NCG100071_DMR_20200206

409 Rogers View Court
• Raleigh,NC 27610
M d Atlantic office 919.250.9918
Engineering& Environmental Solutions facsimile 919.250.9950
MAAONLINE.COM
RECEIVED
March 2, 2020
MAR 11 2020
CENTRAL FILES
NCDEQ/DWR DWR SECTION
Attention: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Subject: STORMWATER SAMPLING RESULTS
1-40 USED AUTO PARTS, INC.
101 PARTON AVENUE
MORGANTON, NORTH CAROLINA
NPDES PERMIT NO. NCG100074
To Whom It May Concern:
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 Outfalls 1 and 2 on February 6, 2020 and analyzed for total suspended
solids (TSS), pH, total recoverable lead, oil and grease and ethylene glycol. As indicated
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.
Ron Davis
Stormwater Services
Attachment: Discharge Outfall Monitoring Report
Laboratory Analytical Report
EXPERIENCED CUSTOMER FOCUSED INNOVATIVE

STORM WATER DISCHARGE OUTFALL(SDO)
MONITORING REPORT
CERTIFICATE OF COVERAGE NO. NCG100074 SAMPLES COLLECTED DURING CALENDAR YEAR: 2020
FACILITY NAME 1-40 Used Auto Parts, Inc COUNTY Burke
PERSON COLLECTING SAMPLE(S) Kenneth Hemming PHONE NO. [phone]
CERTIFIED LABORATORY(S) Pace Analytical Lab#12
Lab# PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Part A:Stormwater Benchmarks and Monitoring Results
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.
Outfall Date 00400 00530 ---- 77023 01051 78141
No. Sample Collected, Total pH, Total Suspended Non-polar Ethylene Glycol, Lead,Total Total Toxic
mo/dd/year Rainfall, Standard Solids(TSS), O&G/TPH mg/L Recoverable, 3
Organics ,
inches Units mg/L (Method 1664 mg/L mg/L
SGT-HEM),mg/L
8,000
Benchmark 6.0—9.01 100/502 15 (Tiers 2 and 3) 0.03 1.0
Outfall 001 02/06/2020 1.57 4.4 <5.0 <5.0 <0.005 NA
Outfall 002 02/06/2020 1.57 7.0 <5.0 <5.0 <0.005 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 October 25,2012
Page 1 of 2

STORM WATER 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 Pollutio Prevention Plan."
-rA44.744._ (,46.47
Name(Print name)
/ -c
Title(Print t'tle)
Signature Date
Mail Original and one copy to:
Division of Water Quality
Attn:Central Files
1617 MailServiceCenter
Raleigh, North Carolina27699-1617
"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."
/64"47‘ ANITA\-- 15.20
(Date)
Form SWU-251,last revised October 25, 2012
Page 2 of 2

Pace Analytical Services,LLC
® 9800 Kincey Ave. Suite 100
("Ace Analytical Huntersville,NC 28078
www.pacelabs.ean [phone]
February 20, 2020
Chuck Hoffman
Mid-Atlantic Associates, Inc
409 Rogers View Court
Raleigh, NC 27610
RE: Project: 1-40 Used Auto Parts
Pace Project No.: 92464133
Dear Chuck Hoffman:
Enclosed are the analytical results for sample(s) received by the laboratory on February 07, 2020.
The results relate only to the samples included in this report. Results reported herein conform to the
most current, applicable TNI/NELAC 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,
Tyriek Hooks
[e-mail]
[phone]
Project Manager
Enclosures
cc: Ron Davis, Mid Atlantic Associatees,Inc.
-
- 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 15

Pace Analytical Services,LLC
® 9800 Kincey Ave. Suite 100
aceAnalytical Huntersville,NC 28078
mnr.psc&sls.Cmn [phone]
CERTIFICATIONS
Project: 1-40 Used Auto Parts
Pace Project No.: 92464133
Pace Analytical Services Indianapolis
7726 Moller Road, Indianapolis, IN 46268 Ohio VAP Certification#:CL0065
Illinois Certification#:200074 Oklahoma Certification#:9204
Indiana Certification#:C-49-06 Texas Certification#:T104704355
Kansas/NELAP Certification#:E-10177 West Virginia Certification#:330
Kentucky UST Certification#:80226 Wisconsin Certification#:999788130
Kentucky WW Certification#:98019 USDA Soil Permit#:P330-19-00257
Michigan Department of Environmental Quality,Laboratory
#9050
Pace Analytical Services Charlotte
9800 Kincey Ave.Ste 100,Huntersville,NC 28078 South Carolina Certification#:99006001
Louisiana/NELAP Certification#LA170028 Florida/NELAP Certification#:E87627
North Carolina Drinking Water Certification#:37706 Kentucky UST Certification#:84
North Carolina Field Services Certification#:5342 VirginiaNELAP Certification#:460221
North Carolina Wastewater Certification#: 12
Pace Analytical Services Asheville
2225 Riverside Drive,Asheville, NC 28804 North Carolina Wastewater Certification#:40
Florida/NELAP Certification#:E87648 South Carolina Certification#:99030001
Massachusetts Certification#:M-NC030 VirginiaNELAP Certification#:460222
North Carolina Drinking Water Certification#:37712
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 15

Pace Analytical Services,LLC
9800 Kincey Ave. Suite 100
(efiri‘ceAnaVicale Huntersville,NC 28078
www•pscslabs.ceo [phone]
SAMPLE ANALYTE COUNT
Project: 1-40 Used Auto Parts
Pace Project No.: 92464133
Analytes
Lab ID Sample ID Method Analysts Reported Laboratory
92464133001 Outfall 1 EPA 1664E WAM 1 PASI-C
EPA 8015 Alcohol-Glycol CPH 1 PASI-I
EPA 6010D SH1 1 PASI-A
SM 2540D-2011 CJL 1 PASI-A
92464133002 Outfall 2 EPA 1664B WAM 1 PASI-C
EPA 8015 Alcohol-Glycol CPH 1 PASI-I
EPA 6010D SH1 1 PASI-A
SM 2540D-2011 CJL 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 15

Pace Analytical Services,LLC
aceAnalyticale 9800 Kincey Ave. Suite 100
Huntersville,NC 28078
www.pacNsbs.csn [phone]
ANALYTICAL RESULTS
Project: 1-40 Used Auto Parts
Pace Project No.: 92464133
Sample: Outfall 1 Lab ID: 92464133001 Collected: 02/06/20 07:35 Received: 02/07/20 09:40 Matrix: Water
Parameters Results Units Report Limit DF Prepared Analyzed CAS No. Qual
1664 SGT-HEM,TPH Analytical Method:EPA 1664E
Total Petroleum Hydrocarbons ND mg/L 5.0 1 02/17/20 09:58
8015M Glycols in water Analytical Method: EPA 8015 Alcohol-Glycol
Ethylene glycol ND mg/L 5.0 1 02/19/20 16:43 107-21-1
6010 MET ICP Analytical Method:EPA 6010D Preparation Method: EPA 3010A
Lead ND ug/L 5.0 1 02/15/20 00:46 02/15/20 14:32 7439-92-1
2540D Total Suspended Solids Analytical Method:SM 2540D-2011
Total Suspended Solids 4.4 mg/L 2.6 1 02/12/20 16:21
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced,except in full,
Date:02/20/2020 02:23 PM without the written consent of Pace Analytical Services,LLC. Page 4 of 15

Pace Analytical Services,LLC
(..:PieAnalytical. 9800 KinceyAve. Suite 100
Huntersville,NC 28078
Mww.aodlb.coo [phone]
ANALYTICAL RESULTS
Project: 1-40 Used Auto Parts
Pace Project No.: 92464133
Sample: Outfall 2 Lab ID: 92464133002 Collected: 02/06/20 07:45 Received: 02/07/20 09:40 Matrix: Water
Parameters Results Units Report Limit DF Prepared Analyzed CAS No. Qual
1664 SOT-HEM,TPH Analytical Method:EPA 1664B
Total Petroleum Hydrocarbons ND mg/L 5.0 1 02/17/20 09:58
8015M Glycols in water Analytical Method:EPA 8015 Alcohol-Glycol
Ethylene glycol ND mg/L 5.0 1 02/19/20 16:53 107-21-1
6010 MET ICP Analytical Method:EPA 6010D Preparation Method: EPA 3010A
Lead ND ug/L 5.0 1 02/15/20 00:46 02/15/20 14:35 7439-92-1
2540D Total Suspended Solids Analytical Method:SM 2540D-2011
Total Suspended Solids 7.0 mg/L 2.7 1 02/12/20 16:22
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced,except in full,
Date:02/20/2020 02:23 PM without the written consent of Pace Analytical Services,LLC. Page 5 of 15

Pace Analytical Services,LLC
9800 Kincey Ave. Suite 100
aceAnalytical Huntersville,NC 28078
rrrcpIalabs.cota [phone]
QUALITY CONTROL DATA
Project: 1-40 Used Auto Parts
Pace Project No.: 92464133
QC Batch: 525440 Analysis Method: EPA 1664E
QC Batch Method: EPA 1664E Analysis Description: 1664 SGT-HEM,TPH
Associated Lab Samples: 92464133001,92464133002
METHOD BLANK: 2808410 Matrix: Water
Associated Lab Samples: 92464133001,92464133002
Blank Reporting
Parameter Units Result Limit Analyzed Qualifiers
Total Petroleum Hydrocarbons mg/L ND 5.0 02/17/20 09:58
LABORATORY CONTROL SAMPLE: 2808411
Spike LCS LCS %Rec
Parameter Units Conc. Result %Rec Limits Qualifiers
Total Petroleum Hydrocarbons mg/L 20 17.1 86 64-132
MATRIX SPIKE SAMPLE: 2808412
35530436001 Spike MS MS %Rec
Parameter Units Result Conc. Result %Rec Limits Qualifiers
Total Petroleum Hydrocarbons mg/L 5.0U 20 21.7 90 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:02/20/2020 02:23 PM without the written consent of Pace Analytical Services,LLC. Page 6 of 15

Pace Analytical Services,LLC
eAnalytical:(1rP .(c 9800 Kincey Ave. Suite 100
Huntersville,NC 28078
www.pcslsbs.oasi [phone]
QUALITY CONTROL DATA
Project: 1-40 Used Auto Parts
Pace Project No.: 92464133
QC Batch: 548193 Analysis Method: EPA 8015 Alcohol-Glycol
QC Batch Method: EPA 8015 Alcohol-Glycol Analysis Description: EPA 8015 Modified
Associated Lab Samples: 92464133001,92464133002
METHOD BLANK: 2527850 Matrix: Water
Associated Lab Samples: 92464133001,92464133002
Blank Reporting
Parameter Units Result Limit Analyzed Qualifiers
Ethylene glycol mg/L ND 5.0 02/19/20 17:20
LABORATORY CONTROL SAMPLE: 2527851
Spike LCS LCS %Rec
Parameter Units Conc. Result %Rec Limits Qualifiers
Ethylene glycol mg/L 25 20.4 81 48-150
MATRIX SPIKE&MATRIX SPIKE DUPLICATE: 2527852 2527853
MS MSD
92464133002 Spike Spike MS MSD MS MSD %Rec
Parameter Units Result Conc. Conc. Result Result %Rec %Rec Limits RPD Qual
Ethylene glycol mg/L ND 25 25 18.7 21.3 71 82 34-153 13
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:02/20/2020 02:23 PM without the written consent of Pace Analytical Services,LLC. Page 7 of 15

Pace Analytical Services,LLC
. (:LrficeAnalyticals 9800 Kincey Ave. Suite 100
Huntersville,NC 28078
www.pacelabs.eom [phone]
QUALITY CONTROL DATA
Project: 1-40 Used Auto Parts
Pace Project No.: 92464133
QC Batch: 525315 Analysis Method: EPA 6010D
QC Batch Method: EPA 3010A Analysis Description: 6010 MET
Associated Lab Samples: 92464133001,92464133002
METHOD BLANK: 2808070 Matrix: Water
Associated Lab Samples: 92464133001,92464133002
Blank Reporting
Parameter Units Result Limit Analyzed Qualifiers
Lead ug/L ND 5.0 02/15/20 13:29
LABORATORY CONTROL SAMPLE: 2808071
Spike LCS LCS %Rec
Parameter Units Conc. Result %Rec Limits Qualifiers
Lead ug/L 500 462 92 80-120
MATRIX SPIKE&MATRIX SPIKE DUPLICATE: 2808072 2808073
MS MSD
92463622001 Spike Spike MS MSD MS MSD %Rec
Parameter Units Result Conc. Conc. Result Result %Rec %Rec Limits RPD Qual
Lead ug/L ND 500 500 493 490 99 98 75-125 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:02/20/2020 02:23 PM without the written consent of Pace Analytical Services,LLC. Page 8 of 15

Pace Analytical Services,LLC
aceAnalytical• 9800 KinceyAve. Suite 100
Huntersville,NC 28078
t+IMM Mglabs.calll [phone]
QUALITY CONTROL DATA
Project: 1-40 Used Auto Parts
Pace Project No.: 92464133
QC Batch: 524819 Analysis Method: SM 2540D-2011
QC Batch Method: SM 2540D-2011 Analysis Description: 2540D Total Suspended Solids
Associated Lab Samples: 92464133001,92464133002
METHOD BLANK: 2805233 Matrix: Water
Associated Lab Samples: 92464133001,92464133002
Blank Reporting
Parameter Units Result Limit Analyzed Qualifiers
Total Suspended Solids mg/L ND 2.5 02/12/20 16:17
LABORATORY CONTROL SAMPLE: 2805234
Spike LCS LCS %Rec
Parameter Units Conc. Result %Rec Limits Qualifiers
Total Suspended Solids mg/L 250 274 110 90-110
SAMPLE DUPLICATE: 2805235
92464094001 Dup
Parameter Units Result Result RPD Qualifiers
Total Suspended Solids mg/L 294 308 5
SAMPLE DUPLICATE: 2805236
92464288001 Dup
Parameter Units Result Result RPD Qualifiers
Total Suspended Solids mg/L 158 169 7
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:02/20/2020 02:23 PM without the written consent of Pace Analytical Services,LLC. Page 9 of 15

Pace Analytical Services,LLC
aceAnalytical 9800 Kincey Ave. Suite 100
_,(1113
Huntersville,NC 28078
www.pcNab.com
[phone]
QUALIFIERS
Project: 1-40 Used Auto Parts
Pace Project No.: 92464133
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.
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
PAST-A Pace Analytical Services-Asheville
PASI-C Pace Analytical Services-Charlotte
PASI-I Pace Analytical Services-Indianapolis
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced,except in full,
Date:02/20/2020 02:23 PM without the written consent of Pace Analytical Services,LLC. Page 10 of 15

(Iir Pace Analytical Services,LLC
ace Analytical 9800 Kincey Ave. Suite 100
Huntersville,NC 28078
www.pacelabs.com
[phone]
QUALITY CONTROL DATA CROSS REFERENCE TABLE
Project: 1-40 Used Auto Parts
Pace Project No.: 92464133
Analytical
Lab ID Sample ID QC Batch Method QC Batch Analytical Method Batch
92464133001 Outfall 1 EPA 1664B 525440
92464133002 Outfall 2 EPA 1664E 525440
92464133001 Outfall 1 EPA 8015 Alcohol-Glycol 548193
92464133002 Outfall 2 EPA 8015 Alcohol-Glycol 548193
92464133001 Outfall 1 EPA 3010A 525315 EPA 6010D 525336
92464133002 Outfall 2 EPA 3010A 525315 EPA 6010D 525336
92464133001 Outfall 1 SM 25400-2011 524819
92464133002 Outfall 2 SM 2540D-2011 524819
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced,except in full,
Date:02/20/2020 02:23 PM without the written consent of Pace Analytical Services,LLC. Page 11 of 15

Document Name: Document Revised:February 7,2018
Sample Condition Upon Receipt(SCUR) Page 1 of 2
ace Analytical Document No.: Issuing Authority:
i F-CAR-CS-033-Rev.06 Pace Carolinas Quality Office
Laboratory receiving samples:
Asheville ❑ EdenL Greenwood❑ Huntersville L` Raleigh❑ Mechanicsville❑
Sample Condition Client Name: WO# : 9246413;3
Upon Receipt Kli
! Project p:
i�''t - It{. �'I t
Courier: Rved Ex ❑UPS ❑LISPS ❑Client 1111111111111111111111
❑Commercial ❑Pace ❑Other: 92464133
I
Custody Seal Present? [Yes [? o Seals Intact? ❑Yes -E No �,(
Date/Initials Person Examining Contents: r) 1 L ? 7(3
Packing Material: ❑Bubble Wrap QBubble Bags ONone ❑ Other Biological Tissue Frozen?
Thermometer: Eves .J f ON/A
Dm Gun ID: 92T058 Type of Ice: , et ❑Blue ❑None
Cooler Temp(IC): ) . Correction Factor:Add/Subtract(°C) 0.0°C
Temp should be above freezing to VC
Cooler Temp Corrected cc): 1 • ❑Samples out of temp criteria.Samples on ice,cooling process
has begun
USDA Regulated Soil ( N/A,water sample)
Did samples oriOatein a quarantine zone within the United States:CA,NY,or SC(check maps)? Did samples originate from a foreign source(internationally,
❑Yes j No Including Hawaii and Puerto Rico)?Des ONo
Comments/Discrepancy:
Chain of Custody Present? es ❑No ON/A 1.
Samples Arrived within Hold Time? I2 es ❑No ON/A 2.
Short Hold Time Analysis(<72 hr.)? Ores No ❑N/A 3.
.
Rush Turn Around Time Requested? Oven el ❑N/A 4.
Sufficient Volume? 2 es ❑No ON/A 5.
Correct Containers Used? rives ONo ON/A 6.
-Pace Containers Used? ves ❑No ❑N/A
Containers Intact? --E es ❑No ON/A 7.
Dissolved analysis:Samples Field Filtered? Oyes ❑No (7giA B.
Sample Labels Match COC? „las ❑No ON/A 9.
G
-Includes Date/Time/ID/Analysis Matrix:
r }� I I r
Headspace in VOA Vials(>5 6mm)7 Yes ❑No ❑N/A 10.L 1 ) �1. j-- ��/; V J /�? V 4 , ) ,1/2.?,
Trip Blank Present? Oyes .0N10 ON/A 11.
Trip Blank Custody Seals Present? Des LiNo ON/A
COMMENTS/SAMPLE DISCREPANCY Field Data Required? Oyes ❑No
Lot ID of split containers:
CLIENT NOTIFICATION/RESOLUTION
Person contacted: Date/Time:
�1Project Manager SCURF Review: Date: gd/�0
6'
"��-
Project Manager SRF Review: Date: ,940. ram(( )
Page 12 of 15

Document Name: Document Revised: February 7,2018
Sample Condition Upon Recelpt(SCUR) Page 1 of 2
7... c7Ci9AflalyflCal Document No.: Issuing Authority:
F-CAR-CS-033-Rev,06 Pace Carolinas Quality Office
*Check mark top half of box if pH and/or dechlorination is Project# . 92/�(tea 131�
verified and within the acceptance range for preservation WO# : `T V"'r
samples. PM: TIH Due Date: 02/18/20
Exceptions:VOA,Coliform,TOC,Oil and Grease,DRO/8015(water)DOC,LLHg
**Bottom half of box is to list number of bottle CLIENT: 92—MID ATLAN
u ^ J a a
_ ¢ ¢ n ?
z z z u _ u _ Z _ Z - a n °i 9 0
Z ry
-0 -0 23 Z N N oa ,--, j Z -al N V U ? r r y Q
2 2 2 a i = a = „ a, N 2 vim= z Y a z p 2 ? 2
a w a, 2 a a ro n v v a Z ? a ? N a' - v
a, w ar ai a m ii "' = a a• G m Q Z ,n u .Y u ,, Ili
n a n 0 ) = m v n n c O a m = iv n >
c c c n N 0 Z O� l7 a u O O = Q ? O ? O o� > A E.�° Z c o a
7 2 « a L.
.u-. .0 •.,7.4: __ a E., `., ? t a`, y .0 a`, a E S Z J 2 Y ar 'V-' .0 = nad
n A A A .o a E .o F. < < e ¢ t ;, v ,`o E c
a a rs a n d n E E E a E Q e-v O O O O n . N tr.; a
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E E v f E E EE; E fo E E
ut 0 8 ,=. ,n 0 v,, N,,n 3 - — o = 2 oOo . a N o o 0 0
. 1-.1 N , IN - 4-4 N v a i •;;. N ,...4 N V
E , m N N e rn a a t .+ .r m ,-1 M M an of Q1 Ql Q to to N m O 8
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m m m m m m m m 3 a a a a a a o > > o > > v, ,n m a > 0
1 \ ( \)\\ s \
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pH Adjustment Log for Preserved Samples
Sample IO Type of Preservative pH upon receipt Date preservation adjusted Time preservation Amount of Preservative Lot tl
adjusted added
Note: Whenever there is a discrepancy affecting North Carolina compliance samples,a copy of this form will be sent to the North Carolina DEIINR Certification Office(i.e.
Out of hold,incorrect preservative,out of temp,incorrect containers.
Page 13 of 15

j�/ CHAIN-OF-CUSTODY/Analytical Request Document
FaeeAna�yt/Cad The Chain-of-Custody is a LEGAL DOCUMENT.All relevant fields must be completed accurately.
Section A Section B Section C
Page: of
Required Client Information Required Project Information: Invoice Information
Company Mid-Atlantic Associates,Inc. ReporlTo Chuck Hoffman([e-mail]) 1Attenthon Chuck Hoffman
Address' 409 Rogers View Court Copy To Ron Davis([e-mail] Company Name' Mid-Atlantic Associates,inc. REGULATORY AGENCY
Raleigh. NC 27610 Address 409 Rogers View Court,Raleigh,NC NPDES GROUND WATER '• DRINKING WATER
Email To. [e-mail] Purchase Order No.: R3179.00 Pace ouole — UST UST RCRA OTHER
Reference: �J
Phone [phone] Fax [phone] Project Name I-40 Used Auto Part; Pace Project Tyriek Hooks Site Location /��/
Manages NC
Requested Due Date/TAT: standard Project Number R3179.00 Pace Profile f- 5921
STATE: /
Requested Analysis Filtered(YIN) j
Section D Valid Matrix Codes ~ /
z
Required Client Information -MATRIX Q-QDE a CO_LECTED Preservatives i NYNY
selhnr:lN WATER OW WT 0 Z ,
WATER VAN 0 N
WASTE WATER P U COMPOSITE START COMPOSITE
PRODUCT SL 9? ENDrCPAW w f6 Z
SOIL/SOLID QL e, j V }
OIL WP O O . -. (D o
SAMPLE ID wiPE AR -' 6U y m o
AIR 01 r— W Qt
(A-Z.0-9/,-) OTHER TS O w < ? .D F— o j, 0_ o
Sample IDs MUST BE UNIQUE TISSUE 0 n- - H at (n r (9 To V
o 1- Hw• z p 'Lis
N N O
at x - UO of O C . iu C F �f )/� /!
w Q -- a 0 Q O 0 O rn .-, L c N = T m m L TlL1L `T ( 7
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CHAIN-OF-CUSTODY / Analytical Request Document
/ The Chain-of-Custody is a LEGAL DOCUMENT.All relevant fields must be completed accurately
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