NCG140112_MONITORING INFO_20181211

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
DOC TYPE ❑HISTORICAL FILE
[$ MONITORING REPORTS
DOC DATE p � o f � I c� 1 �
YYYYMMDD

ANNUAL SUMMARY DISCHARGE MONITORING
REPORT (DMR) — STORMWATER
SUBMIT TO CENTRAL OFFICE*
General Permit No. NCG140000
Calendar Year o4)lef
'Report ALL STORMWATER monitoring data on this form (include "No Flow"( " c $e' Benchmark
Exceedances) from the previous calendar year to the DEQ by M��i
Certificate of Coverage No. NCG 14 ❑U [j]❑[
Facility Name: . - /�fi�y/ � CENTH-AL FILES
County: &k%7 _ _ .
Phone Number: {t;? 2 7 f.1 - 1?%yk Total no. of SDOs monitored
Certified Laboratory4/��,�t� ire �_ Lab # /—
Lab #
Stormwater Discharge Outfall (SDO) No. VMA Outfall? Yes ❑ NoX
Is this outfall currently in Tier 2 for any parameter? Yes ❑ No 0
Was this outfall ever in Tier 2 during the past year? Yes ❑ No
If this outfall was in Tier 2 last year, was monthly monitoring discontinued?
Yes, enough consecutive samples below benchmarks to decrease frequency ❑
Yes, received approval from DEMILR to reduce monitoring frequency ❑
Other ❑
Outfa I
1 N°'
__�____
Total Rainfall;
inches
-
Total.
Suspended
Solids (TSS),
...:m lI
:.
H , ..
SLI.,
. on po ar..
(EPA Method
1664 SGT-FIE�li )) r
mg1l (VMA)
New Motoi Oil
:Usage (gallmo.)
ffappfrca6le
Stormwater
Benchmarks
Irrriicale NO FLOWN
appficabfe
Circle Benchmark
100150
6.0-9.0
L
J
>SS gallmo, average requires T55 and
Non -polar O&G monitoring
Date Sample'
Collected,
moldd/yr
'
ti
-
t
Permit Date 8/1/2017 — 6/30/2022
Last Revised 8-22-2015

Certificate of Coverage No. NCG 14 ❑0❑❑
CERTIFICATION
"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
know[edge 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."
[Required by 40 CFR §72
Signature /v^
Date
Mail Annual Summary Stormwater WAR to the NCDEQ Central Office:
Note the address is correct— Central Files is housed in DWR (not DEMLR)
I.C. Department of Environmental Quality (DEQ)
Division of Water Resources
Attn: DWR Central Files
1617 Flail Service Center
Raleigh, IBC 27699-1617
Central Files Telephone [phone]
Questions? Contact DEM!_R Stormwater Permitting Staff in the Central Office at:
[phone]
Permit Date 8/112017 — 6/3012022
Last Revised 8-22-2075

ElMommmq % hmumbd
Wastewater ZD: 10
114 OAKMONT DRIVE -- - - - -- - ---- - - ---� -- - - - PHONE [phone]
GREENVILLE, N.C. 27858 FAX [phone]
ARGOS READY MIXED(6214 WILLIAMSTON)
QUINN VAUGHAN
1020 E. 5TH ST.
WASHINGTON ,NC 27889
PARAMETERS
PH (not to be used for reporting)
Total Suspended Residue, mg/l
Stormwater Analysis Method
Discharge Date Analyst Code
8.4 11/13/18 JMS 4500HB-11
<2.6 11/14/18 ]TH 2540D-II
ID#: 1095
DATE COLLECTED: 11/12/18
DATE REPORTED : 11/15/18
REVIEWED BY:

EVN-Irorirrsent 1, Inc. t CHAIN OF CUSTODY RECORD
P.O. Box 7085, 114 Oakmont Dr. Page I of
Greenville. NC 27858
environment 1 inc.com
DISINFECTION
CHLORINE NEUTRALIZED AT COLLECTION
Phone [phone] • Fax [phone]
CHLORINE
pHCHECK (LAB)
CLIENT: logs Week:39
Ij uv
p
p
CONTAINER TYPE, PIG
►RGOS READY M1XED(6214 WILLIAMSTON)
❑ NONE
)UINN VAUGHAN
020 E. 5TH ST.
CHEMICAL PRESERVATION
,VASHINGTON NC 27889
A
A
A - NONE D - NAOH
o
E
252) 717-0318
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COLLECTION
J
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S
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2
< G - NATHiOSULFATE
SAMPLE LOCATION
DATE
TIME
r1
,
Stormwater Discharge
1.7 I
Eq C
1
CLASSIFICATION:
L j WASTEWATER(NPDES)
DRINKING WATER
DWOIGW
SOLID WASTE SECTION
CHAIN OF CUSTODY (SEAL) MAINTAINED
DURING WMENT/DELIVERY
Y N
SAMPLES D BY:
(Please Print)
SAMPLES RECEIVED IN LAB AT"� °C
RELINQUISHED BY (SIG:) (SAMPLER)
j D IME
1�5-1,2
RE EIVED BY ( )
DATElRME
COMMENTS:
Au
RELINQUIS D BY (A.)
DATEITIME
RECEI B (SIG.)
DATEITIME
} h3h
-V a-v
RELINQUISHED BY (SIG.)
DATEMME
RECEIVED BY (SIG.)
DATETIME
PLEASE READ Instructions for completing this form on the reverse side. Sampler must place a "C" for composite sample or a "G" for NO 338701
t,FORM #5 Grab sample in the blocks above for each parameter requested.

e.
SAMPLING INSTRUCTIONS AND FORM COMPLETION
FAILURE TO PROPERLY CHILL, CHEMICALLY PRESERVE, COLLECT IN PROPER BOTTLE
TYPES, MEET REQUIRED HOLDING TIMES, NEUTRALIZE CHLORINE IN CHLORINE
SENSITIVE SAMPLES, AND SEAL COOLERS WITH TAPE WILL RESULT IN SAMPLES BEING
REJECTED BY THIS LABORATORY AS PER NORTH CAROLINA REGULATORY CODE.
1) Samples not falling within the required guidelines will need to be re -collected. The client will be contacted and informed of any
deviation and asked to collect another set of samples. The client may request the laboratory to proceed with the analyses of the current
samples. Any samples analyzed outside of the required guidelines will be "qualified". This means that a note will be included on the
sample result and "Chain of Custody" specifying the deviation. The laboratory is also required to send a letter to the State noting the
deviations.
2) Sample Temperature. Samples for compliance monitoring must be chilled with wet ice to a temperature of 6C or less. Freezing is
not permitted. Samples delivered to the lab shortly after collection may not have had enough time to be chilled below 6C. In this case the
temperature at time of collection must be noted in the space provided. The samples will meet the requirements of the regulation if there
is a temperature drop from the time of collection until received in the lab. Regardless, all samples should be packed in wet ice using as
much ice as will fit in the cooler.
3) Sample Chemical Preservation. Many samples require a chemical preservation such as Sulfuric Acid or Sodium Hydroxide. The
laboratory will either provide the preservative in the sample bottle, or in the case of 40 ml. Volatiles Vials, provide a bottle of Acid with
detailed descriptions on how to collect the sample. Never rinse sample bottles before collecting samples. Any residue or liquid in the
bottle is required for proper chemical preservation. The lab must verify proper chemical preservation upon arrival in the lab and will note
this information in the spaces provided on the front of this form.
4) Chlorine Neutralization. Some samples require that any Total Chlorine Residual be removed at the time of collection. The lab will
provide the proper neutralizing agent in the sample bottle when technically possible. There are some samples (Total Kjeldahl Nitrogen
and Ammonia Nitrogen) where this is not possible due to interferences between the required chemical preservation (Acid) and the
dechlorinating agent. Therefore, these samples must be de -chlorinated at the time of collection before being placed in our sample bottles.
Sodium Thiosulfate is the chemical of choice to neutralize chlorine. It must be added to your sample and then the sample checked for
Total Chlorine before the sample is poured in our bottle. Facilities using chlorine for disinfection should have a means of measuring Total
Chlorine. Non -chlorinated sample sources will not need to be checked. The person neutralizing the chlorine must put his initials in the
"Chlorine Neutralized at Collection" row on the front of this form above the proper parameter. Samples such as Coliforms (which have
Thiosulfate in the bottles shipped from the lab) will be checked for proper neutralization upon arrival in the lab. It is also required that you
note the "Total Chlorine at Collection" on the front of this form for any sample locations applicable. This value would be before any
neutralization is performed.
5) A "C" for Composite Sample or a "G" for Grab Sample should be placed in the box for all requested parameters. Grab temperatures
as well as Composite start dates and times can be recorded in the "comments" section.
6) Other information required to be completed by the client are:
Collection Date and Collection Time for each sample location Temperature at Time of Collection
Printed name of -person or persons collecting samples Signature, Date, and Time samples are relinquished
Other added sample locations and analyses required Type Of Disinfection
Deletion on the form for any samples which are not needed (example: dry upstream location)
Any other information felt to be pertinent should be included in the "Comments" section
CONSIDERATIONS:
Coliform and Enterococci samples have a holding time of hours from time of collection to time of analysis. Therefore, samples should
be collected as late in the day as possible to allow enough time for transportation, checking in at the lab and analysis.
SOD, Nitrate, Ortho Phosphorus, Settleable Matter, Turbidity, Color, and M BAS samples have a 48 hour holding time. The lab reserves the
right to establish required sample collection and delivery dates in order to meet the required holding times.
CAUTION
Sample bottles may contain acids or other corrosive and potentially harmful chemicals. Laboratories are required to add these chemicals
for certain analyses in order to comply with EPA preservation requirements. Use extreme care when opening and handling the shipping
container and bottles. If any chemical should get into your eyes, on your skin or on your clothes, flush liberally with water and seek medical
attention. Material Safety Data Sheets (MSDS) are available upon request which specify proper handling and personal protection.

ANNUAL SUMMARY DISCHARGE MONITORING
REPORT (DMR) — STORMWATER
SUBMIT TO CENTRAL OFFICE*
General Permit No. NCG140000
Calendar Year cZ019
*Report ALL STORMWATER monitoring data on this form (include "No Flow'T'No Discharge" and Benchmark
Exceedances) from the previous calendar year to the DEQ by MARCH 1 of each year.
Certificate of Coverage No. NCG14 Om©®
Facility Name: AS ,��r9i /y%�'�E�
County: g2,l�rr�
Phone Number. QS.Z )_ 'jQ, - 31-49 _ Total no. of SDOs monitored
Certified Laboratory,&N/idr (_ Lab # (U
Lab #
Stormwater Discharge Outfall (SDO) No. VMA Outfall? Yes ❑ Nog
Is this outfall currently in Tier 2 for any parameter? Yes ❑ No 0
Was this outfall ever in Tier 2 during the past year? Yes ❑ No g]
If this outfall was in Tier 2 last year, was monthly monitoring discontinued?
Yes, enough consecutive samples below benchmarks to decrease frequency ❑
Yes, received approval from DEMLR to reduce monitoring frequency ❑
Other ❑
Outfall No.
Total Rainfall;
inches
--
Total
Suspended
p
Solids TSS
(.. ..�,
..'.m /I,Napplicable.'
H
p �
SU.
Non -polar 08r,G
(ESA Method
1664 SGT-HEM ,
( }}�
: mgll (VMA)_ _
New Motor Oil
Usage (gallmo.)
lrapplfcabre
Stormwater
Benchmarks
Indicate NO FLOW ff
applicable
Circle Benchmark
0
100�5fl
6.0-9.0
1 b
>55 galfine. average requires TSS and
Non -polar C&Q monitoring
Date Sampler
Collected
molddlyr .
R E C E IVIE,
ki nv y A OMR
CENTRAL FILL
.'S
DVTR SEA I i c
rq
Permit Date 8/1/2017 — 6/30/2022
Last Revised 8-22-2015

Certificate of Coverage No, NCG14 ❑❑❑❑
CERTIFICATION
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 informationt1-0cluding the possibility of fines and imprisonment for knowing violations."
Required by 40 CFR §122.2
Signature
Date ,111-46
Mail Annual Summary Stormwater DMR to the NCDEQ Central Office:
Note the address is correct — Central Files is housed in D WR (riot DEMLR)
N.C. Department of Environmental Quality (DEQ)
Division of Water Resources
Attn: DWR Central Files
1617 Mail Service Center
Raleigh, NC 27699-1617
Central Files Telephone [phone]
Questions? Contact DEMLR Stormwater Permitting Staff in the Central Office at:
[phone]
Permit Date 811/2017 — 6/30/2022
Last Revised 8-22-2015

Eflwohumml T, kwno wmuo
Was tewater:ID:-10
P.O. BOX 7085, 114 OAI(iVIONT DFiIV ---PHONE [phone]
GREENVILLE, N.C. 27835-7085 FAX [phone]
ARGOS READY MIXED(6214 WILLIAMSTON)
QUINN VAUGHAN
1020 E. 5TH ST.
WASHINGTON ,NC 27889
PARAMETERS
PH (not to be used for reporting)
Total Suspended Residue, mg/l
Stormwater Analysis Method
Discharge Date Analyst Code
6.4 04/25/18 Hl'IN1 4500HB-11
2.9 .04/26/18 KDS 2540D-11
ID#: 1095
DATE COLLECTED: 04/24/18
DATE REPORTED : 04/27/18
REVIEWED BY:

Environment 1, Inc. CHAIN OF CUSTODY RECORD
P.O. Box 7085, 114 Oakmont Dr. Page I of
Greenville, NC 27858
environment] inc.com
Phone (252) Fax [phone]
DISINFECTION
CHLORINE NEUTRALIZED AT COLLECTION
CHLORINE
Ij
CLIENTo w Week: 13
Ij uv
pH CHECK (LAB)
P
P
CONTAINER TYPE, PIG
.EADY MIX CONCRETE (WILLIAMSTON)
❑ NONE
IR. MIKE ODOM
020 E. 5TH ST.
CHEMICAL PRESERVATION
VASHINGTON NC 27889
A
A
�o
E�--
A -NONE D-NAOH
013
252) 325-2004
z-j
w Z
LU
B- HNO3 E HCL
00
a
cc_
LU
C - H2SO, F - ZINC ACETATEINAOH
COLLECTION
!;C-c
a
F
o
6
¢
26
G - NATHIOSULFATE
SAMPLE LOCATION
DATE
TIME
y
a.r
p
Stormwater Discharge
a`r' j$
a✓�(,'
I
CLASSIFICATION:
WASTEWATER(NPDES)
DRINKING WATER
DWOIGW
SOLID WASTE SECTION
CHAIN OF CUSTODY (SEAL) MAINTAINED
DURI�MENT/DELIVERY
N
SAMPLES COLLECTED BY:
(Please Print)
SAMPLES RECEIVED IN LAB AT02(_°C
R INO ISHED BY (SIG.) (SAMPLER)
DATEf{ IM
R ❑ BY
DATEIrIME
COMMENTS:
RELINQUISHED B SIG.)
DATE(IiME 17RECEIVED
SIG.)
DATEJIIME
Z C3
RELINQUISHED BY (SIG.)
DATE/TIME
RECEIVED SIG.
DATE TlME
— - I il
61
- -
PLEASE READ Instructions for completing this form on the reverse side. Sampler must place a "C" for composite sample or a "G"for 0 341855
FORM #5 Grab sample in the blocks above for each parameter requested.

SAMPLING INSTRUCTIONS AND FORM COMPLETION
FAILURE TO PROPERLY CHILL, CHEMICALLY PRESERVE, COLLECT IN PROPER BOTTLE
TYPES, MEET REQUIRED HOLDING TIMES, NEUTRALIZE CHLORINE IN CHLORINE
SENSITIVE SAMPLES, AND SEAL COOLERS WITH TAPE WILL RESULT IN SAMPLES BEING
REXCTED BY THIS LABORATORY AS PER NORTH CAROLINA REGULATORY CODE.
1) Samples not falling within the required guidelines will need to be re -collected. The client will be contacted and informed of any
deviation and asked to collect another set of samples. The client may request the laboratory to proceed with the analyses of the current
samples. Any samples analyzed outside of the required guidelines will be "qualified". This means that a note will be included on the
sample result and "Chain of Custody" specifying the deviation. The laboratory is also required to send a letter to the State noting the
deviations.
2) Sample Temperature. Samples for compliance monitoring must be chilled with wet ice to a temperature of 6C or less. Freezing is
not permitted. Samples delivered to the lab shortly after collection may not have had enough time to be chilled below 6C. In this case the
temperature at time of collection must be noted in the space provided. The samples will meet the requirements of the regulation if there
is a temperature drop from the time of collection until received in the lab. Regardless, all samples should be packed in wet ice using as
much ice as will fit in the cooler.
3) Sample Chemical Preservation. Many samples require a chemical preservation such as Sulfuric Acid or Sodium Hydroxide. The
laboratory will either provide the preservative in the sample bottle, or in the case of 40 mi. Volatiles Vials, provide a bottle of Acid with
detailed descriptions on how to collect the sample. Never rinse sample bottles before collecting samples. Any residue or liquid in the
bottle is required for proper chemical preservation. The lab must verify proper chemical preservation upon arrival in the lab and will note
this information in the spaces provided on the front of this form.
4) Chlorine Neutralization. Some samples require that any Total Chlorine Residual be removed at the time of collection. The lab will
provide the proper neutralizing agent in the sample bottle when technically possible. There are some samples (Total Kjeldahl Nitrogen
and Ammonia Nitrogen) where this is not possible due to interferences between the required chemical preservation (Acid) and the
dechlorinating agent. Therefore, these samples must be de -chlorinated at the time of collection before being placed in our sample bottles.
Sodium Thiosulfate is the chemical of choice to neutralize chlorine. It must be added to your sample and then the sample checked for
Total Chlorine before the sample is poured in our bottle. Facilities using chlorine for disinfection should have a means of measuring Total
Chlorine. Non -chlorinated sample sources will not need to be checked. The person neutralizing the chlorine must put his initials in the
"Chlorine Neutralized at Collection" row on the front of this form above the proper parameter. Samples such as Coliforms (which have
Thiosulfate in the bottles shipped from the lab) will be checked for proper neutralization upon arrival in the lab. It is also required that you
note the "Total Chlorine at Collection" on the front of this form for any sample locations applicable. This value would be before any
neutralization is performed.
5) A "C" for Composite Sample or a "G" for Grab Sample should be placed in the box for all requested parameters. Grab temperatures
as well as Composite start dates and times can be recorded in the "comments" section.
6) Other information required to be completed by the client are:
Collection Date and Collection Time for each sample location Temperature at Time of Collection
Printed name of person or persons collecting samples Signature, Date, and Time samples are relinquished
Other added sample locations and analyses required Type Of -Disinfection
Deletion on the form for any samples which are not needed (example: dry upstream location)
Any other information felt to be pertinent should be included in the "Comments" section
CONSIDERATIONS:
Coliform and Enterococci samples have a holding time of 6 hours from time of collection to time of analysis. Therefore, samples should
be collected as late in the day as possible to allow enough time for transportation, checking in at the lab and analysis.
BOD, Nitrate, Ortho Phosphorus, Settleable Matter, Turbidity, Color, and WAS samples have a 48 hour holding time. The lab reserves the
right to establish required sample collection and delivery dates in order to meet the required holding times.
CAUTION
Sample bottles may contain acids or other corrosive and potentially harmful chemicals. laboratories are required to add these chemicals
for certain analyses in order to comply with EPA preservation requirements. Use extreme care when opening and handling the shipping
container and bottles. If any chemical should get into your eyes, on your skin or on your clothes, Hush liberally with water and seek medical
attention. Material Safety Data Sheets (MSDS) are available upon request which specify proper handling and personal protection.

STORMWATER DISCHARGE OUTFALL (SDO) - Semi -Annual MONITORING FORM
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF COVJ
FACILITY NAME: A
PERSON COLLECTING
CERTIFIED LABORATC
RAGE NOS NC
sir14� Q�
MPLES _L�+r(oS' _ 1��/iCLu
�Il�tll5nir+►�..� i X� Lab #
Lab #
OPTIONAL INFO:
Part A: Stormwater Monitorine Requirements
REC NsEMPLE COLLECTION YEAR: aG17
nI~ r 0 7 2SAMPLING RIOD: July -December ❑ January -June
COUNTY �6Z.4g ,
1 RA FIP_HQNE NO. (2,12 1
u vr[ C,TIADDTO LISTSERVE? ❑YES ONO EMAIL:
DISCHARGING TO CLASS: ❑SA ❑HQW ❑PNA ❑Trout ❑Other,
Outfall No.
Date Sample
Collected
(mo/dd/yr OR
NO FLOW)t
pM
{Standard
Units)
TSS
(mg/L)
Event
Duration
(minutes}
Total
Rainfall ,
(in)
In Tier
Monthly
Monitoring?
(y/n)
# of Months in z Tier
2 Sampling
-
r7'��
/ Zv
/t
& 4
If "NO FLOW" or "NO DISCHARGE, Enter "NO FLOW" or "NO DISCHARGE" for each outfali 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/l, except when discharging to ORW, HQW, Trout, and PNA waters where they are 50 mg/l.
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.
Sample
Date Sam p
Collected
(mo/dd/yr)l
pH
(Standard
Units(
TPH using method
1664A SGT-HEM
(mg/i)
Total Suspended
Solids
(mg/L)
Event
Duration
(minutes)
Total
Rainfall°
(in)
New Motor Oil
Usage
(gal/month)
In Tier 2
Monthly
Monitoring?
(y/n'
# of Months
in Tier 2
2
Sampling
6-9
15
100 Z,3-
-
-
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDS ES AT ANY ONE OUTFALL (INCLUDING VEHICLE MAINTENANCE)? YES ❑ NO 1[
HAVE YOU CONTACTED THE REGION? YES ❑ NO
REGIONAL OFFICE CONTACT NAME:
Mail Original and one copy of this DMR(including all "No Flow" & "No Dischar e" reports) within 30 days of recei t of sample or at end of monitoring eriod
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 qualifi personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or
those persons 5KItly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete
am aware th ere aA;gnificant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
ure of Permitteej
Permit Date:7/1/2011-60/30/2015
/Z-4/-i7
(Date]
Last Revised 7/13/11
Page 2 of 2

EIMADT01mmimq % horpoTmOd
Wastewater ID: 10
P.O. BOX 7085, 114OAKMONT DRIVE- - PHONE [phone]
GREENVILLE, N.C. 27835-7085 FAX [phone]
READY MIX CONCRETE (WILLIAMSTON)
MR. MIKE ODOM
1020 E. 5TH ST.
WASHINGTON ,NC 27889
PARAMETERS
PH (not to be used for reporting)
Total Suspended Residue, mg/I
Stormwater Analysis Method
Discharge Date Analyst Code
7.8 11/09/17 KDS 4500HB-11
1.6 11/10/17 KAC 2540D-11
ID#: 1095
DATE COLLECTED: 11/09/17
DATE REPORTED : 11/13/17
REVIEWED BY:

Environment 1, Inc. CHAIN OF CUSTODY RECORD
P.O. Box 7085, 114 Oakmont Dr.
Page Iof
Greenville, NC 27858
environment] inc.com
DISINFECTION
CHLORINE NEUTRALIZED AT COLLECTION
Phone [phone] • Fax [phone]
CHLORINE
CLIENT: 1095 Week:39
uv
pHCHECK (LAB)
READY Iti9IX CONCRETE (WILLIANISTON)
❑ NONE
P
P
CONTAINER TYPE, PIG
NIR. NI1KE OD01I
CHEMICAL PRESERVATION
1020 E. 5TH ST.
WASHINGTON NC 27889
A
A
o
A -NONE D-NAOH
[phone]
E
ui U
z 1-4
w Z
°;
rn
w
� B - HNO3 E - HCL
OO
z
C
LU
= F
¢
��
w C - HZSO, F - ZINC ACETATE/NAOH
COLLECTION
o
g
Vj ¢
y
a
G - NA THIOSULFATE
a
SAMPLE LOCATION
DATE
TIME
Stormwater Discharge
��
'
TEN IE
s
I � C
I
CLASSIFICATION:
WASTEWATER(NPDES)
DRINKING WATER
DWOIGW
SOLID WASTE SECTION
CHAIN OF CUSTODY (SEAL) MAINTAINED
DURING SHIPMENT/DELIVERY
N
SAMPLES COLLECTED BY:
(Please Print)
SAMPLES RECEIVED IN LAB AT _ °C
R lNQU1SHE Y (SIG.) (SAMPLER)
lull E��
RE D BY G
COMMENTS:
��
1� 9717ji,
Gr./'r
jajE
(+
RELINQUISHED B SIG.)
DATE/T1ME
ECENE Y IG.)K—)Iy,
D TEMME
t1
RELINQUISHED BY (SIG.)
DATE/TIME
RECEIVE SIG.
DATE/TIME
PLEASE READ Instructions for completing this form on the reverse side. Sampler must place a "C"for composite sample or a "G" for N 2 337564
FORM as Grab sample in the blocks above for each parameter requested.

SAMPLING INSTRUCTIONS AND FORM COMPLETION
FAILURE TO PROPERLY CHILL, CHEMICALLY PRESERVE, COLLECT IN PROPER BOTTLE
TYPES, MEET REQUIRED HOLDING TIMES, NEUTRALIZE CHLORINE IN CHLORINE
SENSITIVE SAMPLES, AND SEAL COOLERS WITH TAPE WILL RESULT IN SAMPLES BEING
REJECTED BY THIS LABORATORY AS PER NORTH CAROLINA REGULATORY CODE.
1) Samples not falling within the required guidelines will need to be re -collected. The client will be contacted and informed of any
deviation and asked to collect another set of samples. The client may request the laboratory to proceed with the analyses of the current
samples. Any samples analyzed outside of the required guidelines will be "qualified". This means that a note will be included on the
sample result and "Chain of Custody" specifying the deviation. The laboratory is also required to send a letter to the State noting the
deviations.
2) Sample Temperature. Samples for compliance monitoring must be chilled with wet ice to a temperature of 6C or less. Freezing is
not permitted. Samples delivered to the lab shortly after collection may not have had enough time to be chilled below 6C. In this case the
temperature at time of collection must be noted in the space provided. The samples will meet the requirements of the regulation if there
is a temperature drop from the time of collection until received in the lab. Regardless, all samples should be packed in wet ice using as
much ice as will fit in the cooler.
3) Sample Chemical Preservation. Many samples require a chemical preservation such as Sulfuric Acid or Sodium Hydroxide. The
laboratory will either provide the preservative in the sample bottle, or in the case of 40 mi. Volatiles Vials, provide a bottle of Acid with
detailed descriptions on how to collect the sample. Never rinse sample bottles before collecting samples. Any residue or liquid in the
bottle is required for proper chemical preservation. The lab must verify proper chemical preservation upon arrival in the lab and will note
this information in the spaces provided on the front of this form.
4) Chlorine Neutralization. Some samples require that any Total Chlorine Residual be removed at the time of collection. The lab will
provide the proper neutralizing agent in the sample bottle when technically possible. There are some samples (Total Kjeldahl Nitrogen
and Ammonia Nitrogen) where this is not possible due to interferences between the required chemical preservation (Acid) and the
dechlorinating agent. Therefore, these samples must be de -chlorinated at the time of collection before being placed in our sample bottles.
Sodium Thiosulfate is the chemical of choice to neutralize chlorine. It must be added to your sample and then the sample checked for
Total Chlorine before the sample is poured in our bottle. Facilities using chlorine for disinfection should have a means of measuring Total
Chlorine. Non -chlorinated sample sources will not need to be checked. The person neutralizing the chlorine must put his initials in the
"Chlorine Neutralized at Collection" row on the front of this form above the proper parameter. Samples such as Col iforms (which have
Thiosulfate in the bottles shipped from the lab) will be checked for proper neutralization upon arrival in the lab. It is also required that you
note the "Total Chlorine at Collection" on the front of this form for any sample locations applicable. This value would be before any
neutralization is performed.
5) A "C" for Composite Sample or a "G" for Grab Sample should be placed in the box for all requested parameters. Grab temperatures
as well as Composite start dates and times can be recorded in the "comments" section.
6) Other information required to be completed by the client are:
Collection Date and Collection Time for each sample location Temperature at Time of Collection
Printed name of person or persons collecting samples Signature, Date, and Time samples are relinquished
Other added sample locations and analyses required Type Of'Disinfection
Deletion on the form for any samples which are not needed (example: dry upstream location)
Any other information felt to be pertinent should be included in the "Comments" section
CONSIDERATIONS:
Coliform and Enterococci samples have a holding time of 6 hours from time of collection to time of analysis. Therefore, samples should
be collected as late in the day as possible to allow enough time for transportation, checking in at the lab and analysis.
BOD, Nitrate, Ortho Phosphorus, Settleable Matter, Turbidity, Color, and MBAS samples have a 48 hour holding time. The lab reserves the
right to establish required sample collection and delivery dates in order to meet the required holding times.
CAUTION
Sample bottles may contain acids or other corrosive and potentially harmful chemicals. Laboratories are required to add these chemicals
for certain analyses in order to comply with EPA preservation requirements. Use extreme care when opening and handling the shipping
container and bottles. If any chemical should get into your eyes, on your skin or on your clothes, flush liberally with water and seek medical
attention. Material Safety Data Sheets (MSDS) are available upon request which specify proper handling and personal protection.

STORMWATER DISCHARGE OUTFALL (SDO) - Semi -Annual MONITORING FORM
GENERAL PERMIT No. NCG140000
CERTIFICATE OF CO ERAGE NO. NCG14_Q_�_ j_o?
FACILITY NAME: -e e.­
PERSON COLLECTING SAMPLES r
CERTIFIED LABORATORY&dt i-vo rj C,4 Lab # Imo_
Lab #
OPTIONAL INFO:
Part A: Stormwater Monitoring Requirements
SAMPLE COLLECTION YEAR: ( 6/ -_
SAMPLING PERIOD: ❑ July -December X January -June
COUNTY n
PHONE NO. Qr2)_ qI1- 3lY�
ADD TO LISTSERVE? ❑YES ZNO EMAIL:
DISCHARGING TO CLASS: ❑SA ❑HCRW ❑PNA []Trout ❑Other
Qutfall No.
Date Sample Collected
(mo/dd/yr OR
NO FLOW)t
pH
(Standard
units)
TSS
(mg/L)
Event
Duration
(minutes)
Total
a
Rainfall
(in)
In Tier 2
Monthly
Monitoring?
(y/n)
is of Months in Tier
2 Sampling2
-
6-9
100 ,
-
y`7
A S-
' 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.
a 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)1
pH
(Standard
Units)
TPH using method
1664A SGT-HEM
(mg/L)
Total Suspended
Solids
(mg/L)
Event
Duration
(minutes)
Total
s
Rainfall
(in)
New Motor Oil
Usage
(gal/month]
In Tier 2
Monthly
Monitoring?
(Y/n)
# of Months
in Tier 2 .
2
Sampling
6-9
15
100 '
-
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES AT ANY ONE OUTFALL (INCLUDING VEHICLE MAINTENANCE)? YES ❑ NO X
HAVE YOU CONTACTED THE REGION? YES ❑ NO
REGIONAL OFFICE CONTACT NAME:
Mail Original and one coov 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 CERTIFICATION FOR ANYINFORMATION 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 perso 9812irectly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete.
am aZartthe are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
u&�r-/^7
(S' nature of Permittee) (Date)
Permit Date: 7/1/2011-60/30/2015
Last Revised 7/13/11
Page 2 of 2

EEw'DF@mH(M % hwT
LOB
.Wasfewntex� Ip ''chp
P.O. BOX 7D85, 114 OAKMONT DRIVE -- — ---� -- - PHONE�[phone]
GREENVILLE, N.C. 27835-7085 FAX [phone]
READY MIX CONCRETE (WILLIAMSTON)
MR. MIKE ODOM
1020 E. 5TH ST.
WASHINGTON ,NC 27889
PARAMETERS
PH (not to be used for reporting)
Total Suspended Residue, mg/l
Stormwater Analysis Method
Discharge Date Analyst Code
6.7 04/26/17 KKM 4500HB-00
12 04/27/17 SDB 2540D-97
ID#: 1095
DATE COLLECTED: 04/25/17
DATE REPORTED : 04/28/17
REVIEWED BY:

-Environment 1, Inc.
P.O. B(7x-7085, 114 Oakmont Dr.
Greenville. NC 27858
CHAIN OF CUSTODY RECORD
Page —I— of _;_
environment 1 inc.com
DISINFECTION
Phone (252j 756-6208 • Fax [phone]
CHLORINE NEUTRALIZED AT COLLECTION
CHLORINE
CLIENT: 1()95 Week: 13
pHCHECK (LAB)
UV
P
P
CONTAINER TYPE, PIG
READY MIX CONCRETE (WILLIAMSTON)
❑ NONE
MR. MIKE ODOM
CHEMICAL PRESERVATION
1020 E. 5TH ST.
WASHINCTON NC 27889
A
A
A - NONE D - NAOH
E o
[phone]
v
z_ 4
J
„F 6
w
_
2
cn
C B - HN01 E - HCL
=C
r
z
r
¢
w C - VO, F -ZINC ACETATE/NAOH
COLLECTION
U
¢
o o
LL
a
¢
8
U_
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°
a
r
¢ G - NATHIOSULFATE
a
SAMPLE LOCATION
DATE
TIME
Stormwater Discharge
25 {/�J
M 0
upl
CLASSIFICATION:
WASTEWATER(NPDES)
LjDRINKING WATER
LjDWQIGW
Ij SOLID WASTE SECTION
CHAIN OF CUSTODY (SEAL) MAINTAINED
DURING SHIPMENT/DELIVERY
N
SAMPLES COLLECTED BY:
(Please Print)
SAMPLES RECEIVED IN LAB AT oC
R NQ ISHE Y (SIG.) (SAMPLER)
DATTErnMME
REC D BY G.)
DA�TJEMME
COMMENTS:
y'
I./ /•W
r
RELINQUISHED (SIG.)
DATEITIME
RECEIVED (S .)
DATE/TIME
L
'
UL
RELINQUISHED BY (SIG.)
DATEITIME
RECEIVED BY (SIG.)
DATEMME
PLEASE READ Instructions for completing this form on the reverse side. Sampler must place a "C° for composite sample or a "G" for
FORM #5 Grab sample in the blocks above for each parameter requested. N 2 330329

I SAMPLING INSTRUCTIONS AND FORM COMPLETION
FAILURE TO PROPERLY CHILL, CHEMICALLY PRESERVE, COLLECT IN PROPER BOTTLE
I
TYP'
ES, MEET REQUIRED HOLDING TIMES, NEUTRALIZE CHLORINE IN-'(HLORINE
SENSITIVE SAMPLES, AND SEAL COOLERS WITH TAPE WILL RESULT IN SAMPLES BEING
REJECTED BY THIS LABORATORY AS PER NORTH CAROLINA REGULATORY CODE.
1) Samples not falling within the required guidelines will need to be re -collected. The client will be contacted and informed of any
deviation and asked to collect another set of samples. The client may request the laboratory to proceed with the analyses of the current
samples. Any samples analyzed outside of the required guidelines will be "qualified". This means that a note will b.0 included on the
sample result and "Chain of Custody" specifying the deviation. The laboratory is also required to send a letter to the State noting the
deviations.
..r
s'r .• j
2) Sample Temperature. Samples for compliance monifbring must be chilled with wet ice to a temperature of 6C br less. Freezing is
not permitted. Samples delivered to the lab shortly after collection may not have had enough time to be chilled below 6C. In this case the
temperature at time of collection must be noted in the space provided. The samples will meet the requirements of the regulation if there
is a temperature drop from the time of collection until received in the lab. Regardless, all samples should be packed in wet ice using as
much ice as will fit in the cooler.
3) Sample Chemical Preservation. Many samples require a chemical preservation such as Sulfuric Acid or Sodium -Hydroxide. The
laboratory will either provide the preservative in the sample bottle, or in the case of 40 ml. Volatiles Vials, provide a bottle of Acid with
detailed descriptions on how to collect the sample. Never rinse sample bottles before collecting samples. Any residue or liquid in the
bottle is required for proper chemical preservation. The lab must verify proper chemical preservation upon arrival in the lab and will note
this information in the spaces provided on the front of this form.
4) Chlorine Neutralization. Some samples require that any Total Chlorine Residual be removed at the time of collection. The lab will
provide the proper neutralizing agent in the sample bottle when technically possible. There are some samples (Total Kjeldahl Nitrogen
and Ammonia Nitrogen) where this is not possible due to interferences between the required chemical preservation (Acid) and the
dechlorinating agent. Therefore, these samples must be de -chlorinated at the time of collection before being placed in our sample bottles.
Sodium Thiosulfate is the chemical of choice to neutralize chlorine. It must be added to your sample and then the saniple checked for
Total Chlorine before the sample is poured in our bottle. Facilities using chlorine for disinfection should have a means of measuring Total
Chlorine. Non -chlorinated sample sources will not need to be checked. The person neutralizing the chlorine must put.his initials in the
"Chlorine Neutralized at Collection" row on the front of this form above the proper parameter. Samples such as Coliforms (which have
Thiosulfate in the bottles shipped from the lab) will be checked for proper neutralization upon arrival in the lab. It is also required that you
note the "Total Chlorine at Collection" on the front of this form for any sample locations applicable. This value would be before any
neutralization is performed.
5) A "C" for Composite Sample or a "G" for Grab Sample should be placed in the box for all requested parameters. Grab temperatures
as well as Composite start dates and times can be recorded in the "comments" section.
6) Other information required to be completed by the client are:
Collection Date and Collection Time for each sample location Temperature at Time of Collection
Printed name of person or persons collecting samples Signature, Date, and Time samples are relinquished
Other added sample locations and analyses required Type Of Disinfection
Deletion on the form for any samples which are not needed (example: dry upstream location)
Any other information felt to be pertinent should be included in the "Comments" section
CONSIDERATIONS:
Coliform and Enterococci samples have a holding time of 6 hours from time of collection to time of analysis. Therefore, samples should
be collected as late in the day as possible to allow enough time for transportation, checking in at the lab and analysis.
BOD, Nitrate, Ortho Phosphorus, Settleable Matter, Turbidity, Color, and MBAS samples have a 48 hour holding time. The lab reserves the
right to establish required sample collection and delivery dates in order to meet the required holding times.
CAUTION
Sample bottles may contain acids or other corrosive and potentially harmful chemicals. Laboratories are required to add these chemicals
for certain analyses in order to comply with EPA preservation requirements. Use extreme care when opening and handling the shipping
container and bottles. If any chemical should get into your eyes, on your skin or on your clothes, flush liberally with water and seek medical
attention. Material Safety Data Sheets (MSDS) are available upon request which specify proper handling and personal protection.

STORMWATER DISCHARGE OUTFALL (SDO) - Semi -Annual MONITORING FORM
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF COVERAGE NO. NCG14& j_L zZ
FACILITY NAME: &&/�1t1 (inrnc�c C,z_
PERSON COLLECTING SAMPLES &a,,& ,�'✓ruA
CERTIFIED LABORATORY 1►enftupm. 1 Lab # ib
Lab #
OPTIONAL INFO:
Part A: Stormwater Monitoring Requirements
RECEIVED
SAMPLE COLLECTION YEAR: 0?D14
SAMPLING �)4 luly-December ❑ January -June C
COUNTY e% D
PHONE NO.
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)t
pH
(Standard
units)
7SS
(mg/L)
Event
Duration
(minutes)
Total
a
Rainfail
(in)
In Tier 2
Monthly
Monitoring?
(y/n)
# of Months in Tier
2
2 Sampling
5-9
100 .
-
-
12-Z 4- t
G
' if "NO FLOW" or "NO DISCHARGE, Enter "NO FLOW" or "NO DISCHARGE" for each outfall here. Please make sure to mark the sampie 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 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.
JAN 17 2017
I NTRAL FILES
WR SECTION
Permit Date: 7/1/2011-50/30/2015 Last Revised 7/13/11
Page 1 of 2

6
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c
q
J
�
�
2
R
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�
.�

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)1
pH
(Standard
Units)
TPH using method
1669A SGT-HEM
(mg/L)
Total Suspended
Solids
(mg/L)
Event
Duration
(minutes)
Total
RainfaNa
(in)
New Motor Oil
Usage
(gal/month) ,;
In Tier 2
Monthly
Monitoring?
(y/n)
# of Months
in Tier 2
2
Sampling
6-9
15
100 '
r
HAS YOUR FACILITY HAD a OR MORE BENCHMARK EXCEEDENCES AT ANY ONE OUTFALL (INCLUDING VEHICLE MAINTENANCE)? YES [-]NO
HAVE YOU CONTACTED THE REGION? YES ❑ N0;6
REGIONAL OFFICE CONTACT NAME:
Mail Original and one coov of this DMR Uncludinp, all "No Flow" & "No Discharge" reports) within 30 days of receint of sample for 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 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 person erectly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I
am aware there significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
(Sigpddture of Permittee)
l-IZnry
(Date)
Permit Date:7/1/2011-60/30/2015
Last Revised 7/13/11
Page 2 of 2

ERw'w@10H(@M I hcm
Nd
P.O. BOX 7085, 114 OAKMONT
GREENVILLE. N.G. 27835-7085
.'.Wastewater I,y: 10 '
IVE PHONE [phone]
FAX [phone]
READY MIX CONCRETE (WILLIAMSTON)
MR. MIKE ODOM
1020 E. 5TH ST.
WASHINGTON ,NC 27889
PARAIIF',TEKS
Stormwater Analvsis Method
Discharge Date Analvst Code
PH (not to he used for reporting) 8.3 12/29/16 SDB 4500HB-00
"rota) Suspended Residue, mg/1 <2.7 12/30/16 KDS 2540D-97
ID#: 1095
DATE COLLECTED: 12/29/16
DATE REPORTED : 01/03/17
REVIEWED BY:

Environment 1, Inc. CHAIN OF CUSTODY RECORD
P.O. Box 70$5, 114 Oakmont Dr.
Greenville, NC 27858 Page I of
environment l ine.com
DISINFECTION
Phone *[phone] • Fax [phone]
CHLORINE NEUTRALIZED AT COLLECTION
CHLORINE
Ij
pH CHECK (LAB)
CLIENT: 1095 Week: 39
UV
p
p
CONTAINER TYPE, PIG
READN' 11IN CONCRETE (WILLIA,ISTON)
❑ NONE
AIR. ,HIKE OI)O\i
CHEMICAL PRESERVATION
1020 E. 5TH ST.
WASHINGTON NC 27889
A
A
CnA-NONE D-NAOH
cm
E F
[phone]
z �
Uj
LU
� B - HNO3 E - HCL
00
J
cc 0
Z
c
w C- H2SO, F- ZINC ACETATEINAOH
COLLECTION
U Q
o o
�" ¢
8G
t
- NATHIOSULFATE
a
SAMPLE LOCATION
DATE
TIME
5[ormuater Discharge
p �+-�
!
CLASSIFICATION:
WASTEWATER(NPDES)
DRINKING WATER
DWOIGW
SOLID WASTE SECTION
CHAIN OF CUSTODY (SEAL) MAINTAINED
PMENTIDELIVERY
DURINn__
N
SAMPLES COLLECTED BY:
(Please Print)
SAMPLES RECEIVED IN LAB ATO °C
LINO ISHED BY (SIG.) (SAMPLER)
DATEI IME
RECEI ED BY (SIG
D TEfnME
COMMENTS:
RELINQUIS D BY IG.)
ME
DE61
RECEIVE (SIG.)
ATEMME
r
�f
Alt �5b
'
G
RELINQUISHED BY SIG.)
DATEIIME
RECEIVED SIG.
ATEITIME
PLEASE READ Instructions for completing this form on the reverse side. Sampler must place a "C° for composite sample or a °G" for -
FORM #5 Grab sample in the blocks above for each parameter requested. N o __ 3 12 5.4 1

SAMPLING INSTRUCTIONS AND FORM COMPLETION
FAILURE TO PROPERLY CHILL, CHEMICALLY PRESERVE, COLLECT IN PROPER BOTTLE
TYPES, MEET REQUIRED HOLDING TIMES, NEUTRALIZE CHLORINE IN CHLORINE
SENSITIVE SAMPLES, AND SEAL COOLERS WITH TAPE WILL RESULT IN SAMPLES BEING
REJECTED BY THIS LABORATORY AS PER NORTH CAROLINA REGULATORY CODE.
1) Samples not failing within the required guidelines will need to be re -collected. The client will be contacted and informed of any
deviation and asked to collect another set of samples. The client may request the laboratory to proceed with the analyses of the current
samples. Any samples analyzed outside of the required guidelines will be "qualified". This means that a note will be included on the
sample result and "Chain of Custody" specifying the deviation. The laboratory is also required to send a letter to the State noting the
deviations.
2) Sample Temperature. Samples for compliance monitoring must be chilled with wet ice to a temperature of 6C or less. Freezing is
not permitted. Samples delivered to the lab shortly after collection may not have had enough time to be chilled below 6C. In this case the
temperature at time of collection must be noted in the space provided. The samples will meet the requirements of the regulation if there
is a temperature drop from the time of collection until received in the lab. Regardless, all samples should be packed in wet ice using as
much ice as will fit in the cooler.
3) Sample Chemical Preservation. Many samples require a chemical preservation such as Sulfuric Acid or Sodium Hydroxide. The
laboratory will either provide the preservative in the sample bottle, or in the case of 40 ml. Voiatiles Vials, provide a bottle of Acid with
detailed descriptions on how to collect the sample. Never rinse sample bottles before collecting samples. Any residue or liquid in the
bottle is required for proper chemical preservation. The lab must verify proper chemical preservation upon arrival in the lab and will note
this information in the spaces provided on the front of this form.
4) Chlorine Neutralization. Some samples require that any Total Chlorine Residual be removed at the time of collection. The lab will
provide the proper neutralizing agent in the sample bottle when technically possible. There are some samples (Total Kjeldahl Nitrogen
and Ammonia Nitrogen) where this is not possible due to interferences between the required chemical preservation (Acid) and the
dechlorinating agent. Therefore, these samples must be de -chlorinated at the time of collection before being placed in our sample bottles.
Sodium Thiosulfate is the chemical of choice to neutralize chlorine. It must be added to your sample and then the sample checked for
Total Chlorine before the sample is poured in our bottle. Facilities using chlorine for disinfection should have a means of measuring Total
Chlorine. Non -chlorinated sample sources will not need to be checked. The person neutralizing the chlorine must put his initials in the
"Chlorine Neutralized at Collection" row on the front of this form above the proper parameter. Samples such as Coliforms (which have
Thiosulfate in the bottles shipped from the lab) will be checked for proper neutralization upon arrival in the lab. It is also required that you
note the "Total Chlorine at Collection" on the front of this form for any sample locations applicable. This value would be before any
neutralization is performed.
5) A "C" for Composite Sample or a "G" for Grab Sample should be placed in the box for all requested parameters. Grab temperatures
as well as Composite start dates and times can be recorded in the "comments" section.
6) Other information required to be completed by the client are:
Collection Date and Collection Time for each sample location Temperature at Time of Collection
Printed name of person or persons collecting samples Signature, Date, and Time samples are relinquished
Other added sample locations and analyses required Type Of Disinfection
Deletion on the form for any samples which are not needed (example: dry upstream location)
Any other information felt to be pertinent should be included in the "Comments" section
CONSIDERATIONS:
Coliform and Enterococci samples have a holding time of hours from time of collection to time of analysis. Therefore, samples should
be collected as late in the day as possible to allow enough time for transportation, checking in at the lab and analysis.
BOD, Nitrate, Ortho Phosphorus, Settleable Matter, Turbidity, Color, and MBAS samples have a 48 hour holding time. The lab reserves the
right to establish required sample collection and delivery dates in order to meet the required holding times.
CAUTION
Sample bottles may contain acids or other corrosive and potentially harmful chemicals. Laboratories are required to add these chemicals
for certain analyses in order to comply with EPA preservation requirements. Use extreme care when opening and handling the shipping
container and bottles. If any chemical should get into your eyes, on your skin or on your clothes, flush liberally with water and seek medical
attention. Material Safety Data Sheets (MSDS) are available upon request which specify proper handling and personal protection.

�l"'` - .-S.TORMWATER.DISCHARGE-OUTFALL (SDO) - Semi-Annuai MONITORING FORM
- GENERAL PERMIT NO. NCG140000
CERTIFICATE OF C ERAGE No. NCG14Q _L L
FACILITY NAME:
PERSON COLLECTING S MPLES-
CERTIFIED LABORATORY arm- - V%f_ Lab # !a
Lab #
OPTIONAL INFO:
Part A: Stormwater Monitoring Requirements
SAMPLE COLLECTION YEAR: ?Gt(-
SAMPLING PERIOD: ❑ July -December January -June
COUNTY ^
PHONE NO. (adZ j 17fZ' JVVP --
ADD TO LISTSERVE? ❑YES O EMAIL:
DISCHARGING TO CLASS: nSA ❑HQW ❑PNA ❑Trout ❑Other
Outfall No.
Date Sample Collected
(mo/dd/yr OR
NO FLOW)1
pH
[Standard
Units)
TSS
(mg/L)
Event
Duration
(minutes)
Total
4
Rainfall
(in)
In Tier 2
Monthly
Monitoring?
n
(y/ )
# of Months in Tier
z
2 Sampling
-
-
6-9
100 2,3-
-
-
-
1
A 4!r
rp-
A
Dw
"' LES
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 TSS benchmark values are 100 mg/I, except when discharging to ORW, HQW, Trout, and PNA waters where they are 50 mg/l.
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

6aw

—Part B:• Vehicle Maintenance Activity Monitoring Requirements for facilities using > SS gal of new motor oil/month — averaged over a calendar year.
butfall
'
No.
Date Sample
Collected
(mo/d'd/Yr)
pH ..:
(Standard-
Units).,
TPH using method
1664A SGT-HEM
;(mg/L)------;
Total Suspended
_Solids
(mg/L)
Event
Duration
-(minutes)
Total
A
Rainfall
(in)
New Motor Oil
Usage
(gal/month)
In Tier 2
Monthly
Monitoring?
(Y/n)
# of Months
in Tier 2
2
Sampling
6-9
15
100
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDS CES AT ANY ONE OUTFALL (INCLUDING VEHICLE MAINTENANCE)? YES ❑ NOZ
HAVE YOU CONTACTED THE REGION? YES ❑ NOZ
REGIONAL OFFICE CONTACT NAME:
Mail Original and one copy 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 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 dire 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 t e are ficant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
of
Permit Date:7/1/2011-60/30/2015
_of-f-Ile
(Date)
Last Revised 7/13/11
Page 2 of 2

NC 60 NO / / Eaw'UmEM % RommOod
P.O. BOX 7085, 114 OAKMONT
GREENVILLE, N.C. 27835-7086
READY MIX CONCRETE (WILLIAMSTON)
MR. MIKE ODOM
1020 E. 5TH ST.
WASHINGTON ,NC 27889
PARAMETERS
PH (not to be used for reporting)
Total Suspended Residue, mg/l
Stormwater Analysis Method
Discharge Date Analyst Code
6.9 02/25/16 CMC 4500HB-00
3.9 02/26/16 SDB 2540D-97
FAX [phone]
ID#: 1095
DATE COLLECTED: 02/24/16
DATE REPORTED : 02/29/16
REVIEWED BY: / =

h:nvunEuncnt 1, 111c, CHAIN OF CUSTODY RECORD
P.O. Rox 7085„) 14 Onknront Dr. Vage ! of I
Greenville, NC 27858
environtile nll inc.com
DISINFFCI'ION
I'lume [phone] • Fix [phone]
CHLORINE NEUTRALIZED AT COLLECTION
Ij CH1.0[ZW1.
pHCHECK (LAB)
CLIENT: 1095 Week- 13
lJV
p
p
CONTAINER TYPE, P/G
READY MIX CONCRETE (WILLIAMSTOm
NONE:
MR. MIKE ODOM
CHEMICAL PRESERVATION
1020 E. 5TH ST.
WASHINGTON NC 27889
A
A
`r' A - NONE D • NAOH
zo
E
[phone]
? �
w z
w
C B HNO E- HCL
Cr o
L
z
Cl) a
= w
w
w C- H,SO, F- ZINC ACETATE/NAOH
COLLECTION
v c
w
2 8
txcc
G NATHIOSULFATE
SAMPLE LOCATION
DATE
TIME
'ID- 'Cr)W¢
o
F
Stormwater Discharge
�l�
i�
1
CLASSIFICATION:
WASTEWATER (NPDES)
ORINKINGWATER
DWQIGW
SOLID WASTE SECTION
CHAIN OF CUSTODY (SEAL) MAINTAINED
DURING kIIPMENT/DELIVERY
N
SAMPLES COLLECTED BY:
(Please Print)
SAMPLES RECEIVED IN LAB AT (J �L'C
jRrIN0 1SHED Y (SIG.) (SAMPLER)
DATFJTIME
REC D BY IG
DATE/t1ME
COMMENTS:
a-�s�c� 1
`,� G
RELINQUISHED B . 'IG.)
DATEITIME
RECD BY (SIG
OATFJTIM`E�
�a K'
�� I
RELINQUISHED BY (SIG.)
DATEITIME
RECEIVED BY ( IC
DATEMME
PLEASE READ Instructions for completing this form on the reverse side. Sampler must place a "C" for composite sample or a "G" for N o 303.480 FOAM +rs Grab sample in the blocks above for each' parameter requested.

STORM WA TERDISCHARGE-OUTFALL (SDO) - Semi -Annual MONITORING FORM
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF C ERAGE NO. NCG14 5 _L L .2
FACILITY NAME:
PERSON COLLECTING S MPLES- CQA.110t
CERTIFIED LABORATORY C^G Lab # !a
Lab #
OPTIONAL INFO:
Part A: Stormwater Monitoring Requirements
SAMPLE COLLECTION YEAR: ?61l-
SAMPLING,,P,yEE��RIO��D: ❑ July -December January -June
COUNTY
PHONE NO. (292 ? 17t.1-X/YF
ADD TO LISTSERVE? ❑YES O EMAIL:
DISCHARGING TO CLASS: nSA ❑HQW ❑PNA ❑Trout []Other
Outfall No.
Date Sample
Collected
(mo/dd/yr OR
NO FLOW}1
pH
-ar.
[Stand d .
Units}
TS5
{mg/L}
Event
Duration
{minutes}
Total
4
Rainfall
(in}
In Tier 2
Monthly
Monitoring?
(Y/n)
H of Months in Tier
2 Samplingz
-
-
6-9
1001,
-
-
-
' 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 TSS benchmark values are 100 mg/l, except when discharging to ORW, HQW, Trout, and PNA waters where they are 50 mg/L
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
r
(ma/dd/yr)
-PH.—.- .
Standard �
{ )
Units
7PH using method
16S4A SGT-HEM
=(m /Lj
g
.Total Suspended
Soli ds'
(mp,/l)
Event
Duration
(rriinutes):
Total
a
Rainfall
(in)
New Motor Oil
usage ..
(gal/month)
In Tier 2
Monthly
Monitoring)
Wri)
# of Months
in.Tier2
. z
Sampling
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDE CES AT ANYONE OUTFALL (INCLUDING VEHICLE MAINTENANCE)? YES ❑ NOe
HAVE YOU CONTACTED THE REGION? YES ❑ NO
REGIONAL OFFICE CONTACT NAME:
Mail Original and one co Py 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 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 dire 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 to acre jjyAficant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
of Permittee
Permit Date:7/1/2011-60/30/2015
197-4(
go 0
(Date)
Last Revised 7/13/11
Page 2 of 2

1.
EmW'UmmH&W 90 hc
TOW
P.O. BOX 7085, 114 OAKMONT DRIVE
GREENVILLE, N.C. 27835-7085
READY MIX CONCRETE (WILLIAMSTON)
MR. MIKE ODOM
1020 E. 5TH ST.
WASHINGTON ,NC 27889
PARAMETERS
PH (not to be used for reporting)
Total Suspended Residue, mg/l
Stormwater Analysis Method
Discharge Date Analyst Code
6.9 02/25/16 CMC 4500HR-00
3.9 02/26/16 SDB 2540D-97
wastewater ID: 10
—_---PHONE [phone]
FAX_(252) 756-0633
ID#: 1095
DATE COLLECTED: 02/24/16
DATE REPORTED : 02/29/16
REVIEWED BY:

Environment 1, Inc. CHAIN OF CUSTODY RECORD
P.O. Box 7085,.(14 Oakmont Dr.
Greenville. NC 27858 Page 1 of
environment] inc.com
DISINFECTION
CHLORINE NEUTRALIZED AT COLLECTION
Phone [phone] • Fax [phone]
CHLORINE
CLIENT: 1095 Week: 13
pH CHECK (LAB)
Ij UV
P
P
CONTAINER TYPE, PIG
READY INUX CONCRETE (WILLIANISTON)
❑ NONE
NIR. MIKE ODOM
1020 E. 5TH ST.
CHEMICAL. PRESERVATION
WASHINGTON NC 27889
A
A
A - NONE D - NAOH
E o
[phone]
z LLI
z
�
� B - HNO3 E - HCL
O JO
� O
Z
p�
_ �
5 t
w C - H2SO, F - ZINC ACETATE/NAOH
COLLECTION
w �
8
S
LL
2
F,
G - NATHIOSULFATE
SAMPLE LOCATION
DATE I
TIME
Storm -water Discharge
/G
/Z�''�D
�Q
1
CLASSIFICATION:
WASTEWATER (NPDES)
DRINKINGWATER
DWUGW
SOLID WASTE SECTION
CHAIN OF CUSTODY (SEAL) MAINTAINED
OURINIPMENT/DELIVERY
N
SAMPLES COLLECTED BY:
(Please Pdnt)
SAMPLES RECEIVED IN LAB AT Q °C
R NQ ISHED Y (SIG.) (SAMPLER)
DATEMME
REC D BY I
DATEIl1ME
COMMENTS:
RELINQUISHED B IG.}
DATEMME
RECD BY (SIG
DATFJTIME
RELINQUISHED BY (SIG.)
DATEMME
RECEIVED BY (I
DATEMME
PLEASE READ Instructions for completing this form on the reverse side. Sampler must place a "C" for composite sample or a "G for FORM #5 Grab sample in the blocks above for each parameter requested. No - -
_ 303480

SAMPLING INSTRUCTIONS AND FORM. COMPLETION
FAILURE TO PROPERLY CHILL, CHEMICALLY PRESERVE, COLLECT IN PROPER BOTTLE
TYPES, MEET REQUIRED HOLDING TIMES, NEUTRALIZE CHLORINE IN CHLORINE
SENSITIVE SAMPLES, AND SEAL COOLERS WITH TAPE WILL RESULT IN SAMPLES BEING
REJECTED BY THIS LABORATORY AS PER NORTH CAROLINA REGULATORY CODE.
1) Samples not falling within the required guidelines will need to be re -collected. The client will be contacted and informed of any
deviation and asked to collect another set of samples. The client may request the laboratory to proceed with the analyses of the current
samples. Any samples analyzed outside of the required guidelines will be "qualified". This means that a note will be included on the
sample result and "Chain of Custody" specifying the deviation. The laboratory is also required to send a letter to the State noting the
deviations.
2) Sample Temperature. Samples for compliance monitoring must be chilled with wet ice to a temperature of 6C or less. Freezing is
not permitted. Samples delivered to the lab shortly after collection may not have had enough time to be chilled below 6C. In this case the
temperature at time of collection must be noted in the space provided. The samples will meet the requirements of the regulation if there
is a temperature drop from the time ofcollection until received in the lab. Regardless, all samples should be packed in wet ice using as
much ice as will fit in the cooler.
3) Sample Chemical Preservation. Many samples require a chemical preservation such as Sulfuric Acid or Sodium Hydroxide. The
laboratory will either provide the preservative in the sample bottle, or in the case of40 mi. Volatiles Vials, provide a bottle of Acid with
detailed descriptions on how to collect the sample. Never rinse sample bottles before collecting samples. Any residue or liquid in the
bottle is required for proper chemical preservation. The lab must verify proper chemical preservation upon arrival in the lab and will note
this information in the spaces provided on the front of this form.
4) Chlorine Neutralization. Some samples require that any Total Chlorine Residual be removed at the time of collection. The lab will
provide the proper neutralizing agent in the sample bottle when technically possible. There are some samples (Total Kjeldahl Nitrogen
and Amtnonia Nitrogen) where this is not possible due to interferences between the required chemical preservation (Acid) and the
dechlorinating agent. Therefore, these samples must be de -chlorinated at the time of collection before being placed in our sample bottles.
Sodium Thiosulfate is the chemical of choice to neutralize chlorine. It must be added to your sample and then the sample checked for
Total Chlorine before the sample is poured in our bottle. Facilities using chlorine for disintection should have a means of measuring Total
Chlorine. Non -chlorinated sample sources will not need to be checked. The person neutralizing the chlorine must put his initials in the
"Chlorine Neutralized at Collection" row on the front of this form above the proper parameter. Samples such as Coliforms (which have
Thiosulfate in the bottles shipped from the lab) will be checked for proper neutralization upon arrival in the lab. It is also required that you
note the "Total Chlorine at Collection" on the front of this form for any sample locations applicable. This value would be before any
neutralization is performed.
5) A "C" for Composite Sample or a "G" for Grab Sample should be placed in the box for all requested parameters. Grab temperatures
as well as Composite start dates and times can be recorded in the "comments" section.
6) Other information required to be completed by the client are:
Collection Date and Collection Time for each sample location Temperature at Time of Collection
Printed name of person or persons collecting samples Signature, Date, and Time samples are relinquished
Other added sample locations and analyses required Type Of Disinfection
Deletion on the form for any samples which are not needed (example: dry upstream location)
Any other information felt to be pertinent should be included in the "Comments" section
CONSIDERATIONS:
Coliform and Enterococci samples have a holding time of 6 hours from time of collection to time of analysis. Therefore, samples should
be collected as late in the day as possible to allow enough time for transportation, checking in at the lab and analysis.
BOD, Nitrate, Ortho Phosphorus, Settleable Matter, Turbidity, Color, and MBAS samples have a 48 hour holding time. The lab reserves the
right to establish required sample collection and delivery dates in order to meet the required holding times.
CAUTION
Sample bottles may contain acids or other corrosive and potentially harmful chemicals. Laboratories are required to add these chemicals
for certain analyses in order to comply with EPA preservation requirements. Use extreme care when opening and handling the shipping.
container and bottles. If any chemical should get into your eyes, on your skin or on your clothes, Hush liberally with water and seek medical
attention. Material Safety Data Sheets (MSDS) are available upon request which specify proper handling and personal protection.

r
STORMWA TER -DISCHARGE OUTFALL (SDO) - Semi -Annual MONITORING FORM
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF C RAGE NO. NCG14D- L
FACILITY NAME: a C ' Go lot" #a
PERSON COLLECTING SAMPLES 6 M
CERTIFIED LABORATORY4Ajef&A ,&ft+ !L rc Lab # 10
Lab #
OPTIONAL INFO:
Part A. Stormwater Monitoring Requirements
RECEIVED
SAMPLE COLLECTION YEAR: aO 19 DEC 0 4 2015
SAMPLING PERIOD: duly -December ❑ January-JuneCENTRAL FILES
COUNTY /�24r, -- DWR SECTION
PHONE NO. (2faj ri%,Z - <<i
ADD TO LISTSERVE? DYES ®NO EMAIL:
DISCHARGING TO CLASS: [_]SA ❑HQW ❑PNA ❑Trout [-]Other
w a
Outfall No
r� " r
Date Sample{
fr
. Collected
s
t
NOFLOW).
w
P
(Standard
v
Um
nits
u
�,TSS f
5 Event
s : {
Duration
=x tMonitoring.
minutes j,.'(in)'{y
Total x.
a .,.
Rainfall
.In'Tie 2'<
t•: Monthly
/ nj
Ka ,,.
# of Months in -Tier ;
z
2 Sampling M
' 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 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 .

I

Part B: 4i�hicie Maintenance Activity Monitoring Requirements for facilities using > 55 gal of new motor oil/month — averaged over a calendar year.
iF
'
pH
TPH.using method
Total Suspended,'
Event
Total
,.New Motor Oil
�� hly
# of Months
. Outfall .
�
Date Sam le
� ., P
(Standard ,,
1664A�SGT HEM
Solids :,
. Duration
4
Rainfall
usage
in Tler Z ­
No.
.
Collected
i
Units]=ln�gll)
.....
(m/L. )
(minutes)
(in)
(gal/itfonth) +
Monitoring.
;..,
'Sampling
(ma/dd/yr}
:°°',
(y/n)
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES AT ANY ONE OUTFALL (INCLUDING VEHICLE MAINTENANCE)? YES ❑ NOg
HAVE YOU CONTACTED THE REGION? YES ❑ NO
REGIONAL OFFICE CONTACT NAME:
Mail Original and one copy 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 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 person irectly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete.
am aware =there si nificant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
�...
(Sig(ature of Permittee) (Date)
Permit Date: 7/1/2011-60/30/2015 Last Revised 7/13/11
Page 2 of 2

Cf
EE40mmmV Ala kc(mmumbd
wastewater iD: iv
fP.O. BOX 7485, 11, OAKMONT DRIVE -�� --- - - PHONE [phone]
GREENVILLE, N.C. 27835-7085 FAX [phone]
READY MIX CONCRETE (WILLIAMSTON)
MR. MIKE ODOM
1020 E. 5TH ST.
WASHINGTON ,NC 27889
PARAMETERS
PH (not to be used for reporting)
Total Suspended Residue, mg/I
0
Stormwater Analysis Method
Discharge Date Analyst Code
7.9 10/28/15 CMC 4500HB-00
<2.8 10/29/15 KDS 2540D-97
ID#: 1095
DATE COLLECTED: 10/27/15
DATE REPORTED : 10/30/15
REVIEWED BY:

Environment 1, Inc. CHAIN OF CUSTODY RECORD
P.O. 13ox 7D85, 114 Oakmont Dr. Page I of
Greenville, NC 27858
environment] inc.aom
DISINFECTION
CHLORINE NEUTRALIZED AT COLLECTION
Phone [phone] • Fax [phone]
Ij CHLORINE
pHCHECK (LAB)
CLIENT. logs Week:39
Ij UV
P
P
CONTAINER TYPE,P/G
READY MIX CONCRETE (WILLIANISTON)
❑ NONE
N1R. N1IKE ODOM
CHEMICAL PRESERVAMON
1020 E. 5TH ST.
WASHINGTON NC 27889
A
A
wA - NONE D - NAOH
E o
[phone]
Z �
LLB,- z
I
G
Cn
� B - HNO, E - HCL
08
cc 0
w
z
p
c
�
C- H2SO4 F- ZINC ACETATE/NAOH
w
COLLECTION
o
uU
CL
a
U_
c
x
G - NATHIOSULFATE
SAMPLE LOCATION
DATE
TIME
Slormwater Discharge
/d X l
`S
!7u
1
CLASSIFICATION:
WASTEWATER(NPDES)
DRINKING WATER
DWOIGW
SOLID WASTE SECTION
CHAIN OF CUSTODY (SEAL) MAINTAINED
DURING SHIPMENT/DELIVERY
0 N
SAMPLES COLLECTED BY:
(Please Print)
las b� ewM
SAMPLES RECEIVED IN LAB AT °C
R INOUISIHEED BY (SIG.) (SAMPLER)
DATEMME
RE Y }
DATEMME
COMMENTS:
RELI BY )
DATE/TIME
4ECEIVE (SIG.)
DATEMME
r
Wgj
EUNOUISHED BY (SIG.)
DATEMME
RECEIVED BY (SIGV U
D MMME
PLEASE READ Instructions for completing this form on the reverse side. Sampler must place a "C" for composite sample or a "G" for N 0 306241
FORM as Grab sample in the blocks above for each parameter requested.

SAMPLING INSTRUCTIONS AND FORM COMPLETION
FAILURE TO PROPERLY CHILL, CHEMICALLY PRESERVE, COLLECT IN PROPER BOTTLE
TYPES, MEET REQUIRED HOLDING TIMES, NEUTRALIZE CHLORINE IN CHLORINE
SENSITIVE SAMPLES, AND SEAL COOLERS WITH TAPE WILL RESULT IN SAMPLES BEING
REJECTED BY THIS LABORATORY AS PER NORTH CAROLINA REGULATORY CODE.
1) Samples not falling within the required guidelines will need to be re -collected. The client will be contacted and informed of any
deviation and asked to collect another set of samples. The client may request the laboratory to proceed with the analyses of the current
samples. Any samples analyzed outside of the required guidelines will be "qualified". This means that a note will be included on the
sample result and "Chain of Custody" specifying the deviation. The laboratory is also required to send a letter to the State noting the
deviations.
2) Sample Temperature. Samples for compliance monitoring must be chilled with wet ice to a temperature of 6C or less. Freezing is
not permitted. Samples delivered to the lab shortly after collection may not have had enough time to be chilled below 6C. In this case the
temperature at time of collection must be noted in the space provided. The samples will meet the requirements of the regulation if there
is a temperature drop from the time of collection until received in the lab. Regardless, all samples should be packed in wet ice using as
much ice as will fit in the cooler.
3) Sample Chemical Preservation. Many samples require a chemical preservation such as Sulfuric Acid or Sodium Hydroxide. The
laboratory will either provide the preservative in the sample bottle, or in the case of 40 mi. Volatiles Vials, provide a bottle of Acid with
detailed descriptions on how to collect the sample. Never rinse sample bottles before collecting samples. Any residue or liquid in the
bottle is required for proper chemical preservation. The lab must verify proper chemical preservation upon arrival in the lab and will note
this information in the spaces provided on the front of this form.
4) Chlorine Neutralization. Some samples require that any Total Chlorine Residual be removed at the time of collection. The lab will
provide the proper neutralizing agent in the sample bottle when technically possible. There are some samples (Total Kjeldahl Nitrogen
and Ammonia Nitrogen) where this is not possible due to interferences between the required chemical preservation (Acid) and the
dechlorinating agent. Therefore, these samples must be de -chlorinated at the time of collection before being placed in our sample bottles.
Sodium Thiosulfate is the chemical of choice to neutralize chlorine. It must be added to your sample and then the sample checked for
Total Chlorine before the sample is poured in our bottle. Facilities using chlorine for disinfection should have a means of measuring Total
Chlorine. Non -chlorinated sample sources will not need to be checked. The person neutralizing the chlorine must put his initials in the
"Chlorine Neutralized at Collection" row on the front of this form above the proper parameter. Samples such as Coliforms (which have
Thiosulfate in the bottles shipped from the lab) will be checked for proper neutralization upon arrival in the lab. It is also required that you
note the "Total Chlorine at Collection" on the front of this form for any sample locations applicable. This value would be before any
neutralization is performed.
5) A "C" for Composite Sample or a "C" for Crab Sample should be placed in the box for al I requested parameters. Grab temperatures
as well as Composite start dates and times can be recorded in the "comments" section.
6) Other information required to be completed by the client are:
Collection Date and Collection Time for each sample location Temperature at Time of Collection
Printed name of person or persons collecting samples Signature, Date, and Time samples are relinquished
Other added sample locations and analyses required Type Of Disinfection
Deletion on the form for any samples which are not needed (example: dry upstream location)
Any other information felt to be pertinent should be included in the "Comments" section
CONSIDERATIONS:
Coliform and Enterococci samples have a holding time of 6 hours from time of collection to time of analysis. Therefore, samples should
be collected as late in the day as possible to allow enough time for transportation, checking in at the lab and analysis.
BOD, Nitrate, Ortho Phosphorus, Settleable Matter, Turbidity, Color, and MBAS samples have a 48 hour holding time. The lab reserves the
right to establish required sample collection and delivery dates in order to meet the required holding times.
CAUTION
Sample bottles may contain acids or other corrosive and potentially harmful chemicals. Laboratories are required to add these chemicals
for certain analyses in order to comply with EPA preservation requirements. Use extreme care when opening and handling the shipping
container and bottles. If any chemical should get into your eyes, on your skin or on your clothes, flush liberally with water and seek medical
attention. Material Safety Data Sheets (MSDS) are available upon request which specify proper handling and personal protection.

STORMWATER DISCHARGE OUTFALL (SDO) - Semi -Annual MONITORING FORM
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF COVERAGE NO. NCG14 I Z
FACILITY NAME: keab. M+� V .78
PERSON COLLECTING SAMPLES Og f`/V "
CERTIFIED LABORATORY,6nyir-mr"e& /j jeLab#
Lab #
OPTIONAL INFO:
Part A: Stormwater Monitoring Requirements
SAMPLE COLLECTION YEAR: ZoJS c,
SAMPLING PERIOD ❑ July -December :Sj�fffnuary-June
COUNTY MOO; ^
PHONE NO. (A&- 2-3 Y cz::9
ADD TO LISTSERVE? []YES RW EMAIL:
DISCHARGING TO CLASS: ❑SA ❑HQW ❑PNA ❑Trout ❑Other
Outfalf No'.—
Date Sample
Collected
mo dd rOR
/ /Y
NO FLOW i
),
pH
( Standard
Units)
�,,, , TSS'
(mg/0
Event
Duration, .=Rainfall
(minutes)
Total
a =
(in)
in Tier 2
Monthly
Moritoring
(Y/n )
# of Months en Tier
x
.2xSampling
2.
5-4
100
-
G Z
13.1`
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.
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 TSS benchmark values are 100 mg/I, except when discharging to ORW, HQW, Trout, and PNA waters where they are 50 mg/l.
"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
RECEIVED
JUL 13 2015
CENTRAL FILES
DWR SECTION1,
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 Sam le
p
Collected
(mo/dd/yr}
pH
(Standard
Units)
TPH using method
1664A SGT-HEM
(mg/L) `. -
Total Suspended
Solids°':.
„ (mg%L)
Event
Duration
(minutes)
Total
Rainfall°
(in)
New Motor Oil
usage
(gal/month) .
In Tier 2
Monthly.
Monitorng?
(yin),100
# of Months',
in Tier,2 ;
7
Sampling
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDEN AT ANYONE OUTFALL {INCLUDING VEHICLE MAINTENANCE)? YES ❑ NO�
HAVE YOU CONTACTED THE REGION? YES ❑ NO
REGIONAL OFFICE CONTACT NAME:
Mail Original and one copy of this DMR fincludine all "No Flow" & "No Discharee" reoorts) within 30 days of receipt of sample (or 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 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 per ons it y esponsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete.
am aw that t are significant enalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
4
(Sig of rmittee) [Dat
Permit Date: 7/1/2011-60/30/2015 Last Revised 7/13/11
Page 2 of 2

ENW,ummul % hCupo mmW
P.Q. BOX 7085, 114 OAKM-ON T DRfVE=
GREENVILLE. N.C. 27835-7085
READY MIX CONCRETE (WILLIAMSTON)
MR. MIKE ODOM
1020 E. 5TH ST.
WASHINGTON ,NC 27889
PARAMETERS
PH (not to be used for reporting)
Total Suspended Residue, mg/l
Stormwater Analysis Method
Discharge Date Analyst Code
8.1 06/26/15 TRB 450011B-00
<2.8 06/29/15 KKF 254OD-97
ID#: 1095
DATE COLLECTED: 06/26/15
DATE REPORTED : 06/29/15
REVIEWED BY:
756-6208
756-0633

STORMWATER DISCHARGE OUTFALL (SDO) - Semi -Annual MONITORING FORM
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF COVERAGE NO. NC/G•14_01 L 7-
FACILITY NAME: ,
PERSON COLLECTING SA PLES 4Ar ds vw-.
CERTIFIED LABORATORY G. Lab # ZQ
Lab #
OPTIONAL INFO:
Part A: Stormwater Monitoring Requirements
SAMPLE COLLECTION YEAR: ze2ly
SAMPLING PERIOD: July -December ❑ January -June
COUNTY 144d;^
PHONE NO. (z52) °% 4'Z-3/
ADD TO LISTSERVE? ❑YES1�41'Q0 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
4
Rainfall
[in)
In Tier 2
Monthly
Monitoring?
(y/n)
# of Months in Tier
Z
2 Sampling
-
6-92
100 ,
-
-
-
-
o
�Z
Z3D
1 If "NO FLOW" or "NO DISCHARGE, Enter "N0 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/l.
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 Sam
Sample
p
Collected 1
(mo/dd/yr)
pH
(Standard
Units)
TPH using method
1664A SGT-HEM
(mg/L)
Total Suspended
Solids
(mg/L)
Event
Duration
(minutes)
Total
a
Rainfall
(in)
New Motor Oil
Usage
(gal/month)
In Tier 2
Monthly
Monitoring?
(Y/n)
i# of Months
in Tier 2
Sampling2
6-92
152
100 .3
-
-
-
-
-
I
HAS 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 coov of this DMR fincludinR all "No Flow" & "No Discharge" rewrtsl within 30 days of receipt of sample for at end of monitorinR 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 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 thatEmittee)
el properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or
those ersonsi or gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete.
am a re tificant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
D -Z3-1
(Sig at (Date)
Permit Date: 7/1/2011-60/30/2015 Last Revised 7/13/11
Page 2 of 2

Eimwohmmg[WAla hw
mbe
was tewate r'. I D.'. .1. 0..
P.O. BOX 7085, 114 6j�KMONT pRIVE PHONE [phone]
GREENVILLE. N.C. 27835-7085 FAX [phone]
READY MIX CONCRETE (WILLIAMSTON)
MR. MIKE ODOM
1020 E. 5TH ST.
WASHINGTON ,NC 27889
PARAMETERS
Stormwater Analysis Metbod
Discharge Date Analyst Code
PH (not to be used for reporting) 6.2 10/16/14 TRS 4500HS-00
Total Suspended Residue, mg/1 <2.7 10/17/14 LW 254OD-97
ID#: 1095
DATE COLLECTED: 10/15/14
DATE REPORTED : 10/20/14
REVIEWED BY:

STORMWATER DISCHARGE OUTFALL (S®O) - Semi -Annual MONITORING FORM
GENERAL PERMIT No. NCG140000
CERTIFICATE OF COVERAGE NO. NCG14 L Z SAMPLE COLLECTION YEAR: 70141
FACILITY NAME: Rr4 ���Co"cam , D��...��SAMPLING PERIOD: ❑July -December �anuary-June
PERSON COLLECTING SAMPLES {/y$ �,CV;vN a4 COUNTY Pktlf '
CERTIFIED LABORATORYw[fU11�vr} 1 Lab # �� PHONE NO. LZS?]
T Lab # ADD TO LISTSERVE? ❑YES RSNO EMAIL:
OPTIONAL INFO: DISCHARGING TO CLASS: [—]SA ❑HQW ❑PNA ❑Trou er
Part A: Stormwater Monitoring Requirements
Outfall No.
Date Sample
Collected
(mo/dd/yr OR
NO FLOW)'
PH
(standard
Units]
TSS
(mg/L)
Event
Duration
[minutes}
Total
,
Rainfall
(in}
In Tier 2
Monthly
Monitoring?
(y/n)
# of Months in Tier
z
2 Sampling
-
-
6-9
100 ,
-
-
-
-
3v
G d
SS'
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.
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 TSS benchmark values are 100 mg/l, except when discharging to ORW, HOW, Trout, and PNA waters where they are 50 mg/l.
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 6: 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)
PH
(Standard
Units)
TPH using method
1664A SGT-HEM
(mg/L)
Total Suspended
Solids
(mg/L)
Event
Duration
(minutes)
Total
Rainfall'
(in)
New Motor Oil
Usage
(gal/month)
In Tier 2
Monthly
Monitoring?
(y/n)
# of Months
in Tier 2
Sampling
6-9
15
100 .
-
-
-
-
-
HAS 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 Orieinal and one copy of this DMR (including all "No Flow" & "No Discharge" reports) within 30 days of receipt of sample (or at end of monitorinjR period
in case of "No Flows to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
YOU MUSTSIGN 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 peLsonnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or
those per so s dire r ponsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete.
am aware iialth a signif�cant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
U LJ -1 Z-1
(Signature of Perm9 ee) (Date)
Permit Date: 7/1/2011-60/30/2015 Last Revised 7/13/11
Page 2 of 2

mmAumfluml Ala hcwpo® mho
I
We SLewateY ID- 10
GREENVILLE, N.C. 27835-7085 FAX [phone]
READY MIX CONCRETE (WILLIAMSTON)
MR. MIKE ODOM
1020 E. 5TH ST.
WASHINGTON ,NC 27889
PARAAfETERS
PH (not to be used for reporting)
Total Suspended Residue, mg/l
Stormwater Analysis A•Iethod
Discharge Date Analyst Code
7.7 05/01/14 TRB 4500HB-00
11 05/02/14 A1DD 2540D-97
ID#: 1095
DATE COLLECTED: 04/30/14
DATE REPORTED : 05/05/14
REVIEWED BY: �4_

GENERAL. PERMIT NO. NCG140000
CERTIFICATE OF COVERAGE NO. NCG14 SAMPLE COLLECTION YEAR: 240141
FACILITY NAME: �ti°td„ 1�li� 1p�LP (��11Ql, Ali,d *SAMPLING PERIOD: [] July -December January -June
PERSON COLLECTING M LES +'�f_�17 �.t y;rN COUNTY MG!$+�^
CERTIFIED LABORATORYF4W1'f0hP%4ef 1 Lab # L PHONE NO. (ZS24
Lab # ADD TO LISTSERVE? []YES P5ND EMAIL:
OPTIONAL INFO: DISCHARGING TO CLASS: ❑SA ❑HQW ❑PNA ❑Trou her
Part A: Stormwater Monitoring Requirements
Outfall No.
Date Sample
Collected
(ma/dd/yr OR
NO FLOW)1
PH
(Standard
Units)
TSS
(mg/L}
Event
Duration
(minutes)
Total
,
Rainfall
(in)
In Tier 2
Monthly
Monitoring?
(y/n)
# of Months in Tier
z
2 Sampling
-
-
6-9
23
100 '
-
-
-
-
3v
G
S'Al
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.
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

Fart 5- vehide roainttenance '�ciivi y Morittw ing 1enuii enrents for ac ilitier, using i 55 gal of kkevf 1T1r4C,E o!I/rrioiiUi — ave aced over a cafe idaar Year.
Outfall
No.
Date Sample
Collected i
(mo/dd/yr)
pH
(Standard
Units)
TPH using method
1664A SGT-HEM
(mg/L)
Total Suspended
Solids
(mg/L)
Event
Duration
(minutes)
Total a
Rainfall
(in)
New Motor Oil
Usage
(gal/month)
In Tir 2
Monthly
Monitoring?
(y/n)
# of Months
in Tier 2
Sampling'
6-9
15
100 ,
-
-
-
-
-
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES AT ANYONE OUTFALL (INCLUDING VEHICLE MAINTENANCE)? YES ❑ NO ❑
HAVE YOU CONTACTED THE REGION? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail Original and one copy of this DMR f including all "No Flow" & "No Discharge" reports) within 30 days of receipt of sample for 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 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 Pasonnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or
those perso s dire r ponsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete.
am aware a th a signific t penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
J5—) Zr JV
(Signature of Permi ee) (Date)
Permit Date: 7/1/2011-60/30/2015 Last Revised 7/13/11
Page 2 of 2

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I
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1D-
- :�.�.x._:..��._X:#-:._..:����.,t..:.;:5.:c:.x��.--"...<rrl.�tr-��..si�*.r��-a'' ' 4-`u�c•3�•;c.� :s�d.�c'�.: �....�°�,_x:� ,.. ,��.res_.ati- _: _.-�. � -
P.O. BOX 7085, 114 OAKMONT DRIVE PHONE [phone]
GREENVILLE, N.C. 27835-7085 FAX [phone]
READY MIX CONCRETE (WILLIAMSTON)
MR. MIKE ODOM
1020 E. 5TH'ST.
WASHINGTON ,NC 27889
Stornmater
Analysis
Method
PARA1•IETERS
Discharge
Date Analyst
Code
PH (not to he used for reporting)
7.7
05/01/14 TRB
4500HB-00
Total Suspended Residue, nig/l
11
05/02/14 MDD
254OD-97
ID#: 1095
DATE COLLECTED: 04/30/14
DATE REPORTED : 05/05/14
REVIEWED BY: