NCG210406_MONITORING INFO_20151116

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
/V C� a � 0 �%i 60
DOC TYPE
❑HISTORICAL FILE
f�( MONITORING REPORTS
DOC DATE
❑
YYYYMMDD

ST'ORNIWA'I ER DISCHARGE OUTFALL (SDO)
AIONIT'ORING REPORT �.
GENERALPEIRVIIT NO. NCC210000 SAMPLES COLLECTED DURING CALENDAR YEAR: Cb i�
CI:RTII' ICAT'E OF COVERAGE NO. NCG210=1 ('This monitoring report is due at the Division no later than 30 days from
the date the facility receives the sampling results from the laboratory.)
FACILITY NA.,ME Godfrey lumber Company Inc. DECEIVED
PERSON COLLECTING SAMPLLS Paul Comings
CERTIFIED LABORATORY Statesville Analytical Lah # 44C NOV 2015
Laln #
CENTRAL FILES
Part A. Specific Monitoring Requirements' DWR SECTION
COUNTY Iredell
PHONE NO. (Ina) q77-F�F6
PLEASE SIGN ON THE REVERSE 4
Outfall
No.
Date
Sample Collected,
nm/dd/vr
T"otal Ra'rnf'all,
inches
00530
00400
00340
Total Suspended Solids,
In r I.
PH,
Standard units
Chemical Oxygen Demand (COD),
m L
Benchmark*
-
-
100
Within 6.0 — 9.0
120
?
v
r
U /
4L
—
.rr
r--. rv:> f::'1
7
I
�`
-- A!c G
y iLi
ot+-i
*Note: If a value is in excess of the benchmark. or outside the benchmark range (for pH), you must implement the "tier 1 or "Pier 2 responses in the General Permit_
l]onitoring is required only if the facility stores exposed piles of sawdust, wood chips. hark, mulch, or other similar material on site for longer than seven (7) days.
A facility that does not retain exposed (either exposed to incident precipitation or exposed to stormwater run on) piles of sawdust. wood chips, bark. mulch, or other similar material on
site for more than seven (7) days before removing the material is not ruquircd to monitor for the parameters in Tablc l of the General Permit. If at any time the material is not removed
Within this time frame, the facility roust begin analytical monitoring inttnedialely. (Reurbider: This c'oadifinx does nol exe mpr (tie1 f lcility from qualitative moniturin vf'JDO.s.)
If the facility removes such materials within seven days to meet the; monitoring exemption, the Permittee shall record and maintain in the facility's S1111P a log which documents. at a
rnlllmltllll, 111e dates when material is generated and removed, how removed, and by whom. The log must be sufficient to establish that no materials were exposed for longer than seven
days. For record -keeping purposes, the Permittee may also nlaintai❑ in the SPPP this form with the signed certification below:
"Based upon my inquiry of the person or persons directly responsible for rnatnaging compliance with the permit requirement for analytical monitoring, 1 certify that to the
best of my knowledge and belief, no piles of sawdust, wood chips, bark, mulch or other similar materials were stored exposed (either to incident precipitation or to
stornlwater run on) for longer than seven (7) days before removal since liling the last discharge monitoring report."
Paul Comings
Name (Print name)
Controller
1" 1nt title
2(fc:�
(Signature) Datu)
S W U-245-1 10408
Paac I of'2

DID THIS FACILITY PERFORM VEHICLE MAIN"I'ENANCE ACTIVIES USING, MORE THAN 55 GALLONS OF NEW NIOTOR OIL PER A7ONTH, ON
AVERAGE, IN I'll I? CALENDAR YEAR?
❑ Yes e*No (If ycs, complete fart I3)
Part B: Vehicle Maintenance Activity NIonitoring Requirements
Oulfall
No.
Date
San►plc Collected,
mo/dd/yr
00400
00556
00530
'Total Rainfall,
inches
New Motor Oil Usage,
Annual average gal/nio
pH,
Standard units
Oil and Crease,
mg/l,
"Total Suspended Solids,
rng/L
Benchmark"
6.0 — 9.0
30
100
of
aL
75
-;(eo AIA
-
<S.
i
~/CoAr
d":�
krrJ
*Note: If you report a value in excess of the benchmark value, or outside the benchmark range (for pH), you must implenuut "Tier I or Tier 2 responses in the General Permit.
Mail original and one copy to:
Division of Watcr Quality
Attn: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
YOU MUST SIGN THIS CFRTl-FICA"l'lON FOR ANY INFORMATION REPORTED IN PARTS A AND/OR B:
"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
possibili�of fines and imprisonment for knowing violations."
(Signature of I'ermittee)
,//"Z,!-
(Date
S W U-245-110408
Page 2 of 2

STORM WATE R DISCHARGE OUTFALI, (SDO)
NIO,NITORING REPORT
GENERAL PERMITNO. NCG210000 SAMPLES COLLECTED DURING CALENDAR YEAR: 7
CERTIFICATE OF COVERAGF. NO. NCG21FqM1911T (`['his monitoring report is due at the Division no later than 30 days from
the date the facility receives the sampling results from the laboratory.)
FACILITY NAME Godfrey Lumber Company Inc. COUNTY Iredell
PERSON COLLECTING SAMPLES Paul Comings PHONE NO. ( 704 ) 872-6366
CERTIFIED LABORATORY Statesville Analytical Lab # 440
Lab # PLEASE SIGN ON THE REVERSE 4
Part A: Specific Monitoring, Requirements'
Outfall
No.
Date
Sample Collected,
ntolild/ r
Total Rainfall,
inches
00530
00400
00340
Total Suspended Solids,
m I,
pH,
Standard units
Chemical Oxygen Demand (COD),
m L
Benchmark"
-
-
100
Within 6,0 — 9.0
120
0
ro `'� r5
, -7_
�--
�-
--
`iJ o-
"r
d / p F
JC.Li
*,Note: If a value is in excess of the benchmark, or outside the benchmark range (for pH), you must implement the "Pier I or "Pier 2 responses in thc: General Permit.
Monitoring is required only if the facility stores exposed piles of sawdust, wood chips, hark, mulch, or other similar material on site for longer than seven (7) days
A facility that sloes not retain exposed (either exposed to incident precipitation or exposed to stormwatcr run on) piles of sawdust, wood chips, bark, mulch, or other similar material on
site for more than seven (7) clays before removing the material is not required to monitor for [lie parameters in Table I of the General Permit. If at any time the material is not removed
within this time frante, the facility must begin analytical monitoring immediately. (Reminder: Ais condition does nor exempi any facility from qualitative monitoring ofSDOs.)
If the facility removes such materials within seven days to meet the monitoring exemption, the Permittee shall record and maintain in the facility's SI'PP a log which documents, at a
minimum, the dates when material is generated and removed, how removed, and by whom. The log must be sufficient to establish that no materials were exposed for longer than seven
days. For record -keeping purposes, the Pcrmittce may also maintain in the SPPP this form with the signed certification below:
"Based upon my inquiry of the person or persons directly responsible for managing compliance with the permit requirement for ana€-ytical monitoring. 1 certify that to the
best of my knowledge and belief; no piles of sawdust, wood chips, bark, mulch or other similar materials were stored exposed (either to incident precipitation or to
stormwater run on) for longer than seven (7) days before removal since filing the last discharge monitoring report."
Paul Comings
Name (Print name)
Controller
"1'i t tt title
(Signature) (1] tc)
S W U-245-1 10408
Page 1 of 2

DID THIS FACILITY PERFORM VEHICLE? :MAINTENANCE ACTIVIES USING MORE THAN 55 GALLONS OF NEW NIO'TOR OIIJ PER ,MONTH, ON
AVERAGE, IN THE CALENDAR YEAR?
❑ -Yes [4�'o (If yes, complete fart B)
Part B: Vehicle Maintenance Activity Monitoring Requirements
Outfall
No.
Date
Sample Collected,
mo/dd/vr
00400
00556
00530
'Total Rainfall,
inches
New Nlotor Oil Usage,
Annual average gallmo
pH,
Standard units
Oil and Grease,
mg/L
Total Suspended Solids,
rng/L
Benchmark's
-
-
-
6.0 — 9.0
30
100
/G� ^7 / 7
,
—
O
7
AotI4
*Note: If ,you report a value in excess of the benchmark value, or outside the benchmark range (for pH), you roust iniplement 'Tier 1 or `Pier 2 responses in the General Pcrmit.
Mail original and one copy to:
Division of Water Quality
Attn: Central Files
1617 Nlail Service Center
Raleigh, North Carolina 27699-1617
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED IN PARTS A AND/OR B:
"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) (Date)
S W U-245-110408
Page 2 of 2

Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Forguidance on filling out this form, please visit: httt):/lh2o.enr.state.nc.us/sulFornts Docuntetits. htm#niiscfornts
Permit No.: N/C/ 2/ 1 / 0 / 0 / 0/ 0l�l or Certificate of Coverage No.: \/C/G/ 2/ 1 / 0/ 4/ 0/ 6/
Facility Name: Godfrey Lumber Company Inc.
County: Iredell phone No. [phone]
Inspector: Paul Comings
Date of lnspcction: /_5
'rime of Inspectiom %C% r t�_ r✓t
f(
Total Event Precipitation (inches):
Was this a Representative Storm Event? (See information below) EKes ❑ No
Please check your• permit to verify if Qualitative Monitoring must be perfortned during a representative
stone event (requirements vary).
A "Representative Storm Event" is a storm event that measures greater than 0. l 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 signature, I certify that this report is actcomplete to the best of my knowledge:
(Signature of Permitter or Designee)
1. Outfull Description: /L7k
outfall No. — 1 Structure (pipe, ditch, etc.)
Receiving Stream: Third Creek
Describe the industrial activities that occur within the outfall drainage area:
Kiln Drying Lumber/Chipmill
2. Color: Describe the color of the discharge u<
(light, medium, dark) as descriptors:
colors (red, brown, blue, etc.) and tint
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil, weak
chlorine odor, etc.): f%j ' -q—
Page 1 of 2
SWU-242-1 QW8

4. Clarity: Choose the number which best describes the clarity of the discharge, where I is clear
and 5 is very cloudy:
1 � 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:
I 2 3 04S,/
eG �zs
G. 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:
1 0 3 4 5
7. Is there any foam in the stormwater discharge? Yes o
S. Is there an oil sheen in the stormwater discharge? Yes l�o
9. Is there evidence of erosion or deposition at the outfall? Yes No
10. Other Obvious Indicators of Stormwater Pollution:
I.,ist and describe
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition may be
indicative of pollutant exhosurc. These conditions warrant further investigation.
Page 2 of 2
SNVU-242-112608

