NCG210219_MONITORING INFO_20190311

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
/v
DOC TYPE
❑ HISTORICAL FILE
C MONITORING REPORTS
DOC DATE
❑ J)0I J 03
YYYYM M D D

STORMWATER DISCHAk, 'PUfFALL (SDO)
MONITORING r. PORT
GENERAL PERMIT NO. NCG210000 SAMPLES COLLECTED DURING CALENDAR YEAR: a0 19
CERTIFICATE OF COVERAGE NO. NCG21®®0® (This monitoring report is due at the Division no later than 30 days from
the 6dCateft-�he facility receives the sampling results from the laboratory.)
FACILITY NAME �^^ R���I V GL1 COUNTY r�A�
PERSON COLLECTING SAMPLES ✓��AR 11 2019 PHONE NO. )
CERTIFIED LABORATORY Me 1 {mow Lab # ' I ( e
Lab # —1ENTRAL FILES PLEASE SIGN ON THE REVERSE 4
E)WR SECTION
Part A: Specific Monitoring Requirementst
Outfall Date 00530 00400.: 00340
No. Sam le Collected Total Rainfall, Total Suspended Solids, pH; Oxygen
P
" Standaid.dnits Che
mical Demand (COD)
rrtoJdd/ r _ niches >, m <. °7
Benchmark!'. 100 Wtthln.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.
---A T6n rnriliiv Chan
1
LniK
ln./Org
If the facility elects not to monitor because accumulated material is removea wiuun seven t i) unys ui 1—, u,�
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 I or Tier 2 responses in the General Permit.
Facilities that do not store exposed (either exposed to incident precipitation or exposed to stormwater tun 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 qualifyforthe analytical monitoring waiver, the
discharger shall sigh 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 stormwater run on) for longer than seven 9RECEIV.E J-)
days before removal since filing the last discharge monitoring report."
MAR ] 1 2019
Name (Print name)
Title (Print title)
(S
(Date)
E--5NTRAL FILE;
SWU-245-072808
Page 1 of 2

MONITORING REPORT
"I certify, under penally 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, 1 am aware that there are significant penalties for submitting false information,
includin c possibility of fines and imprisonment for knowing violations."
(Signature of Pc ditec) (pale)
Farm S1VU-254-071,100
Paer. 2 of 2

Meritech, Inc.
Environmental Laboratory
Laboratory Certification No.165
Contact: Dale Mathews Report Date: 1/18/2019
Client: M & M Water
3191 Gela Dr.
Oxford, NC 27565 Date Sample Rcvd 1/9/2019
Meritech Wort Order # 010919122 Sample: Toney Lumber Stormwater Grab 1/8/19
PaaMdgra Remit AnalYsii Date RqVjW&rX Undt Method
COD 77 mg/L 1/15/19 15 mg/L 6PA 410A
Total Suspended Solids 11 mg/L 1/10/19 2.5 mg/L SM Z540 D
I hereby cerdp that I have reviewed and approve these data. m�,,L,���dn
Laboratory Representadve
642 Tamco Road, Reidsville, North Carolina 27320
tel.[phone] fax.[phone]

Chain of Custody Record (COC)
NPDESN:
MERITECH, INC.
Client.
Client-.
Phone:
14Addr-
Fax:
e,
ENVIRONMENTAL LABORATORIES
c, MsUi;
Email:
y. 642 Taynco, Rd. Phone: [phone]
Projea�--
Reidsville NC 27320 Fax: [phone]
P n If -
Email: [e-mail]
Attentlon;
I•
Tum Arowtcl Tkne
How would you like your report sent?
priora
-RUSH work needs proval.
www.meritechlabs.com
Cirde all that appNcsiaillpretereei Fax
Mail
y 24 - 48.4n
Sampling Dates & Times
M a is R/Print)
s::fati:tise only:
Sample Location and/or ID 0 Start End
comp? I a of
Test(s) Required
-Y --Oftql(?
.
Daft Time Date I Time
Grab? CDrrt.
C1 OK I
51—WF
rbl�:Iro
11% liq
11g.
5krcn 4xWe
G
COD
077
—777777
MW
7777
I
Tarr""". - M1"Pc
Method of
—J
Dechforination (<DS Ppm) of Ammonia, Cyanfdk Phenol and TM
swnples
must be &ne In the field prior to pressssvotion
Comments:
q
ug #:I
Shipment:
t
LJ UPS
Fed Ex
Are these results for regulatory Purposes? yes UNo
Q Report resufts In:
mff/L
ugA ❑
I-J ,Hand Delivery
TIMeRieiNieIA—ZLAAL��'.l
r<-�
Other
=br,� /--f—/Tt�- , 'Ana:
PX
Rom
f r1mc
Me r2 L-e I%
Daft: Tbml
=Tin�?Z-
k4

} STORMWATER DISCHAJ; PUTFALL (SDO)
MONITORING rr,PORT
GENERAL PERMIT NO. NCG210000 SAMPLES COLLECTED DURING CALENDAR YEAR:
CERTIFICATE OF COVERAGE NO. NCG21®®F11® (This monitoring report is due at the Division no later than 30 days from IDS U
the date the facility receives the sampling results from the laboratory.) Z vl
FACILITY NAME r/ COUNTY r�A n Kl
PERSON COLLECTING SAMPLES c�rv_ . PHONE NO. ) `1 G c 7 t 1
CERTIFIED LABORATORY MLab #
Lab # PLEASE SIGN ON THE REVERSE 4
Part A: Specific Monitoring Requirements
Outfall
No ..
Date
Sample Collected;
tdoldd/ r
Total Rainfall; :.
inches . .. .:.
00400:.
00340.
Total Suspended $ohds,
- . ....
pH;
Standard.umts
Chemical Oxygen Demand (COD};
.. h� ..
Benchmark•.
100
V1 tthln 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
_. �_ .:---A T1, 4`.1;14v chal
If the facility elects not to monitor because accumulateo material Is removea wrmmn seven t 1) uuys V= 1O 0, ===L ��_••__��••�•• ��•� - •--_-- -- -- ---- - -_ -
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 stormwater run on) for longer than seven (7)
days before removal since filing the last discharge monitoring report."
Name (Print name)
Title (Print title) r%
(Date)
SWU-245-072808
Page t of 2

+'rclltrynvn'rI R ll, _LWE' OUTFAU, (SDO)
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 persgnncl properly gather and evaluate the information submitted. Bused on my inquiry of the person
or persons who manage the system, or those persons directly responsible for gathering the Information, (lie information submitted is, to the best
of my knowledge and belief, true, accurate, and complete. 1 am aware that there are significant penalties for submitting false information,
inchulin c possibility of fines and imprisonment for knowing violations."
I-14-0
(Signature of Pe Mtee) (pate)
Perm S%VU-254-071,100
Pape. 2 of 2

Chain of Custody Record (COC)
NPDESN:
Client. 1 Phone:
Addr q] 4 R t�D� Fax:
C t] , bJG o[ tr E Email:
Projea
Attention:
How would you like your report sent?
Circle all that app all fpMandl Fax, Mail
TumArmvWTkne•
'RUSH work needs prior approval.
I 24-48 Nn
MERITECH, INC.
J. ' \ ENVIRONMENTAL LABORATORIES
642 Tamco Rd. Phone: [phone]
Reidsville NC27320 Fax: [phone]
Emait:[e-mail]
www.meritechlabs.com
Sample Location and/or ID ti
Sampling Dates & Times
P i
T Ing
m a (5 n/Pdnt}.
_
le6:.USe Qrily'
Start
End
camp?
crab?
oaf
ram.
Test(s)Required
t); ,igeF.Ym'{IH
-E_N::::ao,
OK7
Date
Time
Date
Time
�,
a wi
��aor�
G
1
_
77777777
77777
7
: ; �
Method of
Shipment:
••' Dechlorinetion
4.5 m ofAmmonh
CvanldS Phenol and TKN sam
es must be done in thefield prior to premwicn,
•'•
-'%'--�
�
Comments:
H Q 7r....
�^--
UPS
V Fed Ex
Are these results for regulatory purposes? Yes No
❑
Report resu(t5 In:
mg/L
3,ft ❑ uaA
and Delivery
r�fi (— s Tbnrc
aaoww
_
Tbm:
19 Other
CC In
br. J 71mr.
J
Rase br.
rum
bY: ?rah: Tema:
aec
TIm
r ��

Meritech, Inc.
Environmental Laboratory
Laboratory Certification No.165
Contact: Dale Mathews Report Date: 1/18/2019
Client: M & M Water
3191 Gela Dr.
Oxford, NC 27565 Date Sample Rcvd 1/9/2019
Meritech Work Order # 010919122 Sample: Toney Lumber Stormwater Grab 1/8/19
Paimmrtm H20h Ana(ysia Date RegAVAry Llmit Method
COD 77 mg/L 1/15/19 15 mg/L EPA410.4
Total Suspended Solids 11 mg/L 1/10/19 2.5 mg/L SM 2940 D
I hereby certify that I have reviewed and approve these data. =,� ��� (� )
Laboratory m Representative
642 Tamco Road, Reidsville, North Carolina 27320
tel.[phone] fax.[phone]

/ STORMWATER DISCHA{ *TFALL (SDO)
MONITORING r.,,PORT
GENERAL PERMIT NO. NCG210000
CERTIFICATE OF COVERAGE NO. NCG219®Q$
FACILITY NAME 1 :
PERSON COLLECTING SAMPLES7
LL, k
CERTIFIED LABORATORY A4p�fe
3=c1 La #
Lab #�
Part A: Specific Monitoring Requirements'
Date
Sample. Collected, Total Rainfall, :. To
mo/dd/ r inches
SAMPLES COLLECTED DURING CALENDAR YEAR: -aolq
(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.)
�Y 1i,FC'OUNTY F�4 It
R PHONENo.(
AUG 0 6 Z01PLEASE SIGN ON THE REVERSE 4
CENTtu\L FILES
OWR SECTION
00400:
ds, PH> C
eniical Oxygen Demand
iiio/I.
_......:..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 tun 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 stormwater run on) for longer than seven (7)
days before removal since filing the last discharge monitoring report."
S W U-245-072808
Pagel of 2

S rORN11VATEIt Ih
MONITORING RITOR,r
"1 certify, under penalty of law, that this document and all attachments were prepared under toy 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 systenn, or those persons directly responsible for gathering the information, the information submitted is, tq the best
of toy knowledge and belief, true, accurate, and complete, I am significantare that there are significant penalties For submitting false information,
includhn he possibili of flocs and imprisonment for knowing violations."
(Signature of mittec) (Date)
J'ornt SWU-254-01400
Page 2 of 2

S'1.ORN1IVA'1•ER DISCHA]i )UT•FALL (SDO)
NIONI•I.ORING h,XORT
GENERAL PERMIT NO. NCG210000
CERTIFICATE OF COVERAGE NO. NCG210©0©
FACILITY NAME 1"c��---
PERSON COLLECTI G SAMPLES — —
CER•I.IFIEDLABORATORYML =Q•I^ Lab N '
Part A: Specific Monitoring Requirements'
Outfall
No.
Date
Sample Collected;.
nio/dd/ r. _
Total Rainfall,.
.incfies
0(
Total Susp
_._n
Benchmark*.-75
SAMPLES COLLECTED DURING CALENDAR YEAR:
(This monitoring report is due at the Division no later than 30 days frou
the dale lire facility receives the sampling results from the laboratory.)
COUNTYm
PHONE, NO. (�
PLEASE SIGN ON THE REVERSE 4 0 r D
Qom
00340
00400 Z
olids, - pH, . Chemical Oxygen Demand (COD), G)
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. ven (7) days or less, the certification below must be signed
If the facility elects not to monitor because accumulated material is removed within se. 'the facility shall
intain a log in its SPPP (Stormwater Pollution Prevention Plan) of dates when material is generated and removed, how, and by whom.
also record and ma
r Tier 2 responses in the General Penuit.
*Note: If you report a value in excess of the benchmark value, or outside the benchmark range (for pH), you must implement Tier 1 o
Piles of saw
Facilities that do not store exposed (either exposed to incident precipitation or exposed to stormwater run on) dust, wood chips, bark, nulch, 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 quality 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, nudch or
other similar materials were stored exposed (either to incident precipitation or to stormwater run on) for longer than seven (7)
days before removal since filing the last discharge monitoring report."
name)
Title (Print title)
(Signature)
(Date)
RF('F1N/FD
JAN 12 >j
DWR SECTION
IWOWU ON PROCESSING UNIT
S1VU-245-072808
Page 1 of 2

RIVIWATI'Q(1h .AIWEOUTFAH,(SDO)
MONITORING RETORT
"I certify, under paudly of Iua, that this document:md all attachments were prepared under my direction or supervision in accordance with it
system designed to assure that qualified personnel properly gather arul evaluate the information submitted, Bused oil my inquiry of the person
on persons who manage. the.system, or those persons directly responsible for gathering the information, the information submtlted is, hr the best
of my knowledge and belief, -true, acinirate, and complete. I ann aware that lherc are significant periultics forsubmilling false information,
fncludinglhe pos I Mity of fines and imprisonment for knowing violations."
72
(Sigmutur if Permittoe) (1 utc)
1•onn S\VU-254-071,100

Meritech, Inc.
Environmental Laboratory
Laboratory Certification No. 165
Contact: Dale Mathews
Client: M & M Water
3191 Gela Dr.
Oxford, NC 27565
Report Date: 10/31/2017
Date Sample Rcvd: 10/25/2017
Meritech Work Order #
102517101 Sample:
Toney Lumber Grab
1.0/24/17
Parameters
Result
Analysis Date
Method
COD
102 mg/L
10/30/17 15 mg/L
EPA 410.4
Total Suspended Solids
10 mg/L
10/26/17 2.5 mg/L
SM 2540 D
I hereby certify that 1 have reviewed and approve these data.
Laboratory Representative
642 Tamco Road, Reidsville, North Carolina 27320
tel.[phone] fax.[phone]

.pb Chain of Custody Record (COC)
Address: 1 ei CG.a Fax:ne:
. \y�1 —X9S Email:
Project:
P.O.#:
Attention- e Turn Around Time"
How would you like your report sent? `RUSH work needs prior approval.
St 10 da s) s 24-48 Hrs
Circle all that appl . ,email (preferred) Fax, Mail Imo,
INC.NPDES#:
MERITECH, N
4,
N •. \ ENVIRONMENTAL LABORATORIES
' - - 642 Tamco Rd. Phone: [phone]
E'
° Reidsville NC 27320 Fax: [phone]
Email: [e-mail]
www.meritechlabs.con
Sample Location and/or ID #
Sampling Dates & Timesign/Pri
rson Taking Sample.(Sign t:
/pn
,f
.`: .'..-.,..,,:,. _�•�[
Lab use Only
Start
End
comp?
Grab?
ttof
Cont.
Test(s)
Required
6n.Ice?Yes
/No
1pH OK?
Cl OK?
Date
Time
Date
Time
bey
10
C
ASS
1 D
lolmf,
Temperature. Upon Receipt
Method of
Dechlorination (<0.5 ppm) of Ammonia, Cyanide, Phenol and TKN samples must be done in the field prior to preservation.
Shipment:
Comments:
C' Cry S �-i
Compositor#, '
Jug #`.:...
UPS
Fed Ex
l--�
Are these results for regulatory purposes? Yes No J
[: J
I
Report results in: mg/L mg/kg tp ug/L
I�
Y Hand Delivery
a in by: Date: Time:
�, �,'
Rec iv
Date '• Time:
O, d2
Other
Re] ' u' by: Time:✓,
r �j r
Received by:
Date: Time:
Relinquished by:
Date: Time:
Received by Lab:
path Time: C /O
VL/

S'I'ORNIWATFR DISCHAII ')UTFALL (SDO)
MONITORING r..,PORT
GENERAL PERMIT NO. NCG210000 ����
CERTIFICATE OF COVERAGE NO. NCG21
FACILITY NAME
PERSON COLLF.CTI G SA PLES �—
CERTIFIED LABORATORY MPrli� Lab #
Part A: Specific Monitoring Requirements'
On fall
No.
Date
Sample Collected,
liio/dd/ i ..
Total Rainfall,
inches
OR
Total Suspe
n1'
Benchmark*.
-
I
SAMPLES COLLEC'I'FD DURING CALFNDAR YEAR:
('Phis monitoring report is due at the Division no later than 30 days frill"
the dale the facility receives the sampling results from the labora(ory.)
COUNTY
PHONE N0.
PLEASE SIGN ON T IIE REVERSE 4
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, lieu,, and by whom.
*Note: If you report 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 nut 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 far
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 m to stormwater run oil) for longer than seven (7)
days before removal since filing the last discharge monitoring report."
RECEIVED
JUL 31 2012
ENTRAL FILES
,. „'DWRSECTION
t
Name (Print it e)
Gsa
Title lit title)n
It'Atom-__— (Date)
(Signature)
S W U-245-072808
Page I of 2

