The URL can be used to link to this page

Home My WebLink AboutNCG030234_MONITORING INFO_20150414M t-to STORMWATER DIVISION CODING SHEET NCG PERMITS PERMIT NO. /v u& 3u 3y DOC TYPE ❑ HISTORICAL FILE [ MONITORING REPORTS DOC DATE ❑ a0 ) r' ��I i 7 YYYYM M D D Semi-annual Stormwater Discharge Monitoring Report for North Carolina Division of Water Quality General Permit No. NCG030000 Date submitted 5/11/2015 CERTIFICATE OF COVERAGE No. N0003 0 2 3 4 FACILITY NAME Bendel Tank & Heat Exchanger COUNTY Mecklenburg PERSON COLLECTING SAMPLES Jennifer Wheat/URS LABORATORY Pace Analytical Lab Cert. # 12, 5342, 37706 Comments on sample collection or analysis: Part A: Stormwater Benchmarks and Monitoring Results SAMPLE COLLECTION YEAR 2015 SAMPLE PERIOD ❑ Jan -June ❑ July -Dec or ®❑ Monthly'APdI (month) DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA ❑Zero -flow ❑Water Supply ❑SA ❑■ Other c if frail PLEASE REMEMBER TO SIGN ON PAGES 2 AND/OR 3 -) No discharge this period?2 Outfall No. Date Sample Collected' (mo/dd/yr) 24-hour rainfall amount, Inches' Total Suspended Solids pH, Standard units Copper Lead Zinc Non -Polar O&G/ Total Petroleum Hydrocarbons Total Toxic Organics Benchmarks =__> _ - 100 mg/L or 50 mg/0 6.0 —9.0 0.007 mg/L 0.03 mg/L 0.067 mg/L 15 mg/L 1 mg/L 001 4/14115 0.16 29.6 mg/L 7.6 0.007 <0.005 0.130 <0.005 N/A I Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance•fo' the same parameter at the same outfall. z 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. 4 See General Permit, Table 3 identifying the especially sensitive receiving water classifications where the more protective benchmark applies. s Total Toxic Organics sampling is applicable only for those facilities which perform metal finishing operations, manufacture semiconductors, manufacture electronic crystals, or manufacture cathode ray tubes. For purposes of this permit the definition of Total Toxic Organics is that definition contained in the EPA Effluent Guidelines for the facility subject to the requirement to sample (for metal finishing use the definition as found in 40 CFR 433.11; for semiconductor manufacture use the definition as found in 40 CFR 469.12; for electronic crystal manufacture use the definition as found in 40 CFR 469.22; and for cathode ray tube manufacture use the definition found in 40 CFR 469.31). Permit Date: 11/1/2012-10/31/2017 SWU-245, last revised 10/25/2012 Page 1 of 3 Facilities that incorporate a solvent management plan into the Stormwater Pollution Prevention Plan may so certify, and the requirement for TTO monitoring may be waived. The solvent management plan shall include a list of the total toxic organic compounds used and the other elements listed in the General Permit. For those facilities electing to employ the TTO monitoring waiver, the discharger shall sign the following certification statement: "Based upon my inquiry of the person or persons directly responsible for managing compliance with the permit monitoring requirement for total toxic organics (TTO), I certify that to the best of my knowledge and belief, no dumping of concentrated toxic organics into the stormwater or areas which are exposed to rainfall or stormwater runoff has occurred since filing the last discharge monitoring report. I further certify that this facility is implementing the all the provisions of the solvent management plan included in the Stormwater Pollution Prevention Plan." Jim Rozsa Name (Print name) Vice President, Operations Title (Print t' e) 2� S-- & (5' ture) (Date) Note: Results must be reported in numerical format. 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. 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. Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month. n No dischorae this oeriod?z Outfall No. Date Sample Collected' (mo/dd/yr) 24-hour rainfall amount, Inches; Non -polar O&G/TPH by EPA 1664(SGT-HEM) Total Suspended Solids pH Benchmarks =__> - - 15 mg/L 100 mg/L or 50 mg/L* 6.0 — 9.0 SU NA NA NA NA NA NA Footnotes from Part A also apply to this Part B * See General Permit text, Table 5, identifying the especially sensitive receiving water classifications where the more protective benchmark applies. Permit Date: 11/1/2012-10/31/2017 SWU-245, last revised 10/25/2012 Page 2 of 3 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 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 ANYONE OUTFALL? YES ❑E NO IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑E NO REGIONAL OFFICE CONTACT NAME: Mail an original and one copy of this DMR including all 'No Discharge" reports within 30 days of receipt of the lab results for at end of monitoring 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." of (Date) Permit Date: 11/1/2012-10/31/2017 SWU-245, last revised 10/25/2012 Page 3 of 3 (spqNDELK & HEAT EXCHANGER May 16, 2015 NCDENR Division of Water Quality Attn: DWQ Central Files 1617 Mail Service Center Raleigh, NC 27699-1617 RECEIVED MAY 21 2015 CENTRAL FILES DWR SECTION Subject: Monthly Discharge Monitoring Report Submittal for April 2015 Bendel Tank & Heat Exchanger, 4823 N. Graham Street, Charlotte, Mecklenburg County Stormwater Permit COC NumbertNCG030234_ Dear Division of Water Quality, 704.596.5112 office 866.596.5112 toll -free 704.597.5069 fax 4823 North Graham Street Charlotte, NC 28269 As required by the referenced Storm Water Permit Certificate of Coverage, please find enclosed an original and one copy of the semi-annual storm water Discharge Monitoring Report (DMR) for the referenced facility. This DMR is being submitted as the following sample designated in the Tier 11 section of the permit: Year 3 — Period I April 2015 The April stormwater discharge occurred during a representative rainfall event on April 14, 2015. Based on the reported exceedance for zinc for over four consecutive periods, Bendel has implemented its Tier III response as required intheGeneral Stormwater Permit. Bendel has taken aggressive measures to prevent sediment from impacting site stormwater discharge. Best Management Practices have been implemented including the, installation of rip -rap to reduce stormwater flow velocity, the removal of media blasting material, and sealing potential interior discharge points. Stormwater discharge analytical results for the month of April did not indicate copper above the benchmark value. Copper remains at a Tier11 response level since the previous sampling results were above the benchmark value. Total Suspended Solids (TSS) additionally is below the benchmark value and is no longer in a Tier I response.. Bendel will.continue to implement Best Management Practices (BMPs) to prevent sediment from impacting site stormwater discharge. (mgNDEL TANK & HEAT EXCHANGER 704.596.5112 office 866.596.5112 toll -free 704.597.5069 fax 4823 North Graham Street Charlotte, NC 28269 Zinc, though greatly reduced, is still above the benchmark and continues at a Tier 111 response. As required in Tier III of the Stormwater Plan, Bendel will continue to monitor for all required parameters until such time as the site can demonstrate three consecutive samples that are below the benchmark values. Alternatively, Bendel may seek a variance from NCDENR if continued stonnwater sampling results remain above the respective benchmark values. Please call me at (704) 596-5 112 if you have any questions or if you require any additional information. Sincerer 11imRozsa Vice President, Operations aceAnalytical e e paoeLO&= April 27, 2015 Jennifer Wheat AECOM RE: Project: BENDEL Pace Project No.: 92245407 Dear Jennifer Wheat: 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 April 14, 2015. The results relate only to the samples included in this report. Results reported herein conform to the most current TNI standards and the laboratory's Quality Assurance Manual, where applicable, unless otherwise noted in the body of the report. Analyses were performed at the Pace Analytical Services location indicated on the sample analyte page for analysis unless otherwise footnoted. If you have any questions concerning this report, please feel free to contact me. Sincerely, /,{r000D.1`�aoahPzR Nicole Gasiorowski nicole.gasiorowski@pacelabs.com Project Manager