NCG030056_MONITORING INFO_20191022

W S��
STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
/v u& o30 5`
DOC TYPE.
❑ HISTORICAL FILE
C MONITORING REPORTS
DOC DATE
❑ 0)
YYYYMMDD

Stormwater Discharge Monitoring Report
for North Carolina Division of Energy, Mineral and Land Resources General Permit No. NCG030000
Date submitted 10/17/19
CERTIFICATE OF COVERAGE NO. NCG03 0 0 5 6
FACILITY NAME Gilbarco, Inc.
COUNTY Guilford
PERSON COLLECTING SAMPLES John Burke
LABORATORY Research & Analytical Lab Lab Cert. # 34
Comments on sample collection or analysis:
Part A: Stormwater Benchmarks and Monitoring Results
SAMPLE COLLECTION YEAR 2019
SAMPLE PERIOD ❑ Jan -June Q July -Dec
gf'—i1/,Morp[] Monthly' (month)
DISCHA'RGING•TO CLASS ❑ORW ❑HCtW ❑Trout ❑PNA
OCT 2 2 2019 ❑Zero -flow ■❑Water Supply ❑SA
CENTfutL FILES [:]Other
DVtIR SECT^, SE REMEMBER TO SIGN ON PAGES 2 AND/OR 3 4
n No discharge this period?'
Outfall No.
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
Inches'
Total Suspended Solids
pH
Standard units
Total Copper
Total Lead
Total Zinc
Non -Polar O&G/
Total Petroleum
Hydrocarbons
Total Toxic
Orgamcss
Benchmarks
_
-
100 mg/L or 50 mg/L4
6.0 - 9.0
0.010 mg/L
0.075 mg/L
0.126 mg/L
15 mg/L
1 mg/L
Parameter Code
-
46529
C0530
00400
01119
01051
01094
00552
78141
Outfall 001
9/13/19
0.10
26 mg/I
6.97
0.011 mg/I
<0.005 mg/I
0.117 mg/I
<5 mg/I
SMP
Outfall 002
1 9/13/19
0.10
1 6.8 mg/I
6.12
0.009 mg/I
<0.005 mg/I
0.099 mg/I
<5 mg/I
SMP
Outfall 003
9/13/19
0.10
<5 mg/I
5.28
0.007 mg/I
<0.005 mg/I
0.105 mg/I
<5 mg/I
SMP
Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outtall.
z For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here.
'The total precipitation must be recorded using data from an on -site rain gauge. Unattended sites may be eligible for a waiver of the rain gauge requirement.
4 See General Permit, Section B, Table 1 to identify the especially sensitive receiving water classifications where the more protective benchmark applies.
s Total Toxic Organics sampling is applicable only for those facilities which perform metal finishing operations, manufacture semiconductors, manufacture
electronic crystals, or manufacture cathode ray tubes. For purposes of this permit the definition of Total Toxic Organics is that definition contained in the EPA
Effluent Guidelines for the facility subject to the requirement to sample (for metal finishing use the definition as found in 40 CFR 433.11; for semiconductor
manufacture use the definition as found in 40 CFR 469.12; for electronic crystal manufacture use the definition as found in 40 CFR 469.22; and for cathode ray
tube manufacture use the definition found in 40 CFR 469.31).
_ Permit Date:-11/1_/2SWU-245, last revised 11 1 2
.018-05/31/2021- -- -___ _ - --. _ --- --- - -- - - - - --- - . - - / / 018
- --' -� Page 1of3

Facilities that incorporate a solvent management plan into the Stormwater Pollution Prevention Plan may so certify, and the requirement for TTO monitoring
may be waived. The solvent management plan shall include a list of the total toxic organic compounds used and the other elements listed in the General
Permit. For those facilities electing to employ the TTO 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 monitoring requirement for total toxic organics
(TTO), I certify that to the best of my knowledge and belief, no dumping of concentrated toxic organics into the stormwater or areas which are exposed to rainfall or
stormwater runoff has occurred since filing the last discharge monitoring report. I further certify that this facility is implementing the all the provisions of the
solvent management plan included in the Stormwater Pollution Prevention Plan."
Jamey Greene
Name (Print name)
VP of Operations, Amercias
itle (Print title)
Sqnatunl Date
v
Note: Results must be reported in numerical format. Do not report Below Detection Limit, BDL, <PQL, Non -detect, ND, or other similar non -numerical
format. When results are below the applicable limits, they must be reported in the format "<XX me/L" where XX is the numerical value of the detection
limit, reporting limit, etc. in mg/L.
Note: If you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses. See General Permit text.
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month.
n Nn rlicrhnrnp this nprinrl?2
Outfall No.
Date Sample Collected'
(mo/dd/yr)
24-hour rainfall amount,
Inches3
New Motor Oil or
Hydraulic Oil Usage
Non -Polar O&G/ Total
Petroleum Hydrocarbons
Total Suspended
Solids
Benchmarks
-
-
-
15 mg/L
100 mg/L or 50 mg/L4
Parameter Code
-
46529
NCOIL
00552
C0530
Footnotes from Part A also apply to Part B
Note: If you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses. See General Permit text.
Permit Date: 11/1/2018-05/31/2021 SWU-245, last revised 11/1/2018
Page 2 of 3

FOR PART A AND PART B MONITORING RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANYONE OUTFALL? YES Q NO ❑
IF YES, HAVE YOU CONTACTED THE DEMUR REGIONAL OFFICE? YES 0 NO ❑
REGIONAL OFFICE CONTACT NAME: Mathew Gantt
Mail an original copv of this DMR, including all "No Discharge" reports, within 30 days of receipt a the lab results (or at end of monitoring period in the
case of "No Discharge" reports) to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED:
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to
assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or
those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I
am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
/U-i�7
Date
Permit Date: 11/1/2018-05/31/2021 __ __ --- ,_-- _: _ - - - _ - =-__ = _- - - - - - - SWU-245, last revised 11/1/2018
-_ - - - _-- - -- Page 3 of 3

RESEARch & ANAIyiriul
UboRATORks' INC.
For: Gilbarco
7300 West Friendly Avenue
Greensboro, NC 27410
Attn: John Burke
Client Sample ID: Outfall 01
Site: Gilbarco
Parameter
Copper, Total
Hydrocarbon 0&G
Lead, Total
Total Suspended Solids (TSS)
Zinc, Total
Client Sample ID: Outfall 02
Site: Gilbarco
Hydrocarbon 0&G
Lead, Total
Total Suspended Solids (TSS)
Zinc, Total
Client Sample ID: Outfall 03
Site:; Gilbarco
Parameter
Copper, Total
Hydrocarbon 0&G
Method
EPA 200.7
EPA 1664 Revision B/Silica Gel
EPA 200.7
SM 2540 D-1997
EPA 200.7
Method
EPA 200.7
EPA 1664 Revision B/Silica Gel
EPA 200.7
SM 2540 D-1997
EPA 200.7
Method
EPA 200.7
EPA 1664 Revision B/Silica Gel
Report of Analysis
9/25/2019
ANAL .' 'PCn
!p�4
C 3�.'C',1
' NCN37701 i
Lab Sample ID:
72048-01
Collection Date:
9/13/2019
7:25
Result
Units
Rep Limit Analyst Analysis Date/Time
0.011
mg/L
0.005
JF
9/17/2019
<5
mg/L
5
EE
9/19/2019
<0.005
mg/L
0.005
JF
9/17/2019
26.0
mg/L
5
AW
9/17/2019
0.117
mg/L
0.01
JF
9/17/2019
Lab Sample ID:
72048-02
Collection Date:
9/13/2019
7:35
Result
Units
Rep Limit Analyst Analysis Daterrime
0.009
mg/L
0.005
JF
9/17/2019
<5
mg/L
5
EE
9/19/2019
<0.005
mg/L
0.005
JF
9/17/2019
6.80
mg/L
5
AW
9/17/2019
0.099
mg/L
0.01
JF
9/17/2019
Lab Sample ID:
72048-03
Collection Date:
9/13/2019
7:30
Result
Units
Rep Limit Analyst Analysis Daterrime
0.007
mg/L
0.005
JF
9/17/2019
<5
mg/L
5
EE
9/19/2019
P.O. Box 473 106 Short Street Kernersville, North Carolina 27284 Tel: [phone] Fax: [phone] v .randalabs.com Page 1
rat coa basic vld

RESEARCh & ANAIYTiCAI
Report of Analysis
rtc
UbouiroRi(Es, kc.
9/25/2019
Client Sample
ID: Oulfall 03
Lab Sample ID: 72048-03
Site:
Gilbarco
Collection Date: 9/13/2019 7:30
iParameter
I,
Method
Result
Units
Reo Limit Analyst Analysis DateRime
Lead, Total
EPA 200.7
<0.005
mglL
0.005 JF 9/17/2019
Total Suspended
Solids (TSS) SM 2540 D-1997
<5
mg/L
5 AW 9/1712019
Zinc, Total
EPA 200.7
0.105
mg/L
0.01 JF 9/17/2019
P.O. Box 473 106 ShortStn:el Kernersville, North Carolina 27284
ral coa basic vld
NA = not analyzed
Tel: [phone] Fax: [phone] v .randalabs.com Page 2

RESEARCh & ANALyTICA1
LAbORATORIES, INC.
Analytical / Process Consultations
Phone .[phone]
CHAIN OF CUSTODY RECORD
WATER I WASTEWATER I MISC.
• • •�
ANALYSIS
PROJECT
CITY, STATE, ZIP
PRINT)STREETADDRES
SAMPLER NAME (PLEASE
-CONTACT• -VI Lt
,;�•
y}y/
�ryEQUESTED
. �
��■�a■■ter
©■■■■■e■n■■■■■■
•• •
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,• �.

K11; GVR-226
Environmental
Quality
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance onfilling out this form, please visit https://deq.nc.gov/about/divisions/energy-mineral-land-resources/
npdes-stormwater-gps
PermitNo.: N/C/,6/0/3/olo/o/o/ or Certificate of Coverage No.: N/CIG/0/3/ot0lS'l0
Facility Name: (9Tt_GAq c� T J L
County: GLrC-L-F-on-O Phone No. 3 ,� 6 3
Inspector: J o lh.j A-X - .
Date of Inspection: Ci 113 � tq
Time of Inspection: 1 `.�s A vw -
Total Event Precipitation (inches): O t \ �3
All permits require qualitative monitoring to be performed during a "measurable storm event."
A "measurable storm event" is a storm event that results in an actual discharge from the permitted site
outfall. The previous measurable storm event must have been at least 72 hours prior. The 72-hour storm
interval does not apply if the permittee is able to document that a shorter interval is representative for
local storm events during the sampling period, and the permittee obtains approval from the local DEMLR
Regional Office.
By this signature, I certify that this report is accurate and complete to the best of my knowledge:
of Permince or Designee)
U
1. Outfall Description:
Outfall No. O 0 \ Structure (pipe, ditch, etc.): DA-wZ, A-b-fi DT.r'-e 1E
Receiving Stream:
I -\NA -SF:-
Describe the industrial activities that occur within the outfall drainage area:
m6A!}�— sC-&-,ten �rMQ�E, (oFn�o H�✓}c�xl �,— CaaS
Page 1 of 2
SWU-242, Last modified 06/01/2018

2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: N o (.;�Lcti ,:- L-' (, L�-r T—L. i
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil, weak
chlorine odor, etc.): NJo oOt- -
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is clear
and 5 is very cloudy:
I C2 ) 3 4 5
5. Floating Solids: Choose the number which best describes the amount of floating solids in the
stonnwater discharge, where I is no solids and 5 is the surface covered with floating solids:
O 2 3 4 5
6. Suspended Solids: Choose the number which best describes the amount of suspended solids in
the stormwater discharge, where I is no solids and 5 is extremely muddy:
7
13
9.
�2 3 4 5
Is there any foam in the stormwater discharge? o Yes as No.
Is there an oil sheen in the stormwater discharge? 0Yes ®�'No. _
Is there evidence of erosion or deposition at the outfall? c r es o No.
10. Other Obvious Indicators of Stormwater Pollution:
List and describe
L�
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition may be
indicative of pollutant exposure. 'These conditions warrant further investigation.
Page 2 of 2
SWU-242, Last modified 06/01/2018

