NCG210417_MONITORING INFO_20161102

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
IV C& a? 7
DOC TYPE
❑HISTORICAL FILE
q(MONITORING REPORTS
DOC DATE
❑ �E� �� I I O a
YYYYMMDD

�IV IZ
Stormwater Discharge Outfall
OF v
Qualitative Monitoring Repoa°sil,,QR�
For guidance on filling out this form please visit: http://h2o.enr.state.ne.us/sufFo Doc iments.ht scluMs
Permit No.: NIC/61,21 II Dl D1 GI 0 or Certificate of Coverage No.:
Facility Nance. . 0� PCQUG G
County: _ a o W 6hl Phone No. 7D Ll - Q 78 - 9,Q9l
Inspector: r
Date of Inspection:
Time of Inspection:
Total Event Precipitation (inches):
Was this a Representative Storm Event? (See information below) ❑ Yes 2--No
Please check your permit to verify if Qualitative Monitoring must be performed during a representative
storm event (requirements vary).
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
f occurred. A single storm event may contain up to 10 consecutive hours of no precipitation.
By this signature, I certify that this report is accurate and complete to the best of my knowledge.
(Signature of Permittee or Designee)
L Outfall ription:
Outfall No. _ Structure
Receiving Stream: th- n Q m ej I
industrial activities that occi
ivr. r
ditch, etc.) -i'f �A-1 ti�A 06 fi
1) r- ' I 7 n 1.
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:
�f
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil, weak
chlorine odor, etc.):
Page t of 2
SWU-242- L L 2608

4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is clear
and 5 is very cloudy:
t 2 3 4 S jy�/�-
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: I / �f
1 2 3 4 5 All,
7. Is there any foam in the stormwater discharge? Yes No
S. Is there an oil sheen in the stormwater discharge? Yes No A " 1
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 erosim/deposition may be
indicative of pollutant exposure. These conditions warrant further investigation.
Pago 2 of 2
SWU-242-112608

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit Nwnber: NCS or
Certificate of Coverage Number: NCG
PERSON COLLECTING SAMPLE(S) V
CERTIFIED LABORATORY(S) Lab
Lab
Part A: Specific Monitoring Requirements
SAMPLES COLLECTED DURING CALENDAR YEAR: • nil
(This monitoring report shall be received by the Division no later than 30 days from
the dateWacility receives the sampling results from the laboratory.)
'
��
PIION - NFO�( 7(1 179 -?Wl
�
C3
rlr,5r�[/
E� m
tm ma
1<
(SIGNATURE OF PERMITTEE OR DESIGNEE)
j rn �
o
By this signature, I certify that this report is accurate
�?
¢, rn
complete to the best of my knowledge.
n
f
s
Date}I
Collectedapp.)
!
■�
it:otal
Total
Rainfall!
% I
Does this facility -perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? —yes _no
(if yes, complete Part B)
Part B: VehicIe Maintenance Activity Monito ing Requirements
Outfall
Date
50050
00556 100530
00400
No.
Sample
Collected
Total Flow
(if applicable)
Total Rainfall
Oil & Grease
(if appl.)
Non -polar
O&G/TPH
(Method 1664
SGT-HEM), if
appl.
Total
Suspended
Solids
pH
i
New Motor Oil
Usage
mo/ddl r
MG
inches
MO
Units
al/mo
Form S WU-246-0623 10
Page I of 2

STORM EVENT CHARACTERISTICS:
Datep/6 j�fU 1✓� ��
Total Evert Precipitation (inches):
Event Duration (hours): (only if applicable — see permit.)
(if more than one storm event was sampled)
Date
Total Event Precipitation (inches):
Event Duration (hours): (only if applicable — see permit.)
Mail Original and one copy to:
Division of Water Quality
Attn: Central Files
1617 Mail Service Center
Raleid, North Carolina 27699-1617
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a
system designed to assure that qualified personnel properly gather and evaluate the information submitted, Based on my inquiry of the person
or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best
of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information,
including the possibility of fines and imprisonment for knowing violations."
a /D
I r/
. a_ 422LC� -
(Signature of Permittee (Date)
Form SWU-246 -0623 10
Page 2 of 2

t rmwater Discharge Outfall S
So g t b %
Qualitative Monitoring Report
> C11,
For guidance on filling out this form, please visit- http://h2o.en:r.state.ne.us/su/Forms_Docur6A.htm#miscferms
Permit No.: NIC161 c I % I OI DI OI 0 or Certificate of Coverage No.: NICIGAcQ 1 / !ZI
FacilityName: R U6-112 ` uG
County: _ g o W 4hl Phone No. _ 7014 - Q 7 8 - W 9l
Inspector: AFL
Date of Inspection:
Time of Inspection.
Total Event Precipitation (inches)
Was this a Representative Storm Event? (See information below) ❑ Yes Uv No
Please check your permit to veri, fy if Qualitative Monitoring must be performed during a representative
storm event (requirements vary).
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.
By this signature, I certify that this report is accurate and complete to the best of my knowledge:
(Signature of Permittee or Designee)
L Out all
Outfall No.
Receiving Stream:
Structure (pipe, ditch, etc.) /�) o - fqO d, ?�
industrial activities that occur within the outfall drainage area:
f4 rG r1�r rJe, I?1Grn-��n CA 1.
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.):
Page 1 of 2
SW-242-112608

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 MO-
5. Floating Solids. Choose the number which best describes the amount of flowing solids in the
stormwater discharge, where 1 is no solids and 5 is the surface covered with floating solids:
1 2 3 4 5 /V//5l
6. Suspended Solids: Choose the number which best describes the amount of suspended solids in
the stonnwater discharge, where I is no solids and 5 is extremely muddy:
1 2 3 4 5 N1,4
7. Is there any foam in the stormwater discharge? Yes No
S. Is there an oil sheen in the stormwater discharge? Yes No 111114
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-242-112608

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number: NCS or SAMPLES COLLECTED DURING CALENDAR YEAR: _ QD/
Certificate of Coverage Number: NCG o (This moni�g report shall he received by the Division no later than 30 days from
a r— the date th ility receives the sampling results from the laboratory.)
s
PERSON COLLECTING SAMPLE(S) /'.1a��":VAY �`D
�
CERTIFIED LABORATORY(S) Lab #_.
Lab # ova
r
at
Part A: Specific Monitoring Requirements
m
,.., (SIGNATURE OF PERMITTEE OR DESIGNEE)
m By this signature, I certify that this report is accurate
rn'' 0 complete to the best of my knowledge.
Outfall
1
Dateti
1Total1
Collected
fapp.)I
:
I
�►?�iL�',1JR,Mwklff�
r�Wu
OW*
0AWK01n�r��
Does this facility -perform. Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? yes _no
(if yes, complete Part B)
Part B: Vehicle Maintenance Activity Monitoring Requirements
Outfall
No.
Date
Sample
Collected
50050.
00556
00530
00400
Total Flow
(if applicable)
Total Rainfall
Oil & Grease
(if appl.)
Non -polar
O&GITPH
(Method 1664
SGT-HEM), if
appl.
Total
Suspended
Solids
pH
New Motor Oil
Usage
mo/ddl r
MG
inches
to
mo
Units
gallplo
Form SWU-246-0623 10
Page I of 2

STORM EVENT CHARACTERISTICS:
Date a0/ & A)0 r"/. v LJ
Total Eve t Precipitation (Inc.hes):
Event Duration (hours): .0 (only if applicable — see permit.)
(if more than one storm event was sampled)
Date
Total Event Precipitation (inches):
Event Duration (hours): (only if applicable — see permit.)
Mail Original and one copy to:
Division of Water Quality
Attn: Central Files
1617 Mail Service Center
Ralei:,gh, North Carolina 27699-1617
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a
system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person
or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best
of my knowledge and belief, true, accurate, and complete. 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 (Date)
Form SW 1I-246-062310
Page 2of2

Stormwater Discharge Outfall (SDO�°o,�N <�, �o
A o
Qualitative Monitoring Report s` °F� �6
Forguidance on filling out this form please visit. httpi//h2o,enr.state,nc.us/su/Fo.rms Doccments.h%{ 1?�forrns
Permi t No.: NICI6 l�! % I D/_DI OI 0 or Certificate of Coverage No.: NIGG/d 1 I I01 `) I
FacilityName: HUE i1( ae -IG
County: Rflt,c1w Phone No. _ 704i - a 78 - 9a 9/
Inspector: ' 11 V!�-
Date of Inspection: fl
Time of Inspection: 3,) M
Total Event Precipitation (inches): _ . _]:
Was this a Representative Storm Event? (See information below) Lij,"Y'es ❑ No
Please check your permit to verify if Qualitative Monitoring must be performed during a representative
storm event (requirements vary).
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.
By this signature, I certify that this report is accurate and complete to the best of my knowledge:
(Signature of Permittee or Designee)
1. Outfall Description: n
Outfall No. I Structure (pipe, ditch, etc.) Q G
Receiving Stream: a -tr;bwtery
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:
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil, weak
chlorine odor, etc.): ,5`
Page 1 of 2
S WE T-242- t 12608

4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is clear
and 5 is very cloudy:
] 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:
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
'aand 5 is extremely ,muddy:
1f 2 id / 3 4 5
7. is there any foam in the stormwater discharge? Yes oNo
$. 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 N b
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
Swtl-242-112608

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number: NCS or
Certificate of Coverage Number: NCG d ieglp
FACILITY NAME . - - _ - ,5— RAuz_-Wr"nD P49AU 7A_" PERSON COLLECTING SAMPLE(S) cadDV
CERTIFIED LABORATORY(S) Lab #
Lab #_�
Part A: Specific Monitoring Requirements W
SAMPLES COLLECTED DURING CALENDAR YEAR: !J I
(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.)
co COUNTY )2n 1 m
PHON NO. (-7)
C� LX L'
c. NE .:'
aN) 14 a. (SIGNATURE OF PERMITTEE OR DESIGNEE)
By this signature, I certify that this report is accurate
„ complete to the best of my knowledge.
G 6 C
ea ;u
No.
Date
sample
Collected
Total
Flow :pp
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? yes —no
(if yes, complete Part B)
Part B: Vehicle Maintenance Activity Monitoring Requirements
Outfall
Date
50050
00556
00530
00400
No.
Sample
Collected
Total Flow
(if applicable)
Total Rainfall
Oil & Grease
(if appl.)
Non -polar
O&G/TPH
(Method 1664
SGT-HEM), if
appl.
Total
Suspended
Solids
pH
New Motor Oil
Usage
mo/dd/ r
MG
inches
n
m
Units
al/mo
}
ZVIAi.
& Ce 1/00
Form SWU-246-062310
Page 1 of 2

STORM EVENT CHARACTERISTICS:
Date M ! b7 /%
Total Event Precipitation (inches): ' 7�
Event Duration (hours): qhrf (only if applicable — see permit.)
(if more than one storm event was sampled)
Date
Total Event Precipitation (inches):
Event Duration (hours): (only if applicable — see permit.)
Mail Original and one copy to:
Division of Water Quality
Attn: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a
system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person
or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best
of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information,
including the possibility of fines and imprisonment for knowing violations."
aZ2-4&4�� - loloaI16
(Signature of Permittee) (Date)
Form SWU-246-062310
Page 2 of 2

Analytical Results
Shaver Wood Products
14440 Statesville Blvd
Cleveland, NC 27013
Receive Date: 10/10/2016
Reported: 10/14/2016
For:
Comments:
Sample Number Parameter
Sample ID
Result
Unit Method
Analyzed
Analyst
161010-09-01 Oil and Grease
OF#1
<5.68
mg/L EPA1664Rev8
10/10/2016
CL
161010-09-01 pH
OF#1
6.61
Std. Units SM4500HB-2000
10/10/2016
MD
161010-09-01 TSS
0F#1
29.524
mg/L SM254OD-1997
10/12/2016
CR
Respectfully submitted,
Dena Myers
NC Cert #440,
NCDW Cert #37755,
EPA #NC00909
0
PO Box 228 • Statesville, NC 28687 • 704/872/4697
Page 1 of 3

Condition of Receipt
Sample Number 161010-09-01 Temp on Arrival: 3
pH on Arrival: <2 Parameter Schedule: Oil and Grease
Hydrochloric Acid Received on Ice
Chemicals in containers, lab
Parameter Schedule: TSS
Received on Ice
Parameter Schedule: pH
Received on Ice
Pb Box 228 • Statesville, NC 28687 • 704/872/4697
Page 2of3

S
Client: } /�
!.f � ( ni) Pfil � ou rS
j l� l�
r-
-�
S'I'A'I'I?SVILI.I;ArALY'i'1CAt.
P,o. 87 22ti
122 Court StirectStatesville,
St:ttcsvillc, NC 281i87
[phone]
Chain of
Custody Record
Address: 11-1 y 1- �� T� ��� l n 1_ V9
I („� (�j
r g g i r� h!7 ND N G 2-7vd
Contact Person: ( PAD 'QmVOkPhone #7U11 _ �,?Pr q',7I FAX#,7az-) ,,)71 � 2304)
�
PO # Requisitioned by: (Time Date)
customer
Sample ID#
Lab -ID q
Time sampled
(Grab Only)
Date Sampled
(Grab Only)
a
a
U
Matrix
Parameters requested tvr analysis
swage
w
vnv
OU r 11 1_
"3: I S Pm
0 - 7 - Mo
X
r7+ G rl") Prn ERR
a
P'q C? l 11A 1-1 Or
Relinquished by: f f,� - ! ,#A fQ �! n �� Gt�NI �.� TimeO/7n
Received by: A TimeM%0
Relinquished by: Time
Received by: Time
Composite_ Sampling #1:
Time begin am, pm Date 1IY
Time end am, pm Date _I_I_ Lab Comments:
Composite Sampling #2:
Time begin am, pm Date
Time end am, pm Date
y
am, pm Date AD / /il / I/..
am, pm Date, //0 //4
am, pm Date _l�l_
am, pm Date _I_I_
Sampled by: 11441) S//Adf p
Transported by:
Holding times met:
Compliance work:
Non-compliance work:

�D
Stormwater Discharge Outfall (SOd FNR� I6
Qualitative Monitoring Report t lteRm � 00
g161717/
A61�
16V19-
For guidance on filling out this form, please visa httv:/lh2o.enr.state.nc.us/su/Forms Documents.htm forms
Permit No.: NICI6 /,Ql % I Cal DI Gl 0 or Certificate of Coverage No.: NICIGA9
Facility Name: U� i1 ` uG
County: a 0 tool Phone No. 7D t-1 - Q 7 - 92 9 /
Inspector: )M V2�1
Date of Inspection: 10- 7- / CA
Time of Inspection: 3: 1 Pm
Total Event Precipitation (inches): F 75'�
Was this a Representative Storm Event? (See information below) �es ❑ No
Please check your permit to verify if Qualitative Monitoring must be performed during a representative
storm event (requirements vary).
A "Representative Storm Event" is a storm event that treasures 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.
By this signature, I certify that this report is accurate and complete to the best of my knowledge:
(Signature of Permittee or Designee)
I. Outfall Description:
Outfall No. T/` Stricture (p
Receiving Stream: f).r) - ng m eA fi��4
Describe the industrial activities that occur
2. Color: Describe the color of the
(light, medium, dark) as descriptors: _
ditch, etc.) Q
the outfall drainage area:
using basic colors (red, brown, blue, etc.) and tint
3. Odor: Describe -any distinct odors that the discharge may have (i.e., smells strongly of oil, weak
chlorine odor, etc.): IJe5,
Page 1 of 2
SwU-242- 11260s

0
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is clear
and 5 is very cloudy:
l 2 %�� 4 S
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 g). 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 amend 5 is extremely muddy:
1� 2 j 3 4 5
7. Is there any foam in the stormwater discharge? Yes nNo
S. Is there an oil sheen in the stormwater discharge? Yes hTo
9. Is there evidence of erosion or deposition at the outfall? Yes No
14. Other Obvious Indicators of Storurwater Pollution.:
List and describe N b Mc
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-242-112608
Page 2 of 2

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number: NCS or
Certificate of Coverage Number: NCG, d /0' 11
v
FACILITY NAME 1:5 fAUZU c QQ1) 2900 (-17 fAll
PERSON COLLECTING SAMPLE(S) V =» n v
CERTIFIED LABORATORY(S) _ Lab #'Q
Lab
n '
n
Part A: Specific Monitoring Requirements w
o
SAMPLES COLLECTED DURING CALENDAR YEAR: �J I
(This monitoring report shall he received by the Division no later than 30 days from
the date the facility receives the sampling results from the laboratory.)
COUNTY f2OW41V
o I'HOINI�,c�NO.
('7"y-) .t.
(SIGNATURE OF PERMITTE OR DESIGNEE)
By this signature, I certify that this report is accurate
o complete to the best of my knowledge.
c
its
i
D ate
Sample
Collectedr
--
i
app.)
will
`
� � � i
!!'[w i
��
.i
•
� � � ..
1�, it
__
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? —yes _ -po
(if yes, complete Part B)
Part B. Vehicle Maintenance Activity Monito ing Requirements
Outfall
No.
Date
Sample
Collected
50056
00556
00530
00400
Total Flow
(if applicable)
Total Rainfall
Oil & Grease
(if appl.)
Nan -polar
O&GITPH
(Method 1664
SGT-HEM), if
appl.
Total
Suspended
Solids
pH
New Motor Oil
Usage
moldd/ r
MG
inches
m
m
Units
al/mo
10102
d-7
< '
d � 14
(a i
Form S W U-246-062310
Page 1 of 2

STORM EVENT CHARACTERISTICS:
Date [Z) /Ui /&
Total Event Precipitation (inches)-. � aR
Event Duration (hours): W1r (only if applicable — see permit.)
(if more than one storm event was sampled)
Date
Total Event Precipitation (inches):
Event Duration (hours): (only if applicable —see permit,)
Mail Original and one copy to:
Division of Water Quality
Attn: Central Piles
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a
system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my Inquiry of the person
or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best
of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information,
including the possibility of fines and imprisonment for knowing violations."
� "I jz, (" �
(Signature of Permittee) (Date)
Form SWU-246-0623 10
Page 2 of 2

Analytical Results
Shaver Wood Products
14440 Statesville Blvd
Cleveland, NC 27013
Receive Date: 10/10/2016
Reported: 10/14/2016
For:
Comments:
Sample Number
Parameter
Sample ID
Result
,Unit Method
Analyzed
Analyst
161010-09-01
Oil and Grease
OF#1
<5.68
mg/L EPA1664Rev8
10/10/2016
CL
161010-09-01
pH
0F#1
6.61
Std. Units SM4500HB-2000
10/10/2016
MD
161010-09-01
TSS
OF#1
29.524
mg/L SM25401)-1997
10/12/2016
CR
Respectfully submitted,
Dena Myers
NC Cert #440,
NCDW Cert #37755,
EPA #NC00909
PO Box 228 • Statesville, NC 28687 • 704/872/4697
Page 1 of 3

Condition of Receipt
Sample Number 161010-09-01 Temp on Arrival: 3
PH on Arrival: <2 Parameter Schedule: Oil and Grease
Hydrochloric Acid Received on Ice
Chemicals in containers, lab
Parameter Schedule: TSS
Received on Ice
Parameter Schedule: pH
Received on Ice
PO Box 228 • Statesville, NC 28687 • 704/872/4697
Flag e 2 of 3

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Client: k LA00D f� /�U 6T�
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WATF.SVTI.LEANALYTICAL
Address: ! +
Lr'1 y T �7 � 1 1- L
[22 Coun SUML • P.O. eua 228
Siamvil le, NC UhV
[phone]
MCustody
J
elk IF V191 ) AV L Dy3
Contact Person: ��
p V�K
one Ph
Ivy -
7�3 -5
FAXIi
70H -' 7 - �3D
Chain of
Record
Po # Requisitioned by: (Time Dato)
Cuswmer
SawpIalDR
LOAD s
Tkne Sampled
(GmbOrM
Dato Sarrplod
(Grab )
Skim
Masrhr
w
Hw
Nvernetem nquosted OF analysis
OU PI
Relinquished by: JyI T Time�Op
Received by: I 7L �_..,. Time QD
Relinquished by: -rime
Received by: Time
----
Com osite Sam lin #i:
Time begin am, pm Date —/ /_
Time end am, pm Date —J—J— Lab Comments:
Compashe Sampling 02:
Time begin am, pm Date
Time end am, pm Date _J !—
am, pm Date Ll,al�
am, pm Date./n ✓a / ��
am, pm Date /�1_ _
am, pm Date /�—
Sampled by: CHfo SljhVa
Transported b
Ro Y:
Holding times met:
Compliance work:
Non-compliance work:

STORMWATER DISCHARGE OUI'I<ALL (SDO)
,MONITORING REPORT
GENERAL PF'RMIT NO. NCG210000
CERTIFICATE OF COVERAGE NO. NCG21MZE
FACILITY NAME Cu"
PERSON COLLECTING SAMPLE CERTIFIED LABORATORY LABORATORY Lab # 65V
Lab #
Part A: Specific Monitoring Requirements'
SAMPLES COLLECTED DURING CALENDAR YEAR: J 6
(This monitoring report is clue at the Division no later than 30 days from
the date the facility receives the sampling results from the. laboratory.)
COUNTY ADZ/OiLelOO-
PHONE NO. (74,o
//n 11
PLf:f151: 5[(..i\ ON'T11F, RI":VVIRtit? RECEIVED
SEP 2 6 2016
n r-
Outfall
No.
Date
Sample.Collected,
mo/ddl r
Total Rainfall,
inches
00530
00400
00340
Total Suspended Solids,
mg1L
pH,
Standard units
Chemical Oxygen Demand (COD),
m
Benchmark*
-117--16
100
Within 6.0 — 9.0
120
69
7,6
23
d
--0-
, Z
3
d
TR L F«ES
31 5ECT/0N
'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.
ll' the facility el<.cts not to monitor because accumulated material is removed within seven (7) days or less, the certification below must be signed. The, facility shrill
also record and maintain a log in its SPPP (Stormwater Pollution Prevention Plan) of dates when material is generated and removed, how, and by wham.
*Note: If you report a value in excess of the benchmark value, or outside the benchmark range (for pli), you must implement Tier 1 or Ticr 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."
_ R144,fel-S'eczeeal2s�
Name (Print name) _T
N?/? � Ran4
"Title (Print till )
(Si at e) (Date)
SWIU-245-072808
e1 of

s•
00 0
DID THIS FACILITY PERFORM VEHICLE MAINTENANCE ACTIVIES USING MORE THAN 55 GALLONS OF NEW MOTOR OIL PER MONTH. ON
AVERAGE, IN THE CALENDAR YEAR'!
❑ Yet; Ix
No (If yes, complete fart B)
Part B: Vehicle Mainte rote 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,
nig/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
Ralei h, North Carolina 27699-1617
Yt}Ei �lliti'1' 41(;,\"t'1115 C111"RTIFICIVI'TON FOi: NN' INT'01CMATION ItE:;i'OICI-I1:1? IN PAIZ 1'S A ANIMM I;:
"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
possihilitfif f and jptprisonment fgr knowing violations."
,0 (ezw�/ Se
zi
(Date)
SWU-245-072808
-2of2
n-

f. STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT .
GENERAL PERMIT NO. NCG210000 rv� lJ SAMPLES COLLECTED DURING CALENDAR YEAR: ?&
CERTIFICATE OF COVERAGE NO. NCG2100[]1:1 (This monitoring report is due at the. Division no later than 30 days from
I 1 L the date the facility receives the sampling results from the. laboratory.)
FACILITY NAME �St"am Qa lie C C,-, /� COUNTY (��c�L D�
PERSON COLLECTING SAMPLES r YAO G- / e-LO b RECEIVED PHONE NO.. � l �1100
CERTIFIED LABORATORY Lab* MAY 2 5 2016
Lab# PLEASESIGN
Part A: Specific Monitoring Requirements' CENTRAL
WRSECTION
.;Outfall' :
' No.
Date.
Sample Collected,
moldd/ r.:..
:., _... :.
:. -.Total Rainfall,, :
inches
'.00530 : ...
00400'
00340
Total Suspended Solids,
pH, : `
Standard:units
' Chemical Oxygen Detnand (COD),
m
-Benchmark*
-
100
Within 6.0 - 9:0'
120 =
5-s-
5-�-
.s
7
zro
'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,
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 stonnwater run on) for longer than seven (7)
days before removal since filing the last discharge monitoring report."
Name (Print name)
Title (Print title)
(Sign r (Date)
S W U-245-072808
. . Page 1.

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 kNo (If yes, complete Part B) ry
Part B: Vehicle Maintenance Activity Monitoring Requirements
Outfall
No..
'Date...,` ` '`
Sample Collected,-
mo/dd/yr: c
00400
00556
00530
.Total Rainfall,,
inches • ..
New Motor Oil Usage;
Annual avers e: al/mo
-.pH,
-'Standard units.
` Oil and Grease,
in
To_tal.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 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
Ralei h, North Carolina 27699-1617
YOII :MUST SIGN TIIIS CERTIFICATION FOlt ANY INFOWNIATIOiN ItEPOWITID 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 j nprisonment fqr knowing violations."
11%411114�cl_� 5���..�6
(Signature f Perm- itteey (Date)
SWU-245-072808
• � Page 2 of 2
A

STORMWATI R DISCHARGE OUTFALL (SDO)
MONITORING REPORT
GENERAL PER-Mrr NO. NCG21.0000 SAMPLES COLLECTED DURING CALENDAR YEAR: 20161
CE:RTII+ICATE OF COVERAGE NO. NCG2l❑❑Q❑ (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 NAME CUS40&) -RECEIVED
COUNTY M eCUeiA 64`
PERSON COI.LEC'rING SAMPI.ES, T E MA"to PHONE NO. (70 ) � L/ / O
CERTIFIED LABORATORY Y fyV _ lLab # —55f MAY 2 5 2016
Lab # PLEASE SIGN ON THE REVERSE. 4
CENTRAL FILES
Part A: Specific Monitoring Requirements' r)%AIP tZPrTICIN
Outfall
No,
Date
Sample Collected,
mohldlvr
Total Rainfall,
inches
00530
00400
00340
Total Suspended Solids,
m J
pH,
Standard units
Chemical Oxygen Demand (COD),
=
m ,
Benchmark*
-
-
100
Within
120
0 1
- - i6
-5
165
7.6
Soo
'Note: If a value is in excess of the benchmark, or outside the benchmark range (for pl-1), you must implement the Tier 1 or Tier 2 responses in the General Permit.
'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.
A facility that does not retain exposed (either exposed to incident precipitation or exposed to stormwater run on) piles of sawdust, wood chips, bark, mulch, or other similar material on
site for more than seven (7) clays before removing the material is not required to monitor for the parameters in Table 1 of the General Permit. If at any time the material is not removed
within this time frame, the facility must begin analytical monitoring immediately. (Reminder; This condition does not exempt any facility, fronr qualitative nionitoring of SDOs.)
If the facility removes such materials within seven days to meet the monitoring exemption, the Pcrmittce shall record and maintain in the facility's SPPP a log which documents, at a
minimum, the dates when material is generated and removed, how removed, and by whom. The log must be sufficient to establish that no materials were exposed for longer than seven
days. for record -keeping purposes, the Permittee may also maintain in the SPPP this form with the signed certification below:
"Based upon my inquiry of [lie 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."
M ( 4 swzapa
Name (Print name) j
ay(6,1 Dana YY
Tit(,- (_ nt tit
(5i nature) (Date)
SW U-245-1 10408
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 P(No (If yes, complete Part B)
Part It: 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,
MA
Total Suspended Solids,
mg/L
Benchmark*
-
-
-
6.0 -- 9.0
30
100
*Note: If you report a value in excess of the benchmark value, Of 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 NI UST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED IN PARTS A AND/OR B;
"1 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 persons 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 Permi
- 0 - - . - - -- ., --- - - - - 10
S —I p—,16
(Date)
SWU-245-1 10408
Page 2 of 2
0

STORMWATER DISCHARGE, OUTFALL (SDO)
MONITORING REPORT 7
GENERAL PERMIT NO. NCG210001) C �. p� # �� � � SAMPLES COLLECTED DURING CALENDAR YEAR: zo I [O
CERTIFICATE OF COVERAGE NO. NC&4EEIQO (This monitoring report is due at the Division no later than 30 days from
t tIT da:teltltt�+facility receives the sampling results from the laboratory.)
PXU,-(_� % Cf —'/� G+ V CV COUNTY mP�IL�2I wr
r<ACILITY NAME 6150 MAY 1 � ZQ16
PERSON COLLECTING SAMPLES It -SZL� �� PHONE NO. (_7,,2¢)_ 2! r106_
CERTIFIED LABORATORY k€'W U-0P Lab # 5 NTRAL FILES
Lab #--�WR SECTION PLEASE SIGN ON THE REVERSE 4
Part A: Specific Monitoring Requirementsr
Outfall
No.
Date
Sample Collected,
moldd/vr
Total Raiiifall,
inches
00530
00400
00340
Total Suspended Solids,
mg/L
pH,
Standard units
Chemical Oxygen Demand (COD),
mg/ I.
Benchmark*
-
-
100
Within 6.0 — 9.0
120
.{
z
*Note: If a value is in excess of the benchmark, or outside the benchmark range (for pli), you must implement the Tier 1 or Ticr 2 responses in the Gcncral Permit.
rMonituring is required only if the facility stores exposed piles of sawdust, wood chips, bark, mulch, or other similar material on site for longcs- than seven (7) days_
A facility that does not retain exposed (either exposed to incident precipitation or exposed to storrnwater run on) piles of sawdust, wood chips, bark, mulch, or other similar material on
site for more than seven (7) days before removing the material is not required to monitor for the parameters in Table 1 of the General Permit. If at any bane the material is not removed
within [his time frame, the facility must begin analytical monitoring immediately. (Reminder-: This condition does rant exempt any facility frzirrz qualitative rrronitorixg of SDOs.)
If the facility removes such materials within seven days to meet the monitoring exemption, the Pennitice shall record and maintain in the facility's SPPP a log which documents, at a
rnininxrm, the dates when material is generated and removed, how removed, and by whom. The log must be sufficient to establish that no materials were exposed for longer than seven
days. For record -keeping purposes, the Permiace may also maintain in the SPPP this form with the signed certification below:
"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
stormwatcr run on) for longer than seven (7) days before removal since filing the last discharge monitoring report."
,'Name (Print name)
(-eAl ,
Title (Pri title
i ig ature
0
5-2, - /t/i
(Crate)
CvoY 2--
S W U-245-1 l 0408
�I oft
r'

DID Tll FACILITY PERFORM. VEHICLE MAINTENANCE ACTIVIES USING MORE THAN 55 GALLONS OF NEW MOTOR OIL PER MONTH, ON
AVERAGE, IN THE CALENDAR YEAR?
❑ Yes jJ( No (If yes, complete Part $)
Part IJ: 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/nio
pH,
Standard units
Oil and Grease,
m
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 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
Ralei h, North Carolina 27699-1617
YOU NJUST SIGN THIS CERTIFICATION FOIL ANY INFORMATION REPOItTED IN PARTS A 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."
Permittee)
(Date)
S W U-245-1 10408
Page 2 of 2

RECEIVED
NOV 0 7 n14
CENTP,q FILES DWR SEC7-10N
PROCESS WASTEWATER — Quarterly Discharge Monitoring Report
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF COVERAGE NO. NCG14140418
FACILITY NAME: Thomas Concrete of Carolina- Knightdale Plant
PERSON COLLECTING SAMPLES: Susan Bostian
CERTIFIED LABORATORY: ESC Lab # ENV375
Lab #
LIMIT VIOLATIONS? YES ❑ NO
Part A: Wastewater Monitoring Requirements
SAMPLE COLLECTION YEAR: _2414
SAMPLE QUARTER: ®Jul -Sept ❑Oct -Dec
COUNTY: Wake
PHONE NO. {_919 _ } 557-3144
ADD TO LISTSERVE? ❑YES ®NO EMAIL: _
DISCHARGING TO CLASS: ®SA ❑HQW ❑PNA ❑Trout ❑Other
OPTIONAL INFO:
❑tan -March ❑April -June
Outfall No.
Date Sample
:
Collected
(mm/dd/yr)
Type of Wastewater
NE, RM, MD)z
pH
jstandard)
Total Suspended
Solids
Img/Lj
Settleable
Solids
jmlJL)
TPH usingDischarge
method 3664A
SGT HEAe
mg/L
Duration
{minutes)
Total Flow
(gallons/day)'
6-93.4
W's
01
NO DISCHARGE
' If wastewater systems have not discharged in this quarter-- report "No Flout° or "No Discharge here. Please make sure to mark the sample quarter above.
z Report the abbreviation for the type of Authorized Wastewater Discharges here: Vehicle and Equipment Cleaning (VE), Raw Material Stockpiles (RM), Mixing Drum
Cleanout (MD). Report more than one type if the waste -stream is commingled.
3If an effluent limit is exceeded twice in a row, the permittee is required to institute monthly monitoring for that parameter for six months, unless DWQ RO staff
notifies you to continue monitoring.
` pH limits are 6-9 S.U. for wastewater discharges to freshwaters, and 6.8-8.5 S.U. for discharges to saltwaters.
5 TSS limits are 20 mg/L for wastewater discharges to HQW waters, 10 mg/L for Trout and PNA waters, and 30 mg/L for all other water classifications.
Permit Date: 7/l/2010-06/30/2015 Last Revised D7/13/11
Page 1 of 2

s Process wastewater discharges shall only be monitored for TPH when commingled with stormwater discharges from VMA areas. TPH does not have a limit for wastewater,
but instead Is subject to benchmarks and provisions of Part IV, Section A, including the Tiered Response Action.
Flow rate can be measured continuously or calculated. Flow limits for wastewater discharges to HQW waters shall be set to 50% of the Summer 1Q10 Flow as per 1SA
NCAC 02B .0224. Permittees who discharge wastewater to HQW waters shall obtain a Summer 7Q10 flow and report this information to DWQ- If the permluee cannot
obtain a Summer 7Q10 [low for the receiving waters at the discharge location, the permittee shall notify DWQ, and the DWQ Regional Office may require an annual (low
report on a case -by -case basis.
MAIL ORIGINAL AND ONE COPY OF THIS ANNUAL SUMMARY NNCLUDING ALL "NO FLOW". "NO DISCHARGE") WITHIN 30 DAYS OF RECEIPT OF SAMPLE (OR
AT END OF MONITORING PERIOD IN CASE OF "NO FLOW") TO:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
[phone]
YOU MUST §IGN THIS CER77LI 77PN 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."
f / 11/4/2014
(Signature of Permittee) (Date)
Permit Date: 7/1/2010-06/30/2015 Last Revised 07/13/11
Page 2 of 2

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number: NCS or
Certificate of Coverage Number: NCG d )GL11 i
FACILITY NAME Peel) { _T,
PERSON COLLECTING SAMPLE(S) 111.841) VE
CERTIFIED LABORATORY(S) Lab #
Lab #
Part A. Specific Monitoring Requirements
SAMPLES COLLECTED DURING CALENDAR YEAR: O 1
(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 A°'i(.tAY—__—--- - - „
PHONE, NO. ( 7_�'_) ,9 7f� ••
(SIGNATURE OF PERMITTEE OR DESIGNEE)
By this signature, I certify that this report is accurate
complete to the best of my knowledge.
1
1.
sample
11 I
r•
i
i F
'
iCollected
M
t
1
%rllLw�MEN
s •
/KUM
ME
MINKRINW...
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? yyes _no
(if yes, complete Part B)
Part B: Vehicle Maintenance Activity Monito ing Requirements
Outfall
Date
50050
00556
00530
00400
No.
Sample
Collected
Total Flow
(if applicable)
Total Rainfall
Oil & Grease
(if appl.)
Non -polar
O&G/TPH
(Method 1664
SGT-HEM), if
appl.
Total
Suspended
Solids
pH
New Motor Oil
Usage
moldd/ r
MG
inches
ing
m
Units
galImO
Form SWU-246-062310
Page 1 of 2

STORM EVENT CHARACTERISTICS:
Date _ 5 -) S-1�f
Total Event Precipitation (inches): ,, -7 5—
Event Duration (hours): 4 7 (only if applicable — see permit.)
(if more than one storm event was sampled)
Date
Total Event Precipitation (inches):
Event Duration (hours): (only if applicable — see permit.)
Mail Original and one copy to. -
Division of Water Quality
Attn: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a
system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person
or persons who Inanage 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) (Date)
Dorm SWU-246-062310
Page 2of2

Analytical Results
Shaver Wood Products
14440 Statesville Blvd
Cleveland NC 27013
Entered 5/15/2014
Reported: 5/22/2014
For: Stormwater
Date
Sample ID
Parameter
Cust ID
Result
Units
Method
Analyzed Analyst
140515-23.1
Oil & Grease
Outfal11
<5.2
mg/L
EPA1664RevA
5/21/14
MD
140515-23.1
pH
Outfalll
6.45
STD units
SM4500HB-2000
5/15114
WL
140515-23.1
TSS
Outfalll
940
mg/L
SM254OD-1997
5/16/14
WL
140515-23.2
COD
Outfal12
109
mg/L
HACH8000
5/15/14
CL
140515-23.2
pH
Outfal12
6.52
STD units
SM4500HB-2000
5/15/14
WL
140515-23.2
TSS
Outfa112
88.5
mg/L
SM2540D-1997
5/16/14
WL
140515-23.3
COD
Outfal13
109
mg/L
HACH8000
5/15/14
CL
140515-23.3
pH
Outfal13
6.57
STD units
SM4500HB-2000
5/15/14
WL
140515-23.3
TSS
Outfall3
79.5
mg/L
SM254OD-1997
5/16/14
WL
Respectfully submitted,
Dena Myers
NC Cert #440,
NCDW Cert #37755,
EPA N CO0909
P.O. Box 228 - Statesvil!_le, North Carolina 28687. 704/872/4697
r

,Client: ) 'I I
l r iL # ;1 r y
S 1.
• ��}
STAI'ESVILLEANALYTICAL
122 Court Street • P.O. Box 228
Address:
Statesville, NC 28687
[phone]
Contact Person: ;".i
f
Phone
#
FAX#�Chain
of
Custody Record
PO # Requisitioned by: (Time Date)
Customer
Sample IDk
Sample
Lab -ID #
Time Sampled
(Grab Only)
Date Sampled
(Grab Oniy)
Matrix
parameters requested for a
analysis
SWda.
n
1
( 00'�r: �I
ti]
E�?f'f:U�4rai
f ., ��".. A
A`
k
X
Relinquished by:
Time ;% am,`pm Date/ L 1 ` !
Sampled b f
p y
j
Received by:
if
�P
r`. ,-.,
Time
d , :, `�
am pirl Date
Transported by: �€
Relinquished by:
-----
-- -
-
Time
am, pm Date _ _l�l_
Molding times met:
Received by:
Time
am, pm Date ___I 1
Compliance work:
Composite Sampling
#1:
Time begin
am, pm Date ! /_
Non-compliance work:
Time end
am, pm Date _I_I_
Lab Comments:
Composite Sampling
#2:
01'jI;:
_
`i
�
),(;p)
Time begin
am, pm Date
i/
Time end
am, pm Datel____l____

Condition of Receipt
Sample 1D 140515-23.1-23.3 Client Shaver Wood Producti
Temp on Arrival z
pH upon Arrival <2
pH upon Arrival <'-
pH upon Arrival
pFl upon Arrival
Parameter Schedule COD
❑
HNO3
HCl
NaOH
0
H2S0
Na2S20
❑
Dechlorinated
Parameter Schedule
oil &: Grease
❑
HNO3
-1/1
HCI
❑
NaOH
❑
H2S0
Na2S20
❑
Dechlorinated
Parameter Schedule
PH
❑
HNO3
❑
tic]
❑
NaOH
❑
H2SO
❑
Na2S20
❑
Dechlorinated
Parameter Schedule
TSS
❑
HNO3
HCl
❑
NaOH
❑
H2SO
Na2S20
❑
Dechlorinated
❑ Chemicals in containers,
❑ Chemicals upon receipt
7 Received on lee
Cl Samples chilled upon receipt
EVI Chemicals in containers, lab
❑ Chemicals in containers, client
❑ Chemicals upon receipt
7 Received on lee
❑ Samples chilled upon receipt
W1 Chemicals in containers, lab
❑ Chemicals in containers, client
❑ Chemicals upon receipt
0 Received on Ice
❑ Samples chilled upon receipt
❑ Chemicals in containers, lab
❑ Chemicals in containers, client
❑ Chemicals upon receipt
® Received on Ice
❑ Samples chilled upon receipt
❑ Chemicals in containers, lab
Page 1 of l
P.O. Box 228 • Statesville, North Carolina 28687 • 704/872/4697

yo-
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Forguidance on filling out this form, please visit: http://h2o,eru.state.nc.us/su/Fonns Docurnents-btrn#miscfor ms
Permit No.: NICI61,91 % 1 DI Dl 0l Q or Certificate of Coverage No.: N(C/Gla 1
Facility Name: / P UCINC
County: gnw6hl Phone No. 70`-i - d7a - 9d 9 /
Inspector: d) V�
Date of Inspection:
Time of Inspection:
Total Event Precipitation (inches): o '715-
M,nuyc-S
Was this a Representative Storer Event? (See information below) [!dyes ❑ No
Please check your permit to verify if Qualitative Monitoring must be performed during a representative
storm event (requirements vary).
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.
By this signature, I certify that this report is accurate and complete to the best of my knowledge:
(Signature of Permittee or Designee)
1. Outfall Description:
Outfall No. I_ Structure (pipe, ditch, etc.)
Receiving Stream: f k -nQmed `t!'%i?ufiarY 14, Fo- vrf rl fek
Describe the industrial activities that occur within the outfall drainage area:
Ueyyrc
-
�►
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: _..__. b/b1,0I1 ._npjtuM
3. Odour: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil, weak
chlorine odor, etc.): 0 N -
Page 1 of 2
S WU-242-1 12508

4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is clear
and 5 is very cloudy:
l 2 3 4
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:
l C2 ) 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 6)
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 oatfall? 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 maybe
indicative of pollutant exposure. These conditions warrant further investigation.
Page 2 of 2
SwU-242-112608

Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance on filling out this farm, please visit: htt :Ilh2o.enr.state.nc.us/su/Forms Documents.htm#rnisdornis
Permit No.: NICI619 % 1 DI DI 01 0 orCertificate; of Coverage No.: NICIGIr� 11 I DI `i l I 121
FaciliryName: UE } ` uG
County: krjw4bl Phone No. 7D LI - a 78 - 9 91
Inspector: r:ImD <Slf� --
Date of Inspection: !
Time of inspection:
Total Event Precipitation (inches): o % �j)L F t - H5MA4%S
Was this a Representative Storm Event? (See information below) [dyes ❑ No
Please check your permit to verify if Qualitative Monitoring must be performed during a representative
storm event (requirements vary).
A "Representative Storm Event" is a storm event that measures greaten 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 -
By this signature, I certify that this report is accurate and complete to the best of my knowledge:
(Signature of Perrnittee or Designee)
L. Outfall Description:
Outfall No. a Structure
Receiving Stream: f Afl -nQMeA firms
Describe the industrial activities that occur w
Ro r k 51
ditch, etc.) P + D e
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:. hy-,Dwn _11&r
V
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil, weak
chlorine odor, etc_): _ r)go e-
Page t of 2
SW[J-242-E 125Q8

4. Clarity: Choose the number which best describes the clarity of the discharge, where l is clear
and 5 is very cloudy:
] 2 e-T\ 4 5
S. Floating Solids: Choose the number which best describes the amount of floating solids in the
stormwater discharge, where i is oo solids and 5 is the surface covered with floating solids:
1 2 4 5
6. Suspended Solids: Choose the number which best describes the amount of suspended solids in
the stonnwater discharge, where 1 is no solids and 5 is extremely muddy--
2 3 0 5
7. Is there any foam in the stormwater discharge? Yes Is
8. Is there an oil sheen in the stormwater discharge? Yes DNo
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 erosionldeposition may be
indicative of pollutant exposure. These conditions warrant further investigation.
Page 2 of 2
SWU-242-112608

Stormwate,r Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance on filling out this form, please visit: htt:/ih2o,efu.state.ac.us/sull'orms Documents.htrm#Yisdo-mS
Permit No.: NIC_I C I2I i I DI DI oI C1 or Certificate of Coverage No.: NIC1GIa 1 % IDI J 11 121
Facility Name: UE CQYC
County: _ ko to 171 _ - - Phone No. 70 -1 - a 7 81 - 9,22 /
Inspector: L1114p SA41!e�c
Date of Inspection:
Time of Inspection:
Total Event Precipitation (inches): o % �i n �r1' OWTCS
Was this a Representative Storm Event? (See information below) [dyes ❑ No
Please check your permit to verify if Qualitative Monitoring must be performed during a representative
storm event (requirements vary).
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.
^
By this signature, I certify that this report is accurate and complete to the best of my knowledge:
(Signature of Permittee or Designee)
1. Outfall Description:
Outfall No- .3 Structure (pipe, ditch,
Receiving Stream:
Describe the Idus
r,r. ! . Z -i- 01 rl i
activities that occur within the outfali drainage area: c �� -T(-s i ' ',:_
2. Color: Describe the color of the
(light, medium, dark) as descriptors:
using basic colors (red, brown, blue, etc.) and tint
3. Odor. Describe any distinct odors that the discharge may have (i.e., smells strongly of oil, weak
chlorine odor, etc.)- -- HOM 6
Page I of 2
SWU-242-1 12608

J
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 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 e) 4 5
6. Suspended Solids: Choose the number which best describes the amount of suspended solids in
the storrawaterdischarge, where 1 is no solids and 5 is extremely muddy:
1 2 3 Cq-
5
7. Is there any foam in the stormwater discharge? Yes &11;o,
8. Is there an oil sheen in the storrnwater discharge? Yes ( )
9. is there evidence of erosion or reposition at the outfall? Yes � 07)
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 maybe
indicative of pollutant exposure- These conditions warrant further investigation.
Page 2 of 2
Sw[r-242- 112608

Analytical Results
Shaver Wood Products
14440 Statesville Blvd
Cleveland NC 27013
Entered 5/15/2014
Reported: 5/22/2014
For: Stormwater
Sample ID
Parameter
Cust ID
Result
Units
Method
Date
Analyzed Analyst
140515-24
Oil & Grease
Boiler
17.8
mg/L
EPA1664RevA
5/21/14 MD
140515-24
pH
Boiler
11.5
STD units
SM4500HB-2000
5/15/14 MD
140515-24
T. Chlorine
Boiler
<1
mg/L
SM4500CIG-2000
5/15/14 MD
Respectfully submitted,
l!
Dena Myers
NC Cert #440,
NCDW Cert #37755,
EPA NCO0909
P.O. Box 228 • Statesville, North Carolina 28687. 7041872/4697

Client:
�_���Ci UC"I"
L.t.J I J c-o / -•---
d �%G lfG'7� ..�)^C..:.—
STATESVILLLAhALYTICAL
122 Court Street • P.O. Box 228
Address:
Statesville, NC 28687
[phone]
Contact Person: i
Phone #
FAX
Chain of
Custody Record
PO # Requisitioned by: (Time Date}
Customer
Sample IN
it
Time Sampled
(Grab
(Grab Only}
Date Sampled
(Grab Only)
n
m
a
watrix
Parameters requested for analysis
st��a
v
f
X
IC7f 1ne•
Jna condieg5bia
e
L jz4
]
jo-
Relinquished by:
( 7 W�
- Time _)am,O� Date I
Lj
Sampled by:
Received by:',
r'
Time 12.":
am, m�Date G'1
'I g r
Transported by:
Relinquished by:
Time
am, pm Date _/___
Holding times met: �✓'.
Received by:
Time
am, pm Date /
1
Compliance work: �-•�''"••
Composite Sampling
#1:
Time begin am, pm Date _IJ
Non-compliance work:
Time end am, pm Date hf
Lab Comments:
Composite Sampling
#2:
F.0
PM
Time begin am, pm Date INI
—�'
/7 `-'
Time end am, pm Date _/�
,

Condition of Receipt
Sample ID 140515-24 Client Shaver Wood Products
"Temp on Arrival z
PH upon Arrival `C
PH upon Arrival
pH upon Arrival
Parameter Schedule Oil & Grease
❑
RN03
HCI-
NaOH
❑
H2SO
❑
Na2S20
❑
Dechlorinated
Parameter Schedule
pH
❑
HNO3
HCI
❑
NaOH
❑
H2SO
C1
Na2S20
❑
Dechlorinated
Parameter Schedule
T. Chlorine
❑
HNO3
❑
HCI
LI
NaOH
❑
H2SO
❑
Na2S20
❑
Dechlorinated
❑ Chemicals in containers, client
❑ Chemicals upon receipt
Received on Ice
❑ Samples chilled upon receipt
d❑ Chemicals in containers, lab
❑ Chemicals in containers, client
❑ Chemicals upon receipt
[] Received on Ice
❑ Samples chilled upon receipt
❑ Chemicals in containers, lab
❑ Chemicals in containers, client
❑ Chemicals upon receipt
�� Received on ice
❑ Samples chilled upon receipt
❑ Chemicals in containers, lab
Page 1 of I

C 1 TORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
` f
GENERAL PERMIT NO. NCG2I0000 ;qr' SAMPLES COLLECTED DURING CALENDAR YEAR:
CERTIFICATE OF COVERAGE NO. NCG21000❑ (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 NAME W-� (/ COUNTY
PERSON COLLECTING SAMPLES PHONE NO. (�
CERTIFIED LABORATORY Lab #
Lab # -PLEASF SIGH` ON THE RE- 'ERSE 4
Part A: Specific Monitoring Requirements'
: ,Outfall
No :..
Date
Sample Collected,
molddl r
'Total Rainfall,. ~
inches
.00530 . °.
'00400
00340:
Total Stisgended Solids,
pH, :' '
Standard units
Chemical Oxygen Detuand (COD),
m
'Benchmark*
-
100.
Within 6.0 = 9:0-
120
'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 (Stonnwater 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, mDIch'or-%
other similar materials were stored exposed (either to incident precipitation or to stormwater run on) for longer than sefnf(7)E/ i pj)
days before removal since filing the last discharge monitoring report." �/ —
124t j S'ZG7� p4R, � AIN 19 2014
7 L!4
Name (Print name) /I rya -pt1°rlftp �� SCr10N UAIrr
•-/o
(Date)
S W U-245-072808
PO of 2
•

DID THIS FACILITY PERFORM VEHICLE MAINTENANCE ACTIVIES USING MORE THAN 55 GALLONS OF NEW MOTOR OIL PER MONTH, ON
AVERAGE, 1N THE CALENDAR YEAR?
El Yes n No (If yes, complete Part 13)
Part B. Vehicle Maintenance Activity Monitoring Requirements
,Outfall
No..
:Date
Sample Collected,
-mo/dd/y"r:.:
40440 .
t)4556
00534
'.,Total Rainfall, _ .
inches • ..:
New.Motor Oil Usage,
Annuafaverage: a]Irno
:. pH, '.
'Standard units.
' Oil and Grease,
ril
Total Suspended Solids,
mg/L
Benchmark*
- 6.4'= 9,4
30
140
.t
*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
YOU.NIUS`I' SIGN TIIIS CLRTIF]CAT [ON FOR ANY INFORMATION 12I maji,-U IN I'ARTS A 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 ijMr' or vent fpr knowing violations.".
(Signature o ermittee) (Date)
S WU-245-072808
• � .age 2 of 2

NC& a 10 '417
GENERAL PERMIT NO. NCG210000
STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
CERTIFICATE OF COVERAGE NO. NCG21000❑
FACILITY NAME a54rm
PERSON COLLECTING SAMPLES
CERTIFIED LABORATORY Lab'#
Lab #
Part A: Specific Monitoring Requirements'
SAMPLES COLLECTED DURING CALENDAR YEAR:
(This monitoring report is due at the Division no later than 30 days frotri
the date the facility receives the sampling resu)is from the laboratory.)
COUNTY AOZ 4616()('9
PHONE NO. ( W R2f —t FC30
PLEASE SIGN ON THE REVERSE 4
. �Outfall
No. :.
.Date
Sample Collected,,
moldd/ r .,.
Total Rainfall,.
:'. inches
..00530 .
00400 .
_ 00340
:Total Suspended Solids,
pH, ;'
Standard.tiitits�
tbemical Oxygt n Demand (COD),
m
'Benchmark*
-
100
Within 6.0 = 9:0
120
UQS
FOP— ISUAE
Q5-r—
t-xb 12,1A16
'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 fdischarge monitoring report."
�� Name (Print name).
JUN 0 2 2014 Title (P ' ti eJ_ ' 77 i
CENTRAL FILES
DWQ/80G
S"Z - /4,
(Date)
S W U-245-072808
Pie of 2
0

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 X No (If yes, complete Part B)
Part B: Vehicle Maintenance Act4vity�Mo��toring,R'quirements
::'Outfall
No.
Date,°:.:' -.•.
Sample Collected,:
mo/ddlyr.:
- :. ; -�
s ..:; ..
00400 '
00556
00530
..Total Rainfall, . ,
s � •
inches
New Motor; Oil Usage;,
Annual avera a gallmo
.: pH, '
.'Standard units .
Oil and Grease,
m
'Total.Suspended Solids,
mglL
Benchmark*
- 6.0'=. 9.0 - `
30
100
��it+t7x•`It •vr"1 i�� -+3" .� 1.� � � 1ril• 4.'tl..: �•.. i�X �.1i •'. ,y'' �• i
*Note: If you report a value in excess of the benchmark value, or outside t hesb� �chmark range (for pig), you,must implement Tie"r 1'or Tier 2 responses �ntthe General Permit.
Mail original and one copy to:
Division of Water Quality
Attn: Central Files
1617 Mail Service Center .
Raleigh, North Carolina 27699-1617
YOU 1NlUST SIGN T111S CERTIFICATION FOR ANY INFORMATION REPOIt' ED IN PARTS A AND/01t 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 fin prisonment fQr knowing violations."
(Signs ure o Permitte ` ' �v(Da
ti f
S W U-245-072808
• • 0age 2 of 2

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
GENERAL PERMIT NO. NCG210000 NCC O SAMPLES COLLECTED DURING CALENDAR YEAR:
CERTIFICATE OF COVERAGE NO. NCG21[EOP] [D (This monitoring report is due at the Division no later than 30 days from
f� the date the facility receives the sampling results from the -laboratory.)
FACILITY NAME GUS4o/n `q ��� COUNTY
PERSON COLLECTING SAMPLES PHONE NO. (.7901 -2/ —//Q6
CERTIFIED LABORATORY Lab #
Lab # PLEASE SIGN ON THE Ri VERSE 4
Part A: Specific Monitoring Requirements'
Outfall ::.
No"Sample
�.
'Date
Collected,
tna/dd/ r , .
Total Rainfall,, ,
S inches : ' -
00530 :
00A00°' „
00340
Total Suspended Solids,
m
pH, :
Standard "its'
Chemical Q_sygeu Demand (COD),
m
-Benchmark*.
-
_10W
Within 6.0'- 9:0 '
120 %
620
2
S .d col00d
7.
SS
`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." RECEIVED
A),e4tiell 0794APR1 2014
Name (Print name)
.9
49,
Title (P ' t t' )
(Si ature (D te)
is
CENTRAL FILES
DWQlBOG
S W U-245-072808
Page 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 No (If yes, complete Part B) .
Part B: Vehicle Maintenance Activity Monitoring Requirements
'Outfall 'Date,
No.. Sample Collected;:
jiiolddlyr -=
Benchmark* .
:.
00400 .
.00556
00530
.Total Rainfall,:.
New.Motor.Oil Usage;
pH,'
Oil and Grease,
Total Suspended Solids,
: inches
Anlioal average al/mo
, ,-Standard units .
in
in
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
YOU NIUS`I' SIGN TINS 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 bell, , t e, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the
Dossibility d ines/a+�d rmprisonm9fit fpr knowing violations."
(Signat a of P rmittee) (Date)
SWU-245-072808
Page 2 of 2

k
K & W Laboratories
1 121 Hwy 24/27 W
Midland. North Carolina 28107
Tel [phone] Fax [phone]
Client: Custom Pallet
5104 N. Graham St.
Charlotte, NC 28227
Results Report
Date: 26-Mar-14
Order ID: 14030728
Project:
Location:
Outfall #002
Outfall 4002
Collect Date:
Collect Time:
3/7/2014
4:37:00 PM
REPORTING ANALYSIS
SAMPLE #
PARAMETER
RESULT
UNITS
METHOD
LIMIT
DATE
14030728-01
COD
155
mg1L
SM5220D
10
3/21/2014
14030728-01
pH
7.9
units
SM4500H+8
0.1
3/7/2014
14030728-01
TSS
138
mg/L
SM25400
2.5
3/10/2014
NC Certification: 559 SC Certification: 99051
Certified BY,;u�� .._
G. Kraska / Lab Director

v
K & W Laboratories
1121 Hwv 24/27 W
Midland, North Carolina 28107
Tel [phone] Fax [phone]
Client: Custom Pallet
5104 N. Graham St.
Charlotte, NC 28227
Results Report
Date: 26-Mar-14
OrderlD: 14030727
Project:
Location:
OutfalI #001
Outfail 4001
Collect Date:
Collect Time:
3/7/2014
4:42:00 PM
REPORTING ANALYSIS
SAMPLE #
PARAMETER
RESULT
UNITS
METHOD
LIMIT
DATE
14030727-01
COD
620
mg/L
SM52200
10
3/21/2014
14030727-01
pH
7.1
units
SM4500H+B
0.1
3f712014
14030727-01
TSS
148
mg/L
SM2540D
2.5
3/10/2014
NC Certification: 559 SC Certification: 99051
Certified By 6.
G. Kraska I Lab Director