Enclosures cc: NC Chemists, AECOM (r?ao��xCFONIATOM, IT4:101Z �ys� i.»vCCU U-ilr��y This report shall not be reproduced, except in full, without the written consent of Pace Analytical Services, Inc.. Page 1 of 11 aceAnamical wwwpacgleCscmn CERTIFICATIONS Project: BENDEL Pace Project No.: 92245407 Charlotte Certification IDs 9800 Kincey Ave. Ste 100, Huntersville, NC 28078 Florida/NELAP Certification #: E87627 North Carolina Drinking Water Certification #: 37706 Kentucky UST Certification #: 84 North Carolina Field Services Certification #: 5342 West Virginia Certification #: 357 North Carolina Wastewater Certification #: 12 VirginiaNELAP Certification #: 460221 South Carolina Certification #: 99006001 Pace Analytical Services, Inc. 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 Asheville Certification IDs 2225 Riverside Drive, Asheville, NC 28804 North Carolina Wastewater Certification #: 40 Florida/NELAP Certification #: E87648 South Carolina Certification #: 99030001 Massachusetts Certification #: M-NC030 West Virginia Certification #: 356 North Carolina Drinking Water Certification #: 37712 VirginiaNELAP Certification #: 460222 REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, without the written consent of Pace Analytical Services, Inc.. Page 2 of 11 ' Pace Analytical Services, Inc. aceAnalytical 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 wowpacelaEsm'n (704)875-9092 SAMPLE ANALYTE COUNT Project: BENDEL Pace Project No.: 92245407 Analytes Lab ID Sample ID Method Analysts Reported Laboratory 92245407001 001 EPA 1664B CLW 1 PASI-C EPA 200.7 JMW 3 PASI-A - SM 2540D WRC 1 PASI-A REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, without the written consent of Pace Analytical Services, Inc.. Page 3 of 11 Pace An alyticaI Services, Inc. aceAnalytical e 9800 Kincey Ave. 2800 Huntersville, NCG 28078 w PacelaDs.rnm (704)875-9092 ANALYTICAL RESULTS Project: BENDEL Pace Project No.: 92245407 Sample: 001 Lab ID: 92245407001 Collected: 04/14/1509:30 Received: 04114/151645 Matrix: Water Parameters Results Units Report Limit DF Prepared Analyzed CAS No. Dual 1664 SGT-HEM, TPH Analytical Method: EPA 1664B Total Petroleum Hydrocarbons ND mg/L 5.0 1 04/24/15 08:02 200.7 MET ICP Analytical Method: EPA 200.7 Preparation Method: EPA 200.7 Copper 7.0 ug/L 5.0 1 04/16/15 14:55 04/17/15 20:03 7440-50-8 Lead ND ug/L 5.0 1 04/16/15 14:55 04/17/15 20:03 7439-92-1 Zinc 130 ug/L 10.0 1 04/16/15 14:55 04/17/15 20:03 7440-66-6 2540D Total Suspended Solids Analytical Method: SM 2540D Total Suspended Solids 29.6 mg/L 5.0 1 04/16/15 21:41 REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, Dale: 04/27/2015 04:53 PM without the written consent of Pace Analytical Services, Inc.. Page 4 of 11 lace Analytical w pxelebs.cwn QUALITY CONTROL DATA Pace Analytical services, Inc. 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 Project: BENDEL Pace Project No.: 92245407 OC Batch: GCSV/21061 Analysis Method: EPA 1664E QC Batch Method: EPA 1664B Analysis Description: 1664 SGT-HEM, TPH Associated Lab Samples: 92245407001 METHOD BLANK: 1442565 Associated Lab Samples: 92245407001 Parameter Units Total Petroleum Hydrocarbons mg/L Matrix: Water Blank Reporting Result Limit Analyzed Qualifiers NO 5.0 04/24/1507:41 LABORATORY CONTROL SAMPLE & LCSD: 1442566 1442567 Spike 1-CS LCSD LCS LCSD % Rec Max Parameter Units Conc. Result Result % Rec % Rec Limits RPD RPD Qualifiers Total Petroleum Hydrocarbons mg/L 20 16.7 16.1 84 80 64-132 4 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 or the result. REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, Date: 04/2712015 04:53 PM without the written consent of Pace Analytical Services, Inc.. Page 5 of 11 aceAnalytical rvwwpecdabamrn QUALITY CONTROL DATA Pace Analytical Services, Inc. 