NCS000370_COMPLETE FILE - HISTORICAL_20191217

December 12, 2019
North Carolina Division of Water Quality
Attn: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
BRIDGESTONE AMERICAS
TIRE OPERATIONS, LLC
Wilson Plant
P.O. Box 1139
Wilson, North Carolina 27894-1139
RECEIVED
DEC 7 2018
CEN7i_ Fl
b Wei SECTlO
Re: Storm water Sampling Year 10, Period 1 Analytical Results
Dear Sir or Madam. -
Enclosed is an updated DMR for the Bridgestone Americas Tire Operations, LLC
(BATO) Wilson Plant. On December 10, 2019, Bridgestone received an updated lab
report from Pace Analytical. The reported result for TSS from the South outfall had
been incorrectly reported on the original lab report. The DMR has been updated with
the correct TSS for the South outfall.
The BATO-Wilson facility operates under National Pollutant Discharge Elimination
System (NPDES) permit number NCS000370. The permit requires semi-annual
quantitative sampling of storm water at the facility's two outfalls. The outfalls are named
by their geographic locations, South and East. Please find the analytical results and
Storm Water Outfall Discharge Monitoring Reports for the Sampling Year 10 Period 1
for the South and East outfalls in the Attachment. The samples were collected on
November 11, 2019. The analytical results were received from the laboratory via
electronic mail at BATO Wilson on November 21, 2019. As required, the original and
one copy are enclosed.
If you have any questions concerning this report, please contact Tausha Fanslau at
[phone].
Sincerely,
Vergil Norrod
Plant Manager
BATO — Wilson Plant
cc: BATO Wilson Environmental Department
pAMy Documents\Water-Stormwater\Files19

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number NCS 000370 SAMPLES COLLECTED DURING CALENDAR YEAR: 2019
(This monitoring report shall be received by the Division no later than 30 days from
the date the facility receives the sampling results from the laboratory.)
FACILITY NAME Bridgestone Americas Tire Operations, LLC
PERSON COLLECTING SAMPLE(S) Tausha FansIau R EI �/ ED
CERTIFIED LABORATORY(S Pace Analytical
DEC 17 20l9
Part A: Specific Monitoring Requirements
COUNTY Wilson
PHONE NO. ( 252 j 246-7485
SIGNATURE OF PERMITTEE OR DESIGNEE
REQUIRED ON PAGE 2.
Outfall
No.
Date
Sample
Collected
Total
Flow. (if app.)
Total
Rainfall
ZINC (t)'
COD
TSS
TPH
PH
mo/dd/ r
MG-
inches
Mg/L.
M /L
MIL"
MIL
East
11/12/2019
0.47
0.0246
<25
4.7
< 5
6.4
South
11/12/2019
0.47
0.154
<25
30.2*
5.0
6.2
*Updated due to a lab error, see attached corrected lab report
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? _ yes X no
(if yes, complete Part B)
Part B: Vehicle Maintenance Activity Monitoring Requirements
Outfall
Date
;50054
40556
00530
00400
Total Flow
(if applicable)
Total, :
Ra�nfalh
`,Oil &-Grease :.
{if-appC)
Non -polar
O&GITPH'
(Method 1'664 -
Total -
Suspended
Solids.
pH
New Motor
Oil Usage
No.-
Sample- .
Collected
t
SGT-HEM); if
a 1
moiddi r
MG
inches `
m /L.
mg/1
unit
at/mo
Form SWU-247, last revised 21212012
Page I of 2

STORM EVENT CHARACTERISTICS:
Date 11/12/2019
Total Event Precipitation (inches): _0.47
Event Duration (hours): 4.0 (only if applicable -- see permit.)
(if more than one storm event was sampled)
Mail Original and one copy to:
Division of Water Quality
Attn: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
"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."
(Date
Form SWU-247, last remised 21212012
Page 2 of 2

(�IacieAnalyticalo
www.pacelahs.com
December 10, 2019
Tausha Fanslau
Bridgestone Americas
3001 Firestone Parkway
Wilson, NC 27893
RE: Project: Stormwater Sampling -Revised Report
Pace Project No.: 92453778
Dear Tausha Fanslau:
Pace Analytical Services, LLC
9800 KinceyAve. Suite 100
Huntersville, NC 28078
[phone]
Enclosed are the analytical results for sample(s) received by the laboratory on November 14, 2019.
The results relate only to the samples included in this report. Results reported herein conform to the
most current, applicable TNI/NELAC standards and the laboratory's Quality Assurance Manual,
where applicable, unless otherwise noted in the body of the report.
This revision was issued on 12/10/19 to correctly report the TSS data for sample "SOUTH"
(92453778001). The TSS data in the original report was reported due to an analyst error.
If you have any questions concerning this report, please feel free to contact me.
Sincerely,
Nicole Gasiorowski for
Amanda Payne
[e-mail]
[phone]
Project Manager
Enclosures
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full, .
without the written consent of Pace Analytical Services, LLC.
Page f of 15

lacmnalyficalo
wwarpacilats.cam
CERTIFICATIONS
Project: Stormwater Sampling -Revised Report
Pace Project No.: 92453778
Pace Analytical Services Charlotte
Pace Analytical Services, LLC
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
9800 Kincey Ave. Ste 100, Huntersville, NC 28078
South Carolina Certiflcation #: 99006001
Louisiana/NELAP Certification # LA170028
Florida/NELAP Certification #: E87627
North Carolina Drinking Water Certification #: 37706
Kentucky UST Certification #: 84
North Carolina Field Services Certification #: 5342
VirginiaNELAP Certification #: 460221
North Carolina Wastewater Certification #: 12
Pace Analytical Services Asheville
2225 Riverside Drive, Asheville, NC 28804
Florida/NELAP Certification #: E87648
Massachusetts Certification #: M-NCO30
North Carolina Drinking Water Certification #: 37712
North Carolina Wastewater Certification #: 40
South Carolina Certification #: 99030001
VirginiafVELAP Certification #: 460222
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, LLC. Page 2 of 15

laceAnalytrcal
www.pecelds.cors
SAMPLE ANALYTE COUNT
Project: Stormwater Sampling -Revised Report
Pace Project No.: 92453778
Pace Analytical Services, LLC
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
Lab ID Sample ID Method
Analysts
Analytes
Reported
Laboratory
92453778001 SOUTH EPA 1664B
HH
1
PASI-C
EPA 200.7 Rev 4.4 1994
KQ
1
PASI-A
SM 2540D•2011
CJL
1
PASI-A
EPA 9040C
ECH
1
PASI-A
SM 5220D-2011
GC
1
PASI-A
92453778002 EAST EPA 1664B
HH
1
PASI-C
EPA 200.7 Rev 4.4 1994
KQ
1
PASI-A
SM 2540D-2011
CJL
1
PAS I -A
EPA 9040C
ECH
1
PASI-A
SM 52200-2011
GC
1
PASI-A
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, LLC.
Page 3of15

acleAnalytical
WM."Colabf.com
ANALYTICAL RESULTS
Project: Stormwater Sampling -Revised Report
Pace Project No.: 92453778
Pace Analytical Services, LLC
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
Sample: SOUTH
Parameters
Lab ID: 92453778001 Collected: 11/12/19 13:10
Results Units Report Limit DF
Received: 11/14/19 09:04 Matrix: Water
Prepared Analyzed GAS No. Qual
1664 SGT-HEM, TPH
Analytical Method: EPA 16646
Total Petroleum Hydrocarbons
5.0 mglL 4.8 1
11/20/19 15:17
200.7 MET ICP
Analytical Method: EPA 200.7 Rev 4A 1994 Preparation
Method: EPA 200.7 Rev 4.4 1994
Zinc
154 ug1L 10.0 1
11/16/1912:39 11/18/1906:29 7440-66-6
2540D Total Suspended Solids
Analytical Method: SM 2540D-2011
Total Suspended Solids
30.2 mglL 5.0 1
11/18/19 18:56
9040 pH
Analytical Method: EPA 9040C
pH at 25 Degrees C
6.2 Std. Units 0.10 1
11/17/19 14:50 H3
5220D COD
Analytical Method: SM 5220D-2011 Preparation Method: SM 52200-2011
Chemical Oxygen Demand
ND mg/1- 25.0 1
11/19/19 16:37 11/19/19 23:21
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
Date: 12/10/2019 12:18 PM without the written consent of Pace Analytical Services, LLC. Page 4 of 15

(�IaneA'nalyfical'
www.pacataftsxam
ANALYTICAL RESULTS
Pace Analytical Services, LLC
9800 Kincey Ave. Suite 100
Huntorsville, NC 28078
[phone]
Project: Stormwater Sampling -Revised Report
Pace Project No.: 92453778
Sample: EAST Lab ID: 92453778002 Collected: 11/1211913:30 Received: 11/14/1909:04 Matrix: Water
Parameters Results Units Report Limit DF Prepared Analyzed CAS No, Qual
1664 SGT-HEM, TPH
Analytical Method: EPA 1664B
Total Petroleum Hydrocarbons
ND mg/L 4.8 1 11/20/19 15:17
200.7 MET ICP
Analytical Method: EPA 200.7 Rev 4A 1994 Preparation Method: EPA 200.7 Rev 4.4 1994
Zinc
24.6 ug1L 10.0 1 11/16/19 12:39 11/18/19 06:33 7440-66-6
2540D Total Suspended Solids
Analytical Method: SM 254OD-2011
Total Suspended Solids
4.7 mg/L 2.5 1 11/18/19 18:57
9040 pH
Analytical Method: EPA 9040C
pH at 25 Degrees C
6.4 Std. Units 0.10 1 11/17/19 14:55 H3
5220D COD
Analytical Method: SM 5220D-2011 Preparation Method: SM 5220D-2011
Chemical Oxygen Demand
ND mg/L 25.0 1 11/19/19 16:37 11/19/19 23:21
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
Date: 12/10/2019 1218 PM without the written consent of Pace Analytical Services, LLC. Page 5 of 15

Pace Analytical Services, LLC
aceAnalytical 9eoaKinoeyAve. Suite Huntersville, NC 2807878
www.potollbs.com [phone]
QUALITY CONTROL DATA
Project: SLormwaler Sampling -Revised Report
Pace Project No.: 92453778
QC Batch: 510729 Analysis Method: EPA 1664B
QC Batch Method: EPA 1664B Analysis Description: 1664 SGT-HEM, TPH
Associated Lab Samples: 92453778001, 92453778002
LABORATORY CONTROL SAMPLE:
2739945
Spike LCS
LCS
% Rec
Parameter
Units
Cone. Result
% Rec
Limits
Qualifiers
Total Petroleum Hydrocarbons
mg/L
20 22.1
110
64-132
MATRIX SPIKE SAMPLE:
2739946
35510490004 Spike
MS
MS
% Rec
Parameter
Units
Result Cone.
Result
% Rec
Limits Qualifiers
Total Petroleum Hydrocarbons
mg1L
51.4 19.6
88.9
192
64-132 M1
Results presented on this page are in the units Indicated by the "Units" column except where an alternate unit Is presented to the right or the result.
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full.
Date: 12/10/2019 12:18 PM without tho written consent of Pace Analytical Services, LLC.
Page 6 of 15

aceAnalyltical
www.picalabs.com
Project: Stormwater Sampling -Revised Report
Pace Project No.: 92453778
QC Batch: 509903
QC Batch Method: EPA 200.7 Rev 4.4 1994
Associated Lab Samples: 92453778001, 92453778002
METHOD BLANK: 2736512
Associated Lab Samples: 92453778001. 92453778002
Parameter Units
Zinc ug1L
QUALITY CONTROL DATA
c
Analysis Method: EPA 200.7 Rev 4.4 1994
Analysis Description: 200.7 MET
Matrix: Water
Blank Reporting
Result Limit Analyzed Qualifiers
ND 10.0 11/18/19 05:07
Pace Analytical Services, LLC
9800 Kincey Ave. Suite 100
Huntorsville, NC 28078
[phone]
LABORATORY CONTROL SAMPLE: 2736513
Spike LCS LCS % Rec
Parameter Units Conc. Result % Rec Limits Qualifiers
Zinc ug/L 500 478 96 85-115
MATRIX SPIKE & MATRIX SPIKE DUPLICATE: 2736514 2736515
MS MSD
92452973001 Spike Spike MS MSD MS MSD % Rec
Parameter Units Result Conc. Conc. Result Result % Rec % Rec Limits RPD Qual
Zinc ug/L 153 500 500 619 640 93 97 70-130 3
MATRIX SPIKE & MATRIX SPIKE DUPLICATE: 2736516 2736517
MS MSD
92453397008 Spike Spike MS MSD MS MSD % Rec
Parameter Units Result Conc. Conc. Result Result % Rec % Rec Limits RPD Qual
Zinc ug/L 0,23 500 500 733 715 101 98 70-130 2
mg/L
Results presented on this page are In the units indicated by the "Units" column except where an alternate unit is presented to the right of the result.
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in lull,
Date: 12/10/2019 12:18 PM without the written consent of Pace Analytical Services, LLC.
Page 7 o1 15

aceAnalytical
www.paeataba.eon
QUALITY CONTROL DATA
Project: Stormwater Sampling -Revised Report
Pace Project No.: 92453778
QC Batch: 510251 Analysis Method: SM 254OD-2011
QC Batch Method: SM 2540D-2011 Analysis Description: 2540D Total Suspended Solids
Associated Lab Samples: 92453778001, 92453778002
Pace Analytical Services, LLC
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
METHOD BLANK: 2737978
Matrix: Water
Associated Lab Samples: 92453778001, 92453778002
Blank Reporting
Parameter
Units
Result Limit
Analyzed Qualifiers
Total Suspended Solids
mg/L
ND 2.5
11/18/19 18:51
LABORATORY CONTROL SAMPLE:
2737979
Spike LCS
LCS % Rec
Parameter
Units
Cone. Result
% Rec Limits Qualifiers
Total Suspended Solids
mg/L
250 234
94 90-110
SAMPLE DUPLICATE: 2737980
92453632001 Dup
Parameter Units Result Result RPD Qualifiers
Total Suspended Solids mg/L 44.9 51.7 14
SAMPLE DUPLICATE: 2737981
92453776004 Dup
Parameter Units Result Result RPD Qualifiers
Total Suspended Solids mg/L 40.2 39.4 2
Results presented on this page are In the units Indicated by the "Units" column except where an alternate unit Is presented to the right of the result.
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
Date: 12110/2019 12:18 PM without the written consent of Pace Analytical Services, LLC, Page 8 of 15

aceAnalXical
www,jmcgllbs.com
QUALITY CONTROL DATA
Project: Stormwater Sampling -Revised Report
Pace Project No.: 92453778
QC Batch: 509994 Analysis Method: EPA 9040C
QC Batch Method: EPA 9040C Analysis Description: 9040 pH
Associated Lab Samples: 92453778001, 92453778002
SAMPLE DUPLICATE: 2736835
92452727001 Dup
Parameter Units Result Result RPD Qualifiers
pH at 25 Degrees C Std. Units 7.9 7-7 2 H3
SAMPLE DUPLICATE: 2736836
Parameter
pH at 25 Degrees C
92453279001 Dup
Units Result Result
Std. Units 5.9 5.4
RPD Qualifiers
8 H3
Pace Analytical Services, LLC
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
Results presented on this page are in the units Indicated by the 'Units" column except where an alternate unit Is presented to the right of the result.
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
Date: 12110/2019 12:18 PM without the written consent of Pace Analytical Services, L.L.C. Page 9 of 15

(�15'ne Analytical
wrww.pacelabs.com
QUALITY CONTROL DATA
Project: Stormwater Sampling -Revised Report
Pace Project No.: 92453778
Pace Analytical Services, LLC
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
QC Batch: 510477
Analysis Method: SM 5220D-2011
QC Batch Method: SM 5220D-2011
Analysis Description: 5220D COD
Associated Lab Samples: 92453778001, 92453778002
METHOD BLANK: 2738904
Matrix: Water
Associated Lab Samples: 92453778001, 92453778002
Blank Reporting
Parameter Units
Result Limit
Analyzed Qualifiers
Chemical Oxygen Demand mg/L
ND 25.0
11/19/19 23:16
LABORATORY CONTROL SAMPLE: 2738905
Spike LCS
LCS % Rec
Parameter Units
Conc. Result
% Rec Limits Qualifiers
Chemical Oxygen Demand mg/L
750 757
101 90-110
MATRIX SPIKE & MATRIX SPIKE DUPLICATE: 2738906 2738907
MS MSD
92453323001
Spike Spike MS
MSD MS MSD % Rec
Parameter Units Result
Conc. Conc. Result
Result % Rec % Rec Limits RPD Qual
Chemical Oxygen Demand mg1L ND
100 100 106
103 103 101 90-110 2
MATRIX SPIKE & MATRIX SPIKE DUPLICATE: 2738908 2738909
MS MSD
92453776001 Spike Spike MS MSD MS MSD % Rec
Parameter Units Result Conc. Conc. Result Result % Rec % Rec Limits RPD Qual
Chemical Oxygen Demand mg/L 327 100 100 444 444 118 118 90-110 0 M1
Results presented on this page are in the units Indicated by the "Units" column except where an alternate unit Is presented to the right of the result.
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
Date: 12/10/2019 12:18 PM without the written consent of Pace Analytical Services, LLC.
Page 10 of 15

(�IacieAnalyfical"
www.pacalabs.can
QUALIFIERS
Project: Stormwater Sampling -Revised Report
Pace Project No.: 92453778
DEFINITIONS
DF - Dilution Factor, if reported, represents the factor applied to the reported data due to dilution of the sample aliquot.
ND - Not Detected at or above adjusted reporting limit.
TNTC - Too Numerous To Count
J - Estimated concentration above the adjusted method detection limit and below the adjusted reporting limit.
MDL -Adjusted Method Detection Limit.
Pace Analytical Services, LLC
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
PQL - Practical Quantitation Limit.
RL - Reporting Limit - The lowest concentration value that meets project requirements for quantitative data with known precision and
bias for a specific analyte in a specific matrix.
S - Surrogate
1,2-Diphenylhydrazine decomposes to and cannot be separated from Azobenzone using Method 8270, The result for each analyte is
a combined concentration.
Consistent with EPA guidelines, unrounded data are displayed and have been used to calculate % recovery and RPD values.
LCS(D) - Laboratory Control Sample (Duplicate)
MS(D) - Matrix Spike (Duplicate)
DUP - Sample Duplicate
RPD - Relative Percent Difference
NC - Not Calculable.
SG - Silica Gel - Clean -Up
U - Indicates the compound was analyzed for, but not detected.
Acid preservation may not be appropriate for 2 Chloroethylvinyl ether.
A separate vial preserved to a pH of 4-5 is recommended in SW846 Chapter 4 for the analysis ofAcrolein and Acrylonitrile by EPA
Method 8260.
N-Nitrosodiphenylamine decomposes and cannot be separated from Diphenylamine using Method 8270. The result reported for
each analyte is a combined concentration.
Pace Analytical is TNI accredited. Contact your Pace PM for the current list of accredited analytes.
TNI - The NELAC Institute.
LABORATORIES
PASI-A Pace Analytical Services - Asheville
PASI-C Pace Analytical Services - Charlotte
ANALYTE QUALIFIERS
H3 Sample was received or analysis requested beyond the recognized 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: 12/10/2019 12:18 PM without the written consent of Pace Analytical Services, LLC. Page 11 of 15

aceAnalytical
www.pacelabs.com
QUALITY CONTROL DATA CROSS REFERENCE TABLE
Pace Analytical Services, LLC
9800 KinceyAve. Suite 100
Huntersville, NC 28078
[phone]
Project: Stormwater Sampling -Revised Report
Pace Project No.: 92453778
Analytical
lab ID Sample ID QC Batch Method QC Batch Analytical Method Batch
92453778001
SOUTH
EPA 1664B
510729
92453778002
EAST
EPA1664B
510729
92453778001
SOUTH
EPA 200.7 Rev 4.4 1994
509903
92453778002
EAST
EPA 200.7 Rev 4.4 1994
509903
92453778001
SOUTH
SM 254OD-2011
510251
92453778002
EAST
SM 2540D-2011
510251
92453778001
SOUTH
EPA 9040C
509994
92453778002
EAST
EPA 9040C
509994
92453778001
SOUTH
SM 5220D-2011
510477
92453778002
EAST
SM 5220D-2011
510477
Date: 12/10/2019 12:18 PM
G
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, LLC.
EPA 200.7 Rev 4.4 1994 509934
EPA 2007 Rev 4.4 1994 509934
SM 5220D-2011
SM 5220D-2011
510531
510531
Page 12 of 15

Laboratory receiving samples:
Asheville 0 Eden[] Greenwood ❑ Huntersvlle ❑ Raleigh[g MechanicsvilleE
Client Name: (WO 92458778
{{
• Project tip
r`f. 11
Courier ❑Fed Ex UP5 ❑USP5 Client II Jill' fll]'.111
[] Commercial JDpace Other: 92453778
Custody Seal Present? []Yes gNo - Seals Intact? []Yes allo `_
Date/Initials Person Fxamfning Contents:
N57-
I f l /9
Packing Material: Bubble Wrap • []Bubble Bag_ s E]None ❑ Other Biological Tissue Frozen?
Thermometer. Dyes []No BN/A
AIR Gun ID: q ,. Type of ice: , Wet []Blue QNane
Cooler Temp ('C). - 3 Correction Fact , u j ®• Q
p { 1 _ 3 Temp should he shave freezing to 6'C
Cooler Tem Corrected 'C : O • ❑Samples out of temp criteria. Samples on lie, coaling process
has begun
USDA Regulated Soil (® N/A, water sample)
Did samples orlglnate In a quarantine zone within the United States: CA, NY, or SC (check maps)?
❑Yes ❑No
Old samples orlginate from a foreign source (internationally,
Ineludlne HawAll and Puerto RlcolT ayes r1bla
Comments/Dlscrepanty:
Chain of Custody present?
Yea
No
N/A
1.
Sames Arrived within Hold 7ime7
❑No
N/A
2.
ld Time Anal Is (<72 hr.j?
�Yeaj
ESNo
N/A
3.
Rush Turn Around Time Re uested?
QYes
Na
N/A
4.
SufticlentVolume7
Joyes
No
EIKA
5.
Correct Containers Used?
-Pace Containers Used?
)BYes
es
[]NO
No
❑N/A
N A
6.
Containers Intact?
Yes
[]No
N/A
7.
Oissolvedanol :5am Ies Field Filtered?
Dyes
JDuo
A
I a.
Sample Labels Match COC?
-Includes Date/Time/ID/Analysts Matrix:
Pes
❑No
❑H/A
9.
Heads ace In VOA Vials (>5.6mm)7
QYF3
Na
N/A
10.
Trip Blank Present?
Trip Blank Custody S61SPresent7
❑Yes
es
❑No
QND
/A
/A
11.
COMMENTS/SAMPLE DISCREPANCY
Lot ID of split containers:
CLIENT NOTIFICATION/RESOLUTION
Field Data Required? ❑Yes []NO
Person contacted: Date/Time:
Project Manager SCURF Review: Date:, _ L_i
Project Manager 5RF Review: 1, Date:
Page 13 of 15

*Check mark top half of box If pH and/or dechlorinatlan Is
verified and wlthln the acceptance range for preservation
samples. -
Exceptions: VOA, Collform, TOC, Oil and Grease, DROIB015 (water) DOC, LLHg
"Bottom half of box Is to list number of bottle
W0 22453??5 `y
Project h ,
PM: AP Due Date: 11/21/19
CLIENT.. 92-BFUSA
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Page 14 of 15

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