GVR-226
N. 1;
En"ironmenial
Ali Quality
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance on filling out this form, please visit https://deq.iic.gov/about/divisioiis/energy-mineral-land-resources/
npdes-stormwater-gps
Permit No.: N/C/ G /o / 3lo (o /o/ o l or Certificate of Coverage No.: N_/C/G/O /3 /o lc!> (Sl. 6 /
Facility Name: (9Tt_ Xjk-cu i,a (
County: G U1:L-FOOL -O Phone No. 3 3 6— 33 7— 2 7 `'t
Inspector: J o h,mi 110ILI4-6-
Date of Inspection: 511-S � tg
Time of Inspection: -I iw�
I'
Total Event Precipitation (inches): D, 1 O
All permits require qualitative monitoring to be performed during a "measurable storm event."
A "measurable storm event" is a storm event that results in an actual discharge from the permitted site
outfall. The previous measurable storm event must have been at least 72 hours prior. The 72-hour storm
interval does not apply if the permittee is able to document that a shorter interval is representative for
local storm events during the sampling period, and the permittee obtains approval from the local DEMLR
Regional Office.
By this signature, I certify that this report is accurate and complete to the best of my knowledge:
of Permittee or Designee)
1. Outfall Description:
Outfall No. 002 Structure (pipe, ditch, etc.): ���Y1tiLL (iSnz
Receiving Stream:
lAm/-S(=P(� CocF_�L
Describe the industrial activities that occur within the outfall drainage area:
%`'Y L 5.�u+� G-E<�T_
Page 1 of 2
5 W U-242, Last modified 06/01/2018

2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light; medium, dark) as descriptors: N`0 C. -- t; (,-td� -t x
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil, weak
chlorine odor, etc.): N o o 131,on-
4. Clarity: Choose the number which best describes the clarity of the discharge, where I is clear
and 5 is very cloudy:
1 02 3 4 5
5. Floating Solids: Choose the number which best describes the amount of floating solids in the
stormwater discharge, where I is no solids and 5 is the surface covered with floating solids:
2O 3 4 5
6. Suspended Solids: Choose the number which best describes the amount of suspended solids in
the stormwater discharge, where 1 is no solids and 5 is extremely muddy:
3 4 5
7. Is there any foam in the stormwater discharge? o Yes
ell�io.
S. is there all oil sheen in the stormwater discharge? OYes o"No.
9.
Is there evidence of erosion or deposition at the outfall? O Yes e-T' o.
10. Other Obvious Indicators of Stormwater Pollution:
List and describe
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition may be
indicative of pollutant exposure. These conditions warrant further investigation.
Paget ot2
SWU-242, Last modified 06/01/2018

N,
GVR-226
Environmental
Quality
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance on felling out this form, please visit https://deq.nc.gov/about/divisions/energy-mineral-land-resources/
npdes-stormwater-gps
I
PermitNo.: N/C/ro/fl/3/o(o(n(D/ or Certificate of Coverage No.: N/C/G/0/3/0/U/S'(6/
Facility Name: G M tZ A—P co 1:,j
County: G u>=t_V-arLO Phone No. 3
Inspector: 70 11ro
Date of Inspection: _
Time of Inspection:
13 � to
7 `• 3a Jkw.
Total Event Precipitation (inches): 0, \Z)
All permits require qualitative monitoring to be performed during a "measurable storm event."
A "measurable storm event" is a storm event that results in an actual discharge from the permitted site
outfall. The previous measurable storm event must have been at least 72 hours prior. The 72-hour storm
interval does not apply if the permittee is able to document that a shorter interval is representative for
local storm events during the sampling period, and the permittee obtains approval from the local DEMLR
Regional Office.
By this signature, I certify that this report is accurate and complete to the best of my knowledge:
(Sigma re of Permittee or Designee
i
�i
1. Out:fall Description:
Outfall No. O-o 3 Structure (pipe, ditch, etc.): 4c-rrL DITZA-
i, Receiving Stream:
Describe the industrial activities that occur within the outfall drainage area: Trwut_. ✓ �� V a
Q�aoC NJ Ih 1�+c l d- U t*"S -
Page I of
S WU-242, Last modified 06/0 t/2018

2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: No ( o h k- t-%(-th-r- s�
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil, weak
chlorine odor, etc.): Nv o�
4. Clarity: Choose the number which best describes the clarity of the discharge, where I is clear
and 5 is very cloudy:
1 0 3 4 5
5. Floating Solids: Choose the number which best describes the amount of floating solids in the
stormwater discharge, where I is no solids and 5 is the surface covered with floating solids:
0 3 4 5
6. Suspended Solids: Choose the number which best describes the amount of suspended solids in
the stormwater discharge, where I is no solids and 5 is extremely muddy:
1 (9 3 4 5
7. Is there any foam in the stormwater discharge? o Yes d 110
S. Is there an oil sheen in the stormwater discharge? 0Yes 6-5-
9. Is there evidence of erosion or deposition at the outfall? Q Yes C <NO
to. Other Obvious Indicators of Stormwater Pollution:
List and describe
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition may be
indicative of pollutant exposure. These conditions warrant further investigation.
Pa,-e 2 of 2
S WU-242, Last modified 06/01 /2018

I ca GVR-226
Environmental
Quality
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
rorguidance on filling out this form, please visit https://deq.ne.gov/about/divisions/energy-mineral-land-resources/
npdes-stormwater-gps
PermitNo.: N_/C/G/,0/,3/o/,6/0/o/ or Certificate of Coverage No.: N/C/G/0/3(ol0(S1,6/
Facility Name: GTLZA—Xc- T,a (-
County: GuTIU(art 0 Phone No. 336-337 - 2 IK�
Inspector: 'IT-0
14,u CSuJu�
Date of Inspection: �t l3 I tg
Time of Inspection: g'. Z):Z> Pr"
Total Event Precipitation (inches): D, 1, D
All perm is require qualitative monitoring to be performed during a "measurable storm event."
A "measurable storm event" is a storm event that results in an actual discharge from the permitted site
outfall. The previous measurable storm event must have been at least 72 hours prior. The 72-hour storm
interval does not apply if the permittee is able to document that a shorter interval is representative for
local storm events during the sampling period, and the permittee obtains approval from the local DEMLR
Regional Office.
By t, is signature I-certify-tha�-this-repnrt is accurate and complete to the best of my knowledge:
(Sigma ure of Permittee or Designee)
1. Outfall Description:
OutfallNo. 001A Structure (pipe,ditch, etc.): -(F- DiiGUk
Receiving Stream:
l ivn --F-
Describe the industrial activities that occur within the outfall drainage area: R {Ax-arm
I
q
Page I of 2
SWU-242, Last modified 06/01/2018

2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: _N\l c� L"&'� T-S--d i
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil, weak
chlorine odor, etc.): >v1) Upar`-
4. Clarity: Choose the number which best describes the clarity of the discharge, where I is clear
and 5 is very cloudy: rDI 2 3 4 5
5. Floating Solids: Choose the number which best describes the amount of floating solids in the
stormwater discharge, where 1 is no solids and 5 is the surface covered with floating solids:
10 2 3 4 5
6. Suspended Solids: Choose the number which best describes the amount of suspended solids in
the stormwater discharge, where 1 is no solids and 5 is extremely muddy:
V 2 3 4 5
7. Is there any foam in the storrwater discharge? o Yes
S. Is there an oil sheen in the stormwater discharge? OYes 0-lsi
U]
Is there evidence of erosion or deposition at the outfall? o Yes e No.
10. Other Obvious Indicators of Stormwater Pollution:
List and describe
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition may be
indicative of pollutant exposure. These conditions warrant further investigation.
Page 2 of 2
SWO-242, Last modified 06/01/2018

I
Nra
GVR-226
Environmental
Quality
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance on filling out this form, please visit https://deq.nc.gov/abouUdivisions/energy-mineral-land-resources/
npdes-stormwater-gps
PermitNo.: N/C/g/0/3/0/6/o/o/ or Certificate of Coverage No.: N/C/GI6/3(otolS-(6l
Facility Name:
County: G ua<L-f--arl_0 Phone No. 3 3 6 3 3i — -L" d li
Inspector: J o lh a a")Jlv—L
Date of Inspection: Ci 11-3 tC
Time of Inspection: Q, . to w
Total Event Precipitation (inches): O ', \ O
All permits require qualitative monitoring to be performed during a "measurable storm event."
A "measurable storm event' is a storm event that results in an actual discharge from the permitted site
outf tl 1. The previous measurable storm event must have been at least 72 hours prior. The 72-hour storm
interval does not apply if the permittee is able to document that a shorter interval is representative for
local storm events during the sampling period, and the permittee obtains approval from the local DEMLR
Regional Office.
By thi�.signatttre, cer ' Flcis cep�rt is accurate and complete to the best of my knowledge:
of Permittee or Designee)
1. Outfall Description
Outfall No. DOS Structure (pipe, ditch, etc.): T ,Or
Receiving Stream:
Describe the industrial activities that occur within the outfall drainage area:
SWO-242, Last modified 06/01/2018
Page I of 2

2. Color: Describe the color of the discharge using basic colors (red, L
(light, medium, dark) as descriptors: N-0 G,)w— tb ( vkk 1
blue, etc.) and tint
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil, weak
chlorine odor, etc.): i�10 0/1 a
4. Clarity: Choose the number which best describes the clarity of the discharge, where I is clear
and 5 is very cloudy:
2 3 4 5
5. Floating Solids: Choose the number which best describes the amount of floating solids in the
stormwater discharge, where 1 is no solids and 5 is the surface covered with floating solids:
/ 1 ) 2 3 4 5
6. Suspended Solids: Choose the number which best describes the amount of suspended solids in
the stormwater discharge, where 1 is no solids and 5 is extremely muddy:
01 2 3 4 5
7. Is there any foam in the stormwater discharge? o Yes 1 o.
8. Is there an oil sheen in the stormwater discharge? OYes moo.
9. Is there evidence of erosion or deposition at the oudall? o Yes 'q No.
10. Other Obvious Indicators of Stormwater pollution:
List and describe
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition may he
indicative of pollutant exposure. These conditions warrant further investigation.
Page 2 of 2
SWU-242, Last modified 06/01/2018

NCO GVR-226
Environmental
Quality
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Forguidance on filling out this forni, please nisil helps://deq.iic.gov/about/divisions/energy-mineral-land-resom'ces/
n pdcs-s tormwater-gps
PermitNo.: N_/C/G/o/3/o/o/o/,o/ or Certificate of Coverage No.: N/C/G/0/3/0lol,sl,6/
Facility Name: (9SLZA-t-c� To C-
County: GUT-L-r-wL,0 Phone No. s
Inspector: So It a Q�fU�&
Date of Inspection: 3 I tQ
Time of Inspection: R t6 A,
Total Event Precipitation (inches):
All permits require qualitative monitoring to be perforated during a "measurable storm event."
A "measurable storm event' is a storm event that results in an actual discharge from the permitted site
outfall. The previous measurable storm event must have been at least 72 hours prior. The 72-hour storm
interval does not apply if the permittee is able to document that a shorter interval is representative for
local storm events during the sampling period, and the permittee obtains approval from the local DEM LR
Regional Office.
By this sigh4w er 1 y t tat t is r o is acarrate-and complete to the best of my knowledge:
(Si nature of ermittee or Designee)
1. Outtall Description:
OUtfall No. D O 6 Structure (pipe, ditch, etc.)
Receiving Stream:
{illy+ A 6-r.- 0-f �
a-F-�-t�—
Describe the industrial activities that occur within the outfall drainage area:
C /HL 12—i-vJ L
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2. Color: Describe the color of the discharge using basic colors (red, brown, bluo, etc.) and tint
(light, me(ium, dark) as descriptors: N° (_a, o A-- tie vti
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil, weak
chlorine odor, etc.): tJ 0 o AA°
4. Clarity: Choose the number which best describes the clarity of the discharge, where I is clear
and 5 is very cloudy:
l_/ 2 3 4 5
5. Floating Solids: Choose the number which best describes the amount of floating solids in the
stormwater discharge, where I is no solids and 5 is the surface covered with floating solids:
2 3 4 5
6. Suspended Solids: Choose the number which best describes the amount of suspended solids in
the stormwater discharge, where I is no solids and 5 is extremely muddy:
G 2 3 4 5
7. Is there any foam in the stormwater discharge? o Yes erNro.
8. Is there an oil sheen in the stormwater discharge? OYes 0 No.
9. Is there evidence of erosion or deposition at the outfall? O Yes CTNo.
10. Other Obvious Indicators of Storntwater Pollution:
List and describe
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition may be
indicative of pollutant exposure. These conditions warrant further investigation.
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