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Home My WebLink AboutNC0005771_Wasteload Allocation_19931213NPDES DOCUMENT SCANNIN`i COVER SHEET NC0005771 NPDES Permit: Document Type: Permit Issuance Wasteload Allocation Authorization to Construct (AtC) Permit Modification Speculative Limits Report Instream Assessment (67B) Environmental Assessment (EA) Permit History Document Date: December 13, 1993 This documezit is prixtted oa reuse paper - igare airy cozitezit ozi the reverse Bide 4 lq Rlo 4 N l'o Perrp.cb NPDES WASTE LOAD ALLOCATION PERMIT NO.: NC0005771 PERNIITTEE NAME: FACILITY NAME: Amerada Hess Corporation Charlotte / Paw Creek Terminal Facility Status: Existing Permit Status: Renewal Major Minor Pipe No.: 001 Design Capacity: storm MGD Domestic (% of Flow): 0 % Industrial (% of Flow): 100 % Comments: stormwater flows, Bulk petroleum storage facility , RECEIVING STREAM: an unnamed tributary to Paw Creek Class: C Sub -Basin: 03-08-34 Reference USGS Quad: F-15-SW (please attach) County: Mecklenburg Regional Office: Mooresville Regional Office Previous Exp. Date: 2/28/94 Treatment Plant Class: Classification changes within three miles: changes to WS-V and B when it reaches Lake Wylie, Catawba River. Requested by: l) Randy Kepler Date: 9/8/93 Prepared b Reviewe �ot7w — WEZ /c Date: / zfii/9.3 Date: / 00//3/ /3 7-3 Modeler Date Rec. # S4,1A/ 91gI93 7515" 2 Drainage Area (mi ) 0,6 ( Avg. Streamflow (cfs): 6,0 7Q10 (cfs) 0,0 Winter 7Q10 (cfs) o, v 30Q2 (cfs) 0.0 Toxicity Limits: IWC % Acu hronic Instream Monitoring: Parameters Upstream Location Downstream Location Recommended Limits Monthly Average Daily Max. TSS (mg/I): pH (SU): Oil & Grease (mg/I): Turbidity (NTU): Benzene (µg/1): Toluene (µg/I): Ethylbenzene (µg/p: Xylene 4W1): 50 monitor monitor monitor monitor 45 6-9 45 Mon. Freq, 2/mon 2/mon 2/mon 2/mon Annually Annually Annually Annually WOJEL SPECIAL INSTRUCTIONS OR CONDITIONS Permit must contain flow monitoring requirement such that all volumes of wastewater leaving the facility are monitored. If continuous monitoring is not feasible, then discharger shall record the approximate times that discharge began and ended, along with instantaneous flow at the time of effluent samping. Monitoring for all toxicants should be performed during the first five discrete discharge events (annually thereafter) after the effective date of the NPDES permit. Monitoring should occur at the same time that the whole -effluent toxicitiy sample is collected during the discharge event (samples should be collected within 24 hours of the beginning of the event). Comments: Facility Name: NPDES No.: Type of Waste: Facility Status: Permit Status: Receiving Stream: Stream Classification: Subbasin: County: Regional Office: Requestor: Date of Request: Topo Quad: FACT SHEET FOR WASTELOAD ALLOCATION Request # cF rt.TE+ ess- Charlotte/P Amerada H NC0005771 Industrial - 100% Existing Renewal UT Paw Creek C 030834 Mecklenburg Mooresville Kepler 9/8/93 F15NW . � .FkY' Stream Characteristic: USGS # Date: Drainage Area (tni2). Summer 7Q10 (cfs) W inter 7Q10 (cfs): • Average Flow (cfs): 30Q2 (cfs): IWC (%): 0.01 0.0 0.0 0.0 0.0 100 Wasteload Allocation Summary (approach taken, correspondence with region, EPA, etc.) Facility requesting renewal of existing NPDES permit for discharging stormwater from bulk storage facility. This facility has greater than 1 million gallon storage capacity. Special Schedule Requirements and additional comments from Reviewers: Recommended by: %lj, Date:11/8/93 Reviewed by Instream Assessment:61)/0-th- Regional Supervisor: Di Cc Permits & Engineering: aw Creek Terminalty�y�vt�T}_�,-�'r` � tst4N 1 8')" Date: 11/11/5-3 Date: Date:J2/PA3 RETURN TO TECHNICAL SERVICES BY: DEC 1 4 1993 Type of Toxicity Test: Existing Li it: Recommended Limit: Monitoring Schedule: Existing Limits Settleable Solids (mg/1): pH (SU): Oil & Grease (mg/1): 30 Turbidity ): Napthalen (µg/1): Phenols ( g/1): Lead (14/1): 2 TOXICS 24 HR Fathead Acute Monitoring Episodic (Grab) Annually Mon. Avg. Daily Max. 0.1 0.2 6-9 60 50 monitor monitor 25 *The turbidity in the receiving stream will not exceed 50 NTU. (If 7Q10 = 0, 50 NTU applies as an effluent limit.) Recommended Limits TSS (mg/1): pH (SU): Oil & Grease (mg/1): Turbidity (NTU): Benzene (4g/1): Toluene (g/1): Ethylbenz ne (µg/l): Xylene (141): Monthly Average Daily Max., Mon. Freq. WO/EL 50 monitor monitor monitor monitor 45 6-9 45 2/mon 2/mon 2/mon 2/mon Annually Annually Annually Annually (See page three for special monitoring requirements.) *The turbidity in the receiving stream will not exceed 50 NTU. (If 7Q10 = 0, 50 NTU applies as an effluent limit.) Limits Changes Due To: Parameter(s) Affected Change in 7Q10 data Change in stream classification Relocation of discharge Change in wasteflow New pretreatment information Failing tolficity test Other (onsite toxicity study, interaction, etc.) Instream data New regulations/standards/procedures 4 MISCELLANEOUS INFORMATION & SPECIAL CONDTTIONS Miscellaneous information pertinent to the renewal or new permit for this discharge. Include relationship to the Basinwide Management Plan. SPECIAL INSTRUCTIONS OR CONDITIONS Permit must contain flow monitoring requirement such that all volumes of wastewater leaving the facility are monitored. If continuous monitoring is not feasible, then discharger shall record the approxima a times that discharge began and ended, along with instantaneous flow at the time of effluent s ping. Monitoring for all toxicants should be performed during the first five discrete discharge ents (annually thereafter) after the effective date of the NPDES permit. Monitoring should occ r at the same time that the whole -effluent toxicitiy sample is collected during the discharge event (samples should be collected within 24 hours of the beginning of the event). WASTELOAD SENT TO EPA? (Major) (Y or N) (If yes, then attach schematic toxics spreadsheet, copy of model, or if not modeled, then old assumptions that were made, and description of how wasteload fits into basinwide plan.) Additional Information attached? (Y or N) If yes, explain with attachments. Facility Name Amerada Hess-Charlotte/Paw Creek Permit # NC0005771 _ Pipe # 001 _ ACUTE TOXICITY MONITORING (ANNUAL) The permittee shall conduct annual toxicity tests using protocols defined as definitive in E.P.A. Document 600S-85/013 entitled "The Acute Toxicity of Effluents to Freshwater and Marine Organisms." The monitoring shall be performed as a Fathead Minnow (Pimephales promelas) 24 hour static test, using effluent collected as a single grab sample. Effluent samples for self - monitoring purposes must be obtained below all waste treatment. The permittee will conduct one test annually, with the annual period beginning in January of the calendar year of the effective date of the permit. The annual test requirement must be performed and reported by June 30. If no discharge occurs by June 30, notification will be made to the Division by this date. Toxicity testing will be erformed on the next discharge event for the annual test requirement. The parameter code for this test is TAE6C. All toxicity testing results required as part of this permit conditi n will be entered on the Effluent Discharge Form (MR-1) for the month in which it was perform using the appropriate parameter code. Additionally, DEM Form AT-1 (original) is to be sent to tle following address: Attention: Environmental Sciences Branch North Carolina Division of Environmental Management 4401 Reedy Creek Rd. Raleigh, N.C. 27607 Test data shall be complete and accurate and include all su ortin chemical/physical measurements performed in association with the toxicity tests, as well as all dose/response data. Total residual chlorine of the,, effluent toxicity sample must be measured and reported if chlorine is employed for disinfection of the waste stream. Should any test data from either these monitoring requirements or tests performed by the North Carolina Division of Environmental Management indicate potential impacts to the receiving stream, this permit ma be re -opened and modified to include alternate monitoring requirements or limits. NOTE: Failu a to achieve test conditions as specified in the cited document, such as minimum control organism survival and appropriate environmental controls, shall constitute an invalid test. Failure to submit suitable test results will constitute noncompliance with monitoring requirements. 7Q10 0.0 cfs Permitted Flow NOL _ MGD IWC 100 % Basin & Sub -basin CTB34 Receiving Stream UT Paw Creek County Mecklenburg AAM Fathead 24 Version 10/91 ommended by: "etA. Date 11/8/93 /177 ") E-3 2s�t Li JJ,'a l v1.v , Q , 0 a-6- -7-Sf: e:Lo __ -{ -e ) l m;11 h, A/424 c e‘?".4-IS TELETYPE: 710-998-0873 CABLE ADDRESS: HESOIL FAX: 1-908-750-6745� AMERADA HESS CORPORATION October 13, 1993 Mr. Randy Kepler NCDEHNR Division of Environmental Management P.O. Box 29535 Raleigh, NC 27626-0535 RE: Amerada Hess Corporation Charlotte (Paw Creek) Terminal NPDES Permit #NC0005771 Permit Renewal Application Dear Mr. Kepler: 1 HESS PLAZA WOODBRIDGE, NJ 07095-0961 (908) 750-6000 Per the request of your September 8, 1993 letter, the following information is provided regarding operations at the referenced facility: • The total • There are If there are any facility working capacity is 303,465 Barrels (12,745,530 Gallons). no vehicle maintenance operations at the facility. questions regarding this matter, please call me at (908) 750-6722. Very truly yours, AMERADA HESS CORPORATION Walter D. Toomer Coordinator, Permit Compliance WDT Certified Mail #P 379 573 357 cc: P. Haid J. Hamilton NPDES File WHOLE EFFLUENT TOXICITY TESTING 0[SELF-MONITORING SUMMARY) Fri, Oct 15, 1993 FACILITY REOUIREMENT AMERADA IIESS CORP. PERM:24 HR LC50 AC MONIT EPIS FTHD (GRAB) NC0066711 Begin:5/1/93 Frequency. 5-0WD/A NonComp: County: NEW HANOVER Region: WIRO Subbasin: CPF17 PF: Special 7Q10: IWC(%): NA Oster. YEAR JAN 89 — 90 — 91 92 93 — FEB MAR APR MAY IUN MT. AUG SEP >1001 OCT NOV DEC >1001,>1o01t AMERADA 'MSS CORPITIIRII:T PERM:24 1IR ITIID AC MONIT EPIS (GRAD) NC0005771 Dcgin:4/1/89 Fnqucncy:5.OWD/A NonComp: County:MECKLPNDURG Region: MRO Subhnsin: CTB34 PE: VARIES _ 511edal _ 7Q10:0.0 IWC(%):I00.0 Order 89 — 90 — 91 NONE 92 ... 