NCG080819_MONITORING INFO_20190115 (FIX)

PERMIT NO.
DOC TYPE
STORMWATER DIVISION CODING SHEET
NCG PERMITS
/vc.& a8vyl�
❑ 'HISTORICAL FILE
;K MONITORING REPORTS
DOC DATE , 3614 0 / 14
YYYYMMDD

�VMICROBAC-
Microbac Laboratories, Inc. - Fayetteville
CERTIFICATE OF ANALYSIS
K8L0372
Sysco Foods Raleigh, LLC Project Name, Selma
Mr. Zak Lokken Project / PO Number: RUN CREDIT CARD
1032 Baugh Road Received: 12/19/2018
Selma, NC 27576 Reported: 01/04/2019
Case Narrative
Field pH (by client): 6.4
Analytical Testing Parameters
Client Sample ID: Stornwater, grab
Sample Matrix: A(lueous Collected By: Lokken
Lab Sample ID: K81-0372-01 Collection Date: 12/14/2018 14:00
Wet Chemistry Result RL Units Note Prepared Analyzed Analyst
Method: EPA 1664 Rev. B
Oil 8 Grease (SGT-HEM) <5.00 5.00 mg/L 01/03/19 1126 TAB
Method: SM 2640 D-2011
Total Suspended Solids
28.2 8.33 mg/L 51
Definitions
RL-. Reporting Limit
S1: Relative Percent Difference (RPD) outside accepted recovery limits
Project Requested Certification(s)
Microbac Laboratories, Inc. - Fayetteville
11 North Carolina DENR NPDES
Report Comments
Samples were received in proper condition and the reported results conform to
applicable accreditation standard unless otherwise noted.
The data and information on this, and other accompanying documents, represents
only the sample(s) analyzed. This report is incomplete unless all pages indicated
in the footnote are present and an authorized signature is included.
12/19/18 1007 MT
Reviewed and Approved By:
lL,lLJL"— L---4L&'t
Jeanne Overstreet
Client Relationship Specialist, Environmental
Reported: 01 /04/2019 14:00
Microbac Laboratories, Inc.
2692 Hope Mills Rd I Fayetteville, NC 28306 1910.864.1920 p I www.microbac.com Page 1 of 2

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• 1410
Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Energy, Mineral and Land Resources General Permit No. NCG080000
Date submitted Z-711 17
CERTIFICATE OF COVERAGE NO. NCG08 S 9
FACILITY NAME -5_yS -C°
COUNTY��a�'� f Toh
PERSON COLLECTING SAMPLES Z41C L ol[fCc�
LABORATORY/41 �c­o /3g c_ _ Lab Cert. # j
Comments on sample collection or analysis:
SAMPLE COLLECTION YEAR 2 d / s-
SAMPLE PERIOD ❑ Jan -June N July -Dec
or ❑ Monthly' (month)
DISCHARGING TO CLASS ❑ORW ❑HQW [—]Trout ❑PNA
❑Zero -flow ❑Water supply ❑SA
RC CO C D ❑Other
JAN 15 2019 PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of -new oillperLMonth? ❑ yes [:]no (ifyes complete Part A)
U%N1R SECTION
Part A: Vehicle & Equipment Maintenance Areas Monitoring Requirements (If applicable) ❑ No discharge this period'
Outfall No. '
Date Sample Collected'
(mo/dd/yr)
24-hour rainfall amount,
Inches3
Non -Polar Oil & Grease
mg/L
Total Suspended Solids,
mg/L
New Motor or Hydraulic Oil Usage,
gal/mon
Benchmarks
_
_
15
100 or 504
-
Parameter Code
-
46529
00552
C0530
NCOIL
/2VI 7�
/ U
,�0
2L2
1741
' Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
z For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark 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.
4 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, etc. in mg/L. Conversely, where fecal coliform results exceed the dilution upper limit, report the result as ">W.
Permit Date: 11/1/2018-5/31/2021 5WU-248, last revised 11/1/2018
Page 1 of 2

I a 0 a
Part B: Oil/water Separators and Secondary Containment Areas at Petroleum Bulk Stations and Terminals (If applicable) ❑ No discharge this period'
Outfall
z s l�o
��.. e z(mo/ddlYrl
;- :Date Sample
Collectedl'
ti 24h ur ra
o infail
amount;
:'IncFies�F `
Sa -ple Co!lectedl '
m - -
"moLdd/yr `~#
' �°
Iota I Suspended
r` Solids, :
,/L-�� `
mg
pH,
Standardunits�
`
Non -Pula Q
Grease, I
mj/L
Permit Limrt
c
l00 ar 504
T
6 0 — 9 0
15
Pdramei`erCade--,- -,
k; ti
_ ;, `4- 65291;
4�` F c
C0530� z`. s
>' _00480
00552
/ lY /?
Z a
2. 1y/1,57
Z �. t
�. `�
< T; a 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 Z or Tier 3 responses. See General Permit text.
FOR PARTAAND PART B MONITORING RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART li SECTION B.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES ❑ NO
IF YES, HAVE YOU CONTACTED THE DEMLR REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an original copy of this DMR, including all "No Discharae" reports, within 30 days of receipt of the lab results tar at end of monitoring period in the
case o "No Dischar e" reports] to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED:
N 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."
q 2 0119
Date
Permit Date: 11/1/2018-5/31/2021 SWU-248, last revised 11/1/2018
Page 2 of 2

i
�J
s
"
GNCDENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance on filling out this form, please visit: http:l/t)ortal.ncdenr.org/wei)/wq/ws/str/ripdessw#tab-4
Permit No.: N/C/ q/ o/ F/ o/j/.L/Y/ or Certificate of Coverage No.:
Facility Name. E S C O / 4 I -I !,
County: i%u-r-17— Phone No. 9/5- 7 f S — 2 YLid _
Inspector:7,9K I—Xee n
Date of Inspection: L/// r�/S _
Time of inspection: // PA1
Total Event Precipitation (inches): A 0
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
(See information below.)
2T Yes ❑ No
RECEIVED
NI
Please verify whether Qualitative Monitoring must be performed durir �Y" epreseenBtative storm
event" or "measureable storm event" (requirements vary, deperldingfdfildie Pi r_mitf S
DWR SECTION
Qualitative monitoring requirements vary. Most permits require qualitative monitoring to be
performed during a "representative storm event" or during a "measureable storm event." However,
some permits do not have this requirement. Please refer to these definitions, if applicable.
A "representative storm event" is a storm event that measures greater than 0.1 inches of rainfall
and that is preceded by at least 72 hours (3 days) in which no storm event measuring greater than
0.1 inches has occurred. A single storm event may contain up to 10 consecutive hours of no
precipitation.
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 DWQ Regional Office.
By this signature, 1 certify that this report is accurate and complete to the best of my knowledge:
(Signature of P fttee or Designee)
5WU-242,Last modified 10/25/2012
Page 1 of 2

1. Outfall Description:
Outfall No. _� Structure (pipe, ditch, etc.) _ J! /.
Receiving Stream: Pon "ell*
Describe he industrial activities that occur within the outfall drainage area:
oeel7 Ci+oO
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: r a 1- `,
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.): /-ax-IZ7 _
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
1 2 3 5
S. 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 ® 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 ("-% 4 5
7. Is there any foam in the stoi=mwater discharge? Yes No
8. Is there an oil sheen in the stormwater discharge? Yes C'N
9. Is there evidence of erosion or deposition at the outfall? Yes
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.
is
0
Page 2 of 2
SWU-242, Gast modified 10/25/2012

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No. NCGO80000
Date submitted
CERTIFICATE OF COVERAGE NO. NCG08 e) L
FACILITYNAME SYSCa 1feZe4<!
COUNTY _. 6,1 S 7on _
PERSON COLLECTING SAMPLES Z.qK L aK/<,--,
LABORATORY /w r cro 14c _ Lab Cert. # %
Comments on sample collection or analysis:
Part A: Vehicle Maintenance Areas Monitoring Requirements
SAMPLE COLLECTION YEAR 2 0/ F
SAMPLE PERIOD D<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 4
No discharge this period'
Outfall
No.
Date-
Sample Collected,
mo/dd/yr
00530 .`
00400.
00556
I
"Total Suspended
Solids; mg/L
pH, _
Standard units :
Non=Pola,irOil and Grease/TP.H EPA
Method 1664 (SGT-HEM), mg/L
New.Motor Oil Usage,
Annual average gal/mo
Benchmark
-
50 or 100 see permit
Within 6.6 - 9.0
15
O`� 70al F
/ D, D
. U U
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month?
(if yes, report your analytical results in the table immediately below)
Part B: Oil/water Separators and Secondary Containment Areas at Petroleum Bulk Stations and Terminals
yes _no
Outfall
No.,
Date
Sample Collected,
mo/dd/yr ° .
00556
00530
00400 i
Non -Polar Oil and Grease/TPH EPA Method
1664'(SGT-HEM),'mg/L R` "
.'Total Suspended.Solids,
mg/L
pH,
Standard units,
Permit Limit
-
15
50 or 100 see permit
6.0 — 9.0
k For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here.
SWU-250 last revised October ?5, 2012
Page I of

STORM EVENT CHARACTERISTICS:
Date(first event sampled)
Total Event Precipitation (inches): v
Date (list each additional event sampled this reporting period, and rainfall amount)
Total Event Precipitation (inches):
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 BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANYONE OUTFALL? YES ❑ NO []
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES []NOR
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 (or at end of monitoring period in
the case o "No Discharge"" reports) to:
Division of Water Quality
Attn: DWQ 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 Permittee)
(Date)
Additional copies of this form may be downloaded at: http://portal.ncdenr.org/web/wci/ws/su/npdessw#tab-4
M
SWU-250 • • last revised O* 25, 201
age 2 of 2

Sysco Foods Raleigh, LLC
Mr. Zak Lokken
1032 Baugh Road
Selma, NC 27576
Case Narrative
Field pH (by client): 6.3
Analytical Testing Parameters
*MICROBAC"j
Microbac Laboratories, Inc. - Fayetteville
CERTIFICATE OF ANALYSIS
K8D0399
Project Name: Storm water sample - Semiannual
Project 1 PO Number: RUN CREDIT CARD
Received: 04/18/2018
Reported: 05/03/2018
Client Sample ID: Storruwater, grate
Sample Matrix: Aqueous Collected By: LokKeN
Lab Sample ID: K8D0399-01 Collection Date: 04115/2018 23:00
Wet Chemistry Result RL Units Note Prepared Analyzed Analyst
Method: EPA 1664 Rev. B
Oil & Grease (SGT-HEM) <5.00 5.00 mglL 05/02/18 0956 TAB
Method: SM 2640 D-2011
Total Suspended Solids 10.0
Definitions
RL: Reporting Limit
Project Requested Certification(s)
Microbac Laboratories, Inc. - Payetteville
11
Report Comments
2.50 mg1L
North Carolina DENR NPDES
Samples were received in proper condition and the reported results conform to
applicable accreditation standard unless otherwise noted.
The data and information on this, and other accompanying documents, represents
only the sample(s) analyzed. This report is incomplete unless all pages indicated
in the footnote are present and an authorized signature is included.
Reviewed and Approved By:
Jeanne Overstreet
Project Manager
[e-mail]
05/03/2018 15:32
04119/18 0921 MT
Microbac Laboratories, Inc.
2592 Hope Mills Rd I Fayetteville, NC 28306 1910.864.1920 p I www.microbac.com Page 1 Of 2

I
VMIC013AC
I
Lab Report Address
Client Name:
Address: �0 2 (Jc
City, State, Zip: 2 7 7
Telephone No.:
Send Report via: .I [ ] Fax E-mail (addressx.,/<RC_h_.2�(� RA/C. �ys[�: d� via: [ ]Mail [ ]Fax -mail (address) I M {
Compliance Monitoring? ''' tYes [I No
Project: Location: PO No,: I
I
Sampled by (PRINT): 091el
M lcrobec-FayetteviIle
2592 Hope Mills Rd.
Fayetteville, NC 28306
Invoice Address
Client Name: +
5 �
Address:
City, State, Zip:
Contact:
Telephone No.:
Sampler
Signature:
CHAIN OF CUSTODY RECO �.
Numbe6
Instructions on back —
Turnaround Time
TO BE COMPLETED SYMICROBAC- ;
Routine (5 to T business days)
[ ] RUSH` (notify lab)
Temper cure Upon Receipt (°C) Therm ID
..
Holding�Time
= ;'
(needed by)
Samples Received on lce7 Yes" No N!A . }
Re port Type
"Custody Seals Intact?. Yes-" No NW -_
] ]Results Only [ ]Level 1 [ ]Level
2 [ ]Leve13 [ ]Level 4 [ ]EDD
AgencylProgram
Sampler PhoneG� �77
No.:
Matrix Types: SOUSDlid (8), Sludge, Oil, W ipe, Unniting water (t w ,jcrounowater (uw), sunace water (Sw), waste water (vv W ), timer (specify)
Preservative Types: (1) HNO3. (2) H2SO4, (3) HCI, (4) NaOH, (5) Zinc Acetate, (6) Methanol, (7) Sodium Bisulfate, (8) Sodium Thiosulfate, (9) Hexane, (U) U
REQUESTED ANALYSIS
i
l Lab ID ; Client Sample ID
oI
Date Time I °d '� .� ''
Collected Collected M 1 . 0
I
Preservative
Types'` I lti �t� I j� Additional Notes
'
—
]Hazardous] Non -Hazardous [ ] Radioactive
2.
Sample Disposition Dispose as appropriate [ ] Return [ ] Archive
Possible Hazard Identification [
i !: `
Comments
lRellnquished By (s' at e)
_
Date)Tlme (Received By (signature) Date/Time
7ZI
Rel ed By (signature)
DatelTime )Received By (signature) DatelTime
i-_-
�RellnquishedBy{signature}
—_—
�DatelTime Received By(slgnature) � DatelTime
rev.12/2612017 I i rage —/ — oT
I I

0 0 0
Sample Acceptance Policy for Environmental Chemistry and Microbiology
Chain of Custody
A chain of custody MUST accompany all samples received at the laboratory. The following information on the Chain of Custody must be complete: client name and
address, sample collector's name, sample description/identification, matrix, date and time of collection, number of containers, preservative and requested analysis.
Any missing receipt information will be documented in the final report. The laboratory will analyze those target analyses identified by the client on a project -specific
basis. If project -specific information is not available, then the laboratory's default reference methods and target list of analyses will be used.
Sample Containers
Upon receipt at the laboratory sample containers will be evaluated to ensure that all of the containers are intact, that the container, type meets the requirement of
-the specific analytical method, and that the Sample Containers are properly filled.
Preservatives
Chemical preservatives are required by many analytical methods in order to render a specific analyte stable until analysis can be performed at the laboratory.
Chemical preservatives are to be added AT THE TIME OF SAMPLING (either added directly or via pre -preserved bottles), unless it is unsafe to do so.
Transport/Receipt Temperature
Many of the analytical methods utilized require that samples be kept cool during sample transport. Microbac will assess and document the receipt temperature of
each cooler received at the laboratory. Where thermal preservation is required, the receipt temperature must be in a range of 0.1 — 6°C for environmental
chemistry samples or <10 °C for environmehtal microbiology samples. Samples received on the same day as collection will be measured for temperature but will
be evaluated based on the sample transport conditions. Samples delivered on the same calendar day as collection must be presented to the lab such that an
attempt has been made to cool the samples, such as storage in a cooler on ice.
Holding Time
Samples should be provided; to the laboratory as soon as possible after collection to ensure that analysis can be performed within the method specified Holding;
"Time. Upon receipt at the laboratory, the sample date and time as well as the required chemistries will be evaluated to identify if any of the samples may be past
the maximum holding time.
If it is determined that a container or sample condition has been compromised, is inappropriate for the requested analysis, improperly filled, improperly preserved or
received outside of the required temperature range or received with inadequate holding time available, your Microbac Project Manager will contact you for direction.
Documentation of decisions made to proceed with analysis will be.provided to you as part of the Cooler Inspection form in the final report.
In the absence of a written agreement to the contrary, submission of samples constitutes an acceptance by the Client of Microbac's Sample Acceptance Policy and
Microbac's Standard Terms & Conditions, a copy of which can be found at microbac.com

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water QuPlity General Permit No. NCGO80000
Date submitted
,Z/oh F
CERTIFICATE OF COVERAGE NO. NCG08 0
FACILITY NAME
COUNTY J—,o G's-7,,
PERSON COLLECTING SAMPLES 77,4/e
LABORATORY 1'lteo-v 134c, Lab Cert. #
Comments on sample collection or analysis:
Part A: Vehicle Maintenance Areas Monitoring Requirements
SAMPLE COLLECTION YEAR 2 G / 7
SAMPLE PERIOD ❑ Jan -June (July -Dec
or ❑ monthly' (month)
DISCHARGING TO CLASS [:]ORW DHQW [jTrout [jPNA
Dzero-flow ElwaterSupply [:]SA
00ther
Pf=r,P\/ED PLEASE REMEMBER TO SIGN ON THE REVERSE
JAN 19 2018 El No discharge this period'
DO SECTION..­..v
N.FqRMAUN.56
77,7 7.­
W7�
VW111
1;samp -ollecte'd,
kr
Totausus e­r�iM
p
pi�
T r6� �ett gtpk-
Usage,
Solids,rng/L
'HEM)
-Annualaver
-mg
age gal/,mo,
i--
�—; —hmark Wr60.jeepe,rmiit
0In­
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? _yes _no
(if yes, report your analytical results in the table immediately below) I
Part B: Oil/water Separators and Secondary Containment Areas at Petroleum Bulk Stations and Terminals
S
00400
Grease p"H%Ep'A� tod
o ar0WjndZi "
Total -suspended S@ids;pieC611
P
c
. ,onP
.
;-
16 Mu
tandar&unt s-
Permit ml
i—od seeipermit
L
I For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here.
SWU-250 last revised October 25, 2012
Page 1 of 2

STORM EVENT CHARACTERISTICS:
Date(/%/� / first event sampled)
Total Event Precipitation (inches):
Date (list each additional event sampled this reporting period, and rainfall amount)
Total Event Precipitation (inches):
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 BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES ❑ NO
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO
REGIONAL OFFICE CONTACT NAME:
Mail an original and one cony of this DMR, including all "No Discharge" reports, within 30 days of receipt of the lab results for at end of monitoring Period in
the case o "No Discharge" reports) to:
Division of Water Quality
Attn: DWQ 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
101/'
(Date)
Additional copies of this form may be downloaded at: http://portal.ncdenr.org/weblwcl/ws/sulnpdessw#tab-4
SWU-250 • 1101
last revised 0�r 25, 2012
age 2 of 2

(5)MICROBAC'
Microbac Laboratories, Inc. - Fayetteville
CERTIFICATE OF ANALYSIS
K7KO551
Sysco Foods Raleigh, LLC Project Name: Storm water sample - Semiannual
Mr. Zak Lokken Project / PO Number: RUN CREDIT CARD
1032 Baugh Road Received: 11/14/2017
Selma, NC 27576 Reported: 12/01/2017
Analytical Testing Parameters
Client Sample ID: StormWator, grab
Sample Matrix: Aqueous Collected BY: Lokkerr
Lab Sample ID: K70551-01 Collection Date: 1111012017 11:00
Wet Chemistry
Method: EPA 1664
Oil & Grease (SGT-HEM)
Method: SM 2540 D-1997
Total Suspended Solids
Result
RL
Units
Note Prepared Analyzed
Lab
<5.00
5.00
mglL
11/30/17 0851
FAY
11.4 2.00 mglL 11/15/17 1026 FAY
Laboratory
FAY: Microbac Laboratories, Inc. - Fayetteville
Definitions
RL: Reporting Limit
Report Comments
Samples were received in proper condition and the reported results conform to
applicable accreditation standard unless otherwise noted.
The data and information on this, and other accompanying documents, represents
only the sample(s) analyzed. This report is incomplete unless all pages indicated
in the footnote are present and an authorized signature is included.
Reviewed and Approved By. -
Jeanne Overstreet
Protect Manager
jeanne. [e-mail]
12/0112017 15:55
Microbac Laboratories, Inc.
2592 Hope Mills Rd I Fayetteville, NC 28306 1910.864.1920 p I www.microbac.com
+►
Page 1 of 2

Fayetteville Division 25r32 Hope �1+1111s Road —Fayetteville, NC 2EI30fi (9101 864-1920 ; "
(?��'iiCFi�B��__ 'K7K0551`
CHAIN OF CUSTODY RECORD 112111111111
CUw LAME d Aoonss:
Sysco Foods Raleigh, LLC
1032 Baugh Road
Selma NC 27576
nos
PRarecTr LOCATION:
Storm Water - Semi Annual
L
O-
m
MILL
TYPE OF ANALYSIS
PRESERVATION (CODE)
z
coop` A Nor7e"1
f €
13 HNO3 (pH<2)1'6 C ,
h' C H2SO4(pH<2)
E ZN Acstale + <WLC _
CORT� TPERlow
Mr. Zak Lckken
Prroxs:
919-755-2446
"^
fi� L.Ul r 1
oATEImrrH000F� pmmT:
LA6 10 #
SAMPLI
TYPL
DATE
TIME
LOMP
tuna
Vff
fL0'+v
TEMP•C
CHIRES. DRn1F
SULFIDE
j
Stormwater
X
r
2
C
Rm.q..mw 6y �. rnr. Re�.�.n� eisa<,w�.� -s� r€m• TUrnnro€md l line: REGULAR RUSH
,./T•� .�•k� � � � i� r"� /mot✓ L1[7 ,'u:� Ck'�' -��° �17 1���
Rn€eo.m.ne„n.; ❑w n„e Re Md 4y, rb€ge . Corr menrs or Special Hazards:
' 4 �l
Rel','pu€.nw oy, M.R Trine ecervre er 1 =ee Tim• .
5 6
v" rm!o
-T%-np Fleld I-
lS DATA FOR REG, COMPLIANCE PURPOSE?
ND YES WHICH: _
t-"�
Page 2 of 2

•
•
. h
NCDENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Forguidance on filling out this form, please visit: httD://t)ortal.ncdent'.org/web.lwq,/ws/,su. jnpdesSw#tab-4
Permit No.: or Certificate of Coverage No.:
Facility Name: S,yfC o L -,Of <_ _-
County: Jo h Phone No. 471 - 7 S- S'— 2 `1 ` e
Inspector: Z,1/C
Date of Inspection:
Time of Inspection:
Total Event Precipitation (inches):
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
(See information below.)
29 Yes ❑ No
Please verify whether Qualitative Monitoring must be performed during a "representative storm
event" or "measureable storm event" (requirements vary, depending on the permit).
Qualitative monitoring requirements vary. Most permits require qualitative monitoring to be
performed during a "representative storm event" or during a "measureable storm event." However,
some permits do not have this requirement. Please refer to these definitions, if applicable.
A "representative storm event" is a storm event that measures greater than 0.1 inches of rainfall
and that is preceded by at least 72 hours (3 days) in which no storm event measuring greater than
0.1 inches has occurred. A single storm event may contain up to 10 consecutive hours of no
precipitation.
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 DWQ Regional Office.
By this signature, I certify that this report is accurate and complete to the best of my knowledge:
(Signature of Permit��r Designee)
SWU-242, Last modified 10/25/2012
Pagel of 2

1. Outfall Description: nn
Outfall No. Structure (pipe, ditch, etc.)
Receiving Stream: 96"1
Describe the industrial activities t at occur within the outfall drainage area:
,FLe e-7 S'G'v
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: re c p
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.): /I.0 A.- C--
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
1 3 4 5
S. 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 a 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 2 0 4 5
7. Is there any foam in the stormwater discharge? Yes No
8. Is there an oil sheen in the stormwater discharge? Yes N
9. Is there evidence of erosion or deposition at the outfall? Yes oNo
10. Other Obvious Indicators of Stormwater Pollution:
List and describe /Va/vc—
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 10/25/2012

p ,� � ter►
NCDENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance on filling out this form, please visit: htt rtal.ncdenr.c r web w w u n d essw#tab-4
Permit No.: N/C/G/S1//4-7/ L/.q/ or Certificate of Coverage No.:
Facility Name: 1G o al---rr
County: h IS 7Gj Phone No. 111 - 7 ss = 2 9y4
Inspector: Z 1C Z-4re i
Date of Inspection: s`%/ 7
Time of Inspection:
Total Event Precipitation (inches): %
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined RIPOYE .J
(See information below.)
JUL 11 ZOO,
f Yes ❑ No CENTRAL FILES
MR SECTION "
Please verify whether Qualitative Monitoring must be performed during a "representative storm
event" or "measureable storm event" (requirements vary, depending on the permit).
Qualitative monitoring requirements vary. Most permits require qualitative monitoring to be
performed during a "representative storm event" or during a "measureable storm event." However, ,
some permits do not have this requirement. Please refer to these definitions, if applicable.
1
A "representative storm event" is a storm event that measures greater than 0.1 inches of rainfall
and that is preceded by at least 72 hours (3 days) in which no storm event measuring greater than
0.1 inches has occurred. A single storm event may contain up to 10 consecutive hours of no
precipitation.
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
i 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 DWQ Regional Office.
By this signature, I certify that this report is accurate and complete to the best of my knowledge:
(Signature of Per e or Designee)
Pagel of 2
SWU•242, Last modified 10/25/2012

ti
t
I. Outfall Description:
Outfall No. Structure (pipe, ditch, etc.)
Receiving Stream: �ohr� _ ^ J
OKI-
Describe the industrial activities that occur within the outfall drainage area:
i'Lac 7 S`i a
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: Cc c,
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.):
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
1 2 4.� 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 1 is no solids and 5 is extremely muddy:
1 2 3 / 4) 5
7. Is there any foam in the stormwater discharge? Yes
8. is there an oil sheen in the stormwater discharge? Yes N
9. is there evidence of erosion or deposition at the outfall? Yes eo
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 W/25/2012

