NCG080448_MONITORING INFO_20190513

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
�6o s
/V C�
DOC TYPE
❑HISTORICAL FILE
$� MONITORING REPORTS
DOC DATE
❑ a O ) °I () SI S
YYYYMMDD

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No. NCGO80000
Date submitted
CERTIFICATE OF COVERAGE NO. NCG08 0 SAMPLE COLLECTION YEAR d D l P
FACILITY NAME to ;y SAMPLE PERIOD ❑ Jan -June July -Dec
COUNTY _ L%fG.� �� or ❑ Monthly) (month)
PERSON COLLECTING SAMPLES 1 c c c DISCHARGING TO CLASS ❑ORW ❑HQW [:]Trout❑PNA
LABORATORY--PrS�- Ls•-� ._ Lab Cert. # Cio z CCC IVEQ ❑Zero -flow ❑Water Supply ASA
Comments on sample collection or analysis: SAY Zal ❑Other
FILE�­
GENTRALE r "PLEASE REMEMBER TO SIGN ON THE REVERSE 3
Part A: Vehicle Maintenance Areas Monitoring Requirements DWR SECTION 'MAY 13
❑ No discharge this period'
(9FlY:[
'Outfali-� a;;
No.
:- ;D` ,,;-.,_:rw
.
4 ate ;�,
.i ample,tiCollected,
tna%dd/,y� :
:i.
„004oD g:
j rk .rx4 • y.F y r-:, , r 5 °
oU556 _
'
.
;Total Suspended
wSohtls, mg/L _.
=M r o ;z `pH, , .
-. Y.J'� Y It
t€=�;.Stai7dardunrts ..;
Non, Polar Oil,arid Grease/TP iifPA
,T •Y•;"�. }2-..--
# �aMethodi`664(SGT-HEMj;Annual+averagegal/.mo
-
New Motar Oil=Usage;. `
Benchmark,.,oIOo�see`:permitk.Wftfiini6:1}�
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? _ yes _no
(if yes, report your analytical results in the table immediately below)
Part B: Oil/water Separators and Secondary Containment Areas at Petroleum Bulk Stations and Terminals
:Outfalf
_,-<Date 1
"' i0o556ya ir�� �V,3.=00530
-.-s.i
'f
s. -
s fi5
(}(}400
f,
Non P61W it ands,GreA TPH'.EPA-Methods �
�, �f�
No = '
, -Sample Collected,
'
mo/dd
=1664 5GT r`�'
,Tota3,Suspended`Solitls,
"�L;:-:: ,.
z ;5 n x f j
lord' -units
rL
HEM rn:.�lM1�
to ..
Permit'Lirnit
y° ` ' `
" _ 15 r•z ''
517 or. IOD see ermit;
6:0 = 9'0_
�t,
� ,;
<` p .i
ort03
I For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here.
SWU-250 last revised October 25, 2012
Page 1 of 2

•✓ Ilk
STORM EVENT CHARACTERISTICS:
Date g13 l[ p- (first event sampled)
Total Event Precipitation (inches): .3d
Date (list each additional event sampled this reporting period, and rainfall amount)
Total Event Precipitation (inches):
Note: if you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses. See General Permit text.
FOR PART A AND PART B MONITORING RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER t REQUIREMENTS. SEE PERMIT PART 11 SECTION B.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART 11 SECTION 8.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES ❑ NO
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an original and one coov of this DMR, includina all "No Discharge" reports. within 30 days of receipt of the lab results for at end of monitoring period in
the case of "No Discharge" reports) to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED:
"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, including the possibility of fines and imprisonment for knowing violations."
(Signature of
( Date)
Additional copies of this form may be downloaded at: http://portai.ncdenr.org/web/wq/ws/su/npdessw#tab-4
SWU-250 last revised October 25, 2012
Page 2 of 2

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No. NCGO80000
Date submitted _1-1, r' 9 Zd (r- _
CERTIFICATE OF COVERAGE NO. NCG08_.o SAMPLE COLLECTION YEAR ®'0I e
FACILITYNAME G�LcS4� %1or�nd < C�itd�/n �tcli' SAMPLE PERIOD�an-June ❑ July -Dec
COUNTY A G[� Lam_ � �•-fS � or ❑ Monthly' month
PERSON COLLECTING SAMPLES �/ -Levi L+jocr��7S n` r DISCHARGING TO CLASS ❑ORW ❑HQW [:]Trout❑PNA
LABORATORY Pj- ` S,,j Lab Cert. ## _ LjDZ _ _ ❑Zero -flow ❑Water Supply OsA
Comments on sample collection or analysis: RECEIVED ❑Other
JAIL 2 4 2018
Part A: Vehicle Maintenance Areas Monitoring Requirements CENTRAL_ FILES
DWR SECTION
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
'No discharge this period'
Ccutfall`
',; Y Date `•
0053
00400=
No.
ple;Collecteci,.•.
"{ Total Suspended f'
-
�:,.;ri ^pH; a t �* �`#
{aN n Polar OiIr ',Grease/STPHtuA-�-
t .New+ Motor'Oif'Usage,;•,°
.'
4_Sarr
mo/,dd/,yr :
rr y-: ♦
Solids,,mg/i '. {,;
t�" .'t 3 3'r.-1
Standard unitsk:.;
'2 -r . v" '3'' ,?. '. 1_ d"
Methotl166d(SGT HEMj,inig/L. _
-.•s -t•.. _`. _ r
_ 'Ann_ ualfaverage.gal/mo_
Ben chmark
t'
50 dell. seep ermrt
,
7
p
•—
G ii A f
1
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? ✓yes _no
(if yes, report your analytical results in the table immediately below)
Part B: Oil/water Separators and Secondary Containment Areas at Petroleum Sulk Stations and Terminals
Outfall'
Date b '
= 3 3 Y ;.OU556;£',:.� a�` ,
�"w ,� `y.0530
:;00400-
No.
r Sam e. Collected
1 p...
Non -Polar 0�l and'Grease sTPIf EPA-IVlethod"
/
yF� - To`taf Sus' eiidedzSolids` ��
pe
- H`'
p
'
,
°166a..(SGT.HEM],=mg/,L `�'
ing/,L`
,
3Starsda�d'iunits...
_ .rrio/bdd/yr�
_
.n.
Perrnit'Limtt
- r
� F, t
5D or l00:see '
6.0 = 9 0`
-y
permit;
I For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here.
SWU-250 last revised October 25, 2012
Page 1 of 2

STORM EVENT CHARACTERISTICS:
Date (first event sampled)
Total Event Precipitation (inches):
Date (list each additional event sampled this reporting period, and rainfall amount)
Total Event Precipitation (inches):
Note: If you report a sample value in excess of the benchmark, you must implement Tier .1, Tier 2, or Tier 3 responses. See General Permit text.
FOR PART A AND PART B MONITORING RESULTS:
+ A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES ❑ NO ❑
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an original and one copy of this DMR, including all "No Discharge" reports within 30 days of_receipt of the lob results (or at end of monitoring period in
the case of "No Discharge" reports) to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED:
"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 penaSies for submitting false information, including the possibility of fines and imprisonment for knowing violations."
(Signature
?11-F/rf-
(Date)
Additional copies of this form may be downloaded at: http://portal.ncdenr.orglweb/wg/ws/su/npdessw#tab-4
S WU-250
last revised October 25, 2012
Page 2 of 2

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No. NCG080000
Date submitted J Z//%.Y
CERTIFICATE OF COVERAGE NO. NC 08 o ? y, y
C�l� FACILITY NAME � I ar I, 1-4 A,fi, — F COUNTY /''� �•5
PERSON COLLECTING SAMPLES '�i's r Ats
LABORATORY P,; 4 Lab Cert. #
Comments on sample collection or analysis:
Part A: Vehicle Maintenance Areas Monitoring Requirements
SAMPLE COLLECTION YEAR 7
SAMPLE PERIOD ❑ Jan-JuneJuly-Dec
or ❑ Monthly' month
DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑7S.Aa
[I]Zero-flow❑Water Supply
❑Other
RECEIVED PLEASE REMEMBER TO SIGN ON THE REVERSE 3
FEB 4 6 zois ❑ No discharge this period'
0ONTRAL FILES
DWR SECT
Outfall
No.
Dafe
Sample Collected; .:
mo/dry/yr _.,
00530
00556.
.. Total`Suspended•�._
'Solids; .mg/L
bpH;. s
-Standard ufiits; `_
`..Non Palar oil and`+Grease%TPH:EPA_
Method 1664'(SGT=HEM); mg/L
.New:MotorOil Usage,
Annual'average gal/mo
Benchmark
50'or-100!see-permit-
2
/So
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? ✓es _no
(if yes, report your analytical results in the table immediately below)
Part B: Oil/water Separators and Secondary Containment Areas at Petroleum Bulk Stations and Terminals
Out#all
No.
Date
Sample Collected;
mo/dd/yr _
:•00556
: ;00530•. ,.
00400
Non Pcilar�0il a6d,G�ease/TPH EPA:Method:
166 .(SGT_HEM) rh C
dotal Suspended'Solids;
`mg/L ::
pH,
Standard units
Permit Limit
-
15'
50or.100 see;permit.
6.0 - 9:0
t For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here.
SWU-250 last revised October 25, 2012
D­ 1 _r')

STORM EVENT CHARACTERISTICS:
Date I l7 (first event sampled)
Total Event Precipitation (inches): •
Date (list each additional event sampled this reporting period, and rainfall amount)
Total Event Precipitation (inches):
Alote: If you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses. See General Permit text.
FOR PART A AND PART B MONITORING RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART Il SECTION B.
• 2 EXCEEDANCES 1N A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART II SECTION B/.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY ONE QUTFALL? YES ❑ NO L�
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an original and one copy of this DMR, including all "No Discharge" reports, within 30 days of receipt of the lob results for at end of monitorina period in
the case of "No Discharge" reports) to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED:
"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 penalto for submitting false information, including the possibility of fines and imprisonment for knowing violations."
% A5 o
(Date)
Additional copies of this form may be downloaded at: http://Dortal.ncdenr,org/web/wows/su/npdessw#tab-4
S WU-250 last revised October 25, 2012
Donn I M, I

Semi-annual Stormwater Discharge Monitoring Report
t for North Carolina Division of Water Quality General Permit No. NCG080000
Date submitted -AlS
CERTIFICATE OF COVERAGE NO. NCGO80 t
FACILITY NAME (.ram n-ky- Cbnnft,�imC ortcr4� f-�1
COUNTY k
PERSON COLLE ING SAMP S f &,Sm �n5c�•n�OriPS
LABORATORY W-!La ti Lab Cert. #
Comments on sample collection or analysis:
Part A: Vehicle Maintenance Areas Monitoring Requirements
SAMPLE COLLECTION YEAR , OM) j
SAMPLE PERIOD ZJan-June ❑ July -Dec
or ❑ Monthly' (month)
DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
REISEIVE ,d ❑Zero -flow ❑Water Supply &A
❑Other
MAY 1,AZ017
CENTRAL FILES PLEASE REMEMBER TO SIGN ON THE REVERSE 4
DWR SECTION ❑ No discharge this period'
Outfall`.'
No ?
Date :
5asrnole Collected,
..,
mo/dd/yr
-: 00530
;60 00
,Total Suspended
-'.'-' °
Solids, rng/Lv
s-'pH,
rT� 3�`¥. n.-� 41 »`,�-
Standard units
Non=Pofar:0i€ and, EpA
'.k:. is'. . `e ..... -
Method1664{SGT HEM}, tng/L
New Motor C1€I.Usage,
- :. t_:_ .. i.:.%.'._ _.
'Annualaverageigal/mo `.
BenchrnarkY4'
_` ,-
50 oi;100 see permit
"Within. 6 0 ' 9c0
15
O-A -19 -
(31ZL
3
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? /yes _no
(if yes, report your analytical results in the table immediately below)
Part B: Oil/water Separators and Secondary Containment Areas at Petroleum Bulk Stations and Terminals
Outfall ,T
Date
=.
>: 00556 _
00530
00400
-
k- Non Polar.-Oilrand'�Grease/TPH EPA Methodg'
Total Suspehded Solids, _
pH,
No
Sample Collected;
mo dd<r-afi64
/ /Y
SGF=HEM m L
- ( ),. R/.
.,
::
:Standard,umts
Perrnit Lirriit
:. -
_. :.: - 15 _
50 0r 100°see,:'permit
6: �- 9.0
tA' 1q - 1 rl
- l-
G
l„
I For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here.
SWU-250 last revised October 25, 2012
Pagel of 2

STORM EVENT CHARACTERISTICS:
DateLk~%941 (first event sampled)
Total Event Precipitation (inches): 3 +n
Date (list each additional event sampled this reporting period, and rainfall amount)
Total Event Precipitation (inches):
Note: if you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses. See General Permit text.
FOR PART A AND PART B MONITORING RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES ❑ NO ❑
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mall an oriainal and one coov of this DMR, includina all "No Discharge" reports, within 30 days of receipt of the lab results for at end of monitorina period in
the case of "No Discharge" reports] to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED:
"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, including the possibility of fines and imprisonment for knowing violations."
(Date)
Additional copies of this form may be downloaded at: http://portal.ncdenr.org/web/wct/ws/su/npdessw#tab-4
SWU-250
last revised October 25, 2012
Page 2 of 2

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No. NCGO80000
Date submitted '7. --A0
CERTIFICATE OF COVERAGE NO. N0008014
FACILITY NAME Ulnimn li
COUNTY V_
PERSON COLLE ING SAMPVES
LABORATORY izr� Lab Cert. # .
Comments on sample collection or analysis:
Part A: Vehicle Maintenance Areas Monitoring Requirements
SAMPLE COLLECTION YEAR
SAMPLE PERIOD [gJan-June ❑ July -Dec
or ❑ Monthly' _ (month'
DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
❑Zero -flaw ❑Water Supply NSA
❑Other
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
No discharge this period'
Oi<tfa1l ..
;No _ -
bate ; .. '_
4
Sample Collected,
-,' { V00534 ,.
0
040OQ556
v 0 ;
;k�r T- <� ;r _
-
-Total Suspended
-
561ids,.:mg/L�
' pH, `
z...
Standard units 7
Non:Pofar Oil and Grease/TPHr EPA
-
'.. - _ Metliotl 1654 (SGT FiEINI);_ ing/L
',New Moior0ll Usage;
Anrival average gal/rro
:Benchmarks
see+perm:t
t .INithirrfi 0 90
1
o4 - i9 -
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? ✓yes _no
(if yes, report your analytical results in the table immediately below)
Part B: Oil/water Separators and Secondary Containment Areas at Petroleum Bulk Stations and Terminals
Out#all'
No.
.
-Date
,Sample Collected,
:= `_.. mo/dd/yr
='%00556 .
; 00530;.
00400
;Non-Pola.r'Oil and Grease/TRHEPA Method-,,`:
'1664 (SGT-HEM),,mg/L
' Total`Suspended Solids,
mg/L
pH,
Standard.units
Permit Limit ..
;. _
:; _;:: ,15
- 50 or l0U see permit .
6:0:=.9.0
t For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here.
S"-250 last revised October 25, 2012
Page I of 2

STORM EVENT CHARACTERISTICS:
• DateLk-%94 (first event sampled)
Total Event Precipitation (inches): 3 +n
Date (list each additional event sampled this reporting period, and rainfall amount)
Total Event Precipitation (inches):
Note: !f you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses. See General Permit text.
FOR PART A AND PART B MONITORING RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER ATTHE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES ❑ NO ❑
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an oriainal and one coov of this DMR. includina all "No Dischorae" reports within 30 days of receipt of the lab results for at end of monitorina period in
the case of "No Dischar e" reports) to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED:
"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, including the possibility of fines and imprisonment for knowing violations."
(Signatu
^g -lam
(Date)
Additional copies of this form may be downloaded at: htt ortal.ncdenr.or web w ws su n dessw#tab-4
SW-250
last revised October 25, 2012
Page 2 of 2

;, ISM
'u eDaAIORIEs, NO.
Waste Connections
Lana Brown
5516 Rozzelles Ferry Rd.
Charlotte, NC 28214
NC Cer ificaticn No. 402 Case Narrative
Full -Service Analytical & NC Drinking Water Cert No. 37735 05/02/2017
Environmental Solutions SC Certification No. 99012
Project: Charlotte Haulers Stormwater (Rozells Ferry Rd)
Lab Submittal Date: 04/19/2017
Prism Work Order: 7040350
This data package contains the analytical results for the project identified above and includes a Case Narrative, Sample
Results and Chain of Custody. unless otherwise noted, all samples were received in acceptable condition and processed
according to the referenced methods.
Data qualifiers are flagged individually on each sample. A key reference for the data qualifiers appears at the end of this case
narrative.
Please call if you have any questions relating to this analytical report.
Respectfully,
PRISM LABORATORIES, INC.
Robbi A. Jones
President/Project Manager
Data Qualifiers Key Reference:
Reviewed By Robb! A. Jones
Preside ntlProject Manager
N
BRL Below Reporting Limit
MDL Method Detection Limit
RPD Relative Percent Difference
* Results reported to the reporting limit. All other results are reported to the MDL with values between MDL and ff
reporting limit indicated with a J. 1�
This report should not be reproduced, except in its entirety, without the written consent of Prism laboratories, Inc,
449 Springbrook Road - P.Q. Box 240543 - Charlotte, NC 28224.0543
Phone:704l529-6364 -Toil Free Number: 1-8001529-6364 - Fax: [phone] Page 1 of 8

Full-Sarvice Ans�lyl k:ul &
r- Environmental Snlufions
-�Z5'urww.+w��es. ir�c
Sample Receipt Summary
05/02/201.7
Prism Work Order: 7040350
Client Sample ID Lab Sample 10 Matrix Cate Sampled Date Received
Ouffall 001 7040350-01 Water 04/19/17 04/19/17
Samples were received in good condition at 3.2 degrees C unless otherwise noted.
This report should not be reproduced, except in its entirety, without the written consent of Prism Laboratories, Inc.
449 Springbrook Road - P.O, Box 240543 - Charlotte, NC 28224.0543
Phone: [phone] -Toll Free Number: 1-800152M364 - Fax: 704152"409 Page 2 of 8
N

L"P,
R I S M I Environmantpl Sulutiurts
v.,r.
Waste Connections
Attn: Lana Brown
5516 Rozzelles Ferry Rd.
Charlotte, NC 28214
Field Data
Project: Charlotte Maulers Stormwater
(Rozells Ferry Rd)
Laboratory Report
05/02/2017
Prism Work Order: 7040350
Laboratory ID Client ID Field Parameter Result
7040350-01 Outfall 001
pH 6.8
Temperature (C) 20
�a
This report should not be reproduced, except in its entirety, without the written consent of Prism Laboratories, Inc.
449 5pringbrook Road - P.O. Box 240543 - Charlotte, NC 28224.0543
Phone: [phone] -Toll Free Number: 1-8001529-6364 - Fax: [phone] Page 3 of 8

PRISM I Full -Service AnulyliCW 8
t;: Envlrnnmenlnl Solutions
. l.Ae0AA1'DH ..A, iHC.
k ,
Laboratory Report
05/02/2017
Waste Connections
Project: Charlotte Haulers Stormwater
Client Sample ID: Outfall 001
Attn: Lana Brown
(Rozells Ferry Rd)
Prism Sample ID: 7040350-01
5516 Rozzelles Ferry Rd.
Prism Work Order: 7040350
Charlotte, NC 28214
Sample Matrix: Water
Time Collected: 04/19/17 16:30
Time Submitted: 04/19/17 16:45
Parameter
result Units
Report MDL
Dilution Method Analysis Analyst Batch
Limit
Factor DalelTirne ID
General Chemistry Parameters
Oil 8 Grease (HEM)
BRL mglL
5,0 1.0
1 '166413 5MM7 9:26 TJY P7E0017.
Total Suspended Solids
94 mglL
12 0,80
1 'SM2540 D 4/24117 11:33 SLS P7D0382
(1'
This report should not be reproduced, except in its entirety, without the written consent o1 Prism Laboratories, Inc.
449 Springbrook Road - P.O. Box 240543 - Charlotte, NC 28224-0543
Phone: 704152"364 -Toll Free Number; 4.8001529-6364 - Fax: [phone] Page 4 0f $

R , I S M � Full -Service Analytical
I;L Envirnnmantal Snlutlnns
LaA1NM14rd,1M I —
Waste Connections
Attn: Lana Brown
5516 Rozzelles Ferry Rd.
Charlotte, NC 28214
General Chemistry Parameters - Quality Control
Project: Charlotte Haulers Stormwater
(Rozells Ferry Rd)
Level II QC Report
512117
Prism Work Order: 7040350
Time Submitted: 4/19/2017 4:45:00PIVI
Reporting Spike Source %REC RPD
Analyie Result Limit Units Level Result %REC Limits RPD limit Notes
Batch P7D0382 - NO PREP
Blank (P7D0382-BLK1) Prepared & Analyzed: 04/24/17
Total Suspended Solids BRL 5.0 mg/L
LCS (P700382-BSI) Prepared & Analyzed: 04/24/17
Total Suspended Solids 480 5.0 mg1L 477.0 100 90-110
Batch P7E0012 - NO PREP
Blank (P7E0012-BLK
Oil & Grease (HEM)
BRL 5.0 mglL
05)01/17
LCS (P7E0012-BSI) _ Prepared & Analyzed: 05/01/17
Oil & Grease (HEM) 35.4 5.0 mg1L LL 40.00 88 78-114
This report should not be reproduced, except In its entirety, without the written consent of Prism Laboratories, Inc.
r,
449 Springbrook Road - P.O. Box 240543 - Charlotte, NC 28224-0543
Phone: [phone] - Toll Free Number: 1-800/529-6364 - Fax: 7D4/525-0489 Page 5 of 871

CHAIN OF CUSTODY RECORD
s-��rVICE AnBfytiC�l S . i I En:,iionmentai Sulukier,�, PAGE -A — OF\ QUOTEVTOENSURE PROPER BILLING -
Project Name:nr r.�LJ Zn[Et_c l�cu� �Qiw
449 Soria brook Road - Charlotte, NG 28211
n
Phoe 7041529-6364 Fax: [phone] Short Hold Analysis: (Yes) No UST Project: (YGs) NO
Client Company Name: �� C Ct? ti r P1" a �7 *Please ATTACH any project spec fie reporting (QC LEVEL 111111 IV)
t r, provisions and/or QC Requirements
Report To/Contact Name:
Invoice To:
Reporting Address: Address:
Samples INTACT upon arrival?
Received ON WET ICE?
PROPER PRESERVATIVES indicated?
Received WITHIN HOLDING TIMES?
CUSTODY SEALS INTACT?
VOLATILES reed W10UT HEADSPACE=?
PROPER CONTAINERS used?
TEMP: Therm W:_yLE' -7 Observed:
J
YES NO WA 00
J O
cc
tv
Q
I ;c I Cor--- . �°G
Phone: Fax (Yes) (No):
Email Address:
Purchase Order NoJOilling Reference LI) & V
Requested Due Date ❑ Day CI C7 3 Days o 4 Days 05
TO BE FILLED IN BY CLIENT/SAMPLING PERSON L
1 ys Days
Certification: NELAC_ DOD FL NC
EDD Type: PDF_Excel_Other
"Working Days" ❑ 6-9 Days Standard 10 days ❑ Rush Work Mdust Be
OTHER NIA
Site
Site Location Name:
Samples received after 14:00 will be processed next business day,
Site Location Physical Address:
Turnaround time is based on business days, excluding weekends and holidays.
Water Chlorinated: YES_ NO
/NO
(SEE REVERSE FOR TERMS & CONDITIONS REGARDING
RENDERED BY PRISM LABORATORIES, INC. TO CUENT SERVICES
Sample Iced Upon A Collection: YES —
CLIENT
DATE
TIME
COLLECTED
MATRIX
I (SOIL,
SAMPLE CONTAINER
PRESERVA-
ANALYSIS REQUESTED
E� " �a REMARKS
PRISM
LAB
SAMPLE DESCRIPTION
COLLECTED
MILITARY
I WATER OR
*TYPE
NO
g
TIVES
�
ID NO.
r�
SLUDGE]
SEEBELOW
�
L-,:�' ��
[� t
11��HOURS7
r
x0o
I
i
1
1
Sampler's Signature c
Sampled By (Print Name) fl Affiliation
Upon relinquishing, this Chain of Custody is your authorization for Prism to proceed with the analyses as requested above. Any changes must be
submitted in writing to the Prism Project Manager. There will be charges for any changes after analyses have been initialized. PRISM USE ONLY
eli;W"ed By: (Signature)
Received By: (Signatures Date Militaryfll r rs Additional Comments: Site Arrival Time:
Relinquished By (Signature}
Received By: (Signature) Date Site Departure Time:
Relinquishes By: (Signature) -
Received For I ! abgreim By Date � Fietd TeCh Fee ,
i�
Ltf I + ^
Mileage:
Method of SNpment NOTE: ALL SAMPLE COOLERS SHOULD BE117APED SHUT WITH CLWrOlDY SEALS FOR TRANSPORTATION TO THE LABORATORY. COG Group No.
SAMPLES ARE NOT7AEFTED AND VERIFIED AGAINST COC U L RECEIVED AT THE LABORATORY,fy�iO
77 1) l 1/ 1
Fed Ex R UPS fl Hand�elivered m Field Service O
Other
N"L1G.7; US 1: I UKL IUNUYVAI CK: DKINIUNU WAI LK: SULIU WAS I t: KURA: GL-Kt:LA LANDFILL V l HLK:
❑NC❑SC ❑NC ❑SC ©NC ❑SC ❑NC El SC ❑NC ❑SC ❑NC❑SC (a NC
❑SC QNC ❑SC ❑NC ❑SC r
*CONTAINER TYPE CODES: A = Amber C = Clear G= Glass P = Plastic; TL = Teflon -Lined Cap VOA = Volatile Organics Anatysis (Zero Head Space)

Semi-annual Stormwater Discharge Monitoring Report
' for North Carolina Division of Water Quality General Permit No. NCGO80000
Date submitted t -- VF -( c4
CERTIFICATE OF COVERAGE NO. NCG08_Q q q � SAMPLE COLLECTION YEAR Zc(S
FACILITY NAME L-k)0. �e `Lt�rthec ;orss_ Gl�a.ftb �e f-�cccc(," i SAMPLE PERIOD ❑ Jan -June ,July -Dec
COUNTY Icy ��I VD or ❑ Monthly"_ (month)
PERSON COLLECTING SAMP ES _ AO rz - -� E [ DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
LABORATORY Pr: s,- L_G +� 5- ►,j c- Lab Cert. #gO 2 FEB 03 1� �13 ❑Zero -flow ❑Water Supply NSA
Comments on sample collection or analysis: CENTRAL FILES ❑Other
DWR SECTION
PLEASE REMEMBER TO SIGN ON THE REVERSE
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? X yes _no
(if yes, report your analytical results in the table immediately below)
Part A: Vehicle Maintenance Areas Monitoring Requirements (If applicable)
❑ No discharge this period'
Outfall
a No" `-
L
.` ., Date
-SamPI6 Collected,
mo/dd/yr
, ` _ ..<00530?;LL ...,
00400<::
�, �00556t
Total Suspended ;'
SolidsJimp%L ;:
`; pH,
FStanchrd-units
Non'Po1ar'Oil and-Grease/TPH'EPA�
. Method§16"(SGT-HEM),-m �,
~; New MotorO�l Usage, F,.
:Annual average gal%mo '3
Benchrnark'
-._ . „
50 or-100;see .ermit
_
_
Part B: Oil/water Separators and Secondary Containment Areas at Petroleum Bulk Stations and Terminals (If applicable)
Outfall
w.. Date
.,r00556... r ...:,
_
:
,00530 - ..
00400
No.
Sample°Collected,
Non �Polar4"0il and Grease/TPH�EPAyMethod
Total;Suspended Solids, ;�
r
pH„
mo/dd/yr
;
mg/L,
:'
:Standard,unitst
-1664°(SGT-HEM),,mg/!'.
{_
Permit;Limit
_ _
15..
-
65Q or 10Q�See•permit n...,
_ 4
6 0 =`9 0 ,
t For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here.
SWU-250 last revised April 11, 2013
Page] of 2

STORM EVENT CHARACTERISTICS:
Date f -11 S (first event sampled)
Total Event Precipitation (inches): 1 • ZS.,
Date (list each additional event sampled this reporting period, and rainfall amount)
Total Event Precipitation (inches):
Note: if you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses. See General Permit text.
FOR PART A AND PART B MONITORING RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• TIER 3: HAS YOUR FACILITY HAD a OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES ❑ NO ❑
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an original and one co_py of this DMR, including all "No Discharge" reports, within 30 days of receipt of the lab results for at end of monitoring period in
the case of "No Discharae" reports) to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED:
"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, including the possibility of fines and imprisonment for knowing violations."
{Signature
( Date)
Additional copies of this form may be downloaded at: http://portal.ncdenr.orp/web/wq/ws/su/npdessw#tab-4
last revised April 11, 2013
Page 2 of 2

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No. NCG080000
Date submitted
CERTIFICATE OF COVERAGE NO. NCG080 LA L\
FACILITY NAME t_AC__T� 0,
COUNTY M 0
PERSON COL! ING SAMPLES fcb•� Q,►Qi j
LABORATORYVf%' 5r--A 1—&) Le_ Lab Cert. # V (�
Comments on sample collection or analysis:
Part A: Vehicle Maintenance Areas Monitoring Requirements
SAMPLE COLLECTION YEAR �U
SAMPLE PERIOD ❑ Jan -June ®July -Dec
or []Monthly' (month)
DISCHARGING TO CLASS ❑ORW ❑HCQW ❑Trout ❑PNA
RECEIVED ❑Zero -flow ❑water Supply XSA
RECEIVED []Other
APR 17 20111
CENTRAL FILES PLEASE REMEMBER TO SIGN ON THE REVERSE 4
DWR SECTION! ❑ No discharge this period'
No
:_. ,...
_D-
S
mo/dd/Yr s. w:: `
.
,._ "00400
006Outfa!!,_
ded
_..
.. __ ='Solids, mg/!
_
r Standardunit`s'_ ..
a
a6dGreeTPHEPA
MethodE1664, SGT ITEM ` rri i.�.
( �, g/
NewMotor Cil Usage,Tot!spamCletoed
Annuala�era'ge gal%rpn.'
Benchmark• ,
''S0'or;100,seeipermit-'
:�Witi�in 6:0 `9:0°
1
j_0
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? _ yes _no
(if yes, report your analytical results in the table immediately below)
Part B: Oil/water Separators and Secondary Containment Areas at Petroleum Bulk Stations and Terminals
Outfall'
= No
=Date
,Sample Co€lected,
,�00530 ._..
;00400
Non Pa€ar�0il and Gi`ease%'fPH�EPA'Method
1664 (SGT=HEM},;mg/4'w_
- ;_Total Suspended Solids;
_.. _-..g�L'
:pH;
'Standardunits,
Permit.Limit• ;
.. -."..:.
,. . -., Y,1.S'
50<or:10OSeefpermit
b:0..;- 0
I For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here.
SWU-250 last revised October 25, 2012

STORM EVENT CHARACTERISTICS:
Date (first event sampled)
Total Event Precipitation (inches):
Date (list each additional event sampled this reporting period, and rainfall amount)
Total Event Precipitation (inches):
Note: if you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses. See General Permit text.
FOR PART A AND PART B MONITORING RESULTS:
+ A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART 11 SECTION B.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANYONE OUTFALL? YES ❑ NO ❑
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ N0 ❑
REGIONAL OFFICE CONTACT NAME:
Mail an original and one copy of this DMR, including all "No Discharge" reports, within 30 days of receipt of the lob results (or at end of monitoring period in
the case g f "No Discharge" r_portsl to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
YOU MUST SIGN TH15 CERTIFICATION FOR ANY INFORMATION REPORTED:
"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, including the possibility of fines and imprisonment for knowing'violations."
rmittee)
LA -10-1`I
(Date)
Additional copies of this form may be downloaded at: http://portal.ncdenr.org/web/wq/ws/su/npdessw#tab-4
SWU-250 last revised October 25, 2012
Paee 2 of 2

Full -Service Analytical &
Environmental Solutions
®7La90aa7DAiES, iNG
Waste Connections
Nelson Breeden
265 Brookview Center Way Suite 205
Knoxville, TN 37919
NC Certification No. 402 Case Narrative
NC Drinking Water Cart No. 37735 10/06/2016
SC Certification No. 99012
Project: Rozelles Ferry Road Stormwater (Charlotte Haulers)
Lab Submittal Date: 09/26/2016
Prism Work Order: 6090428
This data package contains the analytical results for the project identified above and includes a Case Narrative, Sample
Results and Chain of Custody. Unless otherwise noted, all samples were received in acceptable condition and processed
according to the referenced methods.
Data qualifiers are flagged individually on each sample. A key reference for the data qualifiers appears at the end of this case
narrative.
Please call if you have any questions relating to this analytical report_
Respectfully,
PRISM LABORATORIES, INC.
Robbi A. Jones
President/Project Manager
1z:t4__ a__ (_ �
Reviewed By Robbi A. Jones
President/Project Manager
a
Data Qualifiers Key Reference:
BRL Below Reporting Limit
MDL Method Detection Limit
RPD Relative Percent Difference
* Results reported to the reporting limit. All other results are reported to the MDL with values between MDL and
reporting limit indicated with a J.
This report should not be reproduced, except in its entirety, without the written consent of Prism Laboratories, Inc.
449 Springbrook Road - P.O. Box 240543 - Charlotte, NC 28224-0543
Phone: [phone] - Toll Free Number: 1-8001529-6304 - Fax: T041525-04a9 Page 1 of $

