NCS000235_DMR_20220429

STORM WATER DISCHARGE OUTFALL(SDO)
MONITORING REPORT
Permit Number NCS: 000235 SAMPLES COLLECTED DURING CALENDAR YEAR: 2022
(This monitoring report shall be received by the Division no later than 30 days from _
the date the facility receives the sampling results from the laboratory.) "`' ._ '
cl��� ty
,:- d
FACILITY NAME: Southern Resin,Inc. COUNTY : Davidson
PERSON COLLECTING SAMPLE(S)_Brandon Conrad PHONE NO.[phone] •`.;' e, 2 y 2022 <i
CERTIFIED LABORATORY(S)_Pace Analytical Lab#_704-977-0981_ • a
CERTIFIED LABORATORY _Analytical Environmental Services_Lab#_800-972-4889_
SIGNATURE OF PERMITTEE OR DESIGNEE., a; Ji-,,ce
REQUIRED ON PAGE 2.
Part A: Specific Monitoring Requirements
Outfall Date 50050
No. Sample Total Total Formaldehyde COD NH3-N NO2+NO3 TKN Zinc pH
Collected Flow(if app.) Rainfall
mo/dd/yr MG inches Mg/I Mg/I Mg/I Mg/I Mg/I Mg/I Std
units
Bench Mark .49 120 7.2 .68 20 .126 6-9
SWO1 04/07/2022 1.7 .076 87.7 .63 .076 4.3 .012 7.1
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month?___yes X no
(if yes,complete Part B)
Part B: Vehicle Maintenance Activity Monitoring Requirements
Outfall Date 50050 00556 00530 00400
No. Sample Total Flow Total Oil&Grease Non-polar Total pH New Motor
Collected (if applicable) Rainfall (if appl.) O&G/TPH Suspended Oil Usage
(Method 1664 Solids
SGT-HEM),if
appl.
mo/dd/yr MC inches mg/I mg/1 unit gal/mo
Form SWU-247,last revised 2/2/2012
Page 1 of 2

STORM EVENT CHARACTERISTICS: Mail Original copy to:
Land Quality Section,Winston-Salem Regional Office
Date 04-07-2022 Division of Energy,Mineral and Land Resources
Total Event Precipitation(inches): 1.7 North Carolina Department of Environmental Quality
Event Duration(hours): (only if applicable—see permit.) 450 West Hanes Mill Road,Suite 300
Winston-Salem,NC 27105-7407
(if more than one storm event was sampled)
Date
Total Event Precipitation(inches):
Event Duration(hours): _ (only if applicable—see permit.)
"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 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."
A---- '1/Z 74. z—
(Signature of Permittee) (Date)
Form SWU-247,last revised 2/2/2012
Page 2 of 2

Pace Analytical Services,LLC
0 1377 South Park Drive
ace Analytical Kemersville,NC 27284
rww.paahbston - • ;.)i [phone]
E;f.vironr:_fr-i. , : s!ity
P,L:c,-2jv:_ci Page 1 of 1
')nn
APR 29 2
Laboratory Report Winston-Salem
Regional Office
Brandon Conrad Report Date: 04/20/2022
Southern Resin Date Received: 04/07/2022
3440 Denton Road
Thomasville, NC 27360
Project: Southern Resin
Pace Project No.:92597722
Sample: SW 01 Outfall Lab ID: 92597722001 Collected: 04/07/22 09:45 Matrix: Water
Method Parameters Results Units Report Limit Analyzed Qualifiers
SM 4500-H+B-2011 pH at 25 Degrees C 7.1 Std.Units 0.10 04/08/22 14:57 H3
EPA 200.7 Rev 4.4 1994 Zinc 12.1 ugiL 10.0 04/12/22 18:56 BC
TKN+NO3+NO2 Total Nitrogen 4.4 mg/L 0.040 04/20/22 11:37
Calculation
EPA 350.1 Rev 2.0 1993 Nitrogen,Ammonia 0.63 mg/L 0.10 04/15/22 12:25
EPA 351.2 Rev 2.0 1993 Nitrogen,Kjeldahl,Total 4.3 mg/L 0.50 04/20/22 03:08
EPA 353.2 Rev 2.0 1993 Nitrogen,NO2 plus NO3 0.076 mg/L 0.040 04/14/22 14:53
SM 5220D-2011 Chemical Oxygen Demand 87.7 mg/L 25.0 04/14/22 04:52
ANALYTE QUALIFIERS
BC The same analyte was detected in an associated blank at a concentration above 1/2 the reporting limit but below the
laboratory reporting limit.
H3 Sample was received or analysis requested beyond the recognized method holding time.
Reviewed by:
Stephanie Knott
704-977-0981
[e-mail]
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 VirginiaNELAP 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 VirginiaNELAP Certification#:460025
Page 1 of 12

SIR SPEEDY PRINTING CENTER • MINNEAPOUS,MN 55414 • 612-378-7778
WO## : 92597722 -
CHAIN-OF-CUSTODY Analytical Request Document LAB USE ONLY-Affix Worko� I
MT; Ill
II'I111111
IIIIIIIIIPace AnalyticalChain-of-Custody is a LEGAL DOCUMENT-Complete all relevent fields Ill Company: Billing Information
� L4\ ,( . /R ZS ALL SHADED AR._--_._ -_
Address: ��� Container Preservative Type•• Lab Project Manager:
3y,tO ,DeeN .�, l ihm.se,)!e 1 1 1 1 1 1 1 1 1
Report To: Email To: ••Preservative Types:(1)nitric acid,(2)sulfuric acid,(3)hydrochloric acid,(4)sodium hydroxide,(5)zinc acetate,
) "'r : a(),-k5 1""IY..tS 5l:Alteec\rzSiYN,,C.Lx~`
(6)methanol,(7)sodium bisulfate.(8)sodium thlosulfate.(9)hexane,(A)ascorbic acid,(8)ammonium sulfate,
Copy To: Site Collection Info/Address: (C)ammonium hydroxide,(D)TSP,(U)Unpreserved.(0)Other
e Analyses Lab Profile/line:
Customer Project Name/Number: State: County/City: Time Zone Collected: I Lab Sample Receipt Checklist:
L � U.-VC I i / / ( IPTI IMT[ ICT I )ET
/ " C, ( Custody Seals Present/Intact Y N NA
Phone: ,) ,I Site/Facility ID A: Compliance Monitoring' Custody signatures Present Y N NA
Email: f ��SC fo Ek e'N ci «%^_, [ ) Yes [ J No Collector Signature Present Y N HA
L Bottles Intact Y N HA
Collected By(print): Purchase Order A: DW PWS ID B: _ Correct Bottles Y N NA
34 Sufficient Volume Y N NA
(t:,oY, i�ruS Quote q: DW Location Code:
Sample° Received on Ice Y N NA
Collected By(signature): Turnaround Date Required: Immediately Packed on Ice: ::..'4n VOA - Headapace Acceptable Y N NA
I IYes ( JNo Cr-r USDA Regulated Roils Y N NA
(, samples in 'folding Time Y H NA
Sample Disposal: Rush: Field Filtered(if applicable): V Roeidual Chlorine Present Y H NA
I )Dispose as appropriate ( I Return I )Same Day I I Next Day [ I Yes [ I No 1 i j Cl Strips: _
( I Archive: I J 2 Day ( J 3 Day ( J 4 Day I I S Day y Sample pH Acceptable Y N NA
I I Hold: _ 8 Apply) Analysis: -� r pH Stripe:
(fxpedite Charges ,7 t 2 Sulfide Present Y H NA
'd i Lead Acetate Striper
•Matrix Codes(Insert in Matrix box below):Drinking Water(OW),Ground Water(OW),Wastewater(WW), - -
Product(P),Soil/Solid(Si),Oil(OL),Wipe(WP),Air(AR),Tissue(TS),Bioassay(It),Vapor(V),Other(OT) 7, /
/^, 'a J LAD USE ONLY:
Comp/ Collected(or Res N of 6, "- ,( c Lab Sample a / Comments
Customer Sample ID Matrix• Grab Composite Start) Composite End Cl Ctns O
Date Time Date Time
S;v l 0-4 J I 1417- q:i1, Lq? ' q:Lir J J . -I ✓ ✓ 'i
Customer Remarks/Special Conditions/Possible Hazards: Type of Ice Used: /P Blue Dry None SHORT HOLDS PRESENT(02 hours): Y N N/A Lab Sample Temperature Info:
Packing Material Used: Lab Tracking Si: Temp Blank Received:T Y N .,NA
2 6 0 3 5 9 5 Therm IDM: 4(/ o D fi
Cooler I Temp Upon Receipt:3 oC
Samples received via: Cooler 1 Therm Corr.Factor: 0 oC
Radchem sample(s)screened(<S0O cpm): Y N NA FEDEX UPS Client ouner Pace Courier Cooler 1 Corrected Temp: 3 _oC
Relinquished by/Company:(Signature) Date/Time:Ti� "'le Received by/Comp :(Signature) Datee//Time:: MTiL LAB USE ONLY Comments:
�- �! [[ Lt'������/A� 4(,,,----"'
4/I�L F I 1 ID 7 able p:
Acctnum
Relinquished by/Company:(Signature) Date/Time: �tecerved by/C yature) Date/Time:ry Template: Trip Blank Received: Y N NA
o Prelogin: HCL McOH TSP Other
Relinttbished by/Company:(Signature) Date/Time: Received by/Company:(Signature) Date/lime: PM: Non Conformance(s): Page:
PB: YES / NO of:

