NCG180194_MONITORING INFO_20141212

STORMWATER DIVISION CODIP
NCG PERMITS
PERMIT NO. /V C& /� U I �y
DOC TYPE HISTORICAL FILE
[� MONITORING REPOR'
DOC GATE 0Q 0 I l"/ f a I -.)-
YYYVMMDD

RECEivii
GA
CEi4 i �►L FILES
��;�� DWR SECrIc�N
0�t rm e� Discharge Outfall (SDO)
cF g4t��tative Monitoring Report
DwR SAC FjLF3
For guidance on filling out tT&M lease visit hits llh20 Lnr stati- nL us/su/Form,, Doc.u7%nt� IIt1v##1111SOornis
Pernut No NICI,(„�1 1 I a'901�ISl�I or Certificate of Coverage No N/C/G/ / 1 e/4/J 1911/
Facility Name 1rt,LA34srNE2 Fur?Nt7-'RC
County 2AArQ01-PJ4 Phone No _ _2—T6 - (v 2S - ro 17 S1,
Inspector U N
Date of Inspection 9 Z9 2 c I
Time of Inspection '? yS- Pn
Total Event Precipitation (inches) D 2 Y
Was this a Representative Storm Event'? (See information below) ® Yes Q No
Please check your permit to venfy if Qualitative Monitoring must be performed during a representative
storm event (requirements vary)
A "Representative Storm Event" is a storm event that measures greater than 0 1 inches of rainfall and that
is preceded by at least 72 hours (3 days) in which no storm event measuring greater than 0 1 inches has
occurred A single storm event may contain up to 10 consecutive hours of no precipitation
By this signaturertify that this report is accurate and complete to the best of my knowledge
(Signature of Pernuttee or Designee)
1 Outfall Description
OutfaJI No /I Structure (pipe, ditch, etc } pifGli
Receiving Stream Lj .ryA#1Ep �M ift V-rAg!e .Ld _CEiiArt jSORtc r-REEK
Describe the industrial activities that occur within the outfall drainage area
u Svc/EArX'9iKrL
2 Color: Describe the color of the discharge using basic colors (red, brown, blue, etc ) and tint
(light, medium, dark) as descriptors _ C Le,4+P
3 Odor Describe any distinct odors that the discharge may have (i e , smells strongly of oil, weak
chlorine odor, etc ) C-
Page 1 of 2
SWU-242-112608

4 Clarity Choose the number which best describes the clarity of the discharge, where l is clear
and 5 is very cloudy
0 2 3 4 5
5 Floating Solids Choose the number which best describes the amount of floating solids in the
stormwater discharge, where 1 is no solids and 5 is the surface covered with floating solids
(l 2 3 4 5
6 Suspended Solids Choose the number which best describes the amount of suspended solids in
the stormwater discharge, where l is no solids and 5 is extremely muddy
2 3 4 5
7 Is there any foam in the stormwater dtscharge9 Yes No
8 Is there an oil sheen in the stormwater discharge? Yes
F
9 Is there evidence of erosion or deposition at the outfall? Yes (00
10 Other Obvious Indicators of Stormwater PollutMon
List and describe Nvti t~
Note Low clarity, high solids, and/or the presence of foam, oil sheen, or eroston/deposition may be
indicative of pollutant exposure These conditions warrant further investigation
Page 2of2
SwU 242-112608

*FOR PART A AND PART B MONITORING RESULTS
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS SEE PERMIT PART II SECTION B
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS SEE PERMIT PART II SECTION B
• TIER 3 HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANYONE OUTFALL7 YES ❑ NO X❑
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME
Marl an original and one copy of this DMR, including all "No Discharge" reports, within 30 days of receipt of the lab results (or at end of
monitoring period in the case of "No Discharge" reports) to
Division of Water Quality
Attn DWQ Central Files
1617 Mail Service Center
Raleigh, NC 27699-1617
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED
"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)
o—aD—/
(Date)
Additional copies of this form may be downloaded at http //portal ncdenr org/web/wq/ws/su/npdessw#tab 4
-pV U-249
I-a,,t Rt viud Oc.tohu 19 2012
PdgL 2 of 2

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water Quality General Permit No 0
Date submitted 11/30/2014
CERTIFICATE OF COVERAGE NO NCG05 180194
FACILITY NAME KLAUSSNER FURNITURE INDUSTRIES
COUNTY RANDOLPH
PERSON COLLECTING SAMPLES SUSAN FEIR
LABORATORY MERITECH Lab Cert # 165
Part A Stormwater Benchmarks and Monitoring Results
SAMPLE COLLECTION YEAR 2014
FACILITY ACTIVITIES INCLUDE {check all that apply)
❑ use/process meats ❑ use animal fats/byproducts
DISCHARGING TO SALTWATERS7 ❑YES RINO
PLEASE REMEMBER TO SIGN ON THE REVERSE —)
Total event rainfall z 0 24" or ❑ No discharge this perlod3
Outfall No
Sample Collected,
mo/dd/yr
TSS,
mg/L
pH,
Standard units
COD,
mg/L
Oil and Grease,
mg/L
Fecal Coliform ,
Colonies per 100 ml
Enterococci ,
Colonies per 100 ml
Benchmark
-
100 or 50
Within 6 0 — 9 0
120
30
1000
Soo
1 Only applies to facilities that use/process meats
2The total precipitation must be recorded using data from an on site rain gauge-
3 For sampling periods with no discharge at any outfalls You must still submit this discharge monitoring report with a checkmark here
4See General Permit text Table 3 identifying the especially sensitive receiving water classifications where the more protective benchmark applies
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor ail per month? ❑ yes x❑ no
Part B Vehicle Maintenance Area Monitoring Results only for facilities averaging > 55 gal of new motor oil/month
Outfall No
Sample Collected,
xmo/dd/yr
Oil and Grease,
mg/L
TSS,
mg/L
pH,
Standard units
New Motor Oil Usage,
Annual average gal/mo
Benchmark
-
30
100 or 50
6 0 -- 9 0
-
KFI #1
09129/2014
<5 mg/L
_ .
693
' Only applies to facilities that use/process meats
2The total precipitation must be recorded using data from an on site rain gauge
3 For sampling periods with no discharge at any outfalls, you must still submit this discharge monitoring report with a checkmark here
4See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies
(if yes• complete Part B)
SWU-249 Last RL viscd 09.(()hcr 19 2011
Pag4 I Off

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water Quality General Permit No. NCG1.80010
Date submitted 05/28/2014
:ERTIFICATE OF COVERAGE NO NCG06 180194
AGILITY NAME KLAUSSNER FURNITURE INDUSTRIES
:OUNTY RANDOLPH
PERSON COLLECTING SAMPLES SUSAN FOR
ABORATORY MERITECH Lab Cert # 165
)art A Stormwater Benchmarks and Monitoring Results
SAMPLE COLLECTION YEAR 2014
RECEIVED
AUG 13 �014
CENTRAL FILES
FACILITY ACTIVITIES INCLUDE (check all that apply] L'"WIBOG
❑ use/process meats ❑ use animal fats/byproducts
DISCHARGING TO SALTWATERS7 ❑YES X❑NO
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Total event rainfall z 2 08" or ❑ No discharge this period'
Outfall No
Sample Collected,
mo/dd/yr
TSS,
mg/L
pH,
Standard units
COD,
mg/L
Oil and Grease,
mg/L
Fecal Coliform ,
Colonies per 100 ml
Enterococci I,
Colonies per 100 ml
3enchmark
-
100 or 50
Within 6 0 — 9 0
120
30
1000
S00
Only applies to facilities that use/process meats
The total precipitation must be recorded using data from an on site rain gauge
For sampling periods with no discharge at any outfalls You must still submit this discharge monitoring report with a checkmark here
See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies
)id this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? ❑ yes x❑ no
?art 8 Vehicle Maintenance Area Monitoring Results only for facilities averaging > 55 gal of new motor oil/month
Outfall No
Sample Collected,
mo/dd/yr
Oil and Grease,
mg/L
TSS,
mg/L
pH,
Standard units
New Motor Oil Usage,
Annual average gal/mo
3enchmark
30
100 or 50
6 0 — 9 0
KFI #1
0511512014
<5 m IL
- ---
621
Only applies to facilities that use/process meats
The total precipitation must be recorded using data from an on site rain gauge
For sampling periods with no discharge at any outfalls you must still submit this discharge monitoring report with a checkmark here
See General Permit text Table 3 identifying the especially sensitive receiving water classifications where the more protective benchmark applies
)WU 249
(ifye5, complete Part B)
L,atit Revised October 18 2012
P ibe 1 of 2

YL
•
*FOR PART A AND PART B MONITORING RESULTS
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS SEE PERMIT PART II SECTION B
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS SEE PERMIT PART II SECTION B
• TIER 3 HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANYONE OUTFALL? YES ❑ NO x❑
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME
Marl an original and one copy of this DMR, including all "No Discharge" reports, within 30 days of receipt of the lab results (or at end of
monitoring period in the case of "No Discharge" reports) to
Division of Water Quality
Attn DWQ Central Files
1617 Mail Service Center
Raleigh, NC 27699-1617
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED
"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 "
Y � L
(Signature of Permittee)
3-1- 141-
(Date)
Additional copies of this form may be downloaded at http //portal ncdenr org/web/wq/ws/su/npdessw#tab 4
S W U-249
Last Rey iced October 19 2012
Page 2 of 2