HomeMy WebLinkAboutNCG060205_MONITORING INFO_20190618STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT N0.
�V CCU CIQ Da 05
DOC TYPE
❑HISTORICAL FILE
�. MONITORING REPORTS
DOC DATE
❑ �b �� b �0 � O
WYYMMDD
STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Energy, Mineral and Land Resources General Permit No. NCG060000
Date submitted rp'/(]��
CERTIFICATE OF COVERAGE NO. NCG06
FACILITY NAME Ct/5 ty. /� -� ,s z� •S J,, c
COUNTY �ui {+►/mil
PERSON COLLECTING SAMPLES i
LABORATORY geStA-f t { [L- Lab Cert. ## NG 3q
RECEIVED
JUN 18 2019
GEIITF: Al_ FILES
DWR SECTION
Part A: Stormwater Benchmarks and Monitoring Results
SAMPLE COLLECTION YEAR �Ol q
SAMPLE PERIOD Jan -June [] July -Dec
or Monthly' (month)
DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
❑Zero -flow ❑Water Supply ❑SA
[ 0therSur-ore 4611 W Alc-
FACILITY ACTIVITIES INCLUDE (check all that apply):
❑ use/process meats ❑ use animal fats/byproducts
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Total event rainfall z, 2C- or [:]No discharge this period3
Outfall No.:
Date Sample
Collected, mo,/dd/yr
TSS,
"'mg/L
pH;
Standard units
COD
mg/C
Oil and Grease
mg/L ..Coloniesper100.m'
Fecal Coliform,
Enterococci,
olonieper 100 ml I
Benchmark
-
160 or 50'
Within 6.0 — 9.6
120
30
10001
5001
Parameter Code
-
C0530
00400
00340
00556
31616
61211
s
! a 3 r
<5
'7, 0
7
4�S
NtA
1 Only applies to facilities that use/process meats.
'The total precipitation must be recorded using data from an on -site rain gauge.
3 For sampling periods with no discharge at any outfalls. You must still submit this discharge monitoring report with a checkmark here.
'See General Permit text, Table 1, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
'Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new oil per month? ❑ yes [9"no
(if yes, complete Part B)
Permit Date: 11/l/2018-05/31/2021
SWU-249, Last Revised 11/5/2018
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new motor oil/month.
Outfall No.
Date Sample Collected
(mo/dd/yr)
24-hour rainfall amount,
Inchesz
New Motor, Oil or
Hydraulic Oil Usage .' '
Non -Polar O&G/Total
Petroleum Hydrocarbons
Total Suspended Solids
Benchmarks
-
-
15 mg/L
100 mg/L or 50 mg/L°
Parameter Code
-
46529
„' NC.0IL
00552
C0530
Footnotes from Part A also apply to Part B
*FOR PART A AND PART B MONITORING RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES ❑ NO
IF YES, HAVE YOU CONTACTED THE DEMLR REGIONAL OFFICE? YES ® NO
REGIONAL OFFICE CONTACT NAME:
Mail an original 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, NC 27699-1617
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED:
"l 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
4/AE�� 6-((- �
Date
Permit Date: 11/1/2018-05/31/2021
SWU-249, Last Revised 11/5/2018
Environmental
Quality
Stormwater Discharge Outfall (SDQ)
Qualitative Monitoring Report
For guidance on filling out this form, please visit hops://deq.nc.gov/about/divisions/energy-mineral-]and-resourcest
npdes-stormwater-gps
Permit No.: N_ICI Z I 161 0l pl ol0 / or Certificate of Coverage No.: NICIGI 1 10 1 1 pl
Facility Narne: �'✓s �^' >C^ ; �-•-s SM� — — —
County:
Inspector:
Date of Inspection: s-/;? 3119
Time of Inspection: � � ql� A
Total Event Precipitation (inches):
Phone No, 3 3�- `- 3 1 714 1
All permits require qualitative monitoring to be performed during a "measurable storm event."
A "measurable storm event" is a storm event that results in an actual discharge from the permitted site
outfall. The previous measurable storm event must have been at least 72 hours prior. The 72-hour storm
interval does not apply if the permittee is able to document that a shorter interval is representative for
local storm events during the sampling period, and the permittee obtains approval from the local DEMLR
Regional Office.
By this signature, I certify that this report is accurate and complete to the best of my knowledge:
(Signature of Pen-Attee or Designee)
1. Outfall Description:
Outfall No. 5? :2- Structure (pipe, ditch, etc.): {
Receiving Stream:
the industrial activities that occur within the outfall drainage area:
dr1.eL� + CnGl�r*
Page 1 of 2
S W U-242, Last modified 06/0 U2018
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: \/C- V- � jk-t�U oLK
11
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil, weak
chlorine odor, etc.): /lln '4J6�� L.3�- 4e,:1-4
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is clear
and 5 is very cloudy:
1 0 3 4 5
5. Floating Solids: Choose the number which best describes the amount of floating solids in the
stormwater discharge, where 1 is no solids and 5 is the surface covered with floating solids:
p 2 3 4 5
6. Suspended Solids: Choose the number which best describes the amount of suspended solids in
the stormwater discharge, where I is no solids and 5 is extremely muddy:
1 D2 3 4 5
7. Is there any foam in the stormwater discharge? O Yes ® No.
8. Is there an oil sheen in the stormwater discharge? OYes ® No.
9. Is there evidence of erosion or deposition at the outfall? o Yes ® No.
10. Other Obvious Indicators of Stormwater Pollution:
List and describe ! D t�r-� a-r v" d #-,%C-e a -f .0 It "h �-
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition may be
indicative of pollutant exposure. These conditions warrant further investigation.
Page 2 of 2
SWU-242, Last modified 06/01/2018
RESEARCh & ANAIYACA1
LkORATORiES, INC.
Analytical / Process Consultations
Phone 1336) 996-2841
CHAIN OF CUSTODY RECORD
WATER ! WASTEWATER I misc.
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inRESEARCh & ANAIyTiCA1
LAboRAToRIES, INC.
For: Custom finishers, Inc
2213 Shore Street
High Point, NC 27263,
Attn: Dennis Dzielski
Report of Analysis
5/30/2019
Jpunetp'4
Ole
i 4i
op NC #34 =.
._ NC #37701 1
Client Sample ID: SD02 Lab Sample ID: 67117-01
Site: Custom Finishers Inc Collection Date: 5/23/2019 7:45
Parae r Method Result Units Rap Limlt Analvst Analysis Data/Time
COD EPA 410.4 7 mg/L 5 HW 5/28/2019
Oil & Grease EPA 1664 8 <5 mg/L 5 EE 5/29/2019
Total Suspended Solids (i"SS) SM 2540 D-1997 <5 mg/L 5 AW 5/28/2019
NA = not analyzed
P.O. Box 473 106 Short Street Kemersville, North Carolina 27284 Tel: 336-986-2841 Fax: 336-99B-032b www.randalabs.corr� Page 1
ral coa basic v1d
STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
GENERAL PERMIT NO. NCG060000 SAMPLES COLLECTED DURING CALENDAR YEAR: Zo i `6
CERTIFICATE OF COVERAGE NO. NCG060205 (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.)
FACILITY NAME: Custom Finishers, Inc. COUNTY: Guilford
PERSON COLLECTING SAMPLES: em"Is -D-4.160k) RECEI PHONE NO.: (3361431-7141
CERTIFIED LABORATORY: Research R Analytical Lab #: NC34
Part A: Specific Monitoring Requirements
AUG 3 o z018
CENTRAL PILES
DWR SECTION
PLEASE SIGN ON THE REVERSE -->
Outfall
No.
Date
Sample
Collected,
molddlyr
00530
00400
00340
00556
31616
Total Suspended
Solids,
mglL
pH,
Standard Units
Chemical Oxygen
Demand,
mg1L
Oil and Grease,
mg1L
Fecal Coliform,
Colonies per 100 ml
Benchmark
-
100
Within 6.0 - 9.0
120
30
1000
SD02
B -;k- - IS
.19
?.o
121
-<
N/A
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
Outfalt
No.
Date
Sample Collected,
molddlyr
00556
00530
00400
Oil and Grease,
mglL
Total Suspended Solids,
mg1L
pH,
Standard Units
New Motor Oil Usage,
Annual average gallmo
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 1 or Tier 2 responses.
See General Permit text.
STORM EVENT CHARACTERISTICS: Mail Original and one copy to:
Division of Water Quality
Date (first event sampled) Attn: DWQ Central Files
Total Event Precipitation (inches):_ 1.9 in"es 1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Date (list each additional event sampled this reporting period, and rainfall amount)
Total Event Precipitation (inches):
SWU-249-102107
Page 1 of 2
"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 poss*bility of fines and imprisonment for knowing violations."
17
(Signature of Permittee
(Date)
J5Arr .
ST ORMWATER DISCHARGE OUTFALL (SDO)
QUALITATIVE MONITORING REPORT
Certificate of Coverage No. NCG Ow o Z -�
Facility Name: C v s -tn,m. ,t u
County: C i P. Phone No.: 3 3 Li 3 I - '7 I,4 1
Inspector: -betiN is
Date of Inspection: B - 2 - tg
By this signature, I certify that this report is accurate and complete to the best of my
knowledge:
L Z' k'�
(Signature of Permiuee or De gnee)
Outfall Description
Outfall No.: 5t7 I- Structure (pipe, ditch, etc.):_'?, PC IN LE T
Receiving Stream: A U P e I-trGV--
Describe the industrial activities that occur within the outfall drainage area:
PAL.t C'i S �_ !,c T1�4 «� I T►y r�� H 0 G,c,y o < d Cs u_Cz T1..J
2. Color
Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors:
y4 L1 c rt , 6,2Ay
Odor
Describe any distinct odors that the discharge may have (i.e. smells strongly of oil, weak
Chlorine odor, etc.):
Ala o p ojLs D E 7y-.-- 7-E 0
8/22/97
4. Clarity
Choose the number which best describes the clarity of the discharge where 1 is clear and
10 is very cloudy: v
1 K2) 3 4 5 6 7 8 9 10
5. Floating Solids
Choose the number which best describes the amount of floating solids in the storm water
Discharge where 1 is no solids and 10 is the surface covered in floating solids:
1 ("29 3 4 5 b 7 8 9 10
b. Suspended Solids
Choose the number which•best describes the amount of suspended solids in the
Storm water discharge where 1 is no solids and 10 is extremely muddy.
1 0 3 4 5 b 7 8 9 10
7. Foam
Is there any foam in the storm water discharge? YES (NO )
S. Oil Sheen
Is there an oil sheen in the storm water discharge? YES (DO
9. Other Obvious Indicators of Storm water Pollution:
List and describe:
'17fE2E WLwz' A" cL uorcotT /2s or fir! Y KerrD. T E
W 19-4 A4-0 V 106 NC- E OF SWft 7riL %ao LLu I`7c1N.
NOTE; Low clarity, high solids and/or presence of foam or oil sheens may be
Indicative of pollutant exposure. These conditions may warrant further
Investigation.
8/22/97
RESEARCh & ANA[YfiCAI
UboRATQRiES, INC.
Analytical / Process Consultations
Phone (386) 996-2841
CHAIN OF CUSTODY RECORD
WATER! WASTEWATER I MISC.
COMPANY
4 Li i ir{ -- 1 I'jis1.1.1: g j _ t '
JOB NO:
m
�
z
ti
y0' O^
,may?a�.y�
h v c� �'" y � O��
\Qm�O rq0� J Q robC 1�
�W o� �'j o� z•`z �`°�ca'
�� ro 0��0�
m
Q� O` G .� Q
p0 O� O Q Q' Q.
`� ry ryy ryh ^ �v v �.: y REQUESTED ANALYSIS
STREET ADDRESS
•]•'1 � S i�G t:•a=. `s'T:
PROJECT[
.:.)�Y>'vW�l
CITY, STATE, ZIP
INCv'L1Cl.s�,
SAMPLER NAME (PLEASE PRINT)
CONTACT PHONE
ll 7 {
SAMP ER SIGNATURE
--
SAMPLENUMBER
(LAB 115E ONLY)
DATE
TIME
COY
GRAB
TEMP
C
FlES
.G
I �i
GdOR F_
R�tta c�
ramp
1AU
ntnrrtn
is
SAMPLE LOCATION! LD-
�3
S
fS COO OIL f CAcA!;L;'
R Q.UISHEED BY.
DATE/i E.
RECEIVED BY.
REMARKS:
SAMPLE TEMPEURE AT. RECEIPT
RELINOUISHE BYi
DATEITIME
RECEIVED BY
FL
ESEA Ch .ANA1YTiCA�.Report of nalysis
.,
LA ORA-�OfiIES8
rN.c, 8i812018'
�tt�u.�errr�
For: Custom Finishers. Inc
tr CH
q
2213 Snore Street
Ai
High Point, NC 27263
L9
�, C9 NC934 ;
Attn: Dennis Dzielski
4
Nesi37701 Y
r�rrrrif �tNt
client Sample ID: SD02
Lab Sample iD:
54163-01
Site: Custom Finishers Inc
Collection Date:
8/2/2018 9:30
Pararmeter — Method
Result Units
Rena Limit An6l•sf Analysis'DatelTime-..
