NCG210111_DMR_20200619

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina DEMLR General Permit No. NCG210000
Date submitted 6/19/2020
CERTIFICATE OF COVERAGE NO. NCG21 0111
FACILITY NAME Blue Ridge Fiberboard
COUNTY Caswell
PERSON COLLECTING SAMPLES Christie Kueneman
LABORATORY face Lab Cert. #
Comments on sample collection or analysis:
SAMPLE COLLECTION YEAR 2020
SAMPLE PERIOD Jan -June ❑ July -Dec
RF(',4\lF, or ❑ Monthly' (month)
DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
SUN 2 9 2020 ❑Zero -flow ©Water Supply [:]SA
FILES
❑Other
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Part A: Stormwater Benchmarks and Monitoring Results (Monitoring is required only if the facility stores exposed accumulations of sawdust, wood chips,
bark, mulch, or other similar material on site for longer than seven (7) days.)
❑ No discharge this period?2
Outfall No.
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
Inches3
Chemical Oxygen Demand
Total Suspended Solids
Benchmarks ===>
-
-
120 mg/L
100 mg/L or 50 mg/L4
NC001
5/27/2020
.48
0 mg/1
42.2 mg/1
NCO02
5/27/2020
.48
167 mg/l
34.6 mg/1
1 Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
2 For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here.
3The total precipitation must be recorded using data from an on -site rain gauge. Unattended sites may be eligible for a waiver of the rain gauge requirement.
4 See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Note: Results must be reported in numerical format. For example, do not report Below Detection Limit, BDL, <PQL, Non -detect, ND, or other similar non -
numerical format. When results are below the applicable limits, they must be reported in the format, "<XX mg/L", where XX is the numerical value of the
detection limit, reporting limit, etc. in mg/L.
Note: If you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses. See General Permit text.
Permit Date: 8/1/2013-7/31/2018 SWU-245, last revised 7/31/2013
Page 1 of 2

Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month.
❑ No discharge this period?Z
Outfall No.
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
Inches3
Non -polar O&G by EPA
1664 (SGT-HEM)
Total Suspended Solids
Benchmarks ===>
_
15 mg/L
100 mg/L or 50 mg/L4
Footnotes from Part A also apply to this Part B
Note: if you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses. See General Permit text.
FOR PART A AND PART B MONITORING RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES ❑ NO
IF YES, HAVE YOU CONTACTED THE DEMLR REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an original and one copv of this DMR, including all "No Discharae" reports, within 30 days of receipt of the lab results (or at end of monitorina period
in the case of "No Discharae" reports) to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED:
"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."
(Signature of Permittee)
Permit Date: 8/1/2013-7/31/2018
6/19/2020
(Date)
SWU-245, last revised 7/31/2013
Page 2 of 2

aceAnalytical
www.pacelabs.com
June 03, 2020
Mike Veihl
Blue Ridge Fiberboard
RE: Project: WW Testing (5/27-5/28)
Pace Project No.: 92479352
Dear Mike Veihl:
Pace Analytical Services, LLC
205 East Meadow Road - Suite A
Eden, NC 27288
[phone]
Enclosed are the analytical results for sample(s) received by the laboratory on May 28, 2020. The results relate only to the
samples included in this report. Results reported herein conform to the applicable TNI/NELAC Standards and the
laboratory's Quality Manual, where applicable, unless otherwise noted in the body of the report.
The test results provided in this final report were generated by each of the following laboratories within the Pace Network:
• Pace Analytical Services -Asheville
• Pace Analytical Services - Eden
If you have any questions concerning this report, please feel free to contact me.
Sincerely,
Clayton McCrickard
[e-mail]
[phone]
Project Manager
Enclosures
cc: David Gillespie
Christina Kueneman, Blue Ridge Fiberboard
Regina Raines, Blue Ridge Fiberboard
Mike Veihl, Blue Ridge Fiberboard
Tammy Yeatts, Blue Ridge Fiberboard
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 11

aceAnalytical
www.pwmlbs.com
Project: WW Testing (5/27-5128)
Pace Project No.: 92479352
Pace Analytical Services, LLC
205 East Meadow Road - Suite A
Eden, NC 27288
[phone]
Pace Analytical Services Asheville
2225 Riverside Drive, Asheville, NC 28804
Florida/NELAP Certification #: E87648
Massachusetts Certification #: M-NC030
North Carolina Drinking Water Certification #: 37712
Pace Analytical Services Eden
205 East Meadow Road Suite A, Eden, NC 27288
North Carolina Drinking Water Certification #: 37738
CERTIFICATIONS
North Carolina Wastewater Certification #: 40
South Carolina Certification #: 99030001
Virginia/VELAP Certification #: 460222
North Carolina Wastewater Certification #: 633
Virginia/VELAP Certification #: 460025
REPORT OF LABORATORY ANALYSIS
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without the written consent of Pace Analytical Services, LLC. Page 2 of 11

G
1�;a'ceAnalytica(
www.pacolabs.com
Project: WW Testing (5127-5/28)
Pace Project No.: 92479352
Lab ID Sample ID
92479352001 OUTFALL 1
92479352002 OUTFALL 2
92479352003 OUTFALL 3
92479352004 CLARIFIER
92479352005 #2 LAGOON
92479352006 WET WELL
PASI-A = Pace Analytical Services - Asheville
PASI-E = Pace Analytical Services - Eden
Pace Analytical Services, LLC
205 East Meadow Road - Suite A
Eden, NC 27288
[phone]
SAMPLE ANALYTE COUNT
Method
Analysts
Analytes
Reported
Laboratory
SM 2540D-2011
SOB
1
PASI-E
SM 5220D-2011
LMS1
1
PASI-A
SM 2540D-2011
SOB
1
PASI-E
SM 5220D-2011
LMS1
1
PASI-A
SM 2540D-2011
SOB
1
PASI-E
SM 5220D-2011
LMS1
1
PASI-A
SM 2540D-2011
SOB
1
PASI-E
SM 521OB-2011
SOB
1
PASI-E
SM 2540D-2011
SOB
1
PASI-E
SM 521OB-2011
SOB
1
PASI-E
SM 254OD-2011
SOB
1
PASI-E
SM 521 OB-2011
SOB
1
PASI-E
REPORT OF LABORATORY ANALYSIS
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without the written consent of Pace Analytical Services, LLC. Page 3 of 11

aceAnalytical
wrrw.p *18bS.coe
ANALYTICAL RESULTS
Pace Analytical Services, LLC
205 East Meadow Road - Suite
Eden, NC 27288
[phone]
Project: WW Testing (5/27-5/28)
Pace Project No.: 92479352
Sample: OUTFALL 1
Lab ID: 92479352001 Collected: 05/27/20 17:10
Received: 05/28/20 12:30 Matrix: Water
Parameters
Results Units Report Limit DF
Prepared Analyzed CAS No. Qual
2540D TSS, Low -Level, Eden
Analytical Method: SM 254OD-2011
Pace Analytical Services - Eden
Total Suspended Solids
42.2 mg/L 2.2 1
06/01/20 15:29
5220D COD
Analytical Method: SM 5220D-2011 Preparation Method: SM 5220D-2011
Pace Analytical Services -Asheville
Chemical Oxygen Demand
ND mg/L 25.0 1
06/01/20 18:14 06/02/20 15:48
Sample: OUTFALL 2
Lab ID: 92479352002 Collected: 05/27/20 17:25
Received: 05/28/20 12:30 Matrix: Water
Parameters
Results Units Report Limit DF
Prepared Analyzed CAS No. Qual
2540D TSS, Low -Level, Eden
Analytical Method: SM 254OD-2011
Pace Analytical Services - Eden
Total Suspended Solids
34.6 mg/L 1.1 1
06/01/20 15:29
5220D COD
Analytical Method: SM 5220D-2011 Preparation Method: SM 5220D-2011
Pace Analytical Services -Asheville
Chemical Oxygen Demand
167 mg/L 25.0 1
06/01/20 18:14 06/02/20 15:48
Sample: OUTFALL 3
Lab ID: 92479352003 Collected: 05/27/20 17:35
Received: 05/28/20 12:30 Matrix: Water
Parameters
Results Units Report Limit DF
Prepared Analyzed CAS No. Qual
2540D TSS, Low -Level, Eden Analytical Method: SM 254OD-2011
Pace Analytical Services - Eden
Total Suspended Solids 57.4 mg/L 2.9 1 06/01/20 15:29
5220D COD Analytical Method: SM 5220D-2011 Preparation Method: SM 5220D-2011
Pace Analytical Services - Asheville
Chemical Oxygen Demand 34.7 mg/L 25.0 1 06/01/20 18:14 06/02/20 15:49
Sample: CLARIFIER Lab ID: 92479352004 Collected: 05/28/20 09:08 Received: 05/28/20 12:30 Matrix: Water
Parameters Results Units Report Limit DF Prepared Analyzed CAS No. Qua[
2540D TSS, Low -Level, Eden Analytical Method: SM 254OD-2011
Pace Analytical Services - Eden
Total Suspended Solids 152 mg/L 13.3 1 06/01/20 15:30
5210E BOD, 5 day EDN Analytical Method: SM 521 OB-2011 Preparation Method: SM 521 OB-2011
Pace Analytical Services - Eden
BOD, 5 day 564 mg/L 2.0 1 05/28/20 14:30 06/02/20 09:57
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
Date: 06/03/2020 02:11 PM without the written consent of Pace Analytical Services, LLC. Page 4 of 11

IaceAnalytical*
(�
wmr.NeMb.eon
ANALYTICAL RESULTS
Project: WW Testing (5/27-5/28)
Pace Project No.: 92479352
Pace Analytical Services, LLC
205 East Meadow Road - Suite A
Eden, NC 27288
[phone]
Sample: #2 LAGOON Lab ID: 92479352005 Collected: 05/28/20 09:28 Received: 05/28/20 12:30 Matrix: Water
Parameters Results Units Report Limit DF Prepared Analyzed CAS No. Qual
2540D TSS, Low -Level, Eden Analytical Method: SM 254OD-2011
Pace Analytical Services - Eden
Total Suspended Solids 313 mg/L 33.3 1 06/01/20 15:30
5210B BOD, 5 day EDN Analytical Method: SM 521OB-2011 Preparation Method: SM 521 OB-2011
Pace Analytical Services - Eden
BOD, 5 day 293 mg/L 2.0 1 05/28/20 14:30 06/02/20 10:01
Sample: WET WELL Lab ID: 92479352006 Collected: 05/28/20 09:38 Received: 05/28/20 12:30 Matrix: Water
Parameters Results Units Report Limit DF Prepared Analyzed CAS No. Qual
2540D TSS, Low -Level, Eden Analytical Method: SM 254OD-2011
Pace Analytical Services - Eden
Total Suspended Solids 403 mg/L 28.6 1 06/01/20 15:31
5210B BOD, 5 day EDN Analytical Method: SM 521OB-2011 Preparation Method: SM 521OB-2011
Pace Analytical Services - Eden
BOD, 5 day 243 mg/L 2.0 1 05/28/20 14:30 06/02/20 10:06
Date: 06/03/2020 02:11 PM
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, LLC.
Page 5 of 11

Ilac
(
eAnalyttal
trvrw.p Illis.com
QUALITY CONTROL DATA
Pace Analytical Services, LLC
205 East Meadow Road - Suite A
Eden, NC 27288
[phone]
Project: WW Testing (5/27-5/28)
Pace Project No.: 92479352
QC Batch: 544472
Analysis Method: SM 2540D-2011
QC Batch Method: SM 2540D-2011
Analysis Description: 2540D TSS, Low Level, Eden
Laboratory: Pace Analytical Services - Eden
Associated Lab Samples: 92479352001, 92479352002, 92479352003, 92479352004, 92479352005, 92479352006
METHOD BLANK: 2899535
Matrix: Water
Associated Lab Samples: 92479352001, 92479352002,
92479352003, 92479352004, 92479352005, 92479352006
Blank Reporting
Parameter
Units
Result Limit Analyzed Qualifiers
Total Suspended Solids
mg/L
ND 1.0 06/01/20 15:28
LABORATORY CONTROL SAMPLE: 2899536
Spike LCS LCS % Rec
Parameter
Units
Conc. Result % Rec Limits Qualifiers
Total Suspended Solids
mg/L
250 246 98 90-110
SAMPLE DUPLICATE: 2899537
92479352006 Dup
Parameter
Units
Result Result RPD Qualifiers
Total Suspended Solids
mg/L
403 350 14
SAMPLE DUPLICATE: 2899538
92479443001 Dup
Parameter
Units
Result Result RPD Qualifiers
Total Suspended Solids
mg/L
6540 6320 3
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
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Date: 06/03/2020 02:11 PM without the written consent of Pace Analytical Services, LLC. Page 6 of 11

IaceAnalyticale
(�
ttluid.ppl�ls.ean
QUALITY CONTROL DATA
Project: WW Testing (5/27-5128)
Pace Project No.: 92479352
QC Batch: 543918 Analysis Method: SM 521OB-2011
QC Batch Method: SM 521 OB-2011 Analysis Description: 5210E BOD, 5 day Final EDN
Laboratory: Pace Analytical Services - Eden
Associated Lab Samples: 92479352004, 92479352005, 92479352006
Pace Analytical Services, LLC
205 East Meadow Road - Suite A
Eden, NC 27288
[phone]
METHOD BLANK: 2896507
Matrix: Water
Associated Lab Samples: 92479352004, 92479352005, 92479352006
Blank Reporting
Parameter
Units
Result Limit
Analyzed Qualifiers
BOD, 5 day
mg/L
ND 2.0
06/02/20 09:08
LABORATORY CONTROL SAMPLE:
2896508
Spike LCS
LCS % Rec
Parameter
Units
Conc. Result
% Rec Limits Qualifiers
BOD, 5 day
mg/L
198 213
108 84.6-115.4
SAMPLE DUPLICATE: 2896510
92479279002 Dup
Parameter Units Result Result RPD Qualifiers
BOD, 5 day mg/L 58.8 54.0 9
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: 06/03/2020 02:11 PM without the written consent of Pace Analytical Services, LLC.
Page 7 of 11

Iac
(
eAnalytical
alirW PWW8b3XM
QUALITY CONTROL DATA
Pace Analytical Services, LLC
205 East Meadow Road - Suite A
Eden, NC 27288
[phone]
Project: WW Testing (5/27-5/28)
Pace Project No.: 92479352
QC Batch: 544514
Analysis Method: SM 5220D-2011
QC Batch Method: SM 5220D-2011
Analysis Description: 5220D COD
Laboratory: Pace Analytical Services - Asheville
Associated Lab Samples: 92479352001, 92479352002,
92479352003
METHOD BLANK: 2899772
Matrix: Water
Associated Lab Samples: 92479352001, 92479352002,
92479352003
Blank Reporting
Parameter Units
Result Limit
Analyzed Qualifiers
Chemical Oxygen Demand mg/L
ND 25.0
06/02/20 15:47
LABORATORY CONTROL SAMPLE: 2899773
Spike LCS
LCS % Rec
Parameter Units
Conc. Result
% Rec Limits Qualifiers
Chemical Oxygen Demand mg/L
750 765
102 90-110
MATRIX SPIKE & MATRIX SPIKE DUPLICATE: 2899774 2899775
MS MSD
2632331001
Spike Spike MS
MSD MS MSD
% Rec
Parameter Units Result
Conc. Conc. Result
Result % Rec % Rec
Limits RPD Qual
Chemical Oxygen Demand mg/L 411
100 100 509
535 98 123
90-110 5 M1,R1
MATRIX SPIKE & MATRIX SPIKE DUPLICATE: 2899776 2899777
MS MSD
2632313002
Spike Spike MS
MSD MS MSD
% Rec
Parameter Units Result
Conc. Conc. Result
Result % Rec % Rec
Limits RPD Qual
Chemical Oxygen Demand mg/L 2540
100 100 3140
3100 593 558
90-110 1 M1
Results presented on this page are in the units indicated by the "Units" column except where an alternate unit is presented to the right of the result.
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
Date: 06/03/2020 02:11 PM without the written consent of Pace Analytical Services, LLC.
Page 8 of 11

aceAnalytical
WWW.PKWlbs.com
Pace Analytical Services, LLC
205 East Meadow Road - Suite A
Eden, NC 27288
[phone]
QUALIFIERS
Project: WW Testing (5/27-5128)
Pace Project No.: 92479352
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.
ANALYTE QUALIFIERS
M1 Matrix spike recovery exceeded QC limits. Batch accepted based on laboratory control sample (LCS) recovery.
R1 RPD value was outside control limits.
REPORT OF LABORATORY ANALYSIS
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Date: 06/03/2020 02:11 PM without the written consent of Pace Analytical Services, LLC. Page 9 of 11

Pace Analytical Services, LLC
,�aneMalytical ® 205 East MeadowRoad- Suite A
Eden,OWN "callbs cam [phone]
QUALITY CONTROL DATA CROSS REFERENCE TABLE
Project: WV1/ Testing (5/27-5/28)
Pace Project No.: 92479352
Analytical
Lab ID Sample ID QC Batch Method QC Batch Analytical Method Batch
92479352001
OUTFALL 1
SM 2540D-2011
544472
92479352002
OUTFALL 2
SM 2540D-2011
544472
92479352003
OUTFALL 3
SM 2540D-2011
544472
92479352004
CLARIFIER
SM 2540D-2011
544472
92479352005
#2 LAGOON
SM 254OD-2011
544472
92479352006
WET WELL
SM 254OD-2011
544472
92479352004
CLARIFIER
SM 521OB-2011
543918
SM 521OB-2011
543947
92479352005
#2 LAGOON
SM 521OB-2011
543918
SM 521OB-2011
543947
92479352006
WET WELL
SM 521OB-2011
543918
SM 521OB-2011
543947
92479352001
OUTFALL 1
SM 5220D-2011
544514
SM 5220D-2011
544569
92479352002
OUTFALL 2
SM 5220D-2011
544514
SM 5220D-2011
544569
92479352003
OUTFALL 3
SM 5220D-2011
544514
SM 5220D-2011
544569
Date: 06/03/2020 02:11 PM
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, LLC.
Page 10 of 11

i CHAIN -OF -CUSTODY Analytical Request Document
Pace Analytical
Chain -of -Custody is a LEGAL DOCUMENT -Complete all releven[ fields
Company: Billing Information:
Report To:
Email To:
Copy To:
Site Collection Info/Address:
Customer Project Name/Number:
State: County/City: Time Zone Collected:
/ [ JPT[ IMTf JCT [ JET
Phone:
Site/Facility ID 4:
Compliance Monitoring?
Email:
I J Yes [ J No
Collected By (print):
Purchase Order H:
DW PWS ID tf:
1th�,;Ik'er n
Quote k:
DW Location Code:
Collected By (signature):
Turnaround Date Required:
Immediately Packed on Ice:
J J Yes [ J No
Sample Disposal:
Rush:
Field Filtered (if applicable):
( I Dispose as appropriate I J Return
[ J Same Day [ J Next Day
I J Yes [ ]No
I I Archive: ----__-
[ J 2 Day [ j S Day
I Hold
(Expedite harRes Apply)
Analysis:
" Matrix Codes (Insert in Matrix box below): Drinking Water (DW), Ground Water (GW), Wastewater (WW),
Product (P), Soil/Solid (SQ, Oil (OL), Wipe (WP), Air (AR), Tissue (TS), Bioassay (B), Vapor (V), Other (OT)
LAB USE ONLY- Affix Worko WO## : 92479352
III IIIIINIIIINIIII
ALL SHADE
92479352
Container
ntainer Preservative Type " yob yto t an r .tic
" Preservative Types: (1) nitric acid, (2) sulfuric acid, (3) hydrochloric acid, (4) sodium hydroxide, (5) zinc acetate,
(G) methanol, (7) sodium bisulfate, (8) sodium thiosulfate, (9) hexane, (A) ascorbic acid, (B) ammonium sulfate,
(C) ammonium hydroxide, (0) TSP, (U) Unpreserved, (0) Other
Comp / Collected (or Res N of sf
Customer Sample ID Matrix ' Grab Composite Start) Composite End CI Ctns •f. Jll
Date Time Date Time (� V
G ut 1 (-iW C-,'a �12 = '
Lan sampie Receipt CnecKiist:
Custody Seals Present/Intact Y N-UK
Custody Signatures Present Y N,HA'
Collector Signature Present .Y-,N NA
Bottles Intact XN NA
Correct Bottles -r N NA
Sufficient Volume 'V' N NA
Samples Received on Ice? N NA
VOA - Headspace Acceptable Y HIM
USDA Regulated Soils Y N !M,
Samples in Holding 'rime el-N NA
Residual ChlorinpfPJgerf,� _ r Y �b"A
Cl Strips: I �� l�-
Sample pH Accept,b a.•T N NA
PH Strips: _
Sulfide Present t Y N NA
Lead Acetate Strips:
LAB USE ONLY:
Lab Sample # / Comments:
1 Lc "f lS�t 1 6)&' K"Tok 1 1 I s= leiei 1`z<21 2 1 x I I "C I I I I I I I I I
N
Customer Remarks / Special Conditions / Possible Hazards: Type of Ice Used: Wet Blue Dry None SHORT HOLDS PRESENT (<72 hours): N N/A
Packing Material Used: Lab Tracking a: 246109
N� Samples received via:
Radchem sample(s) screened (<500 cpm): Y N r'/ FEDEX UPS Client --Courier Pace C Pie
Ielirtpttished
�by/Co
llllll/ 11 aau Date/T me:�R op y: (Date/Time: f��7fry MTJL LAB US ONLY
, �' Table H:
R early.{Signal / Date/Time: IQ-Z eceived by/Co •(SiRnatur Date/lime: f fn 71`
Pre[ i
PM: IJG.
Lab Sample Temperature Info:
Temp Blank Receiv N
Therm ID#:
Cooler 1 Temp Upon Receipt: oC
Cooler 1 Therm Corr. Factor:— C
Cooler 1 Corrected Temp: oC
Comments:
Trip Blank Received: Y N
HCL McOH TSP Other
Non Conformanre(s): Pa6e _ _. ,
YES / NO of: _