NCG160018_MONITORING INFO_20141114

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
fV
DOC TYPE
❑HISTORICAL FILE
0--MONITORING REPORTS
DOC DATE
❑
YYYYMMDD

STORMWATER DISCHARGE OUTFALL (SDO)
GENERAL PERMIT NO. NCG160000
DISCHARGE MONITORING REPORT (DMR) 1
CERTIFICATE OF COVERAGE NO. NCG16U[d[(]® SAMPLES COLLECTED DURING CALENDAR YEAR:
(This monitoring report is due at the Division no later than 30 days from the date
the facility receives the sampling results from, the laboratory.)
FACILITY NAME PCA ir0k V%Ck l v t - COUNTY C ta. w Ln
PERSON COLLECTING SAMPLES PHONE NO. (B'�R l�'� �$ — 3 ��i
CERTIFIED LABORATORY Lab #
Lab #
Monitoring Requirements
Outfall
No.
Date
Sample'Collected,
mo/dd/
Total Rainfall,
inches
00530 '
.00400 --'
' 00556 '
Total Suspended Solids, mg/1 ,
:' ,
pH... =
=Standard units.""'EPA
Total Petroletim Hydrocarbons, mg/I
Method 1664 SGT-HEM
Benchmark
-
-
too
• Within 6.0 = 9.0 a
15
�
_ `..
1 If a value is in excess of the benchmark, or outside the benchmark range (for pH), you must implement the Tier I or Tier 2 responses in the General Permit.
Mail original and one copy to:
Division of Water Quality
Attn: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
RECEIVED
NOV 1. 4 Zu-14
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED:
' CENTRAL FILES
cT
"I certify, under penalty of law, that this document and all attachments were prepared under n y%ireoctron�f''o ervision 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."
(Si ature of Permittee (Date)
SWU-253-051409
Page 1 of 1

a
wjvrER6r ECH L#1195,.C.
POST OFFICE BOX 1056 - #5 PINEWOOD PLAZA DR. ,
GRANITE FALLS. NORTH CAROLINA 28630
[phone]
SAMPLE: Carolina Paving COLLECTION DATE: 4/7/2014
PERMIT #: COLLECTION TIME: 08:30
ADDRESS: Carolina Paving RECEIVED DATE: 4/7/2014
3203 Highland Ave. NE RECEIVED TIME: 09:20
Hickory, NC 28601
REPORTED: 4/16/2014
ANALYSIS
ANALYSIS
RESULTS
UNITS
DATE
ANALYST
pH ' >holding time
6.8
su's
418114
lag
TSS
88.0
rng/L
419114
irg
Oil & Grease
<5.6
mg/L
4/14/14
ldg
LOG ID: 1404-134
REPORTED BY: NC CERTIFIED LAB # 5C
fk� *
'Pony Gragg, Lab Supervisor

Wi�A,�k1 ll) - T1�CR L-8S ifae,
5 Pinewood Plaza Drive -- P.O. Box 1056
Granite Falls, NC 28630
Phone [phone] - Fax [phone]
CLIENT: Carolina Paving
PERMIT ##:
PHONE NUMBER:
TYPE SAMPLE: Stormwater
No. LOCATIONS:
SAMPLER NAME:
Sample Collection Information
TYPE
CONTAINERS
ANALYSIS REQUIRED
Sample Location
Facility Name
DATE
TIME
TEMP.
oC
Grab/
Composite
No.
Plastic/
Glass
Carolina Paving
y
Grab
3
Plastic,
Glass
pH , TSS , O&G
Reli qui hed By:
Dat
Time:
Recieved B
Date:
917Ic4
Time:
9 �a.o
linquished B
Date:
Time:
Rece' a
Date:
Time:
PRE�S &tiA QN.�
0 4°C
2SO4
(] NaOH
�] HNO3
(] Dechlornating Agent
!] Other
SAMPLE TEMP. @ LAB (°C)-�e'�
Chlorine Residual mgll NC CERTIFIED LAB # 50