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Home My WebLink AboutNCG030531_MONITORING INFO_20190702STORMWATER DIVISION CODING SHEET NCG PERMITS PERMIT NO. Iv U& D 0 3 DOC TYPE. ❑ HISTORICAL FILE C MONITORING REPORTS DOC DATE ❑ 4019 070 YYYYMMDD Semi --annual Stormwater Discharge Monitoring; Report for North Carolina Division of Water Quality General Permit No. NCG030000 Date submitted 6/20/19 CERTIFICATE OF COVERAGE NO. NCG030000 FACILITY NAME Kings Mountain Internaional Inc. COUNTY Cleveland (Y1Q0 its tri PERSON COLLECTING SAMPLES Bob Jafarkhani LABORATORY Pace Labs Lab Cert. # 12 & 40 Comments on sample collection or analysis: Melissa Bilotta Part A: Stormwater Benchmarks and Monitoring Results SAMPLE COLLECTION YEAR 2019 SAMPLE PERIOD ® Jan -June ❑ July -Dec or ❑ Monthly' DISCHARGING TO CLASS ❑ORW ❑HQW []Trout ❑PNA RECEIVED ❑Zero -flow ❑Water Supply ❑SA ®Other Stormwater JUL 0 2 2019 CENTRAL FILES PLEASE REMEMBER TO SIGN ON PAGES 2 AND/OR 3 D?NR SECTION n No discharge this period?' Outfall No. Fateae ) 24-hour rainfall amount, Inches' Total Suspended Solids pH, Standard units Copper Lead Zinc Non -Polar O&G/ Total Petroleum Hydrocarbons Total Toxic Organicss Benchmarks ===> - - 100 mg/L or 50 mg/L4 6.0 — 9.0 0.007 mg/L 0.03 mg/L 0.067 mg/L 15 mg/L 1 mg/L SDO #005 6/7/19 .5 2.5 7.2 .0038J ND .066 ND ND Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfali. For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here. 3The 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, Table 3 identifying the especially sensitive receiving water classifications where the more protective benchmark applies. 5 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/l/2012-10/31/2017 SWU-245, last revised 10/25/2012 Page 1 of 3 Facilities that incorporatea 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." A6,US!&A 4;ll-0_17A Name (Print name) KkArnf b-Cf�P_ Title (Print title) f Z, O6 •20.2o(' (i (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 Z 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. ❑ No discharge this period?' 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 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 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 DWQ REGIONAL OFFICE? YES ® NO ❑ REGIONAL OFFICE CONTACT NAME: Zahid Khan Mail an oriainal and one copy of this DMR including all "No Discharge" reports within 30 days of receipt of the lab results (or 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." (Signature 44•20•206 (Date) Permit Date: 11/1/2012-10/31/2017 SWU-245, last revised 10/25/2012 Page 3 of 3 ikINGS MOUNTAIN 1755 S. Battleground Avenue, Kings Mountain, NC 28086 USA Tel: 704-739-4227 • Fax: 704-739-4223 • www.kmiinc.net • email: kmil755@aol.com June 20, 2019 Central Files Division of Water Quality 1617 Mail Service Center Raleigh, NC 27699-1617 Re: Kings Mountain International, Inc. TTO Exemption Certification CEC Project 121-859 Dear Sirs, Kings Mountain International, Inc. is hereby submitting this required statement by June 15, 2019 as required in Part III Section 5 of our Industrial User Permit. Based upon my inquiry of the person or persons directly responsible for managing compliance with the permit