NCG090009_MONITORING INFO_20170123

M2�
STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT N0.
DOC TYPE
❑HISTORICAL FILE
[� MONITORING REPORTS
DOC DATE
❑ Qu ) � /0 1 a 3
YYYYMMDD

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
GENERAL PERMIT NO. NCG090000
CERTIFICATE OF COVERAGE NO. NCG09 0001
FACILITY NAME Aids' PZ-,wc.4s t a.
PERSON COLLECTING SAMPLES _T, f .lt krEc_
CERTIFIED LABORATORY _ t i "S rn L>a d-t , _ " Lab #
Lab #
Part A: Specific Monitoring Requirements
SAMPLES COLLECTED DURING CALENDAR YEAR: .20 / �
(This monitoring report is due at the Division no later than 30 days from
the date the facility receives the sam ling results from the laboratory.)
COUNTY Uaa
PHONE NO. (_Z�il_) 931j c04
PLEASE SIGN ON THE REVERSE ->
Outfall
No:
Date
Sample Collected,
mb/dd%'..r;
:. 01027
01034
01051
Total Cadinlum,'
TotahChiomiuxn,
Lead,
u
Benchmark
1;.;" , ,
y 1000`
33
#1
ZNOT-
perrrrP0LF'
4
Note: If you report a sampled value in excess of the benchmark value. you must implement Tier 1 or Tier 2 responses. See General Permit text.
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 Activity Monitorint; Requirements
RECEIVED
JAN 2 3 2017
'CENTRAL FILES
DWR SECTION
Outfall
_
No ,
'
- Date
Sample Collected, .
rno/dd/ yr
00556 ..
j'00530 _b«
> , 00400
Ofl and Grease,'_
'Total Sus ended 5blids,
pei
L = ';
"pH,
Standard units
New Motor Od Usage, `
Anuual'average lhno ".
:Benchmark
30
:. 100 ;
<6.0 ': 9.0'Ala
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.
See General Permit text.
STORM EVENT CHARACTERISTICS:
Date (first event sampled)
Total lkvent Precipitation (inches):
Date (list each additional event sampled this reporting period, and rainfall amount)
Total Event Precipitation (inches):
Mail Original and one copy to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
SWO-255-102107
Page 1 of 2

r� .�
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"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."
A;i��1�eeI l7 /
(Signature of Per ' tee) (Date)
S W U-255-102107
Page 2 of 2

STORMWATER DISCHARGE OUTFALL 1SDO)
ONITORING REPORT
GENERAL PE:R.'8117- NO. N00090000 SAMPLES COI,I.EC'I-E1) D( Rlti(: CAI-ENDAR 1'EAR: 2aIG
CE:R'I'IFIC:17'E: OF C01'ERAC:E NO. NCG(l9 0 002 (This monitoring; report is due at the Division no later than 31) days fr
TO
/ ! -� the date the facility receives the s:gipling resiElis from the laboratorl.
FACILITY NAME �2nfdir 1-Tr Gz raa �u , T � . COUNTY 1CUwignS
PERSON COLLECTING SAMPLESLAAAW-- PHONE NO. ( a1) 9-1--3pa4
CERTIFIED LABORATORY PR- Tr, "ar Lab #
Lab # PLEASE SIGN ON THE REVERSE. 4
Part A: Specific -1oniloring Requirements
Outfall
No.
Date
Sample Collected,
mo/ddh•r
01027
01034
01051
Total Cadmium.
tt L
Total Chromium,
ugfL
lead,
u
Benchmark
-
1
1000
33
S Z ZA
I N1m - D e're c-rA aLz
Vote: U you report it sampled value in excess of the benchinark Vaiue. you mtiSt implement Tier 1 or Tier 2 responses. See General Permit text.
Did this facility perform Vehicle Maintenance Activities using more than jj «allnns of new motor oil per month? _ yes _no
(if yes, complete Part B)
Part B. Vehicle 3laintenance Aclivity Monitoring Requirements
RECE0,
IVED
MAY 2 3 Z0 Urs
CENTRAL EfLEs
DWR fDN
O u tfa l l
No.
Date
Sample Collected,
mo/dd/yr
00556
00530
00400
Oil and Grease,
mg/I,
Total Suspended Solids,
m
pH.
Standard units
New Motor Oil Usage.
Annual average gaVrno
Benchmark
-
30
100
6.0 - 9.0
Vote: If you report a sampled value in excess of the benchmarL value. or outside the benchmark range for pH, you must implement Tier 1 or'1•ier 2 responses.
See Gcnerril Permit text.
STORNI EVENT CHARACTERISTICS;
Date 3 (first event sampled) ,
Total .vent Precipitation (inches):
Date (list each additional event sampled this reporting period, and rainfall amount
Total Event Precipitation (inched:
Mail Original and one copy to:
Division of Water Quality
Attw DWQ Central Files
1617 Nlail Service Center
Raleigh. North Carolina 27699-1617
SW-24�-102107
Pace I of 2

"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 nay 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."
r
(Signature of Yermitt (Date
S W U-2»-1 @21 D7
Page 2 of 2

STORi1NIWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
GENERAL PERMIT NO. NCG090000
CERTIFICATE OF COVERAGE NO. NCG09 0 t5 0 9
FACILITY NAME hl * pe- -tot C-T 6,-,o
PERSON COLLECTING SAMPLES. -Jim i�EsS�✓c_ _ _
CERTIFIED LABORATORY Q I S' r+7 L/f i3_5 Lab #
Lab #
Part A: Specific Monitoring Requirements
SAMPLES COLLECTED DURING CALENDAR YEAR: - zA
(This monitoring report is due at the Division no later than 30 days from
the date the facility receives the sampling results from the laboratory.)
COUNTY - k i)Ld l�j
PHONE NO. (_104 932-3d35
PLEASE SIGN ON THE REVERSE 4
Outfall
No .
Date
: Sample Collected,
01027
OI034
01451
Total Gadiiuu�n,
Total Chromium,
>...
Lead,
Beticliinaik
"' 1`'
:'. 1040
:33
11
r
GTT
Note: If you report a sampled value in excess of the benchmark value, you must implement Tier I or Tier 2 responses. See General Permit text.
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 Activity Monitoring Requirements
RECEIVED
DEC 11 Z014
CENTRAL FILES
DWR SECTION
Outfali
No:
spate
: Sample Collected,
irib/dd>< r:
00556 ...>:'.
00530 `4
00400:
Ott and Grease; F
m`"
ytTotal Suspended Solids,
'_ ,�
pH,
::Stanilariitirits
Nevv Motor Orl Usage,
Annual'avera"e `aUmO
Bencliinark
34 .
log '
. 6.0 - 9.0 .
Note: If you report a sampled value in excess of the benchmark value, or outside the benchmark range for pH, you must implement 'Pier 1 or "Fier 2 responses.
See General Permit text.
STORM EVENT CHARACTERISTICS:
Date (first event sampled) . S
Total Ev nt Precipitation (inches):
Date (list each additional event sampled this reporting period, and rainfall amount)
Total Event Precipitation (inches):
Mail Original and one copy to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
SWU-255-102107
Page I of 2

"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. 1 am aware that there are significant penalties for submitting false information, including
the possibility of fines and imprisonment for knowing violations."
��*Jo
>-
(Signature of Permittee) (Date)
S W U-255-102 107
Page 2 of 2

r,
NC Certification No.402 Case Narrative
SC Certification No. 99012
Full -Service Analytical & NC Drinking Water Cert No. 37735
1P OLS M Environmental Solutions VA Certification No. 46021112/05/2014
irs, arc. DoD ELAP: L-A-B Accredited Certficate No. L2307
ISOAEC 17025: L-A-B Accredited Certificate No. L2307
Aldo Products Co., Inc. Project: Stormwater
Jim Weaver
1604 N. Main Street Lab Submittal Date: 11/19/2014
Kannapolis, NC 28081 Prism Work Order: 411 G41 0
This data package contains the analytical results for the project identified above and includes a Case Narrative, Sample
Results and Chain of Custody. Unless otherwise noted, all samples were received in acceptable condition and processed
according to the referenced methods.
Data qualifiers are Flagged individually on each sample. A key reference for the data qualifiers appears at the end of this case
narrative.
Please call if you have any questions relating to this analytical report.
Respectfully,
PRISM LABORATORIES, INC.
Cara C. Rusmisell
Project Manager
Data Qualifiers Key Reference:
6- 4?4a_'�
Reviewed By Cara C. Rusmisell
Project Manager
BRL Below Reporting Limit
MDL Method Detection Limit
RPD Relative Percent Difference
* Results reported to the reporting limit. All other results are reported to the MDL with values between MDL and
reporting limit indicated with a J.
This report should not be reproduced, except in its entrety, without the written consent of Prism Laboratories, Inc.
449 Springbrook Road - P.O. Box 240543 - Charlotte, NC 28224A543
Phone: [phone] - Toll Free Number; 1.800152M364 - Fax: 704l525-W9 Page 1 of 5

4'
�P R I S M I Fun -Service Analytical
Environmental Solutlons
��S.funoa�Ton¢s u+c
Sample Receipt Summary
12/05/2014
Prism Work Order; 4110410
Client Sample ID Lab Sample ID Matrix Date Sampled Date Received
Outfall #1
4110410-01 Water 11/17/14 11/19/14
Samples were received at 20.7 degrees C. See case narrative for further information.
This repo" should not be reproduced, except in its entirety, without the written consent of Prism Laboratories, Inc.
449 Springbrook Road - P.O. Box 240543 - Charlotte, NC 28224-0543
Phone: [phone] - Toll Free Number: 7-800152"364 - Fax: 704152"409 Page 2 of 5

A.I�-4.3.i.s,.F■YG MlFullce Analytical 8Laboratory Report
Environmental Solution 12 O512014
Aldo Products Co., Inc.
Project: Stormwater Client Sample ID: Outfatl #1
Attn: Jim Weaver
Prism Sample ID: 4110410-01
1604 N. Main Street
Prism Work Order: 4110410
Kannapolis, NC 28081
Sample Matrix: Water Time Coltected: 11/17/14 11:00
Time Submitted: 11 /19114 17:15
Parameter
Result
Units
Report
MDL
Dilution
Method
Analysis Analyst
Batch
Limit
Factor
Dste/Time
ID
Total Metals
Cadmium
t3RL
mg/L
0,0010
0.00012
1
'200,7
1213/14 16:00 BGM
P4L0042
Chromium
BRL
mg/L
0.0050
0.00025
1
'200.7
12/3/14 16:00 BGM
P4L0042
Lead
0.0065
mgfL
0.0050
0.00056
1
'200.7
1213114 16:00 BGM
KL0042
This report should not be reproduced, except in its entirety, without the written consent of Prism Laboratories, Inc.
449 Springbrook Road - P.O. Box 240543 - Chartotta, NC 28224-0543
Phone: [phone]W - Toll Free Number. 14001529-6364 - Fax: [phone],0409 L Page 3 of 5

Prep Method: 200.7
Lab Number Batch
4110410-01 P40042
Initial
50 m L
Sample Extraction Data
Final Dat&Mme
50 mL 12102114 7:50
This report should not be reproduced, except in its entirety, without the written consent of Prism Laboratories, Inc.
449 Springbrook Road - P.O. Box 240543 • Charlotte, NC 2822"543
Phone: [phone] - Toll From Number: 1480015294 m - Fax: 704152$4409 Pape 4 Of 5

::vr.•rr. •: r,ve.• :v: : r: rr: • v,: •: �:
1
CHAIN OF CUSTODY RECORD
i
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0
Pwas __L or _L_ auors ra susuas PicpHR arLUMar
�
3°
I �.
, I
'
Full Ssrvkob A WNUCat & Env4onn8nW Salutlons
Pro) ect Name: — 5'h �+'• w w4'ri SA G
r
•w, t
�?
t+
i'
�
eT
449 Sprtrlgbrook Road • P.O. Box 240543 • Charlotte, NC 28224.0543
Phone: 7D4/a2B-MMI - Emit: 7 62b-04os
-
Short Hold Analysts: (Yes) . (No) UST Project (Yes) (No)
'�
�
.'! ! �,'
ca
�
Client Company Namee .� �e%S
Maass ATTACH any project specific reporling (QC LEVEL I:II III M
QC
i1
� .p " l •
Report TO/Contact Name: �—
provisions and/or Require
c
' � fir�8r
��
�
kl
Reporting s: CA-46l � •
.Irf+raloe Tx ��•,��
"Address:
i r
1
-' - � F
Phone:
P rchese Order oJBilling Referenoe _I G S'
TO BE FILLED IN BY CLIENT/SAMPLINC'1 If:EPA:ONlNEIL
Email (Yes) (No) Email Address ) ►.1 �jQ6sL
EDD TYps: �DF Excei_Othaf
Site Location Name 13L4TFAk .-j#1
SIto Location Physical Address: j L c Aj .
ds 29� .
l:tsquested Due Date "o t Day O 2 Day, Q 3 Days o 4 Days 0 5 DBys .
'Worldng Days—, b e-8 Days "standard to daye
Samples received after 16:00 w1:1 he processed next business clay.
MA/n! Turnaround Urns Is based on business days, axohldlnp weekends and holidays. . -
(sfisAsvfiaseFOR TERM&00HOM0118 iEaARDIgQS R+nces
BY PRISM LABORATORIES, RIG. TO OLMin.
Certiiicatlon: NELAC " USACEr_ I*L. Ail;
--- _ __..
OTHESC_TY/A
. SC
Water Chlorinated: YES_ NO—
gample iced Upon Collection., YES— NO
� —
CLIENT
DESCRIPTION
DATE.
COLLECTED
TIME
TIME
COLLECTED
MILITARY
HOURS
MATRDI
(SOIL,.
WATER OR
SLUDGE)
SA►tPLECONTAINER
PRESERVA-
.TIMES
ANALYSES REQUESTED
�VQ��_ +�� REARARKS
p ///
� ��
fRl MBAMPLE
rI ND.
'TYPE
SEE BELOW
-
SIZE
o�t'rf u #r
+i I7
rf 0-0
WkrE
P
:7
I
.
i
i
Sampler's SI nature t
Sampled B (Print Name) Affiliabon AA% F 1 •
r� ^��*� � iF,
Upon resin ulahing, this n of Custody is your outhorizatlon f Prism to proosod wRh tho anatyaea as requested above. Any changes moat be
y otmnge6 after analyses have been Initleilzed.
aubm writingto Prism Project Manager. There Will be es for an yas�,IR�
� #4 g !,q t A*`
I
r• r•
Data o'" Additional Comments:
!✓
fleilnqu •day ISWidlir•)
RdaNa By: (9lgnatirs) DataSii
[(
A h By: {Slptatur• R•oelwd Fay cremrisa ` � DaUTK13 LABORATORY. -in GWip W.
SAMPLES Arne NOT ACCEPTEO AND YEAWID AGAINST ,UNTIL RECErVED AT THE LABORATORY. Log
}} �}
'7 Fad Ex O UPS I] Kend-dmhwW 0 Priem FW SeMce O O'her - - -- _ _ - P 1 " � I V '
: u
NPDES: jj UST; GROUNDWATER: I
c7NO 17SCa'�NC '8C ONC ❑SC I
❑ ! ❑ ❑ !!
DRINKING WATER: SOLID WASTE: RCRA: CERCLA LANDFILL II OTHER:
❑NC ❑5C ❑NC 0SO ❑NC ❑SCIII ❑NC ❑SC, ONO USCJ ❑NC ❑SC
❑ 1 ❑ _ 113 ] ❑ 1 ❑ I ❑
r1Qi!'!ISIAI
"CONTAINER TYPES Coo A = Amber C = Clear G = Glass P = Plastic; TL = TetlarrLtned Cap VOA = Volatile Organics Analysis (Zero Head Space)

L
STORNIWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
GENERAL PERMIT NO. NCG090000
CERTIFICATE OF COVERAGE NO. NCG09 066,9
FACILITY NAME r<�C
PERSON COLLECTING SAMPLES '
CERTIFIED LABORATORY -YQ►srn L t14-f Lab #
Lab #
Part A: Specific Monitoring Requirements
SAMPLES COLLECTED DURING CALENDAR YEAR:
(This monitoring report is due at the Division no later than 30 days from
the date the facility receives the ampling results from the laboratory.)
COUNTY _KatdAW
PHONE NO. (7ol) f?;?
PLEASE SIGN ON THE REVERSE -)
Outfiall: "
No.
"Date
Sample ;Collected, J.
niWd/ r
01027 ; . ,
01034
` 01051
Total. Cadmium,'
ugfL
Total Chromium,
u
Benchmark
1:>;
1,1000
33'
/
.09
.9c
.19
Note: if you report a sampled value in excess of the benchmark value, you must implement Tier.1 or Tier 2 responses. See General Permit text.
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 R: Vehicle Maintenance,Activity Monitorine Requirements
r
RECEIVED
APR 2 8 2014
CENTRAL FILES
DWQlSQG
Outfall
No..
Date: = :
?'Sample Collected; '
mo/dd/ i
00556
00530
>00400
'Oil and Grease; ,
m
Total Suspetided Solids,
; ipH,
Standard units
-New; Motor Oil Usage,
Annua[avera a aIV
'Benchmark
3W
100
6.0 - 9.0
D►i
Note: If you report a sampled value in excess of the benchmark value, or outside the benchmark range for pH, you must implement Tier I orTier 2 responses.
See General Permit text.
STORM EVENT CHARACTERISTICS:
Date "� (first event sampled)
Total • v nt Precipitation (inches):
Date (list each additional event sampled this reporting period, and rainfall amount)
Total Event Precipitation (inches):
Mail Original and one cop}' to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
S W U-255-102107
Page l of 2

"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."
1��Oold4w 14
Signature of a ittee)
--- q/2) 1 I)LI
1 (Date)
5WU-255-102107
Page 2 of 2

M
P RI S M Full -Service Analytical &
Environmental So1ulians
BORATORIES, INC.
Aldo Products Co., Inc.
Jim Weaver
1604 N. Main Street
Kannapolis, NC 28081
NC Certification No. 402
SC Certification No. 99012
NC Drinking Water Cert No, 37735
VA Certification No. 460211
DOD ELAP: L-A-B Accredited Certificate No. L2307
IS011EC 17025: L-A-B Accredited Certificate No. L2307
Project: Stormwater
Lab Submittal Date: 0410712014
Prism Work Order: 4040152
Case Narrative
04/16/2014
This data package contains the analytical results for the project identified above and includes a Case Narrative, Sample
Results and Chain of Custody. Unless otherwise noted, all samples were received in acceptable condition and processed
according to the referenced methods.
Data qualifiers are flagged individually on each sample. A key reference for the data qualifiers appears at the end of this case
narrative.
Narrative Notes:
Sample was received in unpreserved container.
Please call if you have any questions relating to this analytical report.
Respectfully,
PRISM LABORATORIES, INC.
CaraC. Rusmisell
Project Manager
Data Qualifiers Key Reference:
Reviewed By Cara C. Rusmisell
Project Manager
BRL Below Reporting Limit
MDL Method Detection Limit
RPO Relative Percent Difference
* Results reported to the reporting limit. All other results are reported to the MDL with values between MDL and
reporting limit indicated with a J.
This report should not be reproduced, except in its entirety, without the written consent of Prism Laboratories, Inc.
449 Springbrook Road - P.O. Box 240643 - Charlotte, NC 28224-0643
Phone: [phone] - Toll Free Number. 1.8001529.6364 - Fax: [phone] Page 1 Of 5

PRISM Env4 nmen Analytical d
/f Enviranmentnl Solutions
V' LABOHATOR4ES INC
Sample Receipt Summary
04/16/2014
Prism Work Order: 4040152
Client Sample ID Lab Sample ID Matrix Date Sampled Date Received
Stormwater Sample
4040152-01 Water 04/07/14 04/07/14
Samples were received at 22.2 degrees C. See case narrative for further information.
This report should not be reproduced, except in its entirety, without the written consent of Prism Laboratories, Inc.
449 Springbrook Road - P.O. Box 240643 - Charlotte, NC 28224-0543
Phone: [phone] - Toll Free Number. 1-8001529-6364 - Fax: [phone] L Page 2 of 5

P R 1 S IVY 1 Funvir41-Soiwico
men Analytical 8
Environ mortal Solutions
n3
FAQ T-c r li C
Laboratory Report
04/16/2014
Aldo Products Co., Inc. Project: Stormwater Client Sample ID: Stormwater Sample
Attn: Jim Weaver Prism Sample ID: 4040152-01
1604 N. Main Street Prism Work Order: 4040152
Kannapolis, NC 28081 Sample Matrix: Water Time Collected: 04/07/14 10:45
Time Submitted: 04/07/14 16:50
Parameter Result Units Report MDL Dilution Method Analysis Analyst Batch
Limit Factor Datefrime ID
Total Metals
Cadmium
BRL mg1L 0.0010 0.000090 1 *200.7 4114114 23:05 BGM P400203
Chromium
BRL mg1L 0.0050 0.00076 1 *200.7 4/14114 23:05 BGM P41D0203
Lead
BRL mg1L 0.0050 0.00068 1 -200.7 4114114 23:05 BGM P4D0203
This report should not be reproduced, except in its entirety, without the written consent of Prism Laboratories, Inc.
449 Springbrook Road - P.O. Box 240543 - Chadotte, NC 28224-0643
Phone: [phone] - Toll Free Number. 1-8001629-6364 - Fax: [phone]
Page 3 of 5

Prep method: 200.7
Lab Number Batch
4040152-01 P400203
Initial
50 mL
Sample Extraction Data
Final Datefrime
50 mL 04/10114 8:45
This report should not be reproduced, except in its entirety, without the written consent of Prism Laboratories, Inc.
449 Springbrook Road - P.O. Box 240643 - Charlotte, NC 28224-0 43
Phone: [phone] - Toll Free Number: 1-8001629.6364 - Fax: 704f525-0409 Page 4 of 5

1147 CHAIN OF CUSTODY RECORD
Fuli-Service Analytical 8 w .0 _ , r.."., ,� a ..mow, .�y�. ��. ..__,_�• .._
�P S Environmental Solutions
. LJ.9pRAiagIE8 ING -
449 Springbrook Road • P.O. Box 240543 • Charlotte, NC 28224-0543
Phone:[phone] • Fax:704/52 `
�-�t~;
Client Company Name: ni u Q Cf
Report To/Contact Name: Crrm k1iA-Vf, �_
Reportin Address: a?
n
PAGE _4(_ OF I— QUOTE N TO ENSURE PROPER BILLING!
Project Name: _SAg+"MRk� JL'V_ 1
Short Hold Analysis: (Yes) (No) "USYVroject: (Yes) (No)
*Please ATTACH any project specific reporting (QC LEVEL 1 It III IV)
provisions and/or QC Requirements
Invoice To: ,CC I. a 1.1ft
Address: GAZ. M A,
j r A/C �k'Dgl
Phone: _/-D- - 5r32-3ils-q Fax (Yes) 4&D 6-' �� T
Purchase Order N ./Billing Reference
Email es) No) Emil Address ��4yp r a u /,e�� � -_6 Gc
Y fiequ�eled Due Date ❑ 1 Day p 2 Da Q 3 Days p g flays ❑ 5 Days
EDD Type: PDF_ Excel _Other "Working Days" U)� Days a tandard 10 days rJ Rush Work Must Be
Site Location Name: _ - fi t N13ovIc 0 U•fFAit.- Pre Approved
Samples received after 15:00 will be processed next business day.
Site Location Physical Address: Ay MOVE _ Turnaround time Is based an business days, excluding weekends and holidays.
(SEE REVERSE FOR TERMS & CONDITIONS REGARDING SERVICES
-- - RENDERED BY PRISM LABORATORIES, INC. TO CLIENT!
TO BE FILLED IN BY CLIENT/SAMPLING PERSONNEL
Certification: NELAC USACE FL NC
SC OTHER N/A
Water Chlorinated: YES_ NO —
Sample Iced Upon Collection: YES —NO
CLIENT
SAMPLE DESCRIPTION
DATE
COLLECTED
TIME
COLLECTED
MILITARY
HOURS
MATRIX
(SOIL,
WATER OR
SLUDGE)
SAMPLE CONTAINER
PRESERVA-
TIVES
ANALYSES REQUESTED
L�q� �`r v��' REMARKS
PRISM
LAB
ID NO.
. 'TYPE
SEE BELOW
NO.
SIZE
l
c
Sampler's Signature
Sampled By (Print Name)
Affiliation
Site Arrivai.Time.+yX;a�t~
Upon relinquishing, this Chain of Custody is your authorization for Prism to proceed with the analyses as requested above. Any changes must be
submitte writ g to the Prism Project Manager. There will be_oMfs for any changes after analyses have been initialized.
Relinqu y: IS ature
oc"Iyed By. gna reDate
to sure
ry
Additional Comments:
Site be artura Tlme �fr {`{{
Reltnqul ed By: (Slgnalure)
Racely y, (Slffneture)
Date
=Fleld,Tech Fee s� �rc'� �.�r��
Aey6qubed By. (Skpn lure)
�� � ' 1
Recehred For Latxxatorle 9
� �
Date
y`7� ! %
�(p S 0
Mflleagg• j���� ����;''�s`� ,
Hsuv�
MJItMd Of ment: R ALL SAMPLES SHOULD BE TAPED S?JVT WrFti CUSTODY SFALS FOR TRANSFKR A I O E RATORY.
SAMPLES ARE NOT ACCEPTED AND VERIFIED AQAINST�-(iNTIL RECEIVED AT THE LABOAATOAY.
� Fed Fx D UPS ❑ Hand-deltvewd 'l Prism FWd Service -OOthes
coup 0.
/ `�
i ,/
#-
-
NPDES: UST: GROUNDWATER., DRINKING WATER: SOLID WASTE: RCRA: CERCLA LANDFILL f OTHER:
❑ NC O 5C ❑ NC ❑ SC p NO ❑ SC ❑ NC p SC O NC ❑ SC ❑ NC SG ❑ NC SC ❑ NC Li SC I L7 NC0 5C
0 ......________. ❑ _.. — -- - i 0­ -----------
*CONTAINER TYPE CODES: A = Amber C m Clear 0 = Glass P = Plastic; TL = Teflon -Lined Cap. VOA = Volatile Organlcs Analysis (Zero Head Space)
ORIGINAL