NC0090239_Application_20240201

Certified Mail Return Receipt
7022 2410 0001 4110 4405
January 30, 2024
Mr. Sergei Chernikov
Division of Water Resources
Water Quality Permitting Section - NPDES
1617 Mail Service Center
Raleigh, NC 27699-1617
Subject: NPDES Permit NC0090239- Modification
RECEIVED
FEB 01 2024
NCDEQ/DWR/NPDES
Eli Lilly and Company - Concord
1420 Concord Parkway South, Concord, North Carolina 28027
Dear Mr. Chernikov:
Eli Lilly and Company (Lilly) is submitting this NPDES major permit modification to its
existing NPDES Permit NCO090239 to incorporate the groundwater discharge from
dewatering activities. The proposed groundwater discharge to the existing stormwater
management system will be comingled with HVAC condensate and stormwater will continue
to meet the no exposure certification requirements from Lilly's Concord facility located at
1420 Concord Parkway South, Concord, NC, in Cabarrus County. Manufacturing operations
are not expected to begin until the fourth quarter of 2024.
Based on our previous email correspondence, Lilly is providing the following information in
this NPDES Permit Modification Package:
• EPA Form 2C
• Groundwater laboratory results as required by EPA Form 2C
Mailed separately by our procurement department:
• A check in the amount of $340 for Major Permit Modification to an Individual NPDES
permit.

Page 2 of 2
NPDES Permit Application
Thank you in advance for your assistance in processing this permit modification. If you have
any questions regarding the information provided, please contact Jamie Hunter, Eli Lilly and
Company Concord Site HSE Director at 980-356-0790 or by email at [e-mail].
Very truly yours,
Eli Lilly and Company
Rosa Manso �G - CA,. �6-
Site Head, Eli Lilly and Company Concord
cc: Jamie Hunter - HSE Director, Eli Lilly - Concord
Erin Wylie - Senior Engineer, Eli Lilly - Concord
Brian Griesemer, PE - HSE Senior Principal Associate, Eli Lilly - Indianapolis

United States Office of Water EPA Form 3510-2C
Environmental Protection Agency Washington, D.C. Revised March 2019
Water Permits Division
=�EPA Application Form 2C
Existing Manufacturing,
Commercial, Mining, and
Silvicultural Operations
NPDES Permitting Program
Note: Complete this form and Form 1 if your facility is an existing manufacturing, commercial, mining,
or silvicultural facility that currently discharges process wastewater.

Paperwork Reduction Act Notice
The U.S. Environmental Protection Agency estimates the average burden to collect information and
complete Form 2C to be 32.5 hours. This estimate includes time for reviewing instructions, searching
existing data sources, gathering and maintaining the needed data, and completing and reviewing the
collection of information. Send comments about the burden estimate or any other aspect of this
collection of information to the Chief, Information Policy Branch (PM-223), U.S. Environmental
Protection Agency, 1200 Pennsylvania Avenue, NW, Washington, DC 20460, and to the Office of
Information and Regulatory Affairs, Office of Management and Budget, 725 171h Street, NW,
Washington, DC 20503, marked "Attention: Desk Officer for EPA."

FORM 2C—INSTRUCTIONS
General Instructions
Who Must Complete Form 2C?
You must complete Form 2C if you answered "Yes" to Item 1.2.2 on
Form 1—that is, if you are an existing manufacturing, commercial,
mining, or silvicultural facility that currently discharges process
wastewater.
Where to File Your Completed Form
Submit your completed application package (Forms 1 and 2C) to
your National Pollutant Discharge Elimination System (NPDES)
permitting authority. Consult Exhibit 1-1 of Form 1's "General
Instructions" to identify your NPDES permitting authority.
Public Availability of Submitted Information
The U.S. Environmental Protection Agency (EPA) will make
information from NPDES permit application forms available to the
public for inspection and copying upon request. You may not claim
any information on Form 2C (or related attachments) as
confidential.
You may make a claim of confidentiality for any information that you
submit to EPA that goes beyond the information required by Form
2C. Note that NPDES authorities will deny claims for treating any
effluent data as confidential. If you do not assert a claim of
confidentiality at the time you submit your information to the
NPDES permitting authority, EPA may make the information
available to the public without further notice to you. EPA will handle
claims of confidentiality in accordance with the Agency's business
confidentiality regulations at Part 2 of Title 40 of the Code of
Federal Regulations (CFR).
Completion of Forms
Print or type in the specified areas only. If you do not have enough
space on the form to answer a question, you may continue on
additional sheets, as necessary, using a format consistent with the
form.
Provide your EPA Identification Number from the Federal Registry
Service, NPDES permit number, and facility name at the top of
each page of Form 2C and any attachments. If you do not know
your EPA Identification Number, contact your NPDES permitting
authority. See Exhibit 1-1 of Form 1's "General Instructions" for
contact information. Additionally, for Tables A through E, provide
the applicable outfall number at the top of each page.
Do not leave any response areas blank unless the form directs you
to skip them. If the form directs you to respond to an item that does
not apply to your facility or activity, enter "NA" for "not applicable" to
show that you considered the item and determined a response was
not necessary for your facility.
The NPDES permitting authority will consider your application
complete when it and any supplementary material are received and
completed according to the authority's satisfaction. The NPDES
permitting authority will judge the completeness of any application
independently of the status of any other permit application or permit
for the same facility or activity.
Definitions
The legal definitions of all key terms used in these instructions and
Form 2C are in the "Glossary" at the end of the "General
Instructions" in Form 1.
Line -by -Line Instructions
Section 1.Outfall Location
Item 1.1. Identify each of the facility's outfall structures by number.
For each outfall, specify the latitude and longitude to the nearest
15 seconds and name of the receiving water. The application form
provides reporting space for three outfalls. If your facility has more
than this number, attach additional sheets as necessary. The
location of each outfall (i.e., where the coordinates are collected)
shall be the point where the discharge is released into a water of
the United States. Latitude and longitude coordinates may be
obtained in a variety of ways, including use of hand held devices
(e.g., a GPS enabled smartphone), internet mapping tools (e.g.,
httys://mynasgdata.Iarc.nasa.gov/latitudelongitude-finders,
geographic information systems (e.g., ArcView), or paper maps
from trusted sources (e.g., U.S. Geological Survey or USGS).For
further guidance, refer to
http:llwww.epa.qov/geospatial/latitudelongitude-data-standard.
Section 2. Line Drawing
Item 2.1. Attach a line drawing showing water flow through your
facility, from intake to discharge. Indicate the sources of intake
water (e.g., city, well, stream, other); operations contributing
wastewater to the effluent including process and production areas,
sanitary flows, cooling water, and stormwater runoff; and treatment
units labeled to correspond to the more detailed descriptions under
Section 3. You may group similar operations into a single unit.
Construct a water balance on the line drawing by showing average
flows (specify units) between intakes, operations, treatment units,
and outfalls. Show all significant losses of water to products, the
atmosphere, and discharge. You should use actual measurements
wherever available; otherwise use your best estimate. If you cannot
determine a water balance for your activities (such as mining
activities), provide a pictorial description of the nature and amount
of any sources of water and any collection and treatment measures.
An example of an acceptable line drawing is provided in Exhibit
2C-1 at the end of these instructions.
Section 3. Average Flows and Treatment
Item 3.1. For each outfall identified under Item 1. 1, provide the
following information: (1) all processes, operations, or production
areas that contribute wastewater to the effluent for the outfall,
including process wastewater, sanitary wastewater, cooling water,
and stormwater runoff; (2) average flow of wastewater contributed
by each operation in million gallons per day (mgd); (3) a description
of the treatment unit (including size of each treatment unit, flow rate
through each treatment unit, retention time, etc.); (4) the applicable
treatment code(s) from Exhibit 2C-2 (see end of instructions); and
(5) the ultimate disposal of any solid or fluid wastes that are not
discharged to the receiving water. You may describe processes,
operations, or production areas in general terms (e.g., "dye -making
reactor" or "distillation tower"). You may estimate the average flow
of point sources composed of stormwater; however, you must
2C-1

FORM 2C—INSTRUCTIONS CONTINUED
indicate the basis of the rainfall event and the method of estimation
Add additional sheets as necessary.
Item 3.2. Answer whether you are applying for an NPDES permit to
operate a privately owned treatment works. If yes, continue to Item
3.3. If no, skip to Section 4.
Item 3.3. Attach a list to your application that includes the identity of
each user of the treatment works, then answer "Yes" to Item 3.3.
Section 4. Intermittent Flows
Item 4.1. Answer "Yes" or "No" to indicate whether any of the
discharges you described in Sections 1 and 3 of Form 2C are
intermittent or seasonal, except for stormwater runoff, spillage, or
leaks. An intermittent discharge is one that is not continuous. A
continuous discharge is one that occurs without interruption during
the operating hours of the facility, except for infrequent shutdowns
for maintenance, process changes, or other similar activities. A
discharge is seasonal if it occurs only during certain parts of the
year. If yes, continue to Item 4.2. If no, skip to Section 5.
Item 4.2. By relevant outfall number, identify each operation that
has intermittent or seasonal discharges. Indicate the average
frequency (days per week and months per year), the long-term
average and maximum daily flow rates in mgd, and the duration of
the intermittent or seasonal discharges. Base your answers on
actual data if available. Otherwise, provide your best estimate.
Report the average of all daily values measured during days when
the discharge occurred for "Long -Term Average," and report the
highest daily value for "Maximum Daily."
Section 5. Production
Item 5.1. Indicate whether any effluent limitation guidelines (ELGs)
promulgated under Section 304 of the Clean Water Act (CWA)
apply to your facility. If yes, continue to Item 5.2. If no, skip to
Section 6. All ELGs promulgated by EPA appear in the Federal
Register and are published annually in 40 CFR Subchapter N. An
ELG applies if you have any operations contributing process
wastewater in any subcategory covered by a Best Practicable
Control Technology Currently Available (BPT), Best Conventional
Pollutant Control Technology (BCT), or Best Available Technology
Economically Achievable (BAT) guideline. If you are unsure
whether you are covered by a promulgated ELG, consult your
NPDES permitting authority (see Exhibit 1-1 of the "General
Instructions" of Form 1). You must check "Yes" if an applicable ELG
has been promulgated, even if the ELG is being contested in court.
If you believe that a promulgated ELG has been remanded for
reconsideration by a court and does not apply to your operations,
you may answer "No" to Item 5.1 and skip to Section 6.
Item 5.2. Complete Item 5.2 by indicating the applicable ELG
category, ELG subcategory, and corresponding regulatory citation.
See the example below.
d
5.2
ELG Category
ELG
Subcategory
Regulatory
Citation
Pulp, Paper,
Secondary Fiber
40 CFR 430,
and
Non-Deink
Subpart J
Paperboard
Subcategory
CL
Point Source
Category
Item 5.3. Indicate if the limitations in the applicable ELGs are
expressed in terms of production or other measure of operation. For
operational parameter, it is expressed in terms of production (e.g.,
"pounds of biological oxygen demand per cubic foot of logs from
which bark is removed," or "pounds of total suspended solids per
megawatt hour of electrical energy consumed by smelting
furnace"). An example of an ELG not expressed in terms of a
measure of operation is one that limits the concentration of
pollutants. If yes, continue to Item 5.4. If no, skip to Section 6.
Item 5.4. Indicate the operations, products, or materials produced
at the facility for each outfall. For each operation, product, or
material produced, denote the quantity produced per day using the
measurement units specified in the applicable ELG. The NPDES
permitting authority will use the production information to apply
ELGs to your facility. You may not claim that the production
information you submit is confidential. You do not need to indicate
how you calculated the reported information. The production figures
provided must be based on a reasonable measure of actual daily
production, not on design capacity or on predictions of future
operations. To obtain alternate limits under 40 CFR 122.45(b)(2)(ii),
you must define your maximum production capability and
demonstrate to the NPDES permitting authority that your actual
production is substantially below maximum production capability
and that there is a reasonable potential for an increase above
actual production during the duration of the permit.
Section 6. Improvements
Item 6.1. Indicate if you are required by any federal, state, or local
authority to meet an implementation schedule for constructing,
upgrading, or operating wastewater treatment equipment or
practices or any other environmental programs that could affect the
discharges described in your application. The requirements include,
but are not limited to, permit conditions, administrative enforcement
orders, enforcement compliance schedule letters, stipulations, court
orders, and grant or loan conditions. If yes, continue to Item 6.2. If
no, skip to Item 6.3.
Item 6.2. Briefly identify and describe each applicable project (e.g.,
consent decree, enforcement order, or permit condition). For each
condition, specify the affected outfall number(s), the source(s) of
the discharge, the projected final compliance date, and the
required final compliance date.
Item 6.3.OPTIONAL ITEM. If desired, attach descriptions of any
additional water pollution control programs (or other environmental
projects that could affect your discharges) that are now underway
or planned. Indicate in your attachments whether each program is
actually underway or is planned, and indicate your actual or
planned schedule for construction.
Section 7. Effluent and Intake Characteristics
Items 7.1 to 7.17. These items require you to collect and report
data for the parameters and pollutants listed in Tables A through E,
located at the end of Form 2C. The instructions for completing the
tables are table -specific in addition to the criteria for determining
who should complete them. In general, the following conditions
apply:
2C-2

FORM 2C—INSTRUCTIONS CONTINUED
Table
Pollutants/Parameters
Who Completes?
A
Conventional and non-
All applicants from all outfalls unless a
conventional pollutants
waiver is obtained from the NPDES
permitting authority.
B
Toxic metals, cyanide, total
Applicants in the primary industry
phenols, and organic toxic
categories listed in Exhibit 2C-3 at the
pollutants
end of these instructions.
C
Certain conventional and
Applicants subject to ELGs that limit
non -conventional pollutants
pollutants directly or indirectly and
applicants who believe pollutants may
be present in their facility's discharge.
D
Certain hazardous
Applicants who believe pollutants may
substances and asbestos
be present in their facility's discharge.
E
2,3,7,8-tetrachlorodibenzo-
Applicants that use or manufacture the
p-dioxin (2,3,7,8-TCDD)
pollutant or believe the pollutant may
be present in the facility's discharge.
Important note: Read the "General Instructions for Reporting,
Sampling, and Analysis" on pages 2C-5 and 2C-6 before
completing Section 7 and Tables A through E.
Item 7.1 and Table A. All applicants must report at least one
analysis for each conventional and non -conventional pollutant listed
in Table A for each outfall (one table per outfall). This includes
outfalls discharging only noncontact cooling water or stormwater
runoff. However, at your request, the NPDES permitting authority
may waive the requirement to test for one or more of the listed
pollutants for specific outfalls, upon a determination that available
information is adequate to support issuance of your NPDES permit
with less stringent reporting requirements. You may also request a
waiver from your NPDES permitting authority for one or more of the
Table A pollutants for your industry category or subcategory.
Indicate whether you are requesting a waiver in response to Item
7.1. If yes, continue to Item 7.2. If no, skip to Item 7.3.
Item 7.2. Specify the outfalls for which you are requesting a waiver.
Next, indicate on Table A for the applicable outfalls the pollutants
for which the waiver is being requested. Attach your waiver request
and supporting information to your completed Form 2C.
Item 7.3. Test your effluent from each outfall for each pollutant
listed in Table A for which you have not requested a waiver. You
may also conduct optional tests of your intake water for the Table A
pollutants. See the "General Instructions for Reporting, Sampling,
and Analysis" on pages 2C-5 and 2C-6 for further information.
Item 7.4 and Table B. This item asks whether any of the facility's
processes that contribute wastewater fall into one or more of the
primary industry categories listed in Exhibit 2C-3. If you are
applying for a permit for a privately owned treatment works,
determine your testing requirements based on the industrial
categories of your contributors. This exercise is simply to determine
your testing requirements only. You are not giving up your right to
challenge your inclusion in the category determined for testing (e.g.,
for deciding whether an ELG is applicable) before your permit is
issued. If yes, continue to Item 7.5. If no, skip to Item 7.8.
Complete a separate Table B for each outfall. Section 1 of Table B
lists toxic metals, cyanide, and total phenols. Sections 2 through 5
of Table B list the pollutants in each of the gas
chromatography/mass spectrometry (GC/MS) fractions. Note that
inclusion of total phenols in Section 1 of Table B does not mean
that EPA is classifying the group as toxic pollutants.
Item 7.5. Because you indicated in Item 7.4 that the facility's
processes contribute wastewater that falls into one or more of the
primary industry categories, check "Testing Required" for all toxic
metals, cyanide, and total phenols in Section 1 of Table B. Answer
"Yes" to Item 7.5 once you have completed this task.
Item 7.6. Because you indicated in Item 7.4 that the facility's
processes contribute wastewater that falls into one or more of the
primary industry categories, list the primary industry categories
applicable to your facility. Next, review Exhibit 2C-3 to determine
whether testing is required and for which GC/MS fraction(s): volatile
compounds, acid compounds, base/neutral compounds, and
pesticides. Check the applicable boxes for each GC/MS fraction
requiring testing.
Item 7.7. For each of the required GC/MS fractions, check "Testing
Required" for each of the pollutants in the required fraction in
Sections 2 through 5 of Table B. Answer "Yes" to Item 7.7 once you
have completed this task.
Item 7.8 and Sections 1 through 5 of Table B. For all other cases
(secondary industries, nonprocess wastewater outfalls, and
nonrequired GC/MS fractions) and remaining pollutants, check
"Believed Present" or "Believed Absent" in Sections 1 through 5 of
Table B to indicate whether you have reason to believe that any of
the pollutants listed are discharged from your outfalls. Answer "Yes"
to Item 7.8 after you have completed this step.
Item 7.9 and Section 1 of Table B. For each pollutant you know or
have reason to believe is present in your discharge from each
applicable outfall in concentrations of 10 parts per billion (ppb) or
greater, you must report quantitative data. For every pollutant
expected to be discharged in concentrations less than 10 ppb, you
must submit quantitative data or briefly describe the reasons the
pollutant is expected to be discharged. For pollutants in intake
water, see the discussion under "General Instructions for Reporting,
Sampling, and Analysis" below. Answer "Yes" to Item 7.9 once you
have completed Section 1 of Table B.
Item 7.10. This item asks if you qualify as a "small business." If so,
you are exempt from submitting quantitative data for the organic
toxic pollutants on Table B (Sections 2 through 5). You still must
indicate, though, whether you believe any of the pollutants listed in
Sections 1 through 5 are present in your discharge per the
Instructions at Item 7.8 above.
You can qualify as a small business in two ways: (1) If your facility
is a coal mine and if your probable total annual production is less
than 100,000 tons per year, you may submit past production data
or estimated future production (such as a schedule of estimated
total production under 30 CFR 795.14(c)) instead of conducting
analyses for the organic toxic pollutants. (2) If your facility is not a
coal mine and if your gross total annual sales for the most recent
three years average less than $100,000 per year (in second
quarter 1980 dollars), you may submit sales data for those years
instead of conducting analyses for the organic toxic pollutants.
The production or sales data must be for the facility that is the
source of the discharge. The data should not be limited to
production or sales for the process or processes that contribute to
the discharge, unless those are the only processes at your facility.
2C-3

FORM 2C—INSTRUCTIONS CONTINUED
For sales data, in situations involving intra-corporate transfer of
goods and services, the transfer price per unit should approximate
market prices for those goods and services as closely as possible.
Sales figures for years after 1980 should be indexed to the second
quarter of 1980 by using the gross national product price deflator
(second quarter of 1980 = 100). This index is available online from
the U.S. Department of Commerce, Bureau of Economic Analysis
at http://bea.gov/national/pdf/SNTables.pdf.
If you qualify as a small business according to the criteria above,
answer "Yes" to Item 7.10. Check the box at the top of Table B to
show that you are not required to submit quantitative data for the
organic toxic pollutants (Sections 2 through 5 of Table B), then
skip to Item 7.12. Otherwise, answer "No" and continue to Item
7.11.
Item 7.11 and Sections 2 through 5 of Table B. Unless you
qualify as a small business (see Item 7.10), you must provide
quantitative data for all pollutants for which you marked "Testing
Required" in Sections 2 through 5 of Table B. You must also
provide quantitative data for all pollutants you marked as "Believed
Present" in Sections 2 through 5 of Table B if you discharge those
pollutants in concentrations of 10 ppb or greater, except for
acrolein, acrylonitrile, 2,4-dinitrophenol, and 2-methyl-4,6-
dinitrophenol. If you discharge any of the four latter pollutants in
concentrations of 100 ppb or greater, you must report quantitative
data. If you discharge the pollutants in Sections 2 through 5 of
Table B less than these thresholds (i.e., <100 ppb for acrolein,
acrylonitrile, 2,4-dinitrophenol, and 2-methyl-4,6-dinitrophenol and
<10 ppb for all others), you must submit quantitative data or briefly
describe the reasons the pollutant is in your discharge.
For pollutants in intake water, see the discussion under "General
Instructions for Reporting, Sampling, and Analysis" on pages
2C-5 and 2C-6 for further information.
Once you have completed these tasks, answer "Yes" to Item 7.11.
Item 7.12 and Table C. For each outfall (including outfalls
containing only noncontact cooling water or stormwater runoff),
indicate whether you know or have reason to believe that any of
the pollutants listed on Table C are present in your discharge. If
so, mark the box in the "Believed Present" column for each
applicable pollutant. If not, mark the box in the "Believed Absent"
column for each applicable pollutant. Answer "Yes" to Item 7.12
once you have completed the required task for each outfall.
Item 7.13 and Table C. You are required to report quantitative
data for any Table C pollutants that are directly limited in an
applicable ELG or are indirectly limited in an applicable ELG
through an expressed limitation on an indicator (e.g., use of total
suspended solids (TSS) as an indicator to control the discharge
of iron and aluminum). For all other pollutants that you marked as
"Believed Present," you must either report quantitative data or
briefly describe the reasons the pollutant is expected to be
discharged.
For pollutants in intake water, see the discussion under "General
Instructions for Reporting, Sampling, and Analysis" on pages
2C-5 and 2C-6 for further information.
Answer "Yes" to Item 7.13 when you have fully completed the
tasks associated with Table C and Items 7.12 and 7.13 above.
Item 7.14 and Table D. For each outfall, indicate if you believe that
any pollutant listed in Table D is "Believed Present" or "Believed
Absent" in your facility's effluent. Check the boxes in the applicable
columns on Table D next to each pollutant. For every pollutant
believed present, you must briefly describe the reasons the
pollutant is expected to be discharged and report any quantitative
data you have for that pollutant. Note that you are not required to
perform analytical tests for any of the Table D pollutants at this time.
However, if you have prior test results, you must report them.
Item 7.15. Answer "Yes" to this Item when you have completed
Table D.
Under40 CFR 117.12(a)(2), certain discharges of hazardous substances
(listed in Exhibit 2C-4 at the end of these instructions) may be exempted from
the requirements of Section 311 of the CWA, which establishes reporting
requirements, civil penalties, and liability for cleanup costs for spills of oil and
hazardous substances. A discharge of a particular substance can be exempted
if the origin, source, and amount of the discharged substances are identified in
the NPDES permit application or in the permit, if the permit contains a
requirement for treatment of the discharge, and if the treatment is in place.
Exemptions are allowed from the requirements of CWA Section 311.
Applications for exemptions must set forth the following information:
1. The substance and the amount of each substance that may be discharged.
2. The origin and source of the discharge of the substance.
3. The treatment to be provided for the discharge by:
a. An onsite treatment system separate from any treatment system
treating your normal discharge;
b. A treatment system designed to treat your normal discharge and that is
additionally capable of treating the amount of the substance identified
under paragraph 1 above; or
c. Any combination of the above.
See 40 CFR 117.12(a)(2) and (c) or contact your NPDES permitting authority
for further information on exclusions from CWA Section 311.
Item 7.16. Indicate whether:
• Your facility uses or manufactures 2,4,5-trichlorophenoxy
acetic acid (2,4,5-T); 2-(2,4,5-trichlorophenoxy) propanoic acid
(Silvex, 2,4,5-TP); 2-(2,4,5-trichlorophenoxy) ethyl 2,2-dichloro-
propionate (Erbon); 0,0-dimethyl 0-(2,4,5-trichlorophenyl)
phosphorothioate (Ronnel); 2,4,5,-trichlorophenol (TCP); or
hexachlorophene (HCP).
• You know or have reason to believe that 2.3.7,8-
tetrachlorodibenzo-p-dioxin (TCDD) is or may be present in an
effluent.
If yes, continue to Item 7.17. If no, skip to Section 8.
Item 7.17 and Table E. If you answered "Yes" to Item 7.16, you
must report qualitative data, generated using a screening procedure
not calibrated with analytical standards, for TCDD. Your screening
analyses must be performed using gas chromatography with an
electron capture detector. A TCDD standard for quantitation is not
required. Describe the results of your screening analysis (e.g., "no
measurable baseline deflection at the retention time of TCDD" or "a
measurable peak within the tolerances of the retention time of
TCDD.") on Table E. The NPDES permitting authority may require
you to perform a quantitative analysis if you report a positive result.
Answer "Yes" to Item 7.17 when you have completed Table E.
2C-4

General Instructions for Reporting, Sampling, and Analysis
Important note: Read these instructions before completing Tables
A through E and Section 7 of Form 2C.
General Items
Complete the applicable tables for each outfall at your facility. Be
sure to note the EPA Identification Number, NPDES permit number,
facility name, and applicable outfall number at the top of each page
of the tables and any associated attachments.
You may report some or all of the required data by attaching
separate sheets of paper instead of completing Tables A through E
for each of your outfalls so long as the sheets contain all of the
required information and are similar in format to Tables A through
E. For example, you may be able to print a report in a compatible
format from the data system used in your GC/MS analysis
completed under Table B.
Table A requires you to report at least one analysis for each
pollutant listed. Tables B through D require you to report analytical
data in two ways. For some pollutants, you may be required to
check the box in the "Testing Required" column and test and report
the levels of the pollutants in your discharge whether or not you
expect them to be present in your discharge. For all other
pollutants, you must check the box in either the 'Believed Present'
or "Believed Absent" columns based on your best estimate and test
for those you believe to be present (with some exceptions). Base
your determination that a pollutant is present in or absent from your
discharge on your knowledge of your raw materials, maintenance
chemicals, intermediate and final products and byproducts, and any
previous analyses known to you of your effluent or similar effluent.
For example, if you manufacture pesticides, you should expect
those pesticides to be present in contaminated stormwater runoff.
If you would expect a pollutant to be present solely because of its
presence in your intake water, you must mark `Believed Present'
but you are not required to analyze for that pollutant. Instead, mark
an "X" in the long-term average value of the "Intake" column;
optionally, you may instead provide intake data.
Reporting of Effluent Data
Report sampling results for all pollutants in Tables A through C as
concentration and total mass, except for flow, temperature, pH,
color, and fecal coliform organisms. If you are reporting
quantitative data under Table D, report concentration only.
Flow, temperature, pH, color, and fecal coliform organisms must be
reported as mgd, degrees Celsius (°C), standard units, color units,
and most probable number per 100 milliliters (MPN/100 mL),
respectively. Use the following abbreviations in the columns
requiring "units" in Tables A through D.
Concentration
Mass
ppm = parts per million
Ibs = pounds
mg/L = milligrams per liter
ton = tons (English tons)
ppb = parts per billion
mg = milligrams
Ng/L = micrograms per liter
g = grams
MPN = most probable number per
kg = kilograms
100 milliliters
T = tonnes (metric tons)
All reporting of values for metals must be in terms of "total
recoverable metal," unless:
• An applicable, promulgated ELG specifies the limitation for
the metal in dissolved, valent, or total form;
• All approved analytical methods for the metal inherently
measure only its dissolved form (e.g., hexavalent chromium);
or
• The permitting authority has determined that in establishing
case -by -case limitations it is necessary to express the
limitations of the metal in dissolved, valent, or total form to
carry out the provisions of the CWA.
Note that you are not required to complete the "Maximum Monthly
Discharge" and the "Long -Term Average Daily Discharge" columns
of Tables A through C; however, these fields should be completed
if data are available.
If you measure only one daily value, complete the "Maximum Daily
Discharge" columns of the tables and enter 1" in the "Number of
Analyses" columns. The NPDES permitting authority may require
additional analyses to further characterize your discharges.
For composite samples, the daily value is the total mass or
average concentration found in a composite sample taken over the
operating hours of the facility during a 24-hour period. For grab
samples, the daily value is the arithmetic or flow -weighted total
mass or average concentration found in a series of at least four
grab samples taken over the operating hours of the facility during a
24-hour period.
If you measure more than one daily value for a pollutant and those
values are representative of your wastestream, you must report
them. You must describe your method of testing and data analysis.
When an applicant has two or more outfalls with substantially
identical effluents, the NPDES permitting authority may allow the
applicant to test only one outfall and report those quantitative data
as applying to the substantially identical outfall. If the permitting
authority grants your request, attach a separate sheet to the
application form identifying the outfall tested and describing why the
other outfall(s) are substantially identical.
Reporting of Intake Data
You are not required to report data under the "Intake" columns of
Tables A through C unless you wish to demonstrate your eligibility
for a "net' effluent limitation for one or more pollutants in Tables A
through C (i.e., an effluent limitation adjusted by subtracting the
average level of the pollutant(s) present in your intake water).
NPDES regulations allow net limitations only in certain
circumstances. To demonstrate your eligibility, under the "Intake"
columns report the average of the results of analyses of your intake
water and discuss the requirements for a net limitation with your
NPDES permitting authority. If your water is treated before use, test
the water after it has been treated.
2C-5

General Instructions for Reporting, Sampling, and Analysis Continued
Sampling
The collection of samples for the reported analyses should be
supervised by a person experienced in performing sampling of
industrial wastewater. You may contact your NPDES permitting
authority for detailed guidance on sampling techniques and for
answers to specific questions. See Exhibit 1-1 of Form 1 for
contact information. Any specific requirements in the applicable
analytical methods —for example, sample containers, sample
preservation, holding times, and the collection of duplicate
samples —must be followed.
The time when you sample should be representative of your normal
operation, to the extent feasible, with all processes that contribute
wastewater in normal operation, and with your treatment system
operating properly with no system upsets. Collect samples from the
center of the flow channel, where turbulence is at a maximum, at a
site specified in your present NPDES permit, or at any site
adequate for the collection of a representative sample.
Grab samples must be used for pH, temperature, cyanide, total
phenols, residual chlorine, oil and grease, fecal coliform (including
E. coh), and enterococci (previously known as fecal streptococcus
at 40 CFR 122.26(d)(2)(iii)(A)(3)), and volatile organic compounds.
For all other pollutants, a 24-hour composite sample, using a
minimum of four grab samples, must be used unless specified
otherwise at 40 CFR 136. However, a minimum of one grab
sample may be taken for effluents from holding ponds or other
impoundments with a retention period greater than 24 hours.
For stormwater discharges, a minimum of one to four grab
samples must be taken, depending on the duration of the
discharge. One grab sample must be taken in the first hour (or
less) of discharge, with one more grab sample (up to a minimum of
four) taken in each succeeding hour of discharge for discharges
lasting four hours or more.
Except for stormwater discharges, the NPDES permitting authority
may waive composite sampling requirements for any outfall for
which you demonstrate that use of an automatic sampler is
infeasible and that the minimum of four grab samples will be
representative of your discharge. Results of analyses of individual
grab samples for any parameter may be averaged to obtain the
daily average. Grab samples that are not required to be analyzed
immediately may be composited in the laboratory, if the container,
preservation, and holding time requirements are met and if sample
integrity is not compromised during compositing. See Table II at 40
CFR 136.3 for further information.
A grab sample is an individual sample of at least 100 milliliters
collected at a randomly chosen time over a period not exceeding
15 minutes.
A composite sample is a combination of at least eight sample
aliquots of at least 100 milliliters, collected at periodic intervals
during the operating hours of a facility over a 24-hour period. The
composite must be flow proportional; either the time interval
between each aliquot or the volume of each aliquot must be
proportional to either the stream flow at the time of sampling or the
total stream flow since the collection of the previous aliquot.
Aliquots may be collected manually or automatically. For "GC/MS
Fraction —Volatile Compounds" in Table B, aliquots must be
combined in the laboratory immediately before analysis. Four
(rather than eight) aliquots or grab samples should be collected for
this fraction. These four samples should be collected during actual
hours of discharge over a 24-hour period and need not be flow
proportioned. Only one analysis is required.
Use of Historical Data
Existing data may be used, if available, in lieu of sampling
conducted solely for the purposes of this application, provided that:
all data requirements are met; sampling was performed, collected,
and analyzed no more than 4.5 years prior to submission; all data
are representative of the discharge; and all available representative
data are considered in the values reported.
Analysis
Except as specified below, all required quantitative data shall be
collected in accordance with sufficiently sensitive analytical
methods approved under 40 CFR 136 or required under 40 CFR
chapter I, subchapter N or 0. A method is "sufficiently sensitive"
when:
• The method minimum level (ML) is at or below the level of the
applicable water quality criterion for the measured pollutant or
pollutant parameter.
• The method ML is above the water quality criterion, but the
amount of the pollutant or pollutant parameter in the facility's
discharge is high enough that the method detects and
quantifies the level of the pollutant or pollutant parameter in
the discharge.
• The method has the lowest ML of the analytical methods
approved under 40 CFR 136 or required under 40 CFR
chapter I, subchapter N or 0 for the measured pollutant or
pollutant parameter.
Consistent with 40 CFR 136, you may provide matrix- or sample -
specific MLs rather than the published levels. Further, where you
can demonstrate that, despite a good faith effort to use a method
that would otherwise meet the definition of "sufficiently sensitive,"
the analytical results are not consistent with the quality assurance
(QA)/quality control (QC) specifications for that method, then the
NPDES permitting authority may determine that the method is not
performing adequately and the NPDES permitting authority should
select a different method from the remaining EPA -approved
methods that is sufficiently sensitive consistent with 40 CFR
122.21(e)(3)(i). Where no other EPA -approved methods exist, you
must select a method consistent with 40 CFR 122.21(e)(3)(ii).
When there is no analytical method that has been approved under
40 CFR 136; required under 40 CFR chapter I, subchapter N or 0,
and is not otherwise required by the NPDES permitting authority,
you may use any suitable method but shall provide a description of
the method. When selecting a suitable method, other factors such
as a method's precision, accuracy, or resolution, may be
considered when assessing the performance of the method.
2C-6

FORM 2C—INSTRUCTIONS CONTINUED
Section 8. Used or Manufactured Toxics
Item 8.1. Indicate if any pollutant listed in Table B is used or
manufactured in your facility as an intermediate or final product or
byproduct. If yes, continue to Item 8.2. If no, skip to Section 9.
Item 8.2. List the applicable toxic pollutants. Note that the NPDES
permitting authority may waive or modify the requirement if you
demonstrate that it would be unduly burdensome to identify each
toxic pollutant and the permitting authority has adequate
information to issue you a permit. You may not claim this
information as confidential. Note that you do not need to distinguish
between use or production of the pollutants or list amounts.
Section 9. Biological Toxicity Tests
Item 9.1. Indicate if you have any knowledge or reason to believe
that any biological test for acute or chronic toxicity has been made
on any of your discharges or on a receiving water in relation to your
discharge within the last three years. If yes, continue to Item 9.2. If
no, skip to Section 10.
Item 9.2. Identify the tests known to have been performed and the
purposes of each. For each test, check "Yes" or "No" to indicate if
you have submitted the test results to the NPDES permitting
authority and the date the results were submitted. The NPDES
permitting authority may ask you to provide additional details after
reviewing your application.
Section 10. Contract Analyses
Item 10.1. Indicate if any of the analyses reported in Section 7 were
performed by a contract laboratory or consulting firm. If yes,
continue to Item 10.2. If no, skip to Section 11.
Item 10.2. Identify each laboratory or firm used in the table
provided. For each, provide the name, address, and phone number
of the laboratory or firm and the pollutants analyzed.
Section 11. Additional Information
Item 11.1. In addition to the information reported on the application
form, the NPDES permitting authority may request additional
information reasonably required to assess the discharges of the
facility and to determine whether to issue an NPDES permit. The
additional information may include additional quantitative data and
bioassays to assess the relative toxicity of discharges to aquatic life
and requirements to determine the cause of the toxicity. Indicate
under Item 11.1 whether the NPDES permitting authority has
requested additional information from you. If yes, continue to Item
11.2. If no, skip to Section 12.
Item 11.2. List the items requested and attach the required
information to the application.
Section 12. Checklist and Certification Statement
Item 12.1. Review the checklist provided. In Column 1, mark the
sections of Form 2C that you have completed and are submitting
with your application. In Column 2, indicate for each section
whether you are submitting attachments.
Item 12.2. The CWA provides for severe penalties for submitting
false information on this application form. Section 309(c)(2) of the
CWA provides that "Any person who knowingly makes any false
statement, representation, or certification in any application, ...shall
upon conviction, be punished by a fine of no more than $10,000 or
by imprisonment for not more than six months or both."
FEDERAL REGULATIONS AT 40 CFR 122.22 REQUIRE THIS
APPLICATION TO BE SIGNED AS FOLLOWS:
A. For a corporation, by a responsible corporate officer. For the
purpose of this section, a responsible corporate officer means:
(1) a president, secretary, treasurer, or vice-president of the
corporation in charge of a principal business function, or any
other person who performs similar policy- or decision -making
functions for the corporation, or (2) the manager of one or
more manufacturing, production, or operating facilities,
provided the manager is authorized to make management
decisions which govern the operation of the regulated facility
including having the explicit or implicit duty of making major
capital investment recommendations, and initiating and
directing other comprehensive measures to assure long term
environmental compliance with environmental laws and
regulations; the manager can ensure that the necessary
systems are established or actions taken to gather complete
and accurate information for permit application requirements;
and where authority to sign documents has been assigned or
delegated to the manager in accordance with corporate
procedures.
B. For a partnership or sole proprietorship, by a general partner
or the proprietor, respectively.
C. For a municipality, state, federal, or other public facility, by
either a principal executive officer or ranking elected official.
For purposes of this section, a principal executive officer of a
federal agency includes: (1) The chief executive officer of the
agency, or (2) a senior executive officer having responsibility
for the overall operations of a principal geographic unit of the
agency (e.g., Regional Administrators of EPA).
END
Submit your completed Form 1, Form 2C, and
all associated attachments
(and any other required NPDES application forms)
to your NPDES permitting authority.
2C-7

Exhibit 2CA Example Line Drawing
Blue River
Municipal
90,000 GPD Water Supply Blue River
10,000 GPD
��000GPD
45,000 GPD*40,000
PD
Cooling Water
Raw Materials
Finer
15 000
Dyeing
20,00010
000
Drying
5,000 GPD
10,000 GPD
Preparation
GPD
GPDGPD
To Atmospl
40,000 GPD
40,000 GPD
10,000
To Product
GPD
5,000 GPD
Solid Waste
Grit
Neutralization
Loss
Waste
4
41000 GPD
Separator
Tank
6,000 GPD
Treatment
Plant 02
36,000 GPD
34,000 GPD Outfall 002
50,000 GPD
Waste
Outfal1001
Stormwater
Treatment
70,000 GPD + Stormwa er
Max: 20.000 GPD
Plant 41
Schematic of Water Flow
Brown Mills, Inc.
City, County, State
2C-8

Exhibit 2C-2. Codes for Treatment Units and Disposal of Wastes Not Discharged
1—A ................Ammonia
stripping
1—B ................
Dialysis
1—C ................
Diatomaceous earth filtration
1—D ................
Distillation
1—E ................
Electrodialysis
1—F.................
Evaporation
1—G ................
Flocculation
1—H ................
Flotation
1—I..................
Foam fractionation
1—J .................
Freezing
1—K ................
Gas —phase separation
1—L.................
Grinding (comminutors)
2—A ................ Carbon adsorption
2—B
................ Chemical oxidation
2—C
................ Chemical precipitation
2—D
................ Coagulation
2—E
................ Dechlorination
2—F.................
Disinfection (chlorine)
1. PHYSICAL TREATMENT PROCESSES
1—M................Grit
removal
1—N ................Microstraining
1-0 ................
Mixing
1—P.................Moving
bed filters
1—Q ................
Multimedia filtration
1—R ................Rapid
sand filtration
1—S.................Reverse
osmosis (hyperfiltration)
1—T.................
Screening
1—U ................Sedimentation
(settling)
1—V.................Slow
sand filtration
1—W................Solvent
extraction
1—X.................
Sorption
CHEMICAL TREATMENT PROCESSES
2—G................Disinfection (ozone)
2—H ................Disinfection (other)
2-1.................. Electrochemical treatment
2—J .................Ion exchange
2—K................. Neutralization
2—L ................. Reduction
3. BIOLOGICAL TREATMENT PROCESSES
3—A ................
Activated sludge
3—E .................
Pre -aeration
3—B ................Aerated
lagoons
3—F.................
Spray irrigation/land application
3—C ................Anaerobic
treatment
3—G ................Stabilization
ponds
3—D ................
Nitrification—denitrification
3—H ................Trickling
filtration
4. WASTEWATER DISPOSAL PROCESSES
4—A ................
Discharge to surface water
4—C ................
Reuse/recycle of treated effluent
4—B ................Ocean
discharge to outfall
4—D ................Underground
injection
5.
SLUDGE TREATMENT AND DISPOSAL PROCESSES
5—A ................
Aerobic digestion
5—M ................
Heat drying
5—B ................Anaerobic
digestion
5—N ................Heat
treatment
5—C ................
Belt filtration
5-0 ................
Incineration
5—D ................
Centrifugation
5—P .................
Land application
5—E ................
Chemical conditioning
5—Q ................
Landfill
5—F.................
Chlorine treatment
5—R ................Pressure
filtration
5—G ................
Composting
5—S .................
Pyrolysis
5—H ................
Drying beds
5—T .................
Sludge lagoons
5-1..................
Elutriation
5—U ................Vacuum
filtration
5—J .................
Flotation thickening
5—V.................
Vibration
5—K ................
Freezing
5—W ................
Wet oxidation
5—L.................
Gravity thickening
2C-9

Exhibit 2C-3. Testing Requirements for Organic Toxic Pollutants Industry Categories*
INDUSTRY CATEGORY
Adhesives and sealants........................................................
Aluminum forming.................................................................
Auto and other laundries.......................................................
Battery manufacturing...........................................................
Coalmining...........................................................................
Coilcoating...........................................................................
Copperforming.....................................................................
Electric and electronic compounds .......................................
Electroplating........................................................................
Explosives manufacturing.....................................................
Foundries..............................................................................
Gum and wood chemicals (all subparts except D and F) .....
Gum and wood chemicals, Subpart D (tall oil rosin) .............
Gum and wood chemicals, Subpart F (rosin -based
derivatives)...........................................................................
Inorganic chemicals manufacturing ......................................
Iron and steel manufacturing ................................................
Leather tanning and finishing
Mechanical products manufacturing .....................................
Nonferrous metals manufacturing .........................................
Ore mining, Subpart B (base and precious metals) ..............
Organic chemicals manufacturing ........................................
Paint and ink formulation......................................................
Pesticides.............................................................................
Petroleum refining.................................................................
Pharmaceutical preparations ................................................
Photographic equipment and supplies ..................................
Plastic and synthetic materials manufacturing ......................
Plastic processing.................................................................
Printing and publishing.........................................................
Pulp and paperboard mills ....................................................
Rubber processing................................................................
Soap and detergent manufacturing ......................................
Steam electric power plants ..................................................
Textile mills (except Subpart C, Greige Mills) .......................
Timber products processing .................................................
GC/MS FRACTIONt
Volatile
Acid
Base/Neutral
Pesticide
X
X
X
❑
X
X
X
❑
X
X
X
X
X
X
❑
X
X
X
❑
X
X
X
❑
X
X
X
X
X
X
X
❑
❑
X
X
❑
X
X
X
❑
X
X
❑
❑
X
X
X
❑
X
X
X
❑
X
X
X
❑
X
X
X
❑
X
X
X
❑
X
X
X
❑
X
X
X
X
❑
X
❑
❑
X
X
X
X
X
X
X
❑
X
X
X
X
X
7
_
❑
X
X
X
❑
X
X
X
❑
X
X
X
X
X
!I
I
❑
X
X
X
X
X
X
X
X
X
X
X
❑
X
X
X
❑
X
X
i❑
❑
X
X
X
❑
X
X
X
X
* See note at conclusion of 40 CFR 122, Appendix D (1983) for explanation of effect of suspensions on testing requirements for primary
industry categories.
t The pollutants in each fraction are listed in Table B.
X = Testing is required.
❑ = Testing is not required.
2C-10

1. Acetaldehyde
2. Acetic acid
3. Acetic anhydride
4. Acetone cyanohydrin
5. Acetyl bromide
6. Acetyl chloride
7. Acrolein
8. Acr&nitrile
9. Adipic acid
10. Aldrin
11. Allyl alcohol
12. Allyl chloride
13. Aluminum sulfate
14. Ammonia
15. Ammonium acetate
16. Ammonium benzoate
17. Ammonium bicarbonate
18. Ammonium bichromate
19. Ammonium bifluoride
20. Ammonium bisulfite
21. Ammonium carbamate
22. Ammonium carbonate
23, Ammonium chloride
24. Ammonium chromate
25. Ammonium citrate
26. Ammonium fluoroborate
27. Ammonium fluoride
28. Ammonium hydroxide
29. Ammonium oxalate
30. Ammonium silicofluodde
31. Ammonium sulfamate
32. Ammonium sulfide
33. Ammonium sulfite
34. Ammonium tartrate
35. Ammonium thiocyanate
36. Ammonium thiosulfate
37. Amyl acetate
38. Aniline
39. Antimony pentachloricle
40. Antimony potassium tartrate
41. Antimony tribromide
42. Antimony trichloride
43, Antimony tricuoride
44. Antimony trioxide
45. Arsenic disulfide
46. Arsenic pentoxide
47. Arsenic trichloride
48. Arsenic trioxide
49. Arsenic trisulfide
50. Barium cyanide
51, Benzene
52. Benzoic acid
53. Benzonitrile
54, Benzoyl chloride
55. Benzyl chloride
56. Beryllium chloride
57. Beryllium fluoride
58. Beryllium nitrate
59. Butylacetate
60. n-butylphthalate
61. Butylamine
62. Butyric acid
63. Cadmium acetate
64, Cadmium bromide
65. Cadmium chloride
66. Calcium arsenate
67. Calcium arsenite
68. Calcium carbide
69. Calcium chromate
70. Calcium cyanide
71. Calcium dodecylbenzenesulfonate
72. Calcium hypochlorite
Exhibit 2C4. Hazardous Substances
73. Captan
74. Carbaryl
75. Carbofuran
76. Carbon disulfide
77. Carbon tetrachloride
78. Chlordane
79. Chlorine
80. Chlorobenzene
81. Chloroform
82. Chloropyrifos
83, Chlorosulfonic acid
84. Chromic acetate
85. Chromic acid
86. Chromic sulfate
87. Chromous chloride
88. Cobaltous bromide
89. Cobaltous formate
90. Cobaltous sulfamate
91. Coumaphos
92. Cresol
93. Crotonaldehyde
94. Cupric acetate
95. Cupric acetoarsenite
96. Cupric chloride
97. Cupric nitrate
98. Cupric oxalate
99. Cupric sulfate
100. Cupric sulfate ammoniated
101. Cupric tartrate
102. Cyanogen chloride
103. Cyclohexane
104.2,4-D acid (2,4-dichlorophenoxyacetic acid)
105, 2,4-D esters (2,4-dichlorophenoxyacetic acid esters)
106. DDT
107. Diazinon
108. Dicamba
109, Dichlobenil
110. Dichlone
111. Dichlorobenzene
112. Dichloropropane
113. Dichloropropene
114. Dichloropropene-dichloproropane mix
115. 2,2-dichloropropionic acid
116. Dichlorvos
117. Dieldrin
118. Diethylamine
119. Dimethylamine
120. Dinitrobenzene
121. Dinitrophenol
122. Dinitrotoluene
123. Diquat
124. Disulfoton
125. Diuron
126. Dodecylbenzesulfonic acid
127. Endosulfan
128. Endrin
129. Epichlorohydrin
130. Ethion
131. Ethylbenzene
132. Ethylenediamine
133. Ethylene dibromide
134. Ethylene dichloride
135. Ethylene diaminetetracetic acid (EDTA)
136. Ferric ammonium citrate
137. Ferric ammonium oxalate
138. Ferric chloride
139. Ferric fluoride
140. Ferric nitrate
141. Ferric sulfate
142. Ferrous ammonium sulfate
143. Ferrous chloride
144. Ferrous sulfate
145. Formaldehyde
146. Formic acid
147. Fumaric acid
148. Furfural
149. Guthion
150. Heptachlor
151. Hexachlorocyclopentadiene
152. Hydrochloric acid
153. Hydrofluoric acid
154. Hydrogen cyanide
155. Hydrogen sulfide
156. Isoprene
157. Isopropanolamine dodecylbenzenesulfonate
158. Kelthane
159. Kepone
160. Lead acetate
161. Lead arsenate
162. Lead chloride
163. Lead fluoborate
164. Lead fluorite
165. Lead iodide
166. Lead nitrate
167. Lead stearate
168. Lead sulfate
169, Lead sulfide
170. Lead thiocyanate
171. Lindane
172. Lithium chromate
173. Malathion
174. Maleic acid
175. Maleic anhydride
176. Mercaptodimethur
177. Mercuric cyanide
178. Mercuric nitrate
179. Mercuric sulfate
180. Mercuric thiocyanate
181. Mercurous nitrate
182. Methoxychlor
183. Methyl mercaptan
184. Methyl methacrylate
185. Methyl parathion
186. Mevinphos
187, Mexacarbate
188. Monoethylamine
189, Monomethylamine
190. Naled
191. Naphthalene
192. Naphthenic acid
193. Nickel ammonium sulfate
194. Nickel chloride
195. Nickel hydroxide
196. Nickel nitrate
197. Nickel sulfate
198. Nitric acid
199. Nitrobenzene
200. Nitrogen dioxide
201. Nitrophenol
202. Nitrotoluene
203. Paraformaldehyde
204. Parathion
205. Pentachlorophenol
206. Phenol
207.Phosgene
208. Phosphoric acid
209. Phosphorus
210. Phosphorus oxychloride
211. Phosphorus pentasulfide
212. Phosphorus trichloride
213. Polychlorinated biphenyls (PCB)
214. Potassium arsenate
215. Potassium arsenite
2C-11

Exhibit 2C-4. Hazardous Substances
216. Potassium bichromate
245. Sodium phosphate (dibasic)
271. Uranyl acetate
217. Potassium chromate
246. Sodium phosphate (tribasic)
272. Uranyl nitrate
218. Potassium cyanide
247. Sodium selenite
273. Vanadium penoxide
219. Potassium hydroxide
248. Strontium chromate
274. Vanadyl sulfate
220. Potassium permanganate
249. Strychnine
275. Vinyl acetate
221. Propargite
250. Styrene
276. Vinylidene chloride
222. Propionic acid
251. Sulfuric acid
277. Xylene
223. Propionic anhydride
252. Sulfur monochloride
278. Xylenol
224. Propylene oxide
253. 2,4,5-T acid (2,4,5-thchlorophenoxyacetic acid)
279. Zinc acetate
225. Pyrethrins
254.2,4,5-T amines (2,4,5-trichlorophenoxy acetic acid
280. Zinc ammonium chloride
226. Quinoline
amines)
281. Zinc borate
227. Resorcinol
255.2,4,5-T esters (2,4,5-trichlorophenoxy acetic acid
282. Zinc bromide
228. Selenium oxide
esters)
283. Zinc carbonate
229. Silver nitrate
256.2,4,5-T salts (2,4,5-trichlorophenoxy acetic acid salts)
284. Zinc chloride
230. Sodium
257.2,4,5-TP acid (2,4,5-trichlorophenoxy propanoic acid)
285. Zinc cyanide
231. Sodium arsenate
258.2,4,5-TP acid esters (2,4,54richlorophenoxy propanoic
286. Zinc fluoride
232. Sodium arsenite
acid esters)
287. Zinc formate
233. Sodium bichromate
259. ME (tetrachlorodiphenyl ethane)
288. Zinc hydrosulfite
234. Sodium bifluoride
260. Tetraethyl lead
289. Zinc nitrate
235. Sodium bisulfite
261. Tetraethyl pyrophosphate
290. Zinc phenolsulfonate
236. Sodium chromate
262. Thallium sulfate
291. Zinc phosphide
237. Sodium cyanide
263. Toluene
292. Zinc silicofluoride
238. Sodium dodecylbenzenesulfonate
264. Toxaphene
293. Zinc sulfate
239. Sodium fluoride
265. Trichlorofon
294. Zirconium nitrate
240. Sodium hydrosulfide
266. Trichloroethylene
295. Zirconium potassium fluoride
241. Sodium hydroxide
267. Trichlorophenol
296. Zirconium sulfate
242. Sodium hypochlorite
268. Triethanolamine dodecylbenzenesulfonate
297. Zirconium tetrachloride
243. Sodium methylate
269. Triethylamine
244. Sodium nitrite
270. Trimethylamine
2C-12

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
OMB No. 2040-0004
Form U.S. Environmental Protection Agency
2C \`. EPA Application for NPDES Permit to Discharge Wastewater
NPDES EXISTING MANUFACTURING, COMMERCIAL, MINING, AND SILVICULTURE OPERATIONS
SECTIONOUTFALL LOCATIONi
1.1 Provide information on each of the facility's outfalls in the table below.
Outfa
° Numbe w r Receiving Water Name Latitude Longitude
0
0 2 Wetlands to Coddle Creek 35' 23' 29.1" N -80, 37' 40.7" W
J
m
O
SECTIONDRAWING 1
o, 2.1 Have you attached a line drawing to this application that shows the water flow through your facility with a water
balance? (See instructions for drawing requirements. See Exhibit 2C-1 at end of instructions for example.)
J o ❑✓ Yes ❑ No
SECTION• 1
3.1 For each outfall identified under Item 1.1, provide average flow and treatment information. Add additional sheets if
necessary.
"Outfall Number" 2
Operations
Operation Average Flow
Dewatering 0.56 mgd
Y
C
E mgd
Y
mgd
N mgd
3
0 Treatment Units
U-
Description Code from Final Disposal of Solid or
(include size, flow rate through each treatment unit, Table 2C 1 Liquid Wastes Other Than
> retention time, etc.) by Discharge
Stormwater Retention Basin 1-U NA
EPA Form 3510-2C (Revised 3-19) Page 1

EPA Identification Number
NPDES Permit Number
Facility Name
Form Approved 03/05/19
F
1
OMB No. 2040-0004
3.1
**Outfall Number**
cont.
Operations Contributing
to Flow
Operation
Average Flow
mgd
mgd
mgd
mgd
Treatment
Description
Units
Code from
Final Disposal of Solid or
(include size, flow rate through each treatment unit,
Table 2C-1
Liquid Wastes Other Than
retention time, etc.)
by Dischar e
M
d
w
0
U
c
a>
E:
R
N
H
M
*'Outfall Number**
yOperations
0
Operation
Average Flow
LL
mgd
d
<
mgd
mgd
mgd
Treatment
Description
Units
Code from
Final Disposal of Solid or
(include size, flow rate through each treatment unit,
Table 2C•1
Liquid Wastes Other Than
retention time. etc.)
by Discharge
3.2
Are you applying for an NPDES permit to operate a privately owned treatment works?
❑ Yes ❑✓ No 4 SKIP to Section 4.
N�
3.3
Have you attached a list that identifies each user of the treatment works?
❑ Yes ❑ No
EPA Form 3510-2C (Revised 3-19) Page 2

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
OMB No. 2040-0004
SECTION• 1
4.1 Except for storm runoff. leaks, or spills, are any discharges described in Sections 1 and 3 intermittent or seasonal?
❑ Yes ❑✓ No -+ SKIP to Section 5.
4.2
Provide information
on intermittent or seasonal flows for each applicable outfall.
Attach additional pages, if necessar .
Frequency
Flow
Rate
Outfall
Operation
Duration
Average
Average
Long -Term
Maximum
Number
(list)
Da slWeek
MonthsNear
Average
Dail
days/week
months/year
mgd
mgd
days
a
days/week
months/year
mgd
mgd
days
o
days/week
months/year
mgd
mgd
days
dayslweek
months/year
mgd
mgd
days
m
c
days/week
months/year
mgd
mgd
days
days/week
months/year
mgd
mgd
days
days/week
months/year
mgd
mgd
days
days/week
months/year
mgd
mgd
days
days/week months/year mgd mgd days
SECTION•'•D
5.1
• 1
Do any effluent limitation guidelines (ELGs) promulgated by EPA under Section 304 of the CWA apply to your facility?
❑ Yes ❑✓ No 4 SKIP to Section 6.
u,
5.2
Provide the following information on applicable ELGs.
ELG Category
ELG Subcategory
Regulatory Citation
w
m
n
m
U
.Q
d
Q
5.3
Are any of the applicable ELGs expressed in terms of production (or other measure of operation)?
U)
❑ Yes ❑ No 4 SKIP to Section 6.
0
2
5.4
Provide an actual measure of daily production expressed in terms and units of applicable ELGs.
J
Outfall
Operation, Product, or Material
Quantity per Day
Unit of
a
Number
Measure
d
m
r_
0
c.>
v
0
a
EPA Form 3510-2C (Revised 3-19) Page 3

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
OMB No. 2040-0004
SECTION. IMPROVEMENTS (40
6.1 Are you presently required by any federal, state, or local authority to meet an implementation schedule for constructing,
upgrading, or operating wastewater treatment equipment or practices or any other environmental programs that could
affect the discharges described in this application?
❑ Yes ❑✓ No 4 SKIP to Item 6.3.
6.2
applicable project in the table below.
dAffected
—Brieflyidentifyeach
Final Compliance Dates
E
Brief Identification and Description of
Outfalls
Source(s) of
'o
Project
(list outfall
Discharge
Required
Projected
n
number
E
v
c
Vl
N
.D
A
CL
C.
6.3
Have you attached sheets describing any additional water pollution control programs (or other environmental projects
that may affect your discharges) that you now have underway or planned? (optional item)
❑ Yes ❑ No ✓❑ Not applicable
SECTION
See the instructions to determine the pollutants and parameters you are required to monitor and, in turn, the tables you must
complete. Not all applicants need to complete each table.
Table A. Conventional and Non -Conventional Pollutants
7.1
Are you requesting a waiver from your NPDES permitting authority for one or more of the Table A pollutants for any of
your outfalls?
❑✓ Yes ❑ No 4 SKIP to Item 7.3.
7.2
If yes, indicate the applicable outfalls below. Attach waiver request and other required information to the application.
Outfall Number 2 Outfall Number Outfall Number
7.3
Have you completed monitoring for all Table A pollutants at each of your outfalls for which a waiver has not been
c
requested and attached the results to this application package?
✓❑ Yes ❑ No; a waiver has been requested from my NPDES
permitting authority for all pollutants at all outfalls.
Table B.
Toxic Metals, Cyanide, Total Phenols, and Organic Toxic Pollutants
7.4
Do any of the facility's processes that contribute wastewater fall into one or more of the primary industry categories
listed in Exhibit 2C-3? (See end of instructions for exhibit.)
v
❑ Yes ✓❑ No 4 SKIP to Item 7.8.
C
7.5
Have you checked "Testing Required" for all toxic metals, cyanide, and total phenols in Section 1 of Table B?
w
❑ Yes ❑ No
7.6
List the applicable primary industry categories and check the boxes indicating the required GC/MS fraction(s) identified
in Exhibit 2C-3.
Primary Industry Category
Required GC/MS Fraction(s)
Check applicable boxes.
❑ Volatile ❑ Acid ❑ Base/Neutral ❑ Pesticide
❑ Volatile ❑ Acid ❑ Base/Neutral ❑ Pesticide
❑ Volatile ❑ Acid ❑ Base/Neutral ❑ Pesticide
EPA Form 3510-2C (Revised 3-19) Page 4

EPA Identification Number
NPDES Permit Number
Facility Name
Form Approved 03/05/19
OMB No. 2040-0004
7.7
Have you checked "Testing Required" for all required pollutants in Sections 2 through 5 of Table B for each of the
GC/MS fractions checked in Item 7.6?
❑ Yes ❑ No
7.8
Have you checked `Believed Present' or `Believed Absent" for all pollutants listed in Sections 1 through 5 of Table B
where testing is not required?
❑✓ Yes ❑ No
7.9
Have you provided (1) quantitative data for those Section 1, Table B, pollutants for which you have indicated testing is
required or (2) quantitative data or other required information for those Section 1, Table B, pollutants that you have
indicated are 'Believed Present' in your discharge?
✓❑ Yes ❑ No
7.10
Does the applicant qualify for a small business exemption under the criteria specified in the instructions?
❑ Yes -* Note that you qualify at the top of Table B, ❑✓ No
then SKIP to Item 7.12.
7.11
Have you provided (1) quantitative data for those Sections 2 through 5, Table B, pollutants for which you have
o
determined testing is required or (2) quantitative data or an explanation for those Sections 2 through 5, Table B,
N
pollutants you have indicated are 'Believed Present' in your discharge?
`-'
.y
✓❑ Yes ❑ No
Table C. Certain Conventional and Non -Conventional Pollutants
7.12
Have you indicated whether pollutants are 'Believed Present' or 'Believed Absent' for all pollutants listed on Table C
s
for all outfalls?
U
Y
❑ Yes ❑✓ No
7.13
Have you completed Table C by providing (1) quantitative data for those pollutants that are limited either directly or
indirectly in an ELG and/or (2) quantitative data or an explanation for those pollutants for which you have indicated
"Believed Present'?
❑ Yes ❑✓ No
„LU
Table D. Certain Hazardous Substances and Asbestos
7.14
Have you indicated whether pollutants are "Believed Present' or 'Believed Absent' for all pollutants listed in Table D for
all outfalls?
❑ Yes ❑✓ No
7.15
Have you completed Table D by (1) describing the reasons the applicable pollutants are expected to be discharged
and (2) by providing quantitative data, if available?
❑ Yes ❑✓ No
Table E. 2,3,7,8-Tetrachlorodibenzo -Dioxin 2,3,7,8-TCDD
7.16
Does the facility use or manufacture one or more of the 2,3,7,8-TCDD congeners listed in the instructions, or do you
know or have reason to believe that TCDD is or may be present in the effluent?
❑ Yes 4 Complete Table E. ❑✓ No 4 SKIP to Section 8.
7.17
Have you completed Table E by reporting qualitative data for TCDD?
❑ Yes ❑ No
SECTIONOR
MANUFACTURED TOXICS
Is any pollutant listed in Table B a substance or a component of a substance used or manufactured at your facility as
8.1
an intermediate or final product or byproduct?
❑ Yes ❑✓ No 4 SKIP to Section 9.
8.2
List the pollutants below.
1. 4. 7.
0
CD
2. 5. 8.
3. 6. 9.
EPA Form 3510-2C (Revised 3-19) Page 5

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
OMB No. 2040-0004
MCTION 9. BIOLOGICAL• 1
9.1 Do you have any knowledge or reason to believe that any biological test for acute or chronic toxicity has been made
within the last three years on (1) any of your discharges or (2) on a receiving water in relation to your discharge?
❑ Yes ❑✓ No 4 SKIP to Section 10.
9.2
Identify the tests and their
ourposes below.
Test(s)
Purpose of Test(s)
Submitted to NPDES
Date Submitted
X
Permitting Authority?
0
F-
❑ Yes ❑ No
M
0
0
m
❑ Yes ❑ No
❑ Yes ❑ No
I-ECTION
10. CONTRACTi
10.1
Were any of the analyses reported in Section 7 performed by a contract laboratory or consulting firm?
❑✓ Yes ❑ No 4 SKIP to Section 11.
10.2
Provide information for each contract laboratory or consulting
firm below.
Laboratory Number 1
Laboratory Number 2
Laboratory Number 3
Name of laboratory/firm
PACE Analytical Services
U)
�,
Laboratory address
7726 Moller Road
cc
a
Indianapolis, IN 46268
w
U
f9
w
C
0
Phone number
[phone]
Pollutant(s) analyzed
Table 1 and Table 2
pollutants
SECTIONADDITIONAL
INFORMATION
11.1
Has the NPDES permitting authority requested additional information?
o
ElYes ❑✓ No 4 SKIP to Section 12.
E
E
11.2
List the information requested and attach it to this application.
0
1. 4.
M
r-
0
a
2. 5.
a
3. 6.
EPA Form 3510-2C (Revised 3-19) Page 6

EPA Identification Number
NPDES Permit Number Facility Name Form Approved 03/05/19
:1 OMB No. 2040-0004
SECTION 12. CHECKLIST
AND CERTIFICATION STATEMENT 1
12.1
In Column 1 below, mark the sections of Form 2C that you have completed and are submitting with your application.
For each section, specify in Column 2 any attachments that you are enclosing to alert the permitting authority. Note
that not all applicants are required to com lete all sections or provide attachments.
Column 1
Column 2
✓❑ Section 1: Outfall Location
❑ w/ attachments
❑✓ Section 2: Line Drawing
❑ w/ line drawing ❑ w/ additional attachments
Section 3: Average Flows and
❑✓
w/ list of each user of
❑ w/ attachments ❑ privately owned treatment
Treatment
works
❑✓ Section 4: Intermittent Flows
❑ w/ attachments
❑✓ Section 5: Production
❑ w/ attachments
w/ optional additional
❑✓ Section 6: Improvements
❑ w/ attachments ❑ sheets describing any
additional pollution control
tans
❑ w/ request for a waiver and ❑ w/ explanation for identical
supporting information outfalls
w/ small business exemption w/ other attachments
❑ ❑
request
N
✓❑ Section 7: Effluent and Intake
❑✓ w/ Table A ✓❑ w/ Table B
C
Characteristics
❑ w/ Table C ❑ w/ Table D
.2
❑ w/ Table E ❑ w/ analytical results as an
attachment
❑ Section 8: Used or Manufactured
❑ wl attachments
Toxics
❑ Section 9: Biological Toxicity
❑ w/ attachments
Tests
U
✓❑ Section 10: Contract Analyses
❑ w/ attachments
❑✓ Section 11: Additional Information
❑ w/ attachments
❑ Section 12: Checklist and
❑ w/ attachments
Certification Statement
12.2
Certification Statement
1 certify 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. l am aware that there are significant penalties for submitting false information, including the
possibility of fine and imprisonment for knowing violations.
Name (print or type first and last name)
Official title
Rosa Manso
Site Head - Eli Lilly - Concord
Signature
Date signed
jz's5�
_404,
7 o 2- 0 2-
EPA Form 3510-2C (Revised 3-19) Page 7

This page intentionally left blank.

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
OMB No. 2040-0004
Effluent
Intake
1
Pollutant
Waiver
Requested
Units
o tionai
Maximum
Maximum
Long -Term
(specify)
Daily
Monthly
Average Daily
Number of
Long -Term
Number of
(if applicable)
Discharge
Discharge
Discharge
Analyses
Average Value
Analyses
(required)d
available
d available
❑
Check here if you have applied to your NPDES permitting authority for a waiver for all of the pollutants listed on this table for the noted outfall.
1'
Biochemical oxygen demand
El
Concentration
mg/L
2
1
Mass
(BOD5)
2'
Chemical oxygen demand
El
Concentration
mg/L
25
1
Mass
(COD)
Concentration
mg/L
5
3.
Total organic carbon (TOC)
❑
Mass
1
Concentration
mg/L
3.2
4.
Total suspended solids (TSS)
❑
Mass
1
Concentration
mg/L
0.1
5.
Ammonia (as N)
❑
Mass
1
6.
Flow
❑
Rate
Temperature (winter)
❑✓
°C
°C
7.
Temperature (summer)
0
°C
°C
pH (minimum)
❑
Standard units
s.u.
8.6
1
8.
pH (maximum)
❑
Standard units
s.u.
8.6
1
1 Sampling shall be conducted according to sufficiently sensitive test procedures (i.e., methods) approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR chapter I, subchapter N or 0. See instructions and 40 CFR 122.21(e)(3).
EPA Form 3510-2C (Revised 3-19) Page 9

This page intentionally left blank.

EPA Identification Number NPDES Permit Number Facility Name
Outfall Number Form Approved 03/05/19
OMB No. 2040-0004
: • • • • •' •Ll'• 1OM
Presence or Absence
Intake
check one
Effluent
(optional)
Po llutantlParameter Testing Units
Maximum
Maximum
Long -Term
Long-
(and CAS Number, if available) Required Believed Believed (specify)
q (p �)
Daily
Monthly
Average
Number
Term
Number
Present Absent
Discharge
Discharge
Daily
of
Average
of
(required)
(if available)
Discharge
Analyses
Value
Analyses
if available
El
Check here if you qualify as a small business per the instructions to Form 2C and, therefore, do not need to submit quantitative data for any of the organic toxic pollutants in Sections
2 through 5 of this table. Note, however, that you must still indicate in the appropriate column of this table if you believe any of the pollutants listed are present in your discharge.
Section 1. Toxic Metals, Cyanide, and Total Phenols
1.1
Antimony, total
El
❑
El
Concentration
ug/L
50
1.
Mass
(7440-36-0)
1.2
Arsenic. total
El❑
❑
Concentration
ug/L
30
1
Mass
(7440-38-2)
1.3
Beryllium, total
❑
Concentration
ug/L
10
1
Mass
(7440-41-7)
1.4
Cadmium, total
❑
❑
Concentration
ug/L
10
1
Mass
(7440-43-9)
1.5
Chromium, total
El
El
❑
Concentration
ug/L
84.7
1
Mass
(7440-47-3)
1.6
Copper, total
El
❑
Concentration
ug/L
20
1
Mass
(7440-50-8)
1.7
Lead, total
El
El
IZI
Concentration
ug/L
25
1
Mass
(7439-92-1)
1.8
Mercury, total
❑
❑
Concentration
ug/L
0.2
1
Mass
(7439-97-6)
1.9
Nickel, total
❑
Concentration
ug/L
20
1
Mass
(7440-02-0)
1.10
Selenium, total
❑
Concentration
ug/L
40
1
Mass
(7782-49-2)
1.11
Silver, total
✓
Concentration
ug/L
10
1
Mass
(7440-22-4)
EPA Form 3510-2C (Revised 3-19) Page 11

EPA Identification Number NPDES Permit Number Facility Name
Outfall Number Form Approved 03/05/19
OMB No. 2040-0004
�: • • • Ills] • •• 1
Presence or Absence
Intake
check one
Effluent
(optional)
PollutantlParameter Testing Units
Maximum
Maximum
Long -Term
Long -
(and CAS Number, if available) Required Believed Believed (specify)
Daily
Monthly
Average
Number
Term
Number
Present Absent
Discharge
Discharge
Daily
°f
Average
of
(required)
(if available)
Discharge
Analyses
Value
Analyses
if available
1.12
Thallium, total
Concentration
ug/L
200
1
Mass
(7440-28-0)
1.13
Zinc, total
Concentration
ug/L
136
1
Mass
(7440-66-6)
1.14
Cyanide, total
❑
❑✓
Concentration
mg/L
0.008
1
Mass
(57-12-5)
1.15
Phenols, total
El
El
El
Concentration
mg/L
0.02
1
Mass
Section 2. Organic Toxic Pollutants (GC/MS Fraction
—Volatile Compounds)
21
Acrolein
❑
❑
✓0
Concentration
ug/L
5
1
Mass
(107-02-8)
2.2
Acrylonitrile
El
0
Concentration
ug/L
5
1
Mass
(107-13-1)
2.3
Benzene
❑
❑
❑✓
Concentration
ug/L
1
1
Mass
(71-43-2)
2.4
Bromoform
❑✓
Concentration
ug/L
2
1
Mass
(75-25-2)
2.5
Carbon tetrachloride
❑
❑
❑✓
Concentration
ug/L
2
1
Mass
(56-23-5)
2.6
Chlorobenzene
❑
❑
Concentration
ug/L
2
1
Mass
(108-90-7)
2.7
Chlorodibromomethane
❑
❑
❑✓
Concentration
ug/L
2
1
Mass
(124-48-1)
2.8
Chloroethane
❑
Concentration
ug/L
2
1
Mass
(75-00-3)
EPA Form 3510-2C (Revised 3-19) Page 12

EPA Identification Number NPDES Permit Number Facility Name
Outfall Number Form Approved 03/05/19
OMB No. 2040-0004
1Presence
or Absence
check one
Intake
Effluent(optional)
llutant/Parameter Testing Units
JIF(andoCAS
Maximum
Maximum
Long Term
Long-
Number, if available Required Believed Believed
q (specify)
Average
Number
Term
Number
Present Absent
Daily
Monthly
Dail
of
of
Discharge
Discharge
Discharge
Analyses
Average
Analyses
(required)
(if available)
f available
2'9
2-chloroethylvinyl ether
❑
❑
❑
Concentration
ug/L
S
Mass
(110-75-8)
2.10
Chloroform (67-66-3)
Concentration
ug/L
2
Mass
2.11
Dichlorobromomethane
Concentration
ug/L
2
Mass
(75-27-4)
2.12
1,1-dichloroethane
Concentration
ug/L
2
Mass
(75-34-3)
2.13
1,2-dichloroethane
Concentration
ug/L
2
Mass
(107-06-2)
2.14
1.1-dichloroethylene
Concentration
ug/L
2
Mass
(75-35-4)
2.15
1,2-dichloropropane
Concentration
ug/L
2
Mass
(78 87 5)
2.16
1,3-dichloropropylene
Concentration
ug/L
2
cis and trans
isomers
analyzed
analyzed
Mass
CAS #
10061-01-5
10061-02-6
(542-75-6)
2.17
Ethylbenzene
El
IDConcentration
ug/L
1
Mass
(100-41-4)
2.18
Methyl bromide
El
El
Concentration
ug/L
2
Mass
(74-83-9)
2.19
Methyl chloride
El
El
Concentration
ug/L
2
Mass
(74-87-3)
2.20
Methylene chloride
El
El
Concentration
ug/L
2
Mass
(75-09-2)
221
1,1,2,2-tetrachloroethane
El
El
0
Concentration
ug/L
2
Mass
(79-34-5)
EPA Form 3510-2C (Revised 3-19) Page 13

EPA Identification Number NPDES Permit Number Facility Name
Outfall Number Form Approved 03/05/19
OMB No. 2040-0004
�' • • • •' • '• 1
e
Presence or Absence
Intake
check one
Effluent (optional)
PollutantlParameter Testing Units
Maximum
Maximum
Long -Term
Long-
(and CAS Number, if available Re uired Believed Believed s eci
) q (p N)
Daily
Monthly
Average
Number
Term
Number
Present Absent
Discharge
Discharge
Daily
of
Average
of
(required)
(if available)
Discharge
Analyses
Value
Analyses
f available
2.22
Tetrachloroethylene
❑
❑
❑
Concentration
ug/L
2
Mass
(127-18-4)
2.23
Toluene
Concentration
ug/L
1
Mass
(108-88-3)
12-trans-dichloroethylene
El
❑
❑
Concentration
ug/L
2
Mass
62.24 56-60-5)
2.25
1,1,1-trichloroethane
El
ElIZ
Concentration
ug/L
2
Mass
(71-55-6)
2.26
1,1,2-trichloroethane
El
El✓I
Concentration
ug/L
2
Mass
(79-00-5)
2.27
Trichloroethylene
El
El
❑✓
Concentration
ug/L
2
Mass
(79-01-6)
2.28
Vinyl chloride
❑
❑
❑✓
Concentration
ug/L
2
Mass
(75-01-4)
Section 3.Organic Toxic Pollutants (GC/MS
Fraction
—Acid Compounds
3.1
2-chlorophenol
Concentration
ug/L
4.2
Mass
(95-57-8)
3.2
2 4-dichlorophenol
Concentration
ug/L
4.2
Mass
(120-83-2)
3.3
2 4-dimethylphenol
Concentration
ug/L
8.3
Mass
(105-67-9)
3.4
4,6-dinitro-o-cresol
❑
El✓❑
Concentration
ug/L
8.3
Mass
(534-52-1)
3.5
2 4-dinitrophenol
✓❑
Concentration
ug/L
41.7
Mass
(51-28-5)
EPA Form 3510-2C (Revised 3-19) Page 14

EPA Identification Number NPDES Permit Number Facility Name
Outfall Number Form Approved 03/05/19
OMB No. 2040-0004
Presence or Absence
Intake
check one
Effluent (optional)
Pollutant/Parameter Testing Units
Maximum
Maximum
Long -Term
Long -
(and CAS Number, if available) Required Believed Believed (specify)
Daily
Monthly
Average
Number
Term
Number
Present Absent
Discharge
Discharge
Daily
of
Average
of
(required)
(if available)
Discharge
Analyses
Analyses
if available)Value
3.6
2-nitrophenol
El
❑
Concentration
ug/L
4.2
Mass
(88-75-5)
3.7
4-nitrophenol
Concentration
ug/L
8.3
Mass
(100-02-7)
3.8
p-chloro-m-cresol
❑
Concentration
ug/L
4.2
Mass
(59-50-7)
3.9
Pentachlorophenol
El
11
El
Concentration
ug/L
8.3
Mass
(87-86-5)
3.10
Phenol
El
❑
El
Concentration
ug/L
4.2
Mass
(108-95-2)
3.11
2,4,6-trichlorophenol
El
El
0Concentration
ug/L
8.3
Mass
(88-05-2)
Section 4.Organic Toxic Pollutants (GC/MS
Fraction
—Base /Neutral
Compounds)
4.1
Acenaphthene
El
❑
El
Concentration
ug/L
4.2
Mass
(83-32-9)
4.2
Acenaphthylene
El
El
IZI
Concentration
ug/L
4.2
Mass
(208-96-8)
4.3
Anthracene
❑
❑
✓❑
Concentration
ug/L
4.2
Mass
(120-12-7)
4.4
Benzidine
❑
❑
✓❑
Concentration
ug/L
41.7
Mass
(92-87-5)
4.5
Benzo (a) anthracene
❑
❑✓
Concentration
ug/L
4.2
Mass
(56-55-3)
4.6
Benzo (a) pyrene
Concentration
ug/L
4.2
Mass
(50-32-8)
EPA Form 3510-2C (Revised 3-19) Page 15

EPA Identification Number NPDES Permit Number Facility Name
Outfall Number Form Approved 03/05/19
OMB No. 2040-0004
Presence or Absence
Intake
check one
Effluent
(optional)
PollutantlParameter Testing Units
Maximum
Maximum
Long -Term
Long
(and CAS Number, if available) Required Believed Believed (specify)
Daily
Monthly
Average
Number
Term
Number
Present Absent
Discharge
Discharge
Daily
of
Average
of
(required)
(if available)
Discharge
Analyses
Value
Analyses
f available
4.7
3 4-benzofluoranthene
Concentration
ug/L
4.2
Mass
(205-99-2)
4.8
Benzo (ghi) peryleneEl
o
Concentration
ug/L
4.2
Mass
(191-24-2)
4.9
Benzo (k) fluoranthene
El
El
IZI
Concentration
ug/L
4.2
Mass
(207-08-9)
4.10
Bis (2-chloroethoxy) methane
El
1:1
❑✓
Concentration
ug/L
8.3
Mass
(111-91-1)
4.11
Bis (2-chloroethyl) ether
Concentration
ug/L
4.2
Mass
(111-44-4)
4.12
Bis (2-chloroisopropyl) ether
❑
❑✓
Concentration
ug/L
4.2
Mass
(102-80-1)
4.13
Bis (2-ethylhexyl) phthalate
❑
❑
❑✓
Concentration
ug/L
4.2
Mass
(117-81-7)
4.14
4-bromophenyl phenyl ether
❑
❑
Q✓
Concentration
ug/L
4.2
Mass
(101-55-3)
4.15
Butyl benzyl phthalate
El
❑
❑✓
Concentration
ug/L
4.2
Mass
(85-68-7)
4.16
2-chloronaphthalene
Concentration
ug/L
4.2
Mass
(91-58-7)
4.17
4-chlorophenyl phenyl ether
❑
❑
❑✓
Concentration
ug/L
4.2
Mass
(7005-72-3)
4.18
Chrysene
El
El
IZI
Concentration
ug/L
4.2
Mass
(218-01-9)
4.19
Dibenzo (a,h) anthracene
El
❑�
Concentration
ug/L
4.2
Mass
(53-70-3)
EPA Form 3510-2C (Revised 3-19) Page 16

EPA Identification Number NPDES Permit Number Facility Name
Outfall Number Form Approved 03/05/19
OMB No. 2040-0004
Presence or Absence
check one
Effluent Intake
(optional)
PollutantlParameter Testing Units
Maximum
Maximum
Long -Term
Long-
(and CAS Number, if available) Required Believed Believed (specify)
Daily
Monthly
Average
Number
Term
Number
Present Absent
Discharge
Discharge
Daily
°f
Average
of
(required)
(if available)
Discharge
Analyses
value
Analyses
if available
4.20
1,2-dichlorobenzene
El
El
El
Concentration
ug/L
2
Mass
(95-50-1)
4.21
1,3-dichlorobenzene
ElElConcentration
ug/L
2
Mass
(541-73-1)
4.22
1,4-dichlorobenzene
Concentration
ug/L
2
Mass
(106-46-7)
4.23
3,3-dichlorobenzidine
❑
❑
0
Concentration
ug/L
8.3
Mass
(91-94-1)
4.24
Diethyl phthalate
El
El
IZI
Concentration
ug/L
4.2
Mass
(84-66-2)
4.25
Dimethyl phthalate
El
❑
✓❑
Concentration
ug/L
4.2
Mass
(131-11-3)
4.26
Di-n-butyl phthalate
❑
❑
✓❑
Concentration
ug/L
4.2
Mass
(84-74-2)
4.27
2,4-dinitrotoluene
❑
❑
✓❑
Concentration
ug/L
4.2
Mass
(121-14-2)
4.28
2,6-dinitrotoluene
El
El✓0
Concentration
ug/L
4.2
Mass
(606-20-2)
4.29
Di-n-octyl phthalate
❑
❑
E✓
Concentration
ug/L
4.2
Mass
(117-84-0)
4.30
1,2-Diphenylhydrazine
Concentration
ug/L
4.2
Mass
(as azobenzene)(122-66-7)
4.31
Fluoranthene
Concentration
ug/L
4.2
Mass
(206-44-0)
4.32
Fluorene
❑
El
El
Concentration
ug/L
4.2
Mass
(86-73-7)
EPA Form 3510-2C (Revised 3-19) Page 17

EPA Identification Number NPDES Permit Number Facility Name
Outfall Number Form Approved 03/05/19
OMB No. 2040-0004
Presence or Absence
Intake
check one
Effluent
(optional)
PollutantlParameter Testing Units
Maximum
Maximum
Long -Term
Long-
(and CAS Number, if available Required Believed Believed (specify)
) q (p N)
Daily
Monthly
Average
Number
Term
Number
Present Absent
Discharge
Discharge
Daily
of
Average
of
(required)
(if available)
Discharge
Analyses
Value
Analyses
if available
4.33
Hexachlorobenzene
❑
❑
❑
Concentration
ug/L
4.2
Mass
(118-74-1)
4.34
Hexachlorobutadiene
❑
❑
❑✓
Concentration
ug/L
4.2
Mass
(87-68-3)
4.35
Hexachlorocyclopentadiene
❑
El
a
Concentration
ug/L
8.3
Mass
(77-47-4)
4.36
Hexachloroethane
El
✓❑
Concentration
ug/L
4.2
Mass
(67-72-1)
4.37
Indeno (1,2,3-cd) pyrene
❑
❑
✓❑
Concentration
ug/L
4.2
Mass
(193-39-5)
4.38
Isophorone
❑
✓❑
Concentration
ug/L
8.3
Mass
(78-59-1)
4.39
Naphthalene
❑
✓❑
Concentration
ug/L
4.2
Mass
(91-20-3)
4.40
Nitrobenzene
❑
❑✓
Concentration
ug/L
4.2
Mass
(98-95-3)
4.41
N-nitrosodimethylamine
❑
❑
❑✓
Concentration
ug/L
4.2
Mass
(62-75-9)
4.42
N-nitrosodi-n-propylamine
❑
❑
❑✓
Concentration
ug/L
4.2
Mass
(621-64-7)
4.43
N-nitrosodiphenylamine
Concentration
ug/L
8.3
Mass
(86-30-6)
4.44
Phenanthrene
❑
❑
❑✓
Concentration
ug/L
4.2
Mass
(85-01-8)
4.45
Pyrene
Concentration
ug/L
4.2
Mass
(129-00-0)
EPA Form 3510-2C (Revised 3-19) Page 18

EPA Identification Number NPDES Permit Number Facility Name
Outfall Number Form Approved 03/05/19
OMB No. 2040-0004
TABLE B. TOXIC METALS, CYANIDE, TOTAL PHENOLS, AND ORGANIC TOXIC POLLUTANTS (40 CFR
122.21(g)(7)(v))'
Presence or Absence
check one
Effluent Intake
(optional)
Pollutant/Parameter Testing Units
Maximum
Maximum
Long -Term
Long -
(and CAS Number, if available Required Believed Believed
(and q (specify)
Average
Number
Term
Number
Present Absent
1El
Daily
thl
Mony
Dail
of
of
D(sgcharrge
Di
Discharge
Analyses
Average
Analyses
available)
f available
4.46 1,2,4-trichlorobenzene
❑
✓a
Concentration
ug/L
4.2
1 Mass
(120-82-1)
Section 5.Organic Toxic Pollutants (GC/MS Fraction
—Pesticides)
5.1
Aldrin
Concentration
ug/L
0.042
Mass
(309-00-2)
5.2
a-BHC
❑
Concentration
ug/L
0.042
Mass
(319-84-6)
5.3
R-BHC
Concentration
ug/L
0.042
Mass
(319-85-7)
5.4
y-BHC
El
El
IZI
Concentration
ug/L
0.042
Mass
(58 89 9)
5.5
b-BHC
ElElConcentration
ug/L
0.042
Mass
(319-86-8)
5.6
Chlordane
El
El
IZI
Concentration
ug/L
0.42
Mass
(57-74-9)
5.7
4,4'-DDT
El
Concentration
ug/L
0.042
Mass
(50-29-3)
5.8
4,4'-DDE
Concentration
ug/L
0.042
Mass
(72-55-9)
5.9
4,4'-DDD
El
Concentration
ug/L
0.042
Mass
(72-54-8)
5.10
Dieldrin
Concentration
ug/L
0.042
Mass
(60-57-1)
5.11
a-endosulfan
Concentration
ug/L
0.042
see
Enclosulfan
1 & 2
Mass
(115-29-7)
EPA Form 3510-2C (Revised 3-19) Page 19

EPA Identification Number NPDES Permit Number Facility Name
�: • 1 • • • •' • •• 1
Presence or Absence
check one
Pollutant/Parameter Testing Units
(and CAS Number, if available) Required Believed Believed (specify)
Present Absent
Outfall Number Form Approved 03/05/19
OMB No. 2040-0004
Intake
Effluent (optional)
Maximum
Daily
Discharge
(required)
Maximum
Monthly
Discharge
(if available)
Long -Term
Average
Daily
Discharge
if available
Number
of
Analyses
Long-
Term
Average
Value
Number
of
Analyses
5.12
R-endosulfan
(115-29-7)
Concentration
ug/L
0.042
see
Endosulfan
1 & 2
Mass
5.13
Endosulfan sulfate
(1031-07-8)
Concentration
ug/L
0.042
Mass
5.14
Endrin
(72-20-8)
Concentration
ug/L
0.042
Mass
5.15
Endrin aldehyde
(7421-93-4)
Concentration
ug/L
0.042
Mass
5.16
Heptachlor
(76-44-8)
11
El
0
Concentration
ug/L
0.042
Mass
5.17
Heptachlor epoxide
(1024-57-3)
Concentration
ug/L
0.042
Mass
5.18
PCB-1242
(53469-21-9)
Concentration
ug/L
0.42
Mass
5.19
PCB-1254
(11097-69-1)
Concentration
ug/L
0.42
Mass
5.20
PCB-1221
(11104-28-2)
Concentration
ug/L
0.42
Mass
5.21
PCB-1232
(11141-16-5)
El
El
El
Concentration
ug/L
0.42
Mass
5.22
PCB-1248
(12672-29-6)
Concentration
ug/L
0.42
Mass
5.23
PCB-1260
(11096-82-5)
El
El
IZI
Concentration
ug/L
0.42
Mass
5.24
PCB-1016
(12674-11-2)
Concentration
ug/L
0.42
Mass
EPA Form 3510-2C (Revised 3-19) Page 20

EPA Identification Number
NPDES Permit Number
Facility Name
Outfall Number
Form Approved 03/05/19
OMB No. 2040-0004
Presence or Absence
check one
Effluent
Intake
(optional)
PollutanJParameter
Testing
Units
Maximum
Maximum
Long -Term
Long-
(and CAS Number, if available)
Required
Believed Believed
(specify)
Average
Number
Term
Number
Present Absent
Daily
Monthly
Daily
of
of
Discharge
Discharge
Discharge
Analyses
Average
Analyses
(required)
(if available)
if available
Value
Toxaphene
5.25
Concentration
ug/L
0.42
Mass
(g001-35-2)
1 Sampling shall be conducted according to sufficiently sensitive test procedures (i.e., methods) approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR chapter I, subchapter N or 0. See instructions and 40 CFR 122.21(e)(3).
EPA Form 3510-2C (Revised 3-19) Page 21

This page intentionally left blank.

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
OMB No. 2040-0004
0 Ll kTj:I 0 11 Lei HT-1 111111:11KIIIII Its] IFT-I 1
Presence or Absence
Intake
check one Effluent
(Optional)
Pollutant Units Maximum Long -Term
Believed Believed (specify) Maximum Daily Long -Term
1
Present Absent Discharge Monthly Average Daily Number of Average Number of
(required) Discharge Discharge Analyses Value Analyses
1 1 if available if available
❑ Check here if you believe all pollutants on Table C to be present in your discharge from the noted outfall. You need not complete the "Presence or Absence" column of Table C for
each pollutant.
❑ Check here if you believe all pollutants on Table C to be absent in your discharge from the noted outfall. You need not complete the "Presence or Absence" column of Table C for
each pollutant.
1
Bromide
❑
❑
Concentration
Mass
(24959-67-9)
2
Chlorine, total
❑
❑
Concentration
Mass
residual
3.
Color
❑
❑
Concentration
Mass
4.
Fecal coliform
❑
❑
Concentration
Mass
5.
Fluoride
❑
❑
Concentration
Mass
(16984-48-8)
6
Nitrate -nitrite
❑
❑
Concentration
Mass
7.
Nitrogen. total
❑
❑
Concentration
Mass
organic (as N)
8.
Oil and grease
El❑
Concentration
Mass
9
Phosphorus (as
❑
❑
Concentration
Mass
P), total (7723-14-0)
10.
Sulfate (as SO4)
❑
❑
Concentration
Mass
(14808-79-8)
11.
Sulfide (as S)
❑
❑
Concentration
Mass
EPA Form 3510-2C (Revised 3-19) Page 23

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
OMB No. 2040-0004
• • • • • •• 1
Presence or Absence 7Intake
check one Effluent (Optional)
Pollutant Unds Maximum Long -Term
Believed Believed (spe*) Maximum Daily Long -Term
Monthly Average Daily Number of Number of
Present Absent Discharge Average
Discharge Discharge Analyses Analyses
(required)
if available if available)Value
12
Sulfite (as S03)
0
Concentration
Mass
(14265-45-3)
13.
Surfactants
❑
❑
Concentration
Mass
14.
Aluminum, total
❑
❑
Concentration
Mass
(7429-90-5)
15.
Barium, total
11
El
Concentration
Mass
(7440-39-3)
16.
Boron, total
Concentration
Mass
(7440-42-0)
17
Cobalt, total
❑
❑
Concentration
Mass
(744048-4)
18
Iron total
Concentration
Mass
(7439-89-6)
19
Magnesium, total
Concentration
Mass
(7439-95-4)
Molybdenum,
Concentration
20.
total
7439-98-7
Mass
21
Manganese, total
Concentration
Mass
(7439-96-5)
22
Tin, total
Concentration
Mass
(7440-31-5)
23.
Titanium, total
Concentration
Mass
(7440-32-6)
EPA Form 3510-2C (Revised 3-19) Page 24

EPA Identification Number NPDES Permit Number
Facility Name
Outfall Number
Form Approved 03/05/19
OMB No. 2040-0004
•' •
• • • • •
• 1 ••
1
Presence or Absence
Intake
check one
Effluent
(Optional)
Pollutant
Believed Believed
Units
(specify)
Maximum Daily
Maximum Long -Term
Long -Term
Present Absent
Discharge
Monthly Average Daily Number of
Average Number of
(required)
Discharge Discharge Analyses
Value Analyses
if available if available
24.
Radioactivity
Alpha, total
❑
❑
Concentration
Mass
Beta. total
❑
❑
Concentration
Mass
Radium.. total
El
El
Concentration
Mass
Radium 226, total
❑
❑
Concentration
Mass
Sampling shall be conducted according to sufficiently sensitive test procedures (i.e., methods) approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR chapter I, subchapter N or 0. See instructions and 40 CFR 122.21(e)(3).
EPA Form 3510-2C (Revised 3-19) Page 25

This page intentionally left blank.

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
OMB No. 2040-0004
Presence or Absence
Pollutant check one Available Quantitative Data
Believed Believed Reason Pollutant Believed Present in Discharge
(specify units)
Present Absent
1. Asbestos
❑
❑
2. Acetaldehyde
❑
❑
3. Allyl alcohol
❑
❑
4. Allyl chloride
❑
❑
5. Amyl acetate
❑
❑
6. Aniline
❑
❑
7. Benzonitrile
❑
❑
8. Benzyl chloride
❑
❑
9. Butyl acetate
❑
❑
10.
Butylamine
❑
❑
11.
Captan
❑
❑
12.
Carbaryl
❑
❑
13.
Carbofuran
❑
❑
14.
Carbon disulfide
❑
❑
15.
Chlorpyrifos
❑
❑
16.
Coumaphos
❑
❑
17.
Cresol
❑
❑
18.
Crotonaldehyde
❑
❑
19.
Cyclohexane
❑
❑
EPA Form 3510-2C (Revised 3-19) Page 27

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
OMB No. 2040-0004
Presence or Absence
Pollutant check one Reason Pollutant Believed Present in Discharge Available Quantitative Data
Believed Believed (specify units)
FPresent Absent
20.
2,4-D (2,4-dichlorophenoxyacetic acid)
❑
❑
21.
Diazinon
❑
❑
22.
Dicamba
❑
❑
23.
Dichlobenil
❑
❑
24.
Dichlone
❑
❑
25.
2,2-dichloropropionic acid
❑
❑
26.
Dichlorvos
❑
❑
27.
Diethyl amine
❑
❑
28.
Dimethyl amine
❑
❑
29.
Dintrobenzene
❑
❑
30.
Diquat
❑
❑
31.
Disulfoton
❑
❑
32.
Diuron
❑
❑
33.
Epichlorohydrin
❑
❑
34.
Ethion
❑
❑
35.
Ethylene diamine
❑
❑
36.
Ethylene dibromide
❑
❑
37.
Formaldehyde
❑
❑
38.
Furfural
❑
❑
EPA Form 3510-2C (Revised 3-19) Page 28

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
OMB No. 2040-0004
: '�• • 1
Presence or Absence
Pollutant check one Reason Pollutant Believed Present in DischargeAvailable Quantitative Data
Believed Believed (specify units)
Present Absent
39.
Guthion
❑
❑
40.
Isoprene
❑
❑
41.
Isopropanolamine
❑
❑
42.
Kelthane
❑
❑
43.
Kepone
❑
❑
44.
Malathion
❑
❑
45.
Mercaptodimethur
❑
❑
46.
Methoxychlor
❑
❑
47.
Methyl mercaptan
❑
❑
48.
Methyl methacrylate
❑
❑
49.
Methyl parathion
❑
❑
50.
Mevinphos
❑
❑
51.
Mexacarbate
❑
❑
52.
Monoethyl amine
❑
❑
53.
Monomethyl amine
❑
❑
54.
Naled
❑
❑
55.
Naphthenic acid
❑
❑
56.
Nitrotoluene
❑
❑
57.
Parathion
❑
❑
EPA Form 3510-2C (Revised 3-19) Page 29

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
OMB No. 2040-0004
'I• • 1
Presence or Absence
Pollutant check one Reason Pollutant Believed Present in Discharge Available Quantitative Data
Believed Believed (specify units)
Present Absent
58.
Phenolsulfonate
❑
❑
59.
Phosgene
❑
❑
60.
Propargite
❑
❑
61.
Propylene oxide
❑
❑
62.
Pyrethrins
❑
❑
63.
Quinoline
❑
❑
64.
Resorcinol
❑
❑
65.
Strontium
❑
❑
66.
Strychnine
❑
❑
67.
Styrene
❑
❑
68
2,4,5-T (2,4,5-trichlorophenoxyacetic
acid
❑
❑
69.
TDE (tetrachlorodiphenyl ethane)
❑
❑
70
2,4,5-TP [2-(2,4,5-trichlorophenoxy)
anoic acid
El
Elro
71.
Trichlorofon
❑
❑
72.
Triethanolamine
❑
❑
73.
Triethylamine
❑
❑
74.
Trimethylamine
❑
❑
75.
Uranium
❑
❑
76.
Vanadium
❑
❑
EPA Form 3510-2C (Revised 3-19) Page 30

EPA Identification Number
NPDES Permit Number Facility Name Outfall Number
Form Approved 03/05/19
OMB No. 2040-0004
Presence or Absence
Pollutant
F77Vinyllacetate
check one
Believed Believed Reason Pollutant Believed Present in Discharge
Available Quantitative Data
(specify units)
Present Absent
❑
❑
78.
Xylene
❑
❑
79.
Xylenol
❑
❑
80.
Zirconium
❑
❑
1 Sampling shall be conducted according to sufficiently sensitive test procedures (i.e., methods) approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR chapter I, subchapter N or 0. See instructions and 40 CFR 122.21(e)(3).
EPA Form 3510-2C (Revised 3-19) Page 31

This page intentionally left blank.

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
OMB No. 2040-0004
TCDD Presence or
Congeners Absence
Pollutant Used or check one Results of Screening Procedure
Manufactured Believed Believed
Present Absent
2.3 7.8-TCDD El ❑ El
EPA Form 3510-2C (Revised 3-19) Page 33

Line Drawing of Dewatering Wells and
Basement Pumps Discharging to BMP #2
Well 2 —
18 gpm
Max
FF Well 5 —
18 gpm
M..

Pace Analytical Services, LLC
7726 Moller Road
Indianapolis, IN 46268
[phone]
October 11, 2023
Brian Griesemer
Eli Lilly & Company
Corporate Center
Building 147 - LTC South
Indianapolis, IN 46285
RE: Project: NC -Concord Groundwater
Pace Project No.: 50351209
Dear Brian Griesemer:
Enclosed are the analytical results for sample(s) received by the laboratory on August 08, 2023. 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
• Pace Analytical Services - Peachtree Corners, GA
Revised report replaces report dated 09/06/23. Revised to add 624 compounds per client request. 101123hmp
Revised report replaces report dated 08/14/23. Revised to add TOC and Hg. 082223hmp
If you have any questions concerning this report, please feel free to contact me.
Sincerely,
Heather Patterson
[e-mail]
[phone]
Project Manager
Enclosures
cc: TC Garrod, Eli Lilly & Company
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 36

Project: NC -Concord Groundwater
Pace Project No.: 50351209
Pace Analytical Services, LLC
7726 Moller Road
Indianapolis, IN 46268
[phone]
Pace Analytical Services Charlotte
South Carolina Laboratory ID: 99006
9800 Kincey Ave. Ste 100, Huntersville, NC 28078
North Carolina Drinking Water Certification #: 37706
North Carolina Field Services Certification #: 5342
North Carolina Wastewater Certification #: 12
South Carolina Laboratory ID: 99006
Pace Analytical Services Asheville
2225 Riverside Drive, Asheville, NC 28804
Florida/NELAP Certification #: E87648
North Carolina Drinking Water Certification #: 37712
North Carolina Wastewater Certification #: 40
Pace Analytical Services Peachtree Corners
110 Technology Pkwy, Peachtree Corners, GA 30092
Florida DOH Certification #: E87315
Georgia DW Inorganics Certification #: 812
CERTIFICATIONS
South Carolina Certification #: 99006001
South Carolina Drinking Water Cert. #: 99006003
Florida/NELAP Certification #: E87627
Kentucky UST Certification #: 84
Louisiana DoH Drinking Water #: LA029
Virginia/VELAP Certification #: 460221
South Carolina Laboratory ID: 99030
South Carolina Certification #: 99030001
Virginia/VELAP Certification #: 460222
North Carolina Certification #: 381
South Carolina Certification #: 98011001
Virginia Certification #: 460204
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 36

Project: NC -Concord Groundwater
Pace Project No.: 50351209
Lab ID Sample ID
50351209001 Sample 1
SAMPLE SUMMARY
Matrix Date Collected Date Received
Water 08/07/23 15:00 08/08/23 08:00
REPORT OF LABORATORY ANALYSIS
Pace Analytical Services, LLC
7726 Moller Road
Indianapolis, IN 46268
[phone]
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, LLC.
Page 3 of 36

Pace Analytical Services, LLC
7726 Moller Road
Indianapolis, IN 46268
[phone]
SAMPLE ANALYTE COUNT
Project:
Pace Project No.:
NC -Concord Groundwater
50351209
Analytes
Lab ID
Sample ID
Method
Analysts
Reported
Laboratory
50351209001
Sample 1
EPA 608.3
SEM
30
PASI-C
EPA 200.7
MS
13
PASI-GA
EPA 245.1
VB
1
PASI-GA
EPA 625.1
PKS
60
PASI-C
EPA 624.1
SAS
35
PASI-C
SM 2540D-2015
MAB2
1
PASI-A
SM 521OB-2011
KO
1
PASI-A
EPA 9040C
SMS
1
PASI-A
EPA 350.1 Rev 2.0 1993
ARJ
1
PASI-A
EPA420.4 Rev 1.0 1993
ARJ
1
PASI-A
SM 4500-CN-E-2011
KDF1
1
PASI-A
SM 5220D-2011
JMH1
1
PASI-A
SM 531OB-2014
MDW
1
PASI-A
PASI-A= Pace Analytical Services -Asheville
PASI-C = Pace Analytical Services - Charlotte
PASI-GA= Pace Analytical Services - Peachtree Corners, GA
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 36

(-�Face'
ANALYTICAL RESULTS
Pace Analytical Services, LLC
7726 Moller Road
Indianapolis, IN 46268
[phone]
Project: NC -Concord Groundwater
Pace Project No.: 50351209
Sample: Sample 1
Lab ID: 50351209001
Collected: 08/07/23 15:00
Received: 08/08/23 08:00 Matrix: Water
Parameters
Results
Units
Report Limit
DF
Prepared
Analyzed
CAS No. Qual
608 PCB Pest RVE
Analytical Method: EPA 608.3 Preparation Method: EPA 608.3
Pace Analytical
Services -
Charlotte
Aldrin
ND
ug/L
0.042
1
08/09/23 09:31
08/11/23 17:22
309-00-2
alpha-BHC
ND
ug/L
0.042
1
08/09/23 09:31
08/11/23 17:22
319-84-6
beta-BHC
ND
ug/L
0.042
1
08/09/23 09:31
08/11/23 17:22
319-85-7
delta-BHC
ND
ug/L
0.042
1
08/09/23 09:31
08/11/23 17:22
319-86-8
gamma-BHC (Lindane)
ND
ug/L
0.042
1
08/09/23 09:31
08/11/23 17:22
58-89-9
Chlordane (Technical)
ND
ug/L
0.42
1
08/09/23 09:31
08/11/23 17:22
57-74-9
alpha -Chlordane
ND
ug/L
0.042
1
08/09/23 09:31
08/11/23 17:22
5103-71-9
gamma -Chlordane
ND
ug/L
0.042
1
08/09/23 09:31
08/11/23 17:22
5103-74-2
4,4'-DDD
ND
ug/L
0.042
1
08/09/23 09:31
08/11/23 17:22
72-54-8 L1
4,4'-DDE
ND
ug/L
0.042
1
08/09/23 09:31
08/11/23 17:22
72-55-9
4,4'-DDT
ND
ug/L
0.042
1
08/09/23 09:31
08/11/23 17:22
50-29-3
Dieldrin
ND
ug/L
0.042
1
08/09/23 09:31
08/11/23 17:22
60-57-1
Endosulfan I
ND
ug/L
0.042
1
08/09/23 09:31
08/11/23 17:22
959-98-8
Endosulfan II
ND
ug/L
0.042
1
08/09/23 09:31
08/11/23 17:22
33213-65-9
Endosulfan sulfate
ND
ug/L
0.042
1
08/09/23 09:31
08/11/23 17:22
1031-07-8
Endrin
ND
ug/L
0.042
1
08/09/23 09:31
08/11/23 17:22
72-20-8
Endrin aldehyde
ND
ug/L
0.042
1
08/09/23 09:31
08/11/23 17:22
7421-93-4
Heptachlor
ND
ug/L
0.042
1
08/09/23 09:31
08/11/23 17:22
76-44-8
Heptachlor epoxide
ND
ug/L
0.042
1
08/09/23 09:31
08/11/23 17:22
1024-57-3
PCB-1016 (Aroclor 1016)
ND
ug/L
0.42
1
08/09/23 09:31
08/11/23 17:22
12674-11-2
PCB-1221 (Aroclor 1221)
ND
ug/L
0.42
1
08/09/23 09:31
08/11/23 17:22
11104-28-2
PCB-1232 (Aroclor 1232)
ND
ug/L
0.42
1
08/09/23 09:31
08/11/23 17:22
11141-16-5
PCB-1242 (Aroclor 1242)
ND
ug/L
0.42
1
08/09/23 09:31
08/11/23 17:22
53469-21-9
PCB-1248 (Aroclor 1248)
ND
ug/L
0.42
1
08/09/23 09:31
08/11/23 17:22
12672-29-6
PCB-1254 (Aroclor 1254)
ND
ug/L
0.42
1
08/09/23 09:31
08/11/23 17:22
11097-69-1
PCB-1260 (Aroclor 1260)
ND
ug/L
0.42
1
08/09/23 09:31
08/11/23 17:22
11096-82-5
PCB, Total
ND
ug/L
0.42
1
08/09/23 09:31
08/11/23 17:22
1336-36-3
Toxaphene
ND
ug/L
0.42
1
08/09/23 09:31
08/11/23 17:22
8001-35-2
Surrogates
Tetrachloro-m-xylene (S)
72
%
10-137
1
08/09/23 09:31
08/11/23 17:22
877-09-8
Decachlorobiphenyl (S)
88
%
19-200
1
08/09/23 09:31
08/11/23 17:22
2051-24-3
200.7 MET ICP
Analytical Method:
EPA 200.7 Preparation Method: EPA 200.7
Pace Analytical
Services -
Peachtree Corners, GA
Antimony
ND
ug/L
50.0
1
08/09/23 10:55
08/09/23 23:36
7440-36-0
Arsenic
ND
ug/L
30.0
1
08/09/23 10:55
08/09/23 23:36
7440-38-2
Beryllium
ND
ug/L
10.0
1
08/09/23 10:55
08/09/23 23:36
7440-41-7
Cadmium
ND
ug/L
10.0
1
08/09/23 10:55
08/09/23 23:36
7440-43-9
Chromium
84.7
ug/L
10.0
1
08/09/23 10:55
08/09/23 23:36
7440-47-3
Copper
ND
ug/L
20.0
1
08/09/23 10:55
08/09/23 23:36
7440-50-8
Lead
ND
ug/L
25.0
1
08/09/23 10:55
08/09/23 23:36
7439-92-1
Nickel
ND
ug/L
20.0
1
08/09/23 10:55
08/09/23 23:36
7440-02-0
Selenium
ND
ug/L
40.0
1
08/09/23 10:55
08/09/23 23:36
7782-49-2
Silver
ND
ug/L
10.0
1
08/09/23 10:55
08/09/23 23:36
7440-22-4
Thallium
ND
ug/L
200
1
08/09/23 10:55
08/09/23 23:36
7440-28-0
Tin
ND
ug/L
40.0
1
08/09/23 10:55
08/09/23 23:36
7440-31-5
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
Date: 10/11 /2023 11:39 AM without the written consent of Pace Analytical Services, LLC. Page 5 of 36

(-�Face'
ANALYTICAL RESULTS
Pace Analytical Services, LLC
7726 Moller Road
Indianapolis, IN 46268
[phone]
Project: NC -Concord Groundwater
Pace Project No.: 50351209
Sample: Sample 1
Lab ID: 50351209001 Collected: 08/07/23 15:00
Received: 08/08/23 08:00 Matrix: Water
Parameters
Results
Units
Report Limit
DF
Prepared
Analyzed
CAS No. Qual
200.7 MET ICP
Analytical Method: EPA 200.7 Preparation Method: EPA 200.7
Pace Analytical
Services - Peachtree Corners, GA
Zinc
136
ug/L
20.0
1
08/09/23 10:55
08/09/23 23:36
7440-66-6
245.1 Mercury
Analytical Method: EPA 245.1
Preparation Method: EPA 245.1
Pace Analytical
Services - Peachtree Corners, GA
Mercury
ND
ug/L
0.20
1
08/25/2311:00
08/25/231334
7439-97-6
625 RVE
Analytical Method: EPA 625.1
Preparation Method: EPA 625.1
Pace Analytical
Services - Charlotte
Acenaphthene
ND
ug/L
4.2
1
08/09/23 11:52
08/10/23 18:25
83-32-9
Acenaphthylene
ND
ug/L
4.2
1
08/09/23 11:52
08/10/23 18:25
208-96-8
Anthracene
ND
ug/L
4.2
1
08/09/23 11:52
08/10/23 18:25
120-12-7
Benzidine
ND
ug/L
41.7
1
08/09/23 11:52
08/10/23 18:25
92-87-5 L2
Benzo(a)anthracene
ND
ug/L
4.2
1
08/09/23 11:52
08/10/23 18:25
56-55-3
Benzo(a)pyrene
ND
ug/L
4.2
1
08/09/23 11:52
08/10/23 18:25
50-32-8
Benzo(b)fluoranthene
ND
ug/L
4.2
1
08/09/23 11:52
08/10/23 18:25
205-99-2
Benzo(g,h,i)perylene
ND
ug/L
4.2
1
08/09/23 11:52
08/10/23 18:25
191-24-2
Benzo(k)fluoranthene
ND
ug/L
4.2
1
08/09/23 11:52
08/10/23 18:25
207-08-9
4-Bromophenylphenyl ether
ND
ug/L
4.2
1
08/09/23 11:52
08/10/23 18:25
101-55-3
Butylbenzylphtha late
ND
ug/L
4.2
1
08/09/23 11:52
08/10/23 18:25
85-68-7
4-Chloro-3-methylphenol
ND
ug/L
4.2
1
08/09/23 11:52
08/10/23 18:25
59-50-7
bis(2-Chloroethoxy)methane
ND
ug/L
8.3
1
08/09/23 11:52
08/10/23 18:25
111-91-1
bis(2-Chloroethyl) ether
ND
ug/L
4.2
1
08/09/23 11:52
08/10/23 18:25
111-44-4
2-Chloronaphthalene
ND
ug/L
4.2
1
08/09/23 11:52
08/10/23 18:25
91-58-7
2-Chlorophenol
ND
ug/L
4.2
1
08/09/23 11:52
08/10/23 18:25
95-57-8
4-Chlorophenylphenyl ether
ND
ug/L
4.2
1
08/09/23 11:52
08/10/23 18:25
7005-72-3
Chrysene
ND
ug/L
4.2
1
08/09/23 11:52
08/10/23 18:25
218-01-9
Dibenz(a,h)anthracene
ND
ug/L
4.2
1
08/09/23 11:52
08/10/23 18:25
53-70-3
3,3'-Dichlorobenzidine
ND
ug/L
8.3
1
08/09/23 11:52
08/10/23 18:25
91-94-1
2,4-Dichlorophenol
ND
ug/L
4.2
1
08/09/23 11:52
08/10/23 18:25
120-83-2
Diethylphthalate
ND
ug/L
4.2
1
08/09/23 11:52
08/10/23 18:25
84-66-2
2,4-Dimethylphenol
ND
ug/L
8.3
1
08/09/23 11:52
08/10/23 18:25
105-67-9
Dimethylphthalate
ND
ug/L
4.2
1
08/09/23 11:52
08/10/23 18:25
131-11-3
Di-n-butylphthalate
ND
ug/L
4.2
1
08/09/23 11:52
08/10/23 18:25
84-74-2
4,6-Dinitro-2-methylphenol
ND
ug/L
8.3
1
08/09/23 11:52
08/10/23 18:25
534-52-1
2,4-Dinitrophenol
ND
ug/L
41.7
1
08/09/23 11:52
08/10/23 18:25
51-28-5
2,4-Dinitrotoluene
ND
ug/L
4.2
1
08/09/23 11:52
08/10/23 18:25
121-14-2
2,6-Dinitrotoluene
ND
ug/L
4.2
1
08/09/23 11:52
08/10/23 18:25
606-20-2
Di-n-octylphthalate
ND
ug/L
4.2
1
08/09/23 11:52
08/10/23 18:25
117-84-0
1,2-Diphenylhydrazine
ND
ug/L
4.2
1
08/09/23 11:52
08/10/23 18:25
122-66-7
bis(2-Ethylhexyl)phthalate
ND
ug/L
4.2
1
08/09/23 11:52
08/10/23 18:25
117-81-7
Fluoranthene
ND
ug/L
4.2
1
08/09/23 11:52
08/10/23 18:25
206-44-0
Fluorene
ND
ug/L
4.2
1
08/09/23 11:52
08/10/23 18:25
86-73-7
Hexachloro-1,3-butadiene
ND
ug/L
4.2
1
08/09/23 11:52
08/10/23 18:25
87-68-3
Hexachlorobenzene
ND
ug/L
4.2
1
08/09/23 11:52
08/10/23 18:25
118-74-1
Hexachlorocyclopentadiene
ND
ug/L
8.3
1
08/09/23 11:52
08/10/23 18:25
77-47-4
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
Date: 10/11 /2023 11:39 AM without the written consent of Pace Analytical Services, LLC. Page 6 of 36

(-�Face'
Project: NC -Concord Groundwater
Pace Project No.: 50351209
Sample: Sample 1
Parameters
625 RVE
Hexachloroethane
Indeno(1,2,3-cd)pyrene
Isophorone
Naphthalene
Nitrobenzene
2-Nitrophenol
4-Nitrophenol
N-Nitrosodimethylamine
N-N itroso-di-n-propylamine
N-Nitrosodiphenylamine
2, 2'-Oxybis(1-ch loropropane)
Pentachlorophenol
Phenanthrene
Phenol
Pyrene
1,2,4-Trichlorobe nzene
2,4,6-Trichlorophenol
Surrogates
Nitrobenzene-d5 (S)
2-Fluorobiphenyl (S)
Terphenyl-d14 (S)
Phenol-d6 (S)
2-Fluorophenol (S)
2,4,6-Tribromophenol (S)
624 Volatile Organics
Acrolein
Acrylonitrile
Benzene
Bromodichloromethane
Bromoform
Bromomethane
Carbon tetrachloride
Chlorobenzene
Chloroethane
2-Chloroethylvinyl ether
Chloroform
Chloromethane
Dibromochloromethane
1,2-Dichlorobenzene
1,3-Dichlorobenzene
1,4-Dichlorobenzene
1,1-Dichloroethane
1,2-Dichloroethane
1.1-Dichloroethene
Pace Analytical Services, LLC
7726 Moller Road
Indianapolis, IN 46268
[phone]
ANALYTICAL RESULTS
Lab ID: 50351209001 Collected: 08/07/23 15:00 Received: 08/08/23 08:00 Matrix: Water
Results Units Report Limit DF Prepared Analyzed CAS No
Qual
Analytical Method: EPA 625.1 Preparation Method: EPA 625.1
Pace Analytical
Services - Charlotte
ND
ug/L
4.2
1
08/09/2311:52
08/10/2318:25
67-72-1
ND
ug/L
4.2
1
08/09/2311:52
08/10/2318:25
193-39-5
ND
ug/L
8.3
1
08/09/2311:52
08/10/2318:25
78-59-1
ND
ug/L
4.2
1
08/09/2311:52
08/10/2318:25
91-20-3
ND
ug/L
4.2
1
08/09/2311:52
08/10/2318:25
98-95-3
ND
ug/L
4.2
1
08/09/2311:52
08/10/2318:25
88-75-5
ND
ug/L
8.3
1
08/09/2311:52
08/10/2318:25
100-02-7
ND
ug/L
4.2
1
08/09/2311:52
08/10/2318:25
62-75-9
ND
ug/L
4.2
1
08/09/2311:52
08/10/2318:25
621-64-7
ND
ug/L
8.3
1
08/09/2311:52
08/10/2318:25
86-30-6
ND
ug/L
4.2
1
08/09/2311:52
08/10/2318:25
108-60-1
ND
ug/L
8.3
1
08/09/2311:52
08/10/2318:25
87-86-5
ND
ug/L
4.2
1
08/09/2311:52
08/10/2318:25
85-01-8
ND
ug/L
4.2
1
08/09/2311:52
08/10/2318:25
108-95-2
ND
ug/L
4.2
1
08/09/2311:52
08/10/2318:25
129-00-0
ND
ug/L
4.2
1
08/09/2311:52
08/10/2318:25
120-82-1
ND
ug/L
8.3
1
08/09/2311:52
08/10/2318:25
88-06-2
71
%
10-120
1
08109/2311:52
08/10/2318:25
4165-60-0
46
%
15-120
1
08/09/2311:52
08/10/2318:25
321-60-8
136
%
11-131
1
08/09/2311:52
08/10/2318:25
1718-51-0 S3
38
%
10-120
1
08/09/2311:52
08/10/2318:25
13127-88-3
47
%
10-120
1
08/09/2311:52
08/10/2318:25
367-12-4
95
%
10-137
1
08/09/2311:52
08/10/2318:25
118-79-6
Analytical Method:
EPA 624.1
Pace Analytical
Services - Charlotte
ND
ug/L
5.0
1
08/09/23 20:56
107-02-8 AC
ND
ug/L
5.0
1
08/09/23 20:56
107-13-1 AC
ND
ug/L
1.0
1
08/09/23 20:56
71-43-2
ND
ug/L
2.0
1
08/09/23 20:56
75-27-4
ND
ug/L
2.0
1
08/09/23 20:56
75-25-2
ND
ug/L
2.0
1
08/09/23 20:56
74-83-9
ND
ug/L
2.0
1
08/09/23 20:56
56-23-5
ND
ug/L
2.0
1
08/09/23 20:56
108-90-7
ND
ug/L
2.0
1
08/09/23 20:56
75-00-3
ND
ug/L
5.0
1
08/09/23 20:56
110-75-8
ND
ug/L
2.0
1
08/09/23 20:56
67-66-3
ND
ug/L
2.0
1
08/09/23 20:56
74-87-3
ND
ug/L
2.0
1
08/09/23 20:56
124-48-1
ND
ug/L
2.0
1
08/09/23 20:56
95-50-1
ND
ug/L
2.0
1
08/09/23 20:56
541-73-1
ND
ug/L
2.0
1
08/09/23 20:56
106-46-7
ND
ug/L
2.0
1
08/09/23 20:56
75-34-3
ND
ug/L
2.0
1
08/09/23 20:56
107-06-2
ND
ug/L
2.0
1
08/09/23 20:56
75-35-4
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
Date: 10/11 /2023 11:39 AM without the written consent of Pace Analytical Services, I.I.C. Page 7 of 36

Pace Analytical Services, LLC
7726 Moller Road
Indianapolis, IN 46268
[phone]
ANALYTICAL RESULTS
Project: NC -Concord Groundwater
Pace Project No.: 50351209
Sample: Sample 1 Lab ID: 50351209001 Collected: 08/07/23 15:00 Received: 08/08/23 08:00 Matrix: Water
Parameters Results Units Report Limit DF Prepared Analyzed CAS No. Qual
624 Volatile Organics
Analytical Method: EPA 624.1
Pace Analytical Services - Charlotte
trans-1,2-Dichloroethene
ND ug/L
2.0
1
08/09/23 20:56
156-60-5
1,2-Dichloropropane
ND ug/L
2.0
1
08/09/23 20:56
78-87-5
cis- 1, 3-Dich loropropene
ND ug/L
2.0
1
08/09/23 20:56
10061-01-5
trans-1,3-Dichloropropene
ND ug/L
2.0
1
08/09/23 20:56
10061-02-6
Ethylbenzene
ND ug/L
1.0
1
08/09/23 20:56
100-41-4
Methylene Chloride
ND ug/L
2.0
1
08/09/23 20:56
75-09-2
1,1,2,2-Tetrachloroethane
ND ug/L
2.0
1
08/09/23 20:56
79-34-5
Tetrachloroethene
ND ug/L
2.0
1
08/09/23 20:56
127-18-4
Toluene
ND ug/L
1.0
1
08/09/23 20:56
108-88-3
1, 1, 1 -Trichloroethane
ND ug/L
2.0
1
08/09/23 20:56
71-55-6
1,1,2-Trichloroethane
ND ug/L
2.0
1
08/09/23 20:56
79-00-5
Trichloroethene
ND ug/L
2.0
1
08/09/23 20:56
79-01-6
Vinyl chloride
ND ug/L
2.0
1
08/09/23 20:56
75-01-4
Surrogates
4-Bromofluorobenzene (S)
98 %
70-130
1
08/09/23 20:56
460-00-4
Toluene-d8 (S)
101 %
70-130
1
08/09/23 20:56
2037-26-5
1,2-Dichloroethane-d4 (S)
105 %
70-130
1
08/09/23 20:56
17060-07-0
2540D Total Suspended Solids
Analytical Method: SM 2540D-2015
Pace Analytical Services -Asheville
Total Suspended Solids
3.2 mg/L
2.5
1
08/10/23 12:15
5210B BOD, 5 day
Analytical Method: SM 521OB-2011
Pace Analytical Services -Asheville
BOD, 5 day
ND mg/L
2.0
1
08/09/23 07:02 08/14/23 09:44
B3
9040 pH
Analytical Method: EPA 9040C
Pace Analytical Services - Asheville
pH at 25 Degrees C
8.6 Std. Units
0.10
1
08/12/23 10:34
H3
350.1 Ammonia
Analytical Method: EPA 350.1 Rev 2.0
1993
Pace Analytical Services -Asheville
Nitrogen, Ammonia
ND mg/L
0.10
1
08/11/23 14:41
7664-41-7
420.4 Phenolics, Total
Analytical Method: EPA420.4 Rev 1.0
1993 Preparation Method: EPA420.4 Rev 1.0 1993
Pace Analytical Services -Asheville
Phenolics, Total Recoverable
ND mg/L
0.020
1
08/09/23 09:02 08/09/23 11:54
64743-03-9
450OCNE Cyanide, Total
Analytical Method: SM 4500-CN-E-2011 Preparation
Method: SM 4500-CN-E-2011
Pace Analytical Services -Asheville
Cyanide
ND mg/L
0.0080
1
08/10/2310:00 08/10/2312:20
57-12-5
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
08/10/23 11:36 08/10/23 16:46
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
Date: 10/11 /2023 11:39 AM without the written consent of Pace Analytical Services, LLC. Page 8 of 36

ANALYTICAL RESULTS
Project: NC -Concord Groundwater
Pace Project No.: 50351209
Pace Analytical Services, LLC
7726 Moller Road
Indianapolis, IN 46268
[phone]
Sample: Sample 1 Lab ID: 50351209001 Collected: 08/07/23 15:00 Received: 08/08/23 08:00 Matrix: Water
Parameters Results Units Report Limit DF Prepared Analyzed CAS No. Qual
5310E TOC Analytical Method: SM 531 OB-2014
Pace Analytical Services -Asheville
Total Organic Carbon 5.0 mg/L 1.0 1 08/24/23 01:29 7440-44-0
Date: 10/11 /2023 11:39 AM
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, LLC.
Page 9 of 36

QUALITY CONTROL DATA
Project: NC -Concord Groundwater
Pace Project No.: 50351209
Pace Analytical Services, LLC
7726 Moller Road
Indianapolis, IN 46268
[phone]
QC Batch: 792369 Analysis Method: EPA 200.7
QC Batch Method: EPA 200.7 Analysis Description: 200.7 Metals Total
Laboratory: Pace Analytical Services - Peachtree Corners, GA
Associated Lab Samples: 50351209001
METHOD BLANK: 4105939
Associated Lab Samples: 50351209001
Parameter
Units
Matrix:
Blank
Result
Water
Reporting
Limit
Analyzed Qualifiers
Antimony
ug/L
ND
50.0
08/09/23 21:11
Arsenic
ug/L
ND
30.0
08/09/23 21:11
Beryllium
ug/L
ND
10.0
08/09/23 21:11
Cadmium
ug/L
ND
10.0
08/09/23 21:11
Chromium
ug/L
ND
10.0
08/09/23 21:11
Copper
ug/L
ND
20.0
08/09/23 21:11
Lead
ug/L
ND
25.0
08/09/23 21:11
Nickel
ug/L
ND
20.0
08/09/23 21:11
Selenium
ug/L
ND
40.0
08/09/23 21:11
Silver
ug/L
ND
10.0
08/09/23 21:11
Thallium
ug/L
ND
200
08/09/23 21:11
Tin
ug/L
ND
40.0
08/09/23 21:11
Zinc
ug/L
ND
20.0
08/09/23 21:11
LABORATORY CONTROL SAMPLE:
Parameter
4105940
Units
Spike
Conc.
LCS
Result
LCS
% Rec
% Rec
Limits Qualifiers
Antimony
ug/L
1000
1030
103
85-115
Arsenic
ug/L
1000
1040
104
85-115
Beryllium
ug/L
1000
1010
101
85-115
Cadmium
ug/L
1000
1030
103
85-115
Chromium
ug/L
1000
1020
102
85-115
Copper
ug/L
1000
1040
104
85-115
Lead
ug/L
1000
1020
102
85-115
Nickel
ug/L
1000
1030
103
85-115
Selenium
ug/L
1000
1000
100
85-115
Silver
ug/L
1000
999
100
85-115
Thallium
ug/L
1000
1010
101
85-115
Tin
ug/L
1000
1010
101
85-115
Zinc
ug/L
1000
1030
103
85-115
MATRIX SPIKE & MATRIX SPIKE DUPLICATE: 4105941
4105942
MS
MSD
92681230001 Spike
Spike
MS
MSD
MS MSD
% Rec
Max
Parameter Units Result Conc.
Conc.
Result
Result
% Rec % Rec
Limits RPD
RPD Qua[
Antimony ug/L ND 1000
1000
1070
1130
107 113
70-130 5
20
Arsenic ug/L ND 1000
1000
1110
1190
109 117
70-130 7
20
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: 10/11 /2023 11:39 AM without the written consent of Pace Analytical Services, LLC.
Page 10 of 36

QUALITY CONTROL DATA
Project: NC -Concord Groundwater
Pace Project No.: 50351209
Pace Analytical Services, LLC
7726 Moller Road
Indianapolis, IN 46268
[phone]
MATRIX SPIKE & MATRIX SPIKE DUPLICATE: 4105941
4105942
MS
MSD
92681230001
Spike
Spike
MS
MSD
MS
MSD
% Rec
Max
Parameter
Units
Result
Conc.
Conc.
Result
Result
% Rec
% Rec
Limits
RPD
RPD Qual
Beryllium
ug/L
ND
1000
1000
1030
1030
103
103
70-130
0
20
Cadmium
ug/L
ND
1000
1000
1070
1080
107
108
70-130
1
20
Chromium
ug/L
ND
1000
1000
1030
1020
103
102
70-130
1
20
Copper
ug/L
ND
1000
1000
1070
1070
107
107
70-130
0
20
Lead
ug/L
ND
1000
1000
1030
1060
103
106
70-130
3
20
Nickel
ug/L
ND
1000
1000
1030
1090
103
108
70-130
5
20
Selenium
ug/L
66.0
1000
1000
1120
924
105
86
70-130
19
20
Silver
ug/L
ND
1000
1000
1020
1020
102
102
70-130
1
20
Thallium
ug/L
ND
1000
1000
1040
1110
104
111
70-130
7
20
Tin
ug/L
ND
1000
1000
1030
1030
103
103
70-130
0
20
Zinc
ug/L
ND
1000
1000
1010
1430
101
143
70-130
34
20 M1,R1
MATRIX SPIKE & MATRIX SPIKE DUPLICATE: 4105943
4105944
MS
MSD
92681462002
Spike
Spike
MS
MSD
MS
MSD
% Rec
Max
Parameter
Units
Result
Conc.
Conc.
Result
Result
% Rec
% Rec
Limits
RPD
RPD Qual
Antimony
ug/L
ND
1000
1000
1050
1080
105
108
70-130
3
20
Arsenic
ug/L
ND
1000
1000
1060
1090
106
109
70-130
2
20
Beryllium
ug/L
ND
1000
1000
1010
1050
101
105
70-130
3
20
Cadmium
ug/L
ND
1000
1000
1030
1060
103
106
70-130
3
20
Chromium
ug/L
ND
1000
1000
1020
1060
101
105
70-130
3
20
Copper
ug/L
ND
1000
1000
1060
1090
104
108
70-130
3
20
Lead
ug/L
ND
1000
1000
1030
1060
103
106
70-130
3
20
Nickel
ug/L
ND
1000
1000
1050
1080
105
108
70-130
3
20
Selenium
ug/L
ND
1000
1000
1000
1050
100
105
70-130
4
20
Silver
ug/L
ND
1000
1000
983
1010
98
101
70-130
3
20
Thallium
ug/L
ND
1000
1000
927
1030
93
103
70-130
10
20
Tin
ug/L
ND
1000
1000
1000
1040
100
104
70-130
4
20
Zinc
ug/L
0.029
1000
1000
1080
1100
105
107
70-130
2
20
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: 10/11 /2023 11:39 AM without the written consent of Pace Analytical Services, LLC.
Page 11 of 36

Project: NC -Concord Groundwate
Pace Project No.: 50351209
QC Batch: 795988
QC Batch Method: EPA 245.1
Associated Lab Samples: 50351209001
METHOD BLANK: 4124552
Associated Lab Samples: 50351209001
Parameter
Mercury
Pace Analytical Services, LLC
7726 Moller Road
Indianapolis, IN 46268
[phone]
QUALITY CONTROL DATA
Analysis Method: EPA 245.1
Analysis Description: 245.1 Mercury
Laboratory: Pace Analytical Services - Peachtree Corners, GA
Matrix: Water
Blank Reporting
Units Result Limit Analyzed Qualifiers
ug/L ND 0.20 08/25/2313:28
LABORATORY CONTROL SAMPLE: 4124553
Spike LCS LCS % Rec
Parameter Units Conc. Result % Rec Limits Qualifiers
Mercury ug/L 2.5 2.6 103 85-115
MATRIX SPIKE & MATRIX SPIKE DUPLICATE: 4124554 4124555
MS MSD
92683801001 Spike Spike MS MSD MS MSD % Rec Max
Parameter Units Result Conc. Conc. Result Result % Rec % Rec Limits RPD RPD Qual
Mercury ug/L ND 2.5 2.5 2.4 2.0 95 80 70-130 16 20
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: 10/11 /2023 11:39 AM without the written consent of Pace Analytical Services, LLC.
Page 12 of 36

Project: NC -Concord Groundwater
Pace Project No.: 50351209
QC Batch: 792436
QC Batch Method: EPA 624.1
Associated Lab Samples: 50351209001
QUALITY CONTROL DATA
Analysis Method: EPA 624.1
Analysis Description: 624 MSV
Laboratory: Pace Analytical Services - Charlotte
METHOD BLANK: 4106479
Associated Lab Samples: 50351209001
Parameter
Units
Matrix:
Blank
Result
Water
Reporting
Limit
Analyzed
1,1,1-Trichloroethane
ug/L
ND
2.0
08/09/23 12:24
1,1,2,2-Tetrachloroethane
ug/L
ND
2.0
08/09/23 12:24
1,1,2-Trichloroethane
ug/L
ND
2.0
08/09/23 12:24
1,1-Dichloroethane
ug/L
ND
2.0
08/09/23 12:24
1,1-Dichloroethene
ug/L
ND
2.0
08/09/23 12:24
1,2-Dichlorobenzene
ug/L
ND
2.0
08/09/23 12:24
1,2-Dichloroethane
ug/L
ND
2.0
08/09/23 12:24
1,2-Dichloropropane
ug/L
ND
2.0
08/09/23 12:24
1,3-Dichlorobenzene
ug/L
ND
2.0
08/09/23 12:24
II A-Dichlorobenzene
ug/L
ND
2.0
08/09/23 12:24
2-Chloroethylvinyl ether
ug/L
ND
5.0
08/09/23 12:24
Acrolein
ug/L
ND
5.0
08/09/23 12:24
Acrylonitrile
ug/L
ND
5.0
08/09/23 12:24
Benzene
ug/L
ND
1.0
08/09/23 12:24
Bromodichloromethane
ug/L
ND
2.0
08/0912312:24
Bromoform
ug/L
ND
2.0
08/09/23 12:24
Bromomethane
ug/L
ND
2.0
08/09/23 12:24
Carbon tetrachloride
ug/L
ND
2.0
08/09/23 12:24
Chlorobenzene
ug/L
ND
2.0
08/09/23 12:24
Chloroethane
ug/L
ND
2.0
08/09/23 12:24
Chloroform
ug/L
ND
2.0
08/09/23 12:24
Chloromethane
ug/L
ND
2.0
08/09/23 12:24
cis-1,3-Dichloropropene
ug/L
ND
2.0
08/09/23 12:24
Dibromochloromethane
ug/L
ND
2.0
08/09/23 12:24
Ethylbenzene
ug/L
ND
1.0
08/09/23 12:24
Methylene Chloride
ug/L
ND
2.0
08/09/23 12:24
Tetrachloroethene
ug/L
ND
2.0
08/09/23 12:24
Toluene
ug/L
ND
1.0
08/09/23 12:24
trans-1,2-Dichloroethene
ug/L
ND
2.0
08/09/23 12:24
trans-1,3-Dichloropropene
ug/L
ND
2.0
08/09/23 12:24
Trichloroethene
ug/L
ND
2.0
08/09/23 12:24
Vinyl chloride
ug/L
ND
2.0
08/09/23 12:24
1,2-Dichloroethane-d4 (S)
%
105
70-130
08/09/23 12:24
4-Bromofluorobe nzene (S)
%
101
70-130
08/09/23 12:24
Toluene-d8 (S)
%
102
70-130
08/09/23 12:24
Qualifiers
Pace Analytical Services, LLC
7726 Moller Road
Indianapolis, IN 46268
[phone]
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: 10/11 /2023 11:39 AM without the written consent of Pace Analytical Services, LLC.
Page 13 of 36

�cem
QUALITY CONTROL DATA
Project: NC -Concord Groundwater
Pace Project No.: 50351209
LABORATORY CONTROL SAMPLE:
Parameter
4106480
Units
Spike
Conc.
LCS
Result
LCS
% Rec
% Rec
Limits
1,1, 1 -Trichloroethane
ug/L
20
19.4
97
70-130
1,1,2,2-Tetrachloroethane
ug/L
20
19.6
98
70-130
1,1,2-Trichloroethane
ug/L
20
19.1
96
70-130
1,1-Dichloroethane
ug/L
20
19.2
96
70-130
1,1-Dichloroethene
ug/L
20
19.3
97
70-130
1,2-Dichlorobenzene
ug/L
20
19.3
96
70-130
1,2-Dichloroethane
ug/L
20
19.0
95
70-130
1,2-Dichloropropane
ug/L
20
19.0
95
70-130
1,3-Dichlorobenzene
ug/L
20
19.0
95
70-130
1,4-Dichlorobenzene
ug/L
20
19.0
95
70-130
2-Chloroethylvinyl ether
ug/L
40
34.6
87
63-130
Acrolein
ug/L
100
104
104
60-140
Acrylonitrile
ug/L
100
97.4
97
70-130
Benzene
ug/L
20
18.6
93
70-130
Bromodichloromethane
ug/L
20
17.9
89
70-130
Bromoform
ug/L
20
17.5
88
70-130
Bromomethane
ug/L
20
15.9
80
45-151
Carbon tetrachloride
ug/L
20
18.7
93
70-130
Chlorobenzene
ug/L
20
18.9
95
70-130
Chloroethane
ug/L
20
20.8
104
40-152
Chloroform
ug/L
20
19.6
98
70-130
Chloromethane
ug/L
20
17.0
85
58-130
cis- 1,3-Dichloropropene
ug/L
20
18.4
92
70-130
Dibromochloromethane
ug/L
20
17.9
89
70-130
Ethylbenzene
ug/L
20
18.6
93
70-130
Methylene Chloride
ug/L
20
18.6
93
66-130
Tetrachloroethene
ug/L
20
18.4
92
70-130
Toluene
ug/L
20
18.1
91
70-130
trans-1,2-Dichloroethene
ug/L
20
20.1
101
70-130
trans-1,3-Dichloropropene
ug/L
20
17.7
89
70-130
Trichloroethene
ug/L
20
18.9
94
70-130
Vinyl chloride
ug/L
20
15.6
78
62-130
1,2-Dichloroethane-d4(S)
%
105
70-130
4-Bromofluorobenzene (S)
%
102
70-130
Toluene-d8 (S)
%
99
70-130
Pace Analytical Services, LLC
7726 Moller Road
Indianapolis, IN 46268
[phone]
Qualifiers
MATRIX SPIKE & MATRIX SPIKE DUPLICATE: 4106481
4106482
MS
MSD
92681126001
Spike
Spike
MS
MSD
MS
MSD
% Rec
Max
Parameter
Units
Result
Conc.
Conc.
Result
Result
% Rec
% Rec
Limits
RPD
RPD Qual
1,1,1-Trichloroethane
ug/L
ND
20
20
25.1
24.0
125
120
70-150
4
21
1,1,2,2-Tetrachloroethane
ug/L
ND
20
20
22.6
22.1
113
110
69-142
2
30
1,1,2-Trichloroethane
ug/L
ND
20
20
24.0
23.2
120
116
70-138
3
27
1, 1 -Dichloroethane
ug/L
ND
20
20
25.0
24.0
125
120
70-150
4
24
1,1-Dichloroethene
ug/L
ND
20
20
25.7
24.7
129
124
70-156
4
30
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: 10/11 /2023 11:39 AM without the written consent of Pace Analytical Services, LLC.
Page 14 of 36

�ce�
QUALITY CONTROL DATA
Project: NC -Concord Groundwater
Pace Project No.: 50351209
Pace Analytical Services, LLC
7726 Moller Road
Indianapolis, IN 46268
[phone]
MATRIX SPIKE & MATRIX SPIKE DUPLICATE: 4106481
MS
92681126001 Spike
Parameter Units Result Conc.
MSD
Spike
Conc.
4106482
MS
Result
MSD
Result
MS
% Rec
MSD
% Rec
% Rec
Limits
RPD
Max
RPD Qual
1,2-Dichlorobenzene
ug/L
ND
20
20
22.4
21.8
112
109
70-141
2
30
1,2-Dichloroethane
ug/L
ND
20
20
24.7
23.3
124
116
69-143
6
29
1,2-Dichloropropane
ug/L
ND
20
20
24.2
23.4
121
117
70-156
3
30
1,3-Dichlorobenzene
ug/L
ND
20
20
22.2
22.0
111
110
70-143
1
24
1,4-Dichlorobenzene
ug/L
ND
20
20
22.4
22.1
112
111
70-142
1
30
2-Chloroethylvinyl ether
ug/L
ND
40
40
ND
ND
0
0
10-200
34 P5
Acrolein
ug/L
ND
100
100
108
98.4
108
98
40-160
10
30
Acrylonitrile
ug/L
ND
100
100
123
116
123
116
69-147
6
30
Benzene
ug/L
ND
20
20
24.3
23.3
122
117
70-142
4
30
Bromodichloromethane
ug/L
6.3
20
20
30.5
29.7
121
117
70-139
3
30
Bromoform
ug/L
ND
20
20
19.0
18.4
95
92
64-140
3
25
Bromomethane
ug/L
ND
20
20
25.2
23.6
124
116
28-192
7
34
Carbon tetrachloride
ug/L
ND
20
20
23.4
22.9
117
115
70-140
2
26
Chlorobenzene
ug/L
ND
20
20
22.5
22.2
113
111
70-141
1
29
Chloroethane
ug/L
ND
20
20
27.5
24.4
137
122
58-191
12
30
Chloroform
ug/L
46.9
20
20
76.4
75.2
148
142
70-138
2
30 M1
Chloromethane
ug/L
ND
20
20
22.0
15.7
109
77
43-162
34
30 R1
cis-1,3-Dichloropropene
ug/L
ND
20
20
22.9
22.1
114
110
68-151
4
30
Dibromochloromethane
ug/L
ND
20
20
22.2
21.2
109
104
70-144
5
30
Ethylbenzene
ug/L
ND
20
20
22.1
21.7
110
109
70-143
2
30
Methylene Chloride
ug/L
ND
20
20
24.3
23.3
122
117
70-144
4
30
Tetrachloroethene
ug/L
ND
20
20
21.4
21.4
107
107
70-143
0
23
Toluene
ug/L
ND
20
20
22.6
22.1
113
111
69-144
2
22
trans-1,2-Dichloroethene
ug/L
ND
20
20
24.2
24.3
121
121
70-151
0
27
trans-1,3-Dichloropropene
ug/L
ND
20
20
22.0
21.5
110
107
70-139
3
30
Trichloroethene
ug/L
ND
20
20
23.9
23.2
119
116
70-142
3
29
Vinyl chloride
ug/L
ND
20
20
20.6
19.7
103
99
61-162
5
30
1,2-Dichloroethane-d4 (S)
%
104
100
70-130
4-Bromofluorobenzene (S)
%
101
100
70-130
Toluene-d8(S)
%
99
99
70-130
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: 10/11 /2023 11:39 AM without the written consent of Pace Analytical Services, LLC.
Page 15 of 36

aceg
QUALITY CONTROL DATA
Project: NC -Concord Groundwater
Pace Project No.: 50351209
QC Batch: 792101 Analysis Method: EPA 608.3
QC Batch Method: EPA 608.3 Analysis Description: 608 PCB Pest Red Vol
Laboratory: Pace Analytical Services - Charlotte
Associated Lab Samples: 50351209001
METHOD BLANK: 4104402
Associated Lab Samples: 50351209001
Parameter Units
4,4'-DDD
ug/L
4,4'-DDE
ug/L
4,4'-DDT
ug/L
Aldrin
ug/L
alpha-BHC
ug/L
alpha -Chlordane
ug/L
beta-BHC
ug/L
Chlordane (Technical)
ug/L
delta-BHC
ug/L
Dieldrin
ug/L
Endosulfan I
ug/L
Endosulfan II
ug/L
Endosulfan sulfate
ug/L
Endrin
ug/L
Endrin aldehyde
ug/L
gamma-BHC (Lindane)
ug/L
gamma -Chlordane
ug/L
Heptachlor
ug/L
Heptachlor epoxide
ug/L
PCB-1016 (Aroclor 1016)
ug/L
PCB-1221 (Aroclor 1221)
ug/L
PCB-1232 (Aroclor 1232)
ug/L
PCB-1242 (Aroclor 1242)
ug/L
PCB-1248 (Aroclor 1248)
ug/L
PCB-1254 (Aroclor 1254)
ug/L
PCB-1260 (Aroclor 1260)
ug/L
Toxaphene
ug/L
Decachlorobiphenyl (S)
%
Tetrachloro-m-xylene (S)
%
Matrix: Water
Blank
Result
Reporting
Limit
Analyzed
ND
0.050
08/11/2318:13
ND
0.050
08/11/2318:13
ND
0.050
08/11/2318:13
ND
0.050
08/11/2318:13
ND
0.050
08/11/2318:13
ND
0.050
08/11/2318:13
ND
0.050
08/11/2318:13
ND
0.50
08/11/2318:13
ND
0.050
08/11/2318:13
ND
0.050
08/11/2318:13
ND
0.050
08/11/2318:13
ND
0.050
08/11/2318:13
ND
0.050
08/11/2318:13
ND
0.050
08/11/2318:13
ND
0.050
08/11/2318:13
ND
0.050
08/11/2318:13
ND
0.050
08/11/2318:13
ND
0.050
08/11/2318:13
ND
0.050
08/11/2318:13
ND
0.50
08/11/2318:13
ND
0.50
08/11/2318:13
ND
0.50
08/11/2318:13
ND
0.50
08/11/2318:13
ND
0.50
08/11/2318:13
ND
0.50
08/11/2318:13
ND
0.50
08/11/2318:13
ND
0.50
08/11/2318:13
129
19-200
08/11/2318:13
49
10-137
08/11/2318:13
Qualifiers
Pace Analytical Services, LLC
7726 Moller Road
Indianapolis, IN 46268
[phone]
LABORATORY CONTROL SAMPLE:
4104403
Spike
LCS
LCS
% Rec
Parameter
Units
Conc.
Result
% Rec
Limits Qualifiers
4,4'-DDD
ug/L
0.25
0.41
163
31-141 L1
4,4'-DDE
ug/L
0.25
0.34
136
30-145
4,4'-DDT
ug/L
0.25
0.35
139
25-160
Aldrin
ug/L
0.25
0.18
71
42-135
alpha-BHC
ug/L
0.25
0.29
117
37-140
alpha -Chlordane
ug/L
0.25
0.31
122
45-140
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: 10/11 /2023 11:39 AM without the written consent of Pace Analytical Services, LLC.
Page 16 of 36

Project: NC -Concord Groundwater
Pace Project No.: 50351209
LABORATORY CONTROL SAMPLE: 4104403
Parameter Units
beta-BHC
ug/L
delta-BHC
ug/L
Dieldrin
ug/L
Endosulfan I
ug/L
Endosulfan 11
ug/L
Endosulfan sulfate
ug/L
Endrin
ug/L
Endrin aldehyde
ug/L
gamma-BHC (Lindane)
ug/L
gamma -Chlordane
ug/L
Heptachlor
ug/L
Heptachlor epoxide
ug/L
Decachlorobiphenyl (S)
%
Tetrachloro-m-xylene (S)
%
QUALITY CONTROL DATA
Spike
Conc.
LCS
Result
LCS
% Rec
% Rec
Limits
0.25
0.30
120
38-147
0.25
0.26
104
19-140
0.25
0.33
131
36-146
0.25
0.29
117
45-153
0.25
0.29
115
38-155
0.25
0.30
119
42-144
0.25
0.35
140
33-147
0.25
0.28
113
33-153
0.25
0.28
113
32-140
0.25
0.30
121
45-140
0.25
0.26
103
34-140
0.25
0.27
109
37-142
104
19-200
109
10-137
Pace Analytical Services, LLC
7726 Moller Road
Indianapolis, IN 46268
[phone]
Qualifiers
LABORATORY CONTROL SAMPLE:
4104411
Spike LCS LCS
% Rec
Parameter
Units
Conc. Result % Rec
Limits Qualifiers
PCB-1016 (Aroclor 1016)
ug/L
5 5.7 114
50-140
PCB-1260 (Aroclor 1260)
ug/L
5 6.0 119
42-140
Decachlorobiphenyl (S)
%
94
19-200
Tetrachloro-m-xylene (S)
%
100
10-137
MATRIX SPIKE & MATRIX SPIKE DUPLICATE: 4104404
4104405
MS
MSD
92680331004 Spike
Spike
MS
MSD
MS
MSD
% Rec
Max
Parameter
Units Result Conc.
Conc.
Result
Result
% Rec
% Rec
Limits
RPD RPD Qual
PCB-1016 (Aroclor 1016)
ug/L ND 8.3
8.3
10.0
6.4
120
77
50-140
44 36 R1
PCB-1260 (Aroclor 1260)
ug/L ND 8.3
8.3
7.1
4.2
86
50
42-140
53 38 R1
Decachlorobiphenyl (S)
%
75
45
19-200
Tetra chloro-m-xylene (S)
%
114
88
10-137
MATRIX SPIKE & MATRIX SPIKE DUPLICATE: 4104406
4104407
MS
MSD
92680825001
Spike
Spike
MS
MSD
MS
MSD
% Rec
Max
Parameter
Units
Result
Conc.
Conc.
Result
Result
% Rec
% Rec
Limits
RPD
RPD Qual
4,4'-DDD
ug/L
ND
0.42
0.42
0.48
0.49
115
117
31-141
1
39
4,4'-DDE
ug/L
ND
0.42
0.42
0.42
0.42
100
100
30-145
0
35
4,4'-DDT
ug/L
ND
0.42
0.42
0.43
0.41
103
99
25-160
5
42
Aldrin
ug/L
ND
0.42
0.42
0.27
0.25
64
61
42-140
4
35
alpha-BHC
ug/L
ND
0.42
0.42
0.39
0.39
93
94
37-140
0
36
alpha -Chlordane
ug/L
ND
0.42
0.42
0.34
0.35
83
84
45-140
1
35
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: 10/11 /2023 11:39 AM without the written consent of Pace Analytical Services, LLC.
Page 17 of 36

Pace Analytical Services, LLC
7726 Moller Road
Indianapolis, IN 46268
[phone]
QUALITY CONTROL DATA
Project: NC -Concord Groundwater
Pace Project No.: 50351209
MATRIX SPIKE & MATRIX SPIKE DUPLICATE:
4104406
4104407
MS
MSD
92680825001
Spike
Spike
MS
MSD
MS
MSD
% Rec
Max
Parameter
Units Result
Conc.
Conc.
Result
Result
% Rec
% Rec
Limits
RPD
RPD Qual
beta-BHC
ug/L
ND
0.42
0.42
0.39
0.42
93
100
21-147
7
44
delta-BHC
ug/L
ND
0.42
0.42
0.35
0.35
83
84
19-140
1
52
Dieldrin
ug/L
ND
0.42
0.42
0.36
0.36
86
87
36-146
1
49
Endosulfan I
ug/L
ND
0.42
0.42
0.39
0.40
94
95
45-153
1
28
Endosulfan II
ug/L
ND
0.42
0.42
0.37
0.36
89
86
13-174
4
53
Endosulfan sulfate
ug/L
ND
0.42
0.42
0.40
0.40
96
96
26-144
1
38
Endrin
ug/L
ND
0.42
0.42
0.40
0.40
96
97
30-147
1
48
Endrin aldehyde
ug/L
ND
0.42
0.42
0.31
0.31
75
75
10-167
0
30
gamma-BHC (Lindane)
ug/L
ND
0.42
0.42
0.38
0.39
92
93
32-140
2
39
gamma -Chlordane
ug/L
ND
0.42
0.42
0.35
0.35
83
84
45-140
1
35
Heptachlor
ug/L
ND
0.42
0.42
0.32
0.33
78
79
34-140
2
43
Heptachlor epoxide
ug/L
ND
0.42
0.42
0.33
0.33
79
79
37-142
1
26
Decachlorobiphenyl (S)
%
41
42
19-200
Tetrachloro-m-xylene (S)
%
82
85
10-137
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: 10/11 /2023 11:39 AM without the written consent of Pace Analytical Services, LLC.
Page 18 of 36

Pace Analytical Services, LLC
7726 Moller Road
Indianapolis, IN 46268
[phone]
QUALITY CONTROL DATA
Project: NC -Concord Groundwater
Pace Project No.: 50351209
QC Batch: 792337
QC Batch Method: EPA 625.1
Associated Lab Samples: 50351209001
Analysis Method:
Analysis Description:
Laboratory:
EPA 625.1
625 MSS
Pace Analytical Services - Charlotte
METHOD BLANK: 4105871
Matrix: Water
Associated Lab Samples: 50351209001
Blank Reporting
Parameter
Units
Result Limit
Analyzed Qualifiers
1,2,4-Trichlorobe nzene
ug/L
ND
5.0
08/10/23 11:12
1,2-Diphenylhydrazine
ug/L
ND
5.0
08/10/23 11:12
2,2'-Oxybis(1-chloropropane)
ug/L
ND
5.0
08/10/23 11:12
2,4,6-Trichlorophenol
ug/L
ND
10.0
08/10/23 11:12
2,4-Dichlorophenol
ug/L
ND
5.0
08/1012311:12
2,4-Dimethylphenol
ug/L
ND
10.0
08/10/23 11:12
2,4-Dinitrophenol
ug/L
ND
50.0
08/10/23 11:12
2,4-Dinitrotoluene
ug/L
ND
5.0
08/10/23 11:12
2,6-Dinitrotoluene
ug/L
ND
5.0
08/10/23 11:12
2-Chloronaphthalene
ug/L
ND
5.0
08/10/23 11:12
2-Chlorophenol
ug/L
ND
5.0
08/10/23 11:12
2-Nitrophenol
ug/L
ND
5.0
08/10/23 11:12
3,3'-Dichlorobenzidine
ug/L
ND
10.0
08/10/23 11:12
4,6-Dinitro-2-methylphenol
ug/L
ND
10.0
08/10/23 11:12
4-Bromophenylphenyl ether
ug/L
ND
5.0
08/10/23 11:12
4-Chloro-3-methylphenol
ug/L
ND
5.0
08/10/23 11:12
4-Chlorophenylphenyl ether
ug/L
ND
5.0
08/10/23 11:12
4-Nitrophenol
ug/L
ND
10.0
08/10/23 11:12
Acenaphthene
ug/L
ND
5.0
08/10/23 11:12
Acenaphthylene
ug/L
ND
5.0
08/10/23 11:12
Anthracene
ug/L
ND
5.0
08/10/23 11:12
Benzidine
ug/L
ND
50.0
08/10/23 11:12
Benzo(a)anthracene
ug/L
ND
5.0
08/10/23 11:12
Benzo(a)pyrene
ug/L
ND
5.0
08/10/23 11:12
Benzo(b)fluoranthene
ug/L
ND
5.0
08/10/23 11:12
Benzo(g,h,i)perylene
ug/L
ND
5.0
08/10/23 11:12
Benzo(k)fluoranthene
ug/L
ND
5.0
08/10/23 11:12
bis(2-Chloroethoxy)methane
ug/L
ND
10.0
08/10/23 11:12
bis(2-Chloroethyl) ether
ug/L
ND
5.0
08/10/23 11:12
bis(2-Ethylhexyl)phthalate
ug/L
ND
5.0
08110/2311:12
Butyl benzylphthalate
ug/L
ND
5.0
08/10/23 11:12
Chrysene
ug/L
ND
5.0
08/10/23 11:12
Di-n-butylphthalate
ug/L
ND
5.0
08/10/23 11:12
Di-n-octylphthalate
ug/L
ND
5.0
08/10/23 11:12
Dibenz(a,h)anthracene
ug/L
ND
5.0
08/10/23 11:12
Diethylphthalate
ug/L
ND
5.0
08/10/23 11:12
Dimethylphthalate
ug/L
ND
5.0
08/10/23 11:12
Fluoranthene
ug/L
ND
5.0
08/10/23 11:12
Fluorene
ug/L
ND
5.0
08/10/23 11:12
Hexachloro-1,3-butadiene
ug/L
ND
5.0
08/10/23 11:12
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: 10/11 /2023 11:39 AM without the written consent of Pace Analytical Services, LLC.
Page 19 of 36

ace,
QUALITY CONTROL DATA
Project: NC -Concord Groundwater
Pace Project No.: 50351209
METHOD BLANK: 4105871
Matrix:
Water
Associated Lab Samples: 50351209001
Blank
Reporting
Parameter
Units
Result
Limit
Analyzed
Hexachlorobenzene
ug/L
ND
5.0
08/10/23 11:12
Hexachlorocyclopentadiene
ug/L
ND
10.0
08/10/23 11:12
Hexachloroethane
ug/L
ND
5.0
08/10/23 11:12
Indeno(1,2,3-cd)pyre ne
ug/L
ND
5.0
08/10/23 11:12
Isophorone
ug/L
ND
10.0
08/10/23 11:12
N-Nitroso-di-n-propylamine
ug/L
ND
5.0
08/10/23 11:12
N-Nitrosodimethylamine
ug/L
ND
5.0
08/10/23 11:12
N-Nitrosodiphenylamine
ug/L
ND
10.0
08/10/23 11:12
Naphthalene
ug/L
ND
5.0
08/10/23 11:12
Nitrobenzene
ug/L
ND
5.0
08/10/23 11:12
Pentachlorophenol
ug/L
ND
10.0
08/10/23 11:12
Phenanthrene
ug/L
ND
5.0
08/10/23 11:12
Phenol
ug/L
ND
5.0
08/10/23 11:12
Pyrene
ug/L
ND
5.0
08/10/23 11:12
2,4,6-Tribromophenol (S)
%
107
10-137
08/10/23 11:12
2-Fluorobiphenyl (S)
%
67
15-120
08/10/23 11:12
2-Fluorophenol (S)
%
61
10-120
08/10/23 11:12
Nitrobenzene-d5 (S)
%
84
10-120
08/10/23 11:12
Phenol-d6 (S)
%
46
10-120
08/10/23 11:12
Terphenyl-d14 (S)
%
134
11-131
08/10/23 11:12 S3
Qualifiers
LABORATORY CONTROL SAMPLE:
Parameter
4105872
Units
Spike
Conc.
LCS
Result
LCS
% Rec
% Rec
Limits
1,2,4-Trichlorobenzene
ug/L
100
48.2
48
44-142
1,2-Diphenylhydrazine
ug/L
100
78.0
78
25-150
2,2'-Oxybis(1-chloropropane)
ug/L
100
57.9
58
36-166
2,4,6-Trichlorophenol
ug/L
100
78.3
78
37-144
2,4-Dichlorophenol
ug/L
100
61.9
62
1-191
2,4-Dimethylphenol
ug/L
100
64.2
64
32-119
2,4-Dinitrophenol
ug/L
500
388
78
1-181
2,4-Dinitrotoluene
ug/L
100
67.6
68
39-139
2,6-Dinitrotoluene
ug/L
100
71.6
72
50-158
2-Chloronaphthalene
ug/L
100
62.7
63
60-118
2-Chlorophenol
ug/L
100
62.8
63
23-134
2-Nitrophenol
ug/L
100
70.9
71
29-182
3,3'-Dichlorobenzidine
ug/L
200
114
57
1-262
4,6-Dinitro-2-methylphenol
ug/L
200
178
89
1-181
4-Bromophenylphenyl ether
ug/L
100
68.1
68
53-127
4-Chloro-3-methylphenol
ug/L
200
123
61
22-147
4-Chlorophenylphenyl ether
ug/L
100
66.3
66
25-158
4-Nitrophenol
ug/L
500
179
36
1-132
Acenaphthene
ug/L
100
65.5
66
47-145
Acenaphthylene
ug/L
100
66.4
66
33-145
Pace Analytical Services, LLC
7726 Moller Road
Indianapolis, IN 46268
[phone]
Qualifiers
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: 10/11 /2023 11:39 AM without the written consent of Pace Analytical Services, LLC. Page 20 of 36

Project: NC -Concord Groundwater
Pace Project No.: 50351209
LABORATORY CONTROL SAMPLE: 4105872
Parameter
Anthracene
Benzidine
Benzo(a)anthracene
Benzo(a)pyrene
Benzo(b)fluoranthene
Benzo(g,h,i)perylene
Benzo(k)fluoranthene
bis(2-Chloroethoxy)methane
bis(2-Chloroethyl) ether
bis(2-Ethylhexyl)phthalate
Butylbenzylphthalate
Chrysene
Di-n-butylphthalate
Di-n-octylphthalate
Dibenz(a, h)anth race ne
Diethylphthalate
Dimethylphthalate
Fluoranthene
Fluorene
Hexachloro-1,3-butadiene
Hexachlorobe nzene
Hexachlorocyclopentadiene
Hexachloroethane
Indeno(1,2,3-cd)pyre ne
Isophorone
N-N itroso-d i-n-propylamine
N-Nitrosodimethylamine
N-Nitrosodiphenylamine
Naphthalene
Nitrobenzene
Pentachlorophenol
Phenanthrene
Phenol
Pyrene
2,4,6-Tribromophenol (S)
2-Fluorobiphenyl (S)
2-Fluorophenol(S)
Nitrobenzene-d5 (S)
Phenol-d6 (S)
Terphenyl-d14 (S)
Units
ug/L
ug/L
ug/L
ug/L
ug/L
ug/L
ug/L
ug/L
ug/L
ug/L
ug/L
ug/L
ug/L
ug/L
ug/L
ug/L
ug/L
ug/L
ug/L
ug/L
ug/L
ug/L
ug/L
ug/L
ug/L
ug/L
ug/L
ug/L
ug/L
ug/L
ug/L
ug/L
ug/L
ug/L
%
QUALITY CONTROL DATA
Spike
Conc.
100
200
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
200
100
100
100
LCS
Result
62.2
ND
68.6
70.1
69.7
73.6
72.8
62.8
63.2
75.5
80.1
68.0
65.7
69.3
70.2
60.9
61.9
61.4
66.0
45.2
69.1
52.0
42.6
69.3
64.2
69.0
51.6
71.7
52.3
63.9
142
68.8
41.2
84.6
LCS
% Rec
Pace Analytical Services, LLC
7726 Moller Road
Indianapolis, IN 46268
[phone]
% Rec
Limits Qualifiers
62
1-166
2
10-130 L2
69
33-143
70
17-163
70
24-159
74
1-219
73
11-162
63
33-184
63
12-158
75
8-158
80
1-152
68
17-168
66
1-118
69
4-146
70
1-227
61
1-114
62
1-112
61
26-137
66
59-121
45
24-116
69
1-152
52
25-150
43
40-113
69
1-171
64
21-196
69
1-230
52
25-150
72
25-150
52
21-133
64
35-180
71
14-176
69
54-120
41
5-112
85
52-115
74
10-137
60
15-120
44
10-120
63
10-120
35
10-120
74
11-131
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: 10/11 /2023 11:39 AM without the written consent of Pace Analytical Services, LLC.
Page 21 of 36

QUALITY CONTROL DATA
Project: NC -Concord Groundwater
Pace Project No.: 50351209
MATRIX SPIKE & MATRIX SPIKE DUPLICATE: 4105873
MS
Parameter
1,2,4-Trichlorobenzene
2,2'-Oxybis(1-
chloropropane)
2,4,6-Trichlorophenol
2,4-Dichlorophenol
2,4-Dimethylphenol
2,4-Dinitrophenol
2,4-Dinitrotoluene
2,6-Dinitrotoluene
2-Chloronaphthalene
2-Chlorophenol
2-Nitrophenol
3,3'-Dichlorobenzidine
4,6-Dinitro-2-methylphenol
4-Bromophenylphenyl ether
4-Chloro-3-methylphenol
4-Chlorophenylphenyl ether
4-Nitrophenol
Acenaphthene
Acenaphthylene
Anthracene
Benzidine
Benzo(a)anthracene
Benzo(a)pyrene
Benzo(b)fluoranthene
Benzo(g, h, i)peryle ne
Benzo(k)fuoranthene
bis(2-
Chloroethoxy)methane
bis(2-Chloroethyl) ether
bis(2-Ethylhexyl)phthalate
Butylbenzylphthalate
Chrysene
Di-n-butylphthalate
Di-n-octylphthalate
Dibenz(a,h)anthracene
Diethylphthalate
Dimethylphthalate
Fluoranthene
Fluorene
Hexachloro-1, 3-butadiene
Hexachlorobenzene
Hexachlorocyclopentadiene
Hexachloroethane
Indeno(1,2,3-cd)pyrene
Isophorone
92680892004 Spike
Units Result Conc.
ug/L ND 100
ug/L ND 100
Pace Analytical Services, LLC
7726 Moller Road
Indianapolis, IN 46268
[phone]
4105874
MSD
Spike
MS
MSD
MS MSD % Rec
Max
Conc.
Result
Result
% Rec % Rec Limits
RPD RPD Qual
100
25.6
26.6
26 27 44-142
4 30 M1
100
29.3
37.6
29 38 36-166
25 30 M1
ug/L
ND
100
100
39.7
15.3J
40
15
37-144
30 M1
ug/L
ND
100
100
33.9
25.4
34
25
1-191
29
30
ug/L
ND
100
100
35.9
41.6
36
42
32-119
15
30
ug/L
ND
500
500
345
ND
69
0
1-181
30 M1
ug/L
ND
100
100
62.1
70.8
62
71
39-139
13
30
ug/L
ND
100
100
41.5
49.2
41
49
50-158
17
30 M1
ug/L
ND
100
100
31.6
36.3
32
36
60-118
14
30 M1
ug/L
ND
100
100
33.1
30.8
33
31
23-134
7
30
ug/L
ND
100
100
37.3
30.8
37
31
29-182
19
30
ug/L
ND
200
200
124
178
62
89
1-262
36
30 R1
ug/L
ND
200
200
201
ND
101
7
1-181
30
ug/L
ND
100
100
40.9
47.5
41
47
53-127
15
30 M1
ug/L
ND
200
200
68.7
80.3
34
40
22-147
16
30
ug/L
ND
100
100
32.8
39.8
33
40
25-158
19
30
ug/L
ND
500
500
212
ND
42
0
1-132
30 M1
ug/L
ND
100
100
32.5
39.1
32
39
47-145
18
30 M1
ug/L
ND
100
100
32.5
39.4
33
39
33-145
19
30
ug/L
ND
100
100
57.3
62.8
57
63
1-166
9
30
ug/L
ND
200
200
ND
ND
0
10
10-130
30 MO
ug/L
ND
100
100
92.5
105
92
105
33-143
12
30
ug/L
ND
100
100
93.4
105
93
105
17-163
12
30
ug/L
ND
100
100
95.7
110
96
110
24-159
14
30
ug/L
ND
100
100
102
122
102
122
1-219
18
30
ug/L
ND
100
100
93.1
106
93
106
11-162
13
30
ug/L
ND
100
100
32.9
39.4
33
39
33-184
18
30
ug/L
ND
100
100
32.3
44.8
32
45
12-158
33
30 R1
ug/L
ND
100
100
92.8
105
93
105
8-158
12
30
ug/L
ND
100
100
105
111
105
111
1-152
5
30
ug/L
ND
100
100
91.5
105
92
105
17-168
14
30
ug/L
ND
100
100
83.6
96.5
84
97
1-118
14
30
ug/L
ND
100
100
95.3
113
95
113
4-146
17
30
ug/L
ND
100
100
99.9
119
100
119
1-227
17
30
ug/L
ND
100
100
54.8
57.7
55
58
1-114
5
30
ug/L
ND
100
100
38.2
43.8
38
44
1-112
14
30
ug/L
ND
100
100
79.6
95.8
80
96
26-137
19
30
ug/L
ND
100
100
33.5
42.8
33
43
59-121
24
30 M1
ug/L
ND
100
100
24.4
23.9
24
24
24-116
2
30
ug/L
ND
100
100
49.1
58.0
49
58
1-152
17
30
ug/L
ND
100
100
19.2J
17AJ
19
17
25-150
30 M1
ug/L
ND
100
100
22.5
23.6
22
24
40-113
5
30 M1
ug/L
ND
100
100
98.8
118
99
118
1-171
18
30
ug/L
ND
100
100
34.9
43.0
35
43
21-196
21
30
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: 10/11 /2023 11:39 AM without the written consent of Pace Analytical Services, LLC.
Page 22 of 36

Pace Analytical Services, LLC
7726 Moller Road
Indianapolis, IN 46268
[phone]
QUALITY CONTROL DATA
Project: NC -Concord Groundwater
Pace Project No.: 50351209
MATRIX SPIKE & MATRIX SPIKE DUPLICATE:
4105873
4105874
MS
MSD
92680892004
Spike
Spike
MS
MSD
MS
MSD
% Rec
Max
Parameter
Units Result
Conc.
Conc.
Result
Result
% Rec
% Rec
Limits
RPD
RPD Qual
N-Nitroso-di-n-propylamine
ug/L
ND
100
100
36.1
45.8
36
46
1-230
24
30
N-Nitrosodimethylamine
ug/L
ND
100
100
28.4
35.4
28
35
25-150
22
30
N-Nitrosodiphenylamine
ug/L
ND
100
100
46.6
52.6
47
53
25-150
12
30
Naphthalene
ug/L
ND
100
100
28.4
31.5
28
31
21-133
10
30
Nitrobenzene
ug/L
ND
100
100
35.7
42.6
36
43
35-180
18
30
Pentachlorophenol
ug/L
ND
200
200
161
29.9
81
15
14-176
137
30 R1
Phenanthrene
ug/L
ND
100
100
61.6
63.4
62
63
54-120
3
30
Phenol
ug/L
ND
100
100
24.2
24.4
24
24
5-112
1
30
Pyrene
ug/L
ND
100
100
102
102
102
102
52-115
0
30
2,4,6-Tribromophenol (S)
%
71
39
10-137
2-Fluorobiphenyl (S)
%
38
38
15-120
2-Fluorophenol (S)
%
29
16
10-120
Nitrobenzene-d5 (S)
%
41
45
10-120
Phenol-d6 (S)
%
26
22
10-120
Terphenyl-d14 (S)
%
119
105
11-131
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: 10/11 /2023 11:39 AM without the written consent of Pace Analytical Services, LLC.
Page 23 of 36

(-� Face �,
QUALITY CONTROL DATA
Pace Analytical Services, LLC
7726 Moller Road
Indianapolis, IN 46268
[phone]
Project: NC -Concord Groundwater
Pace Project No.: 50351209
QC Batch: 792642
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: 50351209001
METHOD BLANK: 4107466
Matrix:
Water
Associated Lab Samples: 50351209001
Blank
Reporting
Parameter
Units
Result
Limit
Analyzed Qualifiers
Total Suspended Solids
mg/L
ND
2.5 08/10/23 12:14
LABORATORY CONTROL SAMPLE: 4107467
Spike
LCS
LCS % Rec
Parameter
Units
Conc.
Result
% Rec Limits Qualifiers
Total Suspended Solids
mg/L
250
236
94 90-110
SAMPLE DUPLICATE: 4107818
92681221001
Dup
Max
Parameter
Units
Result
Result
RPD RPD Qualifiers
Total Suspended Solids
mg/L
ND
ND 25
SAMPLE DUPLICATE: 4107819
92681293003
Dup
Max
Parameter
Units
Result
Result
RPD RPD Qualifiers
Total Suspended Solids
mg/L
188
230 20 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: 10/11 /2023 11:39 AM without the written consent of Pace Analytical Services, LLC. Page 24 of 36

Project: NC -Concord Groundwater
Pace Project No.: 50351209
QC Batch: 792285
QC Batch Method: SM 521 OB-2011
Associated Lab Samples: 50351209001
METHOD BLANK: 4105761
Associated Lab Samples: 50351209001
Parameter Units
BOD, 5 day mg/L
QUALITY CONTROL DATA
Analysis Method: SM 521OB-2011
Analysis Description: 5210B BOD, 5 day
Laboratory: Pace Analytical Services - Asheville
Matrix: Water
Blank Reporting
Result Limit Analyzed Qualifiers
ND 2.0 08/14/23 09:15 B3
Pace Analytical Services, LLC
7726 Moller Road
Indianapolis, IN 46268
[phone]
LABORATORY CONTROL SAMPLE: 4105763
Spike LCS LCS % Rec
Parameter Units Conc. Result % Rec Limits Qualifiers
BOD, 5 day mg/L 198 196 99 84.6-115 B3
SAMPLE DUPLICATE: 4105764
92681418001 Dup Max
Parameter Units Result Result RPD RPD Qualifiers
BOD, 5 day mg/L 437 460 5 25 B3
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: 10/11 /2023 11:39 AM without the written consent of Pace Analytical Services, LLC.
Page 25 of 36

Pace Analytical Services, LLC
7726 Moller Road
Indianapolis, IN 46268
[phone]
QUALITY CONTROL DATA
Project: NC -Concord Groundwater
Pace Project No.: 50351209
QC Batch: 793145 Analysis Method: EPA 9040C
QC Batch Method: EPA 9040C Analysis Description: 9040 pH
Laboratory: Pace Analytical Services - Asheville
Associated Lab Samples: 50351209001
SAMPLE DUPLICATE: 4110161
92682097006 Dup Max
Parameter Units Result Result RPD RPD Qualifiers
pH at 25 Degrees C Std. Units 9.5 9.5 0 10 H3
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: 10/11 /2023 11:39 AM without the written consent of Pace Analytical Services, LLC. Page 26 of 36

(1a ce°
Project: NC -Concord Groundwater
Pace Project No.: 50351209
QC Batch: 792925
QC Batch Method: EPA 350.1 Rev 2.0 1993
Associated Lab Samples: 50351209001
METHOD BLANK: 4109128
Associated Lab Samples: 50351209001
Parameter Units
Nitrogen, Ammonia mg/L
QUALITY CONTROL DATA
Analysis Method: EPA 350.1 Rev 2.0 1993
Analysis Description: 350.1 Ammonia
Laboratory: Pace Analytical Services - Asheville
Matrix: Water
Blank Reporting
Result Limit Analyzed Qualifiers
ND 0.10 08/11/2314:17
Pace Analytical Services, LLC
7726 Moller Road
Indianapolis, IN 46268
[phone]
LABORATORY CONTROL SAMPLE: 4109129
Spike LCS LCS % Rec
Parameter Units Conc. Result % Rec Limits Qualifiers
Nitrogen, Ammonia mg/L 5 5.0 99 90-110
MATRIX SPIKE & MATRIX SPIKE DUPLICATE: 4109130 4109131
MS MSD
92680667001 Spike Spike MS MSD MS MSD % Rec Max
Parameter Units Result Conc. Conc. Result Result % Rec % Rec Limits RPD RPD Qual
Nitrogen, Ammonia mg/L 1.1 5 5 6.0 6.0 98 98 90-110 0 10
MATRIX SPIKE & MATRIX SPIKE DUPLICATE: 4109132 4109133
MS MSD
92680684002 Spike Spike MS MSD MS MSD % Rec Max
Parameter Units Result Conc. Conc. Result Result % Rec % Rec Limits RPD RPD Qual
Nitrogen, Ammonia mg/L 50.8 5 5 54.9 55.1 82 86 90-110 0 10 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: 10/11 /2023 11:39 AM without the written consent of Pace Analytical Services, LLC.
Page 27 of 36

�ca
QUALITY CONTROL DATA
Pace Analytical Services, LLC
7726 Moller Road
Indianapolis, IN 46268
[phone]
Project: NC -Concord Groundwater
Pace Project No.: 50351209
QC Batch: 792315
Analysis Method:
EPA 420.4 Rev 1.0 1993
QC Batch Method: EPA 420.4 Rev 1.0 1993
Analysis Description:
420.4 Phenolics
Laboratory:
Pace Analytical Services -Asheville
Associated Lab Samples: 50351209001
METHOD BLANK: 4105826
Matrix: Water
Associated Lab Samples: 50351209001
Blank Reporting
Parameter Units
Result Limit
Analyzed Qualifiers
Phenolics, Total Recoverable mg/L
ND 0.020 08/09/23 10:57
LABORATORY CONTROL SAMPLE: 4105827
Spike LCS
LCS % Rec
Parameter Units
Conc. Result
% Rec Limits Qualifiers
Phenolics, Total Recoverable mg/L
0.05 0.053
106 90-110
MATRIX SPIKE & MATRIX SPIKE DUPLICATE: 4105828 4105829
MS MSD
92680834002
Spike Spike MS
MSD MS MSD % Rec Max
Parameter Units Result
Conc. Conc. Result
Result % Rec % Rec Limits RPD RPD Qual
Phenolics, Total mg/L 0.13
0.05 0.05 0.19
0.22 108 168 90-110 15 10 M1,R1
Recoverable
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: 10/11 /2023 11:39 AM without the written consent of Pace Analytical Services, LLC.
Page 28 of 36

Pace Analytical Services, LLC
7726 Moller Road
Indianapolis, IN 46268
[phone]
QUALITY CONTROL DATA
Project: NC -Concord Groundwater
Pace Project No.: 50351209
QC Batch: 792306 Analysis Method: SM 4500-CN-E-2011
QC Batch Method: SM 4500-CN-E-2011 Analysis Description: 450OCNE Cyanide, Total
Laboratory: Pace Analytical Services - Asheville
Associated Lab Samples: 50351209001
METHOD BLANK: 4105788 Matrix: Water
Associated Lab Samples: 50351209001
Blank Reporting
Parameter Units Result Limit Analyzed Qualifiers
Cyanide mg/L ND 0.0080 08/10/2312:02
LABORATORY CONTROL SAMPLE: 4105789
Spike LCS LCS % Rec
Parameter Units Conc. Result % Rec Limits Qualifiers
Cyanide mg/L 0.1 0.082 82 80-120
MATRIX SPIKE & MATRIX SPIKE DUPLICATE: 4105790 4105791
MS MSD
92681415001 Spike Spike MS MSD MS MSD % Rec Max
Parameter Units Result Conc. Conc. Result Result % Rec % Rec Limits RPD RPD Qual
Cyanide mg/L ND 0.1 0.1 0.097 0.082 93 78 80-120 17 10 M1,R1
MATRIX SPIKE & MATRIX SPIKE DUPLICATE: 4105792 4105793
MS MSD
92681417001 Spike Spike MS MSD MS MSD % Rec Max
Parameter Units Result Conc. Conc. Result Result % Rec % Rec Limits RPD RPD Qual
Cyanide mg/L ND 0.1 0.1 0.091 0.096 86 91 80-120 5 10
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: 10/11 /2023 11:39 AM without the written consent of Pace Analytical Services, LLC.
Page 29 of 36

Project: NC -Concord Groundwater
Pace Project No.: 50351209
QC Batch: 792687
QC Batch Method: SM 5220D-2011
Associated Lab Samples: 50351209001
METHOD BLANK: 4107635
Associated Lab Samples: 50351209001
Parameter Units
Chemical Oxygen Demand mg/L
QUALITY CONTROL DATA
Analysis Method: SM 5220D-2011
Analysis Description: 5220D COD
Laboratory: Pace Analytical Services -Asheville
Matrix: Water
Blank Reporting
Result Limit Analyzed Qualifiers
ND 25.0 08/10/2316:43
Pace Analytical Services, LLC
7726 Moller Road
Indianapolis, IN 46268
[phone]
LABORATORY CONTROL SAMPLE: 4107636
Spike LCS LCS % Rec
Parameter Units Conc. Result % Rec Limits Qualifiers
Chemical Oxygen Demand mg/L 750 766 102 90-110
MATRIX SPIKE & MATRIX SPIKE DUPLICATE: 4107637 4107638
MS MSD
92680914002 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 36.2 100 100 145 145 109 109 90-110 0 3
MATRIX SPIKE & MATRIX SPIKE DUPLICATE: 4107639 4107640
MS MSD
92681178001 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 84.9 100 100 187 187 102 102 90-110 0 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: 10/11 /2023 11:39 AM without the written consent of Pace Analytical Services, LLC.
Page 30 of 36

Pace Analytical Services, LLC
7726 Moller Road
Indianapolis, IN 46268
[phone]
QUALITY CONTROL DATA
Project: NC -Concord Groundwater
Pace Project No.: 50351209
QC Batch: 795532 Analysis Method: SM 531OB-2014
QC Batch Method: SM 531 OB-2014 Analysis Description: 5310E TOC
Laboratory: Pace Analytical Services -Asheville
Associated Lab Samples: 50351209001
METHOD BLANK: 4122182 Matrix: Water
Associated Lab Samples: 50351209001
Blank Reporting
Parameter Units Result Limit Analyzed Qualifiers
Total Organic Carbon mg/L ND 1.0 08/24/23 00:57
LABORATORY CONTROL SAMPLE: 4122183
Spike LCS LCS % Rec
Parameter Units Conc. Result % Rec Limits Qualifiers
Total Organic Carbon mg/L 25 24.0 96 90-110
MATRIX SPIKE & MATRIX SPIKE DUPLICATE: 4120115 4120116
MS MSD
92681405001 Spike Spike MS MSD MS MSD % Rec Max
Parameter Units Result Conc. Conc. Result Result % Rec % Rec Limits RPD RPD Qual
Total Organic Carbon mg/L ND 25 25 23.7 24.0 94 95 90-110 1 10
MATRIX SPIKE & MATRIX SPIKE DUPLICATE: 4122184 4122185
MS MSD
92682803003 Spike Spike MS MSD MS MSD % Rec Max
Parameter Units Result Conc. Conc. Result Result % Rec % Rec Limits RPD RPD Qual
Total Organic Carbon mg/L ND 25 25 25.0 25.0 99 99 90-110 0 10
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: 10/11 /2023 11:39 AM without the written consent of Pace Analytical Services, LLC.
Page 31 of 36

Pace Analytical Services, LLC
ace,
7726 Moller Road
{�!
/J/ a Indianapolis, IN46268
V [phone]
QUALIFIERS
Project: NC -Concord Groundwater
Pace Project No.: 50351209
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.
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
AC Analysis of acrolein and/or acrylonitrile was performed from a sample that was field preserved to pH < 2, which is less
than the pH range of 4-5 specified in the test method and required for NPDES compliance per 40CFR Part 136.
B3 The dissolved oxygen depletion of the dilution water blank exceeded 0.2 mg/L.
H3 Sample was received or analysis requested beyond the recognized method holding time.
L1 Analyte recovery in the laboratory control sample (LCS) was above QC limits. Results for this analyte in associated
samples may be biased high.
L2 Analyte recovery in the laboratory control sample (LCS) was below QC limits. Results for this analyte in associated
samples may be biased low.
MO Matrix spike recovery and/or matrix spike duplicate recovery was outside laboratory control limits.
M1 Matrix spike recovery exceeded QC limits. Batch accepted based on laboratory control sample (LCS) recovery.
P5 The EPA or method required sample preservation degrades this compound, therefore acceptable recoveries may not be
achieved in sample matrix spikes.
R1 RPD value was outside control limits.
S3 Surrogate recovery exceeded laboratory control limits. Analyte presence below reporting limits in associated sample
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
Date: 10/11 /2023 11:39 AM without the written consent of Pace Analytical Services, LLC. Page 32 of 36

Pace Analytical Services, LLC
7726 Moller Road
Indianapolis, IN 46268
[phone]
QUALITY CONTROL DATA CROSS REFERENCE TABLE
Project:
Pace Project No..
NC -Concord Groundwater
50351209
Analytical
Lab ID
Sample ID
QC Batch Method
QC Batch
Analytical Method
Batch
50351209001
Sample 1
EPA 608.3
792101
EPA 608.3
792595
50351209001
Sample 1
EPA 200.7
792369
EPA 200.7
792461
50351209001
Sample 1
EPA 245.1
795988
EPA 245.1
796016
50351209001
Sample 1
EPA 625.1
792337
EPA 625.1
792694
50351209001
Sample 1
EPA 624.1
792436
50351209001
Sample 1
SM 2540D-2015
792642
50351209001
Sample 1
SM 5210B-2011
792285
SM 5210B-2011
792304
50351209001
Sample 1
EPA 9040C
793145
50351209001
Sample 1
EPA 350.1 Rev 2.0 1993
792925
50351209001
Sample 1
EPA 420.4 Rev 1.0 1993
792315
EPA 420.4 Rev 1.0 1993
792344
50351209001
Sample 1
SM 4500-CN-E-2011
792306
SM 4500-CN-E-2011
792688
50351209001
Sample 1
SM 5220D-2011
792687
SM 5220D-2011
792816
50351209001
Sample 1
SM 5310B-2014
795532
Date: 10/11 /2023 11:39 AM
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, LLC.
Page 33 of 36

CHAIN -OF -CUSTODY / Analytical Request Document
1"�L Ce The Chain -of -Custody is a LEGAL DOCUMENT. All relevant fields must be completed ac
Submitting a sample via this chain of custody constitutes acknowledgment and acceptance of the Pace Terms and Conditions found at https://info.pacelabs.com/hubfs/pas-:
Section A Section B Section C
_. I ... ;,e I.,r—r;..
Company. E6 Lilly 8 Company
Report To. Griesemer, Brian
Attention:
Address Corporate Center
Copy To:
Company Name:
Building 147 - LTC South, Indianapolis, IN 46285
Address.
Email: riesemerbp@lilt .corn
Purchase Order #.
Pace Quote:
Phone. [phone] JFa.
Project Name: Diesel
Pace Project Manager: [e-mail],
Requested Due Date:
Project #:
Pace Profile #: 14584
tered (YI
a
?
;
o
COLLECTED
Preservatives
>
MATRIX CODE
w
U
O
Dn.W,rg W.I. OW
U
—
WaIw WT
S
m
U
Waa Watw WW
PloOucl P
-
U
O
GI
M
p
$a1's°'° 51 SAMPLE ID
0
START
END
I—
Oi OL
-^
—
a
w
N
n
One Character per box. ftP WP
w
w
z
d
--
(A-Z, 0-9 !. -) omx oT
O
a
O
o_
m
�.
Sample Ids must be unique T,,,ua TS
x
w
w
o
v
o
c
o
b
n
w
n
O
rLu n
n
O
=
O
N
t
D.
O
O
<
a
a
z
Z
O
Q
n
F
O>
H
N
DATE
TIME
DATE
TIME
7
x
=
L
O
m
U
1
2
3
4
5
7
8
9
r
IADDITIONAL COMMENTS I RELINQUISHED BY I AFFILIATION I DATE I TIME I ACCEPTED BY I AFFILIATION I DATE I
PLER NAME AND SIGNATURE
PRINT Name of SAMPLER:
SIGNATURE of SAMPLER:
DATE Signed:

0
O
a
M
3
n
0
C,
s
0
3
f
Cr
r
n
d
0
0
4 N
C d
G �
T A
0
I
A
C
a -O
A
Z
ry
A
i
0 0
f0 't3
CL
0 C
a �
ro rD
m �
r4
dr
c O
I m OCL
CL
N
N
I N
CD
'! G
3 rb
. t1
CL (A`c. f0 ry
a 2 �
a' fD
7 1A
n
3
C
d 0
a --
CL v
o
d N
A
d
m
0
a
oo i m V, Itemp
N F+ O
7zzzzz-zzzzzz-
BP41.1-125 mL Plastic Unpreserved (N/A) (CI-)
BP3U-250 mL Plastic Unpreserved (N/A)
BP2U-500 ml Plastic Unpreserved (N/A)
SP1U-1 liter Plastic Unpreserved IN/A)
BP45-125 mL Plastic H2SO4 (pH < 2) (Cl.)
BP3N-250 mL plastic HNO3 (pH < 2)
BP4Z-125 ml. Plastic ZN Acetate & NaOH (>9)
9z /1Z z z � BP46-125 ml Plastic NaOH (pH > 12) (Cl-)
WGFU-Wide-mouthed Glass jar Unpreserved
5L.' AG1U-1 liter Amber Unpreserved (N/A) (Cl-)
AGSH-1 liter Amber HCI (pH < 21
AG3U-250 ml. Amber Unpreserved (N/A) (CI-)
AGiS-1 liter Amber H2SO4 (pH < 2)
AG3S-250 ml Amber H2504 (pH c 2)
Zz Azz DG94-40 ml. Amber NH4CI (N/A)(CI-)
i,11Z777 OG9H•40 mL VOA HCI (N/A)
VG9T-40 mL VOA Na2S203 (N/A)
VG91.1-40 mL VOA Unpreserved (N/A)
OG9V•40 mL VOA H3PO4 (N/A)
KP71.1-50 rnL Plastic Unpreserved (N/A)
i I V/GK (3 vials per kit)-VPH/Gas kit (N/A)
SPST-125 mL Sterile Plastic (N/A - lab)
SP2T-250 mL Sterile Plastic (N/A - lab)
I
8P3R-2SO mL Plastic (NH2)2SO4 (9.3.9.7)
AGOU-100 ml. Amber Unpreserved (N/A) (Cl-)
VSGU-20 mL Scintillation vials (N/A)
DG9U-40 mL Amber Unpreserved vials (N/A)
0
fay
^
U
M�
m
CL
oo i m V, Itemp
N F+ O
7zzzzz-zzzzzz-
BP41.1-125 mL Plastic Unpreserved (N/A) (CI-)
BP3U-250 mL Plastic Unpreserved (N/A)
BP2U-500 ml Plastic Unpreserved (N/A)
SP1U-1 liter Plastic Unpreserved IN/A)
BP45-125 mL Plastic H2SO4 (pH < 2) (Cl.)
BP3N-250 mL plastic HNO3 (pH < 2)
BP4Z-125 ml. Plastic ZN Acetate & NaOH (>9)
9z /1Z z z � BP46-125 ml Plastic NaOH (pH > 12) (Cl-)
WGFU-Wide-mouthed Glass jar Unpreserved
5L.' AG1U-1 liter Amber Unpreserved (N/A) (Cl-)
AGSH-1 liter Amber HCI (pH < 21
AG3U-250 ml. Amber Unpreserved (N/A) (CI-)
AGiS-1 liter Amber H2SO4 (pH < 2)
AG3S-250 ml Amber H2504 (pH c 2)
Zz Azz DG94-40 ml. Amber NH4CI (N/A)(CI-)
i,11Z777 OG9H•40 mL VOA HCI (N/A)
VG9T-40 mL VOA Na2S203 (N/A)
VG91.1-40 mL VOA Unpreserved (N/A)
OG9V•40 mL VOA H3PO4 (N/A)
KP71.1-50 rnL Plastic Unpreserved (N/A)
i I V/GK (3 vials per kit)-VPH/Gas kit (N/A)
SPST-125 mL Sterile Plastic (N/A - lab)
SP2T-250 mL Sterile Plastic (N/A - lab)
I
8P3R-2SO mL Plastic (NH2)2SO4 (9.3.9.7)
AGOU-100 ml. Amber Unpreserved (N/A) (Cl-)
VSGU-20 mL Scintillation vials (N/A)
DG9U-40 mL Amber Unpreserved vials (N/A)
0
fay
^
U
M�
m
CL
0
fay
^
U
M�
m
CL

DC#_Title: ENV-FRM-HUN1-0083 v02_Sample Condition Upon Receipt
Effective Date: 11/14/2022
Laboratory receiving samples:
Asheville ❑ Eden❑ Greenwood ❑ Huntersvillep Raleigh[]Mechanicsville❑ Atlanta❑ Kernersville❑
samplTeCn_,An
Client Name:
.. � F/ / / / Project #•
L r lf` G ^, al.
Courier: []Fed Ex CUPS ❑USPS ®C lent
❑ Commercial ❑Pace ❑Other: YY
Custody Seal Present? ❑Yes 6dNo Seals Intact? []Yes 5allo � .k /��
Date/Initials Person Examining Contents: �J
Packing Material: []Bubble Wrap (Bubble Bags ❑None ❑ Other Biological Tissue Frozen?
Thermometer:
❑Yes []No $N/A
IRGun 10:� 70
Type of Ice: ('(wet ❑Blue ❑None
Correction Factor:
Cooler Temp: — Add/Subtract ('C) `) Temp should be above freezing to 6°C
❑Samples out of temp criteria. Samples on ice, cooling process
Cooler Temp Corrected (•C): —7� 3 has begun
USDA Regulated Soil ( ® N/A, water sample)
Did samples originate in a quarantine zone within the United States: CA, NY, or SC Did samples originate from a foreign source (internationally,
(check mans)? FlYes nnC No includine Hawaii and Puprto Rirnl7 nYaa 7Nn
Comments/Discrepancy:
Chain of Custody Present?
Yes
❑No
❑N/A
1.
Samples Arrived within Hold Time?
Yes
❑No
❑N/A
2.
Short Hold Time Analysis (<72 hr.)?
glYeS
ONO
❑N/A
3.
Rush Turn Around Time Requested?
[]Yes
❑No
N/A
4.
Sufficient Volume?
@Yes
❑No
❑N/A
S.
Correct Containers Used?
-Pace Containers Used?
(AYes
Jf Yes
❑No
[:]No
❑N/A
❑N/A
6.
_Containers Intact?
E4Yes
❑NO
❑N/A
7.
Dissolved analysis: Samples Field Filtered?
[]Yes
❑NO
&N_/A
8.
Sample Labels Match COC?
--includes Date/Time/ID/Analysis Matrix:
❑Yes
L✓
❑No
rmN/A
9.
Headspace in VOA Vials (>S-6mm)?
C]Yes
&No
❑N/A
10.
Trip Blank Present?
Trip Blank Custody Seals Present?
❑Yes
[:]Yes
[]No
❑No
RN/A
VIN/n
11.
COMMENTS/SAMPLE DISCREPANCY
5Lcm L /Y7L
(,) ffe-c- Jam, A, 7�- e-
T7
CLIENT NOTIFICATION/RESOLUTION
Person contacted:
Project Manager SCURF Review:
Project Manager SRF Review:
Lot ID of split containers:
Date/Time.
Date:
Date:
Field Data Required? ❑Yes ❑No
Qualtrax ID: 69614 Page 1 of 2