NCG210306_MONITORING INFO_20190125

STORMWATER DIVISION CODING'SHEET
NCG PERMITS
PERMIT NO.
/V p7�
DOC TYPE
❑ HISTORICAL FILE
M MONITORING REPORTS
DOC DATE
❑ 0 I O
YYYYM M DD

STORM WATER DISCHARGE OUTFACE (5D0) RECEIN/En
MONITORING REPORT JAN 2 5 2019
GENERAL PERMIT NO. NCG210000 SAMPLES COLLECTED DURING CALENDAR YEAR:TFA6I. _
CEIi=1'30[daysfrom�I'IFICATE OF COVERAGE NO. NCG_1®©®Q {This monitoring report is due at the Division no laterQ•tham J .
the date the facility receives the sampling results from the laboratory.)
FACILITY NAME ZZZs% J:&"_ T c ,796,7,. 1�vy►s: _ COUNTY S ki
PERSON COLLECTING SAMPLES � ► e4 PHONE NO. 3
CERTIFIED LABORATORY CrA-S Z.sc. Lab # !% PO /
Lab # I'LEASh; SIi3\ ON THh: ItEVERSE -�
Part A: Specific Monitoring Requirements
OutfalI
No.
Date
Sample Collected,
mo/dd/ r
Total Rainfall,
inches
00530
00400
00340
Total Suspended Solids,
ma
pH,
Standard units
Chemical Oxygen Demand (COD),
Benchmark*
-
-
100
Within 6.0 - 9.0
120
06 i
to -1 -4.C15
! O
114
17.19
7.2
b c3
1 to- - 45. aw t t!
I . D
.0
Monitoring is required only if the facility stores exposed piles of sawdust, wood chips, bark, mulch, or other similar material on site for longer than seven (7) days.
If the facility elects not to monitor because accumulated material is removed within seven (7) days or less, the certification below must be signed. The facility shall
also record and maintain a log in its SPPP (Stormwater Pollution Prevention Plan) of dates when material is generated and removed, how, and by whom.
*Note: If you report a value in excess of the benchmark value, or outside the benchmark range (for pH), you must implement Tier I or Tier 2 responses in the General Permit.
Facilities that do not store exposed (eithstorm
water exposed to incident precipitation or exposed to storwater run on) piles of sawdust, wood chips, bark, mulch, or other similar material for
longer than seven (7) days on site may so certify, and the requirement for analytical monitoring may be waived. For those facilities that qualify for the analytical 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 requirement for
analytical monitoring, I certify that to the best of my knowledge and belief, no piles of sawdust, wood chips, bark, mulch or
other similar materials were stored exposed (either to incident precipitation or to stormwater run on) for longer than seven (7)
days before removal since filing the last discharge monitoring report."
- �AM6.,�� -
Name (Print name)
Title (Print title)
/ �41)6
(Signature) (Date)
S W U-245-072808
Page 1 of 2

DID THIS FACILITY PERFORM VEHICLE MAINTENANCE ACT VIES USING MORE THAN 55 GALLONS OF NEW MOTOR OIL PER MONTH, ON
AVERAGE, IN THE CALENDAR YEAR?
0 Yes ® No (If yes, complete Pan B)
Part B: Vehicle Maintenance Activity Monitoring. Requirements
Outfall
No.
Date
Sample Collected,
mo/ddlyr
00400
00556
00530
Total Rainfall,
inches
New Motor Oil Usage,
Annual average gallmo
pH,
Standard units
Oil and Grease,
mg/L
Total Suspended Solids,
mg/L
Benchmark*
-
-
-
6.0 — 9.0
30
100
�7' ..DI
"11:3
*Note: If you report a 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.
Mail original and one copy to:
Division of Water Quality
Attn: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
N'OU :bIt ST SIi;N T[HS CERTIFICATION' IC:ATION' FOIZ ANI' INFOWMATION REPORTED IN P.kR`i'S a AND/OR B:
"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
-Z�2-- r
(Date)
S WU-245-072808
Page 2 of 2

(T�EMS, INC.
ENVIRONMENTAL MANAGEMENT SERVICES
Laboratory Services - Plant Operations - Consultants
P.Q. Box 784 • Wytheville, VA 24382
Phone: [phone] • Fax: [phone]
www.emsinclab.com
CERTIFICATE OF ANALYSIS
Final Report
Tom Farthing
Independence Lumber Company
Report Date:
1/21/2019
407 Lumber Lane
Report No:
2019-00140
Independence, VA 24348
Original Report
Sample No.:
18-11528
Location: ELKINISTORMWATER
PWSIDIPermit
No:
Sample Source: 001
Collected By:
Tom Farthing
Date/Time Collected: 12-28-18/0820
Delivered By:
Tom Farthing
Date/Time Received At Laboratory:
12-28-1811110
Received By:
Diana Puckett
Parameter
Result
Units
Analytical Method
DatelTimeAnalyzed
Analyst
Chemical Oxygen Demand
721
mglL
Hach 8000
01-03-19/0934
GLJ
Total Suspended Solids
794
mglL
SM 2540D-2011
12-28-18/1500
DLR
Location: ELKINISTORMWATER
Sample Source: 002
Date/Time Collected: 12-28-18/0805
Date/Time Received At Laboratory: 12-28-1811110
Sample No.: 18-11529
PWSIDIPermit No:
Collected By: Tom Farthing
Delivered By: Tom Farthing
Received By: Diana Puckett
US EPA LAB ID: VA01164 Page 1 of 4
VELAP ID: 460033

