NCG140136_MONITORING INFO_20040604

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
1v 13 La
DOC TYPE,
❑ HISTORICAL FILE
St MONITORING REPORTS
DOC DATE
❑ p����
YYYYMMDD

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Certificate of Coverage No. NCG
FACILITY NAMI:—R�f4,,\%yk%-. R ,d5 gt 36 _
PERSON COLLECTING SAMPLE() r
CERTIFIED LABORATORY(S) Lab #
Lub #
SAMPLES COLLECTED DURING CALENDAR YEAR: e, 00 `7
(This monitoring report shall he received by the Division no later than 30 days
the date the facility receives tha semolina resultsfrom the laboratory.)
COUNTY—
PW�v&#V-L ass-93�-Za _
(SIGNAT� EE OR DESIGNEE)
By this signature, I certify that this report is accurate
complete to the best of my knowledge.
PartA: Vehicle Maintenance Activity Monitoring Requirements (only if, on average, more than 55 gallons per month of new motor oil is used)
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STORM EVENT CHARACTERISTICS:
Date 4&—/OY
Total Event Precipitation (inches);Event Duration (hours): —3rZ ,-S
(if more than one storm event was sampled)
Date
Total Event Precipitation (inches):
Event Duration (hours): RaleiB k
ZO
Mail Original and one copy to:
Division of Water Quality
Attn: Central Files
1617 Mail Service Center
27699-1617
Form Syl-254-071400

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a
tem designed to assure that qualified personnel properly gather and evaluate the Information submitted Based on my inquiry of the person
directly parsons who manage the system, or those persons responsible for gathering the Information, the Information submitted Is, to the best
ny knowledge and belief, true, accurate, and complete. I am aware that there ure significant penalties for submitting false information,
fuding the possibility of fines and imprisonment for knowing violations."
oil �fVY M
(Date)
FormSWU-254-071400
^Page 2 of 2

'^ SwW6ern Testing J6Research Laboratories
` ADivision nfN\icrohocLaboratories
3008Airport Drive, Wilson, INC 27890
`,...'` Phone: 252'237'4175 ° Fax: 252'237'9341
YYebooi1o�www.soo\horntostiog.00nn
CHAIN ~ ` OF CUSTODY
Poge_____of_�___
& Analyses Request Lab Use Only '
'Rush Approval By:
Oliginal Report To
Contact Person: I Sample It
Acct. 0
Transport:
'ry Yes 0 No
Mileage: Other:
Sampled By: Project ID:
Requested Turnaround Time
-�J-I�ormal (2 weeks) 0 Rush (3-5 clays) To it 11 STRL Quote #
C3 Emergency Rush (ASAP) �Cg®r
ADDITIONAL CHARGES WILL APPLY &
CALL FOR APPROVAL Client Requested Due Date:
Item Start End Cornp Grob Samar Description/Sample Marks
# Date/Time Datefrinne Type* Comments
----------------
----------------
----------------
---------------
----------------
----------------
----------------
RELINQUISHED BY
DATE/TIME
RECEIVED BY
DATE/TIME
NOTES:
Field Res. CL. Field Conductivity: Field Temp: Field pH: Field D.O.
IS DATA TO BE USF- FOR REGULATORY COMPLIANCE PURPOSES? CJYES ONO IF YES, WHICH OEGULATORY AGENCY:

ROCvt 6kC IV.4r
STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Certificate of Coverage No. NCG I 'i D 13 (o
1+AC1L1'1'YNAh1E�oe�oi��a� s ' �� (nk'('9 CoMfeft
PERSON COLLECTING SAMPLE ) cbert et+<c
CERTIFIED LABORATORY(S) Lab #
Lab #
SAMPLES COLLECTED DURING CALENDAR YEAR: aoo3
(This monitoring report shall be received by the Division no later than 30 days
,Jrom the date the facility receives the sampling results from the laboratory.)
`O COUNTY I IL
I'HON o. (asa l_S39 9210 S
(SIGNAT1TTEE OR DESIGNEE)
By this signature, I certify that this report is accurate
complete to the best of my knowledge.
Part A: Vehicle Maintenance Activity Monitoring Requirements (only if, on avorage, more than 55 gallons per month of new motor oil is used)
STORM EVENT CHARACTERISTICS:
Date :5-lzl03
Total Event Precipitation (inches); Z. Z S
Event Duration (hours): /—
(if mote than one storm event was sampled)
Date
Total Event Precipitation (inches):
Event Duration (hours):
Mail Original and one copy to:
Division of Water Quality
Attn: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Form SWU-254-071400

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
"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."
�� - 6/a1
(Signature of f(Date)
'erntlttzZj—
Form SWU-254-071400
Page 2 of 2

Southern Testing & Research Laboratories
3809 Airport Drive NW, Wilson, NC 27896-8649 • 252-237-4175 • FAX: [phone]
e-we,.SouthernTesting.com
R E P O R T of A N A L Y S I S
Wayne Bracey
Ready Mixed Concrete
P.O. Box. 7637
Rocky Mount NC 27804
Client- Sample ID: PLANT 36
`darks :
SAMPLE No.: M7314-001
Date Reported: OS/30/03
Phone:[phone] X
Fax: [phone]
P. 0.: INVOICE
Collected: 05/21/03 07:45 I Matrix: STORMWATER
Received: 05/27/03 12:05 Classification: ENV
CAT No. ANALYSES METHOD ANALYZED by PQL RESULT UNITS
a-040.1 Solids: Total Suspended EPA 160.2 05/27/03 PEB 10 51 mg/L
:OMMENTS
,aboratory Contact(s): Reviewed and Approved by:
Je my #Own
En ironmental Manager
'age 1 of 1 M7314R.797 (LJL:V2R08.2) 05/30/103 10:30
Chemical and Microbiological Analyses: Environmental • Agrochemical • Foods • Phannacenlicals
Another Caahpaay

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Southern Testing &Research Labs, Inc.
3809 Airport Drive, Wilson, NC 27896
Phone: [phone] ' Fax: [phone]
E-mail: [e-mail]
CHAIN vF CUSTODY
& Analyses Request
Page 01
�_-_-_ _ _ _ _ _ _ i ------
Lab Use Only
jLogln Datejiime —_—�—.
Original Report Tc:
Contact Person: Isa I #
�rucey
ACR. #
Transport:
<l�✓_
i•i 1,."� C- ,•,«` C,::,
'(1��3��60(
Address:-, _ I (,
Phone #: .. Reid on Ice? Temp: / Res. Cl. pH:
�'1_x) �r. I ❑ ❑ No
�37 Yes
Invoice Address: �I Fax #: 'SAMPLING CHARGES:
a,'i:7!` i(5 ,'Y/✓ C��' l�Om%� !3� USQ !Time* II�Laqs:�r
Requested Turnaround Time PROJECT ID: 7 Analyses Requested
i
ETNomnal (2 weeks)
❑ Rush • PO # STRL QUOTE #
a,
❑ Emergency Rush (ASAP)' _ 41
Client Requested Due Date: Dept: Approved By:
Item Stan End Comp Grab Sample _ Goo 5 � �� N
# Daterrime Dato(Time " •' Type.. Description/Sample Marls Comments
------------------------
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----------
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----------
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----------
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----------
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SAMPLED RELIN UISHED BY
DATE TIME
/ RECEIVED BY
DATE TIME
FIELD NOTES:
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F-irl--d '1'cmp: F-i<IJ fill:
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IS DA I
A 10111: I NI'D F(R Ri= ,III A] ORY COMM LANCE
PURPOSESP F-I YES
r-1 NO IF YES. WHICiI REGULATORY
A GNCY: