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Home My WebLink AboutNCG100176_DMR_20191010 ti 141111 409 Rogers View Court M id Atlantic Rik n;NC 2910 oifica 414.25>?4418 fngtnrrt,ng$ Environmental Solut+ons hcsimii,r 919?SO 99S0 , - MAAONL#NE COM October 10, 2019 NCDEQ/DWR R r' Attention: Central Files EIVFD 1617 Mail Service Center MAR 16 2020 Raleigh, North Carolina 27699-1617 CCtWr DVI 't,~ HLES Subject: STORMWATER SAMPLING RESULTS MARTIN'S AUTO SALVAGE INC. 5810 POOLE ROAD RALEIGH, WAKE COUNTY, NORTH CAROLINA PERMIT NCG100176 MID-ATLANTIC JOB NO. 000R2614.00 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 Outfall 001 on September 10, 2019 and analyzed for total suspended solids (TSS), pH, total recoverable lead, oil and grease and ethylene glycol. As indicated on the attached DMR, all pollutants were reported within their respective benchmark values. If you have any questions or would like to discuss this matter, please contact me at 919-250-9918. Sincerely, MID-ATLANTIC ASSOCIATES, INC. Ron Davis Stormwater Services Manager Attachments: Stormwater Discharge Monitoring Reports Laboratory Analytical Report EXPERIENCED CUSTOMER FOCUSED INNOVATIVE STORMWATER DISCHARGE OUTFALL(SDO) MONITORING REPORT CERTIFICATE OF COVERAGE NO. NCG100176 SAMPLES COLLECTED DURING CALENDAR YEAR:2019 FACILITY NAME Martin's Auto Salvage Inc. Raleigh, NC COUNTY Wake PERSON COLLECTING SAMPLE(S) Paul Spagenburg PHONE NO. (919) 231-6416 CERTIFIED LABORATORY(S) Pace Analytical Lab# 12 Lab# PLEASE REMEMBER TO SIGN ON THE REVERSE - 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. 00400 00530 ---- 77023 01051 78141 Outfall Date Total pH, Total Suspended Non-polar Ethylene Glycol, Lead,Total Total Toxic Sample Collected, Rainfall, Standard Solids(TSS), O&G/TPH mg/L Recoverable, 3 No. Organics 3, mo/dd/year 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 1.0 001 9/10/19 0.50 N/A 8.6 <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 STORMWATER DISCHARGE OUTFALL(SDO) MONITORING REPORT Facilities that incorporate a solvent management plan into the Stormwater Pollution Prevention Plan may request that DWQ waive monitoring of total toxic organics. The solvent management plan shall include a list of the total toxic organic compounds used and the other elements listed in the General Permit. For those facilities allowed such a waiver,the discharger shall sign the following certification statement: Solvent Management Plan Certification Statement "Based upon my inquiry of the person or persons directly responsible for managing compliance with the permit monitoring requirement for total toxic organics(TTO),I certify that to the best of my knowledge and belief, no dumping of concentrated toxic organics into the stormwater or areas which are exposed to rainfall or stormwater runoff has occurred since filing the last discharge monitoring report. I further certify that this facility is implementing all the provisions of the solvent management plan included in the Stormwater Pollution Prevention Plan." Name(Print name) Title(Print title) Signature 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 dir e\I ctly responsible for :ath ring the information,the information submitted is,to the best of my knowledge and belief,true,accurate,and complete. I am aware that th 're s niff nt p:. al ies for submitting false information,including the possibility o`fines and imprisonment for knowing violations." dI ' 1FAOIL 16 I lc] (Signature (Date) Form SWU-251,last revised October 25, 2012 Page 2 of 2 ' Pace Analytical Services,LLC aceAnalytical 9800 Kincey Ave. Suite 100 Huntersville,NC 28078 www.pacelabs.com (704)875-9092 September 20, 2019 Chuck Hoffman Mid-Atlantic Associates, Inc 409 Rogers View Court Raleigh, NC 27610 RE: Project: Martins Auto Salvage Raleigh Pace Project No.: 92444819 Dear Chuck Hoffman: Enclosed are the analytical results for sample(s) received by the laboratory on September 10, 2019. 