NCG160085_MONITORING INFO_20190115

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO. /v u&
DOC TYPE HISTORICAL FILE
�MONI70RING REPORTS
DOC DATE ❑
YYYYMMDD

CERTIFICATE OF COVERAGE NO. NCG 169 JL T, Z
FACILITY NAME /%?Auk' J eZ%,, -
COUNTY
PERSON COLLECTING SAMPLES 1.4 If
LABORATORY M4%" Lab Cert. # o1
Comments on sample collection or analysis:
Part A: Stormwater Benchmarks and Monitoring Results
Semi-annual Stormwater Discharge Monitoring Report (DMR)
for North Carolina DEMLR General P r it No. NCG160000 - Asphalt
Date submitted
SAMPLE COLLECTION YEAR ,20/17
SAMPLE PERIOD ❑ Jan -June ❑ July -Dec
or Monthly'_ 2a*&44C {month)
DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
❑Zero -flow ❑Watersupply ❑SA
[]other
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Outf all No.
Date Sample
Collected
{mo/dd/yr)
24-hour rainfall
amount,
1nches3
Total Suspended Solids
Benchmarks =__>
_
-
100 mg/L or 50 mg/0
o
�r
4
No discharge this period?'
RECO ED
.1AN 15 2019
CENTT-�AL FILES
DWR S CT 0111]
' Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
2 For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here.
3The total precipitation must be recorded using data from an on -site rain gauge. Unattended sites may be eligible for a waiver of the rain gauge requirement.
° See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Note: Results must be reported in numerical format. For example, do not report Below Detection Limit, BDL, <PQL, Non -detect, ND, or other similar non -
numerical format. When results are below the applicable limits, they must be reported in the -format, "<XX_mg/L", where XX is the numerical value of the
detection limit, reporting limit, quantitation limit, etc. in mg/L.
!Vote: If you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses. See General Permit text.
Permit Date: 10/1/2014-9/31/2019 SWU-252, last revised 9/17/2014
Page 1 of 2

Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month.
❑ No discharge this period?'
Outfall No.
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
Inches3
Non -polar O&G by EPA
1664 (SGT-HEM)
Total Suspended Solids
Benchmarks
15 mg/L
100 mg/L or 50 mg/L
Footnotes from Part A also apply to this Part B
Note: If you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses. See General Permit text.
FOR PART A AND PART B MONITORING RESULTS:
A SINGLE BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2.REQUIREMENTS.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE'BENCHMARK EXCEEDANCES FOR THE SAME PARAMETER AT ANYONE OUTFALL? YES ❑ NO ❑
IF YES, HAVE YOU CONTACTED THE DEMLR REGIONAL OFFICE A§REQUIRED BY THE PERMIT? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an on inal and one copy of this DMR including all "No Discharge" reports, within 30 days ot receipt of the lab results for at end of monitorinaperiod
in the case of "No Discharge" reports) to:
Division of Water Resources
Attn: DWR 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
Permit Date: 10/1/2014-9/31/2019 SWU-252, last revised 9/17/2014
Page 2 of 2

Aliokel-11
Semi-annual Stormwater Discharge Monitoring Report (DMR)
for North Carolina DEMLR General Pe it No. NCG160000 - Asphalt
Date submitted
CERTIFICATE OF COVERAGE NO. NCG16 0 j�P
FACILITY NAME
COUNTY �
PERSON COLLECTING SAMPLES !� o K�/ Y Lt/�L!✓Arn,�
LABORATORY_ - f=== Lab Cert. #i �3 w
Comments on sample collection or analysis:
Part A: Stormwater Benchmarks and Monitoring Results
SAMPLE COLLECTION YEAR >20/
SAMPLi: PERIOD ❑ Jan -June M July -Dec
or ❑ Monthly'_ - _ _ _ month)
SEPISCHOWNG TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
CENTRAL FILES ❑Zero -flaw []Water Supply ❑SA
OWR SECTiCN []Other
PLEASE REMEMBER TO SIGN ON THE REVERSE -->
❑ No discharge this period?Z
Outfall No.
Date Sample
Collected
(mo/dd/yr)
24-hour rainfall
amount,
Inches3
Total Suspended Solids
Benchmarks =_->
_
-
100 mg/L or 50 mg/L
' Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
z For sampling periods with no discharge at any single outfali, you must still submit this discharge monitoring report with a checkmark here.
3The total precipitation must be recorded using data from an on -site rain gauge. Unattended sites maybe eligible for a waiver of the rain gauge requirement.
4 See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Note: Results must be reported in numerical format. For example, do not report Below Detection Limit, BDL, <PQL, Non -detect, ND, or other similar non -
numerical format. When results are below the applicable limits, they must be reported in the format, "<XX mg/L", where XX is the numerical value of the
detection limit, reporting limit, quantitation limit, etc. in mg/L.
(Vote: if you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses. See General Permit text.
Permit Date: 10/1/2014-9/31/2019 SWU-252, last revised 9/17/2014
Page 1 of 2

Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month.
❑ No dischorge this period:2
Outfall No.
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
Inches3
Non -polar O&G by EPA
1664 (SGT-HEM)
Total Suspended Solids
Benchmarks =__>
_
-
1S mg/L
100 mg/L or SO mg/0
Footnotes from Part A also apply to this Part 6
Note: If you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses. See General Permit text.
FOR PART A AND PART B MONITORING RESULTS:
• A SINGLE BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDANCES FOR THE SAMEPARAMETER AT ANY ONE OUTFALL? YES ❑ NO ❑
1F YES, HAVE YOU CONTACTED THE DEMLR REGIONAL OFFICE AS'REQUIRED BY THE PERMIT? YES []NO[:]
REGIONAL OFFICE CONTACT NAME:
Mail an original and one cony of this DMR. lncludina all "No Discharge" reports, within 30 days of recelpt of the lab results (or at end of monitoring period
in the case of "No Discharae" reports) to:
Division of Water Resources
Attn: DWR 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 atiachments 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 foe knowing violations."
{Signarure of Permittee)
Permit Date:10/1/2014-9/31/2019
_ y/_
(date)
SWU-252, last revised 9/17/2014
Page 2 of 2

Semi-annual Stormwater Discharge Monitoring Report (DMR)
for North Carolina DEMLR General Permit No. NCG160000 - Asphalt
Date submitted _. 2. -�
CERTIFICATE OF COVERAGE NO. NCG16.0 jj" SAMPLE COLLECTION YEAR XDc q
FACILITY NAME Gu SAMPLE PERIOD [A Jan -June ❑ July -Dec
COUNTY _/�r� or ❑ Monthly' (month)
PERSON COLLECTING SAMPLES, ,_ o4dur f,,%L� �yy�4 ®�r�ISCHARING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
LABORATORY lPAe Lab Cert. fl GG _ _ i� ❑Zero -flow ❑Water Supply BSA
Comments on sample collection or analysis: MAR 0 9 2013 ❑Other
CIEN 1 KAL FILE % PLEASE REMEMBER TO SIGN ON THE REVERSE 4
SECTION
Part A: Stormwater Benchmarks and Monitoring Results
No discharge this period?2
Outfall No.
Date Sample
Collected
(mo/dd/yr)
24-hour rainfall
amount,
Inches
Total Suspended Solids
Benchmarks ===>
_
-
100 mg/L or 50 mg/L
o
'2.L. .toy
a so
2.
1 Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
2For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here.
3The total precipitation must be recorded using data from an on -site rain gauge. Unattended sites may be eligible for a waiver of the rain gauge requirement.
See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Note: Results must be reported in numerical format. For example, do not report Below Detection Limit, BDL, <PQL, Non -detect, ND, or other similar non -
numerical format. When results are below the applicable limits, the must be reported in the format, "<XX mg/L", where XX is the numerical value of the
detection limit, reporting limit, quantitation limit, etc. in mg/L.
Note: If you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses. See General Permit text.
Permit Date: 10/l/2014-9/31/2019 SWU-252, last revised 9/17/2014
Page 1 of 2

Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month.
❑ No discharge this period?z
Outfall No,
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
Inches;
Non -polar O&G by EPA
1664 (SGT-HEM)
Total Suspended Solids
Benchmarks =__>
_
-
15 mg/L
100 mg/L or 50 mg/L
Footnotes from Part A also apply to this Part B
Note: If you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses. See General Permit text.
FOR PART A AND PART B MONITORING RESULTS:
• A SINGLE BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS.
TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDANCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES ❑ NO
IF YES, HAVE YOU CONTACTED THE DEMLR REGIONAL OFFICE•AS"REQUIRED BY THE PERMIT? YES ❑ NO ❑
1
REGIONAL OFFICE CONTACT NAME:
Mail an oriainal and one copy of this DMR, including all "No Discharge" reports, within 30 days of receipt of the lab results (or at end of monitoring period
in the case of "No Discharge" reports) to:
Division of Water Resources
Attn: DWR 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 thereare significant penalties;for submitting false information, including the possibility of fines and imprisonment for knowing violations."
J j
(Signature of P mittee) (Date)
Permit Date: 10/1/2014-9/31/2019 SWU-252, last revised 9/17/2014
Page 2 of 2

Semi-annual Stormwater Discharge Monitoring Report (DMR)
for North Carolina DEMLR General Per it o. NCG160000 - Asphalt
Date submitted -2 -1 1�
CERTIFICATE OF COVERAGE NO. 14CG16 n 0 F �2
FACILITY NAME ,L
COUNTY
PERSON COLLECTING SAMPLES . 1L1AOK4-57
LABORATORY PAee- Lab Cert. # G�
Comments on sample collection or analysis:
Part A: Stormwater Benchmarks and Monitoring Results
SAMPLE COLLECTION YEAR CZ/7
SAMPLE PERIOD ❑ Jan -June X July -Dec
��i+� ,,o ❑ Monthlyl (month)
DISCHARGING-JO CLASS ❑ORW ❑HQW []Trout❑PNA
JAN 09 20i8 ❑zero -flow ❑Water5upply ❑SA
❑Other
Wr0RM4SECTION
OtV PROCE SING U!
EA5E REMEMBER TO SIGN ON THE REVERSE 4
No discharge this period:2
outfall No.
Date Sample
Collected"
(mo/dd/yr)
24-hour rainfall
amount,
Inches3
Total Suspended Solids
Benchmarks =_=>
_
-
100 mg/L or 50 mg/0
' Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
2 For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here.
3The total precipitation must be recorded using data from an on -site rain gauge. Unattended sites may be eligible for a waiver of the rain gauge requirement.
See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Note: Results must be reported in numerical format. For _example _do not report Below Detection Limit, BDL, <PQL, Non -detect, ND, or other similar non -
numerical format. When results are below the applicable limits, they must be reported in the format, "<XX mg/L", where XX is the numerical value of the
detection limit, reporting limit, quantitation limit, etc. in mg/L.
Note: If you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier responses. See General Permit text.
Permit Date: 10/1/2014-9/31/2019 SWU-252, last revised 9/17/2014
Page 1 of 2

Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month.
❑ No discharge this period?z
Outfall No.
Date Sample
Collected,
(mo/dd/yr)
24-hour rainfall
amount,
Inches;
Non -polar O&G by EPA
1664 (SGT-HEM)
Total Suspended Solids
Benchmarks
15 mg/L
100 mg/L or 50 mg/L
Footnotes from Part A also apply to this Part B
Note: If you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses. See General Permit text.
FOR PART A AND PART B MONITORING RESULTS:
• A SINGLE BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDANCES FOR THE SAME PARAMETER AT ANYONE OUTFALL? YES ❑ NO ❑
IF YES, HAVE YOU CONTACTED THE DEMLR REGIONAL OFFICE AS REQUIRED BY THE PERMIT? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an original and one copy of this DMR, including all "No Discharge" reports, within 30 days of receipt of the lab results for at end of monitorina period
in the case of "No Discharge" reports) to:
Division of Water Resources
Attn: DWR Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED: "L
"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."
(Date)
Permit Date:10/1/2014-9/31/2019
SWU-252, last revised 9/17/2014
Page 2 of 2

Semi-annual Stormwater Discharge Monitoring; Report (DMR)
for North Carolina DEMLR General mitlo.";i
NCG160000 - Asphalt
date submitted
CERTIFICATE OF COVERAGE NO. NCG16 0 O TS
FACILITY NAME
COUNTY 4
PERSON COLLECTING SAMPLES 1 o11G✓y_.t 6A*?S
LABORATORY PAek Lab Cert. #; G"
Comments on sample collection or analysis:
Part A: Stormwater Benchmarks and Monitoring Results
SAMPLE COLLECTION YEAR
SAMPLE PERIOD [MJan-June ❑ July -Dec
or ❑ Monthly'_ _ _ _(month)
DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
❑Zero -flow ❑Water Supply ❑SA
❑Other
PLEASE REMEMBER TO SIGN ON THE REVERSE -->
❑ No discharge this period?z
Outfall No.
date Sample
Collected
{mo/dd/yr}
24-hour rainfall
amount,
inches3
Total Suspended Solids
Benchmarks =-=>fftne=
-
100 mg/L or 50 mg/L
a
17
RECEIVED
MAY 0 9 2017
CENTRAL FILES
DWR SECTION
= Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
? For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here.
;The total precipitation must be recorded using data from an on -site rain gauge. Unattended sites may be eligible for a waiver of the rain gauge requirement.
4 See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Note: Results must be reported in numerical format. For example, do not report Below Detection Limit, BDL, <PQL, Non -detect, ND, or other similar non -
numerical format. When results are below the applicable limits, they must be reported in the format, "<XX mg/L", where XX is the numerical value of the
detection limit, reporting limit, quantitation limit, etc. in mg/L.
Note: If you report o sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses. See General Permit text.
Permit Date: 10/1/2014-9/31/2019 SWU-252, last revised 9/17/2014
Page 1 of 2

Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month.
❑ No discharge this period?2
Outfall No.
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
Inches;
Non -polar O&G by EPA
1664 (SGT-HEM)
Total Suspended Solids
Benchmarks =__>
_
-
15 mg/L
100 mg/L or 50 mg/L
Footnotes from Part A also apply to this Part B
Note: If you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses. See General Permit text.
FOR PART A AND PART B MONITORING RESULTS:
• A SINGLE BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDANCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES ❑ NO ❑
1F YES, HAVE YOU CONTACTED THE DEMLR REGIONAL OFFICE AS REQUIRED BY THE PERMIT? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an oriainal and one copv of this DMR, Includina all "No Discharge" reports, within 30 days of receipt of the lab results (or at end of monitorina period
in the case of "No Discharae" reports) to:
Division of Water Resources
Attn: DWR 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 there are significant penalties f6rsubm+tting.false information, including the possibility of fines and imprisonment for knowing violations."
(Signature of Permittee) (Da()
Permit Date: 10/1/2014-9/31/2019 SWU-252, last revised 9/17/2014
Page 2 of 2

Semi-annual Stormwater Discharge Monitoriny, Report (DMR)
for North Carolina DEMLR General Permit No. NCG160000 - Asphalt
Date submitted /O .S ;,?.0/6
CERTIFICATE OF COVERAGE No. NCG16Q (2 9
FACILITY NAME <-41�1E �o.✓s'Ylr.�/ C✓��r .�ir
COUNTY G1A�e
PERSON COLLECTING SAMPLES JJKNNjf 4,/,4 .4r-T
LABORATORY ./9X&A /� ;*Ie Lab Cert. # "011
Comments on sample collection or analysis:
Part A: Stormwater Benchmarks and Monitoring Results
SAMPLE COLLECTION YEAR ,?DIG
SAMPLE PERIOD ❑ Jan -June ® July -Dec
or ❑ Monthly" (month)
EC QISCHARGING TO CLASS ❑ORW ❑HQW [—]Trout❑PNA
11 V D ❑Ze►o-flow ❑Water Supply ❑SA
OCT 1 2 2j16 ❑Other
CENTRAL FILES PLEASE REMEMBER TO SIGN ON THE REVERSE 4
DWR SECTION
❑ No discharge this period?'
outfall No.
Date Sample
Collected
(mo/dd/y►)
24-hour rainfall
amount,
Inches
Total Suspended Solids
Benchmarks
100 mg/L or 50 mg/L
Recevet)
OCT I I all
CENTRAL FILE
DWR SECTION
' Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
z For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here.
3The total precipitation must be recorded using data from an on -site rain gauge. Unattended sites may be eligible for a waiver of the rain gauge requirement.
4 See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Note: Results must be reported in numerical format. For example, do not report Below Detection Limit, BDL, <PQL, Non -detect, ND, or other similar non -
numerical format. When results are below the applicable limits, they must be reported in the format, "<XX me/L", where XX is the numerical value of the
detection limit, reporting limit, quantitation limit, etc. in mg/L.
Note: If you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses. See General Permit text.
Permit Date: 10/1/2014-9/31/2019 5WU-252, last revised 9/17/2014
Page 1 of 2

Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > SS gal of new oil per month.
❑ No discharge this period?Z
Outfall No.
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
inches
Non -polar O&G by EPA
16641SGT-HEM)
Total Suspended Solids
Benchmarks
15 mg/L
100 mg/L or 50 mg/L
Footnotes from Part A also apply to this Part B
Note: If you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses. See General Permit text.
FOR PART A AND PART B MONITORING RESULTS:
• A SINGLE BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDANCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES ❑ NO ❑
IF YES, HAVE YOU CONTACTED THE DEMLR REGIONAL OFFICE AS REQUIRED BY THE PERMIT? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an original and one copy of this DMR. includina all "No Discharae" reports. within 30 days of receipt of the lab results (or at end of monitorina period
in the case of "No Discharae" reports) to:
Division of Water Resources
Attn: DWR 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 gati er'and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or
those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I
am aware that there are significant penalties for submitting'false information, including the possibility of fines and imprisonment for knowing violations."
(Signature of Permittee)
Permit Date:10/1/2014-9/31/2019
(Date)
SWU-252, last revised 9/17/2014
Page 2 of 2
r

Semi-annual Stormwater Discharge Monitoring Report (DMR)
for North Carolina DEMLR General Permit No. NCG160000 - Asphalt
Date submitted
CERTIFICATE OF COVERAGE NO. NCG16 Q 1 L
FACILITY NAME 4W,0- e6A1dTiPd6Tia.✓
COUNTY 4�AM_
PERSON COLLECTING SAMPLES ,o KN_A(� _&eMUA 9 S
LABORATORY ?AC- Lab Cert. fi 9z[►r�l}oo�
Comments on sample collection or analysis:
Part A: Stormwater Benchmarks and Monitoring Results
SAMPLE COLLECTION YEAR -�a/(o
SAMPLE PERIOD ® Jan -June ❑ July -Dec
or ❑ Monthly' (month)
jDISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
`ECEIVED ❑Zero -flow ❑Water Supply ❑SA
JUN 2 8 2016 ❑other
CENTRAL FiLE,PLEASE REMEMBER TO SIGN ON THE REVERSE -�
DWR SECTIOry
No discharge this period?z
Outfall No.
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
Inches3
Total Suspended Solids
Benchmarks ===>
_
-
100 mg/L or 50 mg/L
#�
ds• of,- 16
2-5'
' Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
2 For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here.
3 The total precipitation must be recorded using data from an on -site rain gauge. Unattended sites may be eligible for a waiver of the rain gauge requirement.
"See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Note: Results must be reported In numerical format. For example, do not report Below Detection Limit, BDL, <PQL, Non -detect, N D, or other similar non -
numerical format. When results are below the applicable limits, they must be reported in the format, "<XX me/L", where XX is the numerical value of the
detection limit, reporting limit, quantitation limit, etc. in mg/L.
Note: if you report a sample value in excess of the benchmark, you must implement rer 1, Tier 2, or Tier 3 responses. See General Permit text.
Permit Date: 10/1/2014-9/31/2019 SWU-252, last revised 9/17/2014
Page 1 of 2

Part 8: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month.
❑ No discharge this period?Z
Outfall No.
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
Inches3
Non -polar O&G by EPA
1664 ISGT-HEM}
Total Suspended Solids
Benchmarks ===>
-
-
15 mg/L
100 mg/L or 50 mg/L
Footnotes from Part A also apply to this Part B
Note: If you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses. See General Permit text.
FOR PART A AND PART B MONITORING RESULTS:
• A SINGLE BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS.
• TIER 3. HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDANCES FOR THE,SAME,PARAMETER AT ANY ONE OUTFALL? YES ❑ NO ❑
IF YES, HAVE YOU CONTACTED THE DEMLR REGIONAL OFFICE AS REQUIRED BY THE PERMIT?, YES ❑ NO
REGIONAL OFFICE CONTACT NAME:
Mail an oriainal and one coov of this DMR, includina all "No Discharge" reports, within 30 days of receipt of the lab results for at end of monitorinq period
in the case of "No Discharae" reports) to:
Division of Water Resources
Attn: DWR Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
YOU MUST SIGN THI5.CERTIFICATION FOR ANY INFORMATION•REPORTED: ° t,
"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 there are significant penalties #or submitting false information, including the possibility of fines and imprisonment for knowing violations."
(Signature of Permittee ([Sate}
Permit Date: 10/1/2014-9/31/2019 SWU-252, last revised 9/17/2014
Page 2 of 2

STORMWATER DISCHARGE OUTFALL (SDO)
GENERAL PERMIT NO. NCG160000
DISCHARGE MONITORING REPORT (DMR)
CERTIFICATE OF COVERAGE NO. NCG16©0®[s] SAMPLES COLLECTED DURING CALENDAR YEAR: 2 014
(This monitoring report is due at the. Division no later than 30 days from the date
the facility receives the sampling results from the laboratory.)
FACILITY NAME , 1_ 04 V,COUNTY 1 ✓RK� _
PERSON COLLECTING SAMPLES -PHONE NO. i �) f�
CERTIFIED LABORATORY, Q4C �47vA1•ificw/_ Lab# RECEIVED
T— Lab #
DEC 31 2014
Monitoring Requirements
CENTRAL FILES
n1AIM e%---.--_
Outfall
No.
Date
Sample Collected.
mo/dLtE
Total Rainfall.
Inches
00530
00400
Total Suspended Solids, M911.
pH,
Standard units
Total Petroleum Hydrocarbons; mg/l
EPA Method 1664 SG -HEM)
Benchmark
-
-
100
Within 6.0 -; 9.0
15.
= 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.
Mail original and one copy to:
Division of Water Quality
Attn: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-t6t7
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 responsiblp for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete.
I am aware thahere are sign pen�ltges for submitting false information, including the possibility of fines and imprisonment for knowing violations."
of
(Date)
S WU-253-051409
Page 1 of 1

aceAnalytical
wwwpacafabs.com
October 22, 2014
Mr. Marcus Hackler
Lane Construction
8205 Wilkinson Blvd.
Charlotte, NC 28214
RE: Project: W. RALEIGH ASPHALT PLANT
Pace Project No.: 92221453
Dear Mr. Hackler:
Pace Analytical Services, Inc.
9800 Kincey Ave. Suite 100 a
Huntersville, NC 28078
[phone]
Enclosed are the analytical results for sample(s) received by the laboratory on October 15, 2014.
The results relate only to the samples included in this report. Results reported herein conform to the
most current TN standards and the laboratory's Quality Assurance Manual, where applicable, unless
otherwise noted in the body of the report.
Analyses were performed at the Pace Analytical Services location indicated on the sample analyte
page for analysis unless otherwise footnoted.
If you have any questions concerning this report, please feel free to contact me.
Sincerely,
Calb,,.
Laura J Cooper
[e-mail]
Project Manager
Enclosures
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, Inc..
Page 1 of 11

laneAnalj6cal"
wmpacelabs.tom
Pace Analytical Services, Inc.
9800 Kincey Ave. Suite 100
Huntersvilie, NC 28078 ,�
[phone]
Project: W. RALEIGH ASPHALT PLANT
Pace Project No.: 92221453
Raleigh Certification IDs
6701 Conference Drive, Raleigh, NC 27607
North Carolina Wastewater Certification #: 67
Charlotte Certification IDs
9800 Kincey Ave. Ste 100, Huntersville, NC 28078
North Carolina Drinking Water Certification #: 37706
North Carolina Field Services Certification #: 5342
North Carolina Wastewater Certification #: 12
South Carolina Certification #: 99006001
CERTIFICATIONS
North Carolina Bioassay Certification #: 16
North Carolina Drinking Water Certification #: 37731
FloridalNEIAP Certification #: E87627
Kentucky UST Certification #: 84
West Virginia Certification #: 357
Virginia/VELAP Certification #: 460221
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, Inc.. Page 2 of 11

aceAnalytical
www.pecetab9.cam
SAMPLE ANALYTE COUNT
Project: W. RALEIGH ASPHALT PLANT
Pace Project No.: 92221453
Pace Analytical Services, Inc.
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
Analytes
Lab ID Sample ID Method
Analysts
Reported
Laboratory
92221453001 OUTFALL #1 EPA 1664B
CLW
i
PASI-C
EPA 1664E
CLW
1
PASI-C
SM 2540D
RC
1
PASI-R
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 11

aceAnalytical
www.p30el16s.cvm
ANALYTICAL RESULTS
Pace Analytical Services, Inc.
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
Project: W. RALEIGH ASPHALT PLANT
Pace Project No.: 92221453
Sample: OUTFALL #1 Lab ID: 92221453001 Collected: 10/15/14 09:35 Received: 10/15/14 10:55 Matrix: Water
Parameters Results Units Report Limit DF Prepared Analyzed CAS No. Qual
HEM, Oil and Grease Analytical Method: EPA 1664E
Oil and Grease ND mg/L 5.8 1 10/21/14 08:50
1664 SGT HEM, TPH Analytical Method: EPA 1664B
Total Petroleum Hydrocarbons ND mg/L 5.0 1 10/21/14 08:54
2540D Total Suspended Solids Analytical Method: SM 2540D
Total Suspended Solids 54.0 mg/L 16.7 1 10/22/14 09:49
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in fuil,
Date: 10/22/2014 11:26 AM without the written consent of Pace Analytical Services, Inc..
Page 4 of 11

aceAnalytical"
rvww.paoslabs.com
Project: W. RALEIGH ASPHALT PLANT
Pace Project No.: 92221453
OC Batch: GCSV119242
QC Batch Method: EPA 1664B
Associated Lab Samples: 92221453001
METHOD BLANK: 1311267
Associated Lab Samples: 92221453001
Parameter Units
Oil and Grease mg/L
LABORATORY CONTROL SAMPLE: 1311268
Parameter Units
Oil and Grease mg1L
Pace Analytical Services, Inc.
9800 KinceyAve. Suite 100
Huntersville, NC 28078
[phone]
QUALITY CONTROL DATA
Analysis Method: EPA 1664B
Analysis Description: 1664 HEM, Oil and Grease
Matrix: Water
Blank Reporting
Result Limit Analyzed Qualifiers
ND 5.0 10/21/14 08:50
Spike LCS LCS % Rec
Conc. Result % Rec Limits Qualifiers
40 37.8 94 78-114
MATRIX SPIKE SAMPLE: 1311269
92222103001 Spike MS MS % Rec
Parameter Units Result Conc. Result % Rec Limits Qualifiers
Oil and Grease mg1L <5.0 40 36,6 92 78-114
Results presented on this page are In the units Indicated by the "Units" cotumn 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: 10/22/2014 11:26 AM without the written consent of Pace Analytical Services, Inc.. Page 5 of 11

aceAnaljftal
wwwpomlabs.com
Project: W. RALEIGH ASPHALT PLANT
Pace Project No.: 92221453
QC Batch: GCSV119243
QC Batch Method: EPA 1664B
Associated Lab Samples: 92221453001
METHOD BLANK: 1311274
Associated Lab Samples: 92221453001
Parameter Units
Total Petroleum Hydrocarbons mg/L
LABORATORY CONTROL SAMPLE: 1311275
Parameter Units
Total Petroleum Hydrocarbons mg/L
Pace Analytical Services, Inc.
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
QUALITY CONTROL DATA
Analysis Method: EPA 1664E
Analysis Description: 1664 SGT-HEM, TPH
Matrix: Water
Blank Reporting
Result Limit Analyzed Qualifiers
ND 5.0 10/21/14 08:50
Spike LCS LCS % Rec
Conc. Result % Rec Limits Qualifiers
20 18.1 90 64-132
MATRIX SPIKE SAMPLE: 1311276
92222103001 Spike MS MS % Rec
Parameter Units Result Conc. Result % Rec Limits Qualifiers
Total Petroleum Hydrocarbons mg/L <5.0 20 16.9 84 64-132
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: 10/22/2014 11:26 AM without the written consent of Pace Analytical Services, Inc.. Page 6 of 11

aceAnalytical
tnvw.paoelabs.00m
QUALITY CONTROL DATA
Project: W. RALEIGH ASPHALT PLANT
Pace Project No.: 92221453
QC Batch: RWETf7353 Analysis Method: SM 2540D
QC Batch Method: SM 2540D Analysis Description: 2540D Total Suspended Solids
Associated Lab Samples. 92221453001
METHOD BLANK: 1310490 Matrix: Water
Associated Lab Samples: 92221453001
Blank Reporting
Parameter Units Result Limit Analyzed Qualifiers
Total Suspended Solids mglL ND 2.5 10/22/14 09:49
Pace Analytical Services, Inc.
9600 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
LABORATORY CONTROL SAMPLE: 1310491
Spike LCS LCS % Rec
Parameter Units Cone. Result % Rec Limits Qualifiers
Total Suspended Solids mg1L 250 250 100 90-110
SAMPLE DUPLICATE: 1310492
92221601001 Dup
Parameter Units Result Result RPD Qualifiers
Total Suspended Solids mg/L 1720 1860 8
SAMPLE DUPLICATE: 1310493
92221601002 Dup
Parameter Units Result Result RPD Qualifiers
Total Suspended Solids mg/L 1780 1700 5
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: 10/22/2014 11:26 AM without the written consent of Pace Analytical Services, Inc.. Page 7 of 11

Pace Analytical Services, Inc.
�CV^—aOcal 98D0 Kinsey Ave. Suite 100
VV�.�f! L� Huniersville, NC 28078
WWW'PaC hftcum [phone]
QUALIFIERS
Project: W. RALEIGH ASPHALT PLANT
Pace Project No.: 92221453
DEFINITIONS
DF - Dilution Factor, if reported, represents the factor applied to the reported data due to changes in sample preparation, dilution of
the sample aliquot, or moisture content.
ND - Not Detected at or above adjusted repotting limit.
J - Estimated concentration 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-Diphenylhydrazine (8270 listed analyte) decomposes to Azobenzene.
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.
N-Nitrosodiphenylamine decomposes and cannot be separated from Diphenylamine using Method $270. The result reported for
each analyte is a combined concentration.
Acid preservation may not be appropriate for 2-Chloroethylvinyl ether, Styrene, and Vinyl chloride.
Pace Analytical is TNI accredited. Contact your Pace PM for the current list of accredited analytes.
TN -The NE LAC Institute.
LABORATORIES
PASI-C Pace Analytical Services - Charlotte
PASI-R Pace Analytical Services - Raleigh
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
Date: 10I22l2014 11:26 AM without the written consent of Pace Analytical Services, Inc.. Page 8 of 11

aceAnalXical
www,pecelabs.aorn
QUALITY CONTROL DATA CROSS REFERENCE TABLE
Project: W. RALEIGH ASPHALT PLANT
Pace Project No.: 92221453
Pace Analytical Services, Inc.
9800 Kincey Ave, Suite 100
Huntersville, NC 28078
[phone]
Analytical
Lab ID
Sample ID
QC Batch Method
QC Batch Analytical Method Batch
92221453001
OUTFALL #1
EPA 1664B
GCSVI19242
92221453001
OUTFALL #1
EPA 1664B
GCSV119243
92221453001
OUTFALL #1
SM 2540D
RWET17353
Date: 10/22/2014 11:26 AM
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, Inc..
Page 9 of 11

7t;
Document Name: Sample Condition Upon
i Qo6ument Reylged: April 04,2013
Receipt (SCLIR)
Page.1 of 2
Document No.:
Issuing Authorities.
F-RAL-CS-0011-rev.02
Pace Asheville QualL Moffice
Client Ndime.
zi
-jam (lAa5ba)
Wherb Received: Huntersville C] Asheville C] Eden Raleigh
Courier (Circle): - Fed Ex UPS USPS ClEent Commercial Pace, Other
Custody Seat on Cooler/Box Present., C] yes 0 no S'eals Intact
,Z Yes El no
Packing Material: E] Bubble W B u Is-laags Ef Non Other_
u Wrap
Circle Th'ermometer Used: IR Gut 112 2 0�6 5.3 8 Samples on Ice, cooling proms has begun
.�Pa of Ice Blue None
mane
Wet
IR Gun So IZ20-5311
,'Temp qori)klIon Factor: Add! btrac s
Date'and InI1134 of Personexamining
Corrected Cooler Temp:: C
—C.
Biological Tissue Is Frdzen. Yes No "CIA
cta
tiedk Pro at
7erh.. a d be'0oye freezing to VC
Comments:'
Chain -ofCustod�Pressnt-
/'Yes 'OND OWA
1%
4
Chain of C,',usfooyfilled Out
lChain
Yes OND
OwA
2.
of CostodX Relingiulshod:
Xy, ON,
ONJA
3.
'1Ssmplei.Name.& Signature on COC:
Yes ONo
OwA
4,
Samples Arrived within Hold Tima,
A., ON,
13WA
5.
Short- kdflm i AnLlpls• <72hr):
Dyes &
OwA
6.
Rush Turn Around Time Requested:
OY. No
6 MA
7.
Sufficient
Yos DHo
OWA
8.'
Cbrra6t Containers Used:
ONO
❑WA
1)
S.
'
�Y:
-P a Q'e 6ontainers Used:
ONO
OWA
Containers ntect;
NIA
10.
Flltered,yolqm6-recelved,for Dissolved tests
Oyos ONO
fil'WA
11.
Sample. Ljo lzelsxnatch COC:
Yes Qi4o
Ow
112.
l 1-Udb' -d6te1tlme1ID1Anal)Lsls Matrix:
nb '4
pro$ orvabon have bean chocked.
Yea LINP
ONIA
13.
preservation are found to be In
Yas QNo
E][VA
pompii! wiW.EPA recommendation.
kxceptlonj:'.yq&'. qWrn,.TOC, O&G. WI-DRO(waler)
A. ONO
Sample - s checked for d6chloftatiow
46s. ONO
OWA
14,
H 6adsp'A64i..V0A Vials ( >6mm):
0yes 0140
RUA
16.
Trip I3lb":6"ik"Present:
11Yei ONo
WA
16.
Trip MW Custody Seals Present
OYes ONo
;E!fN/A
Pace Trip,Nnk Lot# (it purchi3sed)-
mC I lent: 1qptificatio n/ Resolution:
Field Data RequIred? Y I N
'.- -:parson Contecte& Datufrime,
PoqMe�ntp/. Resol urion:
WO#:92'221-45
MOLL
.• !,.Not6. Is a discrepanoyeffoctIng North Carolina compliancei�l�lllllflillllllll
samples,. 3 copy of this form will be sent to the Worth Carolina DEHNR
92221453
Certificatioo_:Offioe (i.a W of hold, Inoorroot preservative, out of lamp,
- - - - --
lncorr4ct contains is)
Page lQof 11

..,
• ' Chaim of Custody
• � aceAr�aly�ical W o. #
www.pacflabs.ccm,
5701 Coniererio& Drive, Raleigh, NC 27607
ph:[phone],lax: [phone]
NCWW Cert#67, NCDW Cert#37731
Report Results To:l;" . Bill To:
Company: 4= �' L ►4� E 1 ro*t Reference: W+ 4001
Adti�ess:�?:cos' l�3 .�r�sch. dly� 3 ('Tryr�,��r tgg _T catL
AProject Number:
Attn: M G_✓..� e.i,�i ('�i Purchase Order #. 17—C. f
PhQnek _ �: - .❑ Standard Report Delivery
;.
::f(; , . ❑ Rush Report Delivery (w/surcflarge)-
Fax: ; � ' � •' ' — '•Rush prn)eoks aro sub)ett to prior approvalby""
the laboratory
Sampled by (signature):
t;Wn:r ,r Requested Due Date:
�.�r �y•4ratr ♦•h� 7 '•ify
i� .•�' ' i
`t� .� -�'�•.� �5� �c 11 •�},
�c/��.[P�'} M F. •f{'r, t
S i�C(*'kr
.5S l r
?b+ti� ! �
r at. r i. N: Cv ..e��.'i�:i�.�
:2, if �r
: • 7
� bsy�r �(;5i•
.Z;.r'_'7;?�K
'� z �
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j i� 'Tt /'�- �- ". Y. i�;, 6� rt :�.: •k: �yt Fy�',.CC,�4-, � � � `>{Szzw•
1:TL1�< •at+ •x; �'r�iL�3 , l rj; �rW. �•,.� i!. t a..•. �. %,j�it• 2k,,'
w l � 5 t � � -.. �:L •tn,?.' i ?i ] x i;i •� ,,
t�,ti _:71��iS;ik::k �1'i'-,�.(' rc�' i'.S
% �'i: t•L5.4 .^...,k:; .. rT.,nsF:x>Ui-;�T.:• l:i�:...-r.�'�.•, ;•�1Y: _�.1n:!'a:l.y5
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vsr:�rp
'yiv i
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0.4C, AM
—■
R' ' hed dy (slg
Received (si nature
Date
Time
i
5A
Ad, q,fU4--
: h lshed by. (stgnaaure)
ReNed bil (signaiu }
DatV
Time
Rornquished by (signature)
Received by (slgnature)
Date
Time
Receipt Conditions ( ti, ` 9
❑ 4t2'C ❑ Temp"G$
Res. Chlorine:
❑ Absent ❑ Present I7 Nay
Add preserv. <2?
❑ Yes ❑ No ❑ nia r i
Base preserv. 7127 i ;1
[I Yes ❑No ❑rba `{
Page t.7f 1

Stormwater Discharge Outfall (SD4)
Qualitative Monitoring Report
For guidance on frUing out this form; please visit. bpp2&k22.enr.state.nc.us/su/Forms Documents.hjaftuscforms
Permit No.: NICI �*ILI Isy {Y !_Q/ or Certificate of Coverage No.: NICIGI� I f1 f.?I; 7Sl
FacilityName-, L- W : A `
County: W __Phone No. 3
Inspector. 'T� 1-. n,
Date of Inspection: % ,
Time of Inspection: C G-
Total Event Precipitation (inches):
Was this a Representative Storm Event? (See information. below) Yes ❑ No
PIease check your permit to verify if Qualitative Monitoring must be performed during a representative
storm event (requirements vary).
A "Representative Storm Evenf" is a storm event that measures greater than 'O.l inches of rainfall and that
is preceded by at least 72 hours (3 days) in which no storm event measuring greater than 0.1 inches has
occurred. A single storm event may contain up to -10 consecutive hours of no precipitation.
By this s_gaature, X certify to = ma's -accurate aad complete to the best of rtty lalowledge:
or Designee) .
1. Outfall Description:
Outfall No.. I� Structure (pipe, ditch, etc.) P%pt-
Receiving Stream A,
Describe the industrial activities that: occur within the outfall drainage area: —mil{ T.- d) 40, (6 11
2. Color: Describe the color of the discharge using basic colors (red., brown, blue, etc.) and tint
(light, medium, dark) as descriptors: L i 1, f �Yf ti� L_
3. Odor. Describe any distinct o4ors that the discharge may have (i.e., smells strongly of oil, weak
chlorine odor, etc_): iV ')i
Page 1 of 2
SWU-242-1 L2608

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 [lumber 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 1 is no solids and 5 is extremely muddy:
1 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 01,
9. Is there evidence of erosion or deposition at the outfall? - Yes No
10. Other Obvious Indicators of Stormwater Pollution:
List and describe f i
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition maybe
indicative of pollutant exposure. These conditions warrant further investigation.
Page 2 of 2
SWU-242-1126118

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Analytical
www,pacelabs.com
6701 Conference Drive, Raleigh, NC 27607
ph: [phone], fax: [phone]
NCWW Cert#67, NCDW Cen#37731
Chain of Custody W.O.#
Report Resu its To:
Company: L MJ C C'.113S K
!�
Address:
Attn: Mel ` C- ( 1 S- H ,,I r. 1 e y
Phone: % Q 4 - 3 # 5 - _? G! q
Fax
Sampled by (signature):
Bill To:
Ft L �/ f 7- _ w ,Project Reference: t 411e, `41 _
e (L. It r/? iz'10-
bz o f e .` - L_ Al Z 7 / Project !Number: Sf 1
Purchase Order #: S Z t
❑ Standard Report Delivery
❑ Rush Report Delivery (w/surcharge)
"Rush projects are subject to prior approval by
the laboratory
Requested Due Date:
Sarni le Description
.w _•-
Start Data
End Date
—Matrix-
WW. M. sw
aw, soe.e+c^
Analyses Requested
sampex
.
--Start Time ..
End Time..
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i! 15114
lUllSliv
Relinquished by (signature ,-
Received by (signature)
Date
Time
Reiiriquished by (signature)
Received by (signature)
Date
Time
Relinquished by (signature)
Received by (signature)
Date
Time
Receipt Conditions (Lab Use Only)
❑ 4}2°C ❑ Temp: °C
Res. Chlorine:
❑ Absent ❑ Present ❑ Na
Acid preserv. <2?
❑ Yes ❑ No ❑ n/a
Base preserv- at 2?
Cl Yes 0 No ❑ rVa