NCG180238_COMPLETE FILE - HISTORICAL_20180221

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO. '
wc.�l�OZ
DOC TYPE) HISTORICAL FILE
❑ MONITORING REPORTS
DOC DATE
YYYY M M D D

Compliance Inspection Report
Permit: NCG180238 Effective: 10/03/14 Expiration: 08/31/19 owner: Heritage Home Group LLC
SOC: Effective: Expiration: Facility, Heritage Home Group - Lenoir Upholstery Plant
County: Caldwell 830 Complex St
Region: Asheville
Lenoir NC 28645
Contact Person: David Stout Title: Phone: [phone]
Directions to Facility:
From Hickory go 321 North to intersection of 18 and 90, turn left and follow Highway 18 for approx. 4 miles, on the left.
System Classifications:
Primary ORC: Certification: Phone:
Secondary ORC(s):
On -Site Representative(s):
Related Permits:
Inspection Date: 02121/2018 Entry Time: 10:30AM
Primary Inspector: Isaiah L Reed
Secondary Inspector(s):
Exit Time: 12:OOPM
Michael M Smith
Reason for Inspection: Routine Inspection Type
Permit Inspection Type: Furniture and Fixtures Stormwater Discharge COC
Facility Status: Compliant Not Compliant
Question Areas:
Storm Water
(See attachment summary)
Phone: [phone]
Compliance Evaluation
Page: 1

Permit: NCG180238 Owner - Facility: Heritage Home Group LLC
Inspection Date: 02121/2018 Inspection Type : Compliance Evaluation Reason for Visit: Routine
Inspection Summary:
On February 21, 2018 this site was inspected for compliance. The records on site have been maintained, and the site
walkthrough revealed no Industrial compliance issues. However, it was noted that outfalls 4 and 5 show evidence of severe
erosion at the outfall. These eroded areas should be repaired and stabilized as soon as possible. If the outfall locations are
on property not owned or operated by Heritage Homegroup, it will be necessary to obtain permission from all applicable and
affected landowners, Please inform this office once repairs are complete. [phone]
Page: 2

Permit: NCG180238 Owner - Facility: Heritage Home Group LLC
Inspection Date: 02/21/2018 Inspection Type : Compliance Evaluation Reason for Visit: Routine
Stormwator Pollution Prevention Plan
Yes No NA NE
Does the site have a Stormwater Pollution Prevention Plan?
. ❑ ❑ ❑
# Does the Plan include a General Location (USGS) map?
0 ❑ ❑ ❑
# Does the Plan include a "Narrative Description of Practices"?
E ❑ ❑ ❑
# Does the Plan include a detailed site map including outfall locations and drainage areas?
0 ❑ ❑ ❑
# Does the Plan include a list of significant spills occurring during the past 3 years?
N ❑ ❑ ❑
# Has the facility evaluated feasible alternatives to current practices?
0 ❑ ❑ ❑
# Does the facility provide all necessary secondary containment?
■ ❑ ❑ ❑
# Does the Plan include a BMP summary?
0 ❑ ❑ ❑
# Does the Plan include a Spill Prevention and Response Plan (Si
N ❑ ❑ ❑
# Does the Plan include a Preventative Maintenance and Good Housekeeping Plan?
■ ❑ ❑ ❑
# Does the facility provide and document Employee Training?
0 ❑ ❑ ❑
# Does the Plan include a list of Responsible Party(s)?
❑ ❑ ❑
# Is the Plan reviewed and updated annually?
❑ ❑ ❑
# Does the Plan include a Stormwater Facility Inspection Program?
N ❑ ❑ ❑
Has the Stormwater Pollution Prevention Plan been implemented?
❑ N ❑ ❑
Comment: Please see Summary for further information
Qualitative Monitoring Yes No NA NE
Has the facility conducted its Qualitative Monitoring semi-annualiy? 0 ❑ ❑ ❑
Comment:
Permit and Outfalls Yes No NA NE
# Is a copy of the Permit and the Cerificate of Coverage available at the site? ■ ❑ ❑ ❑
# Were all outfalls observed during the inspection? S ❑ ❑ ❑
# If the facility has representative outfall status, is it properly documented by the Division? [] ❑ ® ❑
# Has the facility evaluated all illicit (nor) stormwater) discharges? 0 ❑ ❑ ❑
Comment:
Page: 3

t; . 14
Heritage Home Croup, LLC
Heritage Home Group
815 Visionary St.
Lenoir, NC 28645
828-759-8510 Tel
828-406-6079 Cell Phone
828-438-2623Fax
David Stout
Director of Environmental Compliance
Email address: david.stoutCmheritagehome.com
March 14, 2014
North Carolina Department of Environment and Natural Resources
Division of Water Quality — Raleigh Central Office
1617 Mail Service Center
Raleigh, NC 27699-1617
MAR 1 9 2014
DENR-WAfi QUALITY
V'LMOS AND STORMWATER g} MCH
RE: Heritage Home Group, LLC --- i
Stormwater & 4Permit COC M238,.080808, 189169` 180241; 180061,:180087, 180177, 180090
1?71 r riacai�l�j
Permit Name/Ownership Change Forms
Attached you will find Permit Name/Ownership Change Forms for all North Carolina facilities that are
owned by Heritage Home Group LLC. Formerly these facilities were owned by Furniture Brands
International, Inc. Furniture Brands filed for Chapter I I protection in September 2013. Many Furniture
Brands facilities were purchased by Heritage Home Group LLC as part of the Chapter 1 I proceedings on
November 25, 2013. 1 am just now filing ownership and name change forms as location names have just
been assigned to the facilities. Previously, i have filed our intentions to renew these Stormwater Permits
on the NCDENR website. Please incorporate these ownership and name changes into the Stormwater
Renewal process. Please note that Stormwater Pennit NCGO80000, C00080808, does not come up for
renewal until 10/31/2017.
Also, I have two Lane Venture Plants that are on adjacent properties and previously operated as separate
facilities with 2 separate Stormwater Permits; COC 180061 & COC 180087. Both of them come up for
renewal on 813112014. These facilities are now under the same plant management and operate as one
facility. 1 would like to have them renewed under one Stormwater Permit; I would like to have COC
180061 rolled into COC 180087. 1 have previously talked to our Stormwater Inspector, Mr_ Lon Snider
out of the Mooresville Regional Office about doing this and he suggested that I wait until the permits
renew. He documented this conversation in his files during his March 22, 2012 Stormwater inspection of
these two facilities.
Also attached is documentation of the sale of these facilities from Furniture Brands to Heritage Home
Group, as required by the Permit Name/Ownership Change Form.

f I %
If you have questions or want to discuss, please contact me.
Sincerely,
Heritage Home Group
David Stout

Herbert, Laura C
From: Herbert, Laura C
Sent: Friday, October 18, 2013 10:44 AM
To: [e-mail]'
Cc: Stepp, Jonathan; 'wayne watkins'
Subject: Woodgrain Millwork NPDES Stormwater Permit Questions Caldwell County
Attachments: Timber NPDES SW Page.pdf; General Permit No. NCG210000.pdf; NOI for Timber.pdf,
Outfall Locations.pdf
Rick,
Thank you for your call regarding questions concerning whether or not your new facility will need a NPDES stormwater
permit. According to you, the only item stored outside will be raw (green) lumber which will be outside for a day or so
before drying (kilns?). You all do currently have an air permit (No. 07568T12). As we discussed, if you use more than 55
gallons per month of new oil or hydraulic fluid (vehicle maintenance area) you will be required to have a stormwater
permit. For the stormwater permit you will be required to monitor any point sources (any discernible, confined, and
discrete conveyance, including but not limited to any pipe, ditch, channel, tunnel, conduit, or well from with pollutants
are or may be discharged). In reviewing your air permit equipment list, a couple of items of interest wrt to stormwater
exposure are as follows:
20,000 gallon fuel oil storage tank (inside or out; with secondary containment?)
Woodwaste Boilers — Is all the feedstock stored inside (silos/building) with no exposure to stormwater?
Truck Dump and hogging operation — Is this inside or outside and potentially exposed to stormwater?
Coating Operations — Are any of the coatings stored in outside tanks or drums or is all of this inside?
Rick, from what I understand this operation is located in the former Broyhill Miller Hill site. The Broyhill Miller Hill
facility was covered under a general stormwater permit (NCG 180238). From documents in this file, it would appear
that they had at least 10 outfall locations. I have included an outfall location layout from a previous inspection at this
facility for your review and consideration. This facility was a furniture operation, not timber.
I have also included the fact sheet for the Timber products general permit (SIC 24xx excluding 2434...) and the general
permit itself. If you do not fall into this SIC category, please let me know what SIC code you are (furniture is SIC 25xx
and 2434), and I will get you that information. You can also access this information on our website at
http://Portal.ncdenr.org/web/wq/ws/su/npdessw
Let me know if you have additional questions and if you would like to discuss.
Thanks,
Laura
Laura Herbert, P.E.
Regional Engineer
Division of Energy, Mineral, and Land Resources - Land Quality Section
NCDENR-Asheville Regional Office
2090 US Highway 70
Swannanoa, NC 28778
Tel:[phone] Fax:[phone]
http://portal.ncdenr.org/web/i
J2�..-75q— )D gI

Notice: E-mail correspondence to and from this address may he subject to the North Carolina Public Records Law and therefore may be disclosed to
third parties unless the content is exempt by statute or other regulation.

Permit No. 07568T12
Page 3
SECTION I- PERMITTED EMISSION SOURCE(S) AND ASSOCIATED AIR
POLLUTION CONTROL DEVICE(S) AND APPURTENANCES
The following table contains a summary of all permitted emission sources and associated air pollution control
devices and appurtenances:
Emission Source
Emission Source Description
Control Device ID
Control Device
LD No.
No.
Description
One threc-pass scotch marine gasified
One multicyclone (40
ES-1 (NSPS,
woodwaste-fired boiler(55.5 million Btu
C1
nine -inch diameter
Subpart Dc;
per hour maximum heat input capacity).
cones)
One bagfilter (5,529
GACT, Subpart
Site generated used oil may be utilized on
JJJJJJ)
boiler start-up only.
F2**
square feet of filter
area)
One three -pass scotch marine gasified
One multicyclone (40
ES-2 (NSPS,
woodwaste-fired boiler (55.5 million Btu
C2
nine -inch diameter
Subpart Dc;
per hour maximum heat input capacity).
cones)
One bagfilter (5,529
GACT, Subpart
Site generated used oil may be used on
JJJJJJ)
boiler start-up only.
F2
square feet of filter
area)
One natural gas -fired boiler (23.7 million
Btu per hour maximum meat input
ES-4
capacity). Propane may be used as light-
NA
NA
off fuel.
Lumber drying operations consisting of
F-S-22*
indirect steam heated kilns (process rate of
NA
NA
24 million board -feet per year, nominal)
One bagftlter (7,555
CD-52**
square feet of filter
Optimizing Line consisting of sawing,
area)
One bagflter (3,825
OPT-1
planing and finger -jointing operations
CD-46**
square feet of filter
(5833 board feet per hour processing rate,
area)
nominal)
One bagfilter (3,825
CD-47**
square feet of filter area
for backup purposes
One bagfilter (3,825
CD-45**
square feet of filter
Moulding Line consisting of Moulding,
area)
One bagfilter (3,825
Tenoning, Sawing, Sanding, and Shaping
MLD-t**
Operations (5833 board feet per hour
CD-57**
square feet of filter
processing rate, nominal)
area)
One bagfilter (3,825
CD-47**
square feet of f titer area
for backup purposes
WHO-1 **
Multi -Purpose Woodwaste Handling
CD-42**
One bagfilter (4,614
square feet of filter
Operations
area)

Permit No. 07568"1'12
Page 4
Emission Source
Emission Source Description
Control Device ID
Con trot Device
M No.
No.
Description
One bagfilter (4,614
CD-44**
square feet of filter
area)
TDO 1'�*
"Truck Dump including 1-lagging Operation
CD-30**
One bagfilter (3,825
square feet of filter
(480 tons per day processing rate, nominal)
area)
One bagfilter (2,219
CD-144* *
square feet of filter
PLAN-1 **
Planing Operation
area)
One bagfilter (3,825
CD-46**
square feet of filter
area)
One bagfilter (1,912
WBDB-I**
Woodwaste boiler fuel day bins
CD-24**
square feet of filter
area)
One bagfilter
CD-17**
(3,825square feet of
WBSS-I**
Woodwaste boiler fuel storage silos
filter area)
One bagfilter
CD-18**
(3,255square feet of
Filter area)
COAT-t**
Moulding Coating Operation
NA
NA
CDO-I,
Two Coating Drying Ovens (Natural gas-
NA
NA
CDO-2**
fired, 1.5 million Btu heat input, each)
* Sources with no applicable requirements.
** These emission sources and control devices are listed as a minor modification per 15A NCAC 2Q .0515. The compliance
certification as described in General Condition P is required. Unless otherwise notified by NC DAQ, the affected terms of this permit
(excluding the permit shield as described General Condition R) for this source shall become final on November 19, 2013. Until this
date, the affected permil terns herein reflect the proposed operating language that the Permittee shall operate this source under pursuant
to ISA NCAC 2Q .0515(o.

ATTACHMENT to Cover Letter to Air Quality Permit Number 07568T12
Table of Changes
Pages
Section
Description of Changes
Cover better
Same
• Used current shell language, updated permit numbers, dates, etc.
• Added 2Q .0515 minor modification language
Insignificant
Same
• Moved the source I -Wood to the permitted equipment list (is now
activities list
WBSS-I
Permit page 1
Same
• Updated revision nos. issue, dates, etc.
Equipment
Same
• Added 2Q .0515 (minor modification) footnote
List
• Remove reference to ES-3
• Removed oil firing capability on ESA
• Removed 6J indicator for ES-4
• Changed the control device on ES-1 from CD-2 to F2
• Removed reference ES-3
• Added reference to all new emission sources and control devices
• Revised descriptor for wood drying operations to reflect that it
primarily consists of indirect steam heated kilns.
• Removed reference to ES-24 in order to group all kilns tinder one
e ui ment ID number. Included a nominal processing rate
2. I .A.3
Same
2D.0502 condition
a.
Same
• Remove reference to CD-2
• Added the following statement:
Only one boiler (f) Nos. ES-1 or ES-2) may be operated at one time.
C.
same
• Added reference to ES-1
d.
NA
• Deleted condition
C.
d.
• Sim le renumbering
f
C.
• Simple renumbering_
g.
f.
• Simple renumbering
2.1.B.
Some
• Removed reference to boiler ES-3 throughout section
• Removed reference to 40 CFR 63 Subpart 6J as it is no longer
appl,icable
2. l.B.l
Same
2D .0503 condition
a.
NA
• Removed ES-3 emission limitation
b.
a.
• Simple renumbering_
C.
b.
• Sim le renumberin
d.
C.
• Removed reference to ES-3 and no. 2 fuel oil firing,
2.1.B.2
Same
2D .0516 condition
a.
Same
• Removed reference to ES-3
C.
Same
• Removed reference to ES-3 and no2 fuel oil firing.
2.1.B.3
Same
2D .0521 condition
a.
Same
• Removed reference to ES-3
C.
Same
• Removed reference to FS-3 and no2 fuel oil firing.
2. LC
Same
• Revised listing of permitted emission sources. Although similar to
previously permitted sources, the equipment itself is substantially
different and is treated as new.
• Removed reference to 2D .0530 as it does not apply to these
2. i.C.l.b.
Same
• Revised reference to Table 2.1.C.
2. LC
Same
2D .0521 condition

Pages
Section
Description of Changes
a.
Same
• Added re ulato citation
C.
Same
. Revised condition to reflect multiple emission points
9 Added the following language
The Perinittee shall establish "normal "for each source emission point in
the first 30 days following the startup after the issuance of permit no.
07568.T12
2.1.C.3.
Same
• Removed CAM condition as the equipment it addressed is no longer
operated at the facility. CAM will be addressed during the next permit
renewal.
NA
2.1.D.
• Added section to address coating operations anddrying ovens
NA
2.1.D.1
• Added condition addressing 2D .515 — No monitoring, recordkeeping
and reporting required given the very small quantities of PM
emissions anticipated
NA
2.1.D.2
. Added condition addressing 2D .521 — No monitoring, recordkeeping
and reporting required given the low visible emissions typical of these
d!ying operations and VDC coating operations
NA
2.1.D.3
• Added a 2D .0958 condition. Typical monitoring, recordkeeping and
reporting is required.
2.2.A.
Same
• Removed reference to boiler ES-3
2.2.A.2
2.1.AA
• Relocated the MACT 6J condition as it now affects only boilers ES-1
and ES-2
2.3
same
_
• Corrected typographical errors in first paragraph as follows
dated March 30, 3001, May 7, 2001 and June 16, 3002
changedto
dated March 30, 2001, May 7, 2001 and June 16, 2002
■ Revised paragraph b. as follows:
15A NCAC 2D .1111 is not applicable facility-svide because
changed to
15A NCAC 2D. I I 11, with revpect to major sources, is not applicable
facility —wide because
General
Same
Update from v 3.4 to 0.6 dated 113112012. Changes include:
Conditions
Condition K - Revised to synchronize issuance and expiration of
Title IV permits (acid rain) with title V permit.
.k[ o , / 5�n.-jt. >t-P " 2,0, vo d 9,&,

FurnitureBrands
David Stout
Director of Environmental Compliance
October 3, 2011
Ms. Linda Wiggs
H.C. Department of Environment and Natural Resources
Division of Water Quality
2090 U.S. Highway 70
Swannanoa, North Carolina 28778
Dear Ms. Wiggs:
Furniture Brands International
One Broyhill Paris
Lenoir, NC 28633
828-759-8510 Tel
828-406-6079 cell
828-438-2623 Fax
[e-mail]
Furniture Brands International is pleased to inform you that we have adopted the American Home Furnishing. Alliance
(AHFA) EFEC Program at the Vision One Plant in Lenoir, North Carolina. EFEC is an acronym for Enhancing Furniture's
Environmental Culture. EFEC is a voluntary environmental management system (EMS developed by the AHFA. For more
information, please see www.ahfa.uslefec. Our EFEC program has the following management systems in place:
• Environmental Policy
• Environmental Goals
• Environmental Awareness Training for Employees
• Incident Preparedness Plans
• Public Communication Policy
• Supplier Interaction
• Regulatory Agency Notification
• Information and Technology Exchange
• Measurement of Progress and Performance
• Corrective Action Plans
If you would like to discuss our program further, please feel free to contact me.
Sincerely
�S r
David Stout,;-_..::
1
OCT - C 2011 11
_.:._._��_...�_.�.._.. Ilk
-y

FurnitureBrands
David Stout
U1rettOr of Environmental Compliance
October 5, 2010
Ms. Linda Wiggs
NC Department of Environment and Natural Resouces
Division of Water Quality
2090 U.S. Highway 70
Swannanoa, North Carolina 28778
Dear Ms. Wiggs;
Furniture Brands International
One Broyhill Park
Lenoir, NC 28633
828-758-3374 Tel
828-221 -5448 cell
828-758-3110 Fax
[e-mail]
Furniture Brands International is pleased to inform you that we have adopted the American Home Furnishing Alliance
(AHFA) EFEC Program at the Thomasville Lenoir Plant No. 25 in Lenoir, North Carolina, EFEC is an acronym for
Enhancing Furniture's Environmental Culture, EFEC is a voluntary environmental management system (EMS developed by
the A]-iFA. For more information, please see www.ahfa.uslefec. Our EFEC program has the following management
systems in place:
• Environmental Policy
• Environmental Goals
• Environmental Awareness Training for Employees
* Incident Preparedness Plans
• Public Communication Policy
• Supplier Interaction
• Regulatory Agency Notification
• Information and Technology Exchange
• Measurement of Progress and Performance
• Corrective Action Plans
If you would like to discuss our program further, please feel free to contact me.
Sincerely
David Stout

