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Home My WebLink AboutNCG030103_MONITORING INFO_20190819STORMWATER DIVISION CODING SHEET NCG PERMITS PERMIT NO. w �� (D3 n O 3 DOC TYPE. ❑ HISTORICAL FILE E( MONITORING REPORTS DOC DATE ❑ a 7 CA 19 YYYYMMDD Stormwater Discharge Monitoring Report for North Carolina Division of Energy, Mineral and Land Resources General Permit No. NCG030000 Date submitted CERTIFICATE OF COVERAGE NO. NCG03 0 1 0 3 FACILITY NAM Moen Inwrporated COUNTY Lee (n 6 PERSON COLL CTING SAMPLES John West LABORATORY Prism Lab Cert. # 402 Comments on sample collection or analysis: Part A: Stormwater Benchmarks and Monitoring Results SAMPLE COLLECTION YEAR 2019 SAMPLE PERIOD ❑ Jan -June ❑ July -Dec or E] Monthly' 06 (month) �� IjcEDDvV-ISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA ❑Zero -flow ❑Water Supply [:]SA AUG 1 9 2019 *Other c CENT RAC FILES PLEASE REMEMBER TO SIGN ON PAGES 2 AND/OR 3 4 DWR SECTION ❑ No discharge this period?' Outfall No. Date Sample Collected' (mo/dd/yr) 24-hour rainfall amount, Inches& Total Suspended Solids pH, Standard units Total Copper Total Lead Total Zinc Non -Polar O&G/ Total Petroleum Hydrocarbons Total Toxic Organicss Benchmarks _ - 100 mg/L or 50 mg/O 6.0 — 9.0 0.010 mg/L 0.075 mg/L 0.126 mg/L 15 mg/L 1 mg/L Parameter Code - 46529 COS30 00400 01119 01051 01094 00552 78141 01 6/12/19 0.55 2.6 7.2 0.020 <0.0020 0.11 <5.0 NA 03 6/12/19 0.55 17 6.3 0.0061 <0.0020 0.027 <5.0 NA ' Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall. z For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here. 3The total precipitation must be recorded using data from an on -site rain gauge. Unattended sites may be eligible for a waiver of the rain gauge requirement. ° See General Permit, Section B, Table 1 to identify the especially sensitive receiving water classifications where the more protective benchmark applies. s Total Toxic Organics sampling is applicable only for those facilities which perform metal finishing operations, manufacture semiconductors, manufacture electronic crystals, or manufacture cathode ray tubes. For purposes of this permit the definition of Total Toxic Organics is that definition contained in the EPA Effluent Guidelines for the facility subject to the requirement to sample (for metal finishing use the definition as found in 40 CFR 433.11; for semiconductor manufacture use the definition as found in 40 CFR 469.12; for electronic crystal manufacture use the definition as found in 40 CFR 469.22; and for cathode ray tube manufacture use the definition found in 40 CFR 469.31). Permit Date: il/1/2018-05/31/2021 SWU-245, last revised 11/1/2018 Page 1 of 3 Facilities that incorporate a solvent management plan into the Stormwater Pollution Prevention Plan may so certify, and the requirement for TTO monitoring may be waived. The solvent management plan shall include a list of the total toxic organic compounds used and the other elements listed in the General Permit. For those facilities electing to employ the TTO monitoring waiver, the discharger shall sign the following certification statement: "Based upon my inquiry of the person or persons directly responsible for managing compliance with the permit monitoring requirement for total toxic organics (TTO), I certify that to the best of my knowledge and belief, no dumping of concentrated toxic organics into the stormwater or areas which are exposed to rainfall or stormwater runoff has occurred since filing the last discharge monitoring report. I further certify that this facility is implementing the all the provisions of the solvent management plan included in the Stormwater Pollution Prevention Plan." Chris Gundler Name (Print name) Plant Manager Title (P/ tle/)� 7 M Signature Date Note: Results must be reported in numerical format. Do not report Below Detection Limit, BDL, <PQL, Non -detect, ND, or other similar non -numerical format. When results are below the applicable limits, they must be reported in the format, "<XX mg/L", where XX is the numerical value of the detection limit, reporting limit, etc. in mg/L. Note: If you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses. See General Permit text. Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month. n No discharge this period?' Outfall No. Date Sample Collected' (mo/dd/yr) 24-hour rainfall amount, Inches3 New Motor Oil or Hydraulic Oil Usage Non -Polar O&G/ Total Petroleum Hydrocarbons Total Suspended Solids Benchmarks - - - 15 mg/L 100 mg/L or 50 mg/L4 Parameter Code - 46529 NCOIL 00552 CO530 Footnotes from Part A also apply to Part B Note: If you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses. See General Permit text. Permit Date: 11/1/2018-05/31/2021 SWU-245, last revised 11/1/2018 Page 2 of 3 FOR PART A AND PART B MONITORING RESULTS: • A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B. • 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART II SECTION B. • TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANYONE OUTFALL? YES ❑ NO ❑ IF YES, HAVE YOU CONTACTED THE DEMUR REGIONAL OFFICE? YES ❑ NO ❑ REGIONAL OFFICE CONTACT NAME: Mail an original copy of this DMR, including all "No Discharge" reports, within 30 days of receipt of the lab results for of end of monitoring period in the case of "No Dischorae" reports) to: Division of Water Quality Attn: DWQ Central Files 1617 Mail Service Center Raleigh, North Carolina 27699-1617 YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED: "I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations." Signature of Permittee Permit Date: 11/1/2018-05/31/2021 Date SWU-245, last revised 11/1/2018 Page 3 of 3 LW�"B�,IqM Moen, Inc John West 2609 Cox Mill Rd. Sanford, NC 27330 NC Certification No. 402 Full -Service Analytical & NC Drinking Water Can No. 37735 Environmental Solutions SC Certification No. 99012 Project: Stormwater Lab Submittal Dale: 06/14/2019 Prism Work Order: 9060244 Case Narrative 6/26/19 15:24 This data package contains the analytical results for the project identified above and includes a Case Narrative, Sample Results and Chain of Custody. Unless otherwise noted, all samples were received in acceptable condition and processed according to the referenced methods. Data qualifiers are flagged individually on each sample. A key reference for the data qualifiers appears at the end of this case narrative. Please call if you have any questions relating to this analytical report. Respectfully, PRISM LABORATORIES, INC. EM( at' Terri W. Cole Project Manager Data Qualifiers Key Reference: BRL Below Reporting Limit MDL Method Detection Limit RPD Relative Percent Difference Reviewed By Jackie Ziner For Terri W. Cole Project Manager Results reported to the reporting limit. All other results are reported to the MDL with values between MDL and reporting limit indicated with a J. This report should not be reproduced, except in its entirety, without the written consent of Prism Laboratories, Inc. 449 Springbrook Road - P.O. Box 240543 - Charlotte, NC 28224-0543 Phone: 7041529-6364 -Toll Free Number: 1-800/529-6364 - Fax: 704/525-0409 Page 1 of 6 PRISM Full-sarvlceAnalytloal a Sample Receipt Summary Environmental Solutions 06/26/2019 ,�eanxicaira ixc Prism Work Order: 9060244 Client Sample ID Lab Sample ID Matrix Date/Time Sampled Date/Time Received 01 9060244-01 Water 06/12/19 19:20 06/14/19 13:30 03 9060244-02 Water 06/12/19 19:25 06/14/19 13:30 Samples were received in good condition at 2.8 degrees C unless otherwise noted. This report should not be reproduced, except in its entirety, without the written consent of Prism Laboratories, Inc. 449 Springbrook Road - P.O. Box 240543 - Charlotte, NC 28224-0543 Phone: 704/529-6364 -Toll Free Number: 1-8001529-0364 - Fax: 704/525-0409 Page 2 of 6 A runI-SeNlee seR I S M I Evironmental Solutions 7ivaw.iwlCx xc Moen, Inc Project: Stormwater Attn: John West 2609 Cox Mill Rd. Sanford, NC 27330 Sample Matrix: Water Laboratory Report 06/26/2019 Client Sample ID: 01 Prism Sample ID: 9060244-01 Prism Work Order: 9060244 Time Collected: 06/12/19 19:20 Time Submitted: 06/14/19 13:30 Parameter Result Units Report MDL Dilution Method Analysis Analyst Batch Limit Factor DateTme ID General Chemistry Parameters Oil & Grease (HEM) BRL mg/L 5.0 1.7 1 '1664B 6121/19 9:33 SLS P91`0340 Total Suspended Solids 2.6 mg/L 2.5 0.70 1 •SM2540 D 6117119 16:53 CBM P9F0264 Total Metals Copper 0.020 Lead BRL Zinc 0.11 mg/L 0.0050 0.0026 1 '200.8 6125/19 19:54 JAB P91`0326 mg/L 0.0020 0.00082 1 '200.8 6/25119 19:54 JAB P9F0326 mg/L 0.020 0.0071 1 '200.8 6125119 19:54 JAB P9F0326 This report should not be reproduced, except in its entirety, without the written consent of Prism Laboratories, Inc. 449 Springbrook Road - P.O. Box 240543 - Charlotte, NC 28224-0543 Phone: 7041529-6364 - Toll Free Number: 1-8001529-6364 - Fax: 7041525-0409 Page 3 of 6 &P�'— I S M 4Laboratory mice I Fullir omen Report EnWronmentel Solutions al Solutio 06/26/2819 Moen, Inc Project: Stormwater Client Sample ID: 03 Attn: John West Prism Sample ID: 9060244-02 2609 Cox Mill Rd. Prism Work Order: 9060244 Sanford, NC 27330 Sample Matrix: Water Time Collected: 06/12/19 19:25 Time Submitted: 06/14/19 13:30 Parameter Result Units Report MDL Dilution Method Analysis Analyst Batch Limit Factor Date/Time ID General Chemistry Parameters Oil & Grease (HEM) BRL mg/L 5.0 1.7 1 '1664B 6/21/19 9:33 SLS P91`0340 Total Suspended Solids 17 mg/L 10 0.70 1 'SM2540 D 6117/19 16:53 Calls P9F0264 Total Metals Copper 0.0061 mg/L 0.0050 0,0026 1 •200.8 6125/19 20:14 JAB P9F0326 Lead BRL mgr- 0.0020 0.00082 1 *200.8 6/25/19 20:14 JAB P9F0326 Zinc 0.027 ni 0.020 0.0071 1 *200.8 6125119 20:14 JAB P9F0326 This report should not be reproduced, except in its entirety, without the written consent of Prism Laboratories, Inc. 449 Springbrook Road - P.O. Box 240543 - CharloHe, NC 28224-0543 Phone: 704/529-6364 - Toll Free Number: 1-800/529-6364 - Fax: 7041525-0409 Page 4 of 6 Sample Extraction Data Prep Method: 200.8 Lab Number Batch Initial Final DateMme 9060244-01 P91`0326 50 mL 50 mL O6/21119 7:10 9060244-02 P9F0326 50 mL 50 mL O6/21/19 7:10 This report should not be reproduced, except in its entirety, without the written consent of Prism Laboratories, Inc. 449 Springbrook Road - P.O. Box 240543 - Charlotte, NC 28224-0543 Phone: 7041529-6364-Toll Free Number: 1-800/52"364 - Fax: 7041525-0409 Page 5 of 6 Almism IFull-Service Analytical& Environmental Solutions u9eM1pRIE4 PS 449 Springbrook Road • Charlotte, NC 2a217 Phone 7041529.63E4 • Fax: 7041525-0409 Client Company Name:Srtt•- Report To/Contact Name: lli Reporting Address: CHAIN OF CUSTODY RECORD PAGE OF OUOTE O TO ENSURE PROPER BILUNOr Project Name: 1..