NCG030659_DMR_20220107

N`Depart o
Environmen merit �`f
Boyer Enterprises East, LLC ReceivedQU"lity
B.E.E. JAN 0 7 2Q22
Winston
December 28, 2021 p 1.
„tonal c
DEQ Winston Salem Regional Office
Attention: DEMLP Stormwater Program
450 West Hanes Mill Road, Suite 300
Winston-Salem, NC 27105
Subject: STORMWATER SAMPLING RESULTS
MATLAB, INC. - PLANT 10
7303 JORDAN ROAD
RAMSEUR, RANDOLPH COUNTY, NORTH CAROLINA
PERMIT NCG030659
Dear Sir/Madam:
Attached please find the Stormwater Discharge Monitoring Reports (DMR) and analytical
report for the sampling conducted at the above-referenced site. A stormwater sample was
collected from Outfall 001 on December 8, 2021 and analyzed for total suspended solids
(TSS) pH, lead (Pb), copper (Cu), zinc, (Zn), chemical oxygen demand (COD), and oil and
grease (O&G). As indicated on the attached DMR, all parameters were reported below or
within their respective benchmark values. If you have any questions or need additional
information, please contact me at [phone].
Sincerely,
BOYER ENTERPRISES EAST, LLC
Ala(Ardowhy
Paul W. Spangenberg
EH&S Compliance Director
Attachments: Stormwater Discharge Monitoring Report
Laboratory Analytical Report
127 Red Hill Church Road 919-971-0415 (24 Hrs.)
Dunn, NC 28334

NCDEQ Division of Energy, Mineral and Land Resources ` Depar 1►7 e is 1
Environmental
Stormwater Discharge Monitoring Report (DMR) Form for NCG03000�
eceived`�u" `y
Metal Fabrication JAN 0 7 222
Click here for instructions
Winston ,I,
Complete,sign,scan and submit the DMR via the Stormwater NPDES Permit Data Monitoring Reporgale0 Slp149g1 form within
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. NCGO3 0659 Person Collecting Samples: Paul W.Spangenberg
Facility Name:Matlab,Inc.-Plant 10 Laboratory Name: Con-Test
Facility County: Randolph Laboratory Cert. No.:652
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?QYes ❑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 D Yes D No
Date Uploaded: 12/28/21
Analytical Monitoring Requirements for Outfalls with Industrial Activities—Benchmarks in(Red)
Parameter Parameter Outfall 1 Outfall 1 Outfall Outfall Outfall
Code
N/A Receiving Stream Class C
N/A Date Sample Collected MM/DD/YYYY 12/08/21
46529 24-Hour Rainfall in inches 0.02
C0530 TSS in mg/L(100 or 50*) 1.0
00400 pH in standard units(6.0—9.0 FW, 6.0
6.8-8.5 SW)
01119 Copper,total recoverable in mg/L 0.00087
(0.010 FW,0.0058 SW)
01051 Lead,total recoverable in mg/L <0.00014
(0.075 FW,0.22 SW)
Zinc,total recoverable in mg/L(0.126
01094 FW,0.095 SW) 0.0047
00340 Chemical Oxygen Demand(COD)in 20
mg/L(120)
00552 Non-Polar Oil&Grease in mg/L(15) <0.33
* Outfalls to Outstanding Resource Waters(ORW),High Quality Waters(HOW),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
FW(Freshwater)SW(Saltwater)
Notes(optional):A second rain event was sample as the bottles arrived at the lab broken.
"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."
,i /%/�aryc rie/y 12/28/21
Signature of Permittee or Delegated Authorized Individual Date
[e-mail] [phone]
Phone Number
Email Address

Table of Contents
i -b con-test°
A Pace Analytical'Laboratory
39 Spruce Street'East Longmeadow, MA 01028'FAX [phone]'TEL.[phone]
December 23,2021
Paul Spangenberg
Boyer Enterprises East,LLC
PO Box 550
Dunn,NC 28208
Project Location:7307 Jordan Rd,Ramseur,NC
Client Job Number:
Project Number:R2943.10
Laboratory Work Order Number:21L0601
Enclosed are results of analyses for samples as received by the laboratory on December 9,2021.If you have any questions
concerning this report,please feel free to contact me.
Sincerely,
HIYL4Alt
Kerry K.McGee
Project Manager
Page 1 of 14

Table of Contents
Table of Contents
Sample Summary 3
Case Narrative 4
Sample Results 5
21L0601-01 5
Sample Preparation Information 7
QC Data 8
Metals Analyses(Total) 8
B297490 8
Conventional Chemistry Parameters by EPA/APHA/SW-846 Methods(Total) 9
B296496 9
B296527 9
B297122 9
B297278 9
Flag/Qualifier Summary 10
Certifications 11
Chain of Custody/Sample Receipt 12
Page 2 of 14

Table of Contents
iCOn-tESt®
.�� A Pace Analytical°Laboratory
39 Spruce Street•East Longmeadow,MA 01028*FAX [phone]*TEL.[phone]
Boyer Enterprises East,LLC
PO Box 550 REPORT DATE: I2,23/202I
Dunn,NC 28208 PURCHASE ORDER NUMBER:
ATTN:Paul Spangenberg
PROJECT NUMBER: R2943.10
ANALYTICAL SUMMARY
WORK ORDER NUMBER: 2I L0601
The results of analyses performed on the following samples submitted to CON-TEST,a Pacc Analytical Laboratory,are found in this report.
PROJECT LOCATION: 7307 Jordan Rd,Ramseur,NC
FIELD SAMPLE rt LAB ID: MATRIX SAMPLE DESCRIPTION TEST SUB LAB
I 21L0601-0I Water EPA I664B
EPA 410.4
SM2I-23 2540D
SM2I-23 4500 H B
SW-846 6020B
Page 3 of 14

Table of Contents
L. _1COn-tESt®
A Pace Analytical*Laboratory
39 Spruce Street`East Longmeadow,MA 01028*FAX [phone]'TEL.[phone]
CASE NARRATIVE SUMMARY
All reported results arc within defined laboratory quality control objectives unless listed below or otherwise qualified in this report.
EPA 410.4
Qualifications:
7,01
Test EPA 410.4 had a calibration point outside acceptable limits. Reanalysis yielded similar non-conformance.
Analyte&Samples(s)Qualified:
Chemical Oxygen Demand
21L0601-01[I]
SM21-23 4500 11 B
Qualifications:
H-05
Holding time was exceeded.pH analysis should be performed immediately at time of sampling. Nominal 15 minute holding time was
exceeded.
Analyte&Samples(s)Qualified:
pH
21 L0601-01[I],B296496-DUP l
The results of analyses reported only relate to samples submitted to Con-Test,a Pace Analytical Laboratory,for testing.
I certify that the analyses listed above,unless specifically listed as subcontracted,if any,were performed under my direction according to the approved methodologies listed
in this document,and that based upon my inquiry of those individuals immediately responsible for obtaining the information,the material contained in this report is,to the
best of my knowledge and belief,accurate and complete.
Tod E.Kopyscinski
Laboratory Director
Page 4 of 14

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COn-tEst®
Analytical"
A Pace
39 Spruce Street•East Longmeadow,MA 01028*FAX [phone]'TEL.[phone]
Project Location: 7307 Jordan Rd,Ramseur,NC Sample Description: Work Order: 21L0601
Date Received: 12/9/2021
Field Sample#: 1 Sampled: 12/8/2021 08:30
Samule ID: 211.0601-01
Sample Matrix: Water
Metals Analyses(Total)
Date Date/Time
Analyte Results RL DL Units Dilution Flag/Qual Method Prepared Analyzed Analyst
Copper 0.00087 0.0(110 0.00027 mg/L I J SW-846 6020B 12/21/21 12/22/21 15:38 QNW
Lead ND 0.00050 0.00014 mg/L I SW-846 6020B 12/21/21 12/22/21 15:38 QNW
Zinc 0.0047 0.010 0.0034 mg/L I J SW-8466020B 12/21/21 12/22/21 15:38 QNW
Page 5 of 14

Table of Contents
L 11 COn-tESt®
A Pace Analyticat1°Laboratory
39 Spruce Street'East Longmeadow,MA 01028'FAX [phone]•TEL.[phone]
Project Location: 7307 Jordan Rd,Ramseur,NC Sample Description: Work Order: 21L0601
Date Received: 12/9/2021
Field Sample 8: 1 Sampled: 12/8/2021 08:30
Samole ID: 21L0601-01
Samole Matrix: Water
Conventional Chemistry Parameters by EPA/APHA/SW-846 Methods(Total)
Date Date/Time
Analyte Results RI. DL Units Dilution Flag/Qual Method Prepared Analyzed Analyst
Chemical Oxygen Demand 20 15 mg/L 1 Z-01 EPA410.4 12:20/21 12/20/21 11:50 LL
pH Q17°C 6.8 pH Units I H-05 SM2I-23 4500 H B 12/9/21 12/9/21 15:15 CB2
Total Suspended Solids 1.0 1.0 0.32 mg/L I SM21-23 2540D 12/10/21 12/10/21 13:55 LL
Oil&Grcasc(HEM) ND 1.4 0.33 mg/L I EPA 1664E 12/17/21 12/17/21 13:12 LL
Page 6 of 14

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11 1 COn-tESt®
A Pace Analytical'Laboratory
39 Spruce Street*East Longmeadow, MA 01028•FAX [phone]*TEL.[phone]
Sample Extraction Data
EPA 1664B
Lab Number[Field ID] Batch Initial]mU] Date
21L0601-01[1] B297I22 1000 12/17/21
EPA 410.4
Lab Number[Field ID] Batch Initial Iml.I Final]mL] Date
21L0601-01[1] B297278 2.00 2.00 12/20/21
Sn121-23 2540D
Lab Number[Field IDI Batch Initial[nt[.] Date
21L0601-01[I] B296527 500 12/10/21
SM21-23 4500 H B
Lab Number[Field IDI Batch Initial[mL] Date
21L0601-01 [I] B296496 50.0 1109;21
Prep Method:SW-846 3005A Analytical Method:SW-846 6020E
Lab Number[Field 1D1 Batch Initial[mL[ Final Intl,' Date
21L0601-01[1] B297490 50.0 50.11 12/21/21
•
Page 7 of 14

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L .._ _► con-test®
A Pace Analytical"Laboratory
39 Spruce Street'East Longmeadow,MA 01028•FAX [phone]*TEL.[phone]
QUALITY CONTROL
Metals Analyses(Total).Quality Control
Reporting Spike Source %REC RPD
\mte Result Limit Units Level Result %REC Limits RPD Limit Notes
Batch B297490-SW-846 3005A
Blank(B297490-BLK1) Prepared:12/21/21 Analyzed:12/22/21
Copper ND 0.0010 mg/L
Lead ND 0.00050 mg/L
Zinc ND 0.010 mg/L
LCS(B297490-BSI) Prepared:12/21/21 Analyzed:12/22/21
Copper 1.01 0.010 mg/L 1.00 101 80-120
Lead 0.513 0.0050 mg/L 0.500 103 80-120
Zinc 0.997 0.10 mg/L 1.00 99.7 80-120
LCS Dup(B297490-BSDI) Prepared:122121 Analyzed:12/22/21
Copper 0.996 0.010 mg/L 1.00 99.6 80-120 1.79 20
Lead 0.512 0.0050 mg/L 0.500 102 80-120 0.162 20
Zinc 0.997 0.10 mg/L 1.00 99.7 80-120 0.0379 20
Page 8 of 14

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(I _ ) con-tEsto
A Pace Analytical'•Laboratory
39 Spruce Street•East Longmeadow,MA 01028•FAX [phone]*TEL.[phone]
QUALITY CONTROL
Conventional Chemistry Parameters by EPA/APHA/SW-846 Methods(Total).Quality Control
Reporting Spike Source %REC RPD
Analyte Result Limit Units Level Result %REC Limits RPD Limit Notes
Batch B296496-SM21-23 4500 H B
LCS(B296496-BS1) Prepared&Analyzed:12/09/21
pH 5.99 pH Units 6.00 99.8 90-110
Duplicate(B296496-DUP1) _ _ Source:21L0601-01 Prepared&Analyzed:12/09/21
pH 6.9 pH Units 6.8 0.556 5 H-05
Batch B296527-SM21-23 25401)
Blank(B296527-BLKI) Prepared&Analyzed:12/10/21
Total Suspended Solids ND 2.5 mg/L
LCS(B296527-BSI) Prepared&Analyzed:12/10/21
Total Suspended Solids 209 mg/L 200 104 53.8-124
Batch B297122-EPA 1664B
Blank(B297122-BLKI) Prepared&Analyzed:12/17/21
Oil&Grease(HEM) ND 1.4 mg/L
Blank(B297122-BLK2) Prepared&Analyzed:12/17/21
Oil&Grease(HEM) ND 56 mg/L
LCS(B297122-BSI) Prepared&Analyzed:12/17/21
Oil&Grease(HEM) 19 1.4 mg/L 20.0 95.5 78-114
LCS(B297122-BS2) Prepared&Analyzed:12/17/21
Oil&Grease(HEM) 740 56 mg/L 800 93.0 78-114
Duplicate(B297122-DUPI) Source:21L0601-01 Prepared&Analyzed:12/17/21
Oil&Grease(HEM) ND 1.4 mg/L ND NC 18
Batch B297278-EPA 410.4
Blank(B297278-BLKI) Prepared&Analyzed:12/20/21
Chemical Oxygen Demand ND 15 mg/L
LCS(B297278-BSI) Prepared&Analyzed:12/20/21
Chemical Oxygen Demand 210 mg/L 200 107 90-110
LCS Dup(B297278-BSDI) Prepared&Analyzed:12/20/21
Chemical Oxygen Demand 210 mg/L 200 106 90-110 1.47 5.61
Page 9 of 14

Table of Contents
j Con-tESt®
A Pace Analytical*Laboratory
39 Spruce Street*East Longmeadow.MA 01028'FAX [phone]•TEL.[phone]
FLAG/QUALIFIER SUMMARY
• QC result is outside of established limits.
t Wide recovery limits established for difficult compound.
Wide RPD limits established for difficult compound.
Data exceeded client recommended or regulatory level
ND Not Detected
RL Reporting Limit is at the level of quantitation(LOQ)
DL Detection Limit is the lower limit of detection determined by the MDL study
MCL Maximum Contaminant Level
Percent recoveries and relative percent differences(RPDs)are determined by the software using values in the
calculation which have not been rounded.
No results have been blank subtracted unless specified in the case narrative section.
H-05 Holding time was exceeded.pH analysis should be performed immediately at time of sampling. Nominal 15
minute holding time was exceeded.
Detected but below the Reporting Limit(lowest calibration standard);therefore,result is an estimated
concentration(CLP J-Flag).
Z-01 Test EPA 410.4 had a calibration point outside acceptable limits. Reanalysis yielded similar non-conformance.
Page 10 of 14

