NCS000235_DMR_20220325

NC Department of
Environmental Quality
Received
STORMWATER DISCHARGE OUTFALL(SDO)
MONITORING REPORT MAR 2 5 2022
Permit Number NCS: 000235 SAMPLES COLLECTED DURING CALENDAR YEAR: 202Vinston-`_.2 lem
(This monitoring report shall be received by the Division no lateR,11.14egfildsm
the date the facility receives the sampling results from the laboratory.)
FACILITY NAME: Southern Resin,Inc. COUNTY : Davidson
PERSON COLLECTING SAMPLE(S)_Brandon Conrad PHONE NO.[phone]
CERTIFIED LABORATORY(S)_Pace Analytical Lab# 704-977-0981_
CERTIFIED LABORATORY _Analytical Environmental Services_Lab#_800-972-4889_
SIGNATURE OF PERMITTEE OR DESIGNEE
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/1 Mg/I Mg/I Mg/I Mg/I Std
units
Bench Mark .49 120 7.2 .68 20 .126 6-9
SWOT 03/09/2022 1.9 .17 41.8 .18 .18 2.4 .013 7.3
I
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 MG inches mg/I mg/I 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 03-09-2022 Division of Energy,Mineral and Land Resources
Total Event Precipitation(inches): 1.9 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 knowled, :nd belief,tru' • = urate,and complete. I am aware that there are significant penalties for submitting false information,
including the pi • of -. s a• s imp sonment for knowing violations."
3 /ZI/z.z,
(Si. ature of Permittee) (Date)
Form SWU-247,last revised 2/2/2012
Page 2 of 2

Pace Analytical Services,LLC
0 1377 South Park Drive
aceAnalytical
Kernersville,NC 27284
www.Dacelabs.com [phone]
Page 1 of 1
Laboratory Report
Brandon Conrad Report Date: 03/22/2022
Southern Resin Date Received: 03/09/2022
3440 Denton Road
Thomasville. NC 27360
Project: Southern Resin
Pace Project No.:92592206
Sample: SW01 Outfall Lab ID: 92592206001 Collected: 03/09/22 08:15 Matrix: Water
Method Parameters Results Units Report Limit Analyzed Qualifiers
SM 4500-H+B-2011 pH at 25 Degrees C 7.3 Std.Units 0.10 03/10/22 15:39 H3
EPA 200.7 Rev 4.4 1994 Zinc 13.2 ug/L 10.0 03/15/22 22:02
TKN+NO3+NO2 Total Nitrogen 2.5 mg/L 0.040 03/22/22 17:55
Calculation
EPA 350.1 Rev 2.0 1993 Nitrogen,Ammonia 0.18 mg/L 0.10 03/22/22 11:42
EPA 351.2 Rev 2.0 1993 Nitrogen,Kjeldahl.Total 2.4 mg/L 0.50 03/22/22 05:25
EPA 353.2 Rev 2.0 1993 Nitrogen,NO2 plus NO3 0.14 mg/L 0.040 03/22/22 09:36
SM 5220D-2011 Chemical Oxygen Demand 41.8 mg/L 25.0 03/22/22 05:23
ANALYTE QUALIFIERS
H3 Sampleam; _was received or analysis requested beyond the recognized method holding time.
Reviewed by: '- "Y"""nce—/G/t Qt
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 11

e CHAIN-OF-CUSTODY Analytical Request Document LAB USE ONLY-Affix Workorder/Login Label Here or List Pace Workorder Number or
PaceAnalytica� MTJL Log-in Number Here
Chain-ol-Custody is a LEGALDCIation- -Complete all relevent fields �O w w�/�/1n0G
Company: Billing Information• 9-2. 922 6
ALL SH
Address I Caltainer,Pres Ilvatuvi \I\1I
ItItIlliti
`
3�yo }or ��1 fI lI I
Report 1 e: �/��./� �/1•1t/�^ [mail To: ,. ••Preservative Types:(I)nitric acid,(2)
J1-Q1Wx \ COnrc.c1 (--cN ,.("' 5t:`^4I`er-1r1CeS iv).fcil (6)methanol,(7)sodium bisulfate.IS)so 92g92206
tint SUII.IIe,
Copy To: `` 11 `` Site Collection Info Address: (C)ammonium hydroxide,ID)ISP,(N)IJn1,.,..". ..,tut uuu•t
K�tZen.l�2: SG.}Is2<1:25•s'ILCT� ,tr,,e Analyses LabProhte/Line:
Customer Project Name/Number. State: County/City: Time Zone Collected: L..b Sample Receipt Checklist:
/ I )PTI 1MTI )CT I JET
S Custody Seals Present/Intact Y fir NA
Phone: Site/Facility ID If Compliance Monitoring? •., Custody Signatures Present r tr NA
Email: Ce :IL ( I Yes ( )No �i Collector Signature Present. N NA
Bottles Intact is !IA
CoIIe ed By(pant) Purchase Order if DW PWS ID H: correct Bottles p it NA
rtU:NC:100 I Quote II: DVJ Location Code: --,-.3 Sufficient Volume .�^rQ� N NA
NZ{ Samples Feceived on ice LS N NA
Collected B g ore ImmediatelyPacked on Ice:
Tumaround Date Required: VOA - Readspace Acceptable Y rl te
J )Yes I I No441
USDA Regulated Soils )' dV IlA
- ^�'. ::amples in Holding Time al It NA
Sa a Disposal. Rush: Field Filtered(if applicable): cy J Res ideal Chlorine Present Ir0 NA
( J Dispose as appropriate I I Return J J Same Day ( J Next Day ( J Yes ( J No —1- cl Strips: at4) ___
Day Day I IDay I J y E.
i.
.,� Sample phi Accept able t9 H II:.
I jArchive I (2I J34SUa ^''
I I Hold: _ (Expedite CharAnalysis: r.. ..// C t— pH Strips: _. �•)--i�-l4,�t�/ __
f Charges Apply) %ii i Sulfide Present I II Ie
'Matrix Codes(Insert in Matrix hex below):Drinking Water(DW),Ground Water(GW),Wastewater(WW). Q� Lead Acetate Strips: M
Product(P).Soil/Solid(SL).Oil(OL),Wipe(WP).Air(AR),Tissue(TS),Bioassay(B),Vapor(V),Other(OT) �JC
Lie USL• ONLY:
Cornp/ C011ecled(or Rey trof t,) z- `Y ,C Z Lab Sample e / Comments:
Customer Sample ID Matrix• Composite End :,
P Grab Composts Start) CI Ctns U L" 1-' N
Date Time Date Time
50.)c I o:. -\\ '3f q e:DO 319 _ (3If is ✓ I x/ - J -1 ,/ .1
`
Customer Remarks/Special Conditions/Possible Hazards: Type of Ice Used: Wet Blue Dry None SHORT HOLDS PRESENT(<72 hours): Y N N/A Lab Sample Temperature Info:
Temp Blank Received Y ill NA
Parking Material Used: Lab Tracking N: 2 6 0 3 5 0 2 Therm IDII: •--<7 5./2.-
Cooler I Temp Upon Receipt:$,I oC
Radchem sample(s)screened(<500 epee): Y N NA Samples received via: Cooler I Therm Corr.FactoroC
FEDEX UPS Client Courier Pace Courier Cooler I Corrected Temp: oC
Relinquished by/Con an • 6igna Dates/Time: t Received// by/Company.(Signature) �Daate/Time: J 0,1 4 MTJL LAB USE ONLY Comments:
la C ��� -
Atctnum:
Reim:nu:shed by/Company:(Signature) Date/Tune: Received by/Company:(Signature) Date/Time:
m Template: Trip Blank Received: Y (S NA
to HCL McOli TSP Other
o Prelogin:
Re�m-u ,fished by/Company.(Signature:) Date!ttrre: Received by/Company:(Signature) Date/Time- PM:
Nnn Contormanre(s); Pape:_
PR: YES / NO of _

L`40£ ed Document Name: Document Issued:November 15,2021
Bottle Identification Form(BIF) Page 1 of 1 _
,' f"aceAnalytica/ Document No.: IssuingAuthority:
ty
F-CAR-Cs-043-Rev.01 Pace Carolinas Quality Office
*Check mark top half of box if pH and/or dechlorination is Project#
verified and within the acceptance range for preservation
samples.
Exceptions:VOA,Coliform,TOC,Oil and Grease,DR0/8015(water)DOC,LLHg
**Bottom half of box is to list number of bottles
Z
Z
d
_ v a s
7.
a zzr
Z Z ZNN z ,N' CZ _
ON U ` � a v , < { .
, g
w v a2' Z a a is 21 a Z v c„, D. •a I Z z i u ` Y vl Z Z O
a a d N sr Ei ' 0 x v d 2 z I
g a a u O O < x 'o .a a a a r E ` m o 2 ry o r ,
c c c `^ < 0 tl7 a c 9 N � E 2 ON o c O a i S c I c ,
n N Z z '� c v < ,n O v' 7 m w z D o
u u u 7 , u ^� V _ I U ' n C m n v a: I `O
m A m .N , r) m w o a a E - E N < < < < d r� `, o E c
J J J a J J E. E < < < J .L O O y .� M J J -� N i
E
E E E a E E E E Cr) `m E a E m E E E o E E E o E 1
N u0i O — N U1 .N-' N - ~ _ O p O O v N ,� ,O O O
Ul O
x •-' N V1 ,-' . N rl 7 7 r...1 ,y N O a C v Q m .+ N N N
A P m 7 6 N 2 N m W Z Z M 'A < S F Z d Y Y F- < > > -
7 •
o E v m N .. a m o a t7 N m ,I m m m m m a+ < 0 'n N m o i w l c
d co a a a a a a a t7 `4 t7 l9 t7 t7 t7 ig t9 O . Si Si m ¢ > C m m r
m m m m m < < < < < Q C ?
I �
1 \ \ i 2 \
2 \ \
3
\\,
4
6 \ \ i___ .
7 \
I �
8
I i
9 \
10 I
11
\\
IC\ *' .\ I \ \
Ili
pH Adjustment Log for Preserved Samples _ _
Sample ID Type of Preservative I pH upon receipt Date preservation adjusted ' Time preservation Amount of Preservative Lot a
adjusted added
1
Note: Whenever there is a discrepancy affecting North Carolina compliance samples,a copy of this form will be sent to the North Carolina DFHNR Certification Office(i.e.
Out of hold,incorrect preservative,out of temp,incorrect containers.