✓r ,/ / 7 j Tl)"O"Ay. 7-r /- Short Hold Analysis: (Yes) (No) UST Project (Yes) (NO) *Please ATTACH any project specific reporting (QC LEVEL 111111 IV) provisions andlor QC Requirements Invoice To: Address: YES NO Samples INTACT upon arrival? Received ON WET ICE? . -_ PROPER PRESERVATIVES "indicated?' Received WITHIN HOLDING TIMES? ' v... CUSTODY SEALS INTACT? VOLATILES rec'd W/OUT HEADSPACE? TEMP. Therm aem T rnotre 7/Sl zssr-TS s / Fax (Yes) (No):ffpl SfC— 76 Purchase Order No./Billing Reference Email TO BE FILLED IN BY CLIENT/SAMPLING PERSONNEL ddress: iJesf'P'ryrveiq-i•e,es dreel_Other Requested Due Date O 1 Day O 2 Days ❑ 3 Days O 4 Days 5 Days Certification: NELAC DoD FL NC EDD T PDF YPe� •mr«kbng Days" ❑ e-s Days O slerdam 10 days ❑Rash Work Mud Be o — Site Location Name: Pre -Approved Samples received after 14:00 will be processed next business day. SC_ OTHER WA She Location Physical Address: Turnaround time is based on business days, excluding weekends and holidays. Water Chlorinated: YES_ NO (SEE REVERSE FOR TERMS a CONDITIONS REGARDING SERVICES RENDERED By PRISM LABORATORIES. NC. TO CLIENT) Sample Iced Upon Collection: YES_ NO — TIME MATRIX SAMPLE CONTAINER ANALYSIS REQUESTED CLIENT DATE COLLECTED ($OIL, PRESERVA- - PRISM *TYPE SAMPLE DESCRIPTION COLLECTED MILITARY WATER OR TiVE9 REMARKS LAB HOURS SLUDGE) SEE BELOW NO. SUE ID NO. 01 s A cv En- one 735 !M 1 9 I w >6 700 3 o Z- AA10z, P 1NOMs Sampler's Signature Sampled By (Print Name) - rd ry Affiliation / F 1 D/ ✓I Upon relinquishing, this Chain of Custody is your authorization for Prism to proceed with the anatyees as requested above. Any changes must be submitted in writing to the Prism Project Manager. There will be charges for any changes altar analyses have been Initialized. . ( reme) - my . Additional Comments: Site Arrival Time: RaM4uanw0 BY• ( rc)Reoelvw By (Sig.wia) Dab Site Departure Time: Rellrpubhed BY:(SlgraWra) era wP' lakrca9mbs By: DW Field Tech Fee: 614 t 9 3 O Mileage: Ateliio0 or Siipment NOTE: ALL 9AYPLE COOLCRa SH TAPED 8 I!T WITH C ODY SEALS r TRANSPORTATIONT67R LABORATORY. SAMPLES ARE NVE NOT ACCEPTED AND RIFIEDAGMNST COC1JMT1tECErVED AT THE LABORATORY. n i ❑ Fed a ❑ UPS O HsWd Jived ❑ Pds. Field Servka O Garr NPDES: UST: GROUNDWATER: DRINKING WATER: SOLID WASTE: RCRA: CERCLA LANDFILL OORRVINM M. ❑NC❑SC ❑NC ❑SC ❑NC ❑SC ❑NC ❑SC I El NC El SC I ❑❑NC LI ❑NC ❑SC ❑NC ❑SCI ❑NC.❑SC I ❑ ❑ ❑THER: ❑ ❑ —. _ — 'CONTAINER TYPE CODES A= Amber C = Clear G= Glass P = Plastic; TL = Teflon-LIned Cap VOA = Volatile Organics Analysis (Zeno Head Space) ORIGINAL Storm Water Discharge Ou fall Qualitative Monitoring Rego®rt (To be completed during a rainfall.) For: Moen Incorporated, 2609 Cox Mill Road, Sanford, NC 27332 (919) 258-3341 Certificate of Coverage No.: NCG030103 Receiving Stream: Trib. Of Carrs Creek / . Inspector: P h n ; s o �e Date: �� Time: UO //l' Weather Conditions: j t� By this signature, I certify that t 's report is accurate and complete to the beat of my Knowledge: C Inspector Outfall Number 1 2 3 4 Color: Describe the color of the discharge using basic colors / Crsh STI L , (red, blue, brown, etc. and tint (light, medium, dark) ss "None" ( descriptors. Write if no color is present. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil, weak chlorine odor, etc.). Write "None" is �{ no odor is present. Clarity: Choose the number which best describes the clarity of the discharge 1 is / 2 —� where clear and 10 is very cloudy. Floating Solids: Choose the number which best describes the amount of floating solids in the stormwater discharge where 1 is no solids and 10 is the surface covered in floating solids. Suspended Solids: Choose the number which best describes the amount of suspended solids in the stormwater discharge ) Z where 1 is no solids and 10 is extremely muddy. Foam: Is there any foam in the stormwater discharge? YES or NO niv j� Oil Sheen: Is there an oil sheen in the stormwater discharge? YES or NO NJ !,J Other Obvious Indicators of Stormwater Pollution: YES or NO. If 'YES," list the outfall number and describe below. fJ D rl wrnments: Note: Low clarity, high solids, and/or the presence of foam or oil sheens may be indicative of pollutant exposures. These conditions must be reported to the Environmental Coordinator and warrant further investigation. Stormwater Discharge Monitoring Report for North Carolina Division of Energy, Mineral and Land Resources General Permit No. NCG030000 CERTIFICATE OF COVERAGE NO. NCG03 o 1 0 3 FACILITY NAME Moen Inmrporated COUNTY Lee PERSON COLLECTING SAMPLES John West LABORATORY Prism Date submitted Lab Cert. # 402 Comments on sample collection or analysis: Part A: Stormwater Benchmarks and Monitoring Results SAMPLE COLLECTION YEAR 2019 SAMPLE PERIOD ❑ Jan -June ❑ July -Dec or Q Monthly' US (month) DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA ❑Zero -flow ❑Water Supply ❑SA *Other c PLEASE REMEMBER TO SIGN ON PAGES 2 AND/OR 3 4 ❑■ No discharge this period?' Outfall No. Date Sample Collected' (mo/dd/yr) 24-hour rainfall amount, Inches3 Total Suspended Solids pH, Standard units Total Copper Total Lead Total Zinc Non -Polar O&G/ Total Petroleum Hydrocarbons Total Toxic Organics' Benchmarks - - 100 mg/L or 50 mg10 6.0 — 9.0 0.010 mg/L 0.075 mg/L 0.126 mg/L 15 mg/L 1 mg/L Parameter Code - 46529 C0530 00400 01119 01051 01094 00552 78141 ' Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall. Z For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here. 'The total precipitation must be recorded using data from an on -site rain gauge. Unattended sites may be eligible for a waiver of the rain gauge requirement. See General Permit, Section B, Table 1 to identify the especially sensitive receiving water classifications where the more protective benchmark applies. 5 Total Toxic Organics sampling is applicable only for those facilities which perform metal finishing operations, manufacture semiconductors, manufacture electronic crystals, or manufacture cathode ray tubes. For purposes of this permit the definition of Total Toxic Organics is that definition contained in the EPA Effluent Guidelines for the facility subject to the requirement to sample (for metal finishing use the definition as found in 40 CFR 433.11; for semiconductor manufacture use the definition as found in 40 CFR 469.12; for electronic crystal manufacture use the definition as found in 40 CFR 469.22; and for cathode ray tube manufacture use the definition found in 40 CFR 469.31). Permit Date: 11/1/2018-05/31/2021 SWU-245, last. revised 11/1/2018 - - - - - - Page 1 of 3 - Facilities that incorporate a solvent management plan into the Stormwater Pollution Prevention Plan may so certify, and the requirement for TTO monitoring may be waived. The solvent management plan shall include a list of the total toxic organic compounds used and the other elements listed in the General Permit. For those facilities electing to employ the TTO monitoring waiver, the discharger shall sign the following certification statement: "Based upon my inquiry of the person or persons directly responsible for managing compliance with the permit monitoring requirement for total toxic organics (TTO), I certify that to the best of my knowledge and belief, no dumping of concentrated toxic organics into the stormwater or areas which are exposed to rainfall or stormwater runoff has occurred since filing the last discharge monitoring report. I further certify that this facility is implementing the all the provisions of the solvent management plan included in the Stormwater Pollution Prevention Plan." Chris Gundler Name (Print name) Plant Manager Title (Pr t i e) 711 e) Signature Date Note: Results must be reported in numerical format. Do not report Below Detection Limit, BDL, <PQL, Non -detect, ND, or other similar non -numerical format. When results are below the applicable limits, they must be reported in the format, "<XX mg/L", where XX is the numerical value of the detection limit, reporting limit, etc. in mg/L. Note: If you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses. See General Permit text. Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > SS gal of new oil per month. ❑ No discharge this period?z Outfall No. Date Sample Collected' (mo/dd/yr) 24-hour rainfall amount, Inches3 New Motor Oil or Hydraulic Oil Usage Non -Polar O&G/ Total Petroleum Hydrocarbons Total Suspended Solids Benchmarks - - - 15 mg/L 100 mg/L or 50 mg/L4 Parameter Code - 46529 NCOIL 00552 CO530 Footnotes from Part A also apply to Part B Note: If you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses. See General Permit text. Permit Date: 11/1/2018-05/31/2021 _ SWU-245, last revised 11/1/2018 Page 2 of 3 FOR PART A AND PART B MONITORING RESULTS: • A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B. • 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART II SECTION B. • TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES ❑ NO ❑ IF YES, HAVE YOU CONTACTED THE DEMLR REGIONAL OFFICE? YES ❑ NO ❑ REGIONAL OFFICE CONTACT NAME: Mail an original copy of this DMR, including all "No Discharge" reports, within 30 days of receipt of the lab results (or at end of monitoring period in the case of "No Discharge" reports) to: Division of Water Quality Attn: DWQ Central Files 1617 Mail Service Center Raleigh, North Carolina 27699-1617 YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED: "I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations." Signature of Permittee Permit Date: 11/1/2018-05/31/2021 Date _SWU-245, last revised 11/1/2018 Page 3 of 3 Stormwater Discharge Monitoring Report for North Carolina Division of Energy, Mineral and Land Resources General Permit No. NCG030000 CERTIFICATE OF COVERAGE NO. NCG03 0 1 0 3 FACILITY NAME Moen Incorporated COUNTY Lee PERSON COLLECTING SAMPLES John West LABORATORY Prism Date submitted Lab Cert. ft 402 Comments on sample collection or analysis: Part A: Stormwater Benchmarks and Monitoring Results SAMPLE COLLECTION YEAR 2019 SAMPLE PERIOD ❑ Jan -June July -Dec or 0 Monthly' US [month) DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA ❑Zero -flow ❑Water Supply ❑SA QOther C PLEASE REMEMBER TO SIGN ON PAGES 2 AND/OR 3 4 n Ain riicrvhnrno Chic norin,02 Outfall No. Date Sample Collected, (mo/dd/yr) 24-hour rainfall amount, Inches' Total Suspended Solids pH, Standard units Total Copper Total Lead Total Zinc Non -Polar O&G Total Petroleum Hydrocarbons Total Toxic Organicss Benchmarks _ - 100 mg/L or So mg/L4 6.0 — 9.0 0.010 mg/L 0.075 mg/L 0.126 mg/L 15 mg/L 1 mg/L Parameter Code - 46529 C0530 00400 01119 01051 01094 00552 78141 iviontniy sampling (Instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall. Z For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here. 'The total precipitation must be recorded using data from an on -site rain gauge. Unattended sites may be eligible for a waiver of the rain gauge requirement. 4 See General Permit, Section B, Table 1 to identify the especially sensitive receiving water classifications where the more protective benchmark applies. s Total Toxic Organics sampling is applicable only for those facilities which perform metal finishing operations, manufacture semiconductors, manufacture electronic crystals, or manufacture cathode ray tubes. For purposes of this permit the definition of Total Toxic Organics is that definition contained in the EPA Effluent Guidelines for the facility subject to the requirement to sample (for metal finishing use the definition as found in 40 CFR 433.11; for semiconductor manufacture use the definition as found in 40 CFR 469.12; for electronic crystal manufacture use the definition as found in 40 CFR 469.22; and for cathode ray tube manufacture use the definition found in 40 CFR 469.31). Permit Date: 11/1/2018-05/31/2021 _ - _ SWU-245, last revised 11/1/2018 - - " - - Page 1 of 3 Facilities that incorporate a solvent management plan into the Stormwater Pollution Prevention Plan may so certify, and the requirement for TTO monitoring may be waived. The solvent management plan shall include a list of the total toxic organic compounds used and the other elements listed in the General Permit. For those facilities electing to employ the TTO monitoring waiver, the discharger shall sign the following certification statement: "Based upon my inquiry of the person or persons directly responsible for managing compliance with the permit monitoring requirement for total toxic organics (TTO), I certify that to the best of my knowledge and belief, no dumping of concentrated toxic organics into the stormwater or areas which are exposed to rainfall or stormwater runoff has occurred since filing the last discharge monitoring report. I further certify that this facility is implementing the all the provisions of the solvent management plan included in the Stormwater Pollution Prevention Plan." Chris Gundler Name (Print name) Plant Manager Title (Pr' t/i e) r/ !- / 7 / llql Signature Date Note: Results must be reported in numerical format. Do not report Below Detection Limit, BDL, <PQL, Non -detect, ND, or other similar non -numerical format. When results are below the applicable limits, they must be reported in the format, "<XX me/L", where XX is the numerical value of the detection limit, reporting limit, etc. in mg/L. Note: If you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses. See General Permit text. Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month. ❑ No discharge this period ?2 Outfall No. Date Sample Collected' (mo/dd/yr) 24-hour rainfall amount, Inches' New Motor Oil or Hydraulic Oil Usage Non -Polar O&G/ Total Petroleum Hydrocarbons Total Suspended Solids .Benchmarks _ - - 15 mg/L 100 mg/L or 50 mg/L4 Parameter Code - 46529 NCOIL - 00552 C0530 Footnotes from Part A also apply to Part B Note: If you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses. See General Permit text. Permit Date: 11/1/2018-05/31/2021 SWU-245, last revised 11/1/2018 - _ _ Page 2 of 3 FOR PART A AND PART B MONITORING RESULTS: • A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B. • 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART II SECTION B. • TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER ATANY ONE OUTFALL? YES ❑ NO ❑ IF YES, HAVE YOU CONTACTED THE DEMLR REGIONAL OFFICE? YES ❑ NO ❑ REGIONAL OFFICE CONTACT NAME: Mail an original copy of this DMR, including all "No Discharge" reports within 30 days of receipt of the lab results for at end of monitoring Period in the case of No Discharge reports) to. - Division of Water Quality Attn: DWQ Central Files 1617 Mail Service Center Raleigh, North Carolina 27699-1617 YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED: "I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. 1 am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations." Signature of Permittee Permit Date:11/i/2018-05/31/2021 Date SWU-245, last revised 11/1/2018 Page 3 of 3 Stormwater Discharge Monitoring Report for North Carolina Division of Energy, Mineral and Land Resources General Permit No. NCG030000 Date submitted CERTIFICATE OF COVERAGE NO. NCG03 0 1 0 3 FACILITY NAME Moen Incorporated COUNTY Lee PERSON COLLECTING SAMPLES John West LABORATORY Prism Lab Cert. # 402 Comments on sample collection or analysis: Part A: Stormwater Benchmarks and Monitoring Results SAMPLE COLLECTION YEAR 2019 SAMPLE PERIOD ❑ Jan -June ❑ July -Dec or Q Monthly' 0`z (month) DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA ❑Zero -flow ❑Water Supply ❑SA *Other C PLEASE REMEMBER TO SIGN ON PAGES 2 AND/OR 3 --> ❑ No discharge this period?' Outfall No. Date Sample Collected' (mo/dd/yr) 24-hour rainfall amount, Inches' Total Suspended Solids pH, Standard units Total Copper Total Lead Total Zinc Non -Polar O&G/ Total Petroleum Hydrocarbons Total Toxic Organics' Benchmarks - - 100 mg/L or 50 mg/O 6.0 — 9.0 0.010 mg/L 0.075 mg/L 0.126 mg/L 15 mg/L 1 mg/L Parameter Code - 46529 C0530 00400 01119 01051 01094 00552 78141 01 04/26/19 0.15 13 7.1 0.15 0.0020 0.17 <5.0 NA ' Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall. 2 For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here. 'The total precipitation must be recorded using data from an on -site rain gauge. Unattended sites may be eligible for a waiver of the rain gauge requirement. ° See General Permit, Section B, Table 1 to identify the especially sensitive receiving water classifications where the more protective benchmark applies. s Total Toxic Organics sampling is applicable only for those facilities which perform metal finishing operations, manufacture semiconductors, manufacture electronic crystals, or manufacture cathode ray tubes. For purposes of this permit the definition of Total Toxic Organics is that definition contained in the EPA Effluent Guidelines for the facility subject to the requirement to sample (for metal finishing use the definition as found in 40 CFR 433.11; for semiconductor manufacture use the definition as found in 40 CFR 469.12; for electronic crystal manufacture use the definition as found in 40 CFR 469.22; and for cathode ray tube manufacture use the definition found in 40 CFR 469.31). Permit Date: 11/1/2018-05/31/2021 SWU-245, last revised 11/1/2018 - - - - - Page 1 of 3 Facilities that incorporate a solvent management plan into the Stormwater Pollution Prevention Plan may so certify, and the requirement for TTO monitoring may be waived. The solvent management plan shall include a list of the total toxic organic compounds used and the other elements listed in the General Permit. For those facilities electing to employ the TTO monitoring waiver, the discharger shall sign the following certification statement: "Based upon my inquiry of the person or persons directly responsible for managing compliance with the permit monitoring requirement for total toxic organics (TTO), I certify that to the best of my knowledge and belief, no dumping of concentrated toxic organics into the stormwater or areas which are exposed to rainfall or stormwater runoff has occurred since filing the last discharge monitoring report. I further certify that this facility is implementing the all the provisions of the solvent management plan included in the Stormwater Pollution Prevention Plan." Chris Gundler Name (Print name) Plant Manager Title (Pri i e) r"'�--/le/19 Signature Date Note: Results must be reported in numerical format. Do not report Below Detection Limit, BDL, <PQL, Non -detect, NO, or other similar non -numerical format. When results are below the applicable limits, they must be reported in the format. "<XX mg/L", where XX is the numerical value of the detection limit, reporting limit, etc. in mg/L. Note: If you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses. See General Permit text. Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month. ❑ No discharge this period?Z Outfall No. Date Sample Collected' (mo/dd/yr) 24-hour rainfall amount, Inches3 New Motor Oil or Hydraulic Oil Usage Non -Polar O&G/ Total Petroleum Hydrocarbons Total Suspended Solids Benchmarks - - - 15 mg/L 100 mg/L or 50 mg/O Parameter Code - 46529 NCOIL 00552 CO530 Footnotes from Part A also apply to Part B Note: If you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses. See General Permit text. Permit Date: 11/1/2018-05/31/2021 _ _ _SWU-245,. last revised 11/1/2018 Page 2 of 3 FOR PART AND PART B MONITORING RESULTS: • A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B. • 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART II SECTION B. • TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES ❑ NO ❑ IF YES, HAVE YOU CONTACTED THE DEMLR REGIONAL OFFICE? YES ❑ NO ❑ REGIONAL OFFICE CONTACT NAME: Mail on original copy of this DMR, including all "No Discharge" reports, within 30 days of receipt of the lab results for at end of monitoring period in the case of "No Discharge" reports) to: Division of Water Quality Attn: DWQ Central Files 1617 Mail Service Center Raleigh, North Carolina 27699-1617 YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED: "I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations." Signature of Permittee Permit Date: 11/1/2018-05/31/2021 Date SWU-245, last revised 11/1/2018 Page 3 of 3 Stormwater Discharge Monitoring Report for North Carolina Division of Energy, Mineral and Land Resources General Permit No. NCG030000 Date submitted CERTIFICATE OF COVERAGE NO. NCG03 0 1 0 3 FACILITY NAME Moen Incorporated COUNTY Lee PERSON COLLECTING SAMPLES John west LABORATORY Prism Lab Cert. # 402 Comments on sample collection or analysis: Part A: Stormwater Benchmarks and Monitoring Results SAMPLE COLLECTION YEAR 2019 SAMPLE PERIOD ❑ Jan -June July -Dec or 0 Monthly'_ 004 (month) DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA ❑Zero -flow [_]WaterSupply ❑SA ❑N Other c PLEASE REMEMBER TO SIGN ON PAGES 2 AND/OR 3 4 Outfall No. Date Sample Collected' (mo/rid/yr) 24-hour rainfall amount, Inches' Total Suspended Solids PH Standard units Total Copper u rvv Total Lead arscnarge rots Total Zinc perioar— Non -Polar O&G/ Total Petroleum Hydrocarbons Total Toxic Organics Benchmarks Parameter Code _ - - 46529 100 mg/L or 50 mg/L° C0530 6.0 - 9.0 00400 0.030 mg/L 01119 0.075 mg/L 01051 0.126 mg/L 01094 15 mg/L 00552 1 mg/L 78141 01 04/26/19 0.15 13 7.1 0.15 0.0020 0.17 <5.0 NA ' Monthiv iamnlina linq..A . f • __-1.... a • ___ - , ..........oa ..IU....=e,,, WUL11 Uie bewno consecutive oencnmarx exceedance for the same parameter at the same outfall. ' For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here. 'The total precipitation must be recorded using data from an on -site rain gauge. Unattended sites may be eligible for a waiver of the rain gauge requirement. ° See General Permit, Section B, Table 1 to identify the especially sensitive receiving water classifications where the more protective benchmark applies. 5 Total Toxic Organics sampling is applicable only for those facilities which perform metal finishing operations, manufacture semiconductors, manufacture electronic crystals, or manufacture cathode ray tubes. For purposes of this permit the definition of Total Toxic Organics is that definition contained in the EPA Effluent Guidelines for the facility subject to the requirement to sample (for metal finishing use the definition as found in 40 CFR 433.11; for semiconductor manufacture use the definition as found in 40 CFR 469.12; for electronic crystal manufacture use the definition as found in 40 CFR 469.22; and for cathode ray tube manufacture use the definition found in 40 CFR 469.31). Permit Date: 11/1/2018-05/31/2021 SWU-245, last revised 11/1/2018 Page 1 of 3 Facilities that incorporate a solvent management plan into the Stormwater Pollution Prevention Plan may so certify, and the requirement for TTO monitoring may be waived. The solvent management plan shall include a list of the total toxic organic compounds used and the other elements listed in the General Permit. For those facilities electing to employ the TTO monitoring waiver, the discharger shall sign the following certification statement: "Based upon my inquiry of the person or persons directly responsible for managing compliance with the permit monitoring requirement for total toxic organics (TTO), I certify that to the best of my knowledge and belief, no dumping of concentrated toxic organics into the stormwater or areas which are exposed to rainfall or stormwater runoff has occurred since filing the last discharge monitoring report. I further certify that this facility is implementing the all the provisions of the solvent management plan included in the Stormwater Pollution Prevention Plan." Chris Gundler Name (Print name) Plant Manager Title (Prip/ti e) Signature Date Note: Results must be reported in numerical format. Do not report Below Detection Limit, BDL, <PQL, Non -detect, NO, or other similar non -numerical format. When results are below the applicable limits, they must be reported in the format. "<XX mg/L", where XX is the numerical value of the detection limit, reporting limit, etc. in mg/L. Note: If you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses. See General Permit text. Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month. n At Footno Outfall No. Date Sample Collected' " (mo/dd/yr) 24-hour rainfall amount, Inches' New Motor Oil or Hydraulic Oil Usage LJ , ,., yc Non -Polar O&G/ Total Petroleum Hydrocarbons anu Pcnw: Total Suspended Solids Benchmarks - - - 15 mg/L 100 mg/L or 50 mg/L4 Parameter Code - 46529 NCOIL 00552 CO530 a. • n au., apP.y au rar[ o Note: If you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses. See General Permit text. Permit Date: 11/1/2018-05/31/2021 _ SWU245, last revised 11/1/2018 Page 2 of 3 FOR PART A AND PART B MONITORING RESULTS: • A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART 11 SECTION B. • 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART 11 SECTION B. • TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES ❑ NO ❑ IF YES, HAVE YOU CONTACTED THE DEMUR REGIONAL OFFICE? YES ❑ NO ❑ REGIONAL OFFICE CONTACT NAME: Mail an original coat' of this DMR including all 'No Discharge" reports within 30 days of receipt of the lab results for at end of monitoring period in the case of No Discharge reports) to: Division of Water Quality Attn: DWQ Central Files 1617 Mail Service Center Raleigh, North Carolina 27699-1617 YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED: "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 person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations." Signature of Permittee Permit Date: 11/1/201"5/31/2021 Date SWU-245, last revised 11/1/2018 Page 3 of 3 a I �P'RISM 7uvioexeairs ec Moen, Inc John West 2609 Cox Mill Rd. Sanford, NC 27330 NC Certification No. 402 Full -Service Analytical a NC Drinking Water Cart No. 37735 Environmental Solutions SC Certification No. 99012 Project: Stormwater Lab Submittal Date: 05/02/2019 Prism Work Order: 9050072 Case Narrative 5/13/19 15:08 n This data package contains the analytical results for the project identified above and includes a Case Narrative, Sample Results and Chain of Custody. Unless otherwise noted, all samples were received in acceptable condition and processed according to the referenced methods. Data qualifiers are flagged individually on each sample. A key reference for the data qualifiers appears at the end of this case narrative. Please call if you have any questions relating to this analytical report. Respectfully, I PRISM LABORATORIES, INC. Terri W. Cole Project Manager Data Qualifiers Key Reference Reviewed By Jackie Ziner For Terri W. Cole Project Manager BRL Below Reporting Limit MDL Method Detection Limit RPD Relative Percent Difference * Results reported to the reporting limit. All other results are reported to the MDL with values between MDL and reporting limit indicated with a J. This report should not be reproduced, except in its entirety, without the written consent of Prism Laboratories, Inc. 449 Springbrook Road - P.O. Box 240543 - Charlotte, NC 28224-0543 Phone: 7041529-6364 -Toll Free Number: 1.800/529-6364 - Fax: 7041525-0409 Page 1 of 5 -PRISI Full -Service Analytical a M Environmental Solutions Sample Receipt Summary 05/13/2019 Prism Work Order: 9050072 Client Sample ID Lab Sample ID Matrix Date/Time Sampled Date/Time Received 01 9050072-01 Water 04/26/19 16:30 05/02/19 10:41 Samples were received in good condition at 3.3 degrees C unless otherwise noted. This report should not be reproduced, except in its entirety, without the written consent of Prism Laboratories, Inc. 449 Springbrook Road - P.O. Box 240543 - Charlotte, NC 26224-0543 Phone: 704/529-6364 - Toll Free Number: 1-8001529-6364 - Fax: 704/525-0409 Page 2 of 5 &�-b�,P,'FR I S M I run-ae ice An„ luVo 4 Envlronmenlel Soletlone Moen, Inc Attn: John West 2609 Cox Mill Rd. Sanford, NC 27330 Project: Stormwater Sample Matrix: Water Laboratory Report 05/13/2019 Client Sample ID: 01 Prism Sample ID: 9050072-01 Prism Work Order: 9050072 Time Collected: 04/26/19 16:30 Time Submitted: 05/02/19 10:41 Parameter Result Units Report MDL Dilution Method Analysis Analyst Batch Limit Factor DaleTme ID General Chemistry Parameters Oil B Grease (HEM) BRL mgf- 5.0 1.7 1 '166413 5/8/19 10:03 SLS P9E0140 Total Suspended Solids 13 mg/L 5.0 0.70 1 •SM2540 D 513119 17:18 CBM P9E0085 'Total Metals Copper 0.15 mg/L 0.0050 0.0026 1 *200.8 5/6119 15:04 JAB P9E0083 'Lead 0.0020 mg/L 0.0020 0.00082 1 *200.8 516119 15:04 JAB P9E0083 Zinc 0.17 mg/L 0.020 0.0071 1 •200.8 5/6/19 15:04 JAB P9E0083 This report should not be reproduced, except in its entirety, without the written consent of Prism Laboratories, Inc. 449 Springbrook Road - P.O. Box 240543 - Charlotte, NC 28224-0543 Phone: 7041529-6364 - Toll Free Number: 1-8001529.6364 - Fax: 704/525-0409 Page 3 of 5 Sample Extraction Data Prep Method: 200.8 Lab Number Batch 9050072-01 P9E0083 Initial Final Date/Tlme 50 mL 50 mL 05/06/19 8:00 This report should not be reproduced, except in its entirety, without the written consent of Prism Labomtones, Inc. 449 Springbrook Road - P.O. Box 240543 - Charlotte, NC 28224-0543 Phone: 7041529-6364 - Toll Free Number: i-800/529.6364-Fax: 7041525-0409 Page 4 Df 5 I Fullironmee Analytical s /-RRISMEnvironmental Solutions flABna.+TOl0E5.Ine 449 Springbrook Road • Charlotte, NC 28217 Phone 7041529-636�4 j•• Fax: 7041525-0409 Client Company Name: lfte'-y Report TolContact Name: o Reporting Address: c _ _ /VL^. 9,2 2 CHAIN OF CUSTODY RECORD PAGE BF L QAUOTE a To ENSURE PROPER BU/JUNG. Short Hold Analys' : (Yes) (NO) UST Project: (Yes) (NO) *Please ATTACH any project specific reporting (QC LEVEL 1 II 111 rV) provisions andlor OC Requirements Invoice To: Address: YES NO WA Samples INTACT upon Snivel? \ y� Received ON WET ICE? PROPER PRESERVATIVES Indicated Received WITHIN HOLDING TIMES? CUSTODY SEALS INTACT? VOLATILES redd W/OUT HEADSPA� _ PROPER CONTAAINEg9 used? 3E Phone ^ " Fax (Yes) (No):(V/9I2S Y7-4' purchase Order NoJBilling Reference TO BE FILLED IN BY CLIENT/SAMPLING PERSONNEL Email ddress: W e Sf LO wt�rr + ++« Requested Due Date 01 Day 0 2 Days ❑ 3 Days 04 Days D 5 Days Certification: NELAC_ DoD_ FL_ NC_ EDD Type: PDF ✓U-ceI_Other "Working Days" 0 S-9 Days O Standard 10 days UFPre-Approvedlux Be ., SC OTHER N/A Site Location Name: • Samples received after 14:00 vnTl be processed next buslness day. Turnaround Dme Is based on business days, excluding weekends and holidays. Water Chlorinated: YES_ NO_ Site Location Physical Address: (9EE REVERSE FOR TERMS a CONDITIONS REGARDING SERVICES Sam le Iced Upon Collection: YES NO RENDERED By PRISM LABORATORIES, INC. TO CLIENT) P CLIENT DATELAB TIMDLLEE TED CMILRARY MATRIX SI [ILL SAMPLE CONTAINER P TWESA ANALYSIS REQUESTED / REMARKS PRISM 'TYPE SAMPLE DESCRIPTION COLLECTED WATER OR NO. SIZE ID NO. HOURS SLUDGE) SEE BELOW i +a ." 1 Sampler's Signature Sampled By (Print Name). Affiliation "PA7 Upon relinquishing, tpd Chain of Custody is your authorization for Prism to proceed with the analyses as requested above. Any changes must be submitted in writin o the Prism Project Manager. There will be charges for any changes after analyses have been initialized. of T i ivedBY: ( .a M) Doti wturymouts Additional Comments: Site Arrival Time: Re rqv Y O Rcrorvoa BY ( ) Site Departure Time: Field Tech Fee: Rofnq YI ) ffe—o FwD#a MIIeSge: Mahod al OTE: SANPIE C00 LD BE TAPED SHUT WRN US S A LASORA R . SAMPLES ARE NOT ACCE➢rED AND VERIFIED AGAINST COC I RECEIVEDAT TORY. ❑ Fed Ex O UPS O Ha W4 ilvsred O Prism Field Ser ❑Omer NIF ES: TER: iWATER: E. F OTHF SCNCSCIILL ❑ N❑NC ❑SCONC ❑SCONC ❑SCONC O C SCI O NC O SC NC O SC I O n n o O *CONTAINER TYPE CODES: A =Amber C = Clear G= Glass P = PIaStJC; TL = Teflon -Lined Cap VOA =Volatile Organics Analysis teem neat opam) ORIGINAL Storrs Water Discharge ®utfall Qualitative Monitoring Report (To be Completed during a ralr&II.) For: Moen Incorporated, 2609 Cox Mill Road, Sanford, NC 27332 (919) 258-3341 Certificate of Coverage No.: NCG030103 Receiving Stream: Trib. Of Carrs Creek Inspector: InJes7L,— Date: 411 �/ Time: � 3L-)/ J Weather Conditions: By this signature, I certify that this report is accurate and complete to the best of my Knowledge: Inspector ' Outfall Number 1 2 3 4 Color: Describe the color of the discharge using basic colors (red, blue, J 1$ (^fi 1 ; k -r brown, etc. and tint (light, medium, dark) as descriptors. Write "None" if no color is present. I { ,t7� �oNP n V (o�� 5 (_ t �11 T? Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil, weak chlorine odor, etc.). Write "None" is no odor is present. NP'^r A 1 Vv� c ,1' t/v,n a nn�� /V ovr t Clarity: Choose the number which best describes the clarity of the discharge where 1 is clear and 10 is very cloudy. 3 Z Floating Solids: Choose the number which best describes the amount of floating solids in the stormwater discharge where 1 is no solids and 10 is the surface covered in floating solids. Suspended Solids: Choose the number which best describes the amount of suspended solids in the stormwater discharge where 1 is no solids and 10 is extremely muddy. Foam: Is there any foam in the stormwater discharge? YES or NO Na `/ fj �,�///�v Nv a/ Oil Sheen: Is there an oil sheen in the stormwater discharge? YES or NO /V,9 /Vc7 ,�� /V// V ��/ &a Other Obvious Indicators of Stonnwater Pollution: YES or NO. If "YES," list the outfall number and describe below. �t / / V J N/ / V o A, /VO Note: Low clarity, high solids, and/or the presence of foam or oil sheens may be indicative of pollutant exposures. These conditions must be reported to the Environmental Coordinator and warrant further investigation.