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Home My WebLink AboutNCG100119_MONITORING INFO_20150604wi `'R o STORMWATER DIVISION CODING SHEET NCG PERMITS PERMIT NO. /v C& J q () I I DOC TYPE [I HISTORICAL FILE [)(MONITORING REPORTS DOC DATE ❑ aoj5P�oy YYYYMMDD ' STORMWATER DISCHARGE OUTFALL (SDO) MONITORING REPORT CERTIFICATE OF COVERAGE NO. NCGIO0119 SAMPLES COLLECTED DURING CALENDAR YEAR:2015 (This monitoring report shall be received by the Division no later than 30 days from the date the facility receives the sampling results from the laboratory.) FACILITY NAME Foss Recycling, Inc. Havelock NC PERSON COLLECTING SAMPLE(S) Bryan Woody CERTIFIED LABORATORY(S) Pace Analytical Lab #12 Lab # Part A: Stormwater Benchmarks and Monitoring Results COUNTYCraven PHONE NO. (252) 566-3167 PLEASE REMEMBER TO SIGN ON THE REVERSE 4 For sampling periods with no discharge, you must submit this discharge monitoring form noting "No Flow" or "No Discharge" within 30 days of the end of that period to comply with permit reporting requirements. ®r,ori", Outfall No. Date Sample Collected, mo/dd/year Total Rainfall, inches 00400 00530 ---- 77023 01051 78141 pH, Standard Units Total Suspended Solids (TSS), mg/L Non -polar O&G/TPH (Method 1664 SGT-HEM), mg/L Ethylene Glycol, mg/L Lead, Total Recoverable, mg/L Total Toxic Organics3 , mg/L Benchmark - - 6.0 — 9.01 100/50z 15 81000 (Tiers 2 and 3) 0.03 1.0 Outfall001 06/04/15 4.0 7.7 19.8 <5.0 <5.0 0.0083 NA 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 in the General Permit. 1See If pH values outside this range are recorded in sampled stormwater discharges, but ambient precipitation pH levels are lower, then the lower threshold of this benchmark range is the pH of the precipitation (within instrument accuracy)instead of 6 S.U. Readings from an on -site or local rain gauge (or local precipitation data) must be documented to demonstrate background concentrations were below the benchmark pH range of 6-9. 2See General Permit text to identify whether the more protective benchmark applies for especially sensitive receiving waters. 3For purposes of this permit the definition of Total Toxic Organics is that list as stated in Appendix D, Table II of Chapter 40 Code of Federal Regulations (CFR) Part 122. Form SWU-251, last revised October25, 2012 Page 1 of 2 STORMWATER DISCHARGE OUTFALL (SDO) MONITORING REPORT Facilities that incorporate a solvent management plan into the Stormwater Pollution Prevention Plan may request that DWQ waive monitoring of total toxic organics. The solvent management plan shall include a list of the total toxic organic compounds used and the other elements listed in the General Permit. For those facilities allowed such a waiver, the discharger shall sign the following certification statement: Solvent Management Plan Certification Statement "Based upon my inquiry of the person or persons directly responsible for managing compliance with the permit monitoring requirement for total toxic organics (TTO), I certify that to the best of my knowledge and belief, no dumping of concentrated toxic organics into the stormwater or areas which are exposed to rainfall or stormwater runoff has occurred since filing the last discharge monitoring report. I further certify that this facility is implementing all the provisions of the solvent management plan included in the Stormwater Pollution Prevention Plan." Name (Print name) Title (Print title) Signature Mail Original and one copy to: Division of Water Quality Attn: Central Files 1617 MailServiceCenter Raleigh, North Carolina27699-1617 Date "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." ct R -I - (Signature of Perm ttee or Designee) (Date) Form SW U-251, last revised October 25, 2012 Page 2 of 2 mold Atlantic Engineering & Environmental Solutions July 7, 2015 NCDENRIDWQ Attention: Central Files 1617 Mail Service Center Raleigh, North Carolina 27699-1617 RECEIVED JUL 2 7 2015 CENTRAL FILES DWR SECTION Subject: STORMWATER SAMPLING RESULTS FOSS RECYCLING INC. - HAVELOCK 901 LAKE ROAD HAVELOCK, NORTH CAROLINA 28532 NPDES PERMIT NO. NCG100119 To Whom It May Concern: 409 Rogers View Court Raleigh, NC 27610 office 919.250.9916 facsimile 919.250,9950 MAAONLINE.COM Attached please find the Stormwater Discharge Monitoring Report (DMR) and analytical report for the sampling conducted at the above -referenced site. A stormwater sample was collected from Outfall 001 on June 4, 2015 and analyzed for total suspended solids (TSS), pH, total recoverable lead, oil and grease and ethylene glycol. As summarized on the attached -DMR, all parameters were reported below or within their respective benchmark values. If you have any questions or need additional information, please contact me at 919-250-9918. Sincerely, MID -ATLANTIC ASSOCIATES, INC. h Ron J. Davis Stormwater Services Manager Attachment: Discharge Outfall Monitoring Report EXPERIENCED CUSTOMER FOCUSED INNOVATIVE aceAnalytical www.pacelabs. corn i June 16, 2015 Chuck Hoffman Mid Atlantic Associates RE: Project: Foss Recycling Inc. - Havelock Pace Project No.: 92253069 Dear Chuck Hoffman: Pace Analytical Services, Inc. 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 Enclosed are the analytical results for sample(s) received by the laboratory on June 05, 2015. 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, Niclole Gasiorowski nicole.gasiorowski@pacelabs.com Project Manager Enclosures cc: Ron Davis, Mid Atlantic Associatees, Inc. Q NCCRZ TN 1 ry 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 14 aceAnalytical www.pacclabs.com Pace Analytical Services, Inc. 9800 Kincey Ave. Suite 1100 Huntersville, NC 28078 (704)875-9092 Project: Foss Recycling Inc. - Havelock Pace Project No.: 92253069 Indiana Certification IDs 7726 Moller Road, Indianapolis, IN 46268 Illinois Certification #: 200074 Indiana Certification M C-49-06 Kansas Certification ME-101771 E-10247 Kentucky UST Certification #: 0042 Kentucky WW Certification #:98019 Louisiana/NELAP Certification #: 04076 Charlotte Certification IDs 9800 KinceyAve. Ste 100, Huntersvilte, NC 28078 North Carolina Drinking Water Certification #: 37706 North Carolina Field Services Certification #: 5342 North Carolina Wastewater Certification #: 12 South Carolina Certification #: 99006001 Asheville Certification IDs 2225 Riverside Drive, Asheville, NC 28804 Florida/NELAP Certification #: E87648 Massachusetts Certification #: M-NC030 North Carolina Drinking Water Certification #: 37712 CERTIFICATIONS Ohio VAP Certification #: CL-0065 Oklahoma Certification #: 2014-148 Pennsylvania Certification #: 68-05340 Texas Certification #: T104704355-15-8 West Virginia Certification #: 330 Wisconsin Certification #: 999788130 USDA Soil Permit #: P330-10-00128 Florida/NELAP Certification #: E87627 Kentucky UST Certification #: 84 West Virginia Certification #: 357 Virginia/VELAP Certification M 460221 North Carolina Wastewater Certification #: 40 South Carolina Certification #: 99030001 West Virginia Certification #: 356 VirginialVELAP Certification #: 460222 REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, without the written consent of Pace AnatyticaI Services, Inc.. Page 2 of 14 ace Analytical" + www,pacelabs.com I Project: Foss Recycling Inc. - Havelock Pace Project No.: 92253069 Lab ID Sample ID 92253069001 OUTFALL NO.1 Pace Analytical Services, Inc. 9800 Kincey Ave. Suite TOO Huntersville, NC 28078 (704)875.9092 SAMPLE ANALYTE COUNT Method Analysts Analytes Reported Laboratory EPA 1664E CLW t PASI-C EPA 8015 Alcohol -Glycol BJW 1 PASI-I EPA 6010 JMW 1 PASI-A SM 2540D WRC 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 14 aceAnalytical www,pacotobs.com Pace Analytical Services, Inc. 9800 KinceyAve. Suite 10o Huntersville, NC 28078 (704)875-9092 ANALYTICAL RESULTS Project: Foss Recycling Inc. - Havelock Pace Project No.: 92253069 Sample: OUTFALL N0.1, Lab ID: 92253069001 Collected: 06/04/15 10:24 Received: 06/05/15 08:00 Matrix: Water Parameters Results Units Report Limit DF Prepared Analyzed CAS No. Qual 1664 SGT-HEM, TPH Analytical Method: EPA 1664B Total Petroleum Hydrocarbons ND mg/L 5.0 1 06/15/15 08:45 8015M Glycols in water Analytical Method: EPA 8015 Alcohol -Glycol Ethylene glycol ND mg/L 5.0 1 06/11/15 18:19 107-21-1 6010 MET ICP Analytical Method: EPA 6010 Preparation Method: EPA 3010 Lead 8.3 ug/L 5.0 1 06/08/15 1710 06/09/15 20:46 7439-92-1 2540D Total Suspended Solids Analytical Method: SM 2540D Total Suspended Solids 19.8 mg1L 3.2 1 06/11/15 14:50 REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, Date: 06/16/2015 06:28 PM without the written consent of Pace Analytical Services, Inc.. Page 4 of 14 aceAnalytical www.pace)abs.com f QUALITY CONTROL DATA Project: Foss Recycling Inc. - Havelock Pace Project No.: 92253069 QC Batch: GCSV/21643 Analysis Method: EPA 1664B QC Batch Method: EPA 1664B Analysis Description: 1664 SGT-HEM, TPH Associated Lab Samples: 92253069001 METHOD BLANK: 1484604 Associated Lab Samples: 92253069001 Parameter Units Total Petroleum Hydrocarbons mg1L LABORATORY CONTROL SAMPLE: 1484605 Parameter Units Total Petroleum Hydrocarbons mg/L MATRIX SPIKE SAMPLE: 1484606 Parameter Units Total Petroleum Hydrocarbons mg/L Pace Analytical Services, Inc. 9800 Kincey Ave. Suite 1b0 Huntersville, NC 28078 (704 )875-9092 Matrix: Water Blank Reporting Result Limit Analyzed Qualifiers ND 5.0 06/15/15 08:44 Spike LCS LCS % Rec Conc. Result % Rec Limits Qualifiers 20 17.9 90 64-132 92253927001 Spike MS MS % Rec Result Conc. Result % Rec Limits Qualifiers ND 20 17.9 87 64-132 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: 06/16/2015 06:28 PM without the written consent of Pace Analytical Services, Inc.. Page 5 of 14 aceAnalytrcal Wwwpacefabs.com Pace Analytical Services, Inc. 9800 Kincey Ave. Suite 100 huntersvik NC 28078 (704)875.9092 Project: Foss Recycling Inc. - Havelock Pace Project No.: 92253069 QC Batch: GCSV115669 QC Batch Method: EPA 8015 Alcohol -Glycol Associated Lab Samples: 92253069001 METHOD BLANK: 1315435 Associated Lab Samples: Parameter Units Ethylene glycol mg1L LABORATORY CONTROL SAMPLE: 1315436 Parameter Units Ethylene glycol mg/L QUALITY CONTROL DATA Analysis Method: EPA 80 15 A Icoh ol-G lycol Analysis Description: EPA 8015 Modified Matrix: Water Blank Reporting Result Limit Analyzed Qualifiers ND 5.0 0611111516:13 Spike LCS LCS % Rec Conc. Result % Rec Limits Qualifiers 25 22.9 92 79-129 MATRIX SPIKE & MATRIX SPIKE DUPLICATE: 1315990 1315991 MS MSD 92252710002 Spike Spike MS MSD MS MSD % Rec Parameter Units Result Conc. Conc, Result Result % Rec % Rec Limits RPD Qual Ethylene glycol mg1L NO 25 25 20.0 20.3 80 81 67-133 1 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: 06/1612015 06:28 PM without the written consent of Pace Analytical Services, Inc.. Page 6 of 14 ace Analytical www pacelabs.cw i Project: Foss Recycling Inc. - Havelock Pace Project No.: 92253069 QC Batch: MPRP118643 QC Batch Method: EPA 3010 Associated Lab Samples: 92253069001 METHOD BLANK: 1476701 Associated Lab Samples: 92253069COl Parameter Units Lead uglL QUALITY CONTROL DATA Analysis Method: EPA6010 Analysis Description: 6010 MET Matrix: Water Blank Reporting Result Limit Analyzed Qualifiers ND 5.0 06/0911519:54 Pace Analytical Services, Inc. 9800 KinceyAve. Sulle 100 Huntersvilie, NC 28078 (704)875.9092 LABORATORY CONTROL SAMPLE: 1478702 Spike LCS LCS % Rec Parameter Units Conc. Result % Rec Limits Qualifiers Lead uglL 500 477 95 80-120 MATRIX SPIKE & MATRIX SPIKE DUPLICATE: 1478703 1478704 MS MSD 92253110004 Spike Spike MS MSD MS MSD % Rec Parameter Units Result Conc. Conc. Result Result % Rec % Rec Limits RPD Qual Lead uglL ND 500 500 477 516 95 103 75-125 8 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: 06/16/2015 06:28 PM without the written consent of Pace Analytical Services, Inc,. Page 7 of 14 aceAnalytrcal www.pacelabs. wrn i QUALITY CONTROL DATA Project: Foss Recycling Inc. - Havelock Pace Project No.: 92253069 QC Batch: WET138051 Analysis Method: SM 2540D QC Batch Method: SM 2540D Analysis Description: 2540D Total Suspended Solids Associated Lab Samples: 92253069001 METHOD BLANK: 1482385 Associated Lab Samples: 92253059001 Parameter Units Total Suspended Solids mg1L LABORATORY CONTROL SAMPLE: 1482386 Parameter Units Total Suspended Solids mg/L SAMPLE DUPLICATE: 1482387 Parameter Units Total Suspended Solids mg/L SAMPLE DUPLICATE: 1482388 Parameter Total Suspended Solids Matrix: Water Blank Reporting Result Limit Analyzed Qualifiers ND 2.5 06/1111514:47 Spike LCS Conc, Result 250 238 92253050001 Dup Result Result 10 22.0 92253245001 Dup Units Result Result mg1L ND ND Pace Analytical Services, Inc. 9800 KinceyAve. Suite 1U0 Huntersvitle, NC 28078 (704 )875-9092 LCS % Rec % Rec Limits Qualifiers 95 90-110 RPD Qualifiers 75 D6 RPD Qualifiers 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: 06/16/2015 06:28 PM without the written consent of Pace Analytical Services, Inc.. Page 8 of 14 ace Analytical" www pacefabs.com Pace Analytical Services, Inc. 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875.9092 QUALIFIERS Project: Foss Recycling Inc. - Havelock Pace Project No.: 92253069 DEFINITIONS DF - Dilution Factor, if reported, represents the factor applied to the reported data due to dilution of the sample aliquot. ND - Not Detected at or above adjusted reporting limit. J - Estimated concentration above the adjusted method detection limit and below the adjusted reporting limit. MDL -Adjusted Method Detection Limit. POL - Practical Quantitation Limit. RL - Reporting Limit. S - Surrogate 1,2-Diphenylhydrazine decomposes to and cannot be separated from Azobenzene using Method 8270. The result for each analyte is a combined concentration. Consistent with EPA guidelines, unfounded data are displayed and have been used to calculate % recovery and RPD values. LCS(D) - Laboratory Control Sample (Duplicate) MS(D) - Matrix Spike (Duplicate) DUP - Sample Duplicate RPD - Relative Percent Difference NC - Not Calculable. SG - Silica Gel - Clean -Up U - Indicates the compound was analyzed for, but not detected. Acid preservation may not be appropriate for 2 Chloroethyivinyl ether, Styrene, and Vinyl chloride. A separate vial preserved to a pH of 4-5 is recommended in SW846 Chapter 4 for the analysis ofAcrolein and Acrylonitrile by EPA Method 8260. N-Nitrosodiphenylamine decomposes and cannot be separated from Diphenylamine using Method 8270. The result reported for each analyte is a combined concentration. 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 - Charlotte PASI-I Pace Analytical Services - Indianapolis ANALYTE QUALIFIERS D6 The relative percent difference (RPD) between the sample and sample duplicate exceeded laboratory control limits. REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, Date: 06/16/2015 06:28 PM without the written consent of Pace Analytical Services, Inc.. Page 9 of 14 aceAnalyticalm www.pacelabs.com Pace Analytical Services, Inc. 9800 Kincey Ave. Suite 100 Huntersville, NC 2807B (704)875-9092 QUALITY CONTROL DATA CROSS REFERENCE TABLE Project: Pace Project No.: Foss Recycling Inc. - Havelock 92253069 Analytical Lab 1D Sample ID QC Batch Method QC Batch Analytical Method Batch 92253069001 OUTFALL NO.1 EPA 1664E GCSV121643 92253069001 OUTFALL NO.1 EPA 8015 Alcohol -Glycol GCSV115669 92253069001 OUTFALL NO.1 EPA 3010 MPRPl18643 EPA 6010 ICPl16724 92253069001 OUTFALL NO.1 SM 2540D WET138051 REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full. Date: 06/16/2015 06:28 PM without the written consent of Pace Analytical Services, Inc.. Page 10 of 14 %t'�7cBkialytrcalm' ,aie uorlaj[ton upon Receipt SC:UK r Document Number: I F-CHR-CS-003-rev.16 Client Name: A tu^ �� A s5,c4 cfxes. Courier: ed Ex ❑ UPS❑ USPS❑ Client❑^ emmercial❑ Pace Other_ Custody Seal on Cooler/Box Present: ❑Zy" 6- 0no Seals intact: ❑ yesPacking Material: ❑ Bubble C)p. ❑ ule Bags ❑ None ❑ Other Thermometer Used: IR Gun 614941Type of Ic e6w V-Blue None Temp Correction Factor T1401 No Correction rage •I or c- Issuing Authority: Pace Huntersville Quality Office ' Page 2 of 2 is for Internal Use Only ❑ no Samples on ice, cooling process has begun Corrected Cooler Temp.: •C Temp should be above freezing to 6°C Biological Tissue is Frozen: Yes No / Comments: Date and Initials QQf pe on�xanrlping contents: /t N- Chbin"of Custody Present: ❑No ❑NIA 1, Chain of Custody Filled Out: ❑Yes No ❑N Chain of Custody Relinquished: O' ❑NIA 3. Sampler Name & Signature on COC: s ❑ o ❑NIA 4. Samples Arrived within Hold Time: s ❑No ❑ A 5, Short Hold Time Analysis <72hr): Dyes A 6. Rush Turn Around Time Requested: Dyes PqI6 ❑N1A 7. Sufficient Volume: es o El NIA 8, Correct Containers Used: -Pace Containers Used: a No Yes ❑N ❑NIA NIA 9. Containers Intact: s ❑No ❑NIA 10 Filtered volume received for Dissolved tests Dyes ❑ 1A 11. Sample Labels match COC: -includes datellime/lD/Analysis Matrix: s ❑No ❑NrA 12. All containers needing preservation have been checked. All containers needing preservation are found to be in compliance with CPA recommendation. exceptions: VOA, ooliform, TOC, O&G, Wi-DRO (water) Yes No ❑N1A Yes Cr ❑NIA• Yes ONO 13. Samples checked for dechlorination: Dyes ONO PfIrA 14. Headspace in VOA Vials( >6mm): [ayes ❑ o ❑NIA 1 Trip Blank Present: Trip Blank Custody Seals Present Pace Trip -Blank Lot # ifpurchased)* [--]Yes ONO Dyes ONO ❑ rA ❑ 1A 1 . Client Notification/ Resolution: Field Data Required? Y I N Person Contacted: Date/Time: Comments/ Resolution: SCURF Review: V wV(,[7 Dater SRF Review: Ullal Date: Note: Whenever there is a discrepancy affecting North Carolina compliance samples, a copy of this form will be sent to the North Carolina DEHNR Certification Office (Le out of hold, incorrect preservative, out of temp, incorrect containers) WOA:92253069 1111111111111111111111 Page 11 of 14 CHAIN -OF -CUSTODY i Analytical Request Document The Chain -of -Custody is a LEGAL DOCUMENT. A8 relevanl fields must be completed accurately. aceAnalKical :lion A Section B Section C Paget Of Iulred Client lnfcmtation: Required P Inrorma5Cn: +old Invoice Infarmatidn: nPany: Mid -Atlantic Associates, Inc. Report To: Chuck Hoffman (choffmangmaaonline.cofn) Anenthn: Chuck Hoffman Tess: 409 Rogers View Court Corr To: Joanna Crow (jcrow@maaonline.com) company Name: Mid -Atlantic Associates, inc. REGULATORY AGENCY Raleigh, NC 27610 Address: 409 Rogers View Court. Raleigh, NC r NPDES r- GROUNDWATER 1' DRINKING WATER l— UST r— RCRA r OTHER 3d To: ehoffman@maaontine.com Purcnasa order No.: R2066.05 Pace Quote — Reterenre: -ne: 919-250-9918 rax: 919-250-9950 PMje<l Name: Foss Recycling, Inc, - Havelock Pace PnOleci Kevin Herring Site Location Manager. STATac; NC guested Due DatertAT: Standard Project Number. R206fi.D0 Task 50000 Pace Prorde a _ -�� ,., �E Requested Analysis Filtered (Y!N) $eCtlOn D Valid Matrix Codes a x I I Required Client lntonna:ion M/PRix GQOE - COLLECTED Preservatives s N Y N Y Oktrnoup WATER OW - O WATER WT u U U O W WASTE WATER WVY COr6P03rrE Gor+p09TE Z PROOEr-T P SOUSOUO ta_ > m START IENOIGRAB tu S SAMPLE ID OIL E WP 0 o U _ (A-$.0-9l,•) OTHER O G ¢ N L 7+ ou U �+�, /% /] 3b( Sample Ips MUST BE UNIQUE r4ssuE rs p 2 � (} m '� t L E�� R: X � ul w p W Q c m , c a) H n a ` n Q C7 O d1 L N DATE TIME o�Ts TIME o x = 2 Z Z O .a.� F 0. CID Pace Project NoJ Lab I.D. 1 Outfall No. t WT c -ice It•-: ;; } 7 4 1 2 x x x x Rainfall (inches):—' f 2 H: 3 4 5 6 7 8 9 10 IS 12 ADDITIONAL COMMENTS REUNOUtSHED BY! AFFILIATION DATE TIME ACCEPTED BY f AFFILIATION DATE TIME SAMPLE CONDITIONS SAMPLER NAME AND SIGNATURE v a w ro X m ? m c PRINT Name of SAMPLER: z E S g SIGNATURE of SAMPLER: /I' �� DATE Signed j t 1 � - a N o (MMIDD/YYj: -Imponanl NOW By signiAg this toms you are accepting Pace's NET 30 day payment terns and agreeing to late charges of 1.5% per MO= for any Invoices not paid within 30 days. F-ALL-0-020rev.08, 12-Ca-2007 %Y�?cef rJaly)iCal � Sam to %,onamon upon Kecel t buuK t'a a -i or z-- ( Document Number: Issuing Authority: F-CHR-CS-003-rev.16 Pace Huntersville Qualitv Office Client Name: rl �- I lu^�r C ss�c� a res. ' Page 2 of 2 is for Internal Use Only Courier: ed Ex ❑ UPS❑ USPS❑ Client❑ emmercial❑ Pace Other p" " "' '��IY `'s'" `""t°'{;•*, Custody Seal on Cooler/Box Present: ❑ y s 0 no Seals intact: ❑ yes ❑ no , Prame°;f.r:„fig Packing Material: ❑ Bubble C)p ❑ Bubble Bags ❑ None ❑ Other Thermometer Used: IR Gun 614flA-'Type of Ice6t---�Blue None Samples on ice, cooling process t as begun Temp Correction Factor T1401 No Correction Corrected Cooler Temp.: 25 'C Temp should be above freezing to 6'C B€D[o fCdl Tissue is Frozen: Yes No I g Comments: Date and Initials of pe on a ami Ing contents: /i P G - Chain of Custody Present: ❑No ❑NIA 1, Chain of Custodx Filled Out: ❑Yes No ❑N Chain of Custody Relinquished: ❑NIA 3. Sampler Name & Signature on COC: s ❑ o ❑NIA 4, Samples Arrived within Hold Time: s ❑No 0,611A 5. Short Hold Time Analysis <72hr : ❑Yes A 6. Rush Turn Around Time Requested: ❑Yes ❑NIA 7. Sufficient Volume: es o ❑NIA 8. Correct Containers Used: -Pace Containers Used: a No Yes ❑N ❑N!A ❑NIA g, Containers Intact; s ❑No ❑NIA 10 Filtered volume received for Dissolved tests ❑Yes ❑ /A 11. Sample Labels match COC: -Includes date/time/ID/Analysis Matrix: s ❑rti ❑N/A 12. All containers needing preservation have been checked. All containers needing preservation are found to be in compliance with EPA recommendation. exceptions: VOA, coliform, TOC, 08.G, W-DRO (water) Yes No ❑NIA Yes ❑N1A Yes ONO 13. Samples checked for dechlorination: ❑Yes ONO Pil A 14, Headspace in VOA Vials >6mm): ❑Yes ❑ Ko ❑NIA 1 Trip Blank Present: Trip Blank Custody Seals Present Pace Trip -Blank Lot #Jif purchased); ❑Yes ONO ❑Yes ONO G IA 12 !A 1 . Client Notification/ Resolution: Field Data Required? Y I N Person Contacted: Date/Time: Comments/ Resolution: SCURF Review: VVLC7 Date: I SRF Review: U Date: r` Note: Whenever there Is a discrepancy affecting North Carolina compliance samples, a copy of this form will be sent to the North Carolina DEHNR Certification Office ( i.e out of hold, Incorrect preservative, out of temp, incorrect containers) W®:92253069 1111111111111111111111 92253069 Page 13 of 14 ppppp- !2neAnalj4ical r^'•'^� PR�'aos cwn CHAIN -OF -CUSTODY 1 Analytical Request Document The Chain -of -Custody is a LEGAL DOCUMENT. AD relevant fields must he completed a=rately. :lion A Section B Section C Page: of lulrrd Client InformaUOn: Required Projoct Irfornation: Invoice Irdormation: marry. Mid -Atlantic Associates, Inc. Report To: Chuck Hoffman (choffman@maaonline.com) Attamon: Chuck Hoffman ress: 409 Rogers View Court Copy To: Joanna Crow (jcrow@maaonline.com) Company Name: Mid -Mantic Associates, inc. REGULATORY AGENCY Raleigh, NC 27610 Address: 409 Rogers View Court, Raleigh, NC i— NPOES I— GROUND WATER 1— DRINKING WATER F UST f— RCRA f— OTHER eil To: ehoffman@maaontine.com Purchase Order No.: R2066.05 Pace Quote -- Reference: ' 919-250-9918 Fax: 919-250-9950 Project Name: Foss Recycling, Inc. - Havelock PaCe Project Kevin Herring, ' ].Manager. Site Location M�� STATE: NC luested Due Date/TAT: standard Prq— Number. R2066.00 Task 50000 Pace Profile s; _ �� y '�1 Requested Analysis Filtered (Y1N) Soction D Valid Matrix Codes Za z I I I RoQulnsd client InrornaEion MATRIX LADE COLLECTED Preservatives s N Y N Y DRwumGWATER ow O z WATER WT g u 0 m WASTE WATER WW PRODUCT P = U O) CAMPOSTE START COMPOSITE END/GRAB p I ar Z SOUSOUD SL SAMPLE ID WIE Wp U W _ a) v o a Q � AIR AR (A-Z. 0-9. 07 wo W a aSample m b� IDs MUST BE UNIQUE nSSUE rs O - � ie X� d 3 p c D Z m m r Q cn z L m - v) DATE TIME DATE TIME N a 7 2 S i-% r a Z O ..� h F w EY Pace Project hol Lab I.D. 1 Qutfall No. 1 wr-�'—;-fti /f,�-';7 i 7 a 1 2 x x x x Rainfall (inches): r! ZI pH: 3 4 5 6 7 8 9 19 11 F� 12 ADDITIONAL COMMENTS RELINQUISHED BY ! AFFILLAT10N DATE TIME ACCEPTED BY! AFFILIATION DATE TIME SAMPLE CONDITIONS SAMPLER NAME AND SIGNATURE m m q z $y i✓ w m m z / PRINT Name of SAMPLER:/ - 1 I 4 O 8 5tGNATUP,EofSAMPLER: j i ! GATE Signed f ! ~ tt (MMfDt)IYY�• c�V ra 'Impofafll NOW By vgnmg Skis forts you arc aceepUng Pace's NET X day paynneni terms and agreeing to We charges of 1.5% per month for any invoices not paid wrinin 30 days. F-ALL-0-020rev.08, 12-Oct-2007