NCG060264_MONITORING INFO_20191231

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
DOC TYPE
❑ HISTORICAL FILE
CAI MONITORING REPORTS
DOC DATE
❑ 3 I
YYYYMMDD

December 20, 2019
North Carolina Department of Environment
Division of Water Resources
Attn: DWR Central Files
1617 Mail Services Center
Raleigh, NC 27699-1617
Subject: NPDES General Permit: NCG060264
The Procter and Gamble Manufacturing Company (P&G)
Greensboro Personal Health Care (GBO PHC)
100 Swing Road, Greensboro, North Carolina 27409
Discharge Monitoring Report
To Whom It May Concern:
Attached, please find Procter and Gamble's submission of:
The Procter & Gamble Manufacturing Co.
Greensboro Site
100 Sexing Roar
Greensboro. NC 27109
,V..;CIN i
• Semi -Annual Storm Water Discharge Monitoring Report for reporting period Jan. 1 to
July 1, 2019
• Scmi-Annual Storm Water Discharge Monitoring Report for reporting period July 1 to
Dec. 31, 2019
• Storm Water analytical report for July I to Dec. 31, 2019
No analytical report was generated for Jan. 1 to July I due lack adequate rain events or unsafe
sampling conditions. The report for July 1 to Dec. 31, finds all parameters below storm water
benchmarks. Should you have any questions on this report please contact the site Health, Safety
and Environmental Technical Contact, Tracy Davis at [phone] or davis.t.26Rpg com.
Sincerely,
r
Ron Matusiak
GBO PHC Plant Manager

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water Quality General Permit No. NCG060000
Date submitted 6-30-2019
CERTIFICATE OF COVERAGE NO. NCG060264 _ SAMPLE COLLECTION YEAR _2019
FACILITY NAME _Procter and Gamble FACILITY ACTIVITIES INCLUDE (check all that apply):
COUNTY Guilford RECEiVEC❑ use/process meats ❑ use animal fats/byproducts
PERSON COLLECTING SAMPLES _N/A jI DEC 3 1 ZD,CHARGING TO SALTWATERS? ❑YES ®NO
LABORATORY —Pace Analytical Services_ Lab Cert. # _12_
Cs NI R'W FILE, PLEASE REMEMBER TO SIGN ON THE REVERSE 4
��WF: SitC I IOtI
n... A. C. 0--- m�rLe �n.l Mnnifnrino Raculic Total event rainfall n1a or M No discharge this period'
._ Outfall No.
- -
`Sample Collected,,
mo/dd/yr
... TSS,
_ -mg/L
a .
.. PH, .-
Standard units
COD, _
mg/L.
Oil and Grease,
mg/L
Fecal Coliform',
Colonies per ml ._
Enterococci', ,
Colonies per 100 ml
Benchmark
_
- -
- 100 or 50'
Within 6.0-9.0
120
30
1000
.500
#1-Spring
n/a
n/a
n/a
ND
ND
n/a
n/a
' Only applies to facilities that use/process meats.
ZThe total precipitation must be recorded using data from an on -site rain gauge.
' For sampling periods with no discharge at any outfalls. You must still submit this discharge monitoring report with a checkmark here.
4See 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 (if yes, complete Part B)
Part B• Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new motor oil/month.
Outfall No.
-
` Sample Collected,
mo/dd/yr ':
Oil and Grease,
mg/L
` `- TS5, ''
mg/L -
-� pH, * -1
Standard units
- New Motor Oil Usage,
Annual average gal/mo
Benchmark
-
30 -
100or5041
6.0-9.0
- -
' Only applies to facilities that use/process meats.
'The 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.. protectivebenchmark applies.
SWU-249 Last Revised: October 18, 2012
Page 1 of 2

*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 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 (or at end of
monitoring period in the case of "No Discharge" reports) to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, INC 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."
Ron Matusiak
(Signature of Permittee)
_12-20-19
(Date)
Additional copies of this form may be downloaded at: http:lZportal.ncdenr.org/web/wq/ws/SuZnpdessw#tab-4
S W U-249
Last Revised: October 18, 2012
Page 2 of 2

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water Quality General Permit No. NCG060000
Date submitted 30- 25-2019
CERTIFICATE OF COVERAGE NO. NCG060264 _ SAMPLE COLLECTION YEAR _2019
FACILITY NAME _Procter and Gamble FACILITY ACTIVITIES INCLUDE (check all that apply):
COUNTY Guilford ❑ use/process meats ❑ use animal fats/byproducts
PERSON COLLECTING SAMPLES _Tracy Davis DISCHARGING TO SALTWATERS? []YES ®NO
LABORATORY _Pace Analytical Services_ Lab Cert. # _12_
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
P-r A• ftnrrnw2ter Rpnrhmnrlre nnrl Mnnitnrina Rpvlltc
Total event rainfall' 0.40 or ❑ No discharge this period'
Outfall No.
-
Sample Collected,
riw/dd/yr
TSS, '
mg/L
pH,
Standard units
COO,
mg/L
Oil and Grease,
-mg/L
Fecal Coliform',
Colonies per 100 ml `
Enterococci', .
-Colonies per 100 ml
Benchmark
100or504
Within 6.0-9.0
.120'
30
1000
Soo
#1
10/16/19
22.8
6.0
46.2
NO
n/a
n/a
1 Only applies to facilities that use/process meats.
'The total precipitation must be recorded using data from an on -site rain gauge.
3 For sampling periodswith 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.
Outfall No.
Sample Collected, ,:
mo/dd/yr
Oil and Grease,
mg/L
-, TSS,
mg/L
, pH,,-
Standard units
New Motor Oil,Usage,
Annual average gal/mo
Benchmark
-
30. '
100 or 501.
6:0-9.0
_
1 Only applies to facilities that use/process meats.
'The 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
(ifyes, complete Part B)
Last Revised: October 18, 2012
Pagel of 2

*FOR PART A AND PART B MONITORING RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES ❑ NO
IF YES, HAVE YOU CONTACTED THE 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 (or at end of
monitoring period in the case of "No Discharge" reports) to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, 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 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 of Perm
_12-20-19 iL/zil
(Date)
Additional copies of this form may be downloaded at: http:ZZportal.ncdenr.orglweb/wq/ws/suZnpdessw#tab-4
S W U-249
Last Revised: October 18. 2012
Page 2 of 2

aceAnalytical
w pacelabs.cam
Pace Analytical Services, LLC
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
October 30, 2019
Mr. Tracy Davis
Procter and Gamble
100 Swing Road
Greensboro, NC 27409
RE: Project: STORMWATER
Pace Project No.: 92450165
Dear Mr. Davis:
Enclosed are the analytical results for sample(s) received by the laboratory on October 17, 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,
Matthew Brainard
[e-mail]
[phone]
Project Manager
Enclosures
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, LLC.
Page 1 of 14

aceAnalytical
w pacelaos.com
Pace Analytical Service, LLC
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
Project: STORMWATER
Pace Project No.: 92450165
Charlotte Certification IDs
9800 Kincey Ave. Ste 100, Huntersville, NC 28078
LouisianalNELAP Certification # LA170028
North Carolina Drinking Water Certification #: 37706
North Carolina Field Services Certification #: 5342
North Carolina Wastewater Certification #: 12
Asheville Certification IDs
2225 Riverside Drive, Asheville, NC 28804
Florida/NELAP Certification #: E87648
Massachusetts Certification #: M-NC030
North Carolina Drinking Water Certification #: 37712
CERTIFICATIONS
South Carolina Certification #: 99006001
Florida/NELAP Certification #: E87627
Kentucky UST Certification #: 84
Virginia/VELAP Certification #: 460221
North Carolina Wastewater Certification #: 40
South Carolina Certification #: 99030001
Virginia/VELAP Certification #: 460222
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
without the nfen consent of Pace Analytical Services, LLC.
Page 2 of 14

