NCG120107_DMR_20211026

4., GOLD E R MEMBER OF WSPnCDepartment
aEvnment Quality
Received
OCT 26 2021
1iL'inston-�::lem
October 25, 2021 R^zional Office Project No. 1913614621
Mr. Levi Hiatt, EIT, Assistant Regional Engineer
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, NC 27105
([e-mail])
THIRD QUARTER NPDES COMPLIANCE SUBMITTAL -SEPTEMBER 2021 EVENT
GREAT OAK LANDFILL, RANDOLPH COUNTY, NORTH CAROLINA
PERMIT NO. NCG120107
Dear Mr. Hiatt,
Stormwater monitoring is performed at the Great Oak Landfill under Permit No. NCG120107. Golder Associates
NC, Inc. personnel were present to inspect and collect samples from the compliance monitoring points on
September 22, 2021. The purpose of this correspondence is to provide Stormwater Discharge Monitoring Report
(DMR) for September 2021.
A quarterly sample was collected from outfall Pond-4. No exceedances were noted for the sample collected from
outfall Pond-4. The hold time for fecal coliform expired due to laboratory error and was not analyzed. Outfall
Pond-1 did not discharge during the precipitation event. Outfall Pond-2 began discharging outside of the normal
operating hours for the facility and was not sampled. The quarterly sampling of outfall Pond 3 occurred on August
3, 2021, and the results were submitted to the North Carolina Department of Environmental Quality on August 30,
2021. The required discharge monitoring report(DMR) is attached for the September 2021 event.
If you have any questions or require any additional information, please contact us. We appreciate your assistance
with this project.
Sincerely,
Golder Associates NC, Inc.
`e
David "Dusty" Y. Reedy II, PG Rachel P. Kirkman, PG
Senior Hydrogeologist Principal and Senior Consultant
Golder Associates NC,Inc.
5B Oak Branch Drive,Greensboro,North Carolina.USA 27407 T:[phone] F.+1 336 852-4904
Engineering Lic.No C-2862/Geology Lic.No.C-399
Golder Associates NC,Inc is a licensed user of the Golder trademark,and an associated operating entity
Golder and the G logo are trademarks of Golder Associates Corporation_ golder.com

Mr.Levi Hiatt,EIT,Assistant Regional Engineer Project No. 1913614621
North Carolina Department of Environmental Quality October 25,2021
CC: Kyle Mertens, Environmental Protection Manager, Waste Management,
[e-mail]
Mike McFeeley, District Manager, Waste Management, 3597 Old Cedar
Falls Road, Randleman, North Carolina 27317. [e-mail]
Attachments: DMR
https://golderassociates.sharepoint.com/sites/142823/project files/5 technical work/phase 303 September
stormwater event/03 deliverables/1913614621.302-01-I-revo-go_dmr.docx
`t/ GOLDER
�,� 0 2

NC Department of
NCDEQ Division of Energy, Mineral and Land Resources Environmental Qu�f ty
Received
Stormwater Discharge Monitoring Report (DMR) Form for NCG120000QCj 2 6 2021
Landfills
Click here for instructions Winston
ReUpl ad f M 'rithin
Complete,sign,scan and submit the DMR via the Stormwater NPDES Permit Data Monitoring Report(DMR)Upload
30 days of receiving sampling results. Mail the original,signed hard copy of the DMR to the appropriate DEMLR Regional Office.
Certificate of Coverage No. NCG12 0107 Person Collecting Samples: David Reedy
Facility Name: Great Oak Landfill Laboratory Name: Pace Analytical
Facility County:Randolph Laboratory Cert. No.: NC633
Discharge during this period:❑✓ 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)?
A copy of this DMR has been uploaded electronically via https://edocs.deq.nc.gov/Forms/SW-DMR ❑ Yes ✓❑ No
Date Uploaded:
Analytical Monitoring Requirements for Outfalls with Industrial Activities—Benchmarks in(Red)
Parameter Parameter Outfall Pond4 Outfall Outfall Outfall Outfall
Code
N/A Receiving Stream Class C
N/A Date Sample Collected MM/DD/YYYY 09/22/2021 _
46529 24-Hour Rainfall in inches 1.2
C0530 TSS in mg/L(100 or 501 38.7
00400 pH in standard units(6.0—9.0) 7.74
00340 Chemical Oxygen Demand in mg/L
(120) 32.6
31616 Fecal Coliform in#per 100 ml(1000) --
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)
NCOIL Estimated New Motor/Hydraulic Oil
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 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."
70A2/2.&kta- 10/25/2021
Signature of Permittee or Delegated Authorized Individual Date
Email Address [e-mail] Phone Number 321-403-2544

Environmental
Qtra.'it;
Storrnwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance on filling out this form,please visit hops.//deq.nc.gov/about/divisions/energy-mineral-land-resources'
npdes-stormwater-gps
Permit No.: N/C/ / / / / / / / or Certificate of Coverage No: N/C/G/ I /2/0/ I/O�/
Facility Name: G rlak Oak:
L-
County: (2.Anck)ktph Phone No. ad—) - c(Oq - 44ct
Inspector: DaAe.1Date of Inspection: 2G-x
Time of Inspection: `2)`.2
Total Event Precipitation (inches) 1. 3
All permits require qualitative monitoring to be performed during a "measurable storm event."
A"measurable storm event" is a storm event that results in an actual discharge from the permitted site
outfall The previous measurable storm event must have been at least 72 hours prior. The 72-hour storm
interval does not apply if the permittee is able to document that a shorter interval is representative for
local storm events during the sampling period, and the permittee obtains approval from the local DEMLR
Regional Office.
By this signature, I certify that this report is accurate and complete to the best of my knowledge.
(Signature of Pernuttee or Desi,, ee)
1. Outfall Description:
Outfall No. SDCI -3 Structure (pipe, ditch, etc.)
Receiving Stream:
41(kblA ark O F rclabc-e,ls U-e .
Describe the industrial activities that occur within the outfall drainage area:
Page t of 2
SWU-242,Last modified 06.01 2018

2. Color: Describe the colui of the discharge using basic colors(red,brown, blue:,etc.)and tint
(light, medium, dark)as descriptors: \-G1V1__ -- — ---
3. Odor: Describe any distinct odors that the discharge may have(i.e,smells strongly of oil, weak
chlorine odor,etc.): _ MN.
4. Clarity: Choose the number which best describes the clarity of the discharge, where I is clear
and 5 is very cloudy:
1 2 3 4 t�
Floating Solids: Choose the number which best describes the amount of floating solids in the
sionnwater discharge,where I is no solids and 5 is the surface covered with floating solids:
0 2 3 4 5
6. Suspended Solids: Choose the number which best describes the amount of suspended solids in
the stormwater discharge, where l is no solids and 5 is extremely muddy:
2 3 4
7. is there any foam in the stormwater discharge? 0 Yes No
8. Is there an oil sheen in the stormuater discharge'' °Yes qk No
9. Is there evidence of erosion or deposition at the outran? 0 Yes (kNo -
ID. Other Obvious Indicators of Storms►ater Pollution:
I ist and describe
Note: Loss clarity, high solids,and/or the presence of foam, oil sheen,or erosion/deposition may be
indicative of pollutant exposure. These conditions warrant further investigation.
Page 2of?
SN'U•242,t.asi modified Oo O1 201 i

Pace Analytical Services,LLC
9800 Kincey Ave. Suite 100
aceAnalytical Hunlersville,NC 28078
www.pacelabs.com
[phone]
October 01, 2021
David Reedy
Golder Associates, Inc.
5B Oak Brank Dr
Greensboro, NC 27407
RE: Project: Great Oak LF
Pace Project No.: 92562743
Dear David Reedy:
Enclosed are the analytical results for sample(s)received by the laboratory on September 22, 2021. 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-Eden
If you have any questions concerning this report, please feel free to contact me.
Sincerely,
t'% ! i,.•..C�.-
Nicole D'Oleo
nicole.d'[e-mail]
[phone]
Project Manager
Enclosures
\l/is� 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 11

Pace Analytical Services,LLC
aceAnalytical® 9800 Kincey Ave. Suite 100
Huntersville,NC 28078
www.pacelabs.ccc
[phone]
CERTIFICATIONS
Project: Great Oak LF
Pace Project No: 92562743
Pace Analytical Services Asheville
2225 Riverside Drive,Asheville,NC 28804 North Carolina Wastewater Certification#:40
Florida/NELAP Certification#:E87648 South Carolina Certification#:99030001
North Carolina Drinking Water Certification#: 37712 VirginiaNELAP Certification#:460222
Pace Analytical Services Eden
205 East Meadow Road Suite A,Eden,NC 27288 North Carolina Wastewater Certification#:633
North Carolina Drinking Water Certification#:37738 VirginiaNELAP 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 11

Pace Analytical Services,LLC
co9800 Kincey Ave.aceAnalyfical Hunters Ile,NCf v28078
www.pacetabs.com [phone]
SAMPLE ANALYTE COUNT
Project: Great Oak LF
Pace Project No.: 92562743
Analytes
Lab ID Sample ID Method Analysts Reported Laboratory
92562743001 Pond 4 SM 2540D-2011 AED 1 PASI-E
SM 5220D-2011 JP1 1 PASI-A
PASI-A=Pace Analytical Services-Asheville
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 11

Pace Analytical Services,LLC
® 9800 Ktncey Ave. Suite 100
aceAnalytical
Huntersville,NC 28078
www.pacelabs.cam
[phone]
ANALYTICAL RESULTS
Project: Great Oak LF
Pace Project No: 92562743
Sample: Pond 4 Lab ID: 92562743001 Collected: 09/22/21 08:25 Received: 09/22/21 15:05 Matrix:Water
Parameters Results Units Report Limit DF Prepared Analyzed CAS No. Qua!
2540D Total Suspended Solids Analytical Method:SM 2540D-2011
Pace Analytical Services-Eden
Total Suspended Solids 38.7 mg/L 3.6 1 09/24/21 13:31
5220D COD Analytical Method:SM 5220D-2011 Preparation Method:SM 5220D-2011
Pace Analytical Services-Asheville
Chemical Oxygen Demand 32.6 mg/L 25.0 1 10/01/21 02:32 10/01/21 06:08
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced,except in full,
Date:10/01/2021 02:57 PM without the written consent of Pace Analytical Services,LLC. Page 4 of 11

Pace Analytical Services,LLC
0 9800 Kincey Ave. Suite 100
aceAnalytical Huntersville,NC 28078
www.pacelabs.ccm [phone]
QUALITY CONTROL DATA
Project: Great Oak LF
Pace Project No.: 92562743
QC Batch: 649236 Analysis Method: SM 2540D-2011
QC Batch Method: SM 2540D-2011 Analysis Description: 2540D Total Suspended Solids
Laboratory: Pace Analytical Services-Eden
Associated Lab Samples: 92562743001
METHOD BLANK: 3405268 Matrix: Water
Associated Lab Samples: 92562743001
Blank Reporting
Parameter Units Result Limit Analyzed Qualifiers
Total Suspended Solids mglL ND 2.5 09/24/21 13:26
LABORATORY CONTROL SAMPLE: 3405269
Spike LCS LCS %Rec
Parameter Units Conc. Result %Rec Limits Qualifiers
Total Suspended Solids mg/L 250 232 93 90-110
SAMPLE DUPLICATE: 3405270
92562687001 Dup
Parameter Units Result Result RPD Qualifiers
Total Suspended Solids mg/L 94.7 103 9
SAMPLE DUPLICATE: 3405271
92562744001 Dup
Parameter Units Result Result RPD Qualifiers
Total Suspended Solids mg/L 84.8 42.1 67 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: 10/01/2021 02:57 PM without the written consent of Pace Analytical Services,LLC. Page 5 of 11

Pace Analytical Services,LLC
aceAnalytical® 9800 Kinsey Ave. Suite100
Huntersville,NC 28078078
www.pacelabs.com [phone]
QUALITY CONTROL DATA
Project: Great Oak LF
Pace Project No.: 92562743
QC Batch: 650288 Analysis Method: SM 5220D-2011
QC Batch Method: SM 5220D-2011 Analysis Description: 5220D COD
Laboratory: Pace Analytical Services-Asheville
Associated Lab Samples: 92562743001
METHOD BLANK: 3410789 Matrix: Water
Associated Lab Samples: 92562743001
Blank Reporting
Parameter Units Result Limit Analyzed Qualifiers
Chemical Oxygen Demand mg/L ND 25.0 10/01/21 06:04
LABORATORY CONTROL SAMPLE: 3410790
Spike LCS LCS %Rec
Parameter Units Conc. Result %Rec Limits Qualifiers
Chemical Oxygen Demand mglL 750 773 103 90-110
MATRIX SPIKE&MATRIX SPIKE DUPLICATE: 3410793 3410794
MS MSD
92562055001 Spike Spike MS MSD MS MSD %Rec
Parameter Units Result Conc. Conc. Result Result %Rec %Rec Limits RPD Qual
Chemical Oxygen Demand mg/L 372 100 100 482 479 109 107 90-110 1
MATRIX SPIKE&MATRIX SPIKE DUPLICATE: 3410838 3410839
MS MSD
92562672001 Spike Spike MS MSD MS MSD %Rec
Parameter Units Result Conc. Conc. Result Result %Rec %Rec Limits RPD Qual
Chemical Oxygen Demand mg/L 93.3 100 100 186 178 92 85 90-110 4 M1,R1
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:10/01/2021 02:57 PM without the written consent of Pace Analytical Services,LLC. Page 6 of 11

Pace Analytical Services,LLC
m
9800 Kincey Ave. Suite100
aceAnalytical
Huntersville,NC 28078078
www.pacetabs.com [phone]
QUALIFIERS
Project: Great Oak LF
Pace Project No.: 92562743
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 Chloroelhylvinyl ether.
A separate vial preserved to a pH of 4-5 is recommended in SW846 Chapter 4 for the analysis of Acrotein 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.
M1 Matrix spike recovery exceeded QC limits. Batch accepted based on laboratory control sample(LCS)recovery.
R1 RPD value was outside control limits.
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced,except in full,
Date: 10/01/2021 02:57 PM without the written consent of Pace Analytical Services,LLC. Page 7 of 11

Pace Analytical Services,LLC
aceAnalytical 9800 Kincey Ave. Suite 100
Huntersville,NC 28078
www.pacelabs.com [phone]
QUALITY CONTROL DATA CROSS REFERENCE TABLE
Project: Great Oak LF
Pace Project No.: 92562743
Analytical
Lab ID Sample ID QC Batch Method QC Batch Analytical Method Batch
92562743001 Pond 4 SM 2540D-2011 649236
92562743001 Pond 4 SM 5220D-2011 650288 SM 5220D-2011 650310
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced,except in full,
Date:10/01/2021 02:57 PM without the written consent of Pace Analytical Services.LLC. Page 8 of 11

•
CHAIN-OF-CUSTODY / Analytical Request Doi aCeArralytiGal The Chain-of-Custody is a LEGAL DOCUMENT.All relevant fields must WO 92562743
. Owe P.M sit CO.
Section A Section D Section C II 1111 I
1111111
II III ill
Required Client Information: Required Project Information: Invoice Information:
Company' Golder Associates.Inc Report 10 David Reedy Attention'. 92562743
Address: 50 Oak Drank Dr Copy To. Company Name
Greensboro.NC 27407 Address Regulatory Agency
Email: david reedyegolder corn Purchase Order It Pace Dude
Phone: [phone] !Fax Project Name Paco Protect Manager. [e-mail], State I Location
Requested Due Date: Project S. &r e♦7 0.t/t L.� Pace Profile U. 13239 NC
ct / 7/7 4 'Cr I Requested Analysis Filtered(YlRJ
2
MATRIX cone - ° COLLECTED Z Preservatives >- ,
d.oWegV uw ti a '.
Wales WI S '-
u
Waste Wale Wet _ W _ Z
SAMPLE ID j°;�'°'.' _ 0 START END tK rn r
I-
C
One Character per box. w'ne wn - w r m E 3
(A-Z,0-81,-) o,ne, or 8 m ! to — In o v
it Sample Ids must be unique r„�°a rs E. x m m o r, O eo (� m
W `r a 3 O =O rn t c Q '0 O w '°
~ ii DATE TIME DATE TIME ' o D I I 3 Z Z 2 0 to u r O
2
3
4
5
6
7
8
9
i 10
11
12 _
ADQ1T10NAL COMMENTS RELINQUISHED BY/AFFILIATION DATE TIME ' • ACCEPTED BY/AFFILIATION DATE - TIME - SAMPLE CONDDITTIONS
tSo ,„,
SAMPLER NAME AND SIGNATURE
c
PRINT Name of SAMPLER: c� ovi
0) f. •m
((0 SIGNATURE o1 SAMPLER: I DATE Signed: j v ? is $ m=
co r K a�Y Urw V}Z E rn_Y
0

I Dc,cJrnen:Name: .:-'enr^.C.,sei:OCt_�•Cer 23, 2_.=' I
I Sample Condition Upon Receipt(SCUR) I Gy_i. Page 1 of 2 1
�' /r"a eAcaI4icai 4 Dz,curnent No: o
Issu'ng AJthJ';t}
F-CAR•CS-033-Rev.07 Pace Ca-clinas Qua::r O c�
Laboratory receiving samples:
Asheville ❑ Eden Greenwood ❑ Huntersville ❑ Raleigh❑ Mechanicsville❑ Atlanta KernersvilleLj
eCondttiort.:}_• Client Name: I
`Rr_ 1Reoeipt-< .:;.: f I Project#:
(.. (-,'+/ !/ ` _ '_ ' '
Courier: ❑Fed Ex DUPS. ❑USPS imer,:
❑Commercial ❑Pace ❑Other.
Custody Seal Present? ❑Yes N. Seals Intact? ❑Yes io 0- -? 7 r 1
c r r l
Date/Initials Person Examining Contents:,
Packing Material: ❑Bubble Wrap ❑Bubble Bags Dion_ ❑ Other Biological Tissue Frozen?
Thermometer: -7 :Met ❑ace ❑hone Oyes ❑No C3rNjA
Drill Gun ID: t:._. `2- ( (./L ✓ Type of Ice:
Correction Factor: - -
Cooler Temp: ' s Add/Subtract('C) Temp should be above freezing to 6°C
•'\ ❑Samples out of temp criteria Samples on ice,cooing process
Cooler Temp Corrected VC):: f• I tb has begun
USDA Regulated Soil(DN/A,water sample)
D:d samples on inate in a quarar:ine zore wit!-in the United Slates:CA,NY,or SC(check macs)? Did samples originate from a foreign source(Internationally,
❑Yes ❑Doc ircluding Hawaii and Puerto Rico)?Des \❑N
Comments/Discrepancy:
Chain of Custody Present? Eyes ❑:o ❑rl/a 1.
i
Sarnales Ar"ived within Hold Time? 'Dies ❑`:a -❑;/A 2.
Short Hold Time Analysis(<72 hr.)? ,L-cfr-a • `i:, • ❑',;• j 3.
Rush Turn Around Time Requested? rive; Ei'I; [TVA 14.
SurficiertVolJme? Deis ❑No ❑ri.'A 1 5.
Correct Cortairer;Used? .Dyes ❑Nc ❑N/a 6
-Pace Containers Used? D're, ON; ON/A
'liner•r:a_t? Q':es riNo ❑N/A 7. -
C•,s:,oi.ed analysis:Samples Field Filtered? i-1Yes ❑rig EN:IA I a.
Samp:e Labels Ma:ch COC? Dyes ❑No ❑N/A 9.
-Includes Date/Time/ID/Analysis Matrix: �i�. ' 1
Headspace in VOA V a't(>5-6mm)? ❑Yes ❑>:a ONIA 10.
Trip Bank Present? Des r`.o Df'i;A _-.
' Trio Blank Custody Seats Present? ❑'yes [ho t NiA
COMMENTS/SAMPLE DISCREPANCY Field Data Required? Dyes ❑nio
. i1 if ' ' ( •ik7 1 . '
_; I
\ It ! 1 Lod ID o's .:-. a -rs.
CLIENT NOTIFICATION/RESOLUTION
Person contacted. Cate/Tine
Project Manager SCURF Review: Date:
Page 10 of 11
Project Manager SRF Review: Date:

F
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�/ '.::..,-.2.-:% y.,.� --- ._ `.2 :. ..1 C.._.- 2.. .._.
pp- s .r�• • S3M3r_Car,.;:ion Upon Reoe'pt'SCU`t , e-c'=
^ y
F-CAR-CS-033'Rev.0i — _ -3:?C? _ -3S C:3 •�Q= c
`Check mark top half of box if pH and/or dechlorination is Project r
verified and within the acceptance range for preservation
samples.
Exceptions.li_ .C:., drm,7:C,C.and Ore 3:v.:r.:,'3.:5('43:e'i: L—
*•Bottom half of box is to list number of bottles
� a . % '- - — < < < • > > > > — G ;,i `� .. < `V
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pH Adjustment Log for Preserved Samples
Samp121C 1 Tice of Preservative ( pH upon receipt Gat_pras?ro3;icr.ad;us;ed Time eras2rv3;:er•, I Amount of?rez2rrar•f•_ l_•7
1 ad;usted 1 I added
I I 1
ii.te, 'ii,An2•:?i t"2'2 iS 3 .:rip I ?: -Car..1:3 c:r',:''t' ?],3 l' 1
3^:'J�! :�f12 P��:r;'. �_c SS^:>"r .- �7':i S f:"tt II..!ieC:....^d�.� C]'3;,r,i C:r
Cut ci hc.d,,Barr?:.pres 3:;er, ve,out of temp,incorrect:ort3 n rs. ���,..- •••�C3',0�C1'fi:?(i.?.
Page 11 of 11