:;,'`::• ANALYTICAL ENVIRONMENTAL SERVICES, INC.
stlm., •
AES
March 16,2022
Stephanie Knott
Pace Analytical
1377 South Park Dr
Kernsville NC 27284
RE: 92592206
Dear Stephanie Knott: Order No: 2203C58
Analytical Environmental Services,Inc.received 1 samples on 3/10/2022 9:05:00 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,
Pam 0/3024-64,
Paris Masoudi
Project Manager
3080 l'r.,nlvntial l)riv.. • Atlanta, u..nrgia 30 340 • Tel: [phone] • Fax:[phone] • Toll Free:800.972.4889
www.aeEallanta.c Page 4 of 11
Page 1 of 8

—.� do.03c5 '
Chain of Custody
PAST Charlotte Laboratory `aceAnalytical0
111111111111111111111111111111111 onn`°
Workorder: 92592206 Workorder Name: Southern Resin Results Requested By: 3/23/2022
Report/Invoice To j Subcontract To :Requested Analysis
Stephanie Knott
Pace Analytical Kemersville AES P.O. S1K030922
1377 South Park Drive 3080 Presidential Dr.
Kemersville,NC 27284 Atlanta,GA 30340
Phone [phone]
Email:[e-mail]
State of Sample Origin: NC preserved Containers
• o
D LL'
Collect
Item Sample ID Date/Time Lab ID Matrix LAB USE ONLY
—1 SWo1 Outfall 3/9/2022 08:15 92592206001 Water 2 X
2
3
4
5
Comments
Transfers _.••t,= V-062*
Date/Tfine n ileaeceived By Date/Time
2
3
Cooler Temperature on Receipt °C I Custody Seal Y or N I Received on Ice Y or N I Samples Intact Y or N
-u
v
N Wednesday,March 09,2022 4:07:07 PM FMT-ALL-C-002rev.00 24March2009 Page 1 of 1
Page 2 of 8

Analytical Environmental Services,Inc Date: I6-Mar-22
Client: Pace Analytical
Project: 92592206 Case Narrative
Lab ID: 2203C58
Formaldehyde by SW8315A:
Since North Carolina does not offer certification for Formaldehyde by SW8315A,per regulation,the laboratory is required to
report the results as uncertified.The results for Formaldehyde by SW8315A are therefore reported as uncertified.
Page 6 of 11
Page 3 of 8

Analytical Environmental Services,Inc Date: 16-Mar-22
Client: Pace Analytical Client Sample ID: SW01 OUTFALL
Project Name: 92592206 Collection Date: 3/9/2022 8:15:00 AM
Lab ID: 2203C58-001 Matrix: Aqueous
Reporting Dilution
Analyses Result Qual Units BatchID Date Analyzed Analyst
Limit Factor
Formaldehyde by SW8315A
Formaldehyde 170 50 ug/L 332345 1 03/11/2022 18:44 TO
Qualifiers: • Value exceeds maximum contaminant level E Estimated(value above quantitation range)
BRL Below reporting limit S Spike Recovery outside limits due to matrix
H Holding times for preparation or analysis exceeded Narr Scc case narrative
N Analyse nut NELAC certified F Analyzed in the lab which is a deviation front the method
B Analvte detected in the associated method blank < Less than Result value
> Greater than Result value 7 Estimated value detected below Reporting Limit Page 7 of 11
Page 4 of 8

