NCG030689_MONITORING INFO_20200108

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
IV u& 0 3 b Lo j
DOC TYPE
❑ HISTORICAL FILE
I MONITORING REPORTS
DOC DATE
❑ ����� 0
YYYYM M D D

DOC TYPE ❑ HISTORICAL FILE
❑ MONITORING REPORTS
DOC DATE I ❑
YYYYMMDD

Environmental
Quality
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
ror,r;uidance on filling out this form, please visit https://deq.nc.gov/about/divisions/energy-mineral-land-resources/
n pdes-storm water-gp s
Permit No.: N/C/, 030000 or Certificate of Coverage No.: N/C/G/ 030689
Facility Name: AW North Carolina
County: Durham Phone No. 919-479-6400
Inspector: Hakim Lundy / Bill Frederick
Date of Inspection: 11-12-2019 R E C F I1/F n
Time of Inspection: 1350 hours - 1715 hours IAW 0 8 ?ON]
Total Event Precipitation (inches):
GENTi'2AL FIL_ -. 2,
UNR S%CIION
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
Office.
By this signature, I certify that this report is
or
1. Outfall Description:
Outfall No. 001
and complete to the best of my knowledge:
Structure (pipe, ditch, etc.): DItCh
Receiving Stream:
Retention pond to Neuse River
Describe the industrial activities that occur within the outfall drainage area:
Automobile transmission manufacturing (metal processing, petroleum storage and use,sftipping)
Page I of 2
S W U-242, Last modified 06/01/201 B

1. Outfall Description:
Outfall No. 002 Structure (pipe, ditch, etc.): Pipe
Receiving Stream:
Retention pond to Neuse River
Describe the industrial activities that occur within the outfall drainage area: _
Automobile transmission manufacturing (metal processing, petroleum storage and use,shipping)
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: clear
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil, weak
chlorine odor, etc.): no odors
4. Clarity: Choose the number which best describes the clarity of the discharge, where I is clear
and 5 is very cloudy:
[Z]I ❑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:
❑� l ❑2 ❑3 ❑4 ❑5
6. Suspended Solids: Choose the number which best describes the amount of suspended solids in
the stormwater discharge, where t is no solids and 5 is extremely muddy:
❑� I ❑ 2 ❑3 ❑4 D
7. Is there any foam in the stormwater discharge? O Yes JK No.
8. Is there an oil sheen in the stormwater discharge? OYes 46 No.
9. Is there evidence of erosion or deposition at the outfall? O Yes j6 No.
10. Other Obvious Indicators of Stormwater Pollution:
List and describe
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.
S W IJ-242, Iasi modified ied 06/01 /2018

1. Outfall Description:
Outfall No. 003 Structure (pipe, ditch, etc.): Pipe
Receiving Stream:
Retention pond to Neuse River
Describe the industrial activities that occur within the cattail drainage area:
Automobile transmission manufacturing (metal processing, petroleum storage and use,shipping)
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: clear
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil, weak
chlorine odor, etc.): no odors
4. Clarity: Choose the number which best describes the clarity of the discharge, where I is clear
and 5 is very cloudy:
7]I E]2 F-]3 ❑4 F—]5
5. Floating Solids: Choose the number which best describes the amount of floating solids in the
stormwater discharge, where I is no solids and 5 is the surface covered with floating solids:
[Z]l E]2 E]3 F]4 F-15
6. Suspended Solids: Choose the number which best describes the amount of suspended solids in
the stormwater discharge, where I is no solids and 5 is extremely muddy:
FI []2 ❑3 F—]4 F]5
7. Is there any foam in the stormwater discharge? O Yes %I No.
8. Is there an oil sheen in the stormwater discharge? OYes q5 No.
9. Is there evidence of erosion or deposition at the outfall? O Yes 46 No.
10. Other Obvious Indicators of Stormwater Pollution:
List and describe
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.
5 W U-242, Last modified ied 06/01 /2018

Stormwater Discharge Monitoring Report
for North Carolina Division of Energy, Mineral and Land Resources General Permit No. NCG030000
Date submitted 12/30/19
CERTIFICATE OF COVERAGE NO. NCG03 030689 SAMPLE COLLECTION YEAR 2019
FACILITY NAME AW North Carolina SAMPLE PERIOD ❑ Jan -June [Z]July-Dec
COUNTY Durham or ❑ Monthly' (month)
PERSON COLLECTING SAMPLES Hakim Lundy & Bill Frederick DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
LABORATORY Pace Lab Cert. # 12 ❑Zero -flow [_]Watersupply [:]SA
Comments on sample collection or analysis: ❑✓ Other Retention pond releases to Neuse River
Part A: Stormwater Benchmarks and Monitoring Results
PLEASE REMEMBER TO SIGN ON PAGES 2 AND/OR 3 4
n No discharqe this period?2
Outfall No.
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
Inches'
Total Suspended Solids
PH
rd units
Standard
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
OOSS2
78141
001
11/12/2019
7.2 mg/L
8.43
<0.010 mg/L
<0.075 mg/L
0.0208 mg/L
<15 mg/L
<1 mg/L
002
11/12/2019
11.5 mg/L
8.09
<0.010 mg/L
<0.075 mg/L
0.0498 mg/L
<15 mg/L
<1 mg/L
003
11/12/2019
13.2 mg/L
8.97
<0.010 mg/L
<0.075 mglL
0.0347 mg/L
<15 mg/L
<1 mg/L
' Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
Z For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here.
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.
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: 11/1/2018-05/31/2021 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
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 fling 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."
9 �,M �y7 dH
Name (Print name)
Man•-
int title)
/2
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.
No discharge this period?z
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
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 1, 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 Q✓
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES r-INO
REGIONAL OFFICE CONTACT NAME:
Mail an original copv 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 thatj4ere-Jr-e--sWgn-tffeaQt penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
/ 2- - o l9
Date
Permit Date: 11/1/2018-05/31/2021 SWU-245, last revised 11/1/2018
Page 3 of 3

STORMWATER DISCHARGE OUTFALL (SDO)
ANNUAL SUMMARY DATA MONITORING REPORT (DMR) I SPPP Annual Update DATA REVIEW FORM
Calendar Year 2019
Individual NPDES Permit No. NCS
Certificate of Coverage (COC) No.
or
This monitoring report summary of the calendar year should he kept on rile on -site with the facility SPPP.
Facility Name: AW North Carolina
County: Durham
Phone Number: (919 ) 479-6400
Total no. of SDOs monitored 3
Outfall No. 001
Is this outfall currently in Tier 2 (monitored monthly)? Yes ❑ No❑✓
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ❑ No❑✓
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes ❑ No ❑✓
Parameter, (units)
Total
Rainfall,
inches
TSS (mg/L)
pH
(standard units)
Total Copper
(mg/L)
Total Lead
(mg/L)
Total Zinc
(mg/L)
Non -Polar
O&G/ TPH
m /L
Total Toxic
Organics
m /L
Benchmark
N/A
100 or 50
6.0 - 9.0
0.010
0.075
0.126
15
1
Date Sample
Collected,
mm/dd/yy
■-�_-----
<0.075
<0.126
<15
<1
02/20/2019
11.1
5
<0.010
11/12/2019
7.2
8.43
<0.010
<0.075
0.0208
<15
<1
ovvu-mv - uenenc r.nnuai Lnvim
Last revised 610112018

