NCG530172_application_20170605

eae• • sTrout Sunburst Firms
TR T FARMS 314 IndustraI Park Drive
Waynesville, INC 28786
828 648 3010°800 673 3051
0
Founded in 1948
www.sunbursttrout.com
May 10, 2017
Dear Mr. Weaver:
I am the CFO of Sunburst Trout LLC. Our fish processing facility is in the Waynesville Industrial Park. The waste
water from our processing goes into the Junaluska Sanitary District. This request is asking that DENR DWR grant a
general NPDES permit for our fish holding tanks to discharge into the storm water drain at the industrial park.
Currently, the well water drawn is metered and that determines the cost of using the sewer discharge for the fish
holding tanks. Currently, the discharge from the fish tanks goes directly into the sewer.
The decision to use Junaluska Sanitary District for the fish tank discharge was made based on erroneous
information from the company that sold and installed the recirculating fish tanks and equipment. The amount of water
needed to efficiently operate the tank system information was drastically underestimated. We were told that this
recirculating system would need almost no fresh well water to be added and discharged. Based on this data of water
exchange and discharge, it was estimated that it would cost approximately $100 per month to operate the partial
recirculating fish tank system.
The partial recirculating system has four total tanks. Each "system" consists of two tanks, and a bead filter.
Oxygen is introduced. The bead filter catches any solids in the system. The fish are not fed for 3 days prior to being
put into the tanks and are not fed after they have been put in the system. Thus, very little solids are introduced into
the tanks. However, if any solids go into the tanks, the filter catches the residual waste. These filters are backwashed
into the sewer 3-4 times per week. We would continue to backwash into the sewer, even if we are granted a general
NPDES permit.
About 1 month after the tanks went into operation, we started getting feedback from some of our customers
that the fish had an "off flavor". After much research, it was determined that the off flavor was coming from geosmin,
the same organic matter in soil. It was determined that the only way to resolve this off -flavor issue was to
continuously run the well and discharge at about 6 gallons per minute 24/7. If there is an upturn in consumer demand
for our fish products, then the discharge number might go as high as 15 gpm due to increase in pounds of fish put into
the system
When we started having to use the well 24/7 at 6 gpm, it was costing about $1,700-$1,800 per month.
Approximately 5 months after we started running the well constantly, Junaluska Sanitary District has almost doubled
the rates. Today it is costing around $3,000 per month to run the well 24/7 at 6 gallons per minute. The annual cost
$36,000 per year is a tremendous financial burden. For a company the size of Sunburst Trout, that money could hire
another employee.
Attached are: an application for a general NPDES permit, a diagram of how the fish holding tanks will discharge
into the storm water drain beside the building, and a water analysis of the discharge from the tanks. Please contact me
for a site visit if you want to see the fish holding tanks. In advance, consideration for this permit is greatly appreciated.
Sincerely,
Ben Eason, CFO
Sunburst Trout LLC
(1'•
Family Grown • Sustainable • Quality
•

Steven W. Troxler
Commissioner
May 10, 2017
North Carolina Department of Agriculture
and Consumer Services
Division of Marketing
Debra Sloan
208 Sugar Cove Rd
Franklin, NC 28734
Agribusiness Development F& A XJuaculture Sp cia;ist
828.524 1264 — office
828 421 96(4 - cell
debrasloan@ ear thlmk nc t
Charles H. Weaver
Environmental Specialist
N C Division of Water Resources
N C Department of Ft,nvironmental Q-aality
1617 Mail Service Center
Raleigh, NC 27669-1617
Joe Sanderson
Director
RECEIVEDINCDEQIDWR
J U N 0.5 2017
Water Quality
Permitting Section
Dear Mr Weaver,
As the western NC Aquaculture Specialist for NCDA & CS, I encourage NCDWR to issue Sunburst Trout Company
LLC a NPD HS General Permit (NC53000) for discharging their fish holding tank water at the Waynesville Industrial Park
in Waynesville As you can see the water analysis enclosed, it provides information which shows the discharge is well
within the parameters of tilt General Permit.
I have worked with Su:.bur >t for almost 30 years. This company is a WNC trout industry leader, the second largest trout
processor, and vital to the trout industry When the new processing facility was built a year ago, they drilled a well to
supply fresh water to their fish holding tanks.
\When the new processing facility was built, the company elected to use the Junaluska Sanitary District for their discharge
from their fish holding tanks since Pentair, the corporation that sold them the fish tanks and filtration system told them
that their water usage was going to be minimal. To use the Junaluska Sanitary District cot the discharge, the well water
withdrawal is metered andis at determines their cost. Given that information, and the estimated cost of only S100 per
month for water, the ccmF z v decided to utilize the Junaluska Sanitary District for their fish tank discharge water All of
Sunburst Trout Company i.t4C processing facility eliminates their processing water into tale municipal system, so they
tied their tank water discharge into the municipal system.
Sunburst management soon found that they were misled regarding the amount of water needed to keep the fish fresh and
to avoid off flavor. To solve the problem more water was needed; the well water is pumped a.t 6 gpm 24/7. The cost for
using the water has now escalated to S3,000 per month and is causing a si_nificant econo,ntc burden as well as poses a
threat to the financial iTlablit7 of this company.
In advance, than' ; c
Best regards,
Debra Sloan
Fui .s consideration. If you have any questions, please contact;1�
1020 Mail Service Center, Raleigh, NC 276 99- i020
(919107.-3100 • Fax [phone] www.nodErnar'ke:s.org
An Equal Opportunity Employer

Company Name
Owner Name
Street Address
City
Telephone #
Cell #
NCDENR
Division of Water Resources
National Pollutant Discharge Elimination System (NPDES)
Application for Coverage Under General Permit
NCG530000
Seafood packing, fish packing and fish.farms
NOTICE OF INTENT
Required by 15A NCAC 02H .0127(d); term definition see 15A NCAC 02H .0103 19
(Please print or type)
1) Mailing address of applicant:
51/41A r \ k r V-cf‘rfaNc LLL
sts& s• IN
3 \NA ste.A vtik QAN 0 ( •
W 1 (\esvCAL
c„t\c6
%AA C-CO \\ i
2) Location of facility producing discharge:
Facility Name
Facility Contact
Street Address
City
County
Telephone #
State i✓i'i
Fax #
Emai 1
FOR
AGENCY
USE
ONLY
Date
Received
Year
Month
Day
ao
()co
QC
,
Certificate
of
Coverage
N
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-7
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Check
#
Amount
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Assigned
To:
CJ'icic€Jts
C
RECEIVED/NCDEQ/DWR
JUN 0 5 2017
Water Quality
Permitting Section
Zip Code till
bv\ 02 \t:IAnrr
5 vskr isk 1 /ou\t ri.(S LLL
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Fax #
3) This Application applies to which of the following activities:
Describe the activities to be ermitted in detail:
S Lee. CO v Z r � te_kk et
Zip Code 61-1
Seafood packing / rinsing
Fish farms [aquaculture]
4) Description of Discharge: [Required by 15A NCAC 02H .0105(c)(1)]
a. Volume of discharge (in GPD): ) 300 se tt_J ObD
b. The discharge is:
'ens" Continuous n Intermittent
If the discharge is intermittent, describe when the discharge occurs:
c. Number of discharge points (outfalls):
Page 1 of 3
Revised 9/1 /2013

d. What percentage of the discharge is treated?
0
NCG530000 New Application
e
S
e. Describe the type of wastewater being discharged (including any known pollutants present in the discharge):
-00 (0 \A,*\-\ 0\- \\vC.- C 0 v\k- h 0 \ k
Describe the nature of the business applying for coverage under the General Permit:
mrdor
t
r
cs\( ck
too le.iSAk PO
f. Identify the treatment methods in use at the facility (check all that apply):
n Settling Ponds n Screens* n Floor Screens*
Other (describe): v� A `gin Ac_ S � c,
None
Treatment Equi ment*
\O a\ k \\\ tri Ce (0 f v 44fr)
n
*If checked, attach a description of all component specifications (design volume, retention time,
surface area, etc.). Describe existing treatment facilities in detail and provide design criteria or
operational data (including calculations) showing the facility can meet the requirements for coverage
under the General Permit, as required by 15A NCAC 02I3.0127.
g. Describe the discharge location (bay, stream, etc.): 4S4co r ( I (0,1 (, t\
h. A USGS topographic map (1:24000 scale) identifying the exact discharge location(s) must be submitted with
this application. Identify all discharge points (outfalls) on this site map.
�. Is the discharge directly to the receiving water? n Yes
j. Name of receiving water(s):
No — If no, mark the path taken by the
discharge from the outfall to the receiving stream
on the site map (including the pathway of any
stortu sewers, ditches, canals, etc.).
rt�1
5) Alternatives to Direct Discharge:
[Evaluation required by G.S. § 143-215.1(b)(5)(a) and I5A NCAC 02H .0105(c)(2))
Address the feasibility of implementing each of the following non -discharge alternatives:
a. Connection to a Regional Sewer Collection System - If the facility is existing and currently discharges
to a POTW, when will connection not be allowed?
b. Subsurface disposal (including nitrification field, infiltration gallery, injection wells, etc.)
c. Spray irrigation
The alternatives to discharge analysis should include boring logs and/or other information indicating that a
subsurface system is neither feas ble nor practical as well as written evidence indicating that connection to a
POTW is not an option. It should also include a present value of costs analysis as outlined in the Division's
EncrineerinaAlternatives Analysi4 [EAA) Guidance Document.
Page 2 of 3 Revised 9/1/2013

