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HomeMy WebLinkAboutNCG140128_MONITORING INFO_20061106STORMWATER DIVISION CODING SHEET NCG PERMITS PERMIT NO. DOC TYPE, ❑ HISTORICAL FILE CX MONITORING REPORTS DOC DATE ❑ b ID l YYYYM M D D AGRA' NC®ENR 63 DISCHARGE OUTFALL MONITORING REPORT GENERAL PERMIT NCG140000 (All sample data shall be reported no later than 30 days after receipt of lab results) Certificate of Coverage NCGI/4 O / Z $ Facility Name 4cQ` County Gra,t,j/ �(•¢ (Phone Number i 5 1396 Certified Laboratory # 3 Person Collecting Sample(s) G 4 —� Collectors Signature / Sample Information Permit Term Year Year Start/End Dates Place check mark to indicate applicable sampling period Discharge Type (check as appropriate) Stormwater. Wastewater I August 1, 2004 to July 31, 2005 Q— ❑' ❑ El ❑ O / ❑ ID ❑ O ❑ ❑ 2 August 1, 2005 to July 31, 2006 3 August 1, 2006 to July 31, 2007 4 August 1, 2007 to July 31, 2008 5 August 1, 2008 to July 31, 2009 Part A: Stormwater Discharge Monitoring Data (For stormwater not combined with process wastewater) Storm Event Characteristics Date Total Event Preci itation (inches) Event Diration (hours) B6 .75 Z Stormwater Discharge Monitoring Outfall No. . Date Sample Collected (mo/dd/ ) Total Flow -- Total Event Precipitation (inches) Event Duration (hours pH (Std. Units) Total Suspended Solids (me/I) O0 2 W& Does this facility perfo Vehicle Maintenance Activities using on average more than 55 gallons of new motor oil per month? El Ye: 7No If yes, complete information below. Stormwater Discharge Monitoring from Vehicle Maintenance Areas Outfall No. Date Sample Collected (mo/dd/ ) Total Flow (MG) Total Event Precipitation (inches)- Event Duration (hours) New Motor Oil Usage (gal/mo) pH (Std. Units) Total Suspended Solids (mg t) Oil and Grease (mg ) SWU-241-080104 Page loft 1� :J '1 y .- (j 1 tJ c� I Part B 'Process wastewater discharge monitoring data i Sample`#'� Effluent Source(s) for this sample Vehicle / Equipment Cleanin ❑ Raw Material Stock -pile Wetting ❑ -Mixing Drum Clean -out ❑ ,Recycle S stem Overflow ❑ Parameter Unit Data Collection Date mo/dd/yr Total Flow MG Event Duration hours pH Sid. units TSS mg/1 Settleable Solids ml/1 Sample # _ Effluent Source(s) for this sample ./ Vehicle / ui ment Cleanin ❑ Raw Material Stock -pile Wettin ❑ Mixing Drum Clean -out ❑ Recycle System Overflow ❑ Parameter Unit Data Collection Date mo/dd/yr Total Flow MG Event Duration hours pH Std. units TSS mg/l Settleable Solids mul Mail original and one copy to: Attn: Central Files Division of Water Quality DENR 1617 Mail Service Center Raleigh, NC 27699-1617 Sample # _ Effluent Source(s) for this sample / Vehicle / Equipment Cleaning ❑ Raw Material Stock -pile Wetting ❑ Mixing Drum Clean -out ❑ Rec cle-S stem,Overflow ❑ Parameter Unit Data Collection Date me/dd/yr Total Flow MG Event Duration hours pH Std. units TSS mg/I Settleable Solids in,/, Sample # Effluent Sources forthis•sam le / V-e'hic-le/'EcluipmentCleanin ❑ Raw Material Stock -pile Wettin ❑ Mixing Drum Clean -out ❑ Recycle System Overflow ❑ Parameter Unit Data Collection Date mo/dd/yr Total Flow MG Event Duration hours pH Std. units TSS mg/I Settleable Solids ml/1 "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 f;--^ Ind imprisonment for knowing violations." / Lu nnLiN / i S9i A 69 of Yermtttee or Designee) SWU-23t-080104 / / Page 2 of 2 0 Stormwater Discharge Outfall (SDO) Qualitative Monitoring Report Permit No.: N/C/" O/ /l AVI or Certificate of Coverage No.: N/CIGILI `1/Ol / l,2 /I/ Facility Name: County: eaiL l� Phone No. Sys^ 4380 Inspector: C,'4 ' ia,rrni/o.. Date of Inspection By this signapre, 1 certify that this is accurate and complete to the best of my knowledge: (Signatul`e ermittee or Designee) 1. O Il Description Outfall No. Structure IQ ditch, etc.) Receiving Stream: Describe the industrial activities that occur within the outfall drainage area: 2. Color Describe the color of the discharge usin basic colors (red, brown, blue, etc.) and tint (light, medium, dark) as descriptors: LI;(— a,IY 3. Odor Describe any distin t c�oat the discharge may have (i.e., smells strongly of oil, weak chlorine odor, etc.) O r 4. Clarity Choose the number which best describes the clarity of the discharge where 1 is clear and 10 is very cloudy: 1 3 4 5 6 7 8 9 10 Page 1 SWU-242-101599 ,1 . 5. Floating Solids Choose the number which best describes the amount of floating solids in the stormwater discharge where 1 is no solids and 10 is the surface covered with floating solids: V I1 2 3 4 5 6 7 8 9 10 6. Suspended Solids Choose the number which best describes the amount of suspended solids in the stormwater discharge where 1 is'no'solids and 10 is extremely muddy: 2 3 4 5 6 7 8 9 10 7. Foam Is there any foam in the stormwater discharge? Y",s' No S. Oil Sheen Is there an oil sheen in the stormwater discharge? Yes No 9. Other Obvious Indicators of Stormwater Pollution List and describe Note: Low clarity, high solids, and/or the presence of foam or oil sheen may be indicative of pollutant exposure. These conditions may warrant further investigation. Page 2 SWU-242-101599 Telephone: (919)834-4984 Fax: (919)834-6497 Vi QoTEST 6701 Conference Drive Raleigh, NC 27607 Laboratory Report --- Prepared for --- LYMAN AUSTIN READY MIXED CONCRETE CO. P.O. BOX 27326 RALEIGH, NC 27611 Page 1 of 1 NC/WW Cent. #: 067 NC/DW Cent. M 37731 Report Date: 10/12/2006 Date Received: 10/6/2006 Work Order #: 0610-00484 Project No.: Cust. Code: RE1520 Project ID: STORMWATER PLANT 13 Cust. P.O.#: No. Sample ID 001 OUTFALL 1 Date Sampled Time Sampled Matrix Sample Type Condition 101612006 10:00 SW Grab 4 +/- 2 deg C Analyzed Test Performed Method Results Date Time Qualifier Total Suspended Solids EPA 160.2 63.6 mg/L 1019/06 16:00 Reviewed by: % for Tritest; Inc.(I' Tritest, Inc. 3909 Beryl Road, Raleigh, NC 27607 ph: (919) 8344984 fax: (919) 834-6497 NCWW CERT#67, NCDW CERT#3➢731 Report Results To Company: READY MIXED CONCRETE CO. Address: P.O. BOX 27326 RALEIGH, NC 27611 Attn: LYMAN AUSTIN Phone: 919-790-1520 Sampled by (signature): _ Fax: 919-981-0910 Chain of Custody Bill To: READY MIXED CONCRETE CO. P.O. BOX 27326 RALEIGH, NC 27611 Tritest W.O. #,O999-G06e3- 66 rd —Oc 49 j Project Reference: Stormwater Project Number: PLANT 13 Purchase Order #: -Standard Report Delivery ElRush Report Delivery (w/surcharge) "Rush wojetl5 are suLjef] to qur apM,ari Ey Ne Nd McOry Requested Due Date: Sample Description Composite Grab —Start Start Date End Date Matrix W ..DW Analyses Requested Tritest Sample Time EndSW,GWS OUTFALL 1 Grab SW WC-T:iS 001 alinquish d b (s/�igpnature) Recei ed y (signature) /Date /Time R q' shed by signature) Recei (signature) I Date Time /0 elinquished signs Received by (signature) C Dat ime Receipt Conditions (Lab Use Only): ❑ 4±2°C tmp: U,t> °C Res. Chlorine OAbsent ❑Present On/a Acid preserv. <2? ❑Yes ONo On/a Base preserv. >12? OYes ONo On/a .. O O UnnTEST SAMPLE PRESERVATION CHECK -IN SHEET w0#: ED —00 VBt( Checked in by: J. Date: Time: Temp: e Route: CD TTS T USM FEDX GC UPS Sample No. Analysis Requested Sample Type Comp/ Grab Container Chlorine Preservative No ,e HCL H2SO4 HNO3 NaOH Thin OTHER Pos / eg No HCL H2SO4 HNO3 NaOH Thio OTHER C / G P / G Pos / neg None HCL H2SO4 HNO3 NaOH Thio OTHER C / G P / G Pos /neg None HCL H2SO4 HNO3 NaOH Thio OTHER C / G P / G Pos / neg None HCL H2SO4 HNO3 NaOH Thio OTHER Pos /neg None HCL H2SO4 HNO3 NaOH Thio OTHER C / G P / G Pos / neg None HCL H2SO4 EIN03 NaOH Thio OTHER C / G P / G Pos / neg None HCL H2SO4 HNO3 NaOH Thio OTHER C / G P / G Pos/neg None HCL H2SO4 HNO3 NaOH Thio OTHER C / G P / G Pos /neg one HCL H2SO4 HNO3 NaOH Thio OTIiER 71 G P / G Pos / neg one HCL H2SO4 HNO3 NaOH Thio OTHER C / G P / G Pos / neg one HCL H2SO4 HNO3 NaOH Thio OTHER C / G P / G Pos/neg None 14CL H2SO4 14NO3 NaOH Thio OTHER C / G P / G Pos/neg None HCL H2SO4 HNO3 NaOH Thio OTHER C / G P / G Pos/neg None HCL H2SO4 HNO3 NaOH Thio OTHER C / G P / G Pos/neg None HCL H2SO4 HNO3 NaOH Thio OTHER C / G P / G Pos/neg None HE H2SO4 HNO3 NaOH Thio OTHER C / G P / G Pos / neg None HCL H2SO4 HNO3 NaOH Thio OT14ER C / G P / G Pos / neg None HCL H2SO4 HNO3 NaOH Thio OTHER C / G P / G Pos / neg None HCL H2SO4 HNO3 NaOH Th o OTHLR C / G 1 P / G Pos / neg None HCL H2SO4 HNO3 NaOH Thio OTHER COMMENTS: ©LA NCDENR DISCHARGE OUTFALL MONITORING REPORT GENERAL PERMIT NCG140000 (All sample data shall be reported no later titan 30 days after receipt of lab results) Certificate of Coverage NCGIA} e7 r Z $ Facility Name c 4J t� _ County Grano((ie (Phone Number S 7 5 - Certified Laboratory # 3 77-3 Person Collecting Sampie(s) , 4 Collectors Signature / Sample Information Permit Term Year Year.Start/End Dates Place check mark to indicate applicable sampling period Discharge Type (check as appropriate) Stormwater. Wastewater 1 August 1, 2004 to July 31, 2005 Q— ❑ ' ❑ ❑ ❑ 0 ❑ ❑ ❑ 13 O ❑ ❑ 2 I August 1, 2005 to July 31, 2006 3 August 1, 2006 to Jul 31, 2007 4 August 1, 2007 to July 31, 2008 5 August 1, 2008 to July 31, 2009 Part A: Stormwater Discharge Monitoring Data (For stormwater not combined with process wastewater) Storm Event Characteristics Date Total Event Precipitation (inches) Event Duration (hours) 49 C,.75 Z I Stormwater Discharge Monitorine Outfall No. . Date Sample Collected (mo/dd/ ) Total Flow -- Total Event Precipitation (inches) Event Duration (hours) pH nits) Total Suspended Solids (ms/I) 00 2 I Does this facility perfo Vehicle Maintenance Activities using on average more than» gallons of new motor oil per month? ❑ Ye: 7No If yes, complete information below. Stormwater Discharge Monitoring from Vehicle Maintenance Areas Outfall No. Date Sample Collected (mo/dd/ r) Total Flow (MG) Total Event Precipitation (inches) Event Duration (hours) New Motor Oil Usage (gal/mo) pH (Sid. Units) Total Suspended Solids (mg 1) Oil and Grease (mg ) 1 I SWU-241-080104 Page loft Part B: Process wastewater discharge monitoring data Sample # Effluent Source(s) for this sample / Vehicle / Equipment Cleanin ❑ Raw Material Stock -pile Wettin ❑ Mixing Drum Clean -out ❑ Recycle System Overflow ❑ Parameter Unit Data Collection Date mo/dd/yr Total Flow MG Event Duration hours pH Std. units TSS mg/1 Settleable Solids mIA Sample # _ Effluent Source(s) for this sample Vehicle / Equipment Cleaning ❑ Raw Material Stock -pile Wetting ❑ Mixing Drum Clean -out ❑ Rec cle System Overflow ❑ Parameter Unit Data Collection Date mo/dd/yr Total Flow MG Event Duration hours pH Std. units TSS mg/1 Settleable Solids ml/1 Mail original and one copy to: Attn: Central Files Division of Water Quality DENR 1617 Mail Service Center Raleigh, NC 27699-1617 S W I;.23I -O8D 1 OA Sample # Effluent Source(s) for this sample / Vehicle / E uioment Cleanin ❑ Raw Material Stock -pile Wettin ❑ Mixing Drum Clean -out ❑ Rec c1e,S stem.Overflow ❑ Parameter Unit Data Collection Date, mo/dd/yr Total Flow MG Event Duration hours pH Std. units TSS mg/l Settleable Solids mm Sample # Effluent Sourcs fofthis•sam le Vehicle / Equipment Cleanin ❑ Raw Material Stock -pile Wetting ❑ Mixing Drum Clean -out ❑ Recycle System Overflow ❑ Parameter Unit Data Collection Date mo/dd/yr Total Flow MG Event Duration hours pH Std. units TSS mg/I Settleable Solids MIA "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, includingthe possibility of f:--- -md imprisonment for knowing violations. Lu mt4N 14,4,SfiI ✓) (P t Nt)/A- of D.. 4;,ta rl--:. i,e) //-/, - o 69 Si �tra. of Perm nee or Designee) (Date)/ Page 2 of 2 Stormwater Discharge Outfall (SDO) Qualitative Monitoring Report Permit No.: N/C/ / Dl /l or Certificate of Coverage No.: NlCIG/LI `1/Ol / l 1 /-' / Facility Name: County: uoz 7� ,Inspector: Cruu a,F/ Date of Inspection By this signapre, I certify that this Phone No. 5 is accurate and complete to the best of my knowledge: (Signatufe ermittee or Designee) 1. Or 11 Description Outfall No. Structure Q ditch, etc.) Receiving Stream: Describe the industrial activities that occur within the outfall drainage 2. Color Describe the color of the dark) as descriptors: using basic colors (red, brown, blue, etc.) and tint (light, medium, f r'U 3. Odor Describe any distin t o ors that the discharge may have (i.e., smells strongly of oil, weak chlorine odor, etc.)�/�� 4. Clarity Choose the number which best describes the clarity of the discharge where 1 is clear and 10 is very cloudy: 1 (6 3 4 5 6 7 8 9 10 Page 1 SWU-242-101599 5. Floating Solids Choose the number which best describes the amount of floating solids in the stormwater discharge where 1 is no solids and 10 is the surface covered with floating solids: 2 3 4 5 6 7 8 9 10 6. Suspended Solids Choose the number which best describes, the amount of suspended solids in the stormwater discharge where 1 is no solids and 10 is extremely muddy: 2 3 4 5 6 7 8 9 10 7. Foam Is there any foam in the stormwater discharge? Yvs' No 8. Oil Sheen Is there an oil sheen in the stormwater discharge? Yes No 9. Other Obvious Indicators of Stormwater Pollution List and describe Note: Low clarity, high solids, and/or the presence of foam or oil sheen may be indicative of pollutant exposure. These conditions may warrant further investigation. Page 2 SWU-242-101599 I O ' O UG3OUTEST 6701 Conference Drive Page 1 of 1 Raleigh, NC 27607 Telephone: (919) 834-4984 NC/WW Cert. M 067 Fax: (919) 834-6497 NC/DW Cert. #: 37731 Laboratory Report --- Prepared for --- LYMAN AUSTIN READY MIXED CONCRETE CO. Report Date: 10/12/2006 P.O. BOX 27326 Date Received: 10/6/2006 RALEIGH, NC 27611 Work Order #: 0610-00484 Project No.: Cust. Code: RE1520 Project ID: STORMWATER PLANT 13 Cust. P.O.#: No. Sample ID Date Sampled Time Sampled Matrix Sample Type Condition 001 OUTFALL 1 10/612006 10:00 SW Grab 4 +/- 2 deg C Analyzed Test Performed Method Results Date Time Qualifier Total Suspended Solids EPA 160.2 63.6 mg/L 1019/06 16:00 Reviewed by: for Tritest, Inc Tritest, In'e. 3909 Beryl Road, Raleigh, NC 27607 ph: (919) 8344984 tax: (919) 834-6497 NCWW CERT#67, NCW CERT#37731 Report Results To: Company: READY MIXED CONCRETE CO Address: P.O. BOX 27326 RALEIGH, NC 27611 Attn: LYMAN AUSTIN Phone: 919-790-1520 Sampled by (signature): _ Fax: 919-981-0910 Chain of Custody Bill To: READY MIXED CONCRETE CO P.O. BOX 27326 RALEIGH, NC 27611 Tritest W.O. # 0669-88633- 66 ro /d1JL A'(?" Project Reference: Stormwater Project Number: PLANT 13 Purchase Order#: �5—Standard ReportDelivery ❑ Rush Report Delivery (w/surcharge) "R.0 r-p. 9R SulgC -p 'Bp -'p NeI]Watory Requested Due Date: Sample Description Composite Grab Start Date End Date Matrix �,DW SW,GWS Analyses Requested Tritest Sample Time End Time OUTFALL 1 Grab —SAart lz —46(e SW WC-TSS 001 6,-oc> 91inqu).sh d b signature) Recei ed y (signature) Date Time R q shed by signature) Recei (signature) I Date Time elinquished Uy CsignaArIF7—Received by (signature) C Date' Time Receipt Conditions (Lab Use Only): ❑ 4±2°C I6mp: N t> °C Res. Chlorine OAbsent ❑Present ❑n/a Acid preserv. <2? OYes ❑No ❑n/a Base present. >12? [Wes ❑No ❑n/a TEST SAMPLE PRESERVATION CHECK -IN SHEET WOk: 10 —00 481i Checked in by: J. Date: Q Time: Temp: C Route: CD TTS TTP USM FEDX I GC UPS Sample No. Analysis Requested Sample Type Comp/ Grab Container Chlorine Preservative Noe HCL H2SO4 HNO3 NaOH Thio OTHER �5 C/S P G Pos / eg No HCL H2SO4 HNO3 NaOH Thin OTHER C / G P / G Pos / neg None HCL H2SO4 HNO3 NaOH Thin OTHER C / G P / G Pos / neg None HCL H2SO4 HNO3 NaOH Thio OTHER C / G P / G Pos / neg None HCL H2SO4 HNO3 NaOH Thin OTHER C / G P / G Pos / neg None HCL H2SO4 HNO3 NaOH Thin OTHER C / G P / G Pos / neg None HCL H2SO4 HNO3 NaOH Thin OTHER C / G P / G Pos / neg None HCL H2SO4 HNO3 NaOH Thin OTHER C / G P / G Pos / neg None HCL H2SO4 HNO3 NaOH Thin OTHER C / G P / G Pos / neg None HCL H2SO4 HNO3 NaOH Thin OTHER C / G P / G Pos / neg None HCL H2SO4 HNO3 NaOH Thin OTHER C / G P / G Pos / neg None HCL H2SO4 HNO3 NaOH Thin OTHER C / G P / G Pos / neg None HCL H2SO4. HNO3 NaOH Thio OTHER C / G P / G Pos / neg None 14CL H2SO4 HNO3 NaOH Thio OTHER C / G P / G Pos / neg None HCL H2SO4 HNO3 NaOH Thin OTHER C / G P / G Pos / neg None HCL H2SO4 HNO3 NaOH Thin OTHER C / G P / G Pos / neg None HCL H2SO4 HNO3 NaOH Thin OTHER C / G P / G Pos / neg None HCL H2SO4 HNO3 NaOH Thin OTHER C / G P / G Pos / neg None HCL H2SO4 HNO3 NaOH Thin OTHER C / G P / G Pos /neg None HCL H2SO4 HNO3 NaOH Thin OTHER C / G P / G Pos / neg None HCL H2SO4 I-IN03 I NaOH Thin OTHER COMMI NTS: AMA Or NCDENR DISCHARGE OUTFALL MONITORING REPORT GENERAL PERMIT NCG140000 Cb / (All sample data shall be reported no later than30 days after receipt of lab results) Certificate of Coverage NCG14 ][Z]®® Facility Name , County Phone Number S%S — 3 Certified Laboratory # FF O Person Collecting Sample(s) 1M ,N:.-`5 l' T, Collectors Signature Sample Information Permit Term Year Year Start/End Dates Place check mark to indicate applicable sampling period Discharge Type (check as appropriate) Stottnwater Wastewater 1 Au ust 1, 1999 to Jul 31, 2000Li ❑ ❑ ❑ ❑ ❑ ❑ E3 ❑ ❑ ❑ 0 2 August 1, 2000 to July 31, 2001 3 August 1, 2001 to July 31, 2002 4 August 1, 2002 to July 31, 2003 5 August 1, 2003 to Jul 31, 2004 Part A: Stormwater Discharge Monitoring Data (For stormwater not combined with process wastewater) Storm Event Characteristics Date Total Event Preci itatioo inches Event Duration hours 3— —v Stormwater Discharge Monitoring Outfall No. Date Sample Collected mo/dd/ Total Flow G Total Event Precipitation inches Event Duration otrrs) pH Std. Units Total Suspended Solids m Does this facility perfo Vehicle Maintenance Activities using on average more than 55 gallons of new motor oil per month? ❑ Yes No If yes, complete information below. Stormwater Discharge Monitoring from Vehicle Maintenance Areas Outfall No. Date Sample Collected (moldd/ Total Flow G Total Event Precipitation inches Event Duration ours New Motor Oil Usage ( mo) pH Std. Units Total Suspended Solids m Oil and Grease m ) SWU-241-0e0199 Page lof 2 'art B: Process wastewater discharge monitoring data ample # Effluent Source(s) for this sample J ehicle / Equipment Cleanin ❑ aw Material Stock- ile Wettin ❑ dixing Drum Clean -out ❑ :ec cle System Overflow ❑ Parameter Unit Data Collection Date mo/dd/yr Total Flow MG Event Duration hours PH Std. units TSS • mg/l ;ettleable Solids ml/1 Sample # Effluent Source(s) for this sample Vehicle / Equipment Cleanin ❑ taw Material Stock -pile Wetting ❑ Yfixing Drum Clean -out ❑ sec cle System Overflow ❑ Parameter Unit Data Collection Date mo/dd/yr Total Flow MG Event Duration hours PH Std. units TSS mgA Settleable Solids mUl Mail original and one copy to: Attn: Central Files Division of Water Quality DENR 1617 Mail Service Center Raleigh, NC 27699-1617 Sample # Effluent Source(s) for this sample Vehicle / Equipment Cleaning ❑ Raw Material Stock -pile Wettin ❑ Mixing Drum Clean -out ❑ Recycle System Overflow ❑ Parameter Unit Data Collection Date mo/dd/yr Total Flow MG Event Duration hours PH Std. units TSS mg/1 Settleable Solids mm Sample # _ Effluent Sources for this sample Vehicle / Equipment Cleanin ❑ Raw Material Stock -pile Wettin ❑ Mixing Drum Clean -out ❑ Recycle System Overflow ❑ : Parameter Unit Data Collection Date mo/dd/yr Total Flow MG Event Duration hours PH Std. units TSS mg/1 Settleable Solids ml/l "I certify, under penalty of law, that this document and all attachment; 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, we, accurate,. and complete. I am aware that there are significant penalties foi submitting false information, including the possibility of fines and imprisonment for knowing e of Permittee or ignee) , '50-)q of Permittee or Designee) (Date) SwU.e41-080199 l % Page 2 of 2 # 13 gv-r-nee- NCDENR DISCHARGE OUTFALL MONITORING REPORT GENERAL PERMIT NCG140000 (All sample data shall be reported no later than 30 days after receipt of lab results) Certificate of Coverage NCG 14 Fiidili Nam e Phone-Ndmbef (,9, 9) _3 -7 , r Certified Laboratory # Peirson'Coli ng Sample(s): Col[i io"'rs- Signaturl'. z$1 4 Sample Information 6fm ,Permit T Tkoechedk4mark tolhdicate Discharge -Ty*,(check ,,-as �appropriate) tormw Wastewater I August 1. 1999 to July 31, 2000 ❑ E3 El 13 ❑ ❑ 2 August 1, 2000 to July 31, 2001 3 August 1, 2001 to July 31, 2002 4 August 1, 2002 to July 31, 2003 5 August 1, 2003 to July 31, 2004 .Part A: Stormwater Discharge Monitoring Data (For stormwater not combined with process wastewater) Storm Event Characteristics ?k1z" otal'EventP `.EVentDuritionj,'(hours y' e Stormwater Discharge Monitorin 'TotalTllow, -- "P T66&EV6ht�'_ ;.EvehtDuration No Collected x 5 Pier}pitanon`S *nd A000 Does this facility perform; V icle Maintenance Activities using on average more than 55 gallons of new motor _Pe 0 oil per month? 11 Yes o If yes, complete information below. Stormwater Discharge Monitorinji from Vehicle Maintenance Areas SWU-241-080199 Page lof2 Part B: Process wastewater discharge monitoring data Sample # _ Effluent Source(s) for this sample Vehicle / Equipment Cleanin ❑ . Raw Material Stock -pile Wetting ❑ Mixing Drum Clean -out ❑ Recycle System Overflow ❑. Collection Date mo/dd/yr Total Flow . MG Event Duration hours pH Std. units TSS mg/I Settleable Solids mm Sample # 4'Effluenf'Source s',forthtssain Vehicle / Equipment Cleanin ❑ Raw Material Stock -pile Wetting ❑ Mixing Drum Clean -out ❑ Recycle System Overflow ❑ Collection Date mo/dd/yr Total Flow MG Event Duration hours pH Std. units TSS mg/1 Settleable Solids ml/I Mail original and one copy to: Attn: Central Files Division of Water Quality DENR 1617 Mail Service Center Raleigh, NC 27699-1617 SWU-241-080199 Sample # _ Effluent Sources for this sample Vehicle / Equipment Cleaning ❑ Raw Material Stock -pile Wetting ❑ Mixing Drum Clean -out ❑ Recycle System Overflow ❑ Parameter - Uiiit Data Collection Date mo/dd/yr Total Flow MG Event Duration hours pH Std. units TSS mg/l Settleable Solids mm Sample # .�"Effluent Source s` for'ahis9s le 'i` Vehicle / Equipment Cleaning ❑ Raw Material Stock -pile Wetting ❑ Mixing Drum Clean -out ❑ Recycle System Overflow ❑ '�,1rParameter'�y;>` _u v,{'.UnrC '_,� Collection Date mo/dd/yr Total Flow MG 'Event Duration hours pH Std. units TSS mg/l Settleable Solids ' -n-AA "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 aryl imprisonment for knowing of Perrnitt or Design ) Perin tee or Designee) (Date) Page 2 of 2 STORMWATER DISCHARGE OUTFALL (SDO) QUALITATIVE MONITORING REPORT Certificate of Coverage No. NCG--_./-- 0 �/-;" 5' Facility Name: County: z.. Phone No.: W Inspector Date of Inspectiow. By this signature, I certify that this report is accurate and complete to the best of my knowledge-. (Signature of Perminee or Designee) 1. Outfall Description Outfall No.. Structure (pipe, ditch, etc.): 7 - Receiving Stream: Describe the industrial activities that occur within the outfall drainage area: 2. Color Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint (light, medium, dark) as descriptors: 3. Odor Describe any distinct odors that the discharge may have (i.e. smells strongly of oil, weak chlorine odor, etc.): 11/17/97 4., Clarity Choose the number 10 is very cloudy: 1 C.: describes the clarity of the discharge where 1 is clear and 4 5 6 7 8 9 10 5. Floating Solids Choose the number whic best describes the amount of floating solids in the stormwater discharge where 1 is no s lids and 10 is the surface covered in floating solids: 12. 4 5 6 7 8 9 10 6. Suspended Soli Choose the number which best describes the amount of suspended solids in the stormwater discharge whlere 1 is no solids and 10 is extemely muddy: 1 J2% 4 4 5 6 7 8 9 10 7. Foam Is there any foam in the YES NO 8. Oil Sheen Is there an oil sheen in I e stormwater discharge? M NO. 9. Other Obvious Indicators of Stormwater Pollution: ' List and describe: NOTE: Low clarity, indicative of investigation solids and/or the presence of foam or oil sheens may be :ant exposure. These conditions may warrant further 11/17/97 TRITEST, INC. 3909 Beryl Road Raleigh, NC 27607 Telephone: (919)834-4984 NC/WWCart. #:067 Fax: (919) 834-6497 NCIDW Cart. M 37731 Laboratory Report -- Prepared for — 1 of 1 LYMAN AUSTIN READY MIXED CONCRETE CO. Report Date: 911712002 P.O. BOX 27326 Date Received: 9/1/2002 RALEIGH, NC 27611 Work Order#: 0208-01104 Project ID: PLANT 13 Cust. Code: RE1520 Project ID: PLANT #13 Cust. P.O.#: No. Sample ID 001 OUTFALL 1 Date Sampled Time Sampled Matrix 911612002 09:06 SW Condition 412oC Test Performed Method Results Analyzed Qualifier Total Suspended Solids EPA 160.2 2.8 mglL 9/17102 . Report Certified by: for Tritest, Inc. Tritest, Inc. 3909 Beryl Road, Raleigh, NC 27607 ph:(919) 8344984 fax: (919) 834-6497 NCWWCERT# 7. NCDWCERT#37731 Report Results To Company: READY MIXED CONCRETE CO. Address: P.O. BOX 27326 RALEIGH, NC 27611 Attn: LYMAN AUSTIN Phone: 919-790-1520 Sampled by (signature): _ Fax: 919-981-0910 i Ci Chain of Custody READY MIXED CONCRETE CO. P.O. BOX 27326 RALEIGH, NC 27611 Tritest W.O. # 0208-01104 Project Reference: Stormwater Project Number: PLANT 13 Purchase Order #: ❑ Standard ReportDelivery ❑ Rush Report Delivery (w/surcharge) 'Rush gapes.n Subject to pr* r.b,xoval by the labonlo y Requested Due Date: Sample Description Composite Grab — Start. Date, End Date_ 1 Matrix ww.Dw sw.GWs Analyses Requested Tritest Sample Start Time End me OUTFALL 1 Grab SW WC-TSS 001 Relinquished by (signature) Race! d Dat p % Timeby�(slgn�ture) c - . Relin ed by (s' ture), Received . (signature) D to Time 4 /� / Relin sh y (sign e) Received by (signature) Dat Tim Receipt Conditions (Lab,/s�e Only). ❑ 4t2-C ASlTemp: r -C �+\\ Res. Chlorine +L bsent ❑Present Onla Acid preserv. <27 OYes ONo , a Base preserv. >121 OYes ❑No 4Vfia A NCDENR DISCHARGE OUTFALL MONITORING GENERAL PERMIT NCG140000 (Al1 sample data shall be reported no later than 30 days after receipt of lab results), Certificate of Coverage NCG 14 F96ili Nance C, 4� I Phdr'le�N� I.: ", ol 9) Q1V Certified Laboratory # "n CollngSaffiple(s): .7 Collectors Stgnattrre Sample Information 4Place check matk toandtcate period Discharge -T-yp'e:(ch6dk,,iLs'6ppropriate).; storinwater'N'-7�. �,`,-IW.astewater An st 1, 1999t July 31, 2000 ❑ E3 13 13 13 EJ E:l ;E3 2 August 1, 2000 to July 31, 2001 13 August 1, 2001 to July 31, 2002 4 Au 1, 2002 to July 31, 2003 5 August 1, 2003 to July 31, 2004 Part A: Stormwater Discharge Monitoring , * g Data (For stormwater not combined with process wastewater) Storm Event Characteristics Stormwater Discharge Monitoring Outfall Date S E­ D :,;�,F�p —WX�—`76tal'- �0 No: Prec �,i!ration S n e uspe 6 kl:�N; d ollids--� - -6 in P7 Does this facility perform rVe icle Maintenance Activities using on average more than 55 gallons of new motor 0 oil per month? 0 Yes 2-&o If yes, complete information below. Stormwater Discharge Monitoring from Vehicle Maintenance Areas SWU-241-080199 Page lof 2 Part B: Process wastewater discharge monitoring data Sample # Effluent Source(s) for this sam le . Vehicle / Equipment Cleaning ❑ . Raw Material Stock -pile Wetting ❑ Mixing Drum Clean -out ❑ Recycle System Overflow ❑. Patatneter Umt Data_'.: Collection Date mo/dd/yr Total Flow . MG Event Duration hours pH Std. units TSS mg/l Settleable Solids mil Sample # Icy wlieiif Sources for thus saiii le? Vehicle / Equipmenu Cleaning ❑ Raw Material Stock -pile Wetting ❑ Mixing Drum Clean -out ❑ Recycle System Overflow ❑ Collection Dater mo/dd/yr Total Flow MG Event Duration hours pH Std. units TSS mg/l Settleable Solids L.. mm Mail original and one copy to: Attn: Central Files Division of Water Quality DENR 1617 Mail Service Center Raleigh, NC 27699-1617 SWU-241-090199 Sample # Effluent Sources for this Sample Vehicle / Equipment Cleaning ❑ Raw Material Stock -pile Wetting ❑ Mixing Drum Clean -out ❑ Recycle System Overflow ❑ Paimeter '. Unit :-Data Collection Collection Date mo/dd/yr Total Flow MG Event Duration hours pH Std. units T 911 Sli ods mlSettleable Sample # _ ,�EfflnintySui»rce s fo'rahisaa le Vehicle / Equipment Cleaning ❑ Raw Material Stock -pile Wetting ❑ Mixing Drum Clean -out ❑ Recycle System Overflow ❑ Collection Date mo/dd/yr Total Flow MG Event Duration hours pH Std. units TSS mg/1 Settleable Solids -n-AA "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 a�d imprisonment for knowing -' °-- , ie�ro-f,Perrmtt / or Design) �t of Permittee or Designee) (Date) Page 2 of 2 STORMWATER DISCHARGE OUTFALL (SDO) QUALITATIVE MONITORING REPORT Certificate of Coverage No. NCG I/ ;_ C) ✓"? Facility Name : County: c. Phone No.: C? 1L Inspector. Date of Inspection: 0- By this signature, I certify that this report is accurate and complete to the best of my knowledge: (Signature of Perinittee or Designee) 1. Outfall Description Outfall No.: Structure (pipe, ditch, etc.): L Receiving Stream:—.-,,,, Describe the industrial activities that occur within the outfall drainage area: 2. Color Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint (light, medium, dark) as descriptors: 3. Odor Describe any distinct odors that the discharge may have (i.e. smells strongly of oil, weak chlorine odor, etc.): 11/17/97 4. Clarity Choose the number which best describes the clarity of the discharge where 1 is clear and. 10 is very cloudy: 1 6.' 3 4 5 6 7 8 9 10 S. Floating Solids Choose the number which best describes the amount of floating solids in the stormwater discharge where 1 is no solids and 10 is the surface covered in floating solids: 1 Z.% 3 4 5 6 7 8 9 10 6. Suspended Solids Choose the number which best describes the amount of suspended solids in the stormwater discharge where 1 is no solids and 10 is extemely muddy- 1 j 2) 3 4 5 6 7 8 9 10 7. Foam Is there any foam in the stormwater discharge? YES NO ` 8. Oil Sheen Is there an oil sheen in the stormwater discharge? YES NO. 9. Other Obvious Indicators of Stormwater Pollution: List and describe: NOTE: Low clarity, high solids and/or the presence of foam or oil sheens may be indicative of pollutant exposure. These conditions may warrant further investigation. 11/17/07 TRITEST, INC. 3909 Beryl Road Raleigh, NC 27607 Telephone: (919) 834-4984 NCIWW Cart.#: 067 Fax: (919) 834-6497 NCIDW Cert. #. 37731 Laboratory Report --- Prepared for -- 1 of 1 LYMAN AUSTIN Report Date: 9/17/2002 P.O. BOX 27326 READY MIXED CONCRETE CO. Date Received: 912002 RALEIGH, NC 27611 Work Order #: 0208-01104 Project ID: PLANT 13 Cust. Code: RE1520 Project ID: PLANT #13 Cust. P.O.#: No. Sample ID Date Sampled Time Sampled Matrix Condition 001 OUTFALL 1 9/16/2002 09:06 SW 4n2oC Test Performed Method Results Analyzed Qualifier Total Suspended Solids EPA 160.2 2.8 mglL 9/17102 Report Certified by: for Tritest, Inc. Tritest, Inc. 3909 Beryl Road, Raleigh, NC 27607 ph: (919) 8344984 fax: (919) 834-6497 NCW CERT#67, NCDWCERT#37731 Report Results To Company: READY MIXED CONCRETE CO. Address: P.O. BOX 27326 RALEIGH, NC 27611 Attn: LYMAN AUSTIN Phone: 919-790-1520 Sampled by (signature): _ Fax: 919-981-0910 Chain of Custody Bill To: READY MIXED CONCRETE CO. P.O. BOX 27326 �RALEIGH, NC 27611 Tritest W.O. # 0208-01104 Project Reference: Stormwater Project Number: PLANT 13 Purchase Order #: ❑ Standard ReportDelivery IDRush Report Delivery (w/surcharge) •'Ru P*e an su*d W Pe appaval by NO hb tM Requested Due Date: Sample Description Composite Grab — Start. Date Egg! Date., Matrix 6W,GV 3w6 Analyses Requested Tritest Sample Start me End Time OUTFALL1 Grab SW WC-TSS 001 Relinquished by.(signature) fed Rae iI d br (signature) DD t Time Relin by (s' ture). Received by(signature) o Time zDabt Relin sh y (signs e) Received by (signature) Tim Receipt Conditions (Lab Use Only): •„ ❑ 4±2`C /RTemp: °C v\\ Res. Chlorine �bsent ❑Present ❑n/a Acid preserv. <2? ❑Yes ❑No Base preserv. >12? ❑Yes ❑No —/a r A NCDENR DISCHARGE OUTFALL MONITORING REPORT GENERAL PERMIT NCG140000 (All sample data shall be reported no later than 30 days after receipt of lab results) Certificate of Cov.erage NCG 14 F.- Fa % cili I Name 4ea-cq rnhK-elt County , 6-1n V,'11, Phone Ntmitter eq 15 75 - 1Y3- V Ptr 13 Certified Laboratory # Person,Colie6iing Sample(s) y1i, CI,rvorl�j Collelcto-is3ignature Sample Information :-Permit Tenn . Year StarUEnd Dates, -P1iciithe6kih;arV NtO�in4��ate. p enbd.' &p Disch ropriate) Discharge Typ�e,'(ch&k��iLapp z. Stormwater, r1ri I August 1, 1999 to July 31, 2000 Li 0 ra", Q ❑ Q 2 August 1, 2000 to July 31, 2001 3 August 1, 2001 to July 31, 2002 4 August 1, 2002 to July 31, 2003 5 August 1, 2003 to July 31, 2004 Part�A: Storinwater Discharge Monitoring Data (For stormwater not combined with process wastewater) Storm Event Characteristics `—D qz of Stormwater Discharge Monitoring Outfall':Date Sample,� s TTotal Flow Total EvEfil Event Duranon pH y No Collected mold Std. Units) 912,1410 I 0e) (0 e) q— t. -S7 Does this facility perform Vehicle Maintenance Activities using on average more than 55 gallons of new motor oil per month? 0 Yes No If yes, complete information below. Stormwater Discharge Monitoring from Vehicle Maintenance Areas Outfall,- NO: Date Sample. Collected (mo/dd/ r -Total'Flow. .. ... G -Totall Event PrI66pitatton (inches Event Wiitiofi.-. hours New,. .'Motor Oil ..Usage (gal/mo) PH' (Std. Units) 76tal Suspended Solids.�.: (M Oil,and Grease (mg/1) SWU-241-080199 Page lof 2 Part B: Process wastewater discharge monitoring data Sample # _ Effluent Source(s) for this sample Vehicle / Equipment Cleaning ❑ Raw Material Stock -pile Wetting ❑ Mixing Drum Clean -out ❑ Recycle System Overflow ❑ Parameter Untt :Data? Collection Date mo/dd/yr Total Flow MG Event Duration hours pH Std. units TSS mg/l Settleable Solids mul Sample # i � EffliientSource s forthts±'sam 1e z;�: Vehicle / Equipment Cleaning ❑ Raw Material Stock -pile Wetting ❑ Mixin& Drum Clean -out ❑ Recycle System Overflow ❑ Parameter ah.i Umtxxbata y , Collection Date mo/dd/yr Total Flow MG Event Duration hours pH Std. units TSS mg/l Settleable Solids mUl Mail original and one copy to: Attn: Central Files Division of Water Quality DENR 1617 Mail Service Center Raleigh, NC 27699-1617 Sample # _ Effluent Source(s) for this sample Vehicle / Equipment Cleanin ❑ Raw Material Stock -pile Wettin ❑ Mixing Drum Clean -out ❑ Recycle System Overflow ❑ Parameter ?r ': Unit Data Collection Date mo/dd/yr Total Flow MG Event Duration hours pH Std. units TSS mg/l Settleable Solids mul Sample # _ s?'Effliient SoiiTce(s forit}ii's sam le ': Vehicle / Equipment Cleanin ❑ Raw Material Stock -pile Wetting ❑ Mixing Drum Clean -out ❑ Recycle System Overflow ❑ Parameterf; + [Jmt' a s Data Collection Date mo/dd/yr Total Flow MG Event Duration hours pH Std. units TSS mg/l Settleable Solids inm "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, rue, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility, of fine and imprisonment for knowing violations." .I A / Name of of Permittee or Designee) (Date) SWU-241-080199 \—1 Page 2 of 2 STORMWATER DISCHARGE OUTFALL (SDO) QUALITATIVE MONITORING REPORT Certificate of Coverage No. Facility Name: Rea L44 fhra)L!ej Cytic: ee72 601-an% /3 County: ( Phone No.: (qM) S7 S -' L138n Inspector: `b+e - 1,..r.( eydrT- Date of Inspection: 'K— 30 — 0 1 By this signature, I certify that this report is accurate and complete to the best of my knowledge: 1. Outfall Description Outfall No.: Structure (pipe, ditch, etc.): Receiving Stream: Describe the industrial activities that occur within the outfall drainage area: 2. Color Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint (light, medium, dark) as descriptors: l I < h T 73 �r��.✓rL o- 3. Odor Describe any distinct odors that the discharge may have (i.e. smells strongly of oil, weak chlorine odor, etc.): 11/17/97 4. Clarity Choose the number which best describes the clarity of the discharge where 1 is clear and 10 is very cloudy: 1 2 3 4 5 6 lam' 8 9 10 5. Floating Solids Choose the number which best describes the amount of floating solids in the stormwater discharge where 1 is no solids and 10 is the surface covered in floating solids: 1 2 0 4 5 6 7 8 9 10 6. Suspended Solids Choose the number which best describes the amount of suspended solids in the stormwate discharge where 1 is no solids and 10 is extemely muddy: 2 3 4 6 7 8 9 10 7. Foam Is there any foam in the stormwater discharge? YES NO 8. Oil Sheen Is there an oil sheen in the stormwater discharge? YES NO 9. Other Obvious Indicators of Stormwater Pollution: List and describe: ) NOTE: Low clarity, high solids and/or the presence of foam or oil sheens may be indicative of pollutant exposure. These conditions may warrant further investigation. 11/17/97 TRITEST, INC. 3909 Beryl Road Raleigh, NC 27607 Telephone: (919) 834-4984 NC/WW CerL#: 067 Fax: (919) 834-6497 NCIDW Cert. P. 37731 Laboratory Report --- Prepared for --- 1 of 1 LYMAN AUSTIN Report Date: 10112101 READY MIXED CONCRETE CO. Date Received: 10/12/1 P.O. BOX 27326 RALEIGH, NC 27611 Work Order#: 0109-01012 Project ID: PLANT 13 Cust. Code: RE1520 Project ID: PLANT #13 Cust. P.O.#: No. Sample ID 001 OUTFALLI Date Sampled Time Sampled Matrix 9/24/01 14:00 SW Condition 4n2oc Test Performed Method Results Analyzed Qualifier Total Suspended Solids EPA 160.2 17 mg/L 10YI/01 Report Certified by: for Tritest, Inc. / T.itest, Inc. 39G9 Beryl Road, Raleigh, NC 27607 ph:(919) 8344984 fax: (919) 834-6497 NCW W CERTW. NCOW CERT#37731 Report Results To: Company: READY MIXED CONCRETE CO. Address: P.O. BOX 27326 RALEIGH, NC 27611 LYMAN AUSTIN Attn: Phone: 919-790-1520 Fax: 919-981-0910 Sampled by (signature): Chain of Custody Bill To: READY MIXED CONCRETE CO. Project Reference: P.O. BOX 27326 Project Number: RALEIGH, NC 27611 Purchase Order #: Tritest W.O. # 04ei 6 #2� Stormwater PLANT 13 ❑ Standard ReportDelivery ❑ Rush Report Delivery (w/surcharge) "Basil pa,'eOs= suEi� b p Wpord byY s3Gv Requested Due Date: Sample Description tRWosite Grab S art Date Fnd Date — Matrix MM•DW SW.GWS Analyses Requested Tritest Sample Start'rime End Time OLITFALL 1 Grab SW WC-TSS 001 Relinquished ignature) Received by /} f/iGa-[J Dat g l D Time �'ddA Relinquishe y (' re) Received b 1gn re) D. to L - Time lli Relinquished signature) Received by (signature) Dhte Time Receipt Conditions (Lab Use Only): 7t ❑ 4±2°C OTemp: C Res. Chlorine []Absent ❑Present .1 n/a Acid present. <2? OYes [--]No oVa Base present. >12? DYes ❑No Xn/a Tritest, In e. 3909 Beryl Road, Raleigh, NC 27607 ph:(919) 8344984 fax: (919) 834-6497 NCWW CERTM7, NCDW CERP737731 Report Results To Company: READY MIXED CONCRETE CO. Address: P.O. BOX 27326 RALEIGH, NC 27611 Attn: LYMAN AUSTIN Phone: 919-790-1520 Fax: 9i9-961-09i0 Sampled by (signature):`i� Chain ®f Custody Bill To: READY MIXED CONCRETE CO. P.O. BOX 27326 RALEIGH, NC 27611 C Tritest W.O. # 0107-00642 Project Reference: Stormwater Project Number: PLANT 13 Purchase Order #: i ❑ Standard Report Delivery ❑ Rush Report Delivery (w/surcharge) "Rush 1..tl.a-Ijl bW''�W-W U1 ux LlW11-1 Requested Due Date: Sample Description _ posite Grab — Start Date nd Date - Matrix vna,DW SW.GWs Analyses Requested - Tritest Sample st.r�Tima End OUTFALL 1 Grab . 4'0 hoc? SW WC-TSS 001 , ed Relinquishignature) -� Received by �j Dat Time Relinquishe.A gy (' re) Received b ign re) Dpte Time A : Relinquished signature) Ar (signature) D to Time Receipt Conditions (Lab Use Only): 71 ❑ 4t2'C O remp: -C - Res. Chlorine OAbsent ❑Present Va Acid preserv. <2? ❑Yes ONo /— a Base preserv. >12? OYes ❑No An1a