Ur ,ABCU;OU't'1ATA,(SDO)
MONITORING RICTORT
"I certify, under penalty of Ia1Y, that this docuusnl and all attachments were prepared under my direction or supervision in accordance with (r
system designed to assurev that yuulified personnel properly gather and evaluate the information submitted. Bused on my inquiry of the persmr
or persons who manage, lhe,system, or (hose persons directly responsible for gathering the information, the information subn fitted is, to the hest
of my knowledge and belief, trac, acon-ate, and complete, 1 am aware that there are siguilicant pcmdties'for:submitling false information,
I includiu the possibility of fines and imprisonment for knowing violations,"
(Signahue of 1 ,mittee) (Date)
7
Puna SMI 25A.p71,1b(1
Page. 2 of 2

Meritech, Inc.
Environmental Laboratory
Laboratory Certification No.165
Contact: Dale Mathews
Client: M & M Water
3191 Gela Dr.
Oxford, NC 27565
Meritech Work Order # 06151782 Sample: Toney Lumber Grab
Parameters
Result Analysis Date
COD
142 mg/L 6/16/17
Total Suspended Solids
3 mg/L 6/16/17
Settleable Solids
<0.1 mg/L 6/16/17
Report Date: 6/23/2017
Date Sample Rcvd: 6/15/2017
6/15/17
Regulatory Limit Method
15 mg/L
PPA 410.4
2.5 mg/L
SM 2540 D
0.1 mg/L
SM 2540F
1 hereby certify that 1 have reviewed and approve these data,
Laboratory Representative
642'ramco Road, Reidsville, North Carolina 27320
tel.[phone] fax.[phone]

s¢to6 Chain of Custody Record (COC)
pp NPDES#:
Phone:
Address: �qI Ge1� EC LS Fax:
cD CS S Email:
Project:
P.O.#:
Attention: Cn�c S TumAround rime*
•RUSH work needs prior approval.
How would you like your report sent?
Circle all that apply: mai preferred), Fax, Mail Std lOda s) 3 5 Daxs z4-?$Hrs
�Lab�Use
I�IEFtITECH, INC.
ENVIRONMENTAL LABORATORIES
642 Tamco Rd. Phone: [phone]
Reidsville NC 27320 Fax: [phone]
Email: [e-mail]
L,
www.merltechlabs.com
Sample Location and/or ID #
Sampling Dates & Times
son Taking Sample (Sign/VrC ): r
LL
Only
Start
End
Comp?
Grab?
#of
Cont.
Test(s)
Required
On Ice? Yes
/No
pH OK?
Cl OK?
Date
Time
Date
Time
Temperature Upon Receipt:
�U C-C
Method
Dechlorination (<0.5 ppm) of Ammonia, Cyanide, Phenol and TKN samples must be done in the field prior to preservation.
of
Shipment:
Comments:
F`H Q
Compositor #
[] UPS
Jug#
Fed Ex
Are these results for regulatory purposes? Yes Z No
�
Report results in: mg/L ls1 mg/kg ug/L U
Hand Delivery,
e ui ed by' �_ Date: Time: O
Rec ed by: Dat Tim e: O
Other
Relin hed by: at : Time:
l/-"
Receive y: Date: Time:
Relinqui d by: Date: Time:
Received lab: y j Time:

Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Permit No.: N/C/C�/J/.
Facility Name:
County: 7�
Inspector
Date of Inspection: a
By this signature, I
or Certificate of Coverage No.: N/C/G/ 2/L/Q/ Llj—l-�l
Phone No.
report is accurate and complete to the best of my knowledge:
(Signature of Permittee o rg'nee)
1. Outfall Description
Outfall No. Structure (pipe, ditch, etc.) 1
ks
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: C1" ,-
3. Odor
Describe any distinct odors that the discharge may have,(i.e., smells strongly of oil, weak chlorine odor,
etc.)
4. Clarity
Choose the number which best describes the clarity of the discharge where 1 is clear and 10 is very
cloudy:
1 22 3 4 5 6 7 8 9 10
Page i
SWU-242-101599

5.. Floating Solids
Choose the number which best describes the amount of floating solids in the stormwater discharge where
I is no solids and 10 is the surface covered with floating solids:
1 3 4 5 6 7 8 9 10
6. Suspended Solids
Choose the number which best describes the amount of suspended solids in the stormwater discharge
where 1 is no solids and 10 is extremely muddy:
,'•.5 6 7 8 9
7. Foam
Is there any foam in the stormwater discharge? Yes
8. Oil Sheen
Is there an oil sheen in the stormwater discharge? Yes
9. Other Obvious Indicators of Stormwater Pollution
List and describe
Note:.. Low clarity, high solids, and/or the presence of foam or oil sheen may be indicative of pollutant
exposure. These conditions may warrant further investigation.
Page 2
SWU-242-101599

S'1'ORNIWA'1'EltDIScilml JUL'FALI,(SDO)
NIONITORING n PORT
GENERAL PERMITNO. NCG210000 SAMPLES COLLECTED DURING CALENDAR YEAR:
21-11
-�arlo of—.r�
CERTIFICATE OF COVERAGE NO. NCG210®Q5 R�p�iisy�rrtonrt`nr�tg report is due at the Division no later than 3o days from
the dale the facility receives the sampling results from the laboratory.)
%�. JAN 2 5 Z�?;
COUNTY
FACILITY NAMES--
PERSON COLLEC'PI SA PLES CENTRAL FILES PHONE N
CERTIFIED LABORATORY Mete %=e'h Lab # f_�— DWR SECTION PLEASE SIGN ON "PIPE REVERSE -�
Lab #
Part A: Specific Monitoring Requirements
Outfall
No.
Date
Sautple Collected;_
rno/dd/ r....
Total Rainfall;_
inches
0053
Total Suspenl
Vivo,
Benchmark*.
10(
/
3
Monitoring is required Duty 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, tile certification below must be signed. `file facility shall
also record and maintain a log in its SPPP (Stormwater g
Pollution Prevention Plan) of dates when material is enerated and removed, hour, and by
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.
precipitation or exposed to stormwater tun on) piles of sawdust, wood chips, bark, mulch, other similar material for
Facilities that do not store exposed (either exposed to incident monitoring may be waived. For those facilities that quality for the analytical
ytical monitoring waiver, the
longer than seven (7) days on site may so certify, and the requirement for analytical
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 ur
other similar materials were stored exposed (either to incident precipitation of to stormwater run on) for longer than seven (7)
days before removal since filing the last discharge monitoring report...
Name (Print name)
Title (Print title)
(Date)
(Signature)
S W U-2n5-072808
Page I of 2

fi't'illtl\ WATNRIli .A[zCVOljT M,1,(SDO)
MONITORING REPORT
"I certify, under penalty of luw, that this docuuunl and all attachments were prepared under my direction nr supervision ill accordance with a
system designed to assure that qualified personnel properly gather and evaluate the information submitted. Ifused oil my inquiry of the person
or pen:sons who manage. thesystem, or those hrcrsons directly responsible for gathering the information, the information submitted is, to the best
of my knowledge and belief, h'uc, aeivrde, and complete, 1 on aware that there are significant penalties for'subnnitting false information,
fnclu 1, the pussibili of fines and imprisonment fur knowing violations." / ^�
I �6 t l
(Signuture of I' mittec) (Dole)
[hum SWU 2.54-071d00
Page. 2 of 7.

JAN 2 5 2D17
Les
pWFtCTON
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Permit No.: N/C/4-/-ZO /v/ Z/ / /'Ll or Certificate of Coverage No.: N/C/G/ Z/ ( /ice/ Z/ l /-' /
Facility Name: �e.i L,. f-a
County: _ Phone No. 9,S • [/ 4r, - 5 7 11
Inspector: n
Date of Inspection:
By this signaySN, I certify/M* this report is accurate and complete to the best of my knowledge:
(Signature of Permitte'e or Designee)
1. Outfall Description
Outfall No. I— Structure (pipe, ditch, etc.) l],
Receiving Stream:
Describe the industrial activities that occur within the outfall drainage area:
2. Color
Describe the color of the
dark) as descriptors:
3. Odor
using basic colors (red, brown, blue, etc.) and tint (light, medium,
Describe any distinct odors,that the discharge may have (i.e., smells strongly of oil, weak chlorine odor,
etc.)
4. Clarity
Choose the number which best describes the clarity of the discharge where 1 is clear and 10 is very
cloudy:
2 3 4 5 6 7 8 9 10
Page I
SWU-242-101599

S. Floating Solids
Choose the number which best describes the amount of floating solids in the stormwater discharge where
1 is no solids and 10 is the surface covered with floating solids:
1 3 4 5 6 7 8 9 10
6. Suspended Solids
Choose the number which best describes the amount of suspended solids in the stormwater discharge
where 1 is no solids'and 10 is extremely muddy:
1 v 3 4 5 6 7 8 9 10
7. Foam
Is there any foam in the stormwater discharge? Yes. (Vo .
8. Oil Sheen
Is there an oil sheen in the stormwater discharge? Yes No
9. Other Obvious Indicators of Stormwater Pollution
y .
List and describe
Ii! t.�. C�mJP_ �Aai2dl (i0
Ado 6� A -SS )¢�1---
Note: . Low clarity, high solids; and/or the presence of foam or oil sheen maybe indicative of pollutant
exposure. These conditions may warrant further investigation.
Page 2
SWU-242-101599 `

Meritechr Inc.
Environmental Laboratory
Laboratory Certiflcation No.165
Contact: Dale Mathews Report Date: 12/19/2016
Client: M & M Water
3191 Gela Dr.
Oxford, NC 27565 Date Sample Rcvd: 12/7/2016
Meritech Work Order # 120716146 Sample: Toney Lumber Stormwater Grab 12/6/16
Parameters Result Analysis Date RegWatojjLimit Method
COD 104 mg/L 12/8/16 15 mg/L EPA410.4
Total Suspended Solids 98 mg/L 12/13/16 2.5 mg/L SM 2540 D
I hereby certify that I have reviewed and approve these data.
Laboratory Represe native
642 Tamco Road, Reidsville, North Carolina 27320
teL[phone] fax.[phone]

s.>q. Chain of Custody Record (COQ NPDES#:
k MERITECH, Pho
INCe Address: S Fax:ne:
r ��Clien C--et���
ENVIRONMENTAL LABORATORIES Email:
i. 642 Tamco Rd. Phone: [phone] Project:
Reidsville NC 27320 Fax: [phone]
Email: [e-mail] Attention: S Turn Around Time,
How would you like your report sent? 'RUSH work n33ee55dsppprior approval.
www.meritechlabs.com Circle all that apply: ma (preferred), Fax, Mail S ) f� Za- Ns
Sampling Dates & Times Person Taking Sample (SI /Print): Lab Use Only
Sample Location and/or ID # Start End c p? -# of on ice? Yes pH 00
Date Time Date Time Grab? Cont. Test(s) Required / No CI OK?
Lush r 4/ ado, '�r Lku
e - —
Temperature Upon Receipt:
Method of "'Dechlorination c0.5 m ofAmmonia, C nide Z C" Phenol and TKN samples must be done in the field prior to preservation. �
Shipment:p��U Comments: �-7 r Compositor#
el� l",a l �lyi� �t�, C/� i'�y G
UPS ✓/ Pug #
Fed Ex Are as r ults for regulatory pur s? Yes [a No eppirt su in: mg/L QSJ mg/kg ❑ ug/L
Hand Delivery RNlnqu shed by: _ Tim: D Ret Date: Time: / /0
Other R °16 dbv. rune: IltN b Date: nme:
.rh efinqul a Date: Time: R= Ub: Time: .

S'l01094VA'fERDISCHAIi JUTFALL(,SDO)
MONITORING hoPORT
GENERAL PERTVI11' NO. NCG210000 SAMPLES COLLEC-1iD DURING CALENDAR YEAR:
CERTIFICATE OF COVERAGE NO, NCG21FQ ®0® (This monitoring report is due at file Division no later than 30 days from
lire dale the facility receives the sampling results from (he laboratory.)
FACILITY NAME / +• (
PERSON COLLECTIN ' SAM LFS —_-- —
CERTIFIED LABORATORY Lab 9-
Lai) N
Part A: Specific Monitoring Regttiremenlsr
PHONE NO. (`3/L—) 4zA 3 �I\'rD
PLEASE SIGN ON THE REVERSE 4 AUG 2 6 2016
NTRAL FILES
R SECTION
Outfall
No.
Benchmark*-
Date
Sample Collectedi
nio/dd/ i'..
Total Rainfall,
.iitcfies-
-
00530
00400
00340 D
Total Suspended Solids,
m L-:
- . too
- pH,
Slandarduiiils
_ Within 6.0=9.0
Chemical Oxygen Demand (COD);
nt
120
`_
.
t
n.,_..:,..d.,.far
longer than seven (7) days
'Monitoring is required only if the facility stores exposed piles or sawdust, wood snipe, UO!R, in CFO •�•c• atio — o
If the facility elects not to monitor because accumulated material is removed within seven (7) days or Tess, the certification below must be signed. The facility shall
also record and maintain a log in its SPPP (Sim inwater 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 I 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, nn lch, or o rer 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 atial}rmonitoring waiver, the
discharger shall sign the following certification statement: 40
"Based upon my inquiry of the person or persons directly responsible for managing compliance with the permit requirement forto
analytical monitoring, I certify that to the best of my knowledge and belief, no piles of sawdust, woad chips, bark, mulch or
other similar materials were stored exposed (either to incident precipitation or to stormwater mn on) for longer than seven (7)
days before removal since filing the [as discharge monitoring report."
Name (Print me)
Title (Print title)
(Signature) (Date)
S W U-245 -072808
Page 1 of 2

;i'i'OIflblll'i5,'I'I?ItLh �:�ItCI?UU'I'1�,\L1.(`�O(71
MONITORING 10"'POIt'1'
"1 certify, uadw pcualty of law, that this docuumnl and all attachments were prepared under my direction or supervision in accordance with a
system dcsigncd to assure that qualified personnel properly gather and evaluate file information suhmiltcd. Based on m)• Inquiry ot'the person
or persons who nonage 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 congdeto, 1 am aware that there arc Significant penalties for submitting false information,
including the poss' MO, of fines and imprisonment for knowing violations."
(Signature ()ermittcc) - (Date)
Puna S W U-254-0'/ 1400
Page. 1. of 7.

s
aceAnalj6cal
s .pacelahsmn
June 21, 2016
Doug Dunne
RE: Project: STORMWATER
Pace Project No.: 92301716
RECEIVED
CENTRAL FILES
DWR SECTION
Pace Analytical Services, Inc.
6701 Conference Drive
Raleigh, NC 27607
[phone]
Dear Doug Dunne:
Enclosed are the analytical results for sample(s) received by the laboratory on June 16, 2016. The
results relate only to the samples included in this 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,
\'�rcam,.-_ cg:,--.,L.)h—
Liamm Harrison
[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..
Q g
CQ
y
Q
Page 1 of 11

acmnalytical
w vicacelebs.=
Project: STORMWATER
Pace Project No.: 92301716
Asheville Certification IDs
Pace AnaWal Services, Inc.
6701 Conference Drive
Raleigh, NC 27607
(919)8344984
2225 Riverside Drive, Asheville, NC 28804
Florida/NELAP Certification #: E87648
Massachusetts Certification #: M-NC030
North Carolina Drinking Water Certification #: 37712
Eden Certification IDs
205 East Meadow Road Suite A, Eden, NC 27288
North Carolina Drinking Water Certification #: 37738
CERTIFICATIONS
North Carolina Wastewater Certification #: 40
South Carolina Certification M 99030001
Virginia/VELAP Certification #: 460222
North Carolina Wastewater Certification #: 633
Yaginia/VELAP 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 2 of 11