may.
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For -guidance on filling ow this form, please visit: hit .//h2o.enr.state.nc.us/su/Forms Docaruents.htm#miscforms
Permit No.: N/C/ 2/ 1 / 0 / 0/ 0/ 0/—/ or Certificate of Coverage No.: \/C/G/ 2/ 1 / 0/ 4/ 0/ 6/
Facility Name: Godfrey Lumber Company Inc.
County: _
Inspector:
Iredell Phone No. [phone]
Paul Comings
Date of Inspection:
Time of Inspection:
r/
Totai Event Precipitation (inches): I j
Was this a Representative Storm Event? (See information below) 2//Y es ❑ No
Please check yoarr permit io verify if'Qualitative Moniloring must be performed during a representative
storm event (requirements va)-y).
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 signature, I-.Q-cI ify that this report is accu c� complete to the best of my knowledge:
d
(Signature of 1'ermittee or Designee)
1. Outfall escription:
Outfall No. Structure (pipe, ditch, etc.)
Receiving Strcam: Third Creek
aUCh -
Describe the industrial activities that occur within the outfall drainage area:
Kiln Drying LumberlChipmill
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: _� — A- ,L, �%U't. &,
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil, weak
chlorine odor, etc.): fe
Page 1 of 2
SWG-242-112608

4. Clarity: Choose the number which best describes the clarity of the discharge. where 1 is clear
and 5 is very cloudy:
L"'�' 2 3 4 5
5. Floating Solids: Choose the number which best describes the aniount 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
6. Suspended Solids: Choose the number which best describes the amount of suspended solids in
the stormwater discharge, where l isis--��no solids and 5 is extremely muddy:
0 2 3 4 5
7. Is there any foam in the stormwater discharge? Yes 'o
8. Is there an oil sheen in the stormwater discharge? Yes CNI
9. Is there evidence of erosion or deposition at the outfall? Yes ct,
10. Other Obvious Indicators of Stormwater Pollution:
List and describe
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erasion/deposition may be
indicative of pollutant exposure. 'These conditions warrant further investigation.
Page 2 of 2
swti-242-112608

3
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance on filling ow rhi.s form, please visit: htti):9112o.enr.Stale.nc.res/su/Forms DOcrlrl]erlts.htrtl#ntisefornis
Permit No.: N/C/ 2/ 1 / 0 / 0 / 0l 0l l
Facility Name: Godfrey Lumber Comp
County: Iredell
Inspector: Paul Comings
Date of Inspection: fC��
'rime of Inspection: IO , . 3c) rA +�
or Certificate of Coverage No.: N/C/GI 21 11 01 4/ 0l 6/
inv Inc.
'rota] Event Precipitation (inches): /I - S
Phone No [phone]
Was this a Representative Storm ]:vent? (See information below) Yes ❑ No
Please check your permit to verify if Qualitative Monitoring must he 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 signature, I certify that this.fcport is accurate and complete to the best of my knowledge:
(Signature of Permittee or Designee)
i. Outfall scription:
Outfall N. 1 Structure (pipe, ditch, etc.) Y1
Receiving Stream: Third Creek
Describe the industrial activities that occur within the outfall drainage area:
Kiln Drying Lumber/Chipmill
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(tight, medium, dark) as descriptors:
2nEi -
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil, weak
chlorine odor, etc.): n 1cp C-- _.
Page 1 of 2
SWt1-242-112608

t
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is clear
and 5 is very cloudy:
a 2 3 4 5
S. Floating Solids: Choose the number which best describes the amount of floating solids in the
stormwater disclarge, where I is no solids and 5 is the surface covered with floating solids: r j
1 2 3 4
Ves
6. Suspended Solids: Choose the number which best describes the amount of suspended solids in
the stormwater discharge. where l isis01-
nnoosolids and 5 is extremely muddy:
2 3 4 5
7. is there any foam in the stormwater discharge? Yes No
8. Is there an aril sheen in the stormwater discharge? Yes CINO)
9. Is there evidence of erosion or deposition at the outfall? Yes LN oD
10. Other Obvious Indicators of Stormwater Pollution:
List and describe
Note: Low clarity. high solids, and/or the presence of foam, oil sheen, or eras iorddeposition may be
indicative of pollutant exposure. These conditions warrant further investigation.
Page 2 of 2
SWU-242-112608

r� 5 AXZ,,
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance on filling out this form, please visit: http://112o.enl-.st.ite.nC.LIS/Su/FL)riiis Doc uments.htn4mvscforms
Permit No.: NICI 2/ 1 / 0 / 0 / 0/ 0/_/ or Certificate of Coverage No.: N/C/G/ 211/ 0/ 4/ 0/ 61
mm
Facility Name: Godfrey Luber Copany Inc.
County: Iredell phone No. [phone]
Inspector-: Paul Comings
Date of Inspection: i0 az
Time of Inspection:
Total Event Precipitation (inches): I �
Was this a Representative Storm Event? (See information below) Yes ❑ No
Please check your permit to verify rf Qualitative Monitoring must be petforined during a representative
storm event (requirements vary).
A "Representative Storm Event" is a storm event that treasures greater than 0.1 inches of rainfall and that
is preceded by at least 72 hours (3 days) in which no storm event treasuring greater than 0.1 inches has
occurred. A single storm event may contain up to 10 consecutive hours of no precipitation.
By this signature. I certify that
this report is accurate and complete to the best of my knowledge:
(Signature of Permiltce or Designee)
1. Outfall D cription: _
Otttfall I Structure t (pipe, ditch, etc.)
Receiving Stream: Third Creek
Describe the industrial activities that occur within the outfall drainage area:
Kiln Drying Lumber/Chipmill
2. Color: Describe the color of the disch
(light, medium, dark) as descriptors:
is colors (red, brown, blue, etc.) and tint
3. Odor: Describe any distinct odors that the discharge may have (i.e.. smells strongly of oil, weak
chlorine odor, etc.):
Page 1 of 2
Styli-242-112608

q
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is clear
and 5 is very cloudy: ��
l / 2j 3 4 5
5. Floating; Solids: Choose the number which best describes the amount of floating solids in the
stormwater discharge, where 1 is no solids and 5 is the surface covered with floating solids:
1 2 3 � 5
6. Suspended Solids: Choose the number which best describes the amount of suspended solids in
the stormwatcr discharge, where I is no solids and 5 is extremely muddy:
1 2 3 4 5
7. Is there any foam in the stormwatcr discharge`? Yes \,o
8. Is there an oil sheen in the stormwater discharge? Yes No
9. Is there evidence of erosion or deposition at the outfall? Yes CN�"
10. Other Obvious Indicators of Slormwater Pollution:
List and describe
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition may be
indicative of pollutant exposure. These conditions warrant further investigation.
Page 2 of 2
S WU-242-112608

Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
,For guidance on filling out dais fonn, please visit: littu://li2o,enr.state.nc.uslsu/I'ornts DOCLl117ellis.htln#niisefoa'nis
Permit No.: \/C/ 2/ 1 / 0 / 0 / 0/ 0/_1 or Certificate of Coverage No.: N/C/G/ 21 1 / 0/ 4l 0 / 6 /
Facility Name: Godfrey Lumber Company Inc.
County: Iredell Phone No. [phone]
Inspector: Paul Comings
Date of Inspection: Z0 i7r_/c� _
Time of Inspection: %G --
Total Event Precipitation (inches): li /S Irr
Was this a Representative Storm Event? (See information below) , zy'-es ❑ No
Please check votat• permit to verify If Qualitative Monitoring Hurst be petfrlrarted 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 signature, I certify that this report is accurate and e to the best of my knowledge:
(Signature of Pernuttee or Designee)
1. Outfall ascription: �
Outfall No. i �,-6� Structure (pipe, ditch, etc.)
Receiving Stream: . Third Creek
Describe the industrial activities that occur within the outfall drainage area:
Kiln Drying LumberlChipmill
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, t-nedium, dark) as descriptors:
v
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil, weak
chlorine odor, etc.):
Page I of 2
PA" i-242-112608

4. Clarity; Choose the number which best describes the clarity of the discharge, where 1 is clear
and 5 is very cloudy: %%�� �
1 J 2 3 4 5
5. Floating Solids: Choose the number which best describes the amount of flowing solids in the
stormwatcr discharge. where 1 is no solids and 5 is the surface covered with floating solids:
1 2 3 4 5
0
6. Suspended Solids: Choose the number which best describes the amount of suspended solids in
the stormwatcr dischargc, where I is no solids and 5 is extremely muddy:
1� 2 3 4 S
7. Is there any foam in the stormwatcr discharge? Yes DINO
8. Is there an oil sheen in the stormwater discharge? Yes oNo
9. Is there evidence of erosion or deposition at the outfall? Yes bNo
10. Other Obvious Indicators of Stormwater Pollution:
List and describe
r
Note: Low clarity, high solids. and/or the presence of foam, oil sheen, or erosion/deposition may be
indicative of pollutant exposure. These conditions warrant further investigation.
Page 2 of 2
SWU-242-t 12608

f�
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance on filling out this form, please visit: httn:/Ih2o.enr,Staie,llc.us/su/Forms DOCLrnlenls.htnl#Iuiscfornis
Permit No.: N-/C/ 2/ 1 / 0 / 0 / 0/ 0/_/ or Certificate of Coverage No.: N/C/G/ 21 � 1 01 `ll 0l 61
Facility Name: Godfrey Lumber Company Inc.
County: Iredell Phone No. [phone]
Inspector: Paul Comings
Date of Inspection:
Time of Inspection: C7
''`/I
Total Event Precipitation (inches): �
Was this a Representative Storm Event? (See information below) Yes ❑ No
Please check your permit to verify if Qualitative Monitoring mum be performed during a representative
storm event (requirements vary),
........................._.- -.-------.--_-.--.. _..---- --- ___
A "Representative Storm Event" is a storm event that treasures greater than 0.1 inches of rainfall and that
is preceded by at least 72 hours Q 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 signature. I certify that this report is accurate ark-e Ieete to the best of my knowledge:
(Signature of Pcrmittce orDcsignec)
I. Outfall�D+escription:
Outfail No. ( - Structure (pipe, ditch, etc.)
Receiving Stream: Third Creek
Describe the industrial activities that occur within the outfall drainage area:
Kiln Drying Lumber/Chipmill
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors:
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil, weak
chlorine odor, etc.):
Page 1 of 2
MVU-242-112608

Q
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is clear
and 5 is very cloudy: �,:)
(: 2 3 4 5
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 floa
t
i
ngsolids:
U
1 2 3 4 a
G. 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:
cl-�
2 3 4 5
7. Is there any foam in the stormwater discharge? Yes CIO
S. Is there an oil sheen in the stormwater discharge? Yes No
1
9. Is there evidence of erosion or deposition at the outfall? Yes iAo
10. Other Obvious Indicators of Stormwater Pollution:
List and describe
Note: Low clarity, high solids, and/or the presence of foam. oil sheen. or erosion/deposition maybe
indicative of pollutant exposure. These conditions warrant further investigation.
Page 2 of 2
SW[J 242-112608