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L) con-
A Pace AnalyhcattEst Laboratory®
39 Spruce Street'East Longmeadow,MA 01028*FAX [phone]*TEL.[phone]
CERTIFICATIONS
Certified Analyses included in this Report
Analyse Certifications
EPA 166411 in Water
Oil&Grease(HEM) CT,MA,NH,NY,RI,NC,ME,VA
EPA 410.4 in Water
Chemical Oxygen Demand CT,MA,NH,NY,RI,NC,ME,VA
SM2I-23 2540D in Water
Total Suspended Solids CT,MA,NH,NY,RI,NC,ME,VA
SM2I-23 4500 H Bin Water
pH CT,MA,RI
SW-846 6020B in Water
Copper CT,NH,NY,ME,VA,NC
Lead CT,NH,NY,ME,VA,NC
Zinc CT,NH,NY,ME,VA,NC
Con-Test,a Pace Environmental Laboratory,operates under the following certifications and accreditation:
Code Description Number Expires
AIHA AIHA-LAP,LLC-1S017025:2017 100033 03/1/2022
MA Massachusetts DEP M-MAI00 06/30/2022
CT Connecticut Department of Publilc Health PH-0165 12/31/2022
NY New York State Department of Health 10899 NELAP 04/1/2022
NH-S New Hampshire Environmental Lab 2516 NELAP 02/5/2022
RI Rhode Island Department of Health LA000I 12 12/30/2021
NC North Carolina Div.of Water Quality 652 12/31/2022
NJ New Jersey DEP MA007 NELAP 06/30/2022
FL Florida Department of Health E871027 NELAP 06/30/2022
VT Vermont Department of Health Lead Laboratory LL72074I 07/30/2022
ME State of Maine MA00100 06/9/2023
VA Commonwealth of Virginia 460217 12./14/2022
NH-P New Hampshire Environmental Lab 2557 NELAP 09/6/2022
VT DW Vermont Department of Health Drinking Water VT-255716 06/12/2022
NC-DW North Carolina Department of Health 25703 07/31/2022
PA Commonwealth of Pennsylvania DEP 68-05812 06/30/2022
MI Dept.of Env,Great Lakes,and Energy 9100 09/6/2022
Page 11 of 14

h :u/www,contestlabs.corn Doc#379 Rev 1_03242017
jJ con-tEst- Phone: CHAIN OF CUSTODY RECORD(North Carolina) 39 Spruce Street
East Longmeadow,MA 01028 Page—t—of—1 -
Fax:4 Requested Turnaround Time
Email:infot9contestlabs.com 7-Day ❑ 10-Day1 2 1 1 1 1 1
Company Name: : ❑ _ of Containers
p y Boyer Enler1xlses East,LLC Due Date: H NNNS 1 Preservation Code
Address:127 Red Hill Church Road Rush-Approval Required P G P P P P P
Container Code
Phone:[phone] 1-Day ❑ 3-Day 0 ANALYSIS REQUESTED Dssip�,s_ieefANelclaSarrtf[s
Mattel),Inc. 2-Day 0 4-Day 0 ❑ Field Filtered
Project Location: 7307 Jordan Road,Ramseur,NC p Data Delivery El .Lab to Filter
Project Number: Plant 10 Format: PDF EI EXCEL ■
Project Manager: Paul W.Spangenberg Other: L.,
Con-Test Quote Name/Number: CLP Like Data Pkg Required; Li 0 a E N O Field Filtered
Invoice Recipient: pangenberg(a?boyer-enterprises-ea;Email To: pancienberg(c03boyer-enterprises-eas 0 Lab to Filter
Sampled By: Paul W.Spangenberg Fax To p:
[on-Test Sampie ID!besot beginning Date/Time- Ending Dats/Tlme Composite Grab rC x cone Code Work or t COdpt
ders GW= round Water
t 1 12/8/21,08:30 12/8/21,08:30 x 0 L X DW n Drinking Water
1 12/8/21,08:30 12/8/21,08:30 x 0 L X 8 n Soill
1 12/8/21,08:30 12/8/21,08:30 x 0 L X ' sSoL=sotgd
1 12/8/21,08:30 12/8/21,08:30 x 0 L X X X 0=Other(please
, deflno)
_i 1 12/8/21,08:30 12/8/21,08:30 x 0 L x
t Preservation Codes:
I=Iced
H=HCL
M-Methanol
N-Nitric Acid
S-Sulfuric Acid
B-Sodium Bisulfate
X=Sodium Hydroxide
T-Sodium
Comments: Thiasulfate
3au)s an p 0.Other(please
enbGr p g. be q( Doyer-enter rises-east.Com Please use the following codes to Indicate possible sample concentration within the define)
Conc Code column above:
H-High;M-Medium;L-Low; C-Clean; U-Unknown
Rain Event'1/8 pH 6.0 'ContainerCodes:
A-Amber
mber Glass
Relinquished by:(signature) North Carolina Detection Limit Requirements Program Information G-Glass
e4eSo bwr/P'/?,/Tl 1112L DSCA ❑ USTt�7irust Fund P=Plastic
Recelyed, _ _ r� ❑ REC ST=Sterile
by: gnature) L1, t2-`,\ L] GWPC ❑ SWS Landfill V=Vial
G 1Up1 Li SWSL ❑ iHSB Orphaned Landfill S-Summa Canister
Relinquishedby:(signature) IHSB ❑ State Lead T=Tedler Bag
+ MSCC 0=Other(please
"" r Other: define)
Received by:(signature)
xk'.:slt! q .tI_01:1liIr\lt/:rriAS,k/L,: R -'' i
Re fished by:(signature) Project Entity Other ?CB ONLY sv
W 0-
Government ❑ Municipality ❑ Chromatogram ❑ Soxhlet
Re cp oil by:(signature) ❑ Federal ❑ Brownfield ❑ AJHA-LAP,LLC ❑ Non Soxhlet o
_ N ❑ City ❑ School 0
0 0
A FIT
to

Table of Contents
FeCEC..
TRACK ANOTHER SHIPMENT
921838001921 O?
ADD NICKNAME
Delivered
Thursday, 12/9/2021 at 10:27 am
•
DELIVERED
Signed for by: R.RIOS
GET STATUS UPDATES
OBTAIN PROOF OF DELIVERY
FROM TO
RAMSEUR,NC US East Longmeadow,MA US
MANAGE DELIVERY v
Travel History
TIME ZONE
Local Scan Time v
Thursday,December 9,
2021
10:27 AM East Longmeadow,MA Delivered
8:41 AM WINDSOR LOCKS,CT On FedEx vehicle for delivery
8:30 AM WINDSOR LOCKS,CT At local FedEx facility
6:44 AM EAST GRANBY,CT At destination sort facility
3.39 AM MEMPHIS,TN Departed FedEx hub
Wednesday,December 8,
2021
10:31 PM MEMPHIS,TN Arrived at FedEx hub
5:50 PM GREENSBORO,NC Picked up
1:07 PM ASHEBORO.NC Picked up
Tendered at FedEx Office
Page 13 of 14

Table of Contents
I Have Not Confirmed Sample Container can-test
,::
Numbers With Lab Staff Before Relinquishing ANALYTICAL LABORATORY
Over Samples
. Doc#'277. Rev 5 2017 .
Login Sample Receipt Checklist-(Rejection Criteria Listing - Using Acceptance Policy) Any False
Statement will be brought to the attention of the Client-State True or False
Client e p QC-
Received By� Date IZ—L - Z ( Time [Oa--9
How were the samples In Cooler T No Cooler On Ice / No Ice
received? Direct from Sampling Ambient Melted Ice
Were samples within By Gun# .5Actual Temp -
Temperature?2-6°C I By Blank# Actual Temp -
Was Custody Seal Intact? Were Samples Tampered with?
Was COC Relinquished ? Does Chain Agree With Samples? -}
Are there broken/leaking/loose caps on any samples? --
Is COC in ink/Legible? T Were samples received within holding time?
Did COC include all Client ? Analysis j Sampler Name
pertinent Information? Project -T- ID's i Collection Dates/Times T
Are Sample labels filled out and legible? ;
Are there Lab to Filters? F Who was notified?
Are there Rushes? F Who was notified?
Are there Short Holds? j Who was notified?
Is there enough Volume? -r
Is there Headspace where applicable? ),) MS/MSD? (-
Proper Media/Containers Used? Is splitting samples required? I=
Were trip blanks received? r On COC? F
Do all samples have the proper pH? Acid Base
Unp- 1 Liter Amb. 9. 1 Liter Plastic _ i 16 oz Amb.
HCL- 500 mL Amb. 500 mL Plastic 8oz Amb/Clear
Meoh- 250 mL Amb. ( 250 mL Plastic v 4oz Amb/Clear
Bisulfate- Flashpoint Col./Bacteria 2oz Amb/Clear
DI- Other Glass Other Plastic Encore
Thiosulfate- SOC Kit Plastic Bag Frozen:
Sulfuric- Perchlorate Ziplock
Unused;Media
Unp- 1 Liter Amb. 1 Liter Plastic 16 oz Amb.
HCL- 500 rnL Amb. 500 mL Plastic 8oz Amb/Clear
Meoh- 250 mL Amb. 250 mL Plastic 4oz Amb/Clear
Bisulfate- Col./Bacteria Flashpoint 2oz Amb/Clear
DI- Other Plastic Other Glass Encore
Thiosulfate- SOC Kit Plastic Bag Frozen:
Sulfuric- Perchlorate Ziplock
Comments:
Page 14 of 14 f

•
1CR I H CAPOuno.
Permit and Facility Information:
Please enter the permit number and other details for this upload
IMPORTANT: Until the eDMR system is implemented for DEMLR Stormwater Program permits,an original signed
hardcopy of the DMR MUST be mailed to the address in your permit,in addition to this electronic upload.
Fields marked with a red asterisk*are required.
Permit Number* Enter COC or Individual Permit Number(NOT General Permit number with all O's)
NCG030659
Must begin with NCS or NCG
Facility Name:* Matlab,Inc.
County:* Randolph
After uploading here,the original signed hardcopy must be mailed to:
DEQ Winston-Salem Regional Office
Attn: DEMLR Stormwater Program
450 West Hanes Mill Road
Suite 300
Winston-Salem,NC 27105
Further contact details at https://deq.nc.gov/contact/regional-offices/winston-salem
Monitoring Period Information:
Monitoring Period What is the YEAR of the sample date(s)?
Year:* 2021
Multiple DMRs from sampling periods within the same year can be uploaded together, but please upload different years
with a new submittal form.
Also. copies of the lab results and qualitative(visual)monitoring should NOT be submitted unless specifically
requested by DEQ staff. Only upload the completed and signed DMR forms.
DMR Upload* Click the upload button or drag and drop files here to attach document.
DMR.pdf 7.67MB
Only PDFs are accepted.
Comments:
* ✓ By checking the box and signing box below, I certify that:
o I have given true. accurate,and complete information on this form;
o I agree that submission of this Data Monitoring Report(DMR)upload form is a"transaction"subject to Chapter 66,
Article 40 of the NC General Statutes(the"Uniform Electronic Transactions Act"),
o I agree to conduct this transaction by electronic means pursuant to Chapter 66,Article 40 of the NC General Statutes
(the"Uniform Electronic Transactions Act"):
o I understand that an electronic signature on this upload form has the same legal effect and can be enforced in the same
way as a written signature,AND

I intend to electronically sign and submit this DMR upload form.
Full Name:* Paul William Spangenberg
Name of person submitting this Form
Email Address:* [e-mail]
Phone Number:* 9196240630
Signature:*
Date:* 12/28/2021