NCG060042_MONITORING INFO_20191105

w%o
STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
DOC TYPE
❑ HISTORICAL FILE
q<MONITORING REPORTS
DOC DATE
❑ 3eD
YYYYMMDD

Dear Sirs,
Attached is storm water sampling data from our four discharges at Commonwealth
Brands Inc. collected on October 16th, 2019. Everything was within permit
requirements. Please note that this facility is scheduled to close permanently in
December of 2019. All permits will be closed in early 2020.
Sincerely,
James K Gusler
Ken Gusler
OHS & E Specialist
Commonwealth Brands, Inc.
An IMPERIAL TOBACCO GROUP Company
301 N Scales Street,
Reidsville, NC, 27320
336-634-4237
ken.guslerCoDus.imotob.com
RECEIVED
NOV 0 5 2019
CENTRAL FILES
DWR SECTION
AD/01 a
Date

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
GENERAL PERMIT NO. NCG060000 SAMPLES COLLECTED DURING CALENDAR YEAR: 2011
CERTIFICATE OF COVERAGE NO. NCG06 tWLia- (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.)
FACILITYNAME c�/h1t1O1t1Wt6 `JYC"t S COUNTY 1 c.n
PERSON COLLECTING SA11] 1 ES { m i.w c Y cr c'���-Q PHONE NO. (3361 63�1- °t2 3 7
CERTIFIED LABORATORY Mtvd Lab # IbS �G` �G
Lab # NOv Q 5 Z�19 PLEASE SIGN ON THE REVERSE 4
Part A: Specific Monitoring Requirements
GEN?� �F-TION
OutfallF -i
Date
J r005301'.fi i*'
'�' *SQ0400 1 l
, '1t_ . O0340 g 4
?t00556z)
.. �31616
y No
x Sample
l: TotalSol
tE Kax < 3 �7".TFf}'
} St
K o
}}ChDe
tiO�il rind Gease,
oer
r
ds`e
nd d unifs
ia0a �gen�
'1 ,Yr�,
tmg/L r,i
Colonies' p 100 ml •-
rt,mo/dti/vr
-
,s,J, m /L�;,,�F rf
�•,.,,�-�t�4.rc-•i���•r__.t.a.o3,�...m
/Ll..,._�.n
.�'�m=-:.r.a..�.f,� .tr.
.7_ •:a
9 rn ,- .4
100 >L
- ii, vr.' .- m'+;
lf,,,W hin,6 0 -..9.0
R - -,Rt k
120y : ,;. ,r-
i rr- w a
.,r. fe, 30., ..•,
_ .:, , 1000 ,--
o
li7 t. 14
6
7.X
is
C
NA
w 14
5
1.0
.cis
<5
A
Note: If you report a sampled value in excess of the benchmark value, or outside the benchmark range for pH, you must implement Tier 1 or Tier 2 responses.
See General Permit text.
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? _ yes �no
(if yes, complete Part B)
Part B: Vehicle Maintenance Activitv Monitoring Requirements
Outfall
ate 1;
00530
No
Collected, .
( h "
a Od and Grease J .;�f
TotalFSuspended,Sohds;
pH; £
r New Motor Od!Usage,
.Sample
Y'.` .y.}
S�
'i�� W: 4 1 ..tw
.». aY.,
i Annual"average
/L ; P,
a,..Sfand'srd,untts� u
aVmo'
�'-.-, :
a2�,tL`�t ,Z�..*30."�'._.,++ ��,t` +.
�c�t_ •'3,Ns100 RR :1 %'t,'=R
F^?eav„^ 6 0 19 0
Y'----"
Note: If you report a sampled value in excess of the benchmark value, or outside the benchmark range for pH, you must implement Tier 1 or Tier 2 responses.
See General Permit text.
STORM EVENT CHARACTERISTICS:
Date {� (first event sampled)
Total Event Precipitation (inches): .
79
Date (list each additional event sampled this reporting period, and rainfall amount)
Total Event Precipitation (inches):
Mail Original and one copy to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
SWU-249-102107
Page 1 of 2

"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 limes and imprisonment for knowing violations."
of Permittee)
>08
(Date)
S WU-249-102107
Page 2 of 2

