#5623_2016_1117_JS_FINAL

INSPECTION REPORT ROUTING SHEET
To be attached to all inspection reports in-house only.
Laboratory Cert. #:
5623
Laboratory Name:
City of Belmont Water Plant
Inspection Type:
Field Municipal Initial
Inspector Name(s):
Jason Smith
Inspection Date:
November 17, 2016
Date Forwarded for Initial
December 20, 2016
Review:
Initial Review by:
Anna Ostendorff
Date Initial Review
December 20, 2016
Completed:
❑ Insp. Initial ❑ Insp. Reg
Cover Letter to use:
❑Insp. No Finding ❑Insp. CP
®Corrected
❑Insp. Reg. Delay
(to use: rt click, properties, check)
Unit Supervisor/Chemist III:
Todd Crawford
Date Received:
December 29, 2016
Date Forwarded to Admin.:
January 5, 2017
Date Mailed:
January 12, 2017
Special Mailing Instructions:
Copy Wes Bell MRO

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January 11, 2017
5623
Mr. Joseph Roy
City of Belmont Water Plant
P.O. Box 431
Belmont, NC 28012
SUBJECT: North Carolina Wastewater/Groundwater Laboratory Certification (NC WW/GW LC)
Initial Inspection
Dear Mr. Roy:
Enclosed is a report for the inspection performed on November 17, 2016 by Jason Smith. Since the
Finding(s) cited during the inspection were all corrected prior to the completion of the enclosed report, a
response is not required. The staff is commended for taking the initiative in correcting the Findings in
such a timely manner. For Certification maintenance, your laboratory must continue to carry out the
requirements set forth in 15A NCAC 2H .0800.
Copies of the checklists completed during the inspection may be requested from this office. Thank you
for your cooperation during the inspection. If you wish to obtain an electronic copy of this report by
electronic mail, or if you have questions or need additional information, please contact me at (919) 733-
3908 ext. 251.
Sincerely,
D�
Todd Crawford
Technical Assistance & Compliance Specialist
NC WW/GW Laboratory Certification Branch
Attachment
cc: Dana Satterwhite, Jason Smith, Master File 5623

LABORATORY NAME:
NPDES PERMIT #:
ADDRESS:
CERTIFICATE #:
DATE OF INSPECTION:
TYPE OF INSPECTION:
AUDITOR(S):
LOCAL PERSON(S) CONTACTED:
I. INTRODUCTION:
City of Belmont Water Plant
NCO077763
205 N. Tenth Street
Belmont, NC 28012
5623
November 17, 2016
Field Municipal Initial
Jason Smith
Joseph Roy and Jennifer Gibson
This laboratory was inspected by a representative of the North Carolina Wastewater/Groundwater
Laboratory Certification (NC WW/GW LC) program to verify its compliance with the requirements
of 15A NCAC 2H .0800 for the analysis of environmental samples.
IL GENERAL COMMENTS:
The laboratory maintains certification voluntarily. The facility's effluent is discharged to the
Belmont WWTP and their NPDES permit is inactive. No samples within the scope of NC WW/GW
LC rules have been analyzed since obtaining certification.
All required Proficiency Testing (PT) samples have been analyzed for the 2016 PT calendar year
and the graded results were 100% acceptable.
Current Quality Assurance Policies for Field Laboratories and Approved Procedure documents
for the analysis of the facility's currently certified Field Parameters were provided at the time of
the inspection.
Requirements that reference 15A NCAC 2H .0805 (g) (1), stating "Data pertinent to each analysis
must be maintained for five years. Certified Data must consist of date collected, time collected,
sample site, sample collector, and sample analysis time. The field benchsheets must provide a
space for the signature or initials of the analyst and proper units of measure for all analyses", are
intended to be a requirement to document all pertinent information for historical reconstruction of
data. It is not intended to imply that existing records are not adequately maintained unless the
Finding speaks directly to that.
III. FINDINGS REQUIREMENTS COMMENTS AND RECOMMENDATIONS:
Documentation
Comment: The traceability log did not include the vendor. The NC WW/GW LC Quality
Assurance Policies for Field Laboratories document states: All chemicals, reagents, standards

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#5623 City of Belmont Water Plant
and consumables used by the laboratory must have the following information documented: Date
Received, Date Opened (in use), Vendor, Lot Number, and Expiration Date. Notification of
acceptable corrective action (i.e., an updated traceability log including documentation of the
vendor with an implementation date of December 5, 2016) was received by email on December 5,
2016. No further response is necessary for this Finding.
Quality Assurance
Comment: The automatic pipettor used to prepare the PT sample has not been calibrated. This is
considered a critical measurement since it is analogous to preparing a standard. The NC
WW/GW LC Quality Assurance Policies for Field Laboratories document states: Mechanical
volumetric liquid -dispensing devices (e.g., fixed and adjustable auto-pipettors, bottle -top
dispensers, etc.), used for critical measurements, must be calibrated at least every twelve months
and documented. Each liquid -dispensing device must meet the manufacturer's statement of
accuracy. For variable volume devices used at more than one setting, check the accuracy at the
maximum, middle and minimum values. Testing at more than three volumes is optional. When a
device capable of variable settings is dedicated to dispense a single specific volume, calibration is
required at that setting only. Notification of acceptable corrective action (i.e., annual calibration of
the automatic pipettor will begin to be performed along with the balance calibration prior to the
next critical measurement such as PT preparation) was received by email on December 5, 2016.
No further response is necessary for this Finding.
Comment: Calibration of the automatic pipettor would not be required if the laboratory uses a
Class A volumetric pipet that is the appropriate volume to prepare the PT sample.
Chlorine, Total Residual — Hach 10014 (Aqueous)
Comment: Instrument identification was not documented on the benchsheet. The NC WW/GW
LC Approved Procedure for the Analysis of Total Residual Chlorine document states: The
following must be documented in indelible ink whenever sample analysis is performed: Instrument
identification. Notification of acceptable corrective action (i.e., an updated benchsheet including
the instrument model and serial number with an implementation date of December 15, 2016) was
received by email on December 15, 2016. No further response is necessary for this Finding.
Comment: The benchsheet did not include a space to document the time and date of sample
collection or the sample site. North Carolina Administrative Code, 15A NCAC 2H .0805 (g) (1)
states: Data pertinent to each analysis must be maintained for five years. Certified Data must
consist of date collected, time collected, sample site, sample collector, and sample analysis time.
The field benchsheets must provide a space for the signature or initials of the analyst and proper
units of measure for all analyses. This was not documented because the laboratory has only
analyzed PT samples which are not collected. The benchsheet must still include a space to
document this information to be ready to analyze environmental samples when needed.
Notification of acceptable corrective action (i.e., an updated benchsheet including space for the
sample site, date collected and time collected with an implementation date of December 15, 2016)
was received by email on December 15, 2016. No further response is necessary for this
Finding.
Comment: A check standard was not being analyzed prior to sample analysis. The NC WW/GW
LC Approved Procedure for the Analysis of Total Residual Chlorine document states: When a
five -standard annual standard curve verification is used, the laboratory must check the calibration
curve each analysis day. To do this, the laboratory must analyze a calibration blank to zero the
instrument and analyze a check standard each day that samples are analyzed. The value
obtained for the check standard must read within 10% of the true value of the check standard. If

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#5623 City of Belmont Water Plant
the obtained value is outside of the ±10% range, corrective action must be taken. General
absorbance standard (i.e., DR/check) supplied by some manufacturers cannot be used for the
check standard. Gel -type standards may be used for this purpose. These standards must be
verified initially and every 12 months thereafter, with the standard curve. Notification of acceptable
corrective action (i.e., a calibration log to be used for TRC gel standard analysis with an
implementation date of December 5, 2016 and a statement that the gel standard will be analyzed
prior to sample analysis) was received by email on December 5, 2016. No further response is
necessary for this Finding.
IV. PAPER TRAIL INVESTIGATION:
No paper trail performed.
V. CONCLUSIONS:
All Findings noted during the inspection were adequately addressed prior to the completion of
this report. The inspector would like to thank the staff for its assistance during the inspection and
data review process. No response is required.
Report prepared by: Jason Smith Date: December 20, 2016
Report reviewed by: Anna Ostendorff Date: December 20, 2016