aceAnalj6cal
s 'Pacelabs=
SAMPLE ANALYTE COUNT
Pace Analytical Services, Inc.
6701 Conference Drive
Raleigh, NC 27607
[phone]
Project:
Pace Project No.:
STORMWATER
92301716
Analysts
Lab ID
Sample ID
Method
Analysts
Reported
Laboratory
92301716001
STORMWATER 1ST DISCHARGE
SM 2540D
CRP
1
PASI-E
SM 4500-H+B
DWJ
1
PASI-E
SM 5220D
WRC
1
PASI-A
REPORT OF LABORATORY ANALYSIS
This report shall not be repmduced, except in lull,
without the written consent of Pace Analytical Services, Inc.. Page 3 of 11

w
-
. } ..
r
' I � r
Pi
� 1...... _
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acmnalytical
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ANALYTICAL RESULTS
Pace Analytical Services, Inc.
6701 Conference Drive
Raleigh, NC 27607
(919)8344984
Project: STORMWATER
Pace Project No.: 92301716
Sample: STORMWATER 1ST
Lab ID: 92301716001 Collected:
06/16/16 08:55
Received: 06116/16 09:15 Matrix: Water
DISCHARGE
Parameters
Results Units Report Limit
OF
Prepared Analyzed CAS No. Oual
2540D Total Suspended Solids
Analytical Method: SM 2540D
Total Suspended Solids
21.2 mg/L
7.4
1
06120/16 16:00
4500H+ pH, Electromeltric EON
Analytical Method: SM 4500-H+S
pH at 25 Degrees C
6.9 Std. Units
1.0
1
06/17/16 10:00 1-11,1-16
52200 COD Low Level
Analytical Method: SM 52200
Chemical Oxygen Demand
94.0 mg/L
10.0
1
06121116 15:30
Date: 06121/2016 04:37 PM
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 11

laceAnalytical'
xxwpscelabs.cwn
QUALITY CONTROL DATA
Project: STORMWATER
Pace Project No.: 92301716
QC Batch: EDEN/23188 Analysis Method: SM 2540D
QC Batch Method: SM 2540D Analysis Description: 2540D Total Suspended Solids
Associated Lab Samples: 92301716001
METHOD BLANK: 1759839 Matrix: Water
Associated Lab Samples: 92301716001
Blank Reporting
Parameter Units Result Limit Analyzed Qualifiers
Total Suspended Solids mg/L NO 2.5 06/20/16 15:56
Pace Analytical services, Inc.
6701 Conference Drive
Raleigh, NC 27607
[phone]
LABORATORY CONTROL SAMPLE:
1759840
Spike
LCS LCS % Rec
Parameter
Units
Conc.
Result % Rec Limits Qualifiers
Total Suspended Solids
mg/L
250
258 103 9D-110
SAMPLE DUPLICATE: 1759841
92301706001 Dup
Parameter Units Result Result RPD Qualifiers
Total Suspended Solids mg/L 26.7 27.5 3
Results p wear W ones, page are In gu u lm InNcatad by IM'UrdW column except where an allemem wtll IS pavam ad to the rips ofthe result.
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
Date: 06/21/2016 04:37 PM without the written consent of Pace Analytical Services, Inc.. Page 5 of 11

aceAnalytical.
~..pacelft=
QUALITY CONTROL DATA
Project: STORMWATER
Pace Project No.: 92301716
QC Batch: EDEN/23170 Analysis Method: SM 4500-H+B
QC Batch Method: SM 4500-H+B Analysis Description: 4500H+B pH EDEN
Associated Lab Samples: 92301716001
SAMPLE DUPLICATE: 1758083
Parameter
pH at 25 Degrees C
92301684001 Dup
Units Result Result RPD Qualifiers
Sid. Units 7.3 7.3 0 H3,H6
Pace Ana"cal services, Inc.
6701 Conference Drive
Raleigh, NC 27607
[phone]
Results amsawNe mn tlrh Page am In the uMb � by Ure'UMb' column except where an atternats mit to Mn W the rl9ht oltlu reW
REPORT OF LABORATORY ANALYSIS
This report shell not be reproduced, except in full,
Date: 06/21/2016 04:37 PM without the written consent of Pace Analytical Services, Inc..
Page 6 of 11

aceAnalytical e
a ..pacdabsmm
QUALITY CONTROL DATA
Project: STORMWATER
Pace Project No.: 92301716
QC Batch: WETA/28024 Analysis Method: SM 5220D
QC Batch Method: SM 5220D Analysis Description: 5220D COD, low Level
Associated Lab Samples: 92301716001
METHOD BLANK: 1760369
Associated Lab Samples: 92301716001
Parameter Units
Chemical Oxygen Demand mg/L
Matrix: Water
Blank Reporting
Result Limit Analyzed Qualifiers
NO 10.0 0612111615:30
Pace Analytical services, Inc.
6701 Conference Drive
Raleigh, NC 27607
(919)6344994
LABORATORY CONTROL SAMPLE: 1760370
Spike LCS LCS % Rec
Parameter Units Cone. Result % Rec Limits Qualifiers
Chemical Oxygen Demand mg/L 75 78.0 104 90-110
MATRIX SPIKE & MATRIX SPIKE DUPLICATE: 1760371
1760372
MS
MSD
92301557001 Spike
Spike
MS
MSD MS MSD % Rec
Parameter Units Result Cone.
Conc.
Result
Result % Rec % Rec Limits RPD Qual
Chemical Oxygen Demand mg/L 37.0 300
300
376
376 113 113 90-110 0 Mt
Reautb praearded on this pale an In the, unit, lmacated by tM'Unaa' column except whore an atlernam u h Is atma ted to tho dlpa of Ura result
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except In full,
Date: 06/21 /2016 04:37 PM without the written consent of Pace Analytical Services, Inc..
Page 7 of 11

aceAnalytical
w»wpscebbsmm
QUALIFIERS
Project: STORMWATER
Pace Project No.: 92301716
DEFINITIONS
Pace Analytical Services, Inc.
6701 Conference Drive
Raleigh, NC 27607
(919)6344964
OF - Dilution Factor, if reported, represents the factor applied to the reported data due to dilution of the sample aliquot.
NO - Not Detected at or above adjusted reporting 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 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 be 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 AcryloniMle by EPA
Method 8260,
N-Nitrosodiphenylamine decomposes and cannot be separated from Dipherylamine using Method 8270. The result reported for
each analyte is a combined concentration.
LABORATORIES
PASI-A Pace Analytical Services - Asheville
PASI-E Pace Analytical Services - Eden
ANALYTE QUALIFIERS
H1 Analysis conducted outside the EPA method holding time.
H3 Sample was received or analysis requested beyond the recognized method holding time.
H6 Analysis initiated outside of the 15 minute EPA required holding time.
M7 Matrix spike recovery exceeded QC limits. Batch accepted based on laboratory control sample (LCS) recovery.
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
Date: 06/21/2016 04:37 PM without the written consent of Pace Anayticel Services, Inc.. Page 8 of 11

laceAnalytical"
~vMcalaes.com
QUALITY CONTROL DATA CROSS REFERENCE TABLE
Pace Analytical Services, Inc.
6701 Conference Drive
Raleigh, NC 27607
(919)8344984
Project:
STORMWATER
Pace Project No.:
92301716
Analytical
Lab ID
Sample ID
OC Batch Method
OC Batch Analytical Method Batch
92301716001
STORMWATER 1ST DISCHARGE
SM 2540D
EDEN/23188
92301716001
STORMWATER 1ST DISCHARGE
SM 4500-H+B
EDEN/23170
92301716001
STORMWATER 1ST DISCHARGE
SM 5220D
WETA/28024
Date: 06/21/2016 04:37 PM
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced. except in lull,
without the wriCen consent of Pace Analytical Services, Inc..
Page 9 of 11

i
W0#:92301716
Custody Seal Present?
PackingMaterial: Date/Initials Person Examining Contents!
[]Bubble Wrap ❑Bubble Bags. None�/❑Other:_
Thermometer: T1505 Typ fIc • ew t ❑glue (]none slmplesonice,coolin8praesshasbexun
Correction Factor: 0.0'C Cooler Temp Corrected ('Cl: Biological Tissue Frozen? ❑Yes �Nd Q /A
Temp should be above freezing to 6'C
USDA Regulated Soil �frN/A, water sample) //
Did samples or nate In a quarantine zone within the United States: CA, NY, or SC (check maps)? Old samples odglnate from a foreign source (Internjjdrnaily,
❑Yes (2o _ hcluding Havall and Puerto Rico)? ❑Yes .QNo
C
Comments/Discrepancy:
Chain of Custody Present?
ffYes
ONO
N/A
1.
Samples Arrived within Hold Time?
es
❑No
N/A
2.
Short Hold Time Analysis(<72 hr.?
es
❑N/A
3.
Rush Turn Around Time Requested?
Yes
�oo
No
N/A
4.
Sufficient Volume?
26s
No
N/A
5,
Correct Containers Used?
ees
[]No
❑N/A
6.
-Pace Containers Used?
Yes
No
N/A
Containers Intact?
171Yss
ONO
ON/A
7.
Samples Field Flltered?
Zfe..
ONO
ON/A
8. Note E sediment is visible In the dissolved container
Sample labels Match COC7
Yes
ON.
ON/A
9.
-Includes Date/Time/ID/Analysis Matrix:
w
All containers needing acid/base preservation have been
10. wurx,z
checked?
��'
,I�IYes
❑No
❑N/A
All containers needing preservation are found to be In
xri,xe
compliance with EPA recommendation?
,xawsxa
(HNOs,HzSOs,HCI<2; Na0H>9 Sulfide, NaOH>12 Cyanide)
'pYes
No
ON/A
x.axxwrr
Exceptions: VOA, Collform, TOC, Oil and Grease,
'
DRO/8015(water DOC,LLHg
Yes
No
NA
Samples checked for dechlorinatlon?
OYes
QNo
N/A
21.
Headspace In VOA Vials>5-6mm?
QYes
No
12.
Trip Blank Present?
OYes
❑No
A
3.
Trip Blank Custody Seats Present?
OYes
ONO
2141A
Pace Trip Blank Lot M(iFpurchased):
CLIENT NOTIFICATION/RESOLUTION
Field Data Required? ❑Yes ONO
Person Contacted: Date/lime:
Comments/Sample
Discrepancy:
Project Manager SCURF Review: Date: L �,
Project Manager SRF Review: ( E\- . Date: � u -1- i �
Note: Whenever there is a discrepancy affecting North Carolina compliance samples, a copy of this form w8besenttothe North Carolina DEHNRCertification Office (i.e.
Out of hold, Incorrect preservative, out of temp, Incorrect containers)
Page 10 of 11

/2AIyW- CHAIN -OF -CUSTODY / Analytical Request Document
Section A The Chairwf-Custody is a LEGAL DOCUMENT. All relevant fields must be completed accurately.
Smrinn w
`o
a
a

5"I'ommivAITIt DISCHAI; ''HH FALL (SUO)
iNIONITORING t,�PORT
GENERAL PERMIT NO. NCG210000
CERTIFICATE OF COVERAGE NO. NCG21FQ1®0ft1
FACILITY NAVIE
PERSON COLLECTING SANfY1,FS_ _—
CERTIFIED LABORATORY--- Lab h_
Lab k
Part A: Specific Monitoring Requirements
SAMPUS COLLF,CPED DURING G\LENDAR YEAR:
(Tlti.s monitoring report is due at tile. Division no later than 30 days from
lire dale the facility receives the sampling results front the laboratory.)
COUNTY [�
PHONE NO. (9/�) g$(a,_3y R3
PLEASE SIGN ON T HE REVERSE 4
Oatfall
No.
m
Benchark`
Date
Sample collected;.
riio/dd/ yi'
-
Cotal Rainfall,
inches
00530
Total Suspended Solids,
...:. rn /L ,.
- too -
00400
pH, -
Standard units
_ Within 6:0-9.0
00340
Chemical Oxygen Demand (COD),
°f L
120
—y L
91
.__,.
._..1,.i. ,..,.n,.,. �,nid— „��ie�Lil
nn site for lom 4cr than seven (7) daye
Mnn onong is require(] only t tie facility Stoics exposes piles
If the facility elects not to monitor because accumulated material is removed within seven (7) days or less, the certification below niust be signed. The facility shall
also record and maintain a log in its SPPP (Stortnwater 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 I or Tier 2 responses in the General Permit.
Faciiities that do not store exposed (either exposed to incident precipitation or exposed to stormwater nut on) piles of sawdust, wood chips, bark, mulch. or other similar material for
he
longer than seven (7) days on site inay so certify, and the requirement for analytical monitoring may be waived. For those facilities that yualily for the analytical monitoring waiver, [
discharger shall sign the following certificatimt statement:
"Based upon my inquiry of the person or persons directly responsible for managing compliance will, 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 stormwater run on) for longer lhau seven (7)
days before removal since Filing the las�disclmge monitoring report."
Name (pii
Title (Print title)
(Signature)
(Date)
S W U-245-072808
Page I of 2

tlHM'Cl,NNIh .AR(:1!:()l)l'RAIJ,c;DO)
MONI'I'URINC RKTOR'I'
'I certify, nllder pcually of law, that this dnc.uuuad 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 iuforpcation submitted. Ilased on my, inquiry of the person
or poisons who manage the system, or those persons directly responsible for gatheing the information, file information submitted is, to the hest
of my knowledge and belief, true, accurate, and complete, I am awmv that TwT are siguincat penallies fur submitting false information,
including I w puss' ility olJim and imprisonment fur knowing violations."
�]
F./D- /4,
(,Siguuhirc o b'emtilteo) (Dale) --
lbrm SNVU-254071400
page 2 of 2

accAnalytical e
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June 21, 2016
Doug Dunne
RE: Project: STORMWATER
Pace Project No.: 92301716
Pace Analytical Services, Inc.
6701 Confererce Drive
Raleigh, NC 27607
[phone]
Dear Doug Dunne:
Enclosed are the analytical results for sample(s) received by the laboratory on June 16, 2016. The
results relate only to the samples included in this 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,
Liamm Harrison
[e-mail]
Project Manager
Enclosures
REPORT OF LABORATORY ANALYSIS
This report shell rot be reproduced, except In full,
wMW the written consent of Pace An*bcal Services, Inc.. Page 1 of 11

, aceAnalyticale
eww.pawlassavn
CERTIFICATIONS
Pace Anayecal Services, Inc.
6701 Conference Drive
Raleigh, NC 27607
[phone]
Project: STORMWATER
Pace Project No.: 92301716
Asheville CertliHoatlon IDs
2225 Riverside Drive, Asheville, NC 28804
North Carolina Wastewater Certification #: 40
Florida1NELAP Certification #: E87648
South Carolina Certification #: 99030001
Massachusetts Certification #: M-NCO30
VirginiafVELAP Certification #: 460222
North Carolina Drinking Water Certification It: 37712
Eden Certification IDs
205 East Meadow Road Suite A, Eden, NC 27288
North Carolina Wastewater Certification #: 633
North Carolina Drinking Water Certification #: 37738
Virginia/VEIAP Certification #: 460025
REPORT OF LABORATORY ANALYSIS
This report shell not be reproduced, except in full,
wlCaut the written consent of Pace Anal) ical Services, Inc.. Page 2 of 11

aeol
aceAnalytical
x�nrpararaa%mm
SAMPLE ANALYTE COUNT
Pace Analydcal Services, Inc.
8701 Conference Drive
Raleigh, NC 27607
[phone]
Project:
Pace Project No.:
STORMWATER
92301716
Analytes
Lab ID
Semple ID
Method Analysts
Reported
Laboratory
92301716001
STORMWATER 1ST DISCHARGE
SM 2540D CRP
1
PASI-E
SM 4500-H4B DWJ
1
PASI-E
SM 5220D WRC
1
PASI-A
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced. except in full,
wdM d the written mnsent of Pece Analytical Services. Inc.. Page 3 of 11

aceAnalytical
~..paceleb&o
ANALYTICAL RESULTS
Pace Analytical Services, Inc.
6701 Conference Drive
Raleigh, NC 27607
[phone]
Project: STORMWATER
Pace Project No.: 92301716
Sample: STORMWATER IST Lab ID: 92301716001 Collected: 0611611608:55 Received: 06/16/1609:15 Matrix: Water
DISCHARGE
Parameters Results Units Report Limit DF Prepared Analyzed CAS No. Oual
2540D Total Suspended Solids
Analytical Method: SM 2540D
Total Suspended Solids
21.2 mg/L 7.4 1 0620/16 16:00
45001,1+ pH, Eleotromefzic EDN
Analytical Method: SM 450D-H+13
pH at 25 Degrees C
6.9 Sid. Units 1.0 1 D6/17/16 10:00 H1,H6
5220D COD Low Level
Analytical Method: SM 5220D
Chemical Oxygen Demand
Il mg/L 10.0 1 06121/16 15:30
REPORT OF LABORATORY ANALYSIS
This report Mall not be repreduoee, except in full,
Date: 06/212016 04:37 PM wi&W the wneen oonsent of Pace Anetyecal Services, Inc.. Page 4 of 11

relol
aceAnalytical e
xevepa<elabsoorri
QUALITY CONTROL DATA
Pace Analytical $ekes, Inc.
6701 Conference Drive
Raleigh, NC 27607
[phone]
Project: STORMWATER
Pace Project No.: 92301716
CC Batch: EDEN/23188
Analysis Method:
SM 2540D
QC Batch Method: SM 2540D
Analysis Description:
2540D Total Suspended Solids
Associated Lab Samples: 92301716001
METHOD BLANK: 1759839
Matrix: Water
Associated Lab Samples: 92301716001
Blank Reporting
Parameter
Units
Result Limit
Analyzed Qualifiers
Total Suspended Solids
mg/L
NO 2.5 06/20/16 15:56
LABORATORY CONTROL SAMPLE: 1759840
Spike LCS
LCS %Rec
Parameter
Units
Concz Result
% Rec Limits Qualifiers
Total Suspended Solids
mg/L
250 258
103 90-110
SAMPLE DUPLICATE: 1759841
92301706001 Dup
Parameter
Units
Result Result
RPD Qualifiers
Total Suspended Solids
mg/L
26.7 27.5 3
Result presenbd an this leas en In dw uab brakab0 by tM'UntW column exeW when an a6unae unit Is pmented to the rlam a Ue ream.
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full.
Date: 06/21/2016 04:37 PM vdthout the written consent of Pace Analytical Seniors, Irk.. Page 5 of 11

aceAnalytical o
awwpeMlaeS.mm
QUALITY CONTROL DATA
Project: STORMWATER
Pace Project No.: 92301716
QC Batch: EDEN/23170 Analysis Method: SM 4500-H+B
QC Batch Method: SM 4500-H+B Analysis Description: 4500H+B pH EDEN
Associated Lab Samples: 92301716001
SAMPLE DUPLICATE: 1758083
Parameter
pH at 25 Degrees C
92301684001 Dup
Units Result Result RPD Qualifiers
Std. Units 7.3 7.3 0 H3,H6
Pace Analytical Services, Inc.
6701 Conference Drive
Raleigh, NC 27607
[phone]
Rwr@a pamftd en hob papa am In the unit Inmcahe by tho'UrAW column except whom an aeaMe unit Is pew ftd to the right of the result.
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except In MI,
Date: 06/21/2016 04:37 PM without the wri8en consent of Pace Anaytical Services, Inc..
Page 6 of 11

aceMalytical'
wnwpatelabsmm
QUALITY CONTROL DATA
Project: STORMWATER
Pace Project No.: 92301716
QC Batch: WETA/28024 Analysis Method: SM 5220D
QC Batch Method: SM 5220D Analysis Description: 5220D COD, Low Level
Associated Lab Samples: 92301716001
METHOD BLANK: 1760369
Associated Lab Samples: 92301716001
Parameter Units
Chemical Oxygen Demand mg/L
Matrix: Water
Blank Reporting
Result Limit Analyzed Qualifiers
ND 10.0 06121/1615:30
Pace Analytical Services, Inc.
6701 Conference Drive
Raleigh, NC 27607
(919)8344984
LABORATORY CONTROL SAMPLE: 1760370
Spike LCS LCS % Rec
Parameter Units Conic, Result % Rec Limits Qualifiers
Chemical Oxygen Demand mg/L 75 78.0 104 90-110
MATRIX SPIKE & MATRIX SPIKE DUPLICATE: 1760371 1760372
MS MSD
92301557001 Spike Spike MS MSD MS MSD % Rec
Parameter Units Result Conc. Conc. Result Result % Rec % Rec Limits RPD Qual
Chemical Oxygen Demand mg/L 37.0 300 300 376 376 113 113 90-110 0 M1
Remits presented an this page are In the rette Indlttlsd by the'11 t cahnnn except atrele an abmste u h Is presented to the right of the reu t
REPORT OF LABORATORY ANALYSIS
This report shell not be reproduced, except In full,
Date: 06/21/2016 04:37 PM without the written convent of Pace Ana"wl Services. Inc..
Page 7 of 11

0
ace Analytical
rvww.pxafaesxom
QUALIFIERS
Project: STORMWATER
Pace Project No.: 92301716
DEFINITIONS
DF - Dilution Factor, if reported, represents the factor applied to the reported data due to dihdfon 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.
MDL-Adjusted Method Detection Limit.
PQL- Practical Quantitation Limit.
RL - Reporting Limit.
Pace Analytical Services, Inc.
6701 Conference Drive
Raleigh, NC 27607
(919)6344984
S - Surrogate
1,2-Diphen ylhydrazirte decomposes to and cannot be separated from Azobenzene using Method 8270. The result for each anayte 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 be appropriate for 2 Chlorcethylvinyl 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-Nitrosodiphenylamirte decomposes and cannot be separated from Diphenyfamine using Method 8270. The result reported for
each anayte is a combined concentration.
LABORATORIES
PASI-A Pace Analytical Services - Asheville
PASI-E Pace Analytical Services - Eden
ANALYTE QUALIFIERS
H1 Analysis conducted outside the EPA method holding time.
H3 Sample was received or analysis requested beyond the recognized method holding time.
H6 Analysis inflated outside of the 15 minute EPA required holding time.
Mt Matrix spike recovery exceeded OC limits. Batch accepted based on laboratory control sample (LCS) recovery.
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except In full,
Date: 06/21/2016 04:37 PM without the written consent of Pace Analytical Services, Inc.. Page 8 of 11

aceAnalytical'
wwwpsceHososm
QUALITY CONTROL DATA CROSS REFERENCE TABLE
Project: STORMWATER
Pace Project No.: 92301716
Lab ID
Sample ID
OC Batch Method
OC Batch
92301716001
STORMWATER 1ST DISCHARGE
SM 2540D
EDEN/23188
92301716001
STORMWATER 1ST DISCHARGE
SM 450D-H+B
EDEN/23170
92301716001
STORMWATER 1ST DISCHARGE
SM 5220D
WETA/28024
Date: 06212016 04:37 PM
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
without the written consent of Pace Ana"cal Services, Inc..
Pace Analytical Sm Icea, Inc.
6701 Conference Dmre
Raleigh, NC 27607
(919)8344984
Analytical Method
Analytical
Batch
Page 9 of 11

thaw CHAIN -OF -CUSTODY / Analytical Request Document m
A The Cfiakrro Custody is a LEGAL DOCUMENT. All relevant fields must be wmpletee accurately. IL Sttlien

S'I'Ol(1A'1WATER DISCIIAI; JOTIFALL(SDO)
NIONITORING md'ORT
GENERAI, PFIZ�4ITNO. NCG210000 I�'
CJSKf 1rIG'ATE OF COVERAGE NO. NCG21©F2EX�
FACILITY NAME �/f _� -- �''�-- I -
PERSON COLLEC :TIN
G:—
CERTIFIED LABORATORY I4Lab # 33731
Lab #
fart A: Specific Monitoring Requirements'
SAMPLES COI,I,ECTI?D DURING CALENDAR YEAR:
(']'his monitoring report is due at the Division no later than 30 days from
the dale the facility receives the sampling results front file Iabura(orY.)
COUNTY FiA•K II"
1'HONI?N0.(aL�_) � il/ - ECEIVED
PLEASE SIGN ON THE REVERSE 4 AUG 0 6 2015
CENTRAL FILES
DWR SECTION
Outfall
No.
Date
Sample Collected,.
mo/dd/ r..
-
Total Rainfall,
inches
- ..:. -.
00;30
Total Suspended Solids,
... tit L :
.. :..100 .....
00400.
pH,
Standtird ititits
Witititi6:0-9.0
00340
Chemical oxygen Demand (COD);
ni
..]20'
00
Renchnark*.
-
Ih ther similar material
on site for longer than seven (7) day!
Monitoring is required only if tile n
e facility stores exposed piles of sawdust, wood chips, bark, ut c , of u
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 (Storntwater Pollution Prevention Plan) of dates when material is generated and removed, how, and by whom.
}Note: If you report a value it, excess of the benchmark value, or outside the benchmark range (for pH), you most implement Tier I or Tier 2 responses in the General Permit.
Facilities that do not store exposed (either exposed to incident precipitation or exposed to stormwater rm 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 mouitoring waiver, the
dischmger shall sign the following certification statemene
"Based upon lily 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, uo piles of sawdust, wood chips, bark, mulch or
other similar mateiials were stored exposed (either to incident precipit<tion or to stormwater run on) for longer than seven ("])
days before removal since filing the last discharge monitoring report"
(Print name)
Title (Print title)
(Signature)
(Date)
S W U-245-072808
Page I of 2

.��"•:)ftl'c11M1`i�,'i'lia{ I1� �;l It (;I!; lll1'f 1�,1 L!, (tiliUl
it9t)NHIMINC 10:I'ORT
"I certify, uud er penalty of law. that this docunimt :nd all attachnwn!s in accordance with a
system designer( to assure tlwt cju:ditied 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 respmWWe for gathering the infnrtnulion, the information submittal is, to the best
ot'iny kuowlcdge mud belief, lt•ue, aceunde, and c mile(, 1 am alvare that (here ;uT signilicant pcoalties for submitting fntse information,
including -the possibility of fines mill imprisonnwnt for knowing violations,"
_ 7' 3� c5
(Sigcmturu c 'ermittee) --
1)ale)
fort❑ SNYU-254-0714(1(1
loge 2 of 2

- aceAnalytical
ax+vpeceleCs.com
Doug Dunne
Project: STORMWATER
Pace Project No.: 92252982
Sample: STORMWATER
Laboratory Report
Pace Analytical services, Inc.
6701 Conference Drive
Raleigh, NC 27607
(9191,834-4984
Page 1 of 1
Report Date: 06/09/2015
Date Received: 06/04/2015
Lab ID: 92252982001 Collected: 06/04/15 08:10 Matrix: Water
Parameters
Results Units
Report Limit
Analyzed Qualifiers
Total Suspended Solids
25.0 mg/L
12.5
06/05/15 10:44
pH
6.9 Sid. Units
0.10
06/09/15 13:30 H6
Chemical Oxygen Demand
100 mg/L
10.0
06/09/15 12:30
ANALYTE QUALIFIERS
H6 Analysis initiated outside of the 15 minute EPA recommended holding time.
Reviewed by: ' `r,
Liamm Carrubba
[e-mail]
Raleigh Certification IDs
6701 Conference Drive, Raleigh, NC 27607
North Carolina Wastewater Certification #: 67
Asheville Certification IDs
2225 Riverside Drive, Asheville, NC 28804
Florida/NELAP Certification #: E87648
Massachusetts Certification #: M-NC030
North Carolina Drinking Water Certification #: 37712
North Carolina Bioassay Certification #: 16
North Carolina Drinking Water Certification #: 37731
North Carolina Wastewater Certification #: 40
South Carolina Certification #: 99030001
West Virginia Certification #: 356
VirginiaNELAP Certification #: 460222
Page 1 of 3

Document Name: Sample Condition Upon
Document Revised: May 15, 2015
aceAna iC I
Receipt SCUR
Page 1 of 2'
Document No.:'
F-RAL,CS-00
Issuing Authorities:
I Pace Raleigh Quallt Office
" ^ °•'° '°'"
(
'Page 2 of -2 Is for Internal Use Only
Client Name:_`"Sn�t � kkA,- \0es(
Courier (Circle): Fed Ex UPS USPS Client Commercial Pace ther
Custody Seal on Cooler/Box Present: yes Z ,no Seals Intact: Z yes p no
Packing Materlah 13 Bubble Wrap le Bags ref None Other
Circle Thermometer Used: IR OurN:122065387T o of Ice: et 5 Blue None Samples on toe, cooling process has begun
IR sun Bac 2065e71
Temp Correction Factor: Add (V ubtraZ� .�.o C
Biological Tissue Is Frozen: Yes No
Corrected Cooler Tomp.:�C 9
Temp should be above freezing to 6'C Comments:
Data and Initials of persons am n ng
t Pr a at
check lD- IS
Chain of Custody Present:
Yes ONO
ON/A
1.
Chain of Custody Filled Out:
6y.. ON.
❑wA
2.
Chain of Custody Relinquished;
16yos ONO
❑NIA
3.
Sampler Name & Signature on COC:
Yos ONO
❑NIA
4.
Samples Arrived velthln Hold Time:
Y.. ONO
ONIA
5.
Short. Hold Time Analysis <72hr:
❑Yee ONO
ONIA6.
Rush Turn Around Time Requested:
OYoe No
❑NIA
7.
'
Sufficient Volume:
12Yos ONO
EIWA
8.
Correct Containers Used:
-Pace Containers Used:
ryes ONO
Yes ONO
ON/A
OWA
9.
'
Containers Intact:
Yon ONO
❑N/A
10.
Filtered volume received for Dissolved tests
Oyes ONO
OwA
11.
Sample Labels match COC:
-Includes date/time/ID/Analysis Matrix:
Ye ONO
_
DNA
12.
All containers needing preservation have been checked.
All containers needing preservation are found to be In
compllonee'vAIh EPA recommendation.
exceptloiu: VOA, ceatorm, TOc, 0a0; MDR0 (walar)
p/(Yes ONO
rIDYes ONO
Yee ONO
❑NIA
❑NIA
13.
'
w.
Sam los checked for dechlorination:
es ONO
ON/A
14.
'
Heads ace In VOA Vials >Bmm :
Ores ONO
N/A
15,
Trip Blank Present:
Trip Blank Custorly Seals Present
Pace Tdp Blank Lot q If purchased):
OYes ONO
Elyse ONO
IWA
CJwA
16.
- I
Client Notification/ Resolution; Field Data Required? Y I N
Person Contacted: Datemme:
CcmmenW Resolution:. .
Place label here
SCURF' ISRF Dote.
Note: Wbonever Chore b a discrepancy affecting North Carolina compliance
sampins, a c py c(this form Wit be sent to the North Carolina DEHNR-
®
:;eNOcalbn Office (Le out of held, incorrect preservative, out of temp, `' 11A11� �11�11I'olI,1�I�lI.
Inr»necl corrainera)
Page 2 of 3

1. t��arx,Tra�
CHAIN -OF -CUSTODY f Analytical Request Document
The CKW"I-C uIody Is a LEGAL DOCUMENT. AB relevant fields must be completed acojmtey.
eatlee A Secaon 8 3ac9on D Z. -
• AP pNN Mortnatlan: . Rea V nd Pm}ea YrbrtaYJo2 ' MtJca Mrcms9on: - P 1 Of 1
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�R'44
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Permit No.: N/C4Ij/Ll�l
Facility Name: Je
County:
Inspector:
Date of Inspection:
or Certificate of Coverage No.: N/C/G/ Z/ i / 0/,` / ( / 9 /
Phone No.
By this signature, I certifythat this report is accurate and complete to the best of my knowledge:
(Signature of PerrMttee or Designee)
1. Outfall Description
Outfall No. � Structure (pipe, ditch, etc.) U/t�
Receiving Stream:
Describe the industrial activities that occur within the outfall drainage area:
l l Lt �4c,....h.sl-1
2. Color
Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint (light, medium,
dark) as descriptors: C [&.N
3. Odor
Describe any distinct o
etc.)
4. Clarity
that the discharge may have (i.e., smells strongly of oil, weak chlorine odor,
Choose the number which best describes the clarity of the discharge where 1 is clear and 10 is very
cloudy:
2 3 4 5 6 7 8 9 10
Page 1
SWU-242-101599

e
5. Floating Solids
Choose the number which best describes the amount of floating solids in the stormwater discharge where
1 is no solids and 10 is the surface covered with floating solids:
1 3 4 5 6 7 8 9 10
6. Suspended Solids
Choose the number which best describes the amount of suspended solids in the stormwater discharge
where 1 is.no solids and 10 is extremely muddy:
1 O 3 . 4. 5 6 7 8 9 10
7. Foam
Is there any foam in the stormwater discharge? Yes V
8. Oil Sheen
Is there an oil sheen in the stormwater discharge? Yes No
9. Other Obvious Indicators of Stormwater Pollution
List and describe
Note: Low clarity, high solids, and/or the presence of foam or oil sheen may be indicative of pollutant
exposure. These conditions may warrant further investigation.
Page 2
SWU-242-101599