NCG080905_DMR_20200610

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No. NCG080000
Date submitted 06/10/2020
CERTIFICATE OF COVERAGE NO. NCG080905
FACILITY NAME Glen Raven Logistics, LLC
COUNTY Alamance
PERSON COLLECTING SAMPLES Mike Murray
LABORATORY Pace Analytical Lab Cert. # 633 Comments
on sample collection or analysis: JUN 2 3 202
SAMPLE COLLECTION YEAR 2020
SAMPLE PERIOD ® Jan -June ❑ July -Dec
or ❑ Monthly' (month)
DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
❑Zero -flow ❑Water Supply [:]SA
❑Other
,'ENTRAL FILES PLEASE REMEMBER TO SIGN ON THE REVERSE 4
f?1r.rr, vECTI�P;t
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? X yes
(if yes, report your analytical results in the table immediately below)
Part A: Vehicle Maintenance Areas Monitoring Requirements (If applicable)
no
❑ No discharge this period'
Outfall
No.
Date
Sample Collected,
mo/dd/yr
00530
00400
00556
Total Suspended
Solids, mg/L
pH,
Standard units
Non -Polar Oil and Grease/TPH EPA
Method 1664 (SGT-HEM), mg/L
New Motor Oil Usage,
Annual average gal/mo
Benchmark
-
50 or 100 see permit
Within 6.0 — 9.0
15
-
1
05/29/2020
10.1
6.8
Not detected (ND)
97.5
Part B: Oil/water Separators and Secondary Containment Areas at Petroleum Bulk Stations and Terminals (If applicable)
Outfall
No.
Date
Sample Collected,
mo/dd/yr
00556
00530
00400
Non -Polar Oil and Grease/TPH EPA Method
1664 (SGT-HEM), mg/L
Total Suspended Solids,
mg/L
pH,
Standard units
Permit Limit
-
15
50 or 100 see permit
6.0 — 9.0
n/a
n/a
n/a
n/a
n/a
STORM EVENT CHARACTERISTICS:
For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here.
SWU-250 last revised April 11, 2013
Page I of 2

Date 05/29/2020 (first event sampled)
Total Event Precipitation (inches): 2
Date (list each additional event sampled this reporting period, and rainfall amount)
Total Event Precipitation (inches):
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 ANYONE OUTFALL? YES ❑ NO ❑
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an original and one copy of this DMR, including all "No Discharge" reports, within 30 days of receipt of the lab results (or at end of monitoring period in
the case of "No Discharge" reports) to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
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)
(Date)
Additional copies of this form may be downloaded at: http://portal.ncdenr.org/web/wq/ws/su/npdessw#tab-4
SWU-250
last revised April 11, 2013
Page 2 of 2

00vitown'-Atal
Qmlhty
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance on filling out this form, please visit https:l/dcq,nc,gov/about/divisions/ciiergy-mineral-land-resources/
npdes-stormwater-gps
Permit No.: NJC/,4g_/ 0 4 0 b/ d/ ca/ or Certificate of Coverage No,: N/C/G/ 0 J r/ 0/ q J 6 I51/
Facility Name: V_AL Aqva) e
County: No.
Inspector: M CAA V,_4Ax
Date of Inspection: __ fl-2
Time of Inspection: ----- E. Jx) -/4 tyI
Total Event Precipitation (inches): _d.
. ..........
All permits require qualitative monitoring to be performed during a "measurable storm event."
A "measurable storm event" is a storm event that results in an actual discharge from the permitted site
outfall. The previous measurable storm event must have been at least 72 hours prior. The 72-hour storm
interval does not apply if the permittee is able to document that a shorter interval is representative for
local storm events during the sampling period, and the permittee obtains approval from the local DEMLR
Regional Office.
By this signature, I certify that this report is accurate and complete to the best of my knowledge:
(Signature of Permittee or Designee)
I. outfall Description:
Outfall No. Structure (pipe, ditch, etc.):
Receiving Stream:
Describe the industrial activities that occur within the outfall drainage area:
W11 A C /7(0tj S C'
Page I ot'2
SWU-242, Last modified 06A)IMIR

2. Color: Describe the color of the di
(light, medium. dark) as descriptors:
using basic colors (red, bro blue, etc.) and tint
An W V ( A C L.. 1; 1
3. Odor: Describe any distinct odors that the discharge may have (i.e,, smells strongly of oil, weak
chlorine odor, etc.): ri 1) 1 1 -,
4. Clarity: Choose the number which best describes the clarity of the discharge, where I is clear
and 5 is very cloudy: I C2) 3 4 5
S. Floating Solids. Choose the number which best describes the amount of floating solids in the
stormwater discharge, where I is no solids and 5 is the surface covered with floating solids:
( 1) 2 3 4 5
6. Suspended Solids: Choose the number which best describes the amount of suspended solids in
the stormwater discharge, where I is no solids and 5 is extremely muddy:
0 4 5
7. Is there any foam in the stormwater discharge? 0 Yes 0 No.
8. Is there an oil sheen in the storniwater discharge? 0Yes &No.
9. Is there evidence of erosion or deposition at the outfall? 0 Yes 0 No.
10. Other Obvious Indicators of Stormwater Pollution:
List and describe
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition may be
indicative of pollutant exposure. These conditions warrant further investigation.
Page 2 of 2
SWU-242, Last modified 06/0 1 /2018

aceAnaljftal
www.pacalabscom
June 04, 2020
Steven Losiewicz
Glen Raven
RE: Project: GLEN RAVEN (5/29)
Pace Project No.: 92479508
Dear Steven Losiewicz:
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 29, 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 - Charlotte
• 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: Kristy King (Truck Wash), Glen Raven Mills,lnc
Mike Murray, Glen Raven -Logistics
Charles Walser, GRTF-Logistics
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

aceAnalytieai®
wwar.pocaiabs can
Project: GLEN RAVEN (5/29)
Pace Project No.: 92479508
Pace Analytical Services, LLC
205 East Meadow Road - Suite A
Eden, NC 27288
[phone]
Pace Analytical Services Charlotte
9800 Kincey Ave. Ste 100, Huntersville, NC 28078
Louisiana/NELAP Certification # LA170028
North Carolina Drinking Water Certification #: 37706
North Carolina Field Services Certification #: 5342
North Carolina Wastewater Certification #: 12
Pace Analytical Services Eden
205 East Meadow Road Suite A, Eden, NC 27288
North Carolina Drinking Water Certification #: 37738
CERTIFICATIONS
South Carolina Certification #: 99006001
Florida/NELAP Certification #: E87627
Kentucky UST Certification #: 84
Virginia/VELAP Certification #: 460221
North Carolina Wastewater Certification #: 633
Virginia/VELAP 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 11

aceAna�j/�ical
'J `
www.Puslabs.com
SAMPLE ANALYTE COUNT
Pace Analytical Services, LLC
205 East Meadow Road - Suite A
Eden, NC 27288
[phone]
Project:
GLEN RAVEN (5/29)
Pace Project No.:
92479508
Analytes
Lab ID
Sample ID
Method
Analysts
Reported
Laboratory
92479508001
GLEN RAVEN
SM 2540D-2011
AMI
1
PASI-E
EPA 9040C
MWF
1
PASI-E
EPA 1664B
WAM
1
PASI-C
PAST-C = Pace Analytical Services - Charlotte
PASI-E = Pace Analytical Services - Eden
REPORT OF LABORATORY ANALYSIS
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without the written consent of Pace Analytical Services, LLC. Page 3 of 11

aceAnaljftal
www.pacNsbs.com
ANALYTICAL RESULTS
Pace Analytical Services, LLC
205 East Meadow Road - Suite A
Eden, NC 27288
[phone]
Project: GLEN RAVEN (5/29)
Pace Project No.: 92479508
Sample: GLEN RAVEN
Lab ID: 92479508001 Collected:
05/29/20 08:00
Received: 05/29/20 10:07 Matrix: Water
Parameters
Results Units Report Limit DF
Prepared Analyzed CAS No. Qual
2540D Total Suspended Solids
Analytical Method: SM 2540D-2011
Pace Analytical Services - Eden
Total Suspended Solids
10.1 mg/L
2.6 1
05/29/20 12:01
9040 pH
Analytical Method: EPA 9040C
Pace Analytical Services - Eden
pH at 25 Degrees C
6.8 Std. Units
0.10 1
05/29/20 15:12 H3
HEM, Oil and Grease
Analytical Method: EPA 1664B
Pace Analytical Services - Charlotte
Oil and Grease
ND mg/L
5.0 1
06/04/20 10:53
Date: 06/04/2020 02:59 PM
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, LLC.
Page 4 of 11

au AnalXical
j fila
www.pacmlabs.com
QUALITY CONTROL DATA
Project: GLEN RAVEN (5/29)
Pace Project No.: 92479508
QC Batch: 544146 Analysis Method: SM 25400-2011
QC Batch Method: SM 254OD-2011 Analysis Description: 2540D Total Suspended Solids
Laboratory: Pace Analytical Services - Eden
Associated Lab Samples: 92479508001
METHOD BLANK: 2897857 Matrix: Water
Associated Lab Samples: 92479508001
Blank Reporting
Parameter Units Result Limit Analyzed Qualifiers
Total Suspended Solids mg/L ND 2.5 05/29/20 11:56
Pace Analytical Services, LLC
205 East Meadow Road - Suite A
Eden, NC 27288
[phone]
LABORATORY CONTROL SAMPLE: 2897858
Spike LCS LCS % Rec
Parameter Units Conc. Result % Rec Limits Qualifiers
Total Suspended Solids mg/L 250 248 99 90-110
SAMPLE DUPLICATE: 2897859
92479441001 Dup
Parameter Units Result Result RPD Qualifiers
Total Suspended Solids mg/L 825 867 5
Results presented on this page are In the units Indicated by the "Units" column except where an alternate unit Is presented to the right of the result.
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
Date: 06/04/2020 02:59 PM without the written consent of Pace Analytical Services, LLC.
Page 5 of 11

a0;Analjftal
www.ptacelabs.com
I
QUALITY CONTROL DATA
Project: GLEN RAVEN (5/29)
Pace Project No.: 92479508
QC Batch: 544208 Analysis Method: EPA 9040C
QC Batch Method: EPA 9040C Analysis Description: 9040 pH EDEN
Laboratory: Pace Analytical Services - Eden
Associated Lab Samples: 92479508001
SAMPLE DUPLICATE: 2898206
Parameter
pH at 25 Degrees C
92479378001 Dup
Units Result Result
Std. Units 6.5 6.5
RPD Qualifiers
0 H3
Pace Analytical Services, LLC
205 East Meadow Road - Suite A
Eden, NC 27288
[phone]
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: 06/04/2020 02:59 PM without the written consent of Pace Analytical Services, LLC.
Page 6 of 11

aceAnalXical
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QUALITY CONTROL DATA
Project: GLEN RAVEN (5/29)
Pace Project No.: 92479508
QC Batch: 545175 Analysis Method: EPA 1664E
QC Batch Method: EPA 1664B Analysis Description: 1664 HEM, Oil and Grease
Laboratory: Pace Analytical Services - Charlotte
Associated Lab Samples: 92479508001
METHOD BLANK: 2902785
Associated Lab Samples: 92479508001
Parameter Units
Oil and Grease mg/L
LABORATORY CONTROL SAMPLE: 2902786
Parameter Units
Oil and Grease mg/L
MATRIX SPIKE SAMPLE: 2902787
Parameter Units
Oil and Grease mg/L
Matrix: Water
Blank Reporting
Result Limit Analyzed Qualifiers
ND 5.0 06/0412010:53
Spike LCS LCS
Conc. Result % Rec
40 34.5 86
92479969002 Spike MS
Result Conc. Result
ND 40 35.5
Pace Analytical Services, LLC
205 East Meadow Road - Suite A
Eden, NC 27288
[phone]
% Rec
Limits Qualifiers
78-114
MS % Rec
% Rec Limits Qualifiers
88 78-114
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: 06/04/2020 02:59 PM without the written consent of Pace Analytical Services, LLC.
Page 7 of 11

aceAnalytical
www.Pacolabs.com
Pace Analytical Services, LLC
205 East Meadow Road - Suite A
Eden, NC 27288
[phone]
QUALIFIERS
Project: GLEN RAVEN (5/29)
Pace Project No.: 92479508
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
H3 Sample was received or analysis requested beyond the recognized method holding time.
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
Date: 06/04/2020 02:59 PM without the written consent of Pace Analytical Services, LLC. Page 8 of 11

acaAnaljftal
www.pecolabi.com
QUALITY CONTROL DATA CROSS REFERENCE TABLE
Pace Analytical Services, LLC
205 East Meadow Road - Suite A
Eden, NC 27288
[phone]
Project: GLEN RAVEN (5/29)
Pace Project No.: 92479508
Analytical
Lab ID Sample ID QC Batch Method QC Batch Analytical Method Batch
92479508001
GLEN RAVEN
SM 2540D-2011
544146
92479508001
GLEN RAVEN
EPA 9040C
544208
92479508001
GLEN RAVEN
EPA 1664B
545175
Date: 06/04/2020 02:59 PM
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, LLC.
Page 9 of 11

CHAIN -OF -CUSTODY Analytical Request Document LAB USE ONLY -Affix Workorder/L WO# : 92479508
PaceAnalytical MT)
Chain -of -Custody is a LEGAL DOCUMENT - Complete all relevent fields
�ompany: Billing Information:
� &-) - t f ALL SHADED AE 92479508
kddress: - Container Preservative Type
2eport To: E l T _ /} Preservative Types: (1) nitric acid, (2) sulfuric acid, (3) hydrochloric acid, (4) sodium hydroxide, (S) zinc acetate,
_ 'd' l�fti1 1��•t% - �.,Q�� (6) methanol, (7) sodium bisulfate, (8) sodium thiosulfate, (9) hexane, (A) ascorbic acid, (B) ammonium sulfate,
opy TO Site Collection Info ddress: (Q ammonium hydroxide, (D) TSP, (U) Unpreserved, (0) Other
WA- %AY '" ���' �'� Analyses Lab Profile/Line:
:ustomer Project ame/Number: State: County/City: Time Zone Collected: Lab Sample Receipt Checklist:
/ ( JPT( JMT[ JCT ( JET
Custody Seals Present/Intact(Si7 NA
'hone: Site/Facility ID 9: Compliance Monitoring? Custody Signatures Present Y f A
-mail:( ) Yes ( ]No Collector Signature Present Yi N NA
Battles Intact D N NA
:ollected By (print): Purchase Order N: DW PWS ID q: Correct Bottles N NA
Quote H: OW Location Code: Sufficient volume N NA
Samples Received on Ice ON NA'
:ollected By (signature): Turnaround Date Required: immediately Pace on —Ice- : VOA - Headspace Acceptable Y N',gt
( )Yes ( ]No USDA Regulated Soils Y N�MeM
Samples in Holding Time N
iampfe Disposal: Rush: Field Filtered (if applicable): Residual Chlor' ne Present Y N N -r
I Dispose as appropriate ( ) Return [ ] Same Day [ J Next Day ( J Yes [ ]No Cl Strips: _
( Archive: ( j 2 Day ( ] 3 Day ( j 4 Day [ 15 Day \ Sample pB Aacep e'��_ Y NNa
Hold: Analysis: - PH Strips: -
(Expedite Charges Apply) Sulfide Present Y N 7A '
` Matrix Codes (Insert in Matrix box below): Drinking Water (DW), Ground Water (GW), Wastewater (WW), ` Lead Acetate Strips:
Product (P), Soil/Solid (SL), Oil (OL), Wipe (WP), Air (AR), Tissue (TS), Bioassay (B), Vapor (V), Other (OT)
Lr9 USE ONLY:
Comp / Collected (or Composite End Res H of . / !� i' Lab Sample 1t / comments:
Customer Sample 10 Matrix ' Grab Composite Start) CI Ctns
Date Time Date Time
:ustomer Remarks / Special Conditions / Possible Hazards: Type of Ice Used: Wet Blue Dry None SHORT HOLDS PRESENT (<72 hours): Y N N/A Lab Sample Temperature Info:
N
Packing Material Used: Lab Tracking u: Temp Blank Received: Y NTherm IDft: 41` _7
Cooler 1 Temp Upon Receipt:,] _oC
Radchern sample(s) screened (<5007Samples received via: Cooler 1 Therm Corr, Factor- '• t':oc
): Y N NA
FEDEX UPS Client Courier Pace Courier Cooler 1 Corrected Temp: LJ cC
telinquished by/Company: (Signature) Date(Time: Receive pa Sig red Date/Time: MTJL LAB USE ONLY Comments
lay �s��t
Table M
,4_
Acctnum:
telmqu by/Co any- gnature) Date/Time R - uved,by o any ' I (Signature) Dat me-, / .r Tri Blank Received: Y N NA
Template: yy R
Prelog;n� 1� 4 HCL McOH TSP Other
TORguished by/Company: (Signature) Dat /Time: Reteibed by/Company: (Signatur Date/Time: pM i1 Pa e: _
7 C�Non pag
PB:'*=rT( cC YES / NO Iof: —

Pa''ceAnalytrcal CHAIN -OF -CUSTODY Analytical Request Document
Chain -of -Custody is a LEGAL DOCUMENT - Complete all relevent fields
Company: r
Billing Information:
Address:
L 314 e
Report To:
E I T - lGN iQw`CC, ' o,
Copy . To
IQ A kk
Site Collection Info ddress:
Customer Project ame/Number:
State: County/City: Time Zone Collected:
/ [ JPT[ JMT[ ICT [ JET
Phone:
Email:
Site/Facility ID if:
Compliance Monitoring?
[ J Yes [ ]No
Collected By (print):
Purchase Order #:
Quote #:
DW PWS ID #:
DW Location Code:
Collected By (signature):
Turnaround Date Required:
immediately Packed on Ice:
( J Yes ( ]No
Sample Disposal:
I I Dispose as appropriate ( ) Return
( I Archive:
( IHold:
Rush:
[ J Same Day ( J Next Day
( 12 Day ( j 3 Day ( J 4 pay ( 15 Day
(Expedite Charges Apply)
Field Filtered (if applicable):
I I Yes ( ]No
Analysis:
' Matrix Codes (Insert in Matrix box below): Drinking Water (DW), Ground Water (GW), Wastewater (WW),
Product (P), Soil/Solid (SL), Oil (OL), Wipe (WP), Air (AR), Tissue (TS), Bioassay (B), Vapor IV), Other (OT)
Customer Sample ID
Matrix "
Comp f
Grab
Collected (or
Composite Start)
Composite End
Res
Cl
# of
Ctns
Date
Time
Date
Time
eA-1 u
S3`/�
Customer Remarks / Special Conditions / Possible Hazards:
Type of Ice Used: Wet Blue Dry None
Packing Material Used:
Relinquished by/Company: (Signature)
"FXt Yyvt:1,€�",4,4-
liiquished by/Company: (Signature)
Radche n sample(s) screened (<500
Date/Time: I Received _
7 R ived y
LAB USE ONLY- Affix Workorder/L � V � � 9Z479508
MT, 11111111111111111111111
ALL SHADED AF 92479508
Container Preservative Type *`
" Preservative Types: (1) nitric acid, (2) sulfuric acid, (3) hydrochloric acid, (4) sodium hydroxide, (5) zinc acetate,
(6) methanol, (7) sodium bisulfate, (9) sodium thiosulfate, (9) hexane, (A) ascorbic acid, (6) ammonium sulfate,
(C) ammonium hydroxide, (D) TSP, (U) Unpreserved, (0) Other
Analyses
Lab Profile/Line:
Lab Sample Receipt Checklist^^.
Custody Seals Present/lntactc.Yi�N NA
Custody Signatures Present Y NA
Collector Signature Present YA
Bottles intact - 'iN NA
Correct Bottles (`fN NA
Sufficient Volume �N NA
Samples Received On Ice !,N NA
VOA - Readspace Acceptable Y N iEl
USDA Regulated Soils Y N(!9
Samples in Holding Time epN NA
i.�
s�-
Residual Chlor'ne Present Y N� ��.
r
Cl Strips: '
Sample Accep role_ Y N4Nk
pH
PH strips:
Sulfide Present Y N As
Lead Acetate Strips:
LAB USE ONLY:
Lab Sample tf / Comments:
o
t
SHORT HOLDS PRESENT(<72 bours): Y N N/A
Lab Tracking #: '„s
,1 cj
Samples received via:
): Y N NA FEDEX UPS Client Courier Pace Courier
ap�J(Sig ej� Date/
Time: MTJL LAB USE ONLY
� Table#:
Lab Sample Temperature Info:
Temp Blank Received: _Y N
Therm lD#:1
Cooler 1 Temp Upon Receipt: oC
Cooler 1 Therm Corr. Factor-!�- (z'oC
Cooler 1 Corrected Temp: X-Jy oC
Comments:
ny. (Signal re) Dat Ime, t
.t � �Cr Template: Trip Blank Received: Y N NA
n�. HCL McOH TSP Other
Prelol
ny:(Signatur Date/Time:
PM: Non ConformancePage:
_
PB: F �s -� (` YES / NO of:
j