NCG160005_MONITORING INFO_20100527

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
/V u& �Q �O CD
DOC TYPE
❑ HISTORICAL FILE
MONITORING REPORTS
DOC DATE
❑ p2T)/ o b ) a'
YYYYM M DD

STORMWATER DISCHARGE OUTFALL (SDO)
ANNUAL SUMMARY DATA MONITORING REPORT (DMR) MAY 2 7 2010
Calendar Year A 010
General Permit No. NCG160000
Certificate of Coverage No. NCG16000
This monitoring report summary is due to the DWQ Regional Office no later than 30 days from the date
the facility receives laboratory sampling results from the final sample of the calendar year.
Facility Name:—BARNHILL CONTRACTING COMPANY — I&,-,_-0_ .j1 1 1-e
County: PITT I
Phone Number: (_252_)752-2611 Total no. of SDOs monitored
Outfall No. _1
Is this outfall currently in Tier 2 (monitored monthly)? Yes ❑ No X
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ❑ No X
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other 1 ❑
Outfall
Total Rainfall, inches
00530
00400
00556
Vehicle
Maintenance
Activities
TSS, mglL
pH, s.u.
Oil &
Grease,
mglL
New Motor Oil
Usage,
gal/month
Benchmark
N/A
100 j
6.0— 9.0
30
N/A
Date Sample Collected,
molddlyr
5/19/2010
1 %11
3.7
7.1
<5.0
NIA
�I
SWU-25ONCG16-051709

Additional QLtfall Attachment
Outfall No. _2
Is this outfall currently in Tier 2 (monitored monthly)?
Yes ❑ No X
Was this outfall ever in Tier 2 (monitored monthly) during the past year?
Yes ❑ No X
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency
❑
Received approval from DWQ to reduce monitoring frequency
❑
Other I
❑
Outfall _2_
Total Rainfall, inches
00530
00400
00556
Vehicle
Maintenance
Activities
TSS, mg/L
pH, s.u.
Oil &
Grease,
mg/L
New Motor Oil
Usage,
gal/month
Benchmark
N/A
1001
6.0-9.0
30
N/A
Date Sample Collected,
mo/ddlyr
5/19/2010
1 %11
4.3
7.3
<5.0
NIA
I
it
SW U-250 N CG 16-051709

I
STORMWATER DISCHARGE OUTFALL (SDO)
ANNUAL SUMMARY DATA MONITORING REPORT (DMR)
Calendar Year IDIO
General Permit No. NCG160000
Certificate of Coverage No. NCG16000
This monitoring report summary is due to the DWQ F
the facility receives laboratory sampling results from
Facility Name: _BARNHILL CONTRACTING COMPANY
County: PITT
Phone Number: (_252_j752-2611
rnal Office no later than 30 days from the date
final sample of the calendar year.
Total no. of SDOs monitored
Outfall No. _3 i
i
Is this outfall currently in Tier 2 (monitored monthly)? I Yes ❑ No X
Was this outfall ever in Tier 2 (monitored monthly) during lthe past year? Yes ❑ No X
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to delcrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Outfall _3_
Total Rainfall, inches
00530
00400
00556
Vehicle
Maintenance
Activities
TSS, mglL
pH, s.u.
Oil g
Grease,
mg/L
New Motor Oil
Usage,
gal/month
Benchmark
N/A
100
6.0 - 9.0
30
N/A
Date Sample Collected,
moldd/yr
5/19/2010
1 %11
4.3
7.0
<5.0
N/A
I
SWU-250NCG16-051709

Additional C3utfall Attachment
Outfall No.
Is this outfall currently in Tier 2 (monitored monthly)?
Yes ❑ No X
Was this outfall ever in Tier 2 (monitored monthly) during the past year?
Yes ❑ No X
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency
❑
Received approval from DWQ to reduce monitoring frequency
❑
Other
❑
Outfall _4
Total Rainfall, inches
00530
00400
00556
Vehicle
Maintenance
Activities
TSS, mg/L
pH, s.u.
Oil g
Grease,
mg/L
New Motor Oil
Usage,
gallmonth
Benchmark
N/A
100,
6.0— 9.0
30
N/A
Date Sample Collected,
moldd/yr
5/19/2010
1 %11
2.8
7.1
<5.0
N/A
SW U-250NCG 16-051709

" I certify, under penalty of law, that this document and all aft
supervision in accordance with a system designed to assure
evaluate the information submitted. Based on my inquiry of
those persons directly responsible for gathering the informal
knowledge and belief, true, accurate, and complete. I am a%
submitting false information, including the possibility of fines
Signs
Date
chments were prepared under my direction or
that qualified personnel properly gather and
he person or persons who manage the system, or
on, the information submitted is, to the best of my
that there are significant penalties for
imprisonment for knowing violations."
Mail Annual DMR Summa Iry Reports to:
I
DWQ Regional Office Contact Inform-ti-
Asheville Office ......
[phone]
Fayetteville Office ...
[phone]
Mooresville Office ...
[phone]
Raleigh Office ........
[phone]
Washington Office ...(252)
946-6481
Wilmington Office ...
[phone]
Winston-Salem ......
[phone]
Central Office .........
[phone]
2090 US Highway 70
Swannanoa, NC 28778
[phone]
3800 Barrett Drive
Raleigh, NC 27609
[phone]
LEM
585 Waughtown Street
Winston-Salem, NC 27107
[phone]
225 Green S
Systel Building
Fayetteville, NC 2
(910) 433-3
943 Washington Sq
Washington, NC
(252) 946-64
1617 Mail Service
Raleigh, NC 2769'
(919) 807-631
t 610 East Center Avenue/Suite 301
714 Mooresville, NC 28115
1-5043 [phone]
Mall 127 Cardinal Drive Extension
39 Wilmington, NC 28405-2845
[phone]
:r "To preserve, protect
7 and enhance
North Carolina's water..."
SWU-25ONCG16-051709

APAC-Atlantic, Inc.
July12, 2004
NCDENR
Division Of Water Quality
1617 Mail Service Center
Raleigh NC 27699-1617
Attention: Central Files
RE: Stormwater Discharge Report
COC Permit .Number NCG160005
Dear .Mr. Sennett:
A subsidiary of Ashland Paving And Construction, Inc.
Coastal Carolina Division
P.O. Box 399
Kinston, NC 28502-0399
TO: 252 527-8021, Fax: [phone]
Please find enclosed our resubmitted (with original submittal) Stormwater
Discharge Report for our Greenville Asphalt Plait for the year 2004.
If ),on have any questions, please call me at [phone] Est. 2763.
Sincerely,
APAC-:atlantic Inc.
Coastal Carolina Division
in a C?Huggins
EHS Director
Enclosures: Discharge Outfall Monitoring Report,
Environment I, Inc. Analytical Report
Chain Of Custody
Cc: Washington Regional Office

r _
r � -- i,_
4_�� '���n _ ,
r,, ,

STORNIAVATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
"I"NPat.AL PERMIT N'O. NCGI60000
'I? OF COVERAGE NO. NCG16 0005
CIAO: IFICA'I
1ACILITYNAME, APAC-Atlantic, Inc. / Coastal Carolina
PERSON COLLECTING SAMPLE(S) 7 nda Huggins
t:Elrru u.D l.:\BOR:\"rt>RYtS) Environmental j Irtic_b tt 413
Lab k
I'll' l %: Specific ]lonituring Requirements
SAMPLES COLLECTED DURING CALENDAR YEAR:
(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 laboratory.)
Div. COUNTY Pitt
PHONO O.[phone] E. 2763
(SMNAVURE OF PERMITTEE ESIGNEE)
By this signature, I certify that this report is accurate
complete to the best of my knowledge
Oulfall
No.
Date
Sample
Collected
511050
00530
00556
00400
Tntal
Flow
Total
Suspended
Solids
Oil and
Grease
pH
mo/dd/yr
MG
mg/I
m
units
1
5-3-04
5.6
12
2
5-3-04
l hoc' this li,cilily pcitorm Vehicle .Maintenance Activities using more than 55 gallons of new motor oil per month'? _yes no
cmnplcic pall tit o
Out[.][]
No.
Date
Sample
Collected
• ---- - ----^
50050
-_-. _.._.........
00556
_
00530
00400
Total Floc
Oil and
Grease
Total
Suspended
Solids
pH
New Motor
Oil Usage
mo/dd/yr
MG
mo
MO
unit
al/mo
S'101(NI I:\'E.\'I' Cf l:%It:\C7'EItISTICS:
Date 5-3-04 (if more than one storm event was sampled)
Date
Focal Evenl Precipitation (inches): 1 112 Total Event Precipitation (inches):
1-1-rent Duration (hours): 3 Event Duration (hours):
Mail Original and one copy to:
Division of Rater Quality
Attn: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Form SW1I-252-071400
face I ur 2

STORM\VATER DISCHARGE OUTFALL (SDO)
NIONITORING REPORT
"I certil'y, under penally of law, that this document and all attachments were prepared under my direction or supervision in accordance with a
ss:Slcm 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 nq knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information,
including the possibililp Of' fines and imprisonment for knowing violations."
I S�natu ul'Pcrmillee)
* Submitted originally on incorrect form. (Attached)
5-27-04 (Original Date)
(Date)
7-2-04 (Resubmit Date)
Form S W II-2i2-07140O
Page 2 ,1 2

June 23, 2004
Ms. Linda C. Huggins, EHS Director
APAC-Atlantic Inc.
PO Box 399
Kinston. NC 28502-0399
SUBJECT
Dear Ms. Huggins:
Michael F. Easley
Governor
William G. Ross Jr., Secretary
Department of Environment and Natural Resources
Alan W. Klimek, P.E., Director
Division of Water Quality
APAC-Greenville Asphault Plant
Pitt County
The attached monitoring data was submitted on the wrong form. Please resubmit the data on the correct form. The
correct form for NCG160000 is attached.
If you have any questions, please me at 919-733-5083, ext. 542.
Sincerely,
Mack Wiggins
Storrnwater and General Permits Unit
cc: Stormwater and General Permits Unit
cwrn
Cu<loinr� Seri vigo Ihai,.ion of IVdloi Qu' lily : t.ldd Sorcice Collier R;doiull. N ,::7699-1,;1 (9mlt ..: i_'p1

�d--ILAiV®�
APAC-Atlantic, Inc.
Mayl,27, 2004
NCDENR
Division Of Water Quality
1617 Mail Service Center
Raleigh NC 27699-1617
Attention: Central Files
RE: Stormwater Discharge Report
COC Permit Number NCG160005
Dear Mr. Bennett:
A subsidiary of Ashland Paving And Construction, Inc.
Coastal Carolina Division
P.O. Box 399
Kinston, NC 28502-0399
Tel: [phone]. Fax: [phone]
JUN 2 2001
I"
Please find enclosed our Stormwater Discharge Report for our Greenville Asphalt
Plant for the year 2004.
If you have any questions, please call me at [phone] Ext. 2763.
Sincerely,
APAC-Atlantic Inc.
Coastal Carolina Division
Linda C.1 Huggins
EHS Director
Enclosures: Discharge Outfall Monitoring Report)
Environment 1, Inc. Analytical Report
Chain Of Custody
Cc: Washington Regional Office

��r�oQoW����
Flo
��coQpoQa�c�c]
P.O. BOX 7085. 114 OAKMONT DRIVE
GREENVILLE. N.C. 27835-7085
APAC (GREENVILLE ASPHALT)
DIV. OF APAC-CAROLINA, INC.
LINDA C. HUGGINS
P.O. BOX 399
KINSTON ,NC 28502
PARAMETERS
Total Suspended Residue, mg/I
Oil & Grease, mg/I
Stormwater Stormwater
(Nl, Grab) (#2, Grab)
5.6 50
19 5.9
Analysis 1
Date Analyst
05/03/04 I IKD
05/04/04 TMC
PHONE [phone]c
FAX [phone]
Drinking Water ID: 37715
Wastewater ID: 10
ID#: 413
DATE COLLECTED: 05/03/04
DATE REPORTED : 05/05/04
REVIEWED BY;
Method
Code
SM2540D
SM5520B
) ao-��U-
AV
p� a

DISCHARGE OUTFALLIMONITORING REPORT
NCDENR GENERAL PERMIT NCG140000
(All sample data shall be reported no later than 30'days after receipt of lab results)
Certificate of Coverage
NCG16EEDFal©
Facility Name
APAC-Atlantic Inc.
Coastal Carolina Div
County
Pitt
Phone Number
[phone]/E.276
Certified Laboratory #
413
Person Collecting Sample(s)
Linda C. Huggins
Collectors Signature
Sample 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
❑
❑
❑
®
❑
❑
❑
❑
®
❑
❑
❑
❑
❑
2
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 July 31, 2004
Part A: Stormwater Discharge Monitoring Data (For stormwater not combined with process wastewater)
Storm Event Characteristics
Date Total Event Precipitation inches I Event Duration hours
I
Stormwater Discharce Monitoring
Outfall
No.
Date Sample
Collected
mo/dd/vr)((MG)
Total Flow
Total Event
Precipitation
(inches)
Event Divation
(hours)
pH
Std. Units)
Total
Suspended
Solids
m D
I
Does this facility perform Vehicle Maintenance Activities using on average more than 55 gallons of new motor
oil per month? ❑ Yes R No If yes, complete information below.
Stormwater Discharge Monitoring from Vehicle Maintenance Areas
Outfall
No.
Date Sample
Collected
(mn/dd/vr)
Total Flow
(MG)
Total Event
Precipitation[(hours)
(inches)
Event
Duration
New I
Motor Oil
Usage
(gaumo)
pH
(Sid. Units)
Total
Suspended
Solids
(mp/l)
Oil and
Grease
(mv/D
I
I
I
I
I
19t:.]a! nsoIoo 1'acc lot:

Part B: Process wastewater discharge monitoring data
Sample # 1
Effluent Source(s) for this sample
Vehicle / Equipment Cleaning
Raw Material Stock -pile Wetting
Mixing Drum Clean -out KI
Recycle System Overflow ❑
Parameter
Unit
Data
Collection Date
mo/dd/yr
5/3/04
Total Flow
MG
Event Duration
hours
3
pH
Std. units
7.2
TSS
mg/I
5-6
Settleable Solids
ml/l
19
Sample # P
Effluent Source(s) for this sample
Vehicle / Equipment Cleaning
Raw Material Stock -pile Wetting
Mixing Drum Clean -out �jc]
Recycle System Overflow ❑
Parameter
Unit
Data
Collection Date
mo/dd/yr
5/3/04
Total Flow
MG
Event Duration
hours
3
pH
Std. units
7.6
TSS
mg/I
50
Settleable Solids
mL/I
5.9
Mail original and one copy to:
Attn: Central Files
Division of Water Quality
DENR
1617 Mail Service Center
Raleigh, NC 27699-1617
i Sample #
Effluent Source(s) for this sample
Vehicle / Equipment Cleanin ❑
I Raw Material Stock -pile Wetting ❑
Mixing Drum Clean -out ❑
Recycle System Overflow ❑
Parameter
Unit
Data
Collection Date
mo/dd/yr
Total Flow
MG
'Event Duration
hours
j pH
Std. units
TSS
mg/I
Settleable Solids
mUl
/ Equipment Cleaning 10
iterial Stock -pile Wetting ❑
Drum Clean -out ❑
Svstem Overflow O
i Parameter
Unit
Data
Collection Date
mo/dd/yr
Total Flow
MG
Event Duration
hours
pH
Std. units
TSS
mg/I
Settleable Solids
mul
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 thatithere are significant penalties for submitting false
information, including the possibility of fines and imprisonment for knowing
violations."
(Print Nalne of Permittee or DesIiignee)
4(Signature of Permittee or Desinec) (Date)
SWU-241-080190 Page 2 of 2

May 27, 2004
NCDENR
Division Of Water Quality
1617 Mail Service Center
Raleigh NC 27699-1617
Attention: Central Files
RE: Stormwater Discharge Report
COC Permit Number NCG160005
APAC-Atlantic, Inc.
A subsidiary of Ashland Paving And Construction, Inc.
Coastal Carolina Division
P.O. Box 399
Kinston, NC 28502-0399
Tel: [phone], Fax: [phone]
RECEWIVF.D
MAY 2 8 2004
DWQ-WARO
Dear Mr. Bennett:
Please find enclosed our Stormwater Discharge Report for our Greenville Asphalt
Plant for the year 2004.
If you have any questions, please call me at [phone] Ext. 2763.
kdantic Inc.
Carolina Division
Linda C. Huggins
EHS Director
I
Enclosures: Discharge Outfall Monitoring Report
Environment 1, Inc. Analytical Report
Chain Of Custody
Cc: Washington Regional Office

A -ARA
NCDENR
DISCHARGE OUTFALL MONITORING REPORT
GENERAL PERMIT NCG140000
(All sample data shall be reported no later than 30 days after receipt of lab results)
Certificate of Coverage
NCGIg120[DIE
Facility Name
- an is nc.
Coastal Carolina Div
County
Pitt
Phone Number
[phone]/E.276
Sample Information
Sample(s)
413
C�
Permit Term
Year
Year Start/End Dates
Place check mazk to iridicate
applicable sampling period
Discharge T (check as appropriate)
Stormwater
Wastewater
l
August 1. 1999 to July 31, 2000
Li 1
❑
El1
❑
®
❑
❑
❑
❑
®
❑
El3
El4
❑
❑
2
August 1, 2000 to July 31.2001
August 1, 2001 to July 31. 2002
August 1.2002 to July 31, 2003
5
August 1. 2003 to July 31. 20064
Part A: Stormwater Discharge Monitoring Data (For stormwatei not combined with process wastewater)
Storm Event Characteristics
Date Total Event Precipitation inches Event Duration hours
I
Stormwater Discharge Monitoring
Outfall
No.
Date Sample
Collected
mo/dd/vr)
Total Flow
G)
Total Event
Precipitation
(inches)
Event Duration
(hours)
pH
Std. Units)
Total
Suspended
Solids
m 1)
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. i
Outfall
No.
Date Sample
Collected
(mo/dd/vr)
Total Flow
(MG)
Total Event
Precipitation
(inches)
Event
Duration
(hours)
New I
Motor Oil
Usage,
(al/mo)
pH
(Sid. Units)
Total
Suspended
Solids
m I)
Oil and
Grease
(mg/1)
I
I
I
SRa _41 0801IN PaL'e lot:

Part B: Process wastewater discharge monitoring data
Sample # 1
Effluent Sources for this sample
Vehicle / Equipment Cleaning
Raw Material Stock -pile Wetting
Mixing Drum Clean -out
.Recycle System Overflow ❑
Parameter
Unit
Data
Collection Date
mo/dd/yr
5/3/04
Total Flow
MG
Event Duration
hours
3
pH
Std. units
7.2
TSS
mg/l
5.6
Settleable Solids
myl
19
Sample # 2
Effluent Sources for this sample
Vehicle / Equipment Cleaning
Raw Material Stock -pile Wetting
Mixing Drum Clean -out
Recycle System Overflow ❑
Parameter
Unit
Data
Collection Date
mo/dd/yr
5/3/04
Total Flow
MG
Event Duration
hours
3
pH
Std. units
7.6
TSS
mg/1
50
Settleable Solids
ml/l
5.9
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 sample
Vehicle / u1 ment Cleanin ❑
Raw Material Stock- ile Wettin ❑
MixingDrum Clean -out ❑
Recycle S stem Overflow ❑
Parameter
Unit
Data
Collection Date
mo/dd/yr
Total Flow
MG
Event Duration
hours
PH
Std. units
TSS
mg/l
Settleable Solids
ml/I
Sample #
Effluent Source(s) for this sample
Vehicle / Equipment Cleanin ❑
Raw Material Stock -pile Wetting ❑
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
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. 1 am aware that there are significant penalties for submitting false
information, including the possibility of fines and imprisonment for knowing
violations."
(PriZNaa of Permittee or Designee) -
C
(Signature of Permittee or Desi nee) (Date)
SWU-241-080199 Page 2 of 2

N •• .'. .P h.. _ .. � 1 . .,._x. ...C_ .Jn .r+.@+.�aA.J.a✓..:.: i.x 1 .` ...'..Lr_. n+.. — .:% ,n ,�. ul
P.O. BOX 7085 114 OAKMONT DRIVE PHONE [phone]
GREENVILLE, N.C. 27835-7085 FAX [phone]
Drinking Water ID, 37715
Wastewater ID, 10
ID#: 413
APAC (GREENVILLE ASPHALT)
DIV. OF APAC-CAROLINA, INC.
LINDA C. HUGGINS DATE COLLECTED: 05/03/04
P.O. BOX 399 DATE REPORTED : 05/05/04
KINSTON ,NC 28502
REVIEWED BY: ' e
Stormwater Stormwater Analysis Method
PARAMETERS (#1, Grab) (#2, Grab) Date Analyst Code
Total Suspended Residue, mg/I 5.6 50 05/03/04 1 JKD SM2540D
Oil & Grease, mg/l 19 5.9 05/04/04 I TMC SM5520B
-i 3- Oy .
�-L.rt-
Labomtory Analyses — Environmental Consultants

I-mt7)nt I
I'I IB,\7(ti5. 114 (aknwm Di: CHAIN OF CUSTODY RECORD
i rccin illc- :NC 2785S
I'In Inc (251) 756-62W • 1=as (252) 756-063.3
DISINFECTION
Fi Cl ILORINE,
('I,11•;N•�413 Weck:34
UV
Y
APAC(GREENVILLE ASPHALT)
P
G
I)IV. OF APAC-CAROLINA, INC.
❑ NONIi
P.O. BOX 399
A
C
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KINSTON NC 28502
tied
[phone]
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COLLECTION
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:-I'."rLE LC�i.?.TIGII
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Stormwater (NI, Grab)
2
—
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Stormwater 02, Grab)
2
BYISIG.)ISAMPLERI DATE,,T, E
Ilk- 4-MI
HELINUUtSHED BY(SIG .j DATE,TIME ROL- ,7 DBY(SIG.)
RECEIVED BY (SIG.)
Page 1 of 1
CHLORINE NEUTRALIZED AT COLLECTION
PH CHECK (LAB)
CONTAINER TYPE, PIG
CHEMICAL PRESERVATION
A -NONE D-NAOH
B-HNO. E-HCL
C -H,SO, F - ZINC ACETATE
G - NA THIOSULFATE
a
CLASSIFICATION:
WASTEWATER(NPDES
DRINKINGWATER
- --
❑ DWO/GW
SOLID WASTE SECTION
OTHER_SPr•w\
SAMPLES COLLECTED BY:
(Please Pont)
SAMPLES RECEIVED IN LAB AT`=U, P °C
COMMENTS:
m
Instructions for completing this form are on the reverse side.
Sampler must place a "C" for composite sample or a "G" for
n In ^ 0 4 4 n