WQ0006941_Monitoring - 09-2022_20221025

Monitoring Report Submittal
Permit Number #*
Name of Facility:*
Month: * September
Report Information
WQ0006941
Stoney Creek Elementary School
Type *
NDMR, NDAR-1, NDAR-2, NDMLR
Confirmation Email Address:*
Name of Submitter: *
Signature:
Date of submittal:
Initial Review
Year:* 2022
Upload Document*
Stoney Creek_Sept.pdf 722.32KB
PDF Only
Please upload one PDF containing all applicable monitoring reports
(i.e., NDMR, NDAR-1, NDAR-2, NDMLR, GW-59).
[e-mail]
Jessica Mize
jwd rA lip
Reviewer: Gerald, Wanda
10/25/2022
This will be filled in automatically

Is the project number correct?* WQ0006941
Is the monitoring report accepted?* Yes No
Regional Office* Winston-Salem
Reviewer: _anonymous
Review Date: 11/10/2022

FORM: NDMR 05-16 NON -DISCHARGE MONITORING REPORT (NDMR) Page _1_ of _2_
Permit No.: WQ0006941
Facility Name: Stoney Creek Elementary School
County: Caswell
PPI: 001
Flow Measuring Point:
Parameter Monitoring Point:
Parameter Code -►
50050-
00310
50060
31616
00610
00625
00620
00600
00400
00665
00530
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24-hr
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", GPD„.
mg1L
m 1L.=''.-
#1100 mL
_::mg1L =
mg/L
mg1L .�'
m 1L
su
mg1L
2
1,120".
3
1,120 --
5
11120
6
1,120
7
11120,
8
10:16
0.25
11120 °±,
Q.11 ., _:
6.4 ;
9
10
11
988
12
13
14
11:47
0.25
988 .'
-0.19.
-;6.4
15
1,133
16
1,133.,
17
1433,
18
1-133
19
1,133
20
1,133
21
1033..<;
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13:38
0.25
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23
1,207
241
1,207.
25
1,2p7 _
26
27
28
1,207,
29
10:10
0.75
1;20T <:-
26
;; 0.25.,",
2420
29.8 -s
34.9
0:44
35.3
6.4
4.3
14.9
30
31
Average:
.J_ 17 -
26.00
0.16
2,420.00
29.80
34.90
0.44'
35.30
4.30
14.90
Daily Maximum:.,
1,207., :�:
26.00
0.25 F'
2,420.00
;;=29.80.: ;
34.90
- °,0.44
35.30
5.50 ...
4.30
14.90 ;.
Daily Minimum:
988. ; =
26.00
2,420.00
_ i :29.80
34.90
' . 0.44,.
35.30
: i 8;40
4.30
:14.90 _. <'
Sampling Type:
EsHmate
Grab
Grab ,jr
GrabGrab
.-
Grab
:,Grab
Grab
Grab
Grab
Grab < <
Monthly Limit:
3500<`
_.
Daily Limit:
Sample Frequency:
G Monthly"
3 X Year
3 X Year
_ 3:K Year :,
3 X Year
. � X'Year.
3 X Year
Weekly '1
3 X Year
'3 X Year,
Month: September I Year: 2022

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? M bDmpiiant ❑ Non -compliant
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. Auacn aaaroonai sneers it
Operator in Responsible Charge (ORC) Certification
Permittee Certification
ORC: Glenn Price
Permittee: Baron Neal McDuffie ( Authorized Agent)
Certification No.: 987931/20771
signing Official: Baron Neal McDuffie
Grade: II Phone Number: 336-996-2841
Signing officiars Titie: Field Services Director ( Pace Analytical }
Has the ORC changed since the previous NDMR? ❑ Yes I] No
Phone Number: 336-996-2841 Permit Expiration: 8/31/2021
�"JJJ
27 - 4 Z�2z
Signature Date
Signature Date
By this signature, I certify that this report is accurrate and complete to the best of my knowledge.
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 an quail ied 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
knowing violations.
Mail Original and Two Copies to:
Division of Water Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

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?
MK.mpliant
❑ Non -Compliant
Were adequate measures taken to prevent effluent ponding in or runoff from the sites?
IJ'Compllant
❑ Nan-Camptiard
Was a suitable vegetative cover maintained on all sites as specified in your permit?
Compliant
❑ Non -Compliant
Were all setbacks listed in your permit maintained for every application to each permitted site?
I11Compliant
❑ Non -compliant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit?
VIM'
❑ Non -Compliant
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
acuonts) taKen. Attacn aaaiaonai sneers it necessary.
IOperator in Responsible Charge (ORC) Certification 11 Permittee 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 Officials Title: Field Services Director (Pace Analytical Services)
Has the ORC changed since the previous NDARA? ❑ Yes O No Phone Number: 336-996-2841 Permit Exp.: 8/31 /21
Signature Date Signatur Date
By this signature, I certify that this report is accurrate and complete to the best of my knowledge. I certify, under penally of taw. that this document and all attachments were under m direction or supervision
Prepared Y 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 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 significant
penalties for submitting false 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 27699-1617

aceAnalytical
www.pacelaba.eom
Caswell County Schools /Jerry
Caswell County Schools
P.O. Box 160
Yanceyville, NC 27379
Project: Stoney Creek Elementary
Pace Project No.: 92628294
Sample: Effluent
Laboratory Report
Pace Analytical Services, LLC
1377 South Park Drive
Kemersville, NC 27284
[phone]
Page 1 of 1
Report Date: 10/10/2022
Date Received: 09/29/2022
Lab ID: 92628294001 Collected: 09129/22 10:43 Matrix: Water
Method Parameters
Results
Units Report Limit
Analyzed Qualifiers
SM 254OD-2015 Total Suspended Solids
14.9
mg/L
4.1
09/30/22 16:49
EPA 353.2 Rev 2.0 1993 Nitrogen, NO2 plus NO3
0.44
mg/L
0.040
09/30/22 09:39
EPA 353.2 Rev 2.0 1993 Nitrogen, Nitrate
0.44
mg/L
0.040
09/30/22 09:39
SM 521 OB-2016 BOD, 5 day
26.0
mg/L
2.0
10/05122 11:06
Colitert-18 Fecal Coliforms
2420
MPN/100mL
1.0
09/30/22 10:33 El
TKN+NO3+NO2 Total Nitrogen
35.3
mg/L
0.040
10/10/22 16:38
Calculation
EPA 350.1 Rev 2.0 1993 Nitrogen, Ammonia
29.8
mg/L
0.60
10/04/22 16:06
EPA 351.2 Rev 2.0 1993 Nitrogen, Kjeldahl, Total
34.9
mg/L
2.5
10/08/22 07:34
EPA 365.1 Rev 2.0 1993 Phosphorus
4.3
mg/L
0.050
10/04/22 19:07
ANALYTE QUALIFIERS
El Reported value should be considered a minimum
estimate since it
is the maximum reportable number for this method
based on the sample volume used. The true
value is likely greater
than the value reported.
Reviewed by:
Stephanie Knott
704-977-0981
[e-mail]
Pace Analytical Services Asheville
2225 Riverside Drive, Asheville, NC 28804
Flodda/NELAP Certification #: E87648
North Carolina Drinking Water Certification #: 37712
North Carolina Wastewater Certification #: 40
Pace Analytical Services Eden
205 East Meadow Road Suite A, Eden, NC 27288
North Carolina Drinking Water Certification #: 37738
South Carolina Laboratory ID: 99030
South Carolina Certification #: 99030001
VirginiaNELAP Certification #: 460222
North Carolina Wastewater Certification #: 633
Virginia/VELAP Certification #: 460025
Page 1 of 3

CHAIN -OF -CUSTODY Analytical Request Document
dGB�I/lc��,�lCBl4
Chain -of -Custody is a LEGAL DOCUMENT- Complete all relevent fields
LAS USE ONLY- Affix Workorder/Login Label Here or Ust Pace Workorder Number or
MT.n --._...._..-_••/-�- /►�/� /�
WO# : 9262SL94
WWWW TTTTTTTT rV,/ LL V V �,/
ALL SHADED A
Container Preservative T e `
z 92628294 —
•' Preservative Types: (1) nitric acid, (2) sulfuric acid,
(6) methanol, (7) sodium bisulfate, (8) sodium thiosulfate, (9) hexane, (A) ascorbic acid, (B) ammonium sulfate,
(C) ammonium hydroxide, (0) TSP, (U) Unpreserved, (0) Other
Company:
Stoney Creek Elementary
Billing Information:
Address:
Report TO:
Email TO:
Copy To:
Site Collection Info/Address:
Analyses
L ab Profile/Line:Lab
Customer Project Name/Number:
State: County/City: Time Zone Collected:
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Sample Receipt Checklist:
Custody Seals Prevent./Intact- Y NA
custody signatures Prevent N A
Collector Signature Present N NA
bottles Intact N NA
Correct Bottles N NA
Sufticient volume NA
samples Received on Ice t
van = Handspace Acceptable, ` Y tr
USUA Regulated &oils �Y N
Samples in Holding Time(DN NA
Residual Chlorine r erit Y QA
Cl Strips: O
Sample pti Acce table iliA
pit Stripn? i�_
Sulfide Prea;nt
Load Acetate Stripe:
LAB USE ONLY -
Lab sample b / Comments:
Phone:
Email-
Site/Facility ID It:
Compliance Monitoring?
[ /Yes [ I No
Colle PY (print):
Purchase Order #:
Quote#:
DW PWS ID #:
DW Location Code:
ollected By (signatu(e):
Turnaround Date Required:
Imme late y Pace on ce:
( ]Yes [ ]NO
Sample Disposal:
( ) Dispose as appropriate I I Return
( ) Archive:
( J Hold:
Rush:
I I Same Day [ I Next Day
[ ] 2 Day [ 13 Day ( } 4 Day [ ] S Day
(Expedite Charges Apply)
Field Filtered (if applicable):
[ I Yes [ ] No
Analysis:
" Matrix Codes (insert in Matrix box below): Drinking Water (DW), Ground Water (GW), Wastewater (WW),
Product (P), Soil/Solid (SL), Oil (OL), Wipe (WP), Air (AR), Tissue (TS), Bloassay (B), Vapor (V), Other (OT)
Customer Sample l0
P
Matrix "
Comp (
Grab
Collected (or
Composite Start)
Composite End
Res
Cf
# of
Ctns
ate
Time
Date
Time
Effluent
WWG
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p
Customer Remarks / Special Conditions / Possible Hazards:
" Gasweli County Schools ""
Type of ice Used: Wet Blue Dry''' None
SHORT HOLDS PRESENT (02 hours)'
Y N NIA
Lab Sample Temperature Info:
Temp Blank Received: Y N NA
Therm !D#: _}�-�'IL . (p O Z-
Cooler 1 Temp Upon Receipt: 5.1 oC
Cooler 1 Therm Corr. Factor:... 1 oC
Cooler 1 Corrected Temp: q • ( oC
Comments:
Packing Material Used: , , ,, /}
Lab Tracking #:
Radchem sample(s) screened {c50D cpm): Y N NA
Samples received via:
FEDEX UPS Client Courier Pace Courier
Relinquished by/Co ny: (Signature
7,"059!%
Dat me:
! �—
Rec ed byjCompany: Signature)
Date/Time:
V i ct h -1 ([ a
MTJL LA LY
Table #:
Acctnum:
Template:
Pretogin:
PM-
_PB'___—.---_____r__._
Re qiquished Company, ,W. r e)
43
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Date ime:
Received by/Co ny: (5 ature)
Date/Time:
Trip Blank Received: Y N NA
P
HCL MCOH TSP Other
RelQquished by/Company: (Signature)
Date/Time:
Received by/Company: (Signature)
_
Date/Time;
Non Conforrnance(s): Page:
YES / NO of:

Document Name: Document Issued: November 15, 2021
Bottle Identification Form IBIFj I Page 1 of 1
aeeAralftical Document No.: Issuing Authority:
F-CAR-CS-C33•Ray.01 Pace Carolinas Quality Off,Ce
*Check mark top half of box if pH and/or dechlorination is
verified and within the acceptance range for preservation
samples.
Exceptions: VOA, Coliform, TOC, Oil and Grease, DRO/5015 (water) DOC, LLHg
**Bottom half of box is to list number of bottles
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pH Adjustment Log for Preserved Samples
sample ID
Type of Preservative
pH upon receipt
Date preservation adjusted
Time preservation
adjusted
Amount of Preservative
added
Lot N
-- win ue sent w cne rvortn �-aronna utnriR Certification office (i.e.
Out of hold, incorrect preservative, out of temp, incorrect containers.
Page 3 of 3