Analytical Results
Godfrey Lumber. Company
PO Box 615
Statesville, NC 28687
Receive Date: 10/27/2015
Reported: 11 /06/2015
For: Stormwater
Comments:
Sample Number
Parameter
Sample ID
Result
Unit
Method
Analyzed
Analyst
151027-14-01
Chemical Oxygen
OF1
46
mg/L
HACH8000
10/29/2015
CL
Demand
151027-14-01
Oil and Grease
OF1
<5.8
mg/L
EPA1664RevB
11/04/2015
MD
151027-14-01
TSS
OF1
185
mg/L
SM254OD-1997
10/28/2015
WL
151027-14-02
Chemical Oxygen
OF4
25
mg/L
HACH8000
10/29/2015
CL
Demand
151027-14-02
Oil and Grease
OF4
<5.8
mg/L
EPA1664RevB
11/04/2015
MD
151027-14-02
TSS
OF4
346.8
mg/L
SM254OD-1997
10/28/2015
WL
Respectfully
subm itted,
axwo,
jyht -)
Dena Myers
NC Cert #440,
NCDW Cert #37755,
EPA #NC00909
PO Box 228 • Statesville, NC 28687 • 704/872/4697
Page 1 of 2

_, Condition of Receipt
Temp on
Sample Number 151027-14-01 Arrival: 3
Parameter Schedule: Oil and Grease
Hydrochloric Acid Received on Ice
Chemicals in containers, lab
Parameter Schedule: TSS
Received on Ice
Parameter Schedule: Chemical Oxygen Demand
Sulfuric Acid Received on Ice
Chemicals in containers, lab
Temp on
Sample Number 151027-14-02 Arrival: 3
Parameter Schedule: Oil and Grease
Hydrochloric Acid Received on Ice
Chemicals in containers, lab
Parameter Schedule: TSS
Received on Ice
Parameter Schedule: Chemical Oxygen Demand
Sulfuric Acid Received on Ice
Chemicals in containers, lab
PO Box 228 • Statesville, NC 28687 • 704/872/4697
Page 2of2

n I r
Client:
STATESVILLEANALYTICAL.
122 Court Street P.O. Box 228
Statesviiie, NC 28697+
(704}8724697
Address: f� _
x ~% 15
�5 ✓ t!r ( (� PVC_ 01.���
Phone # FAX#
Contact Person:PC, CO
Chain of
Custody Record
PO # V Requisitioned by: Rime AD���
,Customer
Sample ID#
Lab ID #
Time Sampled
(Grab Only)
Date Sampled
(Grab Only)
D
s
a
E
U
Matrix
'F.
Parameters requested for analysis
Sludge
w
ww
=ff,f� 1 i
510�� -f
-01
/cos3o�
� 7/•s
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(J C C;
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f 4 .
laua-7-14109
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Relinquished by:
_ Time
am, pm Date
Sampled by: '
Received by:�
A JTime I am; p fJ Date /� 1S
Transported by:
.�
----
Relinquished by:
Time
am, pm Date
Holding times met:
Received by:
Time
am, pm Date _/�T
Compliance work:
Composite Sampling #1:
Time begin am, pm Date _l�l�
Non-compliance work:
Time end am, pm Date/ IT
Lab Comments:.
Composite Sampling #2:
Time begin am, pm Date
Time end am, pm Date

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
GENERAL PERMIT NO. NCG210000
CERTIFICATE OF COVERAGE NO. NCG21®©b0®
FACILITY NAME
PERSON COLLECTING SAMP)L 'S
CER'I'IFIEDLABORATORY,,%4e!si,,-IIC
Lab #
Part A: Specific Monitoring Requirements'
SAMPLES COLLECTED DURING CALENDAR YEAR:
(This monitoring report is due at the Division no later than 30 days from
the date the facility receives the sampling results from the laboratory.)
R���COIiTY �f�ctCZL(
PI�E NO. (,—A:-4L) —Ca
AUG 2 7 2014PLF:ASE SIGN ON'rHE REVERSE 4
CENTRAL FILES
Outfall;j,; :
No.
, Date '
Sample Collected,
mo/ddl r.
Total Rainfall;
inches
00530
JVVU1 i00400
00340
Total Suspended Solids,
_ m
'PH,
Standard units
ChemicaLOxygenDemand {COD},
m
Benchmark*_
100
Within 6:0 - 9.0
120
1
Y
:%
a
n
e
`Note: If a value is in excess of the benchmark, or outside the benchmark range (for pH), you must implement the `Fier I or Tier 2 responses in the General Permit.
'Monitoring is required only if the facility stores exposed piles of sawdust, wood chips, bark, mulch, or other similar material on site for longer than seven (7) days.
A facility that does not retain exposed (either exposed to incident precipitation or exposed to stormwater run on) piles of sawdust, wood chips, bark, mulch, or other similar material on
site for more than seven (7) days before removing the material is not required to monitor for the parameters in Table 1 of the General Permit. If at any time the material is not removed
within this time frame, the facility must begin analytical monitoring immediately. (Reininder: This condition does not exempt airy facility from qualitative nronitor•ing of SDOs.)
If the facility removes such materials within seven days to meet the monitoring exemption, the Permittee shall record and maintain in the facility's SPPP a log which documents, at a
minimum, the dates when material is generated and removed, how removed, and by whom. The log must be sufficient to establish that no materials were exposed for longer than seven
days. For record -keeping purposes, the Permittee may also maintain in the SPPP this form with the signed certification below:
"Based upon my inquiry of the person or persons directly responsible for managing compliance with the permit requirement for analytical monitoring, I certify that to the
best of my knowledge and belief, no piles of sawdust, wood chips, bark, mulch or other similar materials were stored exposed (either to incident precipitation or to
stormwater run on) for longer than seven (7) days before removal since filing the last discharge monitoring report."
QC,L",� �_ ASS _
Name (Print name)
1" rint title)
(Signature) (Date)
S W U-245-110408
Page /of

DID THIS FACILITY PERFORM VEHICLE MAINTENANCE ACTIVIES USING MORE THAN 55 GALLONS OF NEW MOTOR OIL PER MONTH, ON
AVERAGE, IN THE CALENDAR YEAR?
❑ Yes 2 o (If yes, complete Part B)
Part B: Vehicle Maintenance Activity Monitoring Requirements
Outfall
No..
Date
Sample Collected,
mo/ddlyr
-
00400
00556
00530
Total Rainfall,
inches
New Motor Oil Usage;
Annual average aUmo
pH,
Standard units
Oil and Grease,
mglL
Total Suspended Solids,
mg/L
Benchmark* .
-
-
6.0 - 9.0
30
too
1
! ILI
Al 14
S.
C-?q1
i `5
a
*Note: If you report a value in excess of the benchmark value, or outside the benchmark range (for pH), you must implement Tier I or Tier 2 responses in the General Permit.
Mail original and one copy to:
Division of Water Quality
Attn: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED IN PARTS A AND/OR li:
"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)
(Date
S W U-245-110408
Page 2 of

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
GENERAL PERMIT NO. NCG210000
CERTIFICATE OF COVERAGE, NO. NCG2I®R©®
FACILITY NAME er
PERSON COLLECTING SAM
CERTIFIED LABORATOR �' tb #
b #
Part A: Specific Monitoring Requirements'
SAMPLES COLLECTED DURING CALENDAR YEAR:
(This monitoring report is due at the Division no later than 30 days from
the date the facility receives the sampling results from the laboratory.)
COUNTY -ram
PHONE NO. �'
PLEASE, SIGN ON TILE REVERSE.. �
Out falL,
,No.,Sample
Date
Collected,
, mo/ddl r,
--
i :Total Rainfall,: y
inches_ s
00530
00400
_ 00340. -
Total Suspended Solids,
pH; C
Chemical Oxygen Deinand (COD),
Ienchmark*
-
r
10U
Within,6:0 — 9A'.'
120 t,
*Note: 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.
'Monitoring is required only if the facility stores exposed piles of sawdust, wood chips, bark, mulch, or other similar material on site for longer than seven (7) days.
A facility that does not retain exposed (either exposed to incident precipitation or exposed to stormwater run on) piles of sawdust, wood chips, bark, mulch, or other similar material on
site for more than seven (7) days before removing the material is not required to monitor for the parameters in Table I of the General Permit. If at any time the material is not removed
within this time frame, the facility must begin analytical monitoring immediately. (Reminder: This condirion does not exempt arty facilityfrom qualiultive monitoring of SDOs.)
if the facility removes such materials within seven days to meet the monitoring exemption, the Permittee shall record and maintain in the facility's SPPP a log which documents, at a
minimum, the dates when material is generated and removed, how removed, and by whom. The log must be sufficient to establish that no materials were exposed for longer than seven
days. For record -keeping purposes, the Permittee may also maintain in the SPPP this form with the signed certification below:
"Based upon my inquiry of the person or persons directly responsible for managing compliance with the permit requirement for analytical monitoring, I certify that to the
best of my knowledge and belief, no piles of sawdust, wood chips, bark, mulch or other similar materials were stored exposed (either to incident precipitation or to
stormwater run on) for longer than seven (7) days befor emoval since filing the last discharge monitoring report."
Name (Print name)
LLX�6
T' (Print tit )
r
(Signature) Date)
S W U-245-1 10408
Pag3 ofq

DID THIS FACILITY PERFORM VEHICLE MAINTENANCE ACTIVIES USING MORE THAN 55 GALLONS OF NEW MOTOR OIL PER MONTH, ON
AVERAGE�IN,
IN THE CALENDAR YEAR?
❑ Yes (If yes, complete Part B)
Part B: Vehicle Maintenance Activity Monitoring Requirements
'Outfall:
_No
Date
Same 1c Collected
P
F nmoldil/yr,
x
f_:_.
''r00A00" ';'
'r= 0U556 ,
00530 };r,..;-.
Total RainfallY
"
1':�nche5 ..
New Motor Oil Usa e ,
'Anoual'ayerage gaUmo_
a H
?:Staard nit ndus
Oil acid Grease `
Total'S►is etzded';Sohds
P .
6.0 — 9 0 _
'30,
-100�
5A
I
►'
,v
�.
1tC.�
�n
*Note: If you report a value in excess of the benchmark value, or outside the benchmark range (for pH), you must implement Tier I or Tier 2 responses in the General Permit.
Mail original and one copy to:
Division of Water Quality
Attn: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
YOU NIUST SIGN THIS Cl?R`I'IFICATION FOR ANY INFORMATION REPORTED IN PARTS A ANIXOR B:
"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."
kaignature m r-errnnLee)
f
(D te)
S W U-245-,110408
Pag# of q

Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance on filling out this firm, please visit: httn://112o.enr.stale,nc.uslsu/Forms Doctunents.htrv#miseforms
Permit No.: NU94
Facility Name:
County:
Inspector:
Date of Inspection: _
Time of Inspection:
I0/_l or Certificate of Coverage No.- NICIGIcIII ID 1411UIO
T/
Total Event Precipitation (inches): A f
ne No.
Was this a Representative Storm Event? (See information below) 12 Yes ❑ No
Please check your pertnh io verify if Qualitative Monitoring must be petfor►ned 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 signature, I certify that this report is acSjurate and complete to the best of my knowledge:
(Signature of Permittcc or Designee)
1. Outfall Description: �,%_
Outfall No. J Structure ipe, ditch, etc.) _ n /! C.I —A
Receiving Stream: _.- ! AgE i! fato T
Describe the industrial activities. that occur Within the outfall drainage area:
2. Color: Describe the color of thedi�slcharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: a 1�� r_e w�Geel 1�, r--�%
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil, weak
chlorine odor, etc.): Gr)
Page t of 2
SWl1-242-11260$

4. Clarity: Choose the number which best describes the clarity of the discharge, where I is clear
and 5 is very cloudy:
1 2 3 5
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 03 4 5
6. Suspended Solids: Choose the number which best describes the amount of suspended solids in
the stormwater discharge, where 1 is no solids and 5 ii--''s extremely muddy:
1 2 ( 3) 4 5
7. Is there any foam in the stormwater discharge? Yes No
8. Is there an oil sheen in the stormwater discharge? Yes oNo
9. Is there evidence of erosion or deposition at the outfall? Yes oNo
10. Other Obvious Indicators of Stormwater Pollution:
List and describe
Note: Low clarity. high solids, and/or the presence of foam, oil sheen, or erosion/deposition may be
indicative of pollutant exposure. These conditions warrant further investigation.
Page 2 of 2
SWU-242-11260E

Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance on filling out this form, please visit: http://h2o,enr.st ite.11c.us/su/1-orrns DOCumenCS.htm#miscforms
Permit No.: ITT/CI(// /
Facility Name -
County: rP
Inspector:
Date of Inspection:
Time of Inspection:
/01011 or Certificate of Coverage No.: NICIGI�21Lldly /olr l
'Iota] Event Precipitation (inches): / ./i
r
Phone No.
Was this a Representative Storm Event? (See information below)
10/y, es ❑ No
Please check your perntit to verify if Qualitative Monitoring must be perfortned 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 thir�aturc, I certify that this report
(Signature of Permittee or Designee)
1. OutfaIl Description:
Outfall No. S
Receiving Stream: i r
Describe the 'ndustria acttvtt s
omplctc to the best of my knowledge:
(pipe, ditch, etc.)��}
occur within the outfall drainage area:
2. Color: Describe the color of the
(light, medium, dark) as descriptors: _ __
using basic c9ors (red, brown, blue, etc.) and tint
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil, weak
chlorine odor, etc.):
Page 1 of 2
SWU-242-112608

4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is clear
and 5 is very cloudy:
1 2 3 4 5
5. Floating Solids: Choose the number which best describes the amount of floating solids in the
stormwatcr discharge, where 1 is no solids and 5 is the surface covered with floating solids:
l 2 3 l../ 5
6. Suspended Solids: Choose the number which best describes the amount of suspended solids in
the stormwatcr discharge, where I is no solids and 5 is extremely muddy-
1 2 (:3:)/ 4 5
7. Is there any foam in the stormwatcr discharge`?
8. Is there an oil sheen in the stormwatcr discharge?
9. Is there evidence of erosion or deposition at the outfall?
10. Other Obvious Indicators of Stormwater Pollution:
List and describe
Yes 1\TO
Yes No
Yes
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition may be
indicative of pollutant exposure. These conditions warrant further investigation.
Pagc 2 of 2
S W U-242- l 12608

o,a STArr a
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
f'or guidance on frlling out lhis form, please visit: httP://h2o.ei r.state.nc.tis/su/Forms Docuitients.htm#n-iscforins
Permit No.! ITT/C/, `Rl f 1 al v
Facility Name:
County: �r
Inspector:
Date of Inspection: V/ l�/� _
Time of Inspection: V4bemiswy 7:—XDg_-^,
- tl
Total Event Precipitation (inches): f
Was this a Representative Storm Event? (See information below) Yes ❑ No
Please check your permit to verify 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 signature, I certify that this report is c and complete to the best of my knowledge:
(Signature of Permittee or Designee)
1. Outfall Description:
Outfall No. -3 _.___ _ Stru
Receiving Stream: r1ird
Describe the industrial activities th
2. Color: Describe the color of the
(light, medium, dark) as descriptors:
3. Oder: Describe any distinct
chlorine odor, etc.): /"10
pc, ditch. etc.) 7�
within the gutfall drainage area:
using basic colors (red, brown, blue, etc.) and tint
that the discharge may have (i.e., smells strongly of oil, weak
Page 1 of 2
S W U-242-112608

4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is clear
and 5 is very cloudy:
l 2 3 4
5. Floating Solids: Choose the number which best describes the amount of floating solids in the
stormwater discharge, where 1 is no solids and 5 is the surface covered with floating solids:
1 2 4 5
G. Suspended Solids: Choose the number which best describes the amount of suspended solids in
the stormwater discharge, where 1 is no solids and 5 is extremely muddy:
ud
1 2 3 4 (5 )
7. Is there any foam in the stormwater discharge? Yes No
S. Is there an oil sheen in the stormwater discharge? Yes No
9. Is there evidence of erosion or deposition at the outfall? Yes No
14. Other Obvious Indicators of Stormwater Pollution:
List and describe
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition may be
indicative of pollutant exposure. These conditions warrant further investigation.
Page 2 of 2
SWU-242-112608

