NCG140091_MONITORING INFO_20040606

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
/V L)
DOC TYPE
❑ HISTORICAL FILE
C� MONITORING REPORTS
DOC DATE
❑ ) b D % Dy�
YYYYM M DD

I
e
MUM
coy
DISCHARGE OUTFALL MONITORING REPORT
GENERAL PERMIT NCG140000
(All sample data shall be reported no later than 30 days after receipt of lab results)
SmmnlP T,.Fn,.,_,,,«__
^Part A: Stormwater Discharge Monitoring Data (For stormwater not combined with process wastewater)
Does thisf'acility perform Vehicle Maintenance Activities using on average more than 55 gallons of new motor
Oil per month? O Yes UrNo If yes, complete information below.
Stormwater Dimhn...
SWU-241-080199
Page loft
S'd 90IB6699EE ijastl L09 odoexom dol:21 50 La idy

SElIR)-ANNUAL tNSPECTiON REPORT
(Part A)
Plant Name: —� l
NC DWO Permit No. NCG 140 - 1
Inspected By: 1-014,1
—e— ctti L .� Date: _oq
By this signature. I car* that this report is aocureta and con pieLD to the best of my k.�axledge:
(Signah:re)
This Inspacilon Report auto Includes Part B (STORMWATER QUALITATIVE iMONITORINO REPORT). DiSCFfARGE OUTFALL j9D0)
SECONDARY CONTAWIgENT INSPECTION CHECKLIST
(If you have more'than one secondsrY Containment structure attach additicr at cgpics of this re
structure. )
port for each
1. Secondary Containment for. —AAM C
2. Is drain valve locked in the dosed positiat or the handle removed? Yes
3. Structural integrity: No
Are there any signs of leaks through the walls or floor?
Yes
Are there any eraos, holes, broken welds, etc.?
Yes
Are there any leaking tanks or plumbing?
Yes
Is the drain secura/tigttt etyre it passes through the wail?
4. Is there water/liquid inside the waft.? as
(If Yes, remove and fill out Secondary Containment Release Yes
f2eport)
GOOD HOUSEKEEPING CHECKLIST
' Are outside areas kept in a neat and
°ICY condition?
2. Is there evidence of drips or leaks from trucks or equipment?
3. Is trash removed from the site on a timely basis?
4. Are tra!Ptc areas free from equ`pment, materials, or otherobyacts?
5. Are effective cleanup procedures used for spills?
S. Are materials stored in proper -labeled containers?
PMQ* t of 2
No
lDO
No
No
No
No
9'd 9018669966 tjasn L09 odd ExoN d11:21 so L2 jdU

SEMI-ANNUAL INSPECTION REPORT
(Part A)
Plant Name: t
qNC DWQ Permit No. NCG 140CP
Inspected layZDate:By this signatucertify that this rapJrt' 1 and campiete to the hest of my k rbwled9e.
This Inspection Report also includes Part B (STORMWATER DISCHARGE OUTFALL (SOO)
QUALITATIVE MONfrORING REPORT),
SECONDARY CONTAINMENT INSPECTION CHECKLIST
(If you have more than one secondary containment structure attach addiUonal copies of this report for each
structure.)
1. Secondary Containment for. ��r�AV
2. Is drain valve locked in the dosed position or the handle removed? Yes
No
3. Structural integrity:
Are there any signs of leaks through the wails or floor?
Yes a
Are there any cracks, holes, broken welds, etc.?
Yea No
Are there any leaking tanks or plumbing? ('
Y o
Is the drain secureRigh! where f passes through the waltz
Yes No
d. Is there water/liquid inside the waft? �'�
(if yes, remove and fill out Secondary Containment RYes + oD
Release Report)
GOOD HOUSEKEEPING CHECKLIST
1. Are outside areas kept in a neat and orderly condition?
No
2. 4
Is there evidence of drips or leaks from trucks or equipment? Yes
o
/Z 1
3. Is trash removed from. the site an a timely basis?
� No
4. Are traffic areas free from equipment, materials, or other objects?
No
5. Are effektvv cleanup procedures used for spills?
es No
6. Are materials stored in proper -labeled containers?
POW 1of2 �a No
e'd 90TS669966 T.+asn L09 o8oaxoN dal:al so La .+dy

Apr 27 05 12:09p
e�,�
NCDENR
Certificate of Coverage
Facility Name
County
Phone Number
-------.
Year .
ROXBORO 607 Userl 3365998106 p.l
DISCHARGE OUTFALL MONITORING REPORT
GENERAL PERMIT NCG140000
(All sample data shall be reported no later than 30 days after receipt of lab results)
NCG14 Certified Lab oratory#
J
r uC Y c" C Person Collecting Sample(s)
Signature
Sample Information
2 Au st 1, 2000 to July 31, 2001 tJ� i
c
3 AUgust 1. 200] to July 31, 2002 ❑ t 'T 0
4 A20 u ust 1, 02 to Jul 31. 2003 ❑' ❑
5 August 1, 2003 to Jul 31, 2004 ❑ �� 1 y ti f `t7 C I'(`-2i
X�slllwastq
iPart A: Stormwater Dischara Monitorin Data
g g (For stormwater not combined with water)'1 _ 1
o
Storm Event Characteristics t v
Date - Total EvenIcipitazion (inches) Event Durehn fh t
Stormwater Discharge onitorin
httfall Daze Sample. Total Flow . Total Event Event Duration pH Total
No: Collected Precipitation
Suspended
(mddd/ r G Solids
_ (inches) fhoursl cc.a rr..:..I
Does this facility perform Vehicle Maintenance Activities using on average more than 55 gallons of new motor
oil per month? ❑ Yes O No If yes, complete information below.
Stormwater Discharge Monitoring from Vehicle Maintenance Areas
No. Date Sample .Total Flow Total Event Event New pH Totai Oil and
No. Collected Precipitation tion Motor Oi( Suspended Grease
fnnn/ddrorl n,Ar_, Usage 11 1 1 1 Solids '.
swo-24-o8019e Page lof 2

Apr 27 05 12:10p ROXBORO 607 Userl 3365998106 p.2
STORMWATER DISCHARGE OUTFALL (SDO)
QUALITATIVE MONITORING REPORT
Certificate of Coverage No.
Facility Name: Zrz,�1.% d/,� -F1���
County: Phone No.: az')
Date of Inspection: er, Z%o -L+_5
By this signature, I certify th*this report is accurate and complete to the best of my
knowledg
+
v
(Signature of Permittee or Designee)
1. Outfall Description
Outfall No.: 1 Structure (pipe, ditch, etc.): 7i Fc
Receiving Stream:_i—
Describe the industrial activities that occur within the outfall drainage area:
2. Color
Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors:
3. Odor
Describe any distinct odors that the discharge may have (i.e. smells strongly of oil, weak
chlorine odor, etc.):
11/17/97

Apr 27 05 12:10p ROXBORO 607 Userl 3365998106 p.3
SEMI-ANNUAL INSPECTION REPORT
- (Part A)
Plant Name: f NC DWQ Permit No. NOG 140 C-cr /
Inspected By, r
a Date:
9y this signature. I oertiiy that this report is aCcurpbe and complete to the pest of k - my nowledge:
This inspection Report also Includes Part B (STORMWATER DISCHARGE OUTFALL (SDO)
QUALITATIVE MONITORING REPORT).
SECONDARY CONTAINMENT INSPECTION CHECKLIST
(If you have More than one secondarycontainment shucWre
Structure.) attach adyi[icnal copies of this report for each
1. Secondary Containment for. _ pj j ,�t\r
2. Is drain valve locked in the dosed position or the handle removed?
No
3. Structural integrity:
Are there any signs of leaks through the waits or floor)
Yes
�G
Are them any tracts, holes, broken wekfs, etc.?
Yes
\
Are there any leaking tanks or plumbing?
Yes
�,.
re
Is the drain setukight where it passes through the wall?
es
No
4. Is there waterniquid inside the waft?
(If
Yes
No
yes, remove and fill out Secondary Containment Release Report)
GOOD HOUSEKEEPING CHECKLIST
t. Are Outside areas kept in a neat and orderly condition?
�
2. Is there evidence of drips or leaks from trucks or equipment?
es
Yes
No
Nc?
3. Is trash removed from the site on a timely basis?
Yes,
No
4. Are traffic areas free from equipment, materials, or other oLyects?
Yas i
No
5. Are effective cleanup procedures used for spills?
Yes
No
B. Are materials stored it proper -labeled containers? =-
- es
No
Page 1 of 2

DISCHARGE OUTFALL MONITORING REPORT
GENERAL PERMIT NCG140000
(An sample data 3ha0 be reported 00 larer db 30 days after mceipt of lab msWrs)
,cart A: Stormwater Discharge Monitoring Data (For stormwatar Got combined with process wasaewatef)
Storm Event Qtancteris 'cs
SWU-241-080199
's W' No jf n
Yes. complete information below.
St—°r�wat!�DisCharge Monignrin
- �•w+�a+.�c ncnvtnes us; g on average more than 55 gallons of new motor
Stone ate Dischaz e
onitorin from Vehicle Maintenance Ar
F6)a.{�?low'_ s':QTzal-Ever;r��
Page lof 2
L'd 9DI866S9EE Ijasn L09 OHDHXDH d2l:2I SD LE Jdd

-ampies 1 11.302 Belmont Street
I" T F. R N A T 1 0 N `--------
Submitted Burlington, NC 27215
11370 West
eSIMeadow
L to: Tel: [phone]
Eden, NC 27288
Fax: [phone]
Tel: [phone]
Client Name P/SaSO COMY 10le ALL Sect-
Fax: [phone]
6 of this
form. Instructi
Address Project
City, State, Zip Locationt
Contact PO
Telephones Compliance-- Itoring?
I J Yes []No
Sampled by (PRINT) if Yes, lisl Agency and wr
Send Report via Sampler Signature 4
[I Mail I Telephone j V'ax (fax "
Matrix Types: (DM L : I I 0-mail (address)
Preservative Tye!s:Groundwater, 1 11 1 ­ 1 11 . — —
: 1 11 ''1 11 ' 1, 1 r I­,'—Wa­.tS­W`SIc­r—
I "l, (4) NaOH im � ­ - , (P) PIM.71 1�71 �.­
Chain of Custody -Record .Ni
Number 0
Turnaround Time Requested
Standard
0
I RUSH ' (nOlJfy lab Prior to delivery)
needed by_
O
­`4nc
(Use I line per Co"alne"PrOSerVaWn Type -rmaiceh de ASOOrbicc Act U- firs01V.1 wed
Tag NO. I Collected 00 Container
Client Sample ID Matrix Grab Comic a
0 oat TimE
CL e I? X3 No. Presem'
of Type­
C
Analysis Method Requested
M
0
-,3
Lab Use
Only W-1k.rd r, (D
Possible Hazard Identification
CHazardous
Comments Non -hazardous Radioactive
Rellnquis! I B Sam le Dls I lgnature) )at i E INS Ose as a ro
Me Return
Received By (Signature) Date/Tim 1 0 Archive
Relinquished By(signature)
Daterrim .1 a -0
Received for Lab 13Y (Signature)
DateRI a
Page of

