NCG140069_COMPLETE FILE - HISTORICAL_20030902

STORMWATER DIVISION CODING SHEET
RESCISSIONS
PERMIT NO.
DOC TYPE
COMPLETE FILE - HISTORICAL
DATE OF
RESCISSION
❑ ab�3 C
YYYYMMDD

Larry Spence
Ready Mixed Concrete Company
P. O. Box 27326
Raleigh, North Carolina 27611
Subject:
Dear Mr. Spence:
Michael F. Easley
Governor
William G. Ross, Jr., Secretary
North Carolina Department of Environment and Natural Resources
September 2, 2003
Rescission of NPDES Permit
Ready Mixed Concrete Company
NPDES Permit NCG140069
Wake County
Alan W. Klimek, P. E., Director
Coleen H. Sullins, Deputy Director
Division of Water Quality
(n
rn
D
Reference is made to your request for rescission of the subject NPDES Permit. Division staff
have confirmed that this permit is no longer required. Therefore, in accordance with your
request, NPDES Permit NCG140069 is rescinded, effective immediately.
If in the future you wish to again discharge stormwater to the State's surface waters, you must
first apply for and receive a new NPDES Permit. Operating a facility without a valid NPDES
Permit will subject the responsible party to a civil penalty of up to $25,000 per day.
If you have questions about this matter, please contact Vanessa Manuel at [phone],
extension 532 or the Water Quality staff in the Raleigh Regional Office at [phone].
Sincerely,
'7414 9�g
Alan W. Klimek, P.E.
Cc: Kenneth Schuster,DWQRRO— w/- attachments
Bradley Bennett. NPDES Stormwater Unit
Fran McPherson, DWQ Budget Office
Central Files — w/ original attachment
dA
NCDENR
N. C. Division of Water Quality 1617 Mail Service Center Raleigh, NC 27699-1617 [phone]
Customer Service
1 800 623-7748

MEMORANDUM
To:
Through:
From:
DIVISION OF WATER QUALITY
July 31, 2003
Vanessa Manuel, Chemist
Point Source Compliance Enforcement Unit
Randy Jones
Engineer II
�1
Myrl Nisely \
Environmental Specialist 11
Subject: Status of Ready Mixed Concrete Plant for Permit Recession Request
Ready Mixed Concrete Co.
9220 Durant Rd.
Raleigh, NC 27609
NPDES Permit No. NCG140069
Wake County
I have observed this manufacturing site to verify that the ready mixed operation is shut dorm.
The plant is essentially dismantled.
xc: Central Office
?)easo r&5C1XJ Nc

READY MIXED CONCRETE COMPANY
3610 Bush Street, Raleigh, NC 27609
Telephone [phone]
Fax [phone]
Guaranteed Strenqth
July 24 2003
Kenneth Schuster
NCDENR/DWQ
1628 Mail Service Center
Raleigh, North Carolina 27699-1628
Mr. Shuster,
P.O. Box 27326, Raleigh. NC 27611
tMy�i) ?IS. ce,�:v-,.-)
Av5
rJPars Ge.,,Pl;a�,,�v
.� beci��`� r"G
Please accept this letter for the recession of our permit #NCG140069 located at
9220 Durant Rd., Raleigh, NC. Wake County
We have removed the concrete plant and have sold the property, so no longer
require this permit
Please call if you have any questions, call me at [phone] or e-mail me at
larry. [e-mail]
Sincerely,
arty Spence
Assets Manager
;9_mb,rNo;ionol RcxA,i;1iara Co:i( IP Associoiloo

DIVISION OF WATER QUALITY
July 31, 2003
To: Vanessa Manuel, Chemist
Point Source Compliance Enforcement Unit
Through: Randy Jones
Engineer II �
From: Myrl Nisely a'v
Environmental Specialist II
Subject: Status of Ready Mixed Concrete Plant for Permit Recession Request
Ready Mixed Concrete Co.
9220 Durant Rd.
Raleigh, NC 27609
NPDES Permit No. NCG 140069
Wake County
I have observed this manufacturing site to verify that the ready mixed operation is shut down.
The plant is essentially dismantled.
xc: Central Office
ease r&5c104 /k�/����

READY MIXED CONCRETE COMPANY
®� J 3610 Bush Street, Raleigh, NC 27609 P.O. Box 27326, Raleigh, NC 27611
• — . �I Telephone [phone]
Fax [phone]
Guaranteed Strength
July 24 2003 0 �`PD1�v M4-
114►.,G�-r 4 ��
%la �vu of J
Kenneth Schuster ��,a�S G�'tiPl�an,GU
NCDENR/DWQ
1628 Mail Service Center ok
Raleigh, North Carolina 27699-1628
Mr. Shuster, (J
Please accept this letter for the recession of our permit #NCG140069 located at
9220 Durant Rd., Raleigh, NC. Wake County
We have removed the concrete plant and have sold the property, so no longer
require this permit
Please call if you have any questions, call me at [phone] or e-mail me at
[e-mail]
Sincerely,
JaSpence
Assets Manager
Member National Reddy Mixed Concrete Association

READY MIXED CONCRETE COMPANY
I ftz�'
Guaranteed Strength_
July 24 2003
3610 Bush Street, Raleigh, NC 27609
Telephone [phone]
Fax [phone]
Kenneth Schuster
NCDENR/DWQ
1628 Mail Service Center
Raleigh, North Carolina 27699-1628
Mr. Shuster,
Myrl) ?is. c-0
P.O. Box 27326, Raleigh, NC 27611
aS YLG(le,a54�j)
r1 ( 6ti9A/U a1 M4f/Y "4 ��
ill
LV i L✓� l/o NPIIo-�LL�I
d,
4
Please accept this letter for the recession of our permit #NCG140069 located at
9220 Durant Rd., Raleigh, NC. Wake County
We have removed the concrete plant and have sold the property, so no longer
require this permit
Please call if you have any questions, call me at [phone] or e-mail me at
[e-mail]
Sincerely,
arty Spence
Assets Manager
Member Notional Ready Maud Concrete Associntion

DIVISION OF WATER QUALITY
July 31, 2003
MEMORANDUM
To: Vanessa Manuel, Chemist
Point Source Compliance Enforcement Unit
Through: Randy Jones
Engineer II
From: Myrl Nisely inn ck
I
Environmental Specialist III` l
Subject: Status of Ready Mixed Concrete Plant for Permit Recession Request
Ready Mixed Concrete Co.
9220 Durant Rd.
Raleigh, NC 27609
NPDES Permit No. NCG140069
Wake County
I have observed this manufacturin.- site to verify that the ready mixed operation is shut down.
The plant is essentially dismantled.
xc: Central Office
sG r&g5c;wd

READY MIXED CONCRETE COMPANY
3610 Bush Street, Raleigh, NC 27609
Telephone [phone]
Fax [phone]
Guaranteed Strenqth
July 24 2003
Kenneth Schuster
NCDENR/DWQ
1628 Mail Service Center
Raleigh, North Carolina 27699-1628
Mr. Shuster,
P.O. Box 27326, Raleigh, NC 27611
Myr!) ?is. Gong; V,..�� r
-
benL
nl?a � Gor.,Pl;aw�v G
a
Please accept this letter for the recession of our permit #NCG140069 located at
9220 Durant Rd., Raleigh, NC. Wake County
We have removed the concrete plant and have sold the property, so no longer
require this permit
Please call if you have any questions, call me at [phone] or e-mail me at
[e-mail]
Sincerely,
Japence
Assets Manager
Member National Ready Mixed Concrete Association

m

State of North Carolina
Department of Environment
and Natural Resources
Raleigh Regional Office
Michael F. Easley, Governor
William G. Ross, Secretary
NC®ER
NORTH CAROUNA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
April 22, 2002
CERTIFIED MAIL
RETURN RECEIPT REQUESTEDti
0
MR. LARRY SPENCE
READY MIXED CONCRETE COMPANY
3610 BUSH STREET
RALEIGH, NC 27609
Subject: Notice of Violation
NPDES Stormwater Permit
COC Number NCG 140069
Ready Mixed Concrete Co. Plant 24, Durant Road
Wake County
Dear Mr. Spence
On April 5, 2002 representatives from this office: Joe Albiston, Charles Brown. and I conducted
an audit with you of the paperwork for the subject facility. The audit was done to ensure
compliance with the stormwater permit. You were asked to provide a copy of the permit and the
associated documentation that accompanies the permit. You stated that the current permit was at
the plant office.
Part I1. Section A. Stormwater Pollution Prevention Plan (SPPP) was reviewed and the
following deficiencies were found. The facility did have a SPPP for the fac ility. However, it was
an older document and has not been updated for the present General Permit effective August 1.
1999.
I
L(a) The facility did have a USGS quadrangle map showing the location. It also needs to contain
the name of the receiving water(s) to which the stormwater outfall(s) discharges, or if the
discharge is to a municipal separate storm sewer system, the name of the municipality and the
ultimate receiving waters, and accurate latitude and longitude of thelpoint(s) of discharge.
L(b) The facility did have a narrative description of storage practices, loading and unloading
activities, outdoor process areas, dust or particulate generating or control processes, and waste
disposal practices on site.
1628 Mail Service Center, Raleigh, NC 27699.1628
An Equal Opportunity Affirmative Action Employer
Telephone [phone] FAX [phone]
50% recyl Iedl10% post -consumer paper

Ready Mixed Concrete NOV
Page 2
1.(c) There was a hand -drawn site map that had only minimal information. It needs to be redone
specifically as per the language in this condition.
1.(d) There was no list of spills or leaks that have occurred ovel the last 3 years (as well as
corrective actions for mitigation) as required.
1.(e) No signed certification was available. There was a page for document certification but it was
not signed.
i1
2.(a) The SPPP did not have a Stormwater Management Plan (SMP) feasibility study. This
technical analysis is important in determining how you will meet compliance on the site.
2.(b) Secondary containment was observed at this site in an earlilr site inspection by Charles
Brown. Records documenting the individual making the observation, and the description of the
accumulated stormwater was not available upon inspection.
2.(c) There was a BMP summary, but it is not clear where all the discharge points are and how
each individual one is being controlled.
3. A Spill Prevention and Response Plan (SPRP) document has been prepared for Ready Mixed
Concrete Company at this location. However, it was written December 14, 1995. It shows what
could be implemented but nothing is documented on what was implemented.
4. The facility shall maintain a Preventative Maintenance and Good Housekeeping Program. The
documentation did have what the program should consist of, but there was no documentation of
what inspections, maintenance, etc. that was actually being conducted.
5. The facility shall maintain an employee training program on spill clean up and preventative
maintenance. No documentation was provided of this activity. I
6. The SPPP shall identify a specific person who will coordinate the SPPP and ensure the
implementation as per permit condition Part II Section A 6. The plant manager stated that the
SPPP is being developed at this time. 1
7. "Plan amendment" needs to be continuously updated. The SPPP shall be reviewed and updated
on an annual basis.
1
8. The facility is required to have a "facility inspection program" that inspects all stormwater
systems at least on a semiannual basis and records maintained of thisl activity.
i
9. The facility shall implement the plan and document all monitoring, measurements, inspections
and maintenance. The facility did have some minimal documentation, including the use of the
DENR monitoring form. I
1628 Mail Service Center, Raleigh, NC 27699-1628
An Equal Opportunity Affirmative Action Employer
I
Telephone [phone] FAX [phone]
50% recycled/10% post -consumer paper

Ready Mixed Concrete NOV
Page 3
Part II Section B: Analytical monitoring requirements- Stormwater discharge (SPPP) was
reviewed and the following deficiencies were found. The facility did have a SPPP for the facility.
However, it was an older document and has not been updated for the present General Permit
effective August .1, 1999.
Section B 1. States that the permittee shall perform analytical Isampling of the stormwater
discharge from the facility. No results were available on site for the August 1, 2000 to July 31,
2001. Since no stormwater discharge points were labeled on site map, where is the sampling point
for the January 23, 2002 data and are there any more discharge points?
Section B 2. States that the permittee shall perform analytical sampling of the stormwater
associated with on -site vehicle maintenance discharge from the facility. Facility uses less than 55
gallons of new motor oil so analytical sampling is not needed. I
Section C 2,4,5. States that the permittee shall perform analytical sampling of discharge of process
wastewater associated with the four distinct activities listed in the permit from the facility. This
site had a discharge outfall monitoring report, but failed to record Total Suspended Solids and
Settleable solids for the January 23, 2002 event. No discharge outfall monitoring report was
available on site for the August 1, 2000 to July 31, 2001. I
Section F states that the permittee shall perform qualitative monitoriing of the stormwater outfalls
on a semiannual basis. This is done to assess the effectiveness of the SPPP and assess new areas
of stormwater pollution at the facility. -This site had a qualitative monitoring discharge outfall
monitoring report for January 23, 2002, but no records for previous years were available.
Part III Section D 6. states that all documentation and records associated with the permit shall be
maintained on site for a period of 5 years. There was a discharge monitoring report dated January
23, 2002 but, no other records were available during the audit. l
Part III Section E 7,8,9. Reporting Requirements states that permittee shall report occurrence
discharges of abnormal quantity waste, unit failure, or by-pass directly to receiving waters within
24 hours from the time the permittee became aware of the circumstances.
As per your telephone call you are making the necessary changes to your SPPP and other
doucments relative to the permit. Please respond to the above comments in this Notice within 30
working days after its receipt detailing the actions taken to ensure compliance with the stormwater
permit. If you have any questions regarding the inspection or this notice please contact Mr.
Albiston at 919-571-4700 ext 322.
Sincerely,
cc: NPDES Compliance Unit
Wake Co. Health Dept.
Central Files
Kenneth Schuster, P.Ef
Regional Water Quality Supervisor
i

�14/2600 1 6: 02 919-970-1434
State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
James B. Hunt, Jr„ Governor
Wayne McDevitt, Secretary
Kerr T. Stevens, Director
LYMAN AUSTIN
READY MIXED CONCRETE CO
3610 BUSH STREET
RALEIGH, NC 27609
Dear Permittee:
I MARK H SLOANPAGE
IA1
N', CDENR
NORTR CAROLINA DEPARTMENT OF
ENVIRONMENT AND NArURAL RESou ROES
July 26, 1999
Subject: Reissue - NTDES',Stormwatcr Permit
Ready Mixed Concrete Co
COC Number NCG140069
Wake County
In response to your renewal application for continued coverage under general permit NCG 140000, the Division of
Water Quality (DWQ) is forwarding herewith the reissued stormwater general permit, This permit is reissued
pursuant to the requirements of North Carolina General Statute 143-215.1 and the Memorandum of Agreement
between the state of North Carolina and the U.S. Environmental Protection Agency. dated December 6, 1983.
The following information is included with your permit package:
A copy of general stormwater permit NCO140000
A Stormwater Pollution Prevention Plan (SPPP) Certification Form. Completion of this form is required to
certify that you have developed and implemented the SPPP as per the conditions of the permit. This form
must be completed and returned to the Division within 30 days of receipt of this letter.
DO NOT SEND the SPPP with the signed form.
Five copies of the Analytical Monitoring form and five copies of the Qualitative Monitoring form
A copy of a Technical Bulletin for the general permit which outlines changes�in the permit, key requirements,
and addresses frequently asked questions
* A Certificate of Coverage
Your coverage under this general permit is not transferable except after notice to DWQ. The Division may require
modification or revocation and reissuance of the Certificate of Coverage. This permit does not affect the legal
requirements to obtain other permits which may be required by DENR or relieve the permittee from responsibility
for compliance with any other applicable federal, state, or local law, rule, standard,, ordinance, order, judgment, or
decree,
If you have any questions regarding this permit package please contact Bill Mills of the Central Office Stmmwatcr
and General Permits Unit at [phone], ext. 548
Sincerely,
for KerrT. Stevens
cc' Central Files
Stormwater and General permits Unit Files
Raleigh Regional Office
0'.
1617 Mail Service Center, Raleigh, North Cerollna 27699-1817 Telephone [phone] Fox 919-733-9919
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`01/14/2000 16:03 919-870-1434 MARK H SLOAN PAGE 01
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF COVERAGE No, NCG140069
STORMWATER AND PROCESS WASTEWATER DISCHARGES
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
In compliance with the provision of North Carolina General Statute 143�215.1, other lawful standards and
regulations promulgated and adopted by the North Carolina Environmental Management Commission, and the
Federal Water Pollution Control Act, as amended,
READY MIXED CONCRETE CO
is hereby authorized to operate a process wastewater treatment system, and is hereby authorized to discharge process
wastewater and stormwater from a facility located at
READY MIXED CONCRETE CO
9220 DURANT RD
RALEIGH
WAKE COUNTY
to receiving waters designated as a UT of the Neuse River in the Neuse River Basin
in accordance with the effluent limitations, monitoring requirements, and other conditions set forth in Parts I. II. Ili,
IV, V, and VI of General Permit No. NCGI40000 as attached.
This certificate of coverage shall become effective August L 1999,
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day July 26, 1999.
for Kerr T. Stevens, Director
Division of Water Quality
By Authority of the Environmental Management Commission

i
a1i14izaaa
16:1a
919-e7a-1434
MARK H SLOAN
PAGE 01
I N.C. Division of Water Quality, Stormwater and CeneraliPermits Unit
Facility Name:
READY MIXED CONCRETE CO
COC Number:
NCO14OD69
Location Address:
9220 DURANT RD
RALE10H, NC 27609
County:
WAKE
"I certify, under penalty of law, that the Stormwater Pollution Prevention Plan (SPPP) document and all attachments
were developed and implemented under my direction or supervision in accordance with a system designed to assure
that qualified personnel properly gather and evaluate the Information required by the SPPP. Hawed on my inquiry of
the person or persons who manege the system, or those persons directly responsible for gathering the Information,
the information gathered is, to the best of my knowledge and belief, true, accurate, Bind complete"
"I certify that the SPPP has been developed, signed and retained at the facility location and the SPPP has been fully
implemented at the named facility location in accordance with the terms and conditions of the stormwater general
permit."
"t am aware that there are significant penalties for falsifying information, Including the possibility of fines and
Imprisonment for knowing violallons"
Sign (according to permit signatory requirements) and return this Certification. `Iteturn within 30 days of
reeelpt It the date on your Initial Certificate of Coverage Is before August 1,1909:'"1f )our initlal Certificate
of Coverage was Issued after August 1, 1999, sigh And return this CertMclttibn within 30 days of
lmplerhentatlon of your Stormwater Pollution Prevention Plan. DO NOT SENT) THE STORMWATER
POLLUTION PREVENTION PLAN WITH TIRE CERTIFICATION.
Signature
A A-) AAA4)
Print or t pe name of person signing above
Please Return to:
Date'l0 99
An
Title
Division of Watet Quality/ WQ Section
Stormwater and General Permits Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
SPPP Catirrcatim 07199
1617 Mail Service Center, Raleigh, North Carolina 27899.1617 Telephone [phone] FAX [phone]
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01/14/20aa 16:12
919-870-1,134
MARK H SLOAN
PAGE 01
Technica.I But
For General Permit NCG1
in NCDENR
NORTH CAROLINA DIVISION OF WATER QUALITY
I— Volumr ( August 1, 1999 1.
e NPDES verMJ11412's obiective
reduce the pollutant load enters g the wplirl of the
sure by:
1. Educating the permitted community about
stormwater and wastewater pollutants,
2. Encouraging the use of Best Management Practices
(BMPs) to minimize the entry of pollutants into the
waters of the state via stormwater and wastewater
discharges, and
3. Using collected analytical data to assess these
discharges contribution to water pollution to help
prioritize controls in problem areas.
Chpigges in Rcillued GenerpJ Permit
Several important changes from the previous version of
this permit are.
• Revision to the parameters for analytical monitoring
with respect to stormwater runoff from vehicle
maintenance areas. (Part II, Section S.2)
• Clarification of the types of process wastewater that
can be discharged under this permit. (Part 11, Section
C)
• Effluent limits for process wastewater discharges
have been incorporated. (Part II, Section C)
• The definition of the Representative Storm Event for
the analytical monitoring of stormwater discharges
has changed (see the definitions section of the
permit) and the sample window of April through
November has been dropped.
• Discharge Monitoring Reports for analytical
monitoring should be submitted to the Division of
Water Quality within 30 days of the date the facility
receives the laboratory results instead of waiting
until the end of the year,
• All new facilities must obtain a Certificate of
Coverage prior to beginning operation. Portable
plant exception has been eliminated.
• Clarification as to the Pcrmittees responsibility to
notify the Division if their facility is closed or sold .
(Part 111, Section 8.2)
The Division recognizes that some of the new conditions
in the permit represent major changes. Recognizing that
constraints may exist at some facilities , the Division has
made the decision to phase -in the permits process
wastewater effluent limits. The limits will go into effect
August 1, 2001, 241months from the effective date of the
permit. This phase in period will allow time for
pernuttees to conduct sampling and if needed, to make
site improvements such that the effluent limits can be met.
Please note that thephase-in period is with respect to the
effluent limits only) all other conditions, requirements,
and limits of the permit will apply from the effective date
of the permit.
Key Permit Reaulrements
I
• Implementation of a Stormwater Pollution Prevention
Plan (SPPP). (Part II, Section A)
• Provide secondary containment for all bulk storage of
liquid materials, (Part II, Section A: 2. (b))
• Perform annual' analytical monitoring at stormwater
discharge outfalls, and submit the results on the
monitoring report forma provided with the permit.
(Part U, Section B)
• Perform annual analytical monitoring for vehicle
maintenance area, if present, and submit the results
on the monitoring report forms provided with the
permit. (Pan II, Isection B)
• Perform annual analytical monitoring for process
wastewater discharges, if present, and submit the
results on the monitoring report forms provided with
the permit. (Part 11, Section C)
• Perform and document semi-annual stormwater
discharge outfall qualitative monitoring. (Pan II,
Section D) I
Process Wastewater Discharize Sampling
This general permit luthorizes the discharge of process
wastewater associated with four distinct activities:
1) Vehicle and equipment cleaning - external surface!
2) Overflow from recycle systems that receive
stormwater runoff
3) Wetting of raw material stockpiles
4) Mixing drum cleaning
Annual monitoring is required for each activity, if they
discharge during the monitoring year. If the discharge
from multiple activities commingle prior to discharge, a
single sample will meet the intent of the monitoring
requirement. For example, if a facility has all four types
of discharges and three drain to one outfall and the fourth
drains to another outfall. A sample at each outfall (i.e. a

01/1a/2000 16:13 919-670-1434
MARK H SLOAN PAGE 01
total of two samples) will meet the monitoring
"requirement.
Discharge Monitorin!' Reports (I)MR)
The DMR (Form SWU-241) for this permit has been
revised. Please dispnse of old copies and utilize the new
forms. The form can be used for submitting analytical
monitoring data on stormwater and/or process wastewater
discharges.
The new form is divided into three sections:
• General information
• Stormwater discharge monitoring data
• Process wastewater discharge monitonng data
The requirement for permitlees to submit duplicate signed
copies of all DMR's to DWQ Central Files remains in
effect.
New Facilities
New or proposed facilities seeking coverage under this
General Permit are required to submit plans and
specifications for any process wastewater treatment
systems being constructed. This includes all treatment
systems. from passive devices such as washout pits and
detention ponds to more complex systems such as
mechanized recycling devices
Other sources of Information on North Carolina's
NPDES Stormwater and Generpl Permits Program
The following documents are available through the
Stormwater and General Permits Unit by calling
[phone].
• 5ummary of Fedcral National Pollutant Discharge
Application Regulations for Stormwatrr Discharges
Associated with IndustriALA vities.
• S3ormw9ter Pollution Prevcntion plan Guidance
ocumem.
• Stormwater Management Guidance Manual.
• Qgpies of General Permits and Fact Sheets
• Previous General Permit Technical Bulletins
The Division can be found on the World Wide Web at
ht o //h2o.eru.slate.nc.us/. Another Source of information
is the DENR Customer Service Center They may be:
reached at 1-877•NC ENR 4 U (1-877-623-6748). An
additional source of information is the North Carolina
Office of Waste Reduction. They have tots of specific
information on how to minimize pollutants at various
types of industries. They may be reached at (919) 571-
4100.
Win, •4T7-j I .
1) Does a certifled lab need to be used to analyze
samples?
yes, a North Carolina certified lab must be used to
perform analytical monitoring, The only exception to
this rule is when measuring the value of pH. pH
values should be measured in the field because they
may change considerably between when the sample
is pulled and it is analyzed at the laboratory. A list of
certified labs is available from the Division.
I) What If 1 Sell 'iMy Business Or The Name of My
Business Changes ?
The Division views changes of name or ownership as
a minor modification and requires the Director's
approval. Name and ownership changes require you
to complete a Namelownership Change Form SWU-
239. The forms are available by contacting the
Stormwater and General Permits Unit at (919) 733-
5083
3) What Do I Do When The Permit Expires?
In the State of North Carolina, the NPDES General
Permit is in force and effect and covered facilities
are allowed to continue discharging under the permit
until the general perr ut is reissued or a new general
permit is issued.
QWer Information
Additional Technical Bulletins will be available in the
future from the Division. Contact us at:
N.C. Division of Water Quality
Water Quality Seeder
Stormwater and General Permits Unit
1617 Mail Service Center
Raleigh, N.C. 27699-1617
Phone: [phone]
Fax: [phone]
Please make us aware of any issues you feel should be
addressed in future Technical Bulletins.

01/14/2000 15:15
91S-970-1434
MARK H SLOAN
PAGE 01
a
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
GENERAL PERMIT NO. NCG140000
TO DISCHARGE STORMWATER / PROCESS WASTEWATER UNDER THE
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
In compliance with the provision of North Carolina General Statute 143-215.1, other lawful
standards and regulations promulgated and adopted by the North Carolina Environmental
Management Commission and the Federal Water Pollution Control Act, as amended, this permit
is hereby issued to all owners or operators, hereafter permittees, which are covered by this permit
as evidenced by receipt of a Certificate of Coverage by the Environmental Management
Commission to allow the discharge of stormwater. and process wastewater to the surface waters
of North Carolina or separate storm sewer systems conveying stormwater to surface waters in
accordance with the terms and conditions set forth herein.
Coverage under this general permit is applicable to all owners orloperators of stormwatet point
source discharges and process wastewater discharges associated with activities classified as
establishments primarily engaged in Ready Mixed Concrete [Standard Industrial Classification
Code (SIC) 3273).
Also included in this General Permit are stormwater discharges from those areas at the facilities
described above which are used for vehicle maintenance activities.
The following activities are specifically excluded from coverage under this General Permit:
I
' Disposal of process wastewater not specifically designated in this permit into stormwater
conveyances, storm sewer outfalls or into waters of the state.
* Disposal of return concrete and dumping excess concrete directly into stormwater
conveyances, storm sewer outfalls or into waters of the state.
The General Permit shall become effective on August 1, 1999•
The General Permit shall expire at midnight on July 31, 2004.
Signed this day July 22, 1999.
Kerr T. Stevens, Director
Division of Water Quality
By the Authority of the Environmental Management Commission

d';- State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Wayne McDevitt, Secretary
Kerr T. Stevens, Director
IEWIFWA
1 0
CDENR
rH CAROLINA DEPARTMENT OF
<MENT AND NATURAL RESOURCES
July 26, 1999
LYMAN AUSTIN
READY MIXED CONCRETE CO
3610 BUSH STREET
RALEIGH, NC 27609
Subject: Reissue - NPDES Stormwater Permit
Ready Mixed Concrete Co
COC Number NCG 140069
Dear Permittee: Wake County
In response to your renewal application for continued coverage under general permit NCG140000, the Division of
Water Quality (DWQ) is forwarding herewith the reissued stormwater general permit. This permit is reissued
pursuant to the requirements of North Carolina General Statute 143-215.1 and the Memorandum of Agreement
between the state of North Carolina and the U.S. Environmental Protection AgencyJ dated December 6, 1983.
The following information is included with your permit package:
* A copy of general Stormwater permit NCG140000
* A Stormwater Pollution Prevention Plan (SPPP) Certification Form. Completion of this form is required to
certify that you have developed and implemented the SPPP as per the conditions of the permit. This form
must be completed and returned to the Division within 30 days of receipt of this letter.
DO NOT SEND the SPPP with the signed form.
* Five copies of the Analytical Monitoring form and five copies of the Qualitativel Monitorine form
* A copy of a Technical Bulletin for the general permit which outlines changes in the permit, key requirements,
and addresses frequently asked questions
* A Certificate of Coverage
I
Your coverage under this general permit is not transferable except after notice to Dvvp. The Division may require
modification or revocation and reissuance of the Certificate of Coverage. This permit does not affect the legal
requirements to obtain other permits which may be required by DENR or relieve the permittee from responsibility
for compliance with any other applicable federal, state, or local law, rule, standard, ordinance, order, judgment, or
decree..
If you have any questions regarding this permit package please contact Bill Mills of the Central Office Stormwater
and General Permits Unit at [phone], ext. 548
Sincerely,
for Kerr T. Stevens
cc: Central Files
Stormwater.,n•' 5enerel permits Unit Files
Raleigh Regional Office
1617 Mail Service Center, Raleigh, North Carolina 27699-1617 Telephone [phone] Fax [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ 10%I, past -consumer paper

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
GENERAL PERMIT NO. NCG140000 1
CERTIFICATE OF COVERAGE No. NCG140069
STORMWATER AND PROCESS WASTEWATER DISCHARGES
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
In compliance with the provision of North Carolina General Statute 143-215.1, othe lawful standards and
regulations promulgated andadoptedby the North Carolina Environmental Management Commission, and the
Federal Water Pollution Control Act, as amended,
READY MIXED CONCRETE CO
is hereby authorized to operate a process wastewater treatment system, and is hereby lauthorized to discharge process
wastewater and stormwater from a facility located at
READY MIXED CONCRETE CO
9220 DURANT RD
RALEIGH
WAKE COUNTY
to receiving waters designated as a UT of the Neuse River in the Neuse River Basin
in accordance with the effluent limitations, monitoring requirements, and other conditions set forth in Parts I, II, III,
IV, V, and VI of General Permit No. NCG140000 as attached.
This certificate of coveraee shall become effective August 1, 1999.
This Certificate of Covera-e shall remain in effect for the duration of the General Permit.
Signed this day July 26, 1999.
b,4-u��:y J y� c'C1
for Kerr T. Stevens, Director
Division of Water Quality
By Authority of the Environmental Management Commission

'9".aA16 of North Carolina
Department of Environment,
Health and Natural Resources
Division of Environmental Management
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
A. Preston Howard, Jr., P.E., Director
Mr. Larry Spence
Ready Mixed Concrete Co.
3610 Bush Street
Raleigh, NC 27609
Dear Mr. Larry Spence
1
s
C) F= FR
March 31, 1995
Subject: General Permit No. NCG 140000
Ready Mixed Concrete Co.
COC NCG140069
Wake County
In accordance with your application for a stormwater discharge permit received on November 30, 1994, we
are forwarding herewith the subject certificate of coverage to discharge under the subject state - NPDES general
permit. This permit is issued pursuant to the requirements of North Carolina General Statute 143-215 .1 and the
Memorandum of Agreement between North Carolina and the US Environmental Protection agency dated
December 6, 1983. 1
The stormwater permit you are receiving, NCG140000, does not permit wasting concrete, dumping excess
concrete, directly into storm sewer outfalls or into waters of the state. Any, facility which either dumps excess
concrete or washes excess concrete into storm sewers or waters of the state will be operating in direct violation to
both the terms of this permit and the North Carolina General Statutes. Such a discharge shall be considered an
illegal discharge and may subject the owner to enforcement actions in accordance with North Carolina General
Statutes 143-215.6A
If any parts, measurement frequencies or sampling requirements con -ned in this permit are unacceptable to
you, you have the right to request an individual permit by submitting an individual permit application. Unless
such demand is made, this certificate of coverage shall be final and binding.
Please take notice that this certificate of coverage is not transferable except after notice to the Division of
Environmental Management. The Division of Environmental Management may require modification or revocatior
and reissuance of the certificate of coverage.
This permit does not affect the legal requirements to obtain other permits which may be required by the
Division of Environmental Management or permits required by the Division of Land Resources, Coastal Area
Management Act or any other Federal or Local governmental permit that may be required.
If you have any question concerning this permit, please contact Mr. Bill Mills at telephone number 919/733-
5083, extension 548.
cc:= a1R eigh-Regional-0ffrce
Mr. Roosevelt Childress, EPA
P.O. Box 29535, Raleigh, North Carolina 27626-0535
An Equal Opportunity Affirmative Action Employer
Sincerely, I
Original Signed By
Coleen H. Sullins
A. Preston Howard, Jr. P.E.
Telephone [phone] FAX [phone]
50% recycled/ 10% post -consumer paper

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT, HEALTH, AND NATURAL RESOURCES
DIVISION OF ENVIRONMENTAL MANAGEMENT
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF COVERAGE NO, NCG140069
STORMWATER DISCHARGES
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
In compliance with the provision of North Carolina General Statute 143-215.1, other lawful standards and
regulations promulgated and adopted by the North Carolina Environmental Management Commission, and the
Federal Water Pollution Control Act, as amended,
Ready Mined Concrete Co.
is hereby authorized to discharge stomtwater and rinse waters from a facility located at
Plant #24
9220 Durant Road
Raleigh
Wake County
to receiving waters designated as an unnamed tributary to Neuse River in the Neuse River Basin
in accordance with the effluent limitations, monitoring requirements, and other conditions set forth in Parts I, II, III
and IV of General Permit No. NCG140000 as attached.
This Certificate of Coverage shall become effective March 31, 1995.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day March 31, 1995.
Ori,,inal Signed P..y
Coicen Fi: Sullins
A. Preston Howard, Jr., P.E., Director
Division of Environmental Management
By Authority of the Environmental Management Commission

o
o � 1
Ff
JAC
a lLl(G
1 }kk k
11 � JJ f

efr-c�- C/
WDEEM
DISCHARGE OUTFALL MONITORING REPORT
GENERAL PERMIT NCG140008 1
(All sarnple data shall be reported no later than 30 days after receipt I of lab resulW
Certificate of Coverage
NCG14��p ®©
Facility Name
j
fAvi
County
W fR tl
Phone Number
Cl►q_ $jO-ly1
Certified Laboratory 0
Person Collecting Salnple(s)
!)4 * y5 Y" t C bier
Collectors Signature
1 1I
,LC-0 w —�
Permit Term
Year
Year Start/End Dates
Place check mark to indicate
applicable sampling period
ischer e T (check as appropriate)
I Sto mwater
Wastewater
1
August 1, 1999 to July 31 2000
U❑
❑
ll
❑
❑
C
❑
❑
❑
❑
❑
2
Aujusj 1, 2000 to July 312Wl
3
Auval 1, 2001 to July 31, 2002
4
August 1, 2002 to Jul 31, 2003
5
Au ttl. 2003 to Jul 31, 2004
Part A: Stormwater Discharge Monitoring Data (For stormwata not cotilbinedlwiith process wastewater)
Storm Event Characteristics
Date
Total Event Prec' 'tation inches
Event Duration (hours)
-ll-
r
Outfall
No.
'Date Sample
Collected
m
Taal Flow
G
Total Event
Precipitation
011ches
Event 5watiO—u
I pH
Std. Units
Tohl
Suspended
Solids
m
I
U I L
i
i;
Does this facility perform Vehicle Maintenance Activities using on av$rage more than 55 gallons of new motor
oil per month'? ❑ Xes Orf4o if yes, complete information below.
i;
pitfall
Na
Date Sam a
Coll
tnol
Total Flow
Total Evert
Precipitation
inches
Event
Duration
New pHl
Motor Oil
UsW
mo ' Std. Unity
Total
Suspended
Solids
m
Oil and
Grease
m
I
SwU-2414A01" Page lof 2

Part B: Process wastewater discharge mijfitoring data
Sample # ,I
Effluent Source(s) for this Sample k
Vehicle / Equipment Cleaning
Material Stock- ilc Wcttin
Drum Clean -out
Svstem Overflow ❑_
Sample #
Effluent Sources) fof thisSIE
Vehicle / ui menu C anitRaw
Raw Material Stock- i WeMixin
Mixin Drum Clean-o tRecvcle
Rec cle S stem Overflpa
Parameter
Unit
Data i
Collection Date
mo/dd/yr
10 -/0- 011
Total Flow
MG
, 3
Event Duration
hours
y A v
pH
Std. units
g
TSS
mg/l
Settleable Solids
i mVl
Sample #
Effluent Source(s) for this sam le J
Vehicle / Equipment Cleanin ❑
Raw Material Stock -pile Wettin ❑
Mixing Drum Clean -out ❑
Recycle System Overflow ❑
parameter
Unit
..Data
Collection Date
mo/dd/yr
Total Flow
MG
Event Duration
hours
pH
Std. units
TSS
mg/l
Settleable Solids
mi/1
Mail original and one copy to:
Attn: Central Files
Division of Water Quality
DENR.
1617 Mail Service Center
Raleigh, NC 27699-1617
SWU•241-060199
Parameter
Unit
,Data
Collection Date
mo/dd/yr
Total Flow
MG
Event Duration
hours
pH
Std. units
TSS
ang/I
Settleable Solids
trim
Sample # —
Effluent Source s EE this sample
❑
Vehicle / Equipment Cleanin
Raw Material Stock - a Wettin
❑
Mixing Drum Clean -opt
❑
Recycle System Overflow
Q
Parameter
Unit
Data
Collection Date
mo/dd/yr
Total Flow
MG
Event Duration
hours
pH
Sid. units
TSS
mg/1
Settleable Solids
m A
"I certify, under penalty of law, that this document and all atunhments were
prepardd under my direction or supervision in accordance with a stem designed
to assure that qualified personnel properly gather and evaluate die information
submitted. Based on my inquiry of the person or persons who mamige the system,
or these persons directly responsible for gathering the information, the
information submitted is, to the best of my knowledge and belief, true, actuate,
and ctmmplete. I am aware that there are significant penalties for submitting false
information, including the possibility of fines and imprisonment for knowing
violations."
(Print hlamc of Permittee or Designee)
(Signature of Permittee or Designee) (Date)
Page 2 of 2

Pape 1
Certificate of
County:
Inspected by
Date of In%x
READY MIXED C
PLANT
STORMWATER
No. NCG
COMPANY
OUTFALL
VO.
REPORT
Plant Name: ^— i Q
By this signature, I certify that this report is acct;rate and complete to the best of my knowledge:
(signi
�yvx q*4 ;
STORNWATER DISCHARGE OUTFALL (8o) VISUAL MONITORING REPORT
1 Outfall Description (attech SDO Vl�jal Moni6orVrg Report for each add l SOO)
Outfall No. SDO Structure (pipe, ditch, etc.) a , + o-'
Receiving Stream:
Describe the indue
occur
drainage area:
2 Color
Describe the color of the discharge using basid;,00lors (red blue, etc.) and, tin I htImedlum,
3 Odor
Describe any distinct odors that the discharge play have (Le. smells strongly of otl, weak chlorine odor, etc.)
V o ,v&- I
4 Clarity
Choose the number which best describes the clarity of the discharge where 1 is clear and 10 is very cloudy.
1 2 3 0 5
8 7 8 9 10
Form 6.1
SWPPRMCC

--4 7
Page 2
5 Solids
Choose the number which best describes the amount of solids In the storrnweter discharge where
1 is clear and 10 is extremely muddy.
1 2 9 4 5
8 7 8 9 10
8 Foam
Is there any foam in the stonnwater diwitarge4 ciio NO
7 Oil Sheen
Is there any oil sheen in the stonnwater discharge? YES IS
8 Outfall Staining
Describe any staining around the stonnwater o�ftl:
wJ�rrG -.
9 Other Indicators
Describe any other obvious indicators of stomv�ater pollution:
NOTE: Low clarity, high solids and/or the RRjjesence of foam, oil sheen, or outfall staking may be
indicative of pollutant exposure. These oonditKns may warrant further investigation.
SWPPRMCC

j FIGURE 1
READ MIXED CONCRETE COMPANY
PLANT NO.
STOOMWATER SAMPLING RECORD
I
Sampler's Name: �e ►- S c t�ti. �,l
Date: Outf4 Number: Storm Begin Time: %30
a!r !pm
I have verified that no storrr$. event measuring greaterthan0.1 Inches has occurred
in the 72 hours prior to thisptorm event and that all information recorded herein is
accurate and true to the beat of my knowledge.
Signature:��nn.. c.
Flow Begin Time: 730 i Opm
pH Test Method: a er / npeter
Storm End Time: - I - '31, arre
Grab Sample Time:
pH:�
i
Storm Duration:_ hours
Total Precipitation:_ ).3 Inches

AFA DISCHARGE OUTTALL MONITORING REPORT
MCDENR GENERAL PERMIT NCG140000
(All sample data shall be reported no later than 30 days after recei pt of lab results)
Certi.ficate I of Cov"e
NCG14
i .
Certified Laboratory
amp,
�nCoUecting S c(s)',
ture tc(rs.
lawn
Sample Information
v'erta'Um
s
Ooe �Ifbz6t m-'MI'cate:
Dischage'T#ijRhea
Vroppnp'aatnee):
.mA pgEMN"AW
I
August 1, 1999 to July 31, 2000
Li
C3
❑
❑
E3
2-/
El
0
13
El
❑
❑
❑
2
&u 1: to July 31, 2001
3
TT
V�Aug!l 001 to July 31,2002
4
August 1, 2002 to July 31, 2003
5
August 1, 2003 to July 31, 2004
Part A: Storrawater Discharge Monitoring Data (For stormwater not combined with process wastewater)
Storm Event Characteristics
Stormwater Dischame Monitoring
i1
..... .
.N
R
ka
0 Y-V
N
Wta
M
-2—
1 10
tlid
a
Does this facility perflorm��cle Maintenance Activities using on average
oil per month? 0 Yes 2*No If yes, complete information below.
than 55 gallons of new motor
Collect
D
J
'sk
SWU-241-080M Pagelof2

Part B: Process wastewater discharge monitoring data
Sample # i
Effluent Sources for this sample /
Vehicle / Equipment Cleaning
Raw Material Stock -pile Wetting
MixingDtum Clean -out
Recycle System Overflow ❑
` Parameter
Butt
-
Collection Date
mo/dd/yr
Total Flow
MG
J +
Event Duration
hours
l r
PH.
Std. units
J�
TSS
Settleable Solids
mul
Sample #
Vehicle / FAuipment Cleaning❑
Raw Material Stock -pile Wetting❑
MixingDrum Clean -out ❑
Recycle System Overflow ❑
Collection Date
mo/dd/yr
Total Flow
MG.
Event Duration
hours
pH
Std. units
TSS
mg/l "
Settleable Solids.
ml/i
Mail original and one copy to:
Attn: Central Files
Division of Water Quality
DENR
1617 Mail Service Center
Raleigh, NC 27699-1617
Sample #
Effluent Sources for this sample 4
Vehicle / Equipment Cleaning ❑
Raw Material Stock -pile Wettin ❑
Mixing Drum Clean -out ❑
Recycle System Overflow ❑
U t ..
Data .
Collection Date
mo/dd/yr
Total Flow
MG
Event Duration
hours
pH
Std. units
TSS
mg/1
Settleable Solids
mul
Sample # _
Vehicle / Equipment Cleaning.
❑
Raw Material Stock -pile Wettin
❑
Mixing Drum Clean -out
❑
Recycle System Overflow
❑
ta
Collection. Date'_
mo/dd/yr
Total Flow
MG
`Even[ Duration .
hours
PH
Std. units
ns.
mg/l
Settleable Solids
ml/1
"I certify, under penalty of law, that this document and all attachments were
prepared under my direction or supervision in accordance with a system designed
to assure that qualified personnel properly gather and evaluate the information
submitted. Based on my inquiry of the person or persons who manage the system,
or those. persons directly responsible for gathering the information, the
information submitted is, to the best of my knowledge and belief, true, accurate,
and complete. I am aware that there are significant penalties for submitting false
information, including the possibility of fines and imprisonment for knowing
violations."
(Print Name of Perrnittee or Designee)
(Signature of Permittee or Designee) (Date)
SWU-241-080199 - - Page 2 of 2

a
Certificate of
Facility Namt
01
STORMWATER DISCHARGE
QUALITATIVE MONITOF
No.
Phone No.: f :51 _`T `) 0,
Inspector..%: 4 - r V�yit'M It
Date of Inspection:
'FALL (SDO)
REPORT
By this signature, I certify that this report is accurate and complete to ,I a best of my
knowledge:
(Signature of Perm' itte r Designee)
1. Outfall Description
Outfall No.: f Structure (pipe, ditch, etc.):_
Receiving Stream: 1 A pi 2 %tog to
Describe the industrial activities that occur within the outfall drainage
2. Color
Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors:
3. Odor
Describe any distinct odors that the discharge may have (i.e. smells
chlorine odor, etc.):
of oil, weak
11/17/97

4. Clarity
Choose the number which best describes the clarity of the discharge where 1 is clear and
10 is very cloudy:
1 2 3 4 5@ 6 7 8 9 10
S. Floating Solids
Choose the number which best describes the amount of floating solids in the stormwater
discharge where 1 is no solids and 10 is the surface covered in floating solids:
(1 } 2 3 4 5 6 7 8 9 10
6. Suspended Solids
Choose the number which best describes the amount of suspended solids in the
stormwater discharge where 1 is no solids and 10 is extemely muddy:
1) 2 3 4 5 6 7 8 9 10
7. Foam _
Is there any foam in the stormwater discharge? YES `NO)
8. Oil Sheen
Is there an oil sheen in the stormwater discharge? YES NO
9. Other Obvious Indicators of Stormwater Pollution:
List and describe: r1'
11
NOTE- Low clarity, high solids and/or the presence of foam or oil sheens may be
indicative of pollutant exposure. These conditions may warrant further
investigation.
11/17/97

TRITEST, INC.
3909 Beryl Road
b Raleigh, NC 27607
Telephone: [phone]
Fax: [phone]
Laboratory Report
--- Prepared for ---
LYMAN AUSTIN
READY MIXED CONCRETE CO.
P.O. BOX 27326
RALEIGH, NC 27611
Project ID: PLANT 24
Project ID: PLANT #24 / OUTFALL 1
No. Sample ID
001 OUTFALLI.
Test Performed
Report Certified by:
for Tritest, Inc.
Date Sampled Time Sampled
1/23/02 09:32
Method
Results
NCIWW Cert. #: 067
NC/DW Cert. M 37731
1 of 1
rt Date: 2/5IO2
Received: 1 /24/02
Order#: 0201-01361
Code: RE1520
P.O.#:
Condition
4n2oC
Analyzed Qualifier

9
Tritest, Inc.
3909 Beryl Road, Raleigh, NC 27607
p;r (919) 9344984 fax: [phone]
NCP49 CERT#67. NCDW CERT#37731
Report Results To:
Company: READY MIXED CONCRETE CO.
Address: P.O. BOX 27326
RALEIGH, NC 27611
Attn: LYMAN AUSTIN
Phone: [phone]
Sampled by (signature): _
Fax: [phone]
Chain of Custody
Bill To:
READY MIXED CONCRETE CO. Project Reference:
P.O. BOX 27326 Project Number:
RALEIGH, NC 27611
Purchase Order #:
e%a o /— o /3(o�
Tritest W.O. # BtfrT---66 fi--
Stormwater
PLANT 24
❑ Standard Report Delivery
❑ Rush Report Delivery (W.surcharge)
"Rush prvja.Ya ar [ublM b p or approval by N lab fy
Requested Due Date:
Sample Description
_
Composite
Grab_
--
Start Date
_ —
Start me
End Date
-
End Time
Matrix
-WW.DW—
SW.GWS
Analyses Requested - -
Tritest
Sample
OUTFALL 1
Grab
f
/
SW
WC-TSS
001
t9
elinquished by (signature)
Rec ived by (signatur)
Date
Time
elinquished y nalu e)
Receiveo.by (signature)
Date
Time
Relinquished
3v
by (sigture)
Receive by (signature)
Date
Time
Receipt Conditions (Lab Use Only):
❑ 432°C OTeemp: 3, 0 'C
Res. Chlorine Absent OPresent On/a
Acid preserv. <2? []Yes ONo /�(tn/a
Base preserv. >12? - ❑Yes ❑No ! `kva