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Home My WebLink AboutNCG100170_MONITORING INFO_20170724STORMWATER DIVISION CODING SHEET NCG PERMITS PERMIT NO. /V J l 7 DOC TYPE ❑HISTORICAL FILE C� MONITORING REPORTS DOC DATE ❑ a�� U�a! YYYYMMDD r•! Mid Atlantic Engincaring 8 Em�ironmcntal Solutions July 17, 2017 409 Rogcn View Cotxt Rz-c:gh, NC 77610 cffwc 919 M-991 a (2"knIc 919 250 9950 MAAONLINE COM RECEIVED NCDEQ/DWR Attention: Central Files JUL 2 4 2011 1617 Mail Service Center CENTRAL FILES Raleigh, North Carolina 27699-1617 DWR SECTION Subject: STORMWATER SAMPLING RESULTS CRUTCHFIELD MOBILE CRUSHER 1911 .LtS . _W 70 MErsANE, NORTH CAROLINA 27302 NPDES PERMIT NO. NCG100170 To Whom It May Concern: Attached please find the Stormwater Discharge Monitoring Report (DMR) and analytical report for the sampling conducted at the above -referenced site. A stormwater sample was collected from Outfalls 001 and 002 on June 21, 2017 and analyzed for total suspended solids (TSS, Outfall 001 only), pH, total recoverable lead, oil and grease and ethylene glycol. Please note that the TSS sample for Outfall 002 was inadvertently not submitted to the lab for analysis; TSS monitoring will be continued at each outfall location during the upcoming sampling period (July -December 2017). As summarized on the attached DMR, all parameters were reported below or within their respective benchmark values for the current monitoring period. If you have any questions or need additional information, please contact me at 919-250-9918. Sincerely, MID -ATLANTIC ASSOCIATES, INC. Ron J. Davis Stormwater Services Manager Attachment: Stormwater Discharge Outfall Monitoring Report Laboratory Analytical Report EXPERIENCED CUSTOMER FOCUSED ININOVATNt STORMWATER DISCHARGE OUTFALL (SDO) MONITORING REPORT CERTIFICATE OF COVERAGE NO. NCG100170 FACILITY NAME Crutchfield Mobile Crusher, Mebane, NC PERSON COLLECTING SAMPLE(S) Edd Marsh CERTIFIED LABORATORY(S) Pace Analytical Lab # 12 Lab # Part A: Stormwater Benchmarks and Monitoring Results SAMPLES COLLECTED DURING CALENDAR YEAR: 2017 (This monitoring report shall be received by the Division no later than 30 days from the date the facility receives the sampling results from the laboratory.) COUNTY Alamance PHONE NO. (919) 369-2752 PLEASE REMEMBER TO SIGN ON THE REVERSE 4 For sampling periods with no discharge, you must submit this discharge monitoring form noting "No Flow" or "No Discharge" within 30 days of the end of that period to comply with permit reporting requirements. Outfall No. Date Sample Collected, mo/dd/year Total Rainfall, inches 00400 00530 - - - - 77023 01051 78141 pH, Standard Units Total Suspended Solids (TSS), mg/L Non -polar O&G/TPH (Method 1664 SGT-HEM), mg/L Ethylene Glycol, mg/L Lead, Total Recoverable, mg/L Total Toxic Organics3, mg/L Benchmark - - 6.0 — 9.01 100/50Z 15 8,000 (Tiers 2 and 3) 0.03 1.0 Outfall001 06/21/17 1 0.48 44.5 <5.0 <5.0 <0.005 NA Outfall002 06/21/17 0.48 NA <5.0 <5.0 0.0064 NA Note: If you report a sampled value in excess of the benchmark value, or outside the benchmark range for pH, you must implement Tier 1 or Tier 2 responses in the General Permit. 1See If pH values outside this range are recorded in sampled stormwater discharges, but ambient precipitation pH levels are lower, then the lower threshold of this benchmark range is the pH of the precipitation (within instrument accuracy) instead of 6 S.U. Readings from an on -site or local rain gauge (or local precipitation data) must be documented to demonstrate background concentrations were below the benchmark pH range of 6-9. 2See General Permit text to identify whether the more protective benchmark applies for especially sensitive receiving waters. Form SW U-251, lost revised October 25, 2012 Page 1 of 2 STORMWATER DISCHARGE OUTFALL (SDO) MONITORING REPORT 3For purposes of this permit the definition of Total Toxic Organics is that list as stated in Appendix D, Table II of Chapter 40 Code of Federal Regulations (CFR) Part 122. Facilities that incorporate a solvent management plan into the Stormwater Pollution Prevention Plan may request that DWQ waive monitoring of total toxic organics. 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 allowed such a waiver, the discharger shall sign the following certification statement: Solvent Management Plan 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 all the provisions of the solvent management plan included in the Stormwater Pollution Prevention Plan." Name (Print name) Title (Print title) Signature Mail Original and one copy to: Division of Water Quality Attn: Central Files 1617 MailServiceCenter Raleigh, North Carolina27699-1617 Date "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 gatherirlg the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete am aware that there are signif nt pen s for sub ' ing false information, including the possibility of fines and imprisonment for knowing violations." (Signature of Permittee or Designee) (Date) Form SWU-251, last revised October 25, 2012 Page 2 of 2 s aceArralytical seam Pace Analytical Services, LLC 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 July 06, 2017 Chuck Hoffman Mid -Atlantic Associates, Inc 409 Rogers View Court Raleigh, NC 27610 RE: Project: Crutchfield Mobile Crusher Pace Project No.: 92345050 Dear Chuck Hoffman: Enclosed are the analytical results for sample(s) received by the laboratory on June 21, 2017. The results relate only to the samples included in this report. Results reported herein conform to the most current, applicable TNIINELAC standards and the laboratory's Quality Assurance Manual, where applicable, unless otherwise noted in the body of the report. If you have any questions concerning this report, please feel free to contact me. Sincerely, Nicole Gasiorowski nicole.gasiorowski@pacelabs.com (704)875-9092 Project Manager Enclosures cc: Ron Davis. Mid Atlantic Associatees. Inc. pCCR�rO r l9eORAI, REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, without the written consent of Pace Analytical Services, LLC. Page 1 of 14 aceAnalyficals www4uoawmcom Pace Analytical Services, LLC 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 CERTIFICATIONS Project: Crutchfield Mobile Crusher Pace Project No.: 92345050 Indiana Certification IDs 7726 Moller Road, Indianapolis, IN 46268 Ohio VAP Certification #: CL-0065 Illinois Certification #: 003971 Oklahoma Certification #: 2016-075 Indiana Certification #: C-49-06 Texas Certification #: T104704355-16-10 Kansas/NELAP Certification #:E-10177 West Virginia Certification #: 330 Kentucky UST Certification #: 80226 Wisconsin Certification #: 999788130 Kentucky WW Certification #:98019 USDA Soil Permit #: P330-16-00257 Charlotte Certification IDs 9800 KinceyAve. Ste 100, Huntersville, NC 28078 South Carolina Certification #: 99006001 North Carolina Drinking Water Certification #: 37706 Florida/NELAP Certification #: E87627 North Carolina Field Services Certification #: 5342 Kentucky UST Certification #: 84 North Carolina Wastewater Certification #: 12 VirginialVELAP Certification #: 460221 Asheville Certification IDs 2225 Riverside Drive, Asheville, NC 28804 Florida/NELAP Certification #: E87648 Massachusetts Certification #: M-NC030 North Carolina Drinking Water Certification #: 37712 North Carolina Wastewater Certification #: 40 South Carolina Certification #: 99030001 Virginia/VELAP Certification #: 460222 REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, without the written consent of Pace Analytical Services, LLC. Page 2 of 14 aceAnalytical *WW4KWebd)&C0M Pace Analytical Services, LLC 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 SAMPLE ANALYTE COUNT Project: Pace Project No.: Crutchfield Mobile Crusher 92345050 Analytes Lab ID Sample ID Method Analysts Reported Laboratory 92345050001 Outfall No. 1 EPA 1664E JMS 1 PASI-C EPA 8015 Alcohol -Glycol BJW 1 PASI-I EPA6010 SH1 1 PASI-A SM 2540D CJH1 1 PASI-A 92345050002 Outfall No. 2 EPA 1664E JMS 1 PASI-C EPA 8015AIcohol-Glycol BJW 1 PASI-I EPA6010 SH1 1 PASI-A REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in Full, without the written consent of Pace Analytical Services, LLC. Page 3 of 14 %%ceanaryacar' Pace Analytical Services, LLC 9800 KinceyAve. Suite 100 Huntersville, NC 28078 (704)875-9092 F-11 ki 1-11 WA I RTA 0N*11111*1 Project: Crutchfield Mobile Crusher Pace Project No.: 92345050 Sample: Outfall No. 1 Lab ID: 92345050001 Collected: 06/20/17 09:15 Received: 06/21/17 09:04 Matrix: Water Parameters Results Units Report Limit DF Prepared Analyzed CAS No. Qual 1664 SGT-HEM, TPH Analytical Method: EPA 1664B Total Petroleum Hydrocarbons ND mg1L 5.0 1 06/23/17 06:44 8015M Glycols in water Analytical Method: EPA 8015 Alcohol -Glycol Ethylene glycol ND mg1L 5.0 1 06/23/17 12:51 107-21-1 6010 MET ICP Analytical Method: EPA 6010 Preparation Method: EPA 3010A Lead ND uglL 5.0 1 06/22/17 16:40 07/02/17 23:40 7439-92-1 2540D Total Suspended Solids Analytical Method: SM 2540D Total Suspended Solids 44.5 mg1L 4.2 1 06/23/17 03:48 REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, Date: 07/06/2017 03:04 PM without the written consent of Pace Analytical Services, LLC. Page 4 of 14 aceAnalylicals r. J1-' da6s.mm Pace Analytical Services, LLC 9800 KinceyAve. Suite 100 Huntersville, NC 28078 (704)875-9092 ANALYTICAL RESULTS Project: Crutchfield Mobile Crusher Pace Project No.: 92345050 Sample: Outfall No. 2 Lab ID: 92345050002 Collected: 06/20/17 09:15 Received: 06/21/17 09:04 Matrix: Water Parameters Results Units Report Limit DF Prepared Analyzed CAS No. Qual 1664 SGT-HEM, TPH Analytical Method: EPA 1664B Total Petroleum Hydrocarbons ND mg1L 5.0 1 06/23/17 06:45 8015M Glycols in water Analytical Method: EPA 8015 Alcohol -Glycol Ethylene glycol ND mg1L 5.0 1 06/23/17 13:00 107-21-1 6010 MET ICP Analytical Method: EPA 6010 Preparation Method: EPA 3010A Lead 6.4 ug1L 5.0 1 06/22/17 16:40 07/02/17 23:43 7439-92-1 REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, Date: 07/06/2017 03:04 PM without the written consent of Pace Analytical Services, LLC. Page 5 of 14 aceARalyfical www.paasfabs.c= Pace Analytical Services, LLC 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 QUALITY CONTROL DATA Project: Crutchfield Mobile Crusher Pace Project No.: 92345050 QC Batch: 366181 Analysis Method: EPA 1664B QC Batch Method: EPA 1664B Analysis Description: 1664 SGT-HEM, TPH Associated Lab Samples: 92345050001, 92345050002 METHOD BLANK: 2029870 Matrix: Water Associated Lab Samples: 92345050001, 92345050002 Blank Reporting Parameter Units Result Limit Analyzed Qualifiers Total Petroleum Hydrocarbons mglL ND 5.0 06/23/17 06:32 LABORATORY CONTROL SAMPLE: 2029871 Spike LCS LCS % Rec Parameter Units Conc. Result % Rec Limits Qualifiers Total Petroleum Hydrocarbons mg1L 20 19.5 98 64-132 MATRIX SPIKE SAMPLE: 2029872 92345060001 Spike MS MS % Rec Parameter Units Result Conc. Result % Rec Limits Qualifiers Total Petroleum Hydrocarbons mglL ND 20 19.7 98 64-132 Results presented on this page are in the units Indicated by the "Units" column except where an alternate unit is presented to the right of the result. REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, Date: 07/06/2017 03:04 PM without the written consent of Pace Analytical Services, LLC. Page 6 of 14 aceAnalytical" trmo4aoe11 am Pace Analytical Services, LLC 9800 Kincey Ave. Suite 10C Huntersville, NC 28078 (704)875-9092 QUALITY CONTROL DATA Project: Crutchfield Mobile Crusher Pace Project No.: 92345050 QC Batch: 393768 Analysis Method: EPA 8015 Alcohol -Glycol QC Batch Method: EPA 8015 Alcohol -Glycol Analysis Description: EPA 8015 Modified Associated Lab Samples: 92345050001, 92345050002 METHOD BLANK: 1815337 Matrix: Water Associated Lab Samples: 92345050001, 92345050002 Blank Reporting Parameter Units Result Limit Analyzed Qualifiers Ethylene glycol mglL ND 5.0 06/23/17 12:05 LABORATORY CONTROL SAMPLE: 1815338 Spike LCS LCS % Rec Parameter Units Conc. Result % Rec Limits Qualifiers Ethylene glycol mg1L 25 18.0 72 41-162 MATRIX SPIKE & MATRIX SPIKE DUPLICATE: 1815339 1815340 MS MSD 92344945001 Spike Spike MS MSD MS MSD % Rec Parameter Units Result Conc. Conc. Result Result % Rec % Rec Limits RPD Qual Ethylene glycol mglL ND 25 25 21.4 22.2 81 84 20-172 4 Results presented on this page are In the units indicated by the "Units" column except where an alternate unit is presented to the right of the result. REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, Date: 07/06/2017 03:04 PM without the written consent of Pace Analytical Services, LLC. Page 7 of 14 laceAnalyfical* www4mcdabs.cm+ Pace Analytical Services, LLC 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 QUALITY CONTROL DATA Project: Crutchfield Mobile Crusher Pace Project No.: 92345050 QC Batch: 365947 Analysis Method: EPA 6010 QC Batch Method: EPA 3010A Analysis Description: 6010 MET Associated Lab Samples: 92345050001, 92345050002 METHOD BLANK: 2028740 Matrix: Water Associated Lab Samples: 92345050001, 92345050002 Blank Reporting Parameter Units Result Limit Analyzed Qualifiers Lead uglL ND 5.0 07/02/17 23:03 LABORATORY CONTROL SAMPLE: 2028741 Spike LCS LCS % Rec Parameter Units Conc. Result % Rec Limits Qualifiers Lead ug/L 500 516 103 80-120 MATRIX SPIKE & MATRIX SPIKE DUPLICATE: 2028742 2028743 MS MSD 92345013001 Spike Spike MS MSD MS MSD % Rec Parameter Units Result Conc. Conc. Result Result % Rec % Rec Limits RPD Qual Lead ug/L ND 500 500 506 501 101 100 75-125 1 Results presented on this page are In the units indicated by the "Units" column except where an alternate unit is presonted to the right of the result. REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, Date: 07/06/2017 03:04 PM without the written consent of Pace Analytical Services, LLC. Page 8 of 14 ace Analytical www.paaefabacom Pace Analytical Services, LLC 9800 KinceyAve. Suite 100 t{untersville, NC 28078 (704)875-9092 Project: Crutchfield Mobile Crusher Pace Project No.: 92345050 QC Batch: 366174 QC Batch Method: SM 25400 Associated Lab Samples: 92345050001 METHOD BLANK: 2029863 Associated Lab Samples: 92345050001 Parameter Units Total Suspended Solids mg/L LABORATORY CONTROL SAMPLE: 2029864 Parameter Units Total Suspended Solids mg/L SAMPLE DUPLICATE: 2029865 Parameter Units Total Suspended Solids mg1L QUALITY CONTROL DATA Analysis Method: SM 2540D Analysis Description: 2540D Total Suspended Solids Matrix: Water Blank Reporting Result Limit Analyzed Qualifiers ND 2-5 06/23/17 03:43 Spike LCS LCS % Rec Conc. Result % Rec Limits Qualifiers 250 242 97 90-110 92345001019 Dup Result Result ND ND SAMPLE DUPLICATE: 2029866 92345024002 Dup Parameter Units Result Result Total Suspended Solids mg/L 34.8 36.2 RPD Qualifiers RPD Qualifiers 4 Results presented on this page are in the units indicated by the "Units" column except where an alternate unit is presented to the right of the result. REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, Date: 07/06/2017 03:04 PM without the written consent of Pace Analytical Services, LLC. Page 9 of 14 s aceAnalytica! rrw,ppar Pace Analytical Services, LLC 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 QUALIFIERS Project: Crutchfield Mobile Crusher Pace Project No.: 92345050 DEFINITIONS DF - Dilution Factor, if reported, represents the factor applied to the reported data due to dilution of the sample aliquot. ND - Not Detected at or above adjusted reporting limit. TNTC - Too Numerous To Count J - Estimated concentration above the adjusted method detection limit and below the adjusted reporting limit. MDL-Adjusted Method Detection Limit. PQL - Practical Quantitation Limit. RL- Reporting Limit. S - Surrogate 1,2-Diphenyihydrazine decomposes to and cannot be separated from Azobenzene using Method 8270. The result for each analyte is a combined concentration. Consistent with EPA guidelines, unrounded data are displayed and have been used to calculate % recovery and RPD values. LCS(D) - Laboratory Control Sample (Duplicate) MS(D) - Matrix Spike (Duplicate) DUP - Sample Duplicate RPD - Relative Percent Difference NC - Not Calculable. SG - Silica Gel - Clean -Up U - Indicates the compound was analyzed for, but not detected. Acid preservation may not be appropriate for 2 Chloroethylvinyl ether. A separate vial preserved to a pH of 4-5 is recommended in SW846 Chapter 4 for the analysis of Acrolein and Acrylonitrile by EPA Method 8260. N-Nitrosodiphenylamine decomposes and cannot be separated from Diphenylamine using Method 8270. The result reported for each analyte is a combined concentration. Pace Analytical is TNI accredited. Contact your Pace PM for the current list of accredited analytes. TN -The NELAC institute. LABORATORIES PAS I -A Pace Analytical Services -Asheville PASI-C Pace Analytical Services - Charlotte PASI-I Pace Analytical Services - Indianapolis REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, Date: 07/06/2017 03:04 PM without the written consent of Pace Analytical Services, LLC. Page 10 of 14 aceAnalytrcal rwrr�aoe�a6x.arn Pace Analytical Services, LLC 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 QUALITY CONTROL DATA CROSS REFERENCE TABLE Project: Crutchfield Mobile Crusher Pace Project No.: 92345050 Analytical Lab ID Sample ID QC Batch Method QC Batch Analytical Method Batch 92345050001 Outfall No. 1 EPA 1664E 366181 92345050002 Outfall No. 2 EPA 1664B 366181 92345050001 Outfall No. 1 EPA 8015AIcohol-Glycol 393768 92345050002 Outfall No.2 EPA 8015AIcohol-Glycol 393768 92345050001 Outfall No. 1 EPA 3010A 365947 EPA 6010 92345050002 Outfall No. 2 EPA 3010A 365947 EPA 6010 92345050001 Outfall No. 1 SM 2540D 366174 Date: 07/06/2017 03:04 PM REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, without the written consent of Pace Analytical Services, LLC. 367357 367357 Page 11 of 14 Sample Condition Upon Receipt(SCUR) ! Page 1 of 2 1�' aceAnalytical Document No.: Issuing Authority: ,F-CAR-CS-433-Rev.01 Pace Quality Office Laboratory receiving samples: Asheville ❑ Eden❑ Greenwood ❑ Huntersville Raleigh❑ Mechanicsville❑ • Client Name: ?4, f, ;rV _ Project#: WO# . 92345050 Courier: ^❑Fed Ex ❑UPS Q SPS ❑Client ❑ Commercial ❑Other: 11�ee 92345050 Custody Seal Present? [:]Yeses 4:1,No Seals Intact? ❑Pes 1l,,o Date/Initials Person Examining contents Packing Material: ❑Bubble Wrapubble Bags ❑None ❑Other: Thermome ern yyet ❑61ue ❑Nose •� rip es on ice, cooling process has begun Gun ID: — 1Type o ce: Correction F ctor: Cooler Temp Corrected ('C): r Biological Tissue Frozen? [—]Yes C]1410 []N/A Temp should be abo 4efreezing to 6'C USDA Regulated SoiN/A,water sample) Didsamples riginatequarantine zone within the United States: CA, NY, or SC (check maps)? Did samples originate from a foreign source (internationally, ❑Yes o including Hawaii and Puerto Rico)? ❑Yes No Cam ments/Discrepancy: Chain of Custody Present? Samples Arrived within Hold Time? Short Hold Time Analysis (02 hr.)? Rush Turn Around Time Requested? Sufficient Volume?' Correct Containers Used? -Pace Containers Used? Containers intact? Samples Field Filtered? Sample Labels Match COC? Includes Date/rime/ID/Analysis Matrix: La Ffeadspace in VOA Vials (>5-6mm)? Trip Blank Present? Trip Blank Custody Seals Present? CLIENT NOTIFICATION/RESOLUTION Person Contacted: Commen,a/Sample Discrepancy: Project Manager SCURF Review: Project Manager SRF Review: ❑No UN/A ) 1. ❑No ❑N/A 2. Na ❑N/A 3. 02D, ❑N/A 4. []NO ❑NIA S. ❑No ❑NIA 1 6. es []NO ❑N/A 7. ❑Yes ❑Na /A 8, Note if sediment is visible in the dissolved container . %,,�Y[s ONO ❑N/A 9.`I��`' ❑Yes qVo ❑N/A Date/Time: Field Data Required? ❑Yes ❑No 016-7 _ _ T Date: 1 Date: Note: Whenever there is.a discrepancy affecting North Carolina compliance samples, a copy of this form will be sent to the North Carolina DEHNR Certification Office (i.e. Out of hold, incorrect preservative, out of temp, incorrect containers) Page 12 of 14 Item# BP4U-125 ml Plastic Unpreserved (N/A) (Cl-) BP3U-2S0 mL Plastic Unpreserved (N/A) 8P2U-500 mt. Plastic Unpreserved (N/A) BP1U-1 liter Plastic Unpreserved (N/A) BP3S-250 ml. Plastic H2504 (pH < 2) (CI-) SM-250 mL plastic HNO3 (pH < 2) BP3Z-250 ml Plastic ZN Acetate & NaOH (>9) BP3C-250 ml. Plastic NaOH (pH > 12) (CI-) WGFU-Wide-mouthed Glass jar Unpreserved AGW-1 liter Ambrr Unpreserved (N/A) (Cl.) zz z z AG1H-1 liter Amber HCI (pH < 2) AG3U-250 mL Amber Unpreserved (N/A) (CI-) AG1S-1 liter Amber H2SO4 (pH < 2) AMS-250 mt. Amber 112504 (pH c 2) z__zzzzzz AG3A(DG3A)-250 mLAmber NH4C1 (N/A)ICI-) DG9H-40 mL VOA HCI (N/A) VG9T-40 mL VOA Na2S203 (N/A) VGSU-40 mL VOA U n p (N/A) DG9P-40 mL VOA 1131304 (N/A) VOAK (6 vials per kit)-5035 kit (N/A) V/GK (3 vials per kit)-VPH/Gas kit (N/A) SPST-125 mL Sterile Plastic (N/A — lab) SPIT-2S0 mLSterile Plastic (N/A —lab) BP3A-250 mL Plastic (NH2)2SO4 (9.3.9.7) Cubitainer VSGU-20 mt. 5clntillation vials (N/A) GN ,*'/ CHAIN -OF -CUSTODY 1 Analytical Request Document f ' PaCC4n2lytlCd1 The Chain -of -Custody is a LEGAL DOCUMENT. All relevant fields must be completed accurately. Section A Section B Section C Required Client Information: Required Project Information: Invoice Information: Page: 1 Of 1 Company: Mid Atlantic Associates, Inc Report To: Hallman, Chuck Attention, Atldrass: 409 Ropers view Cl Copy To; Company Name. Rafe' h. NC 27;10 Address: Regulatory Agency Email: Purchase Order n, Pace Quote; Phone; JFax Project Nam% Crutchfield Mooile Crusner Pace Project Manager: rticale. asi0rewski acelDos,Com, State I Location Requested Duo Data: Project IF: Pace Profile 0: 5221 NC Request Ans Es Rhored Y!N � � z KATRIR CODE S COLLECTED Preservatives >' thmkinn Wala OW Warm WT g $ Cj Ws1. Watw WW w Z P'".0 P SAMPLE ID aeluaatm S� START END t- ow One Character per boa, v+a• W .. w - � >_ W 61 _ lik61nn (A•2, e•fi! , -j AP OT m _ Sample Ida must be unique T... IS 8 +3 z ' o� z° `� m a y m Ci?�uSO V+ DATE TIME DATE TIME w = a x z z o r w 1 ¢ 1 Outfall No, 1 vVT x x x x 2 putfap No. 2 NIT x x x X COy 3 4 5 8 7 8 9 10 11 12 ADDITIONAL COMMENTS RELINQUISHED BY I AFFILATION DATE TIME ACCEPTED BY I AFFILIATION DATE TIME SAMPLE CONDE71010 SAMPLER NAMP AND SIGNATURE PRINT Name of SAMPLER;, „j G( ems} 'n�>' m in } SIGNATURE a a DATR SiQ e- r r CERTIFICATE OF COVERAGE NO. NCG100170 STORMWATER DISCHARGE OUTFALL (SDO) MONITORING REPORT RECEIVED JAN 19 2017 CENTRAL FILES DWR SECTION FACILITY NAME Crutchfields Mobile Crusher, Mebane, NC PERSON COLLECTING SAMPLE(S) Edd Marsh CERTIFIED LABORATORY(S) Pace Analytical Lab #12 Lab # Part A: Stormwater Benchmarks and Monitoring Results SAMPLES COLLECTED DURING CALENDAR YEAR:2016 (This monitoring report shall be received by the Division no later than 30 days from the date the facility receives the sampling results from the laboratory.) COUNTY Alamance PHONE NO. (919) 369-2752 PLEASE REMEMBER TO SIGN ON THE REVERSE 4 For sampling periods with no discharge, you must submit this discharge monitoring form noting "No Flow" or "No Discharge" within 30 days of the end of that period to comply with permit reporting requirements. Outfall No. Date Sample Collected, mo/dd/year Total Rainfall, inches 00400 00530 ---- 77023 01051 78141 pH, Standard Units Total Suspended Solids (TSS), mg/L Non -polar O&G/TPH (Method 1664 SGT-HEM), mg/L Ethylene Glycol, mg/L Lead, Total Recoverable, mg/L Total Toxic Organics3, mg/L Benchmark - - 6.0 — 9.01 100/502 15 8,000 (Tiers 2 and 3) 0.03 1.0 Outfall001 12/06/16 359.0 <5.0 <5.0 0.0252 NA O u tfa 11002 12/06/16 19.0 <5.0 <5.0 <0.005 NA Note: If you report a sampled value in excess of the benchmark value, or outside the benchmark range o ,you must implement Tier 1 or Tier 2 responses in the General Permit. See If pH values outside this range are recorded in sampled Stormwater discharges, but anibient precipitation pH levels are lower, then the lower threshold of this benchmark range is the pH of the precipitation (within instrument accuracy)instead of 6 S.U. Readings: from an on -site or local rain gauge (or local precipitation data) must be documented to demonstrate background concentrations were below the benchmark pH range of 6-9. 2See General Permit text to identify whether the more protective benchmark applies for especially sensitive receiving waters. 3For purposes of this permit the definition of Total Toxic Organics is that list as stated in Appendix D, Table It of Chapter 40 Code of Federal Regulations (CFR) Part 122. A l Form SWU-251, lost revised October 25, 2012 Page 1 of 2 STORMWATER DISCHARGE OUTFALL (SDO) MONITORING REPORT Facilities that incorporate a solvent management plan into the Stormwater Pollution Prevention Plan may request that DWQ waive monitoring of total toxic organics. 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 allowed such a waiver, the discharger shall sign the following certification statement: Solvent Management Plan 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 all the provisions of the solvent management plan included in the Stormwater Pollution Prevention Plan." Name (Print name) Title (Print title) Signature Mail Original and one copy to: Division of Water Quality Attn: Central Files 1617 MailServiceCenter Raleigh, North Carolina27699-1617 Date "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 significarpenalties for bmitting false information, including the possibility of fines and imprisonment for knowing violations." (Signature of Permittee or Designee) (Date) Form SWU-251, lost revised October 25, 2012 Page 2 of 2