NCG160167_COMPLETE FILE - HISTORICAL_20140210

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
(- G N u/ V/
DOC TYPEHISTORICAL
FILE
MONITORING REPORTS
DOC DATE
❑ C9o) ( a%
YYYYMMDD

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NCDEHR
North Carolina Department of Environment and Natural Resources,
Division of Energy, Mineral and Land Resources
Land Quality Section
Tracy E. Davis, PE, CPM Pat McCrory, Govenor
Director John Skvada, III Secretary
February 10, 2014
Danny Eudy
The LANE Construction Corporation
8205 Wilkinson Blvd
Charlotte, NC 28214
Subject: Stormwater Permit Rescission Request Denial
Certificate of Coverage Number NCG 160167
LANE (Kings Mountain)
Cleveland County
Dear Mr. Eudy:
On October 2, 2013, the Division of Energy, Mineral and Land Resources received your request
to rescind your coverage under Certificate of Coverage Number NCG160167.
Based on our review of your request and the recommendation of our Mooresville Regional
Office, your request for rescission has been denied. Your request was denied because on
inspection, it was determined that there is the potential for discharge of stormwater from
industrial materials. Your Certificate of Coverage Number NCG160167 will remain in effect,
and you must continue to comply with your NPDES stormwater permit.
If you have questions about this matter, please contact Julie Ventaloro at 919-807-6370, or the
Stormwater staff in our Mooresville Regional Office at 704-663-1699.
Sincerely,
CONAL SIGNED
KEN PICKLE El
for Tracy E. Davis, P.E., CPM
cc: Mooresville Regional Office — Z. Khan
Stormwater Permitting Program
Central Files - w/attachments
Ms. Denise Isenhour, The LANE Construction Corporation, 208 Quarry Rd,
Kings Mountain, NC 28086
1612 Mail Service Center, Raleigh, North Carolina 27699-1612.919-707-9200 / FAX: [phone]
512 North Salisbury Street, Raleigh, North Carolina 27604 - Internet: htto://portal.ncdenr.oro/web/Ir/
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M,00/LSv 414
October 2, 2.01.3
SW NPDES permit Coverage Recession
A.TTN: Stormwater Permitting Unit
1617 Mail Service Center
Raleigh NC 27699-1617
Re: NCG 160167 Permit Recession
(LANE) Kings Mountain
Please see the attached permit recession form. This facility all drains to pond that does not discharge off
site. Please let me know should you have any further questions at 704-395-3264.
Sincerely,
arso U
arcus . Hackler
Environmental Coordinator
CC: DJE RLR DCM
The Lane Construction Corporation
8205 Wilkinson Boulevard Charlotte, NC 28214 USA T704.394.8354 F704.394.5354 LaneConstruct.com
An Equal Opportunity Employer M/F/D/V

FNA
, • e Division of Water Quality / Surface Water Protection
National Pollutant Discharge Elimination System
NC®ENR
RESCISSION REQUEST FORM
Exnrowrncxr �xo N.R¢pp C.
FOR AGENCY USE ONLY
Date Received
Year
Month
Day
Please fill out and return this form if you no longer need to maintain your NPDES stormwater permit.
1) Enter the permit number to which this request applies:
Individual Permit (^ ;t Certificate of Coverage
N C I��I I
2) Owner/Facility Information: ' Final correspondence will be mailed to the address noted below
Owner/Facility Name The LANE Construction Corporation
Facility Contact Diense Isenhour
Street Address 208 Quarry Rd
City Kings Mountian StateNC _ ZIP Code 28086
County Cleveland E-mail Address plant079 lganeconstruct.com
Telephone No. 704 739 2344 Fax: [phone]
3) Reason for rescission request (This is required information. Attach separate sheet if necessary):
❑ Facility closed or is closing on S7 . All industrial activities have ceased such that no discharges of
stormwater are contaminated by exposure to industrial activities or materials.
❑ Facility sold to _s on Ta l . If the facility will continue operations under the new owner it
may be more appropriate to request an ownership change to reissue to permit to the new owner.
B Other: Facility drains to a pond that does not discharge.
4) Certification:
I, as an authorized representative, hereby request rescission of coverage under the NPDES Stormwater Permit for the
subject facility. I am familiar with the information contained in this request and to the best of my knowledge and belief
such information is true, complete and accurate.
Signature Date
aU LQ Ass\.
Print or type name of person signing above Title �—
Please return this completed rescission request form to:
1617 Mail Service Center, Raleigh, North Carolina 27699-1617
Location: 512 N. Salisbury St, Raleigh, North Carolina 27604
Phone: [phone] FAX: 91H07-64921 Customer Service: 1-877-623-6748
Internet: vv w ncwaterquality.org
An Equal Opportunity 1 Affirmative Action Employer
SW NPDES Permit Coverage Rescission
Stormwater Permitting Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
NorthCarolina
Naturally

Ventaloro, Julie
From:
Ventaloro, Julie
Sent:
Saturday, February 08, 2014 10:02 AM
To:
Khan, Zahid
Cc:
Kormanik, Ryan; Bou-ghazale, Samar; Pickle, Ken
Subject:
RE: Storm water rescission requests
Thank you all for talking with Ken and me about these two facilities. I talked them over
with Bradley, and this is how we plan to proceed:
NCGNE0899 UFP Mid -Atlantic - Approve the request to rescind their No Exposure exclusion. We
are approving it based on the facts that 1) Industrial activities have ceased, and 2) There
is no exposure of industrial materials to stormwater. As I understand it, we don't get many
requests to rescind No Exposure certifications. But when we do, it is appropriate to take
into account whether or not materials remaining onsite will be exposed to stormwater. If
there is exposure, the rescission request would be denied.
NCG160167 Lane Construction - Deny the request to rescind their permit. We are denying it
based on the fact that there appears to be industrial materials onsite that are exposed to
stormwater and have the potential to discharge. On the aerial photographs, there appears to
be a large pile of scrap asphalt materials located outside the berm that is exposed to
stormwater and has the potential to discharge contaminated runoff.
Thanks, Ryan, for inspecting these facilities and getting back to me so quickly. Let me know
if you have any questions/concerns about how we plan to proceed.
Julie Ventaloro
stormwater Permitting Program
NC Division of Energy, Mineral, and Land Resources
1612 Mail Service Center, Raleigh, NC 27699-1612
Phone: [phone] Fax: [phone]
Website: http://watersupplywatershed.nc.gov
E-mail correspondence to and from this address may be subject to the North Carolina Public
Records Law and may be disclosed to third parties.
-----Original Message -----
From: Khan, Zahid
Sent: Monday, February 03, 2014 2:24 PM
To: Ventaloro, Julie
Cc: Kormanik, Ryan
Subject: FW: Storm water rescission requests
Julie,
Julie,
Please see E-mail from Ryan, Recommendation is not to rescind these permits. Please let me
know if you need any more information. Thanks
-----Original Message -----
From: Kormanik, Ryan
Sent: Monday, February 03, 2014 1:35 PM
To: Khan, Zahid
Subject: Storm water rescission requests
1

Zahid,
NCG160167-Lane Construction. Although the pond does not have a discharge point, there is
always a potential for overflow or breach. If this occurs, impacts to a potential wetland and
Kings Creek are possible. With this in mind and the activity has a SIC code which requires a
discharge permit, I would not recommend rescinding the permit.
NCGNE0899-UFP Mid -Atlantic. Although the facility is closed, materials are being stored on
site from other sites. They are still meeting the NOE standards. At this time I would not
recommend rescinding the permit until all materials are removed from the site.
Thank you,
Ryan Kormanik
Environmental Senior Specialist
Division of Energy, Mineral, and Land Resources NCDENR Land Quality Section
704.663.1699 - Office
828.461.3445 - Cell
E-mail correspondence to and from this address may be subject to the North Carolina Public
Records Law and may be disclosed to third parties.
2

ADivision of Water Quality / Surface Water Protection
National Pollutant Discharge Elimination System
NCDERR
"`"`"`"°'""'"""` ., , PERMIT NAME/OWNERSHIP CHANGE FORM
n.o.o.�.r..
FOR AGENCV USE ONLY
Date Received
Veer Month
Da
1. Please enter the permit number for which the change is requested.
NPDES Permit (or) Certificate of Coverage
G 1 1 1 6 p 6 7
11. Permit status arior to requested change.
a. Permit issued to (company name): Rea contracting LLC
b. Person legally responsible for permit: Danny i audy
First MI - Last
Asst. District Manager
Title
Permit Holder Mailing Address
Chad "Ia Nc 28214
City State Zip
( 704 )395 3201 (704 )394 5354
Phone Fax
c. Facility name (discharge): Rea Contracting LLC- Kings Mountain Plant 075
d. Facility address: 208 Quarry Road
Address
Kings Mountain NC 28086
City State Zip
e. Facility contact person: Denise A. Isenhour ( 704 ) 739 2344
First / Nil / Last Phone
111. Please provide the following for the requested change (revised permit).
a. Request for change is a result of: ❑ Change in ownership of the facility
x] Name change of the facility or owner
/f other please explain
b. Permit issued to (company name):
The LANE Construction Corporation
c. Person legally responsible for permit:
Danny o Eudy
First MI Last
Asst. District Manager
Title
8205 Wilkinson Blvd
Permit Bolder Mailing Address
charlotte NC 28214
City State Zip
(704 ) 395-3201 Danny.Eudy®reacontract.coat
Phone E-mail Address
d. Facility name (discharge):
LANE (Kings Mountain)
e. Facility address:
208 Quarry Road
Address
Kings Mountain NC 28086
City State Zip
f. Facility contact person:
Denies A Isenhour
First MI Last
( 704 ) 739 2344 KingsMountain.plat0790reacontract.com
Phone E-mail Address
Revised 2012Apr23