monitoring requirement for total toxic organics (TTO), 1 certify that, to the best of my knowledge and belief, no leak, spill, or dumping of concentrated toxic organics into the stormwater or onto 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 all the provisions of the Solvent Management Plan included in the Stormwater Pollution Prevention Plan. Sincerely, Melissa Bilotta, Plant Manager Kings Mountain International, Inc. NCO Environmental Quality Stormwater Discharge Outfall (SDO) Qualitative Monitoring Report For guidance on filling out this form, please visit https://deq.nc.gov/about/divisions/energy-mineral-1and - resources/energy-minera l -la nd-permits /Stormwater-permits /nodes-industria l-sw#tab-4 Permit No.: N/C/ G/ 0/ 3/ 0/ 0/ 0/ 0/ or Certificate of Coverage No.: Facility Name: Kings Mountain International, Inc County: Cleveland Phone No. 704-739-4227 Inspector: Bob lafarkhani Date of Inspection: 6U2019 Time of Inspection: 2:00 pm Total Event Precipitation (inches): .5 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, 1 certify that this report is accurate and complete to the best of my knowledge: S ittee or Designee) 1. Outfall Description: Outfall No. 005 Structure (pipe, ditch, etc.): Ditch Receiving Stream: Dixon Branch Tributary Describe the industrial activities that occur within the outfall drainage area: Metal Finishing 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 ® No. 8. Is there an oil sheen in the stormwater discharge? o Yes 0 No. 9. Is there evidence of erosion or deposition at the outfall? O Yes ®No. 10. Other Obvious Indicators of Stormwater Pollution: List and describe None 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 SWO-242, Last modified 07/28/2017 i laceAnalyticalo wxw.parele0.c com June 17, 2019 ii Melissa Bilotta Kings Mountain International 1755 South Battleground Ave. Kings Mountain, NC 28086 Pace Analytical Services, LLC 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 RE: Project: storm water Pace Project No.: 92432439 Dear Melissa Bilotta: Enclosed are the analytical results for sample(s) received by the laboratory on June 10, 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, Taylor Taylor Ezell taylor.ezell@pacelabs.com �j (704)875-9092 Project Manager " Enclosures n cc: Stacy Barker, Kings Mountain International Mr. Ivan Cooper, Kings Mountain International Donna Goins, Kings Mountain International Ryan Wagenknight 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 aceAnalytical e w»wpecela0.ccam CERTIFICATIONS Project: storm water l Pace Project No.: 92432439 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 South Carolina Certification #: 99006001 Louisiana/NELAP Certification 9 LA170028 Florida/NELAP Certification #: E87627 North Carolina Drinking Water Certification #: 37706 Kentucky UST Certification M 84 North Carolina Field Services Certification #: 5342 VrginiaNELAP Certification #: 460221 North Carolina Wastewater Certifcatlon #: 12 Asheville Certification IDs 2225 Riverside Drive, Asheville, NC 28804 North Carolina Wastewater Certification #: 40 Florda/NELAP Certification #: E87648 South Carolina Certification M 99030001 Massachusetts Certification #: M-NC030 YrginiaNELAP Certification M 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 13 aceAnalytical e e»wpacelaAs.com I I i Project: storm water Pace Project No.: 92432439 Lab ID Sample ID I 92432439001 SDO #005 SAMPLE SUMMARY Matrix Date Collected Water 06/07/1914:00 Date Received 06/10/19 10:25 REPORT OF LABORATORY ANALYSIS This report shall not be reproducer, except in full, without the written consent of Pace Analytical Services, LLC. Pace Analytical Services, LLC 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 Page 3 of 13 aceAnalytical® ~pacelabs.com SAMPLE ANALYTE COUNT Pace Analytical Services, LLC 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 Project: Pace Project No.: storm water 92432439 Analytes Lab ID Sample ID Method Analysts Reported Laboratory 92432439001 SDO #005 EPA 1664B JMS 1 PASI-C EPA 200.7 Rev 4.4 1994 SH1 3 PASI-A I' I l SM 254OD-2011 MJP 1 PASI-A �i 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 Pace Analytical Services, LLC aceAnalytical ® 9800Kincey Ave. te 100 Hunlersville, NC128078 tnwpacelaDscdn (704)875-9092 ANALYTICAL RESULTS I Project: storm water II' Pace Project No.: 92432439 it Sample: SDO #005 Lab ID: 92432439001 Collected: 06/07/19 14:00 Received: 06/10119 10:25 Matrix: Water Report Parameters Results Units Limit MDL DF Prepared Analyzed CAS No. Oust HEM, Oil and Grease Analytical Method: EPA 1664B �i Oil and Grease ND mg1L 4.8 1.2 1 06/12/1906:03 200.7 MET ICP Analytical Method: EPA 200.7 Rev 4.4 1994 Preparation Method: EPA 200.7 Rev 4.4 1994 Copper 0.0038J mg/L 0.0050 0.0021 1 06/12/1916:49 06/1411900:34 7440-50-8 Lead ND mg/L 0.0050 0.0016 1 06/1211916:49 06/14/1900:34 7439-92-1 j Zinc 0.066 mg/L 0.010 0.0039 1 06/1211916:49 06/1411900:34 7440-66-6 li 2540D Total Suspended Solids Analytical Method: SM 25400-2011 it Total Suspended Solids 2.5 mg/L 2.5 2.5 1 06/14/19 12:15 Date: 06/17/2019 12:08 PM REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, without the written consent of Pace Analytical Services, L-C. Page 5 of 13 iI aceAnalytical wl»vpacplahscdn QUALITY CONTROL DATA Pace Analytical Services, LLC 9800 Kincey Ave. Suite 100 Huntersville, INC 28078 (704)875-9092 Project: storm water Pace Project No.: 92432439 OC Batch: 480559 Analysis Method: EPA 1664B QC Batch Method: EPA 1664E Analysis Description: 1664 HEM, Oil and Grease Associated Lab Samples: 92432439001 METHOD BLANK: 2599794 Matrix: Water Associated Lab Samples: 92432439001 Blank Reporting Parameter Units Result Limit MDL Analyzed Qualifiers Oil and Grease mg/L ND 4.8 1.2 06/12/19 05:55 LABORATORY CONTROL SAMPLE: 2599795 - Spike LCS LCS % Rec ll Parameter Units Conc. Result % Rec Limits Oualifiers ',. Oil and Grease mg/L 38.5 37.4 97 78-114 MATRIX SPIKE SAMPLE: 2599796 92432130001 Spike MS MS %Rec Parameter Units Result Conc. Result %Rec Limits Qualifiers " Oil and Grease mg/L ND 38.5 38.1 96 78-114 Results presented on this page are In Me units indicated by Ne'Unib' column except whore an alternate unit Is presented to the right of the result. p REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, Date: 06/17/2019 12:08 PM without the written consent of Pace Analytical Services. LLC. Page 6 of 13 aceAnalytical mrwpacelecs.cwn QUALITY CONTROL DATA �i Project: storm water Pace Project No.: 92432439 QC Batch: 480722 Analysis Method: EPA 200.7 Rev 4.4 1994 OC Batch Method: EPA 200.7 Rev 4.4 1994 Analysis Description: 200.7 MET Associated Lab Samples: 92432439001 METHOD BLANK: 2600460 Matrix: Water Associated Lab Samples: 92432439001 Pace Analytical Services, LLC 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 Blank Reporting Parameter Units Result Limit MDL Analyzed Qualifiers Copper mg/1- ND 0.0050 0.0021 06/14/1913:22 Lead mg/L ND 0.0050 0.0016 06/13/19 22:56 Zinc mg/1- NO 0,010 0.0039 06/13/19 22:56 'I LABORATORY CONTROL SAMPLE: 2600461 Spike LCS 1-CS %Rec Parameter Units Conc. Result %Rec Limits Qualifiers Copper mg/L 0.5 0.50 99 85-115 � Lead ni 0.5 0.49 97 85-115 n Zinc i ni 0.5 0.51 101 85-115 MATRIX SPIKE & MATRIX. SPIKE DUPLICATE: 2600462 2600463 MS MSD 92429955006 Spike Spike MS MSD MS MSD e/ Rec Max Parameter Units Result Conc. Conc. Result Result % Rec % Rec Limits RPD RPD Qual Copper mg/L NO 0.5 0.5 0.49 0.48 98 96 70-130 2 20 ,Lead mg/L ND 0.5 0.5 0.48 0.47 96 93 70-130 3 20 'i Zinc mg/L 0.055 0.5 0.5 0.57 0.56 104 100 70-130 3 20 MATRIX SPIKE & MATRIX SPIKE DUPLICATE: 2600464 2600465 MS MSD 92431938001 Spike Spike MS MSD MS MSD p/ Rec Max Parameter Units Result Conc. Conc. Result Result p/ Rec %Rec Limits RPD RPD Qual i'Copper mg/1- 27.9 ug/L 0.5 0.5 0.53 0.51 100 96 70-130 4 20 l,',Lead mg/L NO 0.5 0.5 0.49 0.47 97 94 70-130 3 20 Zinc mg/L 57.6 ug/L 0.5 0.5 0.58 0.56 104 101 70-130 3 20 Results presented on this page are In the units inElwteci by Me'Units- column except where an alternate unit is presented to the right of the result. Date: 06/17/2019 12:08 PM I� REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, without the written consent of Pace Analytical Services, LLC. Page 7 of 13 o- !, aceAnalyticalo 1' mtwpecelehsrom I I 'I i! li Project: storm water 1, Pace Project No.: 92432439 OC Batch: 481177 OC Batch Method: SM 25400-2011 i, Associated Lab Samples: 92432439001 I I METHOD BLANK: 2602778 Associated Lab Samples: 92432439001 Parameter Units ' Total Suspended Solids mg/L I LABORATORY CONTROL SAMPLE: 2602779 I Parameter Units I Total Suspended Solids mg/L SAMPLE DUPLICATE: 2602780 I. Parameter Total Suspended Solids Parameter Total Suspended Solids Pace Analytical Services, LLC 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 QUALITY CONTROL DATA Analysis Method: SM 2540D-2011 Analysis Description: 2540D Total Suspended Solids Matrix: Water Blank Reporting Result Limit MDL Analyzed Qualifiers ND 2.5 2.5 06/14/1912:15 Spike LCS LCS e/ Rec Conc. Result %Rec Limits Qualifiers 251 246 98 90-110 92432547001 Dup Units Result Result mg/L 27.4 19.2 92432553002 Dup Units Result Result mg/L 17.6 30.4 Max RPD RPD Qualifiers 35 5 D6 Max RPD RPD Qualifiers 53 5 D6 p Results presemed on Mts 09e are In Me units indicated by the -Units' column except where an alternate unit is presented to Me right of the result. REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, Date: 06/17/2019 12:08 PM without the written consent of Pace Analytical Services, LLC. Page 8 of 13 I aceAnalytical e i' wwwlwcNees.mm Pace Analytical Services, LLC 9800 Kincey Ave. Suite 100 Huntersville, INC 28078 (704)875-9092 QUALIFIERS j'Project: storm water I Pace Project No.: 92432439 DEFINITIONS p 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. I TNTC - Too Numerous To Count I J - Estimated concentration above the adjusted method detection limit and below the adjusted reporting limit. MDL -Adjusted Method Detection Limit. ,I POL- Practical Ouantitation Limit. RL - Reporting Limit - The lowest concentration value that meets project requirements for quantitafive 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 4 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-Nitrosodiphehylamine 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 analyles. TNI - The NELAC Institute. LABORATORIES I, 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: 06/17/2019 12:08 PM without the written consent of Pace Analytical Services, LLC. Page 9 of 13 I aceAnalytical wwwpocela65.cam QUALITY CONTROL DATA CROSS REFERENCE TABLE Project: storm water Pace Project No.: 92432439 Paco Analytical Services, LLC 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 :1 Lab ID Sample ID QC Batch Method QC Batch Analytical Analytical Method Batch 92432439001 SDO #005 EPA 16648 480559 92432439001 SDO #005 EPA 200.7 Rev 4.4 1994 480722 EPA 200.7 Rev 4.4 1994 480773 92432439001 Ii SDO #005 SM 254OD-2011 481177 Date: 06/17/2019 12:08 PM REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, without the wnllen consent of Pace Analytical Services, -LC. Page 10 of 13 Document Name: Document Revised: February 7, 2018 v . aceMalytrcal a Sample Condition Upon Recei t SCUR Pa e 1 of 2 Document No.: Issuing Authority: F-CAR-CS-033-Rev.06 Pace Carolinas Quality Office Laboratory receiving samples: Asheville ❑ Eden❑ Greenwood ❑ Huntersville [/__� Raielgh❑ Mechanicsvillen Client Name: �I0: g2432439 �iit✓l�fsjlrlpvHFa,`-� Po4j I' D��I��0�� Courier: ❑Fed Ea ❑UPS ❑USPS Client �I VII� IUIII ❑ Commercial ❑Pace ❑Other:_ 92432439 Custody Seal Present? Dyes ONO Seals Intact? ❑Yes to jJ / / Date/Initials Person Examinin.rnn,..,.- Dh CA9 PackingMaterial: 4/V� []Bubble Wrap ubhle Bags oneC¢K❑ Other Biological ssue Frozen? Thermomete ❑Yes No ❑N/A IR Gun lo: 92TO48 Type of Ice: ❑wet ❑Blue ❑None Cooler Temp ('Cj: �, r Correction Factor: Add/Subtract ('C( 0.0 p (, j p.s� _ Temp should be above freezing to 6Y Cooler Temp Corrected C : ❑Samples out of temp criteria. Samples on ice, cooling process USDA Regulated Sol[ ( N/A, water sample( hasbegun Did samples origiyte in a quarantine zone within the United States: CA, NY, or SC (check maps)? Did samples originate from a foreign source Intern sionally, nyes 41 nnwmng nawanano vueno Nlcp)IIJYes ONO Comments/Dttcre anc : Chain of Custody Present?AOYe Yes ONO ❑N/A 1. Samples Arrived within Hold Time?Yes No ❑N/A ]. Short Hold Time Analysis e72 hr.l?Yes 6 N/A 3. Rush Turn Around Time Requested No ❑rv/A q, Suffldent Volume? No ❑N/A S. Correct Containers Used?s ❑No ❑N/A 6. -Pace Containers Used? No NA Containers Intact? yes No N 7. Dissolved analysis: Samples Field Filtered? ❑v s ONO N/A 8. Sample Labels Match COC? Yes ONO ❑N/A 9. - I ~/ .Includes Date/Time/ID/Analysis Matrix: Headspace in VOA Vials (o5.6mm)? OYes ❑ N/A 10. Trip Blank Present? ❑Yes UNO ❑N/ 11. Trip Blank Custody Seals Present?cly,N ONO MIJA COMMENTS/SAMPLE DISCREPANCY Field Data Required? Elves (—]No - Te4IP. Gb°�e 6.0'6 9A4 o + g� Lot ID of split Containers: `I CLIENT NOTIFICATION/RESOLUTION Person contacted: Date/Tlme: Project Manager SCURF Review; Project Manager SRF Review: Date: Date: Page 11 of 13 Document Name: Document Revised: February 7, 2018 aceAnalyticai r Sample Conditlpn U pon Recei t(SCUR) I 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. Exceptions: VOA, Collform, TOC, Oil and Grease, DRO/8015 (water) DOC, LLHS "Bottom half of box Is to list number of bottle Pro W'O# : 92432439 PM: PTE Due Date: 06/17/19 CLIENT: 92-KingsMtn b_ TF a a E V E 2 a J n v G m y N a a a j n 6 m ?? b 2 v J SV r2•, 6 m Z Z u n ` r ca m x u ON n a (L m x a o z of N z 6 m i ^J n '� N o ti e 6 m x a E .N., 6 m m 9 " 3 E i ° u .r .�. U• a v a E _ n x U' a z 2 u c of N m'ai q a " 9 °' .y ty a -- x E c N n 1J• a a_ a E E .�. V• a z x 0O > E $ > E C Y z ra O E a P V. > a M. >O E a a 01 V. O ii ? � Y a > i i d 5 Y > 2 m uE� N F i Z c.c. E 1m/1 N tL N — T z — E N m M a L M EuIs a E a a w o E ,X E N z i u t c a E P 7 O 1 2 3 a s 6 7 e 9 0 11 12 PH Adjustment Log for Preserved Samples Sample lD Type of Preservative pH upon receipt Date preservation adjusted Tlme precervatlon adjusted Amount of Preservative added Lotp .r,s .__._....... .......rr •••••••. �......,�=.an m ure norm larAana utnnn LertlricanGn On ice (i.e. Out of hold, incorrect preservative, out of temp, incorrect con[alners. Page 12 of 13 / / ceAnaly(ical" CHAIN -OF -CUSTODY / Analytical Request Document o The Cinirvgl-Custody 5 a LEGAL DOCUMENT. All rcknanl lirlds mull be <omfMelM nccumlely. 9 li Requlmd Client Worn»Iron. be tion B Section C , R ulred Plottel INamalan Invncr Inlrnmalbn', Page of Auenlmn: Stacy Barker co"'utul'. Kings Mountain International Rd n To. Melissa Bilotla ndtress 1755 South Battleground Ave. Cn To. Icooper@cecinc.com Cwmlany 14- IC Kin s Mountain International, Inc g Cleveland NC 28086 MbilDtla@km,,m, net REGULATORY AGENCY ndewas: - Ts -'To sbarker@kmilnc.net Pm time l- NPDES I GROUNDWATER I- DRINKING WATER Pfiaua 704-739-4227 Faa'. Paul Omer No: u,i No. rx�onar I n�Ien�u� UST (- RCRA f_ OTHER Storm Water FMe n al —la, 1 Taylor Ezell Site Location nxe i',0N, e. 3729-2 NC Requested Due Da@/IDT: Prot NumOer. STATE: Requested Analysis Filtered (YIN) Section D Valid It Code. - - � Reo.e.0 c.m,War�nnrr Myra. co " --COLLECTED Preservatives i u o ruroele w"s". to vm M SAMPLE ID - �_ IT rc N (A.Z.0.g/,) uurn w ¢ jl To Squalo IOs MUST BE UNIQUE 11s, r^ p tu a < a F- 9 I `� w VIAT 91-RM NM-1C7 m = ti u. M v o t a m a z�5 a - 1� o c h OZ U m ? u m qif' nn TE TIME DarE TIME x D >" = x Z Z i O o N _ PaceVrojett No.l Lab I.D. t - SOO u005 2 SDO R005 or G - 2•oa t x x 3 SOO #005 OT G a s 6 7 e 9 t0 11 t2 ADDITIONAL COMMENTS /FEYYQUIS ED PYI AFRUATION DATE TIME ACCEPTED BY/AFFILIATION DATE TIME SAMPLE CONDITIONS i,%ro �70 �[•3' A/ i SAMPLER NAME AND SIGNATURE •� u_ - j N = - m PRINT Name of SAMPLER: wl E SIGNATURE of SAMPLERo GATE Sipndd WOW (� 0 a fMM/DD/YY/: tj Aar e1 saroa lma la.n,o„e,a.xr:alMe F 'a Tao day mvmmm urrs..rerornml to lnm uw.m ar Les Fr+nwctm na e..,n.lr aoerya. _—. F-ALL-O-0-eurev.07. 1SFeF2007