NCG060205_MONITORING INFO_20191112

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STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
DOC TYPE
❑ HISTORICAL FILE
MONITORING REPORTS
DOC DATE
❑ b� I I !
YYYYM M D D

STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Energy, Mineral and Land Resources General Permit No. NCG060000
Date submitted 11,10101
CERTIFICATE OF COVERAGE NO. /N^CG06 D 1 QS SAMPLE COLLECTION YEAR Z 0 I q
FACILITY NAME Gu $ tam r c--:S l-,r s'�T_ss SAMPLE PERIOD ❑Jan -June []July -Dec
COUNTY .{ or ❑ Monthly' (month)
PERSON COLLECTING SAMPLES 7mk,c
LABORATORYIC.e1ta,,l,� Ctjf...41-re..( Lab Cert. [J N L ;Lf DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
REc�IVFn ❑Zero -flow ❑Water Supply ❑SA
is V I_ t J QOther SU,' Vie, 14, O o-� N e
NOV 12 2019 FACILITY ACTIVITIES INCLUDE (check all that apply):
CENTW+L FIDES ❑ use/process meats ❑ use animal fats/byproducts
DWR SECTION
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Part A: Stormwater Benchmarks and Monitoring Results
Total event rainfall z . 2 !� or n No discharge this period'
- Outfall No.
Date Sample
Collected, mo/dd/yr
TSS,
mg/L
` pH,
Standard units
COD,
mg/L
Oil and Grease,
mg/L
, `Fecal Coliform,
Colonies per 100 ml
- Enterococci,
Colonies per 100 ml
Benchmark
--
100 or 504
Within 6.0-9.0
120
30 -
10001 -
Soo,
Parameter Code
-
- C0530
00400
00340
00556
31616
61211
s
o 4 14
L S
O
GS
LS
N
a
1 Only applies to facilities that use/process meats.
'The total precipitation must be recorded using data from an on -site rain gauge.
3 For sampling periods with no discharge at any outfalls. You must still submit this discharge monitoring report with a checkmark here.
'See General Permit text, Table 1, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
'Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new ail per month? ❑ yes [�no (if yes, complete Part B)
Permit Date: 11/1/2018-05/31/2021 SWU-249, Last Revised 11/5/2018
Page 1 of 2

Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new motor oil/month.
-• -�
Outfall No. .--'
�. Date Sample Collected
(mo/dd/yr)
24-hour rainfall.amount,-
Inches2
=New Motor Oil or
'<:Hydraulic Oil Usage
Non-PolalrO&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
*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 ❑ NO
IF YES, HAVE YOU CONTACTED THE DEMLR REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an original copy of this DMR including all "No Discharge" reports within 30 days of receipt of 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, NC 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 vjglations."
Signature of Permittee
Permit Date: 11/1/2018-05/31/2021
4
Date
SWU-249, Last Revised 11/5/2018
Page 2 of 2

Environmental
Quality
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Far guidance on filling out this form, please visit https://deq.ne.gov/abouUdivisioils/energy-mineral-land-resources/
n pdes-sto rmwater-gps
PermitNo.: or Certificate of Coverage No.: N/C/G/0/6/0/2-/0/!/
r �
Facility Name: Cu STrom F N�st+Eres J n�
County: C
Inspector: U&J � 1 s U 2-1 e's
Date of Inspection: to 1 l . 11 9
Time of Inspection: 10: :e, At.^
Total Event Precipitation (inches):
No. 3 3(.—'+ 3 1— 'i 1 41
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 thatthisreport is accurate and complete to the best of my knowledge:
(Signature of Permittee or Desi e)
I. Outfall Description:
Outfall No. 5 i Structure (pipe, ditch, etc.):
Receiving Stream:
Pagel of 2
S W U-242, Last modified 06/012018

2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: t/er!�' 51 ig-' s'r q ro Go I,-- � Ex r— Q:3c
3. Odor: Describe any distinct odors that the
chlorine odor, etc.): No e 40v S W{
may have (i.e., smells strongly of oil, weak
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is clear
and 5 is very cloudy:
1 P 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:
nl 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:
IT 2 3 4 5
7. Is there any foam in the stormwater discharge? o Yes or No.
8. Is there an oil sheen in the stormwater discharge? oYes 9C No.
9. Is there evidence of erosion or deposition at the outfall? O Yes m No.
10. Other Obvious Indicators of Stormwater Pollution:
List and describe Ver.0 rw j Or a Vi dam, r,
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 06/012018

RESEARCh & ANAlyTICAI
j I_AbORATORIES, INC.
q Analytical / Process Consultations
°f" Phone [3361 996-2841
CHAIN OF CUSTODY RECORD
WATER/WASTEWATER I MISC.-
COIVIPANY (' 1 TT -
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REQUESTED ANALYSIS
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CITY, STATE. ZIP -
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AMPLER. NAME (PLEASE. PRINT}
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PHONE
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DATE
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TBMP
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REMARKS:
SAMPLE TEMPERATURE AT RECEIPT �' � °C
RELINQUISHED
DATEITIME
RECEIVED BY

b o O y INC.
For: Custom Finishers, Inc
2213 Shore Street
High Point, NC 27263,
Attn: Dennis Dzielski
Report of Analysis
10/2912019
A1�ACYj� ON,
�'65 INC 434 Zt•
L NC#37701 f
RSCTO.
Ar. ,�9
Client Sample ID: SD02 Lab Sample ID: 73652.01
Site: Custom Finishers Inc Collection Date: 10/16/2019 10:00
Parameter Method . . Result Units - .Rep Limit Analyst AnalysisDatefTime
COD EPA 410.4 <5 mg/L 5 HW 1022/2019
Hydrocarbon O&G EPA 1664 Revision B/Silica Gel <5 mg/L 5 EE 10124/2019
Total Suspended Solids (TSS) SM 2540 D-1997 <5 mg/L 5 LP 10/21/2019
NA = not analyzed
P.O. Box 473 106 Short Street Kernersville, North Carolina 27284
Tel: [phone]
Fax: [phone]
a .randalabs.com
Page 1
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