WQ0003090_Monitoring - 08-2023_20240102

Monitoring Report Submittal
Permit Number#* wg0003090
Name of Facility:* town of liberty wwtp
Month: * August Year: * 2023
Report Information
Type* Upload Document*
NDMR, NDAR-1, NDAR-2, NDMLR august 2023 spray report.pdf 4.05MB
PDF Only
Please upload one PDF containing all applicable monitoring reports
(i.e., NDMR, NDAR-1, NDAR-2, NDMLR, GW-59).
Confirmation Email Address: * [e-mail]
Name of Submitter: * Elix Fike
Signature:
Date of submittal: 1/2/2024
This will be filled in automatically
Initial Review
Reviewer: Wanda.Gerald

Is the project number correct?* wg0003090
Is the monitoring report accepted?* Yes NO
Regional Office* Winston-Salem
Reviewer: _anonymous
Review Date: 1/24/2024

FORM: NDMR 10-13 NON -DISCHARGE MONITORING REPORT (NDMR)
Page _1 _ of _1
Permit No.: W00003090
Facility Name: Town Of Liberty - Wastewater
County: Randolph
Month: August
Year: 2023
PPI: 002
Flow Measuring Point: ❑✓ Influent ❑ Effluent ❑ No flow generated
Parameter Monitoring Point: ❑ influent Q Effluent ❑ Groundwater Lowering ❑ Surface Water
Parameter Code — ►
�'�; 00400
00610
31613
00625
50060
Q� 70300_kg
00630
a
R
O
N
Z�
R
1° c
k '.
d}
7
i
ry
+
i d
l6
d
»
R
t6
F fn
UL O
a"
W U)
i
Z
24-hr
hrs
su
mg/L
#/100 mL
mg/L
mg/L
m mg/L
mg/L
1
7:00
8
mom
Ifilm
WIN "I
NEW
2
7:00
8
BMW
rMM
t,
NMI 1 110
3
7:00
8
6.97
11.4
2420
15.2
0
, , m
<0.040
f 3a
ENE
5
6
mom
7
EV,wT"mom
v.
8
mom
fl
TO
NMI
u
6.98
11
z
R
a,
12
NIUM
131
INEM
x
N
WE
14
7:00
8
, N
15
7:00
8Ism
16
7:00
8
mom
17
7:00
8
5.91
��
11.3
2420
16.1
0�n
,
<0.040
18
7:00
8
394
,�
19
9:30
2
offim
SUM,
r
k
20
12:00
2
.RKK11
Y,,,,,i
t
21
7:00
8
K
m
22
7:00
8#'
"
tElm
� g
0
23
7:00
8
{.tw
'
24
7:00
8
5.72
0
25
7:00
8
_
'.
st
26
11:00
2
z
.
27
13:45
2
,
,
28
7:00
8F
Bey
29
7:00
8
aim,
30
7:00
8:.;�
;x
IN
;.
31
7:00
8
5.97
NMI
0.9
Average:•
11.35
2,420.00
#REF!
0.18
,,5$
0.00
Daily Maximum:
6.98
11.40
2,420.00
Man#REF!
k
0.90
,`
E `0.04
,
Daily Minimum:
` ' 5.72
11.30
2,420.00
z..-
#REF!
0.00
i _,..
0.04',"'
Sampling Type:
° Grab
Grab
Grab
v
Grab
Grab
�,,��
Grab
Monthly Avg. Limit:
Daily Limit:
Sample Frequency:
t u week)
2x month
2x month
2x month
weekl
` 3x ear
2x month
I
,

FORM: NDMR 10-13
NON -DISCHARGE MONITORING REPORT (NDMR)
Sampling Person(s) Certified Laboratories
Name: GLENN PRICE Name: PACE ANALYTICAL
Name: GARRETT DREYER Name:
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? U Compliant L—I 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.
Operator in Responsible Charge (ORC) Certification
Permittee Certification
ORC: Elix Tremaine Fike
Permittee: Scott Kidd
Certification No.: 989290
Signing Official:
Grade: SI Phone Number: 336 622 2990
Signing Officials Title: Town Manager
Has the ORC changed since the previous NDMR? ❑ Yes El No
Phone Number: 336 622 4276 Permit Expiration: 8/31 /2024
9/27/2023�
q z
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

�Yace
Tremaine Fike
Town of Liberty
PO Box 1006
Liberty, NC 27298
Project: Town of Liberty
Pace Project No.: 92680747
Sample: Effluent
Method
SM 2540D-2015
EPA 353.2 Rev 2.0 1993
EPA 353.2 Rev 2.0 1993
EPA 353.2 Rev 2.0 1993
SM 521OB-2016
Colilert-18
TKN+NO3+NO2
Calculation
EPA 350.1 Rev 2.0 1993
EPA 351.2 Rev 2.0 1993
EPA 365.1 Rev 2.0 1993
Parameters
Total Suspended Solids
Nitrogen, NO2 plus NO3
Nitrogen, Nitrate
Nitrogen, Nitrite
BOD, 5 day
Fecal Coliforms
Performed by
Collected By
Collected Date
Collected Time
pH
Chlorine, Total Residual
Total Nitrogen
Nitrogen, Ammonia
Nitrogen, Kjeldahl, Total
Phosphorus
Laboratory Report
Pace Analytical Services, LLC
1377 South Park Drive
Kernersville, NC 27284
[phone]
Page 1 of 1
Report Date: 08/17/2023
Date Received: 08/03/2023
Lab ID: 92680747001 Collected: 08/03/23 12:35 Matrix: Water
Results
Units
Report Limit
Analyzed
16.1
mg/L
8.1
08/04/23 09:15
ND
mg/L
0.040
08/04/2310:59
ND
mg/L
0.040
08/04/2310:59
ND
mg/L
0.040
08/04/2310:59
16.6
mg/L
2.0
08/09/2310:07
2420
MPN/100ml-
1.0
08/04/2312:31
PACE
08/03/23 12:35
Garrett
08/03/23 12:35
Dreyer
08/03/23
08/03/23 12:35
1235
08/03/23 12:35
6.97
Std. Units
08/03/23 12:35
0.00
mg/L
08/03/23 12:35
15.2
mg/L
0.040
08/15/2312:55
11.4
mg/L
0.20
08/11/2315:15
15.2
mg/L
0.50
08/12/23 05:50
2.8
mg/L
0.050
08/17/23 00:11
ANALYTE QUALIFIERS
D6 The precision between the sample and sample duplicate exceeded laboratory control limits.
El Reported value should be considered a minimum estimate since it is the maximum reportable number for this method
basseed� on the )sample volume used. The true value is likely greater than the value reported.
Reviewed by:
Stephanie Knott
704-977-0981
[e-mail]
Pace Analytical Services Asheville
2225 Riverside Drive, Asheville, NC 28804
Florida/NELAP Certification #: E87648
North Carolina Drinking Water Certification #: 37712
North Carolina Wastewater Certification #: 40
Pace Analytical Services Eden
205 East Meadow Road Suite A, Eden, NC 27288
North Carolina Drinking Water Certification #: 37738
South Carolina Laboratory ID: 99030
South Carolina Certification #: 99030001
VirginiaNELAP Certification #: 460222
North Carolina Wastewater Certification #: 633
Virginia/VELAP Certification #: 460025
Qualifiers
M
Page 1 of 4

)TEAS #
�
�
d. 3
�
b bo Z aBed
m
3
O
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N
w
a
y
o
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ro
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W
Ot yp
�
�Y!I M
S
7i
Cx
m
$ '
alap'
Om
Qc
Z
iD
? p
as
MATRIX CODE (sqe valid Codgs lq IBN)
m
3
SAMPLE TYPE (G=GRAFT C=COMP)
Q
d
F
m
w
A
Q
pro}
47 ?
m
i4 )rt
m
O
pm
T 1 ®
4
v
N
m
m
SAMPLE TEMP AT COLLECTION
in
S OF CONTAINERS
o a
Unpreserved
C
v
v
p
H2504
HNO3its
i
HCI
w�
At
NaOH
Na2S203
Melhanol
S
rn
0
Ocher
X
Anatyses Test
800 5-day
YIN
ro
v
X
TSS
X
Nitrate
e?
ra
Ammonialiotai Phos
aX
t�lte
X
TKNITN
v
X
Fecal Coll
X
pH (Field)
X
TRC (Field) =�
m
TEMP in C
Residual Chlorine (Y/N)
0
Q
Received on
Ice
(YIN)
r
us o y
Sealed
Coolar
(YIN)
,mples

