NCS000354_MONITORING INFO_20190516

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STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
boo �U/
DOC TYPE
❑ HISTORICAL FILE
MONITORING REPORTS
DOC DATE
❑ J dl O " I
YYYYMMDD

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Envirmmenral MAY 16 2011
Stormwater Discharge Outfall (SDO)ORMWATER PEWITTING
DENR-LAND QUALITY
Qualitative Monitoring Report
Forguidance on filling out this form, please
Permit No.:
Facility
County: J
Inspector:
Date of Ins
Time of In:
or Certificate of Coverage No.: N/-/G/_/
Total Event Precipitation (inches):
Phone No. 3.36 0l6 1 x 3,7
All permits require qualitative monitoring to be'performed during a "meassurable storm event"
A "measurable storm event" is a storm event that results in an actual discharge from the
permitted site outfall. The previous'measurable storm event must have'been at least 72 hours
prior. The 72-hour storm interval does not apply if the permittee is able to document that a shorter
interval is representative for local storm events during the sampling period, and the permittee
obtains approval from the local DEMLR RegiiinalIOffice.
By this signature, 1 certify that this report is accurate and complete to the best of my knowledge:
ilm Seaf-,Wl� ail
(Signat of Permittee or Designee)
1. Outfall Description:
Outfall No. _I 5
Receiving Stream:
ditch, etc.):
Describe the industrial activities that occur within the outfall drainage area: I 0.x-
SWU-242, Last modified 04/09/2018
Pagel of 2

2. Color: Describe the color of the
(light, medium, dark) as descriptors:
basic colors (red, brown, blue, etc.) and tint
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.): None
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
1 0 3 4 5
5. Floating Solids: Choose the number which best describes the amount of floating solids in
the stormwater discharge, where 1 is no solids and 5 is the surface covered with floating solids:
0 2 3 4 5
6. Suspended Solids: Choose the number which best describes the amount of suspended
solids in the stormwater discharge, where 1 is no solids and 5 is extremely muddy:
V 2 3 4 5
7. Is there any foam in the stormwater dischargO Yes K.
8. Is there an oil sheen in the stormwater discharp? o Yes No
9. Is there evidence of erosion or deposition at the outfaC? )(Yes 19
No.
10. Other Obvious Indicators of Stormwater Pollution:
List and describe Nione
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition
may be indicative of pollutant exposure. These conditions warrant further investigation.
Page 2 of 2
SWU-242, Last modified 04/09/2018

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number NCS N� , ��y SAMPLES COLLECTED DURING CALENDAR YEAR: ► 9
(This monitoring report shall be received by the Division no later than 30 days from
the date the facility receives the sampling results from the laboratory.)
FACILITY NAME COUNTY ?o_ndo�pt11
PERSON COLLECTING SAMPLE(S) PHONE NO. (Zj/,)/tea -0161 X i
CERTIFIED LABORATORY(S) Lab #1(>�
Lab #
SIGNATURE OF PERMITTEE OR DESIGNEE
REQUIRED ON PAGE 2.
Part A: Specific Monitoring Requirements
'Outfall
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Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? — yes no
(if yes, complete Part B) —
Part B: Vehicle Maintenance Activitv Mnnitnrinn Requirement�
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Form S WU-247, last revised 611212015
Page 1 of 2

STORM EVENT CHARACTERISTICS:
Date a.3z2J05 /I
Total Event Precipitation (inches): Q, 6
Event Duration (hours): (only if applicable — see permit.)
(if more than one storm event was sampled)
Date
Total Event Precipitation (inches):
Event Duration (hours): (only if applicable — see permit.)
Mail Original and one copy to:
Division of Energy Mineral and Land Resources
Attn: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
"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/-pf fines and imprisonment for knowing violations."
of Permittee)
15 I
(Date)
Form S W U-247, last revised 611212015
Page 2 of 2

Meritech, Inc.
Environmental Laboratory
Laboratory Certification No.165
Contact: Natasha Wicker
Client: Star Pet INC
801 Pineview Rd
Asheboro, NC 27204
Report Date:
Date Sample Rcvd:
4/4/2019
3/22/2019
Meritech Work Order # 03221951 Sample: Stormwater # 450982 Grab
3/22/19
Parameters Results Analysis Date
Reporting Lim
Method Qualifter
BOD„5 day 13.6 mg/L 3/22/19
2.0 mg/L
SM 5210 B G8
COD 34 mg/L 3/26/19
15 mg/L
EPA 410.4
Total Suspended Solids 12 mg/L 3/26/19
2.5 mg/L
SM 2540 D
pH 6.53 S.U. 3/22/19
1.0 - 14.0 S.U.
SM 4500-HB
G8 Oxygen usage is less than 2 mg/L for all dilutions set The reported value is an estimated less than value
and is calculated for the dilution using the most amount of sample.
I hereby certW that I have reviewed and approve these data. Amo nda - Ali i UC or-L
Laboratory Representative
642 Tamco Road, Reidsville, North Carolina 27320
tel.[phone] fax.[phone]

aro,a Chain of Custody Record (COC)
NPDES#:
Client: M �I�V Phone:
Address: Fax:
Email:
MERITECH INC,
ENVIRONMENTAL LABORATORIES
642 Tamco Rd. Phone: [phone]
a
Reidsville NC 27320 Fax: [phone]
Project:
P.O.#:
Email: [e-mail]
Attention: 'rum Around Time -
www.meritechlabs.com
RUSH work needs prior approval,
How would you like your repo; t sent? char A nniv
Circle all that apply: Email (preferred), Fax, Mail Std SO days) - D 5 24-48 Hrs
Sampling Dates & Times
Sample Location and/or ID # Start End
Date Time Date Time
M.Z1
Person Taking Sample (Sign/Print): Lab Use Only
Comp?
Grab?
ont
Cont.Test(s)
Required
es ice?
Yes / No
pH OK?
CI OK?
L
Temperature Upon
Receipt:
""• Dechlorination (<0.5 ppm) of Ammonia, cyanide Phenol and TKN samples must be done in the field prior to reservation. "••
Comments:
cDmpDsitor 7t
Are these results for regulatory o Jug #
g rypurposes. Yes � No Report results in: mg/L mg/kg ug/L [�
RelingujshR��y-' 1/ �� I p ^ `� Time: �_� Re we y: J Dat Time: S
Rell ulsh by: •Yu-�� 1,(/ /JDat l Time: Received,by: Date: Time:
Method of
Shipment:
UPS
Fed Ex
`Hand Delivery
Othef
Re inqulshed by: Date: Time:
Receive - -7 Dat