NCG160050_MONITORING INFO_20130927

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
/v L) W L
DOC TYPE
❑ HISTORICAL FILE
14 MONITORING REPORTS
DOC DATE
❑ 13 1
YYYYM M D D

J
STORMWATER DISCHARGE OUTFALL (SDO)
ANNUAL SUMMARY DATA MONITORING REPORT (DMR)
Calendar Year .9oi3 SEP 27 2013
General Permit No. NCG160000 I
Certificate of Coverage No. NCG16©©❑S ©❑
This monitoring report summary is due to the DWO Regional Office no later than 30 days from the date
the facility receives laboratory sampling results from the final sample of the calendar year.
Facility N
County:
Phone Number:
Outfall No.
( 152) 240 - 6-19iZ Total no. of SDOs monitored
Is this outfall currently in Tier 2 (monitored monthly)?
Was this outfall ever in Tier 2 (monitored monthly) during the past year?
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWO to reduce monitoring frequency ❑
Other
Yes ❑ No Pd
Yes ❑ No ®'
Outfall ii _'
..;:.
Total Rainfall, Inches
_
-00530 -
00400
00556
` .
TSS, mglL ;.
--} pH, s.u..
Total Petroleum
:. Hydrocarbons, mglL
Benchmark
N/A
100
6.0 - 9.0
15
Date Sample Collected,`''
.
v
"
s
-19-�i3
a
7
"/9,0
SW U-250NCG16-051709

Additional Outfall Attachment
Outfall No.
Is this outfall currently in Tier 2 (monitored monthly)? Yes ❑ No ❑
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ❑ No ❑
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
outfall
_. �-
-
S
Total Rainfall, inches
,
00530
00400
00556
TSS, mg/L
pH, s u .,
Total Petroleum
Hydrocarbons, mg/L
Benchmark
N/A
100
6.0 — 9.0 . '
15
Date Sample Collected,
mo/dd/yr " .. `.
x ;
SW U-250NCG16-051709

ON
"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."
DteSignature9
Date
Mail Annual DMR Summary Reports to:
DWO Regional Office Contact Information:
Asheville Office ......
[phone]
Fayetteville Office ...
[phone]
Mooresville Office ...
[phone]
Raleigh Office ........
[phone]
Washington Office ...(252)
946-6481
Wilmington Office ...
(910) 79677215
Winston-Salem ......
[phone]
Central Office .........(919)
807-6300
2090 US Highway 70
Swannanoa,'NC 28778
[phone]
3800 Barrett Drive
Raleigh, NC 27609
[phone]
585 Waughtown Street
Winston-Salem, NC 27107
[phone]
225 Green Street
Systel Building Suite 714
Fayetteville, NC 28301-5043
[phone]
943 Washington Square Mall
Washington, NC 27889
[phone]
1617 Mail Service Center
Raleigh, NC 27699-1617
[phone]
610 East Center Avenue/Suite 301
Mooresville, NC 28115
[phone]
127 Cardinal Drive Extension
Wilmington, NC 28405-2845
[phone]
preserve
( � araerhance
SW U-25ONCG16-051709

r_
STORMWATER DISCHARGE OUTFALL (SDO)
General Permit No. NCG160000
Certificate of Coverage No. NCG16❑e ©❑❑S Q❑
This monitoring report summary is due to the DWO Regional Office no later than 30 days from the date
the facility receives laboratory sampling results from the final sample of the calendar year.
Facility Name: S, T W�oT0kl CIAV7Z41 As RffifzT'
County: ..fir A,67OW
Phone Number: (out ) .2 S912 Total no. of SDOs monitored
Outfall No.
Is this outfall currently in Tier 2 (monitored monthly)? Yes ❑ No
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ❑ No
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑ .
Other ❑
6 if it
Total Rainfall,' inches
'00530
00400 ''
00556
TSS, mg/L
pH, sm.
`Total Petroleum
Hydrocarbons, mg/L
Benchmark
N/A
.100
6.0 - 9.0
15
Date Sample Collected,
mo/dd/yr
r
„ t; o, s
-a -
75'
a
G, s
N"o
SW U-25ONCG16-051709

