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Home My WebLink AboutNCG080819_MONITORING INFO_20191230Z� STORMWATER DIVISION CODING SHEET NCG PERMITS PERMIT NO. 4C ( b U 6 V l DOC TYPE ❑ HISTORICAL FILE E% MONITORING REPORTS DOC DATE ❑ vv I 3 YYYYMMDD §MICROBAC' M i crobac-Fayetteville 2592 Hope Mills Rd. Fayetteville, NC 28306 CHAIN OF CUSTODY RECORD Number Instructions on back -_- Lab Report Address Invoice Address Turnaround Time TO BE COMPLETED BYMICROBAC Client Name: Sysco Raleigh Client Name: Sysco Raleigh [X ] Routine (5 to 7 business days) Temp. Upon Receipt (°C) Therm ID Address: 1032 Baugh Road Address: 1032 Baugh Road [ ] RUSH* (notify lab) Holding Time City, State, Zip: Selma NC. 27576 City, State, Zip: Selma NC. 27576 (needed by) Samples Received on Ice?: Yes No WA Contact: Zak Lokken Contact: Zak Lokken Report Type Custody Seals Intact? Yes No N/A " _ Telephone_No_: 919-755-2446 Telephone No.: 1-919-755-2446 Results Only [ ] Level 1 [ ] Level 2 [ ] Leve13 [ ] Level 4 [ ] EDD Send Report via. J. ] Mail ., [ ] Fax a -mail Send Invoice via Od Mail Fax a -mail .»..,...�...m, - Project:__ _ .. Location: PO No.: Compliance Monitoring? [ X ] Yes [ ] No [ ] Agency/Program. Sampled by (PRINT Zak Lokken Sampler Signature:_ Matrix Types: Soil/Solid (S), Sludge, Oil, Wipe, Drinking Water (I Preservative Types:_ (1) HNO3, (2) H2SO4, (3)_HCI,, (4) NaOH, (5) Zinc impler Phone No.: 1-919-755-2446 (GW ), Surface Water (SW), Waste Water (W W ), Other (specify) nol_(7) Sodium Bisulfate, (8) Sodium Thiosulfate, (9) Hexane, (U) Unpreserved .., REQUESTED ANALYSIS Lab ID Client Sam le ID P Date Collected Time Collects d No. of Container s Matrix Grab or comptype Preservative .� H L v .Additional Notes /h 9r n Possible Hazard Identificatim [ ] Hazardous [ ] Non -Hazardous [) Radioactive Saml [ ] Dispose as appropriate p[]Return []Archive Comments P H, / S C� Relinquished By(si ature Date/Ti a 'Received By (signature) DateTma M2 Reli a signature - DateTme 'Received By (signature) DateTme Relinquished By (signature) DateTme . Received By (signature) DateTme !_ or _! Semi-annual Stormwater Discharge Monitoring Report for North Carolina Division of Energy, Mineral and Land Resources General Permit No. NCG080000 Date submitted CERTIFICATE OF COVERAGE NO. NCG08_a S ( / FACILITY NAME SYSCG /f,-Zet � COUNTY ✓a 4 r 1 s,t ' — PERSON COLLECTING SAMPLES STc r�_ ,t/c &_ Par- T- LABORATORYMr ci o Z^6 Lab Cert. # C SAMPLE COLLECTION YEAR 2. G / 4 SAMPLE PERIOD ❑ Jan -June Z July -Dec .; or ❑ Monthly'_ (month) DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA E]Zero-flow ❑Water Supply ❑SA m oments on sample collection or analysis: R EC, E i `F- i.p Other DEC !$b 294ASE REMEMBER TO SIGN ON THE REVERSE 4 Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new oilpeFmdnth?[Kyes ❑ no if es complete Part A) !Dirl•i s �cu I ION Part A: Vehicle & Equipment Maintenance Areas Monitoring Requirements (If applicable) ❑ No discharge this periodZ Outfall No 'Date Sample Collected° 24-hour rainfall amount Non Polar Oil &Grease. - TotalSuspenHed -Solids,'i. New Motor or Hydraulic Oil Usage, (mo/dd/Yr) :' Inches3 mg/L - . - Benchmarks . a0, 17 715 I d100or53" PammeterCode. - -,, _ .. 46529 - , ... ., 00552 �; •; C0530 NCOIL,_ / If in i 6 e .�• - . .- .. ' Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall. '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. i 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 "<)IX 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 ">XX". Permit Date: 11/1/2018-5/31/2021 SWU-248, last revised 11/1/2018 Page 1 of 2 1 4, < Part B oil/water Separators and Secondary Containment Areas at Petroleum Bulk Stations and Terminals (If applicable)EINO discharge this period1 x Outfall a - No Permit Limrt - Parametereode';:� Date Sample ' pxCoilected't� .. _. ....... , t 24hour rainfall , 3 .:%� , 46529 Sample Collected) _'- Total Suspended - Solids, .r.0053U , - _ PH Standard units - ^k00400 � -` - Non -Polar Od-&.,„ Grease, ;00552 Footnotes from Part A also aooly to this Part R Note: If you report a sample value in excess of the benchmark, you must Implement Tier 1, Ter 2, or Tier 3 responses. See General Permit text. FOR PART 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 PARAMETEWAT ANYONE OUTFALL? YES r NO IF YES, HAVE YOU CONTACTED THE DEMLR REGIONAL OFFICE? YES ❑ NO O IM REGIONAL OFFICE CONTACT NAME: case of"No Ofscharae"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." w / Signature 11112111 Date Permit Date:11/1/2018-5/31/2021 SWU-248, last revised 11/1/2018 Page 2 of 2 *MICROBAC Microbac Laboratories, Inc. - Fayetteville CERTIFICATE OF ANALYSIS K9K0160 Project Description Storm water sample - Semiannual For: Accounts Payable Sysco Foods Raleigh, LLC 1032 Baugh Road Selma, NC 27576 Administration Brittany Smith Thursday, November 21, 2019 Please find enclosed the analytical results for the samples you submitted to Microbac Laboratories. Review and compilation of your report was completed by Microbac Laboratories, Inc. - Fayetteville. If you have any questions, comments, or require further assistance regarding this report, please contact your service representative listed above. I certify that all test results meet all of the requirements of the accrediting authority listed within this report. Analytical results are reported on a'as received' basis unless specified otherwise. Analytical results for solids with units ending in (dry) are reported on a dry weight basis. A statement of uncertainty for each analysis is available upon request. This laboratory report shall not be reproduced, except in full, without the written approval of Microbac Laboratories. The reported results are related only to the samples analyzed as received. Microbac Laboratories, Inc. 2592 Hope Mills Rd I Fayetteville, NC 28306 1910.864.1920 p i www.microbac.com Page 1 of 8 OMICROBAC" Microbac Laboratories, Inc. - Fayetteville CERTIFICATE OF ANALYSIS K91<0160 Analytical Testing Parameters Client Sample ID: S grab �"onl Sample tormwater, grab [Sample Matrix: Aqueous Collected By: Lokkeri '0 z 1) . Lab Sample 10: K9K0 1630 01 Collection Date: 11/1212019 820 ...... ...... mesull KL -Units-- Dilution Note Prepared Analyzed Analyst EPA 1664 Rev. B Oil & Grease (SGT-HEM) <5.00 5.00 mg1L 1 11/18119 1200 TBM SM 2540 D-2011 Total Suspended Solids 67.0 12.5 mg1L 1 11/14119 1305 CLB Microbac Laboratories, Inc. 2592 Hope Mills Rd I Fayetteville, NIC 28306 1910.864.1920 p I www.microbac.com F—Page —3—of —8—] Microbac Laboratories, Inc. - Fayetteville CERTIFICATE OF ANALYSIS K9K0160 Definitions mg/L: Milligrams per Liter RL: Reporting Limit Cooler Receipt Log Cooler ID: Default Cooler Temp: 1.0°C Cooler Inspection Checklist Ice Present or not required? Yes Shipping containers sealed or not required? Yes Custody seals intact or not required? Yes Chain of Custody (CDC) Present? yes CDC includes customer information? Yes Relinquished and received signature on COC? Yes Sample collector identified on COC? Yes Sample type identified on COC? Yes Correct type of Containers Received Yes Correct number of containers listed on COC? Yes Containers Intact? Yes COG includes requested analyses? Yes Enough sample volume for indicated tests received? Yes Sample labels match CDC (Name, Date & Time?) Yes Samples arrived within hold time? Yes Correct preservatives on CDC or not required? Yes Chemical preservations checked or not required? Yes Preservation checks meet method requirements? Yes VOA vials have zero headspace, or not recd.? Yes Project Requested Certification(s) Microbac Laboratories, Inc. - Fayetteville 11 North Carolina DENR NPDES Report Comments Reviewed and Approved By: 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 samples) analyzed. This report is incomplete unless all pages indicated Brittany Smith in the footnote are present and an authorized signature is included. Administration Reported: 11/21/2019 23:02 Microbac Laboratories, Inc. 2592 Hope Mills Rd I Fayetteville, NC 28306 1910.864.1920 p ( www.microbac.com Page 5 of 8 Semi-annual Stormwater Discharge Monitoring Report •olina Division of Energy, Mineral and Land Resources General Permit No. NCG080000 Date submitted 3. NCG08� S` I _QG�GlL� i STcya ,tfc c.r Par 7- Lab Cent. k in or analysis: SAMPLE COLLECTION YEAR 2. G / 4 SAMPLE PERIOD ❑ Jan -June X 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 e Maintenance Activities using more than 55 gallons of new oil per month? Kyes ❑ no (if Yescomplete Part A) laintenance Areas Monitoring Requirements (If applicable) ❑ No discharge this periodz Collected' /yr) 24-hour rainfall amount, Inches3 Non -Polar Oil & Grease .. .. mg/L Total Suspended Solids, mB/L :. . New Motor or Hydraulic Oil Usage, i . . gal/man. . . 46529 OOS52 C0530.-p,.:..:r:: ......:..: NCOIL ., /RG :mi-annuai) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall. scharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here. recorded using data from an on -site rain gauge. Unattended sites may be eligible for a waiver of the rain gauge requirement. L, identifying the especially sensitive receiving water classifications where the more protective benchmark applies. in numerical format For example, do not report Below Detection Limit, BDL, <PQL, Non -detect, ND, or other similar non - are below the applicable limits, they must be reported in the format "<XX me/L" where XX is the numerical value of the ( tc. in mg/L Conversely, where fecal coliform results exceed the dilution upper limit, report the result as ">W. \t1�31 loll oG 'K9K0160' Page 2oflast revised 11/1/2018 ` Page 7 of 8