NCS000528_MONITORING INFO_20190717

STORMWATER DIVISION CODING SHEET
NC5 PERMITS
PERMIT NO.
nI CS V � D5J
DOC TYPE
❑FINAL PERMIT
), MONITORING REPORTS
❑ APPLICATION
❑ COMPLIANCE
❑ OTHER
DOC DATE
❑ Q O ICE
YYYYMMDD

ajWATERS EDGE ENVIRONMENTAL,LLC
1434 CHESTER ROAD • RALEIGH, NC 27608 • PHONE [phone]
July 57 2019
NCDEQ
Division of Water Quality
Central Files
1617 Mail Service Branch
Raleigh, North Carolina 27699-1617
Reference: Year 5- Period I Stormwater Monitoring; Report
Premiere Fibers Facility
Ansonville, North Carolina A�
Stormwater Permit No. NCS000528 , 1
Waters Edge Job No. R9-21 J04
To Whom It May Concern:
DzAYr
We are presenting the stormwater monitoring report for Year 5- Period 1 in 2019.s are within
required parameters with the exception of the following:
• Outfall 001- TSS (1,250 mg/1- versus benchmark at 100 mg/L) and pl-I (5.4 versus benchmark
between 6-9- unitless)
• Outfal1 002- pH (5.6 versus benchmark between 6-9- unitless)
• Outfall 003- pH (5.5 versus benchmark between 6-9- unitless)
• Outfal1 004- COD (136 mg/L versus benchmark at 120 mg/L)
• Outfall 005- COD (148 mg/L versus benchmark at 120 mg/L)
We have performed a Tier 11 inspection and will resampled those locations on the next representative
event. It is felt that with acid rain, the pH across North Carolina and the remainder of the country is
decreasing and is not due to any anthropogenic activities at the site. We have attached the DMR, SDO,
and laboratory analytical results -see Appendix A and 13). If you have any questions, or if we may be of
further assistance. please contact me at prahn a watersedgeenv.com or 919.859.9987.
Sincerely,
Waters Edge Environmental, LLC
Phillip L. Rahn
President
cc: Mr. Dewey Fulton and Mr. Kevin Bowers- Premier Fibers
19-043

Permit Number: NCS 000528
Certificate of Coverage Number: NCG
FACILITY NAME Premiere Fibers
STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
or SAMPLES COLLECTED DURING CALENDAR YEAR: 2019
(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.)
PERSON COLLECTING SAMPLE(S) T. Haynes
CERTIFIED LABORATORY(S) Face Lab # 633
Lab #
Part A: Specific Monitoring Requirements
COUNTY Anson
PHONE: NO. [phone]
(SIGNATURE OF PERINUTTEE OR DESIGNEE)
By this signature; 1 certify that this report is accurate complete to
the best of my knowledge.
Outfall
Date
No.
Sample
Collecte_ d
Total
Rainfall
Total
Suspended
Solids (TSS)
C61)
pH
Pcrmit'Bench ,
NIA
'106 -
120 A
6-9
mo/dd/yr _ _
inches
mg/i
mg/l
Units
1
6.7.19
See Below
1,250
45.7
5.4
2
6.7.19
ND
ND
5.6
3
6.7.19
9.2
38.6
5.5
4
6.7.19
18.0
136
6.1
5
6.7.19
96.5
148
6.2
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)
Forni S W U-246-112608
Page I of 2

Part B: Vehicle Maintenance Activity Monitoring Requirements
Outfall
No.
Date
Sample
Collected
50050
00556
00530
00400
Total Flow
(if applicable)
Total Rainfall
Oil & Grease
Total
Suspended
Solids
pH
New Motor Oil
Usage
mo/dd/yr
MG
inches
mg/l
mg/l
Units
gal/mo
STORM EVENT CHARACTERISTICS:
Date 6.7.19
Total Event Precipitation (inches): 1.1
Event Duration (hours): NIA
(if more than one storm event was sampled)
Date NIA
Total Event Precipitation (inches):
Event Duration (hours):
(only if applicable — see permit.)
(only if applicable — see permit_)
Mail Original and one copy to:
Division of Water Quality
Attn_ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
"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."
41gnatVrPermittee
7 11'7
Date
Form SWU-246-112608
Page 2 of 2

0
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance on filling out this form, please visit: http:llh2o.enr.state.ne.us/su/Forms_Documents.htm#ntiseforms
Permit No.: j N 1 C 1 S 10 0 1 0 51211 8 or Certificate of Coverage No.:
Facility Name: Premiere Fibers
County: Anson Phone No. 704.826.8321
Inspector: Thomas Haynes
Date of Inspection: 6.7.19
Time of Inspection: 11:00-12:00/10:30 AM
Total Event Precipitation (inches): 1.12
Was this a Representative Storm Event? (See infonnation below) ® Yes ❑ No
Please check your permit to verify ff Qualitative Monitoring must he performed during a representative storm event
(requirements vary).
. ..... _
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.
By this signature, I certify that this report is accurate and complete to the best of my knowledge:
��.� %17t�ll
(Signature of Permittee or Designee)
Outfall Description:
Outfall No. 001-005 Structure (pipe, ditch, etc.) Pipe to Ditch
Receiving Stream: Buffalo Creek
Describe the industrial activities that occur within the outfalI drainage area:
Textile Manufacturina
2 Color:
Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint (light, medium, dark) as
descriptors:
bight brown
Page I of 2
S W U-242-1 12608

3 Odor:
Describe any distinct odors that the discharge may have (i.e., smells strongly of oil, weak chlorine odor, etc.):
No odor noted
4 Clarity:
Choose the number which best describes the clarity of the discharge, where 1 is clear and 5 is very cloudy:
1 2 O 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:
O 2 3 4 5
6 Suspended Solids:
Choose the number which best describes the amount of suspended solids in the stormwater discharge, where I is no
solids and 5 is extremely muddy:
l a2 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
4 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
S W U-242- l 12609

ace Analytical
www.p&;@4bs.C"
June 17, 2019
Mr. Phil Rahn
Waters Edge Environmental
1434 Chester Road
Raleigh, NC 27606
RE: Project: PREMIERE FIBERS R9-21
Pace Project No.: 92432311
Dear Mr. Rahn:
Pace Analytical Services, LLC
205 East Meadow Road - Suite A
Eden. NC 27208
[phone]
Enclosed are the analytical results for sample(s) received by the laboratory on June 10, 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.
If you have any questions concerning this report, please feel free to contact me.
Sincerely,
Clayton McCrickard
[e-mail]
[phone]
Project Manager
Enclosures
REPORT OF LABORATORY ANALYSIS
This report shall rot be reproduced, except in full,
without the written consent of Pace Analytical Services, LLC,
Page 1 of 12

aceAnalytical.
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Project: PREMIERE FIBERS R9-21
Pace Project No.: 92432311
Pace Analytical Services, LLC
205 East Meadow Road - Suite A
Eden, NC 27288
[phone]
Asheville Certification IDs
2225 Riverside Drive, Asheville, NC 28804
Florida/NELAP Certification #: E87648
Massachusetts Certification #: M-NC030
North Carolina Drinking Water Certification #: 37712
CERTIFICATIONS
North Carolina Wastewater Certification #: 40
South Carolina Certification #: 99030001
VrginiaNELAP Certification #: 460222
Eden Certification IDs
205 East Meadow Road Suite A, Eden, NC 27288 North Carolina Wastewater Certification #: 633
North Carolina Drinking Water Certification #: 37738 VirginiaNELAP Certification #: 460025
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, LLC. Page 2 of 12

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SAMPLE SUMMARY
Project: PREMIERE FIBERS R9-21
Pace Project No.: 92432311
Lab ID
Sample ID
Matrix
Date Collected
Date Received
92432311001
OUTFALL 001
Water
06/07/19 13:15
06/10/19 10:25
92432311002
OUTFALL 002
Water
06/07/19 13:30
06/10/19 10:25
92432311003
OUTFALL 003
Water
06/07/19 13:45
06/10/19 10:25
92432311004
OUTFALL 004
Water
06/07/19 14:00
06/10/19 10:25
92432311005
OUTFALL 005
Water
06/07/19 14:15
06110/19 10:25
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in lull,
without the written consent of Pace Analytical Services, LLC.
Pace Analytical Services, LLC
205 East Meadow Road - Suite A
Eden, NC 27288
[phone]
Page 3of12

Pace Analytical Services, LLC
aceAnalytical 0
205 East MeadoEden
NC 27288
www.paookbx0°^f
[phone]
SAMPLE ANALYTE COUNT
Project: PREMIERE FIBERS R9-21
Pace Project No.: 92432311
Analytes
Lab ID Sample ID
Method
Analysts
Reported
Laboratory
92432311001 OUTFALL 001
SM 254OD-2011
SOB
1
PASI-E
SM 4500-H+B-2011
MWF
1
PAS1-E
SM 5220D-2011
GC
1
PASI-A
92432311002 OUTFALL 002
SM 2540D-2011
SOB
1
PASI-E
SM 4500-H+B-2011
MWF
1
PASI-E
SM 5220D-2011
GC
1
PASI-A
92432311003 OUTFALL 003
SM 2540D-2011
SOB
1
PASI-E
SM 4500-H+B-2011
MWF
1
PASI-E
SM 5220D-2011
GC
1
PASI-A
92432311004 OUTFALL 004
SM 254OD-2011
SOB
1
PASI-E
SM 4500-H+B-2011
MWF
1
PASI-E
SM 5220D-2011
GC
1
PASI-A
92432311005 OUTFALL 005
SM 2540D-2011
SOB
1
PASI-E
SM 4500-H+B-2011
MWF
1
PASI-E
SM 5220D-2011
GC
1
PASI-A
REPORT OF LABORATORY ANALYSIS
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Pace Analytical Services, LLC
aceAnalytical ® 205 East Meadow Road - Suite A
Eden, NC 27288
www.Pacelab&cam [phone]
ANALYTICAL RESULTS
Project: PREMIERE FIBERS 139-21
Pace Project No.: 92432311
Sample: OUTFALL 001 Lab ID: 92432311001 Collected: 06/07/19 13:15 Received: 06/10/19 10:25 Matrix: Water
Report
Parameters Results Units Limit MDL OF Prepared Analyzed CAS No. Qual
2540D Total Suspended Solids
Analytical Method: SM 254OD-2011
Total Suspended Solids
1250 mg/L 38.5
38.5 1
06/12/19 09:58
4500H+ pH, Electrometric EDN
Analytical Method: SM 4500-H+B-2011
PH at 25 Degrees C
5.4 Std. Units 1.0
0.10 1
06/11/19 10:47 H3
5220D COD
Analytical Method: SM 5220D-2011 Preparation Method: SM 5220D-2011
Chemical Oxygen Demand
45.7 mg1L 25.0
12,5 1
06/14/19 18:00 06/17/19 16:11
Sample: OUTFALL 002
Lab ID: 92432311002 Collected:
06/07/19 13:30
Received: 06/10/19 10:25 Matrix: Water
Report
Parameters
Results Units Limit
MDL DF
Prepared Analyzed CAS No. Qua$
2540D Total Suspended Solids
Analytical Method: SM 254OD-2011
Total Suspended Solids
ND mg/L 2.5
2.5 1
06112/19 09:58
4500H+ pH, Electrometric EDN
Analytical Method: SM 4500-H+8-2011
PH at 25 Degrees C
5.6 Std. Units 1.0
0.10 1
06/11/19 10:49 H3
5220D COD
Analytical Method: SM 52200-2011 Preparation
Method: SM 5220D-2011
Chemical Oxygen Demand
ND mg/L 25.0
12.5 1
06/14/19 18:00 06/17119 16:11
Sample: OUTFALL 003
Lab ID: 92432311003 Collected:
06/07/19 13:45
Received: 06/10/19 10:25 Matrix: Water
Report
Parameters
Results Units Limit
MDL DF
Prepared Analyzed CAS No. Qual
2540D Total Suspended Solids Analytical Method: SM 254OD-2011
Total Suspended Solids 9.2 mg1L 3.0 3.0 1 06/12/19 09:59
4500H+ pH, Electrometric EDN Analytical Method: SM 4500-H+B-2011
pH at 25 Degrees C 5.5 Std. Units 1.0 0.10 1 06111/19 10:50 H3
5220D COD Analytical Method: SM 5220D-2011 Preparation Method: SM 52200-2011
Chemical Oxygen Demand 38.6 mg/L 25.0 12.5 1 06/14/19 18:00 06117/19 16:12
Sample: OUTFALL 004 Lab ID: 92432311004 Collected: 06/07119 14:00 Received: 06/10/19 10:25 Matrix: Water
Reporl
Parameters Results Units Limit MDL DF Prepared Analyzed CAS No. Qual
2540D Total Suspended Solids Analytical Method: SM 254OD-2011
Total Suspended Solids 18.0 mg/L 10.0 10.0 1 06/12/19 09:59
REPORT OF LABORATORY ANALYSIS
This report shall not he reproduced, except in full.
Date: 06/17/2019 04:44 PM without the written consent of Pace Analytical Services, LLC.
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aceAnalytrcal
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ANALYTICAL RESULTS
Project: PREMIERE FIBERS R9-21
Pace Project No.: 92432311
Pace Analytical Services, LLC
205 East Meadow Road - Suite A
Eden, NC 27286
[phone]
Sample: OUTFALL 004 Lab ID: 92432311004 Collected: 06/07/19 14:00 Received: 06/10/19 10:25 Matrix: Water
Report
Parameters Results Units Limit MDL DF Prepared Analyzed CAS No. Qual
4500H+ pH, Electrometric EDN Analytical Method: SM 4500-H+B-2011
pH at 25 Degrees C 6.1 Std. Units 1.0 0A0 1 06/11/19 10:51 H3
5220D COD Analytical Method: SM 5220D-2011 Preparation Method: SM 5220D-2011
Chemical Oxygen Demand 136 mg1L 25.0 12.5 1 06/14/19 18:00 06/17/19 16:12
Sample: OUTFALL 005
Parameters
Lab ID: 92432311005 Collected:
Report
Results Units Limit
06/07/19 14:15
MDL DF
Received: 06/10/19 10:25 Matrix: Water
Prepared Analyzed CAS No. Qual
2540D Total Suspended Solids
Analytical Method: SM 254OD-2011
Total Suspended Solids
96.5 mg/L 6.2
6.2 1
06/12119 09:59
4500H+ pH, Electrometric EDN
Analytical Method: SM 4500-H+B-2011
pH at 25 Degrees C
6,2 Std. Units 1.0
0.10 1
06111/19 10:52 H3
5220D COD
Analytical Method: SM 5220D-2011 Preparation Method: SM 5220D-2011
Chemical Oxygen Demand
148 mg/L 25.0
12.5 1
06/14/19 18:00 06/17119 16:12
REPORT OF LABORATORY ANALYSIS
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Date: 06/17/2019 04:44 PM without the written consent of Pace Analytical Services, LLC, Page 6 of 12

aceAnalytical.
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QUALITY CONTROL DATA
Project: PREMIERE FIBERS R9-21
Pare Project No.: 92432311
Pace Analytical Services, LLC
205 East Meadow Road - Suite A
Eden, NC 27288
[phone]
QC Batch: 480605
Analysis Method: SM 2540D-2011
QC Batch Method: SM 254OD-2011
Analysis Description: 2540D Total Suspended Solids
Associated Lab Samples: 92432311001, 92432311002,
92432311003, 92432311004, 92432311005
METHOD BLANK: 2599961
Matrix: Water
Associated Lab Samples: 92432311001, 92432311002.
92432311003. 92432311004, 92432311005
Blank Reporting
Parameter
Units
Result Limit MDL
Analyzed Qualifiers
Total Suspended Solids
mg1L
ND 2.5 2.5
06/12/19 09:53
LABORATORY CONTROL SAMPLE:
2599962
Spike LCS LCS
% Rec
Parameter
Units
Conc. Result % Rec
Limits Qualifiers
Total Suspended Solids
mg/L
250 274 110
90-110
SAMPLE DUPLICATE: 2599963
92431729001 Dup Max
Parameter Units Result Result RPD RPD Qualifiers
Total Suspended Solids mg/L ND ND 5
SAMPLE DUPLICATE: 2599964
92431813003 Dup Max
Parameter Units Result Result RPD RPD Qualifiers
Total Suspended Solids mg/L 64.7 67.5 4 5
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: 06/17/2019 04:44 PM without the written consent of Pace Analytical Services, LLC. Page 7 of 12

e }
aceAnalyilcal
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QUALITY CONTROL DATA
Project: PREMIERE FIBERS R9-21
Pace Project No.: 92432311
QC Batch: 480327 Analysis Method: SM 4500-H+B-2011
QC Batch Method: SM 4500-H+B-2011 Analysis Description: 4500H+B pH EDEN
Associated Lab Samples: 92432311001, 92432311002, 92432311003, 92432311004, 92432311005
Pace Analytical Services, LLC
205 East Meadow Road - Suite A
Eden, NC 27288
[phone]
SAMPLE DUPLICATE: 2598821
92432311001 Dup Max
Parameter Units Result Result RPD RPD Qualifier&
pH at 25 Degrees C Std. Units 5.4 5.4 0 10 H3
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: 06/17/2019 04:44 PM without the written consent of Pace Analytical Services, LLC,
Page 8 of 12

Pace Analytical Services, LLC
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w Road - Suite A
205 East Meadow
f�ceAnalytrcal
Eden, NC 27288
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[phone]
QUALITY CONTROL DATA
Project: PREMIERE FIBERS R9-21
Pace Project No.: 92432311
QC Batch: 481294
Analysis Method: SM 5220D-2011
QC Batch Method: SM 5220D-2011
Analysis Description; 5220D COD
Associated Lab Samples: 92432311001, 92432311002, 92432311003, 92432311004, 92432311005
METHOD BLANK: 2603464
Matrix: Water
Associated Lab Samples: 92432311001, 92432311002, 92432311003, 92432311004, 92432311005
Blank Reporting
Parameter Units
Result Limit MDL
Analyzed Qualifiers
Chemical Oxygen Demand mg1L
ND 25.0
12.5 06117/19 16:08
LABORATORY CONTROL SAMPLE: 2603465
Spike LCS LCS
% Rec
Parameter Units
Cone. Result % Rec
Limits Qualifiers
Chemical Oxygen Demand mg/L
750 755 101
90-110
MATRIX SPIKE & MATRIX SPIKE DUPLICATE: 2603466 2603467
MS MSD
92432705001
Spike Spike MS MSD
MS MSD % Rec Max
Parameter Units Result
Cone. Cone. Result Result
% Rec % Rec Limits RPD RPD Qual
Chemical Oxygen Demand mg/L 105
100 100 213 208
107 103 90-110 2 3
MATRIX SPIKE & MATRIX SPIKE DUPLICATE: 2603468 2603469
MS MSD
92432430001 Spike Spike MS MSD MS MSD % Rec Max
Parameter Units Result Cone. Conc. Result Result % Rec % Rec Limits RPD RPD Qual
Chemical Oxygen Demand mg1L 60200 100 100 64200 66200 4060 5970 90-110 3 3 M1
Results presented on this page are in the units indicated by the "Units" column except where an alternate unit la presented to the right of the result.
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced. except in full,
Date: 06/1712019 04:44 PM without the written consent of Pace Analytical Services, LLC.
Page 9 of 12

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QUALIFIERS
Project: PREMIERE FIBERS R9-21
Pace Project No.: 92432311
DEFINITIONS
Pace Analytical Services, LLC
205 East Meadow Road - Suite A
Eden, NC 272BB
[phone]
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.
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, unrounded data are displayed and have been used to calculate % recovery and RPD values.
LCS(D) - Laboratory Control Sample (Duplicate)
MS(D) - Matrix Spike (Duplicate)
DUP - Sample Duplicate
RPD - Relative Percent Difference
NC - Not Calculable.
SG - Silica Gel - Clean -Up
U - Indicates the compound was analyzed for, but not detected.
Acid preservation may not be appropriate for 2 Chloroethylvinyl ether.
A separate vial preserved to a pH of 4-5 is recommended in SW846 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
PASI-E Pace Analytical Services - Eden
ANALYTE QUALIFIERS
H3 Sample was received or analysis requested beyond the recognized method holding time.
M1 Matrix spike recovery exceeded OC limits. Batch accepted based on laboratory control sample (LCS) recovery.
REPORT OF LABORATORY ANALYSIS
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Date: 06/17/2019 04:44 PM without the written consent of Pace Analytical Services, LLC, Page 10 of 12

Pace Analytical
Services, LLC
aceAnalytical
205 East Meadow Road - Suite A
Eden, NC 27288
wwwp&cefabs.com
[phone]
QUALITY CONTROL DATA CROSS REFERENCE TABLE
Project:
PREMIERE FIBERS
R9-21
Pace Project No.:
92432311
Analytical
Lab ID
Sample ID
QC Batch Method
QC Batch
Analytical Method
Batch
92432311001
OUTFALL 001
SM 254OD-2011
480605
92432311002
OUTFALL 002
SM 254OD-2011
480605
92432311003
OUTFALL 003
SM 254OD-2011
480605
92432311004
OUTFALL 004
SM 25400-2011
480605
92432311005
OUTFALL 005
SM 2540D-2011
480605
92432311001
OUTFALL 001
SM 4500-H+B-2011
480327
92432311002
OUTFALL 002
SM 4500-H+6-2011
480327
92432311003
OUTFALL 003
SM 4500-H+B-2011
480327
92432311004
OUTFALL 004
SM 4500-H+B-2011
480327
92432311005
OUTFALL 005
SM 4500-H+B-2011
480327
92432311001
OUTFALL 001
SM 5220D-2011
481294
SM 5220D-2011
481336
92432311002
OUTFALL 002
SM 5220D-2011
481294
SM 5220D-2011
481336
92432311003
OUTFALL 003
SM 5220D-2011
481294
SM 5220D-2011
481336
92432311004
OUTFALL D04
SM 5220D-2011
481294
SM 5220D-2011
481336
92432311005
OUTFALL 005
SM 522DD-2011
481294
SM 5220D-2011
481336
Date: 06/1712019 04:44 PM
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
without the wntten consent of Pace Analytical Services, LLC.
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® 9243231 �.
p� CHAIN -OF -CUSTODY Analytical Request Document LAB USE ONLY-AffixWorkorder/Loj
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Chain -of -Custody is a LEGAL DOCUMENT - Complete all relevent fields >>
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• • Preservative Types: ill nitric acid, (n sulfuric acid, (3) hydroch€uric acid. (4) sodium hydroxide, (5) zinc acetate,
%.�1
(6) methanol, (71 sodium bisulfate, 18) sodium thiosulfate, (9) hexane. (A) ascorbic acid, (B) ammonium sulfate,
[C) ammonium hydroxide, lo) TSP, (U) Unpreserved, (0) Other
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Site Collection Info/Address:
Analyses
Lab Profile/Line: -
CustRmer Project Name/Number:
r, - v 2) (/1}�i�%
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State: County/City: Time Zone Collected: C
I i [ ]PT[ )MT( ]CT [l T
1! R/L'
Lab sample Receipt checklist:
Cua Cody Scaly Presentf Intact Y ri NAB
Custody Signatures Present Y ri tiS:l
eN
Phone:
Site/Faci€ity ID 4:
Co liance Monitoring?
7es
Email-
[ [ ) No
Collector Signature Present ZIA
Bottles Intact Y N NA
Correct Bottles Y'N NA
Collet d By (print'
Purchase Order q:
DW PWS ID p:
Quote ft:
DW Location Code:
Sufficient VPILIMe Y' N PA
/I
Samples Received on Ice 1'N 1rA
VGA - Heads table Y' N NA ace Acceptable
p
- USDA Regulated Soils Y N uit,
Coll card 8y sr aCure): _Turnaround
Date Required:P
Immediately PaC a on Ice:
[ YPS [ ] NO
Samples in Holding •:•ime -eN NA
Residual Chlorine Present Y N N!!
Cl'Strips.
Sa`m fe Disposr
Rush:
] Same Day [ ] Next Day
Field Filtered (if applicable):
Yes No
Ii Dispose as a proprlale [ ] Return
( I Archive:
[
[ ) 2 Day [ ) 3 Day [ ] 4 bay [ ] 5 Day
I [ [ ]
Analysis:
Sample pu ACcepteble N ItA
pH Strips: __(50-'L'Z'L
I IHoid:
(Expedite Charges Apply)
Sulfide Present Y N Nlt�
Lead Acetate- Strips:
Matrix Codes (insert in Matrix box below): Drinking Water (DW), Ground Water (GW), Wastewater (WW),
Product (P), Soil/Solid (SL], Oil (OL), Wipe (WP), Air (AR), Tissue (TS), Bioassay (B), Vapor (V), Other (OT)
:y
LAB OSS ONLY:
Lab Sample t f Couments:
Comp /
Collected (or
Composite End
Res
'1 of
Customer Sample ID
Matrix'
Grab
Composite Start)
C)
Ctns
J
-
Date
Time
Date
Time
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ea
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Customer Remarks / Special Conditions / Possible Hazards:
type of Ice Used: a Blue Dry None
SHORT HOLDS PRESENT (<72 hours): Y N N/A
Lab Sample Temperature Info:
Temp Blank Received: Y N NO'
.The� rm IDO: q
Packing Material Used-.
Lab Tracking Pt
2361126.
Cooler 1 Temp Upon Receipt: -3 oC
Samples received via:
Cooler 1 Therm Corr. Factor: �T oC
Radchem sample(s) screened (<500 cpm): Y N NA
FEDEX_ UPS C)i�� Courier Pace Courier
Cooler 1 Corrected Temp: 3 oC
Comments:
Relinquished by/Cpa y: (Signature[
Date/Time:
Received by/Company: (Signature)
MTJL LAB USE ONLY
Table d:
�y
/ Ct
/Date//me:
r6
Acctnum:
Template:
S
gnquished by/Co : (Signature)
ate/T/me:
Received by/Company: (Signature)
Date�me:
Trip Blank Received: Y N NO—
CD!
s
Prel i + �
PfN:�
� � � "�
HCL . McOH TSP Other
RQ,nquish y/Company: (Signature)
N
Date/Tme:
Received by/Company: (Signature)
Date/Time;ti?1
Non Conformance[s]:
Page:
!
p8:
YES / NO
of: