NCG030124_DMR_20210308

3/3/2021
Submission Completed
G
Stormwater NPDES Permit Data Monitoring Report
NC Department of
Environmental Quality
F wtlI mUROQL�rv�ry (DMR) Upload Received
MAR 0 8 20111
Winston-Salem
Regional Office
Permit and Facility Information:
f le.ue enter the permit number and other details for this upload,
__.............__.._. _.... __.........._....
IMPORTANT. Until the eDMR system is implemented for DEMLR Stormwater Program permits, an original
signed hardcopy of the DMR MUST be mailed to the address in your permit, in addition to this electronic
upload.
Fields marked with a red asterisk are required.
Permit Number* Enter COC or Individual Permit Number (NOT General Permit number with all 0's)
NCG030124
Must begin with NCS or NCG
Facility Name: * Wieland Copper Products, LLC
County: * Stokes
After uploading here, the original signed hardcopy must be mailed to:
DEQ Winston-Salem Regional Office
Attn: DEMLR Stormwater Program
450 West Hanes Mill Road
Suite 300
Winston-Salem, NC 27105
Further contact details at https://deq.nc.gov/contact/regional-offices/winston-
Salem
Monitoring Period Information:
Monitoring Period What is the YEAR of the sample date(s)?
Year:* 2021
Multiple DMRs from sampling periods within the same year can be uploaded together, but please upload different
years with a new submittal form.
hUps://edocs.deq.nc.gov/Forms/Form/Submit 1/2

3/3/2021
Submission Completed
Also, copies of the lab results and qualitative (visual) monitoring should NOT be submitted unless specifically
requested by DEQ staff. Only upload the completed and signed DMR forms.
DMR Upload* Click the upload button or drag and drop files here to attach document.
Stormwater Report First QTR 2021.pdf 2AMB
Only PDFs are accepted.
Comments: WCP is in Tier 1 for TSS for Outfall 001. My investigation of the area revealed that
the demolition crew is using the dirt and gravel road and driving on it with heavy
trucks and equipment. The demolition of the old equipment should be completed
within a month or so. We will replace the gravel once the work has been
completed.
* By checking the box and signing box below, I certify that:
o I have given true, accurate, and complete information on this form;
o I agree that submission of this Data Monitoring Report (DMR) upload form is a "transaction" subject to Chapter 66,
Article 40 of the NC General Statutes (the "Uniform Electronic Transactions Act");
o I agree to conduct this transaction by electronic means pursuant to Chapter 66, Article 40 of the NC General
Statutes (the "Uniform Electronic Transactions Act");
o I understand that an electronic signature on this upload form has the same legal effect and can be enforced in the
same way as a written signature; AND
o I intend to electronically sign and submit this DMR upload form.
Full Name:* Tony Ryan Sprinkle
Name of person submitting this form
Email Address: * [e-mail]
Phone Number: * 336-445-4526
Signature: *
Date: * 03/03/2021
https://edocs.deq.nc.gov/Forms/Form/Submit 2/2

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number NCS NCG030124
FACILITY NAME Wieland Copper Products, LLC
PERSON COLLECTING SAMPLE(S) Clifford Cain
CERTIFIED LABORATORY(S) Pace Analytical -Eden Lab # 633
Lab #
Part A: Specific Monitoring Requirements
SAMPLES COLLECTED DURING CALENDAR YEAR: 2021
(This monitoring report shall be received by the Division no later than 30 days from
the date the facility receives the sampling results from the laboratory.)
COUNTY Stokes
PHON 6 445 4526
SIGNATURE OF PERMITTEE OR DESIGNEE
REOUIRED ON PAGE 2.
Outfall
No.
Date
Sample
Collected
50050
Total
Flow ifs
Total
Rainfall
TSS
Total CU
Lead
Oil &Grease
Total Zinc
PH
mo/ddtvr
MG
inches
mA
m/I
m/I
m/1
m/l
001
2/11/21
0.534
1.00
155
1.23
0.0098
9.1
0.0829
6.7
002
2/11/21
0.099
1.00
9
0.176
ND
ND
0.039
6.7
003
1 2/11/21
1 0.192 1
1.00
1 47
1.64
1 ND
ND
1 0.134
6.8
004
2/11/21
0.309
1.00
20
0.750
ND
ND
0.067
6.8
005
2/11/21
0.347
1.00
52
0.708
ND
ND
0.057
6.6
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? Qyes Ono
(if yes, complete Part B)
Part B: Vehicle Maintenance Activity Monitoring Requirements
Outfall
No.
Date
Sample
Collected
50050
00556
00530
00400
Total Flow
(if applicable)
Total
Rainfall
Oil & Grease
(if appl.)
Non -polar
O&G/PPH
(Method 1664
SGT-HEM), if
appl.
Total
Suspended
Solids
pH
New Motor
Oil Usage
mo/dd/ r
MG
inches
m /l
MCA
unit
al/mo
N/A
Form SWU-247, last revised 611212015
Page 1 of 2

STORM EVENT CHARACTERISTICS:
Date 2/11/21
Total Event Precipitation (inches): 1.00
Event Duration (hours): (only if applicable — see permit.)
(if more than one storm event was sampled)
Date
Total Event Precipitation (inches):
Event Duration (hours): (only if applicable— see permit.)
Mail Original and one copy to:
Division of Energy Mineral and Land Resources
Attn: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
"1 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."
K gVLG /)O2it
(Sig ermittee) (Date)
Form SWU-247, last revised 611212015
Page 2 of 2

Footnotes:
1 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 definitions of Total Toxic Organics is that definition contained in the EPA Effluent Guidelines for the facilities sub*t
to the requirement to sample (for metal finishing use the definition as found in 40 CFR 433.1 1; 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 my tube manufacture use the definition found in 40 CFR 469.31).
Facilities that develop a solvent management plan to be incorporated into the Stotmwater Pollution Prevention Plan may make a request to DWQ that monitoring of total toxic
organics be waived The solvent management plan shall include a list of the total toxic organic compounds used; the method of disposal used instead of dumping, such as
reclamation, contract hauling, or incineration; and the procedures for assuring that toxic organics do not routinely spill or leak into the stonnwater. For those facilities allowed such
a waiver, the discharger shag include the following signed certification statement on the discharge monitoring report.
"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
stonnwater or areas which are exposed to rainfall w stonnwater runoff has occurred since filing the last discharge monitoring report. I
further certify that this facility is implementing the solvent management plan included in the Stormwater Pollution Prevention Plan"
" 1 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 perfom 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.'
(Date)
Form MR-03
Page 2 of 2

Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance on filling out this jarrn, please visit hnp://Dorlal-ncdenr.or-'web,'%vq/ws/su/nr)dessw*tab-4
Permit No.: N/C
Facility Name:
County:
Inspector:
Date or Inspection:
Time of Inspection:
Total Event Precipitation (inches):
or Certificate of Covera,N/C/G &2-,�,O
Phone No.
00 AGh-'S
Was this a "Representative Storm Event" as defined by the permit?
(See infor tion below.)
es ❑ No
Please verb whether Qualitative honitoring must be performed during a "representative storm event or "measureable storm
event" (requirements vary, depending on the permit.)
Qualitative monitoring requirements vary. Most permits require qualitative monitoring to be performed during a
"representative storm event" or during a "measurable storm event." However, some permits do not have this requirement.
Please refer to these definitions, if applicable.
A "representative storm event" is a storm event that measures greater than 0.1 inches of rainfall and that is preceded by at least 72
hours (3 days) in which no storm event measuring greater than 0.1 inches has occurred. A single storm event may contain up to
10 consecutive hours of no precipitation.
A "measurable storm event" is a storm event that results in an actual discharge from the permitted site outfall. The previous
measumble storm event must h
able to document that a shorter
approval from the local DWQ Regional Office.
By this
swu-tu-ozotos
is accurate and complete to the best of my knowledge:

I.Outfall Description
170�-
Outfall No. eig1 Structure (pipe, ditch, etc.) '
Receiving Stream: t
Describe the industrial activities that occur within the outfall drainage area:
a
v
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: Q0 A- _ j AICk-L
3.Odor: Describe any distinct colors that the discharge may have (i.e., smells strongly of oil, weak chlorine odor,etc.)
A i _. _ n
4: Clarity: Chose the number which best describes the clarity of the discharge, where I is clear and 5 is very cloudy:
2 D
4 5
5. Floating Solids: Choose the number which best describes the amount of foating solids in the stormwater discharge, where
1 is no solids and 5 is the surface covered with floating solids:
0 4 5
6. Suspended Solids: Choose the number which best describes the amount of suspended solids in the stormwater
discharge, where 1 is no solids and 5 is extremely muddy:
1 2 3 4 5
7. Is there any foam in the stormwater discharge? Yes (,No-'
8. is there an oil sheen in the stormwater discharge? Yes CN9)
9. Is there any evidence of errosion or deposition at the outfall? Yes N
10.Other Obvious indicators ofStormwater Pollution:
List and describe: 1\ _0
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or errosion/deposition may be indicative of pollutant exposure.
These conditions warrant further investigation.

Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance on filling out this form, please visit htmlloortal nedenr ore`viceb'wvq'ws'su'npdessvv-tab 4
Permit No.: N,C or Certificate of Covera,N,'C/G V,>of 9�`)
Facility Name:
County: ,� k P S Phone No.
Inspector.
Date of Inspection. _ �/ ,�/
Time of Inspection: /tilt•]
Total Event Precipitation (inches): I - 0 v i kic h- S
Was this a "Representative Storm Event" as defined by the permit?
(See informs ' n below.)
es ❑ No
Please verb whether Oualitative Slonitoring must be perforated daring a "representative storm evert or "measureable storm
event" (requirements vary, depending on the permit.)
Qua!i=ive monitoring requirements van'. Most permits require qualitative moni Loring to be perforated during a
"representative storm event" or during a "measurable storm event." However, some permits do not have this requirement.
Please refer to these definitions, if applicable.
A "representative storm event" is a storm event that measures greater than 0.1 inches or rainfall and that is preceded by at least 72
hours (3 days) in which no storm event measuring greater than 0.1 inches has occurred. A sin_ele storm event may contain up to
10 consecutive hours of no precipitation.
A "measurable storm event" is a storm event that results in an actual discharge from the permitted site outfall. The previous
measurable storm event must h
able to document that a shorter
approval from the local DWQ Regional Office.
this
or
swu-t+:-0e0705
that this report is accurate and complete to the best or my knowledge:

1. Vuttall Description
Outfall No. DQ Structure (pipe, ditch, etc.) Iri
Receiving Stream:
Describe the industrial activities that occur within the outfall drainage area: �
2. Color: Describe the color of the discharge using basic colors (red, bro r'l-
3.
4: Clarity: Chose the number which best describes the clarity of the discharge, where I is clear and 5 is very cloudy:
I 4 5
S. Floating Solids: Choose the number which best describes the amount of foating solids in the stormwater discharge, where
1 is no solids and 5 is the surface covered with floating solids:
4 5
6. Suspended Solids: Choose the number which best describes the amount of suspended solids in the stormwater
discharge, where I is no solids and 5 is extremely muddy:
I 4 5
7. Is there anv foam in the stormwater discharge? Yes No
8. Is there an oil sheen in the stormwater discharge? Yes N
9. is there any evidence of errosion or deposition at the outfall? Yes 'CN
9)
10. Other Obvious Indicators of Stormwater Pollution:
List and describe:
Note: Low clarity, high solids, and,'or the presence of foam, oil sheen, or errosion/deposition may be indicative of pollutant exposure.
These conditions warrant further investigation.

StorniNvater Discharge Outfall (SDO)
Qualitative Monitoring Report
For gnidanwe ort.filli)W nut this form. please visit h :: ,'portal ncdenr or"'vveb'wn'vvs'su npdessvv-tab 4
Permit No.: N'C or Certificate ofCoveralN.'CiG D-aQla`,
Facility Name:
County: ��,,;tkV�.. Phone No.
Inspector: _
Date of lnspection:
Time of Inspection:
Total Event Precipitation (inches): I - C) ^ 1 RC h.-,5
Was this a "Representative Storm Event" as defined by the permit?
(See information below.)
es ❑ No
Please ver fi whether Qualitative ,i(oniioritg nurse be perforated dewing a "representative stor•ne event or "measureable storm
event" (requirements vmy, depending rat the permit.)
2ua!i;a:ive muni:oring:equiremens van. %lost permits require
representative stone event" or durin_ a "measurable storm event.
refer to these definitions, if applicable.
dilative munitoring to be performed during a
However. some permits do not have this requirement.
.A "representative storm event" is a storm event that measures greater than 0.1 inches of rainfall and that is preceded by at least 72
hours (3 da}'s) in which no storm event measuring greater than 0.1 inches has occurred A sin_flle storm event may contain up to
10 consecutive hours of no precipitation.
A "measurable storm event" is a storm event that results in an actual discharge from the permitted site outfall. The previous
measurable storm event must h
to document that a shorter
oval from the local DW'Q Regional Office.
By thi igna ce . that this report is accurate and complete to the best of my knowledge;
swims au.oimns

1. Vutfall Description
Outfall No. OD Structure (pipe, ditch, etc.) '
Receirina Stream:
Describe the industrial activities that occur within the outfall drainage area:
?. Color: Describe the color of the discharge using basic colors (red. br ��n, blue, etc.) and tint
(light, medium. dark) as descriptors: M.,)k,/ _ I ; � -.L- _
3. Odor: Describe any distinct colors that the discharge may have (i.e., smells strongl. of oil, weak chlorine odor,etc.)
11— n
4: Clarity: Chose the number which best describes the clarity of the discharge, where I is clear and 5 is ven• cloudy:
3 '/ 3 4 5
l.�
5. Floatina Solids: Choose the number which best describes the amount of foating solids in the stormwater discharge, where
I is no solids and 5 is the surface covered with floating solids:
1 ' 4 5
6. Suspended Solids: Choose the number which best describes the amount of suspended solids in the stormwater
discharge, where I is no solids and 5 is extremely muddy:
2 ; 4 5
7. Is there any foam in the stormwater discharge? yes ONO
8. Is there an oil sheen in the stormwater discharge? yes N
9. Is there any evidence of errosion or deposition at the outfall? Yes /Nn
10. Other Obvious Indicators of Stormwater Pollution:
List and describe:
Note: Low clarity, high solids, and,or the presence of foam, oil sheen, or errosion/deposition may be indicative of pollutant exposure.
These conditions warrant further investigation.

Storniwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For gzihknee on filling out this form, please visit htm: "eortal.nedenr om,v%eb'ua'ws'su'nmdessv0 tab 4
Permit No.: N'C or Certificate orCov'era,N.•C/G olaL,
Facility Name: I:j7P('UJn , P,,vA.r�-L.
County
Inspector: _
Date of Inspection:
Time of Inspection:
Phone No.
Total Event Precipitation (inches): _ C) L7
Was this a "Representative Storm Event" as defined by the permit?
(See inI ation below.)
7es ❑ No
Please ver fv whether Qualitative •i,lonitoring ours[ be performed during a "representative storm event or "measureable slornt
event" (requirements vary. depending on the penuit.)
Qualitatve mnci:orine rcqui:emen;s �nr:. %lost permits require qualitative monitoring Lobe performed during a
"representative storm event" or during a "measurable storm event." However. some permits do not have this requirement.
Please refer to these definitions. if applicable.
.A "representative storm event" is a storm event that measures greater than 0.1 inches of rainfall and that is preceded by at least 72
hours (3 days) in which no storm event measuring greater than 0.1 inches has occurred. A single storm event may contain up to
10 consecutive hours of no precipitation.
A "measurable storm event" is a storm event that results in an actual discharge from the permitted site outfall. The previous
measurable storm event must h
able to document that a shorter
approval from the local DW'Q Regional Office.
that this report is accurate and complete to the best army knowledge:
SWU4424 a7a5

1.Outtall Description
Outfall No. coq Structure (pipe, ditch. etc.)
Reeeivin_ Stream:
Describe the industrial activities that occur within the outfall drainage aria:
2. Color: Describe the color of the discharge using basic colors (red, b o%%n, blue, etc.) and tint
(light, medium. dark) as descriptors: /�.; rkd . 1 �
3. Odor: Describe apv distinct colors that the discharge may have (i.e., smells strong=1-, of oil,
iA —.�
weak chlorine odor,etc.)
�
4: Clarity: Chose the number which best describes the clarity of the discharge, where I is clear and 5 is very cloudy:
l 4 5
S. Floating Solids: Choose the number which best describes the amount of foating solids in the stormwater discharge, where
I is no solids and 5 is the surface covered with floating solids:
1 4 5
6. Suspended Solids: Choose the number which best describes the amount of suspended solids in the stormwater
discharge, where I is no solids and 5 is extremely muddy:
1 2 4 5
7. is there any foam in the stormwater discharge? Yes No
8. Is there an oil sheen in the stormwater discharge? Yes fNq
9. Is there any evidence of errosion or deposition at the outfall? Yes N
10. Other Obvious Indicators of Stormwater Pollution:
List and describe:
Note: Low clarity, high solids, andf'or the presence of foam, oil sheen, or errosion;deposition may be indicative of pollutant exposure.
These conditions warrant further investigation.

Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance on filling out this form. please visit hM2"Portal ncdenr or"'web'wP'tvs'su'nodessw=tab 4
Permit No.: N;C or Certificate of CoverarN.'C!G 301 aq
Facilitv name: ),J'Q A C L)3n? % P,,A �. r
Countv ,� I 1 Phone No.
Inspector:
Date of Inspection: _/ t
Time of Inspection:
Total Event Precipitation (inches): I v o d I VtC+_07
Was this a "Representative Storm Event" as defined by the permit?
(See information below.)
es ❑ No
Please verb, it hether Qualitative .Monitoring must be performed during a "representative storm event or "measureahle storm
event" (requirements vary. depending on the permit.)
hive monitoring rcquir=cros vac; . %lost permits require qualitative monitoring to be performed during a
Tentative storm event" or during a "measurable slomi event." However, some permits do not have this requirement.
refer to these definitions, if applicable.
A "representative storm event" is a storm event that measures greater than 0.1 inches of rainfall and that is preceded by at least 72
hours (3 days) in which no storm event measuring greater than 0.1 inches has occurred. A single storm event may contain up to
10 consecutive hours of no precipitation.
A "measurable storm event" is a storm event that results in an actual discharge from the pennitted site outl'all. The previous
measurable storm event must h
to document that a shorter
aval from the local DWO Regional Office.
B^ this sigethat this report is accurate and complete to the best of my knowledge:
swuu-2424320705

1. Vutfall Description
Outfall No. no5 Structure (pipe, ditch. etc.)
Receirine Stream:
Describe the industrial activities that occur within the outfall drainage area:
?. Color: Describe the color of the discharge using basic colors (red, bro�%n. blue. etc.) and tint
(light, medium. dark) as descriptors: ,
3. Odor: Describe any distinct colors that the discharge may have (i.e., smells strongly of oil, weak chlorine odor,etc.)
►. 1 e% . _
4: Clarity: Chose the number which best describes the clarity of the discharge, where I is clear and 5 is very cloudy:
2 03 4 5
S. Floatiincy Solids: Choose the number which best describes the amount of foating solids in the stormwater discharge, where
1 is no solids and 5 is the surface covered with floating solids:
1 ? 4 5
6. Suspended Solids: Choose the number which best describes the amount of suspended solids in the stormwater
discharge, where 1 is no solids and 5 is extremely muddy:
1 ? 0 4 5
7. Is there any foam in the stormwater discharge? Yes No
8. Is there an oil sheen in the stormwater discharge? Yes Nd
9. Is there any evidence of errosion or deposition at the outfall? Yes No
10. Other Obvious Indicators of Stormwater Pollution:
List and describe:
Note: Low clarity, high solids, and,'or the presence of foam, oil sheen, or errosion/deposition may be indicative of pollutant exposure.
These conditions warrant further investigation.

P ceAnalytical
www.pacelahsxom
February 24, 2021
Tony Sprinkle
3990 US 311 Hwy North
Pine Hall. NC 27042
RE: Project: Wieland Copper
Pace Project No.: 92521915
Dear Tony Sprinkle:
Pace Analytical Services, LLC
106 Short St.
Kemersville, NC 27284
336-996-2841
Enclosed are the analytical results for sample(s) received by the laboratory on February 12, 2021. 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
• Pace Analytical Services - Eden
• Pace Analytical Services - Kemersville, NC
If you have any questions concerning this report, please feel free to contact me.
Stephanie Knott
[e-mail]
336-996-2841
Project Manager
Enclosures
cc: Cliff Cain
Accounts Payable, Wieland Copper Products LLC
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced. except in full,
without the written consent of Pace Analytical Services, I.I.C.
Page 1 of 15

(�Ia'ucrlea.Analytical
WmPacelabs.cara
CERTIFICATIONS
Project: Wieland Copper
Pace Project No.: 92521915
Pace Analytical Services, LLC
106 Short St.
Kemersville, NC 27284
336-998-2841
Pace Analytical Services Charlotte
9800 Kincey Ave. Ste 100, Huntersvllle, 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
Virginia/VELAP Certification #: 460221
North Carolina Wastewater Certification #: 12
Pace Analytical Services Asheville
2225 Riverside Drive, Asheville, NC 28804
North Carolina Wastewater Certification #: 40
Flodda/NELAP Certification #: E87648
South Carolina Certification #: 99030001
North Carolina Drinking Water Certification #: 37712
Vrginia/VELAP Certification #: 460222
Pace Analytical Services Eden
205 East Meadow Road Suite A, Eden, NC 27288
North Carolina Wastewater Certification #: 633
North Carolina Drinking Water Certification #: 37738
Vlrginia/VELAP Certification #: 460025
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 15

aceAnalyical
www.pacelabs.com
SAMPLE ANALYTE COUNT
Project: Wieland Copper
Pace Project No.: 92521915
Pace Analytical services, LLC
106 Short St.
Kemersviile, NC 27284
336-998-2841
Analyses
Lab ID
Sample ID
Method
Analysts
Reported
Laboratory
92521915001
002
SM 2540D-2011
AFJ
1
PASI-E
EPA 1664E
WAM
1
PASI-C
EPA 200.7 Rev 4.4 1994
SH1
3
PASI-A
AF
6
PASI-KR
92521916002
001
SM 2540D-2011
AFJ
1
PASI-E
EPA 1664B
WAM
1
PASI-C
EPA 200.7 Rev 4.4 1994
SH 1
3
PASI-A
AF
6
PASI-KR
92521915003
003
SM 2640D-2011
AFJ
1
PASI-E
EPA 1664B
WAM
1
PASI-C
EPA 200.7 Rev 4.4 1994
SH 1
3
PASI-A
AF
6
PASI-KR
92521915004
004
SM 2540D-2011
AFJ
1
PASI-E
EPA 1664B
WAM
1
PASI-C
EPA 200.7 Rev 4.41994
SH1
3
PASI-A
AF
6
PASI-KR
92521915005
005
SM 2540D-2011
AFJ
1
PASI-E
EPA1664B
WAM
1
PASI-C
EPA 200.7 Rev 4.4 1994
SH1
3
PASI-A
AF
6
PASI-KR
PASI-A = Pace Analytical Services - Asheville
PASI-C = Pace Analytical Services - Charlotte
PASI-E = Pace Analytical Services - Eden
PASI-KR = Pace Analytical Services - Kemersville, NC
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, I.I.C. Page 3 of 15

aceAnalytical
l rrww.pacaiaba.com
1
ANALYTICAL RESULTS
Project: Wieland Copper
Pace Project No.: 92521915
Pace Analytical Services, LLC
106 Short St.
Kernersville, NC 27284
336-996-2841
Sample: 001
Parameters
Lab ID: 92521915002 Collected: 02/11/21 14:52
Results Units Report Limit DF
Received: 02/12/21 10:30 Matrix: Water
Prepared Analyzed CAS No. Qual
2540D Total Suspended Solids
Analytical Method: SM 254OD-2011
Pace Analytical Services - Eden
Total Suspended Solids
155 mg/L 16.7
1
02/15/21 16:32
1664 SGT HEM, TPH
Analytical Method: EPA 1664B
Pace Analytical Services - Charlotte
Total Petroleum Hydrocarbons
9.1 mg/L 5.0
1
02/22/21 10:37
200.7 MET ICP
Analytical Method: EPA 200.7 Rev 4.41994 Preparation
Method: EPA 200.7 Rev 4.4 1994
Pace Analytical Services -Asheville
Copper
1230 ug/L 5.0
1
02/17/21 01:43 02117/2122:22 7440-50-8
Lead
9.8 ug/L 5.0
1
02/17/21 01:43 02/1712122:22 7439-92-1
Zinc
82.9 ug/L 10.0
1
02/17/21 01:43 02/17/2122:22 7440-66-6
Field Data Kernersville
Analytical Method:
Pace Analytical Services - Kemersville, NC
Performed by
Pace
1
02/11/21 14:52
Collected By
Cllfford
1
02/11/21 14:52
Cain
Collected Date
02/11/2021
1
02/11/21 14:52
Collected Time
1452
1
02/11/21 14:52
pH
6.7 Std. Units
1
02/11/21 14:62
Temperature
8 deg C
1
02/11/21 14:52
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
Date: 02/24/2021 02:24 PM without the written consent of Pace Analytical Services, LLC. Page 5 of 15

(�Ia'ucvAnalytical
www.pacelabo.com
ANALYTICAL RESULTS
Project: Wieland Copper
Pace Project No.: 92521915
Pace Analytical Services, LLC
106 Short St.
Kemersville, NC 27284
336-906-2841
Sample: 002 Lab ID: 92621915001 Collected: 02/11/21 14:44 Received: 02/12/21 10:30 Matrix: Water
Parameters
Results Units Report Limit
DF
Prepared Analyzed CAS No. Qual
26400 Total Suspended Solids
Analytical Method: SM 2540D-2011
Pace Analytical Services - Eden
Total Suspended Solids
9.0 mg/L 2.8
1
02/15/21 16:31
1664 SGT HEM, TPH
Analytical Method: EPA 1664B
Pace Analytical Services - Charlotte
Total Petroleum Hydrocarbons
ND mg/L 5.0
1
02/22/21 10:37
200.7 MET ICP
Analytical Method: EPA 200.7 Rev 4.41994 Preparation Method: EPA 200.7 Rev 4.4 1994
Pace Analytical Services -Asheville
Copper
176 ug/L 5.0
1
02/17/21 01:43 02/17/21 22:19 7440-50-8
Lead
ND ug/L 5.0
1
02/17/21 01:43 02/17/21 22:19 7439-92-1
Zinc
39.4 ug/L 10.0
1
02/17/21 01:43 02/17/21 22:19 7440-66-6
Field Data Kernersville
Analytical Method:
Pace Analytical Services - Kemersville, NC
Performed by
Pace
1
02/11/21 14:44
Collected By
Clifford
1
02/11/21 14:44
Cain
Collected Date
02/11/2021
1
02/11/21 14:44
Collected Time
14"
1
02/11/21 14:44
pH
6.7 Std. Units
1
02/11/21 14:44
Temperature
8 deg C
1
02/11/21 14:44
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
Date: 02/24/2021 02:24 PM without the written consent of Pace Analytical Services, LLC.
Page 4 of 15

aceAnalyfical
www.pacatabstall
ANALYTICAL RESULTS
Project: Wieland Copper
Pace Project No.: 92521915
Pace Analytical Services, LLC
108 Short St.
Kemersville, NC 27284
336-998-2841
Sample: 003 Lab ID: 92521916003 Collected: 02/11/21 15:00 Received: 02/12/21 10:30 Matrix: Water
Parameters
Results Units Report Limit
DF
Prepared Analyzed CAS No. Qual
2640D Total Suspended Solids
Analytical Method: SM 2540D-2011
Pace Analytical Services - Eden
Total Suspended Solids
47.1 mg/L 5.2
1
02/15/21 16:32
1664 SGT HEM, TPH
Analytical Method: EPA 1664B
Pace Analytical Services - Charlotte
Total Petroleum Hydrocarbons
ND mg/L 5.0
1
02/22/21 10:37
200.7 MET ICP
Analytical Method: EPA 200.7 Rev 4.41994 Preparation Method: EPA 200.7 Rev 4.4 1994
Pace Analytical Services -Asheville
Copper
1640 ug/L 5.0
1
02/19/21 02:30 02/19/21 15:41 7440-50-8
Lead
ND ug/L 6.0
1
02/19/2102:30 02/19/2115:41 7439-92-1
Zinc
134 ug/L 10.0
1
02/19/21 02:30 02/19/21 15:41 7440-66-6
Field Data Kernersville
Analytical Method:
Pace Analytical Services - Kemersville, NC
Performed by
Pace
1
02/11/21 15:00
Collected By
Clifford
1
02/11/21 15:00
Cain
Collected Date
02111/2021
1
02/11/21 15:00
Collected Time
1500
1
02/11/21 15:00
pH
6.8 Std. Units
1
02/11/21 15:00
Temperature
9 deg C
1
02/11/21 15:00
REPORT OF LABORATORY ANALYSIS
This report shatl not be reproduced, except in fell,
Date: 02/24/2021 02:24 PM without the wd ton consent of Pace Analytical Services, LLC.
Page 6 of 15

aceAnalytical
www.p:cetabs.ccm
ANALYTICAL RESULTS
Project: Wieland Copper
Pace Project No.: 92521915
Pace Analytical Services, LLC
106 Short St.
Kemersville, NC 27284
336-998-2841
Sample: 004
Parameters
Lab ID: 92521916004 Collected: 02/11/21 15:05
Results Units Report Limit DF
Received: 02/12/21 10:30 Matrix: Water
Prepared Analyzed CAS No. Qual
25400 Total Suspended Solids
Analytical Method: SM 2540D-2011
Pace Analytical Services - Eden
Total Suspended Solids
20.4 mg/L 3.0
1
02/15/21 16:32
1664 SGT HEM, TPH
Analytical Method: EPA 1664E
Pace Analytical Services - Charlotte
Total Petroleum Hydrocarbons
ND mg/L 5.0
1
02/22/21 10:37
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
760 ug/L 5.0
1
02/19/21 02:30 02/19/21 15:44 7440-50-8
Lead
ND ug/L 5.0
1
02/19/2102:30 02/19/21 15:44 7439-92-1
Zinc
67.2 ug/L 10.0
1
02/19/21 02:30 02/19/21 15:44 7440-66-6
Field Data Kerneravllle
Analytical Method:
Pace Analytical Services - Kerersville, NC
Performed by
Pace
1
02/11/21 15:05
Collected By
Clifford
1
02/11/21 15:05
Cain
Collected Date
02/1112021
1
02/11/21 16:05
Collected Time
1606
1
02/11/21 15:06
pH
6.8 Std. Units
1
02/11/21 15:06
Temperature
8 deg C
1
02/11/21 15:05
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full.
Date: 02/24/2021 02:24 PM without the written consent of Pace Analytical Services, LLC. Page 7 of 15

(�Ia'ceAnalytical
www.pacelabs.ccrs
ANALYTICAL RESULTS
Project: Wieland Copper
Pace Project No.: 92521915
Pace Analytical Services, LLC
106 Short St.
Kemersville, NC 27284
336-996-2841
Sample: 005
Parameters
Lab ID: 92521916006 Collected: 02/11/21 15:11
Results Units Report Limit DF
Received: 02/12/21 10:30 Matrix: Water
Prepared Analyzed CAS No. Qual
2640D Total Suspended Solids
Analytical Method: SM 2540D-2011
Pace Analytical Services - Eden
Total Suspended Solids
52.3 mg/L 7.1
1
02/15/21 16:32
1664 SGT HEM, TPH
Analytical Method: EPA 1664E
Pace Analytical Services - Charlotte
Total Petroleum Hydrocarbons
ND mg/L 5.0
1
02/22/21 10:37
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
708 ug/L 5.0
1
02/19/21 02:30 02/19/21 15:48 7440-50-8
Lead
ND ug/L 5.0
1
02/19/2102:30 02/19/21 15:48 7439-92-1
Zinc
57.4 ug/L 10.0
1
02/19/21 02:30 02/19/21 16:48 7440-66-6
Field Data Kernersville
Analytical Method:
Pace Analytical Services - Kemersville, NC
Performed by
Pace
1
02/11/21 15:11
Collected By
Clifford
1
02/11/21 15:11
Cain
Collected Date
02/11/2021
1
02/11/21 15:11
Collected Time
1511
1
02/11/21 15:11
pH
6.6 Std. Units
1
02/11/21 15:11
Temperature
8 deg C
1
02/11/21 15:11
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full.
Date: 02/24/2021 02:24 PM without the written consent of Pace Analytical Services, LLC. Page 8 of 15

aceAnalytical
rrwnw.pacalabs.com
QUALITY CONTROL DATA
Project: Wieland Copper
Pace Project No.: 92521915
Pace Analytical Services, LLC
106 Short St.
Kernersville, NC 27284
336-996-2841
QC Batch: 599922
Analysis Method: SM 2540D-2011
QC Batch Method: SM 254OD-2011
Analysis Description: 2540D Total Suspended Solids
Laboratory: Pace Analytical Services - Eden
Associated Lab Samples: 92521915001, 92521915002, 92521915003, 92521915004, 92521915005
METHOD BLANK: 3162599
Matrix: Water
Associated Lab Samples: 92521915001, 92521915002,
92521915003, 92521915004, 92521915005
Blank Reporting
Parameter
Units
Result Limit Analyzed Qualifiers
Total Suspended Solids
mg/L
ND 2.5 02/15/21 16:28
LABORATORY CONTROL SAMPLE:
3162600
Spike LCS LCS % Rec
Parameter
Units
Conc. Result % Rec Limits Qualifiers
Total Suspended Solids
mg/L
250 260 104 90-110
SAMPLE DUPLICATE: 3162601
92521783004 Dup
Parameter
Units
Result Result RPD Qualifiers
Total Suspended Solids
mg/L
56.0 76.2 31 D6
SAMPLE DUPLICATE: 3162602
92521916005 Dup
Parameter
Units
Result Result RPD Qualifiers
Total Suspended Solids
mg/L
52.3 59.1 12
Results presented on this page arc 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: 02/24/2021 02:24 PM without the written consent of Pace Analytical Services, LLC.
Page 9 of 15

aceArialylcal
www pacelabs.eeta
1
QUALITY CONTROL DATA
Project: Wieland Copper
Pace Project No.: 92521915
Pace Analytical Services, LLC
106 Short St.
Kernersville, NC 27284
336-996-2841
QC Batch: 601591
Analysis Method:
EPA 1664B
QC Batch Method: EPA 1664B
Analysis Description:
1664 SGT HEM, TPH
Laboratory:
Pace Analytical Services - Charlotte
Associated Lab Samples: 92521915001, 92521915002, 92521915003, 92521915004, 92521915005
METHOD BLANK: 3170085
Matrix: Water
Associated Lab Samples: 92521915001, 92521915002, 92521915003, 92521915004,
92521915005
Blank Reporting
Parameter
Units
Result Limit
Analyzed Qualifiers
Total Petroleum Hydrocarbons
mg/L
ND 5.0 02/22/21 10:37
LABORATORY CONTROL SAMPLE:
3170086
Spike LCS
LCS % Rec
Parameter
Units
Conc. Result
% Rec Limits Qualifiers
Total Petroleum Hydrocarbons
mg/L
20 16.5
82 64-132
MATRIX SPIKE SAMPLE:
3170087
92522076001 Spike
MS MS % Rec
Parameter
Units
Result Conc.
Result % Rec Limits Qualifiers
Total Petroleum Hydrocarbons
mg/L
ND 20
7.0 14 64-132 M1
Results presented on this page are In the units Indicated by the "Unite" 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: 02/24/2021 02:24 PM without the written consent of Pace Analytical Services, LLC.
Page 10 of 15

a %Mnalytical
www.pacelabs.com
QUALITY CONTROL DATA
Project: Wieland Copper
Pace Project No.: 92521915
Pace Analytical Services, LLC
106 short St.
Kernersville, NC 27284
336-996-2841
QC Batch: 600513
Analysis Method: EPA 200.7 Rev 4.4 1994
QC Batch Method: EPA 200.7 Rev 4.41994
Analysis Description: 200.7 MET
Laboratory: Pace Analytical Services - Asheville
Associated Lab Samples: 92521915001, 92521915002
METHOD BLANK: 3165276
Matrix: Water
Associated Lab Samples: 92521916001, 92521915002
Blank
Reporting
Parameter
Units
Result
Limit
Analyzed Qualifiers
Copper
ug/L
ND 5.0
02/17/2120:58
Lead
ug/L
ND 5.0
02/17/2120:58
Zinc
ug/L
ND 10.0
02/17/2120:58
LABORATORY CONTROL SAMPLE:
3165277
Spike
LCS
LCS % Rec
Parameter
Units
Conc.
Result
% Rec Limits Qualifiers
Copper
ug/L
500
530
106 85-115
Lead
ug/L
500
495
99 85-115
Zinc
ug/L
500
477
95 86-115
MATRIX SPIKE & MATRIX SPIKE DUPLICATE: 3165278
3165279
MS
MSD
92520977001
Spike
Spike MS
MSD MS MSD
% Rec
Parameter
Units Result
Conc.
Conc. Result
Result % Rec % Rec
Limits
RPD Qual
Copper
ug/L 0.036
500
500 564
583 105 109
70-130
3
mg/L
Lead
ug/L ND
500
500 501
518 100 103
70-130
3
Zinc
ug/L 0.22
500
500 703
727 96 101
70-130
3
mg/L
MATRIX SPIKE & MATRIX SPIKE DUPLICATE: 3165280
3165281
MS
MSD
92521347001
Spike
Spike MS
MSD MS MSD
% Rec
Parameter
Units Result
Conc.
Conc. Result
Result % Rec % Rec
Limits
RPD Qual
Copper
ug/L 29.4
500
500 567
672 108 109
70-130
1
Lead
ug/L ND
500
500 488
490 98 98
70-130
0
Zinc
ug/L 415
500
500 912
924 99 102
70-130
1
Results presented on this page are In the units Indicated by the "UnW 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: 02/24/2021 02:24 PM without the written consent of Pace Analytical Services, LLC. Page 11 of 15

la'Cl ive A na ly Aca /
www.pacalabs.ccrn
QUALITY CONTROL DATA
Project: Wieland Copper
Pace Project No.: 92521915
Pace Analytical Services, LLC
106 Short St
Kennersvilie, NC 27284
336-998-2841
QC Batch: 601143
Analysis Method: EPA 200.7 Rev 4.41994
QC Batch Method: EPA 200.7 Rev
4.4 1994
Analysis Description: 200.7 MET
Laboratory: Pace Analytical Services -Asheville
Associated Lab Samples: 92521915003,
92521915004, 92521915005
METHOD BLANK: 3166278
Matrix: Water
Associated Lab Samples: 92521915003,
92521915004, 92521915005
Blank Reporting
Parameter
Units
Result Limit
Analyzed Qualifiers
Copper
ug/L
ND 5.0
02/19/2115:12
Lead
ug/L
ND 5.0
02119/2115:12
Zinc
ug/L
ND 10.0
02119/2115:12
LABORATORY CONTROL SAMPLE:
3168279
Spike LCS
LCS % Rec
Parameter
Units
Cone. Result
% Rec Limits Qualifiers
Copper
ug/L
500 523
105 85-115
Lead
ug/L
500 487
97 85-115
Zinc
ug/L
500 458
92 85-115
MATRIX SPIKE & MATRIX SPIKE DUPLICATE: 3168280 3168281
MS MSD
92521339001
Spike Spike MS
MSD MS MSD
% Rec
Parameter
Units Result
Cone. Cone. Result
Result % Rec % Rec
Limits
RPD Qual
Copper
ug/L 0.087
500 500 645
638 112 110
70-130
1
mg/L
Lead
ug/L ND
500 500 505
498 100 99
70-130
1
Zinc
ug/L 0.11
500 500 581
577 94 93
70-130
1
mg/L
MATRIX SPIKE & MATRIX SPIKE DUPLICATE: 3168282 3168283
MS MSD
92522136001
Spike Spike MS
MSD MS MSD
% Rec
Parameter
Units Result
Cone. Cone. Result
Result % Rec % Rec
Limits
RPD Qual
Copper
ug/L 8.5
500 500 554
530 109 104
70-130
4
Lead
ug/L ND
500 600 518
489 104 98
70-130
6
Zinc
ug/L 70.2
500 500 570
542 100 94
70-130
5
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: 02/24/2021 02:24 PM without the written consent of Pace Analytical Services, LLC.
Page 12 of 15

aceAnalytical
www.pacelabs.com
QUALIFIERS
Project: Wieland Copper
Pace Project No.: 92521915
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.
Pace Analytical Services, LLC
106 Short St.
Kernersville, NC 27284
338-985-2841
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 Chlorcethylvinyl 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.
M1 Matrix spike recovery exceeded QC limits. Batch accepted based on laboratory control sample (LCS) recovery.
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
Date: 02/24/2021 02:24 PM without the written consent of Pace Analytical Services, LLC. Page 13 of 16

aceAnalytical
www.pacelabs.ccra
Project: Wieland Copper
Pace Project No.: 92521915
Lab ID
92521915001
92621915002
92521916003
92521915004
92621916005
92521916001
92621916002
92521915003
92521916004
92521915005
92621915001
92521916002
92521915003
92521915004
92621916005
92621915001
92621915002
92521916003
92621915004
92521915005
Pace Ana"cal Services, LLC
106 Short Sc
Kemersville, NC 27284
336-998-2841
QUALITY CONTROL DATA CROSS REFERENCE TABLE
Sample ID QC Batch Method QC Batch Analytical Method
002
SM 2540D-2011
599922
001
SM 2540D-2011
599922
003
SM 2540D-2011
599922
004
SM 2540D-2011
599922
006
SM 2540D-2011
599922
002
EPA 1664E
601591
001
EPA 1664B
601591
003
EPA 1664B
601691
004
EPA 1664E
601591
005
EPA 1664B
601591
002
001
003
004
006
002
001
003
004
006
Date: 02/24/2021 02:24 PM
Analytical
Batch
EPA 200.7 Rev 4.4 1994
600513
EPA 200.7 Rev 4.41994
600545
EPA 200.7 Rev 4.4 1994
600513
EPA 200.7 Rev 4.4 1994
600545
EPA 200.7 Rev 4.4 1994
601143
EPA 200.7 Rev 4.4 1994
601181
EPA 200.7 Rev 4.4 1994
601143
EPA 200.7 Rev 4.4 1994
601181
EPA 200.7 Rev 4.4 1994
601143
EPA 200.7 Rev 4.4 1994
601181
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, LLC. Page 14 of 15

CHAIN -OF -CUSTODY Analytical Request Document
F ceAnalytical
Chain -of -Custody is a LEGAL DOCUMENT -Complete all relevant fields
LAB USE ONLY- Affix Workorder/Login Label I Here or List Pace Workorder Number or
A-- - • •mHcr Here
6
�0# 92521915
ALL SHADED Container Preserva[ieT d
111111111111111111 I III
92521915
• • Preservative Types: (1) nitric acid, (2) sulfuric..
(6) methanol, (7) sodium bisulfate, Iel sodium thiosulfate, (9) hexane, (A) au.u, 11.1.,...,
(C) ammonium hydroxide, IDI 75P, ILI Unpreserved, (0) Other
Company:
s n
L
Billing Information:
Address:
Report To:
Email To:
Copy To:
Site Collection Info/Address:
Analyses
Lab Proflle/Line:
Customer Project Name/Number:
Pt Ll�
State: County/City: Time Zone Collected:
l [ I PT ( ] MT ( I CT I JET
J4
g
�
y
G
n'
ltJ
tab sample RecPIPL cheeki,1;
Custody Seale Present/Inteet Y N NA
Custody Signatures Present Y N NA
Collector Signature Present Y N NA
Bottles Intact Y N NA
Correct Bottles Y N NA
Sufficient Volume Y N NA
Samples Received on Ice Y N NA
VOA - Heedspace Acceptable Y N NA
USDA Regulated Soils Y N NA
Samples in Holding Time Y N NA
Plsstulp chlorine ereaent Y N NA
Cl 9t[ipe:
Sample pH Acceptable Y N NA
a: Strl H
P P
Sulfide Present V N NA
Lead Acetate strips: -
LAB Use ONLY:
Lob Sample k I Comments;
Phone:
Email:
Site/Facilitf ID k:
Compliance Monitoring?
es I INo
C011g�pted riot)'
/
Purchase Order p:
Quote B:
DINPWS ID k:
DIN Location Code:ta
CO ¢(t B igoatUr )'
/ ` Qi•-
Turnaround Date Required:
Imme iat2 ate on [e:
e5 ( INo
Sample posal:
I I Dispose as appropriate I I Return
Archlve
[ 1 -
[ eHoltl:
Rush:
[ ] Same Day I I Next Day
2 Da ] 3 Da 4 Da 5 Da
[ ] Y ] Y I ] Y [ ] Y
(Expedite Charges Apply)
Field Filtered (if applicable):
I ] Yes [ ] No
Analysis:
'Matrix Codes (insert in Matrix box below): Drinking Water(DW), Ground Water(GW), Wastewater(WW),
Product (P), Soil/Solid (SQ, Oil (OL), Wipe (WP), Air (AR), Tissue ITS), Bioassay (B), Vapor (V), Other (OT)
Customer Sample ID
Matrix •
Comp/
Grab
Collected (or
Composite Start)
Composite End
Res
O
¢of
Clans
Date
Time
Date
Time
-
_
JJYY
t
3
TCVl21
!7
W
-a.
Customer Remarks / Special Conditions / Possible Hazards:
Type of Ice Used: Wet Blue Dry None
SHORT HOLDS PRESENT (.72 hours): Y N N/A
Lab Sample Temperature Info:
Temp Blank Received: Y N NA
Therm IDk:
Cooler 1 Temp Upon Receipt:la.0
Cooler 1 Therm Corr. Factor: O oC
Cooler L Corrected Temp:— T-_oC
Comments:
Packing Material Used:
Lab Tracking N: ^ O O
L 4 o O
Radchem sampte(s) screened(4500 cpm): Y N NA
Samples received via:
FEDEA UPS Client Courier Pace Courier
Relin hP4 by/Company: (Si gture)
�Nti
Date�me:
LC a'f Y�V lT
i�a'f( 1 A
Receiv d by/Comps : (Signature)
Date/Time: IC.t
�1��
MTIL LAB USE ONLY
Table tl:
Acctnum:
Relinquishe /Company: (Signature)
DateRm :
Received by/Company: (Signature)
Datelfime:
Template:
Prelogm:
P Tri Blank Received. Y N NA
HCL McOH TSP Other
Relinquished by/Company: (Signature)
Date/Time:
Received by/Company: (Signature)
Date/Time:
PM:
PB:
Non Conformance(s):
YES / NO
Page:
Of: