NCG030271_MONITORING INFO_20100125

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
Iv CC
DOC TYPE
❑HISTORICAL FILE
CB<'MONITORING REPORTS
DOC DATE
p �a ti 001 QS
YYYYMMDD

STORMWATER DL__LARGE OUTFALL (SDO)
'MONITORING REPORT.
GENERAL PERMIT NO. NCG030000
CERTIFICATE OF COVERAGE NO. NCG03
FACILITY NAME
PERSON COLLECTING SAMPLES -74—,­7 7�o
CERTIFIED LABORATORY
01 . I Lkb #
Part A: Specific Monitoring Requirements
SAMPLES COLLECTED DURING CALENDAR YEAR:
(This monitoring report Is due atthe Division no later than 30 days from
,the date the facility receives the ' sampling results from the laboratory.)
COUNTY
-PHONE NO.
PLEASE SIGN ON THE REVERSE 4
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No tc: It 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 Llho
(if yes, complete Part 13)
Part B.- Vehicle Maintenance. Activity Monitoring Requirements
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Note: If you report a sampled value in excess of the benchmark value, or outside the benchmark range lot ph, you must implement "bier I or Tier 2 responses.
See General Permit text.
STORM EVENT CHARACTERISTICS: Mail Original and one copy to:
Division of Water Quality
Date 4ZZS & (first event sampled) Attn: DWQ Central Files
Total lEvent Precipitation (inches): 1617 Mail Service Center
Raleigh, North Carolina 27699LI617.
Date (list each additional event sampled this reporting period, and rainfall amount)
Total Event Precipitation (inches):
a
SWU-245-102107
age 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'Eflluent Guidelines for the facility subject
to the requirement to sample (for•metal finishing' use the definition as fo4 nd, in 40 �CFR 433.`11; for seriiiconauotor inanufaeturc use #lie'defuuiidn $s:found in 40 CFR 469.12; for
electronic crystal manufacture use the';defmition-' as found M 40 CFA 469-22; and for cathode ray tube manufacture use the definitioa•found in 40'CFR 469.31). "
Facilities that incorporate a solvent management plan into the Stormwater Pollution Prevention Plan may request -that DWQ waive monitoring of total toxic organics. 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 allowed such a 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 knowledgc 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 ti
2111110
(Signature) (Da )
"I certify, under penalty of law, that this document and all attachments were prepared tinder. 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. lam aware that there are significant penalties for submitting false information, including
the possibility of fines and imprisonment for knowing violations."
(Signature of Permittee) (Date)
r S)k z45-102107

STORMWATER Di____iARGE OUTFALL (SDO)
. MONITORING REPORT.
GENERAL PERMIT NO. NCG030000 SAMPLES COLLECTED DURING CALENDAR YEAR: Flo
CERTIFICATE OF COVERAGE NO. NCG03 0 2 71 (This monitoring report is due at the Division no later than 30 days from
the date the facility receives the'vampling results from the laboratory.)
FACILITYNAME COUNTY j024-�
PERSON COLLECTING SAMPLES. PHONE NO. VV-) 6 6/
CERTIFIED LA130RATORY eZz:�2 L kj,-� j- Lab # Z 2
Lab # PLEASE SIGN ON THE REVERSE
Part A: Specific Monitoring Requirements
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Note: It you repoirt 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 --no---
(if yes, complete Part B)
Pnrf'R-- Vehirlp Mnintpnnnep Artivift Mnnitnrina RPnidrPmPnt.,q
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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;
Date event sampled)
- fi
rst
tio
Tot2li've-n Precirp'lla n (inches):
Date (list each additional event sampled this reporting period, and rainfall amount)
Total Event Precipitation (inches):
Mail Original and one copy to.,
Division of Wat& Quality
Attn: DWQ Central Files
1617 Mail Service Center - -
Raleigh, North Carolina 27699-1617
SWU-245-102107
Page 1 of 2

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-meial finishing' use the.iiefinit as foµnd,in 44 CF13 433.11; for semiconductor iiii"c'ture:iii'd.11e'definitidn a&found in 40 CFR 469.12; for
electronic crystal manufacture use the'°definitionas foundin 40 CFR 469.22; and for cathode ray tube manufactrue use the definition'found in 40'CFR 469.3l). '
Facilities that incorporate a solvent management plan into the Stormwater Pollution Prevention Plan may request that DWQ waive monitoring of total toxic organics. 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 allowed such a 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 (170), 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 stotmwater
runoff has occurred since filing the last discharge monitoring report. I fiuther 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 riot title
2 1 AD -
(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 besi 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.",
2,11
(Signature 'of Permittee) ate)
S WU-245-102107

o Page 1 of 2
URD"TEST
Laboratory Report
Lab Location 'R' Lab Location 'C' Lab Location 'W'
NCANW Cert.#: 067 NCIDW Cert#: 37711 NCM/W Cert.#: 103 NC1DW CerL#: 37733 NCAJVW Cert#: 075 NC1DW Cert.#: 37721
6701 Conference Dr, Raleigh, NC 27007 6300 Ramada Dr, Suite C2, Clemmons, NC 27012 6624 Gordon Rd, Unit G, Wilmington, NC 28411
Ph: [phone] Fax: [phone] Ph: [phone] Fax: [phone] Ph: [phone] Fax: [phone]
Project No.: Report Date: 212/2010
Project ID: STORMWATER Date Received: 1126/2010
— Prepared for —
TOM THOMPSON
CHAMPION INDUSTRIES Work Order#: 1001-02461
3765 CHAMPION BOULEVARD Gust. Code: CH1556
WINSTON-SALEM, NC 27105 Cust. P.O.#:
No. Sample ID
Date Sampled
Time Sampled Matrix
Sample Type
Condition
001 OUTFALL #1
1/2612010
7:50 SW
Grab
4 +1- 2 deg C
Analyzed
Test Performed
Method
Results
Lab Loc ate
Time Qualifier
Lead
EPA 200.8
<0.005 mg/L
R 1127/10
14:12
Total Suspended Solids
SM 2540D
6 mg1L
C 1/29110
10:30
Oil 8 Grease
EPA 1664A
7.8 mg1L
R 1127110
8:00
No. Sample ID
Date Sampled
Time Sampled Matrix
Sample Type
Condition
002 OUTFALL #2
1/25/2010
8:30 SW
Grab
4 +1- 2 deg C
Anal ed
Test Performed
Method
Results
Lab Loc Datr
Time Qualifier
Lead
EPA 200.8
<0.005 mgJL
R 1127110
14:12
Total Suspended Solids
SM 2540D
58 mg1L
C 1129/10
10:30
Oil & Grease
EPA 1664A
6.8 mg1L
R 1/27110
8:00
No. Sample ID
Date Sampled
Time Sampled Matrix
Sample Type
Condition
003 OUTFALL #5
1/2512010
9:05 SW
Grab
4 +1- 2 deg C
Analyzed
--
Test Performed
Method
Results
Lab Loc Datd "
Time Qualifier
Lead
EPA 200.8
0.007 mg1L
R 1127/10
14:12
Total Suspended Solids
SM 2540D
6 mg1L
C 1129110
10:30
Oil & Grease
EPA 1664A
6.0 mg1L
R 1/27110
8:00
No. Sample 1D
Date Sampled
Time Sampled Matrix
Sample Type
Condition
004 OUTFALL #6
112512010
9:40 - SW
Grab
4 +1- 2 deg C
Test Performed
Method
Results
Lab Loc Dated
Time Qualifier
Lead
EPA 200.8
0.006 mgtL
R 1/27110
14:12
Total Suspended Solids
SM 2540D
2 mg1L
C 1129110 .10:30
Oil & Grease
EPA 1664A
6.3 mg1L
R 1127110
8:00

O
�G TEST
6701 Conference Drive. Page 2 of 2
Raleigh, NC 27607
Telephone: [phone]
Telephone: [phone] Fax: [phone] NCNVW Cert. #: 067
Fax: [phone] NC1DW Cert. #: 37731
Laboratory Report
Work Order #: 1001-02461
No. Sample ID
005 OUTFALL #7
Date Sampled
1/25/2010
Time Sampled Matrix
10:10 SW
Sample Type
Grab
Condition
4 +1- 2 deg C
Test Performed
Method
Results
Lab Lac
f�nal ed
at Time Qualifier
Lead
Total Suspended Solids
Oil & Grease
EPA 200.8
SM 2540D
EPA 1664A
a0.005 mg1L
54 mg1L
6.0 mg1L
R
C
R
1127110
1/29110
1127110
14.12
10.30
8:00
No. Sample ID
006 OUTFALL #8
Date Sampled
1125/2010
Time Sampled Matrix
10:40 SW
Sample Type
Grab
Condition
4 +1- 2 deg C
Test Performed
Method
Results
Lab Loc
&nal ed
ate
Time Qualifier
Lead
Total Suspended Solids
Oil 8 Grease
EPA 200.8
SM 2540D
EPA 1664A
c0.005 mglL
48 mg[L
8.8 m91L
R
C
R
1127/10
1129110
1127110
14:12
10:30
8:00
Reviewed by:
Xt
for Tritest, Inc.