I'Aace Upon Receipt
,boratory receiving samples:
sheville E] Eden n Greenwood [] Huntersville Rai ieig hr"' MechanicsvilMechanicsville[]AtlantaAtlanta[-Kernersvi
LJ
INOWN Client Name: Project ft:
Durier: Fe Ex OUPS DUSPS [:]client
] Commercia: R21 'cle
arrier Tracking Number:
ustody Seal Present? []Yes No seals Intact? Dyes o Date/I$ni als Perion Exafining Content/�
aclking Material: []Oubble Wrap ElBubble Bags None Other Biological Tissue Froze
unrmometer:: _61R Gun 1016J?�110 0--� Typeoficp.� Owet 021lue
crier Temp ('c): k Correction Factor: Add / Subtract ('C
rrected Cooler Temp ( C
AA Regulated 5012 N,�A, water sample)
d samples origin e in a quarantine zone wit,iiN the United Stales: CA, NY,,,-,r Sr.. !check M, ap�;?
]Yes E)Ng/_
[]Yes E]No E.4N'/ A
0 None
Temp should be above freezing to B®C
(Samples out of temp criteria. Samples on ice, cooling procp
has begun
Did samples originate from a foreigfi source (internationally,
indudina liawiii and Puerto Rie.nli r'IY.,,. mm—
Comments/Discrepancy:
Chain of Custody Present?
es lNo
:)N/A
1,
samples Arrived within Hold T me?
E]NiA
Z.
short Hold Time Analysis (<72 hr�)?
Ft�
E]N,�'A
_1
Rush Turn Around Time Requested?
___Llyes _J:CN
C]N,A
4.
ufficient Volume?
Sufficient
Y11
E]N/A
S.
Correct Contamers Used?
ElNo
EJN/A
6,
-Pace Containers Used?
11KI", nZ,
A
�es
Containers Intact? p
y []No
CIN/
7,
CissolvOlanalysis: Samples Fie•d Ffltet,�?
Elyle- DNo No
N/A
B.
Samole Labels Match COC?
.
[]No
EINIA
9
-1 ricludes Dateifirne/lO/Ana ysts Matrix;E)�l!S
Headspace in VOA Vials (>5-6mrn;?
No
Q]:
A
10
Trip lank Present?
Elyes E)No
14
Trip Blank Custody Seals
[No
_D_Q_
D_Q_
D_Q_
_... A
L
Temp Log: Ternp must be maintained
at <6 C during login, record temp
evetry 20 rn I n i�
V I �'emp.
Time opened;
IT, y "� ; - put in caster
------
iiim—' � - ----- Tempi
Project Manager SCURF Review:
project Manager SRT Review:
CLIENT NOTIFICAT
Lot ID of split containers:
EM
Held Data Required? UYeS Doll.;
Qualtrax Document 11D: 70677
Page I of 2
Page 3 of 4

Document Name- 'oocurnent Issued: November 15, 1 2021
Bottle Identification Form (81F) PaF'e I of I
rlkeAffllyfiml
Document No,: Issuing Authority:
F-CAR-CS ' -043-Rev'.04 Pace Carolinas Quality Office
*Check mark top half of box if pH and/or dechlorination is Project 13
verified and within the acceptance range for preservation
Exceptions: VOA, Coliform, TOC, Oil and Grease, DRO/8015 (water) DOC, LLI-Ig U oj
"Bottom half of box is to list number of bottles
pH Adjustment Log for Preserved Samples
samgle It? Type of Preservative DMe Weservation adjusted pH upon receipt Time pre servatian
I ' adjusted I 'Aded
We: 'Nherye w thep� i� i dkcfqranty aff�,� king, fqorih c4rohn't
011k of hnht lnr'oiiect pfcn('�fvaifwa' ook of 1w:orf%'('k C.�)py of kh!�' fours will to the North North W-WIR HJ�
Page 4 of 4

Laboratory Report
Tremaine Fike
Town of Liberty
PO Box 1006
Liberty, NC 27298
Project: Liberty WWTP
Pace Project No.: 92682187
Pace Analytical Services, LLC
1377 South Park Drive
Kernersville, NC 27284
[phone]
Page 1 of 1
Report Date: 08/11/2023
Date Received: 08/10/2023
Sample: Effluent Lab ID: 92682187001 Collected: 08/10/23 14:05 Matrix: Water
Method Parameters Results Units Report Limit Analyzed Qualifiers
Performed by PACE 08/10/23 14:05
Collected By Garrett 08/10/23 14:05
Dreyer
Collected Date 08/10/23 08/10/23 14:05
Collected Time 1405 08/10/23 14:05
pH 6.98 Std. Units 08/10/23 14:05
Chlorine, Total Residual 0.00 mg/L 08/10/23 14:05
� J
Reviewed by:
Stephanie Knott
704-977-0981
[e-mail]
Page 1 of 2

