NCG030535_DMR_20200427

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Resources General Permit No. NCG030000
Date submitted �/ -2 % a0,;20
CERTIFICATE OF COVERAGE NO. NCG03L 3 S
FACILITY NAME ZF C 4 SS ��rno c.� c.z tS L t— C
COUNTY _ CA TA w A,4 T —
PERSON COLLECTING SAMPLES c.,
LABORATORY P CE Lab Cert. h dal ;2 7 yo
Comments on sample collection or analysis:
Part A: Stormwater Benchmarks and Monitoring Results
SAMPLE COLLECTION YEAR
SAMPLE PERIOD QC Jan -June July -Dec
or ❑ Monthly'_ (month)
DISCHARGING TO CLASS []ORW 0HQW ❑Trout ❑PNA
❑Zero -flow ❑Water Supply FISA
RECEI\/FD ®Other C,
MAY 6V 2020REMEMBER TO SIGN ON PAGES 2 AND/OR 3 4
CENTRAL FILE
.. • vLV
1 1. ,vv
ulJU1u1 yC
L111.� PtCr100!
Outfall No.
Date Sample
i
Collected
24-hour rainfall
amount,
Total Suspended Solids
P H
Copper
Lead
Zinc
Non -Polar O&G/
Total Petroleum
Total Toxic
(mo/dd/yr)
Inches
Standard units
Hydrocarbons
Organicss
Benchmarks =__>
_
-
100 mg/L or 50 mg/L°
6.0 — 9.0
0.007 mg/L
0.03 mg/L
0.067 mg/L
15 mg/L
1 mg/L
-
16.1
D
/Vl b
6,
/
Nb
N
.0) ,
.039rn
�.,.," Y o 1'Hill 15 ,n'xcau ,., milli-amivaiI riiUSL uegilI wiui me secona consecutive benchmark exceedance for the same parameter at the same outfall.
Z For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here.
3 The 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, Table 3 identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
s Total Toxic Organics sampling is applicable only for those facilities which perform metal finishing operations, manufacture semiconductors, manufacture
electronic crystals, or manufacture cathode ray tubes. For purposes of this permit the definition of Total Toxic Organics is that definition contained in the EPA
Effluent Guidelines for the facility subject to the requirement to sample (for metal finishing use the definition as found in 40 CFR 433.11; for semiconductor
manufacture use the definition as found in 40 CFR 469.12; for electronic crystal manufacture use the definition as found in 40 CFR 469.22; and for cathode ray
tube manufacture use the definition found in 40 CFR 469.31).
Permit Date: 11/1/2012-10/31/2017 SWU-245, last revised 10/25/2012
Page 1 of 3

Facilities that incorporate a solvent management plan into the Stormwater Pollution Prevention Plan may so certify, and the requirement for TTO monitoring
may be waived. The solvent management plan shall include a list of the total toxic organic compounds used and the other elements listed in the General
Permit. For those facilities electing to employ the TTO monitoring waiver, the discharger shall sign the following certification statement:
"Based upon my inquiry of the person or persons directly responsible for managing compliance with the permit monitoring requirement for total toxic organics
(TTO), I certify that to the best of my knowledge and belief, no dumping of concentrated toxic organics into the stormwater or areas which are exposed to rainfall or
stormwater runoff has occurred since filing the last discharge monitoring report. I further certify that this facility is implementing the all the provisions of the
solvent management plan included in the Stormwater Pollution Prevention Plan."
bl//I
Name (Print name)
Title (Print title)
(Signature)
(Date)
Note: Results must be reported in numerical format. 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 me/L" where XX is the numerical value of the detection
limit, reporting limit, etc. in mg/L.
Mote: 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.
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month.
Aln rlicrhnrnp fhic norin4.)2
Outfall No.
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
Inches3
Non -polar O&G/TPH by
EPA 1664 (SGT-HEM)
Total Suspended Solids
pH
Benchmarks =__>
_
-
15 mg/L
106 mg/L or 50 mg/L*
6.0 — 9.0 SU
Footnotes from Part A also apply to this Part B
* See General Permit text, Table 5, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Permit Date: 11/1/2012-10/31/2017 SWU-245, last revised 10/25/2012
Page 2 of 3

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 Q NO
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an original and one
in the case of "No Discha
this DMR, including all "No Discharge" reports, within 30 days o
Division of Water Resources
Attn: DWR Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
to:
of the lab results
at end of monitoring period
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)
(Date)
Permit Date: 11/1/2012-10/31/2017 SWU-245, last revised 10/25/2012
Page 3 of 3

_ aceAnalytica('
www.pacelabs.com
Pace Analytical Services, LLC
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
April 06, 2020
William Edens
ZF Chassis Components LLC
1570 E. P St. Ext.
Newton, NC 28658
RE: Project: STORMWATER SAMPLING
Pace Project No.: 92471265
Dear William Edens:
Enclosed are the analytical results for sample(s) received by the laboratory on March 26, 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 - Charlotte
If you have any questions concerning this report, please feel free to contact me.
Sincerely,
Tyriek Hooks
[e-mail]
[phone]
Project Manager
Enclosures
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 14

/�e Analytical
www.pacelabs.com
Pace Analytical Services, LLC
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
Project: STORMWATER SAMPLING
Pace Project No.: 92471265
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 Asheville
2225 Riverside Drive, Asheville, NC 28804
Florida/NELAP Certification #: E87648
Massachusetts Certification #: M-NC030
North Carolina Drinking Water Certification #: 37712
CERTIFICATIONS
South Carolina Certification #: 99006001
Florida/NELAP Certification #: E87627
Kentucky UST Certification #: 84
Virginia/VELAP Certification #: 460221
North Carolina Wastewater Certification #: 40
South Carolina Certification #: 99030001
Virginia/VELAP Certification #: 460222
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 14

/71aceAnalyfical"
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Pace Analytical Services, LLC
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
SAMPLE ANALYTE COUNT
Project: STORMWATER SAMPLING
Pace Project No.: 92471265
Lab ID Sample ID
Method
Analysts
Analytes
Reported
Laboratory
92471265001 3-2020 #1 A,B,C,D
EPA 1664B
WAM
1
PASI-C
EPA 200.7 Rev 4.4 1994
SH1
3
PASI-A
SM 2540D-2011
JNS
1
PASI-A
EPA 9040C
ECH
1
PASI-A
92471265002 3-2020 #2 A,B,C,D
EPA 1664B
WAM
1
PASI-C
EPA 200.7 Rev 4.4 1994
SH1
3
PASI-A
SM 2540D-2011
JNS
1
PASI-A
EPA 9040C
ECH
1
PASI-A
PASI-A = Pace Analytical Services - Asheville
PASI-C = Pace Analytical Services - Charlotte
REPORT OF LABORATORY ANALYSIS
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without the written consent of Pace Analytical Services, LLC. Page 3 of 14

,��IaceAnalXical
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Pace Analytical Services, LLC
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
ANALYTICAL RESULTS
Project: STORMWATER SAMPLING
Pace Project No.: 92471265
Sample: 3-2020 #1 A,B,C,D
Lab ID: 92471265001 Collected:
03/25/20 10:30
Received: 03/26/20 10:47 Matrix: Water
Parameters
Results Units Report Limit
DF
Prepared Analyzed CAS No. Qual
HEM, Oil and Grease
Analytical Method: EPA 1664E
Pace Analytical Services - Charlotte
Oil and Grease
ND mg/L
5.0
1
03/31/20 09:50
200.7 MET ICP
Analytical Method: EPA 200.7 Rev 4.4
1994 Preparation
Method: EPA 200.7 Rev 4.4 1994
Pace Analytical Services - Asheville
Copper
ND mg/L
0.0050
1
04/02/20 01:31 04/02/20 22:49 7440-50-8
Lead
ND mg/L
0.0050
1
04/02/20 01:31 04/02/20 22:49 7439-92-1
Zinc
0.028 mg/L
0.010
1
04/02/20 01:31 04/02/20 22:49 7440-66-6
2540D Total Suspended Solids
Analytical Method: SM 2540D-2011
Pace Analytical Services - Asheville
Total Suspended Solids
10 mg/L
4.4
1
04/01/20 11:27
9040 pH
Analytical Method: EPA 9040C
Pace Analytical Services - Asheville
pH at 25 Degrees C
6.1 Std. Units
0.10
1
04/05/20 14:17 H3
Date: 04/06/2020 03:54 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 14

1"'�e Analytical
www.pactiabs.com
Pace Analytical Services, LLC
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
ANALYTICAL RESULTS
Project: STORMWATER SAMPLING
Pace Project No.: 92471265
Sample: 3-2020 #2 A,B,C,D
Lab ID: 92471265002 Collected:
03/25/20 11:00
Received: 03/26/20 10:47 Matrix: Water
Parameters
Results Units Report Limit
DF
Prepared Analyzed CAS No. Qual
HEM, Oil and Grease
Analytical Method: EPA 1664B
Pace Analytical Services - Charlotte
Oil and Grease
ND mg/L
5.0
1
03/31/20 09:50
200.7 MET ICP
Analytical Method: EPA 200.7 Rev 4.4
1994 Preparation
Method: EPA 200.7 Rev 4.4 1994
Pace Analytical Services -Asheville
Copper
ND mg/L
0.0050
1
04/02/20 01:31 04/02/20 22:52 7440-50-8
Lead
ND mg/L
0.0050
1
04/02/20 01:31 04/02/20 22:52 7439-92-1
Zinc
0.039 mg/L
0.010
1
04/02/20 01:31 04/02/20 22:52 7440-66-6
2540D Total Suspended Solids
Analytical Method: SM 2540D-2011
Pace Analytical Services - Asheville
Total Suspended Solids
4.4 mg/L
2.5
1
04/01/20 11:28
9040 pH
Analytical Method: EPA 9040C
Pace Analytical Services - Asheville
pH at 25 Degrees C
6.4 Std. Units
0.10
1
04/05/20 14:22 H3
Date: 04/06/2020 03:54 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 14

aceAnalytical
www.patelabs.com
Pace Analytical Services, LLC
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
QUALITY CONTROL DATA
Project: STORMWATER SAMPLING
Pace Project No.: 92471265
QC Batch: 533428 Analysis Method: EPA 1664E
QC Batch Method: EPA 1664B Analysis Description: 1664 HEM, Oil and Grease
Laboratory: Pace Analytical Services - Charlotte
Associated Lab Samples: 92471265001, 92471265002
METHOD BLANK: 2847559 Matrix: Water
Associated Lab Samples: 92471265001, 92471265002
Blank Reporting
Parameter Units Result Limit Analyzed Qualifiers
Oil and Grease mg/L ND 5.0 03/31/20 09:50
LABORATORY CONTROL SAMPLE:
2847560
Spike LCS
LCS
% Rec
Parameter
Units
Conc. Result
% Rec
Limits
Qualifiers
Oil and Grease
mg/L
40 35.4
88
78-114
MATRIX SPIKE SAMPLE:
2847561
2630482002 Spike
MS
MS
% Rec
Parameter
Units
Result Conc.
Result
% Rec
Limits Qualifiers
Oil and Grease
mg/L
ND 40
35.2
87
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: 04/06/2020 03:54 PM without the written consent of Pace Analytical Services, LLC.
Page 6 of 14

_�laceAnalXical
www.pacelabs.com
Pace Analytical Services, LLC
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
QUALITY CONTROL DATA
Project: STORMWATER SAMPLING
Pace Project No.: 92471265
QC Batch: 533890 Analysis Method: EPA 200.7 Rev 4.4 1994
QC Batch Method: EPA 200.7 Rev 4.4 1994 Analysis Description: 200.7 MET
Laboratory: Pace Analytical Services - Asheville
Associated Lab Samples: 92471265001, 92471265002
METHOD BLANK: 2849637
Associated Lab Samples: 92471265001, 92471265002
Parameter Units
Copper mg/L
Lead mg/L
Zinc mg/L
Matrix: Water
Blank Reporting
Result Limit
Analyzed
ND 0.0050
04/02/20 22:25
ND 0.0050
04/02/20 22:25
ND 0.010
04/02/20 22:25
Qualifiers
LABORATORY CONTROL SAMPLE:
2849638
Spike
LCS LCS % Rec
Parameter
Units
Cone.
Result % Rec Limits Qualifiers
Copper
mg/L
0.5
0.49 98 85-115
Lead
mg/L
0.5
0.48 96 85-115
Zinc
mg/L
0.5
0.47 94 85-115
MATRIX SPIKE & MATRIX SPIKE DUPLICATE:
2849639
2849640
MS
MSD
92471518001
Spike
Spike
MS
MSD
MS
MSD
% Rec
Parameter Units
Result
Cone.
Cone.
Result
Result
% Rec
% Rec
Limits RPD Qual
Copper mg/L
ND
0.5
0.5
0.51
0.50
103
100
70-130 2
Lead mg/L
ND
0.5
0.5
0.50
0.49
100
98
70-130 2
Zinc mg/L
46.3
0.5
0.5
0.54
0.53
99
97
70-130 2
ug/L
MATRIX SPIKE & MATRIX SPIKE DUPLICATE:
2849641
2849642
MS
MSD
92471863003
Spike
Spike
MS
MSD
MS
MSD
% Rec
Parameter Units
Result
Cone.
Cone.
Result
Result
% Rec
% Rec
Limits RPD Quaf
Copper mg/L
ND
0.5
0.5
0.59
0.57
117
114
70-130 3
Lead mg/L
ND
0.5
0.5
0.52
0.50
103
100
70-130 3
Zinc mg/L
ND
0.5
0.5
0.51
0.49
101
98
70-130 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
This report shall not be reproduced, except in full,
Date: 04/06/2020 03:54 PM without the written consent of Pace Analytical Services, LLC.
Page 7 of 14
n

71ac1�eAnalXical'
r
www.pacelabs.com
Pace Analytical Services, LLC
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
QUALITY CONTROL DATA
Project: STORMWATER SAMPLING
Pace Project No.: 92471265
QC Batch: 533719 Analysis Method: SM 2540D-2011
QC Batch Method: SM 2540D-2011 Analysis Description: 2540D Total Suspended Solids
Laboratory: Pace Analytical Services - Asheville
Associated Lab Samples: 92471265001, 92471265002
METHOD BLANK: 2848751 Matrix: Water
Associated Lab Samples: 92471265001, 92471265002
Blank Reporting
Parameter Units Result Limit Analyzed Qualifiers
Total Suspended Solids mg/L ND 2.5 04/01/20 11:13
LABORATORY CONTROL SAMPLE: 2848752
Spike LCS LCS % Rec
Parameter Units Conc. Result % Rec Limits Qualifiers
Total Suspended Solids mg/L 250 246 98 90-110
SAMPLE DUPLICATE: 2848813
92471037001 Dup
Parameter Units Result Result RPD Qualifiers
Total Suspended Solids mg/L 2460 2380 3
SAMPLE DUPLICATE: 2848814
92470717002 Dup
Parameter Units Result Result RPD Qualifiers
Total Suspended Solids mg/L 1000 1400 33 D6
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: 04/06/2020 03:54 PM without the written consent of Pace Analytical Services, LLC.
Page 8 of 14

/71aceAnalXical"
www.pacelabs.com
i
QUALITY CONTROL DATA
Project: STORMWATER SAMPLING
Pace Project No.: 92471265
QC Batch: 534419 Analysis Method: EPA 9040C
QC Batch Method: EPA 9040C Analysis Description: 9040 pH
Laboratory: Pace Analytical Services - Asheville
Associated Lab Samples: 92471265001, 92471265002
SAMPLE DUPLICATE: 2852076
92471370001 Dup
Parameter Units Result Result RPD Qualifiers
pH at 25 Degrees C Std. Units 7.9 7.6 4 D6,H3
SAMPLE DUPLICATE: 2852077
92471437001 Dup
Parameter Units Result Result RPD Qualifiers
pH at 25 Degrees C Std. Units 7.1 7.2 1 H3
Pace Analytical Services, LLC
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[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: 04/06/2020 03:54 PM without the written consent of Pace Analytical Services, LLC.
Page 9 of 14

71aceAnalytical
www.poesiabs.com
Pace Analytical Services, LLC
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
QUALIFIERS
Project: STORMWATER SAMPLING
Pace Project No.: 92471265
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
D6 The precision between the sample and sample duplicate exceeded laboratory control limits.
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: 04/06/2020 03:54 PM without the written consent of Pace Analytical Services, LLC. Page 10 of 14

s
1�7aceAnalXical `�
www.pacelabs.com
Pace Analytical Services, LLC
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
QUALITY CONTROL DATA CROSS REFERENCE TABLE
Project: STORMWATER SAMPLING
Pace Project No.: 92471265
Lab ID
Sample ID
QC Batch Method
QC Batch
92471265001
3-2020 #1 A,B,C,D
EPA 1664B
533428
92471265002
3-2020 #2 A,B,C,D
EPA 1664B
533428
92471265001
3-2020 #1 A,B,C,D
EPA 200.7 Rev 4.4 1994
533890
92471265002
3-2020 #2 A,B,C,D
EPA 200.7 Rev 4.4 1994
533890
92471265001
3-2020 #1 A,B,C,D
SM 2540D-2011
533719
92471265002
3-2020 #2 A,B,C,D
SM 2540D-2011
533719
92471265001
3-2020 #1 A,B,C,D
EPA 9040C
534419
92471265002
3-2020 #2 A,B,C,D
EPA 9040C
534419
Date: 04/06/2020 03:54 PM
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, LLC.
Analytical
Analytical Method Batch
EPA 200.7 Rev 4.4 1994 533919
EPA 200.7 Rev 4.4 1994 533919
Page 11 of 14
J

Document Name:
Document Revised: February 7, 2018
b
ace Analytical
Sample Condition Upon Recelpt(SCUR)
Page 1 of 2
Document No.:
Issuing Authority:
F-CAR-CS-033-Rev.06
Pace Carolinas Quality Office
Laboratory receiving samples:
Asheville ❑ Eden[] Greenwood ❑ Huntersville ❑' Ralelgh❑ Mechanicsville❑
• , ; Client Name: n Receipt Project # WO# : 9247126 5
i I,; ,
Courier: ❑Fed Ex ❑UPS ❑LISPS ❑Client
❑ Commercial 015ace ❑Other:
92471265
Custody Seal Present? ❑Yes ❑No Seals Intact? ❑Yes []No � P
oats/Initials Parson Examining Contents:
Packing Material: []Bubble Wrap ❑Bubble Bags ❑None ❑ Other
Thermometer:
Type of Ice: OG/et ❑slue
❑IR Gun ID: 92TO60
Cooler Tempj f ('C): `7 �> Correction Factor: Add/Subtract ('C) 0.0
Cooler Temp Corrected ('C)i
USDA Regulated Soll ([Q�N/A, water sample)
Did samples originate In a quarantine zone within the United States: CA, NY, or SC (check maps)?
nve• nu.,
Biological Tissue Frozen?
[_—]Yes[]NO[]N/A❑None
Temp should be above freezing to 6'C
❑Samples out of temp criteria. Samples on ice, cooling process
hasbegun
Did samples originate from a foreign source (internationally,
inrllldine Hawaii and Puerto Rlcnl? 1—IYes nNo
Comments/Discrepancy:
'chain of Custody Present? `
Yes
ONO
❑N/A
1.
Samples Arrived within Hold T"imel
es
ONO
N/A
2.
;Short Hold Time Analysis <72hr.?
❑Yes
o
N/A
3.
Rush Turn Around Time Requested?
Yes
ffNo
N/A
4.
Sufficient volume?
es
ONo
N/A
S.
Correct Containers Used?
-Pace Containers Used?
[Yes
[Yes
❑No
❑No
❑N/A
❑N/A
6.
Containers Intact?
Byes
ONo
N A
7.
Dissolved analysis: Samples Field Filtered?
Yes
No
06/A
8.
Sample Labels Match COC?
QYes
❑No
[]N/A
9.
-Includes Date/Time/ID/Analysis Matrix:
Heads ace in VOA Vials (>S-6mm)?
❑Yes
❑No
/A
10,
Trip Blank Present?
Trip Blank Custody Seals Present)
❑Yes
OYes
❑No
No
(3k/A
' N/A
11.
COMMENTS/SAMPLE DISCREPANCY
CLIENT NOTIFICATION/RESOLUTION
Person contacted:
Project Manager SCURF Review:
Project Manager SRF Review:
Lot ID of split containers:
Date/Time:
Date:
Date:
Field Data Required? ❑Yes ❑No
Page 12 of 14
. 1

Document Name: Document Revised: February 7, 2018
Sample Condition Upon Recelpt(SCUR) Page 1 of 2
�aceAnal�,trcal _ _ ------ --
y� Document No.: Issuing Authority:
F-CAR-CS-033-Rev.06 Pace Carolinas Quality Office
*Check marls top half of be)( if pH and/or dechlorination is Project # © �� /1 S 26
verified and within the acceptance range for preservation
samples. ppl: TIH Due Date: 04/09/20
Exceptions: VOA, Coliform, TOC, Oil and Grease, DRO/8015 (water) DOC, LLHg CLIENT: 92-Memf ord
`*Bottom half of box is to list number of bottle
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pH Adjustment Log for Preserved Samples
Sample ID
Type of Preservative
pH upon receipt
Date preservation adjusted
Time preservation
adjusted
Amount of Preservative
added
Lot d
Note: Whenever there is a discrepancy attesting Nor -in Laronna compnance samples, a copy o, m,5 w-- vrm tie 6enl to u!c k,.c.
Out of hold, incorrect preservative, out of temp, incorrect containers.
Page 13 of 14
ll

' Paceafalyticaj" CHAIN -OF -CUSTODY / Analytical
Request Document
The Chain -of -Custody is a LEGAL DOCUMENT. At
relevant fields must be completed accurately.
ion A Section B Section C
uired Client Information: Required Project Information: Invoice Information:
P8 e ;
1 Of
pant ZF Chassis - Newton
Report To: WIIIIam Edens
Attention ..r i
ess 1570 East P Street Ext
Copy To:
Company Name: ,',j�
ton, NC 28658
Address: IS' L —
Rc ula
ory Agency
Il. [e-mail]
Purchase Order #
Pace Quote:
1e [phone] Fax
Project Name: Stormwater Sampling
rnP 9tyriek.hooks
Pace Project Manager
pacelabs.eom.
State
Location
jested Due Date:
Project
Pace P,Cfoe 4 3736-1
NC
Re
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MATRIX CODE
COLLECTED
Preservatives
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SAMPLE CONDITIONS
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