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NCG080283_MONITORING INFO_20141121
M,7)-c) STORMWATER DIVISION CODING SHEET NCG PERMITS PERMIT NO. DOC TYPE ❑HISTORICAL FILE � MONITORING REPORTS DOC DATE ❑ a o l � I / a J YYYYMMDD RECE!I V EI) NOV 21 2014 CENTRAL FILES DINR SECTION November 19, 2014 Howell's Motor Freight, Inc. Charlotte Terminal COC NCG080283 On October 15, 2014 a stormwater sample was taken at outfall 1 pursuant to the requirements of the permit referenced above. Lab results showed that the TSS results slightly exceeded the benchmark. The facility was inspected. The silt fence has been replaced. Additionally we are working with an excavating contractor to determine the best solution to the issue. 4.4 PREVENTATIVE MAINTENANCE AND HOUSEKEEPING PROGRAMS Periodic site inspections are a key element of the SWPPP. Recommended BMPs used for preventative maintenance and housekeeping at this facility are described in Worksheet 92. 4.5 SITE SECURITY This facility operates 24 hours per day, 6 days per week. The facility is lighted and fenced. 4.6 NATURAL DISASTERS Should a natural disaster such as hurricane, tornado, flood, etc. occur, the Terminal Manager and Safety Department will be notified immediately in order to activate contingency plans. 4.7 EMPLOYEE TRAINING Howell's relies on employee training as the first line of defense in Pollution Prevention. Training Programs are recorded on Worksheet 97. COUNTER MEASURES 5.1 COUNTER MEASURES TO BE UNDERTAKEN BY THE FACILITY Terminal personnel are trained to take measures to control spills and to contact the appropriate outside personnel to deal with clean-up as necessary. A trained and responsible person shall be on site at all times during facility operations. See Worksheet U. 5.2 EVACUATION PLANS Each Howell's terminal has a site specific evacuation plan. This plan is practiced at least annually. Emergency phone numbers are posted throughout the terminal and are also part of the Emergency Contingency Plan. 5.3 EMERGENCY EQUIPMENT Each facility is equipped with the following emergency equipment: 1. Fire Extinguishers 2. First Aid Kits 3. Shovels 4. Spill Kits and Absorbent 5. Eye Washes EMERGENCY SPILL CONTROL NETWORK 6.1 LOCAL EMERGENCY RESPONSE AGENCIES Worksheet 94 contains a list of Howell's contacts, local emergency response agencies, hospitals and their telephone numbers. r Semi-annual Stormwater Discharge Monitoring Report for North Carolina Division of Water Quality G neral Permit No. NCGO80000 Date submitted 11 CERTIFICATE OF COVf RAGE No. NCGO8 D Z B 3 FACILITY NAME f 0k(411'r M o1bA.. F.G�/5k� , -=i✓G COUNTY PERSON COLLECTING SAP4PLE LABORATORY M?5& ,a i Lab eert. # Comments on sample collection or analysis: Part A. Vehicle Maintenance Areas Monitoring Requirements SAMPLE COLLECTION YEAR SAMPLE PERIOD ❑ Jan -June ❑ July -Dec or ❑ Monthly' _ (month) DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA ❑Zero -flow ❑Water Supply ❑SA ❑Other PLEASE REMEMBER TO SIGN ON THE REVERSE 4 El No discharge this period' �b $Outfa1.1 No., Dates w Sample Collected, --r ..,trio/dd/yr "F{DD530j 00400 ' 00556 Total Suspended Solids, mg/L pH, Standard units Non -Polar Oil and Grease/TPH EPA Method 1664 (SGT-HEM), mg/L New Motor Oil Usage, Annual average gal/mo Benchmark, ,. ,� : ; 50 or 100 see permit Within 6.0 — 9.0 15 - Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? _ yes _no (if yes, report your analytical results in the table immediately below) Part B: Oil/water Separators and Secondary Containment Areas at Petroleum Bulk Stations and Terminals No. - - - Date• ` ' _. Sample Collected,. rno/dd/yr , 00556 00530 00400 Non -Polar Oil and Grease/TPH EPA Method 1664'(SGT-HEM), mg/L Total Suspended Solids, mg/L pH, Standard units Permit Limit - - 15 50 or 100 see permit 6.0 — 9.0 I For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here. S`VU-250 last revised October 25, 2012 Page l of 2 STORM EVENT CHARACTERISTICS: Date N �Z i (first event sampled) Total Even Precipitation (inches): • 1.3 Date (list each additional event sampled this reporting period, and rainfall amount) Total Event Precipitation (inches): 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 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 ot this DMR including all "No Discharge" reports, within 30 days of receipt of the lab results or at end of monitoring eriod 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. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations." (Signature Permittee) (Da e) Additional copies of this form may be downloaded at: http://portal.ncdenr.org/web/wq/wsjsu/npdessw#tab-4 SWU-250 last revised October 25, 2012 Page 2 of 2 Stormwater Discharge Outfall (W) Qualitative Moifitor-ing Report For guidance on filling out this form, please visit cd Permit No.: v/ o/� or Certificate ofCoverage No::- N/�/fa/�� �/.�1� Facility Name: lfe Us Yu a 'P %& -r County: MCrX Phone No. - - o s Inspector: 'Z1F date of Inspection:. 1s L Time of Inspection 3 0 Total Event Precipitatior7 (inches}: ©- 3 Was this a "Representative Storm Event" or `Measureable Storm Event" as defined by the permit? =(See information below.) Vyes []'.No -- Please verify whether Qualitative Monitoring must be performed•during a "representative storm event" or "measureable storm event" (requirements vary, depending on the'permit). Qualitative monitoring requirements vary. Most permits,retluire qualitative monitoring to be performed during a "representative storm even' or during a "measureable storm event." Elowever, 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 stain events during the sampling period, and the permittee 1, obtains approval from fie local DWQ Regional Office. By this signature, I certify that this report is accurate and complete to the best of my knowledge: 1" (Signature of Permittee or Designee) I. Outfall Description: Outfall No. c2CO lI Structure (pipe, ditch, etc.) Receiving Stream: Describe the industrial activities that occur within thee-outfall drainage area: 2: . Color. Describe the colorof the discharge using basic colors (reel, brown, blue, etc). and tint (light; medium, ,dark) as descriptors: qmw, A Al— _IeJ 3. Odor. Dascribe any distinct odors that the discharge may have (Le., smells strongly of oil, weak chlorine odor, etc.): Xoz A;- no+. cLd 6?a vc&Ti P-s 5%L-4- 4. Clarity: Choose the number which best describes the clarity of the discharge, where is clear and-5 is very cloudy: 1 3 4 5 S., Roating.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 3 4 5 6. : 5nspended 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: 1 (Z> 3 4 •5 7. is there any foam in the stormwater discharge? Yes 95 8. Is there. an oil sheen in the stormwater discharge? Yes 9. is there evidence of erosion or deposition at the outfall? Yes 10. Other Obvious indicators of Stormwater Pollution. - List and describer^ - .S aa.a 4-T tq+ki0 - a 1r ~fraZ 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. aceAnalytical xw�'Pecelak— Pace Analytical Services, Inc. 9800 KinceyAve . Suite too Huntersville, NC 28078 (704)a75-9092 October 20, 2014 Mr. Bryan Rose Howell's Motor Freight 10028 Metromont Ind. Blvd. Dept. 1096-76700-30 Charlotte, NC 28269 RE: Project: HOWELLS CHARLOTTE Pace Project No.: 92221571 Dear Mr. Rose: Enclosed are the analytical results for sample(s) received by the laboratory on October 15, 2014. The results relate only to the samples included in this report. Results reported herein conform to the most current TNI standards and the laboratory's Quality Assurance Manual, where applicable, unless otherwise noted in the body of the 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, Nicole Gasiorowski nicole.gasiorowski@pacelabs.com Project Manager Enclosures cc: Mr. Tim Shephard, Howell's Motor Freight REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, without the written consent of Pace Analytical Services, Inc.. Page 1 of 11 aceAnalytical www.pacWabs.com Paco Analytical Services, Inc. 9800 KinceyAve. Suite 100 Huntersville, NC 28078 (704)875-9092 Project: HOWELLS CHARLOTTE Pace Project No.: 92221571 Charlotte Certification IDS 9800 Kincey Ave. Ste 100, Huntersville, NC 28078 North Carolina Drinking Water Certification #: 37706 North Carolina Field Services Certification #: 5342 North Carolina Wastewater Certification #: 12 South Carolina Certification #; 99006001 Ashevitte Certification Ids 2225 Riverside Drive, Asheville, NC 28804 FloridalNEIAP Certification #: E87648 Massachusetts Certification #: M-NC030 North Carolina Drinking Water Certification #: 37712 CERTIFICATIONS FloridalNELAP Certification #: E87627 Kentucky UST Certification #; 84 West Virginia Certification #: 357 Virginia/VELAP Certification #: 460221 North Carolina Wastewater Certification #: 40 South Carolina Certification #: 99030001 West Virginia Certification #: 356 VirginiaNELAP Certification #; 460222 REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, without the written consent of Pace Analytical Services, Inc.. Page 2 of 11 • aooAnalXical www.pacWab&wm Paco Analytical Services, Inc, 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 SAMPLE ANALYTE COUNT Project: HOWELLS CHARLOTTE Pace Project No.: 92221571 Analysos Lab ID Sample ID Method Analysts Reported Laboratory 92221671001 10/15/14 SAMPLE EPA 1664E CLW 1 PASI-C SM 25400 TEP 1 PASI-A EPA 9040 MAB 1 PASI-A REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, without the written consent of Pace Analytical Services, Inc.. Page 3 of 11 axAnalWieal wwwpacefabs.00m Pace Analytical Services, Inc. 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 ANALYTICAL RESULTS ProjeCt: HOWELLS CHARLOTTE Pace Project No.: 92221571 Sample: 10/15/14 SAMPLE Lab ID: 92221571001 Collected: 10/15/14 08:35 Received: 10/15/14 15:05 Matrix: Water Parameters Results Units Report Limit DF Prepared Analyzed CAS No. Qual HEM, Oil and Grease Analytical Method: EPA 1664B Oil and Grease ND mg/L 5.0 1 10116/14 12:26 25400 Total Suspended Solids Analytical Method: SM 2540D Total Suspended Solids 106 mg/L 12.5 1 10/17/14 06:49 9040 pH Analytical Method: EPA 9040 pH 7.6 Sid. Units 0.10 1 10/17/14 13:22 H6 Date: 10/20/2014 10:13 AM REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, without the written consent of Pace Analytical Services, Inc.. Page 4 of 11 tt aceAnalytical www.peoelebs.com Pace Analytical Services, Inc. 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 Project: HOWELLS CHARLOTTE Pace Project No.: 92221571 QC Batch; GCSV119200 QC Batch Method: EPA 1664B Associated Lab Samples: 92221571001 METHOD BLANK: 1308348 Associated Lab Samples: 92221571001 Parameter Units Oil and Grease mg1L QUALITY CONTROL DATA Analysis Method: EPA 1664B Analysis Description: 1664 HEM, Oil and Grease Matrix: Water Blank Reporting Result Limit Analyzed Qualifiers ND 5.0 10116I14 12:17 LABORATORY CONTROL SAMPLE: 1308349 Spike LCS LCS % Rec Parameter Units Conc. Result % Rec Limits Qualifiers Oil and Grease mg1L 40 34.6 86 78-114 MATRIX SPIKE SAMPLE: 1308350 92221354001 Spike MS MS % Rec Parameter Units Result Conc. Result % Rec Limits Qualifiers Oil and Grease mg1L ND 40 36.5 91 78-114 Results presented on We page are In the units indleated 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: 1012012014 10:13 AM without the written consent of Pace Analytical Services, Inc.. Page 5 of 11 aceAna1jcal wwwpacelabs.00m Pace Analytical Services, Inc. 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 QUALITY CONTROL DATA Project: HOWELLS CHARLOTTE Pace Project No.: 92221571 QC Batch: WET/33793 Analysis Method: SM 2540D QC Batch Method: SM 2540D Analysis Description: 2540D Total Suspended Solids Associated Lab Samples: 92221571001 METHOD BLANK: 1309332 Associated Lab Samples: 92221571001 Parameter Units Total Suspended Solids mg/L LABORATORY CONTROL SAMPLE: 1309333 Parameter Units Total Suspended Solids mg/L SAMPLE DUPLICATE: 1309334 Parameter Units Total Suspended Solids mg/L SAMPLE DUPLICATE: 1309335 Parameter Units Total Suspended Solids mg/L Matrix: Water Blank Reporting Result Limit Analyzed Qualifiers NO 2.5 10/17/14 06:39 Spike LCS LCS % Rec Conc. Result % Rec Limits Qualifiers 250 264 106 90-110 92221868001 Dup Result Result NO NO 92221523001 Dup Result Result 142 151 RPD Qualifiers RPD Qualifiers 6 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: 10/20/2014 10:13 AM without the written consent of Pace Analytical Services, Inc.. Page 6 of 11 aceAnalytical wwwparislab&eem Pace Analytical Services, Inc. 9800 Kincey Ave. Suite 100 Huntersville, NC 2BO76 (764)675-9092 QUALITY CONTROL DATA Project: HOWELLS CHARLOTTE Pace Project No.: 92221571 QC Batch: WET133794 Analysis Method: EPA 9040 OC Batch Method: EPA 9040 Analysis Description: 9040 pH Associated Lab Samples: 92221571001 SAMPLE DUPLICATE: 1309387 Parameter pH SAMPLE DUPLICATE: 1309388 Parameter pH 92221443001 Dup Units Result Result RPD Qualifiers Std, Units 7.6 7.8 1 H6 92221843002 Dtip Units Result Result RPD Qualifiers Std. Units 6.6 6.5 1 H6 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 thi result. REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, Date: 10/20/2014 10:13 AM without the written consent of Pace Analytical Services, Inc.. Page 7 of 11 aceAnalytical www.pecalabacom Pace Analytical Services, Inc. 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 QUALIFIERS Project: HOWELLS CHARLOTTE Pace Project No.: 92221571 s1:171a111ll1912W DF - Dilution Factor, if reported, represents the factor applied to the reported data due to changes in sample preparation, dilution of the sample aliquot, or moisture content. ND - Not Detected at or above adjusted reporting limit. J - Estimated concentration above the adjusted method detection limit and below the adjusted reporting limit. MOIL -Adjusted Method Detection Limit. PQL - Practical Quantitation Limit. RL - Reporting Limit. S - Surrogate 1,2-Diphenylhydrazine (8270 listed analyte) decomposes toAzobenzene. 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. N-Nitrosodiphenylamine decomposes and cannot be separated from Diphenylamine using Method 8270. The result reported for each analyte is a combined concentration. Acid preservation may not be appropriate for 2-Chloroethytvinyl ether, Styrene, and Vinyl chloride. 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 - Chariotte ANALYTE QUALIFIERS H6 Analysis initiated outside of the 15 minute EPA recommended holding time. REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, Date: 10/20/2014 10:13 AM without the written consent or Pace Analytical Services, Inc.. Page 8 of 11 Pace Analytical Services, Inc. e r� r, ll�� j lX 9800 Kincey Ave. Suite 100 �! ���p Huntersville, NC 28078 www.pecelabscom (704)875-9092 QUALITY CONTROL DATA CROSS REFERENCE TABLE Project: HOWELLS CHARLOTTE Pace Project No.: 92221571 Analytical Lab ID f Sample ID QC Batch Method QC Batch Analytical Method Batch 92221571001 10115M4 SAMPLE EPA 1664B GCSV119200 92221571001 10/15/14 SAMPLE SM 25400 WET133793 92221571001 10/15/14 SAMPLE EPA 9040 WET133794 REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, Date: 10/20/2014 10:13 AM without the written consent of Pace Analytical Services, Inc., Page 9 of 11 � cfl�rk�Jytical' Sample Cohditlon tJ on.Recei• f SGUR Paige 1 of 2 Document Numlaer: ls'suing.Autitority: F CHR-.CS 003_'rev.15 Pace Hunteesville Qualit Office Client Name:_g,,,,,tflr �,f,,r 1;y. q- Courier: ❑ Fed Ex ❑ UPS❑ USPS❑ 'Clien*E, Commercial❑ Pa Other Custody Seal on CoolerlBox Present: ❑ yes [,�no Seals intact: ❑ yes ❑ no Packing Material;; 2--Bubble VDp Bubble Sag,-! ❑ None ❑ Other Thermometer Used: IR.Gun 14f?1 TY4ie"of Ice: (QW Blue None �ampies on`ice.; cooling process has begun Temp Correction Factor T1401 No Correction Corrected Cooler Temp:: _ C ' plogical Tissue'is Frozen. Yes :No NIA Date and'Initials of porson examining contents; • = Temp should be above freezing to 6°C 4 Comments: Chain of Custody Present: C` IS. ON, ❑NIA_ 1, Chain of Custod Filled Out: No ❑NIA 2. !J� anor 1. • S fs or► ce�C .,.ia, ,r Chain.of Custody Relinquished: 0.�`es O.No . ❑N(A 3, ; 'Sampler -Name &.Signature on COC: !Yes ONO, ❑NrA 4; Samples Arrived wllhin.Hold Time: _. ., LXres..ONo,, ❑N1,4 5, Short.Wold Time Anal sis <72hr : G-YYe', 13C, ❑WA 6. Rush Turn,Around Time Requested: Yes tsNo ❑NA 7. Suffic€ent Volume: �C _G es .❑No . 0N1n 8. Correct Containers Used: tdYes ON, ❑NI'A g, -Pace Containers Used: Yes ©No• ❑NIA Containers. intact: We's ONO "ON/A. 10. �C Filtered volume received for bissoived tests 6Yes ONO NIA 11, Sample Labels match COC: a C+Yes ONO "CINIA . 12, -Includes dateltimellDlAna! sis Matrix: ; Aircdntalners needing preservation have been checked. ` - Yes ONO 13. All containers needing'preservatlon ere found to be'Itt FjYes ❑No //A .I�NrA' compllance with EPA recommendation. exceptions:'VOA, colifdrm,TOC,°0&G, WI•DRO(water) C�+Yes ❑No .: Samples checked- for, dechlorinatior) Yes ❑No GK6 14" Heads ace in VOA Vials '>6mm): C'lves ONO OU' 15. Trip Blank Present: G).Yes ONO,." R11A 16, Trip Blank Custody Seals Present C-Wes ❑No'. I1NlA 7 l ' f d Pace'i '8 rank Lot# J. i , ; purchase : Client Notification! Resalutloh: Field Data Regulr`ed? Y'., ,1• N Person Contacted:; ' '4 Date/Time:' Comments/ Resolut!on: SGURFReview: Date' • Plnnp lahplIhprp 1SRF Review: out., Dater 1 `0~ Note: Whenever there is a,discrepancy affecting North?Caiolina`compfiance sarn_ pies; a:co_ py of this form .wiil be sen-i4o.tlie North Ci`rol6 DEFINR. Certification Office (I.Bold{ e, out of d{ ineotre'CC.._. presc� ryatile, out'of temp, Incorrect containers) 'CHAIWOF-CUSTODY-1 Analytical Request Document The Chairl-of-Custcdy is aLEGAL DOCUMENT. All relevant fields must be'completed accurately. Section B section c Rocuirod 6ietifiniwmaliow Rociulro Fr9jid [Aformatioh: Invoice Information: Attention: 17,960,4 9 7 Company Name: .�x Address- F NPDES F_ ROUND,WATER DRINKINGWATER' r UST- r:!.:R6zX.&. No.: fate Quote RMereooe. Phone: Project Name; paw FTI- Requested Due Oatw7AT, Project Number. Pecs Pmrde tP, ijestid-Afialys !$-.Fitt i Section D Matriiicod" MATRIX I Z�2E COLLECTED Preservatives Drinking water 'DW io Water WT 0 Waste Water VVW Pr6clUef P ST.�RT tu ,�oevsokd SL SAMPLEID WiOil OL pe VVP (A-Z, 0-9 Lu U) 5 w .Air AR C) w IL 'Sample tDs MUST BE UN104JE Tissue TS C) Other OT w ul z 0 c F_ (L 0 U_ (56 -nm 0 0 ul < < o E I ZE DATE TIME DATE TIME u) . z z 0 Pace: Project NoJ Lab 61 to; 13;, Iq e3-6 or"y jt,4sj,( j?._j 0 jofj;.Z f, a-.r ,12 ADDITIONAL COMMENTS RELINQUISH.50SY/AFFILIATION DATE TIME ACE BY/AF TION DATE TIME SAMPLE CONDITIONS -Pillrole ,stiff rb, t' SAMPLER D SIG14ATURE" :xZ ORIGINAL mwru.ii. f sAmnm-, SIGNATUFM'6f SA�PLCR�: DA��Siqned yam.. Impofti-A NC40: By37ngl�l f0m,Mea"P's NET agemqMaiaige�of 1,5% pmonth for any irmV�6ag nor paid J7.0 30 43YsF_Cozqrevmyf. 15May_zJyfac�do