NCG030056_MONITORING INFO_20190521

i
STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
/v ('S
DOC TYPE
❑HISTORICAL FILE
❑ MONITORING REPORTS
DOC DATE
� ao l 9 b 5 a i
YYYYMMDD

Stormwater Discharge Monitoring Report
for North Carolina Division of Energy, Mineral and Land Resources General Permit No. NCG030000
Date submitted 5/21119
CERTIFICATE OF COVERAGE NO. NCG03 0 0 5 6
FACILITY NAME Gilbarco, Inc
COUNTY Guilford
PERSON COLLECTING SAMPLES John Burke
LABORATORYR&A Labs Lab Cert. # 34
Comments on sample collection or analysis:
Part A: Stormwater Benchmarks and Monitoring Results
SAMPLE COLLECTION YEAR 2019
SAMPLE PERIOD 0 Jan -June ❑ July -Dec
RECEI1xn or ® Monthly) (month)
DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
MAY 2 3 2019 ❑Zero -flow OWater Supply []SA
[:]OtherC IE1� i�AL FILI~S
SECTION PLEASE REMEMBER TO SIGN ON PAGES 2 AND/OR 3
El No discharge this period?2
Outfall No.
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
Inches3
Total Suspended Solids
pH,
Standard units
Total Copper
Total Lead
Total Zinc
Non -Polar O&G/
Total Petroleum
Hydrocarbons
Total
Organnicsics5
Benchmarks
_
-
100 mg/L or 50 mg/L"
6.0 -- 9.0
0.010 mg1L
0.075 mg/L
0.126 mg/L
15 mg/L
1 mg/L
Parameter Code
-
46529
C0530
00400
01119
01051
01094
00552
78141
Outfall 01
4/19/19
0.50
109 mg/L
6.85
0.036 mg/L
0.009 mg1L
1.140 mg/L
<5
TTO
Outfall 02
4/19/19
0.50
48 mg/L
6.45
0.030 mg/L
0.007 mg/L
0.204 mg/L
<5
TTO
Outfall 03
4/19119
0.50
30 mg1L
6.10
0.026 mg/L
<0.005 mg/L
0.182 mg/L
<5
TTO
1 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.
a See General Permit, Section B, Table 1 to identify the especially sensitive receiving water classifications where the more protective benchmark applies.
s Total Toxic Organics sampling is applicable only for those facilities which perform metal finishing operations, manufacture semiconductors, manufacture
electronic crystals, or manufacture cathode ray tubes. For purposes of this permit the definition of Total Toxic Organics is that definition contained in the EPA
Effluent Guidelines for the facility subject to the requirement to sample (for metal finishing use the definition as found in 40 CFR 433.11; for semiconductor
manufacture use the definition as found in 40 CFR 469.12; for electronic crystal manufacture use the definition as found in 40 CFR 469.22; and for cathode ray
tube manufacture use the definition found in 40 CFR 469.31).
Permit Date: 11/1/2018-05/31/2021 SWU-245, last revised 11/1/2018
Page 1 of 3

Facilities that incorporate a solvent management plan into the Stormwater Pollution Prevention Plan may so certify, and the requirement for TTO monitoring
may be waived. The solvent management plan shall include a list of the total toxic organic compounds used and the other elements listed in the General
Permit. For those facilities electing to employ the TTO monitoring waiver, the discharger shall sign the following certification statement:
"Based upon my inquiry of the person or persons directly responsible for managing compliance with the permit monitoring requirement for total toxic organics
(TTO), I certify that to the best of my knowledge and belief, no dumping of concentrated toxic organics into the stormwater or areas which are exposed to rainfall or
stormwater runoff has occurred since filing the last discharge monitoring report. I further certify that this facility is implementing the all the provisions of the
solvent management plan included in the Stormwater Pollution Prevention Plan."
Rob Bondos
Name (Print name)
VP NA Operations
T' . e (P ' t title)
Signature Date
Note: Results must be reported in numerical format. 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.
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.
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month.
❑ No discharge this period?z
Outfall No.
Date Sample Collected'
(mo/dd/yr)
24-hour rainfall amount,
Inches3
New Motor Oil or
hydraulic Oil Usage
Non -Polar 0&G/ Total
Petroleum Hydrocarbons
Total Suspended
Solids
Benchmarks
-
-
-
15 mg/L
100 mg/L or 50 mg/L°
Parameter Code
-
46529
NCOIL
00552
C0530
Footnotes from Part A also apply to Part B
Note: if you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses. See General Permit text.
Permit Date: 11/1/2018-05/31/2021 SWU-245, last revised 11/1/2018
Page 2 of 3

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 11 SECTION B.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY ONE OUTFALU YES ED NO
IF YES, HAVE YOU CONTACTED THE DEMLR REGIONAL OFFICE? YES 0 NO ❑
REGIONAL OFFICE CONTACT NAME: Glenn White
Mail an on inol copy of this AMR including all "No Discharge" reports, within 30 days of receipt ot 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 pyroJTq that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
�- C�,S-2&�
Signature of Permittee Date
Permit Date: 11/1/2018-05/31/2021 SWU-245, last revised 11/1/2018
Page 3 of 3

Research & Analytical Laboratories, Inc.
PO Box 473
Kemersville, NC 27285
Phone [phone] Fax [phone]
Email: [e-mail]
Bill To:
Gilbarco, Inc.
7300 W. Friendly Avenue
Greensboro, NC 27410
Attention: John Burke/AP
Make all checks payable to: Research & Analytical Laboratories, Inc.
Date: May 01, 2019
TERMS: NET 30
"Past due Invoices accrue interest at 1 112% interest per month until paid, should collection be required,
customer agrees to pay all expenses incurred Including attorney fees."

RESEARCh & ANA1yTicA[
UboR 1T®Ri(ES, INC.
000
For: Gilbarco
7300 West Friendly Avenue
Greensboro, NC 27410
Attn: John Burke
Report of Analysis
4/30/2019
`,IIIIIIJ100
rrn''++
NC#34 i::":
w NC #37701 %
' D AIA
Client Sample ID: Outfall #03
Lab Sample ID:
65697-01
Site: Gilbarco
Collection Date:
4/19/2019
15:18
Parameter
Method
Result
Units
Rep Limit Analyst Analysis Dateajme
Copper, Total
EPA 200.7
0.026
mg1L
0.005
JF
4/29/2019
Hydrocarbon O&G
EPA 1664 Revision B/Silica Gel
<5
mg/L
5
EE
4/24/2019
Lead, Total
EPA 200.7
<0.005
mg/L
0.005
JF
4/29/2019
Total Suspended Solids (TSS)
SM 2540 D-1997
30.0
mg1L
5
LP
4/22/2019
Zinc, Total
EPA 200.7
0.182
mg/L
0.01
JF
4/29/2019
Client Sample ID: Outfall #02
Lab Sample ID:
65697-02
Site: Gilbarco
Collection Date:
4/19/2019
15:22
Parameter
Method
Result
Units
Rep Limit Analy-st Analysis Dateajme
Copper, Total
EPA 200.7
0.030
mg/L
0.005
JF
4/29/2019
Hydrocarbon O&G
EPA 1664 Revision B/Silica Gel
<5
mg/L
5
EE
4/24/2019
Lead, Total
EPA 200.7
0.007
mg1L
0.005
JF
412912019
Total Suspended Solids (TSS)
SM 2540 D-1997
48.0
mg/L
5
LP
4/22/2019
Zinc, Total
EPA 200.7
0.204
mg/L
0.01
JF
4/29/2019
Client Sample ID. Outfall #01 Lab Sample ID: 65697-03
Site: Gilbarco Collection Date: 4/i912019 15:28
Parameter Method Result Units Rep Limit An._ aiyst Analysis Date/Time
Copper, Total EPA 200.7 0,036 mg/L 0.005 JF 4/29/2019
Hydrocarbon 0&G EPA 1664 Revision B/Silica Gel <5 mg/L 5 EE 4/24/2019
P.O. Box 473 106 Short Street Kernersville, North Carolina 27284 Tel: [phone] Fax: [phone] www.randalabs.com� Page 1
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RESURCh & ANALyTICA1 Report of Analysis
LABORATORIES, INC. 4/30/2019
Client Sample ID: Outfall #01
Lab Sample ID:
65697-03
Site: Gilbarco
Collection Data:
4/19/2019
15,28
a�f[
BQBUli
Unfla
ROP Limit AnalystAnWyals
pAjqMme
Lead, Total EPA 200.7
0.009
mg/L .
0.005
JF
4/29/2019
Total Suspended Solids (CSS) SM 2540 D-1997
109
mg/L
5
LP
422/2019
Zinc, Total EPA 200.7
1.14
mg/L
0.01
JF
4292019
NA = not onolyzed
P.O.6ox 473 106 Short Str et Kemersviile, North Carolina 27284 Tel: 33r-m-2a41 Fax [phone] www.randalabs.com Page 2
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RESEARCh & ANA[yTiCA1
LAbORATORIES, INC.
Analytical / Process Consultations
Phone [phone]
CHAIN OF CUSTODY RECORD
WATER I WASTEWATER I MISC.
COMPANY G Y
JOB NO. 1 / 1
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REQUESTED ANALYSIS
STREETADDRESS
3�� �.., � s i Fr>�r�.,rD c_.rf �rz�
PROJECT
s~cvtw- v�-t�`+�-
CITY, STATE, ZIP
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SAMPLER NAME PLEASE PRINK
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CONTACT PHONE
PLER SIGNATURE
SAMPLENUMBER
;LAB USE OI•'LY)
BATE
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REC.IDUISHED BY
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RECEIVED BY
REMARKS:
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SAMPLE TEMPERATURE AT RECEIPT °C
LI1 OUISHED BY
DATEITIME
RECEIVED BY

Environmental
Quality
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance on filling out this form, please visit https://deq.nc.gov/about/divisions/energy-mineral-land-resources/
npdes-stormwater-gps
Permit No.: NIC/G / o/3/ o / el O I Ol or Certificate of Coverage No.: NICIGI I I I I 1 I
Facility Narne: (7 t Li3 AA" :r:w L
County: 60 s Phone No,
inspector: =0khvJ
Date of Inspection: LA � t
Time of Inspection: 3 ' t Pvv\
Total Event Precipitation (inches): 0, SO '
All permits require qualitative monitoring to be performed during a "measurable storm event."
A "measurable storm event' is a storm event that results in an actual discharge from the permitted site
outfall:` The previous measurable storm event must have been at least 72 hours prior. The 72-hour storm
interval does not apply if the permittee is able to document that a shorter interval is representative for
local storm events during the sampling period, and the permittee obtains approval from the local DEML.R
Regional Office.
By this signature, I certify that this report is accurate and complete to the best of my knowledge:
Sign ure of Permittee or Designee)
1. Outfall Description:
Outfall No. p u 1 Structure (pipe, ditch, etc.). -
Receiving Stream:
kkt/LsC PFS-.4 Fd CAX- �L
Describe the industrial activities that occur within the outfall drainage area:
C
S Nam-
Pagel of 2
SwU-242, Last modified 06/0 U2018

2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: C..)&,, - C.t-WnA 4?6Az—"*' Tz-
3. Odor: Describe any distinct odors that the discharge inay have (i.e., smells strongly of oil, weak
chlorine odor, etc.): p ° o0s'�-
4. Clarity: Choose the number which best describes the clarity of the discharge, where I is clear
and 5 is very cloudy:
1 2 3� 4 5
5. Floating Solids: Choose the number which best describes the amount of floating solids in the
stormwater discharge, where l' is no solids and 5 is the surface covered with floating solids:'
2 3. 4 5
6. Suspended Solids: Choose the number which best describes the amount of suspended solids in
the stormwater discharge, where I is no solids and 5 is extremely muddy:
2 03 4 • ' 5
7. Is there any foam in the stormwater discharge? o Yes
8. Is there an oil sheen in the stormwater discharge? 0Yes
1
9. Is there evidence of erosion or deposition at the outfall? Cr'7'es o No. SWIV67- &4-✓1A—
10. Other Obvious Indicators of Stormwater Pollution:
List and describe
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition may be
indicative of pollutant exposure. These. conditions warrant further investigation.
Page 2 of 2
SWU-242, Last modified 06/01/2019

4
Environmental
Quality
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report '
For guidance on filling out this form, ,please visit https://deq.nc.gov/about/divisions/energy-mineral-land-resources/
npdes-stormwater-gps
Permit No.: N/CIG 1 0/ " 3/v IQ / v/ vl or Certificate of Coverage No.: NICIGI I I I 1 I I
Facility Name: GS aA&-j L w (.,
County: %ur-�--FOA—O Phone No. 33 � —S`-Q —S'"y
Inspector: —,Y6VVj1J a n-
Date of Inspection
Time of Inspection:
Total Event Precipitation (inches): 0.5- D
All permits require qualitative monitoring to be performed during a "measurable storm event."
A "measurable storm event" is a storm event that results in an actual discharge from the permitted site
outfall. The previous measurable storm event must have been at least 72 hours prior. The 72-hour storm
interval does not apply if the permittee is able to document that a shorter interval is representative for
local storm events during the sampling period, and the permitter obtains approval from the local DEN LR
Regional Office.
By this signature, I certify that this report is accurate and complete to the best of my knowledge:
of Permittee or nesignee)
I. — Outfall Description:
Outfall No. U U Z Structure (pipe, ditch, etc.): {Y�`LN-
Receiving Stream:
Describe the industrial activities that occur within the outfall drainage area:
SWU-242, Last modified 06/01/2018
Page I of 2

tj
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors:QL*. t,.) r5-4- 'TAT LZ r
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil, weak -
chlorine odor, etc.): _ Nc
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is clear
and 5 is very cloudy:
1 0. 3 4 5
5. Floating Solids: Choose the number which best describes the amount of floating solids in the
stormwater discharge, where .1 is no solids and 5 is the surface covered with floating solids:
2 3. 4 5
6. Suspended Solids: Choose the number which best describes the amoun{ of suspended solids in
the stormwater discharge, where 1 is no solids and 5 is extremely muddy:
a3 4 5
7. Is there any foam in the stormwater discharge? O Yes O-N'o
8. Is there an oil sheen in the stormwater discharge? 0Yes
9.
Is there evidence of erosion or deposition at the outfall? O Yes a- To.
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.
SwU-242, Last modified 06/01 /2018
Page 2 of 2

l�
Kra -
Environmental
Quality
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance on filling out this form, please visit https://deq.nr-.gov/about/divisions/energy-mineral-land-resources/
npdes-stormwater-gps
Permit No.: NICIG / 0/`3 / a I 0 /.0 I vl or Certificate of Coverage No.: '/C/G/ I 1 I I I 1
Facility Name: (.,;,%c.O4--k- W S tj L..,
County: GT11-L'av, -O Phone No.
Inspector: 3bM-,d L (.n-1
Date of Inspection
Time of Inspection:
!9 I
3 t f f rv,�
Total Event Precipitation (inches): Q 1 5- Z>
All permits require qualitative monitoring to be performed during a "measurable storm event."
A "measurable storm event" is a storm event that results in an actual discharge froth the permitted site
outfall. The previous treasurable storm event must have been at least 72 hours prior. The 72-hour storm
interval does not apply if the permittee is able to document that a shorter interval is representative for
local storm events during the sampling period, and the permittee obtains approval from the local DEMLR
Regional Office.
By this signature, I certify that this report is accurate and complete to the best of try knowledge:
Permittee or Designee
1. Outfall Description:
Outfall No. O 0 3 Structure (pipe, ditch, etc.): DT-n��r'
Receiving Stream:
Describe the industrial activities that occur within the outfaIl drainage area:
t—cvp 4+�)O-C q }yP e (►-F-e--T�
5WU-242, Las[ modified W01/2018
Page I of 2

2. Color: Describe the color of the discharge Using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: Cz,L,,)-^ , 0 -"N 'rT-X—
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil, weak
chlorine odor, etc.): NUwIt
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
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:
2 3, 4 5
G. Suspended Solids: Choose the number which best describes the amount of suspended solids in
the stormwater discharge, where I is no solids and 5 is extremely muddy:
1 j 3 4 , 5
7. Is there any foain in the stormwater discharge? O Yes
8. Is there an oil sheen in the stormwater discharge? OYes
1
9
0
c
Is there evidence of erosion or deposition at the outfall? O 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.
SWU-242, Last modified 06/01/2018
Page 2 of 2

I—)
Environmental
Quality
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance onfrlling out thisform, please visit httpsa/deq.nc.gov/about/divisions/energy-mineral-land-resources/
npdes-stormwater-gps
Pen -nit No.: NICIG / v /3 l 0l vl 6l `3l or Certificate of Coverage No.: NIC/GI 1 1 I l I 1
Facility Name: �i'��^-�� 1 v✓ L
County: G ul: Phone No.
Inspector: _ a � [3,�
Date of Inspection: V I ) Q I
Time of Inspection: L •'.> a P•,
3 36 -5-41 _S' o a 3
Total Event Precipitation (inches):y, SO 1.
All pen -nits require qualitative monitoring to be performed during a "measurable storm event."
A "measurable storm event' is a storm event that results in an actual discharge from the permitted site
outfall. The previous measurable stonn event must have been at least 72 hours prior. The 72-hour stone
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 pennittee obtains approval from the local DEMLR
Regional Office.
By this signature, I certify that this report is accurate and complete to the best of my knowledge:
Permittee or D
1. Outfall De ription:
Outfall No. 0 0 Structure (pipe, ditch, etc.): U"
Receiving Stream:
1 hO*jSt7_ 4 G , x.4 l,__
Describe the industrial activities that occur within the outfall drainage area:
SWU-242, Last modified 06/01/2018
Page 1 of 2

2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: nN G>" 1/1-
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil, weak
chlorine odor, etc.): AN an D*�-
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is clear
and 5 is very cloudy:
0 2 3 4 5
5. Floating Solids: Choose the number which best describes the amount bf 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
5. Suspended Solids: Choose the number which best describes the aariount 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? O Yes
8. Is there an oil sheen in the stormwater discharge? &- es moo.
l )
9. Is there evidence of erosion or deposition at the outfall? o Yes C� No.
10. Other Obvious Indicators of Stormwater Pollution:
k—)
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. .
SWU-242, Last modified 06/01/2018
Page 2 of 2

t�
i
Environmental
Quality
Stormwater Discharge Outiall (SDO)
Qualitative Monitoring Report'
For guidance on filling out this form, please visit https:Hdeq.nc.gov/abouttdivisions/encrgy-mineral-land-resources/
z npdes-stormwater-gps
Permit NTo.: \TICIG / vl �3/ dI 0I d 10I or Certificate of Coverage No.: NICIGI 1 I I I 1 l
Facility Name: <:R� G A-&t-AD T;11.1L
County: �' �L�--C`J ) Phone No. 3 3 b - 5,It I —If "•ra
Inspector:
Date of Inspection: i S
Time of Inspection
Total Event Precipitation (inches)
0;S'o
All permits require qualitative monitoring to be performed during a "measurable storm event."
A "measurable storm event" is a storm event that results in an actual discharge from the permitted site
outfall. The previous measurable storm event must have been at least 72 hours prior. The 72-hour storm
interval does not apply if the permittee is able to document that a shorter interval is representative for
local storm events during the sampling period, and the permittee obtains approval from the local DERILR
.Regional Office.
By tNs,s gliature, I certify that this report is accurate and complete to the best of my knowledge:
of Permittee or Designee)
1. 0Wall Description:
Outfall No. O 0 S
Receiving Stream:
Structure (pipe, ditch, etc.): n i 1 c. t�-
Describe the industrial activities that occur within the outfall drainage area:
SWU-242, Last modified 06/01/2018
Page I of 2

2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: Q" C.)+-:^--
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil, weak
chlorine odor, etc.): -1 ') rvlz-
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is clear
and 5 is very cloudy:
O2 3 4 5
5. Floating Solids: Choose the number which best describes the amount of floating solids in the
stormwater discharge; where 1 is no solids.and 5 is the surface covered with floating solids:
2 3. 4 5 r
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:
U 2 3 4 5
7. Is there any foam in the stormwater discharge? O Yes
8. Ts there an oil sheen in the stormwater discharge? cyi',es O No. -YLX4 ,s
9.
Is there evidence of erosion or deposition at the outfall? O Yes o-'140
10. Other Obvious Indicators of Stormwater Pollution:
List and describe
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition may be
indicative of pollutant exposure. These conditions warrant further investigation.
Page 2 of 2
SWU-242, Last modified 06/01/2018

1 1
j
Environmental
Quality
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance on filling out this form, please visit https://deq.ne.gov/about/divisions/energy-mineral-land-resources/
npdes-stormwater-gps
Permit No.: NIC/,G / 0/3 !il I ° 1 vl `) I or Certificate of Coverage No.: NICIGI I 1 I l I I
Facility Name: G x -53 A^ -,o 17 vj 4
County:
ore-f-4,A-0 Phone No. 37 (, 'Lt 1 — �' 3 D
Inspector:
Date of Inspection:
Time of Inspection: tA : 0 P —
Total Event Precipitation (inches)
C) ,,S
All permits require qualitative monitoring to be performed during a "measurable storm event."
A "measurable storm event" is a storm event that results in an actual discharge from the permitted site
outfall. The previous measurable storm event must have been at least 72 hours prior. The 72-hour storm
interval does not apply if the pen-nittee 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 DE1vLLR
Regional Office.
By this signature, I certify that this report is accurate and complete to the best of my knowledge:
(Signature oyPermittee or Designee)
1. Outfall Description:
Outfall No. C o 6
Receiving Stream:
Structure (pipe, ditch, etc.): 0'4--�
Describe the industrial activities that occur within the outfall drainage area:
CA,,LA49 tJ G
swU-242, Last modified 0610112018
Page 1 of 2

2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(Iight, medium, dark) as descriptors: Ef C,�>Loy—
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil, weak
chlorine odor, etc.): _ lup ME-
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is clear
and 5 is very cloudy:
2 3 4 5
5. Floating Solids: Choose the number which best describes "the ainount of floating solids in the
stormwater discharge, where I• is no solids and 5 is the surface covered with floating solids:•
2 3, 4 'S`,-
6. Suspended Solids: Choose the number which best describes the amourit 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? O Yes o'NT-0.
8. Is there an oil sheen in the stormwater discharge? OYes
9.
l► I M.
Is there evidence of erosion or deposition at the outfall? O Yes o'No
10. Other Obvious Indicators of Stormwater Pollution:
List and describe
_. k
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition may be
indicative of pollutant exposure. These conditions wart -ant further investigation. , !
Page 2 of 2
SIVU-242, Last modified 06/01 /201 S

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No, NCG030000
Date submitted 10/22/18
CERTIFICATE OF COVERAGE NO. NCG030056
FACILITY NAME Gilbarco Inc
COUNTY Guilford RECE1\1ED
PERSON COLLECTING SAMPLES John Burke
LABORATORY_R&A Labs Lab Cert. # 34 OCT 2 NIB
Comments on sample collection or analysis: FILES
CENTRAL
p1NR SECTION
Part A: Stormwater Benchmarks and Monitoring Results
SAMPLE COLLECTION YEAR _2018
SAMPLE PERIOD ❑ Jan -June ® July -Dec
or ❑ Monthly' _ (month)
DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
❑Zero -flow ®Water Supply ❑SA
❑Other
PLEASE REMEMBER TO SIGN ON PAGES 2 AND/OR 3 -->
❑ No discharge this period?'
Date Sample
24-hour rainfall
pH,
Non -Polar O&G/Total
Toxic
Outfall No.
Collected'
amount,
Total Suspended Solids
Standard units
Copper
Lead
Zinc
Total Petroleum
Organics '
(mo/dd/yr)
Inches'
Hydrocarbons
Benchmarks ===>
-
-
100 mg/L or 50 mg/L4
6.0 — 9.0
0.007 mg/L
0.03 mg/L
0.067 mg/L
15 mg/L
1 mg/L
Outfall 001
9/26/18
0.2
53.5 mg/I
7.25
0.018 mg/L
<0.005 mg/L
0.098 mg/L
<5.00 mg/L
SMP
Outfall 002
9/26/18
0.2
17.4 mg/I
6.62
0.022 mg/I
<0.005 mg/L
0.148 mg/I
<5.00 mg/L
SMP
Outfall 003
9/26/18
0.2
<5 mg/I
5.73
0.012 mg/1
<0.005 mg/L
0.171 mg/I
<5.00 mg/L
SMP
1 Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
2 For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here.
'The 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.
a See General Permit, Table 3 identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
5 Total Toxic Organics sampling is applicable only for those facilities which perform metal finishing operations, manufacture semiconductors, manufacture
electronic crystals, or manufacture cathode ray tubes. For purposes of this permit the definition of Total Toxic Organics is that definition contained in the EPA
Effluent Guidelines for the facility subject to the requirement to sample (for metal finishing use the definition as found in 40 CFR 433.11; for semiconductor
manufacture use the definition as found in 40 CFR 469.12; for electronic crystal manufacture use the definition as found in 40 CFR 469.22; and for cathode ray
tube manufacture use the definition found in 40 CFR 469.31).
Permit Date: 11/1/2012-10/31/2017 SWU-245, last revised 10/25/2012
Page 1 of 3

Facilities that incorporate a solvent management plan into the Stormwater Pollution Prevention Plan may so certify, and the requirement for TTO monitoring
may be waived. The solvent management plan shall include a list of the total toxic organic compounds used and the other elements listed in the General
Permit. For those facilities electing to employ the TTO monitoring waiver, the discharger shall sign the following certification statement:
"Based upon my inquiry of the person or persons directly responsible for managing compliance with the permit monitoring requirement for total toxic organics
(TTO), 1 certify that to the best of my knowledge and belief, no dumping of concentrated toxic organics into the stormwater or areas which are exposed to rainfall or
stormwater runoff has occurred since filing the last discharge monitoring report. I further certify that this facility is implementing the all the provisions of the
solvent management plan included in the Stormwater Pollution Prevention Plan."
ROBER'1' BONDOS
Name (Print name)
Vice President of North American Operations
TitI Pn t title)
eoT�Rz�— ('�� A6 D/�zIE8
(Signature) (Date)
Note: Results must be reported in numerical format. 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 m L" where XX is the numerical value of the detection
limit, reporting limit, etc. in mg/L.
Note: if you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses. See General Permit text.
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month.
❑ No discharge this period?'
dutfall No.
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
Inches}
Non -polar O&G/TPH by
EPA 1664 (SGT-HEM)
Total Suspended Solids
pH
Benchmarks
15 mg/L
100 mg/L or 50 mg/L*
6.0 -- 9.0 SU
Footnotes from Part A also apply to this Part B
* See General Permit text, Table 5, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Permit Date: 11/1/2012-10/31/2017 SWU-245, last revised 10/25/2012
Page 2 of 3

Note: If you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses. See General Permit text.
FOR PART AAND PART B MONITORING RESULTS:
• A 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: Glenn White
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 away that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
(Signature of Permittee)
,C24/ LZ
(Date)
Permit Date: 11/1/2012-10/31/2017
SWU-245, last revised 10/2S/2012
Page 3 of 3

RESEARCH & ANA1YTiCA[
QO UbORATORIES, INC.
For: Gilbarco
7300 West Friendly Avenue
Greensboro, NC 27410
Attn: John Burke
Report of Analysis
1013I2018
. `*%j1aIIlpflo
•�'`�l��..`
'.t V C
N.
6.A:u , G "�
�a'v� NC#34 �
NC #37701
r `
i
p�.) if i A AN''. +�
Client Sample ID: Stormwater Outfall 03
Lab Sample ID:
56737-01
Site: Gilbarco
Collection Date:
9/26/2018
18:20
Parameter
Method
Result
Units
Rep Limit Anal ,st Analysis Dateaime
Copper, Total
EPA 200.7
0.012
mg1L
0.005
JF
10/1/2018
Hydrocarbon 0&G
EPA 1664 Revision Milica Gel
<5
mg/L
5
EE
9/28/2018
Lead, Total
EPA 200.7
<0.005
mg/L
0.005
JF
101112018
Total Suspended Solids (TSS)
SM 2540 D-1997
<5
mg/L
5
AW
10/1/2018
Zinc, Total
EPA 200.7
0.171
mg/L
0.01
JF
1011/2018
Client Sample ID: Stormwater Outfall 02
Lab Sample ID:
56737-02
Site: Gilbarco
Collection Date:
9/26/2018
18:25
Parameter
Method
Result
Units
Rep Limit Analyst Analysis Datefrime
Copper, Total
EPA 200.7
0,022
mg/L
0.005
JF
10/112018
Hydrocarbon O&G
EPA 1664 Revision B/Silica Gel
<5
mg/L
5
EE
912812018
Lead, Total
EPA 200.7
<0.005
mgfL
0.005
JF
10/1/2018
Total Suspended Solids (TSS)
SM 2540 D-1997
17.4
mg/L
5
AW
10/1/2018
Zinc, Total
EPA 200.7
0.148
mg/L
0.01
JF
10/1/2018
Client Sample ID: Stormwater Outfall 01 Lab Sample ID: 56737-03
Site: Gilbarco Collection Date: 9/26/2018 18:35
Parameter Method Result Units Rep Limit Analyst Analysis Dateffime
Copper, Total EPA 200.7 0.018 mg/L 0.005 JF 10/1/2018
Hydrocarbon O&G EPA 1664 Revision B/Silica Gel <5 mg/L 5 EE 9/28/2018
P.O. Box 473 106 Short Street Kernersville, North Carolina 27284 Tel: [phone] Fax: [phone] www,randalabs.com Page 1
sa! coa basic v!d

QQ
ova
RESEARCh & ANA1YTiCA1
LAbORATORIESr INC.
Report of Analysis
10/3i2018
Client Sample
ID: Stormwater Outfall 01
Lab Sample ID: 56737-03
Site:
Gilbarco
Collection Date: 9/26/2018 18:35
Parameter
Method
Result Units
Rev Limit Analyst Analysis DatelTime
Lead, Total
EPA 200.7
<0.005 mg1L
0.005 JF 1011/2018
Total Suspended Solids (fSS) SM 2540 D-1997
53.4 mg1L
5 AW 10/1/2018
Zinc, Total
EPA 200.7
0.098 mg1L
0.01 JF 10/1/2018
I
NA = not analyzed
P.O. Box 473 106 Short Street Kernersville, North Carolina 27284 Tel: [phone] Fax: [phone] wwv.randalabs.com Page 2
ral coa basic vid

f RESEARCh & ANA1yTICA[
I-AbQRATORIES, INC.
Analytical / Process Consultations
Phone [phone]
CHAIN OF CUSTODY RECORD
WATER I WASTEWATER MISC.
COMPANY
JOB NO.
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SAMPLER NAME (PLEASE PRINT)
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CONTACT PHONE
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01h
ENV-EXT-F-008B RevO
•.
NC ENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Forguidance on filling out this form, please visit: hup:1mortal.ncdenr.org/web/wq/ws/suInpdessw#tab-4
Permit No,: o/ U/ U/ a / or Certificate of Coverage No.: N/C/G/
Facility Name: r-Vj ( —
County: _
Inspector:
,,mac Fo�r> Phone No. 3 3 6 - 3 3 `] - i--7 L4, �
Date of Inspection: �?
Time of Inspection: 6
to
Total Event Precipitation (inches):y 1-0
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
{See info •oration below.)
Yes ❑ No
Please verify whether Qualitative Monitoring must be performed during a "representative storm
event" or "measureablestorm 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 eventmay contain up to 10 consecutive hours of no
precipitation.
A "measurable storin 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 DWC
Office.
certify that this report is aZNtRte and complete to the best of any knowledge:
of Permittee or Designee)
Page 1 of 2
SWU-242, LaAMOdi[led 10/25/2012

I. Outfall Description:
Outfall No. 6 b Structure (pipe, ditch, etc.)
Receiving Stream;
Describe the industrial activities that occur within the outfall drainage area:
j t l+ -' rr%�T�+L 5 rw^ -'a tsf - C uf-w� j'f�-ram ►l-c� f��\ Q-1a +� .t�,r/L ., R.z sr� t� rLw�rs jo,Ij _ _T
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: Liter
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.): N II i--
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
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
6. Suspended Solids: Choose the number which best describes the amount of suspended
solids in the stormwater disch rge, where is no solids and 5 is extremely muddy:
2 3 4 5
7. is there any foam in t e stormwater discharge? Yes o
B. is there art oil sheen in the stormwater discharge? Yes
9. is there evidence of erosion or deposition at the outfali?
10. Other Obvious Indicators of Stormwater Pollution:
List and describe .S %
Yes
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

ENV-EXT-F-008B RM
W5 N Rm
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For•guidance on filling out this form, please visit: htt}p:/%p. rtaLncdenr.or-/web/wo fws15u1i1p ssw#tabA-
PermitNo.: orCertifiicate of Coverage No.: N/C/ / 0/3/ o/
Facility Name: sVi C-1
County: Phone No. 3 3 � -"3 3
Inspector: - t,_r,
Date of Inspection:
Time of Inspection:
A^n
Total Event Precipitation (inches): C ?-z:;)
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
{See inf •motion below.)
Yes ❑ No '
Please verify whether Qualitative Monitarirrg must be performed during a "representative storm
event" or "ineasureablestorm 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.
3 -
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
f interval is representative for local storm events during the sampling period, and the permittee
obtains approval from the local DWQ Regional Office.
By this signatur fy that this re • is accurate and complete to the best of my knowledge:
of Permittee or Designee)
Pagel of 2
SWI1-242- Lactmadifred 10/25/2012

1. Outfall Description:
Outfall No. 00 2 Structure (pipe, ditch, etc.)
Receiving Stream:
Describe the industrial activities that occur within the outfall drainage area.:
G ti—-�-i5
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: __% - I _
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:
S. FIoating 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 dischairge, Where 1 is no solids and 5 is extremely muddy:
2 3 4 5
zo�
7. Is there any foam in the stormwater discharge? Yes Fo
J
S. Is there an oil sheen in the stormwater discharge? Yes No
9. Is there evidence of erosion or deposition at the outfall? Yes No
10. Other Obvious Indicators ofStormwater Pollution:
List and describe &F BA-sj-t'L
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 madified 10/25/2012

ENV-EXT-F-008B RevO
NCR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report _
Forguidanceonfilling out thrsform,please vrsit: httu://(portal.ncdenr.org/webfwa/wsfsuIn
-pdessw#tab 4
Permit No.: Njc// �? // �/ u/ �/ / or Certificate of Coverage No.:
Facility Name: CST- _� C_- T
County: G JV-Lp�9 Phone No. 9 3 ^ 3 3 t"t L-�
Inspector: _ 7'WL--P,
Date of Inspection: 9( 11-V 1 cR
Time of Inspection: (,) -"
Total Event Precipitation (inches): o ' ZiD
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
(See inf •(nation below,) 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. 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 treasuring 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 thi_ s� t eaort is accurate and complete to the best of my knowledge:
of Permittee or D
Page 1 of 2
SWIi-242_ Last modified 10/25/2012

1. Outfall Description:
Outfall No. DD -� Structure (pipe, ditch, etc.) .Z 1ar
Receiving Stream: E 'L5 fz P-Av"-'
Describe the industrial activities that occur within the outfall drainage area:
5 f's
2. Color: Describe the color of the di
(light, medium, dark) as descriptors: _ j
3. Odor: Describe any
weak chlorine odor, etc.): _
rge using basic colors (red, brown, blue, etc.) and tint
-t odors that the discharge may have (i.e., smells strongly of oil,
AA-
4. CIarity: Choose the number which hest describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
J ) 2 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:
G) 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:
2 3 4 5
7. Is there any foam in the stormwater discharge? Yes No
S. Is there an oil sheen in the stormwater discharge? Yes CLf
9. Is there evidence of erosion or deposition at the outfall? Yes CO)
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
5WU-242, Last atodif ed 10/25/2012

ENV-EXT-F-008B RevO
CDENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Por•guidanceonfilling out thisform,please visit: Eap)f/portal.ncdennorg/web/wo/wsfsu_jnpdessw#tab-4
Permit No.: or Certificate of Coverage No.:
Facility Name: C9r-c-+1�v-j C—
County: C� ������ _ Phone No. 3 " 3 3
Inspector: Tb"-�
Date of Inspection:
Time of Inspection:
(R
`J t,1--) P eK
Total Event Precipitation (inches): 0,
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
{See inmation below,)
Yes ❑ No
Please verify whether Qualitative Monitoring trust be pet formed during a "representative stomp
event"or "tneasureablestorm event" (requirements vary, depending on the permit).
Qualitative monitoring requirements,vary. Most permits require qualitative monitoring to be
performed during a "representative storm ev" ent" 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 O.J. 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 perrnittee 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 DW(
Regional Office.
re, I certify that ort is accurate and complete to the best of my knowledge:
of Perrnittee or Designee)
Page 1 of 2
CW I-247._Lastmadified10125/2012

1. Outfall Description:
Outfall No. Do' ---A Structure (pipe, ditch, etc.) nT� Receiving Stream, 1 S,r'.- pfu\jTi__.
Describe the industrial activities that occur within the outfall drainage area: P'Y-�v✓��
2. Color: Describe the color of the
(light, medium, dark) as descriptors:
3. Odor: Describe any dis
weals chlorine odor, etc,): i
using basic colors (red, brown, blue, etc.) and tint
odors that the discharge may have (i.e., smells strongly of oil,
4. CIarity: Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy: ��
j1 J 2 3 4 s
5. Floating Solids: Choose the number which best describes the amount of floating solids in
the stormwater discharge, where is no solids and 5 is the surface covered with floating solids:
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:
(? 2 3 4 5
7. Is there any foam in the storinwater 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 e)-�
Other Obvious Indicators ofStormwater 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
SWO-242, fast modified 10/25/2012

�� ENV-EXT-F=-008B RevO
NCDE R
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Forgi dance on filling out thisform,please visit: htt,p:f/portal.ncdenr.oig%web/wgfws/sufnpdessw#tab-4
Permit No.: N/C/ 6/.r / 3 / -!2�/ U/ �/ o / or Certificate of Coverage No.: N19;1 /
Facility Name: C��� ���_ s+J C
County: G oi(-t-�- Phone No. 3 3 6- 3 3
inspector:
Date of inspection: „
Time of Inspection: )
Total Event Precipitation (inches): 0' Z`'
Was this a "Representative Storm Event" or "Measureahle Storm Event" as defined by the permit?
{See in""
below,)
Yes ❑ No
Please verify whether Qualitative Monitoring must be per formed during a "representative storm
event" or "rneasureable 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 dining 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"treasurable 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 focal storm events during the sampling period, and the permittee
obtains approval from the local DWG
By this s*ature, I certify that this
Perini
Regional Office.
ate and complete to the nest of my knowledge:
MMI-247.. LartmndiGed 10/25/2012
Page 1 of 2

1. Outfall Descriptiou,
Outfail No. Ov Structure (pipe, ditch, etc.) OTVLA
Receiving Stream: i M-S-r ()-v•,n1 /--�
Describe the industrial activities that occur within the outfall drainage area: ?A--
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: V'
3. Odor: Describe any distinc�odors that the discharge may have (Le.; smells strongly of oil,
N
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:
2 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:
0 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:
2 3 4 5
7. Is there any foam in the stormwater discharge? Yes 'N
8. Is there an oil sheen in the stormwater discharge? Yes 6N
9. Is there evidence of erasion or deposition at the outfall? Yes 61
10. Other Obvious Indicators ofStormwater 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

AWYV ENV-EXT-F-008B RevO
lr
A -
MCDENR
Stormwater Discharge Outfaii (SDO)
Qualitative Monitoring Report
For guidance on filling out this form, please visit. http://portal.ncdennorg/webIwo/ws/su/nodessw#tab-4
Permit No.: or Certificate of Coverage No,: N/C/ i/
Facility Name: G T�-LAAO� r_� (—
county-. G ��� " — Phone No. 3 - -3 3 `] - L-1 Lc
Inspector: _ (2;,,_O-
Date of Inspection:
Time of Inspection:
t3
'. zz P n--
Total Event Precipitation (inches): o' Z`-)
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
{see inf matian 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. 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 storin 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 DW(
nal Office.
By this siknature, I certify that this report is accuse and complete to the best of any knowledge:
of Permittee or Designee)
Pagel of 2
CW11-242. fastmadliied 10/25/2012

1. Outfall Description:
Outfall No. da 6 Structure (pipe, ditch, etc.) QI-Tz- .~--
Receiving Stream: 1A--,;� jC, FT-�J
Describe the industrial activities that occur within the outfall drainage area:
2. Color: Describe the color of the disc]
(light, medium, dark) as descriptors: OIL,.
rge using basic colors (red, brown, blue, etc.) and tint
3. Odor. Describe any distinct o4ors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.): /I —
4. Clarity. Choose the number which hest describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
DI 2 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:
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:
2 3 4 5
7. Is there any foam in the stormwater discharge? Yes no
S. Is there an oil sheen in the stormwater discharge? Yes V
9. Is there evidence of erosion or deposition at the outfall? Yes
10. Other Obvious indicators ofStortnwater 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 inadified 10/25/2012

45�, Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No. NCG030000
Date submitted 4/30/18
CERTIFICATE OF COVERAGE No. NCG030056
FACILITY NAME Gilbarco Inc
COUNTY Guilford
PERSON COLLECTING SAMPLES John Burke
LABORATORY_R&A Labs_ Lab Cert. # 34
Comments on sample collection or analysis: RECEIVED
Part A: Stormwater Benchmarks and Monitoring Re?affR 'L FILES
pW R SECTION
SAMPLE COLLECTION YEAR _2018
SAMPLE PERIOD Jan -June �. July -Dec
or ❑ Monthly' (month)
DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
❑Zero -flow ®Water Supply [:]SA
❑Other
PLEASE REMEMBER TO SIGN ON PAGES 2 AND/OR 3 4
❑ No discharge this period?z
Date Sample
24-hour rainfall
P H,
Non -Polar O&G/
Total Toxic
Outfall No.
Collected'
amount,
Total Suspended Solids
P
Standard units
Co
Copper
Lead
Zinc
Total Petroleum
Organicss
(mo/dd/yr)
Inches3
Hydrocarbons
Benchmarks ==W>
-
-
100 mg/L or 50 mg/L°,
6.0 — 9.0
0.007 mg/L
0.03 mg/L
0.067 mg/L
15 mg/L
1 mg/L
Outfall 001
4/4/18
0.15'
18.6 mg/1
6.50
0.011 mg/L 1
<0.005 mg/L
0.060 mg/L
<5.00 mg/L
SMP
Outfall 002
4/4/18
0.15
13.2 mg/I
5.9
0.014 mg/I
<0.005 mg/L
0.108 mg/1
<5.00 mg/L
SMP
Outfall 003
4/4/18
0.15
5.8 mg/I
5.5
0.009 mg/I
<0.005 mg/L
0.087 mg/I
<5.00 mg/L
SMP
1 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.
'The 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.
a See General Permit, Table 3 identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
s Total Toxic Organics sampling is applicable only for those facilities which perform metal finishing operations, manufacture semiconductors, manufacture
electronic crystals, or manufacture cathode ray tubes. For purposes of this permit the definition of Total Toxic Organics is that definition contained in the EPA
Effluent Guidelines for the facility subject to the requirement to sample (for metal finishing use the definition as found in 40 CFR 433.11; for semiconductor
manufacture use the definition as found in 40 CFR 469.12; for electronic crystal manufacture use the definition as found in 40 CFR 469,22; and for cathode ray
tube manufacture use the definition found in 40 CFR 469.31).
Permit Date: 11/1/2012-10/31/2017 SWU-245, last revised 10/25/2012
Page 1 of 3

Facilities that incorporate a solvent management plan into the Stormwater Pollution Prevention Plan may so certify, and the requirement for TTO monitoring
may be waived. The solvent management plan shall include a list of the total toxic organic compounds used and the other elements listed in the General
Permit. For those facilities electing to employ the TTO monitoring waiver, the discharger shall sign the following certification statement:
"Based upon my inquiry of the person or persons directly responsible for managing compliance with the permit monitoring requirement for total toxic organics
(TTO), I certify that to the best of my knowledge and belief, no dumping of concentrated toxic organics into the stormwater or areas which are exposed to rainfall or
stormwater runoff has occurred since filing the last discharge monitoring report. I further certify that this facility is implementing the all the provisions of the
solvent management plan included in the Stormwater pollution Prevention Plan."
ROBERT BONDOS
Name (Print name)
Vice PrOWent of North American 0 erations
Ti (Pri t title)
(
L �
(Signature) (Date)
Note: Results must be reported in numerical format. bo 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 form_at,_"<XX mg/L", where XX is the numerical value of the detection
limit, reporting limit, etc. in mg/L.
Note: If you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses. See General Permit text.
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month.
❑ No discharge this period?2
Ouifall No.
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall'
amount,
IncheS3
Non-polar-O&G/TPH by
EPA 1664 (SGT-HEM)
Total Suspended Solids
pH
Benchmarks
15'mg/L
100 mg/L or 50 mg/L*
6.0 — 9.0 SU
Footnotes from Part A also apply to this Part B
* See General Permit text, Table 5, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Permit Date: 211112012-1013112017 SWU-245, last revised 10/25/2012
Page 2 of 3

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 11 SECTION B.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART it 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: Glenn White
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 aw,afe—T�at there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
re of Permittee)
Permit Date: 11/1/2012-10/31/2017
SWU-245, Last revised 10/25/2012
Page 3 of 3

Krrnnruwe. NorthCuvfre 27284 23 April 2018
Gilbarco, Inc.
7300 W. Friendly Avenue
Greensboro, NC 27410
Attention: John Burke / AP
WMARdl
TicA
L_�1.11.1i����ii�ll..
'�de-C
Pbm Off= 6ac 473 N OM MO. 5 5 7
Job ## 040418
Project Name: Stormwater
Samples collected 04/04/18
Analysis of three (3) samples for:
Oil & Grease, TPE
0 $75.00/sample
)read, Total
@ $15.00/sample
TSS
$10.00/sample
COpper,TOt
@ $12.00/sample
Zinc,Tot
$12.00/sample
TOTAL INVOICE
(Report enclosed)
TERMS: NET 30
'PAST DUE INVOICES ACCRUE
INTEREST AT 1 D5% INTEREST PER
MONTH UNTIL PAID
SHOULD COLLECTION BE REQUIRED,
CUSTOMER AGREES TO PAY
ALL EXPENSES INCURRED INCLUDING
ATTORNEY'S FEES'
FIE;
Phow 3361996.2841
$225.00
$ 45.00
$ 30.00
$ 36.00
$ 36.00
$372.00

ESEARCh & ANA1yT9CA1
Apo LA ORAT®RkSf INC.
000
For: Gilbarco
7300 West Friendly Avenue
Greensboro, NC 27410
Attn: John Burke
Report of Analysis
4/20/2018
• • •� �i fp
'to NC #34 Z. SR
NC #37701
to
a
Client Sample ID: Outfall 03
Site: Gilbarco
Lab Sample lD:
Collection Date:
48741-01
4/4/2018
6:55
Parameter
Method
Result
Units
Rep Limit An_ alyst Analysts DatelTime
Copper, Total
EPA 200.7
0.009
mg/L
0.005
KL
4/6/2018
Hydrocarbon O&G
EPA 1664 Revision B/Silica Gel
<5
mg/L
5
AW
4/11/2018
Lead, Total
EPA 200.7
<0.005
mg/L
0.005
KL
4/6/2018
Total Suspended Solids (TSS)
SM 2540 D-1997
5.8
mg/L
5
AA
4/5/2018
Zinc, Total
EPA 2001
0.087
mg/L
0,01
Kt-
4/6/2018
Client Sample ID:
Outfall 02
Lab Sample ID:
48741-02
Site:
Gilbarco
Collection Date:
4/4/2018
7:00
Parameter
Method
Result
Units
Rep Limit Analyst Analysis Date/Time
Copper, Total
EPA 200.7
0.014
mg1L
0,005
KL
4/6/2018
Hydrocarbon O&G
EPA 1664 Revision B/Silica Gel
<5
mg/L
5
AW
4/11/2018
Lead, Total
EPA 200.7
<0.005
mg/L
0.005
KL
4/6/2018
Total Suspended Solids (TSS)
SM 2540 D-1997
13.2
mg/L
5
AA
4/5/2018
Zinc, Total
EPA 200.7
0.108
mg/L
0.01
KL
4/6/2018
Client Sample ID:
Outfall 01
Lab Sample ID:
48741-03
Site:
Gilbarco
Collection Date:
4/4/2018
7:05
Parameter
Method
Result
Units
Rep Limit Analyst Analysis Date/Time
Copper, Total
EPA 200.7
0.011
mg/L
0,005
KL
4/6/2018
Hydrocarbon O&G
EPA 1664 Revision B/Silica Gel
<5
mg/L
5
AW
411212018
P.O. Box 473 106 Short Street Kernersville, North Carolina 27284
IC-0 tj
Tel:[phone] Fax:[phone] www.randalabs.com
Page 1

RESEARCh & ANA YTICAL
Report of Analysis
C a
LA O RAT®Ri ES, INC.
4/20/2018
Q
Client Sample
ID: Outfall 01
Lab Sample ID: 48741-03
Site:
Gilbarco
Collection Date: 4/4/2018 7:05
Parameter
Method
Result Units
Rep Limit Analyst Analysis DatefTime
Lead, Total
EPA 200.7
<0.005 mg/L
0.005 KL 416/2018
Total Suspended Solids (TSS) SM 2540 D-1997
18.6 mg/L
5 AA 415/2018
Zinc, Total
EPA 200.7
0.060 mg1L
0.01 KL 416/2016
NA = not analyzed
P.Q. Box 473 106 Short Street Kernersville, North Carolina 27284 Tel: 336-99fi-284i Fax: [phone] www,randalabs.com VPage 2
1d

5 RESEARCH A�� �nruCAi
'UbORATOOES M.
'Analytical / Process Consultations
Phone [phone]
CHAIN OF CUSTODY RECORD
WATER I WASTEWATER IGIISC.
OMPANY
S.rJ
JOH NO. LI L
rx
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x
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? O�COVIOp o'Upol
of pF Q C� Q' 1z, Q c
ti� ti ryh ryh ,v v ,v v Gj�c REQUESTED ANALYSIS
TREETADDRESS
'] o J W r 5r FBI- lu o
PROJECT
$tD�^tiw 1�,"T"a✓� T]�3
ITY, STATE, ZIP
(LF.F �5 C3 a � N L Z� � {,o
SAMPLER NAME (PLEASE PRINT)
� l�-rJ (�.�,n-tvf�
ONTACT PHONE
336
SAMP ERSIGNATLIRE
SAMPLE NUMBER
(LAB USE ONLY]
DATE
TIME
CGjdP
GRAB
TE�F
PIES
Im n
CKGRJUE
EU•Mfl
SA E
15
SAMPLE LOCATION l I.C.
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IN4tIIS
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RECEIVED BY
REMARKS:
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SAMPLE TEMPERATURE AT RECEIPT ' t °C
LIN ISHED 8Y
DATErrIME
RECEIVED BY

ENV-EXT-F-00813 Revo
,4
NCDENR
Stormwater Discharge Outfall (SDD)
Qualitative Monitoring Report
Forgaidance on filling aut this form, please visit: http://ooi-talaicdenr.orL-/web/wq/wsLsujnpdess�v#Lab-4
Permit No.: NIxl G/ 2/ / 2/ 2/11 / `J/ or Certificate of Coverage No,: N/C/G/ 2/ 3/ U/ v1 S/ 6/
Facility Name,`' 1(�1-rw 5 0%cr
County: Phone No.
Inspector: Zo
Date of Inspection: 1l 1
Time of Inspection:
Total .Event Precipitation (inches): ZD, ) 5-
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
(See information below.)
[t]/Yes/ ❑ No
Please verify whether Qralitative 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 fours of no
precipitation.
` A "[neasurable 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
I interval is representative for local storm events during the sampling period, and the permittee
1 obtains approval from the local DWQ Regional Office.
By this signature,,) certify.that this report is a LIgrate and complete to the best of my Knowledge:
(Signature 4 Perr4ittee or D
Page 1 of 2
Swtr-242, Lastmodfried 10/25/2012

1. Outfall Description: {�
Outfall No. M (- 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
(iiglit, medium, dark) as descriptors: eAa-t)-
3. Odor: Describe any distinct odors that the discharge may have (i.e., smelis strongly of oil,
weals chlorine od or, etc.): AJ +`j rL
4. Clarity: Choose the number which hest describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
0 2 3 4 5
5, Floating Solids: Choose the number which best describes the amount of floating solids in
the stormwater discharge, where 1 is no solids and 5 is the surface covered with floating solids:
0 2 3 4 5
6. Suspended Solids: Choose the number which best describes the amount of suspended
solids in the stormwater discharge, where T is no solids and 5 is extremely muddy:
0 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
9. Is there evidence of erosion or deposition at the outfall?
14. Other Obvious Indicators of Stormwater Pollution:
List and describe
Yes CNo)
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 modifled 10/25/2012

