NCS000332_MONITORING INFO_20190503

STORMWATER DIVISION CODING SHEET
NCS PERMITS
PERMIT NO.
n'L / 0 �3
l"
DOC TYPE
❑FINAL PERMIT
A MONITORING REPORTS
❑ APPLICATION
❑ COMPLIANCE
0 OTHER
DOC DATE
❑� � I -I V� U 3
YYYYMMDD

May 1, 2019
REGFI ED
MAY 0 3 Z019
Division of Energy Mineral and Land I7esources
CEIV'I"Itf�i., f+lirEa
Attn: Central Piles DWR SECTION
1617 Mail Service Center
Raleigh, NC 27699
Subject: Discharge Monitoring Report for Period 1 (October 2018 to March 2019)
Hexion Specialty Chemicals, Inc.
NPDES Permit No. NCS000332
To Whom It May Concern:
Hexion Specialty Chemicals, Inc. (Hexion) operates under NPDES Permit No.
NCS000332. As a part of this permit, Hexion is required to submit semiannual
Discharge Monitoring Reports (DMRs). Please find enclosed the completed DMR Form
(Attachment 1) and the analytical testing report (Attachment 2) for Period 1 (October
2018 to March 2019). Also included is an additional copy of the form, as required by
Permit NCS000332 for the monitoring period October 2018 — March 2019.
The analytical report received from Pace Analytical indicated that the sample was
tested outside of the EPA specified holding time of 72 hours for formaldehyde (method
8315) due to lab logistics. As such, Hexion has deemed the formaldehyde result is
invalid. 711e facility will retest formaldehyde within 30 days and submit a subsequent
DMR.
This DMR serves to report results for ammonia, Chemical Oxygen Demand (COD) and
pH for Period 1 (October 2018 to March 201.9).
If you have any questions or require any additional information, please contact me at
828.219.3503.
Sincerely,
Hexion Specialty Chemicals, Inc.
9f Wj
Jeff McDaniel
Site Leader
Attachments

Attachment 1
Completed DMR Form for
Period 1
(October -March 2019)

Attachment 2
Analytical Testing Report
for Period 1
(October 2018 -March 2019)

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number NCS 000332
FACILITY NAME Hexion Inc
PERSON COLLECTING SAMPLES)
CERTIFIED LABORATORY(S) Pace Analytical Services Lab # 40
Analytical Environmental Lab # 562
Part A: Specific Monitoring Requirements
SAMPLES COLLECTED DURING CALENDAR YEAR: 1
(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.)
COUNTY Burke
PHONE NO. 8( 28 ) 219-3504
SIGNATURE OF PER�tiMITTEE OR DESIGNEE
REQUIRED ON PAGE 2.
Outfall _ Date '50050 rri41L m4/L mp/L_ ..m4/L. mQ/L mg/L
No. Sample' Total; Total
COD, Ammonia -a
Gallecte$, H lo►dr if a Rainfall -'
mo/dd/vr... MG.v.,. ;, - .inches ,..,.... -- mglL mq/Ls mgIL mglL• ,. m41L m47L:
001 03I21 /2019 54.9 0.83 7.17
Does 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 Mnnitnrinn Requirements
Outfall : ;
Datek "r "::'SOU5U
i00556-;
`00530
00400
Sample `
total Flow
xTotal '-` '_
'Oil re ,a
IVon ,polar
Total "
:pH
\ew ytilotor
C ollecteil�(�f
apphcakile):
�
;Rainfall
(if appl };r
�:�&G/TPH
pF
Sus ended
Oi[Usabe
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'
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,(Method 1664
Solids
yM
4
inches :.'
mtrll. :' `
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m II ^
:unit .
al/mo:=
Form SWU-247, last revised 6/1212015
Page I of 2

STORM EVEN'r CHARACTERIST[CS:
Date 3/21 /19 U - � ' CA'—, VIIA� n�h
S Total Event Precipitation (inches): 4ptS -0�- l�cxukl'
Event Duration (hours): 0.(; - 1,p(only if applicable — see permit.) K SITS Wks
(if more than one storm event was sampled)'
Date
Total Event Precipitation (inches):
Event Duration (hours): (only if applicable — see permit.)
Mail Original and one copy to:
Division of Energy Mineral and Land Resources
Attn: Central Files
1617 Mail Service Center
Raleigh. North Carolina 27699-1617
"1 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 Imes and imprisonment for knowing violations."
�J? m rh:4 430�
(Signature of Per to (Date)
Form SWU-247, last revised 611212015
Page 2 of 2

aceAnalytical
»wwpecelabs.=n
April 01, 2019
Jeff McDaniel
Hexion
114 Industrial Blvd
Morganton, NC 28655
RE: Project: Morganton SW 3121
Pace Project No.: 92422471
Dear Jeff McDaniel:
Pace Analytical Services, LLC
2225 Riverside Dr.
Asheville, NC 28804
[phone]
Enclosed are the analytical results for sample(s) received by the laboratory on March 22, 2019. The
results relate only to the samples included in this report. Results reported herein conform to the most
current, applicable TNIINELAC standards and the laboratory's Quality Assurance Manual, where
applicable, unless otherwise noted in the body of the report.
Some analyses have been subcontracted outside of the Pace Network. The subcontracted
laboratory report has been attached.
If you have any questions concerning this report, please feel free to contact me.
Sincerely,
Chris Derouen
[e-mail]
[phone]
Project Manager
Enclosures
cc: Mr, Phil Busovne, Hexion
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, LLC.
Page 1 of 18

laceAnalytrcaI
www.pecelabscnm
Project: Morganton SW 3121
Pace Project No.: 92422471
Asheville Certification IDs
2225 Riverside Drive, Asheville, NC 28804
Florida/NEtAP Certification #: E8764B
Massachusetts Certification #: M-NC030
North Carolina Drinking Water Certification #: 37712
CERTIFICATIONS
North Carolina Wastewater Certification #: 40
South Carolina Certification #: 99030001
VirginiaNELAP Certification #: 460222
REPORT OF LABORATORY ANALYSIS
Pace Analytical Services, LLC
2225 Riverside Dr.
Asheville, NC 28804
[phone]
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, LLC.
Page 2 of 18

aceAnaIj,lcal
www.pacWabs,com
SAMPLE ANALYTE COUNT
Pace Analytical Services, LLC
2225 Riverside Dr.
Asheville, NC 28604
[phone]
Project: Morganton SW 3121
Pace Project No.: 92422471
Analytes
Lab ID Sample ID Method Analysts Reported Laboratory
92422471001 SW-01AlBIC EPA350.1 Rev 2.01993 CJH1 1 PASI-A
SM 5220D-2011 GC 1 PASI-A
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, LLC. Page 3 of 18

Pace Analytical Services, LLC
acekialXical0
Asheville,
Riverside NC 2880404
www.p&cWabs.com
[phone]
ANALYTICAL RESULTS
Project: Morganton SW 3121
Pace Project No.: 92422471
Sample: SW-01AIB/C Lab ID: 92422471001 Collected: 03/21/19 17:30 Received: 03/22/19 10:42 Matrix: Water
Parameters Results units Report Limit DF Prepared Analyzed CAS No. Qual
350.1 Ammonia Analytical Method: EPA 350.1 Rev 2.0 1993
Nitrogen, Ammonia 0.83 mg/L 0,10 1 03/30/19 18:12 7664-41-7
5220D COD Analytical Method: SM 5220D-2011 Preparation Method: SM 5220D-2011
Chemical Oxygen Demand 54.9 mg1L 25.0 1 03/25/19 17:00 03/25/19 22:17
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
Date: 04101/2019 03:56 PM without the written consent of Pace Analytical Services, LLC, Page 4 of 18

(�Iacmnaljdical"
www.pacelabs.com
QUALITY CONTROL DATA
Pace Analytical Services, Lt_C
2225 Riverside Dr,
Asheville, NC 28804
[phone]
Project: Morganton SW 3.t21
Pace Project No.: 92422471
QC Batch: 466438
Analysis Method: EPA
350.1 Rev 2.0 1993
QC Batch Method: EPA 350.1 Rev 2.0 1993
Analysis Description: 350.1 Ammonia
Associated Lab Samples: 92422471001
METHOD BLANK: 2535309
Matrix:
Water
Associated Lab Samples: 92422471001
Blank
Reporting
Parameter Units
Result
Limit
Analyzed Qualifiers
Nitrogen, Ammonia mg1L
ND 0.10
03/30119 17:42
LABORATORY CONTROL SAMPLE: 2535310
Spike
LCS
LCS %P Rec
Parameter Units
Conc.
Result
% Rec Limits Qualifiers
Nitrogen, Ammonia mg1L
5
5.0
99 90-110
MATRIX SPIKE & MATRIX SPIKE DUPLICATE: 2535311
2535312
MS
MSD
92421810009
Spike
Spike MS
MSD MS MSD
% Rec
Parameter Units Result
Conc.
Conc. Result
Result % Rec % Rec
Limits
RPD Qual
Nitrogen, Ammonia mg1L ND
5
5 5.0
5.0 101 101
90-110
0
MATRIX SPIKE & MATRIX SPIKE DUPLICATE: 2535313
2535314
MS
MSD
92421810014
Spike
Spike MS
MSD MS MSD
% Rec
Parameter Units Result
Conc.
Conc. Result
Result % Rec % Rec
t-imits
RPD Qual
Nitrogen, Ammonia mg1L ND
5
5 5.0
5.0 99 99
90-110
0
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: 04/01/2019 03:56 PM without the written consent of Pace Analytical Services, LLC.
Page 5 of 18

(�IaceAnalyfical"
www.pac6 boom
QUALITY CONTROL DATA
Project: Morganton SW 3/21
Pace Project No.: 92422471
OC Batch: 465289 Analysis Method: SM 5220D-2011
QC Batch Method: SM 5220D-2011 Analysis Description: 5220D COD
Associated Lab Samples: 92422471001
METHOD BLANK: 2529980
Associated Lab Samples: 92422471001
Parameter Units
Chemical Oxygen Demand mg/L
Matrix: Water
Blank Reporting
Result Limit Analyzed Qualifiers
ND 25.0 03/25/19 22:14
Pace Analytical Services, LLC
2225 Riverside Dr.
Asheville, NC 28804
[phone]
LABORATORY CONTROL SAMPLE: 2529981
Spike LCS LCS % Rec
Parameter Units Conc. Result % Rec Limits Oualifers
Chemical Oxygen Demand mg/L 750 760 101 90-110
MATRIX SPIKE & MATRIX SPIKE DUPLICATE: 2529982 2529983
MS MSD
92422361001 Spike Spike MS MSD MS MSD % Rec
Parameter Units Result Conc. Conc. Result Result % Rec % Rec Limits RPD Qual
Chemical Oxygen Demand mg1L 1310 100 100 1430 1420 115 108 90-110 1 M1
Results presented on this page are In the units Indicated by the "Units" column except where an alternate unit Is presented to the right of the result.
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
Date: 04/01/2019 03:56 PM without the written consentof Pace Analytical Services, LLC.
Page 6 of 18

aceAnalj cal
www.pecalab&mm
QUALIFIERS
Project: Morganton SW 3121
Pace Project No.: 92422471
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.
TNTC - Too Numerous To Count
J - Estimated concentration above the adjusted method detection limit and below the adjusted reporting limit.
MDL -Adjusted Method Detection Limit.
Pace Analytical Services, LLC
2225 Riverside dr.
Asheville, NC 28804
[phone]
PQL - Practical Quantitation Limit.
RL - Reporting Limit - The lowest concentration value that meets project requirements for quantitative data with known precision and
bias for a specific analyte in a specific matrix.
S - Surrogate
1.2-Diphenylhydrazine decomposes to and cannot be separated from Azobenzene using Method 8270. The result for each analyte is
a combined concentration.
Consistent with EPA guidelines, 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 Chloroethylvinyl ether.
A separate vial preserved to a pH of 4-5 is recommended in SW646 Chapter 4 for the analysis of Acrolein 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
ANALYTE QUALIFIERS
M 1 Matrix spike recovery exceeded QC limits. Batch accepted based on laboratory control sample (LCS) recovery.
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full.
Date: 04/01/2019 03:56 PM without the written consent of Pace Analytical Services, LLC. Page 7 of 18

aceAnalyrrcal
"W..pecefabsppm
QUALITY CONTROL DATA CROSS REFERENCE TABLE
Project: Morganton SW 3)21
Pace Project No.: 92422471
Pace Analytical Services, LLC
2225 Riverside Dr,
Asheville, NC 28804
[phone]
Lab 10
Sample 10
GC Batch Method
QC Batch Analytical Method
92422471001
92422471001
SW-01AIB/C
SW-01AIB/C
EPA 350.1 Rev 2.0 1993
SM 5220D-2011
46643B
465269 SM 5220D-2011
Date: 04/01/2019 03:56 PM
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, LLC,
Analytical
Batch
465339
Page 8 of 18

Document Name:
Document Revised: February 7, 2018
28ceAnalytiCal'
Sample Condition Upon Receipt(SCUR)
Page 1of2
Document No.:
Issuing Authority:
F-CAR-CS-033-Rev.06
Pace Carolinas Quality Office
Laboratory receiving samples:
Asheville 0 Eden❑ Greenwood ❑ Huntersville ❑ Raleigh[] Mechanicsville❑
• �
ib Client Nam1e:
I
Project #: WOE , . 92422471
Courier:
❑Fed Ex
❑UPS ❑USPS
❑ Commercial
[]Pace
❑Other:
,QClient
I
Custody Seal Present?
Oyes []No Seals Intact? [yes
92422471
[:]No OateJlnitlals person ExaminingContents:
Packing Material:
❑Bubble Wrap
ubble Bags ❑None
❑ other Biological Tissue Frozen?
Thermom:
7RGunID:
7��
Type atice: Wet
❑Yes []No ETN/A
[] Blue ❑None
Cooler Temp ('C):
5, Correction Factor: Add/Subtract ('C) �y
j
Cooler Temp Corrected �' � 1
Temp should be above freezing to 6'C
j'C]:
[]Samples out of temp tfiteria. Samples on Ice, cooling process
has begun
USDA Regulated Soil P N/A, water sample)
Did samples originate in a quarantine zone within the United States: CA, NY, or SC (check maps)? Did samples originate from a foreign source (internationally,
[7]Yes ❑No inrludine Hawaii and Puerto Ricol? ❑Yes ❑Na
Comments/Discrepancy:
Chain of Custody Present?
Yes
❑N❑
❑NIA
1,
Samples Arrived within Hold Time?
Ycs
ONO
N/A
2.
Short Hold Time Analysis (<72 hr.)?
Qyes
ONO
❑N/A
3.
Rush Turn Around Time Requested?
Yes
No
❑NIA
4.
Sufficient Volume?
Yes
❑No
N/A
5.
Correct Containers Used?
-Pace Containers Used?
QYes
OYes
[]No
❑No
❑N/A
[:]N/A_
6.
Containers Intact?
Yes
[]No
❑N/A
7.
Dissolved analysis: Samples Field Filtered?
Yes
ONO
❑N/A
8.
Sample Labels Match COC?
-Includes Date/Time/ID/Analysis Matrix:
wyes
vi
❑No
[_—]N/A
9.
Headspace in VOA Vials (>5-6mm)?
❑Yes
EINo
[�N/A
10.
Trip Blank Present?
Trip Blank Custody Seals Present?
❑Yes
QYes
©No
❑No
N/A
MNJA
11.
COMMENTS/SAMPLE DISCREPANCY
Field Data Required? Dyes mf�o
Lot ID of split containers:
CLIENT NOTIFICATION/RESOLUTION
Person contacted:
Date/Time:
Project Manager SCURF Review:
Project Manager SRF Review:
Date:
Date: 7 ��
Page 9 of 18

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SP2U-500 mL Plastic Unpreserved (N/A)
8P1U-1 liter Plastic Unpreserved (N/A)
8P45-125 mL Plastic H2504 {p}! < 2) (CI-)
BP314-250 mL plastic HNO3 (pH < 2)
BP4Z-125 mL Plastic ZN Acetate & NaOH (>9)
BP4C-125 mL Plastic NaOH (pH> 12) (Cl-)
WGFU-Wide-mouthed Glass jar Unpreserved
AG1U-1 liter Amber Unpreserved (N/A) (CI-)
AG1H-1 liter Amber HCI (pli < 2)
AG3U.250 mL Amber Unpreserved (N/A) (CI-)
AG1S-1 liter Amber H2SO4 (pH < 21
A635-250 mL Amber 1-12504 (pH < 2)
ZZIZZ
AG3A(DG3A)-250 mL Amber NH4CI (N/A)(CI-)
DG9H-40 mL VOA HO (N/A)
VG9T-40 mL VOA Na25203 (N/A)
VG9U-4o n+L VOA Unp (N/A)
DG9P-40 mL VOA H3PO4 (N/A)
VQAK (6 vials per kit)-5035 kit (N/A)
V/GK (3 vials per kit)-VPH/Gas kit (N/A)
SP5T-125 mL Sterile Plastic (N/A — lab)
SP2T-250 mLSterile Plastic ( N/A --tab)
8P3A-250 mL Plastic (NH2)2504 (9.3.9.7)
AGOU-100 mL Amber Unpreserved vials (N/A)
VSGU-20mL Scintillation vials (N/A)
AG9U-40 mL Amber Unpreserved vials (N/A)
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CHAIN -OF -CUSTODY I Analytical Request Document
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The Chain -of -Custody is a LEGAL DOCUMENT. AMrelevant UWWS must be completed accurately. �
Page: of EL
Section A Suction B Section C
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Required CWN Information: Required Project Wormatiom Invoice information:e.p
Company: Report To: tlenC
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ANALYTICAL ENVIRONMENTAL SERVICES, INC.
AES
March 29, 2019
Chris Derouen
Pace Analytical Services, Inc.
2225 Riverside Dr
Asheville NC 28804
RE: 92422471
Dear Chris Derouen: Order No: 19031`64
Analytical Environmental Services, Inc. received 1 samples on 3/26/2019 10:24:00 AM
for the analyses presented in following report.
No problems Nvere encountered during the analyses. Additionally, all results for the associated
Quality Control samples were within EPA and/or AES established limits. Any discrepancies associated with the
analyses contained herein will be noted and submitted in the form of a project Case Narrative. Al S'
certifications are as follows:
-NE1,A1'/f=lorida State Laboratory ID 1 87582 for analysis of Non-1'olable Water, Solid K Chemical Materials,
Air 8 Emissions for Organics, and Drinking Water Microbiology x Metals, clllective 07/01/18-06/30/19,
-North Carolina Certification number 562 for analysis ol'Surlacc Water, Groundwater, Eflluent, effective until
12/31 / i 9,
-South Carolina Environmental Laboratory Certification number, 98016003 elfective until 6/30/19,
These results relate only to the items tested as received. This report may only be reproduced in full and with
written permission from the laboratory.
f you have any questions regarding these test results, please feel free to call.
Sincerely,
Jessica Shilling
Project Manager
3080 Prebidential Drive • Atlanta, Georgia 30340 • 17.1: 770.457.81 77 • Fax: [phone] • Toll Free: 800.972.4889
%vu.w.aesatlaFit a_com Page 12 of 18
Page 1 of 7

Chain of Custody
Workorder: 92422471 Workordet Name: Morganton SW =1
Results Requested By -
lq0SR04
a ceAnalytical
Cl 41212019
Raportl Invoice To t
todAna tyass'
Chris Derouen
Paw AnaLytical AshwAlle P.O.
2225 Riverside Dr.
AsheAlo, NC 28804 AE -S
Phone [phone]
Ernall: chrtsto".derbUer4peo6l*b3.00M 30VO e-c A':Ar- 6' 1
C.Otl 303,10
State of Sample Orfqln: NC '770 - 5 1- f177 FT Preserved Cwtainers-,
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By
Dldomrne
1
h&W& 6Af—
2
®RD-cWVQd
—A5-
Cooler TemperaturG on Recel t T CustodySeal N YL t�r Received on Ice Y�.,-N Sam es Intact Y or N
Monday. March 25, 26I 9 11:01:38 Am
FMT,ALL-C,=rev.00
Pap 1 01 1
Page 13 of 18
Page 2 of 7

Analytical Environmental Services, Inc
Date: 29-Mar-19
Client: face Analytical Services. Inc.
Project: 92422471 Case Narrative
Lab I1): 19031164
Sample Receiving Nonconformance:
Sample 19031)64-001 A was received OUtslde EPA/Method specified holding time of 72 Hours for method 8315. I'er Christopher
Dcroucn via email on 3/26/2019 at 12:48 pm, proceed with analysis out ol'hold.
Formaldehyde Analysis by Method 8315:
Sample 19031'64-001 A was extracted and analyzed outside holding time of 72 hours. Analysis was requested by client after
holding time had expired.
Page 14 of 18
Page 3 of 7

Analytical Environmental Services, Inc
Date: 29-Mar-19
Client:
Pacc Analytical Services, Inc.
Client Sample ID:
SW-01A/B/C
Project ,Name:
92422471
Collection Date:
3/21/2019 5:30:00 I'M
La1)ID:
19031)64-001
Matrix:
Aqueous
ReportingDilution
Analyses Result (lual Units f3atchlD DalcAnahyicd Analyst
Limit Factor
Formaldehyde by SW8315A
Formaldehyde
Quotirl—: . Value exceeds maximum conuminant level
BRI. lielow reporting limit
11 Holding times for preparation or analysis exceeded
N Analyte not NELAC certified
13 Analyte detected in the associated method blank
> G eater than Result value
600 50 H ugll. 276526 1 03127/201916:50 IZI'
1: Estimated (value above quantization range)
S Spike Recovery outside limits dot to matrix
Nate Sct case narrative
NC Not confirm d
< Less than Result 1al ue
7 Hsi imated value detected below Reporting Limit
Page 15 of 1.13
Page 4 of 7

ALYnCAL Clear Save as
EwtROrhtSEAYIChS, INC. i srreu
AE$ III SAMPLE/COOLER RECEIPT CHECKLIST
1. client Name: Pace Analytical Services, Inc. AES Work Order Number: 1903P64
2. Carrier: Fed Ex 0 UPS ❑ USPS❑ Client" Courier❑ Other
Yes No N/A Details Comments
3.
4.
S.
6.
7.
8.
9.
la.
11.
12.
Shipping container/cooler received in good condition?
•
damaged ❑ leaking ❑ other❑
Custody seals present on shipping container?
•
Custody seals intact on shipping container?
0
•
Temperature blanks present?
•
Cooler temperatures) within limits of 0-61C? (See item 13 and 14 for
temperature recordings.)
O
O
O
Cooling initiated for recently collected samples/ ice
present ❑
Chain of Custody (COC) present?
•
Chain of Custody signed, dated, and timed when relinquished and received?
•
Sampler name and/or signature on COC?
•
Were all samples received within holding time?
•
#if
TAT marked on the COC?
•
no TAT indicated, proceeded with standard TAT per Terms & Conditions. ❑
13. Cooler 1 Temperature 3.9
14, Cooler 5 Temperature
15. Comments:
16.
17.
18.
19.
20,
21.
22,
23,
24.
25.
26.
°C Cooler 2 Temperature °C Cooler 3 Temperature
°C Cooler 6 Temperature °C Cooler 7 Temperature
Yes No N/A
°C Cooler 4 Temperature °C
°C Cooler 8 Temperature °C
I certify that I have completed sections 1-15 (dated initials). AP 3/26/19
Details Comments
Were sample containers intact upon receipt?
•
Custody seals present on sample containers?
•
Custody seals intact on sample containers?
0•
Do sample container labels match the COC?
O
O
O
incomplete info ❑ illegible ❑
no label ❑ other ❑
Are analyses requested indicated on the COC?
•
Were all of the samples listed on the COC received.7
O
O
o
samples received but not listed on COC ❑
samples listed on COC not received ❑
Was the sample collection date/time noted?
•
Did we receive sufficient sample volume for indicated analyses?
•
Were samples received in appropriate containers?
•
Were VOA samples received without headspace (a 1/4" bubble)?
•
Were trip blanks submitted?
_at
•
listed on COC ❑ not listed on COC ❑
27. Comments:
This section only applies to samples where pH can be
I certify that I have completed sections 16-27 (dated initials). MH 3/26/19
checked at Sample Receipt. Yes No N/A Details Comments
28. Have containers needing chemical preservation been checked?' •
2$ Containers meet preservation guidelines? •
Was pH adjusted at Sample Receipt? •
m
Note: Certain analyses require chemical preservation but must be checked in the laboratory and not upon Sample Receipt such as Coliforms. VOCs and Oil & GreaseFFPH. MH 3/26/19
o I certify that I have completed sections 28-30 (dated initials).
Aecklist 6.9.17 Rev 2 Locked Page 5 of 7

