NCG030166_DMR_20200302

TIMKEN
Where You Turn
Douglas R. Simmons
Sr. Environmental Engineer CERTIFIED MAIL
RETURN RECEIPT REQUESTED RECEIVED
March 03, 2020 MAR 1 0 2020
CEN F< L FILES
Attn: Central Files DWR SECTION
Division of Water Resources (DWR)
1617 Mail Service Center
Raleigh,NC 27699-1617
Re: Certificate of Coverage No. NCG030166
Enclosed is the discharge monitoring report(SDMR) signed by Lincolnton's plant
manager Marty Hallman and the analytical results from storm water sampling
completed at the Timken Company's Lincolnton Bearing Plant located at Iron
Station, N.C.
This sampling was performed to comply with the analytical monitoring requirements
of the LBP's Metal Fabrication Storm Water General Permit, Certificate of Coverage
NCG030166, which requires sampling once during the first and second half of each
year respectively. The attached analytical reports and Storm water discharge
monitoring report is for the lst Half of 2020
Sinc ly,
V2/2,6 Z
Douglas R. Simmons
Sr. Environmental Engineer
Enclosure
- Pace Storm water analytical results report#92463869
- Signed Semi-annual Storm Water Discharge Monitoring report
Cc: Gensuite Task—Storm Water monitoring
Lincolnton Storm water hardcopy File—LIN-01
The Timken Company
Mail Code: LIN-01
1000 Timken Place
Iron Station,N.C.28080
Telephone: [phone]
Facsimile: [phone]
[e-mail]

Stormwater Discharge Monitoring Report
for North Carolina Division of Energy, Mineral and Land Resources General Permit No. NCG030000
Date submitted 03/02/2020
CERTIFICATE OF COVERAGE NO. NCGO3 0 1 6 6 SAMPLE COLLECTION YEAR 2020
FACILITY NAME Timken Company-Lincolnton Bearing Plant SAMPLE PERIOD 0 Jan-June ❑July-Dec
COUNTY Lincoln or ❑ Monthly' (month)
PERSON COLLECTING SAMPLES Doug Simmons DISCHARGING TO CLASS f ORW HQW UTrout 1PNA
LABORATORY Pace Analytical Lab Cert.# 5342 Zero-flow ' Water Supply SA
Comments on sample collection or analysis: (Other
Metal Fabrication permit
PLEASE REMEMBER TO SIGN ON PAGES 2 AND/OR 3 -)
Part A: Stormwater Benchmarks and Monitoring Results
No discharge this period?'
Non-Polar O&G/
Date Sample 24-hour rainfall pH, Total Toxic
Outfall No.
Collected1 Total Suspended Solids Total Copper Total Lead Total Zinc Total Petroleum amount, Standard units Organics'
(mo/dd/yr) Inches3 Hydrocarbons
Benchmarks - - 100 mg/L or 50 mg/L4 6.0—9.0 0.010 mg/L 0.075 mg/L 0.126 mg/L 15 mg/L 1 mg/L
Parameter Code - 46529 C0530 00400 01119 01051 01094 00552 78141
001 02/05/2020 0 375 < 5.0 mg/I 6.54 <0.005 mg/I <0.005 mg/I <0.010 mg/I <5 0 mg/I
1 Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
2 For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here.
'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, Section B,Table 1 to identify the especially sensitive receiving water classifications where the more protective benchmark applies.
'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: 11/1/2018-05/31/2021 SWU-245, last revised 11/1/2018
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."
Marty A. Hallman
Name(Print name)
Plant Manager
Title(Print title)
5..2.-2c`Z�
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 mg/L",where XX is the numerical value of the detection
limit, reporting limit, etc. in mg/L.
Note: If you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses. See General Permit text.
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month.
No discharge this period?'
Outfall No. Date Sample Collected' 24-hour rainfall amount, New Motor Oil or Non-Polar O&G/Total Total Suspended
(mo/dd/yr) Inches3 Hydraulic Oil Usage Petroleum Hydrocarbons Solids
Benchmarks - - - 15 mg/L 100 mg/L or 50 mg/L4
Parameter Code 46529 NCOIL 00552 C0530
Footnotes from Part A also apply to Part B
Note: If you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses. See General Permit text.
Permit Date: 11/1/2018-05/31/2021 SWU-245, last revised 11/1/2018
Page 2 of 3

