NCG030016 DMR SW

It
Luxfer®
Gas Cylinders
December 11, 2015
Central Files
Division of Water Quality
1617 Mail Service Center
Raleigh, NC 27699-1617
RECEIVED
DEL 16 2015
CENTRAL FILES
DWR SECTION
Subject: Storm Water Discharge Monitoring Report
General Permit No. NCG030000
Certificate of Coverage No. NCG0300016 l'/V c'6� 0 3 6(0
Dear Sir or Madam:
Please find enclosed our Monitoring Report and Qualitative Monitoring Report (original and one
copy) from our facility SDO No. 1.
The storm event that was sampled took place on November 11, 2015. The samples were taken
by a Luxfer employee and analysis made by Meritech, Inc. # 165, Reidsville, NC.
Should you have any questions on this report, please call me at [phone], Ext. 3019.
Sincerely,
Hunter Owen
Human Resources/Health & Safety/Environmental Manager
c: Jack Nauman, Operations Manager
235 Riverbend Road, Graham, NC 27253 USA, Telephone: [phone], Fax: [phone], www.luxfercylinders.com
Setting the Standard Worldwide

=o- Chain of Custody Record (COC)
NPDES#:
Client: ��.�`r Phone:
Address: Fax:
Email:
Project:
P.O_#:
Attention: Turn Around Time*
How would you like your report sent? `RUSH work needs prior approval.
Circle all that apply: Email (preferred), Fax, Mail Std�l-O-d—avys) 3-5 Days F24-48Hrs
M E FR I T E C H"INC ..
1
ENVIRONMENTAL LABORATORIES
w 642 TamcoRd. Phone: [phone]
x;
Reidsville NC 27320 Fax: [phone]
Email: [e-mail]
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vV vV .mentech-labs.com
Sample Location and/or ID #
.Sampling Dates & TflH'4'bes
Person Faking Sample (Sign/Print):
Lab. Use ®n!y
Start
End
comp?I
Crab?
#of
cont.
Test(s) Required
On Ice?
e'Sy No
pH OK?
Cl OK?
Date
Time
Date
Time
Z
TS
-
Temperature Upon
ge�1p�
Method Of
Shipment:
'** Dechlorination
(<0.5 ppm) of Ammonia, cyanide, Phenol and TKN samples must be done in the field priorto preservation.
Comments:
Compositor #:
dug #
UPS
Fed Ex
Are these res re to purposes? Yes Qs, No 0":
Rep reSU mg/L mg/kg ( ug/L '
Q` --Hand Delivery
Relinquished Date: Time:
­ /(.;I 0
Received by:Dale: Time:
2? -o)-)5
Other
Relinquished by: Date: Time:
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Received by: Date: Time:
Relinquished by. Date: Time:
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