NCG090025_MONITORING INFO_20170124

AA 20
STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
DOC TYPE
❑HISTORICAL FILE
[X MONITORING REPORTS
DOC DATE
❑ aro / -7 (, / )y
YYYYMMDD

Y-,
Semi-annual Stormwater Discharge Monitorinjg Report
for North Carolina Division of Water Quality General Permit No. NCG090000
Date submitted 1/16/2017
CERTIFICATE OF COVERAGE NO. NCG09 0 0 2 5
FACILITY NAME BonaKemi USA, Inc.
COUNTY Union
PERSON COLLECTING SAMPLES
LABORATORY Prism Labs
Lisa King
Lab Cert. 11 401
Comments on sample collection or analysis:
Part A: Stormwater Benchmarks and Monitoring Results
SAMPLE COLLECTION YEAR 2016
SAMPLE PERIOD ❑ Jan -June Q July -Dec
or ❑ Monthly' (month)
DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
RECEIRECEIVED ❑Zero -flow ❑Watersupply ❑SA
VED �J QOther
JAN 2 4 2017
CENTRAL FILES
DWR SECTION
PLEASE REMEMBER TO SIGN ON THE REVERSE --)�
❑ No discharge this period?z
•Outfall No:
Date Sample .
Collected'
(mo/dd/yr)
.24-hour rainfall
-
amount,.
Inches3
Total Cadmium
Total Chromium
Total Lead
Benchmarks =__>
-
-
0.001 mg/L
1.0 mg/L
0.03 mg/L
001
11/30/2016
1.0
<0.001 mg/L
<0.005 mg/L
<0.005 mg/L
1 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.
Note: Results must be reported in numerical format. 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 mg/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:11/1/2012-10/31/2017
SWU-255, last revised 10/25/2012
Page 1 of 2

Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month.
❑ No discharge this period?z
Dutfall No. '
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
Inches;
Non -polar O&G/TPH by
EPA 1664 (SGT-HEM)
Total Suspended Solids
pH
Benchmarks ===>
-
-
15 mg/L
100 mg/L or 50 mg/L*
6.0 _ 9.0 SU
Footnotes from Part A also apply to this Part B
* See General Permit text, Table 5, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Note: If you report a sample value in excess of the benchmark, you must implement Tier 1, Tier Z, or.Tier 3 responses. See General Permit text.
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 X❑
IF YES, HAVE YOU CONTACTED THE DWQ 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. I
am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
(Signature of PekMttee)
Permit Date:11/1/2012-10/31/2017
w i6 - %
(Date)
SWU-255, last revised 10/25/2012
Page 2 of 2
,.j

A�
NCDENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Porguidance on filling out this farm, please visit., httP://portai,ncdenr.org/webIWQIWS/SLIIni2dessw#t.ib_
Permit No.:
Facility Name: BonaKemi USA, Inc.
County: Union
Inspector: Lisa King
Date of Inspection: 12/112016
Time of Inspection: 0800
Total Event Precipitation (inches): 1.0
or Certificate of Coverage No.;
Phone No. 704-220-6943
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
(See information below.)
0 Yes ❑ 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 pert -nits require qualitative monitoring to be
performed during a "representative storm event" or during a "measureable storm event." However,
some permits do not have this requirement. Please refer to these definitions, if applicable.
i i
i l
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 storm events during the sampling period, and the permittee
obtains approval from the local DWQ Regional Office,
By this signature, I certify th#t this report is accurate and complete to the best of my knowledge:
(Signature Permittee or Designee)
Page 1 of 2
SWU-242, Last modified 10/25/2012

1. Outfall Description:
Outfail No. 001 Structure (pipe, ditch, etc.) Ditch
Receiving Stream: Twelve Mile Creek
Describe the industrial activities that occur within the outfall drainage area: None
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: very light brown
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.): None
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
1 O 3 4 5
5. Floating 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:
1r1 2 3 4 5
6. Suspended 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:
1O 2 3 4 5
7. Is there any foam in the stormwater discharge? Yes ©°
S, Is there an oil sheen in the stormwater discharge? Yes No
9. Is there evidence of erosion or deposition at the outfall? Yes No
10. Other Obvious Indicators of Stormwater Pollution:
List and describe
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.
Page 2 of 2
SWU-242, Last modified 10/25/20U

P°��o,L�%aonaoRiea rrc
Bona US
Lisa King
4275 Corporate Center Drive
Monroe, NC 28110
NC Certification No. 402
Full -Service Analytical 8 NC Drinking Water Cert No. 37735
Environmental Solutions SC Cerlification No. 99012
Project: Stormwater
Lab Submittal Date: 12/02/2016
Prism Work Order: 6120065
Case Narrative
12/16/2015
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.
r
Terri W. Cole Reviewed By Terri W, Cole
Project Manager Project Manager
Data Qualifiers Key Reference:
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 entirety, without the written consent or Prism Laboratories, Inc.
449 Springbrook Road - P.D. Box 240543 - Charlotte, NC 26224-0543
Phone: [phone]-Toll Free Number:l-a00r529.6364- Fax: [phone] Page 1 of

I
n,
PR ISM I Environmental
Fullo Analytical 8
antnl Solutions
L1BOPnTOPi[$ we
Sample Receipt Summary
12116/2016
Prism Work Order: 6120065
Client Sample ID Lab Sample ID Matrix Date Sampled Date Received
Stormwater#1 6120065-01 Water 11/30/16 12/02/16
Samples were received in good condition at 2.1 degrees C unless otherwise noted.
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 28224.0543
Phone: [phone] - Toll Free Number: 1-8001529-6364 - Fax: [phone] Page 2 of 5

:7ueon�rononmiecnetal Solutions I FEunjv'ir anatci
Laboratory Report
12116/2016
Bona US Project: Stormwater Client Sample ID: Stormwater #1
Attn: Lisa King Prism Sample ID: 6120065-01
4275 Corporate Center Drive Prism Work Order; 6120065
Monroe, NC 28110 Sample Matrix: Water Time Collected: 11130/16 20:00
Time Submitted: 12/02/16 12:30
Parameter Result Units Report MDL Dilution Method Analysis Analyst Batch
Limit Factor DatetTime ID
Total Metals
Cadmium
BRL mg1L 0,0010 0.000070 1
*200.7 12114116 21:28 bgm P610191
Chromium
BRL mg1L 0.0050 0.00030 1
*200.7 12114116 21:28 bgm P61-0191
Lead
BRL mg1L 0.0050 0.00090 1
*200.7 12/14116 21:28 bgm PGL0191
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 28224.0543
Phone: [phone] - Toll Free Number: 1-8001529.6364 - Fax: [phone] Page 3 of 5

Sample Extraction Data
Prep Method:200.7
Lab Number Batch Initial Final ❑atefTirne
6120065-01 PGL0191 50 mL 50 mL 12/12/16 7:40
This report should not be reproduced, except in its entirety, w thout the written consent of Prism Laboratories, Inc.
449 Springbrook Road - P.Q. Box 240543 - Charlotte, NC 28224-0543
Phone: [phone] - Toll Free Number: 1-8001529.6364-Fax: [phone] Page 4 Qf 5

A"
CHAIN OF CUSTODY RECORD
,u Full -Service Analytical & ++ +r
f -r .F �r, NOa� 2i�ElA't UJ
Environrnental Solte[ions PAGELOF�_ QUOTE#TO ENBU'AE PROPEA BILLING: o-,r rrO2� D6r1y� , t-1
.� .-�'LncwanroRres mr: Sanlpt �s INTACT -upon arnvai7, ,k ' ';r� �` .sr T3 o
448 Springhrook Road •Charlotte, NC 28217 Project Name: _f L �+ Recetved ON WET_IGE7 5� q _ t'' ai•' a +,t•., T� t0
Phone 704I529-631 4 - Fax: TG41525-0409 Short Hold Analysis: (Yes) o UST Project: (Yes) O PROPER PRESrRVATiVESmdicatodp a)
Client Company Name ; ur z G 'Please ATTACH any project specific reporting (QC LEVEL I II 1[I I ReceEveA VdITHtN HOt PING TIA1E57 ' x V
P y provisions and/or QC Requirements A f I CUSTpDY SEALS.INTACT?
Report To/Contact Name: CZ_ Ki fua Invoice To: 3ona kcjnL - USA T+r- Ac-LoUn4S Pa J a -Me VOL4TILEs read wrou7 HEf+pSPACE�._ s r
Reporting Address: �%)S �rAofwt� Ceeftr l7r•—_ F PROPER CONTAitJERSused7 y,1
Address: S"$"O $•. �a-f k S �Q�
M O rjr O Z� 1 V _r Therm ID.
i utora r Co- a os2lY
Phone: 7t74-21U -y9ri( Fax(Yes) (No): Purchase Order NoJBilling Reference (') ;2 % a fZ. TO BE FILLED IN BY CLIENTISAMPLING PERSONNEL
Email Address: Li.To_ K� N P.. hnA& . CO /'1 Requested Due Date O 1 Day 0 2 Days ❑ 3 pays ❑ 4 Days Q 5 Days Certification: NELAC DOD FL NC
EDD Type: PDF�Exco�Other Working Days" q t:9 Days Standard 10 days ❑ Pre h W rk Must Be — "'
SC OTHER NIA
Site Location Name: e_ Samples received after 14:00 will be processed next business day"
Site Location Physical Address: Above Turnaround time is based on business days, excluding weekends and holidays. Water Chlorinated: YES_ NO
{SEE REVERSE FOR TERMS & CONDITIONS RENDERED BY PRISM LABORATORIES, INC. .TTO CI IENT)GARDING S VICES Sample iced Upon Collection: YES NO
CLIENT
SAMPLE DESCRIPTION
DATE
COLLECTED
TIME
COLLECTED
MILITARY
HOURS
MATRIX
(SOIL,
WATER OR
SLUDGE)
SAMPLE CONTAINER
PRESERYA-
Tim
ANALYSIS REQUESTED
REMARKS
PRISM
O.
ID S
-TYPE
SEE BELOW
NO.
SIZE
I1 ao-/L
aa: va
wier
=
DS A
r
l
Sampier's Signaturgr
Sampled By (Print Name) Lis-0, i m
Affiliation GM /d IF If
r
r
;Site Anrval Time ;
Upon relinquishing, llils Chain of CustodV4s your authorization for Prism o proceed es with the analysas requested above. Any changes must bb
submitted in writing to the Prism Project anger. There will be charges r any changes after ana es have been initialized.
Ralingwshed By (Signature) h ��
stewed By ( I lure)
;Oats C
1aary -rs
Additional Comments:
>5$e Depanur© _n, 5
ReImquished By: (Signature)
Received By: ignature
Date'
-FleldfTeGh Fea S
Relinquished By (Signature)
Recgivetl For Pris tortes By:
Date _ I,�
-
Method of Sh,pmeni NOTE: ALL SAMPLE COOLERS S OUL E TAPED SHUT WITH CUS DY SEALS FOR TIWNSPORTATION TO THE LABORATORY.
SAMPLESARE NOT AIC7�EPTEDAND VERIFIED AGAINST 000UNTIL'RECEIVED AT THE LABORATORY.
0 Fed Fx ❑ UPS ❑ Hand -deli emtl EYPrisrr, Field Service D Other
CAC Group No.
s� Co
Ly v 0 Co %
NPDES: UST: GROUNDWATER: DRINKING WATER: SOLID WASTE: RCRA: CERCLA I LANDFILL OTHER:
❑ NC ❑ SC ❑ NC ❑ SC ❑ NC ❑ SC ❑ NC ❑ SC El NC ❑ SC I ❑ NC ❑ SC ❑ NC ❑ SC ❑ NC ❑ SC ❑ NC ❑ SC
❑ Q _ ❑ ❑ CJ ❑ ❑ ❑ ❑
'CONTAINER TYPE CODES: A = Amber C = Clear G= Glass P = Plastic; TL = Teflon -Lined Cap VOA = Volatile Organics Analysis (Zero Head Space)

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No. NCG090000
Date submitted 8/512016
CERTIFICATE OF COVERAGE NO. NCG09 0 Q 2 5
FACILITY NAME BonaKemi USA, Inc.
COUNTY Union
PERSON COLLECTING SAMPLES
LABORATORY Prism Labs
Lisa King
Lab Cert. # 402
Comments on sample collection or analysis:
Part A: Stormwater Benchmarks and Monitoring Results
SAMPLE COLLECTION YEAR 2016
SAMPLE PERIOD x❑ Jan -June ❑ July -Dec
or ❑ Monthly' (month)
DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
RECEOV ED ❑Zero -flow [:]WaterSupply ❑SA
QOther
AUG 2 3 2016
CENTRAL FILESPLEASE REMEMBER TO SIGN ON THE REVERSE 4
DWR SECTION
❑ No discharge this period?z
Outfall No.
Date Sample
1
Collected •
-Imo/dd/yrj .
24-hour rainfall
amount, .
Inches3
Total Cadmium
Total Chromium
Total Lead
Benchmarks
0.001 mg/L
1.0 mg/L
0.03 mg/L
001
6/27/2016
0.5
<0.001 mg1L
<0.005 mglL
<0,005 mg/L
1 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.
Note: Results must be reported in numerical format. Do not report Below Detection Limit, BDL, <PQL, Nan -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: 11/1/2012-10/31/2017 5WU-255, last revised 10/25/2012
Page 1 of 2

Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month.
❑ No discharge this period?z
Outfall No. ,
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
Inches.
Non-polar,0&G/TPH by
EPA 1664 (SGT-HEM)
Total Suspended Solids
pH
Benchmarks =__>
-
-
15 mg/L
100 mg/L or So mg/L*
6.0 — 9.0 SU
Footnotes from Part A also apply to this Part B
* See General Permit text, Table 5, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
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 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 X❑
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an oriainal and one coon of this DMR, includina all "No Discharae" reports, within.30 days of receipt of the lab'results for at end of monitorina 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. I
am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
r
(Signatureeermittee)
Permit Date: 11/1/2012-10/31/2017
(Date)
SWU-255, last revised 10/25/2012
Page 2 of 2

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No. NCG090000
Date submitted 12/18/2014 _
CERTIFICATE OF COVERAGE NO. NCG090025
FACILITY NAME BonaKemi USA, Inc.
COUNTY Union County
PERSON COLLECTING SAMPLES _Lisa King
LABORATORY Prism Labs Lab Cert. # 402
Comments on sample collection or analysis:
Part A: Stormwater Benchmarks and Monitoring Results
SAMPLE COLLECTION YEAR _2014
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
El No discharge this period-?2
Outfall No.
gate Sample
Collected
(mo/dd/yr)
24-hour rainfall
amount,
inches
Total Cadmium
Total Chromium
Total Lead
Benchmarks
-
-
0.001 mg/L
1.0 mg/L
0.03 mg/L
001
11/17/2014
0.75
<0.001 mg/L
<1.0 mg/L
<0.03 mg/L
RECEIVED
DEC 29 2014
CENTRAL FILES
DWR SECTION
1 Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
2 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.
Note: Results must be reported in numerical format. 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 mg/L", where XX is the numerical value of the detection
limit, reporting limit, etc. in mg/L.
(Vote: 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: 11/1/2012-10/31/2017 SWU-255, last revised 10/25/2012
Page 1 of 2

Part 13: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month.
❑ No discharge this period?'
Outfall No.
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
Inches3
Non -polar O&G/TPH by
EPA 1664 (SGT-HEM)
Total Suspended Solids
pH
Benchmarks ===>
_
-
15 mg/L
100 mg/L or 50 mg/L*
6.0 — 9.0 SU
Footnotes from Part A also apply to this Part B
* See General Permit text, Table 5, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
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 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 8.
TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANYONE OUTFAI_L? YES ❑ NO ❑
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an original and one copv of this DMR, including all "No Discharge" reports, within 30 dovs of receipt of the lab results for at end of monitorina 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. I
am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
re of tOmitteej
Permit Date: 11/1/2012-10/31/2017
12/18/2014
(Date)
SWU-255, last revised 10/25/2012
Page 2 of 2

rj NC Certification No. 402
dv� SC Certification No. 99012 Case Narrative
aPED J Full -Service Analytical 8 NC Drinking Water Cert No. 37735
'R M Environmental Solutions VA Certification No.460211 12/03/2014
©7VtABORWORIE`S RIG DoD ELAP: L-A-B Accredited Certificate No. L2307
ISOIIEC 17025: L-A-B Accredited Certificate No. L2307
BonaKemi USA, Inc. Project: Stormwater
Lisa King
4275 Corporate Center Drive Lab Submittal Date: 11/17/2014
Monroe, NC 28110 Prism Work Order: 4110351
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.
Terri W. Cole
Project Manager
Data Qualifiers Key Reference:
Reviewed By Terri W. Cole
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 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: 1.8001529.6364 - Fax: [phone] Page 1 of 5

A Sample Receipt Summary
vPr� u Full -Service Analytical &
Ry� I S M Ernironmsntol Soiutione 1210312D14
%—v I9GRArcVNM INC
Prism Work Order: 4110351
Client Sample ID Lab Sample ID Matrix Date sampled Date Received
Stormwater.#1 4110351-01 Water 11/17/14 11/17/14
Samples were received in good condition at 2.1 degrees C unless otherwise noted.
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 28224-0543
Phone: [phone]{364 - Toll Free Number: 1-8001529.6364 - Fax: [phone] Page 2 of 5

�r
nt. \
n A //�� f Fulb5ervice Analytical &
aP R I 1 V 1 ! Env ronmentnl Solutions
Th.saru<.oqEs �
BonaKemi USA, Inc.
Attn: Lisa King
4275 Corporate Center Drive
Monroe, NC 28110
Laboratory Report
12/03/2014
Project: Stormwater Client Sample ID: Stormwater #1
Prism Sample ID: 4110351-01
Prism Work Order: 4110351
Sample Matrix: Water Time Collected: 11/17/14 11:00
Time Submitted: 11/17114 17:20
Parameter
Result
Units
Report
Limit
MDL
Dilution
Factor
Method
Analysis Analyst
Datefrime
Batch
ID
Total Metals
Cadmium
BRL
mglL
0.0010
0.00012
1
'200.7
11/22/14 0:42 BGM
P4K0365
Chromium
BRL
mg1L
0.0050
0.00025
1
200,7
11/22/14 0:42 BGM
P41<0365
Lead
BRL
mg1L
0.0050
0.00056
1
'200.7
11/22114 0:42 BGM
P41<0365
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 26224-0543
Phone: [phone] - Toll Free Number; 1-8001529-6364 - Fax: [phone] Page 3 Of 5

Prop Method: 200.7
Lab Number Batch
4110351-01 P4K0365
Sample Extraction Data
Initial Final Date[Time
50 mL 50 mL 11/21114 8:10
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 29224-0543
Phone; 7041529.6364- Toll Free Number: 1.8001529-6364- Fax: [phone] Page 4 of S

]PIrlism
LA BORA romes. INC.
Full Service Analytical & Environmental Solutions
449 Springbrook Road • P.O. Box 240543 • ChaHotte, NC 28224-0543
Phone:[phone] • Fax�:370_4�/5��2�5-04W
Client Company Name: CrLrz f-c'rhl UVi _1r'1 C
Report To/Contact Name: L-I.zo Klr�
y
Reporting Address:
1i 6Ar-Q t'
CHAIN OF CUSTODY RECORD
PAGE _L OF € QUOTE 0 TO ENSURE PROPER BILLING: Z s013397 FC:-lw
Project Name: M20NSic r"P 1 Lt i' t'�
Short Hold Analysis: (Yes) OND UST Project: (Yes) No
'Please ATTACH any project specific reporting (QC LEVEL 111 [II IV)
provisions and/or CIC Requiremegts
invoice To:•"+�K�r
Address: S1Z1 f!"l 4-k
_ Allr{Iru Qr, 'i' X)/Ll
Fi7--4v
YES. NO
NIA
to
Samples INTACT upon arrival?
y
O
Received ON WET. ICE? Temp i
to
PROPER PRF-SERVA71VF-S indicated?
r
a
Received WITHIN HOLDING TIMES?
a
CUSTODY SEALS INTACT?`
VOLAT:LES reed WOUT HEADSPACE?
PROPER CONTAINERS used?
—/
Phone: ]C1-)X L•5.i `/ Fax (Yes) (No):
�-,� p❑ ❑ urchase Order No.BilEing Reference i � � ' '`
Email es) (No) E ail Address j I Ii �cL •kr r,G (' ��O,ic:.CC x
Requested Due Date L7 1 Day ❑ 2 Days J 3 Days 4 Days 5 Days
EDD Type: PDF� Excel _Other "Working Days O s - Standard 10 days J 6-9 Da Rush Work Must Be
y Pro -Approved
Site Location Name: nn Samples received after 15:00 will be processed next business day.
Site Location Physical Address: Sa )yyr r-i ClS' h,` Turnaround time Is based on 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 USAGE FL NC
SC OTHER NIA
Water Chlorinated YES— NO —
Sample Iced Upon Collection: YES NO
SAMPLE DESCRIPTION
DATE
COLLECTED
TIME
COLLECTED
MILITARY
HOURS
MATRIX
(SOIL,
WATER OR
SLUDGE)
SAMPLE CONTAINER
PRTIVES -
TIMES
L ANALYSES REQUESTED
REMARKS
e
J/ / / /
PRISMCLIENT
LAB
ID NO.
'-TYPE
SEE BELOW
NO.
I SIZE
,r..l7
5A
ON)
__�h_,_
oI
FF
Sampler's Signature 7 �ti
�( _
Sampled By (Print Name) �I Sc ' l f /-\
Affiliation
Site Arrival Time:
Upon relinquishing,.Lhis aain of Custody is your �dLtthorization for Prism to proceed with the analyses as equested above. Any changes mu"e
submitted in writing to the Prism Project Manages: There will be charges for any changes after analyses have 69en initialized.
RahrgluAed Byc { to Y
11
Received By: (Signature) /
Date r -7
i(11
MilitaryMocyurs
Additional Comments:
Site Departure Time'
Relinquished By: (Signature) v
Recelved By: (Signature)
Date
Field Tech Fee:
Relinquished By, (Signature)
Received For Prism Laboratories B /
-� -2 t__ ,�
Date ,J
( i 1 17
�J 7'
f^`G1
Mileage:
Method o1 Shipment: NOTE ALL 5AMPLE COOLERSSHOULD BE TAPIEDSHUT WITWCUSTODY SEALS FOR TRANSPORTATION TO THE LABORATORY.
SAMPLES ARE NOT ACCEPTED AND VERIFIED AGAINST COC•UNTIL RECEIVED AT THE LABORATORY.
❑ Fed Ex ❑ UPS U Hand -delivered ❑ Prism Field Service 3 Other ~'
roup No.
q 1 L}
NPDES: I UST: i GROUNDWATER- t DRINKING WATER: ! SOLID WASTE: RCRA: CERCLA LANDFILL OTHER:
O NC :1SC -J NC ❑ Sc ❑ NC 0 Sc ❑ NC ❑ SC I ❑ NC 0 SC I ❑ NC ❑ SC ❑ NC 0 SC J NC El ID NC ❑ SC
a 1 ❑ __ _ _ I � _._.._ 1 o ❑ - U --
'CONTAINER TYPE CODES: A = Amber C = Clear G = Glass P = Plastic; TL - Teflon -Lined Cap VOA — Volatile Organics Analysis (Zero Head Space)
ORIGINAL

Arlin
NCDENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance on filling out this form, please visit: http_/Iportal.ncdenr.org/web jwq /ws/su/npdessw#Cab-4
Permit No.:
Facility Name: BonaKemi USA, Inc.
County: Union County
Inspector: Lisa King
Date of Inspection: 11/17/2014
Time of Inspection: 0930
Total Event Precipitation (inches): _1.25
or Certificate of Coverage No.:
Phone No. 704-220-6954
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
(See information below.)
® Yes ❑ 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 require qualitative monitoring to be
performed during a "representative storm event" or during a "measureable storm event." However,
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 perlittee is able to document that a shorter
interval is representative for local storm events during the sampling period, and the permittee
obtains approval from the local DWQ Regional Office.
By thAsignature, I certify that this -report is accurate and complete to the best of my knowledge:
(Signature �6)Permititee or Designee)
Pagel of 2
SWU-242, Last modified 10/25/2012

1. Outfall Description:
Outfall No. 1 Structure (pipe, ditch, etc.) Ditch
Receiving Stream: Twelve Mile Creek
Describe the industrial activities that occur within the outfall drainage area: None
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: Very light brown
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.): None
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
1
5. Floating 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:
1 2 3 4 5
6. Suspended 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 2 3 4 5
7. Is there any foam in the stormwater discharge? Yes No
B. Is there an oil sheen in the stormwater discharge? Yes No,
9. Is there evidence of erosion or deposition at the outfall? Yes No
10. Other Obvious Indicators of Stormwater Pollution:
List and describe None
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.
Page 2of2
SWU-242, Last modified 10/25/2012

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No. NCG090000
Date submitted 7/7/2014
CERTIFICATE OF COVERAGE NO. NCG090025
FACILITY NAME BonaKemi USA Inc.
COUNTY Union County
PERSON COLLECTING SAMPLES Lisa King
LABORATORY Prism Labs Lab Cert. # 402
Comments on sample collection or analysis:
Part A: Stormwater Benchmarks and Monitoring Results
SAMPLE COLLECTION YEAR _2014
SAMPLE PERIOD ® Jan -June ❑ July -Dec
or ❑ Monthly' (month)
DIStC►HARGING TO CLASS ®ORW ❑HQW [:]Trout❑PNA
RED! V EL) ❑Zero -flow ❑Water Supply ❑SA
JUL 14 2014 ❑Other
CENTRAL FILES PLEASE REMEMBER TO SIGN ON THE REVERSE 4
DWQIBOG
❑ No discharge this period?z
Outfall No.
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
Inches3
Total Cadmium
Total Chromium
Total Lead
Benchmarks =__>
-
-
0.001 mg/L
1.0 mg/L
0.03 mg/L
001
5/15/2014
1.25
<0.001 mg/L
<3.0 mg/L
<0.03 mg/L
1 Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
2 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.
Note: Results must be reported in numerical format. 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: 11/1/2012-10/31/2017 SWU-255, last revised 10/25/2012
Page 1 of 2

Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month.
❑ No discharge this period?z
outfall No.
Date Sample
Collected'
{mo/dd/yrj
24-hour rainfall
amount,
s
Inches
Non -polar O&G/TPH by
EPA 1664 (SGT-HEM)
Total Suspended Solids
pH
Benchmarks =__>
_
-
15 mg/L
100 mg/L or 50 mg/L*
6.0 — 9.0 SU
Footnotes from Part A also apply to this Part B
* See General Permit text, Table 5, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
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 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 DWQ REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an oriainal and one copy of this DMR, includina all "No Discharae" reports, within 30 days of receipt of the lab results for at end of monitorina Deriod
in the case of "No Discharae" 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."
re of Permitteej
7/7/2014
(Date)
Permit Date: 11/1/2012-10/31/2017
SWU-255, last revised 10/25/2012
Page 2 of 2

NCDENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Forguidance on filling out this form, please visit: httpi//portal.ncdenr.orgf webjwq /ws/suInodessw#tab-4
Permit No.: IV/C/—/—/—/—/—/—/—/ or Certificate of Coverage No.:
Facility Name: BonaKemi USA, Inc.
County: Union County
Inspector: Lisa King
Date of Inspection: 5/15/2014
Time of Inspection: 0930
Total Event Precipitation (inches): _1.25
Phone No. 704-220-6954
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
(See information below.)
® Yes ❑ No
Please verify whether Qualitative Monitoring must he performed during a "representative storm
event" or "measureable storm event" (requirements vary, depending on the permit).
..... ..... .------------------- -......_..............-..-..-.... ...... .........-..-..-..-........... ..................................-...-. _... .-...-......-.. __._._._._......----.------ -- ---.-------------
Qualitative monitoring requirements vary. Most permits require qualitative monitoring to be
performed during a "representative storm event" or during a "measureable storm event." However,
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
I 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
I prior. The 72-hour storm interval does not apply if the permittee is able to document that a shorter
interval is representative for local storm events during the sampling period, and the permittee
obtains approval from the local DWQ Regional Office.
By this signature, I certify that this report is accurate and complete to the best of my knowledge:
(SignatOre of Permittee or Designee)
Page 1 of 2
SWU-242, Last modified 10/25/2012

1. Outfall Description;
Outfall No. 1 Structure (pipe, ditch, etc.) Ditch
Receiving Stream: Twelve Mile Creek
Describe the industrial activities that occur within the Outfall drainage area: None
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: Very light brown
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.): None
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
1 2 3 4 5
S. Floating 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:
1 2 3 4 5
6. Suspended 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 2 3 4 5
7. Is there any foam in the stormwater discharge? Yes No,
8. Is there an oil sheen in the stormwater discharge? Yes No
9. Is there evidence of erosion or deposition at the outfall? Yes No,
10. Other Obvious Indicators of Stormwater Pollution:
List and describe None
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.
Page 2 of 2
SWU-242, Last modified 10/25/2012

NC Certification No.9402
90 Case Narrative
ff PP SC Certification No. 99012
L�1`51 l I S M Environmental
Analytical & NC Drinking Water Cert No. 37735
f Environental Solutions VA Certification No. 460211 0611012014
., y.ABnRATORTS, ANC- DoD ELAP: L-A-B Accredited Certificate No. L2307
ISOIIEC 17025: L-A-B Accredited Cendicate No. L2307
BonaKemi USA, Inc. Project: Stormwater
Lisa King
4275 Corporate Center Drive Lab Submittal Date: 05/23/2014
Monroe. NC 28110 Prism Work Order: 4050562
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.
Terri W. Cole
Project Manager
Data Qualifiers Key Reference:
Reviewed By Terri W. Cole
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 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; 1.8001529-6364 - Fax: [phone] Page 1 of 5

ISMService Analytical K
Sample Receipt Summary
Envirnnmr.n}al Sohtlinn:� 06l10/201Q
r/'PR
:= GtAI011rE3. INC
Prism Work Order: 4050562
Client Sample ID Lab Sample ID Matrix Date Sampled Date Received
5tormwater #1 4050562-01 Water 05/15/14 05/23/14
Samples were received in good condition at 0.9 degrees C unless otherwise noted.
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 28224-0543
Phone: [phone] - Toll Free Number: 1.800I529.8764 • Fax: [phone] Page 2 Of rJ

Laboratory Report
r°,C.
8
P R I S M, E Yl w
L 11VIiU 11IISI'illlill
un'Sol tiol
eu Ulull UllF
06 ( 4
flt]l1011 t)14
.�i /i rt1lMrtliirlil:; IVC
BonaKemi USA, Inc.
Project: Stormwater
Client Sample ID: Stormwater #1
Attn: Lisa King
Prism Sample 1 4050562-01
4275 Corporate Center Drive
Prism Work Order, 4050562
Monroe, NC 28110
Sample Matrix: Water
Time Collected: 05/15/14 09:30
Time Submitted: 05/23/14 16:45
Parameter
Result
Units
Report
MDL
Dilution Method Analysis Analyst
Basch
Limit
Factor DatUTime
ID
Total Metals
Cadmium
BRL
mg1L
0.0010
01000090
1 '200.7 5127/14 11 1
I'4E0519
Chromium
BRL
mg1L
00050
0.00076
1 '200.7 5/2.7/14 11 1
P4E0519
Lead
BRL
mglL
0.0050
0.0oma
1 '200.7 5fV114 18:57 1
P4E0519
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 28224-0543
Phone: [phone] - Toll Free Number: 1.8001529-6364 - Fax: [phone] Page 3 of 5

Prep Method: 200.7
Lab Number Batch
4050562-01 P4E0519
Sample Extraction Data
Initial Final DatefTime
50 mL 50 mL 05127114 9:35
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 2a224-0543
Phone: [phone] - Toll Free Number: 1-800f529-5354 - Fax: [phone] Page 4 of 5

CHAIN OF CUSTODY RECORD
IEnv{Qnrn&r. Analyt do s ?� EnVi4nmant:ji$OIL'lianS pAG€_`� OF _� OUOTe a TO ENSURE PROPER BILLING:ism
(
44$ Springbrook Road • Ghartotte, NC 28217 Project Name: �CI �� IS+ rM �4er
Phone 704f529-6364 Far: 7041525.0408 Short Hold Analysis: (Yes) No) UST Project: (Yes} O]}
C _ � 1� 'Please ATTACH any project specific reporting (QC LEVEL 111 Ili IV)
Client Company Nam e:Q I provisions and/or QC Requirements
Report TolContact Name: L_'i5aL ALI (�
1 Invoice To: ►.�Yir.��h-�l � S r� LAC, _
Reporting Address: qW Cflf06(Uk_'Q sni'Zr Y. Address: d
Monroe- WC. 311 ra CU OOIy
Phone:70q"140 - �Pq�tL Fax (Yes) (No?: 7[�'( Billing
Purchase Orders N Reference
TO BE FILLED IN BY CLIENTISAMPLING PERSONNEL
Email Address. f ISd, I (\a rr nA, Cct"%
Requested Due Date D I Day ., 2 Days 13 Days 04 Days U 5 Days
Certification: NELAC DOD FL NC
EDD Type: PDF,?,Excel � ther
"Working Days" ❑ 6-4 Daysx&andard 10 days 0 Rush
e Work Be
rApove
SC OTHER NIA
Site Location Name: C,n� µdrtf0 C
_
Samples recaived after 14:00 will be processed next busiress day.
Site Location Physical Address-, Sc�rn� cAs Z
it
Turnaround time is oased an tx.-siness days, excluding weekends and �olicays.
Water Chlorinated: YES— NO —
(SEE REVERSE FOR TERMS A CONDITIONS REGARDING SERVICES
RENDERED BY PRISM LABORATORIES, INC. TO CLIENT)
Sample Iced Upon Collection: YES NO
CLIENT
SAMPLE DESCRIPTION
I DATE TIME
COLLECTED
COLLECTED MILITARY
HOURS
MATRIX
{SOIL,
WATER OR
SLUDGE)
SAMPLE CONTAINER
ANALYSIS REQUESTED
/
PRESERVA- / ff�f % , PRISM
TIVES k / REMARKS LA8
I �/ / 1 / / / 4 ID ND.
TYPE
SEE 13ELOW i NO. i SIZE
IetZoiL Yi 1"�T I i� i i I ! ca 26. 0— r,niv lC/mil
Sampler's Signature% _ Sampled Sy (Print Name) L i SLL !� V� AYlia(ionM� [17 1� e
Upon relinquishing, this Chain of C..t.4 is your authorization for Prism to proceed with the analyses a quested above. Any changes k1st be
subr ted in writing to the Prism Project Manager. There will be charges for any changes after analyses have been initialized.
fin had By: (Signau } ReceivI By: aignacu ❑arr. A4�IsarylHour
V hoa or Shipment: NOTE: ALL SAMPLE COOLERS SHOULD BE TAPED SHU ITH CUST
Y SEALS FOR TRANSPORTATION TO THE LABORATORY.
�. COC Group No.
•
SAMPLES ARE NOT ACCEPTED AND VERIFIED AGAINS£COC UNTIL
ECEIVED AT THE LABORATORY.
wrl
:1 Fed Ex rJ UPS ❑ Hand -delivered Field $enlce n Other
j
NPDES:
I UST: I G O NDWATER: DRINKING WATER:
SOLID WASTE: ' RCRA: CERCLA
LANDVILL
OTHER:
❑NC;JSC
El NC ❑SC: rf NC ❑SC ❑NC '❑SC
I 'NC ❑SC I ❑NC'❑SC ❑NC ❑SC'
'❑NC '�ISC
❑NC '0SC
❑
❑ i ❑� ❑
❑ J ❑_
�'❑_
❑
`CONTAINER TYPE CODES: A = Amber C = Clear G= Glass P = Plastic: TL = Teflon -Lined Cap VOA = Volatile Organics Analysis (Zero Head Space)
Comments: Site Arrival Time:
Site Departure Tirne:
Field Tech Fee:
Mileage:
ORIGINAL