Document Name: Document Revised:November 15,2021
Sample Condition Upon Receipt(SCUR) Page 1 of 2
aceAnalftical Document No.: Issuing Authority:
F-CAR-CS-033-Rev.08 Pace Carolinas Quality Office
Laboratory receiving samples:
Asheville ❑ Eden Greenwood ❑ Huntersville❑ Raleigh Mechanicsville❑ Atlanta❑ Kernersville[tt—
Sample Condition Client Name:
•UponReceipt Project ft:
if 0 ICI e vn
Courier: ❑Fed Ex CUPS ❑USPs [Client ElCommercial ❑Pace ['Other: to e J I h
Custody Seal Present? ['Yes ❑lco Seals Intact? DYes Di
Date/Initials Person Examining Contents: TT
Packing Material: ❑Bubble Wrap ❑Bubble Bags Elgrne ❑ Other Biological Tissue Frozen?
Thermometer: _ Dyes ❑No 1/A
0 IR Gun ID: �—�i O O Z Wet ['Blue I.]None
Type of Ice;
Correction Factor:
Cooler Temp: 2 Add/Subtract C C) Temp should be above freezing to 6'C
❑Samples out of temp criteria.Samples on ice,cooling process
Cooler Temp Corrected('C): 3 . O has begun
USDA Regulated Soil(❑N/A,water sample)
Did samples originate in a quarantine sane within the United States:CA,NY,or SC(check maps)? Did samples originate from a foreign source(Inzsuponally,
[(Yes -No Including Hawaii and Puerto Rico)?Dyes 0No
Comments/Discrepancy:
Chain of Custody Present? r<s ❑No DNA 1.
Samples Arrived within Hold Time? es °No ON/A 2.
Short Hold Time Analysis(<72 hr.)? nes [ No UN/A 3.
��°,,
Rush Turn Around Time Requested? ❑Yes l�oNo� ON/A 4.
Sufficient Volume? ecs ❑No ON/A 5.
Correct Containers Used? ❑No ON/A 6.
-Pace Containers Used? Bres ❑No ON/A
_�
Containers intact? tire's (]No ON/A 7.
Dissolved analysis:Samples Field Filtered? Eves ❑Na fi.ork 8.
Sample Labels Match COC? es ❑Na ON/A 9.
-Includes Date/Time/iD/Analysis Matrix:_,
Headspace in VOA Vials(>5-6mm)? ❑Yes ❑Na KI/A 10.
I Trip Blank Present? ❑Yes ❑No frN/A 11.
Trip Blank Custody Seals Present? ales ❑No N/A
COMMENTS/SAMPLE DISCREPANCY Field Data Required? Oyes ❑No
Lot ID of split containers:
CH ENT NOTIFICATION/RESOLUTION
Person contacted: Date/Time:
Project Manager SCURF Review: Date:
Project Manager SRF Review: Date:
Page 3 of 12

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i;,".s . ANALYTICAL ENVIRONMENTAL SERVICES, INC.
lens,
AES
April 12,2022
Stephanie Knott
Pace Analytical
1377 South Park Dr
Kcrosville NC 27284
RE: 92597722
Dear Stephanie Knott: Order No: 2204966
Analytical Environmental Services,Inc.received 1 samples on 4/8/2022 9:27:00 AM
for the analyses presented in following report.
"No problems were encountered during the analyses except as noted in the Case Narrative or by qualifiers in
the report or QC Summary.Additionally,all results for the associated Quality Control samples were within
EPA and/or AES established limits.
AES'certifications are as follows:
-NELAP/Florida State Laboratory ID E87582 for analysis of Non-Potable Water,Solid&Chemical Materials,
Air&Emissions for Organics,and Drinking Water Microbiology&Metals,effective 07/01/21-06/30/22.
-North Carolina Certification number 562 for analysis of Surface Water,Groundwater,Effluent,effective until
12/31/22.
-South Carolina Environmental Laboratory Certification number 98016003 effective until 6/30/22.
These results relate only to the items tested as received. This report may only be reproduced in full and with
written permission from the laboratory.
If you have any questions regarding these test results,please feel free to call.
Sincerely,
•
tCV/A4. 1/1 Gp0`24-e4-
Paris Masoudi
Project Manager
;ccstt I'r....1.•nt.] t)r,ve • Itlanta,Ge.,roa 30340 • 'I'rl: 770.457.81 77 • Fax: [phone] • Tell Fret.:800.972.4889
www.aesatlunta." Page 5 of 12
Page 1 of 8

vrA'/n—(/n a
Z 204 1 lf/ w
Chain of Custody
®
PASI Charlotte Laboratory aceAnalytical lJ
II11I111110111[n1QIII1aI1lI1 II vriew.pacelattscaro
Workorder. 92597722 Workorder Name: Southern Resin Results Requested By: 4/21/2022
Report I invoice To Subcontract To • , • _.._ _ isquested Analysis -
Stephanie Knott
Pace Analytical Kemersville AES P.O. SJK040722
1377 South Park Drive 3080 Presidential Drive
Kemersville,NC 27284
Phone [phone] Atlanta,GA 30340
Email:[e-mail] It
7
State of Sample Origin: NC -_Preserved Contalners4'
:, j
>' 4 2
Item ' ;Sample ID. Daffi/Ttme Lab ID Matr6t g LAB USE ONLY
_
1 SW 01 Outfan 4/7/2022 09:45 92597722001 Water 2 X
2
4 ,
5 _ .
Co
Transfers I@ ed By DateITimo nefitoceived BY ,f DatelTlme
1(
2
3 Vi
rr/zz 9:,z74
Cooler Temperature on Receipt °C 1 Custody Seal Y N I Received on Ice Y or N I Samples Intact Y or N
-u
a,
ca
m
°' Thursday,April 07,2022 3:28:59 PM FMT-ALL C-002rev.00 24March2009
o PPage 1 of 1
M
Page 2 of 8

