NCG060400_MONITORING INFO_20190206

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
/V C� �� U l uv
DOC TYPE
❑HISTORICAL FILE
C�MONITORING REPORTS
DOC DATE
❑ a c I I �� D u �°
YYYYMMDD

STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Energy, Mineral and Land Resources General Permit No. NCG060000
Date submitted / - ;� 7 - A 0 :1;rD
CERTIFICATE OF COVERAGE NO. NCG060 _L I Q �3
FACILITY NAME S c. -r_ c+ S c t, ,i r-
COUNTY LJ'• c-ti--
PERSON COLLECTING SAMPLES �Y ✓ � _
LABORATORY PRCIC 44:14.. / Lab Cert. #g 0�-
RECEIVED
FEB a 6 2019
PILES
,-VR SECTION
Part A: Stormwater Benchmarks and Monitoring Results
SAMPLE COLLECTION YEAR -,? 0 /9
SAMPLE PERIOD ❑ Jan -June ;R July -Dec
or ❑ Monthlys _ (month)
DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
❑Zero -flow ❑Water Su ly [:]SA®Other Q; r .� 77
FACILITY ACTIVITIES INCLUDE (check all that apply):
9 use/process meats P9 use animal fats/byproducts
PLEASE REMEMBER TO SIGN ON THE REVERSE -->
Total event rainfall z , 37 or ❑ No discharge this period'
Outfall No.
pate Sample
Collected, mo/dd/yr
TSS,
mg/L
pH,
Standard units
COD,
mg/L
Oil and Grease,
mg/L
Fecal Collform,
Colonies per 100 ml
Enterococci,
Colonies per 100 ml
Benchmark
-
100 or SW
Within 6.0 -- 9.0
120
30
10001
Soo,
Parameter Code
-
C0530
00400
00340
00556
31616
61211
-1'7--A01
L)
—
A C C
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 1, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
SMonthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
')id this facility perform Vehicle Maintenance Activities using more than 55 gallons of new oil per month? ❑ yes ED no (if Zes complete Part B)

-Outfall No.
Date Sample Collected
[mo/dd%yr).a.:;:°'
24-hour rainfall amount,
2
Inches..: _
New Motor Oil or
Hydraulic Oil Usage
Non -Polar O&G/Total
Petroleum Hydrocarbons
Total Suspended Solids
Benchmarks"-,
-
-
-
15 mg/L-
100 mg/L or 50 mg/L`
AarameterCocle _
- `;
- 46529" _
kNCDIL.
.00552
-CO530•-'.
Footnotes from Part A also apply to Part B
*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 DEMLR REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an original cony of this DMR. including all "No Discharae" 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 Centrai 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 supervise n 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."
_ J C -,,2 9, �Z u-,t 10
Signature of Permittee Date
Permit Date: 1111/2018-05/31/2021 5WU-249, Last Revised 11/5/2018
Page 2 of 2

'acmnalytical
www.pocttabs.corn
December 31, 2019
Jeff Ross
Sun River Service Corporation
2018 Beeler Rd
Wilson, NC 27893
RE: Project: Stormwater
Pace Project No.: 92457724
Pace Analytical Services, LLC
6701 conference Drive
Raleigh, NC 27607
(919 y834-49t34
Dear Jeff Ross:
Enclosed are the analytical results for sample(s) received by the laboratory on December 17, 2019.
The results relate only to the samples included in this report.
Analyses were performed at the Pace Analytical Services location indicated on the sample analyte
page for analysis unless otherwise footnoted.
If you have any questions concerning this report, please feel free to contact me.
Sincerely,
Tyriek Hooks
[e-mail]
[phone]
Project Manager
Enclosures
cc: Vickie Brock, Sun River Service Corporation
Ray Davis, Sun River Service Corporation
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 15

aceAnalytical
www.Pacdahs.com
Project: Stormwater
Pace Project No.: 92457724
Pace Analytical Services Raleigh
6701 Conference Drive, Raleigh, NC 27607
North Carolina Wastewater Certification #: 67
Pace Analytical Services, LLC
6701 Conference Drive
Raleigh, NC 27607
[phone]
Pace Analytical Services Charlotte
9800 Kincey Ave. Ste 100, Huntersvilie, NC 28078
Louisiana/NELAP Certification # LA170028
North Carolina Drinking Water Certification #: 37706
North Carolina Field Services Certification #: 5342
North Carolina Wastewater Certification #: 12
Pace Analytical Services Asheville
2225 Riverside Drive, Asheville, NC 28804
FloridalNELAP Certification #: E87648
Massachusetts Certification #: M-NCO30
North Carolina Drinking Water Certification #: 37712
Pace Analytical Services Eden
205 East Meadow Road Suite A, Eden, NC 27288
North Carolina Drinking Water Certification #: 37738
CERTIFICATIONS
North Carolina Bioassay Certification #: 16
North Carolina Drinking Water Certification #: 37731
South Carolina Certification #: 99006001
Florida/NELAP Certification #: E87627
Kentucky UST Certification #: 84
VirginiaNELAP Certification #: 460221
North Carolina Wastewater Certification #: 40
South Carolina Certification #: 99030001
VirginiaNELAP Certification #: 460222
North Carolina Wastewater Certification #: 633
VirginiaNELAP Certification #: 460025
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 15

aceAnalyticalar
www,pacelabi.com
SAMPLE ANALYTE COUNT
Project: Stormwater
Pace Project No.: 92457724
Pace Analytical Services, LLC
6701 Conference Drive
Raleigh, NG 27607
[phone]
Lab ID Sample ID Method
Analysts
Analytes
Reported
Laboratory
92457724001 In Bound SM 25401)-2011
AMI
1
PASI-E
SM 4500-H+B-2011
MWF
1
PASi-E
EPA 1664B
HH
1
PASI-C
EPA 1664B
HH
1
PASI-C
SM 9222D-2006
WT
1
PASI-R
SM 52200-2011
NAL
1
PASI-A
92457724002 Out Bound SM 254OD-2011
AMI
1
PASI-E
SM 4500-H+3-2011
MWF
1
PASI-E
EPA 1664E
HH
1
PASI-C
EPA 1664B
HH
1
PASI-C
SM 922213-2006
WT
1
PASI-R
SM 5220D-2011
NAL
1
PAS1-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 15

aceAnalyticalm
www.pacelabi.com
ANALYTICAL RESULTS
Project: Stormwater
Pace Project No.: 92457724
Pace Analytical Services, LLC
6701 Conference Drive
Raleigh, NC 27607
[phone]
Sample: In Bound
Lab ID: 92457724001 Collected: 12/17/19 11:20
Received: 12/17/19 13:15 Matrix: Water
Parameters
Results Units Report Limit DF
Prepared Analyzed CAS No.
Qual
25400 Total Suspended Solids
Analytical Method: SM 254OD-2011
Total Suspended Solids
329 mg/L 17.1 1
12/19/19 09:42
4500H+ pH, Electrometric EDN
Analytical Method: SM 4500-H+B-2011
pH at 25 Degrees C
6.9 Sid. Units 0.10 1
12/18/19 12:56
H3
HEM, Oil and Grease
Analytical Method: EPA 1664E
Oil and Grease
ND mg/L 5.0 1
12/31/19 09:23
M1
1664 SGT•HEM, TPH
Analytical Method: EPA 16645
Total Petroleum Hydrocarbons
ND mg/L 5.0 1
12/31/19 09:23
M1
MBIO 9222D Fecal Coliform RAL
Analytical Method: SM 9222D-2006 Preparation Method:
SM 9222D-2006
Fecal Coliforms
6000 CFU/100 mL 1.0 1
12/17/19 14:47 12/18/19 14:52
u2
52200 COD
Analytical Method: SM 5220D-2011 Preparation Method: SM 52200-2011
Chemical Oxygen Demand
311 mglL 25.0 1
12/19/19 17:12 12/19/19 20:09
Sample: Out Bound
Lab ID: 92457724002 Collected: 12/17/19 11:30
Received: 12117/19 13:15 Matrix: Water
Parameters
Results Units Report Limit DF
Prepared Analyzed CAS No.
Qual
2540D Total Suspended Solids
Analytical Method: SM 25400-2011
Total Suspended Solids
411 mg/L 31.2 1
12/19/19 09;43
4500H+ pH, Electrometric EDN
Analytical Method: SM 4500-H+6-2011
pH at 25 Degrees C
7.0 Sid. Units 0.10 1
12/18/19 12:58
H3
HEM, Oil and Grease
Analytical Method: EPA 1664B
Oil and Grease
NO mg/L 5.0 1
12/31/19 09:23
1664 SGT-HEM, TPH
Analytical Method: EPA 1664B
Total Petroleum Hydrocarbons
ND mg1L 5.0 1
12/31/19 09:23
MBIO 9222D Fecal Coliform RAL
Analytical Method: SM 9222D-2006 Preparation Method:
SM 92220-2006
Fecal Coliforms
6000 CFU/100 mL 1.0 1
12/17/19 14:47 12/18/19 14:52
u2
5220D COD
Analytical Method: SM 5220D-2011 Preparation Method: SM 5220D-2011
Chemical Oxygen Demand
315 mg/L 25.0 1
12/19/19 17:12 12/19/19 20:09
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
Date: 12/3112019 04714 PM without the written consent of Pace Analytical Services, LLC. Page 4 of 15

acmnalytical
www,plcolab3.COM
QUALITY CONTROL DATA
Project: Stormwater
Pace Project No.: 92457724
QC Batch; 515732 Analysis Method: SM 25400-2011
QC Batch Method: SM 2540D-2011 Analysis Description: 25400 Total Suspended Solids
Associated Lab Samples: 92457724001. 92457724002
METHOD BLANK: 2763350 Matrix: Water
Associated Lab Samples: 92457724001, 92467724002
Blank Reporting
Parameter Units Result Limit Analyzed Qualifiers
Total Suspended Solids mg/L ND 2.5 12/19/19 09:38
Pace Analytical Services, LLC
6701 Conference Drive
Raleigh, NC 27607
[phone]
LABORATORY CONTROL SAMPLE: 2763351
Spike LCS LCS % Rec
Parameter Units Conc. Result % Rec Limits Qualifiers
Total Suspended Solids mglL 250 246 98 90-110
SAMPLE DUPLICATE: 2763352
92457579002 Dup
Parameter Units Result Result RPO Qualifiers
Total Suspended Solids mg)L 100 101 1
SAMPLE DUPLICATE: 2763353
92457741001 Dup
Parameter Units Result Result RPD Qualifiers
Total Suspended Solids mg/L 412 450 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 of the result.
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
Date: 12/31 /2019 04:14 PM without the written consent of Pace Analytical Services, LLC. Page 5 of 15

aceAnalXical
www.patelabs.com
QUALITY CONTROL DATA
Project: Stormwater
Pace Project No.: 92457724
QC Batch: 515529 Analysis Method: SM 4500-H+B-2011
QC Batch Method: SM 4500-H+B-2011 Analysis Description: 4500H+B pH EDEN
Associated Lab Samples: 92457724001, 92457724002
SAMPLE DUPLICATE: 2762285
92457596002 Cup
Parameter Units Result Result RPD Qualifiers
pH at 25 Degrees C Sid. Units 7.0 7.0 0 H1
Pace Analytical Services, LLC
6701 Conference Drive
Raleigh, NC 27607
[phone]
Results presented an 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: 12131I2019 04:14 PM without the written consent of Pace Analytical Services, LLC.
Page 6 of 15

aceAnalytical
www.pacalabi.com
QUALITY CONTROL DATA
Project: Stormwater
Pace Project No.: 92457724
QC Batch: 517359 Analysis Method: EPA 1664E
OC Batch Method: EPA 1664E Analysis Description: 1664 HEM, Oil and Grease
Associated Lab Samples: 92457724001, 92457724002
METHOD BLANK: 2770347 Matrix: Water
Associated Lab Samples: 92457724001, 92457724002
Blank Reporting
Parameter Units Result Limit Analyzed Qualifiers
Oil and Grease mglL ND 5.0 12/31/19 09:22
Pace Analytical Services, LLC
6701 Conference Drive
Raleigh, NC 27607
(919)834A984
LABORATORY CONTROL SAMPLE:
2770348
Spike LCS
LCS
% Rec
Parameter
Units
Conc. Result
% Rec
Limits
Qualifiers
Oil and Grease
mgtL
40 36.2
90
78-114
MATRIX SPIKE SAMPLE:
2770349
92457724001 Spike
MS
MS
% Rec
Parameter
Units
Result Conc.
Result
% Rec
Limits Qualifiers
Oil and Grease
mg1L
ND 40
24.9
51
78-114 M1
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 he reproduced, except in full,
Date: 12/3112019 0414 PM without the written consent of Pace Analytical Services, LLC. Page 7 of 15

m
(�5acmnalytical
www.pacelabs.com
QUALITY CONTROL DATA
Project: Stormwater
Pace Project No.: 92457724
QC Batch: 517361 Analysis Method: EPA 1664E
QC Batch Method: EPA 16646 Analysis Description: 1664 SGT-HEM, TPH
Associated Lab Samples: 92457724001, 92457724002
Pace Analytical Services, LLC
6701 Conference Drive
Raleigh, NC 27607
[phone]
METHOD BLANK: 2770352
Matrix:
Water
Associated Lab Samples: 92457724001, 92457724002
Blank
Reporting
Parameter
Units
Result
Limit Analyzed Qualifiers
Total Petroleum Hydrocarbons
mg1L
ND
5.0 12/31/19 09:22
LABORATORY CONTROL SAMPLE:
2770353
Spike
LCS LCS % Rec
Parameter
Units
Conc.
Result % Rec Limits Qualifiers
Total Petroleum hydrocarbons
mg1L
20
16.6 83 64-132
MATRIX SPIKE SAMPLE: 2770354
92457724001 Spike MS MS % Rec
Parameter Units Result Conc. Result % Rec Limits Qualifiers
Total Petroleum Hydrocarbons mg1L ND 20 15.4 55 64-132 M1
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: 12/31/2019 04:14 PM without the written consent of Pace Analytical Services, LLC. Page 8 of 15

aceAnalytical
www.picsl&bs.com
QUALITY CONTROL DATA
Project: Stormwater
Pace Project No.: 92457724
QC Batch: 516916 Analysis Method: SM 9222D-2006
QC Batch Method: SM 9222D-2006 Analysis Description: 9222D Fecal Coliform(MF) - RAL
Associated Lab Samples: 92457724001, 92457724002
METHOD BLANK: 2758780 Matrix: Water
Associated Lab Samples: 92457724001, 92457724002
Blank Reporting
Parameter Units Result Limit Analyzed Qualifiers
Fecal Coliforms CFU/100 mL ND 1.0 12/18119 14:52
SAMPLE DUPLICATE: 2768781
92457724001 Dup
Parameter Units Result Result RPD Qualifiers
Fecal Coliforms CFU1100 mL 6000 6000 0 u2
Pace Analytical Services, LLC
6701 Conference Drive
Raleigh, NC 27607
[phone]
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: 12/3112019 04:14 PM without the written consent of Pace Analytical Services, LLC.
Page 9 of 15

acmnalXical
rwrl.pecelabs.com
QUALITY CONTROL DATA
Project: Stormwater
Pace Project No.: 92457724
QC Batch: 515650 Analysis Method: SM 522OD-2011
QC Batch Method: SM 5220D-2011 Analysis Description: 52200 COD
Associated Lab Samples: 92457724001, 92457724002
METHOD BLANK: 2763124 Matrix: Water
Associated Lab Samples: 92457724001, 92457724002
Blank Reporting
Parameter Units Result Limit Analyzed Qualifiers
Chemical Oxygen Demand mg1L ND 25.0 12/19/19 20:04
Pace Analytical Services, LLC
6701 Conference Drive
Raleigh, NC 27607
(9191834.4984
LABORATORY CONTROL SAMPLE: 2763125
Spike LCS LCS % Rec
Parameter Units Conc. Result % Rec Limits Qualifiers
Chemical Oxygen Demand mg1 750 751 100 90-110
MATRIX SPIKE & MATRIX SPIKE DUPLICATE: 2763126 2763127
MS MSD
92457447001 Spike Spike MS MSD MS MSD % Rec
Parameter Units Result Conc. Conc. Result Result % Rec % Rec Limits RPD Qua(
Chemical Oxygen Demand mg1 53.6 100 100 165 165 111 111 90-110 0 M1
MATRIX SPIKE & MATRIX SPIKE DUPLICATE: 2763128 2763129
MS MSD
92457469001 Spike Spike MS MSD MS MSD % Rec
Parameter Units Result Conc, Conc. Result Result % Rec % Rec Limits RPD Qual
Chemical Oxygen Demand mg1L 46.7 100 100 153 155 107 109 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: 12/31 /2019 04:14 PM without the written consent of Pace Analytical Services, LLC.
Page 10 of 15

laceAnalyficalo
www,pacslabs.com
QUALIFIERS
Project: Stormwater
Pace Project No.: 92457724
11174df�IfiireTkW
Pace Analytical Services, LLC
6701 Conference Drive
Raleigh, NC 27607
(919)8344984
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 ofAcrolein 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.
LABORATORIES
PASI-A
Pace Analytical Services - Asheville
PASI-C
Pace Analytical Services - Charlotte
PASI-E
Pace Analytical Services - Eden
PASI-R
Pace Analytical Services - Raleigh
ANALYTE QUALIFIERS
H1 Analysis conducted outside the EPA method holding time.
H3 Sample was received or analysis requested beyond the recognized method holding time.
M1 Matrix spike recovery exceeded QC limits. Batch accepted based on laboratory control sample (LCS) recovery.
u2 Colonies are too numerous to count. Actual result may be greater than reported.
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
Date: 12/31 /2019 04:14 PM without the written consent of Pace Analytical Services, LLC. Page 11 of 15

Pace Analytical Services, LLC
aeeAnalXical
6701 Conference Drive
Raleigh, NC 27607
wwa.pscelbbs'com
[phone]
QUALITY CONTROL DATA CROSS REFERENCE TABLE
Project:
Stormwater
Pace Project No.:
92457724
Analytical
Lab ID
Sample ID
QC Batch Method
QC Batch
Analytical Method
Batch
92457724001
In Bound
SM 254OD-2011
515732
92457724002
Out Bound
SM 2540D-2011
515732
92457724001
In Bound
SM 4500-H+B-2011
515529
92457724002
Out Bound
SM 4500-H+B-2011
515529
92457724001
In Bound
EPA1664B
517359
92457724002
Out Bound
EPA16646
517359
92457724001
In Bound
EPA1664B
517361
92457724002
Out Bound
EPA1664B
517361
92457724001
In Bound
SM 9222D-2006
516916
SM 9222D-2006
516918
92457724002
Out Bound
SM 92220-2006
516916
SM 9222D-2006
516918
92457724001
In Bound
SM 52200-2011
515650
SM 5220D-2011
515898
92457724002
Out Bound
SM 52200-2011
515650
SM 5220D-2011
515898
Date: 12/31/2019 04:14 PM
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, LLC.
Page 12 of 15

Laboratory receiving sampfes:
Asheville Eden[] Greenwood ❑ Huntersvilfe ❑ Ralefgh& Mechanicsville[]
Client Name: �• '92,�5.77 �
Project g:
Courier: LJFed Ex UPS USPS gglent
Q commercial QPace []Other: 1192457724' " • .
Custody Seat Present? Dyes &0, Seals intact? QYes 1&0 z1�l 112- -/ %-
Date/Inldati Person Examlydng Contents: %
Packing Material: QBubbie Wrap - []6ubble Bags RNone ❑ Other alologfcaI Tissue Frozen?
Thermometer. too rypeorlcc: >�vec ❑oiue ❑Noll! ❑Yes ONO f5a4/A
❑ IR Gun ID: l v✓
Cooler Temp ('C): Correction factor: Add/Subtract ('C) (5,0
Temp should be above freeiing to fi'C
Cooler Temp Corrected ('C): •$ QSamples oat ofternp criteria. Samples on Ice, cooling process
has begun
USDA Regulated Soil (9 N/A, water sample)
Old samples originate in a quarantlae zone wlthfn the United States: CA, NY, or SC (check maps)? Did samples originate from -a foreign source (Internadonally,
my.. f IU in,i,,An. r .„ 17 end u,.a to aim17 f_1Y09 f1N)
Comments/Discrepancy:
Chain ofCuStod Present?
Yes
QNo
N/A
L
Samples Arrived within Hold Time?
&JYm
No
❑N/A
2.
Short Hold Timo Analysis <77 hr.)?
®Yes
EINa
NIA
3.
Rush Turn Around Time Requested?
Yes
4
N A
4.
SufficlentVnfume7
es
Na
N A
S.
Correct Containers Used?
-Pace Containers Used?
(g,Yex
OYes
[]NO
No
[]N/A
N/A
6•
Containers Intact?
&tx
qNo.
N/A
7.
DlssnNed anal sis: Sam les Field Flltered7
Yes
EINo
/A
H.
Sample Labels Match COC?
-Includes 0are/Tlme ID/Analysq Matrix: W V
5W
❑No
❑N/A '
9.
Heads pace In VOA Vlals(>5-8mrn)?
❑Yes
QNo
PqKIA
10,
Trip Blank Present?
Trip Blank Custody Seals Present?
(Yes
Yes
©No
No
/A
/A
11.
COMMENTS/SAMPLE DISCREPANCY
_ Lot ID of s flt containers:
CLIENT NOTIFICATION/RESOLUTION
Field Data Raqulred? ❑Yes ❑No
Person contacted: pate/Time: _
Project Manager SURF Review: Date: ovi
�7
Project Manager SRF Review: Date:
Page 13 of 15

Item&
Z777zoSP4U-125 ;sal. Plastic Unpreserved (N/A) (CI-)
9P3U-2SU mL Plastic Unpreserved (N/A)
9PZU-S00 mL Plastic Unpreserved (N/A].
. l BP1U-1 Il:er Plosde Unpreserved (N/A)
9P4S-125 mL Plastic H2504 (pH < 2) (Cl-)
BP3N.250 mL plast]c HNO3 (pH < 2)
XVBP4Z-125 mt Plastic ZN Acetate & MOH (r9)
BP4C-125 mt Plastic NaDH (PH;— 12) (CH
WGFU-Wide-mouthed Glals)ar Unpreserved
tt
3 AG3U-1 Uter Amber Unpreserved (NIA) (C-J
!)))�
AGIWI 11ter Amber HCl (pH < 2)
AG3U-250 mL Amber Unpreserved (N/A) (U-)
AG1S-1 Itter Amber H2SO4 (pH < 2)
AG35-250 mL Amber H2SO4 (pH < 21
AG3A(1563A)-250 ml.Amber NH4(1 (N/A)(Cl-j
6G9H-40 mL VOA HCl (N/A)
VGST-40 mL' VOA Na2S203 (N/A)'
VGOU-40 mL VOA Unp (N/A)
• DG9P-40 mL VOA H3PO4 (N/A)
V DAK (S vials per kit)-5035 Idt (N/A)
V/GK (3 vials per lclt)-VPH/Gas kit (N/A)
SPET-125 mL Sterile Plastic (N/A - iab)
SP2r 250 rnLSterile Plastic (N/A --lob)
BP3A-250 mL Plastic (NH2)2SAD4 (9.3-9.7)
AGCt -ID0 ML Amber U npreserved vials (N/A)
' VSGU-20 mL Scintlll;kVon vtsls (N/A)
DG9iJ-40 mL Amber Unprest!"ed vlats (N/A)
A
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f�J CHAIN OF -CUSTODY / Analytical Request Document
The Chain -of -Custody is a LEGAL DOCUMENT. AA relevant fields must be completed accuralely.
Seetton A Section B section C
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Address. 2019 8eolor Rd
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Wfton, NC 27893
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Prejea Name: StomrwJter
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