Clear Save as
apANALYTICAL
ENVIRONMENTAL
AES SAMPLE/COOLER RECEIPT CHECKLIST
AES SgRVICFS.INC.
1. Client Name: PACE ANALYTICAL AES Work Order Number: 2203C58
2. Carrier: FedEx n UPS I-1 USPS[ I Client( _I Courier( I Othei
Yes No N/A Details Comments
3. Shipping container/cooler received in good condition? • damaged ❑ leaking ❑ other❑
4. Custody seals present on shipping container? •
5. Custody seals intact on shipping container? •
6. Temperature blanks present? • O
Cooler temperature(s)within limits of 0-6°C?[See item 13 and 14 for • O O Cooling initiated for recently collected samples/ice
7 temperature recordings.] present❑
8. Chain of Custody(COC)present? 0 I
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? 0 If no TAT indicated,proceeded with standard TAT per Terms&Conditions. I I
13. Cooler 1 Temperature 2.1 °C Cooler 2 Temperature °C Cooler 3 Temperature °C Cooler 4 Temperature °C
14. Cooler S 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). CW 3/10/22
Yes No N/A Details Comments
16. Were sample containers intact upon receipt? i
17. Custody seals present on sample containers? •
18. Custody seals intact on sample containers? •
O O ® incomplete info L-.I illegible ❑
19. Do sample container labels match the COC? no label L.I other LI
20. Are analyses requested Indicated on the COC? ® � O
21. Were all of the samples listed on the COC received? 0 0O samples received but not listed on COC Ell
samples listed on COC not received ❑
22. Was the sample collection date/time noted? d
23. Did we receive sufficient sample volume for indicated analyses? 0
24. Were samples received in appropriate containers? 0
25. Were VOA samples received without headspace(<1/4"bubble)? • •
26. Were trip blanks submitted? t' • listed on COC [I 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). CW 3/10/22
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/I-PH
oI certify that I have completed sections 28-30(dated initials). CW 3/10/22
This also excludes metals by EPA 200.7,200.8 and 245 1 which will be verified between 16 and 24 hours after preservation.
Checklist 7.9.20 Rev 3 Locked
Page 5 of 8

Analytical Environmental Services, Inc Date: 16-Mar-22
Client: Pace Analytical
Project Name: 92592206 Dates Report
Lab Order: 2203C58
Lab Sample ID Client Sample ID Collection Date Matrix Test Name TCLP Date Prep Date Analysis Date
2203C58-001A SW01 OUTFALL 3/9/2022 8:15:00AM Aqueous Formaldehyde by SW8315A 3/11/2022 6:36:23AM 03/11/2022
Page 9 of 11
Page 6 of 8

Analytical Environmental Services,Inc Date: 16-Mar-22
Client: Pace Analytical ANALYTICAL QC SUMMARY REPORT
Project Name: 92592206
Workorder: 2203C58
BatchlD: 332345
Sample ID: MB-332345 Client ID: Units: ug/L Prep Date: 03/11/2022 Run No: 480000
SampleType: MBLK TcstCode: Formaldehyde by SW8315A BatchlD: 332345 Analysis Date: 03/11/2022 Scq No: 11102199
Analytc 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-332345 Client ID: Units: ug/I, Prep Date: 03/11/2022 Run No: 480000
SampleType: LCS TestCode: Formaldehyde by SW8315A BatchiD: 332345 Analysis Date: 03/11/2022 Seq No: 11102200
Analyte Result RPT Limit SPK value SPK Ref Val %REC Low Limit High Limit RPD Ref Val %RPD RPD Limit Qual
Formaldehyde 906.0 50 1000 90.6 70 130
Sample ID: 2203C67-001AMS Client ID: Units: ug/L Prep Date: 03/11/2022 Run No: 480001
SampleType: MS TestCode: Formaldehyde by SW8315A BatchlD: 332345 Analysis Date: 03/11/2022 Seq No: 11102209
Analytc Result RPT Limit SPK value SPK Rcf Val %REC Low Limit I ligh Limit RPD Ref Val %RPD RPD Limit Qual
Formaldehyde 5613 250 5000 988.2 92.5 49.4 135
Sample ID: 2203C67-001AMSD Client ID: Units: ug/L Prep Date: 03/11/2022 Run No: 480001
SampleType: MSD TestCode: Formaldehyde by sw8315n Batch1D: 332345 Analysis Date: 03/11/2022 Seq No: 11102210
Analytc Result RPT Limit Sl'K value SI'K Ref Val %REC Low Limit I ligh Limit RPD Ref Val %RPD RPD Limit Qual
Formaldehyde 5597 250 5000 988.2 92.2 49.4 135 5613 0.277 26.4
Qualifiers: > Greater than Result value < Less dim Result value B Analyse detected in the associated method blank
BIB. Below reporting limit E Estimated(value above quantitution range) II Holding times for preparation or analysis exceeded
1 Estimated value detected below Reporting Limit N Analyse not NELAC certified It. RPD outside limits due to matrix
Rpt Lim Reporting Limit S Spike Recovery outside limits due to matrix Page 10 of 11
Page 7 of 8