Pace Analytical Services, LLC
aceAnalytical 6701 Conference Drive
Raleigh, NC 27607
www.pacelabs.cam
[phone]
Page 1 of 3
Laboratory Report
Hakim Lundy Report Date: 12/06/2019
A W North Carolina Date Received: 11/13/2019
4112 Old Oxford Highwy
Durham, NC 27712
Project: Outfall 1 11112
Pace Project No.: 92453617
Sample: OF-1
Method
Lab ID:
Parameters
92453617001 Collected: 11/12/1914:30 Matrix:
Results Units Report Limit
Water
Analyzed Qualifiers
EPA 1664B
Oil and Grease
NO
mg/L
5.0
12/05/19 10:58
EPA 1664E
Total Petroleum Hydrocarbons
NO
mg/L
5.0
12/05/19 10:58
EPA 608.3
Aldrin
NO
ug/L
0,050
11/2011914:02
EPA 608.3
alpha-BHC
NO
ug/L
0.050
11/2011914:02
EPA 608.3
beta-BHC
NO
ug/L
0.050
11/20/1914:02
EPA 608.3
delta-BHC
NO
ug/L
0.050
11/20/1914:02
EPA 608.3
gamma-BHC(Lindane)
NO
ug/L
0.050
11/20/1914:02
EPA 608.3
Chlordane (Technical)
NO
ug/L
0.50
11/20/191402
EPA 508.3
alpha -Chlordane
NO
ug/L
0.050
11/20/19 14:02
EPA608.3
gamma -Chlordane
NO
ug/L
0.050
11120/1914: 02
EPA 608.3
4,4'-DDD
NO
ug/L
0.050
11/20/1914:02
EPA 608.3
4,4'-DDE
NO
ug/L
0.050
11/20/1914:02
EPA 608.3
4,4'-DDT
NO
ug/L
0.050
11/20/1914:02
EPA 608.3
Dieldrin
NO
ug/L
0.050
11/20/1914:02
EPA 608.3
Endosulfan I
NO
ug/L
0,050
11/20/1914:02
EPA 608.3
Endosulfan 11
NO
ug/L
0.050
11/20/1914:02
EPA 608.3
Endosulfan sulfate
NO
ug/L
0.050
11/20/1914:02
EPA 608.3
Endrin
NO
ug/L
0.050
11/20/1914:02
EPA608.3
Endrin aldehyde
NO
ug/L
0,050
11/20/1914:02
EPA 608.3
Heptachlor
NO
ug/L
0.050
111201191402
EPA 608.3
Heptachlor epoxide
NO
ug/L
0.050
11120/1914:02
EPA 608.3
PCB-1016 (Aroclor 1016)
NO
ug/L
0.50
11/20/19 14:02
EPA 608.3
PCB-1 221 (Aroclor 1221)
NO
ug/L
0.50
11/20/1914:02
EPA 608.3
PCB-1232 (Aroclor 1232)
NO
ug/L
0.50
11/20/19 1402
EPA 608.3
PCB-1242(Aroclor 1242)
NO
ug/L
0.50
11/20/1914:02
EPA 608.3
PCB-1248(Aroclor 1248)
NO
ug/L
0.50
11/20/1914:02
EPA 608.3
PCB-1254 (Aroclor 1254)
NO
ug/L
0.50
11/20/1914:02
EPA 608.3
PCB-1260 (Aroclor 1260)
NO
ug/L
0.50
11/20/19 14:02
EPA 608.3
Toxaphene
NO
ug/L
0.50
11/20/1914:02
EPA 200.7 Rev 4.41994
Copper
NO
ug/L
5.0
11/21/1901:36
EPA 200.7 Rev 4.41994
Lead
ND
ug/L
5.0
11/21/1901:36
EPA 200.7 Rev 4.41994
Zinc
20.8
ug/L
10.0
11/21/1901:36
EPA625.1
Acenaphthene
NO
ug/L
5.0
11/2411917:50
EPA 625.1
Acenaphthylene
NO
ug/L
5.0
11/24/1917:50
EPA625.1
Anthracene
NO
ug/L
5.0
11/24/1917:50
EPA 625.1
Benzo(a)anthracene
ND
ug/L
5.0
11124/1917:50
EPA 625.1
Benzo(a)pyrene
NO
ug/L
5.0
11/24/1917:50
EPA 625.1
Benzo(b)fluoranthene
NO
ug/L
5.0
1112411917:50
EPA 625.1
Benzo(g,h,i)perylene
NO
ug/L
5.0
11/24/1917:50
EPA 625.1
Benzo(k)fluoranthene
NO
ug/L
5.0
11/24/1917:50
EPA 625.1
4-Bromophenylphenyl ether
NO
ug/L
5.0
11/2411917:50
EPA 625.1
Butylbenzylphthalate
NO
ug/L
5.0
11/24/1917:50 Pagel of

aceAnalytical
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Pace Analytical Services, LLC
6701 Conference Drive
Raleigh, NC 27607
[phone]
Page 2 of 3
Sample: OF-1
Method
Lab ID:
Parameters
92453617001 Collected: 11/12/19 14:30 Matrix:
Results Units Report Limit
Water
Analyzed Qualifiers
EPA 625.1
4-Chloro-3-methylphenol
NO
ug/L
5.0
11124/1917:50
EPA 625.1
bis(2-Chloroethoxy)methane
ND
ug/L
9.9
11/24/1917:50
EPA 625.1
bis(2-Chloroethyl) ether
NO
ug/L
5.0
11/24/1917:50
EPA 625.1
2-Chloronaphthalene
NO
ug/L
5.0
11/24/1917:50
EPA 625.1
2-Chlorophenol
NO
ug/L
5.0
11/24/1917:50
EPA 625.1
4-Chlorophenylphenyl ether
NO
ug/L
5.0
11/24/1917:50
EPA625.1
Chrysene
NO
ug/L
5.0
11124/1917:50
EPA 625.1
Oibenz(a,h)anthracene
NO
ug/L
5.0
11124/1917:50
EPA625.1
3,3'-Dichlorobenzidine
NO
ug/L
24.8
11/24/1917:50
EPA 625.1
2,4-Dichlorophenol
NO
ug/L
5.0
11/24/1917:50
EPA 625.1
Diethylphthalate
NO
ug/L
5.0
11/24/1917: 50
EPA 625.1
2,4-Dimethylphenol
NO
ug/L
9.9
1112411917:50
EPA 625.1
Dimethylphthalate
NO
ug/L
5.0
11/2411917:50
EPA 625.1
Di-n-butylphthalate
NO
ug/L
5.0
11/24/1917: 50
EPA 625.1
4,6-Dinitro-2-methylphenol
NO
ug/L
19.8
11/24/1917:50
EPA625.1
2,4-Dinitrophenol
NO
ug/L
49.5
11/24/1917:50
EPA625.1
2,4-Dinitrotoluene
NO
ug/L
5.0
11/24/1917:50
EPA 625.1
2,6-Dinitrotoluene
NO
ug/L
5.0
11/24/191750
EPA 625.1
Di-n-octylphthalate
NO
ug/L
5.0
11124/1917:50
EPA 625.1
bis(2-Ethylhexyl)phthalate
NO
ug/L
5.0
11/24/1917:50
EPA 625.1
Fluoranthene
NO
ug/L
5.0
11/24/1917:50
EPA 625.1
Fluorene
NO
ug/L
5.0
11/24/1917:50
EPA 625.1
Hexachloro-1,3-butadiene
NO
ug/L
5.0
1112411917:50
EPA 625.1
Hexachlorobenzene
NO
ug/L
5.0
11/2411917: 50
EPA 625.1
Hexach lorocyclopentadiene
NO
ug/L
9.9
1112411917: 50
EPA 625.1
Hexachloroethane
NO
ug/L
5.0
11/24/1917:50
EPA 625.1
Indeno(1,2,3-cd)pyrene
NO
ug/L
5.0
11/24/1917:50
EPA 625.1
Isophorone
NO
ug/L
9.9
11124/191750
EPA 625.1
Naphthalene
NO
ug/L
5.0
11/24/1917:50
EPA 625.1
Nitrobenzene
NO
ug/L
5.0
11124/1917: 50
EPA 625.1
2-Nitrophenol
ND
ug/L
5.0
11/24/1917:50
EPA625.1
4-Nitrophenol
ND
ug/L
49.5
11/24/1917:50
EPA 625.1
N-Nitrosodimethylamine
NO
ug/L
5.0
11/24/1917:50
EPA 625.1
N-Nitroso-di-n-propylamine
NO
ug/L
5.0
11/24/1917:50
EPA 625.1
N-Nitrosodiphenylamine
NO
ug/L
9.9
11/24/1917:50
EPA 625.1
2,2'-Oxybis(1-chloropropane)
NO
ug/L
5.0
11/24/1917:50
EPA625.1
Pentachlorophenol
ND
ug/L
9.9
11/24/1917:50
EPA 625.1
Phenanthrene
NO
ug/L
5.0
11/24/1917:50
EPA 625.1
Phenol
NO
ug/L
5.0
11124/1917:50
EPA 625.1
Pyrene
ND
ug/L
5.0
1112411917: 50
EPA 625.1
1,2,4-Trichlorobenzene
NO
ug/L
5.0
11/24/1917:50
EPA 625.1
2,4,6-Trichlorophenol
NO
ug/L
9.9
11/24/1917:50
EPA 624.1
Benzene
NO
ug/L
1.0
11/19/1902:24
EPA624.1
Bromodichloromethane
NO
ug/L
2.0
11/19/1902:24
EPA 624.1
Bromoform
NO
ug/L
2.0
11/19/1902:24
EPA 624.1
Bromomethane
NO
ug/L
2.0
11/19/1902:24
EPA 624.1
Carbon tetrachloride
NO
ug/L
2.0
11/1911902:24
EPA 624.1
Chlorobenzene
ND
ug/L
2.0
11/19/1902:24
EPA 624.1
Chloroethane
ND
ug/L
2.0
11/19/1902:24
EPA 624.1
Chloroform
NO
ug/L
2.0
11/19/1902:24
EPA 624.1
Chloromethane
NO
ug/L
2.0
11/19/1902:24
EPA624.1
Dibromochloromethane
NO
ug/L
2.0
1111911902:24
EPA 624.1
1,2-Dichlorobenzene
NO
ug/L
2.0
11/1911902:24
EPA 624.1
1,3-Dichlorobenzene
NO
ug/L
2.0
11/19/1902:24
EPA 624.1
1,4-Dichlorobenzene
ND
ug/L
2.0
11/19/1902:24
EPA 624.1
1,1-Dichloroethane
NO
ug/L
2.0
11/19/1902:24
EPA 624.1
1,2-Dichloroethane
NO
ug/L
2.0
11119/1902:24
EPA 624.1
1,1-Dichloroethene
NO
ug/L
2.0
11/19/1902:24 Page of

aceAnalytical
www.pacelabs.com
Pace Analytical Services, LLC
6701 Conference Drive
Raleigh, NC 27607
[phone]
Page 3 of 3
Sample: OF-1
Lab ID:
92453617001 Collected: 11/12/19 14:30
Matrix:
Water
Method
Parameters
Results
Units Report Limit
Analyzed Qualifiers
EPA 624.1
cis-1,2-Dichloroethene
NO
ug/L
2.0
11119/1902:24
EPA 624.1
trans-1,2-Dichloroethene
NO
ug/L
2.0
11/19/1902: 24
EPA 624.1
1,2-Dichloropropane
NO
ug/L
2.0
11/19/1902:24
EPA 624.1
cis-1,3-Dichloropropene
NO
ug/L
2.0
11/19/1902:24
EPA 624.1
trans-1,3-Dichloropropene
NO
ug/L
2.0
11/19/1902:24
EPA 624.1
Ethylbenzene
NO
ug/L
1.0
1111911902:24
EPA 624.1
Methylene Chloride
NO
ug/L
2.0
11/19/1902:24
EPA 624.1
1,1,2,2-Tetrach loroethane
ND
ug/L
2.0
11/19/1902:24
EPA 624.1
Tetrachloroethene
NO
ug/L
2.0
11/19/1902:24
EPA 624.1
Toluene
NO
ug/L
1.0
11/19/1902:24
EPA 624.1
1,1,1-Trichloroethane
NO
ug/L
2.0
11/19/1902:24
EPA 624.1
1,1,2-Trichloroethane
NO
ug/L
2.0
11/19/1902:24
EPA 624.1
Trichloroethene
ND
ug/L
2.0
11/19/1902:24
EPA 624.1
Trichlorofluoromethane
NO
ug/L
2.0
11/19/1902:24
EPA624.1
Vinyl chloride
NO
ug/L
2.0
11/19/1902:24
SM 2540D-2011
Total Suspended Solids
7.2
mg/L
5.0
11/15/19 11:11
EPA 9040C
pH at 25 Degrees C
5.5
Sid. Units
0.10
12/01/19 13:56 D6,H3
SM 4500-CN-E-2011 Cyanide
NO
mg/L
0.0080
11/19/19 12:28
Sample: OF-1 PHENOL Lab ID:
92453617002 Collected:
11/18/19 14:30
Matrix:
Water
Method
Parameters
Results
Units Report
Limit
Analyzed Qualifiers
EPA 420.4 Rev 1.01993
Phenol
NO
mg/L
0.020
11/25/1913:38
ANALYTE QUALIFIERS
D6
The precision between the sample and sample duplicate exceeded
laboratory control limits.
H3
was received oranalysisrequested
beyond the recognized
method holding time.
Reviewed by:
/Sample
bv"--�`�"""`--
Chris Derouen
[phone]
[e-mail]
Pace Analytical Services Charlotte
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
Virginia/VELAP Certification #: 460221
North Carolina Wastewater Certification #: 12
Pace Analytical Services Asheville
2225 Riverside Drive, Asheville, NC 28804
North Carolina Wastewater Certification #: 40
Florida/NELAP Certification #: E87648
South Carolina Certification #: 99030001
Massachusetts Certification #: M-NC030
Virginia/VELAP Certification #: 460222
North Carolina Drinking Water Certification #: 37712
Page 3 of 7

Document Name:
Document Ravlsed: Fehruary 7, 2018
Sample Condition Upon n ReoeWSCUR
Pa e 1 of 2
Document No.:
Issuing Authority:
/ ��PPdd ^ra,rl.wu
F-CAR-CS-033-Rev.06
Pace Camllnas Quality Office
Laboratory reedving samples:
Asheville ❑ Eden❑ Greenwood ❑ Huntersvllle ❑ Ralelgh0� Mechanicsville[]
Client Name: Protect 4: WO# : 92453617
VV L
Courier: d UPs ❑LISPS []ClientIIIIII I�I II I I�Od�I �II
❑ Commercial ace []Other:_
r�// �� 92453617
Custody Seal Present? ❑Yes Mno' Seals Intact? ❑Yes Mnro
DateAnitub Person Examining Contentr.
Packing Material: []Bubble Wrap ble Bags ❑None ❑ Other rC�-tB�,iological Tissue Frozen?
Thermometers .f- Type of ke: ❑Wet ❑Blue ❑None C]yes []NO p,�r..
❑IR Gun ID: /�O
Cooler Temp ('C): Correction Factor: Add/Subtract ('C)
� Temp should be above freezing to 6'C
Cooler Temp Corrected ('C):
❑Samples out of temp attorla. Samples on Ice, coding process
has begun
USDA Regulated Soo ( A; water sample)
Did samples originate In a quarantine zone within the United States: CA, NY, or SC (check maps)? Did samples originate from a foreign source (Internatlonally,
i—lYes r1Nn Indudim Hawaii and Puerto Wool? ❑Yes ONO
Comments/Discrepancy:
Chain of Custody Present?
[]No
❑N/A
1.
Samples Arrived within Hold Time?
ON.
N/A
2.
Shot Hold Time Analysis (<72 hr.)?
ElYas
[]No
❑N/A
3.
Rush Turn Around Time Requested?
Yes
o
EINIA
4.
Suffldent Volume]
No
N/A
S.
Correct Containers Used?
-Pace Containers used?
❑No
No
❑N/A
N/A
6.
Containers Intact)
Dyes
QN2
❑N/A
7.
Dissolved analysts: Samples Field Filtered?
Yes
No
B.
Sample labels Match COC?
-Includes Date/Time/lb/ArmlysIs Matrix
❑Yes
[]NO
❑N/A
9.
Heads ace In VOA Vlals (>S-6mm)7
Dyes
a
EINIA
10.
Trip Blank Present?
Trip Blank Custody Seals Present?
❑yea
es
[]NO
No
M*W—
MWr-
11.
COMMENn/SAMPLE DISCREPANCY Field Data Regdred? Over []No
Ace (v t 4435 No fi FJ
Lot ID of split containers:
CLIENT NOTIFICATION/RESOLUTION
Person contacted:
Project Manager SCURF Review:
Project Manager SRF Review:
Cacti
Date: t
Date:
i
Page 4 of 7

'Check mark top half of box if pH and/or dechlorinatlon Is Project # WO# : 92453617
vertfled and within the acceptance range for preservation PM: CDl
Due Dale: 11/26/19
samples. CLIENT: 91—AWNC
Fxeeptlonz VOA,Cogforsn, TOt, Ohl and Grease, ORO/9015 (water) D04 Mg
""Bottom half of box is to list number of bottle
o
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¢
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J'N
7
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I NNNNI
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u
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pH Adjustment Log for Preserved Samples
Sample ID
Type of Prvervadve
pH upon racelpt
Date praservatlon adlmted
Time presina, an
adjusted
anaunt of prUeMtIM
added
Lot i
rsote: W henawr Ih are if a dkaepancy affecting North 6mgna compliant, amplea. a copy of :hit form Wail "MET U tna No nn "M.Ma uannn ceracnunn c,,.,, p.•.
Out of hole.lrccrrvtt prosarntive, cut of temp. IntpR,a mnUlnen.
Page 5 of 7

CHAIN -OF -CUSTODY I Analytical Request Document
TO QMWCusw* Is. LEGAL DOCUMENT. AB reWwd u W --PWW a —Val*
r— NPDES C- GROUNDWATER DRWrJNGWATER
F. UST F. RCRA OTHER
S� D
MATB%
SAIMPLE ID
OT
SW�00 109 MUST BE UNIQUE
MINEEMEMEN
OEM
MEMMEMSEM
NEENESSENESEN--M
MOMMIMINI
ENSEEMEEMEMEM
MEMEMMESOMMEM
ME
MEMENMENEENEM
F-ALL-0-020r .W,12-0a-2 7
ry
O
P-

`o
CHAIN -OF -CUSTODY Analytical Request Document
Chainot-Custody Is a LEGAL DOCUMENT -Complete all relevent fields
:opy To:
OtA VIiIL
U
/ I ]PT( IMT1 ]CT ( JET
Phone:
Site/Fac rty, ID d:
Compliance Monitoring?
Email:
F I Y.. I )NO
Q BtYjprint)
♦
Order R:
DW PWSIDR:
1 •LFlW11
Iylr
ume a:
Cluot
qe R:
DW lttatlon fade:
Collected By (signature):
Turnaround Date Required:
immediately Packed on cc:
I 1 Yes l ]NO
Sample Disposal:
Rush:
Field Filtered (if applicable)-
1 I Dispose as appropriate I I Return
l ] Same Day [ I Next Day
I ]Yes' [ ]NO
I I Archf.:
. I 1 2 Day ( ] 3 Day I 1 R Day 1 15 Day
Analysis:
I ]Hold:
(Expednc Charges Applyl
• Matra Codes (Insert In Matrix box below): Drinking Water (DW), Ground Water (GW), Wastewater (VJW),
Product (P), Soll/Solld (SL), Oil (OL), Wipe (WP), Air (AR), Tissue ITS), Bioassay, (B), Vapor (V), Other (OT)
Comp /
Collected (or
Composite End
Res
Customer Sample ID
Matrix •
Grab
Composite Start)
O
Ctn
tts
Date
lime
Dale
Time
nI
ULM
I7.,
11, 11. Willi
RI
Customer Remarks / Special Conditions / Possible Hazards:
Recehred

