NCG060021_MONITORING INFO_20190821

1 vS7�
STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
DOC TYPE
❑ HISTORICAL FILE
5t MONITORING REPORTS
DOC DATE
❑
YYYYMMDD

(jD
Tyson
August 12, 2019
North Carolina Department of Environment, Health and Natural Resources
Division of Water Quality
Attn:Central Files 1617 RCCEIVED
1617 Mailail Service Center
Raleigh, NC 27699-1617 AUG 2 12019
CL�PJTRAL FILES
Subject: General Permit No. NCG060000 DVVR+ SECTION
Tyson,Foods, Roaring River Feed Mill
COC NCG060021
Wilkes County
Dear Madam or Sir:
Enclosed are two copies of the required storm water sampling results.
For the outfalls Covered under the above subject permit and certificate of coverage.
Tyson Farms, Inc. Storm water sampling Period 1 semi-annual monitoring. Data receive for
PRISM labs indicated RRIV — 04 TSS, COD parameters was above the benchmark.
Tyson Foods, Inc. has made significant improvements to reduce the concentrations of the
parameter of concern.
Please contact me at 336- 838- 2171, extension 2871 should you have any questions.
S
.lames Brown
Complex Environmental Manager
Tyson Farms Inc. Fresh Retail Division 704 Factory Wilkesboro, N.C. 28697
336-651-3836 336.838.2171 Fax: [phone] w .tysonfoods.com

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
For North Carolina Division of Water Quality General Permit No. NCG060000
Date submitted: 08 -12- 2019
CERTIFICATE OF COVERAGE NO. NCG060021 SAMPLE COLLECTION YEAR 2019
FACILITY NAME Tyson Farms Inc. FACILITY ACTIVITIES INCLUDE (check all that apply):
Roaring River Feed Mill ❑ use/process meats ® use animal fats/byproducts
COUNTY Wilkes DISCHARGING TO SALTWATERS? [_]YES ®NO
PERSON COLLECTING SAMPLES James Brown
LABORATORY Prism Labs Lab Cert. # 402
Part A: Storm water Benchmarks and Monitoring Results
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Total event rainfall z.5 or ❑ No discharge this period]
Outfall No.
Sample Collected,
Mo./dd./yr.
TSS,
mg/L
pH,
Standard units
COD,
mg/L
Oil and Grease,
mg/L
Fecal Coliform',
Colonies per 100 ml
Enterococci',
Colonies per 100 ml
Benchmark
-
100 or 50'
Within 6.0 — 9.0
120
30
1000
500
RRIV - 01
07/22-2019
8.4
6.87
50
5.0
NA
NA
RRIV - 02
07/22-2019
10
7.08
50
5.0
NA
NA
RRIV - 04
07/22-2019
180
7.19
230
5.0
NA
NA
1 Only applies to facilities that use/process meats.
ZThe total precipitation must be recorded using data from an on -site rain gauge.
3 For sampling periods with no discharge at any outfalls. You must still submit this discharge monitoring report with a checkmark here.
°See General Permit text, Table 3 identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? ® Yes ❑ no
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new motor oil/month.
(if yes, complete Part B)
Outfall No.
Sample Collected,
Mo./dd./yr.
Oil and Grease,
mg/L
Non Polar Oil
&Grease/TPH
mg/L
TSS,
mg/L
pH,
Standard units
New Motor Oil Usage,
Annual average gal/mo
Benchmark
-
30
15
100or.504
6.0-9.0
-
RRIV - 04
07/22-2019
5.0
5.0
180
7.19
215
1 Only applies to facilities that use/process meats. '
ZThe total precipitation must be recorded using data from an on -site rain gauge.
3 For sampling periods with no discharge at any outfalls, you must still submit this discharge monitoring report with a checkmark here.
'See General Permit text table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
SWU-249 Last Revised: October 18, 2012
Page] of 2

*FOR PART A AND PART B MONITORING RESULTS:
* A BENCHMARK EXCEEDANCE TRIGGERS TIER iREQUIREMENTS. SEE PERMIT PART If 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 and one copy of this DMR including all "No Discharge" reports within 30 days of receipt of the lab results for at end of
monitoring period in the case of "No Discharge" reports) to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, NC 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 z
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."
of Permittee)
(Date)
Additional copies of this form may be downloaded at: http://portal.ncdenr.org/web/wq/ws/su/npdessw#tab-
SWU-249
Last Revised: October 18, 2012
Page 2 of 2

Roaring River Storm Water Calu. Sheet
Date 7-22-2019
Rain Begin:
4:25 PM light on and off
Runoff Begin:
4:35 PM
Grab Samples:
5:05 PM
Rain at end of
Storm Event:
0.50
Sampling Point RRIV- 01 Drainage Area = (150 acres `43560) Ft 2
Q = CIA
1 = 0.50 " (Total)
C = 0.35
Q = 0.35(0.50/12)(6,534,000'7.5)/1,000,000
= 0.715 MG
Sampling Point RRIV- 02 Drainage Area = (96485) Ft 2
Q = CIA
1 = 0.50 " (Total)
C = 0.95
Q = 0.95(0.50/12)(96485-7.5)/1,000,000
= 0.029 MG
Sampling Point RRIV- 04 Drainage Area = (75,085) Ft 2
Q = CIA
1 = 0.50" (Total)
C = 0.95
Q = 0.95(0.50/12)(75,085'7.5)/1,000,000
= 0.022 MG

��A
NCDENR
Storm water Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance on filling out this form, please visit: http•//portal ncdenr org/web/wit/ws/su/nodessw#tab-4
Permit No: N/C/G/0/6/0/0/0/0 or Certificate of Coverage No. N/C/G/0/6/0/0/2/1
Facility Name: Tyson Farms Inc. Roaring River Feed Mill
County: Wilkes
Phone No: 336.696.2741
Inspector: Raymond Nichols
Date of Inspection: 07/22/2019
Time of Inspection: S'.05 -� VY1
Total Event Precipitation (inches):.5
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit? (See
information below.)
dYes ❑ No
Please verify whether Qualitative Monitoring must he performed during a "representative storm event"or
"measureahlestorm event" (requirements vary, depending on the permit).
ttuautative monitoring requirements vary. most permits require qualitative monitoring to be performed
during a "representative storm event" or during a "measureable storm event" However, some permits do not
have this requirement. Please refer to these definitions, if applicable.
A "representative storm event" is a storm event that measures greater than 0.1 inches of rainfall and that is
preceded by at least 72 hours (3 days) in which no storm event measuring greater than
0.1 inches has occurred. A single storm event may contain up to 10 consecutive hours of no
precipitation.
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 DWQ Regional Office.
By this signature, I certify that this report is accurate and complete to the best of my knowledge:
of Permittee or Designee)
Page 1 of 2
SWU-242, Last modified 10/25/2012

1. On all Description:
Outfall No. RiV - () ( Structure (pipe, ditch, etc.)
Receiving Stream: ��Y\1\cx.vrcu�—TC:4tu%.y "-o A c yJ�1C'.r� :VGA
Describe the industrial activities that occur within the outfall drainage area: (v%x)C:!'i p L
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: L' C;wk
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil, weak
chlorine odor, etc.): 1\ 0 h C.
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is clear and
5 is very cloudy:
1 0 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:
n 2 3 4 5
6. Suspended Solids: Choose the number which best describes the amount of suspended solids in
the stormwater discharge, where 1 is no solids and 5 is extremely muddy:
V 2 3 4 5
7. Is there any foam in the stormwater discharge? Yes
N
8. Is there an oil sheen in the stormwater discharge? Yes
N
9. Is there evidence of erosion or deposition at the outfall? Yes
N
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.
Page 2 of 2
SWU-242, Last modified 10/25/2012

NCDENR
Storm water Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance on filling out this form, please visit: httl2i//bortal.ncdennorg/web/wq/ws/, u/nodessw#tab-4
Permit No: N/C/G/0/6101O/OL or Certificate of Coverage No. N/C/G/0/6/0/0/2/1
Facility Name: Tyson Farms Inc. Roaring River Feed Mill
County: Wilkes
Phone No: 336.696.2741
Inspector: Raymond Nichols
Date of Inspection: 07/22/2019
Time of Inspection: r� QIYI
Total Event Precipitation (inches):.5
Was this a "Representative Storm Event" or "Measureable Storm Event' as defined by the permit? (See
information below.)
M/Yes No
Please verify whether Qualitative Monitoring must he performed during a "representative storm event" or
"measureahlestorm event" (requirements vary, depending on the permit).
ttuainanve monitoring requirements vary. most permits require qualitative monitoring to be performed
during a "representative storm event' or during a "measureable storm event." However, some permits do not
have this requirement. Please refer to these definitions, if applicable.
A "representative storm event" is a storm event that measures greater than 0.1 inches of rainfall and that is
preceded by at least 72 hours (3 days) in which no storm event measuring greater than
0.1 inches has occurred. A single storm event may contain up to 10 consecutive hours of no
precipitation.
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 DWQ Regional Office.
By this^ signature, I certify that this report is accurate and complete to the best of my knowledge:
of Permittee or Designee)
Pagel of 2
SWU-242, Last modified 10/25/2012

1. Outfall Description:
Outfall No. 9QX%4 .. not,
Receiving Stream: NXnrt(A
ditch, etc.)�� P�'� 'i
Describe the industrial activities that occur within the outfall drainage
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: 1—I S h-�
3.
Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil, weak
chlorine odor, etc.):
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is clear and
5 is very cloudy:
1 9 3 4 S
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:
2 3 4 5
6. Suspended Solids: Choose the number number which best describes the amount of suspended solids in
the stormwater discharge, where 1 is no solids and 5 is extremely muddy:
(0 2 3 4 5
7. Is there any foam in the stormwater discharge? Yes I✓
8. Is there an oil sheen in the stormwater discharge? Yes
9. Is there evidence of erosion or deposition at the outfall? Yes Ip9
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.
Page 2 of 2
S WU-242, Last modified 10/25/2012

NCDENR
Storm water Discharge Outfall (SDO)
Qualitative Monitoring Report
Forguidonce on filling out thisform, please visit: htti2://portal.ncdenr.org/web/wq/ws/su/­npdessw#tab-4
Permit No: N,C/G/0/6/0/0/0/0 or Certificate of Coverage No. N/C/G/0/6/0/0/2/1
Facility Name: Tyson Farms Inc. Roaring River Feed Mill
County: Wilkes
Phone No: 336.696.2741
Inspector: Raymond Nichols
Date of Inspection: 07 22 2019
Time of Inspection: 5��M
Total Event Precipitation (inches):.5
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit? (See
information below.)
Yes No
Please verify whether Qualitative Monitoring must be performed during a "representative storm event" or
"measureablestorm event" (requirements vary, depending on the permit).
t2uautanve monitoring requirements vary. most permits require qualitative monitoring to be performed
during a "representative storm event" or during a "measureable storm event." However, some permits do not
have this requirement. Please refer to these definitions, if applicable.
A "representative storm event' is a storm event that measures greater than 0.1 inches of rainfall and that is
preceded by at least 72 hours (3 days) in which no storm event measuring greater than
0.1 inches has occurred. A single storm event may contain up to 10 consecutive hours of no
precipitation.
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 DWQ Regional Office.
By this signature, I certify that this report is accurate and complete to the best of my knowledge:
(Signature o fpermittee or Designee)
Pagel of 2
SWU-242, Last modified 10/25/2012

1. On I1 Description: `
Cu[fall No. G�-r ' 64 Structure (pipe, ditch, etc.)
Receiving Stream: Yt ha C:%tt ry -+b .+ C tOAK:lh %vex
Describe the industfial activities that occur within the outfall drainage areaik` ^4 OF oct «c
S e-c V: Ce- 9.r\+Cr
2. Color: Describe the color of thi discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: _Z ' iV
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil, weak
chlorine odor, etc.): i\O A f-
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is clear and
5 is very cloudy:
1 /l 3 4 5
S. Floating Solids: Choose the number which best describes the amount of Floating solids in the
stormwater discharge, where 1 is no solids and 5 is the surface covered with Floating solids:
1 t 3 4 5
6. Suspended Solids: Choose the number which best describes the amount of suspended solids in
the stormwater discharge, where 1 is no solidss and 5 is extremely muddy:
1 V 3 4 5
7. Is there any foam in the stormwater discharge? Yes
I�
8. Is there an oil sheen in the stormwater discharge? Yes
N)
9. Is there evidence of erosion or deposition at the outfall? Yes
(0
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.
Page 2 of 2
SW U-242, Last modified 10/25/2012

gPiRISM
-D 908AT9alEe,I11G
Full -Service Analytical &
Environmental Solutions
Tyson Farms, Inc. -Roaring River
Raymond Nichols
179 Roaring River Rd.
Roaring River, NC 28669
NC Certification No. 402
NC Drinking Water Cart No, 37735
SC Certification No. 99012
Project: Stormwater
Lab Submittal Date: 07/23/2019
Prism Work Order: 9070324
Case Narrative
8/7/19 14:28
This data package contains the analytical results for the project identified above and includes a Case Narrative, Sample
Results and Chain of Custody. Unless otherwise noted, all samples were received in acceptable condition and processed
according to the referenced methods.
Data qualifiers are Flagged individually on each sample. A key reference for the data qualifiers appears at the end of this case
narrative.
Please call if you have any questions relating to this analytical report.
Respectfully,
PRISM LABORATORIES, INC.
M
Terri W. Cole
Project Manager
Data Qualifiers Key Reference
Reviewed By Jackie Ziner For Terri W. Cole
Project Manager
L Parameter reported with possible low bias. LCS recovery below the QC limit.
OG HEM O&G is less than the reporting limit, therefore TPH (SGT-HEM) is less than the reporting limit. Sample not
extracted for TPH (SGT-HEM).
BRL Below Reporting Limit
MDL Method Detection Limit
RPD Relative Percent Difference
Results reported to the reporting limit. All other results are reported to the MDL with values between MDL and
reporting limit indicated with a J.
This report should not be reproduced, except in its entirely, without the written consent of Prism Laboratories, Inc.
449 Springbrook Road - P.O. Box 240543 - Charlotte, NC 28224-0543
Phone: [phone] - Toll Free Number: 1-8001529-6364 - Fax: [phone] Page 1 of 7

Sample Receipt Summary
�P R I S M
I Full-SeMea Analytical 4
Environmental Solutions06/07/2019
✓wawnmmct irc
Prism Work Order: 9070324
Client Sample ID
Lab Sample ID
Matrix
Date/Time Sampled Date/Time Received
RRIV-01
9070324-01
Water
07/22/19 17:05 07/23/19 16:30
RRIV-02
9070324-02
Water
07/22/19 17:10 07/23/19 16:30
RRIV-04
9070324-03
Water
07/22/19 17:25 07/23/19 16:30
Samples were received in good condition at 3.9 degrees C unless otherwise noted.
This report should not be reproduced, except in its entirety, without the written consent of Prism Laboralones, Inc.
449 Springbrook Road - P.O. Box 240543 - Charlotte, NC 28224-0543
Phone: [phone] - Toll Free Number: 1-6001529-6364 - Fax: [phone] Page 2 of 7

R ISM I Fullironmee Analytical S
[J L, Environmental Solutions
Tyson Farms, Inc. -Roaring River
Attn: Raymond Nichols
179 Roaring River Rd.
Roaring River, NC 28669
Project: Stormwater
Sample Matrix: Water
Laboratory Report
08/07/2019
Client Sample ID: RRIV-01
Prism Sample ID: 9070324-01
Prism Work Order: 9070324
Time Collected: 07/22/19 17:05
Time Submitted: 07/23/19 16:30
Parameter Result Units Report MDL Dilution Method Analysis Analyst Batch
Limit Factor DalerFune ID
General Chemistry Parameters
Chemical Oxygen Demand BRL mg/L 50 10 1 'SM5220D 7/26119 8:19 SLS PSG0430
Oil B Grease (HEM) BRILL mg/L 5.0 1.7 1 '1664B 8/1/19 10:07 SLS P9H0052
Total Suspended Solids 8.4 mg/L 5.0 0.70 1 'SM2540 D 7129/19 17:01 CBM P9G0484
This report should not be reproduced, except in its entirety, without the written consent of Prism Laboratories, Inc.
449 Springbrook Road - P.O. Box 240543 - Charlotte, INC 28224-0543
Phone: [phone] -Toll Free Number: 1-8001529-6364 - Fax: [phone] Page 3 of 7

n �
f f E31 S M I
FnlliSe s
Environmental Solutions Tyson Farms, Inc. -Roaring River
Attn: Raymond Nichols
179 Roaring River Rd.
Roaring River, NC 28669
Project: Stormwater
Sample Matrix: Water
Laboratory Report
08/0712019
Client Sample ID: RRIV-02
Prism Sample ID: 9070324-02
Prism Work Order: 9070324
Time Collected: 07/22/19 17:10
Time Submitted: 07/23/19 16:30
Parameter Result Units Report MDL Dilution Method Analysis Analyst Batch
Limit Factor DateMme ID
General Chemistry Parameters
Chemical Oxygen Demand BRL mg/L 50 10 1 'SM5220 D 7/26/19 8:19 SLS P9G0430
Oil B Grease (HEM) BRILL mg/L 5.0 1.7 1 '1664B 8/l/19 10:07 SLS P9H0052
Total Suspended Solids 10 mg/L 5.0 0.70 1 'SM2540 D 7129/19 17:01 CBM P9G0484
This report should not be reproduced, except in its entirety, without the written consent of Prism Laboratories, Inc.
449 Springbrook Road - P.O. Box 240543 - Charlotte, NC 28224-0543
Phone: [phone]- Toll Free Number: 1-8001529-6364 - Fax: [phone] Page 4 of 7

4
R I S M I Fullironmee
Laboratory Report
al
�P Environmental
'J aowron,ra,xc
Solutions
8oluuone
08/07/2019
Tyson Farms, Inc. -Roaring River
Project: Stormwater
Client Sample ID: RRIV-04
Attn: Raymond Nichols
Prism Sample ID: 9070324-03
179 Roaring River Rd.
Prism Work Order: 9070324
Roaring River, NC 28669
Sample Matrix: Water
Time Collected: 07/22/19 17:25
Time Submitted: 07/23/19 16:30
Parameter
Result Units
Report
MDL
Dilution Method Analysis Analyst
Batch
Limit
Factor DateTme
ID
General Chemistry Parameters
Chemical Oxygen Demand
230 mg/L
50
10
1 'SM5220 D 7126119 8:19 SLS
PgG0430
Oil 8 Grease (SGT-HEM)
BRLOG mg/L
5.0
1.6
1 '1664B 8/6/19 9:00 SLS
P91-10094
Total Suspended Solids
180 mg/L
17
0.70
1 'SM2540 D 7/29/19 17:01 CBM
P9G0464
a
This report should not be reproduced, except in its entirety, without the written consent of Prism Laboratories, Inc.
449 Springbrook Road - P.O. Box 240543 - Charlotte, NC 28224-0543
Phone: [phone] - Toll Free Number: 1-8001529.6364 - Fax: [phone] Page 5 of 7

A4.ronwaR ISM I Enviro nice al Solutio d
Environmental Solullone
we
Level II QC Report
817/19
Tyson Farms, Inc. -Roaring River
Attn: Raymond Nichols
179 Roaring River Rd.
Roaring River, NC 28669
General Chemistry Parameters - Quality Control
Analyte
Batch P9G0430 - NO PREP
Project: Stormwater
Reporting
Result Limit Units
Prism Work Order: 9070324
Time Submitted: 7/23/2019 4:30:00PM
Spike Source %REC RPD
Level Result %REC Limits RPD Limit Notes
Blank (P9G0430-BLK1) Prepared & Analyzed: 07/26/19
Chemical Oxygen Demand BRL 50 mg/L
LCS (P9G0430-BSI) Prepared & Analyzed: 07/26/19
Chemical Oxygen Demand 498 50 mg/L 500.0 100 90-110
Batch 139130484 - NO PREP
Blank (PgG0484-BLKI) Prepared & Analyzed: 07/29/19
Total Suspended Solids BRL 5.0 mg/L
LCS (P9G0484-BSI) Prepared & Analyzed: 07/29/19
Total Suspended Solids 480 5.0 mg/L 477.0 101 90-110
Batch P9H0052 - NO PREP
Blank (P9H0052-BLK1) Prepared & Analyzed: 08/01/19
Oil & Grease (HEM) BRL 5.0 mg/L
LCS (P9H0052-BS1) Prepared &Analyzed: 08/01/19
Oil & Grease (HEM) 30.5 5.0 mg/L 40.00 76 78-114 L
Batch 139110094 - NO PREP
Blank (P91,10094-BLK1) Prepared & Analyzed: 08/06/19
Oil & Grease (SGT-HEM) BRL 5.0 mg/L OG
This report should not be reproduced, except in its entirety, without the written consent or Prism Laboratories, Inc.
449 Springbrook Road - P.O. Box 240543 - Charlotte, NC 28224-0543
Phone: [phone] - Toll Free Number: 1.8001529-6364 - Fax: [phone] Page 6 of 7

S1VI CHAIN
CUSTODY
/�'LAB USE rABORATenRa, INC s. Of i91�'N OF �/{%ST®®i RECORD OI\
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Project Name:Raoe.�dwIXi�NfE�rrICE)TempY=e-ti Co
419 Springbrook Road • P.O. Box RaW4S • Charlotte, NC �71A-0513 ti PROPEA PRESERVATIVES firw0®te�
Phone: 704/529d984 • Fmr: 704/5)S M09 Short Mold Analysis: (Yea) (No) UST Protecc (Yea) (NO) nr-b
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mplvry Name: Please ATTACH arty pro)ect specific re111111 Repo CO porting IOC LEVEL III) �.`=WSTODY feel a NTI I �oyislODs and/or OC Requhements r 1
Report To/Corrtact Name: - vOUTR� reed w/011i HEAtgPACE) = _ Imdce TO: cc c�.mr tz,r.
Reporting Adrhess: rPROPFA COHTA1N0181aM1�7
Address:
r�r1II' Purchase Order NoJBilling Reference
B*
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Emall (1' s) (No) Email Ad att%"r G5 .
EDD Type:�POF_ Ezcel_D a TY'SLh.,0,o7 Requested Due Data 1 Day z Days Sonya a Days s Days
Certification: NELAC_USACE_ FL_ NO
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Site Location Name: —/ kN received alter 15:00 wia be � next business day.
�urtiamund
SC_ OTHER WA
Site Location Physical Ad re33: tlme h based on bus4leas da
ys' ya ezcluding vreekends and rolweya
Water Chlorinated: YES NO
L (SEE REVERSE FOR TERMS A CONDITIONS REOARDWO SEIMCM
RFJmprm er PI71SM IAaORATO1vE5, rNc. TD CLgxg
Sample Iced Upon Collection: YES NO —
TIME
MATRIX
SAMPLE CO ER
ANALYSES REQUESTED
SAMPLE IENT ION
COLLECTED DATE
CO LrELLECTED
WATER OR
PRTIVES ESFRVA-
/ / / REMARKS
RrS
PLAB
`TYPE
HOURS
SLUDGE)
SEE BELOW
NO.
SIZE
ID NO.
RRIV-01
7122/19
17:05
Water
G
1
1000
none
01
1
500
H2s04
1
1000
HCL
y
RRIV-02
7/22/19
17:10
1
1000
none
1
500
H2so4
rvb
�.
1
1000
HCL
RRIV-04
7/22/19
17:25
WGA"
`
1000
none
J!
03
500
H2so4
D
a
1000
HCL
'PO
1'I
M
changes must be
,/r-ea E3i eraPHartlEaDwreO �[I sarvka oner�uMlLRmwm AT THE LABORATORY. -
t�703VI
_ NC LIST: _ SC I _ NC -SIC DRINKING SWATER: I SOLID _ SC I R NRA:- _ NC SC I _ LANDFILL SC _ NC SC
•CONTAINER TYPE CODES: A = AmDer C =Clear G = Glass P = Plastic; TL = Teflon -Lined Cap VOA = Volalle OXganl s Analysts (Zero Head Space)
:Silo Arrh®i_TBtre:l,,,-yy
'Bile DePero'+e Ilme ' :3A��
77�Fl�ekl,Teoh'Fee:. c�'ii,,
+um -.ten„ ,4, v#I�
ORIGINAL