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Home My WebLink AboutNCG200491_MONITORING INFO_20140915STORMWATER DIVISION CODING SHEET NCG PERMITS PERMIT NO. /V U'-I cI / DOC TYPE. ❑ HISTORICAL FILE ❑MONITORING REPORTS DOC DATE ❑ U �� YYYYM M DD r Mid Atlantic Engineering & Environmental Solutions August 19, 2014 RECEIVED NCDENR/DWQ SEP 15 2014 Attention: Central Files CENTRAL FILES 1617 Mail Service Center DWR SECTION Raleigh, North Carolina 27699-1617 Subject: STORMWATER SAMPLING RESULTS WILSON RECYCLING 6601 WARD BOULEVARD (HIGHWAY 301) WILSON, WILSON COUNTY, NORTH CAROLINA PERMIT NCG200491 MID -ATLANTIC JOB NO. 00OR2418.00 To Whom It May Concern: 409 Rogers View Court Raleigh. NC 27610 office 919.250.9918 facsimile 919.250.9950 MAAONLINE.COM Attached please find the Stormwater Discharge Monitoring Report and analytical report for the sampling conducted at the above -referenced site. A stormwater sample was collected from Outfall 001 on August 1, 2014 and analyzed for Total Suspended Solids (TSS), Cadmium, Copper, Iron, Lead, Zinc and Oil and Grease. The analytical results from this sampling event indicated the stormwater sample collected from Outfall 001 exceeded the established benchmark values for cadmium, copper, lead and zinc. All other parameters were reported below or within their respective benchmark values. Based on these results, a Tier One Response has been implemented at the facility. If you have any questions or need additional information, please contact me at 919-250-9918. Sincerely, MID -ATLANTIC ASSOCIATES, INC. Charles B. Hoffman, P.G. Project Geologist Attachments: Stormwater Discharge Monitoring Report Laboratory Analytical Report EXPERIENCED CUSTOMER FOCUSED INNOVATIVE August 30, 2014 To whom it may concern Owing to the supprising storm watering results, I would like to make a note.) always thought that my facility is one of the cleanest scrap yards in NC. But analytical report is showing that the sample exceeded the established bench mark valuesfor cadmium, Copper, Lead and Zinc. I missed the opportunity to collect the sample during the July that was pretty dry. On August i,2014, when it raines around 10:20 am, I prepared and colleted the sample around 10:45 am. there were not much rain fall when I collected the sample that I had a difficulty in collecting the sample. I suspect the dust on the concrete combined with dry weather might resulted in such results. I will review the facility practices to prevent storm water from discharging. Please call me at 919-423-1133 or email me at hlcho501@gmail.com when you have a question. Thanks, Best Regards, Sirius Metal Recycling, INC 6601 Ward blvd Wilson, NC 27893 252-206-1137 1 STORMWATER DISCHARGE OUTFALL (SDO) GENERAL PERMIT NO. NCG200000 DISCHARGE MONITORING REPORT (DMR) CERTIFICATE OF COVERAGE NO. NCG200491 FACILITY NAME Wilson Recycling PERSON COLLECTING SAMPLES Hanglae Cho CERTIFIED LABORATORY Pace Analytical Lab # Lab # COUNTY Wilson PHONE NO. (919)423-1133 Part A: Specific Monitoring Requirements Mail original and one copy to: SAMPLES COLLECTED DURING Division of Water Quality CALENDAR YEAR: 2014 Attu: CentralsFiles= (This monitoring report is due at the Division no 12 r'' -- ,. later than 30 days from the date the facility 161z7 Mail Service Center receives the sampling results from the laboratory.) 