NCG140015_MONITORING INFO_20180619

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
/v
DOC TYPE
❑HISTORICAL FILE
C� MONITORING REPORTS
DOC DATE
❑ a �� � � � 1 7
YYYYMMDD

Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance on filling out this for7n, please visit. hLL12://12ot tai,nc�glw( ib/wq/ws./�Su/nr)clesswit L;ib-11.
Permit No.: N/C/ G/j_/ q or Certificate of Coverage No.: N/C/G/
Facility Name: IWIye$3 GCE
County: l► i G Phone No. c {
Inspector: 6% SIN
Date of Inspection: � `-29 - IF
Time of Inspection:..,,, 1 L : W A n1l _ JUN 1 8
Total Event Precipitation (inches): - 9S CENTRAL FILES
DWR SECTION
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by file permit?
(See information below.]
ER"Y"es ❑ No
Please verify whether Qualitative Monitoring must he performed during a "representative storm
event" or "measureable storm event" (requirements vary, depending on the permit).
Qualitative monitoring requirements vary. Most permits require qualitative monitoring to be
performed during a "representative storm event" or during a "measw-eable storm event." However,
some permits do not have this requirement. Please refer to these definitions, if applicable.
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.
A "measurable storm event" is a storm event that results in an actual discharge from the
permitted site outfall. The previous measurable storm event must have, been at least72 hoUr's
prior, The 72-hoUr' Storm interval does not apply if the permittee is able to document that a shorter
interval is representative for local storm events during the sampling period; and the permittee
obtains approval from the local DWQ Regional Office,
By this signature, I certify thatthis report is accurate and complete to the best of my knowledge:
t6re of Permittee or Designee)
Page 1 of 2
SWU-242, last mnutitied 10/25/2012

t
1. Outfall Description:
Outfall No. i Structure (pipe, ditch, etc.) 1��;
Receiving Stream:
Describe the industrial activities that occ i
r 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: M esd L4
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 5 is very cloudy:
1 0 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:
a 2 ` 3 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 is extremely muddy:
1 (D 3 4 5
7. Is there any foam in the stormwater discharge? Yes l)
8. Is there an oil sheen in the stormwater discharge? Yes U
9. Is there evidence of erosion or deposition at the outfall? Yes CN)
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.
SM-242, Last modified 10/25/2012
Page 2 of 2

STORMWATER DISCHARGE OUTFALL (SDO) - Semi -Annual MONITORING FORM
GENERA. PERMIT NO. NCG140000
CERTIFICATE OF COVERAGE NtNCG14 0 v ( .S
FACILITYNAME: Aco, 1 ,rho AAry -w G,{clC C
PERSON COLLECTING SAMPLES ]2 -� ekr- k-e
CERTIFIED LABORATORY 6Nti-, -r4mc_l l Lab # IG�Y
Lab # ^
OPTIONAL INFO:
Part A: Stormwater Monitoring Requirements
SAMPLE COLLECTION YEAR: 0?0 i �/
SAMPLING PERIOD: ❑ July -December l January -June
COUNTY 'W4-i NL
PHONE NO. (2! 1 ?,N -USCG
ADD TO LISTS ERVE7 []YES DICO EMAIL:
DISCHARGING TO CLASS: ❑SA ❑HQW ❑PNA ❑Trout
Ether
Outfall No.
Date Sample
Collected
(mo/dd/yr OR
NO FLOW)t
PH
(Standard
Units)
TSS
(mg/L)
Event
Duration
(minutes)
Total
Rainfall ,
(in)
in Tier 2
Monthly
Monitoring?
(y/n)
# of Months in Tier
2 Samplingz
-
6-92
100
12
J
Y 7 I t
I
! If "NO FLOW" or "NO DISCHARGE, Enter "NO FLOW" or "NO DISCHARGE" for each outfall here. Please make sure to mark the sample period above.
2 If a value is in excess of the benchmark, or outside the benchmark range Ifor pH), you must implement the Tier 1 or Tier 2 responses in the General Permit, Tier 2
Monthly sampling shall be done until 3 consecutive samples are below the benchmark or within the benchmark range.
TS5 benchmark values are 100 mg/I, except when discharging to ORW, HQW, Trout, and PNA waters where they are 50 mg/I.
For each sampled measurable storm event the total precipitation must be recorded using data from an on -site rain gauge.
Permit Date: 7/1/2011-60/30/2015 Date of last pH meter calibration: Last Revised 7/13/11
Page 1 of 2

