WQ0006941_Monitoring - 01-2021_20210521

Monitoring Report Submittal
...........................................................................................................................................
Permit Number #* WQ0006941
Name of Facility:*
Month:* January
Report Information
Stoney Creek Elementary School
Type *
Revised - NDMR, NDAR-1, NDAR-2,
NDMLR
Confirmation Email Address:*
Name of Submitter:*
Signature:
Date of submittal:
Initial Review
Year:* 2021
Upload Document*
Stoney Creek January 1.68MB
Amended.pdf
PDF Cnly
Please upload one PDF containing all applicable monitoring reports
(i.e., NDMR, NDAR-1, NDAR-2, NDMLR, GW-59).
Jessica. [e-mail]
Jessica Mize
Reviewer: Williams, Kendall N
5/21 /2021
This will be filled in automatically

Is the project number correct?* WQ0006941
Is the monitoring report t: Yes r No
accepted?*
Regional Office* Winston-Salem
Accepted Date: 5/21/2021

FORM: NDMR 05-16 NON -DISCHARGE rIONITORING REPORT (NDMR) AfV QVj&QL Page _1_of_2_
III01.941
Facility Name: Stoney CreekElementary ••
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. . •.Parameter
Monitoring Point:
•.
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' FORM: NDMR 05-16
NON -DISCHARGE MONITORING REPORT (NDMR)
Page
of
Sampling Person(s)
Name: Glenn Price
Name:
Certified Laboratories
Name: Pace Analytical Services
Name:
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit?
■
If the facility is non -compliant, please explain in the space below the reason(s) the facility was not in compliance. Provide in your explanation the date(s) of the non-compliance and describe the corrective
taKen. Anacn aaanionai sneets a
Operator in Responsible Charge (ORC) Certification
Permittee Certification
ORC: Glenn Price
Permittee: Baron Neal McDuffie ( Authorized Agent)
Certification No.: 987931120771
Signing Official: Baron Neal McDufFie
Grade: II Phone Number: 336-996-2841
Signing Official's Title: Field Services Director ( Pace Analytical )
Has the ORC changed since the previous NDMR? 0 Yes O No
Phone Number: 336-996-2841 Permit Expiration: 8/31/2021
Signature Date
Signature Date
By this signature, I certify that this report is accurrato and complete to the best of my knowledge.
I ce", 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 all qualified personnel properly gathered and evaluated the information
submitted. Based on my Inquiry of the person or persons who manage the system, or arose 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 signiflcard penalties for submitting raise information, including the possibility of fines and imprisonment for
knowing violations.
Mail Original and Two Copies to:
Division of Water Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 276994617

FORM: NDAR-1 05-16 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page _2_of_2_
w000.941
Facility Name: Stoney Creek Elementary School-
1
irrigation
• occur
at this facility*?
..:Cover
Crop:..
■ YES G NO
HourlyHourly-.
Annual Rate (in):
JZ=
Field Irrigated?
Field Irrigated?
Field Irrigated?
Field Irrigated?
®
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__
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----
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mm0
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----
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----
m
0mm----
12 Month Floating Total
///////%///////.%/////%%//////%i%//////�%//////

FORM: NDAR-1 05-16 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page of
Did the application rates exceed the limits in Attachment B of your permit?
Were adequate measures taken to prevent effluent ponding in or runoff from the sites?
Was a suitable vegetative cover maintained on all sites as specified in your permit?
Were all setbacks listed in your permit maintained for every application to each permitted site?
Were all freeboards maintained in accordance with the specified freeboard heights in your permit?
�TCompiiant
❑ Non -Compliant
—pliant
❑ NorrCompiiant
�.mnpliant
❑ Nonfiamphant
U Omp1lant
❑ Non -Compliant
�mpliant
❑ NorrGompliant
If the facility is non -compliant, please explain in the space below the reason(s) the facility was not in compliance. Provide in your explanation the date(s) of the non-compliance and describe the corrective
taxen. tutac i aaamonai sneers n
Operator In Responsible Charge (ORC) Certification
Pormittee Certification
ORC: Glenn Price
Permittee:
Baron Neal McDuffie (Authorized Agent)
Certification No.: 987931/20771
Signing Official: Baron Neal McDuffie
Grade: II Phone Number: 336-996-2741
Signing Official's Title: Field Services Director (Pace Analytical Services)
Has the ORC changed since the previous NDAR-1? ❑ yes O No
Phone Number: 336-996-2841 Permit Exp.: 8/31/21
Signature Date
Signature Date
By this signature, I certify that this report is aceurrate and complete to the best of my knowledge.
I car*, 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 all qualified personnel property gathered and evaluated 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 knovA g violations.
Mail Original and Two Copies to:
Division of Water Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

aceAnalj(tical
www."Celeta.eom
Pace Analytical Services, LLC
106 Short St.
Kernersville, NC 27284
336-996-2841
Laboratory Report
Caswell County Schools /Jerry
Caswell County Schools
P.O. Box 160
Yanceyville, NC 27379
Project: Stoney Creek
Pace Project No.: 92518796
Page 1 of 1
Report Date: 02/08/2021
Date Received: 01/27/2021
Sample: Effluent
Method
Parameters
Lab ID: 92518796001 Collected: 01/27/21 11:39 Matrix:
Results Units Report Limit
Water
Analyzed Qualifiers
HACH 10206
Nitrogen, Nitrate
ND
mg/L
0.30
01/27/21 19:11
SM 254OD-2011
Total Suspended Solids
9.9
mg/L
6.7
01/28/21 08:29
SM 521OB-2011
BOD, 5 day
ND
mg/L
2.0
02/02/21 14:29
Colilert-18
Fecal Coliforms
ND
MPN/100ml-
1.0
01/28/21 12:37
TKN+NO3+NO2
Total Nitrogen
7.2
mg/L
0.52
02/08/21 15:05
Calculation
EPA 350.1 Rev 2.01993
Nitrogen, Ammonia
6.4
mg/L
0.10
02/08/21 10:48
EPA 351.2 Rev 2.01993
Nitrogen, Kjeldahl, Total
7.2
mg1L
0.50
02/02/21 03:53
EPA 353.2 Rev 2.0 1993
Nitrogen, NO2 plus NO3
ND
mg/L
0.040
02/04/21 11:36 M1
EPA 365.1 Rev 2.01993
Phosphorus
1.3
mg/L
0.050
02/02/21 13:29
ANALYTE QUALIFIERS
M1 Matrix spike recovery exceeded QC limits. Batch accepted based on laboratory control sample (LCS) recovery.
Reviewed by: 5v-le-.5 �
Stephanie Knott
336-996-2841
[e-mail]
Pace Analytical Services Asheville
2225 Riverside Drive, Asheville, NC 28804
Florida/NELAP Certification #: E87648
North Carolina Drinking Water Certification #: 37712
Pace Analytical Services Eden
205 East Meadow Road Suite A, Eden, NC 27288
North Carolina Drinking Water Certification #: 37738
North Carolina Wastewater Certification #: 40
South Carolina Certification #: 99030001
VirginiaIVELAP Certification #: 460222
North Carolina Wastewater Certification #: 633
Virginia/VELAP Certification #: 460025
Page 1 of 2

CHAIN -OF -CUSTODY Analytical Request Document
j LAB useor�tY-ar�xWarkardM, �a# J N
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Chain -of -Custody is a LEGAL DOCUMENT - Complete all relevent fields
SHADED 11111111
_ Container Preservative T �$�8i96
company. Stoney Creek
ff . -
Billinglnformation:ALL
-
'Address:
u 2 8
Report To:
Email To: _/
•• Preservative
Types.
(1) nitric acid, (2) sulfuric acid,
(3) hydrochloric add, (4) sodium hydroxide (5) zlnt acetate,
(6) methanol,
(t) ammonium
(7) sodium
hydroxide,
bisulfate, (8) sodium thiosulfate,
(D) TSP, (u) Unpreserved, (0)
(9) hexane, (A) ascorbic acid, (a) ammonium sulfate,
Other
Copy To:
Site Collection Info/Address:
Analyses
Lab Profile/Une:-
Customer Project Name/Number:
State: County/City: Time Zone Collected:
Lab sample Receap et et hecxliat;
/ [ ]PT[ JMT[ ]CT [ ]ET
Z
Y
Z
tj
p
Z
z
Custody Seals Present/Intact Y N NA
Custody Signatures Present Y N NA
Collector Signature Present Y N NA
Bottles Intact Y N NA
correct Bottles Y N NA
Sufficient: volume Y N NA
Samples Received on Ice Y N NA
VOA - Headspace Acceptable Y N NA
USDA Regulated Soils Y N NA
Samples in Holding 'lime Y Ff NA
Residual chlorine Present Y N NA
Phone:
Email:
Site/Facility ID #:
Compliance Monitoring?
[ Yes [ ] No
Collected rint):
e-cle—
Purchase Order #:
Quote#:
DW PWS ID #:
DW Location Code:
Collected By (signature):
Turnaround Date Required:
Immediately Pace on Ice:
[ ]Yes [ ]No
Sample Disposal:
Rush:
Field Filtered (if applicable):
[ ) Dispose as appropriate ( 1 Return
[ ] Archive:
[ ] Hold:
[ ) Same Day [ ] Next Day
[ ) 2 Day [ ] 3 Day [ ] 4 Day [ ) 5 Day
(Expedite Charges Apply)
[ ] Yes [ ] No
Analysis:
ro
9
-
Ll
39
Cl Strips;
sample pH Acceptable Y N NA
PH Strips:
Sulfide Present Y N NA
Lead Acetate Strips:
` Matrix Codes (Insert in Matrix box below): Drinking Water [DW), Ground Water(GW), Wastewater (WW),
Product (P), Soil/Solid (Si oil (OL), Wipe {WP), Air (AR), Tissue (TS), Bioassay (B), Vapor (V), Other JOT)
F-
W
H
2
ai
z
o
U
LL
LAB USE ONLY:
tab Sample N / comments:
Customer Sample ID
Matrix
Comp /
Grab
Collected (or
Composite Start)
Composite End
Res
Cl
# of
Ctns
at
Time
Date
Time
Effluent
G
27 Z 1
i? 3`l
_
__--
Customer Remarks / Special Conditions / Possible Hazards:
Type of Ice Used: Wet Blue Dry None
SHORT HOLDS PRESENT (e72 hours);
Y N N/A
Lab Sample Temperature Info:
Temp Blank Received: Y N NA
Therm IDN:
Cooler 1 Temp Upon Receipt: Z oC
Packing Material Used:
Lab Tracking #:
Radchem sample{sj screened (cSDD cpnt): Y N NA
Samples received via:
FEDEX UPS Client Courier Pace Courier
Cooler i Therm Carr. Factor: ' oC
Cooler I Corrected Temp:oC
Comments:
Relinquished by/Company; ignature)
Da /Ti
Received y/C mpany: (Si nature[
Date,Time:
MTJL LAB USE ONLY
Table #:
—
Acctnum:
Template:
Trip Blank Received: Y YN NA
Relinquished by/Company: (Signature)
Date/Time:
Received b Co a : gn ture)
Date/Time:
Prelagln:
HCL McOFI TSP Other
Non Conformance(s); Page:
Relinquished by/Company: (Signature)
Date/Time:
Received by/Company: (Signature) jDate/Time:
j
PM.,
PB:
I YES / NO of: