HomeMy WebLinkAboutNCS000582_MONITORING INFO_20190830�,\j Z5-1 Z-,,o
STORMWATER DIVISION CODING SHEET
NCS PERMITS
PERMIT NO.
DOC TYPE
❑FINAL PERMIT
� MONITORING REPORTS
❑ APPLICATION
❑ COMPLIANCE
❑ OTHER
DOC DATE
❑ a00
YYYYMMDD
STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number NCS 000582 R EC E I E QAMI'LES COLLECTED DURING CALENDAR YEAR: 2019
AUG 3 20,9
(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 Ennis -Flint (High Point facility) CENTRAL FILES
PERSON COLLECTING SAMPLE(S) Niclloltts MLirphreNt _ 'ON
CERTIFIED LABORATORY(S) Pace National Lab ## 1
Lab ##
Part A: Specific Monitoring Requirements
COUNTY Guilford
PHONE NO. ( -336) 475-6600
SIGNATURE OF PERMITTEE OR DESIGNEE
REQUIRED ON PAGE 2,
Outfall,
No.
Date
Sample
Collected
50050
U0530
60310
003 U
00610
00400
Total
Flow if a
Total
'Rainfall
TotahSusp.,-
Solids: -SS),
Biochern`Osv:.
Demand; BOD
,Chemical�Oxy.
Demand COD
Ammonia as
Nitrogen
PH
imo/dd/yr
MG
inches
m IL
m ''/L
m61L .
mg/L
SU
henchmark
--
--
--
100
30
12U
8.4
6.0 - 8.0
001
07/2'V19
--
0.17
20.8
9.7
29.4
0.262
8.0
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? _yes Xno
(if yes, complete Part B)
Part 13: Vehicle Maintenance Activity Monitoring Requirements
Outfall
No.
f bate
:Sample
Collected
.50050
E00556.
i00530
00400
Total Flow`
(if applicable)..
.Total
Rainfall' -
E(3i1.& Grea► e, ;
:(it ippl.).
Non=polar
O>I:P.II
{1lethod 1664 ;
°SGT-IIEM), if
a 1.
"=Total
!Suspended
k5.olids
pH
New Motor
Oil Usage
mo/dd/vr
\1G
inches
nrr I
m /l
unit
al/mo
Form SWU-247. lasr raised 21212012
Page 1 of 2
STOR11 EVENTCHARACTERISTICS:
Date 07/2'V 19
Total Event Precipitation (inches): 0.17
Event Duration (hours): (only if applicable— see permit.)
(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 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."
OIJ4 Mai O
(Sign afli re of erniittee) (Date)
Form SWU-247. last revised 21212012
Page 2 of 2
aceAnalyiical n ANALYTICAL REPORT
NaliOndl Cerrlg+ to Tesnnq S rnnwatw++ July 30, 2019
i
l
Piedmont Geologic
I Sample Delivery Group:
Samples Received:
i
j Project Number:
I Description:
FS1
L1121645
07/24/2019
F
1914
!
Ennis Flint - High Paint
FO
I
E
Pete Dressel
6003 Chapel Hill Rd
uAl
Ste 14S
Raleigh, NC 27607
95c
Entire Report Reviewed By: 4�41�
Heather J Wagner
Project Manager
` Results relate only to the items tested or Calibrated dnd are reported as rounded values. This test report shail not be J
reproduced, except in lull, w'thout written approval of the laboratory. Where �rpphwblr, sampling conducted by Pace ,,,,,+���-rrrw.-
Anulstical National is peeiormed per guidance provided in laboratory standard operating procedures ENV-SOP-MTJL-06fi7 and '.
ENV-SOP-MLL-0068, Where samplrnq mnducted by the customer, results relate to the accuracy of the information p'robrded, '
and as the samples are received, fr
ACCOUNT: PROJECT: SDG: OATEITIME: PAGE:
Piedmont Geciogic 1914 L1121645 07/30/19 15A7 1 of 14
TABLE OF CONTENTS ONE LAB NATIONWIDE
Cp: Cover Page
t
Tc: Table of Contents
2
Ss: Sample Summary
3
Cn: Case Narrative
4
Sr: Sample Results
5
FS
OUTFALL-001 L1121645-01
5
Oc: Ouality Control Summary
6
Fn
Gravimetric Analysis by Method 2540 D-2011
6
Fr
Wet Chemistry by Method 350.1
7
Chemistry by Method 410.4
8
roWet
Wet Chemistry by Method 5210 B-2011
9
GI: Glossary of Terms
11
F
Al: Accreditations & Locations
12
F
Sc: Sample Chain of Custody
13
ID
ACCOUNT: PROJECT: SDG: DATEITIM E: PAGE:
Piedmens Geologic 19Z4 L1121645 07130r91547 2 of 14
SAMPLE SUMMARY ONE LAB. NATIONWIDE.
Colleted by
Collected datLmimo
Received dateAlme
OUTFALL-001 L1121645-01 GW
07123,191030
07)241190345
Method
Batch
Dilution Piepaiation
Analysis
Analyst
Location
doLt!Itime
datLkF11e
Gravimetric Analy.Sis by M;rthod 2540 0-2011
WG1315741
1 CW27119 21:53
0712W19 23:45
TH
Mt. Julie,, TN
Wel Chemimiy by Method 350.1
WG1317714
1 07l26119 20:58
07126i19 20:53
JER
Mt. Juliet, TN
Wet Chemist+y by Method 4T0.4
WG1317938
1 07/26119 14A7
07126n9 20:59
RDW
Mt. Juliet, TN
Wet Chemistjy by Method 5210 B-2011
WG1316726
1 07/2469 16:42
0712911911,09
ARM
Mt. Juliet, TN
ACCOUNT: PROJECT: SDG: DATE/TIME: PAGE:
Piedmont Geclegic 19M L112164S 07130fl915A7 3 of 14
CASE NARRATIVE ONE LAB NATIONWIDE
Ali sample aliquots were received at the correct temperature, in the proper containers, with the
Cp
appropriate preservatives, and within method specified holding times, unless qualified or notated within
the report. Where applicable, all MDL (LOD) and RDL (LOO) values reported for environmental samples
F
have been corrected for the dilution factor used in the analysis. All Method and Batch Quality Control
are within established criteria except where addressed in this case narrative, a non-confofmance form
or properly qua}ified within the sample results. By my digital signature below, I affirm to the best of my
F
knowledge, all problems/anomalies observed by the laboratory as having the potential to affect the
quality of the data have been identified by the laboratory, and no information or data have been
knowingly withheld that would affect the quality of the data.
Fr
Fc
F
Heather J Wagner
Project Manager
F,
FC
ACCOUNT: PROJECT: SDG: DATEITIM E: PAGE:
Piedmont Geologic 1914 L112W5 0713011915,47 4 of 14
OUTFALL-001 SAMPLE RESULTS - 01 ONE LAB. NATIONWIDE.
Collected date/time: 07/23119 10:00 L1121645
Additional Information
Result Units FC
Analyte
PH ;On Site] S su T C
Gravimetric Analysis by Method 2540 D-2011 r
q
Result Oualifier RDL Dilution Analysis Batch
Analyte ugll ugil dale /time
Suspended Solids 20800� 2650 1 07127f2019 23 46 WG1315741 R
Wet Chemistry by Method 350.1 0
Result OualiFler
RDL
Dilution Analysis
Batch
ugn
ugil
datu /time
FAnalyte
Ammmnia Nitrogen 202
10D
1 07125i2019 20:58
W01317711
Wet Chemistry by Method 410.4
El
Result Qualifier
RDL
Dilution Analysis
Batch
F
Analyte ugll
ugil
date t time
COD 29400
10000
1 07/261201920:59
WG13i7933
rq5c
Wet Chemistry by Method 5210 B-2011
Result Qualifier
RDL
Dilution Analysis
Batch
Analyte Ug11
ugtl
date 1 time
BOD 9700 J-
2000
1 071291201911:09
WG1315725
ACCOUNT: PROJECT: SDG: ❑ATEITIME: PAGE:
Piedmont Geologic 1914 L1121645 0713011915:47 5 of 14
WG1316741 QUALITY CONTROL SUMMARY ONE LAB, NATIONWIDE.
Gravimelric Analysis by Method 2540 D-2011 Ll121645-01
Method Blank (MB)
(W) R3435043-1 07/27/19 23:46
MB Result
Analyte ugll
Suspended Solids U
MB Qualifier M8 MDL M8 RDL
ugA ugA
350 2500
L1121614-01 Original Sample (OS) • Duplicate (DUP)
(OS) 1-1121614-01 07/27119 23:46 • (DUP) R343SO43-3 07/27/19 23:46
Original Restilt DUP Result Dilution DUP RPD DUP Qualifier DUP RPD
Limits
Analyte ug11 ug1l %
Suspended Solids 63500 64500 1 1.56 5
L1121946-01 Original Sample (OS) • Duplicate (DUP)
(OS) L1121946-01 07/27/19 23:46 • (DUP) R3435043-4 07/27/19 23:46
Original Result DUP Result Dilution DUP RPD DUP Qualifier DUP RPD
Limits
Analyte ugli ugll %
Suspended Solids 137000 139000 1 0.727 5
Laboratory Control Sample (LCS)
(LCS) R3435043-2 07/27/19 2346
Spike Amount LCS Result LCS Rec. Rec. Limits LCS Qualifier
Analyte ugp ugll % %
Suspended Solids 713000 764000 98.8 85.0-115
ACCOUNT: PROJECT: SDG:
Piedmont Geologic 1914 L1121645
DATE/TIME:
07/3011915A7
PAGE:
6of14
WG1317714 QUALITY CONTROL SUMMARY ONE LAB. NATIONWIDE.
Wet Chemistry by Method 350.1 L1121545-01
Method Blank (MB) FID
(MB) R3434936-1 07/26/39 17:47
MR Result MR Qua[Aisr MR MDt MR RDL
Analyze ug/I ugll uyll
Arnnionia Nitrogen U 31.7 100
L1121569-01 Original Sample (OS) • Duplicate (DUP)
(OS) 1-1121569-01 07/26/19 17:53 • (DUPI R3434936-3 07/26/19 17:55
Original Result DUP Result Dilution DUP RPD DUP Qualifier DUP RPD
Limits
Analyte ug/I ugll % %
Ammonia Nitrogen ND 0.000 1 0.000 10
L1121744-02 Original Sample (OS) • Duplicate (DUP)
(OS) L1121744-02 07/26/19 2101 • (DUP) R3434936-5 07/26/19 21:02
Original Result DUP Result Dilution DUP RPD DUP Qualifier DUP RPD
Limits
Analyze ug/I ug/I % %
Ammonia Nitrogen U 0.000 1 0.000 10
Laboratory Control Sample (LCS)
(LCS) R3434936-2 07/26/19 17:49
Spike Amount LCS Result LCS Rec, Rec. Limits LCS Qualifier
Analyte ug/I ug/I % %
Ammonia Nitrogen 7500 7180 95.7 90.0-110
L1121586-01 Original Sample (OS) • Matrix Spike (MS)
(OS) L1121586-01 07/26/19 17:S6 • (MS) R3434936-4 07/26/19 17:58
Spike Amount Original Result MS Result MS Rec. Dilution Rec. Limits MS Qualifier
Analyze ugll ug/I ug/I
Ammonia Nitrogen 5000 ND 4720 94.4 1 90.0-110
L1121749-01 Original Sample (OS) • Matrix Spike (MS) • Matrix Spike Duplicate (MSD)
(OS) L1121749-01 07/26/19 2104 • (MS) R3434936-6 07/26/19 21:05 • (MSD} R3434936-7 07/26/19 21:07
Spike Amount Original Result MS Result MSD Result MS Rec. MSD Rec.
Analyte ug/I ugll ugfl ugll % %
Ammonia Nitrogen 5000 7040 10100 115DO 61.1 89.2
ACCOUNT: PROJECT:
Piedmont Geologic 1914
Dilution Rec. Limits MS Qualifier MSD Oualifier RPD RPD Limits
1 90.0-110 E J6 E J3 J6 13.0 10 —
SDG: DATEITIME: PAGE:
1-1121645 07/30/1915A7 7 al 14
WG1317938
QUALITY CONTROL SUMMARY
ONE LAS. NATIONWIDE. 40
Wet Chemistry by Method 410.4
L1121645-01
'
Method Blank (MB)
(mB) R3434847-1 C7126/19 20:58
RP
MB Result MB Qualifier MB MDL
Analyte ugll ugll
MB ROL
ugll
COD U 3000
10000
3
5s
L1121745-01 Original Sample (OS) • Duplicate (DUP)
(OS) L1121745-01 07/26/19 21:00 • (DUP) R3434847-5 07/26/19 21:0)
Fqn
Original Result DUP Result Dilution DUP
RPD DUP OualiTier DUP RPD
Limi[5
s
Sr
Analyte ugll ugll %
a,
COD 62000 58900 1 5.73
—
20
---_ — -
Laboratory Control Sample (LCS)
�GI
(LCS) R3434847-2 07/26/19 20:58
Spike Amount LCS Result LCS Rec.
Rec. Limits LCS Qualifier
Analyte ugll ug/I %
AI
COD 222000 207000 93.2
— — - --
90.0-110
-_---- —
BSc
L1121697-01 Original Sample (OS) . Matrix Spike (MS)
. Matrix Spike Duplicate (MSD)
(OS) L1121697-01 07/26/19 20:59 • (I` -AS) R3434847-3 07/26/19 20:59 - (MSO( R34348474 07/26/19 20:59
Spike Amount Original Result MS Result
MSD Result MS Rec. MSD Rec. Dilution Rec. Limits MS Qualifier MSD Oualifier RPD
RPD Limits
Analyte ug/I ug/I ugll
ugll % % % %
%
COD 400000 ND 378000
376000 94.5 94.0 1 80.0-120 0.568
20
ACCOUNT:
PROJECT:
SDG:
DATEITIME:
PAGE:
Piedmcnt Geologic
1914
L1121645
07/30/19 15A7
8 of 14
WG1316726 QUALITY CONTROL SUMMARY ONE LAB. NATIONWIDE.
Wet Chemistry by Method 5210 B-2011 L1121645-01
Method Blank (MB)
L l�
(MR) P3435205-1 07/29/19 11;27
MB Result MB Oualifier MB MDL MB RDL
Analyte ugll ugll ugll ITC
BOD U 200 200
L1121368-01 Original Sample (OS) • Duplicate (DUP)
(OS) 1-1121368-01 0709119 09.19 • (DUP) R3435205-5 07/29/19 09:22
Original Result DUP Result Dilution DUP RPD DUP Qualifier DUP RPD
Limits
Analyte ugll ugll % %
BCD 55300 50300 1 9 30
L1121602-01 Original Sample (OS) • Duplicate (DUP)
(OS) 0121602-01 07/29/19 10:31 • (DUP) R3435205-6 07/29/19 10:33
Original Result DUP Result Dilution DUP RPD DUP Qualifier DUP RPD
Limits
Analyze ug/l ugll % %
BOO 3600 4000 1 11 30
L1121614-02 Original Sample (OS) • Duplicate (DUP)
(OS) L1121614-02 07/29/19 10:45 • (DUP) R3435205-7 07/29/19 10:46
Original Result DUP Result Dilution DUP RPD OUP Qualifier DUP RPD
Limits
Analyte ugll Ugli % %
BCD 3900 3600 1 6 30
L1121615-01 Original Sample (OS) • Duplicate (DUP)
(OS) L1121615-01 07/29A9 1115 - (DUP) R34352CS-8 07/29/19 11:16
Original Result DUP Result Dilution DUP RPD DUP Qualifier DUP RPD
Limits
Analyte ugll ugil % %
BOD 7400 7200 1 3 30
ACCOUNT: PROJECT: SDG'
Piedmont Geologic 1914 L1121645
DATEITWEI
07130119 ISA7
PAGE:
9of14
WG1316726 QUALITY CONTROL SUMMARY ONE LAB. NATIONWIDE. �
Wet Chemistry by Method 5210 8-2011 L1121645-01
Laboratory Control Sample (LCS)
(LCS) R3435205-2 07/29/19 09 14
Spike Amount LCS Result LCS Rec. Rec. Limits LCS Qualifier
Analyte ugll ugll %
SOD 198000 149000 75.4 84.6-115 J-
Laboratory Control Sample (LCS)
(LCS) P3425205-3 07/29/19 10:34
Spike Amount LCS Result LCS Rec. Rec Limits LCS Qualifier
Analyte ugA ugll % %
SOD 198000 153000 77.1 84.6-115 J-
LaborMaiy Control Sample (LCS)
(LCS) R3435205-4 07129/1911:25
Spike Amount LCS Result LCS Rec. Rec. Limits LCS Qualifier
Analyte ugh ugll %
SOD 198000 201000 102 84 6-115
ACCOUNT:
PROJECT:
SDG'.
DATE/TIME:
PAGE:
Piedmont Geologic
1914
L1121645
07/3011915:47
10 of 14
GLOSSARY OF TERMS
ONE LAB NATIONWIDE, 0
Guide to Reading and Understanding Your Laboratory Report
The information below is designed to better explain the various terms used in your report Of 8nalytical results from the Laboratory. This is not
H
intended as a comprehensive explanation, and if you have additional questions please contact your project representative,
Results Disclaimer - Information
that may be provided by the customer, and contained within this report, include Permit Limits, Project Name.
TC
Sample ID. Sample Matrix.
Sample preservation. Field Blanks. Field Spikes. Field Duplicates. On -Site Data. Sampling Collection Dates/Times, and
Sampling Location. Results relate to the accuracy of this information provided, and as the samples are received.
Abbreviations and Definitions
I qs
MDL
ND
Method Detection Limit.
Not detected at the Reporting Limit;or MDL where applicable),
Rn
RDL
Reported Detection Limit.
Rec.
Recovery.
y
RPD
Relative Percent Difference.
Sr
SDG
U
Sample Delivery Group.
Not detected at the Reporting Limit (or MDL where applicable).
FO
Analyte
The name of the particular compound or analysis performed. Some Analyses and Methods will have multiple anal}2es
reported.
If the sample matrix contains an interfering material, the sample preparation volume or weight values differ fiern the
Dilution
standard, or if concentrations of analytes in the sample are higher than the highest limit of concentration that the
laboratory can accuretely report, the sample may be diluted for analysis. If a value different than 1 is used in this field, the
result reported has already been corrected for this factor.
F
These are the target % recovery ranges or % difference value that the laboratory has historically determined as normal
Limits
for the method and analyte being reported. Successful CC Sample analysis will target all analyzes recovered or
duplicated within these ranges.
9
Original Sample
The non -spiked sample in the prep batch used to determine the Relative Percent Difference (RPD) from a quality control
SC
sample, The Original Sample may not be included within the reported SDG.
This column provides a letter and/or number designation that corresponds to additional information concerning the result
Qualifier
reported. If a Qualifier is present, a definition per Qualifier is provided within the Glossaty and Definitions page and
potentially a discussion of possible implications of the Qualifier in the Case Narrative if applicable.
The actual analytical final result (corrected for any sample specific characteristics) reported for your sample. If there was
no measurable result returned for a specific analyte, the result in this column may state "ND" (Not Detected) or "BDL"
Result
(Below Detectable Levels), The information in the results column should always be accompanied by either an MDL
(Method Detection Limit) or RDL (Reporting Detection Limit) that defines the lowest value that the laboratory could detect
Or report for this analyze,
Uncertainty
(RadiochemisUy)
Confidence level of 2 sigma.
A brief discussion about the included sample results, including a discussion of any non -conformances to protocol
Case Narrative (Cn)
observed either at sample receipt by the laboratory from the field or during the analytical process. if present, there will
be a section in the Case Narrative to discuss the meaning of any data qualifiers used in the report.
Quality Control
This section of the report includes the results of the laboratory quality control analyses required by procedure or
Summary
analytical methods to assist in evaluating the validity of the results reported for your samples. These analyses are not
being performed on your samples typically. but on laboratory generated material.
This is the document created in the field when your samples were initially collected. This is used to verify the time and
Sample Chain of
elate of collection. the person collecting the samples, and the analyses that the laboratory is requested to perform. This
Custody (Sc)
chain of custody also documents all persons (excluding commercial shippers) that have had control or possession of the
samples from the time of collection until delivery to the laboratory for analysis.
This section of your report will provide the results of all testing performed on your samples. These results are provided
Sample Results (Sr)
by sample ID and are separated by the analyses performed on each sample. The header line of each analysis section for
each sample wily provide the name and method number for the analysis reported.
Sample Summary (Ss)
This section of the Analytical Report defines the specific analyses performed for each sample ID. including the dates and
times of preparation aridlor analysis.
Qualifier
Description
E
The analyze concentration exceeds the upper limit of the calibration range of the instrument established by the initial
calibration (ICAL).
J3
The associated batch QC was outside the established quality control range for precision.
J6
The sample matrix interfered with the ability to make any accurate determination: spike value is low.
J-
The associated batch QC was outside the lower control limits, associated data has a potential negative bias.
ACCOUNT: PROJECT: SDG: DATEITIME: PAGE:
i
Piedmont Geologic 1914 L1121645 07/30/19 15:47 It of 14
ACCREDITATIONS &
LOCATIONS
ONE LAD NATIONWIDE
Pace National is the only environmental laboratory accreditedlcertified to support your work nationwide from
one location. One phone call, one point of contact,
one laboratory. No other lab is as
accessible or prepared to handle your needs throughout the country. Our capacity and capability from our single location laboratory is comparable to the collective
tolais of the network
laboratories in our industry, The most significant benefit to our one location design is the design of our laboratory
campus. The model is conducive to accelerated productivity, decreasing
CA
tum.around time. and preventing cross contamination,
thus protecting sample integrity. Our focus on premium quality and prompt service allows us to be YOUR LAB OF CHOICE.
' Not all certifications held by the laboratory are applicable to the results reported in the attached report.
' Accreditation is only applicable to the test
methods specified on each scope of accreditation held by Pace National
FC
State Accreditations
Alabama
40660 _ _
_Nebraska_ _
_ NE-OS-15-05
3
55
Alaska - - -
17-026 -
_
Nevada -
-- TN-03-2_00_2.34 -
Arizona
- _- _- ---- __-
AZ0612
-- - - - - - -
New Hampshire
-
2975
�__
Arkansas
88-0469
NewJers_ey-NELAP
TN002
FCn
California w - - --
- 2932 _ - - - - -- -- _ _
_
New Mexico' _-- -- _-.
--
_--nla-
Colorado_ _
Connecticut _ _ _
TN00003 _ _ _
PH-0197
New _Y_oiIr _
North Carolina
_ 11742
Env375
SF
Florida
E87487
North Carolina
DW21704
— _ --
Georgia _ _ _ _
Georgia'
- �- - - - -
NELAP _ _
923
North Carolina'
41 _
R-140
FO
North Dakota
Idaho
TN00003 �
A_
Ohio-VAP
CL0069
Illinois _
Indiana
_ C-TN-01_
C-TN-01 _ -_
Oklahoma
_
TN2
TN200002
Oregon
Iowa
364
Pennsylvania
68-02979
-
Kansas
Kentucky's
E•10277
Rhode Island
tA000356
South Carolina
_
Kentucky'
16
15 Y — --
South Dakota
nM
nla
Louisiana
A130792
Tennessee' `
r�
2005
Louisiana'
LA180010
Maine
TN0002
Maryland
324
Massachusetts
M-TNO03
Michigan
9958
Minnesota
047-999395
Mississippi
TN00003
Missouri
340
Montana
CER10086
Third Party Federal Accreditations
Texas
T104704245-18-15
SC
Texas`
_
LABO152
Utah
TN00003
Vermont
VT2006
Virginia
460132
Washington
C847
West Virginia
233 _
Wisconsin
9980939970
Wyoming
A2LA
A2tA - ISO 17025 1461.01 AIHA-LAP.LLC EMLAP 100789
A2LA - ISO 17025 s 1461.02 DOD 1461.01
Canada 1461.01 USDA P330-15.00234
EPA-Crypto TN00003
' Drinking Water ' Underground Storage Tanks 'Aquatic Toxicity ' ChemicalfMicrobiologicai s Mold 'Wastewater nfa Accreditation not applicable
Our Locations
Pace National has sixty-four client support centers that provide sample pickup andlor the delivery of sampling supplies. If you would like assistance from one of our support offices, please contact
our main office. Pace National performs all testing at our central laboratory.
WA
OR
T ID
T NV
CA
T
MT
ND
M N
SD
T rot
WY
IA
T
NE
OF
T •
•
CO
KS
MO l
NM
AK
.O
4 ,�O
rn Fri ( S
ACCOUNT: V'
Piedmont Geologic
T TX T
T
PROJECT
1914
Mr T
IL lit OH
1
Iy
AMS Al �T GA
LA
SDG:
L1121645
ME
NY
T PA T
VVV VAT
TdT
1
SC
FL
T
DATEITIME:
07/30/1915:47
PAGE:
12 of 14
Company Name/Address:
Piedmont Geologic
6003-145 Chapel Hill Road
(Raleigh, NC 27607
Billing Information:
5c` o—
Analysis
/
Container
Preservative
Chain of Custody Page _ of _
E
C,A-B S,C.r•E•N.C.V.S
1206s Lebanon xd �: ii
Mount lurr, 3i177 %
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Report to:
Pete Dressel
Email Tq;
pjdressel@piedmontgeologic.com:
Project
Ennis Flint - High Point
Description:g
City/State
A
Colled: cte�� �•y �p r'� ,y
J
La 1 ����
Table
�
Phone: (9i 97 1i54-9700
Far:
Client Project ri
i 4
1914
tab Project q
-
CollectelIdby (print}: h
Site/Facility ID a
P.D. p
Acctnum: PIEGEO
Template: -
Prclogin:
TSR: Wagner
Cooler;
Collected by (signature):
.. n
lrrtmediaiely-7woDay
Packed on Ice , N - -• Y V -
Rush? (Lab MUST Be Notified)
Same Day ......... ............_.... 200%
_Next Dar............_ .........toa%
• ....:.........:..:.-...,.,..SO%
ThFee Day._.._._-...-......_..75%
Date Results Needed0.
_
Email? No Yes
- FAX? `No —yes -
w
No.
of
-
Shipped via.
Sample ID
Comp/Grab
Matrix'
Depth
Date
Time
ntrs
Re.jComammant
S. pk Pilab onto
Matrix: SS - Sol]1GW - Groundwater' WW' wastewater DW - Drinking Water OT - Other pH '� � O Tem
Rearks: H .._ S t 0 tr7U , 01 i( J'' Flow Other Hold it
m� p
Relinquished by: (Signature)
Relinquished by: (' na; �^
Date:. -
Date:
f > !�
Time; Received
Time: Receiv
�rf �=
by: (Sig tu: e) - .
u:- -
Samples returned via: ❑ UPS'
tSi Fed Ex ❑ Courier ❑ _
Temp: )Y�� Bottles Received:
.[ 1`l.�
Conaitionr, (lab use only)
��/� _
" "' SCREEN 4;A9 ftiAN
CDC Seal Intact: _Y _N ✓ NA
_
Relin ed Uy gn3lure) S `
pate:
Time: Received
bby:(Signature) -.
Jlfoorycr%lab
Date: 7 Timec:/a,,
pH Checked: -
NCF:
n w . •
Client: SDG#:. /i u�y�
Cooler Received/Opened On: 7 1 L /1 9 Temperature: 2.
Received' B : Rile Dem se
S i nature:
Receipt Check List
-Yes
COC Seal Present / Intact?
-•
COC Signed / Accurate?
Bottles arrive intact?
Correctbottles used?
Sufficient volume sent?
If Applicable
VOA Zero headspace?�
Preservation Correct / Checked?
- :r