Analytical Environmental Services, Inc
Date: 29-Mar-19
Client: Pace Analytical Services, Inc.
Project Name: 92422471 Dates Report
Lab Order; 1903P64
Lab Sample ID Client Sample ID Collection Date Matrix Test Name TCLP Date Prop Date Analysis Date
1903P64-001A SW-01A1B1C 3/2112019 5,30:OOPM Aqueous Formaldehyde bySW8315A 312712019 11:00:00 AM 03/2712019
Page 17 of 1e
Page 6 of 7

Analytical Envirunlnental Services. Inc
Client:
face Analytical Services, Inc.
Project Namc:
92422471
Wo rku rder:
1903 P6a
Date: 29-i'lar-19
ANALYTICAL QC SUMMARY REPORT
Batchll): 276526
Sample ID: MR-276526 ClicrnID: Units: ugll, Prep Dale: 03l2712019 Run'4 394330
SampleTypc: ,N11tLK ZeStCode: Furmaldah5dah) Sw'R315A [3aichlD; 276526 Analysis Date: 0312712019 Seq No: 8829391
Analyte Result ' RPr Limit SPK value SPK Ref Val %RISC LOW Linlil High L 11111 RI'D Rcf' Val iuRPD RI'D Limit Qual
Formaldehyde RRL 50
Sample ID: LCS-276526
Client ID:
Units: ug1L
Prep Date: 03/27/2019
Run No', 394330
Smnplc type: LCS
JestCo(Ie: Furmalduh)& h) SN'R3t5A
Rnwh[D; 276526
Analysis Date; 0312712019
Scq No: 8829342
Analyze
Result RPf Limit SPK value SI'K RdVal
%Rl:c LOW I,i111i(
High IJ110 RPD Rcf Val %RPI)
RI'D Limit Qual
FDnnaldchydc 966.2 50 1000 96,6 7n 110
Sample ID: 1903Q89-a01GNIS Client ID: Units: ug1L Prep Date: 0312712019 Run No: 394330
SampleType: 31S TcstCode: Furmaldth5de h) SM K315A RalchID: 276526 Analysis Date; 0312712M9 Seq No; NN29437
Analyte Result RPT Limit SPIT value SPK Rcf Val ioRliC Low Limit High Limit RI'D Rcf Val %R111) RI'D Limit Qual
Formaldehyde 1128 50 1000 159.1 96.9 50.1 1119
Sarnplc [D: 1903Q89-00IG.%ISD
Client ID:
Units: uglL
Prep Datc: 03127R4119
Run ND: 3943310
Sample'lYpe: \[$D
TesiCode: FO—AldchS& h) 815'8515A
PatchlD: 276526
Analysis Date: 03127121119
Scq No; 8329462
Analytc
Result RPt Limit S11K value SPK Rcf Val
%RIiC Low Limit
high Limit MID Rcf Val %RI'D
RI'D Limit Oual
Fonnaldchydc 1079 50 1000 159.1 92.0 50.1 139 Ii28 442 16.2
Qu.141kn. > (;— v avn R-11 value I I.en dtm Resutt , .We 11 Anehte daahrl in the nxwv:intnl ined,,d Llunt
I IRL Bd— ldna F. Mvc qunn—W -go 11 Iraldiag limo rm pnTnrstian o wW5.w Decoded
5 ndimlul r,NdaWe dbelow l(e{ 1mg 1,irtut N Annl) lenol NFLAC ccMied R RFr)nutsi.k lintitsduemnuui.
Rpl Lim Rq.nmq Li-i 5 Spite Rnoven outside timm due to morns Page 18 of 18
Page 7 of 7