� y G
DISCHARGE OUTFALL MONITORING REPORT p
NC®ENR GENERAL PERMIT NCG140000 0
(All sample data shall be reported no later than 30 days after receipt of lab results) VC
Certtficateof:Coverage ,
NCG14 ❑p®©
Facthty Name
CritgNa�C
,.:
- r
Onnty !�
1
/V
PtionC^�Ntim" ber 1 f�
Certified Laboratory #
850
«_
Person(Collechng Sample(s) .
�Collectors�Signatiire
Sample Information
ernut Term
1
August 1, 1999 to July 31, 2000
acehcpee Tffi9&it6Wrddicate
fir.
appltcabesamP>?�gfPen
Li❑
❑
❑
Q
❑
Dischazge<Type (check
arEDpro
Stormwa_ter�
f4'JW. iewate_r(
❑
❑
0
❑
❑
❑
❑
p
❑
2
August 1, 2000 to July 31, 2001
3
August 1, 2001 to July 31, 2002
4
August 1, 2002 to uly 31, 2003
5
August 1, 2003 to uly 31, 2004
Part A: Stormwater Discharge Monitoring Data (For stormwater not combined with process wastewater)
Storm Event Characteristics
t
;; ,.Dtite =
O
0 1Event?Pect tiWtibn
Inc es,�tr,�vedtiDurafton
hot1ur' u
O
Stormwater Discharge Monitoring
a-=xOutfll
DatesS41r)
of 1Fl
Too"ta1fEvent
ven tvan"'7alle
"
ectpitanon
Sus entlP"'�'
"ht.xn
a
t3n.`Frr
S011dS'1?�Wp
'. mo/d
(}
inches ;
h I
Sidra nits
m :k
a
o'to
1.6
14
1
,.$r,
Does this facility perform Vehicle Maintenance Activities using on average more than 55 gallons of new motor
oil per month? ❑ Yes 21`1�O If yes, complete information below.
Stormwater Discharge Monitoring from Vehicle Maintenance Areas
rp0ittfall "a�
a
yD$te Sampler
fit! 6t$!tbja1
rt )� •,
Ev ntat
s f - E
ho s•
ozv;' <a�4
�T<.r
sage -y
al(md,":
Hq
ton
s.Z�
K
ar Tr
. Std. LTihts
�eSuspeniled
ix,'-�'
.�stq"tiSogg
• t nn l
0tia
Greasepi4
ter ra c
:m r
SWU-241-080199 Page lof 2

jfr'� X
Part B: Process wastewater discharge monitoring data
Sample #
fflaentSobcce(s for this sain le ," /
Vehicle / Equipment Cleaning
Raw Material Stock -pile Wetting
Mixing Drum Clean -out Q
Recycle System Overflow ❑
Collection Date
mo/dd/yr
q
Total Flow
MG
pO 20
Event Duration
hours
f,7f
pH
Std. units
q, 3
TSS..
mg/1
Settleable Solids.
ml/1 1
1.0.1
Sample # _
W 4 Yh. SVl 3{p A'IJ�t'i.
ffl ent�SouXce s :�fon t11rs sa_ to 1
Vehicle / Equipment Cleanin ❑
Raw Material Stock -pile Wettin ❑
Mixing Drum Clean -out ❑
Recycle System Overflow ❑
�mt� Aiter R m:
P;ar e
i f
-
x
Collectioq Dafe
mo/dd/yi• .
Total Flow
MG.
Event Duration
hours
,PI -I
Std. units
TSS ``
mg/I
Settleable Solids
CUM
Mail original and one copy to
Attn: Central Files
Division of Water Quality
DENR
1617 Mail Service Center
Raleigh, NC 27699-1617
Sample #
Effluent Source(s) for this sam "le
Vehicle / Equipment Cleaning ❑
Raw Material Stock -pile Wetting ❑
Mixing Drum Clean -out ❑
Recycle System Overflow ❑
m
mo/dd/yr
MG
hours
pH
Std. units
-.TSS
mg/l
Settleable Solids
ml/I
Sample # —
flueri ourcels? fort}iis , m le;= _ fVehicle / Equipment Cleanin ❑
Raw Material Stock -pile Wettin ❑
Mixing Drum Clean -out ❑
Recycle S stem Overflow ❑
Parame�te �
r?px�
a�'aa r
Collection Date'•:
mo/dd/yr
Total•Flow :.
MG
Event Duration
hours
PH
Std. units
TSS
mg/I
Settleable'Solids
HIM
"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 gatheringthe 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.
V A-1YI&5, If�.iA9AN
(Print Nam f Permittee or Designee)
66 3
(Signature f P rmittee or Designee (Date)
SWU-241-080199 Page 2 of 2

I N T E R N A T I O N A L
Date: 16-Apr-03
CLIENT:
Chandler Concrete Company
Client Sample ID: 607
Lab Order:
B03040245
Tag Number:
Project:
Roxboro
CallectionBegin Date:
Lab ID:
B03040245-OIA
Collection End Date: 4/9/2003 10:00:00 AM
Matrix: STORM WATER
Analyses Result Limit Units Date Prepared Date Analyzed
SETTLEABLEABILITY E160.5 Analyst KPP
Settleable Matter < 0.1 0.1 mL/L/Hr 4/9/2003 1:28:00 PM 4/9/2003 2:28:00 PM
Certifications: Simalabs- Burlington
EP Burlington Lab m: NCO1365, Eden Lab 11): NCO1364
NC Chemistry: #85, Biomonitoring: #002, Drinking Water: 437743, #37738, Radiation License: t1001-904-OG
SC Laboratory ID: 499042
VA S WCB ID: #000061, Drinking Water: 400018 )
Burlington Eden
1302 Belmont Street • Burlington, NC 27215-0935 370 W. Meadow Road • Eden, NC 27288
Phone [phone] • FAX [phone] Phone [phone] • FAX [phone]
Phone [phone]

I N T E R N A T I O N A L
Date: 16-Apr-03
CLIENT:
Chandler Concrete Company
Client Sample ID: 607
Lab Order:
B03040245
Tag Number:
Project:
Roxboro
CollectionBegin Date:
Lab ID:
B03040245-OIB
Collection End Date: 4/9/2003 10:00:00 AM
Matrix: STORM WATER
Analyses Result Limit Units Date Prepared Date Analyzed
TOTAL SUSPENDED SOLIDS E 160.2 Analyst: AHV
Total Suspended Solids (Residue, 16.7 4.0 mg/L 4/15/2003 11:35:00 AM 4/15/2003 4:37:00 PM
Non -Filterable)
Certiricauons: Simatabs- Burlington
EP Burlington Lab ID: NC01365, Eden Lab m: NCO1364
NC Chemistry: 985, Biomonitoring: #002, Drinking Water: 437743, #37738, Radiation License: N001-904-OG
SC Laboratory ID: 899042
VA SWCB ID: 4000061, Drinking Water: k00018 2
Burlington Eden
1302 Belmont Street a Burlington, NC 27215-6935 370 W. Meadow Road • Eden, NC 27288
Phone (336) 570,4661 • FAX [phone] Phone [phone] • FAX [phone]
Phone [phone]

®��
NCDENR
DISCHARGE OUTFALL MONITORING REPORT
GEYERXL PERMIT NCG140000
(All sample data shall be reported no later than 30 days after receipt of tab results)
:ertificate of Coverage I
NCG14 ❑O o�Fq]�
taciliry Name .
CtrJtriC(t� C:ouaeF Ca.
l�oc.A o na —
:ounty
7�(LSor 1
'hone Number
3 34 - 599 - 83 q3
Certified Laboratory *
8S
Person Collecting Sample(s)
I Mt
Collectors Signature
t
`-a
Sample Information
Permit Term
Year
-
Year.Start/Ebd'Dates .,,
Place check mark to indicate
applicalilasamplingperiod
Discharge Type (checkers oriate)'
Stormwater :. Wastewater
1
August
Au
l August
August
Au
1. 1999 to Julv 31.2000
t L. 2000 to July 31. 2C01
1.2001 to Julv 31. 2002
1, 2002 to July 31, 2003
t 1.2003 to July 31.2004
Q
❑
❑
❑
❑
Ca-
❑
❑
❑
❑
21
❑
❑
❑
2
3
4
Part A: Stormwater Discharge Monitoring Data (For stormwarer not combined with process wastewater)
Storm Event Characteristics
Stormwater Discharge Monitoring
Outfall
. Date Sam lee-
Goliected
^'✓a�
mofddlvr}
Tota1Flow .
� E:
:otad EvmiE—
--_� 1.iti.K: t�
<.EveacDuration
� � � -
outs
E Total
,. 'ir• �J'.'"�- .Wha• `_.T
StdrFTmcsT._
(0107101
OOO 4408
1 0
I
I
Does this facility perform Vehicle Maintenance Activities using on average more than 55 gallons of new motor
oil per month? ❑ Yes 0 No If yes, complete information below.
Stormwater Discharge Monitoring from Vehicle Maintenance Areas
Outfall. _
Date Sample:
--Total Flow:
To
ToralEveat
Event:
Z New
pH 7-
Total
OLI: and _.
No `p'
.' Collected_
Pteczp ttaaaa
-lhsinoa `
%; IVfomrOtl
`�,...
Sttspended.
.Greaser �;
-.
(mo/dd/vrT
_
(bfG7
(inches)
(hoursT
E¢aUmo)
(Std_Ltnstc,�
!maul
' fTol

Part B: Process wastewater discharge monitoring data
Sample 4 (
Effluent Source(s) for this samole
Vehicle / Equipment Cleaning
Q
Raw Material Stock-oile Wetting
Q
Mixine Drum Clean -out
❑
Recvcle Svstem Overflow
❑
Parameter
I Unit
Data
Collection Date
mo/dd/yr
or, O o 1
Total Flow
MG
I , o0o 40e
Event Duration
hours
/ ,p
pH
Sid. units
q" 2
TSS
mg/l
(o, O
Settleable Solids
I mU,
0. t O
Sample 4 _
EffiuenrSource(s) for thi"anrdle
Vehicle / Equipment Cleaning
❑
Raw Material Stock -pile Wettin
❑
NE-ung Drum Clean -out
❑
Recvcle System Overflow
❑
Paramete
data :-
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
DE`1R
1617 Mail Service Center
Raleigh, INC 27699-1617
Sample MI
I Effluent Sources) for this sample /
Vehicle / Equipment Cleaning ❑
Raw Material Stock -pile Wetting ❑
Mixine Drum Clean -out ❑
Recvcle System Overflow ❑
Parameter
Unit
r '' Data
Collection Date
mo/dd/yr
Total Flow
MG
Event Duration
hours
pH
Std. units
TSS
mg/l
Settleable Solids
T:::
mul
Sample l* _
;.-�=EffluiefitSotrice s fort5issamvle =.
Vehicle / Equipment Cleanine
❑
Raw Material Stock -vile Wetting
❑
Mixing Drumm Clean -out
❑
❑
Recvcle System Overflow
Collection:Date
mo/dd/yr
Total Flow
MG
Event Duration
hours
PH.
Std. units
TSS
mg/1
Settleable Solids
MYI
"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 Permittee or Designee)
(Signature of Permittee or Designee) (Date)
swU•241-080199 Page 2 of 2

e
Simalabs International I N T E R N A T 1 0 N A L Date: 14-Jun-01
CLIENT:
Chandler Concrete Company
Client Sample ID:
Roxboro
Lab Order:
B01060208
Tag Number:
Project:
607 Roxboro
Collection Begin:
6/7/2001 5:00:00 PM
Lab ID:
B01060208-01
Collection End/Date:
6/7/2001 5:10:00 PM
Matrix:
SURFACE WATER
Analyses
Result
Limit Units Date Prepared Date Analyzed
SETTLEABLEABILITY
E160.5
Settleable Matter
0.10 0.10 mL/UHr
TOTAL SUSPENDED SOLIDS
E160.2
Total Suspended Solids (Residue,
6.00 1.00 mg/L
Non -Filterable)
Analyst: SAP
6/8/2001 9:20:00 AM 6/8/2001 M20:00 A
Analyst: KS
6/10/2001 7:45:00 AM 6/10/2001 3:00:00 P
Certifications: Simalabs- Burlington
EPA Chemistry Lab ID: NCO0137, Bioassay Lab ID: NC2721500
NC Chemistry: 985, Biomonitoring: #002, Drinking Water: #37743, #37738, Radiation License: #001-904-OG
SC Laboratory ID: #99042
VA SWCB Ill: #000061, Drinking Water: 400018
I
1302 Belmont Street, Burlington, NC 27215-6935 TEL.[phone] FAX [phone]

GMF'�
DISCHARGE OUTFALL MONITORING REPORT
NC®ENt GENERAL PERMIT NCG140000
(All sample data shall be reported no later than 30 days after receipt of lab results)
Certificate of Coverage
NCG14 ❑p ZEE�jj]
Facility Name
County
7� 25 fl N
Phone Number
336 - SfQ- 83 q2,
Certified Laboratory #
8.c
Person Collecting Sample(s)
Alt kC PM
Collectors Signature
Sample Information
Permit Term.
Year :
YearStartlEnd Dates I IPlace:
"`
"' ... _ '-� '
check. mark to indicate
appl cablcsam ling period` '
Discharge T (clieckas appropriate) '
.:.Stormwater -;_,
:. Wastewater 'r
1
August 1, 1999 to Jul 31, 2000
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
2
August 1, 2000 to July 31, 2001
3
August 1, 2001 to July 31, 2002
4
Augmt 1, 2002 to July 31, 2003
5
Augmt 1, 2003 to July 31, 2004
Part A: Stormwater Discharge Monitoring Data (For stormwater not combined with process wastewater)
Storm Event Characteristics
-..mches
;7
-
.::.°Evecif�iaahaa' Dios -
Stormwater Discharge Monitoring
a Outfall
DatcSampl
"sToralFlow
�'TotalEvent
Ei6tDization
pH
r r Dial
No
Collected'
r„ precipttation`r
' r{
"`
SY ndedR
r.,-.=
'.; �...„',
'-�
Solids
_
mdTdd/
G_
, inches?
ours
Sid Umts'_-,
in
Do
1
, o
/Q I
Does this facility perform Vehicle Maintenance Activities using on average more than 55 gallons of new motor
oil per month? ❑ Yes No If yes, complete information below.
Stormwater Discharge Monitoring from Vehicle Maintenance Areas
Outfall
Date Sample-_
Total.Flow,
.Total Event
pH
:dotal
_ .Oil and-
No.Collected
t� ti
Ptecipitanon
Dur4noa
Usage
RY:(pl/mo)
Solids
mo/dd/
inches .
ours_:.
StdUmts -
m
m -
SwU-241-080199 Page lof 2

Part B: Process wastewater discharge monitoring data
Sample # I
Effluent SoE
s) for this sam le
Vehicle / urit Cleanin [�
Raw Material Stock -pile Wettin [�]
Mixin Drumn-out Rec cle S sterflow
Parameter
Unit
'Data
Collection Date
mo/dd/yr
7/1 _�0 0
Total Flow
MG
,002/0
Event Duration
hours
2, 0
pH
Std. units
/O, /
TSS
mg/I
1.
Settleable Solids
m]/1
.2,0
Sample #
EffluentSotuce s for thissam -Ie
Vehicle / F ui ment Cleaning ❑
Raw Material Stock -pile Wetting ❑
Mixing Drum Clean -out ❑
Recycle System Overflow ❑
-
Collection Date
mo/dd/yr
Total Flow
MG
Event Duration
hours
pH
Std. units
TSS
mg/!
Settleable Solids
mm
Mail original and one copy to:
Attn: Central Files
Division of Water Quality
DENR
1617 Mail Service Center
Raleigh, NC 27699-1617
SWU-241-080199
Sample #
EfflueMclean-out
or this sam le
Vehicle leanin ❑
Raw Maile Wettin ❑
Mixingut ❑
Recycle flow ❑
Parameter
Unit
Data
Collection Date
mo/dd/yr
Total Flow
MG
Event Duration
hours
PH
Std. units
TSS
mg/l
Settleable Solids
mIA
Sample # — -
"FffIuetrt'Soiace s foet5is s le :c
Vehicle / Equipment Cleanin ❑
Raw Material Stock- ile Wettin ❑
Mixing Drum Clean -out ❑
Recycle System Overflow ❑
Collection Date
mo/dd/yr
Total Flow
MG
Event Duration
hours
FI
Std. units
TSS
mg/1
Settleable Solids
mM
"I certify, under penalty of law, that this document and all attachments were
prepared under my direction or supervision in accordance with a system designed
to assure that qualified personnel properly gather and evaluate the information
submitted. Based on my inquiry of the person or persons who manage the system,
or those persons directly responsible for gathering the information, the
information submitted is, to the best of my knowledge and belief, true, accurate,
and complete. I am aware that there are significant penalties for submitting false
information, including the possibility of fines and imprisonment for knowing
violations."
'X4 0 /
(Print Name of Permittee or Dfsign,
(Signature of er ttee or Designee) (Date)
Page 2 of 2
a

BURLIN.GTON
RESEARCH
NPDES Analyses, Aquatic Toxicity Testing, Field Services,
n frastructure Evaluation, Chemical Product Environmental Assessments,
Toxicity Reduction Evaluations ..
ANALYTICAL REPORT
CUSTOMER: Chandler Concrete Company
REPORT TO: Mr. Jon Faubel
SAMPLE DESC: ROXBORO
SAMPLE TYPE: STORMWATER, GRAB
COLLECTED: 06/16/00 07:00
WORK ORDER #:
OF456-001
RECENED:
06/16/00
REPORTED:
06/23/00
PO NUMBER:
PARAMETER DATE/11ME/ANALYST MOL RESULT'
bouas, i otai Suspended Started 06/19/00 0955 1.0 17.0 mg/L:
EPA 1602 Analyzed 06/19/00 by ELR at BRI - Burlington
MQL = Minimum Quantitation Limit
Certifications:
BRI - Burltn¢too
NC ChemDrinking istry #85, Biomonitoring: #002, Drinng Water. #37743, Radiation license: #001-0904-OG
VA SWCB 1D: #000061, Drinldng Water. #00018
SC laboratory ID: #99042
EPA Chemistry lab ID: NC00137, Bioassay Lab ID: NC2721500
Burlington - Corporate Offices
1302 Belmont Street • Burlington, NC 27215-6935 Page
Phone [phone] • Fax [phone]
Eden
370 W. Meadow Road • Eden, NC 27288
Phone [phone] • Fax [phone]
A Subsidiary of SIMAIABS International

NPDES Analyses, Aquatic Toxicity Testing, Field Services,
Infrastructure Evaluation, Chemical Product Environmental Assessments,
Toxicity Reduction Evaluations
BURLINGTON
RESEARCH
ANALYTICAL REPORT
CUSTOMER: Chandler Concrete Company
REPORT TO: Mr. Jon Faubel
SAMPLE DESC:
ROXBORO #607
SAMPLE TYPE:
STORMWATER, GRAB
COLLECTED:
07/13/00 07:00
WORK ORDER #:
OG317-001
RECEIVED:
07/13/00
REPORTED:
07/17/00
PO NUMBER:
PARAMETER DATE/TIME/ANALYST MOL RESULT
oetueaoutty 5lartea 07/13/00 12:30 0.1 2.0 mL/L/Hr.
EPA 160.5 Analyzed 07/13/00 by LMB at BRI - Burlington
MQL = Minimum Quantitation Limit
Certifications:
BRI - Burlington
NC Chemistry: #85, Biomonitoring: #002, Drinking Water: #37743, Radiation License: #001-0904-0G
VA SWCB ID: #000061, Drinking Water: #00018
SC Laboratory ID: #99042
EPA Chemistry Lab ID: NC00137, Bioassay Lab ID: NC2721500
Burlington Corporate Offices Eden
1302 Belmont Street • Burlington, NC 27215-6935 Page 1
370 W. Meadow Road • Eden, NC 27288
Phone 1336) 5i0.4661 • Fax [phone] Phone [phone] • Fax [phone]
A Subsidiary of SIMAIABS International