" 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-trJe-ac rate, and complete. I am aware that there are significant penalties for submitting false information,
including the possibility/of fines and imprison ent for knowing violations."
Signatu�/ IJ
Date /.Z-3t9-�
For questions, contact your local Regional Office:
DEMLR Regional Office Contact Information:
ASHEVILLE REGIONAL OFFICE
FA.Y:ET.TEV:ILLE+REGIONXLq FFICE
MOORESVILLEIREGIONALWFICE
2090 US Highway 70
225 Green Street
610 East Center Avenue/Suite 301
Swannanoa, NC 28778
Systel Building Suite 714
Mooresville, NC 28115
[phone]
Fayetteville, NC 28301-5043
[phone]
[phone]
RALEIGH REGIONAL OFFICE
WASHINGTONREGIONA n FFICE
WIL"MINGTONIREGIONAL OFFICE
3800 Barrett Drive
943 Washington Square Mall
127 Cardinal Drive Extension
Raleigh, NC 27609
Washington, NC 27889
Wilmington, NC 28405-2845
[phone]
[phone]
[phone]
WINSTON-SALEMREGIONAL OFFICE
CENTRALOEFICE
1617 Mail Service Center
450 Hanes Mill Rd. Suite 300
Winston-Salem, NC 27105
Raleigh, NC 27699-1617
[phone]
[phone]
SWU-264 - Generic Annual DMR
Last revised 6(01/2018

Additional Outfall Attachment
Outfall No. 002
Is this outfall currently in Tier 2 (monitored monthly)? Yes ❑ No ❑./
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ❑ No ❑✓
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes ❑ No ❑✓
Parameter, (units)
Total
Rainfall,
inches
TSS (mg/L)
pH
(standard units)
Total Copper
(mg/L)
Total Lead
(mg/L)
Total Zinc
(mg/L)
Non -Polar
O&G/ TPH
(mg/L
Total Toxic
Organics
m /L
Benchmark
N/A
100 or 50
&0 - 9.0
0.010
0.075
0.126
15
1
Date Sample Collected,
mm/dd/yy
<0.075
0.0464
<15
<1
02/20/2019
7.1
6.6
<0.010
11/12/2019
11.5
8.09
<0.010
<0.075
0.0498
<15
<1
SWU-264 - Generic Annual DMR
Last revised 61012018

Pace Analytical Services, LLC
aceAnalytical ® 6701 Conference Drive
Raleigh, NC 27607
ww.paceleb.com
(919)8344964
Page 1 of 3
Laboratory Report
Hakim Lundy Report Date: 11/27/2019
A W North Carolina Date Received: 11/13/2019
4112 Old Oxford Highwy
Durham. NC 27712
Project: Outfall 2 11 /12
Pace Project No.: 92453621
Sample: OF-2
Method
Lab ID:
Parameters
92453621001 Collected: 11/12/19 15:00 Matrix:
Results Units Report Limit
Water
Analyzed Qualifiers
EPA 1664B
Oil and Grease
NO
mg/L
5.0
11/26/19 13:48
EPA 1664E
Total Petroleum Hydrocarbons
NO
mg/L
5.0
11/26/19 13:48
EPA 608.3
Aldrin
NO
ug/L
0.050
11/20/1914:17
EPA 608.3
alpha-BHC
NO
ug/L
0,050
11/20/19 14:17
EPA 608.3
beta-BHC
NO
ug/L
0.050
11/20/19 14:17
EPA 608.3
delta-BHC
NO
ug/L
0.050
11120/1914:17
EPA 608.3
gamma-BHC(Lindane)
NO
ug/L
0.050
11/20/19 14:17
EPA 608.3
Chlordane (Technical)
NO
ug/L
0.50
11/20/19 14:17
EPA 608.3
alpha -Chlordane
NO
ug/L
0,050
11/20/19 14:17
EPA 608.3
gamma -Chlordane
NO
ug/L
0.050
11120/1914:17
EPA 608.3
4,4'-DDD
NO
ug/L
0,050
11/2011914:17
EPA 608.3
4,4'-DDE
NO
ug/L
0.050
1112011914:17
EPA 608.3
4,4'-DDT
ND
ug/L
0.050
11/20/19 14:17
EPA 608.3
Dieldrin
NO
ug/L
0.050
11/20/19 14:17
EPA 608.3
Endosulfan I
NO
ug/L
0.050
11120/1914:17
EPA 508.3
Endosulfan II
NO
ug/L
0.050
11/20/19 14:17
EPA 608.3
Endosulfan sulfate
NO
ug/L
0.050
11120/1914:17
EPA 608.3
Endrin
NO
ug/L
0.050
11/20/19 14:17
EPA 608.3
Endrin aldehyde
NO
ug/L
0,050
11/20/19 14:17
EPA 608.3
Heptachlor
NO
ug/L
0,050
11/20/19 14:17
EPA 608.3
Heptachlor epoxide
NO
ug/L
0.050
11/20/19 14:17
EPA 608.3
PCB-1016 (Aroclor 1016)
NO
ug/L
0.50
11/20/19 14:17
EPA 608.3
PCB-1221(Aroclor 1221)
NO
ug/L
0.50
11/20/19 14:17
EPA 608.3
PCB-1232 (Aroclor 1232)
NO
ug/L
0.50
11/20/19 14:17
EPA 608.3
PCB-1242 (Aroclor 1242)
NO
ug/L
0.50
11/20/19 14:17
EPA 608.3
PCB-1248 (Aroclor 1248)
NO
ug/L
0.50
11/20/19 14:17
EPA 608.3
PCB-1254 (Aroclor 1254)
NO
ug/L
0.50
11/20/19 14:17
EPA 608.3
PCB-1260 (Aroclor 1260)
ND
ug/L
0.50
11/20/19 14:17
EPA 608.3
Toxaphene
ND
ug/L
0.50
11/20/19 14:17
EPA 200.7 Rev 4.41994
Copper
NO
ug/L
5.0
11/21/1901:39
EPA 200.7 Rev 4.41994
Lead
NO
ug/L
5.0
11/21/1901:39
EPA 200.7 Rev 4.4 1994
Zinc
49.8
ug/L
10.0
11121 /19 01:39
EPA 625.1
Acenaphthene
ND
ug/L
5.0
11/24/1918:24
EPA 625.1
Acenaphthylene
ND
ug/L
5.0
11/24/1918:24
EPA 625.1
Anthracene
NO
ug/L
5.0
11124/1918:24
EPA 625.1
Benzo(a)anthracene
NO
ug/L
5.0
11/24/1918:24
EPA625A
Benzo(a)pyrene
NO
ug/L
5.0
11/24/1918:24
EPA 625.1
Benzo(b)fluoranthene
NO
ug/L
5.0
11/24/1918:24
EPA625.1
Benzo(g,h,i)perylene
NO
ug/L
5.0
11/24/1918:24
EPA 625.1
Benzo(k)fluoranthene
NO
ug/L
5.0
11/24/1918:24
EPA 625.1
4-Bromophenylphenyl ether
NO
ug/L
5.0
11/24/1918:24
EPA 625.1
Butylbenzylphthalate
NO
ug/L
5.0
11/24/19 18:24 Page 1 of 6

aceAnalytical
w .pecnlebsxcm
Pace Analytical Services, LLC
6701 Conference Drive
Raleigh, NC 27607
[phone]
Page 2 of 3
Sample: OF-2
Method
Lab ID:
Parameters
92453621001 Collected: 11/12/19 15:00 Matrix:
Results Units Report Limit
Water
Analyzed Qualifiers
EPA 625.1
4-Chloro-3-methylphenol
ND
ug/L
5.0
11/24/1918:24
EPA 625.1
bis(2-Chloroethoxy)methane
ND
ug/L
10.0
11/2411918:24
EPA 625.1
bis(2-Chloroethyp ether
ND
ug/L
5.0
11/24/1918:24
EPA 625.1
2-Chloronaphthalene
ND
ug/L
5.0
11/2411918:24
EPA625.1
2-Chlorophenol
ND
ug/L
5.0
11/24/1918:24
EPA 625.1
4-Chlorophenylphenyl ether
ND
ug/L
5.0
11/24/1918:24
EPA 625.1
Chrysene
ND
ug/L
5.0
11/24/1918:24
EPA 625.1
Dibenz(a,h)anthracene
ND
ug/L
5.0
11/24/1918:24
EPA625A
3,3'-Dichlorobenzidine
ND
ug/L
25.0
1112411918: 24
EPA625.1
2,4-Dichlorophenol
ND
ug/L
5.0
11/24/1918:24
EPA 625.1
Diethylphthalate
ND
ug/L
5.0
11/24/1918:24
EPA 625.1
2,4-Dimethylphenol
ND
ug/L
10.0
11/24/1918:24
EPA 625.1
Dimethylphthalate
ND
ug/L
5.0
11/24/1918:24
EPA 625.1
Di-n-butylphthalate
ND
ug/L
5.0
11124/1918:24
EPA625.1
4,6-Dinitro-2-methylphenol
ND
ug/L
20.0
11/24/1918:24
EPA 625.1
2,4-Dinitrophenol
ND
ug/L
50.0
11/2411918:24
EPA 625.1
2,4-Dinitrotoluene
ND
ug/L
5.0
11/24/1918:24
EPA625A
2,6-Dinitrotoluene
ND
ug/L
5.0
11/24/191824
EPA625.1
Di-n-octylphthalate
ND
ug/L
5.0
11124/1918:24
EPA625.1
bis(2-Ethylhexyl)phthalate
ND
ug/L
5.0
11/24/1918:24
EPA 625.1
Fluoranthene
ND
ug/L
5.0
11/24/1918:24
EPA 625.1
Fluorene
ND
ug/L
5.0
11/24/1918:24
EPA 625.1
Hexachloro-1,3-butadiene
ND
ug/L
5.0
11/24/191824
EPA 625.1
Hexachlorobenzene
ND
ug/L
5.0
11124/1918:24
EPA 625.1
Hexachlorocyclopentadiene
ND
ug/L
10.0
11/24/1918:24
EPA 625.1
Hexachloroethane
ND
ug/L
5.0
11/24/1918:24
EPA 625.1
Indeno(1,2,3-cd)pyrene
ND
ug/L
5.0
11124/1918:24
EPA 625.1
Isophorone
ND
ug/L
10.0
11124/1918:24
EPA625.1
Naphthalene
ND
ug/L
5.0
11/24/1918:24
EPA 625.1
Nitrobenzene
ND
ug/L
5.0
11/24/1918:24
EPA 625.1
2-Nitrophenol
ND
ug/L
5.0
11/24/1918:24
EPA 625.1
4-Nitrophenol
ND
ug/L
50.0
11/24/1918:24
EPA625A
N-Nitrosodimethylamine
ND
ug/L
5.0
11/24/1918:24
EPA 625.1
N-Nitroso-di-n-propylamine
ND
ug/L
5.0
11/24/1918:24
EPA 625.1
N-Nitrosodiphenylamine
ND
ug/L
10.0
11/24/1918:24
EPA 625.1
2,2'-Oxybis(1-chloropropane)
ND
ug/L
5.0
11/24/1918:24
EPA 625.1
Pentachlorophenol
ND
ug/L
10.0
11/24/1918:24
EPA625A
Phenanthrene
ND
ug/L
5.0
11/2411918:24
EPA 625.1
Phenol
ND
ug/L
5.0
11/24/1918:24
EPA 625.1
Pyrene
ND
ug/L
5.0
11/24/1918*24
EPA 625.1
1,2,4-Trichlorobenzene
ND
ug/L
5.0
11/24/1918:24
EPA 625.1
2,4,6-Trichlorophenol
ND
ug/L
10.0
11/24/1918:24
EPA 624.1
Benzene
ND
ug/L
1.0
11119/1902:42
EPA 624.1
Bromodichloromethane
ND
ug/L
2.0
1111911902:42
EPA 624.1
Bromoform
ND
ug/L
2.0
11/1911902:42
EPA 624.1
Bromomethane
ND
ug/L
2.0
11/19/1902:42
EPA 624A
Carbon tetrachloride
ND
ug/L
2.0
11/19/1902:42
EPA624.1
Chlorobenzene
ND
ug/L
2.0
11/19/1902:42
EPA 624.1
Chloroethane
ND
ug/L
2.0
11/19/1902:42
EPA 624.1
Chloroform
ND
ug/L
2.0
11/19/1902:42
EPA 624A
Chloromethane
ND
ug/L
2.0
11/19/1902:42
EPA 624.1
Dibromochloromethane
ND
ug/L
2.0
11119/1902:42
EPA 624.1
1,2-Dichlorobenzene
ND
ug/L
2.0
11/19/1902:42
EPA 624.1
1,3-Dichlorobenzene
ND
ug/L
2.0
11/1911902:42
EPA 624.1
1,4-Dichlorobenzene
ND
ug/L
2.0
11/19/1902:42
EPA 624.1
1,1-Dichloroethane
ND
ug/L
2.0
11119/1902:42
EPA 624.1
1,2-Dichloroethane
ND
ug/L
2.0
11/19/1902:42
EPA 624.1
1,1-Dichloroethene
ND
ug/L
2.0
1111911902:42 Page 2 of 6

aceAnalytical
W".Dacelabc.com
Pace Analytical Services, LLC
6701 Conference Drive
Raleigh, NC 27607
(919)8344984
Sample: OF-2 Lab ID: 92453621001
11/12/1915:00 Matrix: Water
Method
Parameters
Results
Units
Report Limit
EPA 624.1
cis-1,2-Dichloroethene
ND
ug/L
2.0
EPA624.1
trans-1,2-Dichloroethene
ND
ug/L
2.0
EPA624.1
1,2-Dichloropropane
ND
ug/L
2.0
EPA 624A
cis-1,3-Dichloropropene
ND
ug/L
2.0
EPA 624.1
trans-1,3-Dichloropropene
ND
ug/L
2.0
EPA624A
Ethylbenzene
ND
ug/L
1.0
EPA624.1
Methylene Chloride
ND
ug/L
2.0
EPA 624A
1,1,2,2-Tetrachloroethane
ND
ug/L
2.0
EPA 624.1
Tetrachloroethene
ND
ug/L
2.0
EPA 624.1
Toluene
ND
ug/L
1.0
EPA624.1
11,1-Trichloroethane
ND
ug/L
2.0
EPA 624.1
1,1,2-Trichloroethane
ND
ug/L
2.0
EPA 624A
Trichloroethene
ND
ug/L
2.0
EPA 624A
Trichlorofiuoromethane
ND
ug/L
2.0
EPA 624.1
Vinyl chloride
ND
ug/L
2.0
SM 2540D-2011
Total Suspended Solids
11.5
mg/L
3.4
EPA 9040C
pH at 25 Degrees C
6.0
Sid. Units
0.10
EPA 420.4 Rev 1.0 1993
Phenol
ND
mg/L
0.020
SM 4500-CN-E-2011
Cyanide
ND
mg/L
0.0080
ANALYTE QUALIFIERS
H3 Sample was received or analysis requested beyond the recognized method holding time.
Reviewed by: G'L- - \; -
Chris Derouen
[phone]
[e-mail]
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
2225 Riverside Drive, Asheville, NC 28804
Florida/NELAP Certification #: E87648
Massachusetts Certification #: M-NC030
North Carolina Drinking Water Certification #: 37712
South Carolina Certification #: 99006001
Florida/NELAP Certification #: E87627
Kentucky UST Certification #: 84
Virginia/VELAP Certification #: 460221
North Carolina Wastewater Certification #: 40
South Carolina Certification #: 99030001
VirginiaNELAP Certification #: 460222
Page 3 of 3
Analyzed Qualifiers
11/19/19 02:42
11 /19119 02:42
11/19/19 02:42
11/19/19 02:42
11/19/19 02:42
11/19/19 02:42
11/19/19 02:42
11/19/19 02:42
11/19/19 02:42
11/19/19 02:42
11/19/19 02:42
11/19/19 02:42
11119/19 02:42
11/19/19 02:42
11/19/19 02:42
11/15/19 11:11
11/24/1917:01 H3
11/20/19 12:58
11/21/19 14:33
Page 3 of 6

d��Aar�l
Document Name:
Sam a CondW0 U n Renl SOUR)
Document Revised: February 7, 2018
Pa e 1 of 2
Document No.:
Issuing Authorhy:
^"�rJv
.
F-CAR•CS•033-11ev.06
Pace Carolinas Quality Office
Laboratory receiving samples;
Asheville Eden[] Greenwood Huntersvllle ❑¢�Raleigh�' Mechanicsvi❑
Protect t,: lle
UlentName: W®# : 92453521
w NG
Courier: UPS❑LISPS ❑talent❑ Commercial II I II� III II I II I I II I III
[]Other: 92453921
Custody Seal Present? Dyes .911� Seals Intact? Dyes
Padding Material: []Bubble Wrap ble Bags ❑None ❑ Other
Thermometer
❑IR Gun ID: , 05 Type of Ice: ❑wet ❑Blue
Cooler Temp ('C); I..? Correction Factor: Add/Subtract (-C)
Cooler Temp Corrected (Y): )--
USDA Regulated Son (water sample)
Dld samples originate In a quarandne zone within the United States: CA, NY, or SC (check maps)?
❑Yes ❑No
OetePnitigb Pe nEn iNng Comentr.AN' /I- -`/Y
Biological Tissue Frozen?
❑None ❑Yes ❑NO ❑ h*—
Temp should be above freezing to VC
❑5empks anof temp vlteda. Samples an Ice, cooling process
has begun
Did samples orlglmce from a foreign source (Inirmatlanally,
Indudlns Hawall and Puerto RIMP rlYes 11No
WmmenWObs n :
Chain of Custody Present?
No
N/A
]_
Sam IesArrlvedwlthln Hold--
No
N/A
2.
Short Hold Time Analysis <71hr.)?
es
No
N/A
3.
Rush Tum Around Time Re uested?
c
o
N/A
4.
sufficient volume?
No
ONIA
5.
Correct Containers Used?
-Pace Containers Used?
❑yd-
ONO
No
❑N/A
WA
6.
Containers Intact?
er
No
N/A
7.
Dissolvedanal Ls:Sam les Field Flitered7
Yes
No
a.
Sample Labels Match CDC?
-Includes Date/Dme/ID/Analysis Matrbu
❑yes
❑No
❑N/A
9.
Headspace In VOA vlals (oS-6mm)?
es
o
WA
S0.
Trip Blank Dresent?
Trip Blank Custody Seals Present?
❑Yes
es
ONO
ONO
GJW_
11.
COMMENTS/SIMPLE DISCREPANCY
Lot ID of split containers:
C11ENT NOTIFICATION/A ESOLU110N
Person contacted:
Project Manager SCURF Review;
Project Manager SRF Review:
Date/Time:
Fleld Data Required? ❑Yes []No
Date: It /11/4
Date: ((
Page 4 of 6

Dowmem Name:
Document ReAssd: FdnlW 7,2018
Sample CundWon Upon Reca t(SCUR)
Page I of 2
ovannem No.:
Issuing Authoffty:
FCAR-0-0334ev D6
Pace Carolinas QuaRN DRla
$Check mark top half of box If pH and/or deddorfnatlon is
vedfled and within the acceptam range for preservatlon
samples.
Fxcepuow.. VD0. Catfarm, TDC, Ul and Grease, DRDf IS f water) DDC, UHg
"Bottom half of box Is to list number of bottle
Project N W0# : 92453 26 1
PM: COI Due Date: 11/27/19
CLIENT: 91—AWNC
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PH Adjustment Log for Preserved Samples
Simple to
Type of Pmanradva
pH upon receipt
Late prammtlon adttuted
Time presamtion
adjusted
Amount of Presemd"
added
Lott
Note: W harem there ie a dkrrepanq affactfrg North Carolina compliarce amploe, a :coy of mla form MII be ant to tit Norm tSrdlno OENNa CeRlend m ofto V.e.
Out of hold. Incortaa ar•earraw. ouraf tame :nmrted rvntalnen Page 5 of 6

T
ceAaa"cal
CHAIN -OF -CUSTODY / Analytical Request Document
Ti, Cha,14C.OWI I, a LECAL DOWNEHT. M mWa ft TNCs m be ccmpleW B=mt Y.
T
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a
SAMPLE ID
■■■�iir�■■■■■■■■■■■
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■■■■■■■■■EMI■■
■■■■■■■■■■■■■■■■
■■■■■■■■■■■■■■■■
■■■■MINI■■■■■■■
■■■■NI■■■■■■■■■■■■
■■■MINI■■■■■■■■
■■■■■■■■■■■■■■■■■
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` t �'
b e LEGA: pOCUMEN
aceAnayticai'
The CNm.ol-CvsloM
�
> ^yC
r
.Y
Sect,., B
Im'olr<Inl
Seotbn A
Requlrad C1eM lnfomalion:
Rtqulnd Propa lnlonretim.
`rc A}`-+3„',
com, Dy: A W North Camena
Repw To David Kannianen
Narner.
AOdrem: 4112 Old Oxford NWY
Copy T.
Addlest .,'
Durham, NC 27712
P"' °ide
Emn To davidkanniann(� eavmc.wm
PuNbte ONa No.:
ReldeRc•:
Ptu p _ Ch
pre. 919-479-2243 Ft*: 919479-8955
on
Plo'+Nx"'°' Outfall
rN t..
Requested Due Dtt A I:
Proles NumneT.
Rn
tee„ D
vtnd Malls Code•
COLLECTED
Re Iu CN In/wnullan
t1AMix
SLR 9 O
O
petlJx M41EA
? 0 1E
U CC
f
U
./ TE WATER
NW a STMTMT
i
PROaST
Sd/yaD
P aK
oL O
O N
U d'
SAMPLE ID
as
°`
(A-Z
rO
o
Oi O wa
W 0
CL
Semple IDa MUST RE UNIQUE
MUST BE
UE
TIssEE
Ts U Z
w O y
U m 0
TIME _
f w DA
I DATE
1Owl
V G
2
12 TK1N pAT THE
ADDRIONAL COMMENTS
NOUIS B
SAMPLER NAME AND SIGNAI ula
PRINT Name o1 SAMPLER:
� SIGNATURE of SAMPLER
NET ]O Oey WYm
eN lemu end ePed to We Wryn of 1.SX PM
N
',EGUTATORY AGENCY
NPDES r GROUND WATER (-- t_
r UST r RCRA f D1�y
Sim LDCeUDn
STATE:
N
m
(i
ACCEPTED By I AFRUATION
u
e
DATE I TIME
E
r

" 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 impns ent for knowing violations."
Date
For questions, contact your local Regional Office:
DEMLR Regional Office Contact Information:
ASHEVILLEREGIONAL OFFICE
FAYETTEVILLEREGIONA'LiOE WE—
MOORESVIOCEAEGIONAL OFFICE
2090 US Highway 70
225 Green Street
610 East Center Avenue/Suite 301
Swannanoa, NC 28778
Systel Building Suite 714
Mooresville, NC 28115
[phone]
Fayetteville, NC 28301-5043
[phone]
[phone]
RALEIGH REGIONAL OFFICE
WASHINGTON'REGIONAE OFFICE
WILMINGTON REGIONAL OFFICE
3800 Barrett Drive
943 Washington Square Mall
127 Cardinal Drive Extension
Raleigh, NC 27609
Washington, NC 27889
Wilmington, NC 28405-2845
[phone]
[phone]
[phone]
WINSTON-SALEM REGIONAL. OFFICE
CENTRAL -OFFICE
1617 Mail Service Center
450 Hanes Mill Rd. Suite 300
Winston-Salem, NC 27105
Raleigh, NC 27699-1617
[phone]
[phone]
SWU-264 - Generic Annual DMR
Last revised 6/01/2018

Additional Outfall Attachment
Outfall No. 003
Is this outfall currently in Tier 2 (monitored monthly)? Yes ❑ No MV
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes❑ No
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes ❑ No v/
Parameter, (units)
Total
Rainfall,
inches
TSS (mg/L)
pH
(standard units)
Total Copper
(mg/L)
Total Lead
(mg/L)
Total Zinc
(mg/L)
Non -Polar
O&G/ TPH
(mg/L
Total Toxic
Organics
m /L
Benchmark
N/A
100 or 50
6.0 - 9.0
0.010
0.075
0.126
15
1
Date Sample
Collected,
mm/dd/yy
■-__-----
<0.075
0.0402
<15
<1
02/20/2019
7.4
6.66
<0.010
11/12/2019
11.5
8.97
<0.010
<0.075
0.0498
<15
<1
SWU-264 - Generic Annual DMR
Last revised 610112018

aceAnalytical
www Fi cdebscom
Pace Analytical Services, LLC
6701 Conference Drive
Raleigh, NC 27607
[phone]
Laboratory Report
Hakim Lundy
A W North Carolina
4112 Old Oxford Highwy
Durham. NC 27712
Page 1 of 3
Report Date: 11/27/2019
Date Received: 11/13/2019
Project: Ou tfa l l 3 11112
Pace Project No.: 92453623
Sample: OP-3 Lab ID: 92453623001 Collected: 11/12/1914:00 Matrix: Water
Method
Parameters
Results
Units
Report Limit
EPA 1664B
Oil and Grease
ND
mg/L
5.0
EPA 1664B
Total Petroleum Hydrocarbons
ND
mg/L
5.0
EPA 608.3
Aldrin
ND
ug/L
0.050
EPA 608.3
alpha-BHC
ND
ug/L
0.050
EPA 608.3
beta-BHC
ND
ug/L
0.050
EPA 608.3
delta-BHC
NO
ug/L
0.050
EPA 608.3
gamma-BHC(Lindane)
ND
ug/L
0.050
EPA 608.3
Chlordane (Technical)
ND
ug/L
0.50
EPA 608.3
alpha -Chlordane
ND
ug/L
0.050
EPA 608.3
gamma -Chlordane
ND
ug/L
0.050
EPA 608.3
4.4'-DDD
ND
ug/L
0.050
EPA 608.3
4,4'-DDE
ND
ug/L
0.050
EPA 608.3
4,4'-DDT
ND
ug/L
0.050
EPA 608.3
Dieldrin
ND
ug/L
0.050
EPA 608.3
EndosulfanI
NO
ug/L
0.050
EPA 608.3
Endosulfan II
NO
ug/L
0,050
EPA 608.3
Endosulfan sulfate
ND
ug/L
0.050
EPA 608.3
Endrin
ND
ug/L
0.050
EPA 608.3
Endrin aldehyde
NO
ug/L
0.050
EPA 608.3
Heptachlor
ND
ug/L
0.050
EPA 608.3
Heptachlor epoxide
ND
ug/L
0.050
EPA 608.3
PCB-1016 (Aroclor 1016)
ND
ug/L
0.50
EPA 608.3
PCB-1221(Aroclor 1221)
NO
ug/L
0.50
EPA 608.3
PCB-1232 (Aroclor 1232)
ND
ug/L
0.50
EPA 608.3
PCB-1242 (Aroclor 1242)
ND
ug/L
0.50
EPA 608.3
PCB-1248 (Aroclor 1248)
NO
ug/L
0.50
EPA 608.3
PCB-1254 (Aroclor 1254)
ND
ug/L
0.50
EPA 608.3
PCB-1260 (Aroclor 1260)
NO
ug/L
0.50
EPA 608.3
Toxaphene
NO
ug/L
0.50
EPA 200.7 Rev 4.4 1994
Copper
5.8
ug/L
5.0
EPA 200.7 Rev 4.4 1994
Lead
ND
ug/L
5.0
EPA 200.7 Rev 4.4 1994
Zinc
34.7
ug/L
10.0
EPA625.1
Acenaphthene
ND
ug/L
4.9
EPA 625.1
Acenaphthylene
NO
ug/L
4.9
EPA 625.1
Anthracene
ND
ug/L
4.9
EPA 625.1
Benzo(a)anthracene
ND
ug/L
4.9
EPA 625.1
Benzo(a)pyrene
ND
ug/L
4.9
EPA 625.1
Benzo(b)fluoranthene
NO
ug/L
4.9
EPA625.1
Benzo(g,h,i)perylene
ND
ug/L
4.9
EPA625.1
Benzo(k)fluoranthene
ND
ug/L
4.9
EPA 625.1
4-Bromophenylphenyl ether
ND
ug/L
4.9
EPA 625.1
Butylbenzylphthalate
ND
ug/L
4.9
Analyzed Qualifiers
11/26/1913:52 M1
11/26/19 13:52
11/20/19 14:32
11/20/19 14:32
11/20/19 14:32
11/20/19 14:32
11/20/19 14:32
11/20/19 14:32
11/20/19 14:32
11/20/19 14:32
11/20/19 14:32
11/20/19 14:32
11/20/19 14:32
11/20/19 14:32
11/20/19 14:32
11/20/19 14:32
11/20/19 14:32
11/20/19 14:32
11/20/19 14:32
11/20/19 14:32
11/20/19 14:32
11/20/19 14:32
11/20/19 14:32
11/20/19 14:32
11/20/19 14:32
11/20/19 14:32
11/20/19 14:32
11 /20119 14:32
11/20/19 14:32
11 /21 /19 01:42
11 /21 /19 01:42
11/21/19 01:42
11/24/19 18:58
11/24/19 18:58
11/24/19 18:58
11/24/19 18:58
11/24/19 18:58
11/24/19 18:58
11/24/19 18:58
11/24/19 18:58
11/24/19 18:58
11/24/19 18:58 Page 1 of 6

aceAnalytical
www.pacalahs.com
Pace Analytical Services, LLC
6701 Conference Drive
Raleigh, NC 27607
[phone]
Page 2 of 3
Sample: OF-3
Method
Lab ID:
Parameters
92453623001 Collected: 11/12/19 1400 Matrix:
Results Units Report Limit
Water
Analyzed Qualifiers
EPA 625.1
4-Chloro-3-melhylphenol
NO
ug/L
4.9
11124/1918:58
EPA 625A
bis(2-Chloroethoxy)methane
NO
ug/L
9.8
11/24/1918:58
EPA625.1
bis(2-Chloroethyp ether
NO
ug/L
4.9
11/24/1918:58
EPA625.1
2-Chloronaphthalene
NO
ug/L
4.9
11/24/1918:58
EPA 625.1
2-Chlorophenol
NO
ug/L
4.9
11/24/191858
EPA 625.1
4-Chlorophenylphenyl ether
NO
ug/L
4.9
11/24/1918:58
EPA 625.1
Chrysene
NO
ug/L
4.9
11/24/1918:58
EPA625A
Dibenz(a,h)anthracene
NO
ug/L
4.9
11/24/1918:58
EPA 625.1
3,3'-Dichlorobenzidine
NO
ug/L
24.5
11124/1918:58
EPA 625.1
2,4-Dichlorophenol
NO
ug/L
4.9
11124/1918:58
EPA 625.1
Diethylphthalate
NO
ug/L
4A
11/24/1918: 58
EPA 625.1
2,4-Dimethylphenol
NO
ug/L
9.8
11/24/1918:58
EPA 625.1
Dimethylphthalate
NO
ug/L
4.9
11124/1918:58
EPA 625.1
Di-n-butylphtha late
NO
ug/L
4.9
11/24/1918:58
EPA 625.1
4,6-Dinitro-2-methylphenol
NO
ug/L
19.6
11/24/1918:58
EPA 625.1
2,4-Dinitrophenol
NO
ug/L
49.0
11124/1918:58
EPA 625.1
2,4-Dinitrotoluene
NO
ug/L
4.9
11/24/1918:58
EPA 625A
2,6-Dinitrotoluene
NO
ug/L
4.9
11/24/1918:58
EPA 625.1
Di-n-oclylphthalate
NO
ug/L
4.9
1112411918:58
EPA625.1
bis(2-Ethylhexyl)phthalate
NO
ug/L
4.9
11/24/1918:58
EPA625.1
Fluoranthene
NO
ug/L
4.9
11/2411918:58
EPA 625.1
Fluorene
NO
ug/L
4.9
11/24/1918:58
EPA 625.1
Hexachloro-1,3-butadiene
NO
ug/L
4.9
11/24/1918:58
EPA 625.1
Hexachlorobenzene
NO
ug/L
4.9
11/2411918:58
EPA 625.1
Hexachlorocyclopentadiene
NO
ug/L
9.8
11/24/1918:58
EPA 625.1
Hexachloroethane
NO
ug/L
4.9
11/24/1918:58
EPA 625.1
Indeno(1,2,3-cd)pyrene
NO
ug/L
4.9
1112411918: 58
EPA625.1
Isophorone
NO
ug/L
9.8
11/2411918:58
EPA625A
Naphthalene
NO
ug/L
4.9
11/24/1918:58
EPA 625.1
Nitrobenzene
NO
ug/L
4.9
11/24/1918:58
EPA625.1
2-Nitrophenol
NO
ug/L
4.9
11/24/1918:58
EPA 625.1
4-Nitrophenol
NO
ug/L
49.0
11124/1918:58
EPA 625.1
N-Nitrosodimethylamine
NO
ug/L
4.9
11124/1918:58
EPA 625.1
N-Nitroso-di-n-propylamine
NO
ug/L
4.9
11/24/1918:58
EPA 625.1
N-Nitrosodiphenylamine
NO
ug/L
9.8
11/24/1918:58
EPA625A
2,2'-Oxybis(1-chloropropane)
NO
ug/L
4.9
11/24/1918:58
EPA 625.1
Pentachlorophenol
NO
ug/L
9.8
11/24/1918:58
EPA 625.1
Phenanthrene
NO
ug/L
4.9
11/24/1918:58
EPA 625.1
Phenol
NO
ug/L
4.9
11124/1918:58
EPA 625.1
Pyrene
NO
ug/L
4.9
1112411918:58
EPA625A
1,2,4-Trichlorobenzene
NO
ug/L
4.9
11/24/1918:58
EPA625.1
2,4,6-Trichlorophenol
NO
ug/L
9.8
11/24/1918:58
EPA 624.1
Benzene
NO
ug/L
1.0
11119/1903:00
EPA 624.1
Bromodichloromethane
NO
ug/L
2.0
11119/1903:00
EPA 624.1
Bromoform
NO
ug/L
2.0
11/1911903:00
EPA 624.1
Bromomethane
NO
ug/L
2.0
11/1911903:00
EPA 624.1
Carbon tetrachloride
NO
ug/L
2.0
11/19/1903:00
EPA 624.1
Chlorobenzene
NO
ug/L
2.0
11119/1903:00
EPA 624.1
Chloroethane
NO
ug/L
2.0
1111911903:00
EPA624.1
Chloroform
NO
ug/L
2.0
1111911903:00
EPA 624.1
Chloromethane
NO
ug/L
2.0
11/19/1903:00
EPA 624.1
Dibromochloromethane
NO
ug/L
2.0
11/19/1903:00
EPA 624.1
1,2-Dichlorobenzene
NO
ug/L
2.0
11/19/1903:00
EPA 624.1
1,3-Dichlorobenzene
NO
ug/L
2.0
11/1911903:00
EPA 624.1
1,4-Dichlorobenzene
NO
ug/L
2.0
11119/1903:00
EPA 624.1
1,1-Dichloroelhane
NO
ug/L
2.0
11/19/1903:00
EPA 624.1
1,2-Dichloroethane
NO
ug/L
2.0
11/19/1903:00
EPA 624.1
1,1-Dich loroethene
NO
ug/L
2.0
11/19/1903:00 Page of

aceAnalytical
ww.pecelass.cam
Pace Analytical Services, LLC
6701 Conference Drive
Raleigh, NC 27607
[phone]
Page 3 of 3
Sample: OF-3
Method
Lab ID:
Parameters
92453623001 Collected: 11/12/19 14:00 Matrix:
Results Units Report Limit
Water
Analyzed Qualifiers
EPA624.1
cis-1,2-Dichloroethene
ND
ug/L
2.0
11/1911903: 00
EPA 624.1
trans-1,2-Dichloroethene
ND
ug/L
2.0
11/19/1903:00
EPA 624A
1,2-Dichloropropane
ND
ug/L
2.0
11/19/1903:00
EPA 624A
cis-1,3-Dichloropropene
ND
ug/L
2.0
11/19/1903:00
EPA 624.1
trans-1,3-Dichloropropene
ND
ug/L
2.0
11/19/1903:00
EPA624.1
Ethylbenzene
ND
ug/L
1.0
11/19/1903:00
EPA 624.1
Methylene Chloride
ND
ug/L
2.0
11/19/1903:00
EPA 624.1
1,1,2,2-Tetrachloroethane
ND
ug/L
2.0
1111911903:00
EPA 624.1
Tetrachloroethene
ND
ug/L
2.0
11119/1903:00
EPA 624A
Toluene
ND
ug/L
1.0
11/19/1903:00
EPA 624.1
1,1,1-Trichloroethane
ND
ug/L
2.0
11/19/1903:00
EPA 624.1
1,1,2-Trichloroethane
ND
ug/L
2.0
11/19/1903:00
EPA 624.1
Trichloroethene
ND
ug/L
2.0
11/19/1903:00
EPA 624.1
Trichloro0uoromethane
ND
ug/L
2.0
11/19/1903:00
EPA 624.1
Vinyl chloride
ND
ug/L
2.0
11/19/1903:00
SM 2540D-2011
Total Suspended Solids
13.2
mg/L
5.0
11/15/19 11:11
EPA 9040C
pH at 25 Degrees C
5.7
Std. Units
0.10
11/24/19 16:55 H3
EPA 420.4 Rev 1.0 1993
Phenol
ND
mg/L
0,020
11/20/19 12:59
SM 4500-CN-E-2011
Cyanide
ND
mg/L
0.0080
11121/1914: 34
ANALYTE QUALIFIERS
H3 Sample was received or analysis requested beyond the recognized method holding time.
M1 Matrix spike recovery exceeded QC limits. Batch accepted based on laboratory control sample (LCS) recovery.
Reviewed by: G/L
Chris Derouen
[phone]
[e-mail]
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
2225 Riverside Drive, Asheville, NC 28804
Florida/NELAP Certification #: E87648
Massachusetts Certification #: M-NC030
North Carolina Drinking Water Certification #: 37712
South Carolina Certification #: 99006001
Florida/NELAP Certification #: E87627
Kentucky UST Certification #: 84
VirginiaNELAP Certification #: 460221
North Carolina Wastewater Certification #: 40
South Carolina Certification #: 99030001
VirginiaNELAP Certification #: 460222
Page 3 of 6

g^/
Document Name:
Document Revised: February 7, 2018
j •
/ Ce
Sample Condition Upon Repel [(SLUR)
Page 1 of 2
Document No.:
Issuing Authority:
. �
.
F-CAR-CS-033-Rev.06
Pau Carolinas Quality Office
Laboratory recelving samples:
Asheville ❑ Eden❑ Greenwood ❑ Huntersvllle ❑ Ralelgha�-- Mechardcsville❑
CllentName: project Al. W®# :92453623
Courier.
Commercial U; ce�L ❑UPS OOther._ ❑tllent IIIII I2I II I III III 6II
lx
92453623
Custody Seal Present? QYes � Seals IntaR? ❑Yes o
Date/Initials Person Esmmininl Contents: /f lr/J-lY
Packing Material: ❑Bubble Wrap bie Bags Done . 0 Other
Thermometer. i-
❑IRGunID: ISO Type of lee: ❑Wet .❑Blue
Cooler Tamp('C):; Correctionfactor.Add/Subtract(-C)
Cooler Temp Corrected('C):�•i
USDA Regulated Sol] (water sample)
Did samples originate In a quarantine zone wkhin the Unked States: CA, NY, or SC (check maps)?
[ yes; rINo
Biological Tissue Froun?
❑Novo
QYet []No ❑G/A—
Temp should be above freezing to EC
❑Simples out of temp criteria. Samples on lee, cooling process
has begun
Old Sartples migbum from a foreign source (Internationally,
._. Comments/Discrepancy: u
dy Present?
No
N/A
L
Arrived wkhin Hold Time?
=AnaIy5ls(<72
No
❑N/a
L
Time Analysis(<72 hr.7
Yes
No
❑N/A
3.
und Tlme R tested?
Yes
o
N/A
4.
me?
No
WA
5.
Correct Containers Used?
-Pace Containers Used?
�
❑Ne
No
❑N/A
N/A
G.
Containers intact?
es
No
N/Aered?
7.
Dlssclved amisls: Samles Feld Flh
m
No
a.
Sample labels Match COC?
-lncIuc1esDate/nme/IC/Analysls Mattls:�✓
❑Yes
❑No
❑H/A
9.
Heads u In VOA Vials (>5-6mm)7
yes
o
N/a
10.
Trip Blank Present?
TrIE Blank Custody Seats Present?
❑Yes
Ya
❑No
No
(-/JyJlr
11.
COMMENTS/SAMPLE DISCREPANCY
CLIENT NOTIFICATION/RESOLUTION Lot ID of split containers•
Person contacted:
Project Manager SCURF Review:
Project Manager SRF Review:
Date/ilme:
Date: h rY
Date: /� r
Field Data Required? ❑Yes [:]NO
i
I
Page 4 of 6

'Check mark top half of box if pH and/or dechlorinatlon is
verified and within the acceptance range for preservation
samples.
EwPft- voa rmrmm, Tor. Da and Grease, Da0/8015 (waters DDC, uHg
"Bottom half of box is to list number of bottle
Project WO# : 92453623
PM: COI Due Date: 11/27/19
CLIENT: 91-AWNC
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12
pH Adjustment Log for Preserved Samples
Sampla LD
Type of?resemdva
pH upon recelpt
Date presamtlon aditnted
none pra "Hen
adiusted
Amount of pruarvativa
added
Lot
nu.v: rr nenev[r merp e a 0=,.pancy ar2Cnnp NoCaranna Campllanca Umplas, a Copy or Tb rorrnWal aewncop tr. NOM CKMMA UWrvX urtrn9non v:�¢a p.a.
Dut of hold. inovraa orassrre v.. out oa [emo �nmrteo mncalnen
I
Page 5 of 6

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IMMEMINIM
Milli
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1MMEMIN
Page 6 of 6

" 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 impri�pnment for knowing violations."
Sign
Date
For questions, contact your local Regional Office:
DEMLR Regional Office Contact Information:
ASHEVILLE REGIONAL OFFICE
FAYETTEVILLE REGIONAL OFFICE
MOORESVICLE REGIONAL OFFICE
2090 US Highway 70
225 Green Street
610 East Center Avenue/Suite 301
Swannanoa, NC 28778
Systel Building Suite 714
Mooresville, NC 28115
[phone]
Fayetteville, NC 28301-5043
[phone]
[phone]
RALEIGH REGIONAL OFFICE
WASHINGTON REGIONAG:OFFICE
WILzMINGTON`REGIONAL OFFICE j
3800 Barrett Drive
943 Washington Square Mall
127 Cardinal Drive Extension
Raleigh, NC 27609
Washington, NC 27889
Wilmington, NC 28405-2845
[phone]
[phone]
[phone]
WINSTON-SALEM REGIONAL OFFICE
CENTRAli OFFICE
1617 Mail Service Center
450 Hanes Mill Rd, Suite 300
Winston-Salem, NC 27105
Raleigh, NC 27699-1617
[phone]
[phone]
SWU-264 - Generic Annual DMR
Last revised 610112018