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No. NCG080000
Date submitted ;7/-r// I'
CERTIFICATE OF COVERAGE NO. NCGO8 0
FACILITY NAME 1 ,a
COUNTY-�X,� 70 La, ..
PERSON COLLECTING SAMPLES=�cfF�s �ns G••r __ _
LABORATORY A c- Lab Cert. # t
Comments on sample collection or analysis:
Part A: Vehicle Maintenance Areas Monitoring Requirements
SAMPLE COLLECTION YEAR 2017
SAMPLE PERIOD LgJan-June ❑ July -Dec
' or LJ Monthly' _ Lmonth
DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
❑Zero -flow ❑Water supply ❑SA
❑Other
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
❑ No discharge this period'
Oatfall .
.
- No.
_.: Date_
Sample oll ct
C e ed,
mo/dd%yr `
00530:
005S6,
Total pe k
of Sus nded
.,Solids;'mg/L" y
r_ w an H:�> "` K
p
;Standard unitsrlVMethod-1b64
P PA
'Non'Polar Oil .and Grease/T H E
(SGF-HfM};.mg/L..
New Motor Qi! Usa e,
g
_.Annual average gal/mo:
Benchmark"
_ .
., 50 or,100 seed ermit..
- LNithtn.6.R n 9.0- '
s z. - 15
Ir
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? _yes _no
(if yes, report your analytical results in the table immediately below)
Part B: Oil/water Separators and Secondary Containment Areas at Petroleum Bulk Stations and Terminals
Outfall
.. 'Date
'Sample Collected;
L` mo/dd/yr
00556 F�
00530'
00400
EPA Method ,
NonPolar
1664(SGT=HEM}, mg/L* ? , r```"'�
� endeSolids,
Total Su$pNo
` 'mg/L
pHOrlG/TPi
Standard units
Permit limit
- - .
_�:'- :35 ``
` 50'or.100 seepermlt='.' "
6.0 =.9.0
For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring' report with a checkmark here.
SWU-250 last revised October 25, 2012
j.. Page I of 2

STORM EVENT CHARACTERISTICS:
Date S`% (first event sampled)
Total Event Precipitation (inches):
Date (list each additional event sampled this reporting period, and rainfall amount)
Total Event Precipitation (inches):
Note: If you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 1, or Tier 3 responses. See General Permit text.
FOR PART A AND PART B MONITORING RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES.FOR THE SAME PARAMETER AT ANYONE OUTFALL? YES ENOEg
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YE5 ❑ 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 (or at end of monitoring 2eriod in
the case of "No Discharge" reports) to:
Division of Water Quality
Attn: DWQ 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 Pen
'76�/
(Date)
Additional copies of this form may be downloaded at: http:/Jportal.ncdenr.org/web/wq/w5/Su/npdessw#tab-4
tj
S W U - 2 5 0 ;,, last revised Or. a ,r 25, 2012
age 2 of 2

Fayetteville Division
Certificate of Analysis
Sysco Foods Raleigh, LLC Date Reported: 06/12/17
Mr. Zak Lokken Project: Storm watersample-Semiannual Date Received: 06/07/17
1032 Baugh Road Date Sampled: 06/05/17
Selma NC, 27576 Sampled By: Johnson
Stormwater, grab
K7F0188-01
Analyte Result
Units
Analyzed
Analyzed By
Method Qualifier
Field Data
pH 6.6
pH Units
06/05/17 13:45
Johnson
pH
Analyzed by: Microbac Laboratories, Inc. - Fayetteville
Oil & Grease (SGT-HEM) <5.00
mg/L
06/12/17 08:45
JR
EPA 1664
Total Suspended Solids 13.8
mg/L
06/080 14:00
TAB
SM 2540 D-1997
QC Batch Run - (Merobac laboratories, 6te. - Fayetteville)
Analyte
Result
Units
Source
_ RPD
Limit
Total Suspended Solids
300
mg/L
K7F0269
3
5
Total Suspended Solids
21.5
mg/L
K7F0245
2
5
Total Suspended Solids
79.0
mg/L
K7F0190
I t
5
State Certifications: Respectfully Submitted
NCDNR # I I
NCDO14 #37714
Bonnie K. Sanders, Senior Project Nlanagei
Thank you for your business. We invite your feedback on oar level ofservice to you. Please contact the Divivon,blonagcr, Rob Oertner of 910-864-1910 with ony
questions. You may also contact J. Trevor Boyce, President at presidenl0inicmbac. com
Page 1 of 2

Fayetteville Division 2592 Hope Mills Road - Fayetteville, NC 28306 (910) B64-1920
C�D M I C R O B A C' 'K`` I7F018�84"
CHAIN OF CUSTODY RECORD
cLLENT NANe 6 ACORPSC
Sysco Foods Raleigh, LLC
1032 Baugh Road
Selma NC 2757E
Po. PRa�EarrtocAnaN:
' Storm Water - Semf Anneal
1
m
U-
O
#
TYPE OF ANALYSIS
PRESERVATION (COME)
:'
��
11
.
CAI
0`
cnoe:"A Nana
9 HNO3 H<2 �5°C
= (P i
C = H2SO4 (pH<2) + �5'C
D = NaCH � <S'C
E = ZN Acetate + -6°C
F = HCI
G = Sodium Thio
CONTACT PERSON:
Mr. Zak Lokken
PHONE:
919-765-2446
sAmPLacr:
_-C
S .'
OATE I MU400 of SHIPK-UM
LAB ID !R
SAMPLE
TYPE
GATE
TIME
COMP
GRAB
PN
FlO4Y
TEW I-
RE9.
CHLpRINe
sULFIpE
I
Stormwater
X
z
c
LZ
F1
I J
pH Field:
Temp Field 1
Lap inmals--►
Tirrnnrntmd limn: REGULAR
RUSHY r
Comments or Soeciaf Hazards: CJ
IS DATA FOR REG. COMPLIANCE PURPOSE?
No— YES WHICH:
I — Page 2"of 2—

' Semi-annual Stormwater Discharge Monitoring Report 10
for North Carolina Division of Water Quality General Permit No. NCG080000
Date submitted S`����/C
CERTIFICATE OF COVERAGE NO. NCG08 U 1
FACILITY NAME _�SGa :a%,� _
COUNTY , G�ih f Toh .
PERSON COLLECTING SAMPLES - et' _Z o_1i-+f
LABORATORY rate cru f?+c_ Lab Cert. #
Comments on sample collection or analysis:
Part A: Vehicle Maintenance Areas Monitoring Requirements
SAMPLE COLLECTION YEAR
C
SAMPLERERIOD ® Jan -June ❑ July -Dec
or ❑ Monthly' :!Imffinth
'DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout <f]PNA
❑Zero -flow ❑Water Supply ❑SA
[_]Other
PLEASE REMEMBER TO SIGN ON THE REVERSE; -)
❑ No discharge this period'
Outfall
No.
r
Date
Sample, Collected,
mo/dd/yr.
00530
00400
00556
Total Suspended :
Solids, mg/L__ .:
;pH, -
l Standard units + .
z Non -Polar Oil and Grease/TPH EPA
• Method-.'1664 (SGT-HEM_ ), mg/L
New Motor. Oil Usage,
Annual average gal%mo
Benchmark
-
50 or 100.see permit
Within 6.0 - 9.0-
5� I e
2 O
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month?
(if yes, report your analytical results in the table immediately below)
Part B: Oil/water Separators and Secondary Containment Areas at Petroleum Bulk Stations and Terminals
yes _no
Outfall
No.
Date.
Sample Collected,
mo/dd/yr f
00556
00530
00400 ;
Non -Polar Oil and Grease/TPH EPA Method
1664 (SGT-HEM); mg/L F" _'''
Total Suspended Solids,
mg/L.
pH,
Standard units]
Permit Limit
-
15
50 or 100 see permit .
6:0 -- 9.0 1
�n
q. 26
For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here.
SWU-250 last revised October 25, 2012
Pa-c I of 2

STORM EVENT CHARACTERISTICS:
Date (first event sampled)
Total Event Precipitation (inches):
Date (list each additional event sampled this reporting period, and rainfall amount)
Total Event Precipitation (inches):
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 BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART II SECTION B.
TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANYONE OUTFALL? YES ❑ NO ❑
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an original and one copy of this AMR including all "No Discharge" reports, within 30 days of receipt of the tab results or at end of monitoring period in
the case of "No Discharge" reports) to:
Division of Water Quality
Attn: DWQ 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
(Date)
Additional copies of this form may be downloaded at: http://portal,ncdenr.org/web/wq/ws/su/npdessw#tab-4
v
SWU-2500 0 last revised O 25, 2012
*age 2 of 2

OMICROBAC"'
Fayetteville Division
Certificate of Analysis
Sysco Foods Raleigh, LLC Date Reported: 05/11/16
Mr. Zak Lokken Project: Storm water sample - Semiannual Date Received: 05/06/16
1032 Baugh Road Date Sampled: 05/04/16
Selma NC, 27576 Sampled By: Johnson
Stormwater, grab
K6E0263-01
Analvte Result Units Analvzed Analyzed By Method Qualifier
Field DattL
pH 6.3 pH Units 05/04/16 07:45 Johnson pH
Analyzed by: Microbac Laboratories, Inc. - Fayetteville
Oil & Grease (SGT HEM) <5.00 mg/L 05/09/16 14:01 SW EPA 1664
Total Suspended Solids 9.20 mg/L 05/09/16 10:45 CCR SM 2540 D-1997
QC Batch Run - (Alferohac Lahorarorres, Inc. - hnJerreri!!e�
Analyte Result Units Source MID Limit
Total Suspended Solids 126 Ing/L K6E0321 27 5
Total Suspended Solids
State Certifications:
NCDNR # l 1
NCD0I1 #37714
272 mg/L
K6E0287 4 5
Respectfully Submitted
��.e��r �. Liu-r✓��;'.s�_�
Jeanne Overstreet, Project Manager
Thank you for your business. We im ire pourfi crlh[rrk on uur Irre! r f crn•ic e !n mu. Yleas'v cumucr the Dirisom ,Manager, Ifuh 1 h'oner al 910-864-1929 with tiny
elvesri(M.S. )iru may also Cunracl J. 1 ievor BoJrc, 1'rc,Oent ❑r prvw4vit0a nucmhuc,COW
V Microbac Laboratories, Inc. Page 1 Of 2
2592 Hope Mills Road I Fayetteville, NC 28306 1 910.864.1920 p 1910.864.8774 f I www.microbac.com

Fayetteville Division 2592 Hope Mills Road — Fayetteville, NO 28306 (910) B64-1920 ! I
CHAIN OF CUSTODY RECORD
voulliffil
cUENTNAME &AD E5/5:
!3 2 1*3z _-3 c
}-7 �e'
f.�l �•
PO PROJECriLOCATION:
w
O
00
TYPE
OF ANALYSIS
PR>=SERVATION (CODE)
`-
y
`
S
con: A =None
B = HNO3 (pH<2) + <6'C
C = H2SO4 (pH<2) + <6'C
p = NaOH + <B'C
E = ZN Acetate + <6'13
F = HCI
G = Sodium Thlo
CONTACT PERSON:
PHONE:
q1 17— 7 f` S = 2 `!i C' -
SAMPLED eY;
v t�s�•
DATE I METHOD OF SHIPMENT:
�°�f�/� V/115
LAB ID-#
SAMPLE TYPE
DATE
TIME
COMP
ORAE
PH
FLOW7fJJP'C
CHRES,
LORINE
SULFIDE
G
La13
Relinyulahed by,
Date
Time
Received by; iSlgOalure)
Dale
Time
2
RellrlgU ■h■ y:
Dale
Time
Rece ve by: (Signature)
Datt
Time
3
4
TomRa
Inqu he by:
0
Data
Time
Rece va try: i aturejjj��
g
Dame^
JA'/I&
Time
gJr'q
5
r`�t�
ph Field:. ph Field: Water Level #1
Tamp Field 1: Tamp Field 2: Water Level #2
REVIEWED
Inittats--�
Turnaround time: REGULAR RUSH
Comments or Special Hazards:
bm kul I'll coo Ier. ce, 51(0Iw on
iS DATA FOR REG, COMPLIANCE?PURPOS1?
NO YES WHICH;
~ Page 2 of 2

•
•
is
NCDENR RfeCE}vED
Stormwater Discharge Outfall (SDO) mAY 13 'LUI6
Qualitative Monitoring Report CENTRAL. FILES
DWR SECTION
For guidance on filling out this form, please visit. -
Permit No.:
FacilityName: S C-o Kriici5A
County: �10 �i h s Tod
inspector: ZA < LoKKen
Date of Inspection.
Time of Inspection: 0 7 Ie S
or Certificate of Coverage No.:
Total Event Precipitation (inches): - S
Phone No. 1//9-7SrS!'- ZY.,YC
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
(See information below.)
N Yes ❑ No
Please verify whether Qualitative Monitoring must be performed during a "representative storm
event" or "measureable storm event" (requirements vary, depending on the permit).
Qualitative monitoring requirements vary. Most permits require qualitative monitoring to be
performed during a "representative storm event" or during a "measureable storm event." However,
some permits do not have this requirement. Please refer to these definitions, if applicable.
A "representative storm event" is a storm event that measures greater than 0.1 inches of rainfall
and that is preceded by at least 72 hours (3 days) in which no storm event measuring greater than
0.1 inches has occurred. A single storm event may contain up to 10 consecutive hours of no
precipitation.
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 DWQ Regional Office.
By this signature, I certify that this report is accurate and complete to the best of my knowledge:
(Signature of PV1OKe or Designee)
SM-242, Last modified 10/2S/2012
Pagel of 2

1. Outfall Description:
Outfall No. Structure (pipe, ditch, etc.)
Receiving Stream: gaA _
Describe the industrial activities that occur within the outfall drainage area: j� 7 S 4 o;10
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: __%roc•-�
I Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.): /yo ti b�-
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
1 2 C3 ) 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) 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: is
1 V 3 4 5
7. is there any foam in the stormwater discharge? Yes Co
8. is there an oil sheen in the stormwater discharge? Yes
9. is there evidence of erosion or deposition at the outfall? 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 10/25/20 L2

• •
Semi-annual Stormwater Dischame Monitoring Report
for North Carolina Division of Water Quality General Permit No. NCG080000
Date submitted 1117011 r
CERTIFICATE OF COVERAGE NO. NCG08 C7 S I
FACILITY NAME .57%Z'o ga-Z� <z
COUNTY o&
PERSON COLLECTING SAMPLES J Ja4r.
LABORATORY/`lfc-o /i a Lab Cert. # r✓
Comments on sample collection or analysis:
Part A: Vehicle Maintenance Areas Monitoring Requirements
SAMPLE COLLECTION YEAR 2 G /
SAMPLE PERIOD ❑ Jan -June tg July -Dec
or ❑ Monthly' (month)
�ECEIVED13CHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
❑Zero -flow ❑Water Supply [:]SA
DEC 0 2 201 ❑Other - _--
CENTRAL FILES
DWR SECTION PLEASE REMEMBER TO SIGN ON THE REVERSE
CEASE
❑ No discharge this period'
7"i
O�tfall
No.a
Date
Sample Collected,
mo/dd/yr
'00530
00400
00556
Total Suspended . _
Solids, mg/L
.': ' pH -` :
Standard units.' ,
Non -Polar Oil and Grease/TPH EPA
Method 1664 (SGT-HEM), mg/L
New Motor Oil Usage,
Annual average gal/mb
Benchmark
- - -
50.& 100 see permit
Within 6.0'— 9.0. ,
15.
- r
II az
- 5!7s
l-
, vG
IV3
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? _yes _no
(if yes, report your analytical results in the table immediately below)
Part B: Oil/water Separators and Secondary Containment Areas at Petroleum Bulk Stations and Terminals
�;Outfall.
No.
-Date
Sample Collected,
mo/dd/yr
-00556
00530
00400
Non_ -Polar Oil and Grease/TPH EPA Method
1664 (SGT-HEM), mg/L `
Total Suspended Solids,
mg/L
pH,
Standard units•
Permit Limit
-
As
SO:or 100 see permit
6.0 — 9.0
G-
For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here.
SWU-250 last revised October 25, 2012
Page l of 2

STORM EVENT CHARACTERISTICS:
Date / (first event sampled)
Total Event Precipitation (inches): _ r�
Date (list each additional event sampled this reporting period, and rainfall amount)
Total Event Precipitation (inches):
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 BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• - TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANYONE OUTFALL? YES ❑ NO 19
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? 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 (or at end of monitoring Period in
the case of "No Discharge" reports) to:
Division of Water Quality -
Attn: DWQ 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
!`. Jd�/ s
(Date)
Additional copies of this form may be downloaded at: http://portal.ncdenr.org/web/wq/ws/su/npdessw#tab-4
SWU-250 0 •
last revised Or 25, 2v12
*age 2 6-2

NC®ENR 3
I� Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
•
For guidance on filling out this form, please visit: htto;/luor•tal.ticdenr.orglwch/wcl/ws/su/nRdessw#tab-4
Permit No.: NX/G/D/ I/Q/-Y/j-/j-/ or Certificate of Coverage No.: N/C//_/_/_/_/_/_/
Facility Name: S' ICo a�N+
County: 0 6. f ;r _ Phone No. - 7 S
Inspector: ZALrke-�
Date of Inspection: / i 12JI 5-
Time of Inspection: /0
Total Event Precipitation (inches): 2-­
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
(See information below.)
® Yes ❑ No
Please verify whether Qualitative Monitoring must he performed during a "representative storm
event" or "measureahle storm event" (requirements vary, depending on the permit).
Qualitative monitoring requirements vary. Most permits require qualitative monitoring to be -
performed during a "representative storm event" or during a "measureable storm event." However,
some permits do not have this requirement. Please refer to these definitions, if applicable.
A "representative storm event" is a storm event that measures greater than 0.1 inches of rainfall
and that is preceded by at least 72 hours (3 days) in which no storm event measuring greater than
0.1 inches has occurred. A single storm event may contain up to 10 consecutive hours of no
precipitation.
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 perrittee
obtains approval from the local DWQ Regional Office.
By this signature, I certify that tlys report is accurate and complete to the best of my knowledge:
(Signature,pfIVrmittee or Designee)
SWU-242, Last modified 10/25/2012
Pagel of 2

1. Outfall Description:
Outfall No. _f Structure (pipe, ditch, etc.) •
Receiving Stream: �l
Describe the industrial activities that occur within the outfall drainage area:
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: a.--ot✓rt _
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.): %1f e I -
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
1 2 3 40 5
S. 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 07. 3 4 5
7. is there any foam in the stormwater discharge? Yes No
8. is there an oil sheen in the stormwater discharge? Yes
9. Is there evidence of erosion or deposition at the outfall? Yes CN
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 10/25/2012

Fayetteville Division 2592 Hope Mills Road - Fayetteville, NC 28305 (910) 864-19201864-6774 fax 'K5K0240"
CHAIN OF CUSTODY RECORD
} PACE 1 OF '7
1032 Baugh Road
Selma NC 275
®
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BF
IN-
T—p Flrld,;
Turnaround pma: REGULAR RUSH
Comments or Sandal Hazards: REVIEW
IS DATA FOR REG. COMPLIANCt OSE?
NO_ YES C HICK
UPS
Page 2 of 2

0
�VMICROBAC
Fayetteville Division
Certificate of Analysis
Sysco Foods Raleigh, LLC
Mr. Zak Lokken Project: Storm water sample - Semiannual
1032 Baugh Road
Selma NC, 27576
Date Reported: I I/16/15
Date Received: 11/06/15
Date Sampled: 11 /02/ 15
Sampled By: l_okken
Stormwater, grab
K5K0240-01
Analyte Result Units Analyzed Analyzed By Method Qualifier
Analyzed by: Microbac Laboratories, Inc. - Fayetteville
Oil & Grease (HEM) <5.00
Total Suspended Solids 10.7
mg/L 11 / 12/ 15 09:1 l SW EPA 1664 Rev. B
mg/L 11/10/15 16:44 SW SM 2540 D-1997 H
QC Batch Ran - (Afierobac Laboralnriev, Inc. -1 arerleville)
Analyte Result Units Source RPD Limit
Total Suspended Solids 4.75 mg/L K5K0314 5 5
Total Suspended Solids
Notes and Definitions
160 m c* L
ti Analyte was prepared and/or analyzed outside of the analytical method holding time
State Certiticalions:
NCDNR #II
NCDOH #37714
K5K0268 9 5
lM
RespectCully Submitted
Jeanne Overstreet, Project Manager
Thank you for your business. We ionwe rourfeeelhack on our level rf semce io you, Please conracr the Dii'mon Alanayer, Nob Derrner ai 910-864-1910 u irh anv
quesm"Ia, I'm nrav almn con7acf J. T hrv'ur Bowe, Pmxldenr al pm.'WernG_Hrrricmhac.cony
Microbac Laboratories, Inc. Page 1 of 2
2592 Hope Mills Road I Fayetteville, NC 28306 1910.864.1920 p 1910.864.8774 f I www.microbac.com

•
Semi-annual Stormwater Discharpee Monitoring Report
for North Carolina Division of Water Quality General Permit No. NCGO80000
Date submitted
CERTIFICATE OF COVERAGE NO. NCGO8 0 8 1 g
FACILITY NAME -W-rCO
COUNTY r. A 7,14
PERSON COLLECTING SAMPLES
LABORATORY 141 Co �4c Lab Cert. # f t'
Comments on sample collection or analysis:
Part A. Vehicle Maintenance Areas Monitoring Requirements
SAMPLE COLLECTION YEAR 7 U 1 S
SAMPLE PERIOD [K Jan -June ❑ Juiy-Dec
or D monthly' month
DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout OPNA
❑Zero -flow ❑Water Supply ❑SA
❑Other
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
3ut 13 2015 �
CENTRAL FILES
❑ No discharge this period'
OWR SECTION
Outfa ll
No.
Date
Sample,Collected,
mo/dd/yr
00530
00400 ; . -
00556
Total Suspended
Solids, mg/L,
:pH, '
Standard units
Mon -Polar Oil and Grease/TP.H EPA
Method. 1664 (SGT?.HEM), mg/L
New Motor Oil Usage,
Annual average gal/mo
Benchmark _
-
50 or 100.see permit
-Within 6.0 = 9.0
15
jr,,Z
12
12. 0
7.
< S oa
11
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month?>(yes _no
(if yes, report your analytical results in the table immediately below)
Part B: Oil/water Separators and Secondary Containment Areas at Petroleum Bulk Stations and Terminals
Outfall
No.
i
Date
Sample Collected,
mo/dd/yr
00556
00530
00400
Non -Polar Oil and Grease/TPH EPA Method
1664 (SGT-HEM); mg/L'
Total Suspended Solids,
mg/L
pH,
Standard units'
Permit Limit
-
15
50 or 100 see permit
6.0— 9.0
For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here.
SWU-250 last revised October 25, 2012
Page 1 of 2

STORM EVENT CHARACTERISTICS:
Date ZeW (first event sampled) /
Total Event Precipitation (inches): L
Date (list each additional event sampled this reporting period, and rainfall amount)
Total Event Precipitation (inches):
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 BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS, SEE PERMIT PART II SECTION B.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALLTRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART li SECTION B.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANYONE OUTFALL? YES ❑ NO ❑
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? 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 for at end of monitoring period in
the case of "No Discharge" reports to:
Division of Water Quality
Attn: DWQ 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 Permitti
(Date)
Additional copies of this form may be downloaded at: http://portal,ncdenr.org_/web/wq/ws/su/npdessw#tab-4
SAV-u _ 0
last revised O r 25, 201'2
*age 2 of 2

0
is
NCDENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Forguidance on filling out this farm, please visit: htt rtal.ncde r.oi- r web w ws su n dessw#tab-4
Permit No.: or Certificate of Coverage No.: N/C/Q/d/j/U/
Facility Name:yic"_„-
County: �1,. �hh s7�n Phone No. `7l 11- 7s- -,2 Yye
inspector: 41,' T (— -/<f�c
Date of Inspection: r' ll,
Time of Inspection: 7) `1 % IM
Total Event Precipitation (inches): _ e
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
(See information below.)
9 Yes ❑ No
Please verify whether Qualitative Monitoring must be performed during a "representative storm
event" or "measureable storm event" (requirements vary, depending on the permit).
Qualitative monitoring requirements vary. Most permits require qualitative monitoring to be
performed during a "representative storm event" or during a "measureable storm event." However,
some permits do not have this requirement. Please refer to these definitions, if applicable.
I E
A "representative storm event" is a storm event that measures greater than 0.1 inches of rainfall
and that is preceded by at least 72 hours (3 days) in which no storm event measuring greater than
0.1 inches has occurred. A single storm event may contain up to 10 consecutive hours of no
precipitation.
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 DWQ Regional Office.
By this signature, I certify that this resort is accurate and complete to the best of my knowledge:
(Signature of-P�j�rr�tee designee)
swu-242, Last modified 10/25/20 i 2
Page 1 of 2

1. Outfall Description:
Outfall No. �-4 Structure (pipe, ditch, etc.)
Receiving Stream:
Describe the industrial activities that occur within the outfall drainage area:
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: flro c.--%
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.):
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
1 2 3 6 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 © 3 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 V 3 4 5
i. Is there any foam in the stormwater discharge? Yes
8. is there an oil sheen in the stormwater discharge? Yes 'C`'J
9. Is there evidence of erosion or deposition at the outfall? Yes N6
10. Other Obvious indicators of Stormwater Pollution:
List and describe _ _ /1nu 't'-!
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition e
may be indicative of pollutant exposure. These conditions warrant further investigation.
Page 2 of 2 ,
SWU-242, List modified 10/25/2012

Fayetteville Division l
Certificate of Analysis
Sysco Foods Raleigh, LLC Date Reported: 05/21/15
Mr. "Laic Lokken Project: Storm water sample - Semiannual Date Received: 05/14/15
1032 Baugh Road Date Sampled: 05/12/15
Selma NC. 27576 Sampled By: Lokken
Stormwater, grab
K5E0490-01
Analyte Result Units Analyzed Analyzed By Method Qualifier
Field Data
pH 7.2 pH Units 05/12/15 06:45 Lokken pH
Analyzed by: Microbac Laboratories, Inc. - Fayetteville
Oil & Grease (HEM) <5.00 mg/L 05/20/15 09:30 AFO EPA 1664 Rev. B.
Total Suspended Solids <1.00 mg/L 05/15/15 14:30 MLW SM 2540 D-1997
QC Batch Run - (dfierabae L.aboralories. Inc. - Fayetteville)
Analyte Result Units Source RPD Limit
Total Suspended Solids 22.0 mg/L K5E0493 115 5
Total Suspended Solids
State Certifications:
NCDNIt #II
NCDOH #37714
92.0 ing/L
K5E0445 0 5
Respectfully Submitted
Jeanne Overstreet, Project Manager
Thank you for your business. W • in we your feedback on oar ievvi fy vervice to vou. Plea.ve crrnracl the Division :t lanager, 1t„h lJermer ea 910-864-1920 wish uxv
'jVWSlionc. Ynn rrury also conrau J. 'Trevor Rowe, lln,.sOvnl u1 prnviderrr�r micrnbuc.cum
Microbac Laboratories, Inc.
'• Page.1 of 2,"�
2592 Hope Mills Road I Fayetteville, NC 28306 1910.864.1920 p j 910-864.8774 f I www.microbac.com

•
Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No. NCG080000
Date submitted
CERTIFICATE OF COVERAGE NO. NCG08V 1
FACILITY NA E S S C- o 0
COUNTY wlo h
PERSON COLLECTING SAMPLES a Z.,ICA'c1,
LABORATORY/"/ ery 134 e- _- Lab Cert. # _. / I
Comments on sample collection or analysis:
Part A: Vehicle Maintenance Areas Monitoring Requirements
SAMPLE COLLECTION YEAR 20111
SAMPLE PERIOD ❑ Jan -June ® July -Dec
or ❑ Monthly' month
RECEIVED DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout [❑PNA
RECEIVED ❑Zero -flow ❑Water Supply ❑SA
DEC 0 5 20+4 ❑Other
CENTRAL FILES PLEASE REMEMBER TO SIGN ON THE REVERSE -4
DWR SECTION
❑ No discharge this period'
Outfall
No..
F
' ' Date
-Sample Collected,
mo/dd/yr
00530
00400
00556
Total -Suspended.,
Solids, mg/L
pH,
Standard units ' I .%
'Nor' -Polar Oil and. Grease/TPH EPA
Method 1664 (SGT-HEMj, mg/L .
New Motor Oil Usage,
Annual average gal/mo
Benchmark
-
50 or 100 see ermit:
•Within 6.0 - 9.0-
11 ! 7/
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? _yes _no
(if yes, report your analytical results in the table immediately below)
PartB: Oil/water Separators and Secondary Containment Areas at Petroleum Bulk Stations and Terminals
Outfall
'No. •
Date
Sample Collected,
mo/dd/yr :
00556
00530
00400
Non -Polar Oil and Grease/TPH-EPA Method
1664 (SGT=HEM),`mg/L>
Total Suspended'Solids,
mg/L`.
pH,
Standard units
Permit Limit
-
15 `
50 or 100 see, permit
6.0-9.0
1/ /7 /
• 2
.
For sampling periods with no discharge at any single outfall, you must still submit this discharge -monitoring report with a checkmark here.
SWU-250 last revised October 25. 2012
Page I of•2

STORM EVENT CHARACTERISTICS:
Date Z 10y (first event sampled)
Total Event Precipitation (inches): 7-eA
Date (list each additional event sampled this reporting period, and rainfall amount)
Total Event Precipitation (inches):
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 BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANYONE OUTFALL? YES ❑ NO ❑
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an original and one copy of this DMR, including all "No Discharge" reports, within 30 days o receipt of_the Jab results or at end o monitoring period in
the case of "No Discharge" reports) to:
Division of Water Quality
Attn: DWQ 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 Per
(Date)
Additional copies of this form may be downloaded at: http://Uortal.ncdenr.org/web/wq/ws/su/`npdessw#tab-4
. SWU-250 ,� last revised O 25, 2012
age 2of2

•
NCDENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance on filling out this farm, please visit; http://12ortal.ncdenr.org/web/wct/ws/su/ripdessw#tab-4
Permit No.: N/C/ O/ F/ D/ a/ G/ -q/j/ or Certificate of Coverage No.: N/C/G/O/ff/Q/ F/1/-.9/
Facility Name: Vf 0_9-a-cic!
County: r%Ai,s 7v� Phone No. 1/ 5- 7 5' f 1 `71Y 4(
Inspector: Za4/l 400"c-.,
Date of Inspection: ! -7 _ Time of Inspection: -/., -y
Total Event Precipitation (inches):
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
(See information below.)
Yes ❑ No
Please verify whether Qualitative Monitoring must be performed during a "representative storm
event" or "measureable storm event" (requirements vary, depending on the permit).
-- _ — ___ _ _ __ _ ._ __.-- _._ _ _ - ------------
Qualitative monitoring requirements vary. Mast permits require qualitative monitoring to be
performed during a "representative storm event" or during a "measureable storm event." However,
some permits do not have this requirement. Please refer to these definitions, if applicable.
A "representative storm event" is a storm event that measures greater than 0.1 inches of rainfall
and that is preceded by at least 72 hours (3 days) in which no storm event measuring greater than
0.1 inches has occurred. A single storm event may contain up to 10 consecutive hours of no
precipitation.
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 DWQ Regional Office.
By this signature, I certify that this report is accurate and complete to the best of my knowledge:
(Signature of.P''- Ettee or Designee)
SWII-242, Last modified 10/25/2012
Page 1 of 2

iim
1. Outfall Description:
Outfall No. _ Structure (pipe, ditch, etc.) "I e
Receiving Stream:c-
Describe the industrial activities that occur within the outfall drainage area: 7+-& ele 8, r -'
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: _ �i`aG, .-t
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.): &J A,- ~'
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
1 2 3 64) 5
S. 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 4 5
6. Suspended Solids: Choose the number which best describes the amount of suspended
solids in the stormwater discharge, wheree 1 is no solids and 5 is extremely muddy: 10
1 3 4 5
7. is there any foam in the stormwater discharge? Yes
8. Is there an oil sheen in the stormwater discharge? Yes N
9. Is there evidence of erosion or deposition at the outfall? Yes '�
10. Other Obvious Indicators of Stormwater Pollution:
List and describe zt- Cry C
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.
•
SwU-242, Last modified 10/25/2012
Page 2 of 2

. .y
�MICROBACt`
Fayetteville Division
Certificate of Analysis
Sysco Foods Raleigh, LLC Date Reported: 12/03/14
Mr. Zak Lokken Project: Storm water sample - Semiannual Date Received: 11/19/14
1032 Baugh Road Date Sampled: 11/17/14
Selma NC. 27576 Sampled By: Lokken
Stormwater, grab
K4K0504-01
Analyte Result Units Analyzed Analyzed By Method Qualifier
Field Data
pH
6.3
pH Units 11/17/14 17:00
Lokken
pH
Analyzed by: Microbac Laboratories, Inc. -
Fayetteville
Oil & Grease (SGT--HEM)
1.07
mg/L l 1/26/14 08:00
JAO
EPA 1664
B
Total Suspended Solids
1.75
mg/L l l/20/14 10:04
SW
SIM 2540 D-1997
SI
QC Batch Run - (Alicrnhne l,rthorruuries, Ine. - Froletreville)
Analyte
Result
Units
Source
RPD
Limit
Total Suspended Solids
4.25
mg/L
K4K0516
43
5
Total Suspended Solids
3.00
mg/L
K4K0470
15
5
Total Suspended Solids
2.00
mg/L
K4K0504
13
5
Notes and Definitions
Sl Relative Percent DitTerence (RPD) outside accepted recovery limits
B Detected in the associated Method Blank
State Certifications:
NCDNR N I I
NCDOH #37714
Respectlully Submitted
�.g t
Bonnie K. Sanders, Senior Project Manager
Thank you for your business. We f,rrite vourjeedhaek un ourlevel uJ: cn4c'e !o yvue. 1 •levee curuac•r the Division i4unager, Rob Perrne'r ai 910-8G4-I920 wish rrm•
quesimm. Fbu n+uv utm, cowed .1. 1'vv,,r &q.ce, President ur prersidem0(i p (cmhuc.eomn
Microbac Laboratories. Inc, page'�'of 2'
2592 Hope Mills Road I Fayetteville, NC 28306 1910.864.1920 p 1910.864.8774 f I www.microbac.com

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No. NCG080000
Date submitted y/yl
CERTIFICATE OF COVERAGE NO. NCGO8 6 V I
FACILITY NA S S �� alet
COUNTY o Ton
PERSON COLLECTING SAMPLES C-
LABORATORY 14?tCrO 6 �r[. __ Lab Cert. # _
Comments on sample collection oranalysis:
Part A: Vehicle Maintenance Areas Monitoring Requirements
SAMPLE COLLECTION YEAR 2 d % /
SAMPLE PERIOD [Z Jan -June 0 July -Dec
or ❑ Monthly' (month)
DISCHARGING TO LASS ❑ORW ❑HQW ❑Trout ❑PNA
❑Zero -flow ❑Water Supply ❑SA
RECEIVED
QED ❑Other
APR 0 8 2014 PLEASE REMEMBER TO SIGN ON THE REVERSE 4
CENTRAL FILES ❑ No discharge this period'
©WQIBOG
Outfa#I
No.
Date
Sample Collected,
mo/dd/yr
-.
00530
00400 _
00556
Total Suspended ..-��.
'Solids, mg/L
�.-.�,pH, �;-
_ Standard units
'Non-Polar.0il and Grease/TPH EPA
Method 1664 (SGT-HEM), mg/L
New Motor Oil Usage,
Annual average gal/mo
Benchmark
/8 / Ll
50 or 100 see permit
Within 6.0 - 9.0
15
-
�� �y<
Z sa
d 5-
< 5'.00
12
Did this facility perform Vehicle Maintenance Activities using more than S5 gallons of new motor oil per month? _ yes _no
(if yes, report your analytical results in the table immediately below)
Part B: Oil/water Separators and Secondary Containment Areas at Petroleum Bulk Stations and Terminals
Outfa ll
No.
Date
Sample Collected,
mo/dd/yr
00556
00530
00400
Non -Polar Oil and Grease/TPH EPA Method
1664 (SGT-HEM), mg/L ' '
Total Suspended Solids,
mg/L
pH,
Standard units
Permit Limit
-
15
50 or 100 see. permit
6.0— 9.0
1
< 2 - 5"6
1.
I For sampling periods with no discharge at any single outfall, you must still submit this discharge- monitoring report with a checkmark here.
SWU-250 last revised October 25. 2012
Page I of 2

STORM EVENT CHARACTERISTICS:
Date l8. (first event sampled)
Total Event Precipitation (inches): 7 -re-, `74,f
Date (list each additional event sampled this reporting period, and rainfall amount)
Total Event Precipitation (inches):
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 BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS, SEE PERMIT PART II SECTION B.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANYONE OUTFALL? YES ❑ NO ❑
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an original and one copy of this DMR including all "No Discharge" re orts within 30 days of receipt of the lab results for at end of monitoring eriod in
the case of "No Discharge" reports) to:
Division of Water Quality
Attn: DWQ 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
yyf
(Date)
Additional copies of this form may be downloaded at: http://Portal,ncdenr.org/web/wq/ws/su/npdesswt#tab-4
e.
SWU-250 . Vast revised O r 25, 2,012
*age 2 of 2

•
NCDENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Forguidance on filling out this farm, please visit: htt oi,tal.ncd enr.or web we ws u n dessw#tab-4
Permit No.:
Facility Name: S 1' Co
County: I-o A n C7o 4
Inspector: —ZAM Lokkc L
Date of Inspection: 3 €Z/V
Time of Inspection:
or Certificate of Coverage No.:
Phone No. I/ f - 7 P - 2 `f `f C
Total Event Precipitation (inches): . 7 7G•, r4,
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
(See information below.)
Please verify whether Qualitative Monitoring must he performed during a "representative storm
event" or "measureable storm event" (requirements vary, depending on the permit).
Qualitative monitoring requirements vary. Most permits require qualitative monitoring to be
performed during a "representative storm event" or during a "measureable storm event." However,
some permits do not have this requirement. Please refer to these definitions, if applicable.
A "representative storm event" is a storm event that measures greater than 0.1 inches of rainfall
and that is preceded by at least 72 hours (3 days) in which no storm event measuring greater than
0.1 inches has occurred. A single storm event may contain up to 10 consecutive hours of no
precipitation.
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 DWQ Regional Office.
By this signature, 1 certify that this report is accurate and complete to the best of my knowledge:
(Signatu,rert�,'-Fermittee or Designee)
SWO-242, Last modified 10/2.S/2012
Page] of 2

1. Outfall Description:
Outfall No. _I Structure (pipe, ditch, etc.) Y) 1pe _
Receiving Stream: o
Describe the industrial activities that occur within the outfall drainage area: 7,- ve.k__
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: L .-o 4,m w
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.): A d oz e
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
1 2 3 5
S. 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 0 3 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 a 3 4 5
7. is there any foam in the stormwater discharge? Yes No
8. Is there an oil sheen in the stormwater discharge? Yes
9. Is there evidence of erosion or deposition at the outfall? Yes Cam/
10. Other Obvious Indicators of Stormwater Pollution:
List and describe _/V u
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.
•
•
0
Page 2 of 2
5WU-242, Last modified 10/25/2012

Sysco Foods Raleigh, LLC
Mr. Zak Lokken
1032 Baugh Road
Selma NC, 27576
101
Fayetteville Division
2592 Hope Mills Rd
Fayetteville, NC 28306
910.864.1920 Phone
910.864.8774 Fax
Certificate of Analysis
Project. Storm water sample - Semiannual
Stormwater, grab
1403410-01
Date Reported: March 29, 2014
Date Received. March 19, 2014
Date Sampled: March 18, 2014
Sampled By: Johnson
Anal to Result Units Analyzed Analyzed By Method Qualifier
Analyzed by: Microbac - FayetteWle Division
Oil & Grease HEM SGT <5.00 mg/L 3/28/14 14:47 MSL EPA 1664
Total Suspended Solids <2.50 mg/L 3/20/14 8:30 JTL SM 2540 D-1997
QC Duplicate Results
Analyte Result Units Source RPD Limit
Total Suspended Solids ND mg/L 1403421 5
Total Suspended Solids 276 mg/L 1403424 1 5
State Certifications:
Respectfully Submitted
NCDNR 411
NCDOH #37714
USDA #3787
Bonnie K. Sanders, Senior Project Manager
Page I of 1