NCG120099_2023 DMR_20231116 (2)

environmental
October 31, 2023
Attn: DEMLR Stormwater Program
North Carolina Department of Environmental Quality
Division of Mineral, Energy, and Land Resources, Stormwater Division
Land Quality Section, Winston-Salem Regional Office
450 West Hanes Mill Road, Suite 300
Winston-Salem, North Carolina 27105
RE: NPDES COMPLIENCE SUBMITTAL FOR THIRD QUARTER 2023
HIGH POINT CONSTRUCTION AND DEMOLITION LANDFILL
GUILFORD COUNTY, NORTH CAROLINA, PERMIT NO. NCG120099
To Whom It May Concern,
WI High Point Landfill, LLC is monitoring stormwater under Permit No. NCG120099 at the High
Point Construction and Demolition Landfill. The purpose of this correspondence is to report that
samples were collected during a qualifying rainfall event from ouffalls on SB-1 and ST-1 on
August 3, 2023. Total suspended solids were reported above benchmark levels in both ST-1 and
SB-1, and chemical oxygen demand exceeded benchmark in ST-1. There was no discharge
during operational hours for the third quarter compliance period for outfalls, SB-2, and SB-8
during a qualifying storm event within a timeframe that would allow the submittal of the fecal
coliform sample to the laboratory within the hold time. The Stormwater Discharge Monitoring
Report is attached.
If you have any questions or require any additional information, please contact us. We
appreciate your assistance with this project.
Sincerely,
WI High Point Landfill, LLC
1
9/, , 0.))LL
Steve Cobb
General Manager II
CC: Matthew Scheidt, PG, WSP USA Inc., 5B Oak Branch Drive, Greensboro, North Carolina,
27407, 336-971-8905, [e-mail]
Travis Hitchcock, 3301 Benson Drive, Raleigh, North Carolina, 27609,
[e-mail]
Bryan Wuester, Regional Landfill Manager, 7434 Roseboro Highway, Roseboro, Sampson
County, North Carolina 28382, [e-mail]
John Pflager, Regional Environmental Compliance Manager, GFL Environmental, 3301
Benson Drive, Suite 601, Raleigh, North Carolina 27609,[e-mail]
Attachment: DMR
1236 Elon Place High Point NC, 27263
Tel.:[phone] Fax:[phone] gflenv.com

NCDEQ Division of Energy,Mineral and Land Resources
Stormwater Discharge Monitoring Report(DMR) Form for NCG120000
Landfills
Click here for instructions
Complete,sign,scan and submit the DMR via the Stormwater NPDES Permit Data Monitoring Rei!ort(DMR)Upload form within
30 days of receiving sampling results. Mail the original,signed hard copy of the DMR to the ap ro,riate DEMLR Regional Office.
Certificate of Coverage No. NCG12 0099 Person Collecting Samples: Johnathan Serencsics
Facility Name: High Point C&D Landfill Laboratory Name:Pace Analytical
Facility County:Guilford Laboratory Cert. No.: NC633
Discharge during this period:ID Yes ❑ No (if no,skip to signature and date)
Has your facility implemented mandatory Tier response actions this sample period for any benchmark exceedances?❑Yes ❑✓ No
If so,which Tier(I,II,or III)? Tier II
A copy of this DMR has been uploaded electronically via https::/edocs.deq.nc.gav/Forms/SW-DMR ❑Yes ❑ No
Date Uploaded:
Analytical Monitoring Requirements for Outfalls with Industrial Activities—Benchmarks in(Red)
Parameter
Code Parameter Outfall ST-1 Outfall SB-1 Outfall SB-2 Outfall SB-8 Outfall
N/A Receiving Stream Class C C C C
N/A Date Sample Collected MM/DD/YYYY 8/3/23 8/3/23 -- --
46529 24-Hour Rainfall in inches 0.15 0.15 0.15 0.15
C0530 TSS in mg/L(100 or 50*) 697 114
00400 pH in standard units(6.0—9.0) 5.96 7.20
00340 Chemical Oxygen Demand in mg/L 272 53.9
(120)
31616 Fecal Coliform in#per 100 ml(1000) 182 82
Additional parameters for outfalls in drainage areas that use>55 gallons per month of new hydraulic oil on average
00552 Non-Polar Oil&Grease in mg/L(15) <4.9
NCOIL Estimated New Motor/Hydraulic Oil 55 gal
Usage in gal/month
*Outfalls to Outstanding Resource Waters(ORW),High Quality Waters(HQW),Trout Waters(Tr)and Primary Nursery Areas(PNA)
have a benchmark TSS limit of 50 mg/L.All other water classifications have a benchmark of 100 mg/L
Notes(optional):
"I certify by my signature below,under penalty of law,that this document and all attachments were prepared under my direction or supervision in
accordance with a system designed to assure that qualified personnel properly gather and evaluate the information submitted.Based on my
inquiry of the person or persons who manage the system,or those persons directly responsible for gathering the information,the information
submitted is,to the bt t of my nowledge and belief,true,accurate,and complete.I am aware that there are significant penalties for submitting
false information,inc g th passibility of fines and imprisonment for knowing violations."
±1/1.4.3._
Signature of rmittee or Delegated Authorized Individual Dat
Email Address [e-mail] Phone Number 336-886-3560

