NCG140130_MONITORING INFO_20180219

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
/v qo 13 J
DOC TYPE
❑HISTORICAL FILE
9'MONITORING REPORTS
DOC DATE
❑
YYYYMMDD

STORMWATER DISCHARGE OUTFALL (SDO) - Semi -Annual MONITORING FORM
GENERAuPERMrrLNO. NCG140000
CERTIFICATE OF COVERAGE NO. NCG14I0 FEB �4��
�
SAMPLE COLLECTION YEAR: �Z O 1'?
FACILITY NAME: RCXZ5- CENTRAL FISAMPLING PERIOD: 11 July -December ❑ January -June
PERSON COLLECTING SAMPLES L vvm 3E TIENINTY OR'RN"
CERTIFIED LABORATORY Lab tt_ PHONE NO. (�
Lab p ADD TO LiSTSERVE? ❑YES ❑NO EMAIL:
OPTIONAL INFO: DISCHARGING TO CLASS: [:]SA ❑HQW ❑PNA ❑Trout ❑Other
Part A: Stormwater Monitoring Requirements
Dutfall No.
Date Sample
Collected
(mo/dd/yr OR
No FLOW)1
PH
{Standard
Units)
TSS
(mg/L)
Event
Duration
(minutes)
Total
Rainfall,
(in)
In Tier 2
Monthly
Monitoring?
n
(y/ )
# of Months in Tier
2
2 Sampling
-
-
6-9
100 '
-
-
-
-
I
.Z
11DDM.
511
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/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 l 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
1664,4 5GT-HEM
(mg/L)
Total Suspended
Solids
(Mg/0
Event
Duration
(minutes)
Total
a
Rainfa!!
(in)
New Motor Oil
Usage
(gat/month)
In Tier 2
Monthly
Monitoring?
Wn)
# of Months
in Ter Z
Sampling,
6-9
is
100 2.3-
-
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 Oriainal and one cony of this DMR fincludine all "No Flow" & "No Dischame" reports) within 30 days of receipt of samDle for at end of monitorine Deriod
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 CERTIFlCATION FOR ANY INFORMATION REPORTED:
"1 certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to
assure that qualified personnel properly gather and evaluate the information submitted_ Based on my inquiry of the person or persons who manage the system, or
those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete
am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
(Signature of Iter ittee) �, (Date)
Permit Date: 7/1/2011-60/30/2015 Last Revised 7/13/11
Page 2 of 2

A��
MCDENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Forguidonce on filling out this form, please visit; http llportal.nc enr a g/web/Ir/npdes-stormwateU
Permit No.: W!L1—/_/_/_/_/_1^1 or Certificate of Coverage No.: Nyj( &I-Li1
Facility Name., _gnuAPIGY& 2-6
County: Phone No. --
Inspector: _.._ LTru W ws
Date of Inspection: 4 YL 1 1 i„
Time of Inspection:. § 3g pry -
Total Event Precipitation (inches): 1-1
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
(See information below.)
[3'*Yes ❑ No
Please verify whether Qualitative Monitoring must be 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 "measureable 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 least 72 hours
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 that this report is accurate and complete to the best of my knowledge:
(Signature of Per(�itte°e or Designee)
Page t of 2
SwU-242, Last modified 7/31/2013

1. Outfall Description:
Outfall No. - J — Structure (pipe, i c tc.)
Receiving Stream:
Describe the ipdustrial activities that occur within the outfall drainage area:
2. Color: Describe the color of the discharge usi g basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: Ll. AF- Ry _
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.): 1� )6
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
1 C2 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 L/ 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:
J 2 3 4 5
7. Is there any foam in the stormwater discharge? Yes (ip-)
8. Is there an oil sheen in the stormwater discharge? Yes 101j),
9. is there evidence of erosion or deposition at the outfall? Yes
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, Last modified 7/31/2013

Z-'/6
Analytkal"
~wAlaEasan
Section A RMlen a
Ragtdmtl [Piet ID+DDr®Ow. Raw*" Pt *o 1r11Dreae an.
CHAIN -OF -CUSTODY I.Analytical Request Document
The Chaktef-C tDry a -a LEGAL DOCUMENT. AU rotararq PAM &.XM tr CaropM ixl a=ffwt y.
Sedwo C
ImmkoirdafmaGart
COR1irMl•
Tv
tarb—,
Z 1
Add"-: 36 a �
fcpy TO:(,lprygry
Manic
REGULATORY Ate/
"t
O
Aaaau
i wpm ;" GROUND WATER ' OMMG WATER
'
i' usT i RCRA ,� OTTER
€mpY TO:
Cdw..OrdenNa.:
Cmm
STATE
Ra¢aytad Um Oata+TAn
Mar+Dar. p� A .� .PM
1
R" �
R"'
W9
as
A-
Ois
€itts►
d
MM
D
MNWb%dC6.4
Kau Codas
Gam.
a
COLLECTEDserverdlves
r
=
`a
H
waacr VITyftft
LS wvv
SK 6
FlRif,r41L
U
MVaip
A-isgft
OL
�`
.}
r'
SAMPLE Id
YOVIP
IA.Z 0-91 ;)
LRJw
Air AR
LU
lJ • -"' �.
Samoa N)z 6E U"pam
Th T
ppp
LJ
Z
5�.7
a
X
m
p�p
T
S
:.
Pace Proccs,'loJLiaoI.U.
DATE
TW,E
WE
TINE
M
D
x T
z
2
+
aw i
LAf
iiLs
60
:9
41
ry
; , A
i
P,4
y + } 1
s
i
s
�
4
5
6
7
e
r
H#,-F
16
it
iz
F
A1rWTXXQkLCOWMEBM
RE12NQi1sMA&ME7'lAF:{ insaN
DATE
riYE
A 7�.cEP?MgY1AFn ATWN
DATE
TIRE
I SAfaiPLECONO[Tri:t t
OFi1G 4NAL
SAMPLER NAMti AND 81Gum tE
" �
A
3
PRMT Neese of SAMPLM
a
�IDste'd
�
8
� �
+
81GNATUREcf CAUPt,.EFL
{Loaoarrra:
a]
• qW-a K-: Gj GW Viia tan yooa Uftf-,aP_>< her 30 Jrr aarmwaaemw 12 LW.00avF-ALL-"20m.07. 15.Uw-2007

i
aceAmlyticai°
i
wwwP6069 .cnr,+
September 18, 2017
Jay Watkins
Ready Mix Concrete
3610 Bush Street
Raleigh, NC 27609
RE: Project: Plant 25 Rougemont
Pace Project No.: 92355104
Poe* Analytical Sorvlcea, LLC
9800 Klncey Ave. Suite 100
Huntersville, NC 28078
(7D4)87&SD92
Dear Jay Watkins:
Enclosed are the analytical results for sample(s) received by the laboratory on September 13, 2017.
The results relate only to the samples included in this report. Results reported h erein conform to the
most current, applicable TNIINELAC standards and the laboratory's Quality Assurance Manual,
where applicable, unless otherwise noted in the body of the report.
If you have any questions concerning this report, please feel free to contact me.
Sincerely,
wa— qYl ,
Angela Baioni
angela.baioni@ pacelabs.com
[phone]
Project Manager
Enclosures
2 t REPORT OF LABORATORY ANALYSIS
i`99� This report short not be reproduced, except in full,
tlgBO f�I� without the wrihen consent of Pace Analytical Services, LLC.
Page 1 of 10

aceAnalXical e
www.peoelaba.com
Project: Plant 25 Rougemont
Pace Project No.: 92355104
Eden Certification tDs
205 East Meadow Road Sulte A, Eden, NC 27288
North Carolina Drinking Water CertiScatlon #: 37738
CERTIFICATIONS
North Carolina Wastewater Certification 0: 633
VirginiaIVELAP Certification #: 460025
REPORT OF LABORATORY ANALYSIS
This report shall not be raproduced, except In full,
vrithout the written consent of Pace Analyttcal Services, LLC.
Pace Analytical Sorvices, LLC
8890 Klncey Ave Sulte 100
Huntamitle, NC 28078
[phone]
Page 2 of 10

n��n�r, y a
N ! f iy
11/www.aaralabs.carrr
i
Project: Plant 25 Rougemont
Pace Project No.: 923551D4
SAMPLE ANALYTE COUNT
Pace Analytical Sorvlces; LLC
8800 Klncey Ave. Suge 100
Huntersvtle, NC 28078
[phone]
Analytes
Lab ID Sample ID
Method
Analysts Reported laboratory
92356104001 Outfall #1 Rougemont 26
SM 2540D
CTB 1 PASI-E
}
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
without the writlen consent of Pace Analytical Services, LLC.
Page 3 of 10

aceAna4 cal
��
ANALYTICAL RESULTS
Project: Plant 25 Rougemont
Pace Project No.: 92355104
Pau Analytical Services; LLC
9800 Klncey Ave. Suite 100
Huntersvilk, NC 28078
(704)8759092
Sample: Outfall #1 Rougemont 25 Lab ID: 92365104001 Collected: 09112117 08:34 Received'. 09113117 13:35 Matrix: Water
Parameters Results Units Report Limit OF Prepared Analyzed CAS No. Oual
2640D Total Suspended Solids Analytical Method: SM 2540D
Total Suspended Solids 7.6 mglL 2.5 1 09/15/17 10:37
U
Date: 09118/2017 03:24 PM
a
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in fun,
w@hout the written consent of Pace Analytical Services, LLC.
Page 4 of 10

CBAnalytical e
www.peoela6s.oxn
i
QUALITY CONTROL DATA
Pace Analytical Services; LLC
e8oDKtneeyave. Sulteloo
HunlemvNe, NC 28078
(704)875-W92
Project: Plant 25 Rougemont
Pace Project No.: 92355104
QC Batch: 377900
Analysts Method:
SM 2540D
QC Batch Method_ SM 2540D
Analysis Description:
2540D Total Suspended Solids
Associated Lab Samples: 92355104001
METHOD BLANK: 2093661
Matrix: Water
Associated Lab Samples: 92355104001
Blank Reporting
Parameter
Units
Result Limit
Analyzed Qualifiers
Total Suspended Solids
mg/L
ND
2.5 09115/17 10:33
LABORATORY CONTROL SAMPLE: 2093652
Spike LC5
LCS % Rec
Parameter
Units
Conc. Result
°Ao Rec Limits Qualifiers
Total Suspended Solids
mg/L
250 240
96 W110
SAMPLE DUPLICATE: 2093663
92355099001 Dup
t Parameter
Units
Result Result
RPD Qualifiers
` Total Suspended Solids
mg/L
159
273 53 D6
SAMPLE DUPLICATE: 2093664
92355087001 Dup
Parameter
Units
Result Result
RPD Qualifiers
Total Suspended Solids
mg/L
3.7
164 191 D6
0
Resuhs presented on this page are In the units indicated by the "units" coturn except wohere an alternate unit is presentad to the right of the result
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except In full,
Date: 09/18/2017 03:24 PM wiVrout the written consent of Pace Analytical Services, LLC, Page 5 of 10

Pace Analytical Sarvicer, LLC
acemalyfiol e �°° ICineeyAve. too
Huntereville, NCC 28078
j wwwp� eb&MM (704)87--W92
QUALIFIERS
Project, Plant 25 Rougemont
Pace Project No.: 92355104
DEFINITIONS
DF - Dilution Factor, if reported, represents the factor applied to the reported data due to dilution of the sample aliquot.
ND- Not Detected at or above adjusted reporting Iimit.
TNTC - Too Numerous To Count
J - Estimated concenlration above the adjusted method detection limit and below the adjusted reporting limit.
MDL -Adjusted Method Detection Limit.
PQL - Practical Quantitation Limit.
RL- Reporting Limit.
S- Surrogate
1,2-Diphenythydrazine decomposes to and cannot be separated from Azobenzene using Method 8270. The result for each analyte is
a combined concentration.
Consistent with EPA guidelines, unrounded data are displayed and have been used to calculate % recovery and RPD values,
LCS(D) - Laboratory Control Sample (Duplicate)
MS(D) - Matrix Spike (Duplicate)
FLIP - Sample Duplicate
RPD - Relative Percent Difference
NC - Not Calculable.
SG - Silica Gel - Clean -Up
U - Indicates the compound was analyzed for, but not detected.
Acid preservation may not be appropriate far 2 Chloroethylvinyl ether.
A separate vial preserved to a pH of 4.5 Is recommended In SW846 Chapter 4 for the analysis ofAcrolein and Acrylonitrtle by EPA
Method 8260.
N-Nitrosodiphenylamine decomposes and cannot be separated from Diphenylamine using Method 8270. The result reported for
each analyte is a combined concentration.
Pace Analytical is TNI accredited. Contact your Pace PM for the current list of accredited anatytes.
TNI - The NELAC Institute.
LABORATORIES
PASI-E Pace Analytical Services - Eden
ANALYTE QUALIFIERS
D6 The precision between the sample and sample duplicate exceeded laboratory control limits.
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
Date: 09/18/2017 0124 PM whhout the writion consent of Pace Analytical Services, LLC. Page 6 of 10

�;a'ceAna4tical"
! nww.pKefabs.='n
f
QUALITY CONTROL DATA CROSS REFERENCE TABLE
Pace Ana4y0cal Service,$ LLC
9800 Kincey Ave. Suite llo0
Huntersville, NC 28078
{704Je75-9092
I
1 Project: Plant 25 Raugamanl
` Pace Project No.: 92355104
I
Analytical
Lab Ill Sample ID QC Batch Method QC Batch Analytical Method Batch
92355104001 Outfall #1 Rougemont 25 SM 2540D 377900
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
Dalh: 09/1812017 03:24 PM wftut the wriaen consent of Pace Analytical Services, LLC.
Page 7 of 10

Document Name: DoomentRevlsed:Juff2, 2017
8A9Sam a Cbndltlon upon Recew(sCUR) P • 1 of 2
Document No.: IswingAuthorlty.
F-CAR-CM3•Rev.D3 Pace Quallty Office
Asheville ❑ Eden❑ Greenwood ❑ _
Huntersville ❑ V Ralelgh���Machafltalle�
som glent Name: .� ProjectU: W0# : 92355104
c•
Courier, Fed Ex Oupi �� LISPS lent I ll f l IIiI l l i I1 I IIl ❑Contmerclal ❑Puce skier.` 92355104
Paddng Materiei: ❑Bubble Wrap ❑Bubble Sags
Z—
=Jses—
Date/laliab Parton Fxarrtlrriag Caeteatsw•
one [ Other BIDIDOCA1TlssueFN%M?
[Net ❑eWn ©Noss Yet [�NO
ee �s— a ve
iJs+erplesautoftempulterjiSamp annceo nfo pr«w�
hu brtun
USDA Regulated $09 { k; water sample)
_, _ Dldsr mples ariginarto iya qusraretine tone within the Unked $rates: (ANY, or SC (check maps)? Did sertpks or}pnata tram a kretgtrsouroe
Yes ?ic
lndWIrq H&m1 snd PueAD Rka7? © as '� o��, •-- : - •
.Chain of[ustod Present?
as
Na
N A - .
1.
Samples Arrived within Hold Time?
n
No
N!A
7.
Short HoldTlmeArud 02hr.?
nym,
- n
Qra
3.
Rush Turn Around TlmeRequestedT
mer
NJA
4.
Suffiden: Votun,eP
n
No
N/A
5.
CerrettContainersUst3?
-Pate Containers Used?
es
en
No
No
❑N/A
N/A
8-
CrntAners Intact?_
Of.
No
DoX,
7.
Dissolved ana ds: $am s Fkfd Filtered?
ny.,
RCA
B.
Sample labels Match COC?
-inihldas Date)Tirnt/ID Anat is Murk:
u
❑No
©N/A
B.
Heods ace In VOA Vials >5-bmm?
Trip BlankPresent?
---•--__..� ..
t
+a/A
NJA NJA
10.
HeidDate RIQuhsd! []yes ❑No
• Personcontarked:
Comments/Sample 04CM00nq!
Datemrm:
Pfo)ed Manegee SCURF Review:
Date: ~, -+• .
ProlettMRnagtfSJtPReaiew:fly Imo-- —� Dice: _
Kate: +4heoever Mien is a ddrrepancy afrecOnt North Choi m complhrnee samplei a copyof this farm will btsar+tw*e NoAh Corals" DEEM Cardflcadon Of" (ta-
outofhNd,kwRoctDrew0flee,CAOftemp.tecarret=tslncrr] .
ge8of10

Document Name: oneement Rerked:luly 25, 2017
Sample Condition Upon Ntcel t(scup Page 2 of 2
i w� 2lytiCe?I Document No.* IsauingAuthatttY
i i•CAR•CS-MR-Rev.03 paw Qnsty rifts
•Cfiech marRto h i o r and%oiaechE'orfna on - P'raj�c WO# 92355104 is verified and within the acceptance range for _ w �
08/27/17
P
Preservation samples. lf: R?1H Due Cale:
008ottom half of box is to list number ofbottles CLIENT: 92—Rrady Mix
RZ
E � .� j
_ r
*,".
4
S
]2
pN Adjustment Log for Preservad SMp1es
uponrec111,11, t�ft Datapryte!! BOn+dj�t� t + " ArtoYnrofpn�
eeluxaa tadea
I
E
Page 9 of 10

RECEIVED
A946,7 MAY Q42017
NCDENR CENTRAL FILES
Stormwater Discharge Outfall (SDO) DWR SECTION
Qualitative Monitoring Report
Forguidance an filling out thisform, please visit: Irttp./ Qrtalncdeur.orgfwelzLlr/`oizdes-sts w
Permit No.: Ll/C/_/_/_/_/_/_/�� or Certificate of Coverage No.: NIC/G/%/H/ O/ _ I-31p/,
Facility Name:
County: O JeA
Inspector:
Date of Inspection:
Time of Inspection: ��t. 3 4 P ►'A._
Phone No.
Total Event Precipitation (inches): 2- I!�--
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
(See information below.)
Yes ❑ No
Please verify whether Qualitative Monitorinq must be performed during a "representative storm
event" or "rneasureable 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 "rrreasureable 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 tip to 1.0 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 (neasurable storm event must have been at least 72 hours
prior. The 72-hour storm interval does not apply if the perrittee 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 that this report is accurate and complete to the best of my knowledge:
(Signature of Pgrmiftee or Designee)
Page 1 of 2
SWn-242, Last modified 7/31/2013

1. outfall Description:
Outfall No. 1 Structure (pip d c , .)
Receiving Stream:
Describe the industKial aftivities that occur within the outfall drainage area:
2. Color: Describe the color of the dis barge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: CkA r-
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.): Oyp'a~
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy: Ll�
2 3 4 S
S. 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:
© 2 3 4 5
b. 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:
0 2 3 4 S
7. Is there any foam in the stormwater discharge? Yes
8. Is there an oil sheets in the stormwater discharge? Yes
9. is there evidence of erosion or deposition at the outfall? Yes
10. Other Obvious Indicators of Stormwater Pollution:
List and describe M 0 V -
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, Last modified 7/31/2013

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division -of Water Quality General Permit No. NCG060000
Date submitted 11-15t 1 `1
CERTIFICATE OF'COVERAGE NO. NCG06 01_I _�Q SAMPLE COLLECTION YEAR Zo M
FACILITY NAME 7's FACILITY ACTIVITIES INCLUDE„(check all that apply):
COUNTY ❑ use/process, meats [-]use anima! fats/byproducts
PERSON COLLECTING SAMPLES DISCHARGING TO SALTWATERS? ❑YES �NO
LABORATORY PhL --- Lab Cert. # q - -- - -
Part A: Stormwater Benchmarks and Monitoring Results
PLEASE REMEMBER. TO?SIGN ON'.THE REVERSE •3-
Total event rainfall z - 1' or [] Na discharge this period'
Outfall No.,
,Sample Collected,
mo/dd/yr
TSS,
mg/L
pH,
Standard units
COD,.
mg/L
Oil and Grease,
mg/L
'Fecal Coliform ,
Colonies per 100 ml
Enterococci ,
Colonies per 100 ml
Benchmark
-
100 or 504
Within 6.0 — 9.0
120
30
1000
50o
f•172.4t7
!Z .
' Only applies to facilities that use/process meats.
2The total precipitation must be recorded using data from an on -site rain gauge.
3 For sampling periods with no discharge at any outfalls. You must still submit this discharge monitoring report with a checkmark here;
°See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Did this facility perform Vehicle, Maintenance Activities.using more than 55 gallons of new motor oil per month?[] yes [N no
Part B:.Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new motor oil/month.
Outfall No.
Sample Collected,
mo/dd/yr
Oil and Grease,
mg/L
T55,
mg/L
pH,
Standard units
New Motor oil Usage,
Annual'average gal/mo
Benchmark
-
30
100 or 50
6.0 - 9.0
A Only applies to facilities that use/process meats.
ZThe total precipitation must be recorded using data from an on -site rain gauge.
3 For sampling periods with no discharge ate outfalls, you must still submit this discharge "monitoring report with a checkmark here.
°See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
(if yes, complete Part B)
SWU-249 Last Revised: October I & 2012
Page 1 of 2

*FOR.PART A AND PART.B MONITORING RESULTS:
• A BENCHMARK. EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART 11 SECTION B.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS'. SEE PERMIT PART 11 SECTION B.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES ❑ NO �.
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail on original and one copy of this DMR, including all "No Discharge" reports, within 30 days of receipt of the lab results (or at end of
monitoring period in the case of "No Discharge" reports), :
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, NC 27699-1617
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED:
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a
system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the
person or persons who manage the system, or those persons directly responsible for gathering the information, the information -submitted is,
to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false
information, including the possibility of fines and imprisonment for knowing violations."
(Signature of Pe
51,1 t -r
(Date)
Additional copies of this form may be downloaded at: http://porta1.ncdenr.org/web/wq/ws/su/npdessw#tab-4
S WU-249
Last Revised: October 18. 2012
Page 2 of 2

-PaceAnalyfical'
L.r.e...r.r
CHAIN -OF -CUSTODY I Analytical Request Document
The Chain-al-Cuswdy Is a LEGAL DOCUMENT. All relevant fields nwa 6o canpiaiod arc mt0y.
Pepe: of
Seaton A SecUan 6 gacrbn O
RaqulrodCHIInlormagon: RagWrWPrpjoctlntcrrnWi0n: invoiceinfonnati0fr
Company. Recom Tu. A{tention:
2097573
Andros& Copy
To:
Compvey Natnr.
REGULATORY AGEACY,
Aderm
I NPDES GROUND WATER j"' DRINKING WATER
r UST .� RCRA i OTHER
Enroll To,
Purchase Craw No.:
pace Oral.
("00
L'i•+one: Fax:
P"ect Namu:
3+w Pmwa
Site Location
- STATE:
Rogrrarad Dm VAWTAT.
P^OleCt Nnmtlar: �1 Z
1
Deco PrNJe a:
Regiuestod
Analysis,
Filtered
(YIN)
SMITi D Matrix Code*
R.Wftdcsi rnhrmrrwr t/A7Rtx r CODE
3
1
COLLECTED
PmServativos
5;
.
Un1W N Water DW
u
wslr W7
Waete Waller VM
y
CGFCeIAne'
i'W-1 P
i!
srYx.rvUgrs
0
5alr50K SL
g
C9
O
+M
SAMPLE ID Oil o+
3
9v
F
d)
).n 4;s., r
"Do WP
(0.2.0.9:.-i Mr AN
d
�
2
I�
t5
tK
�A,.}.�.i��y
S6MPIV Lp. MUST BE UNIQUE TWLIB TS
p�p
O
a
Other OT
v
z
•W
iyp,
R
=r
�
�
U
y
O�
d
�
�
E
y�jO
`=
i
z
a
z
L
5
°c-�
d
DATE
TIME
DATE
TIMES
;y
Pace Project Nod Lab I.D.
'2.
d
6
r8
7
e:
p
10
1l
12
. .. APDITIONALCOMUENTS
_ RL1.lN BYlAFf1LIAT30N-.
DA-it
'_TMM
C tiYPFA, iAIATION
DATE
TIME
SAMPLE CONDITIONS
I
!AMPLER N"r- AND SIQNATURE
u
n
t
PMNr Name of SAMPPLER:
,� r
r
t;
StGNATURC of SAMPLER:
DATE Signed
"-n On' NDW: By syr w-a U.. r,.r,r y --P*bv rare& NET 30" PAl" M-A 19rrra "a npwrrU m Pan cnsrgen of 1 5%rM.... 1, for -rry -ekes rat Paid w1hn 3C days. F•ALL,D-02Ur9v.07. 15-May-2U07

I
eAnalytical.
—paselabsxw
ANALYTICAL RESULTS
Pace Analytical Services, LLC
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
Project: PLANT 25 ROUGEMONT
Pace Project No.: 92338349
Sample: OUTFALL #1 PLANT 25 Lab ID: 92338349001 Collected: 04/24/17 07:34 Received: 04/25/17 14:55 Matrix: Water
Parameters Results Units Report Limit OF Prepared Analyzed CAS No. Qual
2540D Total Suspended Solids
Total Suspended Solids
Date: 04/27/2017 03:05 PM
Analytical Method: SM 2540D
12.0 mg/L 3.1 1
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except In full,
without the written consent of Pace Analytical Services, LLC.
04/26/17 13:40
Page 4 of 10

�>�ceArlalytical� Sample Condition Upan Receipt(SLURj_• Page 1 of 2
Document No.! Issuing Authority:
FCARQA Ot]3 Rev.OZ - — Pace Quality office -
Laboratory receiving samples:
Asheville ❑ Eden[] Greenwood ❑ Huntersville ❑ Raleigh® Mechanicsville[]
ple • • •
Client Name.r
: 92338349
Project st: Wp#
�S
Courier-
❑ d Ex ❑UPS ❑USPS
ien
1111111111111111111111❑
Commercial
❑Pace (:]Other.r,
Custody seal Present?
Dyes O Seals intact? El
`
92336349
No
Packing Material:
i/
❑Bubble Wrap ❑Bubble Bags xgone
Oatelleitlais Person Exam inEng Contents: _
❑Other.
Thermometer:
®IR Gun 30
IS-3492 06
Type of ke:
❑Blue ❑None ❑Samples on ice, cooling process has begun
r
Correction Factor: AddrA6
_
Cooler Temp Corrected (°C). �� f
_
Biological Tissue Frozen? []Yes❑No i�t'IIJA
Temp should be ahove fr exing to C*C
USDA Regulated Soil {
N/A water sample)
Did samples originate in a
uarantine zone within the Unified States: CA, NY, ar SC (rheck maps(? Did samples originate from a foreign source lint rnatbnally,
❑Yes KNo
including Hawal! and Puerto NCO? Dyes AffN0
Comments/Dtscre a
Bain of Custody Present?
©
1.
airiples Arrived within 3ltif�Ttmef
©
�.
Short Hold "rime Analos (42 hr.)?
©
3.
Rush Turn Around Time Requested?
Sufficient volume?
S.
Correct Containers Used?
-Pace Containers Used?
r
L1
6.
Containers intact?
U
❑
©
7.
Samples Feld Filtered?
8. Note 0 sediment is visible in the dissolved container
Sample Labels Match WC?
-Includes Date/Time/ID/Analysls
9.
Headspace in VOA Vials (�5-6mm)7
Yes
No
1A
10,
Trip Blank Present?
Trip Blank CustodySeals Present?
es
❑
Yes
No
❑
No
N A
A
11,
CLIENT N0TIFICATION/RES0LLMON
Person Contacted:
Comments/Sample Discrepancy:
Date/Time:
field Data Required? ❑Yes LJNo
Project Manager SCURF
Review: ( J Date: q
Project Manager SRF
Review: Date:
Note: Whenever there is a discrepancy affecting North Carolina compliance samples, a copy of this form will be sent to the North Carolina OEHNR Certification Office (Le.
Out of hold, Incorrect preservative, out of temp, Incorrect containers)
77
' - Page 8 of 10

