NCG140025_MONITORING INFO_20170523

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
DOC TYPE
❑ HISTORICAL FILE
;r5 MONITORING REPORTS
DOC DATE
❑ jai C) a3
YYYYM M D D

M`�
NCDENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance on filling out th isform, please visit: http:Uportal.ncdenr.org/web/wq/wsjsuInpdessw#tab-4
Permit No.: N/C/_/_/_/_
Facility Na e: SS L,l N
° County:
Inspector: I
Date of Inspection:
Time of Inspection:
or Certificate of Coverage No.: N/C/fi/ I
Total Event Precipitation (inches): y,S
Phone No. _ �;1l —
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
(See information below.)
O/Yes ❑ No
Please verify whether Qualitative Monitoring must be performed during a "representative storm
event" or "measureable storm event" (requirements vary, depending on the permit).
Qualitative monitoring, requirements vary. Most permits require qualitative monitoring to be
performed during a "representative storm event" or during a "measureable storm event." However,
some permits do not have this requirement. Please refer to these definitions, if applicable.
A "representative storm event" is a storm event that measures greater than 0.1 inches of rainfall
and that is preceded by at least 72 hours (3 days) in which no storm event measuring greater than
0.1 inches has occurred. A single storm event may contain up to 1.0 consecutive hours of no
precipitation.
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 DWQ Regional Office.
By this signature, I certify that this report is accurate and complete to the best of my knowledge:
lt� C—,
(Signature of Permittee or Designee)
Page 1 of 2

a
1. Outfall Description:
Outfall No. I Structure (pi
Receiving Stream: � tk
etc.) ;
Descr e indu trial activities that occur withi the
Cs ". c��
2. Color: Describe the color of the discharge
(light, medium, dark) as descriptors:
I drainage area:
basic colors (red, brown, blue, etc.) and tint
3. Odor: Describe any dist4ct odors that the discharge may have (i.e., smells strongly of oil, .
weak chlorine odor, etc.). 74 JO►-4 ot—
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:
1� 2 3 4 5
6. Suspended Solids: Choose the number which best describes the amount of suspended
solids in the stormwater discharge, where 1 is no solids and 5 is extremely muddy:
r
2 3 4 5
7. Is there any foam in the stormwater discharge? Yes E
B. Is there an oil sheen in the stormwater discharge? Yes
9. Is there evidence of erosion or deposition at the outfaIl? Yes
10. Other Obvious Indicators of Stormwater Pollution:
List and describe
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.
SWU-242, Last modified 10/25/2012
Page 2 of 2

V,
r r..nlihrnti
HYDROGEN -ION CONCENTRATION (pH)
Calibration and Sample Analysis Log
1r__ _gamnlP AnalvciG 1
Datef ime
Analyst's
initials
*pH 7
Buffer
"pH 4
Suffer
*pH 14
Buffer
Slope or
Efficiency
TIME—
COLL. ANAL.
Sample ID
Sample
Result
Comments
i
Must check at least the pH 7 buffer and one other buffer bracketing the range of the expected sample concentration. To cover the entire range, check all
three buffers.
* Samples must be analyzed within 15 minutes of collection

STORMWATER DISCHARGE OUTFALL (SDO) - Semi -Annual -MONITORING FORM
GENERALPERMIT NO. NCG140000
CERTIFICATE OF COVERAGE NO. CG14�
FACILITY NAME: �iP �'�i l�u•i�C��1
PERSON COLLECTING SAM LE5 C_,
CERTIFIED LABORATORY Ot' Lab `1
Lab #
OPTIONAL INFO:
Part A: Stormwater Monitoring Requirements
SAMPLE COLLECTION YEAR: -zo/ !
SAMPLING�£RIOD ❑ July -December , nuary-June
COUNTY Rjj jAi.�,-_
PHONE NO. ( qt,:�) - 2
ADD TO LISTSERVE? ❑YES PO EMAIL:
DISCHARGING TO CLASS: ❑SA ❑HQW ❑PNA []Trout
[]Other
Outfall No
Date Sample :
Cofiected -
(mo/dd/yr OR
1.
NCM:FLOW} ::
PN -:
{standard
llntts },
a
- 7SS r mm
Y
a (fig/L)
Event',Tofal
Duration
(minutes)
Rainfall
In i ier
"L IVlonthly ` r
Monitor�ng7; r
tt of Months m Tier'
,-
a 2 Samplmg2
' If "NO FLOW" or "NO DISCHARGE, Enter "NO FLOW" or "NO DISCHARGE" for each outfall here. Please make sure to mark the sample period above.
Z If a value is in excess of the benchmark, or outside the benchmark range (for pH), you must implement the Tier 1 or Tier 2 responses in the General Permit. Tier 2
Monthly sampling shall be done until 3 consecutive samples are below the benchmark or within the benchmark range.
3 TSS benchmark values are 100 mg/I, except when discharging to ORW, HQW, Trout, and PNA waters where they are 50 mg/l.
For each sampled measurable storm event the total precipitation must be recorded using data from an on -site rain gauge.
Permit Date: 7/1/2013-60/30/201S Last Revised 7/13/11
Page 1 of 2

Part B: Vehicle Maintenance Activity Monitoring Requirements for facilities using > 55 gal of new motor oil/month — averaged over a calendar year.
Outfall
No.
is r.
:.,.Date,S'amples.
— = Collected
i
pH
r
Standartl. =
tts
�':~-,n',.
..
�TPH using�methad
= 166t1;ASGT HEM,
L
{fng/�
1
y...
i�i,- 1 �.: a :.E;
,.. a
Tiat2 „Suspend d
_ u; ::
—` , Solids,o
r ..
rr1' " L , c
ert { gl �i�
i :,�Iw'"a. P �
_Eve t' ,,
_ n
~' ,i
Duration;
:minutes;
-
'e, '� :� e�',1 ,.:'.� I
ti ,, It { ,r
r }�7Q a a
Ralnfafi v-;
�. *
mr
9 �:,J A
�, w
Nq Motor 0�I
' Usa e° -�
I�`I,' g : w�
:_; al month " IF
,(g a�
I-T
i Ad
-,':{
P In T+er 2�J u
F, P-,
Y
=.Monitarin 7 I
51,;, h:l
,� a
r.l: - (Y/nj
. jS
rp V.eN C�' -
4t of ant s
`e "7nPTier 2� :
, .
' 4Sam"I�ny
ram' p, g _r
7..
- ' .J _
., fi.9
10Q .'..
,'k- ..:_.
,:•'� ;`F
-�a__ .� `.
:! _ �.. d..l_:
i P5 f".R�,
--
L60
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES AT ANY ONE OUTFALL (INCLUDING VEHICLE MAINTENANCE)? YES ❑ NO ❑
HAVE YOU CONTACTED THE REGION? YES ❑ NO [,
REGIONAL OFFICE CONTACT NAME:
Mail OriRinal and one copy of this DMR (including all "No How" & "No Discharge" reports) within 30 days of receipt of sample (or at end of monitorine period
in case of "No Flow" 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 l re are significant penalties for submitting false information, including the possibility
rof fines nd imprisonment for knowing violations."
c�1`44 f� �-_3
(Signature of Permittee) (Date)
Permit Date: 7/1/2011-60/30/2015 Last Revised 7/13/11
Page 2 of 2

�t I
13
C-va
STORMWATER DISCHARGE OUTFALL (SDO)
VISUAL MONITORING REPORT
Cectific
Facfflry
Counry
lnspm
Date of
'A-Mo--J-ot�
By This signature. I certify that this report is accurate and complete to the best of my
knowledge: , , ,
2
I. Outfall Description
Outfall No. �. 1 Structure (pipe, ditch, ctc.)_
Reccsving Stream 'C Qe
Describe the jndusir�iai activities that occur within the outfadl image axes
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 oit weak
chlorine odor, etc.).-
P'Ue I Of
�8 -..'94
80/i9 39tid
XIVJ AQti3�1 May b085S5tr0t6 bE�iT L00�/YZ/0T

4 _ Clarity
Choose the number which best describes the ciadty of the discharge where ] is clear and t a
is very cloudy:
1 9Z 3 5 6 7 8 9 10
5. Solids
Choose the numbet which best describes the amount of solidi in the stormwater discharge
where i is no solids and 10 is extemely muddy:
1 2 4 5 b 7 8 9 10
6. Foam
Is there any foam in the stormwater discharge? YES
7. Oil Sheen
Ls there an oil sheer, in the storromater discharge? YES hFO,
9. Outran Staining
Describe an) staining around the stormwater otitfall:
9. Other Indicators
Describe any other obvious indicators of stormwater pollution:
NOTE. Lave claritk'. high solids and/or Ehe presence of fozr, oil shcens, or outfa3,
LC'.1'Iltit mz-,' be of pofluiatlt=kpc<L;re, ; lies.' conditions rnay war ,ni
60/Z0 39VJ XIW AGV3H MBS b08SSSb0TS bE:TT L00Z/TZ/0T

STORMWATER DISCHARGE OUTFALL (SDO)
VISUAL MONITOMG REPORT
Certificate of Coverage No. NCG o
Facility N 1 vauj e
County Phone
Inspector—.,.,
Date of Insprctiox 4 ►a
By this signature. I certify that this mpon is accurate and comgime io the best of my
knowledge- . t ,
{Signature of perminge or
1. Outfail Description
Outfall No. _J. -
Receiving Stream
Structure (pipe, ditch, cw. >:
Describe the irtdu teal activideS that occur To-
the outfall drainage area:
2.
Color
Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, mediwu, dark) as descriptors:
3. Odor
Describe any distinct odors that the discharge may have (i.e. smells strongly of oil, weak
ctlEorinc odor, ctc.):
Pagt i of 3
8r']:94
80 /E8 39V8
XIW AGV38 MTS
b88SSSb0T6 VE : TT tOK/TZ/0T

4 _ Cli ari ty
Choose the number which best describes the clarity of the discharge where I is clear and 10
is very cloudy:
I 2 �°j? S 6 7
8 9 10
S . Solids
Choose the number which best describes the, amount of solids in the stormwater discharge
where I is no solids and 10 is extemely muddy:
1 �5 3 4 S 6 7
8 9 10
6. Foam
Is there any Roan in the storm water discharge? YES
7. Oil Sheen
Is there an coil sheen in the stormwater &SC1 arge? YES
S . OutW1 Staining
Describe any staining around the stonnwater outfaH.
9. Other Indicators
Describe any other obvious indicators of stormwamr pa}iu6on:
\'OTC: Lose ciari�+, bigh soh s and/or .he presence of foam . oil sheens, or oulfall
sminino he indicasz•:. of poliuta,7: exposure. Tbe;e conditions .n=y warrLn-
F,. rzher;n eS�eadori_
Pa s
TM XIW AQd36 MSS b08995b0T6 VE:TT L00Z/TZ/OT
80/00 39tid

r
STORMWATER DISCHARGE OUTFALL (SDO)
VISUAL MONITORING REPORT
Certificate of Coverar No.
Facility N
County
Inspector..
Date of Ynspection�-TVA - !-_0 3
By this signarare, I certify that this report is accurate and complete to the best of my
knowledge: , .
of
I . Outfall Description
Outfan No Structure (pipe, ditch,
Receiving Stream: 11 T 0�
Describe the industrial activities that occur %yithin the outran drainage area -
Color
Describe the color of the discharge using basic colors (red, brown, blue., etc.) and tint
(light, medium, dark) as descripEors:
3. Odor
Describe any distincE odors that the discharge may have (i.e. smells strongly of oil, weak
chlorite odor, ere..):
80/50 3Sdd
Page. ; of
XIW AGV3�1 MT5
S: 11;94
b8899500T6 bE:TT L00L/TZ/0T

4. Clarity
Choose the number which best describes the clarity
of the discharge
where l is vicar and 10
is very cloudy:
1 3 5 6
7
8 9 10
5. Solids
Choose the number which best describes the amount
of solids in the stannwamr discharge
where 1 is no solids and 10 is externely muddy:
1 © 4 5 6
7
8 9 10
6, Foam
Is there any foam in the s=mwater discharge?
YES
7. Oil Sheets
Is there an oil Sheen in the stormwater discharge?
YES
8. Outfati Staining
Describg any staining around the stortinwater outfall:
9. Other Indicators
Describe any other obvious indicators of stormwater pollution:
NOTE. Low cleric%-, hire solis ardlor tote presence of fozi-n, oil sheens', or outfa11
staiyning mak, he irt�iicau' -f of polluiant exrosurc. Tnc>' conditions may warTani
fi:^hcr 1Ti�eS'�gG=sort.
Pare 2 ?
80/90 39va XIW AaV38 MSS b085SSb0T6 bE:TT L00Z/TZ/0T

STORNWATER DISCHARGE OUTFALL (SDO)
VISUAL MONffOR NG REPORT
Certificate of Coverage rb_ I�CG
Facility Naroe: S SLJ
llsv'etl- -bp-
County:
Date of 1_ASDCC60ri:
By a IS signarure, i Certify that this report is acc=tc and complem to the bm of mj.
knowledge' /�
(Signature of perm✓,'i W or )
1. Outfa[l Description
Outfali No.
Receiving Stream._
Describe the industrial activide$ that
r I k C1 r
2. Color
Structure (pipe• dirch, etc.).-- ` tom"`-
within tt outfall drainage area:
Describe tlu color of the charge using Wic Colors (red, browa. blue, etc.) and tint
(light, medium, dark)as dtScnptnrs:
3. Odor -
Describe any diis4nct odds that the discharge may have (i-e. Sri Us strongly of oil, weak
Chlorine odor, etc-):
P:h v 1 of .
5 .. Y-;
BO/LO 30ad XiW lOMI MBS b0899900 6 tE:TT L00Z/TZ/OT

4. Clarity
Choose the number wtuch Est desuibes tha clarity of the discharge wh= I is clear and 14
is very cloudy:
3 , 5 6 7 8 9 10
5. Solids
Choose the number which best describes the amount of solids m the stormwamr discharge
where 1 is no solids and Ia is extemely muddy:
i - 2 :3 4 S 6' T 8 9 Ia
6. FORM
Is there any foam in the suormwatrr dis duap?
7. Oil Sheen,
Is there an oil sheen in the stormwater discharge'` YES Cam,
9. Outfalt Staining
Describe any staining around the stonnwater outfall:
9 . Other Indicators
Describe any other obvious indicarars of stormwater po3ludow
NOTE. Low c2a^l1v. h;gl,sTl1 : and/or the pFesenct of foam, W! S�Ets s- -3, 001f al'; '
Past 7 of ,
80/80 3E)Cd XIW AaV38 MBS 0085S9b0TG bE:TT L00Z/TZ/0T