Report No: 2019-00140
Parameter
Result
Units
Analytical Method
Oil & Grease
7.3
mglL
EPA 1664B
Chemical Oxygen Demand
184
mglL
Hach 8000
Total Suspended Solids
149
mglL
SM 2540D-2011
Subcontracted Laboratories:
EPA 1664E
Waypoint Analytical
Location: ELKINISTORMWATER
Sample Source: 003
DatelTime Collected: 12-28-18/0730
Date/Time Received At Laboratory: 12-28-1811110
Date/Time Analyzed Analyst
01-10-19/0900 '
01-03-19/0934 GLJ
12-28-18/1500 DLR
VELAP ID: 460181
Sample No.: 18-11530
PWSIDIPermit No:
Collected By: Tom Farthing
Delivered By: Tom Farthing
Received By: Diana Puckett
Parameter
Result
Units
Analytical Method
Date/Time Analyzed
Analyst
Chemical Oxygen Demand
98
mglL
Hach 8000
01-03-19/0934
GLJ
Total Suspended Solids
25.0
mglL
SM 2540D-2011
12-28-18/1500
DLR
Sample No.: 18-11531
Location: ELKINISTORMWATER PWSIDIPermit No:
Sample Source: 004 Collected By: Tom Farthing
Date/Time Collected: 12-28-18/0745 Delivered By: Tom Farthing
Date/Time Received At Laboratory: 12-28-1811110 Received By: Diana Puckett
Parameter
Result
Units
Analytical Method
Date/Time Analyzed
Analyst
Chemical Oxygen Demand
185
mglL
Hach 8000
01-03-1910934
GLJ
Total Suspended Solids
88.0
mglL
SM 2540D-20i1
12-28-1811500
DLR
US EPA LAB ID: VA01164 Page 2 of 4
ZZ—
NI
e
VELAP ID: 460033

Location: ELKINISTORMWATER
Sample Source: 009
Date/Time Collected: 12-28-18/0835
Date/Time Received At Laboratory: 12-28-1811110
Parameter
Chemical Oxygen Demand
Total Suspended Solids
t� 0a /""
Gary Mychel Johnson
Laboratory Manager
Result Units Analytical Method
84 mglL Hach 8000
26.4 1 SM 2540D-2011
Report No: 2019-00140
Sample No.: 18-11532
PWSIDlPermit No:
Collected By: Tom Farthing
Delivered By: Tom Farthing
Received By: Diana Puckett
DatelTime Analyzed Analyst
01-03-19/0934 GLJ
12-28-18/1500 DLR
The analytical data contained in this report has been validated using standard quality control measures specified by the analytical method, SOP's, and the
Laboratory's Quality Assurance Manual. Unless otherwise noted, all reported results meet the requirements of the analytical method and of NELAP. Parameters
analyzed in the field or designated by a '-' symbol are not included in the Laboratory's Scope of Accreditation. Sample preservation is documented at the time
of receipt and/or during analysis. Unless otherwise noted, analysis was performed on preservation compliant sametes.
The analytical data contained in this report relates only to the samples submitted for analysis- This report shall not be reproduced, except in full, without the
written permission of EMS, Inc. EMS, Inc. assumes no responsibility, expressed or implied, as to the interpretation or use of the data contained in this report.
The liability of EMS, Inc. in any claim shall be limited to (at the option of EMS, Inc.) repeating the analysis in question or the refund of fees paid.
Please feel free to contact us at 276-228-6464 if you have any questions or need any additional information.
US EPA LAB ID: VA01164 Page 3 of 4
0—
VELAP ID: 460033

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INDEPENDENCE LUMBER, INC.
Division of Water Quality
Attn: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
To Whom It May Concern;
July 9, 2018
407 LUMBER LANE
INDEPENDENCE, VA 24348
RECEIVED
JUL 13 2018
CENTfRAL FILES
DWR SECTION
Reference Permit Number NCG210306
In reference to the Storm Water Pollution Prevention Permit Number NCG210306 for our facility
in Elkin North Carolina please find the enclosed Storm Water Discharge Outfall Monitoring Report for a
rain event that occurred on June 22, 2018.
The permit requirements for the permit period of January 1, 2018 to June 30, 2018. These
samples were analyzed by EMS Inc. in Wytheville Virginia.
If you have any questions give me a call at 276-773-3744 extension 207.
Sincerely;
Tom Farthing
Director of Environmental
Health and Safety
OFFICE # 276-773-3744 www.indlhr.com
FAX # [phone]I

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
GENERAL PERMIT NO. NCG210000
CERTIFICATE OF COVERAGE NO. NCG21®[fl0®
FACCLITY NAME
PERSON COLLECTING SAMPLES To.
CERTIFIED LABORATORY ehl.S. Esc •'Lab # llAz,//b-Y
Lab #
Part A: Specific Monitoring Requirementst
SAMPLES COLLECTED DURING CALENDAR YEAR: v?d /k
(This monitoring report is due at the Division no later than 30 days from
the date the facility receives the sampling results from the laboratory.)
COUNTY 51 �_
PHONE NO. (3-I )_ fro
PLl-.;;BSI? SIGN 0N." THE iZEIVERSF, 4
Outfall
No.
Date
Sample Collected,
mo/dd/ r
Total Rainfall,
inches
00530
00400
00340
Total Suspended Solids,
m
pH,
Standard units
Chemical Oxygen Demand (COD),
Benchmark*
-
-
100
Within 6.0 — 9.0
120
�4
06 sa /Fr
3'1,-% rha IL
7. /
.3 3 m �-
Monitoring is required only if the facility stores exposed piles of sawdust, wood chips, bark, mulch, or other similar material on site for longer than seven (7) days.
If the facility elects not to monitor because accumulated material is removed within seven (7) days or less, the certification below must be signed. The facility shall
also record and maintain a log in its SPPP (stormwater Pollution Prevention Plan) of dates when material is generated and removed, how, and by whom.
*Note: If you report a 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.
Facilities that do not store exposed (either exposed to incident precipitation or exposed to stormwater run on) piles of sawdust, wood chips, bark, mulch, or other similar material for
longer than seven (7) days on site may so certify, and the requirement for analytical monitoring may be waived. For those facilities that qualify for the analytical 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 requirement for
analytical monitoring, I certify that to the best of my knowledge and belief, no piles of sawdust, wood chips, bark, mulch or
other similar materials were stored exposed (either to incident precipitation or to stormwater run on) for longer than seven (7)
days before removal since filing the last discharge monitoring report."
Name (Print name)
G !Lfi
Title (P t title)
(Signature) (Date)
S W U-245-072808
Page I of 2

DID THIS FACILITY PERFORM VEHICLE MAINTENANCE ACTIVIES USING MORE THAN 55 GALLONS OF NEW MOTOR OIL PER MONTH, ON
AVERAGE, IN THE CALENDAR YEAR?
ZL Yes ❑ No (If yes, complete Part B)
Part B: Vehicle Maintenance Activity Monitoring Requirements
Outfall
No.
Date
Sample Collected,
mo/dd/yr
00400
00556
00530
Total Rainfall,
inches
New Motor Oil Usage,
Annual average gal/mu
pH,
Standard units
Oil and Grease,
mg/L
Total Suspended Solids,
mg/L
Benchmark*
-
-
-
6.0 -- 9.0
30
100
*Note: If you report a 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.
Mail original and one copy to:
Division of Water Quality
Attn: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
1'[.)l aI[i5'! SIGN `Ck11S CI?ItTIl-1CATION FOi: AXY INFORMATION REPORTFI) IN I-:XIZ 'S .A ANC)/01Z I3:
"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)
-_�o2lJ/�
(Date)
SWU-245-072808
Page 2 of 2

(Z�EMS, INC.
ENVIRONMENTAL MANAGEMENT SERVICES
Laboratory Services - Plant Operations - Consultants
P.O. Box 784 , Wytheville, VA 24382
Phone:[phone] • Fax: [phone]
www.emsinclab.com
CERTIFICATE OF ANALYSIS
Final Report
Tom Farthing
Independence Lumber Company Report Date
407 Lumber Lane Report No:
Independence,VA 24348
Location: ELKINI STORMWATER
Sample Source: 001
Date/Time Collected: 06-22-1810630
DateMme Received At Laboratory: 06-25-18/1035
Parameter
Chemical Oxygen Demand
Total Suspended Solids
Result Units Analytical Method
343 mg/L Hach 8000
31.2 mg/L SM 2540D-2011
7/5/2018
2018-01702
Original Report
Sample No.: 18-05400
PWSIDIPermit No'.
Collected By: Tom Farthing
Delivered By: Tom Farthing
Received By: Diana Puckett
Date/Time Analyzed Analyst
06-28-1810835 GLJ
06-26-18/2025 SLC
Sample No.: 18-05401
Location: ELKINI STORMWATER PWSIDIPermit No:
Sample Source: 002 Collected By: Tom Farthing
Date/Time Collected: 06-22-1810645 Delivered By: Tom Farthing
DateMme Received At Laboratory: 06-25-18/1035 Received By: Diana Puckett
US EPA LAB ID: VA01164 Page 1 of 4
N!
VELAP ID: 460033

Parameter
Result
Oil & Grease
<1.4
Chemical Oxygen Demand
253
Total Suspended Solids
83.3
Subcontracted Laboratories:
EPA 1664A
Waypoint Analytical
Report No:
2018-01702
Units
Analytical Method
DatelTime Analyzed Analyst
mg/L
EPA 1664A
07-02-18/1310
mg/L
Hach 8000
06-28-1810835 GLJ
mg/L
SM 2540D-2011
06-26-18/2025 SLC
Location: ELKINI STORMWATER
Sample Source: 003
DatelTime Collected: 06-22-1810700
Date/Time Received At Laboratory: 06-25-1811035
VELAP ID: 460181
Sample No.: 18-05402
PWSIDIPermit No:
Collected By: Tom Farthing
Delivered By: Tom Farthing
Received By: Diana Puckett
Parameter
Result
Units
Analytical Method
Date/Time Analyzed
Analyst
Chemical Oxygen Demand
107
mg/L
Hach 8000
06-28-1810835
GLJ
Total Suspended Solids
9.4
mg/L
SM 2540D-2011
06-26-18/2025
SLC
Sample No.: 18-05403
Location: ELKINI STORMWATER PWSIDIPermit No:
Sample Source: 004 Collected By: Tom Farthing
Date/Time Collected: 06-22-18/0715 Delivered By: Tom Farthing
DatelTime Received At Laboratory: 06-25-1811035 Received By: Diana Puckett
Parameter
Result
Units
Analytical Method
Date/Time Analyzed
Analyst
Chemical Oxygen Demand
468
mg/L
Hach 8000
06-28-18/0835
GLJ
Total Suspended Solids
222
mg1L
SM 254OD-2011
06-26-18/2025
SLC
US EPA LAB ID: VA01164 Page 2 of 4
I�cnp
VELAP ID:460033

Report No: 2018-01702
Sample No.: 18-05404
Location: ELKINI STORMWATER
PWSlWPermit No:
Sample Source: 009
Collected By: Tom Farthing
DatelTime Collected: 06-22-1810730
Delivered By: Tom Farthing
DateMme Received At Laboratory:
06-25-18/1035
Received By: Diana Puckett
Parameter
Result Units
Analytical Method Date/Time Analyzed Analyst
Chemical Oxygen Demand
58 mg1L
Hach 8000 06-28-1810835 GLJ
Total Suspended Solids
161 mg/L
SM 25400-2011 06-26-1812025 SLC
Gary Mychel Johnson
Laboratory Manager
The analytical data contained in this report has been validated using standard quality control measures specified by the analytical method, SOP's, and the
Laboratory's Quality Assurance Manual. Unless otherwise noted, all reported results meet the requirements of the analytical method and of NELAP. Parameters
analyzed in the field or designated by a '-' symbol are not included in the Laboratory's Scope of Accreditation. Sample preservation is documented at the time
of receipt and/or during analysis. Unless otherwise noted, analysis was performed on preservation compliant samples.
The analytical data contained in this report relates only to the samples submitted for analysis. This report shall not be reproduced, except in full, without the
written permission of EMS, Inc. EMS, Inc. assumes no responsibility, expressed or implied, as to the interpretation or use of the data contained in this report.
The liability of EMS, Inc. in any claim shall be limited to (at the option of EMS, Inc.) repeating the analysis in question or the refund of fees paid.
Please feel free to contact us at 276-228-6464 if you have any questions or need any additional information
US EPA LAB ID: VA01164 Page 3 of 4
T
VELAP ID: 460033

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INDEPENDENCE LUMBER, INC.
Division of Water Quality
Attn: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
To Whom It May Concern;
January 8, 2018
407 LUMBER LANE
INDEPENDENCE, VA 24348
GOD V%
KK
0WR pRCpG�S %G UW
1N�4RMp,Z14N
Reference Permit Number NCG210306
In reference to the Storm Water Pollution Prevention Permit Number NCG210306 for our facility
in Elkin North Carolina please find the enclosed Storm Water Discharge Outfall Monitoring Report for a
rain event that occurred on December 20, 2017.
The permit requirements for the permit period of July 1, 2017 to December 31, 2017. These
samples were analyzed by EMS Inc. in Wytheville Virginia.
If you have any questions give me a call at 276-773-3744 extension 207.
Sincerely;
, � �z 6 '-
Tom Farthing
Director of Environmental
Health and Safety
OFFICE # 276-773-3744 www.l`ndibr.com
FAX # [phone]

DID THIS FACILITY PERFORM VEHICLE MAINTENANCE ACTIVIES USING MORE THAN 55 GALLONS OF NEW MOTOR OIL PER MONTH, ON
AVERAGE, IN THE CALENDAR YEAR?
❑ Yes F1 No (If yes, complete Part B)
Part B: Vehicle Maintenance Activity Monitoring Requirements
Outfall
No.
Date
Sample Collected,
mo/dd/yr
00400
00556
00530
Total Rainfall,
inches
New Motor Oil Usage,
Annual average gal/mo
pH,
Standard units
Oil and Grease,
mg/L
Total Suspended Solids,
mg/L.
Benchmark*
-
-
-
6.0 — 9.0
30
100
Ube
�- U DI
1?17
7, U
3
Sao
*Note: If you report a value in excess of the benchmark value, or outside the benchmark range (for pH), you must implement Tier I or Tier 2 responses in the General Permit.
Mail original and one copy to:
Division of Water Quality
Attn: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
YOI.i ,),IUS'f' SIGN TIlls CERTIFICATION' F(M AINY INFORMATION RGP0Ii TED IN I'AIZTS A ANDAW B-
"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."
t? -e n-
(Signature of Permittee)
(Date)
SWU-245-072808
Page 2 of 2

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
GENERAL PERMIT NO. NCG210000 SAMPLES COLLECTED DURING CALENDAR YEAR: .26l?
CERTIFICATE OF COVERAGE NO. NCG21®Q2® (This monitoring report is due at the Division no later than 30 days from
the date the faciIity receives the sampling results from the laboratory.)
FACILITY NAME ,�.,J�.fa)_�,�.`7�� ���5� a�tt11 iJ COUNTY
PERSON COLLECTING SAMPLES i- ri7hw` PHONE NO. (,L) Lola - 3'fGy
CERTIFIED LABORATORY _�' f]\S �2"1ilc Lab # k&lm
Lab # PLEASE SIGN ON THE REVERSE 4
Part A: Specific Monitoring Requirements[
Outfall
No.
Date
Sample Collected,
mo/dd/ -r
Total Rainfall,
inches
00530
00400
00340
Total Suspended Solids,
m
pH,
Standard units
Chemical Oxygen Demand (COD),
Benchmark*
-
-
100
Within 6.0 - 9-0
120
V V
)A-oab
v C>3
-4v I?
ILsU
1
la
a
—
-
.3
'Monitoring is required only if the facility stores exposed piles of sawdust, wood chips, bark, mulch, or other similar material on site for longer than seven (7) days.
If the facility elects not to monitor because accumulated material is removed within seven (7) days or less, the certification below must be signed. The facility shall
also record and maintain a log in its SPPP (Stormwater Pollution Prevention Plan) of dates when material is generated and removed, how, and by whom.
*Note: If you report a 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.
Facilities that do not store exposed (either exposed to incident precipitation or exposed to stormwater run on) piles of sawdust, wood chips, bark, mulch, or other similar material for
longer than seven (7) days on site may so certify, and the requirement for analytical monitoring may be waived. For those facilities that qualify for the analytical 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 requirement for
analytical monitoring, I certify that to the best of my knowledge and belief, no piles of sawdust, wood chips, bark, mulch or
other similar materials were stored exposed (either to incident precipitation or to stormwater run on) for longer than seven (7)
days before removal since filing the last discharge moritoring report."
Name (Print name)
Title;Z(P"t title)
(Signature) (Date)
S WU-245-072808
Page i of 2

EMS, INC.
ENVIRONMENTAL MANAGEMENT SERVICES
Laboratory Services - Plant Operations - Consultants
P.O. Box 784 • Wytheville, VA 24382
Phone: [phone] • Fax: [phone]
www.emsinclah.com
CERTIFICATE OF ANALYSIS
Final Report
Tom Farthing Report Date:
Independence Lumber Company
407 Lumber Lane Report No:
Independence, VA 24348
Location: STORM WATER - ELKIN
Sample Source: 001
Date/Time Collected: 12-20-1711000
DateMme Received At Laboratory: 12-20-17/1330
Parameter
Result
Units
Analytical Method
Chemical Oxygen Demand
484
mg1L
Hach 8000
Total Suspended Solids
368
mg/L
SM 2540D-2011
1/5/2018
2018-00097
Original Report
Sample No.: 17-11050
PWSID1Permit No:
Collected By: Tom Farthing
Delivered By: Tom Farthing
Received By: Angel Battaglia
Date/Time Analyzed Analyst
12-21-1710830 G LJ
12-22-17/1947 SLC
Sample No.: 17-11051
Location: STORM WATER - ELKIN PWSID/Permit No:
Sample Source: 002 Collected By: Tom Farthing
Date/Time Collected: 12-20-17/0930 Delivered By: Tom Farthing
Date/Time Received At Laboratory: 12-20-17/1330 Received By: Angel Battaglia
US EPA LAB ID: VA01164 Page 1 of 4
VELAP ID: 460033

Report No: 2018-00097
Parameter
Result
Units
Oil & Grease
37.7
mg/L
Chemical Oxygen Demand
544
mg/L
Total Suspended Solids
300
mg/L
Subcontracted Laboratories:
EPA 1664A
Waypoint Analytical
Analytical Method
Date/Time Analyzed Analyst
EPA 1664A
12-29-17/1030
Hach 8000
12-21-17/0830 GLJ
SM 254OD-2011
12-22-17/1947 SLC
VELAP ID: 460181
Sample No.: 17-11052
Location: STORM WATER - ELKIN PWSIDIPermit No:
Sample Source: 003 Collected By: Tom Farthing
Date/Time Collected: 12-20-17/0915 Delivered By: Tom Farthing
Date/Time Received At Laboratory: 12-20-17/1330 Received By: Angel Battaglia
Parameter
Result
Units
Analytical Method
Date/Time Analyzed
Analyst
Chemical Oxygen Demand
105
mg1L
Hach 8000
12-21-1710830
GLJ
Total Suspended Solids
100
mg1L
SM 2540D-2011
12-22-1711947
SLC
Location: STORM WATER - ELKIN
Sample Source: 004
Date/Time Collected: 12-20-1710945
Date/Time Received At Laboratory: 12-20-17/1330
Sample No.: 17-11053
PWSIDIPermit No:
Collected By: Tom Farthing
Delivered By: Tom Farthing
Received By: Angel Battaglia
Parameter
Result
Units
Analytical Method
DaterTme Analyzed
Analyst
Chemical Oxygen Demand
256
mg/L
Hach 8000
12-21-17/0830
GLJ
Total Suspended Solids
215
mg[L
SM 2546D-20i1
12-22-1711947
SLC
N
VELAP ID: 460033
US EPA LAB ID: VA01164 Page 2 of 4

Report No: 2018-00097
Sample No.: 17-11054
Location: STORM WATER - ELKIN PWSIDIPermit No:
Sample Source: 009 Collected By: Tom Farthing
DaterFime Collected: 12-20-17/0900 Delivered By: Tom Farthing
DateMme Received At Laboratory: 12-20-1711330 Received By: Angel Battaglia
Parameter Result Units Analytical Method Date/Time Analyzed Analyst
Chemical Oxygen Demand 20 mglL Hach 8000 12-21-1710830 GLJ
Total Suspended Solids 60.1 mglL SM 254OD-2011 12-22-17/1947 SLC
Gary Mychel Johnson
Laboratory Manager
The analytical data contained in this report has been validated using standard quality control measures specified by the analytical method, SOP's, and the
Laboratory's Quality Assurance Manual. Unless otherwise noted, all reported results meet the requirements of the analytical method and of NELAP. Parameters
analyzed in the field or designated by a '-'symbol are not included in the Laboratory's Scope of Accreditation. Sample preservation is documented at the time
of receipt andlor during analysis. Unless otherwise noted, analysis was performed on preservation compliant samples.
The analytical data contained in this report relates only to the samples submitted for analysis. This report shall not be reproduced, except in full, without the
written permission of EMS, Inc. EMS, Inc. assumes no responsibility, expressed or implied, as to the interpretation or use of the data contained in this report.
The liability of EMS, Inc. in any claim shall be limited to (at the option of EMS, Inc.) repeating the analysis in question or the refund of fees paid.
Please feel free to contact us at 276-226-6464 it you have any questions or need any additional information.
US EPA LAB ID: VA01164 Page 3 of 4
*V
VELAPli 460033

Report No: 2018-00097
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VELAP ID: 460033
US EPA LAB ID: VA01164 Page 4 of 4

LI
INDEPENDENCE LUMBER, INC.
Division of Water Quality
Attn: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
To Whom it May Concern;
March 9, 2017
407 LUMBER LANE
INDEPENDENCE, VA 24348
MAR 2 Q 2017
DENR-LAND
STORiAWATER Pt--'V-1 ,
Reference Permit Number NCG210306
In reference to the Storm Water Pollution Prevention Permit Number NCG210306 for our facility
in Elkin North Carolina please find the enclosed Storm Water Discharge Outfall Monitoring Report for a
rain event that occurred on February 15, 2017.
apologize that I have missed the sampling for the period of July 1, 2016 to December 31, 2016
due to the inability to sample the event within the first 30 minutes for it to be determined a proper
sample as required by regulations. Observations of each outfall were taken during this period but no
samples were sent to the lab. If needed I will submit another report before the June 30th deadline.
If you have any questions give me a call at 276-773-3744 extension 207.
Sincerely;
6%fl i��i
Tom Farthing
Director of Environmental
Health and Safety
OFFICE # 276-773-3744 www.indihr.com

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
GENERAL PERMIT NO. NCG210000
CERTIFICATE OF COVERAGE NO. NCG21 l�[S®&
FACILITY NAME Jt�tb�
PERSON COLLECTING 9AMPLES
CERTIFIED LABORATORY 66 i S a # �
Lab #
Part A: Specific Monitoring Requirements`
SAMPLES COLLECTED DURING CALENDAR YEAR: d bl
(This monitoring report is due at the Division no later than 30 days from
the date the facility receives the sampling results from the laboratory.)
COUNTY
PHONE NO. (33(,) 3N i� 3 U _. �.. r'p
t ` t r r
I'LLikSF SIG ()\ THE RF- E R S F
OR 2 � 1!
Outfall
No.
Date
Sample Collected,
mo/dd/ •r
Total Rainfall,
inches
00530
00400
00340
Total Suspended Solids,
m
pH,
Standard units
Chemical Oxygen Demand (COD);0`-
mgfL
Benchmark*
-
-
100
Within 6.0 - 9.0
I20
ot>
0.3- - l-5- -.2U1-7
Cl
04>3
0 - l -- AVr7
. �5'
7 • I
& 3
bo X4
v - -, aY1
• of
3
7, S
31)9
Monitoring is required only if the facility stores exposed piles of sawdust, wood chips, bark, mulch, or other similar material on site for longer than seven (7) days.
If the facility elects not to monitor because accumulated material is removed within seven (7) days or less, the certification below must be signed. The facility shall
also record and maintain a log in its SPPP (Stormwater Pollution Prevention Plan) of dates when material is generated and removed, how, and by whom.
r,t:•,r�, ,J, ti0
*Note: If you report a value in excess of the benchmark value, or outside the benchmark range (for pH), you must implement Tier I or Tier 2 responses in the General Permit.
Facilities that do not store exposed (either exposed to incident precipitation or exposed to stormwater run on) piles of sawdust, wood chips, bark, mulch, or other similar material for
longer than seven (7) days on site may so certify, and the requirement for analytical monitoring may be waived. For those facilities that qualify for the analytical 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 requirement for
analytical monitoring, I certify that to the best of my knowledge and belief, no piles of sawdust, wood chips, bark, mulch or
other similar materials were stored exposed (either to incident precipitation or to stormwater run on) for longer than seven (7)
days before removal since filing the last discharge monitoring report."
!1 G. rr�-
Name (Print name)
Title (Print title)
((Sig ature) (Date)
S W U-245-072808
Page 1 of 2

DID THIS FACILITY PERFORM VEHICLE MAINTENANCE ACTIVIES USING MORE THAN 55 GALLONS OF NEW MOTOR OIL PER MONTH, ON
AVERAGE, IN THE CALENDAR YEAR?
❑ Yes [K No (If yes, complete Part B)
Part B: Vehicle Maintenance Activity Monitoring Requirements
Outfall
No.
Date
Sample Collected,
mo/dd/yr
00400
00556
00530
Total Rainfall,
inches
New Motor Oil Usage,
Annual average gal/mo
pH,
Standard units
Oil and Grease,
mg/L
Total Suspended Solids,
mg/L
Benchmark* 1
6.0 — 9.0
30
100
*Note: If you report a value in excess of the benchmark value, or outside the benchmark range (for pH), you must implement Tier I or Tier 2 responses in the General Permit.
Mail original and one copy to:
Division of Water Quality
Attn: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
('1"RTIFICATION I'Oi::1i11' I\'I=OR\19'[ lC1N IZEPOItTED IN PARTS A ANi)1(11t 13:
"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)
-3 - F -
(Date)
S W U-245-072808
Page 2 of 2

(T�EMS, INC.
ENVIRONMENTAL MANAGEMENT SERVICES
Laboratory Services - Plant Operations - Consultants
P.O. Box 784 • Wytheville, VA 24382
Phone: [phone] • Fax:[phone]
www.emsinclab.com
CERTIFICATE OF ANALYSIS
Final Report
Tom Farthing Report Date: 317l2017
Independence Lumber Company
407 Lumber Lane Report No: 2017-00513
Independence, VA 24348
Original Report
Location: ELKIN
Sample Source: 001
DatelTime Collected: 02-15-1710700
DatelTime Received At Laboratory 02-15-17/1140
Sample No.: 17-01086
PWSID/Permit No:
Collected By: T. Farthing
Delivered By: T. Farthing
Received By: Lori Shoemaker
Parameter
Result
Units
Analytical Method
DatelTlmeAnalyzed
Analyst
Chemical Oxygen Demand
284
mglL
Hach 8000
02-16-17/0843
GLJ
Total Suspended Solids
351
mglL
SM 254OD-2011
02-16-17/1808
SLC
Comments:
TSS batch duplicate RPD was outside of QC limits
Sample No.: 17-01087
Location: ELKIN PWSIDIPermit No:
Sample Source: 002 Collected By: T. Farthing
DatelTime Collected: 02-15-17/0715 Delivered By: T. Farthing
Date/Time Received At Laboratory 02-15-17/1140 Received By: Lori Shoemaker
US EPALAB ID: VA01164 Page 1 of
OWL
NOW
VELAP ID: 460033

Report No: 2017-00513
Parameter
Result
Units
Analytical Method
Date/Time Analyzed Analyst
Oil & Grease
22.4
mg1L
EPA 1664A
02-21-17/1330
Chemical Oxygen Demand
381
mg1L
Hach 8000
02-16-17/0843 GLJ
Total Suspended Solids
191
mglL
SM 254OD-2011
02-16-17/1808 SLC
Subcontracted Laboratories:
EPA 1664A
Waypoint Analytical
VELAP ID: 460181
Comments:
TSS batch duplicate RPD was outside of QC limits
Sample No.: 17-01088
Location: ELKIN PWSID1Permit No:
Sample Source: 003 Collected By: T. Farthing
Date/Time Collected: 02-15-1710730 Delivered By: T. Farthing
Date/Time Received At Laboratory: 02-15-1711140 Received By: Lori Shoemaker
Parameter
Chemical Oxygen Demand
Total Suspended Solids
Result
Units
Analytical Method
63
mg1L
Hach 8000
28.6
mg1L
SM 254OD-2011
Comments:
TSS batch duplicate RPD was outside of QC limits
DatelTime Analyzed
Analyst
02-16-17/0843
GLJ
02-16-17/1808
SLC
Sample No.: 17-01089
Location: ELKIN PWSID1Permit No:
Sample Source: 004 Collected By: T. Farthing
DatelTime Collected: 02-15-1710745 Delivered By: T. Farthing
DatelTime Received At Laboratory: 02-15-1711140 Received By: Lori Shoemaker
Parameter
Result
Units
Analytical Method
Date/TlmeAnalyzed
Analyst
Chemical Oxygen Demand
572
mg1L
Hach 8000
02-16-17/0843
GLJ
Total Suspended Solids
643
mg1L
SM 2540D-2011
02-16-17/1808
SLC
Comments:
TSS batch duplicate RPD was outside of QC limits.
US EPA LAB ID: VA01164 Page 2 of 4
VELAP ID: 460033

Report No: 2017-00513
Location: ELKIN
Sample Source: 009
Date/Time Collected: 02-15-1710800
Date/Time Received At Laboratory: 02-15-1711140
Sample No.- 17-01090
PWSID/Permit No:
Collected By: T. Farthing
Delivered By: T. Farthing
Received By: Lori Shoemaker
Parameter
Result
Units
Analytical Method
Date[Time Analyzed
Analyst
Chemical Oxygen Demand
76
mg/L
Hach 8000
02-16-17/0843
GLJ
Total Suspended Solids
260
mg1L
SM 2540D-2011
02-16-17/1808
SLC
Comments:
TSS batch duplicate RPD was outside of QC limits.
J00a`'���
Gary Mychel Johnson
Laboratory Manager
The analytical data contained in this report has been validated using standard quality control measures specified by the analytical method, SOP's, and the
Laboratory's Quality Assurance Manual. Unless otherwise noted, all reported results meet the requirements of the analytical method and of NELAP Parameters
analyzed in the field or designated by a '-' symool are not included in the Laboratory's Scope of Accreditation. Sample preservation is documented at the time
of receipt and/or during analysis_ Unless otherwise noted, analysis was performed on preservation compliant samples
The analytical data contained in this report relates only to the samples submitted for analysis. This report shall not be reproduced, except in full, without the
written permission of EMS, Inc. EMS, Inc. assumes no responsibility, expressed or implied, as to the interpretation or use of the data contained in this report.
The liability of EMS, Inc, in any claim shall be limited to {at the option of I=MS, Inc.) repeating the analysis in question or the refund of fees paid.
Please feel free to contact us at 276-228-6464 if you have any questions or need any additional information.
US EPA LAB ID: VA01164 Page 3 of 4
r
f t
VELAP ID: 460033

Report No: 201300513
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North Carolina Department of
Environment and Natural Resources
450 West Hanes Mill Road, Suite 300
Winston Salem Regional Office
Winston Salem, NC 27107
Attn: Glen White
Dear Mr. White
aGr 0/0 3 d 6
RECEIVED
N.C. Dept. of ENR (,6
DEC 3 1 2015
WINSTON-SALEM
REGIONAL OFFICE
December 16, 2015
Reference Permit Number NCG210000
In reference to your inspection report dated August 14, 2015, pertaining to Certificate of
Coverage NCG210306 for our facility in Elkin North Carolina please find the attached Analytical
Monitoring Report for a rain event that occurred on November 19, 2015.
If you have any questions give me a call at 276-773-3744 extension 207.
Sincerely;
Tom Farthing
Director of Environmental
Health and Safety

DID THIS FACILITY PERFORM VEHICLE MAINTENANCE ACTIVIES USING MORE THAN 55 GALLONS OF NEW MOTOR OIL PER MONTH, ON
AVERAGE, IN THE CALENDAR YEAR?
❑ Yes ;�[ No (If yes, complete Part B)
Part B: Vehicle Maintenance Activity Monitoring Requirements
Outfall
No.
Date
Sample Collected,
mo/dd/yr
00400
00556
00530
Total Rainfall,
inches
New Motor Oil Usage,
Annual average gal/mo
pH,
Standard units
Oil and Grease,
mg/L
Total Suspended Solids,
mg/L
Benchmark* 1
6.0 — 9.0
30
100
% -
*Note: If you report a 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.
Mail original and one copy to:
Division of Water Quality
Attn: Central Files
1617 Mail Service Center
Ralei h, North Carolina 27699-1617
l t]U :*QIiST SIGN TI-I IS Cl?IZ'FIF1(.'ATION F()i::1Nl' IN' PARTS .-+ AND/OR 13:
"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
4_
(Date)
SWU-245-072808
Page 2 of 2

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
GENERAL PERMIT NO. NCG210000 SAMPLES COLLECTED DURING CALENDAR YEAR: a r3-
CERTIFICATE OF COVERAGE NO. NCG21 c: ❑3 ®® (This monitoring report is due at the Division no later than 30 days from
the date the facility receives the sampling results from the laboratory.)
FACILITY NA ME �� � F'`�� L°4n'b��— � 1Z�"'� COUNTY . -_ L2�-�
PERSON COLLECTING SAMPLESPHONE NO. 033(0
CERTIFIED LABORATORY ` , ` Lab #
�c2. cf5 Lab # PLEASE, 5ICX ON THE ]:E VERSE 4
Part A. Specific Monitoring Requirements'
Outfall
No.
Date
Sample Collected,
mo/dd/ r
Total Rainfall,
inches
00530
00400
00340
Total Suspended Solids,
m
pH,
Standard units
Chemical Oxygen Demand (COD),
m
Benchmark*
-
-
100
Within 6.0 — 9.0
120
vo
r7.1
btliJ-
ao3
o G L4
317
Monitoring is required only if the facility stores exposed piles of sawdust, wood chips, bark, mulch, or other similar material on site for longer than seven (7) days.
If the facility elects not to monitor because accumulated material is removed within seven (7) days or less, the certification below must be signed. The facility shall
also record and maintain a log in its SPPP (Stormwater Pollution Prevention Plan) of dates when material is generated and removed, how, and by whom.
*Note: If you report a value in excess of the benclunark value, or outside the benchmark range (for pH), you must implement Tier 1 or Tier 2 responses in the General Permit.
Facilities that do not store exposed (either exposed to incident precipitation or exposed to stormwater run on) piles of sawdust, wood chips, bark, mulch, or other similar material for
longer than seven (7) days on site may so certify, and the requirement for analytical monitoring may be waived. For those facilities that qualify for the analytical 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 requirement for
analytical monitoring, I certify that to the best of my knowledge and belief, no piles of sawdust, wood chips, bark, mulch or
other similar materials were stored exposed (either to incident precipitation or to stormwater run on) for longer than seven (7)
days before removal since filing the last discharge monitoring report."
�A Jm"i
Name (Print name)
Titl' (Prult title rn
(Signature)
(Date)
SWU-245-072808
Page I of 2

EMS, Inc.
Environmental Management Services
Laboratory Services - Plant Operations - Consultants
P.O. Box 784 - Wytheville, VA 24382
Phone: [phone] - Fax: [phone]
E-mail: [e-mail]
www.emsinclab.com
CERTIFICATE OF ANALYSIS
Final Report
Tom Farthing
Report Date: 12/7/2015
Independence Lumber Company
Report No: 2015-02669
407 Lumber Lane
Original Report
Independence,VA 24348
Sample No.: 15-07445
Location: 001
PWSIDIPermit No:
Sample Source: ELKIN
Collected By: T Farthing
DatelTime Collected: 11-19-15/0745
Delivered By: T. Farthing
Date/Time Received At Laboratory:
11-19-15/1035
Received By: Lori Shoemaker
Parameter
Result Uni s
Analytical Method Date/Time Analyzed,Anal s
Chemical Oxygen Demand
55 mg/L
Hach 8000 11-19-15/1216 GLJ
Total Suspended Solids
22.0 mglL
SM 254OD-2011 11-20-15/1120 DLR
Comments:
TSS batch duplicate RPD was outside of QC limits
Sample No.: 15-07446
Location: 002 PWSIDIPermit No:
Sample Source: ELKIN Collected By: T. Farthing
Date[Time Collected: 11-19-15/0755 Delivered By: T. Farthing
Date/Time Received At Laboratory: 11-19-15/1035 Received By: Lori Shoemaker
°QB
VELAP ID: 460033
US EPA LAB ID: VA01164 Page 1 of 4

Report No: 2015-02669
Parameter
Resul
Units
Oil & Grease
6.2
mglL
Chemical Oxygen Demand
144
mglL
Total Suspended Solids
88.8
mg1L
Subcontracted Laboratories:
EPA 1664A
Waypoint Analytical
Comments:
TSS batch duplicate RPD was outside of QC limits.
Location: 003
Sample Source: ELKIN
DatelTime Collected: 11-19-1510810
Date/Time Received At Laboratory: 11-19-15/1035
Analytical Method
EPA1664A
Hach 8000
SM 2540D-2011
DatelTime Analyzed Analys
12-03-15/1500
11-19-1511216 GLJ
11-20-15/1120 DLR
VELAP ID: 460181
Sample No.:
15-07447
PWSIDIPermit No:
Collected By:
T. Farthing
Delivered By:
T. Farthing
Received By:
Lori Shoemaker
Parameter Result Units Analytical Method Date/Time Analyzed Anal
Chemical Oxygen Demand 46 mglL Hach 8000 11-19-15/1216 GLJ
Total Suspended Solids 5.1 mg/L SM 2540D-2011 11-20-15/1120 DLR
Comments:
TSS batch duplicate RPD was outside of QC limits.
Location: 009
Sample Source: ELKIN
Date(Time Collected: 11-19-1510835
Date/Time Received At Laboratory: 11-19-15/1035
Sample No.:
15-07448
PWSIDIPermit No:
Collected By:
T. Farthing
Delivered By:
T. Farthing
Received By:
Lori Shoemaker
Parameter
Result
Units
Analytical Method
Date/Time Analyzed
Analyst
Chemical Oxygen Demand
37
mg/L
Hach 8000
11-19-15/1216
GLJ
Total Suspended Solids
16.0
mglL
SM 2540D-2011
11-20-15/1120
DLR
Comments:
TSS batch duplicate RPD was outside of QC limits.
US EPA LAB ID: VA01164 Page 2 of 4
_ NI
aPo
VELAP ID: 460033

Report No: 2015-02669
Gary Mychei Johnson
Laboratory Manager
The analytical data contained in this report has been validated using standard quality control measures specified by the analytical method, SOP's, and the
Laboratory's Quality Assurance Manual. Unless otherwise noted, all reported results meet the requirements of the analytical method and of NELAP. Parameters
analyzed in the field or designated by a' —'symbol are not included in the Laboratory's Scope of Accreditation. Sample preservation is documented at the time
of receipt and/or during analysis. Unless otherwise noted, analysis was performed on preservation compliant samples.
The analytical data contained in this report relates only to the samples submitted for analysis. This report shall not be reproduced, except in full without the
written permission of EMS, Inc. EMS, Inc. assumes no responsibility, expressed or implied, as to the interpretation or use of the data contained in this report.
The liability of EMS, Inc. in any claim shall be limited to (at the option of EMS, Inc.) repeating the analysis in question or the refund of fees paid.
Please feel free to contact us at 276-228-6464 if you have any questions or need any additional information.
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US EPA LAB ID: VA01164 Page 3 of 4

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INDEPENDENCE LUMBER, INC.
August 18, 2016
Division of Water Quality
y
Attn: Central Files 74e�
1617 Mail Service Center CO
Raleigh, North Carolina 27699-1617 A
To Whom It May Concern;
407 LUMBER LANE
INDEPENDENCE, VA 24348
RECEIVED
AUG % 3 1015
CENTRAL FILES
DN1R SECTION
Reference Permit Number NCG210306
In reference to the Storm Water Pollution Prevention Permit Number NCG210306 for our facility
in Elkin North Carolina please find the enclosed Storm Water Discharge Outfall Monitoring Report for a
rain event that occurred on August 3, 2016.
apologize that I have missed the sampling for the period of January 1, 2016 to June 30, 2016
and ask that this report I am submitting will cover that period. I will also submit another report before
the December 3151 deadline.
If you have any questions give me a call at 276-773-3744 extension 207.
Sincerely;
Tom Fart ing
Director of Environmental
Health and Safety
OFFICE 4 276-773-3744 FAX # [phone]

STORMWATER DISCHARGE OUTF•ALL (SDO)
MONITORING REPORT
GENERAL PERMIT NO. NCG210000 SAMPLES COLLECTED DURING CALENDAR YEAR: AW4
CERTIFICATE OF COVERAGE NO. NCG210®©® (This monitoring report is due at the Division no later than 30 days from
the date the facility receives the sampling results from the. laboratory.)
FACILITYNAME i�r �z �.y�,y _� ,lC_ i=llrta btt)►S(o.J
PERSON COLLECTING SAMPLES `71 /n �At w1b,
CERTIFIED LABORATORY E2JS MSC. Lab # I/W6 6,4
Lab #
Part A: Specific Monitoring Requirementst
COUNTY si_XL:� - REG 1 V Ev
PHONE NO. (2 (P) 34-6- ;ldc) � 3 2A
PLEASF: SIGN ON THE REVERSE 4 AL FILES
'ENAL
�Vvi, SECTION
Outfall
No.
Date
Sample Collected,
moldd/ r
Total Rainfall,
inches
00530
00400
00340
Total Suspended Solids,
nWjL
pH, .
Standard units .
Chemical Oxygen Demand (COD),
m
Benchmark*
-
-
100
Within 6.0 - 9.0
120
0p L
D$ - 4a- aLlitoS
/,V
?W I
Al t
I'1
i?e
`Monitoring is required only if the facility stores exposed piles of sawdust, wood chips, bark, mulch, or other similar material on site for longer than seven (7) days.
If the facility elects not to monitor because accumulated material is removed within seven (7) days or less, the certification below must be signed. The facility shall
also record and maintain a log in its SPPP (Stormwater Pollution Prevention Plan) of dates when material is generated and removed, how, and by whom.
*Note: If you report a value in excess of the benchmark value, or outside the benchmark range (for pH), you must implement Tier i or Tier 2 responses in the General Permit.
Facilities that do not store exposed (either exposed to incident precipitation or exposed to stormwater run on) piles of sawdust, wood chips, bark, mulch, or other similar material for
longer than seven (7) days on site may so certify, and the requirement for analytical monitoring may be waived. For those facilities that qualify for the analytical 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 requirement for
analytical monitoring, I certify that to the best of my knowledge and belief, no piles of sawdust, wood chips, bark, mulch or
other similar materials were sto ed exposed (either to incident precipitation or to stormwater run on) for longer than seven (7)
days before removal since filin the last discharge monitoring report_"
Name (Print name)
Title (Print title)
(Signature)
011;r= /7 -aG%
(Date)
S W U-245-072808
Page I of 2

DID THIS FACILITY PERFORM VEHICLE MAINTENANCE ACTIVIES USING MORE THAN 55 GALLONS OF NEW MOTOR OIL PER MONTH, ON
AVERAGE, IN THE CALENDAR YEAR?
❑ Yes 9L No (If yes, complete Part B)
Part B: Vehicle Maintenance Activity Monitoring Requirements
Outfall
No.
Date
Sample Collected,
cno/dd/yr
00400
00556
00530
Total. Rainfall,
inches
New Motor Oil Usage,
Annual aveiia a gal/mo
pH,
Standard units
Oil and Grease,
mKX
Total Suspended Solids,
Benchmark"
-
6.0'— 9.0
30
100
*Note: 1f you report a 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.
Mail original and one copy to:
Division of Water Quality
Attn: Central Files
1617 Mail Service Center
Ralei h, North Carolina 27699-1617
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED IN PARTS A AND/OR B:
"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 f9r knowing violations."
(Signature of
(Date)
SWU-245-072808
Page 2 of 2