Affix 1€Uorkarderf Lo$Irr Label Here or list Pam NJorkorder iNumber or
HAI - -CUST D al ti aY e ue DocumentONLY- MTJL Log -in Number Here
3C'6Ana1A,,/ c E,��r C Mete at relevent fields
Chair]-oi-Custody s a L_GA. DQ�UM amr
Company 'Bill ns'nfOrrnat on ALL � a
AddreS>
Report 7v' —__. Emai' To-
Copy T0- )Site ColteCtion Info/Address:
1
Customer Froject Narne%�tumber: _ . State: tour tyjC3;y Time
a'I
e Zone CoetYed:
f F
d t P T E ! M T ((k 1 CT ,... ET
PhonA' Site/Facrhty iD d:. Compliance Monitoring?
Email- (Yes ]NO
Col e ted B tp�r i,s, / Pu ,de _ _ W PWS D
Q.otl DW Location Code.
Co cte: ature'l" Turnaround Date Required: I mmel�atelj Yac�ule on
..✓' -J [! Yes ( No
e 17spos Rush: Held Filtered ;if applicat
Dispose as apPropriaze ( Return 1 $ ; Same Day ( J Next Day [ J Yes ( ) No
( Archive: 1 ( 12 Day f 13 Day I I a Day { j S Day `Anal sis:
( ) Hold: {Expedite Charges Apply) �� Y
" Matrix Codes {Insert in Matrix box below): Drinking Water (DW), Ground Water (GW), Wastewater (i° W),
Product {P), Soil/So=id (SQ, Di (oL), W pe (WP), Air (AR), Tissue (TS), Sioassay (H), Vapor (Vj Other (OT)
__. Camp i Collected (or
Composite End
Customer Sample Ili Matrix ! Grab i Composite Start) '
i Date { Time Date Time j
_
,
Containe. res-rv<
Preservative
Types (1) n rrc acid.(5) 1111111111111111111111
methanol...,
sodium bisulfate,isulfate, (:.
92682187
(C) ammonium
hydroxide, (D) TSP ti
Analyses - _
ltaa €'ratsWUr ie:.:.. _..
.�..u. �
Lab Sample Receiov C"teeklist
Custody seals present Intact
Y 9 NA
{ ; (
custody Signatures Present
Y Rr NA
Collector Sigrature Present
Y ti KA
Bathes intact
Y :v Ilk
I
3 }
correct Bottles
Y N NA
sufficient Volume
Y SS NA
j
samples Received on Ice
Y SS NA
VOA - Headapace Acceptable
Y N NA
USDA. Regulated Solls
Y N NA
!
i Samples in Holding Time
Y N NA.
t
Residual Chlorine Pre ,en.L
Cl Strips:
Y PE ;IR
# -
sample phi Acceptable
Y N 2IF1
SE,
PH stripe:
sulfide Present
Y k NA
PL
i
Lead Acetate Strive:
_
1
LA3 USE CKLY.
Res ° #Of j ZJ j ( Lab Sample comimerts:
Ct CtnS ! i
Customer RerrarFs / Special 'onditions t Possible Hazards: 'sTKPe Of Ice Used: Yet BlueDry None
Packing Material Used:
i
Radchem sample(s) screened (<5W cpm): Y N NA
(
E
;ie inquishe s � � gD T Date/Time: y Rec tyr'Corripa : (Signature)
! e .
:;i5ned"T3q'ICompanv_ (Sigrtaturei
tm
N
me:
s
!SHORT HOLDS PRESENT (<72 hours), Y N N/A
j Lab Tracking # :
`5,mptes received via:
FEDEX L°Ps- £)lent Courier Pace Courier
Date/Tim ' MTJL LAS USE ONLY
a`� ® I SAS 1abk #:
pretogin.,
Lab Sample Temperature Info:
Temp Blank Received: Y N NA
ThermlD4:
Cooler; Temp Upon Receipt: oC
Cooler 1 Therm Carr. Factor: oC
Cooler 2 Correrted Temp: oC
Comments:
Trip dank Received: Y N NA
HCL McOH TSP Other
jZsIshedi}/C pan,-(S3grature}
Date/Time: Received by/Company: (Signature)
Hate/Time'
R&-
Non Conforrnance(s): Page:
YES f NO t:f

�Yace�'-'
Tremaine Fike
Town of Liberty
PO Box 1006
Liberty, NC 27298
Project: Town of Liberty
Pace Project No.: 92683317
Sample: Effluent
Method
SM 2540D-2015
EPA 353.2 Rev 2.0 1993
EPA 353.2 Rev 2.0 1993
EPA 353.2 Rev 2.0 1993
SM 521OB-2016
Colilert-18
TKN+NO3+NO2
Calculation
EPA 350.1 Rev 2.0 1993
EPA 351.2 Rev 2.0 1993
EPA 365.1 Rev 2.0 1993
Parameters
Total Suspended Solids
Nitrogen, NO2 plus NO3
Nitrogen, Nitrate
Nitrogen, Nitrite
BOD, 5 day
Fecal Coliforms
Performed by
Collected By
Collected Date
Collected Time
pH
Chlorine, Total Residual
Total Nitrogen
Nitrogen, Ammonia
Nitrogen, Kjeldahl, Total
Phosphorus
Laboratory Report
Pace Analytical Services, LLC
1377 South Park Drive
Kernersville, NC 27284
[phone]
Page 1 of 1
Report Date: 08/31 /2023
Date Received: 08/17/2023
Lab ID: 92683317001 Collected: 08/17/23 12:15 Matrix: Water
Results
Units
20.7
mg/L
ND
mg/L
ND
mg/L
0.047
mg/L
14.8
mg/L
2420
MPN/100mL
PACE
Garrett
Dreyer
08/17/23
1215
5.91
Std. Units
0.00
mg/L
16.1
mg/L
11.3 mg/L
16.1 mg/L
2.9 mg/L
Report Limit
8.6
0.040
0.040
0.040
2.0
1.0
Analyzed
08/18/23 10:27
08/18/23 10:43
08/18/23 10:43
08/18/23 10:43
08/23/23 13:33
08/18/23 12:34
08/17/23 12:15
08/17/23 12:15
08/17/23 12:15
08/17/23 12:15
08/17/23 12:15
08/17/23 12:15
0.040
08/29/23 08:52
0.20
08/30/2313:20
0.50
08/29/23 03:39
0.050
08/31/23 09:22
ANALYTE QUALIFIERS
El Reported value should be considered a minimum estimate since it is the maximum reportable number for this method
based on the sample volume used. The true value is likely greater than the value reported.
Reviewed by:
Stephanie Knott
704-977-0981
[e-mail]
Pace Analytical Services Asheville
2225 Riverside Drive, Asheville, NC 28804
Florida/NELAP Certification #: E87648
North Carolina Drinking Water Certification #: 37712
North Carolina Wastewater Certification #: 40
Pace Analytical Services Eden
205 East Meadow Road Suite A, Eden, NC 27288
North Carolina Drinking Water Certification #: 37738
South Carolina Laboratory ID: 99030
South Carolina Certification #: 99030001
Virginia/VELAP Certification #: 460222
North Carolina Wastewater Certification #: 633
Virginia/VELAP Certification #: 460025
Qualifiers
Page 1 of 4

CHAIN -OF -CUSTODY ! Analytical Rt=ques WO#*92683317
The Chain-d-Custody is a LEGAL DOCUMENT. All relevant fields rr
l Submitting a sample via this chain of custody constitutes acknowledgment and acceptance of the Pace Terms and Conditions found at https1finfo.
Section A Section 5 Section C
1111111
Required Client Information: Required Project Information: Invoice Information:
�
Company: Town of L&erty Repon To: Tremaine Fike Attention. '
Address: PO Box 1006 Copy Tc: Company Name:
Litwty, NC 27298 Address:
R
Email [e-mail] Purchase Order #: Pace Quote:
Phone: !336)622-e275 Fax Project Name: Town of Liberty - Every 2 Weeks Pace Projectt Manager. [e-mail].
State t iseatlon
Requested Due pate: PrJect #: Pace Profile*: 13077
NO
F�fsred
YtTIY
a
COLLECTED
Preservatives >'
MATRtx CODE
u
o
On,k.V W, 6W
V
—
wrar.
Wmm water wiv g
<
tL
Yy
P
Produc s
J
O
RED
A
p
�o p�
SAMPLE ID Soc,��o3 s:
�
START
END
to
One Character per box. W. VV a
M
Sample Ids must be unique rs x
L
1
a O
m
z
� C
m
_
a)
r
13_
z
x
C3
z
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._.
S a m
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s
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ud
DATE
TIME
DATE
i ME
m a
=
z"
rY
1
Effluent ANT
I>
X
X X
X
X k
X
X
' Z
3
4
6'
7
tit
11
42
COMMENTSADDITIOMAL
IMO1WIAFFtR.SATKW
DATE Tim
ACCEPTEDBYlAFFR ATBCN; DATE
TQ SAf�LECONDF7 18
SAMPLER NAME AND SiGMATURE
CD PRINT Nance of SAMPLER: / c
IVs
m
o
N �d a
0 SIGNATURE of SAMPLER: _ DATE Signed: w
=
_
ro z

Upon Receipt
EffscUva Dalo, 05,'-12)2022
)r atary receiving samples:
eville Eden Greenwood
Huntersville
MechanicsvifleAtlanta- Kernersville'
Client Name:
Project 'q
Al
FIF J E'.
K—P
e 4-y
M P. r a c P
ief Tracking Number,
kody Seal Present?
seals Intact?
El
Dateinitials Person Examining Contents, f7,--C
In?, Material 5 b'-, i e Y IP 3 P
b b le gags
n e
Biological Tissue fron?
F-)yes nlqo
MoMeter.
Type of ke
O'P
r Temp ('C Fa�torl
iubz(ic" J'C)
Te;-P shoo d be above freez;ng to WC
�Cted cooler
A Regulated Soil
n,�! r ha i i
S t C A, Ve,
�4,)W3:i drd ?UQ(10 rt.. oi? Ely� [J
C 0 m M 0 n ts Q I s c r e P a n (Y
ctlain Of cus'Od,
od wit�
�'w 5acno:es Ac 'i0lo Time?
Short Hold Time Analysis (<72 hr,)?
-LIN, A
Rush Turn Aroond Time Requested? - ------
QJ N,,,A
cxf
Corsc, Cws',xrer.
ffY'! a
EJN �A
'Pare
A
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3,.e VQA
T,'I'p Dlan,!( Custodf SeVs Prewnt"
- --- ---- —
6MMENTS/SAMPLE DISCREPANCY
FseW Data Required') e'; ai
0 ! maintained
Log; Temp must be maintained
"'
CLIENT NOTIF"CATION/RESO!
A JT 1 0 N
_
it <6 C during login, record temp
nutes.
inutes.
v v ZO mi
-------- ------
FTemp
TiMe opened:f Temp: I
'I itne: If put in cooler
Time:.Temp�
Pers')nC(—'a"'ted
ipo;ea Manager SCURF Review,
Date
project Manager SRF Review'
Date
Q_J,,JJtt-aX 1)()CUffleW K) 706 R
Page 21
Page 3 of 4

Document Name Document Issued: Nowrrlbff r 15,2021
Brittle Identification Foam (W) Pare 1 of 1
Document No.: issuing Autfiuray
fi•i FaR Cs pA3 €$ev p l aCe Cur (AIM i Qu army Cif fife
*Chock rk trap half of box if plyand/or cirlorination is Project it
verified and within the acceptance range for preservation
Samples,
� �N
Cxe,�ptimm, VOA, Coliforni, TOC. Oil and Grease, DRO/80 5 (water) OOC, lt.Ng
"Bottom half of box is to list nurnb r of bottles
pH Adjustaient Log f€ f Preserved Samples
Sample It) Yyffe of Prosetvative PH Upon receipt irate preservation adjusted ) ime preservation € mount of Preservative Lot p
adjusted addeo
Notrs: Wh never there is a discmpancy Afect'inp North Cariilhw (umpiiame samples, a cog)y of thus form will by,, sent to the Nortfi Carnfrm ClilINR C€ rtlieation Office ().e
out of hold, incorrect preservative, out of temp, inrorrfcl containers.
Page 4 of 4

Laboratory Report
Tremaine Fike
Town of Liberty
PO Box 1006
Liberty, NC 27298
Project: Liberty WWTP
Pace Project No.: 92684569
Pace Analytical Services, LLC
1377 South Park Drive
Kernersville, NC 27284
[phone]
Page 1 of 1
Report Date: 08/25/2023
Date Received: 08/24/2023
SamPle: Effluent
Method Parameters
Lab ID: 92684569001 Collected: 08/24/23 11:30 Matrix:
Results Units Report Limit
Water
Analyzed Qualifiers
Performed by
PACE
08/24/23 11:30
Collected By
Garrett
08/24/23 11:30
Dreyer
Collected Date
08/24/23
08/24/23 11:30
Collected Time
1130
08/24/23 11:30
pH
5.72 Std. Units
08/24/23 11:30
Chlorine, Total Residual
0.00 mg/L
08/24/23 11:30
c�u�
Reviewed by:
Stephanie Knott
704-977-0981
[e-mail]
Page 1 of 2

LAS USE ONLY- Label Here or List Fare Worimirder Number or
CHAN-OF-CUSTODY Analytical Request Document I re
14P
WO#
-*92684569
Cha n-of,Cutody is a LEGAL DOCUMENT,, Cornp3etE all r Isvent Fields
Company, 7 at=, ALL SHAD
Address: Container Preservative TLp
921
IReport To: ail To: Preservative Types, t It n trio acid (2) sulfur
f61-, methanoli,:71 sodium bisu fate, 18) sodium thiosolfate,'9) hexane, .Ai ascorv,. —1., s.J
FCopy To: site Collection Info/Address: IC) ammonium hydroxide, (0) 7SP, (U) Unpreserved, (0) Other
Analyses Lab Pr—ofll Obn e:
Customer Project NlarnejNumberState- County/City: Ti ne Zone Collected:
Lab Sample Receipt Checklist:
)PT` 1MT! ICT ET
clustody Seals Present/rntact
Y N NA
Phone.
Com pliance Monitoring?
Custody Signatures Present
Y N MA
N40
Collector Signature Present
Y X NA
Erna 1:
Bottles Intact
Y If VA
C le--ted BylptiiIL". Purchase Order
I ec 5y 111`,�110,,
DVI PWS ID
Correct Bottles
Y 'IT NA
VVf Location Code:
Sufficient Volume
Samples Received on
Y --I NA
Y N NA
*1ed
Coll If I Turnaround Date Requlred:
Immediately Packed on ice -
-Ice
V0A - Readspace Acceptable
USDA Regulated soils
Y N NA
Y N NA
1 ]Ye-5 No
ssq
Samples in Hold ing Time
Residual Chlorine Present
Y K NA
Y N NA
ample Sal:
"ple
Field F ltered (if applicab e):
Dispose as approprote Return Sarne Day Next Day
4 DBY 5 Dav
Jyes NO
Cl Strips%
Sample pH Acceptable
Y N -M
Archwe: 12 Day J
Analysis:
PH Strips:
Exm�dixe Charges Apply)
sulfide Freeent
Y N NA
Matrx Codes (insert ii Matrix box be)ow): Ormking Water (DW), Ground Water (Gw), wastewater (wvj),
Lead Acetate Strips:
Product JP), Soff/Sokd (5Q, 0;1 (OL), Wipe (WP), Air (AP), Tissue(TS), Bioassay (S),
Vapor (V), Other (OT)
LAB USE ONLt�
Comp I Collected jot
Res of
Lab Sample # I Comments:
i
Customer Semple ID Grab Composite Start)
Composite End
Cl Ctris
Date Time
Date Time
It
Customer R mar {s i Spacial Can fiirsns;' POssivle Hazard=: Type "ice Wed: Wet g3t2 DrY gsse ShORi Hd�L6S PRE5s 7 2 hours)- Y N k/A
(Signature)
Samples rece€ved via:
Radchen, sarnPlels) screened f<500 cPq,* Y N NA FEDEX UPS Client
Dzie/-Nrne: Recn' Ed by/Company,' ignature) 0 te/Time:
41;lwinnp #ec' wed.Date/Time:
Dare/Time:
(Signature,
Courier Pace Courier
MM LAE, USE ONLY
bie 4:
Lab Sample Temperature Iffo.
Ternp, Stank Received; Y N NA
Therm
Coos er I Temp U.Poin Receipt: CC
Cooler 1 Therm, Corr. Facto,: cc
Cooler I Corrected Terrii:n o C
comments,,
Trip Blank Received: Y N NA
HCL MeOH TSP other
'-
Non Confounancell T77page
Y:S

Laboratory Report
Tremaine Fike
Town of Liberty
PO Box 1006
Liberty, NC 27298
Project: Liberty WWTP
Pace Project No.: 92685618
Pace Analytical Services, LLC
1377 South Park Drive
Kernersville, NC 27284
[phone]
Page 1 of 1
Report Date: 08/31/2023
Date Received: 08/31/2023
Sample: Effluent
Lab ID: 92685618001 Collected: 08/31/23 10:15 Matrix:
Water
Method Parameters
Results Units Report Limit
Analyzed Qualifiers
Performed by
Pace
08/31/23 16:29
Collected By
Garrett
08/31/23 16:29
Dreyer
Collected Date
08/31/2023
08/31/23 16:29
Collected Time
1015
08/31/23 16:29
pH
5.97 Std. Units
08/31/23 16:29
Chlorine, Total Residual
0.09 mg/L
08/31/23 16:29
Reviewed by: �CZ&rue<
Stephanie Knott
704-977-0981
[e-mail]
Page 1 of 2

CIHAIN-OF-CUSTODY Analytical Request Document
aceAna4lical Chain -of -Custody is a LEGAL DOCUMENT Complete all relevant fields
CompeSTing Information:
'any: l
�Address:
Report To: Email To,
Copy ToSite7,Collection info/Address:
N -u m ber: state: County/City: Time Zane Coltected- i
JPT[ JIMTJ "CT r(ET
Phone: S te/Fac?f ty ID 9
Compiancemonitoring
lErriai 1� i
[ (Yes No
I
�C?liected By ;,prsn" Purchase Order
DW PW5 ID
DW Location Code:
Quote
L �C_lrmm
�Turnaround Date Required:
I meciate€�Park-P on Ice,
Yes )No
i, P e Disposal: Rush-
Field Filtered (if applicab e)-
Dispose as appropriate l J Return Same Day j Next Day
Yes )NO
Archive: I j2Day I 13Day j4Day 5 Day
Ana ysis:
Hot& i[Expedite charges Apply,'
Matrix Codes (Insert in Matrix box below): Drinking Water (DW), Ground Water (GW),
Wastewater (WW),
product IP, Soil/Solid (SL), oil fOL), Wipe tWP), Air (AR), Tissue (TS), Sioassay (B),
Vapor (LAY. Other (OT)
Comp/ I Collected (or
Customer Sample ID Matrix Grab 1i Composite Start)
Res 4 of
Composite End
1 Cl ctns
Date i Time
i Date i Time
pe
Customer Remarks Special' Conditions/ Possible Hazards: 'Tyof ice Used: Wet Blue Dry None
Packing Material Used:
elf shed ny: (Signature)
CD
ReiWshed by,'Company: fSignature)
to
Radchern sample(s) screened (<500 cpm): Y N NA
LAB USE ONLY- Affix Workorder/Logirt Label Here or List Pace Workordie'r Nuinhn.
­
Wo#'92685618
ALL SHAD
Container Preservative Tyt
2
Preservative Types: i 1 l; nitric acid, (2) su fug zinc acetate,
(6) methanol (7) sodium bisulfate, (8} sodium th,osulfate, (9) hexane, (A) ascorbic acid, jii) ammonium Sulfate,
iC' arnmonium hydroxde, (D) TSP, ju) Unpresei,ed, (0) other
Analyses ]Lab Profile/Line-
Lab Sample Receipt cinecxllst:
Custody Seals eresent,'Intact
Y IN NA
Llistody Signatures Present
Y N NA
Collector Signature Present
Y 9 NA
Bottles intact
y N KA
Correct Stoles
y 11 Mk
Sufficient Volume
Y N NX
Samples Received on ice
VIDA - Beadspace Acceptable
y N NA
Y N NA
USDA Pegialated scila
y N KA
Samples in Holding Time
y N b-A
Residual Chlorine Present
y N NA
C! Strips:
Sample pH Acceptable
y N NA
PH Strips:
Sulfide Present
Lead Acetate Strips:
Y n VA
LAB LSE; ob-my,
Lab Sample # f comrientsz
)RT HOLDS PRESENT (<72 hours). Y N N/A
Tracking#.
pies received via:
FEDEX UPS Client
Courier Pace Courier
Date/Tirne:
MT)ILLAB USE ONLY
Date/Time:
Prelogin.,
(late/Time: Received by/Company: (S griature) Date/Time: PM:
Pa:
—7 —Lab —Sample Temperature —info,"
Temp Blank Received, Y N NA
Therm, 'D#:
Cooler I Temp Upon Receipt:
__4 _oC
i Cooler I Therm Corr, Factor: oc
t Cooler I Corrected Temp: aC
Comments:
Trip Blank Received: Y N NA
HCL MeOH TSP Cither
Non Conformance(s): 'Page!
YES I NO f.

DATE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
August 2023
Liberty N.C.W.W.T.F.
Freeboard Lagoon Inches
10 1/2
10 1/4
11
R
0.2
12
12 1/2
12 1 /2
R
0.5
13
R
0.5
14
14 1/2
15
R
0.6
16
16 1/2
17
17 1/2
18
R
0.5
18 1/2
18 1/2
19
19 3/4
19 3/4
19 1/2
20
21
22
R
0.2
23
24
R
0.5
23 1 /2
R
0.2
23
22 1 /2
R
0.4
21 3/4
21 1/4
R
1.0
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