93 — PASS! NONE >100 >001 AMERADA IIESS/SELMA PERM:48 FIR AC MONIT EPIS (GRAB) NC0076589 Begin:10/16/89 Frequency: 5 OWD NonComp: County:JOHNSTON Region: RRO Subbasin:NEU02 PF: VAR Special 7Q10: 0.0 IWC(%):100.0 Order. 89 — 90 -•- 91 — 92 — 93 — -- -- — — — --- -- NONE >90' — •-- •-- --- --- -- --- --• NONE --• --- — -- -- — — NONE >100 — — — N --- -- NONE --- --- --- -- --- — >80 — AMERICAN AIRLINES GLYCOL (001) PERM AC MONTT EPIS: 24HR FTHD LC50 (GRAB) 89 --- -- --- "- — — NC0075604/001 Begin:9/1/92 Frequency: 5 OWD/A AFTER DE-ICING NonComp: 90 — -- --- -•- --- .- -- — — — -- -- County:WAKE Region: RRO Suhbasin: NEU02 91 — — . -- — -- -- — — — — -- -- PF: NA Special 92 — — — — — — — — — — — -- 7Q10: NA IWC(%):NA Order 93 — >90.0't 81',>901t >90.olf >90.olt — — — AMERICAN AIRLINES GLYCOL (002) PERM AC MONIT EPIS: 24HR F171D LC50 (GRAB) 89 --- — •-• -•- — -- — — — -• — — NC0075604/002 Begin:9/1/92 Eminency: 5OWD/A AFTER DE-ICING NonComp: 90 -- — -- -- -- — -- — — — — •- County:WAKE Region: RRO Subhasin: NEU02 91 — — — -- -- — — — — — — — PE: Special 92 ... ... -- — --- -- — — .- ... -- --- 7Q10: 1WC(%):NA Order. 93 -- -.• DO --- -- ••- -- -- AMERICAN AIRLINES GLYCOL (003) PERM AC MONIT EPIS: 24FIR FTHD LC50 (GRAD) 89 -- --• — — — -- — — -- — --- --- NC0075604/003 Begin:9/1/92 Eminency: 5OWD/A AFTER DP. -ICING NonConp: 00 -- ••• -- •-- -- -- •- -- — --- — --- -County:WAKE Region: RRO Subbnsin: NEU02 91 — — "- -- •- — — --- — -- — --- PP:NA - Special 92 .- — — -- — -. — ... • — — -- -- 7Q10: NA IWC(%): NA Order: 93 -- >90.0't Btl,>90.0It >90.0't >90.olt -- — — AMI72ICAN CYANAMID I'IiRM:48 1112 AC MONITT I/I'IS (GRAB) 99 NC0040690 Begin:2/l/90 Frequency: 5OWD NonComp: 90 County:MECKLENBURG Region: MRO Subbnsin: CTB34 91 PP: 0.10 Special 92 7Q10:0.00 IWC(%):100.00 Orden 93 AMOCO OIL CO. PERM:48 HR AC MONIT EPIS DAP (GRAB) 89 — — — — — — — — — — — -- NC0003671 Begin:2/I/91 Ftcqucncy:5-0WD/A NonComp: 90 --- — — — -- — — — — — — — County:GUILFORD Region: WSRO Subbnsin: CPPO2 91 --- — 3>90 NONE -- — — — — — — — PF: NA Special 92 NONE — — --- -- — — — -- — — — 7QI0:0.0 IWC(%):100.0 Order 93 >90.0 -- --- --• --- --- AMOCO OIL CO. -PAW CREEK PERM:48 HR AC MONIT EPIS DAP (GRAB) 89 NC0005185/001 Begin:1/16/91 Frequency 5-OWD/A NonComp: 90 County: MECKLENBURG Region: MRO Subbnsin: CTB34 91 PP: NA Special 92 7Q10: 0.0 IWC(%): 100.0 Osier. 93 AMOCO OIL CO. -PAW CREIEK/002 PERM:48 IIR AC MONTI' EPIS DAP (GRAB) 89 NC0005185/002 Begin:1/16/91 Frequency:5-0WD/A NonComp: 90 - County:MECKLENBURG Region: MRO Subbasin: CTB34 91 PF:NA Special 92 7QI0: 0.0 IWC'(%): 100.0 Onler. 03 0 2 consecutive failures = significant noncompliance Y Pre 1989 Data Available LEGEND: PERM = Penult Requirement LET= Administrative Letter - Target Frequency= Monitoring frequency: Q- Quarterly; M- Monthly; BM- Bimonthly; SA- Semiannually; A- Annually; OWD- Only when discharging: D- Discontinued monitoring requirement; IS- Conducting independent study Begin = First month required 7Q10 = Receiving stream low Bow criterion (cfs) A = quarterly monitoring increases to monthly upon single failure Months that testing must occur - ex. JAN,APR,JUL,OCT NonComp = Current Compliance Requirement PF=Permitted