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Home My WebLink AboutNCG030669_MONITORING INFO_20200107M I /9 STORMWATER DIVISION CODING SHEET NCG PERMITS PERMIT NO. c- G DOC TYPE ❑ HISTORICAL FILE CX MONITORING REPORTS DOC DATE ❑ o` 1 10 -7 YYYYM M D D Stormwater Discharge Monitoring Report for North Carolina Division of Energy, Mineral and Land Resources General Permit No. NCG030000 Date submitted O 1- 02-- 2 (2>2-CD CERTIFICATE OF COVERAGE NO. NCG03 0 G G 9 FACILITY NAME A G iL l r y (-- S COUNTY /ZoWA/V PERSON COLLECTING SAMPLES t?09E-/?7 NEW 51- C y LABORATORY r0/1 C F A/V& Y'7 / CAL Lab Cert. N /yC I)W 37711 Comments on sample collection or analysis: OW 3,77o 6 Part A: Stormwater Benchmarks and Monitoring Results SAMPLE COLLECTION YEAR 20 / `7 SAMPLE PERIOD ❑ Jan -June July -Dec or ❑ Monthly' (month) DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA WW XE40 []Zero -flow ❑Water Supply ❑SA WvY !,2• Other HEOF �N/F JAN 0 7 2020 PLEASE REMEMBER TO SIGN ON PAGES 2 AND/OR 3,. --> r. f74V i S'G710;1 n No discharge this period?z Outfall No. Date Sample Collected' (mo/dd/yr) 24-hour rainfall amount, Inches3 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/O 6.0 - 9.0 0.010 mg/L 0.075 mg/L 0.126 mg/L 15 mg/L 1 in Parameter Code - 46529 C0530 00400 01119 01051 01094 00552 78141 %j /Z//o /i9 4.42 < 2. 5 < '4 2 i2ho�/9 o.4-2 < 2,5 "J/f -7.22 < 4,8 "VK. ' 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. '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. ' 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 1of3 `- - -- --- - -- - - - - - - -- - - :. 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. 1 further certify that this facility is implementing the all the provisions of the solvent management plan included in the Stormwater Pollution Prevention Plan." /3R'(AtV IVIEWI-101?7- Name (Print name) �Il?CC7-0/7 Of oPE1?47,/O/Y$ Title (Print title) Signature Catek 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/L" 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/l/2018-05/31/2021 _ _ _ SWU-245, last revised 11/1/2018 - - — - ---- - - --_ —- _ - - - - Page 2of3 FOR PART AND 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 oriainal copy of this DMR, including all 'No Discharae" 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." Signature -�,6 Date Permit Date: 11/1/2018-05/31/2021 " _ SWU-245,.lastrevised 11/1/2018 - Page 3 of 3 laceAnalyficalo w .pacNaas.cum December 20, 2019 Robert Hensley Agility Fuel Systems 1010 Corporate Center Drive Salisbury, NC 28146 RE: Project: Stormwater Testing Pace Project No.: 92457361 Pace Analytical Services, LLC 9800 Kincey Ave. Suite too Huntersville, NC 28078 (704)875-9092 Dear Robert Hensley: Enclosed are the analytical results for sample(s) received by the laboratory on December 13, 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, Tyriek Hooks tyriek.hooks@pacelabs.com (704)875-9092 Project Manager Enclosures PCCNp01 2 ��O TNI REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, without the written wnsent of Pace Analytical Services, LLC. Page i of 13 aceAnalytical wtaia.Daceabs.cam Project:, Slormwater Testing Pace Project No.: 92457361 Pace Analytical Services Charlotte 9800 Kincey Ave. Ste 100, Huntersville, NC 28078 Louisiana/NELAP Certification # LA170028 North Carolina Drinking Water Certification #: 37706 North Carolina Field Services Certification #: 5342 North Carolina Wastewater Certification #: 12 [Pace Analytical Services Asheville CERTIFICATIONS South Carolina Certification #: 99006001 Flodda/NELAP Certification #: E87627 Kentucky UST Certification #: 84 VirginiaNELAP Certification #: 460221 Pace Analytical Services, LLC 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 2225 Riverside Drive, Asheville, NC 28804 North Carolina Wastewater Certification #: 40 Florida/NELAP Certification #: E87648 South Carolina Certification #: 99030001 Massachusetts Certification #: M-NC030 1ArginiaNELAP Certification #: 460222 North Carolina Drinking Water Certification #: 37712 REPORT OF LABORATORY ANALYSIS This report shell not be reproduced, except in full, without the written consent of Pace Analytical Services, L.I.C. Page 2 of 13 aceAnalytical e rsa.bacalabs.com SAMPLE ANALYTE COUNT Pace Analytical Services, LLC 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 Project: Pace Project No.: Stormwater Testing 92457361 Analytes Lab ID Sample ID Method . Analysts Reported Laboratory 92457361001 OUTFALL 1B GRAB EPA 1664B HH 1 PASI-C EPA 200.7 Rev 4.4 1994 SH1 3 PASI-A SM 25400-2011 EWS 1 PASI-A '1 92457361002 OUTFALL 2 GRAB EPA 1664E HH 1 PASI-C EPA 200.7 Rev 4.41994 SHi 3 PASI-A I' • SM 254OD-2011 EWS 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 3 of 13 Pace Analytical Services, LLC 55?eAnalyticalo 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 w".paulabs.[sm (704)878-9092 ANALYTICAL RESULTS Project: Slormwaler Testing Pace Project No.: 92457361 Sample: OUTFALL lB GRAB Lab ID: 92457361001 Collected: 12/1011 9 16:10 Received: 12113/19 10:35 Matrix: Water Parameters Results Units Report Limit DF Prepared Analyzed CAS No. Qual �1664 SGT-HEM, TPH Analytical Method: EPA 1664E Total Petroleum Hydrocarbons ND mg/L 4.8 1 12/20/19 07:41 200.7 MET ICP Analytical Method: EPA 200.7 Rev 4.4 1994 Preparation Method: EPA 200.7 Rev 4.4 1994 Copper ND ug/L 5.0 1 12/17/1902:24 12/17/1920:36 7440-50-8 Lead ND ug/L 5.0 1 12117/1902:24 12/1711920:36 7439-92-1 .Zinc ND ug/L 10.0 1 12/17/19 02:24 12/17/19 20:36 7440-66-6 2540D Total Suspended Solids Analytical Method: SM 254OD-2011 Total Suspended Solids ND mg/L 2.5 1 12/17/1913:44 REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, Date: 12/20/2019 02:20 PM without the written consent of Pace Analytical Services, LLC. Page 4 of 13 aceAnalytical ww.pNdaUs.com ANALYTICAL RESULTS Pace Analytical Services, LLC 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 Project: Stormwater Testing Pace Project No.: 92457361 '.Sample: OUTFALL 2 GRAB Lab ID: 92457361002 Collected: 12/10/19 17:00 Received: 12/13/19 1035 Matrix: Water Parameters Results Units Report Limit OF Prepared Analyzed CAS No. Oual 1664 SGT-HEM, TPH Analytical Method: EPA 1664B Total Petroleum Hydrocarbons NO mg/L 4.8 1 12/20/19 07:41 200.7 MET ICP Analytical Method: EPA 200.7 Rev 4.4 1994 Preparation Method: EPA 200.7 Rev 4.4 1994 'Copper NO ug/L 5.0 1 12/17/1902:24 12/17/1920:45 7440-50-8 Lead NO ug/L 5.0 1 12/17/1902:24 1211711920:45 7439-92-1 Zinc NO ug/L 10.0 1 1211711902:24 12/17/1920:45 7440-66-6 2540D Total Suspended Solids Analytical Method: SM 254OD-2011 Total Suspended Solids NO mg/L 2.5 1 12117/1913:44 REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, Dale: 12/20/2019 02:20 PM without the written consent of Pace Analytical Services, LLC. Page 5 of 13 (55?eAnalyficalv watw.patalaba.com QUALITY CONTROL DATA Project: Stormwater Testing Pace Project No.: 92457361 QC Batch: 515960 Analysis Method: EPA 1664B QC Balch Method: EPA 1664E Analysis Description: 1664 SGT-HEM, TPH Associated Lab Samples: 92457361001, 92457361002 METHOD BLANK: 2764713 Matrix: Water Associated Lab Samples: 92457361001, 92457361002 Blank Reporting Parameter Units Result Limit Analyzed Qualifiers Total Petroleum Hydrocarbons mg/L ND 5.0 12/20/19 07:37 .LABORATORY CONTROL SAMPLE: 2764714 Pace Analytical Services, LLC 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 n Spike LCS LCS % Rec Parameter Units Conc. Result %Rec Limits Qualifiers Total Petroleum Hydrocarbons mg/L 19.2 18.3 95 64-132 MATRIX SPIKE SAMPLE: 2764715 92457428001 Spike MS MS % Rec Parameter Units Result Conc. Result %Rec Limits Qualifiers Total Petroleum Hydrocarbons mg/L NO 19.2 7.8 34 64-132 Results presentee on this papa ere 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: 12/20/2019 02:20 PM without the written consent of Pace Analytical Services, LLC. Page 6 of 13 (�IaceAnalyficale www.prtellid.com QUALITY CONTROL DATA Project: Stormwater Testing Pace Project No.: 92457361 QC Batch: 515148 Analysis Method: EPA 200.7 Rev 4.4 1994 QC Batch Method: EPA 200.7 Rev 4.4 1994 Analysis Description: 200.7 MET Associated Lab Samples: 92457361001, 92457361002 METHOD BLANK: 2760704 Matrix: Water Associated Lab Samples: 92457361001, 92457361002 Blank Reporting Parameter Units Result Limit Analyzed Qualifiers Copper ug/L NO 5.0 12/1711919:05 ,,Lead ug/L NO 5.0 12117/1919:05 Zinc ug/L NO 10.0 12/17/1919:05 Pace Analytical Services, LLC 9800 Kincey Ave. Suite too Huntersville, NC 28078 (704)875-9092 LABORATORY CONTROL SAMPLE: 2760705 Spike -CS -CS %Rec Parameter Units Cone. Result % Rec Limits Qualifiers Copper ug/L 500 490 98 85-115 Lead ug/L 500 479 96 85-115 Zinc ug/L 500 458 92 85-115 MATRIX SPIKE & MATRIX SPIKE DUPLICATE: 2760706 2760707 MS MSD 92456214001 Spike Spike MS MSD MS MSD % Rec Parameter Units Result Cone. Cone. Result Result %Rec %Rec Limits RPD ,Copper ug/L <5.0 500 500 517 511 102 101 70-130 1 Lead ug/L <5.0 500 500 496 488 99 98 70-130 1 '7inc 11 ug/L <10.0 500 500 481 476 96 95 70-130 1 Qual 'MATRIX SPIKE & MATRIX SPIKE DUPLICATE: 2760708 2760709 MS MSD 92457330001 Spike Spike MS MSD MS MSD % Rec Parameter Units Result Cone. Cone. Result Result % Rec % Rec Limits RPD Qual Copper ug/L NO 500 500 504 515 100 103 70-130 2 Lead ug/L NO 500 500 491 506 98 100 70-130 3 Zinc ug/L 22.0 500 500 500 513 96 98 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, Date: 12/20/2019 02:20 PM without the written consent of Pace Analytical Services, I.I.C. Page 7 of 13 aceAnalytical e www.paataba.com QUALITY CONTROL DATA Project: Stormwater Testing Pace Project No.: 92457361 QC Batch: 515129 Analysis Method: SM 254OD-2011 QC Batch Method: SM 254OD-2011 Analysis Description: 2540D Total Suspended Solids Associated Lab Samples: 92457361001, 92457361002 METHOD BLANK: 2760639 Matrix: Water Associated Lab Samples: 92457361001, 92457361002 Blank Reporting Pace Analytical Services, LLC 9800 Kincey Ave. Suite 100 Hunlersville, NC 28078 (704)875-9092 Parameter Units Result Limit Analyzed Qualifiers Total Suspended Solids mg/L ND 2.5 12/17/19 13:44 LABORATORY CONTROL SAMPLE: 2760640 Spike LCS LCS % Rec Parameter Units Conc. Result % Rec Limits Qualifiers Total Suspended Solids n mg/L 250 272 109 90-110 SAMPLE DUPLICATE: 2760641 92457009001 Cup • Parameter Units Result Result RPD Qualifiers Total Suspended Solids mg/L 424 340 22 SAMPLE DUPLICATE: 2760642 92457317001 Dup Parameter Units Result Result RPD Qualifiers ,Total Suspended Solids mg/L 193 233 19 Results presented on thus page are In the units indicated by the "Units" column except whore 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: 12/20/2019 02:20 PM without the written consent of Pace Analytical Services, U.C. Page 8 of 13 aceAnalytical e ww .Daulsle.cem QUALIFIERS Project: Stormwater Testing Pace Project No.: 92457361 DEFINITIONS Pace Analytical Services, LLC 9800 Kincey Ave. Suite 100 Hunlersville, 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. 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. 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 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 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 REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, Dale: 12/20/2019 02:20 PM without the written consent of Pace Analytical Services, LLC. Page 9 of 13 laceAnalyticalo www.pcalabs.cam QUALITY CONTROL DATA CROSS REFERENCE TABLE Project: Stormwater Testing Pace Project No.: 92457361 Pace Analytical Services, LLC 9800 Kincey Ave. Suite 100 Hunlersville, NC 28078 (704)875-9092 Lab ID Sample ID QC Batch Method QC Batch Analytical Method Analytical Batch 92457361001 OUTFALL I GRAB EPA 1664E 515960 92457361002 OUTFALL 2 GRAB EPA 16648 515960 92467361001 OUTFALL 1 B GRAB EPA 200.7 Rev 4.4 1994 515148 EPA 200.7 Rev 4.4 1994 515162 92457361002 OUTFALL 2 GRAB EPA 200.7 Rev 4.4 1994 515148 EPA 200.7 Rev 4.4 1994 515162 92457361001 OUTFALL 1B GRAB SM 254OD-2011 515129 92457361002 OUTFALL 2 GRAB SM 254OD-2011 515129 Dale: 12/20/2019 02:20 PM REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, without the written consent of Pace Analytical Services, -LC. Page 10 of 13 Document Name: Document Revised: February 7, 2018 '. aceAnaMical Sample Condition Upon Recel t SCUft page 1 of 2 Document No.: Issuing Authority: FCARd5-033-Rev.05 Pace Carolinas Quality Office Laboratory receiving samples: Asheville ® Eden[] Greenwood ❑ Huntersvllle ❑ Raleigh0 Mechani Client Name: /U®# : 92457361 & f l tx rue i Project0: —Courier, ed Ex UPS— U PS "_QCllent--- IIiIIi I'I 19�IL, �iIII.III:_ ❑ Commerdal ❑Pace 00ther:_ 82487361 Custody Seal Present? ❑Yes ®No seals Intact? ❑Yes �31`10 Dob/InlUah Person Examining Contents; Packing Material: ❑Hubble Wrap Oeubbte Bags ❑None ❑ Other Biological Tlssue Frozen? Thermometer: p r�/�� ,Y� ❑Yes []NO �N/A 12d IR Gun ID: 13—TQ6( Typo of ice: y1,IWet []Blue ❑None Cooler Temp('Cl: _�., I Correction factor: Add/Subtract ('C) _ Temp should be above freezing to 6'C Cooler Temp Corrected ('C):[]Samples out of temp criteria. Samples on ice, cooling process hit begun USDA Regulated Sall (Pd N/A, water sample) Did samples originate In.a quarantine zone within the United States: CA, NY, or SC (check maps)? Did Dmples originate from aforeign source (intematlonaliv, ....u,..d a.unn eMnll My.. MNa res Lein. --- - Comments/Disc anc Chain of Custody Present? MYes No N A 1. Samples Arrived within Hold Time? haft EIN. ONIA 2. Short Hold Time Analysis <n hr.)? es ONO N/A 3. Rush Turn Around Time Requested? Qyes MNO N/A 4. Sufficient Volume? MYes No N/A S. Correct Containers Used? -Pace Containers Used? MYcs es ❑No No []N/A N A 6. Containers Intact? Yef No E3WA 7. Dissolved analysis! Samples Field Flltered7 QYes ONO N/A 8. Sample Labels Match COC? -includes Oate/Time D/Anal is Matrix: Mves ❑No ❑N/A 9- Heads ace in VOA Vials ,5-6mm? Qyes No N/A 30. Trip Blank Present? Trip Blank Custody Seals Present? ❑Yes Yes []NO No J�N/A N/A 11. COMMENTS/SAMPLE DISCREPANCY CLIENT NOTIFICATION/RESOLUTION Person contacted: __ Date/Tlme Field Data Required? []Yes ❑No Project Manager SCURF Review: Date: a//n�(O — Project Manager SRF Review: Date: N Ilo Page 11 of 13 J Document Name: Document Revised: February 7, 2pi6 . y :9CBAf181y!lCr7) Sam le Condition U on Recei t SCUR Page 1 of 2 Document No.: Issuing Authority: F{AR-CS-033-Ray.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, Coliform, TOC, Oil and Grease, DRO/6015 (water) DOC, LtHg * Bottom halt of.boxistolist number. of. bottle Project u 11(lif PM'. TIN Due Date: 12/20/19 CLIENT: 92-Rg1llity F on VVFA NNIMMIUMENRIM MEMO nommilooLiLl 0 MONOMMINOM 0 MEMO no NODDED 01000122001100 ODEON 1MEEMENIMEMME101 100110 DINNER pH Adjustment Log for Preserved Samples sample ID Type of Preservadve pH upon recolpt Date preservation adjusted Time pratervadon adjusted Amount of Preservative added Lot p Nato: WhoneVer there is a dhcrepancy affecting North Carolina compliance samples, a copy of this Term Will to sent tot hemrtll Carolina UtltNn Certlii"Sion Vmcep.u. Out of hold, Incorrect preservatve, out of temp, Incorrect containers. Page 12 of 13 CHAIN -OF -CUSTODY / Analytical Request Document The Chainw&Cmtody is a LEGAL DOCUMENT. AO relevant fields must he cornpleted accurately. 3ectiar A Sectiao 8 Sacdan C Ie uimd Ckm mfofm.ovn: Rega Pro bdamafiun: trrraiae lydanrtion: Page! 1 Of t % Y M Fu s Repot Ta: aeCNvt9T' 1AtMtat Vtreva: 1010Ca *.Ce Ddl Caps Ta Carysary N. . NC 281% 7.me: Si EY G rL T T FS . 2;wV Palma Drdar r Z-530-78 Pam w alum: C/Oa 3,u Fm Proje Nara: 5bm+alr rasing Pam PmlactMarpQ. rleP+anetl Oae Date: Pnyea l: Pam Prato 81914 I NC e a C(XIECTE9 PreservaWW r k•v3 -t'>!' -y?r.T _yam,-• wtau caOE z A '° SAMPLE ID i o sr oxr ENo y � 0 U ,aaPa�m�..aea�. w TDAICTVIIE TOATEIIW gj Qp o Z p r $ 7 736/ W i dO � m Q 2 �Q v" .% d 5 ti Ou7 FrLG [ IR GRAB T G ! roll lG:r 3 C� z. o UT i= rl t L 2 GRAB T G ro/ 17_ 3 U GWro .'ate •' �nASCry.: � �+X4=V?V "�. ..F:�rti+.?N�I, �LE�1^�6111T1'4" - �. ui .:7•��( S' & Y��F} y[!�'k .uv1J.v1.Y. .' 'r=1�3^iC!� 'wJ-.' 'a •nu]b�T //Grin i2l2 t�,o Fep�X I I I "` PRINT Nam of 5(VaPLEA: Ely m o g �' i a -'oo z E` 2 �L 4GNATVRf of $AIaPLq: l OATeB 12777, !9„�'