NCG160170_COMPLETE FILE - HISTORICAL_20121130

mT/D I A (4-�P6
STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
(- G
DOC TYPE
STORICAL FILE
❑ MONITORING REPORTS
DOC DATE
❑
YYYYM M D D

North Carolina
Beverly Eaves Perdue
Governor
Danny J. Eudy
The LANE Construction Corp
8205 Wilkinson Blvd
Charlotte, NC 28214
Dear Mr. Eudy:
NC®ENR
Department of Environment and Natural Resources
Division of Water Quality
Charles Wakild, P. E. Dee Freeman
Director Secretary
November 30, 2012
Subject: NPDES General Permit NCG 160000
Certificate of Coverage NCG160170
LANE (Kannapolis)
Formerly Rea Contracting-Kannapolis
076
Rowan 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: w .ncwaterquality.org
An Equal opportunity 1 Affrnng ive Action Employer
One
NorthCarolina
Nawrally

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
GENERAL PERMIT NO. NCG 160000
CERTIFICATE OF COVERAGE No. NCG160170
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 ControlfAct, as amended,
'file LANE Construction Corp
is hereby authorized to discharge stormwater from a facility located at
LANE (Kannapolis)
2250 China Grove Rd
Kannapolis
Rowan Counnv
to receiving waters designated as Cold Creek, waters in the Catawba River Basin in accordance with the
effluent limitations, monitoring requirements, and other conditions set forth in Parts I, II, 111, IV, V and
VI of General Permit No. NCG 160000 as attached.
This 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 B1
KEN PICKLE
for Charles Wakild, P.E., Director
Division of Water Quality
By Authority of the Environmental Management Commission

4 0 F Division of Water Quality / Surface Water Protection
N�De National Pollutant Discharge Elimination System
WC. E.D R
""` 6 "" "" °' PERMIT NAME/OWNERSHIP CHANGE FORM
FOR AGENCY USE ONLY
Date Received
Year I Month
I Da
I. Please enter the permit number for which the change is requested.
NPDES Permit (or) Certificate of Coverage
0 !J I 1 1 6 1 0 1 1 1 70
II. Permit status prior to requested change.
a. Permit issued to (company name): Rea Contracting LLC
b. Person legally responsible for permit: nanny o End -
First MI Last
Asst. District Manager
Title
8205 Wilkinson Blvd
Permit
holder Mailing Address
Charlotte
Me
28214
City
State
Zip
( 704 )395 3201
(704
)394 5354
Phone
Fax
c. Facility name (discharge):
Rea Contracting LLC- Kannapolis 076
d. Facility address:
2250 China Grove Road
Address
Kannapolis
NC
26053
City
Stale
Zip
e. Facility contact person:
Nathan L. Harrison
( 704
) 933 6929
First / MI / Last
Phone
Ill. 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
If other please e.rplain
b. Permit issued to (company name):
The LANE Construction Corporation
c. Person legally responsible for permit:
Danny J 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.COM
Phone E-mail Address
d. Facility name (discharge):
LANE (Kannapolis)
e. Facility address:
2250 China Grove Road
Address
Kannapolis NC 282053
City State Zip
f. Facility contact person:
Nathan L.
First MI Last
( 704 ) 933 6929 Kannapolis.plant0760reacontract.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: MAPLOS W. NAcKI£-2
First I MI Last
�NVieDnrvtisi,16L (rnz01Af Aral
Title
SZ.Cr� Wtt141stcZn1 FlVd
Mailing Address
cNAtLorE NC, z92/4
City State Zip
(7oq) 395-32b4 ,tl0.ews.H1'X_Z(�D_P��+caJ&AW,4ni
Phone E-mail Address
V. Will the permitted facility continue to conduct the same industrial activities conducted prior
to this ownership or name change?
xI Yes
❑ No (please explain)
VI. Required Items: THIS APPLICATION WILL, BE RETURNED UNPROCESSED IF ITEMS
ARE INCOMPLETE OR MISSING:
x❑ 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. I 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. I 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.
Signatur 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

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
GENERAL PERMIT NO NCG160000
CERTIFICATE OF COVERAGE No. NCG160170
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 (Kannapolis)
2250 China Grove Road
China Grove
Rowan County
to receiving waters designated as Cold Creek in the Catawba River Basin in accordance with the effluent
limitations, monitoring requirements, and other conditions set forth in Parts I, II, III, IV, V and VI of
General Permit No. NCG160000 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.
4-j
Coleen H.-,Sullins'
Director
Division d Water Quality
By Authority of the Enviromnental Management Commission

AMA
i NR
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 NCG16170
Rea Contracting (Kannapolis)
Formerly Rea Contracting, LLC
Rowan 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, GA-
Coleen H. Sullins
cc: DWQ Central Files
Mooresville Regional Office
Stormwater Permitting Unit
i
Wetlands and Stonnwater Branch
1617 Mail Service Center, Raleigh, North Carolina 27699-1617
Location: 512 N. Salisbury St. Raleigh, North Carolina 27604
Phone: 919-807�63001 FAX: [phone] Customer Service: 1-871fi23-6748
Internet: www.nmaterquality.org
An Equal Opportunity l Affirmative Action Employer
Nne
oi[hCarolina

�® q
NCDEN
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Colleen 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 mg/L 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�bncdenr.gov.
Sincerely,
I
Marcia Allocco, MS
Environmental Chemist 0 /7 _
Surface Water Protection
cc: Stormwater permitting `
L
Central files MAR 2 1 2011 j
Mooresville Regional Office '^_�ft
Location: 610 East Center Ave., Suite 301 Mooresville, NC 28115 One -
Phone: [phone] Fax: [phone] Customer Service: 1-877-623-6748 North Carolina
Internet: h0pI/portal,ncdenr.orglweolwq
An Equal Opp«tuniy l Affirmative Action Employer -30%Recycledll0% Posl Consumer paper

\oa�F W a rF9oG Michael F. Easley
Governor
r William G. Ross Jr., Secretary
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., 076 Kannapolis Plant
COC NCG160170
Rowan 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 .l 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 919/733-
5083 ext. 542.
cc: Mooresville Regional Office
Central Files
Stormwater and General Permits Unit Files
OR lX
IGINt SIGNED BY
WILLIAM C. MILLS
Alan W. Klimek, P.E.
a«n
NGDEAft
Customer Service
1 800 623-7748
Division of Water Quality 1617 Mail Service Center Raleigh, NC 27699-1617 [phone]

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
GENERAL PERMIT NO. NCG160000
CERTIFICATE OF COVERAGE No. NCG160170
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, LLC.
is hereby authorized to discharge stormwater from a facility located at
076 Kannapolis Plant
2250 China Grove Road
northeast of Kannapolis
Rowan County
to receiving waters designated as Cold Water Creek in the Catawba River Basin in accordance with the effluent
limitations, monitoring requirements, and other conditions set forth in Parts 1, 11, 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 G. MILLS
for Alan W. Klimek, P.E.. Director
Division of Water Quality
By Authority of the Environmental Management Commission

7° W I
�y ivai, mapiecn, inc.

7° W

Markers
Name: Discharge Site-NCG160170
Short Name: Dschrg
Coordinates: 0350 31'01.9" N, 0800 34'30.6" W
Comment: Rea Contracting, LLC., Subbasin 030712, Yadkin River Basin, Rowan County,
Cold Water Creek, Class WS-IV CA, Quad E16SE

for North Carolina DEMLR Gener I P
CERTIFICATE OF COVERAGE NO. NCG16.e L % Q
FACILITY NAME BL 7//E /w.t/APoc.s
COUNTY An/
PERSON COLLECTING SAMPLES
LABORATORY r'J a?jj Lab Cert. p _
Comments on sample collection or analysis:
a e 1 No. NCG160000 - Asphalt
Date submitted p-
RECFsAMPIE!COLLECTIONYEAR
MAY 011�L5 PERIOD ©Jan -June [I July -Dec
or ❑ Monthly'_ /month)
;tN i rtNQISIP `kRGING TO CLASS ❑ORW ❑Hgyy
DWR SECTION ❑Trout ❑PNA
❑Otherther
❑low ❑Water Supply ❑SA
Part A: Stormwater Benchmarks and Monitoring Results
Outfall No.
Date Sample 24-hour rainfall
Collected' amount,
(mo/dd/yr) Inches'
Total Suspended Solids
100 mg/l or 50 mg/T
PLEASE REMEMBER TO SIGN ON THE REVERSE ->
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 d_ onot ort 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 "< where XX is the numerical value of the
detection limit, reporting limit, quantitation limit, etc. in mg/L. XX me/L
Note: If you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses.
Permit Date: 10/1/2014-9/31/2019
See General permit text.
5WU-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.
Benchmarks =_=>
Date Sample
Collected'
(mo/dd/yr)
_
24-hour rainfall
amount,
Inches'
-
Non -polar O&G by EPA
1664 (SGT-HEM)
15 mg/L
Total Suspended Solids
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 2, 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:
Mad an original and one copy of this DMR including all "No Discharge" reports within 30 days of receipt of the lob 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."
(Signature of
Permit Date:10/1/2014-9/31/2019
(Date) l
SWU-252, last revised 9/17/2014
Page 2 of 2

STORMWATER DISCHARGE OUTFALL (SDO)
GENERAL PERMIT NO. NCG160000
DISCHARGE MONITORING REPORT (DMR)
CERTIFICATE OF COVERAGE NO. NCG16000❑0
RECEIVED
APR 0 3 N14
CEpES
WQIBOG
SAMPLES COLLECTED DURING CALENDAR YEAR: 2 014
(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 LAtt1= CePA+kt-t-,s\ COUNTY &4"
PERSON COLLECTING SAMPLES Nr?ra HvraQl�^ PHONE NO. (7&f 3)5 3264
CERTIFIED LABORATORY rar-Du Lab # `tbz—
Lab #
Monitoring Requirements
Outfall
No.
Date
Sample Collected.
nio/ddtyr
Total Rainfall.
inches
00530
00400
00556
Total Suspended Solids. mg4 ..
-
pH, ..
Standard units
Total Petroleum Hydrocarbons, mg/1
EPA Method 1664 (SG -HE
Benchmark
too
Within 6.0 _ 9.0
15 -
oot
7-11-Ih
,/0
50 1 L
0,74
Fiee.L
r 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:
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 theinformation submitted. Based on my inquiry of the person or persons who manage the system, or
those persons directly responsible for gath ring the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete.
I am aware that there are sijinificant pen tties�r submitting false information, including the possibility of fines and imprisonment for knowing violations."
(Signature
(Date)
SWU-253-051409
Page 1 of 1

0 Invoice for Laboratory Services
c D n /� Full -Service Analytical & Invoice Number: 1400993
I
4P o S �/I Environmental Solutions
Duaoaaloaies iuc ®r%.A F T Invoice Date: 03/13/14
Lane Construction Corporation, The
Project Name Kannapolis Plant
Ater: Accounts Payable/Ms. Lisa Payne
Project No.:
8205 Wilkinson Blvd,
Project Manager: Marcus Heckler
Charlotte,NC 28214
PO Number:
Customer Number: 7511
Sales Code: 00
The following charges are due for the indicated samples (s) received by the laboratory on 03/12/2014
Work Order Number: 4030217 Prism Sample ID No. collected from 3/12/2014 105600AM to 3/12/2014 10:56:00AM
4030217-01
Matrix Analysis/Description
Method Priority
Unit Price Oty
Total
Water O & G - TPH (SGT-HEM)
1664A 10 day
S40.00 1
$40.00
Water TSS
SM 2540 D 10 day
$20.00 1
$20.00
Additional Items
Environmental Fee for Sample Disposal
$8.00 1
$8.00
Comments: Minimum Analysis Fee applies
Invoice Total:
$68.00
-- Qji7,0 W/TN (�,QfpafL�O
We Appreciate Your Business
Payment Terms: Net 10 Days
Remit Payment to: Prism Laboratories, Inc.
PO Box 240543
Charlotte, N.C. 28224-0543
[phone]
WE ACCEPT MASTERCARD AND VISA
ACCT.#
EXP DATE:
NAME ON CARD:
SIGNATURE:
Page 1 of 1

t] Full -Service Analytical &
aP I S M Environmental Solutions
-A 71nAiOnIES ING
Lane Construction Corporation, The
Marcus Hackler
8205 Wilkinson Blvd.
Charlotte, NC 28214
NC Certification No. 402
SC Certification No. 99012
NC Drinking Water Cen 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: Kannapolis Plant
Lab Submittal Date: 03112/2014
Prism Work Order: 4030217
Case Narrative
03/24/2014
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:
The pH was reported by the client.
Please call if you have any questions relating to this analytical report.
Respectfully,
PRISM LABORATORIES, INC.
nt10
Terri W. Cole
Project Manager
Data Qualifiers Key Reference
Reviewed By Terri W. Cole
Project Manager
OG HEM O&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 240643 - Charlotte, NC 28224-0543
Phone: [phone] - Toll Free Number: 1-8001629-6364- Fax: [phone] Page 1 of5

17IN Sample Receipt Summary
®P'R ISM I rue.9e Mee al Solutions
4
�] en�„oeme�,ei sm�uens 03/24/2014
vL"cuATcns& .,
Prism Work Order: 4030217
Client Sample ID Lab Sample ID Matrix Date Sampled Date Received
Outfall #1
4030217-01 Water 03/12/14 03/12/14
Samples were received in good condition at 5.0 degrees C unless otherwise noted.
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 28224-0543
Phone: [phone] - Toll Free Number: 1-8001529.6364 - Fax: [phone] Page 2 of 5

I�R®P I�.;\ISM full-S avlcounnen al Solutions
Environmenml Solutions
vu,aa„ous>.»
Lane Construction Corporation, The
Attn: Marcus Hackler
8205 Wilkinson Blvd.
Charlotte, NC 28214
Field Data
Laboratory ID
4030217-01
Project: Kannapolis Plant
Client ID
Outfall #1
Laboratory Report
03/24/2014
Prism Work Order: 4030217
Field Parameter Result
pH
This report should not be reproduced, except in its entirety, without the written consent of Pdsm Laboratories, Inc.
8.74
449 Springbrook Road - P.O. Box 240643 - Charlotte, NC 28224-0643
Phone: [phone] - Tall Free Number: 1-8001629-6364 - Fax: [phone] Page 3 0f 5

"I"\
u ♦ Full -Service Analytical &
dP R I S M Mironmental Solution¢
Lane Construction Corporation, The
Attn: Marcus Hackler
8205 Wilkinson Blvd.
Charlotte, NC 28214
Project: Kannapolis Plant
Sample Matrix: Water
Laboratory Report
03/24/2014
Client Sample ID: Outfall #1
Prism Sample ID: 4030217-01
Prism Work Order: 4030217
Time Collected: 03/12/14 10:56
Time Submitted: 03/12/14 12:00
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 3/17/14 11:35 JAB P4C0316
Total Suspended Solids 56 mg/L 12 0.90 1 'SM 2640 D 3/17/14 16:00 JAB P4C0320
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 28224-0543
Phone: [phone]-Toll Free Number: 1-8001529-6364-Fax: [phone] Page 4 of 5

PdR I C M I Full -Service Analytical 8
CHAIN OF CUSTODY RECORD
"r J Environmental Solutions PAGE— OF_QUOTE PTO ENSURE PROPER BILLING:
�R7�-'TPALA90P.T00.1ES INC.
"t) Springbrook Road • Charlotte, NC 23217 Project Name:
Phone [phone] • Fax: [phone] Short Hold Analysis: (Yes) (No) UST Project: (Yes) (NO)
I r� a H `Please ATTACH any project specific reporting (QC LEVEL 1 II III IV)
M Client Company Name: t- provisions and/or QC Requirements
Report To/Contact Name: MOO r GrA4 Invoice To:
Reporting Address: ec� 0 i TV I_�C-1,►3at,
Address:
DWA AI C_ A9111 I V
Phone: Fax (Yes) (No):
Purchase Order NodBllling Reference
TO BE FILLED IN BY CLIENT/SAMPLING PERSONNEL
Email Address: KAk e
Ard itequesled Due Date O 1 Day ❑ 2 Days ❑ 3 Days o a Days ❑ 5 Days
Certification: NELAC_ DoD_
FL_ NC_
EDD Type: PDF_Excel Other a
p_
Urro✓C `61,10orking Days" U6-9 Days O Standard 10 days ORueshWork
dust Belar
SC OTHER
N/A
She Location Name: ErA k 11 a.1Q01 ; 5
Samples received after 14:00 will be processed next business day.
$•3 Turnaround time is based on business days, excluding weekends and holidays.
Water Chlorinated: YES_ NO_
Site Location Physical Address: A% C - .'i.ICI
_ (SEE REVERSE FOR TERMS S CONDITIONS REGARDING SERVICES
Sample Iced Upon Collection: YES
NO
RENDERED BY PRISM LABORATORIES, INC. TO CLIENT)
TIME
MATRIX
I
SAMPLE CONTAINER
ANALYSIS
REQUESTED
PRISM
CLIENT
DATE
COLLECTED
(SOIL,
PRESERVA.
/
REMARKS
LAB
`TYPE
NO.
SIZE
SAMPLE DESCRIPTION
COLLECTED
MILITARY
WATER OR
TNES
tJ
ID NO.
HOURS
SLUDGE)
SEE BELOW
re
j
I
I
I
i
Sampler's Signatult_
Sampled By (Print Name) QU 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 knpjecManager. There will be charges for any changes after analyses have been Initialized.
mquis y gne re
Re,eived By.(Signatura) ate
'^ary tars Addifional Commeents,,
Site Arrival Tlme ,
R ma By (Slgnaium)
ing
ReceNetl By. Sgneture) Dale
.�.
(�w ��1�
Site Departure Time:
Field Tach Fee
Relinquished BY (Signature)
Rec�N 'am Labors B Dat
—ll.-` LI
(%tJ'
..�=
(�.O'd.7 1 1X!
Mlle2go
Method of SNpmenL NOTE: ALL SAMPLE COOLERS SHOULD BE TAPED S H CUSTODY SEALS FOR TRA PORTATION TO THE ORATORY COC Group No.
SAMPLES ARE NOT ACCEPTED AND VERIFIED AS CCUNTIL RECEIVED AT THE LABORATORY.
_
N O S l,l'I
^I
T
❑ Fed Ex O UPS ❑ HaM-deFered O Prim Field Service O Other
NPDES: UST: GROUNDWATER: DRINKING WATER: SOLID WASTE: RCRA: CERCLA LANDFILL
UST.
OTHER:
❑ NC ElSC El ❑ SC ❑ NC ❑ SC ❑
NC.,❑ SC ❑ NC ❑ SC ❑ NC ❑ SC ❑ NC ❑ SC ❑ NC ❑ SC
❑ NC ❑ SC
n n ❑ ❑
..... ❑ ❑ ❑ ❑
❑
! `CONTAINER TYPE CODES: A =Amber C = Clear G= Glass P = Plastic; TL = Teflon -Lined Cap VOA = Volatile Organics Analysis (Zero Head Space)
., , ORIGINAL

Tom.
Storalwater Discharge Clutfall (SDO)
Qualitative Monitori-tg Report
For guidance on filling out this farm, please visit: bnol/h2o enr si ltc ne us/su/Forms Imcuments.htmgmiseforms
Permit No.: N!C/%/ I /byk-ok! Ol or Certificate of Coverage No.: N1GGI 6- OIll11Ql
Facility Name_ eT nrA po).
ew . Phone No. 7O�
County:
tr3O n
Date of Inspection: 3-1 a — j y
Time of Inspection: L ' Sy 2`%
Total Event Precipitation (inches): 6-1 '-
Was this a Representative Storm Event? (See information below) EMS ❑ No
Please check your permit to verify if Qualitative Monitoring :::ust be performed daring a representative
storm event (requirements vary).
A •'Representative Storm Event" is a storm event that meastuvs greater than 0.1 inches of rainfall and that
is preceded by at least 72 hours (3 days) in which no storm event measuring greater than 0.1 inches has
occurred. A single storm event may contain up to 10 conse= Live hours of no precipitation.
By this signature, I certify that this
(Signature of Petmittee or Designee)
and comolete to the best of my knowledge:
1. Outfall Description: ��
Outfall No.
i Structure!' ditch, etc.) _
Receiving Stream: _ to C k S
Describe the indµsttial activities thacaccytr within the ouji / Lnage area:
Color: Describe the color of the dischar using basic colors (ted, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: -+ .P II U w
3. Odor. Describe any distinct od rs th�a�dischargo may have (i.e., smells strongly of oil, weak
chlorine odor, etc.): -
Page l of 2
aWU-242-1 t2608

4. Clarity: Choose the number which best describes the clarity of the discharge, where I is clear and 5 is very cloudy:
1 2 4 5
5. gloating Solids: Choose the number which best describes the amount of floating solids in the
stormwater discharge, where 1 is no solids and 5 is the surface covered with floating solids:
1 .1< 3 1 5
6. Suspended Solids: Choose the number which best describes the amount of suspended solids in
the stormwater discharge, where 1 is no solids and 5 is extremely muddy:
1 3 4 5
7. Is there any foam in the stormwater discharge? Yes No
& Is there an oil sheen in the stormwater, discharge? Yes Nn
9. is there evidence of erosion or deposition ut the outfall? yes No
10. Other Obvious Indicatursof Storrawnter Pollution:
Ust and describe AIGA 2
• • Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition maybe
• indicative of pollutant exposure. 7bcse conditions warrant further investigation.
Page 2 of 2
SWLL242.1126M
�I

Monthly Weather forecast for China Grove, NC (28023) - weather.com
Page I oft
Add D Location C LSanrcn Zip Qq' a Rby (D.11.1 W'ud! Q 'F -C
FORECASTS MAPS VIDEO PHOTOS NEWS TV taIDpM Ouw oPat.. aD.YmO'YPv
Hama W"b Ma NWa IIa Clrin4Grove,IEC28023
R55 ..'. &'a 0•blmnY Rim
�aIlO1 tieir NburlF ramma. YW.Lerb Sary to Obv uonyM ]Bw
MaNply CynnV IDr
CIMM Grove. EK (28023)
( Erbr. I RLN4I
M.. Na.ltwrm .
II sM MM rub vY.a mu rn I:u
I
i !
� DaSERYEn
.:F
LOA[
' P•ep Ml
-]
e o e rr
LbBFTinrppSEgVEp CtlYgVEO�pa.SEgVEO CB,.W, L6•[gvEp'1Y1,CRVFpI
''F NBt'F NNF N5a'F
NH'[
N1P[
NBi r
la.b'[ Lo.',I'F La MY ls:"
Lay'r
lu M[
In IB'[
�� RwCerV RraCMI P'rroClbl Pronfnl
RroCfnl
Prof M!
I RroClnl
h' _O)SN. On � On
oyn
ONn
pn
0 Ip 11 I 12
U
IJ
y {
I�faSCgvCp CgBENVLtI OWEgVED G'B.^LPHU'DBSF4VF.p
CBB0nD:CDEERVFp
N)I'f Nitl'F MJf'r
NJ.11
NBI'F
! NiP[
In J]`[ 10 11Y tn!!`F 1p Ft'[
Ie TY
I.TJ'!
aL5.1'
1
( Rwo 0.1 hroPfxl' R•op Ml Prpp(nl'
�
PnWlnl
RnaF lnl'
P—'m
pn pn eEux al
II
f0 C. O fB tp
10
OBpFPy[p pa5[PVED OBBCPVCp OBEEPVEO
OB9FPVFp
rpSERYFt1IOPfI
0Lpi
"p
( M51'[ MYI'! M•YF I M[T!
ryy•
air
NTTF
.WF Ie by 1In 1pY Ito<'[
le H'[
to As
MJV[
N [umolnl . Pr
I napFnl ' Ryvlml
I
Rwn(nl
rrpaixl
1
{ rra; (N
a-Onl
O O.n 0]pn poJx pv
as
px
I
yr
33 b }5 ]a
P
]e
]p r
CBSFgHD'pepERVEp C85ERLED OaSERVEp
r165FRVF0
OesF VI.
CBeEp.Ep'�
N ]S'[
I Ia HK Ln ]CF t. l:'[ In IB'G
L.]I'F
to JiF
I I.o 1rF
PwPI'N' R.a!Inl P•ep1x1 � rnpfn!
.rY
P.w4nl
Pwplxl
Crculnl �
oun pq { aIw aYr
,
y.,
o..
axn
OBSE/RVFDICBYa\ip
�maY MMF
1' !rnl VrMPllnl
1
On nn
. FDPFfASr UpLrw Fp 111N.n Er
,
CCMrM1 VNco
i..rt
II
Month -to -Date totals
T.nyMnaVa
r.npl.lnb
� er'F R.aaa Non
Today's Top Picks
Y{ ml.--. b oo LVn. po..M
• roam War.aaro.bMW.
Ip YVaMTr.Na Clbn _
• �PRv.a iM RI yyIM Gov.
aN C.M cM lion a Novi rrrr.a.nn�
- CI!.[J IN W.uN.r PnYw Rvae I
rbn b Cbvl Y. C.,
parA Yar'.I. T.r Ma
&Roma FbrrpY F. W., p.a W DrI.M
http://www.weather.conVweather/monthly/28023'?month=-1 4/1 /2014

STORMWATER DISCHARGE OUTFALL (SDO)
GENERAL PERMIT NO. NCG160000
DISCHARGE MONITORING REPORT (DMR)
CERTIFICATE OF COVERAGE NO. NCG16000®
SAMPLES COLLECTED DURING CALENDAR YEAR: 24r ZZ 14
(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 LAKE (eAowkP c. COUNTY KCW hhi
PERSON COLLECTING SAMPLES khifl vssc, PHONENO. 7( 041 935-(0'129
CERTIFIED LABORATORY Lab #
Lab #
Monitoring Requirements
Outfall
No.
Date
Sample Collected,
mo/dd/ r
Total Rainfall.
inches
00530
00400
00556
Total Suspended Solids. mg/l
pH,
Standard units
Total Petroleum Hvdrocarbons, mgfl
EPA Method 1664 SG -HE
Benchmark
too
Within 6.0 = 9.0
15
ool
3 i9
1
zav
$,s
i3FL
If a value is in excess of the benchmark, or outside the benchmark range (for pH), you must implement the Tier 1 or Tier*2responses in the'General Permit.
Mail original and one copy to:
tu(v v
Division of Water Quality
Attn: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
YOU MUST SIGN THIS
FOR ANY INFORMATION REPORTED:
MAR 14 2014
CENTML FILES
DW0180G
"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 signilca t penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
C
3- ro-2ty-f
(Signat4e of Perms ee)/ (Date)
SWU-253-051409
Page 1 of 1

/&"RISM
=Dueaaloreea Iac
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 Can 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: Kannapolis Plant
Lab Submittal Date: 02/03/2014
Prism Work Order: 4020011
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
o�lUu-lk�
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 MOIL 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 240643 - Charlotte, NC 28224-0643
Phone: [phone]-Toll Free Number: l-80g/S29-6364-Fax: [phone] Page 1 of5

\ Sample Receipt Summary
P R I S M I Fanlronmen al Solution 6
�. e.,,o-enm..tAi sownon• 02/18/2014
I.�AMAIOP�lA MC
Prism Work Order: 4020011
Client Sample ID Lab Sample ID Matrix Date Sampled Date Received
Outfall #1 4020011-01 Water 02/03/14 02/03/14
Samples were received in good condition at 3.7 degrees C unless otherwise noted.
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: 1-8001529-6364 - Fax: [phone] Page 2 of 5

PRISM
Full -Service Analytical a
Environmental Solutions
Lane Construction Corporation, The
Attn: Marcus Heckler
8205 Wilkinson Blvd.
Chadotte, NC 28214
Field Data
Laboratory ID
4020011-01
Project: Kannapolis Plant
Client ID
Outfall #1
Laboratory Report
02/18/2014
Prism Work Order: 4020011
Field Parameter Result
pH
This report should not be reproduced, except in its entirety, without the written consent of Prism Laboratories, Inc.
8.84
449 SprinBbrook Road - P.O. Box 240643 -Charlotte, NC 28224-0643
Phone: [phone]-Toll Free Number: 1-8001629-6364- Fax: [phone] Page 3 of 5

\\
r Full -Service Analytical a
&PRISM I Environments] Solutions
'7 mnen ec
Lane Construction Corporation, The
Attn: Marcus Hackler
8205 Wilkinson Blvd.
Charlotte, NC 28214
Project: Kannapolis Plant
Sample Matrix: Water
Laboratory Report
02/18/2014
Client Sample ID: Outfall #1
Prism Sample ID: 4020011-01
Prism Work Order: 4020011
Time Collected: 02/03/14 08:30
Time Submitted: 02/03/14 10:25
Parameter
Result
Units
Report
MDL Dilution Method Analysis Analyst
Batch
Limit
Factor DateTme
ID
General Chemistry Parameters
Oil & Grease (SGT-HEM)
BRLOG
mg/L
5.0
1.2 1 '1664A 2/10/14 9:30 JAB
P4130147
Total Suspended Solids
200
mg/L
25
0.90 1 'SM 2640 D 214114 13:30 JAB
P4130040
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: t-800/629.6364-Fax: [phone] Page 4 of 5

CHAIN OF CUSTODY RECORD
-ISM PACE — OF _ QUOTE 4 TO ENSURE PROPER OR -LING:
LABORATORIES INC,`; F.
Project Name:
Full Service Annlyt¢al & Environmental Solutions Short Hgid Analysis: (Yes) (No) UST Project: (Yes) (NO)
449 Springbrook Road • P.O. Box 240M • Charlotte, NC 28224-0543 'Please ATTACH any project specific reporting
Phone: [phone] • Fax: 7D4/525-0409 provisions and/or QC Requirements
Client Company Name: nno Invoice To:
Report To/Contact pName: 'fr Address:
ReP orthn9 Add re s045, wlikers-6-%
Purchase Order NodBilling Reference
TO BE FILLED IN BY CLIENT/SAMPLING PERSONNEL
Phone: F r (Yes) (NO):
Requested Due Date ZI 1 Day 0 2 Days ❑ 3 Days U 4 Days 0 5 Days
Certification: NELAC USACE_
FL _ NC_
Site Location Name: P%n tl
Site Location Physical Address: O
❑ s-s Days o Standard 10 days
t L Samples received after 15:00 will he processed next business day.
Tumamumd time is based on business days, excluding weekends and holidays.
(SEE REVERSE FOR TERMS S CONDITIONS REGARDING SERVICES
RENDERED aY PRISM LABORATORIES, INC. TO CLIENT)
SC OTHER
Water Chlorinated: YES_ NO
Sample lead m On COIIBctloYES
P P
WA
NO
CLIENT
SAMPLE DESCRIPTION
DATE
COLLECTED
- TIME
COLLECTED
MILITARY
HOURS
MATRIX
(SOIL,
WATER OR
SLUDGE)
SAMPLE CONTAINER
PRESERVA•
TIVES
ANALYSES REOUESTED
//__
V 5 REMARKS
( -
SUB
LAB
CERT.
ID NO.
PRISM
LAB
ID NO.
'TYPE
SEE BELOW
NO.
SIZE
Samplers 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 wie be charges for any changes after analyses have been Initialized.
etinqulsh ay iggwt i
ReerpukAed BY: (S44
ignazure)
Received By:(SlIl Date
Received BY (SlpreWre) par¢
Mgaery Dorm �ditional OmR18�s
otltl
Sile`Arrival Tlme.-'"-
S:le Departure Tlme
/f
. �Isltl Tech Fee., -.
Relipuiehed By. (Signazure)
Ned Fyr- Lebo _ Dale
-
Method of hipment NOTE -ALL SAMP CpOtdaiS SWUID BE ED SHUT WITH STODY SEALS TBANSPORTATON TO THE LABORATORY. Twin mip No.
SAMPLES ARE NOT ACCEPTED AND VERIRFDAGAINST COC LRECEIVEDA LABORATORY.
❑ Fed & ❑ UPS ❑ Hand-de0vered ❑ Prism Feld Ssr c ❑ Oder y aZ� i
-
NPDES: UST: GROUNDWATER:
DRINKING WATER: SOLID WASTE: RCRA: CERCLA LANDFILL
OTHER:
NC O SC NC ❑ SC NC ❑ SC
0❑ NC ❑ SC' NC ❑ SC NC O SC N( ❑ SC C NC ❑ SC
O NC 0 SC
O El O
O O O
ORIGINAL
"CONTAINER TYPE CODES: A = Amber 0 = Clear G = Glass P = Plastic; TL = Teflon -Lined Cap VOA = Volatile Organics Analysis (Zero Head Space) .

1�f
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidmice on filling old thirfamr. please visit. tmo:/fh2o.enrsia
/r;O= Document. a.htm#miscforms
Permit No.: N/CJii l 16 010/'0 Ol or certif( a of Coverage No.: N/CJG/ /I
Facility Name• _/�anneno75 $C N t Lan{ ['fin? fact nq
County: K Phone No.
Inspector, N _ IJ _ rrfSC�
Date of l specuon:
Time of Inspection: 9
Total Event Precipitation (inches): �—
Was this a Representative Storm Event? (See information below) 2rYes ❑ No
Dative Monitoring must be performed during a representative
Please check your permit to verify if Qualitative .
storm event (requirements Vary/
A Representative Swum Event" is a storm event that measw o:::ng
an 0.1 inches of rainfall and that
is preceded by at least T2 hours (3 days) in which no storm evgreater than 0.1 inches has
occurred- A single storm event may contain up to 10 consecuf no predpitation.
By this signature, I certify that duh sj lia=�raw and complete to the best of my knowledge:
(Signature of Permttec of Designee) .
1. Outfall Description: P p�
outfall No. I_ SuvcutreEj)duch, etc')
Receiving Sueam:
Describe the industrial activities 7mrOFE within the on. tfall drainage area
of the discharge upsin�g�basic colors (ted, btowmrblue, etc) and tint
2. Color: Describe the color
(light, medium, dark) as descriptors:---d—
3, prior. Describe any distinct odors that the dischar�c may have (i.e., smells strongly of oil. weak
chlorine odor, etc-): 06 h i
page I of 2
SWU-242-I INAE

4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is clear
and 5 is very cloudy:
1 2 3 4 5
S. Floating Solids: Choose the number which best describes the amount of floating solids in the
stormwater discharge, where I is no solids and 5 is the surface covered with floating solids:
1 2 3 4 5
6. Suspended Solids: Choose the number which best describes the amount of suspended solids in
the stormwater discharge, where 1 is no solids and 5 is extremely muddy:
1 2 3 4 5
7. Is there any foam in the stormwater discharge?
8. Is there an oil sheen in the stormwater discharge?
9. Is there evidence of erosion or deposition at the outfall?
10. Other Obvious Indicators of Stormwater Pollution:
List and describe
Yes No
Yes Nn
Yes No
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition maybe
indicative of pollutant exposure. 7tiese conditions warrant further investigation.
Page 2 of 2
`- 1
AA1f zFa"M1_--I

Semi-annual Stormwater Discharge Monitoring Report (DMR)
for North Carolina DEMLR General Per i No. NCG160000 - Asphalt
Date submitted /D /r ,2o/b ,
CERTIFICATE OF COVERAGE NO. NCG16 0 I % O
FACILITYNAME 4aS' Cr6f���syl,Qcf7is+t/
COUNTY /'arfe_zee1s
PERSON COLLECTING SAMPLES /.r -DA*Or
LABORATORY A000- Lab Cert. # X/0 2
Comments on sample collection or analysis:
Part A: Stormwater Benchmarks and Monitoring Results
SAMPLE COLLECTION YEAR ^D /f
SAMPLE PERIOD ❑ Jan -June © July -Dec
or ❑ Monthly' (month)
DISCHARGING TO CLASS ❑ORW ❑HQW [—]Trout ❑PNA
[]Zero -flow ❑Water Supply ❑SA
❑Other
PLEASE REMEMBER TO SIGN ON THE REVERSE -i
❑ No discharge this period?Z
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
OCT 14 2016
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.
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 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 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?'
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 oriainal 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, 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."
(Signature of Permi (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 Permit No. NCG160000 - Asphalt
Date submitted oG ao. �•6
CERTIFICATE OF COVERAGE NO. NCG16 0 L 7.0
FACILITY NAME 4AW_r 0oAA6rAtT/ew lCt A1A1A,0dj S �[hAlr
COUNTY PLO k; N
PERSON COLLECTING SAMPLES GQE4 r)A✓S
LABORATORY QA1$M Lab Cert. ff _ fox
Comments on sample collection or analysis:
Part A: Stormwater Benchmarks and Monitoring Results
SAMPLE COLLECTION YEAR 04016
SAMPLE PERIOD © Jan -June ❑ July -Dec
or ❑ Monthly' (month)
DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
❑Zero -flow Watersupply ❑SA
RECEIVE® ❑
Other
7 ^•c PLEASE REMEMBER TO SIGN ON THE REVERSE 4
❑ No discharge this period?Z
Outfall No.
Date Sample
Collected
(mo/dd/yr)
24-hour rainfall
amount,
Inches'
Total Suspended Solids
Benchmarks =__>
100 mg/L or SO mg/L
O � /6
G. S9
6-2
'Monthly 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 mR/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 > 5S gal of new oil per month.
❑ No discharge this period?Z
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/0
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 2, 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 oriainal and one copv of this DMR, includina all 'No Discharae" reports, within 30 dovs of receipt of the lab results for at end of monitorina Period
in the case of "No Discharae" 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 INFORMATIOWREPORTED:
"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 qua Iified-personael,properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or
those persons directli 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 significantY.penalties for submitting false iriformatidn, including the possibility of fines and imprisonment for knowing violations."
(Signatur Permittee) (Date)
Permit Date: 10/l/2014-9/31/2019 SWU-252, last revised 9/17/2014
Page 2 of 2

Semi-annual Stormwater Di xhar a Monitoring Report DMR
for North Carolina DEMLR General Permit No. NCG160000 - Asphalt
Date submitted •/�'/�
CERTIFICATE OF COVERAGE NO. NCG16'0 / %' O'
FACILITY NAME 1 ,,:,0oc,l ,q�p�� DCN✓T
COUNTY &AL14n/
PERSON COLLECTING SAMPLES
LABORATORY IQr,S'e/
Lab Cert. # 01
Comments on sample collection or analysis:
Part A: Stormwater Benchmarks and Monitoring Results
SAMPLE COLLECTION YEAR ,Zo/?
SAMPLE PERIOD Jan -June July -Dec
or Monthly'- (month)
DISCHARGING TO CLASS ❑ORW ❑HQW QTrout OPNA
❑Zero -flow QWater Supply QSA
Mother
PLEASE REMEMBER TO SIGN ON THE REVERSE -3
❑ 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 s0 mg/L
O
�o io i8
L 2.
RECEIVED
OCT 2 4 tots
CENTRAL, FILES
Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at`Sthe same outfall.
' 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 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 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 > SS gal of new oil per month.
n No discharge this period?'
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 SO 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 2REQUIREMENTS.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDANCES FOR THESAME PARAMETER AT ANY ONE OUTFALL? YES ❑ NO ❑
IF YES, HAVE YOU CONTACTED THE DEMLRREGIONAL 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 (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_e`valuate 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."
(Signature of Permittee)
Permit Date: 10/1/2014-9/31/2019
' (Date)
SWU-252, last revised 9/17/2014
Page 2 of 2

Semi-annual Stormwater Discharge Monitoring Report (DMR)
for North Carolina DEMLR General Permit No. NCG160000 - Asphalt
Date submitted
CERTIFICATE OF.COVERAGE NO. NCG16 O / % 0
FACILITY NAME L,i �Cgat/g
COUNTY
PERSON COLLECTING SAMPLES 4 Y>A✓kS
LABORATORY_ 296511r Lab Cert. If yo2
Comments on sample collection or analysis:
Part A: Stormwater Benchmarks and Monitoring Results
SAMPLE COLLECTION YEAR , /4F
SAMPLE PERIOD ® Jan -June ❑ July -Dec
or Monthly'_ /monthl
DISCHARGING TO CLASS []ORW []HQW QTrout []PNA
[]Zero -flow []WaterSuppiy []SA
Mother
PLEASE REMEMBER TO SIGN ON THE REVERSE -j
Dutfall No.
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
Inches3
Total Suspended Solids
Benchmarks ==_>
100 mg/L or 50 mg/L
G
No discharge this period?'
RECEIVED
MAY 14 2018
CENTRAL FILES
DWR SECTION
' Monthly sampling (instead ofsemi-annual) must b
' egin 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.
'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 -
detection limit, reporting limit, quantitation limit, etc. in mnumerical 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
g/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 > SS gal of new oil per month.
❑ No discharge this period?1
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 Ter 1, Tier 2, 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 orfainal and one copy of this DMR, includina all "No Discharge" reports, within 30 days of receipt of the lob results for at end of monitorina 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 forgathering 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'foi submitting false information, including the possibility of finy and imprisonment for knowing violations."
(Date)
Permit Date: 10/1/2014.9/31/2019
SWU-252, last revised 9/17/2014
Page 2 of 2

4fiVIAt;o
Semi-annual Stormwater Discharge Monitoring Report (DMR)
for North Carolina DEMLR General Per it No. NCG160000 -Asphalt
Date submitted /$ 2r
CERTIFICATE OF COVERAGE NO. NCG16 O / 7.0
FACILITY NAME IAAIC �e�S�G/�on/ �YN/Li�pKiJ
COUNTY Rowe/
PERSON COLLECTING SAMPLES
LABORATORY PR/h71K Lab Cert. q _02
Comments on sample collection or analysis:
Part A: Stormwater Benchmarks and Monitoring Results
SAMPLE COLLECTION YEAR 20' /-7
SAMPLE PERIOD ❑ Jan -June July -Dec
or ❑ Monthly' (month)
DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
❑zero -flow ❑Water Supply ❑SA
PLEASE REMEMBERTOSfGN007 REVERSE
NOV 15 2017
❑ No discharge t EFsN Wak321LES
IR S9 TION
Outfall No.
Date Sample
Collected)
(mo/dd/yr)
24-hour rainfall
amount,
Inches'
Total Suspended Solids
Benchmarks =__>
_
-
100 mg/L or 50 mg/L
' 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 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 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 > SS gal of new oil per month.
❑ No discharge this period?z
Outfall No.
Date Sample
Collected
(mo/dd/yr)
24-hour rainfall
amount,
Inches'
Non -polar 0&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 2, or Tier 3 responses. See General Permit text.
FOR PART 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 OFFICERS REQUIRED BY THE PERMIT? YES [:]NO ❑
REGIONAL OFFICE CONTACT NAME: -
Mail an oriainal and one copy of this DMR, includina all "No Discharge" reports, within 30 days of receipt of the lab results for at end of monitoring period
in the case of "No Discharae" 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 thereare significant.penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
(Signaturelf- P ermittee) ID e)
Permit Date: 10/1/2014-9/31/2019
SWU-252, last revised 9/17/2014
Page 2 of 2

•�.... nc vl � lJ1Vlt1
for North Carolina DEMLR General Per i No. NCG160000 -Asphalt
Date submitted ,p i7
CERTIFICATE OF COVERAGE NO. NCG16a L Z p
FACILITY NAME LANE d DNA u.I?
COUNTY vvAV r
PERSON COLLECTING SAMPLES /.' 774✓.S
LABORATORY J%Q/.$>( Lab Cert. B— --fopZ--_ Comments on sample collection or analysis: —
Part A: Stormwater Benchmarks and Monitoring Results
Outfall No.
Date Sample I 24-hour rainfall
Collected'
SAMPLE COLLECTION YEAR oZP/%
SAMPLE PERIOD Jan -June July -Dec ❑
�D SC�HgRGG TO❑CLASS Monthly' El
❑HQyy lmonthJ
IN ❑Trout ❑PNA
APR 0 A G
❑Zero -flow ❑Water Supply ❑SA
04?S%- TON ❑Other
L„fQR ,ai1QNFRQCESSIN6!lPfT
LEASE REMEMBER TO SIGN ON THE REVERSE i
Total Suspended Solids
100 mg/L or So
No discharge this period?z
' Monthly sampling (instead at 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.
'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 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 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 2, 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 ❑ 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 forgathering 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
Permit Date: 10/l/2014-9/31/2019
3 i
(Date)
SWU-252, last revised 9/17/2014
Page 2 of 2