Part B: Vehicle Maintenance Activity Monitoring Requirements for facilities using > 55 gal of new motor oil/month — averaged over a calendar year.
Outfall
No.
Date Sample
Collected
(mo/dd/yr}'
pH
(standard
Units)
TPH using method
1664A5GT-HEM
(mg/L)
Total Suspended
Solids
(mg/L)
Event
Duration
(minutes)
Total
a
Rainfall
(in)
New Motor Oil
Usage
(gal/month)
In Tier 2
Monthly
Monitoring?
(y/n}
i
# of Months
in Tier 2
z
Sampling
6-9
15
100 '
-
-
-
-
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES AT ANY ONE OUTFALL )INCLUDING VEHICLE MAINTENANCE)? YES ❑ NO ❑
HAVE YOU CONTACTED THE REGION? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail Original and one copy of this DMR (including all "No Flow" & "No Discharee" reports) within 30 days of receipt of sarnale for at end of monitoring oeriod
in case of "No Flow") to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED:
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to
assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or
those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete.
aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
of Permittee}
6 - Z-?-//
(Date)
Permit Date: 7/1/2011-60/30/2015
Last Revised 7/13/11
Page 2 of 2

STORMWATER DISCHARGE OUTFALL (SDO) - Semi -Annual MONITORING FORM
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF COVERAGE( rho. NCG14 D O f S njj� 1 _
FACILITY NAME: /`r��USAdY lY iY60. theldS Pl�tn7 �S
PERSON COLLECTING SAMPLES _7n-� � )4obcr }Sara
CERTIFIED LABORATORY_ GN1f0L0rJ rnw *j— Lab # / b 9? _
Lab #
OPTIONAL INFO:
Part A: Stormwater Monitoring Requirements
141=r-1=AIFD
SAMPLE COLLECTION Y R: 9 01 rl I
SAMPLING PERIOD: July-Decernber ❑ January -June
COUNTY UJ4y 1`4C INFORW
PHONE NO. (qt�
ADD TO LISTSERVE? []YES O EMAIL:
DISCHARGING TO CLASS: ❑SA ❑HQW ❑PNA ❑Trout Other,
Outfall No.
Date Sample
Collected
(mo/dd/yrOR
NO FLOW)t
{Standard
Llnits)
TSS
(mg/L)
Event
Duration
(minutes)
Total
Rainfall°
(m)
In Tier 2
Monthly
Monitoring?
(y/n)
# of Months inTier
2 Sampling
-
-
6-9
100
-
-
-
!
1. a/ 1 7
S, 1
35
y D
. 05
tv
�j
F
1 If "NO FLOW" or "NO DISCHARGE, Enter "NO FLOW" or "NO DISCHARGE" for each outfall here. Please make sure to mark the sample period above.
z It a value is In excess of the benchmark, or outside the benchmark range (for pH), you must implement the Tier 1 or Tier 2 responses in the General Permit. Tier 2
Monthly sampling shall be done until 3 consecutive samples are below the benchmark or within the benchmark range.
3 TSS benchmark values are 100 mg/I, except when discharging to ORW, HQW, Trout, and PNA waters where they are 50 mg/l.
`For each sampled measurable storm event the total precipitation must be recorded using data from an on -site rain gauge.
.IA N 0 9 2018
DWR SECTION
TION PROCESSING UNIT
Permit Date: 7/1/2011-60/30/2015
I Last Revised 7/13/11
Page 1 of 2