NCG530000 New Application
Additional Application Requirements:
For new or proposed discharges, the following information must be included in triplicate with this application or it
will be returned as incomplete; per 15A NCAC 02H .0105(c)
a. USGS topographic map (or photocopied portion thereof) with discharge location clearly indicated. If the
discharge is not directly to a stream, the pathway to the receiving stream must be clearly indicated.
b. If this application is being submitted by a consulting engineer (or engineering firm), include documentation from
the applicant showing that the engineer (or firm) submitting this application has been designated an Authorized
Representative of the applicant; per 15A NCAC 02H .0138(b)(1).
c. Final plans for the treatment system (if applicable). The plans must be signed and sealed by a North Carolma
registered Professional Engineer and stamped ' FINAL DESIGN - Not Released for Construction;" per 15A
NCAC 02H .0139.
d. Final specifications for all major treatment system components (if applicable). The specifications must be signed
and sealed by a North Carolina registered Professional. Engineer and shall include a narrative description of the
tieatment system to be constructed; per 15A NCAC 02H .0139.
I certify that I am familiar with the information contained in this application and that to the best of
my knowledge and belief such information is true, complete, and accurate.
Printed Name of Person Signing:
Title:
(Please review ISA NCAC 02H .0106(e0 for authorized signing officials)
(Signature of Applicant
tl
(Date Signed)
North Carolina General Statute 143-215.6B provides that:
Any person who knowingly makes any false statement representation, or certification in any application, record, report, plan, or other document filed or
required to be maintained under this Article or a rule implementing this Article; or who knowingly makes a false statement of a material fact in a
rulemaking proceeding or contested case under this Article; or who falsifies, tampers with, or knowingly renders inaccurate any recording or monitoring
device or method required to be operated or maintained under this Article or rules of the Commission implementing this Article, shall be guilty of a Class 2
misdemeanor which may include a fine not to exceed ten thousand dollars ($10,000). 18 U.S.C. Section 1001 provides a punishment by a fine or
imprisonment not more than 5 years, or both, for a similar offense.
Design of treatment facilities must comply with requirements in 15A NCAC 02H .0138.
Mail this application and one copy of the entire package to:
NC DENR / DWR / Water Quality Permitting Section
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Attn: Charles Weaver
Page 3 of 3 Revised 9/1/2013

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ace Anal kali®
wwwpacelabs.cam
April 26, 2017
P rivate Client
P rivate Client
P rivate Client
Asheville, NC 28804
RE Project: Sunburst Trout Farm 4/14
Pace Project No: 92337258
Pace Analytical Services, LLC
2225 Riverside Dr.
Asheville, NC 28804
[phone]
RECEIV D/NCDEQ/DWR
JUN052017
Water Quality
Permitting Section
Dear Private Client:
Enclosed are the analytical results for sample(s) received by the laboratory between April 14, 2017
and April 18, 2017 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,
Chris Derouen
[e-mail]
[phone]
Project Manager
Enclosures
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
without the wntten consent of Pace Analytical Services, LLC. Page 1 of 13

ace Anal ical
wwwpacetabs.com
CERTIFICATIONS
P roject Sunburst Trout Farm 4/14
P ace Project No.: 92337258
Pace Analytical Services, LLC
2225 Riverside Dr.
Asheville, NC 28804
[phone]
Asheville Certification IDs
2225 Riverside Drive, Asheville, NC 28804
Florida/NELAP Certification # E87648
Massachusetts Certification #. M-NC030
North Carolina Drinking Water Certification #: 37712
N orth Carolina Wastewater Certification #: 40
S outh Carolina Certification #. 99030001
VirginiaNELAP 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 13

ace Analytical®
wwwpacelabs.com
SAMPLE ANALYTE COUNT
Project Sunburst Trout Farm 4/14
Pace Project No.: 92337258
Pace Analytical Services, LLC
2225 Riverside Dr.
Asheville, NC 28804
[phone]
Lab ID
Sample ID
Method
Analysts
Analytes
Reported Laboratory
92337258001
92337258002
Holding Tanks
Holding Tanks
S M 2540D
S M 2540F
S M 5210B
S M 5220D
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, LLC.
CJH1
ALC
MLS
MDW
1
1
1
1
PASI-A
PASI-A
PASI-A
PASI-A
Page 3 of 13

aceAnalytical®
wwwpacelabs.corn
ANALYTICAL RESULTS
Project: Sunburst Trout Farm 4/14
Pace Project No.: 92337258
Pace Analytical Services, LLC
2225 Riverside Dr.
Asheville, NC 28804
[phone]
Sample: Holding Tanks Lab ID: 92337258001 Collected: 04/14/17 08:00 Received: 04/14/17 12:50 Matrix: Water
Parameters Results Units Report Limit DF Prepared Analyzed CAS No. Qual
2540D Total Suspended Solids Analytical Method: SM 2540D
Total Suspended Solids ND mg/L 2.5 1 04/15/17 00:53
2540F Total Settleable Solids Analytical Method: SM 2540F
Total Settleable Solids ND mL/Uhr 0.10 1 04/14/17 14:45
Sample: Holding Tanks Lab ID: 92337258002 Collected: 04/18/17 07:15 Received: 04/18/17 09:06 Matrix: Water
Parameters Results Units Report Limit DF Prepared Analyzed CAS No. Qual
5210B BOD, 5 day Analytical Method: SM 5210B
BOD, 5 day 2.5 mg/L 2.0 1 04/18/17 18:50 04/23/17 13:58
5220D COD Analytical Method: SM 5220D
Chemical Oxygen Demand ND mg/L 25.0 1 04/18/17 22:20
Date: 04/26/2017 01:13 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 13

aceAnal lcat
www. pacelabs.com
QUALITY CONTROL DATA
P roject: Sunburst Trout Farm 4/14
P ace Project No.: 92337258
Pace Analytical Services, LLC
2225 Riverside Dr.
Asheville, NC 28804
[phone]
Q C Batch: 356772 Analysis Method. SM 2540D
Q C Batch Method: SM 2540D Analysis Description: 2540D Total Suspended Solids
Associated Lab Samples: 92337258001
METHOD BLANK: 1979316 Matrix: Water
Associated Lab Samples: 92337258001
Blank Reporting
Parameter Units Result Limit Analyzed Qualifiers
Total Suspended Solids mg/L ND 2.5 04/15/17 00:46
LABORATORY CONTROL SAMPLE: 1979317
Spike LCS LCS % Rec
Parameter Units Conc. Result % Rec Limits Qualifiers
Total Suspended Solids mg/L 250 268 107 90-110
SAMPLE DUPLICATE 1979318
92337252001 Dup
Parameter Units Result Result RPD Qualifiers
Total Suspended Solids
mg/L 12.0 11.6 3
SAMPLE DUPLICATE: 1979319
92337220001 Dup
Parameter Units Result Result RPD Qualifiers
Total Suspended Solids mg/L 6980 7960 13 J(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.
Date: 04/26/2017 01:13 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 13

ace Analytical®
www.psceIabs.com
QUALITY CONTROL DATA
P roject: Sunburst Trout Farm 4/14
P ace Project No.: 92337258
Pace Analytical Services, LLC
2225 Riverside Dr.
Asheville, NC 28804
[phone]
Q C Batch: 356762 Analysis Method SM 2540F
Q C Batch Method: SM 2540F Analysis Description: 2540F Total Settable Solids
Associated Lab Samples: 92337258001
METHOD BLANK 1979241 Matrix: Water
Associated Lab Samples: 92337258001
Blank Reporting
Parameter Units Result Limit Analyzed Qualifiers
Total Settleable Solids mL/Uhr ND 0.10 04/14/17 14:45
SAMPLE DUPLICATE: 1979242
92337258001 Dup
Parameter Units Result Result RPD Qualifiers
Total Settleable Solids mL/Uhr ND ND
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.
Date: 04/26/2017 01:13 PM
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, LLC.
Page 6 of 13