'Raii6i h' NdrililCaroliha 27699-i617 Outfall No. Date Sample Collected mo/dd/vr Total Rainfall inches 00530 00340 00556 00400 01113 01119 00980 01114 01094 Total Suspended Solids m /I Chemical Oxygen Demand m /I Oil & Grease m /I pH S.U. Cadmium' m /I Copper' m /I Iron' m /I Lead' m /I Zinc' m /I Benchmark' - - 100 120 30 6.0-9.0 0.001 0.007 N/A 0.03 0.067 001 08/01/14 0.62 36.0 NA 9.1 6.1 0.0021 0.174 9.240 0.111 0.645 ' 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. - Total recoverable. Only complete Part B if Utis facility uses more than 55 gallons of new motor oil per monfli. Part B: Vehicle Maintenance Activity Mo itorine Requirements Outfall No. Date Sample Collected mo/dd/ r Total Rainfall inches New Motor Oil Usage al/month 00530 00400 00556 Total Suspended Solids m /I pH S.U. Oil & Grease m /I Benchmark) - - - 100 6.0-9.0 30 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'Nowing violations." of Permittee) 'f - 30 -,2,o% (Date) f� NCG200000 DMR Form SWU-256 Page 1 of 1 t aceAnalytical mnvmcelabs.= August 06, 2014 Darin McClure Mid Atlantic Associates, Inc. RE: Project: Wilson Recycling Pace Project No.: 92211748 Dear Darin McClure: Pace Analytical Services, Inc. 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 Enclosed are the analytical results for sample(s) received by the laboratory on August 04, 2014. The results relate only to the samples included in this report. Results reported herein conform to the most current TNI standards and the laboratory's Quality Assurance Manual, where applicable, unless otherwise noted in the body of the report. Analyses were performed at the Pace Analytical Services location indicated on the sample analyte page for analysis unless otherwise footnoted. If you have any questions concerning this report, please feel free to contact me. Sincerely, Jon D Bradley jon.bradley@pacelabs.com Project Manager Enclosures cc: Joanna Crow, Mid Atlantic Associates, Inc. Chuck Hoffman, Mid Atlantic Associates Beverly Oglesby, Mid Atlantic Associates, Inc. �J.P PCCRpa!' L iNlh B�p�P 0 114101[4(+1yWa1:i4117N1101 X/a1i!f_1IIIIK This report shall not be reproduced, except in full, without the written consent of Pace Analytical Services, Inc.. Page 1 of 12 aceAnalytical w»wperelabs.com Project: Wilson Recycling Pace Project No.: 92211748 Charlotte Certification IDs 9800 Kincey Ave. Ste 100, Huntersville, NC 28078 North Carolina Drinking Water Certification #: 37706 North Carolina Field Services Certification #: 5342 North Carolina Wastewater Certification #: 12 South Carolina Certification #: 99006001 Asheville Certification IDs 2225 Riverside Dr., Asheville, NC 28804 Florida/NELAP Certification #: E87648 Massachusetts Certification #: M-NC030 North Carolina Drinking Water Certification #: 37712 1614AMATIM-1 -111011M Florida/NELAP Certification #: E87627 Kentucky UST Certification #: 84 West Virginia Certification #: 357 VirginiaNELAP Certification #: 460221 North Carolina Wastewater Certification #: 40 South Carolina Certification #: 99030001 West Virginia Certification #: 356 VrginiaNELAP Certification #: 460222 REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, without the written consent of Pace Analytical Services, Inc.. Pace Analytical Services, Inc. 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 Page 2 of 12 ace Analytical www.parolaas.cam Project: Wilson Recycling Pace Project No.: 92211748 Lab ID Sample ID 92211748001 Outfall No. 1 Pace Analytical Services, Inc. 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 SAMPLE ANALYTE COUNT Method Analysts Analytes Reported Laboratory EPA 1664B CLW 1 PASI-C EPA 200.7 SH1 5 PASI-A SM 2540D TEP 1 PASI-A EPA 9040 MDW 1 PASI-A REPORT OF LABORATORY ANALYSIS This report shall not to reproduced, except in full, without the written consent of Pace Analytical Services, Inc.. Page 3 of 12 aceAnalytical wwwpattlaas.crvn I ANALYTICAL RESULTS Pace Analytical Services, Inc. 9600 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 Project: Wilson Recycling Pace Project No.: 92211748 Sample: Outfall No. 1 Lab ID: 92211748001 Collected: 08/01/14 08:45 Received: 08/04/14 10:20 Matrix: Water Parameters Results Units Report Limit DF Prepared Analyzed CAS No. Oual HEM, Oil and Grease Analytical Method: EPA 1664B Oil and Grease 9.1 mg/L 5.0 1 08/05/14 09:52 200.7 MET ICP Analytical Method: EPA 200.7 Preparation Method: EPA 200.7 Cadmium 2.1 ug/L 1.0 1 08/05/14 15:30 08/06/14 15:57 7440-43-9 Copper 174 ug/L 5.0 1 08/05/14 15:30 08/0611413:04 7440-50-8 Iron 9240 ug/L 50.0 1 08/05/14 15:30 08/06/1413:04 7439-89-6 Lead 111 ug/L 5.0 1 08105/1415:30 08/0611413:04 7439-92-1 Zinc 645 ug/L 10.0 1 08105/1415:30 08/0611413:04 7440-66-6 2540D Total Suspended Solids Analytical Method: SM 2540D Total Suspended Solids 36.0 mg/L 8.3 1 08/06/14 04:25 9040 pH Analytical Method: EPA 9040 pH 6.1 Std. Units 0.10 1 08/06/14 10:45 H6 REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full. Dale: 08/06/2014 04:37 PM without the written consent of Pace Analytical Services, Inc.. Page 4 of 12 ace Analytical www.pecelaDs.cpm QUALITY CONTROL DATA Pace Analytical Services, Inc. 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 Project: Wilson Recycling Pace Project No.: 92211748 QC Batch: GCSV/l8439 Analysis Method: EPA 1664B QC Batch Method: EPA 1664E Analysis Description: 1664 HEM, Oil and Grease Associated Lab Samples: 92211748001 METHOD BLANK: 1256345 Matrix: Water Associated Lab Samples: 92211748001 Blank Reporting Parameter Units Result Limit Analyzed Qualifiers Oil and Grease mg/L NO 5.0 08/05/14 09:49 LABORATORY CONTROL SAMPLE: 1256346 Spike LCS LCS %Rec Parameter Units Conc. Result %Rec Limits Qualifiers Oil and Grease mg/L 40 38.6 97 78-114 MATRIX SPIKE SAMPLE: 1256347 92211748001 Spike MS MS % Rec Parameter Units Result Conc. Result % Rec Limits Qualifiers Oil and Grease mg/L 9.1 46.5 49.5 87 - 78-114 Results presented on this page are In the units indicated by the "Units" column except where an alternate un It is presented to the right of the result. REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, Date: 08/06/2014 04:37 PM without the written consent of Pace Analytical Services, Inc.. Page 5 of 12 aceAnalytical www.pacelabs.com i QUALITY CONTROL DATA Project: Wilson Recycling Pace Project No.: 92211748 QC Batch: MPRP/16598 Analysis Method: EPA 200.7 QC Batch Method: EPA 200.7 Analysis Description: 200.7 MET Associated Lab Samples: 92211748001 METHOD BLANK: 1256811 Matrix: Water Associated Lab Samples: 92211748001 Blank Reporting Parameter Units Result Limit Analyzed Qualifiers Cadmium ug/L ND 1.0 0810611411:34 Copper ug/L ND 5.0 0810611411:34 Iron ug/L NO 50.0 08/06/14 11:34 Lead ug/L NO 5.0 08/0611411:34 Zinc ug/L NO 10.0 08/06/14 11:34 Pace Analytical Services, Inc. 