NCG160121_MONITORING INFO_20180220

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO
/v c� /(� v � fv�
IV L E 13a� c 6l
DOC TYPE
❑HISTORICAL PILE
[MONITORING REPORTS
DOC DATE
❑ 301b Dq-�-b
YYYYMMDD
� o 6-3

4
STORMWATER DISCHARGE OUTFALL (SDO)
ANNUAL SUMMARY DATA MONITORING REPORT (DMR)
Calendar Year 2017
Individual NPDES Permit No NCS ❑❑UU❑❑ or
Certificate of Coverage (COC) No NCG 160 111
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 # 9
County Alamance County
Phone Number [phone] Total no of SDOs monitored 2
jl�
-ER 2 n
Outfall No 001
Is this outfall currently in Tier 2 (monitored monthly)? Yes ❑ No ® RECEIVE®
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ❑ No ® FEB 21 2013
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑ CENTRAL FILES
Received approval from DWQ to reduce monitoring frequency ❑ DWR SECTION
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes ❑ No
Parameter, (units
Total
Rainfall,
inches
Total
Suspended
Solids mg/1
Benchmark
N/A
100
Date Sample
Collected
mmlddlyy
�rw��
a
27-s t s'-^'.,
3131/17
043
<0 80
818117
1 5
95
SWU-264-Generic-13Dec2012

J
C
Additional Outfall Attachment
Outfall No 002
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 mgll
Benchmark
N/A
100
Date Sample
x
Pyyg-
r
Collected,
-
g
v
mmlddlyy
3131/17
043 1
<0 80
818117
15
62
S WU-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 �2/14118
C'r-� cu�
For questions, contact your local Regional Office
DWQ Regional Office Contact Information
S WU-264-Generic-1 Mec2012

ASHEVILLE REGIONAL OFFICE
FAYETTEVILLE REGIONAL OFFICE
MOORESVILLE REGIONAL OFFICE
2090 US Highway 70
225 Green Street
610 East Center Avenue/Suite 301
Swannanoa, NC 28778
Systel Building Suite 714
Mooresville, NC 28115
[phone]
Fayetteville, NC 28301-5043
[phone]
[phone]
RALEIGH REGIONAL OFFICE
WAS"INGTON REGIONAL OFFICE
WILMINGTON REGIONAL OFFICE
3800 Barrett Drive
943 Washington Square Mall
127 Cardinal Drive Extension
Raleigh NC 27609
Washington NC 27889
Wilmington, NC 28405-2845
[phone]
[phone]
[phone]
,NVINSTON-SALEM REGIONAL OFFICE
CENTRAL OFFICE
1617 Mail Service Center
'%preserve protect
585 Waughtown Street
Winston-Salem, NC 27107
Raleigh NC 27699-1617
and enhance
{336) 771-5000
[phone]
Nor7h Carofrnas vafer -
SWU-264-Genenc-1 Mec2012

0 1612
t STORMWATER DISCHARGE OUTFALL (SDO)
ANNUAL SUMMARY DATA MONITORING REPORT (DMR) DEB
Calendar Year 20'17
Individual NPDES Permit No NCS ❑❑❑❑❑❑ or
Certificate of Coverage (COC) No NCG 160 121
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 # 8
County Alamance County
Phone Number [phone] Total no of SDOs monitored 3
Outfall No 001
1s this outfall currently in Tier 2 (monitored monthly)? Yes ❑ No ® RECEIVED
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? FEB 21 2013
Enough consecutive samples below benchmarks to decrease frequency ❑ CENTRAL FILES
Received approval from DWQ to reduce monitoring frequency ❑ DWR SECTION
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes ❑ No 21
Parameter, units)
Total
Rainfall,
inches
Total
Suspended
Solids mg/1
Benchmark
N/A
100
Date Sample
Collected
mmlddlyy
5/2117
026
60
818l17
1 0
30
SWU-264-Generic-13Dec2012

f Additional Outfall Attachment
Outfall No 002
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
SWU-264-Generic-1 Mec2012

1 Additional Outfall Attachment
Outfall No 003
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
Rainfall,
inches
Total
Suspended
Solids mgll
Benchmark
N/A
100
Date Sample
Collected,
mmlddlyy
512117
026
100
818117
1 0
29
S WU-264-Generic-13Dec2012

f "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 _2114/18
C� catt_'_
For questions, contact your local Regional Office
DWQ Regional Office Contact Information
'ASHEVILLE REGIONAL OFFICE
FAYETTEVILLE REGIONAL OFFICE
1YI00RESVILLE REGIONAL OFFICE
2090 US Highway 70
225 Green Street
610 East Center Avenue/Suite 301
Swannanoa NC 28778
Systel Building Suite 714
Mooresville, NC 28115
[phone]
Fayetteville, NC 28301-5043
[phone]
[phone]
RALEIGH REGIONAL OFFICE
LASHINGTON RLG_I_ONAL OFFICE
WI_LMINGTON REGIONAL OFFICE
3800 Barrett Drive
943 Washington Square Mall
127 Cardinal Drive Extension
Raleigh NC 27609
Washington NC 27889
Wilmington, NC 28405-2845
[phone]
[phone]
[phone]
WINSTON-SALE,NI REGIONAL OFFICE
CENTRAL OFFICE
1617 Mail Service Center
To preserve, protect
585 Waughtown-Street
Winston-Salem, NC 27107
Raleigh, NC 27699-1617
and enhance
(3� 771-5000
[phone]
North Carolina s zvacer
SWU-264-Generic-13Dec2012

t
STORMWATER DISCHARGE OUTFALL (SDO)
ANNUAL SUMMARY DATA MONITORING REPORT (DMR)
Calendar Year 2017 11 FEB
Individual NPDES Permit No NCS ❑❑❑❑❑❑ or
Certificate of Coverage (COC) No NCG 160 122
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 # 10
County Guilford County
Phone Number [phone] Total no of SDOs monitored 2
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 ® RECEIVED
r�
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued? RECEIVED
Enough consecutive samples below benchmarks to decrease frequency ❑ FEB 21 2013
Received approval from DWQ to reduce monitoring frequency ❑
Other
❑ CENTRAL FILE$
GWR SECTIONWas this SDO monitored because of vehicle maintenance activities? Yes ❑ No
Parameter, units)
Total
Rainfall,
inches
Total
Suspended
Solids mgll
Benchmark
N/A
100
Date Sample
Collected
mmlddlyy���
w ��-
w� � �
i+,:, K � .. ..�YS�%ti rn-�P+-.."" s1a .+�.n �.
���� �, �,�� �
�S'`" "i
-��
� ti� � ��
�..,� u��%�� �-
pr
r+
4/24/17
244
16
1216117
05
62
S WU-264-Generic-13Dec2012

i Additional Outfall Attachment
Outfall No 002
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 5DO monitored because of vehicle maintenance activities? Yes ❑ No
5 WU-264-Generic-13Dec2012

.01
i "I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a
system designed to assure that qualified personnel properly gather and evaluate the information submitted Based on my inquiry of the person
or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the
best of my knowledge and belief, true, accurate, and complete 1 am aware that there are significant penalties for submitting false information,
including the possibility of fines and imprisonment for knowing violations "
Signature
Date _2/14118
For questions, contact your local Regional Offlce
DWO Regional Office Contact Information
ASHEVILLE REGIONAL OFFICE
FAYETTEVILLE REGIONAL OFFICE
MOORESVILLE REGIONAL OFFICE
225 Green Street
610 East Center Avenue/Suite 301
2090 US Highway 70
Swannanoa NC 28778
Systel Building Suite 714
Mooresville, NC 28115
[phone]
Fayetteville, NC 28301-5043
[phone]
[phone]
RALEIGH REGIONAL OFFICE
WASHINGTON REGIONAL OFFICE
tWILMINGTON REGIONAL OFFICE
3900 Barrett Drive
943 Washington Square Mall T
127 Cardinal Drive Extension
Raleigh, NC 27609
Washington, NC 27889
Wilmington, NC 28405-2845
[phone]
[phone]
[phone]
WINSTON-SALEM REGIONAL OFFICE
CENTRAL OFFICE
1617 Mall Service Center
To preserve, protect
585 Waughtown Street
Winston-Salem, NC 27107
Raleigh, NC 27699-1617
Wand enhance
[phone]
[phone]
North Carolina's tivater
SWU-264-Generic-13Dec2012

J'
w
STORMWATER DISCHARGE OUTFALL (SDO)
ANNUAL SUMMARY DATA MONITORING REPORT (DMR) nn �/7
Calendar Year 2017 Ili 11 V
Individual NPDES Permit No NCS ❑❑❑❑❑❑ or �g
Certificate of Coverage (COC) No NCG 160 123
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 # 11
County Guilford County
Phone Number [phone] Total no of SDOs monitored 3
Outfall No 001
Is this outfall currently in Tier 2 (monitored monthly)? Yes ❑ No ® RECEIVED
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ❑ No ® FEB 21 2013
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑ CENTRAL_ FILES
Received approval from DWQ to reduce monitoring frequency ❑
DWR SECTI0�1
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes ❑ No
Parameter, units
Total
Rainfall,
inches
Total
Suspended
Solids mg/l
Benchmark
N/A
100
Date Sample
Collected,
mmlddlyy
4/19117
012
12
1123118
075
33
SWU-264-Generic-13Dec2012

r
� Additional Outfall Attachment
Outfall No 002
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 mgll
Benchmark
N/A
100
Date Sample
Collected,��
FS� ar�'�`
W -
� 1
' 7� w
mmlddlyy
9
1 /23/18
075
33
SWU-264-Generic-13Dec2012

If
Additional Outfall Attachment
Outfall No 003
Is this outfall currently in Tier 2 (monitored monthly)? Yes ❑ No
Was this outfall ever in Tier 2 (monitored monthly) during the past years 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 mg/l
Benchmark
N/A
100
Date Sample
Collected?,-
mmlddlyy
n
-,'N Y _ �, —" d'
k5.� 9aia.. �M7
�.xr� z �la
[�'� Gar?. ti 3• xA
1123118
075
37
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
FAYETTEVILLE REGIONAL OFFICE
MOORESVILLE REGIONAL OFFICE,
225 Green Street
610 East Center Avenue/Suite 301
2090 US Highway 70
Swannanoa NC 28778
Systel Building Suite 714
Mooresville, NC 28115
[phone]
Fayetteville, NC 28301-5043
[phone]
[phone]
RALEIGH REGIONAL OFFICE
NNIASHINGTON REGIONAL OI+FICE
WILMINGTON REGIONAL OFFICE
943 Washington Square Mall
127 Cardinal Drive Extension
3800 Barrett Drive
Raleigh NC 27609
Washington NC 27889
Wilmington, NC 28405-2845
[phone]
[phone]
[phone]
WINSTON-SAL ENI REGIONAL OFFICE
CENTRAL OFFICE
1617 Mail Service Center
Raleigh, NC 27699-1617
'To preserver protect
and enhance
., ...,_,._
85 Waughtown Street
Winston-Salem, NC 27107
[phone]
[phone]
North Caiolrnas ,eater
S WU-264-Generic-i 3Dec2012

I
STORMWATER DISCHARGE OUTFALL (SDO)
ANNUAL SUMMARY DATA MONITORING REPORT (DMR)
Calendar Year 2017
Individual NPDES Permit No NCS ❑❑❑❑❑❑ or
Certificate of Coverage (COC) No NCG 160 126
This monitoring report summary of the calendar year should be kept on file on -site with the fac►hty SPPP
Facility Name APAC Atlantic, Inc Plant # 15
County Guilford 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 F
Was this SDO monitored because of vehicle maintenance activities? Yes ❑ No
SWU-264-Generic-13Dec2012

„;dO
't
” 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 C_.,
Date �2/14/18
For questions, contact your local Regional Office
DWQ Regional Office Contact Information
ASHEVILLE REGIONAL OFFICE
FAYEVI EVILLE REGIONAL OI,FICE
'MOORESVILLE REGIONAL OFFICE
225 Green Street
610 East Center Avenue/Suite 301
2090 US Highway 70
Swannanoa NC 28778
Systel Building Suite 714
Mooresville, NC 28115
[phone]
Fayetteville NC 28301-5043
[phone]
[phone]
RALEICH REGIONAL OFFICE
,NVASHINGTON REGIONAL OFFICE
,WILMINGTON RLGIONAL OFFICL
943 Washington Square Mall
127 Cardinal Drive Extension
3800 Barrett Drive
Raleigh NC 27609
Washington NC 27889
Wilmington, NC 28405-2845
[phone]
[phone]
[phone]
,«'INSTON-SALEM REGIONAL_ OFFICE
CEN I RAL OFFICE
1617 Mail Service Center
Raleigh NC 27699-1617
To preserve, protect
and enhance
585 Waughtown Street
Winston-Salem NC 27107
[phone]
[phone]
North Carohna's water -
SWU-264-Generic-13Dec2012

r.Ar
STORMWATER DISCHARGE OUTFALL (SDO)
ANNUAL SUMMARY DATA MONITORING REPORT (DMR)
Calendar Year 2017 001904 u
Individual NPDES Permit No NCS LI0❑❑❑11 or 4 0 Z018
Certificate of Coverage (COC) No NCG 160 135 1 RL_, 1, , \
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 # 5
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 ❑ RECEIVED
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ❑ No ® FEB 2
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued? ���
Enough consecutive samples below benchmarks to decrease frequency ❑ CENTRAL FILEl )
Received approval from DWQ to reduce monitoring frequency ❑ OWR SECTIOAI
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes ❑ No
Total
Rainfall,
inches
Parameter, units)
Total
Suspended
Solids mgll
Benchmark
N/A
100
Date Sample
Collected,
mmlddlyy
73,
416117
10
130
10/27/17
15
220
SWU-264-Generic-13Dec2012

,, e
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 posse dity of fines a imprisonment for knowing violations "
Signature cl�
Date 2/14/18
For questions, contact your local Regional Office
DWQ Regional Office Contact Information
ASHEVILLE REGIONAL. OFFICF
FAYETTEVILLE REGIONAL OFFICE
MOORESVILLE REGIONAL OFFICE
2090 US Highway 70
225 Green Street
610 East Center Avenue/Suite 301
Swannanoa NC 28778
Systel Building Slnte 714
Mooresville NC 28115
[phone]
Fayetteville NC 28301-5043
[phone]
[phone]
RALEIGH REGIONAL OFFICE
IWASHINGTON REGIONAL OFFICE
EWILMINGTON REGIONAL OFFICE
3800 Barrett Drive
943 Washington Square Mall
127 Cardinal Drive Extension
Raleigh NC 27609
Washington NC 27889
Wilmington, NC 28405-2845
[phone]
[phone]
[phone]
WINSTON-SALEANI REGIONAL OFFICE
CENT RAL OFFICE
1617 Mail Service Center
'To preserve, prolecr
585 Waughtown Street
Winston-Salem NC 27107
Raleigh, NC 27699-1617
and enhance
[phone]
[phone]
_ 1Vonh carohna s water
SWU-264-Generic-I3Dec2012

k
�aW FI,
0 2018 P STORMWATER DISCHARGE OUTFALL (SDO)
ANNUAL SUMMARY DATA MONITORING REPORT (DMR)
... =.. Calendar Year 2017
Individual NPDES Permit No NCS ❑❑❑❑❑❑ or
Certificate of Coverage (COC) No NCG 160 157
This monitoring report summary of the calendar year should be kept on file on -site with the facthly SPPP
Facility Name APAC Atlantic, Inc Plant # 4
County Forsyth County
Phone Number [phone] Total no of SDOs monitored 3
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 ® RECEIVED
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued' Imo►
Enough consecutive samples below benchmarks to decrease frequency ❑ FEB 21 2013
Received approval from DWQ to reduce monitoring frequency ❑ CENTRAL FILES
Other ❑ DWR SECTION
Was this SDO monitored because of vehicle maintenance activitiesl Yes ❑ No
Parameter. (units
Total
Total
Rainfall,
Suspended
inches
Solids mg/l
Benchmark
N/A
100
Date Sample,�
Collected,
,Y,�
1
�� �
- �n
� "
mmlddlyy��-�
4/19117
043
<0 80
10127117
20
19
S WU-264-Generic-13 Dec2012

L Additional Outfall Attachment
Outfall No 002
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 mgll
Benchmark
N/A
100
Date Sample
Collected,�s
w
g'�
mmlddlyy
�
4/19117
043
<0 80
10/27/17
20
19
SWU-264-Generic-13Dec2012

Additional Outfall Attachment
Outfall No 003
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
S VVU-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 posse ility of fines anpjmprisonment for knowing violations "
Signature cj'.�
Date _2/14/18
For questions, contact your local Regional Office
DWQ Regional Office Contact Information
ASHEVILLE REGIONAL OFFICE
FAYETTEVILLE REGIONAL OFFICE
MOORESVILLE REGIONAL OFFICE
2090 US Highway 70
225 Green Street
610 East Center Avenue/Suite 301
Swannanoa NC 28778
Systel Building Suite 714
Mooresville, NC 28115
[phone]
Fayetteville NC 28301-5043
[phone]
(9 i 0) 433-3300
RALEIGH REGIONAL OFFICE
LNi'ASIIINGTON REGIONAL OFFICE
WILMINGTON REGIONAL OFFICE
3800 Barrett Drive
943 Washington Square Mall
127 Cardinal Drive Extension
Raleigh NC 27609
Washington, NC 27889
Wilmington, NC 28405-2845
[phone]
[phone]
[phone]
WINSTON-SALEM REGIONAL OFFICE
CENTRAL OFFICE
1617 Mail Service Center
To preserve protect
585 Waughtown Street
Winston-Salem, NC 27107
Raleigh, NC 27699-1617
and enhance
[phone]
[phone]
North Carolina's ivater
SWU-264-Generic-1 Mec2012

Semi-annual Stormwater Discharge Monitoring Report DMR
for North Carolina DEMLR General Permit No NCG160000 - Asphalt
Date submitted _ 04/19/2017
CERTIFICATE OF COVERAGE No NCG1601-35 /S7
FACILITY NAME APAC Atlantic, Inc Plant #4
COUNTY Forsyth
PERSON COLLECTING SAMPLES Robby Lewis
LABORATORY Prism Lab Cert #402
Comments on sample collection or analysis
Part A Stormwater Benchmarks and Monitoring Results
R C IVEi5
AUL 2 0 2017
C'�NTFtgiI�RS
DwR SECTION
SAMPLE COLLECTION YEAR 2017
SAMPLE PERIOD ® Jan June ❑ July Dec
or ❑ Monthly' (month)
DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
[]Zero flow ❑Water Supply [—]SA
®Other C Mill Creek
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
❑ No discharge this period ?I
Outfall No
Date Sample
Collected'
(mo/dd/yr)
24 hour rainfall
amount
Inches
Total Suspended Solids
Benchmarks
-
100 mg/L or 50 mg/L'
001
04/19/2017
043
BRL
002
04/19/2017
043 i
BRL
003
04/19/2017
043
BRL
' 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
3 The total precipitation must be recorded using data from an on site ram 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 cPQL Non detect ND or other similar non
numerical format When results are below the applicable limits they must be reported In the format, "cXX mg/L. where XX is the numerical value of the
detection limit reporting limit quantitation limit etc in mg/L
Note !f you report o sample value in excess of the benchmark, you must implement Tier 1, Tler 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 fast revised 9/17/2014
Page 1 of 2

❑ No discharge this period?'
Outfall No
Date Sample
Collected'
jmo/dd/yr}
24 hour rainfall
amount
Inches3
Non -polar O&G by EPA
1W (SGT-HEM)
Total Suspended Solids
Benchmarks =_>
1S mg/L
100 mg/L or SO mg/O
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 Z or Tler 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 OUTFALL7 YES ❑ NO ❑
IF YES HAVE YOU CONTACTED THE DEMLR REGIONAL OFFICE AS REQUIRED BY THE PERMIT? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME
Mad an orlarnal and one coav of this DMR rncludina all "No Drscharae" reports, within 30 days of receipt of the lab results for at end of monitoring period
in the case of No Drscharae" 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 there are significant penalties for submitting false information including the possibility of fines and imprisonment for knowing violations
jSignature of Permrtteej (Date)
Permit Date 10/1/2014 9/31/2019 SWU 252 last revised 9/17/2014
Page 2 of 2

{
4P'RISM
-Din,r�roaiE.% INC
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 Cart No 37735
SC Certification No 99012
Project APAC Stormwater Testing
Project No Plant # 4
Lab Submittal Date 04/21/2017
Prism Work Order 7040420
Case Narrative
05/01 /2017
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
a'_1
Angela D Overcash
VP Laboratory Services
Data Qualifiers Key Reference
Reviewed By Tern W Cole For Angela D Overcash
Project Manager
BRL Below Reporting Limit
MDL Method Detection Limit
RPD Relative Percent Difference }
* Results reported to the reporting limit Ail 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 Spring brook Road P 0 Box 240543 Charlotte NC 28224-0643
Phone [phone] Toll Free Number 1-8001629-6364 Fax [phone] Page 1 of 7

' 4
Fumll service Analytical
Environents! Solutions
� wypnwmniea �Nc,
Sample Receipt Summary
05/01 /2017
Prism Work Order 7040420
Client Sample ID Lab Sample ID Matrix Date Sampled Date Received
Outfall1
7040420-01
Water
04/19/17
04/21/17
Outfall2
7040420-02
Water
04/19/17
04/21/17
Outfall3
7040420-03
Water
04/19/17
04/21/17
Samples were received in good condition at 1 9 degrees C unless othermse noted
This report should not be reproduced except in its entirety without the written consent or Prism Laboratories Inc
449 Springbrook Road P O Box 240543 Charlotte NC 28224-0643
Phone [phone] Toll Free Number 1-000162"364 Fax [phone] Page 2 of 7

T\
AP R c
IR i I V Full Service Analytical of
Environmental Solutions
Vueo�u�uc: sc
El Group Inc - Morrisville
Attn Josh Dunbar
2101 Gateway Center Dr Ste 200
Morrisville NC 27560
Project APAC Stormwater Testing
Project No Plant # 4
Sample Matrix Water
Laboratory Report
Client Sample ID Outfall 1
Prism Sample ID 7040420-01
Prism Work Order 7040420
Time Collected 04/19/17 15 05
Time Submitted 04/21/17 16 40
05/01 /2017
Parameter Result Units Report MDL Dilution Method Analysis Analyst Batch
Limit Factor DatelTme ID
General Chemistry Parameters
Total Suspended Solids BRL mg/L 28 080 1 SM2540 D 4/25/17 15 34 SLS P7D0413
This report should not be reproduced except in its entirety without the written consent of Prism Laboratones Inc
449 Springbrook Road P O Box 240543 Charlotte NC 28224-0643
Phone [phone] Toll Free Number 1-8001529.6364 Fax [phone] Page 3 of 7

4�
APIQ I C fl Full Service Anstytical 8
��l J' V Emlronmental Solutions
ueauron�a Inc
El Group Inc - Morrisville
Attn Josh Dunbar
2101 Gateway Center Dr Ste 200
Mornsvllle NC 27560
Project APAC Stormwater Testing
Project No Plant # 4
Sample Matrix Water
Laboratory Report
Client Sample ID Outfall 2
Pnsm Sample ID 7040420-02
Prism Work Order 7040420
Time Collected 04/19/17 15 11
Time Submitted 04/21/17 16 40
05/01/2017
Parameter Result Units Report MDL Dilution Method Analysis Analyst Batch
Limit Factor DatefTime ID
General Chemistry Parameters
Total Suspended Solids BRL mg1L 25 080 1 SM2540 D 4/25117 15 34 SLS P7D0413
This report should not be reproduced except in its entirety without the wntten consent of Pnsm Laboratories Inc
"9 Spnngbrook Road P O Box 240643 Charlotte NC 28224-0643
Phone [phone] Toll Free Number 1-800162"364 Fax [phone] Page 4 of 7

Azi,
RL.M
SI Fun Service al Solution s
EnvirPnmBntel Solutions
El Group Inc - Morrisville
Attn Josh Dunbar
2101 Gateway Center Dr Ste 200
Morrisville NC 27560
Project APAC Stormwater Testing
Project No Plant # 4
Sample Matrix Water
Laboratory Report
Client Sample ID Outfall 3
Prism Sample ID 7040420-03
Prism Work Order 7040420
Time Collected 04/19/17 15 16
Time Submitted 04/21/17 16 40
05/01/2017
Parameter Result Units Report MOIL Dilution Method Analysis Analyst Batch
Limit Factor Date/Time 10
General Chemistry Parameters
Total Suspended Solids BRL mg/L 26 080 1 'SM2540 D 4f25117 15 34 SLS P7DD413
This report should not be reproduced except in its entirety vnthout the written consent of Prism Laboratories Inc
449 5pringbrook Road P O Box 240M Chattotte NC 28224-0643
Phone [phone] Toll Free Number 1-8001529.6364 Fax [phone] Page 5 of 7

1 �
An
1lJLqm.
I Full Service Analytical &
Environmental Solutions
El Group Inc - MornswIle
Attn Josh Dunbar
2101 Gateway Center Dr Ste 200
Morrisville NC 27560
General Chemistry Parameters Quality Control
Project APAC Stormwater Testing
Project No Plant # 4
Level II QC Report
511117
Prism Work Order 7040420
Time Submitted 4/21/2017 4 40 OOPM
Reporting Spike Source %REC RPD
Analyte Result Limit Units Level Result %REC Limits RPD Limit Notes
Batch P7DO413 - NO PREP
Blank IPM0413-BLK1) Prepared & Analyzed 04/25/17
Total Suspended Solids BRL 50 mg1L
LCS (P7D0413-BS1) Prepared & Analyzed 04/25/17
Total Suspended Solids 470 50 mg/L 4770 98 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 28224.0643
Phone [phone] Toll Free Number 1-8001629-6364 Fax [phone] Page 6 of 7

AV
CHAIN OF CUSTODY RECORD
I
R ISM I Full ronmenService al Sol do 8 �',�"�� Environmental Solutions
`RA
PAGE OF QUOTE C TO ENSURE PROPER 6illlN[r J`�! 14�—
upon amval7
Samples ION
YES _ NO NIA �
L.aeoaAToaiES.INC.
, €
Project Name �J' 7"7 Crt'tCrSv tj'e-
�m Received ON Wi„yt SCE?_
WE
-leL
,-L�• — I0
4P Phone 70 rook1529- Road Charlotte NC 28217
09Short
Phone 7D41529.6364 •Fax 704l525-G409
Hold Analysis Yes No UST Project es NO
Y (Yes) { } J (Yes) { )
PROPER PRESERVATIVES Indicated?
�
(D
*Please ATTACH any project specific reporting (QC LEVEL 1 II 111 IV)
Received WITHIN HOLDING TIMES'
Client Company Name _
provisions andlor OC Requirements
CUSTODY SEALS INTACT
Report TolContact Name &Affie2l 'Dung -
Invoice To
VOLATILES reed WIOUT HEADSPACE?
Reporting Address l .Z )d Trf n, ix A'U 5,4 k 1,00
Address
PROPER CONTAINERS used
2. 7 L.& 7
TEMP Therm ID Observed ,�°C I Carr Ia
s
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t
4
Phone T - )i —G$DZ) Faxes)(NoPurchase Order No /Sifting Reference ," tP i M) tx'?
TO BE FILLED IN BY CLIENT/SAMPLING PERSONNELG
�
Email Address yti t,x-.
Requested Due Date ❑ 1 Day ❑ 2 Days 0 3 Days U 4 Days ❑ S Days
Certification NELAC DOD
FL NC
EDO Type PDF Excel —Other _
Working Days' O 6 8 Days Standard 10 days ❑ PresApprrovedust Be
SC OTHER
NIA
Site Location !same a +YI'j' Y 'ter ++ jl L -
Samples received after 14 00 will be processed next business day
Site Location Physical Address 1G S
Turnaround time is based on business days excluding weekends and holidays
Water Chlonnated YES— NO —
K
(SEE REVERSE FOR TERMS B CONDITIONS REGARDING SERVICES
RENDERED BY PRISM LABORATORIES INC TO CLIENT)
Sample Iced Upon Collection YES
NO
TIME
MATRIX
SAMPLE CONTAINER
ANALYSIS REQUESTED
PRISM
CLIENT
DATE
COLLECTED
(SOIL
PRESERVA
REMARKS
SAMPLE DESCRIPTION
COLLECTED
MILITARY
WATER OR
SLUDGE)
'TYPE
NO
SIZE
TIVES
�+
I NO
HOURS
SEE BELOW
�5S Q
11117
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Sampler s Signature Sampled By
(Print Name) /� "- Affiliation
Upon relinqu fiing this aln of Custody Is your authorization for Prism to proceed with the analyses as requested above Any changes must be
submrtted In sting to A Prism Project Manager There will be Charges for any changes after analyses have been Initialized
Relinqw B ) L11 ece v S�rol.,
a�� �,} M�ryM n Additional Comments
( [
Site Arnvai Time21i.
Relingv (s:gnaw Rat
d By (Slgnatu 0490
Site Departure Time
Relupu By ( )
or m Lebor tones By Date
Field Tech Fee
�1 I if V
Method p N ALL SAMPLE COOLERS SHOULD BE APED SHUT WITH C Y SEALS FOR TRANSPORTATION TO BORATORY COC Grdup No
Mileage
PLEB ARE NOT ACCEPTED AND VERIFIED AGAINST COC
UN RECEIVED AT THE LABORATORY
% /� / !
I'
0 Fed Ex O UPS ❑ Hand-deirvered m Field service 0 Other
C V l/ t G��
NPDES UST` GR NOWATER DRINKING WAtER I SOLID WASTE RCRA II CERGLA LANDFILL OTHER
r
ANC❑SC ❑NC ❑SCI oNC El SC ONC ❑SC
ANC El SC ❑NC❑SCi oNC ❑SC ANC 05C ❑NC El SC
I FA 17,11
"CONTAINER TYPE CODES A = Amber C = Clear G= Glass P = Plastic TL = Teflon -Lined Cap VOA = Volatile Organics Analysts (Zero Head Space)
ORIGINAL —

