NCG030200_MONITORING INFO_20161228

STORMWATER DIVISION CODING SHEET
� NCG PERMITS
PERMIT N0. /v p3 o O
DOC TYPE ❑HISTORICAL FILE
i5. MONITORING REPORTS
DOC DATE a .c-�Z)l U pa a8
YYYYM M DD

Semi-annual Stormwater Discharge Monitoring Report
Is for North Carolina Division of Water Quality General Permit No. NCG030000
Date submitted 12/21/16
CERTIFICATE OF COVERAGE NO. NCG03 0 2 0 0
FACILITY NAME Worthington Cylinders -Winston Salem
COUNTY Forsyth
PERSON COLLECTING SAMPLES Peter H. DeVries
LABORATORY R&A Laboratories Lab Cert. # 34 _
Comments on sample collection or analysis:
Field pH by Geoscience & Technology, P.A. NC# 5643
Part A: Stormwater Benchmarks and Monitoring Results
SAMPLE COLLECTION YEAR 2016
SAMPLE PERIOD ❑ Jan -June ✓❑ July -Dec
or ❑ Monthly' (month )
RECEIVeBHARGING TO CLASS ❑ORW 0HQW OTrout ❑PNA
DEC 2 g z016 ❑Zero -flow ❑Water Supply ❑SA
❑✓ Other Class C
CENrR,q
DwR S -+S PLEASE REMEMBER TO SIGN ON PAGES 2 AND/OR 3 -�
p.
R17
CCP VNo discharge this period?'
Outfall No.
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
3
Inches
Total Suspended Solids
pH,
Standard units
Copper
Lead
Zinc
Non -Polar O&G/Total
Total Petroleum
Hydrocarbons
Toxic
Organics5
Benchmarks
-
-
100 mg/L or 50 mg/L
6.0 — 9.0
0.007 mg/L
0.03 mg/L
0.067 mg/L
1S mg/L
1 mg/L
003
11/29/16
0,65
6.2
6.2
0.026
<0.005
0.143
<5.0
NA
` Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
2 For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here.
3 The total precipitation must be recorded using data from an on -site rain gauge. Unattended sites may be eligible for a waiver of the rain gauge requirement.
4 See General Permit, Table 3 identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
5 Total Toxic Organics sampling is applicable only for those facilities which perform metal finishing operations, manufacture semiconductors, manufacture
electronic crystals, or manufacture cathode ray tubes. For purposes of this permit the definition of Total Toxic Organics is that definition contained in the EPA
Effluent Guidelines for the facility subject to the requirement to sample (for metal finishing use the definition as found in 40 CFR 433.11; for semiconductor
manufacture use the definition as found in 40 CFR 469.12; for electronic crystal manufacture use the definition as found in 40 CFR 469.22; and for cathode ray
tube manufacture use the definition found in 40 CFR 469.31).
Permit Date: 11/1/2012-10/31/2017 SWU-245, last revised 10/25/2012
Page 1 of 3

Facilities that incorporate a solvent management plan into the 5tormwater Pollution Prevention Plan may so certify, and the requirement for TTO monitoring
may be waived. The solvent management plan shall include a list of the total toxic organic compounds used and the other elements listed in the General
Permit. 'For those facilities electing to employ the TTO monitoring waiver, the discharger shall sign the following certification statement:
"Based upon my inquiry of the person or persons directly responsible for managing compliance with the permit monitoring requirement for total toxic organics
(TTO), l certify that to the best of my knowledge and belief, no dumping of concentrated toxic organics into the stormwater or areas which are exposed to rainfall or
stormwater runoff has occurred since filing the last discharge monitoring report. I further certify that this facility is implementing the ali the provisions of the
solvent management plan included it the 5tormwater Pollution Prevention Plan."
Name (Print name)
Title (Print title)
(Signature)
(Date)
Note: Results must be reported in numerical format. Do not report Below Detection Limit, BDL, <PQL, Non -detect, ND, or other similar non -numerical
format. When results are below the applicable limits, they must be reported in the format "<XX m t" where XX is the numerical value of the detection
limit, reporting limit, etc. in mg/L.
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.
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month.
❑ No discharge this period?"
Czutfall No.
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
Inches-'
Non -polar O&G/TPH by
EPA 1664 (SGT-HEM)
Total Suspended Solids
pH
Benchmarks
15 mg/L
100 mg/L or 50 mg/L*
6.0 — 9.0 SU
Footnotes from Part A also apply to this Part B
* See General Permit text, Table 5, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Permit Date: 11/1/2012-10/31/2017 5WU-245, last revised 10/25/2012
Page 2of3

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 Q NO ❑
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES © NO ❑
REGIONAL OFFICE CONTACT NAME: Sue White
Mail an original and one copy of this DMR, including all "No Discharge" reports, within 30 days of receipt of the lab 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. 1
am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations,"
(Signatur of Permittee) (Date)
Permit Date: 11/1/2012-10/31/2017 SWU-245, last revised 10/25/2012
Page 3 of 3

rd
r
Semi-annual Stormwater Discharge Monitoring Report
for North Carolina-DiVision of Water Quality General Permit No. NCG030000
Date��submitted
�� 6/14116
CERTIFICATE OF COVERAGE'NO. NCG03 0 2 0 0 SAMPLE COLLECTION YEAR 2016
FACILITY NAME Worthington Cylinders -Winston Salem SAMPLE PERIOD ❑✓ Jan -June ❑ July -Dec
COUNTY Forsyth W or ❑ Monthly' (month)
PERSON COLLECTING SAMPLES Peter H. DeVdesi' DISC A�V GIT CLASS ❑ORW ❑HqW ❑Trout ❑PNA
LABORATORY R&A LaboratariL-S=Lab CertA ~ _34 RE �/ lJ ❑Zero -flaw ❑Water Supply :SA
Comments on sample collection or analysis: JUN 2 2 Z01b ❑✓ Other Class C
Field pH by Geoscience & Technology, P.A. NC# 5643
Part A: Stormwater Benchmarks and Monitoring Results
CENTRAL FRLEASE REMEMBER TO SIGN ON PAGES 2 AND/OR 3
DWR SECTION
No discharge this period?z
Outfall No.
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
Inches3
Total Suspended Solids
pH,
Standard units
Copper
Lead
Zinc
Non -Polar O&G/Total
Total Petroleum
Hydrocarbons
Toxic
Organicss
genchmarks
-
-
100 mg/L or 50 mg/O
6.0 —9.0
0.007 mg/L
0.03 mg/L
0.067 mg/y.
15 mg/L ��
f- 1 mg/L
003
5/17/16
0.8
<5
6.76
0.008
<0.005
0.037 i
<5.07
NA
' Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
z For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here,
3The total precipitation must be recorded using data from an on -site rain gauge. Unattended sites may be eligible for a waiver of the rain gauge requirement.
See General Permit, Table 3 identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
5 Total Toxic Organics sampling is applicable only for those facilities which perform metal finishing operations, manufacture semiconductors, manufacture
electronic crystals, or manufacture cathode ray tubes. For purposes of this permit the definition of Total Toxic Organics is that definition contained in the EPA
Effluent Guidelines for the facility subject to the requirement to sample (for metal finishing use the definition as found in 40T6itt433,11; for semiconductor
manufacture use the definition as found in 40 CFR 469.12; for electronic crystal manufacture use the definition as found in 40 CFR 469.22; and for cathode ray
tube manufacture use the definition found in 40 CFR 469.31).
Permit Date: 11/1/2012-10/31/2017 SWU-245, last revised 10/25/2012
Page 1 of 3

Facilities that incorporate a solvent management plan into the Stormwater Pollution Prevention Plan may so certify, and the requirement for TTO monitoring
maybe waived. The solvent management plan shall include a list of the total toxic organic compounds used and the other elements listed in the General
Permit. For those facilities electing to employ the TTO monitoring waiver, the discharger shall sign the following certification statement:
"Based upon my inquiry of the person or persons directly responsible for managing compliance with the permit monitoring requirement for total toxic organics
(TTO), i certify that to the best of my knowledge and belief, no dumping of concentrated toxic organics into the stormwater or areas which are exposed to rainfall or
stormwater runoff has occurred since Filing the last discharge monitoring report. l further certify that this facility is implementing the all the provisions of the
solvent management plan included in the stormwater Pollution Prevention Plan."
Name (Print name)
Title (Print title)
(Signature)
(Date)
Note: Results must be reported in numerical format. Do not report Below Detection Limit, BDL, <PQL, Non -detect, ND, or other similar non -numerical
format. When results are below the applicable limits, they must be reported in the format "<XX mg/L", where XX is the numerical value of the detection
limit, reporting limit, etc. in mg/L.
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.
Part B. Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month.
❑ No discharge this period?2
Outfall No.
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
Inches3
Non -polar O&G/TPH by
EPA 1664 (SGT-HEM)
Total Suspended Solids
pH
Benchmarks ==_>
_
15 mg/L
100 mg/L or 50 mg/L*
6.0 — 9.0 SU
Footnotes from Part A also apply to this Part B
* See General Permit text, Table 5, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Permit Date: 11/1/2012-10/31/2017 SWU-245, last revised 10/25/2012
Page 2 of 3

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 AAND PART B MONITORiNG RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B.
r 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 ®NO ❑
REGIONAL OFFICE CONTACT NAME: Sue White
Mail an original and one copy 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 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."
16-
(Date)
Permit Date: 11/1/2012-10/31/2017 SWU-245, last revised 10/25/2012
Page 3 of 3

Semi-annual Stormwater Discharge Monitoring Regort
for North Carolina Division of Water Quality General Permit No. NCG030000
Date submitted 0-1 so
CERTIFICATE OF COVERAGE NO. NCG03 0 2 0 0
FACILITY NAME Worthington Cylinders -Winston Salem
COUNTY Forth
PERSON COLLECTING SAMPLES Peter H. De1/ries
LABORATORY R&A Laboratories Lab Cert. tf 34 _
Comments on sample collection or analysis:
Field pH by Geoscience & Technology, P.A._NC# 5643
Part A: Stormwater Benchmarks and Monitoring Results
col S
SAMPLE COLLECTION YEAR 2015
SAMPLE PERIOD [] Ja"WJune—R] Juiy;aec
or ❑ Mon_thlyI. _,-f (month)
RECE" G TO CLASS ❑ORW ❑HQW (-]Trout ❑PNA
❑Zero -flow [-]Watersupply ❑SA
JU N 0 3 2016 ®Other Class C
CENTRAL FILES PLEASE REMEMBER TO SIGN ON PAGES z AND/Olt 3 4
DWR SECTION
,s
❑_No discharge this period?'
outfall No.
Date Sample
24-hour rainfall
Total Suspended Solids
PH,
Copper
Lead
Zinc
Non -Polar O&G/
Total Petroleum
Total Toxic
s
Collected'
amount,
Standard units'
Hydrocarbons
©rganics
imo/dd/yr)
Inches'
i ,j/
Benchmarks
-
-
100 mg/L or 50 mg/L
�� 6.0 - 9:0
0.007 mg/L
0.03 mg/L
0.067 mg/L
15 mg/L
1 mg/L
003
10127/15
1.25
15.4
V /.22
0.008
50.005
0.116
c5.0
NA
1 Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
z For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here.
'The total precipitation must be recorded using data from an on -site rain gauge. Unattended sites may be eligible for a waiver of the rain gauge requirement.
"See General Permit, Table 3 identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
5 Total Toxic Organics sampling is applicable only for those facilities which perform metal finishing operations, manufacture semiconductors, manufacture
electronic crystals, or manufacture cathode ray tubes. For purposes of this permit the definition of Total Toxic Organics is that definition contained in the EPA
Effluent Guideiines for the facility subject to the requirement to sample (for metal finishing use the definition as found in 40 CFR 433.11; for semiconductor
manufacture use the definition as found in 40 CFR 469.12; for electronic crystal manufacture use the definition as found in 40 CFR 469.22; and for cathode ray
tube manufacture use the definition found in 40 CFR 469,31).
Permit Date: 11/1/2012-10/31/2017 SWU-245, last revised 10/2512012
Page 1 of 3

Facilities that incorporate a solvent management plan into the Stormwater Pollution Prevention Plan may so certify, and the requirement for TTO monitoring
may be waived. The solvent management plan shall include a list of the total toxic organic compounds used and the other elements fisted in the General
Permit. For those facilities electing to employ the TTO monitoring waiver, the discharger shall sign the following certification statement:
"Based upon my inquiry of the person or persons directly responsible for managing compliance with the permit monitoring requirement for total toxic organics
(TTO), I certify that to the best of my knowledge and belief, no dumping of concentrated toxic organics into the stormwater or areas which are exposed to rainfall or
stormwater runoff has occurred since filing the last discharge monitoring report. I further certify that this facility is implementing the all the provisions of the
solvent management plan included in the stormwater Pollution Prevention Plan."
Name (Print name)
Title (Print title)
(Signature)
(Date)
Note: Results must be reported in numerical format. Do not report Below detection Limit, BDL, <PQL, Non -detect, ND, or other similar non -numerical
format. When results are below the applicable limits, they must be reported in the format, "<XX mg/L' where XX is the numerical value of the detection
limit, reporting limit, etc. in mg/L.
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.
Part B. Vehicle Maintenance Area Monitoring Results; only for facilities averaging > 55 gal of new oil per month.
E] No discharge this period:2
Outfail No.
pate Sample
collected'
(mo/dd/yr)
24-hour rainfall
amount,
Inches3
Non -polar O&G/TPH by
EPA 1664 (SGT-HEM)
Total Suspended Solids
pH
Benchmarks ===;>
1
15 mg1L
100 mg/L or 50 mg/L*
6.0 — 9.0 SU
Footnotes from Part A also apply to this Part B
* See General Permit text, Table 5, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Permit Date: 11/1/2012-10/31/2017 SWU-245, last revised 10/25/2012
Page 2 of 3

Note: if you report a sample value In excess of the benchmark, you must implement Tier 1, Tier Z, or Tier 3 responses. See General Permit tent.
FOR PART A AND PART B MONITORING RESULTS:
• .`A BENCHMARK EXCI_EDANCE 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 EXCEEDENCE5 FOR THE SAME PARAMETER AT ANY ONE OUTFACE? YES [] NO
IF YES, HAVE YOU CONTACTED THE DWQ RE TONAL OFFICE? YES 0
REGIONAL OFFICE CONTACT NAME: �Y�Q� } : (JoA+ W
Mail an original and one copy of this DMR including a!1 "No Discharge" reports, within 30 dolls of receipt of the lab results (or at end of moniiarinq period
in the case of "No Discharge" reports) to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27599-1617
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)
Permit Date: 11/1/2012-10/31/2017 SWU-245, last revised 10/25/2012
Page 3of3

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No. NCG030000
Date submitted tp�
CERTIFICATE OF COVERAGE NO. NCG03 0 2 0 0
FACILITY NAME Worthington Cylinders -Winston Salem
COUNTY _Forsyth _
PERSON COLLECTING SAMPLES Peter H. DeVries
LABORATORY R&A Laboratories Lab Cert. q 34
Comments on sample collection or analysis:
^Field eH by Geoscience & Technology, P.A. NC# 5643
Part A: Stormwater Benchmarks and Monitoring Results
SAMPLE COLLECTION YEAR 2015
SAMPLE PERIOD ❑✓ Jan -June ❑ July -Dec m4'�
or [:]Monthly' (month)
RE�StL_AA1 �I�ETO CLASS ❑ORW ❑HQW ❑Trout ❑PNA r9FU
❑Zero -flow ❑Water Supply []SA
JUN 17 2015 [2]Other Class C C�2
CI=NTRP,i�. �ILp� �
EN A L FI C ,LEASE REMEMBER TO SIGN ON PAGES 2 AND/OR.3 4 J
r�
❑ No discharge this period?z
outfall No.
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
lnches3
Total Suspended Solids
pH,
Standard units
Copper
Lead
Zinc
Non -Polar O&G/Total
Total Petroleum
Hydrocarbons
Toxic
Organics'
Benchmarks ==_>
_
-
100 mg/L or 50 mg/L°
6.0 — 9.0
0.007 mg/L
0.03 mg/L
0.067 mg/L
15 mg/L
1 mg/L
003
5/1 /15
0.6
<5
7.62
0.006
<0.005
0.058
<5.0
NA
' Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
2 For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here.
-'The total precipitation most be recorded using data from an on -site rain gauge. Unattended sites may be eligible for a waiver of the rain gauge requirement.
° See General Permit, Table 3 identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
s Total Toxic Organics sampling is applicable only for those facilities which perform metal finishing operations, manufacture semiconductors, manufacture
electronic crystals, or manufacture cathode ray tubes. For purposes of this permit the definition of Total Toxic Organics is that definition contained in the EPA
Effluent Guidelines for the facility subject to the requirement to sample (for metal finishing use the definition as found in 40 CFR 433.11; for semiconductor
manufacture use the definition as found in 40 CFR 469.12; for electronic crystal manufacture use the definition as found in 40 CFR 469.22; and for cathode ray
tube manufacture use the definition found in 40 CFR 469.31).
Permit Date: 11/1/2012-10/31/2017 SWU-245, last revised 10/25/2012
Page 1 of 3

Fac'lities that incorporate a solvent management plan into the Stormwater Pollution Prevention Plan may so certify, and the requirement for TTO monitoring
may be waived. The solvent management plan shall include a list of the total toxic organic compounds used and the other elements listed in the General
Permit. For those facilities electing to employ the TTO monitoring waiver, the discharger shall sign the following certification statement:
"Based upon my inquiry of the person or persons directly responsible for managing compliance with the permit monitoring requirement for total toxic organics
(TTO), I certify that to the best of my knowledge and belief, no dumping of concentrated toxic organics into the stormwater or areas which are exposed to rainfall or
stormwater runoff has occurred since filing the last discharge monitoring report. 1 further certify that this facility is implementing the all the provisions of the
solvent management plan included in the stormwater Pollution Prevention Plan."
Name (Print name)
Title (Print title)
(Signature)
(Date)
Note: Results must be reported in numerical format. Do not report Below Detection Limit, BDL, <PQL, Non -detect, ND, or other similar non -numerical
format. When results are below the applicable limits, they must be retorted in the format, "<XX mgjL", where XX is the numerical value of the detection
limit, reporting limit, etc. in mg/L.
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.
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month.
❑ No discharge this period ?2
Qutfall No.
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
Inches
Non -polar O&G/TPH by
EPA 1664 (SGT-HEM)
Total Suspended Solids
pH
Benchmarks ==_>
_
-
15 mg/L
100 mg/L or 50 mg/L*
6.0 — 9.0 SU
Footnotes from Part A also apply to this Part B
* See General Permit text, Table 5, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Permit Date: 11/1/2012-10/31/2017 SWU-245, last revised 10/25/2012
Page 2 of 3

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 It 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 Q
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
a' "� _ reports, within 30,days of receipt of the lab resulgLor at end o monitoring Period
Mar an original and one cony of this DMR,_�ncluding all No Discharge" „
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.
am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
15-15
(Date)
Permit Date: 11/1/2012-10/31/2017 SWU-245, last revised 10/25/2012
Page 3 of 3

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General permit No. NCG030000
[late submitted _ A-�'-
CERTIFICATE OF COVERAGE NO. NCG03 0 2 0 . 0
FACILITY NAME Worthington Cylinders -Winston Salem
COUNTY _Forth
PERSON COLLECTING SAMPLES Peter H. DeVries
LABORATORY R&A laboratories Lab Cert. # 34
Comments on sample collection or analysis:
Field pH by Geoscience & Technology, P.A. NC# 5643 T
Part A: Stormwater Benchmarks and Monitoring Results
SAMPLE COLLECTION YEAR 2015
SAMPLE PERIOD ✓0 Jan -June ❑ July -Dec
or ❑ Monthly' (month)
DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
RECEIVED ❑Zero -flow ❑Water Supply ❑SA
bother Class C
FEB 2 5 2015
CENTRAL. FILES PLEASE REMEMBER TO SIGN ON PAGES 2 AND/OR 3 4
DWR SFCTiON
F] No discharge this period?'
outfall No.
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
Inches'
Total Suspended Solids
pH,
Standard units
Copper
Lead
Zinc
Non -Polar O&G/Total
Total Petroleum
Hydrocarbons
Toxic
Organicss
Benchmarks =_->
-
-
100 mg/L or 50 mg/0
6.0 — 9.0
0.007 mg/L
0.03 mg/L
0.067 mg/1
15 mg/L
1 mg/L
003
1 /23/15
0.8
<5
7.46
0.0074
<0.005
0.260
<5.0
NA
I Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
2 For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here.
3 The total precipitation must be recorded using data from an on -site rain gauge. Unattended sites maybe eligible for a waiver of the rain gauge requirement.
4 See General Permit, Table 3 identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
5 Total Toxic Organics sampling is applicable only for those facilities which perform metal finishing operations, manufacture semiconductors, manufacture
electronic crystals, or manufacture cathode ray tubes. For purposes of this permit the definition of Total Toxic Organics is that definition contained in the EPA
Effluent Guidelines for the facility subject to the requirement to sample (for metal finishing use the definition as found in 40 CFR 433.11; for semiconductor
manufacture use the definition as found in 40 CFR 469.12; for electronic crystal manufacture use the definition as found in 40 CFR 469.22; and for cathode ray
tube manufacture use the definition found in 40 CFR 469.31).
Permit Date: 11/1/2012-10/31/2017 SWU-245, last revised 10/25/2012
Page 1 of 3

Facilities that incorporate a solvent management plan into the Stormwater Pollution Prevention Plan may so certify, and the requirement for TTO monitoring
may be waived. The solvent management plan shall include a list of the total toxic organic compounds used and the other elements listed in the General
Permit. For those facilities electing to employ the TTO monitoring waiver, the discharger shall sign the following certification statement:
ti "Based upon my inquiry of the person or persons directly responsible for managing compliance with the permit monitoring requirement for total toxic organics
(TTO), I certify that to the best of my knowledge and belief, no dumping of concentrated toxic organics into the stormwater or areas which are exposed to rainfall or
stormwater runoff has occurred since filing the last discharge monitoring report. I further certify that this facility is implementing the all the provisions of the
solvent management plan included in the Stormwater Pollution Prevention Plan."
Name (Print name)
Title (Print title)
(Signature)
(Date)
Note' Results must be reported in numerical format. Do no, t_ report Below Detection Limit, BDL, <PqL, Non -detect, ND, or other similar non -numerical
format. When results are below the applicable limits, they must be reported in the•format "<XX mg/L", where XX is the numerical value of the detection
limit, reporting limit, etc. in mg/L
Note: If you report a sample value in excess of the benchmark, you most implement Tier 1, Tier 2, or Tier 3 responses. See General Permit text.
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month.
❑ No discharge this period?2
Dutfall No.
Date Sample
Collected'
(moldd/yr)
24-hour rainfall
amount,
Inches3
Non -polar O&G/TPH by
EPA 1664 (SGT-HEM)
Total Suspended Solids
pH
Benchmarks
15 mg/L
100 mg/L or 50 mg/L*
6.0 — 9.0 SU
Footnotes from Part A also apply to this Part B
* See General Permit text, Table 5, identifying the especially sensitive receiving water classifications where the more protective benchmark applies,
Permit Date; 11/1/2012-10/31/2017 SWU-245, last revised 10/25/2012
Page 2 of 3

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 ATTHE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART 11 SECTION B.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES ❑ NO FZI
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an original and one copy of this DMR includin all "No Discharge' reports, within 30 days of recei t of the lab results Lar at end of monitoring period
in the case o "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."
- ),�-15
(Date)
Permit Date: 11/1/2012-10/31/2017 SWU-245, last revised 10/25/2012
Page 3 of 3

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No. NCG030000
Date submitted-�D-JS_
CERTIFICATE OF COVERAGE NO. NCG03 0 2 0 0
FACILITY NAME Worthington Cylinders -Winston Salem
COUNTY Forsyth
PERSON COLLECTING SAMPLES Peter H. DeVries
LABORATORY R&A Laboratories Lab Cert. # 34
Comments on sample collection or analysis:
Field pH by Geoscience & Technology, P.A. NC# 5643
Part A: Stormwater Benchmarks and Monitoring Results
SAMPLE COLLECTION YEAR 2014
SAMPLE PERIOD ❑ Jan -June 0 July -Dec
or 0 Monthly' month
DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
RECEIVED ❑Zero -flow ❑Water Supply []SA Other Class C �
JAN 21 2015
CENTRAL HLES PLEASE REMEMBER TO SIGN ON PAGES 2 AND/OR 3 4`��
DWR SECTION
No discharge this period?z
Outfall No.
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
Inches3
Total Suspended Solids
pH,
Standard units
Copper
Lead
Zinc
Non -Polar O&G/Total
Total Petroleum
Hydrocarbons
Toxic
Organicss
Benchmarks ===>
-
-
100 mg/L or 50 mg/L
6.0 — 9.0
0.007 mg/L
0.03 mg/L
0.067 mg/L
15 mg/L
1 mg/L
003
12/16/14
0.1
14.0
7.1
0.014
<0.005
0.214
<5.0
NA
1 Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
z For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here.
3The total precipitation must be recorded using data from an on -site rain gauge. Unattended sites may be eligible for a waiver of the rain gauge requirement.
d See General Permit, Table 3 identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
5 Total Toxic Organics sampling is applicable only for those facilities which perform metal finishing operations, manufacture semiconductors, manufacture
electronic crystals, or manufacture cathode ray tubes. For purposes of this permit the definition of Total Toxic Organics is that definition contained in the EPA
Effluent Guidelines for the facility subject to the requirement to sample (for metal finishing use the definition as found in 40 CFR 433.11; for semiconductor
manufacture use the definition as found in 40 CFR 469,12; for electronic crystal manufacture use the definition as found in 40 CFR 469.22; and for cathode ray
tube manufacture use the definition found in 40 CFR 469.31).
7
ift
Permit Date: 11/1/2012-10/31/2017 SWU-245, last revised 10/25/2012
Page 1 of 3

.Facilities that incorporate a solvent management plan into the Stormwater Pollution Prevention Plan may so certify, and the requirement for TTO monitoring
may be waived. The solvent management plan shall include a list of the total toxic organic compounds used and the other elements listed in the General
Permi+. For :;lose facilities electing to employ the TTO monitoring waiver, the discharger shall sign the following certification statement:
"Based upon my inquiry of the person or persons directly responsible for managing compliance with the permit monitoring requirement for total toxic organics
(TTO), I certify that to the best of my knowledge and belief, no dumping of concentrated toxic organics into the stormwater or areas which are exposed to rainfall or
stormwater runoff has occurred since filing the last discharge monitoring report. I further certify that this facility is implementing the all the provisions of the
solvent management plan included in the stormwater Pollution Prevention Plan."
Name (Print name)
Title (Print title)
(Signature)
(Date)
Note: Results must be reported in numerical format. Do not report Below Detection Limit, BDL, <PQL, Non -detect, ND, or other similar non -numerical
format. When results are below the applicable limits, they must be reported in the format. "<XX me/L where XX is the numerical value of the detection
limit, reporting limit, etc. in mg/L.
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.
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month.
F_j No discharge this period?2
Outfall No.
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
Inches3
Non -polar O&G/TPH by
EPA 1664 (SGT-HEM)
Total Suspended Solids
pH
Benchmarks =__>
_
-
15 mg/L
100 mg/L or 50 mg/L*
6.0 — 9.0 SU
Footnotes from Part A also apply to this Part B
* See General Permit text, Table 5, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Permit Date: 11/1/2012-10/31/2017 SWU-245, last revised 10/25/2012
Page 2 of 3

,Note: if you report a sample value in excess of the benchmark, you must implement Tier 1, Tier x, 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 IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART 11 SECTION B.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDANCES 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:
Moil an oric
linal and one copy of this DMR includin all "No Discharge" reports, within 30 days of receipt of the lab results or at end of monitoring eriod
in the case of "No Discharge" reports) to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mall Service Center
Raleigh, North Carolina 27699-1617
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED:
N 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."
(Signat�rmittee) (Date)
Permit Date: 11/1/2012-10/31/2017 SWU-245, last revised 10/25/2012
Page 3 of 3

All
Semi-annual Stormwater Discharge Monitoring Report J J
for North Carolina Division of Water Quality General Permit No. NCG030000
Date submitted
CERTIFICATE OF COVERAGE No. NCG03 0 2 0 0
FACILITY NAME Worthington Cylinders -Winston Salem
COUNTY Forsyth
PERSON COLLECTING SAMPLES Peter H. DeVries
LABORATORY R&A Laboratories Lab Cert. # 34
Comments on sample collection or analysis:
Field pH by Geoscience & Technolo , P.A. NC# 5643
Part A: Stormwater Benchmarks and Monitoring Results
SAMPLE COLLECTION YEAR 2014
SAMPLE PERIOD ® Jan -June ❑ July -Dec
or ❑ Monthly' _ fmonth)
������DISSCCH�A�RGING TO CLASS ❑ORW ❑HOW [:]Trout❑PNA
�V/ ❑Zero -flow [:]WaterSupply [:]SA
SEP 0 3 2014 ©other Class C
CENTRAL FILES PLEASE REMEMBER TO SIGN ON PAGES 2 AND/OR 3 4
DWa/BOG
❑ No discharge this period?'
Outfall No.
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
Inches3
Total Suspended Solids
PH.
Standard units
Capper
Lead
Zinc
Non -Polar O&G/
Total Petroleum
Hydrocarbons
Total Toxic
Organicss
Benchmarks ===s
-
-
100 mg/L or 50 mg/0
6.0 — 9.0
0.007 mg/L
0.03 mg/L
0.067 mg/L
15 mg/L
i mg/L
003
06/19/14
0.2
6.0
7.2
0.010
<0.005
0.100
<5.0
NA
' Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
2 For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here.
3The total precipitation must be recorded using data from an on -site rain gauge. Unattended sites may be eligible for a waiver of the rain gauge requirement.
4 See General Permit, Table 3 identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
5 Total Toxic Organics sampling is applicable only for those facilities which perform metal finishing operations, manufacture semiconductors, manufacture
electronic crystals, or manufacture cathode ray tubes. For purposes of this permit the definition of Total Toxic Organics is that definition contained in the EPA
Effluent Guidelines for the facility subject to the requirement to sample (for metal finishing use the definition as found in 40 CFR 433.11; for semiconductor
manufacture use the definition as found in 40 CFR 469,12; for electronic crystal manufacture use the definition as found in 40 CFR 469.22; and for cathode ray
tube manufacture use the definition found in 40 CFR 469,31).
Permit Date: 11/1/2012-10/31/2017 SWU-245, last revised 10/25/2012
Pagel of 3

�-v
Facilities that incorporate a solvent management plan into the Stormwater Pollution Prevention Plan may so certify, and the requirement for TTO monitoring
may be waived. The solvent management plan shall include a list of the total toxic organic compounds used and the other elements listed in the General
Permit. For those facilities electing to employ the TTO monitoring waiver, the discharger shall sign the following certification statement:
"Based upon my inquiry of the person or persons directly responsible for managing compliance with the permit monitoring requirement for total toxic organics
(TTO), I certify that to the best of my knowledge and belief, no dumping of concentrated toxic organics into the stormwater or areas which are exposed to rainfall or
stormwater runoff has occurred since filing the last discharge monitoring report. I further certify that this facility is implementing the all the provisions of the
solvent management plan included in the Stormwater Pollution Prevention Plan."
Name (Print name)
Title (Print title)
(Signature)
(Date)
Note: Results must be reported in numerical format. Do not report Below Detection Limit, BDL, <PQL, Non -detect, ND, or other similar non -numerical
format. When results are below the applicable limits, they must be reported in the format, "<XX mg/L", where XX is the numerical value of the detection
limit, reporting limit, etc, in mg/L.
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.
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month.
❑ No discharge this period?Z
Outfall No.
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
Inches'
Non -polar O&G/TPH by
EPA 1664 (SGT-HEM)
Total Suspended Solids
pH
Benchmarks =__>
_
-
15 mg/L
100 mg/L or 50 mg/L*
6.0 — 9.0 SU
Footnotes from Part A also apply to this Part B
* See General Permit text, Table 5, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Permit Date: 11/1/2012-10/31/2017 SWU-245, last revised 10/25/2012
Page 2 of 3

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 AAND 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 ANYONE OUTFALL? YES ❑ NO ❑
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an original and one cony 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 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 avVre that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
;nature of Permitteej ✓ �� �too$4
�Illal /o/,-
(Da"te)
a-,
Permit Date:11/1/2012-10/31/2017
SWU-245, last revised 10/25/2012
Page 3 of 3

STORMWATER DISCHARGE OUTIiALL (SDO)
MONITORING REPORT
GENERAL PERMIT NO. NCGO30000
CERTIFICATE OF COVERAGE NO. NCG03 0200
FACILITY NAME Worthington Cylinders/Winston-Salem
PERSON COLLECTING SAMPLES Peter H. D@Vries
CERTIFIED LABORATORY R&A Laboratories_ Lab # 34
Lab #
Part A: Specific Monitoring Requirements
SAMPLES COLLECTED DURING CALENDAR YEAR: 2013
(This monitoring report is due at the Division no later than 30 days from
the date the facility receives the sampling results from the laboratory.)
COUNTY Forsyth
PHONE NO. (33f)_} $96-1300
PLEASE SIGN ON THE REVERSE -)
Outtall
No-
Date
Sample Collected,
moldd/ r
00530
00400
01051
00556
78141
Total Suspended Solids,
m /L
pH,
Standard units
Lead, mg/l,
Oil and Grease,
mgj.
Total -Toxic Organics ,
m L
Benchmark
-
100
Within 6.0 - 9.0
0.033 '
30
1
003
11 /1 /13
-
<0.005
NA
Note: if you report a sampled value in excess of the benchmark value, or outside the benchmark range ror pH, you must implement Tier I or Tier 2 resp(nses. �
See General Permit text.
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month". _yes )Lno
(il'yes, complete fart B)
Part B: 'Vehicle Maintenance Activity Monitoring Requirements
APR 2 8 2614
CENTRAL FILES
DWQ/B0G
Outfall
No.
Date
Sample Collected,
mo/dd/ r
00556
00530
00400
Oil and Grease,
ttt L
Total Suspended Solids,
wlgfL
pH,
Standard units
New Motor Oil Usage,
Annual average g al/mo
Benchmark
-
30
100
6.0 -- 9.0
-
Note: if you report a sampled value in excess of the N-mchmark value, or outside the henchmark range for pl•f, you must implement'rier 1 or Tier 2 responses.
See General Permit text.
STORM EVENT CHARACTERISTICS:
Datel l /1 /13 (first event sampled)
Total Event Precipitation (inches): 0.3
Date (list each additional event sampled this reporting period, and rainfall amount)
Total Event Precipitation (inches):
Mail Original and one copy to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27099-1617
j-,
S W U-245-031308
Page 1 of 2