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 tyriek.hooks@pacelabs.com (704)875-9092 Project Manager Enclosures cc: Ron Davis, Mid Atlantic Associatees, Inc. Q PCCRF-, 4 , 13 _ REPORT OF LABORATORY ANALYSIS This report shall not be reproduced,except in full, \oily <4 ' without the written consent of Pace Analytical Services,LLC. Page 1 of 13 @pRKt0 aceAnalytica! Pace Analytical Services,LLC e 9800 Kincey Ave. Suite 100 Huntersville,NC 28078 wwwpacefebs.00m (704)875-9092 CERTIFICATIONS Project: Martins Auto Salvage Raleigh Pace Project No.: 92444819 Indiana Certification IDs 7726 Moller Road,Indianapolis, IN 46268 Ohio VAP Certification#:CL0065 Illinois Certification#:200074 Oklahoma Certification#:2018-101 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#:P330-16-00257 Michigan Department of Environmental Quality,Laboratory #9050 Charlotte Certification IDs 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 Virginia/ELAP Certification#:460221 North Carolina Wastewater Certification#:12 Asheville Certification IDs 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 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 13 Pace Analytical Services,LLC aceAnalytical 0 9800 Kincey Ave. te 100 Huntersv Ile,NC128078 ei wpecefe6s.com (704)875-9092 SAMPLE ANALYTE COUNT Project: Martins Auto Salvage Raleigh Pace Project No.: 92444819 Analytes Lab ID Sample ID Method Analysts Reported Laboratory 92444819001 Outfall No.1 SM 2540D-2011 NMH 1 PASI-E EPA 1664E AAC1 1 PASI-C EPA 8015 Alcohol-Glycol CPH 1 PASI-I EPA 6010D DS 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 13 Pace Analytical Services,LLC aceAnalytical a 9800 Kincey Ave. Suite 100 Huntersville,NC 28078 www.pac&ebacom (704)875-9092 ANALYTICAL RESULTS Project: Martins Auto Salvage Raleigh Pace Project No.: 92444819 Sample: Outfall No.1 Lab ID: 92444819001 Collected: 09/09/19 09:10 Received: 09/10/19 13:28 Matrix: Water Parameters Results Units Report Limit DF Prepared Analyzed CAS No. Qual 2540D Total Suspended Solids Analytical Method:SM 2540D-2011 Total Suspended Solids 8.6 mg/L 2.5 1 09/11/19 11:09 1664 SGT-HEM,TPH Analytical Method:EPA 1664B Total Petroleum Hydrocarbons ND mg/L 5.0 1 09/20/19 06:32 8015M Glycols in water Analytical Method:EPA 8015 Alcohol-Glycol Ethylene glycol ND mg/L 5.0 1 09/17/19 16:02 107-21-1 6010 MET ICP Analytical Method:EPA 6010D Preparation Method:EPA 3010A Lead ND ug/L 5.0 1 09/12/19 20:48 09/14/19 22:43 7439-92-1 REPORT OF LABORATORY ANALYSIS This report shall not be reproduced,except in full, Date:09/20/2019 06:14 PM without the written consent of Pace Analytical Services,LLC. Page 4 of 13 Pace Analytical Services,LLC aceAnalytical• 9800 Kincey Ave. Suite 100 Huntersville,NC 28078 wwwpacek6s.com (704)875-9092 QUALITY CONTROL DATA Project: Martins Auto Salvage Raleigh Pace Project No.: 92444819 QC Batch: 497150 Analysis Method: SM 2540D-2011 QC Batch Method: SM 2540D-2011 Analysis Description: 2540D Total Suspended Solids Associated Lab Samples: 92444819001 METHOD BLANK: 2676910 Matrix: Water Associated Lab Samples: 92444819001 Blank Reporting Parameter Units Result Limit Analyzed Qualifiers Total Suspended Solids mg/L ND 2.5 09/11/19 09:34 LABORATORY CONTROL SAMPLE: 2676911 Spike LCS LCS %Rec Parameter Units Conc. Result %Rec Limits Qualifiers Total Suspended Solids mg/L 250 226 90 90-110 SAMPLE DUPLICATE: 2676912 92444597001 Dup Parameter Units Result Result RPD Qualifiers Total Suspended Solids mg/L ND ND SAMPLE DUPLICATE: 2676913 92444792001 Dup Parameter Units Result Result RPD Qualifiers Total Suspended Solids mg/L 5.4 5.4 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:09/20/2019 06:14 PM without the written consent of Pace Analytical Services,LLC. Page 5 of 13 Pace Analytical Services,LLC aceAnalytical0 9800 Kincey Ave. Suite 100 Huntersville,NC 28078 xempe acavn (704)875-9092 QUALITY CONTROL DATA Project: Martins Auto Salvage Raleigh Pace Project No.: 92444819 QC Batch: 498910 Analysis Method: EPA 1664E QC Batch Method: EPA 1664B Analysis Description: 1664 SGT-HEM,TPH Associated Lab Samples: 92444819001 METHOD BLANK: 2685357 Matrix: Water Associated Lab Samples: 92444819001 Blank Reporting Parameter Units Result Limit Analyzed Qualifiers Total Petroleum Hydrocarbons mg/L ND 4.8 09/20/19 06:24 LABORATORY CONTROL SAMPLE: 2685358 Spike LCS LCS %Rec Parameter Units Conc. Result %Rec Limits Qualifiers Total Petroleum Hydrocarbons mg/L 19.2 19.4 101 64-132 MATRIX SPIKE SAMPLE: 2685359 35497603001 Spike MS MS %Rec Parameter Units Result Conc. Result %Rec Limits Qualifiers Total Petroleum Hydrocarbons mg/L 5.0U 19.6 21.8 107 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:09/20/2019 06:14 PM without the written consent of Pace Analytical Services,LLC. Page 6 of 13 Pace Analytical Services,LLC aceAnalytical• 9800 Kincey Ave. Suite 100 Huntersville,NC 28078 www.pacwhbs.com (704)875-9092 QUALITY CONTROL DATA Project: Martins Auto Salvage Raleigh Pace Project No.: 92444819 QC Batch: 521772 Analysis Method: EPA 8015 Alcohol-Glycol QC Batch Method: EPA 8015 Alcohol-Glycol Analysis Description: EPA 8015 Modified Associated Lab Samples: 92444819001 METHOD BLANK: 2407467 Matrix: Water Associated Lab Samples: 92444819001 Blank Reporting Parameter Units Result Limit Analyzed Qualifiers Ethylene glycol mg/L ND 5.0 09/16/19 12:53 LABORATORY CONTROL SAMPLE: 2407468 Spike LCS LCS %Rec Parameter Units Conc. Result %Rec Limits Qualifiers Ethylene glycol mg/L 25 29.6 119 48-150 MATRIX SPIKE&MATRIX SPIKE DUPLICATE: 2407469 2407470 MS MSD 92445077002 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 20.0 21.4 80 85 34-153 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:09/20/2019 06:14 PM without the written consent of Pace Analytical Services,LLC. Page 7 of 13 Pace Analytical Services,LLC aceAnalyticale 9800 Kincey Ave. Suite 100 Huntersville,NC 28078 wnwpacelabs.com (704)875-9092 I QUALITY CONTROL DATA Project: Martins Auto Salvage Raleigh Pace Project No.: 92444819 QC Batch: 497627 Analysis Method: EPA 6010D QC Batch Method: EPA 3010A Analysis Description: 6010 MET Associated Lab Samples: 92444819001 METHOD BLANK: 2679460 Matrix: Water Associated Lab Samples: 92444819001 Blank Reporting Parameter Units Result Limit Analyzed Qualifiers Lead ug/L ND 5.0 09/14/19 21:52 LABORATORY CONTROL SAMPLE: 2679461 Spike LCS LCS %Rec Parameter Units Conc. Result %Rec Limits Qualifiers Lead ug/L 500 485 97 80-120 MATRIX SPIKE&MATRIX SPIKE DUPLICATE: 2679462 2679463 MS MSD 92445385001 Spike Spike MS MSD MS MSD %Rec Parameter Units Result Conc. Conc. Result Result %Rec %Rec Limits RPD Qual Lead ug/L ND 500 500 513 514 103 103 75-125 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:09/20/2019 06:14 PM without the written consent of Pace Analytical Services,LLC. Page 8 of 13 Pace Analytical Services,LLC aceAnalytical 9800 KinceyAve. Suite 100 Huntersville,NC 28078 www.pacelabs.com (704)875-9092 QUALIFIERS Project: Martins Auto Salvage Raleigh Pace Project No.: 92444819 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 PASI-A Pace Analytical Services-Asheville PASI-C Pace Analytical Services-Charlotte PASI-E Pace Analytical Services-Eden PASI-I Pace Analytical Services-Indianapolis REPORT OF LABORATORY ANALYSIS This report shall not be reproduced,except in full, Date:09/20/2019 06:14 PM without the written consent of Pace Analytical Services,LLC. Page 9 of 13 Pace Analytical Services,LLC • aceAnalyticale 9800 Kincey Ave. Suite 100 Huntersville,NC 28078 www patxra6s.com (704)875-9092 QUALITY CONTROL DATA CROSS REFERENCE TABLE Project: Martins Auto Salvage Raleigh Pace Project No.: 92444819 Analytical Lab ID Sample ID QC Batch Method QC Batch Analytical Method Batch 92444819001 Outfall No.1 SM 2540D-2011 497150 92444819001 Outfall No.1 EPA 1664E 498910 92444819001 Outfall No.1 EPA 8015 Alcohol-Glycol 521772 92444819001 Outfall No.1 EPA 3010A 497627 EPA 6010D 497642 REPORT OF LABORATORY ANALYSIS This report shall not be reproduced,except in full, Date:09/20/2019 06:14 PM without the written consent of Pace Analytical Services,LLC. Page 10 of 13 Document Name: Document Revised:February 7,2018 q,,'��' Sample Condition Upon Recelpt(SCUR) Pace 1 ofZ rv,cuy�Gai• Document Na.: Issuing Authority: • F-CAR-CS-033-Rev.06 Pace Carolinas Quality Office Laboratory receiving samples: Asheville[] Eden❑ Greenwood❑ Huntersvflle 0 RaleighN Mechanicsville❑ sample Condition. . Client Name: wo# : 92444819 . .Upnn-Rcrcip[_ .. . A Y I i�— t(]lN1�\(� ( " A ly�L�0: III11111111 Courier. :Fed Ex UPS ['LISPS ['Client *1111111 [ointherdal are ['Other._ 92 44819 El924 • Custody Seal Present? ❑Yes [?No Seals Intact? ['Yes No Date/initials Person Examining Conten Packing Material: ❑Bubble Wrapiubble Bags , one ❑ Other Biological Tissue Frozen? (1Yes flNo flN/A Thermometer: /�L.zy� Type of Ice: Wet ❑Blue ❑None SIR nunID:=L(1Lf� Cooler Temp('C): "5 . I Correction Factor:Ad teat `C) Q Temp should be above freezing to o'C Cooler Temp Corrected('C): ;-'81. ❑SamF'es out of temp criteria.Samples an im,cooling process has begun USDA Regulated Soil (71 N/A,watecsamplel Did samples originate in a quarantine tone Kitten tine United States:CA,NY,or SC(check maps)? Did samples originate from a foreign source(internationally, ❑Yes ❑yo including Hawaii and Puerto Rico)?❑Yes ❑No Comm ents/Discrepancy: Chain of Custody Present? k`'t'es ❑No ON/A 1.i Samples Arrivedt Ti Arrived within Hold me? es ❑No ON/A 2. Short Hold lime Analysis(<72 hr.)? Des Vic ❑WA 3- Rush Turn Around Time Requested? Ores (vo ON/A 4. Sufficient Volume? p'es No N/A 5. Correct Containers Used? vies ONO ❑N/A 6. -Pace Containers Used? Res ❑No DN/A , Containers.matt? Res ❑No ON/A 7- I Dissolved analysis:Samples Field Filtered? ❑Yes Dims Q9/A 8. Sample Labels Match CDC? Wgfes ❑No ON/A 9. -Includes Date�me/lD/Analysis Matrix: L sx)T _ Headspace In VOA Vials(>5 6mm)1 _❑N❑ o 'y-+�a , Lo' Trip Blank Present? Ores ❑No !ic/A 11. Trip Blank Custody Seals Present? Ores ❑No 63112A COMMENTS/SAMPLE DISCREPANCY Field Data Required? Ores ONo i Lot ID of split cants inert: CLIENT NOTIFICATION/RESOLUTION i t Person contacted: Dateinme: Date Project Manager SCURF Review: q f/1 1 • , r Project Manager SRF Review: Oats '`//qe 1 I Page 11 of 13 • Document Name: Document Revised:February 7,2018 Sample Condition Upon ReceiptiSCUR) Page loft 2eca Document No.: Issuing Authority: F-CAR-CS-033-Rev.06 Pace Carolinas Qualfry Office *Check mark top half of box if pH and/or dechlorination is Project 13 WO# : 92444819 verified and within the acceptance range for preservation Due Date: 09/24/19 PM: TIH samples. Exceptions:VOA,Conform,TDC,Oil and Grease,DR0/8015(water)DOC,LLHg CLIENT: 92—MID ATLAN **Bottom half of box is to list number of bottle u ft: " u a _ z i < < 4 E 9 O• a - Z Z 7 n : as i0 m ✓ v v Z r'r n '" c ,J v N T U Q 2 ? d ? ? v d e v v f. a v r g ? < e o 7 a N a =a m n A, 2 v `t' n n Z ? a 5 jg Z v� i m v 2 2v `e 4 Z ut u g u ttr a m r A a rn g O Om m 1 � = c c a c C c a l z Za (0 to o. j o ry E ? N ? P 2 > ° y z c c 7 ' ? 2 m N Z - 7 S ._ 2 . a LI y c a " X u u . A m y` u u u « a n .. `e E r Z 3 `i` 5 x = = M a `e u` EE e le `Zl u a E c A o _m a o a o E E d E a n O O O O °n ia n '^ a .al h 6 p- j F. o n. Ja a j m < a , d „L. > > J s „ E E E E E E E E E E E E E v_ u` w o c` m E E E E > i o ° g o 0 .P nP rn -, N n 74 N 3 ,, ,., ,`�• , ,c,Z O y Ls .r ° c N ry ry Y = 7 7 7 3 a 2 N O LL 3 S 3 �n 1 m m A m a ( �n '' m v E a T. N a m v 2 CO 'i0 t9 (7 0 t7 O a i e a a a a a a co a �7 CotO 4m a > 0 m m a m a m m m 3 a d a d a a o > > 0 > r1y\ I + \ \ i .3 \ . 12 \ \ , - \ r3 \ \ 4 _ 5 fi \ I 7 —\\ ,'\, , \\ t 8 \ 9 \ . i ID \ \ u N \\ _ 1 U \ I i \ \ \ 1 1 i . \-' \.\\ pH Adjustment Log for Preserved Samples Sample ID I Type of Preservative r pH upon receipt Date preservation adlusted Time preservation Amount of Preservative tot al adjusted added Note! Whenever there is a d%screpancv affecting North Carcena compliance samples,a copy of this form will be sent to the North Carcl'na DEHMR Cer cstion Office(I.e. Out of Hold,incorrect preservative.out of temp.incorrect containers. Page 12 of 13 ar CHAIN-OF-CUSTODY!Analytical Request Document /�C��`� u� The Chain-of-Custody is a LEGAL DOCUMENT.All relevant fields mt.ct be completed accurately. Section A SectionB Section C Required Client information: Required Project Information: Invoice Mrfomratlon: Company: Martin's Import Sohropc Report To: Junior Mann L Page: 1 Of 1 Attention:Address: 5810 Poole Road Copy To: Raleigh,NC 27610 Company Marne. Email'. Address: _ _ Purchase Order R: Y'�;-:'.`.av'�r.: - Poce Quote: J"r� <-`/ ( Req'Tda 7{9crtcy �:C:+ Phone. Fax ` (Y'��T��"�^r�� Requested Due Date: i ProtectName: Martin's Auto Salvage-RaIo Pace Proeci Mnnage,- r,cote poskxowsktt�pacclets;.corn, Project A: Parr Prorib X. 5921_7 `1 rDA'4t:ocaNdn' T'it173.1 i NC F .. -43 urs R--Airalysis.Flltvry lrffp, �, 3 p;'' `ulna coo' COLLECTED Preservatives ,r _ ❑'i,o, WYe DW b U Q w.•.e, w- 8 .._ _ wxwwe. was n 9 w SAMPLE ID Sal :. ad Mond St V O 40: 2 w a u START END u m: r One Character per box. wee vo v a I" m L7 (A.Z,0-91,-) N' an �i �' w 2 v m a 3 .G Sample Ids must be unique TS chi j ? .. r� .i: g U W Q g N a U e On 4/8/ - sN - 2I o2s �zyy9 DATE TIME DATE TIME e a D = S x z z Q p :a." ' u h mo o_1 . Oulfau No.7 WT 9/(7. �'r7J 'i7 J_'iv — Sfg rrf'-•LY 04 ' .r - a7. Ji.,.:%- BYJJIFF7L1ATIlA1 -T77Sil. f:-^�4 -.r.. - -f �'� ..'t'TY�:i c BYi AF7'1LfA ioiJ' Dn1-,774' r : e: i Y PRINT Name of SAMPLER l: f C� Z o ff/f�' ' n U SIGNATU PLER: 1► DATE : /fined - i �1.4 l_i_ to o co o ca