WQ0005910_Monitoring - 07-2022_20220824 (2)

GW-59A COMPLIANCE REPORT FORM Permit #_W Q Qd0911 O
(Submit one each monitoring period with GW-59 forms.)
1
Enter date monitoring results were due. 1 Will this monitoring report (GIN-59 and GW-59A)
YES
NO
be submitted after the established due date?
2
Was any required information missing on the GW-59 report forms?
YES
NO
IF the answer to question 1 or 2 is "YES" list in the space provided below the well identification number(s) and
explain the problems encountered in obtaining the required information.
/
3
Are any of the monitor wells in need of repair or maintenance (damaged casing, unlocked or missing cap, missing
YES
NO/
Identification plate, area overgrown, etc.)" 1j the answer is •'Fes", contact the Regional Office for guidance.
`//
4
Are any monitored constituents equal to or above the established standards?
YES
NO
If the answer to question 4 is "NO", skip to section 8.
If the answer to question 4 is "YES" list the affected wells individually with constituent(s) and concentration(s)
exceeding standards in the space provided below:
"TVs
Avwaw,o..:wtrA
9(0 S: 5.40 a►w �� = -ti0
%J S RO
5
For the constituents identified In question 4 abovq, have standards been exceeded previously for the
YES
NO
same constituent(s) in the same well(s) in the last two years?
If the answer to question'5 is NO", skip to section B.
If the answer to question 5 is "YES", list in the space provided below, each welt with constituents) exceeding '
standards, concentration(s) reported, and sample toll ction date for each occurrence (for the last two years).
MW %% ANwr.oww W it '(Os MvJ S 'CO S
31301 410
'
313o11�-It.$ 3�x4�?1-9.4�
3thrl 1 Sip h0 $I.0
��iwllt - 9.9V 1�lal�o= 11.$ Z1z31zo-SSI
'�li�ts��'Lotb -tlw124
6
Are the monitoring wells listed in section 5 located at or beyond the review boundary?
YES
NO
If the answer Is "YES", a groundwater quality problem may be occurring. CONTACT THE REGIONAL
OFFICE iMMEDIATELYFOR GUIDANCE. If the answer is "NO", monitoring wells may be improperly
located; contact the Regional Office.
7
Is -the permittee implementing previously approved actions required by the Division involving this
YES
NO
groundwater quality problem?
If the answer to question 7 is "YES", describe those actions in the space provided below.
If the answer to question 7 is 'NO", contact the Regional Office within 90 days; an evaluation may be
disposal system Is having at the review and compliance
required to determine the impact the waste
boundaries surrounding this facility Failure to do so may subject the permittee to a Notice of Violation.
fines and/or penalties.
C �J
! i C3 AUG 2 9 2022
e t-2
N
S
The person completing this portion (GW-59A) *the merit®r_ report should sign below and submit this
form with GW-59 forms for required wells to the`tddress proylted at the tap of the current GW-59 form-
, cs�
..rnw>r' 'rT.
...,...�,�:... .......:.�asw,...,,,,Y.,-...::•,:,;n-...,, ":..-.�A .rwnr.wu.,.;.. .R.,�:-.-,.M:�,,Su • • r
I herbb'y,acknowledge.that;the agoye Infofmatlo►��eva ev (uated and the Infocmatipn bm ed n
report,(Compltajic y'ort,-59Aa,.ls true and,complete io;the best of my')Cnowlac�ge�?�,,;,b
Signature of Pe e ( A horized Agent) Date

SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING:
COMPLIANCE REPORT FORM
FACILITY INFORMATION Please Print Clearly or Type
Facility Name:�Crl LLC.
Permit Name (if different):
Facility Address: 1F v
CVv "Z1 I
(street) NL 2745i eNT`
(City) (Stale) (Zip) County
Contact Person: Telephone
Well Location/ Site Name: No. of Wells to be Sampled: (Ir6
Well Identification Number (from Permit): VNII.A3 - S For Groundwater Treatment Systems
Well Depth: 21-'l ft. Well Diameter: 2. in.
Check one: ❑ Influent (98)
Screened Interval: t5 ft. to 22- ft. ❑ Effluent (99)
Depth to Water Level: LO-S_ft. below measuring point.
Measuring Point (M.P.) is: 2- ft. above land surface. Relative M.P. Elevation in ft.:
Gallons of water pumped/bailed before sampling: S Date sample collected: ^1-20-22
Field analysis: pH LA-ck'l , Specific Conductance uMhos
Temp. 24-S °C, Odor 0rG Appearance
DEPARTMENT OF ENVIRONMENT & NATURAL RESOURCES
WATER QUALITY DIVISION, GROUNDWATER SECTION
1636 MAIL SERVICE CENTER
RALEIGH. INC 27699-1636 Phone: [phone]:
PERMIT #: , EXPIRATION DATE: 1O 31 2 y
Non -Discharge W Q 00o54 k O UIC
NPDES
TYPE OF PERMITTED OPERATION BEING MONITORED
Lagoon
Spray Field
Rotary Distributor
Other:
Remediation: Infiltration Gallery
Remedialion:
Land Application of Sludge
NOTE: Values should reflect dissolved and
colloidal concentrations.
Date sample analyzed:
Laboratory Name: E�nv►YCLV1yr�¢K1�
Certification No.
PARAMETERS (Samples for metals were collected unfiltered ✓ YES NO and field acidified
COD mg/I Nitrite (NO2) as N mg/I
Coliform: MF Fecal /100ml Nitrate (NO3) as N OL4 mg/I
Coliform: MF Total /100ml Phosphorus: Total as P_ 0.09 ma/I
(Note: Use MPN method for highly turbld�samples)
Dissolved Solids: Total �5
mg/I
pH (when analyzed
units
TOC 3 •
mg/I
Chloride
mg/I
Arsenic
mg/I
Grease and Oils
mg/I
Phenol
mg/I
Sulfate
mg/I
Specific Conductance
uMhos
Total Ammonia 0• 09
mg/I
TKN as N
mg/I
Orthophosphate
mg/I
Al - Aluminum
mg/I
Ba - Barium
mg/I
Ca - Calcium 32.'12 ►
mg/I
Cd - Cadmium
mg/I
Chromium: Total
mg/I
Cu - Copper
mg/I
Fe - Iron
mg/I
Hg - Mercury
mg/I
K - Potassium
mg/I
Mg - Magnesium
mg/I
Mn - Manganese
mg/I
YES NO)
Ni - Nickel mg/I
Pb - Lead mg/I
Zn - Zinc mg/I
Ammonia Nitrogen mg/I
Other (Specify Compounds and Concentration Units)
In t
ORGANICS: (GC,GC/MS,HPLC)
(Specify test and method #. Attach lab report.)
Report Attached? Yes �/ (1) No (0)
VOC : method # =
method # =
method # =

SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING:
COMPLIANCE REPORT FORM
FACILITY INFORMATION Please Print Clearly or Type
Facility Name:Awl3ce, LLC-
Permit Name (if different):
Facility Address:-9)y I Avoca Favw, Rowel
tvv (Slreel) NCr 7_ 145-7
Tily) (Stale) (zip)
Contact Person:
Well Location/ Site Name:
County
Telephone
No_ of Wells to be Sampled:
Well Identification Number (from Permit): C'r1J11��
Well Depth: \ q) ft. Well Diameter: 2.
Screened Interval: 3 ft. to V 1b ft.
Depth to Water Level: � b ft. below measuring point
Measuring Point (M.P.) is: 26 ft. above land surface.
Gallons of water pumped/bailed before sampling: 5
Field analysis: pH�— , Specific Conductance
Temp. 'IS- 3 °C, Odor N 0-f-
For Groundwater Treatment Systems
in. Check One: ❑ Influent (98)
❑ Effluent (99)
Relative M.P. Elevation in ft.:
Date sample collected:
uMhos
Appearance C1 f-ew
PARAMETERS (Samples for metals were collected unfiltered
COD mg/I Nitri
Coliform: MF Fecal /100ml Nitr
Coliform: MF Total /100ml Pho
(Note: Use MPN method for highly turbid sa pies)
25�
Dissolved Solids: Total
mg/I
pH (when analyzed
units
TOC - 0(o
mg/I
Chloride 32.
mg/I
Arsenic
mg/I
Grease and Oils
mg/I
Phenol
mg/I
Sulfate
mg/I
Specific Conductance
uMhos
Total Ammonia 4 O.Oy
mg/I
TKN as N
mg/I
DEPARTMENT OF ENVIRONMENT & NATURAL RESOURCES
WATER QUALITY DIVISION, GROUNDWATER SECTION
1636 MAIL SERVICE CENTER
PERMIT#: • EXPIRATION DATE: tul
Non -Discharge W Q 000591 Q UIC
NPDES
TYPE OF PERMITTED OPERATION BEING MONITORED
Lagoon Remediation: Infiltration Gallery
Spray Field Remediation:
Rotary Distributor Land Application of Sludge
Other:
NOTE: Values should reflect dissolved and
colloidal concentrations.
Date sample analyzed: -l- A�,-�t� --!j Qb -3-12
Laboratory Name: Er►v 0YOr►wne^A
Certification No. V0
✓ YES NO and field acidified
to (NO2) as N mg/I
ate (NO3) as N 0 • y-1 mg/I
sphorus: Total as P 4.0.04 mg/I
Orthophosphate mg/I
Al - Aluminum mg/I
Ba - Barium mg/I
Ca - Calcium L4.S 35 mg/I
Cd - Cadmium mg/I
Chromium: Total mg/I
Cu - Copper mg/I
Fe - Iron mg/I
Hg - Mercury mg/I
K - Potassium mg/I
Mg - Magnesium mg/I
Mn - Manganese mg/I
method # =
method # =
YES NO)
y
Ni - Nickel mg/I
Pb - Lean mg/I
Zn - Zinc mg/I
Ammonia Nitrogen mg/I
Other (Specify Compounds and Concentration Units)
Di
ORGANICS: (GC,GC/MS,HPLC)
(Specify test and method #. t4tach lab report.)
Report Attached? Yes ✓ (1) No (0)
VOID : method # =
! 1 9V <. S; A CYIt
print or type

SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING:
COMPLIANCE REPORT FORM
FACILITY INFORMATION Please Print Clearly or Type
Facility Name:Awjocu L.LC.
Permit Name (if different):
Facility Address: , V v O
C.V V F 1, (Street) N �.. Z� 15-7
(City) I(Stale) (zip) County
Contact Person: Telephone #: 2S2r4�2-� 133
Well Location/ Site Name:
No. of Wells to be Sampled:
Well Identification Number (from Permit): tAW-
Well Depth: 00 ft. Well Diameter: 2
Screened Interval: 3 ft. to I % ft.
Depth to Water Level: 11-1 ft. below measuring point
Measuring Point (M.P.) is: Z• ft. above land surface.
Gallons of water pumped/bailed before sampling: S
Field analysis: pH `• 31 , Specific Conductance
Temp. 2-1•a °C, Odor nt,
For Groundwater Treatment Systems
in. Check One: ❑ Influent (98)
El Effluent (99)
Relative M.P. Elevation in ft.:
Date sample collected:l-'A0-'2'A
Appearance
PARAMETERS (Samples for metals were collected unfiltered
COD mg/I Nitri
Coliform: MF Fecal /100ml Nitr
Coliform: MF Total /100ml Pho
(Note: Use MPN method for highly turbid samples)
Slo 0
Dissolved Solids: Total
mg/I
pH (when analyzed
units
TOC 11 •
mg/I
Chloride 2.1
mg/I
Arsenic
mg/I
Grease and Oils
mg/I
Phenol
mg/I
Sulfate
mg/I
Specific Conductance
uMhos
Total Ammonia 0.(03
mg/I
TKN as N
mg/I
_uMhos
C1 c &xv
DEPARTMENT OF ENVIRONMENT & NATURAL RESOURCES
WATER QUALITY DIVISION, GROUNDWATER SECTION
1636 MAIL SERVICE CENTER
RALEIGH. NC 27699-1636 Phone: [phone]:
PERMIT#: EXPIRATION DATE: %O 3: 2 4
Non -Discharge W Q 000154 i 0 UIC
01991:`l
TYPE OF PERMITTED OPERATION BEING MONITORED
Lagoon
Spray Field
Rotary Distributor
Other:
Remediation: Infiltration Gallery
Remediation:
Land Application of Sludge
NOTE: Values should reflect dissolved and
colloidal concentrations.
Date sample analyzed: "1-;M 2-A --1 b-3- 2 X
Laboratory Name: E.tr'►v ocOy%MC ni
Certification No. V)
YES NO and field acidified
to (NO2) as N mg/I
ate (NO3) as N •y mg/1
sphorus: Total as P 1.(o4 mg/I
Orthophosphate mg/I
Al - Aluminum mg/I
Ba - Barium mg/I
Ca - Calcium 34.12S mg/I
Cd - Cadmium mg/I
Chromium: Total mg/I
Cu - Copper mg/I
Fe - Iron mg/I
Hg - Mercury mg/I
K - Potassium mg/I
Mg - Magnesium mg/I
Mn - Manganese mg/I
✓ YES NO)
Ni - Nickel mg/I
Pb - Lean mg/I
Zn - Zinc mg/I
Ammonia Nitrogen mg/I
Other (Specify Compounds and Concentration Units)
Di
ORGANICS: (GC,GC/MS,HPLC)
(Specify test and method #. Attach lab report.)
Report Attached? Yes ✓ (1) No (0)
VOC : method # =
method # =
: method # =

SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING:
COMPLIANCE REPORT FORM
FACILITY INFORMATION Please Print Clearly or Type
Facility Name: P,rnCu LLC
Permit Name (if different):
Facility Address: RIJOCCL Faun, V,,�dacl
tvv "I11 (Sireel) M(_ 219S7
(Cily) (stale) (zip)
Contact Person:
Well Location/ Site Name:
County 1Sew+%e. _
Telephone #:
No. of Wells to be Sampled:
Well Identification Number (from Permit): MU- I
Well Depth: 2•1-$ ft. Well Di meter: 2.
Screened Interval: 10 ft. to 2 ft.
Depth to Water Level: 1L1•�J ft. below measuring point.
Measuring Point (M.P.) is: ? ft. above land surface.
Gallons of water pumped/bailed before sampling:
Field analysis: pH (0-,, Specific Conductance
Temp. SLi- 3 °C, Odor nt-
For Groundwater Treatment Systems
in. Check One: ❑ Influent (98)
❑ Effluent (99)
DEPARTMENT OF ENVIRONMENT & NATURAL RESOURCES
WATER QUALITY DIVISION, GROUNDWATER SECTION
1636 MAIL SERVICE CENTER
RALEIGH. NC 27699-1636 Phone: [phone].
PERMIT #: • EXPIRATION DATE: 10 31 1202q
Non -Discharge W Q 000591 Q UIC
NPDES
TYPE OF PERMITTED OPERATION BEING MONITORED
Lagoon Remediation: Infiltration Gallery
Spray Field Remediation:
Rotary Distributor Land Application of Sludge
Other:
NOTE: Values should reflect dissolved and
colloidal concentrations.
Relative M.P. Elevation in ft.:
Date sample collected: "1'10-2� Date sample analyzed:
uMhos Laboratory Name: Er►v►1�!]tr►v►r,¢r►
Appearance Char Certification No.
PARAMETERS (Samples for metals were collected unfiltered
COD mg/I Nitri
Coliform: MF Fecal /100ml Nitr
Coliform: MF Total /100ml Pho
(Note: Use MPN method for highly turbid samples)
Dissolved Solids: Total 300
mg/I
pH (when analyzed)
units
TOC (• 9
mg/I
Chloride �"1
mg/I
Arsenic
mg/I
Grease and Oils
mg/I
Phenol
mg/I
Sulfate
mg/I
Specific Conductance
uMhos
Total Ammonia 4 O •O l,i
mg/I
TKN as N
mg/I
method # =
method # =
If YES NO and field acidified
to (NO2) as N mg/I
ate (NO3) as N O.SO mg/I
sphorus: Total as P O • o `t mg/I
Orthophosphate mg/I
Al - Aluminum mg/I
Ba - Barium mg/I
Ca - Calcium 4q• S11 mg/I
Cd - Cadmium mg/I
Chromium: Total mg/I
Cu - Copper mg/I
Fe - Iron mg/I
Hg - Mercury mg/I
K - Potassium mg/I
Mg - Magnesium mg/I
Mn - Manganese mg/I
YES NO)
Ni - Nickel mg/I
Pb - Lean mg/I
Zn - Zinc mg/I
Ammonia Nitrogen mg/I
Other (Specify Compounds and Concentration Units)
nl
ORGANICS: (GC,GC/MS,HPLC)
(Specify test and method #. Attach lab report.)
Report Attached? Yes ✓ (1) No (0)
VOC : method # =
a - ,, pVcs;dant
- Please print or type

SUBMIT FORM ON YELLOW PAPER ONLY
method # =
method # =
GROUNDWATER QUALITY MONITORING:
COMPLIANCE REPORT FORM
FACILITY INFORMATION Please Print Clearly or Type
Facility Name: Pwncu LLC.
Permit Name (if different):
Facility Ad`dr1ess:Ck , 1F V pc 1
CVV M• I I (SVeel) NL Z,7 7-7 1 Qi� I • Q.
(city) (Stale) (Zip) County
Contact Person: Telephone
Well Location/ Site Name: No. of Wells to be Sampled: _
Well Identification Number (from Permit): (*%4— tD For Groundwater Treatment Systems
Well Depth: ZO ft. Well Diameter: 2 in. Check One: ❑ Influent (98)
Screened Interval: 3 ft. to ZD ft. ❑ Effluent (99)
Depth to Water Level: VPL-_ft. below measuring point.
Measuring Point (M.P.) is: Z ft. above land surface. Relative M.P. Elevation in ft.:
Gallons of water pumped/bailed before sampling: _. Date sample collected:
Field analysis: pH � , Specific Conductance uMhos
Temp. °C, Odor IVO-C. Appearance CttKf
DEPARTMENT OF ENVIRONMENT & NATURAL RESOURCES
WATER QUALITY DIVISION, GROUNDWATER SECTION
1636 MAIL SERVICE CENTER
PERMIT #: • EXPIRATION DATE: 10 31 12 4
Non -Discharge w Q 0005910 UIC
NPDES
TYPE OF PERMITTED OPERATION BEING MONITORED
Lagoon Remedialion: Infiltration Gallery
\07—Spray Field Remedialion:
Rotary Distributor Land Application of Sludge
Other:
NOTE: Values should reflect dissolved and
colloidal concentrations.
Date sample analyzed: 7-11-'17.--% %-I-22
Laboratory Name: �Y
^Ex) ny%yy%s ►i
Certification No. V0
PARAMETERS (Samples for metals were collected unfiltered ✓ YES
NO and field acidified
COD
mg/I
Nitrite (NO2) as N
mg/I
Coliform: MF Fecal
/100ml
Nitrate (NO3) as N
L4. mg/I
Coliform: MF Total
/100ml
Phosphorus: Total as P
40. 0`4 mg/I
(Note: Use MPN method for highly turbid samples)
Orthophosphate
mg/I
Dissolved Solids: Total LA 10 mg/I
Al - Aluminum
mg/I
pH (when analyzed)
units
Ba - Barium
mg/I
TOC 1.41
mg/I
Ca - Calcium 23.3
%o mg/I
Chloride 93
mg/I
Cd - Cadmium
mg/I
Arsenic
mg/I
Chromium: Total
mg/I
Grease and Oils
mg/I
Cu - Copper
mg/I
Phenol
mg/I
Fe - Iron
mg/I
Sulfate
mg/I
Hg - Mercury
mg/I
Specific Conductance
uMhos
K - Potassium
mg/I
Total Ammonia 0.0S
mg/I
Mg - Magnesium
mg/I
TKN as N
mg/I
Mn - Manganese
mg/I
YES NO)
Ni - Nickel mg/I
Pb - Lead mg/I
Zn - Zinc mg/I
Ammonia Nitrogen mg/I
Other (Specify Compounds and Concentration Units)
Di
ORGANICS: (GC,GC/MS,HPLC)
(Specify test and method #. Attach lab report.)
Report Attached? Yes,/_(1) No (0)
VOC : method # =
L — 1 PvrtS%af'y*
Please print or type

SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING:
COMPLIANCE REPORT FORM
FACILITY INFORMATION Please Print Clearly or Type
Facility Name: -QCf., LLC
Permit Name (if different):
Facility Address: Avoca Favhn Rowel
Cvv %.A,% t 1 (Slfeel) NL 2195-7
(City) , (Stale) (Zip)
Contact Person:
Well Location/ Site Name:
County e- _
Telephone #: 2S7_-y82_-A
No. of Wells to be Sampled:
Well Identification Number (from Permit): (*4W- 1 V For Groundwater Treatment Systems
Well Depth: Z.0 ft. Well Diameter: Z in. Check One: ❑ Influent (98)
Screened Interval: ft. to 20 ft. ❑ Effluent (99)
Depth to Water Level: _ IS-1ft. below measuring point.
Measuring Point (M.P.) is: I ft. above land surface. Relative M.P. Elevation in ft.:
Gallons of water pumped/bailed before sampling: _5 Date sample collected:
Field analysis: pH -l� , Specific Conductance
Temp. 'X4- 1 °C, Odor Al 0•. Appearance .
PARAMETERS (Samples for metals were collected unfiltered
COD mg/I Nitri
Coliform: MF Fecal /100ml Nitr
Coliform: MF Total /100ml Pho
(Note: Use MPN method for highly turbid samples)
Dissolved Solids: Total 120
mg/I
pH (when analyzed)
units
TOC -1-LAW
mg/I
Chloride 2l0
mg/I
Arsenic
mg/1
Grease and Oils
mg/I
Phenol
mg/I
Sulfate
mg/I
Specific Conductance
uMhos
Total Ammonia 0--`Aka
mg/I
TKN as N
mg/I
uMhos
cte'*.i
DEPARTMENT OF ENVIRONMENT & NATURAL RESOURCES
WATER OUALITY DIVISION, GROUNDWATER SECTION
1636 MAIL SERVICE CENTER
PERMIT #: • EXPIRATION DATE:
Non -Discharge W Q OOO591 O UIC
NPDES
TYPE OF PERMITTED OPERATION BEING MONITORED
Lagoon Remediation: Infiltration Gallery
Spray Field Remediation:
Rotary Distributor Land Application of Sludge
Other:
NOTE: Values should reflect dissolved and
colloidal concentrations.
Date sample analyzed:-1^;1 ;X-.27,-3 'b^3-22
Laboratory Name: - Ey_". ►%CO nvy%e^-k
Certification No. ko
✓ YES NO and field acidified
to (NO2) as N mg/I
ate (NO3) as N 0. o mg/I
sphorus: Total as P 'f-10-04 mg/I
Orthophosphate mg/I
Al - Aluminum mg/I
Ba - Barium mg/I
Ca - Calcium _1'l . 0 1 mg/I
Cd - Cadmium mg/I
Chromium: Total mg/I
Cu - Copper mg/I
Fe - Iron mg/I
Hg - Mercury mg/I
K - Potassium mg/I
Mg - Magnesium mg/I
Mn - Manganese mg/I
method # =
method # =
`"e YES NO)
4
Ni - Nickel mg/I
Pb - Leant mg/I
Zn - Zinc mg/I
Ammonia Nitrogen mg/I
Other (Specify Compounds and Concentration Units)
Di
ORGANICS: (GC,GC/MS,HPLC)
(Specify test and method #. Attach lab report.)
Report Attached? Yes ✓ (1) No (0)
VOC : method # =
—. ,I P�cs;dctnt
print or type

E w'nfimgM % hcoo qwn- ho
114 OAKMONT DRIVE
GREENVILLE, N.C. 273588
AVOCA, LLC (WASTEWATER)
MR. BRIAN CONNER
P.O. BOX 129
MERRY HILL, NC 27957
y a
Maotevater ZVI. 10
PHONE [phone]
FAX [phone]
ID#: 132
DATE COLLECTED: 07/20/22
DATE REPORTED : 08/09/22
REVIEWED BY:
Effluent
Well #5
Well #7
Well #8
Well #9
Analysis
Method
PARAMETERS
Date Analyst
Code
BOD, mg/I
1070
07/21/22
HMM
521OB-16
Total Suspended Residue, mg/l
162
07/22/22
DNS
254OD-15
Ammonia Nitrogen as N, mg/l
0.04
0.09
<0.04
0.63
<0.04
07/27/22
KES
350.1 112-93
Total ICjeldahl Nitrogen as N,mg/l
40.50
08/03/22
KES
351.2 112-93
Nitrate+Nitrite as N, mg/l (talc)
0.46
353.2 R2-93
Nitrate Nitrogen as N, mg/l
<0.04
<0.04
0.47
0.45
0.50
07/22/22
KES
353.2 112-93
Nitrite Nitrogen as N, mg/l
0.46
07/22/22
KES
353.2 112-93
Total Phosphorus as P, mg/l
5.38
0.09
<0.04
1.64
0.09
08/03/22
BMD
365.4-74
Total Organic Carbon, mg/I
3.37
5.06
11.28
1.09
07/26/22
HMM
531OC-14
Chloride, mg/l
98
33
32
27
27
07/22/22
DNS
4500CLB-11
Total Dissolved Residue, mg/l
2000
590
250
560
300
07/24/22
DNS
D5907-13
Calcium, ug/l
29354
32721
4535
34723
49371
07/25/22
LFJ
EPA200.7
Magnesium, ug/I
2938
07/25/22
LFJ
EPA200.7
Sodium, ug/I
180636
07/25122
LFJ
EPA200.7
Sodium Adsorption Ratio (talc)
8.5
Total Nitrogen, mg/I (talc)
40.96

114 OAi4MON T DRIVE
GREENVILLE, N.C. 27858
AVOCA, LLC (WASTEWATER)
MR. BRIAN CONNER
P.O. BOX 129
MERRY HILL, NC 27957
wsstewat*r Z:Ds 10
PHONE [phone]
FAX [phone]
ID#: 132
DATE COLLECTED: 07/20/22
DATE REPORTED : 08/09/22
REVIEWED BY: / / `LJ
Well #10
Well #11
Analysis
Method
PARAMETERS
Date Analyst
Code
Ammonia Nitrogen as N, mg/1
0.05
12.96
07/27/22
KES
350.1 R2-93
Nitrate Nitrogen as N, mg/l
4.83
0.08
07/22/22
KES
353.2 R2-93
Total Phosphorus as P, mg/l
<0.04
<0.04
08/03/22
BMD
365.4-74
Total Organic Carbon, mg/l
1.43
7.46
07/26/22
RMM
531OC-14
Chloride, mg/l
93
26
07/22/22
DNS
4500CLB-11
Total Dissolved Residue, mg/l
470
720
07/24/22
DNS
D5907-13
Calcium, ug/l
23346
17081
07/25/22
LFJ
EPA200.7

Environment 1, Inc. CHAIN OF CUSTODY RECORD
P.O. Boo-7085. 114 Oakniont Dr. Page I -
Greenville NC)7858
environment I inc.corn
DISIN17TCTION
CHLORINE NEUTRALIZED AT COLLECTION
Phone [phone] a Fax [phone]
j CHLORINE
CLIENT. 132 Week: 33
F-i UV
VT
L'�
42
pH CHECK (LAB)
P P, P1 P
P I
P1
P1 P
P1
P P
P1
P
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CONTAJNER TYPE, P/G
kVOCA, LLC (WASTEWATER)
NONE
1M. BRIAN CONNER
P.O. BOX 129
CHEMICAL PRESERVATION
M[ERRY HILL NC 27957
A A C C
C
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A
A - NONE D - NACH
'252) 482-2133
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SAMPLE LOCATION
DATE
TIME
Effluent
8
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CLASSIFICA T1ION:
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WASTEWATER (NPDES)
DRINKING HATER
welt"
Well #5
VI,
24AG
7,
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Well #7
I 40
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Wen #9
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Wen #10
DURING SHIPMENT/DELIVERY
WeU#ll
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12, 0 9;
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SAMPLES COLLECTED BY.,
(Please Print?
SAMPLES RECEIVED! LAB AT cC.
RELINQUISHED B SiG,J iSAtvtPLER,
DATFjrIME
REC IVED 91Y (StG.I-- COMMIENTS:
%CEIVED By (SIG.) DATUIME
RECEIVED BY (-5JG,' DAMTIME
RELINQUISHED BY (SIG.)
DATEITIME
RELINQUISHED BY (SIG.)
DATE TiNT
i Sampler must place a "C" for composite sample or a"G"for
PLEASE READ Instructions for completing this form on. the
FORM -05 Grab sample in the blocks above for each parameter requested. N-D 411139

® I Laboratories- LLC
a member of The GEL Group INC
August 08, 2022
Ms. Ann Brown
Environment One, Inc.
114 Oakmont Drive
Greenville, North Carolina 27858
Re: Routine Analytical - North Carolina
Work Order: 587186
Dear Ms. Brown:
0
PO Qux 3t1712 Chadestan-S029417
2040 U.,-ige Road Ctuidwon. SC 29dtt7
P 3ds.5.�S.Bi%i
P 243.766.1 M
GEL Laboratories, LLC (GEL) appreciates the opportunity to provide the enclosed analytical results for the
sample(s) we received on July 25, 2022. This original data report has been prepared and reviewed in accordance
with GEL's standard operating procedures.
Test results for NELAP or ISO 17025 accredited tests are verified to meet the requirements of those standards,
with any exceptions noted. The results reported relate only to the items tested and to the sample as received by
the laboratory. These results may not be reproduced except as full reports without approval by the laboratory.
Copies of GEL's accreditation and certifications can be found on our website at www.gel.com.
Our policy is to provide high quality, personalized analytical services to enable you to meet your analytical needs
on time every time. We trust that you will find everything in order and to your satisfaction. If you have any
questions, please do not hesitate to call me at [phone], ext. 1614.
Sincerely,
Delaney Stone
Project Manager
Purchase Order: PO
Chain of Custody: Bromide
Enclosures
gelxem
Page 1 of 15 SDG: 587186

GEL LABORATORIES LLC
2040 Savage Road Charleston SC 29407 - [phone] - www.gel.com
Certificate of Analysis Report
for
ENV0001 Environment One, Inc.
Client SDG: 587186 GEL Work Order: 587186
The Qualifiers in this report are defined as follows:
* A quality control analyte recovery is outside of specified acceptance criteria
** Analyte is a Tracer compound
** Analyte is a surrogate compound
U Analyte was analyzed for, but not detected above the MDL, MDA, MDC or LOD.
Where the analytical method has been performed under NELAP certification, the analysis has met all of the
requirements of the NELAC standard unless qualified on the Certificate of Analysis.
The designation ND, if present, appears in the result column when the analyte concentration is not detected above
the limit as defined in the 'U' qualifier above.
This data report has been prepared and reviewed in accordance with GEL Laboratories LLC
standard operating procedures. Please direct any questions to your Project Manager, Delaney Stone.
Reviewed by
Page 2 of 15 SDG: 587186

GEL LABORATORIES LLC
2040 Savage Road Charleston SC 29407 - [phone] - www.gel.corn
Certificate of Analysis
Company: Environment One, Inc.
Address : 114 Oakmont Drive
Greenville, North Carolina 27858
Contact: Ms. Ann Brown
Project: Routine Analytical - North Carolina
Client Sample ID:
Effluent
Sample ID:
587186001
Matrix:
Water
Collect Date:
20-JUL-22 12:15
Receive Date:
25-JUL-22
Collector:
Client
Report Date: August 8, 2022
Project: ENV000101
Client ID: ENV0001
Parameter Qualifier Result DL RL Units PF DF Analyst Date Time Batch Method
Ion Chromatography
EPA300.0 Bromide Liquid "As Received"
Bromide 32.3 1.34 4.00 mg/L 20 HXC 1 07/26/22 0325 2294092 1
The following Analytical Methods were performed:
Method Description Analyst Comments
1 EPA 300.0
Notes:
Column headers are defined as follows:
DF: Dilution Factor Lc/LC: Critical Level
DL: Detection Limit PF: Prep Factor
MDA: Minimum Detectable Activity RL: Reporting Limit
MDC: Minimum Detectable Concentration SQL: Sample Quantitation Limit
Page 3 of 15 SDG: 587186

GEL LABORATORIES LLC
2040 Savage Road Charleston SC 29407 - [phone] - www.gel.com
Certificate of Analysis
Company: Environment One, Inc.
Address : 114 Oakmont Drive
Contact:
Project:
Greenville, North Carolina 27858
Ms. Ann Brown
Routine Analytical - North Carolina
Client Sample ID:
Well #5
Sample ID:
587186002
Matrix:
Water
Collect Date:
20-JUL-22 12:35
Receive Date:
25-JUL-22
Collector:
Client
Report Date: August 8, 2022
Project: ENV000101
Client ID: ENV0001
Parameter Qualifier Result DL RL Units PF DF Analyst Date Time Batch Method
Ion Chromatography
EPA300.0 Bromide Liquid "As Received"
Bromide 5.46 0.134 0.400 mg/L 2 HXC1 07/26/22 0354 2294092 1
The following Analytical Methods were performed:
Method Description Analyst Comments
1 EPA 300.0
Notes:
Column headers are defined as follows:
DF: Dilution Factor Lc/LC: Critical Level
DL: Detection Limit PF: Prep Factor
MDA: Minimum Detectable Activity RL: Reporting Limit
MDC: Minimum Detectable Concentration SQL: Sample Quantitation Limit
Page 4 of 15 SDG: 587186

GEL LABORATORIES LLC
2040 Savage Road Charleston SC 29407 - [phone] - www.gel.com
Certificate of Analysis
Company : Environment One, Inc.
Address : 114 Oakmont Drive
Contact:
Project:
Greenville, North Carolina 27858
Ms. Ann Brown
Routine Analytical - North Carolina
Client Sample ID:
Well #7
Sample ID:
587186003
Matrix:
Water
Collect Date:
20-JUL-22 13:40
Receive Date:
25-JUL-22
Collector:
Client
Report Date: August 8, 2022
Project: ENV000101
Client ID: ENV0001
Parameter Qualifier Result DL RL Units PF DF Analyst Date Time Batch Method
Ion Chromatography
EPA300.0 Bromide Liquid "As Received"
Bromide 16.7 0.670 2.00 m9/L 10 HXC1 07/26/22 0424 2294092 1
The following Analytical Methods were performed:
Method Description Analyst Comments
1 EPA 300.0
Notes:
Column headers are defined as follows:
DF: Dilution Factor Lc/LC: Critical Level
DL: Detection Limit PF: Prep Factor
MDA: Minimum Detectable Activity RL: Reporting Limit
MDC: Minimum Detectable Concentration SQL: Sample Quantitation Limit
Page 5 of 15 SDG: 587186

GEL LABORATORIES LLC
2040 Savage Road Charleston SC 29407 - [phone] - www.gel.com
Certificate of Analysis
Company: Environment One, Inc.
Address : 114 Oakmont Drive
Greenville, North Carolina 27858
Contact: Ms. Ann Brown
Project: Routine Analytical - North Carolina
Client Sample ID
Sample ID:
Matrix:
Collect Date:
Receive Date:
Collector:
Well #8
587186004
Water
20-JUL-22 13:10
25-JUL-22
Client
Report Date: August 8, 2022
Project: ENV000101
Client ID: ENV0001
Parameter Qualifier Result DL RL Units PF DF Analyst Date Time Batch Method
Ion Chromatography
EPA300.0 Bromide Liquid "As Received"
Bromide 11.4 0.670 2.00 mg/L 10 HXC1 07/26/22 0554 2294092 1
The following Analytical Methods were performed:
Method Description Analyst Comments
1 EPA 300.0
Notes:
Column headers are defined as follows:
DF: Dilution Factor Lc/LC: Critical Level
DL: Detection Limit PF: Prep Factor
MDA: Minimum Detectable Activity RL: Reporting Limit
MDC: Minimum Detectable Concentration SQL: Sample Quantitation Limit
Page 6 of 15 SDG: 587186

GEL LABORATORIES LLC
2040 Savage Road Charleston SC 29407 - [phone] - www.gel.com
Certificate of Analysis
Company: Environment One, Inc.
Address : 114 Oakmont Drive
Greenville, North -Carolina 27858
Contact: Ms. Ann Brown
Proiect: Routine Analvtical - North Carolina
Client Sample ID:
Sample ID:
Matrix:
Collect Date:
Receive Date:
Collector:
Well #9
587186005
Water
20-JUL-22 12:55
25-JUL-22
Client
Report Date: August 8, 2022
Project: ENV000101
Client ID: ENV0001
Parameter Qualifier Result DL RL Units PF DF Analyst Date Time Batch Method
Ion Chromatography
EPA300.0 Bromide Liquid "As Received"
Bromide 0.294 0.0670 0.200 m9/L 1 HXC 1 07/26/22 0624 2294692 1
The following Analytical Methods were performed:
Method Description Analyst Comments
1 EPA 300.0
Notes:
Column headers are defined as follows:
DF: Dilution Factor Lc/LC: Critical Level
DL: Detection Limit PF: Prep Factor
MDA: Minimum Detectable Activity RL: Reporting Limit
MDC: Minimum Detectable Concentration SQL: Sample Quantitation Limit
Page 7 of 15 SDG: 587186

GEL LABORATORIES LLC
2040 Savage Road Charleston SC 29407 - [phone] - www.gel.com
Certificate of Analysis
Company: Environment One, Inc.
Address : 114 Oakmont Drive
Greenville, North Carolina 27858
Contact: Ms. Ann Brown
Project: Routine Analytical - North Carolina
Client Sample ID:
Sample ID:
Matrix:
Collect Date:
Receive Date:
Collector:
Well #10
587186006
Water
20-JUL-22 13:25
25-JUL-22
Client
Report Date: August 8, 2022
Project: ENV000101
Client ID: ENV0001
Parameter Qualifier Result DL RL Units PF DF Analyst Date Time Batch Method
Ion Chromatography
EPA300.0 Bromide Liquid "As Received"
Bromide 0.402 0.0670 0.200 mg/L I HXCI 07/26/22 0654 2294092 1
The following Analytical Methods were performed:
Method Description Analyst Comments
I EPA 300.0
Notes:
Column headers are defined as follows:
DF: Dilution Factor Lc/LC: Critical Level
DL: Detection Limit PF: Prep Factor
MDA: Minimum Detectable Activity RL: Reporting Limit
MDC: Minimum Detectable Concentration SQL: Sample Quantitation Limit
Page 8 of 15 SDG: 587186

GEL LABORATORIES LLC
2040 Savage Road" Charleston SC 29407 - [phone] - www.gel.com
Certificate of Analysis
Company: Environment One, Inc.
Address : 114 Oakmont Drive
Contact:
Project:
Greenville, North Carolina 27858
Ms. Ann Brown
Routine Analytical - North Carolina
Client Sample ID:
Well #11
Sample ID:
587186007
Matrix:
Water
Collect Date:
20-JUL-22 12:05
Receive Date:
25-JUL-22
Collector:
Client
Report Date: August 8, 2022
Project: ENV000101
Client ID: ENV0001
Parameter Qualifier Result DL RL Units PF DF Analyst Date Time Batch Method
Ion Chromatography
EPA300.0 Bromide Liquid "As Received"
Bromide 6.24 0.335 1.00 mg/L 5 HXC1 07/26/22 1601 2294092 1
The following Analytical Methods were performed:
Method Description Analyst Comments
1 EPA 300.0
Notes:
Column headers are defined as follows:
DF: Dilution Factor Lc/LC: Critical Level
DL: Detection Limit PF: Prep Factor
MDA: Minimum Detectable Activity RL: Reporting Limit
MDC: Minimum Detectable Concentration SQL: Sample Quantitation Limit
Page 9 of 15 SDG: 587186

GEL LABORATORIES LLC
2040 Savage Road Charleston, SC 29407 - [phone] - www.gel.com
QC Summary Report Date: August 8, 2022
Environment One, Inc. Page 1 of
114 Oakmont Drive
Greenville, North Carolina
Contact: Ms. Ann Brown
Workorder: 587186
Parmname NOM Sample Qual QC Units RPD% REC% Range Anlst Date Time
on Chromatography
3atch 2294092
QC1205147521 586558002 DUP
Bromide 1 0.184 0.203 mg/L 9.45 ^ (+/-0.200) HXC 1 07/25/22 18:2
QC1205147520 LCS
Bromide 1.25
QC1205147519 MB
Bromide U
QC1205147523 586558002 PS
Bromide 1.25 J 0.184
Notes:
1.25 mg/L
0.000 mg/L
1.40 mg/L
100 (90%-110%) 07/25/2217:2
07/25/22 16:5
97.4 (90%-110%) 07/25/2218:5
The Qualifiers in this report are defined as follows:
< Result is less than value reported
> Result is greater than value reported
B The target analyte was detected in the associated blank.
E General Chemistry --Concentration of the target analyte exceeds the instrument calibration range
H Analytical holding time was exceeded
J See case narrative for an explanation
J Value is estimated
N/A RPD or %Recovery limits do not apply.
N 1 See case narrative
ND Analyte concentration is not detected above the detection limit
NJ Consult Case Narrative, Data Summary package, or Project Manager concerning this qualifier
Q One or more quality control criteria have not been met. Refer to the applicable narrative or DER.
R Per section 9.3.4.1 of Method 1664 Revision B, due to matrix spike recovery issues, this result may not be reported or used for regulatory compliance
purposes.
R Sample results are rejected
U Analyte was analyzed for, but not detected above the MDL, MDA, MDC or LOD.
X Consult Case Narrative, Data Summary package, or Project Manager concerning this qualifier
Z Paint Filter Test --Particulates passed through the filter, however no free liquids were observed.
Page 10 of 15 SDG: 587186

GEL LABORATORIES LLC
2040 Savage Road Charleston, SC 29407 - [phone] - www.gel.com
QC Summary
Workorder: 587186
Page 2 of
Parmname NOM Sample Qual QC Units RPD% REC% Range Anlst Date Time
^ RPD of sample and duplicate evaluated using +/-RL. Concentrations are <5X the RL. Qualifier Not Applicable for Radiochemistry.
d 5-day BOD--The 2:1 depletion requirement was not met for this sample
e 5-day BOD--Test replicates show more than 30% difference between high and low values. The data is qualified per the method and can be used for
reporting purposes
h Preparation or preservation holding time was exceeded
N/A indicates that spike recovery limits do not apply when sample concentration exceeds spike cone. by a factor of 4 or more or %RPD not applicable.
^ The Relative Percent Difference (RPD) obtained from the sample duplicate (DUP) is evaluated against the acceptance criteria when the sample is greater than
five times (5X) the contract required detection limit (RL). In cases where the duplicate value is less than 5X the RL, a control limit of +/- the RL is used to
evaluate the DUP result.
* Indicates that a Quality Control parameter was not within specifications.
For PS, PSD, and SDILT results, the values listed are the measured amounts, not final concentrations.
Where the analytical method has been performed under NELAP certification, the analysis has met all of the
requirements of the NELAC standard unless qualified on the QC Summary.
Page 11 of 15 SDG: 587186

General Chemistry
Technical Case Narrative
Environment One, Inc.
SDG #: 587186
Product: Ion Chromatography
Analytical Method: EPA 300.0
Analytical Procedure: GL-GC-E-086 REV# 30
Analytical Batch: 2294092
The following samples were analyzed using the above methods and analytical procedure(s).
GEL Sample ID#
Client Sample Identification
587186001
Effluent
587186002
Well 45
587186003
Well #7
587186004
Well #8
587186005
Well #9
587186006
Well #10
587186007
Well #1 l
1205147519
Method Blank (MB)
1205147520
Laboratory Control Sample (LCS)
1205147521
586558002(NonSDG) Sample Duplicate (DUP)
1205147523
586558002(NonSDG) Post Spike (PS)
The samples in this SDG were analyzed on an "as received" basis.
Data Summary:
All sample data provided in this report met the acceptance criteria specified in the analytical methods and
procedures for initial calibration, continuing calibration, instrument controls and process controls where
applicable, with the following exceptions.
Technical Information
Sample Dilutions
The following samples 1205147521 (Non SDG 586558002DUP), 1205147523 (Non SDG 586558002PS),
587186001 (Effluent), 581186002 (Well #5), 587186003 (Well #7), 587186004 (Well #8) and 587186007 (Well
#11) were diluted because target analyte concentrations exceeded the calibration range. Samples 587186001
(Effluent), 587186002 (Well #5), 587186003 (Well #7), 587186004 (Well #8) and 587186007 (Well #11) were
diluted based on historical data. Dilutions may be required for many reasons, including to minimize matrix
interferences or to bring over range target analyte concentrations into the linear calibration range.
587186
Analyte
001
002
003
004
007
Bromide
20X
I 2X
I 10X
I 10X
I 5X
Certification Statement
Where the analytical method has been performed under NELAP certification, the analysis has met all of the
requirements of the NELAC standard unless otherwise noted in the analytical case narrative.
Page 12 of 15 SDG: 587186

KDI , lUNi. I 1=1 C1; kmont [)r.
m,>;.n},_ui I inr.cum
DISINF'17TION
CHLORINE NEUTRALIZED AT COLLECTION
(-j-' )7i6-tlb3:;
(AIL.ORINt
1 9+: 132 Week: 33
pH CHECK (LAB)
J41tA, LLC (WASTEWATER)
NONE
p
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CONTAINER TYPE, PiG
R�:PRIAN CONNER
Ood3OX 129
CHEMICAL PRESERVATION
ER12Y HILL NC 27957
A
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DATE
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WASTEWATER (NPDE5)
DRINKINGIVATER
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Well #J
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DURING SHIPM[NT%DELIVERI'
Well #11
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SAMPLES COLLECTED BY:
(Please Print)
SAMPLES RECEIVED IN LAB AT ';C
iELlh1QUISHED 1:3' SIG.) (SAtvIPLER)
DATErrIME
REC IVED BY (SIC � - -
ATE1TIME
7�21
COMMENTS: �.
Pam# �L i32a`7 2zz2
iELlh QUIShi� BY (. IG.1
DATETIME
_ze-zz 1-1'.ca
;ELINOUISHED BY (SIG.)
DATE;TIME
CEI\ D BY iSIG.)
TE71ME
PLEASE READ Instructions for completing this form on the reverse side. Sampler must place a "C for composite sample or a "G" for -Q 411139
r. A I Grab sample in the blocks above for each parameter requested. N

SA11-TPi.F. RF.f F.iP'f J2r RFVTx'W T?f1R�i .1 1�`1
Client
SDG/AR/COC/Wut$ Order: 67
Received By: MVH
Date Received:
Ctrc)c Applicabc:
PedEx Express FedEx Ground UPS Field Services Courier Other
Carrier and Tracking Number
V1 1 0S C),-� /1 �-Att)--� —� S
Suspected Hazard hd'drmatinn
Z
*If Net Counts > 100cpm on samples not marked "radioactive", contact the Radiation Safety Group for further investigation.
Hnzatd Class Shipped: UNq:
A)SItipped as a DO'r Hazaialuu5?
it UN2910, IN the Radioactive Shipment Survey Compliant? Yes_ No_
B) Did the client' desigtmte the s:unples are to be
COC notation or radioactive stickers on containers, equal client designation.
received as radioactive
C) Did the RSO classify (lie samples as
Maxim in Net Counts Observed" (Observed Counts- Area Background Counts): CPNI I mR/Hr
radioactive?
Classified its: Rad I Rad 2 Rad 3
COC notation or hazard labels on containers equal client designation.
D) Did the client desi nie samples are hazardous?
If D or E is yes, select Hazards below.
E) Did the RSO identify possible hazin-W
PCBs Flammable Foreign Soil RCRA Asbestos Beryllium Other.
Sample Receipt Criteria
^ Z
Z
Couuuents/Qualifiers (Required for Non -Conforming Items)
Shipping containers received intact and
Circle Applicable: Setdx broken Damateed container I-eaking container Other (describe)
I
sealed?
2
Chain of custody documents included
Circle Appgenble: Client conincied rand provided CDC COC created upon receipt
with shipment'?
Preservation Method: Wet Ice Ice Puke Dry ice None ther.
3
Samples requiring cold preservation
':dl temperatures are recorded in Celsius TB11'IPt
within (0 < 6 den. C)?b
4
Daily check performed and passed on IR
Temperature Device Serial M: IR2-21
temperature gun?
Secondary Temperature Device Serial 9 (If Applicable):
eals Circle Applicable: Sbroken Damaged containLe er aking container other (describe)
5
Sample containers intact and sealed?
Samples requiring chemical preservation
Sample ID's and Cnotaincrx Affected:
6
at proper pH?
If Prcsemiflon added, I oM,,
Il' Yes, arc Encores or Soil Kits present for solids? Yes_ N(L_ NA_(.If ),es, take to VOA Freezer)
Do any samples requiro Volatile
Fri liquid VOA vials contain acid preservation? Yes_ No_. NA_ftf unknown. select No)
7
Analysis'?
Are liquid VOA vials freeof beadspuce?Yes_ No_ NA_
Sumple ID's and containers affected:
TD's and tests affected:
8
Samples received within holding time?
9
Sample ID's on CDC mulch ID's on
IDS and containers affected:
battles?
Date & time on COC rants date & time
Circle Applicable: No dates on containers o limes on con COC missing info Other (describe)
10
on bottles? t
Number of containers received match Circle Applicable: No container count on CDC Other (deu-ribc)
I I
number indicated on COC?
12 Are sample containers identifiable as
GL-L provided by use of GEL labels?
1.3 COC form is properly signed in trcle Applicable: Not relinquished Other (describe)
relinquished/received sections?
Comments (Use Continuation Foam if needed):
I'M(or PMA)rcvicw" litiritlsda t,Ny Dale "t' L/T P:g, I of�
GL-CHL-SR-001 Rev 7
Page 14 of 15 SDG: 587186

It -
List of current GEL Certifications as of 08 August 2022
State
Certification
Alabama
42200
Alaska
17-018
Alaska Drinking Water
SC00012
Arkansas
88-0651
CLIA
42D0904046
California
2940
Colorado
SC00012
Connecticut
PH-0169
DoD ELAP/ ISO]7025 A2LA
2567.01
Florida NELAP
E87156
Foreign Soils Permit
P330-15-00283, P330-15-00253
Georgia
SC00012
Georgia SDWA
967
Hawaii
SC00012
Idaho
SC00012
Illinois NELAP
200029
Indiana
C—SC-01
Kansas NELAP
E-10332
Kentucky SDWA
90129
Kentucky Wastewater
90129
Louisiana Drinking Water
LA024
Louisiana NELAP
03046 (A133904)
Maine
2019020
Maryland
270
Massachusetts
M—SC012
Massachusetts PFAS Approv
Letter
Michigan
9976
Mississippi
SC00012
Nebraska
NE—OS-26-13
Nevada
SC000122022-5
New Hampshire NELAP
2054
New Jersey NELAP
SC002
New Mexico
SC00012
New York NELAP
11501
North Carolina
233
North Carolina SDWA
45709
North Dakota
R-158
Oklahoma
2019-165
Pennsylvania NELAP
68-00485
Puerto Rico
SC00012
S. Carolina Radiochem
10120002
Sanitation Districts of L
9255651
South Carolina Chemistry
10120001
Tennessee
TN 02934
Texas NELAP
T104704235-22-20
Utah NELAP
SC000122021-36
Vermont
VT87156
Virginia NELAP
460202
Washington
C780
Page 15 of 15 SDG: 587186