STATE a
J'
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance on filling our this form, please visit: litti)://h2o.enr,stateatc,us/su/Forms Doe unients.hun#ntisefornts
Permit No.: \LO& I 1 o
Facility Name:
Countv:
Inspector: el.�
Date of Inspection:
Time of Inspection:
Total Event Precipitation (inches): 4 / it
Was this a Representative Storm Event? (See information below) 2' 'Yes ❑ No
Please check your permit to verify if Qralitalive Monitoring must be petfornied daring 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 signature, I certify that this report is
(Signature of Permittcc or Designee)
complete to the best of my knowledge:
1. Outfall D scri ption:
Outfall No. Structure (pipe, ditch, etc.)
Receiving Stream: a rZJ2-
Describe the industrial activities thayocrur within the outfall drainage area:
2. Color: Describe the color of the
(light, medium, dark) as descriptors:
using basic colors (red, brown, blue, etc.) and tint
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil, weak
chlorine odor, etc.): A-kn e-
Pagc 1 of 2
SWU-242-112608

4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is clear
and 5 is very cloudy:
1 2 3 � 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 Boating solids:
1 2 C) 4 5
6. Suspended Solids: Choose the number which best describes the amount of suspended solids in
the stormwatcr discharge, where I is no solids and 5 is extremely muddy:
in
3 4 5
7. Is there any foam in the stormwater discharge? Yes l�o
S. Is there an oil sheen in the stormwater discharge? Yes No
9. Is there evidence of erosion or deposition at the outfall? Yes No
10. Other Obvious Indicators of Stormwater Pollution:
List and describe
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition may be
indicative of pollutant exposure. These conditions warrant further investigation.
Page 2 of 2
SWU-242-112608

Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance on filling out this form, please visit: htt ://h2o.ear.state.nc.us/su/Forms Doe unietits. htm#miscforms
Permit No.: \'IC I! IGlo/c►Ic71�1 or Certificate of Coverage No.: N/CIG/C>�// lvl1!lv/Cd
Facility Name:
County: Phone No. —
Inspector: cam.
Date of Inspection: Aq
Time of Inspection:
"Total Event Precipitation (inches): / // I /�
Was this a Representative Storm Event? (See information below) Yes ❑ No
Please check your permit to verify if Qualitative Monitoring must be petfonned daring a representative
storm event (requirements varv).
A "Representative Storm Event" is a storm event that measures greater than 0, l 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 signature, 1 certify that this report is accurate and complete to the best of my knowledge:
(Signature of Permittec or Designee)
]. Outfall Description:
Outfall No. -kA _ Struc une
pe, ditch, etc.) t�1 CX1�
Receiving Stream: itP&
Describe the industripl activities that qt`, Lq within the gVtfall drainage area:
2. Color: Describe the color of the discha ge usi basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors:
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil, weak
chlorine odor, etc.):
Page 1 of 2
SWU-242-112608

4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is clear
and 5 is very cloudy:
1 2 � 4 5
5. Floating Solids: Choose the number which best describes the amount of floating solids in the
stormwater discharge, where 1 is no solids and 5 is the surface covered with floating solids:
1 2 3 / 4 ) 5
6. Suspended Solids: Choose the number which best describes the amount of suspended solids in
the stormwater discharge, where I is no solids and 5 is extremely muddy:
1 (22 me ) 3 4 5
7. Is there any foam in the stormwater discharge? Yes No
S. Is there an oil sheen in the stormwater discharge? Yes No
9. Is there evidence of erosion or deposition at the outfall? Yes 1\'0
10. Other Obvious Indicators of Stormwater Pollution:
List and describe
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition may be
indicative of pollutant exposure. These conditions warrant further investigation.
Pagc 2 of 2
SWU-242-11260$

Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance on filling out This form, please visit: ]ittp://h24,).enr.s1ate.nc.us/su/Forms DOCUnlentS.htnl#miseforuis
Permit No.: NICaLIg�>I�I I�J_I or Certificate of Coverage No.: GGkSZII /Q110I%I
Facility Name: r L
County: -r Phone No.
Inspector: i !�
Date of Inspection: f
Time of Inspection: 1v
Total Event Precipitation (inches):
Was this a Representative Storm Event? (See information below) E31 �YeFl No
Please check your permit to verify if Qualitative Monitoring must he performed during a representative
stoma 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 stornl 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,& g aturc, I certify that this report is
(Signature of Pcrmittce or Designee)
1. Outfall Description:
Outfall No.�
Receiving Stream:
Describe the industrial activit
Structure
- 10
complete to the best of my knowledge:
ditch, etc.)
i� l
ies toat occt}r within the outfal) drainage area:
2. Color: Describe the color of the discharge u
(light, medium, dark) as descriptors:
g basic colors (red, brown, blue, etc.) and tint
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil, weak
chlorine odor, etc.): /Vc7ne—
Page 1 of 2
5WU-242-112608

4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is clear
and 5 is very cloudy:
1 2 / 3J 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 6�) le, VeS
6. Suspended Solids: Choose the number which best describes the amount of suspended solids in
the stormwater discharge, where 1 is no solids and 5 is extremely muddy: me
1 / 2 } 3 4 5
7. Is there any foam in the stormwater- discharge? Yes No
S. Is there an oil sheen in the stormwater discharge? Yes No
9. Is there evidence of erosion or deposition at the outfa117 Yes No
10. Other Obvious Indicators of Stormwater Pollution:
List and describe
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition may be
indicative of pollutant exposure. These conditions warrant further investigation.
Page 2 of 2
5wli-242-112608