NCG030597_2021 DMR_20211222 (4)

NCDEQ Division of Energy, Mineral and Land Resources
Stormwater Discharge Monitoring Report (DMR) Form for NCG030000
Metal Fabrication
Click here for instruct!
Complete, sign, scan and submit the DMR via the Stormwater NPDE=S Permit Data Monitoring Report [DMR) Upload form within
30 days of receiving sampling results. Mail the original, signed hard copy of the DMR to the appropriate DFMLR Regional office,
Certificate of Coverage No. NCG030000
Person Collecting Samples: Brandon Patrick
Facility Name:American Emergency Vehicles
Laboratory Name: Stateville Analytical
Facility County: ASHE
Laboratory Cert. No.: #440
Discharge during this period: E]Yes
No (if no, skip to signature and date)
Has your facility implemented mandatory Tier response actions this sample period for any benchmark exceedances? [7Yes E] No
If so, which Tier (I, 11, or ill)?
A copy of this DMR has been uploaded electronically via https:ZZedacs.deg.nc.gov/Forms/SW-DMR E]Yes El No
Date Uploaded:
Analytical Monitoring Requirements for outfalls with Industrial Activities— Benchmarks in (Red)
Parameter
Parameter
Outfall
Outfall
Outfall
Outfall
Outfall
Code
N/A
Receiving Stream Class
Point 1
Point 2
N/A
Date Sample Collected MM/DD/YYYY
8117/21
8/17/21
46529
24-Hour Rainfall in inches
1,95"
1.95"
C0530
TSS in mg/L (100 or 50*)
23.83 mg/L
<2.688 mg/L
00400
pH in standard units (6.0-- 9.0 FIN,
8.33
7.65
6.8-13.5 SW)
01119
Copper, total recoverable in mg/L
029 mg/L
.009 mg/L
(0,010 FIN, 0,0058 SW)
01051
Lead, total recoverable in mg/ L
.006 mg/L
<.002 mg/L
(0.075 FW, 0.22 SW)
01094
Zinc, total recoverable in mg/ L (0.126
072 mglL
039 mglL
FW, 0.095 SW)
00340
Chemical oxygen Demand (COD) in
<25 mg/L
<25 mg/L
mg/L (120)
00552
Non -Polar Oil & Grease in mg/L (15)
<4.81 mg/L
<5.38 mg/L
* Outfalls to Outstanding Resource Waters (ORW), High Quality Waters (HQW), Trout Waters (Tr) and Primary Nursery Areas (PNA)
have a benchmark TSS limit of 50 mg/L. All other water classifications have a benchmark of 100 mg/L
FW (Freshwater) 5w (Saltwater)
Notes (optional): The process for the eDMR account has ben performed as required as of Aug. 17, 2021.
"I certify by my signature below, 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,jnUbdIng the possibility of fines and Imprisonment for knowing violations."
Signature of Oerrgftfo"or Delegated horized Individual
JEFF'[e-mail] /
Email Address
f'C1_� 0 Z %
Date
336-977-9021
Phone Number

1
St water Discharge 0 ti'ali (SDQ)
ualitative Monitoring Report
Forguldarni;e on iii out i is � �A' jnrn pfPase visit:
hermit No.:
Facia Nand RI i �,1._,1 or Cer�tifl of overage Noy
ty � . V,
County: hone No.
Inspector...
Date of Inspection: S'j 7 - 2 1
Time of Inspection;
Total Event Precipitation {finches): �` s
Was this a "Representative Storm Event" or "Measureable Storm Event* as defined by the permit?
(See information below.) ;
Er ices ❑ No
Please verify whether Quali" Monitoring must be perfiornred during a Impresentative storm
eveneor "measureahie storm event" (requirements vary, dePOnding on the permit).
Qualitative monitoring requirements vary. Most permits require qualitative monitoring to be
performed during a "representative storM event?' or during a "rneasureabls storm event." However,
some permits do not have;this requirement please refer to these definitions, if applicable.
A `representative sctarm.event" is a storm event that measimes greater than Q.1 inches of rainfall
and that is preceded by atleast 72 hours (3 days) in which no storm event measuring greater than
0.1 inches has occurred. ly single storm event tinay contain uP to 10 consecutive hours of no
precipitation,
A 'measurable storm evpu' is a storm event that results In an actuel ftcharge, from the
permitted site outiall. This previous measurable storm event 1hust have been at least 72 hours
prior. -The 72-hour storm interval does tlot•apply if the•pettriittee is able to document that -a, shorter
interval is representative for local storm events during the sampling period, and the perQtittee
obtains approval f nm the!lap] DWQ Regional Office.
By this signature, I certify'
fylthat this report is accurate and complete to the best of my knowledge:
-------- Ale /1�
(Signature of Permitiee or Designee)
Page i of 2
SWU-242. Last i modified 10/25/2012

