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NCG030303_MONITORING INFO_20160205
STORMWATER DIVISION CODING SHEET NCG PERMITS PERMIT NO. /v Cc, DOC TYPE El HISTORICAL FILE MONITORING REPORTS DOC DATE El d o 1 c9 Da 05 YYYYMMDD �rs".e Em- SE'ED A0 VCDFMR Stormwater Discharge Outfall (SDO) Qualitative Monitoring Report F F B 5 2016 For guidance on filling out thisform, please visit: htW://nortal.ncd r.org/web/wa/wsjsuLnndessw#tab-4 Permit No.: jV/��/�/_/_/ or Certificate of Coverage No.: j[/c Facility Name: County Inspector: Date of Inspection: Time of inspection: Total Event Precipitation (inches): e Q C Phone No. -- Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit? (See information below.) wyes ❑ No Please verify whether Qualitative Monitoring must be performed during a "representative storm event" or "measureable storm event" [requirements vary, depending on the permit). Qualitative monitoring requirements vary. Most permits require qualitative monitoring to be performed during a "representative storm event" or during a "measureable storm event." However, some permits do not have this requirement. Please refer to these definitions, if applicable. A "representative storm event" is a storm event that measures greater than 0.1 inches of rainfall and that is preceded by at least 72 hours (3 days) in which no storm event measuring greater than 0.1 inches has occurred. A single storm event may contain up to 10 consecutive hours of no precipitation. A'°measurable storm event" is a storm event that results in an actual discharge from the permitted site outfall. The previous measurable storm event must have been at least 72 hours prior. The 72-hour storm interval does not apply if the permittee is able to document that a shorter interval is representative for local storm events during the sampling period, and the permittee obtains approval from the local DWQ Regional Office, 6y this signature, I certify that this report is accurate and complete to the best of my knowledge: (Signature of6mittA or Designee) Paget of 2 SWU-242, bast modified 10/25/2012 1. Outfall Description: r Outfall No. SM tl Structure (pipe, ditch, etc. ] ,. Receiving Stream: U-A T Describe the industrial activities that occur within the outfalI drainage area: ter-. P !!j , -"� V-r� 2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint (light, medium, dark) as descriptors: _ 1 z S' 3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil, weak chlorine odor, etc.): 1-� t-i-L 4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is clear and S is very cloudy: 2 3 4 5 S. Floating Solids: Choose the number which best describes the amount of floating solids in the stormwater discharge, where 1 is no solids and 5 is the surface covered with floating solids: 0 2 3 4 5 6. Suspended Solids: Choose the number which best describes the amount of suspended solids in the stormwater discharge, where 1 is no solids and 5 is extremely muddy: 2 3 4 5 7. is there any foam in the stormwater discharge? Yes No 8, is there an oil sheen in the stormwater discharge? Yes 9. is there evidence of erosion or deposition at the outfall? Yes No 10. Other Obvious Indicators of Stormwater Pollution: List and describe Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition maybe indicative of pollutant exposure. These conditions warrant further Investigation. Page 2 of 2 swu-242, LaA modified 10/25/2012 Semi-annual Stormwater Discharge Monitoring Report for North Carolina Division of Water Quality General Permit No. NCG030000 Date submitted CERTIFICATE OF COVERAGE No. NCG03 b 3 O FACILITY NAME S ;))Y COUNTY PERSON COLLECTING SAMPLES (L-4aJ 52LL17 --]_ LABORATORY �r Lzn— iab Cert. # 46 Comments on sample collection or analysis: Part A: Starmwater Benchmarks and Monitoring Results SAMPLE COLLECTION YEAR acl:c;' SAMPLE PERIOD ❑ Jan -June July -Dec or ❑ Monthly"_ (month) DISCHARGING TO CLASS ❑ORW ❑HQW []Trout ❑PNA Zero -flaw [:]watersupply [:]SA Other c_2*LErr' PLEASE REMEMBER TO SIGN ON PAGES 2 AND/OR 3 4 �. �,{- ❑ No discharge this period?2 P�f� :..•• ; ::::_........E3ate .. :: O�1tfallNo :��..: •..:.,• . .... Sae? Inn°:: :. , ,.:.�::� y�•::. Callected::��:� .. .........:• •.•: mo dd r ...:.:..:: ,.24 a�yr. rainfall ....>�::,,_:_t ,.::•�•T.otaF�nf ::.: - arnount•��i-:;:�. , 1.., ,-:s, . lnehes;. :� �, .•.. .: .. �...:• ..1.. ended;S�lrrjs,.;. ; :�, �. ��:�.:�:;-� {::,:�•�: a„•-... <. p ..:. ; I., . f ;a:: •:, H {:1 .'.Standardunifs'; .I,[.:�:.Ila" :�;:: :. CO ;�:: I ea" :i _ ' ;Zinc � N� Polar O&G/ oT :Total;i?etroleum H'� drocac6ons�:::: 7nt oxtic'.' O an :,: ..L,. .��� .. :Be hmar --a ...... nc , k; . .. _ .::.::.: ..:.::: t..• .::•::::_:_,.....,:; _ - . ,::�:. .. {„:n l00 m r. m +:.• • �/•l�o . 50. �/L-. ...... frr':- fi:U-9t0 l.' 067 m .L.:. ;15 m L. T`m to r4p 1 Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall. 2 For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here. 3The total precipitation must be recorded using data from an on -site rain gauge. Unattended sites may be eligible for a waiver of the rain gauge requirement. 4 See General Permit, Table 3 identifying the especially sensitive receiving water classifications where the more protective benchmark applies. 5 Total Toxic Organics sampling is applicable only for those facilities which perform metal finishing operations, manufacture semiconductors, manufacture electronic crystals, or manufacture cathode ray tubes. For purposes of this permit the definition of Total Toxic Organics is that definition contained in the EPA Effluent Guidelines for the facility subject to the requirement to sample (for metal finishing use the definition as found in 40 CFR 433.11; for semiconductor manufacture use the definition as found in 40 CFR 469.12; for electronic crystal manufacture use the definition as found in 40 CFR 469.22; and for cathode ray tube manufacture use the definition found in 40 CFR 469.31). Permit Date:11/1/2012-10/31/2017 .SWU-245, last revised 10/25/2012 Page 1 of 3 Facilities that incorporate a solvent management plan into the Stormwater Pollution Prevention Plan may so certify, and the requirement for TTO monitoring may be waived. The solvent management plan shall include a list of the total toxic organic compounds used and the other elements listed in the General Permit. For those facilities electing to employ the TTO monitoring waiver, the discharger shall sign the following certification statement: "Based upon my inquiry of the person or persons directly responsible for managing compliance with the permit monitoring requirement for total toxic organics (TTO), I certify that to the best of my knowledge and bellef, no dumping of concentrated toxic organics into the stormwater or areas which are exposed to rainfall or stormwater runoff has occurred since filing the last discharge monitoring report. I further certify that this facility is implementing the all the provisions of the solvent management plan included in the Stormwater Pollution Prevention Plan." Name (Print na e) Title (Print title) (Signature) (Date) Note: Results must be reported in numerical format. Do not report Below Detection Limit, BDL, <PQL, Non -detect, ND, or other similar non -numerical format. When results are below the applicable limits, they must be reported in the format, "<XX mgZL", where XX is the numerical value of the detection limit, reporting limit, etc. in mg/L. Note. if you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses. See General hermit tent. Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month. ❑ No discharge this period?Z Footnotes from Part A also apply to this Part B " See General Permit text, Table 5, identifying the especially sensitive receiving water classifications where the more protective benchmark applies. Permit Date: 1i/1/2012-10/31/2017 SWU-245, last revised 10/25/2012 Page 2 of 3 Note: if you report a sample value in excess of the benchmark, you must Implement Tier I, Tier Z, or Tier 3 responses. See General Permit text. FOR PART A AND PART B MONITORINQRESULTS: • A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART 11 SECTION B. • 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART II SECTION B. • TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES ❑ NO ❑ IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO ❑ REGIONAL OFFICE CONTACT NAME: Mall an on inal and one copy ot this DAM including all "No Wschar e" reports within 30 days ot receipt of the lab results tar at end of monitoring erlod in the case of "No Discharge" reports) to: Division of Water Quality Attn: DWQ Central Files 1617 Mail Service Center Raleigh, North Carolina 27699-1617 YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED: "I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervislon in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations." (Signature of Permittee) {Date) Permit Date: 11/1/2012-10/31/2017 SWU-245, last revised 10/25/2012 Page 3 of 3 STORMWATER DISCHARGE OUTFALL (SDO) ANNUAL SUMMARY DATA MONITORING REPORT (DMR) Calendar Year 20 (S Individual NPDES Permit No. NCSJ Certificate of Coverage (COC) No. NCG or This monitoring report summary of the calendar year is due to the DWQ Regional Office no later than March a of the following year. Facility Name: _ SQ County:,, Phone Number: () Total no. of SDOs monitored Outfall No. j Is this outfall currently in Tier 2 (monitored monthly)? Yes ❑ No Ij Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ❑ No V If this outfall was in Ter 2 last year, why was monthly monitoring discontinued? Enough consecutive samples below benchmarks to decrease frequency ❑ Received approval from DWQ to reduce monitoring frequency ❑ Other ❑ Was this SDO monitored because of vehicle maintenance activities? Yes ❑ No EF ..�„� .. �..... �:1�+{..:.: �-.y ji I.X'1r -i A.. lii•„-.-5 !:.la ..5:i '::' :11h^":�nr•:?. ;...,.. _ _ __ _ cK<;_ __ ��r: r'L.- fC::l =.._ ___ -1 I,- _y ..r.u-irc7;. :'-n', i a., .>�t::ty�:].I .KH ;J: �•ti: t f�C� _i �np�r D =1, �5 �. � w� I �,:}Total„�r _�r� f : I.-k i z _ �: �k;^ �`\�[• l ff .•���r 4, },Y �, j 7--.. ,,;.� _ r; '' i^; '', �17 L�� ; � r?�,�•� ,.H. J 3 I- , I �, _` �,.� �-_ ; !_ , � _ '._ _ _ ' I -.1 f-. o_�I all•, x-I � 1� to � RI 4 ! e - I'r3�.n:,.:�:.- }f+. j',C .; i_ .I � �I I w,��� .�: [1{, :��� � - .a . k i �-.i_ n- - It.' �. 1 i -- r _ '� ..c. : x•-. x.. .�1-.•. .:I h _ 1 S y- - I ° i -S •R.� fy J 1.1 I :'`� .�-.;i 4 4.. M•, 1.. . "5 i_.:. I FL 1 . J.. _ � I i � r ;r r -:�J. 1..,. _.:� w - L f'J ti 1 ::�- :•:ft �i,i_ Benchmark- ' NIA 10o K It - t.S �IEiate �S�rtiple`� :�x_;Eol�ectecl ? mmTtldlyY�;� ; WNW MAR ism RM f r � V 5 �7 : jU r� 01 R !15 F�� l� r3q -i'; SWU-264-Generic-25May2010 Additional Ouffall Attachment Ouffall No. Is this outfall currently In Tier 2 (monitored monthly)? Yes ❑ No E] Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes 0 NoE:1 If this outfall was in Tier 2 last year, why was monthly monitoring discontinued? Enough consecutive samples below benchmarks to decrease frequency 7 Received approval from DWQ to reduce monitoring frequency F-1 Other 7 Was this SOO monitored because of vehicle maintenance activities? Yes ❑ No [:3 Ra FO C7� Sellchmiirk --NIA `Date-Sa`rriple- Collect In I All 11M SWU-264-Generic-25May20 1 0 I 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. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations." Signature Date _1-06 1,4 Mail Annual DMR Summary Reports to: DWQ Regional Office Contact Information: 2090 US Highway 70 E 225 Green Street Swannand Systel Building Suite 714 (828) : Fayetteville, NC 28301-5043 (9I0) 433-3300 3800 Ba 943 Washington Square Mall Raleigh,; Washington, NC 27889 (gig)-, (252) 946-6481 595 Waugl 1617 Mail Service Center Winston -Sale Raleigh, NC 27699-1617 (336) 7 ___ _ , ^(919 807-6300 610 East Center Avenue/Suite 301 Mooresville, NC 28115 (704) 663-1699 127 Cardinal Drive Extension Wilmington, NC 28405-2845 (910) 796-7215 S W U-264-Generic-25May2010 aceAnaJyW" e'ew.y�p0elellScarn November 05, 2015 Mr. Johnny Baines Eastern Environmental Management PO Box 4030 518 S. Pearl Street Rocky Mount, NC 27803 RE: Project: SPX 10/2015 Pace Project No.: 92273916 Dear Mr. Baines: Pee@ Analytical Services, Inc. 9800 KinceyAve. Suite 108 HuntervAle, NC 28078 (704)875.9092 Enclosed are the analytical results for sample(s) received by the laboratory on October 29, 2015. The results relate only to the samples included in this report. Results reported herein conform to the most current TNI standards and the laboratory's Quality Assurance Manual, where applicable, unless otherwise noted in the body of the report. Analyses were performed at the Pace Analytical Services location indicated on the sample analyte page for analysis unless otherwise footnoted. If you have arty questions concerning this report, please feel free to contact me. Sincerely, Taylor Ezell taylor. ezell@pa celabs.com Project Manager Enclosures cc: his. Cathy Baines, Eastem Environmental Management REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, without the written consent of Pace Analytical Services, Inc., Page 1 of 13 aceAnalytiral` rnOw.paodapacwm Pace Analytical Services, Inc. 9800 Kinney Ave. 5ulte 100 Huntarsvltle, NC 26078 (704)875-0092 CERTIFICATIONS Project; SPX 1012015 Pace Project No.: 92273016 Charlotte Certification IDS 98W Kinwy Ave. Ste TO, Huntersvllie, NC 28078 Florida/NELAP Certification #: E87627 North Carolina Drinking Water CertiSicadon #. 