NCG160042_MONITORING INFO_20180720

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT N0. /v Cc, / b l,)(-"1
DOC TYPE I ❑HISTORICAL FILE
EY MONITORING REPORTS
DOC DATE ❑ J O' Tj (i rI
YYYYMMDD

Semi-annual Stormwater Discharge Monitoring Report (DMR)
for North Carolina DEMLR General Permit No. NCG160000 - Asphalt
Date submitted June 6, 2018
CERTIFICATE OF COVERAGE NO. NCG160042
FACILITY NAME APAC Atlantic, Inc. Plant #40
COUNTY Forsyth _
PERSON COLLECTING SAMPLES Tommy Prokop
LABORATORY ENCO Lab Cert. # 591
Comments on sample collection or analysis:
Part A: Stormwater Benchmarks and Monitoring Results
SAMPLE COLLECTION YEAR 2018
SAMPLE PERIOD ® Jan -June ❑ July -Dec
or ❑ Monthly' (month)
DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
❑Zero -flow ❑Water supply ❑SA
RECEIVED ®Other Class C (Leak Fork)
JUL 2 a 2018 PLEASE REMEMBER TO SIGN ON THE REVERSE 4
CEN`VRAL FILES
CWR SECTfpN❑ No discharge this period?'
Outfall�No.
.. v
Date�Samplek''_
Collected" ',
{mo/dd/yr)
24-h66r rainfalh
amount, ':
Iriches3,
Total Suspended Solids '
Benchmarks =__>
_ o. il
_ <
100 mg/L or 50 mg/L°.
001
04/24/2018
0.90
110
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.
' See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Note: Results must be reported in numerical format. For example, 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/U' where XX is the numerical value of the
detection limit, reporting limit, quantitation 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.
Permit Date: 10/1/2014-9/31/2019 SWU-252, last revised 9/17/2014
Page 1 of 2

❑ No discharge this period?'
Outfall No:
-,.Date Sample
Collected"
(mo/dd/yr)
24-hour rainfall`
: ' ' amount
Inches 3 ...
Non -polar O&G by EPA'
1664.(SGT-HEM) ;
Total Suspended -Solids '
Benchmarks =-_>
_
-
15 mg/L
3.00' /L or 50 mg/L°
Footnotes from Part A also apply to this Part B
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 SINGLE BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS.
• 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 DEMLR REGIONAL OFFICE AS REQUIRED BYTHE PERMIT? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an original and one copy of this DMR, including all "No Discharge" reports. within 30 dovs of receipt of the lab results (or at end of_monitoring_p_.eriod
in the case of "No Discharge" reports) to:
Division of Water Resources
Attn: DWR 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 at there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
0fi 06 gas
(Signature of Permittee) (Date)
Permit Date: 10/1/2014-9/31/2019 SWU-252, last revised 9/17/2014
Page 2 of 2

f �f0
t_Laborato
Accurate. Timely. Responsive, Innovative,
102-A Woodwinds Industrial Court
Cary NC, 27511
Phone: [phone] FAX: [phone]
Friday, May 4, 2018
EI Group, Inc. (TH005)
Attn: Doug Albrecht
2101 Gateway Center Blvd., Suite 200
Morrisville, NC 27560
RE: Laboratory Results for
Project Number: [none], Project Name/Desc: APAC Plant 40
ENCO Workorder(s): CB01690
Dear Doug Albrecht,
Enclosed is a copy of your laboratory report for test samples received by our laboratory on
Wednesday, April 25, 2018.
Unless otherwise noted in an attached project narrative, all samples were received in
acceptable condition and processed in accordance with the referenced methods/procedures.
Results for these procedures apply only to the samples as submitted.
The analytical results contained in this report are in compliance with NELAC standards, except
as noted in the project narrative if applicable. This report shall not be reproduced except in
full, without the written approval of the Laboratory.
This report contains only those analyses performed by Environmental Conservation
Laboratories. Unless otherwise noted, all analyses were performed at ENCO Cary. Data from
outside organizations will be reported under separate cover.
If you have any questions or require further information, please do not hesitate to contact me.
Bill Scott
Project Manager
Enclosure(s)
FINAL This report relates only to the sample as received by the laboratory, and may anly be reproduced in full. I Page 1 of %

s�
www.encolabs.com
SAMPLE SUMMARY/LABORATORY CHRONICLE
Cllentl0: PLANT40 Lab1D: C801690.01 Sampled: 04/24/18 13:30 Received: 04/25/18 11:42
Parameter Preparation HE DatelTimefs7 Prep Date/TimeW Analysis Date1Timefs]
SM 254OD-1997 NO PREP 05/01/18 05/01/18 15:35 05/01/18 1535
FINAL This report relates only to the sample as received by the laboratory, and may only be reproduced in full. I Page 2 Of 7

CcEO
www.enculabs.com
SAMPLE DETECTION SUMMARY
Client ID: PLANT 40 Lab ID: C801690-01
Analvte ResulGt ELaS MDL POL Units Method Notes
Total Suspended Solids 110 12 12 mg/L SM 254OD-1997
FINAL This report relates only to the sample as received try the laboratory, and may only be reproduced In full. Page 3 Of 7

C�GMD
www.encolabs.com
ANALYTICAL. RESULTS
Description: PLANT 40 Lab Sample ID: CB01G90-01 Received: 04/25/18 11.42
Matrix: Water Sampled.04/24/18 13:30 Work Order: CB011590
Project) APAC Plant 40 Sampled By:TOMMY PROKOP
Classical Chemistry Parameters
^ - €NCO Cary—fred analyte (NC 5911
Analyte rCAS Number) Results wag Units DM MDL Pal Batch Method Analyzed By Vgtes
Total Suspended SolidsA 110 mg/L 5 12 12 SE01002 SM 2540D-1997 05/01/18 15:35 OMR
FINAL This report relates only to the sample as received by the laboratory, and may only be reproduced In Pull. I page 4 Of 7

(9 � �0 9
www.enmlabs.com
QUALITY CONTROL DATA
Classical Chemistry Parameters - Quality Control
Batch SE01002 - NO PREP
Blank (8E01002-111.1(l) Prepared & Analyzed: 05/01/2018 15:35
Spike Source %REC RPD
Andyle Result Flan POL UniU Level Result 0/aREC waus RPD Limit Notes
Total Suspended Solids 2.5 U 2.5 mg/L
LCS (8E01002-BS1) Prepared & Analyzed: 05/01/2018 15:35
Spike Source %RRC
RPD
ADRIVIe
Result ELM
Pal.
units
Level Result %AEC .Lim ti g
RPD
M ii Notes
Total Suspended Solids
88
2.5
mg/L
100 88 80-120
Duplicate (SE01002-DUP2)
Prepared &Analyzed: 05/01/2018 15:35
Source: C901514-01
Spike Source %REC
RPD
Anallyte
R sul Flag
P-0L
Wits
level Resul c/o REC Limits
RPD
L M11 (totes
Total Suspended Solids
53
10
mg/L
57
7
20
Duplicate (8E01002-13UP2)
Prepared & Analyzed: 05/01/2018 15:35
Source: C001690-01
Spike Source %REC
RPD
Analvte
Result Ban
POL
Units
Level Result %REC Limits
RPD
Limit Notes
Total Suspended Solids
100
12
mg/L
110
M
20
FINAL TNs report relates only to the sample as rKelved by the laboratory, and may only be reprodumd in full, Page 5 Of 7

www.encolabs.com
FLAGS/NOTES AND DEFINITIONS
B The analyte was detected in the associated method blank.
D The sample was analyzed at dilution.
] The reported value is between the laboratory method detection limit (MDQ and the laboratory method
reporting limit (MRL), adjusted for actual sample preparation data and moisture content, where applicable.
U The analyte was analyzed for but not detected to the level shown, adjusted for actual sample preparation
data and moisture content, where applicable.
E The concentration indicated for this analyte is an estimated value above the calibration range of the
instrument. This value is considered an estimate.
MRL Method Reporting Limit. The MRL is roughly equivalent to the practical quantitation limit (PQL) and is
based on the low point of the calibration curve, when applicable, sample preparation factor, dilution
factor, and, in the case of soil samples, moisture content.
PQL PQL: Practical Quantitation Limit.
N The analysis indicates the presence of an analyte for which there is presumptive evidence (85% or greater
confidence) to make a "tentative identification".
Greater than 25% concentration difference was observed between the primary and secondary GC column.
The lower concentration is reported.
FINAL This report relates only to the sample as received by the IaboraWry, and may only be reproduced in tall. I Page 6 of 7

Sample Chain of Custody Form
Acct#: TH005 Prelog #: CB01690
Client El Group. Inc. (TH005) Project#iReference: APAC Plant 40
Contact: Doug Albrecht Required TAT: 10
Ship To: 2101 Gateway Center Blvd., S►1i1e 20
Morrisville, NC 27560
Report To: 2101 Gateway Center Blvd., Suite 20
Morrisville, NC 27560
ENCO Contact: Lill Scott
102-A Woodwinds Industrial Court
Cary, NC 27511
lvlordsville. NC 27560
CBOi690-01 % F6 / m - �,/f d f') - Analyses: TSS SM2540D
Containers: 1 - 1t P
sampled By: 7en3p' Pei ZEAVI,10-�Cf—'�-�_
ned by::
Condition: _Acceptable _Unacceptable C . ec1 By: l
Notes
-I/LS = l lig1
Date(lTime: 44
Date/Time:
CcInlair:ers io ll4' 541Ir11iio I, It !ray DO, -lain ;J'wllmal r1v.%erv,;lices 0� rocFl;rt!:; bi II Ie Ut=A oendu:o:l !n!.:ra:.±avor+!110 mni7:WCan no four,o tala. 00 N01 rinse contamers prior tr
use'-
Y'hen t11ling pfa'C{y Ca C&Titalr..rrs uli-o G-F.II:C!1 not to Intl,99 vapi%,,hot msy �t1 4a,;Sed in !iw oler- (kii rwr.':Cri IIiY-:•t`-�M�. Its '�S,{;i1[.in A,N" 0(vati ?s r-,llaCt Sal troes in.] N _11-venlllateil area
take apy vp'See c.-i:li'JasG u,:'r t±Jr;atnNt� to I! �a S,ua;;ary- of Rn' fr,anr!;,ly
It is t1lo sn:ppel's respo,ssitO,ly to onsure lma! the sa,np!&5 art, vaci ed nt guff, a Magner to pro--erlt bmaKa14e am, ihrr. sl"-y rrovui,ed ternpe!ta1t4ty i5 nlafniained during minsil unlit reGE:pi at the
laboratory .
A ternveralu_e blank ha; been inOuded to rnetisu,e Ole arlm::enl tamperalure r,f tl,.• euo'_r x¢: ,`';e ri:e :kt t°us rF,rnr a ltr� gnl.7i,s-x tram :tea crxavr, tw:;�a:'r. steno w.tfi tna
samples in a Similar manner, Th:s bottle certain oe:on _LEt earns onir,
The inrOFnls;(Qlt below are PRECAUTIONARY 53 ATChi[NTS ONLY! All iY?..: :ul hs: vr�i• ;:us:eC b� tree: rla3 _'r,a:s !+er_ -t:�! !.L C!t a':l;arasxa:t r�:: arY.lilr:al ir,Crr!8€cr'. 9• assislaltce. Plr•asC
Contact your organ4atiwvs safely rlfoleS iwai_
Caut ons & Abbrwiazlons
HCI : HyarochIo=Acta - STRONG ACID! Avolo skin and uru canmc: 41 u..ntarl is rna:±e- r�t;a a;:,ar:++t€ pi=,�a �•rmr� __:� ricer. welt¢;.
HNO3;NitricA,,iO - STRONG ACIDI SFRONG QXlOV; R" rwo'o skin arul ey<, cgnlav t[:. It,w: it matt._ l..?€i 1^R !:'d +t �05 inrnq¢4a7; ly y:il:l Astc"
HVOh' PhuWhoric Acid --Gi RONG AClrl! Huai.[ sklr, Wfl;7 "' It crr-ra:t ,c e s•.i. ' to r?'T-cie-.r t,­4c VAI! WMW
N'.50e : Sutftxic Acid - STRONG ACID! Avoid skin . no rat c crr.;a::. 1: r.;r ram: i5 mass f� r.r• attr:L'i. >,t" _•yr n , ?d13tr':; r,=:h rnt +
Aie Acid ; Mucti6c Acid - Amid thin w d eye oonttx-l. t: cor,'o: l 15 1lf,Je. iliG!? tYl^C:e+i ra•?Qs +Fl.n>.�315;�7 ';•ll� .c WY_:
ZnAc . Z;nc Acetate - Amid skin and eve Contact if oont=. t5 n.3de (lush a(feG'JC sells :mr?e;tsata!y wi;'1 s:rltCr P`J
a e 1 OT
NaH$Gk i $oat !11 3hlncul!alg -A or(t sl i� $n.H &yt CO S:t =. 3[ rvnllact i5 I: e, flu:Jl aft Iti MQN.s imr. !4fy Y Itt Ktl! :
NaOH ; StxsiLm Hydroxide - ST[IONG CAUSTIC: Amp sk=n and eye comtact, it Gn:l[$ut -is r.,aoe. ilt:s;, rl"adsrl arnns ,ru+?Gdiotaly .=fn-nalel
NIeOH :.rOelkianol • Avoid SAIn and Aye conlaiu I' COrilaC: :_ :t,atle teas;, A!!'r[led 'arena n;l rli:tVaF>. With Sr.;18r.

STORMWATER DISCHARGE OUTFALL (SDO) 199
ANNUAL SUMMARY DATA MONITORING REPORT (DMR) L5 t1 V
Calendar Year: 2017
FEB 2 0 2018
Individual NPDES Permit No. NCS ❑❑❑❑❑❑ or
=AR 01lR Eg
Certificate of Coverage (COC) No. NCG 160 442 ao1 RMifToNr;
This monitoring report summary of the calendar year should be kept on file on -site with the facility SPPP.
Facility Name: APAC Atlantic, Inc. Plant # 40
County: Forsyth County
Phone Number: [phone] Total no. of SDOs monitored: 1
Outfall No. 001
Is this outfall currently in Tier 2 (monitored monthly)? Yes ❑ No
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ❑ No
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes ❑ No
Parameter, units
Total Total
Rainfall, Suspended
inches Solids mgil
Benchmark N/A 100
Date Sample
Collected,
mmlddlyy 4:
NOT
SAMPLED
SWU-264-Generic-13Dec2012

I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a
system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person
or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the
best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information,
including the possibility of fines and imprisonment for knowing violations,"
Signature
Date _2/14/18
For questions, contact your local Regional Office:
DWQ Regional Office Contact Information:
ASHEVILLE REGIONAL OFFICE
2090 US Highway 70
Swannanoa, NC 28778
[phone]
RALEIGH REGIONAL OI
3800 Barrett Drive
Raleigh, NC 27609
[phone]
INSTON-SALEM REGIONAL OFFIC
585 Waughtown Street
Winston-Salem, NC 27107
- - -- - [phone] ._-- - — ---
FAYETTEVILLE REGIONAL OFFICE
225 Green Street
Systel Building Suite 714
Fayetteville, NC 28301-5043
[phone]
WASHINGTON REGIONAL OFFICE
943 Washington Square Mall
Washington, NC 27889
[phone]
CENTRAL OFFICE
1617 Mail Service Center
Raleigh, NC 27699-1617
_ _ (919) 8o7_6300 _.._.__......_.._....
MOORESVILLE REGIONAL OFFICE
610 East Center Avenue/Suite 301
Mooresville, NC 28115
[phone]
127 Cardinal Drive Extension
Wilmington, NC 28405-2845
[phone]
"To preserve, prolecl
and enhance
Norm Carolina's waler..."
S WU-264-Generic-13Dec2012

f
Semi-annual Stormwater Discharge Monitoring Report (DMR)
for North Carolina DEMLR General Permit No. NCG160000 - Asphalt
Date submitted - 07116/2016
CERTIFICATE OF COVERAGE NO. NCG160042 R EC E I V E DmPLE COLLECTION YEAR 2D16
FACILITY NAME: APAC Atlantic, Inc. Plant #40 SAMPLE PERIOD ® Jan -June ❑ July -Dec
COUNTY: Forsyth FEB 2 0 2017 or ❑ Monthly' (month)
PERSON COLLECTING SAMPLES: Robert Settle DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
LABORATORY: Prism Lab Cert. N 402 CENTRAL FILES ❑Zero -flow ❑Water Supply ❑SA
Comments on sample collection or analysis: DWR SECTION ®Other. Leak Fork
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Part A: Stormwater Benchmarks and Monitoring Results
No discharge this period?'
Outfall No.
bate Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
Inches'
Total Suspended Solids
Benchmarks =__>
-
-
100 mg/L or 50 mg/O
001
07/06/2016
6.2
as
'Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
'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 text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Note: Results must be reported in numerical format. For example, 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 mp,/L", where XX is the numerical value of the
detection limit, reporting limit, quantitation 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.
Permit Date: 10/1/2014-9/31/2019 SWU-252, last revised 9/17/2014
Page 1 of 2

n No dischorae this period?-'
Outfall No.
Date Sample
Collected'
(ma/dd/yr)
24-hour rainfall
amount,
Inches'
Non -polar O&G by EPA
1664 (SGT-HEM)
Total Suspended Solids
Benchmarks =__>
-
15 mg/L
100 mg/L or 50 mg/O
Footnotes from Part A also apply to this Part Et
Note: if you report a sample value in excess of the benchmark, you must Implement Tier 1, Tier 2, or Ter 3 responses. See General Permit text.
FOR PART A AND PART B MONITORING RESULTS:
+ A SINGLE BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS.
• 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 OEMLR REGIONAL OFFICE AS REQUIRED BY THE PERMIT? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an oriainal and one copy of this DMR, includina all "No Discharge" reports within 30 days of receipt of the lab resultsAr at end of monitorina_period
in the case of "No Discharge" reports) to:
Division of water Resources
Attn: DWR 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 theregre significant penalties for submitting false information, Including the possibility of fines and imprisonment for knowing violations."
ure of Permittee) (Date)
Permit Date: 10/1/2014-9/31/200 SWU-252, last revised 9/17/2014
Page 2 of 2

P
P'RCISM
► \7LhaORATORlES 1W,,
Full -Service Analytical &
Environmental Solutions
El Group, Inc. - Morrisville
Josh Dunbar
2101 Gateway Center Dr Ste. 200
Morrisville, NC 27560
NC Certification No. 402
NC Drinking Water Geri No_ 37735
SC Certification No. 99012
FL NELAC Cert No. E87519
VA NELAC Cent No, 460211
Project: APAC Stormwater Testing
Project No.: Plant # 40
Lab Submittal Date: 07/08/2016
Prism Work Order: 6070145
Case Narrative
07/15/2016
This data package contains the analytical results for the project identified above and includes a Case Narrative, Sample
Results and Chain of Custody. Unless otherwise noted, all samples were received in acceptable condition and processed
according to the referenced methods.
Data qualifiers are flagged individually on each sample. A key reference for the data qualifiers appears at the end of this case
narrative.
Please call if you have any questions relating to this analytical report.
Respectfully,
PRISM LABORATORIES, INC.
Angela D. Overcash
VP Laboratory Services
Data Qualifiers Key Reference:
BRL Below Reporting Limit
MDL Method Detection Limit
RPD Relative Percent Difference
Reviewed By Cara C. Rusmisell For Angela D. Overcash
Project Manager
* Results reported to the reporting limit. All other results are reported to the MDL with values between MDL and
reporting limit indicated with a J.
This report should not be reproduced, except in its entirety, without the written consent of Prism Laboratories, Inc.
449 5pringbrook Road - P.U. Box 240543 - Charlotte, NC 28224-0543
Phone: [phone] - Toll Free Number: 1-800/529-6364 - Fax: [phone] Page 1 of 5

�.
Full-SFull-Servicetii Sample Receipt Summary
LnR I S M I Environmental Solutions 07/15/2016 LeaORIROREB AMC.
Prism Work Order: 6070145
Client Sample ID Lab Sample ID Matrix Date Sampled Date Received
001 6070145-01 Water 07/06/16 07/08/16
Samples were received in good condition at 5.9 degrees C unless otherwise noted.
This report should not be reproduced, except in its entirety, without the written consent of Prism Laboratories, Inc.
449 Springbrook Road - P.O. Box 240543 - Charlotte, NC 28224.0543
Phone: [phone] -Toll Free Number: 1-8001629-6364 - Fax: [phone] Page 2 of 5

&)RI S M Full -Service AnalyticalEnvironmental Solutions
p'R�eon�raeas ewe
El Group, Inc. - Morrisville
Attn: Josh Dunbar
2104 Gateway Center Dr Ste. 200
Morrisville, NC 27560
Project: APAC Stormwater Testing
Project No.: Plant # 40
Sample Matrix: Water
Laboratory Report
Client Sample ID: 001
Prism Sample ID: 6070145-01
Prism Work Order: 6070145
Time Collected: 07/06/16 14:30
Time Submitted: 07/08/16 14:15
0711512016
Parameter Result Units Report MDL Dilution Method Analysis Analyst Batch
Limit Factor DatefTime ID
General Chemistry Parameters
Total Suspended Solids 88 mg/L 5.0 0.80 1 -SM 2640 D 7112116 14:55 SLS P6130190
This report should not be reproduced, except in its entirety, without the written consent of Prism Laboratories, Inc.
449 Springbrook Road - P.O. Box 240643 -Charlotte, NC 28224-0543
Phone: 704l529-0364- Toll FmeNumber; l-000/529-6364- Fax: 704l52"409 Page 3 of 5

4
JII Fall -Service Analytical &
- L1P L M I Environmental Solutions
a.eeMzo�cs .c
El Group, Inc. - Morrisville
Attn: Josh Dunbar
2101 Gateway Center Dr Ste. 200
Morrisville, NC 27560
General Chemistry Parameters - Quality Control
Project: APAC Stormwater Testing
Project No: Plant # 40
Level II QC Report
7115/16
Prism Work Order: 6070145
Time Submitted: 7/8/2016 4:15:00PM
Reporting Spike Source %REC RPU
Analyte Result Limit Units Level Result %REC Limits RPD Limit Notes
Batch P6G0190 - NO PREP
Blank (PSG0190-BLK1) Prepared & Analyzed: 07/12/16
Total Suspended Solids BRL 5.0 mg/L
LCS (P6G0190-BS1) Prepared & Analyzed: 07/12/16
Total Suspended Solids 440 5.0 mg1L 477,0 93 90-110
This report should not be reproduced, except in its entirety, without the written consent of Prism Laboratories, Inc.
449 Springbrook Road - P.O. Box 240643 - Charlotte, NC 28224.0543
Phone: [phone] -Toll Free Number: 1-6001629.6364 - Fax: [phone] Page 4 of 5

xS,�sy:; ,_ ....., [:'r.� 'fh M :pis'?r:1;'ra.:• _..s/�:•:_�!.•:-- ry..r ...-.. .._.Y.------- -__.
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Fuil-Service Analytical &
CHAIN ®F CUSTODY RECORD
�Im'�gq.� i S Environmental Solutions PAGE OF � OUOT`E aTO ENSURE PROPER BILLING:
' V1LAf30RAT0 IES. INC
I
449 Springbrook Road - Charlotte, NC 28217
Phone [phone] - Fax: [phone]
Client Company Name:
Report To/Contact Name: 'I a+ S& e�
Reporting Address: g136 A. C—It'jn AV,.
%U-S NL 27+os
Project Name:
Short Hold Analysis: (Yes) (No) UST Project: (Yes) (NO)
"Please ATTACK any project specific reporting (QC LEVEL 1 1)111 IV)
provisions andlor QC Requirements
Invoice To:
Address:
l,VJ1VUY5CNL7
VOLAT ILES: r-_C:1 I,
PROPER CONTAR
TEMP. Therm ID
YE5 NO
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Phone.-334 _ 70(. - 99.2ax (Yes) {No): -7L 7 - 3"i 9 ) Purchase Order No./Billing Reference
Email Address: rA . Sf141ctR 440&C. CQfn Requested Due Date ❑ 1 Day ❑ 2 Days ❑ 3 Days C14 Days LI 5 Days
EDO Type: P DF i!EXce l ✓other: "Working Days" O 6-9 Days ❑ Standard 10 days O RushWo;R Must Be
""—
Site Location Name: ! Samples received after 14:00 will be processed next business day.
Site Location Physical _Address: 14I30 u. G term J41/C Turnaround time is based on business days, excluding weekends and holidays.
(SEE REVERSE FOR TERMS Y. CONDITIONS REGARDINu SERVICES
i RENDERED BYMSMLABORATORIES, INC. TOCLIENT}
TO BE FILLED IN BY CLIENTISAMPLING PERSONNEL
Certification: NELAC DOD FL NC
SC OTHER NIA
Water Chlorinated: YES_ NO_
Sample iced Upon Collection: YES NO
CLIENT
SAMPLE OESCRIPTIDN
DATE
COLLECTED
TIME
COLLECTED
MILITARY
HOURS
MATRIX I
(SOIL,
WATER OR
SLUDGE)
SAMPLE CONTAINER
PRESERVA-
TIVES
ANALYSIS REQUESTED
REMARKS
PRISM
LAB
ID NO.
`TYPE
SEE BELOW
NO.
SIZE
001
7- & ita
N- 3
cc�r
�
�
�
i
I
i
r Sampler's Signature i6t:Sampled Sy (Print Name) �. SG Affiliation ;t-prt 'nAY., •
•
Upon relinquishing, this Chad of Custody is your authorization for Prism to proceed with the analyses as requested above. Any changes must he
submitted in writing to tho Prism Project Manager. There will be charges for any changes after analyses have been initialized.
R y ( net c
Rel"qqJ y: (Slgnatum) ' Ro
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Relinqu hed ey: ($ gnatu ) j
fibr—�1 y�.- -- —_
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//.Ignatur ate iGtoryr ours Additional Comments:
By-(Slgna urej - Date f- ly '\
r• f `
46
ed For flrisTjisboraiories 9y: Datb I
/ �, L '
,7y,- 7 ` r f d.
Sit eArrival 7,me:
Site Departuro Time:' "
F:eid Tech Fee
Mileage
Method of Shipmerd: NOTE: ALL MPL 10 RS SHOULD 5 EE TAPE5H SHUT UST0DY 5 EJA LS FOR TRANSPORTATION To THE LABORA DRY. GO Gror.p No. _
SAMPLES ARE NOT ACCEPTED AND VERIFIED AGAINST COC UNTIL RECEIVED AT THE LABORATORY. .y +�� %• /.t ! �./�
❑ Fed Ear ❑ UPS l7 Hand-0elivI
erad srn Field Serv+ca CI OtherNPDESLID E- OTHER:
UU 0SCTER: DRINKING
NC
13 NG ZI SCAR.
0 NC p 5C` NC ❑ SC ❑ NPC
DONO ❑SC U El SC EERCLA NO Q SC ❑ NCFILL
❑ SC� O NC ❑CC�
o rJ . i .
'CONTAINER TYPE CODES: A = Amber C = Clear G= Glass P = Plastir', TL = Teflon -Lined Cap VOA = Volatile Organics Analysis .(Zero Head Space)
- QREG11`J.4L

Semi-annual Stormwater Discharge Monitoring Report (DMR)
for North Carolina DEMLR General Permit No. NCG160000 - Asphalt
Date submitted _07116/2.016
CERTIFICATE OF COVERAGE NO. NCG160042
FACILITY NAME: APAC Atlantic, Inc. Plant #40
COUNTY: Forsyth ^
PERSON COLLECTING SAMPLES: Robert Settle
LABORATORY: Prism Lab Cert. # 402
Comments on sample collection or analysis:
Part A: Stormwater Benchmarks and Monitoring Results
SAMPLE COLLECTION YEAR 2016
SAMPLE PERIOD ® Jan -June ❑ July -Dec
RUpp � i\ j� nor ❑ Monthly' month
!'t k-O SCHARGING TO CLASS ❑ORW ❑HQW []Trout ❑PNA
AUG 12 ZUlb ❑Zero -flaw ❑Water Supply ❑SA
®Other: Leak Fork
CENTRAL FILES
D`jVR SECTION PLEASE REMEMBER TO SIGN ON THE REVERSE
❑ No discharge this period?2
Outfall No.
pate Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
Inches
Total Suspended Solids
Benchmarks =__>
-
-
100 mg/L or 50 mg/L4
001
07/06/2016
0.2
88
i Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
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.
4 See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Note: Results must be reported in numerical format. For example, do not report Below Detection Limit, BDL, <PQL, Non -detect, ND, or othersimilar 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, quantitation 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.
Permit Date: 10/1/2014-9/31/2019 SWU-252, last revised 9/17/2014
Page 1 of 2
"'40

No discharge this period?2
Outfal! No.
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
Inches3
Non -polar O&G by EPA
1664 (SGT-HEM)
Total Suspended Solids
Benchmarks =__>
_
-
15 mg/L
100 mg/L or 50 mg/L°
Footnotes from Part A also apply to this Part B
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 SINGLE BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS.
• 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 DEMLR REGIONAL OFFICE AS REQUIRED BY THE PERMIT? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an original and one copy of this DMR, includiny_all "No Discharge" reports, within 30 days of receipt of the_lab results for at end ofmo_nitorina period
in the case of "No Discharge" reports) to:
Division of Water Resources
Attn: DWR 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."
of Permittee
Permit Date:10/1/2014-9/31/2019
7_i) -1�,
(Date)
SWU-252, last revised 9/17/2014
Page 2 of 2

Semi-annual Stormwater Discharge Monitoring Report (DMR)
for North Carolina DEMLR General Permit No. NCG160000 - Asphalt
Date submitted 11/24/2015
CERTIFICATE OF COVERAGE NO. NCG160042
FACILITY NAME: APAC Atlantic, Inc. Plant #40
COUNTY: Forsyth
PERSON COLLECTING SAMPLES: Robbie Doub
LABORATORY: Prism Lab Cert. # 402
Comments on sample collection or analysis:
Part A: Stormwater Benchmarks and Monitoring Results
SAMPLE COLLECTION YEAR 2015
SAMPLE PERIOD Q Jan -June ® July -Dec
or ❑ Monthly' (month)
DISCHARGING TO CLASS ❑ORW ❑HQW [—]Trout ❑PNA
RE «V-L) ❑Zero -flaw ❑Water Supply ❑SA
AUG 12 Z016 ®Other: Leak Fork
CE-lT RAL F-IL.ES PLEASE REMEMBER TO SIGN ON THE REVERSE 4
DWR SE(3TION
No disc , rge• is period 3I
Outfall No.
pate Sample
Collected:'
(mo/dd/yr)
24-hour rainfall
amount,
Inches'
Total Suspended Solids
Benchmarks ==_>
_
100 mg/L or 50 mg/L°
001
-10/28/2015
1.5
< 2.8
' 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 maybe eligible for a waiver of the rain gauge requirement.
See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Note: Results must be reported in numerical format. For example, 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, quantitation limit, etc. in mg/L.
Note: if you report o sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier responses. See General Permit text.
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month.
Permit Date: 10/1/2014-9/31/2019 5WU-252, last revised 9/17/2014
Page 1 of 2

❑ No discharge this period?2
Outfall No.
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
inches;
Non -polar O&G by EPA
1664 (SGT-HEM)
Total Suspended Solids
Benchmarks ==_>
_
-
1S mg/L
106 mg/L or So mg/L°
Footnotes from Part A also apply to this Part B
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 SINGLE BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDANCES FOR THE SAME PARAMETER AT ANYONE OUTFALL? YES ❑ NO ❑
IF YES, HAVE YOU CONTACTED THE DEMLR REGIONAL OFFICE AS REQUIRED BY THE PERMIT? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an oriainal and one coon of this DMR, includina all "No Discharae" reports, within 30 do vs of receipt of the lab results for at end of monitorina period
in the case of "No Discharge" reports) to:
Division of Water Resources
Attn: DWR Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED:
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to
assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or
those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I
am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
(Signature of Permittee)
Permit Date: 10/1/2014-9/31/2019
(Date)
SWU-2S2, last revised 9/17/2014
Page 2 of 2

EFWA
HCU R
North Carolina Department of Environment and -Natural Resources
Pat McCrory
Governor
Mr. Clarence O. Brickey
APAC Atlantic lnc. - Thompson
Arthur Paving & Construction Division
300 South Benbow Road
Greensboro, NC 27420
Dear Mr. Brickey:
July 16, 2015
Donald R. van der Vaart
Secretary
RECEIVED
JUL 2 0 ?015
CENTRAL FILES
DWR SECTi7M1J
Subject: NPDES General Permit NCG160042
APAC Atlantic Inc.
Formerly Larco Construction
Certificate of Coverage NCG 160042
Forsyth County
Division personnel received your request to revise your stormwater permit Certificate of
Coverage to accurately reflect your new company and/or facility name.
Please find enclosed the revised Certificate of Coverage. The terms and conditions contained in
the General Permit remain unchanged and in full effect. This revised Certificate of Coverage is
issued under the requirements of North Carolina General Statutes 143-215.1 and the
Memorandum of Agreement between North Carolina and the U.S. Environmental Protection
Agency.
If you have any questions or need further information, please contact the Stormwater Permitting
Program at [phone].
for Tracy E. Davis, P.E., CPM, Director
Division of Energy, Mineral and Land Resources
cc: Winston-Salem Regional Office
Storrnwater Permitting Program Files
Central Files
Division of Energy, Mineral, and Land Resources
Energy Section • Geological Surrey Section - Land Quality Section
1612 Mail Service Center, Raleigh, North Carolina 27699-1612.919-707-92001 FAX: [phone]
512 North Salisbury Street, Raleigh, North Carolina 27604 • Internet: http:llportal.ncdenr.org/webA
An Equal Opportunity 1 Affirmative Action Employer — 50% Recycled 110% Post Consumer Paper

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF ENERGY, MINERAL, AND LAND RESOURCES
GENERAL PERMIT NO. NCG160000
CERTIFICATE OF COVERAGE No. NCG160042
STORMWATER DISCHARGES
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
In compliance with the provision of North Carolina General Statute 143-215.1, other lawful
standards and regulations promulgated and adopted by the North Carolina Environmental
Management Commission, and the Federal Water Pollution Control Act, as amended,
APAC Atlantic, Inc.
Thompson Arthur Paving & Construction Division
is hereby authorized to discharge stormwater from a facility located at:
Plant # 40
4130 Glenn Avenue
Winston-Salem
Forsyth County
to receiving waters designated as Leak Fork, in the Pee Dee River Basin, in accordance with the
effluent limitations, monitoring requirements, and other conditions set forth in Parts I, 11, III, and
IV of General Permit No. NCG160000 as attached.
This certificate of coverage shall become effective July 16, 2015,
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day July 16, 2015.
a�c , (zo
for Tracy E. Davis,,P.E., Director
Division of Energy, Mineral, and Land Resources
By the Authority of the Environmental Management Commission

Division of Energy, Mineral & Land Resources
Land Quality Section/Stormwater Permitting
National Pollutant Discharge Elimination System
NCDENR
NdmC.vouru Dowwnm+r w
PERMIT NAME/OWNERSHIP CHANGE FORM
FOR AGENCY USE ONLY
Date Received
Year
Month
Day
1. Please enter the permit number for which the change is requested.
NPDES Permit (or) Certificate of Coverage
N 10 19 10 1 1 1 1 N I C 10 1 1 16 1 0 10 4 2
II. Permit status prior to requested change.
a. Permit issued to (company name): Larco Construction
b. Person legally responsible for permit: Chris Venable
First MI Last
Area Manager
�yu J Title
4130 North Glenn Avenue
Permit Holder Mailing Address
Winston-Salem NC 27115
City State Zip
[phone] { }
Phone Fax
c. Facility name (discharge): Glenn Avenue
d. Facility address: 4130 North Glenn Avenue
Address
Winston-Salem NC 27115-6279
City State Zip
e. Facility contact person: Julian H. Lipscomb [phone]
First / M1 I Last Phone
III. Please provide the following for the requested change (revised permit).
a. Request for change is a result of: ® Change in ownership of the facility
❑ Name change of the facility or owner
If other please explain:
b. Permit issued to (company name): APAC Atlantic Inc. - Thompson Arthur Pavingf&
C D' '
onstruction tvtston
c. Person legally responsible for permit:
Clarence O Brickey_
First M1 Last
RECEIVED
President
Title
JUL 10 2015
300 South Benbow Road
Permit Holder Mailing Address
DENR-LAND QUALITY
Greensboro NC 27420
STORMWATER PERMJTTING
City State Zip
[phone] [e-mail]_
Phone E-mail Address
d. Facility name (discharge):
Plant #40
e. Facility address:
4130 North Glenn Avenue
Address
Winston-Salem NC 27115-6279
City State Zip
f. Facility contact person:
Lori W Carter
First Ml Last
[phone] [e-mail]
Phone E-mail Address
Revised Jan. 27, 2014

NPOES PERMIT NAME/OWNERSHIP CHANGE FORM
Page 2 of 2
1V. Permit contact information (if different from the person legally responsible for the permit)
Permit contact:
First MI Last
Title
Mailing Address
City State Zip
Phone E-mail Address
V. Will the permitted facility continue to conduct the same industrial activities conducted prior
to this ownership or name change?
® Yes
❑ No (please explain)
VI Required Items: THIS APPLICATION WILL BE RETURNED UNPROCESSED IF ITEMS
ARE INCOMPLETE OR MISSING:
❑ This completed application is required for both name change and/or ownership change
requests.
❑ Legal documentation of the transfer of ownership (such as relevant pages of a contract deed,
or a bill of sale) is required for an ownership change request. Articles of incorporation are
not sufficient for an ownership change.
The certifications below must be completed and signed by both the permit holder prior to the change, and
the new applicant in the case of an ownership change request. For a name change request, the signed
Applicant's Certification is sufficient.
PERMITTEE CERTIFICATION (Permit holder prior to ownership change):
I, Chris Venable, attest that this application for a name/ownership change has been reviewed and is accurate
and complete to the best of my knowledge. I understand that if all required parts of this application are not
completed and that if all required supporting information is not included, this application package will be
returned incomplete.
I � S
Sig6ature Date
APPLICANT CERTIFICATION
1, Clarence O. Bdgkey, attest that this application for a name/ownership change has been reviewed and is
accurate and complete to the best of my knowledge. I understand that if all required parts of this
application are not completed and that if all required supporting information is not included, this application
package will be returned as incomplete.
Signat i Date
PLEASE SEND THE COMPLETE APPLICATION PACKAGE TO:
Division of Energy, Mineral and Land Resources
Stormwater Permitting Program
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
Revised Jan. 27, 2014

-----------
Book 3225 Page 1559
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2015012397 00020
FORSYTH CO. NC FEE $26.00
STATE OF NC REAL ESTATE EXTX
$4000.00
PRESENTED & RECORDED
04/14f2015 09:29:28 AM
C. NORMAN HOLLEMAN
REGISTER OF DEEDS
BY: RANDY L SMITH
DPTY
BK: RE 3225
PG: 1568 -1561
NORTH CAROLINA SPECIAL WARRANTY DEED
Tax: i.
Parcel Identifier Nam fi ��� �'��{� �3 q l.�irerified by County on the _ day of
By:
Mail/Box to: Polsiinelli PC. Attn, Jay Mankamyer, 1515 Wvnkootr, Suite 600 Denver. CO 80202
This instrument was prepared by:, 0*&j Hglly B . Olson
Brief description for the Index: Tax Block 1504 l.ot No. 513 and Lot No. 101
THIS DEED made this Q'JI day of (kr h , 2015, by and between
.VIAT -10
Reeves Construction Company, a Georgia corporation, formerly APAC-ATLANITC, INC., a Delaware corporation
known as Sloan Construction Company, Inc., a South Carolina 300 South Benbow Road
corporation Greensboro, North Carolina 27401
250 Plemmons Road
Duncan, South Carolina 29334
The designation Grantor and Grantee as used herein shall include said parties, their heirs, successors, and assigns, and shall include
singular, plural, masculine, feminine or neuter as required by context.
WITNESSET -t that the Grantor, for a valuable consideration paid by the Grantee, the receipt of which is hereby acknowledged, has
and by these presents does grant, bargain, sell and convey unto the Grantee in fee simple, all that certain lot or parcel of land situated in
the City of Winston-Salem, Winston Township, Forsyth County, North Carolina and more particularly described as follows:
SEE E)CHJBIT A
The property hereinabove described was acquired by Grantor by instrument recorded in Book 1963, Pages 2481 to 2484.
All or a portion of the property herein conveyed does not include the primary residence of a Grantor.
TO HAVE AND TO HOLD the aforesaid lot or parcel of land and all privileges and appurtcnaoces thereto belonging to the Grantee in
fee simple.
And the Grantor covenants with the Grantee, that Grantor has done nothing to impair such title as Grantor received, and Grantor will
warrant and defend the title against the lawful claims of all persons claiming by, under or through Grantor, other than the following
exceptions:
SEE EXHIBIT B
Mail after recording to: Harbor City Title Insurance
Agency, Inc., 6201 Fairview Roll , Sine 325,
Charlotte, NC 28210; File No.
7392R& t

Book 3225 Page 1559
IN WITNESS WHEREOF, the Grantor has duly executed the foregoing as of the day and year first above written.
GRANTOR:
Reeves Construction Company
By:
Nam:
Title• _ ony L MaMna, if
COUFMTM
State of _ �T _ County or City of _%&l/' i' J
I, the undersigned Notary Public of the County or City of egar t-z t , and State aforesaid, certify that
n - eft . ,� r .i of Reeves Construction Company, pammally appeared
before me th day and acknowledged the d�e exeoution of the foregoing instrument for the purposes therein expressed. Witness my
hand and Notarial stamp or seal this �� day of2015.
My Commission Expires: Lo M- a qA P r Notary Public
(Affix Seal) Notary's Printed or Typed Name
,+ SUSAN M. GRANER
NOTARY PUBLIC OF NEW JQtSEY
' My Commlasion Expires 311312020

Book 3225 Page 1560
'AMR s 1 -9 tL
Forsyth County, North Carolina
LYING AND BEING in Winston Township, Forsyth County, North Carolina, and beginning at an iron located in the Southeast
corner of Lot 28 of the Chap Bodenheimer Development, as recorded in Plat Book 2 at Page 95 of the Forsyth County Registry;
from said beginning point and running thence South 06° 14' West 89.83 feet to an iron; thence running South 55" 55' 54" East
102.12 feet to an iron located within the right-of-way of Glenn Avenue Extension; thence ranking within the right-of-way of Glenn
Avenue Extension South 41" 45' 39" West 113.94 feet to an iron in the West right -of --way line of Glenn Avenue Extension; thence
rurming on two (2) lines with the property described in Book 1364 at Page 279 of the Forsyth Cotmty Registry and continuing on
two (2) lines with the property described in Book 1542 at Page 1458 of the Forsyth county Registry North 930 11' 50" West 609.10
feet to an iron, South 050 39' 27" West 294.32 feet to an iron and South 820 49' 23" East 43553 feet to an iron in the West right-of-
way line of Glenn Avenue Extension; thence running with the West right-of-way line of Glenn Avenue Extension South 370 5 V
54" West 192.68 &ct to an iron marking the Northeasterntnast corner of the property described in Book 932 at Page 506 of the
Forsyth County Registry; thence running on three (3) lines with the property described in Book; 932 at Page 506 and continuing
with the line of the property described in Book 304 at Page 2 of the Forsyth County Registry North 799 52' 38" West 111.20 feet to
an iron, South 7° 28' 40" West 62.00 feet to an iron and North 84138' 20" West 401.62 feet to an iron; thence running on two 9)
new lines with piedmont Aviation, Inc., North 05` 57' 13" Fast 62.66 feet to an iron and North W 23' 46" West 772.59 feet to an
iron; thence running along the boundary of an adjoining development North 05' 11' 07" East 635.39 feet to an iron; thence running
North 920 09' 31" East 234.01 feet to an iron; thence running South. 83' 00' 40" East 473.68 feet to a point located in the southern
line of Lot 101 of the Chap Bodmheimer Development and continuing along the southern line of the Chap Bodenheimer
Development, South 83 ° 11' 48" East 840.11 feet to an iron located at the point and place of BEGINNING, and containing 20.0
acres, more or less. The foregoing description was taken from a plat of survey prepared by Daniel W. Donathan for Laren Const.,
Inc. dated December M 1986 and is a portion of Lot No. 5B and Lot No. 101 as shown in Forsyth county Tax Block 1504.

---- Book 3225 Page 1561
EXHIBIT B
TO SPECIAL WARRANTY DEED
1, Solid Waste Permit in favor by Forsyth County Public Health, Division of Environmental Health, as recorded in Book
1700, Page(s) 996 of the Forsyth County Registry, reference being made to the records thereof for the full -particulars.
2. Easement(s) in favor of Duke Power Company as recorded in Book 1041, Page 877; and Book 1600, Page(s)1935, all of
the Forsyth County Registry, reference being made to the records thereof for the full particulars.
3. Right(s) of way in favor of Piedmont Natural Gas Company, Inc. as recorded in Book 1602, Page(s) 936 of the Forsyth
County Registry, referenca being made to the records thereof for the fW l particulars.
4. Easement(s) in favor of the Board of Transportation as recorded in Book 1146, Page(s) 554 and 556, all of the Forsyth
County Registry, reference being made to the records thereof for the full particulars.
5. Ordinance Amending the Winston-Salem City Zoning Ordinance and the Official Zoning Map of the City of Winston-
Salem, NC as recorded in Book 1040, Page(s)1581 of the Forsyth County Registry, reference being made to the records
thereof for the full particulars.
6_ Easement reserved in Deed as recorded in Book 1583, Page(s) 270 of the Forsyth County Registry, reference being made
to the records thereof for the full particulars.

Book 3225 Page 1562
I
I
1
2015012398 00021
FORSYTH CO. NC FEE $26.00
STATE OF INC REAL ESTATE EXTX
$11500.00
PRESENTED & RECORDED
04/14/2015 09:31:40 AM
C. NORMAN HOLLEMAN
REGISTER OF DEEDS
BY: RANDY L SMITH
DPTY
BK: RE 3225
PG: 1562-1565
NORTH CAROLINA SPECIAL WARRANTY DEED
Excise Tax:
w. ParceI Identifier NoIo 2-33 . ` 3 " °5.0 y. c[ Verified by - County on the _ day of 20_
L By:
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Mail/Box to: Polsine1ILPC, Attn. Jay Mankaniver,1515 Wvnoon k. Suite 600LDetom, CO 80202
This instrument was prepared by:Holly B . Olson
Brief description for the Index- JaxRlock 2711 Lot Number 007P —
THIS DEED made this day of G i , 2015, by and between
GRANTOR
Larco Construction, a division of Nello L. Teer Company, a
Delaware corporation
432 Mclaws Circle
Williamsburg, Virgin# 23189
GRANTEE
APAC-ATLANTIC, INC., a Delaware corporation
300 South Benbow Road
Greensboro, North Carolina 27401
The designation Grantor and Grantee as used herein shall include said parties, their heirs, successors, and assigns, and shall include
singular, plural, masculine, feminine or neuter as required by contoxt.
WITNESSET K that the Grantor, for a valuable consideration paid by the Grantee, the receipt of which is hereby acknowledged, has
and by these presents does grant, bargain, sell and convey unto the Grantee in fee simple, all that certain lot or parcel of land situated in
the City of Winston-Salem, Forsyth County, North Carolina and more particularly described as follows:
SEE EDUBBIT A
The property hereinabove described was acquired by Grantor by instrument recorded in Book 2271. Pages 1871-1973.
All or a portion of the property herein conveyed does not include the primary residence of a Grantor.
TO HAVE AND TO HOLD the aforesaid lot or parcel of land and all privileges and appurtenances thereto belonging to the Grantee in
fee simple.
And the Grantor covenants with the Grantee, that Grantor has done nothing to impair such title as Grantor received, and Grantor will
warrant and defend the title against the lawful claims of all persons claiming by, under or through Grantor, other than the following
exceptions:
SEE EXHIBIT B
7392738_1
Mail after recording to: Harbor City Title Insurance
Agency, Inc., 6201 Fairview Ron , �I gt325,
Charlotte, NC 28210; File No.

Book 3225 Page 1563
fN WITNESS W MREOI , the Grantor has duly executed the foregoing as of the day and year first above written.
GRANTOR:
Larc , Construction, a division, of Nello L. Teer Cotngany
By. -
Name:
Title:_ 3► �,
State of . _f%•� _- County or Cityof
the undersi ed Notary Public of the County or City of ,��CIG�� ` f and State aforesaid, certify that
as r of Larco Construction, a division of Nano L. Teer
Company, pefsonaty appeared before me this day and acknowledged the due execution of the foregoing instrument for the purposes
therein expressed. Witness my hand and Notarial stamp or seai this _,Ayr$ay of .f , 2015.
My Commission Expires: o ao , G r er Notary Public
(Affix Seal) k Notary's Printed or Typed Name
V:ESUSAW M. ORANERBLIC OF NEW ,IERS€Y
sion E-Xp ee 3113120n

Book 3225 Page 1564
i
E)MBiT A
TO SPECIAL WARRMT',M}j DEAD
Forsyth County, North Carolina
BROMING AT a right-of-way monument in the eastern right-of-way line of U.S. Highway 52, said beginning paint marking the
northwest comer of that property conveyed to William D. Gutty by deed recorded in Deed Book 1647 at Page 3139 of the Forsyth
County Registry; running thence from said beginning point with the eastern right-of-way line of U.S. Highway 52 North 160 54'
43" West 621.94 feet to a right-of-way monument in the eastern right-of-way line of U.S. Highway 52; thence continuing with the
eastern right-of-way line of U.S. Highway 52 Notth 2311 29' 09" West 574.26 feet to a point, said point located South 23° 29' 09"
East 75.94 feet from a right-of-way monument in the eastern right-of-way line of U.S. Highway 52; running thence on a new line
South 880 14' 41" East 300.45 feet to a point; running thence on a new line North 01" 45' 19" East 270.00 feet to a point in the
southern right -of --way line of Hodges Avenue as shown on the Plat of Lexwin as recorded in Plat Book 12, Page 74, Forsyth
County Registry; tanning thence with the southern right-of-way line ofHodges Avenue South 880 14, 41" East 459.72 feet to an
iron; running thence South 86' 25' 32" East 211.15 feet to an iron, the southeast corner of Lot 382 of Lexwin; running thence along
anew line South 02" 3T 30" West 210.00 feet to an iron; running thence along a new line South 45' 18' 50" East 290.00 feet to an
iron; running thence South 32' 46 19" West 216.83 feet to a point in the center line of a branch; running thence with the centerline
of said branch as it meanders south the following sixteen (16) courses and distances: (1) North 73° 00' 17" West 50.00 feet; (2)
South 810 52' 54" West 79.04 feet; (3) South 420 14' 21" West 76.70 feet; (4) South 74" 03' 28" West 116.77 feet; (5) South 51" 12
32" West 68.99 feet; (6) South 23° 03' 04" East 78.96 feet; (7) South 34° 00' 06" East 137.60 &et; (8) South 130 52' 11" East 58.87
feet; (9) South 01" 31' 35" East 55.10 feet; (10) South 37° 06' 41" West 63.01 feet; (11) South 440 23' 46" West 61.45 feet; (12)
South 41* 4T 12" West 90.26 feet; (13) South 35" 21' 41" West 56.80 feet; (14) South 33" 34' 39" West 90.41 feet; (15) South 10"
27' 56" West 39.48 feet; and (16) South 02" IT 06" East 31.87 feat to a point in the northern line of the said Chitty property;
running thence with the northern line of the said Chitty property North 97" 51' 00" West 197.81 feet to THE POINT AND PLACE
OF BEGINNING, containing 20.207 acres, more or less, as shown on a survey prepared for Overdaie Associates, L.L.C. by
Beeson Engineering, Inc., dated March 24, 2000, and last revised July 14, 2000, and designated as Job. No. 00205.

Book 3225 Page 1565
r
i
E) BBIT B
TO SPECI& WARRANTY 12
1. Easemeat(s) in favor of the City of Winston Salem as recorded in Book 993, Pages) 690; as affected by Quitclaim Deed
recorded in Book 1004, Page 554, ail of the Forsyth County Registry, reference being trade to the records thmwf for the
full particulars.
2. Easement(s) in favor of City of Winston Salem as recorded in Book 1004, Page(s) 556; and Boom 1753, Page 2394, all of
the Forsyth County Registry, reference being made to the records thereof for the full particulars.
3. Driveway Easement and Maintenance Agreement by and among Overdale Associates, LL.C, at. als., as recorded in Book
2540, Page(s) 441 of the Forsyth County Registry, reference being made to the records thereof for the full particulars.

APAC-Atlantic, Inc.
Thompson -Arthur Paving & Construction
P. O. Box 21088
Greensboro. NC 27420-1088
Tel: [phone] Fax [phone]
July 2, 2015
Division of Energy, Mineral and Land Resources
Stormwater Permitting Program
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
Re: Ownership Change Request
Certificate of Coverage NCG 160042
Dear Sir or Madam:
APAC-Atlantic, Inc., Thompson Arthur Paving and Construction Division (APAC) is pleased to submit this
completed Ownership Change Form for a hot -mix plant located 4130 North Glenn Avenue in Winston-
Salem. Effective on March 27, 2015, APAC has purchased this facility from Lorco Construction. Also
enclosed is the documentation of the ownership change.
If you have any questions, please do not hesitate to contact me at [phone] or our consultant,
Josh Dunbar with The El Group, Inc. at [phone].
Sincerely,
APAC ATLANTIC, INC.
Lori Carter
Environmental Representative
Enclosures
cc: Mr. Josh Dunbar, The El Group
Safety First
RECEIVED
JUL 10 2015
DENR-LAND QUALITY
�TORMWATER PERMITTING
Equal Opportunity Employer

STORMWATER DISC tGE OUTFALL (SDO)
MONITORING REPORT
GENERAL PERMIT NO. NCG160000 SAMPLES COLLECTED DURING CALENDAR YEAR: 2014
CERTIFICATE OF COVERAGE NO. NCG16 0 0 4 2 (This monitoring report shall be received by the Division no later than 30 days from the date
��� �11ty receives the sampling results from the laboratory.)
FACILITY NAME Larco Construction Co. — Winston-Salem t e�iu COUNTY GUILFORD
PERSON COLLECTING SAMPLE(S) Jim Frei (SwSG) AN ���� P ONEP 336 767-3500
CERTIFIED LABORATORY(S) Pace Analytical Lab # 12167
SwSG Lab # 5---.0-54:,ENTRAL FILES GNATURE OF PERMITTEE OR DESIGNEE
DWR SECTION By this signature, I certify that this report is accurate and complete
to the best of my knowledge. .
Outfall
No.
Date
Sample Collected
mmldd/yr
Total Rainfall,
inches
00530
00400
00556
Total Suspended Solids, mg/L
pH,
Standard Units
Total Petroleum Hydrocarbons, mg/L
EPA Method 1664 (SGT-HEM)
Benchmarks
-
-
100
6.0--9.0
15
001
02/21/14
0.40"
185
7.74
< 5.0
001
12/16/14
0.12"
58.4
6.85
< 5.0
' If a value is in excess of the benchmark, or outside the benchmark range (for pl I), you must implement the Tier I or Tier 2 responses in the General Permit.
Mail Original and one copy to:
NCDENR/ DWR
Attn: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
YOU MUST SIGN CERTIFICATION FOR ANY INFORMATION REPORTED:
1 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 those persons who manage the system, or those persons
directly respons le fo
igathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that
there "sigp ant es for submitting false information, including the possibility of fines and imprisonment for knowing violations.
A (o /
(Date)
SWU-253-051409
Page 1 of I

STORMWATER DISC WE OUTFALL (SDO)
MONITORING REPORT
GENERAL PERMIT NO. NCG160000
CERTIFICATE OF COVERAGE NO. NCG16 0 0 4 2
FACILITY NAME Larco Construction Co. — Winston-Salem
PERSON COLLECTING SAMPLE(S) Jim Frei (SwSG)
CERTIFIED LABORATORY(S) Pace Analytical Lab # 12/ 40
SwSG Lab # 5054
SAMPLES COLLECTED DURING CALENDAR YEAR: 2014
(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 GUiLFORD
P ONE 336 767-3500
GNATURE OF PERMITTEE OR DESIGNEE
By this signature, I certify that this report is accurate and complete
to the best of my knowledge.
Outfall
No.
Date
Sample Collected
mm/dd/yr
Total Rainfall,
inches
00530
00400
00556
Total Suspended Solids, mg/L
pH,
Standard Units
Total Petroleum Hydrocarbons, mg/L
EPA Method 1664 (SGT-HEM)
Benchmark'
-
-
100
6.0 — 9.0
15
001
02/21/14
0,40"
185
7.74
¢ 5.0
If a value is in excess of the benchmark, or outside the benchmark range (for pH), you must implement the Tier I or Tier 2 responses in the General Permit.
Mail Original and one copy to:
Division of Water Quality
Attn: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
YOU MUST SIGN CERTIFICATION FOR ANY INFORMATION REPORTED:
RECEIVED
MAR 10 2014
CENTRAL FILES
DWal80G
1 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 those persons who manage the system, or those persons
directly responsible gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that
rt�j there�agfjlificant�ge�es for submitting false information, including the possibility of fines and imprisonment for knowing violations.
Of
3.
ate)
S WU-253-051409
Page 1 of I

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one

LARCO
Construction
Company
Stormwater
Inspection
Report
November 10
The goal of the Stormwater permit program is to improve the quality
of surface waters by reducing the amount of pollutants potentially
contained in the storm water runoff being discharged. Industrial
facilities subject to an NPDES permit must prepare and implement a
SWPPP for their facility.
The objective of this SWPPP is
three -fold: (])Identify potential
sources of pollution at LARCO
Construction Company
(2)Describe best management
practices (SMPs) (3) Provide
other elements such as, out not
limited to, a facility inspection
program, site compliance
evaluation program, record
keeping and reporting program
that will help LARCO
Construction comply with the
terms and conditions of their
storm water discharge permit

t
•�
City of `Virist7on-Salem
ShOrNMEE
www.stormwatersmart.org Division
t
•}
.q . _.. ._
jS..tn. f3, AJ wfx
MCA'" > .. �'^_
City of Winston-Salem
Stormwater Division
Surface Water Inspection for Industrial Sites
Part 1 'General':Inforsrration
A. Official Company Name: LARCO Construction Company Winston-Salem Asphalt Plant 962
B. Physical Address: 4130 North Glenn Avenue, Winston-Salem, NC 27105
C. Telephone Number: 336-767-3500
D. Mailing Address, if different from above address: Same
F. Primary contact who is authorized to represent company in environmental regulatory issues:
a. Name: Mr_ Fred Fenske
b. Title: Asphalt Plant Manager
c. Contact Number(s): 336-767-3500
d. Email: [e-mail]
F. SIC Code number of business: 2951
G. NC Stormwater NPDES Permit Number: NCG160042
a. Facility Type: Asphalt Paving Mixture
H. Any other control authority Permit(s) (air quality control, wastewater, hazardous waste)&
number(s): Air Quality Permit # 00464R-6
I. Brief description of industrial activities that occur on -site: LARCO Construction Company is a
producer of asphalt product. This facility produces asphalt paving mix, and maintains and repairs
construction vehicles. Additional operation includes truck washing and fueling. The asphalt
paving mix which is a liquid asphalt cement which is mixed with coarse aggregate (which is
heated and dried) and stored in enclosed silos. Fuel oil # 4 and # 2 fuel is used to heat the raw
products, propane is then used to keep the asphalt viscous
J. Receiving Water(s) / MS4: Leak fork Branch, a tributary of Mill Creek
Page 2 of 8

Part;.1;=-lStormwaterrxontrols
1. Best management Practices
A. List the non/structural controls employed by the facility:
1.A stormwater retention pond is located in the NW corner of property, which receives
both non-stormwater and stormwater flows.
2. A 1,000 gallon oil & water separator receives vehicle wash water and automotive fluid
spills from steam clean-up and Fleet Service Center. It is plumbed to the sanitary sewer
system (MS4).
3.A 1,000 gallon oil & water separator receives any spill/leaked diesel fuel from the
refueling pad. This separator is plumbed to sanitary sewer system.
4.LARCO has implemented a policy that an employee oversees all unloading activities by
vendors while they are on -site
S.Bulk storage tanks and hazardous waste containers have secondary containment
structures.
B. Are the BM Ps reasonable & appropriate for the facility: XX Yes No
C. Are BMPs installed correctly, maintained, and effective operation condition: XX Yes No
2. Provide a brief description of other controls that manage/prevent/minimize stormwater
runoff (e. g., erosion and sediment controls, inlet protection/control at storm drains, diversion
structures):
1.Nazardous waste storage area is brimmed and covered in order to minimize rainwater
contact.
2.Oil & Water separator at the fleet vehicle maintenance shop is plumbed to sanitary
sewer system.
3.lnlets cover in the brimmed areas to prevent discharges in case of large spills.
Part1:2e".Miscellaneous
1. Any evidence of discharge to receiving waters/MS4? (e.g., stormwater runoff, dry weather
discharge, co -mingling of process wastewater): xxx Yes No
i. Comments:
2. Does the stormwater outfalls on -site correspond with those listed on the site map and in
SWPPP? Yes xxx No N/A
i. Comments: only one outfall, SDO 001
Page 3 of 8

PMt`3 =SWPPP Review can be °cornpie#ed in office)
--
General
1 Is there a SWPPP?
Yes
No
2) Does SWPPP identify a specific position(s) for responsible
party purposes (e.g. overall coordination, development,
implementation & revision)
Yes
No
3) Does SWPPP designate facility personnel responsible for
implementing SRP?
Yes
No
4 Does SWPPP include a certification statement?
Y
No
5) Are employee training records regarding stormwater pollution
prevention topics included in SWPPP?
Yet s
No
Comments: Check to see if environmental consultant's recommendations have been implemented.
Site Map
NOTES
1 Is there a site map?
;Y s
No
2) Drainage attems/outfalls
Yes
No
Does not show patterns
on the site map.
3) Identification of potential pollutants likely to be
discharged from each drainage area?
lWes
No
4) Narrative description and locations of (check if resent):
1. Storage practices
XX
2. Unload in/Loading activities
XX
3. Outdoor processes _
4. Particulate generating/control processes
XX
XX
5, Waste Disposal
XX
5 Name of receiving waters or MS4's listed?
Yes
No
6) Locations of significant materials exposed to
stormwater?
Yes s
No
7) Locations and descriptions of major spills occurring within the
3 previous years w/ corrective actions to prevent futurespills)?
er s
No
Page 4 of 8

Stormwater Controls
NOTES
1) Does the SWPPP describe the non-structural
controls that will be used to prevent/reduce discharge of
pollutants in stormwater runoff?
Yei s
No
2) Does the SWPPP describe the structural controls
that will be used to prevent/reduce discharge of
pollutants in stormwater runoff?
Yer s
No
3) Does the SWPPP describe other controls that will be
used to prevent/reduce off -site tracking or blowing of
sediment, dust, and raw, final, or waste products, or
other solid materials and floating debris?
Yes
No
4) Does the SWPPP incorporate the 8 baseline controls
(good housekeeping, BMP summary, feasibility study,
PM, SRP procedures, facility inspections, and
comprehensive site evaluations, employee training,
seconds containment, and sediment control?
Y_ e_
No
5) Does the SWPPP describe the pollutant or activity to
be controlled by BMPs and assessed the need of
implementation throu h data collected?
Yes s
No
Non-stormwater Discharges
NOTES
1) Certification that the facility has been tested for non-
stormwater discharges from the site?
Yes
No
2) Description of testing method, drainage points,
observed results, date, and signature?
,Yes
No
Page 5 of 8

Moniforinq
1) Are samples collected within 30 minutes of
measurable weather events occurring 72 hours after
s
No
previous measurable weather event?
i
2) Were samples collected and preserved in
accordance with 40 CFR 136?
Yes s
No
3) Was proper chain -of -custody procedures
followed?
Yes s
No
4) Was analytical and qualitative monitoring
Missing Year 1, Period 1
complete?
Yes
No
analytical monitoring
TSS, Benchmark is 100
5) Any exceedences of pollutant parameters in
mg/l results where
regards to benchmark values?
Yes
No
104m /I
Page 6 of 8

Par'4'S `Required°Actionsto becompacilty
1. Update SWPPP to reflect directional arrows for sheet flow on site plan.
2. Annotate inspection on outfali # 1, for year 1, period 1 (analytical) or annotate that there was no
flow.
3. Initiate tier 1 analytical response for the exceeding the T5S bench mark.
4. Muck out detention basin which has filled with aggregate.
5. Replace spill kit at asphalt off loading area.
6. Refresh containment berm (asphalt) at the # 2 diesel pump area.
7. Replace or extend asphalt berm at vehicle maintenance area.
8. The City of Winston-Salem Stormwater Division is requiring that Items # 1-7 be completed on or
before January 6, 2011. LARCO Construction Company shall keep the Stormwater Division
updated on milestones and activities completed in its progression to comply with these required
actions. The Stormwater Division may conduct follow-up inspections in order to ensure
completion of mandated activities.
Educational Resources:
1. NC Stormwater Manual for Industrial Users:
a. http://h2o.enr.state.nc.us/su/storm water.html.
b. http://portal.ncdenr.org/web/wq/ws/su/bmp-manual
Company Representative(s) that participated in inspection name and tit[e(s): Fred Fenske, Asphalt Plant
Mana er
Start of Inspection: 09:00 AM
Completion of Inspection: 10:45 AM
Date of inspection: 11/10/2010
Signature of Stormwater Inspector and title: William D. Baugher, Stormwater Inspector
Page 7 of 8

Permit: NCG160042
SOC:
County: Forsyth
Region: Winston-Salem
Compliance Inspection Report
Effective: 10/01/09 Expiration: 09/30/14 Owner: Laroo Construction A Division of Sloan
Construction Cc Inc
Effective: Expiration: Facility: Larco Construction Cc - Winston-Salem
4130 N Glen Ave
Contact Person: R D Reeves
Directions to Facility:
System Classifications:
Primary ORC:
Secondary ORC(s):
On -Site Rep rose ntative(s):
Related Permits:
Winston Salem NC 27115
Title: Phone: [phone]
Certification: Phone:
Inspection Date: 11110/2010 Entry Time: 09:00 AM Exit Time: 10:45 AM
Primary Inspector: Ron Boone c Phone: 70 Ext.2021699
Secondary Inspector(s): cT
Reason for Inspection: Routine Inspection Type: Compliance Evaluation
Permit Inspection Type: Asphalt Paving Mixture Stormwater Discharge COC
Facility Status: ❑ Compliant ■ Not Compliant
Question Areas:
E Storm Water
(See attachment summary)
Page:1

Nd
Permit: NCG160042 Owner - Facility: Corcoc onstruction A Division of Sloan Construction
Inspection Date: 1Ill 012010 Inspection Type: Compliance Evaluation Reason for Visit_ Routine
Inspection Summary:
Inspection conducted by Bill Baugher WS Stormwater Division.
Page: 2

Permit: NCG160042 Owner - Facility: Larco Construction A Division of Sloan Construction
Co Inc
Inspection date: 11/10/2010 Inspection Type: Complianoe Evaluation Reason for Visit: Routine
Stormwater Pollution Prevention Plan Yes No NA NE
Does the site have a Stormwater Pollution Prevention Plan?
■
n
n
n
# Does the Plan include a General Location (USGS) map?
■
n
n
n
# Does the Plan include a "Narrative Description of Practices"?
■
n
n
n
# Dees the Plan include a detailed site map including outfall locations and drainage areas?
®
n
n
n
# Does the Plan include a list of significant spills occurring during the past 3 years?
■
❑
n
n
# Has the facility evaluated feasible alternatives to current practices?
■
n
n
n
# Does the facility provide all necessary secondary containment?
■
n
n
n
# Does the Plan include a BMP summary?
■
n
n
n
# Does the Plan include a Spill Prevention and Response Plan (SPRP)?
■
n
n
n
# Does the Plan include a Preventative Maintenance and Good Housekeeping Plan?
■
n
n
n
# Does the facility provide and document Employee Training?
v
n
n
n
# Does the Plan include a list of Responsible Party(s)?
a
n
n
n
# Is the Plan reviewed and updated annually?
■
n
# Does the Plan include a Stormwater Facility Inspection Program?
®
❑
n
n
Has the Stormwater Pollution Prevention Plan been implemented?
®
n
n
n
Comment: Site plan doesn't show directional arrows indicating flow.
Qualitative Monitoring
Yes
No
NA
NE
Has the facility conducted its Qualitative Monitoring semi-annually?
®n
n
n
Comment: None
Analytical Monitoring
Yes
No
NA
NE
Has the facility conducted its Analytical monitoring?
■
n
00
# Has the facility conducted its Analytical monitoring from Vehicle Maintenance areas?
■
n
n
n
Comment: Not all analytical monitoring conducted as required.
Permit and Outfails
Yes
No
NA
NE
# Is a copy of the Permit and the Certificate of Coverage available at the site?
®
n
Cl
n
# Were all outfalls observed during the inspection?
®
n
n
n
# If the facility has representative outfall status, is it properly documented by the Division?
n
n
®
n
# Has the facility evaluated all illicit (non stormwater) discharges?
®
n
n
n
Comment: None
Page: 3