1. Ou1fan Dewiptionr
Outfall No.. , I . Structure (pipe, ditch, eta)
iieceivtng Stream:
Describe the industrial activities that occur within the outtall drainage area:
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: e4AI01 -/M t
S. Odor. Describe any distinct odors that the discharge may have (Le,, smells strongly of all,
weals chlorine odor, etc.); f�o•� _ . ,
4. Clarity; Choose the number which best describes the clarity of tb6 discharge, where I is
clear and 5 is very cloudy:
1 2 3 Q. 5
S. 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:
0 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 extremgly muddy:
2 3 4 5
7. Is there any foam in the stormwater discharge? y'es No
8. is there an oU sheen In the starmwater discharge? No
9. Is there evidence of erosion or deposition at the outfoll? Yes No
ltl. Outer Obvious Indicators of Stoxmwater Pollution:
Gist and describe -- --_
Note: Low clarity, high solids, and/or the presence of foamy off sheen, oar erosion/deposition
may be indicative of pollutant exposure. These conditions wan=t,further Investiption.
Page 2 of 2
SWO-242, Lutmoditfed•10/25/2012

Forguldance onJilling out
Permit No..
Facility Name•
County;
Inspector. ,
Date of Inspection:
Time Of Inspection:
DiSCharge 0 UI (00)
re Wnitoring Report
ftIonm, please visitr
or Cerdflof Eoverage No.:
'.awl 9yi 0 ✓.V&40s/ t ld "..
Total Event Precipitation inches]:
No. 1-
Was tliis a "Representative Storm Event" or "Measuneable Storm Event" as defined by the permit?
(See information below)
Y'es ❑ No
Please verily whether Qualit atfve Monitopfng must be•perprmed during a jrePmentattve storm
event" or Imeasureable storm event" (requirements vary, depindino on the permit).
Qualitative monitoring re4nirements vary. Most pehmits require qualitative monitoring to be
Performed during a "representative storm event?' or during a "me&Wreable storm event" However,
some permits do not have this requirement Please refer to these definitions, if applicable.
A "representative storm;evenr is a storm event that measores greater
and that is preceded by atleast 72 hours 3 days)
in which no storm eventmeaD.�n suriigr of �l
0.1 inches has occurred. Ali single storm eventhour
nSuer titan
precWtation, y contain up to it) consecutive hours of no
A "measurable storm evfnr is a storm event that results in an actual dlsduwp from the
Permitted site outfall. The previous measurable storm event: must have been at least 7 2 fidum
prior. -The 72-hour storm f ntierval does,not apply if the perndUft is able to document that it shorter
interval is representative for local storm events during the sampling period, and the perrhluxe
obtains ajDjorovaj ftom the!Iocal DWQ I; orlal Office.
By this signature, I certi
/l it fY this report is accurate and complete to the best of my knowledge:
(Signature of Permittee of Designee)
Page 1 of 2
SM-242, Lit moMed to/z5/2012

L OutfillDesctlption.-
Outfali No. Z Structure (pipe, ditch, etc.
Receiving Stream:
Describe the industrial activities that occur within the outfail drainage atea:
Z. Color: Describe the color of the di�liarge usinf basic colors (red, brown, blue, ptc j and tint
Might, medium, dark) as desctiptors: Jam' __ •�
3. Odor: Describe any distinct odors that the discharge may have (Le., smells strongly of all,
weak chlorine odor, etc.).-
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 f4 Y 5
5. Floating Solids: Choose the number which b est describes the amount of floating solids in
the stormwater discharge, where 1 is no solids and 5 is the surface covered with floating solids:
2 3 4 5
5. 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 extremgly muddy:
1 7� 3 4 5
7. Is there any faamt in the stormwater discharge? Yes L�9`
8. is there an oil sheen in the st rmwater discharge? Yes
9. is there evidence of erosion or deposition at the oudwl? Yes (10
14. Other Obvious indicators of Stormwater Pailution:
Gist and describe
Note. Low clarity, M& solids, and/or the presence of foam, oil sheen, or erosion/deposition
may be indicative of pollutant esposum These conditions warrant.further investigation.
Page 2 of 2
SwU•242, LastwwMed-10/25/2012

Statesville Analytical Holdings, LLC
122 Court St. Statesville, NC 28677
704-872-4697
CHAIN OF CUSTODY
SAMPLE TYPE: STORM WATER
LOCATION: American Ememency Vehicles
FACILITY ID#: NCG030000
SAMPLER NAME: Brandon Patrick
AEV
*PRESERVATION CODE
1 - H2SO4, 2 - HNO3, 3 - HCL,
4 - NAOH, 5 - NONE, 6 - COOL ICE
7 - NA2S203, 8 - OTHER
COMPOSITE SAMPLE: START DATE: START TIME: STOP DATE: STOP TIME:
SAMPLE NAME:
COLLECTION
DELIV
TEMP
SAMPLE TYPE
PRESERVATION*
PP
verify
CL2-D-CL2
LAB SAMPLE
ID NUMBER
DATE
TIME
TEMP
GRA13
COMP
F-FIELD
L-LAB
YES
NO
COD - Point 1
G
F6
TSS - Point 1
G
F6
Oil & Grease -
Point 1
G
F6
Total Pb - Point 1
G
F6
Total Cu -Point 1
G
F6
Total Zn - Point 1
G
F6
COD - Point 2
G
F6
TSS - Point 2
G
F6
O![ & Grease -
Point 2
G
F6
Total Pb - Point 2
G
F6
Total Cu -Point 2
G
F6
Tofa! zn - Point 2
G
F6
RELINQUISHED BY:
DATE
TIME
RECEIVED BY:
DATE
TIME
RELINQUISHED BY:
DATE
TIME
RECEIVED BY:
DATE
TIME
*Laboratory preservation is ensured by addition of preservatives prior to sample
containers leaving the lab, unless otherwise noted.
CL2-D-CL2 = Chlorine check and dechlorination verification.
PRESERVATION:
() COOL 40C- BOD, RESIDUE, CONDUCTIVITY, MBAS, COLOR, ALKALINITY, CR, VI, TURBIDITY
() COOL 4°C, PH<2 H2SO4: NH3, NO2-NO3, TKN, O&tG, TOC, COD, HARDNESS,
PHENOLS, TOT PHOS.
() COOL 4°C, PH<2 HNO3: METALS EXCEPT CR, VI Point pH
() NONE: CHLORIDE, PH, FLUORIDE Temp
OTHER: Cond
() COOL 4°C, NA2S203: COLIFORM BACTERIA
Rainfall:
Point 2: pH
Temp
Cond

COMPOSITE SAMPLE,
START DAi l : h'€AM -€ €MM a
t Vr vr+I G;
NAME.
COLLECTION ..
D LIV
N
S:�iVtF Lr=.Typr:2
PE EStiRVATION
pH
rE
CL2 D-CL2
LA . ar pLe
tD NUh�I 2'AMPJ--E
C1Aft
T€ME
GRAB
CAi�flF'
-.
YES
NQTEAP
q11 & Grs,ass s
P01ht t
ti8fT7fZ!
�
ToWP4.».F+olot 1.
OBfE7j21
C`r
F&
i'pta€ Cu PoiE3k1
OBf1.7{2�
�'
F$
001117111
oil & bypass -
inYa€ Ili. Pa€t112-
QS1i712I
Q.
T601 ou'•PbW 2.
dwi l{2 E
I C
T0te.4Z='Po€nt2
0$fi7{1;
�,,.�t
t7ELI (UAHED BY:,.
DAU
FIN€
t VIM[ (3Y
AT
r8
iltvi�
l?I S
R.EL€N905 i3 tip.
fib
: 1 M
M
PO Sax 228 • Statesville, NC 28687 • 704/872/4697
Page 5 of 5

Analytical Results
Town of West Jefferson h....
PO Box 490
335 Clearwater Drive
West Jefferson, NC 28694
Receive Date: 08/1812021
Reported, 08/27/2021
For, American Emergency Vehicles Storm Water
Comments:
Sample Number
Parameter
Sample ID
Result
Unit
Method
.Analyzed
Analyst
210818.42-01
Copper
SW -Up
<0.002
mcg/L
EPA 200.7
08124/2021
MD
210818-42-01
Lead
SW -Up
<0.002
mg/L
SM9313S 2004
08/24/2021
MD
210818-42-01
Oil and Grease
SW -Up
<5.03
mg/L
EPA1664Rav6
08/26/2021
CE
210818-42-01
TSS
SW -Up
<2.660
mg/l_
SFA2540D-2011
08/19/2021
LE
210818-42-01
Zinc
SW -lap
0.01
rng/L
EPA200.7
08124J2021
MID
210818-42-02
Copper
SW -Down
0,003
mg/L
EPA200.7
08/24/2021
MD
210818-42-02
Lead
SW -Down
<0.002
mg/L
SM31130-2004
08/24/202•€
MD
210818-42-02
Oil and Crease
SW -Down
<5.18
mg/L
EPAWi4RevB
08/26/2021
CE
210818-42-02
TSS
SW -Down
22.86
mg/L
SN25400-2011
08/19/2021
LE
210818-42-02
Zinc
SW -Down
0.022
mglL
EPA200.7
08/24/2021
MD
210818-42-03
Copper
SWP1
029
mg/L
EPA200.7
08/24/2021
MD
210818-42-03
Lead
8WP1
0.006
mg/L
SM3113B-2004
08/24/2021
MD
210818-42-03
Oil and Grease
SWP1
<4.81
rng/L
EPA1664Rev6
08/2612021
CE
210818.42-03
TSS
SWP1
23.83
mg/L
SLI254OD-2011
08119/2021
LE
210818-42-03
Zinc
SWP1
0.072
mg/L
EPA2aD.7
08/24/2021
MD
210818-42-04
Copper
SWP2
0.009
mg&
EPA 200.7
08/2412021
MD
210B18-42-04
Lead
SWP2
<0.002
mg1L
Wa113B-2004
08/24/2021
. MD
21081E-42-04
Oil and Grease
SWP2
<5.38
mg/L
EPA1664HevB
08/26/2021
CE
210818-42-04
TSS
SWP2
<2.688
mg1L
SM2540D-2011
08/19/2021
LE
210818-42-04
Zinc
SWP2
0,039
mg/L
EPA2DDa
08/24/2021
MD
Respectfully submitted,
Melissa Myers
NC Cart #440,
NCDW Cart #/377: 5,
EPA #1NC00909
PO Box 228 a Statesvilie, NC 28687 0 704/872/4697
Page 1 of 5

Condition of Receipt
Sample Number 21 OB18-42-01 Temp on Arrival: 1.1
PH on Arrival: <2 Parameter Schedule:
Nitric Acid Received on Ice
Chemicals in containers, lab
PH on Arrival: <2 Parameter Schedule: Copper
Nitric Acid Received on Ice
Chemicals in containers, lab
PH on Arrival: <2 Parameter Schedule: Lead
Nitric Acid Received on Ice
Chemicals in containers, lab
PH on Arrival: <2 Parameter Schedule; Oil and Grease
Hydrochloric Acid Received on Ice
Chemicals In containers, lab
Parameter Schedule: TSS
Received on Ice
Sample Number 210818-42-02 Temp on Arrival: 1.1
PH on Arrival: <2
PH on Arrival: <2
PH on Arrival: <2
PH on Arrival: t2
Nitric Acid
Nitric Acid
Nitric Acid
Parameter Schedule:
Parameter Schedule
Parameter Schedule
Received on Ice
Chemicals in containers, lab
Copper
Received on Ice
Chemicals in containers, lab
Lead
Received on Ice
Chemicals in containers, lab
Parameter Schedule: Oil and Grease
Hydrochloric Acid Received an Ice
Chemicals In containers, lab
Parameter Schedule: TSS
Received on Ice
Sample Number 210818-42-03 Temp on Arrival: 1.1
PO Box 228 • Statesville, NC 28687 • 704/872/4697
Page 2 of 5

PH on Arrival: C2 Parameter Schedule:
Nitric Acid Received on Ice
Chemicals in containers, lab
PH on Arrival: a2 Parameter Schedule: Copper
Nitric Acid Received on Ice
Chemicals in containers, lab
pH on Arrival <2 Parameter Schedule: lead
Nitric Acid Received on Ice
Chemicals in containers, lab
PH on Arrival: ¢2 Parameter Schedule: Oil and Grease
Hydrochloric Acid Received on Ice
Chemicals in containers, lab
Sample Number 210818-42-04 Temp on Arrival: 1.1
PH on Arrival: <2
Parameter Schedule:
Nitric Acid Received on Ice
Chemicals in containers, lab
PH on Arrival: <2
Parameter Schedule: Copper
Nitric Acid Received on Ice
Chemicals In containers, lab
pH on Arrival• t2
Parameter Schedule: Lead
Nitric Acid Received on Ice
Chemicals in containers, lab
PH on Arrival: c2 Parameter Schedule: Oil and Grease
Hydrochloric Acid Received on Ice
Chemicals in containers, lab
PO Sox 228 • Statesville, NC 28687 • 704/872/4697
Page 3of5