NCS000209_MONITORING INFO_20190306

STORMWATER DIVISION CODING SHEET
NCS PERMITS
PERMIT NO.
�I `� S � o o
HOC TYPE
PERMIT
,❑LFINAL
L� MONITORING REPORTS
0 APPLICATION
❑ COMPLIANCE
❑ OTHER
DOC DATE
❑ 000 o U (n
YYYYMMDD

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number NCS 0 0 d -�. d 9
FACILITY NAME Haynes Wre Company
PERSON COLLECTING SAMPLE(S) Angela Beck
CERTIFIED LABORATORY(S) James and ,lames Environmental Lab #482
Lab #
Part A: Specific Monitoring Requirements
SAMPLES COLLECTED DURING CALENDAR YEAR: 2018
(This monitoring report shall be received by the Division no later than 30 days from
the date the facility receives the sampling results from the laboratory.)
COUNTY Henderson
PHONE NO, 82( 8 ) 393-1258
SIGNATURE OF PERMITTEE OR DESIGNEE
REQUIRED ON PAGE 2.
l �
w
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? Oyes (.)no
(if yes, complete Part B)
Part B: Vehicle Maintenance Acti ity MonitoringRe uirements
Outfall
No.
Date
Sample -
Collected
50050
00556
00530
00400
Total Flow
(if applicable)
Total
Rainfall
Oil & Grease
(if appl.)
Non -polar
O&G/TPH
(Method 1664
SGT-HEM), if
appl.
Total
Suspended
Solids
pH
New Motor
Oil Usage
molddl r
MG
inches
m
m
unit
al/mo
Form SWU-247, Iasi revised 611212015
Page 1 of 2

STORM EVENT CHARACTERISTICS:
Date 1111312018
Total Event Precipitation (inches): 2.5
Event Duration (hours): (only if applicable — see permit.)
(if more than one storm event was sampled)
Date
Total Event Precipitation (inches):
Event Duration (hours): (only if applicable — see permit.)
Mail Original and one copy to:
Division of Energy Mineral and Land Resources
Ann. Central Files
1617 Mail Service Center
Raleigh, North Carolina 27644-1617
"i certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a
system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person
or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the
best of my knowledge and belief, true, accurate, and complete. 1 am aware that there are significant penalties for submitting false information,
including the possibility of fines and imprisonment for knowing violations."
0,ju, a� a zgs11
(Signature of Permittee) (Date)
Form SWU-247, last revised 611212015
Page 2 of 2

JJEM AQUEOUS SAMPLE COLLECTION/LAB REPORT FORM (NC CERT 482)
Regulated by NCDENRIDWO-Groundwater section
To assign test, label shaded area with sample type (C=composite; G=grab)
.n
r"1
CHAIN OF CUSTODY
LOCATION HAYNES WIRE
COUNTY HENDERSON
SPECIAL INFORMATION(S)
OUTFALL # 1 JOUTFALL#j
ID NO.
HWC 131 g
H WC 131 Z
INITIAL TEMP
u
!"j
i.
GRAB
sam le time
COMP start
sam Ie time
COMP end
date/ time
'<r
4tr..h.'ri?T
'?d"�e .,,. �n`'�. rii�ETTifie. •,b''iri: #r4'.� 4�iLf_5.
-
i?` e$ k{ ;,'+'•,�'^ �.iS e';'" r,- F �+7 , f yT i'f W r J�wa•,.
TEMP @RECEIPT: eC TEMP @RECEIPT: cC
(VOTE: THE ABOVE TEMP INDICATES THE TEMP.
FOR ALL CONTAINER(S) WITHIN. NOTE: THE ABOVE TEMP INDICATES THE TEMP.
FOR ALL CONTAINERISI WITHIN.
AMMONIA SAMPLES PRESERVED WITH H2SO4, pH=<2.0 YES NO
AMMONIA SAMPLES NEUTRALIZED WITH Na2SO3, CI=< 0.1 ES NO
FECAL SAMPLES PRESERVED WITH Na2SO3, CI=< 0.1 YES NO
COLLECTED BY:
ALL SAMPLES COLLECTED AND PRESERVED AT TIME OF COLLECTION IN PLASTIC CONTAINERS UNLESS NOTED OTHERWISE BY:
RELINQUISHED BY
DATE I TIME
RECEIVED BY
SPLIT SAMPLE(S) INFO
I! 1 It 1
ANALYSES 4,'
RESULT n+b,, t
"RESULT .'
{.RESULT::.
"RESULT,�;i;
, .
,i�_. , ._ r>;
DATE-,.
', 'INI rL. ,
PH
G S. -5o
G S.99
Irl r3I Ia
L 5
TSSppm
G0
G�Z.S
!
By the above signature I certify that all Inforrnation is accurate to the best of my knowledge.
COMMENTS Q means QC not met