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Home My WebLink AboutNCG030669_MONITORING INFO_20190711m�lu STORMWATER DIVISION CODING SHEET NCG PERMITS PERMIT NO. DOC TYPE ❑ HISTORICAL FILE L MONITORING REPORTS DOC DATE ❑ a v 0 9 0 7// YYYYM M D D STORMWATER DIVISION CODING SHEET NCG PERMITS PERMIT NO. DOC TYPE. ❑ HISTORICAL FILE ❑ MONITORING REPORTS DOC DATE ❑ YYYYM M DD Stormwater Discharge Monitoring Report for North Carolina Division of Energy, Mineral and Land Resources General Permit No. NCG030000 Date submitted CERTIFICATE OF COVERAGE NO. NCG03 0 6 6 9 FACILITY NAME fi G i L 1 T Y �— S COUNTY 86W.4M PERSON COLLECTING SAMPLES R01?e?7' F!E N5 E Y LABORATORY10A GE h/ 4ZY, iCf}/_ Lab Cert. # r OW 3T712 Comments on sample collection or analysis: DW 37706 Part A: Stormwater Benchmarks and Monitoring Results JUL 112019 ,ron� cll F.Ci SAMPLE COLLECTION YEAR Z O ! 9 SAMPLE PERIOD ?N Jan -June ❑ July -Dec or ❑ Monthly' (month) DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA WI.i OCEIVED ❑Otheflow [:]Watersupply ❑sA Lill LEASE REMEMBER TO SIGN ON PAGES 2 AND/OR 3 4 CElv7ftL FILES DUB SECTION n No discharge this period ?2 Outfall No. Date Sample Collected' (mo/dd/yr) 24-hour rainfall amount, Inches; DYVR SE Total Suspended Solids CTION 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/O 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 B 06 20 l9 0.63 < 2. 5 ""_94 7.20 0.0054°!9/ <,0050'71 <,0/0 Z o6 2o/!9 0..63 < 2.6 "'9/� 7.28 .0059'S'L<.o050 <.oi0n4ye-C <'¢.8 y/ Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall. 2 For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here. 'The total precipitation must be recorded using data from an on -site rain gauge. Unattended sites may be eligible for a waiver of the rain gauge requirement. See General Permit, Section B, Table 1 to identify 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: 11/1/2018-05/31/2021 SWU-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 maybe 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." MOON /z , Name (Print name) FICILITk 4lVdi MA1MrZ-A1At'CE IVAAAGE-i? Titl (Pri t title) Sign�ree 4 - bate 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. ❑ No discharge this period?Z Outfall No. Date Sample Collected' (mo/dd/yr) 24-hour rainfall amount, Inches3 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 C0530 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 AAND PART 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 ❑ NO ❑ IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO ❑ REGIONAL OFFICE CONTACT NAME: Mail an original copy of this DMR, including all "No Discharge" reports, within 30 days of receipt of the lab results (or at end 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 per onnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or those pers s d ectly r sponsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware tt at><I ere ar significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations." Signature of Permittee Permit Date: 11/1/2018-05/31/2021 SWU-245, last revised 11/1/2018 Page 3 of 3 laceAnalytical' ewwpacefabs.corn June 28, 2019 Robert Hensley Agility Fuel Systems 1010 Corporate Center Drive Salisbury, NC 28146 RE: Project: Stormwater Self Monitoring Pace Project No.: 92434305 Dear Robert Hensley: Pace Analytical Services, LLC 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 Enclosed are the analytical results for sample(s) received by the laboratory on June 25, 2019. The results relate only to the samples included in this report. Results reported herein conform to the most current, applicable TNIINELAC 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, 1lq — Tyriek Hooks tyriek.hooks@pacelabs.com (704)875-9092 Project Manager Enclosures 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 15 Wl s aceAnalytical a pacelaes.c Project: Stormwater Self Monitoring Pace Project No.: 92434305 Charlotte Certification IDs 9800 Kincey Ave. Ste 100, Huntersville, NC 28078 LouisianalNELAP Certification # LA170028 North Carolina Drinking Water Certification #: 37706 North Carolina Field Services Certification #: 5342 North Carolina Wastewater Certification #: 12 Asheville Certification IDs 2225 Riverside Drive, Asheville, NC 28804 Florida/NELAP Certification #: E87648 Massachusetts Certification #: M-NC030 North Carolina Drinking Water Certification #: 37712 CERTIFICATIONS South Carolina Certification #: 99006001 FloridalNELAP Certification #: E87627 Kentucky UST Certification #: 84 VirginiaNELAP Certification #: 460221 North Carolina Wastewater Certification #: 40 South Carolina Certification #: 99030001 YrginiaNELAP Certification #: 460222 REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, 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 2 of 15 \�� I aceAnalXical owwpscelabs.cam SAMPLE ANALYTE COUNT Project: Stormwater Self Monitoring Pace Project No.: 92434305 Pace Analytical Services, LLC 9800 Kincey Ave. Suite 100 Hunlersville, NC 28078 (704)878-9092 Lab ID Sample ID Method Analysts Analytes Reported Laboratory 92434305001 Outfall 1B Grab EPA 16648 JMS 1 PASI-C EPA 200.7 Rev 4.4 1994 SH1 3 PASI-A SM 2540D-2011 JP1 1 PASI-A 92434305002 Outfall 2 Grab EPA 1664E JMS 1 PASI-C EPA 200.7 Rev 4.4 1994 SH1 3 PASI-A SM 2540D-2011 JP1 1 PASI-A REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, without the written consent of Pace Analytical Services, LLC. Page 331'of-15 (�IaceAnalyftcal* w pacelebs.corn SUMMARY OF DETECTION Pace Analytical Services, LLC 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 Project: Stormwater Self Monitoring Pace Project No.: 92434305 Lab Sample ID Client Sample ID Method Parameters Result Units Report Limit Analyzed Qualifiers 92434305001 Outfall 1B Grab EPA 200.7 Rev 4.4 1994 Copper 5.4 ug/L 5.0 06/27/19 00:32 92434305002 Outfall 2 Grab EPA 200.7 Rev 4.4 1994 Copper 5.9 ug/L 5.0 06/27/19 00:42 REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, without the wntten consent of Pace Analytical Services, LLC. Page 4 of 15 Y V,P'o laceAnalyficalo w»wpecNaes.com ANALYTICAL RESULTS Pace Analytical Services, LLC 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 Project: Stormwater Self Monitoring Pace Project No.: 92434305 Sample: Outfall 1B Grab Lab ID: 92434305001 Collected: 06/20/19 18:00 Received: 06/25/19 10:00 Matrix: Water Parameters Results Units Report Limit DF Prepared Analyzed CAS No. Oual 1664 SGT-HEM, TPH Analytical Method: EPA 16648 Total Petroleum Hydrocarbons ND mg/L 4.8 1 06/28/19 07:00 200.7 MET ICP Analytical Method: EPA 200.7 Rev 4.4 1994 Preparation Method: EPA 200.7 Rev 4.4 1994 Copper 5.4 ug/L 5.0 1 06/26/19 00:01 06/27/19 00:32 7440-50-8 Lead ND ug/L 5.0 1 06/26/19 00:01 06/27/19 00:32 7439-92-1 Zinc ND ug/L 10.0 1 06/26/19 00:01 06/27/19 00:32 7440-66-6 2540D Total Suspended Solids Analytical Method: SM 254OD-2011 Total Suspended Solids ND mg/L 2.5 1 06/27/19 02:21 REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, Dale: 06/28/2019 07:23 PM without the wnnen consent of Pace Analytical Services, LLC. Page 5 of 15 V laceAnalytical' wwwpacelaba.com ANALYTICAL RESULTS Pace Analytical Services, LLC 9800 Kincey Ave. Suite 100 Huntersvilte, NC 28078 (704)875-9092 Project: Stonnwater Self Monitoring Pace Project No.: 92434305 Sample: Outfall 2 Grab Lab ID: 92434305002 Collected: 06/20/19 19:00 Received: 06/25/19 10:00 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 4.8 1 06/28/19 07:00 200.7 MET ICP Analytical Method: EPA 200.7 Rev 4.4 1994 Preparation Method: EPA 200.7 Rev 4.4 1994 Copper 5.9 ug/L 5.0 1 06/26/19 00:01 06/27/19 00:42 7440-50-8 Lead ND ug/L 5.0 1 06/26/1900:01 06/27/1900:42 7439-92-1 Zinc ND ug/L 10.0 1 06/26/1900:01 06/27/1900:42 7440-66-6 2540D Total Suspended Solids Analytical Method: SM 254OD-2011 Total Suspended Solids ND mg/L 2.5 1 06/27/19 02:22 REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, Dale: 06/28/2019 07:23 PM without the wnden consent of Pace Analytical Services, U.C. Page 6 of 15 0 aceAnalytical wwvpatdabbsomn Project: Slormwater Self Monitoring Pace Project No.: 92434305 QC Batch: 483776 OC Batch Method: EPA 1664B Associated Lab Samples: 92434305001, 92434305002 METHOD BLANK: 2614683 Associated Lab Samples: 92434305001, 92434305002 Parameter Units Total Petroleum Hydrocarbons mg/L QUALITY CONTROL DATA Analysis Method: EPA 1664B Analysis Description: 1664 SGT-HEM, TPH Matrix: Water Blank Reporting Result Limit Analyzed Qualifiers ND 4.8 06/28/19 06:50 Pace Analytical services, LLC 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 LABORATORY CONTROL SAMPLE: 2614684 Spike 1-CS 1-CS % Rec Parameter Units Conc. Result °% Rec Limits Qualifiers Total Petroleum Hydrocarbons mg/L 19.2 20.4 106 64-132 MATRIX SPIKE SAMPLE: 2614685 35477636003 Spike MS MS % Rec Parameter Units Result Conc. Result % Rec Limits Qualifiers Total Petroleum Hydrocarbons mg/L 4.81-1 19.2 21.2 110 64-132 Results presented on this page am In the units Indicated by the "UnIW column except where an alternate unit is presented to the right of the result. REPORT OF LABORATORY ANALYSIS This repast shall not be reproduced, except in full, Date: 06/28/2019 07:23 PM without the written consent of Pace Analytical Services, LLC. Page 7 of 15 VA 00 t, 0 (�IaceAnalytical w»wpecelaea.com QUALITY CONTROL DATA Project: Stormwater Self Monitoring Pace Project No.: 92434305 QC Balch: 483229 Analysis Method: EPA 200.7 Rev 4.4 1994 QC Balch Method: EPA 200.7 Rev 4.4 1994 Analysis Description: 200.7 MET Associated Lab Samples: 92434305001, 92434305002 METHOD BLANK: 2612067 Associated Lab Samples: 92434305001, 92434305002 Parameter Units Copper ug/L Lead ug/L Zinc ug/L Matrix: Water Blank Reporting Result Limit Analyzed ND 5.0 06/26/1923:23 NO 5.0 06/26/1923:23 NO 10.0 06126/1923:23 Qualifiers Pace Analytical Services, LLC 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 LABORATORY CONTROL SAMPLE: 2612068 Spike LCS 1-CS % Rae Parameter Units Cone. Result % Rae Limits Qualifiers Copper ug/L 500 496 99 85-115 Lead ug/L 500 470 94 85-115 Zinc ug/L 500 476 95 85-115 MATRIX SPIKE & MATRIX SPIKE DUPLICATE: 2612069 2612070 MS MSD 92434120001 Spike Spike MS MSD MS MSD %Rec Parameter Units Result Cone. Cone. Result Result %Rec %Rec Limits RPD Qual Copper ug/L 0.0097 500 500 527 507 103 100 70-130 4 mg/L Lead ug/L NO 500 500 495 483 99 97 70-130 2 Zinc ug/L ND 500 500 511 509 101 101 70-130 0 MATRIX SPIKE & MATRIX SPIKE DUPLICATE: 2612071 2612072 MS MSD 92434305001 Spike Spike MS MSD MS MSD % Rae Parameter Units Result Cone. Cone. Result Result %Rec %Rec Limits RPD Qual Copper ug/L 5.4 500 500 499 497 99 98 70-130 1 Lead ug/L ND 500 500 472 472 94 94 70-130 0 Zinc ug/L NO 500 500 497 492 98 97 70-130 1 Results presented on this page are In the unite Indicated by the "Units" column except where an ahemate unit Is presented to the right of the result. REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, Dale: 06/28/2019 07:23 PM without the written consent of Pace Analytical Services, U.C. Page 8 of 15 �A A (�Ia'ceAnalyticalo wwwpecelebs.com QUALITY CONTROL DATA Project: Slormwaler Self Monitoring Pace Project No.: 92434305 OC Batch: 483508 Analysis Method: SM 254OD-2011 QC Batch Method: SM 2540D-2011 Analysis Description: 2540D Total Suspended Solids Associated Lab Samples: 92434305001, 92434305002 METHOD BLANK: 2613258 Matrix: Water Associated Lab Samples: 92434305001, 92434305002 Blank Reporting Parameter Units Result Limit Analyzed Qualifiers Total Suspended Solids mg/L NO 2.5 06/27/19 02:15 Pace Analytical Services, LLC 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 LABORATORY CONTROL SAMPLE: 2613259 Spike LCS LCS % Rec Parameter Units Conc. Result %Rec Limits Qualifiers Total Suspended Solids mg/L 251 228 91 90-110 SAMPLE DUPLICATE: 2613263 92434143002 Dup Parameter Units Result Result RPD Qualifiers Total Suspended Solids mg/L 99.3 96.5 3 SAMPLE DUPLICATE: 2613271 92434056002 Dup Parameter Units Result Result RPD Qualifiers Total Suspended Solids mg/L 5.0 6.7 30 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: 06/28/2019 07:23 PM without the written consent of Pace Analytical Services, -I-C. Page 9 of 15 "ll;V' e0b11 laceAnalyficaI mrwpacelabs.= QUALIFIERS Project: Stormwater Self Monitoring Pace Project No.: 92434305 DEFINITIONS DF - Dilution Factor, if reported, represents the factor applied to the reported data due to dilution of the sample aliquot. NO - 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. MOL -Adjusted Method Detection Limit. Pace Analytical Services, LLC 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)975-9092 PQL - Practical Quantitation Limit. RL - Reporting Limit - The lowest concentration value that meets project requirements for quantitative data with known precision and bias for a specific analyle in a specific matrix. S - Surrogate 1,2-Diphenylhydrazine decomposes to and cannot be separated from Azobenzene using Method 8270. The result for each analyle is a combined concentration. Consistent with EPA guidelines, unrounded data are displayed and have been used to calculate % recovery and RPD values. LCS(D) - Laboratory Control Sample (Duplicate) MS(D) - Matrix Spike (Duplicate) DUP- Sample Duplicate RPD - Relative Percent Difference NC - Not Calculable. SG - Silica Gel - Clean -Up U - Indicates the compound was analyzed for, but not detected. Acid preservation may not be appropriate for 2 Chloroethylvinyl ether. A separate vial preserved to a pH of 4-5 is recommended in SW846 Chapter 4 for the analysis of Acrolein and Acrylonitrile by EPA Method 8260. N-Nitrosodiphenylamine decomposes and cannot be separated from Diphenylamine using Method 8270. The result reported for each analyte is a combined concentration. Pace Analytical is TNI accredited. Contact your Pace PM for the current list of accredited analytes. TNI - The NELAC Institute. LABORATORIES PASI-A Pace Analytical Services - Asheville PASI-C Pace Analytical Services - Charlotte ANALYTE QUALIFIERS 06 The precision between the sample and sample duplicate exceeded laboratory control limits. [arSCd[r:Yf'I:II'IaiFbY7iirl�Sl REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, without the wnften consent of Pace Analytical Services, LLC. Page 11,00 of 15 0 lace Analytical wnw.pacelass.com QUALITY CONTROL DATA CROSS REFERENCE TABLE Project: Storrrlwater Self Monitoring Pace Project No.: 92434305 Lab ID Sample ID QC Batch Method QC Batch 92434305001 Outfall 1 B Grab EPA 1664B 483776 92434305002 Outfall 2 Grab EPA 1664E 483776 92434305001 Outfall I Grab EPA 200.7 Rev 4.4 1994 483229 92434305002 Outfall2 Grab EPA 200.7 Rev 4.41994 483229 92434305001 Outfall 1B Grab SM 2540D-2011 483508 92434305002 Outfall 2 Grab SM 2540D-2011 483508 Date: 06/28/2019 07:23 PM REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, 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 Analytical Analytical Method Batch EPA 200.7 Rev 4.4 1994 483261 EPA 200.7 Rev 4.4 1994 483261 Page 11 of 15 )411,, Document Name: Document Revised: February 7, Pace 1 of 2. Document Laboratory receiving samples: Asheville ` Ederi Greenwood ❑ Client Name: _ c•+ Courier: WFed Ex ❑ Commercial ❑Pace nas Huntersville❑ ' Raleigh[] Mechanicsville[] WO# : 92434305 Project I� Client `II U Ii� II III II I I I I II III 92434305 ._ Custody seal Present? ❑Yes eo Seals intact? []Yes 60 Date/Initials Person Examining contents:_ . Packing Materiel: ❑Bubble Wrap B ON one Bags one ❑ Other Rlological Tissue Frozen? ❑ ❑Yag ❑No ZN/A Thermometer• 0n l) Type of Ice: )�5;`Jat []Blueuilone Gun ID: Cooler Tamp ('C): 6 ! Correction Factor: Add/Subtract IT) 0,6 Temp should be above freezing to 6'C' Cooler Temp Corrected VQ: ! []Samples out of temp atteria. Samples on Ice, cooling process his began USDA Regulated Soil (d N/A, water sample) Did samples originate Ina quarantine zone within the United States: CA, NY, or SC (check maps)? Did samples originate from a forelgesource (internationally, _.i,dn.e um.un and nueno Rlco171—IYes ❑No Yes []NO .... ..........."—_ Comments/ Discrepancy: Chain of Custod Present? Ycs ❑No ❑NIA 1. - Samples Arrived within Hold Time? Yes No NJn 2. Short Hold Time Anal sis <72hr.7 Fes No ❑N/A 3. Rush Turn Around Timo Requested? ❑Ycs No WA 4. Sufficient Volume? Yes No N/A 5. Correct Containers Used? Yes []No ❑N/A 6. -Pace Containers Used? Yes No ❑ff A Containers Intact? Y. ❑Nn NIA 7. Dissolved analysis: Samples FlcW Filtered? Yes No ❑NJA B. Sample Labels Match COC? PYOS ❑No ❑N/A a. -Includes Datc/Tlme/iD/Anal sis Matrix: Headspace in VDA Vials(>5_6mm)7 ❑Ycs ❑No NIA 10. Trip Blank Present? ❑Yes ❑No NIA 11. Trip Blank Custody Seals Present? Yes ONO N/A COMMENTS/SAMPLE DISCREPANCY Person contacted: Date/Time: Project Manager SCURF Review: --a .-- Project Manager SRF Review: J Field Data Required? UYes yNo Date: L124 Date: 60r1 Page 12 of 15 0 Document Name: Document Revised: February 7, 2018 /aceAiiah lCal Sample Condition Upon Recelpt(SOUR) Page 1 of 2 Document No,: Issuing Authority: p-CAR-CS-033-Rov.06 Pace Carolinas Quality Office `Check mark top half of box If pH and/or dechlorination is Project I WO# • 92434305 verified and within the acceptance range for preservation PM: TIN Due Date: 07/02/19 ---.-samples.--...__.__..._ ... ......................... CLIENT: 92—Agility F Exceptions: VDA, Coliform, TOC, OII aM Grease, ORD/8015 (water) DOC, "Bottom half of box Is to list number of bottle a V Z N V V V O U L7 V O v m O = 2 Z N Z 'ni V v a D 2 a a z tl ¢ Z N m a g ? a m m y z a a Z 2 u o n ` u 2 u rn, o ¢ n .'`� q v 9 u u v w z a D o i a m « o u 'A E u ry E at n ._ y g E 'is 's E .N A E 5 q �S °rs E v x u p EA R iu aF J E ,� d m a E z a > E a > E a > E vni 3 3vi n vt n EEEE `t ,ii E E n o 8E > a a vE1 `so uo� pE o vEf f$ pE fn c8 m m m m m m allm 3 a. a a a a a c > > a. > > m a S o 2 I 1 4 5 6 7 6 0 — — 10 11 12 pH Adjustment Log for Preserved Samples Sample lD Type of Preservative pH upon ramlpt Data preservation adjusted Time preservation adjusted Amount oflresarvative added Lot a Note; Whenever there Is a discrepancy affecting North Carolina compliance samples, a copy of tills form Will be sent to the North Carolina DEHNR Certification Office (i.e. Out ct hold, Incorrect mesurvativn, out of temp, Incorrect containers. Page 13 of 15 ��gtr1 i CHAIN -OF -CUSTODY 1 Analytical Request Document The Cheir f-Custody is a LEGAL DOCUMENT. All relevant fields must De completed accurately) Sectien A Sadlon 6 BecSon C _... RequuaE MM lldomutian: Rry r,d F 1N%ormahon Imoi« NRarmaaan: FJ ge : 1 Of �' Co:nPa A .liry Fuel Sysle:ns Repm To; Bob Hensley AacM= AaGeSa: lolo Corjq Cenuv Dive: G°P1 Ta: Ennpany [L-rrc: $2Fstvlty, NC I614fi 'f, F S YD P-7 Pare Prgeq j}anamr. a-ueaCaiolr?ipacelaCs.mm, - 1`tr.:...: +5fala-;iatadon _i._ �:^ Ragx Due Dare: P,*d %: A F Pam Nofue%: P161-1 NC cIX'£ 3 o COLLECTED NArnx SAMPLE ID pva4 a o START One Character Per Cox.. yM wa .. k -ru; a eSample Les mustM urn9ue TUK is a cis ti DATE TIME DATE TWE z o z' z` o v r 0 c ;x ` o(S?SALL 2 GR40 + 6 0% r9: 3 ✓ l,'c%?i _g i i '�`12 �? ups £/1C01iN]M1AL.QNNfAA15 i Nt - _ PAFIJNOU6NFD �;3_� fly/hf)L}AT10N v Y\".]L2 .�._. fr.Il ...,... E ..aa ....zcAi3_ U_ T.fKEPTLTl31Y �_..v'..=e.Y+u I4FFIlJlrT10N v-....-+cam.' �� i.'s 11ATi" ..... F: st�uca..i TIME- _ wi:_.>.✓ --".�gMCCNOTOtF' .,..>_ K'�y h},�.t :.?T;:v_.__ . .-. _.w n��1 �-'::�..>:�.r. ry+q. _.. AAiPLERIV✓AE.NNOSIGNATURE ..' '� 4 '.E-"'.. `s'itr ^�,�-5_ ,.- _.p_ .`F.�' _.__ .. PRAT Name o1 SAMPLER: v !% R! /-�EN5ZE d 61GNATUFE of 6ApPLER: DLT=6i5nm: q - " e y = - � � y � j m N s