Part B., Vehicle Maintenance Activity Monitoring Requirements for facilities using > 55 gal of new motor oil/month — averaged over a calendar year.
Outfall
No.
Date Sample
Collected
(rno/dd/yrj'
pH
(Standard
Units)
TPH using method
3654�4 SGT-HEM
(mg/L)
Total Suspended
Solids
(mg/L)
Event
Duration
(minutes)
Total
,
Rainfall
(in)
New Motor Oil
Usage
(gal/month)
In Tier 2
Monthly
Monitoring?
(y/n)
# of Months
in Tier 2
2
Sampling
6-9
i5
1
-
-
-
- -
i
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES AT ANY ONE OUTFALL (INCLUDING VEHICLE MAINTENANCE)' YES ❑ NO
HAVE YOU CONTACTED THE REGION? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail Original and one copy of this DMR (includine all "No Flow" & "No Discharee" reports) within 30 days of receipt of sample for at end of monitoring period
in case of "No Flow") to:
Division of Water Quallty
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
YOU MUST SIGN THIS CERTIFICA TIO_N FOR ANY INFORMATION REPORTED,
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to
assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or
those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I
C!�reth there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
(ijtdrWof Permittee) (Date)
Permit Date: 7/1/2011-60/30/2015 Last Revised 7/13/11
Page 2 of 2

ElAmmW % hwpo mmud
P.O. BOX 7085, 114 OAKMONT
GREENVILLE, N.C. 27835-7085
READY MIXED CONCRETE (GOLDSBORO)
MR. JEFF ROBERTSON
506 WEST CHESTNUT STREET
GOLDSBORO ,NC 27530
001 Analysis Method
PARAMETERS Discharge Date Analyst Code
PH (not to be used for reporting) 8.1 12/08/17 KMR 4500HB-11
Total Suspended Residue, mg/1 35 12/11/17 MAR 2540D-11
DNE [phone]
FAX [phone]
ID#: 1088
DATE COLLECTED: 12/08/17
DATE REPORTED : 12/12/17
REVIEWED BY:A:::i---

STORMWATER DISCHARGE OUTFALL (SDO) - Semi -Annual MONITORING FORM
GENERAL PERMIT NO. NCG140000 RECEIVED
CERTIFICATE OF COV RAGE NUZNCG14 II
FACILITY NAME: . 1 '40. C_ sic/ nf.,l u
PERSON COLLECTING tAMPLES C S i LV e-4C.
CERTIFIED LABORATORY ✓y Nu Uton Pie.L Lab #
Lab #
OPTIONAL INFO:
Part A: Stormwater Monitoring Requirements
rn� .� JUN I s z�r1
SAMPLE COLLECTION YEAR: c� c� { l
SAMPLING PERIOD: ❑ July -December © nuary-June C'-rRAL FILES
COUNTY _ W � +v L . CWR SECTION
PHONE NO.
ADD TO LISTSERVE? DYES Eallb EMAIL:
DISCHARGING TO CLASS: ❑SA ❑HQW ❑PNA ❑Trout 06ther
Outfall No.
Date Sample
Collected
(mo/dd/yr OR
NO FLOW)
PH '
( d darStan
Units)
TSS
(mg/L)
Event
Duration
(minutes)
Total
Rainfall,
(in)
In Tier 2
Monthly
Monitoring?
{y/n)
# of Months in Tier
2 Samplfngz
-
6-9
100z',
-
-
-
-
CA_) i
�i
1 If "NO FLOW" or "NO DISCHARGE, Enter "NO FLOW" or"NO DISCHARGE" for each outfall here. Please make sure to mark the sample period above.
If a value is in excess of the benchmark, or outside the benchmark range (for PH), you must implement the Tier 1 or Tier 2 responses in the General Permit. Tier 2
Monthly sampling shall be done until 3 consecutive samples are below the benchmark or within the benchmark range.
3 TSS benchmark values are 100 mg/l, except when discharging to ORW, HQW, Trout, and PNA waters where they are 50 mg/l.
For each sampled measurable storm event the total precipitation must be recorded using data from an on -site rain gauge.
Permit bate: 7/1/2011-60/30/2015 Date of last pH nieter calibration: I, Last Revised 7/13/11
Page 1 of 2