flow (MGD) IWC% = Instream waste concentration P/F = Pass/Fail chronic test AC = Acute CI-IR = Chronic Data Notation: f- Fathead Minnow: • - Ceriodaohnia so.: my - Mvsid shrimp: ChV - Chronic value: P - Mortality of staled percentage at highest concentration: at - Performed by DEM Act Tox Grouts: bt - Bad test Reporting Notation: -- = Data not required; NR - Not reported: ( ) - Beginning of Quarter Facility Activity Status: I - Inactive, N - Newly lssued(To construct); 1I - Active but not discharging; t-More data available for month in question SIG = ORC signature needed 2 SHEALY ENVIRONMENTAL SERVICES, INC. BIOLOGISTS, TOXICOLOGISTS & CHEMISTS 106 VANTAGE POINT DRIVE OVERLOOK BUSINESS CENTER CAYCE, SOUTH CAROLINA 29033 (803) 791-9700 FAX (803) 791-9111 CERTIFICATE OF ANALYSIS SC DHEC CERTIFICATION NO. 26103 NC DEM NO. 329 VA VDH-DWSE NO. 00303 TN DHE NO. 2964 Page 1 Client: Attention: AMERADA HESS CORPORATION 7615 Old Mt. Holly Road Paw Creek, NC 28130 Mr. Jesse Hamilton SHEALY Lab No: 42696 Description: 1 Date Received: 07/27/93 Date Reported: 08/02/93 * Analyzed out of 15 minute holding time Parameters Coll. Date: 07/26/93 Coll. Time: 1100 QA/QC Officer Date Result Units Analyst Analyzed BOD5-Total pH at 23.5 C Specific Conductance at 25 C TSS Total Settleable Matter Turbidity Reported by: Mi,Chael A. Woodrum 12i) mg/1 *8.67 SU 0.260 umhos/cm 18 mg/1 <0.100 ml/1 12.9 NTUs Vdce President of Analytical Services RLB RES HDR RES HDR RES 07/28/93 07/27/93 07/29/93 07/29/93 07/27/93 07/27/93 Terms and Conditions on Reverse Side SHEALY ENVIRONMENTAL SERVICES, INC. BIOLOGISTS, TOXICOLOGISTS & CHEMISTS 106 VANTAGE POINT DRIVE OVERLOOK BUSINESS CENTER CAYCE, SOUTH CAROLINA 29033 (803) 791-9700 FAX (803) 791-9111 CERTIFICATE OF ANALYSIS SC DHEC CERTIFICATION NO. 26103 NC DEM NO. 329 VA VDH-DWSE NO. 00303 TN/9 gO.296± Client: Attention: AMERADA HESS CORPORATION 7615 Old Mt. Holly Road Paw Creek, NC 28130- Mr. Jesse Hamilton SHEALY Lab No: 42697 Description: 2 Date Received: Date Reported: Parameters 07/27/93 08/02/93 Coll. Date: 07/26/93 Coll. Time: 1400 QA/QC Officer Date Result Units Analyst Analyzed Oil & Grease-T tal Reported by: chae A. W,odrum Vice President of Analytical Services <5.0 mg/1 AVK 07/30/93 Terms and Conditions on Reverse Side SHEALY ENVIRONMENTAL SERVICES, INC. BIOLOGISTS, TOXICOLOGISTS & CHEMISTS 106 VANTAGE POINT DRIVE OVERLOOK BUSINESS CENTER CAYCE, SOUTH CAROLINA 29033 (803) 791-9700 FAX (R03) 791-9111 Client: Attention: CERTIFICATE OF ANALYSIS AMERADA HESS CORPORATION 7615 Old Mt. Holly Road Paw Creek, NC 28130- Mr. Jesse Hamilton SC DHEC CERTIFICATION NO. 26103- NC DEM NO. 329 VA VDH-DWSE NO. 00303 TNT§e10. 2961 SHEALY Lab No: 42698 Description: 3 Date Received: Date Reported: Parameters 07/27/93 08/03/93 Coll. Date: 07/26/93 Coll. Time: 1400 QA/QC Officer Result op Date Units Analyst Analyzed Total Phenol Reported by: <0.020 chaer A. Woodrum Vice President of Analytical Services mg/1 RES 08/02/93 Terms and Conditions on Reverse Side SHEALY ENVIRONMENTAL SERVICES, INC. BIOLOGISTS, TOXICOLOGISTS & CHEMISTS 106 VANTAGE POINT DRIVE OVERLOOK BUSINESS CENTER CAYCE, SOUTH CAROLINA 29033 (803) 791-9700 FAX (803) 791-9111 CERTIFICATE OF ANALYSIS SC DHEC CERTIFICATION NO. 26103- NC DEM NO. 329 VA VDH-DWSE NO. 00303 TN DHE NO. 2964 Page 1 Client: Attention: AMERADA HESS CORPORATION 7615 Old Mt. Holly Road Paw Creek, NC 28130- Mr. Jesse Hamilton SHEALY Lab No: 42699 Description: 4 Date Received: Date Reported: Parameters 7/27/93 8/05/93 Coll. Date: 07/26/93 Coll. Time: 1400 QA/QC Officer Date Result Units Analyst Analyzed Ammonia-N COD -Total TOC Reported by: 0.291 mg/1 48.5 mg/1 14.0 mg/1 ael A. Woo• rum` Vide President of Analytical Services HDR RES MLK 08/03/93 07/29/93 07/30/93 Terms and Conditions on Reverse Side SHEALY ENVIRONMENTAL SERVICES, INC. BIOLOGISTS, TOXICOLOGISTS & CHEMISTS 106 VANTAGE POINT DRIVE OVERLOOK BUSINESS CENTER CAYCE, SOUTH CAROLINA 29033 (803) 791-9700 FAX (803) 791-9111 CERTIFICATE OF ANALYSIS SC DHEC CERTIFICATION NO. 26103_ NC DEM NO. 329 VA VDH-DWSE NO. 00303 TN DHE NO. 2964� Page Client: Attention: AMERADA HESS CORPORATION 7615 Old Mt. Holly Road Paw Creek, NC 28130- Mr. Jesse Hamilton SHEALY Lab No: Description: 5 Date Received: Date Reported: Parameters 42700 Coll. Date: 07/26/93 Coll. Time: 1400 07/27/93 07/30/93 QA/QC Officer Date Result Units Analyst Analyzed Benzene Ethyl benzene Toluene Total Xylenes Reported by: <4.0 <4.0 <4.0 <12.0 ae A. Woo • um ce President of Analytical Services ug/1 ug/1 ug/1 ug/1 MTS 07/29/93 MTS 07/29/93 MTS 07/29/93 MTS 07/29/93 Terms and Conditions on Reverse Side USE BALL POINT PEI " ', PRESS HARD CFL'_'N OF CUSTODY # Client Name /1/37�%I' /5 J)O- $ Co, Reporting Address 7 L /5' t 11,tyvf Gt7 ,Z / eiek, 4/1, //3 Z 8143 Attention L_JA'k , Telephone No. 7L) y. 3 9 F4).1 ? 4p P.O. No. SHEALY ENVIRONMF `AL SERVICES, INC. 106 Vantag._ ointe Drive Cayce, South Carolina 29033 Telephone No. (803) 791-9700 Fax No. (803) 791-9111 CHAIN OF CUSTODY RECORD SAMPLE ANALYSIS REQUIRED w � � 'age -1—o1l _� NPDES # /v4G- DD $ 7 7 County A1.CRG u#t9, ,4icr . Receiving Stream '/9G✓ j r Outfall No. t 0 / Sample ID (Location) 3 Yr. DA E an Firns 1 itop Sa Start FIB Fi 's TIME Hap #,113- -J 3 a J N a U 0 O U 0 ✓I pH. Conductivity 0 0 m J A 8 ' § Total Phenol v Oil & Grease 0 gr cal 2' 0 o H 4 „kr‘ v j (-PRESERVATION (CODE) CODE: A = None B=HNO3 C=H2SO4 D �+IaOH E .= ICE F= LAB USE ONLY Program Area (Circle) DW CWA/NPDES RCRA SP/SOL SP/LIO Other: REMARKS SESI LAB I.D. V iv 1 2-12-6? 4/ Fish St rt /boo v1 v1 v Finish Start yz7oa Finish Start Finish SAMPLER Print Name: Signature: 51- ,40-140/ Date/Time Received by (Sig.) Date/Time elinq'ed by (Sig.) Relinquished by (Sig.) Date/Time Date/Time Received by (Sig.) Date/Time / ate/Ti 7h7/9Y I o 7) Hazards Associated with Sample d,Jn fC� Custody Sea/ Intact (Circle) YES NO NONE Receipt TRC mon Receipt pH su Recut Temp. 'C Received on Ice (CIrde) YFC it OW • CN c••-. :.. . Mal 791- : 11. _e regalr4c1 by Saiime any client•` a'ref Z.Ca3 in • CCCLV1CtadI woff Cie ICI� Zda s °rs mast aul be's to C. �� was data. Thank Ycu for rain'. cccparaticn cn this mat tar. Sa iaa ID Nos Data Raved: DE= cmc:ms Na'.L*E= OTE: 1 2. 3. 4. 5. 6. 14. ess 2-6 % - 7 rn w . . !?a:f.n.f Custody r,ccird c cliesrt - . aa�e 1,'ct c.Lisurt address 'c samale MO —either 3c .�......�._, - -- - v collection -clots No . collection time 14c samvle coilec..ica tyke (well, solid, co . , =tter c =ntaiz e''s not ide et jfied saaaal a analysis required not ma iced P ese---Trati.cri code not used Nal samtler (relinquished) s icria tur e Relinc fished date/time not complete Mule See reverse for sanole chain —of -custody. For mar information contact Michael Woodrum. • - t .r: