NCG160195_MONITORING INFO_20200128

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
/V
DOC TYPE
❑HISTORICAL FILE
� MONITORING REPORTS
DOC DATE
❑ a Ud U 0 l a
YYYYMMDD

RECEyr L1
Environmental
Quality JAN 2 S 2020
Stormwater Discharge Outfall (SDO)
cErvrR/�L FILE,'-,
Qualitative Monitoring Report dU,/R SECTI0N,1
For guidance on filling out this fbr-m, please visit htips://deq.ne.gov/about/divisions/energy-mineral-land-resources/
npdes-stormwater-gps
Permit No.: NIC/6�- 11 lib /0 /0 /0 /01 or Certificate of Coverage No.: NIC/G/ 1 / 61 d IS
Facility Name: ( fh SP
County: �,VlPhone No. 336 kff—kZDO
Inspector: . �Zzberr—
Date of Inspection: 1,2-110116
Time of Inspection: ID, go 4,e,-
Total Event Precipitation (inches): , S
All permits require qualitative monitoring to be performed during a "measurable storm event."
A "measurable storm event" is a storm event that results in an actual discharge from the permitted site
outfall. The previous measurable storm event must have been at least 72 hours prior. The 72-hour storm
interval does not apply if the permittee is able to document that a shorter interval is representative for
local storm events during the sampling period, and the permittee obtains approval from the local DENILR
Regional Office.
By this signature, I certify that this report is accurate and complete to the best of my knowledge:
(Signature of Permittee or Designee)
1. Outfall Description:
Outfall. No. _I Structure (pipe, ditch, etc.). P, U
Receiving Stream:
Describe the industrial activities that occur within the outfall drainage area: zz" 7-
Pagel of 2
SWU-242, Last niodiftcd 06/01/201 S

2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: _,,m,G(p,�T --
3. Odor: Describe any distinct.odors that the discharge may have (i.e., smells strongly of oil, weals
chlorine odor, etc.): /Vi; 57re�,c, n_dol�s 1IP% a�
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is clear
and 5 is very cloudy:
l 2 J3 / 4 5
5. Floating Solids: Choose the number which best describes the amount of floating solids in the
stormwater discharge, where 1 is no solids and 5 is the surface covered with floating solids:
1 2 3 0 5
6. Suspended Solids: Choose the number which best describes the amount of suspended solids in
the stormwater discharge, where 1 is no solids and 5 is extremely muddy:
1 2 3 C 5
7. Is there any foam in the stormwater discharge? O Yes a No.
8. Is there an oil sheen in the stormwater discharge? CoYes ® No.
9. Is there evidence of erosion or deposition at the outfall? o Yes ® No.
10. Other Obvious Indicators of Stormwater Pollution:
List and describe
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition may be
indicative of pollutant exposure. These conditions warrant further'investigation.
Page 2 of 2
SWU-242, Last modified 06/01/2018

Semi-annual Stormwater Discharge Monitoring Report iDMRI
for North Carolina DEMLR General Permit No. NCG160000 - Asphalt
Date submitted
CERTIFICATE OF COVERAGE NO. NCG16 vial
3�I�II�![1 '►_.ITT
COUNTY jr
PERSON COLLECTING§AMPLES
LABORATORY Afl .Lit. bn L Lab Cert. #
Comments on sample collection or analysis:
Part A: Stormwater Benchmarks and Monitoring Results
SAMPLE COLLECTION YEAR ,ZDI R _
SAMPLE PERIOD ❑ Jan -June [j]July-Dec
or ❑ M6nthlyl _ (month)
DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
❑Zero -flaw ❑Water Supply [:]SA
❑Other
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
n No discharge this period?'
Outfall No.
Date Sample
Collected;
(mo/dd/yr)
24-hour rainfall
amount,
Inches
Total Suspended Solids
Benchmarks
100 mg/L or 5o mg/L4
1-2,
.5
RECEIVED
JAN 2 8 2020
CENTRAL PILES
DWR SECYIO�)
'Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
2For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a check mark here.
3The total precipitation must be recorded using data from an on -site rain gauge. Unattended sites may be eligible for a waiver of the rain gauge
4requirement. See General Permit text, Table 1, identifying the especially sensitive receiving water classifications where the more protective benchmark
applies.
Note: Results must be reported in numerical format. For example, do not report Below Detection Limit, BDL, <PQL, Non -detect, ND, or other similar non -
numerical format. When results are below the applicable limits, they must be reported in the format, "[XX mg/L", where XX is the numerical value of the
detection limit, reporting limit, quantitation limit, etc. in mg/L.
Note: If you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses. See General Permit text.
Permit Date: 08/01/2019-05/31/2024 SWU-252, last revised 09/04/2019
Page 1 of 2

Part B. Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month.
❑ No discharge this period?2
Outfall No:
Date Sample
Collected"
(mo/dd/yr)
24-hour rainfall
amount,
Inches'
Non -polar O&G by EPA
1664 (SGT-HEM)
Total Suspended Solids
New Motor Oil or Hydra utic
Oil Usage, Annual average
gal/mo
Benchmarks =__>
-
-
15 mg/L
100 /L or So mg/O
_
Footnotes from Part A also apply to this Part B
Note: If you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses. See General Permit text.
FOR PART AAND PART B MONITORING RESULTS:
• A SINGLE BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDANCES FOR THE SAME PARAMETER AT ANYONE OUTFALL? YES ❑ NO ❑
IF YES, HAVE YOU CONTACTED THE DEMLR REGIONAL OFFICE AS REQUIRED BYTHE PERMIT? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an original and one copy his DMR, including all "No Discharge" reports, within 30 days of receipt, of the lab results (or at end of monitoring period
in the case of "No Discharge" reports) to: T
Division of Water Resources
Attn: DWR Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED:
"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 property 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."
(Signature of
(Date)
Permit Date: 08/01/2019-05/31/2024 SWiI-252, last revised 09/04/2019
Page 2 of 2

Environmental
Quality
Stormwater Discharge Outfall- (SDO)
Qualitative Monitoring Report
Far guidance on filling out this form, please visit https:Hdeq.nc.gov/about/divisions/energy-mineral-land-resources/
npdes-stormwater-gps
Permit No.: N/CI(rl 11.610/O/0/0l or Certificate of Coverage No.: NIC/G// 1(�101 1 ISI
Facility Name: 6-eMS Old ,
County: &V1114r, Phone No. 33645'� J Zoo
Inspector: Zw 2 ?- j r�
Date of Inspection: 1Z1101
"Time of Inspection: iv; I / irw•
Total Event Precipitation (inches): I
Ail permits require qualitative monitoring to be performed during a "measurable storm event."
A `measurable storm event" is a storm, event that results in an actual discharge from the permitted site
outfall. The previous measurable storm event must have been at least 72 hours prior. The 72-hour storm
interval does not apply if the permittee is able to document that a shorter interval is representative for
local storm events during the sampling period, and the•permittee obtains approval from the local DEMLR
Regional Office.
By this signature I certify that this report is accurate and complete to the best of my knowledge:
(Signature of Permittee or Designee)
1. Outfall Description: -
Outfall No. 12, Structure (pipe, ditch, etc.):
Receiving Strcam:
Describe the industrial activities that occur within the outfall dr*a'mage area: S
Page I of 2
SWU-242, Last modified 06/01/2019

2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: A;)do d6nim
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil, weak
chlorine odor, etc.): n/�_ _iST11c-T 66,�„
4. Clarity: Choose the number which best describes the clarity of the discharge, where I is clear
and 5 is very cloudy: . !-
1 2, (3) 4 5
5. Floating Solids: Choose the number which best describes the amount of floating solids'in the
stormwater discharge, where 1 is no solids and 5-is the surface covered with floating solids:
1 2 4 5
6. Suspended Solids: Choose the number which best describes the amount of suspended solids in
the stormwater discharge, where i is no solids and 5 is extremely muddy:
1 2 3 5
7. Is there any foam in the stormwater discharge? O Yes 0 No.
S. Is there an oil sheen in the stormwater discharge? UYes ' m No.
9. Is there evidence of erosion or deposition at the outfall? o Yes Cr No.
10. Other Obvious Indicators of Stormwater Pollution:
List and describe
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition may be
indicative of pollutant exposure. These conditions warrant further investigation.
Page 2 of 2
SWU-242, Last modified 06/0 f /20 i 8 1 ,

Semi-annual Stormwater Discharge Monitoring Report (DMR)
for North Carolina DEMLR General Permit No. NCG160000 - Asphalt
Date submitted
CERTIFICATE OF
FACILITY NAME
COUNTY &,,
No. NCG 16 OR 5-
PERSON COLLECTING SAMPLES (C
LABORATORY _/✓lpiAa J- Lab Cert. #
Comments on sample collection or analysis:
Part A: Stormwater Benchmarks and Monitoring Results
SAMPLE COLLECTION YEAR Z-0l1
SAMPLE PERIOD ❑ Jan -June ❑ July -Dec
or ❑ Monthly' (month)
DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
❑Zero -flow ❑Water Supply ❑SA
[:]Other
PLEASE REMEMBER TO SIGN ON THE REVERSE -->
n No dischorge this period:
Outfall No.
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
Inches'
Total Suspended Solids
Benchmarks ===>
-
-
100 mg/L or SO mg/0
1 Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
2For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a check mark here.
3The total precipitation must be recorded using data from an on -site rain gauge. Unattended sites may be eligible for a waiver of the rain gauge
"requirement. See General Permit text, Table 1, identifying the especially sensitive receiving water classifications where the more protective benchmark
applies.
Note: Results must be reported in numerical format. For example, do not report Below Detection Limit, BDL, <PQL, Non -detect, ND, or other similar non -
numerical format. When results are below the applicable limits, they must be reported in the format, "<XX mg/V where XX is the numerical value of the
detection limit, reporting limit, quantitation limit, etc. in mg/L.
Note: if you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses. See Genera! Permit text.
Permit Date: 08/01/2019-05/31/2024 SWU-252, last revised 09/04/2019
Page 1 of 2

Part B: vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month.
[] No discharge this period?'
Outfall No.
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
Iriches3
Non -polar O&G by EPA
1664 (SGT-HEM)
Total Suspended Solids
New Motor Oil or Hydraulic
Oil Usage, Annual average
gal/mo
Benchmarks
15 mg/L
100 /L or 50 mg/L'
Footnotes from Part A also apply to this Part B
Note: If you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2; or Tier 3 responses. See General Permit text.
FOR PART A AND PART B MONITORING RESULTS:
+ A SINGLE BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS.
+ 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDANCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES ❑ NO ❑
IF YES, HAVE YOU CONTACTED THE DEMLR REGIONAL OFFICE AS REQUIRED BYTHE PERMIT? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an original and one copy of this DMR, including all "No Discharge" reports, within 30 days of receipt of the lab results tor at end of monitoring period
in the case of "No Discharge" reports) to:
Division of Water Resources
Attn: DWR Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED:
"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."
of
11�2a/zo •
(Date)
Permit Date: 08/01/2019-05/31/2024 SWU-252, last revised 09/04/2019
Page 2 of 2

Emlr«nnWnlal
Qwdiry
Stormwater Discharge ®utfall (SILO)
Qualitative Monitoring Report
For guidance oft f lling out this jbi m, please visit https://deq.ne.gov/about/divisions/energy-mineral-land-resources/
npdes-stormwater-gps
Permit No.: NICI (; 1 / 161. d I010101 or Certificate of Coverage No.: NICIGI I 1 b 1 p I / 191
Facility Name: LrF✓n.�i
County: _ (-rui l t oY e� _ Phone No. T33
Inspector: �, e
Date of Inspection: } L I Ulil
Time of Inspection:
Total Event Precipitation (inches):
All pen -nits require qualitative Monitoring to be performed during a "measurable storm event."
A "measurable storm event" is a storm event that results in an actual discharge from the permitted site
outfall. The previous measurable storm event must have been at least 72 hours prior. The 72-hour storm
interval does not apply if the permittee is able to document that a shorter inten-al is representative for
local storm events during the sampling period, and the permittee obtains approval from the local DEMLR
Regional Office.
By this signature, I certify that this report is accurate and complete to the best of my knowledge:
(Signature of Perinittee or Designee)
1. Outfall Description: l
Outfall No. .3 Structure (pipe; ditch, etc.):
Receivina Stream:
Describe the industrial activities that occur within the outfall drainage area:
Page 1 of 2
SIVU-242. Last modified 06101/2018

2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: r
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil, weak
chlorine odor, etc.): „ ��deid 9: _
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is clear
and S is very cloudy:
1 C2 3 - 4 5
5. Floating Solids: Choose the number which best describes the amount of floating solids in the
stormwater discharge, where 1 is no solids and 5 is the surface covered with floating solids:
1 2 C3 4 5
6. Suspended Solids: Choose the number which best describes the amount of suspended solids in
the stormwater discharge, where 1 is no solids and 5 is extremely muddy:
1 CJ 3 4 5
7. is there any foam in the stormwater discharge? O Yes ® No.
8. Is there an oil sheen in the stormwater discharge? OYes ® No.
9. is there evidence of erosion or deposition at the out -fall? o Yes 0 No.
10. Other Obvious indicators of Stormwater Pollution:
List and describe
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition may be
indicative of pollutant exposure. These conditions warrant further investigation.
Pa4e 2 of 2
SWU-242. Last modified 06/0112016

Semi-annual Stormwater Discharge Monitoring Reiport (DMR)
for North Carolina DEMLR General Permit No. NCG160000 - Asphalt
Date submitted
CERTIFICATE OF COVERAGE
FACILITY NAME ��
COUNTY -✓"`f �1;r .
. NCG16��
PERSON COLLECTING SAMPLES. h.o � r 1Pe (_)
lLp►BDRATORY— J± W_�� _ Lab Cert. #
Comments on sample collection or analysis:
Part A: Storrnwater Benchmarks and Monitoring Results
SAMPLE COLLECTION YEAR �U!
SAMPLE PERIOD ❑ Jan -June v 1 lyDec
or ❑ Monthly' month
DISCHARGING TO CLASS []ORW ❑HQW ❑Trout ❑PNA
[]Zero -flow [-]Water Supply []SA
❑Other
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
n No discharge this period?'
outfall No.
Date Sample
Collected)
(mo/dd/yr)
24-hour rainfall
amount,
Inches3
Total Suspended Solids
Benchmarks -__>
-
-
100 mg/L or So mg/L4
IZ D
5
' Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
2For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a check mark here.
3The total precipitation must be recorded using data from an on -site rain gauge. Unattended sites may be eligible for a waiver of the rain gauge
4requirement. See General Permit text, Table 1, identifying the especially sensitive receiving water classifications where the more protective benchmark
applies.
Note: Results must be reported in numerical format. For example, do not report Below Detection Limit, BDL, <PQL, Non -detect, ND, or other similar non -
numerical format. When results are below the applicable limits, they ust be reported in the format, "�<XX mg/L". where XX is the numerical value of the
detection limit, reporting limit, quantitation limit, etc. in mg/L.
Note: If you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, at Tier 3 responses. See Genera! Permit text.
Permit Date: 08/01/2019-05/31/2024 SWU-252, last revised 09/04/2019
Page 1 of 2

Part 8: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month.
Ej No discharge this period?'
Outfall Na.
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
Inches3
Non -polar O&G by EPA
1664 (SGT-HEM)
Total Suspended Solids
New Motor Oil or Hydraulic
Oil Usage, Annual average
gal/mo
Benchmarks
15 mg/L
100 /L or 50 mg/LA
-
Footnotes from Part A also apply to this Part B
Note: If you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or tier 3 responses. See General Permit text.
FOR PART AAND PART B MONITORING RESULTS:
o A SINGLE BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS.
v 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT TIME SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS.
a TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDANCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES ❑ NO
IF YES, HAVE YOU CONTACTED THE DEMLR REGIONAL OFFICE AS REQUIRED BYTHE PERMIT? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an original and one copy of this DMR, including all "No Discharge" reports, within 30 days of recut of the lab results for at end of monitoririgperiad
in the case o "No Dischar e" re arts to:
Division of Water Resources
Attn: DWR Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED:
"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."
(Signature of
ZU 2aG'
(Date)
Permit Date: 08/01/2019-05/31/2024 SWU-252, last revised 09/04/2019
Page 2 of 2

Meritech, Inc.
Environmental Laboratory
A., „ Laboratory Certification No.165
Contact: Renee Gilbert Report Date: 12/23/2019
Client: Gem Seal NPDES#: NCG500661
139 South Walnut Circle
Greensboro, NC Date Sample Rcvd: 12/12/2019
Meritech Worm Order # 12121908 Sample: Outfall 1 Grab 12/10/19
Parame ers
Result
Analysisate
R ne ortiing Limit
Method
Total Suspended Solids
206 mg/L
12/17/19
2.5 mg/L
SM 2540 D
Oil & Grease (HEM)
<5 mg/L
12/17/19
5 mg/L
EPA 1664E
Meritech Work Order #
12121909 Sample: Outfall 2 Grab
12/10/19
g�a .ametea
Result
Analysis Date
R,porting Limit
M-ethod
Total Suspended Solids
65 mg/L
12/17/19
2.5 mg/L
SM 2540 D
Oil & Grease (HEM)
<5 mg/L
12/17/19
5 mg/L
EPA 1664B
Meritech Work Order #
12121910 Sample: Outfall 3 Grab
12/10/19
Parameters
Result
Analysis Date
RepoEdng LiMitMethod
Total Suspended Solids
493 mg/L
12/17/19
2.5 mg/L
SM 2540 D
Oil & Grease (HEM)
7 mg/L
12/17/19
5 mg/L
EPA 1664B
Meritech Work Order # 12121911 Sample: Non Contact Cooling Grab
Parameters
12/11/19
Resul Analy5is DatC RRpe mifing Limit Method
COD 93 mg/L 12/16/19 15 mg/L EPA 410.4
Meritech Work Order # 12121912 Sample: Boiler Blow Down Grab 12/11/19
Parameters
Result
Analysis Date
Reparhig Limit Mgthod
COD
435 mg/L
12/16/19
15 mg/L EPA 410.4
I hereby certify that I have reviewed and approve these data. .. aj a lb r)cix k )
Laboratory Representative
642 Tamco Road, Reidsville, North Carolina 27320
tel.[phone] fax.[phone]

118 Chain of Custody Record (COC)
NPDES#: a,(r LOQW _
Client: C�� � - Phone: 2A) - 45Y Y�0
Address: _i3 L S, WW�jj,trYr/P Fax:
Email:_ 4rA�/��dl,���/
3�(� �5'� y-cS'.��7 n�/Ge. Project:
-
r_ ��Tit , ���n . /fir �i/t_13. co_r_],% P.O.#:
LJ
Attention: j' Turn Around Time*
*RUSH work needs prior approval,
How would you like your report sent? C iarges AnDly
referred), Fax, Mail Std to sj 3-5 Dates z4C-48HHrs
Circle all that apply: Email �
I L_
M E R I TE C H INC,
ENVIRONMENTAL LABORATORIES
,` 642 Tamco Rd. Phone: [phone]
ii
Reidsville NC 27320 Fax: [phone]
Email: [e-mail]
WWW.meritechlabs.com
Sample Location and/or ID #
Sampling Dates & Times
Person Taking sample (Sign/Print):
Lab Use Only
Start
End
comp?
Grab?
:'►of
Cont.
Test(s) Required/
ce?
No
pH OK?
Cl OK?
Date
Time
Date
Time
L
lZbol I I
to,,-;o M
,z o 1
a•. 1 A
rTES G
.�
oufWlZ
10:341
Z
ps`i
iz !a I q
10;3
L
1 P,3 Ja yh
D G- SS (J
ff o
WI/I
'r /5
14
>rS fA
1(� o
By der 13 loo w
l Z1 J 1
N
�' 7,
L
Temperature Upon
Receipt:
Method of
Shipment:
Dechlorination <0.5 m) of Ammonia, Cyanide, Phenol and TKN samples must be done in the field priorto preservation.
Comments:
Compositor #
❑, UPS
JJUg #
Qi Fed Ex
Are these results for regulatory purposes? Yes I-J No Qi
Report U s in: mg/L Oj mg/kg Lb- ug/L Q_
Hand Delivery
I' hed by: oat Time: � U Z
Recei ` D Time. Z u
U Other
Relinq ' o e: Time �l cy
c3—
Received by: ate: Time:
Rel' qul d by: ate: Time:
Recel ate TI
U