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 Project: BENDEL Pace Project No.: 92245407 QC Batch: MPRP/18290 Analysis Method: EPA 200.7 OC Batch Method: EPA 200.7 Analysis Description: 200.7 MET Associated Lab Samples: 92245407001 METHOD BLANK: 1436381 Matrix: Water Associated Lab Samples: 92245407001 Blank Reporting Parameter Units Result Limit Analyzed Qualifiers Copper ug/L ND 5.0 04/17/1519:30 Lead ug/L ND 5.0 04/1711519:30 Zinc ug/L ND 10.0 04/17/15 19:30 LABORATORY CONTROL SAMPLE: 1436382 Spike LCS LCS e/ Rec Parameter Units Conc. Result % Rec Limits Qualifiers Copper ug/L 500 491 98 85-115 Lead ug/L 500 486 97 85-115 Zinc ug/L 500 481 96 85-115 MATRIX SPIKE & MATRIX SPIKE DUPLICATE: 1436383 1436384 MS MSD 92245359001 Spike Spike MS MSD MS MSD % Rec Parameter Units Result Conc. Conc. Result Result %Rec %Rec Limits RPD Qua] Copper ug/L 0.0096 500 500 506 502 99 99 70-130 1 mg/L Lead ug/L ND 500 500 490 484 97 96 70-130 1 Zinc ug/L 0.026 500 500 507 503 96 95 70-130 1 mg/L MATRIX SPIKE & MATRIX SPIKE DUPLICATE: 1436385 1436386 MS MSD 92245289003 Spike Spike MS MSD MS MSD % Rec Parameter Units Result Conc. Conc. Result Result e/ Rec % Rec Limits RPD Qual Copper ug/L 5.9 500 500 503 528 100 105 70-130 5 Lead ug/L ND 500 500 450 448 90 90 70-130 0 Zinc ug/L ND 500 500 464 477 92 94 70-130 3 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, Dale: 04/27/2015 04:53 PM without the written consent of Pace Analytical Services, Inc.. Page 6 of 11 ' Pace Analytical Services, Inc. aceAna1j4Jca1 • 9800 ncey Ave. Suite 100 Huntersville, NC 28078078 anowpaceleascom (704)875-9092 QUALITY CONTROL DATA Project: BENDEL Pace Project No.: 92245407 QC Batch: WET/36892 Analysis Method: SM 2540D QC Batch Method: SM 2540D Analysis Description: 2540D Total Suspended Solids Associated Lab Samples: 92245407001 METHOD BLANK: 1437000 Matrix: Water Associated Lab Samples: 92245407001 Blank Reporting Parameter Units Result Limit Analyzed Qualifiers Total Suspended Solids mg/L NO 2.5 04/16/15 21:33 LABORATORY CONTROL SAMPLE: 1437001 Spike LCS LCS %Rec Parameter Units Cone. Result %Rec Limits Qualifiers Total Suspended Solids mg/L 250 258 103 90-110 SAMPLE DUPLICATE: 1437002 92245353001 Cup Parameter Units Result Result RPD Qualifiers Total Suspended Solids mg/L 7.1 8.7 20 06 SAMPLE DUPLICATE: 1437003 92245408002 Dup Parameter Units Result Result RPD Qualifiers Total Suspended Solids mg/L 6.7 7.2 6 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: 04/27/2015 04:53 PM without the written consent of Pace Analytical Services, Inc.. Page 7 of 11 aceAnalytical w pacelab&cnm QUALIFIERS Project: BENDEL Pace Project No.: 92245407 DEFINITIONS Pace Analytical Services, Inc. 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 DF - Dilution Factor, if reported, represents the factor applied to the reported data due to dilution of the sample aliquot. ND - Not Detected at or above adjusted reporting limit. J - Estimated concentration above the adjusted method detection limit and below the adjusted reporting limit. MDL -Adjusted Method Detection Limit. POL - 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 Calculable. SG - Silica Gel - Clean -Up U - Indicates the compound was analyzed for, but not detected. Acid preservation may not be appropriate for 2 Chloroethylvinyl ether, Styrene, and Vinyl chloride. A separate vial preserved to a pH of 4-5 is recommended in SW846 Chapter 4 for the analysis of Acrolein and Acrylonitrile by EPA Method 8260. N-Nitrosodiphenylamine decomposes and cannot be separated from Diphenylamine using Method 8270. The result reported for each analyte is a combined concentration. Pace Analytical is TNI accredited. Contact your Pace PM for the current list of accredited analytes. TNI -The NELAC Institute. LABORATORIES PASI-A Pace Analytical Services -Asheville PASI-C Pace Analytical Services - Charlotte ANALYTE QUALIFIERS 06 The relative percent difference (RPD) between the sample and sample duplicate exceeded laboratory control limits. REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, Date: 04/27/2015 04:53 PM without the written consent of Pace Analytical Services, Inc- Page 8 of 11 ' Pace Analytical Services, Inc. aceAnalytical ® 9800 Kincey Ave. Suite 100 H.ntersville, NC 28078078 wwwpaceaAt= (704)875-9092 QUALITY CONTROL DATA CROSS REFERENCE TABLE Project: BENDEL Pace Project No.: 92245407 Analytical Lab ID Sample ID QC Batch Method QC Batch Analytical Method Batch 92245407001 001 EPA 1664E GCSV/21061 92245407001 001 EPA200.7 MPRP/18290 EPA200.7 ICP/16422 92245407001 001 SM 2540D WET/36892 REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, Date: 04/27/2015 04:53 PM without the written consent of Pace Analytical Services, Inc.. Page 9 of 11 �=Anafyfcal' Document Name: Document Revised: September 22. ZU14 I , Paae 1 of 2 Client Name: F-CHR-CS-003-rev,15 TMrsr:: •R by Custody Seal on Cooler/Box Present: El yes El" no Sealsintact: 0 yes—E no Packing Material: ■ Bubble ■.. ■-Bubble Bags ■ None ■ Other Thermometer Used: IR Gun T1401 Type of Ice: We Blue None ❑ Saifiples on ice, cooling process has begun Tpmn Cnrrecfinn Farfnr T1401 No Correction Corrected Cooler Temp.: C Temp should be above freezing o 6'C Biological Tissue Is Frozen: Yes No NIA Comments: Date l itial o er o examining coots is Chain of Custody Present: es ONO ❑NIA 1. Chain of Custody Filled Out: Yes El No ❑NIA 2. Chain of Custody Relinquished: Yes ONO ❑NIA 3. Sampler Name & Signature on COC: Yes ❑No ❑NIA 4. Samples Arrived within Hold Time: yes ONO ❑NIA 5. Short Hold Time Analysis (<72hr): OYes 0 �No 11 NIA 6. Rush Turn Around Time Requested: DYesdNo ❑NIA 7. Sufficient Volume: EY'., ON, ❑NIA 8. Correct Containers Used: -Pace Containers Used: Yee ` ONO LJY ON ❑NIA ❑N/A 9. Containers Intact: OYes ONO ❑y/A 10. Filtered volume received for Dissolved tests OYes ONO ❑NIA 11. Sample Labels match COC: -Includes date/timenD/Analysis Matrix: OYes 11 No El N/A 12. All containers needing preservation have been checked. All containers needing preservation are found to be in compliance with EPA recommendation. exceptions: VOA, coliform, TOC, 08G, WI-DRO (water) QY26"DNo Dyes ONO OYes 11 No ❑NIA ❑NIA 13. Samples checked for dechlorination: OYes ONO GIKI'A 14. Heads ace in VOA Vials >6mm): OYes ONO ONIK 15. Trip Blank Present: Trip Blank Custody Seals Present Pace Trip Blank Lot # (ifpurchased): OYes ❑No DYes ONO ONIA 11 NIA 16. Client Notification/ Resolution: Field Data Required? Y / N Person Contacted: Date rime: Comments/ Resolution: SCURF Review: IVYYI Date: ( SRF Review: WE(a Date: A' At .,1,'/JI Note: Whenever there is a discrepancy affecting North Carolina compliance , samples, a copy of this form will be sent to the North Carolina DEHNR 822,45 Certification Office ( Le out of hold, incorrect preservative, out of temp, incorrect containers) olare label here 24540? of 11 aceAnalytical' CHAIN -OF -CUSTODY If Analytical Request Document The Chain -of -Custody is a LEGAL DOCUMENT. All relevant fields must be complelod accurately. 0 Page: / m of Section A Section B Section C 4 'o Required Client Information: Required Project Inerm/arllon: Invoice Information: Compip Report To: AOantion: 1906821 1 \ O S a n J ,4 Add, ��y-RM S— Capy Te. ) �PanyN REGULATORY AGENCY n _ ,. Aj r ( e ,7 �� Address: 23 tJ AM '-- ' NPDES i- GROUNDWATER F- DRINKING WATER r UST (- RCRA r OTHER E IT0: �'• Purchase Order No.: Paco Ouom i 1 ,^ WY/ I aclamnc.: J P ono' Fax: Project Nam Paw Pr.. Site Location -. t -S t? act(. Mon.... STATE: / 4� i � .quested Due D.terTAT: Project Number. Paw Press, a: /7 -, L Requested Analysis Filtered (YIN) Section D Matrix -s .. z RPqulradCleminfereuuion o COLLECTED PreservativesICOD A Drinking Waiter DW y U F , Waer WT waste Water Ww tl a nariTe O N Product P e t. sco enolew.a 11 (� L� SoN5old St. U V N SAMPLE ID OL �e WPW v z (A-Z, 0.91 1 Al AR v ~ Sample IDs MUST BE UNIQUE Tissue TS O c. r 2 t Other OT U X W TIT9 to z DU Ory o y _U ox w a E O N nUU O m cyxJr o a 2 ¢ = 7 x = z z E O ,.a. Pace Project NoJ Lab I.D. on kA- 4 5 6 7 e j — — ## ADDITIONAL COMMENTS RELINQUISHED BY I AFFILIATION DATE TIME ACCEPTED BY I AFFILIATION DATE TIME SAMPLE CONDITIONS lry,\OJ4, ORIGINAL SAMPLER NAME AND SIGNATURE Q Is oiz Mgr z °'i PRINT Nam. of SAMPLER j ftj Wit fe. r�� Ll.� .. <� E ~ 5V u'm m SIGNATURE of SAMPLER t' DATE Signed1' ' 9 I —I I S r' N Vl NnparMnl N=w By:gw u.a tam you ao Xco" Pecos NET 30 day poymonnams and agwmg 0 Nlo Curepr of1.5%par manor rany-nvpmus not Paid wnhm 30 w,. IF-ALL-0-020rev.07, 15-May-2007