ENV-EXT-F-0086 Revo
AjM
CDENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Forguidanceonfilling out thisform,please visk: http.-/I,ortal.iicdenr.oWweb/wctfw su n desswltab-4.
Permit No.: NJcJ�J�/ l 4 J / p/v / or Certificate of Coverage No.: N/ lfil lj J D J �l SJ /
vacuity Name: L% ;1.P Cr
County: kv-A _ Phone No
Inspector: �ZFz)�'L'"�
Date of Inspection: 7 b
Time of Inspection: ` i" r 7 1 1--
Total .Event Precipitation (inches): 0, 1 5
6 -'S51 7 S'CD
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
(See information below.)
©/Yess ❑ No
Please verify whether Qualitative Monitoring must be pea formed during a "representative storm
event" or "ineasureable storm event" (requirements vary, depending on the permit).
Qualitative monitoring requirements vary. Most permits require qualitative monitoring to be
Performed during a "representative storm evens" or during a "measureabie 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 docurnent 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 signak-e, I. certify.that this report isNcurate and complete to the best of my knowledge:
(Sign
e or Designee)
Page 1 of 2
5WU-242, Lastmodlfted 10/25/2012

�. Outfall Description:
Outfall No. 001. Structure {pipe, ditch, etc.) P4z==
Receiving Stream: _ tkr ►�� r'"�'�
Describe the inPustrial 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: I
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.): N.u� r--
4. CIarity: Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
1 3 4 5
5. Floating Solids: Choose the number which best describes the amount of floating solids in
the storrnwater discharge, where 1 is no solids and 5 is the surface covered with floating solids:
1 S) 3 4 5
6. Suspended Solids; Choose the number which best describes the amount of suspended
solids in the storrawater discharge, where 1 is no solids and 5 is extremely r-nuddy:
1 2 3 4 5
7. is there any foam in the storrnwater discharge? Yes
S. Is there an oil sheen in the storrnwater discharge? Yes
9. Is there evidence of erosion or deposition at the outfall? Yes No
10. Other Obvious Indicators of Storrawater Pollution:
List and describe
Note: Low clarity, high solids, and/or the presence of foam, oil sheeli, or erosion/deposition
inay be indicative of pollutant exposure. These conditions warrant further investigation.
Page 2 of 2
SWU-242, Last modified I0/2s/201.2
r

ENV-E=XT-�F-OO8B RevO
�`� klA
A
MCDEN t
Storlmwater Discharge Outfall (SDO)
Qualitative Monitoring Report
!%orguidance on filling out this forth, please visit: httpj- ja rtaLncdenr.org/web�wu/wLs/suf i Lde_. ,gw#tab _4
Permit No.: N/C/G/ �/3/ D / D/ �/ v/ or Certificate of Coverage No.:
Facility Name:-'' 1� r r .� c_
County: Apv. Phone No
Inspector: n.`c
Date of Inspection:
Time of Inspection: `- �^' " -7 ` }S fir-•
Total Event Precipitation (inches): D, i 5
i-A'l7-SaD-
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. Most permits require qualitative monitoring to be
performed during a "representative storm event" or during a "measureable storm event." However,
j: some permits do not have this requirement. Please refer to these definitions, if applicable.
l
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.
i
A "zneasuirable 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 sign it ertify.that this r ort is accurate and complete to the best of my knowledge:
(Signatu a of ermittee or Designee]
Page 1 of 2
SWU-242, Last modified 10/25/2012

1. Outfall Description:
outfall No, Cw tA Structure (pipe, ditch, etc.)
Receiving Stream: i �"S-� ��- t `L L,
Describe the indust 'al 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: 1 _
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.): Nv-1--
4. Clarity, Choose the number which hest describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy: 9
2 3 4 5
5. Floating Solids: Choose the number which best describes the amount of floating solids in
the stormwater discharge, where 1 is no solids and 5 is the surface covered with floating solids:
1� 2 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 inuddy:
2 3 4 5
7. Is there any foam in the stormwater discharge? Yes I�
B. Is there an oil sheen in the stormwater discharge? Yes `AFd
9. is there evidence of erosion or deposition at the outfall? Yes +o
10. Other Obvious Indicators of Stormwater Pollution:
List and describe
Note: Low clarity, high solids, and/or the presence of foatu, oil sheen, or erosion/deposition
may be indicative of pollutant exposure. These conditions warrant further• investigation.
Page 2 of 2
SWId-242, Last modified 10/25/2012

ENV-EXT-F-008B RevO
MCDENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Forguidance on filling our this form, please visit: httu:Upgi ta[.ncdenr.orgiyeblwn/w 4su/npcle sew#taE -4
Permit No.: NJC///�/ `�/ / v/ �/ or Certificate of Coverage No.:/f// 6/3 J
County: _ I263 i2-'r�_ Phone No.
Inspector: � !-\-� f�111- -
Date of Inspection: YIq 1/
Time of Inspection: =3.0 - -) , k C ►4�
Total Event Precipitation (inches): D, 1 S
L --S�I-SC.3
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
(See information below,)
ZYes (] 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 "ineasurable 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 sloes 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 alcurate and complete to the best of my knowledge:
Perraittee or Designee)
Page 1 of 2
SWU-242, Last modified 10/25/2012

1. Outrall Description:
Outfall No, j2z3 Structure (pipe, ditch, etc.)
Receiving Stream: l — P: - - C«�—
Describe the industrial �}ctivities that occur within the outfall drainage area:
+C fk"Jll� Q".-�- � 4tr"
2. Color: Describe the color of the discharge using basic colors (red, brows;, blue, etc.) and tint
(fight, medium, dark) as descriptors:
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weals chlorine odor, etc.): VD— -
4. Clarity: Choose the number which hest describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
G2 3 4 5
5. Floating Solids: Choose the number which best describes the amount of floating solids in
the stormwater discharge, where is no solids and 5 is the surface covered with floating solids:
(/1 J 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:
0 2 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 No
9. is there evidence of erosion or deposition at the outfall? Yes
10. Other Obvious Indicators of Storinwater 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, i,ast taadified 10/25/2012
I

ENV-EXT-F-008B RevO
MCDENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Forguldance on filling out this form, please visit: httl2:1/aortal.ncdenr.org/web f wnlws/su/ripdessty#tab-4,
Permit No.: L`iICI�/�I/ �/ �J v/I or Certificate of Coverage No.:
Facility Name: raw A c_
County: u , Phone No
Inspector:
i-Sq7.-S'eD0
Date of inspection:
Time of Inspection:
Total Event Precipitation (inches): D, 1 S
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. Most permits require qualitative monitoring to be
i perfor;ned 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
i 0.1 inches has occurred. A single storm event may contain up to 10 consecutive fours of no
precipitation.
A "ineasuralble 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 Iocal storm events during the sampling period, and the permittee
obtains approval from the local DWQ Regional Office -
By this signatu , certify, that this report i) accurate and complete to the best of my knowledge:
(Signat4re ofP4rmittee or Designee)
Page 1 of 2
SWU-242, List modlfied 10/25/2012

1. outfall Description:
Outfall No, Oy 'L Structure (pipe, ditch, etc.)
Receiving Stream: Lpf'5�=-CC-A'—
De scribe 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.-
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.);
4. CIarity: Choose the number which hest describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
L72 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 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 inuddy:
0 2 3 91 5
7. Is there any foam in the stormwater discharge? Yes No
8. Is there ail oil sheen in the stormwater discharge? Yes CNq)
9. Is there evidence of erosion or deposition at the outfall? fe
No
10. Other Obvious Indicators of Storntwater 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, fast Enodified 10/25/2012

ENV-EXT-F-0088 Revd
MC®ENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For•guidance on filling out this form, please visit: htt: rtala dent-.oi we w /ws/su/ ipdessw##tal)-4
Permit No.: NJc// -9/% o/ -Pf or Certif sate of Coverage No.: NlC/G/ �!/3f A /
raciifty Name: 1 L2 -�rw n c�
County: 60-A Phone No.
Inspector: -o
Date of Inspection: 1$
Time of Inspection: � r 3a — 7 •'i � tiv�.
Total Event Precipitation (inches): Q, 1 S
Was this a " representative Storm Event" or "Measureable Storm Event" as defined by the permit?
(See imation below.)
Z
[9 Yes 0 No
Please verify whether Qualitative Monitoring must be performed during a "representative storm
event" or "reasureable 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 storin event" is a storm event that results its 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 sigpatur ertify.that this rep is accurate and complete to the best of any knowledge:
of permittee or Designee)
Page 1 of 2
SWU-242, Lastmodilled 10/25/2012

1. Outfall Description: fti%
Outfall No. 00_1._ Structure (pipe, ditch, etc.)
Receiving Stream:
Describe the industrial activities that occi r within the outfall drainage area:
5':'f-r '--4A ��`'-V S -•ate . ' I- •'=,.; J- s ti-
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors:
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weals chlorine odor, etc.):
4. Clarity: Choose the number which hest describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
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 3 4 5
7. is there any foam in the stormwater discharge? Yes
63
8. Is there an oil sheen in the stormwater discharge? Yes
(12
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.
Page 2 of 2
Swu-242, Lastmodified 10/25/2012

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No. NCG030000
Date submitted 12/22/17
CERTIFICATE OF COVERAGE NO. NCG030056
FACILITY NAME Gilbarco I
COUNTY Guilford
PERSON COLLECTING SAMPLES John Burke �,�-�-EVED
LABORATORY_R&A Labs_ Lab Cert. # 34 ��'�� I
Comments on sample collection or analysis: N-C
CENTRAL FILES
DWR SECTION
Part A: Stormwater Benchmarks and Monitoring Results
SAMPLE COLLECTION YEAR _2016
SAMPLE PERIOD ❑ Jan -June ® July -Dec
or ❑ Monthly' (month)
DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
❑Zero -flow ®Water Supply ❑SA
❑Other
PLEASE REMEMBER TO SIGN ON PAGES 2 AND/OR 3 4
No discharge this period?z
Non -Polar O&G/Totai
Outfall No.
Date Sample
24-hour rainfall
Total Suspended Solids
pH,
Copper
Lead
Zinc
Total Petroleum
Toxic
Collected 1
amount,
Standard units
Hydrocarbons
Organics 5
Imo/dd/yr)
Inches
Benchmarks ===>
-
-
100 mg/L or 50 mg/La
6.0 — 9.0
0.007 mg/L
0.03 mg/L
0.067 mg/L
15 mg/L
1 mg/L
Outfall 001
11/7/17
0.10
38 mg/I
6.30
0.019 mg/L
<0.005 mg/L
0.104 mg/L
<5.00 mg/L
SMP
Outfall 002
11/7/17
0.10
18.5 mg/I
5.80
0.023 mg/I
<0.005 mg/L
0.215 mg/I
<5.00 mg/L
SMP
Outfall 003
11/7/17
0.10
6.0 mg/I
5.30
0.015 mg/I
<0.005 mg/L
0.296 mg/I
<5.00 mg/L
SMP
' Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
2 For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here.
'The 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.
a See General Permit, Table 3 identifying the especially sensitive receiving viater classifications where the more protective benchmark applies.
5 Total Toxic Organics sampling is applicable only for those facilities which perform metal finishing operations, manufacture semiconductors, manufacture
electronic crystals, or manufacture cathode ray tubes. For purposes of this permit the definition of Total Toxic Organics is that definition contained in the EPA
Effluent Guidelines for the facility subject to the requirement to sample (for metal finishing use the definition as found in 40 CFR 433.11; for semiconductor
manufacture use the definition as found in 40 CFR 469.12; for electronic crystal manufacture use the definition as found in 40 CFR 469.22; and for cathode ray
tube manufacture use the definition found in 40 CFR 469.31).
Permit Date: 11/1/2012-10/31/2017 SWU-245, last revised 10/25/2012
Page 1 of 3

Facilities that incorporate a solvent management plan into the Stormwater Pollution Prevention Plan may so certify, and the requirement for TTO monitoring
may be waived. The solvent management plan shall include a list of the total toxic organic compounds used and the other elements listed in the General
Permit. For those facilities electing to employ the TTO monitoring waiver, the discharger shall sign the following certification statement:
"Based upon my inquiry of the person or persons directly responsible for managing compliance with the permit monitoring requirement for total toxic organics
(TTO), I certify that to the best of my knowledge and belief, no dumping of concentrated toxic organics into the stormwater or areas which are exposed to rainfall or
stormwater runoff has occurred since filing the last discharge monitoring report. I further certify that this facility is implementing the all the provisions of the
solvent management plan included in the Stormwater Pollution Prevention Plan."
ROBERT BONDOS
Name (Print name)
Vice President of North American Operations
Titl ( rint title)
(Z ZZL( L
I r I . L -
(Signature) (Date)
Note: Results must be reported in numerical format. 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.
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.
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month.
❑ No discharge this period?2
Outfall No.
Date Sample
collected'
(mo/dd/yr)
24-hour rainfall
amount,
Inches'
Non -polar O&G/TPH by
EPA 1664 (SGT-HEM)
Total Suspended Solids
pH
Benchmarks =__>
-
-
15 mg/L
100 mg/L or 50 mg/L*
6.0 — 9.0 SU
Footnotes from Part A also apply to this Part B
* See General Permit text, Table 5, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Permit Date: 11/1/2012-10/31/2017 SWU-245, last revised 10/2S/2012
Page 2 of 3

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: Glenn White
Mail an original and one copy of this DMR, 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�ret
alified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or
those directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete
am a there are significant pepaiijes for, submitting false information, including the possibility of fines and imprisonment for knowing violations."
(Sign atu?L5 of Permittee) (Date)
Permit Date: 11/1/2012-10/31/2017 SWU-245, last revised 10/25/2012
Page 3 of 3

RESEARCh & ANA1YTiCAI
j Q LAbORATORiES, ONC.
I �00
I
I For: Gilbarco
7300 West Friendly Avenue
Greensboro, NC 27410
Attn: John Burke
Report of Analysis
11/17/2017
NS
Cr :y NC #34 • tn
w = NC 437701
�"4- ISO A01 .�
Client Sample ID: Outfall #03
Lab Sample ID:
42487-01
a
Site: Gilbarco
Collection Date:
11/72017 13:20
Parameter
Method
Result
Units
Rep Limit Analyst Analysis Dateaime
Copper, Total
EPA 200.7
0.015
mglL
0:005
JC 11/9/2017
Hydrocarbon O&G
EPA 1664 Revision B/Silica
-<5
mg/L
5
AW 11/13/2017
Gel
Lead, Total
EPA 200.7
<0.005
mg/L
0.005
JC 11/9/2017
Total Suspended Solids (fSS)
SM 2540 D-1997
6.0
mg/L
5
AA 11/9/2017
Zinc, Total
EPA 200.7
0.296
mg/L
0.01
JC 111912017
Client Sample ID: Outfall #02
Lab Sample ID:
42487-02
Site: Gilbarco
Collection Date:
11/72017 13:25
Parameter
Method
Result
Units
Rep Limit Analyst Analysis Daterrime
Copper, Total
EPA 200.7
0.023
mg/L
0.005
JC 11/9/2017
Hydrocarbon 0&G
EPA 1664 Revision B/Silica
<5
mg1L
5
AW 11/15/2017
Gel
Lead. Total
EPA 200.7
<0.005
mg/L
0.005
JC 11/9/2017
Total Suspended Solids (rSS)
SM 2540 D-1997
18.5
mg/L
5
AA 11/9/2017
Zinc, Total
EPA 200.7
0.215
mg/L
0.01
JC 11/9/2017
Client Sample ID: Outfall #01 Lab Sample ID: 42487-03
Site: Gilbarco Collection Date: 11/7/2017 13:35
Parameter Method Result Units Rep Limit Analyst Analysis Date/Time A
Copper, Total EPA 200.7 0,019 mg/L 0.005 JC 11/9/2017
is
P.O. Box 473 106 Short Street Kemersville, North Carolina 272114 Tel: [phone] Fax: [phone] www.ranIalabs,corn Page 1
rat_co a_basic_a t d

Kammwft North 27284 21 November 2017
Gilbarco, Inc.
7300 W. Friendly Avenue
Greensboro, NC 27410
Attention: John Burke J AP
RSEAM;h & ANlP1 ftcA
L.AboMIWES INC.
Rost Offoe Box 473 I1111MCE NO. 550
Jt
P7
Si
Al
01
0
Le
0
TS
Cc
xi
TO
(R
TERMS: NET 30
"PAST DUE INVOICES ACCRUE
INTEREST AT 1 Yz % INTEREST PER
MONTH UNTIL PAID
SHOULD COLLECTION BE REQUIRED,
CUSTOMER AGREES TO PAY
ALL EXPENSES INCURRED INCLUDING
ATTORNEY'S FEES"
RE.
Phow 336199Fr2841

RESEARCh & ANAtyTUCAL
Report of Analysis
QQ LA ORAT®RiES, 9NC•
11/17/2017
aao
Client Sample ID: Outiall #01
Lab Sample ID: 42487-03
Site: Gilbarco
Collection Date: 1117/2017 13:35
Parameter Method
Result
Units
Rep Limit An. alyst Analysis Dateffime
Hydrocarbon O&G EPA 1664 Revision B/Silica
<5
mg1L
5 AW 11/15/2017
Gel
Lead, Total EPA 200.7
<0.005
mg1L
0.005 JC 11/9/2017
Total Suspended Solids (TSS) SM 2540 D-1997
38.0
mg1L
5 AA 11/912017
Zinc, Total EPA 200.7
0.104
mg/L
0.01 JC 11/9/2017
NA = not onatyzed
P.O. Box 473 106 Short Street Kemersville, North Carolina 27284 Tel: [phone] Fax: [phone] www.randalabs.com Page 2
ral coa basic vId

RESEARCh & ANA1yTICA1
L.AboRATORIES, INC.
Analytical / Process Consultations
Phone [phone]
CHAIN OF CUSTODY RECORD
WATER I WASTEWATER I MISG.
COMPANY
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JOB NO.
1 )-7 Z o 1 7
w
r4
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y 0'
im` I
y0`
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Q• `O} `� p �4 Op �� �p
ti� ry ryyo ��'� �" �" y REQUESTED ANALYSIS
STREETADDRESS { �pJ
PROJECCTT-%
CITY, STAT ,ZIP J
^LG vt S �LJ" n,. � L `•L7 vi L 3
SAMPLER NAME (PLEASE PRINT)
� j V :�y.1�:JJ%.L C:�
CONTACT PHONE
SAMPL SIGNATURE
SAMPLENUMBER
(LAB USE ONLY)
DATE
TIME
CGN?
GRA9
TEMP
,C
RES
i�C1
cKcwne
A� D
[g�Por
SAMPLE LOCATION I.D.
�7-qS1-01
1
30--03
C.0 -Z P
0-2-A
117
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11
x 1�
;>S
LINQUISHED BY
DATUTIME
RECEIVED BY
REMARKS:
1�1�1� ii
SAMPLE TEMPERATURE AT RECEIPT— 1 °C
LI DUISHED BY
DATErrIME
RECEIVED BY

RESEARCh & ANA1yTICA1
LABORATORIES, INC.
Analytical/Process Consultations
Quality Control Summary Results for Project Identified as Stormwatcr
(A G61harco Pro -el ct 1
Prep
ICV
Spike
Spike Duplicate
Parameter
Blank
% Recovery
% Recovery
% Recovery
Oil R. Grease
i
BDL
102
104
N/A
Total Suspended Solids
I3131,
100
N/A
2
Copper, Total
BDL
109
106
<1
Zinc, Total
BDL
108
99
<1
Lead, Total
BDL
91
102
<1
COMMENTS:
Corresponding Sample Dumber: 42487-01-03
ICV = Initial Calibration Verification
% = Percent
P.O. Box 473 • 106 Short Street • Kernersville, North Carolina 27284 • 338-996-2841 • Fax [phone]
www.randalabs,com

® ENV-EXT-F-008B RevO
A�J
NCDENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance on filling out th isform, please visit., http:I/oortalaicdenr.or webjwq/wsjsu&pdessw#tab-4
Permit No.: or Certificate of Coverage No.:
Facility Name. C-1 j 1
County: (� V;1*o ra
Phone No. 33 6 - T4 -7 - So 0 0
Inspector: S'a k4v-� _ Q,f R—y—r
Date of Inspection: 1t -7
Time of Inspection:
Total Event Precipitation (inches): 0.10
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. Most permits require qualitative monitoring to be
performed during a "representative storm event" or during a "measureable storm event." However,
so►ne 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:
permittee or Designee)
Page 1 of 2
SWU-242, Last modified 10/25/2012

I. Outfall Description:
OutfalI No. o 0 1 Structure (pipe, ditch, etc.) Drjr-Ut _ _
Receiving Stream: k*b'L'50- ti Cir-fEr'-V,
Describe the industrial activities that occur within the outfall drainage area: r►t~
O� t'W J>4 , ?A "i .
2. Color., Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: _ N j o'
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells.strongly of oil,
weals chlorine odor, etc.): _. ro
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
C2 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:
C
) 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:
�. 2 3 4 5
7. Is there any foam in the stormwater discharge? Yes 6
8. Is there an oil sheen in the stormwater discharge? Yes CNo
9. Is there evidence of erosion or deposition at the outfall? 30l
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 10/25/2017
i

1. Outfall Description:
Outfall No.. 0 o t Structure (pipe, ditch, etc.) D s; c.�k
Receiving Stream: C4%.-r�y-
Describe the industrial activities that occur within the outfall drainage area: 64rS. LA4a
n-43 (� R. {-.w-r— cu P Ora --c-.. &- Cy-- „ s s CoL-J SNP�s �.
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: _iJ.) &
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.): 4) 1-W
4. CIarity, Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
b 2 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:
V 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:
6) 2 3 4 5
7. Is there any foam in the stormwater discharge? Yes No
B. Is there art oil sheen in the stormwater discharge? Yes 5No
9. is there evidence of erosion or deposition at the outfall? Yes I6
10. Other Obvious Indicators of Stormwater Pollution;
List and describe
Note: Low clarity, high solids, and/or the presence offoain, oil sheen, or erosion/deposition
may be indicative of pollutant exposure. These conditions warrant fiirtber investigation.
Page 2 of 2
5WU-242, fast modified 10/25/201Z

1. Outfall Description:
OUtfall No.. 00 Structure (pipe, ditch, etc.) ^ 0L—rrmL�-
Receiving Stream,
Describe the industrial activities that occur within the outfall drainage area: Syr'�Pl'✓6 '
;L^ c!... •�V M10 o� H!!t I Cam► �� ��.. -g �rU� + S . �_ _
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: n/ W
3. Odor: Describe any
weak chlorine odor, etc.): _
odors that the discharge may have (1e., smells strongly of oil,
4. CIarity: Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
, 2 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:
U 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:
2 3 4 5
7. Is there any foam in the stormwater discharge? Yes 60),
8. Is there art oil sheen in the stormwater discharge? Yes 6
9. is there evidence of erosion or deposition at the outfall? 'Yes co
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
5WU-242, Last madified 10/25/2012

1. Outfall Description:
Outfall No.. Pclq Structure (pipe, ditch, etc.) D'_rC\0*
Receiving Stream: _ 1h%,-i k_ y%,),o CAr&tc- µ
Describe the industrial activities that occur within the outfall drainage area: C
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: P 1
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.):.. _ ra 115,
4. CIarity: Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy: b
2 3 4 5
5. Floating Solids. Choose the number which best describes the amount of floating solids in
the stormwater discharge, where 1 is no solids and 5 is the surface covered with floating solids:
1) 2 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 inuddy:
7
(1 2 3
Is there any foam in the stormwater discharge?
4 5
Yes
Is there an oil sheen in the stormwater discharge? Yes
9. Is there evidence of erosion or deposition at the outfall?
10. Other Obvious Indicators of Stormwater Pollution:
List and describe
6o')
No
Yes 2No
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
Rtif�
swu-242, Last modified 10/25/2012

1. Outfall Description:
Outfall No..005 Structure Cpipe, ditch, etc.)
Receiving Stream: l-1-a,n W- . {�+ C 4%41A' �G
Describe the industrial activities that occur within the outfall drainage area:
2. Color: Describe the color of the discharge using basic colors Cred, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: -- ju Qt
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weals chlorine odor, etc.): _/� I *
4. CIarity: Choose the number which best describes the clarity of the discharge, where I is
clear and 5 is very cloudy:
V 2 3 4 5
5, Floating Solids: Choose the number which best describes the amount of floating solids in
the stormwater discharge, where 1 is no solids and 5 is the surface covered with floating solids:
0 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:
(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
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.
Page 2 of 2
SWU-242, last madified 10/25/2012

1. Outfall Description:
Outfall No.. D°�- Structure (pipe, ditch, etc.)
Receiving Stream: G4wr-,V-- ^
Describe the industrial activities that occur -within the outfall drainage area: ins 6
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: 0 �-
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weals chlorine odor, etc.): -0 )Va
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy: rl
0 2 3 4 5
5. Floating Solids: Choose the number which best describes the amount of floating solids in
the stormwater discharge, where I is no solids and 5 is the surface covered with floating solids:
0 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:
0 2 3 4 5
7. Is there any foam in the stormwater discharge? Yes (2D
a. is there art oil sheen in the stormwater discharge? Yes a
9. Is there evidence of erosion or deposition at the outfall? Yes tL9�
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 ntudiFied 10/25/2012

Semi-annual Stormwater Discharge_ Monitoring Report
for North Carolina Division of Water Quality General Permit No. NCG030000
Date submitted __ _4/28/17
CERTIFICATE OF COVERAGE NO. NCG030056
FACILITY NAME Gilbarco I
COUNTY Guilford
PERSON COLLECTING SAMPLES John Burke
LABORATORY _R&A Labs_ Lab Cert. # 34
Comments on sample collection or analysis:
Part A: Stormwater Benchmarks and Monitoring Results
SAMPLE COLLECTION YEAR �2016
SAMPLE PERIOD ® Jan -June ❑ July -Dec
_ or ❑ Monthly' (month)
ME ` j3ISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
MAY Q LJ ❑Zero -flow ®Water Supply ❑5A
200 ❑Other
CENTRAL. FILES
PLEASE REMEMBER TO SIGN ON PAGES 2 AND/OR 3
DWR`SECTJON
❑ No discharge this period?'
Date Sample
24-hour rainfall
pH,
Non -Polar O&G/
Total Toxic
Outfall No.
Collected 1
amount,
Total Suspended Solids
Standard units
Copper
Lead
Zinc
Total Petroleum
Organicss
(mo/dd/yr)
inches'
Hydrocarbons
Benchmarks ===>
-
-
100 mg/L or 50 mg/L4
6.0 -- 9.0
0.007 mg/L
0.03 mg/L
0.067 mg/L
15 mg/L
1 mg/L
Outfall 001
4/3/17
0.8
25 mg/I
6.70
0.010 mg/L
<0.005 mg/L
0.068 mg/L
<5.00 mg/L
SNIP
Outfall 002
4/3/17
0.8
14.8 mg/I
5.70
0.006 mg/I
<0.005 mg/L
0.080 mg/I
<5.00 mg/L
SNIP
Outfall 003
4/3/17
0.8
8.4 mg/I
5.20
<0.005 mg/I
<0.005 mg/L
0.066 mg/I
<5.00 mg/L
SMP
' Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
2 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.
n See General Permit, Table 3 identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
s Total Toxic Organics sampling is applicable only for those facilities which perform metal finishing operations, manufacture semiconductors, manufacture
electronic crystals, or manufacture cathode ray tubes. For purposes of this permit the definition of Total Toxic Organics is that definition contained in the EPA
Effluent Guidelines for the facility subject to the requirement to sample (for metal finishing use the definition as found in 40 CFR 433.11; for semiconductor
manufacture use the definition as found in 40 CFR 469.12; for electronic crystal manufacture use the definition as found in 40 CFR 469.22; and for cathode ray
tube manufacture use the definition found in 40 CFR 469.31).
Permit Date: 11/1/2012-10/31/2017 5WU-245, last revised 10/25/2012
Page 1 of 3

Facilities that incorporate a solvent management plan into the Stormwater Pollution Prevention Plan may so certify, and the requirement for TTO monitoring
may be waived. The solvent management plan shall include a list of the total toxic organic compounds used and the other elements listed in the General
Permit. For those facilities electing to employ the TTO monitoring waiver, the discharger shall sign the following certification statement:
"Based upon my inquiry of the person or persons directly responsible for managing compliance with the permit monitoring requirement for total toxic organics
(TTO), I certify that to the hest of my knowledge and belief, no dumping of concentrated toxic organics into the stormwater or areas which are exposed to rainfall or
stormwater runoff has occurred since filing the last discharge monitoring report. I further certify that this facility is implementing the all the provisions of the
solvent management plan included in the Stormwater Pollution Prevention Plan."
ROBERT RONDOS
Name (Print name)
Vice President of North American Operations
Ti int title)
r 5 _ oqZ5 ;,
(Signature) (Date)
Note: Results must be reported in numerical format. 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 m L" where XX is the numerical value of the detection
limit, reporting limit, etc. in mg/L.
(Vote: 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.
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month.
❑ No discharge this period?z
Outfall No.
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
Inches'
Non -polar O&G/TPH by
EPA `1664'(SGT-H£M}
Total Suspended Solids
pH
Benchmarks =__>
_
-
'is mg/L
100 mg/L or 50 mg/L*
6.0 — 9.0 SU
Footnotes from Part A also apply to this Part B
* See General Permit text, Table 5, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Permit Date: 11/1/2012-10/31/2017 SWU-245, last revised 10/25/2012
Page 2 of 3

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: Glenn White
Mail an original and one copy of this DMR, including all "No Discharge" reports, within 30 days of receipt of the lob 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
am awa at there are significant enalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
At 2 r1
(Signature of Permittee) (Date)
Permit Date: 11/1/2012-10/31/2017 SWU-245, last revised 10/25/2012
Page 3 of 3

RESEARCh & ANALyTiCAI Report of Analysis
LAbORATORIESF INC. 4/13/2017
Client Sample ID: Outfall 003
Lab Sample ID:
32863-03
Site: Gilbarco
Collection Date:
4/3/2017
16:35
Parameter
Method
Result
Units
Rep Limit Analyst Analysis DaterTime
Hydrocarbon O&G
EPA 1664 Revision B/Silica
<5
mg/L
5
SK
4/5/2017
Gei
Lead, Total
EPA 200.7
<0.005
mg/L
0.005
Kl_
4/6/2017
Total Suspended Solids (TSS)
SM 2540 D-1997
8.4
mg/L
5
AA
4/6/2017
Zinc, Total
EPA 200.7
0.066
mg/L
0.01
KL
4/6/2017
NA = not analyzed
P.O. Box 473 106 Short Street Kemersville, North Carolina 27284Tel: [phone] Fax: [phone] www.randalabs.com Page 2
ral coa basic vtd

RESEARCh & ANA1YTiCA[
LAWRATOR1ES, INC.
Report of Analysis
4/13/2017
For: Gilbarco
T/ ��i
••• G�'
�' C
7300 West Friendly Avenue
�!~� �'�
o
Greensboro, NC 27410
°�
07 NC 934 a
Attn: John Burke
4 NC 937701
Client Sample ID: Outfall 001
Lab Sample ID:
32863-01
Site: Gilbarco
Collection Date:
4/3/2017 16:20
Parameter
Method
Result
Units
Rep Limit An__ alyst Analysis Date/Time
Copper, Total
EPA 200.7
0.010
mg/L
0.005
KL 4/6/2017
Hydrocarbon O&G
EPA 1664 Revision B/Silica
<5
mg/L
5
SK 4/5/2017
Gel
Lead, Total
EPA 200.7
<0.005
mg/L
0.005
KL 4/5/2017
Total Suspended Solids (TSS)
SM 2540 D-1997
25
mg1L
5
AA 4/6/2017
Zinc, Total
EPA 200.7
0.068
mg1L
0.01
KL 4/6/2017
Client Sample 1D: Outfall 002 Lab Sample ID: 32863-02
Site: Gilbarco Collection Date: 4/3/2017 16:30
Parameter Method Result Units Rep Limit Analyst Analysis DatelTime
Copper, Total EPA 200.7 0.006 mg/L 0.005 KL 4/6/2017
Hydrocarbon 0&G EPA 1664 Revision B/Silica <5 mg/L 5 SK 4/5/2017
Gel
Lead, Total
EPA 200.7
<0.005
mg/L
0.005
KL
4/6/2017
Total Suspended Solids (TSS)
SM 2540 D-1997
14.8
mg/L
5
AA
4/6/2017
Zinc, Total
EPA 200.7
0.080
mg/L
0.01
KL
4/6/2017
Client Sample ID: Outfall 003
Lab Sample ID:
32863-03
Site: Gilbarco
Collection Date:
4/3/2017
16:35
Parameter
Method
Result
Units
Rep Limit Analyst Analysis Dateaime
Copper, Total
EPA 200.7
<0.005
mg/L
0.005
KL
4/6/2017
P.O. Box 473 106 Short Street Kemersville, North Carolina 27284 Tel: [phone] Fax: [phone] www.randalabs.com Page 1
oil coo basic vld

RESEARCh & ANAtyTiCAI
I AbORATORIES, INC.
Analytical / Procem Coneultatlons
Phone [phone]
CHAIN OF CUSTODY RECORD
Water/Wastewater
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City, State, Zip I
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Sampler Name (Please Print)
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Contact
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Sample Temperature at receipt °C

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No. NCG030000
Date submitted 4/28/17
CERTIFICATE OF COVERAGE NO. NCG030056
FACILITY NAME Gilbarco Inc
COUNTY Guilford
PERSON COLLECTING SAMPLES John Burke
LABORATORY_R&A Labs Lab Cert. # 34
Comments on sample collection or analysis:
Part A: Stormwater Benchmarks and Monitoring Results
SAMPLE COLLECTION YEAR - 2016
SAMPLE PERIOD ® Jan -June ❑ July -Dec
or ❑ Monthly( _ (month)
DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
❑Zero -flow ®Water supply [:]SA
❑Other
PLEASE REMEMBER TO SIGN ON PAGES 2 AND/OR 3 4
❑ No discharge this period?'
Date Sample
24-hour rainfall
pH,
Non -Polar 0&G/
Total Toxic
Outfall No:
Wlected1
amount,
Total Suspended Solids
Standard units
Copper
Lead
Zinc
Total Petroleum
Organi&
(mo/dd/yr)
Inches3
Hydrocarbons
Benchmarks ==>
-
-
100 mg/L or 50 mg/O
6.0 -- 9.0
0.007 mg/L
0.03 mg/L
0.067 mg/L
15 mg/L
1 mg/L
Outfall 001
4/3/17
0.8
25 mg/1
6.70
0.010 mg/L
<0.005 mg/L
0.068 mg/L
<5.00 mg/L
SMP
Outfall 002
4/3/17
0.8
14.8 mg/I
5.70
0.006 mg/I
<0.005 mg/L
0.080 mg/I
<5.00 mg/L
SMP
Outfall 003
4/3/17
0.8
8.4 mg/l
5.20
<0.005 mg/I
<0.005 mg/L
0.066 mg/I
<5.00 mg/L
SMP
1 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.
3 The total precipitation must be recorded using data from an on -site rain gauge. Unattended sites maybe eligible for a waiver of the rain gauge requirement.
a See General Permit, Table 3 identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
5 Total Toxic Organics sampling is applicable only for those facilities which perform metal finishing operations, manufacture semiconductors, manufacture
electronic crystals, or manufacture cathode ray tubes. For purposes of this permit the definition of Total Toxic Organics is that definition contained in the EPA
Effluent Guidelines for the facility subject to the requirement to sample (for metal finishing use the definition as found in 40 CFR 433.11; for semiconductor
manufacture use the definition as found in 40 CFR 469.12; for electronic crystal manufacture use the definition as found in 40 CFR 469.22; and for cathode ray
tube manufacture use the definition found in 40 CFR 469.31).
Permit Date: 11/1/2012-10/31/2017 SWU-245, last revised 10/2-5/2012
Page Iof3

Facilities that incorporate a solvent management plan into the Stormwater Pollution Prevention Plan may so certify, and the requirement for Tf0 monitoring
maybe waived. The solvent management plan shall include a list of the total toxic organic compounds used and the other elements listed in the General
Permit. For those facilities electing to employ the TTO monitoring waiver, the discharger shall sign the following certification statement:
"Based upon my inquiry of the person or persons directly responsible for managing compliance with the permit monitoring requirement for total toxic organics
(TTO), I certify that to the best of my knowledge and belief, no dumping of concentrated toxic organics into the stormwater or areas which are exposed to rainfall or
stormwater runoff has occurred since fling the last discharge monitoring report. 1 further certify that this facility is implementing the all the provisions of the
solvent management plan included in the Stormwater Pollution Prevention Plan."
ROBERTBONDOS
Name (Print name)
Vice President of North American Operations
Ti inr title}
(Signature) (Gate)
Note: Results must be reported in numerical format. 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.
!Vote: 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:
Part 8: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month.
No discharge this period?'
OLMaIl NO.'
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
Inches
Non -polar O&G/TPH by
EPA 1664 (SGT-HEM)
Total Suspended Solids
pH
Benchmarks
15 mg/L
100 mg/L or so mg/L*
6.0 — 9.0 SU
Footnotes from Part A also apply to this Part B
* See General Permit text, Table 5, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Permit Date: 31/1/2012-10/31/2017 SWU-245, last revised 10/25/2012
Page 2 of 3

Note: If you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses. See General Permit text.
FOR PART AAND PART B MONITORING RESULTS:
• A 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 11 SECTION B.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDANCES FOR THE SAME PARAMETER ATANY ONE OUTFALL? YES ® NO ❑
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ® NO
REGIONAL OFFICE CONTACT NAME: Glenn White
Mail an original and one copy of this 17MR, including all "No Discharge" reports, within 30 days of receipt o 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 awa"at there are significant penalties for submitting false information, Including the possibility of fines and imprisonment for knowing violations."
(Signature of Permittee)
L! A,6 l 1
( Date)
Permit Date: 11/1/2012-10/31/2017 SWU-245, last revised 10/25/2012
Page 3 of 3

RESEARCh & ANALYTICAL Report of Analysis
LAbORATORI ESF INC. 4/13/2017
Client Sample 10: Outfall 003
Lob Sample ID:
32863-03
Site: Gilbarco
Collection Hate:
4/3/2017
16:36
Parameter
Method
Result
Units
Set) Limit AnalystAnalysis
Da ePfime
Hydrocarbon 08G
EPA 1664 Revision B1Sillca
<5
mg/L
5
SK
4/5/2017
Gel
Lead, Total
EPA 200.7
<0.005
mg1L
0.005
KL
418/2017
Total Suspended Solids (TSS)
SM 2540 D-1997
8A
mg1L
5
AA
4/6/2017
Zinc, Total
EPA 200.7
0.066
mglL
0.01
KL
4/6/2017
NA = not anotyzed
P.Q. Box 473 106 Short Street Kemeraville, North Carolina 27204 Tel: 336-9W2641 Rm 336-996.0326 www.randatabs.com Page 2
rat coa basic vid

RESEARCh & ANA1yTlCA1
LAboRATORiES, INC.
For: Gilbarco
7300 West Friendly Avenue
Greensboro, NC 27410
Attn: John Burke
Report of Analysis
4/ 13/2017
iplu11jrfr
�.OGr�►b Af�l'4LY410
i,
NC A37701
i+irrrrir����
Client Sample 1D: Outfail 001 Lab Sample ID: 32863-01
Site: Gilbarco Collection Date: 4/3/2017 16:20
EUM21a Method Result Units ReI2 Uml Analys Analysis DateCxime
Copper, Total EPA 200.7 0.010 mg/L 0.005 KL 4/6/2017
Hydrocarbon O&G EPA 1604 Revision B/Silica <5 mg1L 5 SK 4/5/2017
Gel
Lead, Total
EPA 200,7
<0.005
mglL
0,005
KL
416/2017
Total Suspended Solids (fSS)
SM 2540 D-1997
25
mg1L
5
AA
4/6/2017
Zinc, Total
EPA 200.7
0,068
mg1L
0.01
KL
4/(3/2017
Client Sample Il): Outfall 002
Lab Sample ID:
32863-02
Site: Gilbarco
Collection Date:
4/3/2017
16:30
E!aramete
Method
Result
Units
Reip Liml Analyst Analvsjs
DatelTim
Copper, Total
EPA 200.7
0,006
mg/L
0.005
KL
4/6/2017
Hydrocarbon O&G
EPA 1664 Revision B/Silica
<5
mg1L
5
SK
4/512017
Gel
Lead, Total
EPA 200.7
<0.005
mg1L
0.005
KL
4/6/2017
Total Suspended Solids (TSS)
SM 2540 D-1997
14.8
mg/L
6
AA
4/812017
Zinc, Total
EPA 200.7
0.080
mg1L
0.01
Kt-
4/6/2017
Client Sample IA: Outfal1003
Lab Sample ID:
32863-03
Site: Gilbarco
Collection Date:
4/3/2017
16:35
arame er
Method
Resu
. Units
p Limp Analys3 Analysis
tea (Time
Copper, Total
EPA 200.7
<0.005
mg1L
0,005
KL
4/6/2017
P.O. Box 473 106 Short Street Kemersville, North Carolina 27284 Tei: 336-996-2841 Fax: [phone] www.randalabs.com Page 1
rat coa basic vid

RESEUCh & Amtyric l
LAbJUMYU n III Pro = INC.
mCHAIN OF CUSTODY RECORD
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wme C=6) "G-2841
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ENV-EX-r-F-0086 RevO
_-_-: &M-G-l�
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Forguidance on f Iling out this form, Please visit j tom://Qortal.ncd ni;orrr IL -
Permit No.: ]y,/,f./ G/Q IM / � f p/ d/ or Certificate of Coverage No.:
Facility Name: w
County: Phone No, - � 3 6. 33
Inspector, J 0-1
Date of Inspection: _
Time of Inspection: -
-A-1 I[-)
.{!711�
Total Event Precipitation (inches): 0 + g
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
(See info• tton below,)
es ❑ No
Please verify whether Qualitative Monitoring must be performed during a "representative storm
event"or'aieasureablestorin event"(requirementsvary, depending on the permit).
Qualitative monitoring requirements vary, Most permits require qualitative monitoring to be
performed during a °representative storm event" or during a "Yneasureable storm event." However,
some permits do not have this requirement. Please refer to these definitions, if applicable-
t A "representative storm event" is a storm event that measures greater than 0.1 niches 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 storin event" Is a storm event that results in an actual discharge from the
permitted site otLtfall. 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 ant)roval from the local DWQ Regional Office.
By this signattu e, i that this report is accurate and complete to the best of any knowledge;
Permittee or Designee)
Page 1 of 2
SWU-24Z LastmodiRed 10/25/2012

1. Outfali Descriptlon:4r, •r'
Outfall No, Do � Structure (pipe ditch, etc.}
Receiving Stream: t " � r'C'- j C.
Describe the industrial activities that occurwitlxin the outfall drainage area; Stu✓c.�-�
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors:
3. Odor: Describe any
weal-, chlorine odor, etc.):
odors that the discharge may have (l.e., smells strongly of oil,
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 4' 5
5. Floating Solids: Choose the number which best describes the amount of floating solids in
the stormwa ter discharge, where 1 is no solids and 5 is the surface covered with floating solids:
1 2 3 4 5
&. Suspended Solids: Choose the number which best describes the amount of suspended
solids in the stoi7nwater 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
No
S. Is there an oil sheen in the stormwater discharge? Yes
No
9. Is there evidence of erosion or deposition at the outfall?
Yos No
10. Outer Obvious Indicators of5tormwater Pollution.
List and describe
Note: Low clatlty, high solids, and/or the presence of foam, oil sheen, or erosion/deposition
maybe indicative of pollutant exposure. These conditions warrantfurther investigation:.
Page 2 of 2
SWU-7.42, Lost modified 10/25/2012

eAAj ENV-EXT�F-008B RevO
Stormwater Discharge 4utfall (SDD)
Qualitative Monitoring; Report
Forgiddance on filling outthisfoim, pleasevisit: llttpff L 4rtal i�cdenr.oruJweb� c JwsJ fi gssw#tab-4
Permit No,; jlf�/G/d J3_/s /� �/ d/ or Certificate of Coverage No.:
Facility Name:
County: tauPhone No. 3 3 3-3
Inspector: 6V,,.. l,5ur�4r—
Date of Inspection: ' 17-11 [7
Time of Inspection:.
3 5-
Total Event Precipitation Chiches); 10 L g
Was this a "Representative Storm hvent" or "Measureabie Storm Event" as defined by the permit?
(;zNo
tlonbelow.)
Please verify whether Qualitative Monitorhig must be performed during a '�-epresentczdve storm
event" or•'measur eable storm even (requirements vary, dependbird 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 requireinent, 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
precipitadom
A "measurable storm event" Is a storm eventthat 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 storin events during the sampling period, and the perrnittee
obtains approval from the local DW(
Office.
By this signatu_!e I_certifv�, that this reportis accurate and complete to the best of my lmowledge;
Perinittee or Designee)
Pagel of 2
SM-242, Last rrmodlRod10f25/2012

1. Outfall Description:
Outfall No. Structure (pipe, ditch, etc.)
Receiving Stream;S <-t� _ Cr qz. U-
Desci ibe e industrial activities that occur within the outfall drainage area: G s
2. color: Describe the color of the discharge using basic colors (red, brown, bine, etc.) and tint
(light, medium, dark) as descriptors:
3. Odor: Describe any
weak chlorine odor, etc.) : _
odors that the discharge may have (i.e., swells strongly of oil,
4. CIarlty: Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
5, ploating 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:
/ 1J 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:
/ 1 f 2 3 4 5
7. Is there any foam In the stormwater discharge? Yes
S. Is there an oil sheen in the stormwater discharge? Yes
9. Is there evidence of erosion or deposition at the outfall? Yes
10. Other Obvious Indicators ofStormwater Pollution:
List and describe
CNo
6N).
No'
Note., Low clarity, higli 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
54W-242, LAstntodiflnd 10/2512M

ENV-EXT-F-008B RevD
AA
elf
FICDENR
Stormwater Discharge Outiall (SDO)
Qualitative Monitoring Report
Forguidance on felling outthis form, please vise : ,LpDrtaia�cdenr.a�g/�e jws/ /�iodessw#rab`4
Permit No.: hj/.CI!'/°/3AL �/_�/_!�I orCertificate ofCoverage No.:
Facility Name: Gi l b arw T - -
County. tom" VV_A- Phone No. 3 6 3 111-_1°k- k
Inspector: 5Uri,t.._
Date of Inspection:
Time of Inspection,
u S3a Pw.. - -
Total Event Precipitation (inches): .d 1 Q
Was this a "Representative Storrs Event" or "Measureable Storm Event" as defined by the permit?
(See infare Con below.)
es [] No
Please verify whether Qualitative Monitoring must be per formed during a "represen to Live storm
event" or 'Measureable star m event' (requirements vaM depandinrg on the permit).
Qualitative monitoring requirements vary. Most permits require qualitative monitoring to be
performed during a "representative storm event" or during a "eneasureable 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 lows (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 annroval froze the local AWQ ReRlonal aTFce.
By this signature if that tlzls report is accurate and complete to -the best ofiny knowledge,
f Permittee or. Designee)
Page 1 of 2
SWU-242, Lastmodi[Ecd 10/25/2012

1. Outfall Description:
outfall No. 0'b3 Structure (pipe, d
Receiving Stream: _ ��— RZA"-n
Describe the industrial activiAes the t occur within the outfall drainage area;
2. ColorDescribe the color of the di [,IW!e using basic colors (red, brown, blue, etc.) and tint
(light, nrmedium,dark) as descriptors: .
3. Odor: Describe any
weak chlorine odor, etc j., _
odors that the discharge may leave (i.e., smells strongly of oil,
4. Clarity: Choose the numbhich hest describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
2. 34 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!; is the surface covered with floating solids:
3. 2 3 4 5
d. Suspended Solids: Choose the number which best describes the amount of suspended
solids In the stormwater discharge, here 1 is no solids and 5 is extremely inuddy:
1 2 3 4 5
7. Is there any foam in the stormwater discharge? Yes
8. Is there as 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 Stw inwater 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 nindified 10/25/2012

ENV-EX-r F-008B RevO
,- 7AIR
Stormwatelr Discharge Outfall (SDO)
Qualitative Monitoring Report
For•guidance ors_filling out this form, please visit,httu:lip¢rt �lcdenr.o /webJ ws,(,snUtpSles, v#lab-4
Permit No.: N/,C/�/Q /ems /.!�/-" or Certificate of Coverage No.;
Factlity Name: ^6►w
County: _ �,,;tk� Phone No. _3 3 i,^3`3'1 —g--I -L �
Inspector -
Date of Inspection: � 14
Time of Inspection:
Total Event Precipitation (inches): .6 t Q
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
(See infort tion below
es ❑ No
Please verify whether Qualitative Monitoring must be per formed during a "representative storm
eve' or "nieasureabde 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 "rneasureable storm event" However,
some permits do nothave this requirement. Please refer to these definitions, if applicable.
A `�,epresentative 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 ddys) In which no storm event measuring greater than
E 0.1 inches has occurred. A single storm event may contain up to 10 consecutive hours of no
precipitation.
A "ineasul•able 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 least72 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 Dfllce.
By this si&nat e. I •tifv�tha_t this report is accurate and complete to -the best of my Imowledge;
Permittee or Designee)
Page 2 of 2
SwU-242, last modified 10/25/2012

1. Outfall Descilption:
outfall No. 19O LI Structure (pipe, ditch, etc)
Receiving Stream.��--
Desciibe the industrial activities that occur within the outfall drainage area:
2. ' Color: Describe the color of the dlsch 1�� t using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: _ N _
3. Odor: Describe any distinct od
weals chlorine odor, etc.); i
the discharge may ]rave (Le., smells strongly of oil,
h. Clarity: Choose the number which best describes the clarity of the discharge, where 1 Is
clear and 5 is very. cloudy:
5, FloatingSoIids: Choose the number which best describes the amount of floating solids in
the stormwater discharge, where 1 's 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 discharg here 1 Is no solids and S Is extremely inuddy:
2 3 4 5
7. 1s there any foam in the stormwater discharge? Yes
8. Is there an oil sheen in the stormwater discharge? Yes
9. Is there evidence of erosion or deposition at the outfa117
10. Oilier Obvious Indicators of 5tormwater pollution:
List and describe
Yes
No
61
No
Note; Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposMon
may he Indicative of pollutant exposure. These conditions warrant further investigation.
Page 2 of 2
• SWU-242, Lost modified 10/25/2012

4 ENV-EXT F-0088 RevO
Stormwater Discharge Out -fall (SD.0)
Qualitative Monitoring Report
Forguidan ce on filling out fhrs form, please visie hUWj1 og•tAaj denr,ore/Web.jwQ s/su41ndessw#tab-4#tab-4
Per ,& No.: l�l�I Ala l3 ��—I �j or Certificate of Coverage No.: KIL19/
Facility Name:
County: (��;-l} � Prone No. 3 '3 � -31 7 `U-t-`- .
InSpeCtCtr: _ �nk+� �a.eri[-� _
Date of Inspection:
Time of Inspection,
Total 8ventPrecipitation ['inches]: © L
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
(See infort don below,)
es Q No
Please verify whether Qualitative Monitoring must be per formed during a "representative storm
evenror "nieasureahfe storm event"' (requirements vary, depending on the permit).
Qualitative monitoring requirements vaiy. Most permits require qualitative monitoring to be
performed during a "representative storm event" or during a "measureabie storm event." However,
some permits do notbave this requlreinent. 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 "jeasurable 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 froin the local DWQ Regional Office.
By this signature rti that this report is accurate and complete to -the best of my Imowledge:
Pertnittee or Designee)
Page 1 of 2
sWU-242, Last modMed 14/25/2012

1. Outfall Description: Q
Outfall No. 0-01 Structure (pipe, ditch, etc.) -
Receiving Stream: --
Describe t1le industrial activities that occurwithin the outfall drainage area;
2. Color: DescAbe the color of the disch rge using basic colors (red, brown, blue, etc.) and tint
{light, medium, dark) as descriptors: ) PL
3. Odor: Describe any distinct
weak chlorine odor, etc,]: _ ---
the discharge may have (l.o , smells strongly of oil,
4. Clarity: Choose the number which bestdescrihes the clarity of the discharge, where 1 is
clear and 5 is very cloudy;
Z' 2 3 4 ' S
5, Floating Solids-, Choose the, number which best describes the amount of floating solids in
the stormwater discharge, where Z i no solids and 5 is the surface covered with floating solids-
2 3 4 5
6. Suspended Solids: Choose the number which Kest describes the amount of suspended
solids In the stomnwater discharge, ere Z Is no solids and 5 is extremely muddy:
Z 2 3 4 5
7. Is there any foam in the storrnwater discharge? Yes
8. Is there an oil sheen in the storinwater discharge? Yes No
9. Is there evidence of erosion or deposition at the outfall? Yes SYo/
10. Other Obvious Indicators of Stormwater Pollution:
List and describe
Nate; Low clarity, high solids, and/or tile presence of foam, oil sheen, or erosion/deposition
may be indicative of pollutant exposure. These conditions warrant farther investigation.
Page 2 of 2
SWU-242,14st modified 10/25/2012

'A' , ENV-EXT-F-008B RevD
Y �C��G.1
Stormwatelr Discharge Outfall (SDO)
Qualitative Monitoring Report
Porguidance on frIlfng out this form, please visit: t- web jaws4u fppsdessw#tab-4
Permit No.: KILIJ /A 1,3 I�j� �f or Certificate of Coverage No.;
Facility Name: 6i 1 S,kr ca
County: GV L _A_ Phone No. 3l'3-3 7 —t'n-4- �
Inspector: Soh,�;-
Date oflnspection: ' -t4 I2 It1
True of Cuspection:
Total Event Precipitation (inches): b ► p
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
(;zNo
tion below]
Please verify whether Qualitative Monitoring must be pet farmed during a '5-epresentatfva storm
even tor "nieasureablestorm even t"(requirernentsvary, depending on the permit).
Qualitative monitoring requirements vary. Most permits require qualitative monitoring to be
performed during a "representative storm event" or during a "measureabie 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 thatmeasures 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 storin 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-}tour 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 anuroval from the local DWQ Regional Office.
By this signature,Lcertlfy that this report is accurate and complete to the best of my knowledge:
Permittee or Designee)
Page 1 of 2
SWU-242, Lostmodi[ied 10/25/2012

1. Outfali Da crlption:
Outfall No. ci 0 b Structure (pipe,
Receiving Stream;
h, etc)
wf.�
.Describe the industrial activities that occur within the outfall drainage area:
V
2. Color: Describe the color of the discharge ysing basic colors Fred, brown, blue, etc.) and tint
(light, medium, dark) as descriptors:
3. Odor. Describe any distinct odors
weals chlorine odor, etc,]:
may have (i.e., smells strongly of oil,
4. Clarity: Choose the number which best describes the clarity of the discharge, where 11s
clear and 5 is very cloudy:
1 2 3 4 5
5, Floating Solids: Choose the number which best describes the amount of floating solids in
the stormwater discharge, where 1 i no solids and S is the surface covered with floating solids:
1 2 3 4 S
6. Suspended Solids: Choose the number which best describes the amount; of suspdrided
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 lit the stormwater discharge? Yes
8. Is there an oil sheen in the stormwater discharge?, Yes 1V
9. is there evidence of erosion or deposition at the outfall? Yes N
10. Other obvious Indicators of5tormwater Pollution:
List and describe
Note:.Low-"clarity, high solids, anti/ors the presence of foam, oil sheeii, or erosion/deposition
may ba.ilndlcative of pollutant exposurb. These conditions warrant further Investigation.
Page 2 of 2
SM-242,1,ast itlodi ted 10/25/2012

AIVA ENV-EXT-F-008B RevO
�
NCDE R
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Forguidance on filling out this form, please visit. http.//portalaicdeni•.oi•gjweb/wq/ws/soInpdessw#tab-44
Permit No.: 1V or Certificate of Coverage No.:
Facility Name: ._6a% -�- w
County: C-> ,:x�,-d
Inspector: 3-0V,
Date of Inspection:
2�
Phone No.
3 3 '7 -L't -q- t
Time of Inspection:
MAY 03 2017
Total invent Precipitation (inches): 6 t g CENT
DWR SECTi9,ti
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined y the permit?
(SeZOSO
Lion below.)
No
Please verify whether Qualitative Monitoring must be performed during a "representative storm
event" or "nieasureable 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
Iprecipitation.
A "ineasnrable 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 signattu e I rtif that this report is accurate and complete to the best of my knowledge:
Pertnittee or Designee)
,Page1of2
swu-242, Last modified 10/25/2012

1. Outfall Description:
Outfall No. Du 1 Structure (}pipe, ditch, etc.)
Receiving Stream, ` Ss - p-ft C.r«- } e-
Describe the industrial activities that occur within the outfall drainage area: +^o--47A S' '
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: _
3. Odor: Describe any
weals chlorine odor, etc.]: _
odors that the discharge may have (i.e., smells strongly of oil,
4. CIarity. Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
1 2 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 3 4 5
b. 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:
2 3 4 5
7. Is there any foam in the stormwater discharge? Yes
Na
B. Is there an oil sheen in the stormwater discharge? Yes
No
9. is there evidence of erosion or deposition at the outfall?
Yes No
10. Other Obvious Indicators of Stormwater Pollution:
List and describe S 1
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
sW€4-242, Lastmodified 1,0/25/2012

ENV-EXT' -008B RevO
MCDENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Forgri dance on filling out thisform, please visit.' httu:// o •ta .ncdenr.or we w s,(npdessw#tab-4
Permit No.: Nl/C/-�!19 /3/6/.!2J 2/ 9/ or Certificate of Coverage No.; N/C/G/ 0/
Facility Name: +1)�-4t
County; G�;1�
Inspector; "TUi, �f� c-
Date of Inspection:
Time of Inspection: `4 Q `
Total Event Precipitation [inches): ► 4
Phone No. 3 3 � T 3'7 '7 •- -L:r -q-
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
(See inforr lion below,]
zes ❑ No
Please verify whether Qualitative Monitoring must be performed during a "representative storm
event" or "ineasur•eablestorm 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,
3
1 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
i 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 froin the local DWQ Regional Office.
By this si4nature, I certify that this report is accurate and complete to the best of my knowledge:
(Signature kf Perrnittee or Designee)
Page 1 of 2
SWrJ-242, [.astmodi[ied 10/25/2012

1. Outfall Description:
Outfall No. a L.— Structure (pipe, ditch, etc.)
Receiving Stream: L r L Cr(aL CC -
Describe t e industrial activities that occur within the outfall drainage area: C2<
2, Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors:
3. Odor; Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weals chlorine odor, etc.): /✓ - - --
4. CIarity: Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
1 d 3 4- 5
5. Floating Solids: Choose the number which best describes the amount of floating solids in
the stormwater discharge, where 1 is no solids and S is the surface covered with floating solids:
(3 2 3 4 S
fi, 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
9. Is there evidence of erosion or deposition at the outfall?
10. Other Obvious Indicators of Stormwater Pollution:
List and describe
DNo
rN.
Na�
Yes
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-7.42, I.astntodf@ed 10/25/2017

ENV-EXT=F-008B RevO
ray �m�,m
NCDER
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For,guidance on filling outthis form, please visit: httk.//portal,ncdenr.org/web/wa/ws/su/npdessw#tab-4
Permit No.. Ni jCj.� jU f3 js j�/ �j �/ or Certificate of Coverage No.:
Facility Name: Gi b-,4—a
County: (-,-:1F.-�-_ _ Phone No. _3 3 ;33
Inspector: - 5uk� Guruf—
Date of inspection: ' .14 [2'1 1n
Time of Inspection: y S P P
Total Event Precipitation (inches):
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
(;?CSFl
l tion below.)
No
Please verify whether Qualitative Monitoring must be per formed during a "representative storm
event" or "nieasureable 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 froin the local DWQ Regional Office.
By this signature I rtif that this report is accurate and complete to,the best of my knowledge:
f Permittee or Designee)
Pagel of 2
SWU-242, Last modifEA 10/25/2012

I. Outfall Description:
Outfali No. Structure (pipe, di
Receiving Stream: _ VLT--� ten �(
etc.) ti y
T)escr" a tl�e indtistrial activi 'es�tltat occurwithin the airtFall drainage area:_ ��--�-�, _�
2. Color: Describe the color of the di 1 arge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors:
3. Odor: Describe any
weals chlorine odor, etc.): _
odors that the discharge may have (1.e., smells strongly of oil,
4. CIarity: Choose the numbe which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
1 2 3 4 5
5. Floating Solids: Choose the number which best describes the amount of floating solids in
the stormwater discharge, where 1 is no solids and 5 is the surface covered with floating solids:
1 2 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 inuddy:
1 2 3 4 5
7. is there any foam in the stormwater discharge? Yes
S. is there an oil sheen in the stormwater discharge? Yes
9. is there evidence of erosion or deposition at the outfall? Yes CNo)
10. Other Obvious Indicators of Storinwater 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, i,ast niadified 11l/25/2012

ENV-EXT F-008B RevO
4�
NCDENR
Stormwater Discharge Outfal! (SDO)
Qualitative Monitoring Report
For -guidance on filling out this form, please visit: htttn-//portal.iicdeni•.oiU4wgb/iyq/wslsa/npdessw#tah-4
Permit No.: N/C/�/a /3/s / o/ °/ d/ or Certificate of Coverage No.; N/C/G/'/ 3/ 0/ OJ -5'/ G/
FacilityNanne: Gilbaf�
County: V.- � Plione No. 3 3 ^3'3 7 —
Inspector: 3uk,t-
Date of Inspection:
Time of .Inspection:
Total Event Precipitation (inches): .6
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
(See info2'I tion below.)
es ❑ No
Please verify whether Qualitative Monitoring must be performed during a "representative storm
event" or "nieasureable storm event" (requirements vary, depending an 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 storin event" is a storm event that results in an actual discharge from the
permitted site outfall. The previous measurable storin event trust 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 storin events during the sampling period, and the permittee
obtains approval from the local DWQ Regional Office.
By this signati, I rtif that this report is accurate and complete to the best of my knowledge:
f Permittee or Designee)
Page 1 of 2
SWU-242, East modi&ed 10/25/2012

1. Outfall Description:
Outfall No. 0 a I Structure (pipe, ditch, etc.) Imo► " �-
Receiving Stream: ��- none
Describe the industrial activities that occur within the outfall drainage area:
2. Color: Describe the color of the discha ge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: !!�„-, �
3. Odor: Describe any distinct
weals chlorine odor, etc.);
t the discharge may have (i.e., smells strongly of oil,
4. Clarity: Choose the number which hest describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
1 2 3 4 5
5. Floating Solids: Choose the number which best describes the amount of floating solids in
the storrawater discharge, whe, 's 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 discharg , here 1 is no solids and 5 is extremely muddy:
2 3 4 5
7. Is there any foam in the storanwater discharge? Yes
8. Is there an oil sheen in the storinwater discharge? Yes
9. is there evidence of erosion or deposition at the outfall?
10. Other Obvious Indicators of Storinwater Pollution:
List and describe
Yes
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 2of2
SWU-M, Last rnadified 10/25/2012

ENV-EXT-F-OOSB RevO
NCDENR
Stormwater Discharge Outfall (SDQ)
Qualitative Monitoring Report
For cgtudancc on filling out this form, please visit: hUp: j jportal.ncd nnorg/weblwq/ws�su/nndessw tab-4
Permit No.: N/C/�/q_/3 J6 / ®/ _�/ d/ or Certificate of Coverage lo.:
Facility Name: Gi k boy co
County: l9 : L �,- �- Phone No.
Inspector: _ ,64, Qurtc-t_
Hate of Inspection: ' .4 ! 'z-'? 111
Time of Inspection:
Total Event Precipitation (inches): t
3�-33'7 -2l ­-(
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
(See
intion below.]
No
Please verify whether Qualitative Monitoring must be performed during a "representative storm
event" or "rrieasureablestorm event" (requirements vary, depending on the permit).
Qualitative monitoring requirements vary. Most perinits 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 I
0.1 inches has occurred. A single storm event may contain up to 10 consecutive 11Qllr5 of no i
precipitation.
i
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 storin events during the sampling period, and the permittee
obtains approval from the local DWQ Regional Office.
By this signatUllj9grLIfY that this report is accurate and complete to the best of my knowledge:
(Sigiiature t f Permittee or Designee)
Paget of 2
SWU-242, Lastmodi[ied 10/25/2012

1. Outfall Description: n p
Outfall No. ©� S Structure (pipe, ditch, etc.)
Receiving Stream:
Describe W indiWrial activities that occur within the outfall drainage area:
2. Color: Describe the color of the ditch i-ge Using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors:
3. Odor: Describe any distinct odors
weak chlorine odor, etc,):
the discharge may have (i.e., smells strongly of oil,
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 4 5
S. Floating Solids: Choose the number which best describes the amount of floating solids in
the stormwater discharge, where 1 i no solids and 5 is the surface covered with floating solids:
2 3 4 5
6. Suspended Solids: Choose the number which best describes the amount of suspended
solids in the stormwater discharge, ere 1 is no solids and 5 is extremely muddy:
1 2 3 4 5
ti
7. Is there any foam in the stormwater discharge? Yes N
3. is there an oll sheen in the stormwater discharge? Yes No
9. Is there evidence of erosion or deposition at the outfall? Yes 9p/
10. Other Obvious indicators ofStormwater Pollution:
List and describe
Note: Low clarity, high solids, and/or the presence of foam, oil sheets, or erosion/deposition
may be indicative of pollutant exposure. These conditions warrant further investigation.
Page 2 of 2
SWU-242, i.ast madified 10/25/2012

ENV-EXT=F-008B RevO
CDER
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Forguidance on filling out this farm, please visit. httk/�pnrraiaicdennorg/web/wq/ws su/lipdes sw#tab-4
Permit No.: N/cJ�Ja /3/� /e/ °/ d/ or Certificate of Coverage No.: NJC/ ,/
Facility Name: lt�A L-a
County; l,, tV''"�- _ Phone No, 3 �--3'3 7
Inspector: J ok
Date of Inspection. -
Time of Inspection:
urLsIL-
1-4-111-1
Total Event Precipitation (inches): d ti Q
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
(Sez1esF1
infotion below.]
No
Please verify whether Qualitative Monitoring must be pei formed 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.
j .
! 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 storin 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-hourstorm interval does not apply if the permittee is able to document that a shorter
interval is representative for local storin 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:
(Signoture kf permittee or Designee)
Page 1 of 2
SWU-242, Last modified 10125/2012

1. outfall De criptiorn:
Outfall No. O u g Structure (pipe, ditch, etc.) ti '
Receiving Stream:�, ((
Describe the industrial activities that occur within the outfall drainage area:
Pw-1L---<-
2. Color: Describe the color of the discharge s� ing basic colors Fred, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: tN _
3. Odor: Describe any distinct odors
weak chlorine odor, etc.): ✓
the discharge may have fi.e., smells strongly of oil,
4. CIarity: Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
1 2 3 4 5
S. Floating Solids: Choose the number which best describes the amount of floating solids in
the stormwater discharge, where 1 i no solids and 5 is the surface covered with floating solids:
1 2 3 4 5
b. 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 N
H. Is there an oil sheen in the stormwater discharge? Yes N
9. Is there evidence of erosion or deposition at the outfall? Yes N
10. Other Obvious indicators ofStormwater Pollution:
List and describe
Note: Low clarity, high solids, and/or the presence of foam, oil sheeii, or erosion/deposition
may be indicative of pollutant exposure. These conditiairs warrant further investigation.
Page 2 of 2
t..
sWU-242, Last modified 10/25/2012

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No. NCG030000
Date submitted 11/3/16
CERTIFICATE OF COVERAGE NO. NCG030056
FACILITY NAME Gilbarco Inc
COUNTY Guilford
PERSON COLLECTING SAMPLES John Burke
LABORATORY R&A Labs Lab Cert. # 34
Comments on sample collection or analysis:
Part A: Stormwater Benchmarks and Monitoring Results
SAMPLE COLLECTION YEAR _2016
SAMPLE PERIOD ❑ Jan -June ® July -Dec
or ❑ Monthly' (month)
DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
❑Zero -flow ®Water Supply [:]SA
RECEIVED ❑Other
NOV 0 4 2016 PLEASE REMEMBER TO SIGN ON PAGES 2 AND/OR 3 4
CENTRAL FILES
DWR SECTION
❑ No discharge this period?'
Date Sample
24-hour rainfall
pH,
Non -Polar O&G/Total
Toxic
Outfall No.
Collected'
amount,
Total Suspended Solids
Standard units
Copper
Lead
Zinc
Total Petroleum
Organics
(mo/dd/yr)
Inches'
Hydrocarbons
Benchmarks =__>
_
-
100 mg/L or 50 mg/L4
6.0 — 9.0
0.007 mg/L
0.03 mg/L
0.067 mg/L
15 mg/L
1 mg/L
Outfall 001
10/7/16
0.7
<0.5 mg/I
5.60
0.006 mg/L
<0.005 mg/L
0.066 mg/L
<5.00 mg/L
SMP
Outfall 002
10/7/16
0.7
<0.5 mg/I
5.20
0.007 mg/I
<0.005 mg/L
0.036 mg/I
<5.00 mg/L
SMP
Outfall 003
10/7/16
0.7
<0.5 mg/I
5.05
0.008 mg/l
<0.005 mg/L
0.073 mg/1
<5.00 mg/L
SMP
1 Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
zFor 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, Table 3 identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
5 Total Toxic Organics sampling is applicable only for those facilities which perform metal finishing operations, manufacture semiconductors, manufacture
electronic crystals, or manufacture cathode ray tubes. For purposes of this permit the definition of Total Toxic Organics is that definition contained in the EPA
Effluent Guidelines for the facility subject to the requirement to sample (for metal finishing use the definition as found in 40 CFR 433.11; for semiconductor
manufacture use the definition as found in 40 CFR 469.12; for electronic crystal manufacture use the definition as found in 40 CFR 469.22; and for cathode ray
tube manufacture use the definition found in 40 CFR 469.31).
FIL17:11
b% Il
r
Permit Date: 11/1/2012-10/31/2017 SWU-245, last revised 10/25/2012
Page 1 of 3

Facilities that incorporate a solvent management plan into the Storm water Pollution Prevention Plan may so certify, and the requirement for Tf0 monitoring
may be waived. The solvent management plan shall include a list of the total toxic organic compounds used and the other elements listed in the General
Permit. For those facilities electing to employ the Tf0 monitoring waiver, the discharger shall sign the following certification statement:
"Based upon my inquiry of the person or persons directly responsible for managing compliance with the permit monitoring requirement for total toxic organics
(TTO), I certify that to the best of my knowledge and belief, no dumping of concentrated toxic organics into the stormwater or areas which are exposed to rainfall or
stormwater runoff has occurred since filing the last discharge monitoring report. I further certify that this facility is implementing the all the provisions of the
solvent management plan included in the Stormwater Pollution Prevention Plan."
ROBERT BONDOS
Name (Print name)
Vice President of North American Operations_
TitI int title)
(Signature) (Date)
Note: Results must be reported in numerical format. 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.
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.
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month.
❑ No discharge this period?'
Outfall No.
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
Inches'
Non -polar O&G/TPH by
EPA 1664 (SGT-HEM)
Total Suspended Solids
pH
Benchmarks =__>
-
-
15 mg/L
100 mg/L or 50 mg/L*
6.0 -- 9.0 SU
Footnotes from Part A also apply to this Part B
* See General Permit text, Table 5, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Permit Date: 11/1/2012-10/31/2017
V.
SWU-245, last revised 10/25/2012
Page 2 of 3

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: Mathew Gantt
Mail an original and one copy of this DMR, 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 Permittee)
Permit Date: 11/1/2012-10/31/2017
jDate)
SWU-245, last revised 10/25/2012
Page 3 of 3

GILBARCO
�G VEEDER-ROOT
November 2, 2016
Central Files
Division of Water Quality
1617 Mail Service Center
Raleigh, NC 27699-1617
Dear Sir/Madam:
Gilbarco, Inc.
7300 W. Friendly Ave.
Greensboro, NC 27410-2087 USA
Telephone: 1,336.547,5000
Fax: 1.336.547,5299
www.gi lbarco.com
RECEIVED
NOV 0 4 2016
CENTRAL FILES
DWR SECTION
Enclosed are the original and one copy of the qualitative and quantitative SDO reports for the 2nd half
of 2016.
Gilbarco is continuing to implement its best management practices to control benchmark parameters
but has received approval from the State of NC to forgo additional "Pier level requirements for zinc,
copper, and pH.
If you have any questions please contact John Burke, Environmental Engineer, at 336-337-2746 or
iohn.burkenilbarco.com.
Si er ly,
i
Robert Rondos
VI of North American Operations
Gilbarco, Inc.
Cc: John Burke
Lance Miller
Edgar Young
I -

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit
Date submitted
CERTIFICATE OF COVERAGE NO. NCGO30056
FACILITY NAME Gilbarco Inc
COUNTY Guilford
PERSON COLLECTING SAMPLES John Burke
LABORATORY_R&A Labs_ Lab Cert. # 34
Comments on sample collection or analysis:
Part A: Stormwater Benchmarks and Monitoring Results
5/4116
No. NCG03� 0
SAMPLE COLLECTION YEAR _2,
SAMPLE PERIOD ® Jan -June ❑ July -Dec
or ❑ Monthly' (month]
,rFl\i DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
�� ❑Zero -flow ®Water Supply [:]SA
MAY - 9 .2016 [-]Other
MR SECTION
RFORMATION ROCEss) IT
r
PLEASE REMEMBER TO SIGN ON PAGES 2 AND/OR 3 4
❑ No discharge this period?'
Date Sample
24-hour rainfall
pH,
Non -Polar O&G/Total
Toxic
Outfall No.
Collected'
amount,
Total Suspended Solids
Standard units
Copper
Lead
Zinc
Total Petroleum
Organics5
(mo/dd/yr)
Inches3
Hydrocarbons
Benchmarks =__>
_
-
100 mg/L or 50 mg/L
6.0 -- 9.0
0.007 mg/L
0.03 mg/L
0.067 mg/L
15 mg/L
1 mg/L
Outfall 001
04/12/16
0.14
7.4 mg/L
6.80
0.015 mg/L
<0.005 mg/L
0.081 mg/L
<5.00 mg/L
SMP
Outfall 002
04/12/16
0.14
<0.5 mg/I
6.01
0.015 mg/I
<0.005 mg/L
0.135 mg/I
<5.00 mg/L
SMP
Outfall 003
04/12/16
0.14
<0.5 mg/I
5.35
0.019 mg/I
<0.005 mg/L
0.151 mg/I
<5.00 mg/L
SMP
' Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
2For sampling periods with no discharge at any single'outfall, you must still submit this discharge monitoring report with a 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, Table 3 identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
5 Total Toxic Organics sampling is applicable only for those facilities which perform metal finishing operations, manufacture semiconductors, manufacture
electronic crystals, or manufacture cathode ray tubes. For purposes of this permit the definition of Total Toxic Organics is that definition contained in the EPA
Effluent Guidelines for the facility subject to the requirement to sample (for metal finishing use the definition as found in 40 CFR 433.11; for semiconductor
manufacture use the definition as found in 40 CFR 469.12; for electronic crystal manufacture use the definition as found in 40 CFR 469.22; and for cathode ray
tube manufacture use the definition found in 40 CFR 469.31). r }
MAYO - k 2016
i'-ermit Date: 11/1/2012-10/31/2017 SWU-245, last revised 10/25/2012
Page 1 of 3

Facilities that incorporate a solvent management plan into the Stormwater Pollution Prevention Plan may so certify, and the requirement for TTO monitoring
may be waived. The solvent management plan shall include a list of the total toxic organic compounds used and the other elements listed in the General
Permit. For those facilities electing to employ the TTO monitoring waiver, the discharger shall sign the following certification statement:
"Based upon my inquiry of the person or persons directly responsible for managing compliance with the permit monitoring requirement for total toxic organics
(TTO), I certify that to the best of my knowledge and belief, no dumping of concentrated toxic organics into the stormwater or areas which are exposed to rainfall or
stormwater runoff has occurred since filing the last discharge monitoring report. I further certify that this facility is, implementing the all the provisions of the
solvent management plan included in the Stormwater Pollution Prevention Plan."
ROBERT BONDOS
Name (Print name)
Vice PrasWent of North American Operations
Titl Prin title)
Ak
(Sig ature) (Date)
Note: Results must be reported in numerical format. 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 mgIL where XX is the numerical value of the detection
limit, reporting limit, etc. in mg/L.
Note: if you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses. See General Permit text.
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month.
❑ No discharge this period?Z
Outfall No.
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
Inches3
t
Non -polar O&G/TPH by
EPA 1664 (SGT-HEM)
Total Suspended Solids
pH
Benchmarks ===>
-
-
15 mg/L
100 mg/L or 50 mg/L*
6.0 — 9.0 SU
Footnotes from Part A also apply to this Part B
* See General Permit text, Table 5, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Permit Date: 11/1/2012-10/31/2017 SWU-245, last revised 10/25/2012
Page 2 of 3

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: Mathew Gantt
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 aw re hat there are significant peyalties for submitting false information, including the possibility'of fines and imprisonment for knowing violations."
(Signature of Permittee)
1C)3 I/
(Date)
Permit Date: 11/1/2012-10/31/2017
SWU-245, last revised 10/25/2012
Page 3 of 3

� C62—
I
RESEARCh & �ANA1yTICA1Report of Analysis
• �] � � LAbORATORIEs INC. 4i26i2016
For: Gilbarco
7300 West Friendly Avenue
Greensboro, NC 27.410
Attn: John Burke
sq NC #34
NC #37701
AtA
Client Sample ID: Outfall 001 Lab Sample ID: 17506-01
Site: Gilbarco Collection Date: 4/12/2016 5:20
Parameter Method Result Units Rep Limit Analyst Analysis DatelTime
Copper, Total EPA 200.7 0,015 mg/L 0.005 KL 4/20/2016
Hydrocarbon O&G EPA 1664 Revision B/Silica <5 mg/L 5 DN 4/15/2016
Lead, Total
Total Suspended Solids (TSS)
Zinc, Total
Gel
EPA 200.7
SM 2540 D-1997
EPA 200.7
<0.005 mg/L
7.4 mg/L
0.081 mg/L
0.005 Kt_ 4/20/2016
5 JB 4/13/2016
0.01 KL 4/20/2016
Client Sample ID: Outfall 002 Lab Sample ID: 17506-02
Site: Gilbarco Collection Date: 4/12/2016 5:05
Parameter Method Result Units Rep Limit Analyst Analysis DatelTime
Copper, Total EPA 200.7 0.015 mg/L 0.005 KL 4/20/2016
Hydrocarbon O&G EPA 1664 Revision B/Silica <5 mg/L 5 DN 4/20/2016
Gel
Lead, Total
EPA 200.7
<0.005
mg/L
0.005
KL
4/20/2016
Total Suspended Solids (TSS)
SM 2540 D-1997
<5
mg/L
5
JB
4/13/2016
Zinc, Total
EPA 200.7
0.135
mg/L
0.01
KL
4/20/2016
Client Sample ID: Outfall 003 Lab Sample ID: 17506-03
Site: Gilbarco Collection Date: 4/12/2016 5:10
Parameter Method Result Units Rep Limit Analyst Analysis DatelTime
Copper, Total EPA 200.7 0.019 mg/L 0,005 KL 4/20/2016
Hydrocarbon O&G EPA 1664 Revision B/Silica <5 mg/L 5 DN 4/20/2016
P.Q. Box 473 106 Short Street Kernersville, North Carolina 27284 Tel: [phone] Fax: [phone] www.randalabs.com Page 1
ral coa basic v1d

RESEARCh & ANA1yTICA1
LA ORAT®RiES, INC.
Report of Analysis
4/26/2016
Client Sample ID: 4utfall 003
Lab Sample ID:
17506-03
Site: Gilbarco
Collection Date:
4/12/2016
5:10
Parameter
Method
Result
!Units
Rep Limit Analyst Analysis Date/Time
Gel
Lead, Total
EPA 200.7
<0.005
mg/L
0.005
KL
4/20/2016
Total Suspended Solids (TSS)
SM 2540 D-1997
<5
mg/L
5
JB
4/13/2016
Zinc, Total
EPA 200.7
0.151
mg/L
0.01
KL
4/20/2016
NA = not analyzed
P.O. Box 473 106 Short Street Kernersville, North Carolina 27284 Tet: 336-996-2841 Fax: [phone] www.randalabs.com Page 2
ral coa basic Od

RESEARCh & ANA[yTICA1
UboRATORiES, INC.
Analytical 1 Process Consultations
Phone [phone]
CHAIN OF CUSTODY RECORD
WATER! WASTi=WATER I MISC.
COMPANY
JOB NO. j
i
o
u
z
ob,
mL° Off~ 1 ti2
�?�O+�OO�Op��o `O��m�O
0 Q� Q 0 0 C' 0
Y Y� ti� ^" ^ ^� ^ ^ y REQUESTED ANALYSIS
STREET ADDRESS
PROJECT
CITY, STATE, ZIP
SAMPLER NAME (PLEASE PRINT)
CONTACT PHONE
-1-1 Ll
SAMP R S NATURE
SAMPLE NUMBER LAB USE ONLY)
DATE
TIME
COMP
GRAB
TEMP
4)
(y Mo
x
SAMPLE LOCATION! I.O.
oat
'Z'\
2
- 4 oc_jXefM-
UiSH Y
p jDATEIT E
"!�� -
RECEIVED BY
fl
REMARKS; Lj eA j L d i (3 t c�
� (z.��u�_r..-fir T.i, %!•fit �r c r��•�-,c�' l-•'Y-t �'L��r- 1'jro
SAMPLE TEMPERATURE AT RECEIPT — I _ °C
ELI DISHED BY
DATEMME
RECEIVED BY

DENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Reporti
rot-guidarice onfilling out this form, please visit: http://t)oi-tal.iicdcnv.orgjweb/wq/ws/stu iipdessw#tab-4
Permit No.: NX/ §/ d/,3/!/ 0/ 0/ 0 / or Certificate of Coverage No.:
Facility Name: G i k e4-Lo Tf-
County: _ (5OS-L FOB Phone No, 13 -37 7 -'1
Inspector: —51AW •
Date of Inspection: u2.�i b
Time of Inspection: - SAo A- -ti
Total Event Precipitation (inches): 0. ) K
Was this a "Representative Storm Event" or "Measu reable Storm Event" as defined by the permit?
/inrmation below.)
Yes ❑ No
Please verify whether Qualitative Monitorinq must be pet formed 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 daring 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 inclies has occurred. A single storm event may contain up to 10 consecutive hours of no
precipitation.
s
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 slgnatut•e; I
(Si#naturA of Permittee or Designee)
a is accurate and complete to the best of my knowledge:
Page 1 of 2
SWU-242, Last modified 10/25/2012

1. Outfall Description:
Outfall No. 0 0 � Structure (pipe, ditch, etc.)
Receiving Stream: _.,. l i�S� .f�.*��✓ C-JL4-F,
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: v b"i �
3. Odor: Describe any distinct odors that the discharge may have (Le', smells strongly of oil,
weak chlorine odor, etc.): &"WFi
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 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:
1 2 3 4 5
7. Is there any foam in the stormwater discharge? Yes No
8. Is there an oil sheen in the stortnwater discharge? Yes No
9. Is there evidence of erosion or deposition at the oittfall? Yes No
10. Other Obvious Indicators of StorInwater 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
5WU-242, last modified 10/25/2012

NCDENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring. Report
For guidance on filing out this form, please visit. http://l2nital.ncdent-,oi-glweblwq/ws/su/iipdessw#tab-4
Permit No.: or Certificate of Coverage No
Facility Name: (D i Ibc4-co 'T-A
County: G-L 1=alto Phone No
Inspector: 3�"�kW 5, e-N -4-
Date of Inspection: 141 +2 I ,6
Time of Inspection: ..71->S 4-b..
Total Event Precipitation (inclies): Q. ) H
3 3 c -37?.-1741
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
(See info , ation below,)
es ❑ No
Please verify whether Qualitative Monitoring must be pet formed 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
iand 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 DWO Regional office.
By this signatui certify that this i-Art is accurate and complete to the best of my knowledge:
of Pefmittee or Designee)
Page 1 o[2
SWU-242, Last modified 10/25/2012

1. Outfall Description: : '~
Outfall No. 00'LL Structure (pipe, ditch, etc.) OT—MA-
Receiving Stream: _ _vlv�%'Oe 0 emu-,
Describe the industrial activities that occur within the outfall drainage area: C blfscylrL.N-
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, mediurn, dark) as descriptors: ' IW
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.):. W u ry %
. 1 .
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
1 O 3 4 5
S. Floating Solids: Choose the number which best describes the amount of floating solids in
the stormwater discharge, where 3 is no solids and 5 is the surface covered with floating solids:
I (D 3 4 5
6. Suspended Solids: Choose the number which best describes the amount of suspended
solids in the stormwater discharge, where T is no solids and 5 is extremely muddy:
1 l__/ 3 4 5
7. is there any foam in the stormwater discharge? Yes CNDo
8. is there an. ail sheen in the stot'mwatei discharge? Yes Na
9, is there evidence of erosion or deposition at the outfall? Yes Na
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 he indicative of pollutant exposure. These conditions warrant further investigation.
Page 2 of 2
SWU-247., Last modified 10/25/2012

y5h,
NCD��R
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Forguidance on filling out this form, please visit: htrp://portal.ncdenr.org w b w /ws�su jnpdessty#tab-4
Permit No.: 1/C/%f// 0/ Of a/ U / or Certificate of Coverage No.:
Facility Name: 6 i crco _
County: (,FOA W Phone No. b -31 -1'7`'t�
Inspector: -3-44,il + titi,4L
Date of Inspection: Lf_ .►?-j, J.
Time of Inspection.: 6 S W W'.-
Total Event Precipitation (inches): 0- 1 q
Was this a "representative Storm Event" or "Measureable Storm Event" as defined by the permit?
(See inforination below.)
[Q/Yes ❑ No
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 signatui�-,J,-6rtify that this tjeport is accurate and complete to the best of my knowledge:
of Perinittee or Designee)
Page 1 of 2
SWU-242, Last modified 10/25/2012

1. Outfall Description:
Outfall No. D O 3 - Structure (pipe, ditch, etc.] �_ N-U*
Receiving Stream: Iftp/ 5rz. PfA..I#J U••"y-
Describe the industrial activities that occur within the outfall drainage area: S Vi4 R(vfb
Ccc"'v-J L F- 0- sS
2. Color: Describe the color -of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors:
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells.sti tingly of oil,
weak chlorine odor, etc.):l
4. Clarity: Choose the number which hest describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
01.
2 3 4 5
5. Floating Solids: Choose the number which best describes the amount of floating solids in
the stormwater discharge, where 1 is no solids and 5 is the surface covered with floating solids:
61'
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:
1 2 3 4 5
7. Is there any foam in the stormwater discharge? Yes N�
S, is there an oil sheen in the stormwater discharge? Yes oNo
9. is there evidence of erosion or deposition at the outfall? Yes (01)
10. Other Obvious Indicators of Stormwater Pollution:
List and describe
Note: Love 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-247., Last mudifed 10/25/2012

MCDENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Forguidanceonfllingout thisfortn,please visit. httportahicdennorgfwebfwq/ws/su/npdessw#tab-4
Permit No.: or Certificate of Coverage No.: N/C/C/ DJ 3/ O/ 0/
Facility Name: G ; k %)-rxo_ T-4�
County: (.pav-t, R"� Phone No
Inspector: -514 J + rr vu4L
Date of inspection:
Time of Inspection:An-
Total Event Precipitation (inches): 0- ) H
33C-3-j7-z�'d
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
(See inf Enation below.)
Xes ❑ No
Please verify whether Qualitative Monitoring must be per formed 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 U inches of rainfall
i 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
1permitted 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 docu vent that a shorter
4 interval is representative for local storm events during the sampling period, and the permittee
obtains ammroval from the local DWQ Regional Office.
By this signature, Wify that this repo�yis accurate and complete to the best of my knowledge:
(Signature ofkeririitt�e or Designee)
Page 1 of 2
SWU-242, LastmadiGed 10/25/2012

1. Outfall Description:
Outfall No. o2�1 Structure (pipe, ditch, etc,) TUL -_
Receiving Stream: N�--
Describe the industrial activities that occur within the outfall drainage area: 1�vvl+Jto
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: tx0^19-
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells. stMngly of oil,
weak chlorine odor, etc.]: lvb�ti
4. Clarity: Choose the number which best describes the clarity of the discharge, where I is
clear and 5 is very cloudy: b
2 3 4 5
5. Floating Solids: Choose the number which best describes the amount of floating solids in
the stormwater discharge, where 1 is no solids and 5 is the surface covered with floating solids:
1) 2 3 4 5
b. Suspended Solids: Choose the number which best describes the amount of suspended
solids in the stormwater discharge, where I is no solids and 5 is extremely muddy:
2 3 4 5
7. Is there any foam in the stormwater d ischarge? Yes So
8. Is there an oil sheen in the stormwater discharge? Yes GN
9. Is there evidence of erosion or deposition at the outfall? Yes
10. Other Obvious Indicators of Stormwater Pollution:
List and describe
0
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
5WU-242, last madiFied 20/25/201-2

45
5
MCDENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Forguidance on filling out this farm, please visit: httl:.j/portal.ncdenr.org/weUfwq/ws/w/np-dessw#tali-4
Permit No.:q / or Certificate of Coverage No.: N/C/ ,/
Facility Name: 0 i A ID eKzo
County: _ C,�,s '- F04-10 Phone No.
inspector: _ -44
Date of Inspection: l'L b
Tithe of Inspection: L tz> + -
Total Event Precipitation (inches): 0, ) LI
37& -377-z-7'd
Was this a " epresentative Storm Event" or "Measureable Storm Event" as defined by the permit?
(See inf nation below.)
Yes ❑ No
Please verify whether Qualitative Monitoring must be performed during a "representative storm
event" or "ineasureable 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 incites 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 ceray that' its report isqccurate and complete to the best of my knowledge:
(Signature of
Page 1 of 2
5WU-242, East modified 10/25/2012

a
I. Outfall Description.
Outfall No. Ob! Structure (pipe, ditch, etc.) Pr-T-L h-
Receiving Stream �5 r+`� C.—
Describe the industrial activities that occurwithin the autfall drainage area:
1k ,i c� V
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: fjov�f& _
3. Odor: Describe any distinct odors that the discharge may have (Le" smells.st�6ngly of oil,
weals chlorine odor, etc.): f/twvC
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
Cl- 2 3 4 5
5. Floating Solids: Choose the number which best describes the amount of floating solids in
the stormwater discharge, where 1 is no solids and 5 is the surface covered with floating solids:
2 3 4 5
6. Suspended Solids: Choose the number which best describes the amount of suspended
solids in the stormwater discharg
e, where 1 is no solids and S is extremely muddy:
2 3 4 5
7. is there any foam in the stormwater discharge? Yes is
8. is there an oil sheen in the stormwater discharge? Yes
9. is there evidence oferosion or deposition at the outfall? Yes CNo)'
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
SW[1-242, Last modified 10/25/201.2

YW
HC
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Forguidance on filling out thisform, please visit: http://nortal.ncdennorg/web/wgjws/su&pdes sw4tab-4
Permit No.: VL/ _(?/ 9/3/ o/ o/ o/o / or Certificate of Coverage No.:
Facility Name: G i 1 b c4—w Zn _
County: (, 4_" L Fo,o Phone No. 3-36 -37 7 —1741
Inspector: —3-6) •
Date of Inspection:
Time of Inspection: b 1�
Total Event Precipitation (inches): 0-) H
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
{See infor ation below.)
es ❑ No
Please verify whether Qualitative Monitoring must be performed during a "representative storm
event" or "ineasureable storm event' (requirements vary, depending on the permit).
Qualitative monitoring requirements va3y. Most permits require qualitative monitoring to be !
performed during a "representative storm event" or during a "measureable storm event." Howevei,
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 i
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 "ineasurable 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, f di ;Wthat this report k accurate and complete to the best of my knowledge:
(Signature of+mitt+ or Designee)
Page 1 of 2
5WU-242, last modified 10/25/2012

1. Outfall Description: ti r r
Outfall Na. DO Structure (pipe, ditch, etc.)
Receiving Stream:�-
Describ the industrial activities that occur within the outfall drainage area-
Z. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors:
3. Odor: Describe any distinct odors that the discharge may have (Le.', smells.stMngly of oil,
weals chlorine odor, etc.): ►'���
4. Clarity: Choose the number which hest describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy,
2 3 4 5
5. Floating Solids, Choose the number which best describes the amount of floating solids in
the stormwater discharge, where 1 is no solids and 5 is the surface covered with floating solids:
6�) 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 S is extremely muddy:
2 3 4 5
7. is there any foam in the stormwater discharge? Yes
SN�S
8. Is there an oil sheen in the stormwater discharge? Yes
C�
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.
Page 2 of 2
SWU-242, Last aludi8ed 10/25/2012

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No. NCG030000
Date submitted 9/29/15
CERTIFICATE OF COVERAGE NO. NCG030056 SAMPLE COLLECTION YEAR _2015 cm
FACILITY NAME Gilbarco Inc SAMPLE PERIOD ❑ Jan -June ® July -Dec
COUNTY Guilford or ❑ Monthly' (month)
PERSON COLLECTING SAMPLES John Burke -RE
` DISCHARGING TO CLASS ❑ORW ❑HQW QTrout ❑9NAA
LABORATORYs _R&A LabLab Cert. # 34 1��CEI'V' ED low ®Water Supply DSAO
❑OtherS
Comments on sample collection or analysis: 0 C T &8 2015 La.
CENTRAL FILES PLEASE REMEMBER TO SIGN ON PAGES 2 AND/OR 3 4
DWR SECTION
Part A: Stormwater Benchmarks and Monitoring Results
No discharge this period?'
Date Sample
24-hour rainfall
pH,
Non -Polar O&G/Total
Toxic
Outfall No.
Total Suspended Solids
Copper
Lead
Zinc
Total Petroleum
Collected'
amount,
Standard units
Hydrocarbons
Organics
(mo/dd/yr)
Inches3
Benchmarks ===>
-
-
100 mg/L or 50 mg/L°
6.0 — 9.0
0.007 mg/L
0.03 mg/L
0.067 mg/L
15 mg/L
1 mg/L
Outfall 001
09/09/15
0.16
83.2 mg/L
6.27
0.031 mg/L
0.007 mg/L
0.232 mg/L
<5.00 mg/L
SMP
Outfall 002
09/09/15
0.16
06.2 mg/I
6.05
0.007 mg/I
<0.005 mg/L
0.106 mg/I
<5.00 mg/L
SMP
Outfall 003
09/09/15
0.16
14.2 mg/1
5.27
0.014 mg/I
<0.005 mg/L
0.171 mg/I
<5.00 mg/L
SMP
1 Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
2 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.
" See General Permit, Table 3 identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
5 Total Toxic Organics sampling is applicable only for those facilities which perform metal finishing operations, manufacture semiconductors, manufacture
electronic crystals, or manufacture cathode ray tubes. For purposes of this permit the definition of Total Toxic Organics is that definition contained in the EPA
Effluent Guidelines for the facility subject to the requirement to sample (for metal finishing use the definition as found in 40 CFR 433.11; for semiconductor
manufacture use the definition as found in 40 CFR 469.12; for electronic crystal manufacture use the definition as found in 40 CFR 469.22; and for cathode ray
tube manufacture use the definition found in 40 CFR 469.31).
Permit Date: 11/1/2012-10/31/2017 5WU-245, last revised 10/25/2012
Page 1 of 3

Facilities that incorporate a solvent management plan into the Stormwater Pollution Prevention Plan may so certify, and the requirement for TTO monitoring
may be waived. The solvent management plan shall include a list of the total toxic organic compounds used and the other elements listed in the General
Permit. For those facilities electing to employ the TTO monitoring waiver, the discharger shall sign the following certification statement:
"Based upon my inquiry of the person or persons directly responsible for managing compliance with the permit monitoring requirement for total toxic organics
(TTO), 1 certify that to the best of my knowledge and belief, no dumping of concentrated toxic organics into the stormwater or areas which are exposed to rainfall or
stormwater runoff has occurred since filing the last discharge monitoring report. I further certify that this facility is implementing the all the provisions of the
solvent management plan included in the Stormwater Pollution Prevention Plan."
ROBERT BONDOS
Name (Print name)
Vice President of North American Operations
Titl (Pr" t title) �q
V I
(Signature) (Date)
Note: Results must be reported in numerical format. 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.
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.
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month.
❑ No discharge this period-!"2
Outfafl No.
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
Inches3
Non -polar O&G/TPH by
EPA 1664 (SGT-HEM)
Total Suspended Solids
pH
Benchmarks =__>
_
-
15 mg/L
100 mg/L or 50 mg/L*
6.0 — 9.0 SU
Footnotes from Part A also apply to this Part B
* See General Permit text, Table 5, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Permit Date: 11/1/2012-10/31/2017 SWU-245, last revised 10/25/2012
`~ Page 2 of 3

Not-0- -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 of receipt of the lob 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
am =thatthereare ignificant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
09 Ir'lly
(Signature of Permittee) (Date)
Permit Date: 11/1/2012-10/31/2017 SWU-245, last revised 10/25/2012
Page 3 of 3

RESEARCH & ANA1yTiCAt Report of Analysis
LAbORATORIES, INC. 9/16/2015
For: Gilbarco
J`�4q;•',�l
7300 West Friendly Avenue
.��J'�•b�/�,�r�,�,.
�i3;:'�'�
Greensboro, NC 27410
: o�'
t
Soo NC tt34 • C
Attn: John Burke
NC tt37701
D
��4rgrr<rti��
Client Sample ID: Outfall 01
Lab Sample 1D:
8819-01
Site: Gilbarco
Collection Date:
9/9/2015 13:45
Parameter
Method
Result
Units
Rep Limit Analyst Analysis Date/Time
Copper, Total
EPA 200.7
0.031
mg/L
0.005
AA 9/14/2015
Hydrocarbons, Oil & Grease
EPA 1664 Revision A/Silica
<5
mg/L
5
JB 9/14/2015
Gel
Lead, Total
EPA 200.7
0.007
mg/L
0.005
AA 9/14/2015
Total Suspended Solids (TSS)
SM 2540 D-1997
83.2
mg/L
5
JB 9/11/2015
Zinc, Total
EPA 200.7
0.232
mg/L
0.01
AA 9/1412015
Client Sample iD: Outfall03
Lab Sample ID:
8819-02
Site: Gilbarco
Collection Date:
9/9/2015 13:55
Parameter
Method
Result
Units
Rep Limit Analyst Analysis Date/Time
Copper, Total
EPA 200.7
0.007
mg[L
0.005
AA 9/14/2016
Hydrocarbons, Oil & Grease
EPA 1664 Revision A/Silica
<5
mglL
5
JB 9/14/2015
Gel
Lead, Total
EPA 200.7
<0.005
mg/L
0.005
AA 9/14/2015
Total Suspended Solids (TSS)
SM 2540 D-1997
6.2
mg/L
5
JB 9/11/2015
Zinc, Total
EPA 200.7
0.106
mg/L
0.01
AA 911412015
Client Sample 1D: Ouffall 02
Lab Sample ID:
8819-03
Site: Gilbarco
Collection Date:
9/9/2015 14:05
Parameter
Method
Resul
Units
Rep Limit Analyst Anal sis Datealme
Copper, Total
EPA 200.7
0.014
mg/L
0.005
AA 9/14/2015
Hydrocarbons, Oil & Grease
EPA 1664 Revision A/Silica
<5
mg/L
5
JB 9/14/2015
P.O. Box 473 106 Short Street Kemersville, North Carolina 27284
Tel: [phone]
Fax: [phone] www.randalabs.com Page 1
ral coa basic Od

RESEARCh & ANA YT1CAI Report of Analysis
LAbORATORlES, INC. 9/16/2015
Client Sample ID: Qutfall 02
Lab Sample ID:
8819-03
Site: Gilbarco
Collection Date:
9/9/2015 14:05
Parameter
Method
Resul
Unib
Rep Llmit Analyst Analysis DatefTime
Gel
Lead, Total
EPA 200.7
<0.005
mg/L
0.005
AA 9/14/2015
Total Suspended Solids (fSS)
SM 2540 D-1997
14.2
mg/L
5
JB 9/11/2G15
Zinc, Total
EPA 200.7
0,171
mg/L
0.01
AA 9/14/2015
NA = not analyzed
P.O. Box 473 106 Short Street Kemersvitle, North Carolina 27284 Tel: [phone] Fax: [phone] www.randalabs.com Page-2
ral coa basic Od

NCDENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
t'or'giddance oil filling out this form, please visit: htV./ lAlIctlf Ill'&Mjweb f wjl/ws/S4l jnprlessw#Cab-4
Permit No.: N/C/�/ Q// DJ o/QJ_/ or Certificate of Coverage No,:
Facility Name: _ O L(3PrA'-a -r,J L _
County: C� U U(--v A-3 Phone No. "2, 3
Inspector: S>'yk-0 a j /Ltu[
Date of Inspection: SN -, t
Time of InspectioI: L , L4 a
Total Event Precipitation (inches):
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
{See infor ation below.)
es ❑ No
Please verify whether Qualitative Monitoring must be per formed during a "representative storm
event"or "measureablestorm event"(requirements vary, depending on the permit).
Qualitative monitoring requirements vary. Most Hermits 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 pleasures 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 tip to 10 consecutive hours of no
precipitation.
A "measurable storm event" is a storm event that results in an actual discharge froin the
permitted site outfall. The previous measurable storm event must have been at least 72 hours
1prior. 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
(Signatu'e of P�mnitte jor Designee)
Pagel oi'2
complete to the best of my knowledge:
sWU-242, Last modified 10/25/2012

1. Outfall Description:
Outfall No. 0-01 Structure (pipe, ditch, etc.)
Receiving Strearn:--1--fi-^�-
Describe the industrial activities that occur within the outfall drainage area:
S i fQ �-'P ai M s".1 ' C,0iDL4t'P'K-
Q.0t-(— f--Xc iVAOST5
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: T1 + i w-te r tZ-6-L4r DET::2r.r
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.):
4. CIarity: Choose the number which hest describes the clarity of the discharge, where 1. is
clear and 5 is very cloudy:
1 2 4 5
5. Floating Solids: Choose the number which best describes the amount of floating solids in
the storrnwater discharge, where 1 is no solids and 5 is the surface covered with floating solids:
0 2 3 4 5
6. Suspended Solids: Choose the number which best describes the amount of suspended
solids in the storrnwater discharge, where 1 is no solids and 5 is extremely muddy:
7.
8
Is there any foam in the storrnwater discharge?
4 5
Yes
Is there an oil sheen in the storrnwater discharge? Yes
9. Is there evidence of erosion or deposition at the outfall?
10. Other Obvious Indicators of Stormwater Pollution:
1,ist and describe
iVa
No
Yes No
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition
may he indicative of pollutant exposure. These conditions warrant further investigation.
Rage 2 of 2
s
SWU-242, Last modified 10/25/2012

1. Outfall Description: �tif
Outfall No. 0 O Z Structure pipe, ditch, etc.)
Receiving Stream:
Describe the industrial activities that occur within the outfall drainage area:
C Vr-fr.+w"r'
2. Collor: Describe the color of the discharge using basic colors red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: CL-e-A"`- aro T
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.): . N-UA-( I;—,
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1. is
clear and 5 is very cloudy:
0 2 3 4 5
5. Floating Solids: Choose the number which best describes the amount of floating solids in
the stormwater discharge, where 1 is no solids and 5 is the surface covered with floating solids:
0 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:
1 2 3 4 5
7. Is there any foam in the stormwater discharge? Yes ()
No
S. Is there an oil sheen in the stormwater discharge? Yes No
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 he indicative of pollutant exposure. These conditions warrant further investigation.
Page 2 of 2
SWU-242, Last madified 10/25/2012

1. Outfall Description:
Outfall No, O-o 3 Structure (pipe, ditch, etc.) n 1 r
Receiving Stream:
Describe the industrial activities that occur within the outfall drainage area: S
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: l.rb Wes"- 0,—
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.):
4. CIarity: Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
Cl)
2 3 4 5
5. Floating Solids: Choose the number which best describes the amount of floating solids in
the stormwater discharge, where 1 is no solids and 5 is the surface covered with floating solids:
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:
(9 2 3 4 5
7. is there any foam in the stormwater discharge? Yes No
S. Is there an oil sheen in the stormwater discharge? Yes No
9. Is there evidence of erosion or deposition at the outfall? Yes No
10. Other Obvious Indicators of Stormwater Pollution:
List and describe
Note: Love 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
5WU-242, Last modified 10/25 f2012

1. Outfall Description:
Outfall No. 4�" _ Structure (pipe, ditch, etc.)
Receiving Stream: "7- R4zltj C--' Z'4"L tL
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: P-0 (&a .0— v�L- T o-v-
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.): P o D-0—:.Cx,
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1. is
clear and 5 is very cloudy:
Cl)
2 3 4 5
S. Floating Solids: Choose the number which best describes the amount of floating solids in
the storrnwater discharge, where 1 is no solids and S is the surface covered with floating solids:
6 2 3 . 4 5
6. Suspended Solids; Choose the number which best describes the amount of suspended
solids in the storrnwater discharge, where 1 is no solids and 5 is extremely inuddy:
1 2 3 4 5
7. Is there any foam in the storrnwater discharge? Yes No
8. Is there an oil sheen in the storrnwater discharge? Yes N
9. is there evidence of erosion or deposition at the outfall? Yes DN
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, bast modified 1,0/25/2012

1. Outfall Description:
Outfall No. O D S Structure (pipe, ditch, etc.)
Receiving Stream: Jar- PF-,1 - C_,I-r�-4Z"A--
Describe the industrial activities that occur within the outfall drainage area:
0- A P -tom F eJ (-
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: k)--b z ""�- a'-` T-r-^3i—
3. Odor. Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.): lJ D o ILa-v*—
4. Clarity: Choose the number which hest describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy: 0
2 3 4 5
5. Bloating Solids: Choose the number which best describes the amount of floating solids in
the storinwater discharge, where 1 is no solids and 5 is the surface covered with floating solids-
0 2 3 4 5
6. Suspended Solids: Clio ose the number which best describes the amount of suspended
solids in the stormwater discharge, where 1 is no solids and 5 is extremely muddy:
61 2 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 N
4. Is there evidence of erosion or deposition at the outfall? Yes N�
10. Other Obvious Indicators of Stormwater Pollution;
List and describe
]Vote: 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
5WU-242, Last madifted 10/25/201.2

1. Out -fall Description:
Outfall No. 0-0 Structure ( pe, ditch, etc.) -
Receiving Stream:
Describe the industrial activities that occur within the outfall drainage area: .? G- �
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: & - Cc) (-A-- ..0.C-- 7T--"�' _
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.): _ _ PJ -a 04? D-,--
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
2 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:
0 2 3 4 5
6. Suspended Solids: Choose the number which best describes the amount of suspended
solids in the stormwater discharge, here 1 is no solids and 5 is extremely muddy:
2 3 4 S
7. Is there any foam in the stormwater discharge? Yes 60,
B. Is there an oil sheen in the stormwater discharge? Yes (;
9. Is there evidence of erosion or deposition at the outfall? Yes oNo
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 madified 10/25/2012

RESEARCh & ANA[yTICAL
LABORATORIES, INC.
Analytical 1 Process Consultations
Phone [phone]
CHAIN OF CUSTODY RECORD
wATERIWASTewaTEa I misc.
REQUESTED ANALYSIS
STREETADDRESS
CONTACT -- - PHONE
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MINNIE
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A
r
.:

Semi-annual Stormwater Discharge Monitoring Re.port
for North Carolina Division of Water Quality General Permit No. NCG030000
Date submitted 5/5/15
CERTIFICATE Of COVERAGE NO. NCG030056
FACILITY NAME Gilbarco Inc
COUNTY Guilford
PERSON COLLECTING SAMPLES John Burke.
LABORATORY R&A Labs_ Lab Cert. # 34�
Comments on sample collection or analysis:
Part A: Stormwater Benchmarks and Monitoring Results
SAMPLE COLLECTION YEAR _2015
SAMPLE PERIOD ® Jan -June ❑ July -Dec
or ❑ Monthly' {month) I
RECEMV—�R,GING TO CLASS ❑ORW ❑HQW [-]Trout ❑PNA
�,J ❑Zero -flaw ®Water Supply ❑SA C=
MAY 0 7 2015 ❑Other_
CENTRAL FILES PLEASE REMEMBER TO SIGN ON PAGES 2 AND/OR 3 4 �
DWR SECTION
❑ No discharge this, period:
Non -Polar O&G/
}
Outfall No.
Date Sample
i
24-hour rainfall
Total Suspended Solids
pH,
Copper
Lead
Zinc
Total Petroleum
iotaI Toxic;
s
Collected
amount,_
3.
Standard units
Hydrocarbons
6rgariics-a
(mo/dd/yr)
Inches
Benchmarks = =>
_
-
100 mg/L or 50 mg/L4
6.0 -- 9.0
0.007 mg/L
0.03-mg/L
0.067 mg/L
15 mg/L
1 mg/L
Outfall 001
04/14/15
0.20
14.2 mg/L
6.50
0.007 mg/L
<0.005 mg/L
0.082 mg/L
<5.00 mg/L
SMP
Outfall 002
04/14/15
0.20
75.5 mg/1
6.25
0.018 mg/I
<0.005 mg/L
0.141 mg/l
<5.00 mg/L
SMP
Outfall 003
04/14/15
0.20
16.5 mg/1
6.05
0.008 mg/I
<0.005 mg/L
0.0.82 mg/I.
<5.00 mg/L
SMP
1 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-
3 The 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, Table 3 identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
5 Total Toxic Organics sampling is applicable only for those facilities which perform metal finishing operations, manufacture semiconductors, manufacture
electronic crystals, or manufacture cathode ray tubes. For purposes of this permit the definition of Total Toxic Organics is that definition contained in the EPA
Effluent Guidelines for the facility subject to the requirement to sample (for metal finishing use the definition as found in 40 CFR 433.11; for semiconductor
manufacture use the definition as found in 40 CFR 469.12; for electronic crystal manufacture use the definition as found in 40 CFR 469.22; and for cathode ray
tube manufacture use the definition found in 40 CFR 469,31).
Permit Date: 11/1/2012-10/31/2017 SM-245, last revised 10/25/2012
Page 1 of 3

Facilities that incorporate a solvent management plan into the Stormwater Pollution Prevention Plan may so certify, and the requirement for TTO monitoring
may be waived. The solvent management plan shall include a list of the total toxic organic compounds used and the other elements listed in the General
Permit. For those facilities electing to employ the TTO monitoring waiver, the discharger shall sign the following certification statement:
"Based upon my inquiry of the person or persons directly responsible for managing compliance with the permit monitoring requirement for total toxic organics
(TTO), I certify that to the best of my knowledge and belief, no dumping of concentrated toxic organics into the Stormwater or areas which are exposed to rainfall or
stormwater runoff has occurred since filing the last discharge monitoring report. I further certify that this facility is implementing the all the provisions of the
solvent management plan included in the Stormwater Pollution Prevention Plan."
ROBERT RONDOS
Name (Print name)
Vice President of North American Operations
Titl P int title)
(Signature) (Date)
Note: Results must be reported in numerical format. 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/IL"the , where XX is the numerical value of detection
limit, reporting limit, etc. in mg/L.
Note: If you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses. See General Permit text.
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month.
❑ No discharge this period?2
Outfall No.
Date Sample
1
Collected
{mo/dd/yr}
24-hour rainfall
amount,
3
Inches
Non -polar O&G/TPH by
FPA 1664 (SGT=HDM}
Total Suspended Solids
pH
Benchmarks =_>
_
-
15 mg/L
100 mg/L or 50 mg/L*
6.0 — 9.0 SU
Footnotes from Part A also apply to this Part B
* See General Permit text, Table 5, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Permit Date: 11/1/2012-10/31/2017 SWU-245, last revised 10/25/2012
Page 2 of 3

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 EKCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART 11 SECTION B.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OtJTFAI I_ TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART 11 SECTION B.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANYONE OUTFALL? YES M NO
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES M NO
REGIONAL OFFICE CONTACT NAME: aA, t ® �n11aiJ uQ 'b •tJCDr--NlL-
Mail an orLqinal and one copy of this DMNLincluding 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.
am a are that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
ure of Permittee)
Permit Date: 11/1/012-10/31/2017
(:)Vv�/ t �-
(Date)
SWU-24S, last revised 10/25/2012
Page 3 of 3

RESEARCh & ANA1yTICA1
LAbORATORlESF INC.
For: Gilbarco
7300 West Friendly Avenue
Greensboro, NC 27410
Attn: John Burke
Report of Analysis
4/24/2015
4$Sl{921 f #Tl Ir
a �riD NC #34 Z
NC 437701
��ltrlikLt►��
Client Sample ID: Outfall 001
Site: Gilbarco
Lab Sample ID:
Collection Date:
3010-01
4/14/2015 11:13
EParaineier� Analr�st Anal�rs#s'Date�me
.. "_yee-Mettiod�;;r�x-Resulf�,
S;iJnitsRepl�Ernrt
Hydrocarbons, Oil & Grease
EPA 1664 Revision A/Silica
<5 mg/L
5
JB 4/20/2015
Gel
Copper, Total
EPA 200.7
0.007 mg/L
0.005
AA 4/1712015
Lead, Total
EPA 200.7
-�0.005 mg/L
0.005
AA 4/17/2015
Zinc, Total
EPA 200:7
0.082 mg/L
0,01
AA 4/17/2015
Total Suspended Solids (TSS)
SM 2540 D-1997
14.2 mg/L
5
YJ 4/20/2015 1600
Client Sample 1D: Outfall 002
Lab Sample ID:
3010-02
Site: Gilbarco
Collection Date:
4/14/2015 11:20
Paramefer kMe#hatl_ k-Resu#t Units Reo=Lim�tAnaly_si Analys�s DafeFT�me
Hydrocarbons, Oil & Grease
EPA 1664 Revision A/Silica
<5
mg/L
5
JB 4/20/2015
Gel
Copper, Total
EPA 200.7
0.018
mg/L
0.005
AA 4/17/2015
Lead, Total
EPA 200.7
<0,005
mg/L
0,005
AA 4/17/2015
Zinc, Total
EPA 200.7
0.141
mg/L
0.01
AA 4/17/2015
Total Suspended Solids (TSS)
SM 2540 D-1997
75.5
mg/L
5
YJ 4/20/2015 1600
Client Sample ID: Outfall 003 Lab Sample ID: 3010-03
Site: Gilbarco Collection Date: 4/14/2015 11:25
Hydrocarbons, Oil & Grease EPA 1664 Revision A/Silica
Gel
Copper, Total. EPA 200.7
P.D_ Box 473 106 Short Street Kemersville, North Carolina 27284
,al ^3 J siC t',d
<5 mg/L 5 JB 4/20/2015
0:008 mg/L 0.005 AA 4/17/20.15
Tel: [phone] Fax: [phone] www.randalabs.com Page 1

r
RESEARCh & ANA1yTICAC
LAbORATORkSr INC.
Report of Analysis
4/24/2015
Client Sample ID: Out€all 003
Lab Sample ID:
3010-03
Site: Gilbarco
Collection Date:
4/14/2015 11:25
P ra— -mT �'r_+�
.�Meitiod
��'-'jResult`� yElnfts �Rep�Llm�tAnai�st Analvs�s Date{fitne=n
Lead, Total EPA 200.7
<0.005
mg/L
0.005
AA 4/1712015
Zinc, Total EPA 200.7
0.082
mg/L
0:01
AA 4/17/2015
Total Suspended Solids (TSS) SM'2540 D-1997
16.5
mg/L
5
YJ 4/20/2015 1600
NA = not analyzed
P.O. Box 473 106 Short Street Kemersville, North Carolina 27284 Tel: [phone] Fax: 336-996=0326 www.randatabs.com Page 2

RESEARCh .& ANA[yTiCAl
LAbORATOOES. INC.
Analytical / Process Consultations
Phone [phone]
CHAIN OF CUS
I WATER 1 WA
COMPANY
GZLGAAj.c
JOB NO. '
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STREETADDRESS
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PROJECT
�M1.w�1t��'S'�rJL
CITY, STATE, ZIP
Lj(L¢.��1$ 7tio tJC_ rL% Hto
SAMPLER NAME (PLEASE PRINT)
�3+yt,J Rlt-(L z
CONTACT PHONE
-,
�aL4rJ �+n u! 3� 6-33'z-17L(6
SAMPLER SIGNATURE
o
SAMPLENUMBER ONLY)
[LAB USE ONLY}-
DATE
TIME
C01lP
GRAB
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SAMPLE LOCATION I LD.
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RELINQUISHED BY
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RECEIVED BY
REMARKS;
SAMPLE TEMPERATURE AT RECEIPT 0 A °C
E fNQU15HED BY'
DATEMME
RECEIVED BY

MCDENR
Stormwater Discharge Outfall (SDO)
- Qualitative Monitoring Report
For guidance on filling out this form, please visit: h tal cd nr.or e w w u n e sw to -4
Permit No.: LV/C/Co/ /�/o/D/_/ or Certificate of Coverage No.: N/C/G/
Facility Name:
County: CCU` LFa (L-0 Phone No. 33C, S ti �I— Sa e C;
Inspector: a *,.) & u
Date of Inspection: L4 t `4,I t
Time of inspection: I( iOG u`32) A,
Total Event Precipitation (inches):y - �?- -0
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
(See information below.)
Q Yes 0 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 721rours (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 frorn the
permitted site outfall. The previous measurable storm event must have been at least 72 hours
prior. The 72-haw- 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 t is accurate and complete to the best of my knowledge:
(Signatudof permittee or Designee)
Page I of 2
SVVU-242, Last modified 10/25/2012

1. Outfall Description:
Outfall No. o 0 t Structure (pipe, ditch, etc.) Q %- k�
Receiving Stream:y-e r-Se- PQ— - aye- tL
Describe the industrial activities that occur within the outfall drainage area:
rA'f= i"t9 t_ 5 r tl kfL S L 5 �►�{ L i`�yvti,�a S S y.2ti•1 S
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: C-t.eA-6-
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of ail,
weak chlorine odor, etc.): -mil e
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 .
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:
O 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:
1 � 3 4 5
7. is there any foam in the stormwater discharge? Yes Na
a. is there an oil sheen in the stormwater discharge? Yes No
9. is there evidence of erosion or deposition at the outfall? Yes No
10. Other Obvious indicators of Stormwater Pollution:
List and describe 1_`< 05
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or ei4osion/deposition
may be indicative of pollutant exposure. These conditions warrant further investigation.
Page 2 of 2
SwU-242, Last modified 10/25/2012

1. Outfall Description:
Outfall No. g2 CG L Structure (pipe, ditch, etc.) (JZTC -Las
Receiving Stream:
Describe the industrial activities that occur within the outfall drainage area: C
w e �- S �'ti'ti' � F , R-;-' F 1-'Ue -- r�MS S S a e-rj S, 0N F i t 5 C-&,A P 2LY%-4�
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: _
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.): O ice►(--
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 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:
U 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:
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
9. Is there evidence of erosion or deposition at the outfall?
10. Other Obvious Indicators of stormwater Pollution:
List and describe
Yes
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition
niay be indicative of pollutant exposure. These conditions warrant further investigation.
Page 2 of 2
SWU-242, Last modified 10/25/2012

1. Outfall Description:
Outfall No. B 0 1 Structure (pipe, ditch, etc.)
Receiving Stream: _ l: f'5 < �ji�f+'� �'t e (C—_
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: _ C' _; e-c _
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.): 0-
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
DI-
2 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:
(a 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:
1 2 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 No e
9. is there evidence of erosion or deposition at the outfall? Yes (NDo
10. Other Obvious Indicators of Stoi-mwater 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

1. Outfall Description:
Outfall No. 60 "t Structure (pipe, ditch, ett
Receiving Stream: �_ it- Q ems+'+ .CI-0-
0 Ll
Describe the industrial activities At occur within the outfall drainage area: V {-
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: - C cc-4-1r—
3. Odor: Describe any distinct odors
weak chlorine odor, etc.): l•NY`'
the discharge may have (i.e., smells strongly of oil,'
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 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:
1 2 3 4 5
7. Is there any foam in the stormwater discharge? Yes qNo
8. Is there an oil sheen in the stormwater discharge? Yes
9. is there evidence of erosion or deposition at the outfall? Yes 0No
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, fast modified IO/25/2012 ,

1. Outfall Descriptich.,
Outfall No. CrQ -7 Structure (pipe, ditch, etc.) rP " G
Receiving Stream: � C.('ek-
Describe the industrial activities that occur within the outfall drainage area: l -G #j
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: L�- �-
3. Odor. Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.): jhi�N'�Z
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
z
2 3 4 5
5. Floating Solids: Choose the number which best describes the amount of floating solids in
the stormwater discharge, where 1 is no solids and 5 is the surface covered with floating solids:
1 2 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 2 3 4 5
7. Is there any foam in the stormwater discharge? Yes No
a. Is there an oil sheen in the stormwater discharge? Yes No
4. 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
5WU-242, last madified 10/25/2012

1. Outfall Description:
Outfall No. DQ 6 Structure (pipe, ditch etc.) .
Receiving Stream: S-`?
Describe the industrial activities thJ 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: (1), lr,*a^_
1 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:
Z, 2 3 4 5
5. Floating Solids: Choose the number which best describes the amount of floating solids in
the stormwater discharge, where 1 is no solids and 5 is the surface covered with floating solids:
(31
2 3 4 5
6. Suspended Solids: Choose the number which best describes the amount of suspended
solids in the stormwater discharge, where I is no solids and 5 is extremely muddy:
1 2 3 4 5
7. Is there any foam in the stormwater discharge? Yes o
8. Is there an oil sheen in the stormwater discharge? Yes No j
9, is there evidence of erosion or deposition at the outfall? Yes 4�J
10. Other Obvious Indicators o€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
5WEF242, last modified 10/25/2012

' �' GI BARCQ
T VEEM-ROQT
November 24, 2014
Central Files
Division of Water Quality
1617 Mail Service Center
Raleigh, NC 27699-1617
Dear Sir/Madam:
Gilbarco, Inc.
7300 W. Friendly Ave.
Greensboro, NC 27410-2087 USA
Telephone: [phone]
Fax: l .336.547.5299
www.c,ilbarco.com
Enclosed are the original and one copy of the qualitative and quantitative SDO reports for the 2nj half
of 2014. Please note the following items.
The 2`1 half 2014 results indicate pH below the lower benchmark value of 6.0 for Outfall 003.
o Review of sources of low pH indicate the following:
13 The significant volume of uric acid deposited on the roof by geese is the source
for low pH stormwater.
■ Review of rooftop emission sources and maintenance product usage reveal no
low pH production sources since the company eliminated zinc phosphate
pretreatment operations.
o To reduce the goose impacts, Gilbarco has implemented the use of equipment to deter
them from gathering.
If you have any questions please contact John Burke, Environmental Engineer, at 336-337-2746 or
iohn.burkeRcw2ilbarco.com.
Sinc rely,
Mario Iannanatouno
VP of North American Operations
Gilbarco, Inc.
Cc: John Burke
Lance Miller

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No. NCG030000
Date submitted 11/24/14
CERTIFICATE OF COVERAGE NO. NCG030056
FACILITY NAME Gilbarco Inc
COUNTY Guilford
PERSON COLLECTING SAMPLES John Burke
LABORATORY R&A Labs Lab Cert. f# 34
Comments on,sample collection or analysis:
Part A: Stormwater Benchmarks and Monitoring Results
SAMPLE COLLECTION YEAR _2014
SAMPLE PERIOD ❑ Jan -June ® July -Dec
��++��CC `� or ❑ monthly' month
REVCI V DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
OEC 0 2 Z014 ❑Zero -flow ®Water Supply [:]SA
❑Other
CENTRAL FILES
DWR SECTION PLEASE REMEMBER TO SIGN ON PAGES 2 AND/OR 3 4
❑ No discharge this period?'
Date Sample
24-hour rainfall
pH,
Non -Polar O&G/Total
Toxic
Outfall No.
Collected;
amount,
Total Suspended Solids
Standard units
Copper
Lead
Zinc
Total Petroleum
Organics"
(mo/dd/yr)
Inches3
Hydrocarbons
Benchmarks =__>
_
-
100 mg/L or 50 mg/L
6.0 — 9.0
0.007 mg/L
0.03 mg/L
0.067 mg/L
15 mg/L
1 mg/L
Outfall 001
11/6/14
0.25
54.5 mg/L
6.87
0.012 mg/L
<0.005 mg/L
0.080 mg/L
<5.00 mg/L
SMP
Outfall 002
1 11/6/14
0.25
1 6.8 mg/I
6.10
1 0.022 mg/I
I <0.005 mg/L
0.201 mg/I
I <5.00 mg/L
SMP
Outfall 003
1 11/6/14
0.25
8.5 mg/I
5.80
0.013 mg/I
I <0.005 mg/L
0.212 mg/I
<5.00 mg/L
SMP
1 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.
'The total precipitation must be recorded using•data from an on -site rain gauge. Unattended sites may be eligible for a waiver of the rain gauge requirement.
"See General Permit, Table 3 identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
5 Total Toxic Organics sampling is applicable only for those facilities which perform metal finishing operations, manufacture semiconductors, manufacture
electronic crystals, or manufacture cathode ray tubes. For purposes of this permit the definition of Total Toxic Organics is that definition contained in the EPA
Effluent Guidelines for the facility subject to the requirement to sample (for metal finishing use the definition as found in 40 CFR 433.11; for semiconductor
manufacture use the definition as found in 40 CFR 469.12; for electronic crystal manufacture use the definition as found in 40 CFR 469.22; and for cathode ray
tube manufacture use the definition found in 40 CFR 469.31).
Permit Date: 11/1/2012-10/31/2017 SWU-245, last revised 10/25/2012
Page 1 of 3

Facilities that incorporate a solvent management plan into the Stormwater Pollution Prevention Plan may so certify, and the requirement for TTO monitoring
may be waived. The solvent management plan shall include a list of the total toxic organic compounds used and the other elements listed in the General
Permit. For those facilities electing to employ the TTO monitoring waiver, the discharger shall sign the following certification statement.
"Based upon my inquiry of the person or persons directly responsible for managing compliance with the permit monitoring requirement for total toxic organics
(TTO), I certify that to the best of my knowledge and belief, no dumping of concentrated toxic organics into the stormwater or areas which are exposed to rainfall or
stormwater runoff has occurred since filing the last discharge monitoring report. I further certify that this facility is implementing the all the provisions of the
solvent management plan included in the Stormwater Pollution Prevention Plan."
Mario lannantuono
Name (Print name)
Vice President of North American 0 erations
Tithe ((PPrint title)
--:5z, 4"� �1 )I Lz_z�- Z) 1+
(Signature) (Date)
Note: Results must be reported in numerical format. 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.
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.
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month.
❑ No discharge this period?z
Outfall No.
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall .
amount,
Inches'
Non -polar O&G/TPH by
EPA 1664 (SGT-HEM)
Total Suspended Solids
pH
Benchmarks
15 mg/L
100 mg/L or 50 mg/L*
6.0 — 9.0 SU
Footnotes from Part A also apply to this Part B
* See General Permit text, Table 5, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Permit Date: 11/1/2012-10/31/2017 SWU-245, last revised 10/25/2012
Page 2 of 3

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.
0 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 D_M& 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" re orts 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)
l I A#1 141
(Date)
Permit Date: 11/1/2012-10/31/2017 SWU-245, last revised 10/25/2012
Page 3'of 3

C.
RESEARCh & ANA1YTICA[ ,.•``�.�'Ti
LABORATORIES INC.
NC #34 0 • cn
Analytical/Process Consultations z:
LIED
Gilbarco Date Sample Collected 11/06/14
7300 West Friendly Avenue Date Sample Received 11/06/14
Greensboro, NC 27410 Date Sample Analyzed 11/06/14
Attn: John Burke Date of Report : 11/14/14
Analyses Performed by AA -YJ -JB
Lab Sample Number Lab Sample Number Lab Sample Number
---------------------------------------- --------------------
799045 799046 799047
Parameter Storet 9 Results Results Results
Lead,Tot (01051) <0.005 mg/l <0.005 mg/l <0.005 mg/L
Zinc,Tot (01092) 0.080 mg/l 0.201 mg/l 0.212 mg/l
Copper,Tot (01042) 0.013 mg/l 0.022 mg/l 0.012 mg/l
TSS (00530) 54.5 mg/l 6.8 mg/l 8.5 mg/l
Oil 8 Grease (00556) <5.0 mg/l <5.0 mg/l <5.0 mg/l
---------------------------------------- --------------------
Clients Sample Source OUTFALL 01 OUTFALL 02 OUTFALL 03
Number
Time Collected (Hrs) 1120 1105 1110
P.O. Box 473 • 106 Short Street • Kernersville, North Carolina 27284 • 336-996-2841 • Fax [phone]
www.randslabs.com

RESEARCh & ANAlyTiCA[
LAbORATORiES, INC.
Analytical 1 Process Consultations
Phone [phone]
CHAIN OF CUSTODY RECORD
I WATER 1 WASTEWATER ! MI5C. 1
COMPANY
JOB N0.
(P [1 b 1
W
o
LL
Q
z
�� °•
ti O
Z r=
m= °� ����� m�y� �yy Q�
?a ��
v
tea, O } -G� ~poi O ? \y o
=�• 0}�q °p mco `Op�� �Q C7
p�� pF R,
`� ry ryh ,�� ,v ,v ,v .v h4 REQUESTED ANALYSIS
STREETADDRESS
7 7 o o J e-)L �rC� .-� (�✓ t�
PROJECT
S rb ti «.0 ,t�,-�� 5 -S
CITY, STATE, ZIP r /
jV L 'L't '[ L.c�
SAMPLER NAME (PLEASE PRINT)
�d�.1 f� r rLft.✓`-
CONTACT PHONE }}
SAAPER SIGNATURE
SAMPLE NUMBER
(LAB USE ONLY)
DATE
TIME
COMP
GRAB
TEMP
'C
RES
CI
CreOwNE
REMOVED
Sant E
Is a �x
SAMPLE LOCATION! I.B.
1
tl� o5
o v
(A 9&-
03
q�
RELIN UI D BY
jElTIME
RECEIVED BY
REMARKS:
`' n
SAMPLE TEMPERATURE AT RECEIPT 3A °C
RELI DUI HED BY
DATEITIME
REMVtID BY

STORM EVENT DATA RECORD -
Name of Facility - Gilbarco
Location: Greensboro, NC
No. of Outfafls or Sample Locations = _: 3, Date: 1116/20�4 -
Storm began
1 10:45 AM
Gauge Reading
-0.00
Storm ended
1 2:00 PM
Gauge Reading
0.25
Time interval
Measurable
Sample Time
Time
Sample
Sample
Rain Gauge
(minutes)('
Storm Event
(Hr:Min.)
interval
Container Fill
Container Label
Record
Begin Time
(minutes)
level
(inch)
(Hr Min)
Outfall 001
11-.10 AM
11.20 AM
10
FULL
Outfall 001 TSS
0.12
Outfall 002
10:55 AM
11:05 AM
10
FULL
Outfall 002 TSS
0.05 _
Outfall 003
11:05 AM
11:10 AM
5
FULL
Outfall 003 TSS
0.07
No. of hours since previous measurable rain event
pH reading of buffer solution after meter calibration
pH of samples! Record pH of sample bottle for each outfall:
Outfall Bottle pHTestr 30
Outfall 001 TSS Bottle 6,87
Outfall 002 TSS Bottle 6.10
Outfall 003 TSS Bottle 5.80
T _ 4.01, pHTestr 30 - Buffer USA 4.01
Samples collected by John Burke
Rain gauge reading taken by John Burke_
pH meter read by John Burke
Is Outfall Visual Monitoring Record attached for each outfall? Yes

;f
YV
NC®ENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Forguidance on filling out this form, please visit., b-t p:/Lportal,]ic{lenr.orE/web/-vq/ nws f su/npdessvv#tab-4
Permit No.: N/Q/ 6 / 2/ o/ or Certificate of Coverage No.:
Facility Name. GT- L. 68 n -G.o
County: G U T- - R, R Q , Phone No. 3 3 � - 5`I 7 - S-o o o
Inspector: 3- -o t*0 iS
Date of Inspection: Ll I b I I
Time of Inspection: 1 i '.
J
Z 4P AV,
Total Event Precipitation (inches): 0, SS
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 per formed 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.
k" 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
r obtains approval from the local DWQ Regional Office.
By this ftnature, I certify that this report is accurate and complete to the best of my knowledge:
Perinittee or Designee)
Page 1 of 2
SWU-242, Last modified 10/25/2012

r
1, Outfall Description:
Outfall No. Ob i Structure (pipe, ditch, etc.) DLT�tk
Receiving Stream: -0-5F- PJ-r 0 C(I.F- 9 k4-
Describe the industrial activities that occur within the outfall drainage area: Scn-,aP
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: j!0 F-ai a w, (3 (-W
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.): N a h) 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] 4 S
S. Floating Solids: Choose the number which best describes the amount of floating solids in
the stormwater discharge, where 1 is no solids and S is the surface covered with floating solids:
a 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:
1 2 (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 No
9. is there evidence of erosion or deposition at the outfall? es No
10. Other Obvious Indicators ofStormwater Pollution:
List and describe 6 E 1-b5V-LwJ L) F M rr to 0 A-U-3
Note: Low clarity, nigh 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

NCDENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Forguidance onfilling out thisform, please visit: http:%/pgrtal,ncd�nr.ariz/web/wgjws/�-ujLil2dessw#tab-4
Permit No.:
Facility Name: G z c1 G A R-&o
County: G U Z i- Fa fL D
Inspector- _ J-'�p LA-,j G i (L-�SF_
Date of Inspection: [I
Time of Inspection:— l
or Certificate of Coverage No.:
Total Event Precipitation (inches): D , Z sr
Phone No. 336-5`i7- �Aa�
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
(See information below.)
es ❑ No
Please verify whether Qualitative Monitoring must be performed during a "representative storm
event" or "reasureable storm event" (requirernents vary, depending on the permit).
Qualitative monitoring requirements vary. Most permits require qualitative monitoring to be f
performed during a "representative storm event" or during a "measureable storm event." However,
some permits do not have this ► equirement 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
i
0.1 inches has occurred. A single storm event may contain up to 10 consecutive hours of no
precipitation.
k"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 s
{ obtains aDoroval from the local DWO Regional Office.
By this sig4ture, l c t is accurate and complete to the best of my knowledge:
Permittee or Designee)
Page 1 of 2
SWU-242, i.astmodified 10/25/2012

1. Outfall Description:
OutfaIl No. o o Z Structure (pipe, ditch, etc.) D S 7--�h
Receiving Stream: 1.1a Rs F- E rJ C azE 1�
Describe the industrial activities that occur within the outfall drainage area: G As TE Sr$aj U .
_'—T-
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
[light, medium, dark) as descriptors: N o Caws--
3, Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.): a o rYa A.-
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 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 � 3 4 5
7. Is there any foam in the stormwater discharge? Yes No
S. Is there an oil sheen in the stormwater discharge? Yes No
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 beindicative of pollutant exposure. These conditions warrant further investigation.
Page 2 of 2
SWU-242, Last modified 10/25/2012

NCDENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Forguidance on filling out this form, please visit. http://portal.ncdenr.org/web/wq/wsbu/nndessw#tab-4
Permit No.: or Certificate of Coverage No.:
Facility Name. GsL-G2-&o
County: G0T-i-F-b2a Phone No. Ll7— Soso
Inspector: 374 L .-y f3 L;
Date of Inspection:
Time of Inspection: I I' t o A,
Total Event Precipitation (inches): O , L S—
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. 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.
j -
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
f obtains approval from the local DWQ Regional Office.
By this signs re, I certify that this reporCi,accurate and complete to the best of my knowledge:
of Pirinittee or Designee)
Page 1-of 2
SWU-242, Last modifed 10/25/2012

1. Outfall Description: tip=
Outfali No. 00 3 Structure (pipe, ditch, etc.)
Receiving Stream: 1�,-OAA- ?•CE-J G!`��E LL
Describe the industrial activities that occur within the outfall drainage area: 54S MT4 C
KF- cz.-Js tr I. Q Ate.
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: N a Cas-o,ti
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.): N o IY3 I`-
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
1 3 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 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 3 4 5
7. is there any foam in the stormwater discharge? Yes No
S. is there an oil sheen in the stormwater discharge? Yes No
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, Gast modified 10/25/2012

NCDENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Forguidance on filling out this form, please visit http://,[portal.ncdenr.oi-g/web/wg /Jw,slsu/nndessw#tab-4
Permit No.: or Certificate of Coverage No.:
Facility Name: G T- L- GR-6o
County: G o s L- R D Phone No, 3 3 6- S'17 - S o o
Inspector: _T-P LA-0 (3 u
Date of Inspection: t j j 6
Time of Inspection: 11 ' Li S, AM_ _
Total Event Precipitation (inches): 0 . 'L S
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
(See information below.)
D-fe—s-�
❑ No
Please verify whether Qualitative Monitoring must be pet formed during a "representative storm
event" or ineasureable 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, [ certify that tlu art is accurate and complete to the best of my knowledge:
mittee or Designee)
Page 1 of 2
SWU-242, Last modified 10/25/2012

1. Outfall Description:
0utfall No. O o `f Structure (pipe, ditch, etc.) p' Tc- t
Receiving Stream: k7S7�? A-0 F PE 4 C. o-e l- tL _
Describe the industrial activities that occur within the outfall drainage area: 5 IA-T: P Pr- Oj V j
9,ites.Fj1. 0 Q
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: N o Co w 0--
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.): N o o D p ti
4. CIarity: Choose the number which best describes -the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
2 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:
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,
1 2 3 4 5
7. Is there any foam in the storinwater discharge? Yes No
8. Is there an oil sheen in the stormwater discharge? Yes No
9. Is there:evidence of erosion or deposition at the outfall? Yes No
10. Other Obvious Indicators of Stormwater Pollution:
List and describe
f
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposi!tion
may be indicative of pollutant exposure. These conditions warrant further investigation.
Page 2 of 2
SWU-242, Last modified 10/25/2012

ly
I�CDENR
Stormwater Discharge Outfall%(SDO)
Qualitative Monitoring Report .
Forguidance on filling out this form, please visit: httn://portal.ncdenr.org_/web/wofws/su/iipdessw#tab-4
Permit No.: or Certificate of Coverage No.:
Facility dame: G z. c- G A 240 _
County: G o Z L- i=_0 fL o Phone No.
Inspector: _ 3--o LA-0 13 0
Date of inspection: i i j Lf _
Time of Inspection: 1 tD A#,,
Total Event Precipitation (inches): O. 7-r
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
(See information below.)
ff-Yes ❑ No
Please verify whether Qualitative Monitoring must be per formed 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.
i
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
s interval is representative for local storm events during the sampling period, and the permittee
obtains approval from the local DWQ Regional Office.
By this sign4ure, l certify that t us rep curate and complete to the best of my knowledge:
(Signatute of P4mittee or
Page 1 of 2
SwU-242, last modified 10/25/2012

1. Outfall Description:
Outfall No. 00 ZT- Structure (pipe, ditch, etc.) OV--G��
Receiving Stream: 1� As i< Psi— C tL - - -
Describe the industrial activities that occur within the outfall drainage area:
p Pr A- V-X to t,
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: ni b Czt-a^-
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.): . N3y 0 a /*--
4. Clarity: Choose the number which hest describes the,clarity of the discharge, where 1 is
clear and 5 is very cloudy:
2 3 4 5
5. Floating Solids: Choose the number which best describes the amount of floating solids in
the stormwater discharge, where 1 is no solids and 5 is the surface covered with floating solids:
G2 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:
0 2 3 4 5
7. Is there any foam in the stormwater discharge? Yes
oNo
a. Is there an oil sheen in the stormwater discharge? Yes
No
9. is there of erosion or deposition the
Yes
evidence at outfall?
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
5WU-242, Last modified 10/25/2012

NCDENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance on filling out th isform, please visit: htC:j/portalmcdenr.org/webjwgjwsfsujnpdessw#tab-4
Permit No.: or Certificate of Coverage No,:
Facility Name: GT L-G (LG.o
County: G u T- +— F-0 C2 D Phone No.
Inspector: 3 -0 LA-0 is
Date of Inspection: t 6 '
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.)
❑ 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 Jr
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 "ineasurable 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 Re
1 Office.
By this signature, I certify that this report is accurate and complete to the best of my knowledge:
(Signature, of Permittee or Designee)
Pagel of 2
SWU-242, fast modified 10/25/2012

1. Outfall Description.,
Outfall No. (DO (-> Structure (pipe, ditch, etc.) pLTc-k,�'
Receiving Stream: 14 an -SE ? Jr� A-E-Z-kZ—
Describe the industrial activities that occur within the outfall drainage area:
Q A-ru t&,r- #J L
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: N'3 CzL.aYL-
3, Odor; Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.): . N 6 D"V% -
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is
ciear and 5 is very cloudy:
0' 2 3 4 5
5, Floating Solids: Choose the number which best describes the amount of floating solids in
the stormwater discharge, where 1is no solids and 5 is the surface covered with floating solids:
(31 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:
Z 3 4 5
7. Is there any foam in the stormwater discharge? Yes a
8. Is there an oil sheen in the stormwater discharge? Yes No
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.
Page 2 of 2
5WU-242, last modified 10/25/2012

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No. NCG030000
Date submitted
CERTIFICATE OF COVERAGE NO. NCG030056
FACILITY NAME Gilbarco Inc
COUNTY Guilford
PERSON COLLECTING SAMPLES John Burke
LABORATORY R&A Labs Lab Cert. # 34
Comments on sample. collection or analysis:
Part A: Stormwater Benchmarks and Monitoring Results
6/3/14
SAMPLE COLLECTION YEAR _2014
SAMPLE PERIOD ® Jan -June ® July -Dec
or ❑ Monthly" (month)
REJC3 g^D�ISCCHAARGIING TO CLASS ❑ORW ❑HQW [:]Trout❑PNA
IICC ❑Zero -flow ®Water Supply ❑SA
JUN 0 9 2014 ❑Other
CENTRAL FILES PLEASE REMEMBER TO SIGN ON PAGES 2 AND/OR 3 4
DWQIBOG
❑ No discharge this period?Z
Non -Polar O&G/Total
Outfall No.
Date Sample
i-
24-hour rainfall
Total Suspended Solids
pH,
Copper
Lead
Zinc
Total Petroleum
Toxic
Collected
amount,
Standard units
Hydrocarbons
Organics'
(mo/dd/yr)
Inches3
Benchmarks =__>
_.
-
100 mg/L or 50 mg/L4
6.0 — 9.0
0.007 mg/L
0.03 mg/L
0.067 mg/L
15 mg/L
i mg/L
outfall 001
5/15/14
1 0.45
25 mg/L
6.60
1 0.012 mg/L
<0.005 mg/L
0.087 mg/L
<5.00 mg/L
SMP
Outfall 002
5/15/14
1 0.45
20 mg/I
6.38
0.012 mg/I
<0.005 mg/L
0.120 mg/I
<5.00 mg/L
SMP
Outfall 003
5/15/14
1 0.45
24 mg/I
6.04
0.008 mg/I
<0.005 mg/L
0.124 mg/I
<5.00 mg/L
SMP
' Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
2 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, Table 3 identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
5 Total Toxic Organics sampling is applicable only for those facilities which perform metal finishing operations, manufacture semiconductors, manufacture
electronic crystals, or.manufacture cathode ray tubes. For purposes of this permit the definition of Total Toxic Organics is that definition contained in the EPA
Effluent Guidelines for the facility subject to the requirement to sample (for metal finishing use the definition as found in 40 CFR 433.11; for semiconductor
manufacture use the definition as found in 40 CFR 469.12; for electronic crystal manufacture use the definition as found in 40 CFR 469.22; and for cathode ray
tube manufacture use the definition found in 40 CFR 469,31).
Permit Date: 11/1/2012-10/31/2017 SWU-245, last revised 10/25/2012
Page 1 of 3

Facilities that incorporate a solvent management plan into the Stormwater Pollution Prevention Plan may so certify, and the requirement for TTO monitoring
may be waived. The solvent management plan shall include a list of the total toxic organic compounds used and the other elements listed in the General
Permit. For those facilities electing to employ the TTO monitoring waiver, the discharger shall sign the following certification statement:
"Based upon my inquiry of the person or persons directly responsible for managing compliance with the permit monitoring requirement for. total toxic organics
(TTO), I certify that to the best of my knowledge and belief, no dumping of concentrated toxic organics into the stormwater or areas which are exposed to rainfall or
stormwater runoff has occurred since filing the last discharge monitoring report. I further certify that this facility is implementing the all the provisions of the
solvent management plan included in the Stormwater Pollution Prevention Plan."
Mario lannantuono
Name (Print name)
Vice President of North American Operations
Title Print title}
(Signature) ( Date)
Note: Results must be reported in numerical format. 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 re orted in the format "<XX m L" where XX is the numerical value of the detection
limit, reporting limit, etc. in mg/L.
Note: If you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses. See General Permit text.
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month.
❑ No discharge this period?'
Outfall No.
Date Sample
1
Collected
(mo/dd/yr)
24-hour rainfall
amount,
Inches3
Non -polar O&G/TPH by
EPA 1664 (SGT-HEM)
Total Suspended Solids
pH
Benchmarks
15 mg/L
100 mg/L or 50 mg/L* •
6.0 — 9.0 SU
Footnotes from Part A also apply to this Part B
* See General Permit text, Table 5, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Permit Date: 11/1/2012-10/31/2017 SWU-245, last revised 10/25/2012
Page 2 of 3

nlrte: !f 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 a.
• 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 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 Permittee)
4 � f
(Date)
Permit Date:11/1/2012-10/31/2017
SWU-245, last revised 10/25/2012
Page 3 of 3

Gilbarco, Inc.
7300 W. Friendly Avenue
Greensboro, NC 27410
Attention: John Burke / AP
Pon Office Box 473
J(
P]
S�
FIT
0:
Le
T(
(F
Karnawvila, North Cure 27284 23 May 2014
RESEARch & AWAlyTICA
LAbomoF IEs, INc.
UWWOM No. 4 7 0
TERMS: NET 30
"PAST DUE INVOICES ACCRUE
INTEREST AT 1 '/s % INTEREST PER
MONTH UNTIL PAID
SHOULD COLLECTION BE REQUIRED,
CUSTOMER AGREES TO PAY
ALL EXPENSES INCURRED INCLUDING
ATTORNEY'S FEES"
RE:
Phone: [phone]

,�i�t U Itll�f•I
�
RESEARCh & ANAlyTICAI ~%���!&.
LABORATORIES/ INC. = �`j'
.. ACT : Q� � • . FS7 �
sir" NC#34 o.chw
Analytical/Process Consultations
VP
Gi!ta ro,_ Gatc Sample Collected 05/15/14
7300 West Friendly Avenue Date Sample Received 05/15/14
Greensboro, NC 27410 Date Sample Analyzed 05/15/14
Attn: John Burke Date of Report : 05/22/14
Analyses Performed by YJ -JB -AA
Lab Sample Number Lab Sample Number Lab Sample Number
-------------------- ----------------•--- --------------------
785500 785501 785502
Parameter Storet # Results Results Results
TSS (00530) 25.0 mg/l 20.0 mg/L 24.0 mg/L
Oil & Grease (00556) <5.0 mg/L <5.0 mg/( <5.0 mg/L
2inc,Tot (01092) 0.087 mg/L 0.120 mg/l 0.124 mg/L
Lead,Tot (01051) <0.005 mg/t <0.005 mg/t <0.005 mg/L
Copper,Tot---,. (01042) 0.012 mg/t 0.012 mg/L 0.008 mg/l
Clients Sample Source OUTFALL 001 OUTFALL 002 OUTFALL 003
Number
Time Collected (Errs) 1040 1030 1025
P.O. Box 473 • 106 Short Street • Kernersville, North Carolina 27284 • 336-996-2841 • Fax [phone]
www.randalabs.com

RESEARCh -& ANALyTICA[
LAbORATWES, . INC.
Analytical -/ Process Consultations
Phone [phone]
CHAIN OF CUSTODY RECORD
WATER! WASTEWATER MISC.
COMPANY �.� po- �
JOB NO. O 9, t .5' I l
o
LL
0
z
m gyp, O'
=?��I0}�O
0 S `Pj Q p Q 0 C7 C7G Q
o� F Q, 0 Q' q. q. g°
tiv ti �`� ti y �v v ^� ^� yvm REQUESTED ANALYSIS
STREET ADDRESS �'
-73vo V t5-v' � NOS
PROJECTS
y 1�Y�
CITY, STATE, ZIP n
G�E14s (3V-a Pic, % t�
SAMP ER' rAM, E (PLEASE PRINK
fl �T�1. n u f1.�1�
Sj
CONTACT R }� �� PHONE
�Dw Ga '{r'�"
SAMP R SI
SAMPLE NUMBER
(LAB USE ONLY)
DATE
TIME
COMP
GRAB
TEMPRES
.0
CI
"Lop"
n ED
11E
M w
SAMPLE LOCATION I I.D.
'
1�!y�
du�-1 o� 1
7•
i
�55a PIS Z ? b
2-
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Wt kk of 3
y
SAVA
RELINQUISHED BY
DATEMME
RECEIVED BY
REMARKS:Sm
SAMPLE TEMPERATURE Rf RECEIPT —5j, °C
RE N UISHED BY
DATEUIME
RECEIVED BY
4

NCDENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Forguidance on filling out this form, please visit: h rtal.nc enr.or web w w u n des w Ca -4
Permit No.: or Certificate of Coverage No.: 0
Facility Name:ASV
County: D Phone -No. 33y- Sq7-
Inspector:
Date of Inspection: 151 1A
Time of Inspection: I o ! SS
Total Event Precipitation (inches): "1 S
Was this a "Representative.Storm Event" or "Measureable Storm Event" as defined by the permit?
{See infarr Jtion below.)
es ❑ No
Please verify whether Qualitative Monitoring mast be per formed during a "representative storm
event" or "rneasureable 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 froin the local DWQ Regional Office.
By this sig-Vt-iire, I certify tha�hts-art is accurate and complete to the best of my knowledge:
(Signature 4Permittee or Designer..)
Page 1 of 2
SWU-242, Last modified 10/25/2012

1. Outfall Description:
Outfall No. Structure-(pi�e, ditch, etc.) h
Receiving Stream: tom'^-sr-�- Af-) Gfz'/iL
Describe the industrial activities that occur within the outfall drainage area:
2. Color: Describe the color of the discharge using basic colors (red, browfi, blue, etc.) and tint
(light, medium, dark) as descriptors: NO CzL-0-f— - all TT,,'(-
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly -of oil,
weals chlorine odor, etc.): 1W-V'rz--
4. CIarity: Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy. 7.9
/ 1'/ 2 3 4 S
5. Floating Solids: Choose the number which best describes the amount of floating solids in
the stormwater discharge, where I is no solids and 5 is the surface covered with floating solids:
[ IJ 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:
1 2 3 4 5
7, Is there any foam in the stormwater discharge? Yes Na
8. Is there an oil sheen in the stormwater discharge? Yes o
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 madiFed 10/25/2012

Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance on filing out this form, please visit: h i'tal.iicdeni-.or we w w su i3 de swHta -4
Permit No.: 0/ e/ or Certificate of Coverage No.:
Facility Name: C7LL-GAA�CoV
County: Phone No. 33 L- Sq7-• S'v
Inspector- MV 1c L4--�
Date of Inspection: 1-4
Time of Inspection: L 0 -
Total Event Precipitation (inches): D • `'t :S
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
{See info
aation below.)
Yes ❑ No
Please verify whether Qualitative Monitoring must be per formed 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 "ineasurable 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-lour 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 sig at this report is acc. crate and complete to the best of my Imowledge:
(Signatur of P�ermittee or Designed.)
Page Z of 2
SWU-242, Lastmodified 10/25/2012

1. Outfall Description:
Outfall No. 00l Structure (pipe, ditch
Receiving Stream: L C.
Describe the industrial activities that occur within the outfall drainage area:
ScN4V rrie� 5 M-46--F. Fez- u°K a*f G.¢ s s IJS fit
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: Nj� Wub LT- bvk' 7`P--oi`
3. Odor: ' Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weals chlorine odor, etc.):
4. Clarity: Choose the number which best describes the clarity of the discharge, where I is
clear and 5 is very cloudy:
1 2 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.
J 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:
1_ 2 0 4 5
7. Is there any foam in the stormwater discharge? Yes No
S. Is there an oil sheen in the stormwater discharge? Yes No
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
5WU-242, Last mcdMed 10/25/2012

4\ a
cR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Forgrridanceonfllingout thisform,pleasevisit. http://porta[.ncdenr.org/webjwq/w5/su/npdessw#tab-4
Permit No.: or Certificate of Coverage No.:
Facility Name: GaZLAAA-GO
County: _G�L�Con-D Phone -No.
Inspector: �"v *� (!>vA-t.-Z
Date of Inspection: nFid5. i A
Time of Inspection: 10 ' LS
Total Event Precipitation (inches): 011-�7_
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
(See inf rnation below.)
es ❑ No
Please verify whether Qualitative Monitoring must be pet formed 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 dining 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 0A 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 tnay contain up to 10 consecutive hours of no
precipitation.
A "treasurable 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 DW(
oval Office.
By tis signature, I certify that this report is accurate and complete to the best of my knowledge:
(Sifinkture of Permittee or Designed)
Pagel of 2
SWU-242, f,astmodirsed 10/25/2012

1. Outfall Description:
Outfali No. 003 Structure (pipe, ditch, etc.) 0zlzi+
Receiving Stream:
Describe the industrial activities that occur within the outfall drainage area:
i
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: IJ
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.): IL/
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
1 1.11
1 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:
@ X 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 j2J 3 4 5
7. Is there any foam in the stormwater discharge? Yes No
S. Is there an oil sheen in the stortnwater discharge? Yes LNo)
9. Is there evidence of erosion or deposition at the outfall? Yes No
10. Other Obvious Indicators of Stortnwater Pollution:
List and describe
Note: Low clarity, High solids, and/or the presence of foam, oil sheen, or erasion/deposition
may be indicative of pollutant exposure. These conditions warrant further investigation.
Page 2 of 2
SM-242, i,ast modified 10/25/2012

CDR
Stormwater Discharge Outfalt(SDO)-
Qualitative Monitoring Report
For guidance on filling out this form, please visit: http:/Iportal.ncdennorg/web/wq/ws/su/npdessw#tab-4
Permit No.: N/C/ A/2/ j/ or Certificate of Coverage No.:
Facility Name: _(!,L AA-40 -
County: 6-r-L-C 0 A-D� Phone -No. -__ 3:3 L -- 5417- Sb u-,Lj
Inspector:
Date of Inspection. S
Time of Inspection:
A_ c _z= _
Total Event Precipitation (inches): Q l N J
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
{See info anon below.)
es ❑ No
Please verify whether Qualitative Monitoring must be performed during a "representative storm_
event"or "measureablestorm event" Creguirementsvary, 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 DWG
onal Office.
By this sigh ature, I certify that tjjjLL=W is accurate and complete to the best of my knowledge:
(SignatLire oV.Permittee or Designed)
Pagel of 2
SWU-242, Last modified 10/2S/2012

1. Outfall Description;
Outfall No. 6 0 Structure (pipe, ditch, etc.) pr114A'
Receiving Stream: 1,;Ir+M;SV- P 6N44,4
Describe the industrial activities that occur within the outfall drainage area:
rn a4v-� ST'6' j j G ass s,-V-ALC s 4W ns4ib -. U J 20-o,F
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: ND C-D(.a.'— L--6 %A--i i�-+�
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.): N
4. Clarity: Choose the numberwhich best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
1 � 3 4 5
5. Floating Solids: Choose the number which best describes the amount of floating solids in
the stormwater discharge, where 1 is no solids and 5 is the surface covered with floating solids:
D 2 3 4 5
b. 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 o
8. Is there an oil sheen in the stormwater discharge? Yes No
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 10/25/2012

A LPIW4
71 "'A
DEN
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Forguidance on filling out this form, please visit: htt rta higdenr.or w w w uncle w#tab- 4
Permit No.: N/C/ or Certificate of Coverage No.: N/C/G/ °/ 1/ C'/ -5!/
Facility Name: %LL-GAA4,0
County: tom. r_L✓CaA_D Phone -No. 3:36- S47-
Inspector: -I-b
Date of Inspection:
Time of Inspection:
n-L-n.
D a C-__
Total Event Precipitation (inches): DII
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
(See infar nation below.)
es ❑ No
Please verify whether Qualitative Monitoring must be per formed during a "representative storm
event"or "measureable storm event" Crequirernents 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.
}F .
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 feast 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 ` 1ify that this report is accurate and complete to the best of my knowledge:
(Sig late e of Permittee or Designer.)
Page 1 of 2
5WU-242, Lastmodif:ed 10/25J2012

1. Outfall Description:'r
Outfall No. OO.S Structure (pipe, ditch, etc.)'
Receiving Stream: 1h� "��'- � "' CJVC' G
Describe the industrial activities that occur within the outfall drainage area:
G fzN- p,q�,� 6
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors:
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.): _ ~r-
4. CIarity. Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy.
1 2 3 4 5
5, Floating Solids: Choose the number which best describes the amount of floating solids in
the stormwater discharge, where 1 is no solids and 5 is the surface covered with floating solids-
1 2 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 2 3 4 5
7. Is there any foam in the stormwater discharge? Yes I o
B. Is there an oil sheet) in the stormwater discharge? Yes No
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 madi6ed 10/25/2012

46 I'V
CR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For -,guidance on filling out this form, please visit: htt ortal.n nr.or w w w u hi p des w#tab- 4
Permit No.: N/.Cl/�/l °l 3 l 0/ or Certificate of Coverage No.: N/C/G/ a/ /"//
Facility Name: Gz1AA&fe0
County:y-r_ -f a=A-J� Phone -No. 33 L - Sq 7- S• r,-zl
Inspector: _'vtk-*j Quf'•-v_--
Date of lnsoection: S ff- l-i
Time of Inspection:
Ll
Total Event Precipitation (inches): D,
Was this a " presentative Storm Event" or "Measureable Storm Event" as defined by the permit?
(See info atian below.)
Yes ❑ No
Please verify whether Qualitative Monitoring must be performed during a "representative storm
even t"or "measureablestorm 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 storin 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 sign�twze,_[ certify that this report is accurate and complete to the best of my knowledge;
(Sign*ure of kermittee or
Page 1 of 2
SWU-242, Lastmodl0ed 10/25/2012

1. Outfall Description:}
Outfall No. . DO (oStructure (pipe, ditch; etc.) n G
Receiving Stream: _ ]-� "s�z' "� C-r'A`--
Describe tlae industrial activities that occur within the outfall drainage area:
2. Coior: Describe the color of the discharge using basic colors (red, bt:own, blue, etc.) and tint
(light, medium, dark) as descriptors:
3. Odor: Describe any distinct odors that the discharge may have f i.e., smells strongly of oil,
weals chlorine odor, etc.): n%ff-W rL 1
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 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:
2 3 4 5
6. Suspended Solids: Choose the number which best describes the amount of suspended
solids in the stormwater discharg ,where 1 is no solids and S is extremely muddy:
2 3 4 5
7. Is there any foam in the stormwater discharge? Yes
No
S. Is there an oil sheen in the stormwater discharge? Yes
No
9. Is there evidence of erosion or deposition at the outfall?
Yes oNo
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
5WU-242, fast modified 10/25/2012