NCG140072_MONITORING INFO_20041018

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
/V �� I OOca
DOC TYPE
❑ HISTORICAL FILE
MONITORING REPORTS
DOC DATE
❑ Q�DO�f ��
YYYYM M DD

�r
DISCHARGE OUTFALL MONITORING REPORq
NCDENR GENERAL PERMIT NCG140000 -!��
�A OCR \
(All sample data shall be reported no later than 30 days after receipt of lab results)
Certificate of Coverage
NCG14
Facility Name
Rcr Gi'.�P
County
r Ltl9
Phone Number
Certified Laboratory #
^ Fv' '
e
Person Collecting Sample(s)
U
Collectors Signahue--
v
Sams Information
Permit Term
Year
Year StarvEnd Dates
Place check mark to indicate
applicable sampling period
Discharge T (check as appropriate)
.Stormwater
Wastewater
1
August 1, 1999 to July 31, 2000
❑
❑
"
❑
❑
❑
El
L1
❑
❑
❑
❑
❑
❑ ,
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
Date
Total Event Precipitation inches
Event Duration hours
y
ly
Stormwater Discharge Monitoring
Outfall
No.
'Date Sample
Collected
(mo/dd/
Total Flow
G)
Total Event
Precipitation
(mches)
Event Duration
pH
(Std. Units
Total '
Suspended
Solids
in
i
Does this facility perform 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 I
Oil and
Grease
melp
SWU•241.090199 - Page lof 2

iniple #
Sample # _
Effluent Source(s) for this sample
chicle / Equipment Cleaning ❑
aw Material Stock -pile Wettin ❑
Uxing Drum Clean -out ❑
ec cle System Overflow ❑
Parameter
Unit
Data
,ollection Date
mo/dd/yr
Total Flow
MG
?vent Duration
hours
pH
Std. units
TSS
mgA
.ettleable Solids
mm
;ample #
Effluent Sources for this sample J
lehicle ! Equipment Cleanin ❑
taw Material Stock- ile Wettin ❑
dixing Drum Clean -out ❑
tec cle System Overflow ❑
Parameter
Unit
Data
Collection Date
mo/dd/yr
Total Flow
MG
Event Duration
hours'
pH
Sid. units
TSS
MBA
Settleable Solids
mw
Mail original and one copy to:
Attn: Central Files
Division of Water Quality
DENR
1617 Mail Service Center
Raleigh, NC 27699-1617
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
I Std. units
TSS
I mg/l
Settleable Solids
I m1A
Sample # _
Effluent Sources for this sample
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
me
Settleable Solids.
nil/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 fines and imprisonment for knowing
violations." A / /
vtG a fr) - 17 Z
(Sign ure of Permit —tee or Designee) (Date)
SWU-241.090199 Page 2 of 2

Page 1
READY MIXED CONCRETE COMPANY PLANT NO.
PLANT NO. L' DATE:/e)-/% e?� Form 6.1
STORMWATER DISCHARGE OUTFALL VISUAL REPORT
Certificate of Coverage No. NCG 1400 7.2 Plant Name: !';; `•:.= Y
County. 4(/.lk k
Inspected by
Date of Inspection:
By this signature,,!certify that this report is accurate and complete to the best of my knowledge:
(signature).:
STORMWATER DISCHARGE OUTFALL (SDO) VISUAL MONITORING REPORT
i
1 Outfall Description ( attach SDO Visual Monitoring Report for each add'I SDO)
Outfall No. SDO 3 • Structure (pipe; itc S 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, etc.) ; i . . .
3 Odor
Describe any distinct odors that the discharge may have (Le. smells strongly of oil, weak chlorine odor, etc.)
./l 'Yt.".
4 Clarity
Choose the number which best describes the clarity of the discharge where 1 is clear and 10 is very cloudy:
2� 3 4 5
7 8 9 10
SW?PRMCC

Page 2
5 Solids
Choose the number which best describes the amount of solids in the stormwater discharge where
1 is clear and 10 is extremely muddy.
1 �", 3 4 5
6 7 8 9 10
6 Foam
Is there any foam In the stormwater discharge? YES
7 Oil Sheen
Is there any o1 sheen In the stormwater discharge? YES NO
8 Outfall Staining
Describe any staining around the stormwater outfall:
9 Other Indicators
Describe any other obvious indicators of stormwater pollution:
NOTE: Low clarity, high solids and/or the presence of foam, oil sheen, or outfall staining may be
Indicative of pollutant exposure. These conditions may warrant further investigation.
SWPPRMCC

Page 1
READY MIXED CONCRETE COMPANY PLANT NO.
PLANT NO. DATE: / 0 % na
STORMWATER DISCHARGE OUTFALL VISUAL REPORT
Certificate of Coverage No. NCG 1400 7 Plant Name:
County. Or'):),,�,
Inspected by. ,1'r'."
Date of Inspection: I r -i/• c 2� }1
By this signature I certify that this report is accurate and complete to the best of my knowledge:
(Siggeture) f'
STORMWATER/DISCHARGE OUTFALL (SDO) VISUAL MONITORING REPORT
I. Outfall Description ( attach SDO Visual Monitoring Report for each add'I SDO)
Outfail No. SDO Structure (pip ditch, etc.)
Receiving Stream: c.,,.. n ;,. r t e.°- �; �`
Describe the industrial activities that occur within the outfall drainage area:
/� /.t,i :} ,' � .^✓ in. Cr `fir r .. —1- .
2 Color
Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint (light, medium,
dark, etc.) .
3 Odor
Describe any distinct odors that the discharge may have (i.e. smells strongly of oil, weak chlorine odor, etc.)
U
4 Clarity
Choose the number which best describes the clarity of the discharge where 1 is clear and 10 is very cloudy:
2 3 4 5
6 7 8 9 10
Form 6.1
SWPPRMCC

Page 2
5 Solids
Choose the number which best describes the amount of solids in the stormwater discharge where
1 is clear and 10 is extremely muddy.
! 2 3 4 5
6 .7 a s 1n
6 Foam
Is there any foam In the stormwater discharge?
YES , NO,
7 Oil Sheen
Is there
r ---
any oil sheen in the stormwater discharge?
YES NO '
8 Outfall Staining
Describe any staining around the stormwater outfail:
9 Other Indicators
Describe any other obvious indicators of stormwater pollution:
l
NOTE: Low clarity, high solids and/or the presence of foam, oil sheen, or outfail staining may be
Indicative of pollutant exposure. These conditions may warrant further investigation.
SWPPRMCC

F

--------------
TRITEST, INC.
3909 Beryl Road
Raleigh, NC 27607
Telephone: [phone] NC/WWCert. #:067
Fax: [phone] NC/DW Cert. #: 37731
Laboratory Report
-- Prepared for — 1 of 1
LYMAN AUSTIN
READY MIXED CONCRETE CO. Report -Date: 10/17/2002
P.O. BOX 27326 Date Received: 10/11/2002
RALEIGH, NC 27611
Work Order #: 0210-00971
Project ID: PLANT 8 Cust. Code: RE1520
Project ID: PLANT #8 Cust. P.O.#:
No. Sample ID Date Sampled . Time Sampled Matrix Condition
001 OUTFALL 1 10/11/2002 09:10 SW
4fi2oC
Test Performed Method Results Analyzed Qualifier
No. Sample ID
002 OUTFALL 2
Test Performed
Report Certified by:
Date Sampled Time Sampled Matrix
10/11/2002 09:50 SW
Method
Results
Condition
4fi2oc
Analyzed Qualifier
for Tritest, Inc.

i
r
,-

Tritest, Inc.
3909 Beryl Road, Raleigh, NC 27607
ph: (919) 8344984 fax: [phone]
NCN CERT#67, NCDW CERT#37731
Report Results To:
Company: READY MIXED CONCRETE CO.
Address: P.O. BOX 27326
RALEIGH, NC 27611
Attn: LYMAN AUSTIN
Phone: [phone] / Fax: [phone]
t1
Sampled by (signature): : t t :
Chain of Custody
Bill To: -
READY MIXED CONCRETE CO.
P.O. BOX 27326
RALEIGH, NC 27611
Tritest W.O. #0-19& 4446-
Pzl o-7)o?71
Project Reference: Stormwater
Project Number: PLANT 8
Purchase Order #:
❑ Standard Report Delivery
❑ Rush Report Delivery (w/surcharge)
"Hwl, pinj a am wbjQd la P b appm Ey W I tOn
Requested Due Date:
Sample Description
Composite
Grab-
—Time
Start Date
End Date
Matrix
ww,Dw
Analyses Requested
Tritest
Sample
Start
End TimeSW,GWS
OUTFALL 1
Grab
"''"=''=
SW
WC-TSS
001
-
r?
OUTFALL 2
Grab
j<. %" --'
ri
SW
WC-TSS
002
OUTFALL 3
Grab
SW
WC-TSS
003
Reli uished
C
by s' nature
r
Recei by
(signature)
Date
e
Time
Relin
" ed
by (signature)
Re wed y
(signature) rr��
Date
Time
�P,t�wvx:
Z6,yfK4-
c r
5�
Reli quished
by (signature)
Received by
(signature)
a
Time
Receipt Conditions (Lab Use Only):4 -
❑ 4±2'C kemp: -3 'C / 1�/1
Res. Chlorine J2Absent ❑Present On/a
Acid presew. Q? [JYes ONo PrVa
Base presew. >12? OYes ONo Afl/a

AjA
NCDENR
DISCHARGE OUTFALL MONITORING REPORT
GENERAL PERMIT NCG140000
(All sample data shall be reported no later than 30 days after receipt of lab results)
Cerifi6ate of Coverage
NCG14
.Certified Laboratory #
73)
7
#t bwCollecting Sirmple(s)'
4.
Sample Information
'b erraif Term
, ,, .,y , - rit6i�r�- .;.
d
V ut� chetarkloindicate
EiNe".
-ypv (c7ieck
as ap nape)::
Jul y 31, 2000
E]
El
Q
E3
rW4
❑
E3
El
0
F-1
El
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 Characteristic
20 A
Stormwater Discharge Monitoring
:q ggqug
pendrd
�1
g,
'Z,
AIR
3
7 cz 7
/10
0
Does this facility perform Vehicle Maintenance Activities using on average more than 55 gallons of new motor
oil per month? o Yes "o If yes, complete information tielow.
Stormwater Discharge Monitoring from Vehicle Maintenance Areas
UftfaW
Dke: Sam p16',,
6W�:�K
PH'
To­iid ,r
Oil and
--r itaoi?Or
N,
uration,
011
Us- _­
SiPended{
T Grease
- N'j
1Usago
RMotor
-
m
SWU-241-080199 Page loft

Part B: Process wastewater discharge monitoring data
e
Sample #
Effluent Sources for this sample J
Vehicle / Equipment Cleaning ❑
Raw Material Stock -pile Wetting ❑
Mixing Drum Clean -out ❑
Recycle System Overflow ❑
Parameter
Umt
il)ata
Collection Date
mo/dd/yr
Total Flow .
MG
Event Duration
hours
PH
Std. units
TSS
mg/1
Settleable Solids
min
Sample # _
r %'Hffluent�ouice. s=fot;�his� "'"7eF'`
Vehicle L EquiLment Cleanin ❑
Raw Material Stock -pile Wettin ❑
Mixing Drum Clean -out ❑
Recycle System Overflow ❑
L7nrt�r F
Collection Date
mo/dd/yr
Total Flow
MG
Event Duration
hours
pH
Std. units .
TSS
mgn -
Settleable Solids
rum
Mail original and one copy to:
Attn: Central Files
Division of Water Quality
DENR
1617 Mail Service Center
Raleigh, NC 27699-1617
Sample #
Effluent Sources for this sample
Vehicle / Equipment Cleanin ❑
Raw Material Stock -pile Wettin ❑
Mixing Drum Clean -out ❑
Recycle System Overflow ❑
Parameter :.;
' -Unit
Collection Date
mo/dd/yr
Total Flow
MG
Event Duration
hours
pH
Std. units
TSS
mg/1
Settleable Solids
mm
Sample # _
0- Ee- 5ou2c` s)fot•'IMsrs le'
Vehicle / Equipment Cleaning
❑
Raw Material Stock -pile Wetting❑
MixingDrum Clean -out
❑
Recycle System Overflow
❑
4garam4te>
:�h[9srlc7r
1D_ata
CollectionDate '
mo/dd/yr
Total Flow
MG
-Event Duration
hours
pH
Std. units
TSS
mgn
Settleable Solids
MM
"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." / /Jd Al
Name of
of Permittee or
SWU-241-080199 "v, - Page 2 of 2
(Date)

STORMWATER DISCHARGE OUTFALL (SDO)
QUALITATIVE/t MONITORING REPORT
Certificate of Coverage No. NCG
Facility Name: i %r �'n'era
Phone No.: f9. 1 SS-G • ? S f ;:'f, I `i
County:: � %-t�<,_
Date of Inspection:
By this signature, I certify that this report is accurate and complete to the best of my
knowledge:
(SitOatiure of Permirtee or Designee)
1. Outfall Description
Outfall No.: Structure (pipe, ditch, etc.): C/-Z c
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:
i
3. Odor
Describe any distinct odors that the discharge may have (i.e, smells strongly of oil, weak
chlorine odor, etc.):
i
0
11/17/97

e,
4. Clarity
Choose the number which best describes the clarity of the discharge where 1 is clear and
10 is very cloudy:
1 0 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, 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 extemely muddy:
1 2 (D 4 5, 6 7 8 9 10
7. Foam
Is there any foam in the stormwater discharge? YES O
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

Certificate of
Facility Nami
County:
Inspectc
Date of
STORMWATER DISCHARGE OUTFALL (SDO)
QUALITATIVE MONITORING REPORT
Phone No.: 0171 5 S- Co , 3 /
By this signature, I certify that this report is accurate and complete to the best of my
knowledge:
(SigrVore of Permittee or Designee)
1. Outfall Description
Outfall No.: Structure (Pipe ditch etc.): el
Receiving Stream:
Describegthe 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:
/�li..n. .•.rk.tb,.. ,(�!'[-ri.f` .-(.-C <j.��:.7 �,-.-���� C>,� c'J.n.h..!
3. Odor
Describe any distinct odors that the discharge may have (i.e. smells strongly of oil, weak
chlorine odor, etc.):
I%!*� `r
6

0
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 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 0 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 i is no solids and 10 is extemely muddy:
01 2 3 4 5 6 7 8 9 10
7. Foam 4 Is there any foam in the stormwater discharge? YES NO_-)
8. Oil Sheen
Is there an oil sheen in the stormwater discharge? YES NO f
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 wan -ant further
investigation.
11/17/97

STORMWATER DISCHARGE OUTFALL (SDO)
QUALITATIVE MONITORING REPORT
Certificate of Cover)age No. NCG - l Vy l
Facility Name: t
County: Phone No.: 0
Inspector. 6,eAley
Date of Inspection: /' Y
By this signature, I certify that this report is accurate and complete to the best of my
knowled e:
,....,.-- .n
(Sign4a�rp'r'e ofPermittee or Designee)
1. Outfall Description
Outfall No.: Structure (pipe, ditch, etc.): Gi.1
Receiving Stream:
Dee c be/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

LW
IVA
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
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:
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 extemely muddy:
2 3 4 5 6 7 8 9; 10
v.`
7. Foam E"
Is there any foam in the stormwater discharge? YES NCO
C;
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: [phone] NCIWW Cert.#: 067
Fax: [phone] NCIDW Cert. #: 37731
Laboratory Report
Prepared for --- 1 of 1
LYMAN AUSTIN Report Date: 10/12I01
READY MIXED CONCRETE CO. Date Received: 10112/1
P.O. BOX 27326
RALEIGH, NC 27611 Work Order #: 0109-01015
Project ID:
Project ID:
PLANT 8
PLANT #8
Cust.
Cust.
Code: RE1520
P.O.#:
No. Sample ID
001 OUTFALL1
Date Sampled Time Sampled Matrix
9/24/01 16:10 SW
Condition
4a2oC
Test Performed Method Results Analyzed Qualifier
Total Suspended Solids EPA 160.2 86 mg/L 9/28/01
No. Sample ID
002 OUTFALL2
Date Sampled Time Sampled Matrix
9/24/01 16:10 SW
Condition
4n2oC
Test Performed Method Results Analyzed Qualifier
Total Suspended Solids EPA 160.2 84 mg/L 10/1/01
No. Sample ID
003 OUTFALL3
Test Performed
Report Certified by:
Date Sampled Time Sampled Matrix
9124101 16:05 SW
Method
Results
Analyzed
Condition
4n2oC
for Tritest, Inc.

Tritest, Inc.
3'' 9 Beryl Road, Raleigh, NC 27607
h:[phone] fax: [phone]
NCW W CERT# 7. NCDW CERTn7731
Repor -Results To:
Company: READY MIXED CONCRETE CO.
Address: P.O. BOX 27326
RALEIGH, NC 27611
Attn: LYMAN AUSTIN
Phone: [phone] Fax: g 99,9-81-09�10
Sampled by (signature):�l�C.d-t-�-. r
Chain ®f Custody
Bill To:
READY MIXED CONCRETE CO.
P.O. BOX 27326
RALEIGH, NC 27611
e'i©y- 6/0/,s-
Tritest W.O. # 0+67-e0652
Project Reference: Stormwater
Project Number: PLANT 8
Purchase Order #:
❑ Standard Report Delivery
❑ Rush Report Delivery (w/surcharge)
"AIM Mo are subj mp ap"� by IaOo q
Requested Due Date:
Sample Description
Composite
Grab
-Start
Start Date
End Date
Matrix
WW.DW
SW.GWS
Analyses Requested
Tritest
Sample
Time
Time
OUTFALL 1
Grab
d f
_ud
n
9'2t� t "
SW
WC-TSS
001
opit
OUTFALL 2
Grab
Z7 `-0 i
? : '/•'%
SW
WC-TSS
002
OUTFALL 3
Grab
7 .;`y y 01
t;. —1 a> _,
SW
WC-TSS
003
i
R li quished sig ture)
R:7ved by (signature)
Date
-D
Time
eli 'shed by (sig ure)
Meceived by ignature)
Date
Time
=3o
Relitiquisnea. by (signature)
Received b (signal(Le)
Date
Time
Receipt Conditions (Lab Use Only):
W 4t2°C OTemp: 3" 0 °C
Res. Chlorine ❑Absent ❑Present Xa
Acid preserv. <2? ❑Yes ONo *a
Base presew. >12? ❑Yes ❑No //Na

Tritest, Inc.
3909 Bcryl Road, Raleigh, NC 27607
ph: (919)834—t984 fax: [phone]
NCW W CERT#67. NCDW CERT#37731
Chain of Custody
Report Results To: Bill To:
Company: READY MIXED CONCRETE CO. READY MIXED CONCRETE CO
Address: P.O. BOX 27326 P.O. BOX 27326
RALEIGH, NC 27611 RALEIGH, NC 27611
Attn: LYMAN AUSTIN
Phone: 919-/yu-IDLu a�: 9 9 9 0/' 0
Sampled by (signature):
Project Reference:
Project Number:
Purchase Order #:
Tritest W.O. # 0107-00652
Stormwater
PLANT 8
❑ Standard Report Delivery
❑ Rush Report Delivery (w/surcharge)
Requested Due Date:
Sample Description
Composite
Grab
—
Start Date
End Date
Matrix
WW.DW
SW,GWS
Analyses Requested
Tritest
Sample
Start Time
End Time
OUTFALL 1
Grab
�i, f !/
')�� r l
SW
VVC-TSS
001
3 SOrp�
411,'lJ•'rn
OUTFALL 2
Grab
9- yn'' I
`��.3 `r n?
SW
WC-TSS
002
OUTFALL3
Grab
'-..2V-01
SW
WC-TSS
003
R li quished sig ture)
Rece)ved by (signature)
Date
Time
4 .
eli -shed by (sig ure)_„7,/
Received by.(�ignature) -
Dater Time
Receipt Conditions (Lab Use Only):
>,D 4±2°C ❑Temp: 30 'C
o..�. Chorl?e nnng.,qr nor,,,.,.�e �✓,r
A6,1 nrecon, <99 my., MNIn T41'
Base preserv. >12? ❑Yes ❑No 'Ki7/a