37706 Kentucky UST Certification #: 84 North Carolina Field Sorvioes Certification #: 5342 West Virginia Certiflcation P 357 North Carolina Wastewater Certification #: 12 V1rgln1aNELAP CerSftcstion #: 460221 South Carolina Certification #. 99006W1 Asheville Certification IDS 2225 Riverside Drive, Asheville, NC 28804 North Carolina Wastewater Certlftcation #: 40 FlorddalNELAP CerlNlc ition #: E87648 South Carollna Certification #: 99030001 Massachusetts Certification A M-NCO30 West Virginia Certification #: 356 North Carolina Drinking Water Certification #: 37712 Vfrginie/VELAP Certificatron M 460222 REPORT OF LABORATORY ANALYSIS This report shall not be rerxoduced, except in full, wlthcut the written consent or Pace Analytical Services. Inc.. Page 2 of 13 aceAnalytrtl" -*?wm SAMPLE ANALYTE COUNT Paco AnaVlcal Servilm, Inc, 9800 KlnceyAve. Suite 100 HunterevlU9, NC 28076 (704)876-9092 Project: SPX 1012015 Pace Project No.: 92273916 Analytts Lab 10 Sample ID Method Analysts Reported Laboratory 92273916001 600-1 EPA 16648 JMS 1 PASI-C EPA8082 SWB 8 PASI-C SM 2540D SAM 1 PASI-A EPA 351.2 SER 1 PASI-A EPA 353.2 DMN 3 PASI-A REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except In full, without the written consent of Pace Analytical Services, Inc.. Page 3 of 13 aceAnaly ical r eraw.paad�,cpro I ANALYTICAL RESULTS Project: SPX 1012015 Pace Project No.: 92273916 Pace Analytical Services, Inc. 2800 hIncey Ave. Suite 100 Huntaisvills, NC 28078 (7D4)876-DN2 Sample: SIJO-1 Lab ID: 02273010001 Collected: 10/28/15 15:30 Received: 10/29/15 00:45 Matrix: Water Parameters Results Units Report Limit DF Prepared Analyzed CAS No. Qual HEM, 0II and Grease Analytical Method: EPA 16648 Oil and Grease ND mg/L 5.0 1 1110511510:39 $082 GCS PCB Analytical Method: EPA 8082 Preparation Method: EPA 3610 PCH-1016 (Aroclor 1016) ND ug/L 0.50 1 10/30/15 09:30 10/30/15 19:06 12674-11-2 PCB-1221 (Arocior 1221) ND ug/L 0.50 1 10130/1509:30 1M0115 19:06 11104-28-2 PCB-1232 (Aroctor 1232) ND u911- 0.50 1 10/30/15 09:30 10130/15 19:00 11141-1" PCB-1242 (Arodor 1242) ND ug/L 0.60 1 10130/15 09:30 10/30/15 19:06 53469-21-0 PCB-1248 (Aroclor 1248) ND ug/L 0.50 1 10/30/15 09:30 10/30/15 10:06 12672-29-8 ' PCB-1254 (Arodor 1254) ND ug/L 0.50 1 10/30/15 09:30 10/30/15 19:06 11097�9-1 PC13-1260 (Aroclor 1280) ND ug/L 0.50 1 10V30/15 09:30 10/30/15 10:06 11098-82-5 Surrogates Decachioroblphenyt (S) 35 % 10-132 1 10/30/15 09:30 10/30/15 19:06 2051 24-3 25400 Total Suspended Solids Analytical Method: SM 2540D Total Suspended Solids ND mg/L 5.0 1 11/01/15 16:12 351-2 Total KjeldahI Nitrogen Analytical Method: EPA 351.2 Nitrogen, Kjeldahl, Total ND mglL 0.50 1 11/03/15 03:10 7727-37-9 3632 Nitrogen, N021NO3 unpres Analytical Method: EPA 353.2 Nitrogen, Nitrate 0.15 M91L 0.020 1 10/30/15 10:39 Nitrogen, Nitrite ND mg/L 0.020 1 10/3011610:39 Nitrogen, NO2 plus NO3 0.15 mg/L 0.020 1 1MOM 510:39 REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except In full, Date: 11/05/2015 05:32 PM without ft written consent of Pace Analytical Services, Inc.. Page 4of13 aceAnalytical' wrrtpocebw Lsm QUALITY CONTROL DATA Project: SPX 10Q015 Pace Project No.: 92273916 QC Batch: GCSVI23118 Analysts Method: EPA 1864E QC Batch Method: EPA 1664D Analysts Description: 1664 HEM, Oil and Grease Associated Lab Samples: =73916001 METHOD BLANK: 1599395 Mattlic Water Associated Lab Samples: 92273916001 Blank Reporting Parameter Units Result unlit Analyzed Qualifiers Oil and Grease mg1L ND 5.0 11105115 10:35 Pace Analytfoal Services, Inc. 9600 KlnceyAm Suits 100 Huntersvilla, NC 28078 (7D4)67$-8082 LABORATORY CONTROL SAMPLE & LCSD: 1599396 1699307 Spike LCS LCSD LCS LCSD % Rec Max Parameter Units Cona Result Result % Rec % Rec Umlts RPD RPD Qualiters OR and Grease mg/L 40 35.4 35.3 88 88 78-114 0 30 Results PnaerAed on less Pape are In the units Indicated 6y the'Units' column mcrapt Where an altefnate unit In presented to the right of the reeuh. REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except In full, Date: 11105l2015 05:32 PM wfthout the written consent of Pace AnaVual Services, Inc.. Page 5 of 13 aceArtalAeal ax'w�ecetabf.�pm QUALITY CONTROL DATA Project SPX 1WO% Pace Project No.: 92273916 QC Batch: OEXT138710 Analysis Method: EPA 8082 QC Hatch Method: EPA 3510 Analysis Description: 8062 GCS PCB Associated Lab Samples: 92273916001 METHOD BLANK:. 1594382 Matrix Water Associated Lab Samples: 92273916001 Parameter Units Blank Result Reporting Limit Analyzed Qualifiers PCB-1016 (Arodor 1016) ug/L ND 0.50 10129/15 22:07 PCB-1221 (Aroclor 1221) ug/L ND 0.60 IM9115 22:07 PC13-1232 (Aroclor 1232) uglL ND 0.50 10129/15 22:07 PCB-1242 (Aroclor 1242) ug/L ND 0.60 10/29/15 22:07 PCB-1248 (Arodor 1248) ug1L NO 0.50 10/29/15 22:07 PCB-1254 (Aroclor 1254) uglL ND 0.50 10/29/15 22:07 PCB-1260 (Aroclor 1260) u91L ND 0.50 10/29/15 22:07 Decachlorobiphenyl (S) % 83 10-132 10/29/16 22:07 Paco Analytical Services, Inc. 9800 MnceyAve. Suite 100 Huntorsvlllo, NC 28078 (7C4)875-9092 LABORATORY CONTROL SAMPLE & LCSD: 1594383 1594384 Spike LCS LCSD LCS LCSD % Rec Max Parameter Units Cone. Result Result % Rae % Rec Llmits RPD RPD Qualifiers PCB-1016 (Arodor 1016) uglL 5 4.2 4.3 83 85 50-1 W 2 30 PCB-1260 (Arodor 1260) ug1L 5 4.4 4.4 87 87 50-150 0 30 Decachlorobiphenyl (S) % 82 83 10-132 Results presertad on thia page us in the units IrWicated by the ^Unlls' column except when en sttemate unit Is presented to the right of the resut4 REPORT OF LABORATORY ANALYSIS Thla report shag not be reproduced, except In full, Date: 119W2015 05:32 PM without the written consent of Pace Anotyumi Services, Inc.. Page 6 of 13 IeAnaOcal m�a:pecelthtma QUALITY CONTROL DATA Project SPX 1(Y2015 Pace Project No.: 92273910 QC Batdt WET141157 Analysis Method: SM 25400 QC Be" Method: SM 2540D Anstyals Description: 2540D Total Suspended Solids Associated Lab Samples: 92273916W1 METHOD BLANK: 1596407 Matrix: Water Assodated Lab Samples: 92273916001 Blank Reporting Parameter Units Result Umlt Analyzed Qualifiers Total Suspended Solids mglL ND 2.5 11/01/15 15:06 Pace Analytical Ssrvicee, Inc. 9800 KlnceyAva. Butts 100 Huntefaviila, NC 28078 (704}8764092 LABORATORY CONTROL SAMPLE: 1596408 Spike LCS LCS 96 Roc Parameter Units Conc. Result % Rec Limits Qualifiers Total Suspended Solids RKVL 250 240 96 90-110 SAMPLE DUPLICATE 1596409 92274207001 Dup Parameter Units Result Result RPD Qualifiers Total Suspended Solids mg/L 173 179 3 SAMPLE DUPLICATE: 1596410 92273916001 Dup Parameter Units Result Result RPD Qualifiers Total Suspended Solids mgA- ND ND Results preserded on this paps are in the units Indicated by the "Unite' column a captwhme an alternate unit Is presented to the right at the result. REPORT OF LABORATORY ANALYSIS This report shall not be repmnduced, except In Tull, Date: 11105/2015 05:32 PM wipwut the wrliten consent or Paca Analytical SaMcm, Inc.. Page 7 of 13 I OA17alytical wwnpecatabs.Cam QUALITY CONTROL DATA Project SPX 1012015 Pace Project No.: 92273916 Pace Analytical Services, Inc. 98WKlnceyAve. SLd91D0 Huntersvlpe, NC 28076 (7041875.9092 QC Batch: WETA125207 Analysis Method: EPA 351,2 QC Batch Method. EPA 3512 Analysts Description: 351.2 TKN Associated Lab Samples: 92273016001 METHOD BLANK, 1596242 Mairbl: Water Associated Lab Samples: M73916001 Blank Reporting Parameter Units Result Limit Analyzed Qualifiers Nitrogen, Kjeldshl, Total mg1L NO 0.50 11/03116 02:52 LABORATORY CONTROL SAMPLE: 1598243 Spike LCS LCS % Rec Parameter Units Conc, Result _ % Rec Limits Qualifiers Nitrogen, Kjeldahl, Total rrtg(L 10 10 1100 90-110 MATRIX SPIKE 8r MATRIX SPIKE DUPLICATE: 1596244 1596245 MS MSD 92274056001 Spike Spike MS MSD MS MSD % Rec Parameter Units Result Conc. Conc, Result Result % Rec % Rec Limits RPD Qual Nitrogen, Kjakfahl, Total mg(L 0.94 10 10 11.3 10.8 104 99 W110 4 MATRIX SPIKE & MATRIX SPIKE DUPLICATE: 1596246 1596247 MS MSD 92273502001 Spike Spike MS MSD MS MSD % Rec Parameter Units Result Conc. Conc. Result Result % Rec % Rec Limits RPD Qua] Nitrogen, Kjaldahi, Total Mg1L 6.9 10 10 10.7 16.1 39 92 90-110 40 M1,R1 Results preeented on this page are rn the unlis indicated bythe"llnlW' Column except where an altemato unit is pres©ntod to the right of the ren tL REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except In full, Data: 11/0512015 05:32 PM without the written consent of Pace Analytical Services, Inc.. Page 8 of 13 acaAnalylical "Upimliftoxi QUALITY CONTROL DATA Project SPX 1=015 Pace Project No.: OM73916 QC Batch: WETA125196 Analysis Method: EPA 353.2 QC Batch Method: EPA 353.2 Analysis Description: 353.2 Nitrate + Nitrite, Unpres. Associated Lab Samples: 92273916001 METHOD BLANK: ' 1696416 Associated Lab Samples: 92273916001 Parameter Units Nitrogen. Nitrate mg1L Nitrogen. Nltriba mg1L Nitrogen, NO2 plus NO3 mg1L Matrix Water Blank Reporting Resi It Limit Analyzed Qualifiers ND 0.020 1013011510:36 ND 0.020 10/30/1510:36 ND 0.020 10/30/1510:36 Pace Analytical Services, Inc. 9000 KlnceyAve. Suits 100 Huntersvllle, NC 29070 (704)075.9092 LABORATORY CONTROL SAMPLE: 1595416 Spike LCS LCS % Rec Parameter Units Cone. Result % Rec Limits Qualifiers Nitrogen. Nitrate mglL 2.5 2.4 96 90-110 Nitrogen, Nitrite mg1L 1 0.97 97 90-110 Nitrogen, NO2 plus NO3 mglL 2.5 2.4 96 90-110 MATRIX SPIKE & MATRIX SPIKE DUPLICATE: 1595417 1595418 MS MSD 92273916001 Spike Spike M5 MSD MS MSD % Rae Parameter Units Result Cane. Cone. Result Result % Rec % Rec limits RPD Qual Nitrogen. Nitrate mg1L 0.15 2.5 2.5 2.6 2.6 96 913 90-110 0 Nitrogen, Nitrite mg1L ND 1 1 1.1 1.1 104 104 90-110 0 Nitrogen, NO2 plus NO3 m91L 0.15 2.5 2.5 2.6 2.6 96 w 90-110 0 Reavlb presented on this page era In the unite Indicated by the'UnIW column axvW where en attemste unit [a presented to the right of the recall REPORT Of LABORATORY ANALYSIS This report shell not be reproduced, exoept In full, Date: 11105WS 05:32 PM without tho written consent of Pace Analytical Services, Inc.. Page 9 of 13 aceAna1j&a1 wvw.yxsfaGs.atlm QUALIFIERS Project SPX 1012016 Pace Project No.: 92273916 DEFINITIONS OF - Dilution Factor, If reported, represents the factor applied to the reported data due to dilution of the sample aliquoL NO - Not Detected at or above adjusted reporting limit. J - Estimated ooncentratlon above the adjusted method detection limit and below the adjusted reporting limit MDL -Adjusted Method Detection Limit. PQL - Practical Quantitation Limit. RL- Reporting Limit Paco Analytical Services, Inc. 8800 IQnceyyAve. Suite 100 Huntersville, NC 28078 (704)875-9092 S - Surrogate 1,2-DWheny1hydrazlne decomposes to and cannot be separated from Azabenzene using Method B270. 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 - Glean -Up U - Indicates the compound was analyzed for, but not detected. Add preservation may not be appropriate for 2 Chloroothytvinyl ether, Styrene, and Vinyl chloride. A separate vial preserved to a pH of 4-5 is recommended in SW846 Chapter 4 for the analysis of Acrolein and Acrylonitrlle by EPA Method 8260. N-Nitrosodiphenylam[ne decomposes and cannot be separated from Diphenylamine using Method 8270. The result raported for each anatyle is a oombined concentration. Pace Analytical is TNI accredited. Contact your Pace Pint for the current fist of accredited analytes. TNI - The NELAC institute. LABORATORIES PASI-A Pace Analytical Services -Asheville PAST-C Pace Analytical Services - Charlotte ANALYTE QUALIFIERS M1 Matrix spike recovery exceeded OC limits. hatch accepted based on laboratory control sample (LCS) recovery. R1 RPD value was outside control limits. REPORT OF LABORATORY ANALYSIS This report shall not he reproduced, except In full, Date: 1110512015 06:32 PM without the written consent of Paoe Analytical Servlcas, Inc.. Page 10 of 13 aCeAnalyiical e wax'-0eaanr QUALITY CONTROL DATA CROSS REFERENCE TABLE Project SPX 1Moll 5 Pace Project No.: 92273916 Pace Analytical Sarvtces, Inc. 9800 Klnoey Ave. Suilo 100 Hurteravllle. NC 28078 (704)87&9092 Analytical Lab ID Sample ID QC Batch Method QC Batch Analytical Method Batch 92273916001 8130.1 EPA 18048 GCSVI23118 92273916001 SDO-1 EPA3510 OEXT138710 EPA8082 GCSV123060 92.273916001 SDO.1 SM 2540D WET141157 92273916001 S130-1 EPA351.2 WETA125207 ' 92273916001 S1130-1 EPA353.2 WETA/25196 Date: 11105W15 05:32 PM REPORT OF LABORATORY ANALYSIS This report shall not be reproduood. excopt In full. vdthout the wrtnn consent of Pace AnaMlcat Sery ms. Inc.. Page 11 of 13 . ;a'CLI AfMIXIC81 * locument Name: Sam le Condition Upon Recoil Document Number. F-CHR-CS-003-rev.96 LjvwulJMIL ncrweu. May IV, AV I Palae 1 of 2" Pace Huntersvllle Q Client Name: • rage 2 of 2 Is for Internal Use Oniy Courier: ❑ Fed UP❑ USP[j Cller❑ CommerdC Pace Other t l' tlotlaro-� Custody Seal on Cooler/13ox Praaant: ❑ yes. no Seals intact: ❑ yes [f no r� i. + Z ;.v: Packing Material: ❑Bubble Wrap Bubble Ban None ❑ Oilier Thermometer Used:1R Gun T1A0 Type of Ice: W�t�t31ue None oilSamples on Ice, cooling process has begun Temo Correction Factor T1402 No Correction r , Corrected Cooler Temp.:__,... `I ,�- ,_,_'C Tamp should be above freezing to ti'C Biological Tissue is Frozen: Yea No to Comments: Date and Initia arson a mining contents Chain of Custody Present: DY C1No ON/A 1. .Chain of Custody Filled Out ee ONO OWA 2. Chalri of Custody Relinquished: os ©No DWA 3. . Sa ler Name & Sipnituia on COC: as ON, ❑NIA 4. Sani as Arrived within Hold Time, Yes ONo ONIA 5. Short Hold Time Analysis <72hr : OYes Na . ONIA 6. Rush Turn Around Time Requested-, ❑Y No ONIA 7. Sufficient Volume: Ye ONO ❑NIA 8. Correct Containers Used: -Pow Containers Used: ONO Yes ❑Nb ONIA ❑NIA 9. Containers Intacx es ONo ❑ t0A 10. Filtered volume received for Dissolved tests DY - C]No N!A 11 Sample Labels match COG: -Includes dateAlmellDlAnal sis Matrix: Yes CINo OWA 12. Aff containers needing preservation have been checked. All coMalners needing preservation are found to be In compliance with EPA recommendatlon. amapli=: VOA, wftr l,T0C,0&G,1M-OROtwaterl Ye ❑No Yes ONo Yes ❑No OWA C]NIA 13. Sainpies checked for dechlodnation: es ONO ❑wA 14, Headspace In VOA Vials >Bmm : ❑Yes' X0 ONIA 15, Trip Blank Present: I Trip Blank Custody Seals Present Pace Trio Blank Lot # rf purchased): OYes ONO OYes ONo I _❑4 t�uA 16. Client Notification/ Readiution: Field Oata Required? Y ! N Person Contacted: Datefilme: Comments/ Resolution: SCURF Review: Date: SRF Review; Date; j Z Note: Whenever there is a discrepancy affecting Nodh Caro ins compliance samples, a copy of this fort will besent to the North Carolina DEHNf1 Certification Office ( Le out of.hold, lnc mrt preservative, out of temp, htcorrect containers) WO#:92273936. M���ilmiimwgi Page 12 of 13 PaceAnalj cal vwr cmdafe.emr CHAIN -OF -CUSTODY I Analytical Request Document The Cnairt-or-Cuslody Ip a �EGALDOCUMENT. All relevant rwAds must La completed -= raNly. Section A Section $ -' Section C Pam■: I or 1 Or R■quir" CW4 kder'n■rfen: Ravalrcd P- Lnrarmau*): Hwnlca Inrormr ! amnarrr RaponTo: - - - - - Attwl=: . /# c# 0. r 1"99S&S CapyTa 9 YIVame, REGUkL T�RYAGEf�CY L� L -�C' Ad*m= 7` - Nr QES F GROUNDWATER i ' DPJNiQNG WATER r' UST RCRA - 4TIIER E Pumhaso.OrdcrNo_ PrKx�em fmlurot s-, :n t pralcd Name: �` �Mc argon 8 Ae Lneatfari 7 C uv��11 iCl3 7 C Ba rL 'srarr- lF . , /� RaquestcA6uaDatdTAT: PlipiaCtNun�Daf. pro PaceRsrtop: �G .:.i+ Requested Analysis Fkllet'Cd (YIN) .. . SgcrianO .dlatrix Cadra a 'preservatives .x }} Rc" x1Vrcnl M,agslaawl t�7RCl / GQOCOLLECTED`y COLLECTED i ari*wg Naret OW WT y Mier LS C06C.05M COMP=TE Wastowaw Wm Produot P l� SAMPLE ID �satisose � {A•Z. 0-9 t : Y Air AR M Sa pW Ms MUST 8E U4UE TWS T - o O w _ a c aher or U r 1 ta U a L) W 0 u y p O L C y I- DATE nut O,+TE TO& Z) .L S S 2 Z X- 0 Pace ProjectNo.! Lab I.D. 1 3 Oct. 2 ✓ 3 IV a 5 6 7 6 8 � 14 11 12 ADDmCNALCOr MEWS RELINQUMM5YJAFFU_JAn0N DATE. TIME ACC6PTm8YrAFnuA-MN ' DATE 'Tama, SAAWLECOWMONS SA4KPLEi2 NAME RND SIGNATURE u o �i�ii7ii�.�r� fir }•ap V e i ' PRINT Nana *1$AIAPLLR: SIGNATURE of SAXPLER: EL .--Pwu a Halo. 8y *W-9 t a k-M Yea — aoaPGro P—% NBT-W dayP1Y+7rn kr= am .9ftooD b kqg dww 01 1-M Darsn"I r 1�64'mew Yer pry GE6 30 6ryi - - F-ALL-Q-0Mmv.07. 15.1' Fulcher, Craig From: Cathy Baines <CBaines@eastern-environmental.com> Sent: Tuesday, January 26, 2016 2:57 PM To: Fulcher, Craig Subject: FW: Scanned image from MX-620ON Attachments: nreply@eastern-environmental.com_20160126_164159.pdf (ATTENTION: This email was received from an external source. Please use caution when opening attachments and/or responding to this message.) -----Original Message----- From: nre 1 eastern-environmental.com [nreply(i4eastern-environmental.com] On Behalf Of nreply@ Sent. Tuesday, January 26, 2016 4:42 PM To: Cathy Baines Subject: Scanned image from MX-620ON Reply to: nreply a,eastern-environmental.com <nre 1 eastern-environmental.com> Device Name: Eastern Environmental Management Device Model: MX-620ON Location: Y9314 Rocky Mount, N.C. File Format: PDF MMR(G4) Resolution: 200dpi x 200dpi Attached file is scanned image in PDF format. Use Acrobat(R)Reader4.0 or later version, or Adobe(R)ReaderTM of Adobe Systems Incorporated to view the document. Acrobat(R)Reader4.0 or later version, or Adobe(R)ReaderTM can be downloaded from the following URL: Adobe, the Adobe logo, Acrobat, the Adobe PDF logo, and Reader are registered trademarks or trademarks of Adobe Systems Incorporated in the United States and other countries. http://www.adobe.com/ • Semi-annual Stormwater Discharge Monitoring Report for North Carolina Division of Water Quality General Permit No. NCG030636 Date submitted 11117/2015 CERTIFICATE OF COVERAGE NO. NCG@3O363—fb C (-o30 _?1z.3 FACILITY NAME ITW Warehouse Automation COUNTY Buncombe PERSON COLLECTING SAMPLES Jose Gomez LABORATORY ESC Lab Cert. # L797142 Comments on sample collection or analysis: Total rainfall event 1.0V Part A: Stormwater Benchmarks and Monitoring Results SAMPLE COLLECTION YEAR 2015 SAMPLE PERIOD ❑ Jan -June ® July -Dec or ❑ Monthly' (month) DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA [_]zero -flow []Water Supply ❑SA ®Other SDO PLEASE REMEMBER TO SIGN ON PAGES 2 AND/OR 3 4 ❑ No discharge this period?' Outfall No. Date Sample Collected l (mo/dd/yr) 24-hour rainfall amount, Inches3 Suspended Solids Standard units ard Copper Lead Zinc Non -Polar O&G/ Total Petroleum Hydrocarbons Total Toxic OrganicsTotal Benchmarks =_=> _ - 100 mg/L or 50 mg1V 6.0 — 9.0 0.007 mg/L 0.03 mg/L 0.067 mg/L 15 mg/L 1 mg/L 002 10/27/2015 1.00 2.94 7.73 BDL-0.010 BDL-0.005 0.131 BDL-5.7 1 Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall. 2 For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here. 3The total precipitation must be recorded using data from an on -site rain gauge. unattended sites maybe eligible for a waiver of the rain gauge requirement. a See General Permit, Table 3 identifying the especially sensitive receiving water classifications where the more protective benchmark applies. 5 Total Toxic Organics sampling is applicable only for those facilities which perform metal finishing operations, manufacture semiconductors, manufacture electronic crystals, or manufacture cathode ray tubes. For purposes of this permit the definition of Total Toxic Organics is that definition contained in the EPA Effluent Guidelines for the facility subject to the requirement to sample (for metal finishing use the definition as found in 40 CFR 433.11; for semiconductor manufacture use the definition as found in 40 CFR 469.12; for electronic crystal manufacture use the definition as found in 40 CFR 469.22; and for cathode ray tube manufacture use the definition found in 40 CFR 469.31). Permit Date: 11/1/2012-10/31/2017 SWU-245, last revised 10/25/2012 Page 1 of 3 h. - - - - - .� _ _ ��� , _.� r , .• . J. i _ .��r Facilities that incorporate a solvent management plan into the Stormwater Pollution Prevention Plan may so certify, and the requirement for TTO monitoring may waived. The solvent management plan shall include a list of the total toxic organic compounds used and the other elements listed in the General Permit. For those facilities electing to employ the TTO monitoring waiver, the discharger shall sign the following certification statement: "Based upon my inquiry of the person or persons directly responsible for managing compliance with the permit monitoring requirement for total toxic organics (TTO), I certify that to the best of my knowledge and belief, no dumping of concentrated toxic organics Into the stormwater or areas which are exposed to rainfall or stormwater runoff has occurred since filing the last discharge monitoring report. I further certify that this facility is implementing the all the provisions of the solvent management plan included in the Stormwater Pollution Prevention Plan." Chris Bland Name (Print name) Plant Manager Title (Print title) / /�L (Signature) //// 7,� Date Note: Results must be reported in numerical format. Do not report Below Detection Limit, BDL, <PQL, Non -detect, ND, or other similar non -numerical format. When results are below the applicable limits, they must be reported in the format, "<XX rng/.L", where XX is the numerical value of the detection limit, reporting limit, etc. in mg/L. Note. if you report a sample value in excess of the benchmark, you must implement Tier 1, fer 2, or Tier 3 responses. See General Permit text. Part 8: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month. ❑ No discharge this period?' Outfall No. Date Sample Collected' (mo/dd/yr) Z4-hour rainfall amount, Inches3 Non -polar O&G/TPH by EPA 1664 (SGT-HEM) Total Suspended Solids pH Benchmarks =__> _ - 15 mg/L 100 mg/L or 50 mg/L* 6.0 — 9.0 SU footnotes from Part A also apply to this Part 8 * See General Permit text, Table 5, identifying the especially sensitive receiving water classifications where the more protective benchmark applies. Permit Date: 11/1/2012-10/31/2017 SWU-245, last revised 10/25/2012 Page 2 of 3 Note: If you report a sample value in excess of the benchmark, you must implement rer 1, rer 2, or Tier 3 responses. See General Permit text. FOR PART A AND PART B MONITORING RESULTS: • A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART It SECTION B. • 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART II SECTION B. • TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDANCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES ❑ NO ED IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO ❑ REGIONAL OFFICE CONTACT NAME: Mail an oriainal and one cape of this DMR, including all "No Discharge" reports, within 30 days of receipt of the lab results for at end of monitoring period in the case of "No Discharge" reportsl ta: Division of Water Quality Attn: DWQ Central Files 1617 Mail Service Center Raleigh, North Carolina 27699-1617 YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED: "I 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. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations." (Signature of Permittee) 11,117,1 S [Oat Permit Date: 11/1/2012-10/31/2017 SWU-245, last revised 10/25/2012 Page 3 of 3 WW74Rf N0USf AUTOMATION November 17, 2015 Central Niles Division of Water Quality 1617 Mail Service Center Raleigh, NC 27699-1617 RE: ITW Warehouse Automation Semi-annual discharge monitoring reports (DMR) Monitoring period Year 3-Period 2 To Whom it May Concern, )RECEIVED NOV 302015 CENTRAL FILES °wR SECTION The ITW Warehouse Automation ("ITW") facility located in Arden, North Carolina is submitting the following information to the Division of Water Quality ("Division") in regards to the facility general industrial permit NCG030636. Please note, ITW was formerly named Vertique, Inc. The current monitoring period is recognized,as July 1, 2015 through December 31, 2015. The sample analysis attached was collected from outfall 002. The results were reported within 30 days of the date of collection. In 2015, facility personnel are scheduled to be trained to the SPPP and best management practices. Also, specific personnel were identified to properly collect samples and report out as needed. Attached is the discharge monitoring report required for monitoring period year 3-period 2. The sampling requirements per Section D of the General Permit are below: a. October 27, 2015/ITW location outfai1002/10:30 am b. Jose Gomez/Paint Booth Operator c. November 17, 2015 d. Environmental Science Corporation (ESC) e. See attached analysis f. See attached analysis The benchmark level for zinc has been exceeded this monitoring period. This is the first exceedance reported from the facility. ITW will review the facility perimeters to verify possible sources of zinc and provide corrective actions where applicable. Appalachian Environmental Resources, Inc. has been contracted to handle the water quality program at the facility. The Stormwater Pollution Prevention Plan (SPPP) has been developed and all information pertaining to the NPDES permit for Metal Fabrication has been completed. WWARfHOUSf UiOMAiION If you have any questions or require additional information in regards to this submittal, please contact me at (828)-654-7500 or Michael Fox at (423)-956-2900. I 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. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations Sincerely, Chris Bland Plant Manager ITW Warehouse Automation Cc: File copy Attachments at. 1_..=_'F"..-r;.�.<E.- L'" �BKS��N6R1_.tE.l,°Flit.G."IFC:n•a""I.w�a89.fn',uu,-.e8[_: . I BAJA �wESQ I ANALYTICAL REPORT myESC November 05, 2015 Appalachian Environmental Resources Sample Delivery Group: L797142 Samples Received: 10/28/2015 Project Number: Description: Stormwater (vertique) Report To: Mike Fox 395 Steel St. Johnson City, TN 37601 Entire Report Reviewed By: 4V�� Linda Cashman Technical Service Representative Results relate only to the items tested or calibrated and are reported as rounded values. This test report shall not be reproduced, except in full, without written approval of the laboratory. Where applkable, sampling conducted by ESC is performeC per guidance provided in laboratory standard operating procedures: 060302, 060303, and 060304, TABLE OF CONTENTS ONE LAB. NATIONWIDE. 'Cp: Cover Page 2Tc: Table of Contents 3Ss: Sample Summary 4Cn: Case Narrative 5Sr: Sample Results STORMWATER OUTFALL 001 L797142-01 r'Qc: Quality Control Summary Gravimetric Analysis by Method 2540 D-2011 Wet Chemistry by Method 1664A Wet Chemistry by Method 4500H+ B-2011 Metals (ICP) by Method 200.7 7GI: Glossary of Terms $AI: Accreditations & Locations 9Sc: Chain of Custody 1 2 3 4 5 5 6 6 7 9 10 11 12 ACCOUNT: PROJECT: SDG: Appalachian Environmental Resources L797142 DATEMME: 11/0511517:48 PAGE: 2of12 SAMPLE SUMMARY Collected by STORMWATER OUTFALL 001 L797142-01 WW Mike Fox Method Batch Dilution Preparation dateltime Gravimetric Analysis by Method 2540 D-2011 WG825718 1 111020510:19 Metals (1CP) by Method 200.7 WG825728 1 101307i5 20:21 Wet Chemistry by Method 1664A WG925348 1 10011512:56 Wet Chemistry by Method 4500H� B-2011 WG825397 1 1013011510:00 ONE LAB. NATIONWIDE. Caiiecled dateltime Received dateltime 10127A510:30 10/28/15 09:00 r C p Analysis Analysis Analyst dateltime �z Tc 11103/1510:09 JER 1110111516: WBD 1012911516:56 JM 10130/1510:00 SJM r FSf 6 QC 7Gf 6AI FSC ACCOUNT: PROJECT: SDG: DATE/TIME PAGE: Appalachian Environmental Resources L797142 11/05/1517:48 3 of 12 CASE NARRATIVE ONE LAB. NATIONWIDE. �Cp All MDL (LOD) and RDL (LOQ) values reported for environmental samples have been corrected for the dilution factor used in the analysis. All Method and Batch Quality Control are within established criteria except where addressed in this case narrative, a non-conformance form or properly qualified within the 2TC sample results. By my digital signature below, I affirm to the best of my knowledge, all problems/anomalies observed by the laboratory as having the potential to affect the quality of the data ❑ have been identified by the laboratory, and no information or data have been knowingly withheld that 3S5 would affect the quality of the data. s Sr FQ Linda Cashman Technical Service Representative FAI Sample Handling and Receiving C Sample quantity was not sufficient to complete analysis per recommended method guidelines for the following samples. ESC Sample ID Project Sample ID Method L797142-01 STORMWATER OUTFALL 001 2540 D-2011 The following samples were prepared and/or analyzed past recommended holding time. Concentrations should be considered minimum values. ESC Sample ID Project Sam Method Method L797142-01 STORMWATER OUTFALL 001 4500H+ B-2011 ACCOUNT: PROJECT: SD& DATE/TIME: PAGE: Appalachian Environmental Resources L797142 11105h517:48 4 of 12 STORMWATER OUTFALL 001 SAMPLE RESULTS - 01 ONE LAB. NATIONWIDE. � Collected date/lime: 10127/15 10:30 L797142 Gravimetric Analysis by Method 2540 D-2011 Result Qualifier RDL Dilution Analysis Batch FP Analyte mg4 mg/1 date 1 tlme �Z Suspended Solids 2.94 2.50� 1 111031201510:09 WG825718 TC Wet Chemistry by Method 1664A 35s Result Qualifier RDL Dilution Analysis Batch Analyte mgll mgll date I lime rcn] TPH - Oil & Grease ND 6.49 1 101291201516:56 WG825349 Wet Chemistry by Method 4500H+ B-2011 Result Qualifier Dilution Analysis Batch Analyte su datellime rQC1 pH 7.73 1— 10130/201510700 WG825397 FGI Sample Narrative: 4500H+ B-2011 L797142-01 WG625397: 7.73 at 18.8c IIAi Metals (ICP) by Method 200.7 Qualifier RDL Dilution Analysis Batch FResult Analyte mgll myli dale 1 time Copper NO 0.0100 1 111011201516:03 WG825728 Lead ND 0.00500 1 11/011201516:03 WG825728 Zinc 0.131 0.0500 1 111011201515:03 WG825728 ACCOUNT: PROJECT: SDG: DATEITIME: PAGE: Appalachian Environmental Resources L797142 1110511517:48 5 of 12 WG825718 QUALITY CONTROL SUMMARY ONE LAB. NATIONWIDE, Gravlmetrlc Analysis l Method 2540 D-2011 L797142-01 Method Blank (MB) (MB) 11/03/15 10:05 E MB Result M8 Qualifier MB ROL Analyte mgll mg11 F Suspended Solids ND 2.50 Y FS L797177-01 Original Sample (OS) • Duplicate (DUP) (OS) 11/03/15 10:08 • (DUP) 11/03A5 10:D6 FCn] Original Result DUP Result Dilution DUP RFD DUP Qualifier DUP RFD Limits SSr Analyte mgll mgll % % Suspended Solids 126 135 1 5.78 J3 5 Laboratory Control Sample (LCS) • Laboratory Control Sample Duplicate (LCSD) (LCS) 1110311510:05 • (LCSD)11103/15 10',05 FGi Spike Amount LCS Result LCSD Result LCS Rec. LCSD Rec, Rec. Limits LCS QualiBef LCSD Qualifier RPD RPD Limits Analyte mg11 mgli mgli _ % % A % % --- BAI Suspended Solids 773 812 800 105 103 85.0-115 1.49 5 --- --T- FIC ACCOUNT: PROJECT: SDG: DATE/TIME: PAGE: Appalachian Environmental Resources L797142 11/05/1517:48 6 of 12 WG825348 QUALITY CONTROL SUMMARY ONE LAB, NATIONWIDE. Wet Chemistry by Method 1664A L797142-01 Method Blank (MB) RP(MB) 10I2911516;54 MB Result MB Qualifier MB RDL F Analyrte mg11 mgf! TPH - Oil & Grease ND 5.00 Laboratory Control Sample (LCS) • Laboratory Control Sample Duplicate (LCSD) (LCS) 10/29115 16:54 • (LCSD) 10/29115 16:54 Spike Amount LCS Result LCSD Result LCS Rec. LCSD Rec, Rec. Limits LCS Qualifier LCSD Qualifier RPD RPD Limits Anatyte mgll mgll mg11 % % % a % TPH - Oil & Grease 20.0 20.1 19.8 101 99.0 78.0-114 1.50 18 ACCOUNT: PROJECT: SDG: DAT671ME: PAGE: Appalachian Environmental Resources L797142 4110511517:48 7 of 12 WG825397 Wet Chemistry by Method 4500H+ B-2011 L797109-01 Original Sample (OS) • Duplicate (DUP) (OS)10130/15 10:00 • (DUP)10/30/15 10:00 Original Result DUP Result Dilution Analyse su 5u PH 7.53 7.52 1 L797403-02 Original Sample (05) • Duplicate (DUP) QUALITY CONTROL SUMMARY L797142-01 DUP RPD DUP Qualifier DUP RPD Limits 0.133 1 (OS) 10/30/15 10:00 • (DUP)10/30/15 10:00 Original Result DUP Result Dilution DUP RPD DUP Qualifier DUP RPD Limits Analyte Su su % % PH 7,00 7.02 — -- 1 - ---0.285 1 Laboratory Control Sample (LCS) • Laboratory Control Sample Duplicate (LCSD) (LCS) 10/30/15 10:00 • (LCSD)10130/15 10:00 Spike Amount LCS Result LCSD Result LCS Rec. LCSD Rec. Rec. Limits LCS Qualifier Analyse Su Su sL % % % PH --_ - -- -_ 6.72 6,71 6.70 99.9 99.7 98.5-102 LCSD Qualifier RPD RPD Limits 0,149 1 ONE LAB. NATIONWIDE. ACCOUNT: PROJECT: SDG: DATEITIME: PAGE: Appalachian Environmental Resources L797142 =5/1517AS 9 of 12 WG825728 QUALITY CONTROL SUMMARY ONE t_AB,NATIONWIDE, Metals (ICP) by Method 200.7 1.797142-01 Method Blank (MB) , Cp (MB) 11/01/15 17:55 ❑ ME Result M8 Qualifier ME RDL Analyte mgll mg/1 TC Copper ND 0,0100 Lead ND 0.00500 rq Zinc ND 0.0500 FC Laboratory Control Sample (LCS) - Laboratory Control Sample Duplicate (LCSD) (LCS)11101/15 15:14 • (LCSD) 11/01/3 17:03 S r Spike Amount LCS Result LCSD Result LCS Rec. LCSD Rec. Rec, Limits LCS Qualifier LCSD Qualifer RPD RPD Limits Analyte mgll mgll mg/I % % % % % Copper 1.00 1.06 1.03 106 103 85-115 2 20 Lead 1.00 1.07 Zinc 1.00 1.03 1.04 1.00 107 103 104 85-115 100 85-115 3 3 20 20 FG1 L797067-01 Original Sample (OS) • Matrix Spike (MS) • Matrix Spike Duplicate (MSD) FAI] (OS) 11/01/15 15:20 • (MS) 11/01/15 15:26 • (MSD) 11/01/15 15:29 Spike Amount Original Result MS Result MSD Result MS Rec. MSD Rec. Dilution Rec. Limits MS Qualifier MSD Qualifler RPDRPD Limits rq Analyte mg/I mgll mg11 mgll % % % % Copper 1.00 ND 1.03 1.04 103 104 1 75-125 1 20 Lead 1.00 0.00324 1.06 1.07 105 107 1 75-125 1 20 Zinc 1.00 0.0352 1.04 1.06 100 102 1 75-125 2 20 L7972O9-01 Original Sample (OS) • Matrix Spike (MS) • Matrix Spike Duplicate (MSD) (OS) 1VOW 516:28 • (MS)11/01/15 16:31 • (MSD)11/01115 16:34 Spike Amount Original Result MS Result MSD Result MS Rec. MSD Rec. Dilution Rec. Limits MS Qualifier MSD Qualifier RPD RPD Limits Analyte mgll mg11 mg/I mgll % % % % % Copper 1.00 0.0220 1.09 1,07 106 104 1 75-125 2 20 Lead 1.00 0.00268 1.07 1.05 107 105 1 75-125 1 20 Zinc 1.00 0,191 1.07 1.05 86 86 1 75-125 2 20 ACCOUNT: PROJECT: SDG: DATE/TIME: PAGE: Appalachian Environmental Resources L797142 11/05/15 17:48 9 of 12 GLOSSARY OF TERMS ONE LAB. NATIONWIDE. 0 Abbreviations and Definitions SDG Sample Delivery Group, rqp MDL RDL Method Detection Limit. Reported Detection Limit. �Tc ND,U Not detected at the Reporting Limit (or MDL where applicable). RPD Relative Percent Difference. (dry) Results are reported based on the dry weight of the sample. [this will only be present on a dry RS Original Sample report basis for soils]. The non -spiked sample in the prep batch used to determine the Relative Percent Difference (RPD) rC n from a quality control sample. The Original Sample may not be included within the reported SDG. (S) Surrogate (Surrogate Standard) - Analytes added to every blank, sample, Laboratory Control Sample/Duplicate and Matrix Spike/Duplicate; used to evaluate analytical efficiency by measuring Sr recovery. Surrogates are not expected to be detected in all environmental media. Rec. Recovery. SDL Sample Detection Limit. FC1 MOL Unadj. MOL Method Quantitation Limit. Unadjusted Method Quantitation Limit. Qualifier Description aAl J3 The associated batch QC was outside the established quality control range for precision. Sc ACCOUNT: PROJECT: SDG: DATE171ME: PAGE: Appalachian Environmental Resources L797142 11105/1517:48 10 of 12 ACCREDITATIONS & LOCATIONS ONE LAB. NATIONWIDE. ESC Lab Sciences is the ontyenvironmental laboratory accreditedlcertified to support your work nationwide hom one location. One phone call, one point of contact, one laboratory. No other lab is as accessible or prepared to handle your needs throughout the country. Our capacity and capabllity from our single location laboratory is comparable to the collI totals of the network fahoratories in our Industry. The most significant benefit to our 'one location' design is the design of our laboratory campus. The model Is conducive to accelerated producllvrty, decreasing turnaround time, and preventing cross contamination, thus protecting sample integrity. Our focus on premium quality and prompt service allows us to be YOUR LAB OF CFil State Accreditations Alabama 40660 Nevada TN-03-2002-34 Alaska UST-080 New Hampshire 2975 Arizona AZ0612 New Jersey—NELAP TNO02 Arkansas 88-0469 New Mexico TN00003 California 01157CA New York 11742 Colorado TN00003 North Carolina Env375 Conneticut PH-0197 North Carolina DW21704 Florida E87487 North Carolina 1 41 Georgia NELAP North Dakota R-140 Georgia' 923 Ohio—VAP CLOO69 Idaho TN00003 Oklahoma 9915 Illinois 200008 Oregon TN200002 Indiana C-TN-01 Pennsylvania 68-02979 Iowa 364 Rhode Island 221 Kansas E-10277 South Carolina 84004 Kentucky' 90010 South Dakota nla Kentucky' 16 Tennessee" 2006 Louisiana A130792 Texas T104704245-07-TX Maine TNO002 Texas' LA80152 Maryland 324 Utah 6157585858 Massachusetts M-TNO03 Vermont VT2006 Michigan 9958 Virginia 109 Minnesota 047-999-395 Washington C1915 Mississippi TN00003 West Virginia 233 Missouri 340 Wisconsin 9980939910 Montana CERT0086 Wyoming A2LA Nebraska NE-OS-15-05 Drinking Water z Underground Storage Tanks 1 Aquatic Toxicity ' Lhemical,iMicrolo ologlcal x Mold m Accreditation not applicable Third Party & Federal Accreditations A2LA — $SO 17025 1461.01 AIHA 100789 Canada 1461.01 DOD 1461,01 EPA—Crypto TNO0003 USDA S-67674 Our Locations ESC lab Sciences has sixty-four client support centers that provide sample pickup and/or the delivery of sampling supplies. If you would like assistance from one of our support offices, please contact our main office. ESC Lab Sciences performs all testing at our central laboratory. ACCOUNT: PROJECT: SDG: DATEIrIME: PAGE: Appa$achlan Environmental Resources L797142 11/05/1517:48 11 of 72 Ccmpanv Name/Address: OWIMS Information; Analysis Ccnlal ner J Preservative Chem of Custody Page — of OESC L-A-8 O-C.I-C-N-C-95 12065 Ltbanoh Ad C 9 'A 'J�— Report to: Ice- Fow Email TO: Project Description: Collected: 156 Phone: Fax: Client Project A 1 tab Project $1 Coll t by JpYinti: FdIc, F-� Sitt!/Facility to a P.O' Acctiitum: Temp t9e.' Orelo6w � I � . ITSR: iB: ColJeCJJd by (signaluire): immediately Packed on Ice N Y Rush? ILab MUST Be Notified) Same Day ....... 100% Newt Day ........ 10D% J TWO DSY .................... S(Y% Three Day. .............. —15,% Date Results Needed Email? —No Ye!, FAX? No Yes IND.99 of Shlpped.Via; Sample 10 Camp/Grab Matfi)L • Depth Date lime -ntrs L/ Li o hi J i f 3 oPQ,.— a Matrix: 55 - Sol] GW - Groundwater VrW - WasteWater OW - DrIni,ingWatef Ot - Other ph Temp O d2 ELI) 0 Remarks: How Othet Hi3ld 4' Relinquished by: (Signature] Date: Time: Rec ived Signa* r LI) Samples r turned via: 0 UPS 0 courier 0— COnd;tlor . i: (lab usepptyj COC Seal In I _N NA, Relinquished try ililgrialsire) DAN Time: ReceiViVeAt4rel Te;7 aCBottles Received Relinquished by: JSIgn ature)f Date: Time; 11, �Relelv' 0 d for 13b Ibly: JrYg !ZnalkkTe) Date; Tlmd: pH Chec'kctdi Snap:an Tools 12195 State Line Road Eiizabethton,TN37643 Billing Information: Ja,Yt:e Estep 219S State Line Rd Elizabe.hton, TN 37643 Analysis / Container / Preservative iChain of Custody Page _ of — *ESC L•A•8 G-C•I•E•ee•C•f;:•a &A . O.. p Z I: uy L] = ca ` a C >++ p- a- 2 O tL fs _ E S In cn -� f� 0 N o F� t" n p E 01 V1 in Z rC) a Z. , •= i c w P G7 d z UJ VT O ^� "� C' i as - ;r O. t� Moue1tMe% TN 37122 vfa„e:alsasft-snse phone: 8DO—M7-Sass ru:6ts isa•ses9 Report to: Mike Fox Email Tx Brian.:rwiaesnapon.com;mfox4baenn.com Project Description: discharge monitof> ng-monthly Oty/State Codected: L N ? 941 Phone: 423-543-S771 Fax: Client Project Mcnthly Monitoring Lab Project p SNAPONETN-MONTHLY D188 Collected by {print), v Sitc/Facility ID p P.O. ff 14NO17976 Acctnum: SNAPONETN Template:T63159 Prelogln:. P523158 TSB 650 -Linda ashman PBi ` L eoflecte by signature): Im t Parke on Ice N Y Rush? (Lai) MUST Be ka:ii.ed) Same Div .... ......._........... 20L% _NextDay.._.-........_.._-.......100fL T Two D2Y..............................SO% . _Three Oay ........ ................. 2Sx Date Results Needed Email? Na X Yes FAX? —No Yes of Shipped Vfa- Corp Exp - Sample ID Carrp/Grab Matrix • Depti, Date Time ntrs f�61LIr�1YY11iNRi �11AOt1 I�J� 0��,1 COMPOSITE G, W1N t7 i— Z �q ZO 5 X X X X X GRAB ww p 3 a X X-OIL _ Matrix: SS - Soil GW • Groundwater WW - WasteWater Df'W -- Drl iking Water OT - Other �7 Remarks: pH Temp Flow Other Hold if Relingaishe b &ISignature) Date: (� 5 Time: f deceived by: {Sign turel Samples returned via: ❑ UPS 0 FedEx 0 Courier Condition: (lab use only) COC Seal Intact. Y T N _NA Relinq h y : (Signature). �a, Date: Time: Received by: {Sig OWTJ mp C. bottles Received: Relinquished by. IS$nature Date: Time., Received for lab by: ISl,naturel Date; Time: - ate pH Checked: NCF: A RECEIVED RC—DENR FEB o 5 zIb Stormwater Discharge Outfall (SDO) CENTRAL FILES Qualitative Monitoring Report oWR SECTION For guidance on filling out this form, please visit: Permit No.: ZI/C �_/_/� j or Certificate of Coverage No.: jj/-C/-G/()/3W) 2 i 3 Facility Name: County: Inspector: Date of Inspection: Time of Inspection: Total f'svent Precipitation (inches): r Q C Phone No. Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit? (See information below.) 9Yes ❑ No Please verify whether Qualitative Monitoring must be performed during a "representative storm ' event" or `measureable storm event" (requirements vary, depending on the permit). Qualitative monitoring requirements vary. Most permits require qualitative monitoring to be performed during a representative storm event" or during a "measureable storm event." However, some permits do not have this requirement Please refer to these definitions, If applicable. A "representative storm event" is a storm event that measures greater than 0.1 inches of rainfall and that is preceded by at least 72 hours (3 days) in which no storm event measuring greater than 0.1 inches has occurred. A single storm event may contain up to 10 consecutive hours of no precipitation A'"measurable storm event" is a storm event that results in an actual discharge from the permitted site outfall. The previous measurable storm event must have been at least 72 hours prior. The 72-hour storm interval does not apply if the permittee is able to document that a shorter interval is representative for local storm events during the sampling period, and the permittee obtains approval from the local DWQ Regional Office. By this signature, I certify thgthis report is accurate and complete to the best of my knowledge: (Signature of6!e:mittA or Designee) Page 1 of 2 sWU-242, last modified 10/25/2022 0 1. Outfall Description: y Outfall No. :� L Structure [pipe, ditch, etc (` rk Receiving Stream: U T Describe the industrial activities that occur within the outfall drainage area: r-.<-, 1e 21 - AME--, t� Q - .. 2. Color: Describe the color of the discharge using basic c lors (red, brown, blue, etc.) and tint (light, medium, dark) as descriptors: _ �u e 1+5 3. odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil, weak chlorine odor, etc.): r� �� ._ ... _. _ 4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is clear and 5 is very cloudy: 2 3 4 5 S. Floating Solids: Choose the number which best describes the amount of floating solids in the stormwater discharge, where 1 is no solids and 5 is the surface covered with floating solids: 0 2 3 4 5 6. Suspended Solids: Choose the number which best describes the amount of suspended solids in the stormwater discharge, where i is no solids and 5 is extremely muddy: 2 3 4 5 7. Is there any foam in the stormwater discharge? Yes N 8. is there an oil sheen in the stormwater discharge? Yes 9. is there evidence of erosion or deposition at the outfall? Yes No 10. other Obvious Indicators of Stormwater Pollution: List and describe Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition may be Indicative of pollutant exposure. These conditions warrant further investigation. Page 2 of 2 $WU-242. East modified 10/25/2012 aceAnaly�l tnhcpaveleba�n November 05, 2015 Mr. Johnny Baines Eastern Environmental Management PO Box 4030 518 S. Pearl Street Rocky Mount, NC 27803 RE: Project: SPX 10/2015 Pace Project No.: 92273916 Dear Mr. Baines: Pace Analytical Services, Inc. 980D KIncey Ave. Suite 100 Huntersvf6e, NC 2OD78 (704)8759092 Enclosed are the analytical results for sample(s) received by the laboratory on October 29, 2015. The results relate only to the samples included in this report. Results reported herein conform to the most current TNI standards and the laboratory's Quality Assurance Manual, where applicable, unless otherwise noted in the body of the report. Analyses were performed at the Pace Analytical Services location indicated on the sample analyte page for analysis unless otherwise footnoted. If you have any questions concerning this report, please feel free to contact me. Sincerely, Taylor Ezell taylor.ezell@paoelabs.com Project Manager Enclosures cc M5. Cathy Bah m Eastem Environmental Management REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except In lull, wftut the wrtlten consent of Pace Analytical Services, Inc., Page 1 of 13 I,C AlI I0 CERTIFICATIONS Project: SPX 10/2015 Pace Project No.: 92273M Charlotte CertIfication IDs 9800 Klnc ey Ave. Ste 100, Huntersvllle, NC 28078 Florida/NELAP CerOficatlon M E87627 North Carolina Ddnldng Water Certltfratlon M 37706 Kentucky UST Certif+catbn M 84 North Carolina Field Servioes CerNflcation #: 6342 West Virginia Cerdfloadon #, 367 North Carolina Wastewater Certification #. 12 Vhgln1Wr=LAP CertMcatlon #: 460221 South Carolina Certification M 99006001 Asheville CerdfkeatlOn ms 2225 Riverside Drive, Asheville, NC 28804 North Carolina Wastewater Certlftcation #: 40 Flodda/NELAP Certlfication #: E87648 South Carolina Certiflcation #. 99030001 Massachusetts Certlflcation #: U-NC030 West Virginia Certlflcation M 356 North Caroline Drinking Wader Certification M 37712 VirginieNELAP Certification #: 460222 REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in U, whhout the written Consent of Pace Analytical Services, tnc,. Pace Analytical 39rAces, Inc. 9800 KInaey Ave, Suite t00 , l4unionMIM, NC 28 078 (704)875$062 Page 2 of 13 -4 n n � aceAnaocal won SAMPLE ANALYTE COUNT Project SPX 1012015 Pace Project No.: 92273916 Pace Analytical Sarvlces, Ine. MW KinoeyAve. Suite 100 Hunbaravnle, NC 2807a (704)87H•9092 Analysts Lab ID Sampte ID Method Analysts Reported Laboratory 92273916001 WO-1 EPA 1664B JMS 1 PASS-C EPA8082 SWB 8 PASi-C SM 2540D SAM 1 PASI-A EPA 351.2 SER 1 PASI-A EPA 353.2 DMN 3 PASI-A REPORT OF LABORATORY ANALYSIS This report shag not he reproduced, except In full. without the written torment of Pace Analytical Services. Inc.. Page 3 of 13 aceAnabtr'caie ANALYTICAL RESULTS Project: SPX 1012015 Pace Project No.: M73916 Pace Analytical Services, Im. 9800 KlnceyAwe. Sulfa 100 HuntemAls. NC 28078 (704)B7548092 Sample: SDO.1 Parameters Lab ID: 02273916001 Collected: 10/20/1516:30 Results Units Report Limit OF Received: 10/29/15 09:45 Matrix: Water Prepared Analyzed CAS No. Quell HEM, Oil and Grease Analy9cal Method: EPA 16848 Oil and Grease ND mg/L 5.0 1 1110511510:39 $002 GCS PCB Analytical Method: EPA 8082 Preparation Method: EPA 3510 PCB-1016 (Aroctor 1016) NO ug(L 0.50 1 10130/15 09:30 1W30115 19:06 12074-11-2 PCB-1221 (Arodor 1221) NO ug/L 0.50 1 10/30/15 09:30 10/30/15 19:06 11104-28-2 PCB-1232 (Arodor 1232) ND ug1L 0.50 1 10130/1 S 09:30 10tf30/15 19:08 11141-18-6 PCB-1242 (Arodor 1242) ND ug/L 0.50 1 10/30/15 09:30 10/30/15 19:06 53469-21-9 PCB-1248 (Aroclor 1248) Nil ug& 0.50 1 10130/16 09.30 10/30/1519*06 12672-29-8 ' PCB-1254 (Amdor 1254) ND ug/L 0.50 1 10/30/15 09:30 10/3011519:06 11007.89-1 PCB-1 260 (Arodor 1280) NO ug/L 0.50 1 10130/1509:30 10MOMS19:06 11098-82-5 Surrogates Decachioro6lpherryl (S) 25M Total Suspended Solids Total Suspended Solids 351.2 Total IQeldahl N"on Nitrogen, l9aidahl, Total 353.2 Nitrogen, NO2JN03 unpres Nitrogen, Nitrate Nitrogen. Nitrite Nitrogen, NO2 plus NO3 Date: 1VOW015 05:32 PM 35 % Analytical Method: SM 25400 NO mg/L Analytical Method: EPA 351.2 ND mg/L Analytical Method: EPA 353.2 0.15 mg1L NO mg/L 0.15 mg/L 10-132 1 10/30/15 09:30 110/30115 19-.00 2051-24-3 5.0 1 1110111515:12 0.50 1 11/03/15 03:10 7727-37-9 0,020 1 10/30/15 10.39 0.020 1 1013011510:39 0.020 1 10f3011610:39 REPORT OF LABORATORY ANALYSIS This report aha9 not be reproduced, wept In full. without the writlan cansent of Pars Analytical SerA ces. Inc.• Page 4 of 13 aecAnalyticW e QUALITY CONTROL DATA Project SPX 10r2015 Pace Project No.. =73916 QC Batch: GCSYl23118 Analysts Method: EPA 1684B QC Batch Method: EPA 16648 Analysis Description: 1664 HEM, Oil and Grasse Assodaled Lab Samples: W73918001 METHOD BLANK: 1599395 Matrbr Water Assodated Lab Samples: 02273916001 Blank ReporOng Parameter units Result Limit Analyzed Qualifiers Oil and Grease mg1L ND 5.0 1110511510:35 PaceArtalyttcal Sarvleea, Inr- ONO KinceyAm Suite WO Hurbreville, NC 20078 (704)8754= LABORATORY CONTROL SAMPLER LCSD: 1599396 1599397 Spike LCS LCSD LCS LCSD % Rac Max Parameter Units Conc, Result Result % Rec % Rec Limits RPD RPD Qualifiers DIl and Grease mg/L 40 35.4 35.3 88 88 78-114 0 30 Pastdfe presenbd on Oft papa ere In the units Indicated by ths'Units' column satapt where an alternate unit to praeented to the right of ate result. REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in hill. Date: 11IM015 05:32 PM vrithout the written cwrlseni of Pace Analytical Services, Inc... Page 6 of 13 ceAnalyticxl' QUALITY CONTROL DATA Project: SPX 10/2016 Pace Project No.: 92273916 Pace Analytical Services, Inc. M I(InoeyAve, Suft 100 HuntersvlAe, NC 28078 (704)8759092 QC Batch: OEXT/38710 Analysts Method: EPA SOU OC Batch Method: EPA 3510 Analyals Description: W82 GCS PCB AssocWed Lab Samples: 92273916001 METHOD BLANK: , 1504382 Matrix: Water Associated Laic Samples: %273916001 Blank Reporting Parameter Units Result Limit Analyzed Qualifiers PCB-1016 (Amcor 1016) ug/L ND 0.50 10/29/15 22:07 PCB-1221 (Arodor 1221) ug/L ND 0.60 10/29/15 22:07 PCB-1232 (Amcor 1232) u01L ND 0.50 10/29/15 22 07 PCB-1242 (Arodor 1242) uglL ND 0.50 10/29/16 22:07 PCB-1248 (Aroclor 1248) ug/L ND 0.50 10129115 22.07 PCB-1254 (Aroc or 1264) ug/L ND 0.60 10129/16 22:07 PCB-1280 (Arodor 1260) ug/L ND 0.60 1 =911 5 22:07 Decachlorobiplu" (S) % 83 10-132 10/29/16 22:07 LABORATORY CONTROL SAMPLE 8 LCSD: 1594383 1594384 Spike LCS LCSD LCS LCSD % Rec Max Parameter Units Conc. Result Result % Rec % Rec Llmlls RPD RPD Qualifiers PCB-1016 (Arodor 1016) u91L 5 4.2 4.3 83 86 60-150 2 30 PCB-1260 (Arodor 1260) uglL 5 4.4 4.4 87 87 50-150 0 30 Decachloroblphenyl (S) % 82 83 10-132 b Reaulla prevented on this a an In the unite Indicated Vm tJnity^ cWumn mme when an altemate unit le peg by pt prevented to the Hot of tiu reealL REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except In fun, Date: 11105/2015 05:32 PM without the written consent of Pace ArtaKlcel Servioes, Inc.. Page 6 of 13 ceAnalythx!' Pace Anslyttcal Savicas, Inc. MOO KlnceyAvo. Suite 100 Hurkhmadle. NC 28M (704)B764082 QUALITY CONTROL DATA Project: SPX 1002015 Pace Project No.: 92273916 QC Batch: . WETI41157 Analysts Method: SM 2540D QC Batch Method: SM 2540D Analysts Description: 2640D Total Suspended Solids Assodated lab Samples: M73916001 METHOD BLANK: 1596407 Assodated Lab Samples: 92273916001 Parameter Units Total Suspended Solids mg/L LABORATORY CONTROL SAMPLE: 1596408 Parameter units Total Suspended Solids mglL SAMPLE DUPLICATE: 1596409 Matrbt: Water Blank Reporting Result •Limp Analyzed Qualifiers ND 2.5 11f01115 15:06 Spike LCS LCS % Rec Conc. Result % Rec Limas Qualifiers 250 240 96 90-110 92274207001 Dup Parameter Units Result Result RPO Qualifiers Total Suspended Solids mg/L 173 179 3 SAMPLE DUPLICATE: 1596410 92273916001 Dup Parameter Units Result Result RPD Qualifiers Total Suspended Solids mg/L NO ND Rmuld presented an this papa an In to anita rndlcated by the 'UnWedumn except when m altanuto unit Is pnaented to thsdght of the result. REPORT OF LABORATORY ANALYSIS This report shot not be repraduced, except In full, Data: 11/05f2015 05:32 PM tviihout the written mnmM of Pace Analytical Service®, Inr,. Page 7 of 13 li, laeAnaOcal' QUALITY CONTROL DATA Project SPX 1012015 Pace Project No.: =73916 QC Batch: WETA125207 Analysis Method: EPA 351.2 QC Batch Method: EPA 3512 Analysis Description: 351.2 TKN Associated Lab Samples: 92273916001 METHOD BLANK: 1696242 Matrix: Water Associated Lab Samples: 92273916001 Blank Reporting Parameter Units Result Limit Analyzed Qualifiers Nitrogen, Kjeidahl, Total mgfL NO 0.50 11l03115 02:52 Pace Analytical Services, Inc. N00 Klnsay Are. Sults 100 Huntersvile, NC 28078 (704)876-9092 LABORATORY CONTROL SAMPLE: 15913243 Spike LCS LCS % Rec Parameter Units Conc. Result _ % Rec Limits Qualifiers Nitrogen, Kleldahl, Total mg!L 10 10 100 90-110 MATRIX SPIKE & MATRIX SPIKE DUPLICATE 1696244 1596245 MS MSD 92274056001 Spike Spike MS MSD MS MSD % Rec Parameter Units Result Conc. Conc. Result Result % Rec % Rec Limits RPD Qual Nitrogen, KJeldahl, Total mg&- 0.94 10 10 11.3 10.8 104 99 90-110 4 MATRIX SPIKE & MATRIX SPIKE DUPLICATE: 1596246 1596247 MS MSD 92273502001 Spike Spike MS MSD MS MSD % Rac Parameter Units Result Conc, Conc. Result Result % Rec % Rec Limits RPD Qua! Nitrogen, Kjeidahl, Total mgfL 6.9 10 10 10.7 16.1 39 92 90-110 40 M1,R1 Rasurts pressated on ale page are In the unite lnftated by ths'UnW column except where an altemsto unrt b presented to ere right of the reault. REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except In full, Data: 11/0512015 05:32 PM without the written consent of Pace Analytical Services, Inc,. Page 8 of 13 Paco Analylicai Saalces, Inc. 0800 KlnaeyAve. $We 100 Huntamvl4e, NC 28070 (704)8754092 QUALITY CONTROL DATA Protect SPX 10/2015 Pace Protect No.: =73918 QC Batch: WE-fiA125198 Analysis Method:. EPA353.2 QC Batch Method: EPA 3532 Armlysls Description: 353.2 Nitrate + Nitrite, Unpres. Associated Lab Samples: 92273916001 METHOD BLANK ' 1595416 Matrix Water Associated Lab Samples: 92273916001 Blank Reporting Parameter Units Result Lh tt Analyzed Qualifiers Nitrogen, Nfrate mg/L ND 0.020 10134f15 10:36 Nitrogen, Nitrite mg/L ND 0.020 10f30116 10:36 Nitrogen, NO2 plus M03 mg1L ND 0.020 1 OW1610:38 LABORATORY CONTROL SAMPLE: 1595416 Spike LCS LCS % Rec Parameter Units Cone. Result % Rec Limits Qualifiers Nitrogen, Nitrafie mg/L 2.5 2A 96 90-110 Nitrogen, NIM mg/L 1 0.97 97 90-110 ftogeri, NO2 plus NO3 mg1L 2.5 2.4 96 90-110 MATRIX SPIKE & MATRIX SPIKE DUPLICATE: 1595417 150541 B MS MSD 92273916001 Spike Spike MS MSD MS MSD % Rec Parameter Units Result Conc, Conc, Result Result % Rec % Rec Limits RFD Quel Nitrogen, Nitrate nV& 0.15 2.5 2.5 2.6 2.6 96 96 90-110 0 Nitrogen, Nitrtts MQ& ND 1 1 1.1 1.1 104 104 90-110 0 Nitrogen, NO2 plus M03 mglL GAS 2.5 2.5 2.6 2.6 96 96 90-110 0 Rwultspresaeted an this page Armin the unit todiested by the Zhdls- ealumn except where am atternete ueit Is prssseted to the right of Me raven REPORT OF LABORATORY ANALYSIS Ttds report shall not be reproduced, except in full, Date: 11/0& 2015 05:32 PM without the watten consent of Pace Analytical Services, Inc.. Page 9 of 13 aceAnaocal' rvwcpacub"b rrr QUALIFIERS Project. SPX 10/2015 Pace Project No.: 92273916 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. J - Fgtirnat>sd concentration above the adjusted method detection limit and below the adjusted reporting fimit MDL-Adjuated Method Detection UmIL PQL - Practice[ Quantltation Limit RL - Reporting Limit Paco Analytleal Sw vlcra, Inc. 0800 KlnceyAm Sulfa 100 HuntorsAle, NC 2807a (704)8754002 S - Surrogate 1,2-Diphenylhydrazlne decomposes to and cannot be separated from Azobenzene using Method B270. The result for each anaiyte 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 Semple (Duplicate) MS(D) - Metric Spike (Duplicate) DUP - Sampio DupikNta RPD - Relative Percent Difference NC - Not Calculable. SG - Silica Gel - Gean-Up U - Indicates the compound was analyzed far, but not detected. Add preservation may not be appropriate for 2 Chlomethylvinyl ether, Styrene, and Vinyl chloride. A separate vial preserved to a pH of 4-5 Is recommended in SW846 Chapter a for the analysis of Acrolain and Acryionitrile by EPA Meftrod 8260. I4-Nitrosodiphenylamine decomposes and cannot be separated from bipher yiamine using Method 8270. The result reported for each analyte Is a combined concentration. Paco Analytical is TNI accredited. Contact your Pao& PM for the current Est of accredited ana[ytes. TM - The NELAC Institute. LABORATORIES PASI-A Pace Analytical SeFvfces -Asheville PASI-C Paco Analytical Services - Charlotte ANALYTE QUALIFIERS M1 Matrix spice recovery exceeded QC limits. Batch accepted based on laboratory control sample (LCS) recovery. R1 RPD value was outside control limits. REPORT OF LABORATORY ANALYSIS This report shall not bo roproduoad. except to lull, Date: 11/0512015 D5:32 PM without the wrkttett consent of Pace Analytical SorAws, Inc- Page 10 of 13 ceAnaYical QUALITY CONTROL DATA CROSS REFERENCE TABLE Project SPX 1012015 Pace Project No.: 02273916 Pace Anatytical SaMces, Inc. 0890 K]noeyAve. Suite f00 Nuntersvile, NC 28078 poa)e7n-sc>ss Lab [D Sample ID QC Batch Method QC Bauch Analytical Method 92273916001 8DO-1 EPA 16545 OCSVl23118 92273918001 SDI?-1 EPA3610 OEXT138710 EPA8082 92273916001 SDO.1 SM 25400 WET141157 02273916001 SDO-1 EPA 351.2 WETA125207 ' 92273915001 SDO-1 EPA 353.2 WETA125196 REPORT OF LABORATORY ANALYSIS Thfs report shall not be reproduced, except In full. Date: 11105W15 05.32 PM without the written consent of Pace Anayt&:at Senfces, Inc.. Analytical Batch GCSV123060 Page 11 of 13 uOcument-Name., uVku1?1V11lrwvrmu,limy iv,sWl%r `✓ kW Sam ie Condition Upon Recel t ($CUR) Pagel 1 of 2" Document Number. Issuing Authority: F-CHR-CS-003-rev.16 Pace Huntersvllle Quallty Office Client Name:, l .,r„ • Page 2 oi2 is for Internal Use o„<y Courier: ❑ FedPO"' UP❑ USP[] CllerCl CommereiLl Peoe Other Custody Beal on Coo[erlRwc Present: ❑ yee. `no Seals intact: ❑ ye�,no �^�Q, ME Packing Mabarlal: ❑ Subbfe Wrap Bubble Be None ❑ Other Thermometer Used: IR Gun T74P Type of Ice: �Bl ue None Samples ott ice, coonng process has begun "0 Temo Correction Factor T1402 No Correction l I CorrectedCoolerTelnp.: 'C Temp shouki be stave freezing to M Blologlcal Tissue Is Frozen: Yee No t�iA Comments: / Date and INtla arson OMmining. contents•'oi Chain of Custody Present: DY ❑No ❑NIA 1. Chain of Cus . Filled Out eo ONa ❑NIA 2. Chelri of Custody Relinquished: es ONO pNIA 3. . Sa lei Name & sl ature on Coe: ides 13Na ❑NIA 4. Sam les Arrived within Hold Time, Yes ONO EINIA 6. Short Hold Time Ana 42iir : ❑Yes No ❑NIA B. Rush'Tum Around Time Requested. E)Yqp.dNo 13MA 7. Sufflclent Volume: A'ysj, on. ONIA 8. Correct Containers Used. -Pace Containers Used: ©No Yes ❑Na ❑NIA ❑NIA 9. Containers Intact es ON, [JtPA. 10. Filleted volume received for Dissolved tests ❑Yes-1]No NI,a 11. Sample Labels match COC: -includes dateAime/1D/Anal sts Matrix: Yes CINo OWA 12. , tl contatners needktg preservattan haws been checked. All cohlainem ii 4ng preservatlon are found to be In compliance with EPA recommendation. ems: VQA a dorm,'r0C.OaQ,W-AR0 Y ❑No Yee ONO Ea ONo ❑NIA ❑NIA 13, Sam checked for dechlodnation: V41 ONo ©wIA 14, Headspace in VOA Vials :--i3mm : Ciyes. J34 ❑WA' 15. Trip Blank Present: 1 Trip Blank Custody Seals Present ' Paco Trip Blank Lot# if purchased). OYes ❑No Dyes ❑No l i Q l IiA Ia. Client Notifleationl'Reeolution: Fteid Data Rewired? Y I N Person Contacted: Datelitme: Comments/ Resolution: SCURF Review: - Date: ro � ��lf : 76L747� 1 SRF Review: Date: Nasample, Whenever CVY ofthisthis Imm will Is a be Bad tcy o he North Carolina QEH R� Cerllftcation Oftice ( Le out of.itoid, incorrect.preservathre, out of temp, 92273916 bcorrect containers} Page 12 of 13 PaceArralytical .rw.oaialrsran CHAIR -OF -CUSTODY ! Analytical Request Document fie ChaiR•o6r,ul.Fgdy ¢ a i EGAt OC•CUMENT- An ml4mu FWft mast 6. o=s)leiad accyreWy. - REGU TORYAGENCY i Ptc- • .. 12 SAMPLE >f OZ. COW OT r Y� a VWtWN�ft��gforomVW=C* WUP-.9%NU=daypaY+�+oMklRsum7¢OtirlpbC�S.p4roQec011S;�'Dal.P.n,raicio yraQw'n30Arya' — F-►UJ.-Q-a2QleV.ai,453' Fulcher, Craig From: Cathy Baines <CBaines@eastern-environmental.com> Sent: Tuesday, January 26, 2016 2:57 PM To: Fulcher, Craig Subject: FW: Scanned image from MX-620ON Attachments: nreply@eastern-environmental.com_20160126_164159.pdf {ATTENTION: This email was received from an external source. Please use caution when opening attachments and/or responding to this message.1 ----- gi g p Original Message From: nreply ,eastern-env�ronmental.com nre ]yna,eastern-environmental.com] On Behalf Of nreply@ Sent: Tuesday, January 26, 2016 4:42 PM To: Cathy Baines Subject: Scanned image from MX-620ON Reply to: nre lyReastem-environmental.corn <nre 1 dastern-environmental.com> Device Name: Eastern Environmental Management Device Model: MX-620ON Location: Y9314 Rocky Mount, N.C. File Format: PDF MMR(G4) Resolution: 200dpi x 200dpi Attached file is scanned image in PDF format. Use Acrobat(R)Reader4.0 or later version, or Adobe(R)ReaderTM of Adobe Systems Incorporated to view the document. Acrobat(R)Reader4.0 or later version, or Adobe(R)Readeirm can be downloaded from the following URL: Adobe, the Adobe logo, Acrobat, the Adobe PDF logo, and Reader are registered trademarks or trademarks of Adobe Systems Incorporated in the United States and other countries. http://www.adobe.com/ Semi-annual Stormwater Discharge Monitoring Report for North Carolina Division of Water Quality General Permit No. NCG030000 Date submitted _ _L 3 r /.S CERTIFICATE OF COVERAGE NO. NCG03L _a a 3 FACILITY NAME S_QX COUNTY PERSON COLLES'II G SAMPLES An LABORATORY CLC-f_— Lab Cert. # q6 Comments on sample collection or analysis: SAMPLE COLLECTION YEAR _ ao15 SAMPLE PERIOD R Jan -June ❑ July -Dec or []Monthly' month] DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA []Zero -flow [_]Water Supply [:]SA ❑Other PLEASE REMEMBER TO SIGN ON PAGES 2 AND/OR 3 4 Part A. Starmwater Benchmarks and Monitoring Results ❑ No discharge this period? P� Date Sample 24-hour rainfall pH, To oxic Outfall No :_.. 1: Collected amount Total Suspended Solids . Standard units Cop{�er' :. Zinc Total Petraleu`rn . qr a s 5 : ino dd inch3' es i Hydrocarbons Benchmarks >; _ :100 mg/L ar 50 mgJL "- 6 0 — 9 0 0 007 mg/C 0 03 mg/L € , O'.067. mgJL . 15, mg/L : 1 mg/L ::::; m 1 Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall. ZFor sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here. s The total precipitation must be recorded using data from an on -site rain gauge. Unattended sites may be eligible for a waiver of the rain gauge requirement. 4 See General Permit, Table 3 identifying the especially sensitive receiving water classifications where the more protective benchmark applies. -'Total Toxic Organics sampling is applicable only for those facilities which perform metal finishing operations, manufacture semiconductors, manufacture electronic crystals, or manufacture cathode ray tubes. For purposes of this permit the definition of Total Toxic Organics is that definition contained in the EPA Effluent Guidelines for the facility subject to the requirement to sample (for metal finishing use the definition as found in 40 CFR 433.11; for semiconductor manufacture use the definition as found in 40 CFR 469.12; for electronic crystal manufacture use the definition as found in 40 CFR,469.22- and for -cathode ray tube manufacture use the definition found in 40 CFR 469.31). R C F, ! V L U JUK 08 2015 DIJVR SECTON INF0Rh1ATl0td PROCESS! VG UNIT Permit Date_ 11/1/2012-10/31/2017 SWU-245, last revised 10/25/2012 Page 1 of 3 —C: Facilities that incorporate a solvent management plan into the Stormwater Pollution Prevention Plan may so certify, and the requirement for TTO monitoring may be waived. The solvent management plan shall include a list of the total toxic organic compounds used and the other elements listed in the General Permit. For those facilities electing to employ the TTO monitoring waiver, the discharger shall sign the following certification statement: "Based upon my inquiry of the person or persons directly responsible for managing compliance with the permit monitoring requirement for total toxic organics (TrO), I certify that to the best of my knowledge and belief, no dumping of concentrated toxic organics Into the stormwater or areas which are exposed to rainfall or stormwater runoff has occurred since filing the last discharge monitoring report. I further certify that this facility is implementing the all the provisions of the solvent management plan included in the Stormwater Pollution Prevention Plan." Name (Print nam ) Title (Print title) 0/- 3 (Signature) (Date) Note: Results must be reported in numerical format. Do not report Below Detection Limit, BDL, <PQL, Non -detect, ND, or other similar non -numerical format. When results are below the applicable limits, they must be reported in the format "<XX m L" where XX is the numerical value of the detection limit, reporting limit, etc. in mg/L. Note: If you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses. See General Permit text. Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month. LJ No discharge this period?` Footnotes from Part A also apply to this Part B * See General Permit text, Table 5, identifying the especially sensitive receiving water classifications where the more protective benchmark applies. Permit Date: 11/1/2012-10/31/2017 SWU-245, last revised 10/25/2012 Page 2 of 3 Note: If you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses. See General Permit text FOR PART A AND PART B MONITORING RESULTS: • A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B. • 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART II SECTION B. • TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES ❑ NO ❑ IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO ❑ REGIONAL OFFICE CONTACT NAME: Mail an original and one copy of this DMR, including all "No Discharge" reports, within 30 days of receipt of the lab results for at end of monitoring period in the case of "No Discharge" reports) to: Division of Water Quality Attn: DWQ Central Files 1617 Mail Service Center Raleigh, North Carolina 27699-1617 YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED: "I 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. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations." (Signature of Permittee) Permit Date: 11/1/2012-10/31/2017 _'?- — jDate) SWU-245, last revised 10/25/2012 Page 3 of 3 k*4 n CDENR Stormwater Discharge Outfall (SDO) Qualitative Monitoring Report Forguidance on filling out this form, please visit; httn://nortal,ncdenr.org(web/wq/wsIsulnndessw#ttaL-4 Permit No.: or Certificate of Coverage No.. Nf/L/LI-1—/—/_/—/_/ Facility Name: County: Inspector: Date of Inspection: Time of Inspection: Phone No, Total Event Precipitation (inches):--.,. 3 F _ Was this a "Representative Storm Event' or "Measureable Storm Event" as defined by the permit? (See information below.) 0 Yes ❑ No Please verify whether Qualitative Monitoring must be performed during a "representative storm event" or "measureable storm event" (requirements vary, depending on the permit). Qualitative monitoring requirements vary. Most permits require qualitative monitoring to be performed during a "representative storm event" or during a "measureable storm event." However, some permits do not have this requirement. Please refer to these definitions, if applicable. A "representative storm event" is a storm event that measures greater than 0.1 inches of rainfall and that is preceded by at least 72 hours (3 days) in which no storm event measuring greater than 0.1 inches has occurred. A single storm event may contain up to 10 consecutive hours of no precipitation. A "measurable storm event" is a storm event that results in an actual discharge from the permitted site outfall. The previous measurable storm event roust have been at least 72 hours prior. The 72-hour storm interval does not apply if the permittee is able to document that a shorter interval is representative for local storm events during the sampling period, and the permittee obtains approval from the local DWQ Regional Office. By this signature, I certify that this report is accurate and complete to the best of my knowledge: (Signature of Permittee or Designee) Page 1 of 2 54VI1-242, bast modified 10/25/2012 1. Outfall Description: r Outfall No. 5P4-t Structure (pipe, ditch, etc.) _s.�l Gam_ Receiving Stream: 4 r' r Describe the industrial ac ivities that occur within the outfall drainage area: d Clrrs rrn r-5 2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint (light, medium, dark) as descriptors: El L& - - ( t S 3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil, weak chlorine odor, etc.): 1-4 1 D 4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is clear and 5 is very cloudy: '10 2 3 4 5 S. Floating Solids: Choose the number which best describes the amount of floating solids in the stormwater discharge, where 1 is no solids and 5 is the surface covered with floating solids: � 22 3 4 5 6. Suspended Solids: Choose the number which best describes the amount of suspended solids in the stormwater discharge, where 1 is no solids and 5 is extremely muddy: 2 3 4 5 7. Is there any foam in the stormwater discharge? Yeso 8. is there an oil sheen in the stormwater discharge? Yes 9. is there evidence of erosion or deposition at the outfall? Yes 10. other Obvious Indicators of Stormwater Pollution: List and describe Note. Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition may be indicative of pollutant exposure. These conditions warrant farther investigation. Pagc 2 of 2 SWU-242, Last modified 10/25/2012 aceAnaiXical o www.pacelabs.com May 13, 2015 Mr. Johnny Baines Eastern Environmental Management PO Box 4030 518 S. Pearl Street Rocky Mount, NC 27803 RE: Project: SPX SEMIANNUAL Pace Project No.: 92247861 Dear Mr. Baines: Pace Analytical Services, Inc. 9800 Kincey Ave. suite ioo Huniersvifle, NC 28070 Enclosed are the analytical results for sample(s) received by the laboratory on May 01, 2015. The results relate only to the samples included in this report, Results reported herein conform to the most current TNI standards and the laboratory's Quality Assurance Manual, where applicable, unless otherwise noted in the body of the report. Analyses were performed at the Pace Analytical Services location indicated on the sample analyte page for analysis unless otherwise footnoted. If you have any questions concerning this report, please feel free to contact me. Sincerely, Kevin Herring for Angela Baioni angela.baioni@pacelabs.com Project Manager Endosures cc: Ms. Cathy Baines, Eastern Environmental Management REPORT OF LABORATORY ANALYSIS This report shall not be teproduced, except In tub, without the written consent of Pace Analytical Services, Inc. (704)875.9092 Page 1 of 13 aceAnalytical WmPaceraes.wm Project: SPX SEMI ANNUAL Pace Project No.: 92247861 Pace Analytical Services, Inc. 9800 Kincey Ave. Suite 100 HunlsrsviRe, NC 28078 (704)875-9092 Charlotto Cartlffcation IDs 9800 Kincoy Ava. Ste 100, Huntersvllle, NC 28078 North Carolina Drinking Water Certification #: 37706 North Carolina Field Services Certification #: 5342 North Carolina Wastewater Certification #: 12 South Carolina Certification #: 99006001 Asheville Certificatfon IDs 2225 Riverside Drive, Asheville, NC 28804 FloridalNELAP Certification #: E87648 Massachusetts Certification #: M-NCO30 North Carolina Dtinking Water Certification #: 37712 CERTIFICATIONS FlorldalNEIAP Certification #: E87627 Kentucky UST Certification #: 84 West Virginia Certification #: 357 Vlrginia[VELAP Certification #: 460221 North Carolina Wastewater Certification #: 40 South Carolina Certification #: 99030001 West Virginia Certification #: 356 VrginiaNELAP Certification k 460222 REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, without the written consent or Pace Analytical Services, Inc.. Page 2 of 13 leAnalytical wnttpecermu m SAMPLE ANALYTE COUNT Project: SPX SEMI ANNUAL Pace Project No.: 92247861 Pace Analytical Services, Inc. 9800 Kinsey Ave. Suite 100 Huntersvllle, NC 28078 (704)875-9092 Lab ID Sample ID Method Analysts Analytts . Roportod Laboratory 92247861001 SDD1 EPA 16646 CLW 1 PASI-C EPA 8082 SWB 8 PASI-C SM 2540❑ WRC 1 PASI-A TKN+NO3+NO2 Calculallon EWS 1 PASI-A EPA351.2 JDA 1 PASI-A EPA353.2 DMN 3 PASI-A REPORT OF LABORATORY ANALYSIS This report shall not be repiuduced, except in lull, without the written consent of Pnce Analytical Services, Inc.. Page 3 of 13 aceAnalytical wwwyeceteb:can ANALYTICAL RESULTS Pace Analytical Services, Inc. 9800 Kincey Ave. Suite 100 Huntersvilie, NC 28070 (704)875.9092 Project: SPXSEMIANNUAL Pace Project No.: 92247861 Sample: SD01 Lab ID: 92247861001 Collected: 04/30/15 08:15 Received: 05/01/15 10:15 Matrix: Water Parameters Results Units Report Limit DF Prepared Analyzed CAS No. Qua] HEM, 011 and Grease Analytical Method: EPA 1664E Oil and Grease ND m911- 5,0 1 05105/15 12:30 8082 GCS PCB Analytical Method: EPA 8082 Preparation Method: EPA 3510 PCB-1018 (Aroclor 1016) ND ug/L 0150 1 05/09/15 14:33 06/12/15 10:37 12674-11-2 tit PCB-1221 (Aroetor 1221) ND ug/L 0.50 1 05/09/15 14:33 0511211510:3T 11104-28-2 H2 PCB-1232 (Aroclor 1232) NO uglL_ 0,50 1 05109/15 14:33 05/12115 10:37 11141-16-5 H2 PCB-1242 (Aroclor 1242) ND ug/L 0.50 1 05/09/16 14:33 05/12/15 10:37 53469-21-9 H2 PCB-1248 (Arocior 1248) ND uglL 0.50 1 05/09/15 14;33 05/12/15 10:37 12672-29.6 H2 PCB-1254 (Afadar 1254) ND uglL 0.50 1 05/09/15 14;33 05/12/15 10:37 11097-69-1 H2 PCB-1260 (Aroclor 1260) ND uglL 0,50 1 05/09115 14:33 05/12/15 10:37 11096-82-5 H2 Surrogates Decachloroblphenyl (5) 58 % 10-132 1 05109/15 14:33 05/12/15 10,37 2051-24-3 2540D Total Suspended Solids Analytical Method: 5M 2540D Total Suspended Solids 15.7 mg1L 4.2 1 05/04115 21:56 Total Nitrogen Calculation Analytical Method: TKN+NO3+NO2 Calculation Total Nitrogen 0.41 mg/L 0.12 1 05111/15 16:46 351.2 Total Kjeldahl Nitrogen Analytical Method: EPA 351.2 Nitrogen, Kjeldahl, Total ND mglL 0,50 1 05/10/15 11;23 7727-37-9 353.2 Nitrogen, NO2/NO3 unpres Analytical Method: CPA 353.2 Nitrogen, Nitrate 0.41 mg/L 0.020 1 05/01/15 23:47 Nitrogen, Nlldle ND mglL M020 1 05/01/15 23:47 Nitrogen, NO2 plus NO3 0.41 mg1L 0.020 1 05/01/15 23:47 Date: 05/1312015 08:05 AM REPORT OF LABORATORY ANALYSIS This report shatl not be reproduced, except in full, without the written consent of Pace Analytical Servlccs, Inc.. Page 4 of 13 aceAnalytical" +t+vwpectdabscom QUALITY CONTROL DATA Project: SPX SEMI ANNUAL Pace Project No.: 92247861 QC Batch: GCSV/21189 Analysis Method: EPA 1664B QC Batch Method: EPA 1664B Analysis Description: 1664 HEM, Oil and Grease Associated Lab Samples: 92247861001 METHOD BLANK: 1450156 Associated Lab Samples: 92247861001 Parameter Units Oil and Grease mglL LABORATORY CONTROL SAMPLE: 1450157 Parameter Units Oil and Gresso mg/L Pace Analytical Services, Inc. 9800 KinceyAve, Suite too Huntersville, NC 20078 (704)B75-9092 Matrix: Water Blank Reporting Result Limit Analyzed Qualifiers ND 5.0 0510511512:18 Spike LCS LCS % Rec Conc. Result % Rec Limits Qualifiers 40 33.4 84 78-114 MATRIX SPIKE SAMPLE: 1450158 92247532004 Spike MS MS e% Rec Parameter Units Result Conc. Result % Rec Limits Qualifiers Oil and Grease mglL ND 40 37.2 93 78-114 Results presented oa this page ere In the units Inarcaled by the'I1nNs" column except where on alternate unit Is presented to ttle right of the result. REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in fu8, Dale: 05/13/2015 08:05 AM without the written consent of Pace Analytical Services, Inc.. Page 5 of 13 aceAna46cal www pacelehs.cam QUALITY CONTROL DATA Project: SPX SEMIANNUAL Pace Project No.: 92247861 QC Batch: OEXT134937 Analysis Method: EPA 8082 QC Batch Method: EPA 3510 Analysis Description: 8082 GCS PCB Associated Lab Samples: 92247861001 METHOD BLANK: 1455119 Associated Lab Samples: 92247861001 Parameter Units PCB-1016 (Aroclor 1016) u91L PCB-1221 (Aroclor 1221) ug1L PCB-1232 (Aroclor 1232) ug/L PCB-1242 (Aroclor 1242) ud/L PCB-1248 (Aroclor 1248) ug1L PCB-1254 (Aroclor 1254) ug1L PCB-1260 (Aroclor 1260) ug1L Decachlorobiphenyl (S) % Pace Analytical Services, Inc. 9800 Klncey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 Matrix: Water Blank Reporting Result Limit Analyzed Qualifiers ND 0.50 05/12115 04:46 ND 0.50 05112/15 04:46 ND 0.50 05/12115 04:46 ND 0.50 05/12115 04:46 ND 0.50 05/12115 04:46 ND 0.50 05/12/15 04:46 ND 0.50 05M2115 04A6 70 10-132 05112115 04:46 LABORATORY CONTROL SAMPLE & LCSD: 1455120 1455121 Spike LCS LCSD t-CS LCSD e% Rec Max Parameter Units Conc. Result Result e% Rec % Rec Ltmlts RPD RPD Qualifiers PCB-1016 (Aroclor 1016) ug/L 5 4.2 4.2 85 84 50-150 2 30 PCB-1260 (Arocior 1260) ug1L 5 3.4 37 68 74 50-150 8 30 Decachtorobiphenyl (S) % 62 68 10-132 Results preaented on this page an In the units indicated by the 'units" column except where an alternate unit Is presented to the right of the reauit. REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, Date: 05/13/2015 08:05AM without the written consent of Pace Analytical Services, Inc.. Page 6 o1 13 aceAnalytical rowwpacefabs.com Project: SPX SEMI ANNUAL Pace Project Na.: 92247861 QC Batch: WET137226 OC Batch Method: SM 2540D Associated Lab Samples: 92247861001 METHOD BLANK: 1449805 Associated Lab Samples: 92247861001 Parameter Units Total Suspended Solids mglL LABORATORY CONTROL SAMPLE: 1449806 Parameter Units Total Suspended Solids my1L SAMPLE DUPLICATE: 1449807 Parameter Units Total Suspended Solids mg1L SAMPLE DUPLICATE: 1449608 Parameter Units Total Suspended Solids mglL Pace Analytical Sorvlcos, Inc. 9800 Klncey Avo. Suite 100 Huntersvllle, NC 28076 (704)875-9092 QUALITY CONTROL DATA Analysis Method: SM 2540D Analysis Description: 2540D Total Suspended Solids Matrix: Water Blank Reporting Result Limit Analyzed Qualifiers ND 2.5 051D4/15 21:51 Spike LCS LCS % Rec Conc. Result % Rec Limits Qualifiers 250 226 90 90-110 92247797001 Dup Result Result RPD Qualifiers ND ND 92247760001 Dup. Result Result RPD Qualifiers 53.D 59.0 11 06 Results presented on this page are In the unlls Indlealed by the "Units" column ezt:apt where an altemate unit is presented to the right of the result. REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full. Date: 06113/2015 08:05 AM without the written consent cf Page Analylical Services, Ina.. Page 7 of 13 aceAnalXical. www.pssefabs.com QUALITY CONTROL DATA Project: SPX SEMI ANNUAL Pace Project No.: 92247861 QC Batch: WETA122848 Analysis Method: EPA 351.2 QC Batch Method: EPA 351.2 Analysis Description: 351,2 TKN Associated Lab Samples: 92247861001 METHOD BLANK: 1453909 Matrix: Water Associated Lab Samples: 92247861001 Blank Reporting Parameter Units Result Limit Analyzed Qualifiers Nitrogen, Kjeldahl, Total mg1L NO 0.50 05/10/15 11:16 Pace Analytical Services, Inc. 9800 Klncey Ave. Suite 100 liuntersville, NO 2a078 (704)876.9092 LABORATORY CONTROL. SAMPLE: 1453910 Spike LCS LCS % Rec Parameter Units Conc. Result % Rec Limits Qualifiers Nitrogen, Kjeldahl, Total mg[L 10 10A 101 90-110 MATRIX SPIKE & MATRIX SPIKE OUPLICATF: 1453911 1453912 MS MSD 92248338002 Spike Spike MS MSD MS MSD % Rec Parameter Units - Result Conc. Conc. Result Result % Rec % Rec Limits RPD Qual Nitrogen, Kjeldahl, Total mglL 1.8 10 10 11.5 11.2 97 94 90-110 3 MATRIX SPIKE & MATRIX SPIKE DUPLICATE: 1453913 1453914 MS MSD 92248586001 Spike Spike MS MSD MS MSD % Rec Parameter Units Result Conc. Conc. Result Result % Rec % Rec Limits RPD Oual Nitrogen, Kjeldahl, Total mg1L 15.9 10 10 27.3 26.9 114 110 9D-110 1 M1 Results presented on this page are In the unite Indicated by the "Units" column except where an alternate unit Is presented to the right of the resen, REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except In full, Date: 0511312015 08:05 AM without the wriften consent of Pace Analytical Services, Inc.. Page 8 of 13 aceAnalytical rmw.ptroelahaoom QUALITY CONTROL DATA Project: SPX SEMI ANNUAL Pace Project No.: 92247861 Pace Analytical Servtcas, Inc. 9800 KlnceyAve. Suite 100 Hunleri;Wle, NC 28078 (704)e75-9092 QC Batch: WETA/22781 Analysis Method: EPA 353.2 QC Balch Method: EPA 353.2 Analysis Description: 353.2 Nitrate + Nitrite, Unpres. Associated Lab Samples: 92247861001 METHOD BLANK: 1448938 Matrix: Water Associated Lab Samples: 92247861001 Blank Reporting Parameter Units Result Limit Analyzed Qualifiers Nitrogen, Nitrate mg1L ND 0,020 05/01/15 23:44 Nitrogen, Nitrite mglL ND 0.020 05101/15 23:44 Nitrogen, NO2 plus NO3 mgfL ND 0,020 05/01/15 23:44 LABORATORY CONTROL SAMPLE: 1448939 Spike LCS LCS % Rec Parameter Units Conn, Result % Rec Limits Qualifem Nitrogen, Nitrate mglL 2.5 2.5 100 90-110 Nitrogen, Nitrite rng1L 1 1.0 101 90-110 Nitrogen, NO2 plus NO3 mg1L 2.5 2.5 100 90-110 MATRIX SPIKE 8 MATRIX SPIKE DUPLICATE: 1448940 1448941 MS MSD 92247861001 Spike Spike MS MSD MS MSD % Rec Parameter Units Result Conc. Conc. Result Result e% Rec % Rec Limits RPD Qual Nitrogen, Nitrate mg1L 0.41 2.5 2.5 2.9 2.9 101 100 90-110 0 Nitrogen, Nitrite mg1L ND 1 1 1.0 1.1 104 105 90-110 1 Nitrogen, NO2 plus NO3 mg/L 0,41 2.5 2.5 2.9 2.9 101 100 90-110 0 ResLdta presented on this page are In the units Indicated try the 'Unite' column except where an alternate unit Is presented to the right at the result, REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full. Date: 05113/2015 08:05 AM Without the written consent or Pnce Arinlytical Services, Inc.. Page 9 of 13 aceAnalytical o wvnpambbs cam QUALIFIERS Project: SPX SEMI ANNUAL Pace Project No.: 92247881 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. J - Estimated concentration above the adjusted method detection limit and below the adjusted reporting limit. MDL-Adjusled Method Detection Limit. PQL - Practical Quantitalion Limit. RL - Reporting Limit. Pace Analytical Sarvices, Inc. 9800 Kincey Ave. Suite 100 Hunterswlte, NC 28070 (704)875-9092 S - Surrogate 1,2-Dlphenylhydrazine decomposes to and cannot be separated from Azobenzene using Method 8270. The result for each analyte is a combined concontration. Consistent with EPA guidelines, unfounded 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 Gal - Clean -Up U - Indicates the compound was analyzed for, but not detected. Acid preservation may not be appropriate for 2 Chloroethylvinyl ether, Styrene, end Vinyl chloride. A separate vial preserved to a pH of 4-5 is recommended in SW846 Chapter 4 for the analysis of Acroleln and Acrylonitrile by EPA Method 8260. N-Nitrosodtphonylamine decomposes and cannot be separated from Diphenylamine using Method 8270. The result reported for each analyte is a combined concentration. Pace Analytical Is TNI accredited. Contact your Pace PM for the current list of accredited analytes. TN - The NEI.AC Institute. LABORATOWES PASI-A Pace Analytical Services -Asheville PAST-C Pace Analytical Services - Charlotte ANALYTE QUALIFIERS D6 The relative percent difference (RPD) between the sample and sample duplicate exceeded laboratory control limits. 112 Extraction or preparation conducted outside EPA method holding time. M1 Matrix spike recovery exceeded QC limits. Batch accepted based on laboratory control sample (LCS) recovery. REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, Date: 05/1312015 08:05 AM without the written consent 0 Pace Analytical Services, Inc„ Page 10 of 13 aceAnalytical wwwpac bs.com QUALITY CONTROL DATA CROSS REFERENCE TABLE Project: SPX SEMIANNUAL Pace Project No.: 92247861 PareAnelyticel Services, Inc. 9800 Kincey Ave. Svlte 100 Huntersvills, NC 28078 (704)875-9092 Lab 10 Sample lD QC Batch Method QC Batch Analytical Method 92247861001 8D01 EPA 1664B GCSVl21189 92247861001 SD01 EPAS510 OEXT134937 EPA8082 92247861001 SD01 SM 2540❑ WET137226 92247861001 S1301 TKN+NO3+NO2 WET137383 Calculation 97247861001 8001 EPA351.2 WETAl22848 92247B61001 S001 EPA 353.2 VVETA122781 •Date; 05113/2015 08:D5 AM REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except In Tull, without the written consent of Pace Analytical Services, Inc.. Analytical Batch GCSV121267 Page 11 of 13 � '=Analyflcar" Document Name: Condition Upon Roo R-CS-003-rev.15 Document Revised: Septemuer 11. zui4 Pace 1 of 2 Client Name:�t:V eofth �-iy,,j 2 Courier: ❑ Fod- x ❑ UPS❑ USPS❑ Client��no rnmerctal❑ Pace Other Custody Seal on Cooler/Box Present: ❑ yes Seals intact: ❑ yes ❑ no ace Huntersvllle Quality Office Packing Material: ❑ Bubble V[kp E2fu I ags ❑ None ❑ Other Thermometer Used: IR Gun T1401 Typo of too:, doe[ Blue None Samples on Ice, cooling process has begun Temn Cerractinn Factor T1401 No Corrantlnn Corrected Cooler Temp.: 'C Tamp should be above freezing to WC Biological Tissue is Frozen; Yes No g Comments. Date and Initials p rs r e Wining contents: ' Chain of Custody Present; Y ONO ❑NIA 1. Chain of Custody Filled Out: ZVI ONO,, ❑N/A 2. Chain of Custody Relinquished: Yas o ❑NIA 3. Sampler flame & Signature on COG: —Zye a ONO ❑NIA 4. Sam les Arrived within Hold Time: VfyX LINo L1NIA 6, Short Hold Tlme Analysis a72hr : dyes'OtW ❑NIA 6. Rush Turn Around Time Requested: ❑Y a 141,10 ONIA 7. Sufficient Volume; Y ❑No ❑NIA 8. Correct Containers Used, -Pace Containers Used: s ❑No ZyaC1No ❑NIA ❑NIA 9, Containers Intact: Yea ❑No EIN/6 10, Filtered volume received for Dissolved tests fay, ©No UfNIA 11. Sample Labels match COC: -Includes date/tlmellD/Anal sis Matrix; Yca []No DWA 12. All containers needing preservaton have been checked. All containers needing preservation are found to be in compliance with EPA recommendatlon. exeo !Ions: VOA,celiforrn. TOC, O&G, Wf-DRO (water) EI/Yea ❑No a ❑No Zee❑ No ❑NIA 11NIA 13. Samples checked for dechlorinaVon: 11Y83 ONO ljw 14, Heads ace in VOA Vials ;�6mm : DYes ❑No NI 15. Trip Blank Present: Trip Blank Custody Seals Present Pace Trip Blank Lot # if urchase ❑Yaa ❑No []Yes ONO N 16, Ghent Notification/ Resolution: Field Data Required? Y 1 N Person Contacted: Date/Time: Comments/ Resolution: SCURF RevleW; Date: SRF RBview: Date: Note; Whenever there Is a discrepancy affecting North Carolina compliance samples, a copy of this form will be sent to the North Carolina DEHNR Certification Office ( Le out of hold, Incorrect preservative, out of tomp, Incorrect containers) woe: ezza7aei li�ip�p im mmu -Tage 12 or 13 �.f'3CE'Af131yt1C31' CHAIN -OF -CUSTODY 1 Analytical Request Document The Chaim-of-Crss" is a LEGAL DOCUMENT. All rei&=l fields must be ewn* d a— a%4y. Section A Section B Section C Page: � of f Requimd CFent tnfarmWow Required Prged InfamO&G lnvO= lnfvrrtSY RePcd TD:��y� 14 4 95 G ` , ins CapyTt co v p j REGU RY AGENCY F -7 AdO cI����� '� r NPDES GROUND WATER DRINMNG WATER i UST r- RCRA a OTHER Putd+asc Order No: Po Qua Fax ProjEGt Nsme; sp Para �* Si Location Requested Due Date/TAT- Project Number. oca Froua ; � STATE: RegUested AnalysiS Filtered (YIN) Seeson II Matrix Codes x Rwuki dCk" Womayon r.fAMIX r CODE COLLECT D Preservatfve5 T` Drirauny Water Ovr y� d o Water VV7 tf U Waste Water %%W r m p w Prod U P 504SUd SL Z SAMPLE ID wpe OL W m z 9 (A-Z. 0-9 ! Air AR Sample IDs MUST 8E UNIQUE w W a i 2 a Tissue TS OVw Or O �. 2 g c O O `l - DATE TIME DATE TIME w T T Z O ! i' Pace Project NoJ Lab LD. 2 r _ fi 7 8 9 f 70 11 12 ADDITIONAL COMMENTS FtSUM ULSREDBYIAFFRL4TION DATE TIME AO ATION DATE TIEr1= SAMPLECONDfTIONS IL v P i SAMPL6i NAME AND SIQUATURE. v = 3 2Ci.NA_ PRINT Hamo of SAMPLER: D� log' SIGNATUREclSAtdPLF,R; ! ff � 'tI11pOR Note: ey dgrlrg the tam yw ae smwq Paces NET 3D day payment term$ am eprcalrq 0 t39 erypss of tR% per tnendt far any &&Vkm -6t pald %par, SD rmy$. F-ALL-0-020ray.07, 15-Mzly-20a7