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
GENERAL PERMIT NO. NCG060000 SAMPLES COLLECTED DURING CALENDAR YEAR: XOl
CERTIFICATE OF COVERAGE NO. NCG06 05W)-- (This monitoring report is due at the Division no later than 30 days from
`, an the date the facility receives the sampling results from the laboratory.)
FACILITY NAME C-0MM vlJe� f% j WcAJS- COUNTY ko�t;,Jlc✓t^
PERSON COLLECTING SAMPLES Kerr eJ PHONE NO. (33to) b -N.-3i
CERTIFIED LABORATORY _ tl % Lab # )6S
Lab # PLEASE SIGN ON THE REVERSE 4
Part A: Specific Monitoring Requirements
00530 Fart.°"-.ji
iW2"-`31616 ." "<
No
Samplea
otal'Si Spended` !
u r pH;P, . ��
1ChetnIcaliOxygen r
Ot end Grease;-
, 'Fecal Cohform, '
[Standard"units
7
As
Collected< < =
Solidsr
"
a,p
�I),emand T.
qti;R'AF-
m
Colonies er 100 nil
.+ P
5 c rt
yYaV�' r r>,`�
ino(tl`d/vr«
m'%L
_,rw Ml ,.r
Yi'Tyiy
r m/Limcs.�,,u2
eta a-
,.._�
00
y
10 14 15
G2.
?
<15
C$
NA
604
t) 16 14
n
1
19
AA -
Note: If you report a sampled value in excess of the benchmark value, or outside the benchmark range for pH, you must implement Tier 1 or Tier 2 responses.
See General Permit text.
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? _ yes ,/no
(if yes, complete Part B)
Part B: Vehicle Maintenance Activitv Monitorine Requirements
Oull
00556 '
v 00530 sffr :' ,
nr
rsn
IC0040.Of 2
c t' -
,er
a Oil`and Gr'ease5
Total Suspended Sohds,;
n pH}r ���
�iNew Mo"tor OdaUsage,
Sample Collected,x
: t l
mo/dd/
wit
:.. ,
_?
aUmo >
r
units _ :'-
Whnualjavera e:
fit 1
30�.�Y....._r..._a'
mar ,., n
v
. •, .
,1y-s..,100..��>. i,ku�..:1..,.<..,60,..90
,..._ *.,•
- ? ,_
Note: If you report a sampled value in excess of the benchmark value, or outside the benchmark range for pH, you must implement Tier I or Tier 2 responses.
See General Permit text.
STORM EVENT CHARACTERISTICS:
Date 10 16 14 (first event sampled) a
Total Event Precipitation (inches):
Date (list each additional event sampled this reporting period, and rainfall amount)
Total Event Precipitation (inches):
Mail Original and one copy to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
SWU-249-102107
Page t of 2

"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."
X.
of Permittee)
io /as II -I
(Date)
S WU-249-102 107
Page 2 of 2

C
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
PermitNo.: NlC/tv10/(o/0121
Facility Name: C�"%I
County: IZdc k;rtshsw%
Inspector: _ce c% Y.
Date of Inspection: /0
Time of Inspection: 1 G'i O
or Certificate of Coverage No.: N/U O/ , /0
Total Event Precipitation (inches): a 79
No. 3'w 634 k}S)
Was this a Representative Storm Event? (See information below) VYes ❑ No
Please check your permit to verify if Qualitative Monitoring must be performed during a representative
storm event (requirements vary),
A "Representative Storm Event' is a storm event that measures greater than 0.1 inches of rainfall and that
is preceded by at least 72 hours (3 days) in which no storm event measuring greater than 0.1 inches has
occurred. A single storm event may contain up to 10 consecutive hours of no precipitation.
By this 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. 001 Stiuct
Receiving Stream: wdif
Describe the industrial activities that
ditch, etc.) R, tJs de- Gory i+o 44"',
rr within the outfall drainage area:
2. Color: Describe the color of the discharge
(light, medium, dark) as descriptors: &I Cd
basic colors (red, brown, 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.): /Uo Sme
S WU-242-051306
Page 1 of 2

4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is clear
and 5 is very cloudy:
OI 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:
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:
al 2 3 4 5
7. Is there any foam in the stormwater discharge? Yes iIo
S. Is there an oil sheen in the stormwater discharge? Yes �I
( 9. Is there evidence of erosion or deposition at the outfall? Yes 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 maybe
indicative of pollutant exposure. These conditions warrant further investigation.
Riga oft
S W U-242-051303

