NCS000236 DMR SW (3)

STORMWATER DISCHARGE OUTFALL(SDO)
MONITORING REPORT
Permit Number $;, 0_92.g...)3-0SAMPLES COLLECTED DURING CALENDAR YEAR: ° 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.)
FACILITY NAME Industrial&Agricultural Chemicals, Inc. COUNTY Robeson
PERSON COLLECTING SAMPLE(S) Randall Anrirewsf /- PHONE NO.( 910 ) 843-2121
CERTIFIED LABORATORY(S) •-'fl(r Lab# 3l77
rL I. Lab 3-T-r, g/t„„1...- - •
SIGNATURE OF PERMITTEE OR DESIGNEE
REQUIRED ON PAGE 2.
Part A:Specific Monitoring Requirements -
'Outfall'':”'Date. $0059: : . i' t .1n,-..., „
�:>, '00"4,00 ,Q1022�"rT�;,��,�,01;042;r>,�:;~:, '0x0 � ,. ,,
N S„,;r:1„,:. 01Q92•; Q;Q530 9,0556. oche" ;'
'No`: '=-Sam 1`eu ,�,s. .,v„-x �'. ',f;•`;.•;:,” .�,_� ..�..w a B m�ical> Chemical',~;'
P To al'. Tot I.l t ,i1V•T' g'4 -a'r'.i __ ,=. _� : . ,;.,':r
o -,,r . ;,` _„, ~. 7Cotal.Borort,''T'e!'1 ';.' e •'
, �v�•:c:: � :. .->, �« �;'; .9 �: .•,,., i,-%9;!".g!--1.t' `,":‘a' ,'.;Totl Zinc, :O "e� 'O.x, ':n<
C"olleCt"`�'' - ~<,,w t�,c,�>..��;�,;,:;�>; -. :..<< .,xY J�". y� e ,
E11o'�v(if'a' Dai s' x, >_, = ' F , m; $,
Kz: (., ..PPS)>� nfalt'•"` Grease'�'.,�::~ ,�:'' �=>�-~ <.�%' > _4_
}t.Y,.•�.� . '' t > " � - e '''.:,,f':, ,,'
^''K<{� ..',3.,,,,,T;;;14:.-;'A.4=`;;:',I "' >. _ ,•.G' � ' -. I., . w}s=.wx�3tz!hwS'Waw<e.
.. .. ,.,`k'•L. . .';_:.., >s ., Solids ESS. F,:
mo/dd/yr MG inches 9 (TSS)'-;;; ,..-.,,� ,. ..., �-,. n-, ',.,,. . . , . .. . : .,.. . �'�0D)';-,=:>.�<°s•(C,OD)�'�:`�.{.
Units mg/I mg/1 mg/1 mg/I mg/I mg/I W mg/I mg/I
378041Z)"/I0IIb — 0aC" b- 5. NoNie 2 o '�-9.3s o°ai ® 0'012— r2 .'70 c 2• 0 <3oa0
/ n :_-t's't -A) /art
6 ,a .may 5 If 14 0.,
, 2[116
AUG
CEN i€ ,L FILES
DWF SECTION
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month?_yes ono
,(if yes,complete Part B)
Part B:Vehicle Maintenance Activity Monitoring Requirements
Outfall Date 50050 00556 00530 00400
No. Sample Total Flow Total Oil&Grease Non-polar Total pH New Motor
Collected (if applicable) Rainfall (if appl.) O&G/TPH Suspended Oil Usage
(Method 1664 Solids
SGT-HEM),if
appl.
• mo/dd/yr MG inches mg/1 mg/1 unit gal/mo
Form SWU-247,last revised 2/2/2012
Page 1 of 2

STORM EVENT CHA CTERISTICS: Mail Original and one copy to:
/!) I Division of Water Quality
Date 7/ Attn:Central Files
Total Event P ecipitation(inches): 4— 1617 Mail Service Center
Event Duration (hours): (only if applicable—see permit.) Raleigh,North Carolina 27699-1617
(if more than one storm event was sampled)
Date
Total Event Precipitation(inches):
Event Duration(hours): (only if applicable—see permit.)
"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,
includina the possibility of fines and imprisonment for knowing violations."
Ari,...k_eiW okillt K 1 1.)._1 1 co
(Signature of Permittee) (Date)
Form SWU-247,last revised 2/2/2012
Page 2 of 2

L -.
1 }
.r. ;.
� �• PIVD
Stormwater Discharge Outfall (SDO)
' Ula 1 a alb
Qualitative Monitoring Report OENTL C FILES
g1t1'R ECT6ON
For guidance on filling out this form,please visit: http//112o era.state nc.us/su/Forms Documents htm#miscfoi ins
Permit No.: N/C/ S/0 / 0/0 / 2/3 / 6/ or Certificate of Coverage No.: N/C/G/ / / / / / /
Facility Name: Industrial & Agricultural Chemicals, Inc.
County: Robeson Phone No. 910-843-2121
Inspector: Randall Andrews
Date of Inspection: yj�/
Time of Inspection: !I . i C 0,--A,‘
Total Event Precipitation (inches): 0.,4-' ID
p r�„C F t, '
Was this a Representative Storm Event? (See information below) 21<es ❑ No An 1. 5 2.016
Please checkyourpermit to verifyif ^r-m+RPL FILES
Qualitative Monitoring must be performed during.a"re resent Gzve,
storm event(requirements vary). uv:� � 5���sve�
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 ignature, I certify that this report is accurate and complete to the best of my knowledge:
. I 1 , ' r 0,„.(,c,,,,c,
(Signature of Permittee or Designee)
1. Outfall Description:
Outfall No. 37804 Structure(pipe, ditch, etc.) ditch
Receiving Stream: UT to Burnt Creek
Describe the industrial activities that occur within the outfall drainage area: NiNI C-
2.
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and int
(light,medium, dark) as descriptors: 1.-1 H( -- NS o C p L p K C'L�
3. Odor: Describe any distinct odors at the discharge may have(i.e., smells strongly of oil, weak
chlorine odor, etc): N'ct
Page 1 of 2
S WU-242-112608

4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is clear
and 5 is very cloudy-
.
0 2 3 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:
© 2� 3 4 5
6. Suspended Solids: Choose the number which best descnbes the amount of suspended solids in
the stormwater discharge, where 1 is no solids and 5 is extremely muddy.
1 4WAIIP 4 5
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 outfall? Yes (-1\7 )
10. Other Obvious Indicators of Stormwater Pollution:
List and describe '0l\t V \ S' l KL__�
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