NCS000346 DMR SW (Letter & Their DMR Form)

INSTEEL
WIRE PRODUCTS
RECEIVED
APR 0 2 2U14
CENTRAL FILES
DWQIBOG
Division of Water Quality
Surface Water Protection Section
Att: Central Files
1617 Mail Service Center
Raleigh, NC 27699-1617
To Whom It May Concern,
Larry Blood
General Manager
([e-mail]
Ext. 3179
Please find attached Sample #10 for year 5- period 2 of permit # NCS000346 located at 129 Carter St,
Mt. Airy, NC. Please note the number of our address has changed to 1510 Carter St due to 911
emergency regulations but our physical address has stayed the same. The newest permit renewal
application which has already been submitted reference the new 1510 Carter St. address.
Sincerely,
Larry Blo d
General Manager
1373 BOGGS DRIVE; MOUNT AIRY, NC 27030/PHONE: [3361 786-2141/FAX: [336] 783-4303
WWW.INSTEEL.COM

PRISM I Full -Service Analytical &
CHAIN OF CUSTODY RECORD ONLY
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Project Name: AAKka
449 Springbrook Road • Charlotte, NC 28217 Short Hold Analysis: Yes(NO)'UST Pro ect: es N 'PROPER PRESERVATIVES Indicated? -
Phone [phone] Fax: [phone] y (Yes) j )
^s �� 1 w' `Please ATTACH any project specific reporting (QC LEVEL I II III IV) Received WITHIN HOLDING TIMES?
Client Company Name: `1'-b provisions arl C R quire ents CUSTODY SEALS INTACT?
Report To/Contact Name: Vi L. o Invoice To: 1�t^2 -VOLATILES recd WIOUT HEADSPACE?
Rrt* ng Add re s: J,SI �n r�Q r S Address: 5 PROPER CONTAINERS used?
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Phone 3 OO��Rf�ax (Yes) (No): Purchase Order No./Billing Reference TO BE FILLED IN BY CLIENTISAMPLING PERSONNEL
Email Address: Requested Due Date ❑ 1 Day ❑ 2 Days ❑ 3 Days ❑ 4 Days ❑ 5 Days Certification: NELAC DOD FL NC
EDD Type: PDF Excel Other "Working Days" ❑ 6-9 Days ❑ Standard 10 days ❑ prue h Work Med ust Be SC OTHER NIA
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Site Location Name: �J-�2 e� Lf -9 1 k C� Samples received after 14:00 will be processed next business day.
Site oc tion Phy cal Address: IS / O d c ` 3T Turnaround time is based on business days, excluding weekends and holidays. Water Chlorinated: YES— NO—
Site (SEE REVERSE FOR TERMS & CONDITIONS REGARDING SERVICES Sam le Iced U on Collection: YES NO
• LIC 9:_7 03 Q RENDERED BY PRISM LABORATORIES, INC. TO CLIENT) P P —
TIME MATRIX SAMPLE CONTAINER ANALYSIS REQUESTED PRISM
CLIENT DATE COLLECTED (SOIL, PRESERVA- REMARKS' LAB
SAMPLE DESCRIPTION COLLECTED MILITARY WATER OR "TYPE TIVES �Ol/ S ID NO.
HOURS SLUDGE) SEE BELOW NO. SIZE
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Samplers Signatur Sampled By (Print Name) vI ` Affiliation r GL nSV*\C(, 1' ano, C�
Upon relinquishing, this Chain of CustodA your authorization for Prism to proceed with the analyses as req ested above. Any changes must be PRISM USE ONLY
submitted in writing to the Prism Project Manager. There will be charges for any changes after analyses have been initialized.
Reli q e By: (SignatureReceived By: (Signature) Date Militaryours Additional Comments: Site Arrival Time;
Rel nqulshed By: (Signature) Received By: (Signature) Date Site Departure Time:
4 Of Field Tech Fee:
Relinquished By: (Signature) Received F Laboratt B Date
r�—(S-'(Y (:5 Mileage: -
Method of Shipment: NOTE: ALL SAMPLE COOLERS SHOULD BE TAPED SHUT USTODY SEALS FOR TRANSPORTATION TO THE LABORATORY. COC Group No.
SAMPLES ARE NOT ACCEPTED AND VERIFIED AGAINST UNTIL RECEIVED AT THE LABORATORY. 1
❑ Fed Ex VAPS ❑ Hand -delivered ❑ Prism Field Service ❑ Other
NPDES: UST: GROUNDWATER: DRINKING WATER: SOLID WASTE: RCRA: CERCLA LANDFILL OTHER: RN
❑NC,❑SCI ❑NC ❑SC aNC ESC IENC ❑SC IQNC ❑SC ONC❑SC UNC ESC oNC USC ONC ❑SCTESREME SR&EVCEORNSDEI•r
`CONTAINER TYPE CODES: A = Amber C = Clear G= Glass P = Plastic; TL = Teflon -Lined Cap VOA =Volatile Organics Analysis (Zero Head Space)
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