laceAnalytical
wmvpacetabs.com
Pace Analytical Services, LLC
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
SAMPLE ANALYTE COUNT
Project:
Pace Project No.:
STORMWATER
92450165
Analytes
Lab ID
Sample ID
Method
Analysts
Reported
Laboratory
92450165001
#1 PHC
SM 5220D-2011
GC
1
PASI-A
92450165002
#3#2 PHC
EPA 1664B
AAC1
1
PASI-C
92450165003
#4 PHC
SM 254OD-2011
JP1
1
PASI-A
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, LLC.
Page 3 of 14

aceAnalytical
.aacelabs.com
Pace Analytical Services, LLC '
9800 Kincey Ave. Suite too
Huntersville, NC 28078
[phone]
ANALYTICAL RESULTS
Project: STORMWATER
Pace Project No.: 92450165
aampie: uI me Lab ID: 92450165001 Collected: 10/16/1912:00 Received: 10/17/19 14:15 Matrix: Water
Parameters Results Units Report Limit OF Prepared Analyzed CAS No. Dual
5220D COD
Chemical Oxygen Demand
Date: 10/30/2019 05:52 PM
Analytical Method: SM 5220D-2011 Preparation Method: SM 5220D-2011
46.2 mg/L 25.0 1 10/24/19 16:13 10/24/19 22:19
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, LLC.
Page 4 of 14

laceAnalyficalo
w pscefsbs.wm
Pace Analytical Services, LLC
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
ANALYTICAL RESULTS
Project: STORMWATER
Pace Project No.: 92450165
Sample: #3 #2 PHC Lab ID: 92450165002 Collected: 10/16/19 12:00 Received: 10/17/19 14:15 Matrix: Water
Parameters Results Units Report Limit OF Prepared Analyzed CAS No. Oual
HEM, Oil and Grease
Oil and Grease
Date: 10/30/2019 05:52 PM
Analytical Method: EPA 1664B
ND mg/L 4.8 1
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, L-C.
10/30/19 12:25
Page 5 of 14

aceAnalytical
w rpacelabs com
Pace Analytical Service9, LLC
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
ANALYTICAL RESULTS
Project: STORMWATER
Pace Project No.: 92450165
Sample: #4 PHC Lab ID: 92450165003 Collected: 10/16/19 12:00 Received: 10/17/19 14:15 Matrix: Water
Parameters Results Units Report Limit DF Prepared Analyzed CAS No. Oual
2540D Total Suspended Solids Analytical Method: SM 2540D-2011
Total Suspended Solids 22.8 mg/L 6.9 1 10/22/19 01:47
Date: 10/30/2019 05:52 PM
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, LLC.
Page 6 of 14

aceAnalytical
wwwpacela6s.com
Pace Analytical Services, LLC
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
QUALITY CONTROL DATA
Project: STORMWATER
Pace Project No.: 92450165
QC Batch: 506605 Analysis Method: EPA 1664B
QC Batch Method: EPA 1664B Analysis Description: 1664 HEM, Oil and Grease
Associated Lab Samples: 92450165002
METHOD BLANK: 2720433
Associated Lab Samples: 92450165002
Parameter Units
Oil'and Grease mg/L
Matrix: Water
Blank Reporting
Result Limit Analyzed Qualifiers
NO 4.8 10130/1910:53
LABORATORY CONTROL SAMPLE:
2720434
Spike
LCS
LCS
% Rec
Parameter
Units
Conc.
Result
% Rec
Limits
Qualifiers
Oil and Grease
mg/L
38.5
32.9
86
78-114
MATRIX SPIKE SAMPLE:
2720435
92449952001 Spike
MS
MS
e/ Rec
Parameter
Units
Result
Conc.
Result
% Rec
Limits Qualifiers
Oil and Grease
mg/L
1.7J 38.5
33.3
82
78-114
Rosu Its presented on this 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,
Dale: 10/30/2019 05:52 PM without the written consent of Pace Analytical Services, L-C. Page 7 of 14

aceAnalytical
wwwpacelabs.cpm
Pace Analytical Serviced, LLC
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
QUALITY CONTROL DATA
Project: STORMWATER
Pace Project No.: 92450165
QC Batch: 504884
Analysis Method: SM 254OD-2011
QC Batch Method: SM 2540D-2011
Analysis Description: 2540D Total Suspended Solids
Associated Lab Samples: 92450165003
METHOD BLANK: 2713030
Matrix: Water
Associated Lab Samples: 92450165003
Blank Reporting
Parameter
Units
Result Limit Analyzed Qualifiers
Total Suspended Solids
mg/L
NO 2.5 10/22/19 01:45
LABORATORY CONTROL SAMPLE: 2713031
Spike LCS LCS % Rec
Parameter
Units
Conc. Result % Rec Limits Qualifiers
Total Suspended Solids
mg/L
250 242 97 90-110
SAMPLE DUPLICATE: 2713038
92450171001 Dup
Parameter
Units
Result Result RPD Qualifiers
Total Suspended Solids
mg/L
60.8 63.2 4
SAMPLE DUPLICATE: 2713039
92450171003 Dup
Parameter
Units
Result Result RPD Qualifiers
Total Suspended Solids
mg/L
1950 2130 9
Results presented on this page are in the units Indicated by the "Units" column except where an alternate unit Is presented to the right or the result.
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
Dale: 10/30/2019 05:52 PM without the written consent of Pace Analytical Services, L-C. Page 8 of 14

• o
laceAnalytical
" wwwpacefabs.com
Pace Analytical Services, LLC
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
Project: STORMWATER
Pace Project No.: 92450165
QC Batch: 505622
QC Batch Method: SM 5220D-2011
Associated Lab Samples: 92450165001
METHOD BLANK: 2716326
Associated Lab Samples: 92450165001
I
Parameter Units
Chemical Oxygen Demand mg/L
LABORATORY CONTROL SAMPLE:
2716327
Parameter
Units
Chemical Oxygen Demand
mg/L
QUALITY CONTROL DATA
Analysis Method:
Analysis Description:
Matrix: Water
SM 5220D-2011
5220D COD
Blank Reporting
Result Limit Analyzed Qualifiers
NO 25.0 10/24/19 22:17
Spike LCS LCS e/ Rec
Conc. Result e/ Rec Limits Qualifiers
750 776 104 90-110
MATRIX SPIKE & MATRIX SPIKE DUPLICATE: 2716328 2716329
MS MSD
92450094003 Spike Spike MS MSD MS MSD % Rec
Parameter Units Result Conc. Conc. Result Result e/ Rec e/ Rec Limits RPD Qual
Chemical Oxygen Demand mg/L 25.2 100 100 130 130 105 105 90-110 0
MATRIX SPIKE & MATRIX SPIKE DUPLICATE: 2716330
2716331
MS
MSD
92450558001 Spike
Spike
MS
MSD MS MSD % Rec
Parameter Units Result Conc.
Conc.
Result
Result e/ Rec e/ Rec Limits RPD Qual
Chemical Oxygen Demand mg/L 2840 100
100
2910
2920 75 84 90-110 0 Mt
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: 10/30/2019 05:52 PM without the written consent of Pace Analytical Services, LLC.
Page 9 of 14

(�5ace Analytical
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QUALIFIERS
Project: STORMWATER
Pace Project No.: 92450165
DEFINITIONS
DF - Dilution Factor, if reported, represents the factor applied to the reported data due to dilution of the sample aliquot.
ND - Not Detected at or above adjusted reporting limit.
TNTC - Too Numerous To Count
J - Estimated concentration above the adjusted method detection limit and below the adjusted reporting limit.
MDL -Adjusted Method Detection Limit.
Pace Analytical Services,}LC
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
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
Indicates the compound was analyzed for, but not detected.
Acid preservation may not be appropriate for 2 Chloroethylvinyl ether.
A separate vial preserved to a pH of 4-5 is recommended in SW846 Chapter 4 for the analysis of Acrolein and Acrylonitrile by EPA
Method 8260.
N-Nitrosodiphenylamine decomposes and cannot be separated from Diphenylamine using Method 8270. The result reported for
each analyte is a combined concentration.
Pace Analytical is TNI accredited. Contact your Pace PM for the current list of accredited analytes.
TNI - The NELAC Institute.
LABORATORIES
PASI-A Pace Analytical Services -Asheville
PASI-C Pace Analytical Services - Charlotte
ANALYTE QUALIFIERS
M1 Matrix spike recovery exceeded QC limits. Batch accepted based on laboratory control sample (LCS) recovery.
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
Date: 10/30/2019 05:52 PM without the written consent of Pace Analytical Services, LLC, Page 10 of 14