v '
m
0
0
r�
v
n
R
n.
�n
a
z
0
v
"
3
a�
r+
O
m
a
M
3
C
� R
�
r*
�2
C
6
a
c
�
m
�
m
v<
�
c�
r.i
.•
ttamR
OP4U-125 mL Plastic Unpreserved (N/A) (Cl-)
MU-250mLPlastic Unpreserved(NIA)
I
{
9P2U-500 mt Plastic Unpreserved (N/A)
OPIU-1 liter Plastic Unpreserved {NIA)
t
9P35-250 mL Plastic H2SO4 (pH < 2) (Ci•)
MR-250 mt plastic HNO3 (pH c 21
r
SM-250 mL Plastic ZN Acetate & NaOH (>9)
BP3Gz50 mL Plastic NaOH JpH > 12J (CI-)
WGFU-Wide-mouLhedGlass Jar Unpreserved
AG1U•1 liter Amber Unpreserved (N/A) (G-)
AG1H•1 Ilter Amber HCI (pH < Z)
AG3U-7SC mL Amber Unpreserved (N/A) (G•)
AG LS-1 Ilter Amber H2504 (pH < 2)
AUS•250 mLAmber H2SO4 (pH < 2)
AG3A WUG 250 nit. Amber NH4CI (NIA)(CJ-)
DG9H-40 mL VCA HCl INN
VG9T-40 m L VOA N a 2S2a3 (N/A)
VGSU-40 mL VOAUnp (N/A)
DG9P-40 mi. VOA H3 PO4 (NIA)
VOAK (b vWs per kit)-5035 kit (N/A)
V/GK (3 Walls per kit)-VPH/Gas ktt (N/A)
SP5T-125 mL Sterile Plastic (N/A —lab)
SPZT•25O MLSterile Plastic (NIA — lab)
MA-250 mL Plastic (NHZ)25O4 (9,3.9.7)
.-
�
Qilritainer
V5GU-23mLSrinUl1a1l4nvials (N/A)__
GN
L
A
rt cL 3
=r o �'
m
c w :E o
Cr Mai
a �
x w
tL
^ x
C 1v T
rr >v
rp 7
CL
d �
o 04
f9 ro
O n
uroi � C
O
C
t
9
IA
v
O
n �
N
..
tJ
a v+
(D
i
0
a
p
m
v
5. C
x
o
Oo r.
m
406
T

.- - t;%
RECEIVED
MAR 14 2016
CENTRAL FILES
DWR SECTION
STORMWATER DISCHARGE OUTFALL (SDO) - Semi -Annual MONITORING FORM
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF COVERAGE N0. NCG14 V 13- Q
FACILITY NAME: KAU921MWF it as
PERSON COLLECTING SAM E C `i1�1
CERTIFIED LABORATORY Lab #
Lab #
OPTIONAL INFO:
Part A: Stormwater Monitoring Requirements
SAMPLE COLLECTION YEAR: z0 f6 I
SAMPLING PERIOD: ❑ July -December January -June
COUNTY
PHONE NO. (�3%} _ _364} - I:9 i
ADD TO LISTSERVE? []YES []NO EMAIL:
DISCHARGING TO CLASS: []SA HOW []PNA []Trout Other
Dutfall No.
Date Sample
Collected
(mo/dd/yr OR
NO FLOW)'
pH
(Standard
Units}
TSS
(mg/Lj
Event
Duration
(minutes)
Total
Rainfall
(in)
In Tier 2
Monthly
Monitoring?
(y/n)
# of Months irk Tier
2 Sampling'
6-9
1
Z l
11.0
Ipr
RLO
• 5�
--
If "NO FLOW" or "NO DISCHARGE, Enter "NO FLOW" or "NO 1315CHARGE" for each outfall here. Please make sure to mark the sample period above.
a 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.
T55 benchmark values are 100 mg/I, except when discharging to ORW, HQW, Trout, and PNA waters where they are SC mg/I.
For each sampled measurable storm event the total precipitation must be recorded using data from an un-site rain gauge.
Permit Date: 7/1/2011-60/30/2015 Last Revised 7113/11
Page 1 of 2

Part B: Vehicle Mal ntenance Activity Monitorine Requirements for facilities usine > 55 gal of new motor oil/month—averaeed over a calendar vear
Outfall
No.
Date Sample
I Collected }
mo dd r r
pH
{Standard
Units }
7PH using method
16tr4.4 SGT•HEM
m L
( gl 1
Total Suspended
Solids
(m L
g/)
Event
Duration
minutes
(minutes)
Total
.
Rainfall
m
( }
New Motor Oil
Usage
(gal/month )
In Tler 2
Monthly
Monitoring?
q of Months
in Tier 2
I
Sampling
6-9
i5
1
I
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES AT ANY ONE 0UTFALL {INCLUDING VEHICLE MAINTENANCE)? YES ❑ N44
HAVE YOU CONTACTED THE REGION? YES ❑ NO
REGIONAL OFFICE CONTACT NAME:
Mait 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 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 CERTIFfCATION FOR ANY INFORMATION REPORTED:
"t 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 here are significant penalties for submitting False information, including the possibility of fines and imprisonment for knowingvialations."
n rb
(Signat of p mittee) ! (Date)
Permit Date: 7/l/2011-60/30/2015 Last Revised 7/13/11
Page 2 of 2

9�01 RECEIVED
AIZA. MAR 14 Z016
RCDENR CENTRAL FILES
Stormwater Discharge Dutfall (SD8 SECTION
Qualitative Monitoring Report
Forguidance on filling out this form, please visit: http;//portal.ncdenr.Qre/web jaws/su/npdessw#tab-4
Permit No.: N/C/_/_/_/_/�/�/T/ or Certificate of Coverage No.: N1C/G/! /-Y / a/
Facility Name: RQkA Af �laKf -4*
County: ?Qrwm Phone No. 33(— 36q
Inspector: J WATkildl
Date of Inspection!
Time of Inspection: �8',20 AM
Total Event Precipitation (inches): 0 `50
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
(See information below.)
ErYes ❑ No
Please verify whether Qualitative Monitoring must be 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 "measureable 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 least 72 hours
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 DW(
ional Office.
By this signature, 1 certify that this report is accurate and complete to the best of my knowledge:
re Of Permittee or Designee)
Pagel of 2
SWU-242, Last modified 10/25/2012

1. Outfall Description:
Outfall No. 1 Structure (pip ditch etc.)
Receiving Stream:
Describe the industrial activities that occur within the outfall drainage area:
ep,yv ; ved (waif-dy - lav4
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: Cebu
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.): NOS 'e
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
0 2 3 4 5
S. 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:
0 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:
V 2 3 4 5
7. Is there any foam in the stormwater discharge? Yes
8. 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, Last modified 10/25/2012

TABLE 9.1
ANALYTICAL MONITORING REQUIREMENTS-STORMWATER
READY MIXED CONCRETE COMPANY - PLANT #
DISCHARGE
UNITS
BENCHMARK
SAMPLE
SAMPLING
CHARACTERISTIC
VALUES
LOCATION
SCHEDULE
pH
Standard
Within range
6.0 to 9.0
Each Outfall'
Semi -Annually
Total Suspended Solids (TSS)
mg/L
100 mg/L2
Each Outfall'
Semi -Annually
Total Petroleum Hydrocarbons3
mg/L
15 mg/L
Each Outfall'
Semi -Annually
Event Duration
Minutes
Not applicable
Each Outfall'
Semi -Annually
Total Rainfall
Inches
Not applicable
Each Outfall'
Semi -Annually
New Motor Oil Usage3
Gallons/ Month
Not applicable
Not applicable
Semi -Annually
Notes:
1. Samples shall be collected at each stormwater discharge outfall unless representative outfall status
has been granted and documented by the Division of Water Quality. A copy of the letter granting
representative outfall status shall be kept on site.
2. TSS benchmark for ORW, HWQ, Trout or PNA waters is 50 mg/L.
3. Only required for sites where vehicle maintenance activities occur.
4. All samples must be grab samples. Grab samples shall be collected within the first 30 minutes of
discharge from a stormwater discharge outfall (SDO).
5. All samples must be collected during a measurable storm event. A measurable storm event is an
event that results in an actual discharge from the permitted site outfalls. The previous measurable
storm event must have been at least 72 hours prior. If no discharge occurs during a sampling period,
a monitoring report indicating "No Flow" must be submitted within 30-days of the sampling period.
6. For each sampled measurable storm event the total precipitation must be recorded using an on -site
rain gauge.
7. The permittee shall complete the analytical samplings in accordance with the schedule specified
above, unless adverse weather conditions prevent sample collection. Inability to sample due to
adverse weather conditions must be documented in the SPPP and reported on the appropriate DMR
form (Appendix A).
8. A minimum of 60 days must separate each monitoring event unless monthly monitoring has been
instituted under a Tier Two response
9. The permittee shall compare monitoring results to the above -referenced benchmark values for each
discharge characteristic. Exceedances of benchmark values require the permittee to increase
monitoring, increase management actions, increase record keeping, and/or install stormwater Best
Management Practices (BMPs) in a tiered program, as specified by the general permit.
10. Failure to monitor semi-annually per permit terms immediately institutes monthly monitoring for all
stormwater parameters. After six months of monthly monitoring, the permitee may make a request in
writing to the Division of Water Quality to return to a semi-annual monitoring schedule.

TABLE 9.2
ANALYTICAL MONITORING REQUIREMENTS -PROCESS WASTEWATER
READY MIXED CONCRETE COMPANY — PLANT #
DISCHARGE
EFFLUENT
SAMPLE
SAMPLING
CHARACTERISTIC
UNITS
LIMITATIONS
LOCATION
SCHEDULE
pH
Standard
6.0 — 9.0'
Each Outfal12
Quarterly
Total Suspended Solids (TSS)
mg/L
30 mg/L3
Each Outfa112
Quarterly
Settleable Solids
mUL
5 mUL
Each OutfaI12
Quarterly
Total Petroleum Hydrocarbon$4
mg/L
15 mg/L
Each Outfal12
Quarterly
Event Duration
Minutes
Not applicable
Each Outfal12
Quarterly
Flow'
Gallons/Day
Not applicable
Each Outfall2
Quarterly
New Motor Oil Usage4
Gallons/ Month
Not applicable
Not applicable
Quarterly
Total Volume of Wastewater
Not applicable
50% of summer
Not Applicable
Quarterly
Discharged (HQW)
7Q10 Flow
Notes:
1. pH range for saltwaters is 6.8 — 8.5.
2. Samples shall be collected at each process wastewater outfall during a discharge event.
3. TSS effluent limitation HQW is 20 mg/L and 10 mg/L for Trout or PNA waters.
4. Only required for sites where vehicle maintenance activities occur and process wastewater
commingles with stormwater.
5. Flow may be measured continuously or calculated.
6. See 15A NCAC 0213.0224 and general permit for explanation.
7. All samples must be grab samples. Grab samples shall be collected within the first 30 minutes of
discharge from a process wastewater outfall.
8. If no discharge occurs during a sampling period, record "No Flow" or "No Discharge" within 30-days
of the end of the sampling period and file with SPPP.
9. Commingled discharges must be collected during a measurable storm event. A measurable storm
event is an event that results in an actual discharge from the permitted site outfalls. The previous
measurable storm event must have been at least 72 hours prior.
10. For each sampled measurable storm event the total precipitation must be recorded using an on -site
rain gauge.
11. The permittee shall complete the analytical samplings in accordance with the schedule specified
above, unless adverse weather conditions prevent sample collection. Inability to sample due to
adverse weather conditions must be documented in the SPPP and reported on the appropriate DMR
form (Appendix A).
12. For commingled discharges, a minimum of 60 clays must separate each monitoring event unless
monthly monitoring has been instituted under a Tier Two response
13. The permittee shall compare monitoring results to the above -referenced effluent limitations for each
discharge characteristic. Exceedances of effluent limitations will result in a violation of permit
conditions and may be subject to enforcement.
14. Failure to monitor process wastewater quarterly per permit terms immediately institutes monthly
monitoring for all parameters. After six months of monthly monitoring, the permitee may make a
request in writing to the Division of Water Quality to return to a quarterly monitoring schedule.

PROCESS WASTEWATER— Quarterly Discharge Monitoring Report
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF COVERAGE NO, NCG14
FACILITY NAME:
PERSON COLLECTING SAMPLES:
CERTIFIED LABORATORY: Lab #
Lab fJ
LIMIT VIOLATIONS? YES ❑ NO ❑
Part A: Wastewater Monitoring Requirements
SAMPLE COLLECTION YEAR:
SAMPLE QUARTER: ❑Jul -Sept ❑Oct -Dec ❑Jan -March ❑April -June
COUNTY:
PHONE NO. ( }
ADD TO LISTSERVEI OYES ONO EMAIL:
DISCHARGING TO CLASS: ❑$A ❑HQW ❑PNA ❑Trout ❑Other
OPTIONAL INFO:
Outfall No.
Date Sample
Collected'
(mm/dd/yr)
Type of Wastewater
( VE, RM, MD)'
pN
(standard)
Total Suspended
Solids
(mg/Lf
Settleable
Solids
(ml/L)
7PH using
method 1564a
SGT-HEJVf°
(mg/L)
Discharge
Duration
(minutes)
Total Flow
(gallons/day)
6-9'',
30xs
5'
(15j6
I
' If wastewater systems have not discharged in this quarter— report "No Flow' or "No Discharge" here. Please make sure to mark the sample quarter above.
' Report the abbreviation far the type of Authorized Wastewater Discharges here: Vehicle and Equipment Cleaning (VE), Raw Material Stockpiles (Rf j% Mixing Drum
Cleanout (MD). Report more than one type if the waste -stream is commingled.
3 if an effluent limit is exceeded twice in a row, the permittee is required to institute monthly monitoring for that parameter for Six months, unless DWQ RO staff
notifies you to continue monitoring.
PH limits are 6-9 S.U. for wastewater discharges to freshwaters, and 6.8-8.5 S.U. for discharges to saltwaters.
s TSS limits are 20 mg/L for wastewater discharges to HQW waters,10 mg/L for Trout and PNA waters, and 30 mg/L for all other water classifications.
Permit Date:7/1/2010-06/30/2015 Last Revised 07/13/11
Page 1 of 2

'Process wastewater discharges shall only be monitored for TPH when commingled with starmwater discharges from VMA areas. TPH does not have a limit for wastewater,
but instead is subject to benchmarks and provisions of Part N, Section A, including the Tiered Response Action.
'Flow rate can be measured continuously or calculated. Flow limits for wastewater discharges to HOW waters shall beset to 50% of the Summer 7010 Flow as per 15A
NCAC 028 .0224. Permittees who discharge wastewater tc HOW waters shall obtain a Summer 7Q10 flaw and report this information to DWQ. If the permittee cannot
abtain a Summer 7Q10 Flow for the receiving waters at the discharge location, the permittee shall notify DWO, and the DWQ Regional Office may require an annual flow
report on a case -by -case basis.
MAIL ORIGINAL AND ONE COPY OF THIS ANNUAL SUMMARY (INCLUDING ALL "NO FLOW 'NO_DISCHARGE") WITHIN 30 DAYS OF RECEIPT OF SAMPLEIOIt
AT EN2—QEMQNITQF1lNG PERIOD IN CASE OF "NO FLOW") TO:
Division of Water Quality
Attn: DWQ Central Files
1617 Mall Service Center
Raleigh, North Carolina 27699-1617
[phone]
YOU MUST Sf N THIS CERT14CATIONAtJY 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 respoi slble 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."
(Sig ure o rmittee) (date]
Permit Date: 7/1/2010-06130/2015 Last Revised 07/13/11
Page 2 of 2

P ceAnal ical'
■rw,patsuR>r.wm
CHAIN -OF -CUSTODY 1 Analytical Request Document
The Chairs-af-Custody Is a LEGAL. DOCUMENT. Atl relevant Folds must be complolod accurately.
Section A Section B Suction C
Papr of
Required Cllent Ir f matlom Requlrad Prc oc1 Inlormutlon: Irwdca fnfarmat m
Report Ta: Attenllon:
Company: Re
1821470
1 f
Addtasc Copy
To:
Company Neme:
REGULATORY AGENCY
liLd
Addrasa'
r NPOES C" GROUNDWATER r DRINKING WATER
UST RCRA (-'' OTHER
F,nail To: PurcRaee
A
Ordcr No.:
pace owle
u .c
Rfflla v:
Ph Far: Project
Noma:
PACO I -Mao
Site Location
1.,(r
Manager.
STATE.
RMustfad Due QaterAT; Prtjea
NUmbor.
Pala VrWo p:
Requested
Analyais
Flltored
(YIN)
Section G Matrla Codos
w
z
RJpudadcrwn„Woman MAIRM r Coor:
B
a
COLLECTED
p(UsurvativeS
Y
..
Dnaklrg Wamr DW
Water wr
WVsal0Water ww
U
n7fJaYitL
CLN.PaSRE
m
St..Irr
EfiUIGRAa
�1
solysolld SL
SAMPLE II] QL
SAwino wP
s
�,
a
Z
aj
1
iA-Z,"I.-) Air AR
w
d
W
a
H
Q
Samplo IDs MUST BE UNIQUE TLrsuo TS
0
�
a
�
=
f.-
'
M
tk
Other 07
X
�
0
m
o
u
�
z
a
�
p"
o
i
LO
�
z
s
z
�
�
C
�
DATE
TIME
CATE
TIME
�
�
O
a
Pace Project Nol Lab I.U,
w
6.
z
�1
Z
z
s
6
7
a
S
tD
11
121
ADDfii;ONAL COiIMENT5
REUNQIftSttf� BT! AFEi11A71f}N
OA7£
: TIME
A 0 ! AEF
TI
TE
;TIME
SArtP[ E GDNDfTION3
t
SAMPLER NAME AND SIGNATURE
ORIGINAL
-
PRINT M mr of SAMPL.Ew
r ..
-
MNATURE or SAUPLER:
Signed
�i
(FATE
i I
N
ui
ImpmInnt Nose, By sgnne lRla iarm you wn.,anp" Pr n's NEr 30 day pnymenr ba and agrneine 10 Lntfr rl+areo5 of 1.5%Pew moidn nal paid wk :n 3,n dry FALL-0420rev.07, 15-May-2007

aceAnalytical
www.Pacelabs.com
Pace Analytical Services, Inc.
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
Project: ROUGEMONT #25
Pace Project No.: 92285572
Eden Certification IDs
205 East Meadow Road Suite A, Eden, NC 27288
North Carolina Drinking Water Certification #: 37738
CERTIFICATIONS
North Carolina Wastewater Certification #: 633
VirginiafVELAP Certification #: 460025
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, Inc..
Page 2of9

PaceAnal ical®
wwwpacelabs.com
Pace Analytical Services, Inc.
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
SAMPLE ANALYTE COUNT
Project: ROUGEMONT #25
Pace Project No.: 92285572
Analytes
Lab ID Sample ID Method Analysts Reported Laboratory
92285572001 PLANT 425 0UTFALL #1 SM 2540D DWJ 1 PASI-E
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, Inc.. Page 3 of 9

aceAnalytical"
www.pacelabs.com
i
ANALYTICAL RESULTS
Project: ROUGEMONT #25
Pace Project No.: 92285572
Pace Analytical Services, Inc.
9800 Kincey Ave. Suite i0Q
Huntersville, NC 28078
[phone]
Sample: PLANT #25 OUTFALL #1 Lab ID: 92285572001 Collected: 02/04/16 08:20 Received: 02/05/16 15:10 Matrix: Water
Parameters Results Units Report Limit DF Prepared Analyzed CAS No. Qual
2540D Total Suspended Solids Analytical Method: SM 2540D
Total Suspended Solids 10.3 mglL 2.5 1 02/10/16 10:55
Date: 02/1212016 09:01 AM
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, Inc..
Page 4 of 9

�aceAnalj/fical
www.pacelabs.com
Pace Analytical Services, Inc.
9800 Kinsey Ave. Suite 100
Huntersville, NC 28078
[phone]
QUALITY CONTROL DATA
Project: ROUGEMONT ##25
Pace Project No.: 92285572
QC Batch: EDEN/21705 Analysis Method: N SM 2540D
QC Batch Method: SM 2540D Analysis Description: 2540D Total Suspender{ Solids
Associated Lab Samples: 92285572001
METHOD BLANK: 1663133
Associated Lab Samples: 92285572001
Parameter Units
Total Suspended Solids
mg/L
LABORATORY CONTROL SAMPLE:
Parameter
1663134
Units
Total Suspended Solids
mg1L
SAMPLE DUPLICATE: 1663135
Parameter
Units
Total Suspended Solids
mg1L
SAMPLE DUPLICATE: 1663136
Parameter
Units
Total Suspended Solids
mg/L
Matrix: Water
Blank Reporting
Result Limit Analyzed Qualifiers
ND 2.5 02/10/1610:51
Spike LCS LCS % Rec
Conc. Result % Rec Limits Qualifiers
250 250 100 90-110
92285759001 Dup
Result Result
44.5 45.0
92285802001 Dup
Result Result
98.0 95.0
RPD Qualifiers
i
RPD Qualifiers
3
Results presented on this page are in the units Indicated by the "Units" column except where an alternate unit Is presented to the right of the result.
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
Date: 0211212016 09:01 AM without the written consent of Pace Analytical Services, Inc.. Page 5 of 9

aceAnalyfical
www.pacelabs.com
i
QUALIFIERS
Project: ROUGEMONT #25
Pace Project No.: 92285572
DEFINITIONS
DF - Dilution Factor, if reported, represents the factor applied to the reported data due to dilution of the sample aliquot.
ND - Not Detected at or above adjusted reporting limit.
J - Estimated concentration above the adjusted method detection limit and below the adjusted reporting limit.
MOL - Adjusted Method Detection Limit,
PQL - Practical Quantitatiion Limit.
RL - Reporting Limit.
Pace Analytical Services, Inc.
9800 Kincey Ave, Suite 100
Huntersville, NC 28078
[phone]
S - Surrogate
1,2-Diphenylhydrazine decomposes to and cannot be separated from Azobenzene using Method 8270. The result for each analyte is
a combined concentration,
Consistent with EPA guidelines, unrounded data are displayed and have been used to calculate % recovery and RPD values.
LCS(D) - Laboratory Control Sample (Duplicate)
MS(D) - Matrix Spike (Duplicate)
DUP - Sample Duplicate
RPD - Relative Percent Difference
NC - Not Calculable.
SG - Silica Gel - Clean -Up
U - Indicates the compound was analyzed for, but not detected.
Acid preservation may not to appropriate for 2 Chloroethylvinyl ether, Styrene, and Vinyl chloride.
A separate vial preserved to a pH of 4-5 is recommended in SW846 Chapter 4 for the analysis of Acrolein and Acrylonitrile by EPA
Method 8260,
N-Nitrosodiphenylarnine decomposes and cannot be separated from Diphenylamine using Method 8270, The result reported for
each analyte is a combined concentration.
Pace Analytical is TNI accredited. Contact your Pace PM for the current list of accredited analytes.
TN -The NELAC Institute.
LABORATORIES
PASI-E Pace Analytical Services - Eden
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
Date: 02/12/2016 09:01 AM without the written consent of Pace Analytical Services, Inc.. Page 6 of 9

Pace Analytical Services, Inc.
9800 Kincey Ave. Suite 100
aCMnalyical Huntersville, NC 28078
I www.pacelahs.com (704 )875-9092
I
QUALITY CONTROL DATA CROSS REFERENCE TABLE
Project: ROUGEMONT #25
Pace Project No.: 92285572
Analytical
Lab ID Sample ID QC Batch Method QC Batch Analytical Method Batch
92285572001 PLANT #25 OUTFALL #1 SM 2540D EDEN121705
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
Date: 02/12/2016 09:01 AM without the written consent of Pace Analytical Services, Inc.. Page 7 of 9

Analytical a
Document Name:.
Sample Condition Upon Recelpt(SCUR)
Document rJo,:
F-RAL-CS-0o1-rev,o3
Client Name: Project 4:
MEN
Courier:
-- OFed Ex ❑UPS ❑U5P5 Client
❑Commercial ❑Pace []Other:
Custody 5eai on Cooler/Box Present? []Yes I ,fN0
Packing Material: ❑Bubble Wrap ❑Bubble Bags
IR Gun SN• 122D65387
Oocument Revlsed: 260CT2015
Page 1 of 2
Issuing Authority:
Pace Huntersville quality Office
uoa:s22sssra�
JI�IIlv2oi9111111111111
Seals Intact? ❑Yes G�fqo
None ❑Other:.
Thermometer ti IR Gun SN: 122G65971 Type of Ice: Vet ❑Bice ❑None ❑Samples on ice, cooling process has begun
Used; ++ ''
Cooler Temp Corrected ('C): `i , 2. Biological Tissue Frozen? ❑Yes ❑No [ N A q
Temp should be above freezing to 6°C Correction Factor: 0.0'C Date and Initials of Person Examining Contents: 2 1
USDA Regulated Soil { N/A, water sample)
Did samples o iginate In a quarantine zone within the United States: CA, NY, or SC (check maps)? Old samples originate from a foreign source (international1
Oyes �No including Hawaii and Puerto Rico)? ❑Yes allo
If Yes to either question, fill out a Reeulated Sol] Checklist and include with SCUR/COC naeerwork.
COMi1gENT5:
Chain of Custody Present?
Yes
(]NO
❑NIA
1.
Chain of Custody Filled Out?
Yes
-[]No
N/A
2.
Chain of Custody Relinquished?
Yes
❑No
N/A
3,
Sampler Name and/or Signature onCOC?
Yes
[]No
N/A
4.
5.
Samples Arrived within Hold Time? Yes Q14o N A
Short Hold Time Analysis (c72 hri?
Yes
QN0
N/A
6.
Rush Turn Around Time Requested?
Ycs
No
N A
7,
Sufficient Volume?
Vjy.
❑No
CINJA
B.
Correct ContainersU.sed?
f[lYes
❑No
❑N/A
9.
-Pace Containers Used?
rYes
EINQ
❑N/A
Containers Intact?
es
❑13o
N/A
10.
Filtered Volume Received for Dissolved Tests?
❑Yes
Quo
N/A
11. Note dsediment is visible In the dissolved container
Sample Labels Match COC?
]Yes
[]No
(]N/A
12.
-Includes Date/Time/ID/Analysis Matrix:
All containers needing acid/base preservation have been
13
checked?
®Yes
❑No
❑N/A
Ali containers needing preservation are found to be in
+J
compliance with EPA recommendation?
(HNoj, HzW4, 1-10k2; NaOH >9 Sulfide, NaDH>12 Cyanide)
Yes
❑No
❑N/A
Exceptions: VOA, Collform, TOC, Oil and Grease,
DRO/8015 (water) DOC,LLH
Yes
❑No
❑NIA
Sampies checked for dechlorizatlon
OYes
❑No
N/A
14.
Heads ace In VOA VIaLs >5-6mm)?
Dyes ,
No
N/A
15.
Trip Blank Present?
❑Yes
❑No
/A
16.
Trip Blank Custody Seals Present?
©Yes
[]NoN/A
Pace Trip Blank Lot if (if purchased):
CLIENT NOTIfICATION/RESOLUTION Field Data Required? Dyes, ONO
Person Contacted: Date/Time:
Cornrnents/Resolution: •
Project Manager SCURF Revlevt; C-- _ naro ?AA
Note: Whenever therein a discrepancy affecting North Carolina compliance samples, a copynf this form wdlpe sent to the North Carolina DEHNR Certification Office(Le. out of
hold, incorrect preservative, out of temp, Incorrect containers).
Page 8 of 9

GENERAL PERMIT NO. NCG140000
CERTIFICATE OF COVERAGE NO. N CG14_0 1 3O
FACILITY NAME: Plan+ 2S
PERSON COLLECTING SAMPLES A) S
CERTIFIED LABORATORY_ _P"y Lab # l
Lab #
OPTIONAL INFO:
Part A: Stormwater Monitoring Requirements
SAMPLE COLLECTION YEAR: _ Z 0lq�
SAMPLING PERIOD: Q July-0etember January -June
COUNTY C7/6bAj
PHONE NO. (?Jrj 3L Y -137,-
ADD TO LISTSERVE? ❑YES [—]NO EMAIL:
DISCHARGING TO CLASS: [—]SA ❑HQW ❑PNA ❑Trout ❑Other,
Outfall No.
Date Sample
Collected
(mo/dd/yr OR
NO FLOW)1
pH
(Standard
units)
TSS
(mg/L)
Event
Duration
(minutes)
Total
Rainfall 4
(in)
In Tier 2
Monthly
Monitoring?
(v/n )
# of Months in Tier
2 Samplingz
-
^
6-4Z
1002 3
-
o
-Z
3 b c
NOV I
CENT
1 If "NO FLOW" or "ISO 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.
a 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.
DIVED
ry 404
kL FILES
:CTION
Permit Bate: 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
Outfa[I
No.
Date Sample
Collected
(mo/dd/yr)l
PH
(Standard
Units)
TPH using method
1654A SGT-FITM
(mg/t.)
Total Suspended
Solids
(mg/L)
Event
Duration
(minutes)
'fatal
Rainfalla
(in)
New Motor Oil
Usage
(gal/month)
2 Tier
In InTierMonthly
Monitoring?
Wn)
# of Months
in Tier 2
Z
Sampling
6-92
152
100z,a
-
-
-
-
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES AT ANYONE OUTFALL (INCLUDING VEHICLE MAINTENANCE)? YES ❑ NO
HAVE YOU CONTACTED THE REGION? YES F1 NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail original and one co_pV of 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
am aware that th e are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
D .6 l
(Signature Per ttee) (Date)
Permit Date: 7/1/2011-60/30/2015 last Revised 7/13/11
Page 2 of 2

4
1. Outfall Description:
Outfall No. 1 Structure (pipe itch c.)
Receiving Stream:
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 distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.): NDN -R—
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
0 2 3 4 5
5. Floating Solids: Choose the number which best describes the amount of floating solids in
the stormwater discharge, where 1 is no solids and 5 is the surface covered with floating solids:
]) 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:
2 3 4 5
7. Is there any foam in the stormwater discharge? Yes I o
a. Is there an ah sheen in the stormwater discharge? Yes
:. Is there evidence of erosion or deposition at the outfall? Yes
16, OtherObvious indicators of Stormwater Pollution:
Exist and describe uotAl-
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
5WU-242, Last modified 10/25/2012

I)
RDENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Forguidance on filling out this form, please visit: littl2:1/portal,ncdenr.org/web.�wq/wslsu/npdessw#tab-A
Permit No.: N/C/_/_/_/_/_/_/_/ or Certificate of Coverage No.: N/C/G/L/-Y/ -!?/ 1/-3/ 01
Facility Name: 4?19Ln4- xs RQUJAM04
County: of-1ZSoo Phone No. 336 `364 -13 75'
Inspector: �1 Ahu wmyjws-
Date of Inspection: 10 ✓<1Sh y
Time of Inspection: '] : 3 a A �
Total Event Precipitation (inches): # SD
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
(See information below.)
[5"Y es ❑ No
Please verify whether Qualitative Monitoring must be 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 "measureable 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 least 72 hours
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 that this report is accurate and complete to the best of my knowledge:
off"ermittee or Designee)
Page 1 of 2
SWU-242, Last mortified 10/25/2012

aceAnalytical
www.p9[et&bS.odm
Laboratory Report
Jay Watkins
Ready Mix Concrete
PO Box 27326
Raleigh, NC 27611
Project: PLANT #25 ROUGEMONT
Pate Analytical Services, Inc.
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
Page 1 of 1
Report Date. 10/3112014
Date Received: 10/16/2014
Pace Project No.: 92221752
sample: OUTFALL #11PLANT 25 tab ID: 92221752001 Collected: 10/15/14 07:30 Matrix: Water
Parameters Results Units Report Limit Analyzed Qualifiers
Total Suspended Solids 25.5 mg/L 12.5 10/22/14 09:49
Reviewed by: �f�•.fe n ` ,��~
Laura J Cooper
[e-mail]
Raleigh Certification IDs
6701 Conference Drive, Raleigh, NC 27607
North Carolina Wastewater Certification #: 67
North Carolina Bioassay Certification #: 16
North Carolina Drinking Water Certification #: 37731
Page 1 of 3

Document Name: Sample Condition Upon
Document Revised: April04, 2013
Receipt SCU.R
Pa 91 of 2
r!'c3G8f�f18fj�tiG21+
1 """"P""•`°°""".
Document No.:
Issuing Authorities: •-...;:._..=�.
'
F-RAL-CS-001-rev.02
Pace Asltevllle Qualil t7ifl�
Client Name:_ \�
Where Received: [] Ltuntt;r Ole Asheville Eden aleigh
CouHer (Cfroie): • Fed l=x UPS` USPS le Commercial Paco . Other 4
Custody Seal on Coolerll3ox Present: yes fY no Seals intact: yes Ao 6 h
� F
Packing Material;' Q"EtUbtlfe Wrap' ❑ Bubble Bags None Outer
,.
Circle Thermometer Used: I ' RGun SN:1220555&ype of Ice: Blue None ❑ Samples on Ice, cooling praooes teas mon
• _• lR Gun Bank tip SN:122085371 '
,.
Temp Correction Factor• Add ! Su �r ct C
Dale and Initials of parson axag�intpg .
^1
Corrected Cooler Temp.: C.
Biological Tissue Is Frozen: Yes go
contents Pr eF,.rz n `'
cheak
Temp. should be above freezing to B'C
Comments:
Chi! In of Custody Present
Yes ©No ' DNUA
1•. -
Chain of Custod -Filled Out:
cs ow
❑tVA
2.
-
Chain of Custody Relin ulshed:
0a Otto
❑MA
3:
Sam eler Name & Si nature on CDC:
as: ONO
EWA
4.
Sam les Arrived vdthln Hold Time:
Yea ❑No._
dNw
B.- .
Short Hold Time Analysis' <72hr :
0Yee JKO
OWA
6•
.: •.
Rush Turn Around Time Requested:
pve,
OwA
7.
Sumclent Volume:.
Yas Otb
DNIAl
8' .
Correct Gontalners Used:
ON.
6�A
a. ,
-IJ
Pace Containers Used:
,13i'ei
s ONO
©WA
Contain&rs intacl:-PY98
ONO
©N!A
10.
Filtore'd volume •recalved for Dissolved tests
DYes DNo.
A
11.
SatWole Labels.match COG:
/ ss QRo
ONfA
12;
-Includes dateftime/10/Mal sis Matrix:
Alt contalnere needing preseraadon have been checked.
v � ©No
'' �
t]NUA
13,
All containers needing pmservation are found to be In
ONO
OVA
compliance with EPA recommendation.
.;
rice rbrW JOA, ootlforra, TOO, oho, M-OriO water
as, ON.
Samples chocked for dechlorinatlon:
DY©s C3Na
N!A
•14.
..
Heads ace In VOA Vials ?8rnm :'
Dyes ONO
IA
15,
Trap Blank Presont:
©Yes ONO XNJA
16,
TrOlan% Custody Seals Present
Gves DNto )MIA
Pace Trip Blank Lot It of urchasad
i
i
9
e.
`r
i
.I
Client Notittcatiflnl Resolution: Field Data Required?
F' t . �•..1=. i+).i ,.,.,,; , E
Person Contacted: Datefrime:
Comments/ Resolution:
SCURF/SR - _ date: lu �'� WO� , ; `7�Z 1s72 I
Rovlew:. '�
Note: tWhenever there is a ftoreparry aNecling North Carolina tom 1lance i •-
samples, a copy of lit'ss form Wit be sent to the North Carolina DE MNR 922Z17S2
certification -office( Le out of hold. Enoorrept preservative, out of temp,
incorrect canialnsrsj .
i
"iP"age

M
CHAIN-OF-CUSTODYIAra"gii
l'Request`Docijftte it= S'.
"7= Ti. Chaim. -of -Custody Cusintly is a
LEGAL bOCLEMEIVi. AIE rcic%ani C�clds must be Opmp10to0 aOCUmtpIY, ' -
"r;C. r:1i''' V;(;.rq ...CI-.•., •.
;.
I GVti+'7(IQI � l •
. . .
CD
m
a
' fYM.Wr�78W.CCh
,
Section A '
Sotlion B
Seet€on C
PaIIc: of
'. RaWred C.40n lnformsJoi1
Ra uL ed FraJei:f lnbarmkki., : ��� :
Imrolm trrforrnaElon:• • • ...
-
Camps .
' '
Rcpart 7�
-
-
- O
�fr n` 7 Q
� �- ... 1 8 2 1 1 V
'
Copy To:
-
Company NSML-
1REWLATORY 7lGtN
F WDES
"` GROUND WATER r" DRINKING WATER.
Ta:
Purc3re'e Order No.:
b
F UST
RCRA i"' OTHER
S
a
Fa
Prpject
1 4
ya"p°n Rom.
,L)DCafJon
I.
'
nM- DabdtAi:
lrgea
p,�e Prom a: c6 -
srAiE.
7
Yr
•
3atilonD
Seaton JWneh �4on
tl6aVla Cotla
,9Taex r coot+.
a..
COLLECTED
PreservatnroS-
DRm%u p WSW DW
zz
Water W!
u
O
Water Ww
m ART
w,
2
-%-scw SL
i
wri
SAMPLED
°m`P, WP
'S
a
�'
x
r
rnzaa�.) .,
Air nR•dx
x
1 ]�5
Swn* 103 MUST BE UNWE'
TLMs O TS .
•
_a
w
[00
2,
u
Z
x'
a
W
L`
to
a
m
C)
Q
~
VATS
TIME
DAre-
74de
#
�
�
_
=
z
z
�
�
�
a
Pace Project MaJ Lab LD:
x
f-:
^T
s
-k
.. - ,ilt7txT10±U1LGOiNpILNlSc',
.$f1b14U1,SliFD`S1f.'IAFFTLA710N
�}",;•0{[�F."-=
T1I1tE
SA LECONUMNS00
Ala
SAMPLER 'NAME hN0F,3CctiAT7�R£:':.
.K
ORIGINAL'PRiNTNamvrS
.P..
'�
•..
A'
MPLER_
- - . • .
'
- IIAT
'.
-
-
-
•S4CRATURE pf SAB7PLER:
r..� - ..
' }-f:Y+
,, C.%� z -
. s-'4yr:
/✓..✓'r" {lildldt�+f1'Y :
..✓'r.
^A
�,�
'HVcr'.Anl Nvl=Ely siPM Ve I.— yp rtY4MxptRq Pn,'3 NET JD caY, wCe,l Lid` ;il;i jf"H'Ll'r(11.:'.^-CT3K2i'e(�'f^�"xfLT10f1w.4iLJ .f'V33: .1[If1 '.7 uYhJ :.R'11M1: •••:,y:'. "r•'1Y�.. rYM.'?'::: M.: ,' +`:f:.-1C..::v:`. L��.:l:�Gf 'F.]ail.[.'y(i=k`,�i i'�.Q7:-i�-:�aw7nn?. 's.. _�� ,-

RECEIVED
MCDENR APR o 1 2014
Stormwater Discharge ®utfa➢1(SD) CENTRAL FILES
Qualitative Monitoring Report . ©WQIBOG
For guidance on filling outthisform, please visit, htr 1: � :un ta,l.ilctl�.tll.c�r av�Pl/a�A�. :sti r��rc
Permit No.: N/C/�/�/�/�/_/_/_/ or Certificate of Coverage No.:
Facility Name: P1 .4_aS r2oa.A
County: an Phone No. 336— 3Cq-I —75-
lnspectoi% im 4, c
Date of Inspection: , f r7 Jr-4
Time of Inspection: _ J�so 0,y.
Total Event Precipitation (inches): .25'
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
(See information below.)
211�Yes ❑ No
Please verify whether Qualitative Monitoring must be 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 "measureable storm event." However,
some permits do not have this requirement. Please refer to these definitions, if applicable.
t 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
i 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 rrom the
permitted site outfall. The previous measurable storm event must have been at least 72 hours
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 that this report is accurate and complete to the best of my knowledge:
(Signature`6f Permittee or Designee)
Page 1 of 2
SWU-242, fast modified 10/25/2012

1. Outfall Description:
Outfall No. I Structure (pipe, (a etc.)
Receiving Stream:
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: __ i lcar
3. Odor. Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.): �J 0-
4. Clarity: Choose the number which best describes the clarity of the discharge, where I is
clear and 5 is very cloudy:
(E) 2 3 4 5
S. Floating Solids: Choose the number which best describes the amount of floating solids in
the stormwater discharge, where 1 is no solids and S is the surface covered with floating solids.-
2 3 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:
a 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
9. Is there evidence of erosion or deposition at the outfall? Yes
10. Other Obvious indicators of Stormwater Pollution:
List and describe Nr,'-
Mote: 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, Last modified 10/25/2012

STORMWATER DISCHARGE OUTFALL (SIDO) - Semi -Annual MONITORING FORM
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF COVERAGE NO. NCG14 0 1 c7
FACILITY NAME: _ P1anf,95_
PERSON COLLECTING SAMPLES _ AiA C_
X05-
CERTIFIED LABORATORY Pot& Lab # _ Q I_
Lab #
OPTIONAL INFO:
Part A: Stormwater Monitoring Requirements
SAMPLE COLLECTION YEAR: -ZOi 9 .
SAMPLING PERIOD: ❑ July -December [j?rJanuary-June
COUNTY _ Ora M.-
PHONE NO. (_12A_) 3LY-- Iz7�
ADD TO LISTSERVE? ❑YES ONO EMAIL:
DISCHARGING TO CLASS: ❑SA ❑HQW ❑PNA []Trout ❑Other
Outfall No.
Date Sample
Collected
(mo/dd/yr OR
NO FLOW)1
pH
(Standard
units)
T55
(mg/L)
Event
Duration
(minutes)
Total
a
Rainfall
(in)
In Tier 2
Monthly
Monitoring?
(y/n)
# of Months in Tier
2
2 Sampling
-
-
6-92
1002'
-
-
-
-
1
- 2.
sya
z
I
z 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.
s TSS benchmark values are 100 mg/l, 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
Outfail
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
Rainfalla
(in)
New Motor Oil
Usage
(gal/month)
Month) In Tier Z
y
Monitoring?
Wri)
#1 of Months
in Tier 2
Samplingz
6-92
is
1002,3
-
-
-
-
-
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES AT ANY ONE OUTFALL (INCLUDING VEHICLE MAINTENANCE)? YES ❑ NO 101,
HAVE YOU CONTACTED THE REGION? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail Original and one coov of 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. I
am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
(Signature of lermittee)
�jnlr4l
(Date)
Permit Date: 7/1/2011-60/30/2015
Last Revised 7/13/11
Page 2of2

a0Analytical
"
www.P"ftbscom
Laboratory Report
MD Capps
Ready Mix Concrete
PO Box 27326
Raleigh, NC 27611
Project: PLANTS #25
Pace Project No,:92193593
Sample: OUTFALL 1 Lab ID: 92193593001 Collected: 03/17/14 12:51
Parameters Results Units Report Limit Analyzed
Total Suspended Solids 6.1 mg[L 5.1 03/24/14 16:43
Reviewed by:
Nikitia Jones -Jackson
[e-mail]
Asheville Certification IDS
2225 Riverside Dr., Asheville, NC 28804
Florida/NELAP Certification #: E87648
Massachusetts Certification #: M-NC030
North Carolina Drinking Water Certification #: 37712
Pace Analytical Services, Inc.
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
Page 1 of 1
Report Date: 03/26/2014
Date Received: 03/18/2014
Matrix: Water
Qualifiers
North Carolina Wastewater Certification #: 40
South Carolina Certification #: 99030001
West Virginia Certification #: 356
VirginiaNELAP Certification #: 460222
Page 1 of 3

Report Results to:
Ready Mixed Concrete
P.O.Box 27326
Raleigh, NC 27611
M0 Lapq.>
ATTN: 1ohn-WAS4"
Phone: [phone]
tale Chain of Custody
Bill Results to:
Ready Mixed Concrete
P.O.Box 27326
Raleigh, NC 27611
I" tdck�6,4
ATTN: JDJJrL-W-.l%
4ZI
EIStandard Report Delivery
0 Rush Report Delivery (wl surcharge)
Requested Due Date:
Project Reference: Plants #25
Purchase Order #:
Sampled By: NorApp---,
cp ion
W.
'Q— Of WIM M.—W 11111 N
te
ERE&
Vg -7
§ 144 wra rl� I
U,
.. .... . ... IM w 11 117L- MWI, nil.
r.
iEH -'Piz
i I —M ti 4 ;;1
�!i�L
Outfall I
G
31)7fiY
Sw
TSS
Relinquished by (signature)
46M,:iz
I ReCeiVed by (s atu
I U� t 'L
)
1 1, L(L
D to
- 9
*0ae
.
Time
�O -, a
For Lab Use Only
Temperature at receipt:
ITemp: C.
R�'Ihed by (4-nature)
Receivid by (signature) I
Time
Relinquished by (signature)
Received by (signature)
I
Date
Time
(n
0

Document Name: Sample Condition Upon
Document Revised: April 04, 2013
���aceAnalytic�l�
Receipt (SCUR)
Pa e'1 of
Document No.:
Issuing Authorities:
F- L-CS- 01 rev.02
Pace Asheville Quality Office
Client Name: r
Where Received: Huntersyille Ash Eden Raleig4
Courier (Circle): - Fed'Ex LIPS USPS Client Commercial Pace . Other
Custody Seal on CoolerlSox Present. ❑ yes no Seals Intact. yes no
Packing Material: Ej Bubble Wrap �rbl�4s cgs 4j No Otherl`�
Circe Thermometer Used: IR Gu 5N'1221)65387Type-of ice: Wet Blue done Samples on ice, cooling process has begun
IR Gun B [
Temp'Correctlori Factor: Add A�ac�
Corrected CooterTemp,: .. C
Temp -should be above freezing to S°C
r C
Biological Tissue fs'Frozen: yes W WA
Comments:
Date anti Initials of person examining
Co t #s Pr g o A
check. L -
Chain i}f Custody.Present:...
[Ass —❑No
L7wA
f. :.......
.:... -... ,_.' ...- . .
Chain of Custody -Filled Out;
yes 0No
❑wA
2..
Chain of Custody Rellnqufshad:
Yes L7No
❑N!A
3.
Sampler Name.& Signature on COC:
Yes DNv
DMA
4.
Saris IesArrived wlihin Hold Time.
91Yes -❑No
El N/A
5..
Short Hold Tlme Arialysls <72hr :
❑vas No
❑NIA
B..
Rush Turn Around Time Requested:
clyes No
❑NIA
7.
Sufficient Volume:
es ❑No
❑WA
$: '
Correct Containers Used:
-Pace Containers. Used:
Gres ❑No
/ Yes ❑No
©WA
❑wA
9.
Containers intact:
es ©No
©NIA
10.
Filtered volum6,received for Dissolved tests
Dyes ©No
JZNIA
11.
Sample Labals match COO:
-Includes dateltimelfDlAnal sis Matrix:
Yes QNo
❑NIA
12.
All containers needing preservation have been checked.
M containers needing preservation are found to be Ir.
compliance with EPA recornmendatlon.
exceptlons: YOA, palitorm, TOG, O&G, MDRO (water)
es 0No
yes [:]No
Yes ON.,
❑wA
ONIA
13.
Samples checked for dechlorinatlen:
es ClNo
❑NIA
14,
Heads ace In VOA Vials n6mm):
❑Yes ONO
NIA
16,
Trip Blank Present:
Trip Blank Custody Seals Present
Pace Trip Blank Lot # if purchased):.
OYes ONo
DYes ❑No
NIA
AM
16,
Client Notificatlon7 Resolution: Field Date Required? Y 1 - N
Person Contacted: DateMme:
Comments/ Resolution:
Page 3 of 3