NCG140072_MONITORING INFO_20180219

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
DOC TYPE
❑HISTORICAL FILE
N/ MONITORING REPORTS
DOC DATE
❑ � � � b OCi. J 7
YYYYMMDD

STORMWATER DISCHARGE OUTFALL (SDO) - Semi -Annual MONITORING FORM
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF COVERAGE NO. NCG14 O O
FACILITY NAME: P: f---c ,->t
PERSON COLLECTING SAMPLES 11..ta .+- 14ri
CERTIFIED LABORATORY Pac er Lab # . R
Lab #
OPTIONAL INFO:
Part A: Stormwater Monitoring Requirements
SAMPLE COLLECTION YEAR: ZG 1-E
SAMPLING PERIOD: [July -December ❑ JanuaryJune
COUNTY
PHONE NO.
ADD TO LISTSERVE? ❑YES FIND EMAIL:
DISCHARGING TO CLASS: [:]SA ❑HQW ❑RNA []Trout ❑Other.
Outfall No.
Date Sample
Collected
(mo/dd/yr OR
NO FLOW )1
pH
(Standard
Units)
TS5
(mg/Lj
Event
Duration
(minutes)
Total 4
Rainfall
(in)
In Tier 2
Monthly
Monitoring?
(Y/n)
# of Months in Tier
2 Samplings
-
-
6-9
100
-
-
-
-
2
O'70
CE
TRAi f; 1 c:,
U
SECT16
I
1 If "NO FLOW" or "NO DISCHARGE, Enter "NO FLOW" or "NO DISCHARGE" for each outfall here. Please make sure to mark the sample period above -
If a value is In excess of the benchmark, or outside the benchmark range (for pH), you must implement the Tier 1 or Tier 2 responses in the General Permit. Tier 2
Monthly sampling shall be done until 3 consecutive samples are below the benchmark or within the benchmark range.
3 TSS benchmark values are 100 mg/I, except when discharging to ORW, HQW, Trout, and RNA waters where they are 50 mg/I.
`For each sampled measurable storm event the total precipitation must be recorded using data from an on -site rain gauge.
Permit Date: 711/2011-60/30/2015 1 Last Revised 7/13/11
Page 1 of 2

Part B: Vehicle Maintenance Activity Monitoring Requirements for facilities using > 55 gal of new motor oil/month — averaged over a calendar year.
Ourtfall
No.
Date Sample
Collected
(rno/dd/yr)'
pH
(Standard
Units (
TPH using method
1664ASGT--HEM
m l
( }
Total Suspended
Solids
( m t
Event
Duration
( minutes
Total
Rainfalla
in
New Motor Oil
Usage
al month
(g /
In Tier 2 Monthly
Monitoring?
NMI
# of Months
inTier2
Sam tin
P gi
s-91
15
100
-
-
I
HA5 YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES AT ANY ONE OUTFALL (INCLUDING VEHICLE MAINTENANCE)? YES ❑ NO ❑
HAVE YOU CONTACTED THE REGION? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail Original and one covv of this DMR lincludine all "No Flow" & "No Dischame" reports) within 30 days of receipt of sample for at end of monitorine period
in case of "No Flow") to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
YOU MIDST SIGN THIS CERTIFICAVON 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.
am aware that there are significant penalties for submitting false information, including the possibility of fines,and imprisonment for knowing violations."
(Signature of P rmittee) ! (Date)
Permit Date: 7/1/2011-60/30/2015 Last Revised 7/13/11
Page 2 of 2

r
NCDENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Forguidance on filling out this farm, please visit htrn://no 1, cd�i enr.orgjweb/Ir/np4es:sturmwater/
Permit No.; �f�f _/�/_f�/_/^/�/ or Certificate of Coverage No.: K1jC1Wb7
Facility Name: PUOA 2 1N�rr_EL-, leas?
County: WAKE Phone No. �.
Inspector:. Donal
Date of Inspection:
Time of Inspection:
Total Event Precipitation (inches): , 20
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
(See information below.)
03 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 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 that this report is accurate and complete to the best of my knowledge:
of Permittee or Designee)
Page 1 of 2
SWU-242, Last modified 7/31/2013

1. Outfall Description:
Outfall No. I^ Structure (pipe`Cd�tc.)
Receiving Stream:
Describe the industrial aqivities 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: __'C ljeatz_
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.): rwsie
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 1 is no solids and 5 is extremely muddy:
LY 2 3 4 5
7. Is there any foam in the stormwater discharge? Yes )
8. Is there an oil sheen in the stormwater discharge? Yes No
4. Is there evidence of erosion or deposition at the outfall? Yes No
10. Other Obvious Indicators of Stormwater Pollution:
List and describe M n b£
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
SWU•242, last modified 7/31/2013

1. Outfall Description:
Outfall No. �z__ Structure (pipe,ci;Ltc.)
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: i1aQ2
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.): 1�w'e
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:
V 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:
C) 2 3 4 5
7. Is there any foam in the stormwater discharge? Yes No
s. Is there an oil sheen in the stormwater discharge? Yes (lYo'
9. Is there evidence of erosion or deposition at the outfall? Yes No
10. Other Obvious Indicators of Stormwater Pollution:
List and describe N tax
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
sWU-242, last modified 7/31/2013

aceAnalX cal
www.pecelph c m
November 20, 2017
Jay Watkins
Ready Mix Concrete
3610 Bush Street
Raleigh, NC 27609
RE: Project: Plant 8
Pace Project No,: 92362960
Dear Jay Watkins:
Pace Analytical Services, LLC
9800 Kincey Ave. Suke 100
Huntersville, NC 28078
(704j875.9092
Enclosed are the analytical results for sample(s) received by the laboratory on November 10, 2017.
The results relate only to the samples included in this report. Results reported herein conform to the
most current, applicable TNIINELAC standards and the laboratory's Quality Assurance Manual,
where applicable, unless otherwise noted in the body of the report,
If you have any questions concerning this report, please feel free to contact me.
Sincerely,
Angela Baioni
[e-mail]
[phone]
Project Manager
Endosures
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except In full,
without the written consent of Pace Analytical Services, LLC.
Page 7 of 10

L'eAnal,jII' al
xyrw.PdMiebLa m
Project: Plant 8
Pace Project No.: 92362960
Pace Analytical Services, LLC
9800 Klncey Ave. Suite 100
HuntaisvtRe, NC 20078
[phone]
Eden Certification iDs
205 East Meadow Road Suite A, Eden, NC 27288
North Carolina Drinking Water Certification M 37738
CERTIFICATIONS
North Carolina Wastewater Certification 9: 633
Vrginia(VELAP Certification M 460025
REPORT OF LABORATORY ANALYSIS
This report shalt not be reproduced, except in full,
without the written consent of Pace Analytical Services, LLC. Page 2 of 10

e
ceAnalytical
wMm'.pxele6scam
SAMPLE ANALYTE COUNT
Project: Plant 8
Pace Project No.: 92362960
Pace Analytical Services, LLC
9800 Kincey Ave. Suite 100
Nuntersville, NC 28078
[phone]
Analytes
Lab ID Sample ID Method Analysts Reported Laboratory
92362960001 Plan1801 SM2540D CTB 1 PASI•E
92362960002 Plant B 02 SM 2540D CTB 1 PASI-E
REPORT Of LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, LLC.
Page 3 of 10

(�IaG)eAnalyfical'
ro pacawn.wm
ANALYTICAL RESULTS
Project: Plant 8
Pace Project No,: 923B2B60
Pace Analytical Servicas, LLC
0800 KinceyAve. Sulte 100
Huniersville, NC 28078
(704)875-W92
Sample: Plant 6 #1 Lab ID: 92362960001 Collected: 11/09/17 07:21 Received: 11/10/17 12:55 Matrix: Water
Parameters Results Units Report Limit DF Prepared Analyzed CAS No. Qual
2540D Total Suspended Solids Analytical Method: SM 2540D
Total Suspended Solids ND mg1L 2.5 1 11/16/17 13:25
Sample: Plant 8 #2 Lab ID: 92352960002 Collected: 11109/17 07,11 Received: 11/10/17 12:55 Matrix: Water
Parameters Results Units Report Limft DF Prepared Analyzed CAS No. Qual
25400 Total Suspended Solids
Total Suspended Solids
Date: 11/20/2017 04:42 PM
Analytical Method: SM 2540D
ND mglL 3.0 1 11/1611713:15
REPORT OF LABORATORY ANALYSIS
This report shall riot be reproduced, except In Full,
without the written consent of Pace Analytical Services, LLC,
Page 4 of 10

a9^2 lytical'
www-PX leba.wm
QUALITY CONTROL DATA
Project: Plant 8
Pace Project No.: 92362960
QC Batch: 387129 Analysis Method: SM 2540D
QC Batch Method: SM 2540D Analysis Description: 2WD Total Suspended Solids
Associated Lab Samples: 92362960001, 92362NO002
METHOD BLANK: 2147379 Matrix: Water
Associated Lab Samples: 92362960001, 92362960002
Blank Reporting
Parameter Units Result Limit Analyzed Qualifiers
Total Suspended Solids mg1L ND 2.5 11116/17 13:13
Pace Analytical Services, LLC
9800 Kincey Ave. Suite 100
Huntersvllle, NC 28078
[phone]
LABORATORY CONTROL SAMPLE: 2147380
Spike LCS LCS % Rec
Parameter Units Conc. Result % Rec Limits Qualifiers
Total Suspended Solids mg1L 250 242 97 90-110
SAMPLE DUPLICATE: 2147381
923B2960001 Dup
Parameter Units Result Result RPD Qualifiers
Total Suspended Solids mg1L ND 398
SAMPLE DUPLICATE: 2147382
92363284003 Dup
Parameter Units Result Result RPD Qualifiers
Total Suspended Solids mg1L 224 214 5
Results prowlted on this page are In the units Indlcated by the "Untts" column axtept *,hero an aitemate unit Is prOsentOd to the right of the result,
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
Date: 11/20/2017 04:42 PM without the written consent of Pace Analytical Services, LLC. Page 5 of 10

Pace Analytical 3ervbas, LLC
aceAnalytilG'a!e Be�Huntare+rifke,Nt SuiteKincey Ave. 8078
WvwpscmeD o n [phone]
QUALIFIERS
Project: Plant 8
Pace Project No,: 92362960
DEFINITIONS
DF - Dilution Factor, if reported, represents the factor applied to the reported data due to dilution of the sample aliquot.
ND - Not Detected at or above adjusted reporting limit.
TNTC - Too Numerous To Count
J - Estimated concentration above the adjusted method detection limit and below the adjusted reporting limit.
MDL -Adjusted Method Detection Limit.
PQL - Practical Ouandlation Limit.
RL - Reporting Limit.
S - Surrogate
1,2-Diphenylhydrazine decomposes to and cannot be separated from Azobenzena 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.
Add 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 of Acroleln and Acrylonitrile by EPA
Method 8260.
N-Nitrosodiphenylamirle decomposes and cannot be separated from Diphenylam!no 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-E Pace Analytical Services - Eden
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except In full,
Date: 11120l2017 04:42 PM without the written consent of Pace Analytical Services, LLC. Page 6 of 10

CemaiyrlCale
wwNcperdebt.r�m
QUALITY CONTROL DATA CROSS REFERENCE TABLE
Project: Plant 8
Pace Project No.: 92362960
PaceAnalytical Services, LLC
9800 Klncey Ave. Sufte 100
Hunteravlile. NC 28076
[phone]
Analytical
Leh ID Sample ID QC Batch Method QC Batch Analytical Method Batch
92362960001 Plant 6 #1 SM 2540D 387129
92362960002 Plant 8 92 SM 2640D 387129
REPORT OF LABORATORY ANALYSIS
This report shell not be reproduced, except In full,
Date: 11/20/2017 04:42 PM without the written consent of Pace Analytical Services, I.LC. Page 7 of 10

Document Neme;
Document fkylsed: July 25, 2017
�ZAMIYW+
Semple ConditlooUpon Recal t(SLUR)
P B 1 of2
DocumentNo,:
Issuing Authardy;
F-CAR-CS-033•Rev.03
Pace Quillty Office
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ONE] ❑ Eden[]
Greenwood f4untersville
❑ Raleigh ( Mechanimillell
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`: Client Name:
WO# : 9236296®
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project M
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Cowier:
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NCDENR
Stormwater Discharge outfall (SD4)
Qualitative Monitoring Report
For ytridancc on filling ont this form, please visit: I llnor#al.r cdcrzr.orgf web/h I nndes:�torm+vater /
Permit No.: III I_I�I_ _/�I_ I�I_ I or Certificate of Coverage No.: N&ILI Ll
Facility Name: P1A* 9� fe5+-
-�
County: IN 44 - Phone No.
Inspector: Dirwa
Date of Inspection: _,-,,, a I
Time of Inspection: I 1
V%
Total Event Precipitation (inches): # 2b
Was this a "Representative Storin Event" or "Measureable Storm Event" as defined by the permit?
(See information below.)
Yes ❑ No
Please verify whether Qualitative Moriitorhnq must be leer formed during a "representative storm
event" or "measurea.ble 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 dtiring'a "nieasw-eable storib event." However,
some permits do not have this requirement. Please refer to these definitions, if applicable.
A "representative storm event" is a stai-rn event that measures greater than 0.1 inches of rainfall
and that is preceded b at: least 72 hours (3 clays) in which no storm event measuring greater than
0.1 inches has occrirred. A single storm event may contain up to 10 consecutive hours ol'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 hnurs
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 ghal this report is accur-ate and complete to the best of my knowledge:
(Signatire clPermittee or Designee)
Page 3 of 2
SWn-242, Last it udifled 7/3 1/2013

I. Outfall Description:
Outfall No. 1 Structure (pipe, itc)etc.)
Receiving Stream:
Describe the industrial activities that occur %Vithin 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: U%.C_
3. Odor. Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.): ti W 4-
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
m 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:
© 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:
6) 2 3 4 5
7. Is there any foam in the stormwater discharge? Yes kZw
B. Is there an oil sheen in the stormwater discharge? Yes V
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 he indicative of pollutant exposure. These conditions warrant further investigation.
Page 2 of 2
5W U-242, Last modified 7/31/2013

1. Outfall Description:
Outfall No. Z Structure (pipe setc.)
Receiving Stream:
Describe the industrial activities that ocqui within the outfali drainage area:
2. Color: Describe the colon of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: bur
3. Odor. Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weals chlorine odor, etc.): 1 bPR-
4. Clarity: Choose the number which best describes the clarity of the discharge, where I is
clear and 5 is very cloudy:
© 2 3 4 5
5. Floating Solids: Choose the number which best describes the amount of floating solids in
the stormwater discharge, where I is no solids and 5 is the surface covered with Floating solids:
2 3 4 5
6. Suspended Solids: Choose the number which best describes the amount of suspended
solids in the storniwaterdischarge, where f is no solids and 5 is extremely muddy:
O 2 3 4 5
7. is there any foam in the stormwater discharge? Yes
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 Storrnwater Pollution:
i,ist and describe _l nP
mote: 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
SWU•242, Last modified 7/3i,/2013

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division -of Water Quality General,Permit No. NCGO60000
Date submitted yl A 11
CERTIFICATE OF COVERAGE NO. NCG06 6 0 1 11--
FACILITY NAME Pl am- IL)Ikx& Ax_ I-
COUNTYyikyt-
PERSON COLLECTING SAMPLES R'ttm 4 �r Glr1
LABORATORY ?RL'e- Lab Cert. # q/
Part A: Stormwater Benchmarks and Monitoring Results
SAMPLE COLLECTION YEAR
FACILITY ACTIVITIES INCLUDE -.(check all that apply):
❑ use/process meats ❑ use animal fats/byproducts
DISCHARGING TO SALTWATERS? DYES [�NO
I?LEASEAEMEMBER.TO,SIGN ON'THE REVERSE -)'
Total event rainfall" r 2 & or ❑ No discharge this period?
Outfall No.
Sample Collected,
mo/dd/yr
TSS,
mg%L
pH,
Standard units
COD;
mg/L
Oil and Grease,
mg/L
Fecal Coliform ,
Colonies per 100 ml
Enterococci ,
Colonies per 100 ml
Benchmark
-
100 or 50°
Within 6.0 — 9.0
120
30
1000
500
H 1�
13
b.t
Z
� '1
N a
6• o
S Only applies to facilities that use/process meats.
2The total precipitation must be:recorded using data from an on -site rain gauge.
3 For sampling periods with no discharge at any outfalls. You must still submit this discharge monitoring report with a checkmark here.
°See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Did this facility perform Vehicle. Maintenance Activities using more than 55 gallons of new. motor oil per month? ❑ yes [Rno
Part B: Vehicle Maintenance.Area Monitoring Results: only for facilities averaging > 55 gal of new motor oil/month.
Outfall No.
Sample Collected,
mo/dd/yr
Oil and Grease,
mg/L
TSS,
mg/L
pH,
Standard units
New Motor Oil Usage,
Annual average gal/mo
Benchmark
-
30
100 or 50
6.0 — 9.0
-
Only applies to facilities that use/process meats.
2The total precipitation must be recorded using data from an rain gauge.
3 For sampling periods with no discharge at any outfalls, you must still submit this -discharge monitoring report:with a checkmark here.
°See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
(ifyes, complete Part.B)
SWU-249, Last Revised`. October 18. 2012
Pape 1 of 2

*FOR .PART A AND PARTS MONITORING RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER i REQUIREMENTS_ SEE PERMIT PART li 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 ropy of this DMR, including all "No Discharge"•,rel2orts, within 30 days of receipt of the lab results (or at end of
-monitoring period in the case of "No Discharge"' reporWlo:
Division of Water Quality-
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, NC 27699-1617
'YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED:
'Tcertify, under penalty of law, that this document and allattachments were prepared under my direction or supervision in accordance with
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 ofterfnittee) (Date)
Additional copies of.this form may be downloaded at:.http-Ilportal.ncdenr.orgZweblwq/ws/su/­npdessw#tab-4
SWU-2 i9 L.asE Revised. October 18. 2012
Page 2 of 2

I ZZ,Wm al
5ectian A
Requires Client IntomwElon:
Company. 44.ae N.ix Conn
Ad vess 3613 Bush Street
Roteion NC 27509
CHAIN -OP -CUSTODY / Analytical Request Document
The Chain-o`-Custody is a LEGAL DOCUMENT. All relevant fields must be coplefea acclmlely.
scctian B Sectian C
Rcq.ired Project lnformatton: lnvoics Wom"Gn: C
ficpon To'. .lay Wa:k;m AIIMIIU v
Copy Te: Car�pany Nomc:
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11,�a'oAnalytical
t � w>vw.pacela�s.com
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ANALYTICAL RESULTS
Project: Outfall Plant 8 Wakeforest
Pace Project No.: 92335463
Pace Analytical Services, LLC
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
Sample: Outfall #1 Plant 8 Lab ID: 92335463001 Collected: 03/31/17 09:30 Received: 03/31/17 17:00 Matrix: Water
Parameters Results Units Report Limit DF Prepared Analyzed CAS No. Qual
2640D Total Suspended Solids Analytical Method: SM 2540D
Total Suspended Solids 13.0 mg1L 2.9 1 04/05/17 10:00
Sample: Outfal] #2 Plant 8 Lab ID: 92335463002 Collected: 03/31/17 11:30 Received: 03/31/17 17:00 Matrix: Water
Parameters Results Units Report Limit DF Prepared Analyzed CAS No. Qual
2640D Total Suspended Solids Analytical Method: SM 2540D
Total Suspended Solids ND mg1L 2.6 1 04105/17 10:01
Date: 04/06/2017 08:11 AM
REPORT OF LABORATORY ANALYSIS
This report shall not t>e reproduced, except in full,
without the written consent of Pace Analytical Services, LLC.
Page 4 of 10

Document Narne: ESI Tech Spec
Document Revised: Sept. 21, 2016
-aCBf�Rc?S�fCd�
Sample Condition Upon Receipt(SCUR)
Page 1 of 2
Document No.:
tssuingAuthority:
..�
F-CAR-QA-003-Rev.02
Pace Quality Office
Laboratory receiving samples:
Asheville ❑ Eden❑ Greenwood ❑ Fluntersville ❑ Raleigho Mechanicsvilte❑
BMWClient
Narne:
W0# : 92335453
&��-- ��������
/ "r~: r_
Project
I II I j
Courier:
❑Fed Ex ❑UPS ❑USPS
[Wclient
❑ Commercial
❑Pace ❑Other:
92333453 i ff 1111
Custody seal Present?
Dyes Wio seals Intact?
❑Yes
�!
Po
Date/Initials Person Examining Contents:
Packing Material;
❑Buhbie Wrap❑Bubble Bags
None
[]other.
Thermometer:
. G] IRGun 10:
._ IS-3492Type of Ice: ''VL1
[]Blue ❑rJone []Samples on ice, cooling process has begun
Correction Factor: Aedo.6
Cooler Temp Corrected (°C):
3.1
Biological Tissue Frozen? ❑Yes ❑No ON/A
Tcmp should be at)nve freezing to G°C
USDA Regulated Soil ( Jg11`J/A, vrater sample)
Did samolesarikinate In a ouaranlire zone within the Unhel States: CA. NY_ or fchrck mansl?
Did samples originate from a foreign source (internationally,
? Yes n
Ely do including cludinavraii and Puerto Ricog Hl ❑
Comment s/Disrrepancy:
�M� —❑
Chain ofCusludyPleseut? 1.
SaniplesAriivedwithin Hold Time? ❑ 02.
❑�
Short Hold Time Analysis (02 hr.)? _❑
3
Rush Turn Around Time Requested?
4,
Sufficient Volume?T
S.
fnrre.c� tContaineF5Used? 0 ❑
�_❑
6.
-Pace Containers Used? ❑_
CnntainersIntact? ❑❑ ©
j 7.
Samples Field Filtered? U E
_
8. Note'4 sediment is s�isiiole in the dissolved container
Sample Labels rvlatrh COC'?
`Includes Oate/Time/ID/Analysis
Headspace in VDA Vials (>S-6rnm)? Yes No PI
10.
Trip Blank Present? Yes No N/r
11.
I El ❑
Trip blank Custody Seals Ptesent? Yes No N/A
CLIENT NOTIFICATION/RESOLUTION
Person Contacted; 1
Comments/Sample DiscreparlCy:
Date/Time:
Field Data Required? LJYes LfNo
Project Manager SCURF } 1� rl 1
Review: l ij �� Date: �1
Project Manager SRF ir
Note: Whenever there is a discrepancy affecting North Carolina [OrnpllanCe safnples,'a eopy of this form s: ilE he sent to the North Carolina DEHNR Certaication Office (Le,
Out of hold, incorrect preservative, out of temp, incorrect [ontairieri) = '-„ ' ,
t
° LPage 8 of 10
I

DOCu menr Name: ESI Tech Spec
Dowment Revised: Sept. 21, 2016
Sample Condition Upon ReceiptjSCURj
Page 2 of 2
riiGe�17r1��� 1Ciil
Document No.�
Issuing Authority:
F-CAR-QA-003-Rev,02
Pace Quality Office
*Check mark top half of box if pH and/or dechlorination
is verified and within the acceptance range for
preservation samples.
"Bottom half of box is to list number of bottles
Project P WO# : 92335463
PM: AMB Due Date: 04/14/17
CLIENT: 92—Ready Mix
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Sample tD
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date preservation adjusted
Time preservation
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I
Page '.of 10

NCDENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
rorguidance on filling out this form, please visit: http://portal.ncdenu-rg/web/lr/npdes-starmwater/
Permit No.: N/C/_/_/ /�/_/_/_/ or Certificate of Coverage No.: N/C/ j/_q/_a Q/.,/_/
Facility Name: 91 AA+ 4 W AAL QrM NIL _
CoLmty: _ WAY,& Phone No.
Inspector: Rtu4Q t f �eet%l _
Date of Inspection: 51141Ib
Time of Inspection: 1, 3 5 ? M
Total Event Precipitation (inches): a
Was this a "Representative Storm Event" or "Measureable Storm Event" as definedob the r7#n,iYw--r)
(See information below.)
JUL 14 2016
Yes ❑ No y D11RSECT$DN
�,+1RR1�M4PzUVrf
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, l certify that this report is accurate and complete to the best of my knowledge:
(Sign1Xre(Xf Permittee or Designee)
Page 1 of 2
SWU-242, Last modified 7/31/20I3

1. Outfall Description:
Outfall No. 2 Structure (pip ditch tc.)
Receiving Stream:
Describe the industrial activities that occur within the Outfall drainage area:
Qtadu ]m, iieA Acy.Q+e_ _ Aav4
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors:`Aiowp
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weals chlorine odor, etc.): WIAJ42
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
O 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:
V 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:
rl 2 3 4 5
7. Is there any foam in the stormwater discharge? Yes
B. 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.
Pagc 2 of 2
SWU-242, last modified 7/31/2013

_ aceAnalytical"
www.pacelabs.com
ANALYTICAL RESULTS
Pace Analytical Services, Inc.
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
Project: WAKE FOREST PLANT 8
Pace Project No.: 92298593
Sample: OUTFALL #1 WAKE
Lab ID: 92298593001 Collected: 05119/16 13:30
Received:
05/20/16 14:40 Matrix: Water
FOREST
Parameters
Results Units
Report Limit DF
Prepared
Analyzed CAS No. Qual
2540D Total Suspended Solids
Analytical Method: SM 2540D
Total Suspended Solids
6.7 mg/L
2.5 1
05/25/16 11:35
Sample: OUTFALL #2 WAKE
Lab ID: 92298593002 Collected:
05/19/16 13:35
Received:
05/20/16 14:40 Matrix: Water
FOREST
Parameters
Results Units
Report Limit DF
Prepared
Analyzed CAS No. Qual
2540D Total Suspended Solids
Analytical Method: SM 2540D
Total Suspended Solids
26.0 mg/L
5.0 1
05/25/16 11:35
Date: 06/2012016 02:29 PM
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
without the written Consent of Pace Analytical Services, Inc..
Page 4 of 9

jxeAnalyftalSample Condition Upon ltecel' t So : rage 1 of 2
Document No.: Issuing Authority:
�_, ._•_ ___. F-RAL-CS•001-rev.05 Pace Raleigh Quality Office
� 1��1yy11L((L o--- � ..a, s, W-nal use ONs v
rClient Name: WO# : 92298 93
t v��x NA
Project #;
�_tl.r,•,,.,,,., _ .i! 1!'ace:; .� ❑€�Ps UDtlscr
a2298593
1
(:ottoriy Se:sl present? 0YeS Oka, Seals Intact? Dyes Ao 01 1(0
bate/InElials Person Examining Cvntentsi�[ r�—V
:'ar.kinf rv,Iaterial: �]!iuhiri sVrah ❑Bvubie Bags APlone []Other;1
I tts rrru!r=;, tar: f%, u,E SN: 11206`.,38? ❑iF, 5$1: ! 12065371 Type of Ice; 0Wet ❑Blue ❑Itone []Samples on Ice, cooling process [I,)$ begun
t:nrrecVon proctor: D.11'C Cnnler Temp Corrected ('C): biological Tfssue Frozen? QYes []NO N/A
I or-':) si cuid oe above freezing to 6°C !J
USDA Regulated 5Qil ( NjA, water sample]
Did saull) a origutiato to 3 quarantf a zone within the United States: CA, NY, or SC (check maps)? Did samples originate from a foreign source (intrehrl ationally,
Fl5'P.S mNei 1-1 Alen Waivnil and Puarin RirnP I�Yac II INo
COMMENTS:
Chain of custody Present?
Yes
❑No
❑N/A
1.
Chain of Cvstudy Filled Out?
Yes
❑Na
N/A
2.
Chain of Custody Relloquished?
Y s
On
❑N/A
3.
Samsrler?lame grid/or Signature on CDC?
Yes
ONO
❑N/A
4, _
5<f ilalcsrurivcdscitNnHold Iime?
Yes
❑No
❑N/A
5,
Short Huld lime Analysis (c72 hrl?
[Jr,10
El N/A
6.
_ _
I Hush sure Around Time Requested?.___u—__ —
_❑Yes
[]Yes No
❑N/A
�•
6.
' :wu!:n77
Yes
❑No
❑N/A
9.
.... ., ..... _...., !,.r ; rlso:i? fYcs ❑.'to ❑N/A
:--„:•.:.,•.:ilurr} l!,r.(I
..._ ..
Yes
((Q
Nu
N A
10,
0,11A
11. Note if sediment isvisible lnthe dissolved container
ssalveN Tvtits`� []rro N/A
...__.1
hlatcli CDC?
«©Yes
0Yes
❑No
❑NIA
12.
_i u:!s D�:_•!1';raellDfAn rlpsis €vlatrix:_ _���_s,
Ali otioJinE acid/bade preservation Jiave been
13.
U`cikcd
�/
Qyes
❑No
❑N/A
gall Ct3^iarnP-r5 oteding p(esefvation are found to be in
(
,
rt,rwhancs. vrlth LPA recommendations?
W,10i, H,SD,, 110<2; N,10H >9 Sulfide, Naolf>12 Cyanide)
�jYes
[]No
[]N/A
VOA, Coliform, TOC, Oil and Grease,
IMQ/8015 (water) DOC,LLHg
es
❑No
❑N/A
Samples checked for dechlarination
yes
❑No
❑NIA
14,
+}Ieadspace in VOA Via€s (>5-6mm)?
❑Yes
❑No
N/A
15.
Trip Blaok Present? «
❑Yes
l]NaON/A
16,
ip 0lank Custody 5eais Present?
❑yes
❑Na/A
Puce 1 Tip Blank Lot 0 (if purchase(€):___
CLIENT NOTIFICATfONJRESOLUTION
Date/Tfne:
Field Data Required? Dyes [:]No
Ys'oject Mauagt!r SCURF Review: , Date: , '; 17
Project Manager SRF Review, _ _ � � Date: 1. 3 (��
Nuls•' "Vh1 lit. YCI I€n;ntill s a discrepancy affecting North Carolina compliance samples, a copy of thisform,III he sent to the North Carolina DEHNRCertification Office li,e.
Uur (,I halo, incorrect I)rtast!iV ivr, out of temp, incorrect contairersl
Page 8 of 9

m
F,'
.'FaceAnalytrcal"
r�.oleell6r.com
CHAIN -OF -CUSTODY 1 Analytical Request Document
The Chain -of -Custody is a LEGAL DOCUMENT. AA relevant hells must Oe completed accuratch'•
Section A Section B Section C
Page: o!
R"uked Cbwi SmormZtion: Rcquirvd Project rnlor-a6cn: Invptt intrbma;xn:
C..rnaa'+f" Repon To:
2056311
Altcnrion:
, �
Addres ��la j S l-rC.jC�
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Company Nana:
REGULATORY AGENCY
to z 7b al
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NIPOES 3 GROUND WATER i DRINKtNG WATER
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Email To:
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Poca Rrote
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Requested Due Dat*FAT:
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Requested
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Section D Mslrix Codas
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CC®ENR
Stormwater Discharge 4utfall (SDD)
Qualitative Monitoring Report
Forguidance on filling out this form, please visit, http://portal.ncdenr.org/web/wq/ws/su/npdessw#tab-4
Permit No.: N/C/_/_/_/_/_/_/_/ or Certificate of Coverage No.:
Facility Name: P I -Am4 Q, VVAke.foreSt N L
County: W AK? __ Phone No. R Iq' 5 56 — 3 Q
Inspector: TA-4 &TKiNs
Date of Inspection: IS 11ty
Time of Inspection: 1: Z3 NOV
V
" 2614
Total Event Precipitation (inches): 1_, 5 ____
CENTRAL FILES
DWR SECTION
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
(See information below.)
2 "Y"'es ❑ No
Please verify whether Qualitative Monitoring must he performed during a "representative storm
even t"or "meosureablestorm event" (requirements vary, depending on the permit).
i
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 nc
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 that this report is accurate and complete to the best of my knowledge:
Permittee or Designee)
Page 1 of 2
SWU-242, last modified 10/25/2012

1. Outfall Description:
Outfall No. -- Structure (pipe4ZZ)tc.)
Receiving Stream:
Describe the industrial activities that occur within the outfall drainage area:
Rf4ld f' i nd umtye4O iAN f
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: GIrar
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.): M(gp-e
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
5. 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:
1� 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:
7.
A
9.
© 2 3
Is there any foam in the stormwater discharge?
4 5
Yes
Is there an oil sheen in the stormwater discharge? Yes No
Is there evidence of erosion or deposition at the outfall? Yes 6)
10. Other Obvious Indicators of Stormwater Pollution:
Listanddescribe �JfWo—
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
SWU-242, Last modified 10/25/2012

A&"4j;,A
.rwrrrrr.
NCDENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Forguidance on filling out this form, please visit. http_//portal.ncclenr.org/web/wq/ws/su/npdessw#tab-4
Permit No.: N/C/_/_/_/_/_/_/_/ or Certificate of Coverage No.: N/C/G/L / q/ O/ G/7/ 2/
Facility Name: 04tof 9 w a ka f e1+ 1 iV C
County: W A, ((A Phone No. q 14 - 5.S 6 ^ 3 4 51
Inspector: W
Date of Inspection: foils I IL.
Time of Inspection: 1; Z Z__f
Total Event Precipitation (inches): /, 5
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
(See information below.)
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 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 that this report is accurate and complete to the best of my knowledge:
(Signiregf Permittee or Designee)
Page 1 of 2
SWU-242, Last modified 10/25/2012

1. Outfall Description:
Outfall No. _' Structure (pip ditch c.)
Receiving Stream: _
Describe the industrial activi ies that occur within the outfall drainage area:
kv aj A IM; k9t f nh tr-e 4-e A 1 a h4-
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: C(�e u,C
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.): N01u-
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy: /�
cy
5. 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:
Q 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 �4tnJ
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 e) n X
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
SWU-242, Last modified 10/25/2012

�rI'll I'r ,II rGE �uT�,�l� �s©o) - s �i7,i-;� lull:i�
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF COVERAGE NO. iVCG14_Q .0 ::r 2-
FACILITY NAME: _ 3--I an-}- Q-I&Yfbk -FOaSI , W L
PERSON COLLECTING SAMPLES �S
CERTIFIED LABORATORY Lab #
Lab ##
OPTIONAL INFO:
Part A: Stormwater Monitoring Requirements
SAMPLE COLLECTION YEAR: ZOj.q_
SAMPLING PERIOD: Rriuly-December ❑ January -June
COUNTY •WAye,
PHONE NO. ( j_55(2311951
ADD TO LISTSERVE? AYES ❑NO EMAIL:
DISCHARGING.TO CLASS: OSA ❑HQW ❑PNATrout
❑Other
Outfall No.
Date Sample
Collected
(mo/dd/yr OR
NO FLOW]1
pH
(Standard
Units}
TSS
(mg/1)
[vent
Duration
(minutes]
�'ata)
4
Rainfall
(in)
In Tier 2
Monthly
Monitoring?
(y/n)
# of Months in Tier
2 Sampling2
-
-
Ei;4
1002.3
-
-
-
-
IDI
ti 114-710
N0
LiZo
1,,3
s
ND
z.v
I If "NO FLOW" or "NO DISCHARGE, Enter "NO FLOW" or "NO DISCHARGE" for each outfall here. Please make sure to mark the sample period above.
2 If a value is in excess of the benchmark, or outside the benchmark range (for pH), you must implement the Tier 1 or Tier 2 responses in the General Permit. Tier 2
Monthly sampling shall be done until 3 consecutive samples are below the benchmark or within the benchmark range.
3 T5S benchmark values are 100 mg/I, except when discharging to ORW, HQW, Trout, and PNA waters where they are 50 mg/I.
4 For each sampled measurable storm event the total precipitation must be recorded using data from an on -site rain gauge.
Permit Date: 7/1/2011-60/30/2015 Last Revised 7/13/11
Page 1 of 2

Part 13: Vehicle Maintenance Activity Monitoring Requirements for facilities using > 55 gal of new motor oil/month — averaged over a calendar year
Outfall
No.
Date Sample
Collected
(mo/dd/yr}1
pH
[Standard
Units]
TPH using method
1664A SGi-HEiVI
(mg/L)
Total Suspended
Solids
(mg/L)
Event
Duration
(minutes)
T otaI
a
Rainfall
(in)
New Motor Oil
Usage
(gal/month}
In Tier 2
Monthly
7
MO{v;n�ng'
# of Months
in Tier z
5ampling2
6-92
152
1002,3
-
-
-
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES ATANY ONE OUTFALL (INCLUDING VEHICLE MAINTENANCE)? YES [] NO
HAVE YOU CONTACTED THE REGION? YES ❑ NO
REGIONAL OFFICE CONTACT NAME:
Mail Orieinal and one cores of this DMR (including all "No Flow" & "No Discharge" reports) within 30 days of receipt of sample (or at end of monitoring period
in case of "No Flow"] to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
YOU MUSTSIGN THIS CERTIFICATIOIU FOR ANY INFORMATION REPORTED:
"1 certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to
assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or
those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete.
am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
(Signatu
Permit Date: 7/1/2011-60/30/2015
MAha
(Date)
Last Revised 7/13/11
Page 2 of 2

/5a'ce Analj4 cal
www.Pace+eOs.mrn
Laboratory Report
.fay Watkins
Ready Mix Concrete
PO Box 27326
Raleigh, NC 27611
Project: PLANT #8 WAKE FOREST, NC
Pace Project No.: 92221764
Pace Analytical Services, Inc.
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
Page 1 of 1
Report Date: 10/31/2014
Date Received: 10/16/2014
Sample: QUTFALL #11PLANT 8
Lab ID: 92221764001 Collected: 10/15/14 13.23
Matrix: Water
Parameters
Results Units Report Limit
Analyzed
Qualifiers
Total Suspended Solids
ND m911- 2.5
10/22/14 09:59
Sample: OUTFALL #21PLANT B
Lab ID: 92221764002 Collected:
10115114 13:28
Matrix: Water
Parameters
Results Units Report Limit
Analyzed
Qualifiers
Total Suspended Solids
ND mg1L 2.5
10/22/14 09:59
Reviewed by.
Laura J Cooper
[e-mail]
Raleigh Certification IDs
6701 Conference Drive, Raleigh, NC 27607
North Carolina Wastewater Certiflcation #: 67
North Carolina Bioassay Certification #: 16
North Carolina Drinking Water Certification #: 37731
Page 1 of 3

Document Name: Sample Condition Upon
Do6Umenj ReVised: April 04,201,3
P
Receipt (SCUR)
Page I of 2
Document No,.
issuing Authorities:
P-RAL-CS-001,tev,02
Pace Asheville Quality OM06
Client Name:
Wheio - Rec'elved HuntersvIlle 0 Asheville
C] Eden
Ralelgh
G&4(or(Clicle): Fed Ex UPS LISPS
cornmerolal
Pace Other
Cui!odyteal on CoolorlBox Present: yes no
Seals Intact:
pf yes no
aus Z None Other•_�
VTypo
CIrA:T66ornotor Used: IR Gun SN:1'2' of Ice:
. ..�! 1'­�­
�W5 Blue
None a Oes on cooling process has begun'
t3 ni
Irl bun back Up SN:122963371
TornO corroction Factor' Add I Su tr ct q
Data and Initials of parson oxanilning
Corr'o'cted' CooIerTqrnp.,, A-. C
1 ' '
Biological . Tissue Is Frozen-, yes -fto IA
ch 0
check
Torhp. should be above freezing to 6*,C
ChAlb of Custody Piesonl'
Chflln;O'f :'&_S'fody. Filled Out
Y2!.ON,
ONVAJ2.
0Y..s Lim
C1 NA
3,
Sameler-Naffie & Signature on COC;
oy'" 13HO
04,4
4,
Sam b IeVAM yed within Hold 71me:
XY..13N.
©WA
6..
0Y00,4&0
OWA
8.
Ftwsl);.Y#nn Around Ilene Requested:,
Dyes o
_Owk
7.
Su cielyt.yoluma:
69 ONO
DWA
8.",
C.crrebt Contalners Used:
'Alyeo: ©Na
b7WA
9.-
-Phi' WalnersUsed-
3Lao. ONO.
014A
Containers Intact:
gy6o ONO
11WA
16.
-FlItarod volume -received for Dissolved tests
PY... OW
J*A
A
Samp!e',L-Abels match GM.
Zoo Oo
OXIA
112.
datellimenDlAnaiLsis , Majdn_
All co n[p , 1� - i , o! . medlnq'preservallon have boon checked.
p7os LINO
ONJA
13,
All prsseWlon are found to be In
'rocommendallon.
eYes []No
OW'A
0rn i6ncd vA EPA
ox ldr . ,.jSN QaOrM. TM 090, Wt DRO (water .
j3�08 ONO
$Oftli L�__ _41or deqhlodnatlon:
OYo 13No
A
14,
0yqS ON*
L2kA
16,
Till a
Dye
16,
Trip".' lhk' 6'6'stody Seals Present
©yea: 13NO
ZWA.
PACO'. 410 I6nkLot ft(lfpur"sed)-
Cifti
ficatiorit, Resoltitlon, Field Data Required? y 'I N
Person Cantacted: Date/Thne.
Comm.dnisl Re -solution;
w
keyl6w;: O,'i�`92221,764 '
'N6f6,TM iever. there 5 a d1soropancy effecting North Caroihii CaTollance
of V4 lor(n Wit �o sent to the North Carolina DEHNR'
�Rfnpps. a copy pill 1111 o }I E:,
oMif 922 Ication-office (Lo out of he,�, Incorrect preservative, W of tornp.
14'
lnoorred containers)
Page 2,of

e Ana"caf
CHAIN-OF-CUSTODY/Analyticatk
The Cham-d-Guslocly s a LEGAL D0f--VL1EN'T. AD mWIWU flelds fflxg be C=OeW a=rald
0.
palm: of
Secdan A" SUEfiGn 8 Saaflon C.
Required Cknt ln�: 1141*10d F2,41)W irlrorrr�icwr. lo"lom
1782318
Copy T(K
cwpwy hkm—,
REGULATORY AGENCY
•
AOIMK
r' NPOES GROUND WATER DRJNJNG WATER
i" UST RCRA OTHER
far" V"3",e
I Fig
pwzhna
P� 061010
long id
Fa7bromw
.
I
::�lth Locubon
STATE:
.....
PAKrussod Dun DAWTAM."
Flr.
c� 1� —
Poquested
Anatysis
Fiftered
(YIN,
i
COLLECTED
pmwrvatpv"
3:
o"fm waw ow
Mtff, W
G,
D
p
W"lowsw ww
co
00mmiTE
STA"
Pm6ucl p
sowso6d
od CIL
SAMPLE ID
9
vfto %%,p
W2� "I. ) Air AR
uj
dx
Uj
S&Tgfe Vs MUST OF- UMWE Timm Ts.
O.
1A
U
orw OT
12
011doddlid
0,
a!
LL
CL
�v
I
I
I
I
o
ca
DATE
MOM
DATE
TIME
;a
D
x
X
x
*1
w
PWs ProjeCt NoJ Lab I.D.
ottr mcaj +5 7 —plivite
svll&
iviiii
tair
I
I
-T
4
70
71
MMMMAL COMMENTS
SaELV40tNSHED BY I AFFM.LATWH
RATE
Twe
ACCtPTEID BY I AT-m.!I-To
DATE
TIME
SAUMX CONDMONS
j-
-7
i;�pum mAjvE ANo spriAATURr='
Q
;.)R[GNAL- 'PRINT Name �f SAPAPLM-
'7'
Z
Note: By pw, KE-3 :;j Zw taw.

A��
�.���
NCDENR
Stormwater Discharge Outfall (SDU)
Qualitative Monitoring Report
Forguirlance on filling out this form, please visit: Itttua/Gturtal_t l �ir.n:i ce l?fav trti su/nrulcsswittal�-�i
PermitNo.: N/�/ _/�/_/_/_/_/_/ or Certificate of Coverage No.:
Facility Name: Pk -.I Wak-41F . NC _
County: &J.lc,, Phone No. gig-S5,L-3g5l _,._ .._ ...—.
Inspector: iy)Ac4pt5
Date of Inspection;-kl311H
Time of inspection: _i P W
Total Event Precipitation (inches): - Y
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
(See information below.)
Yes ❑ No
Please verify whether Qualitative Monitoring must be performed during a "representative storm
event" or "measureable storm evert" (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, f
some permits do not have this requirement. Please refer to these definitions, if applicable.
i E
A "representative storm event" is a storm event that measures greater than 0.1 inches of rainfall I
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 that this report is accurate and complete to the best of my knowledge:
(Signature of Permittee or Designee)
RECEIVE®
MAR 13 2014
Page1M 2RALFILES
DWQIBQG
SWU-242, last modified 10/2S/2012
RECEIVED
CENTRAL FILES
DWQ180G

1. Outfall Description:
Outfall No. I Structure (pipe, o, 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, brav<rn, blue, etc,) and tint
{light, medium, dark) as descriptors: L+ i3ro.
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.): &jOA `
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
1 C) 3 4 5
5. Floating Solids: Choose the number which best describes the amount of Boating solids in
the stormwater discharge, where 1 is no solids and 5 is the surface covered with floating solids:
0 2 3 4 5
G. 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:
lJ 2 3 4 5
7. Is there any foam in the stormwater discharge? Yes (90
S. Is there an oil sheen in the stormwater discharge? Yes A}o,
9. Is there evidence of erosion or deposition at the outfall? Yes 0
10. Other Obvious Indicators of Stormwater Pollution:
List and describe
[dote: 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
SVVU-2h2, Lastmodified 10/25/2012

NCDENR
Stormwater Discharge Outfall (SD®)
Qualitative Monitoring Deport
Forgufdance on filling out this form, please visit: I3 rr,:I.i�cil ��r .�u;;� !_t� /ti5
Permit No.: N/C/�/`/_/_/_/_/_/ or Certificate of Coverage No.: N/C/G/ I / 4/ O/d/_1/1/
Facility Name: PI-4 -9 a{ct o L
County: W.(C-e. Phone No. 9r9-5-s4-3-7s1
Inspector: friA c,, s
Date of Inspection:
Time of Inspection: ! : pe, T
Total Event Precipitation (inches): - Y
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
(See information below.)
[Yes ❑ No
Please verify whether Qualitative Monitoring roust be perforated during a "representative storm
eveat" or- "roeasureable storm everli" (requirements vary, depending on the hermit).
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 that this report is accurate and complete to the best of my knowledge:
(Signature of Pcrmittee or Designee)
Page 1 of 2
SW U-242, Last modified 10/25/2012

I. Outfall Description:
Outfall No. ). Structure (pipe, 't+�r i, etc.)
Receiving Stream:
Describe the industrial activities that occur within the outfall drainage area:
lea ✓vW'xe� a„ d
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: e I!ec
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.): 0Cc
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
5. FloatingSolids; Choose the number which best describes the amount of floating solids in
the stormwater discharge, where I 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:
YD 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 No
9. Is there evidence of erosion or deposition at the outfall? Yes No
10, Other Obvious Indicators of Stormwater Pollution:
List and describe
Dote: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition
may be indicative of poliutant exposure. These conditions warrant further investigation.
Page 2 of 2
SWU-24.2, Last modified 10/25/2012

STORMWATFR DISCHARGE OUTFALL (S®O) - Semi -Annual MONITORING FORM
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF COVERAGE NO. NCG14(2. _0 7
FACILITY NAME: 61,Ci,,i n] [.
PERSON COLLECTING SAMPLES
CERTIFIED LABORATORY hnc-s Lab # 41
Lab #
OPTIONAL INFO:
Part A: Stormwater Monitoring Requirements
SAMPLE COLLECTION YEAR: 9D i 4.
SAMPLING PERIOD: ❑ July -December JanuaryJune
COUNTY 1jQ�.,
PHONE NO. ( M &4;-(3 3$SI T
ADD TO LISTSERVE? ❑YES ❑NO EMAIL:
DISCHARGING TO CLASS: ❑SA ❑HQW ❑PNA []Trout ❑Other
Outfall No.
Date Sample
Collected
(mo/dd/yr OR
NO FLOW)'
pH
(Standard
units)
TSS
(mg/L}
Event
Duration
(minutes)
Total
s
Rainfall
(in)
In Tier 2
Monthly'
Monitoring?
(y/n)
# of Months in Tier
2 Sampling'
-
-
6-92
1002'3
-
-
-
-
ILI
7.9
t2.
3 av
.
3
7. 7300
' If "NO FLOW" or "NO DISCHARGE, Enter "NO FLOW" or "NO DISCHARGE" for each outfall here. Please make sure to mark the sample period above.
Z If a value is in excess of the benchmark, or outside the benchmark range (for pH), you must implement the Tier 1 or Tier 2 responses in the General Permit. Tier 2
Monthly sampling shall be done until 3 consecutive samples are below the benchmark or within the benchmark range.
3 TSS benchmark values are 100 mg/I, except when discharging to ORW, HQW, Trout, and PNA waters where they are 50 mg/I.
For each sampled measurable storm event the total precipitation must be recorded using data from an on -site rain gauge.
Permit Date; 7/1/2011-60/30/2015 Last Revised 7/13/11
Page 1 of 2

Part B: Vehicle Maintenance Activity Monitoring Requirements for facilities using > 55 gal of new motor oil/month -- averaged over a calendar year
Outfall
No.
Date Sample
Collected
(mo/dd/yr)3
pH
(Standard
Units)
TPH using method
1664A SGT-HEM
(mg/L)
Total Suspended
Solids
(mg/L)
Event
Duration
(minutes)
Total
Rainfalla
(in)
New Motor Oil
Usage
(gal/month)
In InTier Tier2 Monthly
Monitoring?
(y/d}
# of Months
in Tier 2
Samplingz
6-92
is
1002,3
-
-
-
-
-
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES AT ANYONE OUTFALL (INCLUDING VEHICLE MAINTENANCE)? YES [—]NO
[v�
HAVE YOU CONTACTED THE REGION? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail Orieinal and one copy of this DMR (includine all "No Flow" & "No Dischme" reports) within 30 days of receipt of sample for at end of monitoring oeriod
in case of "No Flow" 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)
3131 i �j
(Date)
Permit Date: 7/1/2011-60/30/2015
Last Revised 7/13/11
Page 2 of 2

Pace Analytical Services, Inc.
5acieAnalyftal 9804 Kinsey Ave. Suite 104
Huntersville, NC 28078
wwwpaceabs.com
[phone]
Page 1 of 1
Laboratory Report
MD Capps
Report Date: 03/11/2014
Ready Mix Concrete Date Received: 03/07/2014
PO Box 27326
Raleigh, NC 27611
Project: PLANTS #8
Pace Project No.: 92192350
Sample: OUTFALL 1
Parameters
Lab ID: 92192350001 Collected:
Results Units Report Limit
03/03/14 13:01
Analyzed
Matrix: Water
Qualifiers
Total Suspended Solids
12.6 mg/t_ 3.2
03/10/14 20:00
Sample: OUTFALL 2
Parameters
Lab ID: 92192350002 Collected: 03103114 13:06
Results Units Report limit Analyzed
Matrix: Water
Qualifiers
Total Suspended Solids
7.7 mg/L 3.1
03/10/14 20:00
Reviewed by: D
Nikitia Jones -Jackson
[e-mail]
Asheville Certification IDs
2225 Riverside Dr., 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 #: 90030001
West Virginia Certification #: 356
VirginiaNELAP Certification #: 460222
Page 1 of 3

e nalyficalia Chain of Custody
Report Results to: Bill Results to: standard Report Delivery
Ready Mixed Concrete Ready Mixed Concrete ® Rush Report Delivery (w/ surcharge)
P.O.Box 27326 P.O.Box 27326 Requested Due Date:
Raleigh, NC 27611 Raleigh, NC 27611
Uti'iQ cqpS Project Reference: Plants #8
ATTN: sera" ATTN: Jo4RJ VffT& i Purchase Order #:
Phone: [phone] C-J ehy Idct�ktl'o Sampled By: _E21D
0
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_ s"=
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_ tapme�.V��>
Outfall 1
G
�l31, Lit
tI .....
1,01 P,
Sw
TSS
Outfall2
Gr�lr�
Sw
TSS
--@ta--•
G
Sw
TSS
Relinquished by (signature)
1�=
R ",ted by ( atur
Peced
Da
I�
Time
-
For Lab Use Only
Temperature at receipt:
Temp: I ► C'
Relinquished by (sign re)
by (si gn a It u �re
oAe 0,
Time
Relinquished by (signature)
Received by (signature)
Date
Time
m
0
ca
d
c
d

Document Name: Sample Condition Upon Document Revised: April 04, 2013
Analytrc,l a Receipt (SCUR) Page 1 of 2
Document No.: Issuing Authorities:
' F-R L-CS-001-rev:02 Pace Asheville Qualitv Office
Client Name.. 1VYL
Where'Received: ❑ i-luntersyille Asheville OUEden Raleigh
Courier (Circle): Fed Ex UPS USPS Clien Commercial Pace . Other___`___w
Custody Seal on CooferlBox Present: ❑ yes. no Seals intact: yes El no
Packing Material: ❑ Bubble Wrap —BuW s None Other
Circle Thermometer Used: IR.Gun Nay 22p65387Type of Ice: •Wet .Blue • None Samples an ice, cooling process has begun _
IR Chun l3p : _ 7Z
Temp Correction Factor. Add/ ubtractej
Corrected Cooler Temp„ -C.
.
Terrip.should be above freezing to 6°C
I C
. ,Biological Tissue is Frozen:.yes H NIA
-Comments:
Date and Initials ofperson examining
. , co to Pr© ry o
check:'
6din'ofCustody Present: :........... ..::.......
... Yea ❑No..(
NIA
i.'.-..._m:,_....._..._...._._.._.
... ._..._:_... . _. ._.. ..r_............._ ......._
Chainof Cusiody.Filled Out:
YeA :�No
❑NIA
2. '
Chaln-of CU,stotl . Relin uished:
Yes .G]ivo
❑wA
3.
5ar4lerName.& Signature on COC:.
Y'ea 0N* o
❑NIA
4.': .
Sam- Ies'Arrived:wlthin }fold Time:
Yos.::ONo
❑NIA
5..
Short Hold Time Analysis t<72hr :
OYas '141
©NIA
6-
Ru' urn.;4round.itme Requested:
❑Yoe No
❑NiA
7..
5ufficlent.V6lume:
Yes ❑No
❑NIA
$. -_
Correct Contalrers Used::
-Pace'C6ntainbrs Used:
Yua ❑No
A. ON.'
❑NIA
❑NIA.
9., '
�Ontaa ners Intact:
Yes 0No•
ON/A
10.
Flltere'd volurnte.received.for Dissolved tests
Dyes ONO
NIA
11,
Sample Latiels.rrtatch COC:.
-Includes dateltlmellDlAnal sis Matrix:
Yes 4Na
ON1A
12.
All -containers needing preservation Kaye been checked.es
All containers needing preservation are found to be In
coinpliencewith EPA recommendation. -
exceptions: VGA, wnforrn, TOC, O&G, WI-DRO (water)
ONO
xea ❑No
Yes ONO
❑NIA
❑N!A
13.
Samples.checked for dochlorinatlon:
- Yas . ONO
ONIA
14.
Heads ace In VOA Vials >emm :
OYas ONO
Trip Blank Present:
Trip Biank Custody Seals Present
Pace Trip Blank Lot # (if purchased}_
OYas ©No
Ovas ❑No
NIA
f�N1A
/
16:
Client Notificatiord Resolution: Feld Data Required? Y 1 N
Person Contacted, Date/Time'
Comments! Resolution: _
SCURF ISRF Ly � Date: LL
/'Review::
Note: Whenever there Is. a discrepancy affecting North Carollr a compliance
samples, a copy of this form will be sent to the North Carolina DEHNR
Certification Office (1.e out of hold, incorrect preservative, out of temp,
Incorrect containers)
Place label here ;
�W0#:92192350 -
11211923
Page 3-of 3