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Home My WebLink AboutNCG030664_MONITORING INFO_20191028Southwire October 23, 2019 Division of Water Quality Attn: DWQ Central Files 1617 Mail Service Center Raleigh, North Carolina 27699-1617 Permit No: NCG030000 Certificate of Coverage: NCG030664 Southwire 12331 Commerce Station Drive Huntersville, NC 28078 Dear Sir/Madam: RECEivFn OCT 2 8 2olg CENTRAL FILES DWR SECTION Enclosed is the Semi -Annual Stormwater Discharge Monitoring Report and associated analytical results for the Southwire Facility. This report covers required sampling for 2019 July — December Semi -Annual. Should you have any questions, please contact me at 704-379-9621 or jamie.mcgrath(a southwire.com. Thank you. Regards, Jamie McGrath EHS Manager Southwire I Huntersville Stormwater Discharge Monitoring Report for North Carolina Division of Energy, Mineral and Land Resources General Permit No. Date submitted 10/23/2019 CERTIFICATE OF COVERAGE NO. N0003 0 6 6 4 FACILITY NAME Southwire COUNTY Mecklenburg PERSON COLLECTING SAMPLES Jamie McGrath LABORATORY Pace Labs Lab Cert. # 12 Comments on sample collection or analysis: Part A: Stormwater Benchmarks and Monitoring Results SAMPLE COLLECTION YEAR tote SAMPLE PERIOD ❑ Jan -June Q July -Dec or ❑ Monthly' (month) DISCHARGING TO CLASS ❑ORW ❑HQW []Trout ❑PNA []Zero -flow ❑Water Supply ❑SA ❑Other C-Waterbody PLEASE REMEMBER TO SIGN ON PAGES 2 AND/OR 3 4 ❑ No discharge this period?' Outfall No. Date Sample Collected' (mo/dd/yr) 29-hour rainfall amount, Inches' Total Suspended Solids pH, Standard units Total Copper Total Lead Total Zinc Non -Polar O&G/ Total Petroleum Hydrocarbons Total Toxic Organics' Benchmarks - - 100 mg/L or 50 mg/L4 6.0 — 9.0 0.010 mg/L 0.075 mg/L 0.126 mg/L 15 mg/L 1 mg/L Parameter Code - 46529 C0530 00400 01119 01051 01094 00552 78141 ROS Outfall #2 10/16/2019 0.44 1.2 mg/L 7.3 <0.0050 mg/L <0.0050 mg/L <0.010 mg/L <5 mg/L N/A ' Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall. ' 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. 4 See General Permit, Section B, Table 1 to identify the especially sensitive receiving water classifications where the more protective benchmark applies. ' 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: 11/1/2018-05/31/2021 SWIJ-245, last revised 11/1/2018 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." Jamie McGrath Name (Print name) EHS Manager Title (Print title) SienAure 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 mR/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 discharge this period?2 Outfall No. Date Sample Collected' (mo/dd/yr) 24-hour rainfall amount, Inches' New Motor Oil or Hydraulic Oil Usage Non -Polar O&G/ Total Petroleum Hydrocarbons Total Suspended Solids Benchmarks - - - 15 mg/L 100 mg/L or 50 mg/L4 Parameter Code - 46529 NCOIL 00552 CO530 Footnotes from Part A also apply to 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. Permit Date: 11/1/2018-05/31/2021 SWU-245, last revised 11/1/2018 Page 2 of 3 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 Q NO ❑ REGIONAL OFFICE CONTACT NAME: James More (704) 235-213s Mail on original 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." Permittee /0 Z3 ZO/ Date Permit Date: 11/1/2018-05/31/2021 SWU-245, last revised 11/1/2018 Page 3 of 3 aceAnalytical l� www.pacelabs.Com 'l. October 22, 2019 Jamie McGrath Southwire 12331 Commerce Station Dr Huntersville, NC 28078 I I it RE: Project: 2019 Semi -Annual Pace Project No.: 92449794 Pace Ana lyticaI Services, LLC 205 East Meadow Road - Suite A Eden, NC 27288 (336)623-8921 Dear Jamie McGrath: Enclosed are the analytical results for sample(s) received by the laboratory on October 16, 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. n If you have any questions concerning this report, please feel free to contact me. I' I Sincerely, Taylor Ezell taylor.ezell@pacelabs.com (704)875-9092 Project Manager Enclosures Q NCCRf6 NI Y <4B0�1A10�"// Ill 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 aceAnalytical www.pacelabs.cwn I' I I Project: 2019 Semi -Annual Pace Project No.: 92449794 CERTIFICATIONS Pace Analytical Services, LLC 205 East Meadow Road - Suite A Eden, NC 27288 (336)623-8921 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 UrginiaNELAP 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 VirginiaNELAP Certification #: 460222 North Carolina Drinking Water Certification #: 37712 q REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in lull, without me written consent of Pace Analytical Services, LLC. Page 2 of l l I aceAnalytical wivwpacelabs.com ,I SAMPLE ANALYTE COUNT Project: 2019 Semi -Annual Pace Project No.: 92449794 Pace Analytical Services, LLC 205 East Meadow Road - Suite A Eden, NC 27288 (336)623-8921 it Lab ID Sample ID Method Analysts Analytes Reported Laboratory 92449794001 ROS Outfall #2 EPA 1664E HH 1 PASI-C EPA 200.7 Rev 4.4 1994 DS 3 PASI-A SM 254OD-2011 MJP 1 PASI-A 9 EPA 9040C ECH 1 PASI-A REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, 1, without the written consent of Pace Analytical Services, LLC. it I, Page 3 of 11 Pace Analytical Services, LLC ace Analytical ® 205 East Meadow Road -Suite A Eden, NC 27288 xwwpacelabscan (336)623-8921 ANALYTICAL RESULTS Project: 2019 Semi -Annual Pace Project No.: 92449794 Sample: ROS Outfall #2 Lab ID: 92449794001 Collected: 10/16/19 07:47 Received: 10/16/19 10:14 Matrix: Water Parameters II Results Units Report Limit DF Prepared Analyzed CAS No. Oual HEM, Oil and Grease Analytical Method: EPA 1664E li Oil and Grease NO mg/L 4.8 1 10/18/19 18:33 200.7 MET ICP Analytical Method: EPA 200.7 Rev 4.4 1994 Preparation Method: EPA 200.7 Rev 4.4 1994 Copper ND mg/L 0.0050 1 10/17/192215 10/19/192022 7440-50-8 Lead NO mg/L 0.0050 1 10/17/19 22:15 10/19/19 20:22 7439-92-1 Zinc ND mg/L 0.010 1 10/17/19 22:15 10/19/19 20:22 7440-66-6 2540D TSS, Low -Level Analytical Method: SM 254OD-2011 I, Total Suspended Solids 1.2 mg/L 1.0 1 10/19/19 06:23 I'. 9040 pH Analytical Method: EPA 9040C pH at 25 Degrees C i� i 7.3 Sod. Units 0.10 1 10/21/19 16:25 H3 I it II �I I I �I 11 REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, Date: 10/22/2019 02:56 PM without the wntien consent of Pace Analytical Services, LLC. Page 4 of 11 i aceAnalytical sxwpecelabs.cwn QUALITY CONTROL DATA � Project: 2019 Semi -Annual Pace Project No.: 92449794 ! QC Balch: 504574 Analysis Method: EPA 1664B I' OC Batch Method: EPA 1664E Analysis Description: 1664 HEM, Oil and Grease I I Associated Lab Samples: 92449794001 METHOD BLANK: 2711750 Associated Lab Samples: 92449794001 '.i Parameter Units !I Oil and Grease mg/L LABORATORY CONTROL SAMPLE: 2711751 'I. Parameter Units ' Oil and Grease mg/L Pace Analytical Services, LLC 205 East Meadow Road - Suite A Eden, NC 27288 (336)623-8921 Matrix: Water Blank Reporting Result Limit Analyzed Qualifiers NO 5.0 10/18/1918:28 Spike LCS LCS % Rec Conc. Result %Rec Limits Qualifiers 40 36.0 90 78-114 MATRIX SPIKE SAMPLE: 2711752 I 92449509001 Spike MS MS %Rec Parameter Units Result Conc. Result % Rec Limits Qualifiers Oil and Grease mg/L 47.2 88.9 43.6 -4 78-114 M7 Results presented on this page are In the units Indicated by Me 'Units' column except where an altemate unit is presentee to Me right of the result I Date: 10/22/2019 02:56 PM REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, without the written consent of Pace Analytical Services, LLC, Page 5 of 11 II aceAnalytical wwwpzcelabs.com QUALITY CONTROL DATA Project: 2019 Semi -Annual Pace Project No.: 92449794 OC Batch: 504348 Analysis Method: EPA 200.7 Rev 4.4 1994 �IQC Batch Method: EPA 200.7 Rev 4.4 1994 Analysis Description: 200.7 MET Associated Lab Samples: 92449794001 Associated Lab Samples: 92449794001 �i Parameter Units Copper mg/L I Lead mg/L Zinc mg/L Matrix: Water Blank Result LABORATORY CONTROL SAMPLE: 2710598 Spike Parameter Units Cone. ' Copper mg/L 0.5 Lead mg/L 0.5 I� Zinc I mg/L 0.5 ND NO NO Pace Analytical Services, LLC 205 East Meadow Road - Suite A Eden, NC 27288 (336)623-8921 Reporting Limit Analyzed Qualifiers 0.0050 10/19/19 1955 0.0050 10/19/19 19:55 0.010 10119/1919:55 LCS LCS % Rec Result % Rec Limits Qualifiers 0.48 96 85-115 0.47 94 85-115 0.46 93 85-115 MATRIX SPIKE 8 MATRIX SPIKE DUPLICATE: 2710599 2710600 MS MSD 92449710001 Spike Spike MS MSD MS MSD %Rec L Parameter Units Result Cone. Cone. Result Result %Rec e/ Rec Limits RPD Qual Copper mg/L 76.3 0.5 0.5 0.58 0.59 100 102 70-130 2 I ug/L Lead mg/L 11.8 0.5 0.5 0.48 0.49 94 96 70-130 2 ug/L Zinc mg/L 196 0.5 0.5 0.67 0.68 94 98 70-130 2 1 ug/L MATRIX SPIKE 8 MATRIX SPIKE DUPLICATE: 2710601 2710602 MS MSD �I 92449873001 Spike Spike MS MSD MS MSD %Rec Parameter Units Result Conc. Cone. Result Result %Rec e/ Rec Limits RPD Dust Copper mg/L 39.4 0.5 0.5 0.51 0.52 95 96 70-130 1 ug/L Lead mg/L NO 0.5 0.5 0.47 0.47 93 93 70-130 0 I'Zinc mg/L 38.5 0.5 0.5 0.51 0.51 94 95 70-130 1 ug/L i Results presented on Nis page are In Me units indicated by Me 'Units' column except where an alternate unit is presented to Me right of Me result Date: 10/22/2019 02:56 PM REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, without the wnften consent of Pape Analytical Services, I.I.C. Page 6 of 11 ii ii Pace Analytical Services, LLC o aceAnalytical 205 East Meadow Road - Suite A Eden, NC 27288 wwwPa.1abs.com (336)623-8921 I QUALITY CONTROL DATA Project: 2019 Semi -Annual Pace Project No.: 92449794 Ij QC Batch: 504603 Analysis Method: SM 2540D-2011 �I OC Balch Method: SM 2540D-2011 Analysis Description: 2540D Total Suspended Solids Associated Lab Samples: 92449794001 ,I METHOD BLANK: 2711853 Matrix: Water Associated Lab Samples: 92449794001 Blank Reporting Parameter Units Result Limit Analyzed Qualifiers ICI Total Suspended Solids mg/L NO 1.0 10/19/19 06:21 LABORATORY CONTROL SAMPLE: 2711854 Spike LCS LCS % Rec I. Parameter Units Conc. Result %Rec Limits Qualifiers 'r Total Suspended Solids • mglL 250 248 99 90-110 SAMPLE DUPLICATE: 2711867 �. 92449852001 Dup Parameter •, Units Result Result RPD Qualifiers Total Suspended Solids I' mg/L 185 207 11 D6 '.� SAMPLE DUPLICATE: 2711868 92449986001 Dup Parameter Units Result Result RPD Qualifiers Total Suspended Solids I! III �I mg/L 1330 1340 1 Results presented on Mis page are In Me units Indicated by the -Unlbi columm except where an altemate unit is presented to the right of Me result. I REPORT OF LABORATORY ANALYSIS I� This report shall not be reproduced, except in full, Date: 10/22/2019 02:56 PM without the written consent of Pace Analytical Services, L-C. Page 7 of 11 aceAnalytical® I' I' xwwparelaEs.ipm i, I Project: 2019 Semi -Annual III. Pace Project No.: 92449794 j QC Batch: 504652 QC Batch Method: EPA 9040C Associated Lab Samples: 92449794001 QUALITY CONTROL DATA Analysis Method: EPA 9040C Analysis Description: 9040 pH SAMPLE DUPLICATE: 2711977 1' 92449480001 Dup Parameter Units Result Result pH at 25 Degrees C Std. Units 7.0 6.8 i SAMPLE DUPLICATE: 2712321 Parameter pH at 25 Degrees C I 92449465002 Cup Units Result Result Std. Units 7.0 6.9 RPD Qualifiers 2 D6,H3 RPD Qualifiers 1 H3 Pace Analytical Services, LLC 205 East Meadow Road - Suite A Eden, NC 27288 (336)623-8921 Results presented on this page are in Me unite Indicated by Me'Un]W' column except where an alternate unit Is presented to the right of Me result. REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, Date: 10/22/2019 02:56 PM without the wntten consent of Pace Analytical Services, I.I.C. p Page 8 of 11 I aceAnalytical www.perelaba.cam QUALIFIERS Project: 2019 Semi -Annual Pace Project No.: 92449794 DEFINITIONS Pace Analytical Services, LLC 205 East Meadow Road - Suite A Eden, NC 27288 (336)623-8921 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. 'i MDL -Adjusted Method Detection Limit. ,I POL- Practical Quantitation Limit. RL - Reporting Limit - The lowest concentration value that meets project requirements for quantitative data with known precision and bias for a specific analyte in a specific matrix. S - Surrogate 1,2-Diphenylhydrazine decomposes to and cannot be separated from Azobenzene using Method 8270. The result for each analyte is a combined concentration. I; 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 P 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 II Method 8260. li 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. I LABORATORIES 'i PASI-A Pace Analytical Services -Asheville II PASI-C Pace Analytical Services - Charlotte I' i' ANALYTE QUALIFIERS i D6 The precision between the sample and sample duplicate exceeded laboratory control limits. H3 Sample was received or analysis requested beyond the recognized method holding time. Ml Matrix spike recovery exceeded QC limits. Batch accepted based on laboratory control sample (LCS) recovery. REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, Dale: 10/22/2019 02:56 PM without the wntten consent of Pace Analytical Services, LLC. Page 9 of 11 I aceAnalytical a www.parelebs.com I II QUALITY CONTROL DATA CROSS REFERENCE TABLE li Project: 2019 Semi -Annual Pace Project No.: 92449794 Pace Analytical Services, LLC 205 East Meadow Road - Suite A Eden, NC 27288 (336)623.8921 i '. Lab ID Sample ID QC Batch Method QC Batch Analytical Analytical Method Batch � 92449794001 ROS Outfall #2 EPA 1664B 504574 92449794001 ROS Outfall #2 EPA 200.7 Rev 4.4 1994 504348 EPA 200.7 Rev 4.4 1994 504398 92449794001 i ROS Outfall #2 SM 254OD-2011 504603 92449794001 ROS Outfall 02 EPA 9040C 504652 REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, Dale: 10/22/2019 02:56 PM without the written consent of Pace Analytical Services, LLC. Page 10 of 11 Gill '" CHAIN -OF -CUSTODY Analytical Request Document Pace Analytical' f-Custody is il LEGAL DOCUMENT- Complete all relevefields Chain -of -Custody LAB USE ONLY -Affix Workorder/lo ' 10# : 9�44y (y4 MT,L W ALL SHADED ARI IIIII� I RE I I�IIII �II Container Preservative Tyu•• 92449794 CumBilling Information: a�tjee 1233i lvrnmr J1arm pe" l WI;i(16$/tl(L1I�C ZVb u a It 7 "E C y/Il Report To:. C /� ,� / Gt Email To: i /q At' I' ie. ,i," '• Pie 16) meth.nol ICI a xrv.five nionivm T,Gies:11)n...I, PI sodium hydio,ide, arid, ei,odmv. lo) TSP. l2),Ulfurm.,imsl,(3) Nn,odium INl unprLsvmtd, mio,ull.m, lot Ilymurhlodr (9) Amer ne..n.. arm, (-N rdiurn Iwi lde, t5)tinr........ IAI .»romir aria. NN. num.1 m smlme. _ Lab Profile/Line: COPY To: "� `! v / /%l 5¢g{yle 'on nfo/Add. s:. lL9J Analyses Customer Project Nd a/N�u/mber �1 2V/ r- /,V1 �),,u l .1 ACC State: COUPIY/City; Time Zone Collected: C I�CG l?bi! / I IPTI IRAT I ICT I/C T t \ - Lab Sample Receipt Checklist: Custody 59e1y F'[esenr/In WC. Y N'.1A� Custody Signatures Present Y it Cohan ror Signature Present ( N NA Uoli les intact LrY N NT Correct Bottles UN De Sufficient volume `..YJ 11 NA samples Received on ice 14 UA 'VOA - Ileadspace Acceptable Le Y 11 qlp USDA Regulated soils Y 11 VA Samples in Holding Time iy'N 11-11am�y1. Residual chlorine Present Y N Nwj Cl strips: Sample pitAcceP[able gun NA Ph aee ips: Sulfide Present Y R PA Lend Acetate strips: I.AB USE ONLY: I.Ab Sample p / Co ments: G IL �L'� Phone: vy 57y &' Email' �tlN 1 Site/Facility ID ft - Co lance Monitoring? I Yes INo I Col>icureq By(prin): / oaq Purchase Order A: Quote p: DW PWS ID II: DW Location Code: Collected By Isigna re):. gZ Turnaround Date Required: Imme iately Packedon Ice: I es I INo Disposal: 7M,, I.,u,m pppmpriate I I Return I )AU,Nve: I ]Hold. Rush: I I Same Day I I Next Day I I?DAY I I30aY 114 DaY BDaY 1 Expedite Charges .Apply) Field Filtered (if applicable): I I Yes I INo Analysis: •Matrix Codes (insert in Matrix box below): Drinking Water (OW), Ground Water(GW), Wastewater( WW), Product (P), Soil/Solid (5Q, Oil (OL), Wipe (WP), Air (AR), Tissue ITS), Bioassay (B). Vapor IV), Other (OTI Customer Sample ID Matrix Comp/ Grab Collected (or Composite Start) Composite End Res Cl 4of Clns Date lime Date I Time p.S 1 z (o lb / 1: y5 to Ib W 41 rA _ Customer Remarks/ Special Conditions/ Possible Hazards: Type of Ice Used: Wet) Blue Dry None SHORT HOLDS FRESENT(02 hours): Y (N") N/A Lab Sample Temperature Info: Temp Blank Itec e1' Y V NA Therm IDN ', V I 'a n -' Cooler !Tem U on Recci H r � 1 PC Cooler I Therm Corr. Factor: U PC Cooler 1 Corrected Temp:' a __ � oC Comments: Packing Material Used: L Y1()1iZ Lab Tracking N: 2418229 Radchem sample(s) screened (<$DD cpml: V N NA Samples received via: 1 ' FEDE% UPS Client) Courier Pace Courier linquished by/C mpanV: Signature) Date1Time: Re/1ce��iwed bV/Compa//n��y: ISignalurBl LV'� v Date/Tune: MTIL LAB USE ONLY Table 4 Acclnum: Acctnu: Rel r; uished by/Comp: y: (5lgnature) m Dam/Time: Received by/Company: (Signature) Dale/Time: Template: P Prelogin: Trip Blank Receive,]: Y (N) NA HCL McOH TSP Other ReliwDished by/Company:(Signature) Dale/Timc: Received by/CUmpany:(Signatme) Date/Time: PM: PB: Non Canforma¢els): YES / bjo0 PAgc:__ oC