NCG030669_2024 DMR_20240416

NCDEQ Division of Energy, Mineral and Land Resources
Stormwater Discharge Monitoring Report(DMR) Form for NCGO3OOOO
Metal Fabrication
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. NCG03 0669 Person Collecting Samples: Robert Hensley
Facility Name: AFS MFG LLC Laboratory Name: Pace Analytical
Facility County: ROWAN Laboratory Cert. No.: DW#37706,WW#12, DW#37712,WW#40
Discharge during this period: Yes Q No (if no,skip to signature and date)
Has your facility implemented mandatory Tier response actions this sample period for any benchmark exceedances?EIYes E No
If so,which Tier(I, II, or Ill)?
A copy of this DMR has been uploaded electronically via https://edocs.deq.nc.gov/Forms/SW-DMR Eyes No
Date Uploaded: 1.4)I
Analytical Monitoring Requirements for Outfalls with Industrial Activities—Benchmarks in(Red)
Parameter Parameter Outfall 1B Outfall 2 Outfall Outfall Outfall
Code
N/A Receiving Stream Class C C
N/A Date Sample Collected MM/DD/YYYY 3/15/2024 3/15/2024
46529 24-Hour Rainfall in inches 0.45" 0.45"
CO530 TSS in mg/L(100 or 50*) <2.5 mg/L <2.5 mg/L
00400 pH in standard units(6.0-9.0 FW, 7.31 7.46
6.8-8.5 SW)
01119 Copper,total recoverable in mg/L <0,0050 m mg/L
(0.010 FW,0.0058 SW) g/L <0.0050
01051 Lead,total recoverable in mg/L <0.0050 mg/L <0.0050 mg/L
(0.075 FW,0.22 SW)
01094 Zinc,total recoverable in mg/L(0.126 <0.0100 mglL <0.0100 mglL
FW,0.095 SW)
Chemical Oxygen Demand(COD)in
00340 <25.0 mg/L <25.0 mg/L
mg/L(120)
00552 Non-Polar Oil&Grease in mg/L(15) <4.8 mglL <4.8 mg/L
*Outfalls to Outstanding Resource Waters(ORW),High Quality Waters(HOW),Trout Waters(Tr)and Primary Nursery Areas(PNA)
have a benchmark TSS limit of SO 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 inf rmation,including the possibility of fines and imprisonment for knowing violations."
Sign ure of Permittee or elegate Authorized Individual Dat
KiAt . mC+ a,{ 9 11e• -,A9 Pk5 t k t c 0 1 D - $1 0 --3 5 f ,
Email Address Phone Number

Pace Analytical Services,LLC
aceo
9600 Kincey Ave. Suite 100
Huntersville,NC 28078
[phone]
March 22, 2024
Robert Hensley
Agility Fuel Systems
1010 Corporate Center Drive
Salisbury, NC 28146
RE: Project: Stormwater
Pace Project No.: 92719773
Dear Robert Hensley:
Enclosed are the analytical results for sample(s)received by the laboratory on March 19, 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-Charlotte
If you have any questions concerning this report, please feel free to contact me.
Sincerely,
Tyriek Hooks
[e-mail]
704-977-0947
Project Manager
Enclosures
cc: Kulema McKoy,Hexagon Agility
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced,except in full,
re �
without the written consent of Pace Analytical Services,LLC. Page 1 of 15.

Pace Analytical Services,LLC
acEr 9800 Kincey Ave. Suite 100
Huntersville,NC 28078
[phone]
CERTIFICATIONS
Project: Stormwater
Pace Project No.: 92719773
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 LIST 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
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 15

Pace Analytical Services,LLC
ace. 9800 Kincey Ave. Suite 100
Huntersville,NC 28078
[phone]
SAMPLE ANALYTE COUNT
Project: Stormwater
Pace Project No.: 92719773
Analytes
Lab ID Sample ID Method • Analysts Reported Laboratory
92719773001 OUTFALL 2 GRAB EPA 1664E YY 1 PASI-C
EPA 200.7 Rev 4.4 1994 DBB1 3 PASI-A
SM 2540D-2015 JAY 1 PASI-A
SM 5220D-2011 JP1 1 PASI-A
92719773002 OUTFALL 1B GRAB EPA 1664B YY 1 PASI-C
EPA 200.7 Rev 4.4 1994 DBB1 3 PASI-A
SM 2540D-2015 RVS 1 PASI-A
SM 5220D-2011 JP1 1 PASI-A
PASI-A=Pace Analytical Services-Asheville
PASI-C=Pace Analytical Services-Charlotte
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 15

Pace Analytical Services,LLC
ace.
L m 9B00 Kinaey Ave. Suite 100
Huntersville,NC 28078
[phone]
ANALYTICAL RESULTS
Project: Stormwater
Pace Project No.: 92719773
Sample: OUTFALL 2 GRAB Lab ID: 92719773001 Collected: 03/15/24 17:00 Received: 03/19/24 12:36 Matrix: Water
Parameters Results Units Report Limit DF Prepared Analyzed CAS No. Qual
1664 SGT-HEM,TPH Analytical Method:EPA 16648
Pace Analytical Services-Charlotte
Total Petroleum Hydrocarbons ND mg/L 4.8 1 03/20/24 11:50
200.7 MET ICP Analytical Method:EPA 200.7 Rev 4.4 1994 Preparation Method:EPA 200.7 Rev 4.4 1994
Pace Analytical Services-Asheville
Copper ND ug/L 5.0 1 03/20/24 12:35 03/20/24 20:37 7440-50-8
Lead ND ug/L 5.0 1 03/20/24 12:35 03/20/24 20:37 7439-92-1
Zinc ND ug/L 10.0 1 03/20/24 12:35 03/20/24 20:37 7440-66-6
2540D Total Suspended Solids Analytical Method:SM 2540D-2015
Pace Analytical Services-Asheville
Total Suspended Solids ND mg/L 2.5 1 03/20/24 16:14
5220D COD Analytical Method:SM 5220D-2011 Preparation Method:SM 5220D-2011
Pace Analytical Services-Asheville
Chemical Oxygen Demand ND mg/L 25.0 1 03/21/24 03:24 03/21/24 06:36
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced,except in full,
Date:03/22/2024 03:54 PM without the written consent of Pace Analytical Services,LLC. Page 4 of 15

Pace Analytical Services,LLC
9800 Kincey Ave. Suite 100
ace.
Huntersville,NC 28078
V [phone]
ANALYTICAL RESULTS
Project: Stormwater
Pace Project No.: 92719773
Sample: OUTFALL 1B GRAB Lab ID: 92719773002 Collected: 03/15/24 18:00 Received: 03/19/24 12:36 Matrix: Water
Parameters Results Units Report Limit DF Prepared Analyzed CAS No. Qual
1664 SGT-HEM,TPH Analytical Method:EPA 1664E
Pace Analytical Services-Charlotte
Total Petroleum Hydrocarbons ND mg/L 4.8 1 03/20/24 11:50
200.7 MET ICP Analytical Method:EPA 200.7 Rev 4.4 1994 Preparation Method:EPA 200.7 Rev 4,4 1994
Pace Analytical Services-Asheville
Copper ND ug/L 5.0 1 03/20/24 12:35 03/20/24 20:46 7440-50-8
Lead ND ug/L 5.0 1 03/20/24 12:35 03/20/24 20:46 7439-92-1
Zinc ND ug/L 10.0 1 03/20/24 12:35 03/21/24 11:52 7440-66-6
2540D Total Suspended Solids Analytical Method:SM 2540D-2015
Pace Analytical Services-Asheville
Total Suspended Solids ND mg/L 2.5 1 03/21/24 05:39
5220D COD Analytical Method:SM 5220D-2011 Preparation Method:SM 5220D-2011
Pace Analytical Services-Asheville
Chemical Oxygen Demand ND mg/L 25.0 1 03/21/24 03:24 03/21/24 06:36
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced,except in full,
Date:03/22/2024 03:54 PM without the written consent of Pace Analytical Services,LLC. Page 5 of 15

Pace Analytical Services,LLC
9800 Kincey Ave. Suite 100
ace(' Huntersville,NC 28078
[phone]
QUALITY CONTROL DATA
Project: Stormwater
Pace Project No.: 92719773
QC Batch: 840339 Analysis Method: EPA 1664B
QC Batch Method: EPA-1664B Analysis Description: 1664 SGT-HEM,TPH
Laboratory: Pace Analytical Services-Charlotte
Associated Lab Samples: 92719773001,92719773002
METHOD BLANK: 4340330 Matrix: Water
Associated Lab Samples: 92719773001,92719773002
Blank Reporting
Parameter Units Result Limit Analyzed Qualifiers
Total Petroleum Hydrocarbons mg/L ND 5.0 03/20/24 11:50
LABORATORY CONTROL SAMPLE: 4340331
Spike LCS LCS %Rec
Parameter Units Conc. Result %Rec Limits Qualifiers
Total Petroleum Hydrocarbons mg/L 20 15.9 80 64-132
MATRIX SPIKE SAMPLE: 4340332
92719613002 Spike MS MS %Rec
Parameter Units Result Conc. Result %Rec Limits Qualifiers
Total Petroleum Hydrocarbons mg/L ND 19.4 17.5 74 64-132
SAMPLE DUPLICATE: 4340333
92719613005 Dup
Parameter Units Result Result RPD Qualifiers
Total Petroleum Hydrocarbons mg/L ND ND
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:03/22/2024 03:54 PM without the written consent of Pace Analytical Services,LLC. Page 6 of 15

Pace Analytical Services,LLC
ace. 9800 Kincey Ave. Suite 100
Huntersville,NC 28078
[phone]
QUALITY CONTROL DATA
Project: Stormwater
Pace Project No.: 92719773
QC Batch: 840356 Analysis Method: EPA 200.7 Rev 4.4 1994
QC Batch Method: EPA 200.7 Rev 4.4 1994 Analysis Description: 200.7 MET
Laboratory: Pace Analytical Services-Asheville
Associated Lab Samples: 92719773001,92719773002
METHOD BLANK: 4340417 Matrix: Water
Associated Lab Samples: 92719773001,92719773002
Blank Reporting
Parameter Units Result Limit Analyzed Qualifiers
Copper ug/L ND 5,0 03/20/24 20:03
Lead ug/L ND 5.0 03/20/24 20:03
Zinc ug/L ND 10.0 03/20/24 20:03
LABORATORY CONTROL SAMPLE: 4340418
Spike LCS LCS %Rec
Parameter Units Conc. Result %Rec Limits Qualifiers
Copper ug/L 500 493 99 85-115
Lead ug/L 500 496 99 85-115
Zinc ug/L 500 505 101 85-115
MATRIX SPIKE&MATRIX SPIKE DUPLICATE: 4340419 4340420
MS MSD
92719556001 Spike Spike MS MSD MS MSD %Rec
Parameter Units Result Conc. Conc. Result Result %Rec %Rec Limits RPD Qual
Copper ug/L 32.9 500 500 567 566 107 107 70-130 0
Lead uglL ND 500 500 537 537 107 107 70-130 0
Zinc ug/L 0.087 500 500 635 635 110 110 70-130 0
mg/L
MATRIX SPIKE&MATRIX SPIKE DUPLICATE: 4340421 4340422
MS MSD
92719603001 Spike Spike MS MSD MS MSD %Rec
Parameter Units Result Conc. Conc. Result Result %Rec %Rec Limits RPD Qual
Copper ug/L 0.30 500 500 887 878 118 116 70-130 1
mg/L
Lead ug/L 0.018 500 500 542 539 105 104 70-130 1
mg/L
Zinc ug/L 4.7 500 500 5010 4910 54 34 70-130 2 M1
mg/L
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:03/22/2024 03:54 PM without the written consent of Pace Analytical Services,LLC. Page 7 of 15

Pace Analytical Services,LLC
ace. 9800 Kincey Ave. Suite 100
Huntersville,NC 28978
[phone]
QUALITY CONTROL DATA
Project: Stormwater
Pace Project No.: 92719773
QC Batch: 840451 Analysis Method: SM 2540D-2015
QC Batch Method: SM 2540D-2015 Analysis Description: 2540D Total Suspended Solids
Laboratory: Pace Analytical Services-Asheville
Associated Lab Samples: 92719773001
METHOD BLANK: 4341050 Matrix: Water
Associated Lab Samples: 92719773001
Blank Reporting
Parameter Units Result Limit Analyzed Qualifiers
Total Suspended Solids mg/L ND 2.5 03/20/24 16:05
LABORATORY CONTROL SAMPLE: 4341051
Spike LCS LCS %Rec
Parameter Units Conc. Result %Rec Limits Qualifiers
Total Suspended Solids mg/L 250 256 102 90-110
SAMPLE DUPLICATE: 4341481
92719292001 Dup
Parameter Units Result Result RPD Qualifiers
Total Suspended Solids mg/L 244 244 0
SAMPLE DUPLICATE: 4341482
92719292003 Dup
Parameter Units Result Result RPD Qualifiers
Total Suspended Solids mglL 3230 3180 2
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:03/22/2024 03:54 PM without the written consent of Pace Analytical Services,LLC. Page 8 of 15

Pace Analytical Services,LLC
ace'. 9800 Kincey Ave. Suite100
Huntersville,NC 28078
[phone]
QUALITY CONTROL DATA
Project: Stormwater
Pace Project No.: 92719773
QC Batch: 840585 Analysis Method: SM 2540D-2015
QC Batch Method: SM 2540D-2015 Analysis Description: 2540D Total Suspended Solids
Laboratory: Pace Analytical Services-Asheville
Associated Lab Samples: 92719773002
METHOD BLANK: 4341882 Matrix: Water
Associated Lab Samples: 92719773002
Blank Reporting
Parameter Units Result Limit Analyzed Qualifiers
Total Suspended Solids mg/L ND 2.5 03/21/24 05:32
LABORATORY CONTROL SAMPLE: 4341883
Spike LCS LCS %Rec
Parameter Units Conc. Result %Rec Limits Qualifiers
Total Suspended Solids mg1L 250 252 101 90-110
SAMPLE DUPLICATE: 4341884
92720056001 Dup
Parameter Units Result Result RPD Qualifiers
Total Suspended Solids mg/L 318 342 8
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:03/22/2024 03:54 PM without the written consent of Pace Analytical Services,LLC. Page 9 of 15

Pace Analytical Services,LLC
ace. 9800 Kincey Ave. Suite 100
Huntersviile,NC 28078
[phone]
QUALITY CONTROL DATA
Project: Stormwater
Pace Project No.: 92719773
QC Batch: 840623 Analysis Method: SM 5220D-2011
QC Batch Method: SM 5220D-2011 Analysis Description: 5220D COD
Laboratory: Pace Analytical Services-Asheville
Associated Lab Samples: 92719773001,92719773002
METHOD BLANK: 4341983 Matrix: Water
Associated Lab Samples: 92719773001,92719773002
Blank Reporting
Parameter Units Result Limit Analyzed Qualifiers
Chemical Oxygen Demand mg/L ND 25.0 03/21/24 06:30
LABORATORY CONTROL SAMPLE: 4341984
Spike LCS LCS %Rec
Parameter Units Conc. Result %Rec Limits Qualifiers
Chemical Oxygen Demand mg/L 750 804 107 90-110
MATRIX SPIKE&MATRIX SPIKE DUPLICATE: 4341985 4341986
MS MSD
92717965001 Spike Spike MS MSD MS MSD %Rec
Parameter Units Result Conc. Conc. Result Result %Rec %Rec Limits RPD Qual
Chemical Oxygen Demand mg/L 620 100 100 718 754 98 133 90-110 5 M1,R1
MATRIX SPIKE&MATRIX SPIKE DUPLICATE: 4341987 4341988
MS MSD
92718461002 Spike Spike MS MSD MS MSD %Rec
Parameter Units Result Conc. Conc. Result Result %Rec %Rec Limits RPD Qual
Chemical Oxygen Demand mg/L 84.7 100 100 189 197 105 112 90-110 4 M1,R1
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:03/22/2024 03:54 PM without the written consent of Pace Analytical Services,LLC. Page 10 of 15

Pace Analytical Services,LLC
(/ iace
9800 Kincey Ave. Suite 100
Huntersville,NC 28078
[phone]
QUALIFIERS
Project: Stormwater
Pace Project No.: 92719773
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:03/22/2024 03:54 PM without the written consent of Pace Analytical Services,LLC. Page 11 of 15

Pace Analytical Services,LLC
(/! ace Huntersville,NC 28078
[phone]
QUALITY CONTROL DATA CROSS REFERENCE TABLE
Project: Stormwater
Pace Project No.: 92719773
Analytical
Lab ID Sample ID QC Batch Method QC Batch Analytical Method Batch
92719773001 OUTFALL 2 GRAB EPA 1664B 840339
92719773002 OUTFALL 1 B GRAB EPA 1664E 840339
92719773001 OUTFALL 2 GRAB EPA 200.7 Rev 4.4 1994 840356 EPA 200.7 Rev 4.4 1994 840484
92719773002 OUTFALL 1 B GRAB EPA 200.7 Rev 4.4 1994 840356 EPA 200.7 Rev 4.4 1994 840484
92719773001 OUTFALL 2 GRAB SM 2540D-2015 840451
92719773002 OUTFALL 1 B GRAB SM 2540D-2015 840585
92719773001 OUTFALL 2 GRAB SM 5220D-2011 840623 SM 5220D-2011 840651
92719773002 OUTFALL 1B GRAB SM 5220D-2011 840623 SM 52200-2011 840651
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced,except in full,
Date:03/22/2024 03:54 PM without the written consent of Pace Analytical Services,LLC. Page 12 of 15

DC## Title: ENV-FRM-HUN1-0083 v03_Sample Condition Upon Receipt
.. ace
Effective Date: 11/29/2023 4:16:30 PM
Laboratory receiving samples:
Asheville❑ Eden❑ Greenwood❑ Huntersville Raleigh❑ Mechanicsville❑ Atlanta❑ KPrnercviIIan
WO# . 92719773
Sample C:ondittan���� Client Name: •
upon Rece) hY044 Project#:
� pt ��a
Courier. ❑Fed UPS ❑USPS ❑Client 1111 � ' I Ell II !11
❑ Commercial Pace ❑Other: 92719773 11 !!! ll
�—y�' �_
Custody Seal Present? DYes -ENO- Seals Intact? ❑Yes ONO N A � C) 1r
Date/Initials Person Examining Content's: I `DJ l 3�f��f:9
Packing Material: 9ubble Wrap ❑Bubble Bags ❑None ❑ Other Biological Tissue Frozen?
❑Yes Q2N/A
m Theromet No
lR Gun ID: `.� cy?
( ✓ Type of Ice: Wet ❑Blue 0 None
Correction Factor:
Cooler Temp: Add/Subtract('C) L/ Temp should be above freezing to 6'C
❑Samples out of temp criteria.Samples on ice,cooling process
Cooler Temp Corrected i'C): has begun
USDA Regulated Soil N/A,water sample)
Did samples originate in a uarantine zone within the United States:CA,NY,or SC Did samples originate from a foreign source(internationally,
(check maps)?❑yes/�No including Hawaii and Puerto Rico)?0Yes —011a
Comments/Discrepancy:
Chain of Custody Present? s D No 3 N/A 1.
Samples Arrived within Hold Time? -Yes ❑Na ❑N/A 2.
Short Hold Time Analysis(<72 hr.)? 0 Yes ,i�No ❑N/A 3.
Rush Turn Around Time Requested? Oyes trNo CI N/A 4.
Sufficient Volume? Yes ❑No O N/A 5.
Correct Containers Used? 'es ❑No ❑N/A 6.
-Pace Containers Used? C,1=tes 0 No ❑N/A
Containers Intact? es ❑No ©N/A 7.
Dissolved analysis:Samples Field Filtered? pps ©No N/A B.
Sample Labels Match COC? Zall Yes ❑No ©rr/A 9.
VI 1-
-Includes Date/Time/ID/Analysis Matrix:
Headspace in VOA Vials(>5-6mm)? El Yes No i/A 10.
Trip Blank Present? ❑Yes ❑No Hare/A 11.
Trip Blank Custody Seals Present? ❑Ycs ONo LdN/A
COMMENTS/SAMPLE DISCREPANCY Field Data Required? ©yes 0 No
Lot ID of split containers:
CLIENT NOTIFICATION/RESOLUTION
Person contacted: Date/Time:
Project Manager SCURF Review: Date:
Project Manager SRF Review: Date:
Qualtrax ID: 69614 Paae 1 of 2 Page 13 of 15

t Ulil.,
Effective Date: 11/1L1/2022
•
`Check mark top half of box if pH and/or dechlorination is verified and Project o WO : 92719773
within the acceptance range for preservation samples. PM: TIN Due Date 03/26/24
Exceptions:VOA,Cotiforrn,TOC.Oil and Grease.DRO/8O15{water)DOC.LLHc CLIENT: 92_Ag g i i ty F
"Bottom half of box is to list number of bottles
i
*"Check all unpreserved Nitrates for chlorine
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pH Adjustment Log for Preserved Samples
Sample ID k Type of Preservative pH upon receipt ( Date preservation adjusted 1 Time preservation Amount of Preservative lot
I adjusted added �` d
! •I 1 1
1
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Note Whenever there is a discrepancy affecting North Carolina compliance samples.a copy of the;tom will be sent to thn Wirth Carolina OENR Certdicatron Office(i e
Out of hold.incorrect preservative.out el temp.incorrect conlarn rt
Qualtrax ID.69614 Page 2 of 2
Page 14 of 15

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Preservation non•conformance Identified for — r Page 15 of 15
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