aceAnalytical
n wpacelabs.corn
Pace Analytical Services, LLC
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
Project: STORMWATER
Pace Project No.: 92450165
Lab ID Sample ID
92450165002 #3#2 PHC
92450165003 #4 PHC
92450165001 #1 PHC
Date: 10/30/2019 05:52 PM
QUALITY CONTROL DATA CROSS REFERENCE TABLE
QC Batch Method
EPA 1664E
SM 2540D-2011
SM 5220D-2011
QC Batch Analytical Method
506605
504884
505622 SM 5220D-2011
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, LLC.
Analytical
Batch
505675
Page 11 of 14

Name:
Document No.:
Laboratory receiving samples:
Asheville Eden❑ Greenwood
Client Name
S4Ltler f IF d F n
nUcoc
❑Commercial ,❑pace []Other: —
Custody Seal Present? ❑Yes []No Seals Intact? ,, ❑i Yes
t Revised: February 7, 2018
Page 1 of 2
Issuing Authority:
Huntersvllle Raleigh[] Mechanicsville❑
lien Project WoII�# I�I: I 9II I2II 4I I 5II �0I�
165
C9
❑No 2450165 Date/Initials Person Examining Contents:; I- } i irl l
Packing Material: ❑Bubble Wrap ❑Bubble Bags ❑None
❑ Other Biological Tissue Frozen?
Thermometer:
❑Q IR Gun ID: 22T049 Type of Ice: Ell et ❑Blue ❑None ❑Yes []No ❑N/A
Cooler Temp (' I: C ,
, , i Correction Factor: Add/Subtract ('Q 0.0
Cooler Temp Corrected ('C): ( Temp should be above freezing to 6'C
Dimples out of temp criteria. Samples on ice, cooling process
USDA Regulated Soil (Q N/A, water sample) has begun
Did samples originate in a quarantine zone within the United States: CA, NY, or SC (check maps)? Did samples originate from a foreign source (internationally,
❑Yes []No
including Hawaii and Puerto Rlcol?I—IYos MO.
of Custody Present?
Hold
Sufficient Volume?
Correct Containers Used?
.rssasveu ana! v Samples Field
Sample Labels Match CDC?
Ispace in VOA
Blank Present
COMMENTS/SAMPLE DISCREPANCY
yes UNo UN/A S.
Oyes ONO ❑N/A 6.
ONO ❑N/A 1 9,
Field Data Required? Dyes ❑NO
CLIENT NOTIFICATION/RESO WTION Lo[ ID Of Split CDn tamers:
Person contacted: Date/Time:
Project Manager SCURF Review: Date:
Project Manager SRF Review: ,
(I ��� Date:
Page 12 of 14

,; BCBA/Id/yllC81
Document Name:
Sample Condition Upon Recel t(SCUR)
Document Revised: February7, 2018
Page 1 of 2
Document No.:
F-CAR•CS-033•Rev.06
Issuing Authority:
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/8015 (water) DOC, LLHg
"Bottom half of box is to list number of bottle
Project W®# : 9245®165
PM: MWB Due Dnto: 10/31/19
CLIENT: 92—P&G
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pH Adjustment Log for Preserved Samples
Sample ID
Type of Preservative
pH upon receipt
Date preservation adjusted
Tlmepreservation
adjusted
Amount of Preservative
added
Lot e
Note: Whenever there is a discrepancy affecting Nart h Carolina compliances amples, acopy of this form will he sent to the No Rh Carol in a DEHNR Certification Office (i.e.
Out of hold, Incorrect preservative, out of temp; Incorrect containers.
Page 13 of 14

/ 7 NwlMiral"
Section A
Section B
Required Client Informalinm _
CHAIN -OF -CUSTODY / Analytical Request Document
The Chain -of -Custody is a LEGAL DOCUMENT. All relevant fields must be completed accurately.
Section C
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