1 Total Toxic Organics sampling is applicable only for those facilities which perform metal finishing operations, manufacture semiconductors, manufacture electronic crystals, or
manufacture cathode ray tubes. For purposes of this permit the definition of Total Toxic Organics is that definition contained in the EPA Effluent Guidelines for the facility subject '
to the requirement to sample (for metal finishing use the definition as found in 40 CFR 433.11 ; for semiconductor manufacture use the definition as found in 40 CFR 469.12; for
electronic crystal manufacture use: the definition as found in 40 CFR 469.22; and for cathode ray tube manufacture use the definition found in 40 CFR 469.31).
Facilities that incorporate a solvent management plan into the Stormwater Pollution Prevention Plan may so certify, and the requirement for TTO monitoring may be waived_ The
solvent management plan shall include a list of the total toxic organic compounds used and the other elements listed in the General Permit. For those facilities electing to employ the
TTfl monitoring waiver, the discharger shall sign the following certification statement:
"Based upon my inquiry of the person or persons directly responsible firr managing compliance with the permit monitoring requirement for total toxic organics (TTfl), I
certify that to the best of my knowledge and belief, no dumping of concentrated toxic organics into the stormwater or areas which are exposed to rainfall or stortnwater
runoff has occurred since filing the last discharge monitoring; report. I further certify that this facility is implementing the all the provisions of the solvent management
plan included in the Stormwater Pollution Prevention Plan."
Namc (Print name)
Title (Print title)
(Signature)
(Date)
" 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."
61�� // /z-7,
Signature of Permittee) (Da e)
SWU-245-031308
Page 2 of 2

, , Sc 0 L1c �'
6chnoRogy,
' A.
EhvhvtvmnaSoh&ons"
December 30, 2011
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Attention Central Files
1617 Mail Service Center
Raleigh, NC 27699-1617
2050 Northpoint Drive • Suite A
Winston-Salem, NC 27106
Phone: [phone]
Fax: [phone]
[e-mail]
www,geotec.com
RECEIVED
N..C.Dept. of ENR
JAN 17 2012 r'
Winston-Salem
Re lonalOfAce
Reference: 2011 Stormwater Discharge Monitoring Report for Lenox/Winston-Salem; NPDES
Certificate of Coverage # NCG030200.
Stormwater Group:
Geoscience & Technology, P.A. (GeoSci), on behalf of Lenox/Winston-Salem (Lenox), is
pleased to submit the enclosed annual stormwater monitoring data for the above -mentioned
facility for November 2011, pursuant to general stormwater certificate of coverage
#NCG030200. Lenox is located at 1690 Lowery Street, Winston-Salem, NC. The Environmental
Manager at Lenox is Kent Leonard (336.777.8600).
Enclosed please find the following documents:
1. Laboratory Analytical Results and Chain of Custody form;
2. Stormwater Discharge Outfall (SDO) Monitoring Report (SWU-246-051100).
Peter H. DeVries, Project Geologist, with GeoSci, performed the stormwater sample collection
and prepared the Qualitative and Quantitative Monitoring Reports. The storm event reported
herein occurred on Wednesday, November 16, 2011, during which a total .of 2.8-inches of rain

was measured in an onsite rain gauge. The storm event started at approximately 0500 hrs on
November 16, 201 J and ended at approximately 1200 hrs on the following day. Rainfall ranged
from light to heavy throughout the event.
A stormwater sample was collected at 1030 hrs November 16, 2011; the rain gauge indicated
0.25-inches at that time. Runoff began at approximately 1000. The previous storm event totaling
more than 0.1-inches ended in the early morning hours of Friday, November 4, 2011,
approximately 11 days prior to the sampled event.
Runoff calculations for this event are available on request.
Please call Peter H. DeVries at 336.8961300 if you have any questions.
Sincerely,
GEOSCIENCE & TECHNOLOGY, P.A.
r
Peter H. DeVries
Project Geologist
CC'
Andrew K. Allen
Senior Stormwater Engineering Technician
City of Winston-Salem
P.O Box 2511
Winston-Salem, NC, NC 27102
Corey Basinger
Surface Water Protection Supervisor
Division of Water Quality
Winston Salem Region
North Carolina Department of Environment and Natural Resources
585 Waughtown Street
Winston-Salem, NC 27107

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
GENERAL PERMIT NO. NCG030000
CERTIMCATE OF COVERAGE NO. NCG03 0200
1FACTLITY NAME Lenox/Winston-Salem
PERSON COLLECTING SAMPLES Peter H_ DeVries
CERTIFIED LABORATORY R&A Laboratories Lab # 34
Lab #
Part A: Specific Monitoring Requirements
SAMPLES COLLECTED DURING CALENDAR YEAR: 2011
(This monitoring report is due at the Division no later than 30 days from
the date the facility receives the sampling results from the laboratory.)
COUNTY Forsyth
PHONE NO. (33-6-) 896-1300
PLEASE SIGN ON THE REVERSE -)
Outfall
No.
Date
Sample. Collected,
mo/dd/ r
00530
00400.
01051 .
' .00556.
. . 78141
Total Suspended Solids,
ru
pH,
Standard units
Lead, mg/L .
Oil-and:Grease,,
m
Total-Toxic,"Org;-X cC ;
m /L
Benchmark
-
100
Within 6.0 — 9.0
0.033
30--'
1•
003
11 /16/11
3.67
6.77
<0.005
<5.0
NA
Note: If you report a sampled value in excess of the benchmark value, or outside the benchmark range for pH, you must implement Tier 1 or Tier 2 responses.
See General Permit text.
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? _ yes X no
(if yes, complete Part B)
Part B: Vehicle Maintenance Activity Monitoring Requirements
Outfall
No.
Date
Sample Collected,
mo/dd/ r
00556
00530
00400
OR and Grease,
m /L
Total Suspended Solids,:
m
pH,
Standard -units
New Motor Oi1:Usage,
Annual'aver e • al/mo
Benchmark
-
30
100
6.0 — 9.0E--
-
i
Note: If you report a sampled value in excess of the benchmark value, or outside the benchmark range for pH, you must implement Tier 1 or Tier 2 responses.
See General Pmniit text.
STORM EVENT CHARACTERISTICS:
Date11 A 6/11(first event sampled)
Total Event Precipitation (inches): 2.8
Date (list each additional event sampled this reporting period, and rainfall amount)
Total Event Precipitation (inches):
Mail Original and one copy to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
SWU-245-031308
Page 1 of 2

I Total Toxic Organics sampling is applicable only for those facilities which perform metal finishing operations, manufacture semiconductors, manufacture electronic crystals, or
manufacture cathode ray tubes. For purposes of this permit the definition of Total Toxic Organics is that definition contained in the EPA Effluent Guidelines for the facility subject
to the requirement to sample (for metal finishing use the definition as found in 40 CFR 433.11; for semiconductor manufacture use the definition as found in 40 CFR 469.12; for
electronic crystal manufacture use the dc0nition as found in 40 CFR 469.22; and for cathode ray tube manufacture use the definition found in 40 CFR 469.31).
'Facilities that incorporate a solvent management plan into the Stormwater Pollution Prevention Plan may so certify, and the requirement for TTO monitoring may be waived. The
solvent management plan shall include a list of the total toxic organic compounds used and the other elements listed in the General Permit. For those facilities electing to employ the
TTO monitoring waiver, the discharger shall sign the following certification statement:
"Based upon my inquiry of the person or persons directly responsible for managing compliance with the permit monitoring requirement for total toxic organics MO), I
certify that to the best of my knowledge and belief, no dumping of concentrated toxic organics into the stormwater or areas which are exposed to rainfall or stormwater
runoff has occurred since filing the last discharge monitoring report. 1 further certify that this facility is implementing the all the provisions of the solvent management
plan included in the Stormwater Pollution Prevention Plan."
Kent Leonard
Name (Print name)
Vice President
Title (P int title)
(Signature) ate)
"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 fine and imprison e t for knowing violations."
aZ�
(Signature of Permittee) (ll te)

RESE
o°o I.Abo
Anaiytica
November 29, 2011
Geoscience & Technology, P.A.
2050 North Point Drive
Winston-Salem, NC 27106
Attention: Peter DeVries
= YJ, AA, TP & JC
ARCM & ANA1YTiCAL
e
RATORIESF INC.
I/Process Consultations
Chemical Analysis for Selected Parameters and Sampling Locations Identified as Lenox Tool Winston-Salem
(A Geoscience & Technology, P.A. Project #98.121, collected 16 November 2011)
mg/L = milligrams per Liter = parts per million (PPM)
Std. Units = Standard units
`'*+�p�uugitri
NC #34 •
Project Name: LenoxAVinston-Salem
_.
Sample
Total
'Oil &Grease
Lead, ,.
Time
I'pH,
Suspended
i6
'(Tss)
(Std `..Units}
(mglL)
(znglL)
1030
6.77
3.67
<5.0
<0.005

.t
ul�&ESEARC J & ANAIraCA
UbORAMRon, �Nc.
Analytical / Process Consultations
Phcne E3361996-2841
c HAN OF CUSTODY RECORD
I WATER ! WASTEWATER Ii MISC. I
C MPANY
-e� ��4 '-i P� �� P�
JOB NO.
�
q,�o� ��y�`��y �,����� p•Z
`Q Z 0"
Q �� O�LOC' 00'
ti" cP Q y v v v
R ti � � h ^ ^ �` REQUESTED ANALYSIS
STREET ADDRESS
PROJECT
lCITY, STATE, TiP
!14✓ � � �� �..1` � `^ G t � IfJ
MPLER NA�f�jE (P S PRINT)
. °� � 5 ` �
CONTACT PHONE
0
7SPLER
4, SIGN�TiJ
SA uPLE NumBER
"a USE ONLY
bA
TIME
4tJ
GRAB
iEdl
°C
RES
E
�Mo ° ORME
MOVEvcwNl
MME
is TRIX
S14MPLE LOCATION I I.D.
1030
t
i
RELI ggQUISHED
fy v Cql.
YQ
R1fE� CE.iIV1 E�Di:B-�Y
RENA8g�NiLt�JSy! /t' iJ 3s
U'
;
SAMPLE TEMPERATURE AT RECEIPT,
RELINQUISHED BY
DATMIME
RECEIVED BY

1&H
RECEIVED -
N.C. Cect. of cyP
MAY 2 6 2011
Winstcn-sale —
Realcna_C": r
May 24, 2011
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Attention Central Files
1617 Mail Service Center
Raleigh, NC 27699-1617
2050 Northpoint Drive • Suite A
Winston-Salem, NC 27106
Phone: [phone]
Fax: [phone]
[e-mail]
www.geotec.com
Reference: 2011 Stormwater Discharge Monitoring Report for Lenox/Winston-Salem; NPDES
Certificate of Coverage # NCG030200.
Stormwater Group:
Geoscience & Technology, P.A. (GeoSci), on behalf of Lenox/Winston-Salem (Lenox), is pleased
to submit the enclosed annual stormwater monitoring data for the above -mentioned facility for
2011, pursuant to general stormwater certificate of coverage #NCG030200. Lenox is located at
1690 Lowery Street, Winston-Salem, NC. The Environmental Manager at Lenox is Kent Leonard
(336.777.8600).
Enclosed please find the following documents:
1. Stormwater Event Runoff Calculations (Table 1);
2. Laboratory Analytical Results and Chain of Custody form;
3. Stormwater Discharge Outfall (SDO) Monitoring Report (SWi1-246-051100).
Peter H. DeVries, Project Geologist, with GeoSci, performed the stonnwater sample collection and
prepared the Qualitative and Quantitative Monitoring Reports. The storm event reported herein
occurred on Wednesday, April 27, 2011, during which a total of 0.18-inches of rain was measured
in an onsite rain gauge. The storm event started at approximately 1345 hrs on the afternoon of April
27, 2011 and ended at approximately 1445 hrs on the same day. Rainfall was relatively heavy
throughout the brief event.

A stormwater sample was collected at 1420 hrs April 27, 2011; the rain gauge indicated 0.15-inches
at that time. Runoff began at approximately 1400. The previous storm event totaling more than 0.1-
inches ended in the early morning hours of Saturday, April 23, 2011, approximately 3-1/2 days or
approximately 85 hours prior to the sampled event.
The attached Table 1 summarizes the historical pervious/impervious and drainage areas for the
designated outfall. Runoff calculations for the April 2011 event are also documented in Table 1.
The calculations indicate a total runoff of 7,501 gallons (0.0075 MG) through outfall 003.
Please call either Peter H. DeVries or Alex McGilvaty at 336.896.1300 if you have any questions.
Sincerely,
GEOSCIENCE & TECHNOLOGY, P.A.
Peter H. DeVries
Project Geologist
A% . Akv,,c., wv'
M. Alex McGilvary
Senior Geologist
cc w/ attachments:
Kent Leonard Andrew K. Allen
Lenox/Winston-Salem. Senior stormwater Engineering Technician
1690 Lowery Street City of Winston-Salem
Winston-Salem, NC 27101 P.O Box 2511
Winston-Salem, NC, NC 27102
Corey Basinger
Surface Water Protection Supervisor
Division of Water Quality
Winston Salem Region
North Carolina Department of Environment and Natural Resources
585 Waughtown Street
Winston-Salem, NC 27107

STORMWATER DISCHARGE OUTFALL (SDO)
MONrFORING REPORT
GENERAL PERMIT NO. NCG030000 SAMPLES COLLECTED DURING CALENDAR YEAR. 2011
CERTIFICATE OF COVERAGE NO. NCG03 02000 (This monitoring report is due at the Division no later than 30 days from
the date the facility receives t e sampling results from the laboratory.)
FACILITY NAME Lenox/Winston-Salem COUNTY rorsyth
PERSON COLLECTING SAMPLES peter H. DeVries PHONE, NO. (336 l 896-1300
CERTIFIED LABORATORYR& A laboratories I.ab #.34 —
Lala # PLEASE SIGN ON THE REVERSE 4
Part A: Specific Monitoring Requirements
Outfall
No.
Date
Sample Collected,
mo/dd/ r
00530
00406
01051
00556
78141
Total Suspended Solids,
m
pH,
Standard units
Lead, mgfL
Oil and Grease,
m
Total Toxic Organics',
m
Benchmark
-
100
Within 6.0 — 9.0
0.033
30
1
003
4/27/11
2. 0
5.63
<0.005
21.1
N
Note: If you report a sampled value in excess of the benchmark value, or outside the benchmark range for pH, you must implement Tier I or Tier 2 responses.
See General Permit text.
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? , yes X no
(if yes, complete Part B)
Part B: Vehicle Maintenance Activitv Monitoring Requirements
Oulfall
No.
Date
Sample Collected,
mo/dd/ r
00556
00530
00400
Oil and Grease,
mg!
Total Suspended Solids,
m
pH,
Standard units
New Motor Oil Usage,
Annual average al/mo
Benchmark
-
30
100
6.0 -- 9.0
-
Note: If you report a sampled value in excess of the benchmark value, or outside the benchmark range for pH, you must implement Tier I or Tier 2 responses.
See General Permit text.
STORM EVENT CHARACTERISTICS:
Date4/27/11 (first event sampled)
Total Event Precipitation (inches): 0.18
Date (list each additional event sampled this reporting period, and rainfall amount)
Total Event Precipitation (inches):
Mail Original and one copy to:
Division of Water Quality
Attm DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
S WU-245-03 1308
Page I of 2

1 Total Toxic Organics sampling is applicable only for those facilities which perform metal finishing operations, manufacture semiconductors, manufacture electronic crystals, or
manufacture cathode ray tubes. For purposes of this permit the definition of Total Toxic Organics is that definition contained in the EPA Effluent Guidelines for the facility subject
to the requirement to sample (for metal finishing use the definition as found in 40 CFR 433.1 1; for semiconductor manufacture use the definition as found in 40 CFR 469,12; for
electronic crystal manufacture use the definition as found in 40 CFR 469.22; and for cathode ray tube manufacture use the definition found in 40 CFR 469,31).
Facilities that incorporate a solvent management plan into the Stormwater Pollution Prevention Plan may so certify, and the requirement for TTO monitoring may be waived. The
solvent management plan shall include a list of the total toxic organic compounds used and the other elements listed in the General Permit. For those facilities electing to employ the
TTO monitoring waiver, the discharger shall sign the following certification statement:
"Based upon my inquiry of the person or persons directly responsible for managing compliance with the permit monitoring requirement for total toxic organics (TTO), I
certify that to the best of my knowledge and belief, no dumping of concentrated toxic organics into the stormwater or areas which are exposed to rainfall or stormwater
runoff has occurred since filing the last discharge monitoring report. I further certify that this facility is implementing the all the provisions of the solvent management
plan included in the Stormwater Pollution Prevention Plan." nt
Name (Print name)
Qc AT,,-T- turn 0
Title (Print title)
o
(Signature) (Date)
"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 Permittee)
—Xirllr. `,pBMat� 5 i�v1�Q
Sip net true Cv%OP .s
sdw•01J n rl •1��
(Date) /
hi4o. —The lot
� �XrC 4rywrjres
47A r t to r � /.1 . /i/
SWU-245-031308
Page 2 of 2

Lenox/Winston-Salem
Table 1: 2011 5tormwater Event Calculations
Year
Building Area (ft`
Park Lot (fe)
Grass Area (FC)
Total Impervious
Area (ft')
Total Pervious
Area V)
Ota
Drainage
Area (W)
%
Impervious
Area
1997
18,228.00
24,993.00
54,491.00
43,221.00
54,491,00
97,712.00
44.23%
1998/001
26,068.00
0.00
32,138.00
26,068.00
32,138.00
58,206.00
44.79%
1998/002
0.00
18,931.50
20,574.50
18,93I.50
20,574.50 1
39,506.00
47.92%
20041003
26,068.00
18,931.50
52,712.50
44,999.50
52,712.50
97,712.00
46.05%
20051003
26,068.00
18,931.50
52,712.50
44,999.50
52,712.50
97,712.00
46.05%
2006/003
26,068.00
18,931.50
52,712.50
44,999.50
52,712.50
97,712.00
46.05%
2007/003
26,068.00
18,931.50
52,712.50
44,999.50
52,712.50
97,712.00
46.05%
2008/003
26,068.00
18,931.50
52 712.50
44,999.50
52,712.50
97,712.00
46.05%
2009/003
26,068.00
18,931.50
52,712.50
44,999.50
52,712.30
97,712.00
46.05%
2010/003
26,068.00
18.931.50
52,713.50
44,999.50
52,713.50
1 97,713.00
1 46.057o
2011/003
26,068.00
18,931.50
52,714.50
44,999.50
52.714.50
1 97,714.00
146.05�
Runoff Coefficient (ROC), pervious: 0.5
Runoff Coefficient (ROC), impervious: 0.9
Total Runoff (gallons) for rainfall event = event rainfall (feet) X {[pervious area (ft'`) X runoff coeff] +
I.impervious area (W) X runoff codi'll X 7.48 gallfe
Discharge 003. Storm Event 4/27/l 1
Total Event Rainfall (in): 0.18 _ 12 in/ft = R015 Feet
Total Pervious Area (ft):
52,712.50
X ROC =
26,356.25
Total Impervious Area (1`0):
44,999.50
X ROC =
40,499.55
Total Event Runoff V).- 1,002.84
Total Event Runoff (ga]): 7,501 MG 0.007501221
4/27/11

RIESIEARCh&ANALYTICAL
I.AbORATORiIES INC.
Anaiytllcal/Process Consultations
May 11, 2011
Geoscience & Technology, P.A.
2050 North Paint Drive
Winston-Salem, NC 27106
Attention: Peter DeVrics
Chemical Analysis for Selected Parameters and Sampling Locations Identified as Lenox/Winston-Salem
(A Geoscience & Technology, P.A. Project #98.121, collected 27 April 2011)
Project Number; 98.1211 Project Name: LenoxfWlnston-Salem
sill 1�1'i �Nil 1 d1i ro U
'M - .1
I' P. 1.11� 11 •.4, H; I. sm V m.:.a. I . V zi.
.ii
it
al lim"O
d.
fit
" Wk,
RAI
T.
kzam
Ou fitH 003 701399 04TZ7/L 1 1420 5.63 12.0 21.1 <0.005
[kriodyst = YJ, NW, JC & T?
ing/L = milligrams per Liter - parts per million (PPM)
Std. Units = Standard units

RESEARCh & ANA[ricA[
LkORATORIES, INC.
Analytical 1 Process Consultations
Prone [phone]
CHAIN OF CUSTODY RECORD
WATER 1 wAsTEwATER I misc.
I e
• •
•
,
STREET ADDRESSUs,
C ON TACT PHONE-
? VU6 - 130 0
IN, t
MISSION
MMINMENION
����■■■■�■
MSON
r■■
■■■■
■O■
1■�■■■��r0■
■■■■■is
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MOON■■■■
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►�1 i ,�,r� �J
D:
,: r

_C
TiqoScience &
ITRO A.
"Nt! ! a,
2050 Northpoint Drive • Suite A
Winston-Salem, NC 27106
Phone: [phone]
RECE[vE6­ Fax: [phone]
N.C. Dew geoscirMgeotec.com
JUN 17 2010 www.geotec.com
Winston-5A
Regional C?t'
June 10, 2010
North Carolina Department of Environment and. Natural Resources
Division of Water Quality
Attention Central Files
1617 Mail Service Center
Raleigh, NC 27699-1617
Reference: 2010 Stormwater Discharge Monitoring Report for Lenox/Winston-Salem; NPDES
Certificate of Coverage # NCG030200.
Stormwater Group:
Geoscience & Technology, P.A. (GeoSci), on behalf of Lenox/Winston-Salem (Lenox), is pleased
to submit the enclosed annual stormwater monitoring data for the above -mentioned facility for
2010, pursuant to general stormwater certificate of coverage #NCG030200. Lenox is located at
1690 Lowery Street, Winston-Salem, NC. The Environmental Manager at Lenox is Kent Leonard
(336.777.8600).
Enclosed please find the following documents:
L Stormwater Event Runoff Calculations (Table 1);
2. Laboratory Analytical Results and Chain of Custody form;
3. Stormwater Discharge Outfall (SDO) Qualitative Monitoring Report (SWU-242-101599), and;
4. Stormwater Discharge Outfall (SDO) Monitoring Report (SWU-246-051100).
R. Jeff Wyatt, Field Services Manager, with GeoSci, performed the stormwater sample collection
and prepared the Qualitative and Quantitative Monitoring Reports_ The storm event reported herein
occurred on Monday, May 3, 2010, during which a total of 0.25-inches of rain was measured in an
onsite rain gauge. The storm event started at approximately 0830 hrs on the morning of May 3`d
and ended at approximately 1230 hrs on the same day. Rainfall was light at the beginning, relatively
heavy between 0930 and 1030 and tapered off until stopping at approximately 1230 hrs.

A stormwater sample was collected at 0940 hrs May 3, 2010; the rain gauge indicated 0.15-iriches
at that time. Runoff began at approximately 0900. The previous storm event ended in the early
morning hours of Sunday, April 25, 2009, just under 8 days or approximately 192 hours prior to
the sampled event.
The attached Table I summarizes the historical pervious/impervious and drainage areas for the
designated outfall. Runoff calculations for the May 2010 event are also documented in Table 1. The
calculations indicate a total runoff of 10,418 gallons (0.01 MG) through outfall 003.
Please call either Peter H. DeVries or Alex McGilvary at 336.896. t300 if you have any questions.
Sincerely,
GEOS-C-I�ENCE & TECHNOLOGY, P.A.
P
/l�l / yl
Peter H. DeVries
Project Geologist
M. Alex McGilvary, P.G.
Senior Geologist
cc w/ attachments:
Kent Leonard
Lenox/Winston-Salem.
1690 Lowery Street
Winston-Salem, NC 27101
14se
Sf AL
1011 6
a1 to tp
00 L Qq�W
A.
Andrew K. Allen
Senior Stormwater Engineering Technician
City of Winston-Salem
P.O Box 2511
Winston-Salem, NC, NC 27102
Steve W. Tedder
Surface Water Protection Supervisor
Division of Water Quality
Winston Salem Region
North Carolina Department of Environment and Natural Resources
585 Waughtown Street
Winston-Salem, NC 27107

Lenox[W inston-Salem
Table 1: 2010 Stormwater Event Calculations
Year
Building Area (ftz
Park Lot (fe)
Grass Area (fC)
Total Impervious
Area (ft)
Total Pervious
Area (fe)
oa
Drainage
Area (ft')
Impervious
Area
1997
18,228.00
24,993.00
54,491.00
43,221.00
54,491.00
97,712.00
44.23%
1998/001
26,068.00
0.00
32,138.00
26,068.00
32,138.00
58,206,00
44,79%
1998/002 1
0.00
18,931.50
20,574.50
18,931.50
20,574.50
39,506.00
47.92%
2004/003
26,069.00
18,931.50
52,712.50
44,999.50
52,712.50
97,712.00
46.05%
200.5/003
26,068.00
18,931.50
52,712.50
44,999.50
52,712.50
97,712.00
46.05%
2006/003
26,068.00
18,931.50
52,712.50
44,999.50
52,712.50
97,712.00
46.05%
2007/003
26,068.00
18,931.50
52,712.50
44,999.50
52,712.50
97,712.00
46.05%
2008/003
26,068.00
18.931.50
52,712.50
44,999.50
52,712,50
97,712,00
46.05%
2009/D03
26,068.00
18,931.50
52,712.50
44,999.50
52,712.50
97,712.00
46.05%
2010/003
26,068,00
18,931.50
52,713.50
44,999.50
1 52,713.50
97,713,00
46.05%d
Runoff Coefficient (ROC), pervious: 0.5
Runoff Coefficient (ROC), impervious: 0.9
Total Runoff (gallons) for rainfall event = event rainfall (feet) X {l pervious area (ft) X runoff coeff] +
[impervious area (ft2) X runoff coeffI) X 7.48 gal/ft3
Discharge 003. Storm Event 5/3110
Total Event Rainfall (in): 0.25 :. 12 in/ft = 0.020833333 Feet
Total Pervious Area (fe): 52,712.50 X ROC = 26,356.25
Total Impervious Area (ft): 44,999.50 X ROC = 40,499.55
Total Event Runoff fft31: 1,392.83
Total Event Runoff (gal): 10,418 MG 0.010418362
5/27/10

RESEARCh & ANAlyTICAI
LABORATORIES, INC.
Analytical/Process Consultations
Geoscience & Technology
2050 Northpoint Drive
Winston-Salem, NC 27106
Attn: Steve Mason
RECEVVE D
N.C. Dent. z)f E4t1.7 2010
Winston-Salem,
Regional Office
.
ate Sample Collected 05/03/10
Date Sample Received 05/03/10
Date Sample Analyzed 05/03/10
Date of Report 05/17/10
Analyses Performed by Y'J -AA -JC
D
Lab Sample Number.
--------------------
672689
Parameter Storet # Results
TSS (00530) 17.7 mg/1
Oil & Grease (00556) <5.0 mg/l
Lead,Tot (01051) <0.005 mg/l
PH (00400) 7.04 Std. Units
--------------------
Clients Sample Source OUTFALL
Number TARACORD/LENNOX
Time Collected (Hrs) 0940
R O. Box 473 - 106 Short Street • Kernersville, North Carolina 27284 • 336-996-2841 • Fax [phone]
www.randalabs.com

RESEARCh& ANA1yTiCA1
LABORATORIES, INC.
Analytical 1 Process Consultations
Phone [phone]
'"�!� JOB NO.
7 C �2
STREET
,{ ADDRESS f ! PROJECT
CITY, STATE, ZIP SAIA ER PLEASIt PRINT) l
CONTACT /)T L 111,,�..,'y77-PHON- /'3 C E SAMPLEFr G- - ^�T RE
CHAIN OF CUSTODY RECORD
WATER ! WASTEWATER
0. c 0.��
Uj
Q49•�_�
O 6 SP O m
SAMPLE NUMBER
(LAB USE ONLY)
DATE TIME COYP
GRAB TEMP
RES
�C c1
CHLORINESAM
MAIPoY P L� Pi c v v v `�C
(Y� K, t9 u Wi PLE/L/dCAF10N! I.D. ti ti ^ REQUESTED ANALYSIS
`
D BY SIVEo BY j 1 RE RKS:
D BY DATE/TIME Rf EIVED BY
SAMPLE TEMPERATURE AT RECEIPT °C

RECEIVED
N.C. Dec?. of EIJ
JUN 17 2010
,. ST:vFa Win5,cmSale--
'"� Regional Cr 'cc
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Permit No.: WC/a/0 /a 0 /Q/010 I or Certificate of Coverage No.: N/C/G/Q/3 /2 /O/Q l
Facility Name: Lenox/Winston-Salem
County: Forsyth Phone No. 336,896,1300
Inspector: R. ,teff Wyatt
Date of Inspection: 5/3/2010
By/t.hy signatu);Zq
attthis report is accurate and complete to the best of my knowledge:
ignature of Permittee or Designee)
1. Outfall Description
Outfall No. 003 Structure (pipe, ditch, etc.) pipe
Receiving Stream: Brushy Fork Creek
Describe the industrial activities that occur within the outfall drainage area:
Manufacture lead-free solder and associated products.
2. Color
Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint (light, medium,
dark) as descriptors: light gray
3. • Odor
Describe any distinct odors that the discharge may have (i.e., smells strongly of oil, weak chlorine odor,
etc.) no odor
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 3 / 2 5
Page I
SWU-242-101599

5. Floating Solids
Choose the number which best describes the amount of floating solids in the stormwater discharge where
I is no solids and 10 is the surface covered with floating solids:
1 X 3 4 5 6 7 8 9 10
6. Suspended Solids
Choose the number which best describes the amount of suspended solids in the stormwater discharge
where 1 is no solids and 10 is extremely muddy:
1 �$ 3 4 5 6 7 8 9 10
7. Foam
Is there any foam in the stormwater discharge? Yes No X
8. Oil Sheen
Is there an oil sheen in the stormwater discharge? Yes No X
9. Other Obvious Indicators of Stormwater Pollution
List and describe No other obvious indicators of stormwater pollution.
Note: Low clarity, high solids, and/or the Presence of foam or oil sheen maybe indicative of pollutant
exposure. These conditions may warrant further investigation.
Page 2
SWU-242-101599

RECOVED
N,C. Deot, of F;NR
STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT:,
Permit Number: NC 030000 or
Certificate of Coverage Number: NCG 0302060
.FACILITY NAME Lenox/\Mnstofl-Salem
PERSON COLLECTING SAMPLE(S) R. Jeff Wyatt
CERTIFIED LABORATORY(S) R& A laboratories Lab #34
Lab #
Part. A: Specific Monitoring Requirements
JUN 17 2010
Winston-Salem
Regional QF 1ce
SAMPLES COLLECTED DURING CALENDAR YEAR-2010-._ `--
(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.)
COUNTY Fors
E
SIGNATURE OF PERMITTEE OR DESIGNEE)
By this signature, I certify that this report is accurate
complete to the best of my knowledge.
Outfall .
'
Date
053
'a :01051
,r..
No
Sample
p
Tatar' r
T6tal'Sus ended
p
k'l
,`
P.
Lead
Oil & Grease
+'
Collected
Flow;''t „'
Solids' 4T
,
:.
,... ..
mald&
MG=
m
mg/l
r,
�.. unifs
_
_ .
003
5/3/2010
0.010
17.7
7.04
<0.005
<5.0
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? —yes ) no
(if yes, complete Part B)
Part B: Vehicle Maintenance Activitv Monitorine Reauirements
:.Outfall Date':: _50050
r ;0i155b a ,00530 _• -- -:,
.00400,�-.�' ,
No. ' Sample T6WI Flow Otl and"Tt tel r' pH New iNotor
Collected " Grease Suspended ,! Oil Usage
:SOI1d5..
molddl
Form SWU-246-051100
Page i of 2

STORM EVENT CHARACTERISTICS:
Date 5/3/2010 0.25
Total Event Precipitation (inches):
Event Duration (hours): 4
(if more than one storm event was sampled)
Date
Total Event Precipitation (inches):
Event Duration (hours):
Mail Original and one copy to:
Division of Water Quality
Attn: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
"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 faIse information,
including he possibility of fi es and imprisonment for knowing violations."
Xf
(Signature of Permittee) (Date)
Form SWU-246-051100
Page 2 of 2

OSC enve, &
9 Y9 �a LC ]So
"Practical Engrneet ng &
Enwrotm ental Solutions"
2050 Northpoint Drive • Suite A • Winston-Salem, NC 27106
Phone: [phone] • Fax: [phone]
e-mail: [e-mail]
April 16, 2009
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Attention Central Files t
1617 Mail Service Center
Raleigh, NC 27699-1617
RECEIVED !
N.C. beat. of ENFt
MAY 18 2M
Winston-Salem
Regional Office
Reference: 2009 Stormwater Discharge Monitoring Report for LenoxlWinston-Salem; NPDES
Certificate of Coverage # NCG030200.
Stormwater Group:
Geoscience & Technology, P.A. (GeoSci), on behalf of Lenox/Winston-Salem (Lenox), is pleased
to submit the enclosed annual stormwater monitoring data for the above -mentioned facility for
2009, pursuant to general stormwater certificate of coverage #NCG030200. Lenox is located at
1690 Lowery Street, Winston-Salem, NC. The Environmental Manager at Lenox is Kent Leonard
(336.777.8600).
Enclosed please find the following documents:
I. Stormwater Event Runoff Calculations (Table 1);
2. Laboratory Analytical Results and Chain of Custody form;
3. Stormwater Discharge Outfall (SDO) Qualitative Monitoring Report (SWU-242-101599), and;
4. Stormwater Discharge Outfall (SDO) Monitoring Report (SWU-246-051100).
Peter H. DeVries, Project Geologist, with GeoSci, performed the stormwater sample collection and
prepared the Qualitative and Quantitative Monitoring Reports. The storm event reported herein
occurred on Wednesday, March 25, 2009 through Thursday, March 26, 2009, during which a total
of 0.6-inches of rain was measured in an onsite rain gauge. The storm event started at
approximately 1130 hrs on the morning of March 251h and ended at approximately 1800 hrs on
March 261h. Rainfall was light at the beginning, relatively heavy between 1330 and 1430 on March

25`h. Very light rainfall continued intermittently through the evening of the 26`h and the morning of
the 27"; however, no additional rainfall was observed in the onsite rain gauge after 1800 on March
26'h.
A stormwater sample was collected at 1400 hrs on March 25, 2009; the rain gauge indicated 0.3-
inches at that time. Runoff began at approximately 1330. The previous storm event ended on
Thursday, March 19, 2009, just under 6 days or approximately 144 hours prior to the sampled
event. Rainfall for the previous event totaled approximately 0.1 inches, according to rainfall records
for the Piedmont Triad Regional Airport.
The attached Table I summarizes the historical pervious/impervious and drainage areas for the
designated outfall. Runoff calculations for the March 2009 event are also documented in Table I
The calculations indicate a total runoff of 25,004 gallons (0.025 MG) through outfal1003.
Please call either Peter H. DeVries or Alex McGilvary at 336.896.1300 if you have any questions.
Sincerely,
GEO IENCE & TECHNOLOGY, P.A.
ti
Peter H. DeVries
Project Geologist a�-0' ,X+ CARU(�,y
$E40 %'•
OL
M. Alex McGilvary, P.G.''.-A'••..,.,.,.•��,
Senior Geologist
cc w/ attachments:
Kent Leonard
Lenox/Winston-Salem.
1.690 Lowery Street
Winston-Salem, NC 27101
Andrew K. Allen
Senior Stormwater Engineering "Technician
City of Winston-Salem
P.O Box 2511
Winston-Salem, NC, NC 27102
Steve W. Tedder
Surface Water Protection Supervisor
Division of Water Quality
Winston Salem Region
North Carolina Department of Environment and Natural Resources
585 Waughtown Street
Winston-Salem, NC 27107

s�iti,..ae-:..J7:
.� � +
�?
4 'a
- �
- �
'J/;, F i
.F �, �ihk hnn v� Mr' `r.

Lenox/Winston-Salem
Table 1 : 2009 Stormwater Event Calculations
Year
Building Area (W)
Park Lot (fe)
Grass Area (fO)
Total Impervious
Area (ft2)
Total Pervious
Area (ft)
O
Drainage
Area (fe)
%
Impervious
Area
1997
18,228.00
24,993.00
54,491.00
43,221.00
54,491.00
97,712.00
44.23%
1998/001 1
26,068.00
0,00
32,138.00
26,068A0
32,138.00
58,206.00
44.79%
1998/002
0.00
18,931.50
20,574.50
18,931.50
20,574.50
39,506.00
47.92%
2004/003
26,068.00
18,931.50
52,712.50
44,999.50
52,712.50
97,712.00
46.05%
2005/003
26,068.00
18,931.50
52,712.50
44,999.50
52,712.50
97,712.00
46.05%
2006/003
26,068.00
18,931.50
52,712.50
44,999.50
52,712.50
97,712.00
46.05%
2007/003
26,068.00
18,931.50
52,712,50
44,999.50
52,712.50
97,712.00
46.05%
2008/003
26,068.00
18,931.50
52,712.50
44,999.50
52,712.50
97,712.00
46.05%
1
2009/003
26,068.00
18,931.50
52,712.50
44,999.50
52,712,50
97,712.00
46.05%
Runoff Coefficient (ROC), pervious: 0.5
Runoff Coefficient (ROC), impervious: 0.9
Total Runoff (gallons) for rainfall event = event rainfall (feet) X {lpervious area (ft) X runoff coeff) +
[impervious area (ft) X runoff coeff]} X 7.48 gal/ft3
Discharge 003: Storm Event 3/25/09
Total Event Rainfall (in): 0.6 - 12 in/ft = 0.05 Feet
Total Pervious Area (ft): 52,712.50 X ROC = 26,356.25
Total Impervious Area (ft): 44,999.50 X ROC = 40,499.55
Total Event Runoff (fe): 3,342.79
Total Event Runoff (gal): 25,004 MG 0.025004069
4/15/09

RESEARCh & ANAL TICA[
LAbORATO&S, INC.
Analytical/Process Consultations
Geoscience &. Technology
2050 Northpoint Drive
Winston-Salem, NC 27106
Attn: Peter DeVries
Date Sample Collected
Date Sample Received
Date Sample Analyzed
Dale of. Report
Analyses Performed by
Lab Sample Number
641931
Parameter Storet # Results
TSS
Oil & Grease (00556)
Lead,Tot (01.051)
PH
(00 400)
Clients Sample Source
Number
Time Collected Mrs)
5.0 mg/1
<5.0 mg/1
<0 . 005
Swan;
1.400
Std on i=
a0.140%tti11 11"0#
cd
tea= o:cn
NC#i34 z•
V
lb� `rid AWP%
03/25/09
03/25/09
03/25/09
04/09/09
YJ -IA -JC -TP
P.O. Box 473 • 106 Short Street • Kernersville, North Carolina 27264 - 336-996-2641 • Fax [phone]
www.randalabs.com

RESEARCIi & ANAlyTiCAI
LABORATORIES, INC.
Analytical / Process Consultations
Phone [phone]
:)MPANY - I JOB
reo IL�r(-9 4' h a e ,
TREETADDRESS r 1 P O
Q a 1
-TY'STATIE, ZIP �emtic 6 6
DNTACY PHONE
)es� 1-� . 11 r,�5 S9��
�7�-I. o a
E- / ,2-/
JECT
PLEB ME (PLEASE INS
P%L SIG r)E rpm
CHAIN OF CUSTODY RECORD
I WATER I WASTEWATER 1 Misc. I
\Qm a O4F A�
SAMPLE NUMBER
(LAB 115E ONLY)
DATE
TIME COUP GRAB
TEM RES
.0 CI
tr ace+[ MMPL.E
pra j MA?NXzy
'-' v c c Q• •, Y a a
SAMPLE LOCATION I I.D. x �y ti ry`� ry� �v �v �" �" �`m REQUESTED ANALYSIS
1 ao
5 00-3
lea
i QUISH>=D � Y
D TEfFI E RECEIVEb $Y
31 �
ARKS:
SAMPLE TEMPERATURE AT RECEIPT' - °C,�
ELINQUISHED BY
C)TEITMME RECEIVED BY

Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Permit No.: N/CIa10 I3_IQ/Q/Qf 0 / or Certificate of Coverage No.. NICIG/D-/2 0 /2 /0/0 I
Facility Name: Lenox Winston-Salem
County: Forsyth Phone No. 336,896,1300
Inspector: Peter H. DeVrieS
Date of Inspection: 325/09
By is signature, c fy tha this report is accurate and
Signature of Permittee or Designee)
1. Outfall Description
-ompl%%ete to the best of my knowledge:
Outfall No. 003 Structure (pipe, ditch, etc.) _pipe
Receiving Stream: Brushy Fork Creek _
Describe the industrial activities that occur within the outfall drainage area:
Metal plating and assembly of various lock components.
2. Color
Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint (light, medium,
dark) as descriptors: _light yellowish -brown
3. Odor
Describe any distinct odors that the discharge may have (i.e., smells strongly of oil, weak chlorine odor,
etc.) no odor
4. Clarity
Choose the number which best describes the clarity of the discharge where 1 is clear and 10 is very
cloudy:
A 2 3 4 5 5 7 8 9 10 3 /
Page I
2 5
SW U-242-101599

5. Floating Solids
Choose the number which best describes the amount of floating solids in the stormwater discharge where
l is no solids and 10 is the surface covered with floating solids:
1 X 3 4 5 6 7 8 9 10
6. Suspended Solids
Choose the number which best describes the amount of suspended solids in the stormwater discharge
where 1 is no solids and 10 is extremely muddy:
X 3 4 5 6 7 8 9 10
7. Foam
Is there any foam in the stormwater discharge? Yes No X
8. Oil Sheen
Is there an oil sheen in the stormwater discharge? Yes No X
9. Other Obvious Indicators of stormwater Pollution
List and describe No other obvious indicators of stormwater pollution.
Note: Low clarity, high solids, and/or the presence of foam or oil sheen maybe indicative of pollutant
exposure. These conditions may warrant further investigation.
Page 2
S W U-242-101599

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number- NC 030000 or
Certificate of Coverage Number: NCG 0302000
FACILITY NAME Lenox/Winston-Salem
PERSON COLLECTING SAMPLE(S) Peter H. DeVries
CERTIFIED LABORATORY(S) R & A Laboratories Lab # 34
Lab #L_
Part A: Specific Monitoring Requirements
SAMPLES COLLECTED DURING CALENDAR YEAR: 2009
(This Monitoring report Sb2ll be received by the Division no later than 30 days from
the date the facility receives the sampling results from the laboratory.)
COLWTY Fors
(9]GNATUkk OF PERMITTEE OR DESIGNEE)
By this signature, I certify that this report is accurate
complete to the best of my knowledge.
�Zou-� fall
te
amIl
le If P
�c
.500504PIM
I W--'.-Q053Q-'
la f.quq:
-r";:
no'..tal 5uspm,
RU AI
R
r.4
:ill_- 4
-ifiWdWf.
-IMQN-A
watffiDL'' gv
-1 --Hale,
wsugX
7P. CVe�.!ff - '.1l
-93
003
3/25/09
0.0250
5.0
6.21
<0.005
<5.0
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? _ yes )(-no
(if yes, complete Part B)
Part 8: Vehicle Maintenance Activity Monitoring Requirements
r
'No.
Sample
IM -'SUS
ifiUCC
USSO
il
K12
P
;MG, :.,!,r
ffi'PA: 1
To
41
Mo
Form SWU-246-051 100
Page 1 of 2

r
ti-
STORM EVENT CHARACTERISTICS:
Date 3/25/09
Total Event Precipitation (inches): 0.6
Event Duration (hours): 3-Q
(if more than one storm event was sampled)
Date
Total Event .Precipitation (inches):
Event Duration (hours):
Mail Original and one copy to:
Division of Water Quality
Attn: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
"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."
7 c)
(Signature of Permittee) ( ke}
Forth SWU-246-051100
Page 2 of 2

--I I ence &
D
jeosc*
"Practical Engineering car
Enviivmnaual klidians"
2050 Northpoint Drive • Suite A • Winston-Salem, NC 27106
Phone: [phone] • Fax: [phone]
e-mail: [e-mail]
July 17, 2008
North Carolina Department of Environment and Natural Resources
Water Quality Section
Stormwater Enforcement Group
P.O. Box 29535
Raleigh, NC 27626-0535
RECEIVED
N.C. Dent. of
!UL 2 4 20
winstoi _
Regioi a:
Reference: 2008 Stormwater Discharge Monitoring Report for Lenox/Winston-Salem; NPDES
Certificate of Coverage # NCG030200.
Stormwater Group:
Geoscience & Technology, P.A. (GeoSci), on behalf of isenox/Winston-Salem (Lenox), is pleased
to submit the enclosed annual stormwater monitoring data for the above -mentioned facility for
2008, pursuant to general stormwater certificate of coverage #NCG030200. Lenox is located at
1690 Lowery Street, Winston-Salem, NC. The Environmental Manager at Lenox is Kent Leonard
(336.777.8600).
Enclosed please find the following documents:
1. Stormwater Discharge Outfall (SDO) Qualitative Monitoring Report (SWU-242-101599);
2. Stormwater Discharge Outfall (SDO) Quantitative Monitoring Report (SWU-246-051100);
3. Laboratory Analytical Results and Chain of Custody form, and;
4. Stormwater Event Runoff Calculations (Table 1);
Peter H. DeVries, Project Geologist, with GeoSci, performed the stormwater sample collection and
prepared the Qualitative and Quantitative Monitoring Reports. The storm event reported herein
occurred on Thursday, June 26, 2008, during which a total of 0.25-inches of rain was measured in
an onsite rain gauge. The storm event started at approximately 1740 hrs on the evening of June 26th
and ended at approximately 1830 hrs on the same day. Rainfall was very heavy for the duration of
the event. A stormwater sample was collected at 1850 hrs on June 26, 2008; the rain gauge indicated

0.25-inches at that time. The previous storm event occurred on Sunday, June 22, 2008, just under 4
days or approximately 84 hours prior to the sampled event. Rainfall for the previous event totaled
approximately 0.61 inches, according to rainfall records for the Piedmont Triad Regional Airport.
Please note that the sampled storm event was typical of recent storms in that it was very localized.
GeoSci attempted to sample a previous storm event on June 12, 2008 that totaled over 0.25 inches
on the north side of Winston-Salem; however, no precipitation was recorded during the same event
at the Lenox site. Several other attempts to sample stormwater occurred in April and May; however,
these events either occurred in the late evening hours during the workweek or on weekends when
personnel were not available to sample.
The attached Table 1 summarizes the historical pervious/impervious and drainage areas for the
designated outfall. Runoff calculations for the June 2008 event are also documented in Table 1. The
calculations indicate a total runoff of 10,418 gallons (0.0104 MG) through outfall 003.
Please call either Peter H. DeVries or Alex McGilvary at 336.896.1300 if you have any questions.
Sincerely,
GEOSCIENCE & TECHNOLOGY, P.A.
c�
Peter H. DeVries
Project Geologist
Alex McGilvary, P.G
Senior Geologist
cc w/ attachments:
Ito 1
CAR
1w� �,�• ��s. a•e•• � Y� pw,v✓
• SE AL
1073
9 " .COL OG
Kent Leonard Andrew K. Allen
Lenox/Winston-Salem. Senior Stormwater Engineering Technician
1690 Lowery Street City of Winston-Salem
Winston-Salem, NC 27101 P.O Box 2511
Winston-Salem, NC, NC 27102
Steve W. Tedder
Surface Water Protection Supervisor
Division of Water Quality
Winston Salem Region
North Carolina Department of Environment and Natural Resources
585 Waughtown Street
Winston-Salem, NC, NC 27107

Lenoxf Winston-Salem
Table 1: 2008 Stormwater Event Calculations
Year
Building Area V
Park Lot (ftz)
Grass Area (fe)
Total Impervious
Area (fe)
Total Pervious
Area (ft�)
°
Drainage
Area (ft2)
%
Impervious
Area
1997
18,228.00
24,993.00
54,491.00
43,221.00
54,491.00
97,712.00
44.23%
1998/001
26,068,00
0.00
32,138.00
26,068.00
32,138.00
58,206.00
44.79%
19981002
0.00
18,931.50
20,574.50
18,931.50
20,574.50
39,506,00
47.92%
2004/003
26,068.00
18,931.50
52,712.50
44,999.50
52,712.50
97,712.00
46.05%
2005/003
1 26,068.00
18,931.50
52,712.50
44,999.50
52,712.50
97,712.00
46.05%
2006/003
26,068.00
18,931.50
1 52,712.50
1 44,999.50
1 52,712.50
1 97,712.00
1 46.05%
2007/003
26,068.00
18,931.50
52,712.50
44,999.50
52,712.50
97,712,00
46.05%
2008/003
26,068.00
18,931.50
52,712.50
44,999.50
52,712.50
1 97,712,00
1 46.05%
Runoff Coefficient (ROC), pervious: 0.5
Runoff Coefficient (ROC), impervious: 0.9
Total Runoff (gallons) for rainfall event = event rainfall (feet) X ([pervious area (W) X runoff coef] +
Iimpervious area (W) X runoff coeff]} X 7.48 gal/ft3
Discharge 003: Storm Event 6/26/08
Total Event Rainfall (in): 0.25 _ 12 in/ft = 0.020833333 Feet
Total Pervious Area (fe): 52,712,50 X ROC = 26,356,25
Total Impervious Area (fO): 44,999.50 X ROC = 40,499.55
Total Event Runoff (fe):
Total Event Runoff (gal):
1,392.83
10,418
7/ 17/08

Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Permit No.: NIG-alO I�10 /QIQI a l or Certificate of Coverage No.: N/GG/DI3 /Q 12/ Q /
Facility Name: Lenox/Winston-Salem
County: Forsldh Phone No. 336,896,1300
Inspector: Peter H. DeVries
Date of Inspection: 6126/08
By t" signature, I car)Athat this report js accurate and complete to the best of my knowledge:
ignature of Permittee or Designee)
1. Outfall Description
Outfall No. 003 Structure (pipe, ditch, etc.) pipe
Receiving Stream: Brushy Fork Creek___ _
Describe the industrial activities that occur within the outfall drainage area:
Metal plating and assembly of various lock components. _
2. Color
Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint (1 ight, medium,
dark) as descriptors: light yellowish -brown
3. Odor
Describe any distinct odors that the discharge may have (i.e., smells strongly of oil, weak chlorine odor,
etc.) no odor
4. Clarity
Choose the number which best describes the clarity of the discharge where 1 is clear and 10 is very
cloudy:
2 3 4 5 6 7 8 9 10 6
Page i
SNVU-242-101599

5. Floating Solids
Choose the number which best describes the amount of floating solids in the stormwater discharge where
is no solids and 10 is the surface covered with floating solids:
X 2 3 4 5 6 7 8 9 10
6. Suspended Solids
Choose the number which best describes the amount of suspended solids in the stormwater discharge
where 1 is no solids and 10 is extremely muddy:
1 X 3 4 5 6 7 8 9 10
7. Foam
Is there any foam in the stormwater discharge? Yes No X
8. Oil Sheen
Is there an oil sheen in the stormwater discharge? Yes X No
9. Other Obvious Indicators of Stormwater Pollution
List and describe No other obvious indicators of stormwater pollution.
Note: Low clarity, high solids, and/or the presence of foam or oil sheen may be indicative of pollutant
exposure. These conditions may warrant further investigation.
Page 2
SWU-242-101599

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number: NC 030000 or
Certificate of Coverage Number: NCG 0302000
FACILITY NAME Lenox/Winston-Salem
PERSON COLLECTING SAMPLE(S) Peter H, DeVries
CERTIFIED LABORATORY(S) R& A Laboratories Lab #34
Lab #
Part A: Specific Monitoring Requirements
SAMPLES COLLECTED DURING CALENDAR YEAR: 2008
(This monitoring report shall be received by the Division no later than 30 days from
the date the facility receives the samppling results from the laboratory.)
COUNTY Forsvitll
O ENO
y
(SIGNATURE OF PERMITTEI OR I NE )
By this signature, i certify that this report is accurate
complete to the best of my knowledge.
OUtfall
1- -
;No 11, ,
x-
Date , �>
t
- .r.�€+�-.:-i:.
:Sample.
1. I' _.":...; .I I.CI YI��.:; ].
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50050:��:
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� Y�-,..',.y..�--r��—,.._
.� . ..[,...
N,1
�•.. .,,r:i?sl
003
6/26/08
0.0104
<5.0
4.54
<0.0
<5.0
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? —yes X-no
(if yes, complete Part B)
Part B: Vehicle Maintenance Activity Monitoring Requirements
(Outfall- s
Dated'
r50050Aff
i00556 '-'i
r00530r ,M
:0040(i AM
•Y=� � 3"�"'--�yx•,
No , L�
i +s'�Y- �-�- - -
Sam Ie Ir =�+ `
- r -- i �r
Total F1ow�
_ r� �
,
FOiI'and
er t'" Ki1x
Grease- .�
� t� �a
Total . �,
eS�uspended�
la•. I I 'I�
Hera
p 7 I?
F'G6:'
�- �•
'-
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j t4Sh lili• '7.,'�
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�Oil,usage
11,-
s
?7
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SUmPM
Form SWU-246-051100
Page I of 2

STORM EVENT CHARACTERISTICS:
Date 6/26/08
Total Event Precipitation (inches): 0.25
Event Duration (hours): 0.5
(if more than one storm event was sampled)
Date
Total Event Precipitation (inches):
Event Duration (hours):
Mail Original and one copy to:
Division of Water Quality
Attn: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
"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 fine and imprisonment for knowing violations."
(Signature of Perruittee) (Da )
Form SWU-246-051100
Page 2 of 2

RESEARCh & ANA[yTICA1
LABORATORIES, INC.
Analytical/Process Consultations
Goossienco & Ter.hrology
2050 Nor.thpoi.nt Drive
Winston-Salem, NC 27106
Attn: Peter DeVries
Date Sample Collected
Date Sample Received
Date Sample Analyzed
Date of Report
Awl.yses Performed by
Lab Sample Number
62t153,]
Parameter ScortL ;; ke nul rs
TSS
00 jW
Oil & Grease NOME
PH (00400,
Lead,Tot (01051)
Clients Sample. NoErce
Number
Time Collected (Hrs)
ti 5 . 0. my/1
4M Std. Units
<0.305 mg/l
:."T&Y.cdW.-. ER OUTCALL
LENOX INDUSTRIAL TOO
18SI
AiaACyT`'�,��
4� �� y Cyr• •� �'i
1 � :�2� �A•iCP �
c �� 'o.cr,�
NC434
's 4
s
fD'AW,\;
06/26/0-8
06/2V/08
07/08/08
YJ ..rn -TP -JC
P 0. Box 473 • 106 Short Street • Kernersville, North Carolina 27284 • 336-996-2841 • Fax [phone]
www.randalabs.com

RESEARCh & ANA1yTICA1
LAbORATORlES, INC.
Analytical / Process Consultations
Phone [phone]
CHAIN OF CUSTODY RECORD
WATER I WASTEWATER I Misc.
•
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J.:= Lam.
WTI, 711
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