NCG140294_COMPLETE FILE - HISTORICAL_20080623

Inu C-h\llt
STORM_ WATER DIVISION CODING SHEET
RESCISSIONS.
PERMIT NO.
Nl�
DOC TYPE
COMPLETE FILE - HISTORICAL
DATE OF
RESCISSION
❑ a b b � b � -)-3
YYYYMMDD

r \O�0 W ATFRQG
o r2tb p�
Q V
June 23, 2008
Mr. Richard Vick
S.T. Wooten Corporation
P.O. Box 2408
Wilson, NC 27894-2408
Subject: Stormwater Inspection
Michael F. Easley, Governor
William G. Ross, Jr., Secretary
North Carolina Department of Environment and Natural Resources
S.T. Wooten Corporation
Uzzle Industrial Dr Facility - NPDES Permit Number NCG 140289
Old Roberts Rd Facility - NPDES Permit Number NCG140294
Johnston County
Dear Mr. Vick:
Colcen 11. Sullins, Director
Division of Water Quality
On June 12, 2008, Ms. Vicki Webb of the Raleigh Regional Office conducted a stormwater evaluation
inspection of S.T. Wooten Corporation's Ready Mix Concrete Facilities on Uzzle Industrial Dr and Old Roberts
Rd in Johnston County with the assistance of Mr. James Washburn, safety associate of the facilities and Mr. Jeff
Palmer, production manager. Their help was appreciated as it eased the inspection process.
The following observations were made:
An inspection of the Uzzle Industrial Dr facility's (NCG140289) stormwater permit was conducted. The site is
located off Hwy 70 and Uzzle Industrial Dr in Wilsons Mills, NC. Stormwater runoff from this site is
discharged to the receiving waters designated as Poplar Creek, a class C NSW stream in the Neuse River Basin.
Stormwater is discharged by means of a level spreader. Process water flows through a series of cells that filters
out solids. The facility then recycles this water back into the plant operations. The facility is looking at
necessary means to utilize stormwater from the detention pond as a way to save water. Please update this
office on your progress.
An inspection of the Old Roberts Rd facility's (NCG140294) stormwater permit was conducted. The site is
located off Hwy 210 and Old Roberts Rd in Benson, NC. Stormwater runoff from this site is discharged to the
receiving waters designated as an unnamed tributary to Beaverdam Creek, in the Neuse River Basin.
The process water and stormwater flow to the cement treatment pits. Water enters into the first pit and flows
through the series to filter out solids. The facility then recycles this water back into the plant operations. The
facility has done a great job redirecting the flow of stormwater to utilize this water in their plant operations.
Stormwater that is not captured with the processed water is directed to the east side of the plant and runs down a
ditch with gravel dams every 25 ft. till it reaches a retention pond in the back of the facility. I suggested that the
facility keep a path cleared to the outfall and the edge around the front side of the retention pond. This will help
aid in qualitative and analytical monitoring.
om
N caro ina
Valura%J
North Carolina Division of Water Quality Raleigh Regional Office Surface Water Protection Phone [phone] Customer Service
Internet: h2o.enrstate.ne.us 1628 Mail Service Center Raleigh, NC 27699-1628 FAX [phone]
An Equal OpportunitylAffrmalive Action Employer— 50% Recycled110°/ Post Consumer Paper

S.T. Wooten
Stormwater Compliance Inspection
NGG140289 and NCG140294
Johnston County
All components of the Stormwater Pollution Prevention Plan were present including: detailed site maps with
labeled storm outfalls, a list of potential contaminants, a spill and response plan, a narrative describing BMPs,
and a contact list of whom to contact in an emergency. Employee training records were on -site. Both facilities
inspect containment areas, storage tanks, and valves and piping on a monthly basis. Both facilities maintain
good house keeping practices. The files are kept in a well organized fashioned. Such order eased the file
review process.
The overall conditions of S.T. Wooten's stormwater programs at the Uzzle Industrial Dr and Old Roberts Rd
facilities are complaint with Division standards. If you have any questions regarding the attached report or any
of the findings, please contact Vicki Webb at: [phone] or email vicki.webb amrictriail.net
Sincerely,
Vicki Webb
Environmental Specialist
Cc: James Washburn - S.T. Wooten
Central Files
RRO

Permit: NCG140294
SOC:
County: Johnston
Region: Raleigh
Compliance Inspection Report
Effective: 08/O1/04 Expiration: 07/31/09 Owner: S. T. Wooten Corporation
Effective: Expiration: Facility: S T Wooten - Benson
624 Old Roberts Rd
Contact Person: Charles Sharp
Directions to Facility:
System Classifications:
Primary ORC:
Secondary ORC(s):
On -Site Representative(s):
Related Permits:
Inspection Date: 06/12/2008
Primary Inspector: Vicki Webb
Secondary Inspector(s):
Benson NC 27504
Title: Phone:[phone]
Certification: Phone:
Entry Time: 08:52 AM Exit Time: 09:26 AM
J7 Phone:
Reason for Inspection: Routine Inspection Type: Compliance Evaluation
Permit Inspection Type: Ready Mix Concrete Stormwater/Wastewater Discharge
COC
Facility Status: ■ Compliant ❑ Not Compliant
Question Areas:
E Storm Water
(See attachment summary)
Page: 1

Permit: NCG140294 Owner - Facility: S. T. Wooten Corporation
Inspection Date: 06/12/2008 Inspection Type: Compliance Evaluation Reason for Visit: Routine
Inspection Summary:
Page: 2

T
w
Porinit:ACG140294' Owner - Fiaclllpy:�S.,T,� ooten n "t,!
IA Inspection
Do
to 06112/20Wj lrspectlb�r-Tjpo�Compliance Evaluation Re sonfor Visit: Routne%, 34,b v- 'Wi' i6i 'l NEStorrwater Paw0n Prevention Plan _ I. Does.the site�have.a StormwAter Pollution Prev6htion Olakiv E3 E)"El
# DoestheP16A include a'Gene'ra'],Location "(U'S*GS)-map? I .....
E1­0 0"0
I I'T 1V
# Does the Plan ih6iuda:b',",Narrative Description of,Practices ,
iii
0 0 ar6a*s?."--
Does'Ahe Plan .Include 'a detaillbol site mapincluding 6utfaii ocati:on's'a'n-d-dr'ai"'n'a'ge'I
Doei Plan Include a list"otsig.�nihcant spiii!i6&urring;c6r,ears?v
0, 11,
ti # Does'the Plan -include a Preventativ
I If - # D I 06i the'fdcllit'provide aird;"docum' .y
Does .the Plan include a list of Rasp
:4 ls,6'1?1a6.reviewed and updated at
N,
# Does ithe Plan ,include 'a"S"iorm'w�a'ter
Ei E) -El 0
Housitke6l�iing! a [3 iO 0 anance and�Good
3
[3�
0 11 -inspection Program? 13 'El'
- - . I " I t I . . ­ I I I .
i beenimplemented?, e [3,C10 C
4
" Y
L r­
Sil
3'spill Jn over, three years Plan is-update"d yearly ,I
dates ,oh'o-ne"pa-ge-to-'e'as-ei the review process'.';,'�
Yes No' -NA 'NE�:
k,,kadthefacility ,conducted :its Qualitative Monitoring sbrini-annivally"Ii",
J
'Comment; -
v,
3`1
'rr '. .
ytica1:Monitoflng,­1,,+ - -mayIY
�-N'ANE
I '.
Has'the-if facility c6ndu6tbd,its'An6lytical'nionitonng? E3,:EF❑ -E)
facility its the aci Analytical monitoring from Vehicle Maintdnance,6reas? ❑0' ❑El 0! ❑D
L
C
omme,nt: Tilefaculty . d6esnot conduct vehicle maintenance on site: South6nn .
-Testing and R6i6i6ich lab of Wilson -NC is the contirkt'l6b.- -A,
Permitiiindbuilla'ili., Yes t,No'NA:LN1E.;-,.
� ❑ 0 0
# IS4 a copy of the Permit and the 'Certi Certificate o 'b overage available.at the site?:-,., -
q
peption o 13� 1I ?
#Ifthe Jaciliiy'has 'repr'ese�t�tv�ou611*st�tui,is',t.erop��rdocu d by the Divisioh?­'I.,e, .0. If bi-ot
# Has the faCility'et;aJU
ated.all illicit (non stormwater)discharges? Ej, 0: 0 c)
a
Page : 3vu"

July 16, 2003
Mr. Myrl Nisely
Raleigh Regional Office
Water Quality Section
1628 Mail Service Center
Raleigh, NC 27669-1628
Subject: Storm Water Sampling Data
Dear Mr. Nisely,
S.T. Wooten
Corporation
In response to your letter of July 8, 03, 1 will provide the Sampling Data that I have and
hopefully give an explanation as to why I do not have the others.
NCG 140248 This is a Builders Firstsource plant and is not a part of S.T. Wooten.
NCG 140120 This plant is in Henderson, we do not have any material at this location
(ie. Cement, Ash, Stone, Sand or Chemicals,) this plant was closed in
1994 or 1995, and has not had any activity to effect Storm Water. I will
send a letter by July 30, to DWQ, Central Files.
NCG 140233 This plant we feel is Sheet Flow, and all Storm Water that is on site is held
by our pit system. A letter will also be sent to DWQ on this as well.
NCG 140269, NCG 140294 Were Builders Firstsource plants and S.T. Wooten has
purchased them. The Sampling will be included in this letter.
NCG 140121 This plant and property did not have Storm Water run off in 2002, but a
letter was not sent to DWQ. 14�
d ,
NCG140010, NCG140122, NCG140234, NCG14035, NCG140236, NCG140289,
NCG I40317; the drought of 2002 made it impossible to take the samples
by July 30, 02, we just did not have enough rain. As time went on the tests
were overlooked due to illness of the employee that was in charge of
Storm Water.
PO Box 2408
Wilson. NC 27894-2408
252.291.5165
FAX [phone]

I hope this will help, and as you know we are making every effort to correct any
problems we have.
Sincerely,
0-'' d. -
James Washburn
Safety Associate
S.T. Wooten

State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
Michael F. Easley, Governor
William G. Ross, Jr., Secretary
Alan W. Klimek, P.E., Director
Mr. Richard Vick
S T Wooten
PO Box 2408
Wilson, North Carolina 27894-2408
Dear Mr. Vick:
A
�-
���fVDRTM-CA'OLINA DEPARTMENT ROF
ENVIRONMENT AND NATURAL RESOURCES
June 4, 2003 , }11
Subject: NPDES Permit1n Modification - Name/,Ownership Change
Permit NCG140294.,_.
S T Wooten Benson
(Formerly Builders First Choice)
Johnston County
In accordance with your request received June 2, 2003, the Division is forwarding the subject permit
modification. This modification documents the change in name/ownership at the subject facility. All other terms
and conditions in the original permit remain unchanged and in full effect. This permit modification is issued
under the requirements of North Carolina General Statute 143-215.1 and the Memorandum of Agreement
between North Carolina and the U. S. Environmental Protection Agency dated December 6, 1983.
If any parts, measurement frequencies or sampling requirements contained in this permit modification
are unacceptable to you, you have the right to an adjudicatory hearing upon written request within thirty (30)
days following receipt of this letter. This request must be a written petition conforming to Chapter 150E of the
North Carolina General Statutes, filed with the Office of Administrative Hearings, 6714 Mail Service Center,
Raleigh, North Carolina 27699-6714, Unless such demand is made, this decision shall be final and binding.
This permit does not affect the legal requirement to obtain other permits which may be required by the
Division of Water Quality, the Division of Land Resources, Coastal Area Management Act, or any other Federal or
Local government permit that may be required. If you have any questions concerning this permit, please contact
Valery Stephens at the telephone number or address listed below.
cc: Central Files
Raleigh Regional Office, Water Quality Section
NPDES Unit
1617 Mail Service Center, Raleigh, North Carolina 27699-1617
Sincerely,
an W. Klimek, P.E.
919 733-5083, extension 520 (fax) 919 733-0719
VISIT US ON THE INTERNET @ ht4lllh2o.enr.shate.nc.us1 [e-mail]

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DMSION OF WATER QUALITY
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF COVERAGE No. NCG140294
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,
S T Wooten
is hereby authorized to discharge stormwater from a facility located at
S T Wooten - Benson
630 Old Roberts Road
Benson
Johnston County
to receiving waters designated as an unnamed tributary to Beaverdam Creek, a class C NSW water 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 coverage shall become effective June 4, 2003.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day June 4, 2003
Alan W. Klimek, P.E. Director
Division of Water Quality
By Authority of the Environmental Management Commission

State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
Michael F. Easley, Governor
William G. Ross, Jr., Secretary
Gregory J. Thorpe, Ph D., Acting Director
Mr. L. C. Medlin
Builders FirstSourcc
PO Box 981
Apex, North Carolina 27502
Dear Mr. Medlin:
2
DEPARTMENTNORTH CAROLINA
February 23, 2002
,
Subject: NPDES Permit Modification — Name Ctiahge
Permit NCG 140294 cr
Builders FirstSource \�•`(�
(Formerly Custom Concrete Company) ;'• ,
Johnston County
In accordance with your request received December 26, 2001, the Division is forwarding the subject permit
modification. This mortification documents the change in name at the subject facility. All other terms and conditions in the
original permit remain unchanged and in full effect. This permit modification is issued under the requirements of North
Carolina General Statute 143-215.1 and the Memorandum of Agreement between North Carolina and the U. S. Environmental
Protection Agency dated December 6, 1983.
If any parts, measurement frequencies or sampling requirements contained in this permit modification are
unacceptable to you, you have the right to an adjudicatory hearing upon written request within thirty (30) days following
receipt of this letter. This request must be a written petition conforming to Chapter 150B of the North Carolina General
Statutes, filed with the Office of Administrative Hearings, 6714 Mail Service Center, Raleigh, North Carolina 27699-6714.
Unless such demand is made, this decision shall be final and binding.
This permit does not affect the legal requirement to obtain other permits which may be required by the Division of
Water Quality, the Division of Land Resources, Coastal Area Management Act, or any other Federal or Local government
permit that may be required. If you have any questions concerning this permit, please contact Valery Stephens at the
telephone number or address listed below.
Sincerely,
kregory J.'rhorpe, Ph D.
cc: Central Files
Raleigh Regional Office, Water Quality Section
NPDES Unit
1617 Mail Service Center, Raleigh, North Carolina 27699-1617
919 733-5083, extension 520 (tax) 919 733-0719
VISIT US ON THE INTERNET @ hlto//h2o.encsta1e.nc.us1 [e-mail]

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF COVERAGE No. NCG140294
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,
Builders FirstSource
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
Builders FirstSource
630 Old Roberts Road
Benson
Johnston County
to receiving waters designated as an unnamed tributary to Beaverdam Creek, in the Neuse River Basin
in accordance with the effluent limitations, monitoring requirements, and other conditions set forth in Parts 1, 11, III, IV, V,
and V I of General Permit No. NCG 140000 as attached.
This certificate of coverage shall become effective February 23, 2002.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day February 23, 2002.
regory J. Thorpe Ph. D. Acting Director
Division of Water Quality
By Authority of the lnviroll
mental Management Commission

V :. 0
State of North Carolina
Department of Environmf
and Natural Resources
Division of Water Quality
Michael F. Easley, Governor
Sherri Evans- Stanton, Acting
Kerr T. Stevens, Director
Mr. W.P. Tatum
Custom Concrete Company
PO Box 2745
Sanford, North Carolina 27331
Dear Mr. Tatum:
{ 2001
. JAN 18
RLGIO,IAL OF
January 12, 2001
IWA
row
Lr4 J Lel
CDENR
TH CAROLINA DEPARTMENT OF
NMENT AND NATURAL RESOURCES
Subject: General Permit No. NCG140000
Custom Concrete Company
Permit Number NCG140294
Johnston County
In accordance with your application for discharge permit received on July 20, 2000 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.
If any parts, measurement frequencies or sampling requirements contained 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 Water Quality. The Division of Water Quality 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 the Division of Water Quality 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 questions concerning this permit, please contact Aisha Lau at telephone
number 919/733-5083 ext. 578.
Sincerely,
WIIAIAM �. [M!I,ZS
For Kerr T. Stevens
cc: Raleigh Regional Office
Central Files
Stormwater and General Permits Unit Files
1617 Mail Service Center, Raleigh, North Carolina 27699-1617 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ 10% post -consumer paper

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF COVERAGE No. NCG140294
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,
Custom Concrete Company
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
Custom Concrete Company
630 Old Roberts Road
Benson
Johnston County
to receiving waters designated as an unnamed tributary to Beaverdam Creek in the Neuse River Basin in accordance
with the effluent limitations, monitoring requirements, and other conditions set forth in Parts I, I1, 111, and IV of
General Permit No. NCG140000 as attached.
This certificate of coverage shall become effective January 12, 2001.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day January 12, 2001.
W��JAWC. Mus
fur Kerr T. Stevens, Director
Division of Water Quality
By Authority of the Environmental Management Commission

I \
;
I \ v �N'mraA-S Fphen son /
Mernorl 31 Fem
50
Stevenson ... 0 � � <J
24
° �I �1
u _c
it
Ir .- V- .
II 1
ranch
201 � / f,_�\ � ... I \u �, —�
Cem
n.
�hnsons Chapel
,
it 7 I
Dem ��, v
Coal E Uj EV A T I10'IN
III'. /`—• —"_ •. , Crossrds oa_
.ass
�� 1VI v _ •II a 252/J
i' �/� Uh 6II•
/ � TOwer°% (- rree -, 56
2l II I
_ -✓1O ___ - �L�� v.(. � _.. � Flo ers Cem
7o
_ Cem \ �� f ° - ReK b th Ch--
i 229
10,
1
263 °. H
__ St Marys
2 _ ° ::Cem'b Ali 4 s
IV
(B SON) 722 132'30" 724000m E. • Irle•I
5254 / NE
SCALE I:24000
0 1 MILE
woo 2000 1000 4000 '000 6000 J000 FEET Medium duty
S 0 l KILOMETRE
CONTOUR INTERVAL 10 FEET
ATIONAL GEODETIC VERTICAL DATUM OF 1929
''.

3800 Brett Dr, Raleigh, NC 27609 to 624 Old Roberts Rd, Benson, NC 27504 - Google Maps htip:Hmaps.google.com/maps?f=d&h1=ens@geocode=7059033063778016935,35.587804,-78...
Start 3800 Barrett Dr
Go'cls
! Raleigh, NC 27609
Maps End 624 Old Roberts Rd
Benson, NC 27504
Travel 27.2 mi — about 30 mins
Get Google Maps on your phone
Tw thw mrd "GMAPS" to466453
i
3800 Barrett Dr
Raleigh, NC 27609
Drive: 27.2 mi — about 30 mins
1. Head west on Barrett Dr toward Haworth Dr
348 ft
♦ 2. Turn right at Six Forks Rd
0.4 mi
1 min
♦ 3. Turn right onto the 1-440/Inner Beltline ramp
0.2 mi
1 min
4. Merge onto 1-440 E
7.3 mi
8 mins
5. Take exit 16 to merge onto 1-40 E toward Benson/Wilmington
17.9 mi
16 mins
6. Take exit 319 for NC-210 E toward Smithfield
0.2 mi
♦ 7. Turn left at NC-210
0.3 mi
2 mins
♦ 8. Turn left at N Pleasant Coates Rd
0.1 mi
♦ 9. Turn left at Old Roberts Rd
0.7 mi
2 mins
,g 624 Old Roberts Rd
Benson, NC 27504
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ
1 of 6/11/2008 3:51 PM

3800 Barrett Dr, Raleigh, NC 27609 to 624 Old Roberts Rd, Benson, NC 27504 - Google Maps
http://naps. google. c oni/map s? hl=en&tab=wl
00811CMaps
of 1 6/11/2008 3:53 PM

ADISCHARGE OUTFALL MONITORING REPORT
NCDENR GENERAL PERMIT NCG140000
(All sample data shall be reported no later than 30 days after receipt of lab results)
Certificate of Coverage
I NCG14 �p ®❑©
Facility Name .
`� - — SD✓X
County
J riNSTD�
Phone Number
I /CJ— 935 - c29�9
Certified Laboratory n
5141110.2 - O 2 /d9
Person Collecting Sample(s)
Collectors Signature
/ �l
M
Samnle Information
Permit Term
Year
Year Start/End Dates
Place check mark to indicate
applicable sampling period
Discharge Type (check as appropriate)
Stormwater
Wastewater
1
August 1, 1999 to July 31, 2000
®
❑
Li
❑
❑
LE
❑
El
❑
❑
❑
❑
2
I August 1, 2000 to July 31, 2001
3
August 1. 2001 to July 31. 2002
4
August 1.2002 to July 31, 2003
5
August 1.2003 to Jul 31, 2004
Part A: Stormwater Discharge Monitoring Data (For stornawater not combined with process wastewater)
® Storm Event Characteristics
Stormwater Discharge Monitoring
Outfall ) Date Sample
No. I Collected
(molddlvr)
Total Flow.
G)
Total Event ,
Pre ipttation
(inches)
Event Duration pH
_
(hours) (Std. Units)
Total ..
Suspended
Solids
(me)
/ I . -oZ
IVAA9
. 5
O. s
I
I
I
4
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
No. ''
Date Sample
Collected =
(moldd/yr)
Total Flow :._Total
:,
-
(MG)
Event
Precipitation
(inches)
_. Event:--
Duration
(hours)
:,-New
Motor Oil:
Usage
(aVmo)
pH
(Std Units)
Total
Suspended
Solids
(mz%
Oil and
Grease
(mg/1)
swu-241-090199 Page lof 2

Part B: Process wastewater discharge monitoring data
Sample' # " /2Y
Effluent Source(s) for this sample
/
Vehicle / Et ui Item Cleaning
❑
Raw Material Stock -pile Wetting
❑
Mixinc Drum Clean -out
❑
Recycle System Overflow
❑
Parameter
Unit
Data
Collection Date
mo/dd/yr
(� —,�g_02
Total Flow
MG
A/lam
Event Duration
hours
'2
pH
Std. units
z
TSS
mg/t
Settleable Solids
mUl
Sample #
Effluent Somcc(s) for this sample
Vehicle / Equipment Cleaning ❑
Raw Material Stock -pile Wetting ❑
Mixing Drum Clean -out ❑
Recycle Svstetn Overflow ❑
Parateter'.
Unit
Data.
Collection Date
mo/dd/yr
Total Flow
MG
Event Duration
hours
pH
Std. units
TSS
mg/I
Settleable Solids
1111/1
Mail original and one copy to:
Attn: Central Files
Division of Water Quality
DENR
1617 Mail Scrvice Center
Raleigh, NC 27699-1617
SWU-241-080199
Sample #
Effluent Somcc(s) for this sample ,/
Vehicle / Equipment Cleaning ❑
Raw Material Stock -pile Wettin ❑
Mixing Drum Clcan-out ❑
Recycle System Overflow ❑
Parameter
Unit
Data
Collection Date
uto/dd/yr
Total Flow
MG
Event Duration
hours
pH
Std. units
TSS
mg/l
Settleable Solids
nil/1
Sample #
C
Effluent Source(s) for this sample
Vehicle / gguipment Cleanin
❑
Raw Material Stock -pile Wettin
❑
Mixing Drum Clean -out
❑
Recycle System Overflow
❑
`Parameter ,
Unit ::
Data
Collection Date
nto/dd/yr
Total Flow
MG
Event Duration
hours
pH
Std. units
TSS
mg/I
Settleable Solids
ml/I
"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 NMne of Pernintee or Design
(S ure of Permittee or Designee)
Page 2 or 2
" �2 d L
(Date)