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Home My WebLink AboutNCG210168_MONITORING INFO_20191122WtA. i o STORMWATER DIVISION CODING SHEET NCG PERMITS PERMIT NO. DOC TYPE ❑ HISTORICAL FILE ❑%MONITORING REPORTS DOC DATE ❑ I I `� a YYYYMMDD Georgia -UP acific Certified Mail # 7017 0190 0000 2521 9273 November 19, 2019 Division of Water Quality Attn: Central Piles 1617 Mail Service Center Raleigh, NC 27699-1617 RE: Georgia-Pacific Wood Products LLC Dudley Plywood Facility NPDES General Stormwater Permit DMR Submittal Certificate of Coverage No. NCG210168 To Whom 1t May Concern: Georgia-Pacific Wood Products LLC Dudley Plywood 139 Brewington Road Dudley, NC 28333 NOV 22 2019 CENTRAL FILES DVVR SECTION As required by the referenced permit in condition Part 111, Section E.1, attached are the original and one copy of the signed discharge monitoring report (DMR) and laboratory analytical results for Year 2019 Period 2 for the Georgia-Pacific Wood Products LLC (GP) Dudley Plywood Facility Outfall 001. Please note that all required monitoring parameters are within their respective benchmarks. Certification: V 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 ani aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations. " Should you have any questions or need additional information, please contact Brandy Turley at 919-705- 0526 or brandy turlev(a),g_apac.com . Thank you. Sincerely, Michael Golden Plant Manager Dudley Plywood Attachments (2 copies): DMR Year 2019 / Period 2; Laboratory Report Semi-annual Stormwater Discharge Monitoring Report for North Carolina DEMLR General Permit No. NCG210000 Date submitted _November 19, 2019 CERTIFICATE OF COVERAGE NO. NCG210168 FACILITY NAME -Georgia Pacific - Dudley Plywood COUNTY Wayne PERSON COLLECTING SAMPLES _Brandy Turley LABORATORY —Pace Analytical Lab Cert. # 12 Comments on sample collection or analysis: SAMPLE COLLECTION YEAR _2019 SAMPLE PERIOD ❑ Jan -June ® July -Dec or ❑ Monthly' (month) DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA []Zero -flow [-]WaterSupply ❑SA ❑Other PLEASE REMEMBER TO SIGN ON THE REVERSE 4 Part A: Stormwater Benchmarks and Monitoring Results (Monitoring is required only if the facility stores exposed accumulations of sawdust, wood chips, bark, mulch, or other similar material on site for longer than seven (7) days.) n No discharqe this period?2 Outfall No. Date Sample Collected` (mo/dd/yr) 24-hour rainfall amount, Inches; Chemical Oxygen Demand Total Suspended Solids Benchmarks ===> - _ - 120 mg/L 100 mg/L or 50 mg/0 001 10/31/2019 0.29 95.8 mg/L 15.5 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. "See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies. Note: Results must be reported in numerical format. For example, 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 me/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. Permit Date: 8/1/2013-7/31/2018 SWU-245, last revised 7/31/2013 Page 1 of 2 Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month. I-1 AI., +A,, ,,,4o2 Outfall No. Date Sample Collected' (mo/dd/yr) 24-hour rainfall amount, Inches; Non -polar O&G by EPA 1664 (SGT-HEM) Total Suspended Solids Benchmarks =__> _ - 15 mg/L 100 mg/L or So mg/L4 001 10/31/19 0.29 <4.9 mg/L 15.5 mg/L Footnotes from Part A also apply to this Part B Note: if you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses. See General Permit text. FOR PART A AND PARTS 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 ATANY ONE OUTFALL? YES ❑ NO X IF YES, HAVE YOU CONTACTED THE DEMLR 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, 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. am aware tha e e areiSigmficant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations." wllf (Da() Permit Date:8/1/2013-7/31/2018 SWU-245, last revised 7/31/2013 Page 2 of 2 aceAnalytical Wmilsnlsbs.com November 14, 2019 Brandy Turley Georgia-Pacific 139 Brewerton Road Dudley, NC 28333 RE: Project: PLY Stormawer Pace Project No.: 92452432 Pace Analytical Services, LLC 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 Dear Brandy Turley: Enclosed are the analytical results for sample(s) received by the laboratory on November 06, 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, Nicole Gasiorowski nicole.gasiorowski@pacelabs.com (704)875-9092 Project Manager Enclosures cc: Sean Coury, Georgia Pacific Accounts Payable c/o GP, Georgia Pacific 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 12 (�55'ceAnai(Xical www.pantsbs.com Project: PLY Stormawer Pace Project No.: 92452432 Pace Analytical Services, LLC 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 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 #: 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 VirginiaNELAP Certification #: 460221 North Carolina Wastewater Certification #: 40 South Carolina Certification If: 99030001 VirginiaNELAP Certification #: 460222 REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, without the written consent of Pace Analytical Services, LLC. Page 2 of 12 aceAnalytical e ww.psctlsbs.com SAMPLE ANALYTE COUNT Pace Analytical Services, LLC 9800 Kincey Ave. Suite 100 Hunlersville, NC 28078 (704)875-9092 Project: Pace Project No.: PLY Stormawer 92452432 Analytes Lab ID Sample ID Method Analysts Reported Laboratory 92452432002 PLY Stormwater EPA 1664E JMS1 1 PASI-C SM 2540D-2011 CJL 1 PASI-A SM 5220D-2011 GC 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 12 aceAnalytical www.pacelabs.com ANALYTICAL RESULTS Pace Analytical Services, LLC 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 Project: PLY Stormawer Pace Project No.: 92452432 Sample: PLY Stormwater Lab ID: 92452432002 Collected: 10/31119 22:45 Received: 11/06/19 07:58 Matrix: Water Parameters Results Units Report Limit OF Prepared Analyzed CAS No. Qual HEM, Oil and Grease Oil and Grease 2540D Total Suspended Solids Total Suspended Solids 5220D COD Chemical Oxygen Demand Date: 11/14/2019 04:37 PM Analytical Method: EPA 1664E NO mg/L 4.9 1 11/14/1909:43 Analytical Method: SM 2540D-2011 15.5 mg/L 12-5 1 11/07/19 09:59 Analytical Method: SM 5220D-2011 Preparation Method: SM 5220D-2011 95.8 mg/L 25.0 1 11/11/19 15:44 11/11/19 23:03 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 12 aceAnalytical W".pacslabs.com QUALITY CONTROL DATA Project: PLY Stormawer Pace Project No.: 92452432 QC Batch: 509477 Analysis Method: EPA 1664B QC Batch Method: EPA 1664E Analysis Description: 1664 HEM, Oil and Grease Associated Lab Samples: 92452432002 METHOD BLANK: 2734080 Associated Lab Samples: 92452432002 Parameter Units Oil and Grease mg/L LABORATORY CONTROL SAMPLE: 2734081 Parameter Units Oil and Grease 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 5.0 11/1411909:43 Spike LCS LCS % Rec Cone. Result % Rec Limits Qualifiers 40 36.1 90 78-114 MATRIX SPIKE SAMPLE: 2734082 92453489002 Spike MS MS % Rec Parameter Units Result Conc. Result % Rec Limits Qualifiers Oil and Grease mg/L ND 39.2 34.6 85 78-114 Results presented on this page are In the units indicated bythe "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: 11/14/2019 04:37 PM without the written consent of Pace Analytical Services, LLC. Page 5 of 12 (�I?ceAnalyfical w .pscehddtxoln QUALITY CONTROL DATA Pace An alyticaI Services, LLC 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 Project: PLY Stormawer Pace Project No.: 92452432 QC Batch: 508115 Analysis Method: SM 2540D-2011 QC Batch Method: SM 2540D-2011 Analysis Description: 2540D Total Suspended Solids Associated Lab Samples: 92452432002 METHOD BLANK: 2727693 Matrix: Water Associated Lab Samples: 92452432002 Blank Reporting Parameter Units Result Limit Analyzed Qualifiers Total Suspended Solids mg/L ND 2.5 11/07/19 09:58 LABORATORY CONTROL SAMPLE &LCSD: 2727694 2727695 Spike LCS LCSD LCS LCSD % Rec Max Parameter Units Conic. Result Result % Rec % Rec Limits RPD RPD Qualifiers Total Suspended Solids mg/L 250 250 246 100 98 90-110 2 25 SAMPLE DUPLICATE: 2727696 92452425001 Dup Parameter Units Result Result RPD Qualifiers Total Suspended Solids mg/L 270 106 87 D6 Results presentod 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: 11/14/2019 04:37 PM without the written consent of Pace Analytical Services, TLC. Page 6 of 12 laceAnalyficalo is".pscelsbs.011 QUALITY CONTROL DATA Pace Analytical Services, LLC 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 Project: PLY Stormawer Pace Project No.: 92452432 QC Batch: 508838 Analysis Method: SM 5220D-2011 QC Batch Method: SM 5220D-2011 Analysis Description: 5220D COD Associated Lab Samples: 92452432002 METHOD BLANK: 2731231 Matrix: Water Associated Lab Samples: 92452432002 Blank Reporting Parameter Units Result Limit Analyzed Qualifiers Chemical Oxygen Demand mg/L ND 25.0 11/11/19 22:58 LABORATORY CONTROL SAMPLE: 2731232 Spike LCS LCS % Rec Parameter Units Cone. Result e/ Rec Limits Qualifiers Chemical Oxygen Demand mg/L 750 765 102 90-110 MATRIX SPIKE & MATRIX SPIKE DUPLICATE: 2731233 2731234 MS MSD 92452270001 Spike Spike MS MSD MS MSD %Rec Parameter Units Result Cone. Cone. Result Result % Rec % Rec Limits RPD Qual Chemical Oxygen Demand mg/L 2600 100 100 2600 2560 0 -38 90-110 1 M7 MATRIX SPIKE & MATRIX SPIKE DUPLICATE: 2731235 2731236 MS MSD 92452324002 Spike Spike MS MSD MS MSD %Rec Parameter Units Result Cone. Cone. Result Result % Rec % Rec Limits RPD Qua[ Chemical Oxygen Demand mg/L 335 100 100 429 437 95 102 90-110 2 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: 11/14/2019 04:37 PM without the written consent of Pace Analytical Services, LLC. Page 7 of 12 aceAnalytical® aww.pacelabs.cmm QUALIFIERS Project: PLY Slormawer Pace Project No.: 92452432 DEFINITIONS DF - Dilution Factor, if reported, represents the factor applied to the reported data due to dilution of the sample aliquot. NO - Not Detected at or above adjusted reporting limit. TNTC -Too Numerous To Count J - Estimated concentration above the adjusted method detection limit and below the adjusted reporting limit. MDL- Adjusted Method Detection Limit. Pace Analytical Services, LLC 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 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 analyles. TNI - The NELAC Institute. LABORATORIES PASI-A Pace Analytical Services -Asheville PASI-C Pace Analytical Services - Charlotte ANALYTE QUALIFIERS D6 The precision between the sample and sample duplicate exceeded laboratory control limits. 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: 11/14/2019 04:37 PM without the written consent of Pace Analytical Services, LLC. Page 8 of 12 aceAnalytical arww.pac0aba.cam QUALITY CONTROL DATA CROSS REFERENCE TABLE Pace Analytic al Services, LLC 9800 Kincey Ave. Suite 100 Hunlersville, NC 28078 (704)875-9092 Project: Pace Project No.: PLY Slormawer 92452432 Analytical Lab ID Sample ID QC Batch Method QC Batch Analytical Method Batch 92452432002 PLY Stormwater EPA1664B 509477 92452432002 PLY Stormwater SM 2540D-2011 508115 92452432002 PLY Stormwater SM 5220D-2011 508838 SM 5220D-2011 508900 REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, Date: 11/14/2019 04:37 PM without the written consent of Pace Analytical Services, LLC. Page 9 of 12 Document Name: Document Revised: February 7, 2018 _ .aceAnalylxal` Sample Condition Upon Recelpt(SCUR) Page 1 of 2 Document No.: Issuing Authority: F-CAR-CS-033-Rev.06 Pace Carolinas Quality Office Laboratory receiving samples: Asheville ❑ Eden[:] Greenwood ❑ Huntersville Ql�Raleigh❑ Mechanicsville[] Client Name: WO# • 92452432 .. Project q: -E]U «4.( Courier: QFed Ex -❑UPS ❑LISPS ❑Client ❑ Commercial ❑Pace []Other:_ 11 92452432' Custody Seal Present? ❑Yes [QN Seals Intact? ❑Yes o Packing Material: ❑Bubble Wrap �y Bubble Bags ❑None, ❑ Other Thermometer: piR Gun ID: 92TO58 Type of ice: j/]We[ ❑Blue Cooler Temp('C): DA Correction Factor: Add/Subtract ('C) 0.0°C r Cooler Temp Corrected ('C); _ USDA Regulated Soil (O/M/A, water sample) Did samples originate in a quarantine zone within the United States: CA, NY, or SC (check maps)? Flyas MN. Date/Initials Biological Tissue Frozen? []None ❑Yes ❑No L1 /A Temp should be above freezing to 6'C ❑Samples outof temp criteria, Samples on Ice, cooling process hasbegun Did samples originate from a foreign source (internationally, Indudint Hawaii and Puerto Rlco)?MYes MNo Comments/Discrepancy: � Chain of Custody Present? [94es ONG EINIA 1. Samples Arrived within Hold Time? es ❑N/o []N/A 2. Short Hold Time Analysis (<72 hr.)? ❑Yes No N/A 3. Rush Turn Around Time Requested? ❑lyes No QN/a 4. "Sufficient Volume? ❑Nci ❑N/A S. Correct Containers Used? ly., DYes []NO []N/A 6. -Pace Containers Used? ' yes QNO ❑N!A Containers Intact? YGS [IN. ON/A _ 7. Dissolved analysis: Samples Field Filtered? ❑Yes ❑no E N/A B. Sample Labels Match COC7 Yes ❑No ❑N/A 9. ij- -Includes Date/Time/ID/Analysis Matrix: Headspace in VOA Vials(>S-6mmj? Qyes ❑No_9N/A 10. Trip Blank Present? ❑Yes []No N/A _ 11. Trip Blank Custody Seats Present? Yes EINQ . N/A COMMENTS/SAMPLE DISCREPANCY Lot ID of split containers: CLIENT NOTIFICATION/RESOLUTION Person contacted: Date/fime: Field Data Required? ❑Yes []NO Project Manager SCURF Review: N "' Date: Project Manager SRF Review: _L Date: Page 10 of 12 aceAnalylicala Document Name: Sample Condition Upon Recelpt(SCUR) Document Revised: February7, 2018 Page Iof2 Document No.: Issuing Authorityi j F-CAR-CS-033-Rev.06 Pace Carolinas Quality Office 'Check mark top half of box if pH and/or dechlorination is Projectill verified and within the acceptance range for preservation samples. Exceptions: VOA, Coliform, TOC, Oil and Grease, ORO18015 (water) DOC, LLHg **Bottom half of box is to list number of bottle PM: NMG, Due Date:! 11/15/19 CLIENT: U-GP NC g Y V:Z d Q — yE N J V b 6 — E INI J. V Z R — E 'i 9 Y Y N n _ V 2 0 (y)� — E Y1 N V S (� 0 E O 2 Y Y a — YES N '/• 21 "2 Q a, VE' V' O A E a_ LL ¢ W U E `Y .Oi N V V a `m e2, Z' Z .V1 V O ¢ E Y M 'V 2 6 Q 0 a i 1`I� e1 ,S (1 O a E N T 2 -i 2 � E n m M 2 S o E' O al a Q Z. o' E O O1 >>• Z m o E O OI O 0 0 E O OI o ,�- �. O am '� 1 a > > a Y w 6 X' 9 = (J a n E P y~j' a _Z .N E :ry O 2 a .0 T = Z V C a 8E m "n C — :E l9 2 V Z• 6 a E m 1 i 2 3 \ , 4 \ 5 6 . a 9 to I1 12 NENSSI pH Adjustment Log for Preserved Samples SamplelD Type of Preservative pH upon receipt Date preservation adjusted Time preservation adjusted Amount of Preservative added Lot Note: Wheneverthere is a discrepancy affecting North Carolina compliance samples, a copy or mis corm ww oesenuo me Noun UdIUMdDm,.u«,,;��a.,��.,��.�s.�. Out of hold, Incorrect preservative, out of temp, incorrect containers. Page 11 of 12 aceAnapical wx.ycwaz �a Section A Section B CHAIN=OF-CUSTODY / Analytical Request Document The Chan -of -Custody Is a LEGAL DOCUMENT. All relevant folds must be Completed accurately, o N RegWmd Client Information: Requlrad Project Information: Invoice lnfmToffl n: Page: of 1 comvany: Georgia Pacific Report ro: Brandy Turley AueMion: Kellen Arney-Johnson Address: '139 Brewington Dr copy To: brandy.turley@gapac.com co mpeny Name: .Georgia Pacific REGULATORY'AGENCY, ;::-' Dudley, NC 28333 Addnu: 139 Brewinglon Or Dudley NC 28333 rJ NPOES f GROUND WATER r DRINKING WATER Email To: brandy.tudey@gapac.eom Purchase Order No.: Pacedmlo Rerermce: r UST F RCRA F OTHER Phone: 919-705-0526 Fas919-735-7140 Pr theme: -PL7 Stonnwater � nicole.gasiorowskiQpacelabs.com `gibi txcatlmi '.1.-`'-°:_'"- NC Requested Due DatarrAT: PT*d Number Pace PmrB s: 4552-11 ":STATE: -?Requested,Analysis:F.ilteied l(YfNj=--' ". Section D valid Matrix Codes aequIRC GIbM lnfermMbn alA Rl% G4DE _ o COLLECTED Preservatives �> MMXWG WAiFx 11N " U 2 .V 'IT x +' WAsTE.MV 1Y U �E ceNVyTE O <m START EILYNIa j I N O H } SAMPLED WPE wP y w t m (Ad, O.9I,) OP,IR or 0 w F a y! Sam" IDs MUST BE UNIQUE tissue Te O t y ol a �) LL 12 C c C c a r— vi E Z t N DATE TIME DATE TIME m 'N Z, M S Z Z O y 1- of Pace Project No./ L/a'b� I.D. 1" PLY Stcurnwater WN G 1wifig 10:45M 4 1' 1 0 2 0 0 0 0 11 % N Z W F ; 4 _, V s T,. 11 Eli '123 ADDITIONALCOMMENTS '..:..- ?RELINQUISHED BY) Annukrh N,�, 1 DATE, .. -Brandy '�SgdCEPTED BYlAFFlIlAT1ON- DATE TIME SAMPLE SAMPLE CONDITIONS Tu ey 11!51i9 7:05em Ss 5 / j% SAMPLER NAME AND SIGNATURE },: PRWTNamaof SAMPLER: Bfa TUTIe - >> °Uz —� V i " _E } SIGNATURE of SAMPLE DATE Signed fMMIOWYY: 1tl5(19 N m m "ImP.n.M Nole: 9y StOMI, IN. IGm yW . ac[epling P.., NET 30 day Psymonl laaa. vN ae." b rye c,u ...f 1.5%Par mNua rw ery bWear rot ppf0 y - 30 &1. Ill/// F-ALL-O-020rev.08, 12-Oct-2007