NCG210219_DMR_20191205

STORMWATER DISCHAIi. Nj3UTFALL(SDO)
MONITORING h,.j'ORT
GENERAL PERMIT NO.NCG210000 SAMPLES COLLECTED DURING CALENDAR YEAR: ZO i l
CERTIFICATE OF COVERAGE NO.NCG21Ot .0 (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 TOIJ L COUNTY Y Ill;,)
PERSON COLLECTING SAMPLES Su..a PHONE NO.(94_.) If 96, S 7 I I
CERTIFIED LABORATORY /t4 2r%- - rye Lab#
Lab# PLEASE SIGN ON THE REVERSE
Part A:Specific Monitoring Requirements'
Outfall Date
_ 00530 " ,,.. :. 00400 00340
No. Sample Collected, Total Rainfall, Total Suspended Solids, pH, Chemical Oxygen Demand(COD),
mo/ddlyr. inches rig/I. :::. ..:.... Standard units mglL
Benchmark*. .. . ,: 100. Within 6.0.=9.0 120
'Monitoring is required only if the facility stores exposed piles of sawdust,wood chips,bark,mulch,or other similar material on site for longer than seven(7)days.
If the facility elects not to monitor because accumulated material is removed within seven(7)days or less,the certification below must be signed. The facility shall
also record and maintain a log in its SPPP(Stormwater Pollution Prevention Plan)of dates when material is generated and removed,how,and by whom.
*Note: If you report a value in excess of the benchmark value,or outside the benchmark range(for pH),you must implement Tier 1 or Tier 2 responses in the General Permit.
Facilities that do not store exposed(either exposed to incident precipitation or exposed to stormwater run on)piles of sawdust,wood chips,bark,mulch,or other similar material for
longer than seven(7)days on site may so certify,and the requirement for analytical monitoring may be waived. For those facilities that qualify for the analytical monitoring waiver,the
discharger shall sign the following certification statement:
"Based upon my inquiry of the person or persons directly responsible for managing compliance with the permit requirement for
analytical monitoring,I certify that to the best of my knowledge and belief,no piles of sawdust,wood chips,bark,mulch or
other similar materials were stored exposed(either to incident precipitation or to stormw er run on)for longer than seven(7)
days before removal since filing the ast discharge monitoring report."
Name Print name)
Title(Print title)
(Signature) (Date)
S W U-245-072808
Page 1 of 2

STOMIWATER Ih ARGE OUT I FA LT,(SI)O)
• MONITORING REPORT
"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,
inc 'ng.the poss. ►ility of fines and imprisonment for knowing violations."
(Signature Permittee) • (Date)
•
•
Form S U-254-07100
Page 2of2

Meritech, Inc.
Environmental Laboratory
Laboratory Certification No.165
Contact: Dale Mathews
Client: M&M Water Report Date: 12/13/2019
3191 Gela Dr.
Oxford,NC 27565 Date Sample Rcvd: 12/5/2019
Meritech Work Order# 12051981 Sample: Toney Lumber Grab
12/5/19
Emmet= Result AnalDis Date Re gulatisy .iml nd
COD 64 mg/L 12/9/19 15 mg/L Total Suspended Solids 7 mg/LEPA 410.4
8/12/10/19 2.5 mg/L SM 2540 D
_1 hereby certify that I have reviewed and approve these data. /2/60
Laboratory Representative
642 Talmo Road,Reidsville,North Carolina 27320
teL[phone] fax.[phone]

mins C chain of Custody Record (cog NPDESS:
Client Dete rr)641\151.Qs. . Phone:
MERITECH, INC. Address: \Oil 6C k ft Vi. !
,Fax
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ENVIRONMENTAL LABORATORIES OVrptli i ‘.›C Q-M(0G ,Email:
i 642 Tarnco ltd. Phone: [phone] Project:
'' Rektstale KC 27320 Fax [phone] KOJI:- % - -
Email:info@ moritechiabs.corn Atterlt/arl:-Zaigtaa4-v------.-- ' MUSH Tvanriturn n....usetis prfo7aPPlwal,
How%you id you like your report sent? • Abik_
INWW.M eritechlabs.com circle all that apPlYpreFerrtocri, Fa X, Mail 1254 t' i 1112281in
Sampling Dates &Times CiPeTsidrvi Sam*(ftn/Ft"); Lab Use Only
Sample Locatirm and/or ID# Start End ,oxlip? it or Test(s) Required onto.? pH OK?
Date Time Date Time carabi coot. Yes / No a ore
7-r-dp•it...k Luurvikles, 111sin Ivi.0.6k G , 1 -, CO3 Si
-Tim•svAs La..v....troir- , , 111 1191$115 4,
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eaverature Upon
Method of s*.DechForinatior(015 ppmf al Ammonia,Cyanide,Phenol and TKN sernpIes must be done In the field prior to preserve don.*** qc)...
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Comments: compositor#
Shipment: -
,D UPS PH - to-A -Temp' is-mi0 Ciz - ikiA Jug#
3 Fed Ex Are these results for regulatory purposes? Yes U1( No c) Report results in mg(L tit milki U us/I- Li
, ' Other
DenverYZrataiirreVii41--me" IV 11 Time: 1/41........--Recsibred bin„Zf...oetC__ /2....„...2 Tm,„2..,
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TY1CrAeaks , ' Date: Thu: I Racelwid by iattrh 2„.e.tik, I)-cTqf I': 92:7