NCG140137_MONITORING INFO_20030521

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
DOC TYPE
❑ HISTORICAL FILE
L MONITORING REPORTS
DOC DATE
b3 I
YYYYM M DD

tS'. m S
STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Certificate of Coverage No. NCG i H O 1 3-1
FACILTTYNAME �,m� � � t11tY�d LontlEF� C�
PERSON COLLECTING SAMPLE(S)
CERTIFIED LABORATORY(S) Lab #
Lub #
SAMPLES COLLECTED DURING CALENDAR YEAR: aZOD 3
(This monitoring report shall be received by the Division no later than 30 days
from the date the facility receives the sampling results from the laboraton•.)
COUNTY Wi /SO/.)
]'HONE-}`l�.(1Y�1 �9/-����
�� nC� j
(SIGNATUREtiFPERR'17TTEE OR DESIGNEE)
By this signature, 1 certify that this report is accurate
complete to the best of my knowledge.
Part A: Vehicle Maintenance Activity Monitoring Requirements (only if, on average, more than 55 gallons per month of new motor oil is used)
STORM EVENT CHARACTERISTICS:
(if more than one storm event was s-ampled)
Date s/zr 03 Date .
Total Event Precipitation (inches): Z Total Event Precipitation (inches):
Event Duration (hours): 10 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
Page 1 of 2

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. Rased 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/ZA
(Signature of 1Date)
Form SWU-254-071400
Page 2 of 2

PV�%V SFq'
SoCY uthern Testing & Research Laboratories
a
y fu 3809 Airport Drive NW, Wilson, NC 27896-8649 • 252-237-4175 • FAX: [phone]
v
� www.Southern'resting.com
4 FAIR PP
SAMPLE No.: 111731.5-001.
R E P O R T of A N A L Y S I S Date Reported: 05/30/03
Wayne Bracey
Ready Mixed Concrete
P.O. Box 7637 Phone:[phone] X
Rocky Mount NC 27804 Pax: [phone].
P. 0.: INVOICE
Client Sample ID: PLANT 30
Marks:
Collected: 05/21/03 08:45 Matrix: STORMWATER
Received: 05/27/03 12:08 Classification: ENV
CAT No. ANALYSES METHOD ANALYZED by PQL RESULT UNITS
EW-040.1 Solids: Total Suspended EPA 160.2 05/27/03 PEB 3 75 mg/L
COMMENTS:
Laboratory Contact(s): Reviewed and Approved by:
IK
Jetmy own
E71"1ron ntal Manager
Page 1 of 1 M7315R.798 (LJL:V2R08.2) 05/30/103 10:31
Chemical and Microbiological Analyses: Environmental • Agrochemic:d • Foods • 1'harmaccoliads
Another ® Company

St. .tern Testing & Research Labs, Inc.
3609 Airport Drive, Wilson, NC 27896
Phone: [phone] ' Fax: [phone]
E-mail: [e-mail]
CHAIN G_ CUSTODY Page of = _ —
& Analyses Request Lab Use Only —'
. fLo9m 6; IDztetTme --
—
oncinal Report. To:
Conan Person:
Sample #
AM. = Transport:
Address: -
Phone z:J
/Rec'd on Ice?
INTeTp:l Res. O. PH: r
❑ Yes ❑ No�-
Invoice Address:
=�� ,LJ Fax #:
_ _
':
!SAMPLING CHARGES:
1"f
ime:
VilWS: ��� � n - — - — - —
Requested Turnaround Time PROJECT ID:
Analyses Requested
2Nomwt (2 weeks) / 'l I, �
^ �
• �
4
X.
❑ Rush' PO #
STRL QUOTE #
i
0
❑ Emergency Rush (ASAP)'
- v` .
Client Requested Due Date: Dept
Approved By:
,� `- L G`nr /
Item Stan End Comp Grab Sample
o c-
# Da[elFime DatuTime '• " Type"
DescriptiordSample Marks
Comments
SAMPLJIA RELIN UISHED BY
DATE TIME
!''
RECEIVED BYt
DATE TIME
FIELD NOTES'
rEi
Field Temp: Field pH:
?. 9
4
IS DA A 0 BE USED FOR REGULATORY COMPLLANCE
PURPOSES? ❑ YES
❑ NO
IF YES, WHICH REGULATORY AGENCY:
SU l (7rop) -wuut t tvnw� c.nnni.r_.., ru •.«...

Pepe 1
Form 5.1
READY MIXED CONCRETE COMP NY C . �� m
• PLANT NO. .30_ DATE:
STORMWATER SYSTEMS EVALUATION FORM
Date: Z f J
Inspectors Name and Title: T f"tt J� A od.r
Inspectors Signature:
Check One:
✓ Routine Evaluation
Non Routine Evaluation ( Reason: 1
Describe the Fallowing:
1 Potential spoil areas: .k� Are ti
W ABM �eww� ARttA �a
2 Existing spills and leaks:
orJ�,
3 Potential new stormwater pollution contact sources:
M7.
N,se(r
4 Inspection of equipment, containers, tanks, drums:
D K.
5 Inspection of existing BMP's:
O K-
6 Recommendation of new BMP's:
A1erlt
7 Visual monitoring for color, foam, outfall staining, visible sheen's and dry
weather Flow:
,ve
Condition and Practice Satisfactory? YES NO
i Signs of deterioration of containers, tanks, and drums ✓
2 Existing BMP's ✓
Comments or Recommendations on SWPPP Review
This evaluation form must be accompanied by a narrative summary including descriptions
of findings and recommendations.
swPPRMCC