.. AARo
f �s
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Permit No.: O/ 0/ f% or Cc 'ficate of Coverage No.: N/C G/ D/4 /Q 0 / 4/ a
Facility Name: t� Co �3YenCY�
County: 1La k,c , Phone No.
Inspector: `;... K.
Date of Inspection: to If l 9D15
Time of Inspection: I1 worm
Total Event Precipitation (inches): Q ii
Was this a Representative Storm Event? (See information below) L' Yes ❑ No
Please check your permit to verify if Qualitative Monitoring must be perforated during a representative
storm event (requirements vary),
A "Representative Storm Event' is a storm event that measures greater than 0.1 inches of rainfall and that
is preceded by at least 72 hours (3 days) in which no storm event measuring greater than 0.1 inches has.
occurred. A single storm event may'contain up to 10 consecutive hours of no precipitation.
By this signature, I certify that this report is accurate and complete to the best of my knowledge:
X.
of Permittee or Designee)
1. Outfall Description:
Outfall No. 019 r?—
Receiving Stream: Udi
Describe the industrial activi
etc.) lto�sj,, t1,�1X.+� i. IX✓girt
occur within the outfall drainage
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: Glu✓
3. Odor: Describe any distinct
chlorine odor, c1c.):
the discharge may have (i.e., smells strongly of oil, weak
Page 1 of 2
SNVU-242-051308

4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is clear
and 5 is very cloudy:
Ol 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 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:
Q2 3 4 5
7. Is there any foam in the stormwater discharge? Yes
8. Is there an oil sheen in the stormwater discharge? - Yes 9
( 9. Is there evidence of erosion or deposition at the outfall? Yes 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 maybe
indicative of pollutant exposure. These conditions warrant further investigation.
Page 2 of 2
SWU-242-051308

a
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Permit No.: N/C/&/
Facility Name: Lg
County: �12 jc
Inspector: T&"
Date of Inspection: _
Time of Inspection:
Total Event Precipitation (inches): 0.1`111
of Coverage No.: N/C/G/O/-6/ 0/.Q/A/Jl(
No. 3'� 63K-4a-1'7
Was this a Representative Storm Event? (See information below) [ Yes ❑ No
Please check your permit to verify if Qualitative Monitoring must be performed during a representative
storm event (requirements vary),
A "Representative Storm Event' is a storm event that measures greater than 0.1 inches of rainfall and that
is preceded by at least 72 hours (3 days) in which no storm event measuring greater than 0.1 inches has
occurred. A single storm event may contain up to 10 consecutive hours of no precipitation.
By this signature, I certify that this report is accurate and complete to the best of my knowledge:
IV-- A. -44d..,
Permittee or Designee)
1. Outfall Description:
Outfall No. DOS
Receiving Stream: Wo1
Describe the industrial activlt
Structure (pipe, ditch, etc.) 1'rwcl¢ J ACI-N u$4(� r0ckb
that occur within the outfall drainage area:
2. Color: Describe the color of the
(light, medium, dark) as descriptors: _
CcIr
using basic colors (red, brown, 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.): JVO Sm, I (
Page I of 2
SWU-242-051303

4. Clarity: Choose the number which best describes the clarity of the discharge, where I is clear
and 5 is very cloudy:
l0 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:
O 2 3 4 5
7. Is there any foam in the stormwater discharge?
8. Is there an oil sheen in the stormwater discharge?
C9. Is there evidence of erosion or deposition at the outfall?
10. Other Obvious Indicators of Stormwater Pollution:
List and describe
Yes
Yes
Yes Io
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
s«v 242-osi3os

a
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Permit No.: N/C/f 0/ �00/1�0 / O/ or Certificate of Coverage No.: N/C/G/ 0/C
t�0 O /a/ W
Facility Name: pngLNUtct'fr1 grt"A
County: Phone No. 33to 63`1 N��7
Inspector: �"fw� (r✓
Date of Inspection: /0 //e/2o1S
Time of Inspection: m:10 PM
t�
Total Event Precipitation (inches): 0. i9
Was this a Representative Storm Event? (See information below) 0 Yes ❑ No
Please check your permit to verify if Qualitative Monitoring must he performed during a representative
storm event (requirements vary),
A "Representative Storm Event" is a storm event that measures greater than 0.1 inches of rainfall and that
is preceded by at least 72 hours (3 days) in which no storm event measuring greater than 0.1 inches has
occurred. A single storm event may contain up to 10 consecutive hours of no precipitation.
By this signature, I certify that this report is accurate and complete to the best of my knowledge:
Permittee or Designee)
1. Outfall Description:
Outfall No. 004
Receiving Stream:
Describe the industrial activ
(pipe, ditch, etc.) A♦-k t j*, ka-K
2. Color: Describe the color of the
(light, medium, dark) as descriptors:
using basic colors (red, brown, blue, etc.) and tint
3. Odor: Describe any distinct odors th [ the discharge may have (i.e., smells strongly of oil, weak
chlorine odor, etc.): Sm�l
Page 1 of 2
S\4U-242-051308

IL
4. Clarity: Choose the number which best describes the clarity of the discharge, where I is clear
and 5 is very cloudy:
G2 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:
1 9 3 4 5 ` `iS r'&i iY.'5 f wur'- r1sFrb( �Yees,
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:
0 2 3 4 5
7. Is there any foam in the stormwater discharge?
8. Is there an oil sheen in the stormwater discharge?
9. Is there evidence of erosion or deposition at the outfall?
10. Other Obvious Indicators of Stormwater Pollution:
List and describe 900%4-
Yes 9
Yes
Yes 0
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
S WU-242-051308

Commonwealth Brands MG/L MG/L MG/L SU (F)
2019 OIL
Samnle In RA Date Time TSS GREASE COD off Temo
1
SDO-001
6/5/2019
4:03PM
40
<5
37
7.0
81
2
SDO-002
6/5/2019
4:15PM
8
<5
49
6.9
84
3
SDO-003
6/5/2019
4:35PM
13
<5
39
6.8
1 79.7
4
SDO-004
6/5/2019
4:27PM
11
<5
43
6.8
79.4
Rainfall recorded:
Duration:
Sampler:
Ken G_us_len
Estimated Inches
0.625 Hours
Minutes
-- --
(---0
35
Limits:
100
30
120
6-9
NA
Commonwealth Brands
MG/L
MG/L
MG/L
SU
(F)
2019
OIL
Samnle ID RA4
Date Time TSS
GREASE
COD
off
Temo
1
SDO-001
10/16/2019
11:40AM
5
<5
15
7.2
63.3
2
SDO-002
10/16/2019
12:OONOON
5
<5
<15
7.0
61.9
3
SDO-003
10/16/2019
12:20PM
<2
<5
<15
7.2
60.6
4
SDO-004
10/16/2019
12:10PM
7
<5
19
7.1
63.1
Rainfall recorded: _ _ Duration: Sampler: KenGusler
Estimated Inches _ 0_.7_9_ Hours Minutes_
6 30 (Intermittently)

Stormwater sampling
10/16/2019 Taken by K. Gusler
Time
pH
Temp C
Description
SDO
- 001
11:40AM
7.2
17.4
Running off Scale street, some debris, no color or small
SDO
- 002
12:OONOON
7.0
16.6
Running between Scale and Sprinkle Street, no color, no smell
SDO
- 003
12:20PM
7.2
15.9
Primary drain from lot, no color, no smell
SDO
- 004
12:1013M
7.1
17.3
Substation drain, no color no smell, lots of nuts from nearby trees
Rain started at 6:OOAM and rained intermittently until 12:30PM
The total rainfall amount was documented at .79"

Meritech, Inc.
Environmental Laboratory
Laboratory Certification No.165
Contact: Ken Gusler
Client: Commonwealth Brands
301 N. Scales St
Reidsville, NC 27320
Report Date: 10/24/2019
NPDES #: NCG060042
Project: Stormwater
Date Sample Rcvd: 10/16/2019
Meritech Work Order # 10161909 Sample: SDO 001 Grab
10/16/19
Parameters
Btu
Analysis Date
Reporting Limit
Method
COD
15 mg/L
10/18/19
15 mg/L
EPA 410.4
Total Suspended Solids
5 mg/L
10/17/19
2.5 mg/L
SM 2540 D
Oil & Grease (HEM)
<5 mg/L
10/21/19
5 mg/L
EPA 1664B
pH
7.2 S.U.
10/16/19
1.0 -14.0 S.U.
SM 4500-HB
Temperature
17.4 OF
10/16/19
- OF
SM 2550 B
I hereby certify that I have reviewed and approve these data. ' l rda ( (�,� l
—i' Laboratory Repr sentative
642 Tamco Road, Reidsville, North Carolina 27320
tel.[phone] fax.[phone]

Meritech, Inc.
Environmental Laboratory
Laboratory Certification No.165
Contact: Ken Gusler
Client: Commonwealth Brands
301 N. Scales St
Reidsville, NC 27320
Report Date: 10/24/2019
NPDES #: NCG060042
Project: Stormwater
Date Sample Rcvd; 10/16/2019
Meritech Work Order #
10161910 Sample: SDO 002 Grab
10/16/19
Parameters
Results
Analysis Date
Reporting Limit
Method
COD
<15 mg/L
10/18/19
15 mg/L
EPA 410.4
Total Suspended Solids
5 mg/L
10/17/19
2.5 mg/L
SM 2540 D
Oil & Grease (HEM)
<5 mg/L
10/21/19
5 mg/L
EPA 1664B
pH
7.0 S.U.
10/16/19
1.0 -14.0 S.U.
SM 4500-HB
Temperature
16.6 °d' c445 i�
10/16/19
- ° F
SM 2550 B
I hereby certify that I have reviewed and approve these data.
642 Tamco Road, Reidsville, North Carolina 27320
tel.[phone] fax.[phone]

Meritech, Inc.
Environmental Laboratory
Laboratory Certification No.165
Contact: Ken Gusler
Client: Commonwealth Brands
301 N.Scales St
Reidsville, NC 27320
Report Date: 10/24/2019
NPDES#: NCG060042
Project: Stormwater
Date Sample Rcvd: 10/16/2019
Meritech Work Order #
10161911 Sample: SOO 003 Grab
10/16/19
Parameters
Results
Analysis Date
Reporting Limit
Metho
COD
<15 mg/L
10/18/19
15 mg/L
EPA 410.4
Total Suspended Solids
<2.5 mg/L
10/17/19
2.5 mg/L
SM 2540 D
Oil & Grease (HEM)
<5 mg/L
10/21/19
5 mg/L
EPA 1664B
pH
7.2 S.U.
10/16/19
1.0 -14.0 S.U.
SM 4500-HB
Temperature
15.9 OF C- `g. v4,
10/16/19
- ° F
SM 2550 B
I hereby certify that I have reviewed and approve these data.
�Qr�� -)
Laboratory Representative
642 Tamco Road, Reidsville, North Carolina 27320
tel.[phone] fax.[phone]

Meritech, Inc.
Environmental Laboratory
Laboratory Certification No.165
Contact: Ken Gusler
Client: Commonwealth Brands
301 N,Scales St
Reidsville, NC 27320
Report Date: 10/24/2019
NPDES #: NCG060042
Project: Stormwater
Date Sample Rcvd: 10/16/2019
Meritech Work Order #
10161912 Sample: SDO 004 Grab
10/16/19
Parameters
Results
Analysis Date
Reporting Limit
Method
COD
19 mg/L
10/18/19
15 mg/L
EPA 410.4
Total Suspended Solids
7 mg/L
10/17/19
2.5 mg/L
SM 2540 D
Oil & Grease (HEM)
<5 mg/L
10/21/19
5 mg/L
EPA 1664B
pH
7.1 S.U.
10/16/19
1.0 - 14.0 S.U.
SM 4500-HB
Temperature
11.3 ° Y' a
il.l
10/16/19
- ° F
,
SM 2550 B
1 hereby certify that I have reviewed and approve these data.
Anmia- a�pi I/
Laboratory Representative
642 Tamco Road, Reidsville, North Carolina 27320
tel.[phone]fax.[phone]

Chain of Custody Record COC
Client: Commonwealth Brands
Address: 301 N Scales St
Reidsville,NC 27320
Attention: Ken Gusler
#:
Phone:
Fax:
Email:
Project:
Po#:
INC.NPDES
MERi 1 ECH I
Environmental Laboratories
A Division of Water Technology and control, Inc.
ot
642 Tamco Rd Phone [phone]
Reidsville, NC Fax: [phone]
27320 Email:
Web Site: wwwmeritechlabs.com
Turn Around Time*
Std (10 days)
3 - 5 Day
O
24.48 Hr
C]
Sample
Location/ID #
Sampling Dates & Times
Person Taking Sample (Signature):
Lab Use Only
START
END
Comp?
Grab?
#of
cons.
Tests Required-
ice?
pH OK?
C 2OK?
Date
Time
Data
Time
SDO
�p I`i
II.4O
G
TSS Q
I
�♦
NN
0
G
f
COD (w/H2SO4)
V,
G
Oil &Grease (w/HCI)
G
pH Temp
63.3 t=
Method of Shipment:
Comments:
UPS
Fed Ex
© Hand Delivery
(]Other
Will these results be used for regulatory purposes?
Yes No
*RUSH work must be approved prior to submitting samples.
Rellnq 'shed by: /J I, at@�Q Time:
✓{/s�',JL G J ! >
Received by: Date: Tima:
Rell &shed by: Data: Time:
Received by. Date: Time:
Relinquished by: Date: Time:
R a b - e: Time: r—
IG
v

Chain of Custody Record COC
Client:
Address:
Attention:
Commonwealth Brands
301 N Scales St
Reidsville,NC 271320
Ken Gusler
NPDES#:
Phone:
Fax:
Email:
Project:
PO#:
MERI'TECH INC.
Environmental Laboratories
A Division of Water Technology and Control, Inc.
642 Tamco Rd Phone [phone]
Reidsville, NC Fax: [phone]
27320 Email:
Web Site: www.meritechiabs.com
Turn Around Time*
Std (10 days)
r—=
3 - 5 Day
O
24 -48 Hr
O
Sample
Location/ID #
Sampling Dates & Times
Person Taking Sample (Signature):
Lab Use Only
START
END
comp?
Grab?
#or
Conts.
Tests Required-
q
on
Ice?
pH OK7
C120K?
Date .
Time
Date
me
SDO DO'.L
14 16 N
It: 00
G
TSS
1
liJ.
�t
�t
G
COD (w/H2SO4)'-
G
Oil & Grease (w/HCQ
`
G
c
pH 20 Temp 14-6
61.9 P'
Method of Shipment:
Comments:
❑ ups
Fed Ex
❑ Hand Delivery
❑Other
Will these results be used for regulatory purposes?
Yes No
*RUSH work must be approved prior to submitting samples.
Reli *(shed 9p Time:
Received by: Date: Time:
R inquished by: Date: Time:
Received by. Date: Time:
Relinquished by: Date:
Time:
Re a[1
l�'
ale:
I S
Time:
3

Chain of Custody Record(COC
Client: Commonwealth Brands
Address: 301 N Scales St
Reidsville,NC 27320
Attention: Ken Gusler
NPDES#:
Phone:
Fax:
Email:
Project
Po#:
MERI'TECH INC.
Environmental Laboratories
0AA Division of Water Technology and control, Inc.
40
642 Tamco Rd Phone [phone]
Reidsville, NC Fax: [phone]
27320 Email:
Web Site: www.meritechlabs.com
Turn Around Time*
Std (10 days)
o
3.5 Day
o
24 -48 Hr
Sample
LocationllD #
Sampling Dates & Times
Person Taking Sample (Signature):
Lab Use Only
START
END
Comp?
Grab?
#of
cords.
Tests Required-
, n
c z pH OK?
ate
Time
Date
me
SDO po
I`t
IL:ZO
G
TSS
G
COD (w/H2SO4)
i
G
Oil Sr Grease (w/HCI)
G
G
pH %-oi Temp ISM
bo-6 r
Method of Shipment:
Comments:
❑ UPS
❑ Fed Ex
❑ Hand Delivery
❑other
Will these results be used for regulatory purposes?
Yes No
*RUSH work must be approved prior to submitting samples.
Relinq hed by: A. Time:
fit, ti 6 t ' 2' ;
Received by: Date: Time:
Reli quished by: Date: Time:
Received by: Date: Time:
Relinquished by: Date: Time:
Fed�-
V

Chain of Custody Record COC
Client:
Address:
Attention:
Commonwealth Brands
301 N Scales St
Reidsville,NC 27320
Ken Gusler
NPDES#:
Phone:
Fax:
Email:
Project
PO#:
MERITECII INC.
Environmental Laboratories
A Division of Water Technology and Control, Inc.
642 Tamco Rd Phone [phone]
Reidsville, NC Fax: [phone]
27320 Email:
Web Site: www.medtechiabs.com
Turn Around Time*
Std (10 days)
3 - 5 Day
I 24 -48 Hr
Sample
Location/ID #
Sampling Dates & Times
Person Taking Sample (Signature):
Lab Use Only
START
END
Comp?
Grab?
dot
Cons.
Tests Required-
Ice?
c 20K?
Date
Time
Date
ime
SDO OULJ
10 16 15
"00 1b."
G
TSS
)
11-10
G
COD (w/H2SO4
�•
tL•1�
G
Oil &Grease w/HCI
_-
G
c
pH -7. ( Temp
Method of Shipment:
Comments:
❑ UPS
❑ Fed Ex
❑ Hand Delivery
Mother
Will these results be used for regulatory purposes?
Yes No
*RUSH work must be approved prior to submitting samples.
Relinquls d by: A / Date: Tim
Received by: Date: Time:
Relin hed by: Data: Time:
Receved by: Date: Time:
Relinquished by: Date:
Time:
ecei