Part B= Vehicle Maintenance Activity Monitoring Requirements for facilities using > 55 gat of new motor oil/month — averaged over a calendar year.
Outfall
No.
Date Sample
Collected
(mo/dd/yir)'
pH
(Standard
Units}
TPH using method
1664A SGT-HEM
(mg/L}
Total Suspended
Solids
(mg/L}
Event
Duration
(minutes}
Total
Rainfall°
(in}
New Motor Oil
Usage
(gal/month}
In Tier 2
Monthly
Monitoring?
(y/n)
# of Months
in Tier 2
Z
Sampling
6-91
1s
100
I
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES AT ANY ONE OUTFALL (INCLUDING VEHICLE MAINTENANCE)? YES ❑ NO ❑
HAVE YOU CONTACTED THE REGION? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail Original and one coov of this DMR (includini; all "No Flow" & "No Discharee" reports) within 30 days of receipt of sample for at end of monitorine period
in case of "No Flow") to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
YOU MUST SIGN THIS CERTIFICATION E0 ANY INFORMATION REPORTED:
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to
assure that qualified personnel properly gather and evaluate the information submitted. eased 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
a a are that th ea significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
(Slinat6r of Permittee) I, (Date)
Permit Date: 7/l/2011-60/30/2015
Last Revised 7/13/11
Page 2 of 2

Emwphm(W % jnwpo mUd
� ..,- k � - -• c ,r,, - + '�a-�,- Fly. 4 � _ 7', waeterater.riD 1'0
y4
P.O. BOX 7085, 114 OAKMONT DRIVE PHONE [phone]
GREENVILLE, N.C. 27835-7085 FAX [phone]
ID#: 1088
READY MIXED CONCRETE (GOLDSBORO)
MR. JEFF ROBERTSON
506 WEST CHESTNUT STREET
GOLDSBORO ,NC 27530
PARAMETERS
PH (not to be used for reporting)
Total _Suspended Residue, mg/I
DATE COLLECTED: 05/23/17
DATE REPORTED : 05/25/17
REVIEWED BY:
001 Analysis Method — --
Discharge Date Analyst Code
9.2 05/23/17 KDS 4500HB-00
14 05/24/I7 KKM 2540D-97

STORMWATER DISCHARGE OUTFALL (SDO) - Semi -Annual MONITORING FORM
GENERAL PERMIT NO. NCG140000
i
CERTIFICATE OF COVERAGE No. NCG14 0 O ! S SAMPLE COLLECTION YEA o�U J
FACILITY NAME: A ��Q� K-e/:�rp�4 OAI)r _r'� �_ ifs NC -+cif 71 SAMPLING PERIOD: July=December ❑January -June
PERSON COLLECTING SAMPLES COUNTY
CERTIFIED LABORATORY �r_f't? t,� _[�, _ Lab i# / U� PHONE NO. (E � } '7 3 �(- 11 �� �
Lab # ADD TO LISTSERVE? ❑YES WO EMAIL:
OPTIONAL INFO: DISCHARGING TO CLASS: ❑SA ❑HQW ❑PNA ❑Trout [�t r
Part A: Stormwater Monitoring Requirements
Outfall No.
Date Sample
Collected
(mo/dd/yr OR
NO FLOW)t
PHEvent
{standard
Units}
TSS
(mg/L)
Duration
(minutes)
Total
Rainfall ,
(in)
in Tier 2
Monthly
Monitoring?
(y/n)
# of Months in Tier
2 Sampling?
-
6-91
1002,3
-
-
-
-2 !a6 ! (�
�.
f J�
L4
J
d 1U11
r'C.1TC1ni
+cailco
M
!R SECTION
1 If "NO FLOW" or "NO DISCHARGE, Enter "NO FLOW" or "NO DISCHARGE" for each outfall here. Please make sure to mark the sample period above.
2 If a value is In excess of the benchmark, or outside the benchmark range (for pH), you must implement the Tier 1 or Tier 2 responses in the General Permit, Tier 2
Monthly sampling shall be done until 3 consecutive samples are below the benchmark or within the benchmark range.
3 T5S benchmark values are 100 mg/l, except when discharging to ORW, HQW, Trout, and PNA waters where they are 50 mg/l.
For each sampled measurable storm event the total precipitation must be recorded using data from an on -site rain gauge.
Permit Date: 7/1/2011-60/30/2015 I Last Revised 7/13/11
Page 1 of 2

Part B: Vehicle Maintenance Activity Monitoring Requirements for facilities using > 55 gal of new motor oil/month —averaged over a calendar year.
Outfall
No.
Date Sample
Collected
(mo/dd/yr)'
pH
(Standard
unitsy
TPH using method
1664ASGT-HEM
(mg/L)
Total Suspended
Solids
(mg/L)
Event
Duration
(minutes)
Total
Rainfalla
(in)
New Motor Oil
Usage
(gal/month)
In Tier 2
Monthly
Monitoring?
(y/n)
1# of Months
in Tier 2
Sampling x
6-9
15
100 '
-
-
I
i
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES AT ANY ONE. OUTFALL (INCLUDING VEHICLE MAINTENANCE)? YES ❑ NO ❑
HAVE YOU CONTACTED THE REGION? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail Original and one copy of this DMR f including all "No Flow" & "No Discharge" reports) within 30 days of receipt of sample (or at end of monitoring period
in case of "No Flow") to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
YOU MUST SIGN THJS CERTIFICATION FOR ANY INFORMATION REPORTED:
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to
assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or
those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete
m a are th there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
iiiinaf9e of Permittee) (Date)
Permit Date: 7/1/2011-60/30/201S Last Revised 7/13/11
Page 2 of 2

STORMWATER DISCHARGE OUTFALL (SDO) - Semi -Annual MONITORING FORM
GENERAL PERMIT NO. NCG1'40000
CERTIFICATE OF COVERAGE NO. NCG14 0 0 1 - 5
FACILITY NAME: 2 YYlt1Cc_� Yj Gat C �(� I5
PERSON COLLECTING SAMPLES
CERTIFIED LABORATORY Lab# lc gg T
Lab H
OPTIONAL INFO:
Part A: Stormwater Monitoring Requirements
SAMPLE COLLECTION YEAR: 0D 16
SAMPLINGRERIOD: ❑ July -December Janua
COUNTY W4, t _ _
PHONE NO. (_qLq_)
ADD TO LISTSERVE? ❑YES O EMAIL:
DISCHARGING TO CLASS: ❑SA ❑HQW ❑PNA ❑Trout Cher_
Outfall No.
Date Sample
Collected
(mo/dd/yr OR
NO FLOW)'
PH
(Standard
Units)
TSS
(mg/L)
Event
Duration
(minutes)
Total
,
Rainfall
(in)
In Tier 2
Monthly
Monitoring?
(y/n)
4# of Months in Tier
2 Samplingz
6-92
100.2 3
_
-
1
tab
RECEIVE
ES
' If "NO FLOW" or "NO DISCHARGE, Enter "NO FLOW" or "NO DISCHARGE" for each outfall here. Please make sure to mark the sample period above.
Z If a value is in excess of the benchmark, or outside the benchmark range (for pH), you must implement the Tier 1 or Tier 2 responses in the General Permit. Tier 2
Monthly sampling shall be done until 3 consecutive samples are below the benchmark or within the benchmark range.
3 TSS benchmark values are 100 mg/I, except when discharging to ORW, HQW, Trout, and PNA waters where they are 50 mg/I.
For each sampled measurable storm event the total precipitation must be recorded using data from an on -site rain gauge
Permit Date: 7/1/2011-60/30/2015 Last Revised 7/13/11
Page 1 of 2

Part B: Vehicle Maintenance Activity Monitoring Requirements for facilities using > 55 gal of new motor oil/month — averaged over a calendar year.
F�
Outfall
No.
Date Sample
collected
(mo/dd/yr}1
pH
(Standard
Units)
TPH using method
1664A SGT-HEM
(mg/L)
Total Suspended
Solids
(mg/L)
Event �
Duration
(minutes)
Total
Rainfa114
(in)
New Motor Oil
Usage
(gal/month)
In Tier 2
Monthly
Monitoring?
(y/n�
# of Months
in Tier 2
2
Sampling
6-92
15Z
'100",
-
-
E
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES AT ANY ONE OUTFALL (INCLUDING VEHICLE MAINTENANCE)? YES ❑ NO ❑
HAVE YOU CONTACTED THE REGION? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail Original and one'cdpyof this DMR (including all "No Flow" & "No Discharge" reports) within 30 days of receipt of sample (or at end of monitoring period
in case of "No Flow") to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED:
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to
assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or
those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete
�aaware tha�4here are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
of Permittee}
(Date)
Permit Date: 7/1/2011-60/30/2015 Last Revised 7/13/11
Page 2 of 2

STORMWATER DISCHARGE OUTFALL (SDO) - Semi -Annual MONITORING FORM
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF COVERAGE NO. NCG14 O 0 ( '�;
FACILITY NAME: r`�dS a o� FAi)e_ CA at. i #.s,4 S
PERSON COLLECTING SAMPLES Jfi�rc 1�u�rj�(iSJY"
CERTIFIED LABORATORY �NO`��anncwr i_ Ta,c Lab # 1 OV
Lab #
OPTIONAL INFO:
Part A: Stormwater Monitoring Requirements
SAMPLE COLLECTION YEAR: I�d
SAMPLING PERIOD: H"July-December ❑ January -June
COUNTY C
PHONE NO. (aL�t_) 13 y- W �.F?
ADD TO LISTSERVE? ❑YES O EMAIL:
DISCHARGING TO CLASS: ❑SA ❑HQW ❑PNA ❑Trout ❑+, 0iher
putfall No.
Date Sample
Collected
(mo/dd/yr OR
NO FLOW)t
pH
(Standard
Units)
TSS
(mg/L)
Event
Duration
(minutes)
Total 4
Rainfall
(in)
In Tier 2
Monthly
Monitoring?
(y/n)
# of Months in Tier
2 Sampling2
j
6-92
100Z'3
-
-
-
-
I
NLy
l
irt:wl
i RAL FILE'
DW
t SFCTIUM
1 If "NO FLOW" or "NO DISCHARGE, Enter "NO FLOW" or "NO DISCHARGE" for each outfali here. Please make sure to mark the sample period above.
2 if a value is in excess of the benchmark, or outside the benchmark range (for pH), you must implement the Tier 1 or Tier 2 responses in the General Permit. Tier 2
Monthly sampling shall be done until 3 consecutive samples are below the benchmark or within the benchmark range.
3 T55 benchmark values are 100 mg/I, except when discharging to ORW, HQW, Trout, and RNA waters where they are 50 mg/I.
For each sampled measurable storm event the total precipitation must be recorded using data from an on -site rain gauge.
Permit Date: 7/1/2011-60/30/2015 Last Revised 7/13/11
Page 1 of 2
hL­

Part S: Vehicle Maintenance Activity Monitoring Requirements for facilities using > 55 gal of new motor oil/month — averaged over a calendar year.
Outfall
No.
Date Sample '
Collected
(mo/dd/yr)z
pH
(Standard
Units)
TPH using method
�
1664A SGT-HEM
(mg/L)
Total Suspended
Solids
(mg/L)
Event
Duration
(minutes)
Total
a
Rainfall
(in)
New Motor Oil
Usage
(gal/month)
In Tier 2
Monthly
Monitoring?
(y/n)
# of Months
in Tier 2
2
Sampling
6-92
15
1002,3
-
-
-
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEFDENCES AT ANY ONE OUTFALL (INCLUDING VEHICLE MAINTENANCE)? YES ❑ NO ❑
HAVE YOU CONTACTED THE REGION? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail Original and one coov of this DMR (includine all "No Flow" & "No Discharge" reports) within 30 days of receipt of sample (or at end of rnonitorine period
in case of "No Flow") to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED:
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to
assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or
those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I
,arP9`zgvare thatAhe(e are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
of Permittee)
Permit Date: 7/1/2011-60/30/2015
1t-la- �S
(Date)
Last Revised 7/13/11
Page 2 of 2

Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance on filling out this form, please visit: littp://h?o.etir,st<rte.nc.us/au/Fornns Docuinenmhtm#iniscrorms
Permit No.: or Certificate of Coverage No.: NICIGI0 /b IL I S7
Facility Name: /Vi,i`IC C a.,-,P G,K �_ L: CO
-- -
County: C Phone No. - 3 Y- Y �I frG
Inspector: ` zr+sue
Date of Inspection:
Time of Inspection: 1 l' o b M
Total Event Precipitation (inches): a
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 accurate and complete to the best of my knowledge:
(SigWture of Permittee or Designee)
1. Outfall Description:
Outfall No. J< Structure (pipe, ditch, etc.)Q�Uc�,►n�
Deceiving Stream:
Describe the industrial activities that occur within the outfall drainage area:
Cc.i,.�c1r4-e. a -D N
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc) and tint
(light, medium, dark) as descriptors: iy C- (6�1rL
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil, weak
chlorine odor, etc.): mope
Page 1 of 2
5 WU-242-112609

4. Clarity: Choose the number which best describes the clarity of the discharge, where I is clear
i and 5 is very cloudy:
1 20 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 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:
G) 2 3 4 5
7. Is there any foam in the stormwater discharge? Yes (N
S. Is there an oil sheen in the stormwater discharge? Yes oNo
9. Is there evidence of erosion or deposition at the outfall? Yes (N)o
I
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.
r '
Page 2 of 2
SWU-242-112608

STORMWATER DISCHARGE OUTFALL (SDO) - Semi -Annual MONITORING FORM
GENERAL PERMIT NO: NCG140000
CERTIFICATE OF COVERAGE NO. NCG14_C> 0 J_ S
FACILITY NAME: /4 f GCa CA2' t A
PERSON COLLECTING SAMPLES
CERTIFIED LABORATORY L`NV+ r-C� n rnc"l 2 Lab #
Lab #
OPTIONAL INFO:
Part A: Stormwater Monitoring Requirements
SAMPLE COLLECTION YEAR:
SAMPLING PERIOD: ❑ July -December anuary-June
COUNTY /A­j to G
PHONENO.(GIgI �) �U — Q ?TQ
ADD TO LISTSERVE? ❑YES QNO EMAIL:
DISCHARGING TO CLASS: ❑SA ❑HQW ❑PNA ❑Trout Bi ther
Outfall No.
Date Sample
Collected
(mo/dd/yr OR
NO FLOW)I
PH
{Standard
Units)
TSS
(mg/L)
Event
Duration
(minutes)
Total 4
Rainfall
(in)
In Tier 2
Monthly
Monitoring?
(y/n)
# of Months in Tier
2
2 Sampling
6-92
1002,3
-
-
I13S
i
MAY
.
CENTRAL
Fll;=S
LWIR SIECTION
1 If "NO FLOW" or "NO DISCHARGE, Enter "NO FLOW" or "NO DISCHARGE" for each out€all here. Please make sure to mark the sample period above.
If a value is in excess of the benchmark, or outside the benchmark range (for pH), you must implement the Tier 1 or Tier 2 responses in the General Permit. Tier 2
Monthly sampling shall be done until 3 consecutive samples are below the benchmark or within the benchmark range.
a TSS benchmark values are 100 mg/I, except when discharging to ORW, HQW, Trout, and PNA waters where they are 50 mg/I.
° For each sampled measurable storm event the total precipitation must be recorded using data from an on -site rain gauge.
Permit Date: 7/1/2011-60/30/2015 Last Revised 7/13/11
Page 1 of 2

S
Part B: Vehicle Maintenance Activity Monitoring Requirements for facilities using > 55 gal of new motor oil/month — averaged over a calendar year.
Outfall
No.
Date Sample
Collected 1
(mo/dd/yr)
pH
(Standard
Units)
TPH using method
1664A SGT- HEM
(mg/L)
Total Suspended
-Solids
(mg/L)
Event
Duration
(minutes)
Total
4
Rainfall
(in)
New Motor Oil
Usage
(gal/month)
In Tier 2
Monthly
Monitoring?
(y/n)
# of Months
in Tier 2
Sampiing2
6-9,
15Z
1002'3
-
-
-
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEED ENCES AT ANYONE OUTFALL (INCLUDING VEHICLE MAINTENANCE)? YES ❑ NO ❑
HAVE YOU CONTACTED THE REGION? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail Original and one copv of this DMIR (includine all "No Flow" & "No Dischawe" retorts) within 30 days of receipt of sample for at end of monitorine period
in case of "No Flow") to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED:
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to
assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or
those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete
am aware th there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
n - S_ rs
of Permittee)
Permit Date: 7/1/2011-60/30/2015
(Date)
Last Revised 7/13/11
Page 2 of 2

0
READY MIXED CONCRETE (GOLDSBORO)
MR. JEFF ROBERTSON
506 WEST CHESTNUT STREET
GOLDSBORO ,NC 27530
001 Analysis Alethod
PARANIETERS Discharge Date Analyst Code
PH (ant to be used for reporting) 6.9 051.11115 TRB 4500HR-00
Total Suspended Residue, mg/I 17 05/12/15 LNV 254OD-97
'FRX°(2a2)
ID#: 1088
DATE COLLECTED: 05/11/15
DATE REPORTED : 05/13/15
REVIEWED BY:

3 1 ;A 11-1�:1 j (j In
Tj
V NT: 1488 Week: 13
READY NMCED CONCRETE (GOLDSBORO)
jj
P1 P
MR. JEFF ROBERTSON
506 WEST CHESTNUT STREET
GOLDSBORO NC 27530
A A
'T:
L Q ATiQ'r F
-A,
-----------............. .. . ...... .... .
. ............
1 001 Dischar2c
! 1:� .. 3
r
'77
A. _ .
1
iz., l1- u U,
----- --
L-24-1
I
N-1

It
STORMWATER DISCHARGE OUTFALL 4SDOj - Semi -Annual MONITORING FORM
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF CO;7VERAGE NO. NCG14 C O 1 •S
FACILITY NAME: ReA Dy (WOC64 -W of r Nc--
PERSON COLLECTING SAMPLES ( c>6c_rCa
CERTIFIED LABORATORY L NVire n&tuv 1- .� _ Lab # J OR?
Lab #
OPTIONAL INFO:
Part A: Stormwater Monitoring Requirements
SAMPLE COLLECTION YEAR: 076� `7
SAMPLING PERIOD: July -December ❑ January -June
COUNTY WA m0 CuuNi
PHONE NO, (a/5
ADD TO L15TSERVE? ]YES ©NO EMAIL:
DISCHARGING TO CLASS: ❑5A ❑HQW ❑PNA []Trout a ther,
Outfall No.
Date Sample
Collected
(moJdd/yrOR
NO FLOW)t
PH
(Standard
Units)
TSS
[mgJL)
Event
Duration
(minutes)
Total ,
Rainfall
(in)
In Tier 2
Monthly
Monitoring?
(y/n)
# of Months in Tier
z
2Sampling
-
-
6-9
100 '
-
-
G
C
NTRAL FiL S
D
' If "NO FLOW" or "NO DISCHARGE, Enter "NO FLOW" or "NO DISCHARGE" for each outfall here_ Please make sure to marls the sample period above.
2 If a value is in excess of the benchmark, or outside the benchmark range (for pH), you must implement the Tier 1 or Tier 2 responses in the General Permit. Tier 2
Monthly sampling shall be done until 3 consecutive samples are below the benchmark or within the benchmark range.
' TSS benchmark values are 100 mg/I, except when discharging to ORW, HQW, Trout, and PNA waters where they are 50 mg/I.
4 For each sampled measurable storm event the total precipitation must be recorded using data from an on -site rain gauge.
Permit Date:7/1/2011-60/30/2015
I Last Revised 7/13/11
Page 1 of 2

;r
a -
Part B: Vehicle Maintenance Activity Monitoring Requirements for facilities using > 55 gal of new motor oil/month — aperaged over a calendar year.
Outfall
No.
Date Sample
Collected
(mo/dd/yr)3
PH
(Standard
Units}
TPH using method
16644 SGT-HEM
(mg/L)
Total Suspended
Solids
(mg/L)
Event
Duration
(minutes)
Total New Motor Oil
Rainfall` I Usage
(in) '' (gal/month}
In Tier 2
Monthly
Monitoring?
(Y/n}
# of Months
in Tier 2
z
Sampling
6-9
15 2
100 ,
-
.i
-
-
I
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES AT ANY ONE OUTFALL (INCLUDING VEHICLE MAINTENANCE)? YES []NOR
HAVE YOU CONTACTED THE REGION? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail Original.and_one copy of this DMR (including all "No Flow" & "No Discharge" reports) within 30 days of receipt of sample (or at end of monitorinR.period
in case of "No flow") to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
6
YOU MUSTSIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED.
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervisia n 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
a are thatttnthere are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations-"
`i _ 6?-I5-/V
(Signa4ure of Permittee) (Date)
Permit Date: 7/1/2011-60/20/2015 Last Revised 7/13/11
Page 2 of 2