NCG060112_DMR_20240403

NC Departure
Nestle Purina PetCare
Environmental Quality
•
863 East Meadow Road Received
Eden, NC 27288 APR 3 2024
April 1, 2024 ' Winston-Salem
Regional Office
North Carolina Department of Environmental Quality
Division of Energy, Mineral and Land Resources
450 West Hanes Mill Road
Suite 300
Winston-Salem, NC 27105
RE: Stormwater Discharge Monitoring Report—01/01/2024—03/31/2024
Nestle Purina PetCare Company—NPDES General Permit#NCG060000
Certificate of Coverage#NCG060112
Dear Sir or Madam:
Please find attached a copy of the Quarterly Stormwater Discharge Monitoring Report (DMR) for the
Nestle Purina PetCare Company facility located at 863 E. Meadow Road, Eden, NC 27288. This report
covers our initial reporting period between January 1st, 2024 and March 31st, 2024 as the facility began
operations during this timeframe. Sample results were received on 03/20/2024 from Pace Analytical
Services, LLC located in Eden, NC. Both visual and analytical sampling results indicate there were no
impacts to stormwater due to activities at the facility.
It should also be noted that the facility has completed the eDMR registration process and has not yet
received access to the NCDEQ electronic reporting system, therefore this hard copy is being submitted to
the Regional Office along with an uploaded copy to the website per NCDEQ guidance. Please contact
Tina Williams at(336) 932-2564 or e-mail to tina.williamspurina.nestle.com if there are any questions or
comments regarding this submittal.
Sincerely,
William Steiner
Factory Manager
816-676-8003

NC Department ",f
Environmental Quality
Received
APR 0 3 2024
NCDEQ Division of Energy,Mineral and Land Resources Winston-Salem
Stormwater Discharge Monitoring Report(DMR)Form for NCG060000 Regional Office
Food and Kindred
Click here for instructions
Complete,sign,scan and submit the DMR via the Stormwater NPDES Permit Data Monitoring Report(DMR)Upload 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.NCGO6 0112 Person Collecting Samples: Andrew Lucas
Facility Name: Nestle Purina PetCare Company Laboratory Name: Pace Analytical Services, LLC
Facility County: Rockingham Laboratory Cert. No.: 40 / 633
Discharge during this period:❑X 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 ❑X Yes ❑ 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
Code
N/A Receiving Stream Class C C C C
N/A Date Sample Collected MM/DD/YYYY 03/06/2024 03/06/2024 03/06/2024 03/06/2024
46529 24-Hour Rainfall in inches 0.35" 0.35" 0.35" 0.35"
C0530 TSS in mg/L(100 or 50*) 8.3 14.0 3.8 13.1
00400 pH in standard units(6.0-9.0 FW, 7 38 7,68 7.71 7.90
6.8—8.5 SW)
31616 Fecal Coliform per 100 ml of N/A N/A N/A N/A
freshwater(if required)(1000)
61211 Enterococci per 100 ml of saltwater N/A N/A N/A N/A
(if required)(500)
00340 (2e0;ical Oxygen Demand in mg/L 32.9 26.0 32.9 <12.5
Additional parameters for outfalls in drainage areas that use>55 gallons per month of new hydraulic oil on average
NCOIL Estimated New Motor/Hydraulic Oil
Usage in gal/month N/A N/A N/A N/A
00552 Non-Polar Oil&Grease in mg/L(15) N/A N/A N/A N/A
*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):
"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 p ssibility of fines and imprisonment for knowing violations."
if //zq6z
Signature of Permittee or Delegated Authorized Individual Date
[e-mail] [phone]
Email Address Phone Number

Pace Analytical Services,LLC
205 East Meadow Road-Suite A
ace. Eden,NC 27288
[phone]
March 20, 2024
Tina Williams
Nestle Purina
863 East Meadow Road
Eden, NC 27288
RE: Project: STORMWATER 1Q 24
Pace Project No.: 92717437
Dear Tina Williams:
Enclosed are the analytical results for sample(s)received by the laboratory on March 07, 2024. 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,
Terri Page
[e-mail]
336-904-4231
Project Manager
Enclosures
cc: Tina Williams, Nestle Purina Eden Plant
, r)'f 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 14

Pace Analytical Services,LLC
205 EastMeadow Road-Suite A
ace.
Eden,NC 27288
[phone]
CERTIFICATIONS
Project: STORM WATER 1Q 24
Pace Project No.: 92717437
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
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 14

Pace Analytical Services,LLC
ace 205 East Meadow Road-Suite A
Eden,NC 27288
[phone]
SAMPLE SUMMARY
Project: STORMWATER 1Q 24
Pace Project No.: 92717437
Lab ID Sample ID Matrix Date Collected Date Received
92717437001 OUTFALL 001 Water 03/06/24 15:00 03/07/24 11:00
92717437002 OUTFALL 002 Water 03/06/24 15:21 03/07/24 11:00
92717437003 OUTFALL 003 Water 03/06/24 15:25 03/07/24 11:00
92717437004 OUTFALL 004 Water 03/06/24 15:33 03/07/24 11:00
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 14

Pace Analytical Services,LLC
ace'/� 205 East Meadow Road-Suite A
/J/ e a Eden,NC 27288
{�!V [phone]
SAMPLE ANALYTE COUNT
Project: STORMWATER 1Q 24
Pace Project No.: 92717437
Analytes
Lab ID Sample ID Method Analysts Reported Laboratory
92717437001 OUTFALL 001 SM 2540D-2015 VLG 1 PASI-E
SM 5220D-2011 JP1 1 PASI-A
92717437002 OUTFALL 002 SM 2540D-2015 VLG 1 PASI-E
SM 5220D-2011 JP1 1 PASI-A
92717437003 OUTFALL 003 SM 2540D-2015 VLG 1 PASI-E
SM 5220D-2011 JP1 1 PASI-A
92717437004 OUTFALL 004 SM 2540D-2015 VLG 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 4 of 14

Pace Analytical Services,LLC
205 East Meadow Road-Suite A
ace" Eden,NC 27288
[phone]
ANALYTICAL RESULTS
Project: STORMWATER 1Q 24
Pace Project No.: 92717437
Sample: OUTFALL 001 Lab ID: 92717437001 Collected: 03/06/24 15:00 Received: 03/07/24 11:00 Matrix: Water
Report
Parameters Results Units Limit MDL DF Prepared Analyzed CAS No. Qual
2540D Total Suspended Solids Analytical Method:SM 2540D-2015
Pace Analytical Services-Eden
Total Suspended Solids 8.3 mg/L 2.9 2.9 1 03/11/24 14:57
5220D COD Analytical Method:SM 5220D-2011 Preparation Method:SM 5220D-2011
Pace Analytical Services-Asheville
Chemical Oxygen Demand 32.9 mg/L 25.0 12.5 1 03/20/24 02:53 03/20/24 06:20
Sample: OUTFALL 002 Lab ID: 92717437002 Collected: 03/06/24 15:21 Received: 03/07/24 11:00 Matrix: Water
Report
Parameters Results Units Limit MDL DF Prepared Analyzed CAS No. Qual
2540D Total Suspended Solids Analytical Method:SM 2540D-2015
Pace Analytical Services-Eden
Total Suspended Solids 14.0 mg/L 2.7 2.7 1 03/11/24 14:57
5220D COD Analytical Method:SM 5220D-2011 Preparation Method:SM 5220D-2011
Pace Analytical Services-Asheville
Chemical Oxygen Demand 26.0 mg/L 25.0 12.5 1 03/20/24 02:53 03/20/24 06:20
Sample: OUTFALL 003 Lab ID: 92717437003 Collected: 03/06/24 15:25 Received: 03/07/24 11:00 Matrix: Water
Report
Parameters Results Units Limit MDL DF Prepared Analyzed CAS No. Qual
2540D Total Suspended Solids Analytical Method:SM 2540D-2015
Pace Analytical Services-Eden
Total Suspended Solids 3.8 mg/L 2.9 2.9 1 03/11/24 14:57
5220D COD Analytical Method:SM 5220D-2011 Preparation Method:SM 5220D-2011
Pace Analytical Services-Asheville
Chemical Oxygen Demand 32.9 mg/L 25.0 12.5 1 03/20/24 02:53 03/20/24 06:23 R1
Sample: OUTFALL 004 Lab ID: 92717437004 Collected: 03/06/24 15:33 Received: 03/07/24 11:00 Matrix: Water
Report
Parameters Results Units Limit MDL DF Prepared Analyzed CAS No. Qual
2540D Total Suspended Solids Analytical Method:SM 2540D-2015
Pace Analytical Services-Eden
Total Suspended Solids 13.1 mg/L 5.2 5.2 1 03/11/24 14:57
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced,except in full,
Date:03/20/2024 01:25 PM without the written consent of Pace Analytical Services,LLC. Page 5 of 14

Pace Analytical Services,LLC
205 East Meadow Road-Suite A
ace Eden,NC 27288
[phone]
ANALYTICAL RESULTS
Project: STORM WATER 1Q 24
Pace Project No.: 92717437
Sample: OUTFALL 004 Lab ID: 92717437004 Collected: 03/06/24 15:33 Received: 03/07/24 11:00 Matrix: Water
Report
Parameters Results Units Limit MDL DF Prepared Analyzed CAS No. Qual
5220D COD Analytical Method:SM 5220D-2011 Preparation Method:SM 5220D-2011
Pace Analytical Services-Asheville
Chemical Oxygen Demand ND mg/L 25.0 12.5 1 03/20/24 02:53 03/20/24 06:23
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced,except in full,
Date:03/20/2024 01:25 PM without the written consent of Pace Analytical Services,LLC. Page 6 of 14

Pace Analytical Services,LLC
205 EastMeadow Road-Suite A
ace a
Eden,NC 27288
[phone]
QUALITY CONTROL DATA
Project: STORMWATER 1Q 24
Pace Project No.: 92717437
QC Batch: 838072 Analysis Method: SM 2540D-2015
QC Batch Method: SM 2540D-2015 Analysis Description: 2540D Total Suspended Solids
Laboratory: Pace Analytical Services-Eden
Associated Lab Samples: 92717437001,92717437002,92717437003,92717437004
METHOD BLANK: 4329147 Matrix: Water
Associated Lab Samples: 92717437001,92717437002,92717437003,92717437004
Blank Reporting
Parameter Units Result Limit MDL Analyzed Qualifiers
Total Suspended Solids mg/L ND 2.5 2.5 03/11/24 14:52
LABORATORY CONTROL SAMPLE: 4329148
Spike LCS LCS %Rec
Parameter Units Conc. Result %Rec Limits Qualifiers
Total Suspended Solids mg/L 250 234 94 90-110
SAMPLE DUPLICATE: 4329149
92717748009 Dup Max
Parameter Units Result Result RPD RPD Qualifiers
Total Suspended Solids mg/L 123 118 5 25
SAMPLE DUPLICATE: 4329150
92717636001 Dup Max
Parameter Units Result Result RPD RPD Qualifiers
Total Suspended Solids mg/L 156 149 5 25
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:03/20/2024 01:25 PM without the written consent of Pace Analytical Services,LLC. Page 7 of 14

Pace Analytical Services,LLC
205 East Meadow Road-Suite A
ace® Eden,NC 27288
[phone]
QUALITY CONTROL DATA
Project: STORMWATER 1Q 24
Pace Project No.: 92717437
QC Batch: 839932 Analysis Method: SM 5220D-2011
QC Batch Method: SM 5220D-2011 Analysis Description: 5220D COD
Laboratory: Pace Analytical Services-Asheville
Associated Lab Samples: 92717437001,92717437002
METHOD BLANK: 4338323 Matrix: Water
Associated Lab Samples: 92717437001,92717437002
Blank Reporting
Parameter Units Result Limit MDL Analyzed Qualifiers
Chemical Oxygen Demand mg/L ND 25.0 12.5 03/20/24 06:15
LABORATORY CONTROL SAMPLE: 4338324
Spike LCS LCS %Rec
Parameter Units Conc. Result %Rec Limits Qualifiers
Chemical Oxygen Demand mg/L 750 772 103 90-110
MATRIX SPIKE&MATRIX SPIKE DUPLICATE: 4338327 4338328
MS MSD
92717959002 Spike Spike MS MSD MS MSD %Rec Max
Parameter Units Result Conc. Conc. Result Result %Rec %Rec Limits RPD RPD Qual
Chemical Oxygen Demand mg/L ND 100 100 124 126 107 109 90-110 2 3
MATRIX SPIKE&MATRIX SPIKE DUPLICATE: 4340103 4340104
MS MSD
92717292001 Spike Spike MS MSD MS MSD %Rec Max
Parameter Units Result Conc. Conc. Result Result %Rec %Rec Limits RPD RPD Qual
Chemical Oxygen Demand mg/L 544 100 100 637 649 93 105 90-110 2 3
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:03/20/2024 01:25 PM without the written consent of Pace Analytical Services,LLC. Page 8 of 14

Pace Analytical Services,LLC
205 East Meadow Road-Suite A
ace, Eden,NC 27288
[phone]
QUALITY CONTROL DATA
Project: STORMWATER 1Q 24
Pace Project No.: 92717437
QC Batch: 839935 Analysis Method: SM 5220D-2011
QC Batch Method: SM 5220D-2011 Analysis Description: 5220D COD
Laboratory: Pace Analytical Services-Asheville
Associated Lab Samples: 92717437003,92717437004
METHOD BLANK: 4338335 Matrix: Water
Associated Lab Samples: 92717437003,92717437004
Blank Reporting
Parameter Units Result Limit MDL Analyzed Qualifiers
Chemical Oxygen Demand mg/L ND 25.0 12.5 03/20/24 06:22
LABORATORY CONTROL SAMPLE: 4338336
Spike LCS LCS %Rec
Parameter Units Conc. Result %Rec Limits Qualifiers
Chemical Oxygen Demand mg/L 750 763 102 90-110
MATRIX SPIKE&MATRIX SPIKE DUPLICATE: 4338337 4338338
MS MSD
92717437003 Spike Spike MS MSD MS MSD %Rec Max
Parameter Units Result Conc. Conc. Result Result %Rec %Rec Limits RPD RPD Qual
Chemical Oxygen Demand mg/L 32.9 100 100 133 140 100 107 90-110 5 3 R1
MATRIX SPIKE&MATRIX SPIKE DUPLICATE: 4338339 4338340
MS MSD
92717673001 Spike Spike MS MSD MS MSD %Rec Max
Parameter Units Result Conc. Conc. Result Result %Rec %Rec Limits RPD RPD Qual
Chemical Oxygen Demand mg/L 660 100 100 756 772 95 112 90-110 2 3 M1
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:03/20/2024 01:25 PM without the written consent of Pace Analytical Services,LLC. Page 9 of 14

Pace Analytical Services,LLC
ace, 205 East Meadow Road-Suite A
Eden,NC 27288
[phone]
QUALIFIERS
Project: STORMWATER 1Q 24
Pace Project No.: 92717437
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 Chloroethylvinyl ether.
A separate vial preserved to a pH of 4-5 is recommended in SW846 Chapter 4 for the analysis of Acrolein 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
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:03/20/2024 01:25 PM without the written consent of Pace Analytical Services,LLC. Page 10 of 14

Pace Analytical Services,LLC
a 205 East Meadow Road-Suite A
ace Eden,NC 27288
[phone]
QUALITY CONTROL DATA CROSS REFERENCE TABLE
Project: STORMWATER 1Q 24
Pace Project No.: 92717437
Analytical
Lab ID Sample ID QC Batch Method QC Batch Analytical Method Batch
92717437001 OUTFALL 001 SM 25400-2015 838072
92717437002 OUTFALL 002 SM 2540D-2015 838072
92717437003 OUTFALL 003 SM 25400-2015 838072
92717437004 OUTFALL 004 SM 2540D-2015 838072
92717437001 OUTFALL 001 SM 5220D-2011 839932 SM 52200-2011 840263
92717437002 OUTFALL 002 SM 5220D-2011 839932 SM 5220D-2011 840263
92717437003 OUTFALL 003 SM 52200-2011 839935 SM 5220D-2011 840264
92717437004 OUTFALL 004 SM 5220D-2011 839935 SM 5220D-2011 840264
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced,except in full,
Date:03/20/2024 01:25 PM without the written consent of Pace Analytical Services,LLC. Page 11 of 14

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DUFF_ itie: tNV-Pm K -HUN1-0033 v03_Sample Condition Upon Receipt
mace
AMMUIa
Effective Date: 11/29/2023
Laboratory receiving samples:
Asheville❑ Edens Greenwood[ ] Huntersville❑ Raleigh❑ Mechanicsville❑ Atlanta❑ Kernersville❑
Sample Condition Client Name:
Upon Receipt bzuLtn c� Project#:
Pw /Courier: ❑Fed Ex UPS l]USPS ❑Client
❑Commercial ['Pace ❑Other:
Custody Seal Present? ❑Yes ❑No Seals Intact? s ['No ON/A
Date/Initials Person Examining Contents
Packing Material: ['Bubble Wrap ['Bubble Bags e ❑ Other Biological Tissue Frozen.
Thermometer: Des ❑No N/A
,'IR Gun ID:
e (63 cType of Ice: ❑Blue :None
Correction Factor:
Cooler Temp: Add/Subtract(°C) Q Temp should be above freezing to 6°C
['Samples out of temp criteria.Samples on ice,cooling process
Cooler Temp Corrected(DC): ! , has begun
USDA Regulated Soil( N/A,water sample)
Did samples originate in a qu rantine zone within the United States:CA,NY,or SC Did samples originate from a foreign source(internationally,
(check maps)?Oyes 21qo including Hawaii and Puerto Rico)?Dyes ❑No
Comments/Discrepancy:
Chain of Custody Present? s ❑No ON/A 1.
Samples Arrived within Hold Time? ,_ '1cs ❑No ON/A 2.
Short Hold Time Analysis(<72 hr.)?
s ONo ON/A 3.
Rush Turn Around Time Requested? ❑Yes ❑No 12FI A 4.
Sufficient Volume? ❑No ON/A 5.
Correct Containers Used? es ❑No ON/A 6.
-Pace Containers Used? es Ono ON/A
Containers Intact? ❑No ON/A 7. _
Dissolved analysis:Samples Field Filtered? Dyes ❑No �N/A 8. _
Sample Labels Match COC? ayes ❑No ON/A 9.
-Includes Date/Time/ID/Analysis Matrix: ( W
Headspace in VOA Vials(>5-6mm)? Oyes ❑No .43N/A 10,
Trip Blank Present? Oyes ❑No ��,N//A 11.
1 rip Blank Custody Seals Present? Dyes ❑No MA
COMMENTS/SAMPLE DISCREPANCY Field Data Required? ❑Yes.�.E}No
Lot ID of split containers:
CLIENT NOTIFICATION/RESOLUTION
d floi (4.12k 1,1-e (ALC -
Person contacted: Date/Time:
Project Manager SCURF Review: Date:
Project Manager SRF Review: Date:
Qualtrax ID:69614 Page 1 of 2
Page 13 of 14

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Effective Date:11/29/2023
'Check mark top half of box if pH and/or dechlorination is verified and, Project#
within the acceptance range for preservation samples. /
Exceptions:VOA,Conform,TOC,Oil and Grease,DRO/8015(water)DOC,Wig fJ
**Bottom half of box is to list number of bottles
***Check all unpreserved Nitrates for chlorine
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E E E a E E uEr ¢ ¢ F a > > ' 0 a N J J ,n Q
N o = ,n • o m of E E E E E E M E E c E E
rl N Li? ey „ryy N N N N N N N 0 O O O O O ut O O O O O
$ eel N 5 a v Y Y u? e N N N 1 (N at
6 0 9 ial 2 N ® ix. z = r a1 e x r° > X Is 12. aG c g a
m Z. X. r. Ei a 2 I ` 2 t9 69 l9 w '5 e1 47 ® rg PJ r ` of eN w1 C a1
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1 LIfIL'1 . II
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. 12
pH Adjustment Log for Preserved Samples
Sample ID Type of Preservative pH upon receipt Date preservation adjusted Time preservation Amount of Preservative lot 1$
adjusted added
Note: Whenever there is a discrepancy affecting North Carolina compliance samples,a copy of this form will be sent to the North Carolina DENR Certification Office(i.e.
Out of hold,incorrect preservative,out of temp,incorrect containers.
Qualtrax ID:69614
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