority:
F-CAR-CS-033-Rev.06 Pace Carolinas Quality Office
laboratory receiving samples: /
Asheville❑ Eden❑ Greenwood ElHuntersville L� Raleigh❑ MechanicsvilleD
Sample Condition Client Name: WO# : 92445570
Upon Receipt Project#:
I I II III I I I III II
Courier. QEedFx I—LUPS nL15P5 Client _
❑Commercial Dace Dither: 9244 67
Custody Seal Present? Dyes i to Seals Intact? Dyes 01(o
Date/Initials Person Examining Contents:'i' \I'
Packing Material: ❑Bubble Wrap ❑Bubble Bags alone 0 Other Biological Tissue F ozen?
t1l - I ; Dyes ❑No "N/A
Thermometer
❑1R Gun 10: 92TQ49 Type of Ice?' B;,j ❑Blue ®Noe
Cooler Temp('C): "i ,I correction factor:Au'tf/Sublr au("C) 0,0
Temp should be above freezing to 6'C
Cooler Temp Corrected('C): r ` ,., ❑Samples out of temp criteria.Samples on ice,cooling process
has begun
USDA Regulated Soli (["N/A,water sample)
Did samples originate in a quarantine zone within the United States:CA,NY,or SC(check maps)? Did samples originate from a foreign source(internationally,
❑Yes ONo Including Hawaii and Puerto Rico)?❑Yes ONo
Comments/Discrepancy:
Chain of Custody Present? g res ONo ON/A 1.
Samples Arrived within Hold Time? j]cles ONo ON/A 2.
Short Hold Time Analysis(<72 hr.)? Dyes O o ❑N/A 3.
Rush Turn Around Time Requested? ales Quo ON/A 4.
Sufficient Volume? 1es ❑Na ON/A 5.
Correct Containers Used? EYes Ono ON/A 6.
-Pace Containers Used? Imes ONo ❑N/A
Containers Intact? Cries ONO -ON/A "-7.
Dissolved analysis:Samples Field Filtered? Oyes ONo i.N/A 8.
Sample Labels Match COC? Llres ❑No ON/A 9.
_-Includes Date/Time/ID/Analysis_Matrix: ti-
Headspace in VOA Vials(>5-6mm)? Dyes Ono ,Q.Jfff4 10.
Trip Blank Present? Oyes ❑No IN/A 11.
Trip Blank Custody Seals Present? Dyes ❑No ❑NN/A
COMMENTS/SAMPLE DISCREPANCY Field Data Required? ales Duo
c:
1 1 Lot ID of split containers:
CLIENT NOTIFICATION/RESOLUTION
Person contacted: Date/Time:
Project Manager SCURF Review: Date: 9/ 7
Project Manager SRF Review: Date: 9"/7
Page 9 of 11

Document Name: Document Revised:February 7,2018
Sample Condition Upon Recelpt(SCUR) Page 1 of 2
ace Analytical H 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 Project# WO* : 92445570
verified and within the acceptance range for preservation
samples. PM: PTE Due Data: 09/20/19
Exceptions:VOA,Conform,TOC,Oil and Grease,DRO/801S(water)DOC,LLHg CLIENT: 924ITC
**Bottom half of box is to list number of bottle _
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pH Adjustment Log for Preserved Samples
Sample ID Type of Preservative pH upon receipt Date preservation adjusted Time preservation Amount of Preservativeervative Lot of
adjusted
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 10 of 11

I
CHAIN-OF-CUSTODY /Analytical Request Document °
Pace Ak7I 1ID1/
The Chain-of-Custody is a LEGAL DOCLMENT All relevant fi,lds must be completed accurately m
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Section A Section 8 Section C
Required Client Information: Required Project Information: Invoice Information: Page: 1 Of 1
Company ATC Group Services LLC-Charlotte Report To. Diana Lar ier Attention
Address 7606 Whitehall Executive Cente. Copy To. Company Name
Charlotte.NC 28273 Address
Regulatory Agency
Email liana lamer@atcgs corn Purchase Order# Pace Quote
Phone [phone] IFax Project Name d$f$•rdretepg4r!Nk c o c ! C-+l.o„„:: Pace Project Manager taylor ezell@pacelabs corp. State/Location
Requested Due Date '7 l/\ r _t-�T[, Project# r :, r, j Pace Profile
e# 2003-2NC
f4.14-a -(- T 7� Requested Analysis Filtered(YM)
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ADDITIONAL COMMENTS RELINQUISHED BY/AFFILIATION DATE } TIME ACCEPTED BY/AFFIWITICN DATE TIME SAMPLE CONDITIONS
SAMPLER NAME AND SIGNATURE c
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PRINT Name of SAMPLER: c m 2
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SIGNATURE of SAMPLER: 1 DA IT Signed: w d Z J A o Z m m z
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