Additional ;outfall Attachment
Outfall No.
Is this outfall currently in Tier 2 (monitored monthly)? Yes ❑ No ❑
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ❑ No ❑
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
00530 'i'
00400
00556,
TSS; ➢ng/L
;; pH, s u
Total Petroleum "
"outfall,
Total Rainfall, inches
Hydrocarbons, mglL'
Benchmark
N/A
100
6 0 — 9.0
15 �.
Date Sample Collected, '
'J'
molddlyr
S W U-250NCG 16-051709

i
"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
Date
Mail Annual DMR'Summary Reports to:
DWQ Regional Office Contact Information:
Asheville Office ......
[phone]
Fayetteville Office ...
[phone]
Mooresville Office ...
[phone]
Raleigh Office ........
[phone]
Washington Office ...(252)
946-6481
Wilmington Office ...
[phone]
Winston-Salem ......
[phone]
Central Office .........(919)
807-6300
2090 US Highway 70
Swannanoa, NC 28778
[phone]
3800 Barrett Drive
Raleigh, NC 27609
[phone]
225 Green Street
Systel Building Suite 714
Fayetteville, NC 28301-5043
[phone]
943 Washington Square Mall
Washington, NC 27889
[phone]
610 East Center Avenue/Suite 301
Mooresville, NC 28115
[phone]
127 Cardinal Drive Extension
Wilmington, NC 28405-2845
[phone]
OFFICE 1617 Mail Service Center
585 Wau htown Street 0 0lw
g Raleigh, NC 27699-1617 �Uk� any eolU!a rce
Winston-Salem, NC 27107 [phone]No �n Ca arr:ra"s at,c..^
[phone]
i
SW U-250NCG16-051709

SMARTER'rODAY I
GREENERTOMORROW
August 23, 2010
Raleigh Regional Office
3800 Barrett Drive
Raleigh NC 27609
Subject: DMR Summary Report I ZZo GI
S. T. Wooten Corporation
Clayton Asphalt Plant
Permit # NCG160V50
Dear Sir or Madam,
Enclosed is the storm water out fall monitoring report for Clayton Asphalt.
Should you require further information, please give me a call
Office 252-291-5165
Cell 919-868-9209
Cell 252-290-5912
Email james.washburn(ir)stwcorp.com
Sincerely,
S. T. Wooten Corporation
ames Washburn
Environmental Compliance Manager
�G VIA VJ
G �� zc

STORMWATER DISCHARGE OUTFALL (SDO)
ANNUAL SUMMARY DATA MONITORING REPORT (DMR)
Calendar Year aoi o
General Permit No. NCG160000
Certificate of Coverage No. NCG16©W©S❑❑o
This monitoring report summary is due to the DWO Regional Office no later than 30 days from the date
the facility receives laboratory sampling results from the final sample of the calendar year.
Facility Name: %5,T, Lckto7zp-� (?4RPoRoMaA/ c_"tAy�tk% /1S,D/,rAtT
County: obw- DA-)
Phone Number: d( S.2 Total no. of SDOs monitored
Outfall No.
Is this outfall currently in Tier 2 (monitored monthly)? Yes ❑ NOA
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ❑ No
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWO to reduce monitoring frequency ❑
Other
O'utfall _[�
Total Rainfall, Inches
' 00530
- 00400'
- ' 00556
TS§, mg/L <
pH, s u. '
Total Petroleum
Hydrocarbons, mg/L
Benchmark
N/A.
100
6.0 - 9.0
15
Date Sample Collected,
mo/ddlyr
- - OID
SO
00
SW U-250NCO16-051709

0
Additional Outfall Attachment
Outfall No.
Is this outfall currently in Tier 2 (monitored monthly)? Yes ❑ No ❑
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ❑ No ❑
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
00530
00400 ..
'00556
Outfall
Total Rainfall, Inches
TSS, mg/L
pH, s u -
Total petroleum 4 ;
_..
' Hydroca'rbons,
Benchmark
N/A
100
6.0 — 9.0
15 ,'
�`
`"'"
" A '
Date Sample Collected,
moldd/yr ,f
ry "'` aX" .Lr.
>
SW U-25ONCG16-051709

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 i"mation, including the possibiJky of fines and imprisonment for knowing violations."
Signature
Date 8
Mail Annual DMR Summary Reports to:
DWQ Regional Office Contact Information:
Asheville Office ......
[phone]
Fayetteville Office ...
[phone]
Mooresville Office ...
[phone]
Raleigh Office ........
[phone]
Washington Office ...(252)
946-6481
Wilmington Office ...
[phone]
Winston-Salem ......
[phone]
Central Office .........(919)
807-6300
2090 US Highway 70
Swannanoa, NC 28778
[phone]
3800 Barrett Drive
Raleigh, NC 27609
[phone]
585 Waughtown Street
Winston-Salem, NC 27107
[phone]
225 Green Street
Systel Building Suite 714
Fayetteville; NC 28301-5043
[phone]
943 Washington Square Mall
Washington, NC 27889
[phone]
1617 Mail Service Center
Raleigh, NC 27699-1617
[phone]
610 East Center Avenue/Suite 301
Mooresville, NC 28115
[phone]
127 Cardinal Drive Extension
Wilmington, NC 28405-2845
[phone]
a tHame
SW U-250NCG 16-051709

Microbac Laboratories Inc.
Southern Testing & Research Division
3809 Airport Drive, Wilson, NC 27896
Phone: [phone] ' Fax: [phone]
Website: w .southemtestina.com
CHAIN OF CUSTODY
and Analyses Request
Lab Use Only- - 0
IRushrApproval By: Date/Time:
rDerr r
Original Report To: �J
Contact Person:
Sample N
Acct. # Transport: r
S. T. hJoo"Tx/ C riRi?
S<I✓l1�S
/c sf�duR�J
Phone p
aso? -
rc
294) --7 71Z
Rec'd on Ice %
❑ yes ❑ No
Temp: Res. Cl. pH:
Address: (� a
/ Q & ayop
Invoice Address: .may
/)IL56� N/ n ' `
Fax a
076-6;7` To2S� -
,,,2Y3- 0462
(SAMPLING CHARGES:
!Time:�_����
'
MIle _Other: - — - — - — - r
sampled ByLPJ�y� ne�R�FF
V
Project ID-
Analyses Re Requested
erted Turnaround Time
L� Normal (2 weeks) ❑ Rush days)'
�7��
44,V' Z - 4'S� AL 7
(3-5
' ❑ Emergency Rush
Poe STRL QUOTE»
Q0
�C C
�
(ASAP)'
ADDITIONAL CHARGES WILL APPLY
p� •`O
O
`c0 JOB pC `�O 11
t
CALL FOR APPROVAL
Client Requested Due Date:
o m
a _:
V
Item Start End Comp Grab
Sample
M Date/Time Date/Time "
Type- Description/Sample Marks
A
�
�
/i g72110 c'�� /
r,?
ICE'
----------------------
----------------------
A.
4
----------------------
----------------------
R/ELINQUISHED B/Y
DATE/TIME
RECEIVED
BV
DATFJTIME
NOTES:
Sd
J�7lf7i
�/ �
7 - rU 7:0 t
/0
IJI�Piti
-Z�
2
I)
`
3
Field Rea. CL.: Field Conductivity: Field Temp: Field pH: L Field D.O.:
IS DATA TO BE USED FOR REGULATORY COMPLIANCE PURPOSES? ❑ YES ❑ NO
IF YES, WHICH REGULATORY AGENCY:
"See Reverse for Codes
I
SAM001.01 (1/06)
FIELD COPY

'* Codes
Container'rype: P = Plastic. G = Glass, AG = Amber Glass, V = 40 mL, EPA purgeable vial. AV = Amber Vial, Etc,
Sample Type: WW = Wastewater, GW = Groundwater, SW = Surface Water. DW = Drinking Water, STW = Sterol Water, S = Soil.
SL = Sludge- U = Unknown, V = Vapor, F = Fiber or Fabric, S = Solvent or Fuel
olo = Time Composited Sample, Grab = A Grabbed Sample
Preservaf on = Indicate Yes/No or indicate the type of preservation used: NI = Nin is Acid, H = Hydrochloric Acid, S = Sulfuric Acid
NA = Sodium Hydroxide. See STRL supplied container for type of preservation.
Terms and Conditions
Samples Submitted for Analysis Must Include
I. Complete analysis (including candng numbers) and billing instructions on Southern Testing Chain of Custody Form, Sample Submission Form,
company letterhead or purchase order, signed and dated by person or agent with authority to submit samples for the client.
2. tdentifyiny-niarks on each sample and on accompanying papeiwork.
3. Name and address for reporting, and forbi l l ing (ifdifferent).
4. _ Telephone iuimher and con[acfname, in case we have questions.
5. Any special instructions, requested turnaround time. additional contacts to receive results.
Non -Routine Analyses -Some infrequently requested analyses may require setup fees For analyses not listed in our fee schedules, samples are accepted
subject to prior approval of the manager of the appropriate technical department.
Turnaround Time (TAT) - Our goal is to meet your'I'A'1' needs. Unless you indicate otherwise. our target TAT will be 10 business days or less for most
routine analyses listed in our fee schedule. TAT is based on business date of receipt of sample at the laboratory. Any samples received, for standard TAT,
after 4 p.m. on regular business days, or on weekends or holidays, will be assigned the nest business day as the receipt date.
RUSli (5 business days) analyses if available is at 50% surcharge above list fee.
EMERGENCY RUSH 12 business days. samples received after I2:00 noon will he considered received the next business day) if available is at a I00c,,o
surcharge over list fee,
RUSH and EMERGENCY RUSH service must be approved by the Department Manager prior to submission.
Recheck Analysis- If client -requested recheck confirms the original test results. the client is charged for additional analysis. If recheck results do not
confirm the original results, the client is not charged for recheck analyses.
Payment Terms - If credit has not been established with STRL payment in advance is required. Payment mustbe made in cash, money order.
MasterCard/Visa. personal check or certified check. For clients with approved credit, terms are net 30 days from date of invoice for completed work. An
interest charge of 1.5% per month applies to all overdue balances. A $25.00 charge will apply to all returned checks. Non -transfer. The clieru ntav not
transferor assign due mcount relationship Without that wriven consent of So ahein Testing & Resemvh Division.
Bees and Discounts - Fees fisted in our Schedules of Setrvices are based on current costs of performing analyses and may be changed without prior notice.
except where bound by contract. Discounts may be offered based on the guaranteed work volume on a project -by- project, or annual contract basis. All
discounts from standard fee schedules are given subject to compliance with our standard payment terms. Discounts are autornatically revoked as invoices
become past (Inc. unless other arrangements are made in advance.
Spimple Pickup Service - A sample pickup fee of $20.00 per stop f 10 minutes or less) is charged when we pick up samples on our regularly scheduled
mutes. Sample pick up, on weekdays other than our scheduled routes, is available for an additional charge, provided at least 24 hour notice is given prior
to date of requested pickup. If a sample pickup is requested that is not on a regular route, we can arrange for a drop/pickup site at one of regularly
scheduled stops. If a meeting site cannot be arranged we can provide pickup hased on Time ($50.00/hr)and Milcage ($.50/mile).
Sample/Data Retention- Unless prior at are made. any portion of samples not used for analyses will he held by the laboratory after reporting
analysis results, and then properly disposed of. according to the following schedule:
Potable water ........ ..... Discarded same day analyzed Food/Perishables.......... 7 days
Woetewauer/Sludge....... 7 days All other samples ....... 30 days
Any samples suspected of being hazardous will be returned a'r the c lient at his/her expense. Alternatively. we can arrange for proper disposal of hazardous
samplesforafee. Clients may request that non -hazardous samples be returned at his/her expense if so desired. The client retains ownership ofall sample;
suhniitted to Southeni'resting for analysis. If Data Retention requirenients are greater than 5 years arrangements must be made with Southern Testing.
Confidentiality, -All work will be peiforned in strict confidence. Results are released only to the client or his/her designated agent. Confidentiality
agreements will gladly be provided and executed upon request.
Warriniy and Limits of Liability - Our wat of ty is limited to the accuracy of analyses of samples as received. We assume no responsibility for the
purposes for which the client uses the test r�uhs, nor liability for any other warranties, expressed or implied, including warranties of fitness for a
particular purpose or for merchantability ma&by the client. These terms and conditions shall supersede tiny eonflicti ng terms and conditions stated on
5n},.purchase order, or other order of work subnt(ned by the client.
rc
Additional Fee,5 gnd LeUld Cases -By submitting samples for analysis. the Client agrees that our analysis fees do no include the cost of any additional
or tic dcmal services that may become associated,,with the analytical results, such as but not limited to interpretation of results to the client ors third party
or participation in any legal case, including�'iecords retrieval and reproduction, attomey's fees , or depositions or court testimony by any Southern
Testing employee. All such additional costs %rill be billed separately I,). or paid m advance by, the client or his/her designated representative, at the sole
`discretion of Southern Testing. at the time additional services are requested.

STORMWATER DISCHARGE OUTFALL (SDO)
GENERAL PERMIT NO. NCG160000
DISCHARGE MONITORING REPORT (DMR)
CERTIFICATE OF COVERAGE NO.--N,CG16©OKFEE❑
FACILITY NAM%Lc�7t/E S. e OKP
PERSON COLLECTING SAMPLES 4244 l /Lfrrr
CERTIFIED LABORATORY MICXWAtC, Lab
Monitoring Requirements
SAMPLES COLLECTED DURING CALENDAR YEAR: a 61 O
(This monitoring report is due at the Division no later than 30 days from the date
the facility receives the sampling results from the laboratory.)
COUNTY J aNA)5721 ✓
PHONENO.(575.2 ;290- 59/2
Outfall
:No.,
Date
Sample Collected;
Trio/ddl-jr
Total Rainfall.
inclms
00530
00400
•00556
Total Suspended Solids, mgA ,
pH
Standard units
Total Petroleum Hydrocarbons, mg/1
EPA Method 1664 SGT-HEM ,
Benchmark
100
Within 6.0 = 9.0.:
15,
-.2 7 - ANO
O
<SC0
' If a value is in excess of the benchmark, or outside the benchmark range (for pH), you must implement the Tier I or Tier 2 responses in the General Permit.
Mail original and one copy to:
Division of Water Quality
Attn: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED:
"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 th""filre are significant penalti or submitting false information, including the possibility of rines and imprisonment for knowing violations."
9-a3 - ao10
(Date)
SWU-253-051409
Page 1 of 1

Fayetteville Division
2592 Hope Mills Rd 8-B Wendy Court
Fayetteville, NC 28306 Greensboro, NC 27409
910.864.1920 Phone [phone] Phone
910.864.8774 Fax [phone] Fax
Certificate of Analysis
S.T. Wooten Corporation
Mr. James Washburn Project Stormwater sample -Clayton Asphalt Date Reported: August 10, 2010
Post Office Box 2408 vvDate Received: July 29, 2010
Wilson NC, 27894 Sampled ByPVAyne Nederho0' Date Sampled: July 27, 2010
OFI, grab
1007891-01
Analyte Result Unit Analysis Datelrime Analyst Method Qualifier
.w. oy. rnaowc -' y ne o mw
Oil & Grease (HEM) <5.00 mg/L, 8/3/10 7:45 RAS EPA 1664 1
"rota) Suspended Solids 13.4 mg/L 8/3/10 10:00 AMM SM 20th Ed. 2540 D
Qualifier Definitions
I Spike recovery outside control limits due to sample matrix interference or high analyte concetration
State Cerfifications: Respectfully Submitted
NCDNR 011, #693
NCDOH #37714, #37795 OR. W- +ba rraa"
USDA #3787 R. W. Sanders, VP/Managing Director
Thank you for your business. Wcinrieyurfcce✓hackonmr[crelojsenicemuw. Pleuwe lacfl&VPMa ing Dimrlor,Rm,,6 enm9l"N-192a.James,V es.Pmxoem,ar
iro4na icroMu.rom or Tronr Nosre.CF.'O.artbosee2microhuamm with anvmmmems nr meeesrions.