aceAnalitical®
www.pacetebs.com
QUALITY CONTROL DATA
P roject: Sunburst Trout Farm 4/14
Pace Project No.: 92337258
Pace Analytical Services, LLC
2225 Riverside Dr.
Asheville, NC 28804
[phone]
Q C Batch: 357013 Analysis Method. SM 5210B
Q C Batch Method: SM 5210B Analysis Description: 5210B BOD, 5 day
Associated Lab Samples: 92337258002
METHOD BLANK: 1980421 Matrix: Water
Associated Lab Samples: 92337258002
Blank Reporting
Parameter Units Result Limit Analyzed Qualifiers
BOD, 5 day mg/L ND 2.0 04/23/17 13:58
LABORATORY CONTROL SAMPLE: 1980422
Spike LCS LCS % Rec
Parameter Units Conc. Result % Rec Limits Qualifiers
BOD, 5 day
mg/L 198 181 91 84.6-115.4
SAMPLE DUPLICATE* 1980423
92337328001 Dup
Parameter Units Result Result RPD Qualifiers
BOD, 5 day mg/L ND ND
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.
Date: 04/26/2017 01:13 PM
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, LLC. Page 7 of 13

ace Anal ical
www pacelabs. COM
QUALITY CONTROL DATA
P roject: Sunburst Trout Farm 4/14
P ace Project No: 92337258
Pace Analytical Services, LLC
2225 Riverside Dr.
Asheville, NC 28804
[phone]
Q C Batch: 357109 Analysis Method. SM 5220D
Q C Batch Method: SM 5220D Analysis Description: 5220D COD
Associated Lab Samples: 92337258002
METHOD BLANK: 1981042 Matrix: Water
Associated Lab Samples: 92337258002
Blank Reporting
Parameter Units Result Limit Analyzed Qualifiers
Chemical Oxygen Demand mg/L ND 25.0 04/18/17 22w20
LABORATORY CONTROL SAMPLE: 1981043
Spike LCS LCS % Rec
Parameter Units Conc. Result % Rec Limits Qualifiers
Chemical Oxygen Demand mg/L 750 753 100 90-110
MATRIX SPIKE & MATRIX SPIKE DUPLICATE 1981044 1981045
MS MSD
92337376001 Spike Spike MS MSD MS MSD % Rec
Parameter Units Result Conc. Conc. Result Result % Rec % Rec Limits RPD Qual
Chemical Oxygen Demand
mg/L 10000 750 750 9850 9720 -24 -41 90-110 1 M6
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.
Date: 04/26/2017 01:13 PM
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, LLC.
Page 8 of 13

accAnalytical
wwwpacelabs.com
QUALIFIERS
Project: Sunburst Trout Farm 4/14
Pace Project No.: 92337258
Pace Analytical Services, LLC
2225 Riverside Dr.
Asheville, NC 28804
[phone]
DEFINITIONS
DF - Dilution Factor, if reported, represents the factor applied to the reported data due to dilution of the sample aliquot.
N D - Not Detected at or above adjusted reporting limit.
MDL - Adjusted Method Detection Limit.
P QL - Practical Quantitation Limit.
RL - Reporting Limit.
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
N C - Not Calculable.
S G - Silica Gel - Clean -Up
U - Indicates the compound was analyzed for, but not detected.
Acid preservation may not be appropriate for 2 Chloroethylvinyi 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.
P ace Analytical is TNI accredited. Contact your Pace PM for the current list of accredited analytes.
TNI - The NELAC Institute.
LABORATORIES
PAST -A Pace Analytical Services - Asheville
ANALYTE QUALIFIERS
J(D6)
M6
Estimated Value. The relative percent difference (RPD) between the sample and sample duplicate exceeded laboratory
control limits.
Matrix spike and Matrix spike duplicate recovery not evaluated against control limits due to sample dilution.
REPORT OF LABORATORY ANALYSIS
Date: 04/26/2017 01:13 PM
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, LLC. Page 9 of 13

Pace Analytical Services, LLC
2225 Riverside Dr.
Asheville, NC 28804
[phone]
QUALITY CONTROL DATA CROSS REFERENCE TABLE
P roject: Sunburst Trout Farm 4/14
P ace Project No.: 92337258
Lab ID
Sample ID
QC Batch Method
QC Batch
Analytical
Analytical Method Batch
92337258001
92337258001
92337258002
92337258002
Holding Tanks
Holding Tanks
Holding Tanks
Holding Tanks
Date: 04/26/2017 01:13 PM
S M 2540D
S M 2540F
SM 5210B
SM 5220D
356772
356762
357013 SM 5210B
357109
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, LLC.
357114
Page 10 of 13

0
Document
Revised:
Page
1
of
Sept.
2
21,2016
Document
Name:
Sample
Condition
Upon
Receipt(SCUR)
ace
Analytical
F-CAR-CS-033-Rev.01
Document
No.:
Issuing
Authority:
Pace
Quality
Office
Laboratory receiving sam
Asheville
ample Con scion Upon
ltecetpt
Courier
Commercial
Ederkk Greenwood
Client Name.:
Huntersville.
UFed Ex
❑Pace
❑UPS EUSPS
E Other:
Custody Seal Present? [Yes Di Seals Intact? flYes
Packing Material:. [Bubble Wrap ❑Bubble Bags
Thermometer:
DIR in ID: 5
Correction Factor: G) Cooler Temp Corrected (°C).
Temp should be above freezin
USDA Regulated Soil /A, water sample)
Type of Ice:69 .
L
PrI W
Raleigh❑ MechanicsvilleE
�C"entin II I 11 IIIIIIIiIII
ow. 92337258
ne COther:
Blue [Done ❑Sampkeson ice, cooling process has be
Biological Tissue Frozen? (_,_Yes DNo N/A
8
Date/Initials Person Examining Content
Did
originate
in
samples
a quarantine
zone within
the
United
States:
CA,
NY,
or SC
(check
maps)?
Did
sarnples
originate
from a
foreign
source
(in ternationa
y,
Dyes
ONa
including
Hawaii
and
Puerto
Ricoj7
OYes
Comments/Discrepancy.
Chain
of
Custody
Present?
�[jNo
❑N/A
1,
Samples
Arrived
Hold
Time?
within
s QNo
❑N/A
2.
Short
Hold
Time Analysis (<72
hr.j?
C1
DNo
❑N/A
3se
f M (C. c`G
Rush
Turn Around
Time
Requested?
DYes.
No
DN/A
4.
Sufficient
Volume?
II
s
DNo
DN/A
5.
Correct
Containers
Used?
pelfgr
DNo
DN/A
6,
-Pace
Containers
Used?
DNo
DN/A
Containers
Intact?
Yes DNo
ON/
Samples
Field
Filtered?
DYes
1:1No.
ril
N/A
8.
Note
if sediment
is visible
in
the
dissolved
container
Sample
Labels
Match
COC?
es
II
No
DN/A
9.
.. tiknut
-Includes
Date/i
irrie/tu/Anatysis
tviatrix:
Headspace
in VOA Vials
(>5-6mm)?
Dyes
DNo
/
b.0.
Trip
Blank
Present?
Dyes
DNo
N/A
11,
Trip
Blank
Custody
Seals
Present?
l
Des
DNo
/A
___
CLIENT NOTIFICATION/RESOLUTION
Person Contacted:
Comments/Sample
Discrepancy:
(Arent-- of (t. brti
Field Data Required? Des
e)Pate/Tirne:
Project Manager SCURF Review:
Project Manager SRF Review:
Date: 14 N`
©ate:
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, outof temp, incorrect containers)
Page 11 of 13

4.
Analytical
a
Sample
Condition
Document
Upon
Name:
Document
Revised:
Page
2
of
Sept.
2
21,
2016
Receipt(SCUR)
ace
F-CAR-CS-033-F
Document
No.:
ev,t1.
Pace
Issuing
Quality
Authority:
Office
*Check
is verified
mark
and
top
within
half
of
the
box
acceptance
if
pH
and/or
range
dechlorination
for
Project3
preservation
**Bottom
half
samples.
box
is
PM:
CLIENT:
CD1
9pPrivate
Due
Date:
04/28/17
of
to
list
number
of
bottles
L Plastic Unpreserved (N/A) (CI-)
L Plastic Unpreserved (N/A)
L Plastic Unpreserved (N/A)
-1 titer Plastic Unpreserved (N/A)
L plastic HNO3 (pH < 2)
IL Plastic ZN Acetate & NaOH (>9)
Puthed.Glass jar Unpreserved
ber Unpreserved (N/A) (GI-)
ber HCI (pH < 2)
tber H2SO4 (pH < 2)
L Amber H25O4 (pH < 2)
L VOA HO (NIA)
L VOA Unp (N/A)
airier
;.
u
LPlastic NaOH (pH > 12) I
(6 vials per kit)-5035 kit (N/A)
(3.vials per kit)-VPH/Gas kit.(N
2,
L Arnber NH41
;tic (N/A
rile Plastic (N/A
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Page 12 of 13

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