- T R i iE ST Chain
of Custody
❑ 6701 Conference Drive, Raleigh, NC 27607
ph: [phone], tax: [phone]
NCWW Cert#67, NCDW Cert#37731
❑ 6624 Gordon Road, Unit G, Wilmington, NC 28411
ph: [phone], fax: [phone]
NCWW Cert#75, NCDW Cert#37721
6300 Ramada Dr., suite C2, Clemmons, NC 27012
ph: [phone], fax: [phone]-,.
NCWW Cert#1D3, NCDW Cert#37733
Report Results To: Bill To:
iIfS7r
Company: `� l? .�1?r;;�c1 N1�✓c,`rJ�'�
Address: ` ` � � ;j ' � 4 � f,;;..� C � v.:, t'r�t f� fix, i
If 7 j �' 1 i� �? 1 r' sty %L, l.� ��' _•C i.•-.�J r c., . G.' +...? '� i'� l" /V �`-' ::
Phone:.:r
Fax: r, A
Sampled by (signature): =7272,q
Tritest W.Q. #
Project Reference:
Project Number:
Purchase Order #:
O Standard Report Delivery
❑ Rush Report Delivery (w/surcharge)
"Rush projects are subject to prior approval by
the laboratory
Requested Due Date:
Sample Description
u
a _ t
cors,vi�re.,
Grab-
1Start Date-:-
_ End Date '!
° Matrix.
ww,rnk,sv
cw sa,e:c:
Analyses Requested _ ' = w�
� {
-r ,at�� ' Ai�i f
Tritest
Samplep
r Startiime,
=End Time+:;
�p
J
/7
C. �
-���, sue, �:, � , , � �.- ,
u_
yJ
_
St✓J
c �, f l/ U` 6
0 CGS
1 .30
�J lllfff
r `
_
F'`,
r
rf' �-� '+�
�'
- Z.•S �b
% - �5--/J
C•G.�
�
i' � J 1 �5 , t� { �
IT
� � � 1
� �, Q
=t:=
/� 2�
/G' i �
.tom
Lt�
Reli� ed by (signature)
y, 77.7 i �� %i+-r=rid
Received by (signature)
�; ;J -" ?
Date
Time
'T
Relinquished by (signature)
Received by (signature)
Date
Time
Relinquished by (signature)
deceived by (signature)
Date
Time
Receipt Conditions (Lab Use Only)
❑ 4t2°C ❑ Temp: °C
Res. Chlorine:
❑ Absent - ❑ Present ❑ n/a
Acid preserv. <2?
O Yes ❑ No ❑ n/a
Base preserv. >12?
0 Yes Cl No 0 n/a

€ A7
Y
Stormwater Discharge' Outfau (SDO)
QuaUtative Monitoring Report
Permit No.: NIC/(S-V& 3If—I) or Certificate of Coverage No.: I�IICIGI�I I C)1 �1�I! 1
Facility Name: �' q io-r� r.1�[rS 1 2f � -ZTtijq,
County_'. r--LO t2S T Fhone No. • C33O
Inspector?
Date of Inspection:
By this ignature, I certify that this report's accurate and complete to the best of my knowledge:
-(Signature of Perrnittee.or Designee)
1. Ou`fau -Description
Dutfall No,- S, &LcttrreQPiPI-
-DcscLibe,, ditch, etc.)
Receiving Stream: ZC4K, the industrial activities that occur within the outfall drainage area:
2. Color
Describe the color of the discharge using basic colors (red., brown, blue, etc-) and:tint (light, medium
dark) as descriptors:
3. Odor ;
Describe arty distinct odors that the discharge may have (Lt., smells strongly of oil, ti�(-,ak chlorine odor,
etc.) D�
Clarity
Cli.00se the number 'wiaich best describes the clarity of the discharge where l is clear and 10 is very . .
cloudy:
1 2 .3 �..". 5 6 7. .8 4 10
Page 1',
swi3-242-020705...

Stoli mw ter Discharge Ouifal (SD®)'
Qualitative Monitoring Report
Permit No.: NIC4±/A.�_3 I D Id IC? /0 . or Certificate of Coverage No.: NLCIGI, f l Q/ 21? 1'
Facility Name: C'gt��io �F.Te7uSl/ L�•iG,
County O Phone No C�3S
nspector: d
Date of Inspection:
By this's' a. ure, I certify tl.t thus report is accurate and complete to the best of my-lmowledge:
(5ignatureofPermiS�ee.orDesYgnee) .. .
1. OutfaH Description
Qutfall No. Z. Structure gi e ditch, etc.)
Receiving Stream: GE/T/C /�_ X
Describe the industrial activities that occur within the outfal. drainage area:
2. Colar
Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint (light, mcdiuin,
dark) as descriptors: LL
3. Odor
Describe any distinct odors that the discharge may have (Lt., smells strongly of oil, Wi e� chlorine odor,
etc.) fvQ�

} Ax
Stormwater Discharge Oi tfaH (SDO)
qualitative Monitoring Repgrt
Permit No.: !QI or Certificate of Coverage No.: NIGGIQ 3-LQ) 2l2-I!
Facility Name: 0njn1r7C1S~!� L..�G,
County--,.re9 �QSc�T _phone No'.��o,
Inspector. -
Date of inspection: /-- Z S-- ?_O U
By this i e, I certify that this report is accurate and complete to the best of my knowledge:
-(Signature of Pernuttee.or Designee)
L Oatfail Description
Dutfall No.- 'S Structure ipe ditch, etc.)
Receiving Stream Z6g/K 4ee1C . 4;Zee-AC
Describe the industrial activities that occur within the outfalk drainage area: +
� � C'E. e��Pa� 1s:� •^r,-�
2. Color
Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint (light, medium,
dark) as descriptors:
3. Odor .
Describe any distinct odors that the discharge may have (i.e., smells strongly of oil; weak chlorine odor,.'
etc.)

WET
Stormwate>r Discharge OdtfaH (SDO).
Qualitata've M6nita»g Report
Permit No.: NICI6:�Ij�ft31©I0 0 /Q/ or Certificate of Coverage No.: N CIG/ 13 dl �1�111
TacilityName:
Phon5NoCounty ,w'e_s 76 �
Inspector -Date of ) nspectioru - . ZS- Za / O
By this signature, I certify that this report is accurate and complete to the hest of my lmowledge:
/fir•-, . �.L,/o .-.-�s,v . - -
.(Signatum of Permittee.or Designee)
L O�tfall Description
OutfaII No: 1p Structure (pipe, ditcni1
Receiving Stream L-�aiC _Forte .-_-
�: describe the ir�dustri�l�alctivities that occur within the outfail drainage area:
2. Color ;
Describe the color of the discharge using basic colors (red, brown, blue, etc.) and brit (light, mediuri, y
dark) as descriptors: , ?'7 ed I. u a,,j J
3. Odor .
Describe any distinct odors that the discharb may hEve "(i.e., srnells strongly of oil.; weea chlorine odor,
etc.} br.f
4. Clarity
Ciiabse the number`which best describes the clarity of the discha,.be where I.is,clear and IQ is very
cloudy: :.
2.
6 7• 8" 9 10.. ;
.. . - - . - - Page_ I� '. . - . � - - . • . .
I'. SWU7242-92.U705

A.T
St®rmwater Discharge Odtfall (SD®)
Qualitative Monitoring Report
Permit No.: NIClLlr�_/JAZ C I IL? IQl or Certificate of Coverage No.: ?�IIGGI�I I CAI IZI r 1
Facility Name: C 661-'71-:7i©.J
County: -. rj, P__S�T Phone No. ' CS3(4� (7
Inspector- ✓ !f©rr�S��
Date of Inspection: j ZS
By this sz Lure, I certify -that this report is accurate and complete to the hest of my lao�vlPdge:
. , • (Signature of Permittee, or Designee) .. _
L. Oatfall Description
Outfall No., '!Z Structuze 6T)iDditch, etc.)
Receiving $tmam LEV/c.
Describe the . ai activities that occur within the outfall drainage area:
��
r
2. -dolor'
Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint (light, medium,
dark) as ci_-scriptom C (`+e.¢
3. Odor .
Describe an distinct odors tY�at the discharge may Rave (i.e., smells strongly of ail; weak chlorine odor,
etc.) ' .
4: Clarity
Choose the number'whiah best describes the clarity of the discharge where I.is.clear and IO is very
cloudy:

.�1
Stormwater Discharge Outfall (SDO)-
'Quaffitative Monitoring Report
Permit No.: NICI&`I I, IO !cam Id /01 or Certificate of Coverage No.: &C CTI 13101217111-
Facility Name: 1- " +7 o.j-�Nr�ct
County: /�o ,'ESe,r7`6 Phone No.
�
In —
.spector. _ Lam_- : LO L-i�..CID I)
Date of inspection: Z, — Ze. V C)
By "gnatura, I certify that this report is accurate and complete to the best of my knowledge:
-(Signature of Permittee.or Designee)
1. Ontfail -Description
Qutf-O No. StructureED ditch., eto.)
�` Receiving Stream L'� iC �o l�� C 2ce/C _
Describe the industrial activities that occur within flit outfall drainage area:
/,r, , /Ci /'rr� a,• z
2. CoI6r
Describe the color of the discharge using basic colors (red, brown, blur, e!r-) and tint (light, median,
dark) as descriptors: �`,� PA 2_yz2� t- r rr : 62n,
3. Odor .
Describe any distinct odors that the discharge may have (i.e., smells strongly of oil, weak chlorine odor,
etc.)
4. Clarity