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NC0071943_Fact Sheet_20231003
DocuSign Envelope ID: FF58D12D-491C-4737-BCBF-C9EE63CE61FC FACT SHEET FOR EXPEDITED PERMIT RENEWALS This form must be completed by Permit Writers for all expedited permits which do not require full Fact Sheets. Expedited permits are generally simple 100% domestics (e.g., schools, mobile home parks, etc.) that can be administratively renewed with minor changes but can include facilities with more complex issues (Special Conditions, 303(d) listed water, toxicity testing, instream monitoring, compliance concerns). Basic Information for Expedited Permit Renewals Permit Writer/Date Charles H. Weaver — 10/3/2023 Permit Number NCO071943 Facility Name Town of Boiling Springs WWTP Basin Name/Sub-basin number 03-08-04 Receiving Stream Sandy Run Creek Stream Classification in Permit C Does permit need Daily Max NH3 limits? Already resent. Does permit need TRC limits/language? Not necessary — UV disinfection. Does permit have toxicity testing? No Does permit have Special Conditions? Total Mercury monitoring Does permit have instream monitoring? No Is the stream impaired (on 303(d) list)? For what parameter? No. Segment 9-46-(1) of Sandy Run Creek is on the list, but this facility discharges to segment 9-46- 3.5 . Any obvious compliance concerns? No enforcements since 1994. One NOV and one NOD during the last permit cycle. Any permit modifications since lastpermit? None New expiration date 8/31/2028 Changes in Draft Permit? ➢ Facility grade changed to WW-3. Monitoring frequencies changed as per 15A NCAC 0213.0508 ➢ Updated eDMR text Changes in Final Permit? ➢ None DocuSign Envelope ID: FF58D12D-491C-4737-BCBF-C9EE63CE61FC LOCALio StarNews I The Dispatch I Times -News PO Box 631697 Cincinnati, OH 45263-1697 Sun Journal I The Daily News I The Star The Free Press I Gaston Gazette PROOF OF PUBLICATION Wren Thedford Deq-Division Of Water Res 1617 MAIL SERVICE CENTER Raleigh NC 27699 STATE OF NORTH CAROLINA, COUNTY OF CLEVELAND The Star, a newspaper printed and published in the city of Shelby, and of general circulation in the County of Cleveland, State of North Carolina, and personal knowledge of the facts herein state and that the notice hereto annexed was Published in said newspapers in the issue dated: 08/17/2023 and that the fees charged are legal. Sworn to and subscribed before on 08/17/2023 My commision expires Publication Cost: $82.50 Order No: 9169598 Customer No: 512930 PO #: NCO071943 THIS IS NOT AN INVOICE! Please do not use this form for payanent remittance. =DENISEOBERTS Public Wisconsin # of Copies: -1 Public Notice North Carolina Environmen- tal Management Commis- sion/NPDES Unit 1617 Mail Service Center Raleigh, NC 27699-1617 Notice of Intent to Issue NPDES Wastewater Permit NCO071943 Boiling Springs WWTP The North Carolina Environ- mental Management Commission proposes to issue a NPDES wastewater discharge permit to the person(s) listed below. Writ- ten comments regarding the proposed permit will be accepted until 30 days after the publish date of this notice. The Director of the NC Division of Water Resources (DWR) may hold a public hearing should there be a significant degree of public interest. Please mail comments and/or informa- tion requests to DWR at the above address. Interested persons may visit the DWR at 512 N. Salisbury