NPDES PERMIT NAME/OWNERSHIP CHANGE FORM
Page 2 of 2
IV. Permit contact information (if different from the person legally responsible for the permit)
Permit contact: /Ap&L6 W. HAC-Vfc.F_
First MI Last
Lll�t PlJr1MEM{AL (',00�ensa-ia2
Title
RZ05 uhtkl.--soN 31va
Mailing Address
CHAEADrr6 hlL Z82_14
City Stale Zip
(7o 1) 3q5 -3210 May-us.IlncYlF2/ ollra�f�o y
Phone E-mail Address
V. Will the permitted facility continue to conduct the same industrial activities conducted prior
to this ownership or name change?
Yes
❑ No (please explain)
VI Required Items: THIS APPLICATION WILL BE RETURNED UNPROCESSED IF ITEMS
ARE INCOMPLETE OR MISSING:
Q This completed application is required for both name change and/or ownership change
requests.
❑x Legal documentation of the transfer of ownership (such as relevant pages of a contract deed,
or a bill of sale) is required for an ownership change request. Articles of incorporation are
not sufficient for an ownership change.
The certifications below must be completed and signed by both the permit holder prior to the change, and
the new applicant in the case of an ownership change request. For a name change request, the signed
Applicant's Certification is sufficient.
PERMITTEE CERTIFICATION (Permit holder prior to ownership change):
1, , attest that this application for a name/ownership change has been reviewed and is accurate and
complete to the best of my knowledge. 1 understand that if all required parts of this application are not
completed and that if all required supporting information is not included, this application package will be
returned as incomplete.
Signature Date
APPLICANT CERTIFICATION
1, , attest that this application for a name/ownership change has been reviewed and is accurate and
complete to the best of my knowledge. 1 understand that if all required parts of this application are not
completed and that if all required supporting information is not included, this application package will be
returned as incomplete.
i / & z6Z2
gnature Date
PLEASE SEND THE COMPLETE APPLICATION PACKAGE TO:
Division of Water Quality
Surface Water Protection Section
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Revised 7/2008

w �
NC®ENR
North Carolina Department of Environment and Natural Resources
Beverly Eaves Perdue
Governor
Danny J. Eudy
The LANE Construction Corp
8205 Wilkinson Blvd
Charlotte, NC 28214
Dear Mr. Eudy:
Division of Water Quality
Charles Wakild, P. E.
Director
November 30, 2012
Dee Freeman
Secretary
Subject: NPDES General Permit NCG 160000
Certificate of Coverage NCG 160167
LANE (Kings Mountain)
Formerly Rea Contractin- Kings
Mountain Plant 075
Cleveland County
Division personnel received your request to revise your stormwater permit Certificate of Coverage to
accurately reflect your new company and facility name.
Please find enclosed the revised Certificate of Coverage. The terms and conditions contained in the
General Permit remain unchanged and in full effect. This revised Certificate of Coverage is issued under
the requirements of North Carolina General Statutes 143-215.1 and the Memorandum of Agreement
between North Carolina and the U.S. Environmental Protection Agency.
If you have any questions, please contact the Stormwater Permitting Unit at 919-807-6300.
Sincerely,
ORIGINAL SIGNED B)
KEN PICKLE
for Charles Wakild, P.E.
cc: Mooresville Regional Office
Central Files
Stormwater Permitting Unit
Wetlands and Stormwater Branch
1617 Mail Service Center, Raleigh, North Carolina 27699-1617
Location: 512 N. Salisbury St. Raleigh, North Carolina 27604
Phone: [phone] FAX: [phone] Customer Service: 1-877-623-6748
Internet www.nottaterquality.org ..
An Equal opportunity 1 Affirmative Action Employer
One
NotthCarolina
Naturally

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
GENERAL PERMIT NO. NCG160000
CERTIFICATE OF COVERAGE No. NCG160167
STORMWATER DISCHARGES
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
In compliance with the provision of North Carolina General Statute 143-215.1, other lawful standards and
regulations promulgated and adopted by the North Carolina Environmental Management Commission,
and the Federal Water Pollution Control Act, as amended,
The LANE Construction Corp
is hereby authorized to discharge stormwater from a facility located at
'LANE (Kings Mountain)
208 Quarry Rd
Kings Mountain
Cleveland County
to receiving waters designated as Kings Creek, in the Neuse River Basin in accordance with the effluent
limitations, monitoring requirements, and other conditions set forth in Parts I,.11, 111, IV, V and VI of
General Permit No. NCG 160000 as attached.
'['his certificate of coverage shall become effective November 30. 2012.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day November 30, 2012. ORIGINAL SIGNED 13)
KEN PICKLE
for Charles Wakild, P.E., Director
Division of Water Quality
By Authority of the Environmental Management Commission

STATE OF NORTI-I CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
GENERAL PERMIT NO NCG160000
CERTIFICATE OF COVERAGE No NCG160167
STORMWATER DISCHARGES
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
In compliance with the provision of North Carolina General Statute 143-215.1, other lawful standards
and regulations promulgated and adopted by the North Carolina Environmental Management
Commission, and the Federal Water Pollution Control Act, as amended,
Rea Contracting, A Division of The Lane Construction Corp.
is hereby authorized to discharge stormwater from a facility located at
Rea Contracting (Kings Mountain)
208 Quarry Road
Kings Mountain
Cleveland Comity
to receiving waters designated as Kings Creek in the Broad River Basin in accordance with the effluent
limitations, monitoring requirements, and other conditions set forth in Parts I,11, IQ, 1V, V and VI of
General Permit No. NCG 160000 as attached.
This certificate of coverage shall become effective December 4, 2009.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day December 4, 2009.
k• Coleen H. Sullins, Director
Division of Water Quality
By Authority of the Environmental Management Commission

R9U K
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins
Governor Director
December 4, 2009
Marcus Hackler
Rea Contracting, A.Division of The Lane Construction Corp.
8205 Wilkinson Blvd.
Charlotte, NC 28214-7006
Dear Mr. Hackler:
Dee Freeman
Secretary
Subject: NPDES General Permit NCG160000
Certificate of Coverage NCG 160167
Rea Contracting (Kings Mountain)
Formerly Rea Contracting, LLC
Cleveland County
On October 1; 2009, division personnel received your request to revise your stormwater permit
Certificate of Coverage to accurately include your new company name.
Please find enclosed the revised Certificate of Coverage. The terms and conditions contained in
the General Permit remain unchanged and in full effect. This revised Certificate of Coverage is issued
under the requirements of North Carolina General Statutes 143-215.1 and the Memorandum of
Agreement between North Carolina and the U.S. Environmental Protection Agency.
If you -have any questions, please contact the Stormwater Permitting Unit at 919-807-6303.
Sincerely,
4J4. L
qta_ Coleen H. Sullins
cc: DWQ Central Files
Mooresville Regional Office
Stormwater Permitting Unit
Wetlands and Stormwater Branch
1617 Mail Service Center, Raleigh, North Carolina 27699-1617
Location: 512 N. Salisbury St. Ralegh, North Carolina 27604
Phone: 919A07-63001 FAX: [phone] Customer Service: 1-877-623-6748
Internet: www.nmaterquality.org
An Equal Oppodunilyl Afirma6ve Action Employer
One
NorthCai-olina
Natural[r

NC®ENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins Dee Freeman
Governor Director , Secretary
March 15, 2011
Mr. Marcus Hackler, Environmental Coordinator
Rea Contracting
8205 Wilkinson Blvd.
Charlotte, North Carolina 28214
Subject: Stormwater Discharge Outfall Annual Data Summary
Rea Contracting facilities
NPDES Stormwater Permit NCG160000
Certificates of Coverage NCG160081, NCG160167,
NCG160168, NCG160170, and NCG160088
Cleveland, Lincoln, Mecklenburg, and Rowan Counties
Dear Mr. Hackler:
This Office is in receipt of your recent submission of the Stormwater Discharge Outfall Annual Data
Summary for the semi-annual stormwater conducted in 2010 at above noted Rea Contracting facilities and
we thank you for this data.
Our review of the data noted one issue with the Stormwater Discharge Outfall Annual Data Summary. For
total petroleum hydrocarbons and total suspended solids you noted "BRL for some of the sampling results.
This notation was most likely used because these parameters were "not detected" above the detection
level established by the analytical laboratory. The notation of "BRL" does not allow the Division to
determine if the analyte in question was detected above or below the benchmark value noted in the permit.
To rectify this issue,you should report a numerical value for each parameter that must be monitored under
the General permit. For those parameters that are not detected above the detection level established by
the analytical laboratory you would report < and the associated detection level reported by the laboratory.
For example, if the analytical laboratory established a detection level of 5.0 ni for oil and grease but
noted that it was not detected in your sample, you would report < 5.0 mg/L on your Stormwater Discharge
Outfall Annual Data Summary.
If you have questions concerning the reporting of data on the Stormwater Discharge Outfall Annual Data
Summary or any other part of the permit please do not hesitate to contact me at [phone] or
marcia.allocco(a)ncdenr.00v.
Sincerely,
Marcia Allocco, MS
Environmental Chemist �J�
Surface Water Protection n? a,
cc: Stormwater permitting I (( {MAR
Central files 2 1 201,
Mooresville Regional Office
Location: 610 East Center Ave., Suite 301 Mooresville, NC 28115
One
Phone: [phone] Fax: [phone] Customer Service: 1-877-623-6748
NOith CaTOhnq
Internet: httpalponal.ncdenr.orglweblwq
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An Equal Opportunity I Affirmative Action Employer- 3n% Recycledlo% Post Consumer paper

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a
\O�0� WAr9pG Michael F. Easley
Governor
VJ r William G. Ross Jr., Secretary
> y Department of Environment and Natural Resources
Alan W. Klimek, P.E:, Director
Division of Water Quality
December 19, 2003
Mr. Gene Mills
Rea Contracting, LLC.
8205 Wilkinson Boulevard
Charlotte NC 28214-7006
Subject: General Permit No. NCG160000
Rea Contracting, LLC.
COC NCG160167
Cleveland County
Dear Mr. Mills:
In accordance with your application for discharge permit received on November 19, 2003, we are forwarding
herewith the subject certificate of coverage to discharge under the subject state - NPDES general permit. This permit is
issued pursuant to the requirements of North Carolina General Statute 143-215 .I and the Memorandum of Agreement
between North Carolina and the US Environmental Protection agency dated December 6, 1983.
If any parts, measurement frequencies or sampling requirements contained in this permit are unacceptable to you,
you have the right to request an individual permit by submitting an individual permit application. Unless such demand is
made, this certificate of coverage shall be final and binding.
Please take notice that this certificate of coverage is not transferable except after notice to the Division of Water
Quality. The Division of Water Quality may require modification or revocation and reissuance of the certificate of
coverage.
This permit does not affect the legal requirements to obtain other permits which may be required by the Division
of Water Quality or permits required by the Division of Land Resources, Coastal Area Management Act or any other
Federal or Local governmental permit that may be required.
If you have any questions concerning this permit, please contact Mack Wiggins at telephone number 9I9/733-
5083 ext. 542.
cc: Mooresville Regional Office
Central Files
Stormwater and General Permits Unit Files
Sincerely,
ORIGINAL SIGNED BY
WILLIAM C. MILLS
Alan W. Klimek, P.E.
NCDE�R
Customer Service
1 800 623-7748
Division of Water Quality 1617 Mail Service Center Raleigh, NC 27699-1617 [phone]

i"
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
GENERAL PERMIT NO. NCG160000
CERTIFICATE OF COVERAGE No. NCG160167
STORMWATER DISCHARGES
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
In compliance with the provision of North Carolina General Statute 143-215.1, other lawful standards and
regulations promulgated and adopted by the North Carolina Environmental Management Commission, and the
Federal Water Pollution Control Act, as amended,
Rea Contracting, I.LC.
is hereby authorized to discharge stormwater from a facility located at
075 Kings Mountain Plant
208 Quarry Road
Kings Mountain
Cleveland County
to receiving waters designated as Kings Creek in the Broad River Basin in accordance with the effluent limitations,
monitoring requirements, and other conditions set forth in Parts L II, III, IV, V, and VI of General Permit No.
NCG 160000 as attached.
This certificate of coverage shall become effective December 19, 2003
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day December 19, 2003
ORIGINAL SIGNED BY
WILLIAM C. MILLS
for Alan W. Klimek, P.E., Director
Division of Water Quality
By Authority of the Environmental Management Commission

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Markers
Name: Discharge Site-NCG160167
Short Name: Dschrg
Coordinates: 0350 13'06.0" N, 0810 20'40.8" W
Comment: Rea Contracting, LLC, Subbasin 030805, Broad River Basin, Cleveland County,
Kings Creek, Class C, Quad G13NE

for North Carolina DEMLR General Permit No..NCG160000 Asphalt
Date submitted,
CERTIFICATE OF COVERAGE NO. NCG16 D Z / Z
FACILITY NAME L/L]/C L'0(/$�iQrJCT/Of/ �aC/9S
COUNTY L�/eiG AA./T
PERSON COLLECTING SAMPLES
LABORATORY Lab Cert. q
Comments on sample collection or analysis:
Part A: Stormwater Benchmarks and Monitoring Results
Outfall No. I Date Sample 24-hour rainfall
Collected' amount,
(mo/dd/yr) Inches
Benchmarks --_>
SAMPLE COLLECTION YEAR —�l0
SAMPLE PERIOD Jan -June ® July -Dec
or ❑ Monthly'_ (month)
RECEDISCHARGING TO CLASS QORW �HQW ❑Trout �PNA
IV EI�: QZero-flow QWaterSupply QSA
JAN 0 6 2011 ❑other
CENTRAL FILES PLEASE REMEMBER TO SIGN ON THE REVERSE %
DWR SECTION
Total Suspended Solids
100 mg/L or So
No discharge this period?'
ZMonthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here.
3The 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.
" See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Note: Results must be reported In numerical format. For example 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 mg/L where XX is the numerical value of the
detection limit, reporting limit, quantitation limit, etc. in mg/L.
Note: If you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 1, or Tier 3 responses. See General Permit text.
Permit Date: 10/1/2014-9/31/2019
SWU-252, last revised 9/17/2014
Page 1 of 2

Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month.
No discharge this period?z
Outfall No.
Date Sample
r
Collected
(mo/dd/yr)
24-hour rainfall
amount,
Inches'
Non -polar O&G by EPA
1664 (SGT-HEM)
Total Suspended Solids
Benchmarks =__>
_
-
15 mg/L
100 mg or 50 mg/L
Footnotes from Part A also apply to this Part B
Note: if you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 1, or Tier 3 responses. See General Permit text.
FOR PART A AND PART B MONITORING RESULTS:
• A SINGLE BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDANCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES ❑ NO ❑
IF YES, HAVE YOU CONTACTED THE DEMUR REGIONAL OFFICE AS REQUIRED BY THE PERMIT? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an original and one coat/ of this OMR includfng all "No Discharge" reports within 30 dovs of receipt of the lob results (or at end of monitoring period
in the case of "No Discharge" reports/ to:
Division of Water Resources
Attn: DWR 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 foreknowing violations."
/ .i 1oi7
(Date)
Permit Date: 10/1/2014-9/31/2019
SWU-252, last revised 9/17/2014
Page 2 of 2
40

Semi-annual Stormwater Discharge Monitoring Report (DMR)
for North Carolina DEMLR General Permit No NCG160000 -Asphalt
Date submitted to f_ , ZzG
CERTIFICATE OF COVERAGE NO. NCG16Q L_L 2
FACILITY NAME
COUNTY G'4r4/e44,yp
PERSON COLLECTING SAMPLES
LABORATORY
Lab Cert. #
Comments on sample collection or analysis:
Part A: Stormwater Benchmarks and Monitoring Results
SAMPLE COLLECTION YEAR o2v16 Colo
SAMPLE PERIOD QX Jan -June July -Dec
or Monthly'_ (month)
DISCHARGING TO CLASS []ORW LjHQW QTrout E]PNA
QZero-flow []WaterSupply QSA
❑Other
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Outfall No.
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
Inches
Total Suspended Solids
Benchmarks ==_>
_
-
100 mg/L or 50 mg/L
No discharge this period?z
RECEIVED
JUN 2 8 nio0
CENTRAL FILES
DWR SECTION
Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
aFor 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.
"See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Note: Results must be reported in numerical format. For example, 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 mg/r where XX is the numerical value of the
detection limit, reporting limit, quantitation 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.
Permit Date: 10/1/2014-9/31/2019 SWU-252, last revised 9/17/2014
Page 1 of 2

Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month.
n No discharge this period?Z
Outfall No.
Date Sample
r
Collected
(mo/dd/yr)
24-hour rainfall
amount,
Inches
Non -polar O&G by EPA
1664 (SGT-HEM)
Total Suspended Solids
-
Benchmarks =__>
_
-
15 mg/L
100 mg/L or 50 mg/L
Footnotes from Part A also apply to this Part B
Note: If you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 1, or Tier 3 responses. See General Permit text.
FOR PART A AND PART B MONITORING RESULTS:
A SINGLE BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS.
2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS.
TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDANCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES ❑ NO ❑
IF YES, HAVE YOU CONTACTED THE DEMLR REGIONAL OFFICE AS REQUIRED BY THE PERMIT? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an original and one copy of this DMR including all "No Discharge" reports within 30 days of receipt of the lab results for at end of monitoring period
in the case of "No Discharge" reports) to:
Division of Water Resources
Attn: DWR 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.
am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
of
(Date)
Permit Date: 10/1/2014-9/31/2019 SWU-252, last revised 9/17/2014
Page 2 of 2

Semi-annual Stormwater Discharge Monitoring Report (DMR)
for North Carolina DEMLR General Per it 19o. NCG160000 - Asphalt
Date sub—;- d
e
CERTIFICATE OF COVERAGE NO. NCG16;l Z
FACILITY NAME
COUNTY 7! CL,yr/D
PERSON COLLECTING SAMPLES
LABORATORY Lab Cert. p
Comments on sample collection or analysis:
Part A: Stormwater Benchmarks and Monitoring Results
SAMPLE COLLECTION YEAR z;�0/57
SAMPLE PERIOD ❑ Jan -June ❑ July -Dec
or ❑ Monthly'_ (monthl
DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
❑Zero -flow ❑Water Supply ❑SA
❑Other
PLEASE REMEMBER TO SIGN ON THE REVERSE --)
© No discharge this period?'
Outfall No.
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
Inches'
Total Suspended Solids
Benchmarks ===>
_
-
100 mg/L or 50 mg/l
RECEIVED
JAN072019
CENTf�AL ALES
DWR SECTIOP!
' Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
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.
"See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Note: Results must be reported in numerical format. For example, 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 ma/L" where XX is the numerical value of the
detection limit, reporting limit, quantitation 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.
Permit Date: 10/1/2014-9/31/2019
SWU-252, last revised 9/17/2014
Page 1 of 2

Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month.
n No discharge this period?'
Outfall No.
Date Sample
Collected
' (mo/dd/yr)
24-hour rainfall
amount,
Inches
Non -polar O&G by EPA
1664 (SGT-HEM)
Total Suspended Solids
Benchmarks =_=>
_
-
15 mg/L
100 mg/L or 50 mg/L
Footnotes from Part A also apply to this Part B
Note: If you report a sample value in excess of the benchmark, you must implement Tier 1, Tier Z or Tier 3 responses. See General Permit text.
FOR PART A AND PART B MONITORING RESULTS:
• A SINGLE BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDANCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES ❑ NO ❑
IF YES, HAVE YOU CONTACTED THE DEMLR REGIONAL OFFICE AS REQUIRED BY THE PERMIT? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an original and one copy of this DMR including all "No Discharge" reports within 30 days of receipt of the lab results for at end of monitoring period
in the case of "No Discharge" reports) to:
Division of Water Resources
Attn: DWR 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.
am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
A�
(Signature of Pe ittee) - (Date)
Permit Date: 10/1/2014-9/31/2019 SWU-252, last revised 9/17/2014
Page 2 of 2

-�• ••• r%c uw L I UIVIH
for North Carolina DEMLR General Pe Mit No NCG
Date submitted , 160pp0 - Asphalt
CERTIFICATE OF COVERAGE NO. NCG16-a11' Z
FACILITY NAME 44n/E &; _
COUNTY Lrl+u/GLa JD
PERSON COLLECTING SAMPLES
LABORATORY lab Cert. p
Comments on sample collection or analysis:
Part A: Stormwater Benchmarks and Monitoring Results
Outfall No. I Date Sample 24-hour rainfall
Collected' amount,
(mo/dd/yr) Inches'
Benchmarks --->
SAMPLE COLLECTION YEAR .67/P
SAMPLE PERIOD 2 1an-June July -Dec
or 0 Monthly' (monthl
DISCHARGING TO CLASS �ORW �HQW QTrout OPNA
RIt f� QZero-flow �WaterSupply QSA
1� ❑Other
JUL 17 2018 PLEASE REMEMBER TO SIGN ON THE REVERSE 3
CENTRAL FILES
DWR SECTION
Total Suspended Solids
100 mg/L or 50
No discharge this period?'
' Monthly sampling (instead Of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
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 fora waiver of the rain gauge requirement.
° See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Note: Results must be reported in numerical format. For example 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, quantitation 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 Tfer 3 responses. See General Permit text.
Permit Date: 10/1/2014-9/31/2019
SWU-2S2, last revised 9/17/2014
Page 1 of 2

Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month.
n No discharge this period?"
Outfall No.
Date Sample
Collected
(mo/dd/yr)
24-hour rainfall
amount,
inches
Non -polar O&G by EPA
1664 (SGT•HEM)
Total Suspended Solids
Benchmarks =__>
-
-
15 mg/L
S00 mg/L or 50 mg/L
Footnotes from Part A also apply to this Part B
Note: If you report a sample value In excess of the benchmark, you must implement Tier 1, Tier Z or Tier 3 responses. See General Permit text.
FOR PART A AND PART B MONITORING RESULTS:
• A SINGLE BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDANCES FOR THE SAME PARAMETER AT ANYONE OUTFALL? YES ❑ NO ❑
IF YES, HAVE YOU CONTACTED THE DEMLR REGIONAL OFFICE AS REQUIRED BY THE PERMIT? YES FIND[]
REGIONAL OFFICE CONTACT NAME:
Mail an original and one copy of this DMR Including all "No Discharge" reports within 30 days of receipt of the lab results for at end of monitoring period
in the case of "No Dischame" reports) to:
Division of Water Resources
Attn: DWR 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."
(Signature of Permittee)
Permit Date: 10/l/2014-9/31/2019
/�
(Date)
SWU-252, last revised 9/17/2014
Page 2 of 2

for North Carolina DEMLR General P it No. NCG160000 -Asphalt
Date submitted
CERTIFICATE OF COVERAGE NO. NCG16-01 jzl 7
FACILITY NAME G4yE Xy9Sr/Tt,�
COUNTY L/�✓ (�4.ry�
PERSON COLLECTING SAMPLES
LABORATORY
Lab Cert. p
Comments on sample collection or analysis:
Part A: Stormwater Benchmarks and Monitoring Results
SAMPLE COLLECTION YEAR 6/7
SAMPLE PERIOD ❑ Jan -June © July -Dec
or ❑ Monthly'_ fmonthl
RFr`Fj'DoiSCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
JAN 1 0 ALL// ❑Zero -flow ❑Water Supply []SA
2�18 ❑Other
WRk SECTION
1,' IFORMATOION PROCESSING UNIT
PLEASE REMEMBER TO SIGN ON THE REVERSE -->
Outfall No.
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
Inchesa
:Total Suspended SolidsBenchmarks
=__>
mg/L or SO mg/L
No discharge this period?Z
Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
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.
" See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Note: Results must be reported in numerical format. For example, 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 mg� where XX is the numerical value of the
detection limit, reporting limit, quantitation 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.
Permit Date: 10/1/2014-9/31/2019
SWU-252, last revised 9/17/2014
Page 1 of 2

Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month.
n No discharge this period?Z
Outfall No.
Date Sample
Collected
(mo/dd/yr)
24-hour rainfall
amount,
Inches3
Non -polar O&G by EPA
1664(SGT-HEM)
Total Suspended Solids
Benchmarks ===>
-
-
15 mg/L
100 mg/L or 50 mg/L
Footnotes from Part A also apply to this Part B
Note: if you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 1, or Tier 3 responses. See General Permit text.
FOR PART A AND PART B MONITORING RESULTS:
• A SINGLE BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDANCES FOR THE SAME PARAMETER AT ANYONE OUTFALL? YES ❑ NO ❑
IF YES, HAVE YOU CONTACTED THE DEMUR REGIONAL OFFICE AS REQUIRED BY THE PERMIT? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an original and one cop of this DMR including all "No Discharge" reports within 30 days of receipt of the lab results for at end of monitoring period
in the case of "No Discharge" reports) to:
Division of Water Resources
Attn: DWR 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."
of
(Date)
Permit Date: 10/1/2014-9/31/2019 SWU-252, last revised 9/17/2014
Page 2 of 2

North Carolina Division of Energy, Mineral, and Land Resources
SEMI-ANNUAL STORMWATER OUTFALL DISCHARGE MONITORING REPORT (DMR)
Vehicle Mainten ce Activities Only
Date submitted .20%%
CERTIFICATE OF COVERAGE NO. NCG AIR O /y % _ SAMPLE COLLECTION YEAR .2o1 %
FACILITY NAME G,4NE C'i/(/s�Qy`Jiar/ A�/'i _r
COUNTY ezeme AaVp
PERSON COLLECTING SAMPLES PLEASE REMEMBER TO SIGN ON THE REVERSE 4
LABORATORY Lab Cent. #
Vehicle Maintenance Activity (VMA) Stormwater Monitoring Results: Only for facilities using an average of > 55 gal of new motor oil per month.
Total event rainfall' or ® No discharge this periodz
Outfall No.
Sample
Collected,
mm/dd/yr
Total Suspended
Solids (TSS), mg/L
Non -polar O&G/TPH, mg/L
(Method 1664 SGT-HEM)
(if applicable)
Oil and Grease, mg/L
(if applicable)
pH, Standard units
(if applicable)
New Motor Oil Usage,
Annual average gal/mo
Benchmark
-
300 or 503
15
30
Within 6.0-9.0
_
"� •�•�• r..c,p"a"on MUSL -� i cwiveo obnig aaia from an on -site ram gauge.
For sampling periods with no discharge at any outfalls. You must still submit this discharge monitoring report with a checkmark here.
3See General Permit text that identifies the especially sensitive receiving water classifications where the more protective TSS benchmark applies.
Note: Results must be reported in numerical format. For example, do not report Below Detection Limit, BDL, <PQL, Non -detect, ND, or any other similar non -
numerical format. When results are below the applicable limits, they must be reported in the format "<XX mg/L" where XX is the numerical value of the
laboratory's 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.
FOR MONITORING RESULTS:
• A single benchmark exceedance triggers TIER 1 REQUIREMENTS. See permit PART 11 SECTION B or C.
• Two exceedances in a row for the same parameter at the same outfall trigger TIER 2 REQUIREMENTS.
• TIER 3: Has your facility had four or more benchmark exceedances for the same parameter at any one outfall? YES ❑ NO ❑
IF YES: Have you contacted the DEMLR Regional Office? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
SWU-254 Vehicle Maintenance Activities DMR Last Revised: August 11, 2014
Page I of 2

Mail an original and one 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 Resources
Attn: DWR 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 violations."
(Signature
(Date)
Additional copies of this form may be downloaded at: http://portal.ncdenr.org/web/Ir/nodes-stormwater
SWU-2" Vehicle Maintenance Activities DMR Last Revised: August 11. 2014
2of2

L
North Carolina Division of Energy, Mineral, and Land Resources
SEMI-ANNUAL STORMWATER OUTFALL DISCHARGE MONITORING REPORT DMR
Vehicle Mainten ce Activities Only
Date submitted7ro
CERTIFICATE OF COVERAGE NO. NCG �lv
FACILITY NAME L,4NE
COUNTY eZev wID
PERSON COLLECTING SAMPLES
LABORATORY
Lab Cert. #
Vehicle Maintenance Activity (VMA) Stormwater Monitoring Results:
Total event rainfall' or ® No discharge this period'
SAMPLE COLLECTION YEAR /%
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Only for facilities using an average of > 55 gal of new motor oil per month.
Outfall No.
Sample
Collected,
mm/dd/yr
Total Suspended
Solids (TSS), mg/L
Non -polar O&G/TPH, mg/L
(Method 1664 SGT-HEM)
(if applicable)
Oil and Grease, mg/L
(if applicable)
pH, Standard units
(if applicable)
Within 6.0 - 9.0
New Motor Oil Usage,
Annual average gal/mo
Benchmark
-
300 or SO
15
30
_
The total precipitation
must be
recorded using riara frnm
�., .,.._�:.e ...:...._..__
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 that identifies the especially sensitive receiving water classifications where the more protective TSS benchmark applies.
Note: Results must be reported in numerical format. For example, do not report Below Detection Limit, BDL, <PQL, Non -detect, NO, or any other similar non -
numerical format. When results are below the applicable limits, they must be reported in the format "<XX mg/L" where XX is the numerical value of the
laboratory's 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.
FOR MONITORING RESULTS
• A single benchmark exceedance triggers TIER 1 REQUIREMENTS. See permit PART II SECTION B or C.
• Two exceedances in a row for the same parameter at the same outfall trigger TIER 2 REQUIREMENTS.
• TIER 3: Has your facility had four or more benchmark exceedances for the same parameter at any one outfall? YES NO IF YES: Have you contacted the DEMLR Regional Office?
YES F-1 NO
REGIONAL OFFICE CONTACT NAME:
SWU-254 Vehicle Maintenance Activities DVIR
Last Revised: August 11, 2014
Page I oft

Mail an original and one copy of this DMR including all "No Discharge" reports within 30 days of receipt of the lab results for at end of
monitoring period in the case of "No Discharge" reports) to:
Division of Water Resources
Attn: DWR 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 violations."
(Signature
/O
(Date)
Additional copies of this form may be downloaded at: http7//portal.ncdenr.org/"`web/Ir/npdes-stgrmwater
SWU-2sehicle Maintenance Activities DMR Last Revised: August 11. 2014
2of2

STORMWATER DISCHARGE OUTFALL (SDO)
GENERAL PERMIT NO. NCG160000
DISCHARGE MONITORING REPORT (DMR)
CERTIFICATE OF COVERAGE NO. NCG1600 ©®p SAMPLES COLLECTED DURING CALENDAR YEAR: 2014
(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.)
FACILITY NAME LMME (Y—I WS 061 COUNTY ('I1VGtC�-rQ
PERSON COLLECTING S PL u. PHONE NO (_)
CERTIFIED LABORATORY p' < Lab # Z
Lab# RECEIVED
Monitoring Requirements
DEC 3 0 2014
Outfall
No.
Date
Sample Collected.
mo/d
Total Rainfall.
inches
00530
00400
00556
Total Suspended Solids, mg/I
pH,
Standard units
Petroleum Hvdrocarbons, mg/l
EPA Method 1664 (SG -HEM
Benchmark
100
Within 6.0=9.0
15 '
s
2.
t If value is in excess of the benchmark, or outside the benchmark range (for pH), you must implement the Tier 1 or Tier 2 responses in the General Permit.
Mail original and one copy to:
Division of Water Quality
Attn: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED:
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to
assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or
those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete.
I am aware that there are significant penalties for submitting false information, including the possibility of fines and Imprisonment for knowing violations."
X �r 7�zzai4
(S' ature o 'tree) (Date)
SWU-253-051409
Page 1 of 1

�PI
®DU'RBOR4IDRIES SM ING
Full -Service Analytical &
Environmental Solutions
Lane Construction Corporation, The
Marcus Hackler
8205 Wilkinson Blvd.
Charlotte, NC 28214
NC Certification No. 402
SC Certification No. 99012
NC Drinking Water Cent No. 37735
VA Certification No. 460211
DoD ELAP: L-A-B Accredited Certificate No. L2307
ISO/IEC 17025: L-A-B Accredited Certificate No. L2307
Project: Kings Mtn. Asphalt Plant
Lab Submittal Date: 07/21/2014
Prism Work Order: 4070416
Case Narrative
08/01/2014
This data package contains the analytical results for the project identified above and includes a Case Narrative, Sample
Results and Chain of Custody. Unless otherwise noted, all samples were received in acceptable condition and processed
according to the referenced methods.
Data qualifiers are flagged individually on each sample. A key reference for the data qualifiers appears at the end of this case
narrative.
Narrative Notes:
Samples were received on wet ice at a temperature of 7.8 degrees C.
Please call if you have any questions relating to this analytical report.
Respectfully,
PRISM LABORATORIES, INC.
Terri W. Cole
Project Manager
Data Qualifiers Key Reference
Reviewed By Terri W. Cole
Project Manager
OG HEM 0&G is less than the reporting limit, therefore TPH (SGT-HEM) is less than the reporting limit. Sample not
extracted for TPH (SGT-HEM).
BRL Below Reporting Limit
MDL Method Detection Limit
RPD Relative Percent Difference
Results reported to the reporting limit. All other results are reported to the MDL with values between MDL and
reporting limit indicated with a J.
This report should not be reproduced, except in its entirety, without the written consent of Prism Laboratories, Inc.
449 Springbrook Road - P.O. Box 240543 -Charlotte, NC 28224-0643
Phone: [phone]-Toll Free Number: l-800/629-6364- Fax: [phone] Page 1 of5

Sample Receipt Summary
Fvl l-Sorvico Anarytical 3
I S M Environmental Solutions Q$/Q1 /2014
�7uec«.,w.re ac
Prism Work Order: 4070416
Client Sample ID Lab Sample ID Matrix Date Sampled Date Received
Stormwater Runoff Ouffall #1 4070416-01 Water 07/21/14 07/21/14
Stormwater Runoff Outfall #2 4070416-02 Water 07/21/14 07/21/14
Samples were received at 7.8 degrees C. See case narrative for further information.
This report should not be reproduced, except in its entirety, without the written consent of Prism Laboratories, Inc.
449 Springbrook Road - P.O. Box 240643 -Charlotte, NC 28224-0543
Phone: [phone] - Toll Free Number: 1-800/529-6364 - Fax: [phone] Page 2 of 5

Fufl- co icol &
LPR ISM I vronmental Solutions
ol is
�Pueauosrca ixc
Laboratory Report
08/01/2014
Lane Construction Corporation, The Project: Kings Mtn. Asphalt Plant Client Sample ID: Stormwater Runoff Oetfall #1
Attn: Marcus Hackler Prism Sample ID: 4070416-01
8205 Wilkinson Blvd. Prism Work Order: 4070416
Charlotte, NC 28214 Sample Matrix: Water Time Collected: 07/21/14 10:25
Time Submitted: 07/21/14 11:45
Parameter Result Units Report MDL Dilution Method Analysis Analyst Batch
Limit Factor Date/Time ID
General Chemistry Parameters
Oil & Grease (SGT-HEM) BRLOG mg/L 5.0 1.2 1 '1664A 7/29/14 11:20 JAB P4G0493
Total Suspended Solids 32 mg/L 8.3 1.0 1 'SM 2640 D 7124/14 11:36 JHB P4G0417
This report should not be reproduced, except in its entirety, without the written consent of Prism Laboratories, Inc.
449 Springbrook Road - P.O. Box 240643 - Charlotte, NC 28224-0643
Phone: [phone]-Toll Free Number: 1-8001629-6364 -Fax: [phone] Page 3 Of 5

R I S M Fvlt-Sarvlas Analytical
Enviranmantsl Solutions
.®V oowroAi�e i.c
Lane Construction Corporation, The
Attn: Marcus Hackler
8205 Wilkinson Blvd.
Charlotte, NC 28214
Laboratory Report
Geroi/2014
Project: Kings Mtn. Asphalt Plant Client Sample ID: Stormwater Runoff Outfall a2
Prism Sample ID: 4070416-02
Prism Work Order: 4070416
Sample Matrix: Water Time Collected: 07/21/14 10:50
Time Submitted: 07/21/14 11:45
Parameter Result
Units
Report
MDL Dilution
Method Analysis Analyst
Batch
Limit
Factor
Daterrime
ID
General Chemistry Parameters
Oil B Grease (SGT-HEM) BRLOG
mg/L
5.0
1.2 1
'1664A 7/29/14 12'.00 JAB
P4G0493
Total Suspended Solids 33
mg/L
8.3
1.0 1
'SM 2640 D 7124/14 11:35 JHB
P4G0417
This report should not be reproduced, except in its entirety, without the written consent of Prism Laboratones, Inc.
449 Spdngbrook Road - P.O. Box 240543 -Charlotte, NC 28224-0543
Phone: [phone]- Toll Free Number: 1-8001629-6364 - Fax: [phone] Page 4 of 5

.............- --
>,
Mr CHAIN OF CUSTODY RECORD
n n I Fun -Service Analytical 8
'v' Environmental Solutions PAOE , OFA_ OUOffi PTO ENSURE PROPER
'.fi'LL�LINytOr 'TL
„['`8'""^•R-'-'Z-*/'u,aauTDRlEs nto Project Name: f_,_-._nag 'u &Pho
449 Springbrook Road • P.O. Box 24OW • Charlotte, NC 28224.OW Short Hold Analysis: (Yes) (NO) UST Project (Yes) (NO)
Phone: [phone] • Fax:[phone] Y]itM Cspecific reporting (OC LEVEL 1 II III IV1
L. 1 ..,r,P �Af' • `Please ATTACH any project 9
Client Company Name:---- provisions and/or OC Requirements
Report To/Contact Name: !�-^•�' E-� {%�- Invoice To:
Reporting Address:
ih5 r-1-� (
- Address: '
:.
�..
r—
,.,,,1
Phone: �UQ �' �(/li Fa/ es
(No): 7�';114 • 4 Purchase Order No.Billing Reference
Email (Yes) (No) Email Address
Requested Due Date ❑ 1 Day ❑ 2 Days U 3 Days ❑ 4 Days ❑ 5 Days
EDD Type: PDF_ Excel_.Other
'WorkingDays" U 6-9 Days IIStandard 10 days Rush Work Must B
y Pre-APPraved
Site Location Name: �A' v
Samples received after 15:00 will be processed nerd business day.
is based business days, excluding weekends and holidays
Site Location Physical Address: ri�09x
©+IA
Turnaround
time on
(SEE REVERSE FOR TERMS A CONDITIONS REGARDING SERVICES
I-
W
RENDERED BY PRISM LABORATORIES, INC. TO CLIENT)
f
TIME
COLLECTED
MATRIX
(SOIL, !
SAMPLE CONTAINER
PflESERVA-
"TYPE
NO.
SIZE
_
CLIENT
SAMPLE DESCRIPTION
DATE
COLLECTED
MILITARY
WATER OR
TIVES
Qom.
HOURS
SLUDGE)
SEE BELOW
f
Sl, rr,fal�y
mIaLLL
10 85
_ 4 —.
—
—.—.
r`>
_ —.---
—
r-A
this Chain of
to the Prism
I
Priam to proceed with the analyses
,areas for any changes after analyst
NTACT upon arrival?
OIJ WE" ICE7 Tamp---
RRESERVATIVESindiatetl?
r —
WrMIN HOLDING TIMES?
r SEALS INTACT?'.
:S reed Vt/OUT HEADSPACE?
CONTAINERS usedZ
�-
_
e
TO BE FILLED IN BY CLIENT/SAMPLING PERSONNEL
Certification: NELAC_USACE_FL_
NC
SC_, OTHER WA
Water Chlorinated: YES_ NO —
Sample Iced Upon Collection: YES —NO
ANALYSES REQUESTED
pR__T­
ISM
A REMARKS
AB
ID NO.
changes must be
Z1-1If
M Snlpmen. OTE:ALL SAMPLE CO LE SHOUID BE TAPED SHUT WRNC TODY SEAL FOR TRANSPORTATION TO THE LABORATORY. rwP e
SAMPLES ARE NOT ACCEPTED AND VERIRFD AONNST COCU IL RECEIVE TTHE LABORATORY. L)J 1V�Iy�
❑F aEr uurs CERCLA I LANDFILL OTHER
NPDES: UST: I GROUNDWATER: ' DRINKING WATER: S LID WASTE: I RCRA.
ONO OSO ONO ❑SC ❑NO USC I UNC OSC I ONO ❑SC ONC USCONC OSCI ❑NC ❑SC ONC Cl SO
-CONTAINER TYPE CODES: A = Amber C = Clear G = Glass P = Plastic; TL = Teflon -Lined Cap VOA = Volatile Organics Analysis (Zero Head Space)
Comments: Site ArrivW'Iime:
.Site Depanuro Time::.
FIddTeon Fee: -
'Miloage:
ORIGINAL

:Ter
fac
........... ......
the best of my knawleil�r
blue etc:)
...........
............ ....... .

Full -Service Analytical
Environmental Solutions
�dLABORATOPIEE, ING
449 Springbrook Road • P.O. Box 240543 • Charlotte, NC 28224-0543
Phone: [phone] • Fax: [phone]
Client Company Name: L.QOQ- CorrD- "CtJ,
+ Report To/Contact Name: MQYcu S �PClt`TW
Reporting `Address;
%,MS 6dI4
CF AIN OF CUSTODY RECORD
PAGE —OF QUOTE A TO ENSURE PROPER BILLING:
Project Name: Kln�s n9al"1G �r ���n/
Short Hold Analysis: (Yes) (No) - UST Project: (Yes) (No)
-Please ATTACH any project specific reporting (OC LEVEL 111 III IV)
provisions and/or CC Requirements
Invoice To: ("Una' (On 51YU CiIt71
Address: W'tKln50�, �j )•x L
%', urlD tR_ Nli- IWO CI I' -
YP NO N/A
Samples INTACT upon arrival? i
Received ON WET ICE? Temp
l
PROPER PRESERVATIVES indicated?
_
Received WITHIN HOLDING TIMES?
i
CUSTODY SEALS INTACT?
i
VOLATILES reed W/OUT HEADSPACE?
7-
PROPER CONTAINERS used?
—
Phone: Ipy_ 3y'O- ��`� f'az(_/esj (No): lur Jf`1 °-'O' )I U .� .�i
� Purchase Order No./Billing Reference
TO BE FILLED IN BY CLIENT/SAMPLING PERSONNEL
Email (Yes) (No) Email Address Requested Due Date D 1 Day D ays D 3 Days D 4 Days D 5 Days
Certification: NELAC_USACE_ FL NC
EDD Type: PDF Excel _Other Working Days" D 6-9 Days tandard 10 days D Rush Work Must Be
5 A4 v) Pre -Approved
SC_ OTHER N/A
n
Site Location Name: Samples received after 15:00 will be processed next business day.
00O$ QVcl YH IA Turnaround time is based on business days, excluding weekends and holidays.
Site Loc1/a�tionnrPhGySlCeyl
Water Chlorinated: YES_ NO
,.A�ddreSS:
S REGARDING SERVICES
SEE REVERSE FOR TERMS & II
t M Nk' a (RENDERED
Sample Iced Upon Collection: YES NO
1 , • �, �/ I I 1 UD BY PRISM LABORATORIES, C. TO CLIENT)
CLIENT
DATE/
TIME
CMHOURSYO
MATRIX
WATER OR
SAMPLE CONTAINER
ANALYSES REQUESTED
Q�
�// / / / / REMARKS
PRISM
LAB
SAMPLE DESCRIPTION
COLLECTED
SLUDGE)
SEEBELOWNO.
SIZE
jO
ID NO.
kPRESERVA-
Ilplo'�-SC,?
rurloC�
W
�
I
I-�eM
Sir-rnwaltr
07a1 l�
I���w.,_
G
a
_
Uu} fo)ti#a,
%15L'VULLA �1Se f h IIOU r
Sampler's Signature " � Sampled By (Print Name) Affiliation
Upon relinquishing, this Chain of Custody is your authorization for Prism to proceed with the analyses as requested above. Any changes must be
submitted in writing to the Prism Project Manager. There will be charges for any changes after analyses have been initialized.
Relinquished By: (Signature) Received By: (Signature) / Date Mllitary/Hours Additional Comments: Site Arrival Time:
/
Relinquished By: (Signature) Received By: (signature) Date Site Departure Time:
/ Field Tech Fee:
Relinquished By: (Signature) Recei or Prism Labe torieBy - - Data
-7-
Mileage:
Methodol Shipment: NOTE: ALL SAMPLE COOLERS SHOULD BE TAPED SHUT WITH CUSTODY SEALS FOR TRANSPORTATION TO THE LABORATORY. roup No.
SAMPLES ARE NOT ACCEPTED AND VERIFIED AGAINST CDC RECEIVED AT THE LABORATORY.
UNTIL
Fed Ex ❑ UPS Cl Hand -delivered D Priam Field Service ❑ Other
NPDES: I UST: GROUNDWATER: I DRINKING WATER: I SOLID WASTE: I RCRA: I CERCLA LANDFILL OTHER: _ r
❑ NC D SC r NC D SC U NC ❑ SC ❑ NC D SC ❑ NC ❑ SC I ❑ NC 0 SC' p NC O SC D NC ❑ SC U NC ❑ SC
n rl n D ❑ ❑ O D El rI ICTnLAco rnOV
"CONTAINER TYPE CODES: A = Amber C = Clear G = Glass P = Plastic; TL = Teflon -Lined Cap VOA = Volatile Organics Analysis (Zero Head Space)

Terms and Conditions
The Terms & Conditions set forth below shall be deemed to be incorporated into the
agreements and understandings by and between Prism Laboratories and the Client
identified on the facing page hereof, The "Perms and Conditions of this Agreement shall
not be modified without prior written consent of Prism Laboratories.
Confidentiality: All work will be performed in
strict confidence. Results are released only to the
client or his designated agent. Prism must receive
a written request from our client to release data to
an independent third party. Confidentiality
agreements will be gladly provided and executed
upon request.
Payment Terms: We require it credit application
from each customer. For our clients with credit
approved by our company, payment terms are Net
10 Days upon receipt of the invoice. An interest
charge of 1 .5% per month applies to all overdue
balances. Payment in advance is required if credit
has not been established or if payment terms have
not been met. We reserve the Tight to withhold
laboratory results on accounts past 60 days over-
due or if credit limit is exceeded. Failure to make
payment in accordance with the Terms and Conditions
set forth herein may result in refusal by Prism
Laboratories in its sole discretion to perform any further
services by Prism Laboratories on behalf of the Client.
Warranty and Limits of Liability: Our warranty is
limited to the accuracy of the analysis of samples
as received. We assume no responsibility for the
purposes for which the client uses the test results
nor liability for any other warranties, express or
implied, including warranties of the fitness for
particular purpose or for merchantability made by
the client. These terms and conditions shall
supersede any conflicting terms and conditions
stated on any purchase order or other order of
work submitted by the client.
Indemnification and Hold Harmless: Client hereby
agrees to indemnify and hold Prism Laboratories harm-
less from any and all acts and/or omissions to act under-
taken by Prism Laboratories in good faith pursuant to
the Terms and Conditions of this Agreement. This
indemnification and hold harmless provision shall apply
to Prism Laboratories, its employees, officers and dnec-
tors and shall survive the terns of this Agreement. Prism
Laboratories shall not he responsible for any misrepre-
sentations by Client and/or any breach of these Terms
and Conditions by Client as set forth herein.
Governing Law: This Agreement shall be governed in
accordance with the laws of the State of North Carolina
Fee Discounts: Fee discounts apply to long-term
contractual work, special projects and quotations,
and large volume requests. Discounts do not apply
to RUSH work.
Hazardous Wastes: Prism Laboratories reserves
the right to return any samples determined to be
hazardous, acutely toxic, or radioactive. It will be
the client's responsibility to dispose of these
samples in accordance with federal regulations. A
sample disposal fee may be charged by Prism
Laboratories. Inc.
Billings: There is it minimum reporting fee of
$52.00. All fees are billed dircoly to the client. if
billing is to go to it third party, Prism requires it
statement signed by the, third party accepting
responsibility of payment.
Litigation Support: All costs associated with compli-
ance to any subpoena for documents, for testimony in a
court of law, or for any other purpose relating to
work performed by Prism Laboratories, in comtec-
tion.of work performed for that client shall be paid
by that client. These costs may include, but are not
limited to, hourly charges for persons involved in
responding to subpoenas, travel and accommoda-
tions, mileage, attorney's preparation of testifier
and advice of counsel in connection with response
to subpoenas, and other expenses associated with
such litigation.
Retention of Samples: Excess samples not used in
analysis will be retained at the laboratory after
report of analysis according to the following
schedule unless other arrangements can be made.
Potable water: Discarded immediately. All other
Samples: 30 days.
Retention of Reports: After results have been
reported to the client. Prism will retain copies for it
period of at least three years: after which such
reports may be destroyed.
Special Reports: All standard prices reflect Level I & 11
Quality Control Program Reports. Level III and above
QC Reports, and additional copies of reports are
available upon request at an additional charge.
Rush Turnaround: Available with prior approval
from Prism. The following price premium Multi-
pliers will apply unless quoted otherwise in a
Prism Analytical Quotation: Less than I Day = 3x
/ I Day - 2.25x / 2 clay - 1.75x / 3 day - 1.5x / 4 day -
1.25x / 5 day - 1.2x / 6-9 [lays - 1.15x. Rush TCLP
Analyses are priced higher. Turnaround time is
based on business days excluding weekends and
holidays. Samples received ;titer 3:00 pm will
be considered received the next business day.
Force Majeure: Neither party to this agrecment
will be liable to the other party for delays in
performance of services nor for the direct or
indirect cost(s) resulting from such delays, that
may result from labor strikes, riots, war,
extraordinary weather conditions, terrorism
or any natural catastrophe or any other cause
beyond the reasonable control of either party.

STORMWATER DISCHARGE OUTFALL (SDO)
GENERAL PERMIT NO. NCG160000
DISCHARGE MONITORING REPORT (DMR)
zot4
CERTIFICATE OF COVERAGE NO. NC4316© /Q®Q SAMPLES COLLECTED DURING CALENDAR YEAR: 217=
(This monitoring report is due at the Division no later than 30 days from the date
'' L 4. \ (1the facility receives the sampling results from the laboratory.)
%R� FACILITY NAME (i{-tJ� 1 tYgs AICW, 1 COUNTY CikL�t, Cow nl"
PERSON COLLECTING 'b6Qtge PHONE NO. '759 2544
CERTIFIED LABORATORY M- 7�t3 Lab # -1-02
Lab #
Monitoring Requirements
Outfall
No.
Date
Sample Collected,
mo/d r
Total Rainfall.
inches
00530
00400
00556
Total Suspended Solids, mg/1
pH,
Standard [nits
Total Petroleum Hvdrocarbons, mgA
EPA Method 1664 (SG -HE
Benchmark
10o
Within 6.0 = 9.0
15
2-4-
L
I0.Z10
,UL
z
-414
Zo
L
38
pL
' If a value is in excess of the benchmark, or outside the benchmark range (for pH), you must implement the Tier 1 or Tier 2 responses in the General Permit.
Mail original and one copy to: RECEIVED
Division of Water Quality
Attn: Central Files MAR y 4 2014
1617 Mail Service Center 1
Raleigh, North Carolina 27699-1617 CENTRAL FILES
DWQ/BOG
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 signiftcantyel allies for jut jotting false information, including the possibility of fines and imprisonment for knowing violations.,,
3-10-19
(Date)
SWU-253-0514D9
Page 1 of 1

LA&RoISM
OIABO RIESINC.
Full -Service Analytical d
Environmental Solutions
Lane Construction Corporation, The
Marcus Heckler
8205 Wilkinson Blvd.
Charlotte, NC 28214
NC Certification No. 402
SC Certification No. 99012
NC Drinking Water Cart No. 37735
VA Certification No. 460211
DoD ELAP: L-A-B Accredited Certificate No. L2307
ISO/IEC 17025: L-A-B Accredited Certificate No. L2307
Project: Kings Mtn. Asphalt Plant
Lab Submittal Date: 02/04/2014
Prism Work Order: 4020044
Case Narrative
02/18/2014
This data package contains the analytical results for the project identified above and includes a Case Narrative, Sample
Results and Chain of Custody. Unless otherwise noted, all samples were received in acceptable condition and processed
according to the referenced methods.
Data qualifiers are flagged individually on each sample. A key reference for the data qualifiers appears at the end of this case
narrative.
Please call if you have any questions relating to this analytical report.
Respectfully,
PRISM LABORATORIES, INC.
Terri W. Cole
Project Manager
Data Qualifiers Key Reference
Reviewed By Terri W. Cole
Project Manager
OG HEM 0&G is less than the reporting limit, therefore TPH (SGT-HEM) is less than the reporting limit. Sample not
extracted for TPH (SGT-HEM).
BRL Below Reporting Limit
MDL Method Detection Limit
RPD Relative Percent Difference
Results reported to the reporting limit. All other results are reported to the MDL with values between MDL and
reporting limit indicated with a J.
This report should not be reproduced, except in its entirety, without the written consent of Prism Laboratories, Inc.
449 Springbrook Road - P.O. Box 240543 - Charlotte, NC 28224-0643
Phone: [phone]-Toll Free Number: l-8001629-6364-Fax: [phone] Page 1 of

n Fun -Service al Solutions
i
IP'R I S M I e�.i,enmenre�
Sample Receipt Summary
02/18/2014
Prism Work Order: 4020044
Client Sample ID Lab Sample ID Matrix Date Sampled Date Received
Stonmwater runoff Outfall #1 4020044-01 Water 02/04/14 02/04/14
Stormwater runoff Outfall #2 4020044-02 Water 02/04/14 02/04/14
Samples were received in good condition at 4.4 degrees C unless otherwise noted.
This report should not be reproduced, except in its entirety, without the written consent of Prism Laboratones, Inc.
449 Springbrook Road - P.O. Box 240643 - Charlotte, NC 28224-0643
Phone: [phone] - Toll Free Number: 1-8001529-6364 - Fax: [phone] Page 2 of 5

IN
Fun.aervice Analxnca, &
R I S M I En n onmentai Solutions
Vuoow�roniea n+c
Lane Construction Corporation, The
Attn: Marcus Hackler
8205 Wilkinson Blvd.
Charlotte, NC 28214
Project: Kings Mtn. Asphalt Plant
Sample Matrix: Water
Laboratory Report
02/18/2014
Client Sample ID: stomtwater runoff outfall #1
Prism Sample ID: 4020044-01
Prism Work Order: 4020044
Time Collected: 02/04/14 15:20
Time Submitted: 02/04/14 16:25
Parameter Result
Units
Report
MDL Dilution
Method Analysis Analyst
Batch
Limit
Factor
Date/Time
ID
General Chemistry Parameters
Oil & Grease (SGT-HEM) BRLOG
mg/L
5.0
1.2 1
'1664A 2/10114 11:25 JAB
P480147
Total Suspended Solids 6.6
mg/L
5.0
0.90 1
'SM 2640 D 216/14 13:45 JAB
P4130081
This report should not be reproduced, except in its entirety, without the written consent of Prism Laboratones, Inc.
449 Springbrook Road - P.O. Box 240643 -Charlotte, NC 28224-0643
Phone: [phone] -Toll Free Number: 1.8001629-6364 - Fax: [phone] Page 3 Of 5

n�1
APR I S M Foll-Service Analytical &
Environmental Solutions
v..eoa.,aea,.��
Lane Construction Corporation, The
Attn: Marcus Hackler
8205 Wilkinson Blvd.
Charlotte, NC 28214
Project: Kings Mtn. Asphalt Plant
Sample Matrix: Water
Laboratory Report
02/1812014
Client Sample 1D: Stommveter runoff Oudan 42
Prism Sample ID: 4020044-02
Prism Work Order: 4020044
Time Collected: 02/04/14 15:35
Time Submitted: 02/04/14 16:25
Parameter Result
Units
Report
MDL Dilution
Method Analysis Analyst
Batch
Limit
Factor
Dalerl-ime
ID
General Chemistry Parameters
Oil & Grease (SGT-HEM) BRLOG
mg/L
5.0
1.2 1
'1664A 2/10/14 12:10 JAB
P4130147
Total Suspended Solids 5.8
m9/L
5.0
0.90 1
'SM 2640 D 2/6114 13:45 JAB
P41210081
This report should not be reproduced, except in its entirety, without the written consent of Prism Laboratories, Inc.
449 Springbrook Road - P.O. Box 240643 - Charlotte, NC 28224-0643
Phone: [phone] - Toll Free Number: 1-8001629-6364 -Fax: [phone] Page 4 of 5

CHAIN OF CUSTODY RECORD �
Full-Sernce Analytical & 1 -<' •-= YES NO NrA
yr4 I Environmental Solutions PAGE OF _ QUOTE P TO ENSURE PROPER BILLINGS Samples INTACT upon ernv,Il7
u,.^�`uedRnrdRiss iHC�S MM,.,4�,11.;►f1�14nt Received ON WET.ICE?Temp 4-•�
Project Name: _
449 Springbrook Road • P.O. Box 240543 • Charlotte, INC 2R224-0543 PROPER PRESERVATIVES Indicated? _
Phone: [phone] Fax: [phone] Short Hold Analysis: (Yes) (No) UST Project (Vas) (No) Received WITHIN HOLDING TIME39 —
Client Company Name: L-4-tN2 tnr\S',rU8RDI0� -Please ATTACH any project specific reporting (QC LEVEL 1 II UI M CUSTODY SEALS INTACT?.. —
r, provisions and/or OC Requirements
Report To/Contact Name: ti() Ir-CALS- Invoice To: Lane - n d VOLATILES read W/OUT HEADSPACE7
Reporting Address: 3ja-5 Wrk%I .jrn B( Addre s: �`a �Jt]JI- n�U �.1.�: PROPEF CONTAINERS used? _
Phone: �M' �u45,20 }Fax es (No): r QL374'x- + purchase Order No.Milling Reference !SIO'*)- JyQ1 _
TO BE FILLED IN BY CLIENT/SAMPLING PERSONNEL
Email (Yes) (No) Email Address Requested Due Date ❑ 1 Day 0 2 Days 03 Days 04 Days ❑ 5 Days
Certification- NELAC_USACE—
FL _ NC_
EDD Type: PDF_ Excel —Other "Working Days" 0 6-9 DaysxStandard 10 days O Push Work Mdust Be
SC
OTHER N/A
Site Location Name: r Samples received aher 15:00 will be processed next business day.
Turnaround time is based on business days, excluding weekends and holidays.
—
Water Chlorinated: YES
_ NO
SItE Location Ph Ical Address: (SEE REVERSE FOR TERMS 6 CONDITIONS REGARDING SERVICES
NO
Sample toed Upon Collection: YES NO
n
j [ ' C RENDERED BY PRISM LABORATOflIEs, INC. TO CLIENT)
— —
TIME
MATRIX
SAMPLE CONTAINER
ANALYSES REQUESTED
PRISM
CLIENT
SAMPLE DESCRIPTION
DATE
COLLECTED
COLLECTED
MILITARY
(SOIL,
WATER OR
PRESERVA-
TIVES
/ /
REMARKS
IDLAB
NO.
`TYPE
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NO.
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Sampler's Signature T10, 4,- Sampled By (Print Name) I,- Y Affiliation
Upon relinquishing, this Chain of Custody is your authorization for Prism to proceed with the analyses as requested above. Any changes must be
Prism Project Manager. Thera will be charges, any changes after analyses have been initialized.
submitted in writing to the
Rellmu"shad By: Ignawre) eceived y: (Synewra) Deto
iiiteryMourt Additional Comments: Site Arrival Time:
Relrx.ished By: (Signature) Roreived By: IS ignawre) Nate
Departure Time:
Field Tech Foe:.
e0rpuishetl 0y: (Slgnawle) Row sm Labor By: Dale
Ib�S
a-I-IY
IMneage:
M o h pment: NOTE: ALL SAMPLE COOLERS SH ULD BE TAPED SH CUSTODY SEALS F R PORTA ION T HE LABORATORY. �1 oup
SAMPLES ARE NOT ACCEPTED AND VERIFIED A OC UNTIL RECENED AT THE LABORATORY. '-t�Z YYyy
—
O Fed El UPS GHarddeMered ❑Prism Feld Sxvice OOlher
NPDES: UST: GROUNDWATER: DRINKING WATER: !SOLID WASTE: RCRA: CERCLA LANDFILL OTHER:
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ONG OSC ONG OSC 0NC ❑SC ONG OSC I ❑NC OSC ❑NC 0SC, ONG ❑SCI ONG OSC
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ORIGINAL
`CONTAINER TYPE CODES: A = Amber C = Clear G = Glass P = Plastic; L = I enon-uneo uap wry = wlanlc �,ya.:� n,o,»� t�r„� �r•�-�

�O�o I C�rYY�u� ��Ctln Since 10Sf 5arnde
o�0,� W AQ� o a10 t/ 13 0 5 1,
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Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Permit No.:N/C/6/!/(.0/O/U/0/U/ or Certificate of
Facility Name: L Con V)in
County: ("if tR I o n( Phone No
Inspector: me n,y—
Date of Inspection:
l /6/0lt /&/71
By this signature, I certify that this report is accurate and complete to the best of my knowledge:
Ss['u.a A �) .�W D it
(Signature of Permittee or Designee)
I. Outfall Description
Outfall No. Structure (pipe, ditch, etc.) ?l (�
Receiving Stream:
Describe the industrial activities that occur within the outfall drainage area: TK eje 4rVVrj(_
2. Color
Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint (light, medium,
dark) as descriptors: � 1 c,)n } �DrO W n
3. Odor
Describe any distinct odors that the discharge may have (i.e., smells strongly of oil, weak chlorine odor,
etc.) WrIq Q,
4. Clarity
Choose the number which best describes the clarity of the discharge where I is clear and 10 is very
cloudy:
1 0 3 4
5 6 7 8 9 10
Page I
S W U-242-020705

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 I is no solids and 10 is extremely muddy:
1 0 3 4 5 6 7 8 9 10
7. Foam
Is there any foam in the stormwater discharge?
8. Oil Sheen
Is there an oil sheen in the stormwater discharge?
9. Deposition at Outfall
Yes No
Yes 6)
Is there deposition of material (sediment, etc.) at or immediately below the outfall?
10. Lrosion at Outfall
Is there erosion at or immediately below the outfall? Yes No
it. Other Obvious Indicators of Stormwater Pollution
List and describe
Yes No
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, deposition or erosion may be
indicative of conditions that warrant further investigation and corrective action.
Page 2
SWU-242-020705

9 ,
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Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
PermitNo.: N/CIG/L/(o/o/o/O/U/
Facility Name: n
County: Cicydor)
Inspector: DZniSP. -
I -Date of Inspection:
or Certificate of Coverage No.:
Phone No.
By this signature, I certify that this report is accurate and complete to the best of my knowledge:
c ? o 1"OL�
(Signature of Permittee or Designee)
1. Outfall Description
Outfall No. I Structure (pipe, ditch, etc.)
Receiving Stream: Yir�.5 ('y-p-K
Describe the industrial acuvrhes that occur within the outFtll drainage area:
2. Color
Describe the color of the dischargeusingmm sing basic colors (red, brown, blue, etc.) and tint (light, ediu,
dark) as descriptors: IiCth krotl)n
3. Odor
Describe any distinct odors that the discharge may have (i.e., smells strongly of oil, weak chlorine odor,
etc.) NOr)9-
4. Clarity
Choose the number which best describes the clarity of the discharge where I is clear and 10 is very
cloudy:
I Q) 3 4 5 6 7 8 9 10
Page I
ID10f!L
S W U-242-020705

S. 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 (D 3 4 5 6 7 8 9 10
6. Suspended Solids
Choose the number which best describes the amount ol'suspended solids in the stormwater discharge
where I is no solids and 10 is extremely muddy:
1 ✓ 3 4 5 6 7 8 9 10
7. Foam
Is there any foam in the stormwater discharge? Yes (\No
8. Oil Sheen
Is there an oil sheen in the stormwater discharge? Yes No
9. Deposition at Outfall
Is there deposition of material (sediment, etc.) at or immediately below the outfall? Yes No
10. Erosion at Outfall
Is there erosion at or immediately below the outfall? Yes No
11. Other Obvious Indicators of Stor mvater Pollution
List and describe
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, deposition or erosion may be
indicative of conditions that warrant further investigation and corrective action.
Page 2
S W U-242-020705

QP7\R ISM I Full -Service Analytical
Environmental Solutions
Q�IABORATORIES INC
449 Springbrook Road • P.O. Box 240543 • Charlotte, NC 28224-0543
Phone: [phone] • Fax: [phone]
1
Client Company Name: ` aLne'
Report To/Contact Name• Q.Y'CtA3�Cr
Reporting Address: aA I KI(1�Cyl )
C MrloHf N Iq I
CHAIN OF CUSTODY RECORD
PAGE ` OF 'L QUOTE M TO ENSURE PROPER BILLING: 1
Project Name: Kinds �1n ArD r /f Plonf
Short Hold Analysis: (Yes) (No) UST Project: (Yes) (NO)
'Please ATTACH any project specific reporting (OC LEVEL 1 II III IV)
provisions a^(�/or OC Requirements
Invoice To: LQ ne, L0na+rU4/01­1
Add a s: W5 1,A) l -05cin 81
F1_t-l0rIDHG ' &% A )
Samples INTACT upon arrival? //-,p
Received ON WET ICE? Temp u_`/
PROPER PRESERVATIVES indicated?
Received WITHIN HOLDING TIMES?
CUSTODY SEALS INTACT?
VOLATILES reed W/OUT HEADSPACE?
PROPER CONTAINERS used?
YES
NO
NIA
Phone: •ICft' .�7.:.ra+vf Fax (YY45f(No): ILrr �'I- DapT g�0 Oi
Purchase Order No./Billing Reference
TO BE FILLED IN BY CLIENT/SAMPLING PERSONNEL
Email (Yes) (No) Email Address Requested Due Date i::1 1 Day ❑ 2 Days D 3 Days U 4 Days D 5 Days
Certification: NELAC USACE FL NC
EDD Type: PDF Excel _Other "Working Days" ❑ 6-9 DaysXStandard 10 days Rush Work Must Be
�fll^�r+n (G Pre -Approved
SC OTHER N/A
Site Location Name: Samples received after 15:00 will be processed next business day.
Sit location P(lysica�A`dresg� Qfrl- Turnaround time is based on business days, excluding weekends and holidays.
�lQl1 (SEE REVERSE FOR TERMS 8 CONDITIONS REGARDING SERVICES
Water Chlorinated: YES_ NO
q J✓Ir
da'' lJ 1J RENDERED BY PRISM LABORATORIES, INC. TO CLIENT
Sample Iced Upon Collection: YES _ NO
P P
CLIENT
TIME
CMILITARY
MATRIX
SAMPLE CONTAINER
PRTIVES A
REQUESTED
PRISM
SAMPLE DESCRIPTION
COLDATE ECTED
WATER
������III [ANALYSES
/�'C�N.J / / / REMARKS
J
LAB
ID NO.
-TYPE
NO.
SIZE
HOURS
SLUDGE)
E)
SEE BELOW
�`
5� mwa,
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1 0
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Sampler's SignatureSampled By (Print Name) t� �-�-tv Tv`'cr Affiliation
Upon relinquishing, this Chain of Custody is your authorization for Prism to proceed with the analyses as requested above. Any changes must be .i>r:?rrri'.rYtj' `
LM141S++� ur-+�
submitted in writing to the Prism Project Manager. There will be charges for any changes after analyses have been initialized.
Relinquished By: (Signature) Receivea By: (Signature) oat. MlrtaryMours Additional Comments: Site Arrival Time:
Relinquished By: (Signature) Received By: (Signature) - Date Site Departure Time:
— - Field Tech Fee:
(Relinquished By: (Signature) _ \ _ Rece/rv�d�For Priam Laboratori2� y:� Date
�J' Mileage:
Method of Shipment: NOTE: ALL SAMPLE COOLERS SHOULD BE TAPED SHUT WITH CUSTODY SEALS FOR TRANSPORTATION TO THE LABORATORY, roup Ne.
SAMPLES ARE NOT ACCEPTED AND VERIFIED AGAINST CDC UNTIL RECEIVED AT THE LABORATORY.
O Fed Ex ❑ UPS ❑ Haxddelivered O Prism Field Service O Outer
NPDES: I UST: GROUNDWATER: DRINKING WATER: SOLID WASTE: I RCRA: CERCLA LANDFILL OTHER:
p NC p SC Ci NC Cl SC ❑ NC p SC Cl NC O SC O NC ❑ SC I D NC O SC O NC O SC ❑ NC ❑ SC i7 NC O SC -
I
rl n F1 ❑ _— ❑ ❑ ❑ ❑ ❑ 11 11,,
'CONTAINER TYPE CODES: A = Amber C = Clear G = Glass P = Plastic; TL = Teflon -Lined Cap VOA = Volatile Organics Analysis (Zero Head Space)

