NCG050229 - ROS Request Form 6/22/2018

FOR AGENCY USE ONLY
Division of Energy, Mineral & Land Resources Date Receivca
Ycar Month Day
Stormwater Program
National Pollutant Discharge Elimination System
Environmental REPRESENTATIVE OUTFALL STATUS (ROS)
Quality DDnrrWem cnDna
If a facility is required to sample multiple discharge locations with verysimilar stormwater discharges, the
permittee may petition the Director for Representative Outfall Status (ROS). DEQ may grant Representative
Outfall Status if stormwater discharges from a single outfall are representative of discharges from multiple
outfalls. Approved ROS will reduce the number of outfalls where analytical sampling requirements apply.
If Representative Outfall Status is granted, ALL outfalls are still subject to the qualitative monitoring
requirements of the facility's permit—unless otherwise allowed by the permit (such as NC6020000) and DEQ
approval. The approval letter from DEQ must be kept on site with the facility's Stormwater Pollution
Prevention Plan. The facility must notify DEQ in writing if any changes affect representative status.
For questions, please contact the DEQ Regional Office for your area (see page 3).
(Please print or type)
1) Enter the permit number to which this ROS request applies:
Individual Permit (or)
N C S
2) Facility Information:
Owner/Facility Name Sealed Air
Facility Contact
Street Address
City
County
Telephone No.
1,10,9,8
Teresa Cornett
Certificate of Coverage
NI C I G 10 15 0 2 2 9
2075 Valway Road
Lenoir State NC ZIP Code 28645
Caldwell E-mail Address [e-mail]
828 726-2100 Fax: [phone]
3) List the representative
outfall(s) information (attach additional sheets if necessary
is representative of Outfalls) 2
Outfalls' drainage areas have the same or similar activities? es ❑ No
Outfalls' drainage areas contain the same or similar materials? ❑ No
Outfalls have similar monitoring results? WYes ❑ No ❑ No data*
Outfall(s) 7,615,4 is representative of Outfall(s)
):
Outfall(s)
3
Outfalls' drainage areas have the same or similar activities? es ❑ No
Outfalls' drainage areas contain the same or similar materials? ❑ No
Outfalls have similar monitoring results? ayes ❑ No ❑ No data*
Outfalls) is representative of Outfall(s)
Outfalls' drainage areas have the same or similar activities? ❑Yes ❑ No
Outfalls' drainage areas contain the same or similar materials? ❑ Yes ❑ No
Outfalls have similar monitoring results? ❑ Yes ❑ No ❑ No data*
*Non-compliance with analytical monitoring prior to this request may prevent ROS approval. Specific
circumstances will be considered by the Regional Office responsible for review.
Page 1 of 3
SWU-ROS-2009 Last revised 12/30/2009

Representative Outfall Status Request
4) Detailed explanation about why the outfalls above should be granted Representative Status:
(Or, attach a letter or narrative to discuss this information.) For example, describe how activities and/or
materials are similar.
This site has a vehicle maintenance shop. Outfalls 1, 10, 9, & a can be represenated by a sample from Outfall 2.
Outfall 2 collects water from the Norlh side of the building where the vehicle maintenance shop is located. Outfall 7, 6, 5 &
4 can be repressenated by a sample from Outfall 3. Outfall 3 collects water from the North side of the bulldino where the
vehicle malntenance shop is located.
S) Certification:
North Carolina General Statute 143-215.6 B(i) provides that:
Any person who knowingly makes any false statement, representation, or certification In any application, record,
report, plan, or other document filed or required to be maintained under this Article or a rule implementing this
Article; or who knowingly makes a false statement of a material fact in a rulemaking proceeding or contested case
under this Article; or who falsifies, tampers with, or knowingly renders inaccurate any recording or monitoring device
or method required to be operated or maintained under this Article or rules of the [Environmental Management]
Commission implementing this Article shall be guilty of a Class 2 misdemeanor which may include a fine not to exceed
ten thousand dollars ($10,000).
I hereby request Representative Outfall Status for my NPDES Permit. I understand that ALL outfalls are still
subject to the qualitative monitoring requirements of the permit, unless otherwise allowed by the permit
and regional office approval. I must notify DEQ in writing if any changes to the facility or its operations
take place after ROS is granted that may affect this status. If ROS no longer applies, I understand I must
resume monitoring of all outfalls as specified in my NPDES permit.
I certify that I am familiar with the information contained in this application and that to the best of my
knowledge and belief such Information is true, complete, and accurate.
Printed Name of Person Signing: Teresa cornett
Title: Duality Manger/EHS Director Lenoir Plant
(Signature of Applicant)
(Date Signed)
Please note: This application for Representative Outfall Status is subject to
approval by the NCDEQ Regional Office. The Regional Office may inspect your
facility for compliance with the conditions of the permit prior to that approval.
Final Checklist for ROS Request
This application should include the following items:
❑ This completed farm.
❑ Letter or narrative elaborating on the reasons why specified outfalls should be granted representative
status, unless all information can be included in Question 4.
❑ Two (2) copies of a site map of the facility with the location of all outfalls clearly marked, including the
drainage areas, industrial activities, and raw materials/finished products within each drainage area.
❑ Summary of results from monitoring conducted at the outfalls listed in Question 3.
❑ Any other supporting documentation.
Page 2 of 3
SWU-ROS-2009 Last revised 12/30/2009

Representative Outfall Status Request
all the entire package to:
NCDEQ DEMLR at the appropriate Regional Office (See map and
addresses below)
Notes
The submission of this document does not guarantee Representative Outfall Status (ROS) will be granted as
requested. Analytical monitoring as per your current permit must be continued, at all outfalls, until written
approval of this request is granted by DEQ. Non-compliance with analytical monitoring prior to this request
may prevent ROS approval. Specific circumstances will be considered by the Regional Office responsible for
review.
For questions, please contact the DEQ Regional Office for your area.
Asheville Regional Office
2090 U.S. Highway 70
Swannanoa, NC 28778 Washington Regional Office
943 Washington Square Mall
Phone [phone] Washington, NC 27889
FAX [phone]
Phone [phone]
Fayetteville Regional Office FAX [phone]
Systel Building,
225 Green St., Suite 714 Wilmington Regional Office
Fayetteville, NC 28301-5094 127 Cardinal Drive Extension
Phone [phone] Wilmington, NC 28405
FAX [phone] Phone [phone]
Mooresville Regional Office FAX [phone]
610 East Center Ave. Winston-Salem Regional Office
Mooresville, NC 28115 585 Waughtown Street
Winston-Salem, NC 27107
Phone [phone] Phone [phone]
FAX [phone] Water Quality Main FAX [phone]
Raleigh Regional Office Central Office
1628 Mail Service Center 1612 Mail Service Center
Raleigh, NC 27699-1628 Raleigh, NC 27699-1612
Phone [phone] Phone [phone]
FAX [phone] FAX [phone]
Page 3 of 3
SWU-ROS-2009 Last revised 12/30/2009

Blue Ridge Labs
PO Box 2940
Lenoir, NC 28645
828-728-0149
Client :
Sealed Air Corporation
PO Box 1018
Lenoir, NC 28645
Attention:
Seth Bradshaw
Date Received:
23 -Apr -18
Report Date:
14 -May -18
Sample Date:
23 -Apr -18
BRLth
BRL-2018-0238
Lab Sample ID:
LSID-2018-01120
Client Sample ID:
Outfall 2
Parameter
Oil &Grease
Result MQL
a .5
Reported sy:
bl ueridgela [e-mail]
Unit Method
mg/I 1664-A O&G
Analysis Analysis
Time Date Analyst
5/2/2018 WtrQlty
5..�¢ohnson, D.R. Wessinger
*Concentrations are below Minimum Quantification Limit except where noted.
NC Laboratory Certificate No. 275
Page I of 4

Blue Ridge Labs
PO Box 2940
Lenoir, NC 28645
828-728-0149 [e-mail]
Client :
Sealed Air Corporation
POBox 1018
Lenoir, NC 28645
Attention:
Seth Bradshaw
Date Received:
23 -Apr -18
Report Date:
l4 -May -18
Sample Date:
23 -Apr -18
BRL H:
BRL-2018-0238
Lab Sample ID:
LSID-2018-01121
Client Sample ID:
Outfall 2
Analysis
Analysis
Parameter
Result
MQL
Unit
Method
Time
Date
Analyst
TSS
+
10
mg/l
2540D 1997
11:14
4/27/2018
KCJ
pH
6.8 HT
0.1
su
4500H+B 200
14:45
4/23/2018
KCJ
Settleable Solids
*
0.1
m1/I
SM19
15:42
4123/2018
KCJ
Reported By:
S. hnson, D.R. Wessinger
" Concentrations are below Minimum Quantification in except where noted.
NC Laboratory Certificate No. 275
Page 2 of 4

Blue Ridge Labs
PO Box 2940
Lenoir, NC 28645
828-728-0149
Client :
Sealed Air Corporation
PO Box 1018
Lenoir, NC 28645
Attention:
Seth Bradshaw
Date Received:
23 -Apr -18
Report Date:
14 -May -18
Sample Date:
23 -Apr -18
BRL#:
BRL-2018-0238
Lab Sample ID: LSID-2018-01122
Client Sample ID: Outfail 3 „
Parameter
blueridgelabslenoimgma il.com
Result MQL Unit Method
*
Oil &Grease
5 mg/l 1664-A O&G
Analysis Analysis
Time Date Analyst
5/2/2018 WtrQity
Reported By:
S mson, D.R. Wessinger
* Concentrations are below Minimum Quantification Limit except where noted.
NC Laboratory Certificate No. 275
Page 3 of 4

Blue Ridge Labs
PO Box 2940
Lenoir, INC 28645
828-728-0149 [e-mail]
Client: Sealed Air Corporation
PO Box 1018
Lenoir, NC 28645
Attention: Seth Bradshaxv
Date Received: 23-Apr-18
Report Date: 14-May-18
Sample Date: 23-Apr-18
BRL#: BRL-2018-0238
Lab Sample ID: LSID-2018-01 123
Client Sample ID: Outfall 3
Analysis Analvsis
Parameter Result MQL Unit Method Time Date Analyst
.., ..... _..—- - ...... ........ . ..
TSS • l0 mg/I 2540D 1997 11:15 4/27/2018 KCJ
pH 7.2 HT 0.1 su 45001F 200 14:47 4/23/2018 KCJ
Settleable Solids * 0.1 ml/1 SM19 16:14 4/23/2018 KCJ
Reported By:
SAV us on, D.R. Wessinger
` Concentrations are below Minimum Quantification Limit except where noted.
NC Laboratory Certificate No. 275
Page 4 of 4

MAY/'i0/20!8/TRU 11:24 AM FAX NI', F, 001/001
WATER QUALITY LAB & OPERATIONS, INC.
P,O. BOX 1167
BANNER ELK, NO 28604
[phone]
CLIENT:
BLUE RIDGE LABS
ADDRESS;
P.O. BOX 2940
CITY:
LENOIR
STATE:
NO ZIP 28645
ID#:
ssi<:;>:;-:>
LOGIN TIME:
SAMPLER:
RECEIVED DATE:
REPORTED DATE:
9 -May -1 B
REPORTED BY: NC CERTIFIED LAB 4544
llza�j+m�Gwv
PAUL ISENHOUR, SUPERVISOR
>:•:•:>:,:;:<.-;::;:::«;.::;:>:>
ssi<:;>:;-:>
RE 1iL.xs.......
F,Ocr�:�
..:.:x�a;��.::.:::.:,•::::;::
OIL & GREASE
1105
7.2
5.00
MG/L
2 -may -l8
PI
OIL & GREASE
1107
10.4
5.00
MO/L
2 -May -18
PI
OIL & GREASE
11201
<5
5.00
MG/L
2 -Ma ,18
pt
OIL & GREASE
1-121
<5
5.00
MG/L
2-M2 -18
PI
OIL & GREASE
1141
<5
5.00
MG/L
2 -Ma -18
PI
OIL & GREASE
1173
<5
5.D0
MG/L
2-MaY-18
pl
REPORTED BY: NC CERTIFIED LAB 4544
llza�j+m�Gwv
PAUL ISENHOUR, SUPERVISOR

Blue Ridge Labs
PO sox 2940
Lenoir, NC 28645
828-728-0149 [e-mail]
Data Qualifiers
The following is a list of data qualifiers used on Blue Ridge Labs' Reports. Any of the
qualifiers may make the data unacceptable for state reporting, Data qualifiers are
found in the results column and their definitions are as follows:
* The concentration found is below our minimum concentration value, which is
reported in the MQL column.
**" The concentration reported is an estimated value. The result is above our
highest standard.
HT The sample was received out of hold time.
IC The sample was received in an improper container.
NC The sample was received without proper cooling.
NP The sample was received without proper preservatives.
IC The sample was received in an improper container.
H5 The V0C container was received with headspace present.
NR The sample was not run due to lab error_
UG Unable to confirm
analysis due to insufficient sample being subrntted.
D Sample was diluted due to physical problems with the sample.
J Value is an estimate from a library search using the nearest internal standard.
NCA Non -certified Analysis
Revised 10/21/16

\\
uo
\
7
e
%
\
\
)
�
0
[I
�
/
\
[/)
§\)ƒ
\
fz(`
*
\
7
e
%
)
�
0
\
\
*
\\
�
(v
�g
�
®
�
\\\
}
®
-)
»�
\\})\
_)\z�
}\) )»
«))®
476w
\[
k9
w®
$
}
\
ƒ
)
�
7
�
g
¥
�
\
7
`
�
R