NCG030124_DMR_20240327

Wieland
March 26, 2024
Wieland Copper Products, LLC
NCDEQ 3990 US 311 Hwy N
Division of Energy, Mineral, and Land Resources Pine Hall, NC 27042
Phone: [phone]
Land Quality Section Fax: [phone]
450 West Hanes Mill Rd., Suite 300 [e-mail]
Winston-Salem, NC 27105 www.wielandcopper.com
Attention:Tamera Eplin NC Department of
Environmental Quality
Subject: Permit No. NCG030124 Received
Stormwater Report MAR 2 7 2024
Dear Tamera: Winston-Salem
Regional Office
Enclosed is the Stormwater Report for the month of March 2024.
Wieland is in Tier 3 for exceeding the copper benchmark value in all 5 Outfalls and in Tier 3 for exceeding
the Zinc benchmark value in Outfall 003 and 004.
Wieland is in Tier 3 for exceeding the pH benchmark value in Outfalls 001, 002, and 004.
The Tier 3 plan that we initiated has reduced the copper and zinc levels in the outfalls.
WCP will continue monthly sampling as long as there is adequate rainfall.
If you have any questions, please feel free to call me at [phone].
Sincerely
/o R. Smkle
EHS Manager

NCDEQ Division of Energy,Mineral and Land Resources N C Department of
Environmental Quality
Stormwater Discharge Monitoring Report(DMR)Form for NCG030000 Received
Metal Fabrication MAR 2 7 2024
Click here for instructions
Complete,sign,scan and submit the DMR via the Stormwater NPDES Permit Data Monitoring Report(DMR plgad Iorm Wiiin
30 days of receiving sampling results. Mail the original,signed hard copy of the DMR to the appropriate DEIOlifiigainii6like.
Certificate of Coverage No. NCGO3 0124 Person Collecting Samples: Clifford Cain
Facility Name:Wieland Copper Products, LLC Laboratory Name: Pace Analytical Services, LLC
Facility County: Stokes Laboratory Cert. No.: 5342
Discharge during this period:ID Yes El 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)? Tier 3
A copy of this DMR has been uploaded electronically via https://edocs.deq.nc.gov/Forms/SW-DMR ®Yes Q No
Date Uploaded:
Analytical Monitoring Requirements for Outfalls with Industrial Activities—Benchmarks in(Red)
Parameter Parameter Outfall 001 Outfall 002 Outfall 003 Outfall 004 Outfall 005
Code
N/A Receiving Stream Class WS-IV WS-IV WS-IV WS-IV WS-IV
N/A Date Sample Collected MM/DD/YYYY 03/06/2024 03/06/2024 03/06/2024 03/06/2024 03/06/2024
46529 24-Hour Rainfall in inches 0.6 0.6 0.6 0.6 0.6
C0530 TSS in mg/L(100 or 50*) 79.6 ND 22.3 44 8.9
00400 pH in standard units(6.0—9.0 FW, 6.0 5.9 6.2 5.8 6.1
6.8-8.5 SW)
01119 Copper,total recoverable in mg/L 0.584 0.164 1.270 1.120 0.287
(0.010 FW,0.0058 SW)
01051 Lead,total recoverable in mg/L ND ND ND ND ND
(0.075 FW,0.22 SW)
Zinc,total recoverable in mg/L(0.126
01094 FW,0.095 SW) 0.075 0.0315 0.253 0.109 0.0874
00340 Chemical Oxygen Demand(COD)in 34.2 ND ND ND ND
mg/L(120)
00552 Non-Polar Oil&Grease in mg/L(15) ND ND ND ND ND
*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
FW(Freshwater)SW(Saltwater)
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 k owledge and belief,true,accurate,and complete.I am aware that there are significant penalties for submitting
false information,includ g t ossibility of fines and imprisonment for knowing violations."
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Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
FI guidance o+n filling out this jorm.please visullt!2•;•1l,te:.nc.Elo% about.dt\hi,in:.en,m'\-Ilin ral-Lu'.t-
res0urce5 enerD.-mineral-land-permit.stornnw-leer-permirs'npdes-indu,tna' sit=tab-4
Permits No.: N/C/ / / / / or Certificate of Coverage No.: N C G'O/. Q. -1_ 2.A
Facility Name: Wi2-c -J. (�c.? ( Pro�kW-.�
County: e-,1-01..ces Phone No.
Inspector: / rd (4i'/)
Date of Inspection:
Time of Inspection: /No qm
I otal Event Precipitation(inches): 0, LeD
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 DEN1LR
Regional Office.
J
By this signature. I c• if i t this report is accurate and complete to the best of my knowledge:
(Signatu .f Pe /ittee or Designee)
1. Outfall Description:
Outfall No. 001 Structure(pipe, ditch,etc.) !Pipe_
Receiving Stream.
Describe the industrial acthi ics that occu ithin the outfall drainage area:
W e-Sk i Ater toof drcLi ti rend pus k nJ J o4
Page 1 of 2
SW 242.Last modified 07 23 2017

?. Color: Describe the color of the dischat_c ti,,n2 basic colors(red. brown. blue. etc.) and not
(light. medium.dark)as descriptors: Re „S,1, — Med.4'1.4r2
3, Odor: Describe any dt,tinct odors that the discharge may hate(i e.. smells st, ofotl, weak
chlorine odor, etc.). Alovse
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 5
Floating Solids: Choose the number w hich best describes the amount of floatinz solids in the
stormwater dischar`e,w here 1 is no solids and 5 is the surface covered with floating,solids:
1 3 4 5
6. Suspended Solids: Choose the number which best describes the amount of suspended solids in
the stormwater discharge,where I is no solids and 5 is extremely muddy:
1 2 3 5
7. Is there any foam in the stormwater discharge? 0 Yes 0 No.
8. Is there an oil sheen in the stonnwater discharge? OYes �No.
9. Is there evidence of erosion or deposition at the outfall'? 0 Yes *No.
10. Other Obvious Indicators of Stormw ater Pollution:
List and describe
Note: Low clarit},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 2 of 2
SWU.242.Last modified 07 28,20 r 7

t4' ibew'
En' :Jn t'Pn•a
Q..y.•
Storm ater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance on filling ow thisfitrrn,please visit Imps dat.tic.an about.dirisions.enern-mineral-l;tnd-
resourcc enertiv-mineral-lam!-permits stornmater-permirs npdes-industrial-st=tab--t
Permit No : N/C/_ / / /_/_/ or Certificate of Coverage No.: N/C G oiaiii 1 l� l
Facilit Name: tN.Y1eLcxr . CcDDer Pro a . -4-S
County �jkDkr S Phone No.
{J`
r ,a 1
Inspector: � /c � ,,/1
Date of Inspection: 3--10-Aq
Time of Inspection: /`.,?7 A-ti-I
Total Event Precipitation(inches): 04 tip
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 DENILR
Regional Office.
By this signature. I certify that this report is accurate and complete to the best of my knowledge:
(Signature of Permittee or Designee)
I. Outfall Description:
Outfall No. pOa, Structure(pipe,ditch,etc.). 1 +
Receiving Stream r e.
0/1Atmed ic,d l.t. y IA t )etn Aver
Descrihe the industrial acti'ities that occur‘‘ithin the outfall drainage area:
E.ns4-s cle rod do i, aAd parkirt6 is
Page I of 2
SWC-242.Last modified 07 28,2017

2. Color: Describe the c, 'or of the discharge u;in; asic colors (red. brown. blue.etc.) and tint
(light. medium.dark)as descript,irs C� � A -
_ _ «cIII
3. Odor: Describe any distinct odors that the discharze may, have(i.e.. smells strongly of oil, speak
chlorine odor.etc.):
4. Clarity: Choose the number which best describes the clarity of the discharge. where I is clear
and 5 is very cloudy:
2 3 4 5
5. Floating Solids: Chuo;,2 the numHcr which best describes the amount of floating solids in the
stormwater discharge, where I is no solids and 5 is the surface covered with floating solids:
Jt / 2 3 4 5
6. Suspended Solids: Choose the n.imber which best describes the amount of suspended solids in
the stormwater discharge,where I is no solids and 5 is extremely muddy:
2 3 4 5
7. Is there any foam in the stormwater discharge? 0 Yes • No.
S. Is there an oil sheen in the stormwater discharge? Oyes 0'No.
9. Is there evidence of erosion or deposition at the outfall? 0 Yes •No.
10. Other Obvious Indicators of Storms%ater Pollution:
List and describe gOie,
•
Note: Loss clarity, high solids,and or the presence of foam,oil sheen, or erosion,deposition may be
indicatise of pollutant exposure. These conditions IN arrant further investigation.
Page 2 of 2
SV L-242.Last modified 07 21.2017

1.1.
hie:
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance on filling out this Pm.pleas`'visit hups:t deo no so% about di%'stuns.encr%-mineral-land-
resourccs erenn.--mineral-land-permits storm\vater-permits npdes-industrial-stab-4
Permit No.: N/C/ / / / / / / / or Certificate of Covera.!e No.: N/C/G'4/3/Q/ 1 /,2,„ /
Facility Name: t AYre_Vs,nci, Cc C' PrOa S
County: S--0 S Phone No.
Inspector: 61 rr , 1 plc n
Date of Inspection: L3—(p.9
Time of Inspection: 1) ,4j71
Total Event Precipitation(inches): 0, laD
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 at tl ' report is accurate and complete to the best of my knowledge:
(Signatur of P itt or Designee)
1. Outfall Description:
Outfall No. 003 Structure(pipe,ditch,etc.) t,pe
Receiving Stream:
WY)aAMc1 71r,) ckl LA ;ver`
Describe the industrial activities that oc ur within the outfall dratna2e area:
L.octd:.ncs dock a.nd, ra41,rea.c) icAck
Page I ot'2
SW'L-242,Lag modified 07 23 2017

2. Color: Desc;:he the color of the discharge usin t,ic c;. Ions (red, bro\‘n. blue.etc.)and tint
!fight. medium,dark) descriptors. r t 1 t�• 14'
3. Odor: Describe am d stinct od is that the discharge ma. ha\e(i.e.. smells stron_sl of eak
chlorine odor.etc.):
4. Clarity: Choose the number«htch best describes the clarity of the discharge. where I is clear
and 3 is very cloudy:
1 a( ? � 3 4
5. Floating Solids: Choose the nurnl cr which best describes the amount of floating solids in the
stormwater d;. .hartze, where I is no s;;hds and 5 is the surface c(‘ered%kith floating solids:
3 4 5
b. Suspended Solids: Choose th,.number which best describes the amount of suspended solids in
the stormwater discharge, where I is no solids and 5 is extremely muddy:
3 4 5
7. Is there any foam in the stormwater discharge? 0 Yes 4111 No.
3. Is there an oil sheen in the stormwater discharge? OYes aeNo.
9. Is there evidence of erosion or deposition at the outfall? 0 Yes a-No.
10. Other Obvious Indicators of Stormwater Pollution:
List and describe 1 r\L
•
Note: Low clarity, high solids,andlor the presence of foam, oil sheen,or erosion:'deposition may be
indicative of pollutant exposure. These conditions warrant further investigation.
Page 2of2
SVWL-242.Lanz modified 0"28 2017

n::rontne•"
Qt.aiu t.
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance on filling out thisJiu•ta.please visit littps:/dcq.nc.vov about divisions.cneruA-mineral-land-
resour cs'enerev-mineral-land-permits storrnwatcr-permits/nodes-industrial-sw4tab--1
Permit No.: N/C/ / / / / / / or Certificate of Coverage No.: N/C/G Q a 0 f 21�/
Facility Name: Wie,\ter , `d:), "'(^ ?r 0 Q‘At.A-S
County: S-k-- Phone No
p et/ to) �.�.,�
Inspector:
Date of Inspection: 3 --to-,ii
Time of Inspection: ).Alv Pm
lot;il I:vent Precipitation (inches): Ct VI/
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 penntttee 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:
K
(Signature of a 't e o estgnee)
1. Outfall Description:
Outfall No. ne)q Structure(pipe, ditch, etc ): R4, ,....
Receiving Stream.
Onhr,m!?C� ))n Ltt4c,f �D 71Ae_ be i`Q
1 v
Describe tht�e industrial activities that occur within the outfall drainage area:
1—oct .j 5 (j.oc,k of-)4 ra�'J road -krack,
Page 1 of 2
SWU-242,Last modified 07 23,2017

2. Color: D,s.:11!-)e the color oft discharge using b`•�'•ic colors(red.b•�awn, blue,etc )and tint
:i�_ht. medium,dark) as descriptors: @re., e(,rj'tt/14-
� I
3. Odor: Dt_,cr he ary distinct odors that the discharge may hate(i.e., smells str.ngly of e-t11,‘yeak
chlorine odor, etc
4. Clarity: Choose the number which best describes the clarity of the discharge,where 1 is clear
and 5 is very cloudy:
2 4 5
5, Floating Solids: Choose the number which best describes the amount of floatin<,solids in the
':ortmkater discharge,where I is no solids and 5 is the surface covered with floating solids•
1 ( '2J 3 4 5
6. Suspended Solids: Choose the number which best describes the amount of suspended solids in
ih,e stormwater discharge,where I is no solids and 5 is extremely muddy
1 2 OP 4 5
7. Is there any foam in the stormwater discharge? 0 Yes ® No.
8. Is there an oil sheen in the stormwater discharge? 0Yes ®No.
9. l' there evidence of erosion or deposition at the outfall? 0 Yes •No.
10. Other Obvious Indicators of Stormwater Pollution:
List and describe
Note: Low 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 2 of 2
SWU-242,Last mcxtified 07 28 2017

I.
-=: ti_ ,.t
Ent ira,r:ert..!
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Fir guidance on filling out this form,please visit hors• deu.nc eon about divisions!ene1 v-mineral-land-
resources enersv-minera!-Iand-permits.stotmwater-nennits nudes-industrial-sw rab-4
Permit No.: N/C/ / / / / / / / or Certificate of Coverage No.: N/C/G/L/3O/!/
Facility Name: LVIiC_iCt-r\C1 Ci,. .e(' 'rCdLLt1
County: S}(,; Phone No.
Inspector: l�i t rd(1‘11.>9
Date of Inspection: 3"(U
Time of Inspection: J .5-pin
Total Event Precipitation(inches): 0,l2,0
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 permitter, 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 P or Designee)
1. Outfall Description:
Outfall No. DOS Structure(pipe, ditch, etc.): Dilikilic
Receiving Stream:
Urvvvned --ry))1 -ar -� 4/le �4 Ri'ver
Describe the indu•,trial activities that occur(\ithin the outfall drainage area:
pair c -CMivt. lA)Coded- o re et ,
Page 1 of 2
SWL:-242,List modified 07 28/2017

2.
Color: Describe the color of the discharge usine bask colors(red, brown,blue, etc.)and tint
(light, medium, dark)as descriptors: F'A ) e /fury
3. Odor: Describe any istinct odors that the discharge ma% ha%e (i.e.. smells strongly of oil, weal,
chlorine odor, etc.): /1Q
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is clear
and 5 is very cloudy:
1 2 CI 4 5
5. Floating Solids: Choose the number which best describes the amount of floating solids in the
stormwater discharge, where 1 is nkl solids and 5 is the surface covered with floating solids:
1 l:/ 3 4 5
6. Suspended Solids: Choose the number which best describes the amount of suspended solids in
the stormwater discharge,where 1 is no solids and 5 is extremely muddy:
1 3 4 5
7. Is there any foam in the stormwater discharge? 0 Yes E No.
8. Is there an oil sheen in the stormwater discharge? 0Yes *No.
9. Is there es idence of erosion or deposition at the outfal ? 0 Yes •No.
10. Other Obvious Indicators of Storms ater Pollution:
List and describe 14.Qfl Q..-
•
•
Note: Low clarity, high solids, and,or the presence of foam,oil sheen, or erosion'deposition mas be
indicative of pollutant exposure. These conditions Ns arrant further investigation.
Page 2 of 2
SWU-2a2,Last modified 07 28.2017

Pace Analytical Services,LLC
Qace''/'� 1377 South Park Drive
I _G Kemersville,NC 27284
V [phone]
Page 1 of 2
Laboratory Report
Tony Sprinkle Report Date: 03/19/2024
Wieland Copper Products Date Received: 03/07/2024
3990 US 311 Hwy North
Pine Hall, NC 27042
Project: Wieland Copper Stormwater
Pace Project No.:92717585
Sample: 001 Lab ID: 92717585001 Collected: 03/06/24 11:40 Matrix: Water
Method Parameters Results Units Report Limit Analyzed Qualifiers
SM 2540D-2015 Total Suspended Solids 79.6 mg/L 10.9 03/08/24 11:19
EPA 1664B Total Petroleum Hydrocarbons ND mg/L 4.8 03/11/24 11:39
EPA 200.7 Rev 4.4 1994 Copper 584 ug/L 5.0 03/11/24 12:55
EPA 200.7 Rev 4.4 1994 Lead ND ug/L 5.0 03/11/24 12:55
EPA 200.7 Rev 4.4 1994 Zinc 75.0 ug/L 10.0 03/11/24 12:55
Performed by PACE 03/06/24 11:40
Collected By Cliff Cain 03/06/24 11:40
Collected Date 03/06/24 03/06/24 11:40
Collected Time 1140 03/06/24 11:40
pH 6.0 Std.Units 03/06/24 11:40
SM 5220D-2011 Chemical Oxygen Demand 34.2 mg/L 25.0 03/16/24 05:53
Sample: 002 Lab ID: 92717585002 Collected: 03/06/24 11:27 Matrix: Water
Method Parameters Results Units Report Limit Analyzed Qualifiers
SM 2540D-2015 Total Suspended Solids ND mg/L 2.5 03/08/24 11:18
EPA 1664B Total Petroleum Hydrocarbons ND mg/L 4.9 03/11/24 11:40
EPA 200.7 Rev 4.4 1994 Copper 164 ug/L 5.0 03/11/24 13:03
EPA200.7 Rev 4.41994 Lead ND ug/L 5.0 03/11/24 13:03
EPA 200.7 Rev 4.4 1994 Zinc 31.5 ug/L 10.0 03/11/24 13:03
Performed by PACE 03/06/24 11:27
Collected By Cliff Cain 03/06/24 11:27
Collected Date 03/06/24 03/06/24 11:27
Collected Time 1127 03/06/24 11:27
pH 5.9 Std. Units 03/06/24 11:27
SM 5220D-2011 Chemical Oxygen Demand ND mg/L 25.0 03/16/24 05:54
Sample: 003 Lab ID: 92717585003 Collected: 03/06/24 11:58 Matrix: Water
Method Parameters Results Units Report Limit Analyzed Qualifiers
SM 2540D-2015 Total Suspended Solids 22.3 mg/L 3.9 03/08/24 08:29
EPA 1664B Total Petroleum Hydrocarbons ND mg/L 4.8 03/11/24 11:40
EPA 200.7 Rev 4.4 1994 Copper 1270 ug/L 5.0 03/11/24 13:06
EPA200.7 Rev 4.41994 Lead ND ug/L 5.0 03/11/24 13:06
EPA 200.7 Rev 4.4 1994 Zinc 253 ug/L 10.0 03/11/24 13:06
Performed by PACE 03/06/24 11:58
Collected By Cliff Cain 03/06/24 11:58
Collected Date 03/06/24 03/06/24 11:58
Collected Time 1158 03/06/24 11:58
pH 6.2 Std. Units 03/06/24 11:58
SM 5220D-2011 Chemical Oxygen Demand ND mg/L 25.0 03/16/24 05:54
Page 1 of 5

Pace Analytical Services,LLC
gace'' 1377 South Park Drive
Kemersville,NC 27284
[phone]
Page 2 of 2
Sample: 004 Lab ID: 92717585004 Collected: 03/06/24 12:06 Matrix: Water
Method Parameters Results Units Report Limit Analyzed Qualifiers
SM 2540D-2015 Total Suspended Solids 44.0 mg/L 8.3 03/08/24 11:19
EPA 1664E Total Petroleum Hydrocarbons ND mg/L 4.8 03/11/24 11:40
EPA 200.7 Rev 4.4 1994 Copper 1120 ug/L 5.0 03/11/24 13:14
EPA 200.7 Rev 4.4 1994 Lead ND ug/L 5.0 03/11/24 13:14
EPA 200.7 Rev 4.4 1994 Zinc 109 ug/L 10.0 03/11/24 13:14
Performed by PACE 03/06/24 12:06
Collected By Cliff Cain 03/06/24 12:06
Collected Date 03/06/24 03/06/24 12:06
Collected Time 1206 03/06/24 12:06
pH 5.8 Std.Units 03/06/24 12:06
SM 5220D-2011 Chemical Oxygen Demand ND mg/L 25.0 03/16/24 05:54
Sample: 005 Lab ID: 92717585005 Collected: 03/06/24 12:15 Matrix: Water
Method Parameters Results Units Report Limit Analyzed Qualifiers
SM 2540D-2015 Total Suspended Solids 8.9 mg/L 3.1 03/08/24 11:22
EPA 1664E Total Petroleum Hydrocarbons ND mg/L 4.9 03/11/24 11:40
EPA 200.7 Rev 4.4 1994 Copper 287 ug/L 5.0 03/11/24 13:17
EPA 200.7 Rev 4.4 1994 Lead ND ug/L 5.0 03/11/24 13:17
EPA 200.7 Rev 4.4 1994 Zinc 87.4 ug/L 10.0 03/11/24 13:17
Performed by PACE 03/06/24 12:15
Collected By Cliff Cain 03/06/24 12:15
Collected Date 03/06/24 03/06/24 12:15
Collected Time 1215 03/06/24 12:15
pH 6.1 Std.Units 03/06/24 12:15
SM 5220D-2011 Chemical Oxygen Demand ND mg/L 25.0 03/16/24 05:54
Reviewed by: —
Arnie Ferguson for
Stephanie Knott
704-977-0981
[e-mail]
Pace Analytical Services Charlotte
South Carolina Laboratory ID:99006 South Carolina Certification#:99006001
9800 Kincey Ave.Ste 100, Huntersville,NC 28078 South Carolina Drinking Water Cert.#:99006003
North Carolina Drinking Water Certification#:37706 Florida/NELAP Certification#:E87627
North Carolina Field Services Certification#:5342 Kentucky UST Certification#:84
North Carolina Wastewater Certification#:12 Louisiana DoH Drinking Water#:LA029
South Carolina Laboratory ID:99006 VirginiaNELAP Certification#:460221
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 2 of 5

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Page 3 of 5

ee
Effective Date:11/29/2023
Laboratory receiving sam les:
Asheville❑ Edep0 Greenwood❑ Huntersville❑ Raleigh❑ Mechanicsville❑ Atlanta❑ Kernersville❑
Condition Client Name:
ul un lie cipt Project a:
Courier: ❑rid Ex utiPS OUSPS ['Client
0 Commercial Pace ❑other:
Custody Seal Present? ales ❑No Seals Intact? ales ❑NoA
:471
Date/Initials Person Examining Contents:_
Packing Material: ['Bubble Wrap ['Bubble Bags JNune ❑ Other Biological Tissue Frozen?
>
Thermometer: Oyes ONo,N/A
12 IR Gun ID:
I tj Type of ice: Wet ❑Blue [None
Correction Factor:
Cooler Temp: ( , Add/Subtract('C) (j Temp should be above freezing to 6'C
r �' ['Samples out of temp criteria.Samples on Ice,cooling process
Cooler Temp Corrected(*C): 1% has begun
USDA Regulated Soil(❑N/A,water sample)
Dld samples originate In a quarantine zone within the United States:CA,NY,or SC Old samples originate from a foreign source(internationally,
(check maps)?Oyes f]No including Hawaii and Puerto Rico)?Dyes [I No
Comments/Discrepancy:
Chain of Custody Present? les QNo ❑N/A 1.
Samples Arrived within Hold Time? zTes DNo ON/A 2.
Short Hold Time Analysis(<72 hr.)? ONo ON/A 3.
Rush Turn Around Tlme Requested? Ores ONo ,QFf/A 4.
Sufficient Volume? Byes ONo ON/A 5.
Correct Containers Used? �fes ❑No ON/A 6.
-Pace Containers Used? J3Yes ONo ON/A
Containers intact? ,(]Yes []No ON/A 7
Dissolved analysis:Samples Field Filtered? Ores QNo .-"ON/A 8.
Sample Labels Match COC? Ares ONo ❑N/A 9.
-Includes Date/Time/ID/Analysis Matrix: 1
Headspace In VOA Vials(>5-6mm)? Dyes ONo __ErN,A 10.
Trip Blank Present? Oyes ONO ){N/A 11.
Trip Blank Custody Seals Present? Oyes Ono /A
COMMENTS/SAMPLE DtsCREPANCY Field Data Required? ales lF
lot ID of spilt containers:
CLIENT NOTIFICATION/RESOLUTION
Person contacted: Date/Time:
Project Manager SCURF Review: Date:
Project Manager SRF Review: Date:
Qualtrax ID:69614 Page 1 of 2
Page 4 of 5

1 WI". i .
Effective Date:11/29/2023
'Check mark top half of box If pH and/or dechtorination bl verMed and project project 1f
within the acceptance range for preservation samples.
Exceptions:VOA,Conform,70C,On and Grease,OR0/8015(water)0OC.LLHG
**Bottom half of box Is to list number of bottles
***Chad(alf unpreserved Nitrates for chlorine
I _ 1 s ty
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pH Adjustment Log far Preserved Samples
Sample ID Type of prosetvatfrr 1 PH upon resell Date Preservation strl d Time preservation I Amount of Praenmitw Lot r
:d�reted sated
Note:Whenever them Ise discrepancy affecting North Carolina compliance samples,a copy of this form will be sant to the North Carotins OENR Certlfcation Office(i.e_
Out of hold,Maimed preservative,out of temp,incorrect containers.
Quaitrax ID:89814
Page 2 of 2
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