Semi-annual Stormwater Discharge Monitoring Report (DMR) A&4&�
for North Carolina DEMLR Genera! Permit No NCG160000 - Asphalt
Date submitted _ 07/07/2016-
CERTIFICATE OF COVERAGE NO NCG160157 SAMPLE COLLECTION YEAR 2016
FACILITY NAME APAC Atlantic, Inc Plant #4 SAMPLE PERIOD ® Jan -June ❑ July -Dec
COUNTY Forsyth or ❑ Monthly' _ (month?
PERSON COLLECTING SAMPLES John Leach DISCHARGING TO CLASS ❑ORW ❑HQW []Trout ❑PNA
LABORATORY Prism Lab Cert # 402 ❑Zero -flow ®Water Supply []SA
Comments on sample collection or analysis [:]OtherRECEIVED
Part A Stormwater Benchmarks and Monitoring Results
JUL 2 8 1016
\NRL FILES
SECTION
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
❑ No discharge this period a`
Outfall No
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
Inches3
Total Suspended Solids
Benchmarks =__>
-
-
100 mg/L or 50 mg/L°
001
07/07/2016
05
83
002
07/07/2016
05
69
003
07/07/2016
05
16
' Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall
2 For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here
3The total precipitation must be recorded using data from an on -site rain gauge Unattended sites may be eligible for a waiver of the rain gauge requirement
4 See General Permit 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 a sample value in excess of the benchmark, you must implement Tier 1, Tier 1, 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

rJ
1A�
❑ No discharge this period 22
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 =__>
_
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 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 coov of this DMR. includina all "No Drscharae" reports. within 30 days of receipt of the lob results (or at end of monitorina period
in the case of "No Drscharae" 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
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 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
I-a5-�
(Date)
SWU 252 last revised 9/17/2014
Page 2 of 2

STORMWATER DISCHARGE OUTFALL (SDO)
ANNUAL SUMMARY DATA MONITORING REPORT (OMR)
Calendar Year 2013
Individual NPDES Permit No NCS ❑❑❑❑❑❑ or
Certificate of Coverage (COC) No NCG 160 157'p
This monitonng report summary of the calendar year should be kept on file on -site with the facility sppP APR 2014
rry
Facility Name APAC Atlantic, Inc Plant #_4- ' ' Nn /wnrOf un'rmrich
4 fL ,�! fl ,jli IX�1 �,
County Forsyth County -
Phone Number [phone] Total no of SDOs monitored 3
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 DWO to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes ❑ No
Total
Rainfall,
inches
Parameter, (units
Total
Suspended
Solids mgll
pH
Standard Units
Total Petroleum
Hydrocarbons, mg/1
EPA Method 1664
HEM)
Benchmark Benchmark
N/A
100
Within 6 0 - 90
15
Date Sample
Collected,
mmlddlyy
2/22/2013
025
NO
751
NO
S W U-264-Ge ne ric-13 Dec2012

Additional Outfall Attachment
Outfall No 002
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
Total
Rainfall,
inches
Parameter, (units)
Total
Suspended
Solids mgll
H
Standard Units
Total
Petroleum
Hydrocarbons,
mg1I
EPA Method
1664 (SGT-
HEM
Benchmark
N/A
100
Within 6 0 - 90
15
Date Sample
Collected,
mmlddlyy
2122/2013
025
ND
748
ND
SWU-264-Generic-13Dec2012

:.
Additional Outfall Attachment
Outfall No 003
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
Total
Rainfall,
inches
Parameter, (units)
Total
Suspended
Solids mgll
pH
Standard Units
Total
Petroleum
Hydrocarbons,
mgll
EPA Method
1664 (SGT-
HEM
Benchmark
N/A
100
Within 6 0. 9 0
15
Date Sample
Collected,
mmlddlyy
2/22/2013
025
ND
750
ND
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 "
Signatu
Date
For questions, contact your local Regional Office
DWQ Regional Office Contact Information
ASHEVILLE REGIONAL OFFICE FAVETTEVILLE REGIONAL OFFICE MOORESVILLE REGIONAL OFFICE
2090 US Highway 70 225 Green Street 610 East Center Avenue/Suite 301
Swannanoa, NC 28778 Systel Building Suite 714 Mooresville NC 28115
[phone] Fayetteville, NC 28301-5043 [phone]
(91 M 433-3300
RALEIGH REGIONAL OFFICE WASHINGTON REGIONAL OFFICE WILMINGTON REGIONAL OFFICE
3800 Barrett Drive 943 Washington Square Mall 127 Cardinal Drive Extension
Raleigh NC 27609 Washington, NC 27889 Wilmington, NC 28405-2845
[phone] [phone] [phone]
WINSTON-SALEM REGIONAL OFFICE CENTRAL OFFICE
W585 Waughtown Street 1617 Mail Service Center j
Winston-Salem, NC 27107 Raleigh, NC 27699-1617
[phone] [phone]
"To preserve, protect
and enhance
Borth Carnlrna s ►valer
SW U-264-Generic-13Dec2012

J
RE:cEIVED
STORMWATER DISCHARGE OUTFACE (SD0) N C Dent of ENR
ANNUAL SUMMARY DATA MONITORING REPORT (DMRMAR 0 12011
Calendar Year 2010 wlnst�n Salem
Regional office
General Permit No NCG160000
Certificate of Coverage No NCG160157
This monitoring report summary is due to the DWO Regional Office no later than 30 days from the date
the facility receives laboratory sampling results from the final sample of the calendar year
Facility Name APAC Atlantic, Inc, Plant #4 Kernersville, NC z k G 3 Kc' % 66
County Forsyth
Phone Number [phone] Total no of SDOs monitored 1
Outfall No 001
Is this outfall currently in Tier 2 (monitored monthly)? Yes ❑ No X
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ❑ No X
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 ❑
Outfall 001
Total Rainfall, inches
00630
00400
00556
Vehicle
Maintenance
Activities
TSS, mglL
pH, s u
Oil &
Grease,
mglL
New Motor Oil
usage,
gallmonth
Benchmark
N/A
100
6 0 - 9 0
310
N/A
Date Sample Collected,
molddlyr
f ; ,Y m
W
02/22/2010
03
ND
61
ND
NA
08/26/2010
03
57
71
ND
NA
SW J-25ONCG16-051709

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 C7 (Q_.!C _ (I
Date _, _a - 14
Mail Annual DMR Summary Reports to
DWQ Remonal Office Contact Information
Asheville Office
[phone]
Fayetteville Office
[phone]
Mooresville Office
[phone]
Raleigh Office
[phone]
Washington Office
[phone]
Wilmington Office
[phone]
Winston-Salem
[phone]
Central Office
[phone]
HEVILEE REGIONAL,OFi
2090 US Highway 70
Swannanoa, NC 28778
[phone]
:1GH-REGIONAL;OFF
3800 Barrett Dave
Raleigh, NC 27609
(919) 7914200
OFFICE -- ---
585 Waughtown Street
Winston-Salem, NC 27107
[phone]
225 Green Street
Systel Building Suite 714
Fayetteville, NC 28301-5043
[phone]
WASHINGTON REGIONAL OFFI
943 Washington Square Mall
Washington, NC 27889
[phone]
1617 Mail Service Center
Raleigh, NC 27699-1617
[phone]
610 East Center Avenue/Suite 301
Mooresville, NC 28115
[phone]
127 Cardinal Drive Extension
Wilmington, NC 28405-2845
[phone]
f"To preserve protect
and enhance
190Nodh Cambna s seater "
SWU-250NCG16-051709

STORMWATER POLLUTION PREVENTION
TRAINING FORM
APAC High Point Plant 4
Kernersville, North Carolina
IECS, Ltd Project No 4G-6335
(Refer to Section 5 4)
Employee Name
Initial or Annual
Training
I
,
I
Moro,
R, W--, A
k
a'
I
1
F
i
I
u *Trauung lrutial, Annual Refresher, Plan`Modification, Spill Follow-up
W
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r t
il.
i
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ram_ i/tic .fly%�,%;�
I�
1
i
i
■
`E
I

Feb 22131221p p2
S
• 7AL1 \ V
3
a
Stormwater Monitoring Event Submission Form
Facility: Name- Koz&z 161 „ In V
i
Person(s) Collecting Samples Jack �� 11
Zontact for Sample Pickup `
INoma and Phone Number! JCii, ,b�.r 9 VI ' 67 1
t D Sba
.�.,
Date of storm evens
total Event Precipitation S
(inches)
Event Durations (hours` ` J �c►+fS _
Location of Rain Gouge
ti
,
Ourrag No
'Dote 3Qrnpb Collected
(mmlddl}ryyyJ
lime somple Collected
•? Z 2 I M �—
1 vi o ��
----pot-----
r�o2
Iz.
/n. r'
3
Y i
f
Completed Forms Attached
Stmmwoter Discharge Outtan WuaRtative tvbr Oring Report
E-r", Cham-of-custody form
Send Completed forms to Stormwater Sampling Coordinator (Falcon Engir►eering) via fox
919 871 0803
Page 1 012

Feb 22131221p p3
n
r
e
Stormwater Monitoring Event Submission Form {continued)
"` nH fists Cogc�xinn Farm
PH Meter Equipment Defc&
Equipment Make
Fou43nw of Motlef No
AU10 TeMP CorreCr$
PH Meter Cabbraf ri Data
k
CuRyafkn Performed
Cobbrafton
Buffers Used
Cokbrafron verfticahm
Date
rum
Low
High
pH Buffer Used
Meossmed Value
/�'zLfl3
"i7St�am
1.{.01
102
�.�l)
—7 01
pH Anafyfled Data
Sample Location
ff * ouffam Ma
PH Performed
AN�d
Measured
values
to
flora
Temp°
001
ha �
�f /
)
!O!OT
{
Ish e-r-11
�JpH I�
1 / �
r
49 °�
Qe z
21 Z7,113
1 , zz.
J, S,rract
-7 y
44 `F
D°
2 �z—Z� 13
f�' 3i�
5
4 cp °F
1
,
,
r
Post-Monlorfng pH Meter CaEbralfon Check
PH &ffer Wed
Memtved Vpiue
—Term IuF)—
� } `—PH
I eo 1
—7,D 3
5 dp
P oga 2 of '2
0

STORM WATER DISCHARGE_OUTFAL1L (SDO)
F GENERAL PERMIT NO NCG160000
DISCHARGE MONITORING REPORTI(DMR)
CERTIFICATE OF COVERAGE NO NCG160 157
FACILITY NAME APAC Atlantic, Inc Plant d 4'
PERSON COLI ECTING SAMPLE(S) Josh Sorrell
l
CERTIFIED I.ABORA rORY(S) Prism l.ab q 402
Lab k
Monitoring Requirements
SAMPLES COLI ECTED DI[IRING THE CAI ENDAR YEAR 2013
(This monitonng report sha11 b received by the Division no later than 30 days from
the date the facility recieves the�samp]mg results from the laboratory)
COUNTY
PHONE. NO
1 336-869 7512
Outfall
No
Date
Sample Collected,
moldd/ r
Total Pawfall,
Inches
OI1530
00400
00556
Total Suspended Solids, mail
pH
Standard Units
Total Petroleum Hydrocarbons melt
EPA Method 1664(SGT HEM
Benchmark'
100
Within 6 0 - 9 0
15
001
2/22/2013
0.25
ND
731
ND
002
2/22/2013
025
ND
749
ND
003
21=013
025
ND
750
ND
Y
4
I
' if a value is In excess of the benchmark or outside the benchmark range (for pH) you must implement the Tier I or 15cr 2 responses in the General Permit,
Mad Original and one copy to 1
Division of Water Quality
Attn Central Files
1617 Mail Service Centcr
Raleigh North Camhna 27699 1617
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFROMATION 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 the person or persons who manage the system, or those persons directly responsibe 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 falst information, Including the
possibility of fines
aannd�
d imprlsionmee�nit,fo�r knowing violations." Q
4&
13
(Signature of Permittee) (Date)
'FILE,
FILEa COPY' FbrTn swu 2�� 1iQn
I

Feb 22 13 12 22p
,
p4
Stormwater Discharge Outfalt (SDO)
Qualitative Monftoring Report
For gurdancenrrfillingout thisfann. p1daseivilt hltnJJ#f���.�nr.,aut,.n�.a:./+u/I�>niti� t)c iatrrt,.,innutiur.clr�nrr
Permit No or Cerlificuic of Coverage No
Facility Name " M �ta►A._-- ikawi,, d, AY_ ,
County __TPhone No 3 3V -gta
,_»
Inspector 1 -
Date of Inspection
Time of Inspection _10 3t? w+"
Total Event Precipitation (inches) . Z 9-
Was this a Representative Storm Event9 (See information below) Dr Yes ❑ No
Please check ),our permit to veiffy if Qualitative Monitoring must be performed during a represenrative
storm ei3Otit (requirements var)j
FA "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 meaburing greater than 01 inches has i
occurred A single storm event may contain tip to 10 consecutive hours of notation -!
By this signature, I certify that this is accurate and complete to the best of my knowledge
2
(Si&—atuf+e of Pei-mutttifi or Designee)
1 Out&H Desrnpt=on:
Outfall No . e>ci 1, --- Structure (pipe, ditch, etc.)
Receiving Stream
Describe the mdastrial activities that occur within the outfull drainage area.
2 Color. Describe the color of the discharge using basic colons (red, brown, blue, etc ) and tint
(light, medium, dark) as descriptors _a&,r
3. Odor: Describe any distinct odors that the discharge may have (i e , smalls strongly of oil, weak
chlorine odor, etc ) _ NEAL
Page 1 of 2
NWLI.242-1 I bW

Feb 22 1312 22p p 5
4 Ctanty Choose the number which best,describes the clarity of the discharge, where I is clear
and 5 is very cloudy
6 2 3 4 5
5 Floating Solids Choose the number which best describes the amount of floating solids in the
storinwater discharge, where 1 is no solids and 5 is the surface covered with floating solids
lJ 2 3 4 5
r 6 Suspended SoUds. Choose the number which best describes the amount of suspended solids in
the stormwater discharge, where I is no sobers and 5 is extremely muddy
j J1sn2 3 4 5
7 Is there any foam in the stormwater discharge) Yes dF
1 8 is there an od sheen in the stormwater discharge? Yes No
^ 9 Is there evidence of eros.on or deposition at the outfall? Yes Sim
10 Other Obvious indicators of Starmwater Pollution
Libi and describe -- •-.--_N�_ -- t'.�v.------
Note Low clarity, high solid% and/or the presserice of foam, oil sheen, or r,rosion/depositson may -be
indicative of pollutant exposure These conditions warrant further investigation
Page 2 of 2
SWU 24: 112"
0

Feb 22 13 12 22p
p6
wry
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For gurdnneronfiUrnBout thrsform pleaseiasu him.lJh?i.Citr.xlai�_ih.u�l.u/l�nrm. i�iu��iieni,.hic}rtnu.�i�ui*
Permit No riISJ�JJSeJ �I Uj v/d / or Certificate of Coverage No
Facility Name :n2n*1,2m ArU.,— Unxssv_lt,, V4 r - �=4
County I�,.Phone No -& U - $4`7 - ? s; z
Inspector I .ias. �(A
Datc of inspection _.2- 7,-�-t 3 -- • -_--
Time of Inspection. )at art. ,_,
Total Event Precipitation (inches)
,25-
Was this a Representative Storm Event9 (See information below) Ej-�es ❑ No
Please check your perrith to verift if Qualttad ve Monitoring roust be performed during a representarne
storm event (requirements vary)
r-. A "Representative Storm Event" is a storm event that measure; greater than 0 1 inches of rainfall and ^that
is preceded by at least 72 hours (3 days) in which no storm event rneu &&ring greater than 01 inches has !,
occurred A single storm event may contain up to 10 consecutive hours of no rccnpitation
By this signature I certiry that this report is aa;urate and complete to the bent of my knowledge
64" Z-2Z- i3
— - (Signature of Permrttee or
I Outfall Description
OutfalI No CO L Structure (pipe, ditch, etc } d • — ____ _ _..
Receiving Stream
Describe the industrial activities that occur within the outfall drainage arcs Aube! 14- &d,. c kL,n
2 (;oior Describe the color of the discharge using basic colors (red, brown, blue, etc ) and tint
(light, medium, dark) as dcscnptors< i
3. Odor. Describe any distmct odors that the discharge may have (i e , smells strongly of oil, weak
chlorine odor, etc) v rl e- --
Pnge l of 2
4wU 242 112608

Feb 22 1312 23p p 7
4 Clanty- Choose the number which best dehcribes the clanty of the discharge, where I is clear
and 5 is very cloudy
6 2 3 4 5
5 Floating Solids: Choose the number which best describes the amount of floating solids in the
stormwater discharge, where l is nosolidsand 5 is the surface covered with Hosting solids.
[i/ 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
a 2 3 4 5
a
7 Is there any Foam in the stortnwater discharge? Yes N
8 Is these an oil sheen in the ctormwater discharge? Yes No
9 Is there evidence of erosion or deposition at the outfalI? Yes
10. Other ObvkKui Ind>Icfftors of Stormwater Pollution
List and describe V o W� * +� �� cuu.�t/ Pollu Pun ,
t
Note —Low -clarity. high-saatds, and/or the presence of foam, oil sheen, or erosionldeposirion ntay be
indicative of pollutant exposure Tbcw conditions warrant further investigation
PuLte 2 of 2
"U-141-1110

Feb 22 13 12 23p
p8
9_
Stormwater Dlwharge Outfall (SDO)
Qualitative Monitoring Report
harguuimict on filling out thlsform please vistl III in4Ai lgi om%wit, 11LALgShc JJFM� 12(Ku1a;1]tj1111 N� 1111nIU1rl13�
Permit No �f��j' l� (mil Olt o/ o l� or Certificate of Coverage No
Facility Name
County rs Phone No 3i - Y &v q
Inspector
Date of lnspecnon
—r
Time of Inspection la(TO
Total Event Precipitation (inches) , 2
Was this a Representative Storm Events (See information below) [Ves ❑ No
Please c,beck your permit to venfv if Qualitative Monitoring must be perfonned during a representative
storm event (requirements vary)
.-� A "Represeraaave Storm Event" is a storm event that measures greater than 0 1 inches of rainfall and that �
f Is preceded by at least 72 hours (3 days) its which no storm event measunng greater than 0 1 inches has
Loccurred A single storm event may contain up to 10 consecutive hours of no precipitation - __J,
By this signature, I certify Pqt this report
- (Signature of Pern'ttttee o>/Dei
and complete to the hest of my knowledge
I out>Ialt Description.
OutfalI No 003 Structure (pipe, ditch, etc.)
Receiving Stream
Describe the industrial activities that occur within the outfall drainage area L�-s� m ?'rd if �
2 Color. Describe the color of the discharge usin basic colors (red, brown, blue, etc ) and tint
(light, modium, dark) as descriptors Z"t'-�- d- ~
3 Odor. Describe any distinct odors that the discharge may have 0 e., smells strongly of oil, weak
chlorine odor etc) _ A& o� {•-
Putt Iof2
5WU 2s2 11260M

Feb 2213 12 23p p 9
—� 4 Chanty Choose the number which best describes the clarity of the discharge, where I is clear
and 5 is very cloudy
" e
2 3 4 S
5. Floating Solids. Choose the number which best describes the amount of floating solids in the
stormwater discharge, where I is no solids and 5 is the surface covered with floating solids
1 2 3 4 5
6 Sus nded Solids. Choose the number which best describes the amount of suspended solids in
the stormwater discharge, where I ss o solids and 5 is extremely muddy
l 2 3 4 5
7 is there any foam in the stormwater discharge?
Yes C
& Is there an oil sheen in the stormwater discharge? Yes
J 14 them evidence of erosion or deposition at the outfal l?' Yen
k
10 Other Obvious iiiclicetors of Stormwater Pollution-
4 �
List and de=b= _ �la hn a(�u �J�i .J � S�r. •Yr i.a � �cr^ f.���6 �rZJ
Note-- —Low clarity. high solids„andfor the presence of foam, oil sheen, or erosion/deposition maybe
indicative of pollutant exposure These conditions warrant further investigation
Page 2 of 7
swu 242.i 126ix

Jul 1212 07 43e p 2
ALCON
Stormwater Monfi oring Event Submission Corm
Faziltty Name: Plant #4'tQMp Tlej�
Person(s) Collecting Samples -
Contact for Sample Pickup
Iran* arw Phone MumbM
Date of storm event -
iota) Event Preapdat(on
lunches)
Event Durations (hours)
Location of Ran Gauoe
f
OuffOU No
Date Scm;n bb CoWded
(mmlddlmiYf
4w
5amp�e Ca'lected
0
y1rf
Z
003
% 3 Z
�I
Completed Rims Attached
Stom water Discharge Outfall dudrtatn+e Morutonng Report
[� Choi"f-custody form
Send Completed forms to Stormwater 5ampdrng Coordinator {Falcon Engineering) Ao fox
919 8710803
Page 1 of 2

Jul 121207"a I p3
i
Stormwater Monitoring �ent Submission Form (co„ inuaa)
RHjD&ta_Qtotm
pN Meter Egaipment petals
t
Equornentmaxe EauornentmetdofNo Temp Coffect9
l4�eh4R ff l q IZAvfo
$ e5
pH Meter CaUbrasan Data
CahbraWn Pedor►ned
CoUbrofion sorters used
CatlbfWm verf -alron
Dale lime
Low
Koh
30erUsW
Measured Value
7/7 IS-
4.ot
110.iof
-7 al
17,0(
pH Analytical Data I
Sarrmpte Locolfon
I No
H Perfomed
'�° 6wd by
Measured Valuas
Date
a
H
T
001
7111 j 1 Z
-7, OVA-
SFr
'7, 3
-r 3.1
DO Z
7 JO I Z
"7. y 8
-7;
Post-AAaMorinD pH Meter Capbratton Check
OR tiler Used
Meosued Value
N
Tern •F
Pogo 2012

i
CHAIN OF CUSTODY RECORD.
SGS Environmental Services Inc.
aw+anuu�a I�aLWuxwtl
Aluh North Ceroliaa
Maryland New kma
.uw. a �a nwe ..wwr
IENT. Falcon
0
n - APAC
Retemneek.NTACT•
page ofJECT.
JoshSorrell PHONENO
FR0
336469-75I2
Kernewdle #4 31�EJPWSID#, 1
e
°
N
A
z±
a
met
VI
.,
Id
I �
RTS TO- Josh Dmitw,1210 Trinity Rd, State 110, Raleigh, NC 27607
Erna d - con.com
c'
c
00
OR"
,E
V OICE TO: Josh Dunbar QUOTE #•
P 0 NUMBER
LAB NO,
SAMPLE IDENTIFICATION
- DATE
Tna
MATRIX
Outfail #1 i
I l 2
-7 i its i
water
G>
>
OutfaD #2 i
r r
71 Z 7. i afn
water
G
1
Outfell #3
'T l ti ►a
7 5 16n,n
water
G
t
4
i
i
f
I
I
1
�
-
I
k
i
Ilacted1Ref mgohhed 8y- ( t)
L& Sot tt 1N
Date
r ! I Z
Time
71 �� atrt
Received By
Came
Ticket No
#191
Samples Received Cold? YES NO
Twn °C• erahtro
Relinquished By (2) I
Date
Time
Received By
ehyer" ReWi
Chain of Cadody Seal (Cirde)
INTACT BROKEN ASSENT
1lagaished By (3)
F
Date
Time
Piwived By
uestad Twmrmd Time and -or Speelal imeuctit=
1
Ralingatshed By (4)
at
Tun
Received For Laboratory By-
m
Potter Drive chorag% AK 9963E !T l -g
T' 0 3180 Pew Road Falrbaak% AK 99701 Tel • (907) 474$b56 _Fay (907),474-9585
5500 Business Drive Wllmington, NC 28405 Tel, [phone] Fm [ 10) 35N 1557

STORMWATER DISCHARGE OUTFALL (SDO)
' GENERAL PERMIT NO NCG1600M
DISCHARGE MONITORING REPORT (DMR)
1
CERTIFICATE OF COVERAGE NO NCGi60 157 SAMPI LS COI I ECTED DURING THE CALENDAR YEAR 2012
(This monttonng report shall be received by the Division no later than 30 days from
the date the factltty recieves the sampling results from the laboratory)
FACILITY NAME APAC Atlantic Inc Plant 4 4 COUNTY I Forsyth
PERSON COLLECTING SAMPLE(S) Josh Sorrell `PHONE NO 336-869-7512
CERTIFIED LABORATOR-t(S) SGS Lab 00 481 i
Lab If
I
Monitoring Requirements
i
Outfail
No
Date
Sam pie Collected,
moldd! r
Total Ramfali,
inches
011530
l 00400
I 00556
Total Suspended Solids mgll
pH,
I Standard Units
Total Petroleum Hydrocarbons, moll
EPA Method 1664 SGT HEM
Benchmark[
100
; Within 60 90
[ 15
001
7/11/2012
100
700
730
N D
002
7111i1012
100
900
748
ND
003
711112012
100
t00
750
ND
f
!
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
Mail Original and one copy to
Division of Water Qua hty
Attn Central Files
1617 Mail Service Center
Pales h North Carolina 27699 t617
YOU MUST SIGN THIS CER7IF[CATION FOR ANY INF ROMATION REPORTED
9 certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision is accordance with a system'destgned 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 responsibe 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 flues and impnstonm t for knowing violations'
(Croon ��w nr P�rrrrrtf..l ln�..� f
FILE COPT
Fortn SWU-233-051409
Page tofI

Jul 12 12 07 44a
p4
Stormwater Discharge
Qualitative
Forguidance onjilrma our rNsform, please wskr
Permnt No ICI OL-
Facility Nan=
County - �r
Inspector . �s
Date of Inspection
Tltnt: of hvgxxzon
fall (SDO)
Report
4I.S/ or CerWecale of Coverage Nm
Ptione No 3 3 I- $6 q - 7 S"M
Total Event Precipitation. (inches) % i0 !
Was this a Representauva Storm Event? (See rnfor=tton be w) � ❑ No
i
Please check your pemar to uerify #'QU4htative Momlorfng n� ba performed dwruig a represenranve
storm event (requirements vary) If
AA Tzpre=tattve Storm Event" is a storm event that MM
greater than 0 1 inches of rainfall and that
i is preceded by al least 722 hairs (3 days) in whtch no swarm at msasunng greater than 0 1 inches bas
occurred A single storm event ma contain to IQ vie hours of no recipitation
By this signamre, I certify
'(Stgnautne of
and cor#lde to the best of my knowledge
1. OutbR DeNripflom
Outfall No ,ran! Smwjum (pipe:,, dttb, etc) _.
Rocetving Stream
Describe the industnal activities that occur within the outfalI d
2. Color: Descnbe the color of the discharge usin ,bast colors (red, brown, blue, etc,) and unt
(light, medium, dark) as descnptorr Clear t,'Dh
3. Odor Describe any distinct odors that the discharge may have G e., smells samoy of oil, weak
chlanne odor, ew-)
Page 1 of 2
SWtI-242-1I2UM

jul 12 12 07 44a P 5
fI
I
4 Ctarity: Choose the number which best describes they clarity of the discharge. where 1 is clear
and 5 is very cloudy
1 � 3 44 5
5 Floating Solids. Choose the number which best dnse�bea the amount of floatins solids in the
stormwater discharge, where 1 is no solids and 5 Is the surfac covered with floating solids
F
9 2 3 4 5
6 Suspended SW]ds Choose the munber which best describes the amount of suspended solids in
the stormwater discharge, where I is no solids and 5 is extmm fly muddy
2 3 4 5
7. Is there any foam in the storinwater discharge? Yes
8 is there an oU screen in the stormwater dtscliage? Yes es
9 Is there evidence of erosion or deposMon at the out ]? Yes
10. Other Obvious Indicators of Stom3water Pollution
List and describe O O yt .cam r
Nate: —Law clarny, high solids, and/or the presence of foam. P shem crerostWdeposition maybe
indicative of potluta tt exposure. '1Lese conditions wa TW further investigation
t
i
t
Face 2 of 2
SWU.249.112=

Jul 12 12 07 45a
M.
E
Stormwater Discharge
Quabtative Monitoi
For guidance on filling out lhufonm, please War
Permit No X196,1!Ar- OJ 4
Faculty Name , az .••�
Coumr
inspector
Date of Itispection '? t
Tim of rnspecuom -7t
feu (SDO)
Report
or ecrtificatc?FCd =asx No j4 C1Qd- j—j _ —j 1� ,
Phone No 13�G
Total Event Pmcipitation (inches) - if,;7
Was this a Representative Storm Event? (See tnformation w) Yes ❑ No
Please check your permfr to verify if Qualuadve Monfroring n?usr be performed daring a representariye
storm Event fregturenients vary).
A "Repnesemative Storm Event" is a storm event that measiuvs greaw than 0 ! inches of rMnfall and that'
is preceded by at least 72 hours (3 days) to winch no stem att measuring greater than Q 1 inches has
! oocatred. A single storm event may contain up to 10 cotrsece hours of no pt=prtatioa.
By ttus signature I
accu a c and complete to the best of my knowledge
(Stgitatlue of Pcrnul 4rNestgnee) --
1. O[ttfhll Desctiptioai
Outfall No g29r-- Structure (pipe, ditch. etc.) . - ... km-
Ramivurg Stz m
Descirilm the mdustrial activities that occur wtthi n the otitfail drainage area
2. Cador. Describe the color of the discharge using basic colors (mad,, brown blur. etc) and tint
(light, medium, dark) as descnptots U�g� &4&
3. Odor-. Describe any distinct odors that the dtacharge amy have (i a, smr is strongly of oil, weak
chlorine odor, etc )r s� .�ge4eni_ _ .... �
u
Per t of 2
5WU 242.112M
d

Jul 12 12 07 458
P7
4 Clarky. Choose the number which bast describes the clanty of the dtscharge; where I is clear
and 5 is very cloudy
CP 2 3 4 5
S. Floaft Solids: Choose the nun*er which best describes tba amount of flonuag solids in the
storrriwater discharge. where I is no solids and 5 is the surfacq capered with floatmg solids:
0 2 3 4 5
b. Suspended Solids. Choose the number which best dt scribes the amount of suspended solids in
the stonrnwater discharge, where l is no solids and 5 is ext y muddy
2 3 - 4 5
7. Is there any foam in the stormwater discharge? Yes
& IS there an all sbeea in the sta mwater discharge? Yes
9 Is there evidence of erosion or depositfon at the oatfall? Yes
10. Other Obvtow Indicators of StermwaterPoliutlnu:
Lust and dascribe�
Note— Low clarity. high solids, ari&or the presence of foam, oil cheer, orerogion/deposition maybe
indicative of pollutant exposure These conditions warsant farther investigation.
Page 2 of 2
SWIY242-112M

Jul 12 12 07 45a
Pg
Stormwater Discharge Outfall (SIDO)
Qualitative Monitoring Report
For guadwwe on frig our Whir farm please visit- ht�Jlt��n.enr ataic.nc.uslevlFornns l]oc�iments.htmgtmeernrms
Permit No fo
FacAny Name. _
County xvr s
Inspector
Date of Inspecuon
Time of hispecuocL
Total Event Precipitation (inches) /iri•
Was this a Representative Storm Event? (See information below) EJ Y. ❑ No
Please check your permi to verify f Qualitative Q?onitoring must be perf+orrned during a representadve
storm even! {rrquerements va yX
A "Representat3ve Strom Event" is a storm event that rnemyr.8 ,greater than 0 t ioc?tes of rsmfall and that
is preceded by at least 72 Roars (3 days) in which no storm event measunng grater than 0 t tnches has
occomed- A smgle storm event may contain up to 10 consecutive hours of no precipitation -
By this sipiiatttre. I ce-Mof to ttc�'epgft)( g4igxate and mapiete to the best of my knowledge.
(Signature of Pertnitde dir Designee)
1 Outfall Description:
OudWi No -_3 Swucture (pipe, ditch, etc.)
Receiving Stmm, - - -
Desc+nbe the industrial activkics r wv that occuOa n the outfall dtattiage area �4/
I Color: Describe the color of the discharIn basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors. C/!ar_ rt"7/ - • • -- -- - -
3. Odor. Describe any dtsu odors that the discharge may have (i.e . smells strongly of oil, weak
chlorine odor. a ,) ,. /r%p 406— _-- -
Page l of 2
swu zaz-i immi

Jul 12 12 07 46a
P9
4. Cbwky- Choose the number which hest describes the clarity of the discharM where 1 is clear
and 5 is very cloudy
l � 3 4 5
S. Floating Soles Choose the number which best describes the amount of floating solids in the
stormwater discharge, where 1 is no solids and 5 is the sarface covered with floating solids.
'(P 2 3 4 5
6. Suspendled Solids Choose" number which best dmcnbes the amount of suspended solids m
the sionT water discharse, where 1 is no solids and 5 is extrerr ely muddy-
S 2 3 4 5
7. b these any foam m the starmwater discharge'? I Yes
8. Is there an ca sheen in the stormwauw discharge) Yes
9. Is there evidence of erosion or deposition at the outfali7 Yes
10. Otliw Obvious Indicators of Stormwater PeRntWn.
List and describe
Note: —Low clarMy. high solids. and/or the pumence of foam, oil sheen. or crosiicWtiepesition wAy be - -
indieative of polintant exposure. These condmons warrant funher investigation.
Page 2 of 2
swu aa2 i i2=

730ALCON
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Stormwater Monitoring Event Submission Form
facility Name: A4%%w ;Naw�- 44- `i l4 k
Person(s) Collecting Samples hest%w'K Se0,414k_1
Contact for Sample Pickup
(Name and Phone Numbw) _A►+ %34t a., I
Date of storm event
Total Event Precipitation
(Inches)
Event Duration (hours)
Location of Rain Gouge:
Ouftl No
Date Sample Collected
rmmlddlyYYy)
nme Sample CoAected
2 oo +
Dt7t
l� ! f lL
Completed Forms Attached
E� Stormwater Discharge Outfaa Qualitative Monitoring Report
[D/ Charcrof-antody form
Send Completed forms to Stormwater Sampling Coordinator (Falcon Engineering) via fax
919 871 0803
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RH Data CaMccdon Form
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STORMWATER DISCHARGE OUTFALU (SDO)
GENERAL PERMIT NO NCGI60NO -
DISCHARGE MONITORING REPORT (DMR)
CERTIFICATE OR COVERAGE NO NCG160 157
FACILITY NAME APAC Atlantic, Inc , Plant N 4 _
PERSON COLLECTING SAMPLE(S) Josh Sorrell
CERTIFIED LABORATORY(S) Pace Analytical Lab # 40
Lab #
Monitoring Requirements
i
SAMPLES COLLECTED DURING THE CALENDAR YEAR.
('Phis monitoring reportshall be i Rceived by the Division ao later than 30 days
from the date the facility reecteveq the sampling results from the laboratory)
COUNTY k _ Forsyth
PHONE NO
Outfali
No.
Date
Sample Collected,
mot r
Total Rainfall,
inches
0053D
004DD
I 00556
Total Suspended Solids, m1Nl
`
pH,
Standard Units
Total Petroleum Hydrocarbons, me
EPA Method 1"4 SGT-HE
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100
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i is
1
1/11/2012
075
131
71
I ND
I
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If a value is inexcess of the benchmark, or outside the benchmark range (far pH), you must implement the Tter I or Tter 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 THIS CERTIFICATION FOR ANY INFROMATION 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, tbose persons directly responskbe for gatherlag the information,
the Information submitted is, to the best of my knowledge and belief, true, accurate, and complete I am aware that tbe'rc are significant penalties for submitting false information, Including the
possibility of lines and Imprisonment for knowing violations." I
' - -
(Siguature of Pertntttte) (Date) HLE
Form SWU 153-051409
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STORMWATER DISCHARGE OUTFALL (SDO)
GENERAL PERMIT NO NCG 160000
DISCHARGE MONITORING REPORT (DMR)
CERTIFICATE OF COVERAGE NO NCGlf9 157 SAMPLES COLLECTED DURING THE CALENDAR YEAR 2011
(This monitoring report shall be received by the Division no later than 30 days frorr
FACILITY NAME APAC Atlantic fnc Plant tl'4
PERSON COLLECTING SAMPLE(S) Josh Sorrell
CERTIFIED LABORATORY(S) Pace Analytical I ab 4 40
Lab #
Monitoring Requirements
the date the facility recieves the lamphng results from the laboratory)
COUNTY
I
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Outfali
No
Date
Sample Collected
moldd! r
Total Rainfall
Inches
00530
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I pH,
Standard Units
Total Petroleum Hydrocarbons mgn
EPA Method 1664 (SGT HFM
Benchmark;
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{
Mail Original and one copy to i
Division of Water Quality
Attn Central Files
1617 Mail Service Center i
Raleigh North Carolina 27699 1617 I
t
YOU MUST SIGN THIS CFRTIFICATION fOR ANY INFROMATION REPORTED
'I cerhfy, under penalty of law, that this document and all attachments were prepared under my direction or supervisson 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 responsibe 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 imprisio cat for knowing violations '
lCivnn urn of Pwrm q�a1 (rl.•nl I
OPY Form SWU 253-051409
FILEI Poge I of I

1,
09/20/2011 14 16 FAX [phone]
Stnrmwater Discharge Outrall (SDO)
Qualitative Monitoring Report
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Stormwater Monitoring Event Submission Form
FaclWy Name. c 1 O
Person(s) Ccl4ecting Samples
Contact for Sompie Pickup
INome and Phone Number)
Date of storm event~
Total Event Precipitation
(Inches)
Event Durations (hours)
Location of Rain Gauge
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Complet d Farms Attached
Stormwater Discharge Ovtfall Qualitative Monitoring Report
Chain-of-cvoody form
Send Completed forms to Stormwater Sampling Coordinator (Falcon Engheeringl via fax
919 8714803
Z7d 668ta W-9££
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CERTIFICATE OF COVERAGE NO NCG160 157
STORMWATER DISCHARGE OUTFALL (SDO)
GENERAL PERMIT NO NCG160009
f
DISCHARGE MONITORING REPORT (DMR)
SAMPLES COLLECTED DURING
FACILITY NAME APAC Atlantic Inc Plant # 4
PERSON COLLECTING SAMPLE(S) Robert Lewis
CERTIFIED LABORATORY(S) Pace Analytical Lab fl 40
Lab tt
Monitoring Requirements
THE CALENDAR YEAR 2011
(This montlormg report shallir f be received by the Division no later than 30 days fro
the date the facility recieves the sampling results from the laboratory)
COUNTY itr _ _ Forsyth
PHONE NO t 336-969 7512 - -
Qutfall
No
Date
Sample Collected,
"dftr
Total Rainfall,
inches
00330 1
00400 1
00556
Total Suspended Solids, mg/1
pH
Standard Units
Total Petroleum Hydrocarboaa, mg/1
EPA Method 1664 SGT-HE"
Benchmark'
-
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Within 6.0 - 9 0 I
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2124✓2011
08
309
70
ND
(
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' If a value is in excess of the benchmark, or outside the benchmark range (for pH) you must Implement the Tier l or Tter 2 responses in the General Permit
Mail Original and one copy to
Division of Water Quality
Attu Central Files
1617 Mail Service Center
Ralei North Carolina 27699,1617
YOU MUST SIGN TMS CERTIFICATION FOR ANY INFROMATION 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 persona who manage the system, or those persons directly respousibe for gathering the Information,
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possibility of flues and Itgprisionment for knowing violations," i 1
k"," « ,�_
( ignature of Per mittee) - (Date)
,,.
Form SWU 253-651409
I L E
DOPY
Aagolofl

Stormwater Discharge OutfA (SDO)
Qualitative Monitoring Report
For guidance oo fdhog out rhts form. please visa, ht11Dd Amr.state,M—1f2 ms Document{ ttMi #miscfomm6
T
Permit No
Facility Name
County -
Inspector
Date of Inspection
Time of Inspection
—W
_ _j_ or Certificate of Coverage No
f If
Total Event Precipitation (inches) Z
phone No ._ Z4,--17—f%1/77
Was this a Representative Storm Event? (See information below) Yes ❑ No
Please check your permit to verify rf Qualitative Monitoring must be performed during a representarive
storm event (requirements varv�
A "Representative Storm Event" is a storm event that measures greater than 41 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 10 consecutive hours of no precipitation
y
y
By this signature, I certify that this report is acgtrate and complete to the hest of my knowledge
(Signature of Permitter or Designee)
1. Ouflall Description
Outfall No --1- Structure (pipe, ditch, etc.) O'/1L ..
Receiving Stream
Describe the industrial activities that occur within the outfall drainage area C rA�
2 Color Describe the color of the disghar_P using basic colors (red. brown, blue, etc ) and ant
(light, medium, dark) as descriptors �j
3 Odor Describe any distinVt odop that the discharge may have (i e., smells strongly of oil, weak
chlorine odor, etc.) t _
Page 1 of 2
SNiIJ-242 112409
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4 Clarity Choose the number which best de,%cribes the clarity of the discharge. where I is clear
and 5 is very cloudy `
® 2 3 4 5
i
5 Floating Solids- Choose the number which best describe% the amount of floating solid% in the
stormwater discharge, where 1 is no solids and 5 is the surface covered with floating solids
I j7 3 4 5
6. Suspended Solids: Choose the number which best descnbe6 the amount of suspended solids in
the scormwater discharge where 1 is no solids and 5 is extremely muddy
1 d 3 4 5
7 Is there any foam in the SLorinwiater discharge) Yes
8 1s there an oil sheen in the ,tonnwaLer discharge? Yes 1
9. Ig diere evidence of erosion or deposition at the outfall? Yes W6
10 Other Obvious Indtcatats of Stor wateir Pollution
4
Ltst and descnbe
Note- Low clanty high solids, and/or the pteaence of foam, rnl sheen or erosion/deposition may be
indicative of pollutant expo%ure These conditions warrant further invesnganon
Page 2 of 2
5wt, 242 112608
£ d 668GZ6Z-m 61, 1NYld dnH.LNV--NOSdWOH1 OVl LO LL SZ qGJ

CERTIFICATE OF COVERAGE NO
STORMWATER DISCHARGE OUTFALL (SDO)
I GENERAL PERMIT NO NCG160000
DISCHARGE MONITORING REPORT (DMR)
NCGI60 157 SAMPLES COLLECTED DURING THE CALENDAR YEAR. 2010
(Thu monitoring report shall be received by the Division no later than 30 days frog
` the date the facility recreves the sampling results from the laboratory)
FACILITY NAME APAC Atlantic Inc Ii Plant N 4 1
PERSON COLLECTING SAMPLE(S) i Robert Lewes I
CERTIFIED LABORATORY(S) Paces Analytical Lab # 40 �!
1 Lab #
Manitonug Requirements
COUNTY Forsyth
PHONE NO 336-869-7512
OmfaIl
No.
Date
Sample Collected,
In
I
j Total Ramfa&
inches
0000
004M
00556
! Total Suspended Solids, mgA
pH,
Stsadard Units
Total Petroleum Hydrocarbons, mg/l
EPA Method 1664 SGT-HEM)
Benchmark'
-
! 100
Within 6.0.9 0
15
I
w5/20t0
03
57
71
ND
I
I
1
l
c If value is m 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
1 (
Mail Orrgmal and one copy to 1
Drvrsion of Water Qualrty
Ann, Central Piles
1617 Marl Service Center
Raleigh North Carolina 27699-1617
YOU MUST SIGN THIS CERTIFICATION FOR ANY WFROMATION REPORTED
"1 certify, under penalty of law, that this doe Iment 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 informanoullsubmitted. Based on my inquiry of the person or perverts who manage the system or those persons dir"ll/ responsibe Far gathenog the information,
the information submitted Is, to the best of mY knowledge and beher, true, accurate, and complete 1 am aware that there are significant penalties for submitting raise information including the
possibility of ties and Impnsionment for owing violations.
-(�, 9-16 m9c,
(Signature of Permittee) (Dale) a�.!N
l �
Form SWU 253-051409
Page t of I

CERI IFiCATF OF COVERAGE NO
FACII ITY NAME AP
PERSON COI LECTING SAMPLL(S)
C LRTIFIED LABORAI ORV(S)
Monitoring Requirements
NCG160 157
44
STORMIWATER DISCHARGE OUTFALL (SDO)
GENERAL PERMIT NO NCGI60000
DISCHARGE MONITORING REPORT (DMR)
Lab # 40 i
Lab # '
SAMPLES COLLECTED DURING THE CALF NDAR YEAR 2010
(This monitoring report shall be received by the Division no later than 30 days fron
the date the facility recieves the sampling results from the laboratory)
COUNTY Forsyth
PHONE NO 336-869-7512
Outfall
No
Date
Sample Collected,
molddl r
I
Total Rainfall
inches
i 00530
00400
00556
(Total Suspended Solids MO
1
pH
Standard Units
Total Petroleum Hvdrocarbons, mgll
EPA Method 1664 (SGT HEM)
Benchmark'
t 100
wsthin 6 0 90
15
1
2/22/2010
I 03
j ND
61
ND
f
1
i 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 Qualify
Ann Ccntral piles I!I
16tI Mait Service Cenwr 1
Ralcigh North Carolina 27699 1617
I
YOU MUSTSIGN THIS CE RTIFICATION FOR ANY 1NFROMATION REPORTED
I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a vystew 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 responsibe 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 imprisio meat for knowing violations '
I
(Signature of Permittee) 1 I (Date)
FILEUff
C SWU 253-0s1409
VT PuF I of 1