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 LABORATORY CONTROL SAMPLE: 1256812 Spike LCS LCS %Rec Parameter Units Conc. Result % Rec Limits Qualifiers Cadmium ug/L 500 487 97 85-115 ,Copper ug/L 500 486 97 85-115 Iron ug/L 5000 4880 98 85-115 Lead ug/L 500 483 97 85-115 Zinc ug/L 500 479 96 85-115 MATRIX SPIKE & MATRIX SPIKE DUPLICATE: 1256813 1256814 MS MSD 92211566001 Spike Spike MS MSD MS MSD % Rec Parameter Units Result Conc. Conc. Result Result % Rec % Rec Limits RPD Qual Cadmium ug/L NO 500 500 494 482 99 96 70-130 3 Copper ug/L 0.0085 500 500 512 505 101 99 70-130 1 mg/L Iron ug/L 0.40 5000 5000 5100 5050 94 93 70-130 1 mg/L Lead ug/L ND 500 500 484 477 97 95 70-130 2 Zinc ug/L 0.11 500 500 581 578 95 94 70-130 1 mg/L MATRIX SPIKE & MATRIX SPIKE DUPLICATE: 1256815 1256816 MS MSD 92211894005 Spike Spike MS MSD MS MSD % Rec Parameter Units Result Conc. Conc. Result Result %Rec %Rec Limits RPD Qual Cadmium ug/L <0.50 500 500 490 489 98 98 70-130 0 Copper ug/L 52.3 500 500 544 541 98 98 70-130 0 Iron ug/L <14.0 5000 5000 4790 4780 96 95 70-130 0 Lead ug/L <4.0 500 500 488 486 98 97 70-130 0 Zinc ug/L 9.7J .500 500 487 484 95 95 70-130 1 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 shell not be reproduced, except in full, Date: 08/06/2014 04:37 PM without the written consent of Pace Analytical Services, Inc.. Page 6 of 12 aceAnalytical. wwxpacelabsrom i QUALITY CONTROL DATA Pace Analytical Services, Inc. 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 Project: Wilson Recycling Pace Project No.: 92211748 QC Batch: WET132481 Analysis Method: SM 2540D QC Batch Method: SM 2540D Analysis Description: 25400 Total Suspended Solids Associated Lab Samples: 92211748001 METHOD BLANK: 1257403 Matrix: Water Associated Lab Samples: 92211748001 Blank Reporting Parameter Units Result Limit Analyzed Qualifiers Total Suspended Solids mg/L NO 2.5 08/06/14 04:23 LABORATORY CONTROL SAMPLE: 1257404 Spike LCS LCS %Rec Parameter Units Conc. Result % Rec Limits Qualifiers Total Suspended Solids mg/L 250 258 103 90-110 SAMPLE DUPLICATE: 1257405 92212068001 Cup Parameter Units Result Result RPD Qualifiers Total Suspended Solids mg/L 397 360 10 SAMPLE DUPLICATE: 1257406 92211878001 Dup Parameter Units Result Result RPD Qualifiers Total Suspended Solids mg/L NO NO 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: 08/06/2014 04:37 PM without the written consent of Pace Analytical Services, Inc.. Page 7 of 12 aceAnalytical aarwpacelabs.cam i QUALITY CONTROL DATA Project: Wilson Recycling Pace Project No.: 92211748 QC Batch: WET132491 Analysis Method: EPA 9040 QC Batch Method: EPA9040 Analysis Description: 9040 pH Associated Lab Samples: 92211748001 SAMPLE DUPLICATE: 1257510 Parameter Units pH Sld. Units 92211921001 Cup Result Result RPD Qualifiers 7.3 7.5 3 D6,1-16 Pace Analytical Services, Inc. 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: 08/06/2014 04:37 PM without the written consent of Pace Analytical Services, Inc.. Page 8 of 12 aceAnalyticala w ..pacefabs.com i QUALIFIERS Project: Wilson Recycling Pace Project No.: 92211748 DEFINITIONS Pace Analytical Services, Inc. 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)B75-9092 DF - Dilution Factor, if reported, represents the factor applied to the reported data due to changes in sample preparation, dilution of the sample aliquot, or moisture content. ND - Not Detected at or above adjusted reporting limit. J - Estimated concentration above the adjusted method detection limit and below the adjusted reporting limit. MDL -Adjusted Method Detection Limit. PQL- Practical Quantilation Limit. RL - Reporting Limit. S - Surrogate 1,2-Diphenylhydrazine (8270 listed analyte) decomposes to Azobenzene. 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 RPO - Relative Percent Difference NC - Not Calculable. SG - Silica Gel - Clean -Up U - Indicates the compound was analyzed for, but not detected. N-Nitrosodiphenylamine decomposes and cannot be separated from Diphenylamine using Method 8270. The result reported for each analyte is a combined concentration. Acid preservation may not be appropriate for 2-Chloroethylvinyl ether, Styrene, and Vinyl chloride. 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 relative percent difference (RPD) between the sample and sample duplicate exceeded laboratory control limits. H6 Analysis initiated outside of the 15 minute EPA recommended holding time. REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, Date: 08/06/2014 04:37 PM without the written consent of Pace Analytical Services, Inc.. Page 9 of 12 ace Analytical � wmepacela6s.crom I QUALITY CONTROL DATA CROSS REFERENCE TABLE Project: Wilson Recycling Pace Project No.: 92211748 Pace Analytical Sorvices, Inc. 9800 Kincey Ave. Suite 100 Hunlersville, NC 28078 (704)875-9092 Lab ID Sample ID QC Batch Method QC Batch Analytical Method 92211748001 Outfall No. 1 EPA 1664B GCSV/18439 92211748001 Outfall No.1 EPA 200.7 MPRP/16598 EPA200.7 92211748001 Ouffall No. 1 SM 2540D WET/32481 92211748001 Outfall No.1 EPA 9040 WET132491 Date: 08/06/2014 04:37 PM REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, without the written consent of Pace Analytical Services, Inc.. Analytical Batch ICP/14986 Page 10 of 12 ' Document Name: Document Revised: AK 110,;aceMnlytiral' Sample Condition Up on Receipt SCUR Page 1 of 2 Document Number: Issuing Author F-CHR-CS-003-rev.14 Pace Huntersville Qw Client Name: i%11 cA Ns-, (,Ic Courier Fed Ex ❑ UPS❑ USPS❑ Client[] Commercial❑ Pace Other O6fl0nl . i •..a.M CustodySeal on Cooler/Box Present: ❑ IDIOM,! .� yes no Seals intact: El ❑ no s e n `4 t Packing Material: Bubble Wrap Bubble Bags ❑ None ❑ Other Thermometer Used: IR Gun T1102 T140 Type of Ice: Wet Blue No e ❑ Samples on ice, cooling process has begun Temp Correction Factor T1102: No Correction T1301: No Correction c Corrected Cooler Temp.: 3 I •C Temp should be above freezing to 6'C Biological Tissue is Frozen: Yes N N/AFDaC1'e.atnc1ents: Comments: Initials of person examining N Chain of Custody Present: Wes ONO ON/A 1. Chain of Custody Filled Out: Wes ON. ON/A 2. Chain of Custody Relinquished: Dyes ❑N/A 3. Sampler Name & Signature on COC: s ONO ❑N/A 4. Samples Arrived within Hold Time: s ONO ON/A 5. Short Hold Time Analysis (c72hr): � OYes Q ❑N/A 6. Rush Turn Around Time Requested: OYes ON/A 7, Sufficient Volume: e o ❑N/A 8. CbQ rv�SStn"0 Correct Containers Used: -Pace Containers Used: res \4*es ONO ONO ON/A ❑N/A g, Containers Intact: s ONO ❑N/A 10. Filtered volume received for Dissolved tests OYes ONO A 11. Sample Labels match COC: -Includes date/time/ID/Analysis Matrix: Oyes Xyo / ON/A 12. p C,CC, Sfn.�S O�ti SA M .- , I �o-N-les SCI� (�: y 5 A" All containers needing preservation have been checked. All containers needing preservation are found to be in compliance with EPA recommendation. exceptions: VOA, coliform, TOG, 0&G, WI-DRO (water) �/es �By ss 110ies ONO ONO ONO ON/A ❑N/A 13. Samples checked for dechlorination: OYes ONO W/A 14. Headspace in VOA Vials >6mm): OYes ONO /A 15. Trip Blank Present: Trip Blank Custody Seals Present Pace Trip Blank Lot # (if purchased): OYes OYes ONO �VNIA ONO �alA 16. Client Notification/ Resolution: Field Data Required? Y / N Person Contacted: 6c. 'otc. Fh.Ft:DateMme: Sff�lfy )/' 3J Comments/ Resolution: TA--' / C /0' 4 (t-4 rr f}c,6 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 11 of 12 /_, PaceAnalytical' CHAIN -OF -CUSTODY / Analytical Request Document The Chain-of-Cuslody is a LEGAL DOCUMENT. AJI relevant fells must be completed accurately. b to m aecaen n Section 8 Section C ReSulratl Cfienl In!onna;ionRequired Protect In!onllatiwf: Inwirn Infamu:gn: Page: of Company: Mid -Atlantic Associates, Inc. all To. Chuck Hoffman (choffmanQn-aaonline.aom) Ave i l: Chuck Hoffman Aaaides'. 409 Rogers Vew Court copy To: Joanna Crow Qcrow@maaonline.com) Oompeny Name Mid -Atlantic Associates, inc. REGULATORY AGENCY Raleigh, NC 27610 Adel 409 Rogers View Court, Raleigh, NC f NPDES F GROUNDWATER F- DRINKING WATER Email To: choffman@maaonline.com PUmcase Order NO.: R2418.00 im7. N° -- Reference r UST FRCRA r OTHER Phone: 919-250.9978 Fa: 919-260-9960 Protect Name i�56N ad <LIN6 I Z pace vmlen Maoso I, Kevin Herrin g Site Location NC Requested Due Date?AT: standl Project Number R2418.00 Paro pmfee P'. -- l STATE: Requested Analysis -Filtered (YIN) Section D Valid Match Codes - a z Re9mred meet mfom„uen auTRlx cooE _ o COLLECTED Preservatives 9 N Y v v Y v v v �uwG Ww:cq PV U cdwidRE TER wa wASTEwwTER + d U 2 O_ RRol P - ¢ STMi 00wassl ENNGRT. W Z SCtt5Cl1G SL SAMPLE ID G, w v . do (A-Z. 0-9 1,-) w Sample IDe MUST eE UNIQUE Te p f < w y y t U TI.TIMIT..T.1 F Z 2 ad U E tE X i Lq O O C T ad Q Q Q O C O Z U O N L .Q. m do m de 2 2 T Z (0 Z ..e , O O U J N U O U C F, 0 N Pace Project No./ Lab I.D. 1 Ouffall No. 1 wr �- /� G - - - 6 1 2 t 1 1 1 2 x X1 x x x ixi x x Rainfall (inches): 2 H: B a s 6 7 - 8 9 t0 11 12 ADDITIONAL C91MMENTS i -- -. REDNaUISHEO aYJ AFFILIATION DATE -; TIME:':, '= ; ACCEPTED BYIAFFILIATION ::. � :`._PATE-" . .TIME SAMPLE CONDITIONS O �R .7LI"I" io: o a 1 I V SAMPLER NAME AND PRINT Name of SAMPLER: ha� let, (h o As SIGNATURE of SAMPLER: / DATE Signed E WMIDD"L -Imponan; Ntle: By all- 1 this loonyw am accq%iry PoaaNET]o ary wyment terms and eyenrg la late rna,., onsx Per rr o,th Ids any invoke: a paid wtlhin 30 days. F-ALL-O-020rev.09, 12-0d-2007