Street, Raleigh, NC 27604 to review the information on file. Addi- tional information on NPDES permits and this notice may be found on our website: https://deq.nc.gov/public- notices-hearings, or by call- ing (919) 707-3601. The Town of Boiling Springs has requested renewal of NPDES Permit NCO071943 for its WWTP (at 2556 Rockford Rd, Shelby) in Cleveland County. This permitted facility discharges treated domestic wastewater to Sandy Run Creek in the Broad River Basin. Currently ammonia nitrogen and fecal coliform are water quality limited. This discharge may affect future allocations in this portion of the river basin. Aug. 17, 2023 #9169598 Page 1 of 1 DocuSign Envelope ID: FF58D12D-491C-4737-BCBF-C9EE63CE61FC North Carolina Department of Environmental Quality Water Pollution Control Systems Operator Certification Commission Roy Cooper Governor SENT VIA EMAIL & CERTIFIED MAIL: W. Corey Basinger Elizabeth Biser Chairman Secretary August 7, 2023 RETURN RECEIPT REQUESTED 7014-2120-0003-9404-3415 Mr. Justin E. Longino Town of Boiling Springs P.O. Box 1014 Boiling Springs, North Carolina 28017-1014 Subject: Re -Classification of Biological Water Pollution Control System: WW-III Boiling Springs WWTP Permit Number: NCO071943 Cleveland County Dear Mr. Longino: In accordance with North Carolina General Statute § 90A-37, the Water Pollution Control System Operators Certification Commission is required to classify all water pollution control systems. Upon review of the permit, the Water Pollution Control System Operators Certification Commission has determined that the subject facility requires a Grade III Biological Water Pollution Control System, effective August 1, 2023. [15A NCAC 08G .0302(c)] There is no action required at this time. The designated operators for this facility meet the requirements. Please review the current operator designations and submit the appropriate designation form, as required. (15A NCAC 08G .0201(3)(b)] Thank you for your attention to this. Please place a copy of this letter with your permit record. If you have any questions, please contact me at 919-707-9038, or via email at maureen.kinney@deq.nc.gov. Sincerely, (,l, NC Operators Certification Program ec: Mike Gibert, Public Works Director, Town of Boiling Springs Charles Weaver, DEQ, DWR NPDES Permitting Wes Bell, DEQ, DWR Mooresville Regional Operations 1618 Mail Service Center I Raleigh, North Carolina 27699-1618 919 807 6353 1 Fax 919 715 2726 1 http://deq.nc.gov/about/divisions/water-resources/operator-certification DocuSign Envelope ID: FF58D12D-491C-4737-BCBF-C9EE63CE61FC Weaver, Charles From: Bell, Wes Sent: Monday, August 7, 2023 8:52 AM To: Kinney, Maureen; Weaver, Charles Subject: RE: DRAFT permit renewal for NC0071943 The WWTP should be a WS-III. Wes Bell Env. Specialist II Mooresville Regional Office Water Quality Regional Operations Section NCDEQ-Division of Water Resources (704) 663-1699 Office (704) 235-2192 Office Direct Line Email: wes.bell@ncdenr.gov 610 East Center Avenue Suite 301 Mooresville, NC 28115 DE ,k.i i i - d ti :ARf]LINA Q� Department of Environmental Oualiiy Email correspondence to and from this address is suhiect to the North Carolina Public Records Law and may be disclosed to third parties_ From: Kinney, Maureen <Maureen.Kinney@deq.nc.gov> Sent: Monday, August 7, 2023 8:44 AM To: Weaver, Charles <charles.weaver@deq.nc.gov>; Bell, Wes <wes.bell@deq.nc.gov> Subject: RE: DRAFT permit renewal for NC0071943 This permit is WW-II in BIMS but it appears to be WW-III by rule. Wes - Is there any reason not to reclassify it to WW-III? Maureen Kinney Extension Education & Training Specialist NC Wastewater Operator Certification Program Office: (919) 707-9038 1 DocuSign Envelope ID: FF58D12D-491C-4737-BCBF-C9EE63CE61FC Ofry�airy of Fnri�or�ne�x3a rn�ail�� Finsol comspcn lience to art from this ackfmss is subject 10 the North Carolina Public Re=ieds Law and may be disclosed to third parfres. From: Weaver, Charles <charles.weaver@deg. nc.gov> Sent: Friday, August 4, 2023 2:46 PM To: Bell, Wes <wes.belI@deg.nc.gov>; Kinney, Maureen <Maureen.Kinney@deg.nc.gov> Subject: DRAFT permit renewal for NCO071943 This one will go to Notice on August 15t". Send me any comments as time permits. Charles H. Weaver Environmental Specialist II Division of Water Resources 919-707-3616 charles.weaver(a)deg. nc. qov (mailing address) 1617 Mail Service Center, Raleigh, INC 27699-1617 QS� Emaif correspondence to and from this address is subject to the North Carobna Public Records jLaw and may be drsabsed to lhrrd parties. Email correspondence to and from this address may be subject to the North Carolina Public Records Law and may be disclosed to third parties by an authorized state official. DocuSign Envelope ID: FF58D12D-491C-4737-BCBF-C9EE63CE61FC Laboratories LLC 5 j a member of The GEL Group INC July 28, 2023 Mr, Tony Gragg Water Tech Laboratories P.O. Box 1056 Granite Falls, North Carolina 28630 Re: Routine Analysis Work Order: 630848 Dear Mr. Gragg: POBOX30712 Cha,dmon.5C29417 20,IO Sa ip Roud Chid AM.8C 20407 P 843.55t,Wl N 80.760.1178 GEL Laboratories, LLC (GEL) appreciates the opportunity to provide the enclosed analytical results for the sample(s) we received on July 26, 2023. This original data report has been prepared and reviewed in accordance with GEL's standard operating procedures. The samples were delivered with proper chain of custody documentation and signatures. All sample containers arrived without any visible signs of tampering or breakage. There are no additional comments concerning sample receipt. 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 accreditations and certifications can be found on our website at www.get.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 (843) 556-8171, ext. 1614. Sincerely, Jordan Melton for Delaney Stone Project Manager Purchase Order: 200901 Enclosures gel.com Page I of 12 SDG: 630848 problem solved DocuSign Envelope ID: FF58D12D-491C-4737-BCBF-C9EE63CE61FC GEL LABORATORIES LLC 2040 Savage Road Charleston SC 29407 - (843) 556-8171 - www.gel.com Certificate of Analysis Report for WATR001 Water Tech Laboratories Client SDG: 630848 GEL Work Order: 630848 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 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 12 SDG: 630848 DocuSign Envelope ID: FF58D12D-491C-4737-BCBF-C9EE63CE61FC GEL LABORATORIES LLC 2040 Savage Road Charleston SC 29407 - (843) 556-8171 - www.gel.com Certificate of Analysis Company: Water Tech Laboratories Address: P.O. Box 1056 Granite Falls, North Carolina 28630 Contact: Mr. Tony Gragg Project: Routine Analysis Client Sample ID: Town of Boiling Springs Eff Sample 1D: 630848001 Matrix: Waste Water Collect Date: 24-JUL-23 09:00 Receive Date: 26-JUL-23 Collector: Client Report Date: July 28, 2023 Project: WATR00101 Client ID; WATR001 Parameter Qualifier Result DL RL Units PF DF Analyst Date Time Batch Method Mercury Analysis-CVAA EPA 1631 Low Level Mercury Analysis "As Received" Mercury 0.548 0.200 0.500 nglL l LYG1 07/28/23 1457 2467518 1 The following Analytical Methods were performed: Method Description_ Analyst Comments I EPA 1631E 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 12 SDG: 630848 DocuSign Envelope ID: FF58D12D-491C-4737-BCBF-C9EE63CE61FC GEL LABORATORIES LLC 2040 Savage Road Charleston SC 29407 - (843) 556-8171 - www.gel.com Certificate of Analysis Company: Water Tech Laboratories Address : P.O. Box 1056 Granite Falls, North Carolina 28630 Contact: Project: Mr. Tony Gragg Routine Analysis Client Sample ID: Town of Boiling Springs Duplicate Sample ID: 630848002 Matrix: Waste Water Collect Date: 24-JUL-23 09:00 Receive Date: 26-JUL-23 Collector: Client Report Date: July 28, 2023 Project: WATR00101 Client ID: WATR001 Parameter Qualifier Result DL RL Units PF DF Analyst Date Time Batch Method Mercury Analysis-CVAA EPA 1631 Low Level Mercury Analysis "As Received" Mercury 0.730 0.200 0.500 ng/L 1 LYG 1 07/28/23 1502 2467518 1 The following Analytical Methods were performed: _ Method � Description _ __ _ �Y Analyst Comments 1 EPA 1631E 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 12 SDG: 630848 DocuSign Envelope ID: FF58D12D-491C-4737-BCBF-C9EE63CE61FC GEL LABORATORIES LLC 2040 Savage Road Charleston SC 29407 - (843) 556-8171 - www.gel.com Certificate of Analysis Report Date: July 28, 2023 Company: Water Tech Laboratories Address : P.O. Box 1056 Granite Falls, North Carolina 28630 Contact: Mr. Tony Gragg Project: Routine Analysis Client Sample ID: Town of Boiling Springs Field Equip Blan Project: WATR00101 Sample ID: 630848003 Client ID: WATRO01 Matrix: Water Collect Date: 24-JUL-23 09:00 Receive Date: 26-JUL-23 Collector: Client . . Parameter Qualifier Result DL RL Units PF DF Analyst Date Time Batch Method Mercury Analysis-CVAA EPA 1631 Low Level Mercury Analysis "As Received" Mercury U <0.2 0.200 0.500 nglL 1 LYGI 07/28/23 1318 2467519 1 The following Analytical Methods were performed: Method Description Analyst Comments _ l EPA 1631 E 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 12 SDG: 630848 DocuSign Envelope ID: FF58D12D-491C-4737-BCBF-C9EE63CE61FC GEL LABORATORIES LLC 2040 Savage Road Charleston SC 29407 - (843) 556-8171 - www.gel.com Certificate of Analysis Report Date: July 28, 2023 Company: Water Tech Laboratories Address : P.O. Box 1056 Contact: Project: Granite Falls, North Carolina 28630 Mr. Tony Gragg Routine Analysis Client Sample ID: Town of Boiling Springs Trip Blank Project: WATR00101 Sample ID: 630848004 Client ID: WATRO01 Matrix: Water Collect Date: 24-JUL-23 09:00 Receive Date: 26-JUL-23 Collector: Client Parameter Qualifier Result DL RL Units PF DF Analyst Date Time Batch Method Mercury Analysis-CVAA EPA 1631 Low Level Mercury Analysis "As Received" Mercury U <0.2 0.200 0.500 ng/L 1 LYG I 07/28/23 1323 2467518 1 The following Analytical Methods were performed: Method Description Analyst Comments I EPA 1631E 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 12 SDG: 630848 DocuSign Envelope ID: FF58D12D-491C-4737-BCBF-C9EE63CE61FC GEL LABORATORIES LLC 2040 Savage Road Charleston, SC 29407 - (843) 556-8171 - www.gol.com QC Summary Report Date: July 28, 2023 Water Tech Laboratories P.O. Box 1056 Granite Falls, North Carolina Contact: Mr. Tony Gragg Workorder: 630848 Page 1 of 2 Page 2 of 2 late Time Parmname NOM Sample qual QC Units RPD% REC% Ranl;e Anlst Date Time Metals Analysis -Mercury Batch 2467518 later than QC1205471730 LCS t/- the Mercury 5.00 4.88 ng/L 97.7 (77%-123%) LYG1 07/28/2312:42 QC1205471729 MB Mercury U ND ng/L QC1205471733 630712908 MS Mercury 5.00 1.07 5.26 ng/L QC1205471734 630712008 MSD Mercury 5.00 1.07 5.19 ng/L Notes: 83.8 (71%-125%) 1.32 82.5 (0%-24%) 07/28/23 12:37 07/28/23 13:54 07/28/23 13:59 The Qualifiers in this report are defined as follows: U Analyte was analyzed for, but not detected above the MDL, MDA, MDC or LOD. J Value is estimated X Consult Case Narrative, Data Summary package, or Project Manager concerning this qualifier N Mctals--The Matrix spike sample recovery is not within specified control limits H Analytical holding time was exceeded < Result is less than value reported > Result is greater than value reported h Preparation or preservation holding time was exceeded R Sample results are rejected ^ RPD of sample and duplicate evaluated using +/-RL. Concentrations are <5X the RL. Qualifier Not Applicable for Radiochemistry. NIA RPD or %Recovery limits do not apply. ND Analyte concentration is not detected above the detection limit E %difference of sample and SD is > 10%. Sample concentration must meet flagging criteria 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. FB Mercury was found present at quantifiable concentrations in field blanks received with these samples, Data associated with the blank are deemed invalid for reporting to regulatory agencies Page 7 of 12 SDG: 630848 DocuSign Envelope ID: FF58D12D-491C-4737-BCBF-C9EE63CE61FC Metals Technical Case Narrative Water Tech Laboratories SDG #: 630848 Product: Mercury Analysis Using the PS Analytical Millennium Automated Mercury Analyzer Analytical Method: EPA 1631E Analytical Procedure: GL-MA-E-018 REV# 19 Analytical Batch: 2467518 The following samples were analyzed using the above methods and analytical procedure(s). GEL Sample ID# Client Sample Identifleation 630848001 Town of Boiling Springs Eff 630848002 Town of Boiling Springs Duplicate 630848003 Town of Boiling Springs Field Equip Blan 630848004 Town of Boiling Springs Trip Blank 1205471729 Method Blank (MB)CVAF 1205471730 Laboratory Control Sample (LCS) 1205471733 630712008(NonSDGS) Matrix Spire (MS) 1205471734 630712008(NonSDGSD) Matrix Spike Duplicate (MSD) The samples in this SDG were analyzed on an "as received" basis. Data Summary: There are no exceptions, anomalies or deviations from the specified methods. 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. 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 9 of 12 SDG: 630848 DocuSign Envelope ID: FF58D12D-491C-4737-BCBF-C9EE63CE61FC 112_e-. 1 01 l Pr ct n: G Qunte 4: OZI.P l 9-166.9 €CC ivumfae�(ij ?O umber 1 j i + tg rr{{ ] L ab o € i t i l am - {r , of (j 1 :;01 ..,r, Ch.rl4Strj . l UC 7e 116T j Aatiiyq,nas',al I �p :al[y Anzl!) ;i;, , 7 fJ " Y f� i fChain ofCustody and Analytical Request - IGLU.. Laboratories- t_C:C 2048 Savage, Road Charleston, SC 2940-1 PhDne:'(843)55r6-8171 Fax: (843) 766-1178 GEL Work Carder !'vumbyr. GEL Project Mirnager; Samuel Hogan Cti Name: PO $oa.1©Sri i Phone P: SampleAnafysisRequested (5) (Fill in the number of containers for each test) PrSj�,IcLiSite Nam6 Pigew od`PI9 za rive i Fax t _ 5hoal8 this sample be considered. ;. e z r l e— Prcscrcative Type f61 � � as s5:. _, �c j -3 R sq � _ -D x -J, CL f2lNote: i „� � � i I COill[IieAtS i extra sample is i required for sample specific QC 1C6ected BY:TcY ��ess �r 4> Send Rrsu is Q.- a i a �. e „� :G ii v = - v W •€ III Sample ID " r-or cornpoS,*c5 - indicate start and stop dateltimC' �r?ato Collected - i 1 (mm-dd-yy) . Collected - (Military) -- (hi+mm3 - QC. Code Cz) Field Filtered (3) $ample' -Matrix (4) I OF R�&/ > 7-2Y—Z 3 j o o x -� G3 � 9 4 1 f r i 1 i I 11 t �� p Sys }� } IL AAC: is .1�L 4/d,-IC - p$F� �•� W } )[/{ V �' cis -Y.r �. .4". 3 1 I ► i %A TAT Requested: forma' Rush: pecify )r'ax Results: l Yes o t Chain ofC•ustody Signature Rckinit„IsitedSy(Signed) Date Time Receivadby(sipl ed) Date TimeFI J' .{3 I !Select Deliverable:'[ I&FA I ; QC Summary I level 1 Level 2 { 1 Level r Levef 4 —y i lfddliiorral.R2mArlrs-209572 Fy = ; ? Far Lair Reedving u-c- ody, Custody Sea"niac#T J I Yes ( [14p Cooler Temp: oC (> Forsaazplesltipping and delirerp details, seeSanzpleRe�eipt & Reviewforrrz Sampfa Collection Time Zane Eastern j I,PaeiF:Central [ j Mountain [ 1 Othcr: I y Chair of Custody Number= Client 6ctarhired i '-k QC Co8es Xt=Normal Sample,TE=Tip, .Blanl:,FD-Field D.phcate-Ea= Equipment Bl.rk, MS= Matrix Spi7se Sample-MSD=Matrix Spi'xe Duo]icete Semple, G=Grab, C:-Composiie P i3.1 Fie!dFiltcrVdFor. iiquidrrbtricesindicaeewith z-Y--aryesthesamplewasfield (lieredas-N� for sanipiewasnattie€d�tte2ed. (a,}'MranlCodes: DV:=iarinkin_Water. SW=SurFaceWater,WVNWastcWater, W-VIater,ML=MiscLiqu480-Suil,�5j]�edineiic,.5;,='Sludge,SS=5otidWast8,O-Gil,F=Filic,, Vip�"r'£���e,f=ficeaf,N= 15.1 Sample Analysis Requ=;cd: Analy,icdl method regL sutd (ire 32605, 6ili OBR470A) and numb-- ofcontsinersprovided for each Ci.e,.H2609 -3, 50108.17470R- 1), h,1 pfdSti at--ryp M:lid.=Hydr6Gl,lonG Acid, Nt=NitrlG Acid:-Sit='Sodium l'iYdfOXitte.$?.-$i11 JYIC Reid,Al4yAsnorbic Acid. [-jX=1•texane,.ST-Sodium ti,io5a!fBrC, ifno pit$G1ative ,5 added=lean 3iCi�bJHpl~A -,., 1") I�`howx RPOSSMEKAZARDS ICharaeteristicHazards I ListedWaste father joi I U ITI Fl Flammablelignitable LW=Listed Waste OT— Other iUnknown (^ iRCR-A Metals CO Corrosive (F,ll:Pond U-listedwasies.} (i-e_ high%low•pH, asbestos, beryllium, h7ifants• other s=Arsenic He=LFercary• ItE i3cactive Wasrecade(s}: nxiscneaithha.:ards,ett} Ba = Barium Se= Seleniumuetip#iou: Cd = Cadmium Ag= Silver TSCA $eguiated Cr=Chromium MR=.Misc_RCP--metals PCI3=Polychlorinated Pb = Lead biphe'tyis 1 please rapidean ' d.dz1:[a...tzal-tCFoils betawraga rdiagkvndlina andlaririsposal concerns (;e_ Origin ofsawle(s). or-- I alai#eeullectedfram,odd,natriecs,ercl ; 1 DocuSign Envelope ID: FF58D12D-491C-4737-BCBF-C9EE63CE61FC LaboivorieS LLC �t) SAMPLE RECRIP'f & REVIRW FORM Client: SI)WARICOCIWork Order.- Received By- VYITY4-- Ditto Received: _ r . Clrc eAPplea6 c: FCd x Bxp oss FedBX Ground UPS I^field Services CgLLriCT Other Carrier nud Zi'aCltill� Number 9 Suspected Hazard Information *If Net Counts a IR(icptn on samples hot markod "ratiioaudvc", Contact the Radiation Safety Omup For fudhot investigation. azard Class Shipped: UNIh A)Sbipped as a DOT Ilazardous7 tfUN2910, Is the Radioactive Shipment Sllt•voyCotopliant? Yes •- No I;) Aid the diem dCStgUalC the Snmp1C9 Ore to be COP AUtatiQA GrmdlDaeilve 811CkCCt On eanlatnere Chtlal olleAt tiCeigrtatlUn 5 received as rediouctivo? C) Did Utc It50 classify the samples as acimum Net Counts Observed* (Observed Counts - Area Background Counts) CPM tu", radioactive? Classified as; >!tad 1 Red 2 Red 3 COG notation orh(izesd labels oucoutaiaers equal client destgttation:. O) Did the 61101u rfesi eta sam ics are hazardous? Uffatllis. Yes, Setect hazards -below. . II Aid the RSO idea ossible hazards? PCWs Flammable Foreign Sail RCRA Asbestos Beryllium Othen Sample Receipt Criteria Corrrmeut9to natiriers. (Required for Nou.CotlformingItems) 1 shippiag containers Teceived intact and Circlo Applcablc: Seals broken i5amngudagntalaer Isakiog.conuapter Other (describo) settled? Circle A � ppocablc; CLenteantuatad aril ptovkled COC COC created upon receipt 2 OW11 of Custody docurnents included with shipment PreservadonMethod, Wotleq ImPacks Dryice ]Vane Other: 3 Samples requiring Cold preservation *all temperatures am re-, d.d Ce sius TE11IP: } within (0 S.S deb. C)?* I d Daily Chock performed and passed on1R Temperature Device Sedat fl. _ tw' Cemperatwe, grin? SeeonrlaryTemperimtru Device Sexipl Of (if App c le): Circle Appllca6la: Scuts broken Dumnged coautinet Laakhtg cooteiner Other (dorcrlba) 5 Sample Containers kitact and: sealed? - 6 8.Wpl"fe44iYih9 Wfottiicnl pirescrwdEtuti' Sample rise wldE oota acre Atrected at proper pf l? tf.Preservatim, added, tots: IPYes; aro Hneares or soli Kits present for solids? Yes_._.., No:.w.-• NA—(lf ycs, take to VGA Freezer) Do any samples require Volatile 2o.liquid VOA vials contain acid preservation? Yes_ No_ NA.(If untmown, select UO) liquid VOA v1Ar, free of ]teadspacv? Y.es-- No —NA..—. 7 Analysis?aEysisAnalysis?Are — Sataple ID's and containers aitected: ID's and tests affected Sample ID's on COC Match ID's on ID's and containers affected: bottles! 14 Date & time on CQC match date & time Circle Applicable: No dates on containers No times ou containers ' COC ntiasing info Other (describe) an boitleV number indi.rated on COC? I2 Are sample containers identifiable as CEI provided by use of GEL labels? 13 COC form is praperiy signed in Circle Applicable: Not rellnquished Other (describe) CalingWshed/received sections? Comments (Use Continuation raffn if necdcd): P.M (orPit(IA)rcview: (idUals � — Date l Page of — Page 11 of 12 SDG: 630848 GL-CllL-SR-001 Rev 7 DocuSign Envelope ID: FF58D12D-491C-4737-BCBF-C9EE63CE61FC List of current GEL Certifications as of 28 duly 2023 State Certification Alabama 42200 Alaska 17-018 Alaska Drinking Water SC00012 Arkansas 88-0651 CLIA 42DO904046 _ California 2940 Colorado SC00012 Connecticut PH-0169 DoD ELAPI ISO17025 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-SCO12 _ Massachusetts PFAS Approv _ Letter Michigan 9976 Mississippi _ SC00012 Nebraska NE-OS-26-13 Nevada SC000122023-4 New Hampshire NELAP 2054 New Jersey NELAP SCO02 New_ Mexico SC00012 New York NELAP 11501 North Carolina 233 North Carolina SDWA 45709 North Dakota R-158 _ Oklahoma 2022-160 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 _ T104704235-22-2T Utah NELAP _ SC000122022-37 Vermont VT87156 Virginia NELAP f T� 460202 Washington C780 Page 12 of 12 SDG: 630848