• gja
NCDENR FI l E C 0 PY
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins
Governor Director
September 14, 2010
David Stout
Broyhill Furniture Industries Inc
One Broyhill Park
Lenoir NC 28633
SUBJECT: NPDES Stormwater Permit Compliance Inspection
Broyhill Furniture, Miller Hill Complex
Permit No: NCG180238
Caldwell County
Dear Mr, Stout:
Dee Freeman
Secretary
This letter is in follow-up to the NPDES Stormwater Permit Compliance Inspection conducted on
September 8, 2010. The facility was found to be in compliance with permit NCG 180238.
Enclosed is a copy of the Compliance Inspection Report, which contains additional observations
and comments for your reference.
Please contact me at [phone] or linda.wi s ncdenr.gov, if I can be of any further
assistance.
Sincerely,
Jc/
Linda Wiggs
Environmental Specialist
Surface Water Protection
Enclosure: Inspection Report
cc: Central Files
Asheville Files
Vicki Setzer-Vision 1
820 Complex P1. Lenoir NC 28645
S:\SWPICaldwell\StormwaterlNCG18 furniture Manufacturelbroyhill-miller hiltlCEI.Broyhill Sept-2010.doc
Location: 2090 U.S. Highway 70, Swannanoa, North Carolina 28778
Phone: [phone] FAX: [phone] Customer Service: 3-877-623.6748
Internet, www.ncwaterquality,org
One
NorthCarolina
Naturally
An Equal OppOrtunily l A(fkrmative Action Employer

Compliance Inspection Report
Permit: NCG180238 Effective: 09/01/09 Expiration: 08/31/14 Owner: Broyhill Furniture Industries Inc
SOC: Effective: Expiration: Facility: Broyhill Furniture, Miller Hill Complex
County: Caldwell 802 Complex St
Region: Asheville
Lenoir NC 28633
Contact Person: David Stout Title: Phone: [phone]
Directions to Facility:
From Hickory go 321 North to intersection of 18 and 90, turn left and follow Highway 18 for approx. 4 miles, on the left.
System Classifications:
Primary ORC: Certification: Phone:
Secondary ORC(s):
On -Site Representative(s):
Related Permits:
Inspection Date: 09/0812010 Entry Time: 12:50 PM Exit Time: 03:30 PM
Primary Inspector: Linda S Wiggs Phone: [phone]
Secondary Inspector(s):
Ext.4653
Reason for Inspection: Routine Inspection Type: Compliance Evaluation
Permit Inspection Type: Furniture and Fixtures Stormwater Discharge COC
Facility Status: ■ Compliant ❑ Not Compliant
Question Areas:
Storm Water
(See attachment summary)
Page: 1

Permit: NCG 1 B0238 Owner - Facility: Broyhill Furniture Industries Inc
Inspection Date: 09/08/2010 Inspection Type: Compliance Evaluation Reason for Visit: Routine
Inspection Summary:
Present during the inspection were David Stout and Vicki Setzer. The Stormwater Pollution Prevention Plan (Plan) was
only evaluated briefly, previous inspections at Broyhill facilities had focused more on the Plan. This inspection was
focused mostly on a site evaluation. The facility was observed inside and outside. Minor recommendations were made as
noted in this report, but overall the facility appeared to be meeting permit requirements and was considered compliant
during the inspection September 8, 2010.
Page: 2

l
Permit: NCG180238 Owner - Facility: Broyhill Furniture Industries Inc
Inspection Date: 09/08/2010 Inspection Type: Compliance Evaluation
Reason for Visit: Routine
Stormwater Pollution Prevention Plan
Yes
No NA
NE
Does the site have a Stormwater Pollution Prevention Plan?
■
❑ ❑
❑
# Does the Plan include a General Location (USGS) map?
■
❑ ❑
Q
# Does the Plan include a "Narrative Description of Practices"?
❑
❑ ❑
■
# Does the Plan include a detailed site map including outfall locations and drainage areas?
■
❑ ❑
❑
# Does the Plan include a list of significant spills occurring during the past 3 years?
❑
❑ ❑
■
# Has the facility evaluated feasible alternatives to current practices?
❑
❑ ❑
■
# Does the facility provide all necessary secondary containment?
■
Q ❑
❑
# Does the Plan include a BMP summary?
Cl
❑ Cl
■
# Does the Plan include a Spill Prevention and Response Plan (SPRP)?
❑
❑ ❑
■
# Does the Plan include a Preventative Maintenance and Good Housekeeping Plan?
❑
❑ ❑
■
# Does the facility provide and document Employee Training?
❑
❑ ❑
■
# Does the Plan include a list of Responsible Party(s)?
Q
❑ ❑
■
# Is the Plan reviewed and updated annually?
■
❑ ❑
❑
# Does the Plan include a Stormwater Facility Inspection Program?
■
❑ ❑
❑
Has the Stormwater Pollution Prevention Plan been implemented?
■
❑ ❑
❑
Comment: The Stormwater Pollution Prevention Plan (Plan) was reveiwed by
inspector briefly, all components of the Plan were not evaluated (NE). However, the
evaluated components of the Plan appeared to be well organized and thorough.
A couple of items noted were:
The need to use the most current qualitative monitoring form, an older version is being
used.
Secondary containment at "A" on Site Plan needs new booms for added measures
when accumulated stormwater is released.
Qualitative Monitoring
Yes
No
NA NE
Has the facility conducted its Qualitative Monitoring semi-annually?
■
❑
❑ ❑
Comment: See note above. Stormwater Discharge Outfall (SDO) Qualitative
Monitoring Report developed by facility is very descriptive and useful.
Analytical Monitoring
Yes
No
NA NE
Has the facility conducted its Analytical monitoring?
❑
❑
■ ❑
# Has the facility conducted its Analytical monitoring from Vehicle Maintenance areas?
Cl
❑
■ ❑
Comment: Not Applicable during this inspection.
Permit and Outfalls
Yes
No
NA NE
# Is a copy of the Permit and the Certificate of Coverage available at the site?
■
❑
❑ ❑
Page: 3

Permit: NCGI80238 Owner - Facility: Broyhill Furniture Industries Inc
Inspection Date: 09/0812010 Inspection Type: Compliance Evaluation Reason for Visit: Routine
# Were all outfalis observed during the inspection?
■ ❑ ❑ ❑
# If the facility has representative outfall status, is it properly documented by the Division? ❑ ❑ ■ ❑
# Has the facility evaluated all illicit (non stormwater) discharges?
Comment: A thorough evalution and identification of all SDO's had been completed by
Vicki Setzer-Environmental Compliance Mgr. SDO Report mentioned above is helpful to
consolidate information and evaluate discharge quality.
SDO #10 is a shared discharge point with Blue Ridge Panels, and possibly another
industry in the future whose inlet would be near the old kiln/boiler area/site plan "Note".
The SD0#10 area receiving stormwater from Broyhill (Furniture Brands) will be less
cluttered once the move/transition of new line is completed.
Stormwater inlet near SDO#3 and 4 had water in it, with a slight amount of foam noted
on the water, possible groundwater intrusion? Facility should keep an eye on qualitative
monitoring in this area (SDO#3 and 4) to see if any excessive foam becomes persistent.
Page: 4

STORMWATER DISCHARGE OUTFALL (SDO)
QUALITATIVE MONITORING REF 'T
Certificate of Coverage No. NCG: 180238
Facifity(s)i Name: Vision 1, BCW Warehouses and BCM
County: Caldwell
Inspector: Mike Smith Phone No_: 828.70,6078
Date of Inspection-
Outfall No.
1
2
3
4
S
6
7
a
9
10
Structure
Corrugated Pipe
Corrugated Pipe
Corrugated Pipe
Dirt Ditch
Corrugated Pipe
Corrugated Pipe
Corrugated Pipe
Corrugated Pipe
Corrugated Pipe
Corrugated Pipe
Receiving Stream
Millers Creek
Millers Creek
Millers Creek
Millers Creek
Millers Creek
Millers Creek
Millers Creek
Lower Creek
Lower Creek
Lower Creek
Outfall Location
Inside Fence. at
In parking lot of
Outside Fence,
Outside Fence,
In Parking Lot of
In Parking Lot of
In BCW Driveway,
LSF comer of
Driveway In grasss,
Across RR track,
Outside Fence, behind
Fence Line, RSF
BCW, across from
across parking lot of
located LSF comer
BCW, across from
BCW, across from
RSF BCW Waste
located 8Cm53 tom
dean steps, located
(Oi• +on coming into gate)
the Lab
BCM
Dock Door A4
BCW Dock Door 1
of SCT parking lot
Dock Door 14
Dock Door 24
Pad
Dock Door 46
at 2nd guard house
r(s}
Trailer Parking,
Gas/Diesel
Driveway,
Containment
Driveway, Wooden
Sample Finishing,
Parking lot,
Driveway. Parking
Drainage, 8CT
Skids Stg, Trailer
Lab Roof Gutters
Roof Gutters
Trailer Parking
Trailer Parking
Parking Lot
Orfvewa
Driveway
Oriveway
Parking
Driveway
COLOR of discharge
(red, brown. blue,etc.)
and TINT (light, medium,
dark)
ODOR (i.e. smells
strongly of oil. weak
chlorine, etc.)
CLARITY of discharge,
where 1 is cleat and 10 is
cloudy -
FLOATING SOLIDS in
stormwater, where 1 is no
solids and 10 is the
surface covered In solids.
SUSPENDED SOLIDS,
wr ' is no solids and
remely muddy.
FOAM, Yes or No
OIL SHEEN, Yes or No
OUTFALL
DEPOSITION•, Yes or
NO
OUTFALL EROSION",
Yes or No
Any other indicators of
stormwater Pollutions;
By this signature, I certify that this report is accurate and cofrrpfete to the best of my knowledge:
Is there deposition of material (setliment,etc) at or immedialely below this oudall?
Is there erosion at or immedi8tely below the outfall?
K.lpprtMhlon\e ,onmentaKSTORMIComplpa Outfal Quaaapye VI l SSPhr1"iti Sem4ar al Ia6p,ti, .ah

'A
NCDENR n�kk ­ -...- .
North Carolina Department of Environ merit a atufaM urces--
Division of Water Quality
Beverly Eaves Perdue Coleen 1•i. SullinsE
`i,— !?ee Fre6man
Governor director Secretary
March 13, 2009�g
Mr. David Stout
Broyhill furniture Industries, lnc. At QOUALITY F°�E
One Broyhill Park Lenoir, NC 28633�F..> ..... :.�..� _.:..�..
Subjcct: General Permit No. NCG 180000
Broyhill Furniture, Miller Hill Complex
COC NCC 180238
Caldwell County
Dear Mr. Stout:
In accordance with your application for a discharge permit received on March 3, 2009, we are
forwarding herewith the subject certificate of coverage to discharge under the subject state — NI'DES
general permit. This permit is issued pursuant to the requirements ot'North Carolina General Statute 143-
215.1 and the Memorandum of Agreement beoxcen North Carolina and the US Environmental Protection
Agency dated May 9, 1994 (or as subsequently amended). We are also hereby rescinding your• current
permil number ArC'G080806.
Please take notice that this certificate of coverage is not transferable except alter notice to the
Division of Water Quality, The Division of Water Quality may require modification or revocation and
reissuance of the certificate of coverage. This permit does not affect the legal requirements to obtain other
permits which may be required by the Division of Water Quality or permits required by the Division of
Land Resources, Coastal Area Management Act or any other federal or local governmental permit that may
be required.
Please note that the attached general permit expires on August 31, 2009. Your COC will be
automatically renewed to cover the fall 5 year term of the soon to be reissued permit. 1n the interim you
must abide by the terms of the expiring permit. You can review the proposed general permit changes at
(www.ncwaterquality,org/su/publicnotice,htm).
If you have any questions concerning this permit, please contact Robert Patterson at telephone
number [phone].
Sincerely,
ORIGINAL, SIGNED Hy
KEN PICKI-�
far Coleen 1-1. Sullins
Wetlands and stormwater Branch
1617 Mail Service Center, Raleigh, North Carolina 27699.1617
Location: 512 N, Salisbury St. Raleigh, north Carolina 27604
Phone: [phone] FAX: 91"07-6494 4 Customer Service. 1-877-623-6746
intemet www.newaterquali y.org
An Equal Opporlunily 1 Alfinnatrre Action Errployer
One
North Carolina
Natumlly

Mr. David Stout
Broyhill FurnitllrC IWILIMHCS, IIIC.- +CG f 80238
March 13, 2009
cc: Asheville Regional Offiicc
Central Files
Stormwater Permitting -Unit Files
SPU File NCGO80806

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
GENERAL PERMIT NO. NCG180000
CERTIFICATE OF COVERAGE No. NCGI80238
STORMWATER DISCHARGES
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
In compliance with the provision of North Carolina General Statute 143-215.1, other lawful
standards and regulations promulgated and adopted by the North Carolina Environmental
Management Commission, and the Federal Water Pollution Control Act, as amended,
Broyhill Furniture Industries, Inc.
is hereby authorized to discharge stormwater from a facility located at
Broyhill Furniture, Miller Hill Complex
802 Complex Street
Lenoir
Caldwell County
to receiving waters designated as Lower Creek, a class C water in the Catawba River Basin, in
accordance with the effluent limitations, monitoring requirements, and other conditions set forth
in Parts I, II, III, IV, V, and VI of General Permit No. NCG180000 as attached.
This certificate of'coverage shall become effective March 13, 2009.
This Certificate of' Coverage shall retrain in effect for the duration of the General Pert -nit.
Signed this 130' day of March, 2009.
4RIGINAI., SIGNED BY
KEN PICKLE
for Coleen H. Sullins., Director
Division of Watcr Quality
By the Authority of the Environmental Management Commission

NCG180238
JAM
Broyhill Furniture Industries, Inc,
Broyhill Miller Hill Complex
Latitude: 350 53' 16" N
Longitude: 811 34' 10" W
County: Caldwell
Receiving Stream: Lower Creek
Stream Class: C
•^... r w 0:' '!
Map Scale 1.: 24, 000
Sub -basin: 03-08-31 (Catawba River Basin)
Facility Location

Re: NCG 180238 - Broyhill Furniture -Miller bill Complex
Subject: Re: NCG 180238 - Broyhill Furniture- Miller I -fill Complex
From: Roger Edwards <Roger.Edward [e-mail]>
Date: Fri, 06 Mar 2009 16:36:40 -0500
To: Robert Patterson <[e-mail]>
CC: [e-mail], Roger Edwards <Roger.Edwards @ncmail.nct>
Robe rt ,
Proceed with issuance, ARO will follow-up with a compliance inspection after they
receive the permit.
Thanks,
R. Edwards
Robert Patterson wrote:
Roger,
Please see NOS attached..
we have received an application for coverage of an existing facility under NCG 18
from Broyhill Furniture Industries, Inc. They are currently covered under
NCGO80806, but have moved an upholstered furniture manufacturing operation to
Lhis facility. The facility drains to Lower Creek (class C) in Lenior (Caldwell
County). This facility does have vehicle maintenance, but no haz waste. Does
the ARO have any concerns about issuing this facility a COC for this general
permit & rescinding the current NCGO8 permit?
Thanks!
Roger Edwards - Roger.Edwards(�+ncmail.net
North Carolina Dept. of Environment and Natural Resources
Asheville Regional Office
Division of water Quality - water Quality Section
2090 U.S. 70 Highway
Swannanoa, NC 28778
Tel: [phone]
Fax: [phone]
Notice: E-mail correspondence to and from this address may be subject to the North
Carolina Public Records Law and therefore may be disclosed to Lhird parties.
Roger Edwards <Roger.Edward s a ncmail.net>
NC DENR -Asheville Regional Office
Division of water Quality - water Quality Section
I of 1 3/16/2009 4:06 PM

Re: NCG 180238 - Broyhill Furniture - Miller Hill Complex
Subject: Re: NCG180238 - Broyhill Furniture - Miller Hill Complex
From: Roger Edwards <Roger.l:,dwards a ncmail.net>
Date: 1-ri, 06 Mau 2009 16:36:40 -0500
To: Robert Patterson <Robert. Pattersona ncmail.net>
CC: Linda.wiggs[a?nentaiLnct, Roger Edwards <Rager.11dwards c�neniail.net>
Robert,
Proceed with issuance. AR4 will follow-up with a compliance inspection after they
receive the permit.
Thanks,
R. Edwards
Robert Patterson wrote:
I Roger,
Please see NOI attached.
We have received an application for coverage of an existing facility under NCG 18
from Broyhill Furniture Industries, Inc. They are currently covered under
NCG080806, but have moved an upholstered furniture manufacturing operation to this
facility. The facility drains to Lower Creek (class C) in Lenior (Caldwell
County). This facility does have vehicle maintenance, but no haz waste. Does the
ARO have any concerns about issuing this facility a COC for this general permit &
rescinding the current NCG08 permit?
Thanks!
Roger Edwards - Roger.EdwardsOncmail.net
North Carolina Dept. of Environment and Natural Resources
Asheville Regional Office
Division of Water Quality - Water Quality Section
2090 U.S. 70 Highway
Swannanoa, NC 28778
Tel: [phone]
Fax: [phone]
Notice: E-mail correspondence to and from this.address may be subject to the North
Carolina Public Records Law and therefore may be disclosed to third parties.
Roger Edwards <Roger.Edwards a ncmail.net> j
NC DE'NR - Asheville Regional Office
Division of Water Quality - Water Quality Section
1 of 1 3/9/2009 6:51 AM

- Division of Water Quality 1 Surface Water Protection FOR AGENCY USE ONLY
4 0 • bate Received
��� Year Month Day
National Pollutant Discharge Elimination System
NCDENR
-o HuU�1rsu "°'-"c.K, R..M�°'
EPERMIT NAME/OWNERSHIP CHANGE FORM
xv�A°wwurr /.n'rtEsp�aCc�
1. Please enter the permit number for which the change is requested.
NPDES Permit
(or) Certificate of Coverage
NI G 1 G
8 0 1 2 3 8
II. Permit status ricer to requested change.
a. Permit issued to (company name):
Furniture Brands International
b. Person legally responsible for permit:
Clyde D Whittington
First Ml Last
Vice President of Logistics & Compliance
Tille
_ 825 Visionary Street ^
Permit I lolder Mailing Address
Lenoir NC 28645
City Slate Zip
[phone] _ NA
Phone Fax
c. Facility name (discharge):
Miller Hill Complex
d. Facility address:
_
802 Complex Street
Address
Lenoir NC 28645
Ciq• State "Lip
e. Facility contact person:
David Stout [phone]
First I M I f Last Phone
Ill. Please provide the following for the requested change (revised permit).
a. Request for change is a result of:
X Change in ownership of the facility
X Name change of the facility or owner
If other please explain:
b. Permit issued to (company name):
c. Person legally responsible for permit:
d. Facility name (discharge):
c. Facility address:
f. Facility contact person:
Heritage liorne Group, LLC
Scott Shuford
First M1 Last
Lenoir U_pholsteg Plant Manager _
Title
_ 830 Complex Street
Femur Holder Mailing Address
Lenoir NC 28645
City State Zip
[phone] scott,[e-mail]
Phone E-rnail Address
Heritage Home Group - Lenoir Upholstery Plant
830 Complex Street
Address
Lenoir NC 28645
City State Zip
David E Stout
First MI Last
[phone] david.stout a heritagehome.coin
Phone E-mail Address
Revised 2012Apr23

NPDES PERMIT NAMEIOWNERSHIP CHANGE FORM
Page 2 of 2
IV. Permit contact information (if different from the person legally responsible for the permit)
Permit contact: David E Stout
First MI Last
Director of Environmental Compliance
Title
815 Visionary Street
Mailing Address
Lenoir NC 28645
City State zip
(828) 759-$510 david.stout a,heritacehome.com
Phone E-mail Address
V. Will the permitted facility continue to conduct the same industrial activities conducted prior
to this ownership or name change`'
X Yes
❑ No (please explain)
VI Required Items: THIS APPLICATION WILL BE RETURNED UNPROCESSED IF ITEMS
ARE INCOMPLETE OR MISSING:
X This completed application is required for both name change and/or ownership change
requests.
X Legal documentation of the transfer of ownership (such as relevant pages of a contract deed,
or a bill of sale) is required for an ownership change request. Articles of incorporation are
not sufficient for an ownership change.
'file certifications below must be completed and signed by both the permit holder prior to the change, and
the ne-%v applicant in the case of an ownership change request. For a name change request, the signed
Applicant's Certification is sufficient.
PERMITTEE CERTIFICATION (I'ennit holder prior to ownership change):
I, Clyde D. Whittington, attest that this application for a name/ownership change has been reviewed and is
accurate and complete to the best of my knowledge. I understand that if all required parts of this
application are not completed and that if all required supporting information is not included, this application
package will be returned as incomplete.
3-Y-/y
Signat c Date
APPLICANT CERTIFICATION
1, Scott Shuford, attest that this application for a name/ownership change has been reviewed and is
accurate and complete to the best of my knowledge. I understand that if all required parts of this
application are not comp] and that if all required supporting information is not included, this application
nackau"ill be retUrnedefts ificomolad')
Date
PLEASE SEND THE COMPLETE APPLICATION PACKAGE TO:
Division of Water Quality
Surface Water Protection Section
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Revised 7/2008

vu i l: -I O Fes.{ C' (i L, L. C.
' NOTG THE ?-0,000-GAL 42 FUG CQL AST LOCATED 14GRT1iFAST ➢f-- VISi➢NS S
IS NCT M-ftM OR tiAIFITA➢ U RY FURNITURE BRANDS INTERNATIONA.. \
J AV i of S'c u f
flAw
F !
Soo
I
SCAB-E IN FEET C-0,r p �J �3
cart. 24
iD it -
L,.
i Iva
t f DLUE RIDGE PANEL
•
/ (NDT A FURNTTURE BRANDS
r f
CENTRAL.
Q 1 FAREHQUSE FURNMRE BRANDS
f 1IFS�dN� 3
,,rr•
,::;o rl,q „ .,13 ATo
LENCIR CHAIR VI
C.EGEI7fh
FUELING AREA AST-,
Q GARAGE AST5
cif USEI] O& AST
INUSSEII FINISHING LIQUID ASTS (PACp4Aaa6
UNUSED FINISfiING LIQUID ASTs (WALL SYSTEms)l '
Q UNUSED F)NISMG LIQUID ASTs (LENOIR CHAIR Sll
HAZARDOUS WASTE STORAGE AREA
GARAGE DRUMS
iQ Olt/VATER SEPARATOR DRUM
0 MAINTENANCE; AREA DRUMS
OR. DRUM (VISIONS I)
WASTE FWI HLNG LIQUID DRUM (LABORATORY.?
Qq TRANYFOR1104
STnPAIWATER HU14OFF FLOW ➢IRECTI➢N
4 Prl.�sl
FIGURE A-2
SITE PLAN AND rAMLITY DIAGRAM
FURNITURE BRANDS INTERNATIONAL, INC.
BROYHILL MILLER HILL CCIPLEX
LLNEIR, NORTH CAROLINA

NOTE, THE 20,000-GAL #2 FUEL OIL AST LOCATED NORTHEAST OF VISI❑NS I
IS NOT OWNED OR MAINTAINED BY FURNITURE BRANDS INTERNATI❑NAL.
0 300
SCALE IN FEET
OdU'TFALL. LALAncti tAloor
LAW ER
REEK CJ k.
LEGENDi
AQ FUELING AREA ASTs
® GARAGE ASTs
CO USED OIL AST
QD UNUSED FINISHING LIQUID ASTs (PACEMAKER)
UNUSED FINISHING LIQUID ASTs (WALL SYSTEMS)
FQ UNUSED FINISHING LIQUID ASTs (LEN❑IR CHAIR #I)
HAZARDOUS WASTE STORAGE AREA
Q GARAGE DRUMS
�I ❑IL/WATER SEPARATOR DRUM
Q MAINTENANCE AREA DRUMS
Q ❑IL DRUM (VISI❑NS 1)
Q WASTE FINISHING LIQUID DRUM (LABORATORY)
A TRANSFORMER
ST❑RMWATER RUNOFF FLOW DIRECTI❑N
CUITVALL
DR-A14
,(e
FIGURE A-2
SITE PLAN AND FACILITY DIAGRAM
FURNITURE BRANDS INTERNATIONAL, INC.
BROYHILL MILLER HILL COMPLEX
LENOIR, NORTH CAROLINA

L XfA�_ /Yk I Y- d*/ ;( -1, 1A
1
0
(IJI 5 o vY-
n �`� 5 I IVI i oP vqm fj;

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
/VC�
DOC TYPE
El HISTORICAL FILE
� MONITORING REPORTS
DOC DATE
❑ cppiO D-1 'v
YYYYMMDD

[F1
Q41AM j.;
J SEP 13 2010
ER r� �ALITY SECTIQN
Stormwater Discharge Qutfali (SDID�,�- f-
0
Qualitative MonitorifigR6ort
Per -nit NO..Q1, / - / / �I I I or Cevifcatt of CoYerage No.: N Ig ---
Facility Name: ;a—
County-, Phase �Io.
Inspector.,
Datgoflnspectioa:
By this Signature, 13rfy that is report is accurate and complete to the best of my knowledge:
1-'eorDesignee}
I. OutfaH Description
outfall No. S=cMM (Pi,.ditch, etc.)
Receiving Stream.
Describe the industrial activities that occur within the outfall dt-atnage area:
2. Color
Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint 'light, rn edium,
darik) as descriptors:
3. Odor
Describe any d'
etc.)
4. Clarity
inn odors that the discharge may have (i.c., smells strongly of oil, weak chlorine odor,
Choose the number which best describes the clarity of the dischirgt where I is clear and 10 is very
cloudy.
4 5 6 7 8 9 10
Page I
SWV-242-1W5W

S. Floating Solids
choose the munber which best describes the amount. of floating solids in Tel: 3toTrnwater discharge whert
! is no solids and !0 is the surface covered with floating solids:
0 2 3 4 5 6 7 8 9 10
6. Suspender! Solids
Choose the number which best describes the amount of suspended solids in the stormwater discharge
where I is no solids and W is extremely muddy:
2 3 4 6 7 8 9 10
i
7. Foam
Is there any foam in the stormwater discharge? Yes Nv
S. 00 $been
Is there an oi.! shccn in the stonnwater discharge? Yes No
9. Other Obviious Indicators of Stormwater Pollution
List and describe
`dote: Low clarity, high solids, and/or the presence of foam or oil sheen may be indicative of pollutant
exposure. These conditions may warrant further investigation.
Page 2
11
swU-242-101599

Stormwater Disebarge Outfall (SDO)
Qualitative Monitoring Report
Perrnit No.: jj1c1^# _I,1 �#or Cercificatt of Coverage No.: �+#�I2!_
Facility Name: t. oIn 4'
' County: Phone No. — C?
Inspector:
Datt of lnspectioa:
By this signature, 1 ' fy tha this report is accurate and corap.lete to the best of my knowledge:
(Signature ofWxmittec or Designee)
I. Outfall Description
Outfall No. � Structure (pipe, ditch., etc.)
Receiving Stream:
Describe Lhe industrial activities that occur within the outfall dzainage area;
2. Color
Describe the color of the discharge using basic colors (red brown, blue, etc.) and tint (light, rnediusn,
dark) as descriptors:"
3. Odor
Describe any distinct odors that the discharge may have (i.e., smells strongly of oil, wear{ chlorine odor,
etc.)
4. Clarity
Choose the number which best describes the clarity of the discharge where I is clear and 10 is very
cloudy.
2 3 4 S b 7 8 9 10
Page 1
sw-247•1ots"

5. Floating Solids
Choose the nurrber whicl, best describes the amount of floating Solids in the stormwater discharge where
j 1 is to solids and 14 is the surface covered with floating solids;
0 2 3 4 a 6 ? 8 9 to
I
b. Suspended Solids
a
Choose the number which best describes the amount of suspended solids in the stormwater discharge
f
where 1 is no solids and 10 is extremely muddy:
� r
2 ? 4 4 6 i 8 9 10
7, x Foam
Is there any foam in the stormwater discharge? Yes I�io
8. nil Sheen
Is there an oil sheen in the stormwater discharge? Yes Igo
9. Other Obvious indicators of Stormwater Pollution
List and describe
Note: Low clarity, high solids, and/or the presence of foam or oil sheen may be indicative of pollutant
exposure. These conditions may warrant further investigation.
Page 2
SWU-242-01599

,T +
Permit No.:
Facility Name:
County: _ ?A
Inspector:
Dat# of Inspection:
By this signature, I
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
_i_l I or CertiScaic of Coverage No.:
Phone No. 1�
`y tha is report is accurate and complete to the best of my knowledge:
(Signature ofF'em�ttee or Designee)
1. Outfall Description
Outfall No. Structure (pipe, ditch, etc.)
Receiving Stream:
Describe the industrial activities that occur within the outfall drainage area:
i. Color
Describe the color of the discharge using basic colors (red, Brown, blue, etc.) anti tint (light, rnediurn,
dark) as descriptors: ✓ _ — -
3. Odor
Describe any distinct odors that the discharge may have (i.e., smells strongly of oil, weak chlorine odor,
etc.)
C Oarity
Choose the number which best describes the clarity of the discharge where I is clear and+ 10 is very
Cloudy:
3 4 5 6 i $ 9 Id
Page 1
5 WU•24I+ 1 of S99

S. Flostin'g Solids
Choose the cumber which best describes the mnount of floating solids is the stormwater discharge where
! is no solids and 10 is the surface covered with floating solids:
0 2 3 4 3 5 7 8 9 10
b. Suspended Solids
Choose the uurnb3 r which best describes the arnount of suspehded solids in the stormwater discharge
where 1 is to solids and 10 is extremely muddy_
3 a j 6 i 8 9 10
7, i Foam
is there any foam in the stormwater discharge?
S. oil Sheen
Is there an oil sheen in the stormwater discharge?
Yes .
Yes No
+9. Other Obvious Indicators of Stormwater Pollution
List and describe
Note: Low clarity, high solids, and/or the presence of foam or oil sheen may be indicative of pollutant
exposure. These conditions may warrant further investigation,
Page 2
a
swt,.=42401599

Permit No.: -c!_
Facility Name_
County
inspector.
pats of IWPection:
By this signature
Stormwatelr Discharge Qutfall (SDO)
Qualitative Monitoring Report
1 or Certificate of Coverage No.:
o ns Ce►x __
Phone No_ %6-P - 0 7 -
fy tjnat this report is accurate and complete to the best of my knowledge:
(Signature off:san� ee or Designee)
1. Outfall Description
Outfall No. T Strucmm (pipe, ditch, etc.)
Receiving Stream:
Describe the industrial activities that occur within the ourfalI drainage area:
2. Color
Describe the color of the discharge ►ising basic colors (red, brown, blue, etc.) and tint (light, rnediusm,
dark) as descriptors:
3. Odor
Describe any distinct odors that the discharge may have (i.e., smells strongly of oil, weak chlorine odor,
etc.)
4. Clarity
Choose the number which best describes the clarity of the discharge where 1 is clear and 10 is very,
cloudy.
2 3 4 5 6 8 9 10
Page E
SWU•242-I01599

5, floating Solids
Goose the number which best describes the ainouot of floating solids is the stormwater discharge where
I is no solids and 10 is the surface covered with floating solids:
2 3 a 5 5 7 8 9 10
6. Suspended Solids
Choose the'number which best describes the amo=t of suspended solids in the stormwater discharge
where 1 is aao solids and 10 is extremely muddy'.
2 3 4 6 7 8 9 10 +
7. i Foam
Is there any foam in the stormwater discharge? Yes rto
8. 00 Sheen
Is there an oil sheen in the stormwater discharge? Yes No
9. Other Obvious Indicators of Stormwater Pollution
List and describe
Note: Low clarity, high solids, and/or the presence of foam or oil sheen may be indicative of pollutant
exposure, These conditions may warrant further investigation,
Page 2
MJ-242-EM99

t
Per -nit No,: Lvl.Q1_
Facility Name:
County:
lttspector:
Datt of Inspection:
®r-:Vi111Q
Stormwatelr Discharge Outfall (SDO)
Qualitative MonitorYng Report
r ! t or Certificate of Cov4rage No.:
U -F-o ,h Alm' ---
Prone No. -Y4�y -
!4'
By this signature, I rtif,�+ at this report is accurate and complete to the best of my knowledge:
(Signature of p rmittee or Designee)
1. OutfaB Description
Outfall No. Structure (pipe, ditch, etc.)
Receiving Stream:
Describe the industrial actin bes that occur within the outfall drainage area:
2. Color
Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint "light, medium,
dark) as descriptors: -
3. Odor
Describe any distinct odors that the discharge may have (i.e., snl eelis strongly of oil, weak chlorine odor,
etc.)
4, Clarity
Choose the number which best describes the clarity of the discharge wbere I is clear and 10 is very.
Cloudy.
6) Ic 3 4 S b 7 8 9 10
Page 1
SwU.242 • I O f 5"

$. Floating Solids
i
Choose the number which best describes the amount of floating solids in the stormwater discharge where
1 is no solids and 10 is the surface covered with floating solids:
4 2 3 4 b 7 8 9 t4
6. Suspended Solids
Choose the number which best describes tht amount of suspended solids in the stormwater discharge
where 1 is t3o solids and 10 is extremely muddy--
3 Q n 7 8 9 to
f,
7. ? Foam
Is there any foam in the stormwater discharge? Yes No
8. Oil Sheen
Is there an oil sheen in the stonnwater discharge? Yes
9. Other Obvious Indicators of Stormwater Pollution
List and describe
Note: Low clar,ty, high solids, and/or the presence of foam or oil sheen may be irdicative of pollutant
exposure. These conditions may warrant ftuther investigation.
Page 2
SwU•342»10IS99

Permit No.: NYC.
Facility Name_
County
inspector: .
Datt of Inspection:
By this signature, i
Stormwater Disebarge Outfall (SDO)
Qualitative Monitoring Report
l�f rilr'� 1 or Certificate of Coverage No.:
Pbone No.
t�ify at this report is accurate and complete to the best of my knowledge:
(Signature of Fermittee or Designee)
1. Outfit[ Description
Outfall No.._._. Structwr (pipe, ditch, etc.)
Receiving Stream:
Describe the industrial activities that occur within the ourfail drainage area:
2. Color
Describe the color of the discharge using basic colors (red, browvn, blue, etc.) and tint (Iight, rnediurn,
dark) as descriptors:
I Odor
Describe any distinct odors that the discharge may have (i.e., sindells strongly of oil, weak chlorite odor,
etc.) a
4. Clarity
Choose the number which best describes the clarity of the discharge where I is clear and 10 is very
cloudy.
2 3 4 5 5 ; 8 4 10
Page 1
5 WU-242-101599

r
S, Floating Solids
t
Choose the number which best describes the amount of floating solids in the stormwater discharge where
1 is no solids and 10 is the surface covered with floating solids:
1 2 3 4 S h 7 8 9 10
6. Suspended Solids
E Choose the number, which best describes the amount of'suspetided solids in the stormwater discharge
where I is no solids and 10 is extremely muddy:
I
2 3 4 6 7 8 9 10
4
{ 7. ? ]~ Gantt
+ Is there any foam in the stormwater discharge? Yes No
S. (aid Sheen
i
Is there an oil sheen in the stormwater discharge? Yes `o
9. Other Obvious Indicators of Stormwater Pollution
List and describe
I
j y..
vote: Low clarity, high solids, and/or the presence of foam or oil sheen maybe irdicarive of pollutant
exposure. These conditions may warrant further investigation.
Page 2
SWU•242•101599

Storrnwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Permit No.: Lv'1�!�1 Irl I r_! I or Certificate of Coverage No.:I���tl__.�_
Facility Name_
County Pbone No.
Inspector.
Dat#oCf IWpection: —
By this si =e,I?0TifYtha this report is accurate and complete to the best of my knowledge:'
(Signature ofPermittec or Designee)
I. Outfall Description
Outfall No. 5trucwm (pipe, ditch, etc.)
Receiving Stream --
Describe the industrial activities that occur within the outfail drainage area:
2. Color
Describe the color of the discharge using basic colors (red, brown., blue, etc.) and tint (light, medium,
dark) as descriptors:
3. Odor
Describe any distinct odors that the discharge may have (i.e., snzeIls strongly of oil, weak chlorine odor.
etc.)
4. Clarity
Choose the number which best describes the clarity of the discharge where I is clear and 10 is very
cloudy.
2 3 4 S 6 7 g g IQ
Page !
swu.242. rass9s

S. Floating Solids
Choosc the number which best describes the amount of floating solids i-, the 5tormwater discharge where
I is no solids and 10 :s the surface covered with floating solids:
0 2 3 4 S 6 8 9 10
6. Suspended Solids
Choose the -�urnbcr which best describes the amount of suspended solids in the stormwater discharge
where I is no solids and 10 is extremely muddy:
2 3 4 3 6 7 8 9 10 ,
a
1. z Foam
J '
Is there any foam in the stormwater discharge? Yes o
8. Oil Sheen
,Is there an oil sheen in the stomwater discharge? Yes No
9. Other Obvious Indicators of Stormwater Pollution
L6--t and describe
Note: Low clarity, high solids, and/or the presence of foam or oil sheen shay be irdicafive of poilu=t
exposure. These conditions may warrant feather investigation,
Page 2
5 WIi-242- E p 1599

Permit No.: Nice
Facility Name: ,2
County
Inspector: l
Datt of inspection°
By this signature,
Stormwater Diseba3rge Outfall (SDO)
Qualitative Monitoring Report
�q I ettify %at this report is accurate and complete. to the best of my knovwledge;
(Signature of�'trmittee or Designee)
1. Outfall Description
Outfall No, Structure (,pipe, ditch, etc.)
Receiving Stream:
Describe the industrial activities that occur within the outfall drainage area:
2. Color
Describe the color of thc-discharge using basic colors (red, brown, blue, etc.) and tint (lightn t, rnediu,
dark) as descriptors:
3. Odor
Describe any distinct odors that the discharge may have (i.e., smells strongly of oil, wear chlorine odor,
etc.)
4. Charity
Choose the number which best describes the clarity of the discharge where l is clear and 10 is very
cloudy.
'= 3 4 S 6 7 8 9 10
PaPart
SWU-241-141599

S. Floating Solids
I
Choose the number which best describes the amount of floating solids in the stornwater discharge where
i is no solids and 10 is the surface covered with fiosting solids:
1 2 3 4 5 5 7 8 9 10
6. Suspended Solids
Choose the rnbl r which best describes tht amount of suspended solids in the stonnwater discharge
where 1 is no solids and 10 is extremely muddy:
fi) 2 3 4 6 7 8 9 10
7. poarn
�I
j Is there any foam in the stormwater discharge? Yes
S. Oil Sheers
Is there an oil sheen in the stonnwater discharge? Yes 16
9. Other Obvious Indicators of 5tormwater Pollution
List and describe
Mote: Low clarity, high solids, an:dlor the presence of foam ar oil sheen may be indicative of pollutant
exposure. These conditims may warrant ftuther investigation,
Page 2
SWU-242-101599

Stormwater Discharge Outfali (SDO)
Qualitative Monitoring Report
Permit No.: N'C*'�I_ !�! ! r r' I or Certificate of Coverage No.:
Facility Name_ A 1Lx
OF
County: Phone No. M
inspector: - - --
Dat# of Iispection:
By this signature, I dfy that this report is accurate and complete to the best of my knowledge;
G.�
(Ssgnature of ermine or Designee)
lr'
1. Outfali Description
Outfau No. 9 .Structure (pipe, ditch, etc.) ; -_-- -- -
Receiving Stream:
Describe the industrial activities that occur within the outfall diainage area:
2. Color
Describe the color of chc discharge using basic colors (red, brown, blue, atc.) and tint (light, rnediwm,
dark) as descriptors: . ZZ r —
3. Odor
Describe any distinct odors that the discharge may have (Le., smells strongly of oil, weak chlorine odor,
etc.;
4. Clarity
Choost the number which bzt describes the clarity of the disoharge where I is clear and 10 is very
cloudy:
2 3 4 S b 8 9 10
Page E
5 WU•242. l 0 s 599

g, Floating Solids
Choose the number which best describes the amount of floating solids in the stormwater discharge where
fI is no solids and 10 is the surface covered with floating solids:
1 2 3 4 > 6 7 8 9 10
6. Suspended Solids
i
Choose the numbe- which best describes the amount of suspended solids in the stormwater discharge
where 1 is uo Solids and 10 is extretncly muddy-.
� O2 3 4 a 7 9 9 10
E 7. - 3 Foam
Is there any foam in the stormwater discharge? Yes a
8. Oil Sheen
j Is there an oil sheen is the stormwatcr discharge" Yes
9. Other Obvious indicators of Storm rater Pollution
List and describe
Note: Low clarity, high solids, and/or the presence of foam or oil sh"n may be indicative of pollutant
exposure. These conditions may warrant further investigation.
Page 2
Swl:•242-MS99

A/w r
Pcr:nit No.: NiC)-
Facility Name: .�
County.
Inspector:
Date of Inspection:
By this signature
Stormwater Disebarge Qutfall (SDO)
Qualitative Monitoring Report
that this report is accurate and complete to the best of my knowledge:
or Designee)
1. Outfall Description
outfall No. Structure (pipe, ditch, etc.)
Receiving ,Stream:
Describe tie industrial activities that occur within the outfall drainage area:
2. Color
Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint (fight, tnediurxY,
dark) as descriptors:
3. Odor
Describe any distinct odors that the discharge may have (i.e., snklis strongly of oil, weak chlorine odor,
etc.)
4. Clarity
Choose the number which best describes the clarity of the discharge where 1 is clear and 10 is very
e,oudy.
l 2 3 4 5 6 8 9 10
Page 1
5 WU-Z42.1013"

S. Floating Solids
Choose the number which hest describes the amount of floating solids ii the stot:nwatet discharge where
1 is no solids and 10 is the surface covered with floating solids:
01 2 4 3 5 7 8 9 10
b. Suspended Solids
Choose the number which best describes the arnount of suspended solid in the stormwater discharge
wncre I is no solids and 10 is extremely muddy:
2 3 4 ; 6 7 8 9 10
7. 2 Foam
is there any foarn in the stormwater discharge? Yes Na
$. Oil Sbeen
Is there an ail sheen in the stormwater discharge? Yes
9. Other Obvious Indicators of Stormwater Pollution
List and describe
Note: Low clarity, high solids, and/or the presence of foam or oil sheen may be indicative of pollutant
exposure. These conditions may warrant further inveitigation.
Page 2
swU•242-101599

r ,
WATE
Tf E- 7 D-\�
1 !, SEP 1 3 2010 ,J
Stormwater Discharge Outfall (SD4) i-F? C'J_/L-;IT' Y SECTION
__, E
Qualitative Monitoring Report
Permit No.: NICJ 1 1 1_I 1 I or Certificate of Coverage No.: NIC/G/
Facility Name: i✓ �% h v✓ �," �,�-- - r�
y
County: Phone No.
Inspector: z
Date of inspection:
By this signature, I cegWy that this report is accurate and complete to the best of my knowledge:
(Signature of FVrmittee or Designee)
1. Outfall Description
Outfall No: - -ZV/ / Structure (pip�e/, Oitch, etc.)
Receiving Stream: ^/�ezw,>,_"Ile1
Describe the industrial activities that occur within the outfall drainage area:
2. Color
Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint (light, medium,
dark) as descriptors:
3. Odor
Describe any stint odors that the discharge may have (i.e., smells strongly of oil, weak chlorine odor,
etc.) /o�c�
4. Clarity
Choose the number which best describes the clarity of the discharge where 1 is clear and 10 is very
cloudy:
2
swU-242-020705
3 4 • 5 6 7
Page I
8 9 10

5. Floating Solids
Choose the number which best describes the amount of floating solids in the stormwater discharge where
1 is no solids and 10 is the surface covered with floating solids:
(9 2 3 4 5 6 7 8 9 l0
C. Suspended Solids
Choose the number which best describes the amount of suspended solids in the stormwater discharge
where I is no solids and 10 is extremely muddy:
2 3. 4 5 6 7 8 9 l0
7. Foam
Is there any foam in the stormwater discharge? Yes
S. . Oil Sheen
c'�
Is there an oil sheen in the stormwater discharge? Yes (NO)
J
9. Deposition at Outfall
Is there deposition of material (sediment, etc.) at or immediately below the outfall?
10. Erosion at Outfall
Is there erosion at or immediately below the outfall? Yes No
11. Other Obvious Indicators of Stormwater Pollution
List and describe.
Yes e
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, deposition or erosion may be
indicative of conditions that warrant further investigation and corrective action.
Page 2
PUT

Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Permit No.: NICIlLI 1 1 I 1 1 or Certif gate of Coverage No.: NIC/G/�l�l
Facility Name: a%,v
County: . Phone No. .
Inspector:
Date of Inspection: - e
By this signature, I i`tify that this report is accurate and complete to the best of my knowledge:
(Signature of Pernvttee or Designee)
1. Outfall Description
Otitfall No. � Structure mpe, ditch, etc.)
Receiving Stream: _ fn, i.iAr C 4Azi _
Describe the industrial activities that occur within the outfall drainage area:
2. Color
Describe the color of the dii charge using basic colors (red, brown, blue; etc,) and tint (light, medium,
dark) as descriptors: G"' /Y
3. Odor
Describe any
etc.)
4. Clarity
odors that the discharge may have (i.e., smells strongly of oil, weak chlorine odor,
Choose the number which best describes the clarity of the discharge where 1 is clear and 10 is very
cloudy:
2 3 4 5 6 7 8 9 10
Page 1
S WV-242-020705

5. Floating Solids
Choose the number which best describes the amount of floating solids in the stormwater discharge where
t is no solids and 10 is the surface covered with floating solids:
( i 2 3 4 5 6 7 8 9 10
6. Suspended Solids
Choose the number which best describes the amount of suspended solids in the stormwater discharge
where 1 is no solids and I0 is extremely muddy:
f�l J 2 3 4 5 6 7 8 9 10
7. Foam
Is there any foam in the stormwater discharge? Yes No
8. Oil Sheen
Is there an oil sheen in the stormwater discharge? Yes No
9. Deposition at Outfall - - -- Is there deposition of material (sediment, etc.) at or immediately below the outfall?
10. Erosion at Outfall DO
Is there erosion at or immediately below the outfall? Yes
11. Other Obvious Indicators of Stormwater Pollution
List and describe
Yes No
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, deposition or erosion may be
indicative of conditions that warrant further investigation and corrective'action.
Page 2
SWU-242-020705

O�\NA7-�02
y �
a �
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Permit No.: NICI 1 1 .1 I or Certific to of Coverage No.: NIGGI I I
Facility Nam I - %ry
County: Phone No. .2 - 11:11SI-?— zl4
Inspector:
Date of Inspection:
dBythis signature, I c - ify t.hats report is accurate and complete to the best of my knowledge:
(Signature of Permittee or Designee) .
1. Outfall Description
Outfall No. �7 tructure (�ip., ditch, etc.)
Receiving Stream:a_f*ltf ✓ [e
Describe the -industrial activities that occur within the outfall drainage area:
2. Color
Describe the color of the
dark) as descriptors:
using basic colors (red, brown, blue, etc.) and tint (light, medium,
3. Odor -
Describe any distinct odors that the discharge may have (i.e., smells strongly of oil, weak chlorine odor,
etc.) �c
4. Clarity
Choose the number which best describes the clarity of the discharge where I is clear and 10 is very
cloudy:
1 2 3 4 5 6 7 8 910
Page 1
SWU-242-020705

5. Floating Solids
Choose the number which best describes the amount of floating solids in the storrnwater discharge where
1 is no solids and 10 is the surface covered with floating solids:
(9 2 3 4 5 6 7 8 9 10
6. Suspended Solids
Choose the number which best describes the amount of suspended solids in the stormwater discharge
where I is no solids and 10 is extremely muddy:
t 2 3 4 5 6 7 8 9 10
7. Foam
Is there any foam in the stormwater discharge? Yes No
8. Oil Sheen
Is there an oil sheen in the stormwater discharge? Yes No
9.- Dep6siti6h at Outfall — - — - -
Is there deposition of material (sediment, etc.) at or immediately below the outfall?
10. Erosion at Outfall
Is there erosion at or immediately below the outfall? Yes
11. Other Obvious Indicators of Stormwater Pollution
List and describe
Yes 5
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, deposition or erosion maybe
indicative of conditions that warrant further investigation and corrective action.
Page 2
swu-242-020705

Permit No.: NI_G
Facility Name- 1,'4'
County:
Inspector:
Date of InstQtiol
By this signature, I
of
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
or Ce�ficaty. of Coverage No.: NIC/GI—IJI 1 1 1_I
No. fff- ' X0 d -
—i_X r
V that this report is accurate and complete to the best of my knowledge:
or Designee)
1. Outfall �esDescription
Outfall No. 7 Structure pipe, ditch, etc.)
Receiving Stream: lle
Describe the industrial activities that occur within the outfall drainage area:
2. Color
Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint (light, medium,
dark) as descriptors:
3. Odor
Describe any
etc.)
4. Clarity
odors that the discharge may have (i.e., smells strongly of oil, weak chlorine odor,
Choose the number which best describes the clarity of the discharge where 1 is clear and 10 is very
cloudy:
l 3 4 5 b 7 8 9 10
Page 1
5WU-242-020705

4
S. Floating Solids
Choose the number which best describes the amount of floating solids in the stormwater discharge where
1 is no solids and 10 is the surface covered with floating solids;
C1/ 2 3 4 5 6 7 8 9 10,
6. Suspended Solids
Choose the number which best describes the amount of suspended solids in the stormwater discharge
where 1 is no solids and 10 is extremely muddy:
0 2 3 .4 5 6 7 8 9 10
7. Foam
Is there any foam in the stormwater discharge? Yes CNo)
8. Oil Sheen
Is there an oil sheen in the stormwater discharge? Yes No
9. Deposition at 0utfall
Is there deposition of material (sediment, etc.} at or immediately below the outfall?
10. Erosion at Outfall
Is there erosion at or immediately below the outfall? Yes No.
11. . Other Obvious Indicators of Stormwater Pollution
List and describe
Yes F
Note: Law clarity, high solids, and/or the presence of foam, oil sheen, deposition or erosion may be
indicative of conditions that warrant further investigation and corrective action.
0
Page 2
SWU-242-029705

Permit No.: NICI_
Facility Nam : _
County: r
Inspector:
Date of Inspection:
WA
Aa 6 �C(T�
5 ~i
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Coverage No.: N/CIGI_I l_l_l_l—1
By this signature,/1 ertify th this report is accurate and complete to the best of my knowledge:
I 4
(Signature ernuttee or Designee)
1. Outfall Description
Outfall No.- Structure ipe, ditch, etc.)
Receiving Stream: 1,(`n 11'.r vIt
Describe the industrial activities that occur within the outfall drainage area:
2. -Color
Describe the color of the
dark) as descriptors: _
3. Odor
Describe any
etc.)
4. Clarity
using basic colors (red, brown, blue, etc.) and tint (light, medium,
Nct odors that the discharge may have (i.e., smells strongly of oil, weak chlorine odor,
176
Choose the number which best describes the clarity of the discharge where I is clear and 10 is very
cloudy:
2 3 4 5 6 7 8 9 10
Page 1
5 WU-242-020705

5. Floating Solids
Choose the number which best describes the amount of floating solids in the stormwater discharge where
1 is no solids and 10 is the surface covered with floating solids:
0 2 3 4 5 5 7 8 9 10
6. Suspended Solids
Choose the number which best describes the amount of suspended solids in the stormwater discharge
where 1 is no solids and 10 is extremely muddy:
2 3 4 5 G 7 8 9 10
7. Foam
Is there any foam in the stormwater discharge? Yes ! j o�
8. Oil Sheen
Is there an oil sheen in the stormwater discharge? Yes No
-Deposition-at Outfall - - - -- - - - - -
Is there deposition of material (sediment, etc.) at or immediately below the outfaIl?
10. Erosion at Outfall
Is there erosion at or immediately below the outfall? Yes 90)
11. Other Obvious Indicators of Stormwater Pollution
List and describe
Yes No
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, deposition or erosion may be
indicative of conditions that warrant further investigation and corrective action.
Page 2
S WU-242-MO705

Pernit No.: NJCJ_
Facility Name:
' County-
- -- ?.A
Iasgector:{
i
Datt of lwpection:
By this signature, I
Stormwater Discharge Qutfall (SDO)
Qualitative Monitoring Report
' I 1 i +' J or Certificate of Coverage No..
Phoac No-
report is accurate and complete to the best of my knowledge:
ignature of 'ttee or Designee)
I. OutfaB Deescriptioa
Outfall No. Stxuettue (pipe ,ditch, etc_)
Receiving Stream: 4
Describe the industrial activities that occur within the outfall drainage area:
2. Color
Describe the color of .he-disch ge using basic colors (red brown, blue, ccc.) and tint 1lig lt, rnediurn,
dark) as descriptors:--
3, Odor
Describe any disfinp4 odors that the discharge may have (i.e., smells strongly of oil, weals chlorine odor,
etc.)
4. Clarity
Choose the number which hest describes the clarity of the discharge where 1 is clear and 10 is very
cloudy.
1& 3 4 5 5 i 8 9 10
Page I
SWV-242-1015"

5. Floating Solids
j Choose Lhe number which best describes the amount of floating solids in the stormwatet discharge where
I i is no solids and 10 ;s the surface covered with floating solids'.
2 3 4 5 6 7 8 4 10
6. Suspended Solids
Choose the numbe- which best describes the arnount of suspended solids in the stormwater discharge
wbere l is no solids and 10 is extremely muddy:
1
L'f 2 3 4 6 7 8 9 10
7. ; Foam
1 ,
Is there any foam in the stormwater discharge? Yes
$, Oil Sheet
Is there an oil sheen in the stormwater discharge' Yes VO
4. Other Obvious Indicators of Stormwater Pollution
List and describe
Vote: Low clarity, high solids, and/or the presence of foam dr oil sheen may be indicative of pollutant
exposure. These conditions may warrant further investigation.
Page 2
sww242,101599

Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Permit No.: �iJ�_ 1 I ! 1_1 ! I or Certificate of Coverage No.:
Facility Name: -Z0/I '
County' Phone No.
}nsgcctor:
Dats of inspection: wT % � �1 _._ - •� - �- —
i4
By this signature, i certify, at this report is accurate and complete to the hest of my knowledge:
210/./-Z
(Signature of Permittee or Desipee)
1. Outfall Description
Outfall No.^ //Structure (p' , disc etc.)
Receiving Stream: _ ,.CD��/, r c
Describe the industrial activities that occur within the cutfall drainage area:
2. Color
Describe the color of the disch ge using basic colors (red, brown, glue, etc.) and tint (light, medium,
dark) as descriptors: cs L
I Odor
Describe any disti odors that the discharge may have (i.e., smells strongly of oil, weak chlorine odor,
etc.) /JtiL
4. Clarity
Choose the number which best describes the clarity of the discharge where 1 is clear and 16 is very
cloudy.
3 4 S 6 7 8 g to
Page 1
swu-242.101599

S. Floating Solids
Choose the number which best describes the amount of floating solids in the stormwater discharge where
1 is no solids and 10 is the surface covered with floating solids:
1 2 3 4 5 b 7 8 9 t0
6. Suspended Solids
Choose cite aurnber which best describes [he amount of suspenders solids in the stormwater discharge
where 1 is no solids and 10 is extremely muddy:
2 3 4 ; a 7 8 9 10
7. Foam
Is there any foam in the stormwater discharge? Yes
$. Oil Sheen
Is there an oil sheen in the stormwater discharge. Yes /o
9. Outer Obvious Indicators of Stormwater Pollution
List and describe
Note: Low clarity, high solids, and/or the presence of foam or oil sheen may be indicative of pollutant
exposure. These conditions may warrant further investigation.
Page 2
S WU-242- a a 3 599

Pei -nit No.: SJ.C!—!_
Facility Name: /5A
County.
Inspector:
Datt of Inspection:
By this signature, I
Stormwatelr DYseharge Outfall (SDO)
Qualitative Monitoring Report
or Certificate of Coverage No.:1C1!_
lull. _ Pbone No- L>
that this report is accurate and complete to the best of my knowledge:
(Sigttaturc a ermittee or Designee)
I. Qutfall Description
Outfall No.� Structure (pipe, ditch, etc.)
Receiving Stream: ..:�?/r. " "s<x-
Describe the industrial activities that occur within the outfall di,-ainage area:
2. Color
Describe the color of the d'is- arge using basic colors (red brown, blue, etc.) and. tint (light, medium,
dark) as descriptors: Cnk
3. Odor
Describe any di ct odors that the discharge may have (i.e., smells strongly of oil, weak chlorine odor.
etc-)
4. Glarit7
Choose the number which best describes the clarity of the discharge where I is clear and 10 is very
cloudy:
2 3 4 5 b 7 8 9 10
Page 1
S WU.242-101399

f
5. Floating Solids
Choose the number which test describes the amount of floating solids in the 3t9rmwater discharge where
l is no solids and 10 is the surface covered witb floating solids:
Q3 2 3 4 5 6 7 8 9 10
6. Suspended Solids
Choose the cumber which best describes the amount of suspended solids in the stormwater discharge
where I is no solids and 10 is extsexrneiy muddy.
2 3 4 6 7 8 9 10 ,
7. ; Foam
Is there any foam in the stormwater discharge? Yes /Ng!
8. Oil Sheen
Is there an oil sheen in the starmwater discharge? Yes
9. Other Obvious Indicators of Stormwater Pollution
List and describe
vote: Low clarity, high solids, and/or the presence of foam or oil sheen may be indicative of pollutant
exposure. These conditions may warrant further investigation.
Pagt 2
SWL3•24I,10I S99

Permit No.: &C/ _
Facility Name:
County'. ?A
inspeetc�r:
DatA of Inspection:
By this signature, i
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
4'
A'fy that this report is accurate and complete to the best of my knowledge:
(Signature of F trmittee or Designee)
1. Outfall Description
Outfall No. - Structure (pipe, ditch, etc-)
Receiving Stream:
Describe the industrial activities that occur xithin the outfall di,•ainagc_area:
2. Color
Describe the color of the ditch ge using basic colors (red brawn, blue, etc.) and tint (light, medium,
dark) as descriptors: e
3. Odor
Describe any distinct rs that the discharge may have (i.e., s ' ells strongly of oil, weak chlorine odor,
etc.) 6
4. Clarity
Choose the number which best describes the civity of the discharge where l is clear End 10 is very
cloudy:
2 3 4 S 5 7 8 9 10
Page E
S WU-2az- 1 0 t 599

� t y
Floating Solids
Choose the number which best describes the amount of floating solids the sto"m water discharge where
I is no solids and 10 is the surface covered with floating solids:
I
1 2 3 4 5 6 7 8 9 10
j 6. Suspended Solids
Choose the which best describes Lht amount of suspended solids in the stormwater discharge
F wbere 1 is no soIids'and 10 is extremely muddy:
I y�
2 1 [phone]
7. Foam
Is there any fnain in the stormwater discharge? Yes ()N
3
8. Oil Sheen
Is there an oil sheen in the storrawater discharge? Yes tv
9. Other Obvious Indicators of Stormwater Pollution
List and describe
Note: Low clarity, high solids, audlor the presence of foam or oil sheen may be indicative of pollutant
exposure. These conditions may warrant :2trther investigation.
Page 2
swu•242-M599

Permit No.: L` IC/ _
Facility Narne:
County-, — ?�4
Inspector-
Date of Inspection:
By this signature, I
Stormwatelr Discharge Outfall (SD4)
Qualitative Monitoring Report
or Certificate of Coverage No.:
,ia11. Phone No. _V�j 9---- -(a �- -- --
4'
report is accurate and cor#lete to the best of my knowledge:
or Designee)
1. Out#all Description
Outfail No. /P Structure (pi Pc, ditch, etc.)
Receiving Stream: v r
Describe the. industrial activities that occur within the outfall diainage area: _ _ --
2. Color
Describe the color of the-di+sc gc ",sing basic colors (red, brown ta
blue, etc.) and tint (lig5,, rnediu,
dark) as descriptors: r��
3. Odor
Describe any ' inct odors that the discharge may have (i.c_, smells strongly of oil, weak chlorine odor,
otc.)
4. Clarity
Choose the number which best describes the clarity of tl&..e discharge where I is clear and 10 is very
cloudy:
3 4 5 5 B 9 14
Page I
S WU•242.10 7 599

5. i+lonflog Solids
r_hoose the number which best describes the amount of floating solids in the stormwater discharge where
l is no solids and 10 is the surface covered with floating solids:
1 2 3 4 5 6 7 8 9 10
6. Suspended, Solids
I
Choose the number which best describes the amount of suspeddtd solids in the stormwater discharge
where I is tao solids and 10 is extremely muddy:
I (1) 4
z 2 5 6 i 8 9 10
2 ..
i
Foam
I is there any foam in the stormwater discharge? Yes l I�qf
S. Oil Sheen
Is there an oil sheen in the stormwater dkebarge? Yes
9. Othtr Obvious Indicators of Stormwater Pollution
List and describe
Note: Low clarity, high solids, and/or the presence of foam or oil sheen may be indicative of pollutant
exposure. These conditions may warrant further investigation.
Page 2
u
M-242-W IS99