Analytical Environmental Services,Inc Date: 12-Apr-22
Client: Pace Analytical
Project: 92597722 Case Narrative
Lab ID: 2204966
Formaldehyde by SW8315A:
Since North Carolina does not offer certification for Formaldehyde by SW 8315A,per regulation,the laboratory is required to
report the results as uncertified.The results for Formaldehyde by SW8315A are therefore reported as uncertified.
Page 7 of 12
Page 3 of 8

Analytical Environmental Services,Inc Date: 12-Apr-22
Client: Pace Analytical Client Sample ID: SW 01 OUTFALL
Project Name: 92597722 Collection Date: 4/7/2022 9:45:00 AM
Lab ID: 2204966-001 Matrix: Aqueous
Analyses Result Reporting Dilution
Qual Units BatchiD Date Analyzed Analyst
Limit Factor
Formaldehyde by SW8315A
Formaldehyde 76 50 ug/L 334009 I 04/08/2022 17:27 DS
Qualifiers: • Value exceeds maximum contaminant level E Estimated(value above quantization range)
BRL Below reporting limit S Spike Recovery outside limits due to matrix
H Holding times for preparation or analysis exceeded Nets See case narrative
N Analytc not NELAC ccrtified F Analyzed in the lab which is a deviation from the method
B Analyze detected in the associated method blank < Less than Result value
> Greater than Result value 1 Estimated value detected below Reporting Limit
Page 8 of 12
Page 4 of 8

� Clear Save as
!` CAL
..d IENWto m1E'.N'1'A1.
AES SERVICES,INC. SAMPLE/COOLER RECEIPT CHECKLIST
1. Client Name: Pace Analytical AES Work Order Number: 2204966
2. Carrier: FedEx Q UPS ` USPS❑ Client ID CourierT] Other
Yes No N/A Details Comments
3.Shipping container/cooler received in good condition? • damaged [ f leaking U other[
4. Custody seals present on shipping container? •
5.Custody seals intact on shipping container? •
6.Temperature blanks present? • 0
7 Cooler temperature(s)within limits of 0-6'C?(See item 13 and 14 for Q O O Cooling initiated for recently collected samples/ice
temperature recordings.) present❑
8. Chain of Custody(COC)present? 0
9. Chain of Custody signed,dated,and timed when relinquished and received? 0
10. Sampler name and/or signature on COC? ` •
11. Were all samples received within holding time? 0
12. TAT marked on the COC? • If no TAT indicated,proceeded with standard TAT per Terms&Conditions. [I
13. Cooler 1 Temperature 2.7 °C Cooler 2 Temperature °C Cooler 3 Temperature °C Cooler 4 Temperature °C
14. Cooler 5 Temperature °C Cooler 6 Temperature °C Cooler 7 Temperature °C Cooler 8 Temperature °C
15. Comments:
I certify that I have completed sections 1-15(dated initials). KH 4/8/22
Yes No N/A Details Comments
16.Were sample containers intact upon receipt? • •
17. Custody seals present on sample containers? •
18. Custody seals intact on sample containers? 0
19. Do sample container labels match the COC? O O 0 incomplete info ❑ Illegible ❑
no label ❑ other ❑
20. Are analyses requested indicated on the COC? 0 O 0
21. Were all of the samples listed on the COC received? 0 O © samples received but not listed on COC ❑
samples listed on COC not received ❑
22. Was the sample collection date/time noted? 0
23. Did we receive sufficient sample volume for indicated analyses? 0
24. Were samples received in appropriate containers? 0
25.IWere VOA samples received without headspace(<1/4"bubble)?
0 •
26. Were trip blanks submitted? • listed on COC ❑ not listed on COC ❑
27. Comments:
This section only applies to samples where pH can be I certify that I have completed sections 16-27(dated initials). SH 4/8/22
checked at Sample Receipt. Yes No N/A Details Comments
28. Have containers needing chemical preservation been checked?• 0
29. Containers meet preservation guidelines? 0
V. Was pH adjusted at Sample Receipt? 0
co
m *Note:Certain analyses require chemical preservation but must be checked in the laboratory and not upon Sample Receipt such as Coliforms,VOCs and Oil&Grease/TPH.
oI certify that I have completed sections 28-30(dated initials). SH 4/8/22
This also excludes metals by EPA 200.7.200.8 and 245.1 which will be verified between 16 and 24 hours after preservation.
N
Locked
Checklist 7.9.20 Rev 3 Page 5 of 8

