NC0072664_Regional Office Historical File Pre 2018 (46)

RECEIVEDINCDENRlDWR
APR 2 9 2015
WQROS
24 April 2015 MOORESVILLE REGIONAL OFFICE
L J
Via, Certified Mail, Return Receipt Requested
7012 1016 0600 M2 4706
NC_WW/GW Laboratory Certification..
DENR/DWR. Laboratory Section
1623 Mail Service Center
Raleigh, NC 27699-1623
RE: Amendment to Environmental Laboratory Certification Application
Laboratory SupervisorChange
Shurtape Techfiologies, LLC
NC. Certification Number 5087
The enclosed: form is hereby submitted to modify the ORC/Laboratory, Supervisor for the.:
referenced location. Effective immediately, Douglas R. Hall will be the: new ORC/Laboratory
Supervisor.
Should you have any questions,or:concerns, please contact me at (828)26:7-8212 or via:email at
ipplin a,shurtape.com: .
Respectfully yours,
Jerry W.. Eplin; PE
Environmental Manager
Enclosures
cc: •David Neff
Matt Moore
Doug Hall:
Shurtape Technologies, LLC
P.O. Box 1530, Hickory, NC 28603 • Phone::828,322,2700 • Toll -Free: 888.4.42.8273

F NORTH CAROLINA Amendment to Environmental
MENT OF ENVIRONMENT.& NATURAL RESOURCES Laboratory Certification Application
DIVISION OF WATER RESOURCES -
WASTEWATER/GROUNDWATER LABORATORY CERTIFICATION Form #101- Amendment application June 1, 2013
INSTRUCTIONS:. This. amendment application is only one part. of the 'certification process; completing and submitting an
amendment form does.:not :constitute official.changes to your certification. Upon review of the completed amendment request;
additional clarifications and documentation may be:required. Information received in a timely manner will expedite the amendment
application process. Please complete'all applicable parts of this form using a typewriter, computer, or print legibly in ink..
To apply for an amendment to your current laboratory certification, return the original and one copy of:this form to:
NC WW/GW:Laboratory Certification
DENR/DWR Laboratory:Section
1623 Mail Service Center
Raleigh, NC 27699-1623
For additional information, contact the NC Wastewater/Groundwater Laboratory Certification program office:
Telephone: [phone]
Fax: [phone]
Program Homepage: http://pbrtEil.hddenr.org/web/Wg/lab/cert
AMENDMENT FEES: :: No fees are charged to file an amendment;request
ADDITIONAL/.RECERTIFICATION::PARAMETER FEES .(Non -Field Laboratories only - no :fees: are assessed ao: Field
Laboratories for adding/recertifying parameters): Requests for additional parameters or recertification of a parameter will be
reviewed and invoices for all additions/recertifications will be calculated-i:n accordance with 15A NCAC 2H .0800. For:each additional
inorganic parameter (excluding metals), a fee of$50_.00 will be assessed. For each additional organic parameter and metals analyte,
a fee of $ioubmill be assessed. For each recertification of a parameter; a: fee of $200.00 will be assessed. Do not submit
... .. ..
I.
payment Untilyou receive -an invoice.:
Section, A: -Facility and Contact Information
Facility Name: Shurtape:Technologies, LLC . NC Certification Number: 5087
Contact Person: Mark E. Hawes Telephone # ext.::. 828-267-8428
E-Mail Address: mhawesCc_shurtape.com Fax #: [phone]
Section: B:. Requested Amendment Complete only applicable areas.
Facility information:. If:facility information has changed, (i.e.,- name of facility, supervisor/manager change, phone numbers,
email or other contact:inforniation) - please indicate below. Complete the information regarding supervisor credentials or operator
certification, when applicable.'
Laboratory Supervisor for this field laboratory _is changing from Travis Edwin Brannon to Douglas R..Hall
Mr. Hall may be reached at 704-585-6511, or via email.at [e-mail]
Laboratory Supervisor/Operator's Certificate Number: _996520 Grade/Type of
Certificate(s):_Grade III Biological Wastewater
Laboratory Supervisor Information. NOTE: An attached resume may be substituted for this.section.
(1) Education: List the College(s), University(ie.$), or Technical Institute(s) attended dates of attendance, and. degree
received.
Mr. Hall does not have a formal degree, however, he. has -over eight years.:of on -the job experience performing analyses
for the Shurtape Certified Lab, and has been an ORC for nearly eight years.

WPaggef 3
NC WW/GW LC Amendment Form
(2) Experience: List work -related experience, indicating the employer, years of employment, and basic job description.
Mr. Hall has been employed at Shurtape since August 1981. He began working with the wastewater treatment plant and
certified field lab at Shurtape in January 2007. He obtained his wastewater operator's license June 14, 2007. Among
other duties at the facility, Mr. Hall has been the backup wastewater operator for the facility since mid-2007. In this role,
he has worked daily with the wastewater treatment plant, and the certified field laboratory, in close cooperation with the
previous laboratory supervisor, Travis Edwin Brannon, and other former laboratory supervisors for the facility.
Change in major equipment: A certified laboratory must submit a written amendment to the certification application each time
that changes occur in major equipment. List equipment changes below.
Deleting parameters: If you are requesting to delete any parameter method technology(s) from your certificate, please list the
analytical parameter(s), including the specific method number(s), matrix(s) and edition(s)/revision(s), below. In addition, be sure to
complete the Change in major equipment section when appropriate.
Adding parameters: If you are requesting additional certified parameter method technology(s) or submitting a change in reporting
limit, please list the information in the table below. All requested information must be supplied. For all organic analytical categories,
please attach a typed list of analyte specific lower reporting limits. DO NOT provide us with the laboratory method detection limit,
unless the lower reporting limit and method detection limit are the same number. For "method reference", list all appropriate method
number(s) and the approved reference(s), such as SM 4500-Cl G-2000, EPA 120.1 (Rev. 1982), Hach 10014 ULR orASTM D888-
09 (B).
Anayical Parameter
Method Number(s) and Reference(s)
*Lower Reporting Limit
Concentration
include. units
Matrix
(A) -Aqueous or
(NA) -Non -Aqueous
When adding parameters, the following must be submitted:
1. Proficiency Testing (PT) -Prior to issuance of certification, this office must receive acceptable proficiency test sample
results from a NELAC or ACLASS-accredited provider for each of the requested parameter method technologies for which
certification is requested and for which PT samples are available (refer to the NC WW/GW LC website for required PTs).

Page of 3
NC WW/GW LC Amendment Form
All testing eounds.rhust have occurred within the six months prior to the date of application. For multi -anal yte parameters
(e.g., Volatile Petroleum Hydrocarbons), results for all spiked components from the primary list of the target group must be
reported. Alternatively, the laboratory may appeal to. report an abbreviated list if they can demonstrate that the abbreviated
list will be a routine reporting scheme for North Carolina client data reporting.
2. Non -field laboratories only: Submit one copy of -the laboratoro Standard Operating Procedure(s), which must include
the established quality control limits (where appropriate to the method) for all requested parameter method technology(s).
3. Non -field laboratories only: Calculated Minimum Detection. Limits (MDLs) and Initial, Demonstration of. Capability (IDOCs)
studies for: Ahblytes by Ion Chromatography, Oil and Grease by EPA 1664, all Organic determinations, Inductively Coupled
Plasma (JCP) and ICP-Mass Spec (ICP-MS) metals MUST be submitted, if certification is requested, with the bornpfeted
application. MDL studies must be conducted as specified by 40 CFR Part 136, Appendix B. For other parameters, the
laboratory attests by signing this application that it has those MDLs and IDOCs; where required by the methods, on file.
MDL and IDOC study summaries for any analytical category may be requested to evaluate the lab's ability to meet the
requirements of certification.
Parameter recertification,if you are requesting recertification, list the.parameter(s) with method number(s), matrix(s) and the
approved reference(s) you wish to'recertify after the decertification period.has expired.
It is. required that an acceptable proficiency testing sample (analyzed within the last six months), for each applicable parameter
to: be added to the certificate attachment, be supplied directly from the vendor to this office: It is required that-two_(2) consecutive.
acceptable proficiency testing samples (analyzed after the decertification effective date and within the last six months) be
submitted directiyfrom the vendor to this office for each applicable parameter prior to recertification.
Are proficiency testing samples (analyzed within the last six months) for each of the:requested additional/recertified analytical
parameter method technology(s) being sent to the Laboratory Section?
Yes No
If not supplied; are they on order? Yes No Anticipated Completion Date:
Has a Corrective Action Report (CAR) been submitted to this office for the unacceptable proficiency testing sample.(s)?
Yes No
Section C: Authorized Signature
Signature of Laboratory Supervisor:
Date:
Print Full Name: Douglas R. Hall
First Name M.I. Last Name
qp
Office (Ise Only:
Date Amendment Received: Date Certification Issued:
Invoice #:. TRC curve/gel verification
Check #: Temp sensor verification
Amendment Process Completed: SC ATC verification
Form101-amend 06/01/2013