FOR PART A AND PART B MONITORING RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES ❑ NO❑
IF YES,HAVE YOU CONTACTED THE DEMLR REGIONAL OFFICE? YES❑ NO❑
REGIONAL OFFICE CONTACT NAME:
Mail an original copy of this DMR,including all"No Discharge"reports, within 30 days of receipt of the lab results(or at end of monitoring period in the
case of"No Discharge"reports)to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
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."
ti �� , p l/ -Z—
Signature of Permittee Date
Permit Date: 11/1/2018-05/31/2021 SWU-245, last revised 11/1/2018
Page 3 of 3

Pace Analytical Services,LLC
/ aceAnal tical 205 East Meadow Road-Suite A
tr I f ela . Eden,NC 27288
www.pacelehs.com [phone]
February 14, 2020
Mr. Doug Simmons
Timken Company- Lincolnton Bearing Plant
1000 Timken Place
Iron Station, NC 28080
RE: Project: Timken Lincolnton
Pace Project No.: 92463869
Dear Mr. Simmons:
Enclosed are the analytical results for sample(s) received by the laboratory on February 05, 2020.
The results relate only to the samples included in this report. Results reported herein conform to the
most current, applicable TNI/NELAC standards and the laboratory's Quality Assurance Manual,
where applicable, unless otherwise noted in the body of the report.
If you have any questions concerning this report, please feel free to contact me.
Sincerely,
Bonnie Vang
[e-mail]
[phone]
Project Manager
Enclosures
cc: Wendy Leonard,Timken Steel
, • REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced,except in full,
•
ej
without the written consent of Pace Analytical Services,LLC. Page 1 of 14

Pace Analytical Services,LLC
aceAnalyficai 205 East Meadow Road-Suite
Eden,NC 27288
www.pacelabs.com [phone]
I
CERTIFICATIONS
Project: Timken Lincolnton
Pace Project No.: 92463869
Pace Analytical Services Charlotte
9800 Kincey Ave.Ste 100,Huntersville,NC 28078 South Carolina Certification#:99006001
Louisiana/NELAP Certification#LA170028 Florida/NELAP Certification#:E87627
North Carolina Drinking Water Certification#:37706 Kentucky UST Certification#:84
North Carolina Field Services Certification#:5342 VirginiaNELAP Certification#:460221
North Carolina Wastewater Certification#: 12
Pace Analytical Services Asheville
2225 Riverside Drive,Asheville,NC 28804 North Carolina Wastewater Certification#:40
Florida/NELAP Certification#:E87648 South Carolina Certification#:99030001
Massachusetts Certification#:M-NC030 VirginiaNELAP Certification#:460222
North Carolina Drinking Water Certification#:37712
REPORT OF LABORATORY ANALYSIS
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without the written consent of Pace Analytical Services,LLC. Page 2 of 14

Pace Analytical Services,LLC
aceAnalyticai® 205 East Meadow Road-Suite A
Eden,NC 27288
www.pecelebs.eom [phone]
SAMPLE ANALYTE COUNT
Project: Timken Lincolnton
Pace Project No.: 92463869
Analytes
Lab ID Sample ID Method Analysts Reported Laboratory
92463869001 Stormwater Outfall#001 EPA 1664B WAM 1 PASI-C
EPA 200.7 Rev 4.4 1994 RDT,SH1 7 PASI-A
SM 2540D-2011 CJL 1 PASI-A
SM 5210B-2011 JP1 1 PASI-A
REPORT OF LABORATORY ANALYSIS
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Pace Analytical Services,LLC
aceAnalyticai a 205 East Meadow Road-Suite A
/
aeAnalytical
w Eden,NC 27288
ww.pac®labs.eom [phone]
i
I
ANALYTICAL RESULTS
Project: Timken Lincolnton
Pace Project No.: 92463869
Sample: Stormwater Outfall#001 Lab ID: 92463869001 Collected: 02/05/20 11:30 Received: 02/05/20 14:15 Matrix: Water
Parameters Results Units Report Limit DF Prepared Analyzed CAS No. Qual
Field Data Analytical Method:
Collected By Doug 1 02/05/20 11:30
Simmons
Collected Date 02/05/20 1 02/05/20 11:30
Collected Time 11:30 1 02/05/20 11:30
pH 6.54 Std.Units 1 02/05/20 11:30
Temperature 15.56 deg C 1 02/05/20 11:30
1664 SGT-HEM,TPH Analytical Method:EPA 1664E
Total Petroleum Hydrocarbons ND mg/L 5.0 1 02/14/20 09:14
200.7 MET ICP Analytical Method:EPA 200.7 Rev 4.4 1994 Preparation Method:EPA 200.7 Rev 4.4 1994
Cadmium ND ug/L 1.0 1 02/11/20 00:57 02/13/20 06:53 7440-43-9
Chromium ND ug/L 5.0 1 02/11/20 00:57 02/14/20 02:12 7440-47-3
Copper ND ug/L 5.0 1 02/11/20 00:57 02/14/20 02:12 7440-50-8
Lead ND ug/L 5.0 1 02/11/20 00:57 02/13/20 06:53 7439-92-1
Nickel ND ug/L 5.0 1 02/11/20 00:57 02/13/20 06:53 7440-02-0
Silver ND ug/L 5.0 1 02/11/20 00:57 02/13/20 06:53 7440-22-4
Zinc ND ug/L 10.0 1 02/11/20 00:57 02/13/20 06:53 7440-66-6
2540D Total Suspended Solids Analytical Method:SM 2540D-2011
Total Suspended Solids ND mg/L 5.0 1 02/07/20 18:00
5210E BOD,5 day Analytical Method:SM 5210B-2011
BOD,5 day ND mg/L 2.0 1 02/06/20 06:34 02/11/20 02:10
REPORT OF LABORATORY ANALYSIS
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Date:02/14/2020 04:32 PM without the written consent of Pace Analytical Services,LLC. Page 4 of 14

Pace Analytical Services,LLC
aceAnalytical a 205 East Meadow Road-Suite A
Eden,NC 27288
www.pacelabs.cola [phone]
i
QUALITY CONTROL DATA
Project: Timken Lincolnton
Pace Project No.: 92463869
QC Batch: 525180 Analysis Method: EPA 1664E
•
QC Batch Method: EPA 1664E Analysis Description: 1664 SGT-HEM,TPH
Associated Lab Samples: 92463869001
METHOD BLANK: 2807148 Matrix: Water
Associated Lab Samples: 92463869001
Blank Reporting
Parameter Units Result Limit Analyzed Qualifiers
Total Petroleum Hydrocarbons mg/L ND 5.0 02/14/20 09:14
LABORATORY CONTROL SAMPLE: 2807149
Spike LCS LCS %Rec
Parameter Units Conc. Result %Rec Limits Qualifiers
Total Petroleum Hydrocarbons mg/L 20 15.8 79 64-132
MATRIX SPIKE SAMPLE: 2807150
92463731002 Spike MS MS %Rec
Parameter Units Result Conc. Result %Rec Limits Qualifiers
Total Petroleum Hydrocarbons mg/L ND 20 16.3 70 64-132
•
Results presented on this page are in the units indicated by the"Units"column except where an alternate unit is presented to the right of the result.
REPORT OF LABORATORY ANALYSIS
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Date:02/14/2020 04:32 PM without the written consent of Pace Analytical Services,LLC. Page 5 of 14

'71
Pace Analytical Services,LLC
aceAnalytical 205 East Meadow Road-Suite A
Eden,NC 27288
www.pacelabs.cam
[phone]
i
I
QUALITY CONTROL DATA
Project: Timken Lincolnton
Pace Project No.: 92463869
QC Batch: 524310 Analysis Method: EPA 200.7 Rev 4.4 1994
QC Batch Method: EPA 200.7 Rev 4.4 1994 Analysis Description: 200.7 MET
Associated Lab Samples: 92463869001
METHOD BLANK: 2803025 Matrix: Water
Associated Lab Samples: 92463869001
Blank Reporting
Parameter Units Result Limit Analyzed Qualifiers
Cadmium ug/L ND 1.0 02/14/20 01:59
Chromium ug/L ND 5.0 02/14/20 01:59
Copper ug/L ND 5.0 02/14/20 01:59
Lead ug/L ND 5.0 02/14/20 01:59
Nickel ug/L ND 5.0 02/14/20 01:59
Silver • ug/L ND 5.0 02/14/20 01:59
Zinc ug/L ND 10.0 02/14/20 01:59
LABORATORY CONTROL SAMPLE: 2803026
Spike LCS LCS %Rec
Parameter Units Conc. Result %Rec Limits Qualifiers
Cadmium ug/L 500 485 97 85-115
Chromium ug/L 500 517 103 85-115
Copper ug/L 500 480 96 85-115
Lead ug/L 500 524 105 85-115
Nickel ug/L 500 489 98 85-115
Silver ug/L 250 244 98 85-115
Zinc ug/L 500 514 103 85-115
MATRIX SPIKE&MATRIX SPIKE DUPLICATE: 2803027 2803028
MS MSD
92463854001 Spike Spike MS MSD MS MSD %Rec
Parameter Units Result Conc. Conc. Result Result %Rec %Rec Limits RPD Qual
Cadmium ug/L ND 500 500 509 511 102 102 70-130 0
Chromium ug/L 21.4 500 500 483 490 92 94 70-130 1
Copper ug/L 68.9 500 500 526 534 92 93 70-130 1
Lead ug/L ND 500 500 534 537 106 107 70-130 1
Nickel ug/L 6.4 500 500 505 506 100 100 70-130 0
Silver ug/L ND 250 250 251 253 100 101 70-130 1
Zinc ug/L 137 500 500 655 666 104 106 70-130 2
MATRIX SPIKE&MATRIX SPIKE DUPLICATE: 2803029 2803030
MS MSD
92463892003 Spike Spike MS MSD MS MSD %Rec
Parameter Units Result Conc. Conc. Result Result %Rec %Rec Limits RPD Qual
Cadmium ug/L ND 500 500 490 485 98 97 70-130 1
Chromium ug/L ND 500 500 450 451 90 90 70-130 0 •
Results presented on this page are in the units indicated by the"Units"column except where an alternate unit is presented to the right of the result.
REPORT OF LABORATORY ANALYSIS
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Date:02/14/2020 04:32 PM without the written consent of Pace Analytical Services,LLC. Page 6 of 14

Pace Analytical Services,LLC
e 205 East Meadow Road-Suite A
aceAnalytical Eden,NC 27288
www.pacelabs.com
[phone]
i
QUALITY CONTROL DATA
Project: Timken Lincolnton
Pace Project No.: 92463869
MATRIX SPIKE&MATRIX SPIKE DUPLICATE: 2803029 2803030
MS MSD
92463892003 Spike Spike MS MSD MS MSD %Rec
Parameter Units Result Conc. Conc. Result Result %Rec %Rec Limits RPD Qual
Copper ug/L ND 500 500 441 440 88 88 70-130 0
Lead ug/L ND 500 500 514 507 103 101 70-130 1
Nickel ug/L ND 500 500 481 476 96 95 70-130 1
Silver ug/L ND 250 250 247 246 99 98 70-130 0
Zinc ug/L ND 500 500 501 499 100 100 70-130 0
Results presented on this page are in the units indicated by the"Units"column except where an alternate unit is presented to the right of the result.
REPORT OF LABORATORY ANALYSIS
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Date:02/14/2020 04:32 PM without the written consent of Pace Analytical Services,LLC. Page 7 of 14

Pace Analytical Services,LLC
'(I'-
aceAnalytical tit 205 East Meadow Road-Suite A
Eden,NC 27288
www.pacelabs.com
[phone]
I
QUALITY CONTROL DATA
Project: Timken Lincolnton
Pace Project No.: 92463869
QC Batch: 523819 Analysis Method: SM 2540D-2011
QC Batch Method: SM 2540D-2011 Analysis Description: 2540D Total Suspended Solids
Associated Lab Samples: 92463869001
METHOD BLANK: 2800612 Matrix: Water
Associated Lab Samples: 92463869001
Blank Reporting
Parameter Units Result Limit Analyzed Qualifiers
Total Suspended Solids mg/L ND 2.5 02/07/20 17:55
LABORATORY CONTROL SAMPLE: 2800613
Spike LCS LCS %Rec
Parameter Units Conc. Result %Rec Limits Qualifiers
Total Suspended Solids mg/L 251 248 99 90-110
SAMPLE DUPLICATE: 2800630
92463819001 Dup
Parameter Units Result Result RPD Qualifiers
Total Suspended Solids mg/L 28.0 25.8 8
SAMPLE DUPLICATE: 2800631
92463831001 Dup
Parameter Units Result Result RPD Qualifiers
Total Suspended Solids mg/L 5450 3320 49 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
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Pace Analytical Services,LLC
® 205 East Meadow Road-Suite A
aceAnalytical Eden,NC 27288
www.pacelabs.com [phone]
QUALITY CONTROL DATA
Project: Timken Lincolnton
Pace Project No.: 92463869
QC Batch: 523530 Analysis Method: SM 5210B-2011
QC Batch Method: SM 5210B-2011 Analysis Description: 5210E BOD,5 day
Associated Lab Samples: 92463869001
METHOD BLANK: 2799306 Matrix: Water
Associated Lab Samples: 92463869001
Blank Reporting
Parameter Units Result Limit Analyzed Qualifiers
BOD,5 day mg/L ND 2.0 02/11/20 01:30
LABORATORY CONTROL SAMPLE: 2799307
Spike LCS LCS • %Rec
Parameter Units Conc. Result %Rec Limits Qualifiers
BOD,5 day mg/L 198 171 87 84.6-115
SAMPLE DUPLICATE: 2799309
92463866001 Dup
Parameter Units Result Result RPD Qualifiers
BOD,5 day mg/L 556 553 0
Results presented on this page are in the units indicated by the"Units"column except where an alternate unit is presented to the right of the result.
REPORT OF LABORATORY ANALYSIS
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Date:02/14/2020 04:32 PM without the written consent of Pace Analytical Services,LLC. Page 9 of 14

•
Pace Analytical Services,LLC
e 205 East Meadow Road-Suite A
aceAnalytical Eden,NC 27288
www.pacelabs.com
[phone]
QUALIFIERS
Project: Timken Lincolnton
Pace Project No.: 92463869
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.
LABORATORIES
PASI-A Pace Analytical Services-Asheville
PASI-C Pace Analytical Services-Charlotte
ANALYTE QUALIFIERS
D6 The precision between the sample and sample duplicate exceeded laboratory control limits.
REPORT OF LABORATORY ANALYSIS
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Pace Analytical Services,LLC
aceAnalyticai a 205 East Meadow Road-Suite A
Eden,NC 27288
www.pacelabs.com
[phone]
t
QUALITY CONTROL DATA CROSS REFERENCE TABLE
Project: Timken Lincolnton
Pace Project No.: 92463869
Analytical
Lab ID Sample ID QC Batch Method QC Batch Analytical Method Batch
92463869001 Stormwater Outfall#001
92463869001 Stormwater Outfall#001 EPA 1664E 525180
92463869001 Stormwater Outfall#001 EPA 200.7 Rev 4.4 1994 524310 EPA 200.7 Rev 4.4 1994 524344
92463869001 Stormwater Outfall#001 SM 2540D-2011 523819
92463869001 Stormwater Outfall#001 SM 5210B-2011 523530 SM 5210B-2011 523549
REPORT OF LABORATORY ANALYSIS
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Document Name: Document Revised:February 7,2018
Sample Condition Upon Receipt(SCUR) Page 1 of 2
(' ceAnaIyticaIaceAnaVicar Document No.: Issuing Authority:
F-CAR-CS-033-Rev.06 Pace Carolinas Quality Office
Laboratory receiving samples:
Asheville❑ Eden❑ Greenwood❑ Huntersvillew Raleigh❑ Mechanicsville❑
Sample Condition - - Client Name: LJO# : 92463869
Upon Receipt ' f Project#:
Courier:
ill Ex ❑UPS ❑ASPS Citent 111II 1 11111111! 11111
0 Commercial OPace ❑other. 02463889
Custody Seal Present? ❑yes ( ►b Seals Intact? Des 12kVo t
Date/Initials Person Examining Contents: ,
Packing Material: ❑Bubble Wrap Et<bble Bags ❑None ❑ Other Biological Tissue Frozen?
Thermometer: Type of ice: et ❑elue ['None Oyes irvo ❑N/A
tali Gun ID:
Cooler Temp(°C): /0, 4orrection Factor:Add/Subtract(°C) 0.0°C
I Temp should be above freezing to VC
Cooler Temp Corrected et:): 1(/- 1 OSamples out of temp aiteria.Samples on ice,cooling process
has begun
USDA Regulated Soil (QrN/A,water sample)
Did samples origin in a quarantine zone within the United States:CA,NY,or SC(check maps)? Did samples originate from a foreign source(internationally,
Dyes ( o Including Hawaii and Puerto Rico)?Oyes ONo
Comments/Discrepancy:
Chain of Custody Present? Yes ©No ON/A 1.
Samples Arrived within Hold Time? Yes ❑No ON/A 2.
Short Hold Time Analysis(c72 hr.)? EFrir O,Ne ON/A 3.
Rush Turn Around Time Requested? Des t3No ON/A 4.
Sufficient Volume? (39es ONo ON/A 5.
Correct Containers Used? el ONo ON/A fi.
-Pace Containers Used? es ©No ON/A
Containers Intact? es ONo ON/A 7.
Dissolved analysis:Samples Field Filtered? Oyes []No EWA 8.
Sample Labels Match COC? .126; ONo ON/A 9.
-Includes Date/Time/ID/Analysis Matrix: ` 11
Headspace in VOA Vials(>5-6mm)? QYes ❑N/A 10.
Trip Blank Present? Oyes I2I ON/A 11.
Trip Blank Custody Seals Present? Oyes ONo /A
COMMENTS/SAMPLE DISCREPANCY Field Data Required? [Yes ONo
Lot ID of spilt containers:
CLIENT NOTIFICATION/RESOLUTION
Person contacted: Date/Time:
Project Manager SCURF Review: 2)\4 Date: I.-,k L_ll'i
Project Manager SRF Review: 5
Date: 'LtL't'2 �-."
Page 12 of 14

Document Name: Document Revised: February 7,2018
Sample Condition Upon Receipt(SCUR) Page 1 of 2
BCeAnalytical Document No.: Issuing Authority:
F-CAR-CS-033-Rev.06 Pace Carolinas Quality Office
*Check mark top half of box if pH and/or dechlorination Is Project# WO# : 92463869
verified and within the acceptance range for preservation PM: BV Due Date: 02/14/20
samples. CLIENT: 95-Timkin
Exceptions VOA,Coliform,TOC,Oil and Grease,DRO/8015(water)DOC,LLHg
**Bottom half of box is to list number of bottle i
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pH Adjustment Log for Preserved Samples
Sample ID Type of Preservative pH upon receipt Date preservation adjusted Time preservation Amount of Preservative Lot tt
adjusted added
Note: Whenever there is a discrepancy affecting North Carolina compliance samples,a copy of this form will be sent to the North Carolina DEHNR Certification Office(i.e.
Out of hold,incorrect preservative,out of temp,incorrect containers.
Page 13 of 14

CHAIN-OF-CUSTODY I Analytical Request Document•
CeArtalyyhC?t The Chain-of-Custody is a LEGAL DOCUMENT.All relevant fields must be completed accurately.
M.rrtc:.e1 cea
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Section A Section B Section C m
a
Required Client Information: Required Project Information: Invoice Information: Page' t Of 1
Company Timken-Iron Station,NC Report To Simmons,Doug Attention
Address 1000 Timken Place Copy To. Company Name
Iron Station,NC 28080 Address
Regulatory Agency
Email' doug smmons@tmken corn / Purchase Order# Pace Quote,
Phone [phone] IFay Protect Name: Timken Lincointon Pare Protect Manager bonnie van gppacelabs corn, State t Location
Requested Due Date Project#t Pace Profile# 1840-7 NC
Requested Analysis Filtered(YTN)
o �!
UM1Tit IX cox .. COLLECTED z Preservatives >' A
Ikmk,nq Wall. OW c O O M1_ .
Wail. WT S U
Waste WIWo WW 4 q 2
Prorlurf SAMPLE ID a 'qtl 5 "ea oL t� START END r to I. v m
wE We „ T 5 W c
One Character per box. n.. t iD „ o
(AZ 0-91,-} Alt AR O W F In m � i
lt Ckim OT V Z •IS u1 v
Sample Ida must be unique Trouue T$ .PS w kl p m v O 2 IS. o
� .r Si a, ci c y z U a et e, L •'� O N 6 m 1- O 1 7 i„L Q +
r4 DATE TIME DATE TIME m m x x z z z a C) O m r Li e- 7 0 C� I
1 a.C . A�¢.SL CAA �A 1 k'/A Gb� /2-6/1'354 o C -C'A )(
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2 3 p w. 6, , 54.
4 Ten - 4.6"t— m /•5.56"c-
5
6
7
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ADDITIONAL COMMENTS RELINQUISHED BY/AFFILIATION DATE TIME ACCEPTED BY!AFPIUATtON DATE TIME SAMPLE-CONDITIONS
-I -�r, ,<,,e 5�?� J�4lS s
s
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SAMPLER NAME AND SIGNATURE
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PRINT Name of SAMPLER: a
SIGNATURE of SAMPLER: DATE Signed:, w m' F.3 76 $z % 2