Pace Analytical Services,LLC
( ace® 9800 Kiney Ave. Suite 100
Huntersville,NC 28078078
[phone]
August 08, 2023
Darren Cox
WSP
5B Oak Branch Drive
Greensboro, NC 27407
RE: Project: High Point C&D Landfill
Pace Project No.: 92680636
Dear Darren Cox:
Enclosed are the analytical results for sample(s)received by the laboratory on August 03, 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
• Pace Analytical Services-Charlotte
• Pace Analytical Services- Eden
If you have any questions concerning this report, please feel free to contact me.
Sincerely,
Angela Baioni
[e-mail]
[phone]
Project Manager
Enclosures
viQ Katt°
,.4t440m.
REPORT OF LABORATORY ANALYSIS
/ This report shall not be reproduced,except in full,
4e13 a
without the written consent of Pace Analytical Services,LLC. Page 1 of 14

Pace Analytical Services,LLC
ace/� 9800 Kincey Ave. Suite 100
/// e, Huntersville,NC 28078
�!V [phone]
CERTIFICATIONS
Project: High Point C&D Landfill
Pace Project No.: 92680636
Pace Analytical Services Charlotte
South Carolina Laboratory ID:99006 South Carolina Certification#:99006001
9800 Kincey Ave.Ste 100,Huntersville,NC 28078 South Carolina Drinking Water Cert.#:99006003
North Carolina Drinking Water Certification#:37706 Florida/NELAP Certification#: E87627
North Carolina Field Services Certification#:5342 Kentucky UST Certification#:84
North Carolina Wastewater Certification#: 12 Louisiana DoH Drinking Water#:LA029
South Carolina Laboratory ID:99006 VirginiaNELAP Certification#:460221
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
Pace Analytical Services Eden
205 East Meadow Road Suite A,Eden,NC 27288 North Carolina Wastewater Certification#:633
North Carolina Drinking Water Certification#:37738 Virginia/VELAP Certification#:460025
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced,except in full,
without the written consent of Pace Analytical Services,LLC. Page 2 of 14

Pace Analytical Services,LLC
ace. 9800 Kincey Ave. Suite 100
Huntersville,NC 28078
[phone]
SAMPLE ANALYTE COUNT
Project: High Point C&D Landfill
Pace Project No.: 92680636
Analytes
Lab ID Sample ID Method Analysts Reported Laboratory
92680636001 SB-1 SM 2540D-2015 RZB 1 PASI-E
SM 9222D-2015 AED 1 PASI-E
SM 5220D-2011 JMH1 1 PASI-A
92680636002 ST-1 SM 2540D-2015 RZB 1 PASI-E
SM 9222D-2015 AED 1 PASI-E
EPA 1664E DVR 1 PASI-C
SM 5220D-2011 JMH1 1 PASI-A
PASI-A=Pace Analytical Services-Asheville
PASI-C=Pace Analytical Services-Charlotte
PASI-E=Pace Analytical Services-Eden
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 14

Pace Analytical Services,LLC
ace. 9800 Kincey Ave. Suite 100
Huntersville,NC 28078
[phone]
ANALYTICAL RESULTS
Project: High Point C&D Landfill
Pace Project No.: 92680636
Sample: SB-1 Lab ID: 92680636001 Collected: 08/03/23 10:34 Received: 08/03/23 12:15 Matrix: Water
Parameters Results Units Report Limit DF Prepared Analyzed CAS No. Qual
2540D Total Suspended Solids Analytical Method:SM 2540D-2015
Pace Analytical Services-Eden
Total Suspended Solids 114 mg/L 16.1 1 08/04/23 09:17
MBIO 9222D Fecal Coliform EDN Analytical Method:SM 9222D-2015 Preparation Method:SM 9222D-2015
Pace Analytical Services-Eden
Fecal Coliforms 82.0 CFU/100 mL 1.0 1 08/03/23 15:10 08/04/23 13:15 D6
5220D COD Analytical Method:SM 5220D-2011 Preparation Method:SM 5220D-2011
Pace Analytical Services-Asheville
Chemical Oxygen Demand 53.9 mg/L 25.0 1 08/08/23 10:39 08/08/23 15:11
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced,except in full,
Date:08/08/2023 09:12 PM without the written consent of Pace Analytical Services,LLC. Page 4 of 14

Pace Analytical Services,LLC
ace. 9800 Kincey Ave. Suite 100
Huntersville,NC 28078
[phone]
ANALYTICAL RESULTS
Project: High Point C&D Landfill
Pace Project No.: 92680636
Sample: ST-1 Lab ID: 92680636002 Collected: 08/03/23 10:10 Received: 08/03/23 12:15 Matrix: Water
Parameters Results Units Report Limit DF Prepared Analyzed CAS No. Qual
2540D Total Suspended Solids Analytical Method:SM 2540D-2015
Pace Analytical Services-Eden
Total Suspended Solids 697 mg/L 21.7 1 08/04/23 09:18
MBIO 9222D Fecal Coliform EDN Analytical Method:SM 9222D-2015 Preparation Method:SM 9222D-2015
Pace Analytical Services-Eden
Fecal Coliforms 182 CFU/100 mL 1.0 1 08/03/23 15:10 08/04/23 13:15 D6
HEM,Oil and Grease Analytical Method: EPA 1664E
Pace Analytical Services-Charlotte
Oil and Grease ND mg/L 4.9 1 08/06/23 11:13
5220D COD Analytical Method:SM 5220D-2011 Preparation Method:SM 5220D-2011
Pace Analytical Services-Asheville
Chemical Oxygen Demand 272 mg/L 25.0 1 08/08/23 10:39 08/08/23 15:11
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced,except in full,
Date:08/08/2023 09:12 PM without the written consent of Pace Analytical Services,LLC. Page 5 of 14

Pace Analytical Services,LLC
ace. 9800 Kincey Ave. Suite 100
Huntersville,NC 28078
[phone]
QUALITY CONTROL DATA
Project: High Point C&D Landfill
Pace Project No.: 92680636
QC Batch: 791392 Analysis Method: SM 2540D-2015
QC Batch Method: SM 2540D-2015 Analysis Description: 2540D Total Suspended Solids
Laboratory: Pace Analytical Services-Eden
Associated Lab Samples: 92680636001,92680636002
METHOD BLANK: 4101363 Matrix: Water
Associated Lab Samples: 92680636001,92680636002
Blank Reporting
Parameter Units Result Limit Analyzed Qualifiers
Total Suspended Solids mg/L ND 2.5 08/04/23 09:10
LABORATORY CONTROL SAMPLE: 4101364
Spike LCS LCS %Rec
Parameter Units Conc. Result %Rec Limits Qualifiers
Total Suspended Solids mg/L 250 244 98 90-110
SAMPLE DUPLICATE: 4101365
92680721002 Dup
Parameter Units Result Result RPD Qualifiers
Total Suspended Solids mg/L 318 332 4
SAMPLE DUPLICATE: 4101370
92680636002 Dup
Parameter Units Result Result RPD Qualifiers
Total Suspended Solids mg/L 697 686 2
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:08/08/2023 09:12 PM without the written consent of Pace Analytical Services,LLC. Page 6 of 14

Pace Analytical Services,LLC
ace. 9800 Kincey Ave. Suite 100
Huntersville,NC 28078
[phone]
QUALITY CONTROL DATA
Project: High Point C&D Landfill
Pace Project No.: 92680636
QC Batch: 791476 Analysis Method: SM 9222D-2015
QC Batch Method: SM 9222D-2015 Analysis Description: 9222D Fecal Coliform(MF)-EDN
Laboratory: Pace Analytical Services-Eden
Associated Lab Samples: 92680636001,92680636002
METHOD BLANK: 4101766 Matrix: Water
Associated Lab Samples: 92680636001,92680636002
Blank Reporting
Parameter Units Result Limit Analyzed Qualifiers
Fecal Coliforms CFU/100 mL ND 1.0 08/04/23 13:15
METHOD BLANK: 4101768 Matrix: Water
Associated Lab Samples: 92680636001,92680636002
Blank Reporting
Parameter Units Result Limit Analyzed Qualifiers
Fecal Coliforms CFU/100 mL ND 1.0 08/04/23 13:15
SAMPLE DUPLICATE: 4101767
92680636001 Dup
Parameter Units Result Result RPD Qualifiers
Fecal Coliforms CFU/100 mL 82.0 36.0 78 D6
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:08/08/2023 09:12 PM without the written consent of Pace Analytical Services,LLC. Page 7 of 14

Pace Analytical Services,LLC
ace. 9800 Kincey Ave. Suite 100
Huntersville,NC 28078
[phone]
QUALITY CONTROL DATA
Project: High Point C&D Landfill
Pace Project No.: 92680636
QC Batch: 791678 Analysis Method: EPA 1664B
QC Batch Method: EPA 1664E Analysis Description: 1664 HEM,Oil and Grease
Laboratory: Pace Analytical Services-Charlotte
Associated Lab Samples: 92680636002
METHOD BLANK: 4102814 Matrix: Water
Associated Lab Samples: 92680636002
Blank Reporting
Parameter Units Result Limit Analyzed Qualifiers
Oil and Grease mg/L ND 5.0 08/06/23 11:13
LABORATORY CONTROL SAMPLE: 4102815
Spike LCS LCS %Rec
Parameter Units Conc. Result %Rec Limits Qualifiers
Oil and Grease mg/L 40 32.8 82 78-114
MATRIX SPIKE SAMPLE: 4102816
92680578001 Spike MS MS %Rec
Parameter Units Result Conc. Result %Rec Limits Qualifiers
Oil and Grease mg/L <1.1 39.6 33.4 83 78-114
SAMPLE DUPLICATE: 4102817
92680662002 Dup
Parameter Units Result Result RPD Qualifiers
Oil and Grease mg/L ND 1.8J
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:08/08/2023 09:12 PM without the written consent of Pace Analytical Services,LLC. Page 8 of 14

Pace Analytical Services,LLC
ace. 9800 Kincey Ave. Suite 100
Huntersville,NC 28078
[phone]
QUALITY CONTROL DATA
Project: High Point C&D Landfill
Pace Project No.: 92680636
QC Batch: 792082 Analysis Method: SM 5220D-2011
QC Batch Method: SM 5220D-2011 Analysis Description: 5220D COD
Laboratory: Pace Analytical Services-Asheville
Associated Lab Samples: 92680636001,92680636002
METHOD BLANK: 4104326 Matrix: Water
Associated Lab Samples: 92680636001,92680636002
Blank Reporting
Parameter Units Result Limit Analyzed Qualifiers
Chemical Oxygen Demand mg/L ND 25.0 08/08/23 15:07
LABORATORY CONTROL SAMPLE: 4104327
Spike LCS LCS %Rec
Parameter Units Conc. Result %Rec Limits Qualifiers
Chemical Oxygen Demand mg/L 750 759 101 90-110
MATRIX SPIKE&MATRIX SPIKE DUPLICATE: 4104328 4104329
MS MSD
92680670002 Spike Spike MS MSD MS MSD %Rec
Parameter Units Result Conc. Conc. Result Result %Rec %Rec Limits RPD Qual
Chemical Oxygen Demand mg/L 63.2 100 100 172 172 109 109 90-110 0
MATRIX SPIKE&MATRIX SPIKE DUPLICATE: 4104330 4104331
MS MSD
92680670003 Spike Spike MS MSD MS MSD %Rec
Parameter Units Result Conc. Conc. Result Result %Rec %Rec Limits RPD Qual
Chemical Oxygen Demand mg/L 84.1 100 100 189 189 104 104 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:08/08/2023 09:12 PM without the written consent of Pace Analytical Services,LLC. Page 9 of 14

Pace Analytical Services,LLC
( ace® 9800 Kincey Ave. Suite 100
Huntersville,NC 28078
[phone]
QUALIFIERS
Project: High Point C&D Landfill
Pace Project No.: 92680636
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.
TNI-The NELAC Institute.
ANALYTE QUALIFIERS
D6 The precision between the sample and sample duplicate exceeded laboratory control limits.
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced,except in full,
Date:08/08/2023 09:12 PM without the written consent of Pace Analytical Services,LLC. Page 10 of 14

Pace Analytical Services,LLC
ace. 9800 Kincey Ave. Suite 100
Huntersville,NC 28078
[phone]
QUALITY CONTROL DATA CROSS REFERENCE TABLE
Project: High Point C&D Landfill
Pace Project No.: 92680636
Analytical
Lab ID Sample ID QC Batch Method QC Batch Analytical Method Batch
92680636001 SB-1 SM 2540D-2015 791392
92680636002 ST-1 SM 2540D-2015 791392
92680636001 SB-1 SM 92220-2015 791476 SM 92220-2015 791477
92680636002 ST-1 SM 92220-2015 791476 SM 92220-2015 791477
92680636002 ST-1 EPA 1664B 791678
92680636001 SB-1 SM 5220D-2011 792082 SM 5220D-2011 792162
92680636002 ST-1 SM 5220D-2011 792082 SM 5220D-2011 792162
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced,except in full,
Date:08/08/2023 09:12 PM without the written consent of Pace Analytical Services,LLC. Page 11 of 14

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ace Upon Receipt
s Effective Date: 05/12/2022
aboratory receiving samples:
ksheville n Eden [1 Greenwood ❑ Huntersville ❑ Raleigh❑ Mechanicsville Atlanta❑ Kernersville"
Sample Condition Upon Client Name:
Receipt \_ 3 Project#: \NJ5-9
:ourier: ['Fed Ex LOPS ❑USPS Eitlent
] Commercial ['Pace DOther:
:airier Tracking Number:
Custody Seal Present? DYes to Seals Intact? DYes ONO Date/Initials Person Examining Contents:
acking Material: ['Bubble Wrap ❑Bubb e Bags None ❑ Other Biological Tissue Frozen?
hermometer: / DYes [No ON/A
(�IR Gun i D• (/ Type of Ice: 0 Wet ❑Blue ❑None
Toler Temp(°C): _1.k Correction Factor:Add/Subtract {•C) •1
',ll Temp should be above freezing to 6°C
orrected Cooler Temp('C):
,Lj ❑Samples out of temp c ite•ia Samples on ce,cool ng proce
has begun
ISDA Regulated Soil(❑N/A,water sample)
rd samples or ginate n a quarant ne zone within the United States CA,NY,or SC(check maps;? Did samples originate from a foreign source linter'-an)•a'V
]Yes ❑No including Hawaii and Puerto Rico)?Oyes ONo
Comments/Discrepancy:
Chain of Custody Present? Yes ONo ]N/A 1.
Samples Arrived within Hold T me? Oces DNo ON/A 2.
Short Hold Time Analysis(<72 hr.)? 'yes ONO ❑N;A 3.
Rush Turn Around Time Requested? Oyes [.}C ❑Nr'A 4.
Sufficient Volume? j3es ❑Nc DNA 5.
Correct Conta ners Used? [1Y ❑No ON/A 6
-Pace Containers Used? IMes ❑No ON.,A
Containers Intact? lees ONo ❑ A 7
Dissolved analysis:Samples Feld Filtered? Oyes ONo N;A 8
Sample Labels Match COC? ,,(� DNA 9
includes Date/Time/ID/Analysis Matrix:�1V 1
Headspace in VOA Vials(>5-6mrn)? ❑Yes ❑No /A 10
Tr p Bunk Present? Oyes ONo A 11
Trip Blank Custody Seals Present? DYes ONo N/A
COMMENTS/SAMPLE DISCREPANCY Field Data Required? ales do
Lot ID of split containers:
Temp Log:Temp must be maintained CLIENT NOTIFICATION/RESOLUTION
at<6 C during login,record temp
every 20 minutes.
Time opened: Temp:
Time: put in cooler
Time: Temp:
Person Contacted: Date/T me:
Project Manager SCURF Review: Date:
Project Manager SRF Review: Date:
Qualtrax Document ID: 70677 Page 1 of 2
Page 13 of 14

Document Name. Document Issued November 15,2021
Bottle Identification Form(BIF) Page 1 of 1
ace Analytical Document No.. Issuing Authority:
F-CAR-CS-043-Rev.01 Pace Carolinas Quality Office
*Check mark top half of box if pH and/or dechlorination is Project#1 �C-f)
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
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pH Adjustment Log for Preserved Samples
Sample ID Type of Preservative pH upon receipt Date preservation adjusted ~ Time preservation Amount of Preservative Lot p
adjusted added
Note: Whenever there is a discrepancy affecting North Carol na compliance samples,a copy of this form will be sent to the North Carolina DEHNR Certification Office(i e
Out of hold,incorrect preservative,out of temp,incorrect containers.
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