WQ0005910_Monitoring - 07-2020_20200824

GW-59A COMPLIANCE REPORT FORM Permit #-W 0,0Oe7591C
(Submit oae each monitoring period with Glk' 59 jorrtts.)
1
Enter date monitoring results were due, jo>-�6Will this monitoring report (GW-59 and GW-59A)
YES/
NO
be submitted after the established due date?
2
Was any required Information missing on the GW-59 report forms? t
YES
NO
IF the answer to question 1 or 2 is "YES", list in the space prQvidedkiow the well identification mber(s) and
explain the problems encountered in obtaining the required inform n.
--
_z `' 0 X
'Tr
N o Q
3
Are any of the monitor wells in need of repair or maintenanc am-qed casio, unlocked or missing cap, missing
YES
NO
identification plate, area overgrown, etc.):" If the answer is "kVZ, contacl the ionai Once for guidance,
c
4
Are any monitored constituents equal to or above the established standards?
YES
NO
If the answer to question 4 is "NO", skip to section 8.'
If the answer to question 4 is "YES" list the affected wells individually with constituent(s) and concentrations)
exceeding standards in the space provided below:
�o•4a1 Am�.w.,;q - tv��� l .9�0 1 OS - Mw5 = 'SS t
- n�uJ ►� : t.3a 9,)12
N�ira�-G- nnw4 = ��•�
S
For the constituents identified In question 4 above, have standards been exceeded previously for the
YES
NO
same constituent(s) In the same well(s) in the last two years?
If the answer to question 5 is 'NO", skip to section B.
If the answer to question 5 is "YES", list in the space provided below, each well with constituents) exceeding
standards, concentration(s) reported, an sample collection date for each occurrence (for the last two years).
M�4-N��irpie- 1 v"s- DS
3130100- to-U 3kA-%4 31301Wo-S-1 3)1V1�`t-��3
�tlavl�q- 1o•$y "SS64 -%0'z1��- WAR)
-11�311q- 1o.S-I►a3h4- (#%-1 311'%%It-(oP%
6
Are the monitoring wells listed in section 5 located at or beyond the review boundary?
YES
NO
If the answer is "YES", a groundwater quality problem may be occurring. CONTACT THE REGIONAL
OFFICE IMMEDIATELY FOR GUIDANCE. If the answer is "NO", monitoring wells may be improperly
located; contact the Regional Office.
(v��J►t i6 v�oh vC(JrCS�^n�4}��ie, G>rt/'�C� �aS hO�J \oecv'► C.IOSetl•
/
N/
Ma ►1 a r%2w We%% aA ; s tno4 ye+ 0Ajea av
7
Is the permittee implementing previously approved actions required by the Division involving this
YES
NO
groundwater quality problem?
If the answer to question 7 is `YES", describe those actions in the space provided below.
If the answer to question 7 is "NO", contact the Regional Office within 90 days; an evaluation may be
required to determine the impact the waste disposal system Is having at the review and compliance
boundaries surrounding this facility. Failure to do so may subject the permittee to a Notice of Violation,
fines and/or penalties.
g
The person completing this portion (GW-59A) of the monitoring report should sign below and submit this
form with GW-59 forms for required wells to the address provided at the top of the current GW-59 form.
r'r
I'iiereb'y.acknowledge thatfthe a . oya Infolmatlon wii evai uated and the Informat(o�n sub teed nrthis,°`k
of
report,(Camplla{�ce Repo G,jl1!,59A�;,Is true and complete to the best mynowlec�gei2
$-10-20
Signature of Perm ttee u r e gent Date

SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING:
COMPLIANCE REPORT FORM
FACILITY INFORMATION Please Print Clearly or Type
Facility Name: Awj)(.cx LLC,
Permit Name (if different):
Facility Address: F " L
LVv "Zit (Street) Mc- 7_1457 County
(City) Istate) (zip) p 2%z 4
Contact Person: Tele hone #: �2--A
Well Location/ Site Name:
No. of Wells to be Sampled:
Well Identification Number (from Permit): tAW - y For Groundwater Treatment Systems
Well Depth: Z\-?) _-_ft. Well Diameter: 2 in. Check One: ❑ Influent (98)
Screened Interval: IS ft. to 22- ft. ❑ Effluent (99)
Depth to Water Level: 11-S ft. below measuring point.
DEPARTMENT OF ENVIRONMENT & NATURAL RESOURCES
WATER QUALITY DIVISION, GROUNDWATER SECTION
1636 MAIL SERVICE CENTER
RALEIGH_ NC 27699-1636 Phone: [phone]:
PERMIT #: • EXPIRATION DATE: t v 1
Non -Discharge w Q cioosq 1 c) UIC
NPDES
TYPE OF PERMITTED OPERATION BEING MONITORED
Lagoon Remediation: Infiltration Gallery
Spray Field Remediation:
Rotary Distributor Land Application of Sludge
Other:
NOTE: Values should reflect dissolved and
colloidal concentrations.
Measuring Point (M.P.) is: Z ft. above land surface. Relative M.P. Elevation in ft.:
Gallons of water pum ed//bbailed before sampling: 5 Date sample collected:_1 -Z4o'2c'� Date sample analyzed:
Field analysis: pH _S.2 -? 1 , Specific Conductance uMhos Laboratory Name: Evnim k�410ny-#% '4
Temp. Z-0.2 °C, Odor IVOr►e. Appearance Qfexv Certification No. ko
PARAMETERS (Samples for metals were collected unfiltered 1/ YES NO and field acidified
COD mg/I Nitrite (NO2) as N mg/I
Coliform: MF Fecal /100ml Nitrate (NO3) as N mg/I
Coliform: MF Total /100ml Phosphorus: Total as P 0-ay mg/I
(Note, Use MPN method for highly turbid samples)
Dissolved Solids: Total 31(p mg/I
pH (when anal zed)
units
TOC ��,
mg/I
Chloride
mg/I
Arsenic
mg/I
Grease and Oils
mg/I
Phenol
mg/I
Sulfate
mg/I
Specific Conductance
uMhos
Total Ammonia
mg/I
TKN as N 4 0. 0 i
mg/I
Orthophosphate
mg/I
Al - Aluminum
mg/I
Ba - Barium
mg/I
Ca - Calcium (04.O1 \
mg/I
Cd - Cadmium
mg/I
Chromium: Total
mg/I
Cu - Copper -
mg/I
Fe - Iron
mg/I
Hg -Mercury
mg/I
K - Potassium
mg/I
Mg - Magnesium
mg/I
Mn - Manganese
mg/I
YES NO)
4
Ni - Nickel mg/I
Pb - Lead mg/I
Zn - Zinc mg/I
Ammonia Nitrogen mg/I
Other (Specify Compounds and Concentration Units)
ORGANICS: (GC,GC/MS,HPLC)
(Specify test and method #. Attach lab report.)
Report Attached? Yes (1) No (0)
VOC : method # =
method # =
method ff =

SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING:
COMPLIANCE REPORT FORM
FACILITY INFORMATION Please Print Clearly or Type
Facility Name: Awt)CcA LLC•
Permit Name (if different):
Facility Address: F "
cvv !-U l 1 ($1ee1) NC. 2"115-7 County (Cl Is12) (zip) p 2S2-4
Contact Person: Tele hone #: 62-A 133
Well Location/ Site Name: No. of Wells to be Sampled:
(fro5crml
Well Identification Number (from Permit): %AVa- s
Well Depth: 2k.-I _ ft. Well Diameter: Z
Screened Interval: 15 ft. to 2-2 ft.
Depth to Water Level: 9 ,g ft. below measuring point
Measuring Point (M.P.) is: Z ft. above land surface.
Gallons of water pumped/bailed before sampling: S
Field analysis: pH 5 , Specific Conductance
Temp. 2-0,'b °C, Odor U0^C
For Groundwater Treatment Systems
in. Check One: ❑ Influent (98)
❑ Effluent (99)
Relative M.P. Elevation in ft.:
Date sample collected: -2'tii'2(
uMhos
Appearance Cekeav,
DEPARTMENT OF ENVIRONMENT & NATURAL RESOURCES
WATER QUALITY DIVISION, GROUNDWATER SECTION
1636 MAIL SERVICE CENTER
RALEIGH. NC 27699-1636 Phone: [phone]
PERMIT #: • EXPIRATION DATE: 110
Non -Discharge U3Q 0005b Q UIC
NPDES
TYPE OF PERMITTED OPERATION BEING MONITORED
Lagoon Remediation: Infiltration Gallery
Spray Field Remediation:
Rotary Distributor Land Application of Sludge
Other:
NOTE: Values should reflect dissolved and
colloidal concentrations.
Date sample analyzed:
Laboratory Name: F—n ►Ypinnne,n'4
Certification No. V)
PARAMETERS (Samples for metals were collected unfiltered ✓ YES NO and field acidified
COD mg/I Nitrite (NO2) as N mg/I
Coliform: MF Fecal /100ml Nitrate (NO3) as N < O. OLA mg/I
Coliform: MF Total /100ml Phosphorus: Total as P 4 O. O4 mg/I
(Note: Use MPN method for highly turbid samples)
Dissolved Solids: Total SS I mg/I
pH (when analyzed
units
TO 2 O
mg/I
Chloride 30
mg/I
Arsenic
mg/I
Grease and Oils
mg/I
Phenol
mg/I
Sulfate
mg/I
Specific Conducta e
uMhos
Total Ammonia U-0'1
mg/I
TKN as N
mg/1
Orthophosphate
mg/I
AI - Aluminum
mg/I
Ba - Barium
mg/I
Ca - Calcium Is. psZ
mg/I
Cd - Cadmium
mg/I
Chromium: Total
mg/I
Cu - Copper
mg/I
Fe - Iron
mg/I
Hg - Mercury
mg/I
K - Potassium
mg/I
Mg - Magnesium
mg/I
Mn - Manganese
mg/I
YES NO)
Ni - Nickel mg/I
Pb - Lead mg/I
Zn - Zinc mg/I
Ammonia Nitrogen mg/I
Qther (Specify Compounds and Concentration Units)
\! � ow,; du.. - LA . 92 wC . I L.
ORGANICS: (GC,GC/MS,HPLC)
(Specify test and method If. Attach lab report.)
Report Attached? Yes (1) No (0)
VOC : method # =
method If =
method If =

SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING:
COMPLIANCE REPORT FORM
FACILITY INFORMATION
Please Print Clearly or Type
Facility Name: PwoCu LLC
Permit Name (if different):
Facility Address: 911H I PNOca F "
wV VA'% l l ISt eeq N L 2"1457
County 1 eir+ % e.
(caY) `. � f�) (zip)
Contact Person:
Telephone #:2S2"416'z-�;t1
Well Location/ Site Name:
No. of Wells to be Sampled: 5
(from Permit)
Well Identification Number (from Permit): MV3— -i
For Groundwater Treatment Systems
Well Depth: ft. Well D eter: 2
in.
Check One: El Influent (98)
Screened Interval: ft. to ft.
❑ Effluent (99)
Depth to Water Level: %2- ft. below measuring point.
Measuring Point (M.P.) is: 2 ft. above land surface.
Relative M.P. Elevation in ft.:
Gallons of water pumppd�/bailed before sampling: 5
Date sample collected:
Field analysis: pH �SOL , Specific Conductance
uMhos
Temp. ZOt o °C, Odor Now-
Appearance Ctear
PARAMETERS (Samples for metals were collected unfiltered
COD mg/I Nitri
Coliform: MF Fecal /100ml Nitr
Coliform: MF Total /100ml Pho
(Note: Use MPN method for highly turbid samples)
Dissolved Solids: Total 2.2.E mg/I
pH (when analyzed)
TOC `i .-Pit)
units
mg/I
Chloride
mg/I
Arsenic
mg/I
Grease and Oils
mg/I
Phenol
mg/I
Sulfate
mg/I
Specific Conductance
uMhos
Total Ammonia < O. ©t-i
mg/I
TKN as N
mg/I
DEPARTMENT OF ENVIRONMENT & NATURAL RESOURCES
WATER QUALITY DIVISION, GROUNDWATER SECTION
1636 MAIL SERVICE CENTER
Phone:[phone]
PERMIT #: . EXPIRATION DATE: 10
Non -Discharge L-3Q 00059 k D UIC
NPDES
TYPE OF PERMITTED OPERATION BEING MONITORED
Lagoon Remediation: Infiltration Gallery
Spray Field Remediation:
Rotary Distributor Land Application of Sludge
Other:
NOTE: Values should reflect dissolved and
colloidal concentrations.
Date sample analyzed:
Laboratory Name: EYYv 1k1CfJy-%MexA
Certification No. ko
YES NO and field acidified ," YES NO)
to (NO2) as N mg/I
ate (NO3) as N �.'1 1 mg/I
sphorus: Total as P < 0 mg/I
Orthophosphate mg/I
AI - Aluminum mg/I
Ba - Barium mg/I
Ca - Calcium 9.2id mg/I
Cd - Cadmium mg/I
Chromium: Total mg/I
Cu - Copper mg/I
Fe - Iron mg/I
Hg - Mercury mg/I
K - Potassium mg/I
Mg - Magnesium mg/I
Mn - Manganese mg/I
4
Ni - Nickel mg/I
Pb - Lead mg/I
Zn - Zinc mg/I
Ammonia Nitrogen mg/I
C
r (Specify Compounds and Concentration Units)
ORGANICS: (GC,GC/MS,HPLC)
(Specify test and method #. Attach lab report.)
Report Attached? Yes (1) No (0)
VOC : method # =
method # =
method # =

SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING:
COMPLIANCE REPORT FORM
FACILITY INFORMATION Please Print Clearly or Type
Facility Name: F-j)(_ x LLC-
Permit Name (if different):
Facility Address: Val-In
cvv "1%111 (streeq Alf.. 2195-7 County
(cay) . (s-'; °' (zip) p 25Z-y
Contact Person: Tele hone #:
Well Location/ Site Name:
No. of Wells to be Sampled:
Well Identification Number (from Permit): Mom) - `d For Groundwater Treatment Systems
Well Depth: \R) __ ft. Well Diameter: 2- in. Check One: ❑ Influent (98)
Screened Interval: 3 ft. to kb ft. ❑ Effluent (99)
Depth to Water Level: I -S _ft. below measuring point.
Measuring Point (M.P.) is: Z ft. above land surface. Relative M.P. Elevation in ft.:
Gallons of water pum ed/bailed before sampling: Jr Date sample collected:
Field analysis: pH , Specific Conductance uMhos
Temp. 2t0 2 °C, Odor ova¢, Appearance C lI eav
DEPARTMENT OF ENVIRONMENT & NATURAL RESOURCES
WATER QUALITY DIVISION, GROUNDWATER SECTION
1636 MAIL SERVICE CENTER
PERMIT #: • EXPIRATION DATE: 1O 31 12024
Non -Discharge W Q 000591 c) UIC
NPDES
TYPE OF PERMITTED OPERATION BEING MONITORED
Lagoon Remediation: Infiltration Gallery
Spray Field Remediation:
Rotary Distributor Land Application of Sludge
Other:
NOTE: Values should reflect dissolved and
colloidal concentrations.
Date sample analyzed:
Laboratory Name: Env iNcOtnm
Certification No. ,)
PARAMETERS (Samples for metals were collected unfiltered YES NO and field acidified
COD
mg/I
Nitrite (NO2) as N
mg/I
Coliform: MF Fecal
/100ml
Nitrate (NO3) as N _ 0.12.
mg/I
Coliform: MF Total
/100ml
Phosphorus: Total as P D 94
mg/I
(Note: Use MPN method for highly turbid samples)
Dissolved Solids: Total 411-} mg/I
Orthophosphate
Al - Aluminum
mg/I
mg/I
pH (when anal zed)
units
Ba - Barium
mg/I
TOC
mg/I
Ca - Calcium 215.012
mg/I
Chloride
mg/I
Cd - Cadmium
mg/I
Arsenic
mg/I
Chromium: Total
mg/I
Grease and Oils
mg/I
Cu - Copper
mg/I
Phenol
mg/I
Fe - Iron
mg/I
Sulfate
mg/I
Hg - Mercury
mg/I
Specific Conductance
uMhos
K - Potassium
mg/I
Total Ammonia
mg/I
Mg - Magnesium
mg/I
TKN as N
mg/I
Mn - Manganese
mg/I
YES NO)
Ni - Nickel mg/I
Pb - Lean mg/I
Zn - Zinc mg/I
Ammonia Nitrogen mg/I
'PAPer (Specify Compounds and Concentration Units)
v0Yw"i<if-- i1.S wu3kI--
ORGANICS: (GC,GC/MS,HPLC)
(Specify test and method #. Attach lab report.)
Report Attached? Yes (1) No (0)
VOC method # =
method # =
method # =

SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING:
COMPLIANCE REPORT FORM
FACILITY INFORMATION Please Print Clearly or Type
Facility Name: PwoCcx LLC
Permit Name (if different):
Facility Address: F "
cvv "It (Street) NC.. 2-145-7 County �
(aC.ow�e� ' zip)
Contact Person:,euTelephone #: 2SZ y�2-� 133
cn _
Well Location/ Site Name: No. of Wells to be Sampled: 7 (from Permit)
Well Identification Number (from Permit): M�-Ct For Groundwater Treatment Systems
Well Depth: 2_2.Eb ft. Well Diameter: in. Check One: ❑ Influent (98)
Screened Interval: tO ft. to Z3 ft. ❑ Effluent (99)
Depth to Water Level: V2 ._1 ft. below measuring point.
DEPARTMENT OF ENVIRONMENT & NATURAL RESOURCES
WATER QUALITY DIVISION, GROUNDWATER SECTION
1636 MAIL SERVICE CENTER
RALEIGH. NC 27699-1636 Phone: [phone],
PERMIT#: • EXPIRATION DATE: tvl
Non -Discharge w Q 00059 k I) UIC
NPDES
TYPE OF PERMITTED OPERATION BEING MONITORED
Lagoon Remediation: Infiltration Gallery
Spray Field Remedialion:
Rotary Distributor Land Application of Sludge
Other:
NOTE: Values should reflect dissolved and
colloidal concentrations.
Measuring Point (M.P.) is: Z ft. above land surface. Relative M.P. Elevation in ft.:
Gallons of water pumped/bailed before sampling: S Date sample collected:-(-2F6-20 Date sample analyzed:
Field analysis: pH S , 2 , Specific Conductance uMhos Laboratory Name: Env ,, ro nme,n-!
Temp. 2S'_1°C, Odor No'W- Appearance C-\euv- Certification No. ko
PARAMETERS (Samples for metals were collected unfiltered
COD mg/I Nitri
Coliform: MF Fecal /100ml Nitr
Coliform: MF Total /100ml Pho
(Note: Use MPN method for highly turbid samples)
Dissolved Solids: Total Z4-1
mg/I
pH (when analyzed)
units
TOC < % . 00
mg/I
Chloride 2
mg/I
Arsenic
mg/I
Grease and Oils
mg/I
Phenol
mg/I
Sulfate
mg/I
Specific Conductance
uMhos
Total Ammonia <� • 4y
mg/I
TKN as N
mg/I
YES NO and field acidified
to (NO2) as N mg/I
ate (NO3) as N 9-SO mg/I
sphorus: Total as P O.00v mg/I
Orthophosphate mg/I
Al - Aluminum mg/I
Ba - Barium mg/I
Ca - Calcium 1-13, 3 7- mg/I
Cd - Cadmium mg/I
Chromium: Total mg/I
Cu - Copper mg/I
Fe - Iron mg/I
Hg - Mercury mg/I
K - Potassium mg/I
Mg - Magnesium mg/I
Mn - Manganese mg/I
YES NO)
Ni - Nickel mg/I
Pb - Lean mg/I
Zn - Zinc mg/I
Ammonia Nitrogen mg/I
Other (Specify Compounds and Concentration Units)
?Orv'0t. O
ORGANICS: (GC,GC/MS,HPLC)
(Specify test and method #. Attach lab report.)
Report Attached? Yes (1) No (0)
VOC : method # =
method # _
method # =

SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING:
COMPLIANCE REPORT FORM
FACILITY INFORMATION Please Print Clearly or Type
Facility Name: NnCck LLC
Permit Name (if different):
Facility Address: tF "
(SL
(.VV "ItII heet) NC. �j4S� County1 �T1�
(city) , tState) (zip) s2S•Z y
Contact Person: u^Un co`wie� Telephone #: 82-� t33
Well Location/ Site Name: No. of Wells to be Sampled: (tra5e mil)
Well Identification Number (from Permit): kUJ - 1 C] For Groundwater Treatment Systems
Well Depth: Zo ft. Well Diameter: Z in. Check One: ❑ Influent (98)
Screened Interval: Z__� ft. to 20 ft. ❑ Effluent (99)
Depth to Water Level: '�:A ."A_ft. below measuring point.
Measuring Point (M.P.) is: 2 ft. above land surface. Relative M.P. Elevation in ft.:
Gallons of water pum ed/bailed before sampling: r Date sample collected: -1-'2b-2�
Field analysis: pH • 09 , Specific Conductance uMhos
Temp. 2-e•q °C, Odor Q 0 vie,, Appearance Ctekv,
DEPARTMENT OF ENVIRONMENT & NATURAL RESOURCES
WATER QUALITY DIVISION, GROUNDWATER SECTION
1636 MAIL SERVICE CENTER
PERMIT #: • EXPIRATION DATE: Iv
Non -Discharge !WQ 000549 O UIC
NPDES
TYPE OF PERMITTED OPERATION BEING MONITORED
Lagoon Remediation: Infiltration Gallery
117— Spray Field Remediation:
Rotary Distributor Land Application of Sludge
Other:
NOTE: Values should reflect dissolved and
colloidal concentrations.
Date sample analyzed:
Laboratory Name: EW% �xc(]hyv%Qy�•�
Certification No. 10
q
PARAMETERS (Samples for metals were collected unfiltered ✓ YES NO
and field acidified
YES NO)
COD
mg/I
Nitrite (NO2) as N
mg/I
Ni - Nickel
mg/I
Coliform: MF Fecal
/100ml
Nitrate (NO3) as N ,COI
mg/I
Pb - Lead
mg/I
Coliform: MF Total
/100ml
Phosphorus: Total as P 0,0S mg/I
Zn - Zinc
mg/I
(Note: Use MPN method for highly turbid samples)
Orthophosphate
mg/I
Ammonia Nitrogen
mg/I
Dissolved Solids: Total H I Li mg/I
Al - Aluminum
mg/I
Qther (Specify Compounds and Concentration Units)
pH (when analyzed)
units
Ba - Barium
mg/Ionn:c�lt
— U• 3�tq ww tl--
TOC 1.25
mg/I
Ca - Calcium 2LA,gj4-1
mg/I
Chloride 35
mg/I
Cd - Cadmium
mg/I
Arsenic
mg/I
Chromium: Total
mg/I
Grease and Oils
mg/I
Cu - Copper
mg/I
Phenol
mg/I
Fe - Iron
mg/I
ORGANICS: (GC,GC/MS,HPLC)
Sulfate
mg/I
Hg - Mercury
mg/I
(Specify test and method #. Attach lab report.)
Specific Conductance
uMhos
K - Potassium
mg/I
Report Attached? Yes (1) No
(0)
Total Ammonia <O, 014
mg/I
Mg - Magnesium
mg/I
VOC method # =
TKN as N
mg/I
Mn - Manganese
mg/I
method # =
method if =

SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING:
COMPLIANCE REPORT FORM
FACILITY INFORMATION Please Print Clearly or Type
Facility Name: AwOCu PLC
Permit Name (if different):
Facility Address: F "
cvv ",Ill (Street) N(.. 21g5-7 County � �e-
tciw) is)
(zip) p 2S2 4
Contact Person: Tele hone #: �2-� 133
Well Location/ Site Name: No. of Wells to be Sampled: (froPermit)
Well Identification Number (from Permit): Mta- \ \ For Groundwater Treatment Systems
Well Depth: 22 _ft. Well Diameter: 2- in. Check One: ❑ Influent (98)
Screened Interval: 3 ft. to 22- ft. ❑ Effluent (99)
Depth to Water Level: -7 ft. below measuring point.
Measuring Point (M.P.) is: 2 ft. above land surface. Relative M.P. Elevation in ft.:
Gallons of water pumped/bailed before sampling: Jr Date sample collected:-1'2%'20
Field analysis: pH (D Specific Conductance uMhos
Temp. 2.0.(0 °C, Odor I40-1¢, Appearance C-ked11'
PARAMETERS (Samples for metals were collected unfi
COD mg/I
Coliform: MF Fecal /100ml
Coliform: MF Total /100ml
(Note: Use MPN method for highly turbid samples)
Dissolved Solids: Total r2)12 mg/I
pH (when analyzed)
units
TOC (& 0
mg/I
Chloride 2-1
mg/I
Arsenic
mg/I
Grease and Oils
mg/I
Phenol
mg/I
Sulfate
mg/I
Specific Conductance
Total Ammonia . 3Z-
uMhos
mg/I
TKN as N
mg/I
DEPARTMENT OF ENVIRONMENT & NATURAL RESOURCES
WATER QUALITY DIVISION, GROUNDWATER SECTION
1636 MAIL SERVICE CENTER
PERMIT #: • EXPIRATION DATE: ►v tt
Non -Discharger Q 00059 t O UIC
NPDES
TYPE OF PERMITTED OPERATION BEING MONITORED
Lagoon Remediation: Infiltration Gallery
Spray Field Remediation:
Rotary Distributor Land Application of Sludge
Other:
NOTE: Values should reflect dissolved and
colloidal concentrations.
Date sample analyzed:
Laboratory Name: E-nv uYptnmeAA
Certification No. `o
eredy YES
NO and field acidified
Nitrite (NO2) as N
mg/I
Nitrate (NO3) as N
O.O'-ti mg/I
Phosphorus: Total as P
0.92 mg/I
Orthophosphate
mg/I
Al - Aluminum
mg/I
Ba - Barium
mg/I
Ca - Calcium 20. (o4I
mg/I
Cd - Cadmium
mg/I
Chromium: Total
mg/I
Cu - Copper
mg/I
Fe - Iron
mg/I
Hg - Mercury
mg/I
K - Potassium
mg/I
Mg - Magnesium
mg/I
Mn - Manganese
mg/I
YES NO)
Ni - Nickel mg/I
Pb - Lead mg/I
Zn - Zinc mg/I
Ammonia Nitrogen mg/I
ther (Specify Compounds and Concentration Units)
l--
ORGANICS: (GC,GC/MS,HPLC)
(Specify test and method #. Attach lab report.)
Report Attached? Yes (1) No (0)
VOC : method # =
method # =
method if =

MwoQ©mEM Flo hwpw nad
114 OAKMONT DRIVE:
GREENVILLE, N.C. 27858
AVOCA, LLC (WASTEWATER)
MR. BRIAN CONNER
P.O. BOX 129
MERRY HILL ,NC 27957
PARAMETERS
BOD, mg/l
Total Suspended Residue, mg/I
Ammonia Nitrogen as N, mg/l
Total Kjeldahl Nitrogen as N,mg/I
Nitrate -Nitrite as N, mg/l (talc)
Nitrate Nitrogen as N, mg/l
Nitrite Nitrogen as N, mg/l
Total Phosphorus as P, mg/I
Total Organic Carbon, mg/l
Chloride, mg/l
Total Dissolved Residue, mg/l
Calcium, ug/I
Magnesium, ug/l
Sodium, ug/I
Sodium Adsorption Ratio (talc)
Total Nitrogen, mg/1 (talc)
PHONE [phone]
FAX [phone]
ID#1: 132
DATE COLLECTED: 07/28/20
DATE REPORTED : 08/17/20
REVIEWED BY:
Effluent Well " Well N5 Well N7 Well N8 Analysis Method
951
172
6.72
61.96
0.31
< 0.04
0.31
14.48
96
1550
70373
4242
144850
4.S
62.27
<0.04
0.07
<0.04
11.36
<0.04
0.71
0.06
<0.04
<0.04
< 1.00
2.90
4.78
26
30
19
316
551
228
64011
35052
5248
Date
Analyst
Code
07/29/20
TMR
52108-11
07/30/20
HJO
254OD-11
1.96
07/30/20
TM
350.1 112-93
08/04/20
TLH
351.2 112-93
353.2 112-93
0.12
07/29/20
DTL
353.2 112-93
07/29/20
DTL
353.2 R2-93
0.94
08/04/20
TCW
365.4-74
23.32
07/29/20
SEJ
531OC-11
24
08/03/20
MAR
4500CL13-11
414
07/30/20
MAR
2540C-11
25032
08/03/20
LFJ
EPA200.7
08/03/20
LFJ
EPA200.7
08/05/20
NAB
3111B-11

7
Environment 1, Incorporated
114 OAKMONT DRIVE
GREENVILLE, N.C. 27858
AVOCA, LLC (WASTEWATER)
MR. BRIAN CONNER
P.O. BOX 129
MERRY HILL ,NC 27957
Drinking Water ID; 37715
Waatewater ID, 10
PHONE [phone]
FAX [phone]
ID#: 132
DATE COLLECTED: 07/28/20
DATE REPORTED : 08/17/20
REVIEWED BY:
Well #9 Well #10 Well #tl Analysis Method
PARAMETERS Date Analyst Code
Ammonia Nitrogen as N, mg/I
Nitrate Nitrogen as N, mg/l
Total Phosphorus as P, Ing/1
Total Phosphorus as P, mg/1
Total Organic Carbon, mg/1
Chloride, mg/I
Total Dissolved Residue, mg/I
Calcium, ug/I
<0.04
<0.04
11.32
5.30
7.01
0.04
0.06
0.04
0.92
<1.00
1.25
8.08
25
35
27
247
414
812
43362
24847
20649
07/30/20
TM
350.1 R2-93
07/29/20
DTL
353.2 1112-93
08/04/20
TCW
365.4-74
08/07/20
TLH
365.4-74
07/29/20
SEJ
531OC-11
08/03/20
MAR
4500CLB-11
07/30/20
MAR
2540C-11
08/03/20
LF4J
EPA200.7

A
M
P.
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(2
Environment 1, Inc. CHAIN OF CUSTODY RECORD
_,p.O. 7085. 114 Oakmont Dr. Page I of 1
Greenville, NC 27858
en vironment l ine.com
DISINFECTION
Phone [phone] - Fax [phone]
CHLORINE NEUTRALIZED AT COLLECTION
CHLORINE
L
14,11.1-4v
pH CHECK (LAB)
CLIENT: 132 Week:33
UV
P
P
P
P
P
P
P
P
P
P
P
P
P
CONTAINER TYPE,PlG
VOCA, LLC (WASTEWATER)
NONE
R. BRIAN CONNER
O. BOX 129
ERRY HILL NC 27957
A
A
C
C
C
A
A
C
C
A
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CHEMICAL PRESERVATION
A -NONE D-NAOH
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SAMPLES COLLECTED BY:
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SAMPLES RECEIVED IN LABAT f `j _
RELINQUISHED BY (SIG.) (SAMPLER)
DATETIME
RECEI BY (SI .}
DATEMME
COMMENTS:
12' y
RELINQUISHED BY (SIG.)
DATE1T1ME
RECEIVED BY (SIG.)
DATE/TIME
BY (SIG.)
RECEIVED BY (SIG.)
PLEASE READ Instructions for completing this form on the reverse side. Sampler must place a "C" for composite sample or a "G" for
FORM #5 Grab sample in the blocks above for each parameter requested. N 0 380730

GEL LABORATORIES LLC
2040 Savage Road Charleston SC 29407 — [phone] — www.gal.com
Certificate of Analysis Report
for
ENV0001 Environment One, Inc.
Client SDG: 517297 GEL Work Order: 517297
The Qualifiers in this report are defined as follows:
* A quality control analyte recovery is outside of specified acceptance criteria
** Analyte is a Tracer compound
** Analyte is a surrogate compound
U Analyte was analyzed for, but not detected above the MDL, MDA, MDC or LOD.
Where the analytical method has been performed under NELAP certification, the analysis has met all of the
requirements of the NELAC standard unless qualified on the Certificate of Analysis.
The designation ND, if present, appears in the result column when the analyte concentration is not detected above
the limit as defined in the 'U' qualifier above.
This data report has been prepared and reviewed in accordance with GEL Laboratories LLC
standard operating procedures. Please direct any questions to your Project Manager, Lindsay Fabra.
Jwj'�/' ;�4�
Reviewed by
Page 2 of 16 SDG: 517297

GEL LABORATORIES LLC
2040 Savage Road Charleston SC 29407 - [phone] - www.gel.com
Certificate of Analysis
Report Date: August 4, 2020
Company: Environment One, Inc.
Address : 114 Oakmont Drive
Greenville, North Carolina 27858
Contact: Ms. Deedee Woolard
Project: Routine Analytical - North Carolina
Client Sample ID:
Effluent Project: ENV000101
Sample ID:
517297001 Client ID: ENV0001
Matrix:
Ground Water
Collect Date:
28-JUL-20 14:45
Receive Date:
31-JUL-20
Collector:
Client
Parameter Qualifier Result DL RL Units PF DF Analyst Date Time Batch Method
on Chromatography
3PA300.0 Bromide Liquid "As Received"
Iromide 37.9 1.34 4.00 mg/L 20 LXA2 08/04/20 0130 2025665 1
The following Analytical Methods were performed:
Method Description Analyst Comments
EPA 300.0
Votes:
Column headers are defined as follows:
DF: Dilution Factor Lc/LC: Critical Level
DL: Detection Limit PF: Prep Factor
\IDA: Minimum Detectable Activity RL: Reporting Limit
VIDC: Minimum Detectable Concentration SQL: Sample Quantitation Limit
Page 3 of 16 SDG: 517297

GEL LABORATORIES LLC
2040 Savage Road Charleston SC 29407 - [phone] - www.gel.com
Certificate of Analysis
Company: Environment One, Inc.
Address : 114 Oakmont Drive
Report Date: August 4, 2020
Contact:
Project:
Greenville, North Carolina 27858
Ms. Deedee Woolard
Routine Analytical - North Carolina
Client Sample ID:
Well #4 Project: ENV000101
Sample ID:
517297002 Client ID: ENV0001
Matrix:
Ground Water
Collect Date:
28-JUL-20 13:45
Receive Date:
31-JUL-20
Collector:
Client
Parameter Qualifier Result DL RL Units PF DF Analyst Date Time Batch Method
on Chromatography
?PA300.0 Bromide Liquid "As Received"
iromide U 0.000 0.0670 0.200 mg/L 1 LXA2 08/01/20 1846 2025665 1
The following Analytical Methods were performed:
Method Description Analyst Comments
EPA 300.0
Dotes:
Column headers are defined as follows:
DF: Dilution Factor Le/LC: Critical Level
DL: Detection Limit PF: Prep Factor
b1DA: Minimum Detectable Activity RL: Reporting Limit
\1DC: Minimum Detectable Concentration SQL: Sample Quantitation Limit
Page 4 of 16 SING: 517297

GEL LABORATORIES LLC
2040 Savage Road Charleston SC 29407 - [phone] - www.gel.com
Certificate of Analysis
Company: Environment One, Inc.
Address : 114 Oakmont Drive
Greenville, North Carolina 27858
Contact: Ms. Deedee Woolard
Project: Routine Analytical - North Carolina
Client Sample ID:
Well #5
Sample ID:
517297003
Matrix:
Ground Water
Collect Date:
28-JUL-20 14:15
Receive Date:
31-JUL-20
Collector:
Client
Report Date: August 4, 2020
Project: ENV000101
Client ID: ENV0001
Parameter Qualifier Result DL RL Units PF DF Analyst Date Time Batch Method
on Chromatography
:PA300.0 Bromide Liquid "As Received"
iromide 4.92 0.134 0.400 mg/L 2 LXA2 08/04/20 0157 2025665 1
The following Analytical Methods were performed:
Vlethod Description Analyst Comments
EPA 300.0
Antes:
Column headers are defined as follows:
DF: Dilution Factor Lc/LC: Critical Level
DL: Detection Limit PF: Prep Factor
VIDA: Minimum Detectable Activity RL: Reporting Limit
MDC: Minimum Detectable Concentration SQL: Sample Quantitation Limit
Page 5 of 16 SDG: 517297

GEL LABORATORIES LLC
2040 Savage Road Charleston SC 29407 - [phone] - www.gel.com
Certificate of Analysis
Company: Environment One, Inc.
Address : 114 Oakmont Drive
Report Date: August 4, 2020
Contact:
Project:
Greenville, North Carolina 27858
Ms. Deedee Woolard
Routine Analytical - North Carolina
Client Sample ID:
Well #7 Project: ENV000101
Sample ID:
517297004 Client ID: ENV0001
Matrix:
Ground Water
Collect Date:
28-JUL-20 16:25
Receive Date:
31-JUL-20
Collector:
Client
Parameter Qualifier Result DL RL Units PF DF Analyst Date Time Batch Method
on Chromatography
'PA300.0 Bromide Liquid "As Received"
Iromide 11.4 0.335 1.00 mg/L 5 LXA2 08/04/20 0224 2025665 1
The following Analytical Methods were performed:
Method Description Analyst Comments
EPA 300.0
Votes:
Column headers are defined as follows:
DF: Dilution Factor Lc/LC: Critical Level
DL: Detection Limit PF: Prep Factor
MDA: Minimum Detectable Activity RL: Reporting Limit
.VDC: Minimum Detectable Concentration SQL: Sample Quantitation Limit
Page 6 of 16 SDG: 517297

GEL LABORATORIES LLC
2040 Savage Road Charleston SC 29407 - [phone] - www.gel.com
Certificate of Analysis
Company: Environment One, Inc.
Address : 114 Oakmont Drive
Report Date: August 4, 2020
Contact:
Project:
Greenville, North Carolina 27858
Ms. Deedee Woolard
Routine Analytical - North Carolina
Client Sample ID:
Well #8 Project: ENV000101
Sample ID:
517297005 Client ID: ENV0001
Matrix:
Ground Water
Collect Date:
28-JUL-20 16:05
Receive Date:
31-JUL-20
Collector:
Client
Parameter Qualifier Result DL RL Units PF DF Analyst Date Time Batch Method
on Chromatography
;PA300.0 Bromide Liquid "As Received"
lromide 11.5 0.335 1.00 mg/L 5 LXA2 08/04/20 0251 2025665 1
The following Analytical Methods were performed:
Method Description Analyst Comments
EPA 300.0
Votes:
Column headers are defined as follows:
DF: Dilution Factor Lc/LC: Critical Level
DL: Detection Limit PF: Prep Factor
,\IDA: Minimum Detectable Activity RL: Reporting Limit
\IDC: Minimum Detectable Concentration SQL: Sample Quantitation Limit
Page 7 of 16 SDG: 517297

GEL LABORATORIES LLC
2040 Savage Road Charleston SC 29407 - [phone] - www.gel.com
Certificate of Analysis
Company: Environment One, Inc.
Address: 114 Oakmont Drive
Contact:
Project:
Greenville, North Carolina 27858
Ms. Deedee Woolard
Routine Analytical - North Carolina
Client Sample ID:
Well #9
Sample ID:
517297006
Matrix:
Ground Water
Collect Date:
28-JUL-20 15:00
Receive Date:
31-JUL-20
Collector:
Client
Report Date: August 4, 2020
Project: ENV000101
Client ID: ENV0001
Parameter Qualifier Result DL RL Units PF DF Analyst Date Time Batch Method
on Chromatography
?PA300.0 Bromide Liquid "As Received"
3romide U 0.000 0.0670 0.200 mg/L 1 LXA2 0910ll20 2128 2025665 1
The following Analytical Methods were performed:
Method Description Analyst Comments
EPA 300.0
JOtes:
Column headers are defined as follows:
DF: Dilution Factor Lc/LC: Critical Level
DL: Detection Limit PF: Prep Factor
\IDA: Minimum Detectable Activity RL: Reporting Limit
\IDC: Minimum Detectable Concentration SQL: Sample Quantitation Limit
Page 8 of 16 SDG: 517297

GEL LABORATORIES LLC
2040 Savage Road Charleston SC 29407 - [phone] - www.gel.com
Certificate of Analysis
Company: Environment One, Inc.
Address : 114 Oakmont Drive
Greenville, North Carolina 27858
Contact: Ms. Deedee Woolard
Project: Routine Analytical - North Carolina
Client Sample ID:
Sample ID:
Matrix:
Collect Date:
Receive Date:
Collector:
Well #10
517297007
Ground Water
28-JUL-20 16:15
31-JUL-20
Client
Report Date: August 4, 2020
Project: ENV000101
Client ID: ENV0001
Parameter Qualifier Result DL RL Units PF DF Analyst Date Time Batch Method
on Chromatography
"sPA300.0 Bromide Liquid "As Received"
lromide 0.399 0.0670 0.200 mg/L 1 LXA2 08/01/20 2155 2025665 1
The following Analytical Methods were performed:
Method Description Analyst Comments
EPA 300.0
votes:
Column headers are defined as follows:
DF: Dilution Factor Lc/LC: Critical Level
DL: Detection Limit PF: Prep Factor
\IDA: Minimum Detectable Activity RL: Reporting Limit
\IDC: Minimum Detectable Concentration SQL: Sample Quantitation Limit
Page 9 of 16 SDG: 517297

GEL LABORATORIES LLC
2040 Savage Road Charleston SC 29407 - [phone] - www.gel.com
Certificate of Analysis
Company: Environment One, Inc.
Address : 114 Oakmont Drive
Report Date: August 4, 2020
Contact:
Project:
Greenville, North Carolina 27858
Ms. Deedee Woolard
Routine Analytical - North Carolina
Client Sample ID:
Well #11 Project: ENV000101
Sample ID:
517297008 Client ID: ENV0001
Matrix:
Ground Water
Collect Date:
28-JUL-20 13:50
Receive Date:
31-JUL-20
Collector:
Client
Parameter Qualifier Result DL RL Units PF DF Analyst Date Time Batch Method
on Chromatography
?PA300.0 Bromide Liquid "As Received"
Iromide 4.89 0.134 0.400 mg/L 2 LXA2 09/04/20 0318 2025665 1
The following Analytical Methods were performed:
Method Description _ Analyst Comments
EPA 300.0
QOtes:
Column headers are defined as follows:
DF: Dilution Factor Lc/LC: Critical Level
DL: Detection Limit PF: Prep Factor
\IDA: Minimum Detectable Activity RL: Reporting Limit
VIDC: Minimum Detectable Concentration SQL: Sample Quantitation Limit
Page 10 of 16 SDG: 517297

GEL LABORATORIES LLC
2040 Savage Road Charleston, SC 29407 - [phone] - www,gel.com
QC Summary
Report Date: August 4, 2020
Environment One, Inc. Page 1 of
114 Oakmont Drive
Greenville, North Carolina
Contact: Ms. Deedee Woolard
Workorder: 517297
Parmname NOM Sample Qual QC Units RPD%, _ REC% Range Anlst Date Time
:on Chromatography
3atch 2025665 — - —
QC1204610530 517140001 DUP
Bromide U 0.000 U 0.000 mg/L N/A LXA2 08/01/2017:2
QC1204610529 LCS
Bromide 1.25 1.27 mg/L 102 (90%-110%) 08/01/2016:3
QC1204610528 MR
Bromide U
QC1204610531 517140001 PS
Bromide 1.25 U 0.000
Notes:
0.000 mg/L
1.28 mg/L 103 (90%-110%)
08/01/20 16:0
08/01 /20 17:5
The Qualifiers in this report are defined as follows:
< Result is less than value reported
> Result is greater than value reported
B The target analyte was detected in the associated blank.
E General Chemistry --Concentration of the target analyze exceeds the instrument calibration range
H Analytical holding time was exceeded
J See case narrative for an explanation
J Value is estimated
N/A RPD or %Recovery limits do not apply.
N 1 See case narrative
ND Analyte concentration is not detected above the detection limit
NJ Consult Case Narrative, Data Summary package, or Project Manager concerning this qualifier
Q One or more quality control criteria have not been met. Refer to the applicable narrative or DER.
R Per section 9.3.4.1 of Method 1664 Revision B, due to matrix spike recovery issues, this result may not be reported or used for regulatory compliance
purposes.
R Sample results are rejected
U Analyte was analyzed for, but not detected above the MDL, MDA, MDC or LOD.
X Consult Case Narrative, Data Summary package, or Project Manager concerning this qualifier
Z Paint Filter Test --Particulates passed through the filter, however no free liquids were observed.
Page 11 of 16 SING: 517297

GEL LABORATORIES LLC
2040 Savage Road Charleston, SC 29407 - [phone] - www.gel.com
QC Summary
Workorder: 517297 Page 2 of
Parmname NOM Sample Qual QC Units RPD% REC% Range Anlst Date Time
^ RPD of sample and duplicate evaluated using +/-RL. Concentrations are <5X the RL. Qualifier Not Applicable for Radiochemistry.
d 5-day BOD--The 2:1 depletion requirement was not met for this sample
e 5-day BOD--Test replicates show more than 30% difference between high and low values. The data is qualified per the method and can be used for
reporting purposes
h Preparation or preservation holding time was exceeded
N/A indicates that spike recovery limits do not apply when sample concentration exceeds spike cone. by a factor of 4 or more or %RPD not applicable.
^ The Relative Percent Difference (RPD) obtained from the sample duplicate (DUP) is evaluated against the acceptance criteria when the sample is greater than
five times (5X) the contract required detection limit (RL). In cases where either the sample or duplicate value is less than 5X the RL, a control limit of +/- the
RL is used to evaluate the DUP result.
• Indicates that a Quality Control parameter was not within specifications,
For PS, PSD, and SDILT results, the values listed are the measured amounts, not final concentrations.
Where the analytical method has been performed under NELAP certification, the analysis has met all of the
requirements of the NELAC standard unless qualified on the QC Summary.
Page 12 of 16 SDG: 517297

General Chemistry
Technical Case Narrative
Environment One, Inc.
SDG #: 517297
Product: Ion Chromatography
Analytical Method: EPA 300.0
Analytical Procedure: GL-GC-E-086 REV# 28
Analytical Batch: 2025665
The following samples were analyzed using the above methods and analytical procedure(s).
GEL Sample ID#
Client Sample Identification
517297001
Effluent
517297002
Well #4
517297003
Well #5
517297004
Well #7
517297005
Well #8
517297006
Well #9
517297007
Well #10
517297008
Well #11
1204610528
Method Blank (MB)
1204610529
Laboratory Control Sample (LCS)
1204610530
5 1714000 1 (NonSDG) Sample Duplicate (DUP)
1204610531
517140001(NonSDG) Post Spike (PS)
The samples in this SDG were analyzed on an "as received" basis.
Data Summary:
All sample data provided in this report met the acceptance criteria specified in the analytical methods and
procedures for initial calibration, continuing calibration, instrument controls and process controls where
applicable, with the following exceptions.
Technical Information
Sample Dilutions
The following samples 517297001 (Effluent), 517297003 (Well #5), 517297004 (Well #7), 517297005 (Well
#8) and 517297008 (Well #11) were diluted because target analyte concentrations exceeded the calibration
range. Dilutions may be required for many reasons, including to minimize matrix interferences or to bring over
range target analyte concentrations into the linear calibration range.
517297
Annlyta
001
1 003
1 004
1 005
008
Bromide
20X
2X
SX
SX
2X
Certification Statemen
Where the analytical method has been performed under NELAP certification, the analysis has met all of the
requirements of the NELAC standard unless otherwise noted in the analytical case narrative.
Page 13 of 16 SDG: 517297

Xnvironment 1, Inc.
T.O. Box 7085, 114 Oakmont Dr.
'11e NC �7858
1VI
Pt
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CHAIN Off' CUSTODY RECORD
57 1 Z-7
Page I of I
reenvi
environmen t I inc.com
DISINFECTION
CHLORINE NEUTRALIZED AT COLLECTION
done [phone] • Fax [phone]
Ij CHLORINE
CLIENT: 132 Week: 33
pH CHECK (LAB)
UV
�OCA, LLC (WASTEWATER)
NONE
P
P
P
P
P
P
P
P
P
P
P
P
P
CONTAINER TYPE, PIG
BRIAN CONNER
JA
JA
CHEMICAL PRESERVATION
. BOX 129
gRRY HILL NC 27957
A
A
C
C
C
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C
C
A
A
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U) A -NONE D-NAOH
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32) 482-2133
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DATE
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Effluent
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DRINKING WATER
Well #4
13, LA 5
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SAMPLES COLLECTED BY:
(Please Print)
SAMPLES RECEIVED IN LAB AT °C
RELINQUISHED BY (SIG.) (SAMPLER)
DATE/TIME
RECEI BY (Si )
DATF TIME
COMMENTS:
-1 t*-ao Y� =at3
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-.----,-
RECEIVED.BY (51G.)----.-------._
—1 ATEZ1ME---.
PLEASE READ Instructions for completing this form on the reverse side. Sampler must place a "C" for composite sample or a "G" for
FORM #5 Grab sample in the blocks above for each parameter requested. N 0 380730

.Em ! Lalxjrafc)res i r;;
1,fe SAMPLE RECEIPT & REVIEW FORM
Client:
SDG/,UVCOCAVork OrIlpti
Received By: AJA
Date Received: 1
FedEx Express FedEx Ground Field Services Courier Other i
Carrier and Trucking Number
Suspected HaxuM Wennation
1
'If Net Counts > I00cpni on samples not marked "radioactive", contact the Radiation Safety Group for further investigation.
1!
Hazard Class Shipped-. UNIT:
A)Shi ed as a 1X7I' Haatrtlous7
If UN2910, Is the Radioactive Shipment Survey Compliant? Yes —No_
i
/ A 1'• 1
B) Did the client designate the samples am to benolouon
or and oactryt sbcl cr3 bn rx)ntd(nefs egdalcllenrde�tgtialiori
received as radioactive?VVV
C) Did rite RSO classify tire samples as
Maximum Net Counts Observed' (Observed Counts - Ana Background Couuts): CPM / mR/IIr
radioactive?
Classified as: Rod ! Rod 2 Pad ] 3
n
COC notanon orhfrzvd latrels on mnterlter5 equal cheutt)esngnahon::
D) Did the client (lest ante samples are hazardous?
If D or E is yes, select Hmnals below.
1E) Did the RSO identify possible hazards?
PCB's Flammable Fureihnt Sul RCRA Asbestos Berylliunt Other: 1
Sample Receipt Criterla
z
Comments/Qualiflers (Requfred forNms-ConformIng Items) j
I
Shipping containers received intact and
isealed7
/
Circle AppGcablr. Sealsbroken Damasedcontainer Leakingcontatner Odrer(descn'be)
v/
Chain of custody documents included
Circle Applicable: Client coninc:ed and piorided COC COC created upon receipt j
Willi shipment?
j
-
3 .
Samples requiring cold presnrvaliom
Preservation Method: Wet toe Ice Packs Dry ice a her. 1
'all tempeadums are recorded in Celsius TEMP: -
within (0 < 6 deg, C ?•
Daily clreck performed and passed on IR
Temperature Device Scriul Y:_jaa-16 j
4
temperature gun?
Secwxl Temperature IfApplicable): '
"'y P ( 3
/
CircLeAppticable: Scalbfoken Damagedcontoincr Leaktogcumainer Other(describe)
5
Sample containers intact anti scaled?
t
Samples requiring chemical preservation
Sample IM and Containers ArfecleJ:
6
at proper p:-[?
1f Pmsenadan Wiled, IzLY; j
�F Ycs, ue Encores or Sail IGts pmsent for solids? Yes_ No_ NrL_(If yrs, take to VOA Freezer)- I
7
Do any samples require Vulaiile
Analysis?
✓
Do liquid VOA vials contain acid preservation? Yes__,_ No_ NA_(tf un)mown, select No)
Arc liquid VOA vials flee otheedspace? Yes_ No_ NA____ .
Sample ID'sand mnuiners affected: -- •
ID's and tests affected: Tj
S
Samples received within holding time?
;
Sample ID's on COC match ID's on
Us and containers affected: l
9
bottles?
t �
I0
Date& lime on COC malch dale & time
CitcicApplicable.: Nodatesoucontalners Notimesmtcauai»ers COCmissinginfo Other(desctibe)
on bottles?
i
Number of containers received match Circle Applicable: Nu container count on COC Other (describe) j
I1
number indicated on COC?
Are sample containers identifiable as j
12 1
GEL provided by use of GEL labels? r
13 COC form is properly signed in Clcic AppGrabh: of relinquisl Other (desuilre) i
relinquished/received sections? j
Comments (Use Continuation Fort if needed):
i
i
I
i
1
PM (or PMA) review: Initials,_- Date _ "7� Page _)( of I
GL-CHL-SR-001 Rev 71
Page 15 of 16 SDG: 517297

List of current GEL Certifications as of 04 August 2020
State
Certification
Alabama
42200
Alaska
17-018
Alaska Drinking Water
SC00012
Arkansas
88-0651
CLIA
42D0904046
California
2940
Colorado
- SCOOO12
Connecticut
PH-0169
Doll) ELAP/ ISO17025 A21-A
2567.01
Florida NELAP
E87156
Foreign Soils Permit
P330-15-00283, P330-15-00253
Georgia
SC00012
Georgia SDWA
967
Hawaii
SC00012
Idaho
SCOOO 12
Illinois NELAP
200029
Indiana
C—SC-01
Kansas NELAP
E-10332
Kentucky SDWA
90129
Kentucky Wastewater
90129
Louisiana Drinking Water
LA024
Louisiana NELAP
03046 (AI33904)
Maine
2019020
Maryland
270
Massachusetts
M—SC012
Massachusetts PFAS Approv
Letter
Michigan
9976
Mississippi
SC00012
Nebraska
NE—OS-26-13
Nevada
SCO00122020-1
New Hampshire NELAP
2054
New Jersey NELAP
SCO02
New Mexico
SC00012
New York NELAP
11501
North Carolina
233
North Carolina SDWA
45709
North Dakota
R-158
Oklahoma
2019-165
Pennsylvania NELAP
68-00485
Puerto Rico
SC00012
S. Carolina Radiochem
10120002
Sanitation Districts of L
9255651
South Carolina Chemistry
10120001
Tennessee
TN 02934
Texas NELAP
T104704235-20-17
Utah NELAP
SC000122020-32
Vermont
VT87156
Virginia NELAP
460202
Washington
C780
Page 16 of 16 SDG: 517297

Sample_Nc Lab_ld laboratory Batch_No Assoc_Blnk Sample_Ty Analyte_Ty Coll_date
Effluent
517297001GEL
2025665
120461052 SAM P LE
TARGET
07/28/20
Well #4
517297002 GEL
2025665
120461052 SAMPLE
TARGET
07/28/20
Well #5
517297003 GEL
2025665
120461052 SAMPLE
TARGET
07/28/20
Well #7
517297004 GEL
2025665
120461052SAMPLE
TARGET
07/28/20
Well #8
517297005 GEL
2025665
1204610S2 SAMPLE
TARGET
07/28/20
Well #9
51729700E GEL
2025665
120461052 SAMPLE
TARGET
07/28/20
Well #10
517297007 GEL
2025665
120461052 SAMPLE
TARGET
07/28/20
Well #11
51729700E GEL
202S665
120461052 SAMPLE
TARGET
07/28/20
M B
120461052 GEL
2025665
120461052 M B
TARGET
08/01/20
LCS
120461052 GEL
2025665
120461052LCS
SPIKE
08/01/20
Rec_date
Ext_date
Anal —date
SDG
Parameter
07/31/20
08/04/20
08/04/20
517297
Bromide
07/31/20
08/01/20
08/01/20
517297
Bromide
07/31/20
08/04/20
08/04/20
517297
Bromide
07/31/20
08/04/20
08/04/20
517297
Bromide
07/31/20
08/04/20
08/04/20
517297
Bromide
07/31/20
08/01/20
08/01/20
517297
Bromide
07/31/20
08/01/20
08/01/20
517297
Bromide
07/31/20
08/04/20
08/04/20
517297
Bromide
08/01/20
08/01/20
08/01/20
517297
Bromide
08/01/20
08/01/20
08/01/20
517297
Bromide

Fraction
Method
Lab_Result Uncertaint Cas_num Units
Lab_Qual
MDL
CRDL_CRQ Dif_Factor Pct_Moist Comments
G
EPA 300.0
37.9
24959-67-S MG/L
1.34
4.00
20.0
100
G
EPA 300.0
ND
24959-67-S MG/L
U
0.0670
0.200
1.00
100
G
EPA 300.0
4.92
24959-67-S MG/L
0.134
0.400
2.00
100
G
EPA 300.0
11.4
24959-674 MG/L
0.335
1.00
5.00
100
G
EPA 300.0
11.5
24959-67-S MG/L
0.335
1.00
5.00
100
G
EPA 300.0
ND
24959-67-i MG/L
U
0.0670
0.200
1.00
100
G
EPA 300.0
0.399
24959-67-S MG/L
0.0670
0.200
1.00
100
G
EPA 300.0
4.89
24959-674 MG/L
0.134
0.400
2.00
100
G
EPA 300.0
ND
24959-674 MG/L
U
0.0670
0.200
1.00
100
G
EPA 300.0
102
24959-67-� %
0.0670
0.200
1.00
100

GEL LABORATORIES LLC
2040 Savage Road Charleston SC 29407 - [phone] - www.gel.com
Certificate of Analysis Report
for
ENVO001 Environment One, Inc,
Client SDG: 517297 GEL Work Order: 517297
The Qualifiers in this report are defined as follows:
* A quality control analyte recovery is outside of specified acceptance criteria
** Analyte is a Tracer compound
** Analyte is a surrogate compound
U Analyte was analyzed for, but not detected above the MDL, MDA, MDC or LOD.
Where the analytical method has been performed under NELAP certification, the analysis has met all of the
requirements of the NELAC standard unless qualified on the Certificate of Analysis.
The designation ND, if present, appears in the result column when the analyte concentration is not detected above
the limit as defined in the 'U' qualifier above.
This data report has been prepared and reviewed in accordance with GEL Laboratories LLC
standard operating procedures, Please direct any questions to your Project Manager, Lindsay Fabra.
J�-Y FrC'G,-"..
Reviewed by
Page 2 of 16 SDG: 517297

GEL LABORATORIES LLC
2040 Savage Road Charleston SC 29407 - [phone] - www.gel.com
Certificate of Analysis
Report Date: August 4, 2020
Company: Environment One, Inc.
Address : 114 Oakmont Drive
Greenville, North Carolina 27858
Contact: Ms. Deedee Woolard
Project: Routine Analytical - North Carolina
Client Sample ID:
Effluent Project: ENV000101
Sample ID:
517297001 Client ID: ENV0001
Matrix:
Ground Water
Collect Date:
28-JUL-20 14:45
Receive Date:
31-JUL-20
Collector:
Client
Parameter Qualifier Result DL RL Units PF DF Analyst Date Time Batch Method
on Chromatography
?PA300.0 Bromide Liquid "As Received"
lromide 37.9 1.34 4.00 mg/L 20 LXA2 09/04/20 0130 2025665 1
The following Analytical Methods were performed:
Method Description Analyst Comments
EPA 300.0
Qotes
Column headers are defined as follows:
DF: Dilution Factor Lc/LC: Critical Level
DL: Detection Limit PF: Prep Factor
MDA: Minimum Detectable Activity RL: Reporting Limit
.ADC: Minimum Detectable Concentration SQL: Sample Quantitation Limit
Page 3 of 16 SDG: 517297

GEL LABORATORIES LLC
2040 Savage Road Charleston SC 29407 - [phone] - www.gel.ccm
Certificate of Analysis
Company: Environment One, Inc.
Address : 114 Oakmont Drive
Greenville, North Carolina 27858
Contact: Ms. Deedee Woolard
Project: Routine Analytical - North Carolina
Client Sample ID:
Sample ID:
Matrix:
Collect Date:
Receive Date:
Collector:
Well #4
517297002
Ground Water
28-JUL-20 13:45
31-JUL-20
Client
Report Date: August 4, 2020
Project: ENV000101
Client ID: ENV0001
Parameter Qualifier Result DL RL Units PF DF Analyst Date Time Batch Method
on Chromatography
3PA300.0 Bromide Liquid "As Received"
)romide U 0.000 0.0670 0.200 mg/L 1 LXA2 08/01/20 1846 2025665 1
The following Analytical Methods were performed:
Vethod Description Analyst Comments
EPA 300.0
Votes:
Column headers are defined as follows:
DF: Dilution Factor Lc/LC: Critical Level
DL: Detection Limit PIT: Prep Factor
\1DA: Minimum Detectable Activity RL: Reporting Limit
\130 Minimum Detectable Concentration SQL: Sample Quantitation Limit
Page 4 of 16 SDG: 517297

GEL LABORATORIES LLC
2040 Savage Road Charleston SC 29407 - [phone] - www.gel.com
Certificate of Analysis
Company: Environment One, Inc.
Address : 114 Oakmont Drive
Contact:
Project:
Greenville, North Carolina 27858
Ms. Deedee Woolard
Routine Analytical - North Carolina
Client Sample ID:
Well #5
Sample ID:
517297003
Matrix:
Ground Water
Collect Date:
28-JUL-20 14:15
Receive Date:
31-JUL-20
Collector:
Client
Report Date: August 4, 2020
Project: ENV000101
Client ID: ENVO001
Parameter Qualifier Result DL RL Units PF DF Analyst Date Time Batch Method
on Chromatography
3PA300.0 Bromide Liquid "As Received"
iromide 4.92 0.134 0.400 m9/1- 2 LXA2 09/04/20 0157 2025665 1
The following Analytical Methods were performed:
\4ethod Description Analyst Comments
EPA 300,0
Votes:
Column headers are defined as follows:
DF: Dilution Factor LcILC: Critical Level
DL: Detection Limit PF: Prep Factor
MDA: Minimum Detectable Activity RL: Reporting Limit
MDC: Minimum Detectable Concentration SQL: Sample Quantitation Limit
Page 5 of 16 SDG: 517297

GEL LABORATORIES LLC
2040 Savage Road Charleston SC 29407 - [phone] - www.gel.com
Certificate of Analysis
Company: Environment One, Inc.
Address: 114 Oakmont Drive
Contact:
Project:
Greenville, North Carolina 27858
Ms. Deedee Woolard
Routine Analytical - North Carolina
Client Sample 1D:
Well #7
Sample ID:
517297004
Matrix:
Ground Water
Collect Date:
28-JUL-20 16:25
Receive Date:
31-JUL-20
Collector:
Client
Report Date: August 4, 2020
Project: ENVO00101
Client ID: ENV0001
Parameter Qualifier Result DL RL Units PF DF Analyst Date Time Batch Method
on Chromatography
3PA300.0 Bromide Liquid "As Received"
lromide 11.4 0.335 1.00 mg/L 5 LXA2 OR/04/20 0224 2025665 1
The following Analytical Methods were performed:
Method Description Analyst Comments
EPA 300.0 _
Dotes:
Column headers are defined as follows:
DF: Dilution Factor Lc/LC: Critical Level
DL: Detection Limit PF: Prep Factor
VIDA: Minimum Detectable Activity RL: Reporting Limit
VIDC: Minimum Detectable Concentration SQL: Sample Quantitation Limit
Page 6 of 16 SDG: 517297

GEL LABORATORIES LLC
2040 Savage Road Charleston SC 29407 - [phone] - www.gel,com
Certificate of Analysis
Company: Environment One, Inc.
Address : 114 Oakmont Drive
Greenville, North Carolina 27858
Contact: Ms. Deedee Woolard
Project: Routine Analytical - North Carolina
Client Sample ID:
Sample ID:
Matrix:
Collect Date:
Receive Date:
Collector:
Well #8
517297005
Ground Water
28-JUL-20 16:05
31-JUL-20
Client
Report Date: August 4, 2020
Project: ENV000101
Client ID: ENVO001
Parameter Qualifier Result DL RL Units PF DF Analyst Date Time Batch Method
on Chromatography
,PA300.0 Bromide Liquid "As Received"
lromide 11.5 0.335 1.00 mg/L 5 LXA2 08/04/20 0251 2025665 1
The following Analytical Methods were performed:
Method Description Analyst Comments
EPA 300.0
Dotes:
Column headers are defined as follows:
DF: Dilution Factor Lc/LC: Critical Level
DL: Detection Limit PF: Prep Factor
VIDA: Minimum Detectable Activity RL: Reporting Limit
MDC: Minimum Detectable Concentration SQL: Sample Quantitation Limit
Page 7 of 16 SDG: 517297

GEL LABORATORIES LLC
2040 Savage Road Charleston SC 29407 - [phone] - www.gel.com
Certificate of Analysis
Report Date: August 4, 2020
Company: Environment One, Inc.
Address : 114 Oakmont Drive
Greenville, North Carolina 27858
Contact: Ms. Deedee Woolard
Project: Routine Analytical - North Carolina
Client Sample ID:
Well #9 Project: ENV000101
Sample ID:
517297006 Client ID: ENV0001
Matrix:
Ground Water
Collect Date:
28-J JL-20 15:00
Receive Date:
31-JUL-20
Collector:
Client
Parameter Qualifier Result DL RL Units PF DF Analyst Date Time Batch Method
on Chromatography
3PA300.0 Bromide Liquid "As Received"
iromide U 0.000 0.0670 0.200 m9/L 1 LXA2 08/01/20 2128 2025665 1
The following Analytical Methods were performed:
Method Description Analyst Comments _
EPA 300.0
dotes:
Column headers are defined as follows:
DF: Dilution Factor Lc/LC: Critical Level
DL: Detection Limit PF: Prep Factor
\IDA: Minimum Detectable Activity RL: Reporting Limit
MDC: Minimum Detectable Concentration SQL: Sample Quantitation Limit
Page 8 of 16 SDG: 517297

GEL LABORATORIES LLC
2040 Savage Road Charleston SC 29407 - [phone] - www.gol.com
Certificate of Analysis
Report Date: August 4, 2020
Company: Environment One, Inc.
Address : 114 Oakmont Drive
Greenville, North Carolina 27858
Contact: Ms. Deedee Woolard
Project: Routine Analytical - North Carolina
Client Sample ID:
Well #10 Project: ENV000101
Sample ID:
517297007 Client ID: ENV0001
Matrix:
Ground Water
Collect Date:
28-JUL-20 16:15
Receive Date:
31-JUL-20
Collector:
Client
Parameter Qualifier Result DL RL Units PF DF Analyst Date Time Batch Method
on Chromatography
?PA300.0 Bromide Liquid "As Received"
lromide 0.399 0.0670 0.200 mg/L I LXA2 08/01/20 2155 2025665 1
The following Analytical Methods were performed:
Method Description Analyst Comments
EPA 300.0
dotes:
Column headers are defined as follows:
DF: Dilution Factor Lc/LC: Critical Level
DL: Detection Limit PF: Prep Factor
MDA: Minimum Detectable Activity RL: Reporting Limit
VIDC: Minimum Detectable Concentration SQL: Sample Quantitation Limit
Page 9 of 16 SDG: 517297

GEL LABORATORIES LLC
2040 Savage Road Charleston SC 29407 - [phone] - www.gel.com
Certificate of Analysis
Company: Environment One, Inc.
Address : 114 Oakmont Drive
Report Date: August 4, 2020
Contact:
Project:
Greenville, North Carolina 27858
Ms. Deedee Woolard
Routine Analytical - North Carolina
Client Sample ID:
Well #1 l Project: ENV000101
Sample ID:
517297008 Client ID: ENV0001
Matrix:
Ground Water
Collect Date:
28-JUL-20 13:50
Receive Date:
31-JUL-20
Collector:
Client
Parameter Qualifier Result DL RL Units PF DF Analyst Date Time Batch Method
on Chromatography
I"PA300.0 Bromide Liquid "As Received"
iromide 4.89 0.134 0.400 mg/L 2 LXA2 08/04/20 0318 2025665 1
The following Analytical Methods were performed:
Method Description Analyst Comments
EPA 300.0 _
Dotes:
r1olumn headers are defined as follows:
DF: Dilution Factor Lc/LC: Critical Level
DL: Detection Limit PF: Prep Factor
\1DA: Minimum Detectable Activity RL: Reporting Limit
\1DC: Minimum Detectable Concentration SQL: Sample Quantitation Limit
Page 10 of 16 SDG: 517297

GEL LABORATORIES LLC
2040 Savage Road Charleston, SC 29407 - [phone] - www.gel.com
Environment One, Inc.
114 Oakmont Drive
Greenville, North Carolina
Contact: Ms. Deedee Woolard
Workorder: 517297
Parmname NOM
QC Summary
Sample Qual QC Units
Resort Date: August 4, 2020
RPD% REC% __Anlst
Page 1 of
Date Time
on Chromatography
_Range
3atch 2025665
--
QC 1204610530 517140001 DUP
Bromide U
0.000 U 0.000
mg/L
N/A LXA2
08/0112017:2
QC1204610529 LCS
Bromide 1.25
1.27
mg/L
102 (90%-110%)
08/01/2016:3
QC1204610528 MB
Bromide
U 0.000
mg/L
08/01/2016:0
QC1204610531 517140001 PS
Bromide 1.25 U
0.000 1.28
mg/L
103 (90%-110%)
08/01/2017:5
Notes:
The Qualifiers in this report are defined as follows:
< Result is less than value reported
> Result is greater than value reported
B The target analyte was detected in the associated blank.
E General Chemistry --Concentration of the target analyte exceeds the instrument calibration range
H Analytical holding time was exceeded
J See case narrative for an explanation
J Value is estimated
N/A RPD or %Recovery limits do not apply.
N 1 See case narrative
ND Analyte concentration is not detected above the detection limit
NJ Consult Case Narrative, Data Summary package, or Project Manager concerning this qualifier
Q One or more quality control criteria have not been met. Refer to the applicable narrative or DER.
R Per section 9.3.4.1 of Method 1664 Revision B, due to matrix spike recovery issues, this result may not be reported or used for regulatory compliance
purposes.
R Sample results are rejected
U Analyte was analyzed for, but not detected above the MDL, MDA, MDC or LOD.
X Consult Case Narrative, Data Summary package, or Project Manager concerning this qualifier
Z Paint Filter Test --Particulates passed through the filter, however no free liquids were observed.
Page 11 of 16 SDG: 517297

GEL LABORATORIES LLC
2040 Savage Road Charleston, SC 29407 - [phone] - www.gel.com
QC Summary
Workorder: 517297
Page 2 of
Parmname NOM Sample Qual QC Units RPD% REC% Range Anlst Date Time
^ RPD of sample and duplicate evaluated using+/-RL. Concentrations are <5X the RL. Qualifier Not Applicable for Radiochemistry.
d 5-day BOD--The 2:1 depletion requirement was not met for this sample
e 5-day BOD--Test replicates show more than 30% difference between high and low values. The data is qualified per the method and can be used for
reporting purposes
h Preparation or preservation holding time was exceeded
N/A indicates that spike recovery limits do not apply when sample concentration exceeds spike cone. by a factor of 4 or more or %RPD not applicable.
^ The Relative Percent Difference (RPD) obtained from the sample duplicate (DITP) is evaluated against the acceptance criteria when the sample is greater than
five times (5X) the contract required detection limit (RL). In cases where either the sample or duplicate value is less than 5X the RL, a control limit of +/- the
RL is used to evaluate the DUP result.
" Indicates that a Quality Control parameter was not within specifications.
For PS, PSD, and SDILT results, the values listed are the measured amounts, not final concentrations.
Where the analytical method has been performed under NELAP certification, the analysis has met all of the
requirements of the NELAC standard unless qualified on the QC Summary.
Page 12 of 16 SDG: 517297

General Chemistry
Technical Case Narrative
Environment One, Inc.
SDG #: 517297
Product: ion Chromatography
Analytical Method: EPA 300.0
Analytical Procedure: GL-GC-E-086 REV# 28
Analytical Batch: 2025665
The following samples were analyzed using the above methods and analytical procedure(s).
GEL Sample ID#
Client Sample Identifieation
517297001
Effluent
517297002
Well #4
517297003
Well #5
517297004
Well #7
517297005
Well #8
517297006
Well #9
517297007
Well #10
517297008
Well #11
1204610528
Method Blank (MB)
1204610529
Laboratory Control Sample (LCS)
1204610530
5 1714000 1 (NonSDG) Sample Duplicate (DUP)
1204610531
517140001(NonSDG) Post Spike (PS)
The samples in this SDG were analyzed on an "as received" basis.
Data Summary:
All sample data provided in this report met the acceptance criteria specified in the analytical methods and
procedures for initial calibration, continuing calibration, instrument controls and process controls where
applicable, with the following exceptions.
Sample Dilutions
The following samples 517297001 (Effluent), 517297003 (Well #5), 517297004 (Well 47), 517297005 (Well
#8) and 517297008 (Well #11) were diluted because target analyte concentrations exceeded the calibration
range. Dilutions may be required for many reasons, including to minimize matrix interferences or to bring over
range target analyte concentrations into the linear calibration range.
517297
Annlyte
001
1 003
OOd
005
M
Bmmide
20X
2X
5X
SX
Certification Statement
Where the analytical method has been performed under NELAP certification, the analysis has met all of the
requirements of the NELAC standard unless otherwise noted in the analytical case narrative.
Page 13 of 16 SDG; 517297

gnvironment 1, Inc.
°j�.0. Box 7085, 114 Oakmont Dr.
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ynvironmenE l i nc .com
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CHLORINE
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CLIENT: 132 Week- 33
pH CHECK (LAB)
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SAMPLES COLLECTED BY:
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SAMPLES RECEIVED IN LAB AT 1 °C
RELINQUISHED BY (SIG.) (SAMPLER)
DATEITIME
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COMMENTS:
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0 � I � f 3 ZG 20) 2U2O
REUNQUISHED BY (SIG.)
DATME
EM
RECEIVED BY (SIG.)
DATE/I1ME
i 113 6
---__.
- RELINQUISHED BY-(SI(1).—__ ---
—DATEI-T-IME----..:.:
-RECEdVED•BY-(S.-.) — --- -
- ATElfJMI--.
PLEASE READ Instructions for completing this form on the reverse side. Sampler must place a "C" for composite sample or a "G" for
FORM Rs Grab sample in the blocks above for each parameter requested. N 2 380730

. � L.aboraloi yes i �c ;
L. Ile SAMPLE RECEIPT & REVIEW FORM i
Client: ZE
SDGMIUCOCAVor(c0 r: 1 2: G/ 1
/� r /�
Received By: AJA
Date Received:
Circle A��a4���blr:
FedEx Express Fe lIx Ground /C)P$}' Field Services Courier Other
i
Currier and Tracking Number
Suspected Hazard hlfonnotion
•UNer Counts> 100cpm on samples nut nmri-ad "radioactive", coal= die Radiation SafatyGnup for further investigntiou.
Hazard Clam Shipped: UNIT:
A)Shipped as a DOT Hazardous?
If UN2910, is the Radioactive Shlpmcat Survey Compliant? Yes_.._ No__
t
I
/
B) Did the client designate the smnples are to be
COC- tomdoo orraiboactive sOcl ers mt cnni�inels equal cljartt $e#rgr atrml
received as radioactive?
J -
C) Did the RSO classify de samples as
Maximum Net Comas Observed* (Observed Counts - Area Background Counts): CPAS / mR/Hr
V
1
radioactive?
Classified as: Rad I Red 2 Red 3
a
COC notation oemz-ard
D) Did the client desigkiate sae les ara hazxdous7
1f D orE is yes, select H,azarls below,
1E) Did the RSO idemifibie hazrtnls7
PCB's Fbummnble Foreign Soil RCRA Asbestos Beryllium Other:
j
I
Sample Receipt Criteria
yB,
x
Commenis/Qualdfiers(Requlred for Non-Confurming Items))
{
Shipping containers received intact and
CircleAµp&cable: Scalsbrokcn Damaged container Leakingcanlainer Other(dcseribe)
1
scaled7
Chain of cuitody documents included
Circle Applicable: Client contacted and pmsided COC COC created upon receipt
Willi shipment?
Preservation Mctho d: Wet Ice Ice Packs Dry ice tt er. 0
3
Surtlples requiring cold preservation
/
'all temperatures arc retarded in Celsius TEMP;
wi thin (0 < 6 deg. C)?'
)f
Daily check performed and passed art 1 R
Tenrperatutc Device Serial M:_(R4,j &-____
4
ternperaturc gun?
Secmld.'r>' Tent rature Device Serial N (IrA hcablc
�' PP � ): �
-
5
Sample containers intact and seated?
/
Circle Applicable: ScaBbroken Dmnagedconlniner Leaking container 011ie r(describe)
J
Samples requiring chemical preservation
Sample ID's and Containers Arfceled:
Is
at proper PH?
If Presenadoa cdo'cdcLotp: t
If Yes, are Encores or Soil Kits present for solids? Yes__ No__ NA_.__(If yes, take io VOA Freczcr)-
Do any simples myuire Valaiilu
/
Do liquid VOA vials contain acid preservation? Yes. No_ N 1—(if unkimwu, select No) i
Are liquid VOA vials hce of Itcarlsimce? Yes_. No___, NA__ i
7
Analysis?
y/
Sample ID's and eonuiners aireeled:
t
e
ID's and tests affected: j
8
Samples received within holding lime?
j
Sample ID's on COC imich ID's on
ID's and cotnuinersaffected: l
9
hooks?
i
10
Date & time an COC much dale A, lime
Circle Applicable: No dates on containers No times on containers COC missing info Other (describe)
on bottles?
i
Number of containers received match
Circle Applicable: No container count on COC Other (describe)
11
number indicated on COC?
1"
Are sample Conlaimf3 identifiable is
GEL orovided by use of GEL labels?
I3
COC form is propedy signed in
Chcle Applimble: of relinquish Other(describe) t
relict uished/received seclions?
i
Comments (Use Continuation Form if needed):
i
1
l
ti
PM (or )1MA) review: InW:ds. —�J Dule
i
GL-CHL-SR-001 Rev Z
I
i
Page 15 of 16 SDG: 517297

List of current GEL Certifications as of 04 August 2020
State
Certification
Alabama
42200
Alaska
17-018
Alaska Drinking Water
SCOOO 12
Arkansas
88-0651
CLIA
42D0904046
California
2940
Colorado
SCOOO 12
Connecticut
PH-0169
DoD ELAP/ ISO17025 A2LA
2567.01
Florida NELAP
E87156
Foreign Soils Permit
P330-15-00283, P330-15-00253
Georgia
SCOOO 12
Georgia SDWA
967
Hawaii
SC00012
Idaho
SCOOO 12
Illinois NELAP
200029
Indiana
C—SC-01
Kansas NELAP
E-10332
Kentucky SDWA
90129
Kentucky Wastewater
90129
Louisiana Drinking Water
LA024
Louisiana NELAP
03046 (A133904)
Maine
2019020
Maryland
270
Massachusetts
M—SC012
Massachusetts PFAS Approv
Letter
Michigan
9976
Mississippi
SCOOO 12
Nebraska
NE—OS-26-13
Nevada
SCO00122020-1
New Hampshire NELAP
2054
New Jersey NELAP
SC002
New Mexico
SCOOO 12
New York NELAP
11501
North Carolina
233
North Carolina SDWA
45709
North Dakota
R-158
Oklahoma
2019-165
Pennsylvania NELAP
68-00485
Puerto Rico
SC00012
S. Carolina Radiochem
10120002
Sanitation Districts of L
9255651
South Carolina Chemistry
10120001
Tennessee
TN 02934
Texas NELAP
T104704235-20-17
Utah NELAP
SC000122020-32
Vermont
VT87156
Virginia NELAP
460202
Washington
C780
Page 16 of 16 SDG: 517297

Sample_Nc Lab_ld laboratory Batch_No Assoc_Blnk Sample_Ty Analyte_Ty Coll date
Effluent
517297001 GEL
2025665
120461052 SAMPLE
TARGET
07/28/20
Well #4
517297002 GEL
2025665
120461052 SAMPLE
TARGET
07/28/20
Well #5
517297003GEL
2025665
120461052 SAMPLE
TARGET
07/28/20
Well #7
517297004 GEL
2025665
120461052 SAMPLE
TARGET
07/28/20
Well #8
517297005 GEL
2025665
120461052 SAMPLE
TARGET
07/28/20
Well #9
51729700E GEL
2025665
120461052 SAMPLE
TARGET
07/28/20
Well #10
517297007 GEL
2025665
120461052 SAMPLE
TARGET
07/28/20
Well #11
51729700E GEL
2025665
120461052 SAMPLE
TARGET
07/28/20
MB
120461052 GEL
2025665
120461052 MB
TARGET
08/01/20
LCS
120461052 GEL
2025665
120461052LCS
SPIKE
08/01/20
Rec_date
Ext_date
Anal date
SDG
Parameter
07/31/20
08/04/20
08/04/20
517297
Bromide
07/31/20
08/01/20
08/01/20
517297
Bromide
07/31/20
08/04/20
08/04/20
517297
Bromide
07/31/20
08/04/20
08/04/20
517297
Bromide
07/31/20
08/04/20
08/04/20
517297
Bromide
07/31/20
08/01/20
08/01/20
517297
Bromide
07/31/20
08/01/20
08/01/20
517297
Bromide
07/31/20
08/04/20
08/04/20
517297
Bromide
08/01/20
08/01/20
08/01/20
517297
Bromide
08/01/20
08/01/20
08/01/20
517297
Bromide

Fraction
Method
Lab_Result Uncertaint, Cas_num Units
Lab_Qual
MDL
CRDL_CRQ Dil_Factor
Pct_Moist Comments
G
EPA 300.0
37.9
24959-67-� MG/L
1.34
4.00
20.0
100
G
EPA 300.0
ND
24959-67-� MG/L
U
0.0670
0.200
1.00
100
G
EPA 300.0
4.92
24959-67-S MG/L
0.134
0.400
2.00
100
G
EPA 300.0
11.4
24959-67-S MG/L
0.335
1.00
5.00
100
G
EPA 300.0
11.5
24959-67-S MG/L
0.335
1.00
5.00
100
G
EPA 300.0
ND
24959-674 MG/L
U
0.0670
0.200
1.00
100
G
EPA 300.0
0.399
24959-67-S MG/L
0.0670
0.200
1.00
100
G
EPA 300.0
4.89
24959-67-� MG/L
0.134
0.400
2.00
100
G
EPA 300.0
ND
24959-674 MG/L
U
0.0670
0.200
1.00
100
G
EPA 300.0
102
24959-674 %
0.0670
0.200
1.00
100