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HomeMy WebLinkAboutWQ0004972_Monitoring - 08-2023_20230927Monitoring Report Submittal ................................................... Permit Number#* WQ0004972 Name of Facility:* Month: * August Forest Lake Preserve WWTP Report Information Type * NDMR, NDAR-1, NDAR-2, NDMLR Confirmation Email Address: * Name of Submitter: * Signature: Date of submittal: Initial Review Year:* 2023 Upload Document* 2023_August_Monthly_Report_WQ0004972 2.2MB complete.pdf PDF Only Please upload one PDF containing all applicable monitoring reports (i.e., NDMR, NDAR-1, NDAR-2, NDMLR, GW-59). agrenier@greenerehssolutions.com Amanda Grenier OAOW- �KIt<ll (I' W;r 'f Reviewer: Wanda.Gerald 9/27/2023 This will be filled in automatically Is the project number correct?* WQ0004972 Is the monitoring report accepted?* Yes No Regional Office* Winston-Salem Reviewer: _anonymous Review Date: 9/27/2023 DocuSign Envelope ID: 483D85C1-E476-41F9-87D6-91691AD1FF38 I-- NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page of Permit No.: Q1114972 Facility Name: Forest Lake D. August 1 irrigation • occur this facility'? Coverat .. . .. . .. . .. ■ NO Hourly Rate (in): Hourly Rate .:Annual Rate (in): Annual Rate (in): Field Irrigated? Field Irrigated? in Monthly ... • :•®"���j�����j����j���j�% 1 11j����j����j��� 1 11��j��j�/����j��% 1 11���j����j 12 Month Floating Total (irm DocuSign Envelope ID:483D85C1-E476-41F9-87D6-91691AD1FF38 Did the application rates exceed the limits in Attachment B of your permit? O Compliant ❑ Non -Compliant Were adequate measures taken to prevent effluent ponding in or runoff from the sites? O Compliant ❑ Non -Compliant Was a suitable vegetative cover maintained on all sites as specified in your permit? O Compliant ❑ Non -Compliant Were all setbacks listed in your permit maintained for every application to each permitted site? O Compliant ❑ Non -Compliant Were all freeboards maintained in accordance with the specified freeboard heights in your permit? ❑ Compliant O Non -Compliant If the facility is non -compliant, please explain in the space below the reason(s) the facility was not in compliance. Provide in your explanation the date(s) of the non-compliance and describe the corrective action(s) taken. Attach additional sheets if necessary. Freeboard was 1.8 ft on 8/14/2023 due to high flows and rainfall. The permit owner was notified and irrigation was done to bring the freeboard back to above 2 ft. Operator in Responsible Charge (ORC) Certification Permittee Certification ORC: Amanda Grenier Permittee: MHC TT, LP Certification No.: 1000089 Signing Official: George Gudgeon Grade: SI Phone Number: 919-356-6509 Signing Officials Title: Sr. Vice President Has the ORC changed since the previous NDAR-1? ❑ yes 0 No Phone Number: 312-279-1400 Permit Exp.: 10/31/27 DocuSigned by: 9/25/23 �Ir C_44Vvu 9/26/2023 Signature Date Signature Date By this signature, I certify that this report is accurrate and complete to the best of my knowledge. I 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 all qualified personnel properly gathered and evaluated 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. Mail Original and Two Copies to: Division of Water Resources Information Processing Unit 1617 Mail Service Center Raleigh, North Carolina 27699-1617 DocuSign Envelope ID:483D85C1-E476-41F9-87D6-91691AD1FF38 Permit No.: WQ0004972 Facility Name: Forest Lake Preserve ELS County: Davie Month: August Year: 2023 PPI: 001 Flow Measuring Point: El Influent 0 Effluent ❑ No flow generated parameter Monitoring Point: ❑ Influent ❑Effluent ❑Groundwater Lowering El Surface Water Parameter Code 0 50050 00400 50060 70300 00530 00310 31616 00600 00610 00625 00630 00620 00615 00665 00940 U£ O H C 0 N H N o 3E O LL x Q CD S°+ -tea O N t ~ tY U 'O ' H N .O C N �a i H G .O N p m m o LL U �o ai .`, Z lE .o l= Q L A d iii Y O Z 0 ad+ la 'w .`, Z Z iy ._. Z CD !" = Z Vl 7 � s 0 (n ~ s a O U 24-hr hrs GPD su mg/L mg/L mg/L mg/L #/100 mL mg/L mg/L mg/L mg/L mg/L mg/L mg/L mg/L 1 08:00 5 59,258 6.4 1.2 2 08:00 5 18,628 6.4 1.3 3 08:00 5 51,809 6.47 1.2 4 08:00 5 87,689 6.46 1.4 5 50,230 6 41,871 7 08:00 5 58,185 6.27 0.2 8 08:00 5 47,923 6.34 8 9 08:00 5 41,106 6.41 6.4 10 08:00 5 41,486 6.61 6.1 11 08:00 5 28,002 6.56 6.7 12 43,536 13 44,859 14 08:00 5 39,316 6.52 0.2 15 08:00 5 63,089 7 7.7 277 4.8 <2 16.8 11.9 16.5 0.25 0.25 <0.04 8.7 16 08:00 5 0 NO FLOW NO FLOW 17 08:00 5 0 NO FLOW NO FLOW 18 08:00 5 17,553 7.22 8 19 25,000 20 24,000 21 10:30 2 25,600 6 1.97 22 08:00 5 19,805 6.05 4.1 23 08:00 5 40,516 6.01 4.3 12 24 08:00 5 33,636 6.43 4.1 25 10:30 2 79,900 6.06 1.8 26 44,033 27 74,570 28 08:00 5 51,974 5.91 0.2 29 08:00 5 73,672 6.24 4.7 30 08:00 5 75,364 5.52 4.1 311 08:00 1 5 46,946 6.41 3.8 Average: 43,534 3.37 277.00 4.80 0.00 12.00 16.80 11.90 16.50 0.25 0.25 0.00 8.70 Daily Maximum: 87,689 7.22 8.00 277.00 4.80 2.00 12.00 16.80 11.90 16.50 0.25 0.25 0.04 8.70 Daily Minimum: 0 5.52 0.20 277.00 4.80 2.00 12.00 16.80 11.90 16.50 0.25 0.25 0.04 8.70 Sampling Type: Monthly Avg. Limit: Daily Limit: LSample Frequency: Continuous 5x/Week 5X/Week Monthly Monthly Monthly Monthly Monthly Monthly Monthly Monthly Monthly Monthly Monthly 3X/year DocuSign Envelope ID:483D85C1-E476-41F9-87D6-91691AD1FF38 Sampling Person(s) Certified Laboratories Name: Amanda Grenier Name: Sam Perry Name: Greener EHS Solutions, LLC Name: Pace Analytical Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? ❑ Compliant O Non -Compliant If the facility is non -compliant, please explain in the space below the reason(s) the facility was not in compliance. Provide in your explanation the date(s) of the non-compliance and describe the corrective action(s) taken. Attach additional sheets if necessary. Monthly average flow exceeded the permitted flow of 24,400 gpd. The permitted application rate was not exceeded. The flow meter was calibrated on June 27, 2023 and the meter was reading significantly before the calibration. This was noted on the June 2023 NDMR. The plant is in the process of an upgrade to increase the capacity as well as investigating extraneous flow for 1/1 and leaking fixtures. There no flow on 8/16 and 8/17 as the plant was pumped down to make necessary repairs. Lab Qualifiers, August 15, 2023 - Phosphorus and TKN, M1 - Matrix spike recovery exceeded QC limits. Batch opted based on laboratory control sample (LCS) recovery. Operator in Responsible Charge (ORC) Certification Permittee Certification ORC: Amanda Grenier Permittee: MHC TT, LP Certification No.: 1000089 Signing Official: George Gudgeon Grade: SI Phone Number: 919-356-6509 Signing Officials Title: Sr. Vice President Has the ORC changed since the previous NDMR? ❑ Yes El No Phone Number: 312-279-1400 Permit Expiration: 10/31/2027 DocuSigned by: �� C'`JAP 9/26/2023 9/25/2023 Signature Date Signature Date By this signature, I certify that this report is accurrate and complete to the best of my knowledge. I 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 all qualified personnel properly gathered and evaluated 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. Mail Original and Two Copies to: Division of Water Resources Information Processing Unit 1617 Mail Service Center Raleigh, North Carolina 27699-1617 DocuSign Envelope ID: 483D85C1-E476-41F9-87D6-91691AD1FF38 aceo Pace Analytical Services, LLC 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 August 28, 2023 Amanda D. Grenier Greener EHS Solutions 21 Selby Ct. Holly Springs, NC 27540 RE: Project: FOREST LAKE MOTNLY Pace Project No.: 92682824 Dear Amanda Grenier: Enclosed are the analytical results for sample(s) received by the laboratory on August 15, 2023. 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 If you have any questions concerning this report, please feel free to contact me. Sincerely, Matthew Brainard matthew.brainard@pacelabs.com (704)875-9092 Project Manager Enclosures REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, without the written consent of Pace Analytical Services, LLC. Page 1 of 16 DocuSign Envelope ID: 483D85C1-E476-41F9-87D6-91691AD1FF38 aceo Pace Analytical Services, LLC 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 CERTIFICATIONS Project: FOREST LAKE MOTNLY Pace Project No.: 92682824 Pace Analytical Services Asheville 2225 Riverside Drive, Asheville, NC 28804 South Carolina Laboratory ID: 99030 Florida/NELAP Certification #: E87648 South Carolina Certification #: 99030001 North Carolina Drinking Water Certification #: 37712 Virginia/VELAP Certification #: 460222 North Carolina Wastewater Certification #: 40 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 16 DocuSign Envelope ID: 483D85C1-E476-41F9-87D6-91691AD1FF38 Pace Analytical Services, LLC �aceo 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 SAMPLE ANALYTE COUNT Project: Pace Project No.: FOREST LAKE MOTNLY 92682824 Analytes Lab ID Sample ID Method Analysts Reported Laboratory 92682824001 EFFLUENT GRAB SM 2540C-2015 RVS 1 PASI-A SM 2540D-2015 MAB2 1 PASI-A SM 521OB-2016 MDM 1 PASI-A TKN+NO3+NO2 Calculation MDW 1 PASI-A EPA 350.1 Rev 2.0 1993 NCF 1 PASI-A EPA 351.2 Rev 2.0 1993 MFO 1 PASI-A EPA 353.2 Rev 2.0 1993 MFO 1 PASI-A EPA 365.1 Rev 2.0 1993 Zip 1 PASI-A PASI-A = Pace Analytical Services - Asheville REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, without the written consent of Pace Analytical Services, LLC. Page 3 of 16 DocuSign Envelope ID: 483D85C1-E476-41F9-87D6-91691AD1FF38 Pace Analytical Services, LLC �aceo 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 ANALYTICAL RESULTS Project: FOREST LAKE MOTNLY Pace Project No.: 92682824 Sample: EFFLUENT GRAB Lab ID: 92682824001 Collected: 08/15/23 08:30 Received: 08/15/23 13:21 Matrix: Water Parameters Results Units Report Limit DF Prepared Analyzed CAS No. Qual 2540C Total Dissolved Solids Analytical Method: SM 2540C-2015 Pace Analytical Services -Asheville Total Dissolved Solids 277 mg/L 25.0 1 08/17/23 17:37 2540D Total Suspended Solids Analytical Method: SM 2540D-2015 Pace Analytical Services -Asheville Total Suspended Solids 4.8 mg/L 2.9 1 08/17/23 14:36 5210B BOD, 5 day Analytical Method: SM 521 OB-2016 Pace Analytical Services -Asheville BOD, 5 day ND mg/L 2.0 1 08/17/23 04:46 08/22/23 04:16 Total Nitrogen Calculation Analytical Method: TKN+NO3+NO2 Calculation Pace Analytical Services -Asheville Total Nitrogen 16.8 mg/L 0.040 1 08/28/23 11:30 350.1 Ammonia Analytical Method: EPA 350.1 Rev 2.0 1993 Pace Analytical Services -Asheville Nitrogen, Ammonia 11.9 mg/L 0.20 2 08/26/23 01:03 7664-41-7 351.2 Total Kjeldahl Nitrogen Analytical Method: EPA 351.2 Rev 2.0 1993 Preparation Method: EPA 351.2 Rev 2.0 1993 Pace Analytical Services -Asheville Nitrogen, Kjeldahl, Total 16.5 mg/L 0.50 1 08/25/23 14:40 08/26/23 06:02 7727-37-9 353.2 Nitrogen, NO2/NO3 unpres Analytical Method: EPA 353.2 Rev 2.0 1993 Pace Analytical Services -Asheville Nitrogen, Nitrate 0.25 mg/L 0.040 1 08/15/23 23:08 14797-55-8 365.1 Phosphorus, Total Analytical Method: EPA 365.1 Rev 2.0 1993 Preparation Method: EPA 365.1 Rev 2.0 1993 Pace Analytical Services -Asheville Phosphorus 8.7 mg/L 0.15 3 08/25/2310:21 08/25/2313:35 7723-14-0 REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, Date: 08/28/2023 11:33 AM without the written consent of Pace Analytical Services, LLC. Page 4 of 16 DocuSign Envelope ID: 483D85C1-E476-41F9-87D6-91691AD1FF38 Pace Analytical Services, LLC �aceo 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 QUALITY CONTROL DATA Project: FOREST LAKE MOTNLY Pace Project No.: 92682824 QC Batch: 794391 Analysis Method: SM 2540C-2015 QC Batch Method: SM 2540C-2015 Analysis Description: 2540C Total Dissolved Solids Laboratory: Pace Analytical Services -Asheville Associated Lab Samples: 92682824001 METHOD BLANK: 4116370 Associated Lab Samples: 92682824001 Parameter Units Total Dissolved Solids mg/L LABORATORY CONTROL SAMPLE: 4116371 Parameter Units Total Dissolved Solids mg/L SAMPLE DUPLICATE: 4116372 Parameter Units Total Dissolved Solids mg/L Matrix: Water Blank Reporting Result Limit Analyzed Qualifiers ND 25.0 08/17/2317:30 Spike LCS LCS % Rec Conc. Result % Rec Limits Qualifiers 250 260 104 90-110 92682476014 Dup Result Result RPD Qualifiers 773 768 1 SAMPLE DUPLICATE: 4116373 92682917001 Dup Parameter Units Result Result Total Dissolved Solids mg/L 83.0 86.0 RPD Qualifiers 4 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: 08/28/2023 11:33 AM without the written consent of Pace Analytical Services, LLC. Page 5 of 16 DocuSign Envelope ID: 483D85C1-E476-41F9-87D6-91691AD1FF38 Pace Analytical Services, LLC �aceo 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 QUALITY CONTROL DATA Project: FOREST LAKE MOTNLY Pace Project No.: 92682824 QC Batch: 794268 Analysis Method: SM 2540D-2015 QC Batch Method: SM 2540D-2015 Analysis Description: 2540D Total Suspended Solids Laboratory: Pace Analytical Services -Asheville Associated Lab Samples: 92682824001 METHOD BLANK: 4115667 Associated Lab Samples: 92682824001 Parameter Units Total Suspended Solids mg/L LABORATORY CONTROL SAMPLE: 4115668 Parameter Units Total Suspended Solids mg/L SAMPLE DUPLICATE: 4115797 Parameter Units Total Suspended Solids mg/L Matrix: Water Blank Reporting Result Limit Analyzed Qualifiers ND 2.5 08/17/2314:31 Spike LCS LCS % Rec Conc. Result % Rec Limits Qualifiers 250 244 98 90-110 92683013001 Dup Result Result RPD Qualifiers 11500 12300 6 SAMPLE DUPLICATE: 4115798 92682923002 Dup Parameter Units Result Result Total Suspended Solids mg/L 120 124 RPD Qualifiers 3 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: 08/28/2023 11:33 AM without the written consent of Pace Analytical Services, LLC. Page 6 of 16 DocuSign Envelope ID: 483D85C1-E476-41F9-87D6-91691AD1FF38 Pace Analytical Services, LLC �aceo 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 QUALITY CONTROL DATA Project: FOREST LAKE MOTNLY Pace Project No.: 92682824 QC Batch: 794098 Analysis Method: SM 521 OB-2016 QC Batch Method: SM 521OB-2016 Analysis Description: 5210E BOD, 5 day Laboratory: Pace Analytical Services -Asheville Associated Lab Samples: 92682824001 METHOD BLANK: 4114884 Associated Lab Samples: 92682824001 Parameter Units BOD, 5 day mg/L LABORATORY CONTROL SAMPLE: 4114886 Parameter Units BOD, 5 day mg/L Matrix: Water Blank Reporting Result Limit Analyzed Qualifiers ND 2.0 08/22/23 04:00 Spike LCS LCS % Rec Conc. Result % Rec Limits Qualifiers 198 224 113 84.6-115 SAMPLE DUPLICATE: 4114887 92682792001 Dup Parameter Units Result Result BOD, 5 day mg/L ND ND RPD Qualifiers 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: 08/28/2023 11:33 AM without the written consent of Pace Analytical Services, LLC. Page 7 of 16 DocuSign Envelope ID: 483D85C1-E476-41F9-87D6-91691AD1FF38 Pace Analytical Services, LLC �aceo 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 QUALITY CONTROL DATA Project: FOREST LAKE MOTNLY Pace Project No.: 92682824 QC Batch: 795862 Analysis Method: EPA 350.1 Rev 2.0 1993 QC Batch Method: EPA 350.1 Rev 2.0 1993 Analysis Description: 350.1 Ammonia Laboratory: Pace Analytical Services -Asheville Associated Lab Samples: 92682824001 METHOD BLANK: 4124110 Associated Lab Samples: 92682824001 Parameter Units Nitrogen, Ammonia mg/L LABORATORY CONTROL SAMPLE: 4124111 Parameter Units Nitrogen, Ammonia mg/L Matrix: Water Blank Reporting Result Limit Analyzed Qualifiers ND 0.10 08/26/23 00:05 Spike LCS LCS % Rec Conc. Result % Rec Limits Qualifiers 5 4.8 96 90-110 MATRIX SPIKE & MATRIX SPIKE DUPLICATE: 4124112 4124113 MS MSD 92683924001 Spike Spike MS MSD MS MSD % Rec Parameter Units Result Conc. Conc. Result Result % Rec % Rec Limits RPD Qual Nitrogen, Ammonia mg/L 0.30 5 5 5.3 5.3 101 101 90-110 0 MATRIX SPIKE & MATRIX SPIKE DUPLICATE: 4124114 4124115 MS MSD 92682567001 Spike Spike MS MSD MS MSD % Rec Parameter Units Result Conc. Conc. Result Result % Rec % Rec Limits RPD Qual Nitrogen, Ammonia mg/L 359 5 5 356 330 -65 -570 90-110 7 M1 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: 08/28/2023 11:33 AM without the written consent of Pace Analytical Services, LLC. Page 8 of 16 DocuSign Envelope ID: 483D85C1-E476-41F9-87D6-91691AD1FF38 Pace Analytical Services, LLC �aceo 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 QUALITY CONTROL DATA Project: FOREST LAKE MOTNLY Pace Project No.: 92682824 QC Batch: 795703 Analysis Method: EPA 351.2 Rev 2.0 1993 QC Batch Method: EPA 351.2 Rev 2.0 1993 Analysis Description: 351.2 TKN Laboratory: Pace Analytical Services -Asheville Associated Lab Samples: 92682824001 METHOD BLANK: 4122933 Associated Lab Samples: 92682824001 Parameter Units Nitrogen, Kjeldahl, Total mg/L LABORATORY CONTROL SAMPLE: 4122934 Parameter Units Nitrogen, Kjeldahl, Total mg/L Matrix: Water Blank Reporting Result Limit Analyzed Qualifiers ND 0.50 08/26/23 05:42 Spike LCS LCS % Rec Conc. Result % Rec Limits Qualifiers 10 10.1 101 90-110 MATRIX SPIKE & MATRIX SPIKE DUPLICATE: 4124954 4124955 MS MSD 92683096001 Spike Spike MS MSD MS MSD % Rec Parameter Units Result Conc. Conc. Result Result % Rec % Rec Limits RPD Qual Nitrogen, Kjeldahl, Total mg/L 14.1 10 10 20.7 21.9 66 78 90-110 6 M1 MATRIX SPIKE & MATRIX SPIKE DUPLICATE: 4124956 4124957 MS MSD 92683096002 Spike Spike MS MSD MS MSD % Rec Parameter Units Result Conc. Conc. Result Result % Rec % Rec Limits RPD Qual Nitrogen, Kjeldahl, Total mg/L 15.2 10 10 24.9 24.1 97 89 90-110 3 M1 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: 08/28/2023 11:33 AM without the written consent of Pace Analytical Services, LLC. Page 9 of 16 DocuSign Envelope ID: 483D85C1-E476-41F9-87D6-91691AD1FF38 Pace Analytical Services, LLC �aceo 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 QUALITY CONTROL DATA Project: FOREST LAKE MOTNLY Pace Project No.: 92682824 QC Batch: 793791 Analysis Method: EPA 353.2 Rev 2.0 1993 QC Batch Method: EPA 353.2 Rev 2.0 1993 Analysis Description: 353.2 Nitrate + Nitrite, Unpres. Laboratory: Pace Analytical Services -Asheville Associated Lab Samples: 92682824001 METHOD BLANK: 4113374 Associated Lab Samples: 92682824001 Parameter Units Nitrogen, Nitrate mg/L LABORATORY CONTROL SAMPLE: 4113375 Parameter Units Nitrogen, Nitrate mg/L Matrix: Water Blank Reporting Result Limit Analyzed Qualifiers ND 0.040 08/15/23 23:00 Spike LCS LCS % Rec Conc. Result % Rec Limits Qualifiers 1.5 1.5 101 90-110 MATRIX SPIKE & MATRIX SPIKE DUPLICATE: 4113376 4113377 MS MSD 92682698004 Spike Spike MS MSD MS MSD % Rec Parameter Units Result Conc. Conc. Result Result % Rec % Rec Limits RPD Qual Nitrogen, Nitrate mg/L 44.4 1.5 1.5 46.4 46.4 139 139 90-110 0 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: 08/28/2023 11:33 AM without the written consent of Pace Analytical Services, LLC. Page 10 of 16 DocuSign Envelope ID: 483D85C1-E476-41F9-87D6-91691AD1FF38 Pace Analytical Services, LLC �aceo 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 QUALITY CONTROL DATA Project: FOREST LAKE MOTNLY Pace Project No.: 92682824 QC Batch: 795746 Analysis Method: EPA 365.1 Rev 2.0 1993 QC Batch Method: EPA 365.1 Rev 2.0 1993 Analysis Description: 365.1 Phosphorus, Total Laboratory: Pace Analytical Services -Asheville Associated Lab Samples: 92682824001 METHOD BLANK: 4123268 Associated Lab Samples: 92682824001 Parameter Units Phosphorus mg/L LABORATORY CONTROL SAMPLE: 4123269 Parameter Units Phosphorus mg/L Matrix: Water Blank Reporting Result Limit Analyzed Qualifiers ND 0.050 08/25/23 13:26 Spike LCS LCS % Rec Conc. Result % Rec Limits Qualifiers 2.5 2.6 102 90-110 MATRIX SPIKE & MATRIX SPIKE DUPLICATE: 4123270 4123271 MS MSD 92681394009 Spike Spike MS MSD MS MSD % Rec Parameter Units Result Conc. Conc. Result Result % Rec % Rec Limits RPD Qual Phosphorus mg/L 0.68 2.5 2.5 3.5 3.4 111 107 90-110 3 M1 MATRIX SPIKE & MATRIX SPIKE DUPLICATE: 4123272 4123273 MS MSD 92682683001 Spike Spike MS MSD MS MSD % Rec Parameter Units Result Conc. Conc. Result Result % Rec % Rec Limits RPD Qual Phosphorus mg/L 1.3 2.5 2.5 4.0 4.2 109 116 90-110 4 M1 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: 08/28/2023 11:33 AM without the written consent of Pace Analytical Services, LLC. Page 11 of 16 DocuSign Envelope ID: 483D85C1-E476-41F9-87D6-91691AD1FF38 aceo Pace Analytical Services, LLC 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 QUALIFIERS Project: FOREST LAKE MOTNLY Pace Project No.: 92682824 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. 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 Chloroethylvinyl 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. Reported results are not rounded until the final step prior to reporting. Therefore, calculated parameters that are typically reported as "Total" may vary slightly from the sum of the reported component parameters. Pace Analytical is TNI accredited. Contact your Pace PM for the current list of accredited analytes. TN -The NELAC Institute. ANALYTE QUALIFIERS 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: 08/28/2023 11:33 AM without the written consent of Pace Analytical Services, LLC. Page 12 of 16 DocuSign Envelope ID: 483D85C1-E476-41F9-87D6-91691AD1FF38 aceo Pace Analytical Services, LLC 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 QUALITY CONTROL DATA CROSS REFERENCE TABLE Project: FOREST LAKE MOTNLY Pace Project No.: 92682824 Lab ID Sample ID QC Batch Method QC Batch Analytical Method Analytical Batch 92682824001 EFFLUENT GRAB SM 2540C-2015 794391 92682824001 EFFLUENT GRAB SM 254OD-2015 794268 92682824001 EFFLUENT GRAB SM 521 OB-2016 794098 SM 521 OB-2016 794111 92682824001 EFFLUENT GRAB TKN+NO3+NO2 796342 Calculation 92682824001 EFFLUENT GRAB EPA 350.1 Rev 2.0 1993 795862 92682824001 EFFLUENT GRAB EPA 351.2 Rev 2.0 1993 795703 EPA 351.2 Rev 2.0 1993 796135 92682824001 EFFLUENT GRAB EPA 353.2 Rev 2.0 1993 793791 92682824001 EFFLUENT GRAB EPA 365.1 Rev 2.0 1993 795746 EPA 365.1 Rev 2.0 1993 795983 Date: 08/28/2023 11:33 AM REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, without the written consent of Pace Analytical Services, LLC. Page 13 of 16 I )e? I DC# Title: ENV-FRM-HUN1-0083 v02 Sample Condition Upon Receipt DocuSign Envelope ID:483D85C1-E476-41F9-87D6-91691AD1FF38 i uvv Effective Date: 11/14/2022 Laboratory receiving samples: Asheville ❑ Eden❑ Greenwood ❑ Huntersville ❑, Raleigh❑ Mechanicsville❑ Atlanta❑ Kernersville❑ SampleodoClient Name: WO# •• 92682824 Upon Receipt r1 Project t Courier: ❑Fed Ex []UPS❑USPS ❑Client II I III I I II II II I IIII III ❑ Commercial Pace ❑Other: 92682824 Custody Seal Present? Dyes QNo Seals Intact? []Yes ❑No Packing Material: ❑Bubble Wrap []Bubble Bags dNne ❑ Other Thermometer: ❑ IR G Date/Initials Person Examining Contents: Biological Tissue Frozen? ❑Yes ❑No [319j.1 un Type of Ice: C]Wet ❑Blue ❑None Correction Factor: Cooler Temp: '— ' Add/Subtract (°C) L Temp should be above freezing to 6°C i Cooler Temp Corrected (e O has be unut of temp criteria. Samples on ice, cooling process L�Ji S USDA Regulated Soil ( N/A, water sample) Did samples originate in a quarantine zone within the United States: CA. NY. or S[ frnm a fnrnian <pur�n cntrrnarnnau� ;check maps)? LJYes (_JNo including Hawaii and Puerto Rico)? ❑Yes ❑No Comments/Discrepancy: Chain of Custody Present? ✓ Yes ❑No ❑N/A 1. Samples Arrived within Hold Time? EEKes _ ❑Na ❑N/A 2. Short Hold Time Analysis (<72 hr.)? Yes 3- Rush Turn Around Time Requested? ❑Yes No []N/A 4. Sufficient Volume? Ddes []No ❑N/A S. Correct Containers Used? -Pace Containers Used? �ff s ❑Y� ❑No ❑NIA ❑No ❑N/A 6. Containers Intact? Yes ❑No ❑N/ 7. Dissolved analysis: Samples Field Filtered? ❑Yes_ []No ' N/A 8. Sample Labels Match COC? -includes Date/Time/ID/Analysis Matrix: QYes ❑No ❑N/A 9. Headspace in VOA Vials (>5-6mm)? ❑Yes []NO N/A 10. Trip Blank Present? Trip Blank Custody Seals Present? ❑Yes ❑yes I]No /'❑N/A Dwo ❑N/A 11. COMMENTS/SAMPLE DISCREPANCY CLIENT NOT Person contacted: Project Manager SCURF Review: Project Manager SRF Review: Lot ID of split containers: Date/Time: Date: Date: Field Data Required? Dyes ❑No Qualtrax ID: 69614 Page 1 of 2 Page 14 of 16 I / I DC#_Title: ENV-FRM-HUN1-0083 v02-Sample Condition Upon Receipt DocuSign Envelope ID:483D85C1-E476-4lF9-87D6-91691AD1FF38 Effective Date: 11/14/2022 *Check mark top half of box if pH and/or dechlorination is verified and within the acceptance range for preservation samples. Exceptions: VOA, Coliform, TOC, Oil and Grease, DRO/8015 (water) DOC. LLHg "Bottom half of box is to list number of bottles **'Check all unpreserved Nitrates for chlorine Project i# 0� PM: MWB Due Date: 08/29/23 CLIENT: 92-Greener z 'O61 a�i z d v z d a2i \ z 'p Z ry V n v g z dS ;zc A a 7 = z 0! m N v - N " V a n, V a V z l ¢ z v < Z it z " �o A 1 z 1 z vi M y v O 'D v > u .+ v > u N W 7 u :. .dn c O u 4 ON u .:. m = u 'N u z u '. 2 u .-. io u L GJ c M d O. v _ d n I x `y O z = z N ¢ - u = z M O z Y c z TO m 2 a! o. M v a Y U a n N v m a G r� = z ... d Q O .n �' A o W. c Ol a ,n N r1 • a J o to ellV7 1 a J 0 O , o (L 61 - r-� ' a J ,E ri ,y a J o vl N , a J N ry ,.y a ,n r� ,.., ° E d E Q v y .ti E Q v ... r-1 ¢ o Ln N E ¢ a - e-1 ¢ J o u1 N E ¢ J E O C O > J E O O ¢O > E O O O > J E O ? Q > E O O m d E O y� m a N A fYl J E u1 N : N J E O N ° a J E O LA ¢ J of O 1!1 E O E Q E O 61 _ d m C ca a m a m V1 a m a a, N d m m a m LL 3 r1 l7 a N l7 a M C7 a , t� ¢ M O a Q1 U o 01 0 c O1 > QI > CI O ❑ (\ a x L7 \ > V1 y �, N a. 0 f/1 a m O l7 ¢ t� v+ > Qf l7 o -1��; — — 2 3 \ I-N -- L\ 4 i \— 14�\— -- S 6 7 8 10 11 12N I I \ — pH Adjustment Log for Preserved Samples Sample ID Type of Preservative pH upon receipt Date preservation adjusted Time preservation adjusted Amount of Preservative added lot # Note: Whenever there is a discrepancy affecting North Carolina compliance samples, a copy of this form will be sent to the North Carolina DENR Certification Office (i,e. Out of hold, incorrect preservative, out of temp, incorrect containers. Qualtrax ID: 69614 Page 2 of 2 Page 15 of 16 M T] m Z D DocuSign Envelope ID: 483685C1-E476-41F9-87D6-91691AD1FF38 n o d f a 3 a A " ^, ITEM # 0 -I 0 0 m z y N p r M � �' � o Z 1 z 1 z M M o m _ to 2.D rn D p v� v mm M ti Z m m >C, C W 1 J m 1 1 �1 C 1�' `_ m I / � n m m 23 m �A D - o 2 I'd in M V J �1 y I m ��= m TEMP in C (�-) Received on n ce F (YIN) m 0 uslo y Z Sealed o Cooler o Y!N w Samples Intact (YIN) m n - Z N N 7 � 7 n A n O - N � � z W C7 O O 3 (n �_ (PD o n D C� n= o N 3 D m rn ' E Co cr Ill = n o 3 x In n o 3 d w 3 ro _O D_ < O ai to n 10 < N O m z d 3 O. 'o " MATRIX CODE (see valid codes to left) o m xx a- v G o � o �' 3 ro SAMPLE TYPE (G-GRAB C=COMP) O M in A -- m m o m a N 0 m = ---1 0 o D M m p� (D m M Z CL D � � v 7 Z V m m 7 (7 r° ai SAMPLE TEMP AT COLLECTION I o D a o' o m W o N OF CONTAINERS u v m m a m? p n -- Unpreserved H2SO4 n m N o O m frl fD a D Q HNO3 HCI NaOH Na25203 Methanol o ro N +� in v m 3 � o' r— ❑ 61 O O D o C n m E5 Z Other o D fl1 o' n v Q o n d m ? °� M Z " i ? f0 (fl o in N Analyses Test YIN r' BOD 5-day ?- � Fecal Coliform MF. M-FC Zl X Ammonia! T. Phos O 3 m c CA O Q Q n Y Total Nitrogen & TKN a v, Nitrate > (D C n TSS x 3 .0 N o tD :3 Tin o- a a j Z N n � n N C n N a m rn m o r o A u O m � . rn 3 `� a Residual Chlorine (YIN) z n n d 0 D O Page 16 of 16 DocuSign Envelope ID: 483D85C1-E476-41F9-87D6-91691AD1FF38 aceo Pace Analytical Services, LLC 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 August 25, 2023 Amanda D. Grenier Greener EHS Solutions 21 Selby Ct. Holly Springs, NC 27540 RE: Project: FOREST LAKE Pace Project No.: 92684131 Dear Amanda Grenier: Enclosed are the analytical results for sample(s) received by the laboratory on August 23, 2023. 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 - Charlotte If you have any questions concerning this report, please feel free to contact me. Sincerely, Matthew Brainard matthew.brainard@pacelabs.com (704)875-9092 Project Manager Enclosures REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, without the written consent of Pace Analytical Services, LLC. Page 1 of 10 DocuSign Envelope ID: 483D85C1-E476-41F9-87D6-91691AD1FF38 aceo Pace Analytical Services, LLC 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 Project: FOREST LAKE Pace Project No.: 92684131 Pace Analytical Services Charlotte South Carolina Laboratory ID: 99006 9800 Kincey Ave. Ste 100, Huntersville, NC 28078 North Carolina Drinking Water Certification #: 37706 North Carolina Field Services Certification #: 5342 North Carolina Wastewater Certification #: 12 South Carolina Laboratory ID: 99006 CERTIFICATIONS South Carolina Certification #: 99006001 South Carolina Drinking Water Cert. #: 99006003 Florida/NELAP Certification #: E87627 Kentucky UST Certification #: 84 Louisiana DoH Drinking Water #: LA029 VirginiaNELAP Certification #: 460221 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 10 DocuSign Envelope ID: 483D85C1-E476-41F9-87D6-91691AD1FF38 aceo Pace Analytical Services, LLC 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 SAMPLE ANALYTE COUNT Project: FOREST LAKE Pace Project No.: 92684131 Analytes Lab ID Sample ID Method Analysts Reported Laboratory 92684131001 EFFLUENT PASI-C = Pace Analytical Services - Charlotte SM 9222D-2015 REPORT OF LABORATORY ANALYSIS KDF PASI-C This report shall not be reproduced, except in full, without the written consent of Pace Analytical Services, LLC. Page 3 of 10 DocuSign Envelope ID: 483D85C1-E476-41F9-87D6-91691AD1FF38 Pace Analytical Services, LLC �aceo 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 ANALYTICAL RESULTS Project: FOREST LAKE Pace Project No.: 92684131 Sample: EFFLUENT Lab ID: 92684131001 Collected: 08/23/23 10:17 Received: 08/23/23 14:00 Matrix: Water Parameters Results Units Report Limit DF Prepared Analyzed CAS No. Qual MBIO 9222D Fecal Coliform CHT Analytical Method: SM 9222D-2015 Preparation Method: SM 9222D-2015 Pace Analytical Services - Charlotte Fecal Coliforms 12.0 CFU/100 mL 1.0 1 08/23/23 15:11 08/24/23 13:21 REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, Date: 08/25/2023 10:07 AM without the written consent of Pace Analytical Services, LLC. Page 4 of 10 DocuSign Envelope ID: 483D85C1-E476-41F9-87D6-91691AD1FF38 Pace Analytical Services, LLC �aceo 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 QUALITY CONTROL DATA Project: FOREST LAKE Pace Project No.: 92684131 QC Batch: 795516 Analysis Method: SM 9222D-2015 QC Batch Method: SM 9222D-2015 Analysis Description: 9222D Fecal Coliform(MF) - CHT Laboratory: Pace Analytical Services - Charlotte Associated Lab Samples: 92684131001 METHOD BLANK: 4122085 Matrix: Water Associated Lab Samples: 92684131001 Blank Reporting Parameter Units Result Limit Analyzed Qualifiers Fecal Coliforms CFU/100 mL ND 1.0 08/24/23 13:21 SAMPLE DUPLICATE: 4122086 Parameter Fecal Coliforms 92684166005 Dup Units Result Result RPD Qualifiers CFU/100 mL ND ND Results presented on this page are in the units indicated by the "Units" column except where an alternate unit is presented to the right of the result. REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, Date: 08/25/2023 10:07 AM without the written consent of Pace Analytical Services, LLC. Page 5 of 10 DocuSign Envelope ID: 483D85C1-E476-41F9-87D6-91691AD1FF38 aceo Pace Analytical Services, LLC 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 QUALIFIERS Project: FOREST LAKE Pace Project No.: 92684131 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. 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 Chloroethylvinyl 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. Reported results are not rounded until the final step prior to reporting. Therefore, calculated parameters that are typically reported as "Total" may vary slightly from the sum of the reported component parameters. Pace Analytical is TNI accredited. Contact your Pace PM for the current list of accredited analytes. TN -The NELAC Institute. REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, Date: 08/25/2023 10:07 AM without the written consent of Pace Analytical Services, LLC. Page 6 of 10 DocuSign Envelope ID: 483D85C1-E476-41F9-87D6-91691AD1FF38 aceo Pace Analytical Services, LLC 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 QUALITY CONTROL DATA CROSS REFERENCE TABLE Project: FOREST LAKE Pace Project No.: 92684131 Analytical Lab ID Sample ID QC Batch Method QC Batch Analytical Method Batch 92684131001 EFFLUENT SM 9222D-2015 795516 SM 9222D-2015 795518 Date: 08/25/2023 10:07 AM REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, without the written consent of Pace Analytical Services, LLC. Page 7 of 10 /iJ,,nn I _ • ••.• —111 a ..a.a a ay.� .—vvvv rvL�Vglflt.Jlc VVIIUIU VII Uf./V11 r`C l.Clf.Jl DocuSign Envelope ID:483D85C1-E476-41F9-87D6-91691AD1FF38 Effective Date: 11/14/2022 Laboratory receiving samples: Asheville ❑ Eden❑ Greenwood ❑ Huntersville E] Raleigh❑ Mechanicsville❑ Atlanta❑ Kernersville❑ SampleClient Name:Upon Receipt PWO# • 92684131 Project h • Courier: ❑Fed Ex ❑UP5 ❑USPS ❑Client✓ II I III I I II I III II II I III ❑ Commercial '❑Pace ❑Other: ' 92684131 Custody Seal Present? Dyes ❑No seals intact? Dyes [DN-a J Date/Initials Person Examining Contents: Packing Material: ,❑Bubble Wrap ❑Bubble Bags ❑None ❑ Other Biological Tissue Fr zen? Thermometer: - -❑Yes—{-]No—L 1/A RGun ID: � � TO-? Type of ice: EFWet l�❑8tue ❑None 3 Correction Factor - Cooler Temp: Add/Subtract (•C) Temp should be above freezing to 6°C Cooler Temp Corrected (°C): ❑Samples out of temp criteria. Samples on ice, cooling process -� 1 has begun USDA Regulated Soil-tE-N/A, water sample) Did samples originate in a quarantine zone within the United States: CA, NY, or SC Did samples originate from a Foreign source (internationally, Trill, Comments/Discrepancy: Chain of Custody Present? []Yes ❑No ❑N/A 1. Samples Arrived within Hold Time? Oyes ❑No [I N/A 2. Short Hold Time Analysis (<72 hr.)? —❑Yes ❑No ❑N/A 3. Rush Turn Around Time Requested? []Yes ❑No ❑N/A 4. Sufficient Volume? ,Le s ON. ❑N/A S. Correct Containers Used? -Pace Containers Used? J]ves ❑Ves []NO ❑No [I N/A []N/A 6. Containers Intact? „❑Yes ❑No ❑N/A 7. Dissolved analysis: Samples Field Filtered? ❑Yes [:]No EJ'N/A 8. Sample Labels Match COC? -Includes Date/Time/ID/Analysis Matrix: i Yes \ V ❑No [:]N/A 9. Headspace in VOA Vials (>5-6mm)? ❑Yes [-]No (]N/A 10. Trip Blank Present? Trip Blank Custody Seals Present? []Yes ❑Yes [-]No ❑No ❑N/A ❑N/A 11. COMMENTS/SAMPLE DISCREPANCY CLIENT NOT Person contacted: Project Manager SCURF Review: Project Manager SRF Review: Qualtrax ID: 69614 Lot ID of split containers: Date/Time: Field Data Required? (JYes "No Date: Date: Page 1 of 2 Page 8 of 10 r-I INITI I SWIM I-'JUq—--oatriplt: %,uriuluon upon Kecelpi DocuSign Envelope ID:483D85C1-E476-4lF9-87D6-91691AD1FF38 t Effective Date: 11/14/2022 "Check mark top half of box if pH and/or dechlorination is verified and within the acceptance range for preservation samples. Exceptions: VOA, Coliform, TOC, Oil and Grease, DRO/8015 (water) DOC, LLHg "Bottom half of box is to list number of bottles ***Check all unpreserved Nitrates for chlorine Projec Wp# : 9268413 PM: MWB Due Date: 09/07/23 CLIENT: 92-Greener z U a z L a z a ? v v N v n _ N v O fO Z -a o _ "y A _ 2 C > u -1 Z a a N z V a > " N v •, N v = c = a a \ z ¢ Z v z .. x M f a •9 t a _ of M of Q n d u Q z < > a a Sl U d a O U m a � D U rU C a O N = n m 0 2 U v Q Z V o O ? N 61 C v S _a L! 2 w C O c O = K 0 N z Z _ lJ i Z Q ? z In O N y 2 Y M ? O 1 of �. C l7 tl v V .s C z N O = ? a C 2 Q C a J E N r1 a J E v❑i N a J E o V1 _m d v = r-1 m a J E ' a J E oIn NNi —y J E ^ a J E '^ ri o E v 3 D E Q `w = E a a`i - E ¢ J E o a E Q " — E Q J E a n a E Q J E O a 0 > J E O O Q O > J E 0 ¢ 0 O J E O ¢ O > J E 0 m y J E O m a N " Vl J E n : ut J E 0 to d J E O In E ¢ J E O 45 U j E O a E Q E v zc M KI 7 7 Q ? V �. N N N u — a m a m a CO a m a m a m a m aQ m 3 C7 a l9 a in a¢ It l� lM7 a❑❑>> l�7 C7 o a Y>�� "' N m m o a> M o — 2 3 4 5 \ 6 i 7 i , g i \ . 9 10-N\N 11 pH Adjustment Log for Preserved Samples Sample ID Type of Preservative pH upon receipt Date preservation adjusted Time preservation adjusted Amount of Preservative added Lot # - Nntp• Whnnnupr rhnr— .St. �.....,..... ,ST.._.:_. - �•'v�^uT .,, U.,,,,8 II Or u, �a,�una wn,puan[e samples, a copy Ofthis Iorm will be sent to the North Carolina DEN R Certification Office( i.e. Out of hold, incorrect preservative, out of temp, incorrect containers. Quallrax ID: 69614 Page 2 of 2 Page 9 of 10 ocuSign Envelope ID: 483D85C1 -E476-41 F9-87D6-91691AD1 FF38 w v ITEM# �1 n 'O m d D a D (7 a 3 M y a m a0 n 9 a G D n � n N m O tD N � > ^ n p N fD O D D y rn N m Q fD v v © D n N u ut ro m j = ..• O 11 c o 3 y N n o O > o ; r. o I Q`IM = NS. o C O ,n M.x v x 3 T 0 z ti fn r R f v fD L n n o o 0 o o a NO y S .per• 9�~`00 ,-. n y o � 3 C � m° o O a W o d o MATRIX CODE (see valid codes to left) IT 3 R /1 D SAMPLE TYPE (G=GRAB C=COMP) o a ^ o v m O V D = m D M 0 l = N D N M ;O r 5 n ._ 6 � r m— — - m — - - D -4 Z Z p m = C m U . D m J D m m o 0 o D m z N N D Z O v v y O D m r r Gl Z m J A 1 c SAMPLE TEIAP AT COLLECTIOSAMPLE N r Y. OF CONTAINERS m v n o? m rJ v -1 D p I Ny Unpreserved m o ' H2SO4 o z n 0 JJJ HNO3 -U d m 3 u HCI CD o m NaOH n�i `D m 0i c Na2S203 N 3 - m Methanol �t v m Other Q C T S a Analyses Test YIN Fecal Coliform MF, M-FC D s" M N Q n � c m o 3 D ti D w I ftl j lti m m �11 J n � Z C O m .D m TEMP in C _ y o rD Residual Chlorine (YIN) .i= n z " U E G o Received on Ice z N D (YIN) m p °= 0 Custody Sealed o Cooler - z �. O YIN N Samples Intact (YIN) Page 10 of 10