Analytical Environmental Services, Inc Date: 12-Apr-22
Client: Pace Analytical
Project Name: 92597722 Dates Report
Lab Order: 2204966
Lab Sample ID Client Sample ID Collection Date Matrix Test Name TCLP Date Prep Date Analysis Date
2204966-001A SW 01 OUTFALL 4/7/2022 9:45:00AM Aqueous Formaldehyde by SW8315A 4/8/2022 2:52:05PM 04/08/2022
Page 10 of 12
Page 6 of 8

Analytical Environmental Services,Inc
Date: 12-Apr-22
Client: Pace Analytical ANALYTICAL QC SUMMARY REPORT
Project Name: 92597722
Workorder: 2204966 BatchID: 334009
Sample ID: MB-334009 Client ID: Units: ug/L Prep Date: 04/08/2022 Run No: 482604
SampleType: MBLK TestCode: Formaldehyde bySW8315A BatchlD: 334009 Analysis Date: 04/08/2022 Seq No: 11179869
Analyte Result RPT Limit SPK value SPK Ref Val %REC Low Limit High Limit RPD Ref Val %RPD RPD Limit Qual
Formaldehyde BRL 50
Sample ID: LCS-334009 Client ID: Units: ug/L Prep Date: 04/08/2022 Run No: 482604
SampleType: LCS TcstCode: Formaldehyde by SW8315A BatchID: 334009 Analysis Date: 04/08/2022 Seq No: 11179870
Analyze Result RPT Limit SPK value SPK Ref Val %REC Low Limit High Limit RPD Ref Val %RPD RPD Limit Qual
Formaldehyde 971.2 50 1000 97.1 70 130
Sample ID: 2204654-001BMS Client ID: Units: ug/L Prep Date: 04/08/2022 Run No: 482604
SampleType: MS TestCode: Formaldehyde by SW8315A BatchlD: 334009 Analysis Date: 04/08/2022 Seq No: 11179877
Analyte Result RPT Limit SPK value SPK Ref Val %REC Low Limit I ligh Limit RPD Ref Val %RPD RPD Limit Qual
Formaldehyde 4426 250 5000 44.40 87.6 49.4 135
Sample ID: 2204654-001BMSD Client ID: Units: ug/L Prep Date: 04/08/2022 Run No: 482604
SampleType: MSD TcstCode: Formaldehyde bySW8315A BatchlD: 334009 Analysis Date: 04/08/2022 Seq No: 11179878
Analyte Result RPT Limit SPK value SPK Ref Val %REC Low Limit High Limit RPD Ref Val %RPD RPD Limit Qual
— I
Formaldehyde 4724 250 5000 44.40 93.6 49.4 135 4426 6.52 26.4
Qualifiers: > Greater than Result value < Less than Result value B Analyte detected in the associated method blank
BRL Below reporting limit [ Estimated(value above quantitation range) II Holding limes for preparation or analysis exceeded
) Estimated value detected below Reporting Limit N Analyte not NELAC certified R RPD outside limits due to matrix
Rpt lint Reporting Limit S Spike Recovery outside limits due to matrix Page 11 of 12
Page 7 of 8