8.
�FWhService dPR I S M I Environmental Solutions
Sample Receipt Summary
10/06/2016
Prism Work Order. 6090428
Client Sample ID Lab Sample ID Matrix Date Sampled Date Received
SW Outfall 001 6090428-01 Water 09/26/16 09/26/16
Samples were received in good condition at 1.8 degrees C unless otherwise noted.
This report should not be reproduced, except in its entirety, without the written consent of Prism Laboratories, Inc.
449 Springbrook Road - P.O. Box 240543 - Charlotte, NC 28224-0543
phone: [phone] - Toll Free Number; 1.8001529.6304 - Fax: [phone] Page 2 of S

�Fuu-Sermsol vice Analytical
P R I S M
' Environ ental Solutiotio nss
Waste Connections
Attn: Nelson Breeden
265 Brookview Center Way Suite 205
Knoxville, TN 37919
Project: Rozelles Ferry Road
Stormwater (Charlotte Haulers)
Laboratory Report
10/06/2016
Prism Work Order: 6090428
Field Data
Laboratory ID Client ID Field Parameter Result
6090428-01 SW OutFall 001
pH 6.7
Temperature (C) 26.7
0
This report should not he reproduced, except in Its entirety, without the written consent of Prism Laboratories, Inc.
449 Springbrook Road - P.O. Box 240543 - Charlotte, NC 28224-0543
Phone: [phone] - Toll Free Number: 1-8001529.6384 - Fax: [phone] Page 3 of 8

AorISM + Full-Servica Analytical & Laboratory Report
Environmental Solution& 10/06/2016
.i L�aOR��ORIEB ING
Waste Connections Project: Rozelles Ferry Road Client Sample ID: SW Outfall 001
Attn: Nelson Breeden Stormwater (Charlotte Haulers) Prism Sample ID: 6090428-01
265 Brookview Center Way Suite 205 Prism Work Order: 6090428
Knoxville, TN 37919 Sample Matrix: Water Time Collected: 09/26/16 12:00
Time Submitted: 09/26/16 16:05
Parameter Result
Units Report
MDL Dilution Method Analysis Analyst
Batch
Limit
Factor DaterTme
ID
General Chemistry Parameters
Oil & Grease (HEM) SRL
mg/L 5.0 ,
1.0 1 '16648 to13116 9:57 TJY
P6J0013
Total suspended Solids 14
mglL 6.2
oleo 1 'SM2540 D 9128116 15:48 SLS
P610473
This report should not be reproduced, except in its entirety, without the written consent of Prism Laboratories, Inc.
449 Springbrook Road - P.O. Box 240543 - Charlotte, NC 28224-0543
Phone: [phone] - Toll free Number: 1-8061529.6364 - Fax: [phone] Page 4 of 8

Fuff-
� R I S M r;nvlr amen al Sol flo s
EnVlronmental Solutfane
Waste Connections
Ann: Nelson Breeden
265 Brookview Center Way Suite 205
Knoxville, TN 37919
General Chemistry Parameters - Quality Control
Anefyte
Batch P610473 - NO PREP
Project: Rozelles Ferry Road Stormwater
(Charlotte Haulers)
Reporting Spike Source
Result Limit Units Level Result
Level II QC Report
1016116
Prism Work Order: 6090428
Time Submitted: 9/26/2016 4:05:00PM
%REC RPD
%REC Limits RPD Limit
Blank (PBI0473-BLK1) Prepared & Analyzed: 09/28/16
Total Suspended Solids BRL 5.0 mg1L
LCS (P610473-BSI)_ Prepared & Analyzed: 09/28/16
Total Suspended Solids 460 5.0 mg/L 477.0 97 90-110
Batch PGJ0013 - NO PREP
Blank (P6J00I3-1131-K1) _ _ _ Prepared & Analyzed: 10/03/16
Oil & Grease (HEM) BRL 5.0 mg1L
LCS (P6J0013-BSI) Prepared & Analyzed: 10/03/16
Oil & Grease (HEM) 37.6 5.0 mg/L 40.00 94 78-114
This report should not be reproduced, except in its_entirety, without the written consent of Prism Laboratories, Inc.
Notes
449 Springbrook Road - P.Q. Box 240543 - Charlotte, NC 28224-0543
Phone: [phone] - Toil Free Number: 1-8001529.6364 - Fax: [phone] Page 5 of 8

.. - _ _ ,.:.-per--._•J -- -!F ... �.'•: :.. _..rerL ., .�•_ �a - _+.i.. •:>..s .;:.��•:4:•, ..,'J'.i sic'-i,
CHAIN OF CUSTODY RECORD
Full- Analytical 8
� I EnvironmentHi $piutinns PIaGE! OF � CUOTE # 7'O ENSURE PROPER BrIJ.rNG:
ISM
YES NO N/J CO
�,`�� onmee __
Samples INTACT upon arrival? ✓ O
� � �, ] ON ICE? 0
Y'l�y�xT WfYY���+�5 FL1 {y�
80.9 Springbrook stead • Charlotte, NC 26217
y 7MIProject Name:
Phon�29-6364 Fax; 704625.04199 Short Hold Analysis: (Yes) o UST Project: (Yes) O
Received -WET
PROPER PRESERVATIVES indicated? _ a
*Please ATTACH any project sc reporting (QC LEVEL 111 M-M
Received WITHIN HOLDING TIMES7 _
Client Company Name:
provisions and/or OC Requirements
CUSTODY -SEALS INTACT?
Report To/Contact Name: Invoice To:
VOLATILES reed WfOUT HEADSPACE?
Reporting Address: V .
--- Address:
PROPER CONTAINERS used?
Al / . .
�C�1� l��a� b e__,__
TEMP: Therm fD: � t i Observed;
rU - _a°C 1 Cnrr.�_°t
Phone: Fax (Yes) (No): Purchase Order No./Billing Reference TO BE FILLED IN BY CLIENTISAMPLING PERSONN L
Email Address: Requested Due Date ❑ 1 Day ❑ 2 ays ❑ 3 Days ❑ 4 Days ❑ 5 Days Certification: NELAC DOD FL NC
EDD Type: PDFExcel Other Rush ork Must Be
"Working Days" ❑ 6-9 Days standard 10 days ❑
ScApproved OTHER NIA
Site Location Name: Samples received after 14:00 will be processed next business day.
,1
Site Location Physical Address: �' �`y[ � � Turnaround time is based On business days, excluding weekends and holidays.
REVERSE FOR TERMS & CONDITIONS REGARDING SERVICES
Water Chlorinated: YES_ NO_
'
(SEE
RENDERED SY PRISM LABORATORIES, INC. TO CLIENT) Sample Iced Upon Collection: YES NO
TIME
MATRIX
SAMPLE CONTAINER
` ANALYSIS REQUESTED
PRISM
CLIENT
SAMPLE DESCRIPTION
DATE
COLLECTED
COLLECTEO
MILITARY
(SOIL,
WATER OR
PRESERVA•
TNES
�^
\'J
REMARKS
REMARKS
LAB
ID NO.
i
NO.
SIZE
HOURS
SLUDGE)
SE
L`
q
Sampler's Signature Sampled By (Print Name) G7 Affiliation
Upon relinquishing, this Chain of Custody is your authorization for Prism to proceed with the analyses as requested above. Any changes must be
submitted in writing to the Prism Project Manager. There will be charges for any changes after analyses have been initialized,
Additional Comments:
Method of Shfprnent: NOTE: ALL SAMPLE COOLERS SHOULD BE TAPED SHUT CUSTODY SEALS FOR TRANSPORTATION TO THE LABORATORY. COC Group No.
SAMPLES ARE NOT CEPTED AND VERIFIED AGAINST COC UNTIL RECENED AT THE LABORATORY.
C] Fed Ex O UPS ❑ Handdeliverad Pdsm Field Service iD Other
NPDES: UST: GROUNDWATER: DRINKING WATER: SOLID WASTE: �RICRA: �CE-RCLA LANDFILL OTHER:
❑NC❑SC ❑NC ❑SC ❑NC 45C I ❑❑NC LSO I pNC ❑SC aNC❑5C oNC ❑SCIoNC i]SCI ANC ❑SC
❑ ❑ ❑
*CONTAiNER TYPE CODES: A = Amber C = Clear G= Glass P = Plastic; TL = Teflon -Lined Cap VOA = Volatile Organics Analysis (Zero Head Space)
Site Arrival Time:
Site Departure T;Rse:
Fleid -I'ecn"Fee:
Weage: _�

'+'LAHaRATOfi1ES lNG
449 Springbrook Road
P. 0. Box 240543
Charlotte, NC 28224
[phone]
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Certificate of Coverage No. NCG
Facility Name:
County: U t` Phone Number:
Inspector: rism laboratories, Inc.
Date of Inspectiom, ' � u Time of Inspection � 0?
ay signature, I certif}lirh this report is accurate and complete to the best of my knowledge:
(Signature of Permittee or Designee)
Total Event Precipitation (inches): �Y Event Duration: -- -Total Flow(MG )
Was this a Representative Storm Event: (See Information below); YES NO
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.
1. Outfall Description ;
Outfall No. DO Structure (pipe-, ditch, etc.) /ke{J ar A � c�.
4 •
Receiving Stream
Describe the industrial activities that occur
2. Color
the odtfall drainage area:
Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint (light, medium, dark)
as descriptions:
3. Odor
Describe any distinct odors that the discharge may have (i.e. smells strongly of ofl, weak chlorine odor,
etc.):
C:1Doc==1s and 9etfmgslrpjona9lL.ocal Setdn %Tempara y Tat=ct FD='Contt:atW51ACM=.38ISW Qualitative Mom=ing Report PR1SM.d Page 7 Of S
on 08/17/11 335 PM Revised 092612 Page 1 of 2

Facility Name:-nrt�j,� li r- OWall No., l�L
4. Clarity
Choose the number which best describes the clarity of the discharge, where 1 is clear and 10 is very
cloudy:
1 3 4 5 6 7 8 9 10
5. Floating Solids
Choose the number which best describes the amount of floating solids In the stormwater discharge where
1 Is no solids and 10 is the surface covered in floating solids:
0 2 3 4 5 6 7 8 9 10
6, Suspended Solids
Choose the number which best describes amount of suspended solids in the stormwater discharge, where
1 is no solids and 10 is extremely muddy:
(� 2 3 4 5 6 7 8 9 10
7. Foam
Is there any foam In the stormwater discharge? YES NC
8. Oil Sheen
i
Is there, an oil sheen In the starmwater discharge? YES IV0
9. Is there evidence of erosion or deposition at the outfall? YES NQ,
10. Other Obvious Indicators of Storrnwater Pollution:
Please list and describe:
11. Please note here if you spoke to anyone on jobsite or on phone regarding this sampling
event (where to sample, etc): Dull Name Details
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