Terms and Conditions
The Terms & Conditions set forth below shall be deemed to be incorporated into the
agreements and understandings by and between Prism Laboratories and the Client
identified on the facing page hereof. The Terms and Conditions of this Agreement shall
not be modified without prior written consent of Prism Laboratories.
,•7
Confidentiality: All work will be performed in
strict confidence. Results are released only to the
client or his designated agent. Prism mu, t'receive
a written request front our client to release data to
an independent third party. Confidentiality
agreements will be gladly provided and executed
upon request.
Payment Terms: We require a credit application
from each customer. For our clients with credit
approved by our company, payment terms are Net
10 Days upon receipt of the invoice. An interest
charge of 1.5%r, per month applies to all overdue
balances. Payment in advance is required if credit
has not been established or if payment terms have
not been met. We reserve the right to withhold
laboratory results on accounts past 60 days over-
due or if credit limit is exceeded. Failure to make
payment in accordance with the Terms and Conditions
set forth herein may result in refusal by Prism
Laboratories in its sole discretion to perform any further
services by Prism Laboratories on behalf of the Client.
Warranty and Limits of Liability: Our warranty is
limited to the accuracy of the analysis of samples
as received. We assume no responsibility for the
purposes for, which the client uses the test results
nor liability for any other warranties, express or
implied, including warranties of the fitness for
particular purpose or for merchantability made by
the client: These terms and conditions shall
supersede any conflicting terms and conditions
stated on any purchase order or other order of
work submitted by the client.
Indemnification and Hold Harmless: Client hereby
agrees to indemnify and hold Prism Laboratories harm-
less from any and all acts and/or omissions to act under-
taken by Prism Laboratories in good faith pursuant to
the Terms and Conditions of this Agreement This
indemnification and hold harmless provision shall apply
to Prism Laboratories, its employees, officers and three -
tors and shall survive the terns of this Agreement. Prism
Laboratories shall not be responsible for any misrepre-
sentations by Client and/or any breach of these Terms
and Conditions by Client as set forth herein.
Governing Law: This Agreement shall be governed in
accordance with the laws of the State of North Carolina.
Fee Discounts: Fee discounts apply to long -tern
contractual work, special projects and quotations,
and large volume requests. Discounts do not apply
to RUSH work.
Hazardous Wastes: Prism Laboratories reserves
(lie right to return any samples determined to be
hazardous, acutely toxic, or radioactive. 11 will be
the client's responsibility to dispose of these
samples in accordance with federal regulations. A
sample disposal fee may be charged by Prism
Laboratories. Inc.
Billings: 'there is a minimum reporting fe �of
$52.00. All fees are billed directly to the client. If
billing is to go to a third party, Prism requires a
statement signed by the third patty accepting
responsibility of payment.
Litigation Support: All costs associated with compli-
ance to any subpoena for documents, for testimony in a
court of law, or for any other purpose relating to
work performed by Prism Laboratories, in connec-
tion of work performed for that client shall be paid
by that client. These costs may include. but are not
limited to, hourly charges for persons involved in
responding to subpoenas, travel and accommoda-
tions. mileage, attorney's preparation of testifier
and advice of counsel in connection with response
to subpoenas, and other expenses associated with
such litigation.
Retention of Samples: Excess samples not used in
analysis will be retained at the laboratory after
report of analysis according to the following
schedule unless other arrangements can be made.
Potable water: Discarded immediately. All other
Samples: 30 days.
Retention of Reports: After results have been
reported to the client, Prism will retain copies for a
period of at least three years; after which such
reports may be destroyed.
Special Reports: All standard prices reflect Level I & 11
Quality Control Program Reports. Level ITI and above
QC Reports, and additional copies of reports are
available upon request at an additional charge.
Rush Turnaround: Available with prior approval
from Prism. The following price premium multi-
pliers will apply unless quoted otherwise in a
Prism Analytical Quotation: Less than I Day = 3x
/ I Day -225x/2day -1.75x/3day - 1.5x/4day -
1.25x / 5 day - 1.2x / 6-9 days - 1.15x. Rush TCLP
Analyses are priced higher. Turnaround time is
based on business days excluding weekends and
holidays. Samples received after 3:00 pin will
be considered received the next business day.
Force Ma•jeure: Neither party to this agreement
will be liable to the other party for delays in
performance of services nor for the direct or
indirect cost(s) resulting from such delays, that
may result from labor strikes. riots, war,
extraordinary weather conditions, terrorism
or any natural catastrophe or any other cause
beyond the reasonable control of either party.

Tracy E. Davis, PE, CPM
Director
Danny Eudy
The LANE Construction Corporation
8205 Wilkinson Blvd
Charlotte, NC 28214
Dear Mr. Eudy:
�r
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Energy, Mineral and Land Resources
Land Quality Section
Pat McCrory, Govenor
John Skvarla, III Secretary
February 10, 2014 RECEIVED
FEB 14 2014
CENTRAL FILES
DWQIBOG
Subject: Stormwater Permit Rescission Request Denial
Certificate of Coverage Number NCG160167
LANE (Kings Mountain)
Cleveland County
On October 2, 2013, the Division of Energy, Mineral and Land Resources received'your request
to rescind your coverage under Certificate of Coverage Number NCG 160167.
Based on our review of your request and the recommendation of our Mooresville Regional
Office, your request for rescission has been denied. Your request was denied because on
inspection, it was determined that there is the potential for discharge of stormwater from
industrial materials. Your Certificate of Coverage Number NCG160167 will remain in effect,
and you must continue to comply with your NPDES stormwater permit.
If you have questions about this matter, please contact Julie Ventaloro at 919-807-6370, or the
Stormwater staff in our Mooresville Regional Office at 704-663-1699.
Sincerely,
for Tracy E. Davis, P.E., CPM
cc: Mooresville Regional Office — Z. Khan
Stormwater Permitting Program
Central Files - w/attachments
Ms. Denise Isenhour, The LANE Construction Corporation, 208 Quarry Rd,
Kings Mountain, NC 28086
1612 Mail Service Center, Raleigh, North Carolina 27699-1612.919-707-92001 FAX: [phone]
512 North Salisbury Street, Raleigh, North Carolina 27604 • Internet: http:llportal.ncdenr.org/web/Ir/
An Equal Opportunity 1 Affirmative Action Employer— 50% Recycled 110% Post Consumer Paper

M 0 014-1v "/ /4
11 LANE
October 2, 2013
SW NPDES permit Coverage Recession
ATTN: Stormwater Permitting Unit
1617 Mail Service Center
Raleigh NC 27699-1617
Re: NCG 160167 Permit Recession
(LANE) Kings Mountain
Please see the attached permit recession form. This facility all drains to pond that does not discharge off
site. Please let me know should you have any further questions at 704-395-3264.
Sincerely,
41D 'V
arcus . Hackler
Environmental Coordinator
CC: D1E RLR DCM
The Lane Construction Corporation
8205 Wilkinson Boulevard Charlotte, NC 28214 USA T704.394.8354 F704.394.5354 LaneConstruct.com
An Equal Opportunity Employer M/F/D/V

�� Division of Water Quality / Surface Water Protection
National Pollutant Discharge Elimination System
/NCDENR
� � wo, RESCISSION REQUEST FORM
F vwyw[rrt �xo N.a�n�t iS�w,cea
FOR AGENCY USE ONLY
Date Received
Year
I Month
Da
Please fill out and return this form if you no longer need to maintain your NPDES stormwater permit.
1) Enter the permit number to which this request applies:
Individual Permit (or) Certificate of Coverage
N I C I S FT= N I C I G 1 6 I 0 1 6 7
2) Owner/Facility Information: ' Final correspondence will be mailed to the address noted below
Owner/Facility Name The LANE Construction Corporation
Facility Contact Diense Isenhour
Street Address 208 Quarry Rd
City Kings Mountian StateNC ZIP Code 28086
County Cleveland E-mail Address [e-mail]
Telephone No. 704 739 2344 -Fax: [phone]
3) Reason for rescission request (This is required information. Attach separate sheet if necessary):
❑ Facility closed or is closing on f l . All industrial activities have ceased such that no discharges of
slormwater are contaminated by exposure to industrial activities or materials.
❑ Facility sold to F 1 on . If the facility will continue operations under the new owner it
may be more appropriate to request an ownership change to reissue to permit to the new owner.
8 Other: Facility drains to a pond that does not discharge.
4) Certification:
I, as an authorized representative, hereby request rescission of coverage under the NPDES Stormwater Permit for the
subject facility. I am familiar with the information contained in this request and to the best of my knowledge and belief
such information is true, complete and accurate.
Signature Date 1611,611113
Print or type name of person signing above Title
Please return this completed rescission request form to: SW NPDES Permit Coverage Rescission
Stormwater Permitting Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
1617 Mail Service Center, Ralegh, North Carolina 27699-1617
Location: 512 N. Salisbury St Raleigh, North Carolina 27604 One
Phone: 91"07-63001 FAX: [phone] Customer Service: 1-877-623-6748 NorthCaroli na
Internet:w .ncwaterquality.org a'atura//ff
An Equal Opportunity l Affirmative Action Employer {/ yK !- `(