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HomeMy WebLinkAboutNCG100024_MONITORING INFO_20190610STORMWATER DIVISION CODING SHEET NCG PERMITS PERMIT NO. NCG �d�bay DOC TYPE ❑ HISTORICAL FILE ❑ MONITORING REPORTS DOC DATE ❑ YYYYMMDD Mid Atlantic Engineering & Environmental Solutioro July 23, 2019 NCDEQ/DWR Attention: Central Files 1617 Mail Service Center Raleigh, North Carolina 27699-1617 Subject: STORMWATER SAMPLING RESULTS FOSS AUTO RECYCLING 1915 RIDDLE ROAD DURHAM, DURHAM COUNTY, NORTH CAROLINA PERMIT NCGl00024 MID -ATLANTIC JOB NO. OOOR2066.00 To Whom It May Concern: 409 Rogan View Court Raleigh, NC 27610 *Me* 919,250.491 a facsimile 919,250,9950 MAAONLINEXCIM Attached please find the Stormwater Discharge Monitoring Report (DMR) and analytical report for the sampling conducted at the above -referenced site. A stormwater sample was collected on June 10, 2019 and analyzed for total suspended solids (TSS), pH, total recoverable lead, oil and grease and ethylene glycol. As indicated on the attached DMR, all parameters were below their respective benchmark values or within their benchmark range. If you have any questions or need additional information, please contact me at 919-250-9918 Sincerely, MID -ATLANTIC ASSOCIATES, INC. Ron J. Davis ^CNOV 21013 Stormwater Services Manager DWR E�Tp S jv Attachments: Stormwater Discharge Monitoring Report Laboratory Analytical Report EXPERIENCED CUSTOMER FOCUSED INNOVATIVE STORMWATER DISCHARGE OUTFALL (SDO) MONITORING REPORT CERTIFICATE OF COVERAGE NO. NCG100024 SAMPLES COLLECTED DURING CALENDAR YEAR: 2019 FACILITY NAME Foss Recycling, Inc., Durham, NC COUNTY Durham PERSON COLLECTING SAMPLE(S) Anthony Smith PHONE NO.(8001 672-9722 CERTIFIED LABORATORY(S) Pace Analytical Lab #12 Lab # PLEASE REMEMBER TO SIGN ON THE REVERSE 4 Part A: Stormwater Benchmarks and Monitoring Results For sampling periods with no discharge, you must submit this discharge monitoring form noting "No Flow' or "No Discharge" within 30 days of the end of that period to comply with permit reporting requirements. Outfall No. Date Sample Collected, mo/dd/year Total Rainfall, inches 00400 00530 ---- 77023 01051 78141 pH, Standard Units Total Suspended Solids (TSS), mg/L Non -polar O&G/TPH (Method 1664 SGT-HEM), mg/L Ethylene Glycol, mg/L Lead, Total Recoverable, mg/L Total Toxic Organics3, mg/L Benchmark - - 6.0 — 9.01 100/502 15 8,000 (Tiers 2 and 3) 0.03 1.0 Outfall001 06/10/19 4.0 7.9 6.3 <4.8 <5.0 <0.005 NA Note: If you report a sampled value in excess of the benchmark value, or outside the benchmark range for pH, you must implement Tier 1 or Tier 2 responses in the General Permit. 1See If pH values outside this range are recorded in sampled stormwater discharges, but ambient precipitation pH levels are lower, then the lower threshold of this benchmark range is the pH of the precipitation (within instrument accuracy)instead of 6 S.U. Readings from an on -site or local rain gauge (or local precipitation data) must be documented to demonstrate background concentrations were below the benchmark pH range of 6-9. 2See General Permit text to identify whether the more protective benchmark applies for especially sensitive receiving waters. 3For purposes of this permit the definition of Total Toxic Organics is that list as stated in Appendix D, Table II of Chapter 40 Code of Federal Regulations (CFR) Part 122. Form SWU-251, last revised October 25, 2012 Page 1 of 2 STORMWATER DISCHARGE OUTFALL (SDO) MONITORING REPORT Facilities that incorporate a solvent management plan into the Stormwater Pollution Prevention Plan may request that DWQ waive monitoring of total toxic organics. 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 allowed such a waiver, the discharger shall sign the following certification statement: Solvent Management Plan 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), 1 certify that to the best of my knowledge and belief, no dumping of concentrated toxic organics into the stormwater or areas which are exposed to rainfall or stormwater runoff has occurred since filing the last discharge monitoring report. 1 further certify that this facility is implementing all the provisions of the solvent management plan included in the stormwater Pollution Prevention Plan." Name (Print name) Title (Print title) Signature Mail Original and one copy to: Division of Water Quality Attn: Central Files 1617 MailServiceCenter Raleigh, North Carolina27699-1617 Date "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 properl ather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons ' ctly responsibl gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. am aware th ere are sig ' is t pen ' s for submitting false information, including the possibility of fines and imprisonment for knowing violations." V/ (Signature pf'Permittee or Designee) (Dat Form SWU-251, last revised October25, 2012 Page 2 of 2 aceAnalytical e ..pacelaba,cvrn Pace Analytical Services, LLC 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 June 21, 2019 Chuck Hoffman Mid -Atlantic Associates, Inc 409 Rogers View Court Raleigh, NC 27610 RE: Project: Foss Recycling -Durham Pace Project No.: 92432460 Dear Chuck Hoffman: Enclosed are the analytical results for sample(s) received by the laboratory on June 11, 2019. The results relate only to the samples included in this report. Results reported herein conform to the most current, applicable TNI/NELAC standards and the laboratory's Quality Assurance Manual, where applicable, unless otherwise noted in the body of the report. If you have any questions concerning this report, please feel free to contact me. Sincerely, Tyriek Hooks tyriek.hooks@pacelabs.com (704)875-9092 Project Manager Enclosures cc: Ron Davis, Mid Atlantic Associatees, Inc. pp "CC '60 ? �O f �gBORA'f0� 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 13 aceAnalytical ~..peceleb&= Pace Analytical Services, LLC 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 Project: Foss Recycling -Durham Pace Project No.: 92432460 Indiana Certification IDs 7726 Moller Road, Indianapolis, IN 46268 Illinois Certification #: 200074 Indiana Certification #: C-49-06 Kansas/NELAP Certification M E-10177 Kentucky UST Certification M 80226 Kentucky WW Certification #: 98019 Michigan Department of Environmental Quality, Laboratory #9050 Charlotte Certification IDs 9800 Kincey Ave. Ste 100, Huntersville, NC 28078 Louisiana/NELAP Certification # LA170028 North Carolina Drinking Water Certification #: 37706 North Carolina Field Services Certification M 5342 North Carolina Wastewater Certification #: 12 Asheville Certification IDs 2225 Riverside Drive, Asheville, NC 28804 Florida/NELAP Certification M E87648 Massachusetts Certification #: M-NC030 North Carolina Drinkina Water Certification #: 37712 CERTIFICATIONS Ohio VAP Certification M CL0065 Oklahoma Certification #: 2018-101 Texas Certification #: T104704355 West Virginia Certification #: 330 Wisconsin Certification M 999788130 USDA Soil Permit* P330-16-00257 South Carolina Certification #: 99006001 Florida/NELAP Certification #: E87627 Kentucky UST Certification #: 84 VirginiafVELAP Certification M 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 written consent of Pace Analytical Services, U.C. Page 2 of 13 19/ aceAnalytical` www.pscelebf.con Pace Analytical Services, LLC 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 SAMPLE ANALYTE COUNT Project: Pace Project No.: Foss Recyding-Durham 92432460 Analytts Lab ID Sample ID Method Analysts Reported Laboratory 92432460001 Outfall 1 EPA 1664E JMS 1 PASI-C EPA8015AIcohol-Glycol CPH 1 PASI-I EPA6010D SH1 1 PASI-A SM 254OD-2011 MJP 1 PASI-A REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, without the written consent of Pace Analytical Services, LLC. Page 3 of 13 aceAnalytical s Pecebbs cam Pace Analytical Services, LLC 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 ANALYTICAL RESULTS Project: Foss Recycling -Durham Pace Project No.: 92432460 Sample: Outfall 1 Lab ID: 92432460001 Collected: 06/10/19 07:45 Received: 06/11/19 09:38 Matrix: Water Parameters Results Units Report Limit DF Prepared Analyzed CAS No. Oual 1664 SGT-HEM, TPH Analytical Method: EPA 1664E Total Petroleum Hydrocarbons ND mg/L 4.8 1 06/20/19 07:29 8015M Glycols in water Analytical Method: EPA 8015 Alcohol -Glycol Ethylene glycol ND mg/L 5.0 1 06/19/19 01:52 107-21-1 6010 MET ICP Analytical Method: EPA 601 OD Preparation Method: EPA 3010A Lead ND ug/L 5.0 1 06/19/19 23:21 06/21/19 02:45 7439-92-1 2540D Total Suspended Solids Analytical Method: SM 2540D-2011 Total Suspended Solids 6.3 mg/L 4.2 1 06/14/19 14:35 REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, Date: 06/21/2019 04:21 PM without the written consent of Pace Analytical Services, LLC. Page 4 of 13 aceAnalytical hwwpemlaba.cprrr Pace Analytical Services, LLC 9800 Kincey Ave. Suite 100 Hunlersville, NC 28078 (704)875-9092 QUALITY CONTROL DATA Project: Foss Recycling -Durham Pace Project No.: 92432460 OC Batch: 482237 Analysis Method: EPA 1664E QC Batch Method: EPA 16648 Analysis Description: 1664 SGT-HEM, TPH Associated Lab Samples: 92432460001 METHOD BLANK: 2607690 Associated Lab Samples: 92432460001 Parameter Units Total Petroleum Hydrocarbons mg/L Matrix: Water Blank Reporting Result Limit Analyzed Qualifiers NO 4.8 06/20/19 07:21 LABORATORY CONTROL SAMPLE: 2607691 Spike LCS LCS % Rec Parameter Units Conc. Result % Rec Limits Qualifiers Total Petroleum Hydrocarbons mg/L 19.2 21.2 110 64-132 MATRIX SPIKE SAMPLE: 2607692 92432460001 Spike MS MS % Rec Parameter Units Result Conc. Result % Rec Limits Qualifiers Total Petroleum Hydrocarbons mg/L ND 19.2 20.3 102 64-132 Results presented on this page are in the units indicated by the "Units" column except where an alternate unit is presented to the right of the result. REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, Date: 06/21/2019 04:21 PM without the written consent of Pace Analytical Services, LLC. Page 5 of 13 aceAnalytical. www.pttcela6s.crom Pace Analytical Services, LLC 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 QUALITY CONTROL DATA Project: Foss Recycling -Durham Pace Project No.: 92432460 QC Batch: 507125 Analysis Method: EPA 8015 Alcohol -Glycol QC Batch Method: EPA 8015 Alcohol -Glycol Analysis Description: EPA 8015 Modified Associated Lab Samples: 92432460001 METHOD BLANK: 2340100 Associated Lab Samples: 92432460001 Parameter Units Ethylene glycol mg/L LABORATORY CONTROL SAMPLE: 2340101 Parameter Units Ethylene glycol mg/L Matrix: Water Blank Reporting Result Limit Analyzed Qualifiers ND 5.0 06/18/1917:03 Spike LCS Conc. Result 25 21.9 LCS % Rec e/ Rec Limits Qualifiers 87 48-150 MATRIX SPIKE & MATRIX SPIKE DUPLICATE: 2340102 2340103 MS MSD 7093905001 Spike Spike MS MSD MS MSD % Rec Parameter Units Result Conc. Conc. Result Result % Rec % Rec Limits RPD Qual Ethylene glycol mg/L <5.0 25 25 21.1 21.2 75 76 34-153 1 Results presented on this page are in the units indicated by the "Units" column except where an alternate unit is presented to the right of the result. REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, Date: 06/21/2019 04:21 PM without the written consent of Pace Analytical Services, LLC. Page 6 of 13 aceAnalytical" awwpswlabs.com Pace Analytical Services, LLC 9800 Kinsey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 QUALITY CONTROL DATA Project: Foss Recycling -Durham Pace Project No.: 92432460 QC Batch: 482185 Analysis Method: EPA 6010D QC Batch Method: EPA 3010A Analysis Description: 6010 MET Associated Lab Samples: 92432460001 METHOD BLANK: 2607536 Matrix: Water Associated Lab Samples: 92432460001 Blank Reporting Parameter Units Result Limit Analyzed Qualifiers Lead ug/L ND 5.0 06/21/1902:39 LABORATORY CONTROL SAMPLE: 2607537 Spike LCS LCS e/ Rec Parameter Units Conc. Result e/ Rec Limits Qualifiers Lead ug/L 500 484 97 80-120 MATRIX SPIKE & MATRIX SPIKE DUPLICATE: 2607538 2607539 MS MSD 92432460001 Spike Spike MS MSD MS MSD % Rec Parameter Units Result Conc. Conc. Result Result % Rec % Rec Limits RPD Qual Lead ug/L ND 500 500 506 490 101 97 75-125 3 Results presented on this page are in the units indicated by the'Units' column except where an alternate unit is presented to the right of the result. REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, Date: 06/21/2019 04:21 PM without the written consent of Pace Analytical Services, LLC. Page 7 of 13 (�IaceAnalytkal w ..pacelabs.opm QUALITY CONTROL DATA Project: Foss Recycling -Durham Pace Project No.: 92432460 OC Batch: 481182 Analysis Method: SM 254OD-2011 OC Batch Method: SM 254OD-2011 Analysis Description: 2540D Total Suspended Solids Associated Lab Samples: 92432460001 METHOD BLANK: 2602798 Associated Lab Samples: 92432460001 Parameter Units Total Suspended Solids mg/L LABORATORY CONTROL SAMPLE: 2602799 Parameter Units Total Suspended Solids mg/L Pace Analytical Services, LLC 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 Matrix: Water Blank Reporting Result Limit Analyzed Qualifiers ND 2.5 06/14/1914:34 Spike LCS LCS % Rec Cone. Result e/ Rec Limits Qualifiers 251 246 98 90-110 SAMPLE DUPLICATE: 2602800 92432543001 Dup Parameter Units Result Result Total Suspended Solids ni 64.7 62.7 SAMPLE DUPLICATE: 2602801 92432558002 Dup Parameter Units Result Result Total Suspended Solids mg/L 36.8 42.0 RPD Qualifiers 3 RPD Qualifiers 13 D6 Results presented on this page are In the units Indicated by the 'Units* column except where an alternate unit Is presented to the right of the result. REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, Date: 06/21/2019 04:21 PM without the written consent of Pace Analytical Services, L-C. Page 8 of 13 aceAnalytical wivw.pal;eWti.mn Pace Analytical Services, LLC 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)075-9092 QUALIFIERS Project: Foss Recycling -Durham Pace Project No.: 92432460 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. PQL - Practical Quantitation Limit. RL- Reporting Limit -The lowest concentration value that meets project requirements for quantitative data with known precision and bias for a specific analyte in a specific matrix. S - Surrogate 1,2-Diphenylhydrazine decomposes to and cannot be separated from Azobenzene using Method 8270. The result for each analyte is a combined concentration. Consistent with EPA guidelines, unrounded data are displayed and have been used to calculate % recovery and RPD values. LCS(D) - Laboratory Control Sample (Duplicate) MS(D) - Matrix Spike (Duplicate) DUP - Sample Duplicate RPD - Relative Percent Difference NC - Not Calculable. SG - Silica Gel - Clean -Up U - Indicates the compound was analyzed for, but not detected. Acid preservation may not be appropriate for 2 Chloroethylvinyl ether. A separate vial preserved to a pH of 4-5 is recommended in SW846 Chapter 4 for the analysis of Acrolein and Acrylonitrile by EPA Method 8260. N-Nitrosodiphenylamine decomposes and cannot be separated from Diphenylamine using Method 8270. The result reported for each analyte is a combined concentration. Pace Analytical is TNI accredited. Contact your Pace PM for the current list of accredited analytes. TNI -The NELAC Institute. LABORATORIES PASI-A Pace Analytical Services -Asheville PASI-C Pace Analytical Services - Charlotte PASI-I Pace Analytical Services - Indianapolis ANALYTE QUALIFIERS D6 The precision between the sample and sample duplicate exceeded laboratory control limits. REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, Date: 06/21/2019 04:21 PM without the written consent of Pace Analytical Services, LLC. Page 9 of 13 aceAnalytical e ..pecelebs.cern Pace Analytical Services, LLC 9800 Kincey Ave. Suite 100 Hunlersville, NC 2BO78 (704)875-9092 QUALITY CONTROL DATA CROSS REFERENCE TABLE Project: Pace Project No.: Foss Recycling -Durham 92432460 Analytical Lab ID Sample ID QC Batch Method QC Batch Analytical Method Batch 92432460001 Outfall 1 EPA 1664B 482237 92432460001 Outfall 1 EPA 8015 Alcohol -Glycol 507125 92432460001 Outfall1 EPA 3010A 482185 EPA6010D 482221 92432460001 Outfall 1 SM 2540D-2011 481182 REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, Date: 06/21/2019 04:21 PM without the written consent of Pace Analytical Services, I.I.C. Page 10 of 13 'yTAG6ty tinytruat' Laboratory receiving samples: / Asheville ❑ Eden Greenwood ❑ Huntersville Bl Raleigh[] Mechanicsville❑ Client Name: WON. Project I : 92432460 ,/1JaAC VpII II Courier: (:dfedEx ❑UPS ❑USPS —[]Client Vlull� IV ��I�Q�III�� QI� ❑ Commercial ❑pace / []Other;— gg,ty3L450 Custody Seat Present? ❑Yes ❑No Seals Intact? ❑Yes Date/Initials Person Examining Contents: Packing Material:—E]Bubble Wrap— - ubble Bags —❑None 0—Other Blaloglcal Tissue Frozen? Thesthometa • .MNIJA IA Gun ID: 9z 8 . TYPe of ice: et ❑Blue ❑None Cooler Temp ('C): y. Z , Correction Factor: Add/Subtract (-C) 0.0 Cooler Temp Corrected ('C):I ? Temp should be above freezing to 6Y ❑Samples out of temp criteria. Samples an Ice, cooling process hasbegun USDA Regulated Sail ; N/A, water sample) Did samples or' gi to in a quarantine tone within the United States: CA, NY, or SC (check maps)? Did sandes originate from a foreign source (internationally, . . Yes o IncludagHawali and Puerto Rico)? ❑Yes []NO Comme?ils/ re anc : Chain Of Custody Present? ,.. � Of. ❑No ❑N/A 1. ' Samples Arrived within Hold Time? _ es []NO ❑N/A 2. Short Hdld.Time Analysis (<72 hr.)? Oyes No []N/A 3, Rush Turn Around Time Requested? Oyes No ❑N/A 4. Sufficient Volume? es No N/A S. Correct Containers Used? -Pace Containers Used?, �Yee - Lf'Yes *❑Na []No []N/A N/A 6. - Containers Intact? ves ❑No N/A 7. - Dissolved analysis: Samples Field Filtered? ❑Yer []No N/A B. Sample Labels Match COC? -Includes Da[e/Time/10/Analysis Matrix: es ❑No ❑N/A 9. Headspace in VOA Vials (o5-6mm)? ves ONO- ❑N/A 10. Trip Blank Present? TripBlank Custody Seals Present? ❑Yes Yes ago ❑No ,❑N//A �[_IN/a 11. . DISCREPANCY fVO 4 Field Data Required? ❑Yes []NO Person contacted: Date/Tlme: --Project Manager SCURF Revlew: -- Date: [/l?6JJ/ Date: � C Y /�/I Project Manager SRF Review: Page 11 of 13 Document No.: Issuing Authority: ( I F-CAR-CS-033-Rev.06 I Pace Carolinas Quality Office 'Cheek mark top half of box If pH and/or dechlorination is Project 1 WI04, : 9►2432460 verified and within the acceptance range for preservation pPl : TIIf Due Date: 06/25/19 samples. Exceptions: VOA, Conform,roc, Oil and Grease,DRO/8019(water) DOC, LLHg CLI:ENT: 92—MID RTLAN "Bottom half of box Is to list number of bottle u U Y v y °a J u N V C y v `r N pp O a m � 6? m s N ry `n S !� j v N n E ? ry 2 o vmi m n I c c n Y% vna u y N ,-„ u i. Y V Y L E a a a A y n a a o E E a 'E E O Q O o a t ;; vd E c u < 1 > >,° vNi n r E E E u E i w r E E n o N m N o ton m o m E E E E .� E o E E N N n „Nj N ti 3 n r, ry N N C q O O V = N' y� N O Q Oq J J J = m' m C Y N Q J J J tma 1 j 2 3 a s 6 7 a 9 30 11 L--i-\N-- NI 12 �Wq-' pH Adjustment Log for Preserved Samples Sample ID Type of Preservative pH upon recelpt Date preservation adjusted Time presemialcn adjusted Amount of Preservative added lot 0 —77 Note: Wheneverthere is a discrepancy affecting North Carolina compliance samples, a copy of this form will be sent to the North Carolina DEHNR Certification Office (i.e. Out of hold, incorrect preservative, out of temp, incorrect containers. Page 12 of 13 11 CHAIN -OF -CUSTODY / Analytical R I�quest PaeeAna1j4 �epal- The Chain-of-C"IMY is a LEGAL DOCUMENT. All relevant fickis Ae,Atpacelaed.com Document oust be completed accurately. Section Section 8 Section C K/ JlO Required Cflew Information: Required Project Information: CompanYl,A J Invoice Information: rIIQ C / Report To: ( O AA p Fyn Attention: AOdnero; �� (� M1 dit bow— COmDanY Na I Address ' �' ER Tor Purcha mil I se Ober No.: Pefere »: coot.Relc Php ¢ - F i, 0 - Prgem Nam Pam Pray7t Roquestetl Due DateR T: 1: Project Number ' `Out MvmgO. I' M OO i-q , l QUO Paco Pmrdn a: �+• y Page: of Q 70 j 1887021 s r REG ULATO 1 YA GENCY r NPDES r UST Site Locatla STATE r r I GROUND WATER I-DRINKINGWATER RCRA r OTHER w 7 t Section D Matrix Codes RnquhaeCcem lmprmalio„ I MATRIX I CODE Onnking Water DW Water WT Wa5t—zoar lNW Product P Shc/Solid SL SAMPLE ID 011 OL wipe (A-4O-9/:) Air AR Sample IDs MUST BE UNIQUE Tax. TS Other OT out I _ § -��-. = to O O % <to M a 'o p V a ¢ a to ra COLLECTED O I — J o a to w soallo N N Z Z O z Preservatives r z i I Requested Analysis Filt red (YIN) WVPoSNE START caom51ty E.Ft Qi Z y 2= 2 ,° Z Z c as Q x m _ y ? >_ U N z� Zy � Pace Project No./ Lab I.D. DATE TIME DATE TIME I i � 2 I I I A I I 5 I I E T I 9 I' I I 9 70 I I 77 I, 72 I I I ADDITIONAL COMMENTS RELINQUISHED BY I AFFILIATION DATE TIME ACCEPTED BY/ FILIATION GATE TIME SAMPLE CONDITIONS ll 33 �LZ y L I L i• - �1 `)q ORIGINAL SAMPLER NAME AND SIGNATURE NT N I �/ r `` PRINT Name of SAMPLER: Vt J p ys SIGNATURE of SAMPLER: W 'Impa4ml Note: By 5 Ws formyw wm.u' opting Pepe s NET 00 dry pnyeeenl term: nM nOrcnirxl to L to cM1argnp pl LS•R Oer monlM1 Iw nny imoims Oitl el.in 30 tl I I I E o f p = .0Z ti 5-IZI to _ N i E — m I ATE Signed I I F-ALL-O-020rev.0T. 15-May-2007