COD EPA 41D.4
22 mg/L
5
HW 'Mao78
Hydrocarbon O&G EPA 1664-Revision 8/Silica Gel
<5 mg/L
5
EE 8/6/.2018
Total Suspended'Solids-(T5S) SM 2540 D-1997
6.19' mglL
5
LP 81612018
NA = not onalyzed,
PA. Box 473 106.Short Street Kerriersvilla, North Carolina 27284 Tel:-336-996-2841 Fax: 336-996-0326 www.randolabs.com Page 1
. . '....lmaia-.�8tla�.�,..`.`�.w.,..,'+n adcvuC-i€,a�`iC?...-n.n.�ff �e .'r.�._..u.ti•.5.. ,..ss,,.:� -' „ -, .__..--
Custom Finishers, Inc.
eagle C
LASER
Division of Water Quality
ATTN: DWQ Central Files
1617 Mail Service Center
Raleigh, NC 27699-1617
,SUBJECT: Storm water Monitoring Report
To Whom It May Concern:
P.O. Box 7008
High Point, North Carolina 27264
Phone (336) 431-7141
FAX: (336) 434-5868
May 8, 2018
Enclosed is an original and a copy of our Storm water Discharge Outfall
Monitoring Report and supporting documents. The period of coverage is January 1,
2018, through June 30, 2018. Please feel free to contact me at (336)431-7141 with any
questions or concerns regarding this submission.
Sincerely,
Chris Wilkins
General Manager
STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
GENERAL PERMIT NO. NCG060000
CERTIFICATE OF COVERAGE NO. NCG060205
FACILITY NAME: Custom Finishers, Inc.
PERSON COLLECTING SAMPLES:
DENNIS 'Dz1f-i tut
CERTIFIED LABORATORY: Research & Analytical
Part A: Specific Monitoring Requirements
Lab #: NC34
SAMPLES COLLECTED DURING CALENDAR YEAR: �O 1 0-
(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: Guilford
PHONE NO.: (336)431-7141
PLEASE SIGN ON THE REVERSE —).
Outfall
No.
Date
Sample
Collected,
molddl r
00530
00400
00340
00556
31616
Total Suspended
Solids,
mglL
pH,
Standard Units
Chemical Oxygen
Demand,
mg1L
Oil and Grease,
mg1L
Fecal Coliform,
Colonies per 100 ml
Benchmark
-
100
Within 6.0 - 9.0
120
30
1000
SD02
15-- IV
1-5-
? o
L 5-
L
NIA
Note: if you report a sampled value in excess of the benchmark value, or outside tha 6brFc ff-Vra g for pH, you must implement Tier 1 or Tier 2 responses.
See General Permit text. U
MAY 18 �0�8
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor of per month? yes X no
(if yes, complete Part 6) �,ENTRAL FILES
DWR SECTION
Part 13: Vehicle Maintenance Activity Monitoring Requirements
Outfall
No.
Date
Sample Collected,
molddl r
00556
00530
00400
Oil and Grease,
mg1L
Total Suspended Solids,
mglL
pH,
Standard Units
New Motor Oil Usage,
Annual average gallmo
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 1 or Tier 2 responses.
See General Permit text.
STORM EVENT CHARACTERISTICS: Mail Original and one copy to:
Division of Water Quality
Date �� 18 (first event sampled) l Attn: DWQ Central Files
Total Event Precipitation (inches): l 3 inc5 1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Date (list each additional event sampled this reporting period, and rainfall amount)
Total Event Precipitation (inches):
SW U-249-102107
Page 1 of 2
"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."
I
(Signature of Permittee
(Date)
STORMWATER DISCHARGE OUTFALL (SDO)
QUALITATIVE MONITORING REPORT
Certificate of Coverage No. NCG : 060205
Facility Name: Custom Finishers, Inc.
County: Guilford Phone No.. 336-431-7141
Inspector: Dennis L. Dzielski
Date of Inspection: Y- 2-57-16
By this signature, I certify that this report is accurate and complete to the best of my
knowledge-
A— Z N
(Signature of PermitteP or Designee)
1. Outfall Description
Outfall No.: SD02 Structure (pipe, ditch, etc.): Pipe Inlet
Receiving Stream: Muddy Creek
Describe the industrial activities that occur within the outfall drainage area:
Pallet Storage, Tractor Trailer Activity, MDF Grinding, and Collection
Color
Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: e
�'�♦ S��rGly 4o�or- J� �Y'O�y+.t l]0.1�C..+1^1S
Odor
Describe any distinct odors that the discharge may have (i.e. smells strongly of oil, weak
Chlorine odor, etc.): /L�ta odQv�s w-e!� cl/
-e_�en_'fe121
8/22/97
4. Clarity
Choose the nurnbcr which best describes the clarity of the discharge where i is clear and
10 is very cloudy:
1 0 3 4 5 6 7 8 9 10
5. Floating Solids
Choose the number which best describes the amount of floating solids in the storm water
Discharge where 1 is no solids and 10 is the surface covered in floating solids:
Q 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
Storm water discharge where 1 is no solids and 10 is extremely muddy:
1a 2 3 4 5 6 7 8 9 10
7. Foam
Is there any foam in the storm water discharge? YES NO
8, Oil Sheen
Is there an oil sheen in the storm water discharge? YES
9. Other Obvious Indicators of Storm water Pollution:
Listrand describe: —1 l
/fte-t (..�a/e h.D Inf �GQ'ForJ !rr e— i �[O
tj a-4,,
NOTE: Low clarity, high solids and/or presence of foam or oil sheens may be
Indicative of pollutant exposure. These conditions may warrant further
Investigation.
8/22/97
RESEARCh & HNA1yTICA1
LABORATORIES, INC.
Analytical / Process Consultations.
Phone 1336) 996-2841
CHAIN OF CUSTODY RECORD
WATER 1 WASTEWATER MISC.
COMPANY
CIJSTa�n i nA3 C
JOB NO.
w
z
o
LL
o
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`1" `�� `� " " REQUESTED ANALYSIS
R ry ^ y
STREETADDRESS
PROJECT0.
CITY, STATE, ZIP
{-LG� N P61 u.r ,1-�24.
to ev
SAMPLER NAME (PLEASE PRINT)
� NN1S `l�-ILL$Kr
CONTACT PHONE
Gil rzi 5 -714
SAM GNATUR
SAMPLE NUMBER
(LAB USE ONLY)
DATE
TIME
COGP
GRAB
TEMP
'C
RES
[ �
REMOVED
n a xl
SAMPLE
Is a W]
SAMPLE LOCATION ! I.D.
4 2S'!fi
7:3nn..
RELINOUISHEDBY
s d�
DATEMME
a `��``�
RECEIVED BY
REMARKS:
SAMPLE TEMPERATURE AT RECEIPT 0 , `t °C
RE INOUISHED
DATErTIME
RECEIVED BY lj
RESEARCh & ANA[yTICA1
LAbORATORIESF INC.
For: Custom Finishers, Inc
2213 Shore Street
High Point, NC 27263,
Attn: Chris Wilkins
Report of Analysis
5/2/2018
i
M NC U34 Z. -
NC 937701
~ri � sfi : O�,q��pg•,r,� ,��
ru n
Client Sample ID: S002 Lab Sample 1D: 49754-01
Site: Custom Finishers Inc Collection Date: 4/25/2018 7:30
Parameter Method Result Units Rep Limit Analyst Analysis Dateliime
COD EPA 410.4 <5 mg/L 5 JF 4/30/2018
Hydrocarbon O&G EPA 1664 Revision B/Silica Gel
Total Suspended Solids (TSS) SM 2540 D-1997
<5 mg/L 5 AW 4/27/2018
<5 mg/L 5 AA 4/26/2018
NA = not analyzed
P.O. Box 473 106 Short Street Kernersville, North Carolina 27284 Tel: 336-996-2841 Fax: 336-996-0326 www.randalabs.com Page 1
rs coa basic v',d
Custom Finishers, Inc.
Division of Water Quality
ATTN: DWQ Central Files
1617 Mail Service Center
Raleigh, NC 2.7699-1617
SUBJECT: Storm water Monitoring Report
To Whom It May Concern:
P.O. Box 7008
High Point, North Carolina 27264
Phone (336) 431-7141
FAX: (336) 434-5868
R ECEIVEL
OCR U 3 Z017
CENTRAL FILES
DWR SECTION
Sept 26, 2017
Enclosed is an original and a copy- of our Storm water Discharge Outfall
Monitoring Report and supporting documents. The period of coverage is July 1, 2017,
through December 31, 2017. Please feel free to contact me at (336)431-7141 with any
questions or concerns regarding this submission.
Sincerely,
Chris Wilkins
General Manager
�/•
STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
GENERAL PERMIT NO. NCG060000 SAMPLES COLLECTED DURING CALENDAR YEAR: ;�o) -7
CERTIFICATE OF COVERAGE NO. NCGO60205 (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.)
FACILITY NAME: Custom Finishers, Inc. COUNTY: Guilford
PERSON COLLECTING SAMPLES:-Dt4,.,,s -MqELai=} PHONE NO.: (336)431-7141
CERTIFIED LABORATORY: Research $ Analytical Lab #: NC34
PLEASE SIGN ON THE REVERSE —).
Part A: Specific Monitoring Requirements
Outfall
No.
Date
Sample
Collected,
moldd! r
00530
00400
00340
00556
31616
Total Suspended
Solids,
mglL
pH,
Standard Units
Chemical Oxygen
Demand,
mglL
Oil and Grease,
mglL
Fecal Coliform,
Colonies per 100 ml
Benchmark
-
100
Within 6.0 - 9.0
120
30
1000
SD02-11
Z. o
Z5
NIA
Note: it you report a sampled value in excess of the benchmark value, or outside the benchmark range for pH, you must implement I ier 1 or I ier 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 6: Vehicle Maintenance Activitv Monitoring Requirements
Outfall
No.
Date
Sample Collected,
molddlyr
00556
00530
00400
Oil and Grease,
mglL
Total Suspended Solids,
mglL
pH,
Standard Units
New Motor Oil Usage,
Annual average gallmo
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 1 or Tier 2 responses.
See General Permit text.
STORM EVENT CHARACTERISTICS:
Date '91 0 4-7 (first event sampled) y
Total Event Precipitation (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 Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
SWU-249-102107
Page 1 of 2
"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."
ature of Permittee
(Date)
STORMWATER DISCHARGE OUTFALL (SDO)
QUALITATIVE MONITORING REPORT
Certificate of Coverage No. NCG : 060205
Facility Name: Custom Finishers, Inc.
County: Guilford Phone No.: 336-431-7141
inspector: Dennis L. Dzielski
Date of Inspection:_ C} 6 / -7
By this signature, I certify that this report is accurate and complete to the best of my
knowledge:
LLtdr--
(Signature of Permittee or signee)
Outfall Description
Outfali No.: SD02 Structure (pipe, ditch, etc.): Pipe Inlet
Receiving Stream. Muddy Creek
Describe the industrial activities that occur within the outfall drainage area:
Pallet Storage, Tractor Trailer Activity, MDF Grinding and Collection
2. Color
Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors:
Tr�f �(sC/f.42 c E L-( -5 c L E Iq r�
3. Odor
Describe any distinct odors that the discharge may have (i.e. smells strongly of oil, weak
Chlorine odor, etc.):
A)o 5 dolz S ktI&�t 6 7- -c 7-6 P —
8/22/97
4. Clarity
Choose the number which best describes the clarity of the discharge where 1 is clear and
10 is very cloudy:
0 2 3 4 5 6 7 8 9 10
5. Floating Solids
Choose the number which best describes the amount of floating solids in the storm water
Discharge where 1 is no solids and 10 is the surface covered in floating solids:
0 2 3 4 5 6 7 8 9 10
6. Suspended Solids
Choose the number which best describes the amount of suspended solids in the
Storm water discharge where 1 is no solids and 10 is extremely muddy:
1 02 3 4 5 6 7 8 9 10
7. Foam
Is there any foam in the storm water discharge? YES NO
8. Oil Sheen
Is there an oil sheen in the storm water discharge? YES NO
9. Other Obvious Indicators of Storm water Pollution:
List and describe: �
7`r1
1-EI-E V J C9-C Al o Tn! J) 72 a a1 S
if —
NOTE: Low clarity, high solids and/or presence of foam or oil sheens may be
Indicative of pollutant exposure. These conditions may warrant further
Investigation.
8/22/97
RESEARCh & ANAIYACA1
LAbORATORIES� INC.
f, Analytical / Process ConsuluaCions
Phone (3361 996-2841
CHAIN! OF CUSTODY RECORD
WATER I WASTEWATER I misc.
COMPANY
C €k
.JOB NO,
,,
i
u
d
e�
eb- . o'
`Qm �� CV Jr C�� +`L�z
M Q
�• .5 �O �0
m � c� a � Q` �,� � ci �-
rypcti�e hQ"
a ' h REQUESTED ANALYSIS
STREETADDRESS�]�
13 S 440 P-'C� �-'T
PROJECT
CITY. STATE, ZIP
416Vj- poI"r N L i �26 3
SAMPLER NAME {PLEASE PRINT)
�C�t Is 'UZl �
CONTACT PHONE
��r•fnils b�i�'c..S k1 3341 Ll 3 ! 71 q(
SAMPLER SIGNATURE
(�
�C`��-.�-.-�...►- �
SAMPLE NUMBER
(LAB USE ONLY)
DATE
TIME
:qup
GRR9
T;M�
U
a s
[i
,C.I
ctflr.lrs
rUWAD
rpN�
sAT;ti[
V F 3l
�saw1
SAMPLE LOCA1 1I.D.
Cif
!� !')
(: pb,
i�—
`�?���
_—
—
---
—
-
ss Coo
RELI UISHEDB/Y
DATE NMI
RECEIVED a
REMARKS.
SAMPLE TEMPERATURE AT RECEIPT �• °C
RELINQUISHED
CIATWIME
RECEIVED 8
RESEARCH & ANAyTiCAL
LAbORATORIES� INC.
For: Custom Finishers, Inc
2213 Share Street
High Point, NC 27263,
Attn: Tom Crane
Report of Analysis
9/15/2017
1.11t13IIfloe
A� w
i tr C NC JR34
w NC 937701
Client Sample ID: SD02 Lab Sample ID: 39619-01
Site: Custom Finishers Inc Collection Oate: 9/6/2017 13:30
Parameter Method Result Units Rep Limit Analyst Analysls DateE:Ime
COD EPA 410.4 7 mg1L 5 SK 9/812017
Hydrocarbon O&G EPA 1664 Revision BlSilica <5 mg1L 5 AW 9/11/2017
Gel
Total Suspended Solids (TSS) SM 2540 D-1997 <5 mg1L 5 AA 9/8/2017
NA = not cno yzecf
P.O. Box 473 106 Short Street Kernersville, North Carolina 27284 Tel: 338.996.2841 Fax: 336-996-0326 "^v.randalabs.conn Page 1
STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
GENERAL PERMIT NO. NCG060000 SAMPLES COLLECTED DURING CALENDAR YEAR: go
t�
CERTIFICATE OF COVERAGE NO. NCG060205 (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.)
FACILITY NAME: Custom Finishers, Inc. COUNTY: Guilford
PERSON COLLECTING SAMPLES: _ v4ii(CS f2 ewp( PHONE NO.: (336)431-7141
CERTIFIED LABORATORY: Research & Analytical Lab #: NC34
PLEASE SIGN ON THE REVERSE
Part A: Specific Monitoring Requirements
Outfall
No.
Date
Sample
Collected,
molddl r
00530
00400
00340
00556
31616
Total Suspended
Solids,
mglL
pH,
Standard Units
Chemical Oxygen
Demand,
mg1L
Oil and Grease,
mg1L
Fecal Coliform,
Colonies per 100 ml
Benchmark
-
100
Within 6.0 - 9.0
120
30
1000
SD02
H
4-
'-1 v
L
G r
NIA
Note: if you report a sampled value in excess of the benchmark value, or o t-4t tF `tbi V rk range for pH, you must implement Tier 1 or Tier 2 responses.
See General Permit text.
MAY 23 2D17
Did this facility perform Vehicle Maintenance Activities using more than 55 a�r� f new motor oil per month? yes X no
(if yes, complete Part B) �.EN RAL FILES
DWR SECTION
Part B: Vehicle Maintenance Activity Monitoring Requirements
Outfal I
No.
Date
Sample Collected,
molddlyr
00556
00530
00400
Oil and Grease,
mg1L
Total Suspended Solids,
mglL
pH,
Standard Units
New Motor Oil Usage,
Annual average gallmo
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 1 or Tier 2 responses.
See General Permit text.
STORM EVENT CHARACTERISTICS: Mail Original and one copy to:
Division of Water Quality
Date Y4 Iq (first event sampled) Attn: DWQ Central Files
Total E ent Precipitation (inches): � A q 1410�S _ 1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Date (list each additional event sampled this reporting period, and rainfall amount)
Total Event Precipitation (inches):
SWU-249-102107
Page 1 of 2
"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 (Date)
STORMWATER DISCHARGE OUTFALL (SDO)
QUALITATIVE MONITORING REPORT
Certificate of Coverage No. NCG : 060205
Facility Name: Custom Finishers Inc.
County: Guilford Phone No.: 336-431-7141
Inspector. Dennis L. Dzielski
Date of Inspection:( I
By this signature, I certify that this report is accurate and complete to the best of my
knowledge:
.' ---
Q" 5L�
(Signature o Permittee Designee)
1. Outfall Description
Outfall No.: SD02 Structure (pipe, ditch, etc.): Pipe Inlet
Receiving Stream: Muddy Creek
Describe the industrial activities that occur within the outfall drainage area:
Pallet Storage, Tractor Trailer Activity, MDF Grinding and Collection
2. Color
Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as de criptors:
V f- -,, Ai %!Lt—
3. Odor
Describe any distinct odors that the discharge may have (i.e. smells strongly of oil, weak
Chlorine odor, etc.):
8/22/97
4. Clarity
El
Choose the number which best describes the clarity of the discharge where 1 is clear and
10 is very cloudy:
1 3 3 4 5 6 7 8 9 10
5. Floating Solids
Choose the number which best describes the amount of floating solids in the stonn water
Discharge where 1 is no solids and 10 is the surface covered in floating solids:
(D 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
Storm water discharge where 1 is no solids and 10 is extremely muddy:
ei/ 2 3 4 5 6 7 8 9 10
7. Foam
Is there any foam in the storm water discharge? YES NO
8. Oil Sheen
Is there an oil sheen in the storm water discharge? YES NO
9. Other Obvious Indicators of Storm water Pollution:
List and describe:
NOTE: Low clarity, high solids and/or presence of foam or oil sheens may be
Indicative of pollutant exposure. These conditions may warrant further
Investigation.
8/22/97
RESEARCh & ANAIYf ICAI
LABORATORIES, INC.
Analytical / Process Consultations
Phone (336) 996-2841
CHAIN OF CUSTODY RECORD
WATER I WASTEWATER I MISC.
COMPANY
JOB NO.
y
o
_
m
y .. `��0 �� 0ac� pr
\Qm ZG°' JcQ�
°�
ao t� c� Q• C9 ¢ Q ¢ ��.
`� n q� 'L� �" *" *" �` REQUESTED ANALYSIS
STREET ADDRESS
r 3 Sto
PROJECT
CITY, STATE, ZIP
14 !� PD 1 N T iV L
SAMPLER NAME (PLEASE PRINT)
DL r E-GJfU
CONTACT PHONE
%Om :336 (-t3 i -7r 4f
SAMP ER SIGNATURE
SAMPLE NUMBER
pw USE ONLY)
DATE
TIME
COUP
GRAB
TEMP
,C
RES
l
CWCRINE
REMOVED
SAMPLE
Ig UX
SAMPL LOCATION I I.D.
TO co® GRme+ OIL
RE UISHEO BY
y-
DATIJTIME
C'��Ad
�R}EECCEIVED BY
" V
REMARKS:
va —
SAMPLE TEMPERATURE AT RECEIPT ✓ °C
RELINQUISHED BY
DATEMME
RECEIVED BY
RESEARCh & ANAtyTICA1
UboRATORIES, INC.
For: Custom Finishers, Inc
2213 Shore Street
High Point, NC 27263,
Attn: Tom Crane
Report of Analysis
5/4/2017
�ti*ttlnnr�r�
A• b A LYTj�r�i�
�': ••
F
y2j,P
Ja0 NC #34
NC#37701
Client Sample ID: SD02 Lab Sample ID: 338ST-01
Site: Custom Finishers Inc Collection Date: 4/24/2017 20:45
Parameter Method Result Units Rep Limi Analyst Analysis Date/Time 7]
COD EPA 410.4 <5 mg/L 5 BR 4/27/2017
Hydrocarbon O&G EPA 1664 Revision Mika <5 mg/L 5 JF 4/28/2017
Gel
Total Suspended Solids (TSS) SM 2540 D-1997 <5 mg/L 5 AA 4/26/2017
NA = not analyzed
P.O. Sox 473 IN Short Street Kemeraville, North Carolina 27284 Tel: 336-9M2841 Fax: 336-996-0326 www.randalabs.com Page 1
rat coa basic yid
STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
GENERAL PERMIT NO. NCGD60000 SAMPLES COLLECTED DURING CALENDAR YEAR:
CERTIFICATE OF COVERAGE NO. NCG060205 (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.)
FACILITY NAME: Custom Finishers, Inc. ;� COUNTY: Guilford
PERSON COLLECTING SAMPLES: ��NNlS J�1LSI�I PHONE NO.: (336)431-7141
CERTIFIED LABORATORY: Research & Analytical Lab #: NC34
PLEASE SIGN ON THE REVERSE —),
Part A: Specific Monitoring Requirements
Outfall
No.
Date
Sample
Collected,
molddl r
00530
00400
00340
00556
31616
Total Suspended
Solids,
m !L
pH,
Standard Units
Chemical Oxygen
Demand,
m lL
Oil and Grease,
mg/L
Fecal Coliform,
Colonies per 100 ml
Benchmark
-
100
Within 6.0 - 9.0
120
30
1000
SD02
. - r L
G
5-
NIA
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. RECEIVED
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
DEC 2 0 2016
CENTRAL FILES
DWR SECTION
Outfall
No.
Date
Sample Collected,
molddl r
00556
00530
00400
Oil and Grease,
m IL
Total Suspended Solids,
m !L
pH,
Standard Units
New Motor Oil Usage,
Annual average allmo
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 1 or Tier 2 responses.
See General Permit text.
STORM EVENT CHARACTERISTICS: Mail Original and one copy to:
Division of Water Quality
Date_!2- `}- I (first event sampled) Attn: DWQ Central Files
Total Event Precipitation (inches): . 37 1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Date (list each additional event sampled this reporting period, and rainfall amount)
Total Event Precipitation (inches):
SWU-249-102107
Page 1 of 2
" 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 Pefmiltee
(Date)
SWU-249-102107
Page 2 of 2
STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
G6JERAL^�PERMIT NO. NCG060000 SAMPLES COLLECTED DURING CALENDAR YEAR: .2° k4
CERTIFICATE OF COVERAGE NO. NCG060205 (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.)
FACILITY NAME: Custom Finishers, Inc. COUNTY: Guilford
PERSON COLLECTING SAMPLES: '�>zrE VS1-f PHONE NO.: 336 431-7141
CERTIFIED LABORATORY: Research & Analytical Lab #: NC34 RECEIVED
PLEASE SIGN ON THE REVERSE �
MAY 18 Z015
Part A: Specific Monitoring Requirements CENTRAL FILES
Outfall
No.
Date
Sample
Collected,
molddl r
00530
00400
0
00556
31616
Total Suspended
Solids,
m 1L
pH,
Standard Units
Chemical Oxygen
Demand,
m lL
Oil and Grease,
mg1L
Fecal Coliform, L
Colonies per 100 ml c
Benchmark
-
100
Within 6.0 - 9.0
120
30
1000
SD02
6-3114-
?.2
41c>
2<
5
NIA
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,
molddl r
00556
00530
00400
Oil and Grease,
m lL
Total Suspended Solids,
m lL
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 1 or Tier 2 responses.
See General Permit text.
STORM EVENT CHARACTERISTICS:
Date S -3 1 1G (first event sampled)
Total Event Precipitation (inches): i 33 -(Advs
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-249-102107
Page 1 of 2
I o-atify, 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."
r
(Sig re oi Permittee (Date)
SWU-249-102107
Page 2 of 2
STORMWATER DISCHARGE OUTFALL (SDO)
QUALITATIVE MONIz
G Rone
Certificate of CoverageG : 0
Facility Name: Customrs In
County: Guilford 336-431-7141
Inspector: Dennis L. Dzielski
Date ofInspection: 513 [ 1�-
By this signature, I certify that this report is accurate and complete to the best of my
knowledge:
(Signature of Permittee A Designee)
Outfall Description
OutfalI No.: SD02 Structure (pipe, ditch. etc.): Pipe Inlet
Receiving Stream: Muddy Creek
Describe the industrial activities that occur within the outfall drainage area:
Pallet Storage, Tractor Trailer Activity, MDF Grinding and Collection
2. Color
Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors:
Lt4 i 62-t`t F(Z=' (:��uskv) 40,-v— 114 L6
3. Odor
Describe any distinct odors that the discharge may have (i.e. smells strongly of oil, weak
Chlorine odor, etc.):
T*f /j-E c S tiL a ai)o(L
8/22/97
4
4. Clarity
Choose the number which best describes the clarity of the discharge where 1 is clear and
10 is very cloudy:
1 2 y 4 5 6 7 8 9 10
5. Floating Solids
Choose the number which best describes the amount of floating solids in the storm water
Discharge where i is no solids and 10 is the surface covered in floating solids:
(D 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
Storm water discharge where 1 is no solids and 10 is extremely muddy:
2 3 4 5 6 7 8 9 10
7. Foam
Is there any foam in the storm water discharge? YES
8. Oil Sheen
Is there an oil sheen in the storm water discharge? YES NO
9. Other Obvious Indicators of Storm water Pollution:
List and describe:
t (ZIC o nA V.0us bre-fF7aO-1
OF :5_lbrLn, �t A ,2 f bL-t-y R o,'J P&N T'
NOTE: Low clarity, high solids and/or presence of foam or oil sheens may be
Indicative of pollutant exposure. These conditions may warrant further
Investigation.
8/22/97
RESEARCh & ANAIYACAI
f kboRATORIES, INC.
Analytical / Process Consultations
Prone (3361 996-21341
CHAIN OF CUSTODY RECORD
WATER I WASTEWATER I MISC,
COMPANY
v5 �m NrS;fT25 yNc
JOB NO,
„
o
z
l
u' O•
d �
�A r20,
y �ScS s� g0"-
Q° rU yp• Jcd (?` •`bc $a ��
O}`Ov�O� O�O`Q
� Q Q,
¢oF R F Q� 0 4' Q' Q' m�
ry ry� ry + �" �" �` REQUESTED ANALYSIS
STREET
2113 5 i- o a-,6 tsi
PROJECT
CITY, STATE• ZIP
lkl�K pbImT 1�C i �S
SAMPLER NAME (PLEASE PRINT)
��N At '{7-2-Ic-"w-,
CONTACT PHONE
SAMPLER SIGNATURE
SAMPLE NUMBER
(LAB USE ONLY)
DATE
TIME
COw
GRAS
TEMP
.0
Res
CI
4-..ur
raw rt
� ��
ttdrn
sAx cif
��
Isawf
SA PLELOCATIONILD.
R INQUISHED 13Y
AT- IME
R D
REMARKS:
�s w
SAMPLE TEMPERATURE AT RECEIPT 3 3 °C
RELINQUISHED BY
DATE/TIME
R CEi E
KESEARCh & ANAl1riW
-
:'{fit
LAb®R,4T®R9ESoIC.
For: Custom Finishers, Inc
2213 Shore Street
Hiah Point, NC 27263,
Attn: Tom Crane
Report of Analysis
5/12/2016
cli
: o•.�Y )
Z.
wI NC.137701
5 ,
Client Sample ID: SD02
Lab Sample ID:
18560-01
Site: Custom Finishers
Inc
Collection Date:
5/312016
9:00
Parameter
Method
Result
Units
Rep Limit Analyst Analysis Date/Time
COD
EPA 410.4
9
n1glL
5
KN
5/5/2016
Hydrocarbon O&G
EPA 1664 Revision BlSilica
<5
mg/L
5
ON
515/2016
Gel
Total Suspended Solids (TSS)
SM 2540 0-1997
7.2
me3/L
5
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P.O. Bor, a73 106 Snort Street Kemersville. North Carolina 27284 Tel: 336.996-2841 Fax: 336-996-0326 V.ww.randalabs.com Page
STORMWATER DISCHARGE OUTFALL (SDO)
GENERAL PERMIT NO. NCG060000
CERTIFICATE OF COVERAGE NO. NCG060205
FACILITY NAME. Custom Finishers, Inc.
PERSON COLLECTING SAMPLES:
CERTIFIED LABORATORY: Research & Analytical
Part A: Specific Monitoring Requirements
MONITORING REPORT
SAMPLES COLLECTED DURING CALENDAR YEAR:y
(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: Guilford
e7Z1t►jV- RECEIVE [IONE NO.: (336)431-7141
Lab #: NC34
NOV 17 2015 PLEASE SIGN ON THE REVERSE �
CENTRAL FILES
DWR SECTION
Outfall
No.
Date
Sample
Collected,
mold d! r
00530
00400
00340
00556
31616
Total Suspended
Solids,
m /L
pH,
Standard Units
Chemical Oxygen
Demand,
m 1L
Oil and Grease,
mglL
Fecal Coliform,
Colonies per 100 ml
Benchmark
-
100
Within 6.0 - 9.0
120
30
1000
SD02
. c7
I
<
NIA
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 8)
Part B: Vehicle Maintenance Activity Monitoring Requirements
Outfall
No.
Date
Sample Collected,
molddl r
00556
00630
00400
Oil and Grease,
m IL
Total Suspended Solids,
m 1L
pH,
Standard Units
New Motor Oil Usage,
Annual averse gallmo
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 1 or Tier 2 responses.
See General Permit text.
STORM EVENT CHARACTERISTICS: Mail Original and one copy to:
Division of Water Quality
Date 106/f%)-- (first event sampled) Q / Attn: DWQ Central Files
Total. E ent Precipitation (inches): • "t 5 1617 Mail Service Center
Date (list each additional event sampled this reporting period, and rainfall amount)
Total Event Precipitation (inches):
Raleigh, North Carolina 27699-1617
SWU-249-102107
Page 1 of 2
" 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."
�L/4-,� �
l�//Ch
(Signatu f Permittee (Date)
SWU-249-102107
Page 2 of 2
STORMWATER DISCHARGE OUTFALL (SDO)
QUALITATIVE MONITORING REPORT
Certificate of Coverage No. NCG : 060205
Facility Name: Custom Finishers. Inc.
County: Guilford Phone No.: 336-431-7141
Inspector: Dennis L. Dzielski
Date of Inspection:
By this signature, I certify that this report is accurate and complete to the best of my
knowledge:
k- "e D,-a-
(Signature of Permitte or Designee)
I . Outfall Description
Outfall No.: SD02 Structure (pipe, ditch, etc.): Pipe Inlet
Receiving Stream: Muddy_Creek
Describe the industrial activities that occur within the outfall drainage area:
Pallet Storage. Tractor Trailer Activity, MDF Grindiny, and Collection
2. Color
Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors:
C
Odor
Describe any distinct odors that the discharge may have (i.e. smells strongly of oil, weak
Chlorine odor, etc.):
8/22/97
4. Clarity
Choose the number which best describes the clarity of the discharge where 1 is clear and
10 is very cloudy:
1 Q 3 4 5 6 7 8 9 10
5. Floating Solids
Choose the number which best describes the amount of floating solids in the storm water
Discharge where 1 is no solids and 10 is the surface covered in floating solids:
0 2 3 4 5 6 7 8 9 10
6. Suspended Solids
Choose the number which best describes the amount of suspended solids in the
Storm water discharge where 1 is no solids and 10 is extremely muddy:
V 2 3 4 5 6 7 8 9 10
7. Foam
Is there any foam in the storm water discharge? YES �10
8. Oil Sheen
Is there an oil sheen in the storm water discharge? YES NO
9. Other Obvious Indicators of Storm water Pollution:
List and describe:
W AT�,--q %JDL.,Jilo,3 je/-E36,,j i
NOTE: Low clarity, high solids and/or presence of foam or oil sheens may be
Indicative of pollutant exposure. These conditions may warrant further
Investigation.
8/22/97
[ ESEAR6 & ANAlyrlcAl
LABORATORIES, INC.
Analytical / Process Consultations
Phone (336) 995-2841
CHAIN OF CUSTODY RECORD
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RE5EARCh & ANALyTICA[
LAbomoRIES, INC.
For: Custom Finishers, Inc
2213 Shore Street
High Point, NC 27263,
Attn: Tom Crane
Report of Analysis
11 /512015
`fo
ap NCtt34 y1
NC937701 }
-��'QECNQ'9 '
Client Sample ID: SM tab Sample ID: 10853-01
Site: Custom Finishers Inc Collection Date: 10272015 15.00
Parameter Method Result Unita Rep Llmft AnalvQt Anaivefa DalefTlme
CAD EPA 410.4 19 mg/L 5 KN 1029/2015
Hydrocarbons, Oil & Grease EPA 1W4 Revision A/Silica 45 mg& 5 JB 11P.12015
Gat
Total Suspended Solids (TSS) SM 2540 D•1997. <5 ffv& 5 JB 10/292015
NA - nol onolyied
A.O. Boz 173 'IN Short Street Kamersvlss, Nonh Carollne 27284 Tot; 336-06-2841 Fas:336.996-0326 www.randalebs.com Page 1
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T
STORMWATER DISCHARGE OUTFALL (SDO)
QUALITATIVE MONITOR
Certificate of Coverage CG : 060205
Facility Name: Custom shers Inc.
County: Guilford ne o.: 336-431-7141
Inspector: Dennis L. Dzielski
Date of Inspection:
By this signature, I certify that this report is accurate and complete to the best of my
knowledge:
� z D'k -
(Signature of Permittee or Desi nee)
1. Outfall Description
Outfall No.: SD02 Structure (pipe, ditch, etc.): Pipe Inlet
Receiving Stream: Muddy Creek
Describe the industrial activities that occur within the outfall drainage area:
Pallet Storage, Tractor Trailer Activity, MDF Grinding and Collection
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.): �rr
8/22/97
4. Clarity
Choose the number which best describes the clarity of the discharge where 1 is clear and
10 is very cloudy:
1 0;) 3 4 5 6 7 8 9 10
5. Floating Solids
Choose the number which best describes the amount of floating solids in the storm water
Discharge where 1 is no solids and 10 is the surface covered in floating solids:
0 2 3 4 5 6 7 8 9 10
6, Suspended Solids
Choose the number which best describes the amount of suspended solids in the
Storm water discharge where 1 is no solids and 10 is extremely muddy -
a, 2 3 4 5 6 7 8 9 10
7. Foam
Is there any foam in the storm water discharge? YES
8. Oil Sheen
Is there an oil sheen in the stone water discharge? YES
9. Other Obvious Indicators of Storm water Pollution:
List and describe:
OP t t u -H V, ,fir es S-K,A'
NOTE: Low clarity, high solids and/or presence of foam or oil sheens may be
Indicative of pollutant exposure. These conditions may warrant further
Investigation.
8/22/97
RESEARCh &. ANA1yTiCA1
} UbORATORIES, INC.
Analytical / Process Consultations
Phone (336) 995-2841
CHAIN OF CUSTODY RECORD
1 WATER l WASTEWATER 1 MISC. I
COMPANY
JOBNC.
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U y' U 2' Q' Q
'dry ,y� ti = REQUESTED At`IA�YSIS
STREET ADDRESS
PROJECT
CITY, STATE, ZIP
roe- "7 Z 3
SAMPLER NAn7E (PLEASE PRINT)
C: rl nL' 5 19 41 L-Sr (
CONTACT {'NONE
1m G%Grwi 34 q 3 + �t tl
SAMP .ER SIGNA7(IR(�{7
tom. 4V .
$AMPLE. NUMBER
(LAB USE ONLY)
} BATE
TIME
Y
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R[9
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SAMPLE LOCATION 11D..
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R LI QUISNED BY
DATEMME I
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RECEIVED BY
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REMARKS:
'
4 t�-
SAI PLE TEMPERATURE AT RECEIPT 2?--L or,
RELINpl;15HED
ATENWE
R E C IVED BY
RESEARCh & ANA1YT9CA[
LABORATORIES? INC.
For: Custom Finishers, Inc
2213 Shore Street
High Paint, NC 27263,
Attn: Tom Crane
Report of Analysis
7/13/2015
A11A1Z(gY"�`�(ii�i
-���q�� 1• C 'a14 : ':
s Zo NC u34 y:
NCn37701
DrA�1O a
Client Sample ID; SD02
Lab Sample 10: 5B91-01
Site: Custom Finishers Inc
Collection Date: 6/27/2015 17:40
Parameter
Method
Result
Units
Ron Limit Analyst Analysis Datefiime I
COD
EPA 410.4
10
mgtL
5 KN 6130/2015
Hydrocarbons, Oil B Grease
EPA 1664 Revision A/Silica
<5
mg/L
5 J8 7/8/2015
Gel
Total Suspended Solids (TSS)
5M 2540 D-1997
<5
mg/L
5 JIB 6/30/2015
NA = not an��yzeC
P.O. Box G73 10fi Shod Street KernersviUe, North Carolina 27284 Tel. 336-996-2841 Fax. 336-996-0326 www.randalabs,cam Page t
rat cns ba_i: v1d
i�
GENERAL PERMIT NO. NCG060000
CERTIFICATE OF COVERAGE NO. NCGO60205
FACILITY NAME: Custom Finishers, Inc.
PERSON COLLECTING SAMPLES: 'D ENrA i 5
CERTIFIED LABORATORY: Research & Analytical
Part A: Specific Monitoring Requirements
STORK%EVJMGEPORT ALI_ (SDO)
JUL 17 2015 SAMPLES COLLECTED DURING CALENDAR YEAR:
CENTRAL FILES(This monitoring report is due at the Division no later than 30 days from
DWR SECTION the date the facility receives the sampling results from the laboratory.)
COUNTY: Guilford
PHONE NO.: (336)431-7141
Lab #: NC34
PLEASE SIGN ON THE REVERSE —*
Outfail
No.
Date
Sample
Collected,
molddl r
00530
00400
00340
00556
31616
Total Suspended
Solids,
m IL
pH,
Standard Units
Chemical Oxygen
Demand,
m IL
Oil and Grease,
mg1L
Fecal Coliform,
Colonies per 100 ml
Benchmark
-
100
Within 6.0 - 9.0
120
30
1000
S002
S
< 5
, o
a
< S
NIA
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 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,
molddl r
00556
00530
00400
Oil and Grease,
m IL
Total Suspended Solids,
m IL
pH,
Standard Units
New Motor Oil Usage,
Annual average gallmo
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 1 or Tier 2 responses.
See General Permit text.
STORM EVENT CHARACTERISTICS: Mail Original and one copy to:
}} Division of Water Quality
Date IN -(first event sampled) , Attn: DWQ Central Files
Total Event Precipitation (inches): . �� 1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Date (list each additional event sampled this reporting period, and rainfall amount)
Total Event Precipitation (inches):
SWU-249-102107
Page 1 